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BACKGROUND: Clinical gait analysis (CGA) is a systematic approach to comprehensively evaluate gait patterns, quantify impairments, plan targeted interventions, and evaluate the impact of interventions. However, international standards for CGA are currently lacking, resulting in various national initiatives. Standards are important to ensure safe and effective healthcare practices and to enable evidence-based clinical decision-making, facilitating interoperability, and reimbursement under national healthcare policies. Collaborative clinical and research work between European countries would benefit from common standards.RESEARCH OBJECTIVE: This study aimed to review the current laboratory practices for CGA in Europe.METHODS: A comprehensive survey was conducted by the European Society for Movement Analysis in Adults and Children (ESMAC), in close collaboration with the European national societies. The survey involved 97 gait laboratories across 16 countries. The survey assessed several aspects related to CGA, including equipment used, data collection, processing, and reporting methods.RESULTS: There was a consensus between laboratories concerning the data collected during CGA. The Conventional Gait Model (CGM) was the most used biomechanical model for calculating kinematics and kinetics. Respondents also reported the use of video recording, 3D motion capture systems, force plates, and surface electromyography. While there was a consensus on the reporting of CGA data, variations were reported in training, documentation, data preprocessing and equipment maintenance practices.SIGNIFICANCE: The findings of this study will serve as a foundation for the development of standardized guidelines for CGA in Europe.

Three-dimensional (3D) cameras used for gait assessment obviate the need for bodily markers or sensors, making them particularly interesting for clinical applications. Due to their limited field of view, their application has predominantly focused on evaluating gait patterns within short walking distances. However, assessment of gait consistency requires testing over a longer walking distance. The aim of this study is to validate the accuracy for gait assessment of a previously developed method that determines walking spatiotemporal parameters and kinematics measured with a 3D camera mounted on a mobile robot base (ROBOGait). Walking parameters measured with this system were compared with measurements with Xsens IMUs. The experiments were performed on a non-linear corridor of approximately 50 m, resembling the environment of a conventional rehabilitation facility. Eleven individuals exhibiting normal motor function were recruited to walk and to simulate gait patterns representative of common neurological conditions: Cerebral Palsy, Multiple Sclerosis, and Cerebellar Ataxia. Generalized estimating equations were used to determine statistical differences between the measurement systems and between walking conditions. When comparing walking parameters between paired measures of the systems, significant differences were found for eight out of 18 descriptors: range of motion (ROM) of trunk and pelvis tilt, maximum knee flexion in loading response, knee position at toe-off, stride length, step time, cadence; and stance duration. When analyzing how ROBOGait can distinguish simulated pathological gait from physiological gait, a mean accuracy of 70.4%, a sensitivity of 49.3%, and a specificity of 74.4% were found when compared with the Xsens system. The most important gait abnormalities related to the clinical conditions were successfully detected by ROBOGait. The descriptors that best distinguished simulated pathological walking from normal walking in both systems were step

Three-dimensional (3D) cameras used for gait assessment obviate the need for bodily markers or sensors, making them particularly interesting for clinical applications. Due to their limited field of view, their application has predominantly focused on evaluating gait patterns within short walking distances. However, assessment of gait consistency requires testing over a longer walking distance. The aim of this study is to validate the accuracy for gait assessment of a previously developed method that determines walking spatiotemporal parameters and kinematics measured with a 3D camera mounted on a mobile robot base (ROBOGait). Walking parameters measured with this system were compared with measurements with Xsens IMUs. The experiments were performed on a non-linear corridor of approximately 50 m, resembling the environment of a conventional rehabilitation facility. Eleven individuals exhibiting normal motor function were recruited to walk and to simulate gait patterns representative of common neurological conditions: Cerebral Palsy, Multiple Sclerosis, and Cerebellar Ataxia. Generalized estimating equations were used to determine statistical differences between the measurement systems and between walking conditions. When comparing walking parameters between paired measures of the systems, significant differences were found for eight out of 18 descriptors: range of motion (ROM) of trunk and pelvis tilt, maximum knee flexion in loading response, knee position at toe-off, stride length, step time, cadence; and stance duration. When analyzing how ROBOGait can distinguish simulated pathological gait from physiological gait, a mean accuracy of 70.4%, a sensitivity of 49.3%, and a specificity of 74.4% were found when compared with the Xsens system. The most important gait abnormalities related to the clinical conditions were successfully detected by ROBOGait. The descriptors that best distinguished simulated pathological walking from normal walking in both systems were s

Purpose: To evaluate physical fitness and its association with fatigue in patients with low grade glioma (LGG). Methods: Cross-sectional study. Muscle strength was measured with a digital dynamometer, cardiorespiratory fitness (peak oxygen uptake (VO2peak), maximal workload (MWL)) by cardiopulmonary-exercise-testing, and fatigue by using the Multidimensional Fatigue Inventory. Results: Thirty patients were included, mean age of 44.1 (SD11.2) years, and 67% were men, 31.2 (SD18) months post-diagnosis. Muscle strength (p < 0.01), and cardiorespiratory fitness (VO 2peak, MWL) (p < 0.01) were significantly decreased compared to predicted values based on age and gender. Thirty percent of the patients experienced severe physical fatigue, and severe mental fatigue was reported in 57% of the patients. Cardiorespiratory fitness showed weak to moderate (r − 0.46 to r − 0.52) but significant (p < 0.01) correlations with physical fatigue, not with mental and general fatigue. Muscle strength was not associated with fatigue. A lower VO 2peak was independently associated with a higher level of physical fatigue, adjusted for Karnofsky Performance Status (R 2 0.40). Conclusions: Physical fitness (muscle strength, cardiorespiratory fitness) is reduced in patients with LLG, and a lower level of cardiorespiratory fitness (VO 2peak) is independently associated with a higher level of experienced physical fatigue. Trials to explore the benefit of exercise programs to improve cardiorespiratory fitness and, consequently, fatigue are warranted.Implications for rehabilitation Physical fitness (muscle strength and cardiorespiratory fitness) is reduced in patients with low-grade glioma. Patients with low-grade glioma should be screened for fatigue with the multidimensional fatigue inventory, to differentiate between mental and physical fatigue. Patients with low-grade glioma with severe physical fatigue should be screened for reduced physi

Aim: To explore whether subgroups of adults with cerebral palsy (CP) with different fatigue diurnal profiles can be discerned, and to explore whether sleep, physical activity, or health-related fitness are associated with these profiles. Method: Thirty-two adults (median age 29 years 8 months; range 20–54 years; 11 males, 21 females) with spastic CP (Gross Motor Function Classification System levels I–III) with physical activity-related fatigue complaints participated. Real-time fatigue and physical activity were assessed for 7 consecutive days by short message service text four times during the day and by wearing an accelerometer respectively. Sleep was assessed by the Pittsburgh Sleep Quality Index, and fitness by assessing body composition and aerobic capacity. Latent class growth modelling was used to classify subgroups according to their diurnal profiles of real-time fatigue. Univariable multinomial logistic regression analysis explored whether participant characteristics, sleep, physical activity, or health-related fitness were associated with diurnal profiles. Results: Three distinct fatigue diurnal profiles were identified: stable low (n = 10), increasing (n = 14), and stable high (n = 8). Only aerobic capacity was associated with fatigue profiles (odds ratio 1.15, 95% confidence interval 1.00–1.34; p = 0.05). Interpretation: Fatigue in adults with CP may be low or high stable or may increase during the day. These findings indicate the relevance of assessing fatigue variability. What this paper adds: We found three patterns of daily fatigue in adults with cerebral palsy (CP). Only aerobic capacity was associated with fatigue profiles in adults with CP. Moment-to-moment variations in fatigue can help with personalized fatigue management.

Trunk motor control is essential for the proper functioning of the upper extremities and is an important predictor of gait capacity in children with delayed development. Early diagnosis and intervention could increase the trunk motor capabilities in later life, but current tools used to assess the level of trunk motor control are largely subjective and many lack the sensitivity to accurately monitor development and the effects of therapy. Inertial measurement units could yield an objective quantitative assessment that is inexpensive and easy-to-implement. We hypothesized that root mean square of jerk, a proxy for movement smoothness, could be used to distinguish age and thereby presumed motor development. We attached a sensor to the trunks of six young children with no known developmental deficits. Root mean square of jerk decreases with age, up to 24 months, and is correlated to a more established method, i.e., center-of-pressure velocity, as well as other standard inertial measurement unit outputs. This metric therefore shows potential as a method to differentiate trunk motor control levels.

Purpose: To evaluate fatigue and cognitive functioning in patients with low-grade glioma and to assess whether cognitive functioning and employment status differ between patients with severe and non-severe mental fatigue. Methods: Cross-sectional study. Fatigue was measured with the multidimensional fatigue inventory, objective cognitive functioning with a neuropsychological test battery, and mood with the Center for Epidemiological Studies Depression Scale. Results: Thirty-one patients, mean age 44 ± 11, mean time post-diagnosis 2.5 ± 1.4 years, participated. Severe mental fatigue was present in 55% and depression in 36% of the patients. Attention deficits were observed in 75% (Stroop’s test), memory deficits in 36% (Rey Auditory Verbal Learning Test), and executive functioning deficits in 42% (Stroop’s test). Severe mental fatigue patients demonstrated significantly worse scores on Stroop’s test-Card-II (p = 0.043), Trail Making Test-B (p = 0.014), Trail Making Test-B/A (p = 0.014), and Digit-Span (p = 0.046), compared to non-severe mental fatigue patients. Severe mental fatigue patients worked significantly less hours per week (p = 0.013) and had more changes in their employment status (p = 0.009) after diagnosis. Conclusions: Patients with low grade glioma show high rates of fatigue, especially in the mental domain, which might be associated with deficits in cognitive functioning and changes in employment status.Implications for rehabilitation The majority of patients with low grade glioma suffers from severe mental fatigue and has deficits in cognitive functioning, which may affect employment status. Patients with low grade glioma should be screened for fatigue with the multidimensional fatigue inventory, to differentiate between mental and physical fatigue. Patients with low grade glioma with severe mental fatigue should be screened for problems in cognitive functioning with an objective neuropsychological test battery. Cognitive and vocational rehabilitati

Background Different interventions are offered to children with cerebral palsy (CP) to improve the activity domain of the international classification of functioning (ICF). In therapy settings, the focus is mostly on motor capacity, but the ultimate goal is to improve motor performance. We therefore examined if changes in motor capacity outcomes are accompanied by changes in objectively measured motor performance after a 3-month intensive treatment period in ambulatory children with CP. Methods A secondary analysis on prospective clinical trial data was performed using multivariate linear regression. Sixty-five children (37 boys and 28 girls) with spastic CP, mean age 7 years and 3 months, Gross Motor Function Classification System (GMFCS) levels I-III were involved in a distinct 3-month intensive treatment period. Motor capacity (Gross Motor Function Measure [GMFM], functional muscle strength [FMS], and walking speed [WS]) and motor performance (using three Actigraph-GT3X+-derived outcome measures) were measured at baseline, 12 and 24 weeks. Results No significant associations were found for any of the change scores ( increment (12)) between motor capacity and motor performance after a 12-week intensive treatment period. After 24 weeks, increment 24FMS (p = .042) and increment 24WS (p = .036) were significantly associated with changes in motor performance outcome measure percentage of time spent sedentary ( increment (24)%sedentary). In this model, 16% of variance of increment (24)%sedentary was explained by changes in motor capacity (p = .030). Conclusions Changes in motor capacity are mostly not accompanied by changes in objectively measured motor performance after an intensive treatment period for ambulatory children with CP. These findings should be taken into account during goal setting and are important to manage expectations of both short- and longer term effects of treatment programmes.

Introduction: To set up and guide interventions with the aim to increase physical activity and lower sedentary behavior valid monitoring of physical behavior is essential. The aim of this study was to evaluate the validity of the single-unit Activ8 activity monitor to classify several body postures and movements.Methods: Twelve healthy adults performed a series of activities, representative for everyday life, according to a standard protocol. Activ8 was both worn in the trouser pocket (prescribed location) and fixated to the front of the thigh. Activities were video recorded and analyzed thereafter. Postures and movements that were analyzed were lying/sitting, standing, walking, cycling, and running.Results: The agreement between Activ8 output and video analysis was 89.7% (inter-subject range: 66.0 to 96.6%) for the pocket location and 91.9% (range 85.5 to 95.1%) for the thigh location. Sensitivity and positive predictive value scores for both locations were all above 80%, except for standing (69% or higher). Differences in classified duration of separate postures and movements were within 20% for walking, sitting and running.Conclusion: The Activ8 is a valid instrument to quantify a defined set of body postures and movements. Because of the smaller time difference, the thigh location is preferred for research purposes.

Background: Accurate measurement of physical behaviour is paramount to better understand lifestyle, health, and functioning, particularly in adults with physical disability as they may be at higher risk of sedentary lifestyle and subsequent negative health consequences. This study aimed: 1) to evaluate the criterion validity of a novel and clinically applicable activity monitor (AM, Activ8), in the detection of body postures and movements in adults with spastic cerebral palsy (CP); and 2) to evaluate the extent that the AM's positioning affects validity.Methods: In this cross-sectional study, 14 ambulatory adults with CP [9 men; mean (SD) age, 35.4 (13.1) years] performed standardized activities while wearing three Activ8 monitors - frontolateral thigh (primary position), frontal thigh, and pant pocket - and being video recorded (criterion measure). AM activity output was compared to synchronized video recordings. Absolute (seconds) and relative [(video time-AM time)/mean time, %] time differences between methods were calculated. Relative time differences of < 10% were indicative of good validity. Comparison of AM attachment positions was completed using Spearman Rho correlation coefficients and Meng's tests.Results: Criterion validity of the AM (frontolateral thigh) was good (average relative time differences: 0.25% for sitting, 4.69% for standing, 2.46% for walking, 1.96% for upright activity, 3.19% for cycling), except for running (34.6%). Spearman Rho correlation coefficients were greater between video/frontolateral thigh position than video/frontal thigh position and video/pant pocket position for body posture and movement categories sitting, standing, walking, and upright activity (p < 0.01 for all).Conclusions: The AM, positioned on the frontolateral thigh, demonstrated good criterion validity in ambulatory adults with CP. Though the Activ8 offers potential as an objective measure of physical activity, appropriate positioning is paramount for valid meas

Objectives: To describe the course of walking behaviour over a period of 1 year after stroke, using accelerometry, and to compare 1-year data with those from a healthy group. Design: One-year follow-up cohort study. Subjects: Twenty-three stroke patients and 20 age-matched healthy subjects. Methods: Accelerometer assessments were made in the participants' daily environment for 8 h/day during the 1st (T1), 12th (T2) and 48th (T3) weeks after stroke, and at one time-point in healthy subjects. Primary outcomes were: percentage of time walking and upright (amount); mean duration and number of walking periods (distribution); step regularity and gait symmetry (quality); and walking speed. Results: Time walking, time upright, and number of walking bouts increased during T1 and T2 (p <0.01) and then levelled off (p >0.30). Mean duration of walking periods showed no significant improvements (p> 0.30) during all phases. Step regularity, gait symmetry and gait speed showed a tendency to increase consistently from T1 to T3. At T3, amount and distribution variables reached the level of the healthy group, but significant differences remained (p <0.02) in step regularity and gait speed. Conclusion: In this cohort, different outcomes of walking behaviour showed different patterns and levels of recovery, which supports the multi-dimensional character of gait.