A pathophysiological model of gait captures the details of the impairment of pace/rhythm, variability and asymmetry in Parkinsonian patients at distinct stages of the disease.

Locomotion in people with Parkinson' disease (pwPD) worsens with the progression of disease, affecting independence and quality of life. At present, clinical practice guidelines recommend a basic evaluation of gait, even though the variables (gait speed, cadence, step length) may not be satisfactory for assessing the evolution of locomotion over the course of the disease. Collecting variables into factors of a conceptual model enhances the clinical assessment of disease severity. Our aim is to evaluate if factors highlight gait differences between pwPD and healthy subjects (HS) and do it at earlier stages of disease compared to single variables. Gait characteristics of 298 pwPD and 84 HS able to walk without assistance were assessed using a baropodometric walkway (GAITRite®). According to the structure of a model previously validated in pwPD, eight spatiotemporal variables were grouped in three factors: pace/rhythm, variability and asymmetry. The model, created from the combination of three factor scores, proved to outperform the single variables or the factors in discriminating pwPD from HS. When considering the pwPD split into the different Hoehn and Yahr (H&Y) stages, the spatiotemporal variables, factor scores and the model showed that multiple impairments of gait appear at H&Y stage 2.5, with the greatest difference from HS at stage 4. A contrasting behavior was found for the asymmetry variables and factor, which showed differences from the HS already in the early stages of PD. Our findings support the use of factor scores and of the model with respect to the single variables in gait staging in PD.

Evaluation of movement and brain activity.

Clinical neurophysiology studies can contribute important information about the physiology of human movement and the pathophysiology and diagnosis of different movement disorders. Some techniques can be accomplished in a routine clinical neurophysiology laboratory and others require some special equipment. This review, initiating a series of articles on this topic, focuses on the methods and techniques. The methods reviewed include EMG, EEG, MEG, evoked potentials, coherence, accelerometry, posturography (balance), gait, and sleep studies. Functional MRI (fMRI) is also reviewed as a physiological method that can be used independently or together with other methods. A few applications to patients with movement disorders are discussed as examples, but the detailed applications will be the subject of other articles.

Rater agreement for assessment of equine back mobility at walk and trot compared to quantitative gait analysis.

BACKGROUND: Lameness assessment in horses is still predominantly performed using subjective methods. Visual assessment is known to have moderate to good intra-rater agreement but relatively poor inter-rater agreement. Little is known about inter- and intra-rater agreement on the evaluation of back motion, for which no objective measurement technique in a clinical setting is available thus far. OBJECTIVES: To describe inter- and intra-rater agreement of visual evaluation of equine back mobility. STUDY DESIGN: Rater reliability study using a fully crossed design in which all horses are rated by all observers. This data is compared with objective gait analysis. METHODS: Seventy equine professionals (veterinarians and physiotherapists) and veterinary students evaluated videos of 12 healthy horses at walk and trot on a hard, straight line. Nine parameters related to back mobility were scored: general mobility, thoracic, lumbar, lumbosacral flexion and extension and left and right thoracolumbar latero-flexion. All parameters were compared with simultaneously measured quantitative motion parameters. After 1 month, six randomly chosen horses were re-evaluated by 57 observers. RESULTS: For each parameter inter- and intra-rater agreements were calculated using intra-class correlation coefficients. For all parameters, inter-rater agreement was very poor (<0.2). The mean intra-rater agreement of all observers and for all parameters was poor (~0.4) but varied between 0.0 and 0.96 for individual observers. There was no correlation between the visual subjective scoring and objective gait analysis measurements. MAIN LIMITATIONS: Horses were scored from videos and by lack of any existing (semi-) quantitative system, a custom-made system had to be used. CONCLUSIONS: The poor inter- and intra-rater agreements of visual scoring of mobility of the equine back and the disagreement between subjective and objective gait analysis data, demonstrate the need for the development and introduction of objective, quantitative and repeatable techniques to assess equine back motion.

A systematic review of exercise testing in patients with intermittent claudication: A focus on test standardisation and reporting quality in randomised controlled trials of exercise interventions.

A systematic review was conducted to identify the range of terminology used in studies to describe maximum walking distance and the exercise testing protocols, and testing modalities used to measure it in patients with intermittent claudication. A secondary aim was to assess the implementation and reporting of the exercise testing protocols. CINAHL, Medline, EMBASE and Cochrane CENTRAL databases were searched. Randomised controlled trials whereby patients with intermittent claudication were randomised to an exercise intervention were included. The terminology used to describe maximal walking distance was recorded, as was the modality and protocol used to measure it. The implementation and reporting quality was also assessed using pre-specified criteria. Sixty-four trials were included in this review. Maximal walking distance was reported using fourteen different terminologies. Twenty-two different treadmill protocols and three different corridor tests were employed to assess maximal walking distance. No single trial satisfied all the implementation and reporting criteria for an exercise testing protocol. Evidence shows that between-study interpretation is difficult given the heterogenous nature of the exercise testing protocols, test endpoints and terminology used to describe maximal walking distance. This is further compounded by poor test reporting and implementation across studies. Comprehensive guidelines need to be provided to enable a standardised approach to exercise testing in patients with intermittent claudication.

Verification of validity of gait analysis systems during treadmill walking and running using human pose tracking algorithm.

BACKGROUND: The human tracking algorithm called OpenPose can detect joint points and measure segment and joint angles. However, the validity of gait analysis using OpenPose has not been examined yet. RESEARCH QUESTION: What is the validity of OpenPose-based gait analysis? METHODS: Twenty-four healthy young people participated in this study. The participants were assessed during walking and running. Pelvic segment angles, and hip, knee, and ankle joint angles during treadmill walking and running were measured using VICON. Simultaneously, images were captured using digital cameras from the right and back sides. After processing with OpenPose, the corresponding angles were measured from the estimated joint points. To validate these estimations, linear regression analysis was performed, and intraclass correlation coefficients [ICCs (2, 1)] between the data obtained by OpenPose and VICON were calculated. Furthermore, the agreement between the data obtained by OpenPose and VICON was assessed by Bland-Altman analysis. RESULTS: For most ranges of motion (ROM) in the sagittal plane, the hip, knee, and ankle joints had large coefficients of determination, without proportional biases. For most peak angles in the sagittal plane, the knee and ankle joints had large coefficients of determination without proportional biases, although the hip joint had nonsignificant coefficients of determination and proportional biases. In particular, for the hip flexion-extension ROM and peak knee flexion angle during running and the knee ROM during slow walking, the ICCs showed good to excellent agreement. However, for the parameters of the pelvis and hip joint in the frontal plane, there were nonsignificant coefficients of determination and poor ICCs with fixed and proportional biases. SIGNIFICANCE: The lower limb ROM in the sagittal plane during gait can be measured by the OpenPose-based motion analysis system. The markerless systems have the advantage of being more economical and convenient than conventional methods.

Do kinematic gait parameters help to discriminate between fallers and non-fallers with Parkinson's disease?

OBJECTIVE: Although a number of clinical factors have been linked to falls in Parkinson's disease (PD), the diagnostic value of gait parameters remains subject to debate. The objective of this retrospective study was to determine to what extent the combination of gait parameters with clinical characteristics can distinguish between fallers and non-fallers. METHODS: Using a video motion system, we recorded gait in 174 patients with PD. The patients' clinical characteristics (including motor status, cognitive status, disease duration, dopaminergic treatment and any history of falls or freezing of gait) were noted. The considered kinematic gait parameters included indices of gait bradykinesia and hypokinesia, asymmetry, variability, and foot clearance. After a parameters selection using an ANCOVA analysis, support vector machine algorithm was used to build classification models for distinguishing between fallers and non-fallers. Two models were built, the first included clinical data only while the second incorporated the selected gait parameters. RESULTS: The "clinical-only" model had an accuracy of 94% for distinguishing between fallers and non-fallers. The model incorporating additional gait parameters including stride time and foot clearance performed even better, with an accuracy of up to 97%. CONCLUSION: Although fallers differed significantly from non-fallers with regard to disease duration, motor impairment or dopaminergic treatment, the addition of gait parameters such as foot clearance or stride time to clinical variables increased the model's discriminant power. SIGNIFICANCE: This predictive model now needs to be validated in prospective cohorts.

The Gait Disorientation Test: A New Method for Screening Adults With Dizziness and Imbalance.

OBJECTIVE: To develop and evaluate a new method for identifying gait disorientation due to vestibular dysfunction. DESIGN: The gait disorientation test (GDT) involves a timed comparison of the ability to walk 6.096 m with eyes open versus eyes closed. In this prospective study, participants were grouped based on vestibular function. All participants completed a clinical examination, self-report- and performance-based measures relevant to vestibular rehabilitation, and the tasks for the GDT. Vestibular-impaired participants underwent the criterion standard, videonystagmography and/or rotational chair testing. SETTING: Ambulatory clinic, tertiary referral center. PARTICIPANTS: Participants (N=40) (20 vestibular-impaired, 30 women, 49.9±16.1years old) were enrolled from a convenience/referral sample of 52 adults. MAIN OUTCOME AND MEASURE(S): We determined test-retest reliability using the intraclass correlation coefficient model 3,1; calculated the minimal detectable change (MDC); examined concurrent validity through Spearman correlation coefficients; assessed criterion validity with the area under the curve (AUC) from receiver operator characteristic analysis; and computed the sensitivity, specificity, diagnostic odds ratio (DOR), likelihood ratios for positive (LR+) and negative (LR-) tests, and posttest probabilities of a diagnosis of vestibulopathy. The 95% confidence interval demonstrates measurement uncertainty. RESULTS: Test-retest reliability was 0.887 (0.815, 0.932). The MDC was 3.7 seconds. Correlations with other measures ranged from 0.59 (0.34, 0.76) to -0.85 (-0.92, -0.74). The AUC was 0.910 (0.822, 0.998), using a threshold of 4.5 seconds. The sensitivity and specificity were 0.75 (0.51, 0.91) and 0.95 (0.75, 1), respectively. The DOR=57 (6, 541.47), LR+ =15 (2.18, 103.0), and LR- =0.26 (0.12, 0.9). Positive posttest probabilities were 89%-94%. CONCLUSIONS AND RELEVANCE: The GDT has good reliability, excellent discriminative ability, strong convergent validity, and promising clinical utility.

Construct validity and test-retest reliability of a free mobile application for spatio-temporal gait analysis in Parkinson's disease patients.

BACKGROUND: Mobile applications may be used to assess gait pattern deviation through mobile smartphones in people with Parkinson's disease (PD). However, few studies have investigated their psychometrics properties. RESEARCH QUESTION: To study the construct validity and test-retest reliability of the RUNZI® free mobile application in people with mild to moderate PD. METHODS: Thirty individuals were evaluated with the RUNZI® app and with the 10-meter walking test (10 MW), simultaneously. In addition, the Timed Up & Go test (TUG), Tinetti scale, and the Berg Balance Scale (BBS) were used to study the construct validity. Also, test-retest reliability of the mobile for spatio-temporal gait parameters was explored. RESULTS: The correlation indices of the 10 MW test with the RUNZI® app at fast speeds was moderate to excellent (r = .588-.957). At a comfortable speed, the correlation was excellent for walking speed (r = 0.944), moderate for steps (r = 0.780) and stride length (r = 0.760), and poor for cadence (r = .424). Results showed significant correlations between TUG and spatio-temporal gait parameters at fast and comfortable speeds. There were no significant correlations or consistent associations between Tinetti and BBS and RUNZI®. The test-retest reliability was good to excellent for parameters measured with the RUNZI®. SIGNIFICANCE: Our findings highlight specific opportunities for a free smartphone-based spatio-temporal gait analysis to serve as a complement to conventional gait analysis methods in clinical practice with a moderate to excellent construct validity with the 10 MW test and good to excellent test-retest reliability in PD patients.

Comparison of Gait Assessment Scales in Dogs with Spinal Cord Injury from Intervertebral Disc Herniation.

Naturally occurring thoracolumbar spinal cord injury (SCI) is common in dogs, and multi-center veterinary clinical studies can serve as translational tools to identify potentially effective therapies for human clinical trials. Assessment of gait is a key outcome, and several scales are used in dogs. The purpose of this study was to determine whether an international group of researchers could score gait reliably, to compare and contrast the performance of gait scales and to describe appropriate data analysis techniques. A training module was developed for a binary scale, modified Frankel Scale (MFS), Texas SCI Scale (TSCIS), and Open Field Scale (OFS). Raters viewed the training module, scored five training video clips to achieve proficiency, then scored 30 video clips from 10 dogs recovering from SCI. Interrater reliability was calculated, and correlation between scales was examined. Ceiling effect was described. Twenty raters with differing experience participated. The training module took 16 min to view. Raters chose identical binary outcomes in 597 of 600 observations. Intraclass correlation for MFS, TSCIS, and OFS was excellent at 0.85, 0.96, and 0.96, respectively, regardless of rater expertise. Ceiling effect occurred in all dogs that recovered ambulation, particularly using MFS and binary outcome. The TSCIS and OFS captured recovery of ambulatory dogs better, and addition of scores on hopping and proprioception mitigated ceiling effect. We conclude that gait in dogs with SCI can be scored reliably after training. A variety of different gait scales can be used in multi-center trials to capture outcome in different ways.

Reliability and Validity of the Functional Gait Assessment in Incomplete Spinal Cord Injury.

BACKGROUND: There are limited psychometrically sound measures to assess higher level balance in individuals with incomplete spinal cord injury (iSCI). OBJECTIVES: To evaluate interrater and intrarater reliability and convergent validity of the Functional Gait Assessment (FGA) in individuals with iSCI. METHODS: Twelve participants (11 male, 1 female) 32 to 73 years old with chronic motor iSCI, American Spinal Injury Association Impairment Scale C (n = 2) or D (n = 10), were included. Participants completed five outcome measures during a single test session including lower extremity motor scores from the International Standards for the Neurological Classification of Spinal Cord Injury, FGA, 10-Meter Walk Test (10MWT), Walking Index for Spinal Cord Injury (WISCI-II), and the Spinal Cord Injury Functional Ambulation Profile (SCI-FAP). RESULTS: Inter- and intrarater reliability for the FGA were excellent. Interrater reliability was excellent with intraclass correlation coefficient (ICC) scores greater than 0.92 (p < .001). Interrater reliability against an expert was also excellent for all raters, with an ICC greater than or equal to 0.92 (p < .01). Intrarater reliability was excellent with an ICC score of greater than 0.91 (p < .002) for all raters. Validity of the FGA with 10MWT was -0.90 (p = .000), FGA with WISCI-II was 0.74 (p = .006), and FGA with SCI-FAP was -0.83 (p = .001). CONCLUSION: The FGA is a reliable and valid outcome measure to use when assessing gait and balance in individuals with motor iSCI. The FGA provides clinicians with a single tool to utilize across a variety of neurologic diagnoses.

Characteristics of cognitive function evaluation using the Montreal cognitive assessment in a cerebrospinal fluid tap test in patients with idiopathic normal pressure hydrocephalus.

OBJECTIVES: Though the Japanese version of the Montreal Cognitive Assessment (MoCA-J) scores change after a cerebrospinal fluid tap test (CSFTT), their characteristics remain unclear. To compare patient response rate to changes in cognitive function observed in the cerebrospinal fluid tap test, and to determine which group of patients were good responders. PATIENTS AND METHODS: This study included 32 patients who were suspected of having idiopathic normal pressure hydrocephalus (iNPH) between May 2017 and October 2018. Cases were divided into, following a CSFTT, a gait responder group and a non-responder group. Scores of the MoCA-J were compared and examined before, one day after, and one week after the CSFTT. RESULTS: Significant changes in MoCA-J scores were observed 1 day and 1 week after the CSFTT in the gait responder group. The change in scores was larger, and had a larger effect size, one week after the CSFTT. On assessment, MoCA-J sub-items began to show changes in attention and abstract items one day after the CSFTT, and significant changes were noted in attention and abstract items in addition to executive functions and orientation one week after the CSFTT. The degree of cognitive function before the CSFTT was less closely related to the amount of change. Changes in cognitive function can be assessed at each time point after the CSFTT, and changes in cognitive function are measured regardless of the level of cognitive function. CONCLUSION: These results suggest that evaluating patients with the MoCA-J may potentially support a more accurate iNPH diagnosis.

Systematic data analysis and data mining in CatWalk gait analysis by heat mapping exemplified in rodent models for neurodegenerative diseases.

BACKGROUND: Motor impairment appears as a characteristic symptom of several diseases and injuries. Therefore, tests for analyzing motor dysfunction are widely applied across preclinical models and disease stages. Among those, gait analysis tests are commonly used, but they generate a huge number of gait parameters. Thus, complications in data analysis and reporting raise, which often leads to premature parameter selection. NEW METHODS: In order to avoid arbitrary parameter selection, we present here a systematic initial data analysis by utilizing heat-maps for data reporting. We exemplified this approach within an intervention study, as well as applied it to two longitudinal studies in rodent models related to Parkinson's disease (PD) and Huntington disease (HD). RESULTS: The systematic initial data analysis (IDA) is feasible for exploring gait parameters, both in experimental and longitudinal studies. The resulting heat maps provided a visualization of gait parameters within a single chart, highlighting important clusters of differences. COMPARISON WITH EXISTING METHOD: Often, premature parameter selection is practiced, lacking comprehensiveness. Researchers often use multiple separated graphs on distinct gait parameters for reporting. Additionally, negative results are often not reported. CONCLUSIONS: Heat mapping utilized in initial data analysis is advantageous for reporting clustered gait parameter differences in one single chart and improves data mining.

Middle-Aged Men With HIV Have Diminished Accelerometry-Based Activity Profiles Despite Similar Lab-Measured Gait Speed: Pilot Study.

BACKGROUND: People aging with HIV are living with increased risk for functional decline compared with uninfected adults of the same age. Early preclinical changes in biomarkers in middle-aged individuals at risk for mobility and functional decline are needed. OBJECTIVE: This pilot study aims to compare measures of free-living activity with lab-based measures. In addition, we aim to examine differences in the activity level and patterns by HIV status. METHODS: Forty-six men (23 HIV+, 23 HIV-) currently in the MATCH (Muscle and Aging Treated Chronic HIV) cohort study wore a consumer-grade wristband accelerometer continuously for 3 weeks. We used free-living activity to calculate the gait speed and time spent at different activity intensities. Accelerometer data were compared with lab-based gait speed using the 6-minute walk test (6-MWT). Plasma biomarkers were measured and biobehavioral questionnaires were administered. RESULTS: HIV+ men more often lived alone (P=.02), reported more pain (P=.02), and fatigue (P=.048). In addition, HIV+ men had lower blood CD4/CD8 ratios (P<.001) and higher Veterans Aging Cohort Study Index scores (P=.04) and T-cell activation (P<.001) but did not differ in levels of inflammation (P=.30) or testosterone (P=.83). For all participants, accelerometer-based gait speed was significantly lower than the lab-based 6-MWT gait speed (P<.001). Moreover, accelerometer-based gait speed was significantly lower in HIV+ participants (P=.04) despite the absence of differences in the lab-based 6-MWT (P=.39). HIV+ participants spent more time in the lowest quartile of activity compared with uninfected (P=.01), who spent more time in the middle quartiles of activity (P=.02). CONCLUSIONS: Accelerometer-based assessment of gait speed and activity patterns are lower for asymptomatic men living with HIV compared with uninfected controls and may be useful as preclinical digital biomarkers that precede differences captured in lab-based measures.

Toward Unobtrusive In-Home Gait Analysis Based on Radar Micro-Doppler Signatures.

OBJECTIVE: In this paper, we demonstrate the applicability of radar for gait classification with application to home security, medical diagnosis, rehabilitation, and assisted living. Aiming at identifying changes in gait patterns based on radar micro-Doppler signatures, this paper is concerned with solving the intra motion category classification problem of gait recognition. METHODS: New gait classification approaches utilizing physical features, subspace features, and sum-of-harmonics modeling are presented and their performances are evaluated using experimental K-band radar data of four test subjects. Five different gait classes are considered for each person, including normal, pathological, and assisted walks. RESULTS: The proposed approaches are shown to outperform existing methods for radar-based gait recognition, which utilize physical features from the cadence-velocity data representation domain as in this paper. The analyzed gait classes are correctly identified with an average accuracy of 93.8%, where a classification rate of 98.5% is achieved for a single gait class. When applied to new data of another individual, a classification accuracy on the order of 80% can be expected. CONCLUSION: Radar micro-Doppler signatures and their Fourier transforms are well suited to capture changes in gait. Five different walking styles are recognized with high accuracy. SIGNIFICANCE: Radar-based sensing of gait is an emerging technology with multi-faceted applications in security and health care industries. We show that radar, as a contact-less sensing technology, can supplement existing gait diagnostic tools with respect to long-term monitoring and reproducibility of the examinations.

Interobserver reliability in the interpretation of three-dimensional gait analysis in children with gait disorders.

AIM: To assess interobserver reliability in the interpretation of three-dimensional gait analysis (3DGA) of children with gait disorders within a single institution. METHOD: Seven experienced interpreters in our institution participated in a quality-assurance program reviewing one unique patient's 3DGA data every 3 months. Between 2014 and 2017, 15 patients' data were interpreted (14 with spastic cerebral palsy, 1 with myelodysplasia). Interpreters were asked to select 'yes', 'no', or 'indeterminate' from a list of problems and treatment recommendations. Kappa and percent agreement calculations were performed to evaluate consistency. RESULTS: Average percentage agreement in problem identification and treatment recommendation was greater than 84 percent and 90 percent for all interpreters respectively. Average kappa for the 10 most consistently identified problems and recommended treatments were 0.69 and 0.59 respectively. Interpreter consistency was moderate or better for the most commonly performed operations at our institution (0.44-0.59). Sagittal plane abnormalities of the hip and knee had the highest consistency. INTERPRETATION: When institutional differences in data collection and regional variations in management philosophies are removed, interobserver consistency in 3DGA interpretation is moderate to substantial for many commonly selected items. Identification of areas with poor consistency may help address underlying causes and improve data processes. WHAT THIS PAPER ADDS: Consistency in three-dimensional gait analysis interpretation and treatment recommendation is high within a single institution. There is moderate or better consistency for most commonly identified problems and recommended treatments. Sagittal plane problem identification of the hip and knee have the highest consistency. Lower consistency is seen in areas with poor objective measures, such as dystonia and balance.

FIABILIDAD INTEREVALUADOR EN LA INTERPRETACIÓN DEL ANÁLISIS TRIDIMENSIONAL DE LA MARCHA EN NIÑOS CON TRASTORNOS DE LA MARCHA: OBJETIVO: Evaluar la fiabilidad interevaluador en la interpretación del análisis tridimensional de la marcha de niños con trastornos de la marcha, pertenecientes a una institución. MÉTODO: Siete evaluadores de la institución con experiencia participaron en un programa de aseguramiento de calidad, revisando los datos del análisis tridimensional de la marcha de un único paciente cada 3 meses. Entre 2014 y 2017, se interpretaron los datos de 15 pacientes (14 con parálisis cerebral espástica, 1 con mielodisplasia). Se solicitó a los intérpretes seleccionar "sí", "no", o "indeterminado" frente a una lista de problemas y recomendaciones de tratamiento. Se calculó el coeficiente de Kappa y el porcentaje de acuerdo, para evaluar la consistencia. RESULTADOS: El porcentaje de acuerdo promedio en la identificación de problemas y recomendaciones de tratamiento fue mayor que 8% y 90% para todos los intérpretes, respectivamente. El coeficiente de Kappa promedio para los 10 problemas y recomendaciones de tratamiento más identificados fue 0,69 y 0,59, respectivamente. La consistencia de intérpretes fue moderada o mejor para las operaciones más frecuentemente realizadas en nuestra institución (0,44-0,59). Los defectos en el plano sagital de la cadera y rodilla tuvieron la mayor consistencia. INTERPRETACIÓN: Cuando se elimina las diferencias en la recolección de datos y en las variaciones regionales de filosofías de manejo, la consistencia interobservador en la interpretación del análisis tridimensional de la marcha es moderada a buena, para las categorías seleccionadas más frecuentes. La identificación de áreas con baja consistencia podría ayudar a abordar causas subyacentes y mejorar el procesamiento de los datos.

CONFIABILIDADE INTER-EXAMINADORES NA INTERPRETAÇÃO DE ANÁLISE TRIDIMENSIONAL DA MARCHA EM CRIANÇAS COM DESORDENS DA MARCHA: OBJETIVO: Avaliar a confiabilidade inter-examinadores na interpretação de análise tridimensional da marcha (A3DM) em crianças com desordens de marcha de um único instituto. MÉTODO: Sete intérpretes experientes de nossa instituição participaram de um programa de avaliação de qualidade revisando os dados de A3DM de um único paciente a cada 3 meses. Entre 2014 e 2017, os dados de 15 pacientes foram intepretados (14 com paralisia cerebral espástica, 1 com mielodisplasia). Os intérpretes foram solicitados a selecionar "sim", "não", ou "indeterminado" a partir de uma lista de problemas e recomendações de tratamento. Cálculos de concordância kappa e porcentagens foram realizados para avaliar a consistência. RESULTADOS: A porcentagem média de concordância na identificação de um problema e recomendação de tratamento foi maior do que 84% e 90% para todos os intérpretes, respectivamente. O kappa médio para os 10 problemas mais consistentemente identificados e tratamentos mais recomendados foi 0,69 e 0,59, respectivamente. A consistência dos intérpretes foi moderada ou melhor para as operações mais comumente realizadas em nossa instituição (0,44-0,59). Anormalidades no plano sagital do quadril e joelho tiveram a maior consistência. INTERPRETAÇÃO: Quando diferenças institucionais na coleta de dados, e variações regionais em filosofias de manejo são removidas, a consistência inter-examinadores da interpretação da A3DM é de moderada a substancial para muitos dos itens comumente selecionados. A identificação de áreas com pobre consistência pode ajudar a abordar causas e melhorar processos de dados.

Repeatability of a Multi-segment Foot Model with a 15-Marker Set in Normal Children.

BACKGROUND: The use of three-dimensional multi-segment foot models (3D MFMs) is increasing since they have superior ability to illustrate the effect of foot and ankle pathologies on intersegmental motion of the foot compared to single-segment foot model gait analysis. However, validation of the repeatability of the 3D MFMs is important for their clinical use. Although many MFMs have been validated in normal adults, research on MFM repeatability in children is lacking. The purpose of this study is to validate the intrasession, intersession, and interrater repeatability of an MFM with a 15-marker set (DuPont foot model) in healthy children. METHODS: The study included 20 feet of 20 healthy children (10 boys and 10 girls). We divided the participants into two groups of 10 each. One group was tested by the same operator in each test (intersession analysis), while the other group was tested by a different operator in each test (interrater analysis). The multiple correlation coefficient (CMC) and intraclass correlation coefficient (ICC) were calculated to assess repeatability. The difference between the two sessions of each group was assessed at each time point of gait cycle. RESULTS: The intrasession CMC and ICC values of all parameters showed excellent or very good repeatability. The intersession CMC of many parameters showed good or better repeatability. Interrater CMC and ICC values were generally lower for all parameters than intrasession and intersession. The mean gaps of all parameters were generally similar to those of the previous study. CONCLUSIONS: We demonstrated that 3D MFM using a 15-marker set had high intrasession, intersession, and interrater repeatability in the assessment of foot motion in healthy children but recommend some caution in interpreting the hindfoot parameters.

BET 2: Ability of a normal gait examination to rule out cerebellar stroke in acute vertigo.

A short-cut review was carried out to establish whether a normal gait examination can rule out cerebellar stroke in patients with acute vertigo. 16 studies were relevant to the question. The author, year and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that a normal gait examination cannot rule out a cerebellar stroke but the presence of an abnormal gait can be associated.

Different reliability of instrumented gait analysis between patients with unilateral hip osteoarthritis, unilateral hip prosthesis and healthy controls.

BACKGROUND: The gait pattern varies within the population and between patient groups with different musculoskeletal diseases. It also varies over time due to various reasons. Three-dimensional gait analysis (3DGA) is frequently used to measure these changes, but the precision of this methodology may vary. METHODS: We primarily aimed to study the repeatability of hip motion measurements in patients with unilateral osteoarthritis (OA), patients with unilateral total hip arthroplasty (THA) and healthy controls. A secondary aim was to delineate any differences in hip motion during walking between these groups. Ten males and 10 females in each group were recruited. All patients underwent gait assessments using 3DGA recorded by 2 examiners. Data was analysed with comparison of variance and linear regression. RESULTS: The variability of the extension-flexion recordings was smallest in healthy controls (SD < 7.7°), increased in patients with THA (SD < 11.1°) and was most pronounced in the OA patients (SD < 12.2°). The degree of hip extension-flexion turned out to be the variable that most effectively could separate the controls from the 2 patient groups and the patient groups from each other. One to 2 years after THA the gait pattern was improved but still differed comparing a group of THA from a group of healthy controls. CONCLUSIONS: Patients with hip osteoarthritis showed the poorest repeatability between gait recordings collected by different examiners, as compared to patients operated with a THA and healthy controls. The walking pattern after THA still differed from healthy controls 1-2 years after the operation.

Operator Bias Errors Are Reduced Using Standing Marker Alignment Device for Repeated Visit Studies.

When optical motion capture is used for motion analysis, reflective markers or a digitizer are typically used to record the location of anatomical landmarks identified through palpation. The landmarks are then used to construct anatomical coordinate systems. Failure to consistently identify landmarks through palpation over repeat tests creates artifacts in the kinematic waveforms. The purpose of this work was to improve intra- and inter-rater reliability in determining lower limb anatomical landmarks and the associated anatomical coordinate systems using a marker alignment device (MAD). The device aids the subject in recreating the same standing posture over multiple tests, and recreates the anatomical landmarks from previous static calibration trials. We tested three different raters who identified landmarks on eleven subjects. The subjects performed walking trials and their gait kinematics were analyzed with and without the device. Ankle kinematics were not improved by the device suggesting manual palpation over repeat visits is just as effective as the MAD. Intra-class correlation coefficients between gait kinematics registered to the reference static trial and registered to follow-up static trials with and without the device were improved between 1% and 33% when the device was used. Importantly, out-of-plane hip and knee kinematics showed the greatest improvements in repeatability. These results suggest that the device is well suited to reducing palpation artifact during repeat visits to the gait lab.