Gait In Subjects Research Articles

Effectiveness of Motor Imagery Training to Improve Gait Abilities of Patients with Sub-Acute Stroke

Aim: To determine the effectiveness of motor imagery training to improve the lower extremity function and gait in subjects with sub-acute stroke. Methods: Forty four patients with subacute stroke with gait impairment were randomly assigned to one of two groups: motor imagery training group or muscle relaxation group. At the beginning and after six weeks of therapy, the ability to use motor imagery and lower limb performance were assessed. Results: There were substantial differences of scores between both groups, with the motor imagery group progressing more than the muscle relaxation group. Conclusion: Motor imagery may have a beneficial and effective task-specific effect on gait function in sub-acute stroke patients. Keywords: motor imagery; gait rehabilitation; sub-acute stroke patients

Sarcopenia and motoric cognitive risk syndrome: a moderated mediation model

BackgroundSarcopenia has been identified as a risk factor for cognitive impairment, and motoric cognitive risk syndrome (MCR) is a recently defined pre-dementia syndrome. It is not known whether they are related. We aimed to investigate the association and potential pathways between sarcopenia and MCR in the community elderly by establishing a moderated mediation model.Methods846 community residents aged ≥ 60 years were recruited from May 2021 to September 2021 and had a comprehensive geriatric evaluation. The diagnosis of sarcopenia followed the criteria issued by the Asian Working Group for Sarcopenia in 2019. MCR was defined as subjective cognitive decline and slow gait. Apathy symptoms and physical activity were assessed by the Apathy Evaluation Scale (AES) and the International Physical Activity Questionnaire (IPAQ). Logistic regression and moderated mediation analyses were conducted to explore the association between the four.Results60 (7.1%) had MCR among 846 participants. After full adjustment, sarcopenia (odds ratio [OR] = 3.81, 95% confidence interval [CI] = 1.69–8.60, P = 0.001), AES score (OR = 1.09, 95% CI = 1.04–1.14, P < 0.001), and IPAQ level (OR = 0.43, 95% CI = 0.28–0.66, P < 0.001) were associated with MCR. Apathy partially mediated the relationship between sarcopenia and MCR. Physical activity played a moderation role in the indirect pathway of the mediation model. The increase in physical activity can alleviate the indirect effect of sarcopenia on MCR.ConclusionWe established a moderated mediation model to uncover the underlying association mechanism of sarcopenia and MCR preliminarily. These findings suggest that attention should be paid to the management of apathy and physical activity in the context of sarcopenia to prevent early dementia actively. Further validation is needed in future longitudinal studies.

Reflex Locomotion Therapy for Balance, Gait, and Fatigue Rehabilitation in Subjects with Multiple Sclerosis.

This study evaluates the effects of a rehabilitation program based on reflex locomotion therapy (RLT) on balance, gait, and fatigue in patients with multiple sclerosis (MS). Twenty-three patients diagnosed with MS participated in this study. Reversal design was carried out. The assessment tools included the Berg Balance Scale (BBS), the Performance Oriented Mobility Assessment (POMA), the Fatigue Severity Scale (FSS) and the instrumental analysis of the gait recorded by Vicon Motion System®. We analyzed spatio-temporal parameters and kinematic variables of the hip, knee, and ankle joints. Additionally, the Client Satisfaction Questionnaire (CSQ-8) was administrated. We did find a significant improvement in balance and gait tools after the RLT period. Regarding instrumental analysis, the statistical analysis of spatio-temporal parameters showed a significant improvement in stride length, double support, and velocity after the RLT period. Concerning kinematic parameters, the analysis showed improvements in hip and knee range of motion (ROM) after RLT period. RLT could improve gait and balance in patients with MS. The patients reported a high level of satisfaction with the therapy received.

Biomechanical Characteristics of the Knee Joint during Gait in Obese versus Normal Subjects.

Knee osteoarthritis (OA) is a growing source of pain and disability. Obesity is the most important avoidable risk factor underlying knee OA. The processes by which obesity impacts osteoarthritis are of tremendous interest to osteoarthritis researchers and physicians, where the joint mechanical load is one of the pathways generally thought to cause or intensify the disease process. In the current work, we developed a hybrid framework that simultaneously incorporates a detailed finite element model of the knee joint within a musculoskeletal model to compute lower extremity muscle forces and knee joint stresses in normal-weight (N) and obese (OB) subjects during the stance phase gait. This model accounts for the synergy between the active musculature and passive structures. In comparing OB subjects and normal ones, forces significantly increased in all muscle groups at most instances of stance. Mainly, much higher activation was computed with lateral hamstrings and medial gastrocnemius. Cartilage contact average pressure was mostly supported by the medial plateau and increased by 22%, with a larger portion of the load transmitted via menisci. This medial compartment experienced larger relative movement and cartilage stresses in the normal subjects and continued to do so with a higher level in the obese subjects. Finally, the developed bioengineering frame and the examined parameters during this investigation might be useful clinically in evaluating the initiation and propagation of knee OA.

Effect of Visual Cue Training on Gait and Walking Velocity in Chronic Stroke Patients- A Quasi-experimental Study

Introduction: Stroke is the major cause of disability and death in the world. More than 80% of stroke survivors face walking impairment due to muscle weakness, incoordination and spasticity. For physical rehabilitation of patients with neurological conditions combination of approaches are used. Visual cuing techniques are useful approaches for rehabilitation but the effect of visual cue training for gait and walking velocity is less explored for a patient with chronic stroke. Aim: To determine the effect of visual cue training on gait and walking velocity in subjects with chronic stroke. Materials and Methods: This was a quasi-experimental study in which 38 patients of chronic stroke were selected from various physiotherapy Outpatient Departments (OPD), of Surat, Gujarat from January 2019 to August 2020. Samples were randomly allocated into two groups, group A and group B; conventional and experimental group respectively. Group A was given conventional training and group B was given visual cue training along with conventional training for three days a week, 20 minutes/session. Both groups received conventional training five days a week, for four weeks. Dynamic Gait Index (DGI) and walking velocity were taken as an outcome measure and checked before intervention and after the end of four weeks of intervention. Statistical analysis was done using Statistical Package of the Social Sciences (SPSS) version 16.0. Paired t-test was carried out for within group comparison. Results: The results of the study indicates that there was significant difference in DGI and walking speed preintervention and postintervention in both the groups (p&lt;0.001). The mean difference of DGI in group A and B was 1.94±0.52 and 3. 26±0.99, respectively (p&lt;0.001). The result of the study suggests that there is greater improvement in visual cue training group. Conclusion: The present study results conclude that visual cue training along with conventional training shows greater improvements in gait and walking velocity than the conventional training alone.

Application of nonlinear analysis for the assessment of gait in patients with Parkinson's disease.

Gait can be affected by diseases such as Parkinson's disease (PD), which lead to alterations like shuffle gait or loss of balance. PD diagnosis is based on subjective measures to generate a score using the Unified Parkinson's Disease Rating Scale (UPDRS). To improve clinical assessment accuracy, gait analysis can utilise linear and nonlinear methods. A nonlinear method called the Lyapunov exponent (LE) is being used to identify chaos in dynamic systems. This article presents an application of LE for diagnosing PD. The objectives were to use the largest Lyapunov exponents (LaLyEx), sample entropy (SampEn) and root mean square (RMS) to assess the gait of subjects diagnosed with PD; to verify the applicability of these parameters to distinguish between people with PD and healthy controls (CO); and to differentiate subjects within the PD group according to the UPDRS assessment. The subjects were divided into the CO group (n= 12) and the PD group (n= 14). The PD group was also divided according to the UPDRS score: UPDRS 0 (n= 7) and UPDRS 1 (n= 7). Kinematic data of lower limbs were measured using inertial measurement units (IMU) and nonlinear parameters (LaLyEx, SampEn and RMS) were calculated. There were significant differences between the CO and PD groups for RMS, SampEn and the LaLyEx. After dividing the PD group according to the UPDRS score, there were significant differences in LaLyEx and RMS. The selected parameters can be used to distinguish people with PD from CO subjects, and separate people with PD according to the UPDRS score.

Compensatory Ground Reaction Forces during Scoliotic Gait in Subjects with and without Right Adolescent Idiopathic Scoliosis

Although the asymmetries of scoliotic gait in adolescent idiopathic scoliosis (AIS) groups have been extensively studied, recent studies indicated conflicting results regarding the ground reaction forces (GRFs) during gait in subjects with spinal deformity. The asymmetry during the stance phase might be clarified with three-dimensional (3D) compensations of GRFs between similar characteristics of subjects with and without AIS. The purpose of this study was to compare the normalized 3D GRF differences during the stance phase of gait while considering age, BMI, and Cobb angle between subjects with and without right AIS. There were 23 subjects with right convexity of thoracic idiopathic scoliosis and 22 age- and gender-matched control subjects. All subjects were right upper/lower limb dominant, and the outcome measures included the Cobb angles, normalized GRF, and KAI. The mediolateral (M/L) third peak force on the dominant limb decreased in the AIS group (t = 2.58, p = 0.01). Both groups demonstrated a significant interaction with the 3D indices (F = 5.41, p = 0.02). The post-hoc analysis identified that the M/L plane of asymmetry was significantly different between groups. The Cobb angles were negatively correlated with the vertical asymmetry index (r = −0.45, p = 0.03); however, there was no significant correlation with age (r = −0.10, p = 0.65) or body mass index (r = −0.28, p = 0.20). The AIS group demonstrated decreased GRF in the dominant limb M/L plane of the terminal stance phase. This compensatory motion was confirmed by a significant group difference on the M/L plane of the KAI. This KAI of vertical asymmetry correlated negatively with the Cobb angle. The asymmetric load transmission with compensatory vertical reactions was evident due to abnormal loading in the stance phase. These kinetic compensatory patterns need to be considered with asymmetry on the dominant limb when developing rehabilitation strategies for patients with AIS.

Which model best assesses gait in healthy elderly? A confirmatory factor analysis of existing conceptual gait models

BackgroundVarious conceptual gait models have been created with exploratory factor analysis to assess gait performance in healthy individuals or patients with orthopaedic or neurological diseases. However, a direct comparison between these models, to determine which is best for assessing gait in healthy elderly subjects, has never been performed. Confirmatory factor analysis is a statistical technique which allows to compare the structure of these models and to evaluate their validity and reliability. Research questionWhich of the current models for evaluating gait shows the best construct, convergent and discriminant validity and reliability when replicated in a sample of healthy elderly subjects? Methods92 healthy elderly subjects (aged 73.3 ± 6.8 years) were enrolled. Participants were instructed to walk on a baropodometric walkway; gait variables were then extracted and analyzed according to 8 different gait models (published between 2007 and 2019). Correlation between variables of each model were investigated. The number of factors to include for each model was assessed with different criteria of principal component analysis. The construct validity of the gait models was assessed in terms of goodness of fit indexes through confirmatory factor analysis. Convergent and discriminant validity and reliability of the models were also assessed. ResultsOf the models considered, only our model previously created for patients with Parkinson’s Disease reached convergence, with an excellent fit in all indexes (χ2 = 18.34, df = 13, p = 0.15, RMSEA = 0.06 (95%CI = 0.00-0.13), CFI = 0.98, TLI = 0.96, SRMR = 0.05). The model showed an acceptable convergent validity. The three factors resulted to be mutually independent (correlations among factors <0.85) and reliable. Most of the other seven considered models presented a high number (12.5-65%) of highly inter-related variables and more factors than necessary. SignificanceFuture studies can use our gait model as a framework for clinical practice or research.

Epidemiological study of cervical cord compression and its clinical symptoms in community-dwelling residents.

Degenerative compressive myelopathy (DCM) is caused by cervical cord compression. The relationship between the magnitude and clinical findings of cervical cord compression has been described in the literature, but the details remain unclear. This study aimed to clarify the relationship between the magnitude and clinical symptoms of cervical cord compression in community-dwelling residents. The present study included 532 subjects. The subjective symptoms and the objective findings of one board-certified spine surgeon were assessed. The subjective symptoms were upper extremity pain and numbness, clumsy hand, fall in the past 1 year, and subjective gait disturbance. The objective findings were: Hoffmann, Trömner, and Wartenberg signs; Babinski's and Chaddock's signs; hyperreflexia of the patellar tendon and Achilles tendon reflexes; ankle clonus; Romberg and modified Romberg tests; grip and release test; finger escape sign; and grip strength. Using midsagittal T2-weighted magnetic resonance imaging, the anterior-posterior (AP) diameters (mm) of the spinal cord at the C2 midvertebral body level (DC2) and at each intervertebral disc level from C2/3 to C7/T1 (DC2/3-C7/T1) were measured. The spinal cord compression ratio (R) for each intervertebral disc level was defined and calculated as DC2/3-C7/T1 divided by DC2. The lowest R (LR) along C2/3 to C7/T1 of each individual was divided into 3 grades by the tertile method. The relationship between LR and clinical symptoms was investigated by trend analysis. The prevalence of subjective gait disturbance increased significantly with the severity of spinal cord compression (p = 0.002812), whereas the other clinical symptoms were not significantly related with the severity of spinal cord compression. The magnitude of cervical cord compression had no relationship with any of the neurologic findings. However, subjective gait disturbance might be a better indicator of the possibility of early stage cervical cord compression.

Wearable Feet Pressure Sensor for Human Gait and Falling Diagnosis.

Human falls pose a serious threat to the person’s health, especially for the elderly and disease-impacted people. Early detection of involuntary human gait change can indicate a forthcoming fall. Therefore, human body fall warning can help avoid falls and their caused injuries for the skeleton and joints. A simple and easy-to-use fall detection system based on gait analysis can be very helpful, especially if sensors of this system are implemented inside the shoes without causing a sensible discomfort for the user. We created a methodology for the fall prediction using three specially designed Velostat®-based wearable feet sensors installed in the shoe lining. Measured pressure distribution of the feet allows the analysis of the gait by evaluating the main parameters: stepping rhythm, size of the step, weight distribution between heel and foot, and timing of the gait phases. The proposed method was evaluated by recording normal gait and simulated abnormal gait of subjects. The obtained results show the efficiency of the proposed method: the accuracy of abnormal gait detection reached up to 94%. In this way, it becomes possible to predict the fall in the early stage or avoid gait discoordination and warn the subject or helping companion person.

Combined internal fixation and transarticular external skeletal fixation to treat traumatic patellar fractures in five dogs

Case history : Medical records were reviewed of dogs (n=5) presented to a single referral hospital in the United Kingdom between 2015 and 2017 with a traumatic patellar fracture treated with transarticular external skeletal fixation (TA-ESF) to augment internal fixation. Clinical findings and treatment : Two dogs had polar patellar fractures, two had comminuted fractures and one dog had a transverse fracture. The median age at the time of the surgery was 21 (min 8, max 132) months and the median body weight was 19.0 (min 8.3, max 28.6) kg. In all cases, TA-ESF (Type IA lateral triangulated or modified Type II) was used in combination with internal fixation with pins and/or orthopaedic wire, supported by nylon leader line (patella-to-tibia mattress suture) and/or absorbable suture in a locking loop and/or circum-patellar pattern. All cases had short-term (6-12 weeks) postoperative radiographic follow-up, which showed evidence of fracture healing in 2/5 cases. All TA-ESF were removed 6 or 7 weeks postoperatively and four dogs had minor complications related to TA-ESF. More than 2 years postoperatively, the owners of all dogs were contacted and questioned regarding the mobility of their pet using the Liverpool Osteoarthritis in Dogs questionnaire. Four of the five cases were re-examined to evaluate their long-term outcomes. Based on the results of goniometric measurement of stifle range of motion, subjective gait assessment and objective gait analysis with a pressure sensitive walkway, all dogs showed a satisfactory outcome at the final follow-up. Clinical relevance : A combination of internal fixation and TA-ESF for stabilisation of traumatic patellar fractures is a valid treatment option. Further investigations with larger case numbers are necessary to evaluate success and complication rates.

Association Between the Normal-Density Psoas Muscle Index and Handgrip Strength or Gait Speed in Maintenance Hemodialysis Patients.

Introduction: This study aimed to evaluate the association between the psoas muscle (PM) index with or without fatty infiltration and various indices associated with muscle mass in hemodialysis (HD) patients.Methods: We included stable HD patients (n = 83). The collected data included subjective global assessment (SGA) score, ASM/Ht2 (appendicular skeletal muscle mass divided by the squared height in meters), gait speed (GS; m/s), and handgrip strength (HGS; kg). The abdominal computed tomography (CT) image was obtained using a CT scanner. The PM and normal-density PM (NPM) indices (mm2/m2) were calculated using the whole PM area or the area with an attenuation range of 35–100 HU divided by the squared height in meters.Results: Correlation coefficients for the SGA score, ASM/Ht2, HGS, and GS were greater for the NPM index than for the PM index. The linear regression analysis showed that, on multivariate analysis, the NPM index was significantly associated with the SGA score, ASM/Ht2, and GS. However, the PM index was significantly associated with the SGA score and ASM/Ht2 but not with HGS or GS. For calculating the low GS, the area under the receiver operating characteristic curve area was significantly greater for the NPM index than for the PM index (P = 0.012).Conclusion: The present study suggested that the NPM index excluding fatty infiltration may be an early and useful indicator for detecting muscle strength and physical performance among HD patients.

Biomechanical Changes in Gait Patterns of Patients with Grade II Medial Gonarthritis.

Deforming osteoarthritis (OA) of the knee is a progressive disease associated with pain and compromised function of the joint. Typical biomechanical modifications in the gait of subjects with medial knee OA are characterized by decreased gait speed and overload on the affected limb. The borderline stage for conservative versus surgical management is Grade II OA. The aim of this research was to study preoperatively the specific features of gait, knee, and hip function in patients with Grade II medial OA. We examined 26 patients with Grade II unilateral gonarthritis with varus deformity and 20 healthy adults. Biomechanical parameters of gait were recorded using an inertial sensor system. The gait cycle (GC) slightly increased both for the affected and for the intact limb. The hip joint movements showed significant symmetrical reduction in the first flexion amplitude, as well as a symmetrical delay in full hip extension at the end of the stance phase. In the knee, the first flexion amplitude was significantly reduced on the affected side compared to healthy control. The extension amplitude in the single support phase was significantly increased in both the affected and the intact lower limbs. The swing amplitude was significantly reduced on the affected side. On the affected side, the changes were more pronounced, both in incidence and in severity. The affected knee showed a syndrome of three reduced amplitudes. In patients, walking is characterized by several groups of symptoms: those of unloading of the affected limb, those of limiting the load on the affected joint and the musculoskeletal system as a whole, and those of gait harmonization. The symptoms of unloading the affected side and those of harmonization are the common symptoms of adaptation, typical for several pathological conditions with a relatively preserved function. The intensity of the observed symptoms can help assess changes in the subject’s functional condition over time and during the treatment.

Responses in knee joint muscle activation patterns to different perturbations during gait in healthy subjects

PurposeTo compare the responses in knee joint muscle activation patterns to different perturbations during gait in healthy subjects. ScopeNine healthy participants were subjected to perturbed walking on a split-belt treadmill. Four perturbation types were applied, each at five intensities. The activations of seven muscles surrounding the knee were measured using surface EMG. The responses in muscle activation were expressed by calculating mean, peak, co-contraction (CCI) and perturbation responses (PR) values. PR captures the responses relative to unperturbed gait. Statistical parametric mapping analysis was used to compare the muscle activation patterns between conditions. ResultsPerturbations evoked only small responses in muscle activation, though higher perturbation intensities yielded a higher mean activation in five muscles, as well as higher PR. Different types of perturbation led to different responses in the rectus femoris, medial gastrocnemius and lateral gastrocnemius. The participants had lower CCI just before perturbation compared to the same phase of unperturbed gait. ConclusionsHealthy participants respond to different perturbations during gait with small adaptations in their knee joint muscle activation patterns. This study provides insights in how the muscles are activated to stabilize the knee when challenged. Furthermore it could guide future studies in determining aberrant muscle activation in patients with knee disorders.

Trunk Rotation Exercises Versus Sit-to-Stand Training with Step-Foot Position on Balance and Gait in Patients with Chronic Stroke

Context: Muscle weakness, decreased range of motion, abnormal muscle tone, incoordination, and multisensory disintegration in stroke patients can lead to balance disturbances, reduced mobility, and higher risk for falls. There is paucity in literature whether trunk rotation exercises or sit-to-stand training protocol would be more beneficial for stroke-related disability. Aims: The aim of this study is to determine the comparative effect of trunk rotation exercises and sit-to-stand training with step-foot position on balance and gait in patients with chronic stroke. Settings and Design: Experimental study was carried out at tertiary care center. Subjects and Methods: Thirty stroke patients were recruited and randomly included in one of the two study groups. Group A was given trunk rotation exercises and Group B received sit-to-stand training with step-foot position for 30 min, 3 times a week, for 4 weeks. Both the groups received conventional physiotherapy for another 30 min. Balance and gait were assessed before and postintervention using the Berg Balance Scale (BBS) and Dynamic Gait Index (DGI), respectively. Statistical Analysis Used: The Mann–Whitney U-test was applied for the comparison of group data. Results: When BBS and DGI were compared at pre-and postintervention time, results were statistically significant for both groups (P &lt; 0.001). However, when between groups posttest scores were compared for BBS and DGI, results were statistically not significant (P &gt; 0.05). Conclusion: Both trunk rotation exercises and sit-to-stand training with step-foot position were equally effective in improving balance and gait in chronic poststroke subjects.

Restoring range of motion in reduced acetabular version by increasing femoral antetorsion – What about joint load?

BackgroundAcetabular retroversion results in reduced range of motion, and is thought to contribute to femoroacetabular impingement. Severe retroversion can be corrected with a periacetabular osteotomy, which is a technically demanding intervention. In this study, we investigated whether increasing femoral antetorsion is a potential alternative to restore the range of motion and how this approach would affect hip joint loading. MethodsSix different finite element models of the same subject were built from MRI and used to simulate different load scenarios during stance phase, including healthy and pathological configurations with different acetabular version and femoral torsion angles. The subject's gait was analysed in our gait lab and motion data as well as joint reaction forces were integrated into the model. Hip range of motion, hip abductor muscle forces as well as localization and magnitude of hip joint loads were determined. FindingsThe negative effects of acetabular retroversion on hip range of motion including flexion and internal rotation can be reversed by increasing femoral anteversion. The rotation of the femur furthermore affected muscular functionality by shortening the moment arms of the hip abductor muscles, resulting in increased abductor muscle forces, joint reaction forces and hip joint loading. InterpretationEven though increased femoral antetorsion can compensate for the loss of hip range of motion due to reduced acetabular version, rotational ostotomy of the proximal femur is likely to alter muscular moment arms and therefore increase hip joint load, conflicting the goal of a long-term healthy joint.

Rater agreement for assessment of equine back mobility at walk and trot compared to quantitative gait analysis.

BackgroundLameness assessment in horses is still predominantly performed using subjective methods. Visual assessment is known to have moderate to good intra-rater agreement but relatively poor inter-rater agreement. Little is known about inter- and intra-rater agreement on the evaluation of back motion, for which no objective measurement technique in a clinical setting is available thus far.ObjectivesTo describe inter- and intra-rater agreement of visual evaluation of equine back mobility.Study designRater reliability study using a fully crossed design in which all horses are rated by all observers. This data is compared with objective gait analysis.MethodsSeventy equine professionals (veterinarians and physiotherapists) and veterinary students evaluated videos of 12 healthy horses at walk and trot on a hard, straight line. Nine parameters related to back mobility were scored: general mobility, thoracic, lumbar, lumbosacral flexion and extension and left and right thoracolumbar latero-flexion. All parameters were compared with simultaneously measured quantitative motion parameters. After 1 month, six randomly chosen horses were re-evaluated by 57 observers.ResultsFor each parameter inter- and intra-rater agreements were calculated using intra-class correlation coefficients. For all parameters, inter-rater agreement was very poor (<0.2). The mean intra-rater agreement of all observers and for all parameters was poor (~0.4) but varied between 0.0 and 0.96 for individual observers. There was no correlation between the visual subjective scoring and objective gait analysis measurements.Main limitationsHorses were scored from videos and by lack of any existing (semi-) quantitative system, a custom-made system had to be used.ConclusionsThe poor inter- and intra-rater agreements of visual scoring of mobility of the equine back and the disagreement between subjective and objective gait analysis data, demonstrate the need for the development and introduction of objective, quantitative and repeatable techniques to assess equine back motion.

Complications with the Zurich Canine Total Hip Replacement System in an Initial Series of Cases Performed by a Single Surgeon.

The aim of this study was to quantify the complications using the Zurich total hip replacement system in an initial series of cases performed by a single surgeon who had experience with other total hip replacement systems. This was a retrospective study in which complications were classified as major if any treatment was needed or if the outcome was less than near-normal function. Complications that did not warrant treatment and that did not result in function that was inferior to near-normal were considered minor. Outcomes were assessed by radiographic review, physical examination, subjective gait evaluation or, in one case, by objective gait analysis. Bilateral total hip replacements were considered separate procedures. The first 21 procedures in 19 dogs performed by a single surgeon were included. The mean time to follow-up was 48 weeks (range: 8-120 weeks; standard deviation: 36 weeks). Two cases (of 21) experienced major complications including one dog with excess internal femoral rotation during weight bearing and one dog having luxation. One case (of 21) had a minor complication; femoral fracture in the presence of an intact bone plate that maintained alignment and healed without treatment. A high rate of successful outcomes with few major complications can be obtained in the initial cases treated using the Zurich total hip replacement system for surgeons with prior experience with other total hip replacement systems.

Development and Preliminary Evaluation of a Lower Body Exosuit to Support Ankle Dorsiflexion

For patients suffering from drop foot due to weakness of ankle dorsiflexion muscles, an ankle foot orthosis provides increased foot clearance during the swing phase of gait, but often restricts other gait functions, such as plantarflexion. Due to steady progress in the development of lighter and smaller actuator technologies, active wearable devices such as exosuits become relevant for rehabilitation, since they can offer an extended functionality including a more comfortable wear than passive plastic orthosis. The aim of the paper is to present a lightweight exosuit supporting dorsiflexion during gait with autonomous recognition of gait phases and conditions. One main requirement during the iterative development of the exosuit is a non-restrictive function, thus no differences between the assisted and non-assisted gait of a healthy subject should occur. We therefore conducted a pilot biomechanics study using statistical parametric mapping to analyze kinematics of the ankle joint and muscle activity of m. tibialis anterior of nine subjects without any gait anomalies walking with and without the exosuit. The results show no significant difference between with and without support. In contrast to passive orthosis, the developed system could be an enhanced solution to assist patients suffering from drop foot, which should be analyzed in the next step for evaluating the development.

Gait profile score and gait variable scores in spina bifida.

Quantitative data assessment on the basis of three-dimensional gait analysis has been routinely used in the evaluation of pathological gait of children with cerebral palsy. However, a similar quantitative methodology has not been applied for spina bifida patients in whom atypical gait patterns are thought to correlate with various levels of neurological paralysis. The purpose of this study is to investigate the differences among gait patterns in spina bifida between different levels of neurological lesions using quantitative methods: Gait profile score (GPS) and gait variable scores (GVS), scoring subject's gait deviation from a reference. In this cross-sectional study, 22 children with spina bifida (11 women, 11 men; mean age 9.4 years, SD 3.8 years, range 3-17 years), were examined using three-dimensional gait analysis from 2008 to 2018. Physical examination allowed for classification of each of the 44 limbs as either L4, L5 or S1 and comparison with the GPS and GVS using a linear mixed model. GPS and the GVS of the pelvis and hip range of motion in the coronal plane were significantly higher in the L4 group than in the L5 and S1 groups (GPS, P = 0.041, P = 0.003, respectively; GVS of pelvis, P = 0.001, P = 0.001; GVS of hip, P < 0.001, P < 0.001) GVS (foot progression angle) was significantly lower in the S1 group than in L4 and L5 groups (P < 0.001, P = 0.037). We found that GPS and GVS enable us to quantitatively assess the differences among gait patterns between different neurological levels. The scoring tool showed the potential for detecting individual neurological changes.