G. Ferraresi

Repeatability of a new protocol for gait analysis in adult subjects.

The reliability of kinematic measurements has a top priority in gait analysis. The aim of the present work was to assess the inter-trial, inter-session and inter-examiner variability of an anatomical-based protocol by an established method. The gait of two young adult volunteers was analyzed by four examiners with different degrees of experience in three sessions 1 week apart. The data of five trials of level walking were collected and the rotations in the three anatomical planes of the pelvis, hip, knee and ankle were calculated. The mean value over the gait cycle of the standard deviation of these rotations was calculated for each of the 24 groups of five trials (inter-trial), the eight groups of five trials multiplied by three sessions (inter-session), and the two groups of five trials multiplied by three sessions multiplied by four examiners (inter-examiner). For each rotation, the inter-examiner variability was larger than the inter-session, and the latter larger than the inter-trial. The present ratio between inter-examiner and inter-trial variability was found to be smaller than that of the conventional protocol for each of the gait variables.

A new protocol for 3D assessment of foot during gait: Application on patients with equinovarus foot

BACKGROUND The aim of this study is to assess the clinical value of a recently introduced original protocol for full three dimensional analysis of ankle rotations in patients with equinovarus foot. METHODS A preliminary study merging the Total3Dgait protocol and the conventional Vicon® Plug-in-Gait marker-sets on five patients with foot deformity was performed to compare the output exactly over the same gait cycles. In the second study, 15 patients with equinus varus foot were assessed retrospectively by means of the Total3Dgait protocol before and after surgery. Data on ankle kinematics were compared to those of a control group. The Functional Ambulation Categories scale and other goals such as orthosis/aids removal, decrease in foot pain, healing of calluses and sores were considered as measures of clinical outcome. FINDINGS The Total3Dgait protocol provides additional joint motion, in the coronal and transverse planes. Kinematics in the three anatomical planes improved significantly although no changes in time-distance parameters were evident. Improvement in clinical outcome measures was also achieved. INTERPRETATION The new protocol provides valuable additional data in measuring full three dimensional kinematics of the foot during gait. Whereas the speed of walking was unchanged after surgery for most of patients, the kinematic changes in the three anatomical planes, as measured by the new protocol, were the only measures able to demonstrate motion changes induced by surgery at the foot and to explain subject-specific gains as improvement in stability during walking, relief of pain, calluses and sores, and removal or modification of foot orthosis and aids.

Electromyographic activity of the vastus intermedius muscle in patients with stiff-knee gait after stroke. A retrospective observational study

Stiff-knee gait (SKG) in hemiplegic patients is often due to an inappropriate activity of the quadriceps femoris. However, there are no studies in literature addressing the vastus intermedius (VI) involvement in SKG. In this study, VI activity was analyzed in a sample of 46 chronic stroke patients with SKG, during spontaneous gait. VI activity was recorded by fine-wire electrodes inserted under ultrasound guidance then confirmed by electrical stimulation. The measured VI activity was compared to the normal reference pattern reported in literature and classified (e.g. premature, prolonged). The occurrences of abnormal activations during each sub-phase of the gait cycle were assessed. VI activity presented an abnormal timing in 96% of the sample. The most common pathological pattern (in 46% of the sample) was the combination of premature and prolonged VI activation. Nearly 20% of patients presented a continuous activity. A pathological activation in patients was found for 91% in mid stance, for more than 50% in terminal stance and pre-swing and for 37% and 70% in initial- and mid-swing. Results indicate that abnormal VI activity is frequent in patients with SKG. Hence, VI activity should be included in the assessment of SKG to assist in the clinical decision-making processes.