Gait-Based Diplegia Classification Using LSMT Networks

Diplegia is a specific subcategory of the wide spectrum of motion disorders gathered under the name of cerebral palsy. Recent works proposed to use gait analysis for diplegia classification paving the way for automated analysis. A clinically established gait-based classification system divides diplegic patients into 4 main forms, each one associated with a peculiar walking pattern. In this work, we apply two different deep learning techniques, namely, multilayer perceptron and recurrent neural networks, to automatically classify children into the 4 clinical forms. For the analysis, we used a dataset comprising gait data of 174 patients collected by means of an optoelectronic system. The measurements describing walking patterns have been processed to extract 27 angular parameters and then used to train both kinds of neural networks. Classification results are comparable with those provided by experts in 3 out of 4 forms

A Review of EMG Techniques for Detection of Gait Disorders

Electromyography (EMG) is a commonly used technique to record myoelectric signals, i.e., motor neuron signals that originate from the central nervous system (CNS) and synergistically activate groups of muscles resulting in movement. EMG patterns underlying movement, recorded using surface or needle electrodes, can be used to detect movement and gait abnormalities. In this review article, we examine EMG signal processing techniques that have been applied for diagnosing gait disorders. These techniques span from traditional statistical tests to complex machine learning algorithms. We particularly emphasize those techniques are promising for clinical applications. This study is pertinent to both medical and engineering research communities and is potentially helpful in advancing diagnostics and designing rehabilitation devices

Testing Gait with Ankle-Foot Orthoses in Children with Cerebral Palsy by Using Functional Mixed-Effects Analysis of Variance

Dr Morrissey is part funded by the NIHR/HEE Senior Clinical Lecturer scheme. Tis report presents independent research part-funded by the National Institute for Health Research (NIHR) CAT SCL-2013-04-00

PREDICT-CP: study protocol of implementation of comprehensive surveillance to predict outcomes for school-aged children with cerebral palsy

Objectives: Cerebral palsy (CP) remains the world’s most common childhood physical disability with total annual costs of care and lost well-being of $A3.87b. The PREDICT-CP (NHMRC 1077257 Partnership Project: Comprehensive surveillance to PREDICT outcomes for school age children with CP) study will investigate the influence of brain structure, body composition, dietary intake, oropharyngeal function, habitual physical activity, musculoskeletal development (hip status, bone health) and muscle performance on motor attainment, cognition, executive function, communication, participation, quality of life and related health resource use costs. The PREDICT-CP cohort provides further follow-up at 8–12 years of two overlapping preschool-age cohorts examined from 1.5 to 5 years (NHMRC 465128 motor and brain development; NHMRC 569605 growth, nutrition and physical activity). Methods and analyses: This population-based cohort study undertakes state-wide surveillance of 245 children with CP born in Queensland (birth years 2006–2009). Children will be classified for Gross Motor Function Classification System; Manual Ability Classification System, Communication Function Classification System and Eating and Drinking Ability Classification System. Outcomes include gross motor function, musculoskeletal development (hip displacement, spasticity, muscle contracture), upper limb function, communication difficulties, oropharyngeal dysphagia, dietary intake and body composition, participation, parent-reported and child-reported quality of life and medical and allied health resource use. These detailed phenotypical data will be compared with brain macrostructure and microstructure using 3 Tesla MRI (3T MRI). Relationships between brain lesion severity and outcomes will be analysed using multilevel mixed-effects models. Ethics and dissemination: The PREDICT-CP protocol is a prospectively registered and ethically accepted study protocol. The study combines data at 1.5–5 then 8–12 years of direct clinical assessment to enable prediction of outcomes and healthcare needs essential for tailoring interventions (eg, rehabilitation, orthopaedic surgery and nutritional supplements) and the projected healthcare utilisation

Machine-learning-based Prediction of Gait Events from EMG in Cerebral Palsy Children

Machine-learning techniques are suitably employed for gait-event prediction from only surface electromyographic (sEMG) signals in control subjects during walking. Nevertheless, a reference approach is not available in cerebral-palsy hemiplegic children, likely due to the large variability of foot-floor contacts. This study is designed to investigate a machine-learning-based approach, specifically developed to binary classify gait events and to predict heel-strike (HS) and toe-off (TO) timing from sEMG signals in hemiplegic-child walking. To this objective, sEMG signals are acquired from five hemiplegic-leg muscles in nearly 2500 strides from 20 hemiplegic children, acknowledged as Winters' group 1 and 2. sEMG signals, segmented in overlapping windows of 600 samples (pace = 5 samples), are used to train a multi-layer perceptron model. Intra-subject and inter-subject experimental settings are tested. The best-performing intra-subject approach is able to provide in the hemiplegic population a mean classification accuracy () of 0.97±0.01 and a suitable prediction of HS and TO events, in terms of average mean absolute error (MAE, 14.8±3.2 ms for HS and 17.6±4.2 ms for TO) and F1-score (0.95±0.03 for HS and 0.92±0.07 for TO). These results outperform previous sEMG-based attempts in cerebral-palsy populations and are comparable with outcomes achieved by reference approaches in control populations. In conclusion, the findings of the study prove the feasibility of neural networks in predicting the two main gait events using surface EMG signals, also in condition of high variability of the signal to predict as in hemiplegic cerebral palsy

Wearable Sensors Applied in Movement Analysis

Recent advances in electronics have led to sensors whose sizes and weights are such that they can be placed on living systems without impairing their natural motion and habits. They may be worn on the body as accessories or as part of the clothing and enable personalized mobile information processing. Wearable sensors open the way for a nonintrusive and continuous monitoring of body orientation, movements, and various physiological parameters during motor activities in real-life settings. Thus, they may become crucial tools not only for researchers, but also for clinicians, as they have the potential to improve diagnosis, better monitor disease development and thereby individualize treatment. Wearable sensors should obviously go unnoticed for the people wearing them and be intuitive in their installation. They should come with wireless connectivity and low-power consumption. Moreover, the electronics system should be self-calibrating and deliver correct information that is easy to interpret. Cross-platform interfaces that provide secure data storage and easy data analysis and visualization are needed.This book contains a selection of research papers presenting new results addressing the above challenges

Understanding Clinical and Patient Reported Response of Children and Young People with Cerebral Palsy to Botulinum Toxin A: A Longitudinal Observational Study (The Toxin Study)

Background Botulinum Toxin A (BoNT-A) is an established treatment for focal spasticity in children and young people with spastic cerebral palsy (CYPwCP). A systematic review of the available literature within this thesis highlighted that the published evidence for BoNT-A effectiveness is mostly related to short term outcomes focused on impairment level, relating to restriction of body functions and structures, rather than more meaningful measures of activity and participation. Aims To determine the effect of lower limb BoNT-A on ambulant CYPwCP by evaluating outcome across the WHO’s International Classification of Functioning and Disability (ICF) domains of body structure and function, activity and participation and change in movement quality over a 12-month period and investigate whether clinical outcomes reflect children and families’ experience of BoNT-A treatment. Method A prospective observational mixed methods longitudinal study used a one group repeated measures design conducted in two phases. In Phase I the Quality Function Measure and the Canadian Occupational Performance Measure were used to evaluate change in movement quality and evaluate goal attainment following lower limb BoNT-A treatment. Change was also evaluated throughout the ICF domains of body structure and function, activity and participation, using a number of secondary outcome measures (64 CYPwCP). In Phase II semi-structured interviews with a subgroup of families from Phase I explored CYPwCP and parents experience of BoNT-A treatment (Phase II: 18 CYPwCP). Results There was a significant improvement in movement quality and goal attainment across the 12 months following BoNT-A. Spasticity was significantly reduced at 6 weeks with mixed results at 6 and 12 months, dependent on the muscles injected. Functional balance and gait improvements, although improved at 6 weeks, only reached clinical significance at 6 and 12 months, respectively. However, clinically significant improvement in motor function and participation outcomes were seen at 6 weeks post BoNT-A and these were maintained across 12 months. CYPwCP and their families described improvements in movement quality and short term reduced stiffness following injections which were associated with increased activity, improved participation opportunities and increased confidence and self esteem

Influence of surgery involving tendons around the knee joint on ankle motion during gait in patients with cerebral palsy

Background Simultaneous motion of the knee and ankle joints is required for many activities including gait. We aimed to evaluate the influence of surgery involving tendons around the knee on ankle motion during gait in the sagittal plane in cerebral palsy patients. Methods We included data from 55 limbs in 34 patients with spastic cerebral palsy. Patients were followed up after undergoing only distal hamstring lengthening with or without additional rectus femoris transfer. The patients mean age at the time of knee surgery was 11.2 ± 4.7 years, and the mean follow-up duration was 2.2 ± 1.5 years (range, 0.9–6.0 years). Pre- and postoperative kinematic variables that were extracted from three-dimensional gait analyses were then compared to assess changes in ankle motion after knee surgery. Outcome measures included ankle dorsiflexion at initial contact, peak ankle dorsiflexion during stance, peak ankle dorsiflexion during swing, and dynamic range of motion of the ankle. Various sagittal plane knee kinematics were also measured and used to predict ankle kinematics. A linear mixed model was constructed to estimate changes in ankle motion after adjusting for multiple factors. Results Improvement in total range of motion of the knee resulted in improved motion of the ankle joint. We estimated that after knee surgery, ankle dorsiflexion at initial contact, peak ankle dorsiflexion during stance, peak ankle dorsiflexion during swing, and dynamic range of motion of the ankle decreased, respectively, by 0.4° (p = 0.016), 0.6° (p < 0.001), 0.2° (p = 0.038), and 0.5° (p = 0.006) per degree increase in total range of motion of the knee after either knee surgery. Furthermore, dynamic range of motion of the ankle increased by 0.4° per degree increase in postoperative peak knee flexion during swing. Conclusions Improvement in total knee range of motion was found to be correlated with improvement in ankle kinematics after surgery involving tendons around the knee. As motion of the knee and ankle joints is cross-linked, surgeons should be aware of potential changes in the ankle joint after knee surgery.This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (NRF-2016R1C1B2008557), and was partly supported by the Technology Innovation Program funded By the Ministry of Trade, Industry and Energy (MOTIE) of Korea (10049785) and SNUBH research fund (grant no. 02-2012-018). No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article