Gait in adolescent idiopathic scoliosis: energy cost analysis

Rehabilitation and Physical Medicine Unit, Unité de Réadaptation, Université catholique de Louvain, Tour Pasteur 5375, Avenue Mounier 53, 1200, Brussels, Belgium.
European Spine Journal (Impact Factor: 2.47). 05/2009; 18(8):1160-8. DOI: 10.1007/s00586-009-1002-0
Source: PubMed

ABSTRACT Walking is a very common activity for the human body. It is so common that the musculoskeletal and cardiovascular systems are optimized to have the minimum energetic cost at 4 km/h (spontaneous speed). A previous study showed that lumbar and thoracolumbar adolescent idiopathic scoliosis (AIS) patients exhibit a reduction of shoulder, pelvic, and hip frontal mobility during gait. A longer contraction duration of the spinal and pelvic muscles was also noted. The energetic cost (C) of walking is normally linked to the actual mechanical work muscles have to perform. This total mechanical work (W(tot)) can be divided in two parts: the work needed to move the shoulders and lower limbs relative to the center of mass of the body (COM(b)) is known as the internal work (W(int)), whereas additional work, known as external work (W(ext)), is needed to accelerate and lift up the COM(b) relative to the ground. Normally, the COM(b) goes up and down by 3 cm with every step. Pathological walking usually leads to an increase in W (tot) (often because of increased vertical displacement of the COM(b)), and consequently, it increases the energetic cost. The goal of this study is to investigate the effects of scoliosis and scoliosis severity on the mechanical work and energetic cost of walking. Fifty-four female subjects aged 12 to 17 were used in this study. Thirteen healthy girls were in the control group, 12 were in scoliosis group 1 (Cobb angle [Cb] < or = 20 degrees), 13 were in scoliosis group 2 (20 degrees < Cb < 40 degrees), and 16 were in scoliosis group 3 (Cb > or = 40 degrees). They were assessed by physical examination and gait analysis. The 41 scoliotic patients had an untreated progressive left thoracolumbar or lumbar AIS. During gait analysis, the subject was asked to walk on a treadmill at 4 km h(-1). Movements of the limbs were followed by six infrared cameras, which tracked markers fixed on the body. W(int) was calculated from the kinematics. The movements of the COM(b) were derived from the ground reaction forces, and W(ext) was calculated from the force signal. W(tot) was equal to W(int) + W(ext). Oxygen consumption VO2 was measured with a mask to calculate energetic cost (C) and muscular efficiency (W(tot)/C). Statistical comparisons between the groups were performed using an analysis of variance (ANOVA). The external work (W(ext)) and internal work (W(int)) were both reduced from 7 to 22% as a function of the severity of the scoliosis curve. Overall, the total muscular mechanical work (W(tot)) was reduced from 7% to 13% in the scoliosis patients. Within scoliosis groups, the W(ext) for the group 1 (Cb > or = 20 degrees) and 2 (20 < or = Cb < or = 40 degrees) was significantly different from group 3 (Cb > or = 40 degrees). No significant differences were observed between scoliosis groups for the W(int). The W(tot) did not showed any significant difference between scoliosis groups except between group 1 and 3. The energy cost and VO2 were increased by around 30%. As a result Muscle efficiency was significantly decreased by 23% to 32%, but no significant differences related to the severity of the scoliosis were noted. This study shows that scoliosis patients have inefficient muscles during walking. Muscle efficiency was so severely decreased that it could be used as a diagnostic tool, since every scoliosis patient had an average muscle efficiency below 27%, whereas every control had an average muscle efficiency above 27%. The reduction of mechanical work found in scoliotic patients has never been observed in any pathological gait, but it is interpreted as a long term adaptation to economize energy and face poor muscle efficiency. With a relatively stiff gait, scoliosis patients also limit vertical movement of the COM(b) (smoothing the gait) and consequently, reduce W(ext) and W(int). Inefficiency of scoliosis muscles was obvious even in mild scoliosis (group 1, Cb < 20 degrees) and could be related to the prolonged muscle contraction time observed in a previous study (muscle co-contraction).

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Available from: Christine Detrembleur, Jul 30, 2015
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    • "compute the joint center locations (Cartesian coordinates) of the pelvis, the hip, the knee and the ankle as proposed by Davis et al., 1991[4]. Then, from the Cartesian coordinates of the joint centers, the joint coordinates q, are numerically determined by a global optimisation method (GOM) as proposed by Lu et al., 1999[4] that estimates the joint coordinates of the multibody model that best fit the experimental joint centers positions [1]. The optimal pose of the multibody model is computed for each data frame such that the difference between the experimental and model-determined marker coordinates is globally minimized in a least squares sense. "
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    ABSTRACT: Introduction: The quantification of internal joint efforts could be essential in the development of rehabilitation tools for patients with musculo-skeletal pathologies, such as scoliosis. In this context, the aim of this study was to compare the hips joint mediolateral forces during gait, between healthy subjects and adolescents with left lumbar or thoracolumbar scoliosis (AIS), categorized by their Cobb angle (CA). Material and methods: Twelve healthy subjects, 12 AIS with CA between 20° and 40° and 16 AIS in pre-operative condition (CA : > 40°) walked at 4 km/h on an instrumented treadmill. The experimental set-up include six infrared cameras allow the computation of the tridimensional (3D) angular displacement and strain gauges located under the motor-driven treadmill allow the computation of ground reaction forces (GRF). The hips joint mediolateral forces were calculated using a 3D inverse dynamic of human body. One-way ANOVA was performed for the maximum, the minimum and the range of medio-lateral forces at each joint of the lower limbs. When appropriate, a Tukey's post hoc was performed to determine the differences. Results: The mediolateral forces were significantly lower at the right hip for AIS with CA between 20° and 40° compared to healthy subject. Conclusion: The spinal deformation leads to a reduced medio-lateral force at the right hip, which could gradually change the scheme of postural adjustments for AIS during gait. Further research on the quantification of the joint lower limb efforts should include the knee and ankle joints to evaluate the impact of spinal deformation on the lower limb dynamic behaviour in AIS patients.
    The 10th Meeting of the International Research Society of Spinal Deformities, Sapporo, Japan; 06/2014
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    • "During step initiation, total movement duration is systematically longer for AIS patients than for healthy subjects. This relative slowness can be associated to an increase in electromyography activity [30], energy production [31] and displacement of GRF and CP during movement [10] [22] [41]. The slowing down of the movement is at its most visible when the task is unusual for the patient [13] [32]. "
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    ABSTRACT: The dynamics behavior of patients with idiopathic scoliosis obviously requires some biomechanical compensatory strategies. Our objective is to analyze the ground reaction forces (GRF) exerted during gait initiation in order to determine the dynamic consequences of idiopathic scoliosis. Ten adolescent girls suffering from idiopathic scoliosis with a right thoracic curvature (Cobb>15°) and 15 healthy adolescents participated in this study. Two force plates were used to record the ground force evolution for the right and left limbs tested during gait initiation. Whichever limb was used to initiate gait, gait initiation duration was found to be significantly longer in persons with scoliosis than in healthy subjects. In the scoliosis group (SG), the impulses, occurrences and forces values were also greater than in healthy subjects. Under the stance foot, the anteroposterior and vertical forces were always increased. Under the swing foot, the SG showed the same characteristics associated to decreased mediolateral impulses parameters. Even greater differences were observed between these two groups in terms of peak occurrences during left-limb gait initiation. The intragroup comparisons only unveiled very few differences between the two limbs for the control group (CG), whereas significantly higher values were recorded for the group of scoliosis patients when gait was initiated with the left limb rather than with the right one. For patients with scoliosis specific dynamic behavior adjustment are made during gait initiation patterns, for both limbs in order to maintain balance during gait to compensate for their spine deformation. Patients with scoliosis always showed slower dynamic patterns than healthy controls. These results show the importance of including specific evaluation and dynamic physical rehabilitation for patients with idiopathic scoliosis.
    Annals of physical and rehabilitation medicine 08/2010; 53(6-7):372-86. DOI:10.1016/
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    • "In 1994 Arosson stated that the type of scoliosis that occurs in patients with FRDA more closely resembles idiopathic scoliosis, which includes a more severe rotation component than scoliosis secondary to neuromuscular causes [1], this fact has been recently argued by Milbrandt, who reported that curve patterns are variable and do not necessarily resemble idiopathic curves [22]. Scoliosis patients have inefficient muscles during walking, this reduction of mechanical work is interpreted as a long term adaptation to economize energy and face poor muscle efficiency but it has never been observed in any pathological gait [20], seeming unlikely that scoliosis may lead to the FRDA ataxic gait. "
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    ABSTRACT: This report describes two families who presented with autosomal recessive ataxia. By means of Polymerase Chain Reaction (PCR) molecular testing we identified expansions in the gene encoding Frataxin (FTX) that is diagnostic of Friedreich ataxia. A history of reproductive loss in the two families, prominent scoliosis deformity preceding the onset of ataxic gait, the presence of a sensitive axonal neuropathy, as well as the common origin of ancestors are unusual features of these families. These cases illustrate the importance of molecular diagnosis in patients with a recessive ataxia. The origin of the expanded gene and the GAA repeat size in the normal population are issues to be further investigated. The molecular diagnosis of Friedreich ataxia is now established in Cuba.
    Neuroscience Letters 03/2010; 472(2):85-9. DOI:10.1016/j.neulet.2010.01.045 · 2.06 Impact Factor
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