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Background: Currently, training of the gait function for patients with cerebral stroke using the biofeedback technology is an independent, effective, and promising method. The most common training and exposure parameters are the gait speed, cycle length, and cadence. However, the application of basic and more complex types of selective training using wearable sensor technology is rare due to the technological complexity of their use for biofeedback. Aims: To study the possibility of using the biofeedback training technology with a targeted effect on one of the basic parameters characterizing the symmetry of walking, the duration of the support period, in patients in the early recovery period of cerebral stroke. Methods: We examined 12 patients who underwent a course of biofeedback training to harmonize the period of support during the early recovery period of hemispheric cerebral stroke in the middle cerebral artery basin. The biomechanics of voluntary walking was investigated before and after the training. The spatio-temporal parameters of walking, kinematics of movements in the hip, knee, and ankle joints, and the maximum EMG amplitudes of the main muscle groups responsible for walking were recorded. The classical clinical scales were also used. The biofeedback training on a treadmill consisted of 10 sessions; the duration of the support period was the training parameter. Results. As a result of the treatment, a significant improvement was noted according to the UpGo clinical scale and Hausers walking index. The differences in the trained support phase after the treatment are not significant and demonstrate positive changes. The kinematics of movements in the joints also demonstrates relatively small, but significant changes for the knee joint. For the hip joint, no dynamics in the parameters values is observed; the joint function does not change significantly, and the amplitude asymmetry remains unchanged. For the knee joint, the greatest dynamics is observed for the main swing amplitude and its phase. Conclusion: The study has shown that the purposeful biofeedback training of the gait function using the support period to reduce the functional asymmetry in this parameter, and also has a positive effect on other gait parameters.

Background: Tandem Gait (TG) testing is known as a clinical method for studying the walking function with complicated coordination. The precise biomechanical walking parameters in this test remain poorly investigated. Moreover, TG is a modified locomotion of walking. In general, walking is a highly automated movement. TG introduces a component of voluntary control into it. Aims: A study of functional and biomechanical symptoms in children after the treatment for the posterior fossa tumor in the long term. Methods: The study involved 15 healthy subjects aged 12 to 35 years (20.47.2), among them 4 men and 11 women control group. The group of patients comprised 33 children who had a tumor of the posterior cranial fossa (HF) at the age of 7 to 17 years (12.33.1), of these 15 boys and 18 girls, who were admitted for rehabilitation treatment to the "Russkoe pole" Rehabilitation Center. A study on the TG kinematics was performed with the Optitrack system. Results: The results showed asymmetry in the duration of the step cycle and an increase in its duration proportional to the severity of the functional state. The pelvic movements showed different abnormalities. The flexion-extension movements in the hip joints were characterized by an extension lag at the end of the transfer period and a slight decrease in the amplitude, which probably became more pronounced with an increase in the degree of the motor impairment. The movements in the knee joints demonstrated two main phenomena: an increase in the flexion setting of the joint and a decrease in the amplitude of the main swing flexion. In addition, there was a delay in the maximum of the swing flexion. The kinematic parameters of the TG of the examined patients, in contrast to the control group, are not stable. This is, presumably, due to the fact, that normally such a modification of walking is easily automated and does not require voluntary control. In patients with SCF, each step in the TG mode requires additional voluntary control, and under these conditions, the stability and repeatability of a movement are dramatically reduced. Conclusions: In contrast to the routine clinical version of the test, the analysis of the movement biomechanics allows one to present an accurate qualitative and quantitative characterization of functional disorders. According to our research, motor function disorders develop at various levels of the musculoskeletal system. The degree of their severity is in a good agreement with the expert assessment of the patient's functional state.

Background: The standard of the surgical treatment for arthrosis of the knee joint (KJ) at the later stages is total arthroplasty, which allows relieving the pain and eliminating the existing deformity. However, there are not enough data on the long-term results after the surgery that is important for understanding the dynamics of the recovery and predicting the result. Aims: Study of clinical, functional, and biomechanical symptoms in patients after total arthroplasty of the knee joint in the long-term period. Methods: 22 patients after knee joint replacement and 20 relatively healthy adults (control group) were examined in long-term periods. The biomechanics of walking was studied at an arbitrary pace. The temporal characteristics of the gait cycle, shock loads and movements in the hip joints (HJ) and KJ were recorded. We recorded the time characteristics of the walking cycle, shock loads and movements in the hip joint (HJ) and KJ. The patients were divided into two subgroups according to the results of the biomechanical study. The patients from subgroup 1 had good functionality with a swing amplitude of the knee joint of 50 degrees or more, the movement algorithm was preserved. The patients from subgroup 2 had a swing amplitude of up to 50 degrees, the movement algorithm was impaired. Results: The temporal characteristics of the waking cycle of knee arthroplasty patients did not differ significantly from the control group in the long term. Abduction-adduction and rotation movements in HJ and KJ show a decrease in the amplitudes, more pronounced in the second subgroup. The main changes in the kinematics of the hip joint are characterized by a decrease in the range of motion and a longer extension time during the support period, which was found for both sides, especially in the second subgroup. The greatest changes were observed in the kinematics of the knee joints movements. They included a decrease in the amplitude of all the movements, not only on the endoprosthesis side, but also on the opposite side. Conclusions: There is no complete restoration of the knee joint function after total arthroplasty in the long term. The function of both lower limbs is symmetrically decreased. The fact of functionally different (less severe and more severe) results may be associated with the initial functional state of the joint before arthroplasty or with the subsequent period of rehabilitation.

The trunk, or the torso, is the central part of body in the anatomic relation and plays an important role in pose stabilization, maintenance of balance in daily and household activities and in the maintenance of controlled movements of the upper limbs during task performance. Registration of standard amplitude parameters of conjugate movements of shoulder joints and trunk in the sitting position in healthy subjects can be an important reference point for the recovery of patients with hemiparesis during the acute period of first hemispheric stroke. The study included 25 healthy subjects (11 women, 14 men; medium age: 52.9 ± 11.0 years). We examined the kinematics of conjugate movements in shoulder joints and trunk in the sitting position with the help of inertial sensors recording the movement in three mutually perpendicular planes. We observed specific patterns in the shoulder joints movements and deviations of the trunk in three mutually perpendicular planes. The movement of separate flexing of each arm is characterized by authentically smaller auxiliary movement of the trunk, and the movements of separate abduction and rotation of each hand are characterized by the bigger amplitude of trunk deviation. Trunk involvement becomes a part of the general strategy for achieving the goal of movement in the upper extremity, an important element of balance and a stabilizing component. The method for recording conjugate movements in shoulder joints and trunk in sitting position can be of interest for the medical and scientific institutions which perform motor rehabilitation.

Phonoarthrography, vibration arthrography are non-invasive methods for assessing the condition of cartilage and the knee joint as a whole based on the sounds made by the joint movement. Acoustic sensors (accelerometers, microphones) are attached to the knee to measure the knee joint noise both in control groups (young adults and elderly subjects) and in patients with knee osteoarthropathies. Different authors propose different methods for attaching sensors, documenting and analyzing the joint sounds. The identified specific features allowed distinguishing between asymptomatic knee joints and those with osteoarthropathies. Acoustic signals were recorded and processed, and their frequency characteristics were determined and classified. The classification effectiveness correlated with the existing diagnostic tests and hence phonoarthrography and vibration arthrography can be qualified as a useful diagnostic aid.

Deforming osteoarthritis (OA) of the knee is a progressive disease associated with pain and compromised function of the joint. Typical biomechanical modifications in the gait of subjects with medial knee OA are characterized by decreased gait speed and overload on the affected limb. The borderline stage for conservative versus surgical management is Grade II OA. The aim of this research was to study preoperatively the specific features of gait, knee, and hip function in patients with Grade II medial OA. We examined 26 patients with Grade II unilateral gonarthritis with varus deformity and 20 healthy adults. Biomechanical parameters of gait were recorded using an inertial sensor system. The gait cycle (GC) slightly increased both for the affected and for the intact limb. The hip joint movements showed significant symmetrical reduction in the first flexion amplitude, as well as a symmetrical delay in full hip extension at the end of the stance phase. In the knee, the first flexion amplitude was significantly reduced on the affected side compared to healthy control. The extension amplitude in the single support phase was significantly increased in both the affected and the intact lower limbs. The swing amplitude was significantly reduced on the affected side. On the affected side, the changes were more pronounced, both in incidence and in severity. The affected knee showed a syndrome of three reduced amplitudes. In patients, walking is characterized by several groups of symptoms: those of unloading of the affected limb, those of limiting the load on the affected joint and the musculoskeletal system as a whole, and those of gait harmonization. The symptoms of unloading the affected side and those of harmonization are the common symptoms of adaptation, typical for several pathological conditions with a relatively preserved function. The intensity of the observed symptoms can help assess changes in the subject’s functional condition over time and during the treatment.

The goal of this research was to investigate functional and biomechanical symptoms in patients with chondromalacia patella. Material and Methods — Gait biomechanics was assessed in 35 patients with diagnosed unilateral chondromalacia patella and in 20 healthy adult controls. We recorded hip and knee movements, impact loads and temporal characteristics of the gait cycle (GC) during self-paced walking. Results — The temporal characteristics of gait and the impact loads remained normal in the patient population. Hip flexion amplitude decreased both on the affected (p=0.002) vs. unaffected (p=0.016) sides, compared to healthy control, whereas the amplitude phase increased on the affected (p=0.012) vs. unaffected (p=0.001) sides, versus healthy control. Hip extension and adduction-abduction amplitudes did not change significantly. Stance-phase and swing-phase knee flexion amplitudes did not change significantly. Knee extension amplitude on the affected limb increased (p=0.015), and knee rotation on the unaffected limb decreased versus control (p=0.016). The so-called stairstep symptom defined in the study was found in 83% of patients: in 23 patients bilaterally and in 6 patients unilaterally. Conclusion — Chondromalacia patella affected the gait biomechanics on both sides. The changes in the kinematic patterns during the flat-surface walking were not substantial. The only pathognomonic functional symptom of the condition was the stairstep symptom.

The purpose of the study was to investigate the biomechanics of walking and of the knee joint in the acute phase of ACL injury. We examined 18 patients with acute ACL injuries and 20 healthy adults as controls. The biomechanics of the knee joint and of walking was assessed by 5 inertial sensors fixed with special cuffs to the lower back, the lower third of the thigh, and the lower third of the shank of the right and left legs. The movements and temporal characteristics were recorded while the subject was walking 10 m at a comfortable pace. Based on the results of examination, the patients were divided into two groups: with severe function impairment (6 patients) and with moderate function impairment (12 patients). It was found that in the first days post-trauma, not only the knee function was reduced, but the function of the entire lower limb as well. This led to a functional asymmetry. The kinematics of movements in the joints changed in accordance with slower walking. The walking became not only slower, but it was also associated with a decreased impact load in the weight acceptance phase. At later dates, the functional impairments were less pronounced. The total range of flexion motion did not exceed 20 degrees in the first group and 55 degrees in the second one. The injured joint developed functional immobilization within the first days post-injury. This was a guarding response by additional muscle strain to prevent unusual and limit physiological movements in the knee joint. The movements in the knee joint while walking were of small amplitude, rocking, and occurred only under load. The amplitude of the main flexion in the swing phase was reduced. The stage of an ACL injury should be assessed not only based on the time post-trauma, but also taking account of the functional parameter—the knee range of flexion while walking. According to our findings, the only factor that had influenced the functional condition of the KJ was the duration of joint immobilization after trauma.

Background The rehabilitation after pediatric brain tumors is a pressing issue in current neuro-oncology. The purpose of this study was to reveal the peculiarities of postural stability in pediatric posterior fossa tumor survivors as compared to the healthy controls. Additionally, we aimed to determine the feasibility of the balance biofeedback training for these patients. Methods We measured 6 postural stability parameters with the eyes opened and closed in 35 patients and 25 healthy controls aged 7–17. Further, the patients were divided into two groups: the intervention and waitlist. The intervention group was the first to undergo a 2-week biofeedback training designed to enhance balance control, while the waitlist group performed only the usual exercises. Then the groups were interchanged. Pre- and post-stability scores were measured in each condition. Findings The current results suggest the pronounced deficiency of stability in the patients. Their results in both opened and closed eyes conditions were similar. The post-training measurements revealed that some stability parameters were improved: ellipse square and mean root square oscillations in the frontal and sagittal planes. Interpretation The patients predictably demonstrated the significantly worse stability measurements as compared to the healthy controls. Moreover, they were shown not to use visual information to correct postural balance thus prompting us to assume severe deficits of the eye movements control due to the cerebellar pathology. This specificity, as well as the post-training significant improvement, emphasizes the clinical necessity to consider them when designing the rehabilitation protocols for posterior fossa tumor survivors.

The objective of the study was to evaluate the clinical, functional, and biomechanical symptoms in patients with anterior cruciate ligament (ACL) rupture before and after ACL reconstruction. The study enrolled 20 patients and 20 healthy subjects as controls. Walking biomechanics was assessed at three time points: before surgery and three months and a year or more after surgical reconstruction. Impact loads on both sides differed significantly from the respective values before surgery (p&lt, 0.05). Walking cycle duration decreased with time after surgery. On both sides (affected and unaffected), hip movement amplitudes were significantly smaller than in control (p&lt, 0.05). They remained so in the follow-up periods after the reconstruction. Before ACL reconstruction, the amplitude of the main flexion of the knee was significantly reduced both on the affected and unaffected sides. The amplitude gradually increased after the reconstruction, and a year post-surgery, it reached, on the operated side, the same values as in the control group. Complete functional recovery of the knee joint was not achieved within a year after the ACL surgical reconstruction. The remaining changes, however, were not clinically pronounced and could only be detected by instrumental gait analysis. The compensatory processes developed bilaterally, in both the hip and knee joints.

The anterior cruciate ligament (ACL) is most often structures to be damaged. In this research investigated biomechanics of walking at the timing, kinematics and dynamics parameters for 34 patients which had verified rupture of ACL. The 11 patients were investigated before surgical treatment and 23 after it. Investigations of patients of the first group were made at the time of 1 week to 6 years after trauma of the knee joint (the average meaning is 18 months). The second group was investigated at the time from 1,5 month to 5,5 years (the average meaning is 13 months). At the current research we did not find any specific for rupture of ACL functional disturbances during level walking compare to normal data and healthy limp. However, we assume some tendency to increase of flection-extention movement at the damaged knee joint after surgery. This result could give us some basis for revision the term of instability, because we did not get definite symptoms at our study.

In the article authors describe the basic pathogenetic mechanisms of development of osteoarthritis, a modern approach to the treatment of this group of diseases. Outlined the problems of treatment of coxarthrosis, gonarthrosis in elderly patients with the presence of concomitant somatic pathology. The study used a unique method for estimating motion in gait. Held objectification of treatment results in aged patients with knee joint hyaluronic acid.

The impaired function of the shoulder joint resulting from cerebral stroke is a common disorder involving permanent total disability as well as impaired capability of self-care. The functional pathological changes in the shoulder joint and the dynamics of the patients' health status during the acute period of cerebral stroke remain virtually unexplored.The objective of the present study was to obtain a deeper insight into the process of recovery of the movements in the shoulder joint of the patients presenting with hemiparesis during the acute period of hemispheric stroke based on the results of the analysis of the biomechanical data and the targeted training with biofeedback (BFB).The study included three groups comprised of 25 subjects each. One (control) group included the subjects having neither neurological nor orthopedic pathology. The second group consisted of the patients receiving the conventional treatment in the combination with therapeutic physical exercises (TPE). Group 3 was composed of the patients given the standard course of conventional and physical (TPE) therapy complemented by biofeedback training (the TPE/BFB group). The study included clinical investigations and biomechanical registration of the movements of the shoulder joints and trunk.The results of the study gave evidence that the patients presenting with hemiparesis during the acute period of hemispheric ischemic stroke including those treated with the application of the active means and methods of rehabilitation, such as BFB training, showed no appreciable dynamics of the parameters being evaluated with the use of the relevant clinical scales. The biomechanical study has demonstrated that the movements in the shoulder joints (in a single plain) of the patients comprising the control group are characterized by the presence of the main component with a maximum amplitude in the plane of this movement and additional components (in other planes with a significantly lower amplitude); they are accompanied by the ancillary movements of the trunk. Functionally, the condition of paresis at the level of the shoulder joint is characterized by a decrease in the amplitude of the primary movement and the increase of one of the additional amplitudes, with the growing amplitude of the auxiliary movements of the trunk. The biomechanical methods for the objective assessment have revealed the following functional changes in the shoulder joints: the 6% improvement of flexion in the group of the patients treated with the use of therapeutic physical exercises and the 10% improvement in those treated with the combination of TPE and BFB. Moreover, abduction in the patients of these two groups improved by 4% and 9% respectively.The method for the study of kinematics of the movements in the shoulder joints appears to be most sensitive and informative for the purpose of diagnostics of disorders of the motor function and assessment of the process of its restoration in the patients presenting with hemiparesis during the acute period of hemispheric stroke.Нарушение функции плечевого сустава в результате церебрального инсульта - частое расстройство, сопровождающееся стойкой утратой трудоспособности и снижением способности к самообслуживанию. Процесс функциональных патологических изменений в плечевом суставе и динамика развития в остром периоде церебрального инсульта изучены недостаточно. Цель - оценить процесс восстановления движений в плечевом суставе у пациентов с гемипарезом в остром периоде полушарного инсульта на основании анализа биомеханических данных, включая целенаправленную тренировку с биологической обратной связью (БОС). Материал и методы. Исследованы три группы по 25 человек в каждой: лица без неврологической и ортопедической патологии - контрольная группа; пациенты, получающие стандартный курс лечения и лечебной физической культуры (ЛФК), - группа ЛФК; больные, у которых курс стандартного лечения и ЛФК был дополнен тренировкой с БОС, - группа ЛФК и БОС. Проводились клиническое исследование и регистрация биомеханики движений в плечевых суставах. Результаты. У пациентов с гемипарезом на протяжении острого периода полушарного ишемического инсульта, в том числе при активном применении средств и методов реабилитации, включая БОС, не наблюдалось существенной динамики при оценке по клиническим шкалам. С помощью биомеханического исследования было обнаружено, что в контрольной группе движения в плечевых суставах в одной плоскости имеют основной компонент с максимальной амплитудой в плоскости данного движения и дополнительные - в других плоскостях с существенно меньшей амплитудой и сопровождаются вспомогательными движениями туловища. Функциональное состояние пареза на уровне плечевого сустава характеризуется уменьшением амплитуды основного движения и увеличением одной из дополнительных амплитуд, при этом амплитуды вспомогательных движений туловища возрастают. С помощью биомеханических методов объективной оценки зарегистрированы функциональные изменения в процессе лечения: улучшение сгибания (в группе ЛФК на 6%, в группе ЛФК и БОС на 10%) и отведения (в группе ЛФК на 4%, в группе ЛФК и БОС на 9%). Заключение. Исследование кинематики движений является более чувствительным и информативным методом диагностики нарушений двигательной функции и оценки процесса восстановления движений в плечевом суставе у пациентов с гемипарезом в остром периоде полушарного инсульта.

To evaluate the recovery of shoulder joint function in patients with hemiparesis in the acute period of hemispheric stroke on the basis of the analysis of electromyography (fEMG) of the muscles of this region before and after rehabilitation measures, including targeted training with biofeedback (BFB).Three groups of 25 people each were studied. Patients of the physical therapy (PT) group received standard treatment and physical therapy; patients of the PT+BFB group received BFB training in addition to PT; the control group consisted of people without neurological and orthopedic symptoms. A clinical study and EMG of the muscles of the shoulder girdle during testing movements was performed.On the side of paresis, the function of muscles was characterized by a decrease in the bioelectric activity (movement amplitude was decreased as well) and later phase of the maximum EMG activity compared to the norm. The time of maximum EMG activity had a trend towards the shift to the normal values during the treatment process, but the difference reached a statistically significant level not for all muscles and all movements. There were variants of the functions of the paretic muscles accompanied by the increased EMG activity. In the early stages (up to 21 days) of stroke, no significant changes in the EMG activity of shoulder girdle muscles were observed. The PT+BFB group showed better results than the PT group not only in the onset of activity, but also in the reduction of the amplitude when performing the same movement that indirectly suggested the more optimal inclusion of muscles in the motor act. In the period of acute hemispheric stroke, there were changes not only in the EMG activity of muscles of the affected side, but also of the contralateral side.A fEMG of the muscles is a more sensitive and informative method of the diagnosis of disorders of motor function and assessment of recovery process of the muscles of the shoulder joint in patients with hemiparesis.Цель исследования. Оценить степень восстановления функции мышц плечевого пояса у пациентов с гемипарезом в остром периоде каротидного инсульта на основании анализа данных функциональной электромиографии (фЭМГ) после проведения реабилитационных мероприятий, включая целенаправленную тренировку с биологической обратной связью (БОС). Материал и методы. Обследованы три группы по 25 человек в каждой: группу ЛФК составили больные, получающие стандартный курс лечения и лечебной физкультуры (ЛФК), группу ЛФК+БОС - пациенты, которым курс ЛФК был дополнен тренировкой с БОС, в контрольную группу вошли здоровые без неврологической и ортопедической патологии. Проводились клиническое обследование и регистрация электромиографии (ЭМГ) мышц плечевого пояса при тестовых движениях. Результаты и обсуждение. На стороне пареза функция мышц характеризуется снижением биоэлектрической активности (амплитуда движения также снижается) и более поздним по сравнению с нормой максимумом активности. Сам момент максимума ЭМГ-активности имеет тенденцию смещения в сторону нормы в процессе лечения, это изменение достигает статистически значимого уровня не для всех мышц и не при всех движениях. Обнаружены варианты функции паретичной мышцы, сопровождающиеся повышением ЭМГ-активности. В ранние сроки (до 21-го дня) инсульта отсутствуют значительные изменения ЭМГ-активности мышц плечевого пояса. В группе ЛФК и БОС установлены лучшие результаты, чем в группе ЛФК, не только по наступлению фазы активности, но и по уменьшению амплитуды биоэлектрической активности дополнительных мышц при выполнении того же движения, что косвенно свидетельствует о более правильном включении мышц в двигательный акт. При инсульте изменяется не только ЭМГ-активность мышц пораженной стороны, но и контралатеральной. Заключение. Методика исследования мышц с помощью фЭМГ является чувствительным и информативным методом диагностики нарушений двигательной функции и оценки процесса восстановления мышц плечевого пояса у пациентов с гемипарезом.