Biomechanical Gait Analysis Research Articles

Comparação dos parâmetros espaçotemporais da marcha durante a execução do TUG associado à dupla tarefa em adultos jovens

Introdução: A análise biomecânica da marcha se mostra eficiente na identificação de alterações nos padrões de movimento e no declínio funcional. Objetivo: Analisar o efeito da dupla tarefa sobre os parâmetros espaçotemporais da marcha. Métodos: Participaram 32 sujeitos de ambos os sexos com idade entre 18 e 25 anos. O teste Timed Up and Go foi aplicado sob duas condições: na forma original e associado à tarefa cognitiva (verbalizar os meses do ano em ordem inversa). Foi avaliado o tempo total de execução, número de passos, cadência, tempo gasto para levantar, velocidade média e variabilidade do tempo de passo. Resultados: Com a adição da tarefa cognitiva, foram observadas mudanças em diversos dos parâmetros espaçotemporais da marcha analisados. Conclusão: Os testes realizados mostraram que o incremento de tarefas cognitivas durante a deambulação pode acarretar alterações no desempenho desta atividade.

Walking in an unstable Masai Barefoot Technology (MBT) shoe introduces kinematic and kinetic changes at the hip, knee and ankle before and after a 6-week accommodation period: a comprehensive analysis using principal component analysis (PCA)

Background: Scientific and anecdotal evidence suggests that some individuals who wear the unstable Masai Barefoot Technology (MBT) shoe experience a reduction in back and joint pain. A more comprehensive biomechanical gait analysis is needed to better understand the mechanisms for symptom relief and what the long-term implications of wearing these shoes might be on the body. Objective: The aim of this study was to determine the gait changes introduced at the hip, knee and ankle before and after wearing an unstable MBT shoe for a 6-week accommodation period. Methods: Three-dimensional joint angles and moments were measured for 23 healthy individuals while walking in an unstable MBT shoe and a stable control shoe, both before and after a 6-week accommodation period of wearing the unstable shoe at their workplace. Principal component analysis (PCA) was used on the stance phase waveforms to identify differences between the two shoes and two testing sessions. Results: Joint angle and moment differences between the two shoe conditions were identified both before and after wearing the unstable shoe for the accommodation period. Notable kinematic changes included reduced hip flexion–extension and ankle adduction–abduction range of motion, increased early stance dorsiflexion and increased knee internal rotation for unstable shoe walking. Ankle moments tended to be greater for the unstable shoe and at the hip and knee, both increases and decreases in moments were observed. Conclusions: While many of the identified changes agree with previous research, this is the first study to report increases in some joint moments for the unstable MBT shoe. These increases along with other notable changes do, however, require further investigation to better understand the long-term implications of the unstable MBT shoe.

Chronic effects of a flexible and minimalist footwear on clinical, functional and gait biomechanical aspects in the knee osteoarthritis: a single-blind randomized clinical trial

Chronic effects of a flexible and minimalist footwear on clinical, functional and gait biomechanical aspects in the knee osteoarthritis: a single-blind randomized clinical trial

Gait analysis of adults with generalised joint hypermobility

BackgroundThe majority of adults with Generalised Joint Hypermobility experience symptoms such as pain and joint instability, which is likely to influence their gait pattern. Accordingly, the purpose of the present project was to perform a biomechanical gait analysis on a group of patients with Generalised Joint Hypermobility and compare them to a group of healthy subjects. MethodsSeventeen adults clinically classified with Generalised Joint Hypermobility (6 males and 11 females) and seventeen healthy subjects (9 males and 8 females) were included in the project.The subjects walked across three force platforms while they were filmed by five video cameras. Net joint moments were calculated in 3D by inverse dynamics and peak values were input to statistical analyses. A 3D knee joint model was used to calculate bone-on-bone forces. FindingsIn the frontal plane both the peak knee and hip abductor moments were 13% higher in the patient group. In the sagittal plane the peak knee extensor moment was 10% higher for the patients and the flexor moment about the knee joint in the middle of stance was 27% lower for the patients. Increased flexion in the knee joint for the patients was also observed. InterpretationThe finding that adults with Generalised Joint Hypermobility display higher joint moments during walking in both the frontal and the sagittal planes and increased knee joint loadings may explain the pain symptoms in the patient group and indicate these subjects are subjected to an increased risk of developing osteo-arthritis.

The relationships between muscle strength, biomechanical functional moments and health-related quality of life in non-elite older adults

to investigate the association between muscle strength, biomechanical functional moments during everyday tasks and health-related quality of life (HRQoL) in older adults. eighty-four healthy adults aged 60-88 years were tested. A torque dynamometer was utilised to measure muscle moments at the knee and hip joints. Functional assessment involved three-dimensional biomechanical analysis of gait, chair rise and sit-down, stair ascent and descent using an 8-camera VICON® system with Kistler force plates. HRQoL was assessed using the Short Form-36 (SF-36) questionnaire. Spearman's correlation coefficient showed significant correlation (P<0.001) between isometric strength and functional moments (r=0.24-0.67). Muscle strength was significantly correlated with SF-36 scores, including physical functioning, bodily pain, vitality, social functioning and role emotional scores. Knee flexion moment was correlated with role physical, vitality, social functioning, role emotional, mental health and mental component scores (r=0.24-0.40). loss of muscle strength is associated with poorer functional ability and both are associated with reduced HRQoL. The reduction in HRQoL is considerable in the physical functioning domain. Cause and effect was not established but studies need to be undertaken to evaluate the benefits of strength training, functional activity training or increased participation in life.

Measuring medial longitudinal arch deformation during gait. A reliability study

Clinical evaluation of medial longitudinal arch deformation (MLAD) during walking gait is often estimated from static measures of e.g. navicular drop (ND) measured during quiet standing. The aim of the present study was to test the reliability of a new three-dimensional method of measuring the MLAD during gait and to compare this method with a static measure and a 2D dynamic method. Fifty-two feet (26 healthy male participants) were tested twice 4–9 days apart in a biomechanical gait analysis laboratory using a 3D three-marker foot model, a 2D video-based model for the measurement of MLAD during gait, and ND for measurements of MLAD during quiet standing. The 3D method showed the highest test-retest reliability among the measurements of MLAD. Furthermore, the ND showed only moderate correlation with both measurements of MLAD during gait. The new 3D method was found to be highly reliable and showed that ND obtained during quiet standing could not predict the MLAD during gait. The 3D method, or alternatively the 2D method, may be used in clinical settings as reliable methods for easy estimation of the foot longitudinal stability.

Is There a Relationship Between Fatigue Questionnaires and Gait Mechanics in Persons With Multiple Sclerosis?

Huisinga JM, Filipi ML, Schmid KK, Stergiou N. Is there a relationship between fatigue questionnaires and gait mechanics in persons with multiple sclerosis? Objective To evaluate reported fatigue levels and gait deficits in patients with multiple sclerosis (MS) to determine the relationships that may exist between fatigue in patients with MS and alterations in gait mechanics. Design Cross-sectional. Setting Biomechanics laboratory. Participants Subjects with MS (n=32) and age- and sex-matched controls (n=30). Interventions None. Main Outcome Measures Fatigue Severity Scale (FSS), Modified Fatigue Index Scale (MFIS), and 36-Item Short Form Health Survey (SF-36) to assess fatigue and general health. Biomechanical gait analysis was performed to measure peak joint torques and powers in the sagittal plane at the ankle, knee, and hip. Correlations were performed between fatigue measures and degree of deficit within each patient with MS for each joint torque and power measure. Results FSS score significantly correlated with deficits in ankle power generation at late stance and walking velocity. MFIS score significantly correlated with deficits in peak knee extensor torque and knee power absorption at early stance. SF-36 subscale scores correlated with several joint torque and power variables. Conclusions Subjective fatigue rating scale scores alone should not be used as an indicator of motor disability or disease progression as it affects walking performance of patients with MS.

Gait Training With Virtual Reality–Based Real-Time Feedback: Improving Gait Performance Following Transfemoral Amputation

Gait training is an important component of rehabilitation after lower-extremity amputation. Abnormal gait performance often persists even for individuals who reacquire a high level of function. This case report describes the use of a virtual reality (VR)-based gait training program that provides real-time feedback in order to improve biomechanical and physiological performance. The aim of this case report is to describe the effects of the training in a person with a transfemoral amputation. A 24-year-old man with a transfemoral amputation completed a 3-week gait training program. The intervention consisted of 12 sessions of treadmill walking with real-time visual feedback on full-body gait kinematics. A treating therapist directed the patient's attention to specific gait deviations as a means to normalize gait biomechanics. The patient completed overground biomechanical gait analyses and multiple-speed treadmill tests 3 weeks apart prior to and following the training program. Biomechanical gait analyses indicated the training produced improved frontal-plane hip, pelvis, and trunk motion during overground walking. Improvement in trunk motion was observed at the posttraining test, and improvements in pelvis and hip motion were observed at the 3-week follow-up test. Decreases of up to 23% in oxygen consumption also were demonstrated. Although the exact contribution of the visual feedback could not be isolated, the training was effective in improving the patient's walking performance. Biomechanical data suggest correcting trunk motion and increasing hip abductor strength (force-generating capacity) may be important in facilitating improvements at the pelvis and hip. Observed improvements in oxygen consumption were significantly larger than achieved through previously reported interventions.

Microvascular reconstructions of traumatic‐combined tissue loss at foot and ankle level

Severe injuries at foot and ankle level with loss of soft tissues and bone are often treated by means of amputation. The transfer of composite free flaps from various donor sites may provide anatomical reconstruction of the foot and ankle and function. Ten patients who sustained severe combined tissue injuries of the foot requiring reconstruction with composite free flaps were studied with a mean follow-up of 3.4 years. A thorough clinical examination was performed, and gait analysis was carried out with kinetic and kinematic parameters. Bone integration and healing was observed with satisfactory foot morphology. All the patients returned to normal activities, although biomechanical gait analysis showed some functional disorders mainly in joint angular kinematics. Our results showed that microvascular flaps afford successful combined tissue reconstruction of the foot.

Poster 79: Task-Oriented Locomotor Training With and Without Load at the Ankle in Stroke Individuals

Objective: To test the impact of a load placed at the ankle during treadmill locomotor training on the paretic hip muscle strength and gait performance in stroke patients. Design: Cross-design study. Setting: Research laboratory at a university-affiliated inpatient rehabilitation hospital. Participants: 10 chronic-stroke participants (56.3±10.5y) with hip weakness on the paretic side and reduced gait speed (0.66±0.19m.s-1). Intervention: Treadmill gait training during two 4-week training periods, separated by 2 weeks of rest. A load of 1.5kg was added at the paretic ankle during one of the two 4-week training periods. Training consisted of three 1-hour sessions per week, including 20 minutes of strenuous walking. Main Outcome Measures: Natural and maximal gait speed measured over a 10-m, 6-minute walk test, maximal flexor and extensor strength at the hemiparetic hip. Results: Over the 8-week training period, the natural gait speed increased from 0.66±0.19 to 0.79±0.29m.s-1 (P=.039, effect size ([ES])=0.53), and maximal gait speed from 0.85±0.35 to 1.05±0.46m.s-1 (P=0.013, ES=0.49), while the six-minute walk test did not improve significantly (from 236.2±93.6 to 290.3±126.4m, P=0.077, ES=0.49). Within this 8-week period, effect sizes were slightly larger for the no-load (0.31<ES<0.41) than the load condition (0.12<ES<0.18), for gait speeds and endurance. However, hip muscle strength increased more with the load than the no-load condition, both for flexors (ES=0.49 vs 0.09) and extensors (ES=0.31 vs 0.13). Conclusions: Despite higher gains in strength obtained during treadmill training with a load at the ankle, gait performances did not improve accordingly during this period. A detailed biomechanical gait analysis will be required to further explain these findings.

Clinical and dual‐tasking aspects in frequent and infrequent fallers with progressive supranuclear palsy

Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease with no sufficient therapeutic options to date. Falls are the most devastating feature. The causes of these falls are not well understood. To test the impact of PSP-associated motor and cognitive features on falls, 26 PSP patients were prospectively recruited and divided into frequent fallers (> one fall/month, 18 patients) and infrequent fallers (<or= one fall/month, 8 patients). Further parameters were assessed by clinical investigation and biomechanical gait and balance analysis with and without dual-task paradigms. Physical activity was measured through an ambulatory device. Frequent fallers scored higher on the total PSP rating scale and the subscales "history," "mental," "bulbar," "supranuclear ocular motor," and "gait/midline exam" but not on disease duration, the subscale "limb exam," the UPDRS motor score and the sway analysis. Frequent fallers also showed an increased probability of an altered walking pattern with shortened step lengths and increased cadence under a dual-task situation. It is concluded that the occurrence of falls in PSP seems strongly associated with the deterioration of bulbar function, but not relevantly with typical parkinsonian features like rigidity and bradykinesia. The decreased ability to deal with distraction of attention under a dual-task situation points to a relevant impact of cortical and subcortical dysfunction on the frequency of falls.

A three-dimensional kinematic and kinetic comparison of overground and treadmill walking in healthy elderly subjects

Background Instrumented treadmills offer a number of advantages for the biomechanical analysis of elderly gait, yet it is unclear how closely treadmill gait approximates overground gait. Although studies have indicated that the kinematics and kinetics of overground and treadmill gait are very similar in young adults, it still needs to be determined whether data collected in elderly adults during treadmill walking can be generalized to overground gait. The purpose of this study, therefore, was to compare the three-dimensional kinematics and kinetics of treadmill gait to overground gait in a group of healthy elderly subjects. Methods Three-dimensional kinematic and kinetic data for 18 healthy, nondisabled elderly subjects, age 65–81 years, were collected for speed-matched overground and treadmill walking conditions. Findings Overall, the kinematics and kinetics of gait during treadmill and overground walking in the elderly had very similar patterns. However, during treadmill walking elderly subjects showed greater cadence, smaller stride length and stride time as well as reductions in the majority of joint angles, moments and powers when compared to overground walking. Interpretation The large increase in cadence suggests that an effective method of acclimation to treadmill walking still needs to be determined. Because of the differences, we believe that in order for instrumented treadmills to become a suitable tool for research and training purposes in healthy elderly, subjects must be adequately acclimated to the treadmill.

Biomechanical Analysis of Gait and Sit-to-Stand Patterns Using a Specially Made Knee Supporter in Healthy Young and Elderly Individuals

This study examined the ergonomic effects of a specially made knee supporter containing spiral bone springs aimed at reducing physical stress on the leg muscles during sit-to-stand (STS) and walking. Twelve young females and fifteen elderly subjects performed STS and treadmill walking with and without a specially made supporter, which may be a simple device for aiding STS and/or walking. During STS, electromyography (EMG) was observed from the vastus lateralis of the right leg. The root mean square (RMS) and mean power frequency (MPF) were calculated from the observed EMG. The changing rate of maximal leg acceleration, the third time derivative of the leg position, was also assessed during treadmill walking at a freely chosen stride frequency and speed. A significant decrease in the RMS was observed during STS when wearing the supporter in both groups. A significant increase in the changing rate of maximal leg acceleration was found during walking with the supporter in both groups. MPF significantly increased when wearing the supporter only in the young group. These results showed that the supporter with spiral bone springs reduced physical stress placed on the quadriceps muscles during STS and walking. This ergonomic contrivance will reduce the possible "risk" of stumbling and/or falling in elderly individuals. The reduced physical burden on the quadriceps muscles will also reduce or delay muscle fatigue, which will further result in an increase in the amount of daily physical activities exhibited in physically poor populations.

Impact of Resistance Training on Balance and Gait in Multiple Sclerosis

Multiple sclerosis (MS) is an incurable neurodegenerative disease whose symptoms are only partially relieved by pharmaceutical intervention. Disability due to this disease process can impede activities of daily living and decrease quality of life, both for MS patients and for their care partners and families. A nonrandomized, nonblinded prospective cohort study of 45 patients with MS was undertaken to investigate the impact of an exercise program emphasizing resistance training on balance and gait. This article presents data for the first 33 participants to complete the study protocol. The exercise program consisted of twice-weekly 50-minute sessions for 6 months. At 3 months and 6 months, statistically significant improvements (P &amp;lt; .05) from baseline were observed for the following measures: Nine-Hole Peg Test, 2- and 3-second Paced Auditory Serial Addition Test, Modified Fatigue Impact Scale, NeuroCom Balance Master (NeuroCom International, Inc, Clackamas, OR), Timed Up and Go test, and Berg Balance Scale. Three-dimensional biomechanical gait analysis showed increased knee power generation during midstance and increased hip power generation during terminal stance. To determine whether individuals with varying levels of disability responded to exercise in a similar fashion, participants were divided into two subgroups based on Expanded Disability Status Scale score: little or no disability (EDSS score 1.0–4.0) and mild-to-moderate disability (EDSS score 4.5–6.5). No statistically significant differences in results were found. The results of this study indicate that participation in a resistance training program improves MS patients' ability to walk and to generate muscular forces during locomotion.

Biomechanical analysis of gait in patients with painful osteoarthritis of the hip treated with WISH-type hip brace

BackgroundA hip brace, the WISH-type S-form brace, improved hip function scores markedly in patients with painful hip osteoarthritis (OA). To evaluate the biomechanical effects of the brace, gait analysis using a force plate was performed. MethodsFor the gait of seven patients with this hip brace, characteristic parameters calculated from three-dimensional (i.e., vertical, forward, and medial) components of the floor reaction force were analyzed using a flat force plate. ResultsGait analyses revealed several tendencies: a shorter time for one step, a stronger step, and a shift of the center of gravity of the body to the contralateral side. in particular, stronger vertical reaction force at the first peak in the early stance and earlier switch from backward to forward reaction force vectors were observed as effects of the hip brace, with statistically significant difference. ConclusionsThese biomechanical assessments suggest that abnormal gait in hip oA may be closer to normal gait in patients using this brace, although the deceleration and weighing-off effects, which are indicators useful for observing gait recovery, did not reach significance.

AN IMPAIRMENT-BASED INTERVENTION FOR A PATIENT WITH NON-SPECIFIC BILATERAL HIP PAIN: CLINICAL AND BIOMECHANICAL OUTCOMES

Study design: Case study. Background: To date, there is little research that has examined the association of impairments at the hip with cumulative trauma syndromes of the hip. The purposes of this case report are to: (1) describe clinical outcomes for a patient with non-specific bilateral musculoskeletal hip pain associated with recreational walking, (2) explore the relationship between this patient's impairments and her cumulative trauma syndrome at the hip, and (3) integrate biomechanical analysis with this patient's clinical diagnosis. Case description: The patient was a 28-year-old female research assistant who reported anterior bilateral hip pain during recreational walking. After examination, the physical therapist diagnosed primary impairments of hip pain, limited hip flexion range of motion (ROM), and weakness of hip musculature, resulting in her ambulation limitations. Intervention consisted of a home exercise program (HEP) designed to strengthen the iliopsoas, gluteus maximus, and gluteus medius (specifically, the posterior portion), increase extensibility of the IT Band and medial hamstrings, and promote posterior glide of the proximal femur. The patient's HEP was the only intervention she received. There were follow-up telephone conversations, but no clinical re-examination for ten weeks. The patient performed the HEP a total of 41 days over the ten week period. Biomechanical gait analysis was performed pre- and post-intervention. Outcomes: Following intervention, the patient was pain-free during recreational walking, and passive hip flexion ROM and manual muscle testing (MMT) grades of hip musculature improved. Global score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) improved ten points. Motion analysis, force plate analysis, and electromyography (EMG) showed that maximum hip extension decreased, maximum hip flexion increased, maximum ground reaction force increased, activation of the gluteus maximus increased, while activation of the gluteus medius and tensor fascia latae (TFL) decreased following the intervention. Discussion: This patient's changes in muscle activity following a HEP appear largely consistent with improved symptoms based on theoretical descriptions of a common muscle imbalance (shortened and overactive TFL and weakness of the gluteus maximus and posterior portion of the gluteus medius), thought to contribute to increased femoral medial rotation.

Comparative biomechanical gait analysis of patients with central cord syndrome walking with one crutch and two crutches

Background Ambulatory people with central cord syndrome often require assistive devices. The selection of a suitable assistive device should be based on an objective assessment. Our objective in this study was to determine whether there was any difference in using two crutches over one crutch, considering that these patients have bilateral upper-limb involvement. Methods Kinematic gait analysis was conducted in 12 patients with central cord syndrome of more than one year of evolution and functional capacity for walking with one crutch or without crutches. Patients were asked to walk with one crutch and with two crutches at a freely chosen walking speed through a 10-m walkway. Three-dimensional kinematic equipment based on active markers was used to analyze temporospatial and articular parameters (maximum, minimum, and range of motion, ROM, throughout the cycle) Findings During two-crutch versus one-crutch walking, speed was lower ( P = 0041), stride time and step time were longer ( P = 0.004 and P = 0.005) and there were fewer strides/minute and steps/minute ( P = 0.005 and P = 0.006). The duration of the single support stance was longer during two-crutch walking ( P = 0.008). With respect to the articular parameters, both ankle ROMs (dorsi-plantar flexion P = 0.003 and pronation–supination P = 0.004) were greater with one-crutch walking than with two-crutch walking. Interpretation In patients with central cord syndrome capable of walking with one crutch or without crutches, walking with two crutches decreases speed, increases stride time and step time and improves stability by increasing single support, and diminishes ankle plantar flexion during swing phase.

Pound for pound: Working out how obesity influences the energetics of walking

Childhood and adult obesity are both serious health problems that are catalyzed by inadequate physical activity and the resulting chronic energy imbalance. For most people, walking consumes more metabolic energy than any other daily activity. Thus it is important to understand the energetic cost of

Atlas-based non-rigid image registration to automatically define line-of-action muscle models: A validation study

Research has raised a growing concern about the accuracy of rescaled generic musculoskeletal models for estimating a subject's musculoskeletal geometry. Information extracted from magnetic resonance (MR) images can improve the subject-specific detail and accuracy of musculoskeletal models. Nevertheless, methods that allow efficient, automated definition of subject-specific muscular models for use in biomechanical analysis of gait have not yet been published to the best of our knowledge. We report a novel method for automated definition of subject-specific muscle paths using non-rigid image registration between an atlas image and the subject's MR images. We validated this approach quantitatively by measuring the distance between automatically and manually defined coordinates of muscle attachment sites. Data was collected for 34 muscles in each lower limb of 5 paediatric subjects diagnosed with diplegic cerebral palsy and presenting varying degrees of increased femoral anteversion. Distances showed an overall median Euclidean error of 6.1 mm: 2.0 mm along the medio-lateral direction, 1.8 mm along the anterior–posterior direction and 3.8 mm along the superior–inferior direction. A qualitative validation between automatically defined muscle points and the muscular geometry observed in the subject's medical image data corroborated the quantitative validation. This automated approach followed by visual inspection and, if needed, correction to the muscle paths, reduced the time required for defining 34 lower-limb muscle paths from around 3.5 to 1 h. Furthermore, the method was also applicable to aberrant skeletal geometry. Using the proposed method, defining MR-based musculoskeletal models becomes a time efficient and more accurate alternative to rescaling generic models.

Biomechanical Gait Analysis for the Extraction of Slip Resistance Test Parameters

Falling accidents caused by slipping represent a high proportion of all accidents and are cost intensive in industry as well as in the private sphere. To prevent such accidents, the slip resistance of flooring must be evaluated. Therefore, measurement methods are necessary. These methods must provide results that comply with an individual's perception of when a floor is slippery. This article describes the analysis of human walking motion to derive essential parameters and estimate their values for measuring the slip resistance of flooring. Human walking motion of 22 persons is analysed to discover the critical phases for slipping. The heel strike was extracted as the critical phase for falling accidents caused by slipping. A model of the friction between the shoe and flooring is set up to describe the conditions in that phase. Heel strike velocity, requirements quotient and contact pressure are extracted as essential parameters from the friction model. With the biomechanical gait analyses of the walking of more than 170 single steps made by 22 test persons, values for these parameters are derived. Suggestions are made to adopt these values as test parameters for slip resistance test devices.