Symmetry function in gait pattern analysis in patients after unilateral transfemoral amputation using a mechanical or microprocessor prosthetic knee

Abstract Background Above-knee amputations (AKAs) contribute to gait asymmetry. The level of asymmetry is affected by the type of knee prosthetic module. There is limited evidence suggesting that more technically advanced solutions (microprocessor modules; MicPK) are superior to less advanced ones (mechanical modules; MechPK). The study aimed to evaluate the variable range of hip and pelvic joint movements during gait and look for differentiating areas with an increased level of asymmetry of the gait cycle in individuals who underwent an AKA and are equipped with MicPK or MechPK. Methods Twenty-eight individuals participated in the study; 14 were assigned to a study group of individuals who underwent a unilateral AKA, and the other 14 were healthy participants as a control group. The movement task was recorded using the optoelectronic SMART-E system following the standard Davis protocol (the Newington model). A new method of quantifying gait symmetry using the symmetry function (SF) is proposed. SF is an integral measure of absolute differences in time-standardized signals between sides throughout the whole cycle of motion variability. Results In the frontal plane, there were significant differences between groups in the asymmetry of the range of movement in the hip joint of the intact limb. In the middle of the support phase, the intact limb was more adducted in individuals with MicPK and less abducted in people with MechPK (differences in mean 180%, p < 0.000; max 63%, p < 0.000; min 65%, p < 0.000). In the sagittal plane, the range of asymmetry of the flexion and thigh extension of the intact limb was similar to and only slightly different from the physiological gait. In the transverse plane, higher asymmetry values were noted for individuals with MicPK. In the final stage of the swing phase, the thigh was more rotated both externally and internally. The size of the asymmetry, when compared to gait of healthy individuals, reached 50% (differences in mean 115%, p < 0.232; max 62% p < 0.26; min 50, p < 0.154). Conclusions In the study group, the assessed ranges of pelvic and thigh movement in the hip joint differed only in the frontal plane. Individuals who underwent a unilateral above-knee amputation may gain less from using MicPK than anticipated.

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Accelerometer-Based Navigation in Total Knee Arthroplasty for the Management of Extra-Articular Deformity and Retained Femoral Hardware: Analysis of Component Alignment

Joints ◽

10.1055/s-0039-1697610 ◽

2019 ◽

Vol 07 (01) ◽

pp. 001-007 ◽

Cited By ~ 1

Author(s):

Andrea Cozzi Lepri ◽

Matteo Innocenti ◽

Fabrizio Matassi ◽

Marco Villano ◽

Roberto Civinini ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Navigation System ◽

Lower Limb ◽

Sagittal Plane ◽

Frontal Plane ◽

Control Group ◽

Navigation Systems ◽

Level Of Evidence ◽

Total Knee

Abstract Purpose Recent advances in total knee arthroplasty (TKA) include an accelerometer portable system designed to improve component position and alignment. The purpose of this study is to evaluate whether accelerometer navigation system can be a valuable option in complex TKAs for extra-articular deformity of the lower limb or in case of retained femoral hardware. Methods A group of 13 patients underwent TKA with an accelerometer navigation system. Three patients had a tibial extra-articular deformity, six had a femoral extra-articular deformity, and four had an intramedullary nail in the femur. Preoperative and postoperative mechanical axes were measured from full-length lower extremity radiographs to evaluate alignment. The alignment of prosthetic components in the frontal and sagittal planes was determined by postoperative radiographs. Results At 30-days postoperative radiographic check, the hip knee ankle angle was within 2.0° (0 ± 1) of the neutral mechanical axis. The alignment of the tibial component on the frontal plane was 90.0° (range 89–91) and on the sagittal plane 5.0° (range 3–7). The alignment of the femoral component on the frontal plane was 90.0° (range 89–91) and on the sagittal plane 3.0° (range 0–5). Conclusion The alignment of the prosthetic components has been accurate and comparable to other navigation systems in literature without any increase in surgical times. The accelerometer-based navigation system is therefore a useful technique that can be used to optimize TKA alignment in patients with extra-articular deformity or with lower limb hardware, where the intramedullary guides cannot be applied. Level of Evidence This is an observational study without a control group, Level III.

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Symmetry function as a new tool for evaluating the symmetry of gait in transfemoral amputees

10.21203/rs.3.rs-49948/v1 ◽

2020 ◽

Author(s):

Slawomir Winiarski ◽

Alicja Rutkowska-Kucharska ◽

Mateusz Kowal

Keyword(s):

Time Series ◽

Gait Cycle ◽

Sagittal Plane ◽

Reaction Force ◽

Frontal Plane ◽

Symmetry Function ◽

The Difference ◽

Force Components ◽

Analysis System ◽

And Shifts

Abstract Background: Numerous studies have demonstrated significant asymmetries in unilateral amputee gait. The underlying dissimilarities between prosthetic and intact limbs have not yet been widely examined. To gain more insight into the functionality of asymmetries, we propose a new tool, the symmetry function (SF), to evaluate the symmetry of walking in terms of kinematic and dynamic variables of patients after unilateral transfemoral amputation and to identify areas with the largest side deviations in the movement cycle. Methods: An instrumented motion analysis system was used to register the gait of fourteen patients after unilateral trans-femoral amputation (TFA). Measurements involved evaluating the time series of gait variables characterizing a range of motion and the time series of the ground reaction force components. Comparison of the involved limb with the uninvolved limb in TFA patients was carried out on the basis of the SF values.Results: The symmetry function proved to be an excellent tool to localize the regions of asymmetry and their positive or negative directions in the full gait cycle. The difference between sides revealed by the symmetry function was the highest for the pelvis and the hip. In the sagittal plane, the pelvis was asymmetrically tilted, reaching the highest SF value of more than 25% at 60% cycle time. In the transverse plane, the pelvis was even more asymmetrically positioned throughout the entire gait cycle (50% difference on average). The hip in the frontal plane reached a 60% difference in SF throughout the single support phase for the prosthetic and then for the intact limb. Conclusions: The symmetry function allows for the detection of gait asymmetries and shifts in the center of gravity and may assess the precise in time adaptation of prostheses and rehabilitation monitoring, especially in unilateral impairments.Trial registration: The trial registration number (TRN): 379991 issued by the Australian New Zealand Clinical Trials Registry (ANZCTR) on 07.05.2020 (retrospectively registered).

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Characterization of Multiple Movement Strategies in Participants With Chronic Ankle Instability

Journal of Athletic Training ◽

10.4085/1062-6050-480-17 ◽

2019 ◽

Vol 54 (6) ◽

pp. 698-707 ◽

Cited By ~ 1

Author(s):

J. Ty Hopkins ◽

S. Jun Son ◽

Hyunsoo Kim ◽

Garritt Page ◽

Matthew K. Seeley

Keyword(s):

Sagittal Plane ◽

Ankle Instability ◽

Vertical Jump ◽

Frontal Plane ◽

Chronic Ankle Instability ◽

Control Group ◽

Ground Reaction Forces ◽

Sensorimotor Deficits ◽

Movement Strategies ◽

Reaction Forces

Context Chronic ankle instability (CAI) is characterized by multiple sensorimotor deficits, affecting strength, postural control, motion, and movement. Identifying specific deficits is the key to developing appropriate interventions for this patient population; however, multiple movement strategies within this population may limit the ability to identify specific movement deficits. Objective To identify specific movement strategies in a large sample of participants with CAI and to characterize each strategy relative to a sample of uninjured control participants. Design Descriptive laboratory study. Setting Biomechanics laboratory. Patients or Other Participants A total of 200 individuals with CAI (104 men, 96 women; age = 22.3 ± 2.2 years, height = 174.2 ± 9.5 cm, mass = 72.0 ± 14.0 kg) were selected according to the inclusion criteria established by the International Ankle Consortium and were fit into clusters based on movement strategy. A total of 100 healthy individuals serving as controls (54 men, 46 women; age = 22.2 ± 3.0 years, height = 173.2 ± 9.2 cm, mass = 70.7 ± 13.4 kg) were compared with each cluster. Main Outcome Measure(s) Lower extremity joint biomechanics and ground reaction forces were collected during a maximal vertical jump landing, followed immediately by a side cut. Data were reduced to functional output or curves, kinematic data from the frontal and sagittal planes were reduced to a single representative curve for each plane, and representative curves were clustered using a Bayesian clustering technique. Estimated functions for each dependent variable were compared with estimated functions from the control group to describe each cluster. Results Six distinct clusters were identified from the frontal-plane and sagittal-plane data. Differences in joint angles, joint moments, and ground reaction forces between clusters and the control group were also identified. Conclusions The participants with CAI demonstrated 6 distinct movement strategies, indicating that CAI could be characterized by multiple distinct movement alterations. Clinicians should carefully evaluate patients with CAI for sensorimotor deficits and quality of movement to determine the appropriate interventions for treatment.

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Orthotic Insoles Improve Gait Symmetry and Reduce Immediate Pain in Subjects With Mild Leg Length Discrepancy

Frontiers in Sports and Active Living ◽

10.3389/fspor.2020.579152 ◽

2020 ◽

Vol 2 ◽

Author(s):

Charlotte Menez ◽

Maxime L'Hermette ◽

Jeremy Coquart

Keyword(s):

Sagittal Plane ◽

Research Question ◽

Frontal Plane ◽

Leg Length Discrepancy ◽

Leg Length ◽

Gait Symmetry ◽

Symmetry Index ◽

Length Discrepancy ◽

The Right ◽

Orthotic Insoles

Background: Mild leg length discrepancy can lead to musculoskeletal disorders; however, the magnitude starting from which leg length discrepancy alters the biomechanics of gait or benefits from treatment interventions is not clear.Research question: The aim of the current study was to examine the immediate effects of orthotic insoles on gait symmetry and pain on mild leg length discrepancy according to two groups of the leg length discrepancy (i.e., LLD ≤ 1 cm vs. LLD > 1 cm).Methods: Forty-six adults with mild leg length discrepancy were retrospectively included and classified into two groups (GLLD≤1cm or GLLD>1cm). All subjects underwent routine 3D gait analysis with and without orthotic insoles. The symmetry index was calculated to assess changes in gait symmetry between the right and left limbs. Pain was rated without (in standing) and with the orthotic insoles (after 30 min of use) on a visual analog scale.Results: There was a significant improvement in the symmetry index of the pelvis in the frontal plane (p = 0.001) and the ankle in the sagittal plane (p = 0.010) in the stance with the orthotic insoles independent from the group. Pain reduced significantly with the orthotic insoles independently from the group (p < 0.001).Significance: Orthotic insoles significantly improved gait symmetry in the pelvis in the frontal plane and the ankle in the sagittal plane, as well as pain in all subjects (both LLD ≤ 1 cm and LLD > 1 cm) suggesting that it may be appropriate to treat even mild leg length discrepancy.

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The first experience of arthroscopy in the case of aseptic necrosis of the femoral head

ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS ◽

10.15674/0030-59872021239-44 ◽

2021 ◽

pp. 39-44

Author(s):

Maxim Golovakha ◽

Vadym Kirichenko ◽

Olexandra Grytsenko ◽

Rostyslav Tytarchuk ◽

Stanislav Bondarenko

Keyword(s):

Femoral Head ◽

Avascular Necrosis ◽

Hip Joint ◽

Comparison Group ◽

Long Term Results ◽

Control Group ◽

Study Group ◽

Hip Joint Replacement ◽

Therapeutic Exercises

Observation of patients with avascular necrosis of the femoral head formed a hypothesis about inability to eliminate the hip contracture by tunneling the femoral head on the background of drug therapy and therapeutic exercises, which causes an unsatisfactory outcomes. Therefore, the was idea to use arthroscopy for performing capsulotomy, synovectomy and removal of free cartilage and bone fragments. Objective. To evaluate efficiency of arthroscopy in patients with avascular necrosis of the femoral head. Methods. In the period from 2010 to 2018, 60 patients were observed. With the I–II stages, absence of inflammatory processes in the joint, body mass index less than 35. In the comparison group (28 patients) we made only tunneling of the femoral head, in the study group (32) at first we performed arthroscopy of the hip joint, capsulotomy, synovectomy, removal of cartilage fragments, and only then — tunneling. We analyzed the proportion of hip joint replacement that was performed in the long term follow up and the intensity of pain by visual analog scale. Results. During arthroscopy we often revealed the joint cartilage lesions — 30 %, articular labrum lesions — 5 %, synovitis — 100 %, CAM impingement — 90 %. In the study group in the first 2 weeks after surgery, the pain was severe more than in the comparison group. Then the pain rate became the same in both groups. In the control group in the period from 3 to 5 years after tunneling of the femoral head, arthroplasty was performed in 11 patients (39.3 %), in the study group for 2 to 3 years after surgery — 8 (25.0 %). Conclusions. Analysis of long-term results of tunneling of the femoral head with arthroscopy of the hip joint in patients with avascular necrosis of the femoral head showed improvement in hip function, no disease progression in 60–75 % patients in 2–3 years after surgery.

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Three-dimensional analysis of gait in children and adolescents with juvenile idiopathic arthritis

Acta of Bioengineering and Biomechanics ◽

10.37190/abb-01511-2019-02 ◽

2020 ◽

Vol 22 (2) ◽

Author(s):

Katarzyna Bazarnik-Mucha ◽

Sławomir Snela ◽

Magdalena Szczepanik ◽

Agnieszka Jarmuziewicz ◽

Agnieszka Guzik ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Children And Adolescents ◽

Sagittal Plane ◽

Gait Pattern ◽

Rehabilitation Program ◽

Control Group ◽

Study Group ◽

Healthy Children ◽

Rehabilitation Center ◽

Abnormal Gait

Purpose: The paper aimed to assess the gait pattern in children and adolescents with juvenile idiopathic arthritis (JIA) treated at the rehabilitation center and to assess changes in this pattern after the end of treatment and 9 months later. Methods: 50 children with JIA were enrolled into the study. 35 healthy volunteers were enrolled into the study for a comparison. Spatiotemporal and kinematic gait parameters were obtained using a movement analysis system. The Gait Deviation Index (GDI) was calculated. The assessment was performed three times: on the day of admission to the rehabilitation center, after the end of a 4-week treatment period and 9 months later. Results: With regard to the majority of spatiotemporal and kinematic parameters, differences in their distribution were highly statistically significant between the study group and the control group (p < 0.001). In two subsequent tests, differences were less significant when compared to the control group (p < 0.01). In the study group, ranges of motion in the sagittal plane in the hip (p < 0.01), knee (p < 0.001) and ankle joints (p < 0.01) increased significantly between tests 1 and 2, and 1 and 3. A significantly lower value of GDI was observed in the study group (right limb; p = 0.036). Conclusions: The gait pattern of children with JIA is significantly different from the one observed in healthy children. A rehabilitation program significantly improved gait in children with JIA, but differences compared to healthy children were still observed, and it indicates that the abnormal gait pattern became permanent in this group of subjects.

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Hip abduction and supported standing affect the ranges of hips extension in spinal muscular atrophy patients

Polish Annals of Medicine ◽

10.29089/2020.20.00141 ◽

2020 ◽

Author(s):

Agnieszka Stępień ◽

Joanna Sikora-Chojak ◽

Katarzyna Maślanko ◽

Wojciech Kiebzak

Keyword(s):

Spinal Muscular Atrophy ◽

Hip Joint ◽

Sagittal Plane ◽

Muscular Atrophy ◽

Lower Limbs ◽

Control Group ◽

Hip Joints ◽

Hip Abduction ◽

And Control ◽

Healthy Participants

Introduction: Recommendations for management of spinal muscular atrophy (SMA) do not contain detailed information about the position of lower limbs during support standing. It has been observed that during the measurement of the range of extension in the hip joint (HE) in SMA patients, the examined limb was often naturally abducted. Aim: The main aim of the study was to compare the values of HE in the sagittal plane and in abduction, and to assess the correlation between the duration of supported standing and HE in SMA patients. Material and methods: The study group consisted of 75 SMA individuals aged 2–22 years and control group consisted of 202 healthy participants. The measurements were performed with the Rippstein plurimeter and goniometer. Results and discussion: Range of HE in SMA patients was larger in abduction than in the sagittal plane. A correlation was noted between the duration of supported standing and HE. Conclusions: Supported standing with hip joint abduction should be used in SMA patients. The obtained results broaden the knowledge about the biomechanics of hip joints in SMA patients.

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Does Regular Dancing Improve Static Balance?

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105056 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5056

Author(s):

Przemysław Stawicki ◽

Agnieszka Wareńczak ◽

Przemysław Lisiński

Keyword(s):

Sagittal Plane ◽

Frontal Plane ◽

Standing Position ◽

Control Group ◽

Static Balance ◽

Mean Velocity ◽

Foot Placement ◽

Eyes Closed ◽

Eyes Open ◽

Closed Position

The aim of the study was to compare the static balance of dancers and non-dancers in a bipedal and unipedal stance. Twenty-three female dancers (mean age: 21.3 ± 1.7) and 24 age and sex-matched subjects (mean age 22.3 ± 1.0) participated in this study. A force platform was used to assess balance. The tests on the balance platform were performed in several positions with different foot placement, such as normal standing (NS) eyes open and eyes closed positions, semi-tandem position (ST), tandem position (TP), and one-leg standing (1L) eyes open and eyes closed position. Significant differences in balance between the dancers and the control group, especially in the tandem position and one-leg standing position with eyes closed were found. We observed higher results for the velocity of the COP in the frontal plane in the TP with a dominant limb in front (p = 0.04) and higher results for the velocity of the COP in the frontal plane (p = 0.01) and in the sagittal plane (p < 0.01) in the TP with a dominant limb in front in the control group. We also observed significant differences between groups in the mean velocity of COP sway in the sagittal plane in the 1 L position with eyes closed (p = 0.04). We concluded that dancing regularly for several years improves static balance.

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Gait Symmetry Analysis in Patients after Treatment of Pilon Fractures by the Ilizarov Method

Symmetry ◽

10.3390/sym13020349 ◽

2021 ◽

Vol 13 (2) ◽

pp. 349 ◽

Cited By ~ 1

Author(s):

Łukasz Pawik ◽

Paweł Wietecki ◽

Artur Leśkow ◽

Andżelika Pajchert Kozłowska ◽

Sławomir Żarek ◽

...

Keyword(s):

Lower Limb ◽

Healthy Subjects ◽

Lower Limbs ◽

Control Group ◽

Ilizarov Method ◽

Study Group ◽

Stride Time ◽

Gait Symmetry ◽

Gait Parameters ◽

Pilon Fractures

The aim of this study was to comprehensively assess the gait parameters in patients who had undergone treatment of pilon fractures by the Ilizarov method. We analyzed gait parameters in patients who had undergone treatment for pilon fractures by the Ilizarov method; 20 patients aged 47.0 years (25.2–78.6) were included in the study. The control group consisted of 32 healthy volunteers. Gait examination was performed using the pedobarographic platform. Statistically significant differences in the following gait parameters: maximum forefoot force (%), step length (cm), and step time (s) were found between the study group and the control group, between the nonoperated leg, and both the operated leg and the dominant limb. Statistically significant differences in the study group between the treated lower limb and the healthy lower limb were only observed in the case of the maximum forefoot force parameter (%). Healthy subjects from the control group obtained significantly higher values during locomotion for stride time, cadence step, and velocity than the patients, with stride time being statistically significantly shorter and the velocity and the cadence step higher. We observed symmetry in the gait parameters after treating pilon fractures by the Ilizarov method. This method of stabilization allows the restoration of gait parameters, with results similar to those obtained after the treatment of other motor organ pathologies described in the literature, although different from those observed in healthy subjects. In particular, the biomechanics of the lower limbs remain disturbed.

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Biomechanical Parameters of Gait after Unilateral Above-knee Amputation. Current State of Research

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0012.3355 ◽

2018 ◽

Vol 20 (4) ◽

pp. 245-256

Author(s):

Mateusz Kowal ◽

Małgorzata Paprocka Borowicz ◽

Anna Starczewska ◽

Alicja Rutkowska-Kucharska

Keyword(s):

Hip Joint ◽

Relevant Literature ◽

Reaction Force ◽

Range Of Movement ◽

Knee Amputation ◽

Current State ◽

Gait Parameters ◽

Pelvic Movement ◽

State Of Research ◽

Intact Limb

The aim of this paper is to present the current state of research on gait parameters in people after unilateral amputation above the knee joint and to compare these gait parameters with those of healthy people. The relevant literature does not include any similar publications. Modern prostheses do not eliminate the asymmetry of gait, although its consequences are diminished. An above-knee amputation leads to significant differences in ground reaction force parameters (GRF) between the sound and amputated limb. The amputated limb is characterised by lower values of vertical and antero-posterior GRF parameters in comparison with the intact limb. Moreover, during the contact of the heel with the ground, the degree of hip joint flexion of the amputated limb decreases in comparison with the intact limb. Other symptoms of asymmetry between the limbs include asymmetry of pelvic movement in the transverse plane and of the range of movement in the ankle joint. Decreased muscle torque on the hip joint in the amputated limb additionally increases asymmetry of biomechanical gait parameters after unilateral transfemoral amputation.

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