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Hebda-Boon A, Shortland AP, Birn-Jeffery A, Morrissey D. Can on-line gait training improve clinical practice? Study protocol for feasibility randomised controlled trial of an on-line educational intervention to improve clinician's gait-related decision-making in ambulant children and young people with cerebral palsy. Pilot Feasibility Stud 2024; 10:76. [PMID: 38745259 PMCID: PMC11091998 DOI: 10.1186/s40814-024-01477-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/12/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Instrumented gait analysis (IGA) is an assessment and research tool with proven impacts on clinical decision-making for the management of ambulant children and young people with cerebral palsy (CYPwCP) but is underused and variably understood by relevant clinicians. Clinicians' difficulties in gaining expertise and confidence in using IGA are multifactorial and related to access for clinical decision-making, limited training opportunities and inability to translate this training into clinical practice. METHODS The primary aim of this study is to test the feasibility of an educational intervention to advance clinicians' application of gait analysis in CYPwCP, to inform a definitive trial. The secondary aim is to measure the effect that appropriate IGA training has on physiotherapists' knowledge, skills, confidence and behaviours. This will be a two-arm feasibility randomised controlled trial with an experimental and control group. The 6-week on-line intervention uses a multicomponent approach grounded in behavioural change techniques. A repeated measures design will be adopted, whereby participants will complete outcome measures at baseline, immediately after the intervention and at 4 months. The primary outcome measures (trial feasibility-related outcomes) are recruitment and engagement. The secondary outcome measures (trial research-related outcomes) are knowledge, skills, confidence and practice change. Outcome measures will be collected via online questionnaires and during observed skill assessments. Analysis of data will use descriptive statistics, two-way mixed ANOVA model and qualitative content analysis. DISCUSSION This study will determine feasibility of the definitive randomised control trial of educational intervention delivered to advance clinicians' application of gait analysis in CYPwCP. This study offers the shift in emphasis from regarding IGA as a tool to a focus on clinicians' requirements for access, training and a well-defined role to optimise utilisation of IGA. The impact of this should be better engagement with IGA and clinical practice change. This study will contribute to a body of educational research into clinical education of healthcare professionals and IGA training offering insight into high levels of evaluation evidence including clinical behaviour change. TRIAL REGISTRATION Protocol has been registered with the Open Science Framework (osf.io/nweq6) in June 2023.
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Affiliation(s)
- Anna Hebda-Boon
- Sport and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Adam P Shortland
- School of Biomedical Engineering and Imaging Science, King's College London, London, UK
| | | | - Dylan Morrissey
- Sport and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Physiotherapy Department, Barts Health NHS Trust, London, UK
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Wang Y, Qi Y, Ma B, Wu H, Wang Y, Wei B, Wei X, Xu Y. Three-dimensional gait analysis of orthopaedic common foot and ankle joint diseases. Front Bioeng Biotechnol 2024; 12:1303035. [PMID: 38456008 PMCID: PMC10919227 DOI: 10.3389/fbioe.2024.1303035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024] Open
Abstract
Walking is an indispensable mode of transportation for human survival. Gait is a characteristic of walking. In the clinic, patients with different diseases exhibit different gait characteristics. Gait analysis describes the specific situation of human gait abnormalities by observing and studying the kinematics and dynamics of limbs and joints during human walking and depicting the corresponding geometric curves and values. In foot and ankle diseases, gait analysis can evaluate the degree and nature of gait abnormalities in patients and provide an important basis for the diagnosis of patients' diseases, the correction of abnormal gait and related treatment methods. This article reviews the relevant literature, expounds on the clinical consensus on gait, and summarizes the gait characteristics of patients with common ankle and foot diseases. Starting from the gait characteristics of individuals with different diseases, we hope to provide support and reference for the diagnosis, treatment and rehabilitation of clinically related diseases.
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Affiliation(s)
| | | | | | | | | | | | | | - Yongsheng Xu
- Orthopedic Center (Sports Medicine Center), Inner Mongolia People’s Hospital, Hohhot, China
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3
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Biomechanical Implications of Congenital Conditions of the Foot/Ankle. Foot Ankle Clin 2023; 28:27-43. [PMID: 36822687 DOI: 10.1016/j.fcl.2022.10.003] [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] [Indexed: 01/03/2023]
Abstract
Segmental foot and ankle models are often used as part of instrumented gait analysis when planning interventions for complex congenital foot conditions. More than 40 models have been used for clinical analysis, and it is important to understand the technical differences among models. These models have been used to improve clinical planning of pediatric foot conditions including clubfoot, planovalgus, and equinovarus. They have also been used to identify clinically relevant subgroups among pediatric populations, quantify postoperative outcomes, and explain variability in healthy populations.
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Hebda-Boon A, Tan XL, Tillmann R, Shortland AP, Firth GB, Morrissey D. The impact of instrumented gait analysis on decision-making in the interprofessional management of cerebral palsy: A scoping review. Eur J Paediatr Neurol 2023; 42:60-70. [PMID: 36563467 DOI: 10.1016/j.ejpn.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/13/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Management of gait-related problems in children and young people with Cerebral Palsy (CYPwCP) is complex and requires an interprofessional approach. Irrespective of underlying mechanisms, instrumented gait analysis (IGA) can provide quantification of gait to support clinical decision-making for CYPwCP when planning treatment interventions. AIM This scoping review aimed to determine the impact of instrumented gait analysis (IGA) on treatment decision-making for CYPwCP, paying particular attention to interprofessional decision-making. METHOD PubMed, EMBASE, Web of Science and Scopus databases were searched from inception to October 2019 for studies including CYPwCP age<25 years. The PRISMA ScR protocol was followed, and Quality was assessed with the Downs and Black (D&B) scale. Influences on decision-making were coded according to the International Classification of Functioning, Disability and Health for Children and Youth framework (ICF-CY). RESULTS Seventeen studies (1144 patients, 2.8-23 years) of varying quality (mean D&B = 17.2, range = 11-26) were included. Studies considered IGA influence at three decision-making stages 'Clinical Planning', 'Treatment Performed' and 'Follow up'. Child and Family, and Clinician and Service-centred factors had a high impact on engagement with IGA recommendations. INTERPRETATION IGA guided recommendations can differ from initial clinical plans, and often lead to modification of the treatment ultimately performed. The effect on individual patients' outcomes when treatment recommendations based on instrumented gait analysis are followed is not yet clear and warrants further research. The differences in clinicians' engagement with IGA recommendations occur due to an array of Child and Family, and Clinician and Service-centred factors. Overall, IGA leads to less surgical recommendations, and has the potential to influence conservative gait-related management in CYPwCP.
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Affiliation(s)
- Anna Hebda-Boon
- Sport and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK; Physiotherapy Department, Barts Health NHS Trust, London, UK.
| | - Xiang-Li Tan
- Sport and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Ricarda Tillmann
- Sport and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK; Orthopaedic Department, Barts Health NHS Trust, London, UK
| | - Adam P Shortland
- School of Biomedical Engineering and Imaging Science, King's College London, UK
| | | | - Dylan Morrissey
- Sport and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK; Physiotherapy Department, Barts Health NHS Trust, London, UK
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Mahaffey R, Le Warne M, Blandford L, Morrison SC. Age-related changes in three-dimensional foot motion during barefoot walking in children aged between 7 and 11 years old. Gait Posture 2022; 95:38-43. [PMID: 35421684 DOI: 10.1016/j.gaitpost.2022.04.001] [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: 07/01/2021] [Revised: 03/22/2022] [Accepted: 04/01/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The biomechanical complexity of children's feet changes throughout childhood, yet kinematic development of the feet is poorly understood. Further work exploring the kinematic profile of children's feet would be beneficial to help inform our understanding of the typical development of children's feet. RESEARCH QUESTION Do three-dimensional segmental kinematics of the feet during gait relate to age in a sample of children age 7-11 years? METHODS This study was a secondary analysis of an existing database representing one hundred and twenty-one children age 7 - 11 years (90 male, 31 female; mean ± SD: age 9.57 ± , 1.17 years, height 1.37 ± 0.08 m, body mass 35.61 ± 9.33 kg). Fifteen, 9 mm retroreflective markers were attached to the right shank and foot of each participant in, line with the 3DFoot model. Multi-segmental joint kinematics were collected during barefoot walking. Sagittal, frontal, and transverse planar motion was described for the shank-calcaneus, calcaneus-midfoot, and midfoot-metatarsals segment of the right foot. Principal component analysis (PCA) was used to reduce the major modes of variation in the data to fully explore foot segment motion over the entire gait cycle. Correlations and multiple regression between PCA outputs with age, and potential confounding factors are presented. RESULTS Significant positive correlations were found between age and greater calcaneus, dorsiflexion, midfoot inversion and adduction, and metatarsal dorsiflexion, plantarflexion and abduction. There were no significant confounding effects of height, body mass, walking speed or gender on the relationships between age and PCA outputs. SIGNIFICANCE The findings from this study demonstrated a relationship between foot kinematics and age suggesting that the development of foot kinematics is ongoing until at least the age of 11 years. This work offers a comprehensive data set of inter-segmental kinematics which helps to advance understanding of the development of the pediatric foot.
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Affiliation(s)
- Ryan Mahaffey
- School of Sport, Health and Applied Sciences, St Mary's University, Twickenham, UK.
| | - Megan Le Warne
- School of Sport, Health and Applied Sciences, St Mary's University, Twickenham, UK.
| | - Lincoln Blandford
- School of Sport, Health and Applied Sciences, St Mary's University, Twickenham, UK.
| | - Stewart C Morrison
- School of Life Course and Population Sciences, King's College London, UK.
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Chan PH, Stebbins J, Zavatsky AB. Efficacy of quantifying marker-cluster rigidity in a multi-segment foot model: a Monte-Carlo based global sensitivity analysis and regression model. Comput Methods Biomech Biomed Engin 2021; 25:308-319. [PMID: 34289759 DOI: 10.1080/10255842.2021.1954170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Marker-based clinical gait analysis and multi-segment foot models (MSFM) have been successfully used for the diagnosis and clinical management of various lower limb disorders. The accuracy and validity of the kinematics measured depend on the design of the model, as well as on the adherence to its inherent rigid body assumption. This study applies a Monte-Carlo based global sensitivity analysis to evaluate the efficacy of using 'rigid body error (σRBE)' in quantifying the rigidity of a MSFM marker-cluster. A regression model is proposed. It is concluded that σRBE is effective in quantifying rigidity.
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Affiliation(s)
- Po-Hsiang Chan
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Julie Stebbins
- Oxford Gait Laboratory, Nuffield Orthopaedic Centre NHS Trust, Oxford, UK
| | - Amy B Zavatsky
- Department of Engineering Science, University of Oxford, Oxford, UK
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Dussa CU, Böhm H, Döderlein L, Forst R, Fujak A. Does an overcorrected clubfoot caused by surgery or by the Ponseti method behave differently? Gait Posture 2020; 77:308-314. [PMID: 32135471 DOI: 10.1016/j.gaitpost.2020.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/08/2020] [Accepted: 02/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Overcorrection is a recognized problem following surgical treatment of congenital clubfoot. Recently this complication has also been mentioned following Ponseti treatment. RESEARCH QUESTION Do overcorrected clubfeet (OCCF) caused by surgery behave differently from those caused by Ponseti treatment in terms of segmental motion of the feet and show differences in the severity of deformity on X-rays? METHODS Children between 7 and 12 years with OCCF were included in this study. Depending on the aetiology causing them, the feet were divided into 2 groups (Ponseti and peritalar release surgery). 25 typically developing children served as controls. All subjects were subjected to clinical and radiological examination and 3-Dimensional gait analysis using the Oxford Foot Model. RESULTS Thirty-two children with OCCF, of these 18 feet in the surgical and 14 feet in the Ponseti group, were included in the study. No radiological differences were seen in the flatfoot parameters between OCCF groups except in the calcaneal inclination angle that was more pathological in the Ponseti group. The clinical ankle plantar flexion was significantly reduced in the surgical group. During walking the range motion of the hindfoot in the frontal plane was significantly reduced in surgically treated feet compared to the Ponseti group. The other parameters did not show any significant difference between groups. SIGNIFICANCE The overcorrected clubfeet following surgery and Ponseti showed similar appearance and showed no significant differences in 11/12 radiological parameters. The segmental motion of the feet showed no significant differences between groups except the in the range of motion of the subtalar eversion. A considerable subtalar joint motion was present even in the surgical group. These findings might help plan the treatment of these feet.
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Affiliation(s)
- Chakravarthy U Dussa
- Department of Paediatric Orthopaedics, Orthopaedische Kinderklinik, Bernauerstrasse 18, D-83229 Aschau i. Chiemgau, Bavaria, Germany.
| | - Harald Böhm
- Gait Laboratory, Orthopaedische Kinderklinik, Bernauerstrasse 18, D-83229 Aschau i. Chiemgau, Bavaria, Germany
| | - Leonhard Döderlein
- Peadiatric Orthopaedic Surgeon, Bismarckstrasse 60, 69198 Schriesheim, Germany
| | - Raimund Forst
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Rathsberger Str. 57, D-91054 Erlangen, Bavaria, Germany
| | - Albert Fujak
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Rathsberger Str. 57, D-91054 Erlangen, Bavaria, Germany
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Stimulation Parameters of Manual Acupuncture and Their Measurement. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:1725936. [PMID: 31558907 PMCID: PMC6735182 DOI: 10.1155/2019/1725936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/10/2019] [Accepted: 08/06/2019] [Indexed: 01/13/2023]
Abstract
The therapeutic effect of manual acupuncture (MA) is closely related to the stimulation amount. In the clinical studies, the stimulation amount is often difficult to be determined. The reason is that there are many parameters affecting the stimulation amount, including manipulation selection, treatment time, needling velocity, and force, and no complete and reasonable scheme is available for the measurement of stimulation parameters. This paper reviewed the theoretical and laboratory measurement studies on MA stimulation, summarized 4 types of available parameters according to the theory of physics, and compared the advantages and disadvantages of the existing methods of parameter measurement. Such efforts are hoped for providing reference for the establishment of the stimulation parameter system of MA and possible technical solutions for future measurement experiments.
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Tang WC, Yang HY, Liu TY, Gao M, Xu G. Motion video-based quantitative analysis of the 'lifting-thrusting' method: a comparison between teachers and students of acupuncture. Acupunct Med 2017; 36:21-28. [PMID: 28844062 PMCID: PMC5865511 DOI: 10.1136/acupmed-2016-011348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare objective measures of needle manipulation between students and teachers of acupuncture using motion video analysis technology, to help support instructional acupuncture education. METHODS A total of 30 teachers and 60 students participated in this study. Acupuncture needles were inserted at LI11 and motion videos were recorded for three subtypes of 'lifting-thrusting' manipulation: (1) 'mild reinforcing-attenuating'; (2) 'reinforcing'; and (3) 'attenuating'. The videos were analysed using Simi Motion 3D software to acquire the movement parameters of four trace marks: 'thumb tip'; 'forefinger tip'; 'forefinger middle joint'; and 'forefinger base joint'. Differences between the two groups were compared using t-tests, X2 tests and/or rank-sum tests. RESULTS Changes in the near-end interphalangeal joint were positively associated with a range of movement along the X axis. Motion parameters for the thumb tip, the proximal interphalangeal (PIP) joint of the forefinger and the X axis shaft swing near the end of the forefinger in the teacher group were higher than those in the student group. The teacher group featured smaller trough dispersion and smaller crest dispersion during 'reinforcing' and 'attenuating' manipulations, respectively. CONCLUSIONS The 'lifting-thrusting' manipulation could be simplified as a fixed-axis rotation using metacarpophalangeal joints in the thumb and forefinger as the shaft centre. Teachers opened at a larger angular variation for the PIP during the lifting and thrusting processes with better spatial control. Temporal control was similar between groups and therefore appears easier to grasp. Repetitive training might be helpful for improving athletic and spatial stability during needle manipulation.
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Affiliation(s)
- Wen-Chao Tang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hua-Yuan Yang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tang-Yi Liu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ming Gao
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Gang Xu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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González I, Fontecha J, Hervás R, Bravo J. Estimation of Temporal Gait Events from a Single Accelerometer Through the Scale-Space Filtering Idea. J Med Syst 2016; 40:251. [PMID: 27714561 DOI: 10.1007/s10916-016-0612-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/13/2016] [Indexed: 11/26/2022]
Abstract
The purpose of this paper is to develop an accelerometry system capable of performing gait event demarcation and calculation of temporal parameters using a single waist-mounted device. Particularly, a mobile phone positioned over the L2 vertebra is used to acquire trunk accelerations during walking. Signals from the acceleration magnitude and the vertical acceleration are smoothed through different filters. Cut-off points between filtered signals as a result of convolving with varying levels of Gaussian filters and other robust features against temporal variation and noise are used to identify peaks that correspond to gait events. Five pre-frail older adults and five young healthy adults were recruited in an experiment. Cadence, step/stride time, step/stride CV, step asymmetry and percentages of the stance/swing and single/double support phases, among the two groups of different mobility were quantified by the system.
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Affiliation(s)
- Iván González
- University of Castilla-La Mancha, Esc. Sup. de Informática, Paseo de la Universidad 4, 13071, Ciudad Real, Spain.
| | - Jesús Fontecha
- University of Castilla-La Mancha, Esc. Sup. de Informática, Paseo de la Universidad 4, 13071, Ciudad Real, Spain
| | - Ramón Hervás
- University of Castilla-La Mancha, Esc. Sup. de Informática, Paseo de la Universidad 4, 13071, Ciudad Real, Spain
| | - José Bravo
- University of Castilla-La Mancha, Esc. Sup. de Informática, Paseo de la Universidad 4, 13071, Ciudad Real, Spain
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Concurrent repeatability and reproducibility analyses of four marker placement protocols for the foot-ankle complex. J Biomech 2016; 49:3168-3176. [DOI: 10.1016/j.jbiomech.2016.07.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 07/27/2016] [Accepted: 07/28/2016] [Indexed: 11/20/2022]
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12
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González I, López-Nava IH, Fontecha J, Muñoz-Meléndez A, Pérez-SanPablo AI, Quiñones-Urióstegui I. Comparison between passive vision-based system and a wearable inertial-based system for estimating temporal gait parameters related to the GAITRite electronic walkway. J Biomed Inform 2016; 62:210-23. [PMID: 27395370 DOI: 10.1016/j.jbi.2016.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 11/30/2022]
Abstract
Quantitative gait analysis allows clinicians to assess the inherent gait variability over time which is a functional marker to aid in the diagnosis of disabilities or diseases such as frailty, the onset of cognitive decline and neurodegenerative diseases, among others. However, despite the accuracy achieved by the current specialized systems there are constraints that limit quantitative gait analysis, for instance, the cost of the equipment, the limited access for many people and the lack of solutions to consistently monitor gait on a continuous basis. In this paper, two low-cost systems for quantitative gait analysis are presented, a wearable inertial system that relies on two wireless acceleration sensors mounted on the ankles; and a passive vision-based system that externally estimates the measurements through a structured light sensor and 3D point-cloud processing. Both systems are compared with a reference clinical instrument using an experimental protocol focused on the feasibility of estimating temporal gait parameters over two groups of healthy adults (five elders and five young subjects) under controlled conditions. The error of each system regarding the ground truth is computed. Inter-group and intra-group analyses are also conducted to transversely compare the performance between both technologies, and of these technologies with respect to the reference system. The comparison under controlled conditions is required as a previous stage towards the adaptation of both solutions to be incorporated into Ambient Assisted Living environments and to provide continuous in-home gait monitoring as part of the future work.
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Affiliation(s)
- Iván González
- University of Castilla-La Mancha, Paseo de la Universidad 4, 13071 Ciudad Real, Spain.
| | - Irvin H López-Nava
- Instituto Nacional de Astrofísica, Óptica y Electrónica, Luis Enrique Erro 1, 72840 Puebla, Mexico.
| | - Jesús Fontecha
- University of Castilla-La Mancha, Paseo de la Universidad 4, 13071 Ciudad Real, Spain.
| | - Angélica Muñoz-Meléndez
- Instituto Nacional de Astrofísica, Óptica y Electrónica, Luis Enrique Erro 1, 72840 Puebla, Mexico.
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Carty CP, Walsh HPJ, Gillett JG. Sensitivity of the Oxford Foot Model to marker misplacement: A systematic single-case investigation. Gait Posture 2015; 42:398-401. [PMID: 26163347 DOI: 10.1016/j.gaitpost.2015.06.189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/18/2015] [Accepted: 06/23/2015] [Indexed: 02/02/2023]
Abstract
The purpose of this paper was to systematically assess the effect of Oxford Foot Model (OFM) marker misplacement on hindfoot relative to tibia, and forefoot relative to hindfoot kinematic calculations during the stance phase of gait. Marker trajectories were recorded with an 8-camera motion analysis system (Vicon Motion Systems Ltd., UK) and ground reaction forces were recorded from three force platforms (AMTI, USA). A custom built marker cluster consisting of 4 markers in a square arrangement (diagonal distance 2 cm) was used to assess the effect of marker misplacement in the superior, inferior, anterior and posterior direction for the sustentaculum tali (STL), the proximal 1st metatarsal (P1M), distal 5th metatarsal (D5M), proximal 5th metatarsal (P5M) and lateral calcaneus (LCA) markers. In addition manual movement of the heel complex 1 cm superiorly, inferiorly, medially and laterally, and also an alignment error of 10° inversion and 10° eversion was assessed. Clinically meaningful effects of marker misplacement were determined using a threshold indicating the minimal clinically important difference. Misplacement of the heel-wand complex had the most pronounced effect on mean kinematic profiles during the stance phase across all degrees-of-freedom with respect to hindfoot-tibia and forefoot-hindfoot angles. Vertical marker misplacement of the D5M and P5M markers affected the sagittal plane, and to a lesser extent frontal plane, forefoot-hindfoot kinematics. In conclusion, the OFM is highly sensitive to misplacement of the heel-wand complex in all directions and the P5M marker in the vertical direction.
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Affiliation(s)
- Christopher P Carty
- Queensland Children's Motion Analysis Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia; Centre for Musculoskeletal Research & School of Allied Health Sciences, Menzies Health Institute Queensland, Gold Coast, Australia.
| | - Henry P J Walsh
- Queensland Children's Motion Analysis Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Jarred G Gillett
- Queensland Children's Motion Analysis Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia; Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
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González I, Fontecha J, Hervás R, Bravo J. An Ambulatory System for Gait Monitoring Based on Wireless Sensorized Insoles. SENSORS 2015; 15:16589-613. [PMID: 26184199 PMCID: PMC4541895 DOI: 10.3390/s150716589] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 12/02/2022]
Abstract
A new gait phase detection system for continuous monitoring based on wireless sensorized insoles is presented. The system can be used in gait analysis mobile applications, and it is designed for real-time demarcation of gait phases. The system employs pressure sensors to assess the force exerted by each foot during walking. A fuzzy rule-based inference algorithm is implemented on a smartphone and used to detect each of the gait phases based on the sensor signals. Additionally, to provide a solution that is insensitive to perturbations caused by non-walking activities, a probabilistic classifier is employed to discriminate walking forward from other low-level activities, such as turning, walking backwards, lateral walking, etc. The combination of these two algorithms constitutes the first approach towards a continuous gait assessment system, by means of the avoidance of non-walking influences.
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Affiliation(s)
- Iván González
- MAmI Research Lab, University of Castilla-La Mancha, Esc. Sup. de Informática, Paseo de la Universidad, 4, 13071 Ciudad Real, Spain.
| | - Jesús Fontecha
- MAmI Research Lab, University of Castilla-La Mancha, Esc. Sup. de Informática, Paseo de la Universidad, 4, 13071 Ciudad Real, Spain.
| | - Ramón Hervás
- MAmI Research Lab, University of Castilla-La Mancha, Esc. Sup. de Informática, Paseo de la Universidad, 4, 13071 Ciudad Real, Spain.
| | - José Bravo
- MAmI Research Lab, University of Castilla-La Mancha, Esc. Sup. de Informática, Paseo de la Universidad, 4, 13071 Ciudad Real, Spain.
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Krzak JJ, Corcos DM, Damiano DL, Graf A, Hedeker D, Smith PA, Harris GF. Kinematic foot types in youth with equinovarus secondary to hemiplegia. Gait Posture 2015; 41:402-8. [PMID: 25467429 PMCID: PMC4574499 DOI: 10.1016/j.gaitpost.2014.10.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 09/05/2014] [Accepted: 10/31/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Elevated kinematic variability of the foot and ankle segments exists during gait among individuals with equinovarus secondary to hemiplegic cerebral palsy (CP). Clinicians have previously addressed such variability by developing classification schemes to identify subgroups of individuals based on their kinematics. OBJECTIVE To identify kinematic subgroups among youth with equinovarus secondary to CP using 3-dimensional multi-segment foot and ankle kinematics during locomotion as inputs for principal component analysis (PCA), and K-means cluster analysis. METHODS In a single assessment session, multi-segment foot and ankle kinematics using the Milwaukee Foot Model (MFM) were collected in 24 children/adolescents with equinovarus and 20 typically developing children/adolescents. RESULTS PCA was used as a data reduction technique on 40 variables. K-means cluster analysis was performed on the first six principal components (PCs) which accounted for 92% of the variance of the dataset. The PCs described the location and plane of involvement in the foot and ankle. Five distinct kinematic subgroups were identified using K-means clustering. Participants with equinovarus presented with variable involvement ranging from primary hindfoot or forefoot deviations to deformtiy that included both segments in multiple planes. CONCLUSION This study provides further evidence of the variability in foot characteristics associated with equinovarus secondary to hemiplegic CP. These findings would not have been detected using a single segment foot model. The identification of multiple kinematic subgroups with unique foot and ankle characteristics has the potential to improve treatment since similar patients within a subgroup are likely to benefit from the same intervention(s).
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Affiliation(s)
- Joseph J. Krzak
- Midwestern University, Physical Therapy Program, College of Health Sciences, 555 31st Street, Downers Grove, IL, United States,Shriners Hospitals for Children®-Chicago, 2211 North Oak Park Avenue, Chicago, IL, United States,Corresponding author at: Midwestern University, Physical Therapy Program, College of Health Sciences, 555 31st Street, Downers Grove, IL, United States. Tel.: +1630 960-3942; fax: +1 630 515-7224. (J.J. Krzak)
| | - Daniel M. Corcos
- Northwestern University Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, 645 North Michigan Avenue, Chicago, IL, United States
| | - Diane L. Damiano
- National Institutes of Health, Functional & Applied Biomechanics Section, 10 Center Drive, Bethesda, MD, United States
| | - Adam Graf
- Shriners Hospitals for Children®-Chicago, 2211 North Oak Park Avenue, Chicago, IL, United States
| | - Donald Hedeker
- University of Chicago, Department of Public Health Sciences, 5841 South Maryland Avenue, Chicago, IL, United States
| | - Peter A. Smith
- Shriners Hospitals for Children®-Chicago, 2211 North Oak Park Avenue, Chicago, IL, United States,RUSH University Medical Center, Department of Orthopaedic Surgery, College of Medicine, 1611 West Harrison Street, Chicago, IL, United States
| | - Gerald F. Harris
- Shriners Hospitals for Children®-Chicago, 2211 North Oak Park Avenue, Chicago, IL, United States,Orthopaedic & Rehabilitation Engineering Center (OREC), Marquette University/Medical College of Wisconsin, 735 North 17th Street, Milwaukee, WI, United States
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Abd-Elaziz H, Rahman SA, Olama K, Thabet N, El-Din SN. Correlation between Foot Progression Angle and Balance in Cerebral Palsied Children. TRENDS IN APPLIED SCIENCES RESEARCH 2015; 10:54-67. [DOI: 10.3923/tasr.2015.54.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Segal G, Elbaz A, Parsi A, Heller Z, Palmanovich E, Nyska M, Feldbrin Z, Kish B. Clinical outcomes following ankle fracture: a cross-sectional observational study. J Foot Ankle Res 2014; 7:50. [PMID: 25478013 PMCID: PMC4252004 DOI: 10.1186/s13047-014-0050-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 11/07/2014] [Indexed: 11/12/2022] Open
Abstract
Background The purpose of the current study was to examine objective and subjective differences between three severity groups of ankle fractures patients compared to healthy controls. Methods This was a case-controlled study. 92 patients with an ankle fracture injury of which 41 patients were eligible to participate in the study. 72 healthy people served as controls. All patients underwent a computerized gait test, completed self-assessment questionnaires (The Foot and Ankle Outcome Score (FAOS) and the SF-36), evaluated with the American Foot and Ankle Score (AOFAS) form and completed the 6-min walk test. The control group performed a computerized gait test and completed the SF-36 health survey. Results All ankle fracture patients presented compromised gait patterns and limb symmetry compared to controls (p < 0.05). Ankle fracture patients also had lower SF-36 scores compared to controls (p < 0.05). Significant differences were found between the unimalleolar group compared to the bimalleolar and trimalleolar groups in most parameters, except for the FAOS scores. There were no significant differences between the bimalleolar fracture group and the trimalleolar fracture groups. Conclusions Although all fracture severity classification groups presented a compromised gait pattern and worse clinical symptoms compared to controls, it seems that patients with a unimalleolar fracture is a different group compared to bimalleolar and trimalleolar fracture. Furthermore, it seems that bimalleolar fracture and trimalleolar fracture affect the gait pattern and clinical symptoms to an equal extent, at least in the short-term. Trial registration NCT01127776.
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Affiliation(s)
- Ganit Segal
- AposTherapy Research Group, 1 Abba Even Blvd, Herzliya, 46733 Israel
| | - Avi Elbaz
- AposTherapy Research Group, 1 Abba Even Blvd, Herzliya, 46733 Israel
| | - Alon Parsi
- AposTherapy Research Group, 1 Abba Even Blvd, Herzliya, 46733 Israel
| | - Ziv Heller
- Department of Orthopedic Surgery, Meir Medical Center, Kfar-Saba, Israel
| | | | - Meir Nyska
- Department of Orthopedic Surgery, Meir Medical Center, Kfar-Saba, Israel
| | - Zeev Feldbrin
- Department of Orthopaedic Surgery, Wolfson Medical center, Holon, Israel, affiliated to the Sacker Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Benjamin Kish
- Department of Orthopedic Surgery, Meir Medical Center, Kfar-Saba, Israel
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Leardini A, O'Connor JJ, Giannini S. Biomechanics of the natural, arthritic, and replaced human ankle joint. J Foot Ankle Res 2014; 7:8. [PMID: 24499639 PMCID: PMC3918177 DOI: 10.1186/1757-1146-7-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 02/03/2014] [Indexed: 11/16/2022] Open
Abstract
The human ankle joint complex plays a fundamental role in gait and other activities of daily living. At the same time, it is a very complicated anatomical system but the large literature of experimental and modelling studies has not fully described the coupled joint motion, position and orientation of the joint axis of rotation, stress and strain in the ligaments and their role in guiding and stabilizing joint motion, conformity and congruence of the articular surfaces, patterns of contact at the articular surfaces, patterns of rolling and sliding at the joint surfaces, and muscle lever arm lengths. The present review article addresses these issues as described in the literature, reporting the most recent relevant findings.
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Affiliation(s)
- Alberto Leardini
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy.
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Mahaffey R, Morrison SC, Drechsler WI, Cramp MC. Evaluation of multi-segmental kinematic modelling in the paediatric foot using three concurrent foot models. J Foot Ankle Res 2013; 6:43. [PMID: 24176241 PMCID: PMC3832939 DOI: 10.1186/1757-1146-6-43] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/24/2013] [Indexed: 11/10/2022] Open
Abstract
Background Various foot models are used in the analysis of foot motion during gait and selection of the appropriate model can be difficult. The clinical utility of a model is dependent on the repeatability of the data as well as an understanding of the expected error in the process of data collection. Kinematic assessment of the paediatric foot is challenging and little is reported about multi-segment foot models in this population. The aim of this study was to examine three foot models and establish their concurrent test-retest repeatability in evaluation of paediatric foot motion during gait. Methods 3DFoot, Kinfoot and the Oxford Foot Model (OFM) were applied concurrently to the right foot and lower limb of 14 children on two testing sessions. Angular data for foot segments were extracted at gait cycle events and peaks and compared between sessions by intraclass correlation coefficient (ICC) with 95% confidence intervals (95%CI) and standard error of measurement (SEM). Results All foot models demonstrated moderate repeatability: OFM (ICC 0.55, 95% CI 0.16 to 0.77), 3DFoot (ICC 0.47, 95% CI 0.15 to 0.64) and Kinfoot (ICC 0.43, 95% CI -0.03 to 0.59). On the basis of a cut-off of 5°, acceptable mean error over repeated sessions was observed for OFM (SEM 4.61° ± 2.86°) and 3DFoot (SEM 3.88° ± 2.18°) but not for Kinfoot (SEM 5.08° ± 1.53°). Reliability of segmental kinematics varied, with low repeatability (ICC < 0.4) found for 14.3% of OFM angles, 22.7% of 3DFoot angles and 37.6% of Kinfoot angles. SEM greater than 5° was found in 26.2% of OFM, 15.2% of 3DFoot, and 43.8% of Kinfoot segmental angles. Conclusion Findings from this work have demonstrated that segmental foot kinematics are repeatable in the paediatric foot but the level of repeatability and error varies across the segments of the different models. Information on repeatability and test-retest errors of three-dimensional foot models can better inform clinical assessment and advance understanding of foot motion during gait.
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Affiliation(s)
- Ryan Mahaffey
- School of Health, Sport and Bioscience, University of East London, Stratford, London E15 4LZ, England.
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Carmody Soni EE, Miller BJ, Scarborough MT, Parker Gibbs C. Functional outcomes and gait analysis of patients after periacetabular sarcoma resection with and without ischiofemoral arthrodesis. J Surg Oncol 2012; 106:844-9. [DOI: 10.1002/jso.23130] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 03/23/2012] [Indexed: 11/12/2022]
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31824bc119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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