Biomechanical Gait Analysis in Patients with Osteonecrosis of the Femoral Head / Análise biomecánica da marcha de pacientes com osteonecrose da cabeça do fémur

Abstract Objectives Although osteonecrosis of the femoral head is a prevalent condition, its effects on gait parameters have not been thoroughly studied and are not well-established in the current literature. The primary aim of the present study is to describe gait in patients with a diagnosis of osteonecrosis. Methods This is a cross-sectional study. Nine patients diagnosed with osteonecrosis of the femoral head who were regularly followed-up at an outpatient clinic were selected for the present study and underwent gait analysis using Vicon Motion Capture Systems. Spatiotemporal data was obtained, and joint angles were calculated using an Euler angle coordinate system. Distal coordinate systems were used to calculate joint momentsand forceplatestoobtaingroundreactionforces. Results Patients with osteonecrosis presented with slower velocity (0.54 m/s ± 0.19) and smaller cadence (83.01 steps/min ± 13.23) than healthy patients. The pelvic obliquity range of motion was of 10.12° ± 3.03 and rotation was of 18.23° ± 9.17. The mean hip flexion was of 9.48° ± 3.40. Ground reaction forces showed reduced braking and propelling forces. Joint moments were reduced for flexion and adduction (0.42 Nm/kg ± 0.2 and 0.30 Nm/kg ± 0.11, respectively) but the abduction moment was increased (0.42 Nm/kg ± 0.18). Conclusions The present study showed that osteonecrosis of the femoral head presents compensatory gait mechanisms, with increased pelvic motion and decreased knee flexion to protect the hip joint. Decreased moments for hip flexion and adduction were also identified and muscle weakness for those groups may be correlated to the disease.

Resumo Objetivos Embora a osteonecrose da cabeça do fêmur seja uma lesão prevalente, seus efeitos sobre os parâmetros da marcha não foram minuciosamente estudados e não estão bem estabelecidos na literatura atual. O objetivo principal do presente estudo é descrever a marcha em pacientes com osteonecrose. Métodos Trata-se de um estudo transversal. Nove pacientes com diagnóstico de osteonecrose da cabeça do fêmur, sob acompanhamento regular em ambulatório, foram selecionados para o presente estudo e submetidos à análise da marcha com Vicon Motion Capture Systems. Os dados espaciais e temporais foram obtidos e os ângulos articulares foram calculados com o sistema de coordenadas angulares de Euler. Sistemas de coordenadas distais e plataformas de força foram utilizados para o cálculo de momentos articulares e de forças de reação ao solo, respectivamente. Resultados Os pacientes com osteonecrose apresentaram menor velocidade (0,54 m/s ± 0,19) e menor cadência (83,01 passos/minuto ± 13,23) do que pacientes saudáveis. As amplitudes de movimento de obliquidade e rotação pélvica foram de 10,12°± 3,03 e 18,23° ± 9,17, respectivamente. A média de flexão do quadril foi de 9,48° ± 3,40. O estudo das forças de reação ao solo revelou redução das forças de frenagem e propulsão. Os momentos articulares de flexão e adução caíram (0,42 Nm/kg ± 0,2 e 0,30 Nm/kg ± 0,11), mas o momento de abdução aumentou (0,42 Nm/kg ± 0,18). Conclusões O presente estudo mostrou que a osteonecrose da cabeça do fêmur é associada a mecanismos compensatórios da marcha, com aumento da movimentação pélvica e diminuição da flexão do joelho para proteção da articulação do quadril. A redução dos momentos de flexão e adução do quadril também foi identificada e a fraqueza destes grupos musculares pode estar correlacionada à doença.

Effects of different cognitive tasks on gait performance during dual-task walking in patients with stroke / 国际脑血管病杂志

Objective:To investigate the effects of cognitive types on dual-task paradigm gait performance in patients with stroke.Method:Using a cross-sectional study design, patients with stroke were trained with single task walking and dual-task walking with four different cognitive tasks (spontaneous speech [SS], serial counting backward [SCB], word list generation (WLG), and auditory Stroop [AS]). A three-dimensional gait and motion analysis system were used to record and analyze gait data, and calculate dual-task effect (DTE) for different cognitive tasks, and compare the differences in spatiotemporal parameters and DTE of gait analysis under different states.Results:A total of 35 patients with stroke (aged 61.0±2.5 years) were included, among which 27 were males (77.1%). There were 25 patients with ischemic stroke (71.4%) and 10 patients with hemorrhagic stroke (28.6%). Compared with single task walking, patients had decreased gait speed, shorter step length on the affected side, and a larger support phase ratio of the unaffected to the affected side during SCB dual task and SS dual task (all P<0.05), and the difference was more obvious during SCB dual task ( P<0.05). Compared with single task walking, patients had a reduced swing phase ratio of the unaffected to the affected side during SCB dual task (all P<0.05). The DTEs of gait speed, step length of the affected side, and the support phase ratio of the unaffected to the affected side during SCB dual task and SS dual task were significantly greater than those during WLG dual task and AS dual task ( P<0.05). The DTEs of gait speed and step length of the affected side during SCB dual task were significantly greater than that during SS dual task (all P<0.05). The DTE of the swing phase ratio of the unaffected to the affected side during SCB dual task was significantly greater than that during other types of cognitive tasks (all P<0.05). Conclusion:Different cognitive tasks had different effects on gait performance during dual-task walking in patients with stroke, and the degree of dual-task interference was associated with specific task types.

An Algorithm for Measuring Vertical Ground Reaction Force Based on Insole Sensors / 医用生物力学

Objective A practical and highly accurate algorithm for dynamic monitoring of plantar pressure was proposed, the magnitude of vertical ground reaction force (vGRF) during walking was measured by a capacitive insole sensor, and reliability of the prediction accuracy was verified. Methods Four healthy male subjects were require to wear capacitive insole sensors, and their fast walking and slow walking data were collected by Kistler three-dimensional (3D) force platform. The data collected by the capacitive insole sensors were pixelated, and then the processed data were fed into a residual neural network, ResNet18, to obtain high-precision vGRF. Results Compared with analysis of the data collected from Kister force platform, the normalized root mean square error (NRMSE) for fast walking and slow walking were 8.40% and 6.54%, respectively, and the Pearman correlation coefficient was larger than 0.96. Conclusions This study provides a novel algorithm for dynamic measurement of GRF in mobile scenarios, which can be used for estimation of complete GRF outside the laboratory without being constrained by the number and location of force plates. Potential application areas include gait analysis and efficient capture of pathological gaits.

Three-dimensional kinematic analysis of knee joint after anterior cruciate ligament reconstruction with personalized femoral positioner based on apex of deep cartilage / 中国修复重建外科杂志

OBJECTIVE@#To investigate the changes of knee joint kinematics after anterior cruciate ligament (ACL) reconstruction assisted by personalized femoral positioner based on the apex of deep cartilage (ADC).@*METHODS@#Between January 2021 and January 2022, a total of 40 patients with initial ACL rupture who met the selection criteria were randomly divided into the study group (using the personalized femoral positioner based on ADC design to assist ACL reconstruction) and the control group (not using the personalized femoral positioner to assist ACL reconstruction), with 20 patients in each group. Another 20 volunteers with normal knee were collected as a healthy group. There was no significant difference in gender, age, body mass index, and affected side between groups ( P>0.05). Gait analysis was performed at 3, 6, and 12 months after operation using Opti _ Knee three-dimensional knee joint motion measurement and analysis system, and the 6 degrees of freedom (flexion and extension angle, varus and valgus angle, internal and external rotation angle, anteroposterior displacement, superior and inferior displacement, internal and external displacement) and motion cycle (maximum step length, minimum step length, and step frequency) of the knee joint were recorded. The patients' data was compared to the data of healthy group.@*RESULTS@#In the healthy group, the flexion and extension angle was (57.80±3.45)°, the varus and valgus angle was (10.54±1.05)°, the internal and external rotation angle was (13.02±1.66)°, and the anteroposterior displacement was (1.44±0.39) cm, the superior and inferior displacement was (0.86±0.20) cm, and the internal and external displacement was (1.38±0.39) cm. The maximum step length was (51.24±1.29) cm, the minimum step length was (45.69±2.28) cm, and the step frequency was (12.45±0.47) step/minute. Compared with the healthy group, the flexion and extension angles and internal and external rotation angles of the patients in the study group and the control group decreased at 3 months after operation, and the flexion and extension angles of the patients in the control group decreased at 6 months after operation, and the differences were significant ( P<0.05); there was no significant difference in the other time points and other indicators when compared with healthy group ( P>0.05). In the study group, the flexion and extension angles and internal and external rotation angles at 6 and 12 months after operation were significantly greater than those at 3 months after operation ( P<0.05), while there was no significant difference in the other indicators at other time points ( P>0.05). There was a significant difference in flexion and extension angle between the study group and the control group at 6 months after operation ( P<0.05), but there was no significant difference of the indicators between the two groups at other time points ( P>0.05).@*CONCLUSION@#Compared with conventional surgery, ACL reconstruction assisted by personalized femoral positioner based on ADC design can help patients achieve more satisfactory early postoperative kinematic results, and three-dimensional kinematic analysis can more objectively and dynamically evaluate the postoperative recovery of knee joint.

The influence of gender and age on foot structure and plantar pressure in asymptomatic adults / Influência de sexo e idade na estrutura do pé e pressão plantar em adultos assintomáticos

Abstract The aim of the study was identify the influence of gender and age of healthy adults on the foot structure and the plantar pressure during gait. Sample comprising 608 women and men participants. To identify the structure of the foot, anthropometric measurements of both the total and the truncated length of the foot, the width of the forefoot, and the heights of the back and navicular were taken. Peak pressure and plantar contact area in three foot-masks (forefoot, middle foot, and hindfoot) were considered markers of plantar pressure. The data were analyzed by two-way variance analysis. No significant influence of age on the foot structure dimensions was identified; however, women presented measures equivalent to the five significantly smaller anthropometric markers. As for the peak plantar pressure, both males and females showed statistically similar values, but significant differences were observed for age. As to the plantar contact area, while age did not have significant influence, men showed significantly higher values in the three foot-masks. The findings suggest that gender influences the foot structure and the plantar contact area, while age influences the peak of plantar pressure.

Resumo O objetivo do estudo foi identificar a influência de sexo e idade na estrutura do pé e na pressão plantar durante a marcha de adultos saudáveis. Amostra constituída por 608 participantes de ambos os sexos. Para identificar a estrutura do pé, foram realizadas medidas antropométricas equivalentes ao comprimento total e truncado do pé, à largura do antepé, às alturas do dorso e do navicular. Pico de pressão e área de contato plantar em três máscaras podais (antepé, médio pé e retropé) foram considerados marcadores de pressão plantar. Os dados foram analisados mediante análise de variância two-way. Não foi identificada influência significativa da idade nas dimensões da estrutura do pé; contudo, mulheres apresentaram medidas equivalentes aos cinco marcadores antropométricos significativamente menores. Quanto ao pico de pressão plantar, ambos os sexos apresentaram valores estatisticamente similares, porém diferenças significativas foram observadas com relação à idade. No caso da área de contato plantar, enquanto a idade não demonstrou influência significativa, os homens apresentaram valores significativamente maiores nas três máscaras podais. Os achados sugerem que o sexo exerce influência na estrutura do pé e na área de contato plantar, enquanto o pico de pressão plantar é influenciado pela idade.

Impact of surgical treatment on the gait of patients with cervical myelopathy / Impacto do tratamento cirurgico na marcha de pacientes portadores de mielopatia cervical / Impacto del tratamiento quirúrgico en la marcha de pacientes con mielopatía cervical

ABSTRACT: Objective: To analyze the impact of surgery on gait characteristics of individuals with Cervical Spondylotic Myelopathy (CSM) after one month of the procedure. Methods: Observational, cohort type study, with a quantitative analysis approach. Two assessments were performed, the first one week before surgery and the second 30 days after the decompression procedure. The following space-time variables were analyzed: steps per minute, step length, cycle time, speed, steps per minute, support time, swing time, step time. The kinematic variables obtained were analyzed by Gait Profile Score (GPS) and Movement Analysis Profile (MAP). Results: comparing pre and postoperative values, there was a decrease in the number of steps per minute (p=0.006), an increase in support time (p=0.011) and an increase in cycle time (p=0.004). Other variables did not present statistically significant differences. The patients' total GPS average in the pre-surgery assessment was 10.41 and 1 month after the procedure, an average of 10.56 was obtained, which does not characterize a statistical difference between the assessments. When establishing a comparison between the two assessments specifically on each joint movement of the lower limbs using the MAP, it was observed that the obliquity and rotation of the pelvis showed some improvement immediately after the surgical procedure. Knee flexion and extension were significantly (p=0.018) more compromised after the procedure when compared to the value of the same population before surgery. Conclusion: the preliminary analysis of the gait of these patients after one month of intervention did not show immediate benefits of the procedure. Level of Evidence II; Therapeutic studies - Investigation of treatment outcomes.

RESUMO: Objetivo: Analisar o impacto da cirurgia na marcha de indivíduos portadores de Mielopatia Cervical Espondilótica (MCE) após um mês do procedimento. Métodos: Estudo observacional, longitudinal, com abordagem de análise quantitativa. Foram realizadas duas avaliações, a primeira uma semana antes da cirurgia e a segunda 30 dias após o procedimento. Foram analisadas as variáveis de espaço-tempo: avanços por minuto, comprimento do passo, tempo de ciclo, velocidade, passos por minuto, tempo de apoio, tempo de balanço, tempo do passo. As variáveis cinemáticas obtidas foram analisadas pelo Gait Profile Score (GPS) e Movement Analysis Profile (MAP). Resultados: comparando os valores pré e pós-operatórios, houve diminuição do número de passos por minuto (p=0,006), aumento no tempo de apoio (p=0,011) e aumento no tempo de ciclo (p=0,004), outras variáveis não apresentaram diferenças estatisticamente significativas. A média do GPS total dos pacientes na avaliação pré-cirurgia foi de 10,41 e após 1 mês do procedimento obteve-se a pontuação média de 10,56 o que não caracteriza diferença estatística entre as avaliações. Ao estabelecer uma comparação entre as duas avaliações em cada movimento articular dos membros inferiores utilizando o MAP, observa-se que a obliquidade e a rotação da pelve apresentaram alguma melhoria imediatamente após o procedimento cirúrgico. Já a flexão e extensão do joelho mostrou-se significativamente (p=0,018) mais comprometida após o procedimento quando comparada com o valor da mesma população pré cirurgia. Conclusão: a análise preliminar da marcha dos pacientes com MCE após um mês de intervenção não evidenciou benefícios imediatos do procedimento. Nível de Evidência II; Estudos terapêuticos - Investigação dos resultados do tratamento.

RESUMEN: Objetivo: Analizar el impacto del tratamiento quirúrgico en las características de la marcha de personas con Mielopatía Cervical Espondilótica (MCE) después de un mes del procedimiento. Métodos: Estudio observacional, longitudinal, con enfoque de análisis cuantitativo. Se realizaron dos evaluaciones, la primera una semana antes de la cirugía y la segunda 30 días después del procedimiento de descompresión. Se analizaron las siguientes variables espacio-temporales: pasos por minuto, longitud de paso, tiempo de ciclo, velocidad, pasos por minuto, tiempo de apoyo, tiempo de balanceo, tiempo de paso. Las variables cinemáticas obtenidas fueron analizadas mediante Gait Profile Score (GPS) y Movement Analysis Profile (MAP). Resultados: Al comparar los valores pre y postoperatorios, hubo una disminución en el número de pasos por minuto (p=0,006), un aumento en el tiempo de soporte (p=0,011) y un aumento en el tiempo de ciclo (p=0,004), otras variables no presentaron diferencias estadísticamente significativas. La media del GPS total de los pacientes en la evaluación prequirúrgica fue de 10,41 y 1 mes después del procedimiento se obtuvo una puntuación promedio de 10,56, lo que no caracteriza diferencia estadística entre las evaluaciones. Al establecer una comparación entre las dos evaluaciones específicamente sobre cada movimiento articular de los miembros inferiores mediante el MAP, se observó que la oblicuidad y rotación de la pelvis mostraron cierta mejoría inmediatamente después del procedimiento quirúrgico. La flexión y extensión de la rodilla estuvieron significativamente (p=0,018) más comprometidas después del procedimiento en comparación con el valor de la misma población antes de la cirugía. Conclusión: Los pacientes con MCE presentan deterioro de la marcha en comparación con la población típica, el análisis preliminar de la marcha de estos pacientes después de un mes de intervención no mostró beneficios inmediatos del procedimiento. Nivel de Evidencia II; Estudios terapéuticos - Investigación de resultados del tratamiento.

Balance training and physical ability of basketball players / Treinamento de equilíbrio e habilidade física dos jogadores de basquetebol / Entrenamiento del equilibrio y la capacidad física de los jugadores de baloncesto

ABSTRACT Introduction Balance in gait is a fundamental factor for rhythmic changes on the court, and physical fitness is a basic requirement for competitiveness in basketball. Objective Analyze the effects of balance training on the gait and physical fitness of basketball players. Methods Thirty basketball athletes were selected and randomly divided into a control and experimental group. A balance training program including balls was added to the experimental group, while the control group followed only the traditional training program. The experiment lasted 8 weeks, with the interventions applied 3 times a week. Finally, relevant data collected before and after the experiment were statistically analyzed and discussed. Results The experimental and the control groups showed a statistical gain in balance, with a greater change interval in the experimental group, demonstrating the effect of dynamic balance training in improving basketball-related physical indices. Conclusion There are some deficiencies in the traditional basketball training program that can be compensated with the addition of the balance training program presented in this article, fully improving the skills of basketball players. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução O equilíbrio na marcha é um fator fundamental para as alterações rítmicas na quadra, sendo a aptidão física um requisito básico para a competitividade no basquetebol. Objetivo Analisar os efeitos do treinamento de equilíbrio sobre a marcha e a capacidade física dos jogadores de basquetebol. Métodos Foram selecionados 30 atletas de basquetebol, divididos aleatoriamente em grupo controle e experimental. Ao grupo experimental, foi adicionado um programa de treinamento de equilíbrio incluindo o uso de bolas enquanto o grupo controle seguiu apenas com o programa tradicional de treinamento. O experimento teve duração total de 8 semanas, sendo as intervenções aplicadas 3 vezes por semana. Ao final, dados relevantes coletados antes e depois do experimento foram analisados estatisticamente e discutidos. Resultados Tanto o grupo experimental quanto o grupo controle mostraram um ganho estatístico de equilíbrio, sendo maior o intervalo de alteração no grupo experimental, demonstrando o efeito do treinamento de equilíbrio dinâmico na melhoria dos índices físicos relacionados ao basquetebol. Conclusão Existem algumas deficiências no programa de treinamento tradicional de basquetebol que podem ser compensadas com a adição do programa de treinamento em equilíbrio apresentados nesse artigo, melhorando integralmente as habilidades dos jogadores de basquetebol. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción El equilibrio en la marcha es un factor fundamental para los cambios de ritmo en la cancha, siendo la aptitud física un requisito básico para la competitividad en el baloncesto. Objetivo Analizar los efectos del entrenamiento del equilibrio sobre la marcha y la condición física de los jugadores de baloncesto. Métodos Se seleccionaron 30 atletas de baloncesto, divididos aleatoriamente en un grupo de control y otro experimental. Al grupo experimental se le añadió un programa de entrenamiento del equilibrio que incluía el uso de pelotas, mientras que el grupo de control siguió sólo con el programa de entrenamiento tradicional. El experimento tuvo una duración total de 8 semanas, y las intervenciones se aplicaron 3 veces por semana. Al final, se analizaron y discutieron estadísticamente los datos relevantes recogidos antes y después del experimento. Resultados Tanto el grupo experimental como el de control mostraron una ganancia estadística en el equilibrio, con un mayor intervalo de cambio en el grupo experimental, lo que demuestra el efecto del entrenamiento del equilibrio dinámico en la mejora de los índices físicos relacionados con el baloncesto. Conclusión Existen algunas deficiencias en el programa tradicional de entrenamiento de baloncesto que pueden ser compensadas con la adición del programa de entrenamiento de equilibrio presentado en este artículo, mejorando integralmente las habilidades de los jugadores de baloncesto. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Comparing gait and hip scores in femoral neck and intertrochanteric fractures / Comparação de escores de marcha e quadril em fraturas do colo femoral e intertrocantéricas

ABSTRACT Objective Treatment modality is controversial in the unstable IT fractures. Ideal hemiarthroplasty treatment for unstable IT fractures should be comparable to that for FN fractures. Therefore, the aim of this study was to compare patients who underwent cementless hemiarthroplasty for a diagnosis of FN and unstable IT in terms of clinical outcomes, functional scores, and smartphone-based gait analysis data. Methods Case matching was applied to 50 patients with FN fracture and 133 patients with IT fracture who underwent hemiarthroplasty treatment, they were compared in terms of, preoperative and postoperative walking status, and Harris hip scores. Smartphone-based gait analysis was applied to 12 patients in the IT group and 14 patients in the FN group who could walk without support. Results There was no significant difference between patients with IT and FN fractures regarding Harris hip scores, preoperative, and postoperative walking status. In the gait analysis, gait velocity, cadence, step time, step length, and step time symmetry values were observed to be significantly better in patients in the FN group. Conclusion Cementless hemiarthroplasty operations for unstable IT fractures have similar hip scores to FN fractures. However, the walking speed and walking symmetry data were seen to be worse. This result should be considered in the selection of appropriate treatment. Level of evidence III; Retrospective study.

RESUMO Objetivo O tratamento das fraturas instáveis da IT possui modalidades de tratamento com diferentes teorias. Hemiartroplastia é o tratamento ideal para fraturas instáveis (IT), devendo ser comparável à hemiartroplastia para fraturas do colo femoral (FN). Portanto, o objetivo deste estudo foi comparar pacientes que foram submetidos a hemiartroplastia não cimentada para diagnóstico do FN e IT instável em seus resultados clínicos, considerando a escala de estado funcional e a análise dos dados de habilidade de marcha coletadas por um smartphone. Métodos A combinação de casos foi aplicada a 50 pacientes com fratura FN e 133 pacientes com fratura IT submetidos ao tratamento de hemiartroplastia, a habilidade de marcha pré e pós-operatório, incluindo suas pontuações Harris Hip, foram comparadas. A análise de marcha foi executada com smartphone em 12 pacientes do grupo IT e 14 pacientes do grupo CF, que conseguiam andar sem apoio. Resultados Não foram encontradas diferenças significativas entre os pacientes com fraturas IT e FN em relação às pontuações Harris Hip nem quanto ao estado de marcha pré e pós-operatório. Na análise da marcha, os valores de velocidade, cadência, tempo de passo, comprimento do passo e simetria do tempo de passo foram significativamente melhores nos pacientes do grupo FN. Conclusão As operações de hemiartroplastia não cimentada para fraturas instáveis de IT, têm pontuação de quadril semelhantes às fraturas FN. Entretanto, os dados de velocidade de caminhada e simetria de caminhada mostraram-se inferiores. Esses resultados devem ser considerados na escolha do tratamento adequado.Nível de evidência III; Estudo retrospectivo.

Investigation of tactile gait parameters based on deep learning of energy consumption estimation algorithm in sport / Investigação sobre parâmetros tácteis de marcha baseados no aprendizado profundo do algoritmo de estimativa de consumo energético no esporte / Investigación sobre los parámetros táctiles de marcha basados en el aprendizaje profundo del algoritmo de estimación del consumo de energía en el deporte

ABSTRACT Introduction In medicine, Deep Learning is a type of machine learning that aims to train computers to perform human tasks by simulating the human brain. Gait recognition and gait motion simulation is one of the most interesting research areas in the field of biometrics and can benefit from this technological feature. Objective To use Deep Learning to format and validate according to the dynamic characteristics of gait. Methods Gait was used for identity recognition, and gait recognition based on kinematics and dynamic gait parameters was performed through pattern recognition, including the position and the intensity value of maximum pressure points, pressure center point, and pressure ratio. Results The investigation shows that the energy consumption of gait as modeled analyzed, and the model of gait energy consumption can be obtained, which is comprehensively affected by motion parameters and individual feature parameters. Conclusion Real-time energy measurement is obtained when most people walk. The research shows that the gait frequency and body parameters obtained from the tactile parameters of gait biomechanics can more accurately estimate the energy metabolism of exercise and obtain the metabolic formula of exercise. There is a good application prospect for assessing energy metabolism through the tactile parameters of gait. Level of evidence II; Therapeutic studies - investigating treatment outcomes.

RESUMO Introdução Na medicina, o aprendizado profundo é um tipo de aprendizado de máquina que visa treinar computadores para a realização de tarefas humanas simulando o cérebro humano. O reconhecimento da marcha e a simulação do movimento de marcha são um dos pontos de maior interesse da investigação no campo da biometria e pode ser beneficiado com esse recurso tecnológico. Objetivo Utilizar o aprendizado profundo para formatar e validar, de acordo com as características dinâmicas da marcha. Métodos A marcha foi utilizada para o reconhecimento da identidade, e o reconhecimento da marcha baseado na cinemática e parâmetros dinâmicos de marcha foi realizado através do reconhecimento de padrões, incluindo a posição e o valor de intensidade dos pontos de pressão máxima, ponto central de pressão e relação de pressão. Resultados A investigação mostra que o consumo de energia da marcha como modelado analisado, e o modelo de consumo de energia da marcha pode ser obtido, o qual é afetado de forma abrangente pelos parâmetros de movimento e pelos parâmetros de características individuais. Conclusão A medição de energia em tempo real é obtida quando a maioria das pessoas caminha. A investigação mostra que a frequência da marcha e os parâmetros corporais obtidos a partir dos parâmetros tácteis da biomecânica da marcha podem estimar com maior precisão o metabolismo energético do exercício e obter a fórmula metabólica do exercício. Há uma boa perspectiva de aplicação para avaliar o metabolismo energético através dos parâmetros tácteis da marcha. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción En medicina, el aprendizaje profundo es un tipo de aprendizaje que pretende entrenar a los ordenadores para que realicen tareas humanas simulando el cerebro humano. El reconocimiento de la marcha y la simulación de su movimiento es uno de los puntos más interesantes de la investigación en el campo de la biometría y puede beneficiarse de este recurso tecnológico. Objetivo Utilizar el aprendizaje profundo para formatear y validar según las características dinámicas de la marcha. Métodos Se utilizó la marcha para el reconocimiento de la identidad, y el reconocimiento de la marcha basado en la cinemática y los parámetros dinámicos de la marcha se realizó mediante el reconocimiento de patrones, incluyendo la posición y el valor de la intensidad de los puntos de presión máxima, el punto de presión central y la relación de presión. Resultados La investigación muestra que el consumo de energía de la marcha, tal y como se analizó, y el modelo de consumo de energía de la marcha se puede obtener, que es ampliamente afectado por los parámetros de movimiento y los parámetros de las características individuales. Conclusión La medición de la energía en tiempo real se obtiene cuando la mayoría de la gente camina. La investigación muestra que la frecuencia de la marcha y los parámetros corporales obtenidos a partir de los parámetros táctiles de la biomecánica de la marcha pueden estimar con mayor precisión el metabolismo energético del ejercicio y obtener la fórmula metabólica del mismo. Existe una buena perspectiva de aplicación para evaluar el metabolismo energético a través de los parámetros táctiles de la marcha. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Study on the correlation between early three-dimensional gait analysis and clinical efficacy after robot-assisted total knee arthroplasty / 中华创伤杂志(英文版)

PURPOSE@#Robot-assisted technology is a forefront of surgical innovation that improves the accuracy of total knee arthroplasty (TKA). But whether the accuracy of surgery can improve the clinical efficacy still needs further research. The purpose of this study is to perform three-dimensional (3D) analysis in the early postoperative period of patients who received robot-assisted total knee arthroplasty (RATKA), and to study the trend of changes in gait parameters after RATKA and the correlation with the early clinical efficacy.@*METHODS@#Patients who received RATKA in the Center of Joint Surgery, the First Hospital Affiliated to Army Military Medical University from October 2020 to January 2021 were included. The imaging parameters, i.e., hip-knee-ankle angle, lateral distal femoral angle, medial proximal tibial angle, posterior condylar angle were measured 3 months post-TKA. The 3D gait analysis and clinical efficacy by Western Ontario Mac Master University Index (WOMAC) score were performed pre-TKA, 3 and 6 months post-TKA. The differences in spatiotemporal parameters of gait, kinetic parameters, and kinematic parameters of the operated limb and the contralateral limb were compared. The correlation between gait parameters and WOMAC scores was analyzed. Paired sample t-test and Wilcoxon rank-sum test were used to analyze the difference between groups, and Spearman correlation coefficient was used to analyze the correlation.@*RESULTS@#There were 31 patients included in this study, and the imaging indexes showed that all of them returned to normal post-TKA. The WOMAC score at 3 months post-TKA was significantly lower than that pre-TKA, and there was no significant difference between at 3 and 6 months. The 3D gait analysis results showed that the double support time of the operated limb reduced at 3 and 6 months (all p < 0.05), the maximum extension and maximum external rotation of the knee joint increased at stance phase, and the maximum flexion angle, the range of motion and the maximum external rotation increased at swing phase. Compared with the preoperative data, there were significant improvements (all p < 0.05). Compared with the contralateral knee joint, the maximum external rotation of the knee joint at swing phase was smaller than that of the contralateral side, and the maximum flexion and extension moment was greater than that of the contralateral knee. The maximum external rotation moment of the joint was greater than that of the contralateral knee joint (p < 0.05). There was a negative correlation between the single support time pre-TKA and the WOMAC score at 3 months (p = 0.017), and the single support time at 3 months was negatively correlated with the WOMAC score at 6 months (p = 0.043). The cadence at 6 months was negatively correlated with the WOMAC score at 6 months (p = 0.031). The maximum knee extension at stance phase at 6 months was negatively correlated with the WOMAC score at 6 month (p = 0.048). The maximum external rotation at stance phase at 6 months was negatively correlated with the WOMAC score at 6 months (p = 0.024).@*CONCLUSION@#The 3D gait analysis of RATKA patients is more sensitive than WOMAC score in evaluating the clinical efficacy. Trend of changes in gait parameters shows that the knee joint support, flexion and extension function, range of motion, external rotation and varus deformity moment of the patient were significantly improved at 3 months after surgery, and continued to 6 months after surgery. Compared with the contralateral knee, the gait parameters of the operated limb still has significant gaps in functionality, such as the external rotation and flexion and extension. The single support time, cadence, knee extension, and knee external rotation of the operated limb have a greater correlation with the postoperative WOMAC score. Postoperative rehabilitation exercises should be emphasized, which is of great value for improving the early efficacy of RATKA.

The reliability and validity of the Chinese version of the Edinburgh visual gait score for children with cerebral palsy / 中华物理医学与康复杂志

Objective:To evaluate the reliability and validity of the Chinese version of the Edinburgh visual gait score (EVGS-CN) for children with cerebral palsy.Methods:The EVGS-CN was established following international guidelines for translation and cross-cultural validation of health status questionnaires. Videos of 30 children with cerebral palsy were assessed independently by six raters (with different levels of experience in gait analysis) using the EVGS-CN. Inter- and intra- observer reliability were evaluated using intraclass correlation coefficients (ICCs). The correlation analysis and group comparison were used to test the technique′s criteria-related validity, convergent validity, and discriminant validity.Results:The ICC values of the 17 items in the EVGS-CN ranged from 0.20 to 0.87 for inter-observer reliability, and from 0.41 to 0.90 for intra-observer reliability. Most items showed good inter- and intra-observer reliability among experienced raters, but only a moderate level when used by inexperienced raters. The EVGS-CN results were strongly correlated with those of physician rating scale (PRS) ( r=0.77, P≤0.001) and observational gait scale (OGS) ( r=-0.85, P≤0.001), moderately correlated with the total gross motor function measure-D/E (GMFM-D/E) score ( r=-0.55, P≤0.01), and strongly correlated with 10MWT times ( r=-0.69, P≤0.001) and timed up and go (TUG) times ( r=0.60, P≤0.001). Moreover, significant differences in average EVGS score were found between different gross motor function classification system (GMFCS) levels and between affected limbs on different sides. Conclusion:The EVGS-CN demonstrates satisfactory reliability and validity in evaluating children with cerebral palsy when it is used by an experienced or inexperienced rater.

Anthropometric profile of leg length inequality and its impact on gait / Perfil antropométrico de la desigualdad en la longitud de las piernas y su impacto en la marcha

SUMMARY: Leg length inequality (LLI) affects gait - primarily pelvic and torso movements. LLI is present in around 40-70 % of the healthy population. Due to LLI's significant impact on the body, as well as the possible occurrence of a variety of associated health problems, the aim of this research is to determine whether there is a significant difference in pelvic movement in all three planes, depending on the degree of LLI. This study was conducted on a sample of 30 healthy subjects. The functional length of lower limbs was measured. When LLI was calculated, kinematic measures were taken of pelvic and lower limb movements during gait using 3D cameras and ©Vicon Motion Systems Ltd. UK. The obtained data on kinematic pelvic movement in all three planes during gait were compared with the reference values. The results show that there is no statistically significant difference in pelvic movement about the axes x, y, and z in cases of LLI of up to 18mm (p>0,05). There is a statistically highly significant positive correlation between the difference in functional leg length (r=0,575; p=0,008) and femur length (r=0,525; p=0,015) on one hand, and the difference in pelvic movement about the axis x on the other, compared to the reference values. In a healthy population with LLI from 0 to 18 mm, gait remains unaffected and an increase in LLI predominantly affects pelvic movement about the horizontal axis (x) - pelvic tilt, which exponentially increases with an increase in femur length discrepancy.

La diferencia en la longitud de las piernas (LLI, por sus siglas en inglés) afecta la marcha, principalmente los movimientos pélvicos y del dorso. La LLI está presente en alrededor del 40-70 % de la población sana. Debido al importante impacto de LLI en el cuerpo, así como a la posible aparición de una variedad de problemas de salud asociados, el objetivo de esta investigación fue determinar si existe una diferencia significativa en el movimiento pélvico en los tres planos, dependiendo del grado de LLI. Este estudio se realizó en una muestra de 30 sujetos sanos. Se midió la longitud funcional de los miembros inferiores. Cuando se calculó el LLI, se tomaron medidas cinemáticas de los movimientos pélvicos y de los miembros inferiores durante la marcha utilizando cámaras 3D y ©Vicon Motion Systems Ltd. UK. Los datos obtenidos sobre el movimiento pélvico cinemático en los tres planos durante la marcha se compararon con los valores de referencia. Los resultados mostraron que no existe diferencia estadísticamente significativa en el movimiento pélvico sobre los ejes x, y, y z en casos de LLI de hasta 18 mm (p>0,05). Existe una correlación positiva estadísticamente muy significativa entre la diferencia en la longitud funcional de la pierna (r=0,575; p=0,008) y la longitud del fémur (r=0,525; p=0,015), y la diferencia en el movimiento pélvico sobre el eje x por otro, en comparación con los valores de referencia. En una población sana con LLI de 0 a 18 mm, la marcha no se ve afectada y un aumento en LLI afecta predominantemente el movimiento pélvico sobre el eje horizontal (x) - inclinación pélvica, que aumenta exponencialmente con un aumento en la discrepancia de longitud del fémur.

Cambios en la marcha asociados con demencia por cuerpos de Lewy: una revisión narrativa de la literatura / Gait changes associated with Lewy body dementia: a narrative review of the literature

RESUMEN INTRODUCCIÓN: La demencia por cuerpos de Lewy (DCL) es una enfermedad neurodegenerativa con alta prevalencia y a menudo subdiagnosticada. En las demencias pueden presentarse alteraciones en la marcha que potencialmente permitan identificar su subtipo y dar una orientación clínica, diagnóstica y terapéutica temprana. Esta revisión narrativa de la literatura busca revisar los cambios de la marcha que se han descrito asociados con DCL. MATERIALES Y MÉTODOS: Se realizó una revisión de la literatura sobre la relación de las alteraciones de la marcha con la DCL. Se seleccionaron los siguientes parámetros de búsqueda mediante el buscador Scopus: ((falls and dementia and gait and (evaluation or analysis))). Los datos se ordenaron según relevancia y se obtuvieron 267 resultados. Igualmente, se hizo una búsqueda en PubMed, para a la que se introdujeron los términos (gait and lewy-body-disease), y no se utilizaron otros filtros; se obtuvieron 139 resultados. Se hizo una selección no sistemática de los artículos para llevar a cabo una revisión narrativa acerca de los cambios en la marcha asociados con DCL. RESULTADOS: Las alteraciones en la marcha pueden tener un valor predictor importante en la DCL. Los pacientes con demencias no debido a EA o causas vasculares muestran un deterioro de la funcionalidad física más rápido comparado con pacientes con EA y sin problemas cognitivos. La priorización incorrecta de las tareas, evidenciada en la EP, también es observable en los pacientes con DCL, y se asocia con el paradigma de doble tarea en el paciente con trastorno neurocognitivo mayor. El congelamiento de la marcha, también conocido como bloqueo de la marcha, se ha asociado con mayor progresión de la alteración cognitiva. Los pacientes con DCL también presentan un mayor compromiso en el tiempo de balanceo y la variabilidad de duración de la zancada, como también peor desempeño en ritmo y variabilidad de la marcha, e inestabilidad de la marcha, con posturas inadecuadas. CONCLUSIONES: Existe una relación entre la DCL y las caídas en el adulto mayor. En este grupo de edad, los cambios en la marcha y en las pruebas de desempeño podrían tener una utilidad clínica como factores asociados a con DCL, así como con las caídas. Al parecer, existe una variación característica entre los parámetros de la marcha y los subtipos de demencias que puede tener un valor como marcador diagnóstico. Se requieren más estudios con respecto a este tema puesto que hay escasa evidencia disponible hasta el momento, lo cual impide definir con mayor precisión las alteraciones más sensibles de cada dominio de la marcha que permitan diferenciar el envejecimiento normal del patológico.

ABSTRACT INTRODUCTION: Lewy body dementia is a highly prevalent neurodegenerative disease and often goes unnoticed due to little knowledge about it. In dementias there may be gait alterations that potentially allow the identification of its subtype and provide early clinical, diagnostic, and therapeutic guidance. This narrative review of the literature aims to review gait changes that have been described as associated with Lewy body dementia. MATERIALS AND METHODS: A literature review was carried out on the relationship of gait disturbances and LBD. The following search parameters were selected using the Scopus search engine: ((falls and dementia and gait and (evaluation or analysis))). The data were ordered according to relevance, obtaining 267 results. Likewise, a search was made in PubMed, using the terms (gait and lewy-body-disease), and no other filters were used, obtaining 139 results. A non-systematic selection of literature was made to carry out a narrative review about the changes in gait associated with LBD. RESULTS: We found that gait disturbances may have an important predictive value in LBD. Patients with dementias not due to AD or vascular causes have a faster deterioration of physical function compared to patients with AD and without cognitive problems. The incorrect prioritization of tasks evidenced in PD is also observable in patients with LBD and is associated with the "dual-task" paradigm in patients with major neurocognitive disorder. Freezing of gait, also known as motor block or "freezing of gait" has been associated with a greater progression of cognitive impairment. Patients with LBD also show greater compromise in swing time, stride duration variability, poorer performance in gait pace and variability, and gait instability with inappropriate postures. CONCLUSIONS: We observe that there is a relationship between LBD and falls in the elderly. Changes in gait and performance tests could have clinical utility as factors associated with LBD as well as falls in the elderly. There appears to be a characteristic variation between gait parameters and dementia subtypes that may have value as a diagnostic marker. More studies are required on this subject since there is little evidence available to date, which makes it impossible to define with greater precision the most sensitive alterations in each domain of gait that make it possible to differentiate normal from pathological aging.

Gait Analysis of Hip Disarticulation Amputees Based on Kinematic Parameters and Plantar Pressure Measurement / 医用生物力学

Objective To analyze the gait characteristics of hip disarticulation amputees, and analyze the reasons for their differences from normal gait, so as to assist clinical diagnosis and evaluation. Methods Through the portable human motion capture device and plantar pressure analysis system, the kinematics and plantar pressure information of 5 hip amputees were collected and compared with 15 healthy volunteers in control group. Gait differences between the amputees and normal subjects and between the affected leg side and the healthy leg side of the amputees were compared. Results The proportion of double-support period for hip amuptees was higher than that of normal gait. Step length, step time, loading response period, mid support period, pre-swing period, proportion of the swing period for the affected leg side and healthy leg side of hip amputees showed significant differences with those of control group. The relative symmetry index of the gait for hip amputees was 0.60±0.05. Compared with the affected leg side, the support period of the healthy leg side was extended, the step length was shortened, the ground reaction force was greater than that of the affected leg side, and the center of pressure trajectory shifted to the affected leg side. Conclusions The gait of hip amputees is significantly different from that of normal people. Hip amputees have weak walking ability, poor gait symmetry, and they lack of continuity in the body’s center of gravity. The results provide experimental basis and theoretical analysis for the design of mechanical structure and control system of novel hip prosthesis.

Knee Joint Moment Estimation During Walking via Wearable Inertial Sensor Network / 医用生物力学

Objective To estimate knee adduction moment (KAM) and knee flexion moment (KFM) under different gait test conditions via an inertial sensor network (ISN). Methods Twelve healthy young male subjects wore eight inertial sensors (located in the trunk, pelvis, both thighs, both shanks, both feet) and walked under different test conditions (changing foot progression angle, trunk sway angle, step width and walking speed). An ISN was used to extract biomechanical features as the input of recurrent neural network (RNN), so as to estimate the KAM and KFM. Results The overall KAM estimation accuracy: relative root mean square error (rRMSE) was 8.54% and r=0.84. The overall KFM estimation accuracy was rRMSE=6.40% and r=0.94. Conclusions The model can be used as the basis for load estimation of knee joints out of the lab and its potential application includes gait training and rehabilitation assessment after knee surgery.

Topological Structure and Biomechanics of Three-Dimensional Printed Height Increasing Insoles for Leg Length Discrepancy / 医用生物力学

Objective To study topological structure of a new type of three-dimensional (3D) printed height increasing insoles for leg length discrepancy (LLD) and its effect on biomechanics of lower limbs. Methods Topological structure for middle and rear part of the insole was optimized by solid isotropic microstructures with penalization (SIMP), the force was loaded and the boundary conditions were set according to force area of the insole, and the height increasing insole with thermoplastic polyurethanes (TPU) materials was printed by selected laser sintering (SLS). The insoles were used in 9 patients with LLD, visual analogue scale (VAS) and Maryland foot function scores were used to compare pain and foot function changes of patients before and after using the insole, and the 3D gait analysis system was used to compare spatiotemporal parameters and vertical ground reaction force (vGRF) of both lower limbs. Result sAfter the patient wore 3D printed insole, VAS scores decreased, Maryland foot function scores increased, vGRF of both lower limbs decreased, and the difference of cadence, stance phase and swing phase in both lower limbs decreased. Conclusions The 3D printed height increasing insole after topology optimization can improve coordination of lower limb movement, reduce ground impact, relieve pain and improve foot function, thus providing an effective personalized orthopedic plan for LLD treatment in clinic.

Common gait assessment methods for neurological diseases / 中华神经科杂志

Gait is a behavioral characteristic of human walking. The formation mechanism of gait is complex and involves multiple organ systems throughout the body, so there are many factors that affect it. Many factors, such as genetics, diseases and accidental injuries, can change a certain link in the walking cycle, leading to changes in gait and abnormal gait. Accurate assessment of abnormal gait can help diagnose the disease, determine the severity of the disease, predict symptom improvement and future functional status, plan appropriate treatment targets, and monitor the effectiveness of interventions. This paper reviews the gait assessment methods commonly used in neurology, including qualitative gait assessment, scale assessment and instrumentalized gait assessment, in order to improve medical staff′s understanding and application ability of common gait assessment methods.

Markerless Gait Analysis System Based on Deep Learning Fusion algorithm / 医用生物力学

Objective Taking three-dimensional (3D) motion capture system (MoCap) as the gold standard, a deep learning fusion model based on bi-lateral long short-term memory (BiLSTM) recurrent neural network and linear regression algorithm was developed to reduce system error of the Kinect sensor in lower limb kinematics measurement. Methods Ten healthy male college students were recruited for gait analysis. The 3D coordinates of the reflective markers and the lower limb joint centers were simultaneously collected using the MoCap system and the Kinect V2 sensor, respectively. The joint angles of lower limbs were calculated using the Cleveland clinic kinematic model and the Kinect kinematic model, respectively. The dataset was constructed using the MoCap system as the target and the angles via the Kinect system as the input. A BiLSTM network and a linear regression model for all lower limb angles were developed to obtain the refined angles. A leave-one subject-out cross-validation method was employed to study the performance of the models. The coefficient of multiple correlations (CMC) and root mean square error (RMSE) were used to investigate the similarity and the mean deviation between the joint angle waveforms via the MoCap and the Kinect system. ResultsIn comparison with the linear regression algorithm, the BiLSTM had better performance in the aspect of dealing highly nonlinear regression problems, especially for hip flexion/extension, hip adduction/abduction, and ankle dorsi/plantar flexion angles. The deep learning refined model significantly reduced the system error of Kinect. The mean RMSEs for all joint angles were mainly smaller than 10°, and the RMSEs of the hip joint were smaller than 5°. The joint angle waveforms presented very good similarity with the golden standard. The CMCs of joint angles were greater than 0.7 except for hip rotation angle. Conclusions The markerless gait analysis system based on deep learning fusion model developed in this study can accurately assess lower limb kinematics, joint mobility, walking functions, and has good prospect to be applied in clinical and home rehabilitation.

Effects of electroacupuncture pretreatment on motor function and cerebral blood flow in MCAO model rats / 针灸推拿医学（英文版）

Objective: To observe the effects of electroacupuncture (EA) pretreatment on motor function, cerebral blood flow, cerebral infarction volume, and vascular endothelial growth factor (VEGF) level in middle cerebral artery occlusion (MCAO) model rats. Methods: Twenty-four male Sprague-Dawley rats were randomly divided into a normal group, a model group, and an EA group, with eight rats in each group. The middle cerebral artery ischemia-reperfusion model was established by the suture-occluded method in the model group and the EA group, while not in the normal group. The EA group was pretreated with EA at bilateral Fengchi (GB20) before model preparation, once a day for 30 min each time for a total of 7 d. The changes in the CatWalk gait parameters, modified Bederson neurological deficit score, cerebral blood flow, cerebral infarction volume after ischemia, and VEGF level in the brain tissue of rats in each group were observed. Results: Compared with the normal group, the modified Bederson neurological deficit score in the model group and the EA group increased after modeling (P<0.05), and the CatWalk gait parameters (one-leg stance duration, gait cadence, and gait cycle) were all changed (P<0.05). Compared with the model group, the modified Bederson neurological deficit score in the EA group decreased (P<0.05), and the CatWalk gait parameters improved (P<0.05). Immediately after ischemia, the cerebral blood flow in the normal group was greater than that in the model group and the EA group (P<0.05); after reperfusion, the cerebral blood flow in the EA group was greater than that in the model group (P<0.05). Compared with the normal group, the cerebral infarction volume in the model group and the EA group increased (P<0.05). Compared with the model group, the cerebral infarction volume in the EA group decreased (P<0.05). The expression level of VEGF-positive cells in the rat brain tissue in the model group was higher than that in the normal group (P<0.05), and was higher in the EA group than in the model group (P<0.05). Conclusion: EA pretreatment improves the limb motor function in MCAO model rats, alleviates the symptoms of neurological deficits, promotes the recovery of cerebral blood flow, reduces the cerebral infarction area after MCAO modeling, and increases the VEGF expression in the brain tissue.

The effects of a half palm ankle-foot orthosis and a hollow-heel ankle-foot orthosis on the gait of stroke survivors / 中华物理医学与康复杂志

Objective:To observe any effect of a half palm ankle-foot orthosis and a hollow-heel ankle-foot orthosis on the gait of stroke survivors.Methods:The walking of twenty-five stroke survivors was quantified using a gait analysis system. They walked barefoot, wearing a half palm ankle-foot orthosis and wearing a hollow-heel ankle-foot orthosis. Walking speed, step frequency, duration of the swing phase on the healthy and affected sides, risk of falling and Timed Up and Go (TUG) test times were recorded and analyzed.Results:The average gait frequency when wearing the hollow-heel ankle-foot orthosis was significantly faster than that in the other two conditions. The gait asymmetry coefficient was significantly different when the subjects wore the hollow-heel ankle-foot orthosis compared with walking barefoot. Compared with being barefoot, the average TUG time was significantly shorter when wearing either orthosis and the risk of falling was significantly less. The fall risk was significantly lower when wearing the hollow-heel orthosis compared to the half palm orthosis.Conclusion:Wearing either ankle-foot orthosis can significantly correct the gait of stroke survivors and lower their risk of falling, with better effect when wearing the hollow-heel ankle-foot orthosis.