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Design of cushioned footwear for children with obesity based on gait dynamics and motion simulation 基于步态动力学和运动模拟的肥胖儿童减震鞋设计
Pub Date : 2023-09-01 DOI: 10.1016/j.gaitpost.2023.07.276
Yihong Zhao, Shiyang Yan, Ruoyi Li, Luming Yang, Bi Shi
Obesity will cause changes in foot structure and plantar pressure distribution, increasing the risk of foot pain and injury [1]. Functional footwear (outsole) is an essential way to distribute the local plantar pressure for children with obesity. However, the traditional design and research of outsoles need to go through the whole process of design, molding, production, fitting experiments, and so on, which is a long time and high-cost consumption. How to obtain the optimal design scheme of cushioned footwear for children with obesity through finite element analysis? Based on the database of foot morphology of children with obesity, a 3D outsole model was established, and the arch height of the outsole was set as 30%, 60%, and 100% of the arch height of children with obesity. Based on the anthropometric data, biomechanical data, and CT imaging data of children with obesity, a biomechanical simulation model of the lower limb musculoskeletal system and a finite element model of the foot were established. To verify the validity of the finite element model, the simulation results of the maximum principal stress of children with obesity during walking were compared with the actual measured data.The structure of the outsole is preliminarily constructed in Solidworks. The arch height (30%, 60%, and 100%) of the outsole was set to simulate the support at the arch. The foot-outsole-ground structure was assembled, and the pressure on the foot-shoe interface was simulated in ANSYS Workbench, to explore the dispersion effect of different arch heights. After obtaining the best design scheme, the actual relief effect of the outsoles was tested through the try-on trials. The simulation results showed that the 60% arch height support could effectively achieve the dispersion of plantar pressure in the plantar toe area and heel area. The try-on results showed that, when wearing the cushioned footwear, the peak pressure in the central forefoot and heel were relieved by 36.8% and 43.8%, respectively, from176.5 kPa and 310.9 kPa to 111.6 kPa and 174.7 kPa. Fig. 1 (a) 3D model of coushioned outsole. (b) Finite element analysis and verfication results. (c) Construction and assembly of the outsole structure. (d) The finite element analysis results between foot and outsole with the 60% arch height. (e) The cushioned footwear. (f) The cushioned effects of the outsole in the try-on experiments.Download : Download high-res image (244KB)Download : Download full-size image Through finite element analysis and fitting verification test, we found that when the arch height of the outsole is 60% of the arch height of the children with obesity, the decompression function is the best, which can transfer the pressure of the front palm and heel to the arch and toe. Finite element analysis makes functional shoe development process more efficient.
肥胖会引起足部结构和足底压力分布的改变,增加足部疼痛和损伤的风险[1]。功能鞋(大底)是肥胖儿童分配足底局部压力的重要途径。但是,传统的外底设计研究需要经过设计、成型、生产、试穿实验等全过程,时间长、成本高。如何通过有限元分析得到肥胖儿童减震鞋的最佳设计方案?根据肥胖儿童足部形态数据库,建立3D大底模型,设置大底足弓高度分别为肥胖儿童足弓高度的30%、60%和100%。基于肥胖儿童的人体测量数据、生物力学数据和CT成像数据,建立了下肢肌肉骨骼系统的生物力学仿真模型和足部的有限元模型。为了验证有限元模型的有效性,将肥胖儿童行走过程中最大主应力的仿真结果与实测数据进行对比。在Solidworks中初步构建了大底的结构。设置外底的足弓高度(30%,60%和100%)来模拟足弓处的支撑。对脚-外底-地面结构进行拼装,在ANSYS Workbench中模拟脚-鞋界面上的压力,探讨不同拱高的分散效应。获得最佳设计方案后,通过试穿试验,检验了外底的实际救济效果。仿真结果表明,60%足弓高度支撑能有效实现足底压力在足趾区和足跟区分散。试穿结果表明,穿缓冲鞋后,前足中央和脚跟的峰值压力分别从176.5 kPa和310.9 kPa降低到111.6 kPa和174.7 kPa,分别减轻了36.8%和43.8%。图1 (a)衬垫外底三维模型。(b)有限元分析和验证结果。(c)外底结构的建造和装配。(d) 60%拱高时足部与大底之间的有限元分析结果。(e)有衬垫的鞋子。(f)试穿实验中大底的缓冲效果。通过有限元分析和拟合验证试验,我们发现,当大底足弓高度为肥胖儿童足弓高度的60%时,减压功能最好,可以将前掌和脚跟的压力传递到足弓和脚趾。有限元分析使功能性鞋的开发过程更加高效。
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引用次数: 0
There is life outside the gait lab: Effectiveness of a self-organising neural map for recognising 24/7 activities of daily living 步态实验室之外还有生活:一种自组织神经地图的有效性,用于识别日常生活中的24/7活动
Pub Date : 2023-09-01 DOI: 10.1016/j.gaitpost.2023.08.018
Gabor Barton, Jacob Beesley, Jasmine Milnes, Gabriela Czanner, Lynne Boddy
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引用次数: 0
Reliability of 3D kinematic recording of jaw and head movements 下颌和头部运动的三维运动学记录的可靠性
Pub Date : 2023-09-01 DOI: 10.1016/j.gaitpost.2023.07.171
Evelina Nilsson, Helena Grip, Catharina Österlund
The jaw and neck sensorimotor systems are functionally integrated during jaw functions1,2. The jaw border movements include maximum opening, laterotrusion to left and right, protrusion and retrusion3. Three-dimensional (3D) kinematic movement analysis provide data to distinguish natural movement patterns from those adapted to pain and dysfunction. Therefore, the reliability of kinematics is crucial to assess movement variability of integrated jaw-neck motor capacity. Can we ensure a high accuracy of the novel method intended to use for estimation of maximum jaw movements and geometric characterization (area and volume)? Is there a high test-retest reliability and intraindividual consistency for a group of healthy participants performing maximum jaw movements? 3D kinematic analysis was used for movement recognition. The first part included three glass beakers of different sizes, with known volumes and the cross-sectional area was estimated with a geometrical algorithm. The percentage deviation between target values and estimated values was calculated and to test the agreement a linear regression was made. The second part included 17 healthy participants (25.37 years ± 2.36). Maximum jaw movements were performed in a pre-determined movement pattern to track reflective marker positions of jaw and head segments. Movement amplitudes, magnitudes, areas, and volumes were analyzed. Intraclass correlation coefficient (ICC)4 estimates and Bland-Altman plots5 were used to assess test – retest reliability. Coefficient of variation (CV)6 tested the within session reliability. Preliminary results for the beakers showed a total percentage deviation from the target area and volume of 0.03 (SD 0.59) and 0.72 (SD 0.81), respectively. The linear regression showed a linear agreement between estimated and target value with R2=0.99. Preliminary results of test – retest reliability per movement outcome variable showed moderate to excellent reliability according to ICC-classification4. The limits of agreement between test and retest session presented with Bland-Altman plots showed good agreement between first and second measurement. The intra individual movement variability expressed as CV showed good repeatability. Jaw movements including the horizontal directions displayed widest ICC 95% confidence interval and highest CV values. (Fig. 1. Coefficient of variation - box plots).Download : Download high-res image (67KB)Download : Download full-size image This study addressed reliability of kinematic parameters of maximum jaw movements and its geometrics. The preliminary main findings indicate high accuracy of the novel method for estimations of volume and area. The agreement between sessions was considered good as well as consistency in repeated movements. Moreover, the more complex movement, the lower reliability and higher variability was seen. In future research of jaw-neck motor function the presented method is suggested to enables valid analysis of jaw movement perf
颌骨和颈部感觉运动系统在颌骨功能中是功能整合的1,2。下颌边界运动包括最大开口、向左右侧挤、前突和后缩3。三维(3D)运动学运动分析提供了区分自然运动模式和适应疼痛和功能障碍的运动模式的数据。因此,运动学的可靠性对于评估综合颌颈运动能力的运动变异性至关重要。我们能否确保用于估计最大下颌运动和几何特征(面积和体积)的新方法的高精度?对于一组健康的参与者进行最大的下颌运动,是否存在高的重测信度和个体内一致性?采用三维运动学分析进行运动识别。第一部分包括三个不同大小的玻璃烧杯,体积已知,横截面积用几何算法估计。计算了目标值与估计值之间的百分比偏差,并进行了线性回归检验。第二部分纳入17名健康受试者(25.37岁±2.36岁)。在预先确定的运动模式下进行最大下颌运动,以跟踪下颌和头部部分的反射标记位置。分析运动幅度、幅度、面积和体积。用类内相关系数(ICC)4估计和Bland-Altman图5评估检验-重测信度。变异系数(CV)6检验了会话内信度。初步结果表明,烧杯与目标面积和体积的总偏差百分比分别为0.03 (SD 0.59)和0.72 (SD 0.81)。线性回归表明估计值与目标值线性一致,R2=0.99。根据icc分类,每个运动结果变量的测试-重测信度的初步结果显示中等至优异的信度。用Bland-Altman图表示的测试和复测之间的一致性界限表明第一次和第二次测量之间的一致性很好。以CV表示的个体内运动变异性具有良好的重复性。包括水平方向在内的下颌运动显示出最宽的ICC 95%置信区间和最高的CV值。(图1所示。变异系数(箱形图)。下载:下载高分辨率图像(67KB)下载:下载全尺寸图像本研究解决了最大下颌运动及其几何参数的可靠性问题。初步结果表明,该方法具有较高的体积和面积估算精度。两次训练之间的一致性和重复动作的一致性被认为是好的。运动越复杂,可靠性越低,变异率越高。在今后对颌颈运动功能的研究中,提出了一种有效分析下颌运动性能的方法。
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引用次数: 0
The effect of perturbation on hip kinematics of transtibial amputees 摄动对经胫截肢者髋关节运动学的影响
Pub Date : 2023-09-01 DOI: 10.1016/j.gaitpost.2023.07.229
Nimet Sermenli Aydın, İlke Kurt, Halit Selçuk, Sinem Salar, Sezer Ulukaya, Hilal Keklicek
Gait adaptation to perturbations is essential for safe interaction with the physical environment and therefore it is important to understand how people with lower-limb amputation adapt their gait to changing conditions (1). Previous studies tried to find some deviation patterns and understand the kinematic strategies of amputee's gait (2). However, there is limited information available on the hip kinematics of amputees during gait and there is no study has yet investigated the effect of the perturbation on the hip kinematics of amputees. How does unpredictable continuous perturbation during gait affect the hip kinematics of unilateral transtibial amputees? Individuals with unilateral trans-tibial amputations and using prostheses with an active vacuum plus carbon foot combination were included in to study. Kinematic data of the hip were collected from 11 amputees and 10 healthy controls during walking on two different ground conditions. Participants walked at least 512 steps at their preferred speed on a motorized treadmill’s (ReaxRun Pro) flat ground condition and then the gait analysis was repeated on a perturbed (5% unpredictable perturbation) ground condition. RehaGait- Pro system was used for evaluation of the kinematics of the hip(min-max hip angles and variability of the hip min-max angles) during gait. Negative values indicated hip hyperextension, positive values indicated hip flexion. The statistical analysis was performed by pairing the residual limbs of amputees with the non-dominant side of the healthy group (RL side), and the sound limbs with the dominant side of the healthy group (HL side). It was observed that the hip hyperextension angle on the sound limb side was bigger in the amputees than in the control group on flat (d=0.462; p=0.034) and perturbated ground (d=0.584; p=0.007). The effect size was larger on the perturbed ground. There was no difference in the maximum hip angles and variability of max-min hip angles between the groups in both ground conditions (p>0.05). The results showed in Table.Download : Download high-res image (142KB)Download : Download full-size image Amputation-related changes were observed in hip kinematics during walking under both ground conditions. However, this change was more prominent on the perturbated ground. The reason for the higher hip hyperextension values in amputees is thought to be due to their efforts to compensate for the ankle (exp. strong plantar flexion) movements. On the unpredictable perturbation ground, the limitation of ankle movements, which is one of the first adaptive mechanisms in adaptation to the ground (exp. subtalar rotations plus plantarflexion), may have made the situation more evident. Future studies may focus on the effect of gait training on perturbed surfaces on gait kinematics, which is an indicator of adaptation to variable conditions.
对扰动的步态适应对于与物理环境的安全交互至关重要,因此了解下肢截肢者如何适应变化的条件非常重要(1)。先前的研究试图找到一些偏差模式并了解截肢者的步态运动学策略(2)。关于截肢者步态时髋关节运动学的信息有限,目前还没有研究调查摄动对截肢者髋关节运动学的影响。步态中不可预测的连续扰动如何影响单侧经胫截肢者的髋关节运动学?单侧经胫骨截肢和使用主动真空加碳足组合假体的个体被纳入研究。收集了11名截肢者和10名健康对照者在两种不同地面条件下行走时的髋关节运动学数据。参与者在电动跑步机(ReaxRun Pro)的平坦地面条件下以他们喜欢的速度行走至少512步,然后在扰动(5%不可预测的扰动)的地面条件下重复步态分析。使用RehaGait- Pro系统评估步态过程中髋关节的运动学(髋最小最大角度和髋最小最大角度的可变性)。阴性值表示髋关节过伸,阳性值表示髋关节屈曲。将截肢者残肢与健康组非优势侧配对(RL侧),健全肢与健康组优势侧配对(HL侧)进行统计分析。结果显示,截肢者的健全肢侧髋关节过伸角在平面上大于对照组(d=0.462;P =0.034)和扰动地面(d=0.584;p = 0.007)。扰动地面的效应值更大。两种地面条件下各组最大臀角和最大-最小臀角变异性均无显著差异(p>0.05)。结果见表。下载:下载高分辨率图像(142KB)下载:下载全尺寸图像在两种地面条件下行走时,观察到与截肢相关的髋关节运动学变化。然而,这种变化在受扰动的地面上更为明显。截肢者髋关节超伸值较高的原因被认为是由于他们努力补偿踝关节(例如强烈的足底屈曲)运动。在不可预测的扰动地面上,脚踝运动的限制,这是适应地面的第一个适应机制之一(例如,距下旋转和跖屈),可能使情况更加明显。未来的研究可能会集中在摄动表面上的步态训练对步态运动学的影响,这是适应可变条件的指标。
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引用次数: 0
A comparative study on wearables and single-camera video for upper-limb out-of-the-lab activity recognition with different deep learning architectures 基于不同深度学习架构的可穿戴设备和单摄像头视频上肢实验室外活动识别的比较研究
Pub Date : 2023-09-01 DOI: 10.1016/j.gaitpost.2023.07.149
Mario Martínez Zarzuela, David González-Ortega, Míriam Antón-Rodríguez, Francisco Javier Díaz-Pernas, Henning Müller, Cristina Simón-Martínez
The use of a wide range of computer vision solutions, and more recently high-end Inertial Measurement Units (IMU) have become increasingly popular for assessing human physical activity in clinical and research settings [1]. Nevertheless, to increase the feasibility of patient tracking in out-of-the-lab settings, it is necessary to use a reduced number of devices for movement acquisition. Promising solutions in this context are IMU-based wearables and single camera systems [2]. Additionally, the development of machine learning systems able to recognize and digest clinically relevant data in-the-wild is needed, and therefore determining the ideal input to those is crucial [3]. For upper-limb activity recognition out-of-the-lab, do wearables or single camera offer better performance? Recordings from 16 healthy subjects performing 8 upper-limb activities from the VIDIMU dataset [4] were used. For wearable recordings, the subjects wore 5 IMU-based wearables and adopted a neutral pose (N-pose) for calibration. Joint angles were estimated with inverse kinematics algorithms in OpenSense [5]. Single-camera video recordings occurred simultaneously. Joint angles were estimated with inverse kinematics algorithms in OpenSense. Single-camera video recordings occurred simultaneously, and the subject’s pose was estimated with DeepStream [6]. We compared various Deep Learning architectures (DNN, CNN, CNN-LSTM, LSTM-CNN, LSTM, LSTM-AE) for recognizing daily living activities. The input to the different neural architectures consisted in a 2-second time series containing the estimated joint angles and their 2D FFT. Every network was trained using 2 subjects for validation, a batch size of 20, Adam as the optimizer, and combining early stopping and other regularization techniques. Performance metrics were extracted from 4-fold cross-validation experiments. In all neural networks, performance was higher with IMU-based wearables data compared to video. The best network was an LSTM AutoEncoder (6 layers, 700 K parameters; wearable data accuracy:0.985, F1-score:0.936 (Fig. 1); video data accuracy:0.962, F1-score:0.842). Remarkably, when using video as input there were no significant differences in the performance metrics obtained among different architectures. On the contrary, the F1 scores using IMU data varied significantly (DNN: 0.849, CNN: 0.889, CNN-LSTM: 0.879, LSTM-CNN: 0.904, LSTM: 0.920, LSTM-AE: 0.936).Download : Download high-res image (108KB)Download : Download full-size image Wearables and video present advantages and disadvantages. While IMUs can provide accurate information about the orientation and acceleration of body parts, body-to-segment calibration and drift can affect data reliability. Similarly, a single camera can easily track the position of different body joints, but the recorded data does not yet reliably represent the movement with all degrees of freedom. Our experiments confirm that despite the current limitations of wearables, with a very si
广泛使用计算机视觉解决方案,以及最近高端惯性测量单元(IMU)在临床和研究环境中越来越受欢迎,用于评估人类的身体活动[1]。然而,为了增加在实验室外环境中患者跟踪的可行性,有必要减少运动采集设备的数量。在这种情况下,有希望的解决方案是基于imu的可穿戴设备和单摄像头系统[2]。此外,需要开发能够识别和消化临床相关数据的机器学习系统,因此确定这些数据的理想输入是至关重要的[3]。对于实验室外的上肢活动识别,可穿戴设备或单摄像头是否能提供更好的性能?使用来自VIDIMU数据集[4]的16名健康受试者进行8项上肢活动的录音。对于可穿戴记录,受试者佩戴5个基于imu的可穿戴设备,并采用中性姿势(N-pose)进行校准。在OpenSense中使用逆运动学算法估计关节角度[5]。单摄像机录像同时发生。在OpenSense中使用逆运动学算法估计关节角。单摄像机录像同时进行,使用DeepStream估计受试者的姿势[6]。我们比较了用于识别日常生活活动的各种深度学习架构(DNN、CNN、CNN-LSTM、LSTM-CNN、LSTM、LSTM- ae)。不同神经结构的输入由包含估计关节角度及其二维FFT的2秒时间序列组成。每个网络使用2个对象进行验证,批大小为20,Adam作为优化器,并结合早期停止和其他正则化技术进行训练。性能指标是从4次交叉验证实验中提取的。在所有神经网络中,与视频相比,基于imu的可穿戴设备数据的性能更高。最佳网络是LSTM AutoEncoder(6层,700 K参数);可穿戴数据精度:0.985,F1-score:0.936(图1);视频数据精度:0.962,F1-score:0.842)。值得注意的是,当使用视频作为输入时,不同架构之间获得的性能指标没有显着差异。与此相反,IMU数据的F1得分差异显著(DNN: 0.849, CNN: 0.889, CNN-LSTM: 0.879, LSTM-CNN: 0.904, LSTM: 0.920, LSTM- ae: 0.936)。下载:下载高清图片(108KB)下载:下载全尺寸图片可穿戴设备和视频呈现优缺点。虽然imu可以提供有关车身部件方向和加速度的准确信息,但车身到车身的校准和漂移可能会影响数据的可靠性。同样,单个摄像机可以很容易地跟踪不同身体关节的位置,但记录的数据还不能可靠地代表所有自由度的运动。我们的实验证实,尽管目前可穿戴设备存在局限性,但通过非常简单的n位校准,IMU数据为上肢活动识别提供了更多的判别特征。我们的结果与先前的研究一致,这些研究表明imu在运动识别方面具有优势[7]。在未来,我们将评估这些数据与金标准系统的比较。
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引用次数: 0
Comparison of neuromuscular and abductor strengthening exercises in the hip abductor muscle strength: A randomized controlled trial 神经肌肉和外展肌加强训练在髋关节外展肌力量方面的比较:一项随机对照试验
Pub Date : 2023-09-01 DOI: 10.1016/j.gaitpost.2023.07.193
Sofia Pastrouma, Filippos Kasiotis, Aikaterini - Evanthia Gkanatsiou, Natalia Kitsouli, Konstantinos Vassis, Zacharias Dimitriadis, Savvas Spanos, Ioannis Poulis
Decreased hip abductor strength has been associated with a range of knee pathologies. Hip abduction muscles play a critical role in providing pelvic stability and leg alignment during weight-bearing movements by eccentrically controlling hip adduction. Poor hip control can result in abnormal lower extremity motions, and studies have reported that lower limb problems such as patellofemoral pain (PFP),1 knee osteoarthritis (OA),2 and ACL injuries,3,4 are linked with altered lower limb kinematics, with a higher prevalence in females.5 A body of literature suggests that increased dynamic knee valgus is associated with hip abductor weakness.6 Moreover, several studies have shown that interventions such as neuromuscular training (NMT) programs can lower the incidence of lower extremity problems. An NMT program emphasizing optimal alignment of the trunk and lower limb joints relative to each other, along with quality movement performance while dynamically and functionally strengthening the lower limb muscles, may be better at enhancing hip muscle strength. Therefore, we performed a randomized controlled trial evaluating the effects of NMT in comparison to a progressive resistance training program (PRT) on muscle hip abductor strength. To investigate whether a 6-week NMT can improve the hip abductor muscle strength better than a PRT. The present study was a single-blind randomized controlled trial aiming to investigate the effects of two interventions on asymptomatic females, aged 18-35 years old. Sample size calculation revealed that 26 participants per group were required. Following a baseline assessment, 52 participants were randomly assigned to either a 6-week PRT or NMT intervention involving 3 sessions per week. The PRT intervention consisted of hip abductor exercises performed in an open kinetic chain, with three to four sets of ten repetitions at a target intensity of 6-8 RPE.7,8,9 The NMT intervention focused on improving functional stability, balance, proprioception, strength, agility, postural function, and orientation,10,11 consisting of weight-bearing positions. The participants were assessed after the 6-week intervention. Mean peak hip abduction, concentric and eccentric torque, were measured by a blinded assessor on a Biodex System 3 Pro isokinetic dynamometer at 60°/s. Dependent t-tests showed significant improvements in CON60, and ECC60 after both interventions (<0.05) (Table 1). Two-way mixed ANOVAs did not reveal statistically significant Group*Time interactions for the CON60 and ECC60. The results from the comparison of the effectiveness of each intervention are visually presented in Figs. 1 and 2. Download : Download high-res image (114KB)Download : Download full-size image Both PRT and NMT improved abductor strength. However, both groups had similar overall differences in strength before and after the intervention. Since no intervention is superior to the other, neuromuscular training might be clinically preferred as it combines dyn
髋关节外展肌力量下降与一系列膝关节病变有关。髋外展肌通过偏心控制髋内收,在负重运动中提供骨盆稳定性和腿部对齐方面发挥关键作用。髋关节控制不佳可导致下肢运动异常,研究报道,下肢问题,如髌股疼痛(PFP),1膝骨关节炎(OA),2和前交叉韧带损伤,3,4与下肢运动学改变有关,女性患病率更高5大量文献表明,动态膝外翻增加与髋外展肌无力有关此外,一些研究表明,神经肌肉训练(NMT)计划等干预措施可以降低下肢问题的发生率。NMT项目强调躯干和下肢关节相对于彼此的最佳对齐,以及在动态和功能性加强下肢肌肉的同时进行高质量的运动表现,可能会更好地增强髋关节肌肉力量。因此,我们进行了一项随机对照试验,评估NMT与进行性阻力训练计划(PRT)对肌肉髋关节外展肌力量的影响。研究6周的NMT是否能比PRT更好地改善髋关节外展肌力量。本研究是一项单盲随机对照试验,旨在探讨两种干预措施对18-35岁无症状女性的影响。样本量计算显示,每组需要26名参与者。在基线评估之后,52名参与者被随机分配到为期6周的PRT或NMT干预组,每周进行3次干预。PRT干预包括在开放的动力链中进行髋关节外展肌锻炼,每组重复3至4组,每组10次,目标强度为6- 8rpe 7,8,9。NMT干预侧重于改善功能稳定性、平衡、本体感觉、力量、敏捷性、姿势功能和定向10,11,包括负重姿势。干预6周后对参与者进行评估。平均峰值髋外展,同心和偏心扭矩,由盲法评估者在60°/s的Biodex System 3 Pro等速测力仪上测量。依赖t检验显示,两种干预措施后CON60和ECC60均有显著改善(<0.05)(表1)。双向混合方差分析未显示CON60和ECC60在组*时间的相互作用具有统计学意义。图1和图2直观地展示了各干预措施有效性比较的结果。下载:下载高分辨率图像(114KB)下载:下载全尺寸图像PRT和NMT均提高了外展肌力量。然而,两组在干预前后的力量总体差异相似。由于没有任何干预措施优于其他干预措施,神经肌肉训练可能是临床首选,因为它结合了个体的动态和功能强化。
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引用次数: 0
The volume of the lateral gastrocnemius appears reduced in some Idiopathic toe walkers 在一些特发性足趾行走者中,腓肠肌外侧的体积减小
Pub Date : 2023-09-01 DOI: 10.1016/j.gaitpost.2023.07.172
Anne Mcnee, Jonathan Noble, Stuart Evans, Karen Ziegler, Stephen Ng Man Sun, Alison Hulme, Nicola Fry, Adam Shortland
Plantarflexion contractures are often the focus for intervention in children who toe walk (TW). Caserta et.al1 found reduced plantarflexor strength in TW and greater proportions of type 1 fibres were identified in the plantarflexors2. Variable but mild differences in kinematics have been found between children with mild bilateral cerebral palsy (CP) and TW3,4. Children with CP have reduced muscle volumes compared to typically developing children5. Plantarflexor morphology in TW has not yet been described. Is ankle plantarflexor volume reduced in children who toe walk? Eight children (5male) aged 7-15 yr (mean=11.86 yrs) referred to our orthopaedic department for toe walking and plantarflexion contractures, with no underlying diagnosis, had a routine examination in the gait laboratory. They were matched for age and sex to children with CP (GMFCS I-II) who had also been examined. Assessment included gait analysis and 2D ultrasound imaging of the lateral gastrocnemius(LG). Muscle volumes were estimated by the Vanmechelen et.al6 method, normalised to mass. Selective motor control (SCALE) was assessed according to Fowler et.al7. Mobility was assessed using the Gillette Functional Assessment Questionnaire (GFAQ) 8. Data was compared to a large database of controls (unpaired t-test) and between groups (paired t-test). One limb per subject was randomly selected for analysis. All children had plantarflexor contractures: mean passive dorsiflexion range (knee extended) of -9.4° (SD10.9°) for TW and -6.5° (SD7.2°) for CP. TW had close to normal motor control (SCALE:Median=10, Range=8-10) whereas CP had a greater variability (SCALE:Median=9.5, Range=5-10). Walking function was within normal limits for TW (GFAQ Median=10 Range=8-10) but more variable for CP (GFAQ Median=8 Range=5-10). No difference in speed/cadence was found between groups (p=0.5/p=0.86) and these were within normal limits. All children were in ankle plantarflexion at initial contact (no difference between groups, p=0.48). Mean ankle dorsiflexion in stance and swing were not different between groups (p=0.94, p=0.84). For four TW children, normalised mean LG volume was significantly smaller than controls (1.07vs1.53 ml/kg) (p<0.01) but no different to CP (1.01 ml/kg) (p=0.64). The other TW had LG CSA which was too great for the US field of view. In the presence of an ankle plantarflexion contracture, TW children show less variability in selective motor control and functional mobility to a matched CP group. TW and CP show similar kinematics at the ankle, cadence and speed. A subgroup of TW children had reduced normalised LG compared to control data, comparable in size to the CP group. Other subjects’ muscles were larger and could not be measured. This suggests subgroups of TW with different muscle sizes, which has implications for aetiology and management. Further work is required to further elucidate the triceps surae muscle morphology in TW and relationship between morphology and toe walking.
足底屈曲挛缩通常是干预儿童脚趾行走(TW)的重点。Caserta等人1发现跖屈肌强度在TW中降低,并且在跖屈肌中发现了更大比例的1型纤维2。在轻度双侧脑瘫(CP)儿童和TW3,4之间发现了可变但轻微的运动学差异。与正常发育的儿童相比,患有CP的儿童肌肉体积减少。跖屈肌的形态尚未被描述。用脚趾走路的儿童踝关节跖屈肌体积会减少吗?8名儿童(5名男性),年龄7-15岁(平均11.86岁),因脚趾行走和跖屈挛缩在骨科就诊,无基础诊断,在步态实验室进行常规检查。他们的年龄和性别与同样接受检查的CP (GMFCS I-II)儿童相匹配。评估包括步态分析和腓肠肌外侧(LG)的二维超声成像。肌肉体积由Vanmechelen et.al6方法估计,归一化为质量。根据Fowler等评估选择性运动控制(SCALE)。使用吉列功能评估问卷(GFAQ) 8评估活动能力。将数据与大型对照数据库(未配对t检验)和组间(配对t检验)进行比较。每个受试者随机选择一条肢体进行分析。所有儿童均有跖屈肌挛缩:TW的平均被动背屈范围(膝关节伸展)为-9.4°(SD10.9°),CP的平均被动背屈范围为-6.5°(SD7.2°)。TW的运动控制接近正常(SCALE:中位数=10,范围=8-10),而CP的变异性更大(SCALE:中位数=9.5,范围=5-10)。步行功能在TW的正常范围内(GFAQ中位数=10 Range=8-10),但CP的变化较大(GFAQ中位数=8 Range=5-10)。各组之间的速度/节奏没有差异(p=0.5/p=0.86),这些都在正常范围内。所有患儿在初次接触时均踝关节跖屈(组间无差异,p=0.48)。两组间站立、摆动时踝关节平均背屈度差异无统计学意义(p=0.94, p=0.84)。对于4例TW患儿,标准化平均LG体积显著小于对照组(1.07 ml/kg vs1.53 ml/kg) (p<0.01),但与CP (1.01 ml/kg)无差异(p=0.64)。另一个TW有LG CSA,这对美国的视野来说太大了。在存在踝关节跖屈挛缩的情况下,TW儿童在选择性运动控制和功能活动方面表现出比匹配的CP组更小的变异性。TW和CP在踝关节、节奏和速度方面表现出相似的运动学。与对照数据相比,TW儿童亚组的标准化LG减少,其大小与CP组相当。其他受试者的肌肉更大,无法测量。这表明TW的亚群具有不同的肌肉大小,这对病因和治疗有影响。进一步的工作需要进一步阐明三头肌表面肌肉形态和形态与脚趾行走的关系。
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引用次数: 0
Gait deviations in rare genetic syndromes: is there a common denomitator for patients with Dravet, HVDAS and TSC? 罕见遗传综合征的步态偏差:Dravet、HVDAS和TSC患者是否有共同特征?
Pub Date : 2023-09-01 DOI: 10.1016/j.gaitpost.2023.08.027
Patricia Van De Walle, An Jansen, An-Sofie Schoonjans, Anke Van Dijck, Colette Puts, Iris van Hal, Marijn Weren, Kinaci Esra, Ann Hallemans
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引用次数: 0
Age related changes in lower-limb joint coordination during gait in children with bilateral cerebral palsy 双侧脑瘫患儿步态中下肢关节协调性的年龄相关变化
Pub Date : 2023-09-01 DOI: 10.1016/j.gaitpost.2023.08.024
Damien Kiernan, Ailish Malone
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引用次数: 0
Explainable machine learning approach on biomechanical features to identify weakness in a population-based setting on aging 生物力学特征的可解释机器学习方法,以识别基于人口的老龄化设置中的弱点
Pub Date : 2023-09-01 DOI: 10.1016/j.gaitpost.2023.07.167
Mariapia Musci, Simona Aresta, Francesco Bottiglione, Michele Ruta, Tommaso Di Noia, Rodolfo Sardone, Ilaria Bortone
Weakness, as measured by maximal Hand Grip Strength (HGS), represents one of the five criteria used in Fried's definition of frailty [1] and is associated with a wide range of health conditions, which makes it challenging to delineate what body system processes are responsible for weakness. [2]. Still, poor studies have investigated the associations between HGS and dynamic functional assessments [3]. To identify a pattern of functional characteristics, extracted from the 5-repetitions-sit-to-stand (5STS) test biomechanical signals best predict weakness. An Explanation approach to a Machine Learning model was also used. In a subcohort of the longitudinal study of aging [4], 86 subjects over 65 performed the 5STS test [5,6]. They were equipped with an IMU on the L5 vertebra and four sEMG probes (BTS Bioengineering) on the Gastrocnemius Medialis and Tibialis Anterior both side muscles. Several kinematic and muscular features were extracted from the cycle, standing and sitting phases. A handgrip dynamometer was used to measure HGS. Men and women who were considered weak had HGS<26 kg and <16 kg, respectively. Socio-demographic information (age, sex and BMI) was also included. The final dataset consisted of 119 features for all subjects. We first performed the undersampling of the majority class (without weakness); then the dataset was divided into 70% training and 30% testing and normalised using the z-score method. Because of the curse of dimensionality, a pipeline for feature selection and hyperparameter tuning, using the GridSearchCV method, was defined to obtain the best Kernel-SVM model. The best model was chosen according to the accuracy score. To evaluate our model accuracy, precision and recall were calculated. All the analyses were performed using the Scikit-Learn library [7] with Python 3.6. To explain our model Python's SHAP library was used [8]. From the hyperparameter tuning, we obtained six features: hip power (Whip), power along the vertical axis (Wvert), and cycle jerk along the vertical axis and its coefficient of variation, age, and sex. Fig. 1 shows the boxplots for the biomechanical selected variables.The model showed 90.0% and 85.7% accuracy on the training and testing sets, respectively. The precision of 100%, recall of 71%, and f1-score 83%, while the precision of 78%, recall of 100%, and f1-score of 88% was obtained on the class without weakness and its counterpart, respectively.The explainability analysis showed that age, Wvert and Whip were the three most important variables in predicting weakness in absolute terms. Sex resulted being the least important variable. Picture 1 - "Boxplot of the biomechanical selected features according to the weakness condition"Download : Download high-res image (71KB)Download : Download full-size image Measures of HGS are associated with deficits in several physical functions. In a population-based setting, we identified biomechanical features from 5STS related to stability that could help pre
虚弱,用最大握力(HGS)来衡量,是弗里德对虚弱的定义中使用的五个标准之一[1],并且与广泛的健康状况有关,这使得描述导致虚弱的身体系统过程具有挑战性。[2]. 然而,很少有研究调查HGS与动态功能评估之间的关系[3]。为了确定一种功能特征模式,从5次重复的坐立(5STS)测试中提取生物力学信号,最好地预测弱点。还使用了机器学习模型的解释方法。在老龄化纵向研究的亚队列研究中[4],86名65岁以上的受试者进行了5STS测试[5,6]。他们在L5椎体上安装了一个IMU,在两侧腓肠肌内侧肌和胫骨前肌上安装了四个sEMG探针(BTS Bioengineering)。从循环、站立和坐姿阶段提取了几个运动学和肌肉特征。用握力计测量HGS。被认为较弱的男性和女性的HGS分别<26 kg和<16 kg。社会人口统计信息(年龄、性别和体重指数)也包括在内。最终的数据集包括所有受试者的119个特征。我们首先对大多数类进行欠采样(没有弱点);然后将数据集分为70%的训练和30%的测试,并使用z-score方法进行归一化。针对核支持向量机的维数问题,利用GridSearchCV方法定义了一个特征选择和超参数调优的管道,以获得最佳的核支持向量机模型。根据准确率评分选择最佳模型。为了评估我们的模型的准确性,我们计算了精密度和召回率。所有分析均使用Scikit-Learn库[7]和Python 3.6进行。为了解释我们的模型,使用了Python的SHAP库[8]。从超参数调谐中,我们获得了六个特征:髋部力量(Whip),沿垂直轴的力量(Wvert)和沿垂直轴的周期抽搐及其变异系数,年龄和性别。图1显示了生物力学选择变量的箱形图。该模型在训练集和测试集上的准确率分别为90.0%和85.7%。无弱点分类的准确率为100%,召回率为71%,f1-score为83%,无弱点分类的准确率为78%,召回率为100%,f1-score为88%。可解释性分析表明,年龄、Wvert和Whip是预测虚弱的三个最重要的绝对变量。性别结果是最不重要的变量。图1 -“根据弱点条件选择的生物力学特征箱线图”下载:下载高分辨率图像(71KB)下载:下载全尺寸图像HGS的测量与几种身体功能的缺陷有关。在以人群为基础的环境中,我们从5STS中识别出与稳定性相关的生物力学特征,这些特征可以帮助预测自由生活环境中的弱点。
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引用次数: 0
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Gait & posture
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