Effects of Biomimetic Shoes on Healthy Young Children's Gait.

Objective To compare the spatial-temporal parameters and walking kinematics of toddlers wearing biomimetic shoes, regular shoes (daily use owned shoes), and barefoot. Methods Spatial-temporal parameters (speed, step length, and stride width), the mean vertical displacement of the center of mass (COM), knee flexion peak, and maximal foot height were analyzed. Results Children were not different in biomimetic shoes and barefoot conditions on speed, step length, and COM vertical displacement. There was no difference among conditions on stride width and foot height. The knee flexion peak was greater in shod conditions than barefoot. The regular shoes showed greater COM vertical displacement than biomimetic shoes and barefoot. Conclusion The findings showed that shoes affected the walking pattern in young children, but a shoe with a biomimetic design had a lesser effect on the walking pattern.

Effects of Resistance Training of Upper Limb and Trunk Muscles on Soccer Instep Kick Kinematics.

The upper body and trunk muscles are crucial to perform soccer kicks. Resistance training targeting these muscles may modify the pattern adopted during kicking. This study aimed to investigate the effect of resistance training of the arm and anterior trunk muscles on instep kicking kinematics. Twenty-six male participants were randomly allocated into a training group or control group. The training group underwent resistance training of arm and trunk muscles and practiced the instep kick for 8 weeks. The control group only practiced kicking during the same period. The trunk, hip, and knee kinematics were assessed during the instep kick before and after the intervention. Kinematics were analyzed according to their data distribution with statistical parametric or nonparametric mapping. The effect of the training on the 1-repetition maximum test was analyzed using a repeated-measures multivariate analysis of variance. The training group showed greater hip extension after the training during the backswing phase (Hedge g effect size of 0.316-0.321) and increased 1-repetition maximum for all exercises. There were no other differences. The present study documented the nonlocal effect of strengthening training in which arm and trunk muscle training resulted in changes in hip kinematics during the backswing phase of the instep kick.

Vertical stiffness and lower limb inter-joint coordination in older versus younger runners.

Older runners (OR) are increasing their participation in races. Aging may impact the adopted running pattern. Hence, the analysis of stiffness and the inter-joint lower limb coordination in the sagittal plane could contribute to investigating this impact. This study aimed to compare the vertical stiffness (Kvert) and the inter-joint lower limb coordination in the sagittal plane between younger runners (YR) and OR. This cross-sectional study recruited 15 YR males and 15 OR males. The pelvis and lower limb motions were assessed while running on a treadmill at self-selected (range OR: 1.94-3.75 m.s-1, YR: 2.08-4.17 m.s-1) and fixed speeds (3.33 m.s-1). Hip-ankle, knee-ankle, and hip-knee coupling angle (CA) and its variability (CAV) were extracted using the vector coding method. Mann-Whitney U tests compared Kvert between groups at each running speed. Watson's U2 tests compared the mean CA between groups in three intervals of the contact phase at each running speed. Statistical Parametric Mapping independent t-test compared the CAV curve between groups at each running speed. OR showed greater Kvert than YR at both speeds. Hip-ankle CA pattern differed between groups during the early stance at both speed conditions. OR showed in-phase, distal dominancy in hip-ankle CA, whereas YR showed anti-phase, proximal dominancy. Knee-ankle CA was distinct only at self-selected speed, in which OR showed in-phase, proximal dominancy, while YR exhibited anti-phase, proximal dominancy. CAV did not differ between groups. The findings showed that OR adopted a stiffer pattern characterized by distinct inter-joint lower limb CA, at early stance, during self-selected and fixed speeds.

Lower limb inter-joint coordination patterns are associated with walking experience in toddlers according to limb and stance periods.

Walking experience is crucial for inter-joint coordination during gait acquisition. Toddlers show asymmetrical lower limb function during early locomotion for transferring body weight (regulatory limb) and steering the direction of walking (impulse limb). This study aimed to investigate the association between coordination patterns and walking experience, and between coordination variability and walking experience according to healthy toddlers' lower limb function and stance periods. Typically developing toddlers (n = 22; 17.27 ± 3.13 months) were distributed into two groups: up to (LWE) and greater than (GWE) three months of walking experience. The lower limbs were classified as regulatory or impulse limb and analyzed during the onset (SO), mid (MS), and late (LS) stance intervals. Hip-ankle, knee-ankle, and hip-knee coupling angle (CA) and its variability (CAV) were assessed. A relationship was found between inter-joint coordination pattern and groups, which was distinct according to stance period and lower limb function: (a) hip-ankle CA: at SO for both limbs, MS for the regulatory limb, and LS for the impulse limb; (b) knee-ankle CA: at SO for both limbs and MS for the regulatory limb; (c) hip-knee CA: at SO for both limbs, at MS for the regulatory limb, and LS for the impulse limb. These findings were linked to differences observed in distal joints between groups, mainly at the ankle during stance onset. The CAV was negatively associated with walking experience only in the regulatory limb in the following variables: hip-ankle at MS, knee-ankle at SO, and hip-knee at LS. Findings showed different functional roles of the lower limbs in dealing with the demands of balance and propulsion during early walking.

The Influence of the Shoe over the Medial Foot Arch and the Lower Limbs Kinematics in Toddlers.

Objective To evaluate the biomechanical behavior of the medial longitudinal arch (MLA) of the foot and the kinematic parameters of the lower limbs with biomimetic footwear (BF) and non-biomimetic (NB1, NB2, NB3 and NB4) footwear in children at the beginning of the gait acquisition phase. Methods Four toddlers were evaluated at the beginning of the gait acquisition phase under the following conditions: walking barefoot, ambulation with BF and NB1, NB2, NB3 and NB4 footwear in hard floor. BF is described as biomimetic because of its property of emulating natural and irregular floors through a dynamic internal insole. The MLA and kinematics of the hip, knee, and ankle during gait were evaluated by three-dimensional motion analysis system. The similarity between the kinematic curves of barefoot and footwear conditions was analyzed by root mean square error (RMSE). Results The use of BF presented the highest magnitude of MLA and the greatest difference in relation to barefoot condition (higher RMSE). The BF showed less difference in the kinematics of the knee and ankle joints during gait when compared to barefoot condition (lower RMSE). NB2 footwear presented hip kinematics more similar to barefoot condition (lower RMSE). Conclusion Biomimetics footwear and NB2 shoes (both with wider forefoot region) generated smaller differences in lower limbs compared to barefoot. In addition, the MLA was higher in the BF, probably because different design from other shoes.

The Influence of the Shoe over the Medial Foot Arch and the Lower Limbs Kinematics in Toddlers / A influência de calçados no arco longitudinal medial do pé e na cinemática dos membros inferiores de crianças no início da fase de aquisição de marcha

Abstract Objective To evaluate the biomechanical behavior of the medial longitudinal arch (MLA) of the foot and the kinematic parameters of the lower limbs with biomimetic footwear (BF) and non-biomimetic (NB1, NB2, NB3 and NB4) footwear in children at the beginning of the gait acquisition phase. Methods Four toddlers were evaluated at the beginning of the gait acquisition phase under the following conditions: walking barefoot, ambulation with BF and NB1, NB2, NB3 and NB4 footwear in hard floor. BF is described as biomimetic because of its property of emulating natural and irregular floors through a dynamic internal insole. The MLA and kinematics of the hip, knee, and ankle during gait were evaluated by three-dimensional motion analysis system. The similarity between the kinematic curves of barefoot and footwear conditions was analyzed by root mean square error (RMSE). Results The use of BF presented the highest magnitude of MLA and the greatest difference in relation to barefoot condition (higher RMSE). The BF showed less difference in the kinematics of the knee and ankle joints during gait when compared to barefoot condition (lower RMSE). NB2 footwear presented hip kinematics more similar to barefoot condition (lower RMSE). Conclusion Biomimetics footwear and NB2 shoes (both with wider forefoot region) generated smaller differences in lower limbs compared to barefoot. In addition, the MLA was higher in the BF, probably because different design from other shoes.

Resumo Objetivo Avaliar o comportamento do arco longitudinal medial do pé (ALM) e os parâmetros cinemáticos dos membros inferiores durante a deambulação com calçados biomiméticos (CBs) e não biomiméticos (NB1, NB2, NB3 e NB4) em crianças no início da fase de aquisição da marcha. Métodos Foram avaliadas quatro crianças no início da fase de aquisição da marcha nas seguintes condições: andar descalço, andar com CBs e calçados NB1, NB2, NB3 e NB4 em solo plano. O calçado biomimético é descrito como biomimético por emular pisos naturais e irregulares por meio de uma palmilha interna dinâmica. O ALM e a cinemática do quadril, joelho e tornozelo durante a marcha foram avaliados por meio de sistema de análise do movimento tridimensional. A similaridade entre as curvas cinemáticas das condições descalça e com calçado foi analisada por meio do cálculo de root mean square error (RMSE). Resultados O CB foi o que apresentou maior magnitude do ALM e maior diferença do ALM em relação à condição descalça (maior RMSE). O CB apresentou ainda menor diferença na cinemática das articulações do joelho e tornozelo durante a marcha quando comparado à condição descalça (menor RMSE). O calçado NB2 apresentou a cinemática do quadril mais semelhante à condição descalça (menor RMSE). Conclusão Os calçados CB e NB2 que apresentam a região do antepé mais larga geraram menores diferenças na cinemática dos membros inferiores. Além disso, o ALM foi maior no CB provavelmente devido a seu design ser diferente daquele dos demais calçados.

Runners with a history of injury have greater lower limb movement regularity than runners without a history of injury.

This study aimed to investigate the regularity of the lower limb joint kinematics in runners with and without a history of running-related injuries. The second aim was to verify if the movement pattern regularities are different among the lower limb joints. Eighteen asymptomatic recreational runners with and without a history of running-related injury participated in this study. Lower limb kinematics in the sagittal plane were recorded during running on a treadmill at a self-selected speed. The regularities of the time series of hip, knee, and ankle were analysed using sample entropy (SampEn). A mixed analysis of variance was used to investigate differences between groups and among joints. Runners with a history of injury had lower SampEn values than runners without a history of injury. Ankle kinematics SampEn was higher than that of the knee and hip. Knee kinematics had higher values of SampEn than that of the hip. Runners with a history of running-related injury had greater joint kinematic's regularity. This result suggests that, even in asymptomatic runners, previous injuries could influence the movement pattern regularity. Also, the regularity was different among joints. The ankle demonstrated the lowest regularity, reinforcing the different functions that lower limb joints perform during running.

Combining balance-training interventions with other active interventions may enhance effects on postural control in children and adolescents with cerebral palsy: a systematic review and meta-analysis.

BACKGROUND: Improvement of postural control in children and adolescents with cerebral palsy is a primary goal in child rehabilitation. OBJECTIVE: A systematic review investigated whether combining balance-training interventions with other active interventions enhances the effects of the active intervention alone on postural control of children and adolescents with cerebral palsy. METHODS: Searches were performed in MEDLINE, PEDro, CINAHL, Cochrane and EMBASE databases without date or language restrictions. Randomized controlled trials investigating the combination of balance-training interventions with other active interventions on the postural control of children and adolescents with cerebral palsy were included. Two independent reviewers screened studies, extracted data, and assessed methodological quality of included studies. Meta-analysis was conducted, and quality of the evidence followed the GRADE methodology. Pooled data were presented using standardized mean difference and 95% confidence interval. RESULTS: Seven studies involving 194 participants were included in this review. A large additional effect on postural control was found when balance-training interventions were combined with Neurodevelopmental Treatment at short-term (standardized mean difference of 1.3; 95% confidence interval 0.5, 2.0, p=0.001). The quality of the evidence was very low due to publication bias, imprecision and inconsistency. CONCLUSION: Combining balance-training interventions with other active interventions may enhance effects on postural control of this population at short-term. As the estimated effect had only very low quality of evidence to support it, larger studies with low risk of bias are needed.

Influence of reducing anterior pelvic tilt on shoulder posture and the electromyographic activity of scapular upward rotators.

BACKGROUND: Modifications of posture in a segment may influence the posture of adjacent and nonadjacent segments and muscular activity. The spine-shoulder and spine-pelvis relationships suggest that the pelvis may influence shoulder posture. OBJECTIVE: To investigate the effect of the active reduction of the anterior pelvic tilt on shoulder and trunk posture during static standing posture and on the electromyographic activity of the scapular upward rotators during elevation and lowering of the arm. METHODS: Thirty-one young adults were assessed in a relaxed standing position and a standing position with 30% active reduction of the anterior pelvic tilt. The pelvic tilt, trunk posture, and forward shoulder posture during the static standing posture and the electromyographic activity during elevation and lowering of the arm were assessed. RESULTS: Paired t-tests indicated that the active reduction of the anterior pelvic tilt reduced the trunk extension (MD=1.09; 95%CI=-2.79 to -1.03). There were no effects on the forward shoulder posture (MD=0.09; 95%CI=-0.92 to 1.09). Repeated measures of analyses of variance indicated an increase in lower trapezius electromyographic activity (MD=3.6; 95%CI=1.28 to 5.92). There was a greater reduction in upper trapezius activity after pelvic tilt reduction during arm elevation (MD=1.52%; 95%CI=-2.79 to -0.25) compared to that during the lowering phase. There were no effects of pelvic tilt reduction on the electromyographic activity of the serratus anterior (MD=3.26; 95%CI=-3.36 to 9.87). CONCLUSION: The influence of pelvic posture on the trunk posture and lower trapezius activation should be considered when assessing or planning exercise for individuals with shoulder or trunk conditions.

Identification of gait events in children with spastic cerebral palsy: comparison between the force plate and algorithms.

OBJECTIVE: To compare the gait event identification of five algorithms recommended in the literature with those provided by force plate (gold standard) in children with unilateral or bilateral spastic cerebral palsy (SCP). METHODS: This was a cross-sectional study of the gait of three girls and four boys with a mean age of 8.6±4.7 years. Four children had unilateral SCP with an equinus gait pattern, and the remaining three children exhibited bilateral SCP with a slide/drag gait pattern. Kinematic and kinetic gait data were collected during barefoot walking at a comfortable speed. From a total of 202 steps, the detection of 202 foot-strike (FS) and 194 toe-off (TO) events by each algorithm was compared with the detection of these same events by the force plate. The error between the events detected by the algorithms and those detected by the force plate was determined in milliseconds. Repeated measures ANOVA was used to compare the errors among the algorithms. RESULTS: The algorithm reported by Ghoussayni et al. showed the best performance in all situations, except for the identification of FS events on the unaffected side in children with unilateral SCP. For these events, the algorithms reported by Desailly et al. and Zeni et al. showed the best performance. CONCLUSION: Ghoussayni et al.'s algorithm can be used to detect gait events in children with SCP when a force plate is not available.

Functional Task Training Combined With Electrical Stimulation Improves Motor Capacity in Children With Unilateral Cerebral Palsy: A Single-Subject Design.

PURPOSE: Reduced propulsive capability can impact negatively on mobility activities of many children with spastic unilateral cerebral palsy (SUCP). This study investigated the effect of a task-oriented training program combined with functional electrical stimulation (FES) on the motor capacity of children with SUCP. METHODS: Single-case A-B design with follow-up. Gross motor function and biomechanical walking data of 4 children with SUCP were measured repeatedly across the baseline, intervention, and follow-up phases. Intervention was a task-oriented training program combined with FES applied on the gastrocnemius. Outcome variables included gait speed, impulsive torque, and ankle/hip power generation ratio. The 2-SD band and celeration line methods compared outcomes among the baseline, intervention, and follow-up periods. RESULTS: One child improved walking speed. All children improved impulsive torque and ankle/hip power ratio of the affected leg. All children improved gross motor function. CONCLUSION: The intervention improved children's propulsive capability and positively influenced their mobility.

Pronação excessiva e varismos de pé e perna: relação com o desenvolvimento de patologias músculo-esqueléticas: revisão de literatura / Excessive pronation and varus alignment of foot and shank: relationship with development of musculoskeletal pathologies: literature review

A literatura propõe mecanismos biomecânicos que relacionam a pronação subtalar excessiva ao desenvolvimento de diversas patologias músculo-esqueléticas. A presença dos desalinhamentos anatômicos antepé varo, retropé varo e tíbia vara pode levar à ocorrência da pronação subtalar excessiva. Entretanto, não existe um consenso sobre a contribuição do padrão de movimento e da presença desses desalinhamentos para o desenvolvimento de patologias. O objetivo deste estudo foi realizar uma revisão da literatura para investigar a influência de varismos aumentados de antepé, retropé e tíbia e da pronação subtalar excessiva no surgimento de patologias músculo-esqueléticas. Foi realizada uma pesquisa bibliográfica sistematizada nas bases Medline, ISI – Web of Science, Lilacs e SciELO, tendo sido selecionados 13 estudos analíticos. Do total de 13 estudos, 10 encontraram associação de patologias no membro inferior com um ou mais dos desalinhamentos anatômicos analisados ou com um ou mais parâmetros cinemáticos relacionadas à pronação subtalar excessiva. A análise dos estudos sugere que a pronação subtalar excessiva e/ou a presença de desalinhamentos que podem levar a esse padrão de movimento são possíveis fatores de risco para o desenvolvimento de patologias músculo-esqueléticas no membro inferior.

The literature proposes biomechanical mechanisms that link excessive subtalar joint pronation to the development of several musculoskeletal pathologies. The presence of forefoot varus, rearfoot varus and tibiofibular varum can lead to the occurrence of excessive subtalar pronation. However, there is no consensus about the contribution of the movement pattern and/or the presence of these anatomical misalignments to the development of pathologies. The aim of the present study was to conduct a literature review in order to investigate the influence of increased varus alignment of forefoot, rearfoot and shank and of excessive subtalar pronation on the development of musculoskeletal pathologies. A systematic literature search was performed in the databases Medline, ISI – Web of Science, Lilacs and SciELO, and 13 analytic studies were selected. Ten studies found significant associations of lower-limb musculoskeletal pathologies with one or more of the anatomical misalignments analyzed or with one or more kinematic parameters related to excessive subtalar pronation. The analysis of the studies suggests that excessive pronation and/or the presence of these anatomical misalagniments should be regarded as possible risk factors for the development of musculoskeletal pathologies in the lower limb.

Effects of strength training aided by electrical stimulation on wrist muscle characteristics and hand function of children with hemiplegic cerebral palsy.

Nine children with spastic hemiplegic cerebral palsy underwent 24 sessions of wrist muscles strengthening in the extended wrist range aided by electrostimulation. Isometric strength of flexors and extensors was registered in three wrist positions (30 degrees of flexion, neutral, and 30 degrees of extension) to infer on angle-torque curves. Passive stiffness of wrist flexors and wrist flexion angle during manual tasks and hand function were also documented. Significant strength gains were observed at 30 degrees of wrist extension for flexors (p= 0.029) and extensors (p= 0.024). No gains were observed at 30 degrees of flexion. The difference in extensor strength between the three test positions changed after intervention (p< 0.034), suggesting a shift in the angle-torque curve. No changes were observed in passive stiffness (p= 0.506), wrist angle (p< 0.586), or hand function (p= 0.525). Strength training in specific joint ranges may alter angle-torque relationships. For functional gains to be observed, however, a more aggressive intervention and contextualized task training would probably be needed.

Biomecânica da marcha em idosos caidores e não caidores: uma revisão da literatura / Gait biomechanics in elderly fallers and non fallers: a literature review

As quedas são comuns em idosos e ocorrem principalmente durante a marcha. Nosso objetivo foi rever as alterações na marcha que ocorrem com o envelhecimento e suas relaçõescom as quedas. Estudos mostram que os idosos tendem a diminuir a velocidade e o tamanho da passada e a aumentar a base de suporte e o tempo da fase de duplo apoio para ganho de estabilidade. Perdas na amplitude das articulações do quadril e joelho também foram identificadas. O fator preditivo apontado como o maior causador de quedas foi a variabilidade dos dados temporais e espaciais durante a passada. Além disso, atraso no pico de momento de força interno de flexão plantar na fase de apoio terminal, levando a um atraso na diminuição da amplitude de dorsiflexão em idosos caidores já foi determinado e caracterizado como fraqueza dos músculos gastrocnêmio e sóleo. A importância do sóleo e gastrocnêmio na manutenção da estabilidade na marcha foi evidenciada em vários estudos. Em ambientes de risco, idosos saudáveis geram aumento da atividade dos músculos tibial anterior e gastrocnêmio com o objetivo de reduzir o movimento médio lateral do centro de gravidade, reduzindo assim, a velocidade angular das articulações do joelho e tornozelo. Acreditamos que essas estratégias estão ausentes em idosos caidores, por ausência desses músculos ou por alterações de comando central.

Falls in the elderly are common and occur mostly during gait. Our objective was to review the alterations in gait that occur during aging and its relation to falls. Studies have shown that elderly subjects decrease their velocity and stride length and increase the base of support and double support time to gain stability during gait. Loss of hip and knee range of motion has also been identified. However, stride-to-stride variability has been pointed as the strongest predictor of falling in elderly subjects. In addition, a significant delay in the internal peak plantar flexion moment in elderly fallers at the end of the terminal stance, delaying the decrease of ankle dorsiflexion range of motion, has been also found and characterized as weakness of the soleus and gastrocnemius muscles. The importance of these muscles in maintaining gait stability has been proved. In constrained floor conditions, healthy elderly subjects increased the level of activity of the tibialis anterior and gastrocnemius muscles to reduce the mediolateral movement of the center of gravity, resulting in reduction of the angular velocity of the ankle and knee joints. We believe that such strategies are absent in elderly fallers, due toweakness or absence of the soleus and gastrocnemius muscles or to alterations in the internal central commands.