Pub Date : 2023-09-01DOI: 10.1016/j.gaitpost.2023.07.265
Niels Waterval, Frans Nollet, Merel-Anne Brehm
{"title":"Ankle power support of spring-like ankle foot orthoses and their effect on compensatory joint work","authors":"Niels Waterval, Frans Nollet, Merel-Anne Brehm","doi":"10.1016/j.gaitpost.2023.07.265","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.265","url":null,"abstract":"","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298549","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}
Patellofemoral pain (PFP) is one of the leading causes of knee pain. Changes in movement patterns and a possible relationship between movement patterns and muscle activation are commonly found in women with PFP [1]. The Movement Deviation Profile (MDP) showed differences in the movement pattern in women with PFP [2], however, to the best of our knowledge, the MDP was not used to differentiate the electromyography of women with and without PFP. This study aimed to verify whether the combined analysis of kinematics and EMG data increases the ability to differentiate between women with and without PFP compared to the independent analysis of kinematics and electromyographic activity. Is there a difference in movement patterns and muscle activation between women with and without PFP? Could the combination of EMG with kinematics data increase the ability to differentiate women with and without PFP? Seventy-one women, 37 with PFP and 34 unimpaired were selected for kinematic and EMG evaluation during the Lateral Step Down (LSD) task. For the 3D kinematics, movements in the sagittal, frontal and transverse planes of the trunk, pelvis and hip were used; sagittal and frontal planes of the knee; ankle sagittal plane; and the transverse plane of the foot in relation to the laboratory. For the EMG, filtered, rectified and smoothed signals from the adductor longus, gluteus medius, vastus lateralis and medialis, rectus femoris, biceps femoris, medial gastrocnemius and tibialis anterior muscles were used, which were normalised in amplitude to the average of the peaks of each cycle of LSD and in time by resampling the EMG envelopes every 1% of the LSD cycle. The MDP, which is a single number measure of movement deviation derived from a multidimensional neural network analysis, was used to analyse kinematics, EMG and kinematics combined with EMG. The Z-score of the MDPmean was calculated to compare the standardised results between women with and without PFP. A multivariate analysis with Bonferroni post-hoc test compared the groups considering p < 0.05. Multivariate analysis showed group interaction (l=0.838; F=4.329; p=0.008). There was a significant difference between groups in the MDPmean Z-Score only for kinematics (0.97). There was no difference between groups for EMG (0.44) and kinematics with EMG (0.39).Download : Download high-res image (117KB)Download : Download full-size image This study corroborates with the literature demonstrating that women with PFP present changes in the movement pattern but not in the amplitude of the electromyography. EMG, even when evaluating with a self-organising neural network (MDP), considering several muscles relevant to PFP, failed to differentiate between women with and without PFP both on its own or combined with kinematics. We conclude that, when using MDP, kinematics is the variable capable of differentiating women with and without PFP during LSD.
{"title":"Movement patterns are different but muscle activations are unchanged in women with patellofemoral pain","authors":"Albuquerque Tadeu, Cintia Lopes Ferreira, Juliane Almeida, Barton Gabor, Paulo Lucareli","doi":"10.1016/j.gaitpost.2023.07.240","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.240","url":null,"abstract":"Patellofemoral pain (PFP) is one of the leading causes of knee pain. Changes in movement patterns and a possible relationship between movement patterns and muscle activation are commonly found in women with PFP [1]. The Movement Deviation Profile (MDP) showed differences in the movement pattern in women with PFP [2], however, to the best of our knowledge, the MDP was not used to differentiate the electromyography of women with and without PFP. This study aimed to verify whether the combined analysis of kinematics and EMG data increases the ability to differentiate between women with and without PFP compared to the independent analysis of kinematics and electromyographic activity. Is there a difference in movement patterns and muscle activation between women with and without PFP? Could the combination of EMG with kinematics data increase the ability to differentiate women with and without PFP? Seventy-one women, 37 with PFP and 34 unimpaired were selected for kinematic and EMG evaluation during the Lateral Step Down (LSD) task. For the 3D kinematics, movements in the sagittal, frontal and transverse planes of the trunk, pelvis and hip were used; sagittal and frontal planes of the knee; ankle sagittal plane; and the transverse plane of the foot in relation to the laboratory. For the EMG, filtered, rectified and smoothed signals from the adductor longus, gluteus medius, vastus lateralis and medialis, rectus femoris, biceps femoris, medial gastrocnemius and tibialis anterior muscles were used, which were normalised in amplitude to the average of the peaks of each cycle of LSD and in time by resampling the EMG envelopes every 1% of the LSD cycle. The MDP, which is a single number measure of movement deviation derived from a multidimensional neural network analysis, was used to analyse kinematics, EMG and kinematics combined with EMG. The Z-score of the MDPmean was calculated to compare the standardised results between women with and without PFP. A multivariate analysis with Bonferroni post-hoc test compared the groups considering p < 0.05. Multivariate analysis showed group interaction (l=0.838; F=4.329; p=0.008). There was a significant difference between groups in the MDPmean Z-Score only for kinematics (0.97). There was no difference between groups for EMG (0.44) and kinematics with EMG (0.39).Download : Download high-res image (117KB)Download : Download full-size image This study corroborates with the literature demonstrating that women with PFP present changes in the movement pattern but not in the amplitude of the electromyography. EMG, even when evaluating with a self-organising neural network (MDP), considering several muscles relevant to PFP, failed to differentiate between women with and without PFP both on its own or combined with kinematics. We conclude that, when using MDP, kinematics is the variable capable of differentiating women with and without PFP during LSD.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298551","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.2023.08.026
Alexia Patinioti, Georgios Gkrimas
{"title":"Comparison of the degree of reliability in forensic gait analysis Methods","authors":"Alexia Patinioti, Georgios Gkrimas","doi":"10.1016/j.gaitpost.2023.08.026","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.08.026","url":null,"abstract":"","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298553","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.2023.07.203
Maria Rassam, Karim Hoyek, Rony El Hayeck, Georges Haddad, Emmanuelle Wakim, Elio Mekhael, Nabil Nassim, Ismat Ghanem, Rami El Rachkidi, Ayman Assi
Scoliosis is a 3D spinal deformity that is known to affect patient’s alignment on static radiographs [1] and their movement during walking or other daily life activities [2]. Crossing obstacles is a common activity that can challenge patients’ stability. However, kinematics of the obstacle-crossing movement is still unknown in adolescent idiopathic scoliosis (AIS). Are kinematics affected in patients with AIS during obstacle-crossing? 18 AIS patients with major right convexity thoracic scoliosis (Cobb: 38° [25-55°]) and 15 controls (age and sex matched: 16 years, 85% F) underwent biplanar X-rays in standing position with the calculation of 3D radiographic spinopelvic parameters. 3D movement analysis was performed during obstacle-crossing, obstacle being fixed at 30% of lower limb length, and executed once with each leg leading the movement. Kinematic parameters of the head, trunk, pelvis, lower limbs and spinal segments were calculated [3,4]. Parameters were compared between the 2 groups and the relationship between kinematic and radiographic variables was investigated. During obstacle-crossing, AIS patients showed an increased thorax extension compared to controls (-19 vs 6°, p<0.05), especially in the main thoracic segment (T3T6-T6T9= 9 vs 14°, p<0.05). Conversely, AIS patients showed a decreased lumbar lordosis when compared to controls (T12L3-L3L5=-14 vs -20°, p<0.05). Moreover, AIS patients showed an anterior rotation (-2 vs 2°) and elevation (6 vs 0°, both p<0.05) of the right shoulder. Patients also showed a decreased hip abduction of the leading leg when compared to controls (-5 vs -9°, p<0.05). The main thoracic extension was correlated to the Cobb angle (r=-0.50) and the shoulder axial rotation to the apical vertebral rotation (r=0.75, both p<0.05; Fig. 1). AIS patients are known to have back flattening with a loss of lumbar lordosis due to their spinal deformity. This spinal malalignment was shown to persist dynamically during obstacle-crossing, associated with a forward shift and elevation of the convexity-side shoulder. The backward movement of the trunk and the shoulder rotation attitude, along with the decreased hip abduction, might hinder stability during obstacle-crossing. These kinematic alterations were shown to increase with the spinal deformity (increased Cobb and apical vertebral rotation). Future studies will investigate kinematic changes in AIS patients following spinal fusion. Fig. 1 Correlations between kinematic limitations and scoliosis severity in adolescent idiopathic scoliosis during obstacle-crossing movement.Download : Download high-res image (100KB)Download : Download full-size image
{"title":"Kinematic limitations during obstacle-crossing in adolescent idiopathic scoliosis","authors":"Maria Rassam, Karim Hoyek, Rony El Hayeck, Georges Haddad, Emmanuelle Wakim, Elio Mekhael, Nabil Nassim, Ismat Ghanem, Rami El Rachkidi, Ayman Assi","doi":"10.1016/j.gaitpost.2023.07.203","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.203","url":null,"abstract":"Scoliosis is a 3D spinal deformity that is known to affect patient’s alignment on static radiographs [1] and their movement during walking or other daily life activities [2]. Crossing obstacles is a common activity that can challenge patients’ stability. However, kinematics of the obstacle-crossing movement is still unknown in adolescent idiopathic scoliosis (AIS). Are kinematics affected in patients with AIS during obstacle-crossing? 18 AIS patients with major right convexity thoracic scoliosis (Cobb: 38° [25-55°]) and 15 controls (age and sex matched: 16 years, 85% F) underwent biplanar X-rays in standing position with the calculation of 3D radiographic spinopelvic parameters. 3D movement analysis was performed during obstacle-crossing, obstacle being fixed at 30% of lower limb length, and executed once with each leg leading the movement. Kinematic parameters of the head, trunk, pelvis, lower limbs and spinal segments were calculated [3,4]. Parameters were compared between the 2 groups and the relationship between kinematic and radiographic variables was investigated. During obstacle-crossing, AIS patients showed an increased thorax extension compared to controls (-19 vs 6°, p<0.05), especially in the main thoracic segment (T3T6-T6T9= 9 vs 14°, p<0.05). Conversely, AIS patients showed a decreased lumbar lordosis when compared to controls (T12L3-L3L5=-14 vs -20°, p<0.05). Moreover, AIS patients showed an anterior rotation (-2 vs 2°) and elevation (6 vs 0°, both p<0.05) of the right shoulder. Patients also showed a decreased hip abduction of the leading leg when compared to controls (-5 vs -9°, p<0.05). The main thoracic extension was correlated to the Cobb angle (r=-0.50) and the shoulder axial rotation to the apical vertebral rotation (r=0.75, both p<0.05; Fig. 1). AIS patients are known to have back flattening with a loss of lumbar lordosis due to their spinal deformity. This spinal malalignment was shown to persist dynamically during obstacle-crossing, associated with a forward shift and elevation of the convexity-side shoulder. The backward movement of the trunk and the shoulder rotation attitude, along with the decreased hip abduction, might hinder stability during obstacle-crossing. These kinematic alterations were shown to increase with the spinal deformity (increased Cobb and apical vertebral rotation). Future studies will investigate kinematic changes in AIS patients following spinal fusion. Fig. 1 Correlations between kinematic limitations and scoliosis severity in adolescent idiopathic scoliosis during obstacle-crossing movement.Download : Download high-res image (100KB)Download : Download full-size image","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298703","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.2023.07.256
Gaia Van Den Heuvel, Wouter Schallig, Marjolein van der Krogt, Ruud Wellenberg, Mario Maas, Annemieke Buizer, Ajay Seth
Children with cerebral palsy (CP) commonly develop deformities of the foot [1], which lead to pain and gait problems. One of the causes of such deformities is likely an imbalance in muscle forces around the foot [2]. In turn, these deformities can also alter muscle function due to altered muscle moment arms. Moment arms can be estimated using musculoskeletal models, but models based on generic bone geometry are unlikely to represent the deformity accurately. Weight-bearing computed tomography (WBCT) enables assessment of abnormal bone alignment under loaded conditions [3]. What are the changes in moment arm lengths of the main invertors and evertors (i.e. the tibialis and peroneal muscles) around the subtalar joint in children with cavovarus and equinovarus foot deformity due to CP? Six children with a severe hindfoot varus deformity due to CP (one female, aged 13.8 ± 2.3 years) and four typically developed (TD) adults (one female, aged 35.8 ± 4.8 years) were included. Personalized musculoskeletal foot models were created in OpenSim Creator [4] using WBCT scans. This foot was attached to the full-body OpenSim gait2392 model, which was scaled using gait analysis data. Muscle moment arms were calculated using OpenSim [5,6] and normalized to tibia length. A non-parametric Mann-Whitney U test was used to compare between groups. Normalized inversion-eversion moment arm lengths are shown in Fig. 1. The tibialis anterior had an inversion moment arm in the deformed CP feet, in contrast to an eversion moment arm in the TD group. No differences were found for the tibialis posterior. Although there was no overall group effect, the eversion moment arm of the peroneal muscles was smaller in most CP children compared to the TD group. Fig. 1 - Moment arms around the subtalar joint, normalized to tibia length. Note the different scales on the vertical axes. * p <.01.Download : Download high-res image (93KB)Download : Download full-size image We present the first study to evaluate altered moment arms in feet of children with CP using personalized musculoskeletal foot models based on WBCT scans. Our results indicate that the tibialis anterior becomes a more effective invertor with a varus deformity of the foot. Despite the fact that the tibialis posterior is often seen as an important cause of the varus deformity, its function as expressed by the moment arm does not change. On the other hand, the eversion moment arms of the peroneal muscles tend to become smaller, meaning they would be less effective in counterbalancing the deformity. Together, these altered moment arms would lead to an even larger varus moment in the subtalar joint with similar muscle forces, thereby pulling the foot even more towards varus. Our results could explain the progression of the deformity once the deformity is present.
患有脑瘫(CP)的儿童通常会出现足部畸形，从而导致疼痛和步态问题。造成这种畸形的原因之一可能是足部周围肌肉力量的不平衡。反过来，由于肌肉力臂的改变，这些畸形也会改变肌肉功能。力矩臂可以使用肌肉骨骼模型来估计，但基于一般骨骼几何的模型不太可能准确地表示畸形。负重计算机断层扫描(WBCT)可以评估负载条件下异常的骨排列[b]。CP引起的足内翻和马内翻畸形患儿距下关节周围主要内翻肌和外翻肌(即胫骨肌和腓骨肌)的力臂长度有什么变化?本研究包括6例由CP引起的严重后足内翻畸形儿童(1例女性，年龄13.8±2.3岁)和4例典型发育(TD)成人(1例女性，年龄35.8±4.8岁)。使用WBCT扫描在OpenSim Creator[4]中创建个性化的肌肉骨骼足模型。将这只脚连接到全身OpenSim gait2392模型上，使用步态分析数据对模型进行缩放。使用OpenSim计算肌肉力臂[5,6]，并将其归一化为胫骨长度。采用非参数Mann-Whitney U检验进行组间比较。归一化倒转力矩臂长度如图1所示。与TD组的外翻力臂相比，畸形CP足的胫骨前肌有内翻力臂。胫骨后肌无明显差异。虽然没有整体的组效应，但与TD组相比，大多数CP儿童的腓骨肌外翻力矩臂较小。图1 -距下关节周围的力臂，与胫骨长度标准化。请注意垂直轴上的不同刻度。* p < 0.01。下载:下载:下载全尺寸图片我们首次使用基于WBCT扫描的个性化足部肌肉骨骼模型来评估CP儿童足部力臂的改变。我们的结果表明，胫骨前肌成为一个更有效的倒置与足内翻畸形。尽管胫骨后肌通常被认为是内翻畸形的重要原因，但它的功能通过力臂表达并没有改变。另一方面，腓肌的外翻力矩臂往往会变小，这意味着它们在平衡畸形方面的效果会降低。总之，这些改变的力臂会导致距下关节在类似的肌肉力量下产生更大的内翻力矩，从而将脚进一步拉向内翻。我们的结果可以解释一旦畸形出现，畸形的进展。
{"title":"The effect of varus foot deformities on muscle moment arms in children with cerebral palsy","authors":"Gaia Van Den Heuvel, Wouter Schallig, Marjolein van der Krogt, Ruud Wellenberg, Mario Maas, Annemieke Buizer, Ajay Seth","doi":"10.1016/j.gaitpost.2023.07.256","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.256","url":null,"abstract":"Children with cerebral palsy (CP) commonly develop deformities of the foot [1], which lead to pain and gait problems. One of the causes of such deformities is likely an imbalance in muscle forces around the foot [2]. In turn, these deformities can also alter muscle function due to altered muscle moment arms. Moment arms can be estimated using musculoskeletal models, but models based on generic bone geometry are unlikely to represent the deformity accurately. Weight-bearing computed tomography (WBCT) enables assessment of abnormal bone alignment under loaded conditions [3]. What are the changes in moment arm lengths of the main invertors and evertors (i.e. the tibialis and peroneal muscles) around the subtalar joint in children with cavovarus and equinovarus foot deformity due to CP? Six children with a severe hindfoot varus deformity due to CP (one female, aged 13.8 ± 2.3 years) and four typically developed (TD) adults (one female, aged 35.8 ± 4.8 years) were included. Personalized musculoskeletal foot models were created in OpenSim Creator [4] using WBCT scans. This foot was attached to the full-body OpenSim gait2392 model, which was scaled using gait analysis data. Muscle moment arms were calculated using OpenSim [5,6] and normalized to tibia length. A non-parametric Mann-Whitney U test was used to compare between groups. Normalized inversion-eversion moment arm lengths are shown in Fig. 1. The tibialis anterior had an inversion moment arm in the deformed CP feet, in contrast to an eversion moment arm in the TD group. No differences were found for the tibialis posterior. Although there was no overall group effect, the eversion moment arm of the peroneal muscles was smaller in most CP children compared to the TD group. Fig. 1 - Moment arms around the subtalar joint, normalized to tibia length. Note the different scales on the vertical axes. * p <.01.Download : Download high-res image (93KB)Download : Download full-size image We present the first study to evaluate altered moment arms in feet of children with CP using personalized musculoskeletal foot models based on WBCT scans. Our results indicate that the tibialis anterior becomes a more effective invertor with a varus deformity of the foot. Despite the fact that the tibialis posterior is often seen as an important cause of the varus deformity, its function as expressed by the moment arm does not change. On the other hand, the eversion moment arms of the peroneal muscles tend to become smaller, meaning they would be less effective in counterbalancing the deformity. Together, these altered moment arms would lead to an even larger varus moment in the subtalar joint with similar muscle forces, thereby pulling the foot even more towards varus. Our results could explain the progression of the deformity once the deformity is present.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135299039","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.2023.07.214
Maria Saade, Ali Rteil, Rami El Rachkidi, Celine Chaaya, Elma Ayoub, Elena Jaber, Elio Mekhael, Nabil Nassim, Abir Massaad, Ayman Assi
Patients with Adult spinal Deformity (ASD) are known to have a deteriorated quality of life (QOL). Severe spinal deformity can develop into postural malalignment caused by a forward shift of the trunk and head. Recent studies have shown that sagittal malalignment in patients with ASD can affect joints and segments’ kinematics during daily life activities [1,2]. On the other hand, ASD patients are known to present with muscular degeneration [3]. However, it is still unknown how trunk muscle’s weakness can affect ASD postural alignment in static position and during daily life activities. To investigate the relationship between muscle forces, radiographic parameters, joint kinematics during daily activities, and QOL scores in ASD. 25 ASD & 19 controls underwent biplanar radiographs in both standing and sitting positions with the calculation of 3D classic spinopelvic and postural alignment parameters (i.e: SVA plumbline between C7 and posterior corner of the sacrum; ODHA angle between line joining odontoid process and middle of hip axis with the vertical). Movement analysis was performed during walking, sit-to-stand, and stair ascent-descent with the calculation of 3D joint and segment kinematics. Participants filled out QOL questionnaires (SF-36 with both physical and mental components, Oswestry Disability Index ODI). The strength of the following muscle groups was measured using a hand-held dynamometer: trunk extensors, flexors, and right & left lateral flexors. ASD were divided into 2 groups based on the age-normalized strength of trunk extensors compared to controls: ASD-normal extensors and ASD-weak extensors (having strength
已知成人脊柱畸形(ASD)患者的生活质量(QOL)恶化。严重的脊柱畸形可发展为由躯干和头部前移引起的姿势失调。最近的研究表明，ASD患者矢状面排列失调会影响日常生活活动中关节和节段的运动学[1,2]。另一方面，已知ASD患者表现为肌肉变性[3]。然而，躯干肌肉无力如何影响ASD在静态位置和日常生活活动中的姿势对齐仍然是未知的。探讨ASD患者肌肉力量、影像学参数、日常活动时关节运动学与生活质量评分之间的关系。25名ASD患者和19名对照组患者分别在站立和坐姿下接受双平面x线摄影，并计算三维经典的脊柱骨盆和体位对齐参数(即C7和骶骨后角之间的SVA垂直线;齿状突连接线与髋中轴之间的ODHA夹角(纵)。在行走、坐立和楼梯升降过程中进行运动分析，并计算三维关节和节段运动学。参与者填写生活质量问卷(SF-36，包括身体和精神部分，Oswestry残疾指数ODI)。使用手持式测力仪测量以下肌肉群的力量:躯干伸肌、屈肌和左右侧屈肌。根据与对照组相比躯干伸肌的年龄标准化强度将ASD分为两组:ASD正常伸肌组和ASD弱伸肌组(对照组强度<均值1sd)。比较两组间影像学参数、运动学变量和生活质量评分。6例ASD伸展肌弱(F=20，对照组为26)。与asd正常伸肌相比，asd弱伸肌患者在站立时呈前矢状排列(ODHA=5°vs 3°，SVA =73 mm vs 24 mm)。他们必须在坐着时增加骨盆后倾，以保持水平凝视(坐-骨盆倾斜=41°vs asd正常伸肌35°)。矢状面排列失调在不同的运动过程中持续存在(动态- odha =16°，而asd正常伸肌为9°)。然而，正常伸肌的ASD在放射学和运动学参数上的改变较小。肌无力与生活质量的恶化相关(物理成分- sf36: r=0.55;P <0.001)，步行速度降低(r=0.44;p<0.001，图1)。该初步研究表明，弱躯干伸肌与站立和坐姿以及日常生活活动中的矢状位错位有关。弱伸肌也与ASD患者生活质量的恶化有关。躯干伸肌的正常力量似乎有助于ASD患者补偿他们在静态和运动时的脊柱畸形。未来的研究将探讨肌肉强化对ASD患者静态和动态对齐及其生活质量的影响。图1:躯干伸肌力量、生活质量评分与步行速度的相关性。下载:下载高分辨率图片(46KB)下载:下载全尺寸图片
{"title":"Relationship between trunk muscle forces, static and dynamic postural malalignment in patients with adult spinal deformity","authors":"Maria Saade, Ali Rteil, Rami El Rachkidi, Celine Chaaya, Elma Ayoub, Elena Jaber, Elio Mekhael, Nabil Nassim, Abir Massaad, Ayman Assi","doi":"10.1016/j.gaitpost.2023.07.214","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.214","url":null,"abstract":"Patients with Adult spinal Deformity (ASD) are known to have a deteriorated quality of life (QOL). Severe spinal deformity can develop into postural malalignment caused by a forward shift of the trunk and head. Recent studies have shown that sagittal malalignment in patients with ASD can affect joints and segments’ kinematics during daily life activities [1,2]. On the other hand, ASD patients are known to present with muscular degeneration [3]. However, it is still unknown how trunk muscle’s weakness can affect ASD postural alignment in static position and during daily life activities. To investigate the relationship between muscle forces, radiographic parameters, joint kinematics during daily activities, and QOL scores in ASD. 25 ASD & 19 controls underwent biplanar radiographs in both standing and sitting positions with the calculation of 3D classic spinopelvic and postural alignment parameters (i.e: SVA plumbline between C7 and posterior corner of the sacrum; ODHA angle between line joining odontoid process and middle of hip axis with the vertical). Movement analysis was performed during walking, sit-to-stand, and stair ascent-descent with the calculation of 3D joint and segment kinematics. Participants filled out QOL questionnaires (SF-36 with both physical and mental components, Oswestry Disability Index ODI). The strength of the following muscle groups was measured using a hand-held dynamometer: trunk extensors, flexors, and right & left lateral flexors. ASD were divided into 2 groups based on the age-normalized strength of trunk extensors compared to controls: ASD-normal extensors and ASD-weak extensors (having strength<mean-1SD in controls). Radiographic parameters, kinematic variables, and QOL scores were compared between groups. 6 ASD had weak extensors (F=20 vs. 26 N in controls). The ASD-weak extensors patients showed a forward sagittal alignment compared to ASD-normal extensors in the standing position (ODHA=5 vs 3°, SVA =73 vs 24 mm). They had to increase their pelvic retroversion while sitting in order to maintain a horizontal gaze (sitting-pelvic tilt=41 vs 35° in ASD-normal extensors). The sagittal malalignment persisted during the different performed movements (dynamic-ODHA=16° vs 9° in ASD-normal extensors). However, ASD with normal extensors had less alterations in their radiographic and kinematic parameters. Muscle weakness was correlated to the deterioration of QOL (physical component-SF36: r=0.55; p<0.001) and decreased walking speed (r=0.44; p<0.001, Fig. 1). This pilot study showed that weak trunk extensors are associated with sagittal malalignment in standing and sitting positions, as well as during daily life activities. Weak extensors also correlate to deteriorated quality of life in ASD. Normal strength of trunk extensors seems to help ASD patients in compensating for their spinal deformity both in static and during movement. Future studies will investigate the effect of muscle strengthening on both static and dynamic","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135299054","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.2023.07.138
Charlotte Lambrechts, Alexandra Kalkantzi, Lisa Decraene, Lize Kleeren, Monica Crotti, Katrijn Klingels, Els Ortibus, Hilde Feys, Lisa Mailleux
In children with unilateral cerebral palsy (uCP), it is well-described that the corticospinal tract (CST) wiring pattern and lesion timing are strongly related to unimanual upper limb function.1 Remarkably, the relation between those neurological factors and bimanual coordination is not yet thoroughly examined, while most daily life activities require the integrated use of both hands. Does bimanual coordination differ depending on the CST-wiring pattern and lesion timing in children with uCP? Bimanual coordination was assessed in 29 children with uCP (12.1 y±2.7 y) using the ball-on-bar task on the Kinarm robotic exoskeleton.2 This task consists of two levels of increasing difficulty, during which participants move a ball to a target while balancing it on a bar through two-dimensional virtual reality visual guidance. Eight parameters of each level were included. Using transcranial magnetic stimulation, the participants were classified into two groups according to their CST-wring pattern: the contralateral (N=10) versus the reorganized ipsilateral or bilateral (N=3/7) CST-wiring. In 9 children, this assessment was not feasible. Based on magnetic resonance imaging, the participants were classified according to their lesion timing in predominant white matter (PWM) lesions (N=16) versus predominant grey matter (PGM) lesions (N=5). In 8 children, brain imaging was missing. Between-group comparisons were calculated with ANCOVA or the non-parametric Quade’s Rank (p<0.05), with age as covariate. Effect sizes were calculated using partial eta squared (np2) and interpreted as: ηp2=0.01 small effect, ηp2=0.06 medium effect, ηp2=0.14 large effect Between the CST-wiring groups, a significant difference was found for hand speed difference in level 2 (F=4.876, p=0.04, ηp2=0.22), indicating a better hand synchrony in children with a contralateral CST-wiring compared to children with a reorganized CST-wiring. Between the lesion timing groups, a significant difference was found for bar tilt standard deviation (SD) in level 1 (F=7.679, p=0.01, ηp2=0.29), reflecting a more stable maintenance of the bar by the PGM-group compared to the PWM-group. Interestingly, a significant group*age interaction was found for level 2 of this parameter (p=0.03), revealing more variability of the bar tilt in the PGM-group with increasing age, in contrast to the PWM-group, which had less variability (Fig. 1).Download : Download high-res image (49KB)Download : Download full-size image Our findings are partially in line with current literature suggesting that children with a contralateral wiring have a better motor function. However, in contrast to previous studies, our results suggest worse bimanual coordination in children with PWM-lesions, which could be explained by the higher incidence of bilateral lesions in PWM-lesions compared to PGM-lesions.3 Nevertheless, future research with larger samples accounting for age interactions is warranted.
{"title":"The relation between bimanual coordination, lesion timing, and corticospinal tract wiring pattern in children with unilateral cerebral palsy","authors":"Charlotte Lambrechts, Alexandra Kalkantzi, Lisa Decraene, Lize Kleeren, Monica Crotti, Katrijn Klingels, Els Ortibus, Hilde Feys, Lisa Mailleux","doi":"10.1016/j.gaitpost.2023.07.138","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.138","url":null,"abstract":"In children with unilateral cerebral palsy (uCP), it is well-described that the corticospinal tract (CST) wiring pattern and lesion timing are strongly related to unimanual upper limb function.1 Remarkably, the relation between those neurological factors and bimanual coordination is not yet thoroughly examined, while most daily life activities require the integrated use of both hands. Does bimanual coordination differ depending on the CST-wiring pattern and lesion timing in children with uCP? Bimanual coordination was assessed in 29 children with uCP (12.1 y±2.7 y) using the ball-on-bar task on the Kinarm robotic exoskeleton.2 This task consists of two levels of increasing difficulty, during which participants move a ball to a target while balancing it on a bar through two-dimensional virtual reality visual guidance. Eight parameters of each level were included. Using transcranial magnetic stimulation, the participants were classified into two groups according to their CST-wring pattern: the contralateral (N=10) versus the reorganized ipsilateral or bilateral (N=3/7) CST-wiring. In 9 children, this assessment was not feasible. Based on magnetic resonance imaging, the participants were classified according to their lesion timing in predominant white matter (PWM) lesions (N=16) versus predominant grey matter (PGM) lesions (N=5). In 8 children, brain imaging was missing. Between-group comparisons were calculated with ANCOVA or the non-parametric Quade’s Rank (p<0.05), with age as covariate. Effect sizes were calculated using partial eta squared (np2) and interpreted as: ηp2=0.01 small effect, ηp2=0.06 medium effect, ηp2=0.14 large effect Between the CST-wiring groups, a significant difference was found for hand speed difference in level 2 (F=4.876, p=0.04, ηp2=0.22), indicating a better hand synchrony in children with a contralateral CST-wiring compared to children with a reorganized CST-wiring. Between the lesion timing groups, a significant difference was found for bar tilt standard deviation (SD) in level 1 (F=7.679, p=0.01, ηp2=0.29), reflecting a more stable maintenance of the bar by the PGM-group compared to the PWM-group. Interestingly, a significant group*age interaction was found for level 2 of this parameter (p=0.03), revealing more variability of the bar tilt in the PGM-group with increasing age, in contrast to the PWM-group, which had less variability (Fig. 1).Download : Download high-res image (49KB)Download : Download full-size image Our findings are partially in line with current literature suggesting that children with a contralateral wiring have a better motor function. However, in contrast to previous studies, our results suggest worse bimanual coordination in children with PWM-lesions, which could be explained by the higher incidence of bilateral lesions in PWM-lesions compared to PGM-lesions.3 Nevertheless, future research with larger samples accounting for age interactions is warranted.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135297865","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.2023.07.141
Cecilia Lidbeck, Bartonek Åsa
Flexed knee is a multidimensional kinematic walking pattern in children with bilateral spastic CP that has been described to develop as gait matures, particularly at higher GMFCS levels (1). One cause might be limited knee extension that have been described to lead to significant disability with a flexed knee gait posture during walking (2). The aim of this study was to compare knee position during walking with passive knee extension in an unloaded body position, and with respect to functional mobility during walking. Gait in 30 children with bilateral spastic CP (13 females) median [min, max] age 11.3 [7.6, 17.1] years and 22 typical developing (TD) children (11 females) median [min-max] age 8.9 [6.5-16.9], was assessed with 3D-motion analysis (Vicon MX40®). Joint contractures in ankle, knee and hip, defined from a neutral joint position, were assessed through goniometric measurement of passive hip extension, knee extension, and ankle dorsiflexion with extended knee in supine position. Orthopaedic lower limb surgeries were documented. Functional mobility was measured with the time up and go test (TUG). Non-parametric statistics were used (p<0.05). Knee contractures were greater at GMFCS III than at GMFCS I and in the TD group (p=0.046 and p= 0.002). During walking, knee angle at initial contact (KneeAngleIC) was greater than peak knee extension in stance (MinKneeFlexSt) in the TD group and at GMFCS I, II, and III (p=0.008, p=0.043, 0.005, and p=0.002) respectively. MinKneeFlexSt exceeded maximum passive knee extension at GMFCS levels II (p=0.004), and III (p=0.002). Both KneeAngleIC and MinKneeFlexSt were greater at GMFCS II and III, than at GMFCS I and the TD group (Fig. 1). TUG took longer for GMFCS II and GMFCS III compared to TD (p<.001 and p<.001) and GMFCS I (p= 0.001 and p<0.001), and longer for GMFCS III compared to GMFCS II (p<0.001). Fig. 1 Light bars represent KneeAngleIC and dark bars MinKneeFlexSt. (+) indicates knee flexion, brackets above the boxes: differences at KneeAngleIC, and below: differences at MinKneeFlexSt.Download : Download high-res image (58KB)Download : Download full-size image This study found that knee flexion in stance was significantly greater than knee contractures at GMFCS levels II and III with no difference in occurrence of orthopaedic surgery. Furthermore, walking ability took longer at GMFCS level III compared to at level II at similar knee flexion contracture. The discrepancy in knee position in weight-bearing versus passive knee extension in the unloaded position at GMFCS II and III, and the large difference in TUG between children at GMFCS level III and those in the other groups, are likely explained by the effort to overcome motor disorders such as spasticity, however, may also be explained by the commonly occurring sensorimotor disorders (4).
膝关节屈曲是双侧痉挛性CP患儿的一种多维运动步行模式，随着步态的成熟而发展，特别是在GMFCS水平较高时(1)。其中一个原因可能是膝关节伸展受限，这被描述为导致行走时膝关节屈曲步态姿势的严重残疾(2)。本研究的目的是比较行走时膝关节位置与无负荷体位时被动膝关节伸展。以及行走时的功能性活动能力。采用3d运动分析(Vicon MX40®)对30名双侧痉挛性CP患儿(13名女性)的步态进行评估，其中中位[最小，最大]年龄为11.3[7.6,17.1]岁，22名典型发育(TD)患儿(11名女性)的中位[最小，最大]年龄为8.9[6.5-16.9]岁。踝关节、膝关节和髋关节的关节挛缩，从关节的中性位置定义，通过测量被动髋关节伸展、膝关节伸展和仰卧位时踝关节背屈的角度来评估。记录了骨科下肢手术。功能活动度采用起走时间(time up and go test, TUG)测试。采用非参数统计(p<0.05)。GMFCS III组的膝关节收缩大于GMFCS I组和TD组(p=0.046和p= 0.002)。行走时，TD组和GMFCS I、II、III组初始接触膝关节角度(knee angleic)分别大于站立时膝关节伸展峰值(MinKneeFlexSt) (p=0.008、p=0.043、0.005和p=0.002)。MinKneeFlexSt超过GMFCS II级(p=0.004)和III级(p=0.002)的最大被动膝关节伸展。GMFCS II组和GMFCS III组的kneangleic和MinKneeFlexSt均高于GMFCS I组和TD组(图1)。与TD组相比，GMFCS II组和GMFCS III组的TUG所需时间更长(p<。(p<0.001)和GMFCS I (p= 0.001和p<0.001)， GMFCS III比GMFCS II的治疗时间更长(p<0.001)。图1亮条代表kneangleic，暗条代表MinKneeFlexSt。(+)表示膝关节屈曲，方框上方括号为膝关节角的差异，方框下方括号为膝关节角的差异。本研究发现，GMFCS II级和III级患者站立时膝关节屈曲明显大于膝关节挛缩，在骨科手术发生率上无差异。此外，在类似膝关节屈曲挛缩的情况下，GMFCS III级患者的行走能力比II级患者需要更长的时间。GMFCS II和III级负重时膝关节位置与无负重时被动膝关节伸展位置的差异，以及GMFCS III级儿童与其他组儿童之间TUG的巨大差异，可能是由于克服痉挛等运动障碍的努力所致，然而，也可能是由于常见的感觉运动障碍所致(4)。
{"title":"Knee flexion while walking versus knee contractures in children with bilateral spastic cerebral palsy","authors":"Cecilia Lidbeck, Bartonek Åsa","doi":"10.1016/j.gaitpost.2023.07.141","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.141","url":null,"abstract":"Flexed knee is a multidimensional kinematic walking pattern in children with bilateral spastic CP that has been described to develop as gait matures, particularly at higher GMFCS levels (1). One cause might be limited knee extension that have been described to lead to significant disability with a flexed knee gait posture during walking (2). The aim of this study was to compare knee position during walking with passive knee extension in an unloaded body position, and with respect to functional mobility during walking. Gait in 30 children with bilateral spastic CP (13 females) median [min, max] age 11.3 [7.6, 17.1] years and 22 typical developing (TD) children (11 females) median [min-max] age 8.9 [6.5-16.9], was assessed with 3D-motion analysis (Vicon MX40®). Joint contractures in ankle, knee and hip, defined from a neutral joint position, were assessed through goniometric measurement of passive hip extension, knee extension, and ankle dorsiflexion with extended knee in supine position. Orthopaedic lower limb surgeries were documented. Functional mobility was measured with the time up and go test (TUG). Non-parametric statistics were used (p<0.05). Knee contractures were greater at GMFCS III than at GMFCS I and in the TD group (p=0.046 and p= 0.002). During walking, knee angle at initial contact (KneeAngleIC) was greater than peak knee extension in stance (MinKneeFlexSt) in the TD group and at GMFCS I, II, and III (p=0.008, p=0.043, 0.005, and p=0.002) respectively. MinKneeFlexSt exceeded maximum passive knee extension at GMFCS levels II (p=0.004), and III (p=0.002). Both KneeAngleIC and MinKneeFlexSt were greater at GMFCS II and III, than at GMFCS I and the TD group (Fig. 1). TUG took longer for GMFCS II and GMFCS III compared to TD (p<.001 and p<.001) and GMFCS I (p= 0.001 and p<0.001), and longer for GMFCS III compared to GMFCS II (p<0.001). Fig. 1 Light bars represent KneeAngleIC and dark bars MinKneeFlexSt. (+) indicates knee flexion, brackets above the boxes: differences at KneeAngleIC, and below: differences at MinKneeFlexSt.Download : Download high-res image (58KB)Download : Download full-size image This study found that knee flexion in stance was significantly greater than knee contractures at GMFCS levels II and III with no difference in occurrence of orthopaedic surgery. Furthermore, walking ability took longer at GMFCS level III compared to at level II at similar knee flexion contracture. The discrepancy in knee position in weight-bearing versus passive knee extension in the unloaded position at GMFCS II and III, and the large difference in TUG between children at GMFCS level III and those in the other groups, are likely explained by the effort to overcome motor disorders such as spasticity, however, may also be explained by the commonly occurring sensorimotor disorders (4).","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135297867","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.2023.07.120
Merve Keskin, Mehmet Irfan Karadede, Derya Ozer Kaya
Dental practices can cause musculoskeletal pain and dysfunction due to cumulative microtrauma and inappropriate working positions (1). The prevalence of musculoskeletal pain in dentists was declared between 64% and 93% (2). The prevalence of low back pain in dentists was reported as 47.6% as the most common musculoskeletal dysfunction (3,4). Is there a difference in spine structure, mobility, and competency of dentists with low back pain compared to those without low back pain? In the study, 65 dentists with low back pain (40 females, 25 males, age: 25.57±2.83 years, weight: 67.64±13.20 kg, height: 171.72±8.46 cm, BMI, 22.75±3.25 kg/m2) and 57 pain-free matched control group (30 females, 27 males, age: 26.36±3.94 years, weight: 69.05±13.00 kg, height: 170.53±7.78 cm, BMI, 23.64±3.52 kg/m2) were included. Spine structure, mobility, and competency in the sagittal and frontal planes were evaluated with the Valedo®Shape device (Idiag, Fehraltorf, Switzerland). Parameters were obtained in degrees: thoracic, lumbar, sacral/hip angle, and trunk inclination angle (angle between straight line from T1 to S1 and vertical line). After the spinous processes of the spine were marked as reference points, the Valedo®Shape device was moved down by the evaluator over all the spinous processes starting from the C7 spinous process to approximately the S3 spinous process. The response of the spine to loading was evaluated using weight for competency measurement. After measuring before the weight, the participant was asked to wait for 30 seconds with the weights in hand, and the measurement was repeated (6). The normality distributions of the data were determined by the Shapiro-Wilk test. In the comparison of the data, the independent sample t-test was used in those with normal distribution, and the Mann-Whitney U test was used for those that were not normally distributed. In patients with low back pain, in the sagittal plane, the inclination angle decreased (p=0.045), there was a shift in the sacral angle with loading (p=0.037). In the sagittal and frontal planes, there was no significant difference in thoracic region angles (p=0.292;0.074) and in the lumbar region angles (p=0.369; p=0.781). In participants with low back pain, the angle of inclination decreased in the sagittal plane and a lateral shift response occurred in the sacrum with loading. It is known that the angles of the lumbopelvic region are directly related to the curvature of the spine and compensatory mechanisms against spinal deformities in the sagittal plane in this region (7). In a previous study, a shift in the inclination angle was reported by dentists with low back pain (8). The changes in the spine in dentists may be seen in the occurrence of low back pain. This should be considered for the assessment and treatment of low back pain.
由于累积的微创伤和不适当的工作位置，牙科治疗会导致肌肉骨骼疼痛和功能障碍(1)。牙医肌肉骨骼疼痛的患病率在64%到93%之间(2)。据报道，牙医腰痛的患病率为47.6%，是最常见的肌肉骨骼功能障碍(3,4)。与没有腰痛的牙医相比，腰痛牙医的脊柱结构、活动性和能力有什么不同吗?本研究纳入65例腰痛牙医师(女性40例，男性25例，年龄25.57±2.83岁，体重67.64±13.20 kg，身高171.72±8.46 cm, BMI 22.75±3.25 kg/m2)和57例无痛匹配对照组(女性30例，男性27例，年龄26.36±3.94岁，体重69.05±13.00 kg，身高170.53±7.78 cm, BMI 23.64±3.52 kg/m2)。采用Valedo®Shape器械(Idiag, Fehraltorf，瑞士)评估脊柱结构、活动能力和矢状面和额面能力。以度为单位获取参数:胸椎角、腰椎角、骶髋角、躯干倾角(T1 - S1直线与垂直线之间的夹角)。将脊柱棘突标记为参考点后，评估者将Valedo®Shape装置移至从C7棘突开始的所有棘突至大约S3棘突。脊柱对负荷的反应是用体重来评估能力的。称重前测量结束后，要求被测者手拿砝码等待30秒，并重复测量(6)。数据的正态分布通过Shapiro-Wilk检验确定。在数据比较中，正态分布采用独立样本t检验，非正态分布采用Mann-Whitney U检验。腰痛患者矢状面倾斜角减小(p=0.045)，骶骨角随负重而移位(p=0.037)。在矢状面和额状面，胸椎区角(p=0.292;0.074)和腰椎区角(p=0.369;p = 0.781)。在患有腰痛的参与者中，随着负荷的增加，矢状面倾斜角度减小，骶骨发生侧向移位反应。众所周知，腰骨盆区域的角度与脊柱的曲度以及该区域矢状面脊柱畸形的代偿机制直接相关(7)。在先前的研究中，下腰痛的牙医报告了倾斜角度的变化(8)。牙医脊柱的变化可能出现在下腰痛的发生中。在评估和治疗腰痛时应考虑到这一点。
{"title":"Comparison of spine structure, mobility, and competency in dentists with and without low back pain","authors":"Merve Keskin, Mehmet Irfan Karadede, Derya Ozer Kaya","doi":"10.1016/j.gaitpost.2023.07.120","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.120","url":null,"abstract":"Dental practices can cause musculoskeletal pain and dysfunction due to cumulative microtrauma and inappropriate working positions (1). The prevalence of musculoskeletal pain in dentists was declared between 64% and 93% (2). The prevalence of low back pain in dentists was reported as 47.6% as the most common musculoskeletal dysfunction (3,4). Is there a difference in spine structure, mobility, and competency of dentists with low back pain compared to those without low back pain? In the study, 65 dentists with low back pain (40 females, 25 males, age: 25.57±2.83 years, weight: 67.64±13.20 kg, height: 171.72±8.46 cm, BMI, 22.75±3.25 kg/m2) and 57 pain-free matched control group (30 females, 27 males, age: 26.36±3.94 years, weight: 69.05±13.00 kg, height: 170.53±7.78 cm, BMI, 23.64±3.52 kg/m2) were included. Spine structure, mobility, and competency in the sagittal and frontal planes were evaluated with the Valedo®Shape device (Idiag, Fehraltorf, Switzerland). Parameters were obtained in degrees: thoracic, lumbar, sacral/hip angle, and trunk inclination angle (angle between straight line from T1 to S1 and vertical line). After the spinous processes of the spine were marked as reference points, the Valedo®Shape device was moved down by the evaluator over all the spinous processes starting from the C7 spinous process to approximately the S3 spinous process. The response of the spine to loading was evaluated using weight for competency measurement. After measuring before the weight, the participant was asked to wait for 30 seconds with the weights in hand, and the measurement was repeated (6). The normality distributions of the data were determined by the Shapiro-Wilk test. In the comparison of the data, the independent sample t-test was used in those with normal distribution, and the Mann-Whitney U test was used for those that were not normally distributed. In patients with low back pain, in the sagittal plane, the inclination angle decreased (p=0.045), there was a shift in the sacral angle with loading (p=0.037). In the sagittal and frontal planes, there was no significant difference in thoracic region angles (p=0.292;0.074) and in the lumbar region angles (p=0.369; p=0.781). In participants with low back pain, the angle of inclination decreased in the sagittal plane and a lateral shift response occurred in the sacrum with loading. It is known that the angles of the lumbopelvic region are directly related to the curvature of the spine and compensatory mechanisms against spinal deformities in the sagittal plane in this region (7). In a previous study, a shift in the inclination angle was reported by dentists with low back pain (8). The changes in the spine in dentists may be seen in the occurrence of low back pain. This should be considered for the assessment and treatment of low back pain.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135297879","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}
Proprioception is a significant factor in balance, coordination, joint stability and movement acuity (1). Among proprioception’s components, joint position sense (JPS) and movement detection have been mostly assessed whereas little is known about the joint velocity proprioceptive sense (2). Finding the joint angular velocity(-ies) that is more comprehensible by the human’s brain, and therefore more accurately reproduced, could be used, among others, in motor learning rehabilitation protocols. To investigate the knee angular velocities envelope inside which the joint can be moved with the most accuracy, depending on the task. 48 subjects (23 men and 25 women) without knee pathology participated in the study (age 21.4 ±3.85). Velocity replication (VR) was assessed in a spectrum of 5 different and randomly chosen low velocities (2°/s, 5°/s, 10°/s, 20°/s and 30°/s) by using concentric quadriceps contraction in an Isokinetic Dynamometer (Biodex System3 Pro). During the procedure the subjects were blindfolded, and the examiners were blind regarding the results.The passive demonstrations of each joint angular velocity were followed by active velocity replications. The number of passive demonstrations and active replications were adapted for each velocity in such a way, that each subject would stay almost the same amount of time, and therefore having the same effect or effort, in all of them. The knee angular velocities of 2°/s and 5°/s had the bigger mean percentage replication errors (68.2% and 29.0%) but the smallest mean errors in absolute value (1.4°/s for both the velocities). In the velocities of 10°/s, 20°/s and 30°/s the mean percentage replication errors were 26.3%, 26.1% and 29.0% respectively, while the mean errors in absolute value were 2.6°/s, 5.5°/s and 8.6°/s respectively. According to the present research, the knee joint can achieve a maximal precision of 1.4°/s angular velocity error, appear in joint velocities below 5°/s. Rehabilitation protocols require precision should focus is this kinematic envelope as, above this threshold, the angular velocity error increases gradually, as the joint velocity increases. For gross motor activities, where percentage joint angular velocity errors are more meaningful than the absolute error values, the kinematic envelope between 10°/s - 20°/s seem to be the ideal for motor learning tasks. According to our knowledge, this is the first attempt in the literature to investigate the knee angular velocity proprioception, and further investigation is needed on the velocity proprioceptive behavior of other joints, as well as any deviations in pathologies or trauma.
{"title":"The use of a novel assessment protocol for the knee joint velocity proprioceptive sense to investigate motor learning abilities","authors":"Anthi Kellari, Eumorphia Papapostolou, Euaggelia Papadimou, Zacharias Dimitriadis, Eleni Kapreli, George Koumantakis, Nikolaos Strimpakos, Asimakis Kanellopoulos","doi":"10.1016/j.gaitpost.2023.07.118","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.118","url":null,"abstract":"Proprioception is a significant factor in balance, coordination, joint stability and movement acuity (1). Among proprioception’s components, joint position sense (JPS) and movement detection have been mostly assessed whereas little is known about the joint velocity proprioceptive sense (2). Finding the joint angular velocity(-ies) that is more comprehensible by the human’s brain, and therefore more accurately reproduced, could be used, among others, in motor learning rehabilitation protocols. To investigate the knee angular velocities envelope inside which the joint can be moved with the most accuracy, depending on the task. 48 subjects (23 men and 25 women) without knee pathology participated in the study (age 21.4 ±3.85). Velocity replication (VR) was assessed in a spectrum of 5 different and randomly chosen low velocities (2°/s, 5°/s, 10°/s, 20°/s and 30°/s) by using concentric quadriceps contraction in an Isokinetic Dynamometer (Biodex System3 Pro). During the procedure the subjects were blindfolded, and the examiners were blind regarding the results.The passive demonstrations of each joint angular velocity were followed by active velocity replications. The number of passive demonstrations and active replications were adapted for each velocity in such a way, that each subject would stay almost the same amount of time, and therefore having the same effect or effort, in all of them. The knee angular velocities of 2°/s and 5°/s had the bigger mean percentage replication errors (68.2% and 29.0%) but the smallest mean errors in absolute value (1.4°/s for both the velocities). In the velocities of 10°/s, 20°/s and 30°/s the mean percentage replication errors were 26.3%, 26.1% and 29.0% respectively, while the mean errors in absolute value were 2.6°/s, 5.5°/s and 8.6°/s respectively. According to the present research, the knee joint can achieve a maximal precision of 1.4°/s angular velocity error, appear in joint velocities below 5°/s. Rehabilitation protocols require precision should focus is this kinematic envelope as, above this threshold, the angular velocity error increases gradually, as the joint velocity increases. For gross motor activities, where percentage joint angular velocity errors are more meaningful than the absolute error values, the kinematic envelope between 10°/s - 20°/s seem to be the ideal for motor learning tasks. According to our knowledge, this is the first attempt in the literature to investigate the knee angular velocity proprioception, and further investigation is needed on the velocity proprioceptive behavior of other joints, as well as any deviations in pathologies or trauma.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135297892","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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