Evaluation of the stability of normal subjects and patients with Perthes and spinal cord injury disorders during short and long periods of time

Gait Compensation among Children with Non-Operative Legg-Calvé-Perthes Disease: A Systematic Review

Perthes disease is a condition that affects walking patterns in young children due to poor blood circulation in the hip joint. Understanding the gait strategies of affected children is of great importance for an objective assessment and better management of this condition. The aim of this systematic review was to evaluate the current literature to identify gait compensation patterns in non-operative children with Perthes disease.

METHODS

A systematic electronic search was performed using MEDLINE, CINAHL, Embase, BIOSIS, and the Cochrane Library to identify studies published from inception up until December 2023. An adapted Downs and Black checklist was utilised to assess methodological quality and project risk of bias. Percentage agreement and nominal kappa statistics with bootstrapped bias-corrected 95% confidence intervals (CIs) were used.

RESULT

A comprehensive literature search revealed 277 citations for review, of which 210 studies entered full-text screening. In total, eight studies met the inclusion criteria for quality assessment by two independent reviewers. The results revealed variations in data quality, with scores ranging from 12 to 17 due to missing information related to subject characteristics, biomechanical model, and power calculation.

CONCLUSIONS

This review reveals common compensation strategies associated with walking among non-operative children with Perthes disease such as Trendelenburg gait due to weakness of the hip abductor muscle.

Validation of inertial measurement units for the assessment of trunk control in subjects with spinal cord injury

BACKGROUND

Trunk control (TC) constitutes one of the main objectives in the rehabilitation of people with a spinal cord injury (SCI), but there are few clinically validated tests to assess it. Accelerometers have been proposed as sensitive and suitable procedures to assess TC.

OBJECTIVE

To evaluate test-retest reliability, construct and criterion validity of accelerometer parameters to assess TC in people with SCI.

METHODS

A cross-sectional study of simultaneous application of Clinical Trunk Control Test (CTCT) and accelerometer evaluation was conducted. Accelerometers were placed on the trunks of 27 people with SCI and 15 people without SCI. Reliability was assessed by three repeated measures in random order of selected static and dynamic TC tasks. Acceleration on three axes was analyzed using five metrics. Criterion validity was assessed by analyzing correlation of acceleration to CTCT scores. Construct validity was assessed by analyzing capacity of inertial measurement units (IMU) to differentiate individual's characteristics, ASIA Impairment scale, gait capacity, level of TC, and neurological level of injury.

RESULTS

Reliable IMU data were obtained in people with SCI and without SCI, of all accelerometer axes, metrics, and tested items of the CTCT. Reliability of acceleration decreases with the increasing demand for TC tasks. Ten acceleration parameters showed construct and criterion validity.

CONCLUSION

Accelerometer parameters are reliable, valid, and sensitive to evaluate TC in people with SCI.

SIGNIFICANCE

A set of IMU parameters were validated as reliable and valid measures to evaluate TC, which could be useful for the assessment of progression of people with SCI and clinical interventions.

Walking ability of spinal cord injury individuals: How to improve it?

BACKGROUND

Subjects with Spinal Cord Injury (SCI) should use various assistive devices to stand and walk. Unfortunately they suffer from slow walking speed, high energy consumption, and too much force applied on upper limb while walking. The aim of this study was to determine the gap between the gait performance of SCI and normal subjects to conclude how the performance of SCI can be improved.

METHOD

Three groups of SCI walked with orthosis, SCI walked without orthosis, and normal subjects were recruited in this study. The normal subjects also walked with the same orthoses as SCI subjects. Some parameters such as ranges of motion of hip, knee and spatiotemporal gait parameters were evaluated by use of Qualysis motion analysis system. The difference between the gait parameters of three groups were evaluated by use of two sample t test.

RESULTS

The mean values of hip joint range of motion of normal subjects while walking with and without orthosis were 48.3 ± 2.5 and 18.5 ± 8.8 degrees, respectively (p-value = 0.00). There was a significant difference between walking speed of normal subjects with and without orthosis. The walking speed of SCI subject with and without orthosis differed significantly.

CONCLUSION

Although use of orthosis enable SCI subjects to stand and walk, but has some restrictions. As use of orthosis decreased the abilities of normal subjects it can be concluded that more attention should be done on design of orthosis and style of walking.

THE INFLUENCE OF TRUNK BRACING ON TIME, SPATIAL PARAMETERS, SYMMETRY OF GROUND REACTION FORCE AND LOADING RATE IN ADOLESCENT IDIOPATHIC SCOLIOSIS

Background: Adolescent Idiopathic Scoliosis (AIS) leads to change between body segments, right-left trunk symmetry and produce pathological gait pattern. The influence of trunk bracing on symmetry of ground reaction force components and loading rate on idiopathic scoliosis has not been well documented. Therefore, the aim of this study was to examine the effect of trunk bracing on symmetry of forces in adolescent with idiopathic scoliosis. Method: A total of 10 patients with AIS and 10 healthy subjects with comparable age, height and weight were recruited in this study. The force applied on the right and left sides in both groups of subjects were recorded by use of a Kistler force plate while walking. The peak of the vertical force (the first and second peaks) and the force applied on the leg in anteroposterior direction (progression and breaking forces) and mediolateral force were collected in this study. Results: The results of this study showed that there was a significant difference between the asymmetry index of anteroposterior force of normal and scoliotic patients [Formula: see text]. Moreover, trunk bracing decreased asymmetry index of loading rate of scoliotic patients significantly [Formula: see text]. There was no significant difference between the other examined kinetic variables. Conclusion: There are some degrees of asymmetry between the forces applied on the leg in scoliotic subjects. Orthosis decreased the forces applied on the leg in patients with scoliosis. Clinicians are to be aware of these findings as orthotic devices may be of value to patients with idiopathic scoliosis.

A comparison of linear and nonlinear stability parameters in different clinical forms of multiple sclerosis

Background

Multiple sclerosis (MS) is one of the neurological diseases that affect the ability of subjects to stand and walk. The stability of MS subjects has been evaluated in various studies, mostly based on linear approach. Based on this approach it is controversial weather stability of MS subjects differ from normal or not. Therefore, the aim of this study was to evaluate stability in three groups of MS subjects (spastic, ataxic and ataxic-spastic) using both linear and non-linear approaches.

Method

Seventeen healthy and 36 subjects with MS participated in this study. The MS group presenting with spastic, ataxic and ataxic-spastic (each group consisted of 12 subjects) participated in the study. The stability of the subjects was evaluated using Kistler force plate. The difference between stability of the subjects was evaluated using the Multi Analysis of Variance and significant value was set at P < 0.05.

Result

There was a significant difference in the mean value of Approximate Entropy (ApEn) in anterior-posterior direction between normal (0.66 ± 0.13) and ataxic (0.85 ± 0.12) and ataxic-spastic (0.90 ± 0.12) subjects (P < 0.05) and no difference between normal and spastic groups (0.76 ± 0.13). The results of both linear and nonlinear approaches confirmed that both ataxic and ataxic-spastic subjects had more instability than normal subjects. Although, the mean values of stability parameters increased in spastic compared to normal, the difference was not statistically significant.

Conclusion

Subjects with ataxic and ataxic-spastic MS disorder had difficulty in controlling their stability during quiet standing. The results of this study also confirmed that spasticity of muscles surrounding the hip and knee joints did not influence standing stability in patients with spastic MS.

STABILITY ANALYSIS IN PATIENTS WITH NEUROLOGICAL AND MUSCULOSKELETAL DISORDERS USING LINEAR AND NON-LINEAR APPROACHES

Standing stability is controlled by musculoskeletal and neurological systems. Various methods have been used to evaluate the performance of subjects during standing including linear and non-linear methods. It is not clear which method has more sensitivity to represent the stability of subjects with various musculoskeletal disorders. Therefore, the aim of this study was to investigate the stability of the subjects with various musculoskeletal disorders by use of linear and non-linear methods. About 65 subjects including, normal and those with flatfoot, Parkinson and Perthes were recruited into this study. A Kistler forceplate was used to evaluate the stability. The difference between the linear (center of pressure excursion, velocity and path length) and non-linear (approximate entropy) parameters were evaluated using the independent t-test. The mean values of stability parameters (linear and non-linear) of flat arch subjects were more than that of normal subjects. Although there was no difference between linear stability parameters of normal and those with Parkinson disease, their mean value of non-linear parameter was less than that of normal subject (p-< 0.05). The results of stability analysis based on both linear and non-linear approaches showed that the subjects with Perthes disease were more unstable than normal subjects. It seems that non-linear method is more sensitive to represent the difference between stability of subjects with flatfoot, Parkinson and Perthes. However, if a combination of various parameters, based on linear method, is used to measure stability, the difference between stability can be enhanced. Depending on the disease condition increasing and decreasing the value of approximate entropy represent the unstability situations.