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Stark NEP, Streamer J, Queen R. Patients with unilateral ankle arthritis have decreased discrete and time-series limb symmetry compared to healthy controls. J Orthop Res 2023; 41:1953-1964. [PMID: 36866826 PMCID: PMC10440243 DOI: 10.1002/jor.25541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/01/2023] [Indexed: 03/04/2023]
Abstract
Patients with ankle arthritis (AA) have side-to-side limb differences at the ankle and in spatiotemporal measures; however, the degree of symmetry between limbs has not been compared to a healthy population. The purpose of this study was to determine differences in limb symmetry during walking for discrete and time-series measures when comparing patients with unilateral AA to healthy participants. Thirty-seven AA and 37 healthy participants were age, gender, and body mass index matched. Three-dimensional gait mechanics and ground reaction force (GRF) were captured during four to seven walking trails. GRF and hip and ankle mechanics were extracted bilaterally for each trial. The Normalized Symmetry Index and Statistical Parameter Mapping were used to assess discrete and time-series symmetry, respectively. Discrete symmetry was analyzed using linear mixed-effect models to determine significant differences between groups (α = 0.05). Compared to healthy participants, patients with AA had decreased weight acceptance (p = 0.017) and propulsive (p < 0.001) GRF, ankle plantarflexion (p = 0.021), ankle dorsiflexion (p = 0.010), and ankle plantarflexion moment (p < 0.001) symmetry. Significant regions of difference were found between limbs and groups throughout the stance phase for the vertical GRF force (p < 0.001), the ankle angle during push-off (p = 0.047), the plantarflexion moment (p < 0.001), and the hip extension angle (p = 0.034) and moment (p = 0.010). Patients with AA have decreased symmetry in the vertical GRF and at the ankle and hip during the weight acceptance and propulsive portions of the stance phase. Therefore, clinicians should try a non improving symmetry focusing on changing hip and ankle mechanics during the weight acceptance and propulsive phases of gait.
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Affiliation(s)
- Nicole E-P. Stark
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 495 Old Turner Street Blacksburg, VA, 24060, USA
| | - Jill Streamer
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 495 Old Turner Street Blacksburg, VA, 24060, USA
| | - Robin Queen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, 495 Old Turner Street Blacksburg, VA, 24060, USA
- Department of Orthopaedic Surgery, Virginia Tech – Carilion School of Medicine, Roanoke, VA, USA
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Cho HM, Seon J, Park J, Ahn J, Lee Y. Usefulness of the Kinect-V2 System for Determining the Global Gait Index to Assess Functional Recovery after Total Knee Arthroplasty. Orthop Surg 2022; 14:3216-3224. [PMID: 36250557 PMCID: PMC9732587 DOI: 10.1111/os.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 08/28/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The Korean Knee Society (KKS) score is used for functional evaluation during follow-up after total knee arthroplasty (TKA), but it is time-consuming to measure and is limited by its subjective nature. We investigated whether the global gait asymmetry index (GGA) that can be obtained using the Kinect-V2 system could overcome the KKS limitations. METHODS Forty-three patients who underwent TKA from January 2019 to December 2019 were included. Postoperatively, regular follow-up was performed at 2, 4, 6, 8, and 12 weeks, and at 4, 6, and 12 months. At each follow-up visit, the KKS was measured, and the walking path was followed with six Kinect-V2 systems. After allowing the participants to walk naturally, the range of motion of each joint of the lower extremity and GGA were obtained. Changes in the KKS and GGA scores and measurement times were investigated until the final follow-up. A statistical model was made to predict the KKS from the GGA score using data at all observed time points, and analysis of variance (ANOVA) with Turkey's post-hoc tests and Pearson correlation tests were used for evaluation. RESULTS Both the KKS and GGA scores improved significantly from 4 weeks postoperatively until the final follow-up. The measurement time was significantly shorter for the GGA (9.3 ± 1.4 min) than for the KKS (32.4 ± 9.2 min; P < 0.001) score. The predicted and actual KKS values clustered close to a straight line on the scatter plot, but the prediction was less accurate in the initial stage (2 weeks post-surgery) than at later time points. The mean absolute error (MAE) and root mean square of the error (RMSE) were considered to be poorly predicted in the initial stage (8 weeks post-surgery) compared to the later time-points (MAE ≥ 5 and RMSE ≥ 6 for 8 weeks post-surgery). CONCLUSION In the early phase after knee joint surgery (up to 12 weeks post-surgery), the GGA index does not predict the KKS well. However, after this time point, the GGA index can be simply measured in the outpatient department and may be able to replace the KKS. Thus, evaluation of the GGA index using the Kinect-V2 may be a useful method to evaluate functional recovery in the outpatient clinic after knee joint surgery.
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Affiliation(s)
- Hong Man Cho
- Department of Orthopedic SurgeryGwangju Veterans HospitalGwangjuSouth Korea
| | - Jangwon Seon
- Department of Orthopedic SurgeryGwangju Veterans HospitalGwangjuSouth Korea
| | - JiYeon Park
- Department of Orthopedic SurgeryGwangju Veterans HospitalGwangjuSouth Korea
| | - Jihoon Ahn
- Department of Orthopedic SurgeryGwangju Veterans HospitalGwangjuSouth Korea
| | - Young Lee
- Veterans Medical Research InstituteVeterans Health Service Medical CenterSeoulSouth Korea
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Kowal M, Winiarski S, Gieysztor E, Kołcz A, Dumas I, Paprocka-Borowicz M. Symmetry Function: The Differences between Active and Non-Active Above-the-Knee Amputees. SENSORS (BASEL, SWITZERLAND) 2022; 22:5933. [PMID: 36015694 PMCID: PMC9413346 DOI: 10.3390/s22165933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
The number of patients with unilateral above-knee amputation (AKA) due to non-vascular causes has remained stable over the years, at 0.92 per 1000 people per year. Post-AKA individuals are at risk of experiencing a higher incidence of chronic pain. Post rehabilitation, it is estimated that between 16−62% of patients with musculoskeletal disabilities fail to meet the minimum criteria for physical activity in comparison to a healthy population. The current study included 14 participants (11 men and 3 women) with a mean age of 46.1 ± 14.2 years, body height of 1.76 ± 0.09 m, and weight of 79.6 ± 18.3 kg, who were all post-unilateral above-the-knee amputees. Patients in the study were divided into two groups: active (AC) and non-active (NAC). This study was conducted in a certified Laboratory of Biomechanical Analysis using the BTS Smart-E system (BTS Bioengineering). In order to investigate the symmetry function (SF) of gait, the only measurements included were the time series assessment of gait variables defining pelvic and lower limb joint motion and ground reaction forces (GRF). Both groups had an asymmetrical gait pattern with a different magnitude and relative position in the gait cycle, which was revealed by SF. The differences in terms of median, minimum, and maximum were statistically significant (p < 0.05), with SF ranging from −25 to 24% for the AC group and from 43 to 77% (59% on average) for the NAC group. The AC’s pattern was more symmetrical compared to the NAC’s pattern, especially in the case of pelvic and hip joint motion.
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Affiliation(s)
- Mateusz Kowal
- Department of Physiotherapy, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Sławomir Winiarski
- Department of Biomechanics, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland
| | - Ewa Gieysztor
- Department of Physiotherapy, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Anna Kołcz
- Department of Physiotherapy, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Ergonomics and Biomedical Monitoring Laboratory, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Ilias Dumas
- Department of Physiotherapy, Wroclaw Medical University, 50-367 Wroclaw, Poland
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Alrawashdeh W, Siebers HL, Reim J, Rath B, Tingart M, Eschweiler J. Gait symmetry - A valid parameter for pre and post planning for total knee arthroplasty. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2022; 22:102-112. [PMID: 35234165 PMCID: PMC8919661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We aimed to determine whether GS can help to plan and rearrange the treated side by using IMUs to measure the joint angle of the hip, knee, and ankle. We hypothesized that the kinematics in healthy individuals for both sides are approximately equal during walking. METHODS IMUs were used to measure the joint angles of 25 healthy participants during walking. The participants performed the 10-meter walk test. The normalized symmetry index (SInorm) was used to calculate the symmetry of joint angles for the hip, knee, and ankle throughout the gait cycle. RESULTS The SInorm demonstrated high symmetry between both legs; and the ranges were -1.5% and 1.1% for the hip, -3.0% and 3.1% for the knee, and -12% and 9.2% for the ankle joint angle throughout the gait cycle. CONCLUSION The SInorm provides strong information that can be helpful in the planning process for the surgeries. Further, the IMUs system gives the possibility to measure the patients before their surgeries and use their data to plan and rearrange for the operated side.
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Affiliation(s)
- Waleed Alrawashdeh
- Department of Orthopedic Surgery, University Hospital RWTH Aachen, Aachen, Germany,Corresponding author: Waleed Alrawashdeh, M.A., Department of Orthopedic Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany E-mail:
| | - Hannah Lena Siebers
- Department of Orthopedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Julia Reim
- Department of Orthopedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Björn Rath
- Department of Orthopedic Surgery, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Markus Tingart
- Department of Orthopedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
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Siebers HL, Alrawashdeh W, Betsch M, Migliorini F, Hildebrand F, Eschweiler J. Comparison of different symmetry indices for the quantification of dynamic joint angles. BMC Sports Sci Med Rehabil 2021; 13:130. [PMID: 34666818 PMCID: PMC8527670 DOI: 10.1186/s13102-021-00355-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Symmetry is a sign of physiological and healthy movements, as pathologies are often described by increased asymmetries. Nevertheless, based on precisely measured data, even healthy individuals will show small asymmetries in their movements. However, so far there do not exist commonly accepted methods and reference values for gait symmetry in a healthy collective. Therefore, a comparison and presentation of reference values calculated by 3 different methods of symmetry indices for lower limb joint angles during walking, ascending, and descending stairs were shown. METHODS Thirty-five healthy participants were analyzed during walking, ascending, and descending stairs with the help of the inertial measurement system MyoMotion. Using the normalized symmetry index (SInorm), the symmetry index (SI) as the integral of the symmetry function, and another normalized symmetry index (NSI), the symmetry of joint angles was evaluated. For statistical evaluation of differences, repeated measurement models and Bland-Altman-Plots were used. RESULTS Apart from a bias between the symmetry indices, they were comparable in the predefined limits of 5%. For all parameters, significantly higher asymmetry was found for ankle dorsi/-plantarflexion, compared with the hip and knee flexion. Moreover, the interaction effect of the joint and movement factors was significant, with an increased asymmetry of the hip and knee during descending stairs greater than while ascending stairs or walking, but a reduced symmetry of the ankle during walking when compared to descending. The movement only showed significant effects when analyzing the SInorm. CONCLUSION Even for healthy individuals, small asymmetries of movements were found and presented as reference values using 3 different symmetry indices for dynamic lower limb joint angles during 3 different movements. For the quantification of symmetrical movements differences between the joints, movements, and especially their interaction, are necessary to be taken into account. Moreover, a bias between the methods should be noted. The potential for each presented symmetry index to identify pathological movements or track a rehabilitation process was shown but has to be proven in further research. TRIAL REGISTRATION DRKS00025878.
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Affiliation(s)
- Hannah Lena Siebers
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Waleed Alrawashdeh
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of the University Heidelberg, Mannheim, Germany
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
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Symmetry function - An effective tool for evaluating the gait symmetry of trans-femoral amputees. Gait Posture 2021; 90:9-15. [PMID: 34358849 DOI: 10.1016/j.gaitpost.2021.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/02/2021] [Accepted: 07/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prostheses can help persons with trans-femoral amputation (TFA) regain normal function, but such individuals still exhibit gait deviations expressed in gait asymmetries. We apply a specialised tool, the Symmetry Function (SF), to evaluate the symmetry of walking in terms of kinematic and dynamic variables and to identify areas with large side deviations (exceeding defined ±5% threshold) in the movement cycle. RESEARCH QUESTION Which movements and joints or GRF components revealed the most significant side deviations in the movement cycle? When exactly are they located in the gate cycle? METHODS In this retrospective observational study, an instrumented motion analysis system was used to register the gait of fourteen patients after unilateral TFA. Measurements involved evaluating the time series of gait variables characterising a range of motion and the ground reaction force components. Comparison of the prosthetic (involved) limb with the sound (uninvolved) limb in TFA patients was carried out on the basis of the Symmetry Function values. RESULTS The Symmetry Function proved to be an effective tool to localise the regions of asymmetry and limb dominance in the full gait cycle. The difference between sides revealed by the Symmetry Function was the highest for the pelvis and the hip. In the sagittal plane, the pelvis was asymmetrically tilted, reaching the highest SF value of more than 25 % at 60 % cycle time. In the transverse plane, the pelvis was even more asymmetrically positioned throughout the entire gait cycle (50 % difference). The hip in the frontal plane reached a 60 % difference throughout the single support phase for the involved and then for the uninvolved limb. SIGNIFICANCE The Symmetry Function allows for the detection of gait asymmetries, temporal shifts in the gait phases and may assess the precise in time adaptation of prostheses and rehabilitation monitoring, especially in unilateral impairments.
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Porta M, Pau M, Leban B, Deidda M, Sorrentino M, Arippa F, Marongiu G. Lower Limb Kinematics in Individuals with Hip Osteoarthritis during Gait: A Focus on Adaptative Strategies and Interlimb Symmetry. Bioengineering (Basel) 2021; 8:bioengineering8040047. [PMID: 33924515 PMCID: PMC8069064 DOI: 10.3390/bioengineering8040047] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/02/2021] [Accepted: 04/11/2021] [Indexed: 01/01/2023] Open
Abstract
Among the functional limitations associated with hip osteoarthritis (OA), the alteration of gait capabilities represents one of the most invalidating as it may seriously compromise the quality of life of the affected individual. The use of quantitative techniques for human movement analysis has been found valuable in providing accurate and objective measures of kinematics and kinetics of gait in individuals with hip OA, but few studies have reported in-depth analyses of lower limb joint kinematics during gait and, in particular, there is a scarcity of data on interlimb symmetry. Such aspects were investigated in the present study which tested 11 individuals with hip OA (mean age 68.3 years) and 11 healthy controls age- and sex-matched, using 3D computerized gait analysis to perform point-by-point comparisons of the joint angle trends of hip, knee, and ankle. Angle-angle diagrams (cyclograms) were also built to compute several parameters (i.e., cyclogram area and orientation and Trend Symmetry) from which to assess the degree of interlimb symmetry. The results show that individuals with hip OA exhibit peculiar gait patterns characterized by severe modifications of the physiologic trend at hip level even in the unaffected limb (especially during the stance phase), as well as minor (although significant) alterations at knee and ankle level. The symmetry analysis also revealed that the effect of the disease in terms of interlimb coordination is present at knee joint as well as hip, while the ankle joint appears relatively preserved from specific negative effects from this point of view. The availability of data on such kinematic adaptations may be useful in supporting the design of specific rehabilitative strategies during both preoperative and postoperative periods.
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Affiliation(s)
- Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (Micaela Porta); (Massimiliano Pau); (B.L.); (M.D.); (M.S.); (F.A.)
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (Micaela Porta); (Massimiliano Pau); (B.L.); (M.D.); (M.S.); (F.A.)
| | - Bruno Leban
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (Micaela Porta); (Massimiliano Pau); (B.L.); (M.D.); (M.S.); (F.A.)
| | - Michela Deidda
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (Micaela Porta); (Massimiliano Pau); (B.L.); (M.D.); (M.S.); (F.A.)
| | - Marco Sorrentino
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (Micaela Porta); (Massimiliano Pau); (B.L.); (M.D.); (M.S.); (F.A.)
| | - Federico Arippa
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (Micaela Porta); (Massimiliano Pau); (B.L.); (M.D.); (M.S.); (F.A.)
| | - Giuseppe Marongiu
- Orthopaedic and Trauma Clinic, Department of Surgical Sciences, University of Cagliari, 09042 Monserrato, Italy
- Correspondence: or ; Tel.: +39-070-6094368
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Borgonovo-Santos M, Telles T, Nessler J, de Castro MP, Fernandes RJ, Vilas-Boas JP. Are the Kinetics and Kinematics of the Surf Pop-Up Related to the Anthropometric Characteristics of the Surfer? SENSORS 2021; 21:s21051783. [PMID: 33806532 PMCID: PMC7961430 DOI: 10.3390/s21051783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 12/02/2022]
Abstract
The surf pop-up is a unique and challenging skill, critical to successful surfing. Hypothesizing that anthropometric characteristics of surfers influence the pop-up performance, we aimed to measure kinematics and ground-reaction forces (GRF) during a simulated pop-up motion, and to relate these variables with anthropometric characteristics. Twenty-three male surfers (age: 28.4 ± 10.1 years old; body mass: 68.3 ± 10.8 kg; height: 1.73 ± 0.07 m; time of practice: 12.4 ± 8.9 years; arm-span: 1.75 ± 8.9 m) perform a simulated pop-up in the laboratory, while GRF and 3D motion-capture data were acquired. The duration of the pop-up was 1.20 ± 0.19 s (60% push-up and 40% reaching/landing phase). During the push-up, the hands were placed 0.46 ± 0.05 m apart and generated a relative total peak-force of 0.99 ± 0.10 N/Weight, with symmetrical impulse of 0.30 ± 0.05 N·s/Weight for the dominant and 0.29 ± 0.07 N·s/Weight for the nondominant hand. Elbow angles were not different during the peak force application (110 ± 18° vs. 112 ± 18°, respectively) of the push-up phase. During the landing phase, the feet were placed 0.63 ± 0.10 m apart and generated a relative peak force of 1.63 ± 0.18 N/Weight. The impact force during landing was applied unevenly between the rear foot (28%) and the front foot (72%). In conclusion, most anthropometric-related variables showed no relationship with performance variables, with the exception of an inverse relationship between muscle mass and pop-up total duration. We also observed no differences in upper- and lower-body kinematics between the dominant vs. nondominant hands and among surfers who preferred a regular vs. “goofy-foot” stance. Finally, the force profiles between hands were similar and symmetric, while the lower extremities during the reaching phase were different, with the front foot applying greater force than that of the rear foot.
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Affiliation(s)
- Márcio Borgonovo-Santos
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport and Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, 4200-450 Porto, Portugal; (M.B.-S.); (T.T.); (R.J.F.)
- Riedel Communications GmbH & Co. KG, R&D Hub Portugal, 4450-718 Porto, Portugal
| | - Thiago Telles
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport and Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, 4200-450 Porto, Portugal; (M.B.-S.); (T.T.); (R.J.F.)
- Laboratory of Aquatic Activities, Physical Education Faculty, Sports Science Department, State University of Campinas, Campinas 13083-521, Brazil
| | - Jeff Nessler
- Department of Kinesiology, California State University, San Marcos, CA 92096, USA;
| | - Marcelo Peduzzi de Castro
- LaBClin Neuromusculoskeletal Rehabilitation and Clinical Biomechanics Laboratory, Florianópolis 88015-310, Brazil;
| | - Ricardo J. Fernandes
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport and Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, 4200-450 Porto, Portugal; (M.B.-S.); (T.T.); (R.J.F.)
| | - João Paulo Vilas-Boas
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport and Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, 4200-450 Porto, Portugal; (M.B.-S.); (T.T.); (R.J.F.)
- Correspondence: ; Tel.: +351-969021297
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Alves SA, Ehrig RM, Raffalt PC, Bender A, Duda GN, Agres AN. Quantifying Asymmetry in Gait: The Weighted Universal Symmetry Index to Evaluate 3D Ground Reaction Forces. Front Bioeng Biotechnol 2020; 8:579511. [PMID: 33195140 PMCID: PMC7644861 DOI: 10.3389/fbioe.2020.579511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/18/2020] [Indexed: 11/13/2022] Open
Abstract
Though gait asymmetry is used as a metric of functional recovery in clinical rehabilitation, there is no consensus on an ideal method for its evaluation. Various methods have been proposed to analyze single bilateral signals but are limited in scope, as they can often use only positive signals or discrete values extracted from time-scale data as input. By defining five symmetry axioms, a framework for benchmarking existing methods was established and a new method was described here for the first time: the weighted universal symmetry index (wUSI), which overcomes limitations of other methods. Both existing methods and the wUSI were mathematically compared to each other and in respect to their ability to fulfill the proposed symmetry axioms. Eligible methods that fulfilled these axioms were then applied using both discrete and continuous approaches to ground reaction force (GRF) data collected from healthy gait, both with and without artificially induced asymmetry using a single instrumented elbow crutch. The wUSI with a continuous approach was the only symmetry method capable of identifying GRF asymmetry differences in different walking conditions in all three planes of motion. When used with a continuous approach, the wUSI method was able to detect asymmetries while avoiding artificial inflation, a common problem reported in other methods. In conclusion, the wUSI is proposed as a universal method to quantify three-dimensional GRF asymmetries, which may also be expanded to other biomechanical signals.
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Affiliation(s)
- Sónia A Alves
- Julius Wolff Institute, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Rainald M Ehrig
- Julius Wolff Institute, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Zuse Institute Berlin, Berlin, Germany
| | - Peter C Raffalt
- Julius Wolff Institute, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Alwina Bender
- Julius Wolff Institute, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alison N Agres
- Julius Wolff Institute, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Gieysztor E, Pecuch A, Kowal M, Borowicz W, Paprocka-Borowicz M. Pelvic Symmetry Is Influenced by Asymmetrical Tonic Neck Reflex during Young Children's Gait. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4759. [PMID: 32630679 PMCID: PMC7370024 DOI: 10.3390/ijerph17134759] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 02/08/2023]
Abstract
Gait is one of the examined functions in child development. It should be economical and symmetrical. One test increasingly used by physiotherapists and pediatricians is asymmetrical tonic neck reflex (ATNR). Physiologically, it is observed from in utero up to six postnatal months. This reaction is inhibited with the growing maturation of the central nervous system (CNS). In some children, when the natural process of development is incorrect, ATNR manifests later in life, when it is observed as an automatic response of muscle tension to head rotation. Analysis of pelvis symmetry in the gait of children with active ATNR is important for better understanding their specific movements. In the gait of children with persistent ATNR, some variations are observed. The aim of the study was to investigate the gait symmetry of preschool children and the influence of persistent ATNR. Fifty preschool children with a trace form of ATNR were examined. The distribution of the gait parameters was determined using a BTS G-SENSOR measurement instrument. ATNR negatively influences pelvic obliquity and pelvic rotation (p < 0.01). Younger children have a statistically higher symmetry index of pelvis obliquity in the examined group (p = 0.015). Boys obtain a higher result of symmetry in pelvic tilt than girls in the group (p = 0.027). ATNR affects walking symmetry in preschool children, thus evaluation of the reflex activity and then proper therapy is required to support proper development.
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Affiliation(s)
- Ewa Gieysztor
- Physiotherapy Department, Faculty of Health Sciences, Wroclaw Medical University, 50-355 Wroclaw, Poland; (A.P.); (M.K.); (M.P.-B.)
| | - Anna Pecuch
- Physiotherapy Department, Faculty of Health Sciences, Wroclaw Medical University, 50-355 Wroclaw, Poland; (A.P.); (M.K.); (M.P.-B.)
| | - Mateusz Kowal
- Physiotherapy Department, Faculty of Health Sciences, Wroclaw Medical University, 50-355 Wroclaw, Poland; (A.P.); (M.K.); (M.P.-B.)
| | - Wojciech Borowicz
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Małgorzata Paprocka-Borowicz
- Physiotherapy Department, Faculty of Health Sciences, Wroclaw Medical University, 50-355 Wroclaw, Poland; (A.P.); (M.K.); (M.P.-B.)
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