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Toda H, Oshima T, Ibara T, Chin T. Longitudinal Alterations in the Control of Lateral Center of Mass Movement During Walking in a Patient With Unilateral Transtibial Amputation: A Case Study. Cureus 2024; 16:e61683. [PMID: 38975414 PMCID: PMC11223945 DOI: 10.7759/cureus.61683] [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] [Accepted: 05/31/2024] [Indexed: 07/09/2024] Open
Abstract
This study assessed longitudinal changes in the control of the center of mass (CoM) in the lateral direction through gait reacquisition in an individual with unilateral transtibial amputation (UTTA). We examined a male patient with UTTA who could walk on a parallel bar. The marker trajectories and ground reaction forces were measured every two weeks (total: four times) using an optical motion capture system and force plates. After two measurements, the samples were collected without a parallel bar. Subsequently, we evaluated the CoM movement and its segmental coordination through uncontrolled manifold (UCM) analysis. After the second measurement, the walking speed and step length increased. The lateral CoM movements gradually increased toward the prosthetic side until the third measurement. In the fourth measurement, the CoM movement towards the prosthetic side was the smallest and closest to the intact side at the end of the stance phase. In addition, segmental coordination improved significantly. Enhanced gait performance delayed the improvement of segmental coordination for CoM movement in the lateral direction.
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Affiliation(s)
- Haruki Toda
- Robot Rehabilitation Center, The Hyogo Institute of Assistive Technology, Kobe, JPN
| | - Takashi Oshima
- Orthopaedics, Hyogo Prefectural Rehabilitation Center, Kobe, JPN
| | - Takuya Ibara
- Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, JPN
| | - Takaaki Chin
- Robot Rehabilitation Center, The Hyogo Institute of Assistive Technology, Kobe, JPN
- Physical Medicine and Rehabilitation, Hyogo Prefectural Rehabilitation Center, Kobe, JPN
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2
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Teater RH, Zelik KE, McDonald KA. Biomechanical effects of adding an articulating toe joint to a passive foot prosthesis for incline and decline walking. PLoS One 2024; 19:e0295465. [PMID: 38758923 PMCID: PMC11101096 DOI: 10.1371/journal.pone.0295465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/23/2024] [Indexed: 05/19/2024] Open
Abstract
Walking on sloped surfaces is challenging for many lower limb prosthesis users, in part due to the limited ankle range of motion provided by typical prosthetic ankle-foot devices. Adding a toe joint could potentially benefit users by providing an additional degree of flexibility to adapt to sloped surfaces, but this remains untested. The objective of this study was to characterize the effect of a prosthesis with an articulating toe joint on the preferences and gait biomechanics of individuals with unilateral below-knee limb loss walking on slopes. Nine active prosthesis users walked on an instrumented treadmill at a +5° incline and -5° decline while wearing an experimental foot prosthesis in two configurations: a Flexible toe joint and a Locked-out toe joint. Three participants preferred the Flexible toe joint over the Locked-out toe joint for incline and decline walking. Eight of nine participants went on to participate in a biomechanical data collection. The Flexible toe joint decreased prosthesis Push-off work by 2 Joules during both incline (p = 0.008; g = -0.63) and decline (p = 0.008; g = -0.65) walking. During incline walking, prosthetic limb knee flexion at toe-off was 3° greater in the Flexible configuration compared to the Locked (p = 0.008; g = 0.42). Overall, these results indicate that adding a toe joint to a passive foot prosthesis has relatively small effects on joint kinematics and kinetics during sloped walking. This study is part of a larger body of work that also assessed the impact of a prosthetic toe joint for level and uneven terrain walking and stair ascent/descent. Collectively, toe joints do not appear to substantially or consistently alter lower limb mechanics for active unilateral below-knee prosthesis users. Our findings also demonstrate that user preference for passive prosthetic technology may be both subject-specific and task-specific. Future work could investigate the inter-individual preferences and potential benefits of a prosthetic toe joint for lower-mobility individuals.
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Affiliation(s)
- Rachel H. Teater
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, United States of America
| | - Karl E. Zelik
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, United States of America
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, United States of America
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN, United States of America
| | - Kirsty A. McDonald
- School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
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Tramontano M, Orejel Bustos AS, Montemurro R, Vasta S, Marangon G, Belluscio V, Morone G, Modugno N, Buzzi MG, Formisano R, Bergamini E, Vannozzi G. Dynamic Stability, Symmetry, and Smoothness of Gait in People with Neurological Health Conditions. SENSORS (BASEL, SWITZERLAND) 2024; 24:2451. [PMID: 38676068 PMCID: PMC11053882 DOI: 10.3390/s24082451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
Neurological disorders such as stroke, Parkinson's disease (PD), and severe traumatic brain injury (sTBI) are leading global causes of disability and mortality. This study aimed to assess the ability to walk of patients with sTBI, stroke, and PD, identifying the differences in dynamic postural stability, symmetry, and smoothness during various dynamic motor tasks. Sixty people with neurological disorders and 20 healthy participants were recruited. Inertial measurement unit (IMU) sensors were employed to measure spatiotemporal parameters and gait quality indices during different motor tasks. The Mini-BESTest, Berg Balance Scale, and Dynamic Gait Index Scoring were also used to evaluate balance and gait. People with stroke exhibited the most compromised biomechanical patterns, with lower walking speed, increased stride duration, and decreased stride frequency. They also showed higher upper body instability and greater variability in gait stability indices, as well as less gait symmetry and smoothness. PD and sTBI patients displayed significantly different temporal parameters and differences in stability parameters only at the pelvis level and in the smoothness index during both linear and curved paths. This study provides a biomechanical characterization of dynamic stability, symmetry, and smoothness in people with stroke, sTBI, and PD using an IMU-based ecological assessment.
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Affiliation(s)
- Marco Tramontano
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, 40138 Bologna, Italy;
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Amaranta Soledad Orejel Bustos
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 00135 Roma, Italy;
| | - Rebecca Montemurro
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
| | - Simona Vasta
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
| | - Gabriele Marangon
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Valeria Belluscio
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 00135 Roma, Italy;
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
- San Raffaele Institute of Sulmona, 67039 Sulmona, Italy
| | | | - Maria Gabriella Buzzi
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
| | - Rita Formisano
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
| | - Elena Bergamini
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 00135 Roma, Italy;
- Department of Management, Information and Production Engineering, University of Bergamo, Via Pasubio 7b, 24044 Dalmine, BG, Italy
| | - Giuseppe Vannozzi
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 00135 Roma, Italy;
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Ghiami Rad A, Shahbazi B. A systematic investigation of sensorimotor mechanisms with intelligent prostheses in patients with ankle amputation while walking. J Mech Behav Biomed Mater 2024; 151:106357. [PMID: 38181570 DOI: 10.1016/j.jmbbm.2023.106357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/25/2023] [Indexed: 01/07/2024]
Abstract
It is thought that creating sensorimotor feedback in people with ankle joint amputation can affect motor biomechanics during gait, but there is little evidence or previous research. This study e aim ed to investigate the sensorimotor mechanism of smart prostheses in with ankle amputations while walking. Search in Google Scholar, Scopus, PubMed and Medline databases between April 2017 and February 2023, in addition to a detailed review in specialized clinical and engineering databases, 29 articles were selected based on the inclusion and exclusion criteria. Trials that mainly include; Proprioception, walking process in movement disorders, ankle amputation were included. Qualitative assessments of selected trials using PEDro' scale was used. The review of studies showed that the use of pressure sensors, neural stimulation through encoded algorithms can provide continuous tactile and positional information of the artificial leg in the direction of neural stimulation throughout the entire walking cycle. These findings indicate that restoration of intraneuronal sensory feedback leads to functional and cognitive benefits. With these definitions, different companies and research centers are trying to improve the mechanics of walking, however, movement strategies are unknown despite little research in creating sense and movement in the use of smart prostheses.
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Affiliation(s)
- Amir Ghiami Rad
- Movement Biomechanics, Department of Movement Behavior, Faculty of Sports Sciences, University Of Tabriz, Tabriz, Iran.
| | - Behnam Shahbazi
- Movement Biomechanics, Department of Sports Biomechanics, Faculty of Sports Sciences, Bu- Ali Sina University, Hamadan, Iran.
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Valle G, Katic Secerovic N, Eggemann D, Gorskii O, Pavlova N, Petrini FM, Cvancara P, Stieglitz T, Musienko P, Bumbasirevic M, Raspopovic S. Biomimetic computer-to-brain communication enhancing naturalistic touch sensations via peripheral nerve stimulation. Nat Commun 2024; 15:1151. [PMID: 38378671 PMCID: PMC10879152 DOI: 10.1038/s41467-024-45190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
Artificial communication with the brain through peripheral nerve stimulation shows promising results in individuals with sensorimotor deficits. However, these efforts lack an intuitive and natural sensory experience. In this study, we design and test a biomimetic neurostimulation framework inspired by nature, capable of "writing" physiologically plausible information back into the peripheral nervous system. Starting from an in-silico model of mechanoreceptors, we develop biomimetic stimulation policies. We then experimentally assess them alongside mechanical touch and common linear neuromodulations. Neural responses resulting from biomimetic neuromodulation are consistently transmitted towards dorsal root ganglion and spinal cord of cats, and their spatio-temporal neural dynamics resemble those naturally induced. We implement these paradigms within the bionic device and test it with patients (ClinicalTrials.gov identifier NCT03350061). He we report that biomimetic neurostimulation improves mobility (primary outcome) and reduces mental effort (secondary outcome) compared to traditional approaches. The outcomes of this neuroscience-driven technology, inspired by the human body, may serve as a model for advancing assistive neurotechnologies.
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Affiliation(s)
- Giacomo Valle
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland
| | - Natalija Katic Secerovic
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland
- School of Electrical Engineering, University of Belgrade, 11000, Belgrade, Serbia
- The Mihajlo Pupin Institute, University of Belgrade, 11000, Belgrade, Serbia
| | - Dominic Eggemann
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland
| | - Oleg Gorskii
- Laboratory for Neuroprosthetics, Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia
- Laboratory for Neuromodulation, Pavlov Institute of Physiology, Russian Academy of Sciences, Saint Petersburg, 199034, Russia
- Center for Biomedical Engineering, National University of Science and Technology "MISIS", 119049, Moscow, Russia
| | - Natalia Pavlova
- Laboratory for Neuroprosthetics, Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia
| | | | - Paul Cvancara
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center, BrainLinks-BrainTools Center of Excellence, University of Freiburg, D-79110, Freiburg, Germany
| | - Thomas Stieglitz
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering-IMTEK, Bernstein Center, BrainLinks-BrainTools Center of Excellence, University of Freiburg, D-79110, Freiburg, Germany
| | - Pavel Musienko
- Laboratory for Neuroprosthetics, Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia
- Sirius University of Science and Technology, Neuroscience Program, Sirius, Russia
- Laboratory for Neurorehabilitation Technologies, Life Improvement by Future Technologies Center "LIFT", Moscow, Russia
| | - Marko Bumbasirevic
- Orthopaedic Surgery Department, School of Medicine, University of Belgrade, 11000, Belgrade, Serbia
| | - Stanisa Raspopovic
- Laboratory for Neuroengineering, Department of Health Sciences and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, Zürich, Switzerland.
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Tramontano M, Argento O, Orejel Bustos AS, DE Angelis S, Montemurro R, Bossa M, Belluscio V, Bergamini E, Vannozzi G, Nocentini U. Cognitive-motor dual-task training improves dynamic stability during straight and curved gait in patients with multiple sclerosis: a randomized controlled trial. Eur J Phys Rehabil Med 2024; 60:27-36. [PMID: 37997324 DOI: 10.23736/s1973-9087.23.08156-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic inflammatory, demyelinating, degenerative disease of the central nervous system and the second most frequent cause of permanent disability in young adults. One of the most common issues concerns the ability to perform postural and gait tasks while simultaneously completing a cognitive task (namely, dual-task DT). AIM Assessing cognitive-motor dual-task training effectiveness in patients with Multiple Sclerosis (PwMS) for dynamic gait quality when walking on straight, curved, and blindfolded paths. DESIGN Two-arm single-blind randomized controlled trial. Follow-up at 8 weeks. SETTING Neurorehabilitation Hospital. POPULATION A sample of 42 PwMS aged 28-71, with a score of 4.00±1.52 on the Expanded Disability Status Scale were recruited. METHODS Participants were randomized in conventional (CTg) neurorehabilitation and dual-task training (DTg) groups and received 12 sessions, 3 days/week/4 weeks. They were assessed at baseline (T0), after the treatment (T1), and 8 weeks after the end of the treatment (T2) through Mini-BESTest, Tinetti Performance Oriented Mobility Assessment, Modified Barthel Index, and a set of spatiotemporal parameters and gait quality indices related to stability, symmetry, and smoothness of gait extracted from initial measurement units (IMUs) data during the execution of the 10-meter Walk Test (10mWT), the Figure-of-8 Walk Test (Fo8WT) and the Fukuda Stepping Test (FST). RESULTS Thirty-one PwMS completed the trial at T2. Significant improvement within subjects was found in Mini-BESTest scores for DTg from T0 to T1. The IMU-based assessment indicated significant differences in stability (P<0.01) and smoothness (P<0.05) measures between CTg and DTg during 10mWT and Fo8WT. Substantial improvements (P<0.017) were also found in the inter-session comparison, primarily for DTg, particularly for stability, symmetry, and smoothness measures. CONCLUSIONS This study supports the effectiveness of DT in promoting dynamic motor abilities in PwMS. CLINICAL REHABILITATION IMPACT Cognitive-motor DT implemented into the neurorehabilitation conventional program could be a useful strategy for gait and balance rehabilitation.
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Affiliation(s)
- Marco Tramontano
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy -
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy -
| | - Ornella Argento
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
| | - Amaranta S Orejel Bustos
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Sara DE Angelis
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
| | - Rebecca Montemurro
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
| | - Michela Bossa
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
| | - Valeria Belluscio
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Elena Bergamini
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Giuseppe Vannozzi
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Ugo Nocentini
- Santa Lucia Foundation, Scientific Institute for Research and Health Care, Rome, Italy
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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Tramontano M, Manzari L, Bustos ASO, De Angelis S, Montemurro R, Belluscio V, Bergamini E, Vannozzi G. Instrumental assessment of dynamic postural stability in patients with unilateral vestibular hypofunction during straight, curved, and blindfolded gait. Eur Arch Otorhinolaryngol 2024; 281:83-94. [PMID: 37382626 DOI: 10.1007/s00405-023-08082-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/15/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE To characterise dynamic postural stability of gait in patients with vestibular hypofunction (PwVH) using a sensor-based assessment while performing dynamic tasks and to correlate the results of this evaluation with clinical scales. METHODS This cross-sectional study involved 22 adults between 18 and 70 years old from a healthcare hospital centre. Eleven patients suffering from chronic vestibular hypofunction (PwVH) and eleven healthy controls (HC) were evaluated through a combined inertial sensor-based and clinical scale assessment. Participants were equipped with five synchronised inertial measurement units (IMUs) (128 Hz, Opal, APDM, Portland, OR, USA): three IMUs were located on the occipital cranium bone, near the lambdoid suture of the head, at the centre of the sternum, and at L4/L5 level, just above the pelvis, and were used to quantify gait quality parameters, while the other two were located slightly above lateral malleoli and used to perform stride and step segmentation. Three different motor tasks were performed in a randomized order: the 10-m Walk Test (10mWT), the Figure of Eight Walk Test (Fo8WT) and the Fukuda Stepping Test (FST). A set of gait quality parameters related to stability, symmetry and smoothness of gait were extracted from IMU data and correlated with the clinical scale scores. PwVH and HC results were compared to test for significant between-group differences. RESULTS Significant differences were found for the three motor tasks (10mWT, Fo8WT and FST) when comparing PwVH and HC groups. For the 10mWT and the Fo8WT, significant differences between the PwVH and HC groups were found for the stability indexes. Considering the FST, significant differences between the PwVH and HC groups were also found in the stability and symmetry of gait. A significant correlation was found between the Dizziness Handicap Inventory and gait indices during the Fo8WT. CONCLUSIONS In this study, we characterized the dynamic postural stability alterations during linear, curved, and blindfolded walking/stepping in PwVH combining an instrumental IMU-based with traditional clinical scales approach. Combining instrumental and clinical evaluation for dynamic stability of gait alterations in PwVH is useful in thoroughly evaluating the effects of unilateral vestibular hypofunction.
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Affiliation(s)
- M Tramontano
- Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
| | | | - A S Orejel Bustos
- Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", 00135, Rome, Italy
| | - S De Angelis
- Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
| | - R Montemurro
- Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
| | - V Belluscio
- Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", 00135, Rome, Italy
| | - E Bergamini
- Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", 00135, Rome, Italy
| | - G Vannozzi
- Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", 00135, Rome, Italy
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8
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Morone G, Princi AA, Iosa M, Montemurro R, Ciancarelli I, Coiro P, Lisi D, Savo R, Granieri MN, De Angelis D, Tramontano M. Effects of shoulder brace usage on postural stability in stroke survivors: A pilot randomized controlled trial. NeuroRehabilitation 2024; 54:449-456. [PMID: 38457159 DOI: 10.3233/nre-230250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Despite advances in stroke rehabilitation, challenges in upper limb motor recovery and postural stability persist, negatively affecting overall well-being. Arm slings and shoulder braces have been proposed to address these issues, but their efficacy in promoting postural stability remains unclear. OBJECTIVE This pilot randomized controlled study aimed to evaluate the impact of a new shoulder brace (N1-Neurosling) on trunk postural stability during walking, pain, and upper limb muscle strength in chronic stroke survivors. METHODS Twenty-four adult chronic stroke patients were involved and randomly assigned to the shoulder brace group (SBg) or control group (CTRLg). Were assessed at baseline (T0) and after 4 weeks (T1) through the Trunk Control Test, the Numerical Rating Scale, the Motricity Index, Manual Muscle Test, and instrumental wearable-based assessment. RESULTS After 4 weeks, the SBg showed significant improvement in Trunk Control Test scores (p = 0.020) and smoothness of gait measured by log dimensionless jerk along the Antero-Posterior axis (- 5.31±0.25 vs. - 5.18±0.27, p = 0.018) compared to the CTRLg. The SBg also demonstrated a reduction in pain in the shoulder girdle and enhanced upper limb muscle strength. CONCLUSION The use of the N1-Neurosling shoulder brace led to improvements in postural stability and smoothness of gait in stroke patients.
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Affiliation(s)
- Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- San Raffaele Institute of Sulmona, Sulmona, Italy
| | | | - Marco Iosa
- Fondazione Santa Lucia IRCCS, Rome, Italy
- Department of Psychology, Sapienza University, Rome, Italy
| | | | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Danilo Lisi
- UOC Risk Management, Azienda Ospedaliera Rilievo Nazionale Sant'Anna e San Sebastiano, Caserta, Italy
| | | | | | | | - Marco Tramontano
- Department of Biomedical and Neuromotor Sciences - DIBINEM, Alma Mater Università di Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
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9
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Hu M, He Y, Hisano G, Hobara H, Kobayashi T. Coordination of Lower Limb During Gait in Individuals With Unilateral Transfemoral Amputation. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3835-3843. [PMID: 37721878 DOI: 10.1109/tnsre.2023.3316749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Understanding the lower-limb coordination of individuals with unilateral transfemoral amputation (uTFA) while walking is essential to understand their gait mechanisms. Continuous relative phase (CRP) analysis provides insights into gait coordination patterns of the neuromusculoskeletal system based on movement kinematics. Fourteen individuals with uTFA and their age-matched non-disabled individuals participated in this study. Kinematic data of the lower limbs of the participants were collected during walking. The joint angles, segment angles, and CRP values of the thigh-shank and shank-foot couplings were investigated. The curves among the lower limbs of the participants were compared using a statistical parametric mapping test. Compensatory strategies were found in the lower limbs from coordination patterns. In thigh-shank coupling, although distinct coordination traits in stance and swing phases among the lower limbs were found, the lower limbs in both groups were discovered to remain in a similar coordination pattern during gait. For individuals with uTFA, in shank-foot coupling, intact limbs demonstrated a short period of foot-leading pattern which was significantly different from that of the other limbs during mid-stance to compensate for the weaker force generation by prosthetic limbs. The findings offer normative coordination patterns on the walking of individuals with uTFA, which could benefit prosthetic gait rehabilitation and development.
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10
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Ranaldi S, De Marchis C, Serrao M, Ranavolo A, Draicchio F, Lacquaniti F, Conforto S. Characterization of prosthetic knees through a low-dimensional description of gait kinematics. J Neuroeng Rehabil 2023; 20:46. [PMID: 37055813 PMCID: PMC10100472 DOI: 10.1186/s12984-023-01160-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/30/2023] [Indexed: 04/15/2023] Open
Abstract
The characterization of both limbs' behaviour in prosthetic gait is of key importance for improving the prosthetic components and increasing the biomechanical capability of trans-femoral amputees. When characterizing human gait, modular motor control theories have been proven to be powerful in providing a compact description of the gait patterns. In this paper, the planar covariation law of lower limb elevation angles is proposed as a compact, modular description of prosthetic gait; this model is exploited for a comparison between trans-femoral amputees walking with different prosthetic knees and control subjects walking at different speeds. Results show how the planar covariation law is maintained in prostheses users, with a similar spatial organization and few temporal differences. Most of the differences among the different prosthetic knees are found in the kinematic coordination patterns of the sound side. Moreover, different geometrical parameters have been calculated over the common projected plane, and their correlation with classical gait spatiotemporal and stability parameters has been investigated. The results from this latter analysis have highlighted a correlation with several parameters of gait, suggesting that this compact description of kinematics unravels a significant biomechanical meaning. These results can be exploited to guide the control mechanisms of prosthetic devices based purely on the measurement of relevant kinematic quantities.
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Affiliation(s)
- Simone Ranaldi
- Department of Industrial Electronics and Mechanical Engineering, University Roma TRE, Rome, Italy.
| | | | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Rome, Italy
- Rehabilitation Centre, Policlinico Italia, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Francesco Lacquaniti
- Department of Systems Medicine and Centre of Space Biomedicine, University of Rome Tor Vergata, Rome, Italy
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Silvia Conforto
- Department of Industrial Electronics and Mechanical Engineering, University Roma TRE, Rome, Italy
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