Using the gross motor function measure evolution ratio to compare different dosage of hyperbaric treatment with conventional therapies in children with cerebral palsy - could it end the controversy?

The Gross Motor Function Measure is used in most studies measuring gross motor function in children with cerebral palsy. In many studies, including those evaluating the effect of hyperbaric treatment, the Gross Motor Function Measure variations were potentially misinterpreted because of the lack of control groups. The Gross Motor Function Measure Evolution Ratio (GMFMER) uses historical data from the Gross Motor Function Classification System curves and allows to re-analyze previous published studies which used the Gross Motor Function Measure by considering the natural expected evolution of the Gross Motor Function Measure. As the GMFMER is defined by the ratio between the recorded Gross Motor Function Measure score increase and the expected increase attributed to natural evolution during the duration of the study (natural evolution yields a GMFMER of 1), it becomes easy to assess and compare the efficacy of different treatments. Objective: The objective of this study is to revisit studies done with different dosage of hyperbaric treatment and to compare the GMFMER measured in these studies with those assessing the effects of various recommended treatments in children with cerebral palsy. Methods: PubMed Searches were conducted to included studies that used the Gross Motor Function Measure to evaluate the effect of physical therapy, selective dorsal rhizotomy, botulinum toxin injection, hippotherapy, stem cell, or hyperbaric treatment. The GMFMER were computed for each group of the included studies. Results: Forty-four studies were included, counting 4 studies evaluating the effects of various dosage of hyperbaric treatment in children with cerebral palsy. Since some studies had several arms, the GMFMER has been computed for 69 groups. The average GMFMER for the groups receiving less than 2 h/week of physical therapy was 2.5 ± 1.8 whereas in context of very intensive physical therapy it increased to 10.3 ± 6.1. The GMFMER of stem cell, selective dorsal rhizotomy, hippotherapy, and botulinum toxin treatment was, 6.0 ± 5.9, 6.5 ± 2.0, 13.3 ± 0.6, and 5.0 ± 2.9, respectively. The GMFMER of the groups of children receiving hyperbaric treatment were 28.1 ± 13.0 for hyperbaric oxygen therapy and 29.8 ± 6.8 for hyperbaric air. Conclusion: The analysis of the included studies with the GMFMER showed that hyperbaric treatment can result in progress of gross motor function more than other recognized treatments in children with cerebral palsy.

Locomotion Efficiency in Children With Cerebral Palsy Experiencing Limited Gross Motor Function: Walking Versus Cycling.

PURPOSE: This study compares cycling and walking efficiency, and energy expenditure in children with bilateral spastic cerebral palsy (CP). In children with CP, locomotion with body weight support aids such as a tricycle is a potential alternative for less exhausting movements. METHODS: Nine children with CP traveled at comfortable speed for 6 minutes by cycling and walking. The energy expenditure index (EEI) and the percentage of the reserve heart rate (%HRR) were calculated. RESULTS: The EEI was lower while cycling than walking, the traveled distance was higher while cycling than walking, and %HRR remained similar between cycling and walking. CONCLUSION: Cycling appears an efficient alternative to walking for children with CP for adapted school environments and in the community.

Effect of Robotic-Assisted Gait at Different Levels of Guidance and Body Weight Support on Lower Limb Joint Kinematics and Coordination.

The Lokomat provides task-oriented therapy for patients with gait disorders. This robotic technology drives the lower limbs in the sagittal plane. However, normative gait also involves motions in the coronal and transverse planes. This study aimed to compare the Lokomat with Treadmill gait through three-dimensional (3D)-joint kinematics and inter-joint coordination. Lower limb kinematics was recorded in 18 healthy participants who walked at 3 km/h on a Treadmill or in a Lokomat with nine combinations of Guidance (30%, 50%, 70%) and bodyweight support (30%, 50%, 70%). Compared to the Treadmill, the Lokomat altered pelvic rotation, decreased pelvis obliquity and hip adduction, and increased ankle rotation. Moreover, the Lokomat resulted in significantly slower velocity at the hip, knee, and ankle flexion compared to the treadmill condition. Moderate to strong correlations were observed between the Treadmill and Lokomat conditions in terms of inter-joint coordination between hip-knee (r = 0.67-0.91), hip-ankle (r = 0.66-0.85), and knee-ankle (r = 0.90-0.95). This study showed that some gait determinants, such as pelvis obliquity, rotation, and hip adduction, are altered when walking with Lokomat in comparison to a Treadmill. Kinematic deviations induced by the Lokomat were most prominent at high levels of bodyweight support. Interestingly, different levels of Guidance did not affect gait kinematics. The present results can help therapists to adequately select settings during Lokomat therapy.

Effect of power training on locomotion capacities in children with cerebral palsy with GMFCS level III-IV.

PURPOSE: Power training (PT) is a promising training modality to improve functional abilities in children with cerebral palsy (CP). This study aimed to implement PT in an adapted school and to assess its effect on locomotion capacities in children with Gross Motor Function Classification System (GMFCS) level III-IV. MATERIALS AND METHODS: Nine children with CP (GMFCS level III-IV) were trained three times/week for 12 weeks. The training sessions took place during the 50-minute physical activity classes and included high intensity exercise. The outcome measures were the performance on the 10-meter comfortable and fast walking tests, the 50-meter sprint test (50M-ST), and the energy expenditure index (EEI). RESULTS: Participants spent 12 ± 7 and 7 ± 9 min per session at an intensity superior to 40% and 60% of the heart rate reserve, respectively. Performance in the 10-meter walking test (13.5 ± 7.8 to 9.9 ± 4.6 s, p < 0.05), the 10-meter fast walking test (8.8 ± 3.1 to 7.0 ± 3.2 s, p < 0.05), the 6-minute walking exercise (199.0 ± 48.6 to 316.6 ± 107.2 m, p < 0.05), and in 50M-ST (53.8 ± 29.5 to 42.3 ± 16.2 s, p < 0.05) increased after training. The EEI was reduced after training (p = 0.01), resulting in a more efficient gait. CONCLUSIONS: PT was successfully implemented in children with CP with GMFCS level III-IV. Results suggest that PT increases walking capacities.Implications for rehabilitationPower training (PT) is feasible with children with bilateral cerebral palsy with GMFCS level III and IV.Physical education course in specialist school is a valuable environment to implement PT in children with poor gross motor function.Power training results in locomotion capacities improvement.

Static Postural Control Deficits in Adults with Myotonic Dystrophy Type 1, Steinert Disease.

BACKGROUND: Myotonic dystrophy type 1 (DM1) is characterized by progressive and predominantly distal muscle atrophy and myotonia. Gait and balance impairments, resulting in falls, are frequently reported in this population. However, the extent to which individuals with DM1 rely more on a specific sensory system for balance than asymptomatic individuals (AI) is unknown. OBJECTIVE: Evaluate postural control performance in individuals with DM1 and its dependence on vision compared to AI. METHODS: 20 participants with DM1, divided into two groups based on their diagnosis, i.e. adult and congenital phenotype, and 12 AI participants were recruited. Quiet standing postural control was assessed in two visual conditions: eyes-open and eyes-closed. The outcomes measures were: center of pressure (CoP), mean velocity, CoP range of displacement in anteroposterior and mediolateral axis, and the 95% confidence ellipse's surface. Friedman and Kruskal-Wallis analysis of variance were used to compare outcomes between conditions and groups, respectively. RESULTS: Significant group effect and condition effect were observed on postural control performance. No significant difference was observed between the two DM1 groups. The significant differences observed between the AI group and the two DM1 groups in the eyes-open condition were also observed in the eyes-closed condition. CONCLUSIONS: The result revealed poorer postural control performance in people with DM1 compared to AI. The DM1 group also showed similar decrease in performance than AI in eyes-closed condition, suggesting no excessive visual dependency.

Relationship between lower limb strength and walking capacities in children with spastic bilateral cerebral palsy.

PURPOSE: Evaluate the relationship between different walking capacities and muscle strength in children with bilateral cerebral palsy (BCP) and assess these relationships in stronger and weaker children. MATERIALS AND METHODS: Thirty-two children with spastic BCP were included. All participants walked under three speed conditions: comfortable, fast, and for a longer period (6 min). Walking speeds, Energy Expenditure Index (EEI), and lower limb muscle strength were measured. A global strength index (GSI) was computed as the sum of each muscle group strength. Pearson's coefficient and regression models were computed between walking capacities and the GSI. RESULTS: GSI was correlated with the EEI and all walking speeds. Logarithmic regressions models explained between 24 and 34% of the variance of walking capacities. Then, the group was divided in two subgroups (weaker and stronger children). GSI was correlated with comfortable and endurance waking speed in weaker children, but not in stronger children. CONCLUSION: This study reports logarithmic relationship between muscle strength and walking capacities in children with BCP. The subgroup analysis implies that muscle strength has an impact on walking capacities solely in weaker children, suggesting that muscle strength must be preserved and reinforced in interventions targeting motor function in weaker children with BCP.Implications for rehabilitationIn a sample of children with spastic bilateral cerebral palsy, this study shows that global muscle strength is associated with walking capacities and the relationship seems more complex than linear.Based on the results, interventions should focus on maintaining or improving muscle strength in weaker children as no association was observed between muscle strength and walking capacities in stronger children.In stronger children, intervention should focus on factors other than muscle strength as it does not influence walking capacities.Based on this study, a more accurate screening of children who could benefit from strength training could be completed by initial global muscle strength.

Can a Knee Brace Prevent ACL Reinjury: A Systematic Review.

This systematic review aimed to investigate whether the use of a knee brace when returning to sport (RTS) could prevent a second injury after anterior cruciate ligament reconstruction (ACLR). This study was registered with the PROSPERO database and followed PRISMA guidelines. A systematic search of PubMed, Ovid Medline, Ovid All EBM Reviews, Ovid Embase, EBSCO Sportdiscus and ISI Web of Science databases for meta-analysis, randomized controlled trials and prospective cohort studies published before July 2020 was undertaken. The inclusion criteria were: (1) Comparing with and without a brace at RTS, (2) follow up of at least 18 months after ACLR, (3) reinjury rates included in the outcomes. Two reviewers independently extracted the data. Quality appraisal analyses were performed for each study using the Cochrane Collaboration tools for randomized and nonrandomized trials. A total of 1196 patients in three studies were included. One study showed a lower rate of reinjury when wearing a knee brace at RTS. One study found the knee brace to have a significant protective effect for younger patients (≤17 years). The effectiveness of knee bracing when RTS remains ambiguous. Current data cannot support that using a knee brace when RTS will decrease the rate of reinjury after ACL reconstruction.

Short Walking Exercise Leads to Gait Changes and Muscle Fatigue in Children With Cerebral Palsy Who Walk With Jump Gait.

OBJECTIVE: The aim of this study was to evaluate kinematic changes and muscle fatigue in jump gait during a walking exercise and the relationship between kinematic changes and muscle fatigue and strength. DESIGN: This preliminary study included 10 children with cerebral palsy who walk with jump gait. Hip and knee maximal isometric muscle strength were measured using a dynamometer. Then, lower-limb kinematics and electromyography were collected while children walked continuously for 6 min at their self-selected speed. Electromyography median frequency and lower-limb joint angles were compared between the first and the sixth minutes of the walking exercise using t test and Wilcoxon rank test. The relationship between kinematic changes and muscle strength and changes in electromyography median frequency were assessed using correlation analyses. RESULTS: During stance, maximal knee flexion significantly increased at the sixth minute (P = 0.01) and was associated with knee extensor muscle weakness (ρ = -0.504, P = 0.03). Muscle fatigue was observed only in the gluteus medius muscle (P = 0.01). CONCLUSIONS: Children with cerebral palsy who walked with jump gait and who had knee extensor weakness were more prone to an increase in knee flexion during a continuous walk. The fatigue in the gluteus medius muscle suggests that physical intervention should target the endurance of this muscle to improve jump gait.

Intra- and inter-tester reliability of spasticity assessment in standing position in children and adolescents with cerebral palsy using a paediatric exoskeleton.

BACKGROUND: The L-STIFF tool of the Lokomat evaluates the hip and knee flexors and extensors spasticity in a standing position. It moves the lower limb at a controlled velocity, measuring joint resistance to passive movements. Since its reliability in children with cerebral palsy remains unknown, our goal was to evaluate the relative and absolute reliability of L-STIFF in children with cerebral palsy. METHODS: Reliability was determined in 16 children with cerebral palsy by two experienced therapists. The changes in resistive torque in hip and knee in both flexion and extension were measured. Relative and absolute reliability were estimated using the intraclass correlation coefficient, standard error of measurement, and minimal detectable change. Reliability was assessed on three levels: (1) intra- and (2) inter-tester within session, and (3) intra-tester between sessions. RESULTS: Intraclass correlation coefficients were moderate to excellent for intra-tester reliability (all p ≤ 0.01). The standard error of measurement ranged from 0.005 to 0.021 Nm/° (i.e., 7-16%) and minimal detectable change from 0.014 to 0.059 Nm/°. Inter-tester intraclass correlation coefficients ranged from 0.32 to 0.70 (all p ≤ 0.01), standard error of measurement ranged from 0.012 to 0.029 Nm/° (i.e., 6-39%), and minimal detectable change ranged from 0.033 to 0.082 Nm/°. L-STIFF reliability was better during fast and medium movement speeds compared to slow speeds. CONCLUSIONS: The assessment tool L-STIFF is a promising tool for quantifying lower limb spasticity in children with cerebral palsy in a standing position. However, the results should be interpreted carefully.Implications for RehabilitationL-STIFF is a promising tool for evaluating lower limb spasticity in standing position.A special care must be given to the installation and alignment of the participant into the Lokomat to minimize erroneous spasticity measurement.Relative standard error of measurement and minimal detectable change should be used to analyze changes spasticity.

Effect of low dose robotic-gait training on walking capacity in children and adolescents with cerebral palsy.

OBJECTIVE: Robotic gait training presents a promising training modality. Nevertheless, evidence supporting the efficacy of such therapy in children with cerebral palsy remains insufficient. This study aimed to assess the effect of robotic gait training in children/adolescents with cerebral palsy. METHODS: Twenty-four children/adolescents with bilateral cerebral palsy (12 female, 10.1 ±â€¯3.1 years, Gross Motor Function Classification System II to IV) took part in this study. They received two 30-45 min sessions/week of Lokomat training for 12-weeks. Muscle strengths, 6-min walk exercise and gait parameters were evaluated pre- and post-training and at 6-months-follow-up. Training effect according to the level of impairment severity (moderate vs severe) was analyzed using a change from the baseline procedure. RESULTS: A significant increase in muscle strength was observed after training (p ≤ 0.01). Hip flexors and knee extensors strength changes were maintained or improved at follow-up (p < 0.05). Comfortable walking speed was significantly increased by +20% after training with a slight reduction at follow-up compared to post-training condition (-2.7%, p < 0.05). A significant step length increase was observed after training (14%, p ≤ 0.001). The distance covered in 6 min was higher in post-training (+24%, p ≤ 0.001) and maintained at follow-up compared to pre-training conditions. No significant changes in kinematic patterns were observed. The analysis by subgroup showed that both groups of children (with moderate and severe impairments) improved muscle strength and walking capacities after Lokomat training. CONCLUSION: The suggested Lokomat training induced improvement in walking capacity of children/adolescents with cerebral palsy whatever the level of severity. Hence, Lokomat training could be viewed as a valuable training modality in this population.

Benefits of a Dance Intervention on Balance in Adolescents with Cerebral Palsy.

AIMS: Cerebral palsy (CP) impacts motor functions such as balance, limits of stability and walking, and may also affect other functions such as attention and rhythm production. Motor and non-motor deficits lead to difficulties in daily life activities. The main objective of this study was to evaluate the effects of a dance intervention on balance in adolescents with CP. The secondary objectives were to evaluate the effects of this intervention on walking speed, attention, and rhythm production. METHODS: A pre-post design study with a double baseline was conducted on ten adolescents with CP in order to assess the effects of a 10-week dance intervention. The dance intervention focused on improving balance and limits of stability. Outcomes on static and dynamic balance were evaluated with clinical and laboratory tests before and after the intervention. Walking speed, attention, and rhythm production were also evaluated before and after the intervention. RESULTS: Balance improved after the dance intervention as assessed with both the clinical tests and a laboratory test. Rhythm production also improved after the dance intervention. CONCLUSIONS: Results suggest that a 10-week dance intervention is an effective activity to improve static and dynamic balance as well as rhythmic production in adolescents with CP.

Muscle fatigue during a short walking exercise in children with cerebral palsy who walk in a crouch gait.

BACKGROUND: A deterioration of crouch gait was found in a group of children with cerebral palsy (CP) after a short walking exercise. The increased knee flexion reported after a continuous walk could be related with muscle fatigue and muscle strength. AIM: Does muscle fatigue appears at the end of a walking exercise in children with CP who walk in a crouch gait? METHODS: Eleven children with cerebral palsy (GMFCS I to III) who walk in a crouch gait were included. Isometric muscle strength was assessed using a handheld dynamometer. Children were asked to walk for 6 min at comfortable speed. Spatio-temporal, kinematic and electromyographic (EMG) measurements were recorded at the first and the last minute of the 6-minute walking exercise. Muscle fatigue was evaluated using the shift of EMG signals median frequency. RESULTS: There was no significant difference in walking speed, cadence, and step length at the end of the 6mwe. Maximal and mean anterior pelvic tilt decreased and knee flexion increased (p < 0.05). Rectus femoris EMG median frequency decreased (p < 0.05). The median frequency in other muscles did not decrease significantly. Greater hip extensor strength was associated with lesser knee flexion at the end of the 6-minute walking exercise (p < 0.05). SIGNIFICANCE: The increase in knee flexion at the end of the 6-minute walking exercise can be explained by muscle fatigue found in rectus femoris. Hip extensor strength can limit the deterioration of crouch gait after a 6-minute walking exercise representative of daily activities.

Reliability of maximum isometric hip and knee torque measurements in children with cerebral palsy using a paediatric exoskeleton - Lokomat.

BACKGROUND: The Lokomat (by L-Force tool) allows the measurement of the maximum voluntary isometric torque (MVIT) at the knee and hip joints in a standing position, as close as possible to the posture adopted during walking. However, the reliability of this measurement in children with cerebral palsy (CP) remains unknown. The main goal of this study was to evaluate inter and intra-tester reliability of a novel tool (L-Force) in CP population. PROCEDURE: L-Force reliability was determined in 17 children with CP by two experienced therapists. We collected MVITs in hip and knee flexors and extensors. Relative and absolute reliability of maximum joint torques were estimated using the intra-class correlation coefficient (ICC) and standard error of measurement (SEM), respectively. The correlation between L-Force and hand-held dynamometer (HHD) was also reported. FINDINGS: ICCs were good to excellent for intra and inter-tester reliability (all P≤0.001). The SEM ranged from 2.0 to 4.1 Nm (12.1 to 21.7%) within-tester and from 2.1 to 3.5 Nm (11.9 to 22.5%) between testers. The correlation was fair to good between L-Force and HHD measures (r=[0.50-0.75]; all P˂0.01) with higher values for flexors than extensors. CONCLUSION: The L-Force is a reliable tool for quantifying the hip and knee flexors and extensors torques in children with cerebral palsy with an important timesaving and in a more functional posture than traditional HHD.

Lower limb extension is improved in fast walking condition in children who walk in crouch gait.

Background and purpose: The strategies for walking fast have never been reported in children with cerebral palsy who walk in crouch gait. This study aimed to assess to what extent children who walk in crouch gait are able to increase their gait speed and to report the corresponding three-dimensional kinematic adaptations.Methods: Eleven children and adolescents (aged between 7 and 17 years) with bilateral cerebral palsy, who walk in crouch gait, were asked to walk at their self-selected comfortable speed and then as fast as possible without running. The spatio-temporal and kinematic parameters, as well as the center of mass displacements were compared between walking conditions.Results: Children were able to walk 30% faster than their comfortable speed (+0.30 m/s, p = 0.000) by increasing both cadence (+21 step/min, p = 0.000) and step length (+0.05 m, p = 0.001). During the stance phase, pelvis anteversion (+3 Deg, p = 0.010), hip flexion-extension range of motion (+4 Deg, p = 0.002), and knee extension (+5 Deg, p = 0.000) were increased in fast walking. During fast walking, the center of mass showed larger range of vertical displacements (p < 0.05).Conclusions: Children with cerebral palsy who walk in crouch gait increased their walking speed by adopting a less crouched posture. Compared to comfortable walking speed condition, fast walking could be beneficial in rehabilitation to solicit higher lower limbs range of motion.Implications for rehabilitation:Children who walk in crouch gait can walk 30% fasterFast walking required higher hip and knee extensions during stance phaseFast walking could be an interesting training modality to improve the lower limb range of motion of children who walk in crouch gait.

Sensorimotor adaptation of whole-body postural control.

The aim of the present study was to examine the modification of postural symmetry during quiet standing using a sensorimotor adaptation paradigm. A group of neurologically typical adult participants performed a visually guided mediolateral (left-right) weight shifting task requiring precise adjustments in body orientation. During one phase of the task, the visual feedback of center of pressure (COP) was systematically biased toward the left or the right, requiring an adjustment in posture to compensate. COP during quiet standing without visual feedback was examined prior to and immediately following the sensorimotor adaptation procedure, in order to observe whether compensatory adjustments in postural control resulting from the visual-feedback manipulation would transfer to the control of whole-body COP during quiet standing. Results showed that the sensorimotor adaptation procedure induced a small but reliable compensatory change in the stance of participants, resulting in a change in postural symmetry and control that was found to persist even after normal visual feedback was restored.

The effect of viewing a virtual environment through a head-mounted display on balance.

INTRODUCTION: In the next few years, several head-mounted displays (HMD) will be publicly released making virtual reality more accessible. HMD are expected to be widely popular at home for gaming but also in clinical settings, notably for training and rehabilitation. HMD can be used in both seated and standing positions; however, presently, the impact of HMD on balance remains largely unknown. It is therefore crucial to examine the impact of viewing a virtual environment through a HMD on standing balance. OBJECTIVES: To compare static and dynamic balance in a virtual environment perceived through a HMD and the physical environment. The visual representation of the virtual environment was based on filmed image of the physical environment and was therefore highly similar. DESIGN: This is an observational study in healthy adults. RESULTS: No significant difference was observed between the two environments for static balance. However, dynamic balance was more perturbed in the virtual environment when compared to that of the physical environment. CONCLUSIONS: HMD should be used with caution because of its detrimental impact on dynamic balance. Sensorimotor conflict possibly explains the impact of HMD on balance.

Joint torque variability and repeatability during cyclic flexion-extension of the elbow.

BACKGROUND: Joint torques are generally of primary importance for clinicians to analyze the effect of a surgery and to obtain an indicator of functional capability to perform a motion. Given the current need to standardize the functional evaluation of the upper limb, the aim of this paper is to assess (1) the variability of the calculated maximal elbow joint torque during cyclic elbow flexion-extension movements and (2) participant test-retest repeatability in healthy young adults. Calculations were based on an existing non-invasive method including kinematic identification and inverse dynamics processes. METHODS: Twelve healthy young adults (male n = 6) performed 10 elbow flexion-extension movement carrying five different dumbbells (0, 1, 2, 3 and 4 kg) with several flexion-extension frequencies (½, (1)/3, » Hz) to evaluate peak elbow joint torques. RESULTS: Whatever the condition, the variability coefficient of trial peak torques remained under 4 %. Bland and Altman plot also showed good test-retest, whatever the frequency conditions for the 0, 1, 2, and 3 kg conditions. CONCLUSION: The good repeatability of the flexion-extension peak torques represents a key step to standardize the functional evaluation of the upper limb.

Impact of a short walking exercise on gait kinematics in children with cerebral palsy who walk in a crouch gait.

BACKGROUND: Crouch gait results in an increase of the joint stress due to an excessive knee flexion. Daily walking exercises, even when performed at a self-selected speed, may result in a decrease of the extensor muscle strength which could lead to a more severe crouch gait pattern. The aim of this study was to assess the impact of a short walking exercise on gait kinematics in children with cerebral palsy who walk with a crouch gait. METHODS: Seven children with cerebral palsy who walk with a crouch gait were asked to walk for 6min at a self-selected speed. The spatio-temporal and kinematic measures, as well as the center of mass position were compared before and after the exercise. FINDINGS: There was no significant difference between walking speed before and after the walking exercise. Knee flexion and the maximal ankle dorsiflexion increased after the walking exercise. The vertical position of the center of mass decreased. No significant difference was found at the hip. INTERPRETATION: Children with cerebral palsy who walk with a crouch gait were more crouched after a 6-min walking exercise performed at their self-selected speed. These gait modifications could be due to fatigue of the extensor muscle groups. This study highlighted that a short walking exercise, corresponding to daily mobility, results in gait pattern modifications. Since therapies in children with cerebral palsy aim to improve motor function in everyday life situations, it could be relevant to evaluate gait adaptation after a few minutes of walking exercise.

Agreement of spatio-temporal gait parameters between a vertical ground reaction force decomposition algorithm and a motion capture system.

INTRODUCTION: A ground reaction force decomposition algorithm based on large force platform measurements has recently been developed to analyze ground reaction forces under each foot during the double support phase of gait. However, its accuracy for the measurement of the spatiotemporal gait parameters remains to be established. OBJECTIVE: The aim of the present study was to establish the agreement between the spatiotemporal gait parameters obtained using (1) a walkway (composed of six large force platforms) and the newly developed algorithm, and (2) an optoelectronic motion capture system. METHODS: Twenty healthy children and adolescents (age range: 6-17 years) and 19 healthy adults (age range: 19-51 years) participated in this study. They were asked to walk at their preferred speed and at a speed that was faster than the preferred one. Each participant performed three blocks of three trials in each of the two walking speed conditions. RESULTS: The spatiotemporal gait parameters measured with the algorithm did not differ by more than 2.5% from those obtained with the motion capture system. The limits of agreement represented between 3% and 8% of the average spatiotemporal gait parameters. Repeatability of the algorithm was slightly higher than that of the motion capture system as the coefficient of variations ranged from 2.5% to 6%, and from 1.5% to 3.5% for the algorithm and the motion capture system, respectively. CONCLUSION: The proposed algorithm provides valid and repeatable spatiotemporal gait parameter measurements and offers a promising tool for clinical gait analysis. Further studies are warranted to test the algorithm in people with impaired gait.