Gait analysis using three-dimensional motion and ground reaction force systems in patients with hemiplegia treated with botulinum toxin type A in ankle plantar flexors / Journal of Rural Medicine

Objective: The efficacy of botulinum toxin type A (BoNT-A) injection on spasticity has usually been measured using the range of motion (ROM) of joints and Modified Ashworth Scale (MAS); however, they only evaluate muscle tone at rest. We objectively analyzed the gait of three patients with hemiplegia using three-dimensional motion analysis and ground reaction force (GRF) systems to evaluate muscle tone during gait.Materials and Methods: We measured passive ankle dorsiflexion ROM with knee extension and the MAS score for clinical evaluation, and gait speed, stride length, single-leg support phase during the gait cycle, joint angle, joint moment, and GRFs for kinematic evaluation before and one month after BoNT-A injection.Results: All patients showed an increase in ankle dorsiflexion ROM, improvement in MAS score, and increase in stride length. Case 1 showed an increase in gait speed, prolongation of the single-leg support phase, increase in hip extension angle and moment, and improvement in the vertical and anterior-posterior components of the GRFs. Case 2 showed an increase in gait speed, improvement in double knee action, increase in ankle plantar flexion moment, and improvement in propulsion in the progressive component of the GRFs. Case 3 exhibited a laterally directed force in the GRFs.Conclusion: We evaluated the effects of BoNT-A injections in three patients with hemiplegia using three-dimensional motion analysis and GRFs. The results of the gait analysis clarified the improvements and problems in hemiplegic gait and enabled objective explanations for patients.

Examination of Kinematic Factors during Single Leg Squatting Associated with the Occurrence of Re-injury after Anterior Cruciate Ligament Reconstruction / The Japanese Journal of Rehabilitation Medicine

Objective：This study aimed to determine the difference in knee joint range of motion (ROM) and coefficient of variation (CV) during preoperative single-leg squatting in patients who developed ipsilateral lower limb anterior cruciate ligament (ACL) re-injury months after ACL reconstruction and in those who did not have the injury.Methods：Participants included 38 patients with non-contact ACL injuries. All patients underwent single-leg squatting the day before ACL reconstruction. Knee joint ROM and CV were assessed during single-leg squatting using a three-dimensional motion analysis system. We investigated the occurrence of ACL reinjury in the ipsilateral lower limb approximately 30 months after ACL reconstruction. Knee joint ROM and CV were then compared between the postoperative and non-injury groups.Results：The postoperative injury and non-injury groups included 9 and 29 patients, respectively. The knee internal/external rotation ROM and CV of knee varus/valgus ROM were greater in the postoperative injury group than in the postoperative non-injury group.Conclusion：During single-leg squatting before ACL reconstruction surgery, the knee internal/external rotation ROM and CV of knee varus/valgus ROM were suggested to be points of evaluation when considering ACL re-injury prevention.

Clinical application of three dimensional motion analysis for testing the balance of hemiplegic stroke patients / 中华物理医学与康复杂志

Objective To investigate the clinical value of a three-dimensional motion analysis system by using the body segmental method for testing the balance of hemiplegic stroke patients.Methods Twenty stroke patients with hemiplegia were measured using the lower extremity Fugl-Meyer motor assessment (FMA-L),the Brunel balance assessment (BBA),the Berg balance sale (BBS) and a 5 m timed up-and-go test (5m-TUGT).The three-dimensional motion analysis system using the body segmental method was applied in three positions-sitting,standing and walking.Spearman's rank correlation coefficient was used to determine the extent of correlation between the values measured by the three-dimensional motion analysis system and the FMA-L,BBA,BBS and 5m-TUGT results.Results Some motion analysis variables (MSAx,MSVx,MSAy,MSVy and SPxy,SP3-D) are recorded in sitting and standing,while the center of gravity (COG) swing in the horizontal plane and some other variables (MSAx,MSVx and SPxy and SP3-D) are measured while walking.Anterior-posterior COG swing had a high negative correlation with the FMA-L,BBA and BBS scores and a high positive correlations with 5m-TUGT times.But except in sitting,MSAz and MSVz were both uncorrelated with FMA-L,BBA or BBS scores or with 5m-TUGT times.COG swing in the horizontal plane in sitting and standing apparently correlates with lower extremity motor function,balance,and walking ability.However,only the X axis swing parameters of the COG while walking correlated with lower extremity motor function,balance or walking ability.Conclusions A three-dimensional motion analysis system using the body segmental method can be used clinically to monitor patients' balance in real time and dynamically in different positions and activities,and it can be used to predict motor function and balance control in hemiplegic stroke patients.

Efficacy of Rehabilitation in Parkinson's Disease Patients using the Unified Parkinson's Disease Rating Scale (UPDRS) and Three-dimensional Motion Analysis / The Japanese Journal of Rehabilitation Medicine

Objective : To demonstrate the importance of physical motor function using the unified Parkinson's disease rating scale (UPDRS) and three-dimensional motion analysis in Parkinson's disease rehabilitation strategies. Participants : Seventeen inpatients with Parkinson's disease. Intervention : Physical training to improve joint mobility, muscle strength and muscle stretch to increase physical capacity was conducted for about four weeks. Results: The mean total scores of UPDRS significantly decreased from 37.9±13.2 (before training) to 27.3±11.2 (after training). The ADL scores of the UPDRS decreased from 12.4±6.9 (before training) to 9.5±6.3 (after training). The motor scores decreased from 22.5±7.5 to 15.3±6.5. Furthermore, muscle rigidity and akinesia, two key Parkinson symptoms, were improved as shown by assessment of the UPDRS motor scores. And physical function of the trunk, and upper and lower extremities was also improved. Finally, the increment of stride length and walking velocity and range of motion (ROM) at the hip and pelvic joints were observed by assessment of three-dimensional motion analysis. Conclusion : This study suggests that improvement of Parkinson symptoms and increment of ROM at the pelvic and lower limbs by physical training may improve stride length and walking velocity.

The feasibility of segmental method in testing human balance control with a three dimensional motion analysis system / 中华物理医学与康复杂志

Objective To investigate the reliability and sensitivity of a three dimensional motion analysis system by using the segmental method.Methods Ten healthy young men participated in this study.They were asked to stand with one leg and with their eyes open and closed,respectively,each lasted for 30 seconds and was re- peated twice.According to the 12-segment rigid body model of the human body,twenty-one infrared light emitting di- ode(1RED)markers were placed over the bony prominences on the proximal and distal ends of each segment,the motion track of the IRED markers was recorded by the three dimensional motion analysis system.The mean sway am- plitude( MSA )and the sway path(SP)of the center of gravity(COG)were calculated.Correlation analysis was used to determine the reliability between the two repetitions.Paired sample t-test was used to determine the sensitivity be- tween the eyes open and closed conditions.Results The correlation coefficients of the MSA of the COG in the eyes open and closed conditions were 0.623 and 0.018,respectively,and the correlation coefficients of the SP of the COG were 0.936 and 0.654,respectively.It was also shown that significant differences existed among the three directions of the MSA of the COG and the SP of the COG.Conclusion Besides the weak reliability of the MSA of COG in the eyes closed condition,the high reliability and sensitivity of the MSA and SP of the COG are found.The segmental method can be used in the scientific study of human balance control.

Gait Analysis in Cervical Spondylotic Myelopathy at Pre- and Post-Surgery

OBJECTIVE: To investigate objectively the postoperative change of the gait pattern in patients with cervical myelopathy through gait analysis. METHODS: Thirty nine patients who underwent cervical decompression and fusion for cervical myelopathy were studied. Preoperatively, gait disturbance was present in all patients. The patients were evaluated with Nurick classification, Functional Independence measure (FIM) score and gait analysis using three dimensional motion analyzer before surgery, 1 week and 3 months after surgery. RESULTS: In the Nurick classification there was statistically significant change but no significant change in FIM score after surgery. In the gait analysis there were statistically significant improvements in all the linear parameters, kinetic (ankle plantarflexion moment) and kinematic (knee range of motion in swing phase) parameters (p<0.05). CONCLUSION: This study suggests that gait analysis can be used as a quantitative tools of postoperative gait improvement in patient with cervical myelopathy.

Measurements of Lumbar Segmental Range of Motion with 3-dimensional Motion Analysis in Healthy Adults

OBJECTIVE: To measure the lumbar segmental range of motion (ROM) with 3-dimensional motion analysis system and compare the results with radiologic ROM measurements. METHOD: Ten healthy adult volunteers were included. We attached surface markers at the corresponding skin surface of each lumbar vertebral bodies and measured lumbar segmental ROM in flexion-extension, right bending, left bending, axial rotation with 3-D motion analysis. We compared some of the results with radiologic segmental ROM measurements. RESULTS: In 3-D motion analysis, segmental ROM of flexion and extension, right bending, left bending, right rotation, left rotation were, respectively: 10.1degrees, 45degrees, 3.5degrees, 1.7degrees and 1.9degrees(L1-L2); 17.9degrees, 6.2degrees, 5.1degrees, 1.4degrees and 1.1degrees (L2-L3); 15.0degrees, 7.2degrees, 4.9degrees, 2.1degrees and 1.1degrees (L3-L4); 14.9degrees, 5.8degrees, 4.6degrees, 1.7degree and 1.6degree (L4-L5); 10.6degrees, 4.9degrees, 3.8degree, 2.6degree and 0.8degree (L5-S1). There was no statistically significant difference in segmental ROM between 3-D motion analysis measurements and radiologic measurements except L5-S1 right bending, L2-L3 and L5-S1 left bending. No statistical significant difference in lumbar flexion and bending ROM was found between two methods. CONCLUSION: 3-D motion analysis is a useful method when measuring the lumbar segmental range of motion and it has an advantage to analyze segmental lumbar motion with three directions simultaneously.