Gait & posture最新文献_第4页

Biomechanical effects of human-mobility aid interaction: A narrative review

IF 2.2 3区医学 Q3 NEUROSCIENCES

Gait & posture

Pub Date : 2025-01-15 DOI: 10.1016/j.gaitpost.2025.01.009

Yanyu Zhang , Chunjing Tao , Hansheng Wang , Yubo Fan

Background

The clinical benefits and widespread use of traditional mobility aids (such as canes, walking frames, wheeled walkers, etc.) have been hampered by improper use, fear of falling, and social stigma. Clarifying the biomechanical impacts of using mobility aids on users is fundamental to optimizing rehabilitation programs.

Research question

What are the biomechanical consequences of human-aid interaction and what differences in variables exist across patients and devices?

Methods

English-language articles from 2000 to May 2024 were identified by searching Web of Science, PubMed, and Google Scholar for the keywords "mobility aids," "walking aids," "assistive devices," "cane," "walking stick," "walking frame," "walker," or "rollator." Articles related to Nordic sticks, crutches, or wheelchairs, as well as dissertations and studies reported only in abstract form, were excluded.

Results

The biomechanical consequences of assisted gait are significantly variable due to individual characteristics, device configuration, and environmental conditions. It is essential to assess the user's residual abilities and assistive needs to determine how the aid will be operated. Appropriate mobility aid selection, height adjustment, and weight-bearing support can enhance the user's functional compensation for the affected side, improving gait, reducing lower limb joint loads, and stimulating muscle activation. Conversely, inappropriate prescriptions may lead to increased energy expenditure and cognitive demands, as well as harm to healthy tissues. Additionally, environmental factors should be taken into account to improve the usability of mobility aids in real-life situations.

Significance

Low adherence to the use of mobility aids has been influenced by mixed factors in different patient populations. These biomechanical findings provide important support for optimizing personalized guidance and improving assistive device design.

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引用次数: 0

Bipedal static postural stability in children with achondroplasia compared to typically developed children in the age range of 9–12 years – A pilot study

IF 2.2 3区医学 Q3 NEUROSCIENCES

Gait & posture

Pub Date : 2025-01-15 DOI: 10.1016/j.gaitpost.2025.01.005

M. Hergenröther , K. Palm , K. Mohnike , K. Witte

Background

Postural stability is a key factor in maintaining an upright standing position. Children with average height (CAH) have elaborate general postural stability up to the age of seven years. Children with achondroplasia (ACH) face body disproportions like shorter arms and legs, bowing of the legs as well as hyperlordosis and hypokyphosis in the spine. These misalignments might affect the postural stability of children with achondroplasia. Therefore, this study aims to investigate if there are differences between children with ACH and CAH in four different bipedal static balance tasks.

Methods

23 children (11 ACH & 12 CAH) participated in this study. Every subject performed four static balance tasks: bipedal standing on the ground (eyes open/closed) and bipedal standing on a foam pad (eyes open/closed). All trials were recorded on a force plate (AMTI) with 1000 Hz and a duration of 30 seconds for each condition. Parameters of interest are the length of CoP (mm), surface area 95 (mm²) as well as three defined ranges of frequency (low: 0.02 – 0.1 Hz, medium: 0.1 – 1 Hz, and high: 1 – 10 Hz) for anterior-posterior (AP) and mediolateral direction (ML). A Mann-Whitney U test was used to investigate the parameters length of CoP (AP & ML) and surface area 95 %. One-way ANOVA was used for the area under the curve parameter for each frequency range.

Results

Nonsignificant differences were found for all parameters. However, non-significant medium and strong effect sizes were detected for certain parameters of the frequency analysis.

Significance

Understanding strategies to maintain postural stability for ACH and CAH during a bipedal stance at a deeper level using frequency analysis helps to detect in which way disturbances might occur and how both cohorts react to those. Knowing the challenges of maintaining postural stability can help to develop therapeutic interventions to reduce disturbances.

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引用次数: 0

Evaluation of balance in children with hemophilia and the effect of balance on quality of life

IF 2.2 3区医学 Q3 NEUROSCIENCES

Gait & posture

Pub Date : 2025-01-15 DOI: 10.1016/j.gaitpost.2025.01.015

Esin Akbaş , Murat İnanır

Background

Repeated joint bleeds are reported to decrease static balance in children with hemophilia (CwH).

Research question

Is dynamic balance affected in CwH? Does dynamic balance affect the quality of life in these patients?

Methods

This cross-sectional study included thirty male children aged 7–18 years diagnosed with hemophilia, along with thirty healthy male children as controls. Dynamic balance was evaluated using the limits of stability (LOS) test and a fall risk test, both conducted via the Biodex Balance System. The quality of life for the hemophilia group was measured using the Hemophilia-Specific Quality of Life Index (Haemo-QoL). The results of the LOS test were compared between the groups using Student’s t-test, and the fall risk test was undertaken with the Mann-Whitney U test. Correlations between balance assessments and Haemo-QoL scores were determined using Spearman’s correlation test.

Results

The median age was 13 years (interquartile range [IQR]=8) in the hemophilia group and 15 years (IQR=8) in the control group, with no significant age difference (p = 0.952). The hemophilia group scored significantly lower on LOS overall (p = 0.016), backward (p = 0.041), backward/right (p = 0.025), and backward/left (p = 0.005) measures. Fall risk scores were significantly higher in the hemophilia group (p = 0.024). LOS overall and fall risk scores had no correlation with Haemo-QoL scores (p = 0.583 and p = 0.805, respectively).

Significance

CwH exhibit reduced dynamic balance and an increased risk of falls compared to their healthy peers. However, dynamic balance appears to have no significant effect on quality of life in this group. These findings may guide the planning of rehabilitation programs for CwH.

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引用次数: 0

The effect of prosthetic alignment on lower limb kinetics in people with a transtibial bone-anchored prosthesis: An experimental within-subject study 假体对齐对经胫骨骨锚定假体患者下肢动力学的影响：一项实验研究。

IF 2.2 3区医学 Q3 NEUROSCIENCES

Gait & posture

Pub Date : 2025-01-14 DOI: 10.1016/j.gaitpost.2025.01.010

Alyssa M.G. Groeneveld , Niels Jonkergouw , Sjoerd M. Bruijn , Han Houdijk , Vera G.M. Kooiman , Ruud A. Leijendekkers , Maarten R. Prins

Background

The alignment of a bone-anchored prosthesis has consequences for the external moments around the residual joints and implant, and these external moments can lead to serious negative long-term effects. A clear understanding of the relationship between transtibial prosthetic alignment and external joint and implant moment for bone-anchored prosthetic users is still lacking.

Research question

What is the effect of systematic frontal plane prosthetic alignment changes on lower limb external joint moments in people with a transtibial bone-anchored prosthesis?

Methods

Participants underwent gait analysis on an instrumented dual belt treadmill. Between analyses, frontal-plane alignment adjustments were made, shifting the prosthetic foot 2, 4, and 6 mm medial and lateral in relation to the residual limb. The effect of alignment changes on frontal- and sagittal plane external joint moments during the stance phase of gait were assessed at the hip, knee, and implant level, using statistical parametric mapping regression analyses.

Results

Twenty-seven unilateral transtibial bone-anchored prosthesis users were included. Alignment changes had a significant effect on external frontal plane knee and implant moments on the prosthetic side, with the largest effect at the level of the implant. Incremental medial and lateral displacements resulted in a progressive increase or decrease of the external adduction moments, respectively. Alignment changes did not significantly affect external moments around the prosthetic hip, non-prosthetic joints in the frontal plane or in any of the evaluated joints or implant in the sagittal plane.

Significance

Mediolateral foot alignment changes have a considerable effect on the frontal plane external knee and implant moments at the prosthetic side of a transtibial bone-anchored prosthesis. The findings of this study can help prosthetists to anticipate and adjust alignment changes for transtibial BAP users to minimize joint moments before issues arise.

背景：骨锚定假体的对中会对残余关节和种植体周围的外部力矩产生影响，这些外部力矩会导致严重的长期负面影响。对于骨锚定假体使用者，对经胫骨假体对准与外关节和种植体力矩之间的关系仍缺乏清晰的认识。研究问题：系统额平面假体对齐改变对经胫骨骨锚定假体患者下肢外关节力矩的影响是什么？方法：参与者在器械双带跑步机上进行步态分析。在分析之间，进行额平面对齐调整，将假足相对于残肢内侧和外侧移动2、4和6 mm。采用统计参数映射回归分析，在步态站立阶段评估对齐改变对髋部、膝关节和植入物水平的正面和矢状面外关节力矩的影响。结果：纳入27例单侧经胫骨骨锚定假体使用者。对齐改变对假体侧膝关节外额平面和假体力矩有显著影响，其中在假体水平处影响最大。内侧和外侧位移的增加分别导致外内收力矩的增加或减少。对齐改变对假体髋关节周围的外部力矩、额平面的非假体关节或任何评估关节或矢状面植入物没有显著影响。意义：经胫骨骨锚定假体的内外侧足位改变对假体一侧的额平面、外膝关节和假体力矩有相当大的影响。本研究的结果可以帮助义肢医生预测和调整经胫骨BAP使用者的对齐变化，在问题出现之前将关节时刻降至最低。

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引用次数: 0

Sensory reweighting for balance in people living with Parkinson’s Disease: Postural adaptation, muscle co-contraction, and perceptual delays

IF 2.2 3区医学 Q3 NEUROSCIENCES

Gait & posture

Pub Date : 2025-01-14 DOI: 10.1016/j.gaitpost.2025.01.012

Paul McDonnell , Matthew Rodger , Luis Augusto Teixeira , Gary Mitchell , Michail Doumas

Background

Postural instability is common in people with Parkinson’s Disease (PwPD), increasing their risk of injurious falls. Evidence suggests a sensory reweighting deficit in PwPD, along with compensatory muscle co-contraction in response to postural challenges. During balance tasks requiring sensory reweighting, older adults exhibit elevated postural sway and muscle co-contraction, as well as longer perceptual delays, compared to young adults. Such responses may be exacerbated in PwPD, with implications for fall risk.

Research question

The aim of this study was to assess postural sway, muscle co-contraction, and perceptual delays in PwPD and healthy age-matched controls during a sensory reweighting balance task.

Methods

Eleven PwPD and 16 control participants completed a sensory reweighting protocol: standing without vision on a fixed platform (2-min), which then undergoes a period of body sway-referencing (3-min) before returning to its fixed position (2.5-min). Anteroposterior (AP) path length, co-contraction index (CCI), and perceptual delay were analysed across task phases.

Results

PwPD showed a longer delay in perceiving when the body sway-referenced platform returned to a fixed position. This perceptual delay in PwPD (43.40-s) was over double that observed in control participants (21.25-s). AP path length and co-contraction aftereffects were longer in control participants than PwPD.

Significance

Where conditions require it, PwPD can effectively adjust their reliance on proprioceptive information for postural control. However, the significant delay shown by PwPD in perceiving changes to sensory conditions could be detrimental during everyday sensory transitions, potentially increasing fall risk.

{"title":"Sensory reweighting for balance in people living with Parkinson’s Disease: Postural adaptation, muscle co-contraction, and perceptual delays","authors":"Paul McDonnell , Matthew Rodger , Luis Augusto Teixeira , Gary Mitchell , Michail Doumas","doi":"10.1016/j.gaitpost.2025.01.012","DOIUrl":"10.1016/j.gaitpost.2025.01.012","url":null,"abstract":"<div><h3>Background</h3><div>Postural instability is common in people with Parkinson’s Disease (PwPD), increasing their risk of injurious falls. Evidence suggests a sensory reweighting deficit in PwPD, along with compensatory muscle co-contraction in response to postural challenges. During balance tasks requiring sensory reweighting, older adults exhibit elevated postural sway and muscle co-contraction, as well as longer perceptual delays, compared to young adults. Such responses may be exacerbated in PwPD, with implications for fall risk.</div></div><div><h3>Research question</h3><div>The aim of this study was to assess postural sway, muscle co-contraction, and perceptual delays in PwPD and healthy age-matched controls during a sensory reweighting balance task.</div></div><div><h3>Methods</h3><div>Eleven PwPD and 16 control participants completed a sensory reweighting protocol: standing without vision on a fixed platform (2-min), which then undergoes a period of body sway-referencing (3-min) before returning to its fixed position (2.5-min). Anteroposterior (AP) path length, co-contraction index (CCI), and perceptual delay were analysed across task phases.</div></div><div><h3>Results</h3><div>PwPD showed a longer delay in perceiving when the body sway-referenced platform returned to a fixed position. This perceptual delay in PwPD (43.40-s) was over double that observed in control participants (21.25-s). AP path length and co-contraction aftereffects were longer in control participants than PwPD.</div></div><div><h3>Significance</h3><div>Where conditions require it, PwPD can effectively adjust their reliance on proprioceptive information for postural control. However, the significant delay shown by PwPD in perceiving changes to sensory conditions could be detrimental during everyday sensory transitions, potentially increasing fall risk.</div></div>","PeriodicalId":12496,"journal":{"name":"Gait & posture","volume":"117 ","pages":"Pages 342-348"},"PeriodicalIF":2.2,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Are challenging walking environments linked to falls or risk of falling in children with cerebral palsy? A systematic review

IF 2.2 3区医学 Q3 NEUROSCIENCES

Gait & posture

Pub Date : 2025-01-13 DOI: 10.1016/j.gaitpost.2025.01.008

Rebecca L. Walker , Thomas D. O’Brien , Gabor J. Barton , Bernie Carter , David M. Wright , Richard J. Foster

Background

Children with cerebral palsy (CP) regularly fall over and this has negative effects on their physical and psychosocial wellbeing (e.g., reduced activity participation). However, the reasons for falls are not well understood. The way in which children negotiate challenging walking environments (e.g., uneven surfaces), may reveal more about how falls occur as these environments require gait modifications to maintain stability. Stability in challenging walking environments has been explored for children with CP; however, it remains unclear how these lead to falls.

Research question

Do challenging walking environments that mimic those faced in the real-world, contribute to increased fall occurrence and fall risk in children with CP?

Methods

Five databases were searched, and 1386 records screened to include ambulatory children with CP, aged 5–18 years old, investigating dynamic walking in challenging environments, with outcomes of fall occurrence or fall risk. The full protocol for this review was registered on PROSPERO (CRD42021290456).

Results

Sixteen studies met the inclusion criteria. One study reported occurrence of stumbles, two reported no falls. Fifteen studies identified gait alterations used by children with CP in challenging environments. Twenty-four gait characteristics were identified to be indicative of cautious walking strategies and seven gait characteristics identified to increase fall risk, suggesting a potential link. However, limited evidence exists as to whether this reflects falls faced in the real-world.

Significance

Investigations into stability over challenging walking environments for children with CP are lacking any measures of fall occurrence. Investigations into the mechanisms that may contribute to high fall risk, or fall avoidance when negotiating obstacles, uneven surfaces, steep declines and stairs may reveal further causes of real-world falls, and in doing so inform future fall prevention techniques. Finally, understanding the multifaceted causes of falls in real-world challenging environments from the perspectives of children with CP is key for future research.

{"title":"Are challenging walking environments linked to falls or risk of falling in children with cerebral palsy? A systematic review","authors":"Rebecca L. Walker , Thomas D. O’Brien , Gabor J. Barton , Bernie Carter , David M. Wright , Richard J. Foster","doi":"10.1016/j.gaitpost.2025.01.008","DOIUrl":"10.1016/j.gaitpost.2025.01.008","url":null,"abstract":"<div><h3>Background</h3><div>Children with cerebral palsy (CP) regularly fall over and this has negative effects on their physical and psychosocial wellbeing (e.g., reduced activity participation). However, the reasons for falls are not well understood. The way in which children negotiate challenging walking environments (e.g., uneven surfaces), may reveal more about how falls occur as these environments require gait modifications to maintain stability. Stability in challenging walking environments has been explored for children with CP; however, it remains unclear how these lead to falls.</div></div><div><h3>Research question</h3><div>Do challenging walking environments that mimic those faced in the real-world, contribute to increased fall occurrence and fall risk in children with CP?</div></div><div><h3>Methods</h3><div>Five databases were searched, and 1386 records screened to include ambulatory children with CP, aged 5–18 years old, investigating dynamic walking in challenging environments, with outcomes of fall occurrence or fall risk. The full protocol for this review was registered on PROSPERO (CRD42021290456).</div></div><div><h3>Results</h3><div>Sixteen studies met the inclusion criteria. One study reported occurrence of stumbles, two reported no falls. Fifteen studies identified gait alterations used by children with CP in challenging environments. Twenty-four gait characteristics were identified to be indicative of cautious walking strategies and seven gait characteristics identified to increase fall risk, suggesting a potential link. However, limited evidence exists as to whether this reflects falls faced in the real-world.</div></div><div><h3>Significance</h3><div>Investigations into stability over challenging walking environments for children with CP are lacking any measures of fall occurrence. Investigations into the mechanisms that may contribute to high fall risk, or fall avoidance when negotiating obstacles, uneven surfaces, steep declines and stairs may reveal further causes of real-world falls, and in doing so inform future fall prevention techniques. Finally, understanding the multifaceted causes of falls in real-world challenging environments from the perspectives of children with CP is key for future research.</div></div>","PeriodicalId":12496,"journal":{"name":"Gait & posture","volume":"117 ","pages":"Pages 306-316"},"PeriodicalIF":2.2,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Estimating the paths and mechanical behaviors of the plantar aponeurosis during dynamic movements using a multiple-marker foot model incorporating anatomically-detailed plantar aponeurosis morphology 利用多标记足模型，结合解剖细节足底腱膜形态，评估动态运动过程中足底腱膜的路径和力学行为。

IF 2.2 3区医学 Q3 NEUROSCIENCES

Gait & posture

Pub Date : 2025-01-11 DOI: 10.1016/j.gaitpost.2025.01.007

Yuka Matsumoto , Naohiko Kanemura , Naomichi Ogihara

Background

Several foot models have been developed to estimate the behaviors of the plantar aponeurosis (PA) during movements. However, these models did not consider the actual path of the PA, and their validity remains insufficiently investigated due to the absence of direct PA measurement during movements.

Research question

Would developing a foot model that considers the actual path of the PA improve the accuracy of estimating the PA behavior during movements?

Methods

The foot model was developed based on the CT scans of the six feet with 20 markers attached. An average foot model was created by calculating the mean positions of the 20 markers and 21 PA landmarks.　The PA on the average foot model was warped onto the motion-captured foot based on the marker positions using the thin-plate spline function to create the subject-specific model of the PA. To estimate the PA behaviors during movements, each of the PA landmarks was represented in an adjacent local coordinate system, and the time changes in the positions of the PA landmarks in the laboratory coordinate system were calculated.

Results

The present foot model incorporating the anatomically-detailed PA morphology estimated paths and lengths of the PA more accurately than the conventional PA model. Dynamic behaviors of the PA during walking and drop-jump were also successfully estimated.

Significance

Incorporating the anatomically detailed PA morphology into the foot model can improve the accuracy of the path and length estimates of the PA. The developed anatomically detailed PA model might serve as a useful tool to clarify the PA function, mechanical effects, and pathogenetic mechanisms underlying foot disorders such as plantar fasciitis.

背景：已经开发了几种足模型来估计足底腱膜（PA）在运动过程中的行为。然而，这些模型并没有考虑到PA的实际路径，而且由于在运动过程中没有直接测量PA，它们的有效性仍然没有得到充分的研究。研究问题：开发一个考虑足部实际路径的足部模型是否会提高估计运动过程中足部行为的准确性？方法：在CT扫描的基础上建立足部模型，并附有20个标记物。通过计算20个标记和21个PA标记的平均位置，创建了一个平均脚模型。基于标记位置，利用薄板样条函数将平均足部模型上的足部扭曲到运动捕获足上，创建足部的受试者特定模型。为了估计运动过程中PA的行为，将每个PA的地标表示在相邻的局部坐标系中，并计算实验室坐标系中PA地标位置的时间变化。结果：结合解剖细节的足部形态模型比常规足部模型更准确地估计足部路径和长度。同时，成功地估计了机器人在行走和落体跳跃过程中的动态行为。意义：将解剖学上详细的足跖点形态纳入足部模型可以提高足跖点路径和长度估计的准确性。解剖学上详细的PA模型可以作为阐明PA功能、机械效应和足底筋膜炎等足部疾病的发病机制的有用工具。

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引用次数: 0

In vivo ankle kinetics after surgical management of concurrent chronic ankle instability and osteochondral lesions of the talus 手术治疗并发慢性踝关节不稳定和距骨软骨病变后的体内踝关节动力学。

IF 2.2 3区医学 Q3 NEUROSCIENCES

Gait & posture

Pub Date : 2025-01-10 DOI: 10.1016/j.gaitpost.2025.01.006

Shengxuan Cao , Yungu Chen , Yunchao Zhu , Shuyun Jiang , Yan Yu , Xu Wang , Xin Ma

Background

Ankle joint moment and reaction force alteration after surgical treatment of chronic ankle instability (CAI) and osteochondral lesions of the talus (OLT) remains unknown.

Research question

The current study aimed to investigate the in vivo kinetic effects of surgical management on patients with CAI and OLT and conduct a comparison with healthy subjects.

Methods

Eight patients with concurrent CAI and OLT were assessed in a stair descent setting prior to surgical management and one-year postoperatively. For inverse dynamic analysis, ground reaction forces and trajectories of skin markers were imported to AnyBody Modelling System to calculate the ankle joint reaction force and external ankle moment. One-dimensional statistical parametric mapping was performed for the comparison of ankle kinetic curves during gait cycle among healthy subjects, patients before surgery and patients after surgery.

Results

Preoperative patients displayed increased dorsiflexion moment compared with healthy subjects during 38.2 %–40.9 % of the gait cycle and during 38.1 %–41.1 % of the gait cycle with postoperative patients. Preoperative patients showed an increased anterior shear force compared with healthy subjects during 42.2 %–43.7 % of the gait cycle, and 42.8 %–43.2 % of the gait cycle with postoperative patients. Patients exhibited an increased maximal medial force preoperatively and postoperatively compared with healthy subjects (p < 0.001).

Significance

One-stage surgical treatment of CAI and OLT can decrease the excessive dorsiflexion moment and anterior force of the ankle joint. Excessive medial force of the ankle joint was partially decreased postoperatively, but it still significantly increased compared with that of healthy subjects. Such a finding may be attributed to impaired peroneal activation and requires additional rehabilitative treatment.

背景：手术治疗慢性踝关节不稳（CAI）和距骨软骨病变（OLT）后踝关节力矩和反作用力的改变尚不清楚。研究问题：本研究旨在探讨手术处理对CAI和OLT患者体内动力学的影响，并与健康受试者进行比较。方法：对8例同时行CAI和OLT的患者进行手术前和术后1年的楼梯下行评估。在逆动力学分析中，将地面反作用力和皮肤标记物的运动轨迹导入到任何人建模系统中，计算踝关节反作用力和踝关节外力矩。采用一维统计参数映射法比较健康受试者、术前患者和术后患者在步态周期中的踝关节动力学曲线。结果：术前患者在38.2 %-40.9 %的步态周期内和术后患者在38.1 %-41.1 %的步态周期内，与健康受试者相比，背曲力矩增加。术前患者在42.2% %- 43.7% %的步态周期和术后患者在42.8% %- 43.2% %的步态周期内，与健康受试者相比，前切力增加。与健康者相比，患者术前和术后最大内侧力均有所增加（p ）。意义：CAI和OLT一期手术治疗可减少踝关节过度背屈力矩和前用力。术后踝关节内侧力过大虽部分减轻，但与健康者相比仍明显增加。这种发现可能归因于腓骨激活受损，需要额外的康复治疗。

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引用次数: 0

Split tendon transfer of the posterior tibialis for spastic equinovarus foot deformity: Does tendon routing impact post-operative ankle kinematics? 胫骨后肌分离肌腱转移治疗痉挛性马蹄内翻足畸形：肌腱移位是否影响术后踝关节运动学？

IF 2.2 3区医学 Q3 NEUROSCIENCES

Gait & posture

Pub Date : 2025-01-08 DOI: 10.1016/j.gaitpost.2025.01.003

Frances Scheepers , Tim Bhatnagar , Karen Davies , Diane Wickenheiser , Alec Black , Kishore Mulpuri , Christine M. Alvarez , Lise Leveille

Background

Split tendon transfer of the posterior tibialis (SPOTT) is a surgical procedure in which the split posterior tibialis tendon is transferred posterior to the fibula (PO) with insertion on the peroneus brevis tendon to rebalance the forces across the hindfoot. Routing of the split tendon through the interosseous membrane (IO) is a variation with the potential benefit of augmenting ankle dorsiflexion in swing.

Research question

Does IO routing improve ankle dorsiflexion in swing and/or varus in stance compared to PO routing?

Methods

A retrospective chart review was completed to identify forty-two patients who underwent a SPOTT procedure for equinovarus foot deformity. 14 patients received IO routing and 28 received PO routing. Two main outcomes: maximum ankle dorsiflexion in swing and average ankle coronal angle in stance were analyzed using a mixed effects model.

Results

Both the IO and PO routing significantly improved maximum dorsiflexion in swing (p = 0.018 and p = 0.001, respectively.) There was no significant difference in the maximum dorsiflexion during swing, post-operatively, between the two groups (p = 0.431). Pre-operatively, patients in the IO group exhibited significantly more average ankle varus during stance, with a median of 6.7 degrees of varus compared to a median of 1.8 degrees of varus in the PO group (p = 0.024). The IO group yielded a statistically significant reduction in average ankle varus during stance (p < 0.001) whereas there was no significant change in the PO group (p = 0.138). There was no difference between groups in proportion of patients that achieved an average ankle coronal angle during stance within one SD of normative data (between −8.7 and 0.7 degrees, p = 0.381).

Significance

The SPOTT procedure utilized for correction of spastic equinovarus foot deformity, can improve ankle kinematics with routing of the tendon through the IO membrane or posterior to the fibula if performed concurrently with the appropriate tendon lengthening to address equinus contracture. More clinical studies are needed to better understand potential confounding factors.

背景：胫骨后肌分裂肌腱转移术（SPOTT）是一种外科手术，将胫骨后肌分裂肌腱转移到腓骨后（PO），并插入腓骨短肌腱，以重新平衡横跨后脚的力量。分裂肌腱通过骨间膜（IO）的路径是一种变化，具有增强踝关节在摆动时背屈的潜在好处。研究问题：与PO路线相比，IO路线是否能改善踝关节在摇摆和/或站内翻时的背屈？方法：回顾性分析42例接受SPOTT手术治疗马蹄内翻足畸形的患者。14例患者接受IO路由，28例患者接受PO路由。采用混合效应模型分析两种主要结果：摆动时最大踝关节背屈度和站立时平均踝关节冠状角。结果：IO和PO路由均显著改善了摆动时的最大背屈度（p = 0.018,p = 0.001）。两组患者术后摆动时最大背屈度差异无统计学意义（p = 0.431）。术前，IO组患者在站立时表现出明显更多的平均踝关节内翻，中位内翻为6.7度，而PO组中位内翻为1.8度（p = 0.024）。意义：SPOTT手术用于纠正痉挛性马蹄内翻足畸形，如果同时进行适当的肌腱延长以解决马蹄挛缩，可以通过肌腱穿过IO膜或腓骨后的路径改善踝关节运动学。需要更多的临床研究来更好地了解潜在的混杂因素。

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引用次数: 0

Gait during community ambulation and laboratory-based walking in people with mild traumatic brain injury 轻度创伤性脑损伤患者社区行走和实验室行走时的步态。

IF 2.2 3区医学 Q3 NEUROSCIENCES

Gait & posture

Pub Date : 2025-01-08 DOI: 10.1016/j.gaitpost.2025.01.002

Prokopios Antonellis , Jae W. Lee , Peter C. Fino , Margaret M. Weightman , Siting Chen , Margaret E. Stojak , Mark E. Lester , Carrie W. Hoppes , Leland E. Dibble , Laurie A. King

Background

Gait impairments are common in individuals with mild traumatic brain injury (mTBI), presenting in the acute phase and often persisting in subtle ways over time. Despite the prominence of laboratory gait evaluations, a comprehensive understanding of gait deficits post-mTBI necessitates the examination of various gait domains in real-world environments. Assessing gait during a community ambulation task (CAT) may capture real-world challenges and influence focused interventions or rehabilitation in individuals with mTBI.

Research Question

The aim of the study was to compare gait performance across independent gait domains in individuals with and without mTBI using wearable sensors during both the CAT and laboratory tasks (i.e., 1-minute walk test). Additionally, associations between the CAT and single- and dual-task walking were investigated.

Methods

In this cross-sectional study, 107 participants, including individuals with mTBI (n = 52) and healthy controls (n = 55), underwent gait assessments during the CAT and 1-minute walk tests (single- and dual-task) using wearable sensors. Four independent gait domains (i.e., gait variability, pace, rhythm, and turning), consisting of thirteen gait variables, were analyzed. Statistical methods included t-tests and partial correlations, adjusted for covariates.

Results

Individuals with mTBI exhibited gait deficits across multiple gait domains. Specifically, increased gait variability, decreased gait pace and turns post mTBI were seen in the CAT and 1-minute walk tests. Notably, the CAT task exhibited greater gait differences in terms of gait variability and pace compared to the laboratory tasks. Across gait domains, the CAT revealed greater number of correlated measures with dual-task walking compared to single-task walking.

Significance

The community ambulation walking task showed more abnormalities across gait domains compared to laboratory walking tests, highlighting the potential importance of incorporating real-life, community ambulatory tasks into post-mTBI evaluation of mobility.

背景：步态障碍在轻度创伤性脑损伤（mTBI）患者中很常见，表现为急性期，并经常以微妙的方式持续一段时间。尽管实验室步态评估很重要，但要全面了解mtbi后的步态缺陷，需要在现实环境中检查各种步态域。评估社区行走任务（CAT）期间的步态可能会捕捉到现实世界的挑战，并影响mTBI患者的重点干预或康复。研究问题：该研究的目的是在CAT和实验室任务（即1分钟步行测试）中，使用可穿戴传感器比较有和没有mTBI的个体在独立步态域的步态表现。此外，还研究了CAT与单任务和双任务行走之间的关系。方法：在这项横断面研究中，107名参与者，包括mTBI患者（n = 52）和健康对照者（n = 55），在CAT和1分钟步行测试（单任务和双任务）期间使用可穿戴传感器进行步态评估。分析了由13个步态变量组成的4个独立的步态域（即步态变异性、步伐、节奏和转身）。统计方法包括t检验和部分相关性，并根据协变量进行调整。结果：mTBI患者表现出多个步态域的步态缺陷。具体来说，在CAT和1分钟步行测试中，可以看到mTBI后步态变异性增加，步态速度和转弯次数减少。值得注意的是，与实验室任务相比，CAT任务在步态变异性和速度方面表现出更大的步态差异。在整个步态域，CAT揭示了与单任务行走相比，双任务行走有更多的相关测量。意义：与实验室步行测试相比，社区步行任务显示出更多的步态域异常，突出了将现实生活中的社区步行任务纳入mtbi后活动能力评估的潜在重要性。

{"title":"Gait during community ambulation and laboratory-based walking in people with mild traumatic brain injury","authors":"Prokopios Antonellis , Jae W. Lee , Peter C. Fino , Margaret M. Weightman , Siting Chen , Margaret E. Stojak , Mark E. Lester , Carrie W. Hoppes , Leland E. Dibble , Laurie A. King","doi":"10.1016/j.gaitpost.2025.01.002","DOIUrl":"10.1016/j.gaitpost.2025.01.002","url":null,"abstract":"<div><h3>Background</h3><div>Gait impairments are common in individuals with mild traumatic brain injury (mTBI), presenting in the acute phase and often persisting in subtle ways over time. Despite the prominence of laboratory gait evaluations, a comprehensive understanding of gait deficits post-mTBI necessitates the examination of various gait domains in real-world environments. Assessing gait during a community ambulation task (CAT) may capture real-world challenges and influence focused interventions or rehabilitation in individuals with mTBI.</div></div><div><h3>Research Question</h3><div>The aim of the study was to compare gait performance across independent gait domains in individuals with and without mTBI using wearable sensors during both the CAT and laboratory tasks (i.e., 1-minute walk test). Additionally, associations between the CAT and single- and dual-task walking were investigated.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, 107 participants, including individuals with mTBI (n = 52) and healthy controls (n = 55), underwent gait assessments during the CAT and 1-minute walk tests (single- and dual-task) using wearable sensors. Four independent gait domains (i.e., gait variability, pace, rhythm, and turning), consisting of thirteen gait variables, were analyzed. Statistical methods included t-tests and partial correlations, adjusted for covariates.</div></div><div><h3>Results</h3><div>Individuals with mTBI exhibited gait deficits across multiple gait domains. Specifically, increased gait variability, decreased gait pace and turns post mTBI were seen in the CAT and 1-minute walk tests. Notably, the CAT task exhibited greater gait differences in terms of gait variability and pace compared to the laboratory tasks. Across gait domains, the CAT revealed greater number of correlated measures with dual-task walking compared to single-task walking.</div></div><div><h3>Significance</h3><div>The community ambulation walking task showed more abnormalities across gait domains compared to laboratory walking tests, highlighting the potential importance of incorporating real-life, community ambulatory tasks into post-mTBI evaluation of mobility.</div></div>","PeriodicalId":12496,"journal":{"name":"Gait & posture","volume":"117 ","pages":"Pages 254-260"},"PeriodicalIF":2.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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