Toulouse University Hospital Center, Department of Physiological Explorations, Toulouse, France.
Toulouse NeuroImaging Center (ToNIC), Inserm, Toulouse University3, Toulouse III - Paul Sabatier University, Toulouse, France.
Eur J Phys Rehabil Med. 2023 Dec;59(6):669-681. doi: 10.23736/S1973-9087.23.07979-0. Epub 2023 Oct 23.
In post-stroke hemiparetic subjects, a systematic and quantified description of the shortening default and compensatory movements during the swing phase of gait is essential to guide treatments and assess the impact of therapeutic interventions. However, such a systematic approach does not exist in the current clinical practice.
The aim of this study was to present a method improving the quantification and visualization of the kinematics of both lower limbs during the swing phase of gait, more specifically the origin of shortening default and the weight of compensations, based on a tool specifically developed: ToulGaitViz.
Observational cohort study.
Three-dimensional kinematic gait analyses of outpatients evaluated in Toulouse university hospital.
ToulGaitViz was applied to 151 post-stroke hemiparetic participants and 48 healthy control participants.
ToulGaitViz is a standalone software allowing to compute 1) limb clearance as the sum of the shortening related to hip, knee and ankle flexion in the sagittal plane; 2) compensations related to the abduction of the limb and hip hiking at mid-swing. Both centimetric and angular values of the clearance were reported as well as their correlations with walking speed.
Overall, the contribution of compensations in clearance was higher in post-stroke hemiparetic subjects than in healthy control participants with both centimetric (130% vs. 33%; P<0.001) and angular methods (23% vs. 1.4%; P<0.001). The centimetric method better represents the specific contribution of each segment to the clearance than the angular method. Symbolically, mean kinematic data from the cohort supports the claim that 2° of pelvic obliquity is equivalent to 10° of knee flexion to increase clearance by 1 cm, emphasizing the non-proportionality between the angular values and the actual contribution to the shortening. ToulGaitViz allows visualization of clearance, segmental shortening and compensation evolution before and after any therapeutic intervention with quantitative and comprehensive data.
The ToulGaitViz could be systematically used in clinical practice to extract relevant kinematic data from the origin of shortening default and the weight of compensations.
This tool allows better understanding of the mechanisms of action of treatments to better link them to the subjects' needs.
在脑卒中偏瘫患者中，系统地描述和量化步态摆动相时的缩短偏距和代偿运动对于指导治疗和评估治疗干预的效果至关重要。然而，目前的临床实践中并没有这样的系统方法。
本研究旨在提出一种方法，通过专门开发的工具 ToulGaitViz，改善步态摆动相时下肢的运动学的定量和可视化，特别是缩短偏距的起源和代偿的权重。
观察性队列研究。
在图卢兹大学医院进行的三维运动步态分析，评估门诊患者。
ToulGaitViz 应用于 151 名脑卒中偏瘫患者和 48 名健康对照者。
ToulGaitViz 是一款独立的软件，可计算 1）肢体间隙，即矢状面中髋关节、膝关节和踝关节屈曲引起的缩短之和；2）在中摆时肢体外展和髋关节抬高引起的代偿。报告了间隙的厘米和角度值，以及它们与步行速度的相关性。
总体而言，代偿在脑卒中偏瘫患者中的间隙贡献高于健康对照组，无论采用厘米法（130%比 33%；P<0.001）还是角度法（23%比 1.4%；P<0.001）。厘米法比角度法更能代表各节段对间隙的具体贡献。象征性地说，从队列中获得的平均运动学数据支持以下说法，即骨盆倾斜 2°相当于膝关节屈曲 10°，可使间隙增加 1 厘米，强调了角度值与实际缩短贡献之间的非比例性。ToulGaitViz 允许在任何治疗干预前后可视化间隙、节段缩短和代偿的演变，提供定量和全面的数据。
ToulGaitViz 可在临床实践中系统使用，从缩短偏距的起源和代偿的权重中提取相关的运动学数据。
该工具可帮助更好地理解治疗方法的作用机制，从而更好地将其与患者的需求联系起来。
