Association of spinal deformity and pelvic tilt with gait asymmetry in adolescent idiopathic scoliosis patients: Investigation of ground reaction force

Biomechanical analysis of trunk and lower limbs during stair activity in patients with scoliosis

Staircases are a frequently encountered obstacle in daily life, requiring individuals to navigate ascending and descending movements that place additional demands on the trunk and lower limbs compared to walking on level surfaces. Therefore, it is crucial to examine the biomechanical characteristics of the trunk and lower limbs in individuals with scoliosis during stair activity. The aim of this study was to investigate the biomechanical differences in trunk and lower limbs during daily stair activities between patients with scoliosis and a healthy population. Additionally, the study aimed to explore the relationship between trunk abnormalities and lower limb biomechanics, providing a clinical and objective assessment basis for scoliosis. The Qualisys system, based in Gothenburg, Sweden, was employed for data collection in this study, with a sampling frequency of 150 Hz. It captured the kinematics of the trunk and lower limbs, as well as the kinetics of the lower limbs during stair ascent and descent for both the 28 individuals with scoliosis and the 28 control participants. The results indicate that scoliosis patients demonstrated significantly higher asymmetry compared to the control group in various measures during ascent and decent. These include different parts of kinematics and kinetics. Scoliosis patients demonstrate noticeable variations in their movement patterns compared to the healthy population when engaging in stair activities. Specifically, during stair ascent, scoliosis patients exhibit a seemingly more rigid movement pattern, whereas descent is characterized by an unstable pattern.

Association of scoliosis with lower extremity alignments, muscle strengths, and foot characteristics and their alterations in adolescent idiopathic scoliosis

BACKGROUND

The association between changes occurring in the spine and lower body parts is not well understood in adolescent idiopathic scoliosis (AIS).

OBJECTIVES

The first aim of the study was to investigate the association of scoliosis with lower extremity (LE) alignments, foot characteristics, and muscle strengths in adolescents. Secondly, comparisons of the data among AIS with single and double curves and control groups were determined.

METHODS

Thirty-one participants were recruited and classified into 3 groups; AIS with a single curve (n= 7), AIS with double curves (n= 14), and controls (n= 10). Association of the presence of scoliosis with LE alignments (Q and TC angles), LE muscle strengths (hip, knee, and ankle), and foot characteristics (arch indexes) were examined using the point biserial correlation, and the data among three groups were compared using the ANOVA.

RESULTS

Scoliosis was associated with Q angle, arch indexes, and all LE muscle strengths except for hip extensors and ankle plantar flexors strengths. Comparisons among the three groups showed significant increases in LE alignments and foot characteristics in AIS. Almost all LE muscle strengths decreased in AIS, especially for the single curve group.

CONCLUSIONS

Apart from spinal deformity, the AIS has changed in LE alignments, muscle strengths, and foot characteristics. Therapists should consider these associations and alterations for designing proper management.

Lower limb joint burden during walking in adolescent idiopathic scoliosis: investigation of mechanical work during walking

BACKGROUND CONTEXT

Adolescent idiopathic scoliosis (AIS) is the most prevalent spinal deformity in adolescents. However, pathophysiology and long-term complications remain unclear. Characteristics of the mechanical work in AIS gait have not been well-studied.

PURPOSE

This study aimed to elucidate the characteristics of mechanical work in AIS gait.

STUDY DESIGN

Observational comparison study.

PATIENT SAMPLE

Participants were composed of two groups: scoliosis group with 68 participants and a control group with 17 participants.

OUTCOME MEASURES

Spinal deformity and coronal spinal balance in the scoliosis group were assessed with Cobb angle, coronal balance, and apical vertebra translation. Three-dimensional motion analysis during walking was conducted to calculate lower limb joint works and external work on the whole body's center of mass.

METHODS

Lower limb joint work (JW) and external work on the whole body center of mass (CoM) were compared between the 2 groups with an independent t-test. Inter-limb and intra-limb comparisons of mechanical work were conducted with a paired t-test. The relationships between mechanical work and frontal trunk deformity were investigated in the scoliosis group.

RESULTS

Walking speed and external work on whole body CoM did not differ between the two groups. Compared to the control group, the scoliosis group showed significantly larger JW on the convex and concave sides.

CONCLUSION

The scoliosis group showed increased lower limb joint burden and limited trunk function for mechanical work during walking. Investigation of mechanical work during walking provides insight into the biomechanical characteristics of AIS. Therefore, future studies should be conducted to verify mechanical work characteristics which have relevance to the progression of spinal deformity and the development of lower limb complications in AIS.

Spinal disorders and mastication: the potential relationship between adolescent idiopathic scoliosis and alterations of the chewing patterns

OBJECTIVE

to evaluate mastication in a group of patients with Adolescent Idiopathic Scoliosis (AIS) with a control group, by means of the prevalence of reverse chewing cycles (RCC).

MATERIAL AND METHODS

this study included a group of patients (N=32; F=24; M=8; mean age ± SD = 14±3 years) with a confirmed diagnosis of Adolescent Idiopathic Scoliosis and a group of control subjects (N=32; F=24; M=8; mean age ± SD = 13±6 years) without spinal disorders. Mastication was recorded with both a hard and a soft bolus, following a standardized protocol, and the prevalence of reverse chewing cycles was compared between the groups.

RESULTS

The prevalence of reverse chewing cycles was significantly higher in the Adolescent Idiopathic Scoliosis group, with both a soft and a hard bolus, compared to the control group (p<0,001).

CONCLUSION

the results of this study indicate that the presence of Adolescent Idiopathic Scoliosis influences mastication, i.e. one of the main functions of the stomatognathic system. A multidisciplinary approach to these patients may be relevant in providing the best possible treatment outcomes.

Compensatory Ground Reaction Forces during Scoliotic Gait in Subjects with and without Right Adolescent Idiopathic Scoliosis

Although the asymmetries of scoliotic gait in adolescent idiopathic scoliosis (AIS) groups have been extensively studied, recent studies indicated conflicting results regarding the ground reaction forces (GRFs) during gait in subjects with spinal deformity. The asymmetry during the stance phase might be clarified with three-dimensional (3D) compensations of GRFs between similar characteristics of subjects with and without AIS. The purpose of this study was to compare the normalized 3D GRF differences during the stance phase of gait while considering age, BMI, and Cobb angle between subjects with and without right AIS. There were 23 subjects with right convexity of thoracic idiopathic scoliosis and 22 age- and gender-matched control subjects. All subjects were right upper/lower limb dominant, and the outcome measures included the Cobb angles, normalized GRF, and KAI. The mediolateral (M/L) third peak force on the dominant limb decreased in the AIS group (t = 2.58, p = 0.01). Both groups demonstrated a significant interaction with the 3D indices (F = 5.41, p = 0.02). The post-hoc analysis identified that the M/L plane of asymmetry was significantly different between groups. The Cobb angles were negatively correlated with the vertical asymmetry index (r = −0.45, p = 0.03); however, there was no significant correlation with age (r = −0.10, p = 0.65) or body mass index (r = −0.28, p = 0.20). The AIS group demonstrated decreased GRF in the dominant limb M/L plane of the terminal stance phase. This compensatory motion was confirmed by a significant group difference on the M/L plane of the KAI. This KAI of vertical asymmetry correlated negatively with the Cobb angle. The asymmetric load transmission with compensatory vertical reactions was evident due to abnormal loading in the stance phase. These kinetic compensatory patterns need to be considered with asymmetry on the dominant limb when developing rehabilitation strategies for patients with AIS.

Effects of lumbar spinal disorders on the vertical ground reaction force and Spatio-temporal parameters in gait

BACKGROUND

Ground reaction forces are biomechanical data, providing information to investigate pathological gait. The vertical component of ground reaction force introduces the upward thrust force within gait progression. Although alterations in the vertical component in patients with spinal disorders were addressed in the literature, still the corresponding effect on spinal disorders is a major issue to scrutiny. In this study, the effects of two different anatomical spinal disorders on the vertical component pattern were investigated.

METHODS

Two groups of patients with lumbar spine stenosis and lumbar intervertebral disc degeneration with lesions at L4-L5 and/or L5-S1 levels, were recruited. The vertical component of ground reaction force and spatio-temporal parameters were obtained and analyzed using one-way analysis of variance.

FINDINGS

The results indicated that all spatio-temporal parameters differed significantly (P < 0.05) except step lengths and stride times (P > 0.05). In a similar test, the Fz2 in patients with lumbar stenosis was higher than that of those with disc degeneration (P < 0.05). Besides, the vertical ground reaction force pattern showed lower slopes in stenosis patients.

INTERPRETATION

This study showed that the vertical component of ground reaction force alterations and spatio-temporal parameters could be employed as indicators for certain spinal lesions. The results of this study could implement as an adjunct diagnostic method to help clinicians to differentiate between stenosis and disc degeneration patients and plan for their rehabilitation purposes.

Footedness and Postural Asymmetry in Amateur Dressage Riders, Riding in Medium Trot on a Dressage Simulator

This study explored the relationship between footedness and postural asymmetry in equestrian riders. 28 female riders completed the Waterloo Footedness Questionnaire- Revised (WFQ-R), giving a score for footedness. They then took part in a test on a riding simulator where measures of saddle force, stirrup force, and degree of lateral tilt of the pelvic, trunk, and shoulder segments were taken over a period of 20 seconds in trot. Symmetry indices were calculated for stirrup force and saddle force. There were no significant correlations between WFQ-R score and any of the measures of postural symmetry. Only a very small number (n=3) participants showed a marked footedness, with the majority of the sample being classed as 'mixed footed' based on test scores. This, coupled with data loss for some participants in each of the parameters, means direct comparison of footedness groups was difficult. However, the variation of asymmetry in the mixed footed group supports the idea that footedness does not have a significant impact on the rider's posture. There was a correlation between trunk lean and stirrup force symmetry index (r=0.537, P=0.021) showing the trunk leaned towards the side of higher stirrup force. There was a significant negative correlation between pelvic obliquity and shoulder tilt (r= -0.481, P=0.023) with 59% of the sample showing pelvic obliquity and shoulder tilt in opposite directions. The findings indicate that there is little effect of footedness on postural asymmetries in the rider. Research should now consider other causal factors to support riders to become more symmetrical.

Vulnerability of the foot's morphological structure to deformities caused by foot loading paradigm in school-aged children: a cross-sectional study

The study aimed to assess the association between the key predictive foot structure variables and its loading paradigm in 625 school-aged children. Clinical appraisal relied primarily on having the plantar parts of their feet comprehensively assessed with Podoscan 2D Foot CAD, and a dynamometer platform, the research tools of choice widely acknowledged for their overall accuracy and reliability, with a view to determining the distribution of respective foot loads, as well as addressing both balance and gait issues. The Clarke's angle, Wejsflog index, length and width of the feet, regardless of gender, proved the key predictive variables for the foot-loading paradigm. Notably the Clarke's angle, construed the most sensitive variable in assessing flat-footedness, offered an extra added value in overall investigative effort. The actual design of the study protocol effectively complements a standard clinical assessment procedure, whereas by comprehensively addressing those variables, it is also believed to aid clinicians in gaining an extra, hands-on, diagnostic potential, so that any teenagers exposed to the highest risk of developing foot deformities could effectively be identified through pertinent screening tests, and consequently offered a task-oriented, therapeutic management, specifically aimed at preventing potential postural complaints in later life.

Postural adjustments in adolescent idiopathic thoracic scoliosis during walking

INTRODUCTION

Adolescent idiopathic scoliosis (AIS) is the most common type of three-dimensional spinal deformity. Identifying the postural adjustments or changes for different phases and events is needed for developing programs to improve the AIS gait, but such information has been limited. The current study aimed to fill the gap via three-dimensional motion analysis of quiet standing and level walking in patients with severe thoracic AIS.

MATERIALS AND METHODS

Sixteen female adolescents with AIS (Lenke 1 or 2, age: 14.9 ± 1.7 years, height: 154.7 ± 5.0 cm, mass: 41.7 ± 7.2 kg) and sixteen sex-, age- and BMI-matched healthy controls (age: 14.8 ± 2.7 years, height: 154.9 ± 5.6 cm, mass: 44.7 ± 6.3 kg) participated in the current study with informed written consent. The kinematic and kinetic changes between the trunk, pelvis, and lower limb segments, and at the lumbosacral level at different gait events were measured during quiet standing and level walking.

RESULTS

The homogeneity of the current patient group helped reduce the effects of the level and severity of spinal deformity on inter-subject variability that has been associated with controversies over reported gait variables in AIS. The current results support the hypothesis that postural adjustments involving the trunk, pelvis and lower limb segments were needed in severe thoracic AIS during both quiet standing and level walking, and differed between concave and convex sides at different key gait events during level walking.

CONCLUSIONS

Although scoliotic spinal deformity occurred mainly in the frontal plane, postural adjustments in all three planes were present at key events during level walking with associated joint loading changes in patients with severe thoracic AIS. Monitoring of such adjustments and the associated joint kinetic changes will be helpful for assessing the disease and treatment outcomes.

Does Vertical Ground Reaction Force of the Hip, Knee, and Ankle Joints Change in Patients with Adolescent Idiopathic Scoliosis after Spinal Fusion?

Study Design

Comparative cross-sectional study.

Purpose

We measured the vertical ground reaction force (vGRF) of the hip, knee, and ankle joints during normal gait in normal patients, adolescent idiopathic scoliosis (AIS) patients with a Cobb angle <40° and in AIS patients with spinal fusion. We aimed to investigate whether vGRF in the aforementioned joints is altered in these three groups of patients.

Overview of Literature

vGRF of the lower limb joints may be altered in these groups of patients. Although it is known that excessive force in the joints may induce early arthritis, there is limited relevant information in the literatures.

Methods

We measured vGRF of the hip, knee, and ankle joints during heel strike, early stance, mid stance, and toe-off phases in normal subjects (group 1, n=14), AIS patients with Cobb angle <40° (group 2, n=14), and AIS patients with spinal fusion (group 3, n=13) using a gait analysis platform. Fifteen auto-reflective tracking markers were attached to standard anatomical landmarks in both the lower limbs. The captured motion images were used to define the orientations of the body segments and force exerted on the force plate using computer software. Statistical analysis was performed using independent t-test and analysis of variance to examine differences between the right and left sides as well as those among the different subject groups.

Results

The measurements during the four gait phases in all the groups did not show any significant difference (p>0.05). In addition, no significant difference was found in the vGRF measurements of all the joints among the three groups (p>0.05).

Conclusions

A Cobb angle <40° and spinal fusion did not significantly create imbalance or alter vGRF of the lower limb joints in AIS patients.

EVALUATION OF GAIT ASYMMETRY USING FORCE PLATES VERSUS ACCELEROMETER

Evaluation of kinetic asymmetry during walking has been important to both researchers and clinicians. Wearable devices such as accelerometers are inexpensive, easily accessible tools provide valuable information in gait analysis and offer the potential to assess asymmetry without restriction to cost-ineffective laboratory settings. The aim of this study is to investigate the feasibility of using an accelerometer in assessment of force asymmetry in gait. To this end, the relationship between asymmetry measured from force platforms and a skin-mounted accelerometer on the lower back was studied during normal walking as well as five different levels of self-induced simulated asymmetry. Results show that there is a positive overall correlation between the asymmetry indices measured by the two methods ([Formula: see text], [Formula: see text]). Future study is needed to investigate factors such as age, gender, and anthropometric properties that can help develop a predictive model.

Gait and energy consumption in adolescent idiopathic scoliosis: A literature review

BACKGROUND

Adolescent idiopathic scoliosis (AIS) is a progressive growth disease that affects spinal anatomy, mobility, and left-right trunk symmetry. The disease can modify human gait.

OBJECTIVE

We aimed to review articles describing the measurement of gait parameters and energy consumption in AIS during walking without any intervention.

STUDY DESIGN

Literature review.

METHODS

The search strategy was based on the Population Intervention Comparison Outcome method and included all relevant articles published from 1996 to 2015. Articles were searched in MEDLINE via PubMed, Science Direct, Google Scholar, and ISI Web of Knowledge databases.

RESULTS

We selected 33 studies investigating the effect of scoliosis deformity on gait parameters and energy expenditure during walking. Most of the studies concluded no significant differences in walking speed, cadence and step width in scoliosis patients and normal participants. However, patients showed decreased hip and pelvic motion, excessive energy cost of walking, stepping pattern asymmetry and ground reaction force asymmetry.

CONCLUSION

We lack consistent evidence of the effect of scoliosis on temporal spatial and kinematic parameters in AIS patients as compared with normal people. However, further research is needed to assess the effect of scoliosis on gait and energy consumption.