1
|
Measuring Recovery and Understanding Long-Term Deficits in Balance, Ankle Mobility and Hip Strength in People after an Open Reduction and Internal Fixation of Bimalleolar Fracture and Their Impact on Functionality: A 12-Month Longitudinal Study. J Clin Med 2022; 11:jcm11092539. [PMID: 35566666 PMCID: PMC9101534 DOI: 10.3390/jcm11092539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/08/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
To analyze how balance and other physical capacities evolved after surgery in patients with a bimalleolar fracture and how these capacities and clinical variables (immobilization or unloading time) contribute to restoring patients’ functionality, 22 patients and 10 healthy people (HC) were assessed for static and dynamic balance (Y-Balance test, YBT), dorsiflexion ankle mobility (ADFROM) and hip strength at 6 and 12 months after surgery. Patients’ functional status was assessed through the Olerud Molander Ankle Score (OMAS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Twenty-one patients with ankle fractures who completed the study showed a worse static and dynamic balance at 6 months. The YBT in the anterior direction (YBTA) revealed balance deficits in the operated limb at 12 months compared to the non-operated limb (−5.6%) and the HC (−6.7%). They also showed a decreased ADFROM compared to the non-operated limb (−7.4°) and the HC (−11°). In addition, medium-term (6 months) deficits in abductor strength hip but no hip strength deficits were found at 12 months after surgery. Relative weight analyses showed that ADFROM and hip strength explained 35–63% of the YBTA variance and AOFAS/OMAS scores. Balance, hip strength and ADFROM seem to be reliable indexes for assessing the functional status of these patients. These results could help to understand the relationship between these physical capacities and the patients’ perceived functional status.
Collapse
|
2
|
Larson J, Roper J, Murrah W, Zabala M. Cognitive dual-task alters Local Dynamic Stability of lower extremity during common movements. J Biomech 2022; 137:111077. [DOI: 10.1016/j.jbiomech.2022.111077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
|
3
|
Gait Alterations in Adults after Ankle Fracture: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12010199. [PMID: 35054366 PMCID: PMC8774579 DOI: 10.3390/diagnostics12010199] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/24/2021] [Accepted: 12/26/2021] [Indexed: 12/04/2022] Open
Abstract
(1) Background: Ankle fracture results in pain, swelling, stiffness and strength reduction, leading to an altered biomechanical behavior of the joint during the gait cycle. Nevertheless, a common pattern of kinematic alterations has still not been defined. To this end, we analyzed the literature on instrumental gait assessment after ankle fracture, and its correlation with evaluator-based and patient-reported outcome measures. (2) Methods: We conducted a systematic search, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, of articles published from January 2000 to June 2021 in PubMed, Embase and PEDro on instrumental gait assessment after ankle fracture. (3) Results: Several changes in gait occur after ankle fracture, including a reduction in step length, swing time, single support time, stride length, cadence, speed and an earlier foot-off time in the affected side. Additionally, trunk movement symmetry (especially vertical) is significantly reduced after ankle fracture. The instrumental assessments correlate with different clinical outcome measures. (4) Conclusions: Instrumental gait assessment can provide an objective characterization of the gait alterations after ankle fracture. Such assessment is important not only in clinical practice to assess patients’ performance but also in clinical research as a reference point to evaluate existing or new rehabilitative interventions.
Collapse
|
4
|
Hemmati F, Haghpanah SA, Karimi MT, Mardani MA, Fadayevatan R. Nonlinear analysis of dynamic stability in walking with toe-only rocker sole shoes in elderly. Med Eng Phys 2022; 99:103738. [DOI: 10.1016/j.medengphy.2021.103738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/28/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
|
5
|
Josiński H, Świtoński A, Michalczuk A, Grabiec P, Pawlyta M, Wojciechowski K. Assessment of Local Dynamic Stability in Gait Based on Univariate and Multivariate Time Series. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2019; 2019:6917658. [PMID: 31428185 PMCID: PMC6683834 DOI: 10.1155/2019/6917658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/26/2019] [Accepted: 07/03/2019] [Indexed: 11/21/2022]
Abstract
The ability of the locomotor system to maintain continuous walking despite very small external or internal disturbances is called local dynamic stability (LDS). The importance of the LDS requires constantly working on different aspects of its assessment method which is based on the short-term largest Lyapunov exponent (LLE). A state space structure is a vital aspect of the LDS assessment because the algorithm of the LLE computation for experimental data requires a reconstruction of a state space trajectory. The gait kinematic data are usually one- or three-dimensional, which enables to construct a state space based on a uni- or multivariate time series. Furthermore, two variants of the short-term LLE are present in the literature which differ in length of a time span, over which the short-term LLE is computed. Both a state space structure and the consistency of the observations based on values of both short-term LLE variants were analyzed using time series representing the joint angles at ankle, knee, and hip joints. The short-term LLE was computed for individual joints in three state spaces constructed on the basis of either univariate or multivariate time series. Each state space revealed walkers' locally unstable behavior as well as its attenuation in the current stride. The corresponding conclusions made on the basis of both short-term LLE variants were consistent in ca. 59% of cases determined by a joint and a state space. Moreover, the authors present an algorithm for estimation of the embedding dimension in the case of a multivariate gait time series.
Collapse
Affiliation(s)
- Henryk Josiński
- Institute of Informatics, Silesian University of Technology, Akademicka 16, 44-100 Gliwice, Poland
| | - Adam Świtoński
- Institute of Informatics, Silesian University of Technology, Akademicka 16, 44-100 Gliwice, Poland
| | - Agnieszka Michalczuk
- Institute of Informatics, Silesian University of Technology, Akademicka 16, 44-100 Gliwice, Poland
| | - Piotr Grabiec
- Centre for Research and Development, Polish-Japanese Academy of Information Technology, Aleja Legionów 2, 41-902 Bytom, Poland
| | - Magdalena Pawlyta
- Centre for Research and Development, Polish-Japanese Academy of Information Technology, Aleja Legionów 2, 41-902 Bytom, Poland
| | - Konrad Wojciechowski
- Centre for Research and Development, Polish-Japanese Academy of Information Technology, Aleja Legionów 2, 41-902 Bytom, Poland
| |
Collapse
|
6
|
Greve L, Dyson S. What can we learn from visual and objective assessment of non‐lame and lame horses in straight lines, on the lunge and ridden? EQUINE VET EDUC 2018. [DOI: 10.1111/eve.13016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L. Greve
- Centre for Equine Studies Animal Health Trust Newmarket Suffolk UK
| | - S. Dyson
- Centre for Equine Studies Animal Health Trust Newmarket Suffolk UK
| |
Collapse
|
7
|
Ekizos A, Santuz A, Schroll A, Arampatzis A. The Maximum Lyapunov Exponent During Walking and Running: Reliability Assessment of Different Marker-Sets. Front Physiol 2018; 9:1101. [PMID: 30197597 PMCID: PMC6117405 DOI: 10.3389/fphys.2018.01101] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/23/2018] [Indexed: 12/31/2022] Open
Abstract
The maximum Lyapunov exponent (MLE) has often been suggested as the prominent measure for evaluation of dynamic stability of locomotion in pathological and healthy population. Although the popularity of the MLE has increased in the last years, there is scarce information on the reliability of the method, especially during running. The purpose of the current study was, thus, to examine the reliability of the MLE during both walking and running. Sixteen participants walked and ran on a treadmill completing two measurement blocks (i.e., two trials per day for three consecutive days per block) separated by 2 months on average. Six different marker-sets on the trunk were analyzed. Intraday, interday and between blocks reliability was assessed using the intraclass correlation coefficient (ICC) and the root mean square difference (RMSD). The MLE was on average significantly higher (p < 0.001) in running (1.836 ± 0.080) compared to walking (1.386 ± 0.207). All marker-sets showed excellent ICCs (>0.90) during walking and mostly good ICCs (>0.75) during running. The RMSD ranged from 0.023 to 0.047 for walking and from 0.018 to 0.050 for running. The reliability was better when comparing MLE values between blocks (ICCs: 0.965–0.991 and 0.768–0.961; RMSD: 0.023–0.034 and 0.018–0.027 for walking and running respectively), and worse when considering trials of the same day (ICCs: 0.946–0.980 and 0.739–0.844; RMSD: 0.042–0.047 and 0.045–0.050 for walking and running respectively). Further, different marker-sets affect the reliability of the MLE in both walking and running. Our findings provide evidence that the assessment of dynamic stability using the MLE is reliable in both walking and running. More trials spread over more than 1 day should be considered in study designs with increased demands of accuracy independent of the locomotion condition.
Collapse
Affiliation(s)
- Antonis Ekizos
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alessandro Santuz
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Arno Schroll
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
8
|
Dyson S, Berger JM, Ellis AD, Mullard J. Behavioral observations and comparisons of nonlame horses and lame horses before and after resolution of lameness by diagnostic analgesia. J Vet Behav 2018. [DOI: 10.1016/j.jveb.2018.05.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
9
|
Transition from shod to barefoot alters dynamic stability during running. Gait Posture 2017; 56:31-36. [PMID: 28482203 DOI: 10.1016/j.gaitpost.2017.04.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/25/2017] [Accepted: 04/27/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Barefoot running recently received increased attention, with controversial results regarding its effects on injury risk and performance. Numerous studies examined the kinetic and kinematic changes between the shod and the barefoot condition. Intrinsic parameters such as the local dynamic stability could provide new insight regarding neuromuscular control when immediately transitioning from one running condition to the other. We investigated the local dynamic stability during the change from shod to barefoot running. We further measured biomechanical parameters to examine the mechanisms governing this transition. METHODS Twenty habitually shod, young and healthy participants ran on a pressure plate-equipped treadmill and alternated between shod and barefoot running. We calculated the largest Lyapunov exponents as a measure of errors in the control of the movement. Biomechanical parameters were also collected. RESULTS Local dynamic stability decreased significantly (d=0.41; 2.1%) during barefoot running indicating worse control over the movement. We measured higher cadence (d=0.35; 2.2%) and total flight time (d=0.58; 19%), lower total contact time (d=0.58; -5%), total vertical displacement (d=0.39; -4%), and vertical impulse (d=1.32; 11%) over the two minutes when running barefoot. The strike index changed significantly (d=1.29; 237%) towards the front of the foot. CONCLUSIONS Immediate transition from shod to the barefoot condition resulted in an increased instability and indicates a worst control over the movement. The increased instability was associated with biomechanical changes (i.e. foot strike patterns) of the participants in the barefoot condition. Possible reasons why this instability arises, might be traced in the stance phase and particularly in the push-off. The decreased stability might affect injury risk and performance.
Collapse
|
10
|
Terrier P, Le Carre J, Connaissa ML, Leger B, Luthi F. Monitoring of Gait Quality in Patients With Chronic Pain of Lower Limbs. IEEE Trans Neural Syst Rehabil Eng 2017; 25:1843-1852. [PMID: 28368823 DOI: 10.1109/tnsre.2017.2688485] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Severe injuries of lower extremities often lead to chronic pain and reduced walking abilities. We postulated that measuring free-living gait can provide further information about walking ability in complement to clinical evaluations. We sought to validate a method that characterizes free gaits with a wearable sensor. Over one week, 81 healthy controls (HC) and 66 chronic lower limb pain patients (CLLPP) hospitalized for multidisciplinary rehabilitation wore a simple accelerometer (Actigraph). In the acceleration signals, steady 1-min walks detected numbered 7,835 (5,085 in CLLPP and 2,750 in HC). Five gait quality measures were assessed: movement intensity, cadence, stride regularity, and short-term and long-term local dynamic stability. Gait quality variables differed significantly between CLLPP and HC (4%-26%). Intraclass correlation coefficients revealed moderate to high repeatability (0.71-0.91), which suggests that seven days of measurement are sufficient to assess average gait patterns. Regression analyses showed significant association (R2 = 0.44) between the gait quality variables and a clinical evaluation of walking ability, i.e., the 6-min walk test. Overall, the results show that the method is easy to implement, valid (high concurrent validity), and reliable to assess walking abilities ecologically.
Collapse
|
11
|
Bensoussan L, Jouvion A, Kerzoncuf M, Delarque A, Theodoridou E, Milhe de Bovis V, Thefenne L, Attarian S, Viton JM. Orthopaedic shoes along with physical therapy was effective in Charcot-Marie-Tooth patient over 10 years. Prosthet Orthot Int 2016; 40:636-42. [PMID: 26015326 DOI: 10.1177/0309364615584657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 03/08/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND The aim was to investigate the effectiveness of custom-made orthopaedic shoes (derby shoes) along with physiotherapy (twice a week) on a person with Charcot-Marie-Tooth over a period of 10 years. CASE DESCRIPTION AND METHODS A 66-year-old woman with Charcot-Marie-Tooth disease, who did not have other health conditions, complained of pain and frequent falls. Physical examination, including ankle, knee and hip muscle strength; sensory evaluation of foot and joint range of motion; self-reported assessment of pain, frequency of falls and sprains; and gait analyses, including spatial and temporal parameters and motion analyses, were performed in 2001, 2007 and 2011. FINDINGS AND OUTCOMES During the 10 years of follow-up, the physical examination parameters had stabilized since 2001; falls, sprains and walking distance had improved as compared to 2000; pain had alleviated since 2001 and gait parameters had improved up to 2007 and stabilized between 2007 and 2011. CONCLUSION Bracing with orthopaedic shoes along with physical therapy was effective in treating pain, improving the gait and enhancing the walking distance (>500 m) without assistive device in a person with Charcot-Marie-Tooth disease. CLINICAL RELEVANCE Orthopaedic shoes along with physical therapy can be a good option for treating Charcot-Marie-Tooth associated pain, foot drop, falls and sprains, improving the gait abnormalities and also increasing the walking distance.
Collapse
|
12
|
Russell DM, Haworth JL, Martinez-Garza C. Coordination dynamics of (a)symmetrically loaded gait. Exp Brain Res 2015; 234:867-81. [PMID: 26661338 DOI: 10.1007/s00221-015-4512-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/20/2015] [Indexed: 11/28/2022]
Abstract
Asymmetries in the resonant frequency of limbs/effectors lead to changes in coordination dynamics, including deviations in relative phase at ϕ = 0 or π rad and reduced stability. These effects have been successfully modeled by the extended Haken-Kelso-Bunz (HKB) coupled oscillator model (Kelso et al. in Attention and performance XIII. Erlbaum, Hillsdale, pp 139-169, 1990), and supported in laboratory tasks of rhythmic limb motions. Efforts to apply the HKB model to walking have supported the predicted deviations in phase, but not the expected decreases in coordination stability. The lack of stability effects arising from asymmetries may be due to the stabilizing influence of a treadmill or may be obscured by the balance requirements and ground impacts in gait. This study examined these possibilities by investigating walking overground with ankle weights of 3 or 6 kg to create asymmetries between the legs, as well as symmetrical loads. Participants walked without a metronome and separately with a metronome to control speed and cadence. Coordination dynamics between the legs were quantified through mean and standard deviation (SD) of ϕ, while individual leg local dynamic stability was calculated as maximum Lyapunov exponent (λ (MAX)). Irrespective of the condition, asymmetrical loads led to deviations in phase from antiphase with the loaded leg lagging behind the other, and both SDϕ and λ (MAX) increased (i.e., stability decreased). Symmetrical loads had no effect on phase deviations, but decreased stability. Overall, these findings indicate that the HKB model captures coordination dynamics in walking, but also highlights limitations in modeling the influence of loads on an individual limb.
Collapse
Affiliation(s)
- Daniel M Russell
- School of Physical Therapy and Athletic Training, College of Health Sciences, Old Dominion University, 3118 Health Sciences Building, Norfolk, VA, 23529, USA.
| | - Joshua L Haworth
- Johns Hopkins School of Medicine, Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA.
| | - Cesar Martinez-Garza
- Division of Science, The Pennsylvania State University - Berks, Reading, PA, 19610, USA.
| |
Collapse
|
13
|
Rábago CA, Dingwell JB, Wilken JM. Reliability and Minimum Detectable Change of Temporal-Spatial, Kinematic, and Dynamic Stability Measures during Perturbed Gait. PLoS One 2015; 10:e0142083. [PMID: 26535580 PMCID: PMC4633040 DOI: 10.1371/journal.pone.0142083] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 10/16/2015] [Indexed: 12/04/2022] Open
Abstract
Temporal-spatial, kinematic variability, and dynamic stability measures collected during perturbation-based assessment paradigms are often used to identify dysfunction associated with gait instability. However, it remains unclear which measures are most reliable for detecting and tracking responses to perturbations. This study systematically determined the between-session reliability and minimum detectable change values of temporal-spatial, kinematic variability, and dynamic stability measures during three types of perturbed gait. Twenty young healthy adults completed two identical testing sessions two weeks apart, comprised of an unperturbed and three perturbed (cognitive, physical, and visual) walking conditions in a virtual reality environment. Within each session, perturbation responses were compared to unperturbed walking using paired t-tests. Between-session reliability and minimum detectable change values were also calculated for each measure and condition. All temporal-spatial, kinematic variability and dynamic stability measures demonstrated fair to excellent between-session reliability. Minimal detectable change values, normalized to mean values ranged from 1–50%. Step width mean and variability measures demonstrated the greatest response to perturbations with excellent between-session reliability and low minimum detectable change values. Orbital stability measures demonstrated specificity to perturbation direction and sensitivity with excellent between-session reliability and low minimum detectable change values. We observed substantially greater between-session reliability and lower minimum detectable change values for local stability measures than previously described which may be the result of averaging across trials within a session and using velocity versus acceleration data for reconstruction of state spaces. Across all perturbation types, temporal-spatial, orbital and local measures were the most reliable measures with the lowest minimum detectable change values, supporting their use for tracking changes over multiple testing sessions. The between-session reliability and minimum detectable change values reported here provide an objective means for interpreting changes in temporal-spatial, kinematic variability, and dynamic stability measures during perturbed walking which may assist in identifying instability.
Collapse
Affiliation(s)
- Christopher A. Rábago
- Center for the Intrepid, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas, United States of America
- Department of Defense and Veterans Affairs Extremity Trauma and Amputation Center of Excellence, JBSA Fort Sam Houston, Texas, United States of America
- * E-mail:
| | - Jonathan B. Dingwell
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas, United States of America
| | - Jason M. Wilken
- Center for the Intrepid, Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas, United States of America
- Department of Defense and Veterans Affairs Extremity Trauma and Amputation Center of Excellence, JBSA Fort Sam Houston, Texas, United States of America
| |
Collapse
|
14
|
Reynard F, Vuadens P, Deriaz O, Terrier P. Could local dynamic stability serve as an early predictor of falls in patients with moderate neurological gait disorders? A reliability and comparison study in healthy individuals and in patients with paresis of the lower extremities. PLoS One 2014; 9:e100550. [PMID: 24949737 PMCID: PMC4065053 DOI: 10.1371/journal.pone.0100550] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 05/28/2014] [Indexed: 11/29/2022] Open
Abstract
Falls while walking are frequent in patients with muscular dysfunction resulting from neurological disorders. Falls induce injuries that may lead to deconditioning and disabilities, which further increase the risk of falling. Therefore, an early gait stability index would be useful to evaluate patients in order to prevent the occurrence of future falls. Derived from chaos theory, local dynamic stability (LDS), defined by the maximal Lyapunov exponent, assesses the sensitivity of a dynamic system to small perturbations. LDS has already been used for fall risk prediction in elderly people. The aim of the present study was to provide information to facilitate future researches regarding gait stability in patients with neurological gait disorders. The main objectives were 1) to evaluate the intra-session repeatability of LDS in patients and 2) to assess the discriminative power of LDS to differentiate between healthy individuals and neurological patients. Eighty-three patients with mild to moderate neurological disorders associated with paresis of the lower extremities and 40 healthy controls participated in the study. The participants performed 2×30 s walking wearing a 3D accelerometer attached to the lower back, from which 2×35 steps were extracted. LDS was defined as the average exponential rate of divergence among trajectories in a reconstructed state-space that reflected the gait dynamics. LDS assessed along the medio-lateral axis offered the highest repeatability and discriminative power. Intra-session repeatability (intraclass correlation coefficient between the two repetitions) in the patients was 0.89 and the smallest detectable difference was 16%. LDS was substantially lower in the patients than in the controls (33% relative difference, standardized effect size 2.3). LDS measured in short over-ground walking tests seems sufficiently reliable. LDS exhibits good discriminative power to differentiate fall-prone individuals and opens up the possibility of future clinical applications for better prediction of fall risk in neurological patients.
Collapse
Affiliation(s)
| | | | - Olivier Deriaz
- Clinique romande de réadaptation SUVACare, Sion, Switzerland
- Institute for Research in Rehabilitation, Sion, Switzerland
| | - Philippe Terrier
- Clinique romande de réadaptation SUVACare, Sion, Switzerland
- Institute for Research in Rehabilitation, Sion, Switzerland
- * E-mail:
| |
Collapse
|
15
|
Walking at the preferred stride frequency maximizes local dynamic stability of knee motion. J Biomech 2014; 47:102-8. [DOI: 10.1016/j.jbiomech.2013.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 09/17/2013] [Accepted: 10/05/2013] [Indexed: 11/23/2022]
|
16
|
Reynard F, Terrier P. Local dynamic stability of treadmill walking: Intrasession and week-to-week repeatability. J Biomech 2014; 47:74-80. [DOI: 10.1016/j.jbiomech.2013.10.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 10/07/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022]
|
17
|
Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2013. [DOI: 10.1097/bco.0b013e3182a6a18b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
18
|
Hilfiker R, Vaney C, Gattlen B, Meichtry A, Deriaz O, Lugon-Moulin V, Anchisi-Bellwald AM, Palaci C, Foinant D, Terrier P. Local dynamic stability as a responsive index for the evaluation of rehabilitation effect on fall risk in patients with multiple sclerosis: a longitudinal study. BMC Res Notes 2013; 6:260. [PMID: 23835061 PMCID: PMC3720262 DOI: 10.1186/1756-0500-6-260] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 07/01/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Gait and balance problems are common in patients with multiple sclerosis, leading to high risk for falls. Local Dynamic Stability (LDS), a non-linear gait stability index, has been advocated as an early indicator of risk for falls. With this longitudinal study over three weeks, we aimed to assess the responsiveness of Local Dynamic Stability to a rehabilitation program and to compare it to other measures. METHODS Eighteen patients (mean 54 years, median EDSS score: 5) participated. They were admitted to inpatient rehabilitation and received a three weeks individually tailored program. They performed a 3-minute walking test at the beginning and at the end of the stay, as well as pain, wellbeing, fatigue, and balance assessment. The Local Dynamic Stability was computed from the acceleration signals measured with a 3D-accelerometer. RESULTS At the end of the rehabilitation process, patients reported reduced pain (Effect Size: -0.7), fatigue (ES:-0.6), and increased wellbeing (ES: 1.1). A small positive effect on static balance was observed (ES: 0.3). LDS was improved (ES: 0.6), and the effect was higher than walking speed improvement (ES: 0.4). CONCLUSIONS The Local Dynamic Stability seemed responsive to assess rehabilitation effects in patients with multiple sclerosis. It could constitute a valuable gait quality index, which could evaluate potential effects of rehabilitation on fall risk. TRIAL REGISTRATION Current Controlled Trials ISRCTN69803702.
Collapse
Affiliation(s)
- Roger Hilfiker
- Institute Health & Social Work; HES-SO Valais-Wallis, University of Applied Sciences Western Switzerland, Sion and Leukerbad, Switzerland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|