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The characterization of both limbs' behaviour in prosthetic gait is of key importance for improving the prosthetic components and increasing the biomechanical capability of trans-femoral amputees. When characterizing human gait, modular motor control theories have been proven to be powerful in providing a compact description of the gait patterns. In this paper, the planar covariation law of lower limb elevation angles is proposed as a compact, modular description of prosthetic gait; this model is exploited for a comparison between trans-femoral amputees walking with different prosthetic knees and control subjects walking at different speeds. Results show how the planar covariation law is maintained in prostheses users, with a similar spatial organization and few temporal differences. Most of the differences among the different prosthetic knees are found in the kinematic coordination patterns of the sound side. Moreover, different geometrical parameters have been calculated over the common projected plane, and their correlation with classical gait spatiotemporal and stability parameters has been investigated. The results from this latter analysis have highlighted a correlation with several parameters of gait, suggesting that this compact description of kinematics unravels a significant biomechanical meaning. These results can be exploited to guide the control mechanisms of prosthetic devices based purely on the measurement of relevant kinematic quantities. [ABSTRACT FROM AUTHOR]

Kinematic and kinetic methods (sacral marker, reconstructed pelvis, segmental analysis, and force platform methods) have been used to calculate the vertical excursion of the center of mass (COM) during movement. In this study we compared the measurement of vertical COM displacement yielded by different methods during able-bodied subjects' hopping at different frequencies (varying between 1.2 and 3.2 Hz). ANOVA revealed a significant interaction between hopping frequency and method (p < 0.001), showing that increasing hopping frequency reduced the differences between methods. A post hoc analysis revealed a significant difference between all methods at the lowest hopping frequency and between the force platform and both the sacral marker and reconstructed pelvis methods at the intermediate hopping frequencies, with differences ranging from 16 to 67 millimeters (all p < 0.05). Results are discussed in view of each methods' limits. We conclude that the segmental analysis and force platform methods can be considered to provide the most accurate results for COM vertical excursion during human hopping in a large range of hopping frequency. [ABSTRACT FROM AUTHOR]

The aims of this study were: (i) to determine kinematic, kinetic, and electromyographic characteristics of Junzuki karate punch in professional karate athletes; (ii) to identify biomechanical parameters that correlate with punch force and lead to a higher punching performance; (iii) to verify the presence of muscle co-activation in the upper limb, trunk, and lower limb muscles. Data were collected from nine experienced karatekas from the Accademia Italiana Karate e Arti Marziali during the execution of the specific punch. Mean punch forces (181.2 N) delivered to the target, the range of motion of both right and left knees (1.13 and 0.82 rad) and right elbow (1.49 rad) joints, and the angles at impact (knee: 0.81 and 0.91 rad; elbow: 1.19 rad) in the sagittal plane were computed. Furthermore, the trunk rotational angular acceleration (63.1 rad s-2), force related to the lower limbs (550.2 and 425.1 N), and co-activation index for the upper limb (36.1% and 34.7%), trunk (24.5% and 16%), and lower limbs (16.0% and 16.1%) muscles were evaluated bilaterally. Significant positive correlations were found between the punch force and both right and left knee flexion at the instant of impact and right and left leg force. Significant negative correlation was found between the punch force and maximum trunk angular acceleration. Significant differences (p = .03) in the co-activation index among the upper limb, trunk, and lower limbs muscles highlighted a rostro-caudal gradient on both body sides. This research could be of use to performers and coaches when considering training preparations. [ABSTRACT FROM AUTHOR]

Background: Patients with degenerative neurological diseases such as cerebellar ataxia, spastic paraplegia, and Parkinson's disease often display progressive gait function decline that inexorably impacts their autonomy and quality of life. Therefore, considering the related social and economic costs, one of the most important areas of intervention in neurorehabilitation should be the treatment of gait abnormalities. This study aims to determine whether an entire dataset of gait parameters recorded in patients with degenerative neurological diseases can be clustered into homogeneous groups distinct from each other and from healthy subjects. Patients affected by three different types of primary degenerative neurological diseases were studied. These diseases were: i) cerebellar ataxia (28 patients), ii) hereditary spastic paraplegia (31 patients), and iii) Parkinson's disease (70 patients). Sixty-five gender-age-matched healthy subjects were enrolled as a control group. An optoelectronic motion analysis system was used to measure time-distance parameters and lower limb joint kinematics during gait in both patients and healthy controls. When clustering single parameters, step width and ankle joint range of motion (RoM) in the sagittal plane differentiated cerebellar ataxia group from the other groups. When clustering sets of two, three, or four parameters, several pairs, triples, and quadruples of clusters differentiated the cerebellar ataxia group from the other groups. Interestingly, the ankle joint RoM parameter was present in 100% of the clusters and the step width in approximately 50% of clusters. In addition, in almost all clusters, patients with cerebellar ataxia showed the lowest ankle joint RoM and the largest step width values compared to healthy controls, patients with hereditary spastic paraplegia, and Parkinson's disease subjects. This study identified several clusters reflecting specific gait patterns in patients with degenerative neurological diseases. In particular, the specific gait pattern formed by the increased step width, reduced ankle joint RoM, and increased gait variability, can differentiate patients with cerebellar ataxia from healthy subjects and patients with spastic paraplegia or Parkinson's disease. These abnormal parameters may be adopted as sensitive tools for evaluating the effect of pharmacological and rehabilitative treatments. [ABSTRACT FROM AUTHOR]

Background: Spastic gait is a key feature in patients with hereditary spastic paraparesis, but the gait characterization and the relationship between the gait impairment and clinical characteristics have not been investigated. Objectives: To describe the gait patterns in hereditary spastic paraparesis and to identify subgroups of patients according to specific kinematic features of walking. Methods: We evaluated fifty patients by computerized gait analysis and compared them to healthy participants. We computed time-distance parameters of walking and the range of angular motion at hip, knee, and ankle joints, and at the trunk and pelvis. Lower limb joint moments and muscle co-activation values were also evaluated. Results: We identified three distinct subgroups of patients based on the range of motion values. Subgroup one was characterized by reduced hip, knee, and ankle joint range of motion. These patients were the most severely affected from a clinical standpoint, had the highest spasticity, and walked at the slowest speed. Subgroup three was characterized by an increased hip joint range of motion, but knee and ankle joint range of motion values close to control values. These patients were the most mildly affected and had the highest walking speed. Finally, subgroup two showed reduced knee and ankle joint range of motion, and hip range of motion values close to control values. Disease severity and gait speed in subgroup two were between those of subgroups one and three. Conclusions: We identified three distinctive gait patterns in patients with hereditary spastic paraparesis that correlated robustly with clinical data. Distinguishing specific features in the gait patterns of these patients may help tailor pharmacological and rehabilitative treatments and may help evaluate therapeutic effects over time. [ABSTRACT FROM AUTHOR]

Objective To explore whether the trigeminocervical reflexes (TCRs) show a reflex receptive field organization in the brainstem. Methods The facial skin of 16 healthy subjects was electrically stimulated at nine sites reflecting the distribution of the three branches of the trigeminal nerve. The reflex-evoked EMG responses were measured bilaterally from the neck muscles and the head and neck kinematic reactions were detected. Results TCRs are site dependent. There was a vertical gradient in the magnitude of the reflex responses. EMG and kinematic reflexes were larger when evoked from ophthalmic and maxillary sites than from mandibular ones. The reflex responses exhibited a crossed right–left behavior. Stimulation of the lateral sites evoked larger reflex responses in the contralateral trapezium muscle as well as head rotation and neck bending away from the stimulated side. Conclusion This modular arrangement of the TCRs seems to be related to withdrawal strategies aimed at protecting the face from injuries, in accordance with the functional role that each group of muscles plays in head and neck motion. Significance It is likely that the CNS may exploit the neck muscle synergies revealed by the painful stimulation of the skin face in order to control the head and neck movements. [ABSTRACT FROM AUTHOR]

Low-back disorders (LBDs) are the most common and costly musculoskeletal problem. Muscle co-activation, a mechanism that stabilises the spine, is adopted by the central nervous system to provide added protection and avoid LBDs. However, during high-risk lifting tasks, the compressive load on the spine grows owing to increased co-activation. The aim of this study was to develop a method for the sample-by-sample monitoring of the co-activation of more than two muscles, and to compare this method with agonist–antagonist methods. We propose a time-varying multi-muscle co-activation function that considers electromyographic (EMG) signals as input. EMG data of 10 healthy subjects were recorded while they manually lifted loads at three progressively heavier conditions. The repeated measures ANOVA revealed a significant effect of lifting condition on our co-activation index. Heavier conditions resulted in higher muscle co-activation values. Significant correlations were found between the time-varying multi-muscle co-activation index and other agonist–antagonist methods. Practitioner Summary:We have developed a method to quantify muscle co-activation during the execution of a lifting task. To do this we used surface electromyography. Our algorithm provides a measure of time-varying co-activation between more than two muscles. [ABSTRACT FROM AUTHOR]

Cerebellar ataxia is associated with unsteady, stumbling gait, and affected patients report a high rate of falls, particularly during locomotor tasks. U-turns (180° turns while walking) require a high level of coordination in order to completely reverse the body trajectory during ongoing motion, and they are particularly challenging for patients with cerebellar ataxia. The aim of this study was to investigate the kinematic strategies adopted by ataxic patients when performing U-turns. Nine ataxic patients and ten controls were analysed as they performed 180° turns to the right while walking. We evaluated the following aspects: centre of mass velocity, body rotation, number of steps needed to complete the task, step length and step width, lower limb joint kinematics and segmental reorientation. Compared with controls, the ataxic patients showed slower deceleration and re-acceleration of the body, needed more steps to complete the U-turn, showed markedly reduced step length and were unable to modulate step width between steps. Furthermore, the patients adopted an extended joint rather than a flexed joint turning strategy, and the degree of knee flexion was found to be negatively correlated with the number of falls. Ataxic patients show an abnormal U-turn in comparison to age-matched healthy subjects. Some of the observed alterations are indicative of a primary deficit in limb-joint coordination, whereas others suggest that patients choose a compensatory strategy aimed at reducing the instability. [ABSTRACT FROM AUTHOR]

An experiment was carried out on supermarket cashiers to evaluate the time, kinematic and electromyographic changes, in both sitting and standing positions, following the redesign of a checkout counter. The novelty of the prototype checkout counter is a disk wheel placed in the bagging area, which is designed to avoid the cashier having to manually push products along the bagging area. The kinematic evaluation was based on the upper limb and trunk range of motions (RoM). The electromyographic parameters assessed were mean and maximum muscular activations. Three factors were taken into account: design (before and after redesign), posture (standing or sitting) and bagging area (anterior or posterior). The results show that the RoM values are lowest after the intervention and in the standing position. Mean and maximum muscular activation patterns are similar. Differences related to the bagging area in which the goods were released also emerged. The disk wheel represents a valid aid for reducing biomechanical overload in cashiers; the standing position is biomechanically more advantageous. Practitioner Summary: EMG and optoelectronic motion analysis systems are useful for the quantitative assessment of the effects of the redesign of the workplace biomechanical risk. Our results suggest that a disk wheel positioned in the bagging area reduces the biomechanical risk for cashiers and increases time spent resting. [ABSTRACT FROM AUTHOR]

Our aim was to perform a comprehensive analysis of the global and segmental features of gait in patients with genetically confirmed inherited ataxias. Sixteen patients with autosomal dominant (spinocerebellar ataxia, SCA1 or 2) or recessive (Friedreich's ataxia, FRDA) ataxia were studied. We used a motion analysis system to record gait kinematic and kinetic data. We measured the mean values of global (time-distance parameters, COM displacement, support moment) and segmental gait parameters (joint displacement and inter-joint coordination), as both discrete and continuous variables, and their variability and correlations with International Cooperative Ataxia Rating Scale (ICARS) scores. We found a marked difference in all global gait parameters between the ataxic patients and the controls and close correlations between longer stride and stance duration and lower gait, posture and total ICARS scores. The only difference between the two patient groups was a shorter step length in the FRDA patients. As regards the segmental features, we found a significantly different waveform shape for all continuous kinematic and kinetic measures between the ataxic patients and the healthy controls, but only minor differences for the discrete measures. Intersegmental coordination evaluated using the continuous relative phase method revealed an irregular alternating joint behaviour without clear evidence of the synchronous pattern of alternating proximal/distal joint seen in healthy subjects. For almost all gait parameters we observed a markedly higher intra-subject variability in the ataxic patients versus the controls, which was strongly related to the clinical ICARS scores. Patients with chronic, progressive inherited ataxias lose the ability to 'stabilize' a walking pattern that can be repeated over time. The most peculiar aspect of the gait of inherited ataxia patients, regardless the different genetic forms, seems to be the presence of increased variability of all global and segmental parameters rather than an invariant abnormal gait pattern. [ABSTRACT FROM AUTHOR]

Background: The above-knee amputation of a lower limb is a severe impairment that affects significantly the ability to walk; considering this, a complex adaptation strategy at the neuromuscular level is needed in order to be able to move safely with a prosthetic knee. In literature, it has been demonstrated that muscle activity during walking can be described via the activation of a small set of muscle synergies. The analysis of the composition and the time activation profiles of such synergies have been found to be a valid tool for the description of the motor control schemes in pathological subjects.Methods: In this study, we used muscle synergy analysis techniques to characterize the differences in the modular motor control schemes between a population of 14 people with trans-femoral amputation and 12 healthy subjects walking at two different (slow and normal self-selected) speeds. Muscle synergies were extracted from a 12 lower-limb muscles sEMG recording via non-negative matrix factorization. Equivalence of the synergy vectors was quantified by a cross-validation procedure, while differences in terms of time activation coefficients were evaluated through the analysis of the activity in the different gait sub-phases.Results: Four synergies were able to reconstruct the muscle activity in all subjects. The spatial component of the synergy vectors did not change in all the analysed populations, while differences were present in the activity during the sound limb's stance phase. Main features of people with trans-femoral amputation's muscle synergy recruitment are a prolonged activation of the module composed of calf muscles and an additional activity of the hamstrings' module before and after the prosthetic heel strike.Conclusions: Synergy-based results highlight how, although the complexity and the spatial organization of motor control schemes are the same found in healthy subjects, substantial differences are present in the synergies' recruitment of people with trans femoral amputation. In particular, the most critical task during the gait cycle is the weight transfer from the sound limb to the prosthetic one. Future studies will integrate these results with the dynamics of movement, aiming to a complete neuro-mechanical characterization of people with trans-femoral amputation's walking strategies that can be used to improve the rehabilitation therapies. [ABSTRACT FROM AUTHOR]

Background: Subjects with transfemoral amputation (TFA) show an asymmetric gait pattern associated with a decreased ability to recover mechanical energy and an increased metabolic cost of walking.Research Question: This study aimed to identify the spatio-temporal and kinematic gait variables correlated with mechanical energy values in subjects with TFA and to observe the ability of the identified parameters to discriminate between TFA and controls according to the type of prosthesis.Methods: The gait of 40 subjects with TFA was evaluated with a motion 3-D optoelectronic system. Nine subjects wore a mechanical prosthesis (TFAm), seventeen a C-Leg prosthesis (TFAc), and fourteen a Genium prosthesis (TFAg). Spatio-temporal and pelvic kinematic parameters were measured. Energy recovery was measured relative to the whole-body center of mass (CoM) kinematics as the fraction of mechanical energy recovered during each walking step (R-step). Correlation tests and multiple linear regression analyses were used to evaluate the correlation and association between kinematic and energy variables, respectively. Receiver operating characteristics curves were plotted to assess the ability of the correlated parameter to distinguish subjects with TFA from controls, and optimal cutoff point values were calculated according to the type of prosthesis.Results: Among the spatio-temporal and kinematic parameters correlated to R-step, only pelvic obliquity of the prosthetic side was significantly associated with R-step. It showed an excellent ability to discriminate between TFA and controls. Furthermore, pelvic obliquity showed an excellent discriminative ability in identifying TFAm and TFAc and a good discriminative ability in identifying TFAg from controls.Significance: Pelvic obliquity plays an important role in energy recovery during gait for subjects using prosthetics. This information might be exploited to monitor the adaptation of subjects with TFA to prosthetic devices, to lower the energetic cost of walking potentially, and to reduce the long-term risks of secondary physical complications in prosthetic users. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to investigate the lower limb muscle coactivation and its relationship with muscles spasticity, gait performance, and metabolic cost in patients with hereditary spastic paraparesis. Methods Kinematic, kinetic, electromyographic and energetic parameters of 23 patients and 23 controls were evaluated by computerized gait analysis system. We computed ankle and knee antagonist muscle coactivation indexes throughout the gait cycle and during the subphases of gait. Energy consumption and energy recovery were measured as well. In addition to the correlation analysis between coactivation indexes and clinical variables, correlations between coactivation indexes and time–distance, kinematic, kinetic, and energetic parameters were estimated. Findings Increased coactivity indexes of both knee and ankle muscles throughout the gait cycle and during the subphases of gait were observed in patients compared with controls. Energetic parameters were significantly higher in patients than in controls. Both knee and ankle muscle coactivation indexes were positively correlated with knee and ankle spasticity (Ashworth score), respectively. Knee and ankle muscle coactivation indexes were both positively correlated with energy consumption and both negatively correlated with energy recovery. Interpretation Positive correlations between the Ashworth score and lower limb muscle coactivation suggest that abnormal lower limb muscle coactivation in patients with hereditary spastic paraparesis reflects a primary deficit linked to lower limb spasticity. Furthermore, these abnormalities influence the energetic mechanisms during walking. Identifying excessive muscle coactivation may be helpful in individuating the rehabilitative treatments and designing specific orthosis to restrain spasticity. [ABSTRACT FROM AUTHOR]

Objective: Although deficit of coordination between the upper and lower body segments might play an important role in impairing gait and stability in ataxic patients, this deficit has not been investigated in subjects with ataxia so far. To evaluate the coordination between trunk and thigh in a sample of patients with ataxia compared with healthy controls and to correlate the coordination measures with the clinical severity.Design: Prospective observational study.Subjects: Sixteen patients with degenerative cerebellar ataxia and sixteen age- and sex-matched controls were studied.Methods: We assessed the coordination on the sagittal plane between trunk and thigh, considered as rigid segments, by the continuous relative phase (CRP) method. We used the coefficient of multiple correlation (CMC) to measure the within-subject (CMCWS) variability, and the SARA scale to assess clinical severity.Results: CRP curves are dissimilar between ataxic patients and controls, the former showing a chaotic behavior compared to the well-shaped CRP curves observed in the latter. Trunk-thigh coordination has a higher within-subject variability in ataxic patients (median CMCWS: 0.53 for patients, 0.89 for controls, p<0.001). We also found that the CMCWS of the CRP curves negatively correlates with the gait (ρ: -0.565, p: 0.023) and stance (ρ: -0.567, p: 0.022) sub-scores and the total score of the SARA scale (ρ: -0.711, p: 0.002).Conclusions: Ataxia shows a deficit of spatio-temporal coordination between trunk and thigh. Such a deficit is correlated with the degree of the clinical impairment indicating an important role of inter-segmental coordination in determining the severity of ataxia. [ABSTRACT FROM AUTHOR]

Abstract: The aims of this study were to develop a kinematic model of the spine, seen as a continuous deformable body and to identify the smallest set of surface markers allowing adequate measurements of spine motion. The spine is widely considered as a rigid body or as a kinematic chain made up of a smaller number of segments, thereby introducing an approximation. It would be useful to have at our disposal a technique ensuring accurate and repeatable measurement of the shape of the whole spine. Ten healthy subjects underwent a whole-spine radiographic assessment and, simultaneously, an optoelectronic recording. Polynomial interpolations of the vertebral centroids, of the whole set of markers were performed. The similarity of the resulting curves was assessed. Our findings indicate that spine shape can be reproduced by 5th order polynomial interpolation. The best approximating curves are obtained from either 10- or 9-marker sets. Sagittal angles are systematically underestimated. [Copyright &y& Elsevier]