Validity of quantitative assessment of posterior pelvic tilt and contralateral vaulting in hemiplegia using 3D treadmill gait analysis.

BACKGROUND: Assessing abnormal gait patterns could indicate compensatory movements, which could be an index for recovery and a process of motor learning. To quantify the degree of posterior pelvic tilt, contralateral vaulting is necessary. OBJECTIVES: This study aimed to develop and evaluate the validity of quantitative indices for posterior pelvic tilt and contralateral vaulting in hemiplegic patients. METHODS: Forty-six healthy control subjects and 112 hemiplegic patients participated in this study. Of the 112 patients, 50 were selected into each abnormal gait pattern group, with some overlap. Three experienced physical therapists observed their walking and graded the severity of the two abnormalities in five levels. An index to quantify each of the two abnormal gait patterns was calculated from the three-dimensional treadmill gait analysis. The index values of patients were compared with those of healthy subjects and with the results of observational gait assessment done by three physical therapists with expertise in gait analysis. RESULTS: The index values were significantly higher in hemiplegic patients than in healthy subjects (28.0% and 44.7% for the posterior pelvic tilt in healthy subjects and patients, respectively and 0.9 and 4.7 for the contralateral vaulting, respectively). A strong correlation was observed between the index value and the median observational rating for two abnormal gait patterns (r = -0.68 and -0.72). CONCLUSIONS: The proposed indices for posterior pelvic tilt and contralateral vaulting are useful for clinical gait analysis, and thus encouraging a more detailed analysis of hemiplegic gait using a motion analysis system.

Quantitative assessment of knee extensor thrust, flexed-knee gait, insufficient knee flexion during the swing phase, and medial whip in hemiplegia using three-dimensional treadmill gait analysis.

BACKGROUND: Most people with hemiplegia experience gait changes after a stroke. Abnormal gait patterns in stroke patients vary across subjects and this make it difficult to assess the cause of gait abnormalities. Therefore, it is necessary to quantitatively evaluate abnormal gait patterns through gait analysis for stroke patients. OBJECTIVE: To develop and evaluate the validity of quantitative assessments of the degree of knee extensor thrust, flexed-knee gait, insufficient knee flexion during the swing phase, and medial whip. METHODS: Forty-six healthy control subjects and 112 people with hemiplegia participated. From the 112 patients, 50 patients were selected into each abnormal gait pattern (knee extensor thrust, flexed-knee gait, insufficient knee flexion during the swing phase, and medial whip) with some overlap. Participants were instructed to walk on a treadmill and were recorded using a three-dimensional motion analysis system. An index to quantify each of the four abnormal gait patterns exhibited by the patients was calculated from the three-dimensional coordinate data. The indices were developed based on the definition of the abnormal gait patterns. The index values for the patients were compared with those of healthy subjects as well as with the results of observational gait assessment by three physical therapists with expertise in gait analysis. RESULTS: Strong correlation was observed between the index value and the median observational rating for all four abnormal gait patterns (-0.64 to -0.86). Most of the patients with an abnormal gait pattern had a higher index value than the healthy subjects. CONCLUSIONS: The use of these indices in gait analysis of people with hemiplegia can help to diagnose severity of gait disorder, determine the appropriate treatment, and evaluate the effectiveness of the treatment.

Quantitative assessment for flexed-elbow deformity during gait following botulinum toxin A treatment.

BACKGROUND: The effect of botulinum toxin A (BoNTA) injection on flexed-elbow deformity is usually evaluated using the Modified Ashworth Scale (MAS), but only with the muscle tone at rest. Some patients show the flexed-elbow deformity during gait despite low muscle tone at rest. OBJECTIVE: This study aimed to evaluate the effect of BoNTA injection on flexed-elbow deformity during gait using a three-dimensional motion analysis system. METHODS: Twenty stroke patients with spastic flexed-elbow deformity during gait received BoNTA injections into the upper limb muscles. The MAS score of the elbow flexors, passive elbow range of motion, comfortable overground gait velocity, and elbow flexion angle during treadmill gait were evaluated just before and 2, 6, and 12 weeks after the injection. Twenty-five healthy subjects were also recruited to provide a normal reference of the elbow flexion angle. RESULTS: The MAS scores at 2, 6 and 12 weeks after the injection were significantly lower than that before the injection. Some patients showed no spasticity at rest but an obviously flexed elbow during gait. The elbow flexion angles during gait at 2 and 6 weeks after the injection were significantly lower than that before the injection. CONCLUSIONS: BoNTA injections to the upper limb muscles reduced muscle tone at rest and flexed-elbow deformity during gait. However, the elbow flexion angle during gait returned to its pre-injection level sooner than the muscle tone at rest. We strongly recommend evaluating muscle tone during motion and at rest, preferably using three-dimensional motion analysis since it can objectively detect small changes.

Quantitative assessment of retropulsion of the hip, excessive hip external rotation, and excessive lateral shift of the trunk over the unaffected side in hemiplegia using three-dimensional treadmill gait analysis.

BACKGROUND: Gait assessment is important to determine the most effective strategy to regain gait function during stroke rehabilitation. To understand the mechanisms that cause abnormal gait patterns, it is useful to objectively identify and quantify the abnormal gait patterns. Objective assessment also helps evaluate the efficacy of treatments and can be used to provide suggestions for treatment. OBJECTIVE: To evaluate the validity of quantitative indices for retropulsion of the hip, excessive hip external rotation, and excessive lateral shift of the trunk over the unaffected side in hemiplegic patients. METHODS: Forty-six healthy control subjects and 112 hemiplegic patients participated. From the 112 patients, 50 patients were selected into each abnormal gait pattern with some overlap. Participants were instructed to walk on a treadmill and were recorded using a three-dimensional motion analysis system. An index to quantify each of the three abnormal gait patterns was calculated from the three-dimensional coordinate data. The index values of patients were compared with those of healthy subjects and with the results of observational gait assessment by three physical therapists with expertise in gait analysis. RESULTS: Strong correlation was observed between the index value and the median observational rating for all three abnormal gait patterns (-0.56 to -0.74). Most of the patients with an abnormal gait pattern had a higher index value than the healthy subjects. CONCLUSIONS: The proposed indices are useful for clinical gait analysis. Our results encourage a more detailed analysis of hemiplegic gait using a motion analysis system.

Feasibility of a Simplified, Clinically Oriented, Three-dimensional Gait Analysis System for the Gait Evaluation of Stroke Patients.

OBJECTIVE: Although previous studies have evidenced the value of three-dimensional gait analysis (3DGA) for evaluating gait disorder, the time-consuming measurement process and space requirement has hampered its use in the clinical setting. The aim of this study was to examine the feasibility of a simplified 3DGA system for stroke patients. METHODS: Thirteen pairs of stroke patients and age- (± 1 year), gender-, and gait speed- (± 0.5 m/s) matched controls were drawn from the Fujita Health University gait analysis database. 3DGA was performed using the KinemaTracer® treadmill gait analysis system. Comparisons of the spatiotemporal and kinematic parameters were performed between stroke patients and matched controls. The correlations between items from the Wisconsin Gait Scale (WGS) and 3DGA data in stroke patients were also investigated. RESULTS: 3DGA measurements clearly showed reduced toe clearance, hip flexion, and knee flexion in stroke patients compared with the matched controls. In contrast, significant increases were observed in hip elevation, shoulder elevation, shoulder lateral shift, and step width in stroke patients. For the four items drawn from the WGS, a significant correlation with three 3DGA parameters was observed: stance time on the impaired side, stance width, and knee flexion from toe off to midswing. CONCLUSIONS: In this study, significant differences in gait parameters of stroke patients and age-, gender-, and speed-matched controls were found using a simplified 3DGA system. A significant correlation with WGS was also observed. These results support the validity of the clinical measurement of gait parameters using a simplified 3DGA system.

Correction: Feasibility of a Simplified, Clinically Oriented, Three-dimensional Gait Analysis System for the Gait Evaluation of Stroke Patients.

[This corrects the article DOI: 10.2490/prm.20160001.].

Differential characteristics and subcellular localization of two starch-branching enzyme isoforms encoded by a single gene in Phaseolus vulgaris L.

Starch-branching enzymes (SBE) have a dominant role for amylopectin structure as they define chain length and frequency of branch points. We have previously shown that one of the SBE isoforms of kidney bean (Phaseolus vulgaris L.), designated PvSBE2, has a molecular mass (82 kDa) significantly smaller than those reported for isologous SBEs from pea (SBEI), maize (BEIIb), and rice (RBE3). Additionally, in contrast to the dual location of the pea SBEI in both the soluble and starch granule fractions, PvSBE2 was found only in the soluble fraction during seed development. Analysis of a pvsbe2 cDNA suggested that PvSBE2 is generated from a larger precursor with a putative plastid targeting sequence of 156 residues. Here we describe the occurrence of a larger 100-kDa form (LF-PvSBE2) of PvSBE2 found both in the soluble and starch granule fractions of the developing seeds. The determined N-terminal sequence, VKSSHDSD, of LF-PvSBE2 corresponded to a peptide sequence located 111 amino acids upstream from the N terminus of purified PvSBE2, suggesting that LF-PvSBE2 and PvSBE2 are products of the same gene. Analysis of the products by 5'-RACE (rapid amplification of cDNA ends) and reverse transcription PCR indicated that the two transcripts for pre-LF-PvSBE2 and pre-PvSBE2 are generated by alternative splicing. Recombinant LF-PvSBE2 (rLF-PvSBE2) was purified from Escherichia coli and the kinetic properties were compared with those of recombinant PvSBE2 (rPvSBE2). rLF-PvSBE2 had much higher affinity for amylopectin (K(m) = 4.4 mg/ml) than rPvSBE2 (18.4 mg/ml), whereas the V(max) of rLF-PvSBE2 (135 units/mg) for this substrate was much lower than that of rPvSBE2 (561 units/mg). These results suggest that the N-terminal extension of LF-PvSBE2 plays a critical role for localization in starch granules by altering its enzymatic properties.