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Wang X, Fu X, Li W, Wang Q, Zhang K, Yan S. Dynamic electromyography findings of the lower leg muscles during walking in spastic cerebral palsy children with hindfoot valgus. Clin Biomech (Bristol, Avon) 2023; 106:106008. [PMID: 37257273 DOI: 10.1016/j.clinbiomech.2023.106008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Hindfoot valgus is one of the most prevalent foot deformities in cerebral palsy children. Investigating the muscle activation patterns of cerebral palsy children with hindfoot valgus is crucial to understand their abnormal gait different from typically developing children. METHODS Electromyography data of 20 cerebral palsy children with hindfoot valgus and 20 typically developing children were recorded for tibialis anterior, peroneal longus, and gastrocnemius medialis. The activation onset and offset times, normalized peak electromyography amplitude, average electromyography amplitude and integral electromyography amplitude for 20 completed cycles were averaged for data analysis. The co-activation index and activation percentage of peroneal longus were used to evaluate the co-activation level for tibialis anterior and peroneal longus muscles. FINDINGS Compared with typically developing children, the activation onset of tibialis anterior and the activation offset of tibialis anterior, peroneal longus, and gastrocnemius medialis were significantly delayed in cerebral palsy children; moreover, the muscle activation durations of tibialis anterior, peroneal longus, and gastrocnemius medialis were significantly longer, and the normalized average electromyography amplitude of tibialis anterior, peroneal longus and gastrocnemius medialis, and the normalized integral electromyography amplitude of tibialis anterior were significantly lower in cerebral palsy children. Furthermore, for cerebral palsy children, the co-activation index was greater, and the peroneal longus muscles activation percentage was lower in the stance phase and greater in the swing phase than that of typically developing children. INTERPRETATION The lower leg muscle activation patterns in cerebral palsy children were found to be abnormal.
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Affiliation(s)
- Xuesen Wang
- School of Biomedical Engineering, Capital Medical University, Beijing, China; Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaohu Fu
- Rehabilitation Department of Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Department of Rehabilitation, Affiliated Hospital of Binzhou Medical College, Shandong, China
| | - Qining Wang
- Robotics Research Group, College of Engineering, Peking University, Beijing, China
| | - Kuan Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical application, Capital Medical University, Beijing, China.
| | - Songhua Yan
- School of Biomedical Engineering, Capital Medical University, Beijing, China; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical application, Capital Medical University, Beijing, China.
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Hejrati N, Pedro K, Alvi MA, Quddusi A, Fehlings MG. Degenerative cervical myelopathy: Where have we been? Where are we now? Where are we going? Acta Neurochir (Wien) 2023; 165:1105-1119. [PMID: 37004568 DOI: 10.1007/s00701-023-05558-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/06/2023] [Indexed: 04/04/2023]
Abstract
Degenerative cervical myelopathy (DCM), a recently coined term, encompasses a group of age-related and genetically associated pathologies that affect the cervical spine, including cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament (OPLL). Given the significant contribution of DCM to global disease and disability, there are worldwide efforts to promote research and innovation in this area. An AO Spine effort termed 'RECODE-DCM' was initiated to create an international multistakeholder consensus group, involving patients, caregivers, physicians and researchers, to focus on launching actionable discourse on DCM. In order to improve the management, treatment and results for DCM, the RECODE-DCM consensus group recently identified ten priority areas for translational research. The current article summarizes recent advancements in the field of DCM. We first discuss the comprehensive definition recently refined by the RECODE-DCM group, including steps taken to arrive at this definition and the supporting rationale. We then provide an overview of the recent advancements in our understanding of the pathophysiology of DCM and modalities to clinically assess and diagnose DCM. A focus will be set on advanced imaging techniques that may offer the opportunity to improve characterization and diagnosis of DCM. A summary of treatment modalities, including surgical and nonoperative options, is then provided along with future neuroprotective and neuroregenerative strategies. This review concludes with final remarks pertaining to the genetics involved in DCM and the opportunity to leverage this knowledge toward a personalized medicine approach.
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Affiliation(s)
- Nader Hejrati
- Division of Genetics and Development, Krembil Research Institute, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Suite 4WW-449, Toronto, ON, M5T 2S8, Canada
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Karlo Pedro
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mohammed Ali Alvi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Ayesha Quddusi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Genetics and Development, Krembil Research Institute, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Suite 4WW-449, Toronto, ON, M5T 2S8, Canada.
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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Khan Z, Jiao X, Hu T, Shao Q, Sun X, Zhao X, Gu D. Investigation of gait, balance and lower extremity muscle activity during walking in patients with cervical spondylotic myelopathy using wearable sensors. Spine J 2023:S1529-9430(23)00106-7. [PMID: 36934793 DOI: 10.1016/j.spinee.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/28/2023] [Accepted: 03/10/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND CONTEXT Cervical spondylotic myelopathy (CSM) is a degenerative disease caused by cervical cord compression and can lead to the significant impairment of motor function including gait and balance disturbances and changes in lower extremity muscle activity. PURPOSE This study aimed to characterize gait, balance and lower extremity muscle activity in patients with CSM compared to age-matched healthy controls (HCs) using wearable sensors in the clinical setting. STUDY DESIGN Non-Randomized, prospective cohort study. PATIENT SAMPLE 10 CSM patients and 10 age-matched HCs were recruited for this study. OUTCOME MEASURES Gait and balance function parameters contained spatial temporal parameters, step regularity (SR1), stride regularity (SR2) and harmonic ratio (HR). EMG muscle activity parameters included time to peak and peak value during loading, stance, and swing phase. METHODS In this study, parameters of gait and balance function were extracted using triaxial accelerometer attached to the spinous processes of Lumbar 5 while participants performed an overground walking at a self-preferred speed. Moreover, muscular activity was simultaneously recorded via sEMG sensors attached to tibialis anterior (TA), rectus femoris (RF), bicep femoris (BF) and gastrocnemius lateral (GL). Independent sample t-test was used to find the differences between CSM patients and HCs. RESULTS Gait analysis showed cadence, step length and walking speed were statistically significantly lower in CSM patients than HCs. Stride time was significantly higher for CSM patients in comparison to HCs. Lower root mean square ratio (RMSR) of acceleration in the mediolateral (ML) direction, HR in the anteroposterior (AP) direction, SR1 in the AP direction and SR2 in all three directions were observed in CSM patients. For muscle activity analysis, EMG RMS for TA and RF during loading phase and RMS for GL during midstance phase was significantly lower for CSM patients, while significantly higher value was observed for RF RMS during midstance phase and GL RMS during swing phase in CSM patients. CONCLUSION Our pilot study shows that wearable sensors are able to detect the changes of gait, balance and lower extremity muscle activities of CSM patients in the clinical setting. This pilot study sets the stage for future researches on the diagnosis and monitor progression of CSM disease using wearable technology.
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Affiliation(s)
- Zawar Khan
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China; School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Xin Jiao
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China; School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Tianyi Hu
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China; School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Qineng Shao
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Xin Sun
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Xin Zhao
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China.
| | - Dongyun Gu
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China; School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China.
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Avdan G, Onal S, Smith BK. Normalization of EMG Signals: Optimal MVC Positions for the Lower Limb Muscle Groups in Healthy Subjects. J Med Biol Eng 2023. [DOI: 10.1007/s40846-023-00782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Tetreault L, Kalsi-Ryan S, Benjamin Davies, Nanna-Lohkamp L, Garwood P, Martin AR, Wilson JR, Harrop JS, Guest JD, Kwon BK, Milligan J, Arizala AM, Kotter MR, Fehlings MG. Degenerative Cervical Myelopathy: A Practical Approach to Diagnosis. Global Spine J 2022; 12:1881-1893. [PMID: 35043715 PMCID: PMC9609530 DOI: 10.1177/21925682211072847] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Narrative Review. OBJECTIVES The objective of this review is to provide a stepwise approach to the assessment of patients with potential symptoms of degenerative cervical myelopathy (DCM). METHODS N/A. RESULTS DCM is an overarching term used to describe progressive compression of the cervical spinal cord by age-related changes to the spinal axis. These alterations to normal anatomy narrow the spinal canal, reduce the space available for the spinal cord, and may ultimately compress the ascending and descending neural tracts. Patients with DCM present with a wide range of symptoms that can significantly impact quality of life, including bilateral hand numbness and paresthesia, gait impairment, motor weakness of the upper and lower extremities, and bladder and bowel dysfunction. Unfortunately, DCM is often misdiagnosed, resulting in delayed assessment and management by the appropriate specialist. The proper evaluation of a patient with suspected DCM includes obtaining a detailed patient history, conducting a comprehensive neurological examination, and ordering appropriate tests to rule in or out other diagnoses. CONCLUSION This review summarizes a stepwise approach to the diagnosis of patients with DCM.
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Affiliation(s)
- Lindsay Tetreault
- Division of Neurology, Graduate
Medical Education, New York University
Langone, New York, NY, USA
| | | | - Benjamin Davies
- Department of Academic
Neurosurgery, University of Cambridge, Cambridge, UK
| | - Laura Nanna-Lohkamp
- Division of Neurosurgery,
Department of Surgery, University of Toronto, Toronto, ON, Canada,Division of Neurosurgery, Spinal
Program, Toronto Western Hospital, University Health
Network, Toronto, ON, Canada
| | - Philip Garwood
- Internal Medicine Resident,
Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Allan R. Martin
- Spine Neurosurgery, University of California
Davis, Davis, CA, USA
| | - Jefferson R. Wilson
- Division of Neurosurgery,
Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - James S. Harrop
- Departments of Neurological and
Orthopedic Surgery, Thomas Jefferson
University, Philadelphia, PA, USA
| | - James D. Guest
- The Miami Project to Cure
Paralysis, University of Miami, Miami, FL, USA
| | - Brian K. Kwon
- Department, of Orthopaedics, University of British
Columbia, Vancouver, BC, Canada
| | - James Milligan
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Mark R. Kotter
- Department of Academic
Neurosurgery, University of Cambridge, Cambridge, UK
| | - Michael G. Fehlings
- Division of Neurosurgery,
Department of Surgery, University of Toronto, Toronto, ON, Canada,Division of Neurosurgery, Spinal
Program, Toronto Western Hospital, University Health
Network, Toronto, ON, Canada,Michael G. Fehlings, MD, PhD, FRCSC, FACS,
Division of Neurosurgery and Spinal Program, Department of Surgery, University
of Toronto, Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst
Street, Suite 4WW-449, Toronto, ON M5T 2S8, Canada.
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Analysis of Spastic Gait in Patients With Cervical Myelopathy Using the Timed Up and Go Test With a Laser Range Sensor. Spine (Phila Pa 1976) 2022; 47:892-898. [PMID: 34802028 DOI: 10.1097/brs.0000000000004284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE This study aimed to objectively evaluate spastic gait and reveal its novel characteristics via analysis of gait in patients with cervical myelopathy (CM) using the Timed Up and Go (TUG) test with a laser range sensor. SUMMARY OF BACKGROUND DATA Among patients with CM, spastic gait is a common diagnostic symptom; thus, objective assessments of spastic gait would be useful for the diagnosis of CM and recognition of disease status. Although spastic gait has been objectively evaluated in previous studies, the methods employed in those studies are not suitable for clinical settings. METHODS In total, 37 and 24 participants were recruited for a control group and CM group, respectively. CM was diagnosed by spine surgeons. We developed a laser TUG test, in which the position and velocity of both the legs were captured. The parameter values for both groups were statistically compared, and odds ratios were calculated using logistic regression analyses. RESULTS The total TUG-test time, time to stand up, time to first step, number of steps, and trajectory error for the CM group were significantly higher than those for the control group, whereas the average velocity and average stride length for the CM group were significantly lower than those for the control group. There was a significant independent association between the total TUG-test time and CM. The optimal cutoff point of the total test time for CM risk was approximately 9 seconds. CONCLUSION Through the use of the laser TUG test, we were able to identify characteristics of spastic gait, which leads to difficulty in standing and taking the first step, wobbling while walking, and an increased risk of falling. We found that the risk of CM was higher if the individual took longer than 9 seconds to complete the TUG test.Level of Evidence: 4.
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7
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Martin AR, Tetreault L, Nouri A, Curt A, Freund P, Rahimi-Movaghar V, Wilson JR, Fehlings MG, Kwon BK, Harrop JS, Davies BM, Kotter MRN, Guest JD, Aarabi B, Kurpad SN. Imaging and Electrophysiology for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 9]. Global Spine J 2022; 12:130S-146S. [PMID: 34797993 PMCID: PMC8859711 DOI: 10.1177/21925682211057484] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE The current review aimed to describe the role of existing techniques and emerging methods of imaging and electrophysiology for the management of degenerative cervical myelopathy (DCM), a common and often progressive condition that causes spinal cord dysfunction and significant morbidity globally. METHODS A narrative review was conducted to summarize the existing literature and highlight future directions. RESULTS Anatomical magnetic resonance imaging (MRI) is well established in the literature as the key imaging tool to identify spinal cord compression, disc herniation/bulging, and inbuckling of the ligamentum flavum, thus facilitating surgical planning, while radiographs and computed tomography (CT) provide complimentary information. Electrophysiology techniques are primarily used to rule out competing diagnoses. However, signal change and measures of cord compression on conventional MRI have limited utility to characterize the degree of tissue injury, which may be helpful for diagnosis, prognostication, and repeated assessments to identify deterioration. Early translational studies of quantitative imaging and electrophysiology techniques show potential of these methods to more accurately reflect changes in spinal cord microstructure and function. CONCLUSION Currently, clinical management of DCM relies heavily on anatomical MRI, with additional contributions from radiographs, CT, and electrophysiology. Novel quantitative assessments of microstructure, perfusion, and function have the potential to transform clinical practice, but require robust validation, automation, and standardization prior to uptake.
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Affiliation(s)
- Allan R Martin
- Department of Neurological Surgery, 8789University of California Davis, Davis, CA, USA
| | - Lindsay Tetreault
- Department of Neurology, 5894New York University, Langone Health, Graduate Medical Education, New York, NY, USA
| | - Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, 27230University of Geneva, Geneva, Switzerland
| | - Armin Curt
- University Spine Center, 31031Balgrist University Hospital, Zurich, Switzerland
| | - Patrick Freund
- University Spine Center, 31031Balgrist University Hospital, Zurich, Switzerland
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, 7938University of Toronto, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, 7938University of Toronto, Toronto, ON, Canada
| | - Brian K Kwon
- Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, BC, Canada
| | - James S Harrop
- Department of Neurological Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Benjamin M Davies
- Department of Neurosurgery, 2152University of Cambridge, Cambridge, UK
| | - Mark R N Kotter
- Department of Neurosurgery, 2152University of Cambridge, Cambridge, UK
| | - James D Guest
- Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, 12235University of Miami, Miami, FL, USA
| | - Bizhan Aarabi
- Department of Neurosurgery, 1479University of Maryland, Baltimore, MD, USA
| | - Shekar N Kurpad
- Department of Neurosurgery, 5506Medical College of Wisconsin, Wauwatosa, WI, USA
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Degenerative Cervical Myelopathy: Clinical Presentation, Assessment, and Natural History. J Clin Med 2021; 10:jcm10163626. [PMID: 34441921 PMCID: PMC8396963 DOI: 10.3390/jcm10163626] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/05/2021] [Accepted: 08/14/2021] [Indexed: 11/17/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is a leading cause of spinal cord injury and a major contributor to morbidity resulting from narrowing of the spinal canal due to osteoarthritic changes. This narrowing produces chronic spinal cord compression and neurologic disability with a variety of symptoms ranging from mild numbness in the upper extremities to quadriparesis and incontinence. Clinicians from all specialties should be familiar with the early signs and symptoms of this prevalent condition to prevent gradual neurologic compromise through surgical consultation, where appropriate. The purpose of this review is to familiarize medical practitioners with the pathophysiology, common presentations, diagnosis, and management (conservative and surgical) for DCM to develop informed discussions with patients and recognize those in need of early surgical referral to prevent severe neurologic deterioration.
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9
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Subclinical gait disturbance and postoperative gait improvement in patients with degenerative cervical myelopathy. Sci Rep 2021; 11:11179. [PMID: 34045643 PMCID: PMC8160212 DOI: 10.1038/s41598-021-90884-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/18/2021] [Indexed: 11/24/2022] Open
Abstract
This study aimed to evaluate the subclinical gait abnormalities and the postoperative gait improvements in patients with degenerative cervical myelopathy using three-dimensional gait analysis. We reviewed the gait analysis of 62 patients who underwent surgical treatment for degenerative cervical myelopathy. The asymptomatic gait group included 30 patients and the gait disturbance group included 32 patients who can walk on their own slowly or need assistive device on stairs. The step width (17.2 cm vs. 15.9 cm, P = 0.003), stride length (105.2 cm vs. 109.1 cm, P = 0.015), and double-limb support duration (13.4% vs. 11.7%, P = 0.027) improved only in the asymptomatic gait group. Preoperatively, the asymptomatic gait group exhibited better maximum knee flexion angle (60.5° vs. 54.8°, P = 0.001) and ankle plantarflexion angle at push-off (− 12.2° vs. − 6.5°, P = 0.001) compared to the gait disturbance group. Postoperatively, maximum knee flexion angle (62.3° vs. 58.2°, P = 0.004) and ankle plantarflexion angle at push-off (− 12.8° vs. − 8.3°, P = 0.002) were still better in the asymptomatic gait group, although both parameters improved in the gait disturbance group (P = 0.005, 0.039, respectively). Kinematic parameters could improve in patients with gait disturbance. However, temporospatial parameters improvement may be expected when the operative treatment is performed before apparent gait disturbance.
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Trivedi J, Srinivas S, Trivedi R, Davidson N, Munigangaiah S, Bruce C, Bass A, Wright D. Preoperative and Postoperative, Three-dimensional Gait Analysis in Surgically Treated Patients With High-grade Spondylolisthesis. J Pediatr Orthop 2021; 41:111-118. [PMID: 33298766 PMCID: PMC7803478 DOI: 10.1097/bpo.0000000000001721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND High-grade spondylolisthesis (HGS) (Myerding grade III-V) in adolescents can lead to a marked alteration of gait pattern and maybe the presenting symptom in these patients. This characteristic gait pattern in patients with HGS has been referred to as the "pelvic waddle." Modern 3-dimensional (3D) gait analysis serves an important tool to objectively analyze the different components of this characteristic gait preoperatively and postoperatively and is an objective measure of postoperative improvement.This study demonstrates the use of 3D gait analysis preoperatively and postoperatively in a cohort of 4 consecutive patients with HGS treated surgically at a single tertiary referral center and utilize this to objectively evaluate outcome of surgical treatment in these patients. This has not been reported previously in a cohort of patients. METHODS This is a prospective analysis of patients with HGS who underwent surgical intervention for spondylolisthesis at a single institution. Patient demographics, clinical, and radiologic assessment were recorded, and all patients underwent 3D gait analysis before and after surgical intervention. Kinetic, kinematic, and spatial parameters were recorded preoperatively and postoperatively for all patients. This allowed the outcome of change in gait deviation index, before and after surgical treatment, to be evaluated. RESULTS We were able to review complete records of 4 adolescent patients who underwent surgical treatment for HGS. Mean age at surgery was 13.5 years with a minimum follow-up of 2.5 years postoperatively (average 40 mo). Preoperative gait analysis revealed marked posterior pelvic tilt in 2 patients, reduced hip and knee extension in all 4 patients and external foot progression in 3 of the 4 patients. Along with an observed improvement in gait, there was an objective improvement in gait parameters postoperatively in all 4 patients. Gait deviation index score improved significantly from 78.9 to 101.3 (mean). CONCLUSIONS Preoperative gait abnormalities exist in HGS and can be objectively analyzed with gait analysis. Surgical intervention may successfully resolve these gait abnormalities and gait analysis is a useful tool to assess the outcome of surgery and quantify an otherwise intangible benefit of surgical intervention. LEVEL OF EVIDENCE Level IV-case series.
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Affiliation(s)
- Jayesh Trivedi
- Robert Jones Agnes Hunt Hospital, Oswestry and Alderhey Children’s Hospital, Liverpool
| | - Shreya Srinivas
- Department of Spine Surgery, University Hospitals Sheffield, Sheffield
| | | | - Neil Davidson
- Robert Jones Agnes Hunt Hospital, Oswestry and Alderhey Children’s Hospital, Liverpool
| | | | | | - Alf Bass
- Alderhey Children’s Hospital, Liverpool, UK
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Cervical Extensor Muscles Play the Role on Malalignment of Cervical Spine: A Case Control Study With Surface Electromyography Assessment. Spine (Phila Pa 1976) 2021; 46:E73-E79. [PMID: 33038198 DOI: 10.1097/brs.0000000000003742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case control study. OBJECTIVE The aim of this study was to identify the potential impact of cervical spine malalignment on muscle parameters. SUMMARY OF BACKGROUND DATA Muscular factors are associated with cervical alignment. Nevertheless, only muscle dimensions or imaging changes have been evaluated, function of cervical muscles has scarcely been investigated. METHODS Thirty-four patients diagnosed as cervical spine degeneration associated with cervical malalignment and 32 control subjects were included in this case control study. Visual analogue scale (VAS) and the neck disability index (NDI) were used. The sagittal alignment parameters and cervical range of motion (ROM) were measured on cervical spine lateral radiographs, included C2-C7 lordosis, C2-C7 sagittal vertical axis (C2-C7 SVA), cervical gravity-sagittal vertical axis (CG-SVA), T1-Slope, and spinal canal angle (SCA). Surface electromyography (SEMG)-based flexion-relaxation ratio (FRR) was measured. RESULTS The result showed VAS score of the neck significantly lower in controls (P<0.05), C2-C7 lordosis, C2-C7 SVA, CG-SVA, T1-Slope and ROM showed significantly different (P<0.001) between malalignment group and control group, FRR of splenius capitis (FRRSpl) and upper trapezius (FRRUTr) of the malalignment group were lower than in the control group, which correlated well with NDI (rSpl = -0.181 rUTr = -0.275), FRRSpl correlated well with VAS (rSpl = -0.177). FRRSpl correlated strongly with C2-C7 SVA (r = 0.30), CG-SVA (r = 0.32), T1-Slope (r = 0.17), ROM (r = 0.19), FRRUTr correlated with C2-C7 lordosis (r = -0.23), CG-SVA (r = 0.19), T1-Slope (r = 0.28), ROM (r = 0.23). CONCLUSION Cervical malalignment patients had more tensional posterior cervical muscle and poor muscle functions. CG-SVA showed advantages in evaluating cervical malalignment.Level of Evidence: 3.
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12
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Qie S, Li W, Li X, Chen X, Gong W, Xi J, Sun F, Yue S. Electromyography activities in patients with lower lumbar disc herniation. J Back Musculoskelet Rehabil 2020; 33:589-596. [PMID: 31658036 PMCID: PMC7458508 DOI: 10.3233/bmr-181308] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lumbar disc herniation (LDH) can affect lower limb muscle function resulting in an abnormal gait. This study aims to use surface electromyography (SEMG) to evaluate patients with L4/L5 and L5/S1 LDH throughout muscle movement. METHODS Twenty L4/L5 LDH patients (L5 Group), twenty L5/S1 LDH patients (S1 Group), and twenty healthy controls (Healthy) were recruited for the study. SEMG of bilateral tibialis anterior (TA) and lateral gastrocnemius (LG) muscles of patients were recorded using the DELSYS Wireless EMG System (TrignoTM Wireless Systems, Delsys Inc., USA). Root-mean-square (RMS), mean power frequency (MPF), and median frequency (MF) were compared between bilateral limbs in each participant. RESULTS Reduced MPF and MF was found in TA measurements of the L5 Group and LG measurements of the S1 Group. The MPF and MF of the TA of symptomatic limbs of the L5 Group were reduced when compared to asymptomatic limbs (p= 0.006, p= 0.012, p< 0.05), and there were no significant differences in LG measurements (p> 0.05). The LG MPF and MF of the S1 Group in symptomatic limbs were reduced when compared to asymptomatic limbs (p= 0.006, p= 0.017, p< 0.05), and there were no significant differences in TA measurements (p> 0.05). Although there were no significant differences in RMS between bilateral limbs of the L5 and S1 Groups, we found some changes in RMS curves. First, compared to asymptomatic limbs of L4/L5LDH patients, β-peaks in the TA of symptomatic limbs appeared earlier. Second, two peaks in the LG of symptomatic limbs were found in L5/S1 LDH patients. CONCLUSION TA is affected in patients with LDH of L4/L5, and LG is affected in patients with LDH of L5/S1. As demonstrated, SEMG can identify LDH-related muscle dysfunction.
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Affiliation(s)
- Shuyan Qie
- Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, China
| | - Wei Li
- Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, China,Department of Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Xiangrong Li
- Department of Respiratory Medicine, School Hospital of Peking University, Haidian District, Beijing, China
| | - Xuemei Chen
- Department of Health Management, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Weijun Gong
- Department of Neurological Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jianing Xi
- Department of Neurological Rehabilitation, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Fenglong Sun
- Department of Orthopedics, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Shouwei Yue
- Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, China,Corresponding author: Shouwei Yue, Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, Shandong, China. Tel.: +86 531 81309107; E-mail:
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Effect of Parkinson's disease and two therapeutic interventions on muscle activity during walking: a systematic review. NPJ PARKINSONS DISEASE 2020; 6:22. [PMID: 32964107 PMCID: PMC7481232 DOI: 10.1038/s41531-020-00119-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/09/2020] [Indexed: 12/26/2022]
Abstract
Gait deficits are a common feature of Parkinson’s disease (PD) and predictors of future motor and cognitive impairment. Understanding how muscle activity contributes to gait impairment and effects of therapeutic interventions on motor behaviour is crucial for identifying potential biomarkers and developing rehabilitation strategies. This article reviews sixteen studies that investigate the electromyographic (EMG) activity of lower limb muscles in people with PD during walking and reports on their quality. The weight of evidence establishing differences in motor activity between people with PD and healthy older adults (HOAs) is considered. Additionally, the effect of dopaminergic medication and deep brain stimulation (DBS) on modifying motor activity is assessed. Results indicated greater proximal and decreased distal activity of lower limb muscles during walking in individuals with PD compared to HOA. Dopaminergic medication was associated with increased distal lower limb muscle activity whereas subthalamic nucleus DBS increased activity of both proximal and distal lower limb muscles. Tibialis anterior was impacted most by the interventions. Quality of the studies was not strong, with a median score of 61%. Most studies investigated only distal muscles, involved small sample sizes, extracted limited EMG features and lacked rigorous signal processing. Few studies related changes in motor activity with functional gait measures. Understanding mechanisms underpinning gait impairment in PD is essential for development of personalised rehabilitative interventions. Recommendations for future studies include greater participant numbers, recording more functionally diverse muscles, applying multi-muscle analyses, and relating EMG to functional gait measures.
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Kitade I, Nakajima H, Takahashi A, Matsumura M, Shimada S, Kokubo Y, Matsumine A. Kinematic, kinetic, and musculoskeletal modeling analysis of gait in patients with cervical myelopathy using a severity classification. Spine J 2020; 20:1096-1105. [PMID: 32032676 DOI: 10.1016/j.spinee.2020.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although a few reports have shown a change in gait motion in cervical myelopathy (CM) patients using a three-dimensional (3D) gait analysis system, there has been no detailed quantitative investigation of their gait including musculoskeletal modeling parameters. Also, 3D gait analysis using a classification of severity has not been substantiated. PURPOSE This study aimed to investigate kinematic, kinetic, and musculoskeletal modeling parameters of gait motion in CM patients using a severity classification. STUDY DESIGN Prospective cohort and cross-sectional study. PATIENT SAMPLE Forty-two patients with CM and 40 healthy, age-matched volunteers. OUTCOME MEASURES Lower extremity spatiotemporal, kinematic, kinetic, and musculoskeletal modeling parameters. METHODS Subjects were classified as to its severity using the Japan Orthopaedic Association score excluding the upper extremity items: group 1 (>10 points); group 2 (7-9 points); and group 3 (<6 points). A 3D motion analysis system and musculoskeletal modeling software were used to obtain the spatiotemporal, kinematic (the lower extremity joints angles in the sagittal plane), kinetic (the lower extremity joints moment and power in the sagittal plane), and musculoskeletal modeling parameters (the muscle-tendon length and velocity). RESULTS Genu recurvatum, deteriorated lower-extremity joint motion, and muscle-tendon velocity were observed in severe CM patients (group 3). Muscle-tendon velocities of the long head of the biceps femoris in controls and mild CM patients (groups 1 and 2) showed a bimodal waveform in the negative direction during the initial contact and preswing phases, whereas these characteristics were not present in severe CM patients (group 3). CONCLUSIONS The strategies of the knee joint moment during gait motion in severe CM patients were different from those of the normal gait pattern. The imbalance between agonist and antagonist muscle tissue during gait could be involved in the occurrence of genu recurvatum. It might be important for CM patients to consider improving the contraction or extension velocity of the biceps femoris muscle during each gait phase from the early stages of symptoms.
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Affiliation(s)
- Ippei Kitade
- Division of Rehabilitation Medicine, University of Fukui Hospital, 23-3, Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
| | - Hideaki Nakajima
- Department of Orthopaedic Surgery, University of Fukui, 23-3, Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
| | - Ai Takahashi
- Division of Rehabilitation Medicine, University of Fukui Hospital, 23-3, Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan; Department of Orthopaedic Surgery, University of Fukui, 23-3, Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
| | - Mayumi Matsumura
- Division of Rehabilitation Medicine, University of Fukui Hospital, 23-3, Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
| | - Seiichiro Shimada
- Division of Rehabilitation Medicine, University of Fukui Hospital, 23-3, Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
| | - Yasuo Kokubo
- Department of Orthopaedic Surgery, University of Fukui, 23-3, Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
| | - Akihiko Matsumine
- Division of Rehabilitation Medicine, University of Fukui Hospital, 23-3, Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan; Department of Orthopaedic Surgery, University of Fukui, 23-3, Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
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Kadone H, Kubota S, Abe T, Noguchi H, Miura K, Koda M, Shimizu Y, Hada Y, Sankai Y, Suzuki K, Yamazaki M. Muscular Activity Modulation During Post-operative Walking With Hybrid Assistive Limb (HAL) in a Patient With Thoracic Myelopathy Due to Ossification of Posterior Longitudinal Ligament: A Case Report. Front Neurol 2020; 11:102. [PMID: 32296380 PMCID: PMC7136555 DOI: 10.3389/fneur.2020.00102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/29/2020] [Indexed: 01/02/2023] Open
Abstract
Disorders of the central nervous system sometimes cause severe sensory motor paralysis accompanied by gait impairment. Recently, there are several reports on the effectiveness of robot-assisted gait training for patients experiencing these issues. The purpose of this case report was to assess the neuromechanical effect of a wearable robot suit HAL (Hybrid Assistive Limb) during post-operative gait training in a patient with gait impairment due to compressive myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). For this purpose, we compared lower limb muscular activities while the patient was walking with and without the robot through a course of treatment sessions by (i) gait phase-dependent muscle usage analysis, (ii) muscle synergy analysis, and (iii) muscle network analysis. The results show (i) enhanced activity of the extensor muscles for weight-bearing in the initial sessions by using HAL and reduced knee extensor and increased hip extensor activations for achieving larger steps and faster gait in the later sessions; (ii) involvement of a greater number of synergies during walking with HAL than without HAL; and (iii) modulated muscle network property during walking with HAL remaining until the next HAL session. The patient's gait was improved after completing HAL sessions, acquiring close to normal joint profile with greater range of joint movement, faster walking speed, and larger step length. We discuss that the muscular activity modulation during walking with HAL suggests altered control of the muscles by the central nervous system during post-operative walking. Activity-dependent sensorimotor augmentation by HAL is discussed in the context of recovery of gait control by the central nervous system. The relationship between the altered control and the achieved gait recovery requires further investigation.
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Affiliation(s)
- Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Shigeki Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Noguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Kenji Suzuki
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Nam KH, Kim DH, Choi BK, Han IH. Internet of Things, Digital Biomarker, and Artificial Intelligence in Spine: Current and Future Perspectives. Neurospine 2019; 16:705-711. [PMID: 31905461 PMCID: PMC6944984 DOI: 10.14245/ns.1938388.194] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 12/05/2019] [Indexed: 12/13/2022] Open
Abstract
Recent interest in medical artificial intelligence (AI) has increased with onset of the fourth industrial revolution. Real-time monitoring of patients is an important research area of medical AI. The medical AI is very closely related to the Internet of Things (IoT), a core element of the fourth industrial revolution. Attempts to diagnose and treat patients using IoT have been already applied to patients with chronic disease such as hypertension and arrhythmia. However, in the spine, research on IoT and digital biomarkers are still in the early stages. The digital biomarker obtained by IoT devices is objective and could represent real-time, real-world, and abundant data. Based on its characteristics, IoT and digital biomarkers can also be useful in the spine. Currently, research on real-time monitoring of physical activity or spinal posture is ongoing. Therefore, the authors introduce the basic concepts of IoT and digital biomarkers, their relationship to AI, and recent trends. Current and future perspectives of IoT and digital biomarker in spine are also discussed. In the future, it is expected that IoT, digital biomarkers, and AI will lead to a paradigm shift in the diagnosis and treatment of spinal diseases.
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Affiliation(s)
- Kyoung Hyup Nam
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dong Hwan Kim
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byung Kwan Choi
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - In Ho Han
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Haddas R, Cox J, Belanger T, Ju KL, Derman PB. Characterizing gait abnormalities in patients with cervical spondylotic myelopathy: a neuromuscular analysis. Spine J 2019; 19:1803-1808. [PMID: 31207317 DOI: 10.1016/j.spinee.2019.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/06/2019] [Accepted: 06/06/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Gait impairment is a hallmark of cervical spondylotic myelopathy (CSM). It has been shown to affect quality of life but has not been well defined. Further electromyographic (EMG) characterization of the gait cycle may help elucidate the true neuromuscular pathology with implications on prognosis and rehabilitation techniques. PURPOSE This study compares neuromuscular activity in patients with CSM to that of healthy age-matched controls. STUDY DESIGN Nonrandomized, prospective, concurrent control cohort study. METHODS Neuromuscular activity was measured in 40 patients with symptomatic CSM during a series of over-ground gait trials at a self-selected speed before surgical intervention. External oblique, multifidus, erector spinae, rectus femoris, semitendinosus, tibialis anterior, medial gastrocnemius, and medial deltoid were assessed. Identical measurements were taken in 25 healthy control patients. Differences in time of muscle onset, peak EMG, time to peak EMG, and integrated electromyography (iEMG) were assessed using one-way ANOVA. RESULTS There were no significant differences between patients with CSM and healthy controls with respect to time of muscle contraction onset. Peak EMG muscle activity was significantly higher in the medial deltoid of patients with CSM (39.3% vs. 23.3% sMVC, p=.042), but no other differences were seen in the remaining muscles tested. They also demonstrated significantly longer time to peak EMG muscle activity compared with controls in 5 of the 8 muscles tested, including the multifidus (20.2 vs. 16.8 ms, p=.050), erector spinae (18.2 vs. 8.9 ms, p<.001), semitendinosis (26.3 vs. 22.4 ms, p=.037), tibialis anterior (14.7 vs. 11.0 ms, p=.050), and medial deltoid (24.2 vs. 9.2 ms, p<.001). Compared with controls, patients with CSM demonstrated significantly higher iEMG activity in the semitendinosis (586.5% vs. 272.5 sMVC, p=.047) and medial deltoid (87.62% vs. 22.5% sMVC, p=.008). CONCLUSIONS The onset of muscle activity is not delayed in CSM patients, but many key muscles take longer to fully contract. This produces a situation in which patients with CSM are unable to fully fire their muscles with sufficient speed to maintain a normal gait. The core and lower extremity muscles do not contract with increased peak amplitude in response, but the deltoid and hamstring muscles are more active, suggesting compensatory activity as patients attempt to maintain balance. The end result is less efficient ambulation. These findings provide a more nuanced understanding of gait in individuals suffering from CSM and may have implications on rehabilitation protocols.
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18
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Haddas R, Ju KL, Belanger T, Lieberman IH. The use of gait analysis in the assessment of patients afflicted with spinal disorders. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:1712-1723. [PMID: 29610989 DOI: 10.1007/s00586-018-5569-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/20/2018] [Accepted: 03/27/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Use gait analysis to establish and detail the clinically relevant components of normal human gait, analyze the gait characteristics for those afflicted with spinal pathology, and identify those aspects of human gait that correlate with pre- and postoperative patient function and outcomes. METHODS Twenty patients with adult degenerative scoliosis (ADS), 20 patients with cervical spondylotic myelopathy (CSM), and 15 healthy volunteers performed over-ground gait trials with a comfortable self-selected speed using video cameras to measure patient motion, surface electromyography (EMG) to record muscle activity, and force plates to record ground reaction force (GRF). Gait distance and temporal parameters, ankle, knee, hip, pelvic, and trunk range of motion (ROM), duration of lower extremity EMG activity and peak vertical GRF were measured. RESULTS Patients with ADS and CSM exhibited a significantly slower gait speed, decrease in step length, cadence, longer stride time, stance time, double support time, and an increase in step width compared to those in the control group. These patients also exhibited a significantly different ankle, knee, pelvic, and trunk ROM. Moreover, spinal disorder patients exhibited a significantly longer duration of rectus femoris, semitendinosus, tibialis anterior and medial gastrocnemius muscle activity along with an altered vertical GRF pattern. CONCLUSIONS Gait analysis provides an objective measure of functional gait in healthy controls as well as those with ADS and CSM. This study established and detailed some of the important kinematic and kinetic variables of gait in patients with spinal disorders. We recommend that spine care providers use gait analysis as part of their clinical evaluation to provide an objective measure of function. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Ram Haddas
- Texas Back Institute, 6020 W. Parker Road, Suite 200, Plano, TX, 75093, USA.
| | | | | | - Isador H Lieberman
- Texas Back Institute, 6020 W. Parker Road, Suite 200, Plano, TX, 75093, USA
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Wright MJ, Twose DM, Gorter JW. Gait characteristics of children and youth with chemotherapy induced peripheral neuropathy following treatment for acute lymphoblastic leukemia. Gait Posture 2017; 58:139-145. [PMID: 28779719 DOI: 10.1016/j.gaitpost.2017.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/11/2017] [Accepted: 05/07/2017] [Indexed: 02/02/2023]
Abstract
Sensory changes and muscle weakness attributable to chemotherapy induced peripheral neuropathy (CIPN) are possible sequela of treatment for acute lymphoblastic leukemia (ALL) which can result in long-lasting difficulties with walking. The purpose of this study was to describe the gait characteristics of children and youth treated for ALL who exhibited CIPN compared to typically developing children and youth using 3D motion analyses and electromyography (EMG). Temporal-spatial, kinematic, kinetic, and electromyographic (EMG) data were collected from 17 youth (mean age 11.2 (5.7) years) with CIPN and compared to data from 10 typically developing youth. Although the gait of the CIPN group was heterogeneous between and within participants, the CIPN group demonstrated primary deviations attributable to CIPN and secondary deviations, both passive effects and active compensatory mechanisms. They had significantly less peak hip extension, knee flexion in loading, dorsiflexion at initial contact, plantarflexion at pre-swing, and dorsiflexion in swing, shorter step lengths, and lower ankle moments and powers than the comparison participants. EMG data from the gastrocnemius and tibialis anterior muscles showed excessive co-activation and atypical firing including out of phase firing of the gastrocnemius in late swing and loading and premature firing of the tibialis anterior in terminal stance. This study, using 3D motion analysis and EMG in youth with CIPN, showed variability in gait suggesting that clinical decision-making should be based on a detailed understanding of individual impairments and associated gait abnormalities.
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Affiliation(s)
- Marilyn J Wright
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada; McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.
| | - Donna M Twose
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada.
| | - Jan Willem Gorter
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada; McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.
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Siasios ID, Spanos SL, Kanellopoulos AK, Fotiadou A, Pollina J, Schneider D, Becker A, Dimopoulos VG, Fountas KN. The Role of Gait Analysis in the Evaluation of Patients with Cervical Myelopathy: A Literature Review Study. World Neurosurg 2017; 101:275-282. [PMID: 28192261 DOI: 10.1016/j.wneu.2017.01.122] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gait analysis represents one of the newest methodologies used in the clinical evaluation of patients with cervical myelopathy (CM). OBJECTIVE To describe the role of gait analysis in the clinical evaluation of patients with CM, as well as its potential role in the evaluation of the functional outcome of any surgical intervention. METHODS A literature review was performed in the PubMed, OVID, and Google Scholar medical databases, from January 1995 to August 2016, using the terms "analysis," "anterior," "cervical myelopathy," "gait," "posterior," and "surgery." Clinical series comparing the gait patterns of patients with CM with healthy controls, as well as series evaluating gait and walk changes before and after surgical decompression, were reviewed. Case studies were excluded. RESULTS Nine prospective and 3 retrospective studies were found. Most of the retrieved studies showed the presence of characteristic, abnormal gait patterns among patients with CM, consisting of decreased gait speed, cadence, step length, stride length, and single-limb support time. In addition, patients with CM routinely present increased step and stride time, double-limb support time, and step width, and they have altered knee and ankle joint range of motion, compared with healthy controls. Moreover, gait and walk analysis may provide accurate functional assessment of the functional outcome of patients with CM undergoing surgical decompression. CONCLUSIONS Gait analysis may well be a valuable and objective tool along with other parameters in the evaluation of functionality in patients with CM, as well as in the assessment of the outcome of any surgical intervention in these patients.
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Affiliation(s)
- Ioannis D Siasios
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA; Department of Neurosurgery, Kaleida Health, Buffalo, New York, USA; Department of Neurosurgery, School of Medicine, University of Thessaly, Larisa, Greece.
| | - Savvas L Spanos
- Department of Physical Therapy, School of Health and Welfare, Central Greece University of Applied Sciences, Lamia, Greece
| | - Asimakis K Kanellopoulos
- Department of Physical Therapy, School of Health and Welfare, Central Greece University of Applied Sciences, Lamia, Greece
| | - Aggeliki Fotiadou
- Department of Neurosurgery, School of Medicine, University of Thessaly, Larisa, Greece
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA; Department of Neurosurgery, Kaleida Health, Buffalo, New York, USA
| | - Daniel Schneider
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Alexander Becker
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Vassilios G Dimopoulos
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA; Department of Neurosurgery, Kaleida Health, Buffalo, New York, USA
| | - Kostas N Fountas
- Department of Neurosurgery, School of Medicine, University of Thessaly, Larisa, Greece
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Bohm PE, Fehlings MG, Kopjar B, Tetreault LA, Vaccaro AR, Anderson KK, Arnold PM. Psychometric properties of the 30-m walking test in patients with degenerative cervical myelopathy: results from two prospective multicenter cohort studies. Spine J 2017; 17:211-217. [PMID: 27592193 DOI: 10.1016/j.spinee.2016.08.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 07/06/2016] [Accepted: 08/29/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The timed 30-m walking test (30MWT) is used in clinical practice and in research to objectively quantify gait impairment. The psychometric properties of 30MWT have not yet been rigorously evaluated. PURPOSE This study aimed to determine test-retest reliability, divergent and convergent validity, and responsiveness to change of the 30MWT in patients with degenerative cervical myelopathy (DCM). STUDY DESIGN/SETTING A retrospective observational study was carried out. PATIENT SAMPLE The sample consisted of patients with symptomatic DCM enrolled in the AOSpine North America or AOSpine International cervical spondylotic myelopathy studies at 26 sites. OUTCOME MEASURES Modified Japanese Orthopaedic Association scale (mJOA), Nurick scale, 30MWT, Neck Disability Index (NDI), and Short-Form-36 (SF-36v2) physical component score (PCS) and mental component score (MCS) were the outcome measures. METHODS Data from two prospective multicenter cohort myelopathy studies were merged. Each patient was evaluated at baseline and 6 months postoperatively. RESULTS Of 757 total patients, 682 (90.09%) attempted to perform the 30MWT at baseline. Of these 682 patients, 602 (88.12%) performed the 30MWT at baseline. One patient was excluded, leaving601 in the analysis. At baseline, 81 of 682 (11.88%) patients were unable to perform the test, and their mJOA, NDI, and SF-36v2 PCS scores were lower compared with those who performed the test at baseline. In patients who performed the 30MWT at baseline, there was very high correlation among the three baseline 30MWT measurements (r=0.9569-0.9919). The 30MWT demonstrated good convergent and divergent validity. It was moderately correlated with the Nurick (r=0.4932), mJOA (r=-0.4424), and SF-36v2 PCS (r=-0.3537) (convergent validity) and poorly correlated with the NDI (r=0.2107) and SF-36v2 MCS (r=-0.1984) (divergent validity). Overall, the 30MWT was not responsive to change (standardized response mean [SRM]=0.30). However, for patients who had a baseline time above the median value of 29 seconds, the SRM was 0.45. CONCLUSIONS The 30MWT shows high test-retest reliability and good divergent and convergent validity. It is responsive to change only in patients with more severe myelopathy. The 30MWT is a simple, quick, and affordable test, and should be used as an ancillary test to evaluate gait parameters in patients with DCM.
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Affiliation(s)
- Parker E Bohm
- Department of Neurosurgery, University of Kansas Medical Center, Mail Stop 3021, 3901 Rainbow Blvd, Kansas City, KS 66160 USA
| | - Michael G Fehlings
- Department of Surgery, University of Toronto, Toronto Western Hospital, University Health Network, 399 Bathurst St, #4W-449, Toronto, Ontario M5T 2S8 Canada
| | - Branko Kopjar
- Department of Health Services, University of Washington, 4333 Brooklyn Ave NE, Rm #14-315, Seattle, WA 98195, USA
| | - Lindsay A Tetreault
- Division of Neurosurgery and Spine Program, University of Toronto, Toronto Western Hospital, University Health Network, 399 Bathurst St, #4W-449, Toronto, Ontario M5T 2S8 Canada
| | - Alexander R Vaccaro
- Departments of Orthopaedic Surgery and Neurological Surgery, The Rothman Institute at Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107 USA
| | - Karen K Anderson
- Department of Neurosurgery, University of Kansas Medical Center, Mail Stop 3021, 3901 Rainbow Blvd, Kansas City, KS 66160 USA
| | - Paul M Arnold
- Department of Neurosurgery, University of Kansas Medical Center, Mail Stop 3021, 3901 Rainbow Blvd, Kansas City, KS 66160 USA.
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The contribution of neurophysiology in the diagnosis and management of cervical spondylotic myelopathy: a review. Spinal Cord 2016; 54:756-766. [PMID: 27241448 DOI: 10.1038/sc.2016.82] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 03/24/2016] [Accepted: 04/06/2016] [Indexed: 12/11/2022]
Abstract
STUDY DESIGN Topical review of the literature. OBJECTIVE The objective of this review article was to assess indications and usefulness of various neurophysiological techniques in diagnosis and management of cervical spondylogenic myelopathy (CSM). METHODS The MEDLINE, accessed by Pubmed and EMBASE electronic databases, was searched using the medical subject headings: 'compressive myelopathy', 'cervical spondylotic myelopathy (CSM)', 'cervical spondylogenic myelopathy', 'motor evoked potentials (MEPs)', 'transcranial magnetic stimulation', 'somatosensory evoked potentials (SEPs)', 'electromyography (EMG)', 'nerve conduction studies (NCS)' and 'cutaneous silent period (CSP)'. RESULTS SEPs and MEPs recording can usefully supplement clinical examination and neuroimaging findings in assessing the spinal cord injury level and severity. Segmental cervical cord dysfunction can be revealed by an abnormal spinal N13 response, whereas the P14 potential is a reliable marker of dorsal column impairment. MEPs may also help in the differential diagnosis between spinal cord compression and neurodegenerative disorders. SEPs and MEPs are also useful in follow-up evaluation of sensory and motor function during surgical treatment and rehabilitation. EMG and NCS improve the sensitivity of cervical radiculopathy detection and may help rule out peripheral nerve problems that can cause symptoms that are similar to those of CSM. CSP also shows a high sensitivity for detecting CSM. CONCLUSION Neuroimaging, especially magnetic resonance imaging, represents the procedure of choice for the diagnosis of CSM, but a correct interpretation of morphological findings can be achieved only if they are correlated with functional data. The studies reported in this review highlight the crucial role of the electrophysiological studies in diagnosis and management of CSM.
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Spinal Disorders as a Cause of Locomotive Syndrome: The Influence on Functional Mobility and Activities of Daily Living. Clin Rev Bone Miner Metab 2016. [DOI: 10.1007/s12018-016-9213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Malone A, Meldrum D, Bolger C. Three-dimensional gait analysis outcomes at 1 year following decompressive surgery for cervical spondylotic myelopathy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:48-56. [PMID: 24622959 DOI: 10.1007/s00586-014-3267-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/25/2014] [Accepted: 02/25/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Gait impairment is an important feature of cervical sponydylotic myelopathy (CSM) as it can have a detrimental effect on function and quality of life. The aim of this study was to measure changes in gait in people with CSM following surgical decompression. METHODS Thirteen participants with clinical and radiological evidence of CSM underwent three-dimensional gait analysis, using a full lower limb kinematic, kinetic and electromyography protocol, before and 12 months after decompressive surgery. RESULTS No significant post-operative changes were detected in temporal-spatial or kinematic parameters. Kinetic data showed significant improvements in knee power absorption [mean improvement, 0.42 watts per kilogram (W/kg)], ankle plantarflexor moment (0.1 Nm/kg) and ankle power generation (0.55 W/kg). Electromyography showed a 4.7 % increase in tibialis anterior activation time. CONCLUSIONS These findings indicate that improvement in locomotor function can be achieved after surgery. Future studies should explore the potential for further recovery of gait through targeted neuro-rehabilitation.
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Affiliation(s)
- Ailish Malone
- Gait Analysis Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland,
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25
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The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: a survey of the "surgical and research" articles in the European Spine Journal, 2013. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:9-18. [PMID: 24384830 DOI: 10.1007/s00586-013-3126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Indexed: 10/25/2022]
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