Search Results (106)

Background: Hemiparetic gait is characterized by reduced limb shortening during swing, increasing the risk of tripping and leading to compensatory strategies. Despite 3D gait analysis being the gold standard for gait assessment, there is no consensus on relevant kinematic biomarkers for limb shortening and compensatory movements. Methods: Systematic review querying five databases (PubMed, Cochrane, Scopus, PEDro, and Web of Science). We included articles that described at least one kinematic biomarker of the lower limb in the sagittal plane and at least one biomarker of the lower limb or pelvis in the transversal or frontal plane, or pelvis in the sagittal plane. Then, we collected kinematic biomarkers from these studies and identified those that seemed relevant to describe limb shortening and compensatory movements during the swing phase. Results: We included 40 studies and collected 385 biomarkers. Among them, 15 described limb shortening, 22 compensations, and 3 toe clearance. Analysis of 12 interventional studies showed that some biomarkers of shortening and compensation were more sensitive to change than others. Conclusions: This review highlights the lack of standardized description for limb shortening and compensatory movements in hemiparetic gait. A set of 13 relevant biomarkers is proposed to improve the interpretation of gait analysis and support consistent evaluation of therapeutic interventions. Full article

Exercise is an important component in the treatment and improvement of function in populations with or at risk of lower limb injury. Cycling is the most common exercise modality used by these populations. However, reduced lower limb joint excursion and/or range of motion (ROM) during cycling might limit the optimization of functional improvements. Increased hip flexion gait (HFgait) is a new exercise modality that might result in larger lower limb joint excursions compared to cycling. The purpose of this study was to compare lower limb kinematics between HFgait and cycling. Twelve healthy individuals participated in the study. Each participant performed cycling and HFgait. Hip, knee, and ankle kinematics in the sagittal, frontal, and transverse planes were analyzed with and without phase offset reduction (POR). Discrete and continuous analyses were performed. Discrete analysis indicated differences for at least one of the variables analyzed (maximum, minimum, and ROM) for the hip (p ≤ 0.041), knee (p ≤ 0.008), and ankle (p ≤ 0.040) across all planes. For the continuous analysis, differences between HFgait and cycling kinematics were observed during the cycles for the hip, knee, and ankle sagittal (hip: original: 85%; with POR: 77%; knee: original: 93%; with POR: 76%; ankle: original: 14%; with POR: 14%), frontal (hip: original: 93%; with POR: 98%; knee: original: 41%; with POR: 12%; ankle: original: 4%; with POR: 5%), and transverse (hip: original: 66%; with POR: 0%; knee: original: 14%; with POR: 0%; ankle: original: 3%; with POR: 0%) planes. HFgait resulted in larger hip (+60.2°) and knee (+38.2°) sagittal plane ROM while maintaining the hip in a more neutral position in the frontal plane compared with cycling. These findings can support the development of rehabilitation strategies with the goal of improving function and joint range of motion while also receiving the health benefits of exercise. Full article

Accurate gait assessment is essential for managing pathological locomotion, especially in elderly patients recovering from hip joint surgeries. Inertial measurement units (IMUs) provide real-time, objective data in clinical settings. This study examined pelvic oscillations in sagittal, frontal, and transverse planes using a wearable IMU system in two groups: Group A (n = 15, osteosynthesis metallica) and Group B (n = 34, arthroplasty), all over age 65. Gait analysis was conducted during assisted and unassisted walking. In the frontal plane, both groups showed statistically significant improvements: Group A from 46.4% to 75.2% (p = 0.001) and Group B from 52.6% to 72.2% (p = 0.001), reflecting enhanced lateral stability. In the transverse plane, Group A improved significantly from 47.7% to 80.2% (p = 0.001), while Group B showed a non-significant increase from 73.0% to 80.5% (p = 0.068). Sagittal plane changes were not statistically significant (Group A: 68.8% to 71.1%, p = 0.313; Group B: 76.4% to 69.1%, p = 0.065). These improvements correspond to better pelvic symmetry and postural control, which are critical for a safe and stable gait. Improvements were more pronounced during unassisted walking, indicating better pelvic control. These results confirm the clinical utility of IMUs in capturing subtle gait asymmetries and monitoring recovery progress. The findings support their use in tailoring rehabilitation strategies, particularly for enhancing frontal and transverse pelvic stability in elderly orthopedic patients. Full article

Background: Asymmetrical brain oscillations may be characteristic of Parkinson’s disease (PD). We investigated differences in oscillation asymmetry between individuals with PD and healthy controls and explored associations between the asymmetry and clinical features. Methods: Clinical and resting-state EEG data from 37 patients and 24 controls were cross-sectionally analyzed. EEG asymmetry indices were calculated for the delta, theta, alpha, and beta frequencies in the frontal, central, and parietal regions. Independent t-tests and linear regression models were employed. Results: Patients exhibited lower alpha asymmetry than controls in the parietal region (t(59) = 2.12, p = 0.03). In the frontal alpha asymmetry models, there were associations with time since diagnosis (β = −0.042) and attention/orientation (β = 0.061), and with Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRSIII)-posture (β = 0.136) and MDS-UPDRSIII-rest-tremor persistence (β = −0.111). In the central alpha model, higher asymmetry was associated with the physical activity levels (International Physical Activity Questionnaire) IPAQ-active (β = 0.646) and IPAQ-very active (β = 0.689), (Timed Up and Go) TUG dual-task cost (β = 0.023), MDS-UPDRSII-freezing (β = 0.238), and being male (β = 0.535). In the parietal alpha asymmetry model, MDS-UPDRSII-gait/balance was inversely associated with alpha asymmetry (β = −0.156), while IPAQ-active (β = −0.247) and being male (β = −0.191) were associated with lower asymmetry. Conclusions: Our findings highlight the potential role of alpha asymmetry as a neurophysiological marker of PD’s motor symptoms, mainly rest tremor, gait/balance, freezing, and specific cognitive domains such as attention/orientation. The models stressed the relationship between disease progression and reduced alpha asymmetry. Brazilian Registry of Clinical Trials (RBR-7zjgnrx, 9 June 2022). Full article

(1) Background: Biofeedback and neurofeedback are gaining attention as non-invasive rehabilitation strategies in Parkinson’s disease (PD) treatment, aiming to modulate motor and non-motor symptoms through the self-regulation of physiological signals. (2) Objective: This review explores the application of biofeedback techniques, electromyographic (EMG) biofeedback, heart rate variability (HRV) biofeedback, and electroencephalographic (EEG) neurofeedback in PD rehabilitation, analyzing their impacts on motor control, autonomic function, and cognitive performance. (3) Methods: This review critically examined 15 studies investigating the efficacy of electromyographic (EMG), heart rate variability (HRV), and electroencephalographic (EEG) feedback interventions in PD. Studies were selected through a systematic search of peer-reviewed literature and analyzed in terms of design, sample characteristics, feedback modality, outcomes, and clinical feasibility. (4) Results: EMG biofeedback demonstrated improvements in muscle activation, gait, postural stability, and dysphagia management. HRV biofeedback showed positive effects on autonomic regulation, emotional control, and cardiovascular stability. EEG neurofeedback targeted abnormal cortical oscillations, such as beta-band overactivity and reduced frontal theta, and was associated with improvements in motor initiation, executive functioning, and cognitive flexibility. However, the reviewed studies were heterogeneous in design and outcome measures, limiting generalizability. Subgroup trends suggested modality-specific benefits across motor, autonomic, and cognitive domains. (5) Conclusions: While EMG and HRV systems are more accessible for clinical or home-based use, EEG neurofeedback remains technically demanding. Standardization of protocols and further randomized controlled trials are needed. Future directions include AI-driven personalization, wearable technologies, and multimodal integration to enhance accessibility and long-term adherence. Biofeedback presents a promising adjunct to conventional PD therapies, supporting personalized, patient-centered rehabilitation models. Full article

Background: Arthrodesis of the first metatarsophalangeal joint (MTP1) is a common intervention for hallux rigidus (HR). The procedure eliminates MTP1 motion but results in significant pain relief and high satisfaction rates, although MTP1 is eliminated. Less evidence is available regarding the effects on gait and the presence of compensatory mechanisms. The aim of this study is to investigate the effects of MTP1 arthrodesis on gait and patient-reported outcome measures (PROMs) compared with preoperative functioning and healthy individuals. Methods: In this prospective study, 10 patients (10 feet) with HR who underwent MTP1 arthrodesis were evaluated before and after surgery and compared with 15 healthy controls (30 feet). Gait analysis was performed with a motion capturing system using the multi-segment Oxford foot model. Spatiotemporal parameters and kinematics were quantitatively analyzed. PROMs were evaluated using validated questionnaires including the American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS-HMI) scale, the Numeric Pain Rating Scale (NPRS), and the Manchester–Oxford Foot Questionnaire (MOXFQ). Results: MTP1 joint motion was reduced in HR and further reduced after MTP1 arthrodesis compared with healthy controls. Furthermore, intersegmental ROM analysis revealed increased forefoot frontal plane motion (pronation and supination) in HR compared with healthy controls. This was also observed after MTP1 arthrodesis, while additionally increased frontal plane motion in the hindfoot (inversion and eversion) was observed compared with HR and healthy controls. PROM evaluation revealed improved AOFAS-HMI (from 55.7 to 79.1 points, p = 0.002) and NPRS (from 5.7 to 1.5 points, p = 0.004) scores after surgery. Additionally, improvements in the MOXFQ score (from 51.0 to 20.0 points, p = 0.002) were observed. Conclusions: Due to the loss of sagittal hallux motion, foot and ankle kinematics are changed in HR patients and after MTP1 arthrodesis compared with healthy controls. Loss of MTP1 motion results in increased frontal plane motion of the forefoot in HR, and increased frontal plane motion of the fore- and hindfoot after MTP1 arthrodesis. Additionally, substantial improvements in PROMs were recorded after surgery. Full article

This study aims to develop and evaluate a cycling-specific marker protocol that minimises the number of markers while accounting for the unique biomechanics of cycling. Although movements in the frontal and transverse planes during cycling are limited, they are clinically relevant due to their association with overuse injuries. Existing gait-based marker protocols often fail to consider cycling-specific factors such as posture, range of motion, marker occlusion, and muscle-induced artifacts. The proposed protocol (PP) uses 15 physical and 8 virtual markers. In the absence of a gold standard for 3D pedalling kinematics, the PP was evaluated by comparing it with established gait analysis protocols. The protocol demonstrated high correlation in gait (CCC > 0.98 for hip and knee in the sagittal plane), low intra-subject variability (CV < 15% for hip, knee, and ankle), and high repeatability. During pedalling, position, velocity, and acceleration were measured in all three spatial directions. Notably, angular velocity and linear acceleration showed significant components outside the sagittal plane, particularly for angular velocity. These findings highlight the importance of considering 3D motion when estimating forces, joint moments, and joint-specific powers in cycling biomechanics. Full article

(1) Background: Plantar heel pain (PHP), a common overuse foot injury, significantly impacts runners. While the mechanical role of the plantar fascia during gait is established, its effect on foot function during running, particularly foot joint coupling, remains unclear. This study investigated foot joint coupling during running in runners with and without PHP using statistical parametric mapping (SPM). (2) Methods: Thirteen uninjured runners (seven m, six f; age = 30.5 ± 5.9 years; BMI = 23.5 ± 3.0 kg/m²) and thirteen runners with PHP (six m, seven f; age = 29.0 ± 8.0 years; BMI = 23.1 ± 2.0 kg/m²) performed running trials at 4.0 m/s. A seven-segment foot model that defined six functional articulations (rearfoot, medial and lateral midfoot, medial and lateral forefoot, first metatarsophalangeal) was used to quantify foot kinematics, vector coding was used to calculate joint coupling between adjacent foot segments, and SPM was used to analyze joint stance phase coupling angles. (3) Results: There were statistically significant differences in rearfoot frontal plane–medial midfoot frontal plane joint coupling between runners with and without PHP from 69 to 70% stance phase (mean difference = 39.41°) and at 76% stance (mean difference = 47.89°). The differences were indicative of greater medial midfoot eversion rotation relative to rearfoot complex inversion in the PHP group. (4) Conclusions: The difference in the rearfoot complex and medial midfoot frontal plane coupling occurred during the propulsion phase of the running stance when the foot should be transitioning to a more supinated position, which may reflect compromised supination due to plantar fascia degeneration. Full article

Background/Objectives: Progressive supranuclear palsy (PSP) is an atypical Parkinsonian disorder characterized by Parkinsonism with gait imbalance, vertical gaze palsy, and frontal cognitive dysfunction. Though digital health technologies (DHTs) are widely used both clinically and in research as outcome measures, there is a lack of consistency applied to these devices and their resulting metrics. This scoping review aims to identify efforts taken to validate wearable DHTs for use in PSP, identify gaps in research, and discuss the steps needed to expand their use and acceptance as primary trial endpoints. Methods: In this scoping review, we conducted a search of the MEDLINE database to examine the use of DHTs as outcome measures in Progressive Supranuclear Palsy. Results: A total of 17 publications were identified and reviewed. Included articles evaluated the use of DHT to measure lower extremity function/gait, balance, upper extremity function, and speech. Conclusions: Our scoping review highlights the importance of standardization of DHT metrics by thorough assessment of their content validity, reliability, construct validity, responsiveness, and discriminant validity. Efforts must be taken to ensure DHTs capture clinically relevant, patient-centered outcome measures that are comparable to conventional rating scales, that consistently discriminate disease progression. Incorporation of DHTs as clinical trial endpoints has the potential to encourage clinical research and to advance patient care. Full article

Postural control arises from the complex interplay of stability, adaptability, and dynamic adjustments, which are disrupted post-stroke, emphasizing the importance of examining these mechanisms during functional tasks. This study aimed to analyze the complexity and variability of postural control in post-stroke individuals during the feedforward phase of gait initiation. A cross-sectional study analyzed 17 post-stroke individuals and 16 matched controls. Participants had a unilateral ischemic stroke in the chronic phase and could walk independently. Exclusions included cognitive impairments, recent surgery, and neurological/orthopedic conditions. Kinematic and kinetic data were collected during 10 self-initiated gait trials to analyze centre of pressure (CoP) dynamics and joint angles (−600 ms to +50 ms). A 12-camera motion capture system (Qualisys, Gothenburg, Sweden) recorded full-body kinematics using 72 reflective markers placed on anatomical landmarks of the lower limbs, pelvis, trunk, and upper limbs. Ground reaction forces were measured via force plates (Bertec, Columbus, OH, USA) to compute CoP variables. Linear (displacement, amplitude, and velocity) and non-linear (Lyapunov exponent—LyE and multiscale entropy—MSE) measures were applied to assess postural control complexity and variability. Mann–Whitney U tests were applied (p < 0.05). The stroke group showed greater CoP displacement (p < 0.05) and reduced velocity (p = 0.021). Non-linear analysis indicated lower LyE values and reduced complexity and adaptability in CoP position and amplitude across scales (p < 0.05). In the sagittal plane, the stroke group had higher displacement and amplitude in the head, trunk, pelvis, and limbs, with reduced LyE and MSE values (p < 0.05). Frontal plane findings showed increased displacement and amplitude in the head, trunk, and ankle, with reduced LyE and MSE (p < 0.05). In the transverse plane, exaggerated rotational patterns were observed with increased displacement and amplitude in the head, trunk, pelvis, and hip, alongside reduced LyE convergence and MSE complexity (p < 0.05). Stroke survivors exhibit increased linear variability, indicating instability, and reduced non-linear complexity, reflecting limited adaptability. These results highlight the need for rehabilitation strategies that address both stability and adaptability across time scales. Full article

Objectives: Gait kinematic and kinetic changes have been identified in older adults, highlighting the need to explore the principal age-related components and how these are associated with functional disability. This study aims to perform a factor analysis, including gait kinematic and kinetic parameters in older adults to establish determinant gait domains. Additionally, this study aims to identify which domains differentiate those without and with functional disability. Methods: Through a cross-sectional design, older adults aged 60 and over (n = 35 without and n = 25 with functional disability) were analyzed during overground gait. A principal component analysis (PCA) was used to determine principal components from gait parameters previously demonstrated to express age-related effects (spatiotemporal parameters, sagittal ankle moment and power, ground reaction forces peak, and tridimensional lower limb joints range of motion and positions at heel strike and toe-off). Results: Pace, variability, propulsion, hip and knee control, transverse ankle control, asymmetry, sagittal ankle control, frontal ankle control, frontal hip control, and pre-swing control domains explained 83.90% of the total gait variance in older adults. pace and frontal hip control distinguished individuals with disabilities. Conclusions: PCA identified ten gait domains in older adults. Pace and frontal hip control distinguished disabilities, revealing cautious walking patterns and weaker hip abductor strength. Full article

The aim of this pilot study was to investigate the feasibility of markerless tracking to assess upper body movements of children with and without human immunodeficiency virus encephalopathy (HIV-E). Sagittal and frontal video recordings were used to track anatomical landmarks with the DeepLabCut pre-trained human model in five children with HIV-E and five typically developing (TD) children to calculate shoulder flexion/extension, shoulder abduction/adduction, elbow flexion/extension and trunk lateral sway. Differences in joint angle trajectories of the two cohorts were investigated using a one-dimensional statistical parametric mapping method. Children with HIV-E showed a larger range of motion in shoulder abduction and trunk sway than TD children. In addition, they showed more shoulder extension and more lateral trunk sway compared to TD children. Markerless tracking was feasible for 2D movement analysis and sensitive to observe expected differences in upper limb and trunk sway movements between children with and without HIVE. Therefore, it could serve as a useful alternative in settings where expensive gait laboratory instruments are unavailable, for example, in clinical centers in low- to middle-income countries. Future research is needed to explore 3D markerless movement analysis systems and investigate the reliability and validity of these systems against the gold standard 3D marker-based systems that are currently used in clinical practice. Full article

Background: Gait assessment is a complex task involving locomotion and balance control across all body segments, requiring a global analysis in the event of motor disorders. Among these are spinal disorders, where an understanding of spinal kinematics during walking is important to improve treatment decisions and outcomes. The technique of stereophotogrammetric motion analysis is currently the gold standard in this context. A new integrated protocol for whole-body kinematic gait analysis is proposed in this study, which takes into account the movements of the spine. Methods: A new protocol with 30 passive markers was developed to analyze gait. Of these markers, 22 implemented the Davis protocol for gait measurement, while the other 8 were placed onto the spine to record spinal movements. The protocol’s accuracy was assessed through comparisons of the constructive angles of a manikin replicating the human body and the angles measured with the optoelectronic system. An assessment of intra- and inter-operator repeatability and protocol usability was carried out by recruiting and applying the protocol in a population composed of ten subjects (mean age 17.36—SD 10.12) without any history of spine pathology. Results: The protocol was validated successfully. The validation accuracy was more than satisfactory: the measured RMSE was 1.2 ± 1° for the data collected with the optoelectronic system with respect to the manikin. The intra-operator repeatability was also good in the sagittal and frontal planes (average ICC > 0.867), and the inter-operator repeatability was moderate or good in all planes (average ICC > 0.77). The usability score obtained using the System Usability Scale was satisfactory (mean 74.75, SD 5.88). Conclusions: This study proposes a new protocol to assess total body kinematics, including the spine in its three main segments, during gait. The successful validation of this protocol in terms of reliability and usability allows for its subsequent clinical application. Full article

The influence of the mounting position of a magnetic-inertial measurement unit (MIMU) on the accuracy of posture estimation for a shank has not been extensively studied and remains unknown. In this study, we conducted comparative experiments using three MIMU positions: the lateral and frontal positions, which are commonly used, and the medial tibial position, which is less affected by muscle protuberance, considering the anatomical structure of the body. To determine the optimal MIMU mounting position on the shank, we repeatedly performed plantar–dorsiflexion and relaxation of the ankle joint in a chair-sitting position and examined the effect of muscle contraction on the posture of the MIMU (Experiment 1). We also performed posture estimation during gait and compared the three-dimensional shank posture measured by the MIMU and optical motion capture to evaluate the estimation accuracy for each mounting position (Experiment 2). In Experiment 1, the orientation change at the medial tibia was significantly smaller than that at the other positions, showing an 80% reduction compared with the anterior tibia during dorsiflexion. In Experiment 2, the medial tibia achieved the highest estimation accuracy, showing a 13% lower RMSE than that of the anterior position. The results of these two experiments suggest that the medial tibia is the optimal position on the shank, as the posture estimation accuracy was the highest when the MIMU was mounted on the medial tibia, where there was no muscle under the mounting surface. Moreover, the posture estimation accuracy was less affected by muscle protuberance under these conditions. Full article

Background/Objectives: Minor amputations are increasingly relevant due to a growing proportion of lower limb amputations but remain underrepresented in research. These amputations impair mobility due to altered gait, and biomimetic devices could potentially address this issue. Fundamental research is needed to better understand this pathological gait pattern. The aim of this study is to analyse the holistic gait characteristics of the lower extremity during barefoot walking in individuals with different levels of minor amputations for the first time. Methods: Eight young to middle-aged subjects with minor foot amputations (four × hallux; four × forefoot) underwent instrumented gait analysis. Kinematic and kinetic data were acquired barefoot at self-selected gait speeds. Individual gait characteristics were considered relative to the physiological gait represented by the 95% confidence interval of ten unimpaired volunteers. Results: Subjects with a minor amputation show reduced walking speed and shorter stride length compared to controls. Sagittal ankle moment and ankle power are lower, with greater deficits in subjects with a forefoot amputation. Proximal joints also show variability, notably reduced knee flexion in subjects with a forefoot amputation and a more flexed hip profile in six subjects. Single-subject frontal plane kinetics also vary. Conclusions: Although the subjects with a hallux amputation exhibit smaller deviations in ankle kinetics than the subjects with a forefoot amputation, proximal joint abnormalities are present across cases. These findings highlight the need for a broad range of care to adequately address individual needs. Full article