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Background: Children with cerebral palsy experience movement disorders that influence gait stability. It is likely that gait stability further decreases when walking on uneven compared to even ground. Therefore, the aim of this study was to investigate gait on uneven ground in children with unilateral cerebral palsy., Methods: Twenty children with unilateral cerebral palsy and twenty typically developing children performed a three-dimensional gait analysis when walking on even and uneven ground. Spatio-temporal parameters, full-body joint kinematics and centre of mass displacements were compared., Findings: On uneven versus even ground, both groups showed decreased cadence, increased stance phase and double support time, increased toe clearance height, and increased knee and hip flexion during swing phase. Whereas only the typically developing children walked slower and had increased dorsiflexion and external foot progression during stance phase, only the patients showed increased stride width, increased elbow flexion (affected and non-affected side), and kept the centre of mass more medial when standing on the affected leg., Interpretation: Patients and healthy children use similar adaptation mechanisms when walking on uneven ground. Both groups increased the toe clearance height by increasing knee and hip flexion during swing. However, whereas patients enlarge their base of support by increasing stride width, healthy children do so by increasing their external foot progression angle. Furthermore, patients seem to feel more insecure and hold their arms in a position to prepare for falls on uneven ground. They also do not compensate with their non-affected side for their affected side on uneven ground., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Structural leg length discrepancy (LLD) is a common phenomenon. However, its effect on spinal gait kinematics remains unclear., Research Question: How does LLD affect spinal gait kinematics in patients with structural LLD and what is the immediate effect of a shoe lift?., Methods: 10 adolescents with structural LLD (20-60 mm) and 14 healthy controls were included. All of whom were fitted with a trunk marker set and requested to walk barefoot as well as with an orthotic shoe lift (only patients). Data were collected using a 12-camera motion capture system. Group comparisons were conducted using one-dimensional Statistical Parametric Mapping (SPM)., Results: Patients with LLD showed statistically significant increased frontal plane lumbar bending angles to the longer side (p = 0.007), increased pelvic drop on the shorter side (p < 0.001) and increased hip adduction angles on the longer leg (p < 0.001) compared to the healthy controls. In the sagittal plane, patients demonstrated changed knee (shorter leg) and ankle joint (longer leg) motion. All gait deviations observed in patients with LLD could immediately be altered by correcting the LLD using a shoe lift., Significance: Due to the LLD, patients showed a lateral pelvic drop on the shorter side, which appeared to be compensated for by a contralateral bending in the lumbar spine and a lateral shift of the pelvis towards the longer side. In addition, the use of an orthotic correction seems to be a suitable option to instantly normalize gait kinematics in patients with mild to moderate LLD., (Copyright © 2018 Elsevier B.V. All rights reserved.)

In clinical gait analysis, it is challenging to acquire usable force plate data for a patient in a limited amount of time. The aim of this study was to compare three measurement protocols, to investigate if any one of them was more time-efficient than the others at collecting kinetic data. Three conditions were compared for 15 orthopaedic patients: 1) approaching the force plate with four steps, 2) approaching the force plate with six steps, and 3) approaching the force plate with four steps while stepping on a target one step before the first force plate. Then, the following characteristics were analysed: the rate of usable force plate steps, the spatio-temporal parameters, the full-body gait kinematics, and the lower body kinetics. For the condition with four steps and targeting, the rate of usable force plate steps was highest: 84% (6.8 usable trials out of 8.1 trials on average per patient). Left hip adduction and rotation, right shoulder flexion, and total left hip power were the gait parameters with statistically significant differences between the four and six step approach. Left cadence, right step time, left thorax lateroflexion, left shoulder abduction, total right knee power, hip rotation, thorax tilt, and head tilt on both sides were statistically different between the four step approach with targeting and without targeting. None of the differences in gait parameters (except for head tilt) were of clinical relevance. Therefore, approaching the force plate with four steps and stepping on a foot-sized target one step prior to stepping on the force plate increases the rate of usable kinetic data., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Patients undergoing a clinical gait analysis often walk slower than healthy people. However, data on how speed affects upper body movements, especially of the arms and shoulders, are scarce. Therefore, in this descriptive study, we examined how changes in walking speed affect upper-body kinematics and aspects of intersegmental coordination between upper and lower body during overground walking in a group of healthy adult subjects. Three-dimensional gait data were collected on 20 healthy subjects (aged between 22 and 31 years) walking at six speeds ranging from extremely slow to very fast. Our results showed significant speed-related changes of upper body kinematic movement curves in three aspects, namely in amplitude (curves for shoulder flexion and abduction, elbow flexion, pelvic obliquity and rotation), timing (curves for shoulder extension and abduction, elbow extension, pelvic rotation) and curve pattern (curves for shoulder and elbow flexion, shoulder rotation, pelvic tilt). The intersegmental coordination between the thorax and pelvis and arm and leg was also affected by a change of walking speed. Our data supplement the already available data in the literature examining the effects of walking speed on lower extremity motion. Furthermore, the data can be used as a reference for both basic biomechanical and clinical gait studies. The results will help in clinical practice to differentiate between effects caused by walking speed and underlying pathology., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: To investigate the immediate effect of four-wheeled- walker(rollator)walking on lower-limb muscle activity and trunk-sway in healthy subjects., Methods: In this cross-sectional design electromyographic (EMG) data was collected in six lower-limb muscle groups and trunk-sway was measured as peak-to-peak angular displacement of the centre-of-mass (level L2/3) in the sagittal and frontal-planes using the SwayStar balance system. 19 subjects walked at self-selected speed firstly without a rollator then in randomised order 1. with rollator 2. with rollator with increased weight-bearing., Results: Rollator-walking caused statistically significant reductions in EMG activity in lower-limb muscle groups and effect-sizes were medium to large. Increased weight-bearing increased the effect. Trunk-sway in the sagittal and frontal-planes showed no statistically significant difference between conditions., Conclusion: Rollator-walking reduces lower-limb muscle activity but trunk-sway remains unchanged as stability is likely gained through forces generated by the upper-limbs. Short-term stability is gained but the long-term effect is unclear and requires investigation., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Correcting a pathological toe walking gait pattern can be achieved by restricting excessive plantarflexion during the swing phase of gait. A common conservative treatment measure is providing the patient with an ankle-foot-orthosis on the affected lower leg. This study examined the lower body gait kinematics and temporal-spatial parameters of fifteen healthy adults when walking freely and with unilateral restricted ankle motion. The latter was achieved by fitting an ankle-foot-orthosis. Specific hip and knee kinematic parameters and temporal-spatial parameters were investigated. Differences between the two conditions were calculated by paired Student's t-tests and 95% confidence intervals. Unilateral restricted ankle motion influenced kinematics mainly in the swing phase. Hip and knee peak flexion in the swing phase were increased on the restricted side (hip: 49.2° (SD 4.2°), knee: 75.9° (SD 6.1°)) compared to walking freely (hip: 43.3° (SD 4.5°), knee: 66.7° (SD 5.3°)). Peak hip flexion occurred earlier in the swing phase in the restricted condition (85% (SD 2%)) compared to the free-walking condition (96% (SD 5%)). For these parameters, the confidence intervals were different, indicating clinical relevance. Walking with unilateral restricted ankle motion had a negative effect on walking velocity, cadence, step time, and step length. The confidence intervals, however, overlapped. These results might be a reaction to unusual sensory feedback from the feet with the ankle-foot-orthosis or due to increased hip flexor activity compensating for the reduced function of the plantarflexors. The evaluation of the immediate changes in unilateral restricted ankle motion in individuals with healthy gaits can contribute to a more complete understanding on this topic., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Movements of the lower limbs during walking have been widely investigated in literature, while quantification of arm movement during gait is scanty. The aim of the present study was to assess quantitatively the upper limb motion during gait in children with Cerebral Palsy (CP). Sixteen children with diplegic CP were evaluated using a full-body marker set, which allows assessing both the lower and upper limb kinematics. Our results demonstrated that movement of the arms was characterized by an abducted shoulder and a more flexed elbow position at the initial contact of the gait cycle with a quite physiological range of motion if compared to controls. These data showed that gait of children with diplegic CP is generally characterized by abnormal upper limb position which could be considered a strategy to keep balance and posture control during walking., (Copyright © 2013 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.)

Experimental data in human movement science commonly consist of repeated measurements under comparable conditions. One can face the question how to identify a single trial, a set of trials, or erroneous trials from the entire data set. This study presents and evaluates a Selection Method for a Representative Trial (SMaRT) based on the Principal Component Analysis. SMaRT was tested on 1841 data sets containing 11 joint angle curves of gait analysis. The automatically detected characteristic trials were compared with the choice of three independent experts. SMaRT required 1.4s to analyse 100 data sets consisting of 8±3 trials each. The robustness against outliers reached 98.8% (standard visual control). We conclude that SMaRT is a powerful tool to determine a representative, uncontaminated trial in movement analysis data sets with multiple parameters., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: The Masai barefoot technology is used as a treatment option within the field of physical therapy to treat leg, back or foot problems. No information, however, is available on how Masai barefoot technology changes gait or muscle activity., Methods: Twelve healthy subjects underwent 3D gait analysis with simultaneously collecting surface electromyography data of the leg muscles when walking with regular shoes and with Masai barefoot technology-shoes. Before data collection, subjects were trained in Masai barefoot technology. A within-subjects study-design compared walking with regular shoes and Masai barefoot technology., Findings: With Masai barefoot technology, subjects walked slower with smaller steps. Movement pattern at the ankle showed major changes with increased dorsiflexion angle at initial contact followed by a continuous plantarflexion movement until terminal stance phase. With changed kinematics, alterations in the activity of tibialis anterior and gastrocnemius muscles could be observed. Smaller differences in movement and muscle activity were seen at knee and hip level., Interpretation: Masai barefoot technology has never been documented in detail concerning changes in movement pattern or muscle activity. This study showed that Masai barefoot technology changes movement patterns, especially at the ankle, and increases muscle activity. It may therefore be a useful training method for strengthening the muscle groups of the lower leg. Knee flexion and electromyographic characteristics around the knee joint are slightly increased and need to be considered in patients with knee problems. Our findings provide critical detailed information on changes compared to walking in regular shoes, but the clinical relevance of those changes remains to be determined.

Objective: To confirm previous findings that hip abductor activity measured by electromyography (EMG) on the side contralateral to cane use is reduced during walking in stroke patients. To assess whether an orthosis (TheraTogs) or hip abductor taping increase hemiplegic hip abductor activity compared with activity during cane walking or while walking without aids. To investigate the effect of each condition on temporo-spatial gait parameters. Design: Randomized, within-participant experimental study. Setting: Gait laboratory. Subjects: Thirteen patients following first unilateral stroke. Intervention: Data collection over six gait cycles as subjects walked at self-selected speed during: baseline (without aids) and in randomized order with (1) hip abductor taping, (2) TheraTogs, (3) cane in non-hemiplegic hand. Main measures: Peak EMG of gluteus medius and tensor fascia lata and temporo-spatial gait parameters. Results: Cane use reduced EMG activity in gluteus medius from baseline by 21.86%. TheraTogs increased it by 16.47% (change cane use-TheraTogs P=0.001, effect size = -0.5) and tape by 5.8% (change cane use-tape P=0.001, effect size = -0.46). In tensor fascia lata cane use reduced EMG activity from baseline by 19.14%. TheraTogs also reduced EMG activity from baseline by 1.10% (change cane use-TheraTogs P=0.009, effect size -0.37) and tape by 3% (not significant). Gait speed (m/s) at: baseline 0.44, cane use 0.45, tape 0.48, TheraTogs 0.49. Conclusion: Hip abductor taping and TheraTogs increase hemiplegic hip abductor activity and gait speed during walking compared with baseline and cane use. [ABSTRACT FROM AUTHOR]

Abstract: Background: It has previously been discussed that treatment of the hemiplegic arm in patients with cerebral palsy can improve gait parameters in the lower body. Our question was whether improving the ankle rocker with an orthosis has an effect on the upper body during walking. The main aim was to investigate, which trunk and arm kinematics of toe walking children with hemiplegic cerebral palsy are changed by wearing a hinged ankle–foot orthosis, restoring an initial heel contact. Methods: Specific parameters of the pelvis, thorax, and arm kinematics were investigated. Differences in the hemiplegic side between the barefoot and the orthotic condition were calculated by Students t-tests. Additionally, the 95% confidence intervals were used to explore clinically relevant differences between the controls and the patients and asymmetries within the patients' affected and unaffected sides. Findings: Pelvic tilt range of motion (barefoot: 7.5° (6.1–9.0°), orthosis: 6.6° (5.1–8.1) P =0.040) and mean shoulder abduction (barefoot: 14.3° (10.2–18.4°), orthosis: 12.1° (8.4–15.8) P =0.027) were the only two parameters with statistically significant differences, although not clinically relevant, between the barefoot and orthotic conditions. Abnormalities in all three planes were explored between the patients and controls. The entire trunk was more externally rotated, the pelvis stood lower, and the elbow was more flexed on the hemiplegic side compared to the unaffected side. Interpretation: A hinged ankle–foot orthosis, restoring the first ankle rocker, had no clinically relevant effects on trunk kinematics. None of the observed upper body gait deviations seemed to be secondary to or caused by toe walking. [Copyright &y& Elsevier]

Most studies investigating trunk kinematics have not provided adequate quantification of spinal motion, resulting in a limited understanding of the healthy spine's biomechanical behavior during gait. This study aimed at assessing spinal motion during gait in adolescents, adults and older individuals. Fourteen adolescents (10-18years), 13 adults (19-35years) and 15 older individuals (≥65years) were included. Using a previously validated enhanced optical motion capture approach, sagittal and frontal plane spinal curvature angles and general trunk kinematics were measured during shod walking at a self-selected normal speed. Postural differences indicated that lumbar lordosis and thoracic kyphosis increase throughout adolescence and reach their peak in adulthood. The absence of excessive thoracic kyphosis in older individuals could be explained by a previously reported subdivision in those who develop excessive kyphosis and those who maintain their curve. Furthermore, adults displayed increased lumbar spine range of motion as compared to the adolescents, whereas the increased values in older individuals were found to be related to higher gait speeds. This dataset on the age-related kinematics of the healthy spine can serve as a basis for understanding pathological deviations and monitoring rehabilitation progression. [ABSTRACT FROM AUTHOR]