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Pau M, Cerfoglio S, Capodaglio P, Marrone F, Grugni G, Porta M, Leban B, Galli M, Cimolin V. Cyclogram-based evaluation of inter-limb gait symmetry in Prader-Willi Syndrome. Gait Posture 2024; 112:167-172. [PMID: 38805861 DOI: 10.1016/j.gaitpost.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/13/2023] [Accepted: 05/23/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is characterized by a complex clinical condition, whose typical features lead to impaired motor and functional skills. To date, limited data is available as regards symmetry of gait in PWS. RESEARCH QUESTION The aim of this study was to characterize lower-limb asymmetry during gait in a group of Prader-Willi Syndrome (PWS) individuals by using the synchronized cyclograms and to compare it with those of two different control groups, a normal-weight group and an obese group. METHODS A total of 18 PWS, 30 normal weight (NW) and 28 obese individuals (OG) matched for age, sex and height were assessed via 3D gait analysis. Gait spatio-temporal parameters were computed together with angle-angle diagrams, characterized in terms of their geometric features (i.e. area, orientation, and trend symmetry index). RESULTS Individuals with PWS exhibit reduced speed, stride length and cadence and increased duration of both stance and double support phase than the other groups. OG was characterized by the same pattern when compared to NW. With respect to inter-limb symmetry, individuals with PWS exhibited significantly larger cyclogram areas at hip joint with respect to the other two groups (203.32 degrees2 vs. 130.73 degrees2 vs. 111.59 degrees2) and significantly higher orientation angle (4.17° vs. 2.11° vs. 1.22°) and Trend Symmetry (3.72 vs. 2.02 vs. 1.21) with respect to the other two groups at knee joint; no differences were found at ankle joint. Both individuals with PWS and those of OG exhibited reduced ROM at knee and ankle joints with respect with normal weight, but no statistically significant differences were observed between PWS and OG. SIGNIFICANCE The obtained results may provide novel and useful insights to understand better the impairments in motor control associated with this pathological state, supporting clinics in the identification of the best rehabilitation program for this rare pathological state, aimed to improve stability and motor control.
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Affiliation(s)
- Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari 09123, Italy
| | - Serena Cerfoglio
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano 20133, Italy; Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics, Rehabilitation and Ergonomics, San Giuseppe Hospital, IRCCS Istituto Auxologico Italiano, Strada Luigi Cadorna 90, Piancavallo 28824, Italy
| | - Paolo Capodaglio
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics, Rehabilitation and Ergonomics, San Giuseppe Hospital, IRCCS Istituto Auxologico Italiano, Strada Luigi Cadorna 90, Piancavallo 28824, Italy; Department of Surgical Sciences, Physical Medicine and Rehabilitation, University of Turin, Turin 10126 , Italy
| | - Flavia Marrone
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano 20133, Italy; Department of of Mechanical Engineering, Politecnico di Milano, via La Masa 1, Milano 20156, Italy
| | - Graziano Grugni
- Unit of Auxology, San Giuseppe Hospital, IRCCS Istituto Auxologico Italiano, Strada Luigi Cadorna 90, Piancavallo 28824, Italy
| | - Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari 09123, Italy
| | - Bruno Leban
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari 09123, Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano 20133, Italy
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano 20133, Italy; Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics, Rehabilitation and Ergonomics, San Giuseppe Hospital, IRCCS Istituto Auxologico Italiano, Strada Luigi Cadorna 90, Piancavallo 28824, Italy.
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Santos A, Silva MF, Dos Santos EH, Tassiana Silva C, Obara K, Bonilha Oda S, Carrasco AC, Cardoso JR. Gait analysis of individuals with specific low back pain undergoing surgery: case series report with one and six-month follow-up. Physiother Theory Pract 2024; 40:1635-1645. [PMID: 36892481 DOI: 10.1080/09593985.2023.2187267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/10/2023]
Abstract
INTRODUCTION In addition to pain, specific low back pain is frequently accompanied by restricted range of motion (ROM) during gait. PURPOSE To compare the behavior of kinematic and spatiotemporal gait parameters, pain, functional status, and self-efficacy, in patients with a diagnosis of herniated disk or lumbar stenosis undergoing surgery, in the pre- and postoperative periods of 1 and 6 months (PO6). METHODS Seven participants and 11 control subjects were assessed. A kinematics system comprising 10 optoelectronic cameras was used to assess gait. The Roland-Morris questionnaire, pain intensity, and self-efficacy, over three periods, were used. RESULTS The ROM of the pelvis, hip, and knee of the hernia group presented an increase after surgery and the stenosis group presented a reduction of values in the hip. During the stance phase, the pelvis and hip ROM of both groups remained smaller than the control group. There was improvement in pain in individuals with hernia and stenosis (effect size = 0.6 and 0.8, respectively) in the three analyzed moments; for functional status there was improvement in the first postoperative period (ES = 0.4) compared to the preoperative in those individuals with hernia; and those with stenosis had improvement at PO6 when compared to the time before the surgery (ES = 0.2). CONCLUSION Surgical intervention modifies the spatiotemporal parameters, the ROM of the pelvis, hip, and knee in the total gait cycle, primarily in the sagittal plane, and causes alterations, particularly in the hip joint, in these individuals during the support phase.
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Affiliation(s)
- Amanda Santos
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Mariana Felipe Silva
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Eduarda Hirle Dos Santos
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Carla Tassiana Silva
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Karen Obara
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Shigueo Bonilha Oda
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Aline Cristina Carrasco
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
- PT Department, Universidade Estadual do Centro-Oeste, Guarapuava, PR, Brazil
| | - Jefferson Rosa Cardoso
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
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Heap-Eldridge KL, Thompson BJ, Fisher C, Louder TJ, Carey J. A Comprehensive Examination of Age-Related Lower Limb Muscle Function Asymmetries across a Variety of Muscle Action Types. Geriatrics (Basel) 2024; 9:79. [PMID: 38920435 PMCID: PMC11202539 DOI: 10.3390/geriatrics9030079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
Previous research has found that lower limb muscle asymmetries increase with age and are linked to fall and injury risks. However, past studies lack a wide variety of muscle function modes and measures as well as comparison to a comparable younger age group. The purpose of this study was to examine age-related lower limb muscle function asymmetries across a variety of muscle action types and velocities in young and old adults. Lower limb balance, strength, power, and velocity were evaluated with concentric, isometric, isotonic, and eccentric muscle actions during a single-leg stance test and on single- and multi-joint dynamometers in 29 young (age = 21.45 ± 3.02) and 23 old (age = 77.00 ± 4.60) recreationally active men and women. Most (15 of 17) variables showed no statistical (p > 0.05) or functional (10% threshold) limb asymmetry for either age group. There was a significant main effect (p = 0.046; collapsed across groups) found for asymmetry (dominant > non-dominant) for the isotonic peak velocity variable. There was a significant (p = 0.010) group × limb interaction for single-joint concentric peak power produced at a slow (60 deg/s) velocity due to the non-dominant limb of the young group being 12.2% greater than the dominant limb (p < 0.001), whereas the old group was not asymmetrical (p = 0.965). The findings of this investigation indicate there is largely no age-related asymmetry of the lower limbs across a range of muscle function-related variables and modes, with a couple of notable exceptions. Also, the significant asymmetries for the isotonic peak velocity variable perhaps show the sensitivity of this uncommonly used measure in detecting minimally present muscle function imbalances.
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Affiliation(s)
- Kylee L. Heap-Eldridge
- Kinesiology and Health Science Department, Utah State University, Logan, UT 84322, USA
- Movement Research Clinic, Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
| | - Brennan J. Thompson
- Kinesiology and Health Science Department, Utah State University, Logan, UT 84322, USA
- Movement Research Clinic, Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
| | - Cody Fisher
- Kinesiology and Health Science Department, Utah State University, Logan, UT 84322, USA
- Movement Research Clinic, Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
| | - Talin J. Louder
- Kinesiology and Health Science Department, Utah State University, Logan, UT 84322, USA
- Movement Research Clinic, Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
| | - Jon Carey
- Kinesiology and Health Science Department, Utah State University, Logan, UT 84322, USA
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Zhang Z, Zou J, Lu P, Hu J, Cai Y, Xiao C, Li G, Zeng Q, Zheng M, Huang G. Analysis of lumbar spine loading during walking in patients with chronic low back pain and healthy controls: An OpenSim-Based study. Front Bioeng Biotechnol 2024; 12:1377767. [PMID: 38817923 PMCID: PMC11138492 DOI: 10.3389/fbioe.2024.1377767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Low back pain (LBP) is one of the most prevalent and disabling disease worldwide. However, the specific biomechanical changes due to LBP are still controversial. The purpose of this study was to estimate the lumbar and lower limb kinematics, lumbar moments and loads, muscle forces and activation during walking in healthy adults and LBP. A total of 18 healthy controls and 19 patients with chronic LBP were tested for walking at a comfortable speed. The kinematic and dynamic data of the subjects were collected by 3D motion capture system and force plates respectively, and then the motion simulation was performed by OpenSim. The OpenSim musculoskeletal model was used to calculate lumbar, hip, knee and ankle joint angle variations, lumbar moments and loads, muscle forces and activation of eight major lumbar muscles. In our results, significant lower lumbar axial rotation angle, lumbar flexion/extension and axial rotation moments, as well as the muscle forces of the four muscles and muscle activation of two muscles were found in patients with LBP than those of the healthy controls (p < 0.05). This study may help providing theoretical support for the evaluation and rehabilitation treatment intervention of patients with LBP.
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Affiliation(s)
- Zhuodong Zhang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Jihua Zou
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
- Department of Rehabilitation Studies, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Pengcheng Lu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jinjing Hu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Yuxin Cai
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Chongwu Xiao
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Gege Li
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Qing Zeng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Manxu Zheng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - GuoZhi Huang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
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Synchronized Cyclograms to Assess Inter-Limb Symmetry during Gait in Post-Stroke Patients. Symmetry (Basel) 2022. [DOI: 10.3390/sym14081560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The aim of this study was to assess the inter-limb symmetry during gait in post-stroke patients using the synchronized cyclograms technique. In total, 41 individuals with stroke (21 left and 20 right hemiplegic patients; age: 57.9 ± 12.8 years; time stroke event 4.6 ± 1.8 years) and 48 age-, sex-, and height-matched individuals (control group: CG; age: 54.4 ± 12.5 years) were assessed via 3D gait analysis. Raw kinematic data were processed to compute spatio-temporal parameters (speed, stride length, cadence, stance, swing, and double support phases duration) and angle–angle diagrams (synchronized cyclograms), which were characterized in terms of area, orientation, and trend symmetry indices. The results reveal that all spatio-temporal parameters are characterized by abnormal values, with reduced speed, stride length, cadence, and swing phase duration and increased stance and double support phases duration. With respect to inter-limb symmetry, higher values were found in post-stroke individuals for all the considered parameters as patients generally exhibited a cyclogram characterized by larger areas, higher orientation, and trend symmetry parameters with respect to CG. The described alterations of gait asymmetry are important from a clinical point of view as the achievement of symmetry in gait represents a crucial objective in the rehabilitation of hemiplegic people.
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Smith JA, Stabbert H, Bagwell JJ, Teng HL, Wade V, Lee SP. Do people with low back pain walk differently? A systematic review and meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:450-465. [PMID: 35151908 PMCID: PMC9338341 DOI: 10.1016/j.jshs.2022.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/04/2021] [Accepted: 12/17/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND The biomechanics of the trunk and lower limbs during walking and running gait are frequently assessed in individuals with low back pain (LBP). Despite substantial research, it is still unclear whether consistent and generalizable changes in walking or running gait occur in association with LBP. The purpose of this systematic review was to identify whether there are differences in biomechanics during walking and running gait in individuals with acute and persistent LBP compared with back-healthy controls. METHODS A search was conducted in PubMed, CINAHL, SPORTDiscus, and PsycINFO in June 2019 and was repeated in December 2020. Studies were included if they reported biomechanical characteristics of individuals with and without LBP during steady-state or perturbed walking and running. Biomechanical data included spatiotemporal, kinematic, kinetic, and electromyography variables. The reporting quality and potential for bias of each study was assessed. Data were pooled where possible to compare the standardized mean differences (SMD) between back pain and back-healthy control groups. RESULTS Ninety-seven studies were included and reviewed. Two studies investigated acute pain and the rest investigated persistent pain. Nine studies investigated running gait. Of the studies, 20% had high reporting quality/low risk of bias. In comparison with back-healthy controls, individuals with persistent LBP walked slower (SMD = -0.59, 95% confidence interval (95%CI): -0.77 to -0.42)) and with shorter stride length (SMD = -0.38, 95%CI: -0.60 to -0.16). There were no differences in the amplitude of motion in the thoracic or lumbar spine, pelvis, or hips in individuals with LBP. During walking, coordination of motion between the thorax and the lumbar spine/pelvis was significantly more in-phase in the persistent LBP groups (SMD = -0.60, 95%CI: -0.90 to -0.30), and individuals with persistent LBP exhibited greater amplitude of activation in the paraspinal muscles (SMD = 0.52, 95%CI: 0.23-0.80). There were no consistent differences in running biomechanics between groups. CONCLUSION There is moderate-to-strong evidence that individuals with persistent LBP demonstrate differences in walking gait compared to back-healthy controls.
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Affiliation(s)
- Jo Armour Smith
- Department of Physical Therapy, Chapman University, Irvine, CA 92618, USA.
| | - Heidi Stabbert
- Department of Physical Therapy, Chapman University, Irvine, CA 92618, USA
| | - Jennifer J Bagwell
- Department of Physical Therapy, California State University, Long Beach, CA 90840, USA
| | - Hsiang-Ling Teng
- Department of Physical Therapy, California State University, Long Beach, CA 90840, USA
| | - Vernie Wade
- Department of Physical Therapy, Chapman University, Irvine, CA 92618, USA
| | - Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, NV 89154, USA
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Lee D, Sung PS. Comparison of kinematic similarity index during gait between adults with and without nonspecific chronic neck pain. Gait Posture 2022; 91:99-104. [PMID: 34673448 DOI: 10.1016/j.gaitpost.2021.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with nonspecific chronic neck pain (NP) walk with a stiffer spine. However, there is a lack of understanding on kinematic similarities on the limbs during gait between individuals with and without NP. RESEARCH QUESTION Are there differences in gait parameters and the kinematic similarity index (SI) between individuals with and without NP? METHODS Eighteen individuals with NP and 17 controls participated in this study. A three-dimensional motion capture system and two force plates were utilized to measure kinematic changes of the upper and lower limbs during gait. The gait parameters included cadence, speed, stride length, and step width. The SI calculations were compared based on the response vectors from the NP group and the prototype response vectors from the control participants. The SI values at 5% intervals of the entire gait cycle were compared between groups. RESULTS Although the gait parameters were not significantly different between groups, the SI values of the control group were significantly higher than the NP group during gait (0.98 ± 0.02 vs. 0.95 ± 0.03), especially at the midstance (10-30 %) and swing (80-90 %) phases. Also, the standard deviation of the SI decreased in the control group when compared to the NP group (0.02 ± 0.01 vs. 0.04 ± 0.02). SIGNIFICANCE The SI was a useful measure to differentiate similarities between groups in the gait cycle at specific phases. These results indicated that the NP group demonstrated a greater variation of walking patterns during the midstance and swing phases and displayed altered compensatory gait. Clinicians need to consider the similarities of the kinematic changes for the NP group to aid in detection of limb motion differences and the resulting gait dysfunction.
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Affiliation(s)
| | - Paul S Sung
- Department of Physical Therapy, Indiana Wesleyan University, 4201 South Washington Street, Marion, IN 46953, USA.
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Gait Asymmetry Comparison between Subjects with and without Nonspecific Chronic Low Back Pain. Symmetry (Basel) 2021. [DOI: 10.3390/sym13112129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Individuals with chronic low back pain (LBP) report impaired somatosensory function and balance. However, there is a lack of investigation on limb motion similarities between subjects with and without LBP during gait. The aim of this study was to compare gait parameters as well as combined limb motions using the kinematic similarity index (KSI) between subjects with and without LBP. Twenty-two subjects with LBP and 19 age- and body mass index-matched control subjects participated in this study. The combined limb motions in the gait cycle of subjects with LBP were compared with those of a prototype derived from healthy subjects. The calculations resulted in response vectors that were analyzed in comparison to control-derived prototype response vectors for the normalized index at 5% increments in the gait cycle. The results of our study indicated that the KSI of the control group demonstrated higher similarities in the swing (t = 4.23, p = 0.001) and stance (t = 6.26, p = 0.001) phases compared to the LBP group. The index for the whole gait cycle was significantly different between the groups (t = 6.52, p = 0.001), especially in the midstance and swing phases. The LBP group could have adjusted the gait patterns during these specific phases. The KSI is useful for clinical outcome measures to differentiate kinematic changes and to demonstrate quantified similarities in the gait cycle between subjects with and without LBP. It is warranted to validate the KSI for the analysis of physiological gait asymmetry using a larger sample in future studies.
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Kinematic Analysis of Lower Limb Joint Asymmetry During Gait in People with Multiple Sclerosis. Symmetry (Basel) 2021. [DOI: 10.3390/sym13040598] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The majority of people with Multiple Sclerosis (pwMS), report lower limb motor dysfunctions, which may relevantly affect postural control, gait and a wide range of activities of daily living. While it is quite common to observe a different impact of the disease on the two limbs (i.e., one of them is more affected), less clear are the effects of such asymmetry on gait performance. The present retrospective cross-sectional study aimed to characterize the magnitude of interlimb asymmetry in pwMS, particularly as regards the joint kinematics, using parameters derived from angle-angle diagrams. To this end, we analyzed gait patterns of 101 pwMS (55 women, 46 men, mean age 46.3, average Expanded Disability Status Scale (EDSS) score 3.5, range 1–6.5) and 81 unaffected individuals age- and sex-matched who underwent 3D computerized gait analysis carried out using an eight-camera motion capture system. Spatio-temporal parameters and kinematics in the sagittal plane at hip, knee and ankle joints were considered for the analysis. The angular trends of left and right sides were processed to build synchronized angle–angle diagrams (cyclograms) for each joint, and symmetry was assessed by computing several geometrical features such as area, orientation and Trend Symmetry. Based on cyclogram orientation and Trend Symmetry, the results show that pwMS exhibit significantly greater asymmetry in all three joints with respect to unaffected individuals. In particular, orientation values were as follows: 5.1 of pwMS vs. 1.6 of unaffected individuals at hip joint, 7.0 vs. 1.5 at knee and 6.4 vs. 3.0 at ankle (p < 0.001 in all cases), while for Trend Symmetry we obtained at hip 1.7 of pwMS vs. 0.3 of unaffected individuals, 4.2 vs. 0.5 at knee and 8.5 vs. 1.5 at ankle (p < 0.001 in all cases). Moreover, the same parameters were sensitive enough to discriminate individuals of different disability levels. With few exceptions, all the calculated symmetry parameters were found significantly correlated with the main spatio-temporal parameters of gait and the EDSS score. In particular, large correlations were detected between Trend Symmetry and gait speed (with rho values in the range of −0.58 to −0.63 depending on the considered joint, p < 0.001) and between Trend Symmetry and EDSS score (rho = 0.62 to 0.69, p < 0.001). Such results suggest not only that MS is associated with significantly marked interlimb asymmetry during gait but also that such asymmetry worsens as the disease progresses and that it has a relevant impact on gait performances.
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The reaction times and symmetry indices in the bilateral trunk and limb muscles in control subjects and subjects with low back pain that persisted two months or longer. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2975-2982. [PMID: 33713175 DOI: 10.1007/s00586-021-06797-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/29/2021] [Accepted: 02/24/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE This study was conducted to investigate the reaction times and symmetry index (SI) of the bilateral trunk and limb muscles between control subjects and subjects with low back pain (LBP) that persisted for two months or longer. METHODS Fifty-seven right limb dominant subjects (31 healthy control subjects and 26 subjects with LBP) participated in this study. The subjects were exposed to a slip perturbation (0.24 m/sec velocity for 1.20 cm), which caused them to move forward for 0.10 s in standing while holding a tray. The electromyography (EMG) electrodes were placed on the bilateral erector spinae (ES), rectus abdominis (RA), rectus femoris, hamstring, tibialis anterior, gastrocnemius, biceps brachii (BB), and triceps brachii muscles. The reaction times were analyzed, and the SI was used to compare the bilateral trunk and limb muscles for the degree of asymmetry between groups. RESULTS The ES reaction time was significantly delayed in the control group (0.33 ± 0.22 vs. 0.22 ± 0.17; t = 2.25, p = 0.03). The SI of reaction times was significantly different on the RA (t = -2.28, p = 0.03), ES (t = -2.36, p = 0.04), and BB (t = -2.15, p = 0.04) muscles between groups. CONCLUSION The delayed non-dominant ES reaction time might indicate a freedom of pain recurrence in the control group. Although the asymmetry increased on the RA and BB muscles in the LBP group, it decreased on the ES muscle. The asymmetries on the trunk and BB muscles were evident in the LBP group. The asymmetrical reactions in the arm-trunk muscles need to be considered for rehabilitation strategies.
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Sung PS, Schalk B, Camp R, Park MS. Gender difference of hip-ankle compensations following a novel trip perturbation in young adults. Clin Biomech (Bristol, Avon) 2020; 80:105194. [PMID: 33086186 DOI: 10.1016/j.clinbiomech.2020.105194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/18/2020] [Accepted: 10/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Women have an increased likelihood of sustaining a fall-related injury compared to men; however, little is known about fall prevention strategies between genders. The purpose of this study was to compare the gender differences in lower limb reactions and three-dimensional recovery patterns following a treadmill-induced trip perturbation. METHODS Seventy-six participants who are right limb dominant enrolled in the study, which included 41 females (26.15 [9.92] years old) and 35 males (27.11 [9.15] years old). The outcome measures included a three-dimensional (3D) range of motion (ROM) analysis on the bilateral hip, knee, and ankle joints following the trip perturbation at a 0.89 m/s velocity for 0.12 m. This induced trip caused subjects to walk forward for a 0.26 s duration. FINDINGS The female group demonstrated significantly increased frontal plane ROM in the right hip (t = 2.71, p = 0.01) and left ankle (t = 2.16, p = 0.03) as well as increased sagittal plane ROM in the right (t = 2.07, p = 0.04) and left (t = 2.36, p = 0.02) ankles. There was a significant gender interaction on 3D body region (F = 6.84, p = 0.01) following the perturbation. INTERPRETATION There was a 3D gender difference on the lower limbs for balance control. The female group demonstrated increased sagittal motion in both ankles following a trip perturbation. In addition, their ROM increased on the dominant hip and non-dominant ankle in the frontal plane, which was compensated by step width for standing stability. Clinicians might want to consider the implications of gender differences on lower limb reaction patterns to help patients avoid potential injuries/falls.
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Affiliation(s)
- Paul S Sung
- Department of Physical Therapy/Motion Analysis Center, Central Michigan University, Mount Pleasant, MI 48858, USA.
| | - Bradly Schalk
- Department of Physical Therapy/Motion Analysis Center, Central Michigan University, Mount Pleasant, MI 48858, USA
| | - Ryan Camp
- Department of Physical Therapy/Motion Analysis Center, Central Michigan University, Mount Pleasant, MI 48858, USA
| | - Moon Soo Park
- Department of Physical Therapy/Motion Analysis Center, Central Michigan University, Mount Pleasant, MI 48858, USA
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Wang W, Wei H, Shi R, Lin L, Zhang L, Yue S, Zhao Q, Jia X, Li K, Zhang Y. Dysfunctional muscle activities and co-contraction in the lower-limb of lumbar disc herniation patients during walking. Sci Rep 2020; 10:20432. [PMID: 33235289 PMCID: PMC7686363 DOI: 10.1038/s41598-020-77150-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/06/2020] [Indexed: 11/19/2022] Open
Abstract
This study aimed to investigate lower-limb muscle activities in gait phases and co-contraction of one gait cycle in patients with lumbar disc herniation (LDH). This study enrolled 17 LDH patients and 17 sex- and age-matched healthy individuals. Bilateral muscle activities of the rectus femoris (RF), biceps femoris long head (BL), tibialis anterior (TA), and lateral gastrocnemius (LG) during walking were recorded. The gait cycle was divided into four phases by the heel strike and top off according to the kinematics tracks. Root mean square (RMS), mean frequency (MF), and co-contraction of surface electromyography signals were calculated. The LDH patients showed enhanced BL RMS during the single support phase (SS), second double support phase, and swing phase (SW) as well as decreased MF of RF during SS and of TA and LG during SW (p < 0.05). The co-contraction of the TA-LG was increased in LDH patients than in the control group (p < 0.05). Positive correlations were observed between TA-LG co-contraction (affected side, r = 0.557, p = 0.020; contralateral side, r = 0.627, p = 0.007) and the Oswestry disability index scores in LDH patients. LDH patients have increased BL firing rate and insufficient motor unit recruitment in specific phases in the lower limbs during walking. Dysfunction in LDH patients was associated with immoderate intermuscular co-contraction of the TA-LG during walking.
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Affiliation(s)
- Wei Wang
- Department of Physical Medicine and Rehabilitation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Hui Wei
- Department of Physical Medicine and Rehabilitation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Runxiu Shi
- Department of Physical Medicine and Rehabilitation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Leitong Lin
- Laboratory of Motor Control and Rehabilitation, Institute of Biomedical Engineering, School of Control Science and Engineering, Shandong University, 17923 Jingshi Aveue, Jinan, 250061, Shandong, China
| | - Lechi Zhang
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Shouwei Yue
- Department of Physical Medicine and Rehabilitation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Qin Zhao
- Department of Physical Medicine and Rehabilitation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China
| | - Xiaofeng Jia
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Department of Orthopedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Ke Li
- Laboratory of Motor Control and Rehabilitation, Institute of Biomedical Engineering, School of Control Science and Engineering, Shandong University, 17923 Jingshi Aveue, Jinan, 250061, Shandong, China.
| | - Yang Zhang
- Department of Physical Medicine and Rehabilitation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, China.
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Sung PS, Cavataio M, Sauve J. Adaptive trunk sway velocities following repeated perturbations in subjects with and without low back pain. J Electromyogr Kinesiol 2020; 52:102423. [PMID: 32416446 DOI: 10.1016/j.jelekin.2020.102423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022] Open
Abstract
Faster trunk motions could be a strategy to prevent loss of balance and fall injuries due to unexpected perturbations. However, it is unclear how trunk sway velocities can be compensated during stepping in subjects with low back pain (LBP). The purpose of this study was to investigate lower limb reaction, swing, and step times, as well as trunk sway velocities at heel strike and toe-off, following repeated step perturbations between subjects with and without LBP. There were 30 subjects with LBP and 42 control subjects who were exposed to treadmill-induced perturbations at a velocity of 0.12 m/sec for 0.62 m. The treadmill-induced steps caused subjects to walk forward for 4.90 sec after the perturbation. The groups demonstrated significant interactions on the lower limb reaction times and on the number of repeated perturbations (F = 4.83, p = 0.03) due to a decreased step time at the first perturbation (t = 2.52, p = 0.01) in the LBP group. For the trunk sway velocities, the repeated perturbations demonstrated a significant interaction between groups (F = 4.65, p = 0.03). This adaptive trunk strategy for gait stability increased step times with repeated perturbations in the LBP group. The group interactions on the trunk sway velocities also indicated a possible somatosensory integration for step time adjustments to avoid potential fall hazards. This adaptive response with repeated step perturbations could result in compensatory trunk sway for gait stability.
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Affiliation(s)
- Paul S Sung
- Department of Physical Therapy/Motion Analysis Center, Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Health Professions Building, 1220 Mt. Pleasant, MI 48859, United States.
| | - Michael Cavataio
- Department of Physical Therapy/Motion Analysis Center, Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Health Professions Building, 1220 Mt. Pleasant, MI 48859, United States
| | - Jake Sauve
- Department of Health Sciences, Central Michigan University, United States
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Lower limb kinematics in individuals with chronic low back pain during walking. J Electromyogr Kinesiol 2020; 51:102404. [DOI: 10.1016/j.jelekin.2020.102404] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/08/2019] [Accepted: 02/12/2020] [Indexed: 11/20/2022] Open
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Zhang W, Smuck M, Legault C, Ith MA, Muaremi A, Aminian K. Gait Symmetry Assessment with a Low Back 3D Accelerometer in Post-Stroke Patients. SENSORS (BASEL, SWITZERLAND) 2018; 18:E3322. [PMID: 30282947 PMCID: PMC6209891 DOI: 10.3390/s18103322] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/15/2018] [Accepted: 09/29/2018] [Indexed: 11/17/2022]
Abstract
Gait asymmetry is an important marker of mobility impairment post stroke. This study proposes a new gait symmetry index (GSI) to quantify gait symmetry with one 3D accelerometer at L3 (GSIL3). GSIL3 was evaluated with 16 post stroke patients and nine healthy controls in the Six-Minute-Walk-Test (6-MWT). Discriminative power was evaluated with Wilcoxon test and the effect size (ES) was computed with Cliff's Delta. GSIL3 estimated during the entire 6-MWT and during a short segment straight walk (GSIL3straight) have comparable effect size to one another (ES = 0.89, p < 0.001) and to the symmetry indices derived from feet sensors (|ES| = [0.22, 0.89]). Furthermore, while none of the indices derived from feet sensors showed significant differences between post stroke patients walking with a cane compared to those able to walk without, GSIL3 was able to discriminate between these two groups with a significantly lower value in the group using a cane (ES = 0.70, p = 0.02). In addition, GSIL3 was strongly associated with several symmetry indices measured by feet sensors during the straight walking cycles (Spearman correlation: |ρ| = [0.82, 0.88], p < 0.05). The proposed index can be a reliable and cost-efficient post stroke gait symmetry assessment with implications for research and clinical practice.
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Affiliation(s)
- Wei Zhang
- Laboratory of Movement Analysis and Measurement Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland.
| | - Matthew Smuck
- Wearable Health Lab, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA 94063, USA.
- Division of Physical Medicine & Rehabilitation, Stanford University, Palo Alto, CA 94304, USA.
| | - Catherine Legault
- Stanford Stroke Center, Stanford University, Palo Alto, CA 94304, USA.
| | - Ma A Ith
- Wearable Health Lab, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA 94063, USA.
- Division of Physical Medicine & Rehabilitation, Stanford University, Palo Alto, CA 94304, USA.
| | - Amir Muaremi
- Novartis Institutes for BioMedical Research, 4056 Basel, Switzerland.
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland.
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Sung PS. Increased double limb support times during walking in right limb dominant healthy older adults with low bone density. Gait Posture 2018; 63:145-149. [PMID: 29730490 DOI: 10.1016/j.gaitpost.2018.04.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 03/06/2018] [Accepted: 04/24/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Older adults with low bone mineral density (BMD) may exhibit early markers for physical frailty; however, there is a lack of understanding of the dominant limb support patterns during walking. RESEARCH QUESTION The purpose of this study was to investigate limb support times during walking in healthy older adults with low BMD. METHODS Seventy-seven right limb dominant older adults (48 female subjects, 29 male subjects) participated in the study. Each participant's BMD (g/cm2) was measured by dual-energy x-ray absorptiometry (DEXA), and a motion capture system was utilized to measure temporal-spatial gait parameters (cadence, speed, stride length, and limb support times). The limb support times included initial double limb support (IDS), single limb support (SS), and terminal double limb support (TDS) in the stance phase. RESULTS Those limb support times were significantly different (F = 44.28, p = 0.001) and demonstrated an interaction with dominance (F = 9.44, p = 0.003). In stance phase, the IDS was longer on the non-dominant limb (t = -3.07, p = 0.003); however, the TDS was significantly longer on the dominant limb (t = 3.07, p = 0.003). The stride length was longer on the dominant limb (t = 2.45, p = 0.02) and was positively associated with single limb support on the dominant limb (r = 0.34 p = 0.001) compared with the non-dominant limb (r = -0.29, p = 0.001). SIGNIFICANCE This longer stride length and single limb loading pattern on the dominant limb could increase asymmetrical balance in the stance phase. The gait modification strategies used to increase stride length on the non-dominant limb may allow for more functional symmetrical gait. Further investigation of asymmetric limb support patterns and gait modification strategies might be needed to enhance functional gait performance.
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Affiliation(s)
- Paul S Sung
- Department of Physical Therapy, Motion Analysis Center, Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Health Professions Building 1220, Mt. Pleasant, MI, 48859, United States.
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