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We used the random forest classifier to predict Gross Motor Function Classification System (GMFCS) levels I-IV from patient reported abilities recorded on the Gillette Functional Assessment Questionnaire (FAQ). The classifier exhibited outstanding accuracy across GMFCS levels I-IV, with 83%-91% true positive rate (TPR), area under the receiver operation characteristic (ROC) curve greater than 0.96 for all levels, and misclassification by more than one level only occurring 1.2% of the time. This new approach to GMFCS level assignment overcomes several difficulties with the current method: (i) it is based on a broad spectrum of functional abilities, (ii) it resolves functional ability profiles that conflict with existing GMFCS level definitions, (iii) it is based entirely on self-reported abilities, and (iv) it removes complex age dependence. Further work is needed to examine inter-center differences in classifier performance-which would most likely reflect interpretive differences in GMFCS level definitions between centers. [ABSTRACT FROM AUTHOR]

Older adults exhibit increased gait variability that is associated with fall history and predicts future falls. It is not known to what extent this increased variability results from increased physiological noise versus a decreased ability to regulate walking movements. To "walk", a person must move a finite distance in finite time, making stride length (Ln) and time (Tn) the fundamental stride variables to define forward walking. Multiple age-related physiological changes increase neuromotor noise, increasing gait variability. If older adults also alter how they regulate their stride variables, this could further exacerbate that variability. We previously developed a Goal Equivalent Manifold (GEM) computational framework specifically to separate these causes of variability. Here, we apply this framework to identify how both young and high-functioning healthy older adults regulate stepping from each stride to the next. Healthy older adults exhibited increased gait variability, independent of walking speed. However, despite this, these healthy older adults also concurrently exhibited no differences (all p>0.50) from young adults either in how their stride variability was distributed relative to the GEM or in how they regulated, from stride to stride, either their basic stepping variables or deviations relative to the GEM. Using a validated computational model, we found these experimental findings were consistent with increased gait variability arising solely from increased neuromotor noise, and not from changes in stride-to-stride control. Thus, age-related increased gait variability likely precedes impaired stepping control. This suggests these changes may in turn precede increased fall risk. [ABSTRACT FROM AUTHOR]

People with central nervous system disorders typically have difficulties in coordination of the upper limb and hand movements, which significantly impairs their activities of daily living. Laboratory-based measures can provide quantitative and objective information about intra-limb coordination to aid the rehabilitation process of this population. However, there is currently no comprehensive review of laboratory-based measures. The aim of this review was to identify and summarize laboratory-based intra-limb coordination measures for different upper limb and hand movements. Searches were performed in the CINAHL, Embase, IEEE Xplore, MEDLINE, PubMed and Web of Science databases to identify studies published between 2013 and 2022. Two authors independently performed paper selection, data extraction and quality assessment. 21 papers were identified, and six types of coordination measures were classified. These included principal component analysis, continuous relative phase analysis, correlation analysis, regression analysis, uncontrolled manifold analysis, and uncorrelated surrogate data analysis, in descending order of occurrence. Regarding psychometric properties, all measures demonstrated good discriminative validity. However, only the principal component analysis approach and the continuous relative phase analysis approach were found to have good convergent validity and responsiveness, respectively. In terms of their practicality, these measures were primarily utilized for quantifying coordination in individuals with neurological disorders, with a greater emphasis on the coordination of upper limb movements rather than hand movements. This review summarized and critiqued the characteristics of six types of joint coordination measures. Researchers and clinicians should therefore select appropriate measures based on individual needs. Future research should continue on analysing coordination in individuals with pathological conditions and exploring the application of these measures in quantifying hand movement coordination, to advance current knowledge and inform rehabilitation practices. • Six intra-limb joint coordination measures are identified in this review. • Principal component analysis is the most popular measure in the past decade. • Joint coordination is often quantified in patients with neurological disorders. • The quantification of hand movement coordination is relatively inadequate. • Validity and responsiveness of the coordination measures are mostly examined. [ABSTRACT FROM AUTHOR]

The sit-to-stand transfer is a fundamental functional movement during normal activities of daily living. Central nervous system disorders can negatively impact the execution of sit-to-stand transfers, often impeding successful completion. Despite its importance, the neurophysiological basis at muscle (electromyography (EMG)) and brain (electroencephalography (EEG)) level as related to the kinematic movement is not well understood. This review synthesises the published literature addressing central and peripheral neural activity during 3D kinematic capture of sit-to-stand transfers. A pre-registered systematic review was conducted. Electronic databases (PubMed, CINAHL Plus, Web of Science, Scopus and EMBASE) were searched from inception using search operators that included sit-to-stand, kinematics and EMG and/or EEG. The search was not limited by study type but was limited to populations comprising of healthy individuals or individuals with a central neurological pathology. From a total of 28,770 identified papers, 59 were eligible for inclusion. Ten of these 59 studies received a moderate quality rating; with the remainder rated as weak using the Effective Public Health Practice Project tool. Fifty-eight studies captured kinematic data of sit-to-stand with associated EMG activity only and one study captured kinematics with co-registered EMG and EEG data. Fifty-six studies examined sit-to-stand transfer in healthy individuals, reporting four dynamic movement phases and three muscle synergies commonly used by most individuals to stand-up. Pre-movement EEG activity was reported in one study with an absence of data during execution. Eight studies examined participants following stroke and two examined participants with Parkinson's disease, both reporting no statistically significant differences between their kinematics and muscle activity and those of healthy controls. Little is known about the neural basis of the sit-to-stand transfer at brain level with limited focus in central neurological pathology. This poses a barrier to targeted mechanistic-based rehabilitation of the sit-to-stand movement in neurological populations. • Four dynamic movement phases are commonly used by most individuals to stand up. • Three muscle synergies are commonly used by most individuals to stand up. • No EEG data during sit-to-stand execution with 3D motion analysis was found. [ABSTRACT FROM AUTHOR]

Developments in vision-based systems and human pose estimation algorithms have the potential to detect, monitor and intervene early on neurodegenerative diseases through gait analysis. However, the gap between the technology available and actual clinical practice is evident as most clinicians still rely on subjective observational gait analysis or objective marker-based analysis that is time-consuming. This paper aims to examine the main developments of vision-based motion capture and how such advances may be integrated into clinical practice. The literature review was conducted in six online databases using Boolean search terms. A commercial system search was also included. A predetermined methodological criterion was then used to assess the quality of the selected articles. A total of seventeen studies were evaluated, with thirteen studies focusing on gait classification systems and four studies on gait measurement systems. Of the gait classification systems, nine studies utilized artificial intelligence-assisted techniques, while four studies employed statistical techniques. The results revealed high correlations of gait features identified by classifier models with existing clinical rating scales. These systems demonstrated generally high classification accuracies and were effective in diagnosing disease severity levels. Gait measurement systems that extract spatiotemporal and kinematic joint information from video data generally found accurate measurements of gait parameters with low mean absolute errors, high intra- and inter-rater reliability. Low cost, portable vision-based systems can provide proof of concept for the quantification of gait, expansion of gait assessment tools, remote gait analysis of neurodegenerative diseases and a point of care system for orthotic evaluation. However, certain challenges, including small sample sizes, occlusion risks, and selection bias in training models, need to be addressed. Nevertheless, these systems can serve as complementary tools, equipping clinicians with essential gait information to objectively assess disease severity and tailor personalized treatment for enhanced patient care. • Low-cost vision-based systems may enable more objective quantification of gait. • Vision-based systems allow early detection and severity monitoring of diseases. • Gait classification systems show high correlations with clinical rating scales. • Gait measurement systems effectively extract spatiotemporal and kinematic data. • A point of care system enabling remote gait analysis and orthotic evaluation. [ABSTRACT FROM AUTHOR]

Analyzing gait deviation is one of the crucial factors during the diagnosis and treatment of children with Cerebral Palsy (CP). The typical diagnostic procedure requires an expensive and complicated three-dimensional gait analysis system based on visual sensors. In this work, we focus on predicting well-known gait pathology scores using only information collected from the BS4P, the affordable isokinetic dynamometer. Using such equipment, it is possible to determine gait pathological indices such as the gait deviation index (GDI) or the Gillette gait index (GGI). Are there correlations between the results of examining patients with CP on the Biodex Pro 4 device and the gait quality metrics (GDI and GGI)? The isokinetic data acquired from biometric sensors (74 records) were analyzed using big data methods. We used several Machine Learning methods to find the correlation between gait deviation and isokinetic data: Adaptive Boosting Regression, K-nearest Neighbor, Decision Tree Regression, Random Forest Regression, and Gradient Boost Regression. In this paper, we provided a detailed comparison of different machine learning regression models in predicting gait quality in patients with CP based only on the data gathered from affordable Biodex 4 Pro device. The best result was obtained using the gradient boosting regression model with Mean Absolute Percentage Error of 6%. However, it was not possible to precisely predict the GGI index using this method. The results obtained showed promising results in the evaluation of gait index scores, which gives the possibility of diagnosing patients with CP without the use of expensive optometric systems. Evaluating gait metrics using the approach proposed in this paper could be very helpful for both physicians and physiotherapists in assessing the condition of patients with CP, as well as other diseases related to gait problems. • It is possible to asses the gait metrics using machine learning approach. • Assessing the gait metrics can be performed without expensive 3d optometric device. • Gait Deviation Index (GDI) can be assessed using Biodex System 4 Pro. [Display omitted] [ABSTRACT FROM AUTHOR]

Biomechanics significantly impacts sports performance and injury prevention. Traditional methods like discrete point analysis simplify continuous kinetic and kinematic data, while one-dimensional Statistical Parametric Mapping (spm1d) evaluates entire movement curves. Nevertheless, spm1d's application in sports and injury research is limited. As no systematic review exists, we conducted a scoping systematic review, synthesizing the current applications of spm1d across various populations, activities, and injuries. This review concludes by identifying gaps in the literature and suggesting areas for future research. What research exists using spm1d in sports biomechanics, focusing on the lower limbs, in what populations, and what are the current research gaps? We searched PubMed, Embase, Web of Science, and ProQuest databases for the following search string: "(((knee) OR (hip)) OR (ankle)) OR (foot) OR (feet) AND (statistical parametric mapping)". English peer-reviewed studies assessing lower limb kinetics or kinematics in different sports or sports-related injuries were included. Reviews, meta-analyses, conference abstracts, and grey literature were excluded. Our search yielded 165 papers published since 2012. Among these, 112 examined healthy individuals (67 %), and 53 focused on injured populations (33 %). Running (n = 45), cutting (n = 25), and jumping/landing (n = 18) were the most common activities. The predominant injuries were anterior cruciate ligament rupture (n = 21), chronic ankle instability (n = 18), and hip-related pain (n = 9). The main research gaps included the unbalanced populations, underrepresentation of common sports and sport-related injuries, gender inequality, a lack of studies in non-laboratory settings, a lack of studies on varied sports gear, and a lack of reporting standardization. This review spotlights crucial gaps in spm1d research within sports biomechanics. Key issues include a lack of studies beyond laboratory settings, underrepresentation of various sports and injuries, and gender disparities in research populations. Addressing these gaps can significantly enhance the application of spm1d in sports performance, injury analysis, and rehabilitation. • There is increasing use of statistical parametric mapping for biomechanics. • Running, cutting, and jumping are the most studied activities found in this review. • The main injuries studied are ACL rupture, ankle instability, and hip pain. • Primary gaps: underrepresented populations, small samples, and non-lab studies. [ABSTRACT FROM AUTHOR]

Gait changes with aging have been investigated, but few studies have examined a wide range of gait parameters across the adult lifespan. This study aimed to investigate gait differences across age groups stratified by sex. This cross-sectional study included 629 healthy, normal-weight (i.e., BMI < 30 kg/m2) participants from Switzerland of the COmPLETE cohort study, aged 20 to over 90 years. Gait metrics were assessed using an inertial measurement unit (IMU)-based gait analysis system, including speed, cycle duration variability, asymmetry, stride length, cycle duration, cadence, double support, stance (time foot is on the ground during a gait cycle), swing (time foot is in the air during a gait cycle), loading (early part of the stance phase), foot-flat (mid-stance phase when foot is flat), and pushing (late stance phase leading to toe-off) phases. Percentile curves were calculated using generalized additive models for location, scale, and shape. Gait data from 545 participants (273 men and 272 women) were analyzed. Participants were equally distributed across the seven age decades, with an average of 40 men and 40 women representing every decade. Both men and women showed a reduction in gait speed and stride length, and an increase in cycle duration variability and asymmetry with aging. Gait speed and stride length declined across the age groups, with a significant difference found in participants aged 80 to 91 compared to younger age groups. Age-related changes in gait parameters were seen in both men and women. These may be attributed to the typical decline in muscle strength, balance, coordination, and neuromuscular function. The results of this study contribute to the understanding of gait changes throughout the lifespan and can be used for comparison with other populations and as reference values for individual patients. • First paper providing norm values for gait parameters in a European population. • Large sample of healthy adults across the life span (20 to over 90 years of age). • Comprehensive overview of gait parameters across age groups, stratified by sex. • Both men and women displayed lower gait speed and stride length with age. • Gait variability and asymmetry was higher from around 60 years of age. [ABSTRACT FROM AUTHOR]

Cerebral palsy (CP) is a group of neuromotor diseases that develops as a result of damage to the developing central nervous system during the perinatal period. The condition is usually accompanied by musculoskeletal problems resulting in movement disorders. Gait improvement therefore, is an important part of its treatment. Roboticassisted gait training (RAGT) is a new potential rehabilitation tool for CP patients, however there is no clear evidence for the effectiveness of this method. Can robotic-assisted gait training improve walking function in children with CP? A systematic search was performed in five databases: MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Scopus, and Web of Science. Eligible studies were randomized controlled trials (RCT) with CP patients under the age of 18. Gross motor function and kinematic gait parameters of patients were the main outcomes. Two authors determined the risk of bias of the RCTs independently using the revised Risk of Bias 2 (ROB 2) tool. Mean Differences (MDs) along with their 95% Confidence Interval (CI) were calculated when at least three studies were present for an outcome, subgroup analysis was performed based on the treatment of the control group. Of the 7363 screened articles, 13 papers met our inclusion criteria and among them, 7 studies could be used in our meta-analyses. The results related to RAGT suggest nonsignificant improvement in standing and walking function (Gross Motor Function Measure D, E), moreover changes in gait speed, step length, and in cadence were also only comparable to controls. The results indicate that there is a trend in some gait parameters where the improvement was higher in the intervention group than in control group. The therapeutic effect of RAGT was probably not superior to physiotherapy combined with treadmill training. • Robotic-assisted gait training is a promising new treatment in cerebral palsy. • Effects and significance are not proven yet. • This review found a tendency for gait improvement after robotic training. • Straightforward evidence for effectiveness is still missing. [ABSTRACT FROM AUTHOR]

Background: Like many physiologic processes, Time of Day may influence postural control and gait. A better understanding of diurnal variations in postural control and gait may help to improve diagnoses, reduce falls, and optimize rehabilitation and training routines. This review summarizes the current literature that addresses these questions.Research Question: Does time of day affect postural control and gait?Methods: We searched PubMed, Google Scholar, and IEEE using a combination of keyword and MeSH terms. We included papers that studied human subjects and assessed gait or postural control as a function of time of day. We evaluated the quality of the identified papers based on nine assessment criteria and analyzed them considering the topic (postural control or gait), age, and characteristics of the conducted assessments. We then quantitatively synthesized the results across studies using a meta-analytical approach (i.e., Hedges' g model).Results: Twenty-two papers considered the relationship between time of day and postural control, and eleven considered the relationship between time of day and gait. Six studies found that postural control was best in the morning, four described postural control being best in the afternoon, four described optimal postural control in the evening, and eight reported no time of day effect. Two studies found gait best in the morning, five described gait best in the afternoon, two described optimal gait in the evening, and two reported no time of day effect. The results of the quantitative analysis suggest that both postural control and gait were best in the evening.Significance: While there is no clear consensus on whether there is a time of day effect for postural control and gait, the findings of this review provide initial evidence suggesting that a small but statistically significant effect exists in favor of the evening. Standardized testing, including repeated and continuous evaluations, may help provide more definitive information on time of day influences on postural control and gait. [ABSTRACT FROM AUTHOR]

Clinical motion analysis involves quantitative measurement of gait patterns to identify gait anomalies that currently or have the potential to impact function, activities of daily living and participation. Clinical motion analysis services are equipped with motion capture technology and comprise specialised staff who deliver 3-dimensional motion analysis services to children and adults who present with varying levels of gait impairment. Data is then used to inform intervention recommendations to clinicians with a view to maintaining independent, functional and pain free walking (or appropriate mobility). The ANZ-CMAG (established in 2013) identified a need to establish recommendations to assist in standardising practice guidelines for both current and new clinical motion analysis services within the region. The group serves to promote collaboration between services in quality assurance processes, clinical practices, data sets and research activities. The clinical practice recommendations described in this paper cover: i) requirements for a motion analysis service (including staffing, facilities and equipment), ii) patient assessments (requirements, clinical information and data gathered, reporting and interpretation of patient data), iii) quality assurance processes (including motion capture system / biomechanical models & limitations, marker placement, data storage / record keeping, creation of normative dataset); iv) helpful resources. Better outcomes for children and adults with gait deviations is dependent upon accurate measurement and evaluation of walking and requires input from multidisciplinary clinical teams with specialist knowledge and skills. The ANZ-CMAG hopes these clinical practice recommendations are beneficial to motion analysis services with an aim to improve clinical practices, patient outcomes, and support research collaboration. [ABSTRACT FROM AUTHOR]

This paper proposes an easy to calculate and adaptable summary gait metric, the Gait Abnormality Index (GAI), which is capable of simultaneously including kinematic and kinetic data, overcoming a key limitation of existing metrics. To determine the validity, reliability and sensitivity of the GAI. The GAI is calculated by averaging Gait Abnormality Scores, which are normalised distance metrics used to describe the deviation of pathological gait data from that of healthy controls. Validity was assessed using Pearson's correlation analysis to explore relationships between the GAI and the Gait Profile Score. Test-retest reliability of the GAI was assessed using intra-class correlation coefficients (ICC) and standard error of the measurement (SEM), and data from total hip arthroplasty patients. An independent samples t-test was used to compare GAI scores between knee osteoarthritis and total hip arthroplasty patients to explore the metrics sensitivity. A strong positive correlation (r ≥ 0.896; p < 001) was reported between the GAI and the Gait Profile Score. Good test-retest reliability (ICC =0.830) was reported for the GAI. Knee osteoarthritis patients displayed significantly (p =.017; Hedge's g effect size = 0.98) greater GAI scores compared to total hip arthroplasty patients, with the mean difference (0.34 a.u) above the SEM (0.15 a.u). The GAI offers an easy to calculate summary metric for three-dimensional gait analysis, which displays good validity and reliability, and is sensitive to different pathological conditions. ● The Gait Abnormality Index provides a valid summary gait metric. ● The Gait Abnormality Index provides a reliable summary gait metric. ● The Gait Abnormality Index provides a sensitive summary gait metric. [ABSTRACT FROM AUTHOR]

Background: Despite advances in laboratory-based supervised fall risk assessment methods (FRAs), falls still remain a major public health problem. This can be due to the alteration of behavior in laboratory due to the awareness of being observed (i.e., Hawthorne effect), the multifactorial complex etiology of falls, and our limited understanding of human behaviour in natural environments, or in the' wild'. To address these imitations, a growing body of literature has focused on free-living wearable-sensor-based FRAs. The objective of this narrative literature review is to discuss papers investigating natural data collected by wearable sensors for a duration of at least 24 h to identify fall-prone older adults.Methods: Databases (Scopus, PubMed and Google Scholar) were searched for studies based on a rigorous search strategy.Results: Twenty-four journal papers were selected, in which inertial sensors were the only wearable system employed for FRA in the wild. Gait was the most-investigated activity; but sitting, standing, lying, transitions and gait events, such as turns and missteps, were also explored. A multitude of free-living fall predictors (FLFPs), e.g., the quantity of daily steps, were extracted from activity bouts and events. FLFPs were further categorized into discrete domains (e.g., pace, complexity) defined by conceptual or data-driven models. Heterogeneity was found within the reviewed studies, which includes variance in: terminology (e.g., quantity vs macro), hyperparameters to define/estimate FLFPs, models and domains, and data processing approaches (e.g., the cut-off thresholds to define an ambulatory bout). These inconsistencies led to different results for similar FLFPs, limiting the ability to interpret and compare the evidence.Conclusion: Free-living FRA is a promising avenue for fall prevention. Achieving a harmonized model is necessary to systematically address the inconsistencies in the field and identify FLFPs with the highest predictive values for falls to eventually address intervention programs and fall prevention. [ABSTRACT FROM AUTHOR]

Background: Attempts to improve protocol standards of marker-based clinical gait analysis (CGA) have been one of the main focuses of research to enhance robustness and reliability outcomes since the 1990s. Determining joint centres and axes constitutes an important aspect of those protocols. Although the hip joint is more prominent in such studies, knee joint center (KJC) and axis (KJA) directly affect all outcomes.Research Question: What recommendations arise from the study of the scientific literature for determining knee joint parameters (KJP) for protocols of CGA?Methods: A systematic, electronic search was conducted on November 2018 using three databases with the keyword combination ("functional approach" OR "functional method" OR "functional calibration") AND ("hip joint" OR "knee joint" OR "ankle joint") and analyzed by four reviewers. Given the existence of a recent review about the hip joint and the lack of material about the ankle joint, only papers about the knee joint were kept. The references cited in the selected papers were also screened in the final round of the search for these publications. The quality of the selected papers was assessed and aspects regarding accuracy, repeatability, and feasibility were thoroughly considered to allow for a comparison between studies. Technical aspects, such as marker set choice, KJP determination techniques, demographics, and functional movements, were also included.Results: Thirty-one papers were included and on average received a rating of about 75 % according to the quality scale used. The results showed that functional methods are superior or equivalent to predictive methods to estimate the KJA, while a regression method was slightly better for KJC prediction.Significance: Calibration methods should be applied to CGA whenever feasibility is reached. No study to date has focused on evaluating the in vivo RoM required to obtain reliable and repeatable results and future work should aim in this direction. [ABSTRACT FROM AUTHOR]

Iliotibial band syndrome is a common overuse injury that is twice as likely to affect female runners compared to male runners. It is unclear if there is a consistent running pattern and strength profile exhibited by female and male runners with iliotibial band syndrome. The purpose of this systematic review and meta-analysis was to determine if any differences existed in lower-extremity kinematics and hip strength between runners who retrospectively, currently, or prospectively had iliotibial band syndrome. Papers included must have reported three-dimensional kinematic running data and/or hip strength data that were statistically analyzed between runners that never developed iliotibial band syndrome and runners with iliotibial band syndrome. Meta-analysis was performed for each kinematic or strength variable reported in at least three studies. Female and male runners were analyzed separately and grouped into three cohorts (retrospective, current, prospective). Seventeen articles were included in this systematic review. Data from 10 cross-sectional studies were included for meta-analysis. Female runners with current iliotibial band syndrome exhibited smaller peak hip internal rotation angles and lower isometric hip abductor strength compared to controls. Although limited biomechanical evidence exists, risk factors for ITBS are different between female and male runners and may vary according to injury status. Specifically, transverse plane hip motion and hip abductor strength weakness may be biomechanical risk factors in female runners with current iliotibial band syndrome only. • It is unknown if iliotibial band syndrome affects female and male runners differently. • Currently injured female runners exhibit smaller peak hip internal rotation angles. • Currently injured female runners exhibit lower hip abductor strength. • More iliotibial band syndrome work must analyze female and male runners separately. [ABSTRACT FROM AUTHOR]

Background: Functional near-infrared spectroscopy (fNIRS) is increasingly used in the field of posture and gait to investigate patterns of cortical brain activation while people move freely. fNIRS methods, analysis and reporting of data vary greatly across studies which in turn can limit the replication of research, interpretation of findings and comparison across works.Research Question and Methods: Considering these issues, we propose a set of practical recommendations for the conduct and reporting of fNIRS studies in posture and gait, acknowledging specific challenges related to clinical groups with posture and gait disorders.Results: Our paper is organized around three main sections: 1) hardware set up and study protocols, 2) artefact removal and data processing and, 3) outcome measures, validity and reliability; it is supplemented with a detailed checklist.Significance: This paper was written by a core group of members of the International Society for Posture and Gait Research and posture and gait researchers, all experienced in fNIRS research, with the intent of assisting the research community to lead innovative and impactful fNIRS studies in the field of posture and gait, whilst ensuring standardization of research. [ABSTRACT FROM AUTHOR]

Background: Crouch or flexed-knee gait is one of the most common pathological gait patterns in cerebral palsy (CP). Differences exist in definitions used; the degree of knee flexion, inclusion of hip or ankle position, and timing in the gait cycle. This ambiguity may be responsible for variations in prevalence rates and difficulty comparing data across studies.Research Question: What are the kinematic parameters used to define crouch or flexed-knee gait in CP gait? A secondary aim was to examine the quality of data reporting, focusing on the sample characteristics, inclusion/exclusion criteria and the choice of limb included for analysis.Methods: Articles included in this review reported on a specified cohort of adults or children with crouch or flexed-knee gait assessed with 3-dimensional gait analysis. A customised data extraction and quality assessment table was designed specific to the research question.Results: The majority (75 %) of included studies used the term crouch gait. Where the pattern was defined, 80 % of crouch papers and 94 % of flexed-knee gait papers based this solely on knee position. Kinematic parameters were clearly defined when they provided objective values of knee flexion, supported this with rationale and provided a reference point in the gait cycle. Only 22 % of crouch papers and 19 % of flexed-knee gait papers provided this information. The majority of studies (67 % crouch; 90 % flexed-knee) specified which limb(s) were included for analysis with the majority including both limbs. Objective values of knee flexion ranged from 8 o to 30 o.Significance: This review highlights that crouch and flexed knee are synonymous and ambiguity exists in the kinematic definition making it difficult to make compare data amongst study cohorts. Future research should provide detailed definitions including the threshold value of knee flexion, how it was derived, the timing in the gait cycle and the limb(s) included in analysis. [ABSTRACT FROM AUTHOR]

Background: Head-worn displays (e.g., "smart glasses") are an emerging technology to provide information, and in many situations they might be used while walking. However, little evidence exists regarding the effects of head-worn displays on walking performance. We found earlier that "smart glasses" had smaller adverse effects on measures of gait variability in the anterior-posterior direction vs. other types of information displays. Participants, however, complained about motion sickness and perceived instability while using smart glasses.Research Question: Were the participants' complaints a result of adverse effects of the smart glasses on the dynamics of lateral stepping and gait stability?Methods: Twenty individuals walked on a treadmill in four different conditions; single-task walking, and three dual-task walking conditions, the latter using smart glasses, smartphone, and a paper-based system to provide secondary cognitive tasks. We assessed the dynamics of lateral stepping and gait stability using the goal equivalent manifold and maximum Lyapunov exponent, respectively.Results: The dynamics of the lateral stepping were more adversely affected using smart glasses compared to the other types of information displays. However, stability measures revealed that the participants were more unstable when they used the smartphone and paper-based system.Significance: Promising results in terms of stability and adaptability suggest that head-worn display technology is a potentially useful alternative to smartphones and other types of information displays for reducing the risk of a fall. Results regarding perceptions of instability and a loss of control over lateral stepping, however, imply that this technology requires further development prior to real-work implementations. [ABSTRACT FROM AUTHOR]

Background: Due to the high susceptivity of the walking pattern to be affected by several disorders, accurate analysis methods are necessary. Given the complexity and relevance of such assessment, the utilization of methods to facilitate it plays a significant role, provided that they do not compromise the outcomes.Research Questions: This paper aimed at identifying the standards for the application of adaptive predictive systems to gait analysis, given the extensive research on this field. Furthermore, we also intended to check whether such methods can effectively support clinicians in determining the number of physiotherapy sessions necessary to recover gait-related dysfunctions.Methods: Through a screening process of scientific databases, we considered studies encompassed from 1968 to April 2019. Within these 50 years, we found 24 papers that met our inclusion criteria. They were analyzed according to their data acquisition and processing methods via ad hoc questionnaires. Additionally, we examined quantitatively the adaptive approaches.Results: Concerning data acquisition, the included papers presented a mean score of 6.1 SD 1.0, most of them applying optoelectronic systems, and the ground reaction force (GRF) was the most used parameter. The AI quality assessment showed an above-average rate of 7.8 SD 1.0, and artificial neural networks (ANN) being the paradigm most frequently utilized. Our systematic review identified only one study that addressed therapeutics including a predictive method.Significance: While much progress has been identified to predict assessment aspects, there is little effort to assist healthcare professionals in establishing the rehabilitation duration and prognostics. Therefore, future studies should focus on accomplishing the production of applications of predictive methods to therapeutics and prognosis, not lingering extremely on the analysis of gait features. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis is a disease of the joint causing decreased function and pain. Currently, treatments range from medication to surgery, with the use of different insoles and footwear recommended. These methods are effective by either correcting the position of the knee or providing shock absorption. However, there is little understanding of the effective characteristics of these devices.Research Question: This paper aims to investigate this question and provide future areas of research to help better define treatment guidelines. Foot orthoses are an example of non-pharmacological conservative treatments mentioned in National Institute for Health and Care Excellence (NICE) guidelines to treat knee osteoarthritis (OA). These include lateral wedge insoles (LWI), developed with the intention of load reduction of the knee. Different footwear has also been shown to affect pain, biomechanical and functional outcomes in knee OA patients.Methods: To address what features of LWIs and footwear make them effective in the treatment of knee OA, scientific databases were used to search for papers on this topic and then selected to be included based on pre-defined criteria. Data were extracted and analysed from these studies to provide a basis for possible areas for future development of these foot orthoses, and research required to improve clinical treatment guidelines. Databases used were PubMed, Scopus and Web of Science.Results and Significance: Thirty-four out of 226 papers were included after application of inclusion and exclusion criteria. Regarding LWIs, the characteristics showing the most beneficial effect on either biomechanical, functional or pain outcomes were customisation, full-length, 5° elevation, shock absorption and arch support. For footwear, barefoot mimicking soles produced the most favourable biomechanics. Results also showed that insoles work in correcting the position of the knee, but it may or may not affect patients' pain and function. [ABSTRACT FROM AUTHOR]

Children with specific learning disorder (SLD) have some cognitive and postural stability problems compared to typically developing (TD) children. Their single and dual-task gait performance may be affected depending on these problems. Are there any differences between the gait parameters of children with SLD and TD under single- and dual-task conditions? A comparative-descriptive study was conducted among 35 children with SLD and 33 TD children. All participants were assessed for gait parameters using a custom wireless inertial sensor under single and dual-task conditions. In the dual-task gait tests, there were the following tasks: to carry a glass of water and to tell apart the color of the paper. The children with SLD exhibited gait deterioration in both single and dual-task gait (p < 0.05). Dual-task cost cognitive values were higher in children with SLD (p < 0.05). This study highlights the worse gait performance of children with SLD under single- and dual-task conditions compared with TD children. However, interventions for their gait impairments are limited. At this point, SLD specialists can focus on multitasking to improve their walking skills. • Single- and dual-task gait parameters were affected in children with SLD. • Dual-task cost cognitive values increased in children with SLD. • Dual-task trainings should be added to SLD rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: The main aim of this review is to report the effect of different types of in-shoe and barefoot wedges on the distribution of the plantar loading of the human foot. We hypothesise that frontal plane wedges modify this parameter.Methods: A systematic review was performed, using the PubMed, CINAHL, Prospero and Scopus databases, consulted from their date of first publication to May 2020. Only observational (cross-over studies), randomised controlled trials (RCTs) and quasi-experimental studies addressing the effects of in-shoe and barefoot frontal plane wedges on plantar loading were included. All articles were subjected to quality assessment, using the Newcastle-Ottawa scale for the observational (cross-over) studies, TREND for quasi-experimental studies and the Cochrane Collaboration's tool for the RCTs.Results: Eleven papers were included in the final review. Four were cross-over studies, other four were quasi-experimental studies and three were RCTs. These eleven studies included 320 patients, with ages ranging from 20 to 60 years. Regarding the risk of bias, most of the observational studies and RCTs had a moderate level of quality.Conclusions: The results suggest that lateral wedges are more effective, producing a lateral shift of the centre of pressure and increasing the pressure. Regarding the impact on the peak impact force there seems to be less consensus among the published data. [ABSTRACT FROM AUTHOR]

Background: Gait event detection (GED) is an important aspect in identifying and interpret a user's gait to assess gait abnormalities and design intelligent assistive devices.Research Question: There is a need to develop robust GED models that can accurately detect various gait instances in different scenarios and environments.Methods: This paper presents a novel method of detecting heel strikes (HS) and toe offs (TO) during the user's gait cycle using a modified Long Short-Term Memory (LSTM) networks approach. The method was tested on a database from Movement Analysis in Real-world Environments using Accelerometers (MAREA) (n = 20 healthy subjects) that consisted of walking and running in indoor and outdoor environments with accelerometers positioned on waist, wrist and both ankles. Modifications include oversampling, composite accelerations and optimizing the LSTM network architecture were made.Results: Performance of our modified model was found to be better than six state-of-the-art GED algorithms, with a median F1 score of 0.98 for Heel Strikes and 0.98 for Toe Offs in the scenario of steady walking in an indoor environment, and a median F1 score of 0.94 for Heel Strikes and 0.68 for Toe-offs in the scenario of walking and running in an outdoor environment.Significance: This paper highlights the potential of the single proposed model to be an alternative to the six GED models in gait detection under various conditions. [ABSTRACT FROM AUTHOR]

Background: Diabetes accelerates the decline in muscle strength in older people and substantially increases the risk for fall and injury. Weakening of lower extremity muscles, in particular, is a strong predictor for falls, but currently there is no established method for its assessment in clinics. The paper grip test (PGT) offers a qualitative assessment of hallux plantar flexor strength and its usefulness for predicting falls has been demonstrated in non-diabetic populations.Research Question: The aim of this study is to test whether the PGT can be used for a quantitative assessment of lower-extremity strength and to investigate its relationship with isometric muscle strength and balance in people with diabetes and peripheral neuropathy.Methods: Isometric muscle strength of all muscle groups of the foot-ankle was assessed using a dynamometer in sixty-nine people with diabetes and neuropathy. Postural sway and the gripping force exerted by the participants during the PGT was measured for the same participants using a plantar pressure assessment system. These measurements were repeated in regular intervals for 18 months in a longitudinal observational cohort study.Results: Cross-sectional analysis of baseline data showed that people who failed the PGT swayed more. Analysis of longitudinal data showed that increasing hallux grip force is significantly associated with reduced postural sway. No significant association was found between dynamometry-based measurements of strength and postural sway. Hallux grip force was significantly correlated to the strength of all muscle groups of the foot-ankle complex.Significance: These results indicate that hallux grip force can assess the strength of the foot-ankle muscles and could potentially be used to identify people at risk of falling. This sets the basis for the development of new screening protocols to assess weakening of the muscles of the foot-ankle and to enhance risk assessment for falls in people with diabetes and peripheral neuropathy. [ABSTRACT FROM AUTHOR]