Search Results (182)

Stroke is a significant global health concern characterized by the abrupt disruption of cerebral blood flow, leading to neurological impairment. Accurate and timely diagnosis—enabled by imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI)—is essential for differentiating stroke types and initiating interventions like thrombolysis, thrombectomy, or surgical management. In parallel, recent advancements in wearable technology, particularly smart clothing, offer new opportunities for stroke prevention, real-time monitoring, and rehabilitation. These garments integrate various sensors, including electrocardiogram (ECG) electrodes, electroencephalography (EEG) caps, electromyography (EMG) sensors, and motion or pressure sensors, to continuously track physiological and functional parameters. For example, ECG shirts monitor cardiac rhythm to detect atrial fibrillation, smart socks assess gait asymmetry for early mobility decline, and EEG caps provide data on neurocognitive recovery during rehabilitation. These technologies support personalized care across the stroke continuum, from early risk detection and acute event monitoring to long-term recovery. Integration with AI-driven analytics further enhances diagnostic accuracy and therapy optimization. This narrative review explores the application of smart clothing in conjunction with traditional imaging to improve stroke management and patient outcomes through a more proactive, connected, and patient-centered approach. Full article

Background and Objective: This study presents a combined osteometric and biomechanical analysis of a Korean female cadaver exhibiting bilateral lower limb bone asymmetry with abnormal curvature and callus formation on the left femoral midshaft. Methods: To investigate bilateral bone length differences, osteometric measurements were conducted at standardized landmarks. Additionally, we developed three gait models using Meta Motivo, an open-source reinforcement learning platform, to analyze how skeletal asymmetry influences stride dynamics and directional control. Results: Detailed measurements revealed that the left lower limb bones were consistently shorter and narrower than their right counterparts. The calculated lower limb lengths showed a bilateral discrepancy ranging from 39 mm to 42 mm—specifically a 6 mm difference in the femur, 33 mm in the tibia, and 36 mm in the fibula. In the gait pattern analysis, the normal model exhibited a straight-line gait without lateral deviation. In contrast, the unbalanced, non-learned model demonstrated compensatory overuse and increased stride length of the left lower limb and a tendency to veer leftward. The unbalanced, learned model showed partial gait normalization, characterized by reduced limb dominance and improved right stride, although directional control remained compromised. Conclusions: This integrative approach highlights the biomechanical consequences of lower limb bone discrepancy and demonstrates the utility of virtual agent-based modeling in elucidating compensatory gait adaptations. Full article

In this study, the effects of walking speed on lower limb muscle activity and gait parameters during over-ground walking were investigated in individuals with chronic stroke. Twenty-four patients with chronic stroke participated in a cross-sectional repeated-measures study, walking 20 m at three different speeds: slow (80% of self-selected speed), self-selected, and maximal speed. Surface electromyography was used to measure muscle activity in five paretic-side muscles (rectus femoris, biceps femoris, tibialis anterior, gastrocnemius, and gluteus medius), while gait parameters, including stride length, stance and swing phases, single-limb support time, and the gait asymmetry index were assessed using a triaxial accelerometer. As walking speed increased, activity in the rectus femoris, biceps femoris, and gastrocnemius muscles significantly increased during the stance and swing phases (p < 0.05), whereas the gluteus medius activity tended to decrease. Stride length on the paretic and non-paretic sides significantly increased with faster walking speed (p < 0.05); however, no significant improvements were observed in other gait parameters or gait asymmetry. These findings suggest that although increasing walking speed enhances specific muscle activities, it does not necessarily improve overall gait quality or symmetry. Therefore, rehabilitation programs should incorporate multidimensional gait training that addresses speed and neuromuscular control factors such as balance and proprioception. 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: Lokomat-assisted robotic rehabilitation is increasingly used for gait restoration in patients with spinal cord injury (SCI). However, the objective evaluation of treatment effectiveness through biomechanical parameters and machine learning approaches remains underexplored. Methods: This study analyzed data from 29 SCI patients undergoing Lokomat-based rehabilitation. A dataset of 46 variables including range of motion (L-ROM), joint stiffness (L-STIFF), and muscular force (L-FORCE) was examined using statistical methods (paired t-test, ANOVA, and ordinary least squares regression), clustering techniques (k-means), dimensionality reduction (t-SNE), and anomaly detection (Isolation Forest). Predictive modeling was applied to assess the influence of age, speed, body weight, body weight support, and exercise duration on biomechanical outcomes. Results: No statistically significant asymmetries were found between left and right limb measurements, indicating functional symmetry post-treatment (p > 0.05). Clustering analysis revealed a weak structure among patient groups (Silhouette score ≈ 0.31). Isolation Forest identified minimal anomalies in stiffness data, supporting treatment consistency. Regression models showed that body weight and body weight support significantly influenced joint stiffness (p < 0.01), explaining up to 60% of the variance in outcomes. Conclusions: Lokomat-assisted robotic rehabilitation demonstrates high functional symmetry and biomechanical consistency in SCI patients. Machine learning methods provided meaningful insight into the structure and predictability of outcomes, highlighting the clinical value of weight and support parameters in tailoring recovery protocols. Full article

School-aged children are routinely exposed to additional physical stress due to carrying school backpacks. These backpacks often exceed recommended limits and can contain not only books and notebooks but also laptops, water bottles, and other personal items. The present study aimed to evaluate the impact of different backpack loads (10%, 15%, and 20% of body weight) on dynamic gait parameters in 7-year-old girls and boys. Twenty-six children (13 girls, 13 boys) participated in the study. Gait analysis was performed using the Footscan® system (RSscan International, Olen, Belgium; 2 m × 0.4 m × 0.02 m, 16,384 sensors) equipped with Footscan software version 7 (Gait 2nd generation), examining peak force (FMAX), peak pressure (PMAX), contact area (CA), and time to peak force (Time to FMAX) across five anatomical foot zones. The study revealed significant changes in all parameters, particularly at loads of 15% and 20% of body weight. Increases in plantar pressure, contact area, and asymmetry were observed, along with delays in time to peak force. These findings support the recommendation that children’s backpack loads should not exceed 10% of their body weight to prevent potential adverse effects on postural and musculoskeletal development. 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

Body asymmetry is often analysed in the context of low back pain (LBP). To date, research has mainly focused on the general relationships between asymmetry and pain, with less attention paid to issues related to pressure distribution and its potential impact on the occurrence of LBP. The aim of this study was to compare biomechanical parameters in people with anatomical leg length discrepancy with and without LBP to identify overloads that may lead to pain. Early detection of common abnormalities in these parameters in both groups may influence the early prevention of 0LBP in the course of LLD. Materials and methods: This study included 60 patients with diagnosed LLD, of whom 30 had LBP (group 1, NP) and 30 were pain-free (group 2, NwP). Body weight distribution during standing and walking was analysed using pedobarography. The analysis was carried out in two stages, the first being the analysis of the biomechanical parameters for the whole study population, for group 1 with LBP and group 2 without LBP, while the second stage focused on the main issue, i.e., the comparison of the group with LBP with the group without LBP. The study included standing and walking tests. Left–right pressure distribution and ground contact time were analysed. In addition, the angle of foot abduction was analysed to indirectly assess compensatory mechanisms resulting from the asymmetry. Results: The standing test showed significantly greater pressure on the longer limb (p = 0.022) in the whole study population (N = 60). When divided into groups, it was found that in those with LBP (NP = 30), the difference was not statistically significant (p = 0.359), whereas in those without pain (NwP = 30), the pressure on the longer limb was significantly greater (p = 0.002). No differences were found between the groups in the comparative analysis. The angle of foot abduction was greater than normal across the study population (N = 60), with greater values in the shorter limb (12.83° vs. 11.04°), which was close to significance (p = 0.065). The group with LBP (NP = 30) showed a similar trend, also close to statistical significance (p = 0.054), with significantly higher values of abduction angle in both legs compared to the group without LBP (NwP = 30). In the walking test, the left–right load distributions were significantly dispersed. The mean pressure on the longer limb was significantly higher in group 1 (NP = 30) (p = 0.031), whereas this difference was not statistically significant in group 2 (NwP = 30). For mean peak pressure, there were no significant differences in any of the groups tested. In addition, the mean ground contact time during gait was longer for the longer limb in the whole study population (N = 60) (938.8 ms vs. 915 ms), but again, this difference did not reach statistical significance (p = 0.305). Comparative analysis showed no differences between the groups. Conclusions: This study showed that in people with anatomical LLD, both with and without LBP, most parameters reflected marked asymmetries in peak and mean pressures and abduction angles. A prolongation of ground contact time has also been shown, and even though some parameters were not statistically significant, it is important to note the high dispersion of left–right loading, which provides information on body load asymmetries in patients with anatomical LLD. Given that there were no differences between the groups for most of the parameters, it is important for both clinical practice and further research that the abnormalities observed in both groups (NP = 30, NwP = 30) may have been a significant predictor of the development of LBP, as the abnormalities preceded the onset of pain. This should be taken into account in diagnostic and preventive measures. Full article

Subtle locomotor asymmetries are common in horses and may go unnoticed during routine pre-race clinical inspections, particularly when based solely on subjective evaluation. This study aimed to describe vertical head and pelvic movement asymmetries in racehorses that passed official pre-race inspections at a traditional racing event. Twenty-four horses were analysed using a markerless AI-based gait analysis system while trotting in-hand and during lungeing in both directions. Asymmetry parameters (HDmin, HDmax, PDmin, and PDmax) were extracted from video recordings, with values ≥0.5 considered clinically relevant. Vertical asymmetries were detected in 71% of horses during straight-line evaluation and in 79% during at least one lungeing direction. Some horses showed relevant asymmetries only under specific movement conditions, underscoring the complementary role of straight-line and lungeing assessments in comprehensive gait evaluation. These results suggest that objective gait analysis could enhance pre-race veterinary assessments, especially in traditional racing, where horses are subjected to significant biomechanical stress, including variable surface properties and repetitive directional loading. In such complex and dynamic environments, relying solely on visual assessment may result in the underdiagnosis of subtle locomotor alterations. The AI-based tools offer potential to improve the detection of subtle irregularities and support evidence-based decisions in performance horse management. Further investigations are warranted to validate the clinical relevance of currently adopted asymmetry thresholds, refine their diagnostic value, and support their integration into standardized pre-race evaluation protocols. Full article

Background/Objectives: Stroke survivors often develop asymmetric gait patterns that may lead to abnormal knee joint loading and potentially increased risk of osteoarthritis. This study aimed to investigate differences in knee joint loading between paretic and non-paretic limbs during walking in individuals post-stroke. Methods: Twenty-one chronic stroke survivors underwent three-dimensional gait analysis. A modified musculoskeletal model with a specialized knee mechanism was used to estimate medial and lateral tibiofemoral contact forces during the stance phase. Statistical parametric mapping was used to identify significant differences in joint kinematics, kinetics, and contact forces between limbs. Stepwise regression analyses examined relationships between knee moments and compartmental contact forces. Results: Significant differences in knee loading were observed between limbs, with the non-paretic limb experiencing higher medial compartment forces during early stance (6.7–15.1%, p = 0.001; 21.9–30.7%, p = 0.001) and late stance (72.3–93.7%, p < 0.001), and higher lateral compartment forces were recorded during pre-swing (86.2–99.0%, p < 0.001). In the non-paretic limb, knee extensor moment was the primary predictor of first peak medial contact force (R² = 0.573), while knee abductor moment was the primary predictor in the paretic limb (R² = 0.559). Conclusions: Musculoskeletal modeling revealed distinct asymmetries in knee joint loading between paretic and non-paretic limbs post-stroke, with the non-paretic limb experiencing consistently higher loads, particularly during late stance. These findings suggest that rehabilitation strategies should address not only paretic limb function but also potentially harmful compensatory mechanisms in the non-paretic limb to prevent long-term joint degeneration. Full article

This case report details the successful rehabilitation of a 31-year-old male Asian elephant (Elephas maximus) presenting with an abnormal left forelimb gait following chronic traumatic injury. The elephant exhibited a distinctive circumduction gait with a semicircular arc movement, characterized by limited flexion at the elbow and carpus, along with compensatory proximal shrugging during the swing phase. Diagnostic evaluations revealed joint space narrowing and ligament fibrosis, while biomechanical gait analysis using inertial measurement units highlighted significant asymmetries between affected and unaffected limbs. An interprofessional team developed a comprehensive rehabilitation protocol that integrated peripheral magnetic stimulation, task-specific therapeutic walking with adjustable obstacles, and progressive strengthening exercises. At the eight-week follow-up, improvements were observed in cross-correlation coefficients of limb movement and imaging assessments, indicating enhanced symmetry and structural improvements with reduced fibrosis. However, persistent discrepancies in elbow functions suggest that further targeted rehabilitation may be warranted. This report underscores the potential of a coordinated interprofessional approach to restore functional gait patterns in elephants and offers valuable insights for future rehabilitative strategies in managing complex musculoskeletal injuries in large mammals. Full article

Myofascial pain syndrome (MPS) is a common source of musculoskeletal pain, characterized by trigger points (TrPs). In horses, MPS is frequently underdiagnosed, and evidence on DN effectiveness is limited. This study investigated whether DN can improve the biomechanics in horses using an artificial intelligence (AI)-based markerless smartphone application (app). Fourteen horses participated, including nine used in assisted therapy, four leisure horses, and one with mixed use. The presence of TrPs was evaluated in six muscles through manual palpation: brachiocephalicus, trapezius, gluteus medius, biceps femoris, semitendinosus, and quadriceps femoris. The horses were divided into a treatment group (TG) (n = 7) and control group (CG) (n = 7). Biomechanical data were recorded in a straight line at a trot before the treatment (T0), immediately after the treatment (T1), and 72 h post-treatment (T72). The stride frequency (SF) was significantly lower (p < 0.05) at 72 h compared with both before and immediately after the treatment. The SF of the TG at 72 h was significantly lower than the SF of the CG at T1 (p < 0.05). Non-significant differences were observed for both the asymmetry push-off and impact phase variables, except for the forelimb head range of motion (FHROM) severity, which was significantly (p < 0.05) greater in the CG than in the TG. This study suggests that DN may enhance the gait quality in horses with MPS. Full article

Background: Post-stroke equinovarus foot (EVF) impairs gait stability, increases the risk of secondary injuries, and contributes to elevated healthcare costs. However, effective targeted interventions for EVF remain limited. Patient concerns: Two patients with chronic EVF—a 63.5-year-old male (9.7 months post-stroke) and a 35.7-year-old female (24.5 months post-stroke)—presented with ankle deformity, gait asymmetry, and impaired balance, all of which interfered with daily activities. Intervention and outcomes: Both patients underwent ultrasound-guided acupotomy targeting spastic ankle muscles, administered over four sessions within two weeks. A quantitative gait analysis revealed substantial improvements in step length ratios (Case 1: 0.61 → 0.86; Case 2: 0.67 → 0.88), as well as enhancements in walking velocity, lateral symmetry, postural balance, and Modified Ashworth Scale scores. No adverse events were reported. Protocol proposal: Based on these observations, a prospective randomized controlled trial is planned to compare ultrasound-guided acupotomy plus conventional therapy versus conventional therapy alone. Outcomes will be assessed quantitatively using gait analysis. Lessons and implications: Ultrasound-guided acupotomy may offer a minimally invasive, targeted approach to releasing spastic muscles while preserving neurovascular structures, thereby improving gait function in patients with post-stroke EVF. Full article

Background: Robot-assisted total knee arthroplasty (TKA) has gained attention for its ability to improve surgical precision, optimize component alignment, and potentially enhance functional outcomes. Despite these advantages, early postoperative deficits, particularly in quadricep activation and the range of motion (ROM), remain common and can delay recovery. The objective of this study was to investigate early postoperative differences in quadricep muscle activation and the ROM between the operated and non-operated sides following robot-assisted TKA. Methods: A total of 101 participants (50 females, 51 males) were included in the study. Surface electromyography (sEMG) was recorded from the vastus lateralis and vastus medialis during an active knee extension test and a 4-m walking test. The ROM was assessed during gait. A linear mixed model was employed with operated side and sex as factors. Results: Significant differences were observed in quadricep muscle activation and the ROM between the operated and non-operated sides. During the knee extension test, males exhibited significantly higher vastus lateralis activity on the non-operated side (mean difference = 174 µV, 95% confidence interval (CI) [90, 258], p < 0.001) and females showed a similar pattern (mean difference = 238 µV, 95% CI [152, 324], p < 0.001). Additionally, vastus medialis activation was significantly higher on the non-operated side for both males (mean difference = 102 µV, 95% CI [34, 169], p = 0.003) and females (mean difference = 137 µV, 95% CI [47, 226], p = 0.003). During the 4-m walking test, females displayed a significantly reduced sagittal-plane ROM on the operated side (mean difference = 7.691°, p = 0.041) whereas no significant ROM differences were found in males (p > 0.903). Conclusions: Robot-assisted TKA patients exhibit significant early postoperative asymmetries in quadricep activation and the gait ROM, particularly among females. 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