Objective Gait Analysis Research Articles

Perceived sidedness and correlation to vertical movement asymmetries in young warmblood horses.

The prevalence of vertical asymmetries is high in "owner-sound" warmblood riding horses, however the origin of these asymmetries is unknown. This study investigated correlations between vertical asymmetries and motor laterality. Young warmblood riding horses (N = 65), perceived as free from lameness were evaluated on three visits, each comprising objective gait analysis (inertial measurement units system) and a rider questionnaire on perceived sidedness of the horse. A subgroup (N = 40) of horses were also subjected to a forelimb protraction preference test intended as an assessment of motor laterality. We hypothesized associations between vertical asymmetry and motor laterality as well as rider-perceived sidedness. Vertical asymmetry was quantified as trial means of the stride-by-stride difference between the vertical displacement minima and maxima of the head (HDmin, HDmax) and pelvis (PDmin, PDmax). Laterality indexes, based on counts of which limb was protracted, and binomial tests were used to draw conclusions from the preference tests. In the three visits, 60-70% of horses exhibited vertical asymmetries exceeding clinically used thresholds for ≥1 parameter, and 22% of horses exhibited a side preference in the preference test as judged by binomial tests. Linear mixed models identified a weak but statistically significant correlation between perceived hindlimb weakness and higher PDmin values attributable to either of the hindlimbs (p = 0.023). No other statistically significant correlations to vertical asymmetry were seen for any of the questionnaire answers tested. Tests of correlation between the absolute values of laterality index and asymmetry parameters (HDmin, HDmax, PDmin, PDmax) identified a weak correlation (p = 0.049) with PDmax, but when accounting for the direction of asymmetry and motor laterality, no correlations were seen for either of the asymmetry parameters. No convincing evidence of associations between vertical asymmetries and motor laterality were seen and further studies investigating motor laterality and the origin of vertical asymmetries are needed.

Prospective evaluation of canine partial limb amputation with socket prostheses.

Canine prostheses have been commercially available for many years but are still in early stages of research, development, and clinical application. To prospectively investigate mid-term clinical outcomes of partial limb amputation with a socket prosthesis (PLASP) in canine patients via a descriptive prospective clinical case series and to describe a clinical protocol for PLASP. Client-owned dogs (n = 12) with distal limb pathology for which total limb amputation was recommended were enrolled. Partial limb amputation was performed and a socket prosthesis was moulded and fitted to the limb. Complications, clinical follow-up, and objective gait analysis (OGA) were recorded for at least 6 months. An online survey was completed by owners after study completion. Ten dogs with thoracic limb pathology and two with pelvic limb pathology were included. The most common site of amputation was mid-radius (n = 5). Eleven of 12 dogs demonstrated quadrupedal gait on OGA with mean per cent body weight distribution (%BWD) of 26% on thoracic limb prostheses and a %BWD of 16% for the one pelvic limb prosthesis that OGA data were available for. Complications included prosthesis suspension difficulties (n = 5), pressure sores (4), bursitis (4), postoperative infection (3), prosthesis aversion (2), dermatitis (1), and owner noncompliance (1). Two owners elected to discontinue prosthesis use. PLASP allowed restoration of quadrupedal gait patterns in most patients. Owners reported overall positive satisfaction, though a high complication rate was observed. PLASP should be considered in select cases as an alternative to total limb amputation for dogs with distal limb pathology.

Identifying requirements of an IMU-based gait assessment interface for incomplete spinal cord injury through user-centred design approach

For most patients with an incomplete spinal cord injury, gait rehabilitation plays a key role in functional recovery. Gait is usually assessed by physiotherapists and rehabilitation physicians through observational analysis or by specialized personnel through laboratory gait analysis. However, observational analysis is prone to misjudgment, and laboratory analysis is complex and time-consuming. Inertial measurement units (IMUs) could be an interesting alternative to bring objective gait analysis closer to the actual healthcare providers. This article focuses on identifying the requirements of an IMU-based gait assessment interface for use in a clinical setting by rehabilitation physicians and physiotherapists. The design process consisted of four stages: (1) user research to identify physicians’ and physiotherapists’ needs and expectations, and the context wherein the system will be used; (2) analysing and interpreting user research results to collect insights and define the design vision; (3) conceptualization and evaluation of initial concepts for the layout of the gait assessment interface and visualization of the gait parameters; (4) developing and evaluating the initial design and prototype of the interface. Future research will need to be conducted to further develop the usability and functionality of the interface.

Fast, non-eccentrically loaded exercise worsens tendinopathic healing responses in a murine model.

To advance the understanding of how alterations in exercise speed and grade (flat vs 17° incline or decline) affect the quality of tendon healing, and to determine if a biomarker relationship exists between serum levels of a ColX breakdown product (CXM) and animals exposed to treadmill running protocols. 35 male mice (C57BL/6J), 8 weeks of age. Mice were preconditioned on a treadmill for 14 days. Tendinopathy was then induced by 2 intra-tendinous TGFβ1 injections followed by randomization into 7 exercise groups. Exercise capacity and objective gait analysis were measured weekly. Mice were euthanized and histopathologic analysis and evaluation of serum CXM levels were performed. Statistics were conducted using a 2-way ANOVA (exercise capacity), Mixed Effects Model (gait analysis, effect of preconditioning), and 1-way ANOVA (gait analysis, the effect of injury, and rehabilitation normalized to baseline; CXM serum analysis), all with Tukey post hoc tests and significance set to P < .05. Exercise at a fast-flat speed demonstrated inferior tendinopathic healing at the cellular level and impaired stance braking abilities, which were compensated for by increased propulsion. Mice exposed to exercise (at any speed or grade) demonstrated higher systemic levels of CXM than those that were cage rested. However, no ColX immunostaining was observed in the Achilles tendon or calcaneal insertion. Exercise at a fast speed and in absence of eccentric loading components (incline or decline) demonstrated inferior tendinopathic healing at the cellular level and impaired braking abilities that were compensated for by increased propulsion.

Equine blood flow restriction training: Safety validation.

Blood flow restriction (BFR) has become a key rehabilitative tool for human orthopaedic conditions. With modernised technology and evolution of clinical application, patient-specific delivery of occlusion percentages is now considered the standard of care in human patients due to improved therapeutic outcomes and minimised safety risks. Safety validation and limb occlusion pressure (LOP) data for horses, however, are lacking. (1) To determine if BFR exposure resulted in forelimb biomechanical gait dysfunction as safety validation and (2) to investigate inter-horse and inter-limb LOP differences. Controlled in vivo experiment. Daily unilateral forelimb BFR was performed in four horses over 56 days. Clinical examinations and objective gait analyses were performed on Days 0, 28 and 56. Daily LOP values were determined by Doppler evaluation to deliver 80% vascular occlusion at a walk. A linear mixed model evaluated for differences in lameness, kinetic and kinematic gait parameters. There were no significant differences in forelimb lameness (range of Grades 0-2 across all forelimbs), kinematic or kinetic gait parameters over time or between BFR-exposed and control (contralateral) limbs (p > 0.05). Clinically apparent complications related to BFR such as thrombosis or dermatitis were not appreciated. Significant differences in mean LOP values between various horses (p < 0.001) and measured left (204.48 mmHg) and right (173.78 mmHg) forelimbs (p < 0.001) were observed. Mean LOP and standard deviation across all readings was 189.1 ± 22.2 mmHg. Optimal BFR occlusion percentages and protocols with documented clinical efficacy are unknown. Small study population. Exposure to BFR did not result in forelimb biomechanical dysfunction in four horses. Applied pressures of 75-151 mmHg would likely simulate a range of 50%-80% vascular occlusion in horses, but inherent physiological variation between horses and forelimbs warrants incorporation of individual pressures.

Inter-rater reliability between osteopaths of differing clinical experience on sagittal plane running gait analysis: A pilot study

ObjectiveClinical running analysis is commonly employed in the screening of running related injuries. Currently, there remains little research exploring the use of clinical running analysis within the osteopathic profession. Hence, the aim of this pilot study is to investigate the inter-rater reliability of sagittal plane visual gait observation amongst osteopathic practitioners. MethodsFourteen osteopaths were recruited through an online platform. Each participant completed five, 11-item gait analysis forms, with each form corresponding to a different running gait video recorded in the sagittal plane. Krippendorff's alpha (Kα) was calculated to determine the inter-rater reliability between all participants, and between groups based on years of clinical experience. ResultsVery low inter-rater reliability was found between all participants (Kα<0.67) across all questions. Strong reliability was found for two questions answered by the 5–10 years’ experience group (Kα<0.8155) with regard to foot strike in the runners. DiscussionThe poor inter-rater reliability found in this pilot study, is in disagreement with previous research that has identified high inter-rater reliability with practitioners of varied clinical experience on a similar gait analysis task. These discrepancies may be explained by a range of methodological differences and limitations, chiefly the sample size and the objective nature of the kinematic observation tasks. ConclusionThe results of this pilot study indicate there is very low reliability between this group of clinicians interpretation of running gait. Building on from this, future research should investigate clinician inter-rater reliability using more objective gait analysis measures.

Performance of four equine pain scales and their association to movement asymmetry in horses with induced orthopedic pain.

ObjectiveThis study investigated the relationship between orthopedic pain experienced at rest, and degree of movement asymmetry during trot in horses with induced reversible acute arthritis. Orthopedic pain was assessed with the Horse Grimace Scale (HGS), the Equine Utrecht University Scale of Facial Assessment of Pain (EQUUS-FAP), the Equine Pain Scale (EPS), and the Composite Orthopedic Pain Scale (CPS). Reliability and diagnostic accuracy were evaluated with intraclass correlation coefficients (ICC) and area under the curve (AUC).Study design and animalsEight healthy horses were included in this experimental study, with each horse acting as its own control.MethodsOrthopedic pain was induced by intra-articular lipopolysaccharide (LPS) administration. Serial pain assessments were performed before induction and during pain progression and regression, where three observers independently and simultaneously assessed pain at rest with the four scales. Movement asymmetry was measured once before induction and a minimum of four times after induction, using objective gait analysis.ResultsOn average 6.6 (standard deviation 1.2) objective gait analyses and 12.1 (2.4) pain assessments were performed per horse. The ICC for each scale was 0.75 (CPS), 0.65 (EPS), 0.52 (HGS), and 0.43 (EQUUS-FAP). Total pain scores of all scales were significantly associated with an increase in movement asymmetry (R2 values ranging from −0.0649 to 0.493); with CPS pain scores being most closely associated with movement asymmetry. AUC varied between scales and observers, and CPS was the only scale where all observers had a good diagnostic accuracy (AUC > 0.72).Conclusions and clinical relevanceThis study identified significant associations between pain experienced at rest and degree of movement asymmetry for all scales. Pain scores obtained using CPS were most closely associated with movement asymmetry. CPS was also the most accurate and reliable pain scale. All scales had varying linear and non-linear relations between total pain scores and movement asymmetry, illustrating challenges with orthopedic pain assessment during rest in subtly lame horses since movement asymmetry needs to be rather high before total pain score increase.

The relation between clinical and objective gait scores in clubfoot patients with and without a relapse

BackgroundObjective gait analysis that fully captures the multi-segmental foot movement of a clubfoot may help in early identification of a relapse clubfoot. Unfortunately, this type of objective measure is still lacking in a clinical setting and it is unknown how it relates to clinical assessment. Research questionThe aim of this study was to identify differences in total gait and foot deviations between clubfoot patients with and without a relapse clubfoot and to evaluate their relationship with clinical status. MethodsIn this study, Ponseti-treated idiopathic clubfoot patients were included and divided into clubfoot patients with and without a relapse. Objective gait analysis was done resulting in total gait and foot scores and clinical assessment was performed using the Clubfoot Assessment Protocol (CAP). Additionally, a new clubfoot specific foot score, the clubFoot Deviation Index (cFDI*), was calculated to better capture foot kinematics of clubfoot patients. ResultsClubfoot patients with a relapse show lower total gait quality (GDI*) and lower clinical status defined by the CAP than clubfoot patients without a relapse. Abnormal cFDI* was found in relapse patients, reflected by differences in corresponding variable scores. Moderate relationships were found for the subdomains of the CAP and total gait and foot quality in all clubfoot patients. SignificanceA new total foot score was introduced in this study, which was more relevant for the clubfoot population. The use of this new foot score (cFDI*) besides the GDI*, is recommended to identify gait and foot motion deviations. Along with clinical assessment, this will give an overview of the overall status of the complex, multi-segmental aspects of a (relapsed) clubfoot. The relationships found in this study suggest that clinical assessment might be indicative of a deviation in total gait and foot pattern, therefore hinting towards personalised screening for better treatment decision making.

Prospective evaluation of complications associated with orthosis and prosthesis use in canine patients.

IntroductionThe use of orthoses and prostheses is expanding in veterinary medicine. However, research evaluating the efficacy and complications of these devices in veterinary patients is limited. The primary objective of this study was to prospectively determine the complications and outcomes associated with custom orthosis and prosthesis use in the canine patient.Materials and MethodsThis was a prospective, clinical trial that followed patients for 12 months following device fitting. Owner-perceived complications, clinical metrology instruments, and objective gait analysis were used as outcome measures at various time points. The patients were grouped into the following four major categories: Patients with a carpal orthosis, patients with a stifle orthosis, patients with a tarsal orthosis, and patients with a prosthetic device.ResultsForty-three patients were included in the study. Thirty-nine out of 43 patients (91%) experienced at least one complication, with 7/7 (100%) prosthesis patients experiencing at least one complication. At least one skin complication was reported for the following patient groups during the first 3 months of use: 8/14 (58%) stifle orthoses, 9/10 (90%) carpal orthoses, 6/10 (60%) tarsal orthoses, and 4/7 (58%) prostheses. Patient non-acceptance of the device was identified in 2/15 (14%) stifle orthoses, 1/10 (10%) tarsal orthoses, and 4/7 (55%) prostheses. One out of 15 (7%) stifle orthoses, 4/10 (40%) carpal orthoses, 4/10 (40%) tarsal orthoses, and 1/7 (15%) prostheses experienced mechanical device problems necessitating repair. The majority of patients with carpal and stifle orthoses showed improvement on objective gait analysis in percent body weight distribution of the affected limb between baseline and the most recent follow-up without the device donned: 83% (n = 6) of patients with carpal orthoses, 100% (n = 11) of patients with stifle orthoses. None of the patients with tarsal orthoses showed a similar improvement (0%; n = 4).Discussion and conclusionThree major complications associated with canine orthosis and prosthesis use were identified in this study as follows: Skin complications (abrasions, loss of hair, and sores), mechanical device problems, and patient non-acceptance of the device. Owners should be notified of these potential complications prior to pursuing orthoses or prostheses as a potential treatment option. Although clinical improvement was noted in the majority of patients with stifle and carpal pathology, given the lack of a control group, it is unknown how much of this improvement can be attributed to the orthoses.

Intra-Articular Injections of Allogeneic Mesenchymal Stromal Cells vs. High Molecular Weight Hyaluronic Acid in Dogs With Osteoarthritis: Exploratory Data From a Double-Blind, Randomized, Prospective Clinical Trial.

This double-blind, randomized, prospective clinical trial was conducted to obtain exploratory data comparing the efficacy of intra-articular allogeneic mesenchymal stem/stromal cells (MSC) to high molecular weight hyaluronic acid (HA) for the treatment of pain associated with canine osteoarthritis (OA). Objective gait analysis (%Body Weight Distribution, %BWD), accelerometry, clinical metrology instruments and veterinary exams were used as outcome measures during various time points throughout the 48-week study period. Fourteen dogs with elbow or coxofemoral OA were enrolled and assigned in a 2:1 ratio to the treatment groups. Each patient received a set of two injections 4 weeks apart. Self-limiting joint flare was observed in seven patients, with six of these in the MSC group. Ten patients completed all follow-up appointments. Both treatment groups showed evidence of mild improvement following the treatment, but the results were inconsistent among the various outcome measures assessed. Overall, dogs enrolled in the HA group showed greater improvement compared to the MSC group. The primary outcome measure, %BWD, showed evidence of improvement, when compared to baseline values, at 36 weeks after injection for the HA group only (p = 0.048, estimated difference: 4.7). Similarly, when treatment groups were compared, evidence of a difference between treatment groups (with the HA-group showing greater improvement) were identified for weeks 24 and 36 (p = 0.02 and 0.01, respectively). The small sample size of this exploratory study does not allow firm conclusions. However, until studies with larger sample sizes are available, the current literature combined with our data do not support the clinical use of intra-articular MSC therapy over high molecular weight HA for the treatment of canine OA at this time.

A Pilot, Open-Label Study to Evaluate the Efficacy of Intra-Articular Administration of a Caninized TNF Receptor Fc Fusion Protein as a Treatment for Osteoarthritis-Associated Joint Pain.

Tumor necrosis factor-α (TNF-α) is a potential target for osteoarthritis (OA) treatment. In several recent clinical studies in human OA, anti-TNF-α therapy showed promising results; however, these were open-label and based on patient-reported outcome measures. In this study, we developed a caninized TNF-α receptor-Fc (caTNFR-Fc) fusion protein and conducted a non-randomized, open-label, pilot study in dogs with OA using objectively measured ground reaction forces and activity. The aims of the study were to assess the efficacy of the intra-articular (IA) injection of the caTNFR-Fc fusion protein as a treatment for OA pain, and additionally to evaluate TNF concentrations in synovial fluid (SF) between joints with/without OA in dogs. Dogs (n = 12) with single-limb lameness due to single joint appendicular OA were recruited. All dogs received caTNFR-Fc fusion protein injection into the affected joint under sedation. Objective kinetic gait analysis using force plate was performed prior to (baseline), and at 14- and 28-days following treatment. Additionally, SF samples were collected from OA joints (n = 69) and non-OA joints (n = 79) in a different cohort of dogs and TNF-α were measured using enzyme-linked immunosorbent assay. No significant treatment effects on the limb use, activity, and the questionnaire were found. The concentration of TNF-α was significantly higher in OA joints than in healthy joints (p = 0.0019), but TNF-α was detected in only 10/69 OA samples. The IA injection of caTNFR-Fc fusion protein provided no benefit in terms of objective limb use and activity data in dogs with OA in this pilot study. Although the SF concentration of TNF-α was significantly higher in OA joints, few OA joints had measurable TNF-α. Collectively, the data indicate TNF-α may not be a good therapeutic target in canine OA.

Efficacy of caudal pedunculopontine nucleus stimulation on postural instability and gait disorders in Parkinson’s disease

Gait-related symptoms like postural instability and gait disorders (PIGD) inexorably worsen with Parkinson's disease (PD) deterioration and become refractory to current available medical treatment and deep brain stimulation (DBS) of conventional targets. Pedunculopontine nucleus (PPN) deep brain stimulation (DBS) is a promising method to treat PIGD. This prospective study aimed to clarify the clinical application of PPN-DBS and to explore effects of caudal PPN stimulation on PIGD. Five consecutive PD patients with severe medication-resistant postural instability and gait disorders accepted caudal PPN-DBS. LEAD-DBS toolbox was used to reconstruct and visualize the electrodes based on pre- and postoperative images. Outcomes were assessed with Movement Disorder Society (MDS)-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), gait-specific questionnaires, and objective gait analysis with GAITRite system. MDS-UPDRS subitems 35-38 scores were improved at postoperative 6months (mean, 4.40 vs 11.00; p = 0.0006) and 12months (mean, 5.60 vs 11.00; p = 0.0013) compared with baseline, and scores at 6months were slightly lower than scores at 12months (mean, 4.40 vs 5.60; p = 0.0116). Gait and Falls Questionnaire, New Freezing of Gait Questionnaire, and Falls Questionnaire scores also significantly improved at postoperative 6months and 12months compared with baseline. In addition, cadence, bilateral step length, and bilateral stride length significantly increased when PPN On-stimulation compared with Off-stimulation. This study suggested that caudal PPN low-frequency stimulation improved PIGD for PD patients at the 6- and 12-month period.

Visual lameness assessment in comparison to quantitative gait analysis data in horses.

Quantitative gait analysis offers objective information to support clinical decision-making during lameness workups including advantages in terms of documentation, communication, education, and avoidance of expectation bias. Nevertheless, hardly any data exist comparing outcome of subjective scoring with the output of objective gait analysis systems. To investigate between- and within-veterinarian agreement on primary lame limb and lameness grade, and to determine relationships between subjective lameness grade and quantitative data, focusing on differences between (1) veterinarians, (2) live vs video assessment, (3) baseline assessment vs assessment following diagnostic analgesia. Clinical observational study. Kinematic data were compared to subjective lameness assessment by clinicians with ≥8years of orthopaedic experience. Subjective assessments and kinematic data for baseline trot-ups and response to 48 diagnostic analgesia interventions in 23 cases were included. Between and within-veterinarian agreement was investigated using Cohen's Kappa (κ). Asymmetry parameters for kinematic data ('forelimb lame pattern', 'hindlimb lame pattern', 'overall symmetry', 'vector sum head', 'pelvic sum') were determined, and used as outcome variables in mixed models; explanatory variables were subjective lameness grade and its interaction with (1) veterinarian, (2) live or video evaluation and (3) baseline or diagnostic analgesia assessment. Agreement on lame limb between live and video assessment was 'good' between and within veterinarians (median κ=0.64 and κ=0.53). There was a positive correlation between subjective scoring and measured asymmetry. The relationship between lameness grade and objective asymmetry differed slightly between (1) veterinarians (for all combined parameters, p-values between P<.001 and 0.04), (2) between live and video assessments ('forelimb lame pattern', 'overall symmetry', both P≤.001), and (3) between baseline and diagnostic analgesia assessment (all combined parameters, between P<.001 and .007). Limited number of veterinarians (n=4) and cases (n=23), only straight-line soft surface data, different number of subjective assessments live vs from video. Overall, between- and within-veterinarian agreement on lame limb was 'good', whereas agreement on lameness grade was 'acceptable' to 'poor'. Quantitative data and subjective assessments correlated well, with minor though significant differences in the number of millimetres, equivalent to one lameness grade between veterinarians, and between assessment conditions. Differences between baseline assessment vs assessment following diagnostic analgesia suggest that addition of objective data can be beneficial to reduce expectation bias. The small differences between live and video assessments support the use of high-quality videos for documentation, communication, and education, thus, complementing objective gait analysis data.

The application of artificial intelligence and custom algorithms with inertial wearable devices for gait analysis and detection of gait-altering pathologies in adults: A scoping review of literature.

BackgroundThe purpose of this scoping review was to explore the current applications of objective gait analysis using inertial measurement units, custom algorithms and artificial intelligence algorithms in detecting neurological and musculoskeletal gait altering pathologies from healthy gait patterns.MethodsLiterature searches were conducted of four electronic databases (Medline, PubMed, Embase and Web of Science) to identify studies that assessed the accuracy of these custom gait analysis models with inputs derived from wearable devices. Data was collected according to the preferred reporting items for systematic reviews and meta-analysis statement guidelines.ResultsA total of 23 eligible studies were identified for inclusion in the present review, including 10 custom algorithms articles and 13 artificial intelligence algorithms articles. Nine studies evaluated patients with Parkinson’s disease of varying severity and subtypes. Support vector machine was the commonest adopted artificial intelligence algorithm model, followed by random forest and neural networks. Overall classification accuracy was promising for articles that use artificial intelligence algorithms, with nine articles achieving more than 90% accuracy.ConclusionsCurrent applications of artificial intelligence algorithms are reasonably effective discrimination between pathological and non-pathological gait. Of these, machine learning algorithms demonstrate the additional capacity to handle complicated data input, when compared to other custom algorithms. Notably, there has been increasing application of machine learning algorithms for conducting gait analysis. More studies are needed with unsupervised methods and in non-clinical settings to better reflect the community and home-based usage.

Effect of Plano-Valgus Foot on Lower-Extremity Kinematics and Spatiotemporal Gait Parameters in Children of Age 5-9.

Aim of the study was to see how a definition of the flexible flat foot (FFF) influences the results of gait evaluation in a group of 49 children with clinically established FFF. Objective gait analysis was performed using VICON system with Kistler force platforms. The gait parameters were compared between healthy feet and FFF using two classifications: in static and dynamic conditions. In static condition, the ink footprints with Clarke’s graphics were used for classification, and in dynamic condition, the Arch Index from Emed pedobarograph while walking was used for classification. When the type of the foot was based on Clarke’s graphics, no statistically significant differences were found. When the division was done according to the Arch Index, statistically significant differences between flat feet and normal feet groups were found for normalized gait speed, normalized cadence, pelvic rotation, ankle range of motion in sagittal plane, range of motion of foot progression, and two parameters of a vertical component of the ground reaction force: FZ2 (middle of stance phase) and FZ3 (push-off). Some statically flat feet function well during walking due to dynamic correction mechanisms.

Long-Term Effects of Neural Precursor Cell Transplantation on Secondary Injury Processes and Functional Recovery after Severe Cervical Contusion-Compression Spinal Cord Injury.

Cervical spinal cord injury (SCI) remains a devastating event without adequate treatment options despite decades of research. In this context, the usefulness of common preclinical SCI models has been criticized. We, therefore, aimed to use a clinically relevant animal model of severe cervical SCI to assess the long-term effects of neural precursor cell (NPC) transplantation on secondary injury processes and functional recovery. To this end, we performed a clip contusion-compression injury at the C6 level in 40 female Wistar rats and a sham surgery in 10 female Wistar rats. NPCs, isolated from the subventricular zone of green fluorescent protein (GFP) expressing transgenic rat embryos, were transplanted ten days after the injury. Functional recovery was assessed weekly, and FluoroGold (FG) retrograde fiber-labeling, as well as manganese-enhanced magnetic resonance imaging (MEMRI), were performed prior to the sacrifice of the animals eight weeks after SCI. After cryosectioning of the spinal cords, immunofluorescence staining was conducted. Results were compared between the treatment groups (NPC, Vehicle, Sham) and statistically analyzed (p < 0.05 was considered significant). Despite the severity of the injury, leading to substantial morbidity and mortality during the experiment, long-term survival of the engrafted NPCs with a predominant differentiation into oligodendrocytes could be observed after eight weeks. While myelination of the injured spinal cord was not significantly improved, NPC treated animals showed a significant increase of intact perilesional motor neurons and preserved spinal tracts compared to untreated Vehicle animals. These findings were associated with enhanced preservation of intact spinal cord tissue. However, reactive astrogliosis and inflammation where not significantly reduced by the NPC-treatment. While differences in the Basso–Beattie–Bresnahan (BBB) score and the Gridwalk test remained insignificant, animals in the NPC group performed significantly better in the more objective CatWalk XT gait analysis, suggesting some beneficial effects of the engrafted NPCs on the functional recovery after severe cervical SCI.

Parental subjective assessment of gait limitations: Comparison with objective gait variables

BackgroundSubjective assessment is an important part of clinical examination providing quality insights into impairments of body structure and functions. Research into the associations between parental perceptions of gait in children with cerebral palsy (CP) and objective clinical gait measures is limited. Research questionWhat are the parental perceived gait limitations in children with CP and are these perceptions associated with objective clinical gait analysis? MethodsParent questionnaires were retrospectively analysed for children with CP who attended our gait analysis laboratory over a 24-month period. Perceived walking limitations caused by pain, weakness, lack of endurance, mental ability, safety concerns, and balance were recorded on a 5-point Likert scale. Normalised gait speed, normalised step length and the Gait Deviation Index (GDI) were calculated. Differences between responses were assessed using Chi-squared tests with Dunn’s post hoc test with Bonferroni adjustment. Spearman’s rank correlations were performed to determine the relationship between responses and gait parameters. ResultsData from 251 participants were included, mean age 9 ± 3.4 years, Gross Motor Function Classification System (GMFCS) level I = 158, II = 64 and III = 29. Balance was perceived to limit walking to the greatest extent, followed by weakness, lack of endurance, safety concerns, pain and mental ability. This rank was consistent across GMFCS levels I, II and III. Perceived balance limitations showed the strongest correlations with objective gait variables, GDI (r = −0.31 p = 0.000), normalised step length (r = −0.30 p = 0.0000) and normalised gait speed (r = −0.24 p = 0.0001). SignificanceSubjective gait perceptions provide a valuable indication of gait function but are weakly associated with objective clinical gait analysis. Outcome measures that are sensitive to changes in balance may be more responsive to parental concerns and help to satisfy their goals and expectations.

Dance Intervention Using the Feldenkrais Method Improves Motor, and Non-Motor Symptoms and Gait in Parkinson's Disease: A 12-Month Study.

ObjectiveThe aim of this study was to assess the effects of dancing (using the Feldenkrais method) on motor and non-motor symptoms, quality of life (QoL), and objective parameters of gait at the time of intervention and at the end of the 1-year study period.MethodsThis was a single-arm study in which 12 subjects with Parkinson’s disease (PD) received dance intervention during a 6-month period. Objective motor scales, gait analysis, and questionnaires on non-motor symptoms were evaluated at baseline and at 3, 6, and 12 months.ResultsDance intervention decreased motor scale (Unified Parkinson’s Disease Rating Scale and Tinetti scale) scores and improved gait disturbance (gait velocity and step length) without increasing levodopa equivalent dose. Furthermore, dancing decreased non-motor scale (Non-Motor Symptoms Scale and Montgomery-Asberg Depression Rating Scale) scores and improved QoL.ConclusionOur findings suggest that dance intervention can be a complementary management method for PD patients.

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.

Randomized Controlled Trial Comparing Autologous Protein Solution to Hyaluronic Acid Plus Triamcinolone for Treating Hip Osteoarthritis in Dogs.

Twenty-three dogs with bilateral hip osteoarthritis were used to compare the efficacy of intra-articular injections of autologous protein solution (APS) to hyaluronic acid plus triamcinolone (HAT). Prior to treatment, owner assessments of pain and mobility were obtained using the canine brief pain inventory (CBPI) and Liverpool Osteoarthritis for Dogs (LOAD) questionnaires. Owners were also asked to list all medications used to control signs of pain associated with hip osteoarthritis (OA). In addition, objective kinetic data using a pressure sensitive walkway was used to quantify the relative weight bearing of each of the limbs (total pressure index; TPI). One hip was then selected using a random number generator for injection with HAT and the contralateral hip was injected with APS under the same sedation event. At 1-, 3-, and 6 months following injection, medication usage was recorded and dogs were re-assessed using the CBPI and LOAD questionnaires and using objective gait analysis to determine the TPI. Twenty dogs completed all aspects of the study and statistically significant (p < 0.05) improvements were noted by dog owners at every post-treatment time point in every category of pain and mobility as assessed by the CBPI and LOAD questionnaires. Only 5 dogs, compared to 14 pre-treatment, received any oral NSAID or other analgesic for the duration of the 6-month study period. The TPI, and change in TPI from baseline, were not statistically significantly different between the two treatments at any time point. These data suggest clinical efficacy of both APS and HAT, but fail to show superiority of one treatment vs. the other. The inability to detect a statistically significant difference between the two treatments could be attributable to a true lack of a difference, or a type II statistical error.