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Changes in gait pattern in patients with scoliosis
Abstract
Introduction. Scoliosis is the most common orthopaedic disorder among children and adolescents thus constituting a serious social problem. 3D deformation of the spine changes the mechanics of the whole body. The aim of this work was to assess changes in gait pattern in patients with scoliosis. Material and methods. Patients: 25 girls aged 12-16 years with idiopathic scoliosis greater than 20 degrees, not treated earlier. Method: objective gait analysis using the system VICON 460 synchronized with dynamic electromyography system and dynamographic platform. Measured parameters: spatio-temporal, kinematic, surface EMG of selected limb and trunk muscles. Calculations were performed with Polygon software. Results. Decreased pelvic tilt was found in 90% of patients, together with an increased pelvic tilt range. In 2/3 of patients, the pelvis was obliqued in the frontal plane, and in the majority, the pelvis was rotated in the transverse plane with respect to the line of progression. The orientation of the hip joints in the frontal and transverse planes was incorrect in half of the patients, and the knees were slightly flexed at initial contact. In some patients, there was a diminished range of motion of the hip joints in the saggital plane, accompanied by an increased internal pelvic rotation at the initial contact. In all patients, the feet were dorsiflexed in the ankle joints in the swing phase, and in the transverse plane, there was an internal rotation of the feet with respect to the shank. In all patients, there was also an abnormal, asymmetrical activity of the trunk muscles, and of the greatest gluteal muscles. Conclusions. Scoliosis changes body mechanics and the orientation of the pelvis at least in one plane (in most cases - in all three planes). Compensatory mechanisms occur that may lead to further pathologies. The increased dorsiflexion of the feet in the swing phase was a surprising finding. As the maximum flexion of the knees in this phase is correct, the increased dorsiflexion could not have served as a compensatory mechanism helping in foot clearance.
... Four studies showed lower pelvic ROM in sagittal, frontal, and transverse planes for scoliosis patients than normal controls [6,10,26,32] (Table 2). However, 2 studies showed that the pelvic kinematics did not significantly differ between normal participants and AIS patients during walking [13,23]. ...
... Four studies showed lower hip ROM in sagittal [32,33], frontal [6], and transverse [6,29,32] planes for scoliosis patients than normal controls. However, other studies showed no difference in hip ROM in the sagittal [20] and coronal planes between the 2 groups [29]. ...
... Four studies showed lower hip ROM in sagittal [32,33], frontal [6], and transverse [6,29,32] planes for scoliosis patients than normal controls. However, other studies showed no difference in hip ROM in the sagittal [20] and coronal planes between the 2 groups [29]. ...
Background:
Adolescent idiopathic scoliosis (AIS) is a progressive growth disease that affects spinal anatomy, mobility, and left-right trunk symmetry. The disease can modify human gait.
Objective:
We aimed to review articles describing the measurement of gait parameters and energy consumption in AIS during walking without any intervention.
Study design:
Literature review.
Methods:
The search strategy was based on the Population Intervention Comparison Outcome method and included all relevant articles published from 1996 to 2015. Articles were searched in MEDLINE via PubMed, Science Direct, Google Scholar, and ISI Web of Knowledge databases.
Results:
We selected 33 studies investigating the effect of scoliosis deformity on gait parameters and energy expenditure during walking. Most of the studies concluded no significant differences in walking speed, cadence and step width in scoliosis patients and normal participants. However, patients showed decreased hip and pelvic motion, excessive energy cost of walking, stepping pattern asymmetry and ground reaction force asymmetry.
Conclusion:
We lack consistent evidence of the effect of scoliosis on temporal spatial and kinematic parameters in AIS patients as compared with normal people. However, further research is needed to assess the effect of scoliosis on gait and energy consumption.
... Gait is the most common of all human movements and it can be defined as a harmonious, energetically efficient activity resulting from a sequence of alternate lower limb steps [5]. Although scoliosis is located in the spine, present literature suggests that the step length [6][7][8][9], cadence [10] and velocity [11], hip, knee and ankle range of motion [7][8][9][12][13][14], loading and unloading [15], duration of trunk and gluteal muscle activation [6,7], magnitude of muscle force [15,16], energy cost and muscle efficiency [7][8][9]11] are affected. However, there is conflicting evidence regarding the effect of the condition on left and right lower limb asymmetries [3,7,[15][16][17]. ...
... The shorter stride length and longer stride time both reflect the slower speed of gait in the SG. A diminished step length and a slower speed of gait in scoliotic subjects has been reported in the literature on more than one occasion, not necessarily in combination [9,12,13]. Furthermore, during intra-group analysis, results indicate that SG subjects tended to be faster when stepping with the limb corresponding to the covexity side of the curve, which may signify that stepping with that limb is more challenging. This corresponds to GRF results which are discussed in the next section. ...
... Ample research is available on trunk musculature [1,8,12,18,19,31] in individuals with scoliosis. Trunk asymmetries lead to proprioception and mechanical dysfunction, which should be expressed in the gait pattern [1,7,15]. ...
Several studies indicate that the gait pattern of subjects suffering from scoliosis differs from the norm. However, there is conflicting evidence regarding the source of this discrepancy.
To evaluate lower limb asymmetries in selected gait variables.
Study design
A case–control study on lower limb asymmetries during gait which can be related to scoliosis.
31 subjects with scoliosis (Study Group - SG) and an equal comparative control sample (Control Group – CG) of subjects underwent objective gait analysis with the Vicon® motion caption system whilst walking at a comfortable speed along the gait laboratory walkway. Analysis was performed at three levels: (1) Asymmetry in the SG against asymmetry in the CG, (2) Difference in magnitude of asymmetry between the SG and CG, and (3) Global mean values in the SG vs. CG. The Paired Student T-Test was used for intra-group analysis whilst the Independent Student T-Test was used for inter-group analysis of the selected parameters, which include temporal parameters (stride length, stride time, step length, individual step speed, speed of gait, cadence, swing-to-stance ratio), ground reaction force (peak GRF values during Loading and Propulsion phases, vertical component only) and electromyography (peak EMG values and their time of onset, as a percentage of the gait cycle) of two lower limb muscles (Gastronemius and Vastus Medialis).
No intra-group variation was found to be significant. However, the speed of gait was found to be significantly slower (p = 0.03) in scoliotic subjects when compared to the norm, as a result of the shorter stride length (p = 0.002 and longer stride time (p = 0.001) in the SG. Furthermore, there was statistical significance in the time of onset of EMG peaks for the Lateral Gastrocnemius (p = 0.02) with regards to inter-group difference in magnitude of lower limb asymmetry and global mean values.
Scoliosis is a tri-planar deformity which has some impact on the gait pattern. This research study concludes that scoliotic subjects have a slower speed of gait due to a shorter stride length and a longer stride time, together with variations in the timing of muscle activation.
... The repetitive asymmetric movements during gait may increase the deformity of the spine and affect the whole body structure, change the position and the performance of other organs in the body such as lungs and heart in more severe cases (Costi et al. 2007;Janicki and Alman 2007). Gait studies on AIS have shown the presence of asymmetry in kinematics and kinetics parameters such as reduced shoulder, hip and pelvis motion in frontal plane, hip motion in transversal plane and knee motion in sagittal plane in adolescents with AIS compared to healthy controls (Syczewska et al. 2006;Mahaudens et al. 2009;Daryabor et al. 2017). Additionally, adolescents with AIS showed reduced step length, stance phase, increased energy expenditure and changes in load distribution during gait (Geissele et al. 1991;Mahaudens et al. 2009;Daryabor et al. 2017). ...
... This difference is also due to the sensitivity of the intervertebral efforts to the kinematics parameters (Raison et al., 2010;Kramers-de Quervain et al. 2004). Syczewska et al. showed that scoliosis changes body orientation and mechanics of the pelvis at least in one plane (Syczewska et al. 2006). These indicators can be implemented in a biofeedback tool. ...
... The repetitive asymmetric movements during gait may increase the deformity of the spine and affect the whole body structure, change the position and the performance of other organs in the body such as lungs and heart in more severe cases (Costi et al. 2007;Janicki and Alman 2007). Gait studies on AIS have shown the presence of asymmetry in kinematics and kinetics parameters such as reduced shoulder, hip and pelvis motion in frontal plane, hip motion in transversal plane and knee motion in sagittal plane in adolescents with AIS compared to healthy controls (Syczewska et al. 2006;Mahaudens et al. 2009;Daryabor et al. 2017). Additionally, adolescents with AIS showed reduced step length, stance phase, increased energy expenditure and changes in load distribution during gait (Geissele et al. 1991;Mahaudens et al. 2009;Daryabor et al. 2017). ...
... This difference is also due to the sensitivity of the intervertebral efforts to the kinematics parameters (Raison et al., 2010;Kramers-de Quervain et al. 2004). Syczewska et al. showed that scoliosis changes body orientation and mechanics of the pelvis at least in one plane (Syczewska et al. 2006). These indicators can be implemented in a biofeedback tool. ...
The intervertebral efforts, i.e., forces and torques, during gait have been recognized as influencing the progression of scoliosis, due to the mechanical modulations according to the Hueter-Volkmann Law. Therefore, these efforts are key variables for posture correction and to control the progression of scoliosis. Using the intervertebral efforts during gait for the clinical follow-ups has never been performed. For this, it would be necessary to identify amongst all these efforts the most relevant ones, which is the objective of this study. A previously developed dynamical model of the human body was used to compute the 3 D intervertebral efforts during the gait of 15 participants with adolescent idiopathic scoliosis (AIS) and 12 typically developed adolescents (TDA). Kolmogorov-Smirnov and Two-sample t-test were applied on the calculated intervertebral efforts and the graphs of intervertebral efforts were studied. Antero-posterior (AP) forces and torques and medio-lateral (ML) forces are the most relevant intervertebral efforts amongst the other efforts in adolescents with AIS during gait. Discussion: Gait analysis in adolescents with AIS based on the relevant intervertebral efforts could be an effective means to follow-up and evaluate the progression of scoliosis during their treatment period. This study highlights the most relevant intervertebral efforts of individuals with AIS during gait. As future work, the identified intervertebral efforts could be implemented in a quantified and visual feedback tool for therapeutic and performance evaluation or interactive sessions in physiotherapy, e.g., via video games for dynamic posture self-correction.
... Compared with the normal subjects, individuals with AIS have reduced frontal pelvis motion, decreased transversal hip motion, decreased sagittal hip motion, decreased frontal hip motion, and decreased sagittal knee motion. [7,[40][41][42] Mahaudens et al. [30] demonstrated that compared with an out-brace situation, the immediate in-brace situation in AIS subjects significantly decreased frontal pelvis (p < 0.001) and hip (p < 0.001) motions with a significant reduction of pelvis rotation (p ¼ 0.003) but without any change in the lower limb motions. When compared with healthy subjects, the AIS patients fitted with a brace had a 39% (p ¼ 0.04) reduction in transversal pelvis motion and a 23% (p ¼ 0.004) reduction in frontal hip motions. ...
... Scoliotic-associated changes in kinematic parameters produced a reduction in the hip and pelvic motions. [7,[40][41][42] The stiffness of the spinal deformity, the bilateral prolonged activation timing of the lumbar, and pelvic muscles may be effective on these changes. [7] Studies have demonstrated that during the gait of scoliotic subjects, the brace reduces frontal pelvis and hip motions as well as pelvic rotation when compared to the pre-brace situation. ...
Background:
Adolescent idiopathic scoliosis (AIS) is a progressive growth disease that affects spinal anatomy, mobility, and left-right trunk symmetry. As a consequence, AIS can modify human gait. Spinal orthoses are a commonly used conservative method for the treatment of AIS.
Objective:
This review evaluated the AIS spinal orthosis literature that involved gait and energy consumption evaluations.
Study design:
Literature review.
Method:
According to the population intervention comparison outcome measure methods and based on selected keywords, 10 studies met the inclusion criteria.
Results:
People with AIS who wore a spinal orthosis, compared with able-bodied participants, walked slower with decreased hip and pelvic movements, decreased hip mediolateral forces, ground reaction force asymmetry, and excessive energy cost. Pelvis and hip frontal plane motion decreased when wearing an orthosis. Hip and pelvis movement symmetry improved when using an orthosis. Ankle and foot kinematics did not change with orthotic intervention. People with AIS continued to have excessive energy expenditure with an orthosis.
Conclusion:
Spinal orthoses may be considered for improving the walking style, although energy cost does not decline following the orthotic intervention. Implications for Rehabilitations Problems related to scoliosis include reduced quality of life, disability, pain, postural alterations, sensory perturbations, standing instability and gait modifications. Wearing corrective spinal orthoses in AIS subjects produce a reduction in walking speed and cadence, increase in stride length and reduction of gait load asymmetry compared to without brace condition. Spinal orthoses do not decline excessive energy expenditure to walk versus without it.
... In our previous study [6] we found that the gait pattern of patients with two-level idiopathic scoliosis differed from that of their healthy peers. They walked with a decreased step length and pelvic tilt but increased range of pelvic motion in transverse plane. ...
... The gait variables which were dependent on the severity of the scoliosis or pelvic deformity had relatively high variability, therefore the ranges for the three groups overlapped. Nevertheless the results do demonstrate that the gait pathology present in scoliotic patients [2][3][4][5][6][7] increases with the severity of the spinal deformity and depends on the pelvic deformity. The results obtained by single gait variable dependence analysis are strongly supported by discriminant analysis, where two models are very high statistical significance (p < 0.001 in both cases). ...
Scoliosis is not only a spinal deformity, but also leads to the development of a pathological gait pattern. Nearly all studies examining walking in scoliotic patients report some degree of gait abnormality, however the results are somewhat contradictory. Therefore the aim of this study is to explore the relationship between gait pathology and degree of scoliotic deformity in a group of patients with idiopathic scoliosis. Sixty three females with idiopathic scoliosis, aged between 12 and 17 participated in the study. They were not treated previously, neither surgically, nor conservatively. They underwent objective gait analysis with a VICON 460 system. Data for the following parameters were analysed: gait velocity, cadence, step length, pelvic tilt, pelvic retraction, pelvic range of motion in the transverse plane, pelvic obliquity, hip and knee range of motion in the sagittal plane, knee flexion at initial contact, ankle dorsiflexion in swing, foot progression angle. Additionally a Gillette Gait Index (GGI) was calculated. Prior to the gait analysis all patients underwent a clinical examination, an X-ray, clinical tests and anthropometric measurements. In conclusion our results indicate that the gait pathology of the patients with idiopathic thoraco-lumbar (i.e. double curve) scoliosis depends on the severity of the spinal deformity and the type of pelvic deformity.
... Although the sample of patients was relatively large (41 patients) and could be divided into three subgroups according to the severity of the deformation, no dependence of the kinematic parameter on the severity of the deformation was found. Our previous study [7] on the gait pathology in scoliotic patients was performed on strictly selected subjects, thus forming the homogeneous group. We found that the gait pattern in scoliotic patients differed from the gait pattern of the healthy subjects. ...
... The number of gait parameters selected for this study were limited. Based on our previous study [7] the authors selected only these parameters which differed from the reference normal data in more than 50% of patients, thus could be characteristic of the gait pattern of scoliotic patients. These parameters could be regarded as a good representation of the scoliotic pathological gait, as they exhibit high inter-trial and test–retest reliability [11]. ...
The gait pattern in scoliotic patients differed from the gait pattern of the healthy subjects. The aim of the present paper was to describe the dependence of the gait pathology on the severity of the spinal deformity. Thirty five patients with confirmed scoliosis participated in the study. All patients underwent the clinical examination (X-ray and anthropometric measurements) as well as the objective gait analysis. Based on clinical examination the patients were divided into subgroups according to six different criteria. The gait parameters were compared between these subgroups. Most of the assessed variables do not depend on the clinical variables, describing the severity of the spinal deformity. The two gait parameters which depend on the clinical variables are pelvic obliquity and step length. The results show that the obliquity increases with the Cobb angle. The step length decreases with the increasing Cobb angle and with the sum of angles describing the spinal deformity in sagittal and frontal planes. The evaluation of the gait pattern of scoliotic patients and the establishment of its dependence on the spinal deformity are of importance for the treatment of these subjects.
... It has been confirmed in several studies that the step length, cadence, velocity, range of motion of the pelvis, hip, knee, and ankle, muscle efficiency, and energy cost are affected [8], [17], [25], [19], [26]. However, some studies showed that patients with AIS had typically poor balance control, but the gait pattern did not differ from the healthy control group [3]. ...
Purpose
This study evaluated changes in selected spatiotemporal and kinematic gait parameters and balance in girls with Adolescent idiopathic scoliosis (AIS) with and without the Chêneau brace.
Methods
15 subjects with scoliosis wearing the Chêneau brace and an equal comparative control group underwent objective gait analysis with the 3D BTS motion caption system. Balance assessment was done with the Kistler platform. The analysis was performed at comparison of gait and balance parameters in patients with scoliosis in two conditions: with and without the Chêneau brace during the study.
Results
Statistically significant differences occurred in many spatiotemporal and kinematic parameters both for the AIS group with and without the Chêneau brace and in the AIS group with and without the Chêneau brace as compared to the control group. When comparing adolescents with AIS with and without the Chêneau brace, statistically significant differences were noted in the COP-X amplitude and in the path length in trials with closed eyes. Compared to the control group the following differences were statistically significant: the value of the the COP-Y amplitude during the trial with closed eyes, both with and without the Chêneau brace, and the Equivalent area of the COP during the trial with closed eyes with the Chêneau brace.
Conclusions
The Chêneau brace in patients with juvenile idiopathic scoliosis affects the level of selected balance and gait parameters.
... [9][10][11][12] Previous studies have shown that idiopathic scoliosis may alter the relative motion between body segments and produces a pathological gait pattern. [12][13][14][15][16][17][18][19][20][21] However, in the study of Chen et al., 22 it was concluded that the gait pattern of idiopathic scoliotic patients is similar to that of normal subjects. In this study, gait pathology was assessed based on spatiotemporal gait parameters; angular motion of the shoulders, trunk, pelvis, and lower-limb joints; and ground reaction force components. ...
Background
Previous research using gait pathology in patients with adolescent idiopathic indicates gait asymmetry based on ground reaction force components, lower-limb joints, pelvic, and trunk excursion during level walking. However, evidence evaluating the effect of trunk bracing on these parameters and on symmetry of gait pattern is scarce. The aims of this study are to evaluate the range of motion of lower-limb joints as well as pelvic and trunk segments and to assess the symmetry of gait pattern in adolescents with idiopathic scoliosis when compared with normal subjects. The effect of trunk bracing on the aforementioned parameters is also investigated.
Method
Ten scoliotic patients (eight girls and two boys) aged between 10 and 16 years and ten normal subjects with comparable age, height, and weight were recruited for this study.
A three-dimensional gait analysis system and Visual3D software were used to evaluate joint range of motion of scoliotic patients in two conditions: with and without brace, as well as from the normal subjects without brace. The symmetry of gait was assessed by use of the asymmetry index.
Results
The results of this study showed that scoliosis led to a decrease in frontal hip, knee, pelvic, and trunk motion. Moreover, it was shown that patients with scoliosis walk with more restricted knee, pelvic, and trunk motions in the sagittal plane. There was no significant difference between the asymmetry index value between walking with and without orthosis. In our study, it was shown that the only discrepancy in the gait pattern between scoliotic patients and healthy subjects is an asymmetrical pelvic movement in the frontal plane.
Conclusion
The results of this study demonstrate that trunk bracing influences the pelvic range of motion and improved symmetry of range of motions of the pelvis. However, bracing did not influence the kinematic parameters of hip, knee, and ankle joints significantly.
... 13,14 Previous research on gait in AIS patients examined the movement of body segments, spatiotemporal gait parameters and ground reaction force components. 5,6,8,[14][15][16][17][18] In studies that assessed the ground reaction force to evaluate the symmetry of gait in AIS patients concluded that patients with this condition had gait asymmetry in vertical, anteroposterior and mediolateral directions 13,18,19 that may be related to changes in global postural control during gait. 18 Based on the results of various studies, the mediolateral forces subjected to variations depends on severity. ...
Background: Adolescent Idiopathic Scoliosis (AIS) leads to change between body segments, right-left trunk symmetry and produce pathological gait pattern. The influence of trunk bracing on symmetry of ground reaction force components and loading rate on idiopathic scoliosis has not been well documented. Therefore, the aim of this study was to examine the effect of trunk bracing on symmetry of forces in adolescent with idiopathic scoliosis. Method: A total of 10 patients with AIS and 10 healthy subjects with comparable age, height and weight were recruited in this study. The force applied on the right and left sides in both groups of subjects were recorded by use of a Kistler force plate while walking. The peak of the vertical force (the first and second peaks) and the force applied on the leg in anteroposterior direction (progression and breaking forces) and mediolateral force were collected in this study. Results: The results of this study showed that there was a significant difference between the asymmetry index of anteroposterior force of normal and scoliotic patients (p = 0.05). Moreover, trunk bracing decreased asymmetry index of loading rate of scoliotic patients significantly (p = 0.042). There was no significant difference between the other examined kinetic variables. Conclusion: There are some degrees of asymmetry between the forces applied on the leg in scoliotic subjects. Orthosis decreased the forces applied on the leg in patients with scoliosis. Clinicians are to be aware of these findings as orthotic devices may be of value to patients with idiopathic scoliosis.
This study aimed to compare the results of gait analysis of adolescent idiopathic scoliosis (AIS) patients and healthy subjects through a meta-analysis of the existing research. The Medline (via PubMed), Cochrane, Scopus, and Embase databases were searched for studies that evaluated the findings of AIS, including spatiotemporal parameters (walking speed, step length, cadence, and stance phase duration), segmental kinematics (frontal, sagittal, and transverse pelvic motion), and electromyographic variables (electrical activity of the quadratus lumborum, erector spinae, and gluteus medius), and were published between January 2000 and May 2020. Two authors extracted the data independently, and any discrepancies regarding the eligibility of retrieved studies were resolved by a consensus. Six comparative studies were identified and subsequently analyzed. It was found that the stance phase and frontal pelvic motion were significantly reduced in AIS patients compared with healthy controls. No significant difference was observed for speed, step length, cadence, sagittal pelvic motion, and transverse pelvic motion. The electrical activity durations of the quadratus lumborum, erector spinae, and gluteus medius were significantly increased in the AIS group compared with healthy subjects. Despite the heterogeneity, a limited number of meta-analyses showed reduced stance phase and frontal pelvic motion with prolonged activation timing of the quadratus lumborum, erector spinae, and gluteus medius muscles. Hence, further large-scale, multicenter studies are required to validate our results.
* Three-dimensional motion analysis is necessary to bridge the gap between static spinal radiographic alignment and dynamic body balance in the setting of pediatric and adult spinal deformities.
* Lessons learned from gait analysis in patients with adolescent idiopathic scoliosis may be applicable to patients with adult spinal deformity, with the potential to improve our understanding of dynamic compensatory mechanisms, the hip-spine complex, and proximal junctional kyphosis.
* Dynamic and functional assessments such as gait analysis are expected to be the future of pediatric and adult spinal deformity research, with potential clinical and surgical applications.
Apart from clinical signs and symptoms, a trauma or disease will often give rise to a dysfunction that impairs the performance of activities of daily living. An optimal rehabilitation program should be based on a thorough understanding of the patients basic problems, including functional difficulties. This is made possible not only by routine clinical examinations, but also by special tests and recently introduced functional evaluations using professional apparatus. The results of these examinations also enable evaluation of treatment progress. The aim of the paper was to review the issue of functional testing with respect to basic problems of disability and the planning and monitoring of rehabilitation. The consecutive parts of the paper discuss functional testing on the basis of examples of common postural and locomotor problems (impairments and limitations). Emphasis is placed on the need of objective examinations and possibilities for quantifying test results. Attention is also drawn to the ability to place various manifestations of disease within cause-and-effect chains and the necessity of appropriate interpretation of test results.
Bac. Compensatory changes in the spatial arrangement of body segments are a characteristic sign of the development of scoliosis. Additional external loads may lead to intensification of existing signs in both static and dynamic conditions. The manner of carrying heavy objects on a daily basis is a key factor here. The aim of this paper was to assess some changes in static and dynamic parameters associated with carrying the school pack in children with scoliosis. Material and methods. Thirty-six children aged 8-15 years with low-grade scoliosis were examined. Foot pressure in static conditions was recorded using a force platform without additional loading, and with a 4 kg external load carried in a symmetric or asymmetric manner. Three-dimensional gait analysis was also performed using a Zebris®system. Parameters were registered during walking without and with the external load. Results. Signs of asymmetric foot pressures were observed that intensified during external loading of spine (both symmetric and asymmetric). These changes were not clearly related to body posture parameters. There were also signs of gait asymmetry that intensified during walking with asymmetrical external loading. The most marked changes were observed with respect to pelvis-related gait determinants. The magnitude of changes was related to the manner of carrying the school pack rather than to body posture parameters. Conclusions. External loads intensify the asymmetry of foot pressure distribution as a result of spontaneous and unpredictable compensatory dislocations. The manner of carrying the school pack is not irrelevant In children with scoliosis.
The main idea of this article is the understanding of the anatomical work of foot rocker mechanisms during gait phases together with the muscle work of the hip, knee, ankle and foot being collectively responsible for the proper positioning of the joints in the lower limb. There are three rockers in a human's foot: the heel rocker, the ankle and forefoot rocker. The names given to each of them are in accordance with their location in the foot. The term rocker is used to describe the process of the rolling of one element in a foot over another. The existing evidence suggests that analyzing foot work and its disorders in gait phases is crucial in planning the treatment of patients with walking problems, as it is an element of the cyclic opening and closing of the biomechanical chain. This analysis should go together with the awareness of the fact that proper gait is the combined? work of the hip, knee and foot and demands a knowledge of the correlation between the tibia, calcaneus, metatarsum and forefoot. The information given helps one to evaluate trials of the ankle and foot and to assess the methodological quality of treatment in close chains in opposition to those in open chains, which brings fewer effects - hence stressing the need to widen the terminology of therapists working on gait problems. A knowledge of the 'rocker mechanism' can be an indicator in treatment progress, rehabilitation documentation as well as in the choice of exercises and the introduction of abilities acquired during therapy to daily functioning.
In this research, we investigated the coordination pattern and consistency of coordination between the thorax and pelvis during gait in patients with idiopathic scoliosis.
Across the study, 69 adolescent girls (controls: 30, patients: 39) participated. All participants were asked to walk 10 m barefoot at a self-selected speed. The walking speed, stride length, and range of motion of the pelvic and thoracic angles were collected using a three-dimensional optical motion analysis system, and the thorax-pelvis coordination was quantified using a vector coding technique. The frequency of four different patterns of coordination (in-phase, anti-phase, pelvis only, and thorax only) and the consistency of coordination including direction and magnitude during the gait cycle of the two groups were investigated. Independent-sample t tests were performed to examine differences between the two groups with regard to coordination patterns and consistency.
The patients with idiopathic scoliosis showed significantly higher in-phase and relatively lower anti-phase in the transverse plane compared to controls. Additionally, the pelvis only in the transverse, frontal, and sagittal planes was significantly lower in patients. The consistency of coordination in patients was significantly lower than in controls in direction and magnitude on the transverse and frontal planes.
From viewpoint of the thorax-pelvis coordination, patients with IS had less gait stability in the trunk than controls.
The continuing debate over the need for public health screening of schoolchildren for scoliosis centres on the efficacy of bracing compared to observation only. The objective of this study was to evaluate the costs and effectiveness of public health screening for idicpathic scoliosis.
A retrospective analysis was conducted on 175,000 seventh grade (11–12 years old) schoolchildren in Oakland County, Michigan (1978/79 to 1990/91 school years inclusive). The analysis included the numbers of children screened and the proportions referred to doctors for evaluation, braced, and referred for surgery. Costs were determined for each step in the process. National and regional surveys were used to determine the costs associated with physicians, orthotists, hospitals, surgeons, administration, and false positive referrals involved in both conservative and surgical treatments.
Screening approximately 12,000 + children per year in the Oakland County Programme costs 7.39 per child). This cost includes the cost of false positives. The costs per case for bracing and surgery were 35,510 respectively. Bracing was effective in reducing the need for surgery by 81 %.
When these statistics are extrapolated to the entire United States, an equivalent screening programme would cost 95.4 million annually in direct costs. This estimate does not include loss of income, welfare, social programmes and other direct or indirect medical costs that may occur with surgical intervention.
Our results support the efficacy and cost effectiveness of public health screening for scoliosis.
Ninety-four females from Southern China, 61 with adolescent idiopathic scoliosis and 33 normal subjects, were evaluated for femoral neck shaft angles and associated asymmetry between the hips. For statistical analysis, the groups were divided into adolescent and adult, and the scoliosis group was further divided into sub-groups according to the type of spinal curvature.
To evaluate femoral neck-shaft angle and asymmetry between the hips, and their relation to adolescent idiopathic scoliosis.
Recently published studies have suggested there is an association between asymmetry of the hip and lower limb and the curvature in AIS. In this study, femoral neck-shaft angle in patients with adolescent idiopathic scoliosis and in normal subjects was evaluated.
Femoral neck-shaft angles of both hips and lateral spinal curvature (using Cobb's method) were measured from standard standing anteroposterior radiographs of the pelvis, including upper femora and spine. Methods of measuring femoral neck-shaft angles were evaluated in an intra- and inter-observer study and were found to be accurate.
Patients with scoliosis had highly significantly greater femoral neck-shaft angles of both hips compared with normal subjects. In normal subjects, the femoral neck-shaft angle difference between the hips (asymmetry) was not statistically significant. This asymmetry in the scoliosis group also was not statistically significant when the results were analyzed upon grouping them all together, irrespective of curve pattern.
Our new findings show that patients with scoliosis have abnormally increased femoral neck-shaft angles, and the asymmetry is characteristic and significantly different from that of normal subjects. Moreover, increased femoral neck-shaft angle is related to type and side of spinal curvature.