Katarzyna Nowakowska

Application of Gait Index Assessment to Monitor the Treatment Progress in Patients with Cerebral Palsy

A three-dimensional analysis of movement is more and more often applied to assess locomotive functions of patients with cerebral palsy (CP). For the past few years there has been a growing interest in gait index methods which enable the evaluation of the patient’s gait with the use of a single numerical value. This research aimed at the assessment of the gait of patients with CP at different stages of treatment on the basis of gait indices Gillette Gait Index (defined by Shutte) and Gait Deviation Index (definied by Schwartz and Rozumalski) as well as finding dependencies between the determined indices values. The studied group consisted of 56 healthy participants and 16 patients with cerebral palsy treated using botulinum toxin. On the grounds of the determined indexes, the improvement of gait was observed in the case of 75 % of patients with CP. Statistically significant differences were found between GGI and GDI values obtained in the initial investigation and after 6 months following the administration of botulinum (PRE and POST). There was a strong linear dependence observed between the GDI and GGI* (\(GGI^*=\ln (\sqrt{GGI})\)) values. No significant dependence was observed between the percentage indices of improvement determined on the basis of the GGI and GDI results obtained (in the PRE and POST examination).

The Upper Limb Motion Deviation Index: A new comprehensive index of upper limb motion pathology

PURPOSE The aim of the research was to formulate a new index enabling assessment of the overall pathology of the upper limb movement. It defines the difference between the pathological movement and a normal movement pattern. METHODS Methodology of determining the index is based on a mathematical algorithm for calculating the Gait Deviation Index which is based on advanced methods of image comparison. To calculate the ULMDI index, one must divide the analyzed movement into cycles appropriate to the nature of the movement (similarly in gait it is the gait cycle) and then determine kinematic quantities (courses of joint angles). RESULTS A group of 23 healthy people (10 women: k1-k10 and 13 men: m1-m13) as the reference group and a group of 3 persons with mobility impairments (p1-p3) took part in the research. Time values of the angles of the joints on both upper limbs were registered and then ULMDI indexes were calculated. CONCLUSIONS It has been shown that the developed ULMDI index allows to detect the deviations from the accepted norm in the performance of movements. The results showed that both the description of the motor dysfunction of examined person based on the diagnosis of the physician, a detailed analysis of kinematic waveforms received during the tests and the calculated values provide a coherent picture of the state of a human movement. The index analysis is less time-consuming for the doctor, and the comparison of the results at various stages of therapy gives an objective picture of the rehabilitation progress.

The Loads Acting on Lumbar Spine During Sitting Down and Standing Up

The paper presents an analysis of the loads acting on lumbar spine during movement of sitting down and getting up from a chair. The study was conducted on a group of 30 people (parents of disabled children) complaining about chronic low back pain. Basing on kinematics, obtained during experiment from APAS system, simulations were performed in the Anybody Modeling System environment. The use of methods, mathematical modeling and static optimization, allowed to determine the magnitude of the loads acting on musculoskeletal system. The results of reactions in the L5-sacrum joint, the muscular forces of erector spinae and the transversus abdominis are significantly correlated with the kinematics of the movement.

Three-Dimensional Children Gait Pattern – Reference Data for Healthy Children Aged Between 7 and 17

The research aimed to determine the standards of kinematic quantities and indices of regularity, namely the Gillette Gait Index and the Gait Deviation Index related to children aged between 7 and 17 as well as the identification of differences concerning the above-named quantities according to age and height. The study group consisted of 56 healthy children aged 7 to 17. The tests were performed using the BTS Smart system. The original applications developed in the Matlab environment for all of the children subjected to the tests enabled the identification of the Gillette Gait Index (GGI) and the Gait Deviation Index (GDI). Detailed analysis involved a set of sixteen variables describing gait kinematics; the above-named variables are used when creating the GGI. The children were divided into five groups in relation to age and six groups in relation to height. Time values of the angles of the joints were registered and then the GGI and the GDI were calculated. Sixteen parameters composing the GGI were determined for all of the children constituting the test group. The confirmation or the exclusion of differences between age-related and height-related groups was based on statistical analysis. The identified courses of the kinematic time series can be used as normative in relation to patients aged 7–17.

The Long-Term Effects of Surgery in Patients with Myelomeningocele and Their Influence on the Parameteres of Gait – Preliminary Research

The aim of the work was to assess locomotion functions and posture stability of patients who had undergone prenatal or postnatal surgery for myelomeningocele. The gait tests were conducted with BTS System and the stabilographic tests with the dynamographic platform by Zebris. Eight patients operated for myelomeningocele, 4 prenatally and 4 postnatally, have undergone the analysis. A thorough analysis was made of the set of space-time, kinematic parameters, values of the Gillette Gait Index and Gait Deviation Index. The patients’ posture stability was assessed on the basis of the path length and the ellipse area. The obtained results were compared with the standard values. The conducted biomechanical examinations of indicate that regardless of the time when the closing of the myelomeningocele was done, the patients show biggest disorders in the motion of the pelvis. Posture stability of children with myelomeningocele is reduced when compared to a group of healthy children.

Assessment of locomotor functions of patients suffering from cerebral palsy qualified to treat by different methods

The aim of this study was to assess locomotor functions of patients with cerebral palsy and qualified for various treatment procedures on the basis of indicative methods and parameters constituting the Gillette Gait Index. The studied group consisted of 57 healthy children and 60 children with different types CP and different degrees of disability: REH - patients subjected to physiotherapy only, BOT - patients subjected to the injection of botulinum toxin and intensive rehabilitation and RIZ - patients qualified for the surgical procedure of the selective dorsal rhizotomy. Gait investigations were carried out using BTS Smart system and the gait assessment was made on the basis of gait indices methods (GGI, GDI). The statistical analysis demonstrated that the most diversified parameters characterising patients with CP qualified for various treatments are: knee flexion at initial contact, time of peak knee flexion, range of knee flexion, range of pelvic tilt.

Research on the stability of the users of chair with a spherical base

One of the way to get rid of the spine issues is using chairs with a movable seat. The essence of chairs with a movable seat is to increase the range of motion of pelvis movement. Natural ability to maintain the upright position of the body can cause the increasing of pelvis movement. That requires the involvement of the spine stabilizing muscles. The construction of chairs with a spherical base should provide stability and prevent from slipping away from the chair. At the same time chairs with spherical base should provide mobility to force pelvis movements. We made an ergonomic analysis of chair with spherical base. Studies have determined the stability of the seat and the range of pelvis movements. These measurements used the whole body kinematics. The ergonomic assessment of the spherical seat required investigation to determine the following parameters: center mass displacement, lean of spherical chair and kinematics of the human body.

Assessment of balance of older people living at a social welfare home

More frequently fall of older people can be caused by increasing of the degeneration of a human motor system and a human maintaining balance system. The aim of study was to determine the association of balance and risk of falling of older people lived at a social welfare home. The authors examined the dependence between the ability to maintain balance in the upright position and the assessment of balance and risk of falling in a functional way. The study group were consisted of 26 elderly people. Postural stability examinations was carried out based on the Romberg test, while the functionally balance was evaluated with a Up&Go test. The statical tests did not manifest significant correlation between the static and dynamic stabiliography parameters, but one proved that there existed strong differences for obtained ellipse area results, among the group of patients performing the Up&Go Test within shorter and longer time than 20 sec.

Evaluation of Locomotor Function in Patients with CP Based on Muscle Length Changes

The aim of this study was to analyze locomotor function of children with cerebral palsy based on changes in muscle length and to evaluate if the muscle length changes may be used as a diagnostic indicator. The study group consisted of 23 people with normal gait and 3 patients with cerebral palsy. Locomotor function tests were performed using the BTS Smart system, while the length of the muscles were determined using mathematical modeling methods with the help of Anybody Modeling System software. In this study the muscle group functioning in connection with the knee joint were analyzed. The results of muscle length changes for children with CP were compared to those of people with no evidence of impaired locomotor function, as well as to the values of GGI and GDI indicators and to kinematic parameters.