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Giardini M, Turcato AM, Arcolin I, Corna S, Godi M. Vertical Ground Reaction Forces in Parkinson's Disease: A Speed-Matched Comparative Analysis with Healthy Subjects. SENSORS (BASEL, SWITZERLAND) 2023; 24:179. [PMID: 38203042 PMCID: PMC10781249 DOI: 10.3390/s24010179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024]
Abstract
This study aimed to investigate and compare the vertical Ground Reaction Forces (vGRFs) of patients with Parkinson's Disease (PwPD) and healthy subjects (HS) when the confounding effect of walking speed was absent. Therefore, eighteen PwPD and eighteen age- and linear walking speed-matched HS were recruited. Using plantar pressure insoles, participants walked along linear and curvilinear paths at self-selected speeds. Interestingly, PwPD exhibited similar walking speed to HS during curvilinear trajectories (p = 0.48) and similar vGRF during both linear and curvilinear paths. In both groups, vGRF at initial contact and terminal stance was higher during linear walking, while vGRF at mid-stance was higher in curvilinear trajectories. Similarly, the time to peak vGRF at each phase showed no significant group differences. The vGRF timing variability was different between the two groups, particularly at terminal stance (p < 0.001). In conclusion, PwPD and HS showed similar modifications in vGRF and a similar reduction in gait speed during curvilinear paths when matched for linear walking speed. This emphasized the importance of considering walking speed when assessing gait dynamics in PwPD. This study also suggests the possibility of the variability of specific temporal measures in differentiating the gait patterns of PwPD versus those of HS, even in the early stages of the disease.
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Affiliation(s)
- Marica Giardini
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, 28013 Gattico-Veruno, Italy; (M.G.); (S.C.); (M.G.)
| | - Anna Maria Turcato
- Rehabilitation Department, The Clavadel—The Geoghegan Group, 1 Pit Farm Road, Guildford GU1 2JH, Surrey, UK;
| | - Ilaria Arcolin
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, 28013 Gattico-Veruno, Italy; (M.G.); (S.C.); (M.G.)
| | - Stefano Corna
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, 28013 Gattico-Veruno, Italy; (M.G.); (S.C.); (M.G.)
| | - Marco Godi
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Veruno, 28013 Gattico-Veruno, Italy; (M.G.); (S.C.); (M.G.)
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Dobler F, Cip J, Lengnick H, Alexander N. Effects of ankle-foot orthoses on different gait patterns in children with spastic cerebral palsy: A statistical parametric mapping study. Prosthet Orthot Int 2023; 47:449-456. [PMID: 36795944 DOI: 10.1097/pxr.0000000000000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/14/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Ankle-foot orthoses (AFOs) are a common treatment to correct gait deviations in children with spastic cerebral palsy (SCP). Studies on the outcome of AFOs on gait often do not account for different gait patterns. OBJECTIVES The aim of this study was to investigate the effects of AFOs on specific gait patterns in children with cerebral palsy. STUDY DESIGN Retrospective, unblinded, controlled, cross-over study. METHODS Twenty-seven children with SCP were assessed in the conditions walking barefoot or with shoes and AFO. AFOs were prescribed based on usual clinical practice. Gait patterns for each leg were classified as excess ankle plantarflexion in stance (equinus), excess knee extension in stance (hyperextension), or excess knee flexion in stance (crouch). Differences in spatial-temporal variables and sagittal kinematics and kinetics of the hip, knee, and ankle between the 2 conditions were determined using paired t-tests and statistical parametric mapping, respectively. The effect of AFO-footwear neutral angle on knee flexion was tested using statistical parametric mapping regression. RESULTS AFO use improved spatial-temporal variables and reduced ankle power generation in preswing. For "equinus" and "hyperextension" gait patterns, AFOs decreased ankle plantarflexion in preswing and initial swing and decreased ankle power in preswing. Ankle dorsiflexion moment increased in all gait pattern groups. Knee and hip variables did not change in any of the 3 groups. AFO-footwear neutral angle had no effect on changes in sagittal knee angle. CONCLUSION Although improvements in spatial-temporal variables were seen, gait deviations could only partially be corrected. Therefore, AFO prescriptions and design should individually address specific gait deviations and their effectiveness in children with SCP should be controlled.
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Affiliation(s)
- Florian Dobler
- Department of Paediatric Orthopaedics, Laboratory for Motion Analysis, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Johannes Cip
- Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Harald Lengnick
- Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Nathalie Alexander
- Department of Paediatric Orthopaedics, Laboratory for Motion Analysis, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
- Department of Orthopaedics and Traumatology, Cantonal Hospital, St Gallen, Switzerland
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Kimura N, Ohata K, Kawasaki S, Nogi S, Tsuruda A, Yamada S. Influencing kinetic energy using ankle-foot orthoses to help improve walking after stroke: a pilot study. Prosthet Orthot Int 2021; 45:513-520. [PMID: 34561378 DOI: 10.1097/pxr.0000000000000041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND An ankle-foot orthosis with an oil damper (AFO-OD) may improve kinetics and kinematics for efficient walking after stroke. Yet it is unknown whether hemiplegic walking behaves like "inverted-pendulum" gait and how it is modulated by using AFO-ODs for efficiency. OBJECTIVES This study examined whether the use of AFO-ODs improves the kinetics of total vertical ground reaction force (vGRF) and kinematics of vertical pelvic displacement (vPD) in different walking phases, and gait speed following stroke. Also, the relationship between those gait parameters was examined to assess efficient walking. STUDY DESIGN Observational study within subject. METHODS Eight participants with hemiplegia walked at self-selected speed without and with AFO-ODs over the walkway and gait speed was measured. Force plates were used to measure total vGRF during the double-limb support phase with the paretic leading limb and with the paretic trailing limb (DSPT). The vPD in the paretic and nonparetic stance phases was measured by a three-dimensional motion analysis system. RESULTS Without AFO-ODs, reduced total vGRF during DSPT was related to greater vPD in the subsequent nonparetic stance. Using AFO-ODs significantly increased gait speed and total vGRF during double-limb support phase with the paretic leading limb and during DSPT, which were significantly correlated. Vertical pelvic displacement in the nonparetic stance was higher than the paretic stance in both conditions. CONCLUSIONS Decreased total vGRF during DSPT was compensated by excessive vPD in the nonparetic stance phase without AFO-ODs, indicating inefficient walking. However, the use of AFO-ODs improved the kinetic energy of total vGRF during the double-limb support phase, contributing to efficient walking. CLINICAL RELEVANCE STATEMENT The AFO-ODs can be used to improve kinetic energy and to modulate functions in the weight transition during the double-limb support phase, with faster walking speed. Thus, AFO-ODs can be considered to be therapeutic AFOs to acquire efficient walking performance in poststroke rehabilitation.
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Affiliation(s)
- Nodoka Kimura
- Center for Information and Neural Networks (CiNet), Advanced ICT Research Institute, National Institute of Information and Communications Technology (NICT), Suita, Osaka, Japan
| | - Koji Ohata
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shihomi Kawasaki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shiori Nogi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiro Tsuruda
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shigehito Yamada
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Skaaret I, Steen H, Niratisairak S, Swanson D, Holm I. Postoperative changes in vertical ground reaction forces, walking barefoot and with ankle-foot orthoses in children with Cerebral Palsy. Clin Biomech (Bristol, Avon) 2021; 84:105336. [PMID: 33848706 DOI: 10.1016/j.clinbiomech.2021.105336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/07/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children with cerebral palsy often have problems to support the body centre of mass, seen as increased ratio between excessive vertical ground reaction forces during weight acceptance and decreased forces below bodyweight in late stance. We aimed to examine whether increasing ankle range of motion through surgery and restraining motion with ankle-foot orthoses postoperatively would have impact on the vertical ground reaction force in weight acceptance and late stance. METHODS Ground reaction forces were recorded from 24 children with bilateral and 32 children with unilateral cerebral palsy, each measured walking barefoot before and after triceps surae lengthening. Postoperatively, the children were also measured walking with ankle-foot orthoses. Changes in vertical ground reaction forces between the three conditions were evaluated with functional curve and descriptive peak analyses; accounting for repeated measures and within-subject correlation. FINDINGS After surgery, there were decreased vertical ground reaction forces in weight acceptance and increased forces in late stance. Additional significant changes with ankle-foot orthoses involved increased vertical forces in weight acceptance, and in late stance corresponding to bodyweight (bilateral, from 92% to 98% bodyweight; unilateral, from 94% to 103% bodyweight) postoperatively. INTERPRETATION Our findings confirmed that surgery affected vertical ground reaction forces to approach more normative patterns. Additional changes with ankle-foot orthoses indicated further improved ability to support bodyweight and decelerate centre of mass in late stance.
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Affiliation(s)
- Ingrid Skaaret
- Department for Child Neurology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Harald Steen
- Division of Orthopaedic Surgery, Department of Research, Oslo University Hospital, Oslo, Norway; Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Sanyalak Niratisairak
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - David Swanson
- Oslo Centre for Biostatistics and Epidemiology (OCBE), Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Inger Holm
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway; Division of Orthopaedic Surgery, Department of Research, Oslo University Hospital, Oslo, Norway
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Inter-limb weight transfer strategy during walking after unilateral transfemoral amputation. Sci Rep 2021; 11:4793. [PMID: 33637849 PMCID: PMC7910552 DOI: 10.1038/s41598-021-84357-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/11/2021] [Indexed: 01/31/2023] Open
Abstract
Although weight transfer is an important component of gait rehabilitation, the biomechanical strategy underlying the vertical ground reaction force loading/unloading in individuals with unilateral transfemoral amputation between intact and prosthetic limbs remains unclear. We investigated weight transfer between limbs at different walking speeds in 15 individuals with unilateral transfemoral amputation and 15 individuals without amputation as controls, who walked on an instrumented treadmill. The normalized unloading and loading rates were calculated as the slope of decay and rise phase of the vertical ground reaction force, respectively. We performed linear regression analyses for trailing limb's unloading rate and leading limb's loading rate between the prosthetic, intact, and control limbs. While loading rate increased with walking speed in all three limbs, the greatest increase was observed in the intact limb. In contrast to the other limbs, the prosthetic limb unloading rate was relatively insensitive to speed changes. Consequently, the regression line between trailing prosthetic and leading intact limbs deviated from other relationships. These results suggest that weight transfer is varied whether the leading or trailing limb is the prosthetic or intact side, and the loading rate of the leading limb is partially affected by the unloading rate of the contralateral trailing limb.
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Narayan J, Kumar Dwivedy S. Preliminary design and development of a low-cost lower-limb exoskeleton system for paediatric rehabilitation. Proc Inst Mech Eng H 2021; 235:530-545. [PMID: 33588634 DOI: 10.1177/0954411921994940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In this work, the design, modeling, and development of a low-cost lower limb exoskeleton (LLES) system are presented for paediatric rehabilitation (age: 8-12 years, mass: 25-40 kg, height: 115-125 cm). The exoskeleton system, having three degrees-of-freedom (DOFs) for each limb, is designed in the SolidWorks software. A wheel support module is introduced in the design to ensure the user's stability and safety. The finite element analysis of the hip joint connector along with the wheel support module is realized for maximum loading conditions. The holding torque capacity of exoskeleton joints is estimated using an affordable spring-based experimental setup. A working prototype of the LLES is developed with holding torque rated actuators. Thereafter, the dynamic analysis for the human-exoskeleton coupled system is carried out using the Euler-Lagrange principle and SimMechanics model. The simulation results of estimating joint actuator torques are obtained for two paraplegic subjects (Case I: 10 years age, 30 kg mass, 120 cm height and Case II: 12 years age, 40 kg mass, 125 cm height). The details of input parameters such as body mass, link lengths, joint angles, and contact forces are discussed. The simulation results of dynamic analysis have shown the potential of estimating the torques of joint actuators for the developed prototype during motion assistance and gait rehabilitation.
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Affiliation(s)
- Jyotindra Narayan
- Mechanical Engineering Department, Indian Institute of Technology Guwahati, Guwahati, India
| | - Santosha Kumar Dwivedy
- Mechanical Engineering Department, Indian Institute of Technology Guwahati, Guwahati, India
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Cappellini G, Sylos-Labini F, Assenza C, Libernini L, Morelli D, Lacquaniti F, Ivanenko Y. Clinical Relevance of State-of-the-Art Analysis of Surface Electromyography in Cerebral Palsy. Front Neurol 2020; 11:583296. [PMID: 33362693 PMCID: PMC7759523 DOI: 10.3389/fneur.2020.583296] [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] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/20/2020] [Indexed: 12/18/2022] Open
Abstract
Surface electromyography (sEMG) can be used to assess the integrity of the neuromuscular system and its impairment in neurological disorders. Here we will consider several issues related to the current clinical applications, difficulties and limited usage of sEMG for the assessment and rehabilitation of children with cerebral palsy. The uniqueness of this methodology is that it can determine hyperactivity or inactivity of selected muscles, which cannot be assessed by other methods. In addition, it can assist for intervention or muscle/tendon surgery acts, and it can evaluate integrated functioning of the nervous system based on multi-muscle sEMG recordings and assess motor pool activation. The latter aspect is especially important for understanding impairments of the mechanisms of neural controllers rather than malfunction of individual muscles. Although sEMG study is an important tool in both clinical research and neurorehabilitation, the results of a survey on the clinical relevance of sEMG in a typical department of pediatric rehabilitation highlighted its limited clinical usage. We believe that this is due to limited knowledge of the sEMG and its neuromuscular underpinnings by many physiotherapists, as a result of lack of emphasis on this important methodology in the courses taught in physical therapy schools. The lack of reference databases or benchmarking software for sEMG analysis may also contribute to the limited clinical usage. Despite the existence of educational and technical barriers to a widespread use of, sEMG does provide important tools for planning and assessment of rehabilitation treatments for children with cerebral palsy.
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Affiliation(s)
- Germana Cappellini
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Carla Assenza
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Laura Libernini
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Daniela Morelli
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Systems Medicine, Centre of Space Bio-medicine, University of Rome Tor Vergata, Rome, Italy
| | - Yury Ivanenko
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
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Cappellini G, Sylos-Labini F, Dewolf AH, Solopova IA, Morelli D, Lacquaniti F, Ivanenko Y. Maturation of the Locomotor Circuitry in Children With Cerebral Palsy. Front Bioeng Biotechnol 2020; 8:998. [PMID: 32974319 PMCID: PMC7462003 DOI: 10.3389/fbioe.2020.00998] [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] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/30/2020] [Indexed: 12/26/2022] Open
Abstract
The first years of life represent an important phase of maturation of the central nervous system, processing of sensory information, posture control and acquisition of the locomotor function. Cerebral palsy (CP) is the most common group of motor disorders in childhood attributed to disturbances in the fetal or infant brain, frequently resulting in impaired gait. Here we will consider various findings about functional maturation of the locomotor output in early infancy, and how much the dysfunction of gait in children with CP can be related to spinal neuronal networks vs. supraspinal dysfunction. A better knowledge about pattern generation circuitries in infancy may improve our understanding of developmental motor disorders, highlighting the necessity for regulating the functional properties of abnormally developed neuronal locomotor networks as a target for early sensorimotor rehabilitation. Various clinical approaches and advances in biotechnology are also considered that might promote acquisition of the locomotor function in infants at risk for locomotor delays.
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Affiliation(s)
- Germana Cappellini
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Arthur H Dewolf
- Centre of Space Bio-medicine and Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Irina A Solopova
- Laboratory of Neurobiology of Motor Control, Institute for Information Transmission Problems, Moscow, Russia
| | - Daniela Morelli
- Department of Pediatric Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Francesco Lacquaniti
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy.,Centre of Space Bio-medicine and Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Yury Ivanenko
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
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Zago M, Corsi C, Condoluci C, Galli M. Kinetic-based indexes for the functional evaluation of gait in diplegic children: a preliminary report. Comput Methods Biomech Biomed Engin 2019; 22:1043-1046. [PMID: 31131627 DOI: 10.1080/10255842.2019.1618454] [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: 10/26/2022]
Abstract
We evaluated the feasibility of a set of indexes based on ground reaction forces to discriminate between the degree of severity of spastic diplegia, identified via Gross Motor Function Classification System (GMFCS). A stepwise discriminant ordinal regression analysis performed on a sample of 58 children returned a subset of variables related to the ratio between braking and propulsive vertical forces and anteroposterior timings. Rather, parameters concerning bilateral symmetry were poorly discriminating. The relative simplicity of the selected indexes allows for their easy implementation on existing gait analysis applications for screening purposes.
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Affiliation(s)
- Matteo Zago
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano , Milano , Italy.,Fondazione Istituto Farmacologico Filippo Serpero , Milano , Italy
| | - Carolina Corsi
- Departamento de Fisioterapia, Federal University of São Carlos , São Carlos , Brasil
| | | | - Manuela Galli
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano , Milano , Italy
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Papageorgiou E, Nieuwenhuys A, Vandekerckhove I, Van Campenhout A, Ortibus E, Desloovere K. Systematic review on gait classifications in children with cerebral palsy: An update. Gait Posture 2019; 69:209-223. [PMID: 30851621 DOI: 10.1016/j.gaitpost.2019.01.038] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/15/2018] [Accepted: 01/28/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait classification systems (GCSs) aim to aid clinicians and researchers in categorizing the gait of pathological populations, with the intent to improve the communication between them, to support treatment planning and enable the evaluation of patients over time. Throughout the years, various GCSs have been defined for children with cerebral palsy (CP), which were first summarized in a systematic review published in 2007. RESEARCH QUESTION The current systematic review aimed to: a) identify GCSs that have been more recently developed, b) appraise their methodological quality and c) specify the most commonly used multiple joint gait patterns for children with CP reported in literature. METHODS Four databases (Medline, EMBASE, CINAHL, Web of Science) were searched until July 2017. Several forms of validity and the reliability of these studies were assessed according to the principles of the consensus-based standards for the selection of health measurement instruments checklist or criteria defined in the original review. All published GCSs were also scrutinized in order to identify multiple joint patterns that have reached a predefined level of consensus. RESULTS Thirty-six studies were considered in this review, 15 of them being GCSs that were not included in the original review. The validity, reliability and clinical applicability of all GCSs was reported, including 3 studies from the original review. Six multiple joint patterns for children with CP reached a consensus in literature. CONCLUSION Since the previous review, obvious progress has been made in the field of GCSs for CP, resulting in improved methodological quality of the majority of published GCSs. This encouraged the applicability of GCSs in clinical or research settings. The six reliable, valid and commonly used multiple joint patterns, emerging from this systematic review, may aid clinical and research applications and create a common language among healthcare providers.
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Affiliation(s)
- Eirini Papageorgiou
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), Leuven, Belgium.
| | - Angela Nieuwenhuys
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), Leuven, Belgium
| | - Ines Vandekerckhove
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), Leuven, Belgium
| | - Anja Van Campenhout
- KU Leuven, Department of Development and Regeneration, Organ Systems, Leuven, Belgium; University Hospitals Leuven, Department of Orthopedics, Leuven, Belgium
| | - Els Ortibus
- KU Leuven, Department of Development and Regeneration, Organ Systems, Leuven, Belgium
| | - Kaat Desloovere
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), Leuven, Belgium; University Hospitals Leuven, Department of Orthopedics, Clinical Motion Analysis Laboratory (CERM), Pellenberg, Belgium
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Martín Lorenzo T, Rocon E, Martínez Caballero I, Lerma Lara S. Medial gastrocnemius structure and gait kinetics in spastic cerebral palsy and typically developing children: A cross-sectional study. Medicine (Baltimore) 2018; 97:e10776. [PMID: 29794756 PMCID: PMC6392514 DOI: 10.1097/md.0000000000010776] [Citation(s) in RCA: 6] [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: 11/25/2022] Open
Abstract
To compare medial gastrocnemius muscle-tendon structure, gait propulsive forces, and ankle joint gait kinetics between typically developing children and those with spastic cerebral palsy, and to describe significant associations between structure and function in children with spastic cerebral palsy.A sample of typically developing children (n = 9 /16 limbs) and a sample of children with spastic cerebral palsy (n = 29 /43 limbs) were recruited. Ultrasound and 3-dimensional motion capture were used to assess muscle-tendon structure, and propulsive forces and ankle joint kinetics during gait, respectively.Children with spastic cerebral palsy had shorter fascicles and muscles, and longer Achilles tendons than typically developing children. Furthermore, total negative power and peak negative power at the ankle were greater, while total positive power, peak positive power, net power, total vertical ground reaction force, and peak vertical and anterior ground reaction forces were smaller compared to typically developing children. Correlation analyses revealed that smaller resting ankle joint angles and greater maximum dorsiflexion in children with spastic cerebral palsy accounted for a significant decrease in peak negative power. Furthermore, short fascicles, small fascicle to belly ratios, and large tendon to fascicle ratios accounted for a decrease in propulsive force generation.Alterations observed in the medial gastrocnemius muscle-tendon structure of children with spastic cerebral palsy may impair propulsive mechanisms during gait. Therefore, conventional treatments should be revised on the basis of muscle-tendon adaptations.
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Affiliation(s)
- Teresa Martín Lorenzo
- Laboratorio de Análisis del Movimiento, Hospital Infantil Universitario Niño Jesús
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos
| | - Eduardo Rocon
- Centro de Automática y Robótica, Consejo Superior de Investigaciones Científicas, Arganda del Rey
| | | | - Sergio Lerma Lara
- Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
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12
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Developing a Low-Cost Force Treadmill via Dynamic Modeling. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:9875471. [PMID: 29065677 PMCID: PMC5474287 DOI: 10.1155/2017/9875471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 04/02/2017] [Indexed: 12/02/2022]
Abstract
By incorporating force transducers into treadmills, force platform-instrumented treadmills (commonly called force treadmills) can collect large amounts of gait data and enable the ground reaction force (GRF) to be calculated. However, the high cost of force treadmills has limited their adoption. This paper proposes a low-cost force treadmill system with force sensors installed underneath a standard exercise treadmill. It identifies and compensates for the force transmission dynamics from the actual GRF applied on the treadmill track surface to the force transmitted to the force sensors underneath the treadmill body. This study also proposes a testing procedure to assess the GRF measurement accuracy of force treadmills. Using this procedure in estimating the GRF of “walk-on-the-spot motion,” it was found that the total harmonic distortion of the tested force treadmill system was about 1.69%, demonstrating the effectiveness of the approach.
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Hasan CZC, Jailani R, Md Tahir N, Ilias S. The analysis of three-dimensional ground reaction forces during gait in children with autism spectrum disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 66:55-63. [PMID: 28284567 DOI: 10.1016/j.ridd.2017.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 02/03/2017] [Accepted: 02/28/2017] [Indexed: 06/06/2023]
Abstract
Minimal information is known about the three-dimensional (3D) ground reaction forces (GRF) on the gait patterns of individuals with autism spectrum disorders (ASD). The purpose of this study was to investigate whether the 3D GRF components differ significantly between children with ASD and the peer controls. 15 children with ASD and 25 typically developing (TD) children had participated in the study. Two force plates were used to measure the 3D GRF data during walking. Time-series parameterization techniques were employed to extract 17 discrete features from the 3D GRF waveforms. By using independent t-test and Mann-Whitney U test, significant differences (p<0.05) between the ASD and TD groups were found for four GRF features. Children with ASD demonstrated higher maximum braking force, lower relative time to maximum braking force, and lower relative time to zero force during mid-stance. Children with ASD were also found to have reduced the second peak of vertical GRF in the terminal stance. These major findings suggest that children with ASD experience significant difficulties in supporting their body weight and endure gait instability during the stance phase. The findings of this research are useful to both clinicians and parents who wish to provide these children with appropriate treatments and rehabilitation programs.
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Affiliation(s)
- Che Zawiyah Che Hasan
- Faculty of Electrical Engineering, Universiti Teknologi MARA, 40450 Shah Alam, Selangor, Malaysia.
| | - Rozita Jailani
- Faculty of Electrical Engineering, Universiti Teknologi MARA, 40450 Shah Alam, Selangor, Malaysia.
| | - Nooritawati Md Tahir
- Faculty of Electrical Engineering, Universiti Teknologi MARA, 40450 Shah Alam, Selangor, Malaysia.
| | - Suryani Ilias
- Faculty of Electrical Engineering, Universiti Teknologi MARA, 40450 Shah Alam, Selangor, Malaysia.
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Cappellini G, Ivanenko YP, Martino G, MacLellan MJ, Sacco A, Morelli D, Lacquaniti F. Immature Spinal Locomotor Output in Children with Cerebral Palsy. Front Physiol 2016; 7:478. [PMID: 27826251 PMCID: PMC5078720 DOI: 10.3389/fphys.2016.00478] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/05/2016] [Indexed: 12/29/2022] Open
Abstract
Detailed descriptions of gait impairments have been reported in cerebral palsy (CP), but it is still unclear how maturation of the spinal motoneuron output is affected. Spatiotemporal alpha-motoneuron activation during walking can be assessed by mapping the electromyographic activity profiles from several, simultaneously recorded muscles onto the anatomical rostrocaudal location of the motoneuron pools in the spinal cord, and by means of factor analysis of the muscle activity profiles. Here, we analyzed gait kinematics and EMG activity of 11 pairs of bilateral muscles with lumbosacral innervation in 35 children with CP (19 diplegic, 16 hemiplegic, 2-12 years) and 33 typically developing (TD) children (1-12 years). TD children showed a progressive reduction of EMG burst durations and a gradual reorganization of the spatiotemporal motoneuron output with increasing age. By contrast, children with CP showed very limited age-related changes of EMG durations and motoneuron output, as well as of limb intersegmental coordination and foot trajectory control (on both sides for diplegic children and the affected side for hemiplegic children). Factorization of the EMG signals revealed a comparable structure of the motor output in children with CP and TD children, but significantly wider temporal activation patterns in children with CP, resembling the patterns of much younger TD infants. A similar picture emerged when considering the spatiotemporal maps of alpha-motoneuron activation. Overall, the results are consistent with the idea that early injuries to developing motor regions of the brain substantially affect the maturation of the spinal locomotor output and consequently the future locomotor behavior.
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Affiliation(s)
- Germana Cappellini
- Centre of Space Bio-medicine, University of Rome Tor Vergata Rome, Italy
| | - Yury P Ivanenko
- Laboratory of Neuromotor Physiology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation Rome, Italy
| | - Giovanni Martino
- Centre of Space Bio-medicine, University of Rome Tor Vergata Rome, Italy
| | | | - Annalisa Sacco
- Department of Pediatric Neurorehabilitation, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation Rome, Italy
| | - Daniela Morelli
- Department of Pediatric Neurorehabilitation, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation Rome, Italy
| | - Francesco Lacquaniti
- Centre of Space Bio-medicine, University of Rome Tor VergataRome, Italy; Laboratory of Neuromotor Physiology, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia FoundationRome, Italy; Department of Systems Medicine, University of Rome Tor VergataRome, Italy
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15
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Are flexible flat feet associated with proximal joint problems in children? Gait Posture 2016; 45:204-10. [PMID: 26979907 DOI: 10.1016/j.gaitpost.2016.02.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 12/31/2015] [Accepted: 02/07/2016] [Indexed: 02/02/2023]
Abstract
The role of flexible flat feet (FF) in the development of musculoskeletal symptoms at joints proximal to the ankle is unclear. We undertook an observational study to investigate the relationship between foot posture and the proximal joints in children. It was hypothesised that reduced arch height would be associated with proximal joint symptoms and altered gait kinematics and kinetics particularly in the transverse plane at the hip and knee. Ninety-five children between the ages of 8-15 were recruited into this ethically approved study. Foot posture was classified using the arch height index (AHI). The frequency of knee and hip/back pain was documented, and each child underwent three dimensional gait analysis. Reduced arch height was associated with increased odds of knee symptoms (p<0.01) and hip/back symptoms (p=0.01). A flat foot posture was also significantly associated with a reduction in the second peak of the vertical ground reaction force (p=0.03), which concomitantly affected late stance hip and knee moments. A reduced AHI was also associated with increased pelvic retraction and increased knee valgus in midstance. No kinematic and kinetic parameter associated with a flat foot posture related to increased proximal joint symptoms in the FF group. Children with a flatter foot posture are more likely to have pain or discomfort at the knee, hip and back; however, the mechanisms by which this occurs remain unclear. Treating FF without explicit understanding of how it relates to symptoms is difficult, and further work in this area is required.
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A Forward Dynamic Modelling Investigation of Cause-and-Effect Relationships in Single Support Phase of Human Walking. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2015; 2015:383705. [PMID: 26175797 PMCID: PMC4484567 DOI: 10.1155/2015/383705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/03/2015] [Accepted: 04/07/2015] [Indexed: 11/18/2022]
Abstract
Mathematical gait models often fall into one of two categories: simple and complex. There is a large leap in complexity between model types, meaning the effects of individual gait mechanisms get overlooked. This study investigated the cause-and-effect relationships between gait mechanisms and resulting kinematics and kinetics, using a sequence of mathematical models of increasing complexity. The focus was on sagittal plane and single support only. Starting with an inverted pendulum (IP), extended to include a HAT (head-arms-trunk) segment and an actuated hip moment, further complexities were added one-by-one. These were a knee joint, an ankle joint with a static foot, heel rise, and finally a swing leg. The presence of a knee joint and an ankle moment (during foot flat) were shown to largely influence the initial peak in the vertical GRF curve. The second peak in this curve was achieved through a combination of heel rise and the presence of a swing leg. Heel rise was also shown to reduce errors in the horizontal GRF prediction in the second half of single support. The swing leg is important for centre-of-mass (CM) deceleration in late single support. These findings provide evidence for the specific effects of each gait mechanism.
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17
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Wang X, Wang Y. Gait analysis of children with spastic hemiplegic cerebral palsy. Neural Regen Res 2015; 7:1578-84. [PMID: 25657696 PMCID: PMC4308754 DOI: 10.3969/j.issn.1673-5374.2012.20.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 04/23/2012] [Indexed: 11/18/2022] Open
Abstract
An experiment was carried out in the key laboratory for Technique Diagnosis and Function Assessment of Winter Sports of China to investigate the differences in gait characteristics between healthy children and children with spastic hemiplegic cerebral palsy. With permission of their parents, 200 healthy children aged 3 to 6 years in the kindergarten of Northeastern University were enrolled in this experiment. Twenty children aged 3 to 6 years with spastic hemiplegic cerebral palsy from Shengjing Hospital, China were also enrolled in this experiment. Standard data were collected by simultaneously recording gait information from two digital cameras. DVracker was used to analyze the standard data. The children with hemiplegic cerebral palsy had a longer gait cycle, slower walking speed, and longer support phase than did the healthy children. The support phase was longer than the swing phase in the children with hemiplegic cerebral palsy. There were significant differences in the angles of the hip, knee, and ankle joint between children with cerebral palsy and healthy children at the moment of touching the ground and buffering, and during pedal extension. Children with hemiplegic cerebral palsy had poor motor coordination during walking, which basically resulted in a short stride, high stride frequency to maintain speed, more obvious swing, and poor stability.
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Affiliation(s)
- Xin Wang
- Department of Human Sports Science, Shenyang Sport University, Shenyang 110102, Liaoning Province, China
| | - Yuexi Wang
- Recuperate Center, Shengjing Hospital of China Medical University, Shenyang 110021, Liaoning Province, China
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18
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Affiliation(s)
- Barry Meadows
- WestMARC, Southern General Hospital, Glasgow, Scotland, UK
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