Assessment of the Kinematic Adaptations in Parkinson’s Disease Using the Gait Profile Score: Influences of Trunk Posture, a Pilot Study

Introduction: Postural abnormalities are common in patients with Parkinson’s disease (PD) and lead to gait abnormalities. Relationships between changes in the trunk posture of PD patients and gait profile score (GPS) and gait spatiotemporal parameters are poorly investigated. The aim of the current study was to investigate the relationships between trunk posture, GPS, and gait spatiotemporal parameters, in patients with PD. Materials and Methods: Twenty-three people with PD and nineteen age-matched healthy people participated in this study. A 3D gait kinematical analysis was applied to all participants using the Plug-In Gait Full BodyTM tool. Trunk and limb kinematics patterns and gait spatio-temporal parameters of patients with PD and the control group were compared. Additionally, correlations between trunk kinematics patterns, gait spatio-temporal parameters, and GPS of the PD group were tested. Results: Cadence, opposite foot off, step time, single support, double support, foot off, gait speed, trunk kinematics, and GPS showed significant differences between the two groups (p ≤ 0.05). Posture of the trunk during gait was not related to the spatio-temporal parameters and gait profile score in the PD group. The trunk flexor pattern influenced GPS domains, mainly of the ankle and the knee. Discussion and Conclusions: Flexed posture of the trunk in patients with PD seems to influence both ankle and knee movement patterns during the gait. The GPS analysis provided direct and simplified kinematic information for the PD group. These results may have implications for understanding the importance of considering the positioning of the trunk during gait.

Standardized Biomechanical Investigation of Posture and Gait in Pisa Syndrome Disease

Pisa syndrome is one of the possible postural deformities associated with Parkinson’s disease and it is clinically defined as a sustained lateral bending of the trunk. Some previous studies proposed clinical and biomechanical investigation to understand the pathophysiological mechanisms that occur, mainly focusing on EMG patterns and clinics. The current research deals with the assessment of a standardized biomechanical analysis to investigate the Pisa syndrome postural effects. Eight patients participated in the experimental test. Both static posture and gait trials were performed. An optoelectronic system and two force plates were used for data acquisition, while a custom multi-segments kinematic model of the human spine was used to evaluate the 3D angles. All subjects showed an important flexion of the trunk superior segment with respect to the inferior one, with a strong variability among patients (range values between 4.3° and 41.0°). Kinematics, ground reaction forces and spatio-temporal parameters are influenced by the asymmetrical trunk posture. Moreover, different proprioception, compensation and abilities of correction were depicted among subjects. Considering the forces exchanged by the feet with the floor during standing, results highlighted a significant asymmetry (p-value = 0.02) between the omo and contralateral side in a normal static posture, with greater load distribution on the same side of lateral deviation. When asked to self-correct the posture, all patients demonstrated a reduction of asymmetry, but without stressing any statistical significance. All these aspects might be crucial for the definition of a PS patients’ classification and for the assessment of the efficacy of treatments and rehabilitation.

Walking Biomechanics and Spine Loading in Patients With Symptomatic Lumbar Spinal Stenosis

Symptomatic lumbar spinal stenosis is a leading cause of pain and mobility limitation in older adults. It is clinically believed that patients with lumbar spinal stenosis adopt a flexed trunk posture or bend forward and alter their gait pattern to improve tolerance for walking. However, a biomechanical assessment of spine posture and motion during walking is broadly lacking in these patients. The purpose of this study was to evaluate lumbar spine and pelvic sagittal angles and lumbar spine compressive loads in standing and walking and to determine the effect of pain and neurogenic claudication symptoms in patients with symptomatic lumbar spinal stenosis. Seven participants with symptomatic lumbar spinal stenosis, aged 44–82, underwent a 3D opto-electronic motion analysis during standing and walking trials in asymptomatic and symptomatic states. Passive reflective marker clusters (four markers each) were attached to participants at T1, L1, and S2 levels of the spine, with additional reflective markers at other spinal levels, as well as the head, pelvis, and extremities. Whole-body motion data was collected during standing and walking trials in asymptomatic and symptomatic states. The results showed that the spine was slightly flexed during walking, but this was not affected by symptoms. Pelvic tilt was not different when symptoms were present, but suggests a possible effect of more forward tilt in both standing (p = 0.052) and walking (p = 0.075). Lumbar spine loading during symptomatic walking was increased by an average of 7% over asymptomatic walking (p = 0.001). Our results did not show increased spine flexion (adopting a trunk-flexed posture) and only indicate a trend for a small forward shift of the pelvis during both symptomatic walking and standing. This suggests that provocation of symptoms in these patients does not markedly affect their normal gait kinematics. The finding of increased spine loading with provocation of symptoms supports our hypothesis that spine loading plays a role in limiting walking function in patients with lumbar spinal stenosis, but additional work is needed to understand the biomechanical cause of this increase.

The effect of upper limb lymphedema in posture of patients after breast cancer surgery

BACKGROUND: Upper limb lymphedema is one of the complications following breast cancer-related surgery. It is a fact that there are alterations in posture of the trunk following surgery, however, there is not much data on whether upper limb lymphedema has any effect on body posture. OBJECTIVES: The main purpose of the study was to investigate the effect of upper limb lymphedema in the trunk posture and spine mobility of patients following breast cancer surgery. METHODS: Twenty-seven women with lymphedema and 29 women without lymphedema with mastectomy or breast-conserving surgery participated in the study. Posture was evaluated by the New York Posture Rating Chart and spinal stability and thoracic mobility were evaluated by the Spinal Mouse device. RESULTS: Posture and spine posture scores were significantly higher in the without lymphedema group (p= 0.004; 0.041; respectively). There was a significant difference between the groups in terms of lateral (p< 0.001) and posterior (p< 0.001) view of shoulders, spine (p= 0.027), upper (p< 0.001) and lower back (p= 0.009), and trunk postures (p= 0.001). CONCLUSIONS: Body posture and spine are more affected due to upper limb lymphedema following breast cancer surgery. Alterations of posture mainly occur on shoulders, spine, upper and lower back, and trunk, but not on head and neck postures.

Trunk Posture during Manual Materials Handling of Beer Kegs

Craft brewing is a rapidly growing industry in the U.S. Most craft breweries are small businesses with few resources for robotic or other mechanical-assisted equipment, requiring work to be performed manually by employees. Craft brewery workers frequently handle stainless steel half-barrel kegs, which weigh between 13.5 kg (29.7 lbs.) empty and 72.8 kg (161.5 lbs.) full. Moving kegs may be associated with low back pain and even injury. In the present study, researchers performed a quantitative assessment of trunk postures using an inertial measurement unit (IMU)-based kinematic measurement system while workers lifted kegs at a craft brewery. Results of this field-based study indicated that during keg handling, craft brewery workers exhibited awkward and non-neutral trunk postures. Based on the results of the posture data, design recommendations were identified to reduce the hazardous exposure for musculoskeletal disorders among craft brewery workers.

The effects of differences on sagittal kinematics and muscle coordination during step up and step down in patients with spinal stenosis

BACKGROUND AND OBJECTIVE: Lumbar spinal stenosis (LSS) is a common spinal disorder that causes patients to assume a forward-trunk posture. Spinal alignment affects swing limb angles and stance limb muscle activities. Therefore, we investigated the effects of differences in step up (SU) and step down (SD) tasks on the kinematics of the trunk and swing limb as well as stance limb muscle coordination in patients with LSS. METHODS: Nine elderly female patients diagnosed with LSS were recruited for this study. The sagittal kinematics of the trunk and swing limb and isolated contraction ratio of the gluteus medius (GMed) and vastus lateralis (VL) during SU and SD tasks were measured using a motion analysis system and surface electromyography system. RESULTS: Thoracic (17.71∘± 7.77∘) and spine angles (13.64∘± 11.34∘) as well as swing hip (48.48 ± 12.76) and pelvic angles (7.52 ± 10.33) were significantly greater during SU than SD (10.14 ± 8.41, 10.03 ± 11.03, 29.42 ± 10.57, 3.21 ± 10.11, all P< 0.05, respectively). The isolated contraction ratio of the GMed of the stance limb (34.12% ± 13.28%) was significantly higher during SU than during SD (26.65% ± 10.02%), whereas that of the VL of the stance limb (65.88% ± 13.28%) was significantly lower during SU than during SD (73.35% ± 10.02%, P= 0.011 for both comparisons). CONCLUSIONS: Patients with LSS demonstrated trunk compensatory mechanisms to address swing hip and knee angles. Trunk position affected pelvic limb muscle coordination in the standing support limb. These findings demonstrate that SD are more challenging than SU for patients with LSS, possibly due to reduced ability to generate adequate leg extensor muscular output to safely control the motion of the body’s center of mass. Therefore, trunk positions must be considered when patients with LSS undergo rehabilitation programs, particularly those involving SD or descending stairs, so that healthcare professionals can better assist patients with LSS. In addition, this study provides a background for further studies.

Upper-Body Posture in Adolescent Pianists: A Cross-Sectional Study

AIMS: Although the significance of upper-body posture in relation to piano performance has often been highlighted, the role of experience remains unclear. The aim of this study was to examine selected upper body posture parameters in adolescent piano students of different performance level (beginners vs advanced). METHODS: Thirteen (13) adolescent piano students (14.7±0.5 yrs; 7 beginners and 6 advanced) volunteered. They all performed two specific major scales (G-major and E-major) in five octaves in two predetermined different tempi (slow and fast). An upper body biomechanical model consisting of 27 reflective markers was applied on specific bony landmarks. A 10-T camera Vicon system running Nexus 2 was employed to capture upper body motion—-a) sway of the trunk in relation to the instrument, b) finger/hand sway over the keyboard, c) overall hand movement, and d) spinal angles—-at selected moments of four different performances. RESULTS: Beginners demonstrated more trunk sway than their advanced counterparts (p<0.05), more finger/hand sway (p<0.05), more overall hand movement (p<0.05), and more flexed spinal angles at the start of their performance (p<0.05). Most of these differences appeared in the G-fast performances, whereas the G-slow equivalents revealed no differences. CONCLUSION: Less-experienced piano players are characterized by more movement in their trunk posture and more upper limb activity than their more advanced colleagues. Future research should examine whether interventional programs designed to alter upper-body posture would have beneficial effects in piano performance.