Correlación entre la Velocidad de Marcha y Largo del Paso en Personas Mayores de la Cuarta Edad que Viven en la Comunidad / Correlation between Walking Speed and Step Length in Seniors Living in the Community

Introducción. La población de personas mayores de la cuarta edad (≥80 años) crece a gran velocidad. Esta se diferencia de la tercera edad en cuanto a su funcionalidad. Es sabido que mientras menor sea la velocidad de la marcha en esta población, mayor es el riesgo de deterioro cognitivo, sarcopenia, discapacidad e institucionalización. La velocidad de marcha disminuida es un predictor importante de deterioro en el rendimiento físico. Objetivo. Determinar la correlación entre la velocidad de marcha, fuerza de miembros inferiores y largo del paso en personas mayores de cuarta edad que viven en la comunidad. Métodos. Estudio transversal en personas mayores saludables de la cuarta edad (n=14; 8 mujeres; 88 ± 3 años; 26,3 ± 3,4 kg·m-2) que fueron sometidas a evaluaciones de rendimiento físico, tales como largo del paso; fuerza de miembros inferiores a través de 1 Repetición Máxima (1RM) de extensión de rodilla en ambos miembros inferiores y velocidad de marcha en 4 metros. Los datos se presentan como media±desviación estándar. Se consideró un valor de P significativo < 0.05. Resultados. Se observó una correlación positiva moderada entre el largo del paso y la velocidad de marcha (R=0,794; P=0,001). No existieron correlaciones entre la fuerza de miembros inferiores y largo del paso (R=0,478; P=0,084), tampoco entre las variables de fuerza y velocidad de marcha (R=0,441; P=0.115). Conclusión. Las personas mayores de cuarta edad presentan una correlación positiva entre su velocidad de marcha y largo del paso.

Background. The population of people older than the fourth age (≥80 years) is growing rapidly. This differs from the third age in terms of its functionality. It is known that the lower the gait speed in this population, the greater the risk of cognitive impairment, sarcopenia, disability and institutionalization. Decreased gait speed is an important predictor of deterioration in physical performance. Objetive. To determine the correlation between gait speed, lower limb strength and stride length in fourth age people (≥80 years) who live in the community. Methods. Cross-sectional study in healthy older people of the fourth age (n=14; 8 women; 88 ± 3 years; 26.3 ± 3.4 kg·m-2) who underwent physical performance evaluations, such as long of the step; strength of lower limbs through 1 Maximum Repetition (1RM) of knee extension in both lower limbs and walking speed in 4 meters. Data are presented as mean ± standard deviation. A significant P value < 0.05 was considered. Results. A moderate positive correlation was observed between stride length and gait speed (R=0.794; P=0.001). There were no correlations between the strength of the lower limbs and stride length (R=0.478; P=0.084), nor between the variables of strength and gait speed (R=0.441; P=0.115). Conclusion. Fourth age older people older present a positive correlation between their walking speed and stride length.

Riesgo de Caídas y Parámetros de Marcha en Personas Mayores de la Comunidad: ¿Cuáles son los Indicadores de Función y Disfunción del Movimiento? / Risk of Falls and Gait Parameters in Community Elderly: What Are the Indicators of Movement Function and Dysfunction?

Introducción. La población de personas mayores (PM) en Chile presenta un incremento sostenido con importantes tasas de fragilidad y riesgo de caídas (RC). El desempeño de marcha permite valorarlo mediante parámetros mecánicos y fisiológicos. Nos preguntamos, ¿cuáles podrían ser los más relevantes para estimar RC en condiciones de marcha confortable (MC) y máxima (MM)? Objetivo. Identificar los principales parámetros de marcha que podrían explicar RC en PM autovalentes de la comunidad. Métodos. Estudio observacional y transversal en el cual participaron 53 PM autovalentes de la comuna de Talca, Chile (edad 71±7años; IMC 29,1±3,4 kg/m2). Se solicitó a los participantes la ejecución de MC (n=53) y posteriormente MM (n=36). Ambas modalidades fueron desarrolladas en un circuito elíptico de 40m durante 3min. El RC se categorizó como: "sin riesgo", "riesgo dinámico" según prueba timed up and go (TUG) positiva, "riesgo estático" según estación unipodal (EUP) positiva y "riesgo mixto" con ambas pruebas positivas. Para la visualización de la variación gráfica en el morfoespacio de los individuos según RC, se realizó un análisis de componentes principales (ACP) mediante el Programa RStudio, utilizando 6 variables cinemáticas: i) velocidad promedio de marcha (VPM), ii) cadencia, iii) máximo despeje del pie (MDP), iv) coeficiente de variación (%CV) del MDP, v) longitud de zancada (LZ) y vi) %CV de la LZ. Además de 2 variables fisiológicas: i) % frecuencia cardiaca de reserva utilizada (%FCRu) y ii) el índice de costo fisiológico según la relación entre FC y VM (latidos/metros). Resultados. Para MC las dimensiones del ACP explican el 56% de la variabilidad de los datos, siendo los indicadores de seguridad de RC la VM, cadencia, LZ y MDP. La variabilidad de marcha explica RC mixto y el ICF junto al %FCRu se asocian a RC dinámico. En condiciones de MM, el ACP explica 60% de la variabilidad de datos, donde las PM sin RC se asocian con VM, LZ y MDP. Por su parte, la variabilidad del MDP se vincula con RC dinámico y las variables fisiológicas con el RC mixto. Conclusiones. Los parámetros de marcha que mejor explican una marcha segura y eficiente son cinemáticos de la fase de balanceo, mientras que la variabilidad y el costo fisiológico se asocian como indicadores de RC dinámico y mixto.

Background. Introduction: The elderly population (EP) in Chile is experiencing a sustained increase with significant rates of frailty and risk of falls (RF). Gait performance can be assessed using mechanical and physiological parameters. We wonder, which ones could be the most relevant to estimate RF in self-selected walking speed (SSWS) and maximum walking speed (MWS) conditions? Objective. Identify the main gait parameters that could explain RF in self-sufficient elderly individuals from the community. Methods. This observational and cross-sectional study included 53 self-sufficient elderly individuals from the commune of Talca, Chile (age 71±7 years; BMI 29.1±3.4 kg/m2). Participants were asked to perform SSWS (n=53) and subsequently MWS (n=36). Both modalities were conducted on a 40m elliptical circuit for 3 minutes. RF was categorized as: "no risk," "dynamic risk" based on a positive timed up and go test, "static risk" based on a positive one-legged stance test, and "mixed risk" with both tests positive. To visualize the graphical variation in the morphospace of individuals according to RF, a principal component analysis (PCA) was conducted using RStudio, utilizing 6 kinematic variables: i) walking speed (WS), ii) cadence, iii) maximum foot clearance (MFC), iv) coefficient of variation (%CV) of MFC, v) stride length (SL), and vi) %CV of SL. In addition to 2 physiological variables: i) % of reserve heart rate used (%RHRu) and ii) the physiological cost index based on the relationship between heart rate and WS (heartbeats/meters). Results. For SSWS, the PCA dimensions explained 56% of the data variability, with gait safety indicators such as WS, cadence, SL, and MFC explaining RF. Gait variability explains mixed RF, while the physiological cost index and %RHRu are associated with dynamic RF. In MWS conditions, PCA explains 60% of the data variability, where the elderly persons without RF are associated with WS, SL, and MFC. On the other hand, MFC variability is related to dynamic RF, and physiological variables are associated with mixed RF. Conclusions. The gait parameters that best explain safe and efficient walking are kinematic parameters of the swing phase, while variability and physiological cost are indicators of dynamic and mixed RF.

Alterações na cinemática angular da marcha de pacientes hemiparéticos após Acidente Vascular Encefálico / Changes in gait angular kinematics of hemiparetic patients After Cerebrovascular Accident

O objetivo deste estudo foi analisar as alterações na cinemática angular da marcha de adultos com hemiparesia após acidente vascular encefálico (AVE). A amostra foi composta por 17 pacientes pós-AVE; e, para a avaliação da marcha, foi utilizado um sistema de captura da trajetória tridimensional da marcha. Quanto aos membros sadio e afetado, as variáveis estudadas foram: velocidade, ângulos máximos de flexão e extensão do quadril e joelho. Para as comparações entre os membros, foi utilizado o teste t pareado; e, para as comparações com valores normais, o teste t para uma amostra, considerando, como critério de decisão, o nível de significância p ≤ 0,05. Os resultados demonstraram, na comparação entre os membros, diferenças significantes na flexão (0,001) e extensão de joelho (0,05). Já na comparação entre o membro afetado e o sadio, destaca-se a diferença significante das angulações de flexão de joelho (<0,000) e extensão de quadril (0,004). Os pacientes com hemiparesia pós-AVE apresentam alterações na cinemática angular da marcha quando comparado o membro afetado com o sadio e com os valores da normalidade. Observou se um padrão de marcha predominantemente flexor, com grande variabilidade entre os pacientes avaliados.

This study aimed to analyze changes in gait angular kinematics of adults with hemiparesis after cerebrovascular accident (CVA). The sample consisted of 17 post- cerebrovascular accident (CVA) patients; and, for gait evaluation, it used a three-dimensional gait trajectory capture system. As for healthy and affected limbs, the variables studied were: speed, maximum angles of flexion, and extension of the hip and knee. For the comparisons between the members, the study used the t-paired test; and, for comparisons with normal values, it used the t test for a sample, whereas, as a decision criterion, the significance level p ≤ 0.05. The results showed, in the comparison between the limbs, significant differences in flexion (0.001) and knee extension (0.05). In the comparison between the affected limb and the healthy one, there is a significant difference in knee flexion angles (<0.000) and hip extension (0.004). Patients with post-CVA hemiparesis present changes in gait angular kinematics when the affected limb is compared with the healthy limb and with normal values. The study observed a predominantly flexor gait pattern, with a considerable variability among the evaluated patients.

A Nonlinear Identification Approach for Gait Analysis of Amyotrophic Lateral SclerosisPatients

Gait data analysis, is giving mixing results regarding locomotion changes associated to Amyotrophic Lateral Sclerosis (ALS) development; the need has been claimed for new tools. We applied a nonlinear identification approach to the study of gait data from both healthy and ALS patients, available from Physionet.org. Kernel nonparametric nonlinear autoregression allowed to obtain noise-free realizations (NFR) that mimicked original traces, though correlation between original data and corresponding NFR was lower among ALS patients (p=0.03), suggesting a higher contribution of stochastic influences. Visual inspection of phase portraits, reconstructed from NFR via Takens theorem application, suggested dynamics differences between control subjects and patients. This was confirmed when phase portrait features were quantified and submitted to discriminant analysis (89% of correct classifications; 24/28). Application of a nonlinear dissimilarity measure for comparing pairs gait recordings, defined as a distance between underlying nonlinear autoregressive functions allowed an excellent separation between ALS and controls, via multidimensional scaling. Obtained projection map clearly suggested that ALS traces lay in a narrower dynamical space. This might reflect the known fact about neuronal degeneration accompanying ALS progression. When dissimilarity matrix principal components were introduced as predicting variables, discriminant analysis yielded an 82% of correct classifications (23/28). Overall, our results suggest that a nonlinear identification approach, centered in the characterization of the dynamics of the gait process can bring new insights to gait data interpretation.

El análisis de datos de la marcha, está dando resultados mixtos con respecto a los cambios de locomoción asociados con el desarrollo de la esclerosis lateral amiotrófica (ELA). Se ha reivindicado la necesidad de nuevas herramientas de análisis de datos de la marcha. Aplicamos un enfoque de identificación no lineal al estudio de los datos de la marcha de pacientes sanos y con ELA, disponibles en Physionet.org. La auto-regresión no lineal no paramétrica del núcleo, permitió obtener realizaciones libres de ruido (NFR) que imitaban las trazas originales, aunque la correlación entre los datos originales y la NFR correspondiente fue menor entre los pacientes con ELA (p = 0,03), lo que sugiere una mayor contribución de las influencias estocásticas. La inspección visual de los retratos de fase, reconstruidos a partir de NFR mediante la aplicación del teorema de Takens, sugirió diferencias dinámicas entre los sujetos de control y los pacientes. Esto se confirmó cuando se cuantificaron las características del retrato de fase y se sometieron a un análisis discriminante (89 % de clasificaciones correctas; 24/28). La aplicación de una medida de disimilitud no lineal para comparar registros de marcha de pares, definida como una distancia entre funciones auto-regresivas no lineales subyacentes, permitió una excelente separación entre ALS y controles, a través de una escala multidimensional. El mapa de proyección obtenido sugirió claramente que las huellas de ALS se encuentran en un espacio dinámico más estrecho. Esto podría reflejar el hecho conocido sobre la degeneración neuronal que acompaña a la progresión de la ELA. Cuando se introdujeron los componentes principales de la matriz de disimilitud como variables predictoras, el análisis discriminante arrojó un 82% de clasificaciones correctas (23/28). En general, nuestros resultados sugieren que un enfoque de identificación no lineal, centrado en la caracterización de la dinámica del proceso de la marcha, puede aportar nuevos conocimientos a la interpretación de los datos de la marcha.

Treino de marcha robótica em pacientes com paralisia cerebral: uma análise retrospectiva / Robotic gait training in patients with cerebral palsy: a retrospective analysis

Objective: The present study sought to retrospectively evaluate the efficacy of robotic gait training in children with cerebral palsy (CP) gross motor function classification system (GMFCS) levels II, III and IV. Method: The medical records from 69 patients with CP, who participated in the Lokomat® protocol, were analyzed using a retrospective approach. The results from the Gross Motor Function Measure (GMFM), 6-minute walk test (6MinWT), 10-meter walk test (10MWT) and Timed Up and Go (TUG) test were analyzed before and after the protocol was administered. Results: An improvement in GMFM was observed for all GMFCS levels. GMFCS level III patients showed a significant improvement in the 6MinWT (p= 0.01), and GMFCS level IV patients displayed a significant improvement in GMFM dimension B (p= 0.03). All tests showed a significant improvement when compared to their performance before the application of the protocol. Conclusion: The study suggests that all patients diagnosed with CP benefit from gait training, using the Lokomat® system, within their expected motor frame.

Objetivo: Verificar retrospectivamente a eficácia do treino de marcha com robótica (Lokomat®) em pacientes com Paralisia Cerebral (PC) níveis II, III e IV da Medida da Função Motora Grossa (GMFCS). Método: Análise retrospectiva descritiva do prontuário de 69 pacientes com PC que realizaram o protocolo da Lokomat®. Os resultados do teste de caminhada de 6 minutos (TC6M), teste de caminhada de 10 metros (TC10M), Timed Up and Go (TUG) e da Avaliação da Função Motora Grossa (GMFM) foram realizados e analisados pré e pós protocolo. Resultados: Foi observada uma melhora no GMFM para pacientes de todos os níveis do GMFCS. Pacientes GMFCS nível III apresentaram melhora significativa do TC6M (p= 0,01) e pacientes GMFCS nível IV apresentaram melhora significativa da dimensão B do GMFM (p= 0,03). Todos os testes mostraram melhoras significativas quando comparados aos resultados antes da aplicação do protocolo. Conclusão: O estudo sugere que todos os pacientes com diagnóstico de PC se beneficiaram do treino de marcha com uso da Lokomat® dentro de seu quadro motor esperado.

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.

Measurement properties of the Brazilian Portuguese version of the Lower-Extremity Motor Activity Log for chronic hemiparetic poststroke patients / Propriedades de medida da versão brasileira da Lower-Extremity Motor Activity Log para pacientes hemiparéticos crônicos pós-AVC

Abstract Background Stroke is among the three leading causes of disability around the world, and it results in immediate difficulty in mobility and gait. There is a lack of instruments to evaluate what daily life is like for these individuals using their lower limbs in real-life environments (outside of the clinical environment). Objective To perform the translation and cultural adaptation to Brazilian Portuguese of the Lower-Extremity Motor Activity Log (LE-MAL) and test its measurement properties in chronic poststroke individuals. Methods The LE-MAL was translated into Brazilian Portuguese and adapted to the Brazilian culture. The comprehension and relevance of the final version were analyzed by a committee of specialists. The reliability, validity, and responsiveness of the LE-MAL/Brazil to detect changes after lower extremity constraint-induced movement therapy (LE-CIMT) and an intensive conventional therapy were tested. Results The LE-MAL/Brazil showed excellent inter- and intrarater reliability, with an intraclass correlation coefficient and Cronbach alpha > 0.70, as well as standard error of measurement and smallest detectable change < 10% of the total instrument score when applied by the same evaluators. Conclusion The responsiveness of the LE-MAL/Brazil to detect changes showed better results after LE-CIMT than after the intensive conventional therapy, with most of the correlations > 0.50.

Resumo Antecedentes O acidente vascular cerebral (AVC) é a terceira causa de deficiência ao redor do mundo, e resulta em dificuldades imediatas relativas à marcha e à mobilidade. Nota-se a ausência de instrumentos que avaliem o dia a dia desses indivíduos quanto ao uso dos membros inferiores em ambientes reais (fora do ambiente clínico). Objetivo Traduzir e fazer a adaptação cultural para o português do Brasil da Lower-Extremity Motor Activity Log (LE-MAL), e testar suas propriedades psicométricas em indivíduos hemiparéticos crônicos pós-AVC. Métodos A LE-MAL foi traduzida para o português do Brasil e adaptada para a cultura brasileira. A compreensão e a confiabilidade da versão final foram testadas por um comitê de especialistas. A confiabilidade, a validade e a responsividade em detectar mudanças após a terapia de contensão induzida para membros inferiores (TCI-MMII) e uma terapia convencional também foram testadas. Resultados A LE-MAL/Brazil mostrou excelente confiabilidade intra e interavaliador, com coeficiente de correlação intraclasse e alfa de Cronbach > 0,70, bem como erro padrão da medida e mínima mudança detectável < 10% da pontuação total quando aplicada pelo mesmo avaliador. Conclusão A responsividade da LE-MAL/Brazil em detectar mudanças após a TCI-MMII apresentou resultados melhores do que após a terapia convencional, com a maioria das correlações > 0,50.

Flexible flatfoot in the childhood: negative influence of inappropriate footwear

An analysis was carried out in relation to the adverse effects produced by the use of inadequately made footwear in patients with flexible flat feet in pediatric ages; we carried out an anatomical-functional reminder of the foot as a basic structure for standing and walking. The functional adaptability of the feet was valued in those populations with the habit of walking barefoot, also making a description of the basic characteristics that a properly made footwear must have. We address the different therapeutic approaches and their behavior over time. We highlight the widespread use in our society of inappropriate footwear, mainly of the flip-flop type, and its negative influence on the feet of those children with flexible flat feet and valgus of the ankle.

Se llevó a cabo un análisis en relación a los efectos adversos producidos por el uso de calzados de confección inadecuada en los pacientes portadores de pies planos flexibles en edades pediátricas. Se realizó un recordatorio anatomo-funcional del pie como estructura básica para la bipedestación y la marcha. Se valoró la adaptabilidad funcional de los pies en aquellas poblaciones con hábito de andar descalzos, haciéndose, además, una descripción de las características básica que debe reunir un calzado adecuadamente confeccionado. Se abordó los diferentes enfoques terapéuticos y su comportamiento en el tiempo, destacando el uso generalizado en la sociedad cubana de calzados inapropiados, principalmente del tipo chancletas, y su influencia negativa sobre los pies de aquellos niños con pies planos flexibles y tobillo valgo.

Efeitos de um treinamento com dispositivo comercial de realidade virtual imersiva sobre a marcha e cognição de pessoas com doença de Parkinson / Effects of a commercial immersive virtual reality device-based training on gait and cognition in people with Parkinson's disease

Objetivo: Avaliar a eficácia e a usabilidade de um treinamento imersivo de realidade virtual usando o Samsung Gear VR OculusTM (SGVR) para marcha e cognitivo em pessoas com doença de Parkinson (DP). Foi realizado um ensaio clínico controlado, quase experimental e cego. Método: Quarenta pessoas com DP foram divididas em dois grupos. O Samsung Gear Virtual Reality Group (VRG) participou de 10 sessões, duas vezes por semana, com duração de uma hora cada, realizando quatro jogos que exigiam movimento da cabeça e deslocamento do centro de gravidade. O grupo controle não recebeu tratamento. Os participantes foram avaliados antes, após a intervenção e 30 dias após a intervenção, com avaliação da marcha por meio do teste Timed Up and Go, teste de caminhada de 10 metros, teste de caminhada de 30 segundos com tarefa simples e dupla e avaliação cognitiva com teste de fluência verbal, dígito para frente e para trás Testes de amplitude e teste Stroop Color. Ao final do treinamento, a VRG respondeu ao questionário System Usabilidade Scale para avaliar a usabilidade do sistema. Resultados: Embora o sistema tenha sido avaliado com excelente usabilidade pelos usuários, não houve efeitos de interação e, portanto, nossos resultados não suportam que o treinamento de realidade virtual imersiva usando jogos SGVR foi superior a nenhum treinamento. Conclusão: No entanto, quando cada grupo foi examinado separadamente, o VRG apresentou melhoras, após a intervenção e 30 dias após a intervenção, para velocidade da marcha (p<0,005 e p<0,001, respectivamente), memória de trabalho, atenção e processamento de informações (p<0,01 em ambos os momentos de avaliação), inibição de resposta, memória de trabalho e de longo prazo (p< 0,01 em 30 dias após a intervenção). A avaliação adicional do dispositivo SGVR é necessária

Objective: Evaluate the effectiveness and the usability of an immersive virtual reality training using Samsung Gear VR OculusTM (SGVR) for gait and cognitive in people with Parkinson's disease (PD). Controlled, quasi-experimental and blinded clinical trial was carried out. Methods: Forty people with PD were divided into two groups. Samsung Gear Virtual Reality Group (VRG) participated in 10 sessions, twice a week, lasting one hour each, performing four games that required head movement and center of gravity shift. Control group didn't receive treatment. Participants were evaluated before, after the intervention and 30 days after intervention, with the Timed Up and Go test, 10 meters walking test, single and dual tasking 30 seconds walking test, verbal fluency test, forward and backward Digit Span tests and Stroop Color test. At the end of the training, VRG responded to the System Usability Scale questionnaire to assess the usability of the system. Results: Even though the system was rated with excellent usability by the users, there were no interaction effects and, therefore, our results do not support that immersive virtual reality training using SGVR games was superior to no training. However, when each group was examined separately, the VRG experienced improvements, after the intervention and 30 days after intervention, for gait velocity (p<0.005, p<0.001, respectively), working memory, attention, and information processing (p<0.01 in both evaluation time points), response inhibition, working and long-term memory (p< 0.01 in 30 days after intervention). Conclusion: Further evaluation of the SGVR device is required

Análise da pisada e da marcha com o uso da órtese TheraTogs® em criança com paralisia cerebral atetóide: um relato de caso / Stepping and gait analysis using TheraTogs® orthosis in a child with athetoid cerebral palsy: a case report

Para crianças com paralisia cerebral (PC), as órteses assumem papel importante em seu desempenho funcional. Objetivo: Analisar a pisada estática e a marcha de uma criança com PC do tipo atetóide após uso diário do TheraTogs®. Método: Estudo de caso de um menino com nove anos de idade, PC do tipo atetóide, já possuía a veste terapêutica, mas não aplicava diariamente. Foi possível verificar dados do sujeito por meio de uma entrevista com a família e, para caracterização motora inicial, utilizou-se o Gross Motor Function Measure ­ 88. Para o diagnóstico e avaliação plantar, executou-se o baropodômetro e, na aferição cinemática da marcha, empregou-se a câmera Gopro Hero 7. O sujeito passou a usar de seis a 10 horas ao dia por oito semanas de forma sistemática e foi reavaliado. Resultado: O mesmo apresentou melhora na passada, redução da rotação externa de quadril e no apoio do pé direito (D) no solo. Na pisada estática, o ponto máximo de pressão ocorreu em retropé D, o centro de gravidade sofreu uma lateralização para a esquerda (E). No arco longitudinal ocorreu uma diminuição da carga, principalmente no médio pé D, onde a pressão maior foi no calcanhar. No médio pé E a descarga no arco longitudinal reduziu, mas ainda permaneceu. Conclusão: Foram encontradas mudanças na pisada estática e na marcha de um paciente com PC do tipo atetóide com uso diário, por oito semanas. São necessárias mais pesquisas que investiguem esse tema

For children with cerebral palsy (CP), the orthotics turn an important role in their functional performance. Objective: The aim of the study was to analyze the static footstep and gait of a child with athetoid type CP after daily use of TheraTogs®. Method: Case study of a nineyear-old boy, CP of the athetoid type, who already had the therapeutic garment, but did not wear it daily. It was possible to verify the individual's data through an interview with the family and for the subject's initial motor characterization, the Gross Motor Function Measure - 88 was used. For the diagnosis and plantar evaluation, a baropodometer was applied, and for the kinematic gait measurement, the Gopro Hero 7 camera was used. The subject started to use it systematically, for a period of six to ten hours a day, for eight weeks and was re-evaluated. Results: He showed improvement in the step, reduction in the external rotation of the knee and hip and in the support of the right foot (R) on the ground. In static treading, the maximum pressure point occurred in hindfoot R, the center of gravity was lateralized to the left (L), in the longitudinal arch there was a decrease in load, especially in the midfoot R, where the greatest pressure was in the heel. In the midfoot L this discharge in the longitudinal arc was reduced, but it still remained. Changes were found in the static tread and gait of a patient with CP of the athetoid type with daily use, for eight weeks. More studies are necessary to investigate this topic. Conclusion: In spite of the static tread and gait changes that were found, more research will be necessary to investigate the required time of use and its advantages in the long term

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.

Analysis on Biomechanical Relationship Between Calcaneal Cyst Lesion Size and Pathological Fracture / 医用生物力学

Objective To investigate the relationship between lesion size of solitary bone cyst ( SBC) and pathological fracture of calcaneus, so as to provide references for the treatment of SBC. Methods The three dimensional (3D) finite element model of foot and ankle was established based on CT images. Four models with gradient spherical bone defects were constructed in the focal area to simulate different SBC lesion sizes, and the biomechanical characteristics of calcaneus in different gait phases were analyzed. Results With the increasement of SBC size, the kinematics of calcaneus did not change significantly, but the peak stress of calcaneus increased gradually. When the SBC size exceeded 75% of the calcaneal width, the stress in calcaneal sulcus and cortical bone below SBC increased by 1. 48 times and 7. 74 times, respectively. Conclusions The risk of pathological fracture increases when the SBC diameter exceeds 75% of the calcaneal width, and early surgical intervention should be recommended. The calcaneal sulcus and the cortex bone below SBC are stress concentration regions and can be used as important areas to evaluate pathological fractures.

Effects of PEEK Anisotropy Formed by 3D Printing on Mechanical Properties of Femoral Substitutes / 医用生物力学

Objective Aiming at the problem of significant anisotropy in the three-dimensional ( 3D) printed polyether-ether-ketone ( PEEK) bone substitutes manufactured by material extrusion technology, taking the femur, the main load-bearing long bone of the lower limb, as an example, the biomechanical properties of the femoral model under different direction in the build chamber were evaluated by the combination of finite element analysis and in-vitro mechanical experiment. Methods A left femoral model was obtained by reconstruction from CT data. The stress and displacement of the 3D printed PEEK femur with different directions in the build chamber under five physiological postures in the human gait cycle were simulated by varying the orthogonal anisotropy mechanical properties. An in-vitro mechanical experiment was conducted to investigate the safety and stability of the femur through a 3D printed PEEK femur. Results When the long axis of the femur model was perpendicular to the building platform of the 3D printer, a better mechanical property was obtained, and the maximum von Mises stress was 46. 56 MPa, which was lower than the yield stress of PEEK, while the maximum displacement was larger than that of the natural femur under same loading condition. Therefore, the 3D printed PEEK femur met the strength requirement, but the stability needs to be improved. Conclusions The long axis is recommended to be perpendicular to the building platform when the material extrusion technology was used for the substitute of the load-bearing long bone, and the effect of its anisotropy on service performance of the substitute should be carefully considered when the 3D printing technology is used for load-bearing bone substitute.

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.

A two-dimensional video based quantification method and clinical application research of motion disorders / 生物医学工程学杂志

The increasing prevalence of the aging population, and inadequate and uneven distribution of medical resources, have led to a growing demand for telemedicine services. Gait disturbance is a primary symptom of neurological disorders such as Parkinson's disease (PD). This study proposed a novel approach for the quantitative assessment and analysis of gait disturbance from two-dimensional (2D) videos captured using smartphones. The approach used a convolutional pose machine to extract human body joints and a gait phase segmentation algorithm based on node motion characteristics to identify the gait phase. Moreover, it extracted features of the upper and lower limbs. A height ratio-based spatial feature extraction method was proposed that effectively captures spatial information. The proposed method underwent validation via error analysis, correction compensation, and accuracy verification using the motion capture system. Specifically, the proposed method achieved an extracted step length error of less than 3 cm. The proposed method underwent clinical validation, recruiting 64 patients with Parkinson's disease and 46 healthy controls of the same age group. Various gait indicators were statistically analyzed using three classic classification methods, with the random forest method achieving a classification accuracy of 91%. This method provides an objective, convenient, and intelligent solution for telemedicine focused on movement disorders in neurological diseases.

A gait signal acquisition and parameter characterization method based on foot pressure detection combined with Azure Kinect system / 生物医学工程学杂志

The gait acquisition system can be used for gait analysis. The traditional wearable gait acquisition system will lead to large errors in gait parameters due to different wearing positions of sensors. The gait acquisition system based on marker method is expensive and needs to be used by combining with the force measurement system under the guidance of rehabilitation doctors. Due to the complex operation, it is inconvenient for clinical application. In this paper, a gait signal acquisition system that combines foot pressure detection and Azure Kinect system is designed. Fifteen subjects are organized to participate in gait test, and relevant data are collected. The calculation method of gait spatiotemporal parameters and joint angle parameters is proposed, and the consistency analysis and error analysis of the gait parameters of proposed system and camera marking method are carried out. The results show that the parameters obtained by the two systems have good consistency (Pearson correlation coefficient r ≥ 0.9, P < 0.05) and have small error (root mean square error of gait parameters is less than 0.1, root mean square error of joint angle parameters is less than 6). In conclusion, the gait acquisition system and its parameter extraction method proposed in this paper can provide reliable data acquisition results as a theoretical basis for gait feature analysis in clinical medicine.

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.

Gait characteristics of middle-aged and eldrly people with mild cognitive impairmentin in community / 中风与神经疾病杂志

Gait characteristics of middle-aged and eldrlypeople with mild cognitive impairmentin in community@#Objective To explore the change of gait of middle-aged and elderly people with mild cognitive impairment in the community,the correlation between gait and cognitive domain,and the role of gait in early recognition of cognitive decline. Methods 140 people over 40 years old in Tongxing Village,Yancheng City,Jiangsu Province were enrolled.The subjects were divided into normal cognitive group (n=64) and mild cognitive impairment group(n=76)through the Montreal Cognitive Assessment and the Minimum Mental State Examination,and gait tests were conducted at the same time.The data were collected and statistically analyzed to explore the difference of gait indicators between the two groups,the relationship between gait indicators and cognitive domains,and the ability of gait indicators to recognize mild cognitive impairment. Results The gait of the mild cognitive impairment group was worse than that of the normal cognitive group in terms of space (stride length,step height,step width) and time (step speed,stride speed,swing speed).Partial correlation analysis showed that step width was negatively correlated with delayed recall;Step size,step width and delayed recall,step height and naming were positively correlated.The logistic regression model constructed by step speed,stride length,stride speed,swing speed,step height and step width can reliably identify the existence of MCI (AUC=0.761,95%CI 0.683-0.840,P<0.05). Conclusion In the middle-aged and elderly community,the spatial and temporal performance of gait of patients with mild cognitive impairment is worse than that of the normal cognitive population.There is a close relationship between spatial indicators and delayed recall and naming.The temporal and spatial characteristics of gait have the potential to identify cognitive decline at an early stage.

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.