Assessment of gait abnormalities in cerebral palsy (CP) is challenging, and access to instrumented gait analysis is not always feasible. Therefore, many observational gait analysis scales have been devised. This study aimed to evaluate the interobserver reliability, intraobserver reliability, and validity of Edinburgh visual gait score (EVGS). Video of 30 children with spastic CP were reviewed by 7 raters (10 children each in GMFCS levels I, II, and III, age 6–12 years). Three observers had high level of experience in gait analysis (10+ years), two had medium level (2–5 years) and two had no previous experience (orthopedic fellows). Interobserver reliability was evaluated using percentage of complete agreement and kappa values. Criterion validity was evaluated by comparing EVGS scores with 3DGA data taken from the same video visit. Interobserver agreement was 60–90% and Kappa values were 0.18–0.85 for the 17 items in EVGS. Reliability was higher for distal segments (foot/ankle/knee 63–90%; trunk/pelvis/hip 60–76%), with greater experience (high 66–91%, medium 62–90%, no-experience 41–87%), with more EVGS practice (1st 10 videos 52–88%, last 10 videos 64–97%) and when used with higher functioning children (GMFCS I 65–96%, II 58-90%, III 35–65%). Intraobserver agreement was 64–92%. Agreement between EVGS and 3DGA was 52–73%. We believe that having EVGS as part of the standardized gait evaluation is helpful in optimizing the visual scoring. EVGS can be a supportive tool that adds quantitative data instead of only qualitative assessment to a video only gait evaluation.

Ankle–foot orthoses can be prescribed to improve gait in children with cerebral palsy. Before evaluating the effects of ankle–foot orthoses on gait, a period to adapt or acclimatize is usually applied. It is however unknown whether an acclimatization period is actually needed to reliably evaluate the effect of a new orthosis on gait. This study aimed to investigate whether specific gait parameters in children with cerebral palsy would change within an acclimatization period after being provided with new ankle–foot orthoses.Ten children with cerebral palsy, walking with excessive knee flexion in midstance (8 boys; mean (SD) 10.2 (1.9) years; Gross Motor Function Classification System levels I–II) were provided with ventral shell ankle–foot orthoses. The orthoses were worn in combination with the child's own shoes and tuned, based on ground reaction force alignment with respect to the lower limb joints. Directly after tuning (T0) and four weeks later (T1), 3D-gait analysis was performed using an optoelectronic motion capture system and a force plate. From this assessment, ten spatiotemporal, kinematic and kinetic gait parameters were derived for the most affected leg. Differences in parameters between T0 and T1 were analyzed using paired t-tests or Wilcoxon signed rank tests (P < 0.05).Over the course of four weeks, no significant differences (P ≥ 0.080) were observed for any investigated parameter.These results imply that the biomechanical effect of ventral shell ankle–foot orthoses on gait in independent walking children with cerebral palsy is immediately apparent, i.e., there is no further change after acclimatization.

This study aims to investigate the involvement of the peripheral nervous system in Ehlers–Danlos syndromes/hypermobility type patients with particular attention to entrapment syndromes.We consecutively enrolled Ehlers–Danlos syndromes/hypermobility type patients. Patients underwent clinical, neurophysiological and ultrasound evaluations. Dynamic ultrasound evaluation was also performed in healthy subjects as control group.Fifteen Ehlers–Danlos syndromes/hypermobility type patients and fifteen healthy subjects were enrolled. Most of patients presented tingling, numbness, cramps in their hands or feet. Clinical evaluation was normal in all patients. One patient was affected with carpal tunnel syndrome and one with ulnar nerve entrapment at elbow. One patient had an increased and hypoechoic ulnar nerve at elbow at ultrasound evaluation. Dynamic ultrasound evaluation of ulnar nerve at elbow showed, in patients, twelve subluxations and three luxations. In the control group dynamic evaluation showed one case of ulnar nerve luxation.Statistical analysis showed a significant difference in the occurrence of ulnar nerve subluxation and luxation between patients and control subjects.The study shows an inconsistency between symptoms and neurophysiological and ultrasound evidences of focal or diffuse nerve involvement. The high prevalence of ulnar nerve subluxation/luxation at elbow in Ehlers–Danlos syndromes/hypermobility type patients could be explained by the presence of Osborne ligament laxity.

Stiff-knee gait (SKG) is commonly encountered in clinic; many other gait abnormalities are seen together with this pathology. Simulation studies revealed that diminished knee flexion (KF) velocity and increased knee extension moments are strongly related with SKG. This study aimed to determine whether tiptoe walking and hip-knee flexion velocity reduction causes SKG pattern in healthy participants.Fourteen able-bodied adults' (Av. age: 23.0 ± 2.4) heel–toe (N), tiptoe (T), and walking with 5% body weight on both shanks (W) were analyzed using 3D gait analysis by controlling cadence (90 step/min). Repeated measures analysis of variance was used followed by Bonferroni correction (p < 0.05).Walking velocity and cadence were similar for all conditions (p > 0.1). Maximum hip flexion velocity was reduced (15%) significantly as well as the KF velocity (10%) in the W condition. The peak knee flexion (PKF) (8.3% for T, 8.6% for W) and total knee range (10.9% for T, 13% for W) were reduced for both conditions (p < 0.05). The knee range in early swing and the duration between toe-off and PKF were reduced only in the weighted-leg condition (p < 0.05).Slow hip and knee flexion diminished all SKG parameters except timing of PKF. Tiptoe gait itself generated a borderline SKG pattern by reducing the PKF and total knee range. By considering that tiptoe gait and SKG commonly seen together, some of the SKG contributors can be treated by normalizing the ankle motion in the stance and increasing the hip–knee flexion velocity by rigorously planned muscle lengthening procedures and effective strengthening exercises.

Acquiring large anatomical volumes in a feasible manner is useful for clinical decision-making. A relatively new technique called 3D freehand ultrasonography is capable of this by combining a conventional 2D ultrasonography system. Currently, a thorough analysis of this technique is lacking, as the analyses are dependent on the software implementation details and the choice of measurement systems. Therefore this study starts by making this implementation available under the form of an open-source software library to perform 3D freehand ultrasonography. Following that, reliability and validity analyses of extracting volumes and lengths will be carried out using two independent motion-tracking systems.A PC-based ultrasonography device and two optical motion-tracking systems were used for data acquisition. An in-house software library called Py3DFreeHandUS was developed to reconstruct (off-line) the corresponding data into one 3D data set. Reliability and validity analyses of the entire experimental set-up were performed by estimating the volumes and lengths of ground truth objects. Ten water-filled balloons and six cross-wires were used. Repeat measurements were also performed by two experienced operators.The software library Py3DFreeHandUS is available online, along with the relevant documentation. The reliability analyses showed high intra- and inter-operator intra-class correlation coefficient results for both volumes and lengths. The accuracy analysis revealed a discrepancy in all cases of around 3%, which corresponded to 3 ml and 1 mm for volume and length measurements, respectively. Similar results were found for both of the motion-tracking systems.The undertaken analyses for estimating volume and lengths acquired with 3D freehand ultrasonography demonstrated reliable design measurements and suitable performance for applications that do not require sub-mm and -ml accuracy.

1) Develop unidimensional instruments to measure osteoarthritis (OA) knowledge among people with hip or knee OA, and 2) assess the structural validity, internal consistency, cross-cultural validity/measurement invariance, test-retest reliability, and measurement error of the Hip Osteoarthritis Knowledge Scale (HOAKS) and the Knee Osteoarthritis Knowledge Scale (KOAKS).Draft HOAKS and KOAKS were developed and refined following best-practice (COSMIN) guidelines with involvement of consumer research partners. Measurement properties of the HOAKS and KOAKS will be assessed through an online survey. The survey will include the novel HOAKS or KOAKS, the current short form of the Hip or Knee injury and Osteoarthritis Outcome Score (HOOS-12/KOOS-12), and items that gather demographic and OA characteristics and explore self-rated OA knowledge. People will be eligible to participate if aged 18 years and older, can communicate in English, and have either hip or knee OA as diagnosed by a health professional or by meeting diagnostic criteria. We aim to obtain 400 complete HOAKS or KOAKS responses and 100 complete HOAKS or KOAKS retest responses one week after initial completion. Rasch analysis will estimate structural validity, internal consistency and cross-cultural validity/measurement invariance. Assessment will include test-retest reliability (intraclass correlation coefficient) and absolute measurement error (standard error of measurement; smallest detectable change).This study will produce robust unidimensional instruments to measure hip and knee OA knowledge. We anticipate that the HOAKS and KOAKS scales will be useful in clinical and research settings to identify knowledge gaps or evaluate interventions designed to improve knowledge.

Two populations commonly presenting with equinus gait are Idiopathic Toe-Walkers and children with Cerebral Palsy. Surgical intervention to treat equinus is defined by three zones. Zone three surgery, performed at the Achilles tendon, is most commonly used clinically. There is however, evidence from simulation studies that zone two surgery, performed at the muscle belly, might provide better functional outcomes. The purpose of this study was to investigate the effect of zone two calf-lengthening on post-operative gait in these populations.A retrospective audit of the Queensland Children's Motion Analysis Service database identified 17 toe-walkers (mean age 10.13 (SD 2.625)) and 11 Cerebral Palsy (mean age 9.72 (SD 4.04)) participants that received calf-lengthening surgery for plantarflexion contracture and had pre- and post-surgery 3D gait analysis. Inverse kinematics, dynamics, and muscle analysis were performed in OpenSim (v3.3) using a modified gait2392 model. Pre to post-surgery comparisons were performed in MATLAB using statistical parametric mapping. Dependent variables included ankle kinematics, powers and muscle-tendon length estimates.The primary outcome of this study was that ankle dorsiflexion increased in both Idiopathic Toe Walking and Cerebral Palsy groups post-calf lengthening across 90% and 85% of the gait cycle respectively. There was an increase in modelled muscle-tendon lengths, specifically in the medial gastrocnemius, of 78% (toe-walkers), and 100% (Cerebral Palsy) of the gait cycle. Power generation during push-off was not affected.Overall, the results appear to support the efficacy of zone 2 calf-lengthening for children with Cerebral Palsy and Idiopathic Toe Walking.

In this paper, the Gait Deviation Index (GDI) was used as a convenient method to evaluate pre-to-postoperative gait pattern changes after total hip arthroplasty and identify factors which might be predictive of outcome.Three-dimensional gait data from a randomized clinical trial was used to determine changes in gait quality in participants walking at self-selected speed. Upon completion of the first assessment, the participants were randomly assigned to either resurfacing hip arthroplasty or conventional hip arthroplasty. The outcome was changes in overall gait ‘quality’ measured with GDI during the 6-month post-surgery follow-up period.38 participants with severe unilateral primary hip osteoarthritis took part in the trial. We found no difference in change scores between the two treatment groups; 1.9 [95%CI: −0.3 to 4.0] or between change scores for the non-operated and the operated limbs; 0.3 [95%CI: −2.3 to 1.7]. However, the score for the two groups (pooled data) improved after surgery by 4.4 [95%CI: 1.8–7.0]. The single level regression analysis identified the preoperative GDI score as a strong predictor of outcome (p < 0.001).Six months after surgery, there was no additional effect of resurfacing hip arthroplasty on GDI scores compared with conventional hip arthroplasty. Participants with the most pathological preoperative gait pattern improved the most. The GDI increased, which indicates an overall improvement in gait pathology after surgery.Trial registration: NCT01229293

Beginning in 2009 with the passage of the Zackery Lystedt law in the state of Washington, all 50 states have passed concussion laws that implement a mandatory framework of care for high school and youth athletes. The structure of these laws generally shares the three primary components of the Lystedt law: (1) preseason concussion education; (2) mandatory removal from play with suspected concussion; and (3) clearance from a healthcare professional prior to return to play. These same three policy components are also found at the collegiate and professional levels of sport, either through established policy or labor contracts. This chapter explores concussion-specific legal and policy developments that currently inform concussion management practices across multiple levels of the US athletic system.

To determine peroxisome proliferator activated receptor α and γ mRNA expression in liver tissue of hepatitis C virus-infected patients with and without human immunodeficiency virus and its possible contribution to an acceleration of liver disease progression.We measured peroxisome proliferator-activated receptor α and γ mRNA expression by real-time polymerase chain reaction in liver tissues from 40 subjects infected only with hepatitis C virus, 36 subjects co-infected with hepatitis C virus and human immunodeficiency virus and 11 normal adults.Hepatic mRNA expression of both peroxisome proliferator-activated receptors was significantly lower in hepatitis C virus-infected subjects with and without human immunodeficiency virus co-infection compared to the controls. Non-black race was also identified as a predictor of lower peroxisome receptor α and γ mRNA expression. Compared to subjects infected only with hepatitis C virus, liver peroxisome receptor γ mRNA expression was significantly lower in hepatitis C virus/human immunodeficiency virus-co-infected subjects (0.0092 in hepatitis C virus/human immunodeficiency virus-co-infection vs. 0.0120 in hepatitis C virus-only; p=0.004). Hepatic peroxisome receptor α mRNA expression in the hepatitis C virus-infected patients was lower in the presence of human immunodeficiency virus co-infection in non-black subjects (0.0769 vs. 0.1061; p=0.02), whereas the levels did not vary based on human immunodeficiency virus status among black subjects.mRNA expression of both peroxisome proliferator-activated receptors is impaired in hepatitis C virus-infected liver and further reduced by human immunodeficiency virus co-infection, although the suppressive effects of the viruses are substantially mitigated in black patients.

For older adults with mobility problems, one focus of rehabilitation is treating the underlying neuromuscular impairment(s) that lead to functional decline and disability. Knowing which neuromuscular impairments contribute to basic mobility tasks among older adults with back pain will fill an important knowledge gap and is a critical step towards developing mechanistically based rehabilitative interventions.To evaluate the relationship of neuromuscular impairments with performance of mobility tasks among older adults with and without back pain.Cross-sectional analysis of baseline data from the Boston Rehabilitative Impairment Study of the Elderly.Primary care−based population.Participants (N = 430) were older primary care patients who completed assessments of neuromuscular impairments and mobility tasks.Back pain was assessed by the use of an established comorbidity questionnaire. Neuromuscular impairments included trunk extensor muscle endurance, kyphosis, leg strength, leg strength asymmetry, leg speed, mean reaction time, leg coordination, and knee and ankle range of motion.Mobility tasks included gait speed, standing balance, chair stand, and patient-reported functional status. Analysis of covariance was used to generate adjusted means for neuromuscular impairments that differed significantly by back pain status. Separate multivariable regression models evaluated the association between neuromuscular impairments and mobility based on back pain status after we adjusted for sociodemographic factors and physiologic impairments.Participants had an average age of 77 years, 68% were female, and 31% reported back pain. Trunk extensor muscle endurance, leg strength, and rapid leg coordination were significantly lower among those with back pain compared to those without (P < .01, P = .01, P = .04, respectively). Patterns of neuromuscular impairments that were associated with mobility tasks differed according to back pain status.The neuromuscular impairment profiles associated with mobility function among older adults with back pain vary compared with older adults without back pain.

The treadmill is widely used as an instrument for gait training and analysis. The primary purpose of this study was to compare biomechanical variables between overground and treadmill walking in children with cerebral palsy (CP). Perceived differences between the two walking modes were also investigated by comparing self-selected walking speeds. Twenty children with CP performed both overground and treadmill walking at a matched speed for biomechanical comparison using a 3-D motion analysis system. In addition, they were asked to select comfortable and fastest walking speeds under each walking condition to compare perceived differences. Significant differences in spatiotemporal variables were found including higher cadence and shorter stride length during treadmill walking at a matched speed (for all, P < .003). The comparison of joint kinematics demonstrated significant differences between overground and treadmill walking, which showed increases in peak angles of ankle dorsi-flexion, knee flexion/extension, and hip flexion (for all, P < .001), increases in ankle and hip excursions and a decrease in pelvic rotation excursion while walking on treadmill (for all, P < .002). Comparison of perceived difference revealed that children with CP chose significantly slower speeds when asked to select their comfortable and fastest walking speeds on the treadmill as compared to overground (for both, P < .001). Our results suggest that these biomechanical and perceived differences should be considered when using a treadmill for gait intervention or assessment.

Upper limb (UL) kinematic assessment protocols are becoming integrated into clinical practice due to their development over the last few years. We propose the ELEPAP UL protocol, a contemporary UL kinematic protocol that can be applied to different pathological conditions. This model is based on ISB modeling recommendations, uses functional joint definitions, and models three joints of the shoulder girdle. The specific aim of this study was to determine the within and between session reliability of the ELEPAP UL model. Ten healthy subjects (mean age: 13.6 ± 4.3 years) performed four reach-to-grasp and five functional tasks, which included a novel throwing task to assess a wide spectrum of motor skills. Three trials of every task in two different sessions were analyzed. The reliability of angular waveforms was evaluated by measurement error (σ) and coefficient of multiple correlation (CMC). Spatiotemporal parameters were assessed by standard error of measurement (SEM). Generally joint kinematics presented low σw and σb errors (<100). A selection of angular waveforms errors was presented to inspect error fluctuation in different phases, which was found to be related to the demands of the different movements. CMCw and CMCb values (>0.60) were found, demonstrating good to excellent reliability especially in joints with larger ranges of motion. The throwing task proved equally reliable, enhancing the universal application of the protocol. Compared to the literature, this study demonstrated higher reliability of the thorax, scapula and wrist joints. This was attributed to the highly standardized procedure and the implementation of recent methodological advancements. In conclusion, ELEPAP protocol was proved a reliable tool to analyze UL kinematics.

Ulomoides dermestoides (Fairmaire, 1893) is a beetle used in alternative medicine treatments in some South American countries. The objective of this study was to evaluate the cytotoxic and genotoxic effects of phenolic fractions (PF) from U. dermestoides. The PF were separated from crude extracts in acetone (PFAc) and ethanol (PFEtOH). The total phenolic content (TPC) was determined by Folin-Ciocalteu test. Volatile and semi-volatile compounds presents in crude extracts were identified by GC-MS; moreover, phenolic fractions were analyzed by HPLC-MS. The cellular viability, after exposition to phenolic fractions, was determined by Trypan blue exclusion test and MTT reduction assay on immortalized human keratinocyte cell line (HaCat); the degree of DNA damage was detected by alkaline comet-DNA assay. The TPC in PFAc and PFEtOH were: 11.34±0.88 mgGAE/g and 6.52±1.28 mgGAE/g, respectively (mean.dif: 4.951; p value = 0.0000). In both samples, HPLC-MS showed a pseudo-molecular ion [M-H]− at m/z 153, tentatively identified as protocatechuic acid. The results of cytotoxic assays suggest that the viability of HaCat cells depends on the concentration and exposure time of each treatment. Furthermore, the comet assay revealed moderate genotoxic effect after 48 hours of exposure to PFAc (40 to 160 μg.mL−1); cytotoxic/genotoxic activity of this fraction could be related to the higher phenol contents.Ulomoides dermestoides (Fairmaire, 1893), es un escarabajo usado en medicina alternativa en algunos países de Sudamérica. El objetivo de este estudio fue evaluar el efecto citotóxico y genotóxico de fracciones fenólicas (FF) de extractos de U. dermestoides. Las FF se separaron desde extractos acetónicos (FFAc) y etanólicos (FFEtOH). El contenido de fenoles totales (CFT) se determinó mediante ensayo de Folin-Ciocalteu. Compuestos volátiles y semi-volátiles, presentes en los extractos crudos, se identificaron mediante CG-EM; por otra parte, las FF se analizaron por HPLC-EM. La viabilidad celular, después de exposición a las FF se determinó mediante la prueba de exclusión con azul de tripano y el ensayo de reducción con MTT, usando la línea celular de queratinocitos humanos inmortalizados (HaCat); el grado de daño en el ADN se detectó mediante el ensayo de ADN-cometa alcalino. CFT en FFAc y FFEtOH fueron: 11,34±0,88 mgAGE/g y 6,52±1,28 mgAGE/g, respectivamente (dif.media: 4,951; p value = 0.0000). En ambas muestras, HPLC-EM mostró un ion pseudo-molecular [M−H]− a 153m/z, identificado tentativamente como ácido protocateuico. Los resultados de los ensayos de citotoxicidad sugieren que la viabilidad de células HaCat depende de la concentración y el tiempo de exposición a cada tratamiento. Además, el ensayo cometa reveló efecto genotóxico moderado después de 48 h de exposición a FFAc (40 a 160 μg.mL−1). La actividad citotóxica/genotóxica de esta fracción podría estar relacionada con el contenido más alto de fenoles.

This study describes the reliability of a clinically oriented model for three-dimensional movement analysis of head and trunk movements in children with spastic diplegia. The model consists of five rigid segments (head, thorax, pelvis, shoulder line, spine) and includes a detailed analysis of spinal segmental movements. Within and between session reliability during gait was tested in 10 children with spastic diplegia (6-14 yrs). Reliability of discrete parameters was assessed with the intraclass correlation coefficient (ICC) and similarity of thorax and pelvis waveforms with the coefficient of multiple correlation (CMC). Measurement errors were calculated for all parameters (SEM, sigma). Results indicated acceptable within and between session reliability of discrete parameters for thorax, pelvis, shoulder line, angle of kyphosis and the majority of the spinal segmental angles, reflected by low SEMs (<4 degrees) and most ICCs > 0.60. Within and between session waveform errors were below 4 degrees. CMCs ranged from poor to very good, with highest values for movements in the frontal and transversal planes. The angle of lordosis showed lower between session reliability for several discrete parameters, although waveform errors were still below 5 degrees. Head parameters showed lower overall reliability. The results of this study support the reliability of the proposed model. Head kinematic parameters should be interpreted with caution, due to difficulties in standardization. Accurate palpation of the spinal markers,, especially the lumbar spine, is critical and demands thorough training of the assessor. (C) 2012 Elsevier B.V. All rights reserved.

This study uses a recently developed trunk model to determine which head and trunk kinematic parameters differentiate children with spastic diplegia from typically developing (TD) children while walking. Differences in head and trunk parameters in relation to the severity of the motor involvement (GMFCS levels) were additionally examined. The trunk model consisted of five segments (pelvis, thorax, head, shoulder line, spine). Discrete kinematic parameters (ROM, mean position) and angular waveforms were compared between 20 children with spastic diplegia (age 9.8 years±2.9 years; GMFCS I: n=10, GMFCS II: n=10) and 20 individually age-matched TD children (9.7 years±3 years). A new measure for overall trunk pathology, the trunk profile score (TPS), was proposed and included in the comparative analysis. Compared to TD children, children with GMFCS II showed a significantly higher TPS and increased ROM for pelvis tilt, for thorax and head in nearly all planes, and the angle of kyphosis. In children with GMFCS I, only ROM of thorax lateral bending was significantly increased. Sagittal ROM differentiated best between GMFCS levels, with higher ROM found in children with GMFCS II. Current results provide new insights into head and trunk kinematics during gait in children with spastic diplegia.