Temporal-spatial Parameters Research Articles

Is BDNF related to spatial-temporal gait parameters in people with multiple sclerosis? An observational study

BackgroundIt has been suggested that the protein Brain-derived Neurotrophic Factor (BDNF) plays a neuroprotective role in people with multiple sclerosis (pwMS). Also, BDNF seems to play a role in cognition performance. In the same line, gait in pwMS requires a higher cognitive resource, mainly during complex walking. Thus, maybe BDNF could be related to gait in pwMS. ObjectiveTo investigate the relationship between BDNF and gait spatial-temporal parameters during unobstructed and obstructed conditions and the Timed Up and Go (TUG) in pwMS and healthy controls (HC). MethodsThe study included 20 pwMS (11F/9M, 33.1±7.5 years, Expanded Disability Status Scale- EDSS 2.2±1.2) and 18 HC (13F/5M, 35.5±5.9 years). Both groups performed 20 gait attempts in two conditions: unobstructed walking (10 trials) and avoiding an obstacle. The obstacle was 15 cm in height and made of foam material. The BDNF serum concentration was collected with participants in fasting and completed before the clinical, gait, and mobility assessments. Clinical variables included the Symbol Digit Modality Test (SDMT), the Fatigue Severity Scale (FSS), and the International Physical Activity Questionnaire (IPAQ- short version). Associations between BDNF and spatial-temporal gait parameters, clinical variables, and TUG were determined by Pearson/Spearman correlations with Bonferroni's correction being applied (p<0.0013). Gait was compared by a two-way, repeated-measures ANOVA (group and condition) to characterize our cohort. ResultsReduced BDNF was observed for pwMS (41.66±4.45 ng/ml) in comparison with HC (61.67±7.07, p<0.001). However, although some correlations presented a moderate correlation between BDNF with gait variables, the correlations didn't reach a significant p-value after Bonferroni's correction. Lastly, pwMS presented shorter step length and slower step velocity for both gait conditions, with more evidence for obstacle conditions. Only pwMS changed gait behavior from unobstructed walking to obstacle avoidance conditions (i.e., reduced step length and velocity and increased step duration). ConclusionBDNF is not related to either clinical (i.e., EDSS, SDMT, FSS, or IPAQ) or gait parameters in pwMS and HC, even in a condition involving higher cognitive demand. These results may suggest that BDNF does not play a role in these parameters' performance.

Cross slope gait biomechanics for individuals with and without a unilateral transtibial amputation

BackgroundThis research was conducted to better understand compensatory strategies during cross-slope walking for adults with and without a unilateral transtibial amputation. MethodsFourteen individuals with unilateral transtibial amputation and 14 individuals with no lower limb amputation participated in this study. Motion and force data were captured while participants walked on a treadmill in a virtual reality environment for level and ± 5° cross slopes. Temporal-spatial parameters, kinematics (ankle, knee, hip, pelvis, trunk), and ground reaction forces were examined. FindingsCompared to level, participants had similar step width but slightly longer steps for top-cross-slope and slightly shorter steps for bottom-cross-slope. Top-cross-slope required a more flexed limb with ankle eversion, and bottom-cross-slope required a more extended limb with ankle inversion. Participants had similar lateral pelvis and trunk motion for all walking conditions, but slightly more anterior trunk lean for top cross-slope with more anterior trunk lean observed for individuals with a lower limb amputation than without lower limb amputation. Participants with a lower limb amputation compensated for limited prosthetic ankle-foot dorsiflexion on the top-cross-slope by increasing prosthetic side hip flexion, reducing intact ankle/knee flexion, and increasing intact push-off force. InterpretationGait adaptations during cross-slope walking were primarily in the lower extremities and were largely similar for those with and without a transtibial amputation. The information presented in this paper provides a better understanding of gait strategies adopted during cross-slope walking and can guide researchers and industry in prosthetic development.

Clinical assessments and gait analysis for patients with Trimalleolar fractures in the early postoperative period

BackgroundTrimalleolar fracture is a common ankle fracture with serious complications and costly healthcare problem. Most studies used clinical assessments to evaluate the functional status of the patients. Although clinical assessments are valid, they are static and subjective. Dynamic, objective and precise evaluations such as gait analysis are needed. Ankle biomechanics studies on gait in patients with trimalleolar fractures are still rare. This study aimed to investigate the clinical outcomes and gait biomechanics in patients with trimalleolar fractures in the early postoperative period and compared to healthy controls.MethodsThis was a cross-sectional study. 12 patients with trimalleolar fractures were recruited, and 12 healthy people served as controls. All patients underwent clinical assessments: Olerud and Molander ankle score (OMAS), ankle swelling and passive range of motion (ROM) of ankle, and completed gait biomechanical analysis when weight-bearing was allowed: temporal-spatial parameters, plantar pressure distributions, and surface electromyography (sEMG). The control group only performed gait test.ResultsPatients had poor outcomes of clinical assessments in the short-term. During gait analysis, patients presented compromised gait patterns: shorter step length, larger step width, slower walking speed and shorter single support compared to healthy controls (P < 0.001), and patients showed asymmetrical gait. Symmetry index of step width and walking speed were mainly correlated with the difference of ankle inversion ROM between two sides (R = -0.750, P = 0.005; R = -0.700, P = 0.011). During walking, patients showed abnormal dynamic plantar pressure features (mainly in the hindfoot and forefoot regions), and the IEMG (integrated electromyography) of tibial anterior muscle (TA) and peroneal longus muscle (PL) were larger than healthy controls (P = 0.002, 0.050).ConclusionsPatients with trimalleolar fractures showed physical impairments of the ankle, and presented altered gait parameters compared to healthy subjects in the short-term. The ankle stability of patients declined, and deficits in TA and PL muscle ability might contribute to it. Restoring complete muscle functions and improving passive ankle ROM are significant to promote the recovery of a normal gait pattern.

Interplay between gait and neuropsychiatric symptoms in Parkinson's Disease.

Parkinson’s Disease (PD) is a neurodegenerative disease which involves both motor and non-motor symptoms. Non-motor mental symptoms are very common among patients with PD since the earliest stage. In this context, gait analysis allows to detect quantitative gait variables to distinguish patients affected by non-motor mental symptoms from patients without these symptoms. A cohort of 68 PD subjects (divided in two groups) was acquired through gait analysis (single and double task) and spatial temporal parameters were analysed; first with a statistical analysis and then with a machine learning (ML) approach. Single-task variables showed that 9 out of 16 spatial temporal features were statistically significant for the univariate statistical analysis (p-value< 0.05). Indeed, a statistically significant difference was found in stance phase (p-value=0.032), swing phase (p-value=0.042) and cycle length (p-value=0.03) of the dual task. The ML results confirmed the statistical analysis, in particular, the Decision Tree classifier showed the highest accuracy (80.9%) and also the highest scores in terms of specificity and precision. Our findings indicate that patients with non-motor mental symptoms display a worse gait pattern, mainly dominated by increased slowness and dynamic instability.

Spre-Pubertal Runners Demonstrate Different Temporal-Spatial Parameters Than Mid- and Post-Pubertal Runners

Background:Temporal-spatial parameters (TSPs; e.g., cadence, step length) have been associated with running-related injuries in adult long-distance runners. However, it is unknown if TSPs are different among adolescent runners of different physical maturation stages. During sprinting, pre-pubertal runners demonstrated lower cadence and shorter step length than mid- and post-pubertal runners, but TSPs have not been investigated for adolescents of different physical maturation stages when running at submaximal speeds.Hypothesis/Purpose:The purpose of this study was to compare TSPs among adolescent long-distance runners of different physical maturation stages. It was expected that pre-pubertal runners would demonstrate a lower cadence and shorter step length than mid- and post-pubertal runners but there would be no differences in TSPs between mid- and post-pubertal runners.Methods:The study was a cross-sectional design with 93 adolescent long-distance runners (F=48, M=45). Participants were categorized into pre- (n=15, age=10.3±1.6 y), mid- (n=35, age=13.0±1.1 y), and post-pubertal (n=43, age=16.4±1.2 y) physical maturation groups. Participants underwent a three-dimensional running analysis at a comfortable self-selected speed. TSPs (cadence [steps/min], step length [m]) were compared among physical maturation groups using one-way ANCOVA (covariate=running speed) with Sidak pairwise comparisons when a main effect was found (P<.05).Results:The average running speeds for pre-, mid-, and post-pubertal runners were 3.36±0.51 m/s, 3.49±0.71 m/s, and 3.79±0.69 m/s, respectively. ANCOVA analysis showed significant differences in cadence (P<.001) and stride length (P<.001) among physical maturation groups when controlling for running speed (Table 1.1). Pre-pubertal runners had a greater cadence (178±13 steps/min) than mid- (169±12 steps/min, P=.01) and post-pubertal runners (168±11 steps/min, P<.001). Pre-pubertal runners also had a shorter step length (1.13±0.20 m) than mid- (1.24±0.20 m, P=.01) and post-pubertal runners (1.36±0.21 m, P<.001). There were no significant differences between mid- and post-pubertal runners (P>.22).Conclusion:When controlling for running speed, pre-pubertal runners demonstrated a greater cadence and shorter step length than both mid- and post-pubertal runners. Lower cadence and longer stride lengths have been associated with running-related injuries in adults. If TSPs have the same association with injury in adolescents as adults, then our study suggest mid- and post-pubertal runners may be at a higher risk of sustaining a running-related injury than pre-pubertal runners due to their lower cadence and longer step lengths. However, prospective research is necessary to better understand the importance of TSPs and running-related injuries in adolescent long-distance runners.Table 1.Temporal-spatial parameters comparison among adolescent long-distance runners of different physical maturation stages.

Establishing Normative Data for the Number Cancelation Test Among Children in Kindergartens and Primary Schools in China.

This study aimed to suggest an attention assessment tool using a Digital Pen for measuring the temporal-spatial parameters during the Number Cancelation Test (NCT), and then to establish the normative data for the NCT among children in kindergartens and primary schools in China by recruiting a total of 989 children (496 males). Four measures, i.e., selective attention (SA), speed of cognitive processing (SpC), averaged time of circlings (ATC), and averaged circumference of circled curves (ACCC), were proposed to evaluate the NCT performance. They basically have a development trend with fast speed in the beginning before Grade 1 or 2 of primary schools, and then enter an extremely slow development period (with ceiling or floor effect). SA and SpC have gender and grade main effects, while ATC and ACCC have the grade main effect, only. In particular, females have higher SA scores than males in middle class of kindergarten, and Grade 2–Grade 5 of primary school, but no gender differences in other grades; females have higher SpC scores than males in middle class of kindergarten, and Grade 3–4 of primary school, but no gender differences in other grades. More importantly, in clinical practice, if SA or SpC measure of a child is below than the 5th centile (i.e., p5 level) of his/her grade-specific normative data, then this child may be predicted to have a high-risk of learning disabilities. Findings suggest that the proposed method can be used for early screening of learning disabilities by setting appropriate cut-off values.

Neuromuscular response to the stimulation of plantar cutaneous during walking at different speeds.

BackgroundA lot of authors have been studied the consequence of postural control strategies through investigating the effects of foot-surface contact. In this context an important variable of textured surfaces or insoles could be related to material stiffness. We apply a particular textured insoles to evaluate neuromuscular response of plantar stimulation during walking. Research question: Could textured insoles alter the human locomotion during walking at different speeds? Methods: Ten adults (age: 27 ± 5 years) completed three trials on the multifunction treadmill at 0.42 ms-1, 0.89 ms-1, and 1.5 ms-1 walking speed. Temporal-spatial parameters, gait line, and kinetic parameters were analyzed. The Co-Contraction Index (CCI) and electromyography (EMG) of the right leg muscles were assessed during four phases of gait: first half stance (FHS), half stance (HS), second half stance (SHS), swing phase (SP). Textured insole and soft control insole were worn while walking. Results: Plantar stimulation improved cadence, stride time, stride length and gait line parameters with increasing speed. First force peaks and maximum force forefoot were always significant. The maximum force midfoot was significant at 0.42 and 0.89 ms-1. The maximum force heel only was significant in lower velocity. The maximum pressure showed different significant values except for the heel. Significant differences in the CCI were always found in the FHS and SHS for the plantar muscles, and in the FHS and HS for the knee muscles. The differences in gait analysis in biomechanical and in electromyographic parameters were more significant in the higher speed tested. Significance: The perception of shape and texture through its linear response to skin deformation over a wide range of deformations could be the reason why the significant differences increase in the higher speed. In conclusion, sensory interventions fallowing appropriate insoles can influence significantly gait. Walking strategy positively adjusts locomotion with high efficiency.

IDF21-0164 Effect of stimulating footwear on gait and posture in people with Diabetes and foot complications

Background: The maintenance of human posture and gait requires the central integration of afferent information and is highly dependent on the somatosensory information from the plantar cutaneous mechanoreceptors. Normal foot structure sends undistorted signals to the brain due to the proper stimulation of mechanoreceptors in the foot soles and therefore brain responds properly by adjusting the skeletal framework into good posture. In the case of abnormal foot structure, the brain receives distorted signals due to poor stimulation of mechanoreceptors. As a result, the brain generates alternate signals to deal with these abnormalities, resulting in poor gait and posture. Aim: The main intention of this study was to develop a new footwear with ultrasonic sensors that emit ultrasonic waves at a lower frequency of 35 kHz to properly stimulate plantar mechanoreceptors. The objective of this study was to evaluate the effect of the above footwear on gait and posture of people with diabetic neuropathy, with foot deformity (bow knee, bilateral genu valgum, leg length discrepancy, abnormal foot arch) and also with foot and/or joint discomfort after 15days of wearing it for 10minutes each day. Method: A total of 5 (3 men and 2 women) subjects volunteered for this study. Informed consent was obtained from each participant. Subjects were prepared using a specialized wireless inertial sensor as per the protocol and were asked to walk freely on the sensorized platform for measuring their plantar pressure and also their spatial temporal parameters. Data was captured using Plantar pressure measuring device and wearable inertial system (BTSBioengineering, Italy). For data analysis, three trials were recorded. A single best trial was selected for processing and reporting. After completion of the initial assessment, subjects were asked to wear the test footwear as a therapy for 10 minutes every day for 15 days. When the switch is on the sensors will emit ultrasound at a frequency of 35 kHz. Following the completion of the 15-days, the subjects were re-evaluated using plantar pressure measuring device and wearable inertial system. Then a comparison was made between the data collected before and after therapy. Results: See Table 1 and Table 2.Table 1Results of Spatial temporal data before and after the therapy. Open table in a new tab Table 2Results of Plantar pressure data before and after the therapy. Open table in a new tab Discussion: The spatiotemporal data, in Table 1, shows a considerable improvement after using the developed footwear. There was a considerable decrease in double limb support time and increase in single limb support, indicating that the subject was able to minimize the contact time of the foot during walking which significantly minimizes foot plantar pressure loading which is the precursor of diabetic foot ulcer. Also, there was a significant increase in cadence and gait velocity after completion of therapy. The plantar pressure data, in Table 2, indicates an increase in the foot contact area which significantly improve the foot pressure distribution, leads to reduction in peak plantar pressure. Also, there was a shift in the maximum pressure from lateral foot to medial foot which shows the distribution of body weight shifted from lateral to medial which is the sign for good posture.

Postural Balance and Gait Parameters of Independent Older Adults: A Sex Difference Analysis.

Postural balance and gait are important factors in the functional status of older people; however, few studies have addressed differences by sex. The objective of this study was to analyze the postural balance and temporal–spatial parameters of gait in independent older adults by sex. A cross-sectional study was conducted. Thirty-eight independent older women (69 ± 5 years), and 33 men (71 ± 5 years) were evaluated. The postural balance test with open and closed eyes was performed on two surfaces (hard/soft) on a force platform. Gait was recorded with cameras to analyze cycle duration and speed, step length, stride length, and foot clearance. The area of postural balance was greater in men in all tests (p < 0.001). Foot clearance height and cycle duration were lower in women (p < 0.05). Men showed a negative correlation between the area of balance and gait parameters. In women, a positive correlation was observed between foot clearance and balance with eyes closed. The postural balance and gait suggest discrepancies by sex, showing that older men behave differently according to the requirement of the motor task compared to women. These findings suggest being corroborated in more complex studies in the future.

Influence of hamstring flexibility on running kinematics in adolescent long-distance runners

BackgroundStudies have found no or minimal differences in running kinematics between flexible and inflexible adult runners. The interaction between hamstring flexibility and running kinematics has not been reported in adolescent long-distance runners. Research questionDoes hamstring flexibility influence running kinematics in adolescent long-distance runners? MethodsAdolescent long-distance runners (n = 140, ages 9–19) were enrolled in our cross-sectional study. Hamstring flexibility was assessed with the forward bending Beighton task. Runners were categorized if they tested positive or negative on the forward bending task. Participants ran at a comfortable self-selected speed on a treadmill. Runners who tested positive on the forward bending task (n = 17) were matched with runners who tested negative on the task (n = 17) according to sex, physical maturation, and running speed. Statistical parametric mapping compared trunk, pelvis, hip, and knee kinematic waveforms throughout the gait cycle and independent sample t tests compared temporal-spatial parameters between the groups. ResultsRunners who tested positive on the forward bending task demonstrated significantly greater anterior pelvic tilt during stance (average difference = 4.8° ± 0.4°, p < .001) and swing (average difference = 4.3° ± 0.2°, p < .01) compared to runners who tested negative on the forward bending task. No significant differences were found between groups for the remaining kinematic waveforms or for any temporal-spatial parameters (p > .05). SignificanceThis is the first study to report the interaction between hamstring flexibility and running kinematics in adolescent long-distance runners. The greater anterior pelvic tilt demonstrated by runners with greater hamstring flexibility may place more eccentric demands on the hamstring musculature. However, as there were no other differences in joint kinematics or temporal-spatial parameters between groups, greater hamstring flexibility does not appear to have a significant interaction with running kinematics when running at sub-maximal speeds. Our results suggest hamstring flexibility does not predispose adolescent long-distance runners to sub-optimal segment positions associated with running-related injuries.

Spatial-temporal parameters, pelvic and lower limb movements during gait in individuals with reduced passive ankle dorsiflexion

BackgroundProper ankle dorsiflexion range of motion (ADF-ROM) allows the anterior roll of the tibia relative to the foot during the midstance phase of gait, which contributes to forward movement of the body. Individuals with reduced passive ADF-ROM may present altered movement patterns during gait due to an inefficient anterior tibial roll over the support foot during the stance phase.Research question: What is the influence of reduced passive ADF-ROM on the pelvic and lower limb movements and spatiotemporal parameters during gait? MethodThirty-two participants divided into two groups according to the degree of passive ADF-ROM—less than 10° (lower ADF-ROM group) or greater than 15° (higher ADF-ROM group) —were subjected to gait assessment using a three-dimensional motion analysis system. Independent t-tests were used to compare the pelvic and lower limb movements and spatiotemporal gait parameters between the groups on this cross-sectional study. ResultsThe lower ADF-ROM group had shorter step length, lower peak of pelvic ipsilateral rotation angle, and lower hip and knee maximum flexion angles in the stance phase (p < 0.05). In addition, the peaks of the ankle and forefoot-rearfoot dorsiflexion angles were smaller in the reduced ADF-ROM group (p < 0.05). The between-group differences presented effect sizes varying from moderate to large. SignificanceIndividuals with reduced passive ADF-ROM presented reduced foot and ankle dorsiflexion, knee and hip flexion, and pelvis rotation movements and shorter step length during gait. However, no differences in foot pronation were noted between groups. Therefore, individuals with reduced passive ADF-ROM present alterations in the lower limb and pelvic movements during gait.

Effect of electroacupuncture on motor function and gait in patients with post-stroke spasticity in lower limbs

To observe the effect on motor function, spasticity degree, muscle strength and the relevant parameters of three-dimensional gait analysis in the patients with post-stroke spasticity in the lower limbs treated with the combined therapy of electroacupuncture (EA) and muscle electricity biofeedback or the simple muscle electricity biofeedback therapy on the base of rehabilitation medicine. A total of 60 patients with post-stroke spasticity in the lower limbs were randomized into an EA + biofeedback group, a biofeedback group and a rehabilitation group, 20 cases in each one. In the rehabilitation group, the basic rehabilitation training was provided, 45 min each time. In the biofeedback group, on the base of the treatment as the rehabilitation group, the biofeedback therapy was added, 30 min each time. In the EA + biofeedback group, besides the treatment as the biofeedback group, acupuncture was supplemented at Futu (ST 32), Liangqiu (ST 34), Zusanli (ST 36) and Fenglong (ST 40), etc, and EA was applid at Zusanli (ST 36) and Taichong (LR 3) with continuous wave and 5 Hz in frequency. In each group, the treatment was given once daily, 5 times a week, for 6 weeks totally. Separately, before and after treatment, the score of Fugle-Meyer assessment (FMA), the score of clinical spasticity index (CSI) in the lower limbs and the strength of the anterior tibial muscle on the affected side were assessed, and the spatial-temporal parameters (step frequency and steep speed) in the three-dimensional gait analysis and the kinematic parameters (maximum dorsal flexion and maximum plantar flexion of ankle joint on the affected side) were measured in the patients of three groups. After treatment, FMA score was increased as compared with that before treatment in all of three groups (P<0.05). FMA score in the EA + biofeedback group and the biofeedback group was higher than the rehabilitation group respectively (P<0.05). CSI score in the EA + biofeedback group and the biofeedback group was lower than that before treatment respectively (P<0.05), and lower than the rehabilitation group (P<0.05). After treatment, the step frequency and speed were all improved and the angles of maximum dorsal flexion and maximum plantar flexion of ankle joint on the affected side were all increased as compared with those before treatment in the patients of three groups separately (P<0.05). The step frequency and speed, as well as the angles of maximum dorsal flexion and maximum plantar flexion of ankle joint on the affected side in either the EA + biofeedback group or the biofeedback group were all higher than the rehabilitation group (P<0.05), and the step speed in the EA + biofeedback group was higher than the biofeedback group (P<0.05). After treatment, the strength of the anterior tibial muscle on the affected side was increased as compared with that before treatment in the patients of each group (P<0.05); and the strength of the anterior tibial muscle in the EA + biofeedback group and the biofeedback group was larger than the rehabilitation group (P<0.05). On the base of rehabilitation treatment, the combined regimen of EA and muscle electricity biofeedback therapy and the simple muscle electricity biofeedback therapy all effectively strengthen the motor functions and reduce spasticity as well as improve step frequency, step speed and the range of motion of ankle joint in the patients with post-stroke spasticity in the lower limbs. Regarding the gait improvement, the combined regimen of EA and muscle electricity biofeedback is better than the simple muscle electricity biofeedback.

Sensor Combination Selection for Human Gait Phase Segmentation Based on Lower Limb Motion Capture With Body Sensor Network

Gait phase contains rich kinematic information of lower limbs, which has great reference significance for rehabilitation medicine, assistive design and identity recognition, etc. This research presents a wearable gait phase segmentation method based on lower limb motion capture technique. In our method, a body sensor network covering the whole lower limbs was established to capture the motion data of human gait, and a 3-D lower limb dynamic model is created to reconstruct lower limb movements through multi-sensor data fusion. Six gait events are labeled by the lower limb dynamic model. Then, a deep classification network combining (temporal convolutional network) TCN and long-short-term memory (LSTM) is proposed to segment the six gait phases as pattern classification. In addition, different sensor combinations for gait phase segmentation were also evaluated to select optimal sensor layouts. Detection performance is evaluated using metrics of accuracy, specificity, recall and F1 score, and the averaged performance values are 98.9%, 98.9%, 98.8% and 98.9%, respectively. The overall experimental results demonstrate that our proposed method can well address the issue of gait phase segmentation and provide spatial-temporal parameters for further gait analysis.

Intelligent Gait Analysis and Evaluation System Based on Cane Robot.

Gait analysis and evaluation are vital for disease diagnosis and rehabilitation. Current gait analysis technologies require wearable devices or high-resolution vision systems within a limited usage space. To facilitate gait analysis and quantitative walking-ability evaluation in daily environments without using wearable devices, a mobile gait analysis and evaluation system is proposed based on a cane robot. Two laser range finders (LRFs) are mounted to obtain the leg motion data. An effective high-dimensional Takagi-Sugeno-Kang (HTSK) fuzzy system, which is suitable for high-dimensional data by solving the saturation problem caused by softmax function in defuzzification, is proposed to recognize the walking states using only the motion data acquired from LRFs. The gait spatial-temporal parameters are then extracted based on the gait cycle segmented by different walking states. Besides, a quantitative walking-ability evaluation index is proposed in terms of the conventional Tinetti scale. The plantar pressure sensing system records the walking states to label training data sets. Experiments were conducted with seven healthy subjects and four patients. Compared with five classical classification algorithms, the proposed method achieves the average accuracy rate of 96.57%, which is improved more than 10%, compared with conventional Takagi-Sugeno-Kang (TSK) fuzzy system. Compared with the gait parameters extracted by the motion capture system OptiTrack, the average errors of step length and gait cycle are only 0.02 m and 1.23 s, respectively. The comparison between the evaluation results of the robot system and the scores given by the physician also validates that the proposed method can effectively evaluate the walking ability.

Effects on Gait Depending on the Wearing of Custom Insoles for Patients with Gross Motor Function Classification System level I and II

The purpose of this study was to determine the effect on the temporal-spatial parameters and timed up and go tests with or without customized insoles for spastic cerebral palsy with Gross Motor Function Classification System (GMFCS) leves (I and II). GAITRite system was measured to temporal-spatial gait pareameters and gait speed were measured with time up and go test (TUG). Participants were 19 subjects diagnosed cerebral palsy and the statistical method was paired t-test. The results showed a significant decrease in walking tests after wearing before wearing the insole, and significant changes velocity, TUG, step length, stride length, single support Rt, double support, stance Lt (p< 0.05), but step time, cycle time, single support Lt, stance Rt did no differ significantly (p> 0.05). As a result, if a significant change occurs in the walking speed, temporal-spatial parameters and the difficulty of walking due to various foot deformations, it has a positive effect on walking by wearing a patient-specific insole.

Bilateral Asymmetry in Balance Control During Gait in Children with Treated Unilateral Developmental Dysplasia of the Hip

About 1% of the newborn population has developmental dysplasia of the hip (DDH), altering joint biomechanics, gait performance and balance control. Pemberton's osteotomy is used in early treatment but it remains unclear whether it will help the patient regain normal balance control during gait. The current study aimed to identify the changes of the whole-body balance control during level walking in children treated for unilateral DDH during toddlerhood, in terms of inclination angles (IA) of the line joining the body's center of mass (COM) and center of pressure (COP), and the rate of change of IA (RCIA). Twelve girls (DDH group; age: 7.1±2.1 years) who had been treated with Pemberton's osteotomy for unilateral DDH during toddlerhood and twelve healthy controls (Control group; age: 7.6±2.1 years) walked at their preferred walking speed while IA, RCIA and temporal-spatial parameters were calculated from measured kinematic and forceplate data, and were compared using independent t-tests. Compared to the Control group, the DDH group showed significantly decreased sagittal IA (p=0.042) but increased range of sagittal RCIA during SLS on the unaffected side (p=0.006), and increased peak sagittal RCIA during DLS (p<0.008). In the frontal plane, the altered COM-COP control occurred mainly during stance phase of the affected side, showing a decreased range of RCIA during SLS (p=0.033) followed by decreased IA (p=0.045) with an increased peak value of RCIA (p=0.023) during terminal DLS. The children with treated unilateral DDH showed compromised, bilaterally different balance control strategies with altered COM-COP control during gait, not only during stance in the frontal plane as expected, but even more so during swing in the sagittal plane. It is thus suggested that routine assessment of the morphological changes and/or altered balance control of both the unaffected and affected hips is equally important for early identification of any signs of insidious hip problems, deteriorating balance control or increased risk of loss of balance.

Percutaneous hamstring lengthening in cerebral palsy: Technique and gait outcomes based on GMFCS level

BackgroundIncreased knee flexion at initial contact and in stance is a common problem for children with cerebral palsy. Surgical correction with percutaneous hamstring lengthening is an alternative to open hamstring lengthening; however, outcomes are less well documented, and there is concern about increasing anterior pelvic tilt. The purpose of this study was to evaluate the short-term outcomes of percutaneous hamstring lengthenings in children with cerebral palsy using comprehensive gait analysis techniques. Research QuestionDoes percutaneous hamstring lengthening improve knee function, and do knee and anterior pelvic tilt outcomes vary by GMFCS level? MethodsA convenience sample of 52 patients with both pre and post-surgical gait analyses was evaluated retrospectively for changes in gait function in terms of temporal-spatial parameters, kinematics and kinetics. Patients were divided into two GMFCS subgroups: GMFCS level I/II and III. ResultsThe percutaneous hamstring lengthening results in statistically significant improvements in knee function during gait with increased knee extension at initial contact (mean 32° SD 13° to mean 21° SD 11°, p = 0.000) and improved mean knee flexion in stance (mean 23° SD 12° to mean 16° SD 11°, p = 0.000) for the total study cohort. Beneficial changes were found for knee function in both GMFCS level subgroups; however, there was an increase in pelvic tilt pre to post-surgery in the GMFCS level III subgroup (mean 21° SD 8° to mean 26° SD 6°, p = 0.012) but not the GMFCS level I/II subgroup (mean 18° SD 7° to mean 20° SD 8°, p = 0.427). SignificancePercutaneous hamstring lengthening can improve knee function for all patients; however, the impact on anterior pelvic tilt varies by GMFCS level, with increasing anterior tilt for GMFCS level III only. This study highlights the importance of understanding differences in surgical outcomes by GMFCS level to better predict post-surgical function.

Effects of Ankle Foot Orthoses on the Gait Patterns in Children with Spastic Bilateral Cerebral Palsy: A Scoping Review.

Background: Cerebral palsy (CP) is the most common cause of motor disability in children and can cause severe gait deviations. The sagittal gait patterns classification for children with bilateral CP is an important guideline for the planning of the rehabilitation process. Ankle foot orthoses should improve the biomechanical parameters of pathological gait in the sagittal plane. Methods: A systematic search of the literature was conducted to identify randomized controlled trials (RCT) and controlled clinical trials (CCT) which measured the effect of ankle foot orthoses (AFO) on the gait of children with spastic bilateral CP, with kinetic, kinematic, and functional outcomes. Five databases (Pubmed, Scopus, ISI Web of SCIENCE, SciELO, and Cochrane Library) were searched before February 2020. The PEDro Score was used to assess the methodological quality of the selected studies and alignment with the Cochrane approach was also reviewed. Prospero registration number: CRD42018102670. Results: We included 10 studies considering a total of 285 children with spastic bilateral CP. None of the studies had a PEDro score below 4/10, including five RCTs. We identified five different types of AFO (solid; dynamic; hinged; ground reaction; posterior leaf spring) used across all studies. Only two studies referred to a classification for gait patterns. Across the different outcomes, significant differences were found in walking speed, stride length and cadence, range of motion, ground force reaction and joint moments, as well as functional scores, while wearing AFO. Conclusions: Overall, the use of AFO in children with spastic bilateral CP minimizes the impact of pathological gait, consistently improving some kinematic, kinetic, and spatial-temporal parameters, and making their gait closer to that of typically developing children. Creating a standardized protocol for future studies involving AFO would facilitate the reporting of new scientific data and help clinicians use their clinical reasoning skills to recommend the best AFO for their patients.

Gait difference between children aged 9 to 12 with and without potential depressive mood

BackgroundIt has been reported that depression has an impact on both temporal spatial parameters and walking kinematics in adults. Given the difference in the walking biomechanics between adults and children, this study aimed to compare the gait difference in children aged 9–12 with and without potential depressive mood (PDM). Methods49 children were recruited from local primary schools. We measured participants’ depression level using Depression Anxiety Stress Scale (DASS) and classified them into control (i.e., DASS depression subscale score = 0.6 ± 1.4; n = 23) or PDM group (i.e., DASS depression subscale score = 21.3 ± 5.3; n = 26). Video gait analysis was employed to assess temporal spatial parameters and sagittal plane kinematics during self-paced overground walking. Independent t tests or Mann-Whitney tests were used to compare the gait parameters between the two groups. ResultsParticipants exhibited similar gait speed, vertical oscillation of the centre of mass, stance time, swing time, step length, upper and lower limb kinematics between the two groups (p > 0.05). However, children with PDM displayed a greater head flexion than controls (p = 0.026; Cohen’s d = 0.66; moderate effect). SignificanceChildren with PDM may present a more slumped posture during walking when compared with their counterparts. This kinematics difference can potentially be used as a biomechanical marker for detection of mood problems in this cohort.

Influence of coronal and sagittal prosthetic foot alignment on socket reaction moments in transtibial prostheses during walking.

The socket reaction moment (SRM) has been reported to change because of alignment changes in transtibial prosthetic sockets. However, the influence of prosthetic foot alignment on SRM remains unclear. Are SRMs predictable from alignment changes of prosthetic feet? Ten users of transtibial prostheses participated in this study. Under five alignment conditions (3 ° plantarflexion and dorsiflexion, 6 ° inversion and eversion, and baseline alignment), temporal-spatial parameters and sagittal and coronal SRMs were measured during walking. Cadence, walking speed, step time, single support time, and step length were compared. The maximum/minimum SRM, % stance (timing) of the maximum/minimum SRM, Zero-cross, and SRMs at 5 %, 20 %, and 75 % stance were extracted and compared. Repeated measures analysis of variance or Friedman tests, and linear regression analyses were conducted for statistical analyses (i.e., alignment conditions as independent variables and SRM parameters as dependent variables). The SRMs at 5%, 20 %, and 75 % stance showed significant differences under coronal angular changes. The minimum SRM, % stance of the minimum/maximum SRM, and Zero-cross showed significant differences under sagittal alignment changes. In linear regression analysis, the minimum SRM, % stance of the minimum/maximum SRM, SRM at 20 % stance, and Zero-cross were significant dependent variables in the sagittal plane. The maximum/minimum SRM, SRM at 20 % and 75 % stance, and % stance of the minimum SRM were significant dependent variables in the coronal plane. The results indicated that the changes in prosthetic feet angles may predict the magnitude of SRM (maximum/minimum SRM, SRM at 20 % and 75 % stance) in the coronal plane, and the timing of SRM (Zero-cross, % stance of the maximum/minimum SRM) in the sagittal plane. These findings suggest that the SRM may be useful for evaluating foot alignment in transtibial prostheses.