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La evaluación de la marcha en cinta caminadora puede resultar relevante para la toma de decisiones clínicas. No obstante, factores demográficos como la edad y el IMC pueden alterar la interpretación de los resultados. Nuestro objetivo fue obtener variables espacio- temporales, energéticas y costo de transporte durante la velocidad autoseleccionada en cinta caminadora para una muestra representativa de adultos uruguayos (n=28) y evaluar si diferentes rangos de edades e IMC pueden ser factores a tener en cuenta en pruebas clínicas donde se consideren dichas variables. Participaron 17 hombres y 11 mujeres (39,3 ± 14,8 años, 75,9 ± 12,5 kg, 1,74 ± 0,09 m, IMC 25,2 ± 4,06). Se realizó una reconstrucción 3D del movimiento en forma sincronizada con el consumo energético. Se obtuvieron valores de referencia y luego de agrupar los participantes según su IMC y rango de edad se compararon los datos mediante test de t (p≤0.05). Los resultados revelaron discrepancias significativas en las medidas espacio-temporales y energéticas de los adultos uruguayos al caminar en cinta con respecto a la literatura. La marcha difiere entre adultos jóvenes y de mediana edad en su velocidad autoseleccionada (p=0,03), longitud de zancada (p=0,01), trabajo mecánico externo (<0,001) y recuperación de energía mecánica (0,009), destacando la importancia de considerar la edad en evaluaciones clínicas. El IMC no influyó significativamente en estas variables. Estos hallazgos subrayan la necesidad de ajustar las interpretaciones de las pruebas clínicas de la marcha sobre cinta caminadora en adultos uruguayos de mediana edad (45 a 65 años).

Treadmill gait assessment can be relevant for clinical decision-making. However, demographic factors such as age and BMI may alter result interpretation. Our aim was to obtain spatiotemporal, energetic, and cost of transport variables during self-selected treadmill walking speed for a representative sample of Uruguayan adults (n=28) and to assess if different age ranges and BMI could be factors to consider in clinical tests involving these variables. Seventeen men and eleven women participated (39.3 ± 14.8 years, 75.9 ± 12.5 kg, 1.74 ± 0.09 m, BMI 25.2 ± 4.06). A synchronized 3D motion reconstruction was performed with energy consumption. Reference values were obtained and data were compared using t-tests (p≤0.05), after grouping participants by BMI and age range. Results revealed significant discrepancies in spatiotemporal and energetic measures of Uruguayan adults walking on the treadmill, compared to the literature. Gait differed between young and middle-aged adults in their self-selected speed (p=0.03), stride length (p=0.01), external mechanical work (p<0.001), and mechanical energy recovery (0.009), emphasizing the importance of considering age in clinical evaluations. BMI did not significantly influence these variables. These findings underscore the need to adjust interpretations of treadmill gait clinical tests in middle-aged Uruguayan adults (45 to 65 years).

A avaliação da marcha na esteira pode ser relevante para a tomada de decisões clínicas. No entanto, fatores demográficos como idade e IMC podem alterar a interpretação dos resultados. Nosso objetivo foi obter variáveis espaço-temporais, energéticas e custo de transporte durante a velocidade de caminhada autoselecionada na esteira para uma amostra representativa de adultos uruguaios (n = 28) e avaliar se diferentes faixas etárias e IMC podem ser fatores a serem considerados em testes clínicos que envolvam essas variáveis. Dezessete homens e onze mulheres participaram (39,3 ± 14,8 anos, 75,9 ± 12,5 kg, 1,74 ± 0,09 m, IMC 25,2 ± 4,06). Foi realizada uma reconstrução tridimensional do movimento sincronizada com o consumo de energia. Foram obtidos valores de referência e os dados foram comparados usando testes t (p≤0,05), após agrupar os participantes por IMC e faixa etária. Os resultados revelaram discrepâncias significativas nas medidas espaço-temporais e energéticas dos adultos uruguaios ao caminhar na esteira, em comparação com a literatura. A marcha diferiu entre adultos jovens e de meia-idade em sua velocidade autoselecionada (p=0,03), comprimento da passada (p=0,01), trabalho mecânico externo (<0,001) e recuperação de energia mecânica (0,009), destacando a importância de considerar a idade em avaliações clínicas. O IMC não influenciou significativamente essas variáveis. Esses achados destacam a necessidade de ajustar as interpretações dos testes clínicos de marcha na esteira em adultos uruguaios de meia- idade (45 a 65 anos).

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With the improvement in survival of patients undergoing knee reconstructive surgeries, the functional parameter became widely studied heading optimize and minimize motor sequelae. In patients undergoing knee endoprosthesis, proximal tibial or distal femoral resections affect the functioning of the knee extensor mechanism, with possible repercussions on gait. Seventeen patients were selected, divided into two groups, undergoing distal femoral or proximal tibial resection, and gait analysis examination was performed. Changes in gait velocity, cadence, step length, and alterations in the support and balance phase were observed. No major statistically significant differences were found in the kinetic and kinematic parameters between the operated groups. The study corroborates that although tibial resections have a higher theoretical risk of compromising the extensor mechanism, such data were not observed in the analyzed sample.

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Given the high morbidity related to the progression of gait deficits in spinocerebellar ataxias (SCA), there is a growing interest in identifying biomarkers that can guide early diagnosis and rehabilitation. Spatiotemporal parameter (STP) gait analysis using inertial measurement units (IMUs) has been increasingly studied in this context. This study evaluated STP profiles in SCA types 3 and 10, compared them to controls, and correlated them with clinical scales. IMU portable sensors were used to measure STPs under four gait conditions: self-selected pace (SSP), fast pace (FP), fast pace checking-boxes (FPCB), and fast pace with serial seven subtractions (FPS7). Compared to healthy subjects, both SCA groups had higher values for step time, variability, and swing time, with lower values for gait speed, cadence, and step length. We also found a reduction in speed gain capacity in both SCA groups compared to controls and an increase in speed dual-task cost in the SCA10 group. However, there were no significant differences between the SCA groups. Swing time, mean speed, and step length were correlated with disease severity, risk of falling and functionality in both clinical groups. In the SCA3 group, fear of falling was correlated with cadence. In the SCA10 group, results of the Montreal cognitive assessment test were correlated with step time, mean speed, and step length. These results show that individuals with SCA3 and SCA10 present a highly variable, short-stepped, slow gait pattern compared to healthy subjects, and their gait quality worsened with a fast pace and dual-task involvement.

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People with Parkinson's disease (PD) face disruptions in arm swing (AS) motion during walking, including a reduction in amplitude and an increase in asymmetry. Both conditions are detrimental to gait performance. Nordic walking (NW) is a walking modality that uses poles and can positively affect the parameters of AS. This study aims to compare an NW with a free walking (FW) protocol and investigate its effects on AS asymmetry, AS amplitude and gait parameters in people with PD. Twenty-eight people with PD, stages 1-3 on the Hoehn and Yahr Scale, will be randomly assigned to the NW training group (n=14) or the FW training group (n=14). The primary outcomes are amplitude asymmetry of AS (%) and AS amplitude (deg). We will also analyse temporospatial measurements during walking, functional mobility and quality of life. Blinded researchers will conduct evaluations at baseline (T0), postintervention (T1) and at 1 month follow-up (T2). Participants will complete 24 supervised NW or FW training sessions for 12 weeks. This is the first study to address the effects of NW on the asymmetry of AS, AS amplitude and its influence on gait parameters. We hypothesise that an NW programme in PD will reduce the asymmetry and increase the AS amplitude during gait to a greater extent than FW. The results of this study may provide new evidence to understand the effects of NW on gait in people with PD. The study was registered in ClinicalTrial.gov (NCT06342271).

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BACKGROUND AND OBJECTIVE: the use of 3D cameras for gait analysis has been highly questioned due to the low accuracy they have demonstrated in the past. The objective of the study presented in this paper is to improve the accuracy of the estimations made by robot-mounted 3D cameras in human gait analysis by applying a supervised learning stage. METHODS: the 3D camera was mounted in a mobile robot to obtain a longer walking distance. This study shows an improvement in detection of kinematic gait signals and gait descriptors by post-processing the raw estimations of the camera using artificial neural networks trained with the data obtained from a certified Vicon system. To achieve this, 37 healthy participants were recruited and data of 207 gait sequences were collected using an Orbbec Astra 3D camera. There are two basic possible approaches for training and both have been studied in order to see which one achieves a better result. The artificial neural network can be trained either to obtain more accurate kinematic gait signals or to improve the gait descriptors obtained after initial processing. The former seeks to improve the waveforms of kinematic gait signals by reducing the error and increasing the correlation with respect to the Vicon system. The second is a more direct approach, focusing on training the artificial neural networks using gait descriptors directly. RESULTS: the accuracy of the 3D camera to objectify human gait was measured before and after training. In both training approaches, a considerable improvement was observed. Kinematic gait signals showed lower errors and higher correlations with respect to the ground truth. The accuracy of the system to detect gait descriptors also showed a substantial improvement, mostly for kinematic descriptors rather than spatio-temporal. When comparing both training approaches, it was not possible to define which was the absolute best. CONCLUSIONS: supervised learning improves the accuracy of 3D cameras but the selection of the training approach will depend on the purpose of the study to be conducted. This study reveals the great potential of 3D cameras and encourages the research community to continue exploring their use in gait analysis.

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OBJECTIVE: To analyze and compare the efficacy of two selective dorsal rhizotomy (SDR) techniques with intraoperative neurophysiological monitoring, using instrumented three-dimensional gait analysis. INTRODUCTION: SDR is a common, irreversible surgical treatment increasingly used to address gait disturbances in children with chronic non-progressive encephalopathy by reducing spasticity. Various techniques have been used, which mainly differ in the percentage of rootlets selected for sectioning. A greater proportion of rootlets sectioned leads to a more effective reduction of spasticity; however, there is a potential risk of unwanted neurological effects resulting from excessive deafferentation. While there is evidence of the short- and long-term benefits and complications of SDR, no studies have compared the effectiveness of each technique regarding gait function and preservation of the force-generating capacity of the muscles. MATERIALS AND METHODS: Instrumented three-dimensional gait analysis was used to evaluate two groups of patients with spastic cerebral palsy treated by the same neurosurgeon in different time periods, initially using a classic technique (cutting 50% of the nerve rootlets) and subsequently a conservative technique (cutting no more than 33% the nerve rootlets). RESULTS: In addition to an increase in knee joint range of motion (ROM), in children who underwent SDR with the conservative technique, a statistically significant increase (p = 0.04) in the net joint power developed by the ankle was observed. Patients who underwent SDR with the conservative technique developed a maximum net ankle joint power of 1.37 ± 0.61 (unit: W/BW), whereas those who were operated with the classic technique developed a maximum net ankle joint power of 0.98 ± 0.18 (unit: W/BW). The conservative group not only showed greater improvement in net ankle joint power but also demonstrated more significant enhancements in minimum knee flexion during the stance phase and knee extension at initial contact. CONCLUSION: Our results show that both techniques led to a reduction in spasticity with a positive impact on the gait pattern. In addition, patients treated with the conservative technique were able to develop greater net ankle joint power, leading to a better scenario for rehabilitation and subsequent gait.

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Gait analysis in a laboratory may be expensive, time-consuming, and restricted to a controlled environment. Validated wearable technology may be an alternative to such analysis. However, wearable technologies should demonstrate reference values of a healthy population. Objective: To establish spatio-temporal gait reference values of an accelerometer (G-Walk) in a healthy Brazilian population. Methods: This is a cross-sectional study with 124 healthy subjects evaluated with G-Walk in the 6-minute and 10-meter walk tests (6MWT and 10MWT). Gait parameters of Velocity, Cadence, Distance, and gait symmetry variables were retrieved for analysis. Clinical and demographical characteristics were also collected and tested with simple linear regression as covariables of the gait characteristics. The bootstrapped 5th percentile of the gait parameter established the reference values. If a covariable influence was found, the reference values were established by subgroup analysis according to the covariable. Results: The study analyzed 114 subjects, mostly women (67.74%), aged 39.36 (SD 12.18). Height was a covariable of cadence for the 10MWT and cadence and stride length for the 6MWT. Age and sex combined were covariables of 6MWT velocity, and sex alone was a covariable of 6MWT. All reference values for symmetry were above 89%, velocity at the 10MWT was above 1.0m/s, and distance at the 6MWT was 354m and 359.5 for females and males, respectively. Conclusions: Our study generated reference values for spatio-temporal gait analysis with G-Walk of a population of a major urban area, considering the covariables of age, height, and sex.

Análises da marcha em laboratório tem custo elevado, demandando tempo e ambiente controlado. Wearables são equipamentos portáteis que podem ser alternativas aos laboratórios. Valores de referência podem determinar parâmetros para análises de marcha de pessoas com patologias. Objetivo: Estabelecer valores de referência espaço-temporais de um acelerômetro (G-Walk) em uma população saudável. Métodos: Trata-se de um estudo transversal com indivíduos saudáveis avaliados com G-Walk nos testes de caminhada de 6 minutos e de 10 metros (TC6 e TC10). Velocidade, cadência, distância e de simetria da marcha foram analisados. Características clínicas e demográficas também foram testadas com regressão linear simples como covariáveis das características da marcha. Os valores de referência foram estabelecidos pelo quinto percentil dos parâmetros por bootstrap e na presença de covariáveis demográficas, os valores foram estabelecidos por análise de subgrupos, de acordo com a covariável. Resultados: O estudo analisou 114 sujeitos, em sua maioria mulheres (67,74%), com idade de 39,36 (DP 12,18). A altura foi uma covariável da cadência do TC10 e da cadência e comprimento da passada do TC6. Idade e sexo combinados foram covariáveis da velocidade do TC6, e o sexo foi uma covariável do TC6. Todos os valores de referência para simetria foram superiores a 89%, a velocidade no TC10 foi superior a 1,0m/s e a distância no TC6 foi de 354m e 359,5m para mulheres e homens, respectivamente. Conclusões: Nosso estudo gerou valores de referência para análise espaço-temporal da marcha com o equipamento G-Walk em uma população de uma grande área urbana, considerando as covariáveis idade, altura e sexo.

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Introduction: Hereditary spastic paraplegias (HSPs) are a heterogeneous group of neurodegenerative diseases in which little is known about the most appropriate clinical outcome assessments (COAs) to capture disease progression. The objective of this study was to prospectively determine disease progression after 4.5 years of follow-up with different clinician-reported (ClinRO) and gait performance outcomes (PerFOs). Methods: Twenty-six HSP patients (15 SPG4, 5 SPG7, 4 SPG5, 2 SPG3A) participated in this single-center cohort study in which the ClinRO: Spastic Paraplegia Rating Scale; and the PerFOs: 10-meters walking test and timed-up and go (TUG), at self-selected and maximal walking speeds; Locomotor Rehabilitation Index; and 6-min walking test were performed at baseline and after 1.5 (18 patients) and 4.5 (13 patients) years. Results: In the 3-year interval between the second and third assessments, significant progressions were only found in PerFOs, while in the overall 4.5 years of follow-up, both PerFOs and ClinROs presented significant progressions. The progression slopes of COAs modeled according to the disease duration allowed the estimation of the annual progression of the outcomes and sample size estimations for future clinical trials of interventions with different effect sizes. TUG at maximal walking speed was the only COA capable of differentiating subjects with a worse compared to a stable/better impression of change and would require the smallest sample size if chosen as the primary endpoint of a clinical trial. Discussion: These findings indicate that both performance and clinician-reported outcomes can capture long-term progression of HSPs, with some PerFOs presenting greater sensitivity to change. The presented data are paramount for planning future disease-modifying and symptomatic therapy trials for this currently untreatable group of diseases.

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Background: The aim was to analyze changes in normal functional parameters of gait analysis by aging, sex, and body mass index (BMI). Methods: A cross-sectional study with a consecutive sample of asymptomatic subjects was performed between 2014 and 2020. Primary outcomes were time and force parameters (contact time and center of force [CoF] time), in the heel, midfoot, and metatarsal areas, measured using an in-office force platform. Results: A total of 156 subjects (312 feet) were included, including 67% of women with a mean age of 47 years. The mean of total contact time was similar in males and females (P = .695) and across BMI (P = .413). Contact time did not show differences by region (P = .648 heel, P = .286 midfoot, and P = .690 metatarsal). CoF time in the heel and metatarsal areas did not change between males and females (P = .288 and P = .879, respectively); meanwhile, it was different in midfoot (P = .002). Maximum force showed a reduction between sexes in the heel (P = .039) but did not in the midfoot and metatarsal areas. By age, differences were detected in the heel and metatarsal areas in females (P = .002 and P = .001) and the metatarsal area in males (P = .001). According to the age groups, total contact time increased in females (P = .001) but not in males (P = .018), and no differences were detected between foot areas. In females, CoF time did not change either foot areas or age groups. In males, CoF time values increased in the midfoot area in the older group (P = .001). Conclusion: Time variables did not change by foot region, independent of age, sex, and BMI. Heel maximum force decreased in females, probably linked to adaptive phenomena by aging. The midfoot remains stable, and acts as an undamaged "bridge." These parameters could be interpreted as normal in asymptomatic subjects. Level of Evidence: Level III, diagnostic and prognostic.

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Three-dimensional (3D) cameras used for gait assessment obviate the need for bodily markers or sensors, making them particularly interesting for clinical applications. Due to their limited field of view, their application has predominantly focused on evaluating gait patterns within short walking distances. However, assessment of gait consistency requires testing over a longer walking distance. The aim of this study is to validate the accuracy for gait assessment of a previously developed method that determines walking spatiotemporal parameters and kinematics measured with a 3D camera mounted on a mobile robot base (ROBOGait). Walking parameters measured with this system were compared with measurements with Xsens IMUs. The experiments were performed on a non-linear corridor of approximately 50 m, resembling the environment of a conventional rehabilitation facility. Eleven individuals exhibiting normal motor function were recruited to walk and to simulate gait patterns representative of common neurological conditions: Cerebral Palsy, Multiple Sclerosis, and Cerebellar Ataxia. Generalized estimating equations were used to determine statistical differences between the measurement systems and between walking conditions. When comparing walking parameters between paired measures of the systems, significant differences were found for eight out of 18 descriptors: range of motion (ROM) of trunk and pelvis tilt, maximum knee flexion in loading response, knee position at toe-off, stride length, step time, cadence; and stance duration. When analyzing how ROBOGait can distinguish simulated pathological gait from physiological gait, a mean accuracy of 70.4%, a sensitivity of 49.3%, and a specificity of 74.4% were found when compared with the Xsens system. The most important gait abnormalities related to the clinical conditions were successfully detected by ROBOGait. The descriptors that best distinguished simulated pathological walking from normal walking in both systems were step width and stride length. This study underscores the promising potential of 3D cameras and encourages exploring their use in clinical gait analysis.

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