Common Gait Patterns Research Articles

Distal femoral osteotomy and patellar tendon advancement for the treatment of crouch gait in patients with bilateral spastic cerebral palsy

BackgroundCrouch gait, or flexed knee gait, represents a common gait pattern in patients with spastic bilateral cerebral palsy (CP). Distal femoral extension and/or shortening osteotomy (DFEO/DFSO) and patellar tendon advancement (PTA) can be considered as viable options when knee flexion contractures are involved. Better outcomes have been reported after a combination of both, independently of the presence of knee extensor lag. In this study, we evaluated the clinical and kinematic outcomes of these procedures. Patients and methodsWe reviewed a cohort of 52 limbs (28 patients) who were treated for crouch gait by DFEO/DFSO alone (group 1, n = 15) or DFEO/DFSO + PTA (group 2, n = 37) as a part of single event multilevel surgery (SEMLS). The mean age at surgery was 14 years, and the mean follow-up time was 18 months. The physical examination data and three-dimensional standardized gait analysis were collected and analyzed before the surgery and postoperatively. ResultsOverall knee range of motion improved in all limbs. The knee flexion decreased significantly in both groups at initial, mid, and terminal stance. Hip flexion significantly decreased in mid-stance for limbs in group 2. Both clinical and gait parameters were most improved in limbs who underwent DFEO/DFSO + PTA. Increased pelvic tilt was observed in both groups after surgery. ConclusionAlthough DFEO/DFSO alone was successful in correcting knee flexion contractures, PTA has helped to improve knee extensor lag and knee extension during gait. Level of evidenceTherapeutic level IV

ANALYSIS OF HUMAN LOWER LIMB DYNAMICS AND GAIT RECONSTRUCTION

In order to achieve gait reconstruction of human posture, a 7-degree-of-freedom model of the human lower limbs is proposed. On the basis of this model, dynamic analysis was conducted and the Lagrange equation of the human lower limb dynamic system was constructed. In the process of solving the kinetic energy–potential energy relationship of the Lagrange equation, the angular solutions of each joint were obtained. Based on actual data, common gait patterns of human lower limbs were presented, and gait reconstruction experiments were conducted. The experimental results show that under the human lower limb model and dynamic analysis method constructed in this paper, the variation curves of the hip joint, knee joint, and ankle joint of the human lower limb have been effectively reconstructed.

Research on the Application of Multi-Source Information Fusion in Multiple Gait Pattern Transition Recognition.

Multi-source information fusion technology is a kind of information processing technology which comprehensively processes and utilizes multi-source uncertain information. It is an effective scheme to solve complex pattern recognition and improve classification performance. This study aims to improve the accuracy and robustness of exoskeleton gait pattern transition recognition in complex environments. Based on the theory of multi-source information fusion, this paper explored a multi-source information fusion model for exoskeleton gait pattern transition recognition in terms of two aspects of multi-source information fusion strategy and multi-classifier fusion. For eight common gait pattern transitions (between level and stair walking and between level and ramp walking), we proposed a hybrid fusion strategy of multi-source information at the feature level and decision level. We first selected an optimal feature subset through correlation feature extraction and feature selection algorithm, followed by the feature fusion through the classifier. We then studied the construction of a multi-classifier fusion model with a focus on the selection of base classifier and multi-classifier fusion algorithm. By analyzing the classification performance and robustness of the multi-classifier fusion model integrating multiple classifier combinations with a number of multi-classifier fusion algorithms, we finally constructed a multi-classifier fusion model based on D-S evidence theory and the combination of three SVM classifiers with different kernel functions (linear, RBF, polynomial). Such multi-source information fusion model improved the anti-interference and fault tolerance of the model through the hybrid fusion strategy of feature level and decision level and had higher accuracy and robustness in the gait pattern transition recognition, whose average recognition accuracy for eight gait pattern transitions reached 99.70%, which increased by 0.15% compared with the highest average recognition accuracy of the single classifier. Moreover, the average recognition accuracy in the absence of different feature data reached 97.47% with good robustness.

Gait assessment in general practice

Patients with a variety of neuromuscular pathologies may present with gait abnormalities. Accurate assessment of each pattern, coupled with appropriate investigations, facilitates diagnostic accuracy followed by treatment or referral, as required. This review outlines the relevant history and examination areas to assess when interpreting gait abnormalities, together with common gait patterns and their aetiologies. A range of factors should be evaluated, including posture, walking aids and footwear. The gait cycle can be broadly divided into the stance and swing phases, and additional features are assessed to identify specific patterns and generate a provisional diagnosis. Gait examination, from the time the patient is called from the waiting room, will help the clinician focus on the relevant systems to examine, investigate and treat.

Kinematic cluster analysis of the crouch gait pattern in children with spastic diplegic cerebral palsy using sparse K-means method

BackgroundCrouch gait pattern is a common gait pattern in children with diplegic cerebral palsy with excessive knee flexion throughout stance phase. Few studies have grouped this pattern of gait and usually have examined only the features of gait in the sagittal plane and mostly lower extremities without considering pelvis and trunk behavior. Studies usually categorize the gait pattern according to important variables from the researcher's point of view.Sparse K-means is high dimensional clustering methods that perform clustering and variable selection simultaneously even with low sample size and large number of variables. Our aim was to define existing clusters of crouch gait pattern in children with spastic diplegic cerebral palsy. MethodsCluster analysis was applied on the lower extremity, pelvis and trunk gait kinematics data of 64 limbs of children with crouch gait pattern and 64 limbs of typically developing children. Eighty-nine kinematic variables were used as input variables for clustering. FindingsFour clusters of crouch gait pattern were defined. Sparse K-means identified influential variables and identified the knee and hip flexion as a major factor in clustering. Kinematic of the trunk, pelvis and ankle was determined in each cluster. Trunk and pelvis kinematic features were strongly correlated with the knee and hip joint flexion severity. InterpretationObtained clusters were confirmed observationally. With increasing knee flexion, the kinematic of the trunk and pelvis were further away from the patterns of typically developing individuals. The clusters ranking appear to be reasonable based on the crouch severity.

Sensing-HH: A Deep Hybrid Attention Model for Footwear Recognition

The human gait pattern is an emerging biometric trait for user identification of smart devices. However, one of the challenges in this biometric domain is the gait pattern change caused by footwear, especially if the users are wearing high heels (HH). Wearing HH puts extra stress and pressure on various parts of the human body and it alters the wearer’s common gait pattern, which may cause difficulties in gait recognition. In this paper, we propose the Sensing-HH, a deep hybrid attention model for recognizing the subject’s shoes, flat or different types of HH, using smartphone’s motion sensors. In this model, two streams of convolutional and bidirectional long short-term memory (LSTM) networks are designed as the backbone, which extract the hierarchical spatial and temporal representations of accelerometer and gyroscope individually. We also introduce a spatio attention mechanism into the stacked convolutional layers to scan the crucial structure of the data. This mechanism enables the hybrid neural networks to capture extra information from the signal and thus it is able to significantly improve the discriminative power of the classifier for the footwear recognition task. To evaluate Sensing-HH, we built a dataset with 35 young females, each of whom walked for 4 min wearing shoes with varied heights of the heels. We conducted extensive experiments and the results demonstrated that the Sensing-HH outperformed the baseline models on leave-one-subject-out cross-validation (LOSO-CV). The Sensing-HH achieved the best Fm score, which was 0.827 when the smartphone was attached to the waist. This outperformed all the baseline methods at least by more than 14%. Meanwhile, the F1 Score of the Ultra HH was as high as 0.91. The results suggest the proposed model has made the footwear recognition more efficient and automated. We hope the findings from this study paves the way for a more sophisticated application using data from motion sensors, as well as lead to a path to a more robust biometric system based on gait pattern.

SUPRA CONDYLAR FEMORAL EXTENSION OSTEOTOMY WITH PATELLAR TENDON ADVANCEMENT TO TREAT FIXED KNEE FLEXION DEFORMITY IN CROUCHING AMBULATORY ADOLESCENTS WITH CEREBRAL PALSY

Background: Ambulatory cerebral palsy (CP) patients present with different gait patterns because of muscular spasticity and contractures and subsequent limited range of motion leading to loss of their functional abilities. Crouch gait is one of the most common gait pattern in ambulatory children with CP. Aim of the work: The purpose of this study is to evaluate the results of supra condylar femoral extension osteotomy (SCFEO) and patellar tendon advancement (PTA) in the treatment of fixed knee flexion deformity (FKFD) in patients with spastic ambulatory cerebral palsy (CP) to achieve full knee extension and restore an appropriate relationship between quadriceps length and tension in order to maintain knee extension during the stance phase of gait to correct the crouch gait. Patient and Methods: This prospective case series study was done on 20 patients (37 knees); 12 males and 8 females, who had spastic or mixed (mainly spastic) CP and walked with a crouch gait, and who underwent combined SCFEO and PTA along with the context of single event multi-level surgery. Results: The mean Fixed Knee Flexion Angle (FKFA) improved from 24.25o ±11.86o to be 2.25o± 2.25o. The mean knee extension lag improved from 15.8o±5.68o to be 4.2o±1.31o. The mean Gross Motor Function Measurement (GMFM) improved from 53.3 to be 69.1. The mean Koshino Index (KI) improved from 1.54±0.29 to be 1.14±0.12.Conclusion: For crouching adolescents there are 4 questions must be answered: Frist, differentiate between isolated myogenic flexion deformity and combined myogenic-arthrogenic knee flexion deformity. Second, assess isolated myogenic flexion deformity due to hamstring shortening by unilateral popliteal angle test. Third, differentiate between apparent and true hamstring shortening by popliteal shift test; apparent functional hamstring shortening and hamstring lengthening is not indicated. Forth, if the unilateral popliteal angle is positive with negative popliteal shift test, true hamstring shortening is found.

Human Body Mixed Motion Pattern Recognition Method Based on Multi-Source Feature Parameter Fusion.

Aiming at the requirement of rapid recognition of the wearer’s gait stage in the process of intelligent hybrid control of an exoskeleton, this paper studies the human body mixed motion pattern recognition technology based on multi-source feature parameters. We obtain information on human lower extremity acceleration and plantar analyze the relationship between these parameters and gait cycle studying the motion state recognition method based on feature evaluation and neural network. Based on the actual requirements of exoskeleton per use, 15 common gait patterns were determined. Using this, the studies were carried out on the time domain, frequency domain, and energy feature extraction of multi-source lower extremity motion information. The distance-based feature screening method was used to extract the optimal features. Finally, based on the multi-layer BP (back propagation) neural network, a nonlinear mapping model between feature quantity and motion state was established. The experimental results showed that the recognition accuracy in single motion mode can reach up to 98.28%, while the recognition accuracy of the two groups of experiments in mixed motion mode was found to be 92.7% and 97.4%, respectively. The feasibility and effectiveness of the model were verified.

Outcome of intensive rehabilitation following single-event multilevel surgery for crouch gait in children with cerebral palsy

BackgroundCrouch gait is one of the most common gait patterns in ambulatory children with cerebral palsy (CP) and is contributed by several factors. The literature reports wide variations in surgical practice and rehabilitation programs following single-event multilevel surgeries.ObjectiveTo evaluate the outcome of rehabilitation after single-event multilevel orthopedic surgery for crouch gait in children with CP.Patients and methodsA total of 20 children with bilateral spastic CP and walked with a crouch gait, with gross motor function classification system levels II, III, and IV, were subjected to single-event multilevel surgery. Ten (20 limbs) patients were men and eight (14 limbs) were women. Their age ranged from 5.5 to 19 years. To assess the outcome of our rehabilitation program, we used clinical couch examination parameters, functional mobility scale, and instrumented three-dimensional gait analysis. Rehabilitation program included preoperative and postoperative rehabilitation at 1-year postoperatively.ResultsHighly statistically significant improvements in clinical parameters, which include hip abduction, femoral anteversion, fixed flexion deformity, popliteal angle, and extension lag, were demonstrated (P<0.01), whereas tibial torsion showed a statistically significant improvement (P<0.05). Functional mobility scale at 5, 50, and 500m improved in 10 (55.6%) cases, 13 (72.2%) cases, and 11 (61.1%) cases, respectively. Instrumented gait laboratory parameters, namely, stride length, crouch angle at initial stance, and peak knee flexion in mid-swing, showed improvement but did not reach statistical significance.ConclusionThe rehabilitation program we offered improves clinical and functional mobility of children with CP with crouch gait. Thus, it is viewed as an important contributor to the overall outcome together with multilevel orthopedic surgery.

Common and specific gait patterns in people with varying anatomical levels of lower limb amputation and different prosthetic components

The present study’s aim was to identify the kinematic and kinetic gait patterns and to measure the energy consumption in people with amputation according to both the anatomical level of amputation and the type of prosthetic components in comparison with a control group matched for the gait speed. Fifteen subjects with unilateral transtibial amputation (TTA), forty with unilateral transfemoral amputation (TFA) (9 with mechanical, 17 with CLeg and 14 with Genium prosthesis) and forty healthy subjects were recruited. We computed the time-distance gait parameters; the range of angular motion (RoM) at hip, knee and ankle joints, and at the trunk and pelvis; the values of the 2 peaks of vertical force curve; the full width at half maximum (FWHM) and center of activity (CoA) of vertical force; the mechanical behavior in terms of energy recovery (R-step) and energy consumption. The main results were: i) both TTA and TFA show a common gait pattern characterized by a symmetric increase of step length, step width, double support duration, pelvic obliquity, trunk lateral bending and trunk rotation RoMs compared to control groups. They show also an asymmetric increase of stance duration and of Peak1 in non-amputated side and a decrease of ankle RoM in amputated side; ii) only TFA show a specific gait pattern, depending on the level of amputation, characterized by a symmetric reduction of R-step and an asymmetric decrease of stance duration, CoA and FWHM and an increase of Peak1 in the amputated side and of hip and knee RoM, CoA and FWHM in the non-amputated side; iii) people with amputation with Genium prosthesis show a longer step length and increased hip and knee RoMs compared to people with amputation with mechanical prosthesis who conversely show an increased pelvic obliquity: these are specific gait patterns depending of the type of prosthesis. In conclusion, we identified both common and specific gait patterns in people with amputation, either regardless of, or according to their level of amputation and the type of prosthetic component.

Review of common gait patterns in cerebral palsy

Review of common gait patterns in cerebral palsy

Potential of lower-limb muscles to accelerate the body during cerebral palsy gait

Two of the most common gait patterns in children with spastic diplegic cerebral palsy (CP) are termed ‘crouch gait’ and ‘jump gait’. While outcomes of surgical interventions designed to improve functional mobility are generally positive, many children displaying these gait patterns show minimal or no improvement post-surgery. A poor response to treatment may be partially attributable to incorrect interpretations of muscle function. Computational techniques that assess muscle function may help address this issue, but before studying specific surgeries, the gait patterns themselves must be better understood. The aim of this study was to identify differences in lower-limb muscle function when comparing crouch, jump and able-bodied gait patterns by quantifying the potential of lower-limb muscles to accelerate the body's center of mass. A muscle's potential acceleration was defined as the acceleration induced by a unit of muscle force. Dynamic simulations of walking using musculoskeletal models were developed for eight children with crouch gait, ten with jump gait, and ten controls. There were significant differences (p<0.05) in muscle potential accelerations between crouch and able-bodied gait patterns, and between jump and able-bodied gait patterns, for most of the major muscles of the hip, knee, and ankle. One important outcome was the identification of the significantly reduced potential of gluteus medius to extend the hip in both crouch gait and jump gait. Potential acceleration analyses appear to be suitable for evaluating differences between common gait patterns and may also be applied to study the effects of surgical treatments. The results of such studies may lead to improved treatment outcomes for individuals with impaired mobility.

Utilisation de fortes doses de toxine botulique de type A chez l'enfant: intérêt et sécurité en pratique clinique

The purpose of this article is to examine the current state of administering high doses botulinum toxin type A for the treatment of chidhood spasticity, particularly Cerebral Palsy. The inter-relationship between the Cerebral Palsy neurological maturation and the early management is discussed, including identification of common gait patterns and the choice of target muscles for focal or multi focal spasticity management. High doses of botulinum toxin type A, when multilevel and integrated management approach is indicated, appear to be a safe, efficacious treatment for multi focal Cerebral Palsy spasticity. A review of literature guides the clinician about necessary adaptation of botulinum toxin doses and found no evidence that higher doses result in a increase of complications. Further studies would be interesting in order to evaluate long term safety and efficacy of this therapy in Cerebral Palsy.

Simulated gait patterns: the resulting effects on gait parameters, dynamic electromyography, joint moments, and physiological cost index

Equinus, crouch and crouch/equinus are common gait patterns seen in children with cerebral palsy. Six normal subjects simulated each of the above gait abnormalities to determine the effect on gait parameters, electromyography, joint moments and physiological cost index. Assessment of normal and the pathological gait patterns was performed using gait analysis. The results indicate that as the complexity of the gait pattern increases, the gait parameters decrease and the physiological cost index increases. Although abnormalities were found in electromyographic activity and joint moments, the patterns were similar to those found in children with cerebral palsy when walking in equinus, crouch and crouch/equinus. Abnormal joint positions produce significant effects on the parameters of gait used to assess the child with cerebral palsy. During interpretation of the gait analysis data significant emphasis must be placed on clinical evaluation and the determination of primary and secondary responses.