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Mary Emily Littrell, Young-Hui Chang and Brian P. Selgrade

Multicamera gait analysis systems and force platforms are used to measure the kinematics and kinetics of locomotion. 1 – 5 Although 3-dimensional analysis provides valuable insights, these systems are difficult to transport and prohibitively expensive for widespread clinical use. However, the

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Felix Stief, Harald Böhm, Katja Michel, Ansgar Schwirtz and Leonhard Döderlein

The standard Plug-in-Gait (PiG) protocol used in three-dimensional gait analysis is prone to errors arising from inconsistent anatomical landmark identification and knee axis malalignment. The purpose of this study was to estimate the reliability and accuracy of a custom made lower body protocol (MA) compared with the PiG protocol. Twenty-fve subjects volunteered to evaluate the intertrial reliability. In addition, intersession reliability was examined in 10 participants. An indirect indicator of accuracy according to the knee varus/valgus and flexion/extension range of motion (ROM) was used. Regarding frontal plane knee angles and moments as well as transverse plane motions in the knee and hip joint, the intersession errors were lower for the MA compared with the standard approach. In reference to the knee joint angle cross-talk, the MA produced 4.7° more knee flexion/extension ROM and resulted in 6.5° less knee varus/valgus ROM in the frontal plane. Therefore, the MA tested in this study produced a more accurate and reliable knee joint axis compared with the PiG protocol. These results are especially important for measuring frontal and transverse plane gait parameters.

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Mustafa M.O. Elhadi, Christina Z. Ma, Duo W.C. Wong, Anson H.P. Wan and Winson C.C. Lee

long-distance walking. Previous studies showed that gait analysis could aid in understanding the cause of difficulty in walking and treatment decision-making ( Davis, Õunpuu, DeLuca, & Romness, 1999 ). While it was documented that older adults walked significantly less than the younger age groups of

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Roel De Ridder, Julien Lebleu, Tine Willems, Cedric De Blaiser, Christine Detrembleur and Philip Roosen

data gathered during the performance of everyday activities or sports and data recorded under controlled conditions in clinical settings. 1 For gait analysis, such wearables are potentially useful for assessing abnormal gait and evaluating the effectiveness of rehabilitation approaches and therapeutic

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Lennart Scheys, Alberto Leardini, Pius D. Wong, Laurent Van Camp, Barbara Callewaert, Johan Bellemans and Kaat Desloovere

The availability of detailed knee kinematic data during various activities can facilitate clinical studies of this joint. To describe in detail normal knee joint rotations in all three anatomical planes, 25 healthy subjects (aged 22–49 years) performed eleven motor tasks, including walking, step ascent and descent, each with and without sidestep or crossover turns, chair rise, mild and deep squats, and forward lunge. Kinematic data were obtained with a conventional lower-body gait analysis protocol over three trials per task. To assess the repeatability with standard indices, a representative subset of 10 subjects underwent three repetitions of the entire motion capture session. Extracted parameters with good repeatability included maximum and minimum axial rotation during turning, local extremes of the flexion curves during gait tasks, and stride times. These specific repeatable parameters can be used for task selection or power analysis when planning future clinical studies.

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Tishya A.L. Wren and Paul C. Mitiguy

Clinical gait analysis usually describes joint kinematics using Euler angles, which depend on the sequence of rotation. Studies have shown that pelvic obliquity angles from the traditional tilt-obliquity-rotation (TOR) Euler angle sequence can deviate considerably from clinical expectations and have suggested that a rotation-obliquity-tilt (ROT) Euler angle sequence be used instead. We propose a simple alternate approach in which clinical joint angles are defined and exactly calculated in terms of Euler angles from any rotation sequence. Equations were derived to calculate clinical pelvic elevation, progression, and lean angles from TOR and ROT Euler angles. For the ROT Euler angles, obliquity was exactly the same as the clinical elevation angle, rotation was similar to the clinical progression angle, and tilt was similar to the clinical lean angle. Greater differences were observed for TOR. These results support previous findings that ROT is preferable to TOR for calculating pelvic Euler angles for clinical interpretation. However, we suggest that exact clinical angles can and should be obtained through a few extra calculations as demonstrated in this technical note.

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Takayuki Hasegawa, Toshiro Otani, Kentaro Takeda, Hideo Matsumoto, Kengo Harato, Yoshiaki Toyama and Takeo Nagura

The purpose of the current study was to longitudinally evaluate how preoperative knee kinematics change after ACL reconstruction. Three-dimensional gait analysis using the point cluster method was undertaken on the same subjects preoperatively and at 3, 6, and 12 months after ACL reconstructive surgery. Thirteen subjects (7 males, 6 females) were examined while performing 2 different activities at self-selected speeds: walking and walk-pivoting (walking, pivoting toward the landed limb side and walking away). The contralateral knees of subjects at 12 months postoperatively were selected as control knees. Flexion range in the stance phase increased with time after surgery, but remained lower than in the contralateral knee, even at 12 months postoperatively (P < .05) during walking and walk-pivoting. The rotation pattern during walking and walk-pivoting showed an offset toward external rotation by 6 months postoperatively compared with control knees, while at 12 months postoperatively the offset had nearly disappeared and the movement pattern resembled that in control knees. These findings suggest that a return to sport participation by 6 months after ACL reconstruction requires careful consideration. Depending on the type of sport, activity restriction even after 12 months may need to be considered to allow complete kinematic restoration.

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Maria Grazia Benedetti, Lisa Berti, Antonio Frizziero, Donata Ferrarese and Sandro Giannini

Context:

Surface replacement of the hip is aimed especially at active patients, and it seems to achieve optimal functional results in a short time if associated with a tailored rehabilitation protocol.

Objective:

To assess the functional outcome in a group of active patients after hip resurfacing.

Design:

Clinical measurement and controlled laboratory study in a case series.

Setting:

Gait-analysis laboratory.

Participants:

8 patients and a control group of 10 subjects.

Interventions:

Patients treated with Birmingham hip-resurfacing system and a tailored rehabilitation protocol

Main Outcome Measures:

Clinical assessment (Harris Hip Score [HHS]) and instrumented gait analysis including muscular electromyographic assessment. Patients were assessed preoperatively and at 3 and 9 mo follow-up after surgery.

Results:

HHS showed a significant increase from the baseline to 3- (P = .008) and 9-month (P = .014) follow-up; 5 patients returned to sport. Gait pattern in the presented case series of patients improved substantially 3 mo postoperatively, and minimal further changes were present 9 months postoperatively. Residual abnormalities of time-distance and hip-kinematics parameters were consistent with a slow gait. A complete restoration of the muscle-activation pattern during gait was achieved.

Conclusion:

Hip resurfacing associated with a rehabilitation protocol based on the characteristics of the implant provides excellent clinical and functional outcome, especially for very active patients.

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Peter Wolf, Renate List, Thomas Ukelo, Christian Maiwald and Alex Stacoff

Before conclusions can be drawn with respect to the quality of adaptations in human gait, the day-to-day consistency of the variables of interest must be known. The present study estimated the day-to-day consistency of kinematic variables collected during barefoot walking and running. Sixteen healthy subjects performed two gait analysis sessions based on skin markers. Test sessions were at least 1 week apart. In total, 48 ranges of motion were monitored for the hip, knee, ankle, and midfoot joint. Based on differences between the repeated gait analysis sessions, the day-to-day consistency was estimated. It was found that the day-to-day consistency was of the magnitude of 3 to 4 degrees for almost all ranges of motion independently of the test condition, the investigated joints, or the cardinal body plane. It was concluded that future studies on effects of interventions or on the characterization of pathological versus normative gait should consider the provided values of day-to-day consistency to improve their interpretation and conclusions.

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Alexander Nazareth, Nicole M. Mueske and Tishya A.L. Wren

This study aimed to determine the effect of tibia marker placement on walking kinematics in children with pathological gait. Three-dimensional lower extremity gait data were collected using both a traditional tibia wand (protruding laterally from the distal shank) and a tibia crest marker on 25 children with pathological gait. Kinematic variables during walking and quiet standing were calculated using each marker and the “Plug-in Gait” implementation of the conventional gait model. For walking, average differences in kinematics between tibia markers ranged from 0.1° to 1.9° at the knee and ankle, except in the transverse plane where differences were 6.0° to 7.2°. No significant differences were found during quiet standing, indicating that differences in kinematics derive primarily from dynamic sources, which likely affect the tibia wand more than the tibia crest marker. These results suggest that the tibia crest marker can be used in place of the traditional tibia wand in clinical gait analysis.