Differences In Gait Kinematics Research Articles

Self-selected speed provides more accurate human gait kinematics and spatiotemporal parameters than overground simulated speed on a treadmill: a cross-sectional study

BackgroundWalking speed, a key element of gait analysis, is essential for evaluating the biomechanics of the musculoskeletal system and is typically assessed on flat surfaces, such as walkways or treadmills. While many authors have compared the differences and similarities between treadmill and overground walking, no studies have yet investigated the differences between treadmill gait analysis at self-selected speed (SS) and overground simulated speed (OS). The hypothesis is that accurate kinematic measurements depend on selecting the correct gait speed; however, a mismatch between the perceived comfortable treadmill speed and actual overground speed may affect the accuracy of treadmill gait analyses. This study aimed to assess treadmill gait in healthy young adults by comparing the SS with the OS. The objectives were to determine whether participants could match SS with OS on a treadmill, examine sex differences in gait kinematics and spatiotemporal parameters (KSP) at different speeds, and identify which speed better reflects natural gait kinematics.MethodsA total of 60 healthy men and 70 healthy women, aged 22–35 years, participated in this cross-sectional study to investigate the gait kinematics and spatiotemporal differences between the SS and OS. Student’s t-test, Bonferroni adjustment, Cohen’s effect size, and quadratic regression were employed to analyse differences across walking speeds and groups.ResultsA discrepancy between OS and SS was observed in 66.4% of the participants. Our findings revealed that the adjusted R² values for KSP at SS were consistently greater than those at OS, suggesting that SS offers a more robust and accurate representation of gait kinematics, whereas OS is less reliable.ConclusionsThese findings underscore the importance of individualized speed selection in gait analysis, as it significantly impacts the accuracy of kinematic and spatiotemporal measurements. This insight is pivotal for clinicians and researchers to develop more effective rehabilitation strategies and comprehensively understand gait dynamics.

Peak vertical ground reaction force used to identify sub-groups of individuals with differing biomechanical gait profiles post-anterior cruciate ligament reconstruction.

Lesser peak vertical ground reaction force (vGRF) has been widely reported among individuals with anterior cruciate ligament reconstruction (ACLR). Peak vGRF remains less than uninjured controls and relatively stable during the first year following ACLR. However, it is unknown whether there are subgroups of individuals exhibiting consistently greater peak vGRF in the first 6-months following ACLR and if individuals with consistently greater peak vGRF exhibit kinematic and kinetic gait differences compared to individuals with low vGRF. The purpose of this study was to determine if distinct clusters exist based upon magnitude of peak vGRF 2- and 6-months post-ACLR. Subsequently, we explored between cluster differences in vGRF, knee flexion angle, and sagittal and frontal plane knee kinetics throughout stance between clusters. Forty-three individuals (58.1%female, 21.4 ± 4.4 years-old, 95.3% patellar-tendon autograft) completed five gait trials at their habitual walking speed 2- and 6-months post-ACLR. A single K-means cluster analysis was used to identify clusters of individuals based on peak vGRF at 2- and 6-months post-ACLR. Functional waveform analyses were used to compare gait outcomes between clusters with and without controlling for gait speed and age. We identified two clusters that included a subgroup with high vGRF (n = 16) and low vGRF (n = 27). The cluster with high vGRF demonstrated greater vGRFs, knee flexion angles, and knee extension moments during early stance as compared to the low vGRF cluster 2- and 6-months post-ACLR. Individuals with peak vGRF ≥1.02 times body-weight 2-months post-ACLR had 35.4 times greater odds of being assigned to the high vGRF cluster.

Ankle Muscle Strength and Gait Function After Dorsal Closing Wedge Calcaneal Osteotomy for Haglund Exostosis-Related Heel Pain.

Haglund exostosis-related heel pain may be surgically treated with dorsal closing wedge calcaneal osteotomy (DCWCO). Recent reports on this technique show good clinical and self-reported outcomes. However, uncertainty about functional consequences related to ankle muscle strength and gait function due to a shortened Achilles tendon lever arm exists. Fifteen patients (15 feet) with Haglund exostosis-related heel pain were surgically treated with DCWCO and evaluated before and 1 year after surgery. Isometric plantar flexion and dorsiflexion strength was quantified for both the involved and the uninvolved limb. Gait analysis was performed at a self-selected walking speed using a 3D motion capture system including force plates. Self-reported outcomes (Foot Function Index and Global Treatment Outcome) were also assessed. Before surgery, as well as after surgery, plantar flexion strength of the involved limb was significantly lower compared to the uninvolved limb while dorsiflexion strength did not differ between limbs at both time points. Step length and time, ankle flexion angles, power generation, and propulsive impulses during gait did not differ between limbs both before and after surgery. Propulsive impulse and step length of the involved limb increased from pre- to postsurgery with an effect size of 1.04 and 0.48, respectively, revealing a general improvement in gait dynamics. Total Foot Function Index improved by 48% after surgery, and 80% of patients rated their surgery as "helped" or "helped a lot" (Global Treatment Outcome). In this relatively small cohort, we found that patients treated for Haglund exostosis-related heel pain with DCWCO surgery had minor interlimb differences in gait kinematics and kinetics and generally improved gait dynamics and self-reported function at 1-year follow-up. Level II, observational prospective cohort study.

INVESTIGAÇÃO QUANTITATIVA E QUALITATIVA DA ANÁLISE TRIDIMENSIONAL DA MARCHA EM PACIENTES COM MIELOPATIA CERVICAL

ABSTRACT Objective: This study aims to describe a kinematic gait assessment protocol and identify its main alterations in individuals with cervical spondylotic myelopathy (CSM) compared to healthy patients. Methods: In total, 14 patients diagnosed with CSM were enrolled and submitted to a three-dimensional gait analysis. The movement of patients was captured with infrared emission cameras that identified tracking markers placed on the lower limbs. Reference positions were used, and the patients walked along a rubberized walkway. The Gait Profile Score (GPS) and Movement Analysis Profile (MAP) were used to analyze variables. Results were subjected to a Student’s t-test at 95% confidence interval. The R Core Team (2016) software was used for statistical analysis, graphically comparing the study results with data from healthy patients. Results: When comparing the kinematic data bilaterally, no statistical differences were found. However, graphical analysis showed changes in the gait of patients with CSM compared to healthy individuals. There were differences in all movements, with a more significant discrepancy in hip and knee flexion and extension, dorsiflexion and plantar flexion, and internal and external hip rotation. Conclusion: We describe a protocol for gait kinematics assessment using GPS and MAP, and we presented the differences in gait kinematics in patients with CSM compared to healthy individuals. Level of Evidence II, Prospective study.

The long-term effects of aggressive spasticity reducing treatment, including selective dorsal rhizotomy, on joint kinematic outcomes of persons with cerebral palsy

BackgroundSelective dorsal rhizotomy (SDR) creates a large and permanent reduction of spasticity for children with cerebral palsy (CP). Previous SDR outcomes studies have generally lacked appropriate control groups, had limited sample sizes, or reported short-term follow-up, limiting evidence for improvement in long-term gait function. Research questionDoes aggressive spasticity management for individuals with CP improve long-term gait kinematics (discrete joint kinematics) compared to a control group of individuals with CP with minimal spasticity management? MethodsThis study was a secondary analysis – focused on joint-level kinematics – of a previous study evaluating the long-term outcomes of SDR. Two groups of participants were recruited based on a retrospectively completed baseline clinical gait study. One group received aggressive spasticity treatment including a selective dorsal rhizotomy (Yes-SDR group), while the other group had minimal spasticity management (No-SDR group). Both groups had orthopedic surgery treatment. Groups were matched on baseline spasticity. All participants prospectively returned for a follow-up gait study in young adulthood (greater than 21 years of age and at least 10 years after baseline). Change scores in discrete kinematic variables from baseline to follow-up were assessed using a linear model that included treatment arm (Yes-SDR, No-SDR), baseline age, and baseline kinematic value. For treatment arm, 5° and 5 Gait Deviation Index points were selected as thresholds to be considered a meaningful difference between treatment groups. ResultsAt follow-up, there were no meaningful differences in pelvis, hip, knee, or ankle kinematic variable changes between treatment arms. Max knee flexion – swing showed a moderate treatment effect for Yes-SDR, although it did not reach the defined threshold. SignificanceAggressive spasticity treatment does not result in meaningful differences in gait kinematics for persons with cerebral palsy in young adulthood compared to minimal spasticity management with both groups having orthopedic surgery.

Sex differences in age-related differences in joint motion during gait in community-dwelling middle-age and older individuals

BackgroundWalking is the most important mode of human locomotion; however, the ability to walk often decreases with age. Age-related differences in lower-limb kinematics during gait may differ depending on sex. However, the question of the compounded effects of age and sex on gait kinematics remains unsolved. Research questionThe present study aimed to clarify the interaction between age and sex in differences in gait kinematics of community-dwelling middle-age and older individuals. MethodsThis study included 836 community-dwelling middle-age and older adults (61.8 % female). Joint motion during comfortable gait was measured using magnetic and inertial measurement units. Hip, knee, and ankle joint angles were calculated in the sagittal plane. Participants were divided into four groups according to age: 50–59, 60–69, 70–79, and 80–89 years. The interaction of sex and age on spatiotemporal gait parameters and the peak value of joint angles was analyzed using two-way analysis of variance (ANOVA) and Tukey’s post hoc test. ResultsGait speed (F = 43.92, P < 0.001), step length (F = 73.00, P < 0.001), hip extension (F = 12.89, P = 0.002), knee flexion (F = 39.99, P < 0.001), and ankle plantar flexion (F = 27.43, P < 0.001) significantly decreased with age. Significant differences according to sex were observed in all parameters except gait speed. Significant age and sex interaction effects were observed for knee flexion (F = 4.97, P = 0.002) and ankle dorsiflexion (F = 4.04, P = 0.007). SignificanceA significant interaction effect of age and sex was observed for peak angle of knee flexion and ankle dorsiflexion during gait. In particular, the knee flexion angle among females during gait began to decrease from 60 years of age, and the decreasing trend was faster and more prominent than that among males.

Kinematic Gait Impairments in Children with Clubfeet Treated by the Ponseti Method: A Systematic Review and Meta-Analysis.

Being aware of possible gait impairments in Ponseti-treated clubfoot children might be useful for optimizing initial and additional treatment. Therefore, this systematic review and meta-analysis aimed to identify kinematic gait abnormalities in children with clubfoot treated with the Ponseti method (with and without relapse). A systematic search was conducted. Studies comparing kinematic gait parameters of Ponseti-treated clubfoot children to healthy controls were included. Meta-analyses and qualitative analyses were conducted on the extracted data. Twenty studies were identified. Twelve of the 153 reported kinematic outcome measures could be included in the meta-analysis. Plantarflexion at push-off, maximum ankle dorsiflexion during the swing, maximal plantarflexion, and ankle range of motion was significantly lower in Ponseti-treated clubfoot children. Ponseti-treated clubfoot children showed more internal foot progression. Qualitative analysis revealed 51 parameters in which pre-treatment relapse clubfeet deviated from healthy controls. Ponseti-treated clubfoot children showed several kinematic gait differences from healthy controls. In future studies, homogeneity in measured variables and study population and implementation of multi-segmental foot models will aid in comparing studies and understanding clubfoot complexity and treatment outcomes. The question remains as to what functional problems gait impairments lead to and whether additional treatment could address these problems.

Speed-dependent biomechanical changes vary across individual gait metrics post-stroke relative to neurotypical adults

BackgroundGait training at fast speeds is recommended to reduce walking activity limitations post-stroke. Fast walking may also reduce gait kinematic impairments post-stroke. However, it is unknown if differences in gait kinematics between people post-stroke and neurotypical adults decrease when walking at faster speeds.ObjectiveTo determine the effect of faster walking speeds on gait kinematics post-stroke relative to neurotypical adults walking at similar speeds.MethodsWe performed a secondary analysis with data from 28 people post-stroke and 50 neurotypical adults treadmill walking at multiple speeds. We evaluated the effects of speed and group on individual spatiotemporal and kinematic metrics and performed k-means clustering with all metrics at self-selected and fast speeds.ResultsPeople post-stroke decreased step length asymmetry and trailing limb angle impairment, reducing between-group differences at fast speeds. Speed-dependent changes in peak swing knee flexion, hip hiking, and temporal asymmetries exaggerated between-group differences. Our clustering analyses revealed two clusters. One represented neurotypical gait behavior, composed of neurotypical and post-stroke participants. The other characterized stroke gait behavior—comprised entirely of participants post-stroke with smaller lower extremity Fugl-Meyer scores than the post-stroke participants in the neurotypical gait behavior cluster. Cluster composition was largely consistent at both speeds, and the distance between clusters increased at fast speeds.ConclusionsThe biomechanical effect of fast walking post-stroke varied across individual gait metrics. For participants within the stroke gait behavior cluster, walking faster led to an overall gait pattern more different than neurotypical adults compared to the self-selected speed. This suggests that to potentiate the biomechanical benefits of walking at faster speeds and improve the overall gait pattern post-stroke, gait metrics with smaller speed-dependent changes may need to be specifically targeted within the context of fast walking.

Flip-Flops: A Survey of Risk Perception and Acceptance

This study’s goal was to better understand risk tolerance associated with wearing flip-flops. A review of existing biomechanical data revealed substantial differences in gait kinematics and kinetics and an increased risk of falling when wearing flip-flops. However, users’ awareness of this increased risk and its potential influence on footwear decisions have not been studied. Nearly 800 participants were surveyed to evaluate usage behaviors of flip-flop wearers. Most participants found flip-flops comfortable and easy to wear, recognized the increased likelihood of a slip, trip, or misstep when wearing flip-flops, and reported experiencing such an event, mostly without injury. Older adults were less likely to have these attitudes and experiences regarding flip-flops. Despite the collective practical knowledge of an increased risk of a slip, trip, or misstep, most participants accepted the risk and chose to wear flip-flops, i.e., footwear choice was infrequently affected by awareness of the increased risk.

Three-Dimensional Gait Analysis in a Healthy Geriatric Cohort

Introduction Three-dimensional gait analysis assesses multiple parameters of lower extremity motion. Neither normative gait patterns nor an understanding of how health and demographic factors impact gait have been established for the geriatric population. Methods A single time-point observational study from October 2013 to February 2015 recruited 25 healthy geriatric participants within three cohorts: 60-69, 70-79, and 80 years-old and older. Participants underwent static lower extremity range of motion assessment and gait analysis to collect lower extremity joint kinematics, joint kinetics, and spatiotemporal data. Questionnaires and tools included: FRAX, SF-12, and Fried Frailty Index. Data was compared with non-geriatric controls with mature gait patterns. Results Mean age was 72(SD 8); 44% women. Significant kinematic differences between the geriatric volunteers and controls were observed. Minimum hip flexion was 1.6°(SD 11.9) versus -6.0°(SD 6.9) in controls. Minimum to maximum ankle dorsiflexion was -13.1°(SD 6.3) to 15.8°(SD 3.1) and -21.6°(SD 9.0) to -13.1°(SD 6.3) in controls. Maximum ankle dorsiflexion was significantly different across age cohorts (60-69, 70-79, 80+ respectively): 15.8°(SD 2.9), 13.9°(SD 3.1), 18.0°(SD 1.6). Minimum hip flexion and minimum knee flexion were significantly higher at older ages: 5.7°(SD 7.7) and 9.4°(SD 2.2) respectively in the age 80+ cohort versus -3.2°(SD 13.9) and 5.9°(SD 3.1) in the 60-69 year-olds. Conclusion Significant kinematic gait differences were observed between geriatric volunteers and controls. Age-related gait differences were found within the geriatric study population. These findings have clinical implications for understanding fall predisposition, directing rehabilitation, and guiding medical and surgical approaches to lessen the impact on gait changes. The study identifies significant declines in geriatric gait and serves as a useful reference for future studies in the geriatric population. Level of Evidence Prognostic Cohort Study, Level III

Nature benefits revisited: Differences in gait kinematics between nature and urban images disappear when image types are controlled for likeability

Exposure to urban environments requires more cognitive processing than exposure to nature; an effect that can even be measured analysing gait kinematics whilst people walk towards photographic images. Here, we investigated whether differences in cognitive load between nature and urban scenes are still present when scenes are matched for their liking scores. Participants were exposed to images of nature and urban scenes that had been matched a priori for their liking scores by an independent participant sample (n = 300). Participants (N = 44) were either asked to memorise each image during walking or to rate each image for its visual discomfort after each walk. Irrespective of experimental task, liking score but not environment type predicted gait velocity. Moreover, subjective visual discomfort was predictive of gait velocity. The positive impact of nature described in the literature thus might, at least in part, be due to people’s aesthetic preferences for nature images.

Gait Kinematic and Kinetic Characteristics of Older Adults With Mild Cognitive Impairment and Subjective Cognitive Decline: A Cross-Sectional Study.

BackgroundOlder adults with mild cognitive impairment (MCI) have slower gait speed and poor gait performance under dual-task conditions. However, gait kinematic and kinetic characteristics in older adults with MCI or subjective cognitive decline (SCD) remain unknown. This study was designed to explore the difference in gait kinematics and kinetics during level walking among older people with MCI, SCD, and normal cognition (NC).MethodsThis cross-sectional study recruited 181 participants from July to December 2019; only 82 met the inclusion criteria and consented to participate and only 79 completed gait analysis. Kinematic and kinetic data were obtained using three-dimensional motion capture system during level walking, and joint movements of the lower limbs in the sagittal plane were analyzed by Visual 3D software. Differences in gait kinematics and kinetics among the groups were analyzed using multivariate analysis of covariance (MANCOVA) with Bonferroni post-hoc analysis. After adjusting for multiple comparisons, the significance level was p < 0.002 for MANCOVA and p < 0.0008 for post-hoc analysis.ResultsTwenty-two participants were MCI [mean ± standard deviation (SD) age, 71.23 ± 6.65 years], 33 were SCD (age, 72.73 ± 5.25 years), and 24 were NC (age, 71.96 ± 5.30 years). MANCOVA adjusted for age, gender, body mass index (BMI), gait speed, years of education, diabetes mellitus, and Geriatric Depression Scale (GDS) revealed a significant multivariate effect of group in knee peak extension angle (F = 8.77, p < 0.0001) and knee heel strike angle (F = 8.07, p = 0.001) on the right side. Post-hoc comparisons with Bonferroni correction showed a significant increase of 5.91° in knee peak extension angle (p < 0.0001) and a noticeable decrease of 6.21°in knee heel strike angle (p = 0.001) in MCI compared with NC on the right side. However, no significant intergroup difference was found in gait kinetics, including dorsiflexion, plantar flexion, knee flexion, knee extension, hip flexion, and hip extension(p > 0.002).ConclusionAn increase of right knee peak extension angle and a decrease of right knee heel strike angle during level walking were found among older adults with MCI compared to those with NC.

Trabecular organization of the proximal femur in Paranthropus robustus: Implications for the assessment of its hip joint loading conditions

Reconstruction of the locomotor repertoire of the australopiths (Australopithecus and Paranthropus) has progressively integrated information from the mechanosensitive internal structure of the appendicular skeleton. Recent investigations showed that the arrangement of the trabecular network at the femoral head center is biomechanically compatible with the pattern of cortical bone distribution across the neck, both suggesting a full commitment to bipedalism in australopiths, but associated with a slightly altered gait kinematics compared to Homo involving more lateral deviation of the body center of mass over the stance limb. To provide a global picture in Paranthropus robustus of the trabecular architecture of the proximal femur across the head, neck and greater trochanter compartments, we applied techniques of virtual imaging to the variably preserved Early Pleistocene specimens SK 82, SK 97, SK 3121, SKW 19 and SWT1/LB-2 from the cave site of Swartkrans, South Africa. We also assessed the coherence between the structural signals from the center of the head and those from the trabecular network of the inferolateral portion of the head and the inferior margin of the neck, sampling the so-called vertical bundle, which in humans represents the principal compressive system of the joint. Our analyses show a functionally related trabecular organization in Pa. robustus that closely resembles the extant human condition, but which also includes some specificities in local textural arrangement. The network of the inferolateral portion of the head shows a humanlike degree of anisotropy and a bone volume fraction intermediate between the extant human and the African ape patterns. These results suggest slight differences in gait kinematics between Pa. robustus and extant humans. The neck portion of the vertical bundle revealed a less biomechanically sensitive signal. Future investigations on the australopith hip joint loading environment should more carefully investigate the trabecular structure of the trochanteric region and possible structural covariation between cortical bone distribution across the neck and site-specific trabecular properties of the arcuate bundle.

Novel velocity estimation for symmetric and asymmetric self-paced treadmill training

BackgroundSelf-paced treadmills (SPT) can provide an engaging setting for gait rehabilitation by responding directly to the user’s intent to modulate the external environment and internal effort. They also can improve gait analyses by allowing scientists and clinicians to directly measure the effect of an intervention on walking velocity. Unfortunately, many common SPT algorithms are not suitable for individuals with gait impairment because they are designed for symmetric gait patterns. When the user’s gait is asymmetric due to paresis or if it contains large accelerations, the performance is diminished. Creating and validating an SPT that is suitable for asymmetric gait will improve our ability to study rehabilitation interventions in populations with gait impairment. The objective of this study was to test and validate a novel self-paced treadmill on both symmetric and asymmetric gait patterns and evaluate differences in gait kinematics, kinetics, and muscle activity between fixed-speed and self-paced treadmill walking.MethodsWe collected motion capture, ground reaction force data, and muscle activity from 6 muscles in the dominant leg during walking from 8 unimpaired subjects. In the baseline condition, the subjects walked at 3 fixed-speeds normalized to their leg length as Froude numbers. We developed a novel kinematic method for increasing the accuracy of the user’s estimated walking velocity and compared our method against other published algorithms at each speed. Afterward, subjects walked on the SPT while matching their walking speed to a given target velocity using visual feedback of the treadmill speed. We evaluated the SPT by measuring steady-state error and the number of steps to reach the desired speed. We split the gait cycle into 7 phases and compared the kinematic, kinetic, and muscle activity between the fixed speed and self-paced mode in each phase. Then, we validated the performance of the SPT for asymmetric gait by having subjects walk on the SPT while wearing a locked-knee brace set to 0° on the non-dominant leg.ResultsOur SPT enabled controlled walking for both symmetric and asymmetric gait patterns. Starting from rest, subjects were able to control the SPT to reach the targeted speeds using visual feedback in 13–21 steps. With the locked knee brace, subjects controlled the treadmill with substantial step length and step velocity asymmetry. One subject was able to execute a step-to gait and halt the treadmill on heel-strikes with the braced leg. Our kinematic correction for step-length outperformed the competing algorithms by significantly reducing the velocity estimation error at the tested velocities. The joint kinematics, joint torques, and muscle activity were generally similar between fixed-speed and self-paced walking. Statistically significant differences were found in 5 of 63 tests for joint kinematics, 2 of 63 tests for joint torques, and 9 of 126 tests for muscle activity. The differences that were statistically significant were not found across all speeds and were generally small enough to be of limited clinical relevance.ConclusionsWe present a validated method for implementing a self-paced treadmill for asymmetric and symmetric gaits. As a result of the increased accuracy of our estimation algorithm, our SPT produced controlled walking without including a position feedback controller, thereby reducing the influence of the controller on measurements of the user’s true walking speed. Our method relies only on a kinematic correction to step length and step time which can support transfer to systems outside of the laboratory for symmetric and asymmetric gaits in clinical populations.

Side to side kinematic gait differences within patients and spatiotemporal and kinematic gait differences between patients with severe knee osteoarthritis and controls measured with inertial sensors

BackgroundKinematic changes associated with knee osteoarthritis (OA) have been traditionally measured with camera-based gait analysis. Lately, inertial sensors have become popular for gait analysis with the advantage of being less time consuming and not requiring a dedicated laboratory. Research questionDo spatiotemporal and discrete kinematic gait parameters measured with the inertial sensor system RehaGait® differ between the affected and unaffected side in patients with unilateral knee OA and between patients with severe knee OA and asymptomatic control subjects? Do these differences have a similar magnitude as those reported in the literature? MethodsTwenty-two patients with unilateral knee OA scheduled for total knee replacement and 46 age matched control subjects were included in this study. Spatiotemporal parameters and sagittal kinematics at the hip, knee, and ankle joint were measured using the RehaGait® system while walking at a self-selected speed for a distance of 20 m and compared between groups. ResultsPatients with knee OA had slower walking speed, longer stride duration, shorter stride length and lower cadence (P < 0.001). Peak knee flexion during stance and swing was lower in the affected than the unaffected leg (-4.8° and -6.1°; P < 0.01). Peak knee flexion during stance and swing (-5.2° and -8.8°; P < 0.01) and knee range of motion during loading response and swing (-3.6° and -4.4°; P < 0.01) were lower than in the control group. SignificanceThese side to side differences within patients and differences between patients with knee OA and control subjects agree with known gait alterations measured with camera-based systems. The RehaGait® inertial sensor system can detect gait alterations in patients with knee OA and is suitable for gait analysis in a clinical environment.

Alterations of kinematics in knees after single versus multiple radius femoral prostheses total knee arthroplasty: a retrospective study

BackgroundDesign modifications in prostheses may cause alterations in gait kinematics, thus influencing functional restoration of knees after total knee arthroplasty (TKA). The aim of the study was to investigate the differences in gait kinematics and clinical outcomes after single radius (SR) versus multiple radius (MR) TKA.MethodThe present retrospective study included 38 unilateral TKA involving 20 knees using MR design implant and 18 knees using SR design implant. Thirty-six healthy volunteers were also recruited. The mean follow-up time was 16 ± 3 months. At the end of follow-up, the 6 degrees of freedom (DOF) kinematics of knees and range of motion (ROM) were measured with a portable optical tracking system. Knee society score (KSS) and knee injury, and osteoarthritis outcome score (KOOS) were also collected.ResultsPatients in the SR group had significantly higher scores in activities of daily living (84.7 ± 15.9) and sports and recreation (67.5 ± 25.2) KOOS sub-score than MR group (69.9 ± 17.6, P = 0.012; 50.0 ± 20.8, P = 0.027, respectively). Significant differences were detected between MR knees and SR knees (1.82° ± 3.11° vs 4.93° ± 3.58°, P = 0.009), and MR knees and healthy knees (1.82° ± 3.11° vs 3.62° ± 3.52°, P = 0.032) in adduction/abduction ROM. The proximal/distal translation was significantly smaller in MR knees (0.58 ± 0.54 cm) compared with SR knees (1.03 ± 0.53 cm, P = 0.003) or healthy knees (0.84 ± 0.45 cm, P = 0.039). SR knees (0.24 ± 0.40 cm) had smaller translation compared with the MR group (0.54 ± 0.33 cm, P = 0.017) and control group (0.67 ± 0.36 cm, P = 0.028). No significant difference was detected in the other DOFs during the gait cycle. Significant difference was detected in extension/flexion, internal/external rotation, adduction/abduction, proximal/distal and medial/lateral among MR, SR and healthy knees.ConclusionAfter TKA, patients have altered gait kinematics compared with the control group. MR and SR design showed varied characteristics in 6 DOF gait kinematics, which could be the cause of the difference in functional outcome.

Gait Adaptations in Youth With Juvenile Idiopathic Arthritis.

Juvenile idiopathic arthritis (JIA) affects body structure and function and physical activity outcomes. The present study was undertaken to examine differences in gait kinematics during fixed-speed treadmill walking for youth with JIA and typically developing (TD) youth. Sagittal plane gait kinematics were obtained using a 12-camera system (Motion Analysis) for youth with JIA (n = 30) and their age and sex-matched TD peers (n = 30). Outcomes included disease activity, pain, well-being, and peak sagittal hip, knee, and ankle joint angles. Kinematics were analyzed for the indexed leg (IL) (i.e., the affected leg of participants with JIA) compared to the dominant leg of TD participants and for the contralateral leg (CL) (i.e., the less/not affected leg of participants with JIA) compared to the nondominant leg of TD participants. Kinematics differences were investigated using multivariate Hotelling's T2 statistic (paired samples; α = 0.05) and simultaneous 95% confidence intervals (95% CIs). Potential confounders (age, sex, body mass index) were assessed using linear mixed-effects models with random effect for pairs. Youth with JIA had low disease activity, pain, and disability scores. Deviations in bilateral joint angles were observed (IL P = 0.015, CL P = 0.009). Youth with JIA walked with greater initial hip flexion (mean difference IL 2.8° [95% CI -0.6, 6.2]; CL 3.0° [-0.9, 6.9]) and lower knee extension (mean difference IL -2.2° [95% CI -4.4, 0.1]; CL -3.3° [-7.4, 0.8]), and lower hip extension during terminal stance (mean difference IL 3.4° [95% CI -0.3, 7.0]; CL 4.0° [1.0, 7.0]). Despite low disease activity, youth with JIA avoided the close-packed knee position, commonly associated with joint inflammation and pain. These findings highlight secondary consequences of JIA and inform targets for physical therapy management for youth with JIA.

Decisional conflict in surgical patients: Should surgeons care?

The choice of surgical approach for total hip arthroplasty (THA) remains a contentious issue with regards to clinical outcome optimization and restoring patient function. The purpose of this study was to determine the impact of surgical approach for THA on quantitative gait analysis. Patients undergoing THA for primary osteoarthritis of the hip were assigned to 1 of 3 surgical approaches: anterior, posterior and lateral. Standardized implants were used at the time of surgery. Three-dimensional gait analysis was performed preoperatively and at 6 and 12 weeks postoperatively. At each time point, we compared temporal parameters, kinematics and kinetics. We included 30 patients in our analysis (10 anterior, 10 posterior, and 10 lateral). The groups were similar with respect to age (p = 0.27), body mass index (p = 0.16), and Charlson Comorbidity Index score (p = 0.66). Temporal parameters were similar among the groups at all time points. The lateral cohort had higher pelvic tilt during stance on the affected leg than the anterior cohort at 6 weeks (p = 0.041). Affected leg ipsilateral trunk lean during stance was higher in the lateral group than in the other cohorts at 6 weeks (p = 0.008) and 12 weeks (p = 0.040). The anterior and posterior groups showed increased external rotation at 6 weeks (p = 0.003) and 12 weeks (p = 0.012) compared with the lateral group. Temporal gait parameters were similar following THA for all approaches. Differences in gait kinematics and kinetics exist; however, given the small absolute differences, the clinical importance of these changes remains undetermined.

Gait profile score identifies changes in gait kinematics in nonfaller, faller and recurrent faller older adults women

BackgroundQuantification of differences in gait kinematics between young and older adults provides insight on age-related gait changes and can contribute to the investigation of risk of falls. Gait Profile Score (GPS) is an index that indicates gait quality, using kinematic gait data, but so far it has not been used in an elderly population without neurological conditions. Research questionIs the Gait Profile Score (GPS) an index that shows reliability for use in old adults? Does this index detect changes in gait quality observed by kinematic data between nonfaller, faller and recurrent faller older adults? MethodsForty-nine women (mean age 72,43 ± 6,44; 27 faller and 22 nonfaller) were included in the study. Intra-session reliability was obtained from the intraclass correlation coefficient (ICC) between the five strides of each session. ResultsOverall value of GPS shows no difference between nonfaller (6.65 ± 1.59º), faller (6.67 ± 2.05º) and recurrent faller (6.62 ± 0.86º) older adult. In all groups larger values of Gait Variable Scores (GVS) were observed in the hip and knee joints. Intra-session ICC values the GVS and GPS presented high stability, ranging from 0.80 to 0.99. MDC lower values in GPS were observed in the faller (0.39; ICC - 0.97) and recurrent faller (0.69; ICC – 0.90). SignificanceDue to the high reliability, GPS has proven to be a valid method to analyze the gait quality of faller and nonfaller older woman. The most sensitive indexes (GPS and GVS) are the gear changes in fallers and recurrent fallers.

Age-related differences in gait kinematics across the gait cycle in healthy individuals

Age-related differences in gait kinematics across the gait cycle in healthy individuals