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Foot ulcers are amongst the most serious complications of diabetes. Guidelines recommend that people with diabetes wear appropriate footwear or insoles to reduce repetitive stresses. Excessive plantar pressure has been recognized as the major risk factor for plantar ulcers in diabetic individuals; custom insoles are indicated as the gold standard treatment to unload the foot structure. The aim of this study was to investigate the effect of custom insoles on biomechanical and neuromuscular functions in diabetic neuropathic individuals. Ten diabetic subjects walked with and without custom insoles at their preferred speed; ten controls were assessed for comparison. Data were captured through seven video cameras, plantar pressure insoles, and surface electromyography. The electrical activity of Rectus Femoris, Tibialis Anterior, Medius Gluteus and Gastrocnemius Lateralis were acquired bilaterally. The plantar pressure and surface electromyographic variables were determined, while videos were used to detect the gait cycle. The following comparisons were made across the variables through the non-parametric SPM1D test (p < 0.05): condition with vs. without insoles vs. controls. Custom insoles provided a reduction in plantar pressure through contact surface redistribution in association with a reduced electromyographic activity. Our results suggest optimizing the prevention approach by including personalized foot and ankle exercises.

Fragile X Syndrome (FXS), the leading form of inherited intellectual disability and autism, is characterized by specific musculoskeletal conditions. We hypothesized that gait analysis in FXS could be relevant for the evaluation of motor control of gait, and help the understanding of a possible correlation between functional and intellectual abilities. Typical deficits in executive control and hyperactivity have hampered the use of standard gait analysis. The aim of our study was to quantitatively assess musculoskeletal alterations in FXS children in standard ambulatory conditions, in a friendly environment. Ten FXS children and sixteen controls, with typical neurodevelopment, were evaluated through four synchronized video cameras and surface electromyography, lower limb joints rotations, spatiotemporal parameters, duration of muscle contraction, activation timing and envelope peaks were determined. Reliability and repeatability of the video based kinematics analysis was assessed with respect to stereophotogrammetry. The Kruskal–Wallis Test (p &lt, 0.05) or SPM1D were used to compare different groups of subjects. Results show a consistently altered gait pattern associated with abnormal muscle activity in FXS subjects: reduced knee and excessive hip and ankle flexion, and altered duration and activity onset on all the recorded muscles (Rectus/Biceps Femoris, Tibialis Anterior, Gastrocnemius Lateralis). Results of this study could help with planning personalized rehabilitations.

The quantification of plantar pressure distribution is widely done in the diagnosis of lower limbs deformities, gait analysis, footwear design, and sport applications. To date, a number of pressure insole layouts have been proposed, with different configurations according to their applications. The goal of this study is to assess the validity of a 16-sensors (1.5 × 1.5 cm) pressure insole to detect plantar pressure distribution during different tasks in the clinic and sport domains. The data of 39 healthy adults, acquired with a Pedar-X® system (Novel GmbH, Munich, Germany) during walking, weight lifting, and drop landing, were used to simulate the insole. The sensors were distributed by considering the location of the peak pressure on all trials: 4 on the hindfoot, 3 on the midfoot, and 9 on the forefoot. The following variables were computed with both systems and compared by estimating the Root Mean Square Error (RMSE): Peak/Mean Pressure, Ground Reaction Force (GRF), Center of Pressure (COP), the distance between COP and the origin, the Contact Area. The lowest (0.61%) and highest (82.4%) RMSE values were detected during gait on the medial-lateral COP and the GRF, respectively. This approach could be used for testing different layouts on various applications prior to production.

The aim of this work was twofold: on one side to determine the most suitable parameters of surface electromyography (sEMG) to classify diabetic subjects with and without neuropathy and discriminate them from healthy controls and second to assess the role of the task acquired in the classification process. For this purpose 30 subjects were examined (10 controls, 10 diabetics with and 10 without neuropathy) whilst walking and stair ascending and descending. The electrical activity of six muscles was recorded bilaterally through a 16-channel sEMG system synchronised with a stereophotogrammetric system: Rectus Femoris, Gluteus Medius, Tibialis Anterior, Peroneus Longus, Gastrocnemius Lateralis and Extensor Digitorum. Spatiotemporal parameters of gait and stair climbing and the following sEMG parameters were extracted: signal envelope, activity duration, timing of activation and deactivation. A hierarchical clustering algorithm was applied to the whole set of parameters with different distances and linkage methods. Results showed that only by applying the Ward agglomerative hierarchical clustering (Hamming distance) to the all set of parameters extracted from both tasks, 5 well-separated clusters were obtained: cluster 3 included only DS subjects, cluster 2 and 4 only controls and cluster 1 and 5 only DNS subjects. This method could be used for planning rehabilitation treatments. Graphical abstract

Axial disorders, including postural deformities, postural instability, and gait disturbances, are among the most disabling symptoms of Parkinson's disease (PD). Equistasi®, a wearable proprioceptive stabilizer device, has been proposed as neurological rehabilitative device for this set of symptoms. To investigate the effects of the device on gait and balance, 24 participants affected by PD were enrolled in this crossover double-dummy, randomized, controlled study. Subjects were assessed four times before and after 8 weeks treatment with either active or placebo device; one-month wash-out was taken between treatments, in a 20-week timeframe. Gait analysis and instrumented Romberg test were performed with the aid of a sterofotogrammetric system and two force plates. Joint kinematics, spatiotemporal parameters of gait and center of pressure parameters were extracted. Paired T-test (p 0.05) was adopted after evidence of normality to compare the variables across different acquisition sessions; Wilcoxon was adopted for non-normal distributions. Before and after the treatment with the active device, statistically significant improvements were observed in trunk flexion extension and in the ankle dorsi-plantarflexion. Regarding balance assessment, significant improvements were reported at the frequencies corresponding to vestibular system. These findings may open new possibilities on PD's rehabilitative interventions. Research question, tailored design of the study, experimental acquisition overview, main findings, and conclusions.

It is well recognized that diabetes and peripheral neuropathy have a detrimental effect on gait. However, there are large variations in the results of studies addressing this aspect due to the heterogeneity of diabetic population in relation to presence and severity of diabetes complications. The aim of this study is to adopt an unsupervised classification technique to better elucidate the gait changes throughout the entire spectrum of diabetes and neuropathy.Sixty subjects were assessed and classified into four groups using a fuzzy logic model: 13 controls (55 ± 7years), 18 diabetics subjects without neuropathy (59 ± 6 years, 11 ± 7 diabetes years), 7 with mild neuropathy (56 ± 4years, 19 ± 7 diabetes years), and 22 with moderate to severe neuropathy (57 ± 5 years, 14 ± 8 diabetes years). Data were gathered by six infrared cameras at 100 Hz regarding lower limb joint kinematics (angles and angular velocities) and the relative phase for the hip-ankle, hip-knee, and knee-ankle were calculated. The K-means clustering algorithm was adopted to classify subjects considering the whole kinematics time series. A one-way ANOVA test was used to compare both clinical and kinematics parameters across clusters.Only the classification based on the intralimb coordination variables succeeded in defining 5 well separated clusters with the following clinical characteristics: controls were grouped mainly in Cluster 2, diabetics in Cluster 4, and neuropathic subjects in Cluster 5 (which included various degrees of severity). Hip-ankle coordination in Clusters 4 and 5 were significantly different (p0.05) with respect to Cluster 2, mainly in the stance phase. During the swing phase, differences were observed in the ankle-knee coordination (p0.05) across clusters.Classification based on intralimb coordination patterns succeeded in efficiently categorize gait alterations in diabetic subjects. It can be speculated that variables extracted from sagittal plane kinematics might be adopted as a support to clinical decision making in diabetes.

Background Under water gait training (UT) has been proposed as an innovative rehabilitative strategy for the treatment of axial disorders in Parkinson Disease (PD) patients, in particular for balance and gait impairment. However, the basis for the improvement is unclear. Research question The aim of this study was to evaluate improvements in the muscular activation in the lower limbs in a cohort of PD patients after UT. Methods Ten PD participants in the “off” state and 10 controls (mean ± standard deviation of age and BMI were respectively: 71 ± 6 years, 28 ± 3 kg/m2; 65.5 ± 7 years, 28 ± 3 kg/m2) were enrolled in the study. After signing informed consent, they walked barefoot at their preferred speed on a 10 m walkway, before and after UT. The electrical activity of four muscles were collected bilaterally by means of a surface electromyography system (sEMG), two force plates and a motion capture system. All signals were synchronized in time with the gait cycle. The sEMG activity of Rectus Femoris (RF), Tibialis Anterior (TA), Biceps Femoris (BF) and Gastrocnemius Lateralis (GL) were acquired. The average from each signal was used to extract the peak of the Envelope (PoE) and its occurrence with respect to the gait cycle (PoPE%). Time and space parameters were determined. Results Our results showed that UT in PD patients improved the muscle’s recruitment pattern towards normal. The PD patients POPE% was comparable with the one of the controls (TA: 20–35 %, 75–80 % of gait cycle; GL: 0–15 %, 25–45 %, 85–100 % of gait cycle) after UT on each muscle with the exception of BF. The muscle co-activation plots failed to show improvement in line with the muscle activation. Significance These results suggest that the muscle activation improvement with UT in PD participants might be due to a reorganisation at the executive rather than at the command level.

Diabetes neuropathy and vasculopathy are the two major complications of diabetes mellitus, leading to diabetic foot disease, of which the worst consequences are plantar ulcers and amputations. Motor impairments like joint stiffness and loss of balance are distinctive effects of diabetes and they have been extensively explored. However, while altered muscle function has been also assessed through experimentally measured surface electromyography, little is known about muscle forces. The objective of this study was to estimate muscle forces in subjects with diabetes and to use these data to identify differences with respect to a population of healthy subjects matched for age and BMI. This was obtained by generating musculoskeletal models of 10 diabetic and 10 control subjects in OpenSim starting from experimentally recorded data. Dynamic simulations of motion were run and hence muscle forces calculated. Student T test (p

Although hydrotherapy is one of the physical therapies adopted to optimize gait rehabilitation in people with Parkinson disease, the quantitative measurement of gait-related outcomes has not been provided yet. This work aims to document the gait improvements in a group of parkinsonians after a hydrotherapy program through 2D and 3D underwater and on land gait analysis. Thirty-four parkinsonians and twenty-two controls were enrolled, divided into two different cohorts. In the first one, 2 groups of patients underwent underwater or land based walking training; controls underwent underwater walking training. Hence pre-treatment 2D underwater and on land gait analysis were performed, together with post-treatment on land gait analysis. Considering that current literature documented a reduced movement amplitude in parkinsonians across all lower limb joints in all movement planes, 3D underwater and on land gait analysis were performed on a second cohort of subjects (10 parkinsonians and 10 controls) who underwent underwater gait training. Baseline land 2D and 3D gait analysis in parkinsonians showed shorter stride length and slower speed than controls, in agreement with previous findings. Comparison between underwater and on land gait analysis showed reduction in stride length, cadence and speed on both parkinsonians and controls. Although patients who underwent underwater treatment exhibited significant changes on spatiotemporal parameters and sagittal plane lower limb kinematics, 3D gait analysis documented a significant (p

Kinetic analysis of human motion with a multi-segment musculoskeletal foot model requires the distribution of loading applied to the modeled foot segments to be determined. This work thus examines the existence of any correlation between intersegmental foot kinematics, foot morphology, and the distribution of vertical loading in a multi-segment foot model. Gait analysis trials were performed by 20 healthy subjects at a self-selected speed with intersegmental foot joint angles and the distribution of vertical loading measured for a multi-segment foot model. A statistical relationship between the sagittal plane foot kinematics and loads applied to each foot sub-area was sought using multiple regression analyses. The sub-segmental loading of the normal and abnormal morphological groups was also compared. No meaningful relationships between sagittal plane foot kinematics and sub-segment foot loading were found (max. R2 = 0.36). Statistically significant relationships between foot morphology classification and sub-area foot loading were however identified, particularly for feet exhibiting hallux valgus. Significant variation in inter-subject foot sub-segmental loading indicates that an appropriate technique for determining this load distribution must be determined before effective kinetic analyses are performed with multi-segment musculoskeletal foot models. The results of this study suggest that foot morphology is a better indicator of sub-area loading than sagittal plane kinematics and warrants further investigation.\ud \ud

The purpose of this study was to evaluate the effects of the rapid palatal expansion (RPE) on posture and gait analysis in subjects with maxillary transverse discrepancies.Forty-one patients between 6 and 12 years were divided into 3 groups: 10 control subjects (Cs), 16 patients with unilateral posterior crossbite (CbMono), 15 patients with maxillary transverse discrepancy and no crossbite (Nocb). Every subject underwent gait analysis and posturographic examination in order to evaluate the presence of balance alterations before (T0) and after (T4) RPE application. The examinations were performed through a six-cameras stereophotogrammetric system (60-120Hz, BTS S.p.A.) synchronized with two force plates (FP4060, Bertec Corp.). Romberg test was performed on a force plate, and the statokinesiogram and joint kinematics were evaluated. One-way Anova was performed among the variables after evidence of normal distribution (Levene's test for equality of variances) and Kruskal-Wallis test (P0.05), in order to compare the three groups of subjects. While paired t-test was performed, or Kruskal-Wallis test, instead when comparing pre- and post-RPE application within the same group of subjects (P0.05). Tamane T2 or Bonferroni correction was applied where needed.The posturographic analysis reveal significant differences across the 3 population: 95% power frequency in medio-lateral and antero-posterior direction in T0, median frequency in medio-lateral direction in T0, mean power frequency in medio-lateral direction in T0. Significant differences were also registered in the three-dimensional joints kinematics variables, mainly between Cs and Cbmono in T0 and T4 and between Cbmono and Nocb in T4.A detectable correlation between dental occlusion and body posture is shown in this study that confirms another benefit of the RPE. This was mainly revealed in the dynamic posture where modifications at the mandibular level affect the whole body.

Resume Objectif Le but de cette etude etait d’evaluer les effets d’une expansion palatine rapide EPR par une analyse de la posture et de la demarche chez des sujets avec deficit transversal du maxillaire. Materiels et methodes Quarante et un patients âges de 6 a 12 ans ont ete divises en 3 groupes : 10 patients temoins (Cs), 16 patients avec une occlusion inversee posterieure unilaterale (Cb Mono), 15 patients avec une anomalie transversale du maxillaire mais sans occlusion inversee (Noc). Chaque sujet a subi une analyse de la demarche et un examen posturographique afin d’evaluer la presence d’une alteration de l’equilibre avant (T0) et apres l’EPR (T4). Les examens ont ete realises a l’aide d’un systeme de stereophotographie comportant six cameras (60–120 Hz, BTS S.p.A.) et synchronise avec deux plateformes de mesure enregistrant la force (FP4060, Bertec Corp.). Le Test de Romberg a ete realise sur une plateforme de mesure, et le statokinesiogramme ainsi que la cinetique des articulations ont ete evalues. L’analyse de variance simple Anova a un facteur controle a ete conduite pour les variables apres avoir obtenu la preuve d’une repartition normale (test de Levene pour l’egalite des variances) et test de Kruskal–Wallis (p Resultats L’analyse posturographique montre des differences significatives entre les 3 populations : puissance maximale/frequence a 95 % dans la direction mediolaterale et anteroposterieure a T0, frequence moyenne dans la direction mediolaterale a T0. Des differences ont egalement ete enregistrees au niveau des variables de cinetique articulaire en 3D, en particulier entre les groupes Cs et Cbmono a T0 et T4, et entre les groupes Cbmono et Nocb a T4. Conclusions Cette etude montre une nette correlation entre l’occlusion dentaire et la posture du corps, ce qui confere un autre avantage a l’EPR. Cela se remarque principalement dans la posture dynamique ou les modifications au niveau mandibulaire affectent l’ensemble du corps.

Plantar pressure simulation driven by integrated 3D motion capture data, using both a finite element and a discrete element model, is compared for ten healthy and ten diabetic neuropathic subjects. The simulated peak pressure deviated on average between 16.7 and 34.2% from the measured peak pressure. The error in the position of the peak pressure was on average smaller than 4.2 cm. No method was more accurate than the other although statistical differences were found between them. Both techniques are thus complementary and useful tools to better understand the alteration of diabetic foot biomechanics during gait. ispartof: Computer Methods in Biomechanics and Biomedical Engineering vol:20 issue:13 pages:1442-1452 ispartof: location:England status: published

Diabetic foot is one of the most debilitating complications of diabetes and may lead to plantar ulcers. In the last decade, gait analysis, musculoskeletal modelling (MSM) and finite element modelling (FEM) have shown their ability to contribute to diabetic foot prevention and suggested that the origin of the plantar ulcers is in deeper tissue layers rather than on the plantar surface. Hence the aim of the current work is to develop a methodology that improves FEM-derived foot internal stresses prediction, for diabetic foot prevention applications. A 3D foot FEM was combined with MSM derived force to predict the sites of excessive internal stresses on the foot. In vivo gait analysis data, and an MRI scan of a foot from a healthy subject were acquired and used to develop a six degrees of freedom (6 DOF) foot MSM and a 3D subject-specific foot FEM. Ankle kinematics were applied as boundary conditions to the FEM together with: 1. only Ground Reaction Forces (GRFs); 2. OpenSim derived extrinsic muscles forces estimated with a standard OpenSim MSM; 3. extrinsic muscle forces derived through the (6 DOF) foot MSM; 4. intrinsic and extrinsic muscles forces derived through the 6 DOF foot MSM. For model validation purposes, simulated peak pressures were extracted and compared with those measured experimentally. The importance of foot muscles in controlling plantar pressure distribution and internal stresses is confirmed by the improved accuracy in the estimation of the peak pressures obtained with the inclusion of intrinsic and extrinsic muscle forces.