Search

Background. Clinicians employ foot morphology assessment to evaluate the functionality of the method and anticipate possible injuries. This study aims to correlate static foot posture and the dynamic barefoot evaluation in a sample of healthy adult participants. Methods. The foot posture was evaluated using the Foot Posture Index-6 (FPI-6) and the dynamics were evaluated through baropodometric examination. Two operators independently assessed the participants' foot posture through FPI-6, and then a dynamic evaluation was performed by asking them to walk 8 times across a platform. One hundred participants (mean age: 32.15 ± 7.49) were enrolled. Results. The inter-rater agreement between the two assessors was found to be excellent. The majority of the feet belonged to the 0 < FPI < 4 class (32%), followed by the 4 < FPI < 8 (31%) and the FPI > 8 ranges (19.5%). Our "area of contact" analysis showed a significant poor correlation between FPI and total foot, midfoot, and the second metatarsophalangeal joint (MTPJ) (−0.3 < r < 0). Regarding "force" parameters, the analysis showed a poor correlation between the midfoot, hallux, and the second toe (−0.2 < r < 2); finally the "pressure" analysis showed a poor correlation between FPI, the fourth MTPJ, and the second toe (−0.2 < rs < 0.3) and a moderate correlation between the hallux (r = 0.374) and the fifth MTPJ (r = 0.427). Conclusions. This study emphasizes the constrained correlation between static foot posture observation and dynamic barefoot examination. [ABSTRACT FROM AUTHOR]

The aim of our study was to evaluate the effect of robot-assisted walking in different modalities on cardiorespiratory responses and energy consumption in subacute stroke patients. Our study consisted of 16 individuals between the ages of 18–65 years. Individuals diagnosed with hemiplegia after unilateral ischemic or haemorrhagic stroke constitute the stroke group. Eight subacute stroke individuals were included in the experimental group, and eight healthy individuals were included in the control group. Each participant tested on the Lokomat in three consecutive days in random sequence, with three tests: the first test: 100% guiding strength (GF)and 100% body weight support (BWS); the second test 80% GF, 50% BWS; the third test 60% GF, 30% BWS was achieved. Gas analyzer (Cosmed, Quark CPET, Italy) measurements were made with the help of a mask to evaluate the cardiorespiratory responses of the participants during all tests. In the comparison of the three test results of the two groups separately, the stroke group's oxygen consumption (VO2), carbon dioxide production (VCO2), tidal volume (VT), pulse reserve (HRR), calories burned per hour (EEh), Borg dyspnea values, control group's VO2, VCO2, VE, HR, HRR, and EEh, Borg values were statistically significantly different (p < 0.005). It was seen that the third test results were significantly greater than the first and second test results (p < 0.005). By decreasing GF and BWS values during robot-assisted walking, adequate cardio-metabolic and energy response in both subacute stroke patients and healthy individuals could be achieved. These results show us that it is important to consider the cardiorespiratory function of the patient when choosing training protocols. [ABSTRACT FROM AUTHOR]

Background: Flexible flatfoot is a frequent condition in childhood that needs to be treated when symptomatic. The aim of this study was to analyze pedobarographic and gait outcomes of patients with painful flexible flatfoot who underwent the anterograde calcaneo-stop procedure. Methods: All patients scheduled for surgical correction of painful flexible flatfoot between April and September 2011 were offered to participate in a study of dynamic pedobarographic and gait analyses before surgery and 3, 12, and 24 months after surgery. A healthy control group of similar age and physical characteristics also underwent dynamic pedobarographic and gait analyses. Results: Fifteen patients accepted to undergo dynamic pedobarography and gait analyses. The data were compared with fifteen controls of similar age and BMI. No significant differences were found on dynamic pedobarography within patients at different endpoints, except for a decreased percentage of plantigrade phase and increased percentage of digitigrade phase at 12 months post-op in comparison with 3 months post-op, nor when compared with control. Similarly, when range of motion was taken into consideration, no significant differences were found within patients at different endpoints, nor when compared with control, except for a decrease in ankle joint range of motion 24 months post-op in comparison with the controls. The stride was significantly decreased before surgery and became like controls 24 months after the procedure. The cadence, significantly decreased 24 months after surgery in comparison with the pre-surgical set, was similar to the controls. No significant differences were seen in the walking speed within patients at different endpoints and the controls. The cycle time significantly increased 24 months after surgery when compared to the pre-op situation, and was similar to the controls. Conclusion: Dynamic pedobarographic and gait analyses were useful not only to identify the gait impairment in patients with symptomatic flexible flatfoot, but also to measure the treatment outcome through the analysis of the surgery's impact on the gait quality. [ABSTRACT FROM AUTHOR]

The effect of the COVID-19 on the physical and mental health of Italian older individuals displaying signs of cognitive deterioration has not been deeply investigated. This longitudinal study examined the impact of COVID-19 lockdown measures on the psychological well-being and motor efficiency of a sample of Italian community-dwellers with and without cognitive decline. Forty-seven participants underwent instrumental gait analysis performed in ecological setting using wearable sensors, and completed a battery of tasks assessing cognitive functioning and psychological well-being, before and after the full lockdown due to the COVID-19 spreading. A series of Multivariate Analyses of Variance (MANOVAs) documented that the superior gait performance of the cognitively healthy participants exhibited before the COVID-19 spread, vanished when they were tested at the end of the lockdown period. Moreover, before the outbreak of the COVID-19, cognitively healthy participants and those with signs of cognitive decline reported similar levels of psychological well-being, whereas, after the lockdown, the former group reported better coping, emotional competencies, and general well-being than the participants displaying signs of cognitive decline. In conclusion, the full COVID-19 outbreak had a significant impact on the mental and motor functioning of older individuals with and without signs of cognitive deterioration living in Italy. [ABSTRACT FROM AUTHOR]

Spinocerebellar ataxia 38 (SCA 38) is a very rare autosomal dominant inherited disorder caused by a mutation in ELOV5 gene, specifically expressed in cerebellar Purkinje cells, encoding an enzyme involved in the synthesis of fatty acids. Seven symptomatic SCA 38 patients of a Sardinian family were administered 15 sessions of cerebellar anodal transcranial direct current stimulation (tDCS) in a cross-over study, employing deltoid cerebellar-only (C-tDCS) and cerebello-spinal (CS-tDCS) cathodal montage. Clinical evaluation was performed at baseline (T0), after 15 sessions of tDCS (T1) and after 1 month of follow-up (T2). Modified International Cooperative Ataxia Rating Scale (MICARS) and the Robertson dysarthria profile were used to rate ataxic and dysarthric symptoms, respectively. Alertness and split attention tests from Zimmermann test battery for attentional performance were employed to rate attentive functions. Moreover, 3D computerized gait analysis was employed to obtain a quantitative measure of efficacy of tDCS on motor symptoms. While clinical data showed that both CS and C-tDCS improved motor, dysarthric, and cognitive scores, the quantitative analysis of gait revealed significant improvement in spatio-temporal parameters only for C-tDCS treatment. Present findings, yet preliminary and limited by the small size of the tested sample, confirm the therapeutic potential of cerebellar tDCS in improving motor and cognitive symptoms in spinocerebellar ataxias and underline the need to obtain quantitative and objective measures to monitor the efficacy of a therapeutic treatment and to design tailored rehabilitative interventions. ClinicalTrials.gov identifier: NCT05951010., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Context: Surface replacement of the hip is aimed especially at active patients, and it seems to achieve optimal functional results in a short time if associated with a tailored rehabilitation protocol. Objective: To assess the functional outcome in a group of active patients after hip resurfacing. Design: Clinical measurement and controlled laboratory study in a case series. Setting: Gait-analysis laboratory. Participants: 8 patients and a control group of 10 subjects. Interventions: Patients treated with Birmingham hip-resurfacing system and a tailored rehabilitation protocol Main Outcome Measures: Clinical assessment (Harris Hip Score [HHS]) and instrumented gait analysis including muscular electromyographic assessment. Patients were assessed preoperatively and at 3 and 9 mo follow-up after surgery. Results: HHS showed a significant increase from the baseline to 3- (P = .008) and 9-month (P = .014) follow-up; 5 patients returned to sport. Gait pattern in the presented case series of patients improved substantially 3 mo postoperatively, and minimal further changes were present 9 months postoperatively. Residual abnormalities of time-distance and hip-kinematics parameters were consistent with a slow gait. A complete restoration of the muscle-activation pattern during gait was achieved. Conclusion: Hip resurfacing associated with a rehabilitation protocol based on the characteristics of the implant provides excellent clinical and functional outcome, especially for very active patients. [ABSTRACT FROM AUTHOR]

Objectives: Among different exercise models proposed for individuals with Parkinson's disease (IwPD), the popularity of traditional forms of dance is increasing. The aim of this study was to evaluate the effects of Sardinian folk dance (Ballu Sardu, BS) on functional performance and motor and nonmotor symptoms in IwPD. Design: Single-blind, randomized controlled pilot trial. Settings: Outpatient health clinic. Subjects and interventions: Twenty IwPD (13M, 7F; 67.4 ± 6.1 years) were randomly assigned to BS (n = 10) or usual care (n = 10). The dance program consisted of two sessions/week, 90-min/class, for 12 weeks. Outcome measures: Motor and nonmotor symptoms, as well as functional performance, were evaluated using different questionnaires and tests such as the Unified Parkinson's Disease Rating Scale Part-III (UPDRS-III), 6-min walking test (6MWT), Berg Balance Scale (BBS), Timed Up-and-Go (TUG) test, Five Times Sit-to-Stand Test (FTSST), Back Scratch Test (BST), Sit-and-Reach Test (SRT), instrumented gait analysis, Parkinson's Disease Fatigue Scale (PFS-16), Beck Depression Inventory, Starkstein Apathy Scale (SAS), and Montreal Cognitive Assessment (MOCA) scale. Results: Repeated-measures analysis of variance revealed significant Time × Group interactions for UPDRS-III and functional variables such as the 6MWT, BBS, FTSST, TUG (all, p < 0.001), BST (p = 0.04), and gait analysis parameters (stride length, p = 0.031; gait speed, p = 0.049; and gait fatigue index (GFI), p = 0.005). For nonmotor symptoms, significant Time × Group interactions for depression (p < 0.001), apathy (p = 0.016), and MOCA scores (p = 0.012) were observed. Of note, for GFI and SAS, the BS group only showed a trend toward improvement, while the condition of the controls worsened significantly. No between-group differences were observed for SRT and PFS-16. Conclusions: BS is an enjoyable activity, which has been proved to be superior to usual care alone in inducing changes in different motor and nonmotor symptoms associated with PD. Results show that BS can be considered a safe tool for contrasting impairments observed in IwPD due to the intrinsic nature of the neurodegenerative disease. [ABSTRACT FROM AUTHOR]

Gait analysis is recognized as a useful assessment tool in the field of human movement research. However, doubts remain on its real effectiveness as a clinical tool, i.e. on its capability to change the diagnostic-therapeutic practice. In particular, the conditions in which evidence of a favorable cost-benefit ratio is found and the methodology for properly conducting and interpreting the exam are not identified clearly. To provide guidelines for the use of Gait Analysis in the context of rehabilitation medicine, SIAMOC (the Italian Society of Clinical Movement Analysis) promoted a National Consensus Conference which was held in Bologna on September 14th, 2013. The resulting recommendations were the result of a three-stage process entailing i) the preparation of working documents on specific open issues, ii) the holding of the consensus meeting, and iii) the drafting of consensus statements by an external Jury. The statements were formulated based on scientific evidence or experts' opinion, when the quality/quantity of the relevant literature was deemed insufficient. The aim of this work is to disseminate the consensus statements. These are divided into 13 questions grouped in three areas of interest: 1) General requirements and management, 2) Methodological and instrumental issues, and 3) Scientific evidence and clinical appropriateness. SIAMOC hopes that this document will contribute to improve clinical practice and help promoting further research in the field. [ABSTRACT FROM AUTHOR]

This paper describes a new motion analysis protocol for race-walking. The protocol has been tested under laboratory conditions on a real athlete of the Italian national race-walking team. The experimental setup included a motion capture system and a force platform to record both kinematic and dynamic aspects of the athletic action. Thus, any infringement of the rules can be detected, based on the measure of knee flexion-extension and the loss of ground contact. The biomechanical efficiency can be determined from the joint angles and the temporal components of gait. The results of experiments show that the protocol can be a valuable tool to assist athletes and trainers in improving race-walking technique. [ABSTRACT FROM AUTHOR]

BACKGROUND: Gait disorders are common in multiple sclerosis (MS) and lead to a progressive reduction of function and quality of life. OBJECTIVE: Test the effects of robot-assisted gait rehabilitation in MS subjects through a pilot randomized-controlled study. METHODS: We enrolled MS subjects with Expanded Disability Status Scale scores within 4.5-6.5. The experimental group received 12 robot-assisted gait training sessions over 6 weeks. The control group received the same amount of conventional physiotherapy. Outcomes measures were both biomechanical assessment of gait, including kinematics and spatio-temporal parameters, and clinical test of walking endurance (six-minute walk test) and mobility (Up and Go Test). RESULTS: 16 subjects (n = 8 experimental group, n = 8 control group) were included in the final analysis. At baseline the two groups were similar in all variables, except for step length. Data showed walking endurance, as well as spatio-temporal gait parameters improvements after robot-assisted gait training. Pelvic antiversion and reduced hip extension during terminal stance ameliorated after aforementioned intervention. CONCLUSIONS: Robot-assisted gait training seems to be effective in increasing walking competency in MS subjects. Moreover, it could be helpful in restoring the kinematic of the hip and pelvis. [ABSTRACT FROM AUTHOR]

Aim: The main purpose of the present study was to verify the feasibility of wearable inertial sensors (IMUs) in a clinical setting to screen gait and functional mobility in Italian older persons. In particular, we intended to verify the capability of IMUs to discriminate individuals with and without cognitive impairments and assess the existence of significant correlations between mobility parameters extracted by processing trunk accelerations and cognitive status., Methods: This is a cross-sectional study performed on 213 adults aged over 65 years (mean age 77.0 ± 5.4; 62% female) who underwent cognitive assessment (through Addenbrooke's Cognitive Examination Revised, ACE-R) instrumental gait analysis and the Timed Up and Go (TUG) test carried out using a wearable IMU located in the lower back., Results: Individuals with cognitive impairments exhibit a peculiar gait pattern, characterized by significant reduction of speed (- 34% vs. healthy individuals), stride length (- 28%), cadence (- 9%), and increase in double support duration (+ 11%). Slight, but significant changes in stance and swing phase duration were also detected. Poorer performances in presence of cognitive impairment were observed in terms of functional mobility as overall and sub-phase TUG times resulted significantly higher with respect to healthy individuals (overall time, + 38%, sub-phases times ranging from + 22 to + 34%), although with some difference associated with age. The severity of mobility alterations was found moderately to strongly correlated with the ACE-R score (Spearman's rho = 0.58 vs. gait speed, 0.54 vs. stride length, 0.66 vs. overall TUG time)., Conclusion: The findings obtained in the present study suggest that wearable IMUs appear to be an effective solution for the clinical assessment of mobility parameters of older persons screened for cognitive impairments within a clinical setting. They may represent a useful tool for the clinician in verifying the effectiveness of interventions to alleviate the impact of mobility limitations on daily life in cognitively impaired individuals.

This study aims to measure and compare spatiotemporal gait parameters in nineteen subjects using a full wearable inertial mocap system Xsens (MVN Awinda, Netherlands) and a photoelectronic system one-meter OptoGait TM (Microgait, Italy) on a treadmill imposing a walking speed of 5 km/h. A total of eleven steps were considered for each subject constituting a dataset of 209 samples from which spatiotemporal parameters (SPT) were calculated. The step length measurement was determined using two methods. The first one considers the calculation of step length based on the inverted pendulum model, while the second considers an anthropometric approach that correlates the stature with an anthropometric coefficient. Although the absolute agreement and consistency were found for the calculation of the stance phase, cadence and gait cycle, from our study, differences in SPT were found between the two systems. Mean square error (MSE) calculation of their speed (m/s) with respect to the imposed speed on a treadmill reveals a smaller error (MSE = 0.0008) using the OptoGait TM . Overall, our results indicate that the accurate detection of heel strike and toe-off have an influence on phases and sub-phases for the entire acquisition. Future study in this domain should investigate how to design and integrate better products and algorithms aiming to solve the problematic issues already identified in this study without limiting the user's need and performance in a different environment.

Proximal femur fractures (PFFs) are an increasing public health concern. Improving gait and mobility after surgical fixation of intertrochanteric femur fractures (IFFs) is the most important target of research efforts. The purpose of this study is to investigate the role of gait analysis in the functional assessment of over-65 patients with stable and unstable IFFs, at a minimum 6-month follow-up. Fourteen patient's over-65 with IFFs (AO/OTA 31-A) treated with intramedullary nailing (EBA-2, Citieffe Srl, Italy) were enrolled. The patients were divided into two groups according to the fracture stable or unstable pattern, according to AO/OTA classification. At follow-up appointments, clinical outcomes [Harris Hip Score (HHS)], Western Ontario and McMaster University (WOMAC) and gait parameters were assessed. Radiographs were analyzed at the time of surgery and at each follow-up visit. At 3-month follow-up, both groups showed a significantly different gait patterns, compared with control subjects. At 6-month follow-up, a significant improvement of both mean HHS score (p=0.43) and mean WOMAC score was observed (p=0.43) within groups. Nonetheless, patients with stable fractures showed a comparable gait pattern, compared with control subjects, while patients with unstable fractures still presented a worse gait pattern, compared with control subjects. Therefore, in presence of an unstable IFF, a more aggressive rehabilitative program is needed. The data provided by postoperative gait analysis, therefore, could be useful to customize the patients' rehabilitative protocol, to quickly improve their walking ability and autonomy, thus reducing the post-operative re-fall risks., (Copyright 2020 Biolife Sas. www.biolifesas.org.)

The main purpose of the present study was to compare the smoothness of gait in older adults with and without cognitive impairments, using the harmonic ratio (HR), a metric derived from trunk accelerations. Ninety older adults aged over 65 (age: 78.9 ± 4.8 years; 62% female) underwent instrumental gait analysis, performed using a wearable inertial sensor and cognitive assessment with the Mini Mental State Examination (MMSE) and Addenbrooke's Cognitive Examination Revised (ACE-R). They were stratified into three groups based on their MMSE performance: healthy controls (HC), early and advanced cognitive decline (ECD, ACD). The spatio-temporal and smoothness of gait parameters, the latter expressed through HR in anteroposterior (AP), vertical (V) and mediolateral (ML) directions, were derived from trunk acceleration data. The existence of a relationship between gait parameters and degree of cognitive impairment was also explored. The results show that individuals with ECD and ACD exhibited significantly slower speed and shorter stride length, as well as reduced values of HR in the AP and V directions compared to HC, while no significant differences were found between ECD and ACD in any of the investigated parameters. Gait speed, stride length and HR in all directions were found to be moderately correlated with both MMSE and ACE-R scores. Such findings suggest that, in addition to the known changes in gait speed and stride length, important reductions in smoothness of gait are likely to occur in older adults, owing to early/prodromal stages of cognitive impairment. Given the peculiar nature of these metrics, which refers to overall body stability during gait, the calculation of HR may result in being useful in improving the characterization of gait patterns in older adults with cognitive impairments.

Background: Stiff Knee Gait (SKG) in stroke patients is typically treated by the inhibition of the rectus femoris (RF) with botulinum toxin (BoNT) after clinical evaluation, obtaining an average pooled recovery in knee flexion (KF) of 7 degrees., Purpose: Our hypothesis is that this limited recovery after BoNT could depend on the inadequacy in the selection of patients to be treated. The aim of this study was to assess the percentage of inappropriate treatments (PIT) that can be avoided when instrumental gait analysis (GA) is used, and to estimate the associated cost savings., Methods: We retrospectively analyzed GA data from chronic stroke patients with SKG and clinically assessed knee extensors spasticity referred to our laboratory over a five-year period. Gait kinematics and dynamic electromyography data were used. Patients were considered unsuitable for RF inhibition when: their SKG was determined by inadequate ankle push-off (APO) rather than by a brake from knee extensors, based on a previously published algorithm using gait kinematics (PIT KIN ); when RF was not active during KF (PIT EMG ); and when a proximal braking mechanism was found, if this was not due to RF activity (PIT GA )., Results: 160 patients, age 20-87 years, gait speed 9-77%height/s, KF peak -4-44 degrees, were included. Of these, in 119 cases poor APO was the main cause of SKG, thus leading to PIT KIN  = 74%. In 48 out of 107 non-obese subjects, RF spasticity was not involved in SKG, resulting in PIT EMG  = 45%. Finally, patients with a braking activity as the main cause and concurrent RF activity were 20/107 = 19%, resulting in PIT GA  = 81% SIGNIFICANCE: When treating SKG, proper use of GA can reduce the percentage of inappropriate treatments by BoNT at the RF up to 81%. Savings are in the order of €100k/year when considering centers treating 100 or more patients/year., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: It has been highlighted that obesity influences the gait reducing walking velocity, stride length, ankle dorsal flexion at initial contact and ankle power generation. Meanwhile, step width, double support, hip flexion, knee extension during stance, hip moment and ankle power absorption was described increased. A tendency to the normalization of these parameters occur when subjects reduced their weight during growth., Objective: We studied the effect of fast weight loss due to Sleeve Gastrectomy on gait pattern of adolescent with severe obesity. The aim is to assess the functional benefit of the surgery., Setting: Pediatric hospital, public health, Italy., Methods: 11 patients before and after 1 year from surgery and 10 controls participated to the study. We studied the gait with an optoelectronic system and two force plates. We evaluated both kinetics and kinematics of walking. Then we looked at the differences between the pre- vs post-surgery and with the control group., Results: Step length and velocity were lower and step width was bigger in adolescent with obesity. Kinematic and kinetic parameters were altered. After surgery we observed the reduction of several gait alteration. Meanwhile, after 1 year alterations at the level of the foot, the knee and the pelvis persist., Conclusion: The sudden loss of weight highlighted the presence of long-term effects on the locomotor system. The results discourage intense walking activities before the weight loss and we suggest further studies for evaluating the necessity of a rehabilitative intervention., (Copyright © 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)