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Background: Elevated plantar pressures represent a significant risk factor for neuropathic diabetic foot (NDF) ulceration. Foot offloading, through custom-made insoles, is essential for prevention and healing of NDF ulcerations. Objective quantitative evaluation to design custom-made insoles is not a standard method. Aims: 1) to develop a novel quantitative-statistical framework (QSF) for the evaluation and design of the insoles' offloading performance through in-shoe pressure measurement; 2) to compare the pressure-relieving efficiency of traditional shape-based total contact customised insoles (TCCI) with a novel CAD-CAM approach by the QSF. Methods: We recruited 30 neuropathic diabetic patients in cross-sectional study design. The risk-regions of interest (R-ROIs) and their areas with in-shoe peak pressure statistically ≥200kPa were identified for each patients' foot as determined on the average of peak pressure maps ascertained per each stance phase. Repeated measures Friedman test compared R-ROIs' areas in three different walking condition: flat insole (FI); TCCI and CAD-CAM insoles. Results: As compared with FI (20.6±12.9 cm2), both the TCCI (7±8.7 cm2) and the CAD-CAM (5.5±7.3 cm2) approaches provided a reduction of R-ROIs mean areas (p<0.0001). The CAD-CAM approach performed better than the TCCI with a mean pressure reduction of 37.3 kPa (15.6%) vs FI. Conclusions: The CAD-CAM strategy achieves better offloading performance than the traditional shape-only based approach. The introduced QSF provides a more rigorous method to the direct 200kPa cut-off approach outlined in the literature. It provides a statistically sound methodology to evaluate the offloading insoles design and subsequent monitoring steps. QSF allows the analysis of the whole foot's plantar surface, independently from a predetermined anatomical identification/masking. QSF can provide a detailed description about how and where custom-made insole redistributes the underfoot pressure respect to the FI. Thus, its usefulness extends to the design step, helping to guide the modifications necessary to achieve optimal offloading insole performances. [ABSTRACT FROM AUTHOR]

Leg Length Discrepancy (LLD) is very often associated to Low Back Pain (LBP), but still controversial is the use of underfoot wedge correction (heel rise) to re-balance pelvis and trunk posture. In a review of our last 5 years clinical activity we observed that more than 70% out of 300 LBP patients presented a LLD. In more than 80 % we ascertained, via Baropodography, the presence of underfoot asymmetric load, during standing. More durable therapy recovery effect has been observed when LLD correction had been adopted. These reasons led us to start a study to assess if a Full 3D multifactorial Posture evaluation approach, by means of Opto-electronic device associated to foot pressure maps recording, was able to quantitatively discriminate the clinically observed phenomena. On a 94 LBP (av. age 46.3±16 Y range 15-82 Y) patients sample, 83 (88%) have been found to improve posture when LLD was corrected. The 94 patients showed a mean lower limb discrepancy of μ=8±3.2mm associated to a mean scoliotic lumbar curve μ=10.5°±5.1° Cobb (frontal plane), mean Spinal offset μ=6.6±4.9mm and mean Global offset 10.7±8.8mm. The applied paired t-test comparison (indifferent vs. corrected orthostasis) showed significant (p < 0.05) postural improvements could be obtained in the whole or in a part of the considered parameters, both in rebalancing and in spine deformities reduction after the application of suitable under-foot wedge. The joint 3D opto-electronic and foot pressure map approach proved to be effective to control several clinical parameters with statistical significance. [ABSTRACT FROM AUTHOR]

The aetiological aspects as well as postural attitude implications represent an open question in scoliosis evaluation and treatment. Leg length discrepancy (LLD) is often recognised in scoliotic patients, but surprisingly still controversial is the use of underfoot wedge corrections in order to compensate pelvis tilt. In fact, literature reports conflicting results on the efficacy of LLD equalization also given the argued uncertainty of LLD clinical assessment and limitations related to X-ray measurements. Moreover concern is about anatomic and functional LLD and associated estimation of the pelvic torsion. In such a topic, a significant helpful tool has been demonstrated to be 3D kinematic optoelectronic measurements and other useful data obtained from force platforms and/or baropodographic systems. 135 (94.4%) out of 143 Scoliotic patients sample (av. age 16.4±10.2 Y range 4-66 Y), have been found to improve posture when LLD was corrected. The 143 patients showed a mean lower limb discrepancy of μ=10.2±5.2mm associated to a mean main scoliotic curve μ=16.4°±9.4° Cobb (frontal plane), mean Spinal offset μ=7.5±5.5mm and mean Global offset μ=10.1±7.1mm. The applied paired t-test comparison (indifferent vs. corrected orthostasis) showed significant (p < 0.05) postural improvements could be obtained in the whole or in a part of the considered postural parameters, after the application of suitable under-foot wedge. The present investigation confirm results of a previous study demonstrating the efficacy of under-foot wedge use in leg asymmetry correction, posture re-balancing and spine deformities reduction, pointing out the significant contribution of the 3D opto-electronic measurement approach in the critical process of assessing the correct under-foot wedge size, therapy planning and monitoring. [ABSTRACT FROM AUTHOR]

Spine and posture disorders cover large interest in rehabilitation. Quantitative functional evaluation represents the main goal in Movement/Gait analysis. However very few studies outline the behaviour of spine during Posture and Movement/Gait analysis. To overcome such limits, several years ago our group started, a project to transfer into a complete fully 3D reliable and detailed representation, different segmental biomechanical models presented in literature. As result a complete 3D parametric biomechanical skeleton model has been developed to be used in quantitative analysis. Posture and Movement/Gait analysis are performed by 3D Opto-electronic stereophotogrammetric measurements of body landmarks labelled by passive markers. Depending on different analysis purposes, the model can work at different stages of complexity. Examples on the application of such model into biomechanical and clinical fields have been presented in literature. Our group is continuously working to add new features to such model, which is now able to fully integrate data deriving from force platforms, SEMG, foot pressure maps. By means of data fusion and optimisation procedures all these inputs are used in the model to assess lower limbs internal joint forces, torques and muscular efforts. The possibility to compute the average of cyclic or repetitive tasks has been included as well. Recently we added the possibility to assess internal joint forces and torques at each spine vertebral level and to correlate these latter with all the other model's features. The aim of this study is to present the methodological aspects of such new features and their potential applicability in clinical and biomechanical fields. [ABSTRACT FROM AUTHOR]

A project to merge into a full 3D reliable and detailed human skeleton representation various segmental biomechanical models presented in literature has been undertaken by our group. The obtained 3D skeleton model is fully parametric and can so be fitted to each subject anthropometric characteristics. A non-ionizing approach based on 3D opto-electronic measurements of body landmarks labelled by passive markers has been chosen to build the 3D parametric biomechanical skeleton model. To this aim various protocols involving different body labelling (and so different related anthropometric data) have been established for different analyses. To analyse human posture and spinal related pathologies, a 27 markers protocol has been set for static analysis, while 49 markers protocol has been set for gait and movement analysis. A special focus has been devoted to identify and model the spine with a correct degree of accuracy and reliability. To this aim complex signal processing and optimisation procedures have been tested. The model is able to fully integrate information deriving from other measurements devices as force platform data, surface EMG, foot pressure maps. The presented model is the first proposed in literature, to authors knowledge, able to process such multifactorial information to perform a full kinematic and kinetic analysis with particular focus on the spine. Several hundreds of patients have been already analysed and followed up with this methodology that proved to be useful for various posture and spine related pathologies (in particular spine deformities, low-back pain etc.). [ABSTRACT FROM AUTHOR]

Following total hip joint replacement (THJR), the durability of a prosthesis is limited by: wearing of frictional surfaces and loosening and migration of the prosthesis-cement-bone system. Literature review witnesses biomechanical studies focused mainly/only on hip functional state while none of them approached leg length discrepancy (LLD), posture unbalancing or spine related problems after THJR. Conversely, these latter could be critical elements for surgery and rehabilitation success, given the possible induction of asymmetric loading patterns. This study presents the results obtained by using a recently proposed methodology, to measure 3D subject posture balance and spine morphology and to evaluate its usefulness in individual therapy tuning/follow up. 3D subject's posture has been measured by means of 3D opto-electronic device, force platform and baropodography. 90 subjects after THJR have been included in this study. The subjects have been evaluated in two different epochs: 3 weeks after surgical intervention and after 3 months. 77/90 patients presented a LLD, pelvic obliquity and posture unbalancing. More than 90% of this group showed an overall postural re-balancing induced by the use of simple underfoot wedge. 70/77 patients needed wedge under the healthy side showing the surgical intervention produced a leg lengthening. 60/90 (52 LLD) patients underwent up to now to control and patients who wore the suggested wedge (63.4%) presented an improvement over all the considered quantitative parameters. Patients who wore a shorter than suggested wedge (23.1%), or that did not wear the suggested wedge (13.5%) presented a moderate or significant worsening of their postural balancing respectively. [ABSTRACT FROM AUTHOR]

Quantitative functional assessment of Posture and Motion Analysis of the entire skeleton and spine is highly desirable. Nonetheless, in most studies focused on posture and movement biomechanics, the spine is only grossly depicted because of its required level of complexity. Approaches integrating pressure measurement devices with stereophotogrammetric systems have been presented in the literature, but spine biomechanics studies have rarely been linked to baropodometry. A new multi-sensor system called GOALS-E.G.G. (Global Opto-electronic Approach for Locomotion and Spine-Expert Gait Guru), integrating a fully genlock-synched baropodometric treadmill with a stereophotogrammetric device, is introduced to overcome the above-described limitations. The GOALS-EGG extends the features of a complete 3D parametric biomechanical skeleton model, developed in an original way for static 3D posture analysis, to kinematic and kinetic analysis of movement, gait and run. By integrating baropodometric data, the model allows the estimation of lower limb net-joint forces, torques and muscle power. Net forces and torques are also assessed at intervertebral levels. All the elaborations are completely automatised up to the mean behaviour extraction for both posture and cyclic-repetitive tasks, allowing the clinician/researcher to perform, per each patient, multiple postural/movement tests and compare them in a unified statistically reliable framework. [ABSTRACT FROM AUTHOR]

Background: The literature reports evidence of leg length discrepancy (LLD) associated with musculoskeletal disorders, alterations in spinopelvic alignment, and body posture, leading to low back pain and lumbar scoliosis. The most common conservative treatment for LLD is the use of internal or external shoe lifts although no treatment guidelines have been established. Aim: The study aimed to contribute to low back pain-LLD relationship comprehension, highlighting the benefits of LLD correction in the nonspecific low back pain (NSLBP) population. Methods: A cross-sectional observational study recruited a cohort of 80 NSLBP patients (48 females, 32 males) with LLD, age ( μ = 35 ± 17.2). Entire body posture, including 3-D spine shape reconstruction, was measured using a nonionizing 3-D optoelectronic stereophotogrammetric approach. After the first 3-D posture evaluation, patients were provided with customized orthotics, including 100% LLD heel lift correction. No other therapeutic interventions were considered. Pain level was assessed using the numerical pain rating scale (NPRS). The gender, age-related, and time-dependent effects of LLD equalization treatment in NSLBP patients was investigated during 2 years of follow-up. The statistical analysis was performed at the global level using multivariate methods by Hotelling T 2 tests and intrasubject-level using t -test. Results and Discussion: An initial average NPRS = 7.8 was determined. In the medium-term follow-up group (4 months), the NPRS dramatically decreased (NPRS = 1.1). The pain disappeared in the long-term (2 years) follow-up group (NPRS = 0). The study results highlight that LLD equalization treatment led to clear statistically significant improvements in all the postural parameters of the frontal plane, including the underfoot load asymmetry. No worsening has been detected. An adaptation period long enough is needed to obtain progressive pain relief improvements and structural posture changes. Younger NSLBP patients showed slightly better improvements than older ones. Minimal differences between healthy young adults' and NSLBP patients' postures were found either in natural erect standing posture or when LLD equalization is applied. Conclusion: Heel-lift customized orthotics with 100% LLD correction are an effective short- and long-term treatment in patients with nonspecific LBP, inducing pain symptom recession and stimulating the improvement of postural parameters without contraindications., Competing Interests: MD and PR own shares of the Bioengineering and Biomedicine Company Srl. This does not alter our adherence to Frontiers in Bioengineering and Biotechnology policies on sharing data and materials. The Bioengineering and Biomedicine Company Srl did not play any direct role in the study design, data collection and analysis, decision to publish, or manuscript preparation. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 D’Amico, Kinel and Roncoletta.)

Background: Conservative treatment in spine deformities and spine related disorders is mainly based on proper individual proprioceptive and motor control training. For these reasons, conservative treatment involves the stimulation of individual capability of perceiving/reducing deformities, blocks and/or improper spine posture by voluntary control. The literature describes that habitually adopted relaxed postures often exacerbate low back pain. Typically, youths can be referred to therapeutic programs aimed at improving the quality of body posture along with fostering the awareness of the importance of correct posture. Few studies in literature outline the subject's individual instinctive ability to perceive properly and control his/her posture and produce an improvement through a self-correction maneuver., Aim: How do healthy young adult subjects perceive and control their posture and spine shape? Are they able to modify them in a correct way through an instinctive self-correction maneuver?, Design: Cross-sectional observational study., Setting: A cohort of asymptomatic young adult university students and workers were recruited at Clinic of Rehabilitation, University of Medical Sciences, Poznan, Poland., Population: One hundred and twenty-one healthy subjects (57 females, 64 males), aged 19-34 years (mean age: 23.5±3.2 years)., Methods: Subject's full body posture including 3D spine shape reconstruction, identified using 27 retro-reflective markers suitably located on anatomical landmarks has been measured by using a non-ionizing 3D optoelectronic stereo-photogrammetric approach and a 3D full skeleton biomechanical model., Results: From the 3D full skeleton and spine reconstruction, eleven quantitative biomechanical parameters describing the nature of body posture have been computed to compare natural erect versus self-corrected standing attitudes. A great number of healthy participants (105, 87%) was unable to modify its spinal shape in the frontal plane. Conversely, the sagittal plane presented significant clinical changes in the thoracic spine, as males reached a greater thoracic spine extension (36.4±8.3) than females (40.8±8.7). When changes occurred, subjects were not able to focus and control their posture globally, but only on few aspects at a time., Conclusions: Instinctive posture proprioception and motor control do not produce an effective self-correction maneuver yielding a global improvement of body posture and spine shape., Clinical Rehabilitation Impact: Self-correction maneuver producing an improvement of body posture and spine shape has to be learned with specific postural training. The 3D stereo-photogrammetric approach is effective in quantitatively describe subject's posture, motor control and proprioceptive capability.

Spine and posture disorders cover large interest in rehabilitation. Quantitative functional evaluation represents the main goal in Movement/Gait analysis. However very few studies outline the behaviour of spine during Posture and Movement/Gait analysis. To overcome such limits, several years ago our group started, a project to transfer into a complete fully 3D reliable and detailed representation, different segmental biomechanical models presented in literature. As result a complete 3D parametric biomechanical skeleton model has been developed to be used in quantitative analysis. Posture and Movement/Gait analysis are performed by 3D Opto-electronic stereophotogrammetric measurements of body landmarks labelled by passive markers. Depending on different analysis purposes, the model can work at different stages of complexity. Examples on the application of such model into biomechanical and clinical fields have been presented in literature. Our group is continuously working to add new features to such model, which is now able to fully integrate data deriving from force platforms, SEMG, foot pressure maps. By means of data fusion and optimisation procedures all these inputs are used in the model to assess lower limbs internal joint forces, torques and muscular efforts. The possibility to compute the average of cyclic or repetitive tasks has been included as well. Recently we added the possibility to assess internal joint forces and torques at each spine vertebral level and to correlate these latter with all the other model's features. The aim of this study is to present the methodological aspects of such new features and their potential applicability in clinical and biomechanical fields.

Following total hip joint replacement (THJR), the durability of a prosthesis is limited by: wearing of frictional surfaces and loosening and migration of the prosthesis-cement-bone system. Literature review witnesses biomechanical studies focused mainly/only on hip functional state while none of them approached leg length discrepancy (LLD), posture unbalancing or spine related problems after THJR. Conversely, these latter could be critical elements for surgery and rehabilitation success, given the possible induction of asymmetric loading patterns. This study presents the results obtained by using a recently proposed methodology, to measure 3D subject posture balance and spine morphology and to evaluate its usefulness in individual therapy tuning/follow up. 3D subject's posture has been measured by means of 3D opto-electronic device, force platform and baropodography. 90 subjects after THJR have been included in this study. The subjects have been evaluated in two different epochs: 3 weeks after surgical intervention and after 3 months. 77/90 patients presented a LLD, pelvic obliquity and posture unbalancing. More than 90% of this group showed an overall postural re-balancing induced by the use of simple underfoot wedge. 70/77 patients needed wedge under the healthy side showing the surgical intervention produced a leg lengthening. 60/90 (52 LLD) patients underwent up to now to control and patients who wore the suggested wedge (63.4%) presented an improvement over all the considered quantitative parameters. Patients who wore a shorter than suggested wedge (23.1%), or that did not wear the suggested wedge (13.5%) presented a moderate or significant worsening of their postural balancing respectively.

A project to merge into a full 3D reliable and detailed human skeleton representation various segmental biomechanical models presented in literature has been undertaken by our group. The obtained 3D skeleton model is fully parametric and can so be fitted to each subject anthropometric characteristics. A non-ionizing approach based on 3D opto-electronic measurements of body landmarks labelled by passive markers has been chosen to build the 3D parametric biomechanical skeleton model. To this aim various protocols involving different body labelling (and so different related anthropometric data) have been established for different analyses. To analyse human posture and spinal related pathologies, a 27 markers protocol has been set for static analysis, while 49 markers protocol has been set for gait and movement analysis. A special focus has been devoted to identify and model the spine with a correct degree of accuracy and reliability. To this aim complex signal processing and optimisation procedures have been tested. The model is able to fully integrate information deriving from other measurements devices as force platform data, surface EMG, foot pressure maps. The presented model is the first proposed in literature, to authors knowledge, able to process such multifactorial information to perform a full kinematic and kinetic analysis with particular focus on the spine. Several hundreds of patients have been already analysed and followed up with this methodology that proved to be useful for various posture and spine related pathologies (in particular spine deformities, low-back pain etc.).

The aetiological aspects as well as postural attitude implications represent an open question in the evaluation and in the treatment to be applied in scoliosis. Legs asymmetry is often recognized in scoliotic patients, but still controversial is the use of underfoot wedges in order to compensate pelvis tilt. This could be due to the great uncertainty and intrinsic error level of the traditional clinical and visual measurements methods that present limitations in the assessment of all the 3D involved postural and morphological parameters. This is especially true given the clinical difficulty in the estimation of pelvic torsion usually coupled to leg asymmetry. In such a topic, a significant helpful tool has been demonstrated to be the opto-electronic measurement approach proposed by D'Amico et al., particularly given the innocuousness of the analysis and the speed of the clinical parameter extraction procedure. The present investigation demonstrates on a sample of 220 patients the efficacy of under-foot wedge use in leg asymmetry correction, posture re-balancing and spine deformities reduction, pointing out the significant contribution of the 3D opto-electronic measurement approach in the critical process of assessing the correct under-foot wedge size, therapy monitoring and follow-up.

Measurements of postural sway are used to determine a subject ability to maintain upright stance. In many clinical analyses, postural control measured during a quiet standing provides very useful insights about CNS and Motor control behaviour. The aim of this paper is to present a new posturographic methodology including both classical parameter extraction techniques and new specially developed figuring algorithms, in which both kinematic patterns and ground reaction force COP evolution are jointly processed in order to identify the biomechanical behaviour in particular of the spine at each metameric level for both orthostatic posture and lateral bending test.

The use of quantitative baropodography measurements, either by means of pressure sensing foot insoles or floor mats, is quickly increasing in clinical and research fields for the analysis of a wide variety of foot and ankle disorders. In this paper we present a set of complex and detailed processing procedures necessary to correctly perform gait cycles normalisation and averaging as well as bivariate statistic for COP analysis, in order to extract quantitative and statistically significant parameters for clinical evaluation of locomotion and orthostatic posture.

A project has been undertaken by our group to merge different segmental biomechanical models presented in literature into a full 3D parametric human skeleton representation, based on opto-electronic measurements. The obtained 3D skeleton model can then be fitted to each subject's anthropometrical characteristics. The accuracy and precision of this model relies both on anatomical findings (cadaver dissections, in vivo measurements, and parametric regression equations) reported in literature and on the approach and signal processing procedures we largely described and discussed in previous papers. The aim of this work is to present and describe the above mentioned 3D parametric biomechanical skeleton model. This model and the related graphical software package have been developed as a clinical tool for diagnostic and therapeutic purposes, and they are currently used in different clinical centres.