Optoelectronic Motion Analysis Research Articles

Ergonomics in Spine Surgery: A Systematic Review.

Systematic Review. This systematic review aims to synthesize existing studies and highlight the significance of ergonomic considerations for spine surgeons' well-being and the impact on patient outcomes. Spine surgery is a physically demanding field that poses several risks to surgeons, particularly with musculoskeletal disorders. Despite the well-documented consequences of musculoskeletal injuries endured by surgeons, surgical ergonomics in spine surgery has received limited attention. Following PRISMA guidelines, a comprehensive literature search was conducted in PubMed and Embase. Studies focusing on surgeon ergonomics in spine surgery were selected. Data extracted included study details, surgeon demographics, ergonomic factors, and outcomes. Qualitative analysis was performed due to the heterogeneous nature of study designs and criteria. Eleven studies met inclusion criteria. Six studies utilized surveys to explore physical challenges, prevalence rates of pain, work practices, and ergonomic tools. Two studies employed optoelectronic motion analysis to assess spinal angles of the surgeon during surgery. Two studies assesed ergonomics in different visualization methods using rapid entire body assessment (REBA). One study applied video analysis to scrutinize surgeons' neck postures during the case. The results demonstrated a varying prevalence and diverse presentations of musculoskeletal disorders, varying impact on surgical performance, and nuanced relationships between experience, workload, and ergonomic concerns. This systematic review summarizes the heterogenous evaluations of ergonomics in spine surgery. Overall, upwards of three-quarters of spine surgeons have reported musculoskeletal discomfort, most commonly presented as back pain, neck pain, and hand/wrist discomfort. These symptoms are often exacerbated by the use of loupes, operating bed height, and extended period of times in various positions. Studies demonstrate that the physical discomfort is associated with the surgeons' mental and emotional well-being, leading to stress, burnout, and reduced job satisfaction; all of which impact patient care.

Contribution of the Medial Hamstrings to Valgus Stability of the Knee.

Multiligament knee injuries involving the medial side are common. When performing surgical reconstruction, use of the medial hamstrings (HS) as grafts remains controversial in this setting. To determine the role of the medial HS in stabilizing the valgus knee for different types of medial-sided knee injury. Controlled laboratory study. A biomechanical study on 10 cadaveric knees was performed. Valgus load (force moment of 10 N/m) was applied at 0°, 30°, and 60° of flexion, and the resultant rotation was recorded using an optoelectronic motion analysis system. Measurements were repeated for 4 different knee states: intact knee, superficial medial collateral ligament (sMCL) injury, deep medial collateral ligament (dMCL) injury, and posterior oblique ligament (POL) injury. For each state, 4 loading conditions (+ loaded; - unloaded) of the semitendinosus (ST) and gracilis (GRA) tendons were tested: ST+/GRA+, ST+/GRA-, ST-/GRA+, and ST-/GRA-. At 0° of flexion, combined unloading of the ST and GRA (ST-/GRA-) increased valgus laxity on the intact knee compared with the ST+/GRA+ condition (P < .05). For all medial-sided injury states (isolated sMCL; combined sMCL and dMCL; and combined sMCL, dMCL, and POL damage), ST-/GRA- increased valgus laxity at 0° and 30° of flexion versus ST+/GRA+ (P < .05 for all). The absolute value of valgus laxity increased with the severity of medial-sided ligament injury. Isolated ST unloading increased valgus laxity for the intact knee and the MCL-injured knee (combined sMCL and dMCL) at 0° of flexion (P < .05 vs ST+/GRA+). Isolated unloading of the GRA had no effect on valgus knee stability. The medial HS tendons contributed to the stabilization of the knee in valgus, and this was even more important when the medial side was severely affected (POL damage). This stabilizing effect was greater between 0° and 30°, in which the POL is the main valgus stabilizer. When deciding on graft selection for multiligament knee injury reconstruction, the surgeon should be aware of the effect of harvesting the medial HS tendon on valgus laxity.

A new approach to assessing the obstetrician's posture and movement during an instrumental forceps delivery

IntroductionThe number of deliveries by forceps decreases significantly in favour of the vacuum. Now, when the use of forceps is necessary, physicians less experimented with this procedure are likely to induce serious and preventable perineal or foetal injuries. Training therefore becomes essential. However, there are no clear recommendations on the technique to perform a delivery by forceps, namely the body posture and gesture to adopt. Our goal is then to provide a protocol that can help to determine if there is an optimal technique to perform a delivery by forceps. MethodWe will include voluntary participants whose level of experience and type of practice differ. We will propose to record their postures and gestures using an optoelectronic motion analysis system during a forceps delivery simulated on a mannequin. We will also measure the traction force produced by the subject on the forceps using force platforms and technical markers placed on the forceps. We will then perform a principal component analysis to look for similar motion patterns. Expected resultsWe plan to analyse about fifty participants (25 seniors and 25 juniors). Our hypothesis is that the realism of the simulation will be deemed satisfactory by the participants, that the experimental conditions will not modify their gestures, and that the degree of experience will result in different techniques. ConclusionA better knowledge on the posture and gesture to adopt to realise a forceps delivery should improve the safety of women and new-borns. The results of this study could also be a valuable contribution for the training of obstetricians.

Validating a Portable Device for Blinking Analyses through Laboratory Neurophysiological Techniques.

Blinking analysis contributes to the understanding of physiological mechanisms in healthy subjects as well as the pathophysiological mechanisms of neurological diseases. To date, blinking is assessed by various neurophysiological techniques, including electromyographic (EMG) recordings and optoelectronic motion analysis. We recorded eye-blink kinematics with a new portable device, the EyeStat (Generation 3, blinktbi, Inc., Charleston, SC, USA), and compared the measurements with data obtained using traditional laboratory-based techniques. Sixteen healthy adults underwent voluntary, spontaneous, and reflex blinking recordings using the EyeStat device and the SMART motion analysis system (BTS, Milan, Italy). During the blinking recordings, the EMG activity was recorded from the orbicularis oculi muscles using surface electrodes. The blinking data were analyzed through dedicated software and evaluated with repeated-measure analyses of variance. The Pearson’s product-moment correlation coefficient served to assess possible associations between the EyeStat device, the SMART motion system, and the EMG data. We found that the EMG data collected during the EyeStat and SMART system recordings did not differ. The blinking data recorded with the EyeStat showed a linear relationship with the results obtained with the SMART system (r ranging from 0.85 to 0.57; p ranging from <0.001 to 0.02). These results demonstrate a high accuracy and reliability of a blinking analysis through this portable device, compared with standard techniques. EyeStat may make it easier to record blinking in research activities and in daily clinical practice, thus allowing large-scale studies in healthy subjects and patients with neurological diseases in an outpatient clinic setting.

Advances and future directions in the care of patients with facial paralysis

Advances and future directions in the care of patients with facial paralysis

Walking Biomechanics and Spine Loading in Patients With Symptomatic Lumbar Spinal Stenosis.

Symptomatic lumbar spinal stenosis is a leading cause of pain and mobility limitation in older adults. It is clinically believed that patients with lumbar spinal stenosis adopt a flexed trunk posture or bend forward and alter their gait pattern to improve tolerance for walking. However, a biomechanical assessment of spine posture and motion during walking is broadly lacking in these patients. The purpose of this study was to evaluate lumbar spine and pelvic sagittal angles and lumbar spine compressive loads in standing and walking and to determine the effect of pain and neurogenic claudication symptoms in patients with symptomatic lumbar spinal stenosis. Seven participants with symptomatic lumbar spinal stenosis, aged 44–82, underwent a 3D opto-electronic motion analysis during standing and walking trials in asymptomatic and symptomatic states. Passive reflective marker clusters (four markers each) were attached to participants at T1, L1, and S2 levels of the spine, with additional reflective markers at other spinal levels, as well as the head, pelvis, and extremities. Whole-body motion data was collected during standing and walking trials in asymptomatic and symptomatic states. The results showed that the spine was slightly flexed during walking, but this was not affected by symptoms. Pelvic tilt was not different when symptoms were present, but suggests a possible effect of more forward tilt in both standing (p = 0.052) and walking (p = 0.075). Lumbar spine loading during symptomatic walking was increased by an average of 7% over asymptomatic walking (p = 0.001). Our results did not show increased spine flexion (adopting a trunk-flexed posture) and only indicate a trend for a small forward shift of the pelvis during both symptomatic walking and standing. This suggests that provocation of symptoms in these patients does not markedly affect their normal gait kinematics. The finding of increased spine loading with provocation of symptoms supports our hypothesis that spine loading plays a role in limiting walking function in patients with lumbar spinal stenosis, but additional work is needed to understand the biomechanical cause of this increase.

The Impact of Peripheral Artery Disease (PAD) on Lower Limb Kinematics in Type 2 Diabetes Mellitus.

BACKGROUNDPeripheral artery disease (PAD) and diabetes mellitus are factors known to influence gait characteristics. However, there is a lack of knowledge on the extent to which type 2 diabetes mellitus (T2D) and PAD as comorbidities cause limb and gait complications.AIMThe purpose of this study was to investigate the impact of PAD as a complication of T2D on ankle joint dorsiflexion and knee joint flexion angles using an optoelectronic motion analysis system and to find out whether these alterations are complications secondary to neuropathy or reduced blood perfusion.METHODSNinety participants were recruited in this quantitative study which applied a prospective, comparative, non-experimental approach. Participants with T2D and PAD (n = 60), categorized according to the severity of PAD (mild and severe group), were compared with a control group consisting of patients with T2D alone. An optoelectronic motion capture system was used to record mean maximum flexion angles of the knee joint and maximum mean dorsiflexion angles of the ankle joint during gait.RESULTS180 limbs were analyzed. Both mild and severe PAD participants exhibited a significant increase in mean maximum ankle joint dorsiflexion angles (p = 0.001) and a significant decrease in mean maximum flexion of the knee joint compared with the control subjects (p = 0.001).CONCLUSIONSThis study shows that T2D and PAD alter ankle joint and knee joint kinematics. This research provides biomechanical understanding of limb and gait alterations in this specific patient population which may contribute to an improved understanding of gait alterations and clinical management. The findings suggest that the reduction in ankle joint dorsiflexion commonly attributed to glycosylation in diabetes may be secondary to neuropathy and not to reduced blood perfusion.

Association between biological maturation and anterior cruciate ligament injury risk factors during cutting.

Adolescent females are particularly susceptible to suffering anterior cruciate ligament (ACL) injuries, likely influenced by well-established maturational changes. This study investigated ACL biomechanical injury risk factors and their association with biological maturation in females. Thirty-five adolescent females (15±1 year) completed a series of maximum-effort 90° unanticipated cutting maneuvers. Established biomechanical ACL injury risk factors (including external knee abduction moments, knee abduction, hip abduction, knee flexion, ground reaction force) were derived from an optoelectronic motion analysis system and force platforms, with inter-limb asymmetries in these risk factors also computed. Biological maturation (percentage of predicted adult stature) was assessed using validated regression equations, incorporating anthropometric measures of participants and their biological parents. Significant bilateral asymmetries were observed with higher peak external knee abduction moments, higher ground reaction forces and less knee flexion (from 0-18% and 30-39% of contact) during the non-dominant vs. dominant cuts (effect sizes =0.36, 0.63 and 0.50, respectively). Maturation did not appear to influence these asymmetries; however, less hip abduction was observed (e.g., 21-51% of contact for dominant cuts) in more biologically-mature females. These results highlight a potential maturation-related change in cutting technique that may explain the apparent heightened ACL injury risk in this population. As females mature, training targeted at neuromuscular control of hip abductor (e.g. gluteal) muscle groups could potentially mitigate ACL injury risk.

Standing posture and balance modalities in unilateral transfemoral and transtibial amputees

IntroductionLower limb amputation impairs postural performance that could be characterized by biomechanical parameters. This study is to investigate postural performance of persons with transfemoral and transtibial amputation compared to controls without amputation. MethodsEight transtibial, nine transfemoral and twelve able-bodied males participated in this study. Lower limb joints, pelvis and trunk angles were obtained from an optoelectronic motion analysis system to evaluate body posture parameters. The mean, range and speed of the center of pressure (CoP) in both antero-posterior and medio-lateral axes as well as the ellipse area covered by 90% of CoP and free moment were calculated using a single force-plate. Results and discussionDifferences in body posture were only noted between the non-amputee and the transtibial groups. Transtibial amputees leaned more forwardly their trunk by 3.5° compared to able-bodied (p = 0.028). The mean CoP position in transfemoral amputees was closer to the non-amputated side than transtibial amputees (p = 0.034) and as compared to the dominant side in non-amputees (p = 0.042). Factor analysis revealed three postural performance modalities. Non-amputees postural performance was characterized solely by body posture parameters. Transfemoral amputees exclusively favored a modality associated with standing balance parameters, whereas transtibial amputees exhibited a mixed modality comprising a combination of postural and balance parameters. ConclusionThese findings support that the level of amputation is characterized by postural performance modalities different from non-amputees. Clinicians could apply this knowledge as part of their routine rehabilitation program to enhance postural and standing balance assessments in unilateral transfemoral and transtibial amputees.

Development of new cartilage lesions after ACL reconstruction is associated with abnormal knee rotation.

The purpose of this study is to examine the association between the development of articular cartilage pathology and knee rotation after single-bundle anterior cruciate ligament (ACL) reconstruction. Seventeen patients that underwent single-bundle ACL reconstruction and did not have any cartilage lesions at the time of surgery based on the Outerbridge classification or meniscal injury that required meniscectomy > 20% were examined by MRI and in the biomechanics laboratory at a 6-year minimum follow-up. Cartilage lesions that occurred after reconstruction were graded on MRI according to a modified Noyes scale. For cartilage evaluation, the lateral and medial femoral condyles were divided into 9 segments each (lateral, central, and medial third and each third was divided into anterior, central, and posterior segment). Tibial rotation during a pivoting task was measured with optoelectronic motion analysis system and side-to-side differences of tibial rotation between the reconstructed and contralateral intact knees were calculated. The association between the total modified Noyes scale score (outcome variable) and side-to-side differences of tibial rotation after controlling for meniscectomy and meniscal repair was investigated with hierarchical regression models. Side-to-side difference of tibial rotation was associated with total modified Noyes scale score (p = 0.015, β = 0.667, adjusted R2 = 42.1%). All patients developed new cartilage lesions in MRI located mainly at the central region of the lateral femoral condyle and less frequently in the central and anterior regions of the medial femoral condyle. Abnormally increased tibial rotation that persists after ACL-R is significantly associated with the development of new articular cartilage lesions at mean 8.4years after reconstruction which were located mainly at the central region of the LFC and secondarily in the central and anterior regions of the MFC (more superficial lesions). These findings suggest that there is emerging evidence that abnormal rotational kinematics is a potential risk factor for the pathogenesis and onset of posttraumatic articular cartilage degeneration after ACLR. IV.

Inertial Sensor-Based Motion Tracking in Football with Movement Intensity Quantification.

Inertial sensor-based measurements of lower body kinematics in football players may improve physical load estimates during training sessions and matches. However, the validity of inertial-based motion analysis systems is specific to both the type of movement and the intensity at which movements are executed. Importantly, such a system should be relatively simple, so it can easily be used in daily practice. This paper introduces an easy-to-use inertial-based motion analysis system and evaluates its validity using an optoelectronic motion analysis system as a gold standard. The system was validated in 11 football players for six different football specific movements that were executed at low, medium, and maximal intensity. Across all movements and intensities, the root mean square differences (means ± SD) for knee and hip flexion/extension angles were 5.3° ± 3.4° and 8.0° ± 3.5°, respectively, illustrating good validity with the gold standard. In addition, mean absolute flexion/extension angular velocities significantly differed between the three movement intensities. These results show the potential to use the inertial based motion analysis system in football practice to obtain lower body kinematics and to quantify movement intensity, which both may improve currently used physical load estimates of the players.

Gait parameters of individuals with Parkinson disease decline during one-year period

Parkinson’s disease (PD) is a neurodegenerative disease, influencing mainly elderly. The key motor factor affecting the level of participation in activities of daily living is the gait function, which is known to be progressively impaired in PD. However, gait characteristics also worsen due to normal aging. The main aim of this study was to investigate whether gait parameters decline in individuals with PD in an interval of one year compared to healthy elderly. Selected gait characteristics were recorded using 3-D optoelectronic movement analysis system ELITE in 13 patients with mild-to-moderate PD and 13 age- and gender-matched controls. Hoehn and Yahr Scale and Unified Parkinson Disease Rating Scale were used for clinical assessment. It was found that PD patients walk with significantly shorter steps and stride and reduced gait speed. In one year, the stride length initiated with right foot and stride walk ratio further decrease in PD patients. On re-evaluation the percentages of stance, swing and double support phase differed significantly between groups. In second measurement, control subjects walked with reduced step width. It was concluded that gait speed and stride length decline in patients with PD in a period of one year, whereas no indication of deterioration of gait function is evident in healthy controls.

Multi-segment foot kinematics during running and its association with striking patterns

ABSTRACT There is an ongoing debate regarding the advantages and harms of different running striking patterns. The purpose of this study was to explore the kinematic differences between running with a midfoot- and rearfoot striking (RFS) pattern. Multi-segment foot kinematics of 12 students were assessed while running barefoot at 3.3 m/s (±10%) using a passive optoelectronic motion analysis system. Participants performed multiple running trials while landing on the rearfoot and midfoot. Comparison of the kinematic waveforms was performed using one-dimensional statistical parametric mapping (1DSPM) (paired t-test). The inter-segment angle between the shank and calcaneus was found to be significantly more plantar-flexed, more inverted and more adducted in the midfoot striking (MFS) condition compared to the RFS pattern. The calcaneus-midfoot inter-segment angle was found to be more plantar-flexed in the MFS condition. The downward angulation of the metatarsals and the medial longitudinal arch angle in the late swing phase was found to be more pronounced during MFS. Differences between midfoot and RFS patterns occur in the first sub-phase of stance (0–50% of the stance phase). These findings may be of interest for the kinesiopathological or pathokinesiological reasoning processes when facing foot- and lower limb-related running injuries.

Optoelectronic measurement of wrist movements in various casts and orthoses used in scaphoid fractures.

We developed an optoelectronic motion analysis protocol to measure anatomical and functional ranges of wrist motion in Colles'-type and scaphoid-type splints and casts. The protocol was used to study the restriction of wrist motion in casts and splints in ten healthy volunteers. Scaphoid-type casts were no more restrictive to wrist motion than Colles'-type casts, but casts were significantly more restrictive than removable splints. Removable splints were more restrictive than no immobilization. Results suggest there is no benefit in using scaphoid-type casts rather than Colles'-type casts to reduce wrist motion.

Mobilization of the contralateral limb in Slump position: effects on knee extension in healthy adult subjects.

Background and aim: In the acute phase of neuropathic pain due to nerve root disorders, the neurodynamic approach proposes the mobilization of the contralateral limb to decrease the pain and increase the range of motion in the affected limb. The aim of this study was to evaluate the effect of the contralateral knee mobilization on the ipsilateral knee extension range of motion in Slump position in healthy adult subjects. Methods: Thirty-eight healthy subjects underwent a placebo, control and experimental manoeuvres that included a passive contralateral knee mobilization into extension. The knee, hip and cervical angles and distance between glabella and femoral condyle achieved in Slump test position were measured with an optoelectronic motion analysis system before and after each manoeuvre. Results: Experimental manoeuvre produced a statistically significant increase of the knee extension ROM when compared to the control (p=.017) and placebo (p=.007) manoeuvres. A significant increase of the hip angle and distance between glabella and femoral condyle was detected after the experimental manoeuvres (p<.001), but not after the placebo and control manoeuvres. Conclusions: The contralateral mobilization in Slump position increases the ipsilateral knee extension ROM. Further research is required to confirm that the knee increment ROM was due to the neural component. (www.actabiomedica.it)

Thoraco-abdominal asynchrony analysis using optoelectronic plethysmography in patients with cervical spinal cord injury

Patients with acute cervical spinal cord injury (CSCI) sometimes present paradoxical respiratory pattern, that is, the chest cage is displaced inward during inspiration. It is known as an example of thoraco-abdominal asynchrony which increases work of breathing. On the other hand, it is known that respiratory movement of such paralytic patients are influenced by position change. The aim of this study was to investigate thoraco-abdominal asynchrony and influence of posture on it in patients with chronic cervical spinal cord injury using optoelectronic plethysmography. Five patients with chronic CSCI (aged 42 ± 14, ASIA impairment scale classified into A in all patients, neurological level C4: 2, C5: 2, C8: 1) were recruited from outpatient clinic of regional rehabilitation center. As control group, 5 age-gender matched healthy subjects were recruited. Volume change of the rib cage and the abdomen were measured with 3 dimention optoelectronic motion analysis system (VICON MX, Motion Capture Systems, Oxford, UK), using 45 reflective markers on the chest wall monitored by 6 infrared cameras. The breath which showed maximum volume change among 3 deep breaths was sampled for analysis in each patient. Measurement was done in the supine position and 30 and 60 degrees head elevation position. With obtained volume change of rib cage and abdomen, Konno Mead Diagram was drawn for each sample. Then we calculated the phase shift angle. The phase shift angle was 47 ± 2 degrees for the patients and 9 ± 6 degrees for healthy controls in supine position, that is, the CSCI patients group showed larger abdominal contribution. The angle tended to increase as head elevation in both groups. Patients with chronic CSCI showed larger asynchrony than healthy controls. Asynchrony tended to increase with head raising in both CSCI patients and controls.

Validation of an inertial measurement unit for the quantification of rearfoot kinematics during running

BackgroundThe popular protocol used to study running motion suffers from problems that lead to a limited ability to generalize the obtained results. Inertial measurement units (IMU) appear to be promising in increasing ecological validity of the collected data. However, quantifying running kinematics utilizing IMU signals is complex and potentially affected by several well-established and less well-known errors. Research questionThe purpose of this study was to examine the validity of kinematic variables obtained from a single, shoe-mounted IMU using an opto-electronic motion analysis reference system. Methods51 recreational runners were analyzed, performing a single continuous run at three different speeds (10, 12, 15 km/h) on a treadmill. Descriptive statistics (Bland & Altman analysis, box plots, scatter plots) were employed to analyze the agreement between the two instruments. ResultsThe findings of this study revealed considerable systematic and large random disagreement, which, in turn, is characterized by substantial inter-individual differences in the error distribution. These discrepancies may partly be explained by differences in foot strike behavior, resulting in varying degrees of vibration impact acting on the IMU. SignificanceAdvances in IMU technology, as well as exploring new application approaches and signal processing strategies, might enhance the usability of IMUs in analyzing running kinematics.

3D Sequential Kinematics of the Femoro-Tibial Joint of Normal Knee from Multiple Bi-planar X-rays: Accuracy and Repeatability

BackgroundSeveral methods can be used to assess joint kinematics going from optoelectronic motion analysis to biplanar fluoroscopy. The aim of the present work was to evaluate the reliability of the use of biplane radiography to quantify the sequential 3D kinematics of the femoro-tibial joint. MethodsBi-planar X-rays (EOS imaging) of 12 lower limbs (6 specimens in vitro and 6 subjects in vivo) were taken for various knee flexion angles. 3D personalized models of the femur and the tibia were registered on each pair of views. To quantify the bias, the kinematic parameters calculated from the registered models were compared to those obtained from the tripods embedded in the specimens. Intra and inter-operator repeatability of each parameter were assessed from the registrations made by 3 operators in vivo. ResultsIn vitro, the bias of the tibia pose estimation obtained from the registration method was inferior to 1.6 mm and 0.4°. In vivo, the repeatability of the sequential kinematic parameters was inferior to 0.3°, 2.1° and 1.8°, for respectively flexion, varus-valgus and medial-lateral rotation and inferior to 1.8 mm for translations. ConclusionCompared to simple fluoroscopy, the accuracy of our method based on sequential images was of the same order of magnitude, with better results for the translation in the frontal plane. The low dose of radiation of the EOS system offers promising prospects for a clinical use of this method to assess the femoro-tibial sequential kinematics.

Biomechanical characterization of slope walking using musculoskeletal model simulation.

Upslope and downslope walking are basic activities necessary for normal daily living in community, and they impose greater joint load on the lower extremities than during level walking. Thus, the purpose of this study was to quantify the resultant and shear forces in the hip and knee joints during slope walking. Twelve healthy volunteers were evaluated when walking under level and 10° up- and downslope conditions. Three-dimensional gait analysis was conducted using a 7-camera optoelectronic motion analysis system combined with a force plate to measure ground reactive force. Joint forces in the hip and knee joints were estimated using musculoskeletal model simulation. Results showed that the resultant hip force was increased significantly to 117.2% and 126.9%, and the resultant knee force was increased to 133.5% and 144.5% in up- and downslope walking, respectively, compared to that of level walking. Furthermore, increased shear force in the hip and knee joints was noted during both slope walking conditions. This information may be beneficial for therapists advising elderly people or patients with osteoarthrosis on an appropriate gait pattern, gait assistive devices, or orthoses according to their living environment.

Identification of specific gait patterns in patients with cerebellar ataxia, spastic paraplegia, and Parkinson’s disease: A non-hierarchical cluster analysis

BackgroundPatients with degenerative neurological diseases such as cerebellar ataxia, spastic paraplegia, and Parkinson’s disease often display progressive gait function decline that inexorably impacts their autonomy and quality of life. Therefore, considering the related social and economic costs, one of the most important areas of intervention in neurorehabilitation should be the treatment of gait abnormalities. This study aims to determine whether an entire dataset of gait parameters recorded in patients with degenerative neurological diseases can be clustered into homogeneous groups distinct from each other and from healthy subjects. Patients affected by three different types of primary degenerative neurological diseases were studied. These diseases were: i) cerebellar ataxia (28 patients), ii) hereditary spastic paraplegia (31 patients), and iii) Parkinson’s disease (70 patients). Sixty-five gender-age-matched healthy subjects were enrolled as a control group. An optoelectronic motion analysis system was used to measure time-distance parameters and lower limb joint kinematics during gait in both patients and healthy controls. When clustering single parameters, step width and ankle joint range of motion (RoM) in the sagittal plane differentiated cerebellar ataxia group from the other groups. When clustering sets of two, three, or four parameters, several pairs, triples, and quadruples of clusters differentiated the cerebellar ataxia group from the other groups. Interestingly, the ankle joint RoM parameter was present in 100% of the clusters and the step width in approximately 50% of clusters. In addition, in almost all clusters, patients with cerebellar ataxia showed the lowest ankle joint RoM and the largest step width values compared to healthy controls, patients with hereditary spastic paraplegia, and Parkinson’s disease subjects. This study identified several clusters reflecting specific gait patterns in patients with degenerative neurological diseases. In particular, the specific gait pattern formed by the increased step width, reduced ankle joint RoM, and increased gait variability, can differentiate patients with cerebellar ataxia from healthy subjects and patients with spastic paraplegia or Parkinson’s disease. These abnormal parameters may be adopted as sensitive tools for evaluating the effect of pharmacological and rehabilitative treatments.