Gait Impairment Research Articles

Inhibitory Effects of Reynoutria japonica Houtt. on Pain and Cartilage Breakdown in Osteoarthritis Based on Its Multifaceted Anti-Inflammatory Activity: An In Vivo and In Vitro Approach.

In the past 30 years, the number of years lived with disability due to osteoarthritis (OA) has doubled, making it an increasing global health burden. To address this issue, interventions that inhibit the progressive pathology driven by age-related low-grade inflammation, the primary mechanism of OA, are being actively pursued. Recent investigations have focused on modulating the age-related low-grade inflammatory pathology of this disease as a therapeutic target. However, no agent has successfully halted the disease's progression or reversed its irreversible course. Reynoutria japonica Houtt. (RJ), a promising East Asian herbal medicine, has been utilized for several diseases due to its potent anti-inflammatory activity. This study aims to determine RJ's capacity to inhibit OA symptoms and associated inflammation, exploring its potential for further development. In vivo and in vitro experiments demonstrated RJ's anti-OA activity and modulation of multifaceted inflammatory targets. RJ significantly inhibited pain, gait deterioration, and cartilage destruction in a monosodium iodoacetate-induced OA rat model, with its analgesic effect further confirmed in an acetic acid-induced writhing model. RJ exhibited consistent anti-inflammatory activity against multiple targets in serum and cartilage of the OA rat model and lipopolysaccharide-induced RAW 264.7 cells. The inhibition of inflammatory cytokines, including interleukin-1β, interleukin-6, matrix metalloproteinase-13, tumor necrosis factor-α, and nitric oxide synthase 2, suggests that RJ's alleviation of OA manifestations relates to its multifaceted anti-inflammatory activity. These results indicate that RJ merits further investigation as a disease-modifying drug candidate targeting OA's inflammatory pathology. To further characterize the pharmacological properties of RJ, future studies with expanded designs are warranted.

Unraveling the stride: exploring the influence of neurogenic orthostatic hypotension on gait and balance in Parkinson's disease.

Neurogenic orthostatic hypotension (nOH) and gait impairment are frequent sources of disability in Parkinson's disease (PD). However, the impact of nOH on balance and gait features remains unclear. This cross-sectional study aimed to assess the influence of nOH on postural and gait parameters in a cohort of patients with PD by means of wearable inertial sensors. Gait and balance were assessed using Opal inertial sensors. nOH was defined as sustained systolic blood pressure (BP) drop ≥ 20mmHg or diastolic BP drop ≥ 10mmHg within 3min of standing, with a ΔHR/ΔSBP ratio ≤ 0.5bpm/mmHg. Analysis of covariance was performed to evaluate differences in gait/balance features between patients with and without nOH, adjusting for age, cognitive status, and motor disability. Moreover, we performed the same analysis considering the presence of hemodynamically relevant nOH (orthostatic mean BP ≤ 75mmHg). A total of 82 patients were enrolled, 26 with nOH (31.7%), of which 13 presented with hemodynamically relevant nOH. After correcting for confounders, nOH was independently associated with lower gait speed (p = 0.027), shorter stride length (p = 0.033), longer time for postural transitions (p = 0.004), and increased postural sway (p = 0.019). These differences were even more pronounced in patients with hemodynamically relevant nOH. Higher postural sway was associated with a 7.9-fold higher odds of falls (p = 0.040). Our study presents an objective demonstration of the independent negative impact of nOH on gait and balance in PD, emphasizing the need for careful detection and management of nOH to mitigate gait and balance disturbances in PD.

A reproducible murine model of studying HIV-associated brain damage in stroke

BackgroundEmerging clinical and epidemiological data indicates that human immunodeficiency virus (HIV) is associated with an increased risk of stroke and aggravated brain damage. We aimed to develop a reproducible murine model of photothrombotic-stroke with HIV infection that mimics the clinical situation. MethodTo evaluate the impact of HIV infection on stroke, male C57BL/6 mice were infected with EcoHIV (p24 2-4 × 106/mouse; i.v.) or mock control. Four weeks post-infection, a stroke was induced by the photothrombotic method (pt-MCAO). After 72 h, a catwalk test was performed for gait impairments, and mice were euthanized for stroke outcomes. ResultsEcoHIV-infection exhibited a larger infarction, brain edema, higher IgG extravasation, hemorrhagic transformation, and gait impairments following pt-MCAO vs mock control. EcoHIV-infected mice showed higher levels of IFN-y and lower levels of IL-6, indicating immune activation without affecting IL-1β and MCP-1 in plasma and brain compared to mock pt-MCAO, suggesting unaltered inflammation. EcoHIV-infection showed increased oxidative stress markers (nitrotyrosine, and 4-hydroxynonenal) and thioredoxin interacting protein expression. Further, EcoHIV-infection significantly activated the microglia and astrocyte cells. ConclusionsThis animal model would be reliable and clinically relevant to future studies investigating pathophysiological mechanisms and developing new therapeutic approaches in stroke patients with HIV conditions.

Are clinical tests and biomechanical measures of gait stability able to differentiate fallers from non-fallers in hereditary spastic paraplegia?

IntroductionBalance and gait impairments are common in people with hereditary spastic paraplegia (HSP) and often result in falls. Measures that identify patients at risk of falling are clinically relevant, but relatively unexplored in HSP. Here, we evaluated the potential of different balance and gait constructs to (1) identify differences between healthy controls and people with HSP and (2) discriminate between fallers and non-fallers with HSP. MethodsWe included 33 people with pure-HSP and 15 healthy controls. We assessed balance confidence (six-item Activities-specific Balance Confidence scale), clinical balance capacity (Mini-Balance Evaluation Systems Test) and gait capacity (ten-meter Walk Test). Biomechanical measures included spatiotemporal gait variability, mediolateral Margin of Stability (MoS), Foot Placement Deviation (FPD), and Local Divergence Exponents (LDEs) of trunk and pelvis, derived from treadmill-walking at comfortable and fixed gait speeds. People with HSP logged their falls during a fifteen-week period and were categorized as ‘faller’ (≥1 fall) or ‘non-faller’. ResultsPeople with HSP had significantly lower balance confidence, balance capacity, and gait capacity compared to age-matched controls. People with HSP also showed reduced gait stability, reflected by increased spatiotemporal gait variability, FPD, and LDEs of trunk and pelvis. Overall, 44% of people with HSP were categorized as ‘faller’. Balance confidence (AUC:0.84) and balance capacity (AUC:0.75) discriminated fallers from non-fallers, whereas none of the biomechanical measures significantly differed. ConclusionBalance confidence, clinical balance and gait capacity, and biomechanical measures are affected in HSP, but clinical measures showed potential to differentiate fallers from non-fallers in people with HSP.

Development and Validation of SCACOMS, a Composite Scale for Assessing Disease Progression and Treatment Effects in Spinocerebellar Ataxia.

Spinocerebellar ataxias (SCA) are rare inherited neurodegenerative disorders characterized by a progressive impairment of gait, balance, limb coordination, and speech. There is currently no composite scale that includes multiple aspects of the SCA experience to assess disease progression and treatment effects. Applying the method of partial least squares (PLS) regression, we developed the Spinocerebellar Ataxia Composite Scale (SCACOMS) from two SCA natural history datasets (NCT01060371, NCT02440763). PLS regression selected items based on their ability to detect clinical decline, with optimized weights based on the item's degree of progression. Following model validation, SCACOMS was leveraged to examine disease progression and treatment effects in a 48-week SCA clinical trial cohort (NCT03701399). Items from the Clinical Global Impression-Global Improvement Scale (CGI-I), the Friedreich Ataxia Rating Scale (FARS) - functional stage, and the Modified Functional Scale for the Assessment and Rating of Ataxia (f-SARA) were objectively selected with weightings based on their sensitivity to clinical decline. The resulting SCACOMS exhibited improved sensitivity to disease progression and greater treatment effects (compared to the original scales from which they were derived) in a 48-week clinical trial of a novel therapeutic agent. The trial analyses also provided a SCACOMS-derived estimate of the temporal delay in SCA disease progression. SCACOMS is a useful composite measure, effectively capturing disease progression and highlighting treatment effects in patients with SCA. SCACOMS will be a powerful tool in future studies given its sensitivity to clinical decline and ability to detect a meaningful clinical impact of disease-modifying treatments.

Psychotic behavior in normal pressure hydrocephalus

Normal pressure hydrocephalus (NPH) usually presents with progressive gait impairment, urinary incontinence, and cognitive deficits. Many studies have shown that NPH can mimic other disorders like Parkinson disease with tremors and rigidity. In this report, we present our experience with three patients who had psychotic behavior and were treated with psychiatric medications but were subsequently investigated and found to have NPH. After lumboperitoneal shunting, all the three became normal and were even able to stop the psychiatric medications completely. The message is that NPH can mimic a psychiatric disorder and awareness about this well treatable condition is important especially among the psychiatrists and geriatricians.

Evaluation of a finite state machine algorithm to measure stepping with ankle accelerometry: performance across a range of gait speeds, tasks, and individual walking ability.

Wearable sensors, including accelerometers, are a widely accepted tool to assess gait in clinical and free-living environments. Methods to identify phases and subphases of the gait cycle are necessary for comprehensive assessment of pathological gait. The current study evaluated the accuracy of a finite state machine (FSM) algorithm to detect strides by identifying gait cycle subphases from ankle-worn accelerometry. Algorithm performance was challenged across a range of speeds (0.4-2.6 m/s), task conditions (e.g., single- and dual-task walking), and individual characteristics. Specifically, the study included a range of treadmill speeds in young adults and overground walking conditions in older adults with neurological disease. Manually counted and algorithm-derived stride detection from acceleration data were evaluated using error analysis and Bland-Altman plots for visualization. Overall, the algorithm successfully detected strides (>96% accuracy) across gait speed ranges and tasks, for young and older adults. The accuracy of an FSM algorithm combined with ankle-worn accelerometers, provides an analytical approach with affordable and portable tools that permits comprehensive assessment of gait unbounded by setting and proves to perform well in in walking tasks characterized by variable walking. These algorithm capabilities and advancements are critical for identifying phase dependent gait impairments in clinical and free-living assessment.

ID: 317275 Spinal Cord Stimulation for Gait Impairment in Parkinson Disease: Scoping Review and Mechanistic Considerations

ID: 317275 Spinal Cord Stimulation for Gait Impairment in Parkinson Disease: Scoping Review and Mechanistic Considerations

The repeatability of stride time variability, regularity, and long-range correlations

BackgroundDetrended fluctuation analysis (DFA) and sample entropy (SE) measure the long-term correlations and regularity of gait patterns, respectively, having previously been used to identify participants at risk of falling, previous history of injury, or patients with motor diseases. Since these measures are more sensitive to gait impairment than linear measures (e.g., the standard deviation [SD] of stride time), they can be potentially used in military medicine to identify soldiers at risk of injury. However, clinometric properties are yet to be established. Research QuestionWhat is the repeatability of DFA, SE, and traditional linear measures of stride time variability (SD and coefficient of variation [CV]) under various load and speed constraints? MethodsFourteen Australian Army trainee soldiers (age: 25.6 ± 5.9 y, height: 1.74 ± 0.08 m, body mass: 77.2 ± 15.1 kg, service: 1.5 ± 1.8 y) attended three sessions over two weeks, completing four 12-minute walking trials on an instrumented treadmill in each session. Participants walked with a combination of 0 kg or 23 kg loads at a self-selected or 5.5 km/h speed. Heel contacts from the right foot were identified using treadmill-embedded force plates. From 512 stride time intervals, linear (SD and CV), and non-linear (DFA and SE) measures were obtained. To assess the between-session repeatability, intraclass correlations (ICC 2,1) were employed. Results and SignificanceThere was poor-to-moderate repeatability for the SD (ICC: 0.357–0.545) and CV (ICC: 0.371–0.529). DFA showed poor-to-moderate repeatability (ICC: 0.013–0.504), while SE had poor repeatability (ICC: 0.133–0.226). Previous studies have shown that differences of > 0.19 in DFA and > 0.66 in SE can differentiate between healthy and pathological gait. These values are greater than this study's reported standard error of measurement, indicating that clinically meaningful changes may still be detectable despite low repeatability.

ROLE OF THE EMOTIONAL-MOTIVATIONAL COMPONENT IN THE DYNAMICS OF CNS FUNCTIONAL CAPACITY IN SECONDARY SCHOOL STUDENTS

The main clinical syndromes of chronic cerebral ischemia (CCI) are impaired gait and balance disorders, High morbidity level among school children, which has been recorded over the past decade in our country, necessitates a review of the contributing causes, mechanisms and factors. Objective. The purpose of the study is to assess CNS functional capacity in secondary school students taking into account anxiety and the motivational component. Materials and Methods. The study enrolled 424 secondary school students aged 10–17, living in Astrakhan. Simple and complex visual-motor reaction test was carried out. To study personality traits, anxiety and motivation levels of the participants, the authors used Junior Eysenck Personality Questionnaire (JEPQ), School Anxiety Test (Phillips Test), and Spielberg-Andreeva motivation questionnaire. Results. A significant decrease in the level of CNS functional capacity was noted when compared with the age norm. CNS functional level increases with age, while its values in the examined 12–13 and 14–15 year-old participants are below the average age ones. A decrease in the motivation level was revealed among the trial subjects. A positive attitude towards learning and effective motivation was revealed in 53.6 % of secondary school students aged 10–11; 38,6 % aged 12–13; 30,3 % aged 14–15 and 30 % aged 16–17. A high level of general anxiety was revealed in 40.9 % of secondary school students aged 10–11; 63.6 % aged 12–13; 12.8 % aged 14–15 and 6 % aged 16–17. Conclusion. The parameters of CNS functional capacity in most cases are characterized by below average values. The anxiety level significantly decreases with age, which indicates an adequate influence of learning environment on students. The highest anxiety level was revealed in the trial subjects aged 12–13. Motivation for learning decreases with age, which is probably due to psychological and motivational age-related changes in adolescence.

Impact of Contextual Factors on the Perceived Participation of People With Multiple Sclerosis and Gait Impairment Using Mobility Assistive Devices: A Qualitative Analysis.

People with multiple sclerosis and gait impairment are particularly susceptible to facing restrictions in their participation. This study aims to investigate (a) which contextual factors within the framework of the International Classification of Functioning, Disability and Health (ICF) are relevant for participation from the perspective of people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices, and (b) how these contextual factors shape the subjective facets of participation, including a sense of connection, efficacy and meaning, based on the social identity approach to health and well-being. We conducted a qualitative analysis on data gathered from four online focus group interviews, each involving four to six people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices (totalling N = 19), and 12 individual online interviews conducted with participants from the focus group interviews. The analysis followed the qualitative content analysis according to Kuckartz. Mobility assistive devices such as walkers, manual wheelchairs and electric wheelchairs/scooters were seen as facilitators that enabled participation in various life situations and enhanced a sense of efficacy by promoting independence. Challenges were encountered in relation to architectural barriers, pathways, weather conditions, public transportation and the lack of integral accessibility to services and systems. Although instrumental support could ease participation, it was also associated with an impaired sense of efficacy. Attitudes, particularly developing an understanding of the experiences of people with multiple sclerosis and gait impairment from others' perspectives, were considered important but often lacking, and discriminatory attitudes were experienced. On the level of personal factors, acceptance of both the mobility assistive devices and the disease itself were seen as facilitators for maintaining involvement in life situations. This study extends the existing literature by shedding light on the interconnectedness of contextual factors within the ICF and various facets of perceived participation, including a sense of connection, efficacy and meaning. These findings provide valuable insights for stakeholders such as urban planners and policymakers in developing inclusive environments that enhance the overall quality of participation for people with multiple sclerosis and gait impairment. This study reports on the lived experiences of people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices. The research team stood in close exchange with project members of the German Multiple Sclerosis Society Lower Saxony, a group representing the interests of people with multiple sclerosis, to design and conduct the focus group interviews. The results from the focus group interviews were the basis for the design of a participatory future workshop in which people with multiple sclerosis and stakeholders involved in the healthcare process collaboratively developed recommendations for improving the provision of mobility assistive devices. German Clinical Trials Register number: DRKS00025532.

Assessment of the Postoperative Progression in Patients With Intramedullary Spinal Cord Tumors Based on the Severity of Preoperative Gait Disturbance.

Retrospective comparative study. This study aimed to determine whether the severity of preoperative gait disturbance remains after surgical resection in patients with intramedullary spinal cord tumors (IMSCTs), and to identify any factors influencing poor improvement in postoperative gait disturbance. The study included a total of 128 patients with IMSCTs requiring surgical excision between 2006 and 2019. Based on the degree of preoperative gait disturbance assessed by the modified McCormick scale (MMCS) grade, patients were categorized into Mild (I-II) and Severe (III-V) groups. The mean postoperative follow-up period was 55.5 ± 34.3months, and demographic and surgical characteristics were compared between the two groups. Significant differences were observed in age at surgery, tumor location, tumor size, estimated blood loss, intraoperative motor-evoked potential disappearance, extent of resection, and tumor histopathology between the Mild and Severe groups. In the Mild group, at the final follow-up, only 7.3% of patients experienced improvement, 56.0% showed no changes, and 36.7% experienced deterioration. Conversely, in the Severe group, 26.3% of patients experienced improvement, 31.6% showed no changes, and 42.1% experienced deterioration. Tumor location and age at surgery were identified as factors correlated with poor improvement in postoperative gait disturbance in the Mild group. Irrespective of the preoperative gait disturbance degree, approximately 40% of patients with IMSCTs experienced deterioration in gait after tumor resection. For preoperative MMCS grade I-II cases, older age at surgery and thoracic IMSCTs would be important factors associated with poor improvement in postoperative gait disturbance.

Cognitive impairment mediates the white matter injury load and gait disorders in subcortical ischemic vascular disease.

Gait disorders are common in patients with subcortical ischemic vascular disease (SIVD). We aim to explore the impact of white matter (WM) damage on gait disorders in SIVD. 21 SIVD patients and 20 normal controls (NC) were included in the study. Montreal Cognitive Assessment (MoCA) was used to evaluate general cognition, while Speed-Accuracy Trade-Off (SAT) was used to assess executive function. Gait velocity, cadence, and stride length were measured. Diffusion Tensor Imaging (DTI) data were analyzed using Tract-Based Spatial Statistics (TBSS) and Peak Width of Skeletonized Mean Diffusivity (PSMD). The relationships among WM damage, gait disorders, and cognitive function were examined through mediation analysis. SIVD scored lower than NC in MoCA and SAT tests (P < 0.001). Gait velocity and stride length were decreased in SIVD. SIVD had lower PSMD (P < 0.001). PSMD correlated with gait parameters, which were totally mediated by MoCA and partially mediated by SAT. The fractional anisotropy (FA) and mean diffusivity (MD) of the genu of the corpus callosum (GCC) and body of CC (BCC) were correlated with gait parameters. The FA of the bilateral anterior corona radiata (ACR) was positively correlated with gait parameters, while the MD of the bilateral superior corona radiata (SCR), bilateral superior longitudinal fasciculus (SLF), and left external capsule (EC) were negatively correlated with them (P < 0.05). Gait impairments in SIVD were associated with cognitive deficits. Cognitive impairment mediated the WM damage and gait disorders. The microstructural alterations of CC, SLF, EC, and CR may be related to changes in gait.

Tau P301S Transgenic Mice Develop Gait and Eye Movement Impairments That Mimic Progressive Supranuclear Palsy.

Progressive supranuclear palsy (PSP) is a neurodegenerative disorder with an estimated prevalence of 5-7 people in 100,000. Clinically characterized by impairments in gait, balance, and eye movements, as well as aggregated Tau pathology, PSP leads to death in approximately 5-8 years. No disease-modifying treatments are currently available. The contribution of Tau pathology to the symptoms of patients with PSP is poorly understood, in part due to lack of a rodent model that recapitulates characteristic aspects of PSP. Here, we assessed the hTau.P301S mouse for key clinical features of PSP, finding progressive impairments in balance and gait coordination. Additionally, we found impairments in fast vertical eye movements, one of the most distinctive features of PSP. Across animals, we found that Tau pathology in motor control regions correlated with motor deficits. These findings highlight the utility of the hP301S mouse in modeling key aspects of PSP.

Physical therapy in patients with Parkinson's disease treated with Deep Brain Stimulation: a Delphi panel study.

Although deep brain stimulation of the subthalamic nucleus (STN-DBS) induces motor benefits in people with Parkinson's disease (PwPD), the size and duration of the effects of STN-DBS on motor axial (e.g., postural instability, trunk posture alterations) and gait impairments (e.g., freezing of gait - FOG) are still ambiguous. Physical therapy (PT) effectively complements pharmacological treatment to improve postural stability, gait performance, and other dopamine-resistant symptoms (e.g. festination, hesitation, axial motor dysfunctions, and FOG) in PwPD who are non-surgically treated. Despite the potential for positive adjuvant effects of PT following STN-DBS surgery, there is a paucity of science available on the topic. In such a scenario, gathering the opinion and expertise of leading investigators worldwide was pursued to study motor rehabilitation in PwPD following STN-DBS. After summarizing the few available findings through a systematic review, we identified clinical and academically experienced DBS clinicians (n=21) to discuss the challenges related to PT following STN-DBS. A 5-point Likert scale questionnaire was used and based on the results of the systematic review along with a Delphi method. Thirty-nine questions were submitted to the panel - half related to general considerations on PT following STN-DBS, half related to PT treatments. Despite the low-to-moderate quality, the few available rehabilitative studies suggested that PT could improve dynamic and static balance, gait performance and posture. Similarly, panellists strongly agreed that PT might help in improving motor symptoms and quality of life, and it may be possibly prescribed to maximize the effects of the stimulation. The experts agreed that physical therapists could be part of the multidisciplinary team taking care of the patients. Also, they agreed on prescribing of conventional PT, but not massage or manual therapy. Our results will inform the rehabilitation and the DBS community to engage, publish and deepen this area of research. Such efforts may spark guidelines for PT following STN-DBS.

N-Check: nerve check to document chemotherapy-induced peripheral neuropathy (CIPN) in incurable cancer

Chemotherapy-induced polyneuropathy (CIPN) encompasses aspectrum of symptoms ranging from hypoesthesia with impaired gait, stance and fine motor skills to painful dysesthesia and allodynia and significantly impairs the quality of life of those affected. In the present pilot study, quantitative sensory testing (QST) was used to investigate CIPN as acommon adverse effect of cytostatic drugs in patients with incurable cancer. The QST is astandardized examination procedure that is not yet routinely used in cancer patients. It is used to examine thermal and mechanical perception and pain thresholds to record the subjectively experienced pain phenotype. In the N‑Check pilot project, the QST was used before and after tumor-specific, potentially CIPN-inducing treatment and the data collected was compared in apre-post analysis. In addition, the specific effects of CIPN on the health-related quality of life of patients treated primarily with apalliative intention were recorded using the Functional Assessment for Cancer Therapy-General (FACT-G) questionnaire. Overall, the patients showed significant heat hypoalgesia after chemotherapy as asign of damage to small nerve fibers. In addition, there were signs of deterioration of the quality of life. The feasibility of QST in patients with incurable cancer and palliative, neurotoxic chemotherapy was demonstrated in this pilot study.

Between-limb difference in peak knee flexion angle can identify persons post-stroke with Stiff-Knee gait

BackgroundStiff-Knee gait affects 25–75 % of individuals with post-stroke gait impairment and is typically defined as reduced swing phase knee flexion. Different studies use various measures to identify Stiff-Knee gait, such as peak swing knee flexion angle, timing of peak knee flexion, knee range of motion, and ankle push-off acceleration, leading to inconsistent results. MethodsThis study used univariate cluster analysis to examine the independence, consistency, validity, and accuracy of different definitions in 50 post-stroke individuals (24 with and 26 without Stiff-Knee gait), as determined by a physiatrist. Spearman's rank correlation was used for correlation analysis, and five clustering techniques along with clinician evaluations were used for validity analysis. FindingsCorrelation analysis showed that peak knee flexion timing and knee hyperextension are poorly correlated with reduced swing-phase knee flexion angle (ρ = −0.09 and ρ = −0.26 respectively). Validity analysis indicated that the between-limb difference in peak swing knee flexion angle and peak swing knee flexion angle at self-selected gait speeds were the most valid differentiators. At the fastest comfortable gait speed, the between-limb difference of peak knee flexion angle had the highest sensitivity, lowest specificity, and highest F1 scores. InterpretationWe determined thresholds of less than 44.3° for peak swing knee flexion angle and greater than 17.0° for the between-limb difference of peak knee flexion angle identify Stiff-Knee gait during self-selected walking. We recommend using the difference in peak swing knee flexion angle between limbs to diagnose post-stroke Stiff-Knee gait due to its robustness to changes in gait speed.

Lower limb maltorsion and acetabular deformity in children and adolescents with X-linked hypophosphatemia.

X-linked hypophosphatemia (XLH) is a rare monogenetic skeletal disorder. Lower limb deformities contribute substantially to impaired gait quality and burden of disease in patients with XLH. Standardized data regarding onset and severity of lower limb maltorsion are unavailable. This study aimed to evaluate lower limb maltorsion using rotational magnetic resonance imaging (MRI) and computed tomography (CT). Rotational MRI and CT of children and adolescents with verified XLH were evaluated retrospectively. Femoral and tibial torsion, acetabular anteversion, and axial acetabular coverage were measured and compared with published age-adapted radiographic, clinical measurements and MRI data, respectively. Fifteen patients (mean age, 10.7 years) were included in the study. Decreased femoral torsion was observed in 47% (14/30 femora) and femoral retrotorsion in 17% (5/30 femora). Ten of 13 hips with coxa vara deformity presented with decreased femoral antetorsion. Reduced external tibial torsion manifested in 64% (18/28 tibiae). Abnormal axial femoral head coverage was present in 67% (20/30 hips), whereas 53% (16/30 hips) showed increased acetabular anteversion. Femoral and tibial torsional pathologies were found in children and adolescents with XLH. The occurrence of severe femoral retrotorsion in a 2-year-old child prior to ambulation raises questions regarding the biomechanical impact of gait on the development of torsional deformities in XLH.

Feasibility and usefulness of video-based markerless two-dimensional automated gait analysis, in providing objective quantification of gait and complementing the evaluation of gait in children with cerebral palsy

BackgroundGait analysis aids in evaluation, classification, and follow-up of gait pattern over time in children with cerebral palsy (CP). The analysis of sagittal plane joint kinematics is of special interest to assess flexed knee gait and ankle joint deviations that commonly progress with age and indicate deterioration of gait. Although most children with CP are ambulatory, no objective quantification of gait is currently included in any of the known international follow-up programs. Is video-based 2-dimensional markerless (2D ML) gait analysis with automated processing a feasible and useful tool to quantify deviations, evaluate and classify gait, in children with CP?MethodsTwenty children with bilateral CP with Gross Motor Function Classification Scale (GMFCS) levels I–III, from five regions in Sweden, were included from the national CP registry. A single RGB-Depth video camera, sensitive to depth and contrast, was positioned laterally to a green walkway and background, with four light sources. A previously validated markerless method was employed to estimate sagittal plane hip, knee, ankle kinematics, foot orientation and spatio-temporal parameters including gait speed and step length.ResultsMean age was 10.4 (range 6.8–16.1) years. Eight children were classified as GMFCS level I, eight as II and four as III. Setup of the measurement system took 15 min, acquisition 5–15 min and processing 50 min per child. Using the 2D ML method kinematic deviations from normal could be determined and used to implement the classification of gait pattern, proposed by Rodda et al. 2001.Conclusion2D ML assessment is feasible, since it is accessible, easy to perform and well tolerated by the children. The 2D ML adds consistency and quantifies objectively important gait variables. It is both relevant and reasonable to include 2D ML gait assessment in the evaluation of children with CP.

Differences in Trunk Acceleration-Derived Gait Indexes in Stroke Subjects with and without Stroke-Induced Immunosuppression.

Background: Stroke-induced immunosuppression (SII) represents a negative rehabilitative prognostic factor associated with poor motor performance at discharge from a neurorehabilitation unit (NRB). This study aims to evaluate the association between SII and gait impairment at NRB admission. Methods: Forty-six stroke patients (65.4 ± 15.8 years, 28 males) and 42 healthy subjects (HS), matched for age, sex, and gait speed, underwent gait analysis using an inertial measurement unit at the lumbar level. Stroke patients were divided into two groups: (i) the SII group was defined using a neutrophil-to-lymphocyte ratio ≥ 5, and (ii) the immunocompetent (IC) group. Harmonic ratio (HR) and short-term largest Lyapunov's exponent (sLLE) were calculated as measures of gait symmetry and stability, respectively. Results: Out of 46 patients, 14 (30.4%) had SII. HR was higher in HS when compared to SII and IC groups (p < 0.01). HR values were lower in SII when compared to IC subjects (p < 0.01). sLLE was lower in HS when compared to SII and IC groups in the vertical and medio-lateral planes (p ≤ 0.01 for all comparisons). sLLE in the medio-lateral plane was higher in SII when compared to IC subjects (p = 0.04). Conclusions: SII individuals are characterized by a pronounced asymmetric gait and a more impaired dynamic gait stability. Our findings underline the importance of devising tailored rehabilitation programs in patients with SII. Further studies are needed to assess the long-term outcomes and the role of other clinical features on gait pattern.