A review of the effectiveness of lower limb orthoses used in cerebral palsy

To produce this review, a systematic literature search was conducted for relevant articles published in the period between the date of the previous ISPO consensus conference report on cerebral palsy (1994) and April 2008. The search terms were 'cerebral and pals* (palsy, palsies), 'hemiplegia', 'diplegia', 'orthos*' (orthoses, orthosis) orthot* (orthotic, orthotics), brace or AFO

Characterizing the Gait of People With Different Types of Amputation and Prosthetic Components Through Multimodal Measurements: A Methodological Perspective

Prosthetic gait implies the use of compensatory motor strategies, including alterations in gait biomechanics and adaptations in the neural control mechanisms adopted by the central nervous system. Despite the constant technological advancements in prostheses design that led to a reduction in compensatory movements and an increased acceptance by the users, a deep comprehension of the numerous factors that influence prosthetic gait is still needed. The quantitative prosthetic gait analysis is an essential step in the development of new and ergonomic devices and to optimize the rehabilitation therapies. Nevertheless, the assessment of prosthetic gait is still carried out by a heterogeneous variety of methodologies, and this limits the comparison of results from different studies, complicating the definition of shared and well-accepted guidelines among clinicians, therapists, physicians, and engineers. This perspective article starts from the results of a project funded by the Italian Worker's Compensation Authority (INAIL) that led to the generation of an extended dataset of measurements involving kinematic, kinetic, and electrophysiological recordings in subjects with different types of amputation and prosthetic components. By encompassing different studies published along the project activities, we discuss the specific information that can be extracted by different kinds of measurements, and we here provide a methodological perspective related to multimodal prosthetic gait assessment, highlighting how, for designing improved prostheses and more effective therapies for patients, it is of critical importance to analyze movement neural control and its mechanical actuation as a whole, without limiting the focus to one specific aspect

Motor patterns evaluation of people with neuromuscular disorders for biomechanical risk management and job integration/reintegration

Neurological diseases are now the most common pathological condition and the leading cause of disability, progressively worsening the quality of life of those affected. Because of their high prevalence, they are also a social issue, burdening both the national health service and the working environment. It is therefore crucial to be able to characterize altered motor patterns in order to develop appropriate rehabilitation treatments with the primary goal of restoring patients' daily lives and optimizing their working abilities. In this thesis, I present a collection of published scientific articles I co-authored as well as two in progress in which we looked for appropriate indices for characterizing motor patterns of people with neuromuscular disorders that could be used to plan rehabilitation and job accommodation programs. We used instrumentation for motion analysis and wearable inertial sensors to compute kinematic, kinetic and electromyographic indices. These indices proved to be a useful tool for not only developing and validating a clinical and ergonomic rehabilitation pathway, but also for designing more ergonomic prosthetic and orthotic devices and controlling collaborative robots

Ganganalyse bei Patienten mit Oberschenkelamputation

This examination analyzes kinematic variability in gait of transfemoral amputees compared to healthy controls and the association between kinematic variability and daily activity. Gait variability was greater during walking in transfemoral amputees compared to healthy controls. Additionally there is a correlation between daily activity and gait variability. Kinematic variability could be a potential marker for quality of gait with diagnostic implications.Diese Arbeit untersucht die Variabilität der Kinematik im Gangbild bei Patienten mit Oberschenkelamputation im Vergleich zu Gesunden sowie den Zusammenhang von kinematischer Variabilität zur Alltagsaktivität. Die Gangvariabilität war bei Patienten im Vergleich zu Gesunden erhöht. Zudem zeigte sich eine Korrelation zwischen Alltagsaktivität und Gangvariabilität. Variabilität der Kinematik kann als Marker für Gangqualität zur Verbesserung der Diagnostik beitragen

DEVELOPMENT AND EVALUATION OF A NOVEL OVER-GROUND WALKING DEVICE: A ROBOTIC WALKER

Ph.DDOCTOR OF PHILOSOPH

Development and Application of the Pelvic Tracker

Backpacks are commonly used by students of all ages and there has been a growing concern in many countries in relation to the backpack loads carried by school children and its association with the rise in complaints of neck, shoulder and back pain. Of further concern is the work of Hestbaek et al. (2006) which has shown a correlation between experiencing back pain as an adolescent and experiencing low back pain as an adult. In recent years, a number of studies have investigated physiological and movement kinematic responses to load carriage, such as oxygen consumption, heart rate, gait pattern and trunk posture (Hong et al., 2000; Pascoe et al., 1997). However, most of the studies that focused on children carrying loads looked only at gait patterns and trunk and neck postures. None of the previous studies investigated the compensatory pelvic motions of school children due to increased loads. Also, it was reported that one of the major limitations of measuring pelvic kinematics whilst carrying a backpack was occlusion of retro-reflective markers, and consequently this limits the type of activity and subject to be measured using an optical motion tracking system. Despite the presence of a variety of models, there are still debates on their reliability and repeatability, and consequently there is no clearly defined standard or consensus. In this thesis, a novel methodology was developed to measure pelvic kinematics. Its repeatability and reliability was validated experimentally by comparing it to the most relevant previous method. The result of this experiment showed that the new method improved the repeatability, reliability and reproducibility of kinematics data of the pelvis and overcomes a number of theoretical and experimental limitations, such as marker occlusion. The validated method was used to develop a protocol to measure the pelvic kinematics in adolescents whilst carrying loaded backpacks of 17% and 25% of their body weight during different activities of daily living on the basis of a survey which was conducted to explore the average daily weight that children carry to school in the UK. The result of this experiment revealed that as the load increased to 25% of the body weight, the instability in postural control increased and significant changes in pelvic tilt and rotation were noted in almost all activities. It was revealed in this study that female and male subjects used different mechanism to compensate for the effect of a heavy backpack. It was evident that carriage of loaded backpack will result in alteration of the movement of the pelvis and may in future promote postural deviation and increase lower back pain.Open Acces

Walk Softly and Carry a Big Stick: Strategies to Decrease Dynamic Knee Joint Loading

Excessive dynamic loading of the knee joint, quantified indirectly during three dimensional gait analysis, is a risk factor for the progression of knee osteoarthritis (OA). The overall objective of this thesis was to explore the effects of prolonged walking and the use of Nordic walking poles on selected gait characteristics indicative of knee joint load. The first study evaluated the time-varying behaviour, reliability, and validity of selected gait kinematics during 60 minutes of treadmill walking in 20 healthy adults. Maximum lateral trunk lean angle and maximum toe-out angle did not change over time, were consistent from day to day and were consistent with values assessed during over-ground gait analysis, suggesting that these measures are appropriate for use in studying potential adaptive gait mechanisms. The second study compared the time-varying behaviour of selected gait kinematics during 30 minutes of treadmill walking in 20 participants with, and 20 participants without, medial compartment knee OA, and explored correlations between these gait kinematics and pain intensity. Trunk lean, toe-out, and pelvic rise were different between those with and without knee OA, but did not systematically change over time in either group. Trunk lean and contralateral pelvic drop were significantly correlated to pain intensity. The third study was a technical report describing the use of three dimensional gait analysis and a Nordic walking pole instrumented with a compression load cell. This methodology was then used in the fourth study to evaluate the effect of walking poles used by 34 patients with medial compartment knee OA. Despite small reductions in the vertical ground reaction force, walking with poles increased the frontal plane lever arm, and therefore the knee adduction moment. The pole force in the vertical direction was inversely related to the increase in first peak knee adduction moment. Overall, this thesis suggests that, although biomechanically plausible, patients with knee OA do not naturally adopt gait characteristics or use walking poles in a way to decrease knee joint loads. These findings support the need for future efforts directed at explicitly teaching walking techniques, including the optimal use of assistive devices, to decrease knee joint loading

Development and Application of 3D Kinematic Methodologies for Biomechanical Modelling in Adaptive Sports and Rehabilitation

Biomechanical analysis is widely used to assess human movement sciences, specifically using three-dimensional motion capture modelling. There are unprecedented opportunities to increase quantitative knowledge of rehabilitation and recreation for disadvantaged population groups. Specifically, 3D models and movement profiles for human gait analysis were generated with emphasis on post-stroke patients, with direct model translation to analyze equivalent measurements while horseback riding in use of the alternative form of rehabilitation, equine assisted activities and therapies (EAAT) or hippotherapy (HPOT). Significant improvements in gait symmetry and velocity were found within an inpatient rehabilitation setting for patients following a stroke, and the developed movement profiles for patients have the potential to address patient recovery timelines. For population groups, such as those following a cerebral incident, alternative forms of rehabilitation like EAAT and HPOT are largely unexplored. Within these studies, relevant muscular activations were found between healthy human gait and horseback riding, supporting the belief that horseback riding can stimulate similar movements within the rider. Even more, there was a strong correlation between the horse’s pelvic rotations, and the responsive joint moments and rotations of the rider. These findings could have greater implications in choosing horses, depending on the desired physical outcome, for EAAT and HPOT purposes. Similar approaches were also used to address another biomechanically disadvantage population, adaptive sport athletes. Utilizing similar methodologies, a novel 3D wheelchair tennis athlete model was created to analyze match-simulation assessments. Significant findings were present in the energy expenditure between two drill assessments. Overall, the quantitative results, coupled with the qualitative assessment chapter, provide a robust assessment of the effects of 3D movement analysis on rehabilitation and adaptive activities

퇴행성 슬 관절염의 객관적 평가를 위한 기계학습 기반의 보행 데이터 분석 연구

학위논문 (박사) -- 서울대학교 대학원 : 공과대학 협동과정 바이오엔지니어링전공, 2020. 8. 김희찬.Osteoarthritis (OA) is a disease that affects above 30% of the elderly population aged 60 years and older. Western Ontario and McMaster Osteoarthritis (WOMAC) and radiographic-based Kellgren–Lawrence (KL) grade methods are currently used to evaluate the severity of knee osteoarthritis (KOA). However, the WOMAC is a subjective method which cannot be performed to certain patients, and is not suitable for tracking changes in severity over time. KL grade requires highly trained experts and is a time consuming process. This dissertation hypothesized that objective and biomechanical gait data can supplement unmet needs of current gold standard. It was hypothesized that specific features from gait data would reflect the severity of KOA. Therefore, this study aims to identify key gait features associated with the severity of KOA and provide a new objective and explainable evaluation method for KOA based on gait analysis. Features were extracted from the gait signal and an automated severity evaluation model was designed based on machine learning technique for WOMAC severity evaluation model. To develop an automated severity evaluation algorithm for KL grade, features were extracted from the plain radiography image using deep learning network, and machine learning was applied to select features from the gait data. Both image and gait features were used to develop a machine learning algorithm for KL grade evaluation. The evaluation algorithm for WOMAC and KL grade showed a correlation of 0.741 and an accuracy of 75.2% with gold standard method, respectively. This dissertation proposed a new evaluation method for KOA and showed the clinical utility of the gait data application that was limited in clinical practice due to the complexity of the signal.퇴행성 관절염은 60세 이상의 노인 인구 약 30%에서 발병하는 질병이다. 현재 퇴행성 슬 관절염의 진단은 Western Ontario and McMaster Osteoarthritis (WOMAC) 방법과 방사선 촬영 기반의 Kellgren–Lawrence (KL) grade 방법이 사용되고 있다. 그러나 WOMAC 환자의 주관적인 판단을 토대로 중증도를 정량화하는 방법이어서 일부 환자들에게 적용이 불가능하고, 수술 후의 중증도를 반영하지 못한다는 단점이 있다. KL grade은 고도로 훈련된 전문가를 필요로 하며, 정확한 진단을 위하여서는 많은 시간을 필요로 한다. 반면 보행 신호는 환자의 보행에 따른 객관적인 생체 역학 신호를 제공하며, 보행이 가능한 모든 사람에게 적용이 가능하며, 주기적인 추적 관찰에 용의하다. 따라서 본 연구는 보행 신호를 이용하여 객관적이며, 결과에 대한 생체 역학적 이유를 알 수 있는 퇴행성 슬 관절염의 새로운 분석 방법을 제시함에 있다. 먼저 자동으로 WOMAC 방법을 진단하기 위해 보행신호에서 특징들을 추출하고 기계학습 기법을 이용하여 평가하는 모델을 개발하였다. 또한 KL grade 방법을 평가하기 위해 방사선 영상에서 딥러닝 알고리즘으로 추출한 특징들과 보행신호에서 추출한 특징들을 기계학습 기법을 이용하였다. 제안하는 퇴행성 슬 관절염의 평가 방법은 WOMAC 및 KL grade 방법과 각각 상관관계 0.741, 정확도 75.2%를 보였다. 본 연구는 퇴행성 슬 관절염의 새로운 평가 방법을 제시하였으며, 신호의 복잡성으로 인하여 임상에서 사용되지 못했던 보행 신호의 임상적 활용성을 보여주었다.1. Introduction 1 1.1. Knee Osteoarthritis 2 1.2. Severity Evaluation of Knee Osteoarthritis 4 1.2.1. Symptomatic Severity evaluation 4 1.2.2. Structural Severity evaluation 5 1.3. Unmet Clinical Needs 7 1.4. Gait analysis and KOA 8 1.5. Thesis objectives 12 2. Symptomatic Severity of Knee Osteoarthritis 14 2.1. Introduction 15 2.2. Methods 18 2.2.1. Participants 18 2.2.2. Gait Data Collection 20 2.2.3. Statistical Analysis and WOMAC Estimation Model 21 2.3. Results 25 2.4. Discussion 34 2.5. Conclusion 41 3. Structural Severity of Knee Osteoarthritis 42 3.1. Introduction 43 3.2. Methods 49 3.2.1. Participants 49 3.2.2. Gait Data Collection 52 3.2.3. Radiographic Assessment 53 3.2.4. Feature Extraction and Classification 54 3.3. Results 62 3.3.1. Feature Analysis 62 3.3.2. Deep Learning Approach Based on Radiographic Images 72 3.3.3. Proposed Model Based on Gait Data and Radiographic Images 74 3.4. Discussion 76 3.5. Conclusion 83 4. Conclusion 84 4.1. Thesis Summary and Contributions 85 4.2. Future Direction 87 Bibliography 89 Abstract in Korean 98Docto

Characterizing the Effects of High-intensity Exercise on Balance and Gait under Dual-task Conditions in Parkinson’s Disease

Parkinson’s disease (PD) is a neurodegenerative disorder, characterized by four cardinal motor symptoms including bradykinesia, tremor, rigidity, and postural instability, and non-motor symptoms including cognitive impairment. Daily activities, such as walking and maintaining balance, are impacted due to impairments in motor function, and are further exacerbated with the addition of cognitive loading, or dual-tasking (DT). High-intensity exercise has demonstrated centrally-mediated improvements of PD symptoms, with additional positive effects on overall health. The goal of this project was to identify changes in dynamic balance recovery and gait function under conditions with and without increased cognitive load after a high-intensity exercise intervention in a PD population. Participants included people with PD who completed an eight-week cycling intervention (PDE), people with Parkinson’s disease who did not complete the intervention (PDC), and healthy age-matched controls (HC), with 14 subjects per group. In Aim 1, while participants underwent a series of destabilizing balance tests, the time taken to regain balance and the center of pressure movement during balance recovery were measured. The PDE group demonstrated greater improvement in balance recovery after exercise compared with the PDC group. In Aim 2, participants completed a series of gait and cognitive tasks, both separately and concurrently. Outcome measures included spatiotemporal and kinematic gait parameters of the lower and upper extremities. The PDE group demonstrated significant improvement in gait measures and DT abilities compared to PDC, while no changes were found in cognitive function for any group. The standard clinical methods of measuring motor function can be subjective, and may not capture subtle motor characteristics. Force plate and motion-capture technologies can provide detailed, objective outcome data, therefore improving the understanding of how exercise affects motor symptoms of Parkinson’s disease. The Motek Computer Assisted Rehabilitation Environment (CAREN) system at the Cleveland Clinic was used to create the testing environment and for data collection. These results of this project suggest global changes in motor function demonstrated by changes in balance recovery and lower and upper extremity gait function. Quantitative gait analysis has shown to be an important metric in assessing effectiveness of an exercise intervention in PD