Search

Purpose: Dynamic intraligamentary stabilization (DIS) has been introduced as a new technique to repair the torn anterior cruciate ligament (ACL) and to restore knee joint kinematics after an acute ACL tear. Aim of the present study was to compare the early post-operative activity, restoration of gait pattern and functional results after DIS in comparison with primary ACL reconstruction (ACLR) for acute ACL tears. It was hypothesized that functional results, post-operative activity and changes in gait pattern after DIS are comparable to those after ACLR.Methods: Sixty patients with acute ACL tears were included in this study and underwent either DIS or ACLR with an anatomic semitendinosus autograft in a randomized manner. Patients were equipped with an accelerometric step counter for the first 6 weeks after surgery in order to monitor their early post-operative activity. 3D gait analysis was performed at 6 weeks and 6 months after surgery. Temporal-spatial, kinematic and kinetic parameters were extracted and averaged for each subject. Functional results were recorded at 6 weeks, 6 months and 12 months after surgery using the Tegner activity scale, International Knee Documentation Committee score and Lysholm score.Results: Patients who underwent DIS showed an increased early post-operative activity with significant differences at week 2 and 3 (p = 0.0241 and 0.0220). No significant differences between groups were found for knee kinematic and kinetic parameters or the functional scores at any time of the follow-up. Furthermore, the difference in anterior tibial translation was not significantly different between the two groups (n.s.).Conclusion: Early functional results and changes in gait pattern after DIS are comparable to those of primary ACLR. Therefore, ACL repair may be an alternative to ACLR in this cohort of patients.Level Of Evidence: I. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to investigate the effects of a 4-wk inpatient rehabilitation program on postural control and gait in pediatric patients with cancer. Design: Eighty-eight patients with brain tumors (n = 59) and bone/soft tissue sarcomas (n = 29) were evaluated. Postural control was assessed examining the velocity of the center of pressure and single-leg stance time on a pressure distribution platform. Walk ratio, a measure of neuromotor control, was used to evaluate intervention effects on gait. Results: Repeated measures analysis of variance showed improvements in postural control measures, indicated by a decrease in velocity of center of pressure of -0.4 cm/sec (F1,80 = 7.175, P = 0.009, ηp² = 0.082) and increase in single-leg stance time (mean [median] = 1.1[2.6]sec, respectively; F1,80 = 12.617, P = 0.001, ηp² = 0.136). Walk ratio increased by 0.2 mm/steps per min (F1,82 = 3.766, P = 0.056, ηp² = 0.044). Mean changes in dependent variables did not differ between both patient groups (P > 0.05). Conclusions: The results indicate benefits of an inpatient rehabilitation program comprising standard physical therapy as well as aquatic and hippo therapy on postural control and gait after treatment of pediatric patients with cancer. [ABSTRACT FROM AUTHOR]

Gait initiation is the task commonly used to investigate the anticipatory postural adjustments necessary to begin a new gait cycle from the standing position. In this study, we analyzed whether and how foot-floor interface characteristics influence the gait initiation process. For this purpose, 25 undergraduate students were evaluated while performing a gait initiation task in three experimental conditions: barefoot on a hard surface (barefoot condition), barefoot on a soft surface (foam condition), and shod on a hard surface (shod condition). Two force plates were used to acquire ground reaction forces and moments for each foot separately. A statistical parametric mapping (SPM) analysis was performed in COP time series. We compared the anterior-posterior (AP) and medial-lateral (ML) resultant center of pressure (COP) paths and average velocities, the force peaks under the right and left foot, and the COP integral x force impulse for three different phases: the anticipatory postural adjustment (APA) phase (Phase 1), the swing-foot unloading phase (Phase 2), and the support-foot unloading phase (Phase 3). In Phase 1, significantly smaller ML COP paths and velocities were found for the shod condition compared to the barefoot and foam conditions. Significantly smaller ML COP paths were also found in Phase 2 for the shod condition compared to the barefoot and foam conditions. In Phase 3, increased AP COP velocities were found for the shod condition compared to the barefoot and foam conditions. SPM analysis revealed significant differences for vector COP time series in the shod condition compared to the barefoot and foam conditions. The foam condition limited the impulse-generating capacity of COP shift and produced smaller ML force peaks, resulting in limitations to body-weight transfer from the swing to the support foot. The results suggest that footwear and a soft surface affect COP and impose certain features of gait initiation, especially in the ML direction of Phase 1. [ABSTRACT FROM AUTHOR]

Background: Deficits in motor control can be observed with a decrease in plantar sensation. There is evidence that changing the plantar feedback leads to kinematic, kinetic and neuromuscular adaptations in static as well as dynamic conditions. The effect of changes in plantar feedback on the modulation of gait has not been clarified conclusively. Objectives: The purpose of this paper was to provide a review of studies reporting the effects of changes in plantar feedback on human gait characteristics. Method: The databases Medline (PubMed), Cochrane Central Register of Controlled Trials and PEDro (Physiotherapy Evidence Database) were searched for clinical (CTs) and randomized controlled trials (RCTs) concerning foot sensation and gait. Results: Twenty-three studies were included in the evaluation. Several methods were used to affect the sensitivity of the foot sole. After cooling or sedating the foot sole, predominant changes occur in decreased peak pressures, muscle activities and joint angles, and relocation of the centre of pressure under the foot was found. Walking on uneven surfaces results in a decrease in gait velocity, cadence and step length and also an increase in step variability. The use of textured insoles during walking leads to increased knee, hip and ankle angles, forces and moments in neurological patients with decreased foot sensation. In particular, individuals with sensory deficits show significant gait improvements when using textured or vibrating insoles. Conclusions: Changes in plantar feedback lead to stimulation-specific adaptations of gait characteristics. Further prospective RCTs should be performed to investigate interventions for enhancing plantar receptor feedback for the prevention of falls and the treatment of injuries and movement disorders. [ABSTRACT FROM AUTHOR]

Purpose: The theoretical superiority of mobile-bearing total knee arthroplasties (TKAs) has not yet been proven in clinical studies. The aim of the current study was to compare and to analyse in a patient population that had received either a fixed or a mobile TKA differences in gait analysis electromyography and clinical scores. Methods: In a prospective, randomized, patient- and observer-blinded clinical study, 33 patients with primary osteoarthritis of the knee were included. All patients received a Genesis II total knee replacement. Sixteen patients received a mobile and 17 a fixed-bearing cruciate retaining Genesis II TKA. Clinical and quality-of-life scores, electromyography and gait analysis were applied preoperatively and postoperatively with a follow-up of 24 months. Results: In both groups, improvements from pre- to postoperative were detected. whereas the results of gait analysis and electromyography did not show any differences. The results from the clinical and the quality-of-life scores improved from pre- to postoperative, while the Knee Society Score showed a superiority of the mobile-bearing group (mean 159 ± 28) over the fixed-bearing group (mean 134 ± 41). Conclusion: No functional advantage of mobile over fixed-bearing TKA was detected, although the mobile-bearing group had better clinical results for which a reason could not be found. These results only apply to cruciate retaining mobile-bearing TKA with a bearing which allows both rotation and anteroposterior translation. Level of evidence: Prospective comparative study, Level II. [ABSTRACT FROM AUTHOR]

Abstract: The foot sole is loaded during stance and gait and plantar cutaneous mechanoreceptors sense the local stress distribution. It is not clear whether the perception thresholds of these mechanoreceptors change during the day and how they respond to walking activities. The primary aim of the present study was to investigate diurnal changes of plantar sensitivity. Furthermore, the aim was to find out whether daily changes depend on the individual level of step activity. Twenty-six healthy subjects, 17 women and 9 men, aged 28.6±6.7years participated in the study. Detection thresholds to light touch were measured in six plantar regions with Semmes–Weinstein monofilaments in the morning, noon and afternoon. Step activity was recorded with a StepWatch™ Activity Monitor and analyzed for three periods (8a.m.–4p.m., 8a.m.–12p.m., 12p.m.–4p.m.). The hallux, the 3rd metatarsal head and the heel showed significantly decreased detection thresholds from 8a.m. to 4p.m. (p ≤0.05). A fair correlation between the decrease of detection threshold and the total number of steps was found for the 3rd metatarsal head and the heel (p ≤0.05). Foot sole sensation appears to improve during the day and seems to be associated with the step activity. This may reflect an improving transfer of afferent information to the central nervous system during the day as well as an adaptation of receptors to gait activity. [Copyright &y& Elsevier]

Abstract: Children under 10 years of age are less efficient than adults regarding their dynamic balance control . The development of the somatosensory system is necessary for the control of posture and balance. The foot, as the final link between body and ground, transfers internal forces during gait. The coordination of force transfer needs to be balanced between both feet thus leading to a potential asymmetry of foot loading. The magnitude of asymmetry in infants’ gait has been previously studied. However, the individual development and improvement of gait symmetry should also be considered. Therefore, the aim of this study was to retrospectively evaluate the longitudinal development of foot loading symmetries from the onset of independent walking. Sixty-two healthy infants were followed over the course of 4 years by means of plantar pressure distribution measurements (mean age of 15 months at study start and 63 months at the end). The subjects attended a total of nine measurements scheduled every 6 months. Foot loading data was recorded during walking with the emed® pressure platform to evaluate contact area, peak pressure, force-time integral, relative maximum force and contact time. An absolute symmetry index was calculated for all parameters. Furthermore, the infants’ data were compared to the data of 26 healthy adults. The adults were measured once and the data acquisition followed exactly the same procedures as the infants’ data. In conclusion, foot loading is asymmetric with the onset of independent walking and shows improved symmetry with increasing age dependent on the foot loading parameters. [Copyright &y& Elsevier]

Evaluation of the clinical and functional results of a new prosthetic knee design with conservation of the physiologic properties of the patellofemoral joint. After total knee arthroplasty there are often patella problems. Some of them may be a result of excessive retropatellar pressure caused by the prosthetic design. Twelve patients with an average age of 68.6 years were evaluated after a follow-up of 16.4 months after implantation of a new prosthetic design. The clinical results were evaluated with the Hospital for Special Surgery Scores (HSS) and the Knee Society Clinical Rating Systems (KSS). Pain was rated on a Visual Analog Scale (VAS). Quality of life was determined with the SF-36 questionnaire. Furthermore, clinical gait analysis was performed with a 3D motion analysis system and force plates as well as surface electromyography of seven lower extremity muscles. The HSS-Score reached a mean value of 79.3 points. The KSS reached 82.3 points for the knee score and 75 points for the functional score. The VAS for pain revealed an average value of 1.7. For the gait analysis only three parameters indicated significant differences between the affected and the contralateral leg. The mean EMG amplitude revealed a significant difference only for the biceps femoris. The clinical and functional outcome of a new prosthesis design show satisfactory results. Even if the presented results appear promising, a further application and long term results are needed. [ABSTRACT FROM AUTHOR]

Highlights: [•] Plantar pressure patterns were investigated in children walking with normal, slow and fast gait speed. [•] Foot loading is affected by gait speed changes but the effects are not uniform across the whole plantar surface. [•] The load is transferred more toward the medial forefoot with faster gait speed. [•] These mechanisms should be kept in mind when comparing results from repeated measurements. [Copyright &y& Elsevier]

Background: Subjective data and physical examinations of patients after total hip arthroplasty are used to assess the outcome. But regarding the physical activity, no objective data can be delivered by existing scores. The level of activity can be measured objectively by counting gait cycles. The aim of this study was to measure activity levels of patients before and after total hip arthroplasty (THA). Methods: Forty-six patients were included in this prospective study. Western Ontario and McMaster Universities Arthritis Index (WOMAC), Harris Hip Score (HHS), and physical activity level based on the number of steps per day were assessed 1 week before surgery, 6 weeks postoperatively, and 3 months postoperatively. To assess the general constitution of the patients, the American Society of Anesthesiologists (ASA) score and BMI were determined. The physical activity level was measured by StepWatch 3™ Activity Monitor (SAM; Orthocare Innovations, Seattle, WA, USA). The number of GCs per day was assessed. Spearman's rank correlation coefficients were used to identify an association between age, body mass index (BMI), and American Society of Anesthesiologists classification with the number of gait cycles and to detect correlation between GCs and HHS and GCs and WOMAC. Results: From preoperatively to 6 weeks postoperatively, the number of gait cycles did not alter significantly. Three months postoperatively, the number of GC/d and GC/h improved significantly. HHS and WOMAC improved significantly from before surgery to 6 weeks and to 3 months follow-up. The number of gait cycles per day did not correlate with the HHS and the WOMAC score at any point of measurement. Age, BMI, and ASA classification did not influence the results. Conclusion: By using a StepWatch 3™ Activity Monitor objective data about physical activity before and after THA can be measured reliable. Subjective and objective data in the postoperative period show different results. Physical activity seems to take longer to reach significantly improved values. By counting gait cycles, surgeons do have an additional tool to measure success after THA. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis (KOA) is a painful disease commonly caused by high loads on the articular cartilage. Orthotic interventions aim to reduce mechanical loading, thereby alleviating pain. Traditional orthotics appear effective, but high drop-out rates have been reported over prolonged periods.Research Question: The aim of this study was to examine the effect of a novel ankle-foot orthosis (AFO) on gait parameters, physical function and activity of KOA patients.Methods: 29 clinically diagnosed KOA patients with varus malalignment wore an AFO for 6 weeks. Prior to and after the intervention period, 3D gait analysis, physical function tests and the KOOS questionnaire were administered. Physical activity was objectively assessed with accelerometers.Results: The AFO immediately reduced the first peak of the knee adduction moment (KAM) and the KAM impulse by 41% and 19%. The knee flexion moment (KFM) was increased by 48%. After six weeks, the first KAM peak and KAM impulse were decreased by 27% and 19% while using the AFO. The KFM was increased by 71%. Furthermore, patients completed the functional tests faster (1.4-2.6%). The KOOS scores decreased significantly. No significant differences were found in physical activity parameters.Significance: The six-week AFO application significantly reduced the KAM. The patients' physical function appeared improved; yet these improvements were only minor and therefore arguably clinically irrelevant. The KFM appeared to be negatively affected after six weeks, as were the scores on the KOOS subscales. In summary, even though the AFO reduced the KAM and improved physical function, the clinical benefit for KOA patients with varus malalignment after the 6-week AFO application is debatable. [ABSTRACT FROM AUTHOR]

Abstract: The objective of this study was to determine the reliability of repeated plantar pressure distribution measurements during normal gait across multiple testing sessions. Testing sessions were conducted on 5 separate days at approximately the same time of day. Nine subjects (five males, four females, age 26±8.4 years) who were free of any musculoskeletal injury were recruited. A capacitive pressure distribution platform (EMED AT, Novel GmbH, Munich, Germany), sampling at 50Hz was used to collect plantar pressure patterns during barefoot walking at a self-selected speed. Four parameters were investigated: peak pressure, maximum force, impulse, and contact time, and these were investigated in 10 areas of the foot after using the PRC mask method of subdividing the foot into ten anatomical areas of interest. Individual means of all the five repeated trials for each foot were calculated, and these values were used to calculate intraclass correlation coefficients (ICC) and coefficients of variation (CoV) for all parameters. The results of this investigation show a generally good level of reliability, the quality of which is dependent on the region of the foot and the parameter investigated. Areas with typically high loading characteristics, such as the central forefoot showed a higher level of reliability in the ICC''s (>0.9) than less loaded areas such as the medial midfoot (<0.8). The conclusion of this study is that plantar pressure distribution measurements can be used in comparative evaluations since the measures of repeatability are satisfactory for the parameters and foot regions usually used in the investigation of clinical populations such as neuropathic diabetics. [Copyright &y& Elsevier]

Background: For demanding activities in daily life, such as negotiating stairs, ramps and uneven ground, the functionality of conventional prosthetic feet ("Daily Life Feet" - DLF) is often limited. With the introduction of microprocessor-controlled feet (MPF) it was expected that the functional limitations of DLF might be reduced. The purpose of the present study was to investigate biomechanical gait parameters with DLF and MPF when walking on a specifically designed ramp involving abruptly changing inclination angles as a scenario reflecting typical situations related to walking on uneven ground.Research Question: The specific aim of the study was to answer the research question if the advanced adaptability of MPF to different ground slopes would lead to more natural motion patterns and reduced joint loading compared with DLF feet.Methods: A specifically designed ramp was installed within a gait lab. During downward motion on this ramp biomechanical parameters - ground reaction forces, joint moments and joint angles were obtained both with DLF and MPF used by four transtibial amputees. A control group of 10 non-amputees (NA) was measured with for comparison.Results: The NA group managed the ramp element with the abruptly changing inclination with a specific ankle joint adaptation. Compared to DLF the MPF considerably improved the ankle adaptation to the abruptly changing inclination which was reflected by a significantly increased stance phase dorsiflexion which was comparable to the NA group. The peak value of the knee extension moment on the prosthetic side was significantly increased with DLF, whereas it was almost normal with MPF (DLF: 0.71 ± 0.13 Nm/kg, MPF: 0.42 ± 0.12 Nm/kg, NA: 0.36 ± 0.07 Nm/kg, p < 0.05 and p < 0.01). The external knee adduction moment was generally reduced for the transtibial amputees and did not show differences between foot designs.Significance: The adaptable ankle joint motion of the MPF is a crucial requirement for a more natural motion pattern and leads to a reduction of sagittal knee joint loading on the prosthetic side. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To detect gait alterations in rheumatoid arthritis (RA) patients using peak pressure curves (PPC) and normalized force curves (NFC) instead of clinical classification based on the health assessment questionnaire (HAQ). Methods: Three RA groups – 30 patients each – were classified according to their HAQ score. Cluster analysis based on a k-means algorithm was applied to PPCs and NFCs in order to classify RA patients with respect to amplitude and shapes of such gait parameters. Results: The best gait pattern identification was obtained by clustering PPCs into three clusters. Peak pressures of the three identified patterns were 1169.5±99.4kPa for cluster 1, 885.8±165.2kPa for cluster 2 and 402.0±128.5kPa for cluster 3 (statistically different, Student’s t-test, p <0.001). 41 patients were included in cluster 3, 31 in cluster 2 and only 18 patients in cluster 1. Most RA3 patients – 17 out of 30 – showed low peak pressures and almost normal PPCs (cluster 3). Cluster 2, which incorporated altered PPCs, was mainly formed by RA1 and RA2 patients. Conclusions: PPC appears as a reliable gait parameter for a shape-based clustering algorithm. The proposed cluster analysis was proved to be reliable and the delivered classifications stable. The distribution of RA patients among the three identified PPC clusters showed only a partial agreement between clinical and functional classification, thus revealing the development of specific gait strategies related to the pathology more than to its clinical level of severity. This finding may be clinically relevant and support effective treatment of RA gait related pathologies. [Copyright &y& Elsevier]

Abstract: The objective of this study was to examine if spatio-temporal gait parameters in healthy children can be determined from accelerations measured at the lower trunk as has been demonstrated in adults, previously. Twenty children aged 3–16 years, participated in a protocol that involved repeated walks of different distances in an indoor environment. During walking, accelerations were measured by three orthogonally mounted acceleration sensors in a small wireless device (DynaPort MiniMod) that was attached to the lower back. Based on an inverted pendulum approach, spatio-temporal gait parameters and walking distances were computed from the acceleration signals. Results were compared to video observations and known walking distances and durations. Steps were successfully detected in 99.6±0.6% of all observed steps (n =5554). On average, walking distance was accurately estimated (100.6±3.3%, range 93–106.7%). No correlation was found between the number of miscounted steps and the total number of steps or the age of the subject. It can be concluded that the use of an inverted pendulum model provides the possibility to estimate spatio-temporal gait parameters in children as well as in adults. The method allows an inexpensive and comfortable assessment of gait parameters in children, is applicable in controlled, indoor environments and could be tested for applicability under free living conditions. [Copyright &y& Elsevier]