3D Stereophotogrammetric Quantitative Evaluation of Posture and Spine Proprioception in Subacute and Chronic Nonspecific Low Back Pain.

The literature shows that low back pain causes a reduced lumbar range of movement, affecting patients' proprioception and motor control. Nevertheless, studies have found that proprioception and motor control of the spine and posture are vague and individually expressed even in healthy young adults. This study aimed to investigate the standing posture and its modifications induced by an instinctive self-correction manoeuvre in subacute and chronic nonspecific low back pain (NSLBP) patients to clarify how NSLBP relates to body upright posture, proprioception, and motor control and how these are modified in patients compared to healthy young adults (121 healthy young adults: 57 females and 64 males). A cohort of 83 NSLBP patients (43 females, 40 males) were recruited in a cross-sectional observational study. Patients' entire body posture, including 3D spine shape reconstruction, was measured using a non-ionising 3D optoelectronic stereophotogrammetric approach. Thirteen quantitative biomechanical parameters describing the nature of body posture were computed. The statistical analysis was performed using multivariate methods. NSLBP patients did not present an altered proprioception and motor control ability compared to healthy young adults. Furthermore, as for healthy subjects, NSLBP patients could not focus and control their posture globally. Proprioception and motor control in natural erect standing are vague for most people regardless of gender and concurrent nonspecific low back pain. Self-correction manoeuvres improving body posture and spine shape must be learned with specific postural training focusing on the lumbar spine.

A Self-Contained 3D Biomechanical Analysis Lab for Complete Automatic Spine and Full Skeleton Assessment of Posture, Gait and Run.

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.

3D Quantitative Evaluation of Posture and Spine Proprioceptive Perception Through Instinctive Self-Correction Maneuver in Adolescent Idiopathic Scoliosis.

BACKGROUND: Conservative treatment in the adolescent idiopathic scoliosis (AIS) population is based on individual proprioceptive and motor control training. Such training includes physiotherapeutic scoliosis-specific exercises (PSSEs) stimulating the individual capacity to perceive and control his/her posture, particularly the shape of the spine. However, limited knowledge about basic proprioception capability in AIS patients is reported in the literature. QUESTIONS: (1) How do AIS patients, who did not receive any previous specific postural education treatment, perceive their posture and 3D spine shape? Are they able to modify their posture and 3D spine shape correctly through an instinctive self-correction (ISCO) maneuver? (2) Are posture and ISCO maneuver ability gender dependent in AIS patients? (3) Do AIS patients present different posture and spine shape characteristics as well as different ISCO ability compared with the healthy young adult population? METHODS: Cross-sectional observational study. 132 (75 females, 57 males) AIS patients' posture and 3D spine shape have been measured comparing indifferent orthostasis (IO) (neutral erect posture) to ISCO using a non-ionizing 3D optoelectronic stereophotogrammetric approach. Thirteen quantitative biomechanical parameters described the AIS patients body posture. The statistical analysis was performed using a multivariate approach to compare genders in IO, ISCO, and AIS patients vs. healthy young adults-previously published data (57 females, 64 males). RESULTS: Males (87.7%) and females (93.3%) of AIS patients were unable to modify posture and 3D spine shape globally. AIS patients gender differences were found in IO, ISCO, and the comparison vs. healthy young adults. When changes occurred, subjects could not focus and control their posture globally, but only in a few aspects at a time. CONCLUSION: Self-correction maneuver producing an improvement in body posture and spine shape is not instinctive and must be trained. In such characteristics, AIS patients are not so dissimilar to healthy young adults. Sagittal plane control is the highest, but ISCO in AIS patients led to worsening in this plane. Control at the lumbar level is neglected in both genders. Such outcomes support the necessity of customized PSSEs to treat AIS patients. The 3D stereo-photogrammetric approach is effective in quantitatively describing the subject's posture, motor control, and proprioception.

Data-driven CAD-CAM vs traditional total contact custom insoles: A novel quantitative-statistical framework for the evaluation of insoles offloading performance in diabetic foot.

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.

Leg Length Discrepancy and Nonspecific Low Back Pain: 3-D Stereophotogrammetric Quantitative Posture Evaluation Confirms Positive Effects of Customized Heel-Lift Orthotics.

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.

Muscle Hypertrophy and Architectural Changes in Response to Eight-Week Neuromuscular Electrical Stimulation Training in Healthy Older People.

Loss of muscle mass of the lower limbs and of the spine extensors markedly impairs locomotor ability and spine stability in old age. In this study, we investigated whether 8 w of neuromuscular electrical stimulation (NMES) improves size and architecture of the lumbar multifidus (LM) and vastus lateralis (VL) along with locomotor ability in healthy older individuals. Eight volunteers (aged 65 ≥ years) performed NMES 3 times/week. Eight sex- and age-matched individuals served as controls. Functional tests (Timed Up and Go test (TUG) and Five Times Sit-to-Stand Test (FTSST)), VL muscle architecture (muscle thickness (MT), pennation angle (PA), and fiber length (FL)), along with VL cross-sectional area (CSA) and both sides of LM were measured before and after by ultrasound. By the end of the training period, MT and CSA of VL increased by 8.6% and 11.4%, respectively. No significant increases were observed in FL and PA. LM CSA increased by 5.6% (left) and 7.1% (right). Interestingly, all VL architectural parameters significantly decreased in the control group. The combined NMES had a large significant effect on TUG (r = 0.50, p = 0.046). These results extend previous findings on the hypertrophic effects of NMES training, suggesting to be a useful mean for combating age-related sarcopenia.

Normative 3D opto-electronic stereo-photogrammetric sagittal alignment parameters in a young healthy adult population.

This paper describes and presents a stable and reliable set of stereo-photogrammetric normative data for global and spino-pelvic sagittal alignment, as a proven reference system for evaluating/measuring a fully unconstrained natural upright neutral standing attitude in a young healthy adult population. The methodological features described in this article will enable future studies to replicate and/or directly compare a wide range of different postural tests and/or sagittal alignment assessment procedures including the study of sagittal spine shape variations occurring during gait performance. To date, the quantitative evaluation of adult spinal deformity (ASD) has been mainly confined to the X-ray imaging approach and, more recently, to 3D X-ray reconstruction. Within the existing evaluation framework an opportunity exists for an additional approach: a quantitative evaluation procedure which is easy, accurate, relatively speedy and non-ionising, in order to monitor and track the progress of patients in the areas of both surgical and non-surgical treatment. The resources and methodology described in this paper have been proven to meet all these criteria. They have enabled full 3D posture (including 3D spine shape and sagittal alignment of the skeleton) to be consistently and successfully measured in adult volunteers. All the measurement/evaluation procedures and outcomes carried out were based entirely on the new non-ionising 3D opto-electronic stereo-photogrammetric approach described in this article. The protocol for this methodology was based on a standard set of 27 pre-selected anatomical "landmarks" on the human body, providing standard reference points for observation and measurement. A total of 124 healthy subjects were successfully assessed and, for each subject, 27 individual markers were applied to the corresponding locations on his/her body. Statistical tests to investigate gender differences were also carried out. Descriptive statistics are provided for all 15 of the spino-pelvic parameters under consideration. Results indicated significant differences between genders in five sets of parameters: Kyphosis tilt, Head tilt, Pelvic tilt, Spino-pelvic angle and T1-pelvic angle. The data also demonstrate a high degree of congruity with results obtained using the X-ray method, as evidenced by the existing literature in the field. In summary, the current study presents a new stereo-photogrammetric opto-electronic technology which can be used successfully for ASD evaluation and introduces a comprehensive set of normative data analogous to those proposed in X-ray analysis for sagittal spino-pelvic and total body alignment.

3D quantitative evaluation of spine proprioceptive perception/motor control through instinctive self-correction maneuver in healthy young subjects' posture: an observational study.

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.

Normative 3D opto-electronic stereo-photogrammetric posture and spine morphology data in young healthy adult population.

DESIGN: Observational cross-sectional study. The current study aims to yield normative data: i.e., the physiological standard for 30 selected quantitative 3D parameters that accurately capture and describe a full-skeleton, upright-standing attitude. Specific and exclusive consideration was given to three distinct categories: postural, spine morphology and pelvic parameters. To capture such 3D parameters, the authors selected a non-ionising 3D opto-electronic stereo-photogrammetric approach. This required the identification and measurement of 27 body landmarks, each specifically tagged with a skin marker. As subjects for the measurement of these parameters, a cohort of 124 asymptomatic young adult volunteers was recruited. All parameters were identified and measured within this group. Postural and spine morphology data have been compared between genders. In this regard, only five statistically significant differences were found: pelvis width, pelvis torsion, the "lumbar" lordosis angle value, the lumbar curve length, and the T12-L5 anatomically-bound lumbar angle value. The "thoracic" kyphosis mean angle value was the same in both sexes and, even if, derived from skin markers placed on spinous processes it resulted in perfect agreement with the X-ray based literature. As regards lordosis, a direct comparison was more difficult because methods proposed in the literature differ as to the number and position of vertebrae under consideration, and their related angle values. However, when the L1 superior-L5 inferior end plate Cobb angle was considered, these results aligned strongly with the existing literature. Asymmetry was a standard postural-spinal feature for both sexes. Each subject presented some degree of leg length discrepancy (LLD) with µ = 9.37mm. This was associated with four factors: unbalanced posture and/or underfoot loads, spinal curvature in the frontal plane, and pelvis torsion. This led to the additional study of the effect of LLD equalisation influence on upright posture, relying on a sub-sample of 100 subjects (51 males, 49 females). As a result of the equalisation, about 82% of this sub-sample showed improvement in standing posture, mainly in the frontal plane; while in the sagittal plane less than 1/3 of the sub-sample showed evidence of change in spinal angles. A significant variation was found in relation to pelvis torsion: 46% of subjects showed improvement, 49% worsening. The method described in study presents several advantages: non-invasive aspect; relatively short time for a complete postural evaluation with many clinically useful 3D and 2D anatomical/biomechanical/clinical parameters; analysis of real neutral unconstrained upright standing posture.

LBP and lower limb discrepancy: 3D evaluation of postural rebalancing via underfoot wedge correction.

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.

Leg length discrepancy in scoliotic patients.

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.

An integrated procedure for spine and full skeleton multi-sensor biomechanical analysis & averaging in posture gait and cyclic movement tasks.

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.

A 3-D biomechanical skeleton model for posture and movement analysis.

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.).

Balance lower limb loads and 3D spine modifications after total hip joint replacement: effects of leg length discrepancy correction.

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.

Scoliosis and leg asymmetries: a reliable approach to assess wedge solutions efficacy.

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.

A 3-D parametric biomechanical skeleton model for posture and spine shape analysis.

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.

Joint segmental kinematic trunk motion and C.O.P. patterns for multifactorial posturographic analysis.

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.

Baropodographic measurements and averaging in locomotion and postural analysis.

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.