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Purpose: Whether kinematic analysis of the trunk can provide useful clinical insight into the relationship between function and various spinal conditions is still under debate. The aim of this study was to develop a clinical protocol and an associated biomechanical model to characterize quantitatively the trunk movements in obese subjects. Methods: Twenty (10 obese, 10 control) female subjects were evaluated with an optoelectronic system and passive markers attached to the spine during forward flexion, lateral bending, and rotation of the trunk. Results: We found a systematic error due to skin artifacts of less than 5° in both groups. Intra- and inter-subject standard deviation was less than 6°. Obese subjects demonstrated a significantly reduced motion in the thoracic spine associated with an increased pelvic tilt angle as compared to controls. Conclusions: Our protocol was able to characterize trunk mobility in obese and normal subjects suggesting that kinematics could represent, even in an obese population, a promising method to investigate subclinical spinal disorders and to assess the effectiveness of rehabilitation programs. [ABSTRACT FROM AUTHOR]

Purpose. Intramuscular botulinum toxin A (BTA) injection is a local reversible treatment with a wide range of therapeutic applications, including temporary reduction of spasticity. The aim of this work was a quantitative, computerized objective evaluation of BTA-induced improvement of the walking functional ability in a group of children with cerebral palsy (CP). Methods. Fifteen children with CP and 20 healthy children were evaluated. All patients were equinus walkers without fixed contractures of triceps surae muscles and they were evaluated before and after about 1.5 months from BTA injections into the calf muscles. The effectiveness of treatment was evaluated by 3D computerized gait analysis. Results. Data analysis revealed a significant improvement of equinus foot and ankle range of motion during gait after BTA injection. Positive effects were evident also at the knee joint as documented by the improvement of kinetics characteristics (moment and power). Conclusions. Computerized gait analysis is a valid method for quantification of BTA effect on walking in children with CP, allowing a detailed evaluation of improvement at each joint and a quantitative evaluation of treatment outcome. [ABSTRACT FROM AUTHOR]

Abstract Background Being severely overweight is a distinctive clinical feature of Prader-Willi Syndrome (PWS). PWS is a complex multisystem disorder, representing the most common form of genetic obesity. The aim of this study was the analysis of the gait pattern of adult subjects with PWS by using three-Dimensional Gait Analysis. The results were compared with those obtained in a group of obese patients and in a group of healthy subjects. Methods Cross-sectional, comparative study: 19 patients with PWS (11 males and 8 females, age: 18–40 years, BMI: 29.3–50.3 kg/m2); 14 obese matched patients (5 males and 9 females, age: 18–40 years, BMI: 34.3–45.2 kg/m2); 20 healthy subjects (10 males and 10 females, age: 21–41 years, BMI: 19.3–25.4 kg/m2). Kinematic and kinetic parameters during walking were assessed by an optoelectronic system and two force platforms. Results PWS adult patients walked slower, had a shorter stride length, a lower cadence and a longer stance phase compared with both matched obese, and healthy subjects. Obese matched patients showed spatio-temporal parameters significantly different from healthy subjects. Furthermore, Range Of Motion (ROM) at knee and ankle, and plantaflexor activity of PWS patients were significantly different between obese and healthy subjects. Obese subjects revealed kinematic and kinetic data similar to healthy subjects. Conclusion PWS subjects had a gait pattern significantly different from obese patients. Despite that, both groups had a similar BMI. We suggest that PWS gait abnormalities may be related to abnormalities in the development of motor skills in childhood, due to precocious obesity. A tailored rehabilitation program in early childhood of PWS patients could prevent gait pattern changes.

Objective: This study aimed to characterize the effect of obesity on foot-ground contact in young individuals affected by Down syndrome (DS) during quiet upright stance., Design: This is a cross-sectional study on 118 individuals with Down syndrome, 59 with obesity aged 3-18 yrs and 59 with normal weight, age- and sex-matched forming the control group. Both groups were evaluated while standing on a pressure-sensitive mat. Foot-ground contact was characterized using contact area and mean pressure calculated for the rearfoot, the midfoot, and the forefoot., Results: The results show that obesity significantly influences the foot-ground interaction, with some differences related to sex. In particular, the females with obesity exhibited larger contact areas and higher plantar pressures (in the forefoot and the midfoot) with respect to the control group, whereas in the males with obesity, only the plantar pressures were found higher than those of the controls. Flatfoot is the prevalent arch type for both groups, but its incidence seems to be unrelated to obesity., Conclusions: The modifications introduced by obesity in foot-ground contact pressure and area may represent a factor capable of aggravating existing negative podiatric issues associated with Down syndrome. Thus, planning periodical monitoring of foot-ground contact during childhood and adolescence is recommended to avoid possible problems related to adverse effects of repeated excessive mechanical stresses on the plantar region.

Purpose: to develop a marker set for simultaneously assessing upper and lower limb biomechanics during gait., Methods: 24 healthy young subjects (mean age: 23.80 years) were assessed quantitatively using an optoelectronic system, two force platform and a video system. Passive markers were positioned according to the proposed marker set which enables acquiring the upper and lower limb movement simultaneously during Gait Analysis. In addition to the traditional parameters obtained from Gait Analysis, the shoulder and elbow angles were computed from markers coordinates of upper limbs; then, some significant parameters were identified and calculated. From shoulder and elbow position, angles, angular velocities, angular acceleration, moments, and powers were calculated for shoulder and elbow joints., Results: Kinematic and kinetic data were obtained in the three planes (sagittal, frontal, and transversal) for the shoulder and in the sagittal plane for the elbow. Normative ranges were obtained for these parameters from data of healthy participants., Conclusions: The proposed experimental set-up enables simultaneous assessment of upper and lower limb movement during gait. Thus, no further trials are required in addition to those acquired during standard gait analysis in order to assess upper limb motion, which also makes the experimental set-up feasible for clinical applications.

Objectives: The aim of our study was to quantitatively analyze facial motion kinematics by means of an optoelectronic system. In particular, we defined a set of easily recognizable reference points for markerization, and tested the applicability of our markerization method for an exhaustive characterization of the subjects' facial motion through the definition of some kinematic parameters., Methods: Thirty healthy subjects (mean age, 24.6 +/- 1.0 years; 15 female and 15 male) participated in the study. A set of markers (diameter, 3 mm) was positioned on several reference points of the face, and some parameters were computed for the characterization of facial morphology and movement, such as ranges of motion, angles, times, and distances., Results: The protocol was tested for inter-rater and intra-rater reliability by use of intraclass correlation, of which the results were good (between 0.4 and 0.75) to excellent (greater than 0.75). The parameters were useful for characterizing the resting position, mimicry, and speaking movements, and highlighted some distinctions between men and women in facial morphology., Conclusions: The protocol can be applied to a variety of facial movements, including speaking. Future works could address the use of the protocol in subjects with disorders and the integrated analysis of kinematic parameters and voice spectrography.

We attempted to quantify the effects of isolated femoral derotation osteotomies using clinical evaluation and gait analysis (kinematics and kinetics) in patients with cerebral palsy (CP). Twelve children with CP were evaluated before and 10 months after isolated femoral derotation osteotomy, and 15 healthy children were evaluated as controls. There were significant improvements on clinical examination. A better position of the hip and ankle in the transverse plane was evident and significant changes occurred in terms of hip and ankle kinetics after surgery. Improvements in kinematics and hip and ankle power are very important biomechanically. The correction of lever arm dysfunction and more physiological hip and ankle power generation result in an improvement in terms of energy consumption, leading to a more functional and economic gait pattern.

The predominant clinical feature of patients with Hereditary Spastic Paraparesis (HSP) is gait disturbance owing to spasticity and weakness of the lower limbs; the spasticity in early-onset disease (infancy or childhood) often cannot be distinguished from mild form of spastic diplegia (SD). The aim of this study was to quantify the gait strategy in HSP and SD children, focusing on the differences between groups as concerns functional limitation during gait. 9 HSP and 16 SD children were evaluated using Gait Analysis; kinematic and kinetic parameters and EMG pattern during walking were identified and calculated to compare the two gait strategies. The results revealed that these two pathologies are characterised by different gait strategies. In particular we found that knee joint, in terms of kinematics and kinetics, and rectus femoris pattern represent discriminatory aspects in order to compare and differentiate gait patterns of HSP and SD children. The findings strongly support the issue that HSP and SD patients need individualised therapeutical program, either neurosurgical or pharmacological treatment, based on the quantification of gait deficiencies and in order to address the peculiarity of their motor limitations and to prevent the onset of compensatory strategies., (Copyright © 2010 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.)

The goal of this work was to analyze postural control in Down syndrome (DS) participants considering three different groups composed by children, teenagers and adults with DS. An analysis of the centre of pressure (COP) displacement during standing position was therefore performed for the three groups of subjects. The obtained signal of COP was then analyzed in both time and frequency domains in order to perform a thorough analysis of the signal. Even if several parameters revealed more differences between the control and DS participants in adulthood, results indicated a divergence of these two groups starting from their early age, although the limit of this study considering a cross-sectional, and not a longitudinal comparison. In particular, COP medio-lateral range of motion pointed out a decrease for both groups considered (pathological and control) in time domain analysis that could lead to the same conclusion in developing strategies, but frequency domain analysis evidenced how this result is reached by the different population: DS people showed a larger frequency of movement in ML more evidenced in adults group (Down Syndrome Adults Group vs. Adults Control Group; 0.35 ± 0.22 Hz vs. 0.17 ± 0.15 Hz; p < 0.05). Even if less pronounced also for the other parameters computed these differences emerged. Aims for the two macro-groups, DS and CG, are different: DS people focused on overcoming the lack of equilibrium caused by hypotonia and ligament laxity, while control group attempted to improve their strategy in term of efficiency, pointing out a different strategy development., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

To improve postural stability in individuals with dystonic cerebral palsy, the concept of a dynamic seat has been suggested as a potential solution. An experimental set-up for the acquisition of movement during extensor thrusts while sitting on a seating system was defined and applied on a group of dystonic individuals, to compare a dynamic versus a rigid seat system, using quantitative movement analysis. The seating system in dynamic configuration is able to reduce the extensor thrust experienced by the consumers, as well as to increase range of motion in the anterior-posterior direction, limiting the sliding down of trunk and showing better upper limb smoothness during extensor thrusts. The procedures used in this study appear to provide a useful tool for better understanding how the concept of a dynamic back in a seat system may affect and influence position and stability of individuals with dystonia on the seat system.

Objective: The aims were: (1) to quantify the functional limitation of children at the beginning of recovery of independent ambulation after Traumatic Brain Injury (TBI), using clinical-functional scales; (2) to evaluate the changes in gait pattern during rehabilitation (about 5 months later), using 3D Gait Analysis (GA) in post-acute phase; (3) to investigate the presence of correlation among parameters obtained by 3DGA, clinical assessment and measures connected with the trauma., Methods: Fourteen children with hemiplegia after severe TBI were evaluated at independent gait recovery (S0) and 5.5 months later (S1) by clinical assessment (GOS, DRS, WeeFIM and GMFM) and 3D GA (spatio-temporal parameters, kinematics and kinetics)., Results: At S1 all clinical measures had improved. Regarding spatio-temporal parameters, velocity and step length improved. Significant progress was evident at the ankle joint, while an unchanged condition appeared at pelvis and hip in sagittal plane with a worsening of hip rotation which increased its internal rotation. Significant correlations were found between motor performance, clinical assessment and trauma-related measures., Conclusions: Repeated GA and clinical evaluations were useful in quantifying the motor recovery of children with TBI during rehabilitation underpinning the role of GA in quantifying these modifications in an objective and non-invasive way.