Relationship between obesity and plantar pressure distribution in youths with Down syndrome.

OBJECTIVE: This study aimed to characterize the effect of obesity on foot-ground contact in young individuals affected by Down syndrome (DS) during quiet upright stance. DESIGN: This is a cross-sectional study on 118 individuals with Down syndrome, 59 with obesity aged 3-18 yrs and 59 with normal weight, age- and sex-matched forming the control group. Both groups were evaluated while standing on a pressure-sensitive mat. Foot-ground contact was characterized using contact area and mean pressure calculated for the rearfoot, the midfoot, and the forefoot. RESULTS: The results show that obesity significantly influences the foot-ground interaction, with some differences related to sex. In particular, the females with obesity exhibited larger contact areas and higher plantar pressures (in the forefoot and the midfoot) with respect to the control group, whereas in the males with obesity, only the plantar pressures were found higher than those of the controls. Flatfoot is the prevalent arch type for both groups, but its incidence seems to be unrelated to obesity. CONCLUSIONS: The modifications introduced by obesity in foot-ground contact pressure and area may represent a factor capable of aggravating existing negative podiatric issues associated with Down syndrome. Thus, planning periodical monitoring of foot-ground contact during childhood and adolescence is recommended to avoid possible problems related to adverse effects of repeated excessive mechanical stresses on the plantar region.

Foot-ground interaction during upright standing in children with Down syndrome.

This study aimed to quantitatively characterize the main foot-ground contact parameters during static upright standing and to assess foot evolution with increasing age in young individuals affected by Down syndrome (DS). To this end, 99 children with DS of mean age 9.7 (1.7) were tested using a pressure sensitive mat, and the raw data were processed to extract information about overall and rearfoot, midfoot and forefoot contact area, Arch Index (AI) and average contact pressure. The values obtained were then compared with those calculated from a sample of age- and gender-matched participants (control group, CG). Children with DS exhibited larger midfoot and reduced forefoot contact areas with respect to CG participants (+53% and -35% respectively, p<0.001), increased AI values (DS 0.31, CG 0.20, p<0.001) and increased average contact pressures in the midfoot and forefoot. The overall foot development for the two groups followed a similar trend, although in individuals with DS a curve that relates increases in midfoot contact area with age is characterized by a steeper gradient, and the forefoot contact area appeared systematically smaller regardless of age. The large prevalence of the flatfoot type in children with DS (which is known to be originated by hypotonia and ligamentous laxity) associated with the presence of higher average contact pressure in midfoot and forefoot justify the need for careful podiatric surveillance throughout childhood to reduce balance and gait impairment which are likely to affect untreated subjects when they reach adulthood.

Quantitative evaluation of facial movement and morphology.

OBJECTIVES: The aim of our study was to quantitatively analyze facial motion kinematics by means of an optoelectronic system. In particular, we defined a set of easily recognizable reference points for markerization, and tested the applicability of our markerization method for an exhaustive characterization of the subjects' facial motion through the definition of some kinematic parameters. METHODS: Thirty healthy subjects (mean age, 24.6 +/- 1.0 years; 15 female and 15 male) participated in the study. A set of markers (diameter, 3 mm) was positioned on several reference points of the face, and some parameters were computed for the characterization of facial morphology and movement, such as ranges of motion, angles, times, and distances. RESULTS: The protocol was tested for inter-rater and intra-rater reliability by use of intraclass correlation, of which the results were good (between 0.4 and 0.75) to excellent (greater than 0.75). The parameters were useful for characterizing the resting position, mimicry, and speaking movements, and highlighted some distinctions between men and women in facial morphology. CONCLUSIONS: The protocol can be applied to a variety of facial movements, including speaking. Future works could address the use of the protocol in subjects with disorders and the integrated analysis of kinematic parameters and voice spectrography.

Quantitative analysis of upper limbs during gait: a marker set protocol.

PURPOSE: to develop a marker set for simultaneously assessing upper and lower limb biomechanics during gait. METHODS: 24 healthy young subjects (mean age: 23.80 years) were assessed quantitatively using an optoelectronic system, two force platform and a video system. Passive markers were positioned according to the proposed marker set which enables acquiring the upper and lower limb movement simultaneously during Gait Analysis. In addition to the traditional parameters obtained from Gait Analysis, the shoulder and elbow angles were computed from markers coordinates of upper limbs; then, some significant parameters were identified and calculated. From shoulder and elbow position, angles, angular velocities, angular acceleration, moments, and powers were calculated for shoulder and elbow joints. RESULTS: Kinematic and kinetic data were obtained in the three planes (sagittal, frontal, and transversal) for the shoulder and in the sagittal plane for the elbow. Normative ranges were obtained for these parameters from data of healthy participants. CONCLUSIONS: The proposed experimental set-up enables simultaneous assessment of upper and lower limb movement during gait. Thus, no further trials are required in addition to those acquired during standard gait analysis in order to assess upper limb motion, which also makes the experimental set-up feasible for clinical applications.

The effects of femoral derotation osteotomy in cerebral palsy: a kinematic and kinetic study.

We attempted to quantify the effects of isolated femoral derotation osteotomies using clinical evaluation and gait analysis (kinematics and kinetics) in patients with cerebral palsy (CP). Twelve children with CP were evaluated before and 10 months after isolated femoral derotation osteotomy, and 15 healthy children were evaluated as controls. There were significant improvements on clinical examination. A better position of the hip and ankle in the transverse plane was evident and significant changes occurred in terms of hip and ankle kinetics after surgery. Improvements in kinematics and hip and ankle power are very important biomechanically. The correction of lever arm dysfunction and more physiological hip and ankle power generation result in an improvement in terms of energy consumption, leading to a more functional and economic gait pattern.

Postural control in children, teenagers and adults with Down syndrome.

The goal of this work was to analyze postural control in Down syndrome (DS) participants considering three different groups composed by children, teenagers and adults with DS. An analysis of the centre of pressure (COP) displacement during standing position was therefore performed for the three groups of subjects. The obtained signal of COP was then analyzed in both time and frequency domains in order to perform a thorough analysis of the signal. Even if several parameters revealed more differences between the control and DS participants in adulthood, results indicated a divergence of these two groups starting from their early age, although the limit of this study considering a cross-sectional, and not a longitudinal comparison. In particular, COP medio-lateral range of motion pointed out a decrease for both groups considered (pathological and control) in time domain analysis that could lead to the same conclusion in developing strategies, but frequency domain analysis evidenced how this result is reached by the different population: DS people showed a larger frequency of movement in ML more evidenced in adults group (Down Syndrome Adults Group vs. Adults Control Group; 0.35 ± 0.22 Hz vs. 0.17 ± 0.15 Hz; p < 0.05). Even if less pronounced also for the other parameters computed these differences emerged. Aims for the two macro-groups, DS and CG, are different: DS people focused on overcoming the lack of equilibrium caused by hypotonia and ligament laxity, while control group attempted to improve their strategy in term of efficiency, pointing out a different strategy development.

3D gait analysis in patients with hereditary spastic paraparesis and spastic diplegia: a kinematic, kinetic and EMG comparison.

The predominant clinical feature of patients with Hereditary Spastic Paraparesis (HSP) is gait disturbance owing to spasticity and weakness of the lower limbs; the spasticity in early-onset disease (infancy or childhood) often cannot be distinguished from mild form of spastic diplegia (SD). The aim of this study was to quantify the gait strategy in HSP and SD children, focusing on the differences between groups as concerns functional limitation during gait. 9 HSP and 16 SD children were evaluated using Gait Analysis; kinematic and kinetic parameters and EMG pattern during walking were identified and calculated to compare the two gait strategies. The results revealed that these two pathologies are characterised by different gait strategies. In particular we found that knee joint, in terms of kinematics and kinetics, and rectus femoris pattern represent discriminatory aspects in order to compare and differentiate gait patterns of HSP and SD children. The findings strongly support the issue that HSP and SD patients need individualised therapeutical program, either neurosurgical or pharmacological treatment, based on the quantification of gait deficiencies and in order to address the peculiarity of their motor limitations and to prevent the onset of compensatory strategies.

Gait Analysis before and after Gastrocnemius Fascia Lengthening for Spastic Equinus Foot Deformity in a 10-Year-Old Diplegic Child.

Purpose. This case study quantified kinematic and kinetic effects of gastrocnemius lengthening on gait in a Cerebral Palsy child with equinus foot. Methods. A 10-year-old diplegic child with Cerebral Palsy was evaluated with Gait Analysis (GA) before and after gastrocnemius fascia lengthening, investigating the lower limb joints kinematics and kinetics. Results. Kinematics improved at the level of distal joints, which are directly associated to gastrocnemius, and also at the proximal joint (like hip); improvements were found in ankle kinetics, too. Conclusions. This case study highlighted that GA was effective not only to quantify the results of the treatment but also to help preoperative decision making in dealing with CP child.

Are knee kinematic anomalies in swing due to rectus femoris spasticity different from those due to femoral anteversion in children with cerebral palsy? A quantitative evaluation using 3D gait analysis.

Quantitative comparison of gait strategy between stiff knee gait caused by rectus femoris spasticity versus that caused by femoral anteversion was the objective of this study. Twenty-three diplegic were divided into group 1 (excessive femoral anteversion without rectus femoris spasticity) and group 2 (normal femoral anteversion and rectus femoris spasticity). Both groups showed low knee flexion during swing (KMSw), but although group 1 exhibited normal KMSw timing and high hip intrarotation, group 2 presented delayed KMSw timing, with normal hip rotation. Reduced KMSw may be because of two different conditions: excessive femoral anteversion, leading only to KMSw reduction, and rectus femoris spasticity, inducing coexistence of reduced KMSw and its delayed timing.

3D-Quantitative evaluation of a rigid seating system and dynamic seating system using 3D movement analysis in individuals with dystonic tetraparesis.

To improve postural stability in individuals with dystonic cerebral palsy, the concept of a dynamic seat has been suggested as a potential solution. An experimental set-up for the acquisition of movement during extensor thrusts while sitting on a seating system was defined and applied on a group of dystonic individuals, to compare a dynamic versus a rigid seat system, using quantitative movement analysis. The seating system in dynamic configuration is able to reduce the extensor thrust experienced by the consumers, as well as to increase range of motion in the anterior-posterior direction, limiting the sliding down of trunk and showing better upper limb smoothness during extensor thrusts. The procedures used in this study appear to provide a useful tool for better understanding how the concept of a dynamic back in a seat system may affect and influence position and stability of individuals with dystonia on the seat system.

Quantitative effects on proximal joints of botulinum toxin treatment for gastrocnemius spasticity: a 4-year-old case study.

Botulinum toxin A (BTA) is a recognized treatment for the early management of spasticity in children with Cerebral Palsy. This study quantified with Gait Analysis (GA) the gait pattern of a 4-year-old diplegic child with calf contracture before, 5 days, and 3 months after BTA injections into gastrocnemius. Kinematic and kinetic data of main lower limb joints were investigated. After only 5 days, ankle dorsi-plantarflexion and knee flex-extension improved, but hip joint worsened, increasing its excessive flexion, to compensate the improvement in knee position of the treated limb and to obtain better stability. A worsening of hip power happened. After 3 months, all joints generally improved their position during gait cycle. Hip and knee joints increased their range of movement and improvements occurred at ankle kinematics and kinetisc, too; a better ankle position and an increase of its capacity of propulsion during terminal stance were evident.

Assessment of gait recovery in children after Traumatic Brain Injury.

OBJECTIVE: The aims were: (1) to quantify the functional limitation of children at the beginning of recovery of independent ambulation after Traumatic Brain Injury (TBI), using clinical-functional scales; (2) to evaluate the changes in gait pattern during rehabilitation (about 5 months later), using 3D Gait Analysis (GA) in post-acute phase; (3) to investigate the presence of correlation among parameters obtained by 3DGA, clinical assessment and measures connected with the trauma. METHODS: Fourteen children with hemiplegia after severe TBI were evaluated at independent gait recovery (S0) and 5.5 months later (S1) by clinical assessment (GOS, DRS, WeeFIM and GMFM) and 3D GA (spatio-temporal parameters, kinematics and kinetics). RESULTS: At S1 all clinical measures had improved. Regarding spatio-temporal parameters, velocity and step length improved. Significant progress was evident at the ankle joint, while an unchanged condition appeared at pelvis and hip in sagittal plane with a worsening of hip rotation which increased its internal rotation. Significant correlations were found between motor performance, clinical assessment and trauma-related measures. CONCLUSIONS: Repeated GA and clinical evaluations were useful in quantifying the motor recovery of children with TBI during rehabilitation underpinning the role of GA in quantifying these modifications in an objective and non-invasive way.

Long-term evaluation of isolated gastrocnemius fascia lengthening in children with cerebral palsy using gait analysis.

The aim of this study was the quantification of outcomes on gait pattern of isolated gastrocnemius fascia lengthening treatment in children with cerebral palsy over time using gait analysis. Twelve children with cerebral palsy were evaluated with gait analysis before and after gastrocnemius fascia lengthening, in different follow-up sessions (from 3 to more than 25 months after treatment). Twenty healthy children were included as controls. Data analysis showed significant improvements in ankle and knee kinematics and in ankle kinetics over time. The results showed that isolated gastrocnemius fascia lengthening improved lower extremity function without producing functional muscle weakness over time.

Clinical implications of gait analysis in the rehabilitation of adult patients with "Prader-Willi" Syndrome: a cross-sectional comparative study ("Prader-Willi" Syndrome vs matched obese patients and healthy subjects).

BACKGROUND: Being severely overweight is a distinctive clinical feature of Prader-Willi Syndrome (PWS). PWS is a complex multisystem disorder, representing the most common form of genetic obesity. The aim of this study was the analysis of the gait pattern of adult subjects with PWS by using three-Dimensional Gait Analysis. The results were compared with those obtained in a group of obese patients and in a group of healthy subjects. METHODS: Cross-sectional, comparative study: 19 patients with PWS (11 males and 8 females, age: 18-40 years, BMI: 29.3-50.3 kg/m2); 14 obese matched patients (5 males and 9 females, age: 18-40 years, BMI: 34.3-45.2 kg/m2); 20 healthy subjects (10 males and 10 females, age: 21-41 years, BMI: 19.3-25.4 kg/m2). Kinematic and kinetic parameters during walking were assessed by an optoelectronic system and two force platforms. RESULTS: PWS adult patients walked slower, had a shorter stride length, a lower cadence and a longer stance phase compared with both matched obese, and healthy subjects. Obese matched patients showed spatio-temporal parameters significantly different from healthy subjects.Furthermore, Range Of Motion (ROM) at knee and ankle, and plantaflexor activity of PWS patients were significantly different between obese and healthy subjects. Obese subjects revealed kinematic and kinetic data similar to healthy subjects. CONCLUSION: PWS subjects had a gait pattern significantly different from obese patients. Despite that, both groups had a similar BMI. We suggest that PWS gait abnormalities may be related to abnormalities in the development of motor skills in childhood, due to precocious obesity. A tailored rehabilitation program in early childhood of PWS patients could prevent gait pattern changes.

Analysis of the correlation between three methods used in the assessment of children with cerebral palsy.

The primary aim of this study was to assess the correlations between gait analysis, magnetic resonance imaging (MRI), and Gross Motor Function Measure (GMFM) scores in children with cerebral palsy (CP). These common diagnostic tools were used to evaluate 21 children affected by CP (mean age: 6 years, range: 5-13 years; 8 females and 13 males; 5 left hemiplegics, 4 right hemiplegics, 12 diplegics). In particular, in order to compare gait analysis data with other diagnostic evaluations, the Normalcy Index (NI) was used. The results showed a good correlation between the NI and the results of MRI, and between NI and the GMFM score (r=-0.76). Therefore, this investigation demonstrated that there exists a strong relationship between gait analysis and other clinical evaluation tools.

Are patients with hereditary spastic paraplegia different from patients with spastic diplegia during walking? Gait evaluation using 3D gait analysis.

Patients with hereditary spastic paraplegia (HSP) often resemble patients with mild spastic diplegia (SD), although their motor limitations differ. The aim of this study was to analyse quantitatively the gait of HSP and SD subjects in order to define the gait pattern in HSP and the differences between the two conditions. Fifteen subjects with HSP, 40 patients with SD and 20 healthy subjects underwent gait analysis (GA). The spatio-temporal and kinematic parameters at the proximal joints were found to be similar in HSP and SD, whereas the most significant differences were found at the knee and ankle joints. Both groups displayed a tendency for knee hyperextension in the midstance phase, but the duration of this hyperextension was longer in the HSP patients. This study shows that GA complements traditional clinical evaluations, making it possible to distinguish, clearly, between motor ability in HSP and in SD patients; the duration of the knee hyperextension during midstance was found to discriminate between the two gait patterns.

Computerized gait analysis of botulinum toxin treatment in children with cerebral palsy.

PURPOSE: Intramuscular botulinum toxin A (BTA) injection is a local reversible treatment with a wide range of therapeutic applications, including temporary reduction of spasticity. The aim of this work was a quantitative, computerized objective evaluation of BTA-induced improvement of the walking functional ability in a group of children with cerebral palsy (CP). METHODS: Fifteen children with CP and 20 healthy children were evaluated. All patients were equinus walkers without fixed contractures of triceps surae muscles and they were evaluated before and after about 1.5 months from BTA injections into the calf muscles. The effectiveness of treatment was evaluated by 3D computerized gait analysis. RESULTS: Data analysis revealed a significant improvement of equinus foot and ankle range of motion during gait after BTA injection. Positive effects were evident also at the knee joint as documented by the improvement of kinetics characteristics (moment and power). CONCLUSIONS: Computerized gait analysis is a valid method for quantification of BTA effect on walking in children with CP, allowing a detailed evaluation of improvement at each joint and a quantitative evaluation of treatment outcome.

Gait alteration of a teenager with Down's syndrome: a 5-year follow-up before and after surgery.

Aim of this study is to evaluate kinematic and kinetic aspects of gait alteration in a teenager with Down's syndrome before and after surgery. The gait pattern of the participant was evaluated quantitatively by gait analysis at different ages. In the interval between 14 and 16 years, a patella surgery was performed on the right knee joint. A worsening of gait ability in kinematic and kinetic patterns was highlighted before surgical treatment. After surgery, a significant improvement was observed. The 5-year follow-up showed an improvement in the gait ability after the surgery and allowed quantitative evaluation of treatment outcomes.

Gait analysis in children affected by myelomeningocele: comparison of the various levels of lesion.

The aim of this study was to utilise the gait analysis (GA) methodology to characterise the walking act in children with different levels of myelomeningocele. To this end, we analysed 30 children (mean age 11 +/- 3 years, still able to walk without ortheses) grouped according to the site of their neurological lesion (localised from L4 down to S5); ten healthy children (mean age 9 +/- 2 years) were also analysed for comparison. Of the many kinematic and kinetic parameters provided by GA, we focused on those providing a good correlation with the level of lesion. In particular, the following parameters are presented and discussed: angle of flexion at the knee joint at the moment of contact of the foot with the ground, knee joint flexion-extension range of motion, flexion of the hip at the beginning of the stride, anterior pelvic tilt, range of rotation of the pelvis in the horizontal plane and ankle joint power. The higher the level of the neurological lesion, the more these parameters of gait were found to deviate from those measured in the control group. This study emphasises the relationship that exists between the site (level) of the neurological lesion and the individual aspects of the functional limitation associated with it.