1st Joint ESMAC-GCMAS Meeting - Análise de Marcha

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medial area of the midfoot region for 28.7% of stance. The COPP then moves from the midfoot into the forefoot region where it progresses medially and forward passing just lateral to the hallux. The period of time the COPP spends in the forefoot is 47.5% of stance phase. The results for the comparative analysis of the two methods of long axis determination are shown in figure 2. The A-T method used 3D kinematic data to determine the long axis of the foot. This method is consistent with common gait analysis approaches for measuring foot progression angle. The remaining eight bars in the graph show the long axis angle for the two repetitions of manual long axis selection by each analyst. Three analysts were within one degree of the A-T method, while the fourth analyst, B, was approximately two degrees less than the A-T method. Statistical analysis found significant differences between the methods, but no differences between the analysts. Excellent intra-rater, 0.975, and inter-rater, 0.969, reliability was observed . 11 12 13 14 15 6 7 1 2 16.00 14.00 12.00 10.00 8.00 6.00 4.00 2.00 0.00 - 173 - Foot angle A-T G1 G2 L1 L2 J1 J2 B1 B2 Discussion The statistical differences shown reflect absolute differences less than 2 degrees, these differences may offer little clinical relevance. With the data stratified into the medial to lateral areas of the heel, midfoot and forefoot clinical classifications can be generated, i.e. varus, valgus, severe varus, severe valgus, equinus, calcaneous, and normal. These results give reasonable confidence that manually selecting the long axis is an acceptable method for feet that are normally shaped. However, using the subjective method for malalligned feet or feet in equinus or varus may not reflect the same level of confidence. This technique provides a rational basis for an objective clinical classification of dynamic foot deformities. References 1. Stokes, IAF, et al. (1975). Acta Orthop Scand, 46, 839-47 2. Duckworth, T, et al. (1985). J. Bone and Joint Surgery, 67, 79-85 3. Chang, CH, et al. (2002). J. Pediatric Orthop, 22, 813-18 4. Bowen, TR, et al (1998). J. Pediatric Orthop, 18, 789-93 5. Jameson, GG (2004). Dev Med Child Neurol, 99, 34 Figure 2. Foot Angle Means and Standard Deviations. The A-T method employs 3D kinematics to determine the long axis of the foot. The subjective method was performed by four observers (G, L, J, & B), two times for each trial. Figure 1. Mean COPP. Dark gray band is mean +/- one standard deviation; light gray is mean +/- two standard deviations.
O-52 BIOMECHANICAL OPTIMIZATION OF ORTHOPEDIC FOOTWEAR FOR DIABETIC PATIENTS USING IN-SHOE PLANTAR PRESSURE MEASUREMENT Bus, Sicco, PhD 1,2 ; Haspels, Rob 2 ; van Schie, Carine, PhD 1 ; and Mooren, Paul 1 1 Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands 2 Diabetic Foot Unit, Department of Surgery, Twenteborg Hospital, Almelo, The Netherlands Summary/conclusions Using in-shoe plantar pressure assessments to evaluate orthopedic footwear can be an effective method to achieve significant pressure reduction at high-risk areas in the diabetic neuropathic foot. Introduction Orthopedic footwear is commonly prescribed to diabetic patients with prior plantar foot ulceration. Several studies have reported large inter-individual differences in the pressure reducing effect of various types of custom insoles and shoes [1,2]. Therefore, predicting the pressure reducing effect of footwear remains difficult. As a result, it has been argued that custom footwear should be evaluated and optimized using in-shoe plantar pressure measurement [1,3]. The purpose of this study was to assess the feasibility of using in-shoe plantar pressure measurements to optimize the pressure reducing effect of custom footwear in patients with diabetes. Statement of clinical significance Diabetic patients with a prior plantar foot ulcer frequently show recurrence of an ulcer. Although there is limited evidence on the effectiveness of orthopedic footwear in preventing recurrence of plantar ulceration, optimizing the pressure-reducing effects of orthopedic footwear using in-shoe pressure analysis may significantly lower the risk for ulcer recurrence in these patients. Methods Ten diabetic patients with peripheral sensory neuropathy and history of plantar foot ulceration who were previously prescribed with orthopedic footwear participated in this study. Using the Pedar-X system (Novel, Germany), in-shoe plantar pressures were measured during four walking trials at a self-selected walking speed. Based on the peak pressure diagrams and values shown on-screen directly after collecting data, a region(s) of interest (ROI) for optimization (i.e. pressure reduction) was defined. This was the region with the highest measured peak pressure and/or with prior ulceration. A maximum of three rounds of footwear modifications were applied. After each round the effect of the modifications on in-shoe plantar pressure was assessed using the same protocol and a standardized walking speed. Footwear modifications included all possible shoe or insole adaptations of which the shoe technician thought they would reduce pressure at the ROI. Criteria for successful optimization were a 25% or more reduction in peak pressure or an absolute reduction of peak pressure below 200 kPa [4]. A detailed analysis of plantar pressure was performed using Novel Multimask software. Results A total of 13 ROIs were defined in the 10 patients tested. The number of optimization rounds varied between one and three. Mean peak pressure at the ROI was reduced from 344 (SD 99) kPa in the non-optimized footwear to 229 (SD 73) kPa after footwear optimization. Twelve out of 13 ROIs were successfully optimized by a minimum 25% reduction in peak pressure (mean 33%, range 22% to 50%, see Figure 1 for two examples). In the remaining case peak pressure was reduced below 200 kPa. The maximum time needed for footwear optimization (including - 174 -
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O-01 KNEE EXTENSION AT TERMINAL SWI
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O-02 THE MODIFIED TARDIEU IN STANDI
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O-03 COORDINATION BETWEEN PELVIS, T
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O-04 CAN GAIT ANALYSIS GUIDE MANAGE
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O-05 DISTAL FEMORAL EXTENTSION OSTE
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O-06 THE EFFECT OF SHOES ON GAIT IN
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O-07 CORRELATIONS BETWEEN CLINICAL
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O-08 DOUBLE CALIBRATION VS GLOBAL O
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O-09 THE SYMMETRICAL AXIS OF ROTATI
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O-10 FEASIBILITY OF A NEW -JOINT CO
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O-11 A SINGLE GAIT CYCLE AS MEASURE
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O-12 IMPROVED TRACKING OF HIP ROTAT
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O-13 PROTOCOL CHANGES CAN IMPROVE T
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O-14 ALTERNATIVE METHODS FOR MEASUR
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O-15 OVERLAY PROJECTION OF 3D GAIT
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O-16 RELATIONSHIP BETWEEN THE ANTHR
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O-17 COMPARING THE RELIABILITY OF V
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O-18 3D HIP AND PELVIC GAIT PATTERN
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O-19 RELIABILITY AND VALIDITY OF AN
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O-20 HOW ACCURATE IS THE ESTIMATION
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O-21 IMPACT OF WHEELCHAIR PROPULSIO
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O-22 TOWARDS A NEW PROTOCOL FOR MOT
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O-23 KINEMATIC ANALYSIS OF UPPER LI
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O-24 KINEMATIC UPPER LIMB ANALYSIS
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O-25 3D KINEMATICS OF UPPER EXTREMI
Page 51 and 52: O-26 CLINICALLY SIGNIFICANT SHOULDE
Page 53 and 54: O-27 OBJECTIVE IDENTIFCATION OF GAI
Page 55 and 56: - 110 - O-28 NORMALCY GAIT INDEX AN
Page 57 and 58: O-29 GILLETTE GAIT INDEX IS CONSIST
Page 59 and 60: O-30 GAITABASE: NEW APPROACH TO CLI
Page 61 and 62: O-31 A MODIFIED GAIT CLASSIFICATION
Page 63 and 64: O-32 QUANTIFICATION OF KINEMATIC ME
Page 65 and 66: O-33 EXTRINSIC AND INTRINSIC VARIAT
Page 67 and 68: O-34 PAIRED OUTCOME ASSESSMENT OF A
Page 69 and 70: O-35 ENERGY EXPENDITURE DURING OVER
Page 71 and 72: O-36 HIGH FAILURE RATES WHEN AVOIDI
Page 73 and 74: O-37 SUBJECT SPECIFIC HIP GEOMETRY
Page 75 and 76: O-38 BIOMECHANICAL AND METABOLIC PE
Page 77 and 78: O-39 BIOMECHANICS OF GAIT IN CHARCO
Page 79 and 80: O-40 SAGITTAL PLANE LOWER EXTREMITY
Page 81 and 82: O-41 AN EXPLORATION OF THE FUNCTION
Page 83 and 84: O-42 DYNAMIC SIMULATIONS OF SLOW, F
Page 85 and 86: O-43 AUTOMATIC IDENTIFICATION OF MU
Page 87 and 88: O-44 DYNAMIC MEASUREMENT OF GASTROC
Page 89 and 90: O-45 ASSESSING THE REGULATORY ACTIV
Page 91 and 92: O-46 ABNORMAL EMG-ACTIVITY IN PATHO
Page 93 and 94: O-47 AVERAGED EMG PROFILES IN RUNNI
Page 95 and 96: O-48 TRACKING DYNAMIC FOOT PRESSURE
Page 97 and 98: O-49 THE INFLUENCE OF FOOTWEAR SOLE
Page 99 and 100: O-50 GAIT ANALYSIS IN CHILDREN TREA
Page 101: O-51 A COMPARISON OF METHODS FOR US
Page 105 and 106: O-53 EFFECT OF SENSORY-THRESHOLD EL
Page 107 and 108: O-54 THE IMPACT OF SINGLE EVENT MUL
Page 109 and 110: O-55 COMPREHENSIVE GAIT ANALYSIS OU
Page 111 and 112: O-56 THE EFFECT OF INCLUDING S2 ROO
Page 113 and 114: O-57 DYNAMIC FUNCTION AFTER ANTERIO
Page 115 and 116: O-58 RECOVERY OF MUSCLE STRENGTH FO
Page 117 and 118: O-59 AUDITORY-PACED WALKING FOLLOWI
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1st Joint ESMAC-GCMAS Meeting - Análise de Marcha

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