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Background Approximately 25% of orthopedic knee conditions are related to patellofemoral pain (PFP), with young women being the most affected. It is thought that this condition is associated with modifications in the kinematics and muscle control patterns of the lower limb during weight-bearing support activities, which increases femur movement under the patella. Objectives To compare kinematics and muscle induced acceleration patterns between PFP subjects and healthy controls during the preparation phase of the single leg triple hop test. Study design Biomechanical analysis was performed using OpenSim. Ten physically active women (23.2 ± 4 years, 59.3 ± 5.8 kg, and 1.63 ± 0.06 m) with no history of lower limb injury (CG) and 11 volunteers (23.5 ± 2 years, 55.4 ± 4.9 kg, and 1.66 ± 0.04 m) with PFP (PFPG) were recruited. The participants performed a series of single leg triple hop tests while the ground reaction forces and kinematic data were recorded. Results Vector field statistical analysis indicated increased lumbar extension, anterior pelvic tilt, contralateral pelvic drop, and lower induced accelerations from the core and hip muscles in PFPG. Conclusion PFP volunteers presented with alterations in lumbar muscle control associated with a possible compensatory pelvic strategy to minimize knee extensor moment.

Introduction Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome characterized by a triad composed of cognitive alteration, urinary incontinence, and gait impairment associated with ventricular enlargement and normal cerebrospinal fluid pressure. Gait impairment is among the earliest symptoms; however, the reliability of the evaluation is not well-established and no consensus has been reaching regarding variables that should be analyzed and which parameters should be considered to accurately assess post-intervention improvement. Research question Are the degree of repeatability, standard error of measurement, and minimum detectable change considered to detect changes in gait variables in iNPH patients? Methods A total of 84 iNPH patients with a mean age of 77.1 (±6.4) years were analyzed. Gait deviation index (GDI), speed, cadence, cycle time, stride length, single support, and first and second double support were chosen as the variables to be analyzed. Statistical analysis was performed by an independent evaluator, with gait repeatability assessed by the intraclass correlation coefficient (ICC) and the standard error of measure (SEM). Results ICC values were 0.76–0.85 with excellent repeatability, while SEM demonstrated that the variables with best repeatability were the GDI (mean, 4.94; 95% confidence interval (CI), 4.63–5.43), representing a 7.65% mean relative error of the measurement (mean, 0.05 m; 95% CI, 0.05–0.06), and stride length (mean 0.05 m; 95% CI, 0.05–0.06), with a 7.69% mean relative error. Significance We concluded that GDI and stride length were the variables with the best repeatability and lower variability in the gait of iNPH patients.

Background and purpose The maintenance of postural control is influenced by the complexity of a given task. Tasks that require greater attention and cognitive involvement increase the risk of falls among older adults. The aim of the present study was to evaluate the adaptation of the postural control system to different levels of task complexity in physically inactive young and older women. Methods A cross-sectional study was conducted with adult women classified as physically inactive based on the results of the International Physical Activity Questionnaire. The participants were 27 young (20-30 years of age) and 27 older (60-80 years of age) women. Sway velocity of the center of pressure in the anterior-posterior and medial-lateral directions was calculated using a force plate under 6 conditions: standing directly on the force plate or on a foam placed over the force plate, eyes open or closed, and dual-task complexity with and without the foam. Results and discussion A 2-way analysis of variance revealed that sway velocity increased in both groups when the task conditions were altered. The older women exhibited significantly greater sway velocity compared with the young women on all tasks. However, the patterns of postural control adaptation to the different levels of complexity were similar among all participants. Conclusions In this study, the adaption of the postural control system to different levels of task complexity did not differ between physically inactive young and physically inactive older women. However, the physically inactive older women exhibited greater sway velocity compared with the young women.

BACKGROUND: Studies evaluating kinematics lead to different conclusions, not all changes appear in all assessed tasks and in all subgroups of patients with patellofemoral pain (PFP). The inconsistencies between studies could be reduced if we knew which task separates patients best from healthy controls. RESEARCH QUESTION: Identify which functional task, between gait, forward step down (FSD), lateral step down (LSD), stair ascent and descent and propulsion and landing phase of the single leg hop test (SLHT), differentiates the three-dimensional kinematics of women with patellofemoral pain from asymptomatic women. METHODS: This cross-sectional study evaluated thirty-five PFP and thirty-five asymptomatic women during the execution of the following tasks: gait, FSD, LSD, stair ascent and descent and the propulsion and landing phase of single leg hop test. Frontal, sagittal and transverse plane angles of the trunk, pelvis and hip, frontal and sagittal plane angles of the knee, ankle dorsiflexion, foot progression angle and hindfoot eversion were analyzed through the Movement Deviation Profile (MDP). To compare the groups, the multivariate analysis with Bonferroni post hoc test were used, with a significance level of p

Aim The aim of this study was to characterize upper limb motor function during a comparative analysis of electromyographic and upper limb movement analysis during drinking between healthy adults and individuals with DCP. Method Fifteen healthy individuals (CG) and fifteen individuals with DCP (DG) participated in the study. Upper limb function was analyzed during drinking and consisted of a task divided into three phases: the going, the adjustment, and the return. Results Electromyographic analysis revealed a lower activity of the anterior deltoid, posterior deltoid, and biceps brachii muscles in the DG. When comparing the interactions between groups and phases, only biceps brachii shower lower muscle activity during going and adjustment phases. The DG presented a smaller range of motion (ROM) for the shoulder, elbow, forearm and wrist movements. An interaction between groups and phases showed smaller ROM for the flexion and internal rotation of the shoulder, elbow flexion, forearm pronation, and ulnar deviation in the return phase compared to CG. Interpretation The results may contribute positively to the quantification of the level of motor impairment and may be used as a reference for the development of therapeutic interventions for patients with DCP.

Subacromial shoulder pain (SSP) accounts for 44-65% of all cases of shoulder pain. Kinematic alterations in the upper limbs have been observed in individuals with SSP, although there is no consensus on such alterations in the literature. Therefore, the present study aimed to compare the three-dimensional kinematics of the scapula, trunk, and arm during shoulder flexion-extension and abduction-adduction movements in individuals with SSP and a control group using statistical parametric mapping (SPM). We evaluated 117 participants [61 with SSP and 56 in the control group (CG)]. The three-dimensional kinematic analysis was performed starting from arm extension/adduction (0%), moving to flexion/abduction, and ending returning to extension/adduction, respectively (100%) in both groups. SSP group flexed more their trunk (0-100%, p

This study aimed to evaluate test and retest reliability according to examiner experience with the three-dimensional kinematics of the trunk, scapula, and arm segments during flexion and unilateral abduction of the arm. Ten men and 10 women (mean age, 25.1 [1.1] years) participated in this study. Each volunteer participated in six test sessions, four on the first day (two for each examiner) and two on the second day (one for each examiner). A 48-h interval was given between test days. The assessments were made by one examiner with movement analysis experience and a second examiner without experience. For each session (intra-day), the volunteers performed five repetitions of unilateral arm flexions and abductions using their dominant arms. After 1 h, the data were re-collected and all markers were replaced. Data from the trunk, scapula, and arm were analysed at 30°, 60°, 90°, and 120° of arm flexion and abduction using intraclass coefficient correlation, standard error of the measurement, and analysis of variance. The results did not differ between the experienced and inexperienced examiners except for trunk axial rotation at all studied angles and for arm rotation at 120° of abduction. The examiner previously trained in movement analysis marker placement demonstrated the same intra-tester reliability as the inexperienced tester when marker placement accuracy was the variable of interest.

Background There is no consensus on kinematics alterations during descending stairs in females with patellofemoral pain (PFP). In addition, there are no studies that have evaluated the three dimensional kinematics of the trunk, pelvis, hip, knee, and ankle using a multi-segmental model of the foot simultaneously during this task in patients with PFP and evaluated the subphases of stair descent. The objectives of this study were to compare the three dimensional kinematics of the trunk, pelvis, and lower limbs during different subphases of stair descent and identify the discriminatory capacity of the kinematic variables among women with PFP and healthy women. Methods In this cross-sectional study, thirty-four women with PFP and thirty-four pain free women between 18 and 35 years-old were submitted to three-dimensional kinematic evaluation during stair descent. Results It was observed that kinematic differences between the groups occurred in the first double support phase of the stair descent, with the variables of internal rotation of the hindfoot in relation to the tibia in the initial contact (2.1°; sensitivity = 68.6%, specificity = 61.8%) and contralateral pelvic drop in load response (1.3°, sensitivity = 65.7%, specificity = 63.7%) presenting the best ability to discriminate women with and without PFP. Conclusion Our results suggest that kinematic changes during stair descent should be used with caution during the evaluation and decision-making process in women with PFP.

This study aimed to compare the concentric and eccentric activity and the temporal order of peak activity of the hip and knee muscles between women with patellofemoral pain (PFP) and healthy women during the single leg triple hop test (SLTHT). Electromyographic (EMG) and Kinematic data were collected from 14 healthy women (CG) and 14 women diagnosed with PFP (PFG) during a single session of the single leg triple hop test. Integral surface electromyography (iEMG) data of the hip and knee muscles in eccentric and concentric phases and the length of time that each muscle needed to reach the maximal peak of muscle activity were calculated. The iEMG in the eccentric phase was significantly higher (p 0.05) than the concentric phase, for the gluteus maximus and gluteus medius muscles (CG and PFG) and for the vastus lateralis muscle (PFG). The vastus lateralis muscle was the first muscle to reach the highest peak of activity in the PFG, and the third to reach this peak in the CG. In the present study, the activity of the vastus lateralis muscle during the eccentric phase of the jump was greater than concentric phase, as a temporal anticipation of its peak in activity among women with PFP.

OBJECTIVE The purpose of this study was to evaluate the effect of treadmill training with body weight support on gait kinematics parameters in patients with PD using DBS. DESIGN Twelve patients completed the protocols (age: 60.9±10.6 years; disease duration: 20±7 years; and time since DBS surgery: 20±4 months). The same set of patients underwent two trainings protocols and four gait analyses (before and after each training). They received eight weeks of treadmill training without body weight support (16 sessions) in conjunction with physiotherapy program followed by six weeks of wash out period, followed by eight weeks of body-weight-supported treadmill training in conjunction with a same physiotherapy program. The Gait Kinematic Analysis involved eight infrared cameras that detected 19 reflective spherical markers attached in limb lower of patients. Statistical analysis used the Wilcoxon test (p≤0.05). RESULTS Both the training no showed significant differences in linear variables. As the angular variables, only training with support showed significant increase of ranges of motion: pelvis tilt, obliquity and rotation amplitude; hip adduction-abduction and rotation amplitude; percentage of peak flexion in swing phase; foot progression amplitude. CONCLUSION The body weight supported treadmill training may promote increase of mobility of lower limbs during gait and it could be a targeted intervention for PD patients treated with DBS.

Functional biomechanical tests allow the assessment of musculoskeletal system impairments in a simple way. Muscle force synergies associated with movement can provide additional information for diagnosis. However, such forces cannot be directly measured noninvasively. This study aims to estimate muscle activations and forces exerted during the preparation phase of the single leg triple hop test. Two different approaches were tested: static optimization (SO) and computed muscle control (CMC). As an indirect validation, model-estimated muscle activations were compared with surface electromyography (EMG) of selected hip and thigh muscles. Ten physically healthy active women performed a series of jumps, and ground reaction forces, kinematics and EMG data were recorded. An existing OpenSim model with 92 musculotendon actuators was used to estimate muscle forces. Reflective markers data were processed using the OpenSim Inverse Kinematics tool. Residual Reduction Algorithm (RRA) was applied recursively before running the SO and CMC. For both, the same adjusted kinematics were used as inputs. Both approaches presented similar residuals amplitudes. SO showed a closer agreement between the estimated activations and the EMGs of some muscles. Due to inherent EMG methodological limitations, the superiority of SO in relation to CMC can be only hypothesized. It should be confirmed by conducting further studies comparing joint contact forces. The workflow presented in this study can be used to estimate muscle forces during the preparation phase of the single leg triple hop test and allows investigating muscle activation and coordination.

Highlights • Hip muscle weakness in PFP patients may be consequence and not the cause of pain. • Pain and disability may not be associated with kinematics after treatment. • Hip muscle weakness may have no causal relationship with dynamic knee valgus. • The mechanical factors that may impair the management of PFP are likely to be overestimated. • PFP patients should be treated on a biopsychosocial approach., Background Patellofemoral pain is a very common musculoskeletal condition. In the last years, evidence regarding this disease increased exponentially. Although widely investigated, this problem still frustrates patients and clinicians for having an unfavorable prognosis. Some gaps still exist in the understanding and managing of patellofemoral pain. Numerous cross-sectional association studies show an association between gluteus muscular strength and dynamic knee valgus in patients with patellofemoral pain. In spite of this biological plausibility, many evidences challenge the direct relationship between these factors. Recent studies have concluded that women with patellofemoral pain show muscular weakness of the hip based on the cross-sectional studies, however prospective studies indicate that hip weakness cannot be considered a risk for development of patellofemoral pain. In addition, some clinical trials have demonstrated that strength training of the gluteal muscles promotes significant improvement in symptoms but not alter the kinematics of the patients with patellofemoral pain. These findings cast doubt on whether the cause of this condition is really being treated, whether all individuals suffering from patellofemoral pain present dynamic knee valgus or if this is a disturbance present in only a subgroup of patients and whether the strengthening of the hip musculature is an option to consider for prevention of patellofemoral pain. Conclusion Certainly, more studies should be conducted to clarify the influence of mechanical patterns on this condition, but with the existing evidence so far, the importance given to these issues in the evaluation and clinical decision on treatment of these patients seems questionable. Therefore, this masterclass explores the understanding about patellofemoral pain, highlighting mainly the importance of muscular strength and dynamic knee valgus, as well as other possible factors that must be consider during the evaluation and the decision making in these patients.

Introduction Kinesio taping consists of the attachment of a thin elastic tape over specific muscles, the thickness of which is similar to that of the epidermis. Objective The aim of the present study was to compare the effect of Kinesio taping and placebo taping on muscle torque, muscle activity and jumping performance soccer players. Methods Thirty athletes were randomly allocated to two groups (Group A: Kinesio taping and Group B: placebo taping). The participants were instructed to perform the Hop test's and were submitted to an isokinetic evaluation of the knee extensors as well as an electromyographic evaluation of the retus femoris muscle of the dominant lower limb. Next, Kinesio taping was performed for the activation of the rectus femoris muscle in Group A and placebo taping was performed in Group B. The participants were reevaluated 30 minutes after taping and 24 hours after the first evaluation using the same tests. Intra-group and inter-group comparisons were made considering the three evaluation times. Results No statistically significant differences were found between groups at any evaluation time regarding the Hop test's, root mean square of the electromyographic signal or peak torque of the knee extensors of the dominant lower limb (p>0.05). Conclusion Kinesio taping for the activation of the rectus femoris muscle has no effect on peak muscle torque, muscle activity or jumping performance among soccer players.

Background Patellofemoral pain has a poor long-term prognosis, which can be explained by a pain sensitization process. The pain sensitization process may be related to the increase of stress in the patellofemoral joint that is already associated with kinematic alterations and weakness in the musculature of the hip and knee. Methods Were compared the pressure pain threshold, temporal summation, conditioned pain modulation, angular kinematics, and muscle strength between 26 patellofemoral pain and 24 asymptomatic women and then correlated pain sensitization variables with biomechanical variables in pain group. The pressure pain threshold was determined on seven points of the knee, tibialis anterior muscle, and elbow. Ten consecutive stimuli were performed for temporal summation, and cold water was used as the conditioning stimulus for conditioned pain modulation. The strength of hip and knee muscles was determined using a manual dynamometer. Three-dimensional kinematics were evaluated during the lateral step down, considering peak and excursion values of the movement and the Movement Deviation Profile. Findings The pressure pain threshold of the elbow (2.13 [1.84–2.41] vs. 1.63 [1.25–2] kg/cm2), all sites of the knee were lower, as well as the Movement Deviation Profile was higher (9.33 [9.20–9.46] vs. 12.43 [12.1–12.75]) in the pain group. No difference in temporal summation, conditioned pain modulation, muscle strength and discrete kinematic values were found. No significant correlation was found between the Movement Deviation Profile and pressure pain threshold. Interpretation Biomechanical factors, pain processing, and modulation in women with patellofemoral pain, when different from asymptomatic individuals, are not necessarily associated.

Patients with patellofemoral pain (PFP) present altered activation of the hip and knee muscles. Electromyography (EMG) analyses in PFP patients are usually performed individually for each muscle. However, several studies suggest that the central nervous system may modulate neural commands directed to groups of co-activated muscles, called muscle synergies. Investigating the synergistic organization in PFP will advance our knowledge of the influence of pain on muscle coordination. This study aimed to compare the motor coordination between women with and without PFP during the lateral step down (LSD). 15 women with PFP and 14 asymptomatic women underwent three-dimensional kinematics and EMG assessment during LSD. The Movement Deviation Profile (MDP) was calculated from kinematic data. Muscle synergies were extracted from EMG data of eight lower limb muscles using a non-negative factorization algorithm. Results revealed differences in MDP and an altered synergistic control between women with PFP and asymptomatic while performing the same motor gesture. Particularly, the variability accounted for (VAF) when using 3 synergies to reconstruct EMGs of the PFP group was higher than in the control group, suggesting reduced complexity of motor control in PFP. Detailed synergy analyses highlighted specific differences between groups in vastii and rectus femoris, which are muscles with a crucial role during the squat phase and the transition to rise phase of the LSD. This study shows the ability of muscle synergies analysis to reveal impaired motor coordination in PFP patients, and has the potential to be explored as a complementary tool to current clinical assessment techniques., The study was financed in part by the Coordenação de Aper-feiçoamento de Pessoal de Nível Superior – Brasil (CAPES) –Finance Code 001.

Background The aim of the proposed study is to analyze the effect of a six-week osteopathic visceral manipulation (OVM) program on the flexion-relaxation phenomenon in individuals with non-specific chronic low back pain (LBP) and functional constipation. Methods/Design An assessor-blinded, two-arm, randomized, placebo-controlled trial will be conducted. The sample will comprise 76 individuals with non-specific chronic LBP who have functional intestinal constipation, aged 18–65 years. The participants will be randomly allocated to two groups: (1) OVM and (2) sham OVM (SOVM). Evaluations will involve an interview, the Oswestry Disability Index, Fear-Avoidance Beliefs Questionnaire, functional constipation according to Rome III criteria, Biering-Sorensen test to normalize electromyographic (EMG) data, T12–L1 paraspinal level of the EMG signal during the flexion-relaxation phenomenon, 11-point numeric pain rating scale and fingertip-to-floor test. OVM and SOVM will be performed once per week for six weeks. Group 1 will receive OVM for 15 min and Group 2 will receive a sham visceral technique. Evaluations will be performed before and after the first session, after six weeks of treatment, and three months after randomization (follow-up). The findings will be analyzed statistically considering a 5% significance level (p ≤ 0.05). The limitation of the study is that the therapist will not be blinded. Discussion This will be the first trial to analyze the clinical response and electromyographic signals during the flexion-relaxation phenomenon after OVM. Trial registration Brazilian Clinical Trial Registry, RBR-7sx8j3. Registered on 26 October 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2532-8) contains supplementary material, which is available to authorized users.

Background: Handgrip strength is currently considered a predictor of overall muscle strength and functional capacity. Therefore, it is important to find reliable and affordable instruments for this analysis, such as the modified sphygmomanometer test (MST). Objectives: To assess the concurrent criterion validity of the MST, to compare the MST with the Jamar dynamometer, and to analyze the reproducibility (i.e. reliability and agreement) of the MST in individuals with Parkinson's disease (PD). Method: The authors recruited 50 subjects, 24 with PD (65.5±6.2 years of age) and 26 healthy elderly subjects (63.4±7.2 years of age). The handgrip strength was measured using the Jamar dynamometer and modified sphygmomanometer. The concurrent criterion validity was analyzed using Pearson's correlation coefficient and a simple linear regression test. The reproducibility of the MST was evaluated with the coefficient of intra-class correlation (ICC 2,1 ), the standard error of measurement (SEM), the minimal detectable change (MDC), and the Bland-Altman plot. For all of the analyses, α≤0.05 was considered a risk. Results: There was a significant correlation of moderate magnitude (r≥0.45) between the MST and the Jamar dynamometer. The MST had excellent reliability (ICC 2,1 ≥0.7). The SEM and the MDC were adequate; however, the Bland-Altman plot indicated an unsatisfactory interrater agreement. Conclusions: The MST exhibited adequate validity and excellent reliability and is, therefore, suitable for monitoring the handgrip strength in PD. However, if the goal is to compare the measurements between examiners, the authors recommend that the data be interpreted with caution.

Background Several clinical effects have been attributed to the use of biofeedback (BF) as an adjuvant in the treatment of women with stress urinary incontinence (SUI). Objectives To determine whether BF is more effective than other interventions for women with SUI in terms of quantification of urine leakage, episodes of urinary loss, quality of life and muscle strength. Data sources Science Direct, Embase, MEDLINE, Pedro, SciELO, CINAHL and LILACS from January 2000 to February 2017. Study selection Randomised controlled trials (RCTs) addressing the effects of pelvic muscle floor training (PFMT) with BF for the conservative treatment of women with SUI. Data extraction and data synthesis Two independent assessors extracted data from articles. The risk of bias for individual studies was assessed using the Jadad scale and Physiotherapy Evidence Database (PEDro) scale. Mean differences (MD) and 95% confidence intervals were calculated and combined in meta-analyses. Results In total, 1194 studies were retrieved and 11 were included in this review. Only two RCTs demonstrated a low risk of bias according to the PEDro scale. The results demonstrated that PFMT with BF was no better than alternative interventions in terms of muscle strength measured using a perineometer. Limitations Low methodological quality of studies, heterogeneity of outcomes, and differences in implementation of intervention protocols and BF modalities. Conclusions PFMT with BF does not offer therapeutic benefits over alternative interventions (no training, PFMT alone and vaginal electrical stimulation) for the treatment of female SUI. Systematic review registration number PROSPERO CRD42017060780.

Diagnosis of lumbar spinal stenosis (LSS) is based on clinical examination and imaging. The aim of this study was to evaluate the influence of 3D gait analysis as a tool in the differential diagnosis of LSS. Fourteen patients participated in the study that consisted of three phases: (1) capture six gait cycles after rest, (2) walk on a treadmill for a maximum of 20 min, (3) capture six gait cycles after effort. From these data, the kinematic variables were compared with the perception of pain and the cross sectional area of the spinal canal as measured by magnetic resonance. Most of correlations were weak and showed that the most significant results are reported by the Gait Deviation Index (GDI). The Gait Deviation Index demonstrated moderate negative correlation with the perception of pain after effort was made by both limbs. This means that there is a significant decrease in the overall function of the lower limbs according to the increase in pain symptoms. This situation may be reflected in decreased cadence and speed beyond the times of single support for the left limb, and the balance of the right limb, as part of a strategy to protect against pain and imbalance. We found no correlation between gait and pain in the cross-sectional area of the spinal canal. Therefore, we believe that there is no advantage for the patient to make a 3-D gait analysis because the analysis does not add relevant information to clinical diagnosis.

Randomized controlled trial.Patients with Patellofemoral pain (PFP) usually present muscular weakness, pain and impaired motor control. Muscle strengthening is an effective treatment strategy for PFP, but the additional benefits of movement control training remain unknown. Therefore, the aim of this study was to compare the effects of movement control training associated with muscle strengthening, with a conventional program of strengthening alone in women with PFP.Thirty-four women were randomly assigned to two groups. The Strengthening group (S group) performed 12 sessions to strengthen the knee and hip muscles. The Movement ControlStrengthening group (MCS group) performed the same exercises and movement control training of the trunk and lower limbs. Effects of the treatment (i.e., between-group differences) were calculated using linear mixed models. Primary outcomes were function and pain intensity after completion of the treatment protocol. Secondary outcomes were; muscle strength and kinematic outcomes during the step down task after 4 weeks of treatment; and function and pain intensity 3 and 6 months after randomization.The MCS group did not present significantly better function (MD -2.5 points, 95% CI;-10.7-5.5) or pain (MD -0.3 points, 95% CI;-1.7-1.0) at 4 weeks. There was a small difference in favour of the MCS group for AKPS scores at 3 months (MD -8.5 points; 95% CI;-16.8 to -0.3). No significant between-group differences were observed for the other outcomes.Movement control training was no more effective than the isolated strengthening protocol, in terms of pain, function, muscle strength, or kinematics.

Three-dimensional gait analysis (3DGA) is an important element in the quantitative evaluation of gait in subjects with Parkinson's disease (PD). Indexes, such as the Gait Deviation Index (GDI), have recently been proposed as a summary measure of gait. The aim of the present study was to investigate the effectiveness of the GDI and spatiotemporal variables in the quantification of changes in gait during a dual-task (DT) exercise. Fourteen patients with idiopathic PD and nine healthy subjects (CG) participated in the study. All subjects walked under two conditions: free walking and DT walking. The GDI was computed from the 3DGA data. The results show gait impairment during DT, a significant difference between groups regarding GDI and an interaction effect involving the group, side and task factors. The CG and PDG were different independent of interference and side, but interference was only different for the PDG group. The results also demonstrate that the GDI should be an appropriate outcome measure for the evaluation of the effects of DT on patients with Parkinson's disease.

For evaluating the patterns of brain activation in sensorimotor areas following motor rehabilitation, seven male patients diagnosed with TBI underwent an fMRI study before and after being subjected to motor rehabilitation. Six patients showed a reduction in the BOLD signal of their motor cortical areas during the second fMRI evaluation. A decrease in cerebellum activation was also observed in two patients. Newly activated areas, were observed in four patients after treatment. In addition, an increase in the activation of the supplementary motor area (SMA) following rehabilitation was observed in only one test subject. The findings show that motor rehabilitation in TBI patients produces a decrease in the BOLD signal for the sensorimotor areas that were activated prior to treatment. In addition, we observed the recruitment of different brain areas to compensate for functional loss due to TBI in line with the cortical reorganisation mechanism.

This study aimed to determine the influence of flexibility of the chair seat surface on the pressure peak and on the contact area during the execution of a task of handling an object on the seated position by individuals with spastic cerebral palsy. Ten individuals of both genders with diagnosis of spastic cerebral palsy, who had some control to voluntarily move the body and the upper limbs, participated in this study. Quantification of data was carried out in two experimental situations: (1) execution of a task of fitting with upper limbs, and with the individual placed on an adapted canvas seat; (2) execution of a task of fitting with the participant positioned on an adapted wooden seat. Data obtained were submitted to a non-parametric and descriptive statistical analysis using the Wilcoxon test. Results indicated that the use of canvas seat increased the contact area and decreased the pressure peak and the medio-lateral displacement of centre pressure on the seated posture.

Possible delays in pre-activation or deficiencies in the activity of the dynamic muscle stabilizers of the knee and hip joints are the most common causes of the patellofemoral pain syndrome (PFPS). The aim of the study was to compare kinematic variables and electromyographic activity of the vastus lateralis, biceps femoris, gluteus maximus and gluteus medius muscles between patients with PFPS and health subjects during the single leg triple hop test (SLTHT). This study included 14 female with PFPS (PFPS group) and 14 female healthy with no history of knee pain (Healthy group). Kinematic and EMG data ware collected through participants performed a single session of the SLTHT. The PFPS group exhibited a significant increase (p

Cross-sectional study.To compare the biomechanical strategies of the trunk and lower extremity during the transition period between the first and second hop of a single-leg triple hop test in women with and without patellofemoral pain (PFP).Recent literature has shown that PFP is associated with biomechanical impairments of the lower extremities. A number of studies have analyzed the position of the trunk and lower extremities for functional activities such as walking, squatting, jumping, and the step-down test. However, studies on more challenging activities, such as the single-leg triple hop test, may be more representative of sports requiring jumping movements.Women between 18 and 35 years of age (control group, n = 20; PFP group, n = 20) participated in the study. Three-dimensional kinematic and kinetic data were collected during the transition period between the first and second hops while participants performed the single-leg triple hop test.Compared to the control group, women with PFP exhibited greater (P.05) anterior and ipsilateral trunk lean, contralateral pelvic drop, hip internal rotation and adduction, and ankle eversion, while exhibiting less hip and knee flexion. A significant difference (P.05) in time to peak joint angle was also found between groups for all the variables analyzed, except anterior pelvic tilt and hip flexion. In addition, women with PFP exhibited greater (P.05) hip and knee abductor internal moments.Compared to the control group, women with PFP exhibited altered trunk, pelvis, hip, knee, and ankle kinematics and kinetics.

The aim of the present study was to analyse the reproducibility of the Oxford Foot Model (OFM) when used with healthy adults during two clinical tests, i.e., the Anterior Step Down Test (SDA) and the Lateral Step Down Test (SDL). Five healthy participants (one male and four females, 10 limbs in total) with a mean age of 22.2 (19–30) years were assessed in four sessions of tests conducted at intervals of one week. Two independent examiners performed two of the sessions of each of the tests. For each session (intra-day), nine repetitions of each clinical test (SDA and SDL) were performed. After an interval of three hours, the data were collected again. The tests were conducted again after an interval of one week using the same experimental conditions. The intra- and inter-session repeatabilities of the ranges of motion of the feet were determined according to the standard error of measurement (SEM) for each examiner and for the differences between the examiners. The repeatabilities of the results were high for both of the conducted tests. The SEM results were as follows: 0.47–1.94° for the intra-examiner assessment (SDA), 0.55–2.01° for the inter-examiner comparison (SDA), 0.44–2.43° for the intra-examiner assessment (SDL), and 0.54–1.89° for the inter-examiner comparison (SDL). The OFM model was shown to be reproducible in terms of assessing the range of motion of healthy adults during functional tests (SDA and SDL).

This special issue was proposed to combine biology, biomechanics, and human locomotion and the use of this knowledge to improve rehabilitation; prescription of physical activity for health promotion and for sports performance are important for the science, not only for the gait but for every type of movement and exercise. In this special issue, men and women were compared in sports, physical activity, and standing posture. P. G. Mouroco and colleagues show that men and women achieve fast front crawl swimming with different strategies; while men use arm stroke, women swim fast using whole-body mean forces. M. Persiani and colleagues showed that men consistently had larger COP parameters than women. They applied lateral optic flow perturbances and found that they cause asymmetry in postural balance and different lateralization of postural controls in men and women. H. Jaafar and colleagues evaluated force-velocity relationship during cycling and arm cranking exercise. They compared the reliability of maximal power, maximal pedal rate, and maximal force in active men and women and showed that they are different according to sex. It is interesting to see how close or far human performance is according to biology. In rehabilitation, evaluation of functional movements is the key element in building a rehabilitation program. M. Caimmi and colleagues provide a set of normative data from healthy subjects of different ages doing upper-limb functional tasks (reaching and hand-to-mouth movements). Their results are important for upper-limb evaluation in different populations. Normative data in quiet standing is important as well. Therefore, A. C. Alonso and colleagues showed that anthropometric variables can explain part of center of pressure sway quiet standing. Developing techniques to evaluate body motion during walking is necessary to understand how people move. C. Buckley and colleagues measured upper body movement during walking and associated it with postural control in persons with Parkinson's disease (PD). They showed that persons with PD attenuate body accelerations differently compared to controls. E. Bergamini and colleagues proposed a method to evaluate wheelchair propulsion based on biomechanics and successfully applied the results to regulate a training program for young wheelchair athletes. But technology is not only applied in rehabilitation to improve measurements; it is applied as an intervention. C. Luque-Moreno and colleagues reviewed and compared VR intervention in stroke, looking for frequently used outcome measures. Multimodal approach, combining VR and conventional physiotherapy, presented the best results in balance and gait. VR mostly improves gait speed, balance, and motor function in stroke patients. Exercise-based interventions improve performance. N. Hedayatpour and D. Falla reviewed neuromuscular adaptations to eccentric exercise, depicting histochemical, metabolic, and neural adaptations due to eccentric training. Besides, exercise changes human biology. W. Y. V. Mak and W. K. C. Lai showed that short duration of resistance exercise may provoke a transient increase in central arterial stiffness in healthy young men. They analyzed acute effect of Valsalva manoeuvre during resistance exercise on arterial stiffness. So, this special issue is very rich and joins different views of the motion study in the same publication, empowering the knowledge for all professionals of this area. Jullia Maria D'Andrea Greve Angelica Castilho Alonso Luiz Mochizuki Paulo R. Lucareli Chandramouli Krishnan Richard Baker

Background: Gait disorders are common in individuals with Parkinson's Disease (PD) and the concurrent performance of motor and cognitive tasks can have marked effects on gait. The Gait Profile Score (GPS) and the Movement Analysis Profile (MAP) were developed in order to summarize the data of kinematics and facilitate understanding of the results of gait analysis. Objective: To investigate the effectiveness of the GPS and MAP in the quantification of changes in gait during a concurrent cognitive load while walking in adults with and without PD. Method: Fourteen patients with idiopathic PD and nine healthy subjects participated in the study. All subjects performed single and dual walking tasks. The GPS/MAP was computed from three-dimensional gait analysis data. Results: Differences were found between tasks for GPS (P Conclusions: The results showed gait impairment during the dual task and suggest that GPS/MAP may be used to evaluate the effects of concurrent cognitive load while walking in patients with PD.

Asymmetry in the alignment of the lower limbs during weight-bearing activities is associated with patellofemoral pain syndrome (PFPS), caused by an increase in patellofemoral (PF) joint stress. High neuromuscular demands are placed on the lower limb during the propulsion phase of the single leg triple hop test (SLTHT), which may influence biomechanical behavior. The aim of the present cross-sectional study was to compare kinematic, kinetic and muscle activity in the trunk and lower limb during propulsion in the SLTHT using women with PFPS and pain free controls. The following measurements were made using 20 women with PFPS and 20 controls during propulsion in the SLTHT: kinematics of the trunk, pelvis, hip, and knee; kinetics of the hip, knee and ankle; and muscle activation of the gluteus maximus (GM), gluteus medius (GMed), biceps femoris (BF) and vastus lateralis (VL). Differences between groups were calculated using three separate sets of multivariate analysis of variance for kinematics, kinetics, and electromyographic data. Women with PFPS exhibited ipsilateral trunk lean; greater trunk flexion; greater contralateral pelvic drop; greater hip adduction and internal rotation; greater ankle pronation; greater internal hip abductor and ankle supinator moments; lower internal hip, knee and ankle extensor moments; and greater GM, GMed, BL, and VL muscle activity. The results of the present study are related to abnormal movement patterns in women with PFPS. We speculated that these findings constitute strategies to control a deficient dynamic alignment of the trunk and lower limb and to avoid PF pain. However, the greater BF and VL activity and the extensor pattern found for the hip, knee, and ankle of women with PFPS may contribute to increased PF stress.

Patients with dyskinetic cerebral palsy (DCP) experience considerable variability in their purposeful movements due to involuntary movements that contribute to functional impairment. Movement analyses can demonstrate how the movements involved in bringing a mug to the mouth are performed by patients with DCP. Sixteen adults with DCP (29.63 ± 4.42 years) and eleven healthy adults (24.09 ± 3.73 years) performed six consecutive movements of bringing a mug to the mouth using their dominant arm. The mug was placed at 75% of each subject's maximum reach. Kinematic data were captured by 10 cameras and processed using biomechanical software. Fifteen reflexive markers were placed on predetermined bony landmarks on the head, trunk and upper limbs. DCP adults required more time to perform the going (bringing the mug to the mouth), adjusting (simulating taking a drink) and returning (lowering the mug back to the table) phases, and their movements were less smooth than the controls, as indicated by the index of curvature, average jerk and number of movement units. The DCP adults took a longer time to complete the task than controls as indicated by the peak velocities, mean velocities and times to peak velocity. With respect to the angular parameters, DCP adults had a smaller range of motion for shoulder and elbow flexion and forearm pronation compared with the controls. The analysis of functional tasks represents an important measure for the evaluation of dyskinetic movements and permits the quantitative characterization of upper limb impairment in adults with DCP.

Made available in DSpace on 2013-08-28T14:14:30Z (GMT). No. of bitstreams: 1 WOS000306956800001.pdf: 238081 bytes, checksum: f42490f2c352458c860cc3c71fae7fed (MD5) Made available in DSpace on 2013-09-30T19:23:25Z (GMT). No. of bitstreams: 2 WOS000306956800001.pdf: 238081 bytes, checksum: f42490f2c352458c860cc3c71fae7fed (MD5) WOS000306956800001.pdf.txt: 30273 bytes, checksum: 1cab9b402bd0bc38881b43da457a2525 (MD5) Previous issue date: 2012-05-16 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:34:11Z No. of bitstreams: 2 WOS000306956800001.pdf: 238081 bytes, checksum: f42490f2c352458c860cc3c71fae7fed (MD5) WOS000306956800001.pdf.txt: 30273 bytes, checksum: 1cab9b402bd0bc38881b43da457a2525 (MD5) Made available in DSpace on 2014-05-20T15:34:11Z (GMT). No. of bitstreams: 2 WOS000306956800001.pdf: 238081 bytes, checksum: f42490f2c352458c860cc3c71fae7fed (MD5) WOS000306956800001.pdf.txt: 30273 bytes, checksum: 1cab9b402bd0bc38881b43da457a2525 (MD5) Previous issue date: 2012-05-16 Nove de Julho University (Brazil) Background: The use of botulinum toxin A (BT-A) for the treatment of lower limb spasticity is common in children with cerebral palsy (CP). Following the administration of BT-A, physical therapy plays a fundamental role in potentiating the functionality of the child. The balance deficit found in children with CP is mainly caused by muscle imbalance (spastic agonist and weak antagonist). Neuromuscular electrical stimulation (NMES) is a promising therapeutic modality for muscle strengthening in this population. The aim of the present study is to describe a protocol for a study aimed at analyzing the effects of NMES on dorsiflexors combined with physical therapy on static and functional balance in children with CP submitted to BT-A.Methods/Design: Protocol for a prospective, randomized, controlled trial with a blinded evaluator. Eligible participants will be children with cerebral palsy (Levels I, II and III of the Gross Motor Function Classification System) between five and 12 years of age, with independent gait with or without a gait-assistance device. All participants will receive BT-A in the lower limbs (triceps surae). The children will then be randomly allocated for either treatment with motor physical therapy combined with NMES on the tibialis anterior or motor physical therapy alone. The participants will be evaluated on three occasions: 1) one week prior to the administration of BT-A; 2) one week after the administration of BT-A; and 3) four months after the administration of BT-A (end of intervention). Spasticity will be assessed by the Modified Ashworth Scale and Modified Tardieu Scale. Static balance will be assessed using the Medicapteurs Fusyo pressure platform and functional balance will be assessed using the Berg Balance Scale.Discussion: The aim of this protocol study is to describe the methodology of a randomized, controlled, clinical trial comparing the effect of motor physical therapy combined with NMES on the tibialis anterior muscle or motor physical therapy alone on static and functional balance in children with CP submitted to BT-A in the lower limbs. This study describes the background, hypotheses, methodology of the procedures and measurement of the results. Nove de Julho Univ, UNINOVE, Post Grad Program Reabilitat Sci, São Paulo, Brazil Univ Estadual Paulista, Fac Dent, Oral Biopathol Postgrad Program, São Paulo, Brazil Univ Camilo Castelo Branco, Doctors Program Biomed Engn, São Paulo, Brazil Nove de Julho Univ, UNINOVE, Post Grad Program Biophoton Appl Hlth Sci, São Paulo, Brazil Univ Estadual Paulista, Fac Dent, Oral Biopathol Postgrad Program, São Paulo, Brazil

Single-blind randomized, controlled clinical study. To evaluate, using kinematic gait analysis, the results obtained from gait training on a treadmill with body weight support versus those obtained with conventional gait training and physiotherapy. Thirty patients with sequelae from traumatic incomplete spinal cord injuries at least 12 months earlier; patients were able to walk and were classified according to motor function as ASIA (American Spinal Injury Association) impairment scale C or D. Patients were divided randomly into two groups of 15 patients by the drawing of opaque envelopes: group A (weight support) and group B (conventional). After an initial assessment, both groups underwent 30 sessions of gait training. Sessions occurred twice a week, lasted for 30 min each and continued for four months. All of the patients were evaluated by a single blinded examiner using movement analysis to measure angular and linear kinematic gait parameters. Six patients (three from group A and three from group B) were excluded because they attended fewer than 85% of the training sessions. There were no statistically significant differences in intra-group comparisons among the spatial–temporal variables in group B. In group A, the following significant differences in the studied spatial–temporal variables were observed: increases in velocity, distance, cadence, step length, swing phase and gait cycle duration, in addition to a reduction in stance phase. There were also no significant differences in intra–group comparisons among the angular variables in group B. However, group A achieved significant improvements in maximum hip extension and plantar flexion during stance. Gait training with body weight support was more effective than conventional physiotherapy for improving the spatial–temporal and kinematic gait parameters among patients with incomplete spinal cord injuries.

INTRODUCTION: There is still no consensus among different specialists on the subject of kinematic variation during the hemiparetic gait, including the main changes that take place during the gait cycle and whether the gait velocity changes the patterns of joint mobility. One of the most frequently discussed joints is the knee. OBJECTIVES: This study aims to evaluate the variables found in the angular kinematics of knee joint, and to describe the alterations found in the hemiparetic gait resulting from cerebrovascular injury. METHODS: This study included 66 adult patients of both genders with a diagnosis of either right or left hemiparesis resulting from ischemic cerebrovascular injury. All the participants underwent three-dimensional gait evaluation, an the angular kinematics of the joint knee were selected for analysis. RESULTS: The results were distributed into four groups formed based on the median of the gait speed and the side of hemiparesis. CONCLUSIONS: The relevant clinical characteristics included the important mechanisms of loading response in the stance, knee hyperextension in single stance, and reduction of the peak flexion and movement amplitude of the knee in the swing phase. These mechanisms should be taken into account when choosing the best treatment. We believe that the findings presented here may aid in preventing the occurrence of the problems found, and also in identifying the origin of these problems.

PURPOSE: The aims of this study were to evaluate the variables found in the alteration of the load-response mechanism on 3-dimensional kinematic analysis of the knee joint during hemiparetic gait following stroke. METHODS: We evaluated 66 adult patients (33 men and 33 women), aged 45.4 ± 8.5 years (mean ± SD), with a diagnosis of ischemic cerebrovascular accident either right or left hemiparesis and brachial prevalence. All the participants underwent 3-dimensional gait evaluation with a Vicon 370, and the values of the angular kinematics of the knee joint were selected for analysis. RESULTS: There were no statistically significant differences (by the Kruskal-Wallis test) between the subjects regarding the following variables: angular knee position at initial contact and time of peak knee flexion in the stance. The clinically relevant characteristics found were: an increase in knee joint flexion during the initial contact and a movement amplitude below that anticipated in this phase of the walking cycle. These should be taken into account when choosing the best treatment, because they are the ones which exhibit the most important alteration in the load-response mechanism in all patients. CONCLUSION: There is still no consensus among the different specialists regarding the variations in kinematics during the hemiparetic gait. One of the most frequently discussed joints is the knee-the way the main changes take place during the gait cycle and whether the gait velocity changes the patterns of joint mobility. OBJETIVO: O objetivo deste estudo foi avaliar as variáveis resultantes da alteração do mecanismo de resposta à carga por análise tridimensional da cinemática angular da articulação do joelho durante a marcha hemiparética oriunda de acidente vascular cerebral. MÉTODO: Estudo retrospectivo com 66 pacientes adultos de ambos os sexos (33 masculino e 33 feminino), com idade 45,4 ± 8,5 anos, com diagnóstico de acidente vascular cerebral isquêmico com hemiparesia em lado direito ou esquerdo. Todos os pacientes foram submetidos ao protocolo de realização do exame tridimensional computadorizado de marcha por meio de VICON/PEAK® 370. Os valores da cinemática angular do joelho foram selecionados para análise. RESULTADOS: Não foram encontradas diferenças estatisticamente significantes (teste de Kruskal Wallis) entre os sujeitos para as variáveis: posição angular e pico de flexão do joelho (p

INTRODUCTION: The floor reaction ankle-foot orthosis is commonly prescribed in the attempt to decrease knee flexion during the stance phase in the cerebral palsy (CP) gait. Reported information about this type of orthosis is insufficient. PURPOSE: The purpose of this study was to determine the effect of clinically prescribed floor reaction ankle-foot orthosis on kinematic parameters of the hip, knee and ankle in the stance phase of the gait cycle, compared to barefoot walking on children with cerebral palsy. METHODS: A retrospective chart review of 2200 patients revealed that 71 patients (142 limbs) had a diagnosis of diplegia, with no contractures in hip, knee or ankle flexion. Their average age was 12.2 ± 3.9. All of them were wearing clinically prescribed hinged floor reaction ankle-foot orthosis undergoing a three dimensional gait analysis. We divided the patients in three groups: Group I, with limited extension (maximum knee extension less than 15º); Group II, with moderate limited extension (maximum knee extension between 15º and 30º) and Group III Crouch (maximum knee extension in stance more than 30º). RESULTS: Results indicate the parameters maximum knee extension and ankle dorsiflexion were significant in Group II e III; no change was observed in Group I. The maximum hip extension was not significant in all three groups. Conclusion: when indicated to improve the extension of the knees and ankle in the stance of the CP patients floor reaction ankle-foot orthosis was effective. INTRODUÇÃO: A órtese de reação ao solo é freqüentemente prescrita com o objetivo de reduzir a flexão do joelho durante a fase de apoio na marcha de pacientes com paralisia cerebral. Não há informações suficientes relatadas na literature sobre este tipo de órteses. OBJETIVOS: O objetivo deste estudo foi determinar o efeito que a órtese de reação ao solo tem na cinamática angular das articulações do quadril, joelho e tornozelo durante a fase de apoio da marcha de crianças com paralisia cerebral, comparando a marcha descalça e com o uso das órteses MÉTODOS: Após um estudo retrospectivo de 2200 pacientes avaliados no laboratório de marcha, 71 pacientes com diagnóstico de paralisia cerebral do tipo diparesia espástica e idade média de 12.2 ± 3.9 foram selecionados (142 membros). Nenhum deles apresentou contratura em flexão dos quadris, joelhos e tornozelos. Todos usavam órteses do tipo reação ao solo articulada durante a avaliação da marcha. Os pacientes foram divididos em três grupos: Grupo I Extensão Limitada (pico de extensão do joelho menor que 15º); Grupo II Extenão Moderadamente Limitada (pico de extensão do joelho entre 15º e 30º) e Grupo III Agachamento (pico de extensão do joelho no apoio maior que 30º). RESULTADOS: Os resultados demostraram que o pico de extensão do joelho e o pico de dorsiflexão tiveram alterações significantes nos grupos II e III enquanto que o grupo I não apresentou alteração. O pico de extensão do quadril não mostrou alteração nos três grupos CONCLUSÃO: A órtese de reação ao solo é eficaz quando indicada para aumentar a extensão do joelho e tornozelo durante a fase de apoio da marcha de crianças com paralisia cerebral

Patellofemoral pain syndrome (PFPS) is a common musculoskeletal condition, particularly among women. Patients with PFPS usually experience weakness in the gluteal muscles, as well as pain and impaired motor control during activities of daily living. Strengthening the hip muscles is an effective way of treating this disorder. Neuromuscular training has also been identified as a therapeutic tool, although the benefits of this intervention in patients with PFPS patients remain inconclusive. This is a protocol of randomized controlled trial with a blind assessor. Thirty-four women with a clinical diagnosis of PFPS participated. These participants were allocated into two groups (experimental and control). The experimental group performed twelve sessions to strengthen the knee extensors, hip abductor and lateral rotator muscles in association with neuromuscular training of the trunk and lower extremities. The control group performed the same number of sessions to strengthen the muscles of the hip and knee. The primary outcome was functional capacity (Anterior Knee Pain Scale – AKPS) at 4 weeks. Pain intensity, muscle strength and kinematic changes were also measured during the step down test after four weeks of intervention. Follow up assessments were conducted after three and six months to assess functional capacity and pain. The effects of the treatment (i.e. between-group differences) were calculated using mixed linear models. The present study was initiated on the 1st of April 2013 and is currently in progress. The results of this study may introduce another effective technique of conservative treatment and could guide physical therapists in the clinical decision-making process for women with PFPS. Current Controlled Trials NCT01804608 .