Lower Limb Movement Research Articles

Pseudoparalysis Secondary to Vitamin C Deficiency: A Rare Presentation in a Toddler.

We present a 17-month-old girl with postencephalitic sequelae only on high-calorie cereal milk through a nasogastric tube. She presented with a 3-week history of swelling and decreased lower limb movements. Synovial fluid analysis ruled out septic arthritis. Plain radiograph and magnetic resonance imaging (MRI) were suggestive of scurvy. She was diagnosed to have pseudoparalysis secondary to scurvy. She was started on vitamin C supplements, after which she showed good clinical improvement. This case report is to re-emphasize the need for awareness of the possibility of scurvy in children with poor nutritional status due to feeding difficulties.

Parkinson Disease Recognition Using a Gamified Website: Machine Learning Development and Usability Study.

Parkinson disease (PD) affects millions globally, causing motor function impairments. Early detection is vital, and diverse data sources aid diagnosis. We focus on lower arm movements during keyboard and trackpad or touchscreen interactions, which serve as reliable indicators of PD. Previous works explore keyboard tapping and unstructured device monitoring; we attempt to further these works with structured tests taking into account 2D hand movement in addition to finger tapping. Our feasibility study uses keystroke and mouse movement data from a remotely conducted, structured, web-based test combined with self-reported PD status to create a predictive model for detecting the presence of PD. Analysis of finger tapping speed and accuracy through keyboard input and analysis of 2D hand movement through mouse input allowed differentiation between participants with and without PD. This comparative analysis enables us to establish clear distinctions between the two groups and explore the feasibility of using motor behavior to predict the presence of the disease. Participants were recruited via email by the Hawaii Parkinson Association (HPA) and directed to a web application for the tests. The 2023 HPA symposium was also used as a forum to recruit participants and spread information about our study. The application recorded participant demographics, including age, gender, and race, as well as PD status. We conducted a series of tests to assess finger tapping, using on-screen prompts to request key presses of constant and random keys. Response times, accuracy, and unintended movements resulting in accidental presses were recorded. Participants performed a hand movement test consisting of tracing straight and curved on-screen ribbons using a trackpad or mouse, allowing us to evaluate stability and precision of 2D hand movement. From this tracing, the test collected and stored insights concerning lower arm motor movement. Our formative study included 31 participants, 18 without PD and 13 with PD, and analyzed their lower limb movement data collected from keyboards and computer mice. From the data set, we extracted 28 features and evaluated their significances using an extra tree classifier predictor. A random forest model was trained using the 6 most important features identified by the predictor. These selected features provided insights into precision and movement speed derived from keyboard tapping and mouse tracing tests. This final model achieved an average F1-score of 0.7311 (SD 0.1663) and an average accuracy of 0.7429 (SD 0.1400) over 20 runs for predicting the presence of PD. This preliminary feasibility study suggests the possibility of using technology-based limb movement data to predict the presence of PD, demonstrating the practicality of implementing this approach in a cost-effective and accessible manner. In addition, this study demonstrates that structured mouse movement tests can be used in combination with finger tapping to detect PD.

A new driving strategy for Lower limb-assisted exoskeleton robot

In this work, a control strategy is developed for a lower limb-assisted exoskeleton. To determine the current motion gait of the human body, the hip and knee joint angles, and plantar pressure values are sensed and analyzed, which are then used to actuate the exoskeleton to provide support for the hip and knee joints. The dual motion systems-the exoskeleton drive system and the human lower limb motion system-are established in this control approach. Without the need to first learn the user's gait, the assistance of the exoskeleton is provided by the motions of the human movement system and is sufficiently flexible to account for changes in step length and walking speed as the user moves through the gait cycle. Throughout this process, the exoskeleton system avoids providing power, providing the freedom to walk and stop in the course of our daily lives.

Short-Term Cast Immobilization of a Unilateral Lower Extremity and Physical Inactivity Induce Postural Instability during Standing in Healthy Young Men.

Previous studies have reported an increased postural sway after short-term unilateral lower limb movement restriction, even in healthy subjects. However, the associations of motion limitation have not been fully established. The question of whether short-term lower limb physical inactivity and movement restriction affect postural control in the upright position remains. One lower limb of each participant was fixed with a soft bandage and medical splint for 10 h while the participant sat on a manual wheelchair. The participants were instructed to stand still for 60 s under eyes-open (EO) and eyes-closed (EC) conditions. Using a single force plate signal, we measured the center of pressure (COP) signal in the horizontal plane and calculated the total, anterior-posterior (A-P), and medial-lateral (M-L) path lengths, sway area, and mean COP displacements in A-P and M-L directions. The COP sway increased and the COP position during the upright stance shifted from the fixed to the non-fixed side after cast removal, compared to before the cast application, under both EO and EC conditions. These findings indicated that 10 h of unilateral lower limb movement restriction induced postural instability and postural control asymmetry, suggesting the acute adverse effects of cast immobilization.

Kinematics and mechanical changes with step frequency at different running speeds.

Running at a given speed can be achieved by taking large steps at a low frequency or on the contrary by taking small steps at a high frequency. The consequences of a change in step frequency, at a fixed speed, affects the stiffness of the lower limb differently. In this study, we compared the running mechanics and kinematics at different imposed step frequencies (from 2 step s-1 to 3.6 step s-1) to understand the relationship between kinematic and kinetic parameters. Eight recreational male runners ran on a treadmill at 5 different speeds and 5 different step frequencies. The lower-limb segment motion and the ground reaction forces were recorded. Mechanical powers, general gait parameters, lower-limb movements and coordination were investigated. At low step frequencies, in order to limit the magnitude of the ground reaction force, the vertical stiffness is reduced and thus runners deviate from an elastic rebound. At high step frequencies, the stiffness is increased and the elastic rebound is optimised in its ability to absorb and restore energy during the contact phase. We studied the consequences of a change in step frequency on the bouncing mechanics of running. We showed that the lower limb stiffness and the intersegmental coordination of the lower-limb segments are affected by running step frequency rather than speed. The runner rather adapts their lower limb stiffness to match a step frequency for a given speed than the opposite.

Empowering Lower Limb Disorder Identification through PoseNet and Artificial Intelligence.

A novel approach is presented in this study for the classification of lower limb disorders, with a specific emphasis on the knee, hip, and ankle. The research employs gait analysis and the extraction of PoseNet features from video data in order to effectively identify and categorize these disorders. The PoseNet algorithm facilitates the extraction of key body joint movements and positions from videos in a non-invasive and user-friendly manner, thereby offering a comprehensive representation of lower limb movements. The features that are extracted are subsequently standardized and employed as inputs for a range of machine learning algorithms, such as Random Forest, Extra Tree Classifier, Multilayer Perceptron, Artificial Neural Networks, and Convolutional Neural Networks. The models undergo training and testing processes using a dataset consisting of 174 real patients and normal individuals collected at the Tehsil Headquarter Hospital Sadiq Abad. The evaluation of their performance is conducted through the utilization of K-fold cross-validation. The findings exhibit a notable level of accuracy and precision in the classification of various lower limb disorders. Notably, the Artificial Neural Networks model achieves the highest accuracy rate of 98.84%. The proposed methodology exhibits potential in enhancing the diagnosis and treatment planning of lower limb disorders. It presents a non-invasive and efficient method of analyzing gait patterns and identifying particular conditions.

O2A3-02 Influence of Vision Limitation on Lower Limb Movements and Uneasiness on Gap Crossing Movement

O2A3-02 Influence of Vision Limitation on Lower Limb Movements and Uneasiness on Gap Crossing Movement

Unusual presentation of primary iliopsoas abscess in an infant: a case report

Iliopsoas abscess (IPA) rarely occurs in newborns and infants. Symptom triad, including fever, inguinal swelling or discoloration, and limited lower limb movement, is observed in most cases. Herein, we report a case of unusual IPA in an 82-day-old boy who presented with fever as the only symptom. To our best knowledge, there have been no reports of infant IPA presenting without localizing signs. This report highlights the importance of a high degree of suspicion for timely diagnosis of infant IPA when an infant presents only with fever.

Validation of ergonomic running handgrip elements to improve arm posture of running novices

Abstract Running is one of the most popular sports worldwide motivating many non-athletic people to start new physical activities. But especially novice runners are at risk to develop injuries as they tend to run with prejudicial posture. Hence, there has been considerable research to identify factors improving running performance. One of these factors is the correct movement of arms as a swinging pendulum during running. Based on this knowledge ergonomically shaped handgrip elements were designed to improve the posture of the shoulder-arm complex during running. The main objective of this study was the validation of the actual effectiveness on shoulder-arm posture of these handgrips. In this sense 25 adult, healthy persons without running experience were examined by motion capture analysis during running on a treadmill with and without the use of the handgrips. The focus of movement analysis was on changes of hand supination, shoulder abduction and shoulder rotation. Flexion of elbows and shoulders were not expected to change and thus, were investigated as an internal control. Significant changes were found in sense of a reduction of forearm pronation, shoulder abduction, and internal rotation of the shoulder, resulting in improved posture during running. At the same time, no significant changes were found in elbow flexion and shoulder flexion. Future studies are needed to investigate the effects of the detected improvement of arm posture on other important running parameters, such as trunk stability, movement of lower limbs, running economy, and risk of injury. These studies should also compare effects in competitive athletes, recreational runners, and novice runners.

Relevance of Ayurveda Management in Duchenne Muscular Dystrophy to Augment the Quality of Life- A Pediatric Case Report

Muscular dystrophy is a myopathy that stakes clinical characteristics of progressive muscular feebleness. Duchenne muscular dystrophy (DMD) is the most common X-linked disorder of muscular dystrophy in children, present in early childhood, and characterized by proximal muscle weakness and calf hypertrophy in affected boys. This case aims to make Ayurveda pediatricians aware of planning a protocol for DMD. The objective is to provide instant relief in motor function to some extent and to augment the quality of life. An 11 years old boy was presented with an in ability to stand, gross muscle weakness, difficulty in movements of lower limbs, and particularly in all vigorous physical activities. He also had decreased strength, stamina, and progressive debility with positive Gower's sign, which suggested DMD. Confirmed economic treatment options are unavailable to prevent progressive illness and mortality. The family members were counselled and assured of improving their quality of life. He was started with multiple pre-panchakarma procedures of alternate Rukshan and Brihan to pacify internal Ayurveda medicines with the support of occupational therapy and physiotherapy in different sittings for three months. His CPK -creatinine kinase was 8335 U/L (NV= 55 to 170 U/L) which became4741U/L post-treatment. He could stand with support for 15 minutes on his own with ease in body movements due to a reduction in contractures & increase in the range of motions measured by the goniometer, as this genetic disease has no medicinal cure. However, by adopting a multi-dimensional integrative approach, family support, and willpower, the quality of life can be augmented to much extent. Ayurveda plays a crucial role in the drastic improvement because of panchkarma shaman procedures, medicines, Yog, physiotherapy, traction, and counselling at regular intervals for lifelong.

Recognition of Lower Limb Movements Using Machine Learning Methods and Bispectral Maps of Wireless sEMG Measurements

Recognition of Lower Limb Movements Using Machine Learning Methods and Bispectral Maps of Wireless sEMG Measurements

Comparison of transversus abdominis activation characteristics between healthy and chronic low back pain population during upright functional movement.

Previous literature suggests that transversus abdominis (TrA) activation is diminished in chronic low back pain (cLBP) subjects compared to healthy subjects in less-functional positions. However, few studies have investigated the effects of upright functional movement on TrA activation in cLBP individuals. This pilot study aimed to compare TrA activation characteristics in healthy and cLBP subjects during the movement of double leg standing (DLS) to single leg standing (SLS) and to a 30∘ single leg quarter squat (QSLS). TrA activation was determined by the percentage change in TrA thickness from DLS to SLS and DLS to QSLS. TrA thickness was measured in 14 healthy and 14 cLBP participants using ultrasound imaging with a probe holder at 20mm and 30mm from the fascia conjunction point. At both measurement points (20 and 30mm), there were no significant main effects of body sides, lower limb movements and the interactions between them on TrA activations between the healthy and cLBP participants even after covariates were adjusted for (all p> 0.05). Results from this study suggest the evaluation of TrA activation during upright functional movements as part of an assessment for cLBP management may not be suggested.

Closure of Giant Dorsal Lumbosacral Myelomeningocele in Children Using Double Expanded Flaps: A Case Report and Literature Review.

Myelomeningocele (MMC) is the most common neural tube defect that can occur due to neural tube's failure to fuse properly during embryonic life. To prevent this, expanded flaps can be used for closure of large MMCs. A 4-year and 6-month girl was diagnosed with multiple congenital anomalies including hydrocephalus, dorsal lumbosacral MMC, and congenital tethered cord syndrome. Preoperative evaluation showed no lower limb movements and the size of the sacrococcygeal region was about 10cm × 8cm × 15cm mass, prominent thoracic kyphosis, and no obvious urogenital or limb anomalies. The large dorsal lumbosacral MMC was treated with a double expanded flap to reconstruct, the soft tissue defect following the neurosurgical reconstruction. The expanded flap was deemed as viable as all wounds were healed without any complications, such as dehiscence, leakage of cerebrospinal fluid, or infection. The technique described in the case report offers an effective method of closure. This flap can be an effective method for reconstruction of large dorsal lumbosacral MMC defects that might improve outcomes and minimize complications. It also ensures minimal wound tension and breakdown.

Correlation between MOVA3D, a Monocular Movement Analysis System, and Qualisys Track Manager (QTM) during Lower Limb Movements in Healthy Adults: A Preliminary Study.

New technologies based on virtual reality and augmented reality offer promising perspectives in an attempt to increase the assessment of human kinematics. The aim of this work was to develop a markerless 3D motion analysis capture system (MOVA3D) and to test it versus Qualisys Track Manager (QTM). A digital camera was used to capture the data, and proprietary software capable of automatically inferring the joint centers in 3D and performing the angular kinematic calculations of interest was developed for such analysis. In the experiment, 10 subjects (22 to 50 years old), 5 men and 5 women, with a body mass index between 18.5 and 29.9 kg/m2, performed squatting, hip flexion, and abduction movements, and both systems measured the hip abduction/adduction angle and hip flexion/extension, simultaneously. The mean value of the difference between the QTM system and the MOVA3D system for all frames for each joint angle was analyzed with Pearson's correlation coefficient (r). The MOVA3D system reached good (above 0.75) or excellent (above 0.90) correlations in 6 out of 8 variables. The average error remained below 12° in only 20 out of 24 variables analyzed. The MOVA3D system is therefore promising for use in telerehabilitation or other applications where this level of error is acceptable. Future studies should continue to validate the MOVA3D as updated versions of their software are developed.

Direction and distance dependency of reaching movements of lower limb.

Efficient body movement is required in our daily lives, as it facilitates responding to the external environment and producing movements in various directions and distances. While numerous studies have reported on goal-directed movements in the frontal direction during gait initiation, there is limited research on the efficient movement of the lower limbs in multiple directions and distances. Therefore, we aimed to examine changes in the kinematics of lower-limb reaching movements to determine skilled motor ability in terms of direction and distance. Sixteen adults (10 male participants) were requested to reach targets projected on the floor in seven directions and at three distances for a total of 21 points. The reaching time slowed down for the contralateral side (right foot to left-sided target) and was caused by a slower start of the toe movement. To identify the cause of this delay, we analyzed the onset of movement at each joint and found that movement to the contralateral side starts from the hip, followed by the knee, and subsequently the toe. The time-to-peak velocity was also calculated, and the motion required to reach the target in the shortest time varied depending on direction and distance. These results suggested that movement kinematics vary with direction and distance, resulting in a slower reaching time on the contralateral side. The results of our study hold promise for potential applications in sports and rehabilitation.

Biomechanical effects of typical lower limb movements of Chen-style Tai Chi on knee joint.

The load and stress distribution on cartilage and meniscus of the knee joint in typical lower limb movements of Chen-style Tai Chi (TC) and deep squat (DS) were analyzed using finite element (FE) analysis. The loadings for this analysis consisted of muscle forces and ground reaction force (GRF), which were calculated through the inverse dynamic approach based on kinematics and force plate measurements obtained from motion capture experiments. Thirteen experienced practitioners performed four typical TC movements, namely, single whip (SW), brush knee and twist step (BKTS), stretch down (SD), and part the wild horse's mane (PWHM), which exhibit lower posture and greater lower limb force compared to other TC styles. The results indicated that TC required greater lower limb muscle strength than DS, resulting in greater knee joint forces. The stress on the medial cartilage in SW and BKTS fell within a range conductive to maintaining the balance between anabolism and catabolism of cartilage matrix. This was due to the fact that SW and BKTS reduce the medial to total tibiofemoral contact force ratios through knee abduction, which may effectively alleviate mild medial knee osteoarthritis (KOA). However, the greater medial contact force ratios observed in SD and PWHM resulted in great contact stresses that may aggravate the pain of patients with KOA. To mitigate these effects, practitioners should consider elevating their postures appropriately to reduce knee flexion angles, especially during the single-leg support phase. This adjustment can decrease the required muscle strength, load and stress on the knee joint.

AI-enabled Hybrid Model for Lower-Limb Movements Recognition using Estimated Muscular Activity from Cortical Brain Signals

Decades of research determined electromyography (EMG) and electroencephalography (EEG), individually, as paramount controls aimed at rehabilitation. However, correlating commands from the central nervous system to lower-limb movements are highly complex raising challenges for anthropomorphic lower-limb prosthesis control. This work establishes a hierarchical relationship between 12-channel EEG and 4-channel surface EMG using a hybrid model (LRG-2L-LSTM) for lower-limb ankle movement recognition by estimating muscular activity from cortical brain signals. The proposed model achieved R 2 = 0.742 ± 0.03, RMSE = 0.067 ± 0.002 for EMG estimation and averaged recognition accuracy of 84.86 ± 0.27% for ankle movements using estimated EMG, thereby, establishing lower-limb prosthesis and exoskeleton control for amputees with little to no muscular strength.

Shape of an obstacle affects the mediolateral trajectory of the lower limb during the crossing process.

In previous studies involving obstacle crossing, vertical foot clearance has been used as an indicator of the risk of contact. Under normal circumstances, individuals do not always cross over obstacles with the same height on both sides, and depending on the shape of the obstacle, the risk of contact may differ depending on the foot elevation position. Therefore, we investigated whether task-related control of the mediolateral foot position is adapted to the shape of the obstacle. Sixteen healthy young adults performed a task in which they crossed over two obstacles with different shapes while walking: a trapezoidal obstacle and a rectangular obstacle, as viewed from the frontal plane. It was shown that when crossing over a trapezoidal obstacle, the participants maintained foot clearance by controlling the mediolateral direction, which chose the height that needed to be cleared. The results of this study suggest that the lower limb movements that occur during obstacle crossing are controlled not only in the vertical direction but also in the mediolateral direction by adjusting the foot trajectory to reduce the risk of contact. It was demonstrated that control was not only based on the height of the obstacle directly under the foot but also in the foot mediolateral direction, considering the shape of the entire obstacle, including the opposite limb.

A Smartphone-Based sEMG Signal Analysis System for Human Action Recognition.

In lower-limb rehabilitation, human action recognition (HAR) technology can be introduced to analyze the surface electromyography (sEMG) signal generated by movements, which can provide an objective and accurate evaluation of the patient's action. To balance the long cycle required for rehabilitation and the inconvenient factors brought by wearing sEMG devices, a portable sEMG signal acquisition device was developed that can be used under daily scenarios. Additionally, a mobile application was developed to meet the demand for real-time monitoring and analysis of sEMG signals. This application can monitor data in real time and has functions such as plotting, filtering, storage, and action capture and recognition. To build the dataset required for the recognition model, six lower-limb motions were developed for rehabilitation (kick, toe off, heel off, toe off and heel up, step back and kick, and full gait). The sEMG segment and action label were combined for training a convolutional neural network (CNN) to achieve high-precision recognition performance for human lower-limb actions (with a maximum accuracy of 97.96% and recognition accuracy for all actions reaching over 97%). The results show that the smartphone-based sEMG analysis system proposed in this paper can provide reliable information for the clinical evaluation of lower-limb rehabilitation.

Rehabilitation Outcome Measures in Patients with Spinal Stenosis: A Literary Review

Background: Lumbar spinal stenosis causes considerable disability in everyday life; its incidence is increasing due to aging in the world population. First-line treatment is generally conservative, but rehabilitation outcome is still unclear; the aim of this systematic review was to define which domains need to be evaluated for the lumbar stenosis physiotherapy approach, further specifying if the literature suggests patient-centred or objective measures. Methods: A systematic review of the literature according to the PRISMA statement was carried out; the PICO model was used to draw research questions. RCTs about the rehabilitation of lumbar spinal stenosis conducted in the last five years were considered includible, with no difference in terms of stenosis location. The following databases were screened through specific search strings: PubMed, EBSCO, PEDro, Cochrane Database, Scopus, and Google Scholar; two independent researchers assessed results and a third opinion was requested to solve conflicts. Critical appraisal of the included studies was conducted through Pedro Jadad scores. The following data were extracted: author and year, country, sample, intervention, outcome domains, and tools. Results: From 10,069 records, three RCTs were included in the final review stage; they all showed high methodological quality. It is recommended for physiotherapists dealing with lumbar spinal stenosis to assess five main domains: disability, pain, clinical tests, mental wellbeing and kynesiophobia, and quality of life. Domains were mainly assessed through self-reported questionnaires/scales, while objective tests evaluate general lower limb movements, the active range of motion, or the muscles’ endurance. Conclusion: This five-domain evaluation model is reliable and can be practised in each rehabilitation setting (home, outpatient, and hospital); sustainability is guaranteed by the prevalent employment of self-reported tools. Future studies should evaluate the best questionnaire/scale for each domain, especially the definition of a gold standard for pain assessment in patients with lumbar stenosis as this is a challenge for the future.