Request PDF on ResearchGate | Gait Analysis: Normal and Pathological Function | In this second edition of Gait Analysis, Jacquelin Perry and Judith Burnfield. Gait Analysis: Normal and Pathological Function. Book · February with 1, Reads. Publisher: 2nd Edition. Publisher: Publisher: Slack. Mar 25, Pdf Online Gait Analysis: Normal and Pathological Function - Online - By Biomedical Sensors and Instruments, Second Edition by Togawa.
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The multidirectional mobility of the hip makes this joint sensitive to dys- function in all 3 planes. A further complexity to assessing the effects of hip pathology is its . PURPOSE: The aim of this second edition is to analyze gait further by bringing the relevant data up to date and covering current research, more. This is a book that was commissioned and published in India. The editor, himself an internationally respected hand surgeon has assembled 48 chapters from.
Abstract Objective We performed a systematic review, meta-analysis and meta-regression of exercise studies that sought to determine the relationship between cardiac troponin cTn and left ventricular LV function. The second objective was to determine how study-level and exercise factors influenced the variation in the body of literature.
Design Random-effects meta-analyses and meta-regressions with four a priori determined covariates age, exercise heart rate [HR], duration, mass. Results Pooled cTn event rates were evident in Participant age was negatively associated with cTn release.
Conclusions High levels of statistical heterogeneity and methodological variability exist in the majority of EICF studies. Our findings show that exercise intensity and age are the most powerful determinants of cTn release. Diastolic function is influenced by exercise HR and cTn release, which implies that exercise bouts at high intensities are enough to elicit cTn release and reduce LV diastolic function. Future EICF studies should 1 utilise specific echocardiographic techniques such as myocardial speckle tracking, 2 ensure participants are euhydrated during post-exercise measurements, and 3 repeat measures in the hours following exercise to assess symptom progression or recovery.
It is also recommended to further explore the relationship between aging, training history, and exercise intensity on cTn release and functional changes.
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All authors assisted with the interpretation. All authors contributed to the drafting and revision of the final article. All authors approved the final submitted version of the manuscript. Funding No financial support was received for the conduct of this study or preparation of this manuscript.
Gait Analysis: Normal and Pathological Function
Ethical approval The need for ethical approval for this study was waived as it used previously published, publicly available data.
Consent for publication Not applicable. Availability of data and materials All data supporting the results in this manuscript are available within the results sections or supplementary data files of the cited articles. Influence of exercise intensity and duration on functional and biochemical perturbations in the human heart. J Physiol. CrossRef Google Scholar 2. Does the human heart fatigue subsequent to prolonged exercise? Sports Med.
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CrossRef Google Scholar 3. The effects of prolonged strenuous exercise on left ventricular function: a brief review. Heart Lung. CrossRef Google Scholar 4. Left ventricular function immediately following prolonged exercise: a meta-analysis. Med Sci Sports Exerc.
CrossRef Google Scholar 5. Cardiac troponin T and I, echocardiographic [correction of electrocardiographic] wall motion analyses, and ejection fractions in athletes participating in the Hawaii Ironman Triathlon. Improvements in quality of life following AHSCT may be also associated with improvements in fatigue, since a recent study has provided relevant evidence in aggressive MS [ 39 ]. To be more specific, Hartung and colleagues calculated the annual cost of MS treatment with immunosuppressive or immunomodulatory drugs at approximately 50,—70, USD in [ 40 ].
This cost accrues indefinitely in contrast to the cost of AHSCT which is a one-time treatment not expected to cause direct costs posttransplant. Nevertheless, AHSCT confers acute and late toxicities that are rather limited compared to allogeneic transplantation and are similar to chemotherapy-induced toxicities. Acute toxicities such as alopecia, infections, mucositis, and gastrointestinal symptoms are addressed by proper supportive care [ 43 ]. Late toxicities are of multisystem nature, involving the endocrine system, autoimmune phenomena, and infertility.
Proper counseling and monitoring by both transplanters and neurologists are required according to current guidelines [ 44 ]. Upcoming multicenter randomized controlled studies are expected to provide further high quality data on the role of AHSCT in MS patients [ 45 ]. Other Factors Despite encouraging results in efficacy, safety, toxicity, and economic cost, several factors not associated with scientific validity limit the broad application of AHSCT. These include both factors associated with transplant units that may have limited resources to treat these patients, treating neurologists that may not be familiar with this procedure, and healthcare reimbursement depending on the healthcare system [ 45 ].
Overcoming these obstacles is needed to offer AHSCT in selected patients according to state-of-the-art treatment recommendations.
Of note, particular forms of pediatric MS severely affect brain development.
Gait Analysis: Normal and Pathological Function pdf download
In this context, the approach of AHSCT seems appealing in children with MS based on the rationale of a one-time treatment that promises elimination of inflammation. These conditions are expected to allow normal brain development avoiding long-term exposure to immunomodulatory or immunosuppressive agents and improvement of quality of life for a long period of time.
Low intensity conditioning regimens might be preferable in the pediatric setting aiming to limit long-term toxic effects of cytotoxic agents. In this context, increased awareness from transplanters and neurologists is warranted to carefully monitor late effects of transplantation according to current recommendations [ 44 , 46 ].
This multicenter study reported outcomes in 22 patients. Mobilization of peripheral blood stem cells was achieved with the standard method of cyclophosphamide and growth factor administration. Regarding safety, only one patient experienced unexpected serious adverse events.
Several novel treatment options as well as high-efficacy therapeutic drugs have emerged including glatiramer acetate, mitoxantrone, natalizumab, fingolimod, teriflunomide, dimethyl fumarate, alemtuzumab, daclizumab, cladribine, and ocrelizumab [ 51 , 52 ]. In general, the majority of these immunomodulatory or immunosuppressive drugs need to be administered continuously in order to control disease activity.
Importantly, despite the expanding therapeutic options, a portion of patients responds insufficiently, whereas others present contraindications or complications to immunomodulatory or immunosuppressive drugs requiring an alternative therapeutic approach [ 53 ].
Therefore, updated recommendations regarding the role of AHSCT in the therapeutic algorithm of MS are required in the era of novel agents.
Existing guidelines place AHSCT as rescue treatment after failure of second-line treatment along with alemtuzumab and other off-line treatments ocrelizumab, rituximab [ 55 ]. In addition, the Belgian group most recently recommended AHSCT in aggressive RRMS patients after treatment failure of at least one highly effective treatment 2 courses of alemtuzumab or at least 6 months of treatment with mitoxantrone, cyclophosphamide, natalizumab, rituximab, and ocrelizumab.
The same group recommended AHSCT in progressive patients with active disease only in case of ocrelizumab treatment failure, since ocrelizumab is indicated for primary progressive patients [ 56 ]. The critical question whether AHSCT might be used in combination with immunomodulatory or immunosuppressive drugs cannot be answered on the basis of existing data.
The only available evidence stems from a recent study in patients that underwent AHSCT following discontinuation of natalizumab. A minimum period of 6 months from the last natalizumab infusion was adopted with the use of a bridging therapy cyclophosphamide or corticosteroid methylprednisolone. AHSCT was performed with acceptable toxicity with no fatalities or serious complications such as progressive multifocal leukoencephalopathy PML.
These are classified into two major categories: endogenous cell therapy including mesenchymal stem cells MSCs and cell-based remyelinating therapy including oligodendrocyte progenitor cells OPCs and induced pluripotent stem cells iPSCs [ 59 ]. Figure 2 summarizes cell-based therapies in MS. Except for endogenous problems that need to be addressed in further studies, ethical considerations represent an important aspect of research in cell-based therapies. Studies with cell-based therapies need to strictly comply with recent guidelines for human embryonic stem cell research [ 60 ].
Figure 2: A schematic representation of cell-based therapies in multiple sclerosis. Endogenous Cell Therapy Although early studies have suggested that MSCs differentiate into both neurons and oligodendrocytes [ 61 ], potential repair-promoting actions of MSCs in the CNS are based rather on their paracrine mechanisms of action than the phenomenon of transdifferentiation.
Therefore, the potential use of MSCs in MS in the context of endogenous cell therapy would be through amelioration of different pathological processes that contribute to tissue damage [ 62 ]. In line with this hypothesis, MSCs from MS patients have demonstrated similar growth in culture, differentiation potential, surface antigen expression, and immunomodulatory properties with MSCs from non-MS individuals [ 63 — 65 ].
Nevertheless, other studies have shown functional differences of MSCs [ 66 , 67 ]. Clinical reports of applications of cell-based therapies in patients with different underlying diseases have shown serious clinical complications including transient aseptic meningitis [ 68 ], acute disseminated encephalomyelitis [ 69 ], glioproliferative spinal cord tumor [ 70 ], and severe visual loss [ 71 ].
A number of additional issues remain to be resolved including the appropriate cell dose, number of infusions, and type of cell preparation, as well as cryopreservation, donor variance, culture expansion, immunogenicity, epigenetic reprogramming, and senescence [ 72 , 73 ]. Therefore, further clinical trials are warranted in this experimental field.
Larger phase 2 studies of bone marrow-derived cells [ 74 , 75 ] and culture-expanded MSCs [ 76 ] are ongoing. Second, OPCs are retrieved in limited numbers from fetal tissue and have limited proliferative capacity when cultured. Alternative approaches to overcome this problem would require the use of allogeneic cells in immunosuppressed recipients or the generation of OPCs from autologous iPSCs.
Another alternative approach would be to find agents acting on intrinsic OPCs to stimulate remyelination. Third, OPCs are already present in chronic lesions of MS, indicating that remyelination is rather limited by other factors, such as their interaction with the axons and the microenvironment [ 78 ].
Therefore, proof-of-principle studies are needed in MS patients to provide safety and feasibility data on remyelination therapy. Lastly, iPSCs have the potential to differentiate to OPCs and could therefore represent a suitable source of autologous cell-based therapy. Recent studies of iPSC-derived neural precursors have observed neuroprotective but not remyelinating properties [ 79 ]. In addition, preclinical models have shown encouraging results in MS [ 80 , 81 ].
However, earlier applications of iPSCs have raised concerns on malignant transformation or immune rejection [ 82 , 83 ]. Over the years, safety and toxicity of AHSCT have improved along with improved efficacy in selected patient populations.
Although no direct comparisons are available, these results compare favorably with conventional treatments paving the way for the use of AHSCT in carefully selected MS patients even in the era of multiple novel treatment options. However, there is no definitive evidence for efficacy in MS, and novel cell-based therapies should be considered only in the context of rigorous clinical trials [ 59 ].
Therefore, future studies need to further explore combinations of cell-based therapy with conventional treatment in an effort to improve outcomes of MS patients. Conflicts of Interest There are no conflicts of interest to report. Acknowledgments E. References I. Spyridonidis and I. Sakellari, Eds. View at Google Scholar A. Fassas, A. Anagnostopoulos, A. Kazis et al. Snowden, R. Saccardi, M.
Allez et al. Openshaw, B. Lund, A. Kashyap et al. Burt, B. Cohen, E.
Russell et al. Kozak, E. Havrdova, and J. View at Google Scholar R. Nash, J. Bowen, P. McSweeney et al. Saiz, Y. Blanco, E. Carreras et al. Saccardi, G. Mancardi, A. Solari et al. Samijn, P. Mondria et al. Xu, B.
Ji, L. Su, H. Dong, X. Sun, and C. Fassas, J. Passweg, A. This coincides with the optimal amount of shock absorption. The skilled practitioner can build and validate a powerful rehabilitation program based on this model incorporating muscle activity and understanding. Consider the patient who presents with a virtually straight COP gait line through their contact phase of gait.
We would note that this patient exhibits a lack of frontal plane motion, which translates to poor shock absorption at the level of the foot and a possibility of significant hyperactivity of the Tibialis Anterior.
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We can see this prolonged onset when muscle activity amplitude and shape is known. Surface Electromyography Direct Transmission Systems give this insight.
This added aspect of methodology could then be applied to all the muscles that effect gait for further insight and targeting treatment. Specific COP gait line patterns of pre-midstance behavior correspond to certain biomechanical foot deformities.
For example, a pes planus foot type tends to show a straighter and slower COP gait line progression in the middle part of foot during midstance while a likely rigid pes caves foot is likely to be arched and move more rapidly through midstance.
Differences in pre-midstance and midstance values directly impact the position with which the forefoot hits the ground. It should also be noted that a rapid and early engagement shorter midstance of the forefoot with the ground should have the healthcare practitioner consider a neurological condition such as foot drop.
During Midstance, the COP gait line at the middle of the pressure plot should be somewhat arced. We have noted that straightening of this arc has been associated with patients reporting back pain thought to be the result of a lack of frontal plane motion to absorb shock created by impact and reactive ground forces, but this is just one hypothesis.
Deviations of the COP gait line due to instability, peripheral neuropathy, and pain are more easily spotted in Midstance as well.
The important event that occurs is the dividing point between the Midstance and Propulsive subphases. This dividing point is the point when the heel lifts or heel-off. Mild to moderate earlier deviations from this timing marker may indicate Achillies Tendon or Equinus issues whereas delays lifting the heel may indicate instability and an apropulsive gait.
Figure 9 COP gait line real time display. We can further break this stage down into two sections, when the contralateral limb is in swing phase, and then, when the contralateral limb comes down to begin its contact phase.
This medial movement during Propulsion is also, coincidentally, towards the foot that was not in stance phase. Balance is an important factor throughout stance phase, and especially at the very end, during Propulsion. Figure 10 COP gait lines during the propulsion phase. Similar deviations from the walking direction are displayed but A.
Exhibits less forefoot pronation in propulsion than B. This Propulsive portion of the COP gait line should extend through the full range of toe extension which is typically rather straight seen in Figure 10 B , but some lines end early or abruptly, without the straightforward angle of roll-off seen in Figure 10 A.
When FHL is present that ratio may be , or double the pressure. The slope, extent, and velocity of movement in this segment of the gait line typically matches the exact direction of movement and speaks to any varus or valgus deformity present in the forefoot and the performance of the transverse arch.
This Propulsive segment overall is one of our main considerations when deciding on forefoot posting and metatarsal pad application and placement. Biomechanics during all phases is all about physical events happening at specified times in a specific order. Aside from looking within the sub-phases of stance phase we can also look at the bigger picture.
We also use the pressure distribution map and data to determine deviations from the direction of the COP gait line movement.
The overall direction of the COP gait line takes into account the entire COP gait line data set visually and graphically. We can eyeball a new straight line named the COP linear regression line. In many cases, an angle value is used to denote a relationship between the subject COP gait line and its regression line to give you measures of linear regression, however, the general shape can be qualitatively very useful in recommending footwear that will complement gait instead of causing friction.
Figure 11 COP Angle is the angle between the walking direction and the linear regression line. In this case we see three different shapes with progressively increasing COP angles.
The last on the right being the largest and having an almost C shape. COP gait lines that show larger curves away from the COP linear regression line creating more area could quite possibly suggest that patients would be most comfortable or perform more optimally in a curved or semi-curved lasted shoe, whereas, fewer and smaller differences might suggest a straight or combination lasted shoe for improved gait.
These correlations are under heavy objective observation in the field and with these computer aided gait analysis tools, the investigations are accelerated. To summarize the goal of the overall COP gait line progression we can look back to the requirements for ambulation. They include accepting our mass, supporting it all on one limb, then advancing the other limb all while keeping contact with the ground. With this information we can help. There is a lot of data put forth and incorporated for uses like these, and you may wonder what the real advantages and procedures are.Direct comparison of cardiac troponin I and cardiac troponin T in the detection of exercise-induced myocardial ischemia.
Aside from looking within the sub-phases of stance phase we can also look at the bigger picture. This Propulsive segment overall is one of our main considerations when deciding on forefoot posting and metatarsal pad application and placement. Allez et al. Therefore, AHSCT utilizes conventional immunoablation followed by reconstitution of the immune system to cause immunosuppression and immunomodulation. Figure 4 Center of Pressure Gait Line: Aggregate of pressure dots from the initial contact point to the termination of stance phase with two to three crossings on the neutral forward axis.
Anagnostopoulos et al.
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