ABSTRACT
Abstract Objective To analyze the effect of combined training (CT) in postural control and gait parameters in postmenopausal women. Methods A parallel-group, randomized, control study was conducted with 16 weeks of combined training (n = 16) versus a non-training control group (n = 12) in postmenopausal women (aged 59.3 ± 8.0). Pre and postintervention assessments included postural control (using an AMTI force platform - Advanced Mechanical Technology, Inc., Watertown, MA, USA) and gait impairments (using baropodometry). In addition, the upper limb strength and abdominal tests, as well as aerobic capacity, assessed functional indicators. Results The CT intervention in postmenopausal women resulted in improved gait (stride length (p = 0.006); speed (p = 0.013); double support time (p = 0.045); and improved postural control (displacement area of postural sway in a normal base of support with eyes open (p = 0.006). Combined training increased functional indicators (abdominal - p = 0.031; aerobic capacity - p = 0.002). Conclusion In conclusion, combined aerobic plus strength training effectively improved gait and balance control in older women. The postmenopausal women from the CT group walked faster and with bigger steps after the intervention than the control group. In addition, they presented decreased postural sway in standing and decreased the percentage of double support time while walking, which means improved static and dynamic balance control and functional indicators.
Resumo Objetivo Analisar o efeito do treinamento combinado (TC) no controle postural e nos parâmetros da marcha em mulheres na pós-menopausa. Métodos Foi realizado um estudo controlado randomizado de grupos paralelos com 16 semanas de treinamento combinado (n = 16) versus um grupo controle sem treinamento (n = 12) em mulheres na pós-menopausa (59,3 ± 8,0 anos). As avaliações pré e pós-intervenção incluíram controle postural (usando a plataforma de força AMTI) e deficiências da marcha (usando baropodometria). Além disso, os testes de força de membros superiors e abdominal, bem como a capacidade aeróbica, avaliaram indicadores funcionais. Resultados A intervenção do TC em mulheres na pós-menopausa resultou em melhora da marcha (comprimento da passada (p = 0,006), velocidade (p = 0,013), tempo de apoio duplo (p = 0,045) e controle postural aprimorado (área de deslocamento da oscilação postural em base de apoio normal com olhos abertos (p = 0,006). O TC aumentou os indicadores funcionais (abdominal - p = 0,031; capacidade aeróbia - p = 0,002). Conclusão Em conclusão, o TC de força e aeróbico melhorou efetivamente o controle da marcha e do equilíbrio em mulheres idosas. As mulheres na pós-menopausa do grupo CT caminharam mais rápido e com passos maiores após a intervenção do que o grupo controle. Além disso, elas apresentaram redução da oscilação postural em pé e do percentual de tempo de apoio duplo durante a caminhada, o que significa melhora no controle do equilíbrio estático e dinâmico e dos indicadores funcionais.
Subject(s)
Humans , Female , Middle Aged , Menopause , Exercise , Postural Balance , GaitABSTRACT
Abstract Objective: Perform the translation and cultural adaptation of the Myelomeningocele Functional Classification (MMFC) into Portuguese (Brazil) and study its psychometric properties. Method: Validation study with translation, cultural adaptation and evaluation of psychometric properties: reliability, test-retest and convergent validity. Sample of 20 individuals with myelomeningocele with a median age of 10 (5 - 24.25) years, with a minimum of 3 and a maximum of 66 years. Reliability was determined by intra and interobserver agreement, using the results of the Intra-class Correlation Coefficient (ICC) and Confidence Interval 95% (IC- 95%). Convergent validity was performed using the Sharrard, Hoffer, Pediatric Evaluation of Disability Inventory (PEDI) and Functional Mobility Scale (FMS) classifications, and The Spearman Correlation Test was calculated. Results: Intra (ICC range: 0.900-1.0) and interobserver (ICC: 0.936; IC- 95%: 0.839-0.975) reliability showed excellent levels of ICC. Convergent validity showed very strong correlations with FMS-5 (r = 0.94, p = 0.00) and FMS-50 (r = 0.94, p = 0.00); strong correlations with FMS-500 (r = 0.87, p = 0.00), Sharrard (r = 0.76, p = 0.00), Hoffer (r = 0.83, p = 0.00), PEDI Functional Skills: Mobility (r = 0.84, p = 0.00) and PEDI Caregiver Assistance: Mobility (r = 0.77, p = 0.00); and weak correlations with self care domain of PEDI (r = 0.46, p = 0,04). The test-retest showed ICC = 1.00. Conclusions: This study presents the psychometric properties of the MMFC, in addition to its translation and cultural adaptation into Portuguese, the native language of the author of the classification. MMFC demonstrates correlation with previously used myelomeningocele classifications. MMFC demonstrated good results in the psychometric properties evaluated. Thus, the MMFC seems adequate and applicable to individuals with myelomeningocele and valid for the Brazilian population.
Resumo Objetivo: Realizar a tradução e adaptação cultural da Classificação Funcional da Mielomeningocele (MMFC) para o português (Brasil) e estudar suas propriedades psicométricas. Método: Estudo de validação com tradução, adaptação cultural e avaliação das propriedades psicométricas: confiabilidade, teste-reteste e validade convergente. Amostra de 20 indivíduos com mielomeningocele e idade mediana de 10 (5 a 24,25) anos, com mínimo de 3 e máximo de 66 anos. A confiabilidade foi determinada pela concordância intra e interobservador, utilizando os resultados do coeficiente de correlação intraclasse (ICC) e o intervalo de confiança de 95% (IC- 95%). A validade convergente foi realizada por meio das classificações de Sharrard, Hoffer, Inventário de Avaliação Pediátrica de Incapacidade (Pediatric Evaluation of Disability Inventory [PEDI]) e Escala de Mobilidade Funcional (Functional Mobility Scale [FMS]). Além disso, o teste de correlação de Spearman foi realizado. Resultados: A confiabilidade intraobservador (ICC: 0,900-1,0) e interobservador (ICC: 0,936; IC - 95%: 0,839-0,975) apresentou excelentes níveis de ICC. A validade convergente mostrou correlações muito fortes com FMS-5 (r = 0,94, p = 0,00) e FMS-50 (r = 0,94, p = 0,00); correlações fortes com FMS-500 (r = 0,87, p = 0,00), Sharrard (r = 0,76, p = 0,00), Hoffer (r = 0,83, p = 0,00) e Habilidades Funcionais: Mobilidade (PEDI) (r = 0,84, p= 0,00) e Assistência do Cuidador: Mobilidade (PEDI) (r = 0,77, p = 0,00); e fracas com o domínio autocuidado de PEDI (r = 0,46, p = 0,04). O teste-reteste revelou que ICC =1,00. Conclusões: Este estudo apresenta as propriedades psicométricas da MMFC, além de sua tradução e adaptação cultural para o português, língua nativa do autor da classificação. A MMFC demonstra correlação com classificações de mielomeningocele anteriormente utilizada. A MMFC teve bons resultados nas propriedades psicométricas avaliadas. Assim, a MMFC parece adequada e aplicável a indivíduos com mielomeningocele e é válida para a população brasileira.
Subject(s)
Humans , Prognosis , Meningomyelocele , Validation Study , GaitABSTRACT
OBJECTIVES@#To investigate the effect of torso training on unstable surface on lower limb motor function in patients with incomplete spinal cord injury.@*METHODS@#A total of 80 patients with incomplete spinal cord injury caused by thoracolumbar fracture admitted in Ningbo Yinzhou No.2 Hospital from April 2020 to December 2021 were randomly divided into control group and study group, with 40 cases in each group. In addition to routine training, the control group received torso training on stable surface and the study group received torso training on unstable surface. The gait, lower limb muscle strength, balance function, lower limb function, mobility and nerve function of the two groups were compared.@*RESULTS@#After treatment, the stride length, stride frequency and comfortable walking speed improved in the two groups (all P<0.05), and the improvements in study group were more significant (all P<0.05). The muscle strength of quadriceps femoris, gluteus maximus, hamstring, anterior tibialis and gastrocnemius were improved in the two groups (all P<0.05), and the improvements in study group were more significant (all P<0.05); the total trajectories of static eye opening and static eye closing gravity center movement in the two groups were significantly shorter (all P<0.05), and the improvements in the study group were more significant (all P<0.05). The dynamic stability limit range and the American Spinal Injury Association (ASIA) lower extremity motor score, Berg balance scale, modified Barthel index scale in the two groups were significantly higher (all P<0.05), and these scores in study group were significantly higher than those in the control group (all P<0.05). Both groups showed a significant improvement in ASIA grade (all P<0.05), and the improvement in the study group was significantly better (P<0.05).@*CONCLUSIONS@#Torso training on unstable surface can effectively improve the gait and lower limb muscle strength of patients with incomplete spinal cord injury and improve the lower limb motor function.
Subject(s)
Humans , Walking/physiology , Spinal Cord Injuries , Gait/physiology , Lower Extremity , TorsoABSTRACT
The surgical installation accuracy of the components in unicompartmental knee arthroplasty (UKA) is an important factor affecting the joint function and the implant life. Taking the ratio of the medial-lateral position of the femoral component relative to the tibial insert (a/A) as a parameter, and considering nine installation conditions of the femoral component, this study established the musculoskeletal multibody dynamics models of UKA to simulate the patients' walking gait, and investigated the influences of the medial-lateral installation positions of the femoral component in UKA on the contact force, joint motion and ligament force of the knee joint. The results showed that, with the increase of a/A ratio, the medial contact force of the UKA implant was decreased and the lateral contact force of the cartilage was increased; the varus rotation, external rotation and posterior translation of the knee joint were increased; and the anterior cruciate ligament force, posterior cruciate ligament force and medial collateral ligament force were decreased. The medial-lateral installation positions of the femoral component in UKA had little effect on knee flexion-extension movement and lateral collateral ligament force. When the a/A ratio was less than or equalled to 0.375, the femoral component collided with the tibia. In order to prevent the overload on the medial implant and lateral cartilage, the excessive ligament force, and the collision between the femoral component and the tibia, it is suggested that the a/A ratio should be controlled within the range of 0.427-0.688 when the femoral component is installed in UKA. This study provides a reference for the accurate installation of the femoral component in UKA.
Subject(s)
Humans , Arthroplasty, Replacement, Knee , Knee Joint/surgery , Knee Prosthesis , Gait , RotationABSTRACT
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.
Subject(s)
Humans , Aged , Parkinson Disease/diagnosis , Aging , Algorithms , Gait , Lower ExtremityABSTRACT
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.
Subject(s)
Humans , Biomechanical Phenomena , Gait , Lower Extremity , Foot , Gait Analysis , Reproducibility of ResultsABSTRACT
Abstract Introduction: The increasing insertion of women into the labor market has created a need to adapt handbags, with different sizes and weights, which consequently can overload the musculoskeletal system. Objective: To evaluate the effect of using a unilateral bag on plantar pressures and static balance in women. Methods: Cross-sectional study, carried out in Fortaleza in 2018. 258 women aged between 18 and 59 years who used a unilateral bag participated in this study. Two questionnaires were applied, targeting sociodemographic variables, life habits, characteristics of bag use and level of physical activity. Height, scapular symmetry, body and bag mass were also measured. A baropodometer was used to assess plantar pressure and static balance with and without the unilateral bag. Independent and paired t-tests were applied to verify the influence of the bag on the variables of interest, using the SPSS Statistics program (version 23.0). Results: On the side where the bag was carried, an increase in lateral mass distribution (LMD), foot pressure and surface area, and a decrease in the distance from barycenter (p < 0.05) were observed. On the opposite side, a decrease in LMD and an increase in barycenter were detected (p < 0.05). In static balance, no differences were observed in the anteroposterior and side-to-side oscillations with bag placement (p > 0.05). Conclusion: The unilateral bag causes alterations in plantar pressures and ipsilateral barycenter alongside the use of the bag, being a risk factor or aggravation for dysfunctions of the musculoskeletal system and for the occurrence of pain.
Resumo Introdução: A crescente inserção das mulheres no mercado de trabalho ocasionou uma necessidade de adaptação das bolsas, com tamanhos e pesos diferentes, que por consequência podem sobrecarregar o sistema musculoesquelético. Objetivo: Avaliar o efeito do uso da bolsa unilateral nas pressões plantares e no equilí-brio estático em mulheres. Métodos: Estudo transversal, realizado na cidade de Fortaleza em 2018. Participaram 258 mulheres com idade entre 18 e 59 anos e que usavam bolsa unilateral. Aplicaram-se dois questionários visando as variáveis sociodemográficas, hábitos de vida, características do uso da bolsa e nível de atividade física. Foram mensuradas estatura, simetria escapular, massa corporal e da bolsa. Utilizou-se baropodômetro para a avaliação das pressões plantares e equilíbrio estático com e sem a bolsa unilateral. Aplicaram-se testes t de amostras independentes e pareado para verificar a influência da bolsa nas variáveis de interesse, pelo programa SPSS Statistics (versão 23.0). Resultados: No lado que a bolsa era carregada foram observados aumento da distribuição de massa lateral (DML), da pressão do pé e da área de superfície e diminuição da distância do baricentro (p < 0,05). No lado oposto foram detectados diminuição da DML e aumento do baricentro (p < 0,05). No equilíbrio estático, não foram verificadas diferenças nas oscilações ântero-posterior e látero-lateral com a colocação da bolsa (p > 0,05). Conclusão: A bolsa unilateral causa alterações nas pressões plantares e no baricentro homolaterais no lado do uso da bolsa, sendo um fator de risco ou agravamento para as disfunções do sistema musculoesquelético e para a ocorrência de dor.
Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Women , Risk Factors , Postural Balance , Gait , Cross-Sectional Studies , HabitsABSTRACT
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.
Subject(s)
Humans , Male , Female , Adult , Young Adult , Anthropometry , Gait , Leg Length Inequality/pathologyABSTRACT
A Paralisia Cerebral (PC) engloba um grupo de desordens do movimento e da postura resultantes de uma lesão não progressiva no sistema nervoso. Diversas abordagens fisioterapêuticas vêm sendo propostas para o tratamento de indivíduos com PC, dentre elas o uso de vestes terapêuticas. Sendo assim, a presente revisão teve como objetivo avaliar os efeitos das vestes terapêuticas na reabilitação de crianças com PC, destacando seus benefícios e possíveis limitações. Tratou-se de uma revisão integrativa da literatura realizada nas bases SciELO, Lilacs, Pubmed, Science Direct e PEDro, por meio do descritor "Paralisia Cerebral" e das palavras-chave "AdeliSuit", "PediaSuit", "TheraSuit". Após o levantamento bibliográfico, foram selecionados 11 estudos envolvendo crianças com idade entre um e 15 anos, os quais descreveram o uso das vestes terapêuticas AdeliSuit, TheraSuit e PediaSuit. Todos os estudos apresentaram efeitos favoráveis ao uso das vestes para função motora das crianças avaliadas. Também houveram relatos de melhora na funcionalidade, velocidade e qualidade da marcha e equilíbrio. Apenas quatro estudos compararam programas de reabilitação envolvendo vestes terapêuticas e outras abordagens, os quais apresentaram resultados controversos. Os achados demonstraram resultados favoráveis ao uso das vestes terapêuticas em indivíduos com diagnóstico de PC, apesar de poucas evidências quanto a sua superioridade sobre outras abordagens. (AU)
Cerebral Palsy (CP) is a group of movement and posture disorders resulting from nervous system non-progressive injury. Several physiotherapy approaches have been proposed to individuals with CP treatment, including the use of therapeutic suits. Thus, the present review aimed to assess the effects of therapeutic suits on children with CP rehabilitation, highlighting their benefits and possible limitations. It was an integrative literature review carried out on SciELO, Lilacs, Pubmed, Science Direct and PEDro databases, using tdescriptor "Cerebral Palsy" and keywords "AdeliSuit", "PediaSuit", "TheraSuit". After bibliographic search, 11 studies were selected involving children aged between one and 15 years old, which described the use of therapeutic suits: AdeliSuit, TheraSuit and PediaSuit. All studies showed positive effects therapeutic suits use during rehabilitation for motor function. Improvements in functionality, speed and quality of gait and balance were also reported. Only four studies compared rehabilitation programs involving therapeutic suits and other therapeutic approaches, which showed controversial results. Those findings demonstrated favorable results for the use of therapeutic suits during rehabilitation programs in individuals with CP, despite little evidence regarding their superiority over other approaches. (AU)
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Cerebral Palsy , Physical Therapy Modalities , Motor Activity , Posture , Therapeutics , Therapeutic Approaches , Muscle Strength , Gait , Movement , Nervous SystemABSTRACT
Objetivo: Avaliar os efeitos da realidade virtual sobre a funcionalidade da marcha e percepção de mudança de indivíduos com hemiparesia crônica. Métodos: Estudo clínico piloto do tipo experimental, longitudinal, prospectivo e de braço único. A amostra foi composta por indivíduos hemiparéticos submetidos ao treinamento funcional em ambiente de realidade virtual (RV). Na avaliação inicial (AV1) utilizou-se o Timed Up and Go (TUG) para análise da mobilidade e após 12 sessões de RV, na avaliação final (AV2), acrescentou-se a Escala de Mudança Percebida (EMP). Para verificar a normalidade dos dados utilizou-se o teste de Shapiro-Wilk, o teste T-Student ou de Wilcoxon para comparar os dados (p ≤ 0,05) e o Effect Size (ES) pela fórmula de Cohen (d) para o tamanho do efeito. Resultados: Dez indivíduos hemiparéticos (64,6 ± 9,53 anos) realizaram o TUG (AV1) em 14,59 ± 5,03 segundos e AV2 em 13,96 ± 4,64 segundos (p = 0,18) e o EF teve efeito insignificante (d = 0,14). O jogo Free Step apresentou diferença significativa entre a primeira e última sessão (p = 0,004) e na EMP os valores obtidos foram de 2,57 ± 0,3 de três pontos. Conclusão: A RV não promoveu melhora significante na mobilidade funcional, mas os indivíduos relataram mudanças positivas em alguns componentes da EMP. (AU)
Subject(s)
Virtual Reality , Gait , Paresis , Physical Therapy Modalities , StrokeABSTRACT
Abstract Objective To evaluate the biomechanical behavior of the medial longitudinal arch (MLA) of the foot and the kinematic parameters of the lower limbs with biomimetic footwear (BF) and non-biomimetic (NB1, NB2, NB3 and NB4) footwear in children at the beginning of the gait acquisition phase. Methods Four toddlers were evaluated at the beginning of the gait acquisition phase under the following conditions: walking barefoot, ambulation with BF and NB1, NB2, NB3 and NB4 footwear in hard floor. BF is described as biomimetic because of its property of emulating natural and irregular floors through a dynamic internal insole. The MLA and kinematics of the hip, knee, and ankle during gait were evaluated by three-dimensional motion analysis system. The similarity between the kinematic curves of barefoot and footwear conditions was analyzed by root mean square error (RMSE). Results The use of BF presented the highest magnitude of MLA and the greatest difference in relation to barefoot condition (higher RMSE). The BF showed less difference in the kinematics of the knee and ankle joints during gait when compared to barefoot condition (lower RMSE). NB2 footwear presented hip kinematics more similar to barefoot condition (lower RMSE). Conclusion Biomimetics footwear and NB2 shoes (both with wider forefoot region) generated smaller differences in lower limbs compared to barefoot. In addition, the MLA was higher in the BF, probably because different design from other shoes.
Resumo Objetivo Avaliar o comportamento do arco longitudinal medial do pé (ALM) e os parâmetros cinemáticos dos membros inferiores durante a deambulação com calçados biomiméticos (CBs) e não biomiméticos (NB1, NB2, NB3 e NB4) em crianças no início da fase de aquisição da marcha. Métodos Foram avaliadas quatro crianças no início da fase de aquisição da marcha nas seguintes condições: andar descalço, andar com CBs e calçados NB1, NB2, NB3 e NB4 em solo plano. O calçado biomimético é descrito como biomimético por emular pisos naturais e irregulares por meio de uma palmilha interna dinâmica. O ALM e a cinemática do quadril, joelho e tornozelo durante a marcha foram avaliados por meio de sistema de análise do movimento tridimensional. A similaridade entre as curvas cinemáticas das condições descalça e com calçado foi analisada por meio do cálculo de root mean square error (RMSE). Resultados O CB foi o que apresentou maior magnitude do ALM e maior diferença do ALM em relação à condição descalça (maior RMSE). O CB apresentou ainda menor diferença na cinemática das articulações do joelho e tornozelo durante a marcha quando comparado à condição descalça (menor RMSE). O calçado NB2 apresentou a cinemática do quadril mais semelhante à condição descalça (menor RMSE). Conclusão Os calçados CB e NB2 que apresentam a região do antepé mais larga geraram menores diferenças na cinemática dos membros inferiores. Além disso, o ALM foi maior no CB provavelmente devido a seu design ser diferente daquele dos demais calçados.
Subject(s)
Humans , Infant , Shoes , Walking , Biomimetics , Foot , GaitABSTRACT
INTRODUÇÃO: Dificuldades de locomoção e equilíbrio são comuns entre os indivíduos com doença de Parkinson (DP). Vários programas diferentes de exercícios foram sugeridos para tratar de problemas de equilíbrio e de marcha para melhorar a qualidade de vida e a adesão do paciente aos exercícios de DP. A dança pode ser uma ferramenta eficaz para resolver esses problemas porque inclui elementos-chave de equilíbrio dinâmico, pode melhorar a mobilidade funcional e, ao mesmo tempo, é agradável e envolvente. OBJETIVOS: O objetivo deste estudo foi avaliar o efeito do movimento de dança Kathak além da fisioterapia convencional no equilíbrio e na marcha em pacientes com doença de Parkinson. MÉTODOS E MATERIAIS: Um total de 44 pacientes diagnosticados com Parkinson foram incluídos no estudo com uma idade média de 63,20 + 8,5 anos. Os pacientes foram divididos aleatoriamente em dois grupos, o grupo controle recebeu fisioterapia convencional, e o grupo experimental recebeu o mesmo juntamente com movimentos de dança Kathak que foram Tatkar e Gatnikas. A intervenção foi dada três dias por semana durante quatro semanas. A pré e pós-avaliação para equilíbrio e marcha foi avaliada por escalas incluindo o teste TUG, Tinetti, FOG-Q e UPDRS-III. A comparação dentro do grupo foi feita usando o teste Wilcoxon Signed rank e entre o grupo usando o teste Mann Whitney U para ver o efeito da intervenção de tratamento. RESULTADOS: A idade média dos participantes de ambos os grupos foi de 64,18±8,53 e 62,23±6,21, respectivamente. A comparação mostrou uma diferença significativa em TUG, Tinetti, e FOG-Q dentro do grupo com p<0,01. A comparação entre grupos não mostrou diferença significativa entre as duas intervenções de tratamento com p=0,361 para TUG, p=0,479 para Tinetti, e p= 0,73 para FOG-Q. CONCLUSÃO: Ambos os grupos mostraram melhorias semelhantes no equilíbrio e na marcha de pacientes com DP. Assim, concluímos que o movimento da Dança Kathak pode ser usado para complementar os exercícios de fisioterapia convencional.
INTRODUCTION: Difficulties with gait and balance are common among individuals with Parkinson's disease (PD). Several different exercise programs have been suggested to address balance and gait problems to improve the quality of life and patient compliance with PD exercises. Dance may be an effective tool for addressing these problems because it includes key elements of dynamic balance, can improve functional mobility, and is, at the same time, enjoyable and engaging. OBJECTIVES: The purpose of this study was to assess the effect of Kathak dance movement in addition to conventional physiotherapy on balance and gait in Parkinson's disease patients. METHODS AND MATERIALS: A total of 44 patients diagnosed with Parkinson's disease were included in the study with a mean age of 63.20 + 8.5 years. Patients were randomly divided into two groups, the control group received conventional physiotherapy, and the experimental group received the same along with Kathak dance movements which were Tatkar and Gatnikas. The intervention was given three days a week for four weeks. Preand post-assessment for balance and gait was assessed by scales including TUG test, Tinetti, FOG-Q, and UPDRS-III. The within-group comparison was made using Wilcoxon Signed rank test and between the group using the Mann Whitney U test to see the effect of treatment intervention. RESULTS: The mean age of participants for both groups were 64.18±8.53 and 62.23±6.21, respectively. The comparison showed a significant difference in TUG, Tinetti, and FOG-Q within the group with p<0.01. The between-group comparison showed no significant difference between the two treatments interventions with p=0.361 for TUG, p=0.479 for Tinetti, and p= 0.73 for FOG-Q. CONCLUSION: Both groups showed similar improvements in balance and gait in PD patients. Thus, we conclude that the Kathak Dance movement can be used to complement conventional physical therapy exercises.
Subject(s)
Parkinson Disease , Physical Therapy Modalities , GaitABSTRACT
Introduction: Most stroke patients present limited movement, which alters gait speed and balance. This study aimed to correlate balance and gait speed, and weight distribution and balance in post-stroke patients.Methods: In total, 36 participants were included. Data collection occurred as follows: filling out the assessment form; assessment with the Berg Balance Scale (BBS); assessment with the baropodometric platform; performing the 10 Meter Walk Test (10mWT) with accelerometer; measurements with the modified Rankin Scale (mRS); the Functional Ambulation Classification (FAC); and the Barthel Index (BI).Results: A negative correlation between FAC and mRS (r = −0.708; p < 0.05) and between BI and mRS (r = −0.716; p < 0.05) was found. The correlation between BI and FAC was positive (r = 0.591). There was a strong positive correlation between the 10mWT values and the BBS score (r = 0.708; p < 0.05). Moreover, a weak negative correlation was observed between BBS values and lower limb weight distribution (r = −0.378; p < 0.05).Conclusion: We found a correlation between the functional ambulation and the degree of independence.This study showed that the better the balance, the greater the gait speed, and the lower the difference on lower limbs weight distribution, the better the balance in post-stroke patients.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Postural Balance , Stroke Rehabilitation/statistics & numerical data , Gait , Stroke/physiopathologyABSTRACT
Spatiotemporal gait parameters provide important information for the rehabilitation of patients with gait dysfunction. These parameters are often obtained by complex systems such as optical motioncapture system and pressure plates. However, these systems cannot be deployed at the lower-limb rehabilitation robot easily because of high costs, large area occupation and wearable requirements. We present a gait measurement system with a Light Detection And Ranging(LIDAR) laser sensor based on the lower-limb rehabilitation robot. Firstly, to calculate gait parameters, the data are aggregated into left and right legs by the clustering algorithm and the legs contour is fitted with two circles respectively according to the least square method. Then, the spatiotemporal gait parameters are defined based on the time and position of initial contact(IC) and toe off(TO). Finally, to verify the validity of the proposed system, we compared the results of the proposed system with a 3D motion capture system based on a lower-limb rehabilitation robot. Experimental results showed that the gait detection system can measure the parameters within a small range of error that testified the validation of the proposed system. This system proved to be a valid and reliable method for the measurement of gait parameters.
Subject(s)
Humans , Biomechanical Phenomena , Gait , Lasers , Lower Extremity , Motion , RoboticsABSTRACT
Neurocognitive impairment is a group of clinical syndromes characterized by impaired cognitive function and decreased motor ability. Non-pharmacological interventions such as physical exercise have advantages in the treatment of patients with neurocognitive impairment. Multicomponent exercise is a combination of various physical exercises, including strength training, endurance training, balance training and flexibility training, that can improve gait, balance and cardiopulmonary function by increasing muscle mass, strength and endurance in people with neurocognitive impairment, while also reducing the risk of falls in elders. This article reviews the benefits of multicomponent exercise for patients with neurocognitive impairment and its evaluation methods; also describes 4 intervention programs and their clinical application, to provide evidence for clinical practice and promote the application of multicomponent exercise in patients with neurocognitive impairment.
Subject(s)
Aged , Humans , Accidental Falls , Cognition , Exercise/physiology , Gait , Resistance TrainingABSTRACT
The body weight support rehabilitation training system has now become an important treatment method for the rehabilitation of lower limb motor dysfunction. In this paper, a pelvic brace body weight support rehabilitation system is proposed, which follows the center of mass height (CoMH) of the human body. It aims to address the problems that the existing pelvic brace body weight support rehabilitation system with constant impedance provides a fixed motion trajectory for the pelvic mechanism during the rehabilitation training and that the patients have low participation in rehabilitation training. The system collectes human lower limb motion information through inertial measurement unit and predicts CoMH through artificial neural network to realize the tracking control of pelvic brace height. The proposed CoMH model was tested through rehabilitation training of hemiplegic patients. The results showed that the range of motion of the hip and knee joints on the affected side of the patient was improved by 25.0% and 31.4%, respectively, and the ratio of swing phase to support phase on the affected side was closer to that of the gait phase on the healthy side, as opposed to the traditional body weight support rehabilitation training model with fixed motion trajectory of pelvic brace. The motion trajectory of the pelvic brace in CoMH mode depends on the current state of the trainer so as to realize the walking training guided by active movement on the healthy side of hemiplegia patients. The strategy of dynamically adjustment of body weight support is more helpful to improve the efficiency of walking rehabilitation training.
Subject(s)
Humans , Biomechanical Phenomena , Gait , Hemiplegia , Pelvis , Range of Motion, Articular , Stroke Rehabilitation , WalkingABSTRACT
Aiming at the problems of individual differences in the asynchrony process of human lower limbs and random changes in stride during walking, this paper proposes a method for gait recognition and prediction using motion posture signals. The research adopts an optimized gated recurrent unit (GRU) network algorithm based on immune particle swarm optimization (IPSO) to establish a network model that takes human body posture change data as the input, and the posture change data and accuracy of the next stage as the output, to realize the prediction of human body posture changes. This paper first clearly outlines the process of IPSO's optimization of the GRU algorithm. It collects human body posture change data of multiple subjects performing flat-land walking, squatting, and sitting leg flexion and extension movements. Then, through comparative analysis of IPSO optimized recurrent neural network (RNN), long short-term memory (LSTM) network, GRU network classification and prediction, the effectiveness of the built model is verified. The test results show that the optimized algorithm can better predict the changes in human posture. Among them, the root mean square error (RMSE) of flat-land walking and squatting can reach the accuracy of 10 -3, and the RMSE of sitting leg flexion and extension can reach the accuracy of 10 -2. The R 2 value of various actions can reach above 0.966. The above research results show that the optimized algorithm can be applied to realize human gait movement evaluation and gait trend prediction in rehabilitation treatment, as well as in the design of artificial limbs and lower limb rehabilitation equipment, which provide a reference for future research to improve patients' limb function, activity level, and life independence ability.
Subject(s)
Humans , Algorithms , Gait , Machine Learning , Neural Networks, Computer , WalkingABSTRACT
Lower limb ankle exoskeletons have been used to improve walking efficiency and assist the elderly and patients with motor dysfunction in daily activities or rehabilitation training, while the assistance patterns may influence the wearer's lower limb muscle activities and coordination patterns. In this paper, we aim to evaluate the effects of different ankle exoskeleton assistance patterns on wearer's lower limb muscle activities and coordination patterns. A tethered ankle exoskeleton with nine assistance patterns that combined with differenet actuation timing values and torque magnitude levels was used to assist human walking. Lower limb muscle surface electromyography signals were collected from 7 participants walking on a treadmill at a speed of 1.25 m/s. Results showed that the soleus muscle activities were significantly reduced during assisted walking. In one assistance pattern with peak time in 49% of stride and peak torque at 0.7 N·m/kg, the soleus muscle activity was decreased by (38.5 ± 10.8)%. Compared with actuation timing, the assistance torque magnitude had a more significant influence on soleus muscle activity. In all assistance patterns, the eight lower limb muscle activities could be decomposed to five basic muscle synergies. The muscle synergies changed little under assistance with appropriate actuation timing and torque magnitude. Besides, co-contraction indexs of soleus and tibialis anterior, rectus femoris and semitendinosus under exoskeleton assistance were higher than normal walking. Our results are expected to help to understand how healthy wearers adjust their neuromuscular control mechanisms to adapt to different exoskeleton assistance patterns, and provide reference to select appropriate assistance to improve walking efficiency.
Subject(s)
Aged , Humans , Ankle/physiology , Ankle Joint/physiology , Biomechanical Phenomena/physiology , Electromyography , Exoskeleton Device , Gait/physiology , Muscle Contraction , Muscle, Skeletal/physiology , Walking/physiologyABSTRACT
OBJECTIVE@#To observe the effect on motor function, spasticity degree, muscle strength and the relevant parameters of three-dimensional gait analysis in the patients with post-stroke spasticity in the lower limbs treated with the combined therapy of electroacupuncture (EA) and muscle electricity biofeedback or the simple muscle electricity biofeedback therapy on the base of rehabilitation medicine.@*METHODS@#A total of 60 patients with post-stroke spasticity in the lower limbs were randomized into an EA + biofeedback group, a biofeedback group and a rehabilitation group, 20 cases in each one. In the rehabilitation group, the basic rehabilitation training was provided, 45 min each time. In the biofeedback group, on the base of the treatment as the rehabilitation group, the biofeedback therapy was added, 30 min each time. In the EA + biofeedback group, besides the treatment as the biofeedback group, acupuncture was supplemented at Futu (ST 32), Liangqiu (ST 34), Zusanli (ST 36) and Fenglong (ST 40), etc, and EA was applid at Zusanli (ST 36) and Taichong (LR 3) with continuous wave and 5 Hz in frequency. In each group, the treatment was given once daily, 5 times a week, for 6 weeks totally. Separately, before and after treatment, the score of Fugle-Meyer assessment (FMA), the score of clinical spasticity index (CSI) in the lower limbs and the strength of the anterior tibial muscle on the affected side were assessed, and the spatial-temporal parameters (step frequency and steep speed) in the three-dimensional gait analysis and the kinematic parameters (maximum dorsal flexion and maximum plantar flexion of ankle joint on the affected side) were measured in the patients of three groups.@*RESULTS@#After treatment, FMA score was increased as compared with that before treatment in all of three groups (P<0.05). FMA score in the EA + biofeedback group and the biofeedback group was higher than the rehabilitation group respectively (P<0.05). CSI score in the EA + biofeedback group and the biofeedback group was lower than that before treatment respectively (P<0.05), and lower than the rehabilitation group (P<0.05). After treatment, the step frequency and speed were all improved and the angles of maximum dorsal flexion and maximum plantar flexion of ankle joint on the affected side were all increased as compared with those before treatment in the patients of three groups separately (P<0.05). The step frequency and speed, as well as the angles of maximum dorsal flexion and maximum plantar flexion of ankle joint on the affected side in either the EA + biofeedback group or the biofeedback group were all higher than the rehabilitation group (P<0.05), and the step speed in the EA + biofeedback group was higher than the biofeedback group (P<0.05). After treatment, the strength of the anterior tibial muscle on the affected side was increased as compared with that before treatment in the patients of each group (P<0.05); and the strength of the anterior tibial muscle in the EA + biofeedback group and the biofeedback group was larger than the rehabilitation group (P<0.05).@*CONCLUSION@#On the base of rehabilitation treatment, the combined regimen of EA and muscle electricity biofeedback therapy and the simple muscle electricity biofeedback therapy all effectively strengthen the motor functions and reduce spasticity as well as improve step frequency, step speed and the range of motion of ankle joint in the patients with post-stroke spasticity in the lower limbs. Regarding the gait improvement, the combined regimen of EA and muscle electricity biofeedback is better than the simple muscle electricity biofeedback.
Subject(s)
Humans , Electroacupuncture , Gait , Lower Extremity , Muscle Spasticity/therapy , Stroke Rehabilitation , Treatment OutcomeABSTRACT
OBJECTIVES@#Stroke patients may have various sensory-motor disorders, such as spasticity, muscle weakness or sensory damage. Spasticity affects 20% to 40% of stroke patients. Patients with spasticity may have problems such as pain, motor function damage, and the decreased range of motion, which leads to decline of activity and quality of daily life. Extracorporeal shock wave therapy (ESWT) is a technique that can improve post-stroke spasticity. Whole body vibration (WBV), as a passive neuromuscular muscle stimulation technique, can improve the posture control, muscle strength, and muscle work of different people. At present, there are still few studies using WBV combined with ESWT for the treatment of hemiplegic patients with stroke. This study aims to explore the effects of WBV combined with ESWT on spasticity of the affected lower limb and gait function in stroke patients.@*METHODS@#From March 2020 to March 2021, 50 hemiplegic patients with stroke were treated in the Department of Rehabilitation Medicine of the First Hospital of Changsha and they were assigned into a control group and a combined group, 25 cases per group. Both groups carried out conventional treatment, while the control group undertook the ESWT and fake WBV based on conventional treatment, and the combined group undertook ESWT after WBV and conventional treatment. Modified Ashworth Scale (MAS), Lower Extremity portion of the Fugl-Meyer Motor Assessment (FMA-LE), Berg Balance Scale (BBS), and parameters of three-dimensional gait analysis including kinematic parameters (peak value of hip flexion and knee flexion) and spatiotemporal parameters (velocity, cadence and stride length) were assessed before and after 4-week treatment between the 2 groups.@*RESULTS@#After 4 weeks of treatment, MAS scores in 2 groups were lower than before (both P<0.05), and the combined group was lower than the control group (P<0.001); BBS and FMA-LE scores were higher than those before treatment (both P<0.05), and the combined group was higher than the control group (both P<0.001); in the control group, the walking speed, stride frequency, and stride length were higher than those before treatment (all P<0.05), and there was no significant difference between the peak value of flexion hip and peak value of flexion knee (both P<0.05); the peak value of hip flexion, peak value of knee flexion, step speed, step frequency, and stride length in the combined group were higher than those before treatment (all P<0.05), and were higher than those in control group (P<0.05 or P<0.001).@*CONCLUSIONS@#WBV combined with ESWT can improve the spasticity and motor function of the affected lower extremity, balance, and gait in hemiplegic patients with stroke.