Search results for: Gait

Authors: Neeraj Vij, Amber Brennan, Jenni Winters, Hadi Salehi, Hamy Temkit, Emily Andrisevic, Mohan V. Belthur

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Idiopathic clubfoot is a common lower extremity deformity with an incidence of 1:500. The Ponseti Method is well known as the gold standard of treatment. However, there is limited functional data demonstrating correction of the clubfoot after treatment with the Ponseti method. The purpose of this study was to study the clinical and functional outcomes after the Ponseti method with the Clubfoot Disease-Specific Instrument (CDS) and pedobarography. This IRB-approved prospective study included patients aged 3-18 who were treated for idiopathic clubfoot with the Ponseti method between January 2008 and December 2018. Age-matched controls were identified through siblings of clubfoot patients and other community members. Treatment details were collected through a chart review of the included patients. Laboratory assessment included a physical exam, gait analysis, and pedobarography. The Pediatric Outcomes Data Collection Instrument and the Clubfoot Disease-Specific Instrument were also obtained on clubfoot patients (CF). The Wilcoxson rank-sum test was used to study differences between the CF patients and the typically developing (TD) patients. Statistical significance was set at p < 0.05. There were a total of 37 enrolled patients in our study. 21 were priorly treated for CF and 16 were TD. 94% of the CF patients had bilateral involvement. The age at the start of treatment was 29 days, the average total number of casts was seven to eight, and the average total number of casts after Achilles tenotomy was one. The reoccurrence rate was 25%, tenotomy was required in 94% of patients, and ≥1 tenotomy was required in 25% of patients. There were no significant differences between step length, step width, stride length, force-time integral, maximum peak pressure, foot progression angles, stance phase time, single-limb support time, double limb support time, and gait cycle time between children treated with the Ponseti method and typically developing children. The average post-treatment Pirani and Dimeglio scores were 5.50±0.58 and 15.29±1.58, respectively. The average post-treatment PODCI subscores were: Upper Extremity: 90.28, Transfers: 94.6, Sports: 86.81, Pain: 86.20, Happiness: 89.52, Global: 88.6. The average post-treatment Clubfoot Disease-Specific Instrument scores subscores were: Satisfaction: 73.93, Function: 80.32, Overall: 78.41. The Ponseti Method has a very high success rate and remains to be the gold standard in the treatment of idiopathic clubfoot. Timely management leads to good outcomes and a low need for repeated Achilles tenotomy. Children treated with the Ponseti method demonstrate good functional outcomes as measured through pedobarography. Pedobarography may have clinical utility in studying congenital foot deformities. Objective measures for hours of brace wear could represent an improvement in clubfoot care.

Keywords: functional outcomes, pediatric deformity, patient-reported outcomes, talipes equinovarus

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Authors: Koichi Kurita

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In this study, we propose a real-time data collection technique for the detection of human walking motion from the charge generated on the human body. This technique is based on the detection of a sub-picoampere electrostatic induction current, generated by the motion, flowing through the electrode of a wireless portable sensor attached to the subject. An FFT analysis of the wave-forms of the electrostatic induction currents generated by the walking motions showed that the currents generated under normal and restricted walking conditions were different. Moreover, we carried out a cepstrum analysis to detect any differences in the walking style. Results suggest that a slight difference in motion, either due to the individual’s gait or a splinted leg, is directly reflected in the electrostatic induction current generated by the walking motion. The proposed wireless portable sensor enables the detection of even subtle differences in walking motion.

Keywords: human walking motion, motion measurement, current measurement, electrostatic induction

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Authors: M. Volpini, D. Alves, A. Horta, M. Borges, P. Reis

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The gait pattern in people that present motor limitations foment the demand for auxiliary locomotion devices. These artifacts for movement assistance vary according to its shape, size and functional features, following the clinical applications desired. Among the ortheses of lower limbs, the ankle-foot orthesis aims to improve the ability to walk in people with different neuromuscular limitations, although they do not always answer patients' expectations for their aesthetic and functional characteristics. The purpose of this study is to explore the possibility of using new design in additive manufacturer to reproduce the shape and functional features of a ankle-foot orthesis in an efficient and modern way. Therefore, this work presents a study about the performance of the mechanical forces through the analysis of finite elements in an ankle-foot orthesis. It will be demonstrated a study of distribution of the stress on the orthopedic device in orthostatism and during the movement in the course of patient's walk.

Keywords: additive manufacture, new designs, orthoses, finite elements

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Authors: Kourosh Fatehi, Niloofar Hanafi

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One of the challenges in providing optimal prosthetic legs for lower limb amputees is to select the appropriate foot stiffness that suits their individual needs and preferences. Foot stiffness affects various aspects of walking, such as stability, comfort, and energy expenditure. However, the current prescription process is largely based on trial-and-error, manufacturer recommendations, or clinician judgment, which may not reflect the prosthesis user’s subjective experience or psychophysical sensitivity. Therefore, there is a need for more scientific and technological tools to measure and understand how prosthesis users perceive and prefer different foot stiffness levels, and how this preference relates to clinical outcomes. This review covers how to measure and design lower leg prostheses based on user preference and foot stiffness. It also explores how these factors affect walking outcomes and quality of life, and identifies the current challenges and gaps in this field from a mechanical engineering standpoint.

Keywords: perception, preference, prosthetics, stiffness

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Authors: Dua Hişam, Serhat İkizoğlu

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Identifying the problem behind balance disorder is one of the most interesting topics in the medical literature. This study has considerably enhanced the development of artificial intelligence (AI) algorithms applying multiple machine learning (ML) models to sensory data on gait collected from humans to classify between normal people and those suffering from Vestibular System (VS) problems. Although AI is widely utilized as a diagnostic tool in medicine, AI models have not been used to perform feature extraction and identify VS disorders through training on raw data. In this study, three machine learning (ML) models, the Random Forest Classifier (RF), Extreme Gradient Boosting (XGB), and K-Nearest Neighbor (KNN), have been trained to detect VS disorder, and the performance comparison of the algorithms has been made using accuracy, recall, precision, and f1-score. With an accuracy of 95.28 %, Random Forest Classifier (RF) was the most accurate model.

Keywords: vestibular disorder, machine learning, random forest classifier, k-nearest neighbor, extreme gradient boosting

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Authors: Drew Commandeur, Ryan Brodie, Sandra Hundza, Marc Klimstra

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The amplitude of raw electromyography (EMG) is affected by recording conditions and often requires normalization to make meaningful comparisons. Bioelectric methods normalize with an EMG signal recorded during a standardized task or from the experimental protocol itself, while biomechanical methods often involve measurements with an additional sensor such as a force transducer. Common bioelectric normalization techniques for treadmill walking include maximum voluntary isometric contraction (MVIC), dynamic EMG peak (EMGPeak) or dynamic EMG mean (EMGMean). There are several concerns with using MVICs to normalize EMG, including poor reliability and potential discomfort. A limitation of bioelectric normalization techniques is that they could result in a misrepresentation of the absolute magnitude of force generated by the muscle and impact the interpretation of EMG between functionally disparate groups. Additionally, methods that normalize to EMG recorded during the task may eliminate some real inter-individual variability due to biological variation. This study compared biomechanical and bioelectric EMG normalization techniques during treadmill walking to assess the impact of the normalization method on the functional interpretation of EMG data. For the biomechanical method, we normalized EMG to a target torque (EMGTS) and the bioelectric methods used were normalization to the mean and peak of the signal during the walking task (EMGMean and EMGPeak). The effect of normalization on muscle activation pattern, EMG amplitude, and inter-individual variability were compared between disparate cohorts of OLD (76.6 yrs N=11) and YOUNG (26.6 yrs N=11) adults. Participants walked on a treadmill at a self-selected pace while EMG was recorded from the right lower limb. EMG data from the soleus (SOL), medial gastrocnemius (MG), tibialis anterior (TA), vastus lateralis (VL), and biceps femoris (BF) were phase averaged into 16 bins (phases) representing the gait cycle with bins 1-10 associated with right stance and bins 11-16 with right swing. Pearson’s correlations showed that activation patterns across the gait cycle were similar between all methods, ranging from r =0.86 to r=1.00 with p<0.05. This indicates that each method can characterize the muscle activation pattern during walking. Repeated measures ANOVA showed a main effect for age in MG for EMGPeak but no other main effects were observed. Interactions between age*phase of EMG amplitude between YOUNG and OLD with each method resulted in different statistical interpretation between methods. EMGTS normalization characterized the fewest differences (four phases across all 5 muscles) while EMGMean (11 phases) and EMGPeak (19 phases) showed considerably more differences between cohorts. The second notable finding was that coefficient of variation, the representation of inter-individual variability, was greatest for EMGTS and lowest for EMGMean while EMGPeak was slightly higher than EMGMean for all muscles. This finding supports our expectation that EMGTS normalization would retain inter-individual variability which may be desirable, however, it also suggests that even when large differences are expected, a larger sample size may be required to observe the differences. Our findings clearly indicate that interpretation of EMG is highly dependent on the normalization method used, and it is essential to consider the strengths and limitations of each method when drawing conclusions.

Keywords: electromyography, EMG normalization, functional EMG, older adults

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Authors: Lewis J. Woollin, Robert I. Davidson, Paul Watson, Philip J. Hyde

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Introduction: In-vitro testing of arthroplasty materials is of paramount importance when ensuring that they can withstand the performance requirements encountered in-vivo. One common machine used for in-vitro testing is a pin-on-plate tribometer, an early stage screening device that generates data on the wear characteristics of arthroplasty bearing materials. These devices test vertically loaded rotating cylindrical pins acting against reciprocating plates, representing the bearing surfaces. In this study, a pin-on-plate machine has been developed that provides several improvements over current technology, thereby progressing arthroplasty bearing research. Historically, pin-on-plate tribometers have been used to investigate the performance of arthroplasty bearing materials under conditions commonly encountered during a standard gait cycle; nominal operating pressures of 2-6 MPa and an operating frequency of 1 Hz are typical. There has been increased interest in using pin-on-plate machines to test more representative in-vivo conditions, due to the drive to test 'beyond compliance', as well as their testing speed and economic advantages over hip simulators. Current pin-on-plate machines do not accommodate the increased performance requirements associated with more extreme kinematic conditions, therefore a next-generation pin-on-plate tribometer has been developed to bridge the gap between current technology and future research requirements. Methodology: The design was driven by several physiologically relevant requirements. Firstly, an increased loading capacity was essential to replicate the peak pressures that occur in the natural hip joint during running and chair-rising, as well as increasing the understanding of wear rates in obese patients. Secondly, the introduction of mid-cycle load variation was of paramount importance, as this allows for an approximation of the loads present in a gait cycle to be applied and to test the fatigue properties of materials. Finally, the rig must be validated against previous-generation pin-on-plate and arthroplasty wear data. Results: The resulting machine is a twelve station device that is split into three sets of four stations, providing an increased testing capacity compared to most current pin-on-plate tribometers. The loading of the pins is generated using a pneumatic system, which can produce contact pressures of up to 201 MPa on a 3.2 mm² round pin face. This greatly exceeds currently achievable contact pressures in literature and opens new research avenues such as testing rim wear of mal-positioned hip implants. Additionally, the contact pressure of each set can be changed independently of the others, allowing multiple loading conditions to be tested simultaneously. Using pneumatics also allows the applied pressure to be switched ON/OFF mid-cycle, another feature not currently reported elsewhere, which allows for investigation into intermittent loading and material fatigue. The device is currently undergoing a series of validation tests using Ultra-High-Molecular-Weight-Polyethylene pins and 316L Stainless Steel Plates (polished to a Ra < 0.05 µm). The operating pressures will be between 2-6 MPa, operating at 1 Hz, allowing for validation of the machine against results reported previously in the literature. The successful production of this next-generation pin-on-plate tribometer will, following its validation, unlock multiple previously unavailable research avenues.

Keywords: arthroplasty, mechanical design, pin-on-plate, total joint replacement, wear testing

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Authors: Hannah Kolano, Paul Nadan, Jeremy Ryan, Sophia Nielsen

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The hooves of goats and other ruminants, or the family Ruminantia, are uniquely structured to adapt to rough terrain. Their hooves possess a hard outer shell and a soft interior that allow them to both conform to uneven surfaces and hook onto prominent features. In an effort to apply this unique mechanism to a robotics context, artificial feet for a hexapedal robot have been designed based on the hooves of ruminants to improve the robot’s ability to traverse unstructured environments such as those found on a rocky planet or asteroid, as well as in earth-based environments such as rubble, caves, and mountainous regions. The feet were manufactured using a combination of 3D printing and polyurethane casting techniques and attached to a commercially available hexapedal robot. The robot was programmed with a terrain-adaptive gait and proved capable of traversing a variety of uneven surfaces and inclines. This development of more adaptable robotic feet allows legged robots to operate in a wider range of environments and expands their possible applications.

Keywords: biomimicry, legged locomotion, robotic foot design, ruminant feet, unstructured terrain navigation

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Authors: Ana Katrina C. Longos, Jarungchai Anton S. Vatanagul

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Objectives: To present a case of two Filipino male siblings initially seen with parkinsonism and eventually with dystonia and to present botulinum A toxin as part of the treatment for X-linked dystonia parkinsonism in Cebu City. Discussion: A 54 year old man presented initially with parkinsonian symptoms and later developed oromandibular and truncal dystonia. Further history revealed that he had an older brother who also presented with the same symptoms. Neuroimaging done on both patients revealed CVD infarcts in the pons and corona radiata respectively which where were not compatible with their symptoms. Family history revealed that their mother was originally from Panay and a diagnosis of X-linked dystonia parkinsonism (XDP) was made. Both patients were able to receive botulinum A toxin injections which provided temporary relief of symptoms. Conclusion: XDP was considered in 2 Filipino male siblings who presented with oromandibular dystonia, truncal dystonia, shuffling gait, resting tremors with ancestry from Panay on the maternal side. There is no cure for XDP, only symptomatic treatment. Until recently, only oral chemotherapy was available in Cebu. Botulinum A toxin injection done in both patients afforded temporary resolution of symptoms.

Keywords: XDP, dystonia of Panay, lubag, dystonia parkinsonism, botulinum a toxin

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Authors: Rami S. Alasmari, Abdullah Al Zahrani, Hattan A. Hassani, Hattan A. Hassani, Nawwaf A. Almalky, Abdullah F. Bokhari, Alwalied A. Hafez

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Diabetes mellitus type 2 (DMT2) is a major chronic condition that is considered common among elderly people, with multiple potential complications that could contribute to falls. However, this concept is not well understood, thus, the aim of this study is to determine whether diabetes is an independent risk factor for falls in elderly. In this observational cross-sectional study, 309 diabetic patients aged 60 or more who visited the primary healthcare centers of the Ministry of National Guard Health Affairs in Jeddah were chosen via convenience sampling method. To collect the data, Semi-structured Fall Risk Assessment questionnaire and Fall Efficacy Score scale were used. The mean age of the participants was estimated to be 68.5 (SD:7.4) years. Among the participants, 48.2% experienced falling before, and 63.1% of them suffered falls in the past 12-months. The results showed that gait problems were independently associated with a higher likelihood of fall among the elderly patients (OR = 1.98, 95%CI, 1.08 to 3.62, p = 0.026. This paper suggests that diabetes mellitus is an independent fall risk factor among elderly. Therefore, identifying such patients as being at higher risk and prompt referral to a specialist falls clinic is recommended.

Keywords: diabetes, fall, elderly, risk factors

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Authors: Lovro Štefan

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The main purpose of the study was to explore if a higher level of Elderly Dietary index score was correlated with lower peak plantar pressures. One-hundred and twenty older adults aged ≥60 years participated in this cross-sectional study. To assess the level of adherence to nutritional recommendations for older adults, we used Elderly Dietary Index score. Plantar pressures beneath the forefoot, midfootandhindfootregions of the foot were determined by pressure platform. Pearson’s coefficient of correlations and partial correlations were used to calculate the relationships. In the unadjusted model, higher Elderly Dietary Index was significantly correlated with lower peak plantar pressure beneath the forefoot (r = -0.45, p<0.001) and hindfoot (r = -0.37, p<0.001) the region, while no significant correlation with peak plantar pressure beneath the (r = -0.15, p=0.113) was observed. When we adjusted for age, body-mass index and gait velocity, higher Elderly Dietary Index remained significantly correlated with lower peak plantar pressure beneath the forefoot (r = -0.41, p<0.001) and hintfoot (r = -0.32, p<0.001) region. This study shows that higher adherence to nutritional recommendations is significantly correlated with lower forefoot and hindfoot peak plantar pressures in older women.

Keywords: elderly, biomechanics, nutrition, associations, force

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Authors: Azadeh Jafari, Mohammad Taghi Karimi, Azadeh Nadi

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Background: Scoliosis is the lateral curvature of the spine which may influence the abilities of the subjects during standing and walking. Most of the scoliotic subjects use orthosis to reduce the curve and to decrease the risk of curve progression. There was lack of information regarding the effects of orthosis on kinematic and joint contact force. Therefore, this research was done to highlight the effects of orthosis on the aforementioned parameters. Method: 5 scoliotic subjects were recruited in this study, with single curve less than 40 (females with age 13.2 ± 1.7). They were asked to walk with and without orthosis. The kinematic of the joints, force applied on the legs, moments transmitted through the joints and joint contact forces were evaluated in this study. Moreover, the lengths of muscles were determined by use of computer muscle control approach in OpenSim. Results: There was a significant difference between the second peak of vertical ground reaction force while walking with and without orthosis (p-value < 0.05). There was no difference between spatiotemporal gait parameters while walking with and without orthosis (P-value > 0.05). The mean values of joint contact forces (vertical component) increased by the use of orthosis, but the difference was not significant (p-value > 0.05). Conclusion: Although the kinematic of most of the body joints was not influenced by the use of orthosis, the joint contact force may be increased by orthosis. The increase in joint contact force may be due to the performance of orthosis which restricts the motions of pelvic and increases compensatory mechanism used by the subjects to decrease the side effects of the orthosis.

Keywords: scoliosis, joint contact force, kinetic, kinematic

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Authors: Gabriel Sitler, Yousef Sardahi, Asad Salem

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This paper presents an optimal and robust sliding mode controller (SMC) to regulate the position of the knee joint angle for patients suffering from knee injuries. The controller imitates the role of active orthoses that produce the joint torques required to overcome gravity and loading forces and regain natural human movements. To this end, a mathematical model of the shank, the lower part of the leg, is derived first and then used for the control system design and computer simulations. The design of the controller is carried out in optimal and multi-objective settings. Four objectives are considered: minimization of the control effort and tracking error; and maximization of the control signal smoothness and closed-loop system’s speed of response. Optimal solutions in terms of the Pareto set and its image, the Pareto front, are obtained. The results show that there are trade-offs among the design objectives and many optimal solutions from which the decision-maker can choose to implement. Also, computer simulations conducted at different points from the Pareto set and assuming knee squat movement demonstrate competing relationships among the design goals. In addition, the proposed control algorithm shows robustness in tracking a standard gait signal when accounting for uncertainty in the shank’s parameters.

Keywords: optimal control, multi-objective optimization, sliding mode control, wearable knee exoskeletons

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Authors: Parya Salimitari, Farhad Tabatabai Ghomsheh, Siyamak Khorramymehr, Hossein Taghadosi, Mohammad Hossein Dashti

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The aim of this study was to evaluate the effect of heel height on the knee joint direction in Genu recurvatum patients compared to normal state. The test was performed on a patient with Genu recurvatum and a healthy person with similar and match biomechanical conditions. Subjects were tested under six different positions of shoes with heels 0, 1, 2, 3, 4 and 5 cm after marking during the gate. The results of the spatial temporal geometry obtained from Vicon Motion System (six-camera T10 model, Oxford Metrics Ltd., Oxford, UK), and were used to compute and analyze the kinematic results. In this study, we tried to determine the effect of shoe heel intervention on knee joint direction correction. The results indicate that the 1 cm heel has been optimized and significantly improved in knee joint flexion and flexion-extension angle so that the difference in knee flexion-extension angle between the patient and the healthy person at some stages of walking has reached zero (good posture). The 3 cm heel compared with the 0 cm heel has reduced the knee recurvatum index (KRI) by up to 21.74% in the patient (from 219.233 mm to 47.6714 mm). According to the findings of this study, it can be concluded that heel increase is effective in correcting knee joints in Genu recurvatum and the optimum heel height is 1 cm.

Keywords: joint alignment of knee, gait analysis, genu recurvatum, heel lift, kinematics, motion-analysis

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Authors: Izabela Zielinska

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Kinesio Taping is classified as physiotherapy method supporting rehabilitation and modulating some physiological processes. It is commonly used in sports medicine and orthopedics. This sensory method has influence on muscle function, pain sensation, intensifies lymphatic system as well as improves microcirculation. The aim of this study was to assess the effect of Kinesio Taping in patients with ongoing treatment of peripheral artery disease (PAD). The study group comprised 60 patients (stadium II B at Fontain's scale). All patients were divided into two groups (30 person/each), where 12 weeks long treadmill training was administrated. In the second group, the Kinesio Taping was applied to support the function of the gastrocnemius muscle. The measurements of distance and time until claudication pain, blood flow of arteries in lower limbs and ankle brachial index were taken under evaluation. Examination performed after Kinesio Taping therapy showed statistically significant increase in gait parameters and muscle strength in patients with intermittent claudication. The Kinesio Taping method has clinically significant effects on enhancement of pain-free distance and time until claudication pain in patients with peripheral artery disease. Kinesio Taping application can be used to support non-invasive treatment in patients with intermittent claudication. Kinesio Taping can be employed as an alternative way of therapy for patients with orthopedic or cardiac contraindications to be treated with treadmill training.

Keywords: intermittent claudication, kinesiotaping, peripheral artery disease, treadmill training

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Authors: Hassan Abo-Salem, Huang Xiaolin

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Background and Purpose: The effectiveness of mirror therapy (MT) has been investigated in acute hemiplegia. The present study examines whether MT, given during chronic stroke, was more effective in promoting motor recovery of the lower extremity and walking speed than standard rehabilitation alone. Methods: The study enrolled 30 patients with chronic stroke. Fifteen patients each were assigned to the treatment group and the control group. All patients received a conventional rehabilitation program for a 4-week period. In addition to this rehabilitation program, patients in the treatment group received mirror therapy for 4 weeks, 5 days a week. Main measures: Passive ankle joint dorsiflexion range of motion, gait speed, Brunnstrom stages of motor recovery, plantarflexor muscle tone by Modified Ashworth Scale. Results: Results: No significant difference was found in the outcome measures among groups before treatment. When compared with standard rehabilitation, mirror therapy improved Ankle ROM, Brunnstrom stages and waking speed (p < 0.05). However, there were no significant differences between two groups on MAS (P > 0.05). Conclusions: Mirror therapy combined with a conventional stroke rehabilitation program enhances lower-extremity motor recovery and walking speed in chronic stroke patients.

Keywords: mirror therapy, stroke, MAS, walking speed

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Authors: B. Medani Amna, M. A. Elbadwi Samia, E. Amin Ahmed

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Variable plants present in nature are used by simple rural and urban people, researchers and drug manufacturers for medicinal purposes. Garad is one of the most commonly used in Sudan for both treatment and prophylaxis of infections in the respiratory, urinogenital tracts and the skin. Water exctracts from Acacia nilotica bods were used in this very experiment to test for their toxicity to Nubian goats at two dose rates under proper experimental conditions. The clinical, pathological, haematological and biological changes in Nubian goats given daily oral doses of 1 and 5 g/kg body weight of Acacia nilotica to two groups of test goats. The goats of the control group were undosed with Acacia nilotica.Other than the dose co-related mortality rates, the clinical signs were observed to be salivation, staggered gait, intermittent loss of voice and low appetite. On histopathological testing, the main lesions were hepatic centrolobular necrosis and fatty changes associated with the significant changes in GGT and ALP are indicating hepatic dysfunction.Renal malfunction is indicated by haemorrhages in addition to the change in the urea concentration. The congested, haemorrhagic, emphysematous, edematous and cyanotic lungs may contribute to the development of dyspnea. Acacia nilotica poisoning may lead to an immunosuppression pointed out by the lymphocyte infiltration. On evaluation of the above results, Acacia nilotica was considered toxic to Nubian goats at the above mentioned doses. Future work for Acacia nilotica was forwarded and practical implications of the result were highlighted.

Keywords: Acaia nilotica, toxicity data, Nubian goats, Garad

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Authors: Surbhi Kaura, Sachin Kandhari, Shahiduz Zafar

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Chronic stroke, characterized by persistent motor deficits, often necessitates comprehensive rehabilitation interventions to improve functional outcomes and mitigate long-term dependency. Luna neurorobotic devices, integrated with EMG feedback systems, provide an innovative platform for facilitating neuroplasticity and functional improvement in stroke survivors. This retrospective study aims to investigate the impact of EMG-based Luna neurorobotic interventions on the strengthening of the affected side in chronic stroke patients. In rehabilitation, active patient participation significantly activates the sensorimotor network during motor control, unlike passive movement. Stroke is a debilitating condition that, when not effectively treated, can result in significant deficits and lifelong dependency. Common issues like neglecting the use of limbs can lead to weakness in chronic stroke cases. In rehabilitation, active patient participation significantly activates the sensorimotor network during motor control, unlike passive movement. This study aims to assess how electromyographic triggering (EMG-triggered) robotic treatments affect walking, ankle muscle force after an ischemic stroke, and the coactivation of agonist and antagonist muscles, which contributes to neuroplasticity with the assistance of biofeedback using robotics. Methods: The study utilized robotic techniques based on electromyography (EMG) for daily rehabilitation in long-term stroke patients, offering feedback and monitoring progress. Each patient received one session per day for two weeks, with the intervention group undergoing 45 minutes of robot-assisted training and exercise at the hospital, while the control group performed exercises at home. Eight participants with impaired motor function and gait after stroke were involved in the study. EMG-based biofeedback exercises were administered through the LUNA neuro-robotic machine, progressing from trigger and release mode to trigger and hold, and later transitioning to dynamic mode. Assessments were conducted at baseline and after two weeks, including the Timed Up and Go (TUG) test, a 10-meter walk test (10m), Berg Balance Scale (BBG), and gait parameters like cadence, step length, upper limb strength measured by EMG threshold in microvolts, and force in Newton meters. Results: The study utilized a scale to assess motor strength and balance, illustrating the benefits of EMG-biofeedback following LUNA robotic therapy. In the analysis of the left hemiparetic group, an increase in strength post-rehabilitation was observed. The pre-TUG mean value was 72.4, which decreased to 42.4 ± 0.03880133 seconds post-rehabilitation, with a significant difference indicated by a p-value below 0.05, reflecting a reduced task completion time. Similarly, in the force-based task, the pre-knee dynamic force in Newton meters was 18.2NM, which increased to 31.26NM during knee extension post-rehabilitation. The post-student t-test showed a p-value of 0.026, signifying a significant difference. This indicated an increase in the strength of knee extensor muscles after LUNA robotic rehabilitation. Lastly, at baseline, the EMG value for ankle dorsiflexion was 5.11 (µV), which increased to 43.4 ± 0.06 µV post-rehabilitation, signifying an increase in the threshold and the patient's ability to generate more motor units during left ankle dorsiflexion. Conclusion: This study aimed to evaluate the impact of EMG and dynamic force-based rehabilitation devices on walking and strength of the affected side in chronic stroke patients without nominal data comparisons among stroke patients. Additionally, it provides insights into the inclusion of EMG-triggered neurorehabilitation robots in the daily rehabilitation of patients.

Keywords: neurorehabilitation, robotic therapy, stroke, strength, paralysis

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Authors: Gabi N. Nehme

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Below-knee amputees commonly experience asymmetrical gait patterns. It is generally believed that ischemia is related to the formation of pressure sores due to uneven distribution of forces. Micro-vascular responses can reveal local malnutrition. Changes in local skin blood supply under various external loading conditions have been studied for a number of years. Radionuclide clearance, photo-plethysmography, trans-cutaneous oxygen tension along with other studies showed that the blood supply would be influenced by the epidermal forces, and the rate and the amount of blood supply would decrease with increased epidermal loads being shear forces or normal forces. Several cases of socket designs were investigated using Finite Element Model (FEM) and Design of Experiment (DOE) to increase flexibility and minimize the pressure at the limb/socket interface using ultra high molecular weight polyethylene (UHMWPE) and polyamide 6 (PA6) or Duraform. The pressure reliefs at designated areas where reducing thickness is involved are seen to be critical in determination of amputees’ comfort and are very important to clinical applications. Implementing a hole between the Patellar Tendon (PT) and Distal Tibia (DT) would decrease stiffness and increase prosthesis range of motion where flexibility is needed. In addition, displacement and prosthetic energy storage increased without compromising mechanical efficiency and prosthetic design integrity.

Keywords: patellar tendon, distal tibia, prosthetic socket relief areas, hole implementation

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Authors: Donna-Marie Phyllis Lanton

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Sarcopenia is a well-known geriatric syndrome characterized by the progressive and generalized loss of muscle quantity or quality. The incidence of sarcopenia increases with age and is associated with adverse outcomes such as the increased risk of falls, cognitive impairment, loss of independence, diminished quality of life, increased health costs, need for care in a skilled nursing facility, and increased mortality. Physical activity, including resistance training, is the most prevalent recommendation for treating and preventing sarcopenia. Residents (N = 23) of a skilled nursing facility in East Orlando, Florida, participated in a 90-day strength training program designed using the PARIHS framework to improve measures of muscle mass, muscle strength, physical performance, and quality of life. Residents engaged in both resistance and balance exercises for 1 hour two times a week. Baseline data were collected and compared to data at Days 30, 60, and 90. T tests indicated significant gains on all measures from baseline to 90 days: muscle mass increased by 1.2 (t[22] = 2.85, p = .009), grip strength increased by 4.02 (t[22] = 8.15, p < .001), balance increased by 2.13 (t[22] = 18.64, p < .001), gait speed increased by 1.83 (t[22] = 17.84, p < .001), chair speed increased 1.87 (t[22] = 16.36, p < .001), and quality of life score increased by 17.5 (t[22] = 19.26, p < .001). For residents with sarcopenia in skilled nursing facilities, a 90-day strength training program with resistance and balance exercises may provide an option for decreasing the incidence of sarcopenia among that population

Keywords: muscle mass, muscle strength, older adults, PARIHS framework

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Authors: Keivan Jmahidi, Afshin Zahedi

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To evaluate neurotoxic effects of ACR on hypothalamus of rat, amino-cupric silver staining technique of de Olmos and electron microscopic examination were conducted. For this purpose 60 adult male Wistar rats (± 250 g) were selected. Randomly assigned groups of rats (10 rats per exposure group, as A, B, C, D, E) were exposed to 0.5, 5, 50, 100 and 500 mg/kg per day×11days i.p. respectively. The remaining 10 rats were housed in group F as control group. Control rats received daily i.p. injections of 0.9% saline (3ml/kg). As indices of developing neurotoxicity, daily weight gain, gait scores and landing hindlimb foot splay (LHF) were determined. After 11 days, two rats for silver stain, and two rats for EM, were randomly selected, dissected and proper samples were collected from hypothalamus. Rats in groups D and E died within 1-2 hours due to sever toxemia. In histopathological studies no argyrophilic neurons or processes were observed in stained sections obtained from hypothalamus of rats belong to groups A, B and F, while moderate to severe argyrophilic changes were observed in different nuclei and regions of stained sections obtained from hypothalamus of rats belong to group C. In ultrastructural studies some variations in the myelin sheet of injured axons including decompactation, interlaminar space formation, disruption of the laminar sheet, accumulation of neurofilaments, vacculation and clumping inside the axolem, and finaly complete disappearance of laminar sheet were observed.

Keywords: acrylamide (ACR), amino-cupric silver staining technique of de Olmos, argyrophilia, hypothalamic neuropathy

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Authors: A. S. Gorobtsov, A. S. Polyanina, A. E. Andreev

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The movement of points feet of the anthropomorphous robot in space occurs along some stable trajectory of a known form. A large number of modifications to the methods of control of biped robots indicate the fundamental complexity of the problem of stability of the program trajectory and, consequently, the stability of the control for the deviation for this trajectory. Existing gait generators use piecewise interpolation of program trajectories. This leads to jumps in the acceleration at the boundaries of sites. Another interpolation can be realized using differential equations with fractional derivatives. In work, the approach to synthesis of generators of program trajectories is considered. The resulting system of nonlinear differential equations describes a smooth trajectory of movement having rectilinear sites. The method is based on the theory of an asymptotic stability of invariant sets. The stability of such systems in the area of localization of oscillatory processes is investigated. The boundary of the area is a bounded closed surface. In the corresponding subspaces of the oscillatory circuits, the resulting stable limit cycles are curves having rectilinear sites. The solution of the problem is carried out by means of synthesis of a set of the continuous smooth controls with feedback. The necessary geometry of closed trajectories of movement is obtained due to the introduction of high-order nonlinearities in the control of stabilization systems. The offered method was used for the generation of trajectories of movement of point’s feet of the anthropomorphous robot. The synthesis of the robot's program movement was carried out by means of the inverse method.

Keywords: control, limits cycle, robot, stability

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Authors: Miriam Palomo-Nieto, Adrian Agricola, Rudolf Psotta, Reza Abdollahipour, Ludvik Valtr

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The importance of vision and the visual control of movement have been labeled in the literature related to motor control and many studies have demonstrated that children with low motor competence may rely more heavily on vision to perform movements than their typically developing peers. The aim of the study was to highlight the effects of different visual conditions on motor performance during walking in children with different levels of motor coordination. Participants (n = 32, mean age = 8.5 years sd. ± 0.5) were divided into two groups: typical development (TD) and low motor coordination (LMC) based on the scores of the Movement Assessment Battery for Children (MABC-2). They were asked to walk along a 10 meters walkway where the Optojump-Next instrument was installed in a portable laboratory (15 x 3 m), which allows that all participants had the same visual information. They walked in self-selected speed under four visual conditions: full vision (FV), limited vision 100 ms (LV-100), limited vision 150 ms (LV-150) and non-vision (NV). For visual occlusion participants were equipped with Plato Goggles that shut for 100 and 150 ms, respectively, within each 2 sec. Data were analyzed in a two-way mixed-effect ANOVA including 2 (TD vs. LMC) x 4 (FV, LV-100, LV-150 & NV) with repeated-measures on the last factor (p ≤.05). Results indicated that TD children walked faster and with longer normalized steps length and strides than LMC children. For TD children the percentage of the single support and swing time were higher than for low motor competence children. However, the percentage of load response and pre swing was higher in the low motor competence children rather than the TD children. These findings indicated that through walking we could be able to identify different levels of motor coordination in children. Likewise, LMC children showed shorter percentages in those parameters regarding only one leg support, supporting the idea of balance problems.

Keywords: visual information, motor performance, walking pattern, optojump

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Authors: Keivan Jamshidi

Abstract:

Distal swelling and eventual degeneration of axon in the CNS and PNS have been considered to be the characteristic neuropathological effects of acrylamide (ACR) neuropathy. This study was conducted to determine the neurotoxic effects of different doses of ACR (0.5, 5, 50, 100, and 500 mg/kg per day × 11days i. p.) on hypothalamus of rat using the de Olmos amino cupric-silver stain and electron microscopy. For this purpose 60 adult male rats (Wistar, approximately 250 g) were randomly assigned in 5 treatment groups as A, B, C, D, E) exposed to 0.5, 5, 50, 100, and 500 mg/kg per dayx11days i. p. and one control group as F received daily i. p. injections of 0.9% saline (3ml/kg). As indices of developing neurotoxicity, weight gain, gait scores and landing hindlimb foot splay were determined. After 11 days, two rats for silver stain, and two rats for EM were randomly selected; dissected and proper samples were collected from hypothalamus. Results did show no neurological behavior in groups A, B and F were observed in group C. Rats in groups D and E died within 1-2 hours due to sever toxemia. In histopathological studies based on de Olmos technique no argyrophilic neurons or processes were observed in stained sections obtained from hypothalamus of rats belong to groups A, B, and F while moderate to severe argyrophilic changes were observed in different nuclei and regions of stained sections obtained from hypothalamus of rats belong to group C. In ultra-structural studies some variations in the myelin sheet of injured axons including decompactation, interlaminar space formation, disruption of the laminar sheet, accumulation of neurofilaments, vacculation, and clumping inside the axolem, and finally complete disappearance of laminar sheet were observed.

Keywords: acrylamide, hypothalamus, rat, de Olmos amino cupric, silver stain, electron microscopy

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Authors: Azadeh Rouhandeh, Chris Joslin, Zhen Qu, Yuu Ono

Abstract:

The centre of rotation of the hip joint is needed for an accurate simulation of the joint performance in many applications such as pre-operative planning simulation, human gait analysis, and hip joint disorders. In human movement analysis, the hip joint center can be estimated using a functional method based on the relative motion of the femur to pelvis measured using reflective markers attached to the skin surface. The principal source of errors in estimation of hip joint centre location using functional methods is soft tissue artefacts due to the relative motion between the markers and bone. One of the main objectives in human movement analysis is the assessment of soft tissue artefact as the accuracy of functional methods depends upon it. Various studies have described the movement of soft tissue artefact invasively, such as intra-cortical pins, external fixators, percutaneous skeletal trackers, and Roentgen photogrammetry. The goal of this study is to present a non-invasive method to assess the displacements of the markers relative to the underlying bone using optical motion capture data and tissue thickness from ultrasound measurements during flexion, extension, and abduction (all with knee extended) of the hip joint. Results show that the artefact skin marker displacements are non-linear and larger in areas closer to the hip joint. Also marker displacements are dependent on the movement type and relatively larger in abduction movement. The quantification of soft tissue artefacts can be used as a basis for a correction procedure for hip joint kinematics.

Keywords: hip joint center, motion capture, soft tissue artefact, ultrasound depth measurement

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Authors: Jill Garner, Belinda Lange, Sheila Lennon, Maayken van den Berg

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Currently, there are approximately one billion people worldwide affected by a neurological condition. Many of whom are assessed and treated by a physiotherapist in a variety of settings. There is a lack of consensus in the literature related to what is clinically assessed by physiotherapists in people with neurological conditions. This study aimed to explore assessment in people with neurological conditions, including how health care setting, experience, and therapeutic approach, may influence neurological assessment. A national survey targeted Australian physiotherapists who assess adults with neurological conditions as part of their clinical practice. The survey consisted of 39 questions and was distributed to physiotherapists through the Australian Physiotherapy Association, and Chief Allied Health Officers across Australia and advertised on the National Neurological Physiotherapy Facebook page. In total, 395 respondents consented to the survey from all states within Australia. Most respondents were female (85.4%) with a mean (SD) age of 35.7 years. Respondents reported working clinically in acute, community, outpatients, and community settings. Stroke was the most assessed condition (58.0%). There is variability in domains assessed by Australian physiotherapists, with common inclusions of balance, muscle strength, gait, falls and safety, function, goal setting, range of movement, pain, coordination, activity tolerance, postural alignment and symmetry and upper limb. There is little evidence to support what physiotherapists assess in practice, in different settings, and in different states within Australia and not enough information to develop a decision tree regarding what is important for assessment in different settings. Further research is needed to explore this area and develop a consensus around best practices.

Keywords: physiotherapy, neurological, assessment, domains

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Authors: Khulood Zahran

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Background and Purpose: The effects of backpack on 'school-age' children (Age 9–12) years, have been a critical subject of discussion throughout the past years. It has been one of the factors that contribute to a bad posture for 40% to 70% of developed countries. A child carrying a heavy backpack for a prolonged period, on a daily base has shown significant changes in the child's spinal posture, foot shape, and gait. The back pain caused by the compensatory posture, or "Backpack syndrome", is also known for its headaches, fatigue, cervical and lumber pain caused by the abnormal body posture. The child tends to balance himself by bending forward to match the heavy backpack, moving his Centre of Gravity forward, resulting in decreased lumber lordosis and increased thoracic kyphosis. Since currently available bags have not addressed the weight distribution issue till now. Therefore, KZ bag is believed to prevent the huge backward shift of COG due to the load, and hence all the symptoms accompanied. This is thought to be possible by combining the design of a normal backpack with a messenger bag. The purpose of this study is to investigate the improvement of the child's spine and to minimize the compensatory posture after using the KZ bag. Materials and Methods: KZ bag would compromise the pros of a messenger bag (keeping the COG in place) by a diagonal load strap and of a backpack (distributing the load on both shoulders) by connecting another load strap parallel to the sagittal plane of the body. The design would be made adjustable to match the child's height, and the bag load kept within limits, (10-15%) of the child's body weight. Measurements of Postural angles (Cervical, shoulders, and Trunk) would be taken after the use of KZ bag for a specified period. Conclusion: KZ bag will prove an improved distribution of weight of the bag on the child's body, and reduce the degree of the compensatory posture, that occurs in the attempt to balance the external weight of the bag.

Keywords: backpack, backpack syndrome, posture, spine

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Authors: R. Periyasamy, Deepak Joshi, Sneh Anand

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Foot posture assessment is important to evaluate foot type, causing gait and postural defects in all age groups. Although different methods are used for classification of foot arch type in clinical/research examination, there is no clear approach for selecting the most appropriate measurement system. Therefore, the aim of this study was to develop a system for evaluation of foot type as clinical decision-making aids for diagnosis of flat and normal arch based on the Arch Index (AI) and foot pressure distribution parameter - Power Ratio (PR) data. The accuracy of the system was evaluated for 27 subjects with age ranging from 24 to 65 years. Foot area measurements (hind foot, mid foot, and forefoot) were acquired simultaneously from foot pressure intensity image using portable PedoPowerGraph system and analysis of the image in frequency domain to obtain foot pressure distribution parameter - PR data. From our results, we obtain 100% classification accuracy of normal and flat foot by using the linear discriminant analysis method. We observe there is no misclassification of foot types because of incorporating foot pressure distribution data instead of only arch index (AI). We found that the mid-foot pressure distribution ratio data and arch index (AI) value are well correlated to foot arch type based on visual analysis. Therefore, this paper suggests that the proposed system is accurate and easy to determine foot arch type from arch index (AI), as well as incorporating mid-foot pressure distribution ratio data instead of physical area of contact. Hence, such computational tool based system can help the clinicians for assessment of foot structure and cross-check their diagnosis of flat foot from mid-foot pressure distribution.

Keywords: arch index, computational tool, static foot pressure intensity image, foot pressure distribution, linear discriminant analysis

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Authors: Ying-Yi Laio, Yea-Ru Yang, Yih-Ru Wu, Ray-Yau Wang

Abstract:

Background: Virtual reality (VR) systems are proved to increase motor performance in stroke and elderly. However, the effects have not been established in patients with Parkinson’s disease (PD). Purpose: To examine the effects of VR based training in improving muscle strength, sensory integration ability and walking abilities in patients with PD by a randomized controlled trial. Method: Thirty six participants with diagnosis of PD were randomly assigned to one of the three groups (n=12 for each group). Participants received VR-based Wii Fit exercise (VRWii group) or traditional exercise (TE group) for 45 minutes, followed by treadmill training for another 15 minutes for 12 sessions in 6 weeks. Participants in the control group received no structured exercise program but fall-prevention education. Outcomes included lower extremity muscle strength, sensory integration ability, walking velocity, stride length, and functional gait assessment (FGA). All outcomes were assessed at baseline, after training and at 1-month follow-up. Results: Both VRWii and TE groups showed more improvement in level walking velocity, stride length, FGA, muscle strength and vestibular system integration than control group after training and at 1-month follow-up. The VRWii training, but not the TE training, resulted in more improvement in visual system integration than the control. Conclusions: VRWii training is as beneficial as traditional exercise in improving walking abilities, sensory integration ability and muscle strength in patients with PD, and such improvements persisted at least for 1 month. The VRWii training is then suggested to be implemented in patients with PD.

Keywords: virtual reality, walking, sensory integration, muscle strength, Parkinson’s disease

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Authors: Lakhoua Najeh

Abstract:

Introduction: In most situations, an industrial system already existing, conditioned by its history, its culture and its context are in difficulty facing the necessity to restructure itself in an organizational and technological environment in perpetual evolution. This is why all operations of restructuring first of all require a diagnosis based on a functional analysis. After a presentation of the functionality of a supervisory system for complex processes, we present the concepts of industrial automation and supervisory control and data acquisition (SCADA). Methods: This global analysis exploits the various available documents on the one hand and takes on the other hand in consideration the various testimonies through investigations, the interviews or the collective workshops; otherwise, it also takes observations through visits as a basis and even of the specific operations. The exploitation of this diagnosis enables us to elaborate the project of restructuring thereafter. Leaving from the system analysis for the restructuring of industrial systems, and after a technical diagnosis based on visits, an analysis of the various technical documents and management as well as on targeted interviews, a focusing retailing the various levels of analysis has been done according a general methodology. Results: The methodology adopted in order to contribute to the restructuring of industrial systems by its participative and systemic character and leaning on a large consultation a lot of human resources that of the documentary resources, various innovating actions has been proposed. These actions appear in the setting of the TQM gait requiring applicable parameter quantification and a treatment valorising some information. The new management environment will enable us to institute an information and communication system possibility of migration toward an ERP system. Conclusion: Technological advancements in process monitoring, control and industrial automation over the past decades have contributed greatly to improve the productivity of virtually all industrial systems throughout the world. This paper tries to identify the principles characteristics of a process monitoring, control and industrial automation in order to provide tools to help in the decision-making process.

Keywords: automation, supervision, SCADA, TQM

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