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Background: Gait disturbances in children with cerebral palsy can increase the hindrance caused by loss of independence and social engagement. The Lokomat, developed by Hocoma, shows promise as a supplementary tool for gait rehabilitation. This study investigates the impact of Lokomat training on gait parameters and trends observed during training. Methods: A total of 26 children (13 male individuals) with a diagnosis of cerebral palsy (CP), aged 4 to 23 years, were enrolled in the study. Patients participated in a standard comprehensive rehabilitation program with additional Lokomat training sessions. Gait function was assessed using the Timed Up and Go Test (TUG) and the 10 m walking test (10mWT) at the beginning and end of the rehabilitation period. Changes in Lokomat parameters (step number, session duration, speed, body weight support, and guidance force) were also analysed. Results: The median duration of the 10mWT and TUG significantly decreased across the groups after the treatment program. The highest increases were observed for the number of steps taken. Across the entire cohort, the linear trend curves for distance and number of steps exhibited near-perpendicular alignment with the horizontal axis, suggesting significant improvement in these parameters. A consistent trend was noted for speed, with the trend line aligned parallel with the horizontal axis. Decreasing trends were observed for body weight support and guidance force. Conclusions: Therapy with the Lokomat functioning as the active gait orthosis can be used as a form of support to the standard rehabilitation protocol for patients with CP. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore the impact of irritating sounds on the postural control of healthy adults, considering both linear and nonlinear parameters, subjective assessments, and gender differences. Methods: Thirty-four young participants (17 females, 17 males) completed three 30 s bipedal standing stability tests on a balance platform: one with visual control (EO), another without visual control (EC), and a third without visual control but accompanied by irritating sounds (ECS). Additionally, participants filled out a questionnaire evaluating their sound sensitivity. Linear and nonlinear parameters from each balance test were considered for statistical analysis. Results: The findings reveal significant gender-based variations in sensitivity to sound, with women exhibiting higher sensitivity. No statistically significant differences in postural control were observed between males and females, except for a notable increase in irregularity (SampEn values) in the anterior–posterior direction for females in the ECS trial. Correlation analyses revealed a moderate and statistically significant correlation between SampEn values in the AP direction and SE scores. Conclusions: This study highlights the intricate relationship between sensory stimuli, attention, and the body's ability to maintain balance. The presence of irritating sounds led to increased irregularity in postural control, particularly in the absence of visual control. [ABSTRACT FROM AUTHOR]

Purpose: External factors can disrupt postural control, but the intricate workings of the postural control system enable an appropriate response. This study seeks to assess how external perturbations affect postural control. Methods: Twenty women participated in study, which consisted four trials involved quiet standing and experiencing induced perturbations by being struck with a boxing bag from the back, right, and left sides, respectively. The center of pressure (CoP) path length was recorded for each of the mentioned trials. Sample Entropy (SampEn), Lyapunov Exponent (LyE), and Fractal Dimension (FD) were computed for the CoP time series, separately for the anterior-posterior (AP) and mediolateral (ML) directions. The nonparametric Friedman ANOVA with Dunn-Bonferroni post-hoc analysis was employed to investigate the influence of external perturbations on both linear and nonlinear parameters on postural control. Results: The post-hoc analysis showed for LyE_AP_quiet (1.02 ± 0.18) significantly higher values than for LyE_AP_right (0.92 ± 0.22) and significantly higher for LyE_AP_left. Lyapunov Exponent was the parameter that differentiated the most between samples. Conclusions: The greatest number of significant differences between samples were demonstrated by the Lyapunov Exponent. This non-linear parameter should be used to evaluate various perturbations during upright position in healthy subjects. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the effects of high-heeled shoes (HHS) and experience with such footwear on foot loading and standing balance using linear and nonlinear methods. Methods: Sixteen young female experts in wearing high-heeled shoes (HHE) and sixteen young females who occasionally wore high-heeled shoes (HHO) completed a Fall Risk Test (FRT) on the Biodex Balance System platform. They also underwent a both-leg standing test on the Zebris pressure mapping platform, both barefoot and while wearing 11 cm HHS. The study analyzed several parameters, including the FRT index, foot loading parameters, linear measures of postural stability (Center of Pressure (CoP) path length and velocity), and nonlinear postural control measures (sample entropy - SampEn, fractal dimension - FD, and the largest Lyapunov exponent - LyE). Results: HHS caused a significant increase the fall risk of more than 44%, but only in the HHE group. The presence of HHS caused a significant increase in CoP path length and CoP velocity by almost 78%. The values of these parameters increased by more than 67% in the HHO group and by more than 92% in the HHE group. HHS caused a significant increase in the values of nonlinear measures (FD and LyE) in the mediolateral direction. Higher FD and LyE values suggest the ability to react faster to destabilizing stimuli and better balance control related to plasticity and adaptability to new conditions. HHS also led to up to 70% loading on the supporting limb. Conclusions: High heels in the population of young women significantly worsen static balance. [ABSTRACT FROM AUTHOR]

Quantifying the dynamical features of discrete tasks is essential to understanding athletic performance for many sports that are not repetitive or cyclical. We compared three dynamical features of the (i) bow hand, (ii) drawing hand, and (iii) center of mass during a single bow-draw movement between professional and neophyte archers: dispersion (convex hull volume of their phase portraits), persistence (tendency to continue a trend as per Hurst exponents), and regularity (sample entropy). Although differences in the two groups are expected due to their differences in skill, our results demonstrate we can quantify these differences. The center of mass of professional athletes exhibits tighter movements compared to neophyte archers (6.3 < 11.2 convex hull volume), which are nevertheless less persistent (0.82 < 0.86 Hurst exponent) and less regular (0.035 > 0.025 sample entropy). In particular, the movements of the bow hand and center of mass differed more between groups in Hurst exponent analysis, and the drawing hand and center of mass were more different in sample entropy analysis. This suggests tighter neuromuscular control over the more fluid dynamics of the movement that exhibits more active corrections that are more individualized. Our work, therefore, provides proof of principle of how well-established dynamical analysis techniques can be used to quantify the nature and features of neuromuscular expertise for discrete movements in elite athletes. [ABSTRACT FROM AUTHOR]

The overhead press is a multi-joint exercise that has the potential to use a high external load due to the cooperation of many muscle groups. The purpose of this study was to compare the activity of shoulder and back muscles during the overhead press with a kettlebell and a dumbbell. Surface electromyography (EMG) for the anterior and posterior deltoid, upper and lower trapezius, serratus anterior, and spinal erectors was analysed for 20 subjects. Participants performed the four trials of pressing kettlebell and dumbbell, weighted at 6 kg, and 70% of one maximum repetition (1RM) in the sitting position. Statistical analysis was performed using a non-parametric Friedman test and a post-hoc test of Dunn Bonferroni. No significant differences were found in the activation of assessed muscles when comparing dumbbell to kettlebell press trials with the same load (6 kg and 70% of 1RM). However, muscle activity of all muscles except the upper trapezius was always higher for kettlebell pressing. Different center of gravity locations in the kettlebell versus the dumbbell can increase shoulder muscle activity during the overhead press. However, more studies are required to confirm these results. [ABSTRACT FROM AUTHOR]

Total knee replacement (TKR) is the treatment of choice for advanced stages of osteoarthritis but it requires good postoperative rehabilitation. This study aimed to assess the effectiveness of exercises using virtual reality to improve gait parameters in patients after TKR. Fifty-nine patients 7–14 days after TKR surgery were divided into a study group (VRG, n = 38) and a control group (CG, n = 21). Both groups underwent the same 4-week rehabilitation protocol. The VRG group had 12 additional nonimmersive virtual reality game sessions on the Virtual Balance Clinic prototype system at 30 min each, focusing on gait and balance improvement. Spatiotemporal, force and foot plantar pressure parameters were collected on an instrumented treadmill during a 30 s walk. The most significant improvement was in the symmetry indices of forefoot force, maximum forefoot force, loading response time, and preswing time (p < 0.05) in both groups. Gait speed increased by 31.25% and 44% in the VRG and CG groups, respectively (p < 0.005). However, the extra exergaming sessions did not significantly improve rehabilitation outcomes. Therefore, additional VR training does not improve gait better than standard rehabilitation alone, but the improvement of gait, especially its symmetry, is significant within the first six weeks after surgery. [ABSTRACT FROM AUTHOR]

Background: Human motor systems contain nonlinear features. The purpose of this study was to evaluate the geometric structure of attractors and analyze recurrence in two different pirouettes (jazz and classic) performed by 15 professional dancers. Methods: The kinematics of the body's center of mass (CoM) and knee of the supporting leg (LKNE) during the pirouette were measured using the Vicon system. A time series of selected points were resampled, normalized, and randomly reordered. Then, every second time series was flipped to be combined with other time series and make a long time series out of the repetitions of a single task. The attractors were reconstructed, and the convex hull volumes (CHV) were counted for the CoM and LKNE for each pirouette in each direction. Recurrence quantification analysis (RQA) was used to extract additional information. Results: The CHVs calculated for the LKNE were significantly lower for the jazz pirouette. All RQA measures had the highest values for LKNE along the mediolateral axis for the jazz pirouette. This result underscores the high determinism, high motion recurrence, and complexity of this maneuver. Conclusions: The findings offer new insight into the evaluation of the approximation of homogeneity in motion control. A high determinism indicates a highly stable and predictive motion trajectory. [ABSTRACT FROM AUTHOR]

Primary osteoarthritis treatments such as a total hip (THR) or knee (TKR) replacement lead to postural control changes reinforced by age. Balance tests such as standing with eyes open (EO) or closed (EC) give a possibility to calculate both linear and nonlinear indicators. This study aimed to find the group of linear and/or nonlinear measures that can differentiate healthy people and patients with TKR or THR from each other. This study enrolled 49 THR patients, 53 TKR patients, and 16 healthy controls. The center of pressure (CoP) path length, sample entropy (SampEn), fractal dimension (FD), and the largest Lyapunov exponent (LyE) were calculated separately for AP and ML directions from standing with EO/EC. Cluster analysis did not result in correct allocation to the groups according to all variables. The discriminant model included LyE (ML-EO, ML-EC, AP-EC), FD (AP-EO, ML-EC, AP-EC), CoP-path AP-EC, and SampEn AP-EC. Regression analysis showed that all nonlinear variables depend on the group. The CoP path length is different only in THR patients. It was concluded that standing with EC is a better way to assess the amount of regularity of CoP movement and attention paid to maintain balance. Nonlinear measures better differentiate TKR and THR patients from healthy controls. [ABSTRACT FROM AUTHOR]

Purpose: The symmetry of feet loading and adequate postural control are crucial aspects of proper squat performance. The study aimed to evaluate the effect of various stance widths during squat on postural control and symmetry of feet loading. Methods: Thirty healthy individuals participated in this study. Each participant performed one type of squat with a narrow stance (NS), hip stance (HS) and wide stance (WS). Results: A significantly higher value of CoP path length, the velocity of sways and Area95 were obtained for the WS squat compared to NS and HS. In addition, the wide feet setting significantly affected not only the feet loading symmetry but also the strategy (high LyE), the amount of irregularities (high SampEn) and the CoP time-series roughness complexity (high FD). It has been shown that as the base of support grew, the asymmetry index grew. Conclusions: The wide squat is less stable, requiring more complex postural control behavior and more flexibility. Performing this squat significantly shifts the pressure to the dominant limb. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the use of nonlinear measures - sample entropy (SampEn), fractal dimension (FD), and the Lyapunov exponent (LyE) - to evaluate postural control in adults during standing on an unstable surface, with and without visual feedback. Methods: 14 healthy young adults (24.07 ± 7.32 years) completed bipedal standing trials on an unstable-plate Biodex Balance System (BBS) connected to a Vicon system, with eyes open and closed. Each trial lasted 20 sec. Analysis was performed based on the center of mass (CoM), for which the three nonlinear measures were calculated. Results: Excluding visual feedback was found to cause a significant increase in linear and nonlinear parameters. Moreover, SampEn and FD values were found to be significantly higher in the PD direction, compared to AP or ML, whereas LyE values in this direction were minimal. Conclusions: Results show that the three nonlinear measures provide a useful way of evaluating postural control in healthy adults. Moreover, it seems that introducing an unstable surface meant that the projection of the CoM was not perpendicular to the surface, but rather set at a certain continually changing angle, forcing the whole system to adapt to chaotic and unpredictable conditions. Such refined changes in conditions can be evaluated in a precise way only by using nonlinear measures. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to analyze the muscle force distribution and lower limb joint loading during two types of pirouettes and check which muscle in which pirouette generates the highest force and which joint is the most loaded. Methods: Skilled dancers (n = 16) performed single-turn pirouettes in jazz and classic styles. Kinematic and kinetic data were collected using the Vicon system and Kistler plates. The joint reaction forces and muscle forces were calculated using a musculoskeletal model in the AnyBody Modeling System. Results: No statistically significant differences were found for the duration of the turn in both pirouettes. The range of motion in all joints of supporting leg in sagittal plane and in hip joint in frontal plane for non-supporting leg were significantly higher in classic pirouette. The ankle joint was the most loaded joint in both pirouettes and its maximal value was significantly higher in classic pirouette. The force generated by ankle plantar flexors muscles was significantly greater in the jazz pirouette in turn phase. For the nonsupport limb, external hip rotators generated significantly greater force when performing the classic pirouette. Conclusions: It seems that early stage dancers may start their lessons with jazz pirouettes, where necessary joint mobility is lesser. They also are supposed to increase muscle strength and body awareness with such proceedings. A better awareness of the mechanical loads on the musculoskeletal system which a dancer performing pirouettes faces should have an impact on the way dance classes are conducted and choreographic elements are sequenced. [ABSTRACT FROM AUTHOR]

Purpose: Yoga is known as a type of exercise that combines physical, mental and spiritual aspects. There has not been much research on the postural control in various yoga poses. The aim of this study was to examine CoP regularity in both yoga instructors and novices during the performance of four yoga poses, and to verify the sensitivity of linear and nonlinear methods for assessing postural stability. Methods: The dynamic characteristics of CoP fluctuations were examined using linear and nonlinear methods on a group of 22 yoga instructors (Y) and 18 age-matched non-practitioners of yoga (NY). The study involved maintaining a balance for 20 seconds while performing four yoga poses. Results: Conventional analysis of CoP trajectories showed that NY and Y exhibited similar control of postural sway, as indicated by similar CoP path-length and area values observed in both groups. These results suggest that the special balance yoga training received by Y may not have an impact on less challenging balance conditions, such as the poses used in this experiment. Interestingly, nonlinear dynamical analysis of CoP showed that Y exhibited less CoP regularity and more complex signal than NY, as evidenced by higher values of sample entropy and fractal dimension. Conclusions: The results shed light on the surplus values of CoP trajectories in the nonlinear dynamical analysis to gain further insight into the mechanisms involved in posture control. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the activity of upper limb muscles during hand rim wheelchair propulsion and lever wheelchair propulsion at two different velocity levels. Methods: Twenty male volunteers with physical impairments participated in this study. Their task was to push a lever wheelchair and a hand rim wheelchair on a mechanical wheelchair treadmill for 4 minutes at a speed of 3.5 km/h and 4.5 km/h in a flat race setting (conditions of moving over flat terrain). During these trials, activity of eight muscles of upper limbs were examined using surface electromyography. Results: The range of motion in the elbow joint was significantly higher in lever wheelchair propulsion (59.8 ± 2.43°) than in hand rim wheelchair propulsion (43.9 ± 0.26°). Such values of kinematics resulted in a different activity of muscles. All the muscles were more active during lever wheelchair propulsion at both velocity levels. The only exceptions were extensor and flexor carpi muscles which were more active during hand rim wheelchair propulsion due to the specificity of a grip. In turn, the examined change in the velocity (by 1 km/h) while moving over flat terrain also caused a different EMG timing of muscle activation depending on the type of propulsion. Conclusions: Lever wheelchair propulsion seems to be a good alternative to hand rim wheelchair propulsion owing to a different movement technique and a different EMG timing of muscle activity. Therefore, we believe that lever wheelchair propulsion should serve as supplement to traditional propulsion. [ABSTRACT FROM AUTHOR]

Background: Pathological movement patterns are characterized by abnormal kinematics, kinetics and muscle activations that alter the distribution of muscle forces during walking.Aim: The objective of this study was to identify what compensatory strategy is evident in muscle force distribution in patients with drop-foot, in response to weakness in the dorsiflexor muscles.Methods: A sample of 10 patients with drop-foot were evaluated by a computerized gait analysis system and compared to a group of 10 healthy subjects. Muscle-actuated simulations of normal and drop-foot walking were performed using OpenSim software. A musculoskeletal model with 43 muscles acting on one lower extremity was used in order to perform the simulations. In order to evaluate the difference between muscle force curves in the healthy and the drop-foot populations, an integrals of each muscle curve were computed.Results: The group of patients with drop-foot exhibited an increased force integral for all muscle groups, except for the ankle evertors. The highest increases were observed for hip adductors (112%), hip extensors (88%), knee and hip flexors (83% and 50%, respectively) and for the plantarflexor (47%). These results were mainly influenced by the following muscles: flexor digitorum and hallucius, tibialis posterior and semitendinosus. The force integral for these muscles increased by more than 200% in the drop-foot group as compared to the control group. In addition, significant changes (>100%) were noted for the posterior thigh muscle group (semitendinosus, biceps femoris long and short head), which are responsible for bending the knee joint and straightening the hip joint.Conclusions: It was proved that the loss in muscle force in individual muscle groups of the ankle joint are compensated for by the increased force and activity in other muscles acting on this joint and another muscles in neighbouring joints. The results may have important implications for physiotherapy treatments. [ABSTRACT FROM AUTHOR]

Background. It is known that cochlear implantation may alter the inner ear and induce vestibular disorders. Research Question. How does cochlear implantation influence gait stability? Material and Methods. An experimental group of twenty-one subjects scheduled for cochlear implantation underwent gait testing twice, on the day before cochlear implantation (BCI) and three months after cochlear implantation (ACI), using a motion capture system. A control group of 30 age-matched healthy individuals were also tested. Results. In the experimental group, the gait stability ratio (GSR) was found to improve in 17 subjects after implantation, by an average of 6%. Certain other parameters also showed statistically significant improvement between the two experimental group tests: step time (p<0.001), single-support phase walking speed (p<0.05), and center of mass (CoM) (p<0.05). Using the CoM results of the control group, we devised a stability classification system and applied it to the pre- and postimplantation subjects. After implantation, increases were seen in the number of subjects classified in interval II (strong stability) and III (weak stability). The number of subjects in interval I (perfect stability) decreased by 1 and in interval IV (no stability) by 4. Significance. (1) Although cochlear implantation intervenes in the vestibular area, we found evidence that gait stability improves in most subjects after the surgery, reducing the risk of falls. (2) We found statistically significant improvements in individual parameters (such as single-support phase time), in GSR, and in CoM. (3) Based on CoM results, we proposed a new rule-of-thumb way of classifying patients into gait stability intervals, for use in rehabilitation planning and monitoring. [ABSTRACT FROM AUTHOR]

Purpose: Seeking a method to evaluate and monitor the performance of the shot put, discus and javelin throw, we analyzed the transfer of mechanical energy between body segments. Methods: The study was conducted on groups consisting of elite throwers on the Polish National Team for each of the aforementioned sport disciplines. The movements of each throw were recorded using Vicon system and Kistler plates. The power and energy fluctuations were computed for the final acceleration phase of each throw. Results: In all three disciplines studied, we found an average energy loss of 1.63 J/kg generated from shoulder to wrist. The value of generated energy from ankle to torso initially increased in all disciplines, followed by a descent - with the exception of the javelin throw, where there was an average 27% decrease in both hip joints. We found strong correlations between relative amplitude values of energy and the athlete's personal performance records: -0.8226 (shot put), 0.6008 (discus) and 0.7273 (javelin). Conclusions: Measuring the transfer of mechanical energy between body segments offers a useful method for evaluating the technique of ballistic movements and for monitoring training progress. [ABSTRACT FROM AUTHOR]

Purpose: Sabre is one of the three disciplines in fencing, characterised by the use of a lightweight cutting weapon to score hits on an opponent while maneuvering for position with dynamic footwork. The aim of this study is concerned with the estimation of the load applied to the lower extremities during a step-forward lunge. Methods: The study group comprised sixteen subjects from ASA club. Examinations of kinetic parameters of analyzed movement were carried out using Vicon system, Kistler plates and the equipment designed to measure joint torques in isometric conditions. Results: Maximal value of the vertical component of the ground-reaction-force generated by the lead leg is significantly higher than the one recorded in the rear leg. The maximal value of hip flexion torque of lead leg in dynamic conditions significantly exceeds the value for this joint recorded in isometric conditions. The maximal value of knee flexion of rear leg in dynamic conditions significantly exceeds the value obtained in the isometric conditions. In general, the sequence of the joint loading from the highest to the lowest is as follows: hip, knee, ankle. Conclusions: The comparative analysis of the torques generated by the muscles in isometric and dynamic conditions provides an adequate tool for the assessment of the characteristics of the muscle effort. Therefore, it defines the structure of movement patterns in saber, from the kinetics' point of view, in the process of improving fencing footwork. [ABSTRACT FROM AUTHOR]

Purpose: Simulating the complexities of lower limb motion can be useful for orthosis or rehabilitation planning. The aim of this study was to develop an artificial neural network (ANN) able to accurately simulate the changes in the angle of the ankle, knee and hip joints during the gait cycle, then to use it to simulate the impact of a restricted range of ankle and hip joint angle changes on the progression of the knee joint angle. Methods: Thirty four young healthy students participated in the study. Gait kinematics data were collected using the Vicon system, then analyzed with an ANN. Results: We developed an ANN able to accurately simulate the progression of joint angles of lower-limb motion; its simulation of the impact of restricted ankle and hip joint angular ranges in the on the knee joint indicate that the braking phase is critical. Conclusions: ANNs offer a useful research method in clinical biomechanics. Further research in this vein should expand our understanding of compensatory functions in the lower limbs. [ABSTRACT FROM AUTHOR]

Muscle forces acting over the ankle joint play an important role in the forward progression of the body during gait. Yet despite the importance of ankle muscle forces, direct in-vivo measurements are neither possible nor practical. This makes musculoskeletal simulation useful as an indirect technique to quantify the muscle forces at work during locomotion. The purpose of this study was to: 1) identify the maximum peaks of individual ankle muscle forces during gait; 2) investigate the order over which the muscles are sorted based on their maximum peak force. Three-dimensional kinematics and ground reaction forces were measured during the gait of 10 healthy subjects, and the data so obtained were input into the musculoskeletal model distributed with the OpenSim software. In all 10 individuals we observed that the soleus muscle generated the greatest strength both in dynamic (1856.1N) and isometric (3549N) conditions, followed by the gastrocnemius in dynamic conditions (1232.5N). For all other muscles, however, the sequence looks different across subjects, so the k-means clustering method was used to obtain one main order over which the muscles' peak-forces are sorted. The results indicate a common theme, with some variations in the maximum peaks of ankle muscle force across subjects. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to derive reference values for a four-level scale intended to evaluate variation in free gait asymmetry measurements in healthy subjects. Methods: This evaluation is based on kinetic values for the left and right lower limbs during gait, registered with advanced measurement systems and assessed using the symmetry index (SI) developed by Robinson. Results: For the majority of parameters, the SI does not follow normal distribution. As such, quartile values were used to create intervals for a four-step scale of assessing symmetry of free gait in healthy subjects for each gait parameter of interest. The SI rating intervals were from 0% (very good symmetry) to 21.2% (very poor symmetry) for kinetic parameters. The poorest symmetry was observed for horizontal force F3. Conclusions: The four-step scale of assessing symmetry in free gait in healthy subjects can be used in diagnosing gait disorders, devising surgical treatment strategies, and monitoring the rehabilitation process. Reference values for intervals of symmetry indicators in healthy subjects can be used as criteria for comparing individuals with/without disabilities. [ABSTRACT FROM AUTHOR]

Background Drop foot is a complex syndrome, with multiple interactions between joints and muscles. Abnormalities in movement patterns can be measured using motion capture techniques, but identifying compensation mechanisms remains challenging. Methods In order to identify compensatory mechanisms in patients with drop foot, this study evaluated a sample of 15 such patients using a computerized gait analysis system, as compared to a group of 15 healthy subjects. Findings Four classes of parameters were distinguished, falling in differing intervals of percentage differences between the groups in the study. The first class comprised two kinematic parameters for which the values of percentage differences in the control group were more than 100% greater than for the patient group. The second class comprised two kinetic parameters falling in the interval of 100–49%. In the third class, in the 49–20% interval the main differences were observed for spatiotemporal parameters, whereas in the 20–4% interval the differences were distributed similarly for kinematic, kinetic and spatiotemporal parameters. Interpretation These differences in gait pattern between the groups may be related to both primary motor deficits and secondary compensatory mechanisms. Generally, we conclude that drop foot affects the patients' overall kinematic and kinetic gait parameters, with compensation seen as a chain originating from a change of movement within the ankle joint. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the differences in ankle muscle strength using hand-held dynamometry and to assess difference in the isometric muscle force distribution between the people with diabetes and control participants. Methods: The maximal muscle strength of ankle plantarflexion, dorsiflexion, eversion, inversion, lesser toes flexors and extensors, hallux flexors, and extensors was assessed in 20 people with diabetes and 20 healthy participants using hand-held dynamometry. The maximal isometric ankle plantarflexion and dorsiflexion were imported to OpenSim software to calculate 12 individual muscle (8 plantarflexors and 4 dorsiflexors) forces acting on ankle joint. Results: A significant reduction in ankle strength for all measured actions and a significant decrease in muscle force for each of the 12 muscles during dorsi and plantar flexion were observed. Furthermore, the ratios of agonist to antagonist muscle force for 6 of the muscles were significantly different between the control group and the group with diabetes. Conclusions: It is likely that the muscles for which the agonist/antagonist muscle force ratio was significantly different for the healthy people and the people with diabetes could be more affected by diabetes. [ABSTRACT FROM AUTHOR]

Objectives: Determination of the phases in a stand-to-sit-to-stand task based on a derivative of the parameter with the lowest variance calculated based on the modified symmetry index. Material and Methods: The study group comprised 11 healthy women and 11 healthy men from the University of Physical Education in Warsaw. The examination of the kinematic and kinetic parameters of sitting down and standing up from a chair was carried out using the Vicon Mx system and Kistler force platforms. Results: The modified symmetry index was employed to select the parameters used to choose those with the lowest variance. Consequently, the phases in a stand-to-sit-to-stand task were determined. Conclusions: It was demonstrated that the task of sitting down is a reverse task with respect to standing up in terms of the symmetry of the parameters analyzed. [ABSTRACT FROM AUTHOR]

Although gait symmetry is being evaluated and reported in the literature with increasing frequency, there is still no generally accepted standard for assessing symmetry, making it difficult to compare studies and establish criteria to guide clinical decision-making. The purpose of this study was to ascertain whether gait symmetry in healthy subjects is consistent when assessed using various coefficients (RI, SI, GA, and SA), and if possible to identify a gait symmetry coefficient with the highest diagnostic utility. The study involved a group of 58 healthy university-level students of physical education and secondary school students aged 20.03 ± 0.97. Measurements of spatial-temporal gait parameters were conducted using the ZEBRIS platform. Our analysis supports existing recommendations that the symmetry index (SI) should be used as the most sensitive assessment of gait symmetry on the basis of spatial-temporal parameters in healthy subjects. Moreover, we developed normative values of individual features for diagnostic purposes. [ABSTRACT FROM AUTHOR]

Backward walking (BW) is a common technique employed in the treatment of a variety of orthopedic and neurological diseases. BW training may offer some benefits especially in balance and motor control ability beyond those experienced through forward walking (FW). The purpose of this study was to determine whether BW represented a simple reversal of FW and, hence muscle force distribution is the same. The study involved one male healthy student of physical education (22 years, h = 185 cm, m = 80 kg). Measurements of spatial-temporal gait parameters were conducted using eight Vicon system cameras, and Kistler plates. Noraxon EMG was used to obtain muscles activity. OpenSim software was used to compute muscle force distribution during both types of gait. During FW and BW there is small difference for force curves produced by m. gluteus maximus (RMS = 0.04), m. biceps femoris short head (RMS = 0.19) and m. tibialis anterior (RMS = 0.16). Good validation by EMG signal was obtained for m. rectus femoris, m. biceps femoris short head, m. tibialis posterior during FW and BW. For m. iliacus, only during BW good validation was achived. [ABSTRACT FROM AUTHOR]

The activity of muscles during motion in one direction should be symmetrical when compared to the activity of the contralateral muscles during motion in the opposite direction, while symmetrical movements should result in symmetrical muscle activation. The literature lacks data on the symmetry of neck muscle activation. Therefore, this study aimed to analyse the activity of the upper trapezius (UT) and sternocleidomastoid (SCM) muscles at rest and during basic motions of the neck and to determine the symmetry of the muscle activation. Surface electromyography (sEMG) was collected from UT and SCM bilaterally during rest, maximum voluntary contraction (MVC) and six functional movements from 18 participants. The muscle activity was related to the MVC, and the Symmetry Index was calculated. The muscle activity at rest was 23.74% and 27.88% higher on the left side than on the right side for the UT and SCM, respectively. The highest asymmetries during motion were for the SCM for the right arc movement (116%) and for the UT in the lower arc movement (55%). The lowest asymmetry was recorded for extension–flexion movement for both muscles. It was concluded that this movement can be useful for assessing the symmetry of neck muscles' activation. Further studies are required to verify the above-presented results, determine muscle activation patterns and compare healthy people to patients with neck pain. [ABSTRACT FROM AUTHOR]

Gait analysis may serve various purposes related to health care, such as the estimation of elderly people's risk of falling. This paper is devoted to gait analysis based on data from depth sensors which are suitable for use both at healthcare facilities and in monitoring systems dedicated to household environments. This paper is focused on the comparison of three methods for spatiotemporal gait analysis based on data from depth sensors, involving the analysis of the movement trajectories of the knees, feet, and centre of mass. The accuracy of the results obtained using those methods was assessed for different depth sensors' viewing angles and different types of subject clothing. Data were collected using a Kinect v2 device. Five people took part in the experiments. Data from a Zebris FDM platform were used as a reference. The obtained results indicate that the viewing angle and the subject's clothing affect the uncertainty of the estimates of spatiotemporal gait parameters, and that the method based on the trajectories of the feet yields the most information, while the method based on the trajectory of the centre of mass is the most robust. [ABSTRACT FROM AUTHOR]

Background: Gait deviations may negatively affect the articular surfaces of the lower extremity joints and lead to some minor degenerative changes. The simplest method for gait evaluation is to assess the symmetry of its parameters, assuming that each undisturbed gait should be symmetrical. This study aims to quantify the degree of asymmetry of kinematic and kinetic parameters caused by the presence of different ankle orthosis settings using Dynamic Time Warping (DTW). Methods: Barefoot gait and gait with four different walker settings were investigated in eighteen healthy persons. Kinematic and kinetic parameters were measured using the Vicon system and Kistler plates. Symmetry was assessed using the DTW method. Results: It was shown that the presence of different ankle orthosis settings significantly disturbs the symmetry of all lower limb kinematic parameters and only knee and hip torques. The highest values of asymmetry were noted for the walker set at 15° of dorsiflexion (15DF). Conclusions: The DTW method allowed us to quantify the degree of asymmetry throughout the gait cycle in relation to barefoot walking. Our results suggest that each orthosis position analysed in this study fulfills its protective function, but gait 15DF can lead to the overload of knee and hip joints. [ABSTRACT FROM AUTHOR]

Osteoporosis is a prevalent health concern among older adults and is associated with an increased risk of falls that may result in fracture, injury, or even death. Identifying the risk factors for falls and assessing the complexity of postural control within this population is essential for developing effective regimes for fall prevention. The aim of this study was to assess postural control in individuals recovering from osteoporotic vertebral fractures while performing various stability tasks. Seventeen individuals with type II osteoporosis and 17 healthy subjects participated in this study. The study involved maintaining balance while standing barefoot on both feet for 20 s on an Advanced Mechanical Technology Inc. (AMTI) plate, with eyes open, eyes closed, and eyes closed in conjunction with a dual-task. Another three trials lasting 10 s each were undertaken during a single-leg stance under the same conditions. Fall risk was assessed using the Biodex Balance platform. Nonlinear measures were used to assess center of pressure (CoP) dynamics in all trials. Reducing the support area or elimination of the visual control led to increased sample entropy and fractal dimension. Results of the nonlinear measurements indicate that individuals recovering from osteoporotic vertebral fractures are characterized by decreased irregularity, mainly in the medio-lateral direction and reduced complexity. [ABSTRACT FROM AUTHOR]

Conventional biomechanical analyses of human movement have been generally derived from linear mathematics. While these methods can be useful in many situations, they fail to describe the behavior of the human body systems that are predominately nonlinear. For this reason, nonlinear analyses have become more prevalent in recent literature. These analytical techniques are typically investigated using concepts related to variability, stability, complexity, and adaptability. This review aims to investigate the application of nonlinear metrics to assess postural stability. A systematic review was conducted of papers published from 2009 to 2019. Databases searched were PubMed, Google Scholar, Science-Direct and EBSCO. The main inclusion consisted of: Sample entropy, fractal dimension, Lyapunov exponent used as nonlinear measures, and assessment of the variability of the center of pressure during standing using force plate. Following screening, 43 articles out of the initial 1100 were reviewed including 33 articles on sample entropy, 10 articles on fractal dimension, and 4 papers on the Lyapunov exponent. This systematic study shows the reductions in postural regularity related to aging and the disease or injures in the adaptive capabilities of the movement system and how the predictability changes with different task constraints. [ABSTRACT FROM AUTHOR]

Over the past decade, researchers have focused on studying the functional context of perceiving painful stimuli, particularly concerning the posturographic correlates of emotional processing. The aim of this study was to investigate the differential modulation of non-linear measures characterizing postural control in the context of perceiving painful stimuli. The study involved 36 healthy young participants who, while standing, viewed images depicting feet and hands in painful or non-painful situations, both actively (by imagining themselves affected by the situation) and passively. For Center of Pressure (COP) displacement, three non-linear measures (Sample Entropy, Fractal Dimension, and Lyapunov exponent) were calculated. The results suggest lower values of FD and LyE in response to active stimulation compared to those recorded for passive stimulation. Above all, our results pledge for the usefulness of the Lyapunov exponent for assessing postural modulation dynamics in response to painful stimuli perception. The feasibility of this calculation could provide an interesting insight in the collection of biomarkers related to postural correlates of emotional processes and their modulation in neurological disease where socio-affective functions can be often impaired before cognitive ones. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess the impact of a vestibular-stimulating exercise regime on postural stability in individuals with visual impairment.The study group consisted of 70 people, including 28 persons (15 female and 13 male) with visual impairment and 42 (21 female and 21 male) without visual impairment. Each individual in the group with visual impairment was medically qualified for a 3-month training program. The research methodology included medical examination, anthropometric tests, and stabilometry tests on a Biodex Balance SystemSD (BBS). The tests were conducted twice: once before the start of training and again after 3 months of rehabilitation. The group with visual impairment showed significantly worse postural stability results than the control group for most of the stability parameters evaluated (OSI, APSI, and MLSI). Differences were noted between the groups with and without visual impairment for dynamic tests in women and for static tests in men. After training, the two groups showed roughly similar results for the stabilometry test with eyes closed. We conclude that exercises stimulating the vestibular system with head and body movements should be recommended for individuals with visual impairments to achieve better balance retention. [ABSTRACT FROM AUTHOR]

Tissue flossing is an increasingly popular method in physiotherapy and sports. There is a belief that tissue flossing can improve range of motion and muscle strength, shorten muscle recovery time, and reduce the risk of injury. The aim of this study was to analyse the effectiveness of tissue flossing for immediately improving muscle strength in recreational athletes when it is performed during warm-up. All participants were randomly assigned to either an experimental group (n = 36) or a control group (n = 34) using a random number generator. The experimental group (n = 36) performed an intervention comprising exercises with muscle tissue flossing and exercises without flossing. The control group (n = 30) performed the same protocol without a floss band. Muscle strength was measured for knee flexion end extension at three speeds (60, 120, and 180 °/s) 3 times. Analysed parameters include peak torque, work, and power related to body weight, flexors–extensors ratio, and time to peak torque. There were no significant changes in the muscle strength parameters from before to after the warm-up in either group (p > 0.05). Significantly lower values of peak torque, work, and power were observed in the experimental group during the warm-up with the floss band applied to muscles (p < 0.05). No clinically significant changes in time to peak torque or flexors–extensors ratio were observed. A single application of flossing does not improve muscle strength or power and can even reduce individuals' maximum muscle strength capabilities. [ABSTRACT FROM AUTHOR]

Exercises in virtual reality (VR) have recently become a popular form of rehabilitation and are reported to be more effective than a standard rehabilitation protocol alone. The aim of this study was to assess the efficacy of adjunct VR training in improving postural control in patients after total knee replacement surgery (TKR). Forty-two patients within 7–14 days of TKR were enrolled and divided into a VR group and a control group (C). The C group underwent standard postoperative rehabilitation. The VR group additionally attended twelve 30-min exercise sessions using the Virtual Balance Clinic prototype system. Balance was assessed on the AMTI plate in bipedal standing with and without visual feedback before and after the four-week rehabilitation. Linear measures and sample entropy of CoP data were analyzed. After four weeks of rehabilitation, a significant reduction in parameters in the sagittal plane and ellipse area was noted while the eyes remained open. Regression analysis showed that sample entropy depended on sex, body weight, visual feedback and age. Based on the sample entropy results, it was concluded that the complexity of the body reaction had not improved. The standing-with-eyes-closed test activates automatic balance mechanisms and offers better possibilities as a diagnostic tool. [ABSTRACT FROM AUTHOR]

The WHO declared COVID-19 a global pandemic [1], but the long-term consequences and aftermath of the disease remain unclear. The SARS-CoV-2 virus infects the respiratory system and probably also affects many other systems, including the musculoskeletal system [2–4]. In clinical practice, it has been observed that after recovering from COVID-19, a large number of seniors report prolonged general weakness and muscle fatigue. Falls, for instance, are a well-known consequence of reduced muscle strength [5,6]. Is COVID-19 infection associated with long-term reductions in muscle strength and balance ability in older women? The Study Group included 25 women, aged 65+, who declared they had recovered from SARS-CoV-2 infection. The Control Group consisted of women (n =30) of similar age, tested prior to the SARS-CoV-2 pandemic. Muscle torques were measured for the knee flexors (KF), knee extensors (KE), trunk flexors (TF), trunk extensors (TE), and elbow flexors (EF) under isometric conditions using a JBA Staniak® isometric torquemeter, by the maximum voluntary contraction method. Balance was assessed using a Biodex Balance System SD (BBS) platform. A static Postural Stability Test (PST) was performed using the stability platform with eyes open and eyes closed. A dynamic Fall Risk Test (FRT) was performed with eyes open at various levels of platform instability, and on this basis a fall risk index (FRI 6-2) was determined for each subject. Differences between the groups were assessed using the Mann-Whitney U test. A significance level of α =0.05 was assumed. Muscle torque values were normalized to the body weight of each subject. Statistical analysis showed higher values of EF, TF and TE for the Control Group. No statistical differences were found in static stabilographic parameters between groups. The Post-COVID Group did show higher results of the dynamic stabilographic index (FRI6-2) compared to the Control Group, which is indicative of poorer balance abilities. Results are presented in Table 1. Table 1 The results of the muscle toques of various muscle groups and fall risk in Post-COVID Group and Control Group [Display omitted] EF– elbow flexors torque; KF– knee flexors torque; KE– knee extensor torque; TF– trunk flexors torque; TE– trunk extensors torque; FRI– fall risk index; *n=24 We found FRI6-2 to be correlated with TE (r= -0.38) and TF (r= -0.37) for all participants, but this correlation was larger in the Post-COVID Group (r= -0.68 for TE and r= -0.55 for TF). Results indicate that post-COVID women exhibit impaired strength of various muscle groups and body balance in dynamic conditions. Post-COVID physiotherapy should therefore take into account not only respiratory problems but also musculoskeletal and equilibrium disorders, e.g. by using resistance training to improve muscle strength. [ABSTRACT FROM AUTHOR]