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Purpose: The computerized Animated Activity Questionnaire (AAQ) for assessing activity limitations in hip and knee osteoarthritis (HKOA) consists of video animations from which patients can choose the animation that best matches their own performance. The AAQ has demonstrated good validity and reliability. Application of the AAQ in international studies, requires good cross-cultural validity, i.e., minimal Differential Item Functioning (DIF) across countries. The aim of this study was to evaluate cross-cultural validity. Methods: Patients in 7 European countries patients completed the AAQ on a computer. Ordinal logistic regression analysis was used to evaluate DIF across languages (Dutch versus 6 other languages). DIF is defined as follows: If a patient in a country has the same level of activity limitation as a patient in the Netherlands (the reference country in which the AAQ is developed), they should score the same on each item of the AAQ. If there is a statistical significant difference between countries, there is DIF. We used frequently described criteria in literature to assess DIF between countries. Criteria for non-uniform DIF were set as a statistical significance (p

Introduction: Residuals of whiplash injury (W.I.) represent one of most common causes of compensation claims in forensic medicine. Until 2012, clinical assessment was deemed sufficient to ascertain the reduction of neck mobility. A new law (n. 27 year 2012/3-ter;3-quarter) has established that in order to assess adamage it is now necessary to demonstrate it both with clinical and instrumental methods. As a consequence, the mere clinical assessment ofW.I. is not anymore accepted by the insurance companies. Sowe need an instrumental evaluationmethod, that should be non invasive, easy to perform, and guarantees a high reproducibility [2]. In forensic medicine there is also another problem: since the assessment of neck mobility has an effect on the economic compensation, the patients may be inclined to demonstrate a deeper damage. So the test should not rely on voluntary actions and should provide some indication of reliability. In our intention this can be achieved by quantifying the passive range of motion (PROM) and by analyzing its variability. Methods: An opto-electronic stereo-photogrammetric system (POSEIDON system BTS, Italy) was employed for obtaining the relative motion between head and upper trunk. Three retroreflective markers were applied to the temples and nasion respectively, and three on acromions and apex of sternum (six markers in total). Only 3-TV camera was sufficient to obtain a reliable acquisition of kinematics at 60 frames/s. While specific physical maneuvers were performed on the subject, the system computed the markers trajectories, the main rotation angles of the head in relation to the trunk (flexion–extension, lateral bending, axial rotation), speed and acceleration. The automatic output was a clinical report that integrates all data related to the morphology and kinematics of the analyzed body segment. Our preliminary study was carried out on 6 healthy, non symptomatic subjects and 6 subjects with history of W.I., whose evaluation was finalized to the insurance assessment. The test was performed in two steps: (1) pure clinical assessment; (2) instrumental assessment. In this second step the subjects were seated on a armchair, in front of the TV-cameras, while the examiner performed the maneuvers to test their PROM inflexion–extension, lateral bending and rotation of the head/neck. Each movement was repeated at least 6 times. The results were compared to age matched control data. Results: Our preliminary data collected on the healthy, asymptomatic subjectsmatched verywellwith data provided in literature [1,3]. Subjects who had residuals ofW.I., exhibited a lower range of motion and some asymmetries that well correlated to the reported symptoms. More interestingly, the standard deviation (SD) of the measured PROM ranged from 1.6◦ to 2.6◦ in the subjects that had no interest in the insurance compensation, and ranged from 3.5◦ to 4.0◦ in symptomatic subjects that were assessed for insurance purposes. In one of them, whose attempt to overstate his reduced mobility was evident clinically, the SD was 8.1. Another interesting observation was that left/right asymmetry for lateral bending and axial rotationwas in the range 0–3◦ in the healthy subjects and 6–21◦ in the W.I. subjects. Discussion: The analysis system adopted allows us to perform an instrumental non invasive, high reliability, easy to use assessment, does not require a large space around the subject and needs only few minutes to produce the written report. When comparing the results of the pure clinical method with results of the instrumental method, the higher resolution of the instrumental method proved to be a clear advantage and allowed us to better understand the clinical condition. It is our impression that this instrumental method offers a major possibility to recognize the simulation. Our aims isnowtocollect a largedatabaseof control subjects, in relation to age and sex, in order to obtain a reference formotion assessment in subjects with history of W.I.

Purpose: Total knee arthroplasty (TKA) is the gold standard treatment for severe arthrosis, with great results in about the 80% of patients. Nevertheless, the remaining 20% complains about residual pain and functional limitations. Some studies showed no balance improvement in orthostatic position after TKA, if no specific proprioceptive training is performed. The aim of this study was to evaluate the effects of proprioceptive training in one patient with TKA using Delos Postural Proprioceptive System (DPPS; Delos, Turin, Italy). Methods: The subject was a 71-years-old female with TKA. The proprioception was evaluated before surgery, after surgery and after training, with a static monopodalic test by mean of the DPPS. Moreover, WOMAC and SPPB score were acquired. The program training consisted in different protocols, aimed to recover joint mobility and improve balance. The patient trained twice a week, for 5 weeks. Parameter considered was the Stability Index (SI) which is a score (0-100%) based on autonomy and postural instability. Results: The SI results before surgery, after surgery and after training in operated limb were respectively: 67.2%, 84.7% and 87% with open eyes; 30.1%, 27.1%, 37.9% with closed eyes. The SI in contralateral limb increased in each follow up, scores were also slightly higher than the operated limb. The WOMAC score improved along the evaluations: 38.54% before the surgery, 8.33% after surgery and 3.1% after training. SPPB results were: 6 before surgery, 9 after surgery and 12 after training. Conclusion: TKA confirmed positive effects in terms of pain reduction and physical function. Nevertheless, the SI performed in operated limb with closed eyes, which is a predictive factor for proprioceptive ability, decreased after surgery. The proprioceptive training was instead able to improve all patterns, giving a much global benefit. In future, a specific proprioceptive training could be used after standard rehabilitation.

Purpose: Total knee arthroplasty (TKA) is the gold standard procedure to treatments of severe arthrosis which aims to alleviate the pain and restore the locomotor functions. TKA procedure can affect the proprioception which is a significant factor in balance, joint stability and coordination. The aim is to evaluate proprioception and postural control in subject with TKA, before and after the surgery, using Delos Postural Proprioceptive System (DPPS; Delos, Turin, Italy). Methods: This study included 12 subjects (6 women and 6 men; age 67.1±4.9) scheduled for TKA. DPPS was used before and after the surgery. The two tests considered to evaluate postural and proprioceptive control were stabilometric test and static Riva test. Parameters considered were the Stability Index (SI; percentage score based on autonomy and postural instability), Autonomy (AU; percentage score based on hands support) and Postural Instability (PI; score in degree based on movement of trunk). Results: The SI measured during the single stance test improved from 58.3%±22.0 to 71.6%±17.4 with opened eyes and decreased from 36.8%±10.5 to 33.2%±10.2 with closed eyes in the operated limb. PI measured during the double stance test increased of 0.10° with opened eyes and decreased of 0.10° with closed eyes. AU improved with open eyes and slightly decreased with closed eyes. Conclusion: The reduction of pain and the restoration of limb alignment are probably the main reason of the several improvements of SI and AU during open eyes tasks, whereas the lack or ineffectiveness of the proprioceptive system, could be the cause of failure improvement of closed eyes tasks. In TKA, mechanoceptors of the knee are sacrificed, this should result in a drop of the proprioceptive information, and consequently a decreased of balance and increased of risk of falls.

Kinesiological electromyography (KEMG) is an essential part of gait analysis as it supports clinicians with the objective assessment of muscular function during walking. During the gait cycle muscles are active with definite actions aimed at controlling joints in order to accomplish requirements of gait such as stability, loading acceptance, and progression. The knowledge of the development of normal EMG activity is of relevance in interpreting gait analysis data. While there is a wide literature on normative kinematics and kinetics data in children, only a few studies reported reference KEMG dataset on a paediatric population and on the maturation of gait in children. The available literature reported that the surface KEMG in children has a significant amount of variability, which should be taken into consideration when performing clinical interpretations. The KEMG timing and duration in normal children can vary with age, body height, body weight, gait velocity and stride length. Moreover, there is evidence that within session EMG variability in children aged 6-8 years is twice than that of adults. Although children in this age range can be considered to have a mature walk, variability about the mean performance continues to develop for many years and stable locomotion may be achieved despite significant variability in the muscle recruitment patterns. Further studies using accurate techniques of signal detection and analysis are required to improve our knowledge on physiological and pathological patterns of muscular activation in children.

Background Flexed posture commonly increases with age and is related to musculoskeletal impairment and reduced physical performance. The purpose of this clinical study was to systematically compare the effects of a physical activity program that specifically address the flexed posture that marks a certain percentage of elderly individuals with a non specific exercise program for 3 months. Methods Participants were randomly divided into two groups: one followed an Adapted Physical Activity program for flexed posture and the other one completed a non-specific physical activity protocol for the elderly. A multidimensional clinical assessment was performed at baseline and at 3 months including anthropometric data, clinical profile, measures of musculoskeletal impairment and disability. The instrumental assessment of posture was realized using a stereophotogrammetric system and a specific biomechanical model designed to describe the reciprocal position of the body segments on the sagittal plane in a upright posture. Results The Adapted Physical Activity program determined a significant improvement in several key parameters of the multidimensional assessment in comparison to the non-specific protocol: decreased occiput-to-wall distance, greater lower limb range of motion, better flexibility of pectoralis, hamstrings and hip flexor muscles, increased spine extensor muscles strength. Stereophotogrammetric analysis confirmed a reduced protrusion of the head and revealed a reduction in compensative postural adaptations to flexed posture characterized by knee flexion and ankle dorsiflexion in the participants of the specific program. Conclusion The Adapted Physical Activity program for flexed posture significantly improved postural alignment and musculoskeletal impairment of the elderly. The stereophotogrammetric evaluation of posture was useful to measure the global postural alignment and especially to analyse the possible compensatory strategies at lower limbs in flexed posture.

E’ stato recentemente proposto un nuovo modello di protesi totale di tibio-tarsica con lo scopo di ottenere la massima compatibilità tra il movimento relativo delle componenti protesiche e il naturale tensionamento dei legamenti. In questo studio il recupero funzionale qui atteso precocemente è stato valutato mediante punteggio clinico e gait analysis eseguiti a pochi mesi dall’intervento. Tredici pazienti operati con protesi BOX (Finsbury Orthopaedics, UK), con età media di 56.3 anni (range 44-71), BMI 25.2 (range 20.4-34.1), 9 maschi e 4 femmine, 11 con osteoartrosi post-traumatica, 1 con artrite psoriasica e 1 con artrite reumatoide, sono stati valutati nel preoperatorio e a 6 e 12 mesi di follow-up. L’esame è consistito in un punteggio clinico (AOFAS) e nella gait analysis (Sistema Vicon 612 - Oxford UK, piattaforme dinamometriche Kistler) mediante l’utilizzo di un protocollo recentemente validato. I risultati sono stati confrontati con quelli di un gruppo di controllo di 20 soggetti, con età media di 27.9 anni (range 23-36), BMI 21.9 (range 18.5-25), 11 maschi e 9 femmine. Il punteggio AOFAS è passato da 39.9 nel pre-op a 81.4 a 12 mesi, con una importante riduzione del dolore (punteggio da 13.1 a 31.5, max 40) e con un miglioramento sia dell’allineamento della caviglia (da 5.4 a 9.1, max 10) che della funzione (da 21.4 a 40.8, max 50). I parametri spazio-temporali hanno mostrato un buon recupero a 6 mesi e un successivo assestamento. Il range di flessione della caviglia è aumentato nei tre piani anatomici a 6 mesi, e si è sostanzialmente mantenuto a 12. Il nuovo modello protesico sembra contribuire ad un precoce recupero funzionale a 6 mesi, mantenuto ad un anno dall’intervento.

Background Many clinical and biomechanical research studies, particularly in orthopaedics, nowadays involve forms of movement analysis. Gait analysis, video-fluoroscopy of joint replacement, pre-operative planning, surgical navigation, and standard radiostereometry would require tools for easy access to three-dimensional graphical representations of rigid segment motion. Relevant data from this variety of sources need to be organised in structured forms. Registration, integration, and synchronisation of segment position data are additional necessities. With this aim, the present work exploits the features of a software tool recently developed within a EU-funded project (‘Multimod’) in a series of different research studies. Methods Standard and advanced gait analysis on a normal subject, in vivo fluoroscopy-based three-dimensional motion of a replaced knee joint, patellar and ligament tracking on a knee specimen by a surgical navigation system, stem-to-femur migration pattern on a patient operated on total hip replacement, were analysed with standard techniques and all represented by this innovative software tool. Segment pose data were eventually obtained from these different techniques, and were successfully imported and organised in a hierarchical tree within the tool. Findings Skeletal bony segments, prosthesis component models and ligament links were registered successfully to corresponding marker position data for effective three-dimensional animations. These were shown in various combinations, in different views, from different perspectives, according to possible specific research interests. Interpretation Bioengineering and medical professionals would be much facilitated in the interpretation of the motion analysis measurements necessary in their research fields, and would benefit therefore from this software tool.

Traditional gait and fluoroscopy analysis of human movement are largely utilised but are still limited in registration, integration, synchronisation and visualisation capabilities. The present work exploits the features of a recently developed software tool based on multimodal display (Data Manager developed within the EU-funded project 'Multimod') in an exemplary clinical case. Standard lower limb gait analysis, comprising segment position, ground reaction force and EMG data collection, and three-dimensional fluoroscopy analysis at the replaced joint were performed in a total knee replacement patient while ascending stairs. Clinical information such as X-rays and standard scores were also available. Data Manager was able to import all this variety of data and to structure these in an original hierarchical tree. Bone and prosthesis component models were registered to corresponding marker position data for effective three-dimensional animations. These were also synchronised with corresponding standard video sequences. Animations, video, time-histories of collected and also processed data were shown in various combinations, according to specific interests of the bioengineering and medical professionals expected to observe and to interpret this large amount of data. This software tool demonstrated to be a valuable means to enhance representation and interpretation of measurements coming from human motion analysis. In a single software, a thorough and effective clinical and biomechanical analysis of human motion was performed.

Il testo di Jacqueline Perry affronta in modo rigorosamente clinico e con un approccio sistematico le problematiche biomeccaniche e strumentali dell'analisi del cammino. La conoscenza del razionale biomeccanico di alcune misure come il calcolo dei momenti articolari, la modalità di posizionamento dei marcatori o l'informazione estraibile da un segnale elettromiografico sono argomenti di grande attualità e rappresentano uno spunto per ulteriori riflessioni. Dal punto di vista clinico la storica suddivisione in fasi del ciclo del passo, la definizione dei requisiti del cammino fisiologico, l'analisi cinesiologica del cammino normale e patologico e soprattutto i dati di riferimento sull'attività muscolare attraverso EMG dinamica costituiscono un punto di riferimento per tutti coloro che si avvicinano alla studio del cammino.

Rotationplasty of the hip joint is a special surgical technique used for the treatment of malignant tumors of the proximal part of the femur. We report a clinical case and gait analysis results before and after rehabilitation training. Evaluation of joint motion, kinetic moments, and the electromyographic findings enabled us to document progressive adaptation of muscle and joint function to their new role in the motor pattern, demonstrating the exceptional strength of rotationplasty. Active control of two fulcrums in the lower limb, the pseudo hip proximally and the pseudo knee intermedially, makes this type of operation extremely advantageous compared to the alternative of hip disarticulation or hemipelvectomy. Total absence of pain together with the preservation of articular and cutaneous proprioception are important advantages. Rotationplasty is an attractive alternative for treatment of malignant tumors of the proximal part of the femur.