3. la valutazione del cammino cagliari 2016trials n. 2782xa04, 2782xa05, 2782xa06, 2782xa07da mod...
TRANSCRIPT
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Programma
Programma delle lezioni e delle esercitazioni
3. La valutazione del cammino – Gait analysis
3.1. Obiettivi della valutazione quantitativa del cammino in ambito clinico.
3.2. Protocolli e standard internazionali.
3.3 Introduzione alla valutazione del report di prove di gait analysis : parametri spazio temporali e grafici di cinematica articolare.
3.4 Prova pratica di Gait Analysis
3.5 Valutazione dei tracciati di dinamica articolare e di eletromiografiasuperficiale
4. – Applicazioni cliniche dell’analisi del movimento in ambito clinico
4.1. La Gait Analysis nel bambino con PCI
4.2. Analisi del movimento nel paziente con Malattia di Parkinson
4.3 Analisi del movimento nel paziente con Sclerosi Multipla.
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Argomenti trattati
• Test clinici maggiormente valutati : La Gait Analysis
• Protocolli, modalità della prova
• Esercitazione pratica
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Analisi del cammino
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Caratteristiche di un cammino funzionale
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Analisi della cinematica articolare nel cammino
Flesso-estensione
Abdo-adduzione
Intra-extrarotazione
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Analisi della dinamica nel cammino
Forze di reazione al terreno
Momenti articolari
Potenze articolari
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Step principali per una prova di GA, come fare una prova di cammino?
Preparazione del paziente
Acquisizione della prova
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Reading a gait analysis report
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Multidisciplinar approach
Since clinical decisions are based on the output of gait analysis models, we should be cautious when interpreting
our data.
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The gait cycle
Stance phase : 60% Swing phase : 40%
Normal values
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Stance Swing
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Grandezze basografiche
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Temporal parameters .Normal values
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Other parameters
Stridelength = Step= Step= Step= StepRightRightRightRight + Step+ Step+ Step+ StepLeftLeftLeftLeft
Left steplengthRight steplength[cm]
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Normalization for subject’s height
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Step width
Step width [mm]
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Cadence:
� It is the n. of steps taken by a person per unit of time.
� It is measured as the n. of steps / sec or per minute.
Cadence = Number of steps / Time
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Walking velocity:It is the rate of linear forward motion of the body, which can be measured in meters or cm/second, meters/minute, or miles/hour.
Walking velocity (meters/sec)=Distance walked (meters)/time (sec)
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Distance parameters: Normal values
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Two examples of report
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Clinical examples
Spatio temporal parameters
of an hemiplegic child
right hemiplegia
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VIDEO Pdf
Children: Hemiplegia- right
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Spatio –temporal parameters:Case study
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Withoutorthopaedicsupport
With orthopaedic support
Spatio –temporal parameters: use of orthesis
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Without orthopaedic support
139 [mm]
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With orthopaedic support
38 [mm]
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Marker (on the body surface)
Virtual Marker (centre of rotation )
Yg
Xg
Zg
Flexion –extension
Abdo-adduction
External internal
rotation
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Modelling – sagittal plane
wwRichardnet/verne
1. We are working in two dimension
2.The human model is modelled as rigidsegments (HAT, Femurs, Tibias and feet)
3.Segment are linked by simple joint
4. The movement about each joint can be described by a single joint angle
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Stance Swing
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Normal Kinematics
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sec
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Gait cycle
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Alcun protocolli
Helen Heyes Marker Set
R. B. Davis, “A gait analysis data collection and redu ction technique,”
Hum. Mov. Sci., vol. 10, pp. 575-587, 1991.
Protocollo SAFLO
Frigo C, Rabuffetti M, Kerrigan DC, Deming LC, Pedott i A.
“Functionally oriented and clinically feasible
quantitative gait analysis method.”
Med Biol Eng Comput 1998; 36: 179-185
Variabili cinematiche
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Misura parametri antropometrici
Helen Heyes Marker Set
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Parametri antropometrici
Protocollo SAFLO
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From marker…….
Flexion/extension abdo/add
external internal rotation
2^ page of the REPORT
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Dal sistema tecnico al sistema anatomico: i centri articolari
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z
y
Hip = (XH, YH, ZH)
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C
θ
β
θ: 28.4 ± 6.6 degrees
β: 18 ± 4 degrees
0153.0115.0 −= legLC25 radiografie di anca
(Newington Children Hospital,1981)
C Cos (θθθθ)
Lleg= antropLleg= antrop
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C
θ
YH
dASISz
y
( )
−⋅=2
sin ASISH
dCSY θ
dASIS= antropdASIS= antrop
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x
z
β
XH
ZH
XdisXdis
[ ] ( ) ( ) ( )βθβ sincoscos CxX disH −−=
( )
−⋅=2
sin ASISH
dCSY θ
[ ] ( ) ( ) ( )βθβ coscossin CxZ disH −−=
Hip = (XH, YH, ZH)
C Cos (θθθθ)
Xdis= antropXdis= antrop
β
90-β
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Esempio: ricostruzione centri articolari
Video 3D .RAW, .RIC
(3138A01)
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Angoli assoluti
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z
x
y
LEFT
RIGHT
Angoli assoluti
Rotazione attorno a Y
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z
x
y
Rotazione attorno a X
Angoli assoluti
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z
x
y
Rotazione attorno a Z
Angoli assoluti
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Descrizione delle rotazioni relative di un segmento rispetto ad un altro considerato segmento di riferimento
DISTALE RISPETTO A PROSSIMALE
Angoli relativi
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Angoli relativi
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Angoli relativi
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Angoli relativi
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Angoli relativi
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PELVIS
HIP
KNEE
ANKLE
Piano Frontale Sagittale Orizzontale
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PELVIS
HIP
KNEE
ANKLE
Frontal Sagittal Horizontal
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Pelvic obliquity
NORMALITY
IC: 0°
LOADING RESPONSE: 5°
MIDSTANCE: 0°
TERMINAL-STANCE/PRE-SWING: -5°
TERMINAL-SWING: 0°
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Anterior Posterior Tilt
NORMALITY
IC: 10°
ROM: 5°
MEAN VALUE: 10°
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Pelvic rotation
NORMALITY
IC: 5°
TERMINAL-STANCE/PRE-SWING: -5°
TERMINAL-SWING: 5°
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Hip Abd/adduction
NORMALITY
IC: 0°
LOADING RESPONSE: 5°
MIDSTANCE: 0°
TERMINAL-STANCE/PRE-SWING: -5°
TERMINAL-SWING: 0°
From Esmac/Siamoc course 2001
+
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Hip flexion extension-
NORMALITY
IC: 35°
TERMINAL-STANCE: -5° ; -10°
TOE-OFF: 0°
MID-SWING/TERMINAL-SWING: 35°
+
-
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HIP ROTATION
-30
-20
-10
0
10
20
30
% gait cyclede
gree
s
MEDIA MEDIA - DS MEDIA + DS
NORMALITY
ROM <10°
IC: -10°
LOADING RESPONSE: 0°
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Knee flexion estention
NORMALITY
IC: 10°
LOADING RESPONSE: 20°
MIDSTANCE: 5°
TOE-OFF: 40° - 50°
EARLY-SWING: 60°
TERMINAL-SWING: 5°
ROM: 55°
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Knee varo Valgus
NORMALITY
STANCE PHASE : 0°
LATE-STANCE/SWING PHASE: 10°
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Ankle plantar/dorsiflexion
NORMALITY
IC: -5°
MIDSTANCE: 10° - 15°
TOE-OFF: -25°
ROM: 35°
Angle= (90 + β )- α
α
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Β= 20° α > 110° means plantarflexion, α < 110° dorsiflexion
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Foot progression
NORMALITY
IC: -10°
ROM STANCE PHASE: 5°
TOE-OFF: -5°
ROM SWING PHASE: 5°
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Reading the graphs: other format
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Gait Analysis data evaluation: consistency
Right vs Right vs Right vs Right
Left vs Left vs Left vs Left
Trials n. 2782xA04, 2782xA05, 2782xA06, 2782xA07da mod
(pdf format)
� Main considerations: high consistency both in kinematics and kinetics patterns
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Gait Analysis data evaluation: mean curves
Mean of n. 2782xA04, 2782xA05, 2782xA06, 2782xA07
(pdf format)
![Page 74: 3. La valutazione del cammino Cagliari 2016Trials n. 2782xA04, 2782xA05, 2782xA06, 2782xA07da mod (pdf format) Main considerations: high consistency both in kinematics and kinetics](https://reader030.vdocuments.pub/reader030/viewer/2022040515/5e73822e41cb642dc640fccc/html5/thumbnails/74.jpg)
Clinical examples
Kinematics
of an hemiplegic child
right hemiplegia
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Ankle
LEFT
RIGHT
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Knee
![Page 77: 3. La valutazione del cammino Cagliari 2016Trials n. 2782xA04, 2782xA05, 2782xA06, 2782xA07da mod (pdf format) Main considerations: high consistency both in kinematics and kinetics](https://reader030.vdocuments.pub/reader030/viewer/2022040515/5e73822e41cb642dc640fccc/html5/thumbnails/77.jpg)
Hip joint
Hip joint sagittalplane
Hip joint frontalplane
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Pelvis
![Page 79: 3. La valutazione del cammino Cagliari 2016Trials n. 2782xA04, 2782xA05, 2782xA06, 2782xA07da mod (pdf format) Main considerations: high consistency both in kinematics and kinetics](https://reader030.vdocuments.pub/reader030/viewer/2022040515/5e73822e41cb642dc640fccc/html5/thumbnails/79.jpg)
Standing
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Thank you
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Prova pratica in laboratorio