Validity of the Pedar Mobile system for vertical force measurement during a seven-hour period

Testing protocols and measurement techniques when using pressure sensors for sport and health applications: A comparative review

Plantar pressure measurement systems are routinely used in sports and health applications to assess locomotion. The purpose of this review is to describe and critically discuss: (a) applications of the pressure measurement systems in sport and healthcare, (b) testing protocols and considerations for clinical gait analysis, (c) clinical recommendations for interpreting plantar pressure data, (d) calibration procedures and their accuracy, and (e) the future of pressure sensor data analysis. Rigid pressure platforms are typically used to measure plantar pressures for the assessment of foot function during standing and walking, particularly when barefoot, and are the most accurate for measuring plantar pressures. For reliable data, two step protocol prior to contacting the pressure plate is recommended. In-shoe systems are most suitable for measuring plantar pressures in the field during daily living or dynamic sporting movements as they are often wireless and can measure multiple steps. They are the most suitable equipment to assess the effects of footwear and orthotics on plantar pressures. However, they typically have lower spatial resolution and sampling frequency than platform systems. Users of pressure measurement systems need to consider the suitability of the calibration procedures for their chosen application when selecting and using a pressure measurement system. For some applications, a bespoke calibration procedure is required to improve validity and reliability of the pressure measurement system. The testing machines that are commonly used for dynamic calibration of pressure measurement systems frequently have loading rates of less than even those found in walking, so the development of testing protocols that truly measure the loading rates found in many sporting movements are required. There is clear potential for AI techniques to assist in the analysis and interpretation of plantar pressure data to enable the more complete use of pressure system data in clinical diagnoses and monitoring.

The Use of Embedded IMU Insoles to Assess Gait Parameters: A Validation and Test-Retest Reliability Study

Wireless wearable insoles are interesting tools to collect gait parameters during daily life activities. However, studies have to be performed specifically for each type of insoles on a big data set to validate the measurement in ecological situations. This study aims to assess the criterion validity and test-retest reliability of gait parameters from wearable insoles compared to motion capture system. Gait of 30 healthy participants was recorded using DSPro® insoles and a motion capture system during overground and treadmill walking at three different speeds. Criterion validity and test-retest reliability of spatio-temporal parameters were estimated with an intraclass correlation coefficient (ICC). For both systems, reliability was found higher than 0.70 for all variables (p < 0.001) except for minimum toe clearance (ICC < 0.50) with motion capture system during overground walking. Regardless of speed and condition of walking, Speed, Cadence, Stride Length, Stride Time and Stance Time variables were validated (ICC > 0.90; p < 0.001). During walking on treadmill, loading time was not validated during slow speed (ICC < 0.70). This study highlights good criterion validity and test-retest reliability of spatiotemporal gait parameters measurement using wearable insoles and opens a new possibility to improve care management of patients using clinical gait analysis in daily life activities.

Wireless pressure insoles for measuring ground reaction forces and trajectories of the centre of pressure during functional activities

Wireless pressure insoles may enable the assessment of movement biomechanics in a real-world setting, and thus play an important role in the recommendation of clinical management, but they are not yet a gold standard due to the unknown accuracy and reliability with respect to different functional activities. Here, we compare novel wireless pressure insoles with force plates and examine the test-retest reliability of the insoles for measuring vertical ground reaction forces (vGRFs) and trajectories of the center of pressure (COP). In this observational study, healthy adults underwent two data collection sessions during one day. The Bland-Altman analysis was used to compare the outcomes measured with the two instruments during squats, jumps, and the sit-to-stand test. Test-retest reliability was assessed by the interclass correlation coefficient and the standard error of measurement for the outcomes during squats, jumps, walking, and stair ambulation. Trajectories of the COP in the anterior-posterior direction were comparable between the two systems during all activities. The insoles consistently measured shorter trajectories of the COP in the medial-lateral direction (except jumps) and lower vGRFs than the force plates. Test-retest reliability of the insoles was fair to high or excellent for all outcomes during all activities. In conclusion, the insoles provide reliable measures of vGRFs and trajectories of the COP during multiple functional activities in healthy adults. Although the insoles do not produce identical results to the force plate, the qualitative similarity and consistency between the two systems confirm the insoles can be used to measure these outcomes, based on the purpose and accuracy required.

Commercially available pressure sensors for sport and health applications: A comparative review

Pressure measurement systems have numerous applications in healthcare and sport. The purpose of this review is to: (a) describe the brief history of the development of pressure sensors for clinical and sport applications, (b) discuss the design requirements for pressure measurement systems for different applications, (c) critique the suitability, reliability, and validity of commercial pressure measurement systems, and (d) suggest future directions for the development of pressure measurements systems in this area. Commercial pressure measurement systems generally use capacitive or resistive sensors, and typically capacitive sensors have been reported to be more valid and reliable than resistive sensors for prolonged use. It is important to acknowledge, however, that the selection of sensors is contingent upon the specific application requirements. Recent improvements in sensor and wireless technology and computational power have resulted in systems that have higher sensor density and sampling frequency with improved usability - thinner, lighter platforms, some of which are wireless, and reduced the obtrusiveness of in-shoe systems due to wireless data transmission and smaller data-logger and control units. Future developments of pressure sensors should focus on the design of systems that can measure or accurately predict shear stresses in conjunction with pressure, as it is thought the combination of both contributes to the development of pressure ulcers and diabetic plantar ulcers. The focus for the development of in-shoe pressure measurement systems is to minimise any potential interference to the patient or athlete, and to reduce power consumption of the wireless systems to improve the battery life, so these systems can be used to monitor daily activity. A potential solution to reduce the obtrusiveness of in-shoe systems include thin flexible pressure sensors which can be incorporated into socks. Although some experimental systems are available further work is needed to improve their validity and reliability.

Concurrent Validity and Test-Retest Reliability of Pressure-Detecting Insoles for Static and Dynamic Movements in Healthy Young Adults

Compared to force-plates, pressure-detecting insoles have the advantage that vertical ground reaction force (vGRF) can be estimated under field rather than laboratory conditions. However, the question arises whether insoles also provide valid and reliable results compared to a force-plate (i.e., the gold standard). The study aimed to investigate the concurrent validity and test-retest reliability of pressure-detecting insoles during static and dynamic movements. Twenty-two healthy young adults (12 females) performed standing, walking, running, and jumping movements while simultaneously collecting pressure (GP MobilData WiFi, GeBioM mbH, Münster, Germany) and force (Kistler^®) data twice, 10 days apart. Concerning validity, ICC values showed excellent agreement (ICC > 0.75), irrespective of the test condition. Further, the insoles underestimated (mean bias: -4.41 to -37.15%) most of the vGRF variables. Concerning reliability, ICC values for nearly all test conditions also showed excellent agreement, and the SEM was rather low. Lastly, most of the MDC_95% values were low (≤5%). The predominantly excellent ICC values for between-devices (i.e., concurrent validity) and between-visits (i.e., test-retest reliability) comparisons suggest that the tested pressure-detecting insoles can be used under field-based conditions for a valid and reliable estimation of relevant vGRF variables during standing, walking, running, and jumping.

Evaluation of Different Pressure-Based Foot Contact Event Detection Algorithms across Different Slopes and Speeds

If validated, in-shoe pressure measuring technology allows for the field-based quantification of running gait, including kinematic and kinetic measures. Different algorithmic methods have been proposed to determine foot contact events from in-shoe pressure insole systems, however, these methods have not been evaluated for accuracy, reliability against a gold standard using running data across different slopes, and speeds. Using data from a plantar pressure measurement system, seven different foot contact event detection algorithms based on pressure signals (pressure sum) were compared to vertical ground reaction force data collected from a force instrumented treadmill. Subjects ran on level ground at 2.6, 3.0, 3.4, and 3.8 m/s, six degrees (10.5%) inclined at 2.6, 2.8, and 3.0 m/s, and six degrees declined at 2.6, 2.8, 3.0, and 3.4 m/s. The best performing foot contact event detection algorithm showed maximal mean absolute errors of only 1.0 ms and 5.2 ms for foot contact and foot off, respectively, on level grade, when compared to a 40 N ascending and descending force threshold from the force treadmill data. Additionally, this algorithm was unaffected by grade and had similar levels of errors across all grades.

Test-Retest Reliability of PODOSmart® Gait Analysis Insoles

It is recognized that gait analysis is a powerful tool used to capture human locomotion and quantify the related parameters. PODOSmart^® insoles have been designed to provide accurate measurements for gait analysis. PODOSmart^® insoles are lightweight, slim and cost-effective. A recent publication presented the characteristics and data concerning the validity of PODOSmart^® insoles in gait analysis. In literature, there is still no evidence about the repeatability of PODOSmart^® gait analysis system. Such evidence is essential in order to use this device in both research and clinical settings. The aim of the present study was to assess the repeatability of PODOSmart^® system. In this context, it was hypothesized that the parameters of gait analysis captured by PODOSmart^® would be repeatable. In a sample consisting of 22 healthy male adults, participants performed two walking trials on a six-meter walkway. The ICC values for 28 gait variables provided by PODOSmart^® indicated good to excellent test-retest reliability, ranging from 0.802 to 0.997. The present findings confirm that PODOSmart^® gait analysis insoles present excellent repeatability in gait analysis parameters. These results offer additional evidence regarding the reliability of this gait analysis tool.

A principal component analysis (PCA) based assessment of the gait performance

The gait assessment is instrumental for evaluating the efficiency of rehabilitation of persons with a motor impairment of the lower extremities. The protocol for quantifying the gait performance needs to be simple and easy to implement; therefore, a wearable system and user-friendly computer program are preferable. We used the Gait Master (instrumented insoles) with the industrial quality ground reaction forces (GRF) sensors and 6D inertial measurement units (IMU). WiFi transmitted 10 signals from the GRF sensors and 12 signals from the accelerometers and gyroscopes to the host computer. The clinician was following in real-time the acquired data to be assured that the WiFi operated correctly. We developed a method that uses principal component analysis (PCA) to provide a clinician with easy to interpret cyclograms showing the difference between the recorded and healthy-like gait performance. The cyclograms formed by the first two principal components in the PCA space show the step-to-step reproducibility. We suggest that a cyclogram and its orientation to the coordinate system PC1 vs. PC2 allow a simple assessment of the gait. We show results for six healthy persons and five patients with hemiplegia.

Inertial measurement units and application for remote healthcare in hip and knee osteoarthritis: a narrative review (Preprint)

Background

Measuring and modifying movement-related joint loading is integral to the management of lower extremity osteoarthritis (OA). Although traditional approaches rely on measurements made within the laboratory or clinical environments, inertial sensors provide an opportunity to quantify these outcomes in patients’ natural environments, providing greater ecological validity and opportunities to develop large data sets of movement data for the development of OA interventions.

Objective

This narrative review aimed to discuss and summarize recent developments in the use of inertial sensors for assessing movement during daily activities in individuals with hip and knee OA and to identify how this may translate to improved remote health care for this population.

Methods

A literature search was performed in November 2018 and repeated in July 2019 and March 2021 using the PubMed and Embase databases for publications on inertial sensors in hip and knee OA published in English within the previous 5 years. The search terms encompassed both OA and wearable sensors. Duplicate studies, systematic reviews, conference abstracts, and study protocols were also excluded. One reviewer screened the search result titles by removing irrelevant studies, and 2 reviewers screened study abstracts to identify studies using inertial sensors as the main sensing technology and a primary outcome related to movement quality. In addition, after the March 2021 search, 2 reviewers rescreened all previously included studies to confirm their relevance to this review.

Results

From the search process, 43 studies were determined to be relevant and subsequently included in this review. Inertial sensors have been successfully implemented for assessing the presence and severity of OA (n=11), assessing disease progression risk and providing feedback for gait retraining (n=7), and remotely monitoring intervention outcomes and identifying potential responders and nonresponders to interventions (n=14). In addition, studies have validated the use of inertial sensors for these applications (n=8) and analyzed the optimal sensor placement combinations and data input analysis for measuring different metrics of interest (n=3). These studies show promise for remote health care monitoring and intervention delivery in hip and knee OA, but many studies have focused on walking rather than a range of activities of daily living and have been performed in small samples (<100 participants) and in a laboratory rather than in a real-world environment.

Conclusions

Inertial sensors show promise for remote monitoring, risk assessment, and intervention delivery in individuals with hip and knee OA. Future opportunities remain to validate these sensors in real-world settings across a range of activities of daily living and to optimize sensor placement and data analysis approaches.

A Novel Tool for Gait Analysis: Validation Study of the Smart Insole PODOSmart®

The new smart insole PODOSmart^®, is introduced as a new tool for gait analysis against high cost laboratory based equipment. PODOSmart^® system measures walking profile and gait variables in real life conditions. PODOSmart^® insoles consists of wireless sensors, can be fitted into any shoe and offer the ability to measure spatial, temporal, and kinematic gait parameters. The intelligent insoles feature several sensors that detect and capture foot movements and a microprocessor that calculates gait related biomechanical data. Gait analysis results are presented in PODOSmart^® platform. This study aims to present the characteristics of this tool and to validate it comparing with a stereophotogrammetry-based system. Validation was performed by gait analysis for eleven healthy individuals on a six-meters walkway using both PODOSmart^® and Vicon system. Intraclass correlation coefficients (ICC) were calculated for gait parameters. ICC for the validation ranged from 0.313 to 0.990 in gait parameters. The highest ICC was observed in cadence, circumduction, walking speed, stride length and stride duration. PODOSmart^® is a valid tool for gait analysis compared to the gold standard Vicon. As PODOSmart^®, is a portable gait analysis tool with an affordable cost it can be a useful novel tool for gait analysis in healthy and pathological population.

Wearable and telemedicine innovations for Olympic events and elite sport

Rapid advances in wearable technologies and real-time monitoring have resulted in major inroads in the world of recreational and elite sport. One such innovation is the application of real-time monitoring, which comprises a smartwatch application and ecosystem, designed to collect, process and transmit a wide range of physiological, biomechanical, bioenergetic and environmental data using cloud-based services. We plan to assess the impact of this wireless technology during Tokyo 2020, where this technology could help characterize the physiological and thermal strain experienced by an athlete, as well as determine future management of athletes during a medical emergency as a result of a more timely and accurate diagnosis. Here we describe some of the innovative technologies developed for numerous sports at Tokyo 2020 ranging from race walking (20 km and 50 km events), marathon, triathlon, road cycling (including the time trial event), mountain biking, to potentially team sports played outdoors. A more symbiotic relationship between sport, health and technology needs to be encouraged that harnesses the unique demands of elite sport (e.g., the need for unobtrusive devices that provide real-time feedback) and serves as medical and preventive support for the athlete's care. The implementation of such applications would be particularly welcome in the field of medicine (i.e., telemedicine applications) and the workplace (with particular relevance to emergency services, the military and generally workers under extreme environmental conditions). Laboratory and field-based studies are required in simulated scenarios to validate such emerging technologies, with the field of sport serving as an excellent model to understand and impact disease.

Validation of Plantar Pressure and Reaction Force Measured by Moticon Pressure Sensor Insoles on a Concept2 Rowing Ergometer

The purpose of this study was to determine the reliability and validity of plantar pressure and reaction force measured using the Moticon and Pedar-x sensor insoles while rowing on a Concept2 ergometer. Nineteen participants performed four 500 m trials of ergometer rowing at 22-24 strokes/min; two trials wearing Moticon insoles and two wearing Pedar-x insoles in a randomised order. Moticon and Pedar-x insoles both showed moderate to strong test-retest reliability (ICC = 0.57-0.92) for mean and peak plantar pressure and reaction force. Paired t-test demonstrated a significant difference (p < 0.001) between Moticon and Pedar-x insoles, effect size showed a large bias (ES > 1.13), and Pearson's correlation (r < 0.37) showed poor agreement for all plantar pressure and reaction force variables. Compared to Pedar-x, the Moticon insoles demonstrated poor validity, however, the Moticon insoles had strong reliability. Due to poor validity, caution should be used when considering Moticon insoles to assess changes in pressure and force reliably over time, across multiple trials or sessions. Moticon's wireless and user-friendly application would be beneficial for assessing and monitoring biomechanical parameters in rowing if validity between measures of interest and Moticon's results can be established.

A wearable motion capture device able to detect dynamic motion of human limbs

Limb motion capture is essential in human motion-recognition, motor-function assessment and dexterous human-robot interaction for assistive robots. Due to highly dynamic nature of limb activities, conventional inertial methods of limb motion capture suffer from serious drift and instability problems. Here, a motion capture method with integral-free velocity detection is proposed and a wearable device is developed by incorporating micro tri-axis flow sensors with micro tri-axis inertial sensors. The device allows accurate measurement of three-dimensional motion velocity, acceleration, and attitude angle of human limbs in daily activities, strenuous, and prolonged exercises. Additionally, we verify an intra-limb coordination relationship exists between thigh and shank in human walking and running, and establish a neural network model for it. Using the intra-limb coordination model, dynamic motion capture of human lower limbs including thigh and shank is tactfully implemented by a single shank-worn device, which simplifies the capture device and reduces cost. Experiments in strenuous activities and long-time running validate excellent performance and robustness of the wearable device in dynamic motion recognition and reconstruction of human limbs.

Current wearable motion capture technologies are unable to accurately detect dynamic motion of human limbs due to drift and instability problems. Here, the authors report a wearable motion capture device combining tri-axis velocity sensor and inertial sensors for accurate 3D limb motion capture.

Bio-Numerical Analysis of the Human Ankle-Foot Model Corresponding to Neutral Standing Condition

Background:

The foot is the most complex body’s structure; it is highly susceptible to disorders because of its loading pattern. The complexity of the foot structure geometry implies the use of reverse engineering tools to obtain a model that can accurately mimic the biomechanical behavior of the foot.

Objective:

The objective of this study is to establish a state-of-the-art ankle-foot finite element (FE) model with anatomically realistic geometry and structure in order to get the model that will suit all cases for future studies on stress injuries and foot insole designs under different loading conditions.

Material and Methods:

In this analytical study, tomography images were imported in DICOM format, after that, the object was exported in the form of three-dimensional structures in STL file format to define and assemble the structures. After that, the computer simulation on numerical model was done. One-way Analysis of variance (ANOVA) test was performed, and a threshold (p&lt;0.05) was used to indicate the significance of results.

Results:

The results showed no significant differences (P>0.05) between the values of the plantar pressure corresponding to neutral standing condition with other foot models in literature. The stresses transferred to the bone structure show that the relatively higher stress was located in the fifth, fourth and third tarsometatarsal, where the maximum von Mises stress in the bone structure was 2155.4 kPa.

Conclusion:

The state-of-the-art ankle-foot FE model with anatomically realistic geometry and structure will be very helpful for future studies on stress injuries and foot insole designs under different loading conditions.

Running after cycling induces inter-limb differences in muscle activation but not in kinetics or kinematics

Overuse injuries are a common problem to triathletes' population. Overuse injuries may arise from inter-limb biomechanical differences during running, but the literature lacks information regarding inter-limb differences in triathletes. In this study inter-limb differences were investigated in injury-free triathletes during the running portion of a simulated cycle-run transition. Thirteen triathletes performed a 5 km run preceded by a 20 min cycling trial at 70% of maximal power output. During the Start, Mid and End stages of running, kinetic, kinematic and muscle activation variables were compared between the preferred and non-preferred limbs across the stance phase. A statistical parametric mapping analysis showed no differences between limbs when considering kinetic and kinematic variables (p > 0.05, ES<0.60). A lower soleus activation was observed in the preferred limb (p < 0.05, ES>0.60) from 53.40-75.9% of the stance phase at the End stage of running. In conclusion, inter-limb differences in kinetic or kinematic variables may not represent a risk for overloading in triathletes. However, inter-limb differences in triceps surae activation during running after cycling may represent one potential factor leading to overuse injuries in triathletes and should be further investigated.

Effect of trunk control training on plantar pressure in patients with lumbar disc herniation

Background/aims

Chronic spinal disc disease leads to disorders in postural movement coordination. An incorrect asymmetrical movement pattern for lower limb loading impairs proprioception and deteriorates postural stability. The aim of this study was to investigate the effect of trunk control training on the redistribution of plantar pressure to reduce the risk of posture sway while standing in patients with sciatica resulting from a herniated lumbar disc.

Methods

This study included 30 male and female patients with sciatica resulting from lumbar disc herniation, their ages ranged from 45–60 years. The patients were randomly assigned to two equal groups. The study group received posture stability training by using the Biodex Balance System in addition to a selected physical therapy programme. The control group received the selected physical therapy programme only.

Results:

The results revealed that in the study group, there was a significant increase of plantar pressure at the right and the left centre of heel, while there was a significant decrease of plantar pressure at the right and the left forefoot post treatment. In the control group, there was no significant difference in plantar pressure at the right and the left centre of the heel and forefoot post treatment.

Conclusions:

Trunk control training, in addition to the selected physical therapy programme, was more effective than only using the selected physical therapy programme to redistribute foot plantar pressure, which can reduce posture sway for patients with sciatica resulting from a herniated lumbar disc.

PI-Sole: A Low-Cost Solution for Gait Monitoring Using Off-The-Shelf Piezoelectric Sensors and IMU

In this paper, viability of low-cost off-the-shelf Piezoelectric ceramic disc elements is explored for an insole-based gait monitoring system, `PI-Sole' (Piezo In-Sole). Piezoelectric elements can sense dynamic changes in pressure in a closed-loop environment with good sensitivity and a wide measurement range. In this paper, method to enable these elements to continuously sense plantar pressure while walking is proposed, making them a very cost-efficient alternative to the widely used Force Sensing Resistors (FSR) and pressure plates for monitoring human gait. However, piezoelectric elements show hysteresis in their force response, inducing a drift in calculated pressure which increases with time. A novel and effective method to perform detrending of the signal is also presented utilizing stride contexts from a 6-DoF Inertial Measurement Unit (IMU) and the same is utilized to perform zero-correction in the pressure data. 3-D trajectories of strides are calculated using the IMU, and parameters like stride length, stride height etc. are further derived. In order to test the validity of our proposed methods, important kinetic parameters like Vertical Ground Reaction Force (VGRF) and Center of Pressure (CoP) are calculated using PI-Sole and compared to the ones calculated using FSR's in multiple prior works. Applicability of PI-Sole is demonstrated further by depicting and analysing characteristic differences between a heel-strike toe-off stance type, and a flat-strike stance type, the latter being one of the primary symptoms in many cases of pathological gait, including Parkinsonian gait. Important artefacts from foot's height profile while walking are analysed for both stance types in context of standard gait events. We report a mean error of 2.8cm in stride length calculation, and a mean accuracy of 94.5% in calculating swing/stance duration of gait cycles.

Are wearable insoles a validated tool for quantifying transfemoral amputee gait asymmetry?

BACKGROUND

Amputee gait is known to be asymmetrical, especially during loading of the lower limb. Monitoring asymmetry could be useful in quantifying patient performance during rehabilitation. Wearable insoles can provide normal ground reaction force asymmetry in real-life conditions.

OBJECTIVES

To characterize the validity of Loadsol^® insoles versus force plates in quantifying normal ground reaction force and gait asymmetry. To determine the influence walking speed has on loading asymmetry in transfemoral amputees.

STUDY DESIGN

This is a prospective study.

METHODS

Six transfemoral amputees, wearing Loadsol^® insoles, walked at three self-selected speeds on force plates. Validity was assessed by comparing normal ground reaction force data from the insoles and force plates. The Absolute Symmetry Index was used to calculate gait loading asymmetry at each speed.

RESULTS

Normalized root mean square errors for the normal ground reaction forces were 6.6% (standard deviation = 2.3%) and 8.9% (standard deviation = 3.8%); correlation coefficients were 0.91 and 0.95 for the prosthetic and intact limb, respectively. The mean error for Absolute Symmetry Index parameters ranged from -2.67% to 4.35%. Loading asymmetry increased with walking speed.

CONCLUSION

This study quantified the validity of Loadsol^® insoles in assessing loading asymmetry during gait in transfemoral amputees. The calibration protocol could be improved to better integrate it into a clinical setting. However, our results support the relevance of using such insoles during the clinical follow-up of transfemoral amputees.

CLINICAL RELEVANCE

This is the first study to validate Loadsol^® insoles versus force plates and report on loading asymmetry during gait at three different speeds in transfemoral amputees. Loadsol^® insoles, which provide visual and audio feedback, are clinically easy to use and could have beneficial application in the amputee's rehabilitation and follow-up.

Estimation of Vertical Ground Reaction Force Using Low-Cost Insole With Force Plate-Free Learning From Single Leg Stance and Walking

For the evaluation of pathological gait, a machine learning-based estimation of the vertical ground reaction force (vGRF) using a low-cost insole is proposed as an alternative to costly force plates. However, learning a model for estimation still relies on the use of force plates, which is not accessible in small clinics and individuals. Therefore, this paper presents a force plate-free learning from a single leg stance (SLS) and natural walking measured only by the insoles. This method used a linear least squares regression that fits insole measurements during SLS to body weight in order to learn a model to estimate vGRF during walking. Constraints were added to the regression so that vGRF estimates during walking were of proper magnitude, and the constraint bounds were newly defined as a linear function of stance duration. Moreover, a lower bound for the estimated vGRF in mid-stance was added to the constraints to enhance estimation accuracy. The vGRF estimated by the proposed method was compared with force platforms for 4 healthy young adults and 13 elderly adults including patients with mild osteoarthritis, knee pain, and valgus hallux. Through the experiments, the proposed learning method had a normalized root mean squared error under 10% for healthy young and elderly adults with stance durations within a certain range (600-800 ms). From these results, the validity of the proposed learning method was verified for various users requiring assessment in the field of medicine and healthcare.

Development of a Bendable Outsole Biaxial Ground Reaction Force Measurement System

Wearable ground reaction force (GRF) measurement systems make it possible to measure the GRF in any environment, unlike a commercial force plate. When performing kinetic analysis with the GRF, measurement of multiaxial GRF is important for evaluating forward and lateral motion during natural gait. In this paper, we propose a bendable GRF measurement system that can measure biaxial (vertical and anterior-posterior) GRF without interrupting the natural gait. Eight custom small biaxial force sensors based on an optical sensing mechanism were installed in the proposed system. The interference between two axes on the custom sensor was minimized by the independent application of a cantilever structure for the two axes, and the hysteresis and repeatability of the custom sensor were investigated. After developing the system by the installation of force sensors, we found that the degree of flexibility of the developed system was comparable to that of regular shoes by investigating the forefoot bending stiffness. Finally, we compared vertical GRF (vGRF) and anterior-posterior GRF (apGRF) measured from the developed system and force plate at the same time when the six subjects walked, ran, and jumped on the force plate to evaluate the performance of the GRF measurement system.

Insole-Based Estimation of Vertical Ground Reaction Force Using One-Step Learning With Probabilistic Regression and Data Augmentation

An insole-based estimation of the vertical ground reaction force (vGRF) is proposed as an alternative to costly force plates for the evaluation of pathological gait. However, machine learning techniques for estimation still rely on the use of force plates. Moreover, measuring plural walking steps in order to prevent overfitting induces fall risks and physically taxes the patients. Therefore, this paper presents an accessible and efficient learning scheme for the insole-based estimation of vGRF. In this system, we employ a low-cost scale as an alternative to force plates. Then, we use Gaussian process regression (GPR) to learn a model in order to estimate vGRF without overfitting of small-sized data sets corrupted by measurement errors and noise of the devices. In addition, we propose a "one-step learning" scheme based on a probabilistic data augmentation. This approach augments actual measurements of a minimum (just one) walking step to a virtual data set for plural steps by considering their typical variability between steps. In experiments, the GPR models learned from two walking steps estimated vGRF with mean errors of 8% or under for entire/local magnitudes. Moreover, the learning from one step with probabilistic augmentation enhanced the estimation accuracy.

Comparison of posturographic outcomes between two different devices

The Interactive Balance System (IBS), a posturography device for assessing posture control, is widely used in clinical and rehabilitation settings. However, data on the validity of the device are unavailable. Fluctuations of the center of pressure (COP) were measured in 24 healthy participants (age: 29 ± 5 (mean ± SD) years, 12 females) synchronously using the IBS, which was rigidly mounted on a Kistler platform. Four different bipedal conditions were examined: eyes open or closed on stable or soft surfaces. Time series were compared using congruity (CON, proportion of the measurement time during which values of both devices changed similarly in direction), whereas IBS-specific postural outcomes were correlated with traditional postural control outcomes of the Kistler force platform. The time-displacement curves showed similar shapes for CON (>0.9) for each of the four standing conditions without differences between male and female participants (P > 0.39). The path length results of both devices showed very high linear associations, explaining on average 92% (medio-lateral) or 96% (anterior-posterior) of the common variance. The Kistler path length of the anterior-posterior direction revealed nearly perfect linear associations with the stability index of the IBS (r² > 0.99). The results of this study indicate that the IBS provides valid posturographic results. Since the medial-lateral and anterior-posterior trajectories of the IBS can be used to calculate COP fluctuations, comparisons between different measurement systems are possible.

Wearable Movement Sensors for Rehabilitation: A Focused Review of Technological and Clinical Advances

Recent technologic advancements have enabled the creation of portable, low-cost, and unobtrusive sensors with tremendous potential to alter the clinical practice of rehabilitation. The application of wearable sensors to track movement has emerged as a promising paradigm to enhance the care provided to patients with neurologic or musculoskeletal conditions. These sensors enable quantification of motor behavior across disparate patient populations and emerging research shows their potential for identifying motor biomarkers, differentiating between restitution and compensation motor recovery mechanisms, remote monitoring, telerehabilitation, and robotics. Moreover, the big data recorded across these applications serve as a pathway to personalized and precision medicine. This article presents state-of-the-art and next-generation wearable movement sensors, ranging from inertial measurement units to soft sensors. An overview of clinical applications is presented across a wide spectrum of conditions that have potential to benefit from wearable sensors, including stroke, movement disorders, knee osteoarthritis, and running injuries. Complementary applications enabled by next-generation sensors that will enable point-of-care monitoring of neural activity and muscle dynamics during movement also are discussed.

Reliability and validity of the Zebris FDM-THQ instrumented treadmill during running trials

Little is known about the reliability, validity and smallest detectable differences of selected kinetic and temporal variables recorded by the Zebris FDM-THQ instrumented treadmill especially during running. Twenty male participants (age = 31.9 years (±5.6), height = 1.81 m (±0.08), mass = 80.2 kg (±9.5), body mass index = 24.53 kg/m² (±2.53)) walked (5 km/h) and ran (10 and 15 km/h) on an instrumented treadmill, wearing running shoes fitted with Pedar-X insoles. A test-double retest protocol was conducted over two consecutive days. Maximal vertical force (F_max), contact time (CT) and flight time (FT) data from 10 consecutive steps were collected. Within- and between-day reliability, smallest detectable differences (SDD) and validity (95% limits of agreement (LOA)) were calculated. ICC values for the Zebris for Fmax were acceptable (ICC ≥ 0.7) while CT and FT reliability indices were predominantly good (ICC ≥ 0.8) to excellent (ICC ≥ 0.9). The Zebris significantly underestimated Fmax when compared with the Pedar-X. The 95% LOA increased with speed. SDD ranged between 96 N and 169 N for Fmax, 0.017s and 0.055s for CT and 0.021s and 0.026s for FT. In conclusion, Zebris reliability was acceptable to excellent for the variables examined, but inferior in comparison with Pedar-X. With increased running speeds, a bias effect (underestimation) existed for the Zebris compared with Pedar-X.

Discrete sensors distribution for accurate plantar pressure analyses

The aim of this study was to determine the distribution of discrete sensors under the footprint for accurate plantar pressure analyses. For this purpose, two different sensor layouts have been tested and compared, to determine which was the most accurate to monitor plantar pressure with wireless devices in research and/or clinical practice. Ten healthy volunteers participated in the study (age range: 23-58 years). The barycenter of pressures (BoP) determined from the plantar pressure system (W-inshoe®) was compared to the center of pressures (CoP) determined from a force platform (AMTI) in the medial-lateral (ML) and anterior-posterior (AP) directions. Then, the vertical ground reaction force (vGRF) obtained from both W-inshoe® and force platform was compared for both layouts for each subject. The BoP and vGRF determined from the plantar pressure system data showed good correlation (SCC) with those determined from the force platform data, notably for the second sensor organization (ML SCC= 0.95; AP SCC=0.99; vGRF SCC=0.91). The study demonstrates that an adjusted placement of removable sensors is key to accurate plantar pressure analyses. These results are promising for a plantar pressure recording outside clinical or laboratory settings, for long time monitoring, real time feedback or for whatever activity requiring a low-cost system.

Validation of Moticon's OpenGo sensor insoles during gait, jumps, balance and cross-country skiing specific imitation movements

The purpose of this study was the experimental validation of the OpenGo sensor insole system compared to PedarX sensor insole and AMTI force-plate systems. Sixteen healthy participants performed trials in walking, running, jumping (drop and counter movement jumps), imitation drills and balance, with simultaneous measures of all three systems. Detected ground contact and flight times with OpenGo during walking, running and jumping were similar to those of AMTI. Force–time curves revealed comparable shapes between all three systems. Force impulses were 13–34% lower with OpenGo when compared to AMTI. Despite differences in mean values in some exercise modes, correlations towards AMTI were between r = 0.8 and r = 1.0 in most situations. During fast motions, with high force and impact, OpenGo provided lower force and latency in force kinetics. During balance tasks, discrepancy in the centre of pressure was found medio-lateral, while anterio–posterior direction was closer to AMTI. With awareness of these limitations, OpenGo can be applied in both clinical and research settings to evaluate temporal, force and balance parameters during different types of motion. The fully mobile OpenGo system allows for the easy and quick system application, analysis and feedback under complex field conditions, as well.

Estimation of ground reaction forces and ankle moment with multiple, low-cost sensors

Background

Wearable sensor systems can provide data for at-home gait analyses and input to controllers for rehabilitation devices but they often have reduced estimation accuracy compared to laboratory systems. The goal of this study is to evaluate a portable, low-cost system for measuring ground reaction forces and ankle joint torques in treadmill walking and calf raises.

Methods

To estimate the ground reaction forces and ankle joint torques, we developed a custom instrumented insole and a tissue force sensor. Six healthy subjects completed a collection of movements (calf raises, 1.0 m/s walking, and 1.5 m/s walking) on two separate days. We trained artificial neural networks on the study data and compared the estimates to a multi-camera motion system and an instrumented treadmill. We evaluated the relative strength of each sensor by testing each sensor’s ability to predict the ankle joint torque calculated from a reference inverse kinematics algorithm. We assessed model accuracy through root mean squared error and normalized root mean square error. We hypothesized that the estimation of the models would have normalized root mean square error measures less than 10 %.

Results

For walking at 1.0 and walking at 1.5 m/s, the single-task, intra-day and multi-task, intra-day predictions had normalized root mean square error less than 10 % for all three force components and both center of pressure components. For the calf raise task, the single-task, intra-day and multi-task, intra-day predictions had normalized root mean square error less than 10 % for only the anterior-posterior center of pressure. The multi-task, intra-day model had similar predictions to the single-task, intra-day model. The normalized root mean square error of predictions from the insole sensor alone were less than 10 % for walking at 1.0 m/s and 1.5 m/s. No sensor was sufficient for the calf raise task. The combination of the insole sensor and the tendon sensor had lower normalized root mean square error than the individual sensors for all three tasks.

Conclusions

The proposed sensor system provided accurate estimates for five of the six components of the ground reaction kinetics during walking at 1.0 and 1.5 m/s and one of the six components during the calf raise task. The normalized root mean square error of the predictions of the ground reaction forces were similar to published studies using commercial devices. The proposed system of low-cost sensors can provide useful estimations of ankle joint torque for both walking and calf raises for future studies in mobile gait analysis.

Variability and repeatability analysis of plantar pressure during gait in older people

INTRODUCTION

Repeatability and variability of the plantar pressure during walking are important components in the clinical assessment of the elderly. However, there is a lack of information on the uniformity of plantar pressure patterns in the elderly.

OBJECTIVE

To analyze the repeatability and variability in plantar pressure considering mean, peak and asymmetries during aged gait.

METHODS

Plantar pressure was monitored in four different days for ten elderly subjects (5 female), with mean±standard-deviation age of 73±6 years, walking barefoot at preferred speed. Data were compared between steps for each day and between different days.

RESULTS

Mean and peak plantar pressure values were similar between the different days of evaluation. Asymmetry indexes were similar between the different days evaluated.

CONCLUSION

Plantar pressure presented a consistent pattern in the elderly. However, the asymmetry indexes observed suggest that the elderly are exposed to repetitive asymmetric loading during locomotion. Such result requires further investigation, especially concerning the role of these asymmetries for development of articular injuries.

A Portable Gait Asymmetry Rehabilitation System for Individuals with Stroke Using a Vibrotactile Feedback

Gait asymmetry caused by hemiparesis results in reduced gait efficiency and reduced activity levels. In this paper, a portable rehabilitation device is proposed that can serve as a tool in diagnosing gait abnormalities in individuals with stroke and has the capability of providing vibration feedback to help compensate for the asymmetric gait. Force-sensitive resistor (FSR) based insoles are used to detect ground contact and estimate stance time. A controller (Arduino) provides different vibration feedback based on the gait phase measurement. It also allows wireless interaction with a personal computer (PC) workstation using the XBee transceiver module, featuring data logging capabilities for subsequent analysis. Walking trials conducted with healthy young subjects allowed us to observe that the system can influence abnormality in the gait. The results of trials showed that a vibration cue based on temporal information was more effective than intensity information. With clinical experiments conducted for individuals with stroke, significant improvement in gait symmetry was observed with minimal disturbance caused to the balance and gait speed as an effect of the biofeedback. Future studies of the long-term rehabilitation effects of the proposed system and further improvements to the system will result in an inexpensive, easy-to-use, and effective rehabilitation device.

Effects of contralateral versus ipsilateral cane use on gait in people with knee osteoarthritis

OBJECTIVE

To compare the immediate effects of contralateral versus ipsilateral cane use on spatiotemporal gait parameters and peak vertical ground force in overweight or obese adults with symptomatic knee osteoarthritis (OA).

DESIGN

Prospective observational study.

SETTING

An academic tertiary Veterans Affairs Healthcare Center.

PARTICIPANTS

Thirty-eight overweight or obese subjects with symptomatic knee OA who had not used a cane for the past 30 days.

METHODS

Spatiotemporal gait data were obtained with an optical motion capture system while subjects walked without a cane, with a cane contralateral to the more painful lower limb, or with a cane ipsilateral to the more painful lower limb at self-selected speeds. An in-shoe dynamic pressure distribution system was used to measure the vertical ground reaction force.

MAIN OUTCOME MEASUREMENTS

Spatiotemporal measures of gait and peak vertical ground reaction force on both lower limbs were recorded for each walking condition: no cane, contralateral cane, and ipsilateral cane.

RESULTS

Walking with a cane either contralateral or ipsilateral to the more symptomatic limb led to significant reductions in gait velocity (14%-16%), cadence (12%-14%), and peak vertical ground reaction force (normalized for body weight; 11%-12%) on the more painful lower limb compared with walking unaided (P < .05). There were no significant differences in the peak vertical ground reaction force on either lower limbs when comparing walking with a cane contralateral to the more painful limb or walking with a cane ipsilateral to the more painful limb. Subjects also experienced a significant decrease in gait velocity with contralateral or ipsilateral cane use compared with walking without a cane; the lower walking speed was due to a decrease in cadence.

CONCLUSIONS

These results support the prescription of a single-point cane to offload a lower limb with painful knee OA by holding the cane either ipsilateral or contralateral to the more painful lower limb.

Increased medial foot loading during drop jump in subjects with patellofemoral pain

PURPOSE

To compare medial-to-lateral plantar forces during drop jump and single leg squat in individuals with and without patellofemoral pain.

METHODS

This cross-sectional study compared 23 young adults with patellofemoral pain to 20 age- and sex-matched controls without knee pain. The plantar pressure distribution was collected during drop jump and single leg squat using pressure-sensitive Pedar insoles, inserted into a standard flat shoe. The primary outcome was the medial-to-lateral force, quantified as the peak force under the medial forefoot as the percentage of force under the total forefoot during drop jump. Secondary outcomes included peak medial-to-lateral force during single leg squat and mean forces during drop jump and single leg squat.

RESULTS

The primary outcome showed that individuals with patellofemoral pain had a 22% higher medial-to-lateral peak force during drop jump, (p=0.03). Secondary outcomes showed 32% higher medial-to-lateral peak force during single leg squat (p=0.01) and 19-23% higher medial-to-lateral mean force during drop jump and single leg squat (p=0.02-0.04).

CONCLUSION

These findings indicate that individuals with patellofemoral pain display a more medially oriented loading pattern of the forefoot compared to individuals without knee pain. This loading pattern may be associated with the distribution of forces acting on the patellofemoral joint and suggest treatment of PFP should consider interventions that target normalisation of foot loading.

LEVEL OF EVIDENCE

III.

Test-retest reliability of an insole plantar pressure system to assess gait along linear and curved trajectories

BACKGROUND

Previous studies have assessed reliability of insole technology for evaluating foot pressure distribution during linear walking. Since in natural motion straight walking is intermingled with turns, we determined the test-retest reliability of insole assessment for curved as well as linear trajectories, and estimated the minimum number of steps required to obtain excellent reliability for each output variable.

METHODS

Sixteen young healthy participants were recruited. Each performed, two days apart, two sessions of three walking conditions: linear (LIN) and curved, clockwise (CW) and counter-clockwise (CCW). The Pedar-X system was used to collect pressure distribution. Foot print was analyzed both as a whole and as subdivided into eight regions: medial and lateral heel, medial and lateral arch, I metatarsal head, II-V metatarsal heads, hallux, lateral toes. Reliability was assessed by using intraclass correlation coefficient (ICC) for clinically relevant variables from analysis of 50 steps per trajectory: Peak Force (PF); Peak Pressure (PP); Contact Area (CA); Stance Duration (S).

RESULTS

When considering whole-foot, all variables showed an ICC >0.80, therefore highly reliable. This was true for both LIN and curved trajectories. There was no difference in ICC of the four variables between left and right foot. When collapsing foot and trajectories, S had a lower ICC than PP and CA, and PP lower than CA. Mean percent error between the values of first and second session was <5%. When separately considering the eight foot regions, ICCs of PF, PP and CA for all regions and trajectories were generally >0.90, indicating excellent reliability. In curved trajectories, S showed smaller ICCs. Since the least ICC value for S was 0.60 in LIN trajectory, we estimated that to achieve an ICC ≥0.90 more than 200 steps should be collected.

CONCLUSIONS

High reliability of insole dynamic variables (PF, PP, CA) is obtained with 50 steps using the Pedar-X system. On the contrary, high reliability of temporal variable (S) requires a larger step number. The negligible differences in ICC between LIN and curved trajectory allow use of this device for gait assessment along mixed trajectories in both clinical and research setting.

OPTIMAL ESTIMATION OF TOTAL PLANTAR FORCE FOR MONITORING GAIT IN DAILY LIFE ACTIVITIES WITH LOW-PRICE INSOLE SYSTEM

This study presented optimal estimation of total plantar force with a suitable sensor layout and a reliable equation for monitoring gait in daily life activities. The plantar pressure of 10 subjects during level walking was measured by Pedar® insoles at 100 Hz for establishing models and selecting the optimal one. Four types of virtual sensors with different sizes were designed. Stepwise linear regressions were performed to reconstruct total plantar force based on each particular type of virtual sensor. 14 models were established, which met the requirements of the explained variance of the regression model and the multicollinearity of the predictors. Estimated total plantar force from each model was compared with the real data from the Pedar® insoles. According to the correlation coefficient (R) and the root mean square error divided by the peak force (RMSE/PF), the optimal model had three sensors located under the heel and metatarsal. Another four subjects were used for validating the optimal model by performing level walking, running, vertical jump-landing, stair ascending and descending. For these five common activities, the correlation was high (R > 0.970) and the error was low (RMSE/PF < 10%). Therefore, this model can accurately estimate total plantar force in daily life activities.

Accuracy and repeatability of the gait analysis by the WalkinSense system

WalkinSense is a new device designed to monitor walking. The aim of this study was to measure the accuracy and repeatability of the gait analysis performed by the WalkinSense system. Descriptions of values recorded by WalkinSense depicting typical gait in adults are also presented. A bench experiment using the Trublu calibration device was conducted to statically test the WalkinSense. Following this, a dynamic test was carried out overlapping the WalkinSense and the Pedar insoles in 40 healthy participants during walking. Pressure peak, pressure peak time, pressure-time integral, and mean pressure at eight-foot regions were calculated. In the bench experiments, the repeatability (i) among the WalkinSense sensors (within), (ii) between two WalkinSense devices, and (iii) between the WalkinSense and the Trublu devices was excellent. In the dynamic tests, the repeatability of the WalkinSense (i) between stances in the same trial (within-trial) and (ii) between trials was also excellent (ICC > 0.90). When the eight-foot regions were analyzed separately, the within-trial and between-trials repeatability was good-to-excellent in 88% (ICC > 0.80) of the data and fair in 11%. In short, the data suggest that the WalkinSense has good-to-excellent levels of accuracy and repeatability for plantar pressure variables.

Reliability and repeatability of the portable EPS-platform digital pressure-plate system

BACKGROUND

Abnormal plantar pressures are the hallmark characteristic of several conditions and pathologic abnormalities. Pressure platforms allow for quick and accurate screening of patients and help guide clinical treatment. However, it is essential to evaluate the reliability and repeatability of these devices before making clinical decisions. The purpose of this study was to determine the reliability of the EPS-Platform during static and dynamic activities.

METHODS

Fifty-six healthy individuals stood and walked onto the pressure platform. Five trials were performed during two separate testing sessions to determine intrasession and intersession reliability. Pressure data were obtained and several variables of interest were calculated for intrasession and intersession reliability using intraclass correlation coefficients (ICCs), SEM, percent error, and coefficient of variation.

RESULTS

Static and dynamic intrasession and intersession reliability produced moderate-to-excellent ICCs, low SEMs, low percent errors, and low coefficients of variation. Static trials had higher ICCs, lower percent errors, and lower coefficients of variation compared with dynamic trials. Intersession reliability also had higher ICCs, lower percent errors, and lower coefficients of variation compared with intrasession reliability.

CONCLUSIONS

This study demonstrates that the EPS-Platform is a reliable device for collecting gait plantar pressures. Static trials produce better reliability, most likely owing to the large inherent variability during dynamic gait. Intersession reliability was higher than intrasession reliability owing to the intersession measures being calculated with an average of five trials. By averaging the trials, the variability of gait is decreased, and this improves the accuracy of the results. These results can be used as the basis for future studies and to determine a priori sample sizes for investigations that use the EPS-Platform.

A wireless flexible sensorized insole for gait analysis

This paper introduces the design and development of a novel pressure-sensitive foot insole for real-time monitoring of plantar pressure distribution during walking. The device consists of a flexible insole with 64 pressure-sensitive elements and an integrated electronic board for high-frequency data acquisition, pre-filtering, and wireless transmission to a remote data computing/storing unit. The pressure-sensitive technology is based on an optoelectronic technology developed at Scuola Superiore Sant'Anna. The insole is a low-cost and low-power battery-powered device. The design and development of the device is presented along with its experimental characterization and validation with healthy subjects performing a task of walking at different speeds, and benchmarked against an instrumented force platform.

Validation of plantar pressure measurements for a novel in-shoe plantar sensory replacement unit

BACKGROUND

Research concerning prevention of diabetic foot complications is critical. A novel in-shoe plantar sensory replacement unit (PSRU) has been developed that provides alert-based feedback derived from analyzing plantar pressure threshold measurements in real time. The purpose of this study was to compare the PSRU device to a gold standard pressure-sensing device (GS-PSD) to determine the correlation between concurrent measures of plantar pressure during walking.

METHODS

The PSRU had an array of eight sensors with a range of 10-75 mm Hg and collected data at 4 Hz, whereas the GS-PSD had 99 sensors with a range of 1-112 mm Hg and collected data at 100 Hz. Based on an a priori power analysis, data were collected from 10 participants (3 female, 7 male) while walking over ground in both devices. The primary variable of interest was the number of data points recorded that were greater than 32 mm Hg (capillary arterial pressure--the minimum pressure reported to cause pressure ulcers) for each of the eight PSRU sensors and corresponding average recordings from the GS-PSD sensor clusters. Intraclass correlation coefficient (2,1) was used to compare data between the two devices.

RESULTS

Compared with the GS-PSD, we found good-to-very-good correlations (r-value range 0.67-0.86; p-value range 0.01-0.05) for six of the PSRU's eight sensors and poor correlation for only two sensors (r = 0.41, p = .15; r = 0.38, p = .18) when measuring the number of data points recorded that were greater than 32 mm Hg.

CONCLUSIONS

Based on the results of the present study, we conclude the PSRU provides analogous data when compared with a GS-PSD.

Correlation of psychomotor findings and the ability to partially weight bear

Background

Partial weight bearing is thought to avoid excessive loading that may interfere with the healing process after surgery of the pelvis or the lower extremity. The object of this study was to investigate the relationship between the ability to partially weight bear and the patient's psychomotor skills and an additional evaluation of the possibility to predict this ability with a standardized psychomotor test.

Methods

50 patients with a prescribed partial weight bearing at a target load of 15 kg following surgery were verbally instructed by a physical therapist. After the instruction and sufficient training with the physical therapist vertical ground reaction forces using matrix insoles were measured while walking with forearm crutches. Additionally, psychomotor skills were tested with the Motorische Leistungsserie (MLS). To test for correlations Spearman's Rank correlation was used. For further comparison of the two groups a Mann-Withney test was performed using Bonferroni correction.

Results

The patient's age and body weight significantly correlated with the ability to partially weight bear at a 15 kg target load. There were significant correlations between several subtests of the MLS and ground reaction forces measured while walking with crutches. Patients that were able to correctly perform partial weight bearing showed significant better psychomotor skills especially for those subtests where both hands had to be coordinated simultaneously.

Conclusions

The ability to partially weight bear is associated with psychomotor skills. The MLS seems to be a tool that helps predicting the ability to keep within the prescribed load limits.

In-shoe plantar pressure measurements for patients with knee osteoarthritis: Reliability and effects of lateral heel wedges

Although plantar pressure measurement systems are being used increasingly during gait analyses to investigate foot orthotics, there is limited information describing test-retest reliability of such measurements. Objectives of this study were to (1) examine the test-retest reliability of lateral heel pressure (LHP) and centre of pressure (COP) during walking with and without lateral heel wedges, and (2) evaluate the effects of 4° and 8° lateral heel wedges on the magnitude of LHP, the pathway of the COP and the peak external knee adduction moment (KAM) in subjects with and without knee osteoarthritis (OA). Twenty-six subjects, 12 patients with knee OA and 14 healthy subjects, were evaluated during three lateral heel wedge conditions (control, 4° and 8°) with standardized footwear. Three-dimensional analyses of gait with optical motion capture, floor-mounted force plate and in-shoe plantar pressure were completed on two occasions. Intraclass correlation coefficients (ICC(2, 1)) for LHP were excellent (0.79-0.83) while ICCs for COP in the medial-lateral and anterior-posterior directions were more variable (0.66-0.86). Reliability was slightly diminished when using heel wedges. Standard errors of measurement suggested considerable day-to-day variability in an individual's measures. Lateral heel wedges significantly (p<0.001) increased LHP, shifted COP anteriorly and laterally, and decreased the KAM. No significant differences were observed between subjects with and without OA. Although the day-to-day variability appears too large to confidently evaluate changes in individual patients, and decreases in reliability with increases in wedge size indicate caution, these results suggest in-shoe measurement of LHP and COP are appropriate for use in studies evaluating biomechanical effects of foot orthoses for knee OA.

Outcome evaluation of ankle osteoarthritis treatments: plantar pressure analysis during relatively long-distance walking

BACKGROUND

This study aimed to use plantar pressure analysis in relatively long-distance walking for objective outcome evaluation of ankle osteoarthritis treatments, i.e., ankle arthrodesis and total ankle replacement.

METHODS

Forty-seven subjects in four groups: three patient groups and controls, participated in the study. Each subject walked twice in 50-m trials. Plantar pressure under the pathological foot was measured using pressure insoles. Six parameters: initial contact time, terminal contact time, maximum force time, peak pressure time, maximum force and peak pressure were calculated and averaged over trials in ten regions of foot. The parameters in each region were compared between patient groups and controls and their effect size was estimated. Besides, the correlations between pressure parameters and clinical scales were calculated.

FINDINGS

We observed based on temporal parameters that patients postpone the heel-off event, when high force in forefoot and high ankle moment happens. Also based on maximum force and peak pressure, the patients apply smoothened maximum forces on the affected foot. In ten regions, some parameters showed improvements after total ankle replacement, some showed alteration of foot function after ankle arthrodesis and some others showed still abnormality after both surgical treatments. These parameters showed also significant correlation with clinical scales in at least two regions of foot.

INTERPRETATION

Plantar pressure parameters in relatively long-distance trials showed to be strong tools for outcome evaluation of ankle osteoarthritis treatments.

Unilateral vs. bilateral total hip arthroplasty - the influence of medial femoral head offset and effects on strength and aerobic endurance capacity

The purpose of the present study was to determine whether unilaterally operated total hip arthroplasty (THA) patients were superior to bilaterally operated THA patients with respect to aerobic endurance capacity, muscle strength and gait patterns 3-5 years after surgery, and to what extent medial femoral head offset (FO) influenced hip abductor strength. 10 unilaterally operated THA patients with normal FO (UNO), 10 bilaterally operated THA patients with normal FO (BNO) and 10 bilaterally operated THA patients with abnormal offset (BDO) participated in the study. Improved muscle strength in the healthy leg of the UNO did not result in differences compared to the BNO and the BDO in work efficiency, gait patterns or maximal oxygen consumption (VO2max ) A reduced FO in the BDO did not result in lower hip abduction strength compared to the BNO. However, a correlation between reduced FO and low abduction strength was found in the BDO (r=0.866, p=0.001). Future focus should be on the quality of rehabilitation.