1,720,984 research outputs found
Use of 3D gait analysis as predictor of achilles tendon lengthening surgery outcomes in children with cerebral palsy
No full textBACKGROUND: In children with spastic Cerebral Palsy (CP), the treatment of equinus foot with Achilles tendon lengthening (ATL) surgery is associated with high incidence of overcorrection, which may result in crouch gait.
AIM: We aimed to assess if gait pattern in preoperative time could be a predictor of the surgery outcome.
DESIGN: Cross-sectional retrospective study.
SETTING: Movement Analysis Lab, IRCCS San Raffaele Pisana Hospital, Rome (ITALY).
POPULATION: Eighteen children (mean age 9.64.7 years) with spastic diplegia CP who underwent bilateral ATL surgery to correct equinus foot were involved.
METHODS: Participants underwent 3D gait analysis before and approximately 12 months after surgery. Primary measures were spatiotemporal, kinematic (summarized by Gait Variable Scores, GVSs) and kinetic parameters. The gait patterns for each leg was defined from kinematic data, using a quantitative classification: Plantar Flexor Knee Extension (PFKE) index. The CP group was split into true equinus and jump gait.
RESULTS: The equinus foot was successfully corrected as demonstrated by the improvement of GVS ankle dorsi-plantarflexion. However, there was a high rate of overcorrection in the true equinus, characterized by increases in knee flexion- extension GVS (8.7° pre vs. 16.7° post P<0.05) and knee flexion angle at initial contact (5.2° vs. 20.6° P<0.05) and by a decrease in the maximum ankle power generated at push-off (1.49 vs. 0.83 W/kg P <0.05).
CONCLUSIONS: Assessment of motor phenotype in preoperative time are good predictors of the results of ATL surgery. In children with true equinus gait, the increase of knee flexion subsequent to ATL is an early indicator that this technique will lead to crouch gait. These results show the influence of true equinus and jump gait patterns on the outcomes of the ATL.
CLINICAL REHABILITATION IMPACT: Therefore, we propose that this approach could have clinical value to evaluate and prescribe rehabilitation in children with CP disease, proposing different solutions depending on motor phenotype
Caratterizzazione strumentale della mobilità funzionale e della forza di presa negli anziani in Sardegna
No full textIntroduzione: Uno dei test più frequentemente impiegati per stimare la mobilità funzionale nell’anziano è il Timed-Up-and-Go (TUG), che consiste nell’alzarsi da una sedia, camminare per 3 metri, girare attorno ad un ostacolo, tornare indietro, ruotare di 180° e sedersi. Il TUG, che sintetizza abilità relative al cammino, all’equilibrio alla coordinazione e alla forza, viene valutato in termini di tempo necessario a compierlo. Tuttavia è possibile realizzarne una versione strumentale che fornisce dati più dettagliati su ciascuna delle singole sotto-fasi, permettendo un’analisi più fine delle limitazioni motorie eventualmente esistenti. Metodi: Sono stati reclutati 133 individui (77 donne e 56 uomini, età 75.7, SD 13.9 anni, range 65-92), i quali hanno effettuato un TUG con sensore inerziale posizionato sul tronco e misura della forza di presa (HGS). Per quanto riguarda il TUG sono stati analizzati 9 parametri: durata totale, tempi di alzata e di seduta, durata e velocità delle rotazioni. Il campione è stato stratificato in 4 fasce (<70 anni, 70-74, 75-80 e >80 anni) e l’analisi statistica dei dati è stata effettuata mediante MANOVA. Risultati: I risultati mostrano un decadimento lineare di tutte le funzionalità motorie con l’avanzare dell’età. In particolare: la forza di presa (22.8 kg per il gruppo <70°) si riduce rispettivamente dell’8%, 32% e 45% per le successive tre fasce di partecipanti. La durata del TUG aumenta da 10 a 17.2 s (+62%) per il gruppo più anziano. Variazioni analoghe sono state riscontrate per i parametri di velocità e i tempi di rotazione intermedia e finale. Conclusioni: Il TUG strumentato fornisce informazioni utili a verificare in quali aspetti della funzionalità motorie le prestazioni dell’anziano tendono a decadere. Nel presente lavoro sono stati forniti valori di riferimento per anziani sani, che possono rivelarsi utili qualora si vogliano individuare problematiche di individui soggetti a cadute ricorrenti o con impairment cognitivi o fisici
Timed Up and Go in men and women with Multiple Sclerosis: effect of muscular strength
No full textObjective: People with Multiple Sclerosis (pwMS) often exhibit generalized weakness that affects several activities of daily life, particularly those relying on balance and gait. While it is known that such a symptom has a strong impact on mobility, to what extent muscular strength is linked with functional mobility in men and women with MS remains mostly unexplored. The aim of this study is to assess the existence of possible sex-related differences in functional mobility in pwMS, also considering the muscular strength capacity.
Methods: Functional mobility and hand-grip strength (HGS) were assessed in 49 pwMS with mild- moderate disability using instrumental Timed-up-and-go (TUG) test carried out using an inertial sensor and digital dynamometry. We investigated the existence of sex-related differences in the duration of each TUG sub-phase and their correlation with the HGS.
Results: No sex-related differences in TUG performance (either in terms of overall or sub-phase time) were found. Similar large negative correlations were found in men and women with MS between HGS and overall TUG and walking phase duration. However, changes in strength have a more marked impact in women as indicated by the different slope of the HGS-TUG time relationship., In women, HGS also appears signi!cantly correlated with all TUG sub-phases, while in men this occurs only for overall TUG and walking time.
Conclusions: Rehabilitation and training programs for pwMS should take into account the peculiar features associated with the interaction between strength and mobility speci!c for each individual's sex to optimize their effectiveness
Age-Related Changes in Smoothness of Gait of Healthy Children and Early Adolescents
No full textIn this study, we acquired and processed trunk accelerations during level walking in 85 children aged 8- 13 years to calculate spatio-temporal parameters and Harmonic Ratio (HR), which is a metrics representative of gait smoothness and step-to-step symmetry. The results show that while spatio-temporal parameters remain unchanged once normalized considering individuals’ anthropometry, significantly higher values of HR for both the antero-posterior and vertical directions were found in participants aged 12–13 with respect to those of 8–9. This indicates an improvement of gait symmetry, which suggests that the gait maturation process is still ongoing for the age ranges tested here
Quantitative assessment of upper limb functional impairments in people with Parkinson's disease
No full textBackground
In clinical routine, upper limb motor disorders of people with Parkinson's disease are commonly assessed using scale- or timed tests, but such tools are not fully suitable for providing detailed information about their type and magnitude. To partly overcome these limitations, the present study aims to quantitatively investigate upper limb functional impairments through quantitative analysis of the “hand-to-mouth” task.
Methods
Twenty-five individuals with Parkinson's disease and 20 age-matched healthy individuals underwent a kinematic analysis of the hand-to-mouth task from which spatio-temporal and kinematic measures, including summary measures (Arm Variable Score and Arm Profile Score), were calculated and correlated with clinical scores (Hoehn & Yahr, H&Y and the Unified Parkinson Disease Rating Scale, UPDRS).
Findings
The “hand-to-mouth” movement is significantly altered in individuals with Parkinson's disease, especially in terms of reduced velocity, reduced range of motion of elbow flexion-extension and deviation from a physiologic pattern (Arm Profile Score 12.8° vs. 10.1° of unaffected, P = 0.002). Significant moderate correlations were found between movement duration and UPDRS-III (rho = 0.478, P = 0.001) and between the Arm Profile Score and H&Y (rho = 0.481, P = 0.024) and UPDRS-III (rho = 0.326, P = 0.001).
Interpretation
On the basis of such findings, we can state that the kinematic analysis of “hand-to-mouth” movement, and in particular the summary indexes, are suitable for easily representing upper limb movement alterations in people with Parkinson's disease, thus allowing the monitoring either of disease progression or effectiveness of pharmacologic and rehabilitative treatments
Sex-independent and dependent effects of older age on cycle-to-cycle variability of muscle activation during gait
Full text linkBackground
Older age is associated with higher stride time variability in female and male gait, which may have a neuromuscular origin. We sought to determine how older age and sex affect muscle activation variability during gait, and how these patterns relate to stride time variability.
Methods
Ninety-three adults (51 females; aged 20–82 years) completed six gait trials at their self-selected speed. Cycle-to-cycle variabilities (CCVs) were calculated for stride time, and for amplitude of electromyography (EMG) of the rectus femoris (RF), tibialis anterior (TA), and gastrocnemius lateralis (GL) recorded over different gait phases. Statistical models tested for Age × Sex × Muscle effects and for relationships between EMG CCVs and stride time CCVs.
Results
Significant Age and Age × Muscle effects on EMG CCV were observed in several phases of gait (p < .05), where each year of age was associated with 0.11–0.18% higher EMG CCV, generally in the RF. A significant Age × Sex × Muscle effect on EMG CCV at mid-stance (p < .05) indicated that, in females, each year of age was associated with 0.11% lower GL CCV. Significant but low strength correlations (ρ = 0.298–0.351) were found between EMG CCV and stride time CCV.
Conclusions
Associations between older age and higher muscle activation variability were generally sex-independent. A sex-dependency in GL activation variability may contribute to gait instability in aging females. Individual variabilities of muscle activation were not strongly related to stride time variability
Does variability in motor output at individual joints predict stride time variability in gait? Influences of age, sex, and plane of motion
No full textOld age is associated with variability in gait motor output, particularly in females, and is linked to fall risk. However, little is known about how older age and sex affect variability in the outputs of individual joints, and how these variabilities contribute to the collective gait output. Healthy adults aged 18–99 years (N = 102, 57 females) completed six trials of straight walking at self-selected speed. Stride time variability (coefficient of variation) and variabilities of lower limb tridimensional joint angles (standard deviations: SD) were calculated. Age * Sex (A * S) mixed models were conducted on all measures and year-by-year rates of change were subsequently estimated. Correlations and stepwise linear regression analyses were computed between joint angular variabilities and stride time variability. Each year of age was associated with 0.022% higher stride time variability (A: p = .002), 0.07° lower variability in peak ankle dorsiflexion (A: p = .004), 0.002–0.098° higher variability in mean ankle inversion/eversion, mean pelvic obliquity, and pelvic rotation range of motion (A: p < .05), and 0.024° higher variability in knee flexion/extension range of motion in males (A * S: p = .003). Higher variability in mean ankle and hip flexion/extension and in mean ankle inversion/eversion correlated with (ρ = 0.211–0.336; ps < 0.05) and independently predicted higher stride time variability (ps < 0.05), together explaining 21.9% of variance. Results suggest that higher stride time variability with older age may be produced by a shift from sagittal plane variability to frontal plane variability at the ankle
Dynamic postural stability, is associated with competitive level, in youth league soccer players
No full textObjectives
To assess the effect of competitive level on dynamic postural stability in young elite and sub-elite soccer players.
Design
Cross-sectional study.
Setting
Laboratory.
Participants
Fifty-four male soccer players of Under 16 and Under 17 categories (mean age 15.9±0.6), divided into two groups who regularly compete at national (n = 28) and regional (n = 26) levels.
Main outcome measures
Dynamic Postural Stability Index (DPSI) and vertical Time to Stabilization (vTTS) for a forward-jump landing. Static postural sway was calculated on the basis of center-of-pressure trajectories for a 20s one-legged stance.
Results
Players at national level exhibit better dynamic postural control than those at regional level, as indicated by the significantly lower DPSI (0.327 vs. 0.373, p<0.001) and vTTS (0.887 vs. 1.158s, p=0.003). In con- trast, no differences between groups were found in any of the postural sway parameters for the static test. Conclusions
Young soccer players at national level are characterized by better balance performance in terms of faster and more efficient stabilization after a forward jump, while one-leg static standing tests appear not challeng- ing enough to reveal differences in balance abilities associated with the combination of superior technical and physical features
Gait and Functional Mobility in Multiple Sclerosis: Immediate Effects of Transcranial Direct Current Stimulation (tDCS) Paired With Aerobic Exercise
Full text linkWalking impairments are a debilitating feature of multiple sclerosis (MS) because of the direct interference with daily activity. The management of motor symptoms in those with MS remains a therapeutic challenge. Transcranial direct current stimulation (tDCS) is a type of non-invasive brain stimulation that is emerging as a promising rehabilitative tool but requires further characterization to determine its optimal therapeutic use. In this randomized, sham-controlled proof-of-concept study, we tested the immediate effects of a single tDCS session on walking and functional mobility in those with MS. Seventeen participants with MS completed one 20-min session of aerobic exercise, randomly assigned to be paired with either active (2.5mA, n = 9) or sham (n = 8) tDCS over the primary motor cortex (M1). The groups (active vs. sham) were matched according to gender (50% vs. 60% F), age (52.1 ± 12.85 vs. 54.2 ± 8.5 years), and level of neurological disability (median Expanded Disability Status Scale score 5.5 vs. 5). Gait speed on the 10-m walk test and the Timed Up and Go (TUG) time were measured by a wearable inertial sensor immediately before and following the 20-min session, with changes compared between conditions and time. There were no significant differences in gait speed or TUG time changes following the session in the full sample or between the active vs. sham groups. These findings suggest that a single session of anodal tDCS over M1 is not sufficient to affect walking and functional mobility in those with MS. Instead, behavioral motor response of tDCS is likely to be cumulative, and the effects of multiple tDCS sessions require further study
Similarities And Differences Of Gait Patterns In Women And Men With Parkinson's Disease With Mild Disability
No full textObjective This study aimed to quantitatively investigate the existence of differences in spatio-temporal and kinematic parameters of gait in men and women with Parkinson’s disease (PD) using computerized three-dimensional gait analysis. Design Retrospective cohort study Setting Laboratory of Biomechanics Participants Thirty-five individuals with PD (17F, 18M) of mean age 70.7 years characterized by mild disability (Hoehn & Yahr ≤ 2.5) who were tested in “On” medication state approximately 60’-90’ after intake of the usual morning Levodopa dose. Intervention Not applicable Main outcome measures Spatio-temporal parameters of gait (speed, stride length, cadence, step width, duration of stance, swing and double support phases) and kinematics of hip, knee and ankle joints in the sagittal plane. Results Men and women exhibit similar spatio-temporal parameters, except for step width (wider in men). In contrast, relevant differences were found in terms of ankle kinematics. In particular, women presented increased ankle dorsiflexion through all the stance phase and mid-late swing phase, and reduced plantarflexion at the stance-swing phase transition. Conclusions Gait patterns of men and women with PD with mild disability are similar in terms of spatio-temporal parameters but characterized by marked differences as regards the ankle kinematics on the sagittal plane. The findings of the present study support the concept that investigations seeking to clarify the complex pathophysiology of PD-related gait disturbances should consider the role played by an individual's sex, thereby achieving more effective designing of physical/rehabilitative treatments
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