Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.110
Narges Jahantigh Akbari, Mohammad Yousefi
MS is an autoimmune disease of the central nervous system (1). Postural balance impairment is frequently depicted as one of the initial symptoms of MS and one of the most impairing MS symptoms (2, 3). the gait impairment is one of the most common indications of MS and influences the quality of life (4). Although investigation of the quiet stance is critical for analyzing the balance impairments, more challenging situations such as gait initiation (GI) may give a deeper knowledge into understanding of the mechanisms of dynamic postural control (5). Therefore, the aim of this study was to evaluate the gait pattern in terms of spatio-temporal, kinematic and kinetic parameters during the gait initiation phase in people with MS. What are the influencing factors on the gait pattern in gait initiation phase in MS patients? Search in PubMed, Cochrane, Science of Direct, Web of science, Scopus, and Google scholar Databases from 2019 to December 2022 was conducted. Studies were included if: individuals with multiple sclerosis disease, examination the gait initiation phase, and assessment of center of pressure(COP), anticipatory postural adjustments (APA), spatio-temporal, kinematic and kinetic parameters and muscular synergies as outcome measure were evaluated. Included studies were independently reviewed by two authors for their quality evaluation using modified Downs and Black checklist. Since meta-analysis was not possible, studies were descriptively presented. Ten articles were selected for final analysis. A total of 231 MS patients and 132 healthy subjects were included with ages ranging from 18 to 76 years old. The findings of studies showed COP position at gait initiation was more anterior and net muscular moments for each joint were significantly different during the APA phase with smoother variations in patients with MS than healthy participants. A lower amount of muscle activity during APA were reported. The first step was shorter in MS patients compared to healthy people. Gait initiation in the early stage of MS could be a useful measure to characterize balance. These results suggest that it is possible to use the gait initiation evaluation as an effective method for the rehabilitation treatment of these patients.
MS是一种中枢神经系统的自身免疫性疾病(1)。体位平衡障碍经常被描述为MS的初始症状之一，也是最具损害性的MS症状之一(2,3)。步态障碍是MS最常见的适应症之一，并影响生活质量(4)。尽管安静姿势的研究对于分析平衡障碍至关重要，更多具有挑战性的情况，如步态起始(GI)可能会让我们更深入地了解动态姿势控制的机制(5)。因此，本研究的目的是从时空、运动学和动力学参数方面评估MS患者在步态起始阶段的步态模式。检索2019年至2022年12月的PubMed、Cochrane、Science of Direct、Web of Science、Scopus和Google学者数据库。研究包括:患有多发性硬化症的个体，检查步态起始阶段，评估压力中心(COP)，预期姿势调整(APA)，时空，运动学和动力学参数以及肌肉协同作用作为评估结果的指标。纳入的研究由两位作者独立审查，使用修改的Downs和Black检查表进行质量评估。由于荟萃分析是不可能的，研究是描述性的。最终选择了10篇文章进行分析。研究共纳入231例MS患者和132名健康受试者，年龄从18岁到76岁不等。研究结果显示，与健康参与者相比，MS患者在步态开始时的COP位置更靠前，每个关节的净肌力矩在APA阶段有显著差异，且变化更平稳。据报道，APA期间肌肉活动量较低。与健康人相比，多发性硬化症患者的第一步要短一些。在MS早期阶段的步态起始可能是表征平衡的有用措施。这些结果表明，步态启动评估可以作为这些患者康复治疗的有效方法。
{"title":"Examining the gait pattern in terms of spatio-temporal, kinematic and kinetic parameters during gait initiation in MS patients","authors":"Narges Jahantigh Akbari, Mohammad Yousefi","doi":"10.1016/j.gaitpost.2023.07.110","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.110","url":null,"abstract":"MS is an autoimmune disease of the central nervous system (1). Postural balance impairment is frequently depicted as one of the initial symptoms of MS and one of the most impairing MS symptoms (2, 3). the gait impairment is one of the most common indications of MS and influences the quality of life (4). Although investigation of the quiet stance is critical for analyzing the balance impairments, more challenging situations such as gait initiation (GI) may give a deeper knowledge into understanding of the mechanisms of dynamic postural control (5). Therefore, the aim of this study was to evaluate the gait pattern in terms of spatio-temporal, kinematic and kinetic parameters during the gait initiation phase in people with MS. What are the influencing factors on the gait pattern in gait initiation phase in MS patients? Search in PubMed, Cochrane, Science of Direct, Web of science, Scopus, and Google scholar Databases from 2019 to December 2022 was conducted. Studies were included if: individuals with multiple sclerosis disease, examination the gait initiation phase, and assessment of center of pressure(COP), anticipatory postural adjustments (APA), spatio-temporal, kinematic and kinetic parameters and muscular synergies as outcome measure were evaluated. Included studies were independently reviewed by two authors for their quality evaluation using modified Downs and Black checklist. Since meta-analysis was not possible, studies were descriptively presented. Ten articles were selected for final analysis. A total of 231 MS patients and 132 healthy subjects were included with ages ranging from 18 to 76 years old. The findings of studies showed COP position at gait initiation was more anterior and net muscular moments for each joint were significantly different during the APA phase with smoother variations in patients with MS than healthy participants. A lower amount of muscle activity during APA were reported. The first step was shorter in MS patients compared to healthy people. Gait initiation in the early stage of MS could be a useful measure to characterize balance. These results suggest that it is possible to use the gait initiation evaluation as an effective method for the rehabilitation treatment of these patients.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The human body is a complex system of interconnected muscles and joints that work together to produce movement. The hip joint is particularly important in this regard, as it is responsible for supporting the weight of the body and facilitating movement of the legs. The flexor and extensor muscles of the hip joint play a crucial role in this process, as they are responsible for moving the leg forward and backward, respectively. Does the swing of the arm affect the activity of the flexor and extensor muscles of the hip joint?Download : Download high-res image (89KB)Download : Download full-size image To investigate the relationship between different swings of the arm and the effect on the flexor and extensor muscles of the hip joint, we utilized the OpenSim software. We created a model of the human body in OpenSim by motion capture data and used it to measuring the activity of the flexor and extensor muscles of the hip joint. sample consisted of 20 healthy adults (10 males, 10 females) between the ages of 18 and 30. All participants were free of any musculoskeletal disorders or injuries that could affect their hip joint function. Results showed that there was a significant difference in muscle activity between arm swings. Specifically, when the arm was swung forward, the activity in the flexor muscles of the hip joint was significantly higher than when the arm was swung backward (p < 0.001). Conversely, when the arm was swung backward, the activity in the extensor muscles of the hip joint was significantly higher than when the arm was swung forward (p < 0.001). We also found that the difference in muscle activity between arm swings was more pronounced in males compared to females (p = 0.03). This suggests that there may be gender-specific differences in the way the hip joint muscles are activated during arm swings. We studied the three types of long, short and normal swing (p = 0.02). These findings provide valuable insight into the relationship between arm swings and hip joint muscle activation, which can be useful for individuals seeking to optimize their hip joint function. This study provides insight into the relationship between different arm swings and the activity of the flexor and extensor muscles of the hip joint. Arm swings can have a significant effect on the activation of these muscles, and this effect may differ between males and females. This information can be useful for individuals seeking to optimize their hip joint function, such as athletes or those undergoing rehabilitation after hip joint injuries.
{"title":"Modeling of different arm swing and the effect on hip flexors and extensors","authors":"Sadegh Madadi, Mostafa Rostami, Afshin Taheri Azam","doi":"10.1016/j.gaitpost.2023.07.145","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.145","url":null,"abstract":"The human body is a complex system of interconnected muscles and joints that work together to produce movement. The hip joint is particularly important in this regard, as it is responsible for supporting the weight of the body and facilitating movement of the legs. The flexor and extensor muscles of the hip joint play a crucial role in this process, as they are responsible for moving the leg forward and backward, respectively. Does the swing of the arm affect the activity of the flexor and extensor muscles of the hip joint?Download : Download high-res image (89KB)Download : Download full-size image To investigate the relationship between different swings of the arm and the effect on the flexor and extensor muscles of the hip joint, we utilized the OpenSim software. We created a model of the human body in OpenSim by motion capture data and used it to measuring the activity of the flexor and extensor muscles of the hip joint. sample consisted of 20 healthy adults (10 males, 10 females) between the ages of 18 and 30. All participants were free of any musculoskeletal disorders or injuries that could affect their hip joint function. Results showed that there was a significant difference in muscle activity between arm swings. Specifically, when the arm was swung forward, the activity in the flexor muscles of the hip joint was significantly higher than when the arm was swung backward (p < 0.001). Conversely, when the arm was swung backward, the activity in the extensor muscles of the hip joint was significantly higher than when the arm was swung forward (p < 0.001). We also found that the difference in muscle activity between arm swings was more pronounced in males compared to females (p = 0.03). This suggests that there may be gender-specific differences in the way the hip joint muscles are activated during arm swings. We studied the three types of long, short and normal swing (p = 0.02). These findings provide valuable insight into the relationship between arm swings and hip joint muscle activation, which can be useful for individuals seeking to optimize their hip joint function. This study provides insight into the relationship between different arm swings and the activity of the flexor and extensor muscles of the hip joint. Arm swings can have a significant effect on the activation of these muscles, and this effect may differ between males and females. This information can be useful for individuals seeking to optimize their hip joint function, such as athletes or those undergoing rehabilitation after hip joint injuries.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.274
Qiang Zhang, Leichao Liang, Weiping Zhu, Xie Wu
Postural compensations with backpack may cause considerable body strains, resulting in fatigue, pain, and injury [1]. Backpack’s position can influence carrier’s posture and dynamic performance [2]. Characterizing the backpack’s position, namely the position of its centre of mass (COM) with respect to the carrier’s body, allows modelling its dynamic loading towards revealing the moment and moment of inertia it renders on the carrier. These knowledges will provide novel insights into the carrier’s postural compensations and musculoskeletal injury [3]. Despite of the importance, there is a lack of an easy approach that can determine and track the movement of a backpack’s COM during dynamic activities. How to determine the position of a backpack’s COM and track its movements in walking with the backpack? A backpack was tightly filled with sandbags, resulting in a total weight of 10 kg. Using a 3D motion capture system (Vicon, UK), we created the backpack’s local coordinate system (CS) with the three reflective markers attached on it. A directional cosine matrix was established for coordinate transformations between the backpack’s and the lab’s CS. A mannequin was then placed on an integrated force plate (Kistler, Switzerland), and its weight and centre of pressure were measured. This measurement was repeated after placing the backpack on the mannequin (two positions, Fig. 1a), and the horizontal coordinates of the backpack’s COM were calculated according to the Varignon's Theorem. Fig. 1. Experiments and outcomes: a) Measuring centre of pressure in backpack’s two postures; b) Displacement of backpack’s and subject’s COM during walking. Download : Download high-res image (81KB)Download : Download full-size image As the coordinates of the backpack’s COM in the backpack’s local CS remained unchanged, an equation could be established to calculate the vertical coordinate of the backpack’s COM with its horizontal coordinates. Finally, the coordinates of the backpack’s COM in the backpack’s local CS were determined through coordinate transformation. Afterwards, a healthy young subject was instrumented with full-body marker set, and then performed walking with the backpack at 5 km/h. Using Visual 3D (C-Motion, USA), a virtual marker was created according to above outcomes, and the marker’s movements were computed from the gait trials. The results indicated that the vertical displacement magnitude of backpack’s and subject’s COM was similar (Fig. 1b), with a small temporal difference. In the mediolateral direction, the displacement of the backpack’s COM was much greater than that of the subject’s COM. A clear lag effect was observed in their mediolateral displacement during walking, where the backpack’s COM reached its ultimate mediolateral positions later than the subject’s COM did. Our approach can be applied to easily determine a backpack’s COM in 3D motion analysis, towards quantifying backpack’s loading effects and studying carrier’s postural adaptation
使用双肩包进行姿势补偿可能会造成相当大的身体紧张，导致疲劳、疼痛和损伤。背包的位置会影响背包携带者的姿势和动态性能。描述背包的位置，即它的质心(COM)相对于载体的身体的位置，允许建模它的动态负载，以揭示它在载体上呈现的力矩和惯性矩。这些知识将为携带者的姿势代偿和肌肉骨骼损伤提供新的见解。尽管这很重要，但在动态活动期间，缺乏一种简单的方法来确定和跟踪背包的COM的运动。如何确定一个背包的COM的位置和跟踪它的运动与背包走路?背包里塞满了沙袋，总重量达10公斤。使用3D动作捕捉系统(Vicon, UK)，我们用三个反射标记创建了背包的本地坐标系统(CS)。建立了一个方向余弦矩阵，用于背包和实验室CS之间的坐标转换。然后将一个人体模型放在一个综合力板上(奇石乐，瑞士)，测量其重量和压力中心。将背包放在人体模型上(两个位置，图1a)后重复测量，并根据瓦里农定理计算背包的COM的水平坐标。图1所示。实验与结果:a)测量背包两种姿势的压力中心;b)行走过程中背包和受试者COM的位移。下载:下载高分辨率图片(81KB)下载:下载全尺寸图片在背包局部CS中的COM坐标不变的情况下，可以建立方程，计算出背包COM与背包横坐标的纵坐标。最后，通过坐标变换确定背包的COM在背包局部CS中的坐标。随后，对健康的年轻受试者进行全身标记设置，然后以5 km/h的速度背着背包行走。使用Visual 3D (C-Motion, USA)软件，根据上述结果创建虚拟标记，并根据步态试验计算标记的运动。结果表明，背包和受试者COM的垂直位移幅度相似(图1b)，但时间差异较小。在中外侧方向上，背包的COM的位移远远大于受试者的COM。在行走过程中，在他们的中外侧位移中观察到明显的滞后效应，背包的COM到达最终的中外侧位置比受试者的COM晚。该方法可以在三维运动分析中方便地确定背包的COM，量化背包的载荷效应，研究背包的姿态适应和控制策略。
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Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.206
Arik Rehani Musagara, Marco Götze, Sebastian I. Wolf
Transversally measured hip rotation can add valuable information in the indication of femoral derotation osteotomy (FDO) (Dreher 2007), which serves as the gold standard in the treatment of internally rotated gait. Typically, studies on gait analyses in the context of FDO relied on the conventional calibration of the knee joint axis (KJA) based on palpation of the epicondyles. However, researchers regularly face discrepancies between planned FDO angle, pre-post changes in anteversion and pre-post changes in hip rotation (Böhm 2015, Putz 2016). Apart from previously discussed factors, we hypothesized that a functional calibration of the KJA might lead to smaller differences between aforementioned parameters and therefore provide more coherent results than the conventional method. Does a functional KJA calibration allow for smaller differences between intraoperative FDO angle and pre-post changes in mean hip rotation in stance (mHipRotSt)? 14 patients (mean age at surgery: 16.2 ± 9.5 years) scheduled for FDO were examined retrospectively in this study. 3D gait analysis including functional KJA calibration and rotational MRIs (available in 8 of 14 patients) for estimating anteversion were measured pre- (1 day) and post-FDO (11.7 ± 3.1 months). Functional calibration included three unassisted, unloaded knee flexion-extension movements in single limb stance and were repeated for both legs. Subsequently the SARA algorithm (Ehrig 2007) was applied. Conventional estimation of the KJA was done with the Knee Alignment Device method. FDO angle was documented during surgery and was measured intraoperatively with a goniometer. Postoperative mHipRotSt was significantly smaller (p <0.001) for both conventional and functional method than before surgery (Table 1). A significant, high correlation was observed between the pre-post FDO change of conventionally measured mHipRotSt and intraoperative external FDO angle (r = 0.62, p < 0.01). For the functionally measured change in mHipRotSt a non-significant, moderate correlation (r = 0.41, p = 0.1) was found. Discrepancies between change in mHipRotSt and mean FDO angle/ change in anteversion were 3.4°/ 1.6° conventionally and 10.4°/ 8.4° functionally measured. Correlation analysis between preoperative Range of motion (ROM) during calibration movement and the change in mHipRotSt revealed a weak, non-significant correlation (r = 0.16, p = 0.549).Download : Download high-res image (110KB)Download : Download full-size image The conventional method is more in alignment with the aimed intraoperative FDO and therefore appears as the preferable option in the decision-making process in the context of FDO. Also changes in the anteversion were closer to conventionally measured values. Analysis on the presumably more restricted ROM did not indicate that it had a strong influence on the differences between pre- and postoperative mHipRotSt.
横向测量髋关节旋转可以为股骨旋转截骨术(FDO)的适应症提供有价值的信息(Dreher 2007)，这是治疗内旋步态的金标准。通常，在FDO背景下的步态分析研究依赖于传统的基于触诊上髁的膝关节轴(KJA)校准。然而，研究人员经常面临计划的FDO角度、前倾前后变化和髋关节旋转前后变化之间的差异(Böhm 2015, Putz 2016)。除了前面讨论的因素外，我们假设KJA的功能校准可能导致上述参数之间的差异较小，因此比传统方法提供更连贯的结果。功能性KJA校准是否允许术中FDO角度与髋位平均旋转(mHipRotSt)前后变化之间的较小差异?本研究回顾性分析了14例计划行FDO的患者(平均手术年龄:16.2±9.5岁)。在fdo前(1天)和fdo后(11.7±3.1个月)测量3D步态分析，包括功能性KJA校准和旋转mri(14例患者中有8例可用)，用于估计前倾。功能校准包括三个无辅助、无负荷的单肢站立膝关节屈伸运动，并在两条腿上重复。随后应用SARA算法(Ehrig 2007)。传统的KJA估计是用膝关节对齐装置方法完成的。术中记录FDO角，术中用测角仪测量。与术前相比，常规方法和功能方法术后mHipRotSt均显著小于术前(p <0.001)(表1)。常规测量的mHipRotSt的FDO前后变化与术中外部FDO角度之间存在显著的高度相关性(r = 0.62, p < 0.01)。对于功能性测量的mHipRotSt变化，发现不显著的中度相关性(r = 0.41, p = 0.1)。mHipRotSt变化与FDO平均角度/前倾变化之间的差异为常规测量的3.4°/ 1.6°和功能测量的10.4°/ 8.4°。校正运动时术前活动范围(ROM)与mHipRotSt变化的相关分析显示，相关性较弱，不显著(r = 0.16, p = 0.549)。下载:下载高分辨率图像(110KB)下载:下载全尺寸图像传统方法更符合术中FDO的目标，因此在FDO的决策过程中似乎是更可取的选择。前倾的变化也更接近常规测量值。对可能更受限的ROM的分析并没有表明它对术前和术后mHipRotSt的差异有很强的影响。
{"title":"Hip rotation obtained via conventional and functional knee joint axis calibration in the context of femoral derotation osteotomy","authors":"Arik Rehani Musagara, Marco Götze, Sebastian I. Wolf","doi":"10.1016/j.gaitpost.2023.07.206","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.206","url":null,"abstract":"Transversally measured hip rotation can add valuable information in the indication of femoral derotation osteotomy (FDO) (Dreher 2007), which serves as the gold standard in the treatment of internally rotated gait. Typically, studies on gait analyses in the context of FDO relied on the conventional calibration of the knee joint axis (KJA) based on palpation of the epicondyles. However, researchers regularly face discrepancies between planned FDO angle, pre-post changes in anteversion and pre-post changes in hip rotation (Böhm 2015, Putz 2016). Apart from previously discussed factors, we hypothesized that a functional calibration of the KJA might lead to smaller differences between aforementioned parameters and therefore provide more coherent results than the conventional method. Does a functional KJA calibration allow for smaller differences between intraoperative FDO angle and pre-post changes in mean hip rotation in stance (mHipRotSt)? 14 patients (mean age at surgery: 16.2 ± 9.5 years) scheduled for FDO were examined retrospectively in this study. 3D gait analysis including functional KJA calibration and rotational MRIs (available in 8 of 14 patients) for estimating anteversion were measured pre- (1 day) and post-FDO (11.7 ± 3.1 months). Functional calibration included three unassisted, unloaded knee flexion-extension movements in single limb stance and were repeated for both legs. Subsequently the SARA algorithm (Ehrig 2007) was applied. Conventional estimation of the KJA was done with the Knee Alignment Device method. FDO angle was documented during surgery and was measured intraoperatively with a goniometer. Postoperative mHipRotSt was significantly smaller (p <0.001) for both conventional and functional method than before surgery (Table 1). A significant, high correlation was observed between the pre-post FDO change of conventionally measured mHipRotSt and intraoperative external FDO angle (r = 0.62, p < 0.01). For the functionally measured change in mHipRotSt a non-significant, moderate correlation (r = 0.41, p = 0.1) was found. Discrepancies between change in mHipRotSt and mean FDO angle/ change in anteversion were 3.4°/ 1.6° conventionally and 10.4°/ 8.4° functionally measured. Correlation analysis between preoperative Range of motion (ROM) during calibration movement and the change in mHipRotSt revealed a weak, non-significant correlation (r = 0.16, p = 0.549).Download : Download high-res image (110KB)Download : Download full-size image The conventional method is more in alignment with the aimed intraoperative FDO and therefore appears as the preferable option in the decision-making process in the context of FDO. Also changes in the anteversion were closer to conventionally measured values. Analysis on the presumably more restricted ROM did not indicate that it had a strong influence on the differences between pre- and postoperative mHipRotSt.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.108
Elena Jaber, Rami El Rachkidi, Elma Ayoub, Ali Rteil, Maria Saade, Celine Chaaya, Rami Rhayem, Ismat Ghanem, Abir Massaad, Ayman Assi
Patients with adult spinal deformity (ASD) are known to compensate by retroverting their pelvis and flexing their knees in order to maintain postural stability [1]. Increased pelvic retroversion in patients with ASD is associated with alteration of acetabular orientation both in standing and during walking, increasing the risk of hip osteoarthritis usually treated by total hip replacement [2,3]. A safe zone is targeted during cup positioning where acetabular orientation is calculated relatively to the invariant morphological Lewinnek plane, unruled by the patient’s position. Changes in hip positioning encountered in daily life activities were associated with higher rates of prosthesis instability in ASD patients. To evaluate the mismatch between Lewinnek and positional acetabular measurements in variable patient’s postures. 121 primary ASD and 32 controls (age and sex matched: 54 years, 73% F) underwent biplanar X-rays in both standing and sitting positions. 3D acetabular parameters (anteversion, abduction, anterior coverage, posterior coverage) were calculated in both the Lewinnek and radiological positional planes (frontal, sagittal and horizontal). The mismatch between Lewinnek and positional acetabular measurements (Δ=Lewinnek-Positional) was evaluated. Radiographic pelvic tilt (PT) adjusted to pelvic incidence (PI) was calculated (adj.PT=0.37*PI-7°). Patients having a high adjusted PT (>2 SD in controls) were grouped as ASD-HighPT, otherwise as ASD-NormPT. 42 ASD had a high PT and 79 a normal PT. Although all 3 groups had similar PI (average: 52°), ASD-HighPT had a decreased lumbar lordosis (L1S1=33°, PT=31°) and decompensated sagittal malalignment (SVA=76 mm). In standing position, ASD-HighPT showed an increased planes mismatch of their acetabular parameters (Δanteversion=-12 vs 2°, Δabduction=-8 vs 0°, ∆anterior coverage=13 vs 0°, Δposterior coverage=-8 vs -1°, all p<0.001), compared to other groups. In the sitting position, ASD-HighPT showed an increased planes mismatch of their acetabular parameters (Δanteversion=-16 vs -10°, Δabduction=-12 vs -8°, ∆anterior coverage=16 vs 11°, Δposterior coverage=-12 vs -8°, all p<0.001), but to a lesser extent than the standing position. PT was strongly correlated to Δanteversion (r=-0.74) and Δanterior coverage (r=0.67, Fig. 1) in the standing position, and moderately correlated in the sitting position (r=-0.40 & 0.28 resp., all p<0.001). This study showed that the Lewinnek plane is not representative of the positional acetabular orientation in the presence of sagittal malalignment. This emphasizes the importance to consider the variation of the acetabular orientation between different postures. It is then necessary to determine a patient-specific functional safe zone in the preoperative planning of total hip replacement to avoid cup instability. Fig. 1: Correlation between pelvic tilt and planes mismatch of acetabular orientation.Download : Download high-res image (91KB)Download : Download full-size
已知成人脊柱畸形(ASD)患者通过骨盆后倾和膝关节屈曲来补偿，以保持姿势稳定[1]。ASD患者骨盆后倾的增加与站立和行走时髋臼方向的改变有关，增加了髋关节骨关节炎的风险，通常采用全髋关节置换术治疗[2,3]。在髋臼杯定位过程中，髋臼方向相对于不变的形态Lewinnek平面计算，不受患者位置的影响。ASD患者在日常生活活动中遇到的髋关节位置改变与假体不稳定的较高发生率相关。评估不同患者体位下Lewinnek测量值与髋臼位置测量值之间的不匹配。121名原发ASD患者和32名对照者(年龄和性别匹配:54岁，73% F)分别以站立和坐姿接受了双平面x光检查。在Lewinnek和放射定位面(额、矢状面和水平面)计算三维髋臼参数(前倾角、外展、前覆盖、后覆盖)。评估Lewinnek和位置髋臼测量值(Δ=Lewinnek- positional)之间的不匹配。计算骨盆倾斜(PT)与骨盆发生率(PI)的比值(adj.PT=0.37*PI-7°)。高调整PT患者(对照组>2 SD)分为ASD-HighPT组，否则分为ASD-NormPT组。42例ASD患者的PT值高，79例患者的PT值正常。虽然3组患者的PI值相似(平均为52°)，但ASD- highpt患者腰椎前凸减小(L1S1=33°，PT=31°)和失代偿矢状位错位(SVA=76 mm)。站立位时，ASD-HighPT患者髋臼参数平面失配增加(Δanteversion=-12 vs 2°，Δabduction=-8 vs 0°，∆前覆盖=13 vs 0°，Δposterior覆盖=-8 vs -1°，均p<0.001)。坐姿时，ASD-HighPT显示髋臼参数平面不匹配增加(Δanteversion=-16°vs -10°，Δabduction=-12°vs -8°，∆前覆盖=16°vs 11°，Δposterior覆盖=-12°vs -8°，均p<0.001)，但程度小于站立位。PT与站立位的Δanteversion (r=-0.74)和Δanterior覆盖率(r=0.67，图1)呈强相关，与坐姿的PT呈中度相关(r=-0.40和0.28)。，均p<0.001)。本研究表明，Lewinnek平面在矢状面排列异常的情况下不能代表髋臼定位。这强调了考虑不同姿势之间髋臼方向变化的重要性。因此，在全髋关节置换术的术前规划中，有必要确定患者特定的功能安全区，以避免髋关节杯不稳定。图1:骨盆倾斜与髋臼方向平面不匹配的相关性。下载:下载高清图片(91KB)下载:下载全尺寸图片
{"title":"Acetabular orientation measured in the Lewinnek plane is not adequate for adult spinal deformity patients with high pelvic retroversion","authors":"Elena Jaber, Rami El Rachkidi, Elma Ayoub, Ali Rteil, Maria Saade, Celine Chaaya, Rami Rhayem, Ismat Ghanem, Abir Massaad, Ayman Assi","doi":"10.1016/j.gaitpost.2023.07.108","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.108","url":null,"abstract":"Patients with adult spinal deformity (ASD) are known to compensate by retroverting their pelvis and flexing their knees in order to maintain postural stability [1]. Increased pelvic retroversion in patients with ASD is associated with alteration of acetabular orientation both in standing and during walking, increasing the risk of hip osteoarthritis usually treated by total hip replacement [2,3]. A safe zone is targeted during cup positioning where acetabular orientation is calculated relatively to the invariant morphological Lewinnek plane, unruled by the patient’s position. Changes in hip positioning encountered in daily life activities were associated with higher rates of prosthesis instability in ASD patients. To evaluate the mismatch between Lewinnek and positional acetabular measurements in variable patient’s postures. 121 primary ASD and 32 controls (age and sex matched: 54 years, 73% F) underwent biplanar X-rays in both standing and sitting positions. 3D acetabular parameters (anteversion, abduction, anterior coverage, posterior coverage) were calculated in both the Lewinnek and radiological positional planes (frontal, sagittal and horizontal). The mismatch between Lewinnek and positional acetabular measurements (Δ=Lewinnek-Positional) was evaluated. Radiographic pelvic tilt (PT) adjusted to pelvic incidence (PI) was calculated (adj.PT=0.37*PI-7°). Patients having a high adjusted PT (>2 SD in controls) were grouped as ASD-HighPT, otherwise as ASD-NormPT. 42 ASD had a high PT and 79 a normal PT. Although all 3 groups had similar PI (average: 52°), ASD-HighPT had a decreased lumbar lordosis (L1S1=33°, PT=31°) and decompensated sagittal malalignment (SVA=76 mm). In standing position, ASD-HighPT showed an increased planes mismatch of their acetabular parameters (Δanteversion=-12 vs 2°, Δabduction=-8 vs 0°, ∆anterior coverage=13 vs 0°, Δposterior coverage=-8 vs -1°, all p<0.001), compared to other groups. In the sitting position, ASD-HighPT showed an increased planes mismatch of their acetabular parameters (Δanteversion=-16 vs -10°, Δabduction=-12 vs -8°, ∆anterior coverage=16 vs 11°, Δposterior coverage=-12 vs -8°, all p<0.001), but to a lesser extent than the standing position. PT was strongly correlated to Δanteversion (r=-0.74) and Δanterior coverage (r=0.67, Fig. 1) in the standing position, and moderately correlated in the sitting position (r=-0.40 & 0.28 resp., all p<0.001). This study showed that the Lewinnek plane is not representative of the positional acetabular orientation in the presence of sagittal malalignment. This emphasizes the importance to consider the variation of the acetabular orientation between different postures. It is then necessary to determine a patient-specific functional safe zone in the preoperative planning of total hip replacement to avoid cup instability. Fig. 1: Correlation between pelvic tilt and planes mismatch of acetabular orientation.Download : Download high-res image (91KB)Download : Download full-size ","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.168
Nabil Nassim, Elio Mekhael, Rami El Rachkidi, Carlo El Khoury, Pascal El Braidy, Mohamad Karam, Abir Massaad, Bilal Ramadan, Ismat Ghanem, Ayman Assi
{"title":"Postural and kinematic changes in the transition from sit-to-stand position in adolescent idiopathic scoliosis","authors":"Nabil Nassim, Elio Mekhael, Rami El Rachkidi, Carlo El Khoury, Pascal El Braidy, Mohamad Karam, Abir Massaad, Bilal Ramadan, Ismat Ghanem, Ayman Assi","doi":"10.1016/j.gaitpost.2023.07.168","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.168","url":null,"abstract":"","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.160
Meroeh Mohammadi, Javad Kalantari, Ali Mohammadi, Reza Najarpour, Fatemeh Bagheri, Abolfazl Panahi, Mahdi Barnamehei, Setayesh Asadollahi, Sara Salehimojarad
Non-contact anterior cruciate ligament (ACL) injuries often happen during the forward jump-landings in soccer [1]. Two main parts of the forward head jump are jumping and landing. Usually, one leg locates front, and another leg locates back during jumping and landing phases [2-4]. The ground reaction force, which presents the impact loads, affects the knee joint reaction loads and can grow biomechanical stress on the anterior cruciate ligament [3,5–7]. Therefore, the aim of the current study was to compare knee joint reaction loads between the back and front leg during the soccer forward jump. What are the differences in knee joint reaction loads between the back and front leg during the soccer forward jump? Twenty elite soccer athletes (68.3±7.5 kg, 178±5.3 cm, 27.5±4.5 years) participated in the current study [8]. Ten Vicon motion captures (Vicon MX, Oxford, UK, 200 Hz) were used to measure the kinematics variables [6,9,10]. EMG activity in the rectus femoris, vastus lateral, vastus medial, tibialis anterior, gastrocnemius medial, gastrocnemius lateral, soleus, biceps femoris, and semitendinosus was recorded by the Myon wireless EMG system [11,12]. Raw EMG signals were full-wave rectified and linear enveloped using a dual-pass fourth-order low-pass Butterworth filter at 4 Hz [13]. A musculoskeletal model with a total of 10 bodies and 92 muscles was used to estimate joint reaction loads in OpenSim [4,14,15]. The inverse kinematics, static optimization, and joint reaction analysis were used to estimate angles, muscle loads, and joint loads, respectively [16,17]. Fig. 1 presents the mean of knee joint reaction forces in anterior-posterior, medial-lateral, and superior-inferior directions during the forward jumping and landing for the back and front leg. Significant differences of knee joint reaction were found between back and front leg.Download : Download high-res image (131KB)Download : Download full-size image Fig. 1: Mean of knee joint reaction forces in anterior-posterior, medial-lateral, and superior-inferior directions during the forward jumping and landing for back and front leg. This study compared the knee joint reaction loads during the soccer forward jump for the back and front leg by a previously described musculoskeletal model. In general, the forces experienced at the knee joint were not of similar magnitude.
{"title":"Evaluation of knee joint reaction force for the back and front leg during the forward jump in soccer","authors":"Meroeh Mohammadi, Javad Kalantari, Ali Mohammadi, Reza Najarpour, Fatemeh Bagheri, Abolfazl Panahi, Mahdi Barnamehei, Setayesh Asadollahi, Sara Salehimojarad","doi":"10.1016/j.gaitpost.2023.07.160","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.160","url":null,"abstract":"Non-contact anterior cruciate ligament (ACL) injuries often happen during the forward jump-landings in soccer [1]. Two main parts of the forward head jump are jumping and landing. Usually, one leg locates front, and another leg locates back during jumping and landing phases [2-4]. The ground reaction force, which presents the impact loads, affects the knee joint reaction loads and can grow biomechanical stress on the anterior cruciate ligament [3,5–7]. Therefore, the aim of the current study was to compare knee joint reaction loads between the back and front leg during the soccer forward jump. What are the differences in knee joint reaction loads between the back and front leg during the soccer forward jump? Twenty elite soccer athletes (68.3±7.5 kg, 178±5.3 cm, 27.5±4.5 years) participated in the current study [8]. Ten Vicon motion captures (Vicon MX, Oxford, UK, 200 Hz) were used to measure the kinematics variables [6,9,10]. EMG activity in the rectus femoris, vastus lateral, vastus medial, tibialis anterior, gastrocnemius medial, gastrocnemius lateral, soleus, biceps femoris, and semitendinosus was recorded by the Myon wireless EMG system [11,12]. Raw EMG signals were full-wave rectified and linear enveloped using a dual-pass fourth-order low-pass Butterworth filter at 4 Hz [13]. A musculoskeletal model with a total of 10 bodies and 92 muscles was used to estimate joint reaction loads in OpenSim [4,14,15]. The inverse kinematics, static optimization, and joint reaction analysis were used to estimate angles, muscle loads, and joint loads, respectively [16,17]. Fig. 1 presents the mean of knee joint reaction forces in anterior-posterior, medial-lateral, and superior-inferior directions during the forward jumping and landing for the back and front leg. Significant differences of knee joint reaction were found between back and front leg.Download : Download high-res image (131KB)Download : Download full-size image Fig. 1: Mean of knee joint reaction forces in anterior-posterior, medial-lateral, and superior-inferior directions during the forward jumping and landing for back and front leg. This study compared the knee joint reaction loads during the soccer forward jump for the back and front leg by a previously described musculoskeletal model. In general, the forces experienced at the knee joint were not of similar magnitude.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.132
Radim Krupicka, Christiane Malá, Slávka Neťuková, Tereza Duspivová, Anna Vážná, None Jan Novák, Evžen Růžička, Ondřej Bezdíček
Gait and cognitive deficits are common symptoms of Parkinson's disease (PD) [1]. Cognitive deficits can manifest themselves in gait impairment and are tested with the gait-cognitive dual task (DT) [2]. Although a study [3] showed that the cognitive deficit represented by Montreal Cognitive Assessment (MoCA) weakly correlated with DT gait parameters, the opposite question, if worse gait performance in DT correlates with cognition in patients with PD, has not been answered. Does the performance in gait-cognitive dual task correlate with the performance in MoCa test in patients with Parkinson's disease? We examined 99 de-novo, drug-naive patients with PD (59±13 years) and 58 healthy controls (CON) (60±9 years) [4]. All subjects completed an extended Timed Up & Go Test (TUG) and Montreal Cognitive Assessment (MoCA). The TUG was performed twice and captured on a 5.15 m long and 0.9 m wide pressure walkway (GAITRite®). Participants were instructed to walk in the two different conditions: (i) at a normal pace (ST) and (ii) at a normal pace while counting down from 100 by seven (DT). Gait velocity, cadence, and stride length were selected as representative gait parameters. Cognitive costs [(DT − ST)/ST × 100] were calculated for each parameter and the first PCA component was calculated for the threshold for gait cognitive impairment. The threshold was defined as the 10th percentile of CON and filtered patients without gate-cognitive deficit. The groupwise comparison was made using the two-sample t-test. The Pearson correlation between MoCA and gait parameters was calculated for filtered PD (31 patients, 61±13 years). The t-test revealed significant differences (p<0.05) between CON and PD in velocity cost and stride length cost. PD’s MoCA moderately correlated with the velocity cost (r=0.37) and strongly correlated with the stride length cost (r=0.52) (see Figure). Figure: Visualization of results A) Distribution and differences in gait parameters of healthy controls (CON) and patients with Parkinson's disease (PD) B) Pearson’s correlation of gait parameters and MoCA presented by r and significance (*p<0.05, **p<0.01). Download : Download high-res image (419KB)Download : Download full-size image The impairment of gait performance in PD is mainly characterized by a slower velocity with a shorter stride length and a compensatory increase in walking cadence [5]. Significant changes in velocity cost and stride length cost confirm that a cognitive task accents gait impairment. Although the studies [2,3] showed a weak correlation between MoCA and DT in patients with cognitive deficits in PD, our study showed a strong correlation in stride length for PD patients with worse DT performance. This may suggest that gait performance is dependent on cognitive performance and may be improved by cognitive training.
{"title":"The effects of cognitive impairment on gait in Parkinson's disease","authors":"Radim Krupicka, Christiane Malá, Slávka Neťuková, Tereza Duspivová, Anna Vážná, None Jan Novák, Evžen Růžička, Ondřej Bezdíček","doi":"10.1016/j.gaitpost.2023.07.132","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.132","url":null,"abstract":"Gait and cognitive deficits are common symptoms of Parkinson's disease (PD) [1]. Cognitive deficits can manifest themselves in gait impairment and are tested with the gait-cognitive dual task (DT) [2]. Although a study [3] showed that the cognitive deficit represented by Montreal Cognitive Assessment (MoCA) weakly correlated with DT gait parameters, the opposite question, if worse gait performance in DT correlates with cognition in patients with PD, has not been answered. Does the performance in gait-cognitive dual task correlate with the performance in MoCa test in patients with Parkinson's disease? We examined 99 de-novo, drug-naive patients with PD (59±13 years) and 58 healthy controls (CON) (60±9 years) [4]. All subjects completed an extended Timed Up & Go Test (TUG) and Montreal Cognitive Assessment (MoCA). The TUG was performed twice and captured on a 5.15 m long and 0.9 m wide pressure walkway (GAITRite®). Participants were instructed to walk in the two different conditions: (i) at a normal pace (ST) and (ii) at a normal pace while counting down from 100 by seven (DT). Gait velocity, cadence, and stride length were selected as representative gait parameters. Cognitive costs [(DT − ST)/ST × 100] were calculated for each parameter and the first PCA component was calculated for the threshold for gait cognitive impairment. The threshold was defined as the 10th percentile of CON and filtered patients without gate-cognitive deficit. The groupwise comparison was made using the two-sample t-test. The Pearson correlation between MoCA and gait parameters was calculated for filtered PD (31 patients, 61±13 years). The t-test revealed significant differences (p<0.05) between CON and PD in velocity cost and stride length cost. PD’s MoCA moderately correlated with the velocity cost (r=0.37) and strongly correlated with the stride length cost (r=0.52) (see Figure). Figure: Visualization of results A) Distribution and differences in gait parameters of healthy controls (CON) and patients with Parkinson's disease (PD) B) Pearson’s correlation of gait parameters and MoCA presented by r and significance (*p<0.05, **p<0.01). Download : Download high-res image (419KB)Download : Download full-size image The impairment of gait performance in PD is mainly characterized by a slower velocity with a shorter stride length and a compensatory increase in walking cadence [5]. Significant changes in velocity cost and stride length cost confirm that a cognitive task accents gait impairment. Although the studies [2,3] showed a weak correlation between MoCA and DT in patients with cognitive deficits in PD, our study showed a strong correlation in stride length for PD patients with worse DT performance. This may suggest that gait performance is dependent on cognitive performance and may be improved by cognitive training.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.157
Alex Mitton, Jonathan Noble, Adam Shortland
Many children with cerebral palsy (CP) develop bony deformities of the femur that require surgical intervention to correct1. Concerns regarding the radiation exposure from CT and the cost and scan time of MRI mean patient-specific 3D models of the femur are rarely used for surgical planning in this patient group, despite evidence supporting their role in improving surgical outcomes2,3,4. Ultrasound (US) imaging presents a cheap, low-risk, and readily available means of constructing such models. However, US is only able to capture partial views of the femur. The “missing” views may be reconstructed using statistical shape modelling; a mathematical technique used to quantitatively analyse complex shapes5,6. Can patient-specific 3D models of the femur be accurately reconstructed from partial surface data acquired with simulated 3D ultrasound using statistical shape modelling? 60 3D meshes of the femur were derived from MR images of 32 young adult subjects (13 with CP, 19 typically developing (TD)). The femur meshes from the left side were flipped horizontally to match those from the right. The meshes from both groups were then used to construct a statistical shape model (SSM) of the femur. An algorithm was written which used the SSM to reconstruct a complete femur mesh from partial information. To test the effectiveness of the algorithm, a dataset of partial surfaces replicating the views possible using US was created. Complete femurs were reconstructed from this dataset, and evaluated against the original 3D meshes using a leave-one-out cross validation procedure. An average point-to-point error of 1.16 ± 0.45 mm was found for reconstructions of the femurs from the TD group, compared to 2.55 ± 0.47 mm in the CP group. Fig. 1 – “a) Example partial surface from the simulated US dataset; b) Example TD reconstruction; c) Example CP reconstruction (reconstruction in purple, original mesh in white”)Download : Download high-res image (36KB)Download : Download full-size image The relatively low error for the reconstructions of the TD femurs demonstrates a promising proof of concept for the proposed technique of creating 3D femur models from partial surface data acquired with US. Future work may develop the algorithm further to improve its performance in the presence of increased femoral deformity, as found in the CP group. With development, this technique has the potential to bring the use of 3D models for preoperative planning into common practice for this patient group, which is likely to improve surgical outcomes. Although the focus of this study has been the creation of 3D models of the femur, the technique of reconstructing US images using statistical shape modelling could be applied to other anatomical structures. Owing to the reduced risk, cost and scan time compared with CT and MRI, the application of the proposed reconstruction technique has the potential to positively impact other surgical services.
{"title":"Reconstructing bones: using statistical shape modelling to create 3D models of the femur from ultrasound images","authors":"Alex Mitton, Jonathan Noble, Adam Shortland","doi":"10.1016/j.gaitpost.2023.07.157","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.157","url":null,"abstract":"Many children with cerebral palsy (CP) develop bony deformities of the femur that require surgical intervention to correct1. Concerns regarding the radiation exposure from CT and the cost and scan time of MRI mean patient-specific 3D models of the femur are rarely used for surgical planning in this patient group, despite evidence supporting their role in improving surgical outcomes2,3,4. Ultrasound (US) imaging presents a cheap, low-risk, and readily available means of constructing such models. However, US is only able to capture partial views of the femur. The “missing” views may be reconstructed using statistical shape modelling; a mathematical technique used to quantitatively analyse complex shapes5,6. Can patient-specific 3D models of the femur be accurately reconstructed from partial surface data acquired with simulated 3D ultrasound using statistical shape modelling? 60 3D meshes of the femur were derived from MR images of 32 young adult subjects (13 with CP, 19 typically developing (TD)). The femur meshes from the left side were flipped horizontally to match those from the right. The meshes from both groups were then used to construct a statistical shape model (SSM) of the femur. An algorithm was written which used the SSM to reconstruct a complete femur mesh from partial information. To test the effectiveness of the algorithm, a dataset of partial surfaces replicating the views possible using US was created. Complete femurs were reconstructed from this dataset, and evaluated against the original 3D meshes using a leave-one-out cross validation procedure. An average point-to-point error of 1.16 ± 0.45 mm was found for reconstructions of the femurs from the TD group, compared to 2.55 ± 0.47 mm in the CP group. Fig. 1 – “a) Example partial surface from the simulated US dataset; b) Example TD reconstruction; c) Example CP reconstruction (reconstruction in purple, original mesh in white”)Download : Download high-res image (36KB)Download : Download full-size image The relatively low error for the reconstructions of the TD femurs demonstrates a promising proof of concept for the proposed technique of creating 3D femur models from partial surface data acquired with US. Future work may develop the algorithm further to improve its performance in the presence of increased femoral deformity, as found in the CP group. With development, this technique has the potential to bring the use of 3D models for preoperative planning into common practice for this patient group, which is likely to improve surgical outcomes. Although the focus of this study has been the creation of 3D models of the femur, the technique of reconstructing US images using statistical shape modelling could be applied to other anatomical structures. Owing to the reduced risk, cost and scan time compared with CT and MRI, the application of the proposed reconstruction technique has the potential to positively impact other surgical services.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.150
Mikko Mattila, Andrey Zhdanov, Juha-Pekka Kulmala
Etiology of idiopathic scoliosis is still unknown. Many theories have been introduced throughout the history to clarify the etiology of the scoliosis. Especially vague is the idiopathic scoliosis that apparently does not have any reasonable explanation. Due to the cosmetic appearance of the scoliotic spine, scoliosis has been mostly studied on its treatment. Because children’s vertebral column is flexible, uneven spinal muscle activity and forces may potentially play a role in the development of scoliosis. Some electromyographic (EMG) studies have reported higher activity in the convex side while other found no differences. Mixed findings may be due to fact that previous studies have analyzed absolute rather than normalized EMG results, although latter is commonly recommended. Do spinal muscles show uneven activity in scoliotic patients when examined using normalized EMG. We report results of six scoliotic patients. Multifidus (Mul), Lumbar erector spinae (Les) and thoracic erector spinae (Tes) EMG was recorded during walking and normalized to values of maximal voluntary contraction (MVC). At groups level, we found relatively little differences in the normalized EMG magnitude between concave (left) and convex (right) side; however, individual results reveal large side-to-side differences especially in the Les and Tes (Fig. 1). The peak normalized EMG values were relatively high often exceeding the 50% level of the MVC. Picture: Scoliotic spine and EMG of the spinal muscles.Download : Download high-res image (125KB)Download : Download full-size image During walking spinal muscles of the young scoliosis patients were activated asymmetrically in a patient-specific manner. While some patients showed relatively low normalized EMG values, others demonstrated high activity levels, indicating that substantial uneven forces are directed to the flexible vertebral column of these patients. Presumably, this influences the stability of the vertebra. It is evident that scoliosis already develops earlier than when it is actually diagnosed, suggesting that a large-scale EMG screening could help to detect abnormal spinal muscle function before scoliosis is manifested.
{"title":"Patients with scoliosis have dysfunctional spinal muscles, preliminary study","authors":"Mikko Mattila, Andrey Zhdanov, Juha-Pekka Kulmala","doi":"10.1016/j.gaitpost.2023.07.150","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.150","url":null,"abstract":"Etiology of idiopathic scoliosis is still unknown. Many theories have been introduced throughout the history to clarify the etiology of the scoliosis. Especially vague is the idiopathic scoliosis that apparently does not have any reasonable explanation. Due to the cosmetic appearance of the scoliotic spine, scoliosis has been mostly studied on its treatment. Because children’s vertebral column is flexible, uneven spinal muscle activity and forces may potentially play a role in the development of scoliosis. Some electromyographic (EMG) studies have reported higher activity in the convex side while other found no differences. Mixed findings may be due to fact that previous studies have analyzed absolute rather than normalized EMG results, although latter is commonly recommended. Do spinal muscles show uneven activity in scoliotic patients when examined using normalized EMG. We report results of six scoliotic patients. Multifidus (Mul), Lumbar erector spinae (Les) and thoracic erector spinae (Tes) EMG was recorded during walking and normalized to values of maximal voluntary contraction (MVC). At groups level, we found relatively little differences in the normalized EMG magnitude between concave (left) and convex (right) side; however, individual results reveal large side-to-side differences especially in the Les and Tes (Fig. 1). The peak normalized EMG values were relatively high often exceeding the 50% level of the MVC. Picture: Scoliotic spine and EMG of the spinal muscles.Download : Download high-res image (125KB)Download : Download full-size image During walking spinal muscles of the young scoliosis patients were activated asymmetrically in a patient-specific manner. While some patients showed relatively low normalized EMG values, others demonstrated high activity levels, indicating that substantial uneven forces are directed to the flexible vertebral column of these patients. Presumably, this influences the stability of the vertebra. It is evident that scoliosis already develops earlier than when it is actually diagnosed, suggesting that a large-scale EMG screening could help to detect abnormal spinal muscle function before scoliosis is manifested.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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