Clinical Gait Evaluation Research Articles

Surgical management of traumatic stifle luxation in cats with using fabelotibial and fibulopatellar sutures

Cats’ ligaments in the stifle joint may become damaged because of several accident kinds. Effective treatment of this condition requires surgical intervention. The objective of this article is to outline the most precise diagnostic process, surgical treatment, as well as investigate the outcomes and potential complications in the surgical treatment of stifle disruption in cats without a temporary transarticular pin. Five cats of various breeds, ranging in age from 1 to 5 years, were used in the study. Each animal has both cruciate ligaments damaged. As a therapeutic therapy, two stabilizing sutures (fabellotibial and fibulopatellar) were applied to the cats. At one, three, five, seven-, and nine-weeks following surgery, each patient underwent control and clinical gait evaluation. A phone call with the owners was conducted 4 months following the surgery to gauge their satisfaction with treatment results and find out whether the cat had fully recovered. After treatment, all patients regained their mobility. No one cat had major complications and required reoperation. Few patients were exposed to minor complications, including swelling, bacteril infection and rupture of sutures. Each owner was satisfied with the results of the therapy and their animal’s recovery. To preserve the entire functionality of the limb, the lateral fabellotibial and fibulopatellar suture technique can be effective in young animals. If the cruciate ligaments are the primary area of damage, the suture technique may be helpful.

Validity and reliability of a commercial wearable sensor system for measuring spatiotemporal gait parameters in a post-stroke population: the effects of walking speed and asymmetry

Objective. Commercial wearable sensor systems are a promising alternative to costly laboratory equipment for clinical gait evaluation, but their accuracy for individuals with gait impairments is not well established. Therefore, we investigated the validity and reliability of the APDM Opal wearable sensor system to measure spatiotemporal gait parameters for healthy controls and individuals with chronic stroke. Approach. Participants completed the 10 m walk test over an instrumented mat three times in different speed conditions. We compared performance of Opal sensors to the mat across different walking speeds and levels of step length asymmetry in the two populations. Main results. Gait speed and stride length measures achieved excellent reliability, though they were systematically underestimated by 0.11 m s−1 and 0.12 m, respectively. The stride and step time measures also achieved excellent reliability, with no significant errors (median absolute percentage error <6.00%, p> 0.05). Gait phase duration measures achieved moderate-to-excellent reliability, with relative errors ranging from 4.13%–21.59%. Across gait parameters, the relative error decreased by 0.57%–9.66% when walking faster than 1.30 m s−1; similar reductions occurred for step length symmetry indices lower than 0.10. Significance. This study supports the general use of Opal wearable sensors to obtain quantitative measures of post-stroke gait impairment. These measures should be interpreted cautiously for individuals with moderate-severe asymmetry or walking speeds slower than 0.80 m s−1.

Impact of Sex and Velocity on Plantar Pressure Distribution during Gait: A Cross-Sectional Study Using an Instrumented Pressure-Sensitive Walkway.

In-shoe systems and pressure plates are used to assess plantar pressure during gait, but additional tools are employed to evaluate other gait parameters. The GAITRite® system is a clinical gait evaluation tool. Extensive literature is available for spatiotemporal parameters, but it is scarce for relative plantar pressure data. Therefore, we investigated whether, when controlling for age, the GAITRite® system is able to distinguish the effects of walking velocity on plantar pressure parameters in six plantar regions in a large sample of adults. Participants (83 women and 87 men, aged 18−85 years) walked at three self-selected velocities (slow, preferred, fast) on a 6-m long GAITRite® walkway. Relative peak pressure, pressure-time integral, peak time and contact area were computed for six zones (lateral and medial heel, mid- and forefoot). The impact of age (covariate), sex, side, velocity, pressure zone and their interactions on pressure variables was evaluated. Velocity affected peak pressure, pressure-time integral, peak time and contact area (p < 0.001). With increasing self-selected gait velocity, medial forefoot peak pressure and pressure-time integral increased (p < 0.001), while heel and lateral forefoot regions displayed a nonlinear plantar pressure evolution. These results suggest lower (heel strike) or more equally distributed (push-off) loads at preferred gait velocity.

IMU-Based Gait Normalcy Index Calculation for Clinical Evaluation of Impaired Gait.

Inertial measurement units (IMU) have been used for gait analysis in many clinical studies, as a more convenient, low cost and less restricted alternative to the laboratory-based motion capture systems or instrumented walkways. Spatial-temporal gait parameters such as gait cycle duration and stride length calculated from the IMUs were often used in these studies for evaluating the impaired gait. However, the spatial-temporal information provided by IMUs is limited, and sometime suffers incomplete and less effective evaluation. In this study, we develop a novel IMU-based method for clinical gait evaluation. Nine gait variables including three spatial-temporal parameters and six kinematic parameters are extracted from two shank-mounted IMUs for quantifying patient's gait deviations. Based on those parameters, an IMU-based gait normalcy index (INI) is derived to evaluate the overall gait performance. Eight inpatient subjects with gait impairments caused by n-hexane neuropathy and ten healthy subjects were recruited. The proposed gait variables and INI were examined on the inpatients at three to five time instants during the rehabilitation process until being discharged. A comparison with healthy subjects and statistical analysis for the changes of gait variables and INI demonstrated that the proposed new set of gait variables and INI can provide adequate and effective information for quantifying gait abnormalities, and help understanding the progress of gait and effectiveness of therapy during rehabilitation process.

The mechanics behind gait problems in patients with Dravet Syndrome

BackgroundDravet Syndrome (DS) is a developmental and epileptic encephalopathy starting in infancy and characterised by treatment resistant epilepsy with cognitive impairment and progressive motor dysfunction. Walking becomes markedly impaired with age, but the mechanical nature of gait problems remains unclear. Research questionWhat are the kinetic strategies characterised in gait of patients with DS? MethodsThis case-control study compared 41 patients with DS aged 5.2–26.1 years (19 female, 22 male) to 41 typically developing (TD) peers. Three dimensional gait analysis (VICON) was performed to obtain spatiotemporal parameters, kinematics and kinetics during barefoot, level walking at self-selected walking velocity. The sagittal plane support moment was analysed using Statistical Parametric Mapping (SPM). Three DS subgroups were identified based on differences in kinetic strategies characterised by the net internal knee joint moments and trunk lean. Kinematic and kinetic time profiles of the subgroups were compared to the TD group (SPM t-test). Clinical characteristics from physical examination and parental anamnesis were compared between DS (sub)groups using non-parametric tests (Kruskal-Wallis, Wilcoxon rank-sum, Fisher’s exact). ResultsSupport moments in stance were significantly increased in the DS group compared to TD and strongly related to minimum knee flexion in midstance. Persistent internal knee extension moments during stance were detected in a subgroup of 27 % of the patients. A second subgroup of 34 % showed forward trunk lean and attained internal knee flexion moments. The remaining 39 % had neutral or backward trunk lean with internal knee flexion moments. Subgroups differed significantly in age and functional mobility. SignificanceInefficient kinetic patterns suggested that increased muscle effort was needed to control lower limb stability. Three distinct kinetic strategies that underly kinematic deviations were identified. Clinical evaluation of gait should pay attention to knee angles, trunk lean and support moments.

What's New in the Orthopaedic Treatment of Ambulatory Children With Cerebral Palsy Using Gait Analysis.

Limb deformities in ambulatory children with cerebral palsy (CP) are common. The natural history of lower extremity deformities is variable and the impact on gait is managed with many treatment modalities. Effective interventions must consider the underlying pathophysiology, patient-specific goals, and incorporate objective outcome assessment. Evaluation and treatment include observation, tone management multilevel orthopaedic surgery to address muscle contractures and bony deformities, and the use of gait analysis for preoperative and postoperative assessment. A PubMed search of the orthopaedic literature for studies published between January 2016 and February 2019 was performed. Eligible abstracts included the use of 3-dimensional instrumented gait analysis in the evaluation and treatment of the lower extremities in ambulatory children with CP. Seven hundred twenty abstracts were reviewed, with 84 papers identified as eligible, of which 45 full manuscripts were included for detailed review. The review summarized recent advances regarding the treatment of torsional alignment, knee deformities and clinical gait evaluation with visual assessment tools compared with instrumented gait analysis. Gait analysis of ambulatory children with CP remains essential to evaluation and surgical decision-making. Promising results have been reported with the goal of maintaining or reaching a higher level of function and increased endurance. Level IV-literature review.

Effects of progressive backward body weight suppoted treadmill training on gait ability in chronic stroke patients: A randomized controlled trial.

A stroke patient with hemiplegic gait is generally described as being slow and asymmetric. Body weight-supported treadmill training and backward gait training are recent additions to therapeutic gait trainings that may help improve gait in stroke patient with hemiplegic gait. Therefore, we examined the effect of progressive backward body weight-supported treadmill training on gait in chronic stroke patients with hemiplegic gait. Thirty subjects were divided to the experimental and control groups. The experimental group consisted of 15 patients and underwent progressive backward body weight-supported treadmill training. The control group consisted of 15 patients and underwent general treadmill gait training five times per week, for a total of four weeks. The OptoGait was used to analyze gait kinematics, and the dynamic gait index (DGI) and results of the 6-minute walk test were used as the clinical evaluation indicators. A follow-up test was carried out four weeks later to examine persistence of exercise effects. The experimental group showed statistically significant results in all dependent variables week four compared to the control group. However, until the eighth week, only the dependent variables, of affected step length (ASL), stride length (SL), and DGI differed significantly between the two groups. This study verified that progressive bodyweight-supported treadmill training had a positive influence on the temporospatial characteristics of gait and clinical gait evaluation index in chronic stroke patients.

Association between linear measurements of corpus callosum and gait in the elderly

Segmentation and diffusion-tensor-imaging of the corpus callosum (CC) have been linked to gait impairment. However, such measurements are impracticable in clinical routine. The purpose of this study was to evaluate the association between simple linear measurements of CC thickness with gait. Two hundred and seventy-two community-dwelling subjects underwent neurological assessment and brain MRI. Mid-sagittal reformats of T1-weighted images were used to determine CC thickness. The association of measurements with clinical evaluation of gait was assessed by multivariate regression, controlling for numerous clinical and imaging confounders. Differences in CC thickness were, moreover, compared between subgroups with no, moderate or severe impairment of gait. In univariate analyses, thickness of the genu and body of CC but not the splenium were associated with postural stability (P < 0.01). Multivariate regression revealed thickness of CC genu as the only imaging variable independently associated with gait (P = 0.01). Genu thickness was significantly different between subjects with high and low (P = 0.0003) or high and moderate (P = 0.001) risk of fall. Atrophy of the CC genu is an imaging marker of gait impairment in the elderly suggesting higher risk of fall. Simple linear measurements of CC can help in MRI evaluation of patients with gait impairment. • Regional atrophy of the corpus callosum reflects disruption of gait regulation • Genu thickness on cranial MRI is an independent marker of gait impairment • Findings help in the MRI evaluation of patients with gait impairment.

Normal pressure hydrocephalus: long-term outcome after shunt surgery

Background/objective:Little is known about the long-term clinical course and management of patients with normal pressure hydrocephalus (NPH) treated by cerebrospinal fluid (CSF) shunting.Methods:We retrospectively reviewed records of 55 patients diagnosed...

Clinical and Histopathologic Study of the Use of Gangliosides for Nerve Regeneration in Rats After Axonotmesis

This study involved a clinical and histopathologic evaluation of the use of gangliosides in nerve regeneration, using an experimental model with higher vertebrates. Forty Sprague Dawley rats had their right sciatic nerve crushed for 1 minute in a hemostatic tweezer. The animals were divided into experimental and control groups. The animals in the experimental group received an intramuscular injection of gangliosides in the left thigh for 25 days, whereas those in the control group received infiltrations of distilled water. A clinical evaluation of gait was made 24 hours and then 45 days after the surgical intervention, and a histopathologic evaluation of the sciatic nerves was performed after 45 days. There were no signs that the use of gangliosides significantly altered the animals' gait after 45 days. The animals in the experimental group had a greater frequency and intensity of inflammatory response than seen in the control group. The systemic use of gangliosides produced no improvement in gait and led to a more frequent and intense inflammatory response at the site of injury.

Diagnosis of the risk of accidental falls in the elderly

The steep increase in the incidence of hip fractures and other fall-related fractures with advancing age is caused by an age-associated combination of increased fall frequency, typical fall mechanisms and reduced bone strength. This article reviews the current knowledge related to fall risk factors and fall mechanisms. Non-syncopal falls during normal daily activities are predominantly age-associated occurrences with serious consequences. 5% of all falls cause fractures, another 10 to 15% lead to a variety of further injuries. The most serious consequences of the geriatric fall syndrome are fractures of hip, humerus, wrist and pelvis. Fear of falling and self limitation of physical activity are self imposed psychological impairments. There is a pathological cascade from age-associated gait and balance disorders to locomotor falls and further to fall-related fractures. Significantly increased fall risk caused by gait and balance disorders can be considered as a distinct chronic pathological condition. It is strongly age-related and definitely has a multifactorial origin. The term "age-associated multifactorial gait disorder" has been coined for this condition. Assessing fracture risk requires evaluating fall risk, fall mechanisms and bone strength. Older people with gait and balance disorders fall mostly sideways, and the impact of such a fall from standing height generates enough force to break an older non-osteoporotic femur. Osteoporosis can decrease bone strength beyond the age-related grade, and is one of the several most important risk factors for fractures. Prospective studies have consistently found the following independent risk factors for non-syncopal falls: 1. Muscle power of lower extremities, 2. Lateral postural stability, 3. Clinical evaluation of gait, 4. Visual impairment, 5. Four or more different medications or certain psychotropic drugs, 6. Cognitive impairment, and 7. History of falling. The fall-related neuromuscular status can be adequately assessed by three diagnostic procedures: The chair rising test represents muscle power, and has proven its relevance for both fall risk and deterioration of mobility and functional independence. Measurement of lateral postural stability can be done by tandem manoeuvres. Clinical evaluation of gait should focus on the regularity of gait as a cyclic event. The fall risk status of an individual depends strongly on the number of the independent risk factors that one accumulates. Both prevention and therapy must focus on each of these individual risk factors. Preventing falls and its consequences is imperative for successful aging.

Graphical presentation of the range of hip and knee rotations for clinical evaluation of gait

Objective. This paper reports a method of using a multi-axis graph to represent the range of rotations at the hip and knee joints during gait for clinical evaluation of a patient's performance. Design and methods. The multi-axis graph uses 12 symmetrically arranged axes to represent each component of range of rotations at the hip and knee joints of both legs. The range of joint rotations of thirteen normal subjects and two patients were measured using an electromagnetic motion tracking system with four foot switches. Results. The range of joint rotations of normal subjects shows a symmetrical star in the multi-axis graph. Abnormal function of a patient shows an asymmetrical star. Conclusions. This representation provides a simple way to examine a patient's performance in a time effective manner. Relevance In clinical practice, the multi-axis representation of joint rotations can be used as an initial evaluation of a patient's performance to identify problems for further investigation.

Comparison of the performance of 3D camera systems II

Abstract The accuracy and processing time of 11 commercially available 3D camera systems were tested to evaluate their performance in clinical gait evaluation. The systems tested were Ariel APAS, Dynas 3D/h, Elite Plus, ExpertVision, PEAK5, PRIMAS, Quick MAG, VICON 140, VICON 370, color Video Locus and reflective Video Locus. The 3D locations of markers on both ends of a rigid bar were determined. The distance between these markers was calculated from these data and compared with the true value, which was measured with a slide caliper prior to the measurement. For the estimation of noise, 3D coordinates of the markers were measured while the same rigid bar was placed on the floor, and the standard deviations were calculated. The processing time for calculating 3D coordinates from data obtained during normal gait was measured.

Statistical Analysis of Child Gait: Temporal and Distance Factors

Sequential steps of gait in children were compared with those in adults and statistically analysed in terms of the distance and temporal gait factors using a new instrumented walkway system. The results indicated: (1) that children showed relatively mature values of gait factors, but that there were large within- and between-group variations which improved with increasing age, indicating their neuromuscular development; (2) that the development process and stage are different for each gait factor; (3) that the new instrumented walkway was useful for clinical evaluation of gait in children.

Gait consistency test based on the impulse-momentum theorem.

The kinematic and dynamic aspects of human locomotion have been investigated during the last eighty years. Significant contributions were made towards the understanding of the mechanics of movement and of the joints. As a consequence the field of Rehabilitation and Orthopaedic Biomechanics advanced considerably. However the complexity of the kinematic and dynamic data of locomotion prevented the various techniques from becoming clinically applicable. This paper attempts to develop a technique for clinical evaluation of gait by relatively simple means. For this purpose the six components of the ground reaction forces were chosen for an analysis. The major tool of the technique is the time integral of the forces. Since this is a quantitative parameter with a distinct physical definition, it can be very meaningful as far as investment of efforts in ambulation is concerned. As a first step towards the reinforcement of this thesis a consistency test was developed. The consistency test ensures that the use of dynamic forceplates do not impose a bias on the test procedure. The test is meant to indicate whether the results are valid for further processing. The concept of the test is based on the fact that the velocity vector is expected to be equal in two equivalent points of consecutive walk cycles. It therefore follows that the time-force integral which equals the difference of momentum between the two points should be zero. The advantage of this test is that it does not discriminate between normal and pathological gait. The theory was tested with 28 subjects and the results have provided sufficient evidence for its verification.