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Suh SW, Kim WS. Lower limb joint burden during walking in adolescent idiopathic scoliosis: investigation of mechanical work during walking. Spine J 2023; 23:1692-1699. [PMID: 37355046 DOI: 10.1016/j.spinee.2023.06.393] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/19/2023] [Accepted: 06/17/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND CONTEXT Adolescent idiopathic scoliosis (AIS) is the most prevalent spinal deformity in adolescents. However, pathophysiology and long-term complications remain unclear. Characteristics of the mechanical work in AIS gait have not been well-studied. PURPOSE This study aimed to elucidate the characteristics of mechanical work in AIS gait. STUDY DESIGN Observational comparison study. PATIENT SAMPLE Participants were composed of two groups: scoliosis group with 68 participants and a control group with 17 participants. OUTCOME MEASURES Spinal deformity and coronal spinal balance in the scoliosis group were assessed with Cobb angle, coronal balance, and apical vertebra translation. Three-dimensional motion analysis during walking was conducted to calculate lower limb joint works and external work on the whole body's center of mass. METHODS Lower limb joint work (JW) and external work on the whole body center of mass (CoM) were compared between the 2 groups with an independent t-test. Inter-limb and intra-limb comparisons of mechanical work were conducted with a paired t-test. The relationships between mechanical work and frontal trunk deformity were investigated in the scoliosis group. RESULTS Walking speed and external work on whole body CoM did not differ between the two groups. Compared to the control group, the scoliosis group showed significantly larger JW on the convex and concave sides. CONCLUSION The scoliosis group showed increased lower limb joint burden and limited trunk function for mechanical work during walking. Investigation of mechanical work during walking provides insight into the biomechanical characteristics of AIS. Therefore, future studies should be conducted to verify mechanical work characteristics which have relevance to the progression of spinal deformity and the development of lower limb complications in AIS.
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Affiliation(s)
- Seung Woo Suh
- Department of Orthopaedic Surgery, School of Medicine, Korea University Guro Hospital, Seoul 10408, Republic of Korea
| | - Woo Sub Kim
- Department of Physical Medicine & Rehabilitation, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu 11759, Republic of Korea.
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Gait Event Prediction Using Surface Electromyography in Parkinsonian Patients. Bioengineering (Basel) 2023; 10:bioengineering10020212. [PMID: 36829706 PMCID: PMC9951979 DOI: 10.3390/bioengineering10020212] [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: 01/03/2023] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Gait disturbances are common manifestations of Parkinson's disease (PD), with unmet therapeutic needs. Inertial measurement units (IMUs) are capable of monitoring gait, but they lack neurophysiological information that may be crucial for studying gait disturbances in these patients. Here, we present a machine learning approach to approximate IMU angular velocity profiles and subsequently gait events using electromyographic (EMG) channels during overground walking in patients with PD. We recorded six parkinsonian patients while they walked for at least three minutes. Patient-agnostic regression models were trained on temporally embedded EMG time series of different combinations of up to five leg muscles bilaterally (i.e., tibialis anterior, soleus, gastrocnemius medialis, gastrocnemius lateralis, and vastus lateralis). Gait events could be detected with high temporal precision (median displacement of <50 ms), low numbers of missed events (<2%), and next to no false-positive event detections (<0.1%). Swing and stance phases could thus be determined with high fidelity (median F1-score of ~0.9). Interestingly, the best performance was obtained using as few as two EMG probes placed on the left and right vastus lateralis. Our results demonstrate the practical utility of the proposed EMG-based system for gait event prediction, which allows the simultaneous acquisition of an electromyographic signal to be performed. This gait analysis approach has the potential to make additional measurement devices such as IMUs and force plates less essential, thereby reducing financial and preparation overheads and discomfort factors in gait studies.
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3
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Patoz A, Malatesta D, Burtscher J. Isolating the speed factor is crucial in gait analysis for Parkinson's disease. Front Neurosci 2023; 17:1119390. [PMID: 37152600 PMCID: PMC10160620 DOI: 10.3389/fnins.2023.1119390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/31/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Parkinson's disease (PD) is characterized by an alteration of the walking gait, frequently including a slower self-selected walking speed (SSWS). Although the reduction of walking speed is inherent to people with PD, such speed reduction also represents a potential confounding factor that might partly explain the observed gait differences between PD and control participants. Methods In this study, each participant walked along a 25 m level corridor during which vertical ground reaction force signals were recorded using shoes equipped with eight pressure sensors. Vertical ground reaction force signals (using statistical parametric mapping) and temporal and kinetic variables as well as their related variability and asymmetry (using Student's t-test) were compared between PD (n = 54) and walking-speed-matched control subjects (n = 39). Results Statistical parametric mapping did not yield significant differences between PD and control groups for the vertical ground reaction force signal along the walking stance phase. Stride time and single support time (equivalent to swing time) were shorter and peak vertical ground reaction force was larger in PD patients compared to controls (p ≤ 0.05). However, the single support time was no longer different between people with PD and healthy subjects when expressed relatively to stride time (p = 0.07). While single support, double support, and stance times were significantly more variable and asymmetric for PD than for the control group (p ≤ 0.05), stride time was similar (p ≥ 0.07). Discussion These results indicate that at matched SSWS, PD patients adopt a higher cadence than control participants. Moreover, the temporal subdivision of the walking gait of people with PD is similar to healthy individuals but the coordination during the double support phase is different. Hence, this study indicates that isolating the speed factor is crucial in gait analysis for PD.
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Affiliation(s)
- Aurélien Patoz
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
- Research and Development Department, Volodalen Swiss Sport Lab, Aigle, Switzerland
- *Correspondence: Aurélien Patoz,
| | - Davide Malatesta
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Johannes Burtscher
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
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Palmisano C, Beccaria L, Haufe S, Volkmann J, Pezzoli G, Isaias IU. Gait Initiation Impairment in Patients with Parkinson's Disease and Freezing of Gait. Bioengineering (Basel) 2022; 9:639. [PMID: 36354550 PMCID: PMC9687939 DOI: 10.3390/bioengineering9110639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 08/03/2023] Open
Abstract
Freezing of gait (FOG) is a sudden episodic inability to produce effective stepping despite the intention to walk. It typically occurs during gait initiation (GI) or modulation and may lead to falls. We studied the anticipatory postural adjustments (imbalance, unloading, and stepping phase) at GI in 23 patients with Parkinson's disease (PD) and FOG (PDF), 20 patients with PD and no previous history of FOG (PDNF), and 23 healthy controls (HCs). Patients performed the task when off dopaminergic medications. The center of pressure (CoP) displacement and velocity during imbalance showed significant impairment in both PDNF and PDF, more prominent in the latter patients. Several measurements were specifically impaired in PDF patients, especially the CoP displacement along the anteroposterior axis during unloading. The pattern of segmental center of mass (SCoM) movements did not show differences between groups. The standing postural profile preceding GI did not correlate with outcome measurements. We have shown impaired motor programming at GI in Parkinsonian patients. The more prominent deterioration of unloading in PDF patients might suggest impaired processing and integration of somatosensory information subserving GI. The unaltered temporal movement sequencing of SCoM might indicate some compensatory cerebellar mechanisms triggering time-locked models of body mechanics in PD.
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Affiliation(s)
- Chiara Palmisano
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Würzburg, Germany
| | - Laura Beccaria
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Würzburg, Germany
| | - Stefan Haufe
- Uncertainty, Inverse Modeling and Machine Learning Group, Faculty IV Electrical Engineering and Computer Science, Technical University of Berlin, 10623 Berlin, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Würzburg, Germany
| | - Gianni Pezzoli
- Centro Parkinson, ASST Gaetano Pini-CTO, 20122 Milano, Italy
| | - Ioannis U. Isaias
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Würzburg, Germany
- Centro Parkinson, ASST Gaetano Pini-CTO, 20122 Milano, Italy
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Zhu S, Wu Z, Wang Y, Jiang Y, Gu R, Zhong M, Jiang X, Shen B, Zhu J, Yan J, Pan Y, Zhang L. Gait Analysis with Wearables Is a Potential Progression Marker in Parkinson's Disease. Brain Sci 2022; 12:1213. [PMID: 36138949 PMCID: PMC9497215 DOI: 10.3390/brainsci12091213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/17/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022] Open
Abstract
Gait disturbance is a prototypical feature of Parkinson's disease (PD), and the quantification of gait using wearable sensors is promising. This study aimed to identify gait impairment in the early and progressive stages of PD according to the Hoehn and Yahr (H-Y) scale. A total of 138 PD patients and 56 healthy controls (HCs) were included in our research. We collected gait parameters using the JiBuEn gait-analysis system. For spatiotemporal gait parameters and kinematic gait parameters, we observed significant differences in stride length (SL), gait velocity, the variability of SL, heel strike angle, and the range of motion (ROM) of the ankle, knee, and hip joints between HCs and PD patients in H-Y Ⅰ-Ⅱ. The changes worsened with the progression of PD. The differences in the asymmetry index of the SL and ROM of the hip were found between HCs and patients in H-Y Ⅳ. Additionally, these gait parameters were significantly associated with Unified Parkinson's Disease Rating Scale and Parkinson's Disease Questionnaire-39. This study demonstrated that gait impairment occurs in the early stage of PD and deteriorates with the progression of the disease. The gait parameters mentioned above may help to detect PD earlier and assess the progression of PD.
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Affiliation(s)
- Sha Zhu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhuang Wu
- Neurotoxin Research Center of Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Yaxi Wang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yinyin Jiang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Ruxin Gu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Min Zhong
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xu Jiang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Bo Shen
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jun Zhu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jun Yan
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yang Pan
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Li Zhang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
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Thigh and Shank, Kinetic and Potential Energies during Gait Swing Phase in Healthy Adults and Stroke Survivors. Brain Sci 2022; 12:brainsci12081026. [PMID: 36009089 PMCID: PMC9405780 DOI: 10.3390/brainsci12081026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 12/10/2022] Open
Abstract
Background/Problem. Given the treatment-resistant gait deficits after stroke and known elevated energy cost of gait after stroke, it is important to study the patterns of mechanical energies of the lower limb segments. There is a dearth of information regarding mechanical energies specifically for the thigh and shank across the gait cycle. Therefore, the purpose of the current work was to characterize the following: (1) relative patterns of oscillation kinetic energy (KE) and potential energy (PE) within lower limb segments and across lower limb segments in healthy adults during the swing phase at chosen and slow gait speeds; (2) KE and PE swing phase patterns and values for stroke survivors versus healthy adults walking at slow speed; and (3) KE and PE patterns during the swing phase for two different compensatory gait strategies after stroke,. Methods. This was a gait characterization study, a two-group, parallel-cohort study of fourteen stroke survivors with gait deficits, walking at <0.4 m/s and eight adults with no gait deficits. For testing, the eight healthy adults walked at their chosen speed, and then at the imposed slow speed of <0.04 m/s. We used a standard motion capture system and calculation methods to acquire, calculate, and characterize oscillation patterns of KE and PE of the limb segments (thigh and shank) across the gait cycle. Results. In healthy adults, we identified key energy conservation mechanisms inherent in the interactions of KE and PE, both within the thigh and shank segments and across those limb segments, partially explaining the low cost of energy of the normal adult chosen speed gait pattern, and the underlying mechanism affording the known minimal set of activated muscles during walking, especially during the early swing phase. In contrast, KE was effectively absent for both healthy adults at imposed slow walking speed and stroke survivors at their very slow chosen speed, eliminating the normal conservation of energy between KE and PE within the thigh and across the thigh and shank. Moreover, and in comparison to healthy adult slow speed, stroke survivors exhibited greater abnormalities in mechanical energies patterns, reflected in either a compensatory stepping strategy (over-flexing the hip) or circumducting strategy (stiff-legged gait, with knee extended throughout the swing phase). Conclusions and contribution to the field. Taken together, these findings support targeted training to restore normal balance control and normal activation and de-activation coordination of hip, knee, and ankle muscles, respectively (agonist/antagonist at each joint), so as to eliminate the known post-stroke abnormal co-contractions; this motor training is critical in order to release the limb to swing normally in response to mechanical energies and afford the use of conservation of KE and PE energies within the thigh and across thigh and shank.
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Arippa F, Leban B, Monticone M, Cossu G, Casula C, Pau M. A Study on Lower Limb Asymmetries in Parkinson’s Disease during Gait Assessed through Kinematic-Derived Parameters. Bioengineering (Basel) 2022; 9:bioengineering9030120. [PMID: 35324809 PMCID: PMC8945156 DOI: 10.3390/bioengineering9030120] [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: 02/21/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022] Open
Abstract
Unilaterality of motor symptoms is a distinctive feature of Parkinson’s Disease (PD) and represents an important co-factor involved in motor deficits and limitations of functional abilities including postural instability and asymmetrical gait. In recent times, an increasing number of studies focused on the characterization of such alterations, which have been associated with increased metabolic cost and risk of falls and may severely compromise their quality of life. Although a large number of studies investigated the gait alterations in people with PD (pwPD), few focused on kinematic parameters and even less investigated interlimb asymmetry under a kinematic point of view. This retrospective study aimed to characterize such aspects in a cohort of 61 pwPD (aged 68.9 ± 9.3 years) and 47 unaffected individuals age- and sex-matched (66.0 ± 8.3 years), by means of computerized 3D gait analysis performed using an optical motion-capture system. The angular trends at hip, knee and ankle joints of pwPD during the gait cycle were extracted and compared with those of unaffected individuals on a point-by-point basis. Interlimb asymmetry was assessed using angle–angle diagrams (cyclograms); in particular, we analyzed area, orientation, trend symmetry and range offset. The results showed that pwPD are characterized by a modified gait pattern particularly at the terminal stance/early swing phase of the gait cycle. Significant alterations of interlimb coordination were detected at the ankle joint (cyclogram orientation and trend symmetry) and at the hip joint (range offset). Such findings might be useful in clinical routine to characterize asymmetry during gait and thus support physicians in the early diagnosis and in the evaluation of the disease progression.
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Affiliation(s)
- Federico Arippa
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (F.A.); (B.L.)
- Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, ARNAS “G. Brotzu”, 09134 Cagliari, Italy;
| | - Bruno Leban
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (F.A.); (B.L.)
| | - Marco Monticone
- Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, ARNAS “G. Brotzu”, 09134 Cagliari, Italy;
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy
| | - Giovanni Cossu
- Neurophysiology and Movement Disorders Unit, Department of Neurology, ARNAS “G. Brotzu”, 09134 Cagliari, Italy;
| | - Carlo Casula
- Physical Medicine and Rehabilitation Unit, ARNAS “G. Brotzu”, 09134 Cagliari, Italy;
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (F.A.); (B.L.)
- Correspondence:
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8
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Leal-Nascimento AH, da Silva ES, Zanardi APJ, Ivaniski-Mello A, Passos-Monteiro E, Martinez FG, Rodrigo de Carvalho A, Baptista RR, Peyré-Tartaruga LA. Biomechanical responses of Nordic walking in people with Parkinson's disease. Scand J Med Sci Sports 2021; 32:290-297. [PMID: 34780079 DOI: 10.1111/sms.14095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/28/2021] [Accepted: 11/08/2021] [Indexed: 11/27/2022]
Abstract
In healthy adults, Nordic walking (NW) is known to increase the external mechanical energy fluctuations, though the external work is unaltered due to an improved pendulum-like recovery in comparison with free walking (FW). We aimed to compare mechanical, pendulum-like, and spatiotemporal parameters of gait at different speeds with and without NW poles in people with Parkinson's disease and healthy controls. The study included 11 people (aged 65.6 ± 7.0 years) with idiopathic Parkinson's disease, scoring between 1 and 1.5 on the Hoehn and Yahr scale (H&Y), and nine healthy controls (aged 70.0 ± 5.6 years). All the people were experienced Nordic walkers. Walking tests were performed at 1.8 km h-1 and 4.7 km h-1 , on eight 3D force platforms on a walkway. We found greater pendulum-like energy recovery (p < 0.05) in the Parkinson group during NW than in FW, while external mechanical work remained similar (p > 0.05). People with Parkinson's disease showed a major increase in vertical and forward energy fluctuations using poles than in healthy controls. In addition, the Parkinson group showed increased stride frequency and reduced stride length compared to controls in the NW and FW conditions. Our findings partly justify the lower walking economy in Parkinson's disease due to reduced pendulum-like mechanism at commonly used speeds. NW alters gait mechanics similarly in Parkinson group and healthy control, increasing the total mechanical work. Therefore, NW can be a compelling strategy for rehabilitation because of its potential for improving functional mobility, increasing pendulum-like mechanism in Parkinson's disease.
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Affiliation(s)
- Antonio Henrique Leal-Nascimento
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Federal Institute of Education, Science and Technology of Pará, Abaetetuba, Brazil
| | - Edson Soares da Silva
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - André Ivaniski-Mello
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Elren Passos-Monteiro
- Postgraduate in Human Movement Sciences, Faculty of Physical Education, Universidade Federal do Pará, Castanhal, Brazil
| | - Flávia Gomes Martinez
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Rafael Reimann Baptista
- Physical Activity Research Laboratory, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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Peyré-Tartaruga LA, Dewolf AH, di Prampero PE, Fábrica G, Malatesta D, Minetti AE, Monte A, Pavei G, Silva-Pereyra V, Willems PA, Zamparo P. Mechanical work as a (key) determinant of energy cost in human locomotion: recent findings and future directions. Exp Physiol 2021; 106:1897-1908. [PMID: 34197674 DOI: 10.1113/ep089313] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/29/2021] [Indexed: 01/09/2023]
Abstract
NEW FINDINGS What is the topic of this review? This narrative review explores past and recent findings on the mechanical determinants of energy cost during human locomotion, obtained by using a mechanical approach based on König's theorem (Fenn's approach). What advances does it highlight? Developments in analytical methods and their applications allow a better understanding of the mechanical-bioenergetic interaction. Recent advances include the determination of 'frictional' internal work; the association between tendon work and apparent efficiency; a better understanding of the role of energy recovery and internal work in pathological gait (amputees, stroke and obesity); and a comprehensive analysis of human locomotion in (simulated) low gravity conditions. ABSTRACT During locomotion, muscles use metabolic energy to produce mechanical work (in a more or less efficient way), and energetics and mechanics can be considered as two sides of the same coin, the latter being investigated to understand the former. A mechanical approach based on König's theorem (Fenn's approach) has proved to be a useful tool to elucidate the determinants of the energy cost of locomotion (e.g., the pendulum-like model of walking and the bouncing model of running) and has resulted in many advances in this field. During the past 60 years, this approach has been refined and applied to explore the determinants of energy cost and efficiency in a variety of conditions (e.g., low gravity, unsteady speed). This narrative review aims to summarize current knowledge of the role that mechanical work has played in our understanding of energy cost to date, and to underline how recent developments in analytical methods and their applications in specific locomotion modalities (on a gradient, at low gravity and in unsteady conditions) and in pathological gaits (asymmetric gait pathologies, obese subjects and in the elderly) could continue to push this understanding further. The recent in vivo quantification of new aspects that should be included in the assessment of mechanical work (e.g., frictional internal work and elastic contribution) deserves future research that would improve our knowledge of the mechanical-bioenergetic interaction during human locomotion, as well as in sport science and space exploration.
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Affiliation(s)
| | - Arthur H Dewolf
- Laboratory of Biomechanics and Physiology of Locomotion, Institute of NeuroScience, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Department of Systems Medicine and Center of Space Biomedicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Gabriel Fábrica
- Departamento de Biofísica, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Davide Malatesta
- Institute of Sport Sciences of the University of Lausanne (ISSUL), University of Lausanne, Lausanne, Switzerland
| | - Alberto E Minetti
- Department of Pathophysiology and Transplantation, Physiology Division, Laboratory of Physiomechanics of Locomotion, University of Milan, Milan, Italy
| | - Andrea Monte
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gaspare Pavei
- Department of Pathophysiology and Transplantation, Physiology Division, Laboratory of Physiomechanics of Locomotion, University of Milan, Milan, Italy
| | | | - Patrick A Willems
- Laboratory of Biomechanics and Physiology of Locomotion, Institute of NeuroScience, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Paola Zamparo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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10
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Peterson DS, Mancini M, Fino PC, Horak F, Smulders K. Speeding Up Gait in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 10:245-253. [PMID: 31561384 DOI: 10.3233/jpd-191682] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Gait speed is an important outcome that relates to mobility, function, and mortality, and is altered in people with Parkinson's disease (PwPD). However, changes in gait speed may not reflect changes in other important aspects of gait. OBJECTIVE To characterize which outcomes change concomitantly with walking speed in PwPD. This information can inform the choice of outcome variables for characterizing and tracking gait performance in this population. METHODS 67 PwPD and 40 neurotypical adults completed 2-minute overground walking bouts at comfortable and fast self-selected speeds. Eight inertial sensors were used to characterize gait and turning. We identified a subset of participants (38 per group) where the PD participant's "fast" walk was similar speed to neurotypical participants "comfortable" walk, facilitating an across-group gait comparison controlling for gait speed. RESULTS Walking at fast gait speed compared to comfortable lead to significant changes in stride length, cadence, and stride time variability, but not in steps to turn, trunk ROM, and trunk and lumbar stability in PwPD. Sub-group analyses showed that despite walking at a similar speed as neurotypical adults, PwPD exhibit altered turning outcomes, lumbar stability, and stride length/cadence. CONCLUSIONS Gait speed is a critical outcome for characterizing mobility. However, in PwPD, several important outcomes do not exhibit a uniform relationship with gait speed, and remain altered compared to neurotypical adults despite "normalizing" walking speed. Given the complex relationship between gait speed and other gait quality measures, care should be taken when choosing outcome measures to characterize the breadth of gait abnormality in PwPD.
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Affiliation(s)
- Daniel S Peterson
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA.,U.S. Department of Veterans Affairs, Phoenix, AZ, USA.,Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Peter C Fino
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT, USA
| | - Fay Horak
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Katrijn Smulders
- Department of Scientific Research Sint Maartenskliniek, Nijmegen, Netherlands
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Wu Z, Xu H, Zhu S, Gu R, Zhong M, Jiang X, Shen B, Zhu J, Pan Y, Dong J, Yan J, Zhang W, Zhang L. Gait Analysis of Old Individuals with Mild Parkinsonian Signs and Those Individuals' Gait Performance Benefits Little from Levodopa. Risk Manag Healthc Policy 2021; 14:1109-1118. [PMID: 33758563 PMCID: PMC7979347 DOI: 10.2147/rmhp.s291669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose Gait analysis and the effects of levodopa on the gait characteristics in Mild parkinsonian signs (MPS) are rarely published. The present research aimed to (1) analyze the gait characteristics in MPS; (2) explore the effects of levodopa on the gait performance of MPS. Methods We enrolled 22 inpatients with MPS and 20 healthy control subjects (HC) from Nanjing Brain Hospital. The Unified Parkinson’s Disease Rating Scale was used to evaluate motor symptoms. Acute levodopa challenge test was performed to explore the effects of levodopa on the gait performance of MPS. The instrumented stand and walk test was conducted for each participant and the JiBuEn gait analysis system was used to collect gait data. Results For spatiotemporal parameters: Compared with HC, the state before taking levodopa/benserazide in MPS group (meds-off) demonstrated a decrease in stride length (SL) (p≤0.001), an increase in SL variability (p≤0.001), and swing phase time variability (p=0.016). Compared with meds-off, the state after 1 hour of taking levodopa/benserazide in MPS group (meds-on) exhibited an increase in SL (p≤0.001), a decrease in SL variability (p≤0.001). For kinematic parameters: Compared with HC, meds-off demonstrated a decrease in heel strike angle (p=0.008), range of motion (ROM) of knee joint (p=0.011) and ROM of hip joint (p=0.007). Compared with meds-off, meds-on exhibited an increase in HS (p≤0.001). Bradykinesia and rigidity scores were significantly correlated with gait parameters. Conclusion Although the clinical symptoms of the MPS group are mild, their gait damage is obvious and they exhibited a decreased SL and joints movement, and a more variable gait pattern. Levodopa had little effect on the gait performance of those individuals.
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Affiliation(s)
- Zhuang Wu
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Hang Xu
- Department of Neurology, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, People's Republic of China
| | - Sha Zhu
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Ruxin Gu
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Min Zhong
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Xu Jiang
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Bo Shen
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jun Zhu
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Yang Pan
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jingde Dong
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jun Yan
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Wenbin Zhang
- Department of Neurosurgery, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Li Zhang
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
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12
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Song MH, Song HR, Kim WS. Inter-limb difference of mechanical work in limb length discrepancy. Gait Posture 2021; 84:79-86. [PMID: 33285382 DOI: 10.1016/j.gaitpost.2020.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Limb length discrepancy (LLD) is common and is associated with musculoskeletal disorders. Selection of adaptation strategies, the side more susceptible to complications, and the relationships between LLD magnitude and musculoskeletal complications are unclear. To elucidate these ambiguities, studies on gait parameters in LLD have been conducted. However, studies on inter-limb difference of mechanical work in LLD are rare. RESEARCH QUESTION To investigate whether inter-limb differences in mechanical work in LLD and the relationship between LLD magnitude and mechanical work performed by each lower limb are significant. METHODS Thirty-seven participants with LLD and without neuromuscular disorders disturbing normal gait were included. Three-dimensional motion analysis was conducted to obtain data on mechanical work, including joint work and the individual limb method (ILM) work. Mechanical work performed by the longer and shorter limbs was compared using paired t-test. Relationships between LLD and mechanical work were investigated using correlation and multiple regression analyses in both limbs. Eighteen participants had LLD > 20 mm, large group (LG), and 19 had LLD < 20 mm, small group (SG). Data exploration was conducted for the effect of LLD severity (LG vs. SG) on mechanical work. RESULTS LLD showed significant inter-limb difference of mechanical work and negative correlations with positive and negative ILM work performed by the shorter limb. The shorter limb in SG performed significantly larger positive ILM work than the longer limb, whereas the longer limb in LG performed significantly larger negative ILM work than the shorter limb. SIGNIFICANCE LLD showed inter-limb difference of ILM work and different adaptation strategies between LG and SG. These differences attribute to the decrease in ILM work performed by the shorter limb with the increase in LLD. Mechanical work including ILM work should be included in future studies to prevent complications and development of treatment methods for LLD.
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Affiliation(s)
- Mi Hyun Song
- Department of Orthopedic Surgery and Institute for Rare Diseases, Korea University Medical Center, Guro Hospital, Seoul, Republic of Korea
| | - Hae-Ryong Song
- Department of Orthopedic Surgery and Institute for Rare Diseases, Korea University Medical Center, Guro Hospital, Seoul, Republic of Korea
| | - Woo-Sub Kim
- Department of Physical Medicine & Rehabilitation, Korea University Medical Center, Guro Hospital, Seoul, Republic of Korea; Motion Analysis Center, Korea University Medical Center, Guro Hospital, Seoul, Republic of Korea.
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13
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Zanardi APJ, da Silva ES, Costa RR, Passos-Monteiro E, Dos Santos IO, Kruel LFM, Peyré-Tartaruga LA. Gait parameters of Parkinson's disease compared with healthy controls: a systematic review and meta-analysis. Sci Rep 2021; 11:752. [PMID: 33436993 PMCID: PMC7804291 DOI: 10.1038/s41598-020-80768-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/28/2020] [Indexed: 12/15/2022] Open
Abstract
We systematically reviewed observational and clinical trials (baseline) studies examining differences in gait parameters between Parkinson’s disease (PD) in on-medication state and healthy control. Four electronic databases were searched (November-2018 and updated in October-2020). Independent researchers identified studies that evaluated gait parameters measured quantitatively during self-selected walking speed. Risk of bias was assessed using an instrument proposed by Downs and Black (1998). Pooled effects were reported as standardized mean differences and 95% confidence intervals using a random-effects model. A total of 72 studies involving 3027 participants (1510 with PD and 1517 health control) met the inclusion criteria. The self-selected walking speed, stride length, swing time and hip excursion were reduced in people with PD compared with healthy control. Additionally, PD subjects presented higher cadence and double support time. Although with a smaller difference for treadmill, walking speed is reduced both on treadmill (.13 m s−1) and on overground (.17 m s−1) in PD. The self-select walking speed, stride length, cadence, double support, swing time and sagittal hip angle were altered in people with PD compared with healthy control. The precise determination of these modifications will be beneficial in determining which intervention elements are most critical in bringing about positive, clinically meaningful changes in individuals with PD (PROSPERO protocol CRD42018113042).
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Affiliation(s)
- Ana Paula Janner Zanardi
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil.,Univel University Center, Cascavel, Brazil
| | - Edson Soares da Silva
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil
| | - Rochelle Rocha Costa
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil
| | - Elren Passos-Monteiro
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil.,Laboratory of PhysioMechanics of Locomotion, Universidade Federal Do Pará, Castanhal, Brazil
| | - Ivan Oliveira Dos Santos
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil
| | - Luiz Fernando Martins Kruel
- Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, 750 Felizardo St, Porto Alegre, RS, 90690-200, Brazil
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14
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Palmisano C, Todisco M, Marotta G, Volkmann J, Pacchetti C, Frigo CA, Pezzoli G, Isaias IU. Gait initiation in progressive supranuclear palsy: brain metabolic correlates. NEUROIMAGE-CLINICAL 2020; 28:102408. [PMID: 33353609 PMCID: PMC7689404 DOI: 10.1016/j.nicl.2020.102408] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/29/2020] [Accepted: 08/30/2020] [Indexed: 02/07/2023]
Abstract
Dysfunctional gait initiation in progressive supranuclear palsy relates to poor feedforward motor control. Hypometabolism of the caudate nucleus impairs programming of anticipatory postural adjustments. Thalamic hypometabolism correlates with the center of mass kinematic resultants of anticipatory postural adjustments.
The initiation of gait is a highly challenging task for the balance control system, and can be used to investigate the neural control of upright posture maintenance during whole-body movement. Gait initiation is a centrally-mediated motion achieved in a principled, controlled manner, including predictive mechanisms (anticipatory postural adjustments, APA) that destabilize the antigravitary postural set of body segments for the execution of functionally-optimized stepping. Progressive supranuclear palsy (PSP) is a neurodegenerative disease characterized by early impairment of balance and frequent falls. The neural correlates of postural imbalance and falls in PSP are largely unknown. We biomechanically assessed the APA at gait initiation (imbalance, unloading, and stepping phases) of 26 patients with PSP and 14 age-matched healthy controls. Fourteen of 26 enrolled patients were able to perform valid gait initiation trials. The influence of anthropometric and base-of-support measurements on the biomechanical outcome variables was assessed and removed. Biomechanical data were correlated with clinical findings and, in 11 patients, with brain metabolic abnormalities measured using positron emission tomography and 2-deoxy-2-[18F]fluoro-D-glucose. Patients with PSP showed impaired modulation of the center of pressure displacement for a proper setting of the center of mass momentum and subsequent efficient stepping. Biomechanical measurements correlated with “Limb motor” and “Gait and midline” subscores of the Progressive Supranuclear Palsy Rating Scale. Decreased regional glucose uptake in the caudate nucleus correlated with impaired APA programming. Hypometabolism of the caudate nucleus, supplementary motor area, cingulate cortex, thalamus, and midbrain was associated with specific biomechanical resultants of APA. Our findings show that postural instability at gait initiation in patients with PSP correlates with deficient APA production, and is associated with multiple and distinctive dysfunctioning of different areas of the supraspinal locomotor network. Objective biomechanical measures can help to understand fall-related pathophysiological mechanisms and to better monitor disease progression and new interventions.
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Affiliation(s)
- Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany; MBMC Lab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Massimiliano Todisco
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany; Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Giorgio Marotta
- Department of Nuclear Medicine, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Claudio Pacchetti
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Carlo A Frigo
- MBMC Lab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Ioannis U Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany.
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15
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Dos Santos Delabary M, Monteiro EP, Donida RG, Wolffenbuttel M, Peyré-Tartaruga LA, Haas AN. Can Samba and Forró Brazilian rhythmic dance be more effective than walking in improving functional mobility and spatiotemporal gait parameters in patients with Parkinson's disease? BMC Neurol 2020; 20:305. [PMID: 32811464 PMCID: PMC7433088 DOI: 10.1186/s12883-020-01878-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/05/2020] [Indexed: 01/09/2023] Open
Abstract
Background Parkinson’s disease (PD) causes motor and nonmotor disorders in patients. Unlike aerobic training, potential adaptations from the practice of dance are less understood in PD, particularly compared with better known exercise modes. This study aimed to verify and compare the effects of a Brazilian dance program, inspired by Samba and Forrró rhythms, and a walking program on functional mobility and spatiotemporal gait parameters in patients with PD. Methods Eighteen participants with PD were divided into a dance group (DG) and a walking group (WG) and were assessed before and after an intervention period of 24 1-h sessions, performed twice per week for 12 weeks. The timed-up-and-go test (TUG) and walking kinematics at self-selected speed (SSS) and fast speed (FS) were determined. The generalized estimating equation method was used to compare the DG and WG pre- and post-intervention and to evaluate the group*time interaction (α < 0.05). Results Both groups demonstrated a significant improvement in TUG test at SSS (p = 0.02; effect size [ES] = 0.42) and FS (p = 0.02; ES = 0.24). In general, spatiotemporal parameters remained unchanged, except at SSS, in which the DG increased the stride frequency (p = 0.011; ES = 0.72). At FS, the swing time demonstrated a significant group*time interaction (p < 0.001; ES = 1.10), in which the two groups exhibited different behaviors: DG decreased (p = 0.015) and WG increased (p = 0.012). Conclusions Functional mobility improved similarly in both groups. The results suggest that a 12-week program of Brazilian dance was sufficient to produce improvements in functional mobility and gait in individuals with PD. Trial registration This study is registered with the International Clinical Trial Registry under number NCT03370315. Registered December 28, 2017 - Retrospectively registered.
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Affiliation(s)
- Marcela Dos Santos Delabary
- Federal University of Rio Grande do Sul, Street Felizardo, 750, Jardim Botânico, Porto Alegre, Rio Grande do Sul, Brazil.
| | | | - Rebeca Gimenes Donida
- Federal University of Rio Grande do Sul, Street Felizardo, 750, Jardim Botânico, Porto Alegre, Rio Grande do Sul, Brazil
| | - Mariana Wolffenbuttel
- Federal University of Rio Grande do Sul, Street Felizardo, 750, Jardim Botânico, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Aline Nogueira Haas
- Federal University of Rio Grande do Sul, Street Felizardo, 750, Jardim Botânico, Porto Alegre, Rio Grande do Sul, Brazil
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16
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Nardello F, Bombieri F, Monte A. Leverage mechanical alterations during walking at self-selected speed in patients with Parkinson's disease. Gait Posture 2020; 79:175-182. [PMID: 32422557 DOI: 10.1016/j.gaitpost.2020.04.030] [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: 04/17/2019] [Revised: 12/30/2019] [Accepted: 04/29/2020] [Indexed: 02/02/2023]
Abstract
Individuals with Parkinson's disease (PD) show poor walking performance compared to healthy adults. Leverage changes may provide insight into this walking abnormality, since they have important effects on both biomechanical and physiological variables. Hence, we investigated the differences in internal and external moment arms at the knee and ankle joints, as well as the effective mechanical advantage during walking at self-selected speed. Furthermore, the effects on walking of a simultaneous cognitive task were analysed. Kinetic (resultant ground reaction force and joint moments), kinematic (movement speed) and mechanical leverage (internal and external moment arms) parameters of 10 mild-to-moderate PD patients and 10 age-matched controls were measured in single and dual task condition. Finally, effective mechanical advantage was calculated as the ratio between internal and external moment arm for each joint. PD patients had a slower walking and showed larger and lower values of knee and ankle joint moments, respectively. No difference in force among groups was recorded. External moment arms were larger (in both joints) for PD, whereas slight changes were observed for internal moment arms. Consequently, effective mechanical advantage values seemed to be lower for PD. Surprisingly, leverage difference among groups was reduced during the dual task condition, resulting in a "more effective" walking strategy for PD. These findings suggest that during single task PD patients have several leverage disadvantages, which could affect the joint assessment. On the contrary, during dual task they reduced these mechanical negative effects by positively obtaining normal values of effective mechanical advantage.
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Affiliation(s)
- F Nardello
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - F Bombieri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - A Monte
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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17
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Sellers WI, Rose KAR, Crossley DA, Codd JR. Inferring cost of transport from whole-body kinematics in three sympatric turtle species with different locomotor habits. Comp Biochem Physiol A Mol Integr Physiol 2020; 247:110739. [PMID: 32446940 DOI: 10.1016/j.cbpa.2020.110739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 11/19/2022]
Abstract
Chelonians are mechanically unusual vertebrates as an exoskeleton limits their body wall mobility. They generally move slowly on land and have aquatic or semi-aquatic lifestyles. Somewhat surprisingly, the limited experimental work that has been done suggests that their energetic cost of transport (CoT) are relatively low. This study examines the mechanical evidence for CoT in three turtle species that have differing degrees of terrestrial activity. Our results show that Apolone travels faster than the other two species, and that Chelydra has higher levels of yaw. All the species show poor mean levels of energy recovery, and, whilst there is considerable variation, never show the high levels of energy recovery seen in cursorial quadrupeds. The mean mechanical CoT is 2 to 4 times higher than is generally seen in terrestrial animals. We therefore find no mechanical support for a low CoT in these species. This study illustrates the need for research on a wider range of chelonians to discover whether there are indeed general trends in mechanical and metabolic energy costs.
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Affiliation(s)
- William I Sellers
- Department of Earth and Environmental Sciences, University of Manchester, UK.
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18
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Palmisano C, Brandt G, Vissani M, Pozzi NG, Canessa A, Brumberg J, Marotta G, Volkmann J, Mazzoni A, Pezzoli G, Frigo CA, Isaias IU. Gait Initiation in Parkinson's Disease: Impact of Dopamine Depletion and Initial Stance Condition. Front Bioeng Biotechnol 2020; 8:137. [PMID: 32211390 PMCID: PMC7068722 DOI: 10.3389/fbioe.2020.00137] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/11/2020] [Indexed: 01/14/2023] Open
Abstract
Postural instability, in particular at gait initiation (GI), and resulting falls are a major determinant of poor quality of life in subjects with Parkinson’s disease (PD). Still, the contribution of the basal ganglia and dopamine on the feedforward postural control associated with this motor task is poorly known. In addition, the influence of anthropometric measures (AM) and initial stance condition on GI has never been consistently assessed. The biomechanical resultants of anticipatory postural adjustments contributing to GI [imbalance (IMB), unloading (UNL), and stepping phase) were studied in 26 unmedicated subjects with idiopathic PD and in 27 healthy subjects. A subset of 13 patients was analyzed under standardized medication conditions and the striatal dopaminergic innervation was studied in 22 patients using FP-CIT and SPECT. People with PD showed a significant reduction in center of pressure (CoP) displacement and velocity during the IMB phase, reduced first step length and velocity, and decreased velocity and acceleration of the center of mass (CoM) at toe off of the stance foot. All these measurements correlated with the dopaminergic innervation of the putamen and substantially improved with levodopa. These results were not influenced by anthropometric parameters or by the initial stance condition. In contrast, most of the measurements of the UNL phase were influenced by the foot placement and did not correlate with putaminal dopaminergic innervation. Our results suggest a significant role of dopamine and the putamen particularly in the elaboration of the IMB phase of anticipatory postural adjustments and in the execution of the first step. The basal ganglia circuitry may contribute to defining the optimal referent body configuration for a proper initiation of gait and possibly gait adaptation to the environment.
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Affiliation(s)
- Chiara Palmisano
- Department of Neurology, University Hospital Würzburg and The Julius Maximilian University of Würzburg, Würzburg, Germany.,MBMC Lab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Gregor Brandt
- Department of Neurology, University Hospital Würzburg and The Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Matteo Vissani
- Translational Neural Engineering Area, The Biorobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Nicoló G Pozzi
- Department of Neurology, University Hospital Würzburg and The Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Andrea Canessa
- Fondazione Europea di Ricerca Biomedica (FERB Onlus), Cernusco s/N (Milan), Italy
| | - Joachim Brumberg
- Department of Nuclear Medicine, University Hospital Würzburg and The Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Giorgio Marotta
- Department of Nuclear Medicine, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg and The Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Alberto Mazzoni
- Translational Neural Engineering Area, The Biorobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | | | - Carlo A Frigo
- MBMC Lab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Ioannis U Isaias
- Department of Neurology, University Hospital Würzburg and The Julius Maximilian University of Würzburg, Würzburg, Germany
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19
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Variance of the Gait Parameters and Fraction of Double-Support Interval for Determining the Severity of Parkinson’s Disease. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10020577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine the gait features that are most suitable for the quantified assessment of the severity of Parkinson’s disease (PD). This study computed the mean and variance of the four phases of gait intervals, i.e., stride, swing, stance and double-support intervals, and lateral difference to determine the difference between three groups, i.e., control subjects and PD patients with two severity levels (early and advanced stage) of the disease, PD1 and PD2. Data from 31 subjects were used in the study. The data were obtained from the public database (16 control healthy subjects, 6 Parkinson’s disease patients with early stages, and 9 Parkinson’s disease patients with advanced stages based on the Hoehn and Yahr scale). The main outcome measure of the study was the group difference of the four gait interval parameters and the statistical significance of this difference. The results show that there was a significant increase in the variance of the four gait intervals with the severity of the disease. However, there was no significant difference in the mean values between the three groups. It was also observed that the fraction corresponding to the double-support interval was significantly higher for PD patients. This study has shown that the variance of the gait parameters and the fraction of double-support interval are associated with the severity of PD and may be suitable measures for a quantified evaluation of the disease.
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20
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Peyré-Tartaruga LA, Coertjens M. Locomotion as a Powerful Model to Study Integrative Physiology: Efficiency, Economy, and Power Relationship. Front Physiol 2018; 9:1789. [PMID: 30618802 PMCID: PMC6297284 DOI: 10.3389/fphys.2018.01789] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/28/2018] [Indexed: 12/02/2022] Open
Abstract
Locomotion is the most common form of movement in nature. Its study allows analysis of interactions between muscle functions (motor) and lever system arrangements (transmission), thereby facilitating performance analysis of various body organs and systems. Thus, it is a powerful model to study various aspects of integrative physiology. The results of this model can be applied in understanding body functions and design principles as performance outputs of interest for medical and biological sciences. The overall efficiency (effoverall) during locomotion is an example of an integrative parameter, which results from the ratio between mechanical output and metabolic input. Although the concepts of cost (i.e., metabolic expenditure relative to distance) and power (i.e., metabolic expenditure relative to time) are included in its calculation, the effoverall establishes peculiar relations with these variables. For a better approach to these aspects, in this study, we presented the physical-mathematical formulation of efficiency, as well as its conceptual definitions and applications. Furthermore, the concepts of efficiency, cost, and power are discussed from the biological and medical perspectives. Terrestrial locomotion is a powerful model to study integrative physiology in humans, because by analyzing the mechanical and metabolic determinants, we may verify the efficiency and economy relationship through locomotion type, and its characteristics and restrictions. Thus, it is possible to elaborate further on various improved intervention strategies, such as physical training, competition strategies, and ergogenic supplementation.
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Affiliation(s)
- Leonardo Alexandre Peyré-Tartaruga
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Program in Pneumological Sciences, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Marcelo Coertjens
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Program in Pneumological Sciences, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,School of Physical Therapy, Federal University of Piauì, Parnaìba, Brazil
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21
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Arnulfo G, Pozzi NG, Palmisano C, Leporini A, Canessa A, Brumberg J, Pezzoli G, Matthies C, Volkmann J, Isaias IU. Phase matters: A role for the subthalamic network during gait. PLoS One 2018; 13:e0198691. [PMID: 29874298 PMCID: PMC5991417 DOI: 10.1371/journal.pone.0198691] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/23/2018] [Indexed: 12/15/2022] Open
Abstract
The role of the subthalamic nucleus in human locomotion is unclear although relevant, given the troublesome management of gait disturbances with subthalamic deep brain stimulation in patients with Parkinson’s disease. We investigated the subthalamic activity and inter-hemispheric connectivity during walking in eight freely-moving subjects with Parkinson’s disease and bilateral deep brain stimulation. In particular, we compared the subthalamic power spectral densities and coherence, amplitude cross-correlation and phase locking value between resting state, upright standing, and steady forward walking. We observed a phase locking value drop in the β-frequency band (≈13-35Hz) during walking with respect to resting and standing. This modulation was not accompanied by specific changes in subthalamic power spectral densities, which was not related to gait phases or to striatal dopamine loss measured with [123I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane and single-photon computed tomography. We speculate that the subthalamic inter-hemispheric desynchronization in the β-frequency band reflects the information processing of each body side separately, which may support linear walking. This study also suggests that in some cases (i.e. gait) the brain signal, which could allow feedback-controlled stimulation, might derive from network activity.
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Affiliation(s)
- Gabriele Arnulfo
- Department of Neurology, University Hospital and Julius-Maximillian-University, Wuerzburg, Germany
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Nicolò Gabriele Pozzi
- Department of Neurology, University Hospital and Julius-Maximillian-University, Wuerzburg, Germany
| | - Chiara Palmisano
- Department of Neurology, University Hospital and Julius-Maximillian-University, Wuerzburg, Germany
- Department of Electronics, Information and Bioengineering, MBMC Lab, Politecnico di Milano, Milan, Italy
| | - Alice Leporini
- Department of Neurology, University Hospital and Julius-Maximillian-University, Wuerzburg, Germany
| | - Andrea Canessa
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
- Fondazione Europea di Ricerca Biomedica (FERB Onlus), Cernusco s/N (Milan), Italy
| | - Joachim Brumberg
- Department of Nuclear Medicine, University Hospital and Julius-Maximillian-University, Wuerzburg, Germany
| | | | - Cordula Matthies
- Department of Neurosurgery, University Hospital and Julius-Maximillian-University, Wuerzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital and Julius-Maximillian-University, Wuerzburg, Germany
| | - Ioannis Ugo Isaias
- Department of Neurology, University Hospital and Julius-Maximillian-University, Wuerzburg, Germany
- * E-mail:
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22
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Shoe-Insole Technology for Injury Prevention in Walking. SENSORS 2018; 18:s18051468. [PMID: 29738486 PMCID: PMC5982664 DOI: 10.3390/s18051468] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/23/2018] [Accepted: 04/29/2018] [Indexed: 12/22/2022]
Abstract
Impaired walking increases injury risk during locomotion, including falls-related acute injuries and overuse damage to lower limb joints. Gait impairments seriously restrict voluntary, habitual engagement in injury prevention activities, such as recreational walking and exercise. There is, therefore, an urgent need for technology-based interventions for gait disorders that are cost effective, willingly taken-up, and provide immediate positive effects on walking. Gait control using shoe-insoles has potential as an effective population-based intervention, and new sensor technologies will enhance the effectiveness of these devices. Shoe-insole modifications include: (i) ankle joint support for falls prevention; (ii) shock absorption by utilising lower-resilience materials at the heel; (iii) improving reaction speed by stimulating cutaneous receptors; and (iv) preserving dynamic balance via foot centre of pressure control. Using sensor technology, such as in-shoe pressure measurement and motion capture systems, gait can be precisely monitored, allowing us to visualise how shoe-insoles change walking patterns. In addition, in-shoe systems, such as pressure monitoring and inertial sensors, can be incorporated into the insole to monitor gait in real-time. Inertial sensors coupled with in-shoe foot pressure sensors and global positioning systems (GPS) could be used to monitor spatiotemporal parameters in real-time. Real-time, online data management will enable ‘big-data’ applications to everyday gait control characteristics.
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23
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Conte C, Serrao M, Cuius L, Ranavolo A, Conforto S, Pierelli F, Padua L. Effect of Restraining the Base of Support on the Other Biomechanical Features in Patients with Cerebellar Ataxia. THE CEREBELLUM 2017; 17:264-275. [PMID: 29143300 DOI: 10.1007/s12311-017-0897-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to analyze the biomechanical consequences of reducing the base of support in patients with ataxia. Specifically, we evaluated the spatio-temporal parameters, upper- and lower-body kinematics, muscle co-activation, and energy recovery and expenditure. The gaits of 13 patients were recorded using a motion analysis system in unperturbed and perturbed walking conditions. In the latter condition, patients had to walk using the same step width and speed of healthy controls. The perturbed walking condition featured reduced gait speed, step length, hip and knee range of motion, and energy recovery and increased double support duration, gait variability, trunk oscillation, and ankle joint muscle co-activation. Narrowing the base of support increased gait instability (e.g., gait variability and trunk oscillations) and induced patients to further use alternative compensatory mechanisms to maintain dynamic balance at the expense of a reduced ability to recover mechanical energy. A widened step width gait is a global strategy employed by patients to increase dynamic stability, reduce the need for further compensatory mechanisms, and thus recover mechanical energy. Our findings suggest that rehabilitative treatment should more specifically focus on step width training.
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Affiliation(s)
- C Conte
- Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza, Polo Pontino, University of Rome, via Franco Faggiana 1668, 04100, Latina, Italy. .,Movement Analysis LAB, Rehabilitation Centre Policlinico Italia, Piazza del Campidano 6, 00162, Rome, Italy.
| | - L Cuius
- Biolab3, Department of Engineering, Roma TRE University, ViaVito Volterra 62, 00149, Rome, Italy
| | - A Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida 1, 00078, Monte Porzio Catone, Rome, Italy
| | - S Conforto
- Biolab3, Department of Engineering, Roma TRE University, ViaVito Volterra 62, 00149, Rome, Italy
| | - F Pierelli
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza, Polo Pontino, University of Rome, via Franco Faggiana 1668, 04100, Latina, Italy.,IRCSS, Neuromed, Pozzilli, IS, Italy
| | - L Padua
- Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy.,Department of Geriatrics, Neuroscience & Orthopaedics, Catholic University, L.go F. Vito, 1, 00168, Rome, Italy
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24
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Rinaldi M, Ranavolo A, Conforto S, Martino G, Draicchio F, Conte C, Varrecchia T, Bini F, Casali C, Pierelli F, Serrao M. Increased lower limb muscle coactivation reduces gait performance and increases metabolic cost in patients with hereditary spastic paraparesis. Clin Biomech (Bristol, Avon) 2017; 48:63-72. [PMID: 28779695 DOI: 10.1016/j.clinbiomech.2017.07.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/22/2017] [Accepted: 07/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to investigate the lower limb muscle coactivation and its relationship with muscles spasticity, gait performance, and metabolic cost in patients with hereditary spastic paraparesis. METHODS Kinematic, kinetic, electromyographic and energetic parameters of 23 patients and 23 controls were evaluated by computerized gait analysis system. We computed ankle and knee antagonist muscle coactivation indexes throughout the gait cycle and during the subphases of gait. Energy consumption and energy recovery were measured as well. In addition to the correlation analysis between coactivation indexes and clinical variables, correlations between coactivation indexes and time-distance, kinematic, kinetic, and energetic parameters were estimated. FINDINGS Increased coactivity indexes of both knee and ankle muscles throughout the gait cycle and during the subphases of gait were observed in patients compared with controls. Energetic parameters were significantly higher in patients than in controls. Both knee and ankle muscle coactivation indexes were positively correlated with knee and ankle spasticity (Ashworth score), respectively. Knee and ankle muscle coactivation indexes were both positively correlated with energy consumption and both negatively correlated with energy recovery. INTERPRETATION Positive correlations between the Ashworth score and lower limb muscle coactivation suggest that abnormal lower limb muscle coactivation in patients with hereditary spastic paraparesis reflects a primary deficit linked to lower limb spasticity. Furthermore, these abnormalities influence the energetic mechanisms during walking. Identifying excessive muscle coactivation may be helpful in individuating the rehabilitative treatments and designing specific orthosis to restrain spasticity.
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Affiliation(s)
- Martina Rinaldi
- Department of Engineering, Roma TRE University, Via Ostiense 159, 00154 Rome, Italy; Rehabilitation Centre, Policlinico Italia, Piazza del Campidano 6, 00162 Rome, Italy.
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy
| | - Silvia Conforto
- Department of Engineering, Roma TRE University, Via Ostiense 159, 00154 Rome, Italy.
| | - Giovanni Martino
- Centre of Space Bio-Medicine, University of Rome Tor Vergata, Via Orazio Raimondo 18, 00173 Rome, Italy; Laboratory of Neuromotor Physiology, Istituto Di Ricovero e Cura a Carattere Scientifico Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy.
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy
| | - Carmela Conte
- Fondazione Don Gnocchi, Piazzale Morandi 6, 20121 Milan, Italy
| | - Tiwana Varrecchia
- Department of Engineering, Roma TRE University, Via Ostiense 159, 00154 Rome, Italy; Rehabilitation Centre, Policlinico Italia, Piazza del Campidano 6, 00162 Rome, Italy
| | - Fabiano Bini
- Department of Mechanical and Aerospace Engineering, Mechanical & Thermal Measurement Lab, University of Rome Sapienza, Via Eudossiana 18, 00184 Rome, Italy.
| | - Carlo Casali
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Via Faggiana 34, 04100 Latina, Italy.
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Via Faggiana 34, 04100 Latina, Italy.
| | - Mariano Serrao
- Rehabilitation Centre, Policlinico Italia, Piazza del Campidano 6, 00162 Rome, Italy; Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Via Faggiana 34, 04100 Latina, Italy.
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25
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Bahreinizad H, Salimi Bani M, Hasani M, Karimi MT, Sharifmoradi K, Karimi A. A comparative study on the mechanical energy of the normal, ACL, osteoarthritis, and Parkinson subjects. Technol Health Care 2017; 25:771-780. [PMID: 28826195 DOI: 10.3233/thc-170843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The influence of various musculoskeletal disorders has been evaluated using different kinetic and kinematic parameters. But the efficiency of walking can be evaluated by measuring the effort of the subject, or by other words the energy that is required to walk. OBJECTIVE The aim of this study was to identify mechanical energy differences between the normal and pathological groups. Four groups of 15 healthy subjects, 13 Parkinson subjects, 4 osteoarthritis subjects, and 4 ACL reconstructed subjects have participated in this study. The motions of foot, shank and thigh were recorded using a three dimensional motion analysis system. The kinetic, potential and total mechanical energy of each segment was calculated using 3D markers positions and anthropometric measurements. RESULTS Maximum value and sample entropy of energies was compared between the normal and abnormal subjects. Maximum value of potential energy of OA subjects was lower than the normal subjects. Furthermore, sample entropy of mechanical energy for Parkinson subjects was low in comparison to the normal subjects while sample entropy of mechanical energy for the ACL subjects was higher than that of the normal subjects. CONCLUSION Findings of this study suggested that the subjects with different abilities show different mechanical energy during walking.
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Affiliation(s)
- Hossein Bahreinizad
- Department of Mechanical Engineering, Sahand University of Technology, Tabriz, Iran
| | - Milad Salimi Bani
- Department of Biomedical Engineering, Faculty of Engineering, University of Isfahan, Isfahan, Iran
| | - Mojtaba Hasani
- Department of Biomedical Engineering, Faculty of Engineering, University of Isfahan, Isfahan, Iran
| | | | - Keyvan Sharifmoradi
- Department of Physical Education and Sport Sciences, Faculty of Human Sciences, University of Kashan, Kashan, Iran
| | - Alireza Karimi
- Basir Eye Health Research Center, Tehran 14186, Iran.,Department of Mechanical Engineering, Kyushu University, Fukuoka 819-0395, Japan
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26
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Gervasoni E, Parelli R, Uszynski M, Crippa A, Marzegan A, Montesano A, Cattaneo D. Effects of Functional Electrical Stimulation on Reducing Falls and Improving Gait Parameters in Multiple Sclerosis and Stroke. PM R 2016; 9:339-347.e1. [PMID: 27825837 DOI: 10.1016/j.pmrj.2016.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 10/17/2016] [Accepted: 10/25/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Loss of neuromuscular control of the ankle joint is a common impairment in neurologic conditions, leading to abnormal gait and a greater risk of falling. Limited information, however, is available on the effectiveness of functional electrical stimulation (FES) on reducing falls, and no studies have investigated its usefulness in improving lower limbs kinematics related to foot clearance and energy recovery. SETTING Clinical setting. STUDY DESIGN Prospective longitudinal study. PARTICIPANTS Twenty-four subjects, 14 people with multiple sclerosis (mean age ± standard deviation 50.93 ± 8.72 years) and 10 people with stroke (55.38 ± 14.55 years). METHODS The number of falls was assessed at baseline and after 8 weeks, and a clinical assessment was performed at the baseline, 4-week, and 8-week time points. A subsample of the 24 subjects comprising 5 people with multiple sclerosis and 5 people with stroke performed a gait analysis assessment at baseline and after 4 weeks. After receiving the equipment and the training schedule, subjects performed daily home walking training using FES for 8 weeks. MAIN OUTCOME MEASUREMENTS The main outcomes were (1) the number of falls, (2) foot clearance, and (3) energy recovery. RESULTS A reduction in the number of falls was observed from baseline (n = 10) to the 8-week assessment (n = 2), P = .02. Foot clearance increased (+5.26 mm, P = .04) between the baseline without FES and at 4 weeks with FES (total effect). No statistically significant differences were found in energy recovery between baseline and 4 weeks. CONCLUSIONS The use of FES had an impact on gait, specifically reducing the number of falls and improving walking. A specific effect at the ankle joint was observed, increasing foot clearance during the swing phase of gait. This effect was not accompanied with a reduction in the energetic expenditure during walking in subjects with multiple sclerosis and stroke.
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Affiliation(s)
- Elisa Gervasoni
- LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Don Gnocchi Foundation I.R.C.C.S., Milano, Italy(∗)
| | - Riccardo Parelli
- LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Don Gnocchi Foundation I.R.C.C.S., Milano, Italy(†)
| | - Marcin Uszynski
- Multiple Sclerosis of Ireland, Western Regional Office, Galway, Ireland(‡)
| | - Alessandro Crippa
- LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, and SaFLo: Gait Analysis Laboratory, Don Gnocchi Foundation I.R.C.C.S., Milano, Italy(§)
| | - Alberto Marzegan
- SaFLo: Gait Analysis Laboratory, Don Gnocchi Foundation I.R.C.C.S., Milano, Italy(¶)
| | - Angelo Montesano
- LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Don Gnocchi Foundation I.R.C.C.S., Milano, Italy(#)
| | - Davide Cattaneo
- LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Don Gnocchi Foundation I.R.C.C.S., Capecelatro 66 - 20148 Milano, Italy(∗∗).
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