The Effect of Prosthesis Alignment on the Symmetry of Gait in Subjects with Unilateral Transtibial Amputation

2006 ◽  
Vol 30 (2) ◽  
pp. 114-128 ◽  
Author(s):  
Daniel H. K. Chow ◽  
Andrew D. Holmes ◽  
Christina K. L. Lee ◽  
S. W. Sin
Keyword(s):  
Knee Flexion ◽  
Dynamic Testing ◽  
Reaction Force ◽  
Step Length ◽  
Gait Pattern ◽  
Vertical Ground Reaction Force ◽  
Gait Symmetry ◽  
Prosthetic Alignment ◽  
Gait Parameters ◽  
Study Results

A high degree of gait symmetry is characteristic of healthy gait. The aim of this study is to examine the symmetry of various gait parameters in subjects with unilateral trans-tibial amputation over a range of acceptable anteroposterior translational and tilt alignments, and further to examine if a consistent alignment of highest symmetry can be found. Acceptable alignments were determined by bench, static and dynamic testing on level and non-level surfaces. A total of 15 kinetic and kinematic parameters were then measured in the seven subjects participating in this study. Results indicate that some parameters show consistently higher symmetries, particularly the vertical ground reaction force parameters and the stance duration, step length and time to full knee flexion during the swing phase. Symmetries in other parameters such as knee flexion at loading response, acceleration impulse, and peak anteroposterior propulsive force seem to have little relevance in determining whether the gait pattern for that prosthetic alignment is acceptable or not. While analysis of the symmetry of more relevant gait parameters may assist the prosthetist in consistently and objectively identifying a most symmetrical alignment within the acceptable range, further clinical study is required before any conclusions can be drawn regarding evaluation of symmetry as a tool in defining any optimum alignment.

scholarly journals Computed dynography, a method for evaluation of gait pattern in treated cases of congenital talipes equino varus

2020 ◽  
Vol 6 (3) ◽  
pp. 611
Author(s):  
Akshay Jain ◽  
Adhir Jain ◽  
Ravi Kant Jain ◽  
Prateek Pathak
Keyword(s):  
Ground Reaction Force ◽  
Reaction Force ◽  
Gait Pattern ◽  
Vertical Ground Reaction Force ◽  
Age And Gender ◽  
Double Support ◽  
Gait Parameters ◽  
Vertical Ground ◽  
Congenital Talipes ◽  
And Gender

<p class="abstract"><strong>Background:</strong> Club foot is characterized by inversion, adduction and equinus. Currently, evaluation of children treated for congenital talipes equino varus (CTEV) includes clinical and radiological examination as well as assessment of function. However, none of the methods is ideal. There should<strong> </strong>be objective methods for better evaluation of function in treated CTEV. Gait analysis is the emerging method in objectively assessing the functional outcome. The aim of the study was to compare the selected measures from vertical ground reaction force variables and gait parameters of treated CTEV children with plantigrade feet, to healthy age and gender matched control group.</p><p class="abstract"><strong>Methods:</strong> We took 31 children with treated CTEV with mean age 8.21 years<strong> </strong>and compared with 31 age and gender matched controls. The patients were initially treated under a standard protocol. Gait cycle properties, step time parameters and vertical ground reaction force variables were recorded and comparison of unilateral and bilateral cases of treated CTEV was done with that of controls.<strong></strong></p><p class="abstract"><strong>Results:</strong> Data showed that despite good clinical results and overall function, residual intoeing, lateral foot walking, mild foot drop, weak plantar flexor power, possible residual inversion deformity of the foot, increased frequency and decreased duration of cycle and asymmetry in gait were the main characteristics of gait of children with treated CTEV. In unilateral cases single and double support times were decreased and in bilateral CTEV double support times are increased.</p><p class="abstract"><strong>Conclusions:</strong> The study confirms that in clubfoot patients who underwent full treatment, gait parameters do not reach normal levels. Gait analysis can be used to quantify gait pattern characteristics and is helpful in evaluation and further development of treatment of patients.</p>

Immediate augmented real-time forefoot weight bearing using visual feedback improves gait symmetry in chronic stroke

2020 ◽  
Vol 28 (6) ◽  
pp. 733-741
Author(s):  
Jihye Jung ◽  
Wonjae Choi ◽  
Seungwon Lee
Keyword(s):  
Visual Feedback ◽  
Weight Bearing ◽  
Step Length ◽  
Gait Pattern ◽  
Gait Symmetry ◽  
Affected Side ◽  
Gait Parameters ◽  
Weight Shift ◽  
Spatiotemporal Parameters ◽  
Single Limb Support

BACKGROUND: Symmetry of gait is an important component of rehabilitation in stroke patients. Insufficient weight-bearing causes gait asymmetry. OBJECTIVE: This study aimed to identify the immediate effects of sufficient weight-bearing on the forefoot during the stance phase using visual feedback. METHODS: Twenty-seven individuals with stroke enrolled in this study. All patients were evaluated for gait parameters with and without visual feedback. Visual feedback was provided through a smart application and a beam projector screen that showed a weight shift as a change in color. Spatiotemporal gait parameters were evaluated, resulting in values for a calculated symmetry index, in addition to heel % and toe % temporal values. RESULTS: Velocity and cadence were significantly decreased when visual feedback was provided (p< 0.05). Spatiotemporal parameters, except for bilateral step length, swing time of affected side, and single-limb support of less affected side, showed significant improvement (p< 0.05). The gait pattern of subjects was more symmetrical with visual feedback compared to non-visual feedback (p< 0.05). The toe-on time significantly improved on the affected side with visual feedback (p< 0.05). CONCLUSION: This study suggests that visual feedback aids in the improvement of gait symmetry, forefoot weight-bearing on the affected side, and spatiotemporal parameters.

Feasibility and Preliminary Efficacy of Gait Training Assisted by Multichannel Functional Electrical Stimulation in Early Stroke Rehabilitation: A Pilot Randomized Controlled Trial

2021 ◽  
Vol 35 (2) ◽  
pp. 131-144
Author(s):  
Maijke van Bloemendaal ◽  
Sicco A. Bus ◽  
Frans Nollet ◽  
Alexander C. H. Geurts ◽  
Anita Beelen
Keyword(s):  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Step Length ◽  
Gait Training ◽  
Control Group ◽  
Significant Group ◽  
Gait Symmetry ◽  
Gait Parameters ◽  
Walking Capacity ◽  
Experimental Group

Background. Many stroke survivors suffer from leg muscle paresis, resulting in asymmetrical gait patterns, negatively affecting balance control and energy cost. Interventions targeting asymmetry early after stroke may enhance recovery of walking. Objective. To determine the feasibility and preliminary efficacy of up to 10 weeks of gait training assisted by multichannel functional electrical stimulation (MFES gait training) applied to the peroneal nerve and knee flexor or extensor muscle on the recovery of gait symmetry and walking capacity in patients starting in the subacute phase after stroke. Methods. Forty inpatient participants (≤31 days after stroke) were randomized to MFES gait training (experimental group) or conventional gait training (control group). Gait training was delivered in 30-minute sessions each workday. Feasibility was determined by adherence (≥75% sessions) and satisfaction with gait training (score ≥7 out of 10). Primary outcome for efficacy was step length symmetry. Secondary outcomes included other spatiotemporal gait parameters and walking capacity (Functional Gait Assessment and 10-Meter Walk Test). Linear mixed models estimated treatment effect postintervention and at 3-month follow-up. Results. Thirty-seven participants completed the study protocol (19 experimental group participants). Feasibility was confirmed by good adherence (90% of the participants) and participant satisfaction (median score 8). Both groups improved on all outcomes over time. No significant group differences in recovery were found for any outcome. Conclusions. MFES gait training is feasible early after stroke, but MFES efficacy for improving step length symmetry, other spatiotemporal gait parameters, or walking capacity could not be demonstrated. Trial Registration. Netherlands Trial Register (NTR4762).

scholarly journals Gait Disorders In Patients After Polytrauma

2015 ◽  
Vol 69 (1-2) ◽  
pp. 27-32
Author(s):  
Ruta Jakušonoka ◽  
Zane Pavāre ◽  
Andris Jumtiņš ◽  
Aleksejs Smolovs ◽  
Tatjana Anaņjeva
Keyword(s):  
Ground Reaction Force ◽  
Knee Flexion ◽  
Reaction Force ◽  
Three Dimensional ◽  
Step Length ◽  
Vertical Load ◽  
Lower Limb Injuries ◽  
Limb Injuries ◽  
Stance Time ◽  
Polytrauma Patients

Abstract Evaluation of the gait of patients after polytrauma is important, as it indicates the ability of patients to the previous activities and work. The aim of our study was to evaluate the gait of patients with lower limb injuries in the medium-term after polytrauma. Three-dimensional instrumental gait analysis was performed in 26 polytrauma patients (16 women and 10 men; mean age 38.6 years), 14 to 41 months after the trauma. Spatio-temporal parameters, motions in pelvis and lower extremities joints in sagittal plane and vertical load ground reaction force were analysed. Gait parameters in polytrauma patients were compared with a healthy control group. Polytrauma patients in the injured side had decreased step length, cadence, hip extension, maximum knee flexion, vertical load ground reaction force, and increased stance time and pelvic anterior tilt; in the uninjured side they had decreased step length, cadence, maximum knee flexion, vertical load ground reaction force and increased stance time (p < 0.05). The use of the three-dimensional instrumental gait analysis in the evaluation of polytrauma patients with lower limb injuries consequences makes it possible to identify the gait disorders not only in the injured, but also in the uninjured side.

Comparison of Biomechanical Factors between the Kicking and Stance Limbs

2004 ◽  
Vol 13 (2) ◽  
pp. 135-150 ◽  
Author(s):  
Scott Ross ◽  
Kevin Guskiewicz ◽  
William Prentice ◽  
Robert Schneider ◽  
Bing Yu
Keyword(s):  
Knee Flexion ◽  
Reaction Force ◽  
Knee Extension ◽  
Knee Kinematic ◽  
Vertical Ground Reaction Force ◽  
Time To Peak ◽  
Balance Task ◽  
Vertical Ground ◽  
Biomechanical Factors ◽  
Anterior Posterior

Objective:T o determine differences between contralateral limbs’ strength, proprio-ception, and kinetic and knee-kinematic variables during single-limb landing.Setting:Laboratory.Subjects:30.Measurements:Hip, knee, and foot isokinetic peak torques; anterior/posterior (AP) and medial/lateral (ML) sway displacements during a balance task; and stabilization times, vertical ground-reaction force (VGRF), time to peak VGRF, and knee-flexion range of motion (ROM) from initial foot contact to peak VGRF during single-limb landing.Results:The kicking limb had significantly greater values for knee-extension (P= .008) and -flexion (P= .047) peak torques, AP sway displacement (P= .010), knee-flexion ROM from initial foot contact to peak VGRF (P< .001), and time to peak VGRF (P= .004). No other dependent measures were significantly different between limbs (P> .05).Conclusion:The kicking limb had superior thigh strength, better proprioception, and greater knee-flexion ROM than the stance limb.

scholarly journals Vertical ground reaction force shape is associated with gait parameters, timed up and go, and functional reach in elderly females

2004 ◽  
Vol 36 (1) ◽  
pp. 42-45 ◽  
Author(s):  
Toshiaki Takahashi ◽  
Kenji Ishida ◽  
Daisuke Hirose ◽  
Yasunori Nagano ◽  
Kiyoto Okumiya ◽  
...  
Keyword(s):  
Ground Reaction Force ◽  
Reaction Force ◽  
Vertical Ground Reaction Force ◽  
Timed Up And Go ◽  
Functional Reach ◽  
Gait Parameters ◽  
Vertical Ground

scholarly journals A Dual-Learning Paradigm Simultaneously Improves Multiple Features of Gait Post-Stroke

2018 ◽  
Vol 32 (9) ◽  
pp. 810-820 ◽  
Author(s):  
Kendra M. Cherry-Allen ◽  
Matthew A. Statton ◽  
Pablo A. Celnik ◽  
Amy J. Bastian
Keyword(s):  
Knee Flexion ◽  
Joint Angle ◽  
Step Length ◽  
Learning Task ◽  
Gait Pattern ◽  
Learning Paradigm ◽  
Post Stroke ◽  
Learning Conditions ◽  
Hip Flexion ◽  
Gait Impairments

Background. Gait impairments after stroke arise from dysfunction of one or several features of the walking pattern. Traditional rehabilitation practice focuses on improving one component at a time, which may leave certain features unaddressed or prolong rehabilitation time. Recent work shows that neurologically intact adults can learn multiple movement components simultaneously. Objective. To determine whether a dual-learning paradigm, incorporating 2 distinct motor tasks, can simultaneously improve 2 impaired components of the gait pattern in people posttroke. Methods. Twelve individuals with stroke participated. Participants completed 2 sessions during which they received visual feedback reflecting paretic knee flexion during walking. During the learning phase of the experiment, an unseen offset was applied to this feedback, promoting increased paretic knee flexion. During the first session, this task was performed while walking on a split-belt treadmill intended to improve step length asymmetry. During the second session, it was performed during tied-belt walking. Results. The dual-learning task simultaneously increased paretic knee flexion and decreased step length asymmetry in the majority of people post-stroke. Split-belt treadmill walking did not significantly interfere with joint-angle learning: participants had similar rates and magnitudes of joint-angle learning during both single and dual-learning conditions. Participants also had significant changes in the amount of paretic hip flexion in both single and dual-learning conditions. Conclusions. People with stroke can perform a dual-learning paradigm and change 2 clinically relevant gait impairments in a single session. Long-term studies are needed to determine if this strategy can be used to efficiently and permanently alter multiple gait impairments.

scholarly journals Effects of selectively assisting impaired subtasks of walking in chronic stroke survivors

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Simone S. Fricke ◽  
Hilde J. G. Smits ◽  
Cristina Bayón ◽  
Jaap H. Buurke ◽  
Herman van der Kooij ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Step Length ◽  
Gait Training ◽  
Chronic Stroke ◽  
Stroke Survivors ◽  
Baseline Trial ◽  
Gait Parameters ◽  
Flexion Extension ◽  
Spatiotemporal Parameters ◽  
Length Width

Abstract Background Recently developed controllers for robot-assisted gait training allow for the adjustment of assistance for specific subtasks (i.e. specific joints and intervals of the gait cycle that are related to common impairments after stroke). However, not much is known about possible interactions between subtasks and a better understanding of this can help to optimize (manual or automatic) assistance tuning in the future. In this study, we assessed the effect of separately assisting three commonly impaired subtasks after stroke: foot clearance (FC, knee flexion/extension during swing), stability during stance (SS, knee flexion/extension during stance) and weight shift (WS, lateral pelvis movement). For each of the assisted subtasks, we determined the influence on the performance of the respective subtask, and possible effects on other subtasks of walking and spatiotemporal gait parameters. Methods The robotic assistance for the FC, SS and WS subtasks was assessed in nine mildly impaired chronic stroke survivors while walking in the LOPES II gait trainer. Seven trials were performed for each participant in a randomized order: six trials in which either 20% or 80% of assistance was provided for each of the selected subtasks, and one baseline trial where the participant did not receive subtask-specific assistance. The influence of the assistance on performances (errors compared to reference trajectories) for the assisted subtasks and other subtasks of walking as well as spatiotemporal parameters (step length, width and height, swing and stance time) was analyzed. Results Performances for the impaired subtasks (FC, SS and WS) improved significantly when assistance was applied for the respective subtask. Although WS performance improved when assisting this subtask, participants were not shifting their weight well towards the paretic leg. On a group level, not many effects on other subtasks and spatiotemporal parameters were found. Still, performance for the leading limb angle subtask improved significantly resulting in a larger step length when applying FC assistance. Conclusion FC and SS assistance leads to clear improvements in performance for the respective subtask, while our WS assistance needs further improvement. As effects of the assistance were mainly confined to the assisted subtasks, tuning of FC, SS and WS can be done simultaneously. Our findings suggest that there may be no need for specific, time-intensive tuning protocols (e.g. tuning subtasks after each other) in mildly impaired stroke survivors.

Factors Affecting Peak Vertical Ground Reaction Forces in Running

1986 ◽  
Vol 2 (1) ◽  
pp. 41-49 ◽  
Author(s):  
Edward C. Frederick ◽  
John L. Hagy
Keyword(s):  
Body Mass ◽  
Stride Length ◽  
Reaction Force ◽  
Step Length ◽  
Leg Length ◽  
Vertical Ground Reaction Force ◽  
Anthropometric Parameters ◽  
Factors Affecting ◽  
Reaction Forces ◽  
Vertical Ground

Nine subjects (6 males, 3 females) ranging in body mass from 90.9 to 45.5 kg ran repeated trials across a force platform while being filmed at 50 fps. The subjects ran five barefooted trials at each of three speeds: 3.35, 3.83, and 4.47 m · s−1. Force data were collected on-line and analyzed for the magnitude and temporal characteristics of the initial impact (Fz1) peak and the active (Fz2) peak of vertical ground reaction force (VGRF). Multiple regression and correlation analysis were used to study the relationship between the magnitudes of these kinetic data and kinematic and anthropometric data taken from the film and from measurements of the subjects. The results support the general conclusion that speed and, indirectly, body mass are significant effectors of the magnitudes of Fz1. In addition, other factors that correlate significantly with Fz1 are reciprocal ponderal index (RPI) and stature; half-stride length, step length, leg length, and vertical hip excursion during a half-stride cycle; and hip offset, contact angle, and dorsiflexion angle at contact. Body mass correlates highly with Fz2 (r = 0.95). Other significant factors correlating with Fz2 are RPI, stature, vertical hip excursion, dorsiflexion angle, hip offset, half-stride length, and step length. These data support earlier findings that speed and the effective mass of the leg at contact are important effectors of the magnitude of Fzl. In addition, the kinematic and anthropometric parameters that contribute significantly to the variability in Fzl and F are generally cross-correlated with body size and/or running speed.

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