Yoshimasa Sagawa

Biomechanics and physiological parameters during gait in lower-limb amputees: A systematic review

OBJECTIVE The purpose of this systematic review was to identify which biomechanical and physiological parameters are the most relevant, commonly used, able to discriminate and/or have specific clinical relevance for the gait analysis of lower-limb amputees (LLA). METHODS We performed an electronic search via the PubMed, EMBASE and ISI Web of Knowledge databases from 1979 to May 2009. Two independent reviewers assessed the title and abstract of each identified study. The quality assessment of the full text was undertaken using a 13-item checklist divided into three levels: A, B, and C. RESULTS The literature search identified 584 abstracts to be considered. After applying the inclusion criteria, we reviewed the full text of a total of 89 articles. The mean article quality was 8±2. No A-level article was found; the primary reason was a negative score in blinded outcome assessment. Sixty-six articles (74%) corresponded to a B-level, and two articles (2%) corresponded to a C-level. Twenty-one articles (24%) did not acquire enough points to be assigned to any level. In this study, we present and discuss the most commonly used and most relevant 32 parameters. Many of the parameters found were not reported in enough studies or in enough detail to allow a useful evaluation. CONCLUSION This systematic review can help researchers compare, choose and develop the most appropriate gait evaluation protocol for their field of study, based on the articles with best scores on the criteria list and the relevance of specific biomechanical and physiological parameters.

Identification of gait patterns in individuals with cerebral palsy using multiple correspondence analysis

Great importance has been placed on the development of gait classification in cerebral palsy (CP) to assist clinicians. Nevertheless, gait classification is challenging within this group because the data is characterized by a high-dimensionality and a high-variability. Thus, the aim of this study was to analyze without a priori, a database of clinical gait analysis (CGA) of CP patients, using multiple correspondence analysis (MCA). A retrospective search, including biomechanical and clinical parameters was done between 2006 and 2012. One hundred and twenty two CP patients were included in this study (51 females and 71 males, mean age ± SD: 14.2 ± 7.5 years). Sixteen biomechanical spatio-temporal and kinematic parameters were included in the analysis. This data was transformed by a fuzzy window coding based on the distribution of each parameter in three modalities: low, average and high. Afterward, a MCA was used to associate parameters and to define classes. From this, seven most explicative gait parameters used to characterize gait of CP patients were identified: maximal hip extension, hip range, knee range, maximal knee flexion at initial contact, time of peak knee flexion, and maximal ankle dorsiflexion in stance phase and in swing phase. Moreover, four main profiles of CP patients have been defined from the multivariate approach: an apparent equinus gait group (the most similar of the control group with diplegic and hemiplegic patients with a GMFCS 1), a true equinus gait group (the youngest group with diplegic and some hemiplegic patients with a GMFCS 1), a crouch gait group (the oldest group with a majority of diplegic and rare hemiplegic patients with a GMFCS 2) and a jump knee gait group (the greatest level of global spasticity of the lower limbs with a majority of diplegic and rare hemiplegic patients with a GMFCS 2). Thus, this study showed the feasibility of the MCA in order to characterize and classify a large database of CP patients.

Associations between gait and clinical parameters in patients with severe knee osteoarthritis: a multiple correspondence analysis

BACKGROUND Given the complexity of the gait of patients with knee osteoarthritis, a multiple correspondence analysis may be helpful to optimise the extraction of relevant gait and clinical information. Therefore, the aims of this study are to identify the main associations with clinical and gait biomechanical parameters and to evaluate whether there are more specific knee osteoarthritis groups with different gait profiles. METHODS Ninety patients with severe knee osteoarthritis and twenty-six healthy individuals participated in this study. Pain and function were assessed with the WOMAC Index; knee joint deformity was assessed by the hip-knee-ankle angle on full-limb radiography; and full body gait analysis was performed with a motion analysis system and force plates. FINDINGS Using multiple correspondence analysis, two categories of gait parameters that best explain the gait variance of patients with knee osteoarthritis were highlighted. The forward displacement category is composed of the parameters speed, stride length, hip flexion and knee flexion. The frontal category is composed of the parameters thorax obliquity and knee adductor moments. Moreover, based on these parameters, four distinct gait profiles were identified: two gait profiles were associated with knee varus deformities, increased thorax obliquity and different forward displacements, while two gait profiles were associated with valgus deformities and different forward displacements. INTERPRETATION These gait parameters can be used to simplify the characterisation of the gait of the knee osteoarthritis population. Patients in varus profiles increase thorax obliquity on the stance limb and may reduce forward displacement. Patients in valgus profiles, however, only reduce forward displacement.

Are clinical measurements linked to the Gait Deviation Index in cerebral palsy patients

OBJECTIVE From a dataset of clinical assessments and gait analysis, this study was designed to determine which of the assessments or their combinations would most influence a low gait index (i.e., severe gait deviations) for individuals with cerebral palsy. DESIGN A retrospective search, including clinical and gait assessments, was conducted from August 2005 to September 2009. POPULATION One hundred and fifty-five individuals with a clinical diagnosis of cerebral palsy (CP) (mean age (SD): 11 (5.3) years) were selected for the study. METHOD Quinlans Interactive Dichotomizer 3 algorithm for decision-tree induction, adapted to fuzzy data coding, was employed to predict a Gait Deviation Index (GDI) from a dataset of clinical assessments (i.e., range of motion, muscle strength, and level of spasticity). RESULTS Seven rules that could explain severe gait deviation (a fuzzy GDI low class) were induced. Overall, the fuzzy decision-tree method was highly accurate and permitted us to correctly classify GDI classes 9 out of 10 times using our clinical assessments. CONCLUSION There is an important relationship between clinical parameters and gait analysis. We have identified the main clinical parameters and combinations of these parameters that lead to severe gait deviations. The strength of the hip extensor, the level of spasticity and the strength of the tibialis posterior were the most important clinical parameters for predicting a severe gait deviation.

Multi-joint postural behavior in patients with knee osteoarthritis

BACKGROUND Previous studies have demonstrated balance impairment in patients with knee osteoarthritis (OA). Although it is currently accepted that postural control depends on multi-joint coordination, no study has previously considered this postural strategy in patients suffering from knee OA. The objectives of this study were to investigate the multi-joint postural behavior in patients with knee OA and to evaluate the association with clinical outcomes. METHODS Eighty-seven patients with knee OA and twenty-five healthy elderly were recruited to the study. A motion analysis system and two force plates were used to investigate the joint kinematics (trunk and lower body segments), the lower body joint moments, the vertical ground reaction force ratio and the center of pressure (COP) during a quiet standing task. Pain, functional capacity and quality of life status were also recorded. RESULTS Patients with symptomatic and severe knee OA adopt a more flexed posture at all joint levels in comparison with the control group. A significant difference in the mean ratio was found between groups, showing an asymmetric weight distribution in patients with knee OA. A significant decrease in the COP range in the anterior-posterior direction was also observed in the group of patients. Only small associations were observed between postural impairments and clinical outcomes. CONCLUSION This study brings new insights regarding the postural behavior of patients with severe knee OA during a quiet standing task. The results confirm the multi-joint asymmetric posture adopted by this population.

Comparison of the International Committee of the Red Cross Foot With the Solid Ankle Cushion Heel Foot During Gait: A Randomized Double-Blind Study

OBJECTIVE To compare the well-recognized solid ankle cushion heel (SACH) foot with the prosthetic foot developed by the International Committee of the Red Cross (CR Equipements SACH) during gait. DESIGN Double-blind study was conducted to compare the influence on the biomechanics of gait of the CR Equipements SACH foot and the SACH foot. SETTING University hospital research center. PARTICIPANTS Participants with unilateral transtibial amputation (N=15) were included. INTERVENTIONS Three-dimensional motion analysis system and 2 forceplates were used to capture body motion and ground reaction forces during gait at a self-selected speed and at 1.2m/s. MAIN OUTCOME MEASURES Nonparametric Wilcoxon matched-pairs tests were used to compare the 2 prosthetic feet with respect to their spatiotemporal (gait velocity, stride length, and percentage of stance phase), kinematic (range and peak angles of the pelvis, hip, knee, and ankle), and kinetic (peak moment and power of the hip, knee, and ankle) parameters. RESULTS Compared with the SACH foot, the CR Equipements SACH foot demonstrated a significantly greater stance phase symmetry ratio (SACH: 94% vs CR Equipements SACH: 97%), a more extensive ankle range of motion in the sagittal plane (SACH: 7° vs CR Equipements SACH: 12°), a greater maximal dorsiflexion angle during the terminal stance phase (SACH: 10° vs CR Equipements SACH: 13°), and a higher ankle power (SACH: .31W/kg vs CR Equipements SACH: .40W/kg). No significant difference was found for the examined knee, hip, and pelvis parameters. CONCLUSIONS The CR Equipements SACH foot provides more symmetry and improves ankle kinematics and kinetics in the sagittal plane compared with the SACH foot. This study suggests that individuals using the CR Equipements SACH foot improve their gait biomechanics compared when using the SACH foot.

Gait tests in multiple sclerosis: Reliability and cut-off values

BACKGROUND Gait limitation is one of the most common disabilities in people with multiple sclerosis (MS). Several studies have used gait parameters to determine the effects of different therapies. However, few studies have determined their reproducibility, also the therapeutic effects could be overestimated. RESEARCH QUESTION To examine the reproducibility in gait measurements during short and long distances. METHODS In this cross-sectional study we recruited a group of MS patients and compare it to a control group. The participants performed the following tests in a fixed order: a 25-foot walk at a comfortable speed, at a fast speed and during a dual task, a timed up-and-go test (TUG) and a six- minute walk test (6MWT). Two measurements were conducted a week apart. Systematic error was evaluated by the Student t-test, reliability by the intra-class correlation coefficients (ICC) and agreement by the minimum detectable change (MDC95). RESULTS A total of 58 people with MS and 19 healthy people were included. The absence of systematic error was only found for the fast speed condition. The reliability of the gait parameters had moderate to high ICC values (ICC > 0.7) except for the dual task cost (DTC) which was 0.45. The MDC95 was higher in people with MS compared to healthy people, and it was higher in people with MS for gait speeds in all conditions (> 34%). For the TUG and 6MWT, the MDC95 were 51.5% and 31.7% respectively. For people with MS the smallest MDC95 was found for the stance time for all conditions (6.8%), whereas the highest was found for the dual task cost (158.7%). SIGNIFICANCE The MDC95 values were higher than the cut-off point based on the minimally important clinical difference (MICD) proposed in previous studies. Thus, the MDC95 should be used as a cut-off rather than MICD values.

Multiple Sclerosis and Clinical Gait Analysis before and after Fampridine: A Systematic Review

Background: Gait impairment is one of the most disabling symptoms in people with multiple sclerosis (PwMS). Fampridine, has demonstrated a positive effect on gait speed in PwMS after 14 days of treatment but the long-term effects have not yet been demonstrated. This study reviews the long-term effects of fampridine on gait in PwMS. Summary: This systematic review was conducted according to the PRISMA statement. Studies were considered long term if treatment exceeded 28 days. From the 498 studies identified, 18 (2,200 patients) fulfilled all eligibility criteria. Only 3 studies followed-up patients for >1 year and one of these showed a non-significant improvement in the gait speed. Key Messages: Fampridine seems to be beneficial at improving gait speed in PwMS in the long term. Further long-term studies are needed on related gait and functional parameters.

Variable compensation during the sit-to-stand task among individuals with severe knee osteoarthritis

BACKGROUND Individuals with knee osteoarthritis (OA) show variability during the sit-to-stand (STS) task, so they may not perform the STS in the same way. This study aimed to determine whether individuals with knee OA have different strategies in performing the STS. METHODS Participants with knee OA and able-bodied individuals underwent STS evaluation at a self-selected pace with use of a motion measurement system consisting of 12 cameras and 2 force plates. RESULTS In total, 101 participants (57 women) with knee OA showed 3 main STS strategies. As compared with the 27 controls (14 women), 24 OA participants, compensated STS, showed greater trunk flexion (47.1° vs. 38.3°; P<0.01) and trunk obliquity (4.6° vs. -0.8°; P<0.001) when completing the STS task in the same amount of time as controls (2.4 vs. 2.7s; P=0.999). The second group (n=59), inadequately compensated STS, also compensated with trunk flexion (47.7° vs. 38.3°; P<0.01) and trunk obliquity (1.6° vs. -0.8°; P<0.001) but took longer than controls (3.4 vs. 2.7s; P=0.001). The third group (n=18), severe impaired STS, took an extended amount of time to execute the STS (6s), with marked trunk flexion (59.2°) and obliquity (4.1°), so participants in this group were perhaps severely impaired in completing the STS. CONCLUSION This study identified 3 groups STS trunk strategies among participants with STS. Moreover, the data reveal a concise representation of the relations among strategy variables. The findings could be used to simplify the characterization of the STS among patients with knee OA and aid with follow-up.

Multiple sclerosis, clinical gate analysis before and after fampridine: A systematic review

Introduction Gait impairment appears as one of the most common and disabling symptoms in people with multiple sclerosis (PwMS). Few symptomatic treatments exist at the progressive phase of the disease. Fampridine (4-aminopyridine) an inhibitor of the potassium channels has demonstrated a positive effect on gait speed in PwMS with gait disturbance. The effects are well established on gait speed after 14 days of treatment but the effect on long-term is not yet demonstrated. This study aimed to review the short- and long-term effects of fampridine on gait in PwMS. Materials–method This systematic review has been conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Literature searches on MEDLINE, Embase, and COCHRANE covered prospective randomized controlled and non-randomized studies. Studies were considered as long-term if treatment exceeded more than 28 days. This limit was arbitrarily determined by doubling the deadline of treatment efficiency of 14 days determined by the French National Authority for Health. Outcomes of interest were gait parameters after treatment. Results From 498 studies identified, 18 (2200 patients) fulfilled all eligibility criteria. Five of these articles were in favor of a significant improvement in Timed 25 Foot Walk (T25FW), after 14 days of treatment (between 11.2 and 34.8%). Only 3 studies made a follow-up over 1 year and one of them showed a significant improvement of gait speed in T25FW of 11.2%. Only one study investigated other gait spatiotemporal parameters than speed on long-term (3 months) and showed an improvement of gait cadence (11%) and step length (12.8%). Discussion–conclusion Fampridine seems to be beneficial in improving gait speed in PwMS at short-term and long-term. It would be advisable to complete these studies by other long-terms study and other gait (spatiotemporal, kinematics) and functional parameters.