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Background\ud \ud The paper-grip-test (PGT) involves pulling a small card from underneath the participant’s foot while asking them to grip with their hallux. The PGT is shown to be effective in detecting foot muscle-weakening but its outcome is operator-dependent. To overcome this limitation, an enhanced PGT (EPGT) is proposed that replaces the pass/fail outcome of the PGT with a continuous measurement of the pulling force that is needed to remove the card (EPGT-force).\ud Research question\ud \ud Is the EPGT-force an accurate, reliable and clinically applicable measurement of strength?\ud Methods\ud \ud Reliability and clinical applicability were examined in two ways. Firstly, two examiners measured EPGT-force for twenty healthy volunteers in a test/retest set-up. EPGT force was measured using a dynamometer, the hallux grip force was measured using a pressure mat. The clinical applicability of the EPGT was tested in ten people with diabetes. Postural sway was also measured.\ud Results\ud \ud Interclass correlation coefficients (ICC) revealed excellent inter-rater reliability (ICC > 0.75). Intra-rater reliability was excellent for the first examiner (ICC = 0.795) and good for the second (ICC = 0.703). Linear regression analysis indicated that hallux grip force accounted (on average) for 83%±4% of the variability in EPGT force. This strong relationship between EPGT force and hallux grip force remained when the test was performed in a clinical setting with the latter accounting for 88% in EPGT force variability. Spearman rank order correlation showed that people with diabetes with a higher difference in EPGT force between limbs swayed more.\ud Significance\ud \ud EPGT force is a reliable and accurate measurement of hallux grip force. Hallux grip force was previously found to be strongly correlated to the strength of all muscle groups of the foot and ankle and to the ability to maintain balance. The proposed EPGT could be used to monitor muscle weakness in clinics for better falls-risk assessment.

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.

Background\ud 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.\ud \ud Methods\ud Databases (Scopus, PubMed and Google Scholar) were searched for studies based on a rigorous search strategy.\ud \ud Results\ud 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.\ud \ud Conclusion\ud 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.

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.

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.

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.

This study aimed to evaluate the accuracy of three measurement systems estimating gait speed during a loaded military march over graded terrain. Systems developed by the Swiss and Netherlands Armed Forces and a commercial wrist-based device were evaluated in comparison to a Global Positioning System. The first part of the paper focuses on the development of the Dutch system, where speed is estimated from a chest worn accelerometer and body measurements. For this validation study 36 subjects were walking or running 13 laps of 200 m at different speeds. Results showed that walking and running speed can be estimated with a R2adj of 0.968 and 0.740, respectively. In the second part of this paper, data from 64 soldiers performing a 35 km march were used to evaluate the accuracy of three measurement systems in estimating speed. Data showed that estimating gait speed with a single accelerometer can be accurate for military activity, even without prior individual calibration measurements. However, predictions should be corrected for confounders such as body size and shoe type to be accurate. Both, downhill and uphill walking led to changes in gait characteristics and to an overestimation of speed by up to 10%. Correcting for slope or gradient using altimetry in future algorithms/experiments could improve the estimation of gait speed.

Inertial sensor systems are increasingly used in the assessment of persons with knee osteoarthritis (KOA) and total knee replacement (TKR). This systematic review aims to (1) investigate the application of inertial sensor systems and kinematics derived from these systems, and (2) assess if current assessment protocols consist of tasks which are, according to the International Classification of Functioning, Disability and Health (ICF) for KOA, relevant for persons with KOA and TKR. A search was conducted in six electronic databases (ACM, CINAHL, EMBASE, IEEE, PubMed, Web of Science) to include papers assessing the knee and one or more adjacent joints by means of inertial sensors in healthy persons or persons with KOA or TKR. Two reviewers checked the methodological quality. Twenty-three papers were included: 18 in healthy persons and five in persons with KOA or TKR. In healthy persons, 11 tasks were related to metrics of the ICF-function and ICF-activity level. In persons with KOA, only walking was assessed. Apart from walking, four additional tasks were related to the ICF-function and ICF-activity level in persons with TKR. In healthy persons, joints located proximally and distally to the knee were assessed, while in persons with KOA and TKR, only the knee and ankle were assessed. This is a shortcoming since hip and trunk motion potentially contain clinically relevant information, in terms of identifying (mal)adaptive compensatory movement strategies. Additionally, physically more demanding tasks should be evaluated as these might be superior in detecting compensatory movement strategies. Former considerations warrant attention in future research. ispartof: Gait & Posture vol:59 pages:229-241 ispartof: location:England status: published

Background Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory arthritis that impacts biomechanical features of gait. This systematic review describes the effects of JIA on gait motion parameters and walking performance. Methods Six databases were searched (PubMed/Medline, Cochrane, the EBSCOHost database SPORTDiscus, Web of Science, and Embase). Studies were restricted to children with any subtype of JIA who were assessed for gait motion features (kinematic, kinetic, temporalspatial) or walking performance (velocity or distance covered); could include intervention or treatment exposure with measures of gait and gait speed; could involve comparison of gait in JIA to healthy controls. Quality of evidence was assessed using the GRADE system. This systematic review was registered at PROSPERO (CRD42018109582) Results The search yielded 625 papers, 23 of which described biomechanical features of gait and/or assessed walking performance. Twenty studies measured walking velocity and walking ability using simple field tests or laboratory methods. Eleven studies measured temporalspatial parameters such as cadence, step length, stride length, step width, single and double support time. Nine studies evaluated kinetic measurements including joint power, flexion and extension and joint moments. Nine studies evaluated kinematic parameters including range of motion, pelvic tilt, center of motion and trunk sway. Conclusions Key features of gait in children with JIA include slower gait velocity, shortened step length, decreased range of motion at the hip, knee and ankle with trend towards flexion, decreased joint power, anteriorly tilted pelvis and trunk with shifted center of motion. There is a potential to ameliorate JIA-related gait changes with exercise and/or pharmaceutical interventions.

Background Poor postural balance in the upright position is strongly correlated to morbidities, such as falls in older adult populations and to lower limb injuries in the younger populations. Good postural balance depends on muscular strength and the integration of neurological and muscular feedback mechanisms throughout the body. Since the interface with the ground is the plantar surface of each foot, an improved understanding of the role of foot muscles in postural balance is warranted. Research question Does improved toe flexor strength result in better postural balance, across the lifespan? Methods A systematic review was conducted of papers from 1900 to 2019 inclusive, from five databases. Inclusion and exclusion criteria were established prior to selection. Inclusion criteria were: observational and longitudinal studies, healthy subjects, at least one balance and one toe flexor strength test conducted. Exclusion criteria were: subjects with a pathology/disability, case study, systematic or literature review. Two examiners assessed a study’s suitability for inclusion in this review, based on the above criteria. Study quality was assessed using the Critical Appraisal Skills Program Tools. The type of studies and methodological heterogeneity precluded the feasibility of conducting a meta-analysis. Results Nine studies were included. In each study, participants were over sixty years of age, and over 73 % of them were female. No study was found for a younger population group. There were seven cross-sectional studies, two randomized control trials and there was one case-control study. All studies provided evidence of directly proportional, clinically significant correlations between toe flexor strength and postural balance. Significance Toe flexor strength contributes to improved postural balance for people over the age of 60. Research is needed to establish the relationship between foot muscle strength and balance in younger adults and children.

Background This paper updates our 2011 systematic review on the clinical efficacy of three-dimensional instrumented gait analysis (3DGA). Research question What is the current evidence base pertaining to the clinical efficacy of 3DGA? Methods We identified English language articles published from September 2009 to October 2019 reporting primary research that used typical motion analysis laboratory methods to study human walking. Five gait laboratory experts classified articles according to the highest type of efficacy they addressed: type 1 (technical), 2 (diagnostic accuracy), 2b (outcome prediction), 3−4 (diagnostic thinking and treatment), 5 (patient outcome), 6 (societal). Articles classified into type 3−4 and higher were rated for quality using LEGEND. Results Of 2712 articles related to the efficacy of 3DGA, over 99% addressed technical (n = 313), diagnostic (n = 1466), or outcome prediction (n = 927) efficacy. Six type 3−4 studies showed that 3DGA changes treatment plans, increases clinicians’ confidence in their treatment decisions, and increases agreement among clinicians. Two type 5 articles based on a randomized controlled trial demonstrated that patient outcomes improved only when 3DGA data were available and its recommendations were followed. A population-based type 5 study found that the incidence of severe crouch gait dropped from 25% to 4% following practice changes including the addition of 3DGA. The strength of evidence was mainly 3b (lesser quality prospective cohort studies) but also included stronger studies (three level 2 controlled clinical trials). Significance Literature related to the clinical efficacy of 3DGA has grown substantially over the last decade. Thousands of articles contribute to continued improvement of data collection and interpretation, as well as understanding of gait pathology and treatment. A smaller number of studies clearly demonstrate the efficacy of 3DGA in changing and reinforcing treatment decisions, increasing clinicians’ confidence in treatment planning, and increasing agreement among clinicians, as well as the potential to improve patient outcomes.

Background Interactive computer play (ICP) becomes popular in rehabilitation for children with cerebral palsy (CP). With the nature of ICP, it could be an effective intervention specifically to improve balance and postural control for children with CP. The present paper aimed to review the effectiveness of ICP on postural control and balance for children with CP. Methods Electronic databases including Medline, AMED, EBSCOhost, PsycINFO, Embase, the Cochrane Library and the DARE were searched up to September 2018. Studies were included if (1) participants were aged under 18 and had CP, (2) ICP intervention was performed, (3) an explicit objective was postural control and balance of the participants, and (4) results were fully published in English-language peer-reviewed journals. Characteristics of study participants, ICP protocols and study results were extracted. Level of evidence of each studies was graded using the guidelines from the American Academy of Cerebral Palsy and Developmental Medicine. Methodological quality was graded using the Physiotherapy Evidence Database (PEDro) scale. Effect sizes were calculated on available data. Results Twenty studies were included, with nine of level I or II evidence. Most studies had fair methodological rigor. Huge variations in the study designs and protocols of ICP were found among the studies. Conclusions ICP seemed to be more effective than conventional therapy in improving postural control and balance, with medium to large effect sizes for children with mild to moderate severity of CP. Future studies of high methodological rigour are required to verify the role of on-site guidance of the children during ICP and the effect on children with more severe CP.

Background Proprioception is one of the most significant factors in balance, joint stability, graceful movement, coordination, and injury prevention. It involves a wide set of receptors located within joints, muscles, and tendons. Given the neurophysiological processes involved in proprioception response are multiple and complex, there is not one single method to measure it. Particularly, proprioception of the knee joint, whether it is healthy, affected by osteoarthritis, or after replacement, is the most investigated by in literature. Research question This review addresses the analysis of proprioception in the knee joint before and after total knee arthroplasty (TKA). The aim is to obtain an overview of the proprioceptive skills in subjects who suffered from osteoarthritis and were subjected to knee replacement, evaluating changes in proprioception before and after the surgery. Methods The research was conducted within four databases: Web of Science®, PubMed Central®, Cochrane®, and PEDro®, between January 2008 and February 2018. Accurate exclusion criteria and selection strategy were applied to screen the 170 articles found. Results Ultimately, 13 papers were fully evaluated and included in this review, divided into two classes: i) works directly measuring proprioception, ii) studies indirectly evaluating proprioception. Contrasting results emerged from the analysis, and no consensus was found in the literature about the improvement or worsening in proprioception before and after TKA. Significance Since currently there is high variability in methods, protocol and parameters used to evaluate knee proprioception, further investigations based on a consistent dataset, a well-defined protocol, measurable outcomes, timeline follow-ups, and rehabilitation programs should be performed in order to obtain reliable results on the effects of TKA on knee proprioception and balance.

Background: Injury to the anterior cruciate ligament (ACL) is common among young athletes and can impact knee stability and control. Wearing proprioceptive knee braces can improve knee control and may reduce the risk factors associated with injury and re-injury, although the effect of such braces after ACL reconstruction (ACLR) is unclear. \ud Research question: This study aimed to determine the effect of proprioceptive knee bracing on knee control and subjective rating of participants post ACLR during three dynamic tasks. \ud Methods: Fifteen participants 2 – 10 years post ACLR performed a slow step down, single leg drop jump, and pivot turn jump with and without a proprioceptive knee brace. Knee kinematics in the sagittal (flexion – extension), coronal (abduction – adduction), and transverse (internal – external rotation) planes were collected using a 3D infrared system. Paired t-tests were performed to explore differences in knee angles and angular velocities between the no brace and brace conditions during the three tasks. After each task, subjective ratings regarding ease of the task were recorded. \ud Results: The brace reduced the peak knee external rotation angle and range of motion in the transverse plane during the pivot turn jump task, and significantly increased the maximum knee flexion angular velocity during the single leg drop jump task. The majority of participants reported that tasks were easier to perform with the proprioceptive brace than without. \ud Significance: This study confirms that proprioceptive knee braces can significantly influence knee kinematics during dynamic tasks post ACLR. The observed effects were clinically relevant. \ud Acknowledgements \ud The brace was supplied by DJO Global, Inc. The suppliers played no role in the design, execution, analysis and interpretation of the data or writing of this paper. We thank Mgr. Zuzana \ud Dvořáková, Mgr. Zdeněk Svoboda, PhD and Prof. RNDr. Miroslav Janura, Dr. for their \ud assistance with data collection and analysis. \ud Funding sources: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Background Virtual reality (VR) has been used to study locomotor adaptability during balance-demanding tasks by exploring how humans react and adapt to the virtual environment (VE) and discordant sensorimotor stimulations. Previous research primarily focused on treadmill walking and little is known regarding the propensity for gait adaptations during overground walking and over time. Research question To what extent healthy young adults modify and adapt gait during overground walking in a VE and with continuous multidirectional perturbations of the visual field while wearing a VR headset? Methods Twelve healthy young adults walked for 6 min on an instrumented walkway in four different conditions: RE, VE, and VE with antero-posterior (AP) and medio-lateral (ML) pseudo-random oscillations of the visual field. For each condition, stride length (SL), stride width (SW), stride time (ST) and their variability (SLV, SWV, and STV) were calculated using one-minute walking intervals. A 2-way repeated-measures ANOVA was performed to determine the main and interaction effects of the walking conditions and time. Results Participants took shorter SL and showed higher SWV while walking in the VE. Perturbations of the visual field resulted in reduced SL, larger SW, and higher stride variability (i.e., SLV, SWV, and STV). The response was anisotropic, such that effects were more pronounced during the ML compared to AP perturbations. Over time, participants adapted to the VE and the visual perturbations by increasing SL and reducing SW, SLV, STV, and ST (only during VE and ML conditions). SWV did not adapt over time. Significance The paper provided first evidence for visuomotor adaptations during unperturbed overground walking and during visual perturbations while wearing a VR headset. It represents an initial investigation that may help the development of new VR methods for early detection and remediation of gait deficits in more ecological conditions.

Background:The aim of this review was to evaluate and summarise the current evidence on non-computerised or non-recorded real time adult gait assessment conducted within the clinical musculoskeletal setting. It was hoped a protocol for best practice and a framework for further research could be developed from this search.Research question:Can a protocol for best practice and a framework for further research be established from previous literature relating to non-computerised or non-recorded real time adult gait analysis in a musculoskeletal clinical setting.Methods:A literature review with no limitation on date of publication was conducted on the 18th February 2017.Results:The review found no significantly informative papers relating to the searchSignificance:The lack of research on the accuracy, reliability and therefore worth of this highly recommended area of musculoskeletal assessment raises concerns over current assessment and treatment pathways. Further work to develop a method by which gait analysis can be routinely employed in musculoskeletal clinics as a diagnostic tool is required, with any new approach undertaking robust methodological testing.

The largest Lyapunov exponent (LyE) is an accepted method to quantify gait stability in young and old adults. However, a range of LyE values has been reported in the literature for healthy young and elderly adults in normal walking. Therefore, it has been impractical to use the LyE as a clinical measure of gait stability. The aims of this systematic review were to summarize different methodological approaches of quantifying LyE, as well as to classify LyE values of different body segments and joints in young and elderly individuals during normal walking. The Pubmed, Ovid Medline, Scopus and ISI Web of Knowledge databases were searched using keywords related to gait, stability, variability, and LyE. Only English language articles using the Lyapunov exponent to quantify the stability of healthy normal young and old subjects walking on a level surface were considered. 102 papers were included for full-text review and data extraction. Data associated with the walking surface, data recording method, sampling rate, walking speed, body segments and joints, number of strides/steps, variable type, filtering, time-normalizing, state space dimension, time delay, LyE algorithm, and the LyE values were extracted. The disparity in implementation and calculation of the LyE was from, (i) experiment design, (ii) data pre-processing, and (iii) LyE calculation method. For practical implementation of LyE as a measure of gait stability in clinical settings, a standard and universally accepted approach of calculating LyE is required. Therefore, future studies should look for a standard and generalized procedure to apply and calculate LyE.

Self-esteem is an important aspect of individual's mental health. When subjects are not able to complete self-report questionnaire, behavioral assessment will be a good supplement. In this paper, we propose to use gait data collected by Kinect as an indicator to recognize self-esteem.178 graduate students without disabilities participate in our study. Firstly, all participants complete the 10-item Rosenberg Self-Esteem Scale (RSS) to acquire self-esteem score. After completing the RRS, each participant walks for two minutes naturally on a rectangular red carpet, and the gait data are recorded using Kinect sensor. After data preprocessing, we extract a few behavioral features to train predicting model by machine learning. Based on these features, we build predicting models to recognize self-esteem.For self-esteem prediction, the best correlation coefficient between predicted score and self-report score is 0.45 (p0.001). We divide the participants according to gender, and for males, the correlation coefficient is 0.43 (p0.001), for females, it is 0.59 (p0.001).Using gait data captured by Kinect sensor, we find that the gait pattern could be used to recognize self-esteem with a fairly good criterion validity. The gait predicting model can be taken as a good supplementary method to measure self-esteem.

The iliocapsularis muscle of the anterior hip may play an important role in hip function, but no electromyographic (EMG) recordings have been made. This muscle provides the most substantial muscular attachment to the anterior hip capsule and is hypothesised to have a dynamic role to limit capsular impingement and to augment joint stability. Current understanding of the function of iliocapsularis is based on limited cadaveric and radiographic studies. Located deep over the hip joint it would require intramuscular fine-wire EMG to evaluate its activity directly with limited cross-talk from overlying muscles. The primary aim of this study was to describe a new technique for insertion of intramuscular EMG electrodes into iliocapsularis and to report its activation during different directions of hip maximum voluntary isometric contraction (MVIC). Fifteen healthy volunteers (10M, mean age (SD) 22 (2) years) who were free from hip pain were recruited for electrode insertion and to perform MVIC's in six directions at 0° and three directions at 90° of hip flexion. Intramuscular electrodes were successfully inserted into the iliocapsularis muscle with guidance from real-time ultrasound imaging. The greatest muscle activity occurred during resisted hip flexion at 90° (Median (IQR); 100.0 (1.2) % MVIC) and lowest activity during hip extension, 0° (0.5 (0.3) % MVIC). These findings have implications for our understanding of iliocapsularis' functional role. This paper provides the first report of intramuscular electrode insertion into iliocapsularis with guided technical instructions for future EMG investigations in other populations and tasks.

Background Cerebral palsy (CP) is a prevalent group of neuromotor disorders caused by early injury to brain regions or pathways that control movement. Patients with CP exhibit a range of functional motor disabilities and pathologic gait patterns. Crouch gait, characterized by increased knee flexion throughout stance, is a common gait pattern in CP that increases energy costs of walking and contributes to ambulatory decline. Our aim was to perform the first systematic literature review on the effectiveness of interventions utilized to ameliorate crouch gait in CP. Methods Comprehensive searches of five medical databases yielded 38 papers with 30 focused on orthopaedic management. Results Evidence supports the use of initial hamstring lengthenings and rectus femoris transfers, where indicated, for improving objective gait measures with limited data on improving gait speed or gross motor function. In contrast, evidence argues against hamstring transfers and revision hamstring lengthening, with recent interest in more technically demanding corrective procedures. Only eight studies evaluated alternatives to surgery, specifically strength training, botulinum toxin or orthoses, with inconsistent and/or short-lived results. Conclusions Although crouch in CP is recognized clinically as a complex multi-joint, multi-planar gait disorder, this review largely failed to identify interventions beyond those which directly address sagittal plane knee motion, indicating a major knowledge gap. Quality of existing data was notably weak, with few studies properly controlled or adequately sized. Outcomes from specific procedures are confounded by multilevel surgeries. Successful longer term strategies to prevent worsening of crouch and subsequent functional decline are needed. Level of evidence Systematic review.

Synchronization of multiple data collection systems is necessary for accurate temporal alignment of data, and is particularly important when considering rapid movements which occur in less than one second. This paper describes a novel method for synchronizing multiple data collection instruments including load cells and a motion capture system, using a common analog signal. An application of the synchronization method is demonstrated using biomechanical data collected during a rapid reach-to-grasp reaction, where data from motion capture and load cells are collected. Results are provided to validate and demonstrate the accuracy of the synchronization of motion capture with other data collection systems. During the reach-to-grasp trials, delays between the data collection systems ranged from 4 ms to 235 ms. The large range and variability in delay times between trials highlights the need for synchronization on a continual basis, rather than application of an average or constant value to correct for time delays between systems.

Highlights • Both types of functional foot orthoses produce similar mechanical effects compared to the sham orthosis. • The sham orthosis was comparable to the shoe only condition. • Both functional foot orthoses and the sham orthoses are appropriate for use in future RCTs., Background Midfoot osteoarthritis (OA) is more prevalent and strongly associated with pain than previously thought. Excessive mechanical loading of the midfoot structures may contribute to midfoot OA and studies suggest that functional foot orthoses (FFO) may relieve pain through improving function. This exploratory study aimed to evaluate the mechanical effect of two off-the-shelf FFOs, compared to a sham orthosis in people with midfoot OA. Methods Thirty-three participants with radiographically confirmed symptomatic midfoot OA were randomly assigned to wear either a commercially available FFO or a sham orthosis. After wearing their assigned orthoses for 12 weeks, plantar pressure measurements were obtained under shoe-only and assigned orthoses conditions. Participants assigned to the sham, were additionally tested wearing a second type of FFO at the end of trial. Descriptive mean change (±95% confidence intervals) in plantar pressure for each orthoses condition, versus a shoe only baseline condition are presented. Findings Compared to the shoe only conditions, both FFOs decreased hindfoot and forefoot maximum force and peak pressure, whilst increasing maximum force and contact area under the midfoot. The sham orthosis yielded plantar pressures similar to the shoe-only condition. Interpretation Findings suggest that both types of off-the-shelf FFO may provide mechanical benefit, whilst the sham orthoses produced similar findings to the shoe only condition, indicating appropriate sham properties. This paper provides insight into the mechanisms of action underpinning the use of FFOs and sham orthoses, which can inform future definitive RCTs examining the effect of orthoses on midfoot OA.

This paper presents long term follow up results from 17 children (6 girls, 11 boys, GMFCS levels II-IV), treated by means of selective dorsal rhizotomy (SDR). The particular focus is on the effect of the adolescent growth spurt on patients who had previously undergone SDR. The children were all assessed using 3D gait analysis, in combination with clinical examination at three time points-before SDR surgery (PRE), after SDR surgery when pre-adolescent (POST1) and post-adolescence (POST2). The total follow up period to POST2 was 8 years 6 months for girls and 9 years 5 months for boys. All children maintained or improved their GMFCS level. Positive changes in ranges of motion and gait were observed at POST1 and these were generally maintained over adolescence to POST2. The mean Gait Profile Score (GPS) had improved by 3.2 points (14.7-11.5) at POST1, with a non-significant deterioration of 0.3 over the adolescent growth spurt. These positive results reflect the total package of care for the children, involving careful pre-operative selection by a multidisciplinary team and post-operative management including intensive physiotherapy and maintenance in tuned ankle foot orthoses. Fifty-nine per cent of children had some additional orthopaedic surgery, mostly bony procedures. The overall benefits arising from their management need to be considered in the light of the likely deterioration experienced by this patient group. The results of this study support the use of SDR as part of a management strategy for carefully selected children with cerebral palsy with the aim of optimizing gait at skeletal maturity.

The purpose of this paper was to systematically assess the effect of Oxford Foot Model (OFM) marker misplacement on hindfoot relative to tibia, and forefoot relative to hindfoot kinematic calculations during the stance phase of gait. Marker trajectories were recorded with an 8-camera motion analysis system (Vicon Motion Systems Ltd., UK) and ground reaction forces were recorded from three force platforms (AMTI, USA). A custom built marker cluster consisting of 4 markers in a square arrangement (diagonal distance 2 cm) was used to assess the effect of marker misplacement in the superior, inferior, anterior and posterior direction for the sustentaculum tali (STL), the proximal 1st metatarsal (P1M), distal 5th metatarsal (D5M), proximal 5th metatarsal (P5M) and lateral calcaneus (LCA) markers. In addition manual movement of the heel complex 1 cm superiorly, inferiorly, medially and laterally, and also an alignment error of 10° inversion and 10° eversion was assessed. Clinically meaningful effects of marker misplacement were determined using a threshold indicating the minimal clinically important difference. Misplacement of the heel-wand complex had the most pronounced effect on mean kinematic profiles during the stance phase across all degrees-of-freedom with respect to hindfoot-tibia and forefoot-hindfoot angles. Vertical marker misplacement of the D5M and P5M markers affected the sagittal plane, and to a lesser extent frontal plane, forefoot-hindfoot kinematics. In conclusion, the OFM is highly sensitive to misplacement of the heel-wand complex in all directions and the P5M marker in the vertical direction.

This paper describes the validation of an IMU-based gait monitor, developed for the long-term capture of gait parameters in the free-living community setting. Seven stroke survivors and 17 healthy participants performed a range of walking bouts upon a CAREN self-paced treadmill. The event timings of the device were compared to the gold-standard Vicon system and resulted in an average RMSE of 37.7 ms across all participants.

More than half of Parkinson’s disease patients (PD) report difficulty in turning. We observed different numbers of turn steps, turn times, turn types, and turn qualities in PD patients compared to healthy adults. Although medication has an effect on motor impairments in PD, its effect on the complex walking turn task is still unclear. The aim of this paper is to investigate the effect of medication on the walking turn. All subjects performed an instrumented extended Timed Up & Go Test (TUG) wearing gyro-accelerometers. The PD patients were assessed twice, first after a withdrawal of medication (OFF) and then after taking a dose of medication (ON). The parameters calculated were duration, mean and the wave kurtosis of the angular rate. The mean angular rate and the waveform kurtosis showed significant differences between the CG and ON (p Our findings showed a difference in some turning parameters, namely duration and mean angular rate, between PD patients with and without medication. According to our results, medication decreases turn duration. Moreover, the mean angular rate increased with medication. These results support the view that turning is positively affected by medication.

Mediolateral weight shifting (MLWS) strategy has not been fully described in healthy populations and doing so would guide the clinician to give meaningful feedback. The aim of this paper is to characterize visually guided MLWS with a home-made game coupling a Kinect and a Wii Balance Board. In this project, 10 healthy adults were asked to catch water drops falling from the top of a screen using COF displacement. The task was divided into 4 levels of two conditions, namely “speed” and “amplitude” for a total of 250 MLWS per subject. This study reports the postural strategy used to perform MLWS tasks at different speed and amplitude in healthy adults. Results highlight modifications of the spatial and temporal parameters of the trunk movement.

The purpose of this paper is to study that the rowers’ technique may be analysed using 3D data. An quantitative analysis of rowing technique, both of the posture and of the handle’s positions while rowing are presented. The analysed parameters in ergometer rowing are obtained from three-dimensional data. They include: stroke count, time and speed of each stroke, angles of the handle and the rower’s back calculated in two planes. One rower and five first-time rowers were the participants in this study. Their movements were recorded using the Vicon motion capture system. The participants rowed a distance of 500 m. The obtained results indicate that an optical motion capture system may be used for verifying the rower’s technique.

Heel strike instants are an important component of gait analyses, yet accurate detection can be difficult without a force plate. This paper presents two novel techniques for kinematic heel strike instant (kHSI) detection which examined maximal resultant horizontal heel displacement (HHD). Each of these HHD techniques calculates HHD from a selected reference location of either the stance ankle or stance heel to the swing heel. The proposed techniques, along with other previously established techniques, were validated against a 10N force plate threshold. Fifty-four healthy adults walked overground at both normal and fast speeds while wearing athletic shoes. The reported true and absolute errors were as low as 3.2 (4.4) and 5.7 (3.4)ms, respectively, across 8678kHSI when using the stance ankle as a reference, which significantly outperformed (p

The Conventional Gait Model CGM has been a standard in\ud clinical gait analysis since the 1990s. Well-known by its commercialisation\ud as Plug-in Gait (PiG, Vicon, Oxford, UK), it is simple and widely\ud understood facilitating discussion between biomechanists and clinicians.\ud Most commercial manufacturers now provide some version of\ud the model. Despite its common use there has been little development of\ud the model since the 1990s perhaps because open source versions have\ud not been available. None of these replicates fully the range of options\ud that are used by different users. The first aim of this paper is thus to\ud present an open source version of the CGM which fully replicates those\ud options.