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Gait analysis (GA) is widely used for clinical evaluations in various pathological states, both in children and in adults, such as in patients with joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT). Otherwise, GA produces a large volume of data and there is the clinical need to provide also a quantitative measure of the patient's overall gait. Starting from this aim some global indexes were proposed by literature as a summary measure of the patient's gait, such as the Gait Profile Score (GPS). While validity of the GPS was demonstrated for the evaluation of the functional limitation of children with Cerebral Palsy, no studies have been conducted in patients JHS/EDS-HT. The aim of our study was therefore to investigate the effectiveness of the GPS in the quantification of functional limitation of patients with JHS/EDS-HT. Twenty-one adult (age: 36.1 ± 12.7 years) individuals with JHS/EDS-HT were evaluated using GA and from GA data the GPS was computed. The results evidenced that the GPS value of patients was 8.9 ± 2.6, statistically different from 4.6 ± 0.9 displayed by the control group. In particular, all values of Gait Variable Scores (GVS) which compose the GPS were higher if compared to controls, with the exception of Pelvic Tilt and Foot Progression. The correlations between GPS/GVS and Lower Extremity Functional Scale (LEFS) showed significant relationship between GPS and the item 11 ("Walking 2 blocks") (ρ=-0.56; p<0.05) and 12 ("Walking a mile") of LEFS (ρ=-0.76; p<0.05). Our results showed that GPS and GVS seem to be appropriate outcome measures for the evaluation of the functional limitation during gait of patients with JHS/EDS-HT.

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People suffering from Ehlers-Danlos syndrome (EDS) hypermobility type present a severe ligament laxity that results in difficulties in muscle force transmission. The same condition is present in people suffering from Down syndrome (DS) even if their clumsy movements are due to cerebral and cognitive impairments. The aim of this study was to quantify the gait patterns of subjects with EDS and with DS using Gait Analysis (GA). We quantified the gait strategy in 12 EDS individuals and in 16 participants with DS. Both pathological groups were compared to 20 age-matched healthy controls in terms of kinematics and kinetics. Results showed that DS individuals are characterized by a more compromised gait pattern than EDS participants, even if both groups are characterized by joint hypermobility. All the patients showed significant decreased of ankle stiffness probably due to congenital hypotonia and ligament laxity, while different values of hip stiffness. These findings help to elucidate the complex biomechanical changes due to joint hypermobility and may have a major role in the multidimensional evaluation and tailored management of these patients.

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Objective. To investigate quantitatively and objectively the effects of repeated muscle vibration (rMV) of triceps surae on the gait pattern in a 5-year-old patient with Cerebral Palsy with equinus foot deformity due to calf spasticity. Methods. The patient was assessed before and one month after the rMV treatment using Gait Analysis. Results. rMV had positive effects on the patient's gait pattern, as for spatio-temporal parameters (the stance duration and the step length increased their values after the treatment) and kinematics. The pelvic tilt reduced its anteversion and the hip reduced the high flexion evidenced at baseline; the knee and the ankle gained a more physiological pattern bilaterally. The Gillette Gait Index showed a significant reduction of its value bilaterally, representing a global improvement of the child's gait pattern. Conclusions. The rMV technique seems to be an effective option for the gait pattern improvement in CP, which can be used also in very young patient. Significant improvements were displayed in terms of kinematics at all lower limb joints, not only at the joint directly involved by the treatment (i.e., ankle and knee joints) but also at proximal joints (i.e., pelvis and hip joint).

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The goal of this work is to analyze postural control in Ehlers-Danlos syndrome (EDS) participants in time and frequency domain. This study considered a pathological group composed by 22 EDS participants performing a postural test consisting in maintaining standing position over a force platform for 30s in two conditions: open eyes (OE) and closed eyes (CE). In order to compare pathological group we acquired in the same conditions a control group composed by 20 healthy participants. The obtained center of pressure (COP) signal was analyzed in time and frequency domain using an AR model. Results revealed differences between pathological and control group: EDS participants pointed out difficulties in controlling COP displacements trying to keep it inside the BOS in AP direction and for this reason increased the use of ML mechanism in order to avoid the risk of fall. Also in CE conditions they demonstrated more difficulties in maintaining posture revealing the proprioceptive system is impaired, due to ligament laxity that characterized EDS participants. Frequency domain analysis showed no differences between the two groups, affirming that the changes in time domain reflected really the impairment to the postural control mechanism and not a different strategy assumed by EDS participants. These data could help in decision-making process to establish a correct rehabilitation approach, based on the reinforcing of muscle tone to supply the ligament laxity in order to prevent risks of falls and its consequences.

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The aims of this study are to compare quantitatively the gait strategy of the right and left hemiplegic children with Cerebral Palsy (CP) using gait analysis. The gait strategy of 28 right hemiparetic CP (RHG) and 23 left hemiparetic CP (LHG) was compared using gait analysis (spatio-temporal and kinematic parameters) and considering the hemiplegic classification based on four gait strategies. Our results demonstrated that velocity was a significant parameter to differentiate RHG and LHG: all hemiplegic types revealed in fact that RHG walked with higher velocity than LHG. The ankle strategy displayed an increased number of differences between RHG and LHG from hemiplegia of Type I to Type III. In all the comparison, the LHG showed the less physiological gait pattern. As for knee kinematics, differences between right and left hemiplegic gait pattern were evidenced only in children with hemiplegia Type II: the LHG walked with a more flexed knee at initial contact, marked hyperextension in midstance and reduced knee flexion ability in the swing phase. The hip strategy was quite normal in both groups in hemiplegia Type I. In the other two types, LHG showed a limited extension ability in midstance in comparison to RHG. In conclusion, our data revealed that RHG and LHG were in general characterised by different gait patterns, evidencing a general a progression of involvement in the different types of hemiplegia; in particular in all the hemiplegic types the LHG patients revealed a more severe involvement than the RHG individuals and the differences were more evident at the distal joints, especially at the ankle joint.

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PURPOSE: To assess postural control in individuals with Down syndrome. METHOD: Sixty young adults with Down syndrome were assessed and compared to 10 non-handicapped young. The subjects were asked to stay on a force platform for 30 seconds. Postural control was evaluated in two conditions: open and closed eyes. The kinetic data carried out from the force platform (i.e., ground reaction forces and Center of Pression (COP) displacements) were both evaluated in time domain and in frequency domain. RESULTS: Patients with Down syndrome are characterized by instable postural control. In particular the data evaluation in frequency domain underlined for Down syndrome subjects versus control group an increase in frequency oscillation both in anterior-posterior and in medio-lateral direction, that are confirmed in time domain analysis only for medio-lateral direction. In DS no changes are evident between eyes open and eyes closed condition. CONCLUSION: This study finds that subjects with Down syndrome included in this research demonstrate that deficits in postural control system that may provide a partial explanation for function balance problems that are common in these subjects.

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Aim of this study is to evaluate kinematic and kinetic aspects of gait alteration in a teenager with Down's syndrome before and after surgery. The gait pattern of the participant was evaluated quantitatively by gait analysis at different ages. In the interval between 14 and 16 years, a patella surgery was performed on the right knee joint. A worsening of gait ability in kinematic and kinetic patterns was highlighted before surgical treatment. After surgery, a significant improvement was observed. The 5-year follow-up showed an improvement in the gait ability after the surgery and allowed quantitative evaluation of treatment outcomes.

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Gait analysis system was used for 3 outpatients who suffered from hemorrhagic stroke 1 year before. They presented with hemiplegia and spasticity. A new treatment was applied to paralyzed muscles of lower limb to improve both static and dynamic balance. The refined system showed that asymmetric load distribution improved in all patients. By contrast, kinematical data improved in 1 patient only. Analysis of the vertical force showed a partial improvement after treatment. More controlled studies are necessary to verify the results of such an approach. A standard therapeutical protocol for spasticity is not yet available, in spite of the need to improve walking and activities of daily life in chronic patients suffering from hemiplegia. Gait analysis is required for monitoring slight changes to assess the proper individual rehabilitation program.

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The aim of this study was to utilise the gait analysis (GA) methodology to characterise the walking act in children with different levels of myelomeningocele. To this end, we analysed 30 children (mean age 11 +/- 3 years, still able to walk without ortheses) grouped according to the site of their neurological lesion (localised from L4 down to S5); ten healthy children (mean age 9 +/- 2 years) were also analysed for comparison. Of the many kinematic and kinetic parameters provided by GA, we focused on those providing a good correlation with the level of lesion. In particular, the following parameters are presented and discussed: angle of flexion at the knee joint at the moment of contact of the foot with the ground, knee joint flexion-extension range of motion, flexion of the hip at the beginning of the stride, anterior pelvic tilt, range of rotation of the pelvis in the horizontal plane and ankle joint power. The higher the level of the neurological lesion, the more these parameters of gait were found to deviate from those measured in the control group. This study emphasises the relationship that exists between the site (level) of the neurological lesion and the individual aspects of the functional limitation associated with it.

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