Tesio Luigi, Malloggi Chiara, Portinaro Nicola M, Catino Luigi, Lovecchio Nicola, Rota Viviana
Departments of aBiomedical Sciences for Health bTranslational Medicine, University of Milan cDepartment of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS dDepartment of Pediatric Orthopedics and Neuro-orthopedics, Humanitas Research Hospital, Milan, Italy.
Int J Rehabil Res. 2017 Dec;40(4):315-324. doi: 10.1097/MRR.0000000000000243.
Gait analysis (GA) typically includes surface electromyographic (sEMG) recording from several lower limb muscles, optoelectronic measurement of joint rotations, and force recordings from ground-based platforms. From the latter two variables, the muscle power acting on the lower limb joints can be estimated. Recently, gait analysis on a split-belt force treadmill (GAFT) was validated for the study of adult walking. It showed high reliability of spatiotemporal, kinematic, dynamic, and sEMG parameters, matching those obtainable with GA on the basis of ground walking. GAFT, however, still needs validation in children. Potential differences with respect to adult GAFT relate to (a) possible high signal-to-noise ratio, given the lower forces applied; (b) higher differences between treadmill and over-ground walking; and (c) limited compliance with the experimental setup. This study aims at investigating whether GAFT provides results comparable with those obtainable from ground walking in children and consistent with results from GAFT in adults. GAFT was applied to three groups of healthy children aged 5-6 years (n=6), 7-8 years (n=6), and 9-13 years (n=8) walking at the same average speed spontaneously adopted overground. The results were compared with those obtained from another study applying GA to an age-matched and speed-matched sample of 47 children, and with those obtained from GAFT in adults. The reliability (as indicated by the SD) of both spatiotemporal and dynamic parameters was higher in GAFT compared with GA. In the 5-6-, 7-8-, and 9-13-year-old groups, at average speeds of 0.83, 1.08, and 1.08 m/s, step length was shorter by 9.19, 3.57, and 2.30% compared with GA in controls at comparable speeds, respectively. For the youngest group, a lower power generation from the plantar flexors (peak power: 1.35±0.32 vs. 2.11±1.02 W/kg) and a slightly more flexed posture of the hip, knee, and ankle joints were observed during GAFT compared with GA in controls. The other gait parameters were very similar between the GAFT and the GA groups. The shortening of step length during GAFT, relative to GA at superimposable speed, was on average of all children 6.8%, in line with the 8% decrease found in adults. The profiles of sEMG and joint rotations, and all of the weight-standardized joint power parameters, matched those recorded in adults. The entire experimental session lasted about 1 h. All children complied with the experimental setting and easily completed the requested tests. In conclusion, GAFT seems to be a promising alternative to conventional GA in children.
步态分析（GA）通常包括记录来自几块下肢肌肉的表面肌电图（sEMG）、关节旋转的光电测量以及来自地面平台的力记录。根据后两个变量，可以估算作用于下肢关节的肌肉功率。最近，用于成人行走研究的分体式皮带测力跑步机上的步态分析（GAFT）得到了验证。它显示出时空、运动学、动力学和sEMG参数具有很高的可靠性，与基于地面行走的GA所获得的参数相当。然而，GAFT在儿童中的应用仍需验证。与成人GAFT相比，可能存在的差异包括：（a）由于施加的力较小，可能具有较高的信噪比；（b）跑步机行走和地面行走之间的差异更大；（c）对实验设置的依从性有限。本研究旨在调查GAFT在儿童中提供的结果是否与地面行走所获得的结果相当，以及是否与成人GAFT的结果一致。GAFT应用于三组5至6岁（n = 6）、7至8岁（n = 6）和9至13岁（n = 8）的健康儿童，他们以与在地面自发行走时相同的平均速度行走。将结果与另一项对47名年龄匹配且速度匹配的儿童样本应用GA所获得的结果以及成人GAFT的结果进行比较。与GA相比，GAFT中时空和动力学参数的可靠性（以标准差表示）更高。在5至6岁、7至8岁和9至13岁组中，平均速度分别为0.83、1.08和1.08米/秒时，与对照组中可比速度下的GA相比，步长分别缩短了9.19%、3.57%和2.30%。对于最年幼的组，与对照组的GA相比，在GAFT期间观察到跖屈肌产生的功率较低（峰值功率：1.35±0.32 vs. 2.11±1.02瓦/千克），髋、膝和踝关节的姿势略为更弯曲。GAFT组和GA组之间的其他步态参数非常相似。与可叠加速度下的GA相比，GAFT期间步长缩短，所有儿童的平均缩短率为6.8%，与成人中发现的8%的下降率一致。sEMG和关节旋转的图谱以及所有体重标准化的关节功率参数与成人中记录的参数相匹配。整个实验过程持续约1小时。所有儿童都遵守实验设置并轻松完成了要求的测试。总之，GAFT似乎是儿童传统GA的一种有前景的替代方法。
