Compliant bipedal model with the center of pressure excursion associated with oscillatory behavior of the center of mass reproduces the human gait dynamics

Although the compliant bipedal model could reproduce qualitative ground reaction force (GRF) of human walking, the model with a fixed pivot showed overestimations in stance leg rotation and the ratio of horizontal to vertical GRF. The human walking data showed a continuous forward progression of the center of pressure (CoP) during the stance phase and the suspension of the CoP near the forefoot before the onset of step transition. To better describe human gait dynamics with a minimal expense of model complexity, we proposed a compliant bipedal model with the accelerated pivot which associated the CoP excursion with the oscillatory behavior of the center of mass (CoM) with the existing simulation parameter and leg stiffness. Owing to the pivot acceleration defined to emulate human CoP profile, the arrival of the CoP at the limit of the stance foot over the single stance duration initiated the step-to-step transition. The proposed model showed an improved match of walking data. As the forward motion of CoM during single stance was partly accounted by forward pivot translation, the previously overestimated rotation of the stance leg was reduced and the corresponding horizontal GRF became closer to human data. The walking solutions of the model ranged over higher speed ranges (~1.7 m/s) than those of the fixed pivoted compliant bipedal model (~1.5 m/s) and exhibited other gait parameters, such as touchdown angle, step length and step frequency, comparable to the experimental observations. The good matches between the model and experimental GRF data imply that the continuous pivot acceleration associated with CoM oscillatory behavior could serve as a useful framework of bipedal model.     

Two biomechanical strategies for locomotor adaptation to split-belt treadmill walking in subjects with and without transtibial amputation

Locomotor adaptation is commonly studied using split-belt treadmill walking, in which each foot is placed on a belt moving at a different speed. As subjects adapt to split-belt walking, they reduce metabolic power, but the biomechanical mechanism behind this improved efficiency is unknown. Analyzing mechanical work performed by the legs and joints during split-belt adaptation could reveal this mechanism. Because ankle work in the step-to-step transition is more efficient than hip work, we hypothesized that control subjects would reduce hip work on the fast belt and increase ankle work during the step-to-step transition as they adapted. We further hypothesized that subjects with unilateral, trans-tibial amputation would instead increase propulsive work from their intact leg on the slow belt. Control subjects reduced hip work and shifted more ankle work to the step-to-step transition, supporting our hypothesis. Contrary to our second hypothesis, intact leg work, ankle work and hip work in amputees were unchanged during adaptation. Furthermore, all subjects increased collisional energy loss on the fast belt, but did not increase propulsive work. This was possible because subjects moved further backward during fast leg single support in late adaptation than in early adaptation, compensating by reducing backward movement in slow leg single support. In summary, subjects used two strategies to improve mechanical efficiency in split-belt walking adaptation: a CoM displacement strategy that allows for less forward propulsion on the fast belt; and, an ankle timing strategy that allows efficient ankle work in the step-to-step transition to increase while reducing inefficient hip work.     

Assessing the Relative Contributions of Active Ankle and Knee Assistance to the Walking Mechanics of Transfemoral Amputees Using a Powered Prosthesis

Powered knee-ankle prostheses are capable of providing net-positive mechanical energy to amputees. Yet, there are limitless ways to deliver this energy throughout the gait cycle. It remains largely unknown how different combinations of active knee and ankle assistance affect the walking mechanics of transfemoral amputees. This study assessed the relative contributions of stance phase knee swing initiation, increasing ankle stiffness and powered plantarflexion as three unilateral transfemoral amputees walked overground at their self-selected walking speed. Five combinations of knee and ankle conditions were evaluated regarding the kinematics and kinetics of the amputated and intact legs using repeated measures analyses of variance. We found eliminating active knee swing initiation or powered plantarflexion was linked to increased compensations of the ipsilateral hip joint during the subsequent swing phase. The elimination of knee swing initiation or powered plantarflexion also led to reduced braking ground reaction forces of the amputated and intact legs, and influenced both sagittal and frontal plane loading of the intact knee joint. Gradually increasing prosthetic ankle stiffness influenced the shape of the prosthetic ankle plantarflexion moment, more closely mirroring the intact ankle moment. Increasing ankle stiffness also corresponded to increased prosthetic ankle power generation (despite a similar maximum stiffness value across conditions) and increased braking ground reaction forces of the amputated leg. These findings further our understanding of how to deliver assistance with powered knee-ankle prostheses and the compensations that occur when specific aspects of assistance are added/removed.     

Diabetic neuropathy and surface sway-referencing disrupt somatosensory information for postural stability in stance

In order to determine the type of somatosensory information for postural control that is most affected by neuropathy, we compared the relative effects of three methods of sway-referencing the surface in a group of subjects with profound loss of somatosensory function associated with sensory polyneuropathy from diabetes with age-matched control subjects. Sway-referencing disrupted somatosensory feedback for postural control by servo-controlling the dorsi- and plantar-flexion rotation of the support surface in proportion to anterior-posterior excursion of (1) ankle angle, (2) center of body mass (CoM) angle or (3) filtered center of pressure (CoP). Postural sway in subjects with somatosensory loss was significantly larger than normal on a firm surface but not on the sway-referenced surfaces, suggesting that sway-referencing disrupts somatosensory information for postural control already disrupted by neuropathy. Control subjects standing on any sway-referenced surface swayed significantly more than neuropathy subjects who stood on a firm surface, suggesting that sway-referencing disrupts more somatosensory information than disrupted by severe neuropathy. CoP sway-referencing was less sensitive than ankle or CoM sway-referencing for distinguishing postural sway in subjects with somatosensory loss from age-matched control subjects. Given that filtered CoP sway-referencing disrupts the ability to utilize somatosensory information related to surface reactive force to a greater extent than the other two methods of sway-referencing, then these results support the hypothesis that subjects with diabetic peripheral neuropathy have lost more CoP information, than ankle or CoM angle information, for controlling postural sway in stance.     

Diabetic neuropathy and surface sway-referencing disrupt somatosensory information for postural stability in stance

In order to determine the type of somatosensory information for postural control that is most affected by neuropathy, we compared the relative effects of three methods of sway-referencing the surface in a group of subjects with profound loss of somatosensory function associated with sensory polyneuropathy from diabetes with age-matched control subjects. Sway-referencing disrupted somatosensory feedback for postural control by servo-controlling the dorsi- and plantar-flexion rotation of the support surface in proportion to anterior-posterior excursion of (1) ankle angle, (2) center of body mass (CoM) angle or (3) filtered center of pressure (CoP). Postural sway in subjects with somatosensory loss was significantly larger than normal on a firm surface but not on the sway-referenced surfaces, suggesting that sway-referencing disrupts somatosensory information for postural control already disrupted by neuropathy. Control subjects standing on any sway-referenced surface swayed significantly more than neuropathy subjects who stood on a firm surface, suggesting that sway-referencing disrupts more somatosensory information than disrupted by severe neuropathy. CoP sway-referencing was less sensitive than ankle or CoM sway-referencing for distinguishing postural sway in subjects with somatosensory loss from age-matched control subjects. Given that filtered CoP sway-referencing disrupts the ability to utilize somatosensory information related to surface reactive force to a greater extent than the other two methods of sway-referencing, then these results support the hypothesis that subjects with diabetic peripheral neuropathy have lost more CoP information, than ankle or CoM angle information, for controlling postural sway in stance.     

Mechanics of toe and heel landing in stepping down in ongoing gait

When stepping down from a height difference in ongoing gait, subjects are known to use a heel landing at small height differences and switch to toe landing for larger height differences. We hypothesized that in toe landing, the leading leg can perform more negative work, to control the momentum gained during the descent, than in heel landing. Ten young male participants walked over a 10-m walkway at 5km/h to step down a height difference of 10cm halfway, using a heel or toe landing in five trials each. Kinematic data and ground reaction forces under the leading and trailing legs were recorded. Inverse dynamical analysis of both strategies showed that the leading leg performed more negative work in toe landing, while the vertical velocity at ground contact was lower. In addition, the impact forces were lower in toe landing than in heel landing. Toe landing was found to reduce gait velocity in the first step on the lower level and required higher moments and negative power around the ankle joint than heel landing. Our results indicate that heel landing may be preferred when stepping down small height differences, because it is less demanding especially for the plantar flexor muscles, while toe landing may be preferred for stepping down larger height differences, because it improves control over the momentum gained during the descent.     

A methodology for studying the effects of various types of prosthetic feet on the biomechanics of trans-femoral amputee gait.

This paper reports on a methodology developed for studying the effects of various types of prosthetic feet on the gait of trans-femoral amputees. It is shown that an analysis in three planes of motion of not only the prosthetic, but also the sound limb provides important information on the performance of prosthetic feet. Two male trans-femoral amputees were tested with four different prosthetic feet; the Springlite II, Carbon Copy III, Seattle LightFoot and the Multiflex foot. A detailed analysis of the results of one amputee and a summary of the most important results of a second subject is presented. The tests were carried out at normal (1.16 m s(-1)) and fast (1.56 m s(-1)) walking speeds. Three dimensional gait analysis was carried out to derive the time curves of the joint angles, intersegmental moments and power at the ankle, knee and hip joints at both the prosthetic and sound sides. A higher first peak of the ground reaction force at the sound side with the Seattle LightFoot compared to that with the Springlite II, may be the result of the lower late stance dorsiflexion angle with the former. Compared to the other two feet, the Carbon Copy III and the Springlite II showed higher prosthetic dorsiflexing moments and positive power at late stance, which could assist in the push-off. The 3D intersegmental loads at the ankle and knee can be used as a guide for design and for compilation of standards for testing of lower limb prostheses incorporating flexible feet.     

Resonance-based oscillations could describe human gait mechanics under various loading conditions

The oscillatory behavior of the center of mass (CoM) and the corresponding ground reaction force (GRF) of human gait for various gait speeds can be accurately described in terms of resonance using a spring–mass bipedal model. Resonance is a mechanical phenomenon that reflects the maximum responsiveness and energetic efficiency of a system. To use resonance to describe human gait, we need to investigate whether resonant mechanics is a common property under multiple walking conditions. Body mass and leg stiffness are determinants of resonance; thus, in this study, we investigated the following questions: (1) whether the estimated leg stiffness increased with inertia, (2) whether a resonance-based CoM oscillation could be sustained during a change in the stiffness, and (3) whether these relationships were consistently observed for different walking speeds. Seven healthy young subjects participated in over-ground walking trials at three different gait speeds with and without a 25-kg backpack. We measured the GRFs and the joint kinematics using three force platforms and a motion capture system. The leg stiffness was incorporated using a stiffness parameter in a compliant bipedal model that best fitted the empirical GRF data. The results showed that the leg stiffness increased with the load such that the resonance-based oscillatory behavior of the CoM was maintained for a given gait speed. The results imply that the resonance-based oscillation of the CoM is a consistent gait property and that resonant mechanics may be useful for modeling human gait.     

Contribution of each leg to the control of unperturbed bipedal stance in lower limb amputees: new insights using entropy

The present study was designed to assess the relative contribution of each leg to unperturbed bipedal posture in lower limb amputees. To achieve this goal, eight unilateral traumatic trans-femoral amputees (TFA) were asked to stand as still as possible on a plantar pressure data acquisition system with their eyes closed. Four dependent variables were computed to describe the subject's postural behavior: (1) body weight distribution, (2) amplitude, (3) velocity and (4) regularity of centre of foot pressure (CoP) trajectories under the amputated (A) leg and the non-amputated (NA) leg. Results showed a larger body weight distribution applied to the NA leg than to the A leg and a more regular CoP profiles (lower sample entropy values) with greater amplitude and velocity under the NA leg than under the A leg. Taken together, these findings suggest that the NA leg and the A leg do not equally contribute to the control of unperturbed bipedal posture in TFA. The observation that TFA do actively control unperturbed bipedal posture with their NA leg could be viewed as an adaptive process to the loss of the lower leg afferents and efferents because of the unilateral lower-limb amputation. From a methodological point of view, these results demonstrate the suitability of computing bilateral CoP trajectories regularity for the assessment of lateralized postural control under pathological conditions.     

Validation of gait event detection by centre of pressure during target stepping in healthy and paretic gait

BackgroundTarget-stepping paradigms are increasingly used to assess and train gait adaptability. Accurate gait-event detection (GED) is key to locating targets relative to the ongoing step cycle as well as measuring foot-placement error. In the current literature GED is either based on kinematics or centre of pressure (CoP), and both have been previously validated with young healthy individuals. However, CoP based GED has not been validated for stroke survivors who demonstrate altered CoP pattern.MethodsYoung healthy adults and individuals affected by stroke stepped to targets on a treadmill, while gait events were measured using three detection methods; verticies of CoP cyclograms, and two kinematic criteria, (1) vertical velocity and position and of the heel marker, (2) anterior velocity and position of the heel and toe marker, were used. The percentage of unmatched gait events was used to determine the success of the GED method. The difference between CoP and kinematic GED methods were tested with two one sample (two-tailed) t-tests against a reference value of zero. Differences between group and paretic and non-paretic leg were tested with a repeated measures ANOVA.ResultsThe kinematic method based on vertical velocity only detected about 80% of foot contact events on the paretic side in stroke survivors while the method on anterior velocity was more successful in both young healthy adults as stroke survivors (3% young healthy and 7% stroke survivors unmatched). Both kinematic methods detected gait events significantly earlier than CoP GED (p < 0.001) except for foot contact in stroke survivors based on the vertical velocity.ConclusionsCoP GED may be more appropriate for gait analyses of SS than kinematic methods; even when walking and varying steps.     

Kinematics of lower limbs during walking are emulated by springy walking model with a compliantly connected,off-centered curvy foot

The dynamics of the center of mass (CoM) during walking and running at various gait conditions are well described by the mechanics of a simple passive spring loaded inverted pendulum (SLIP). Due to its simplicity, however, the current form of the SLIP model is limited at providing any further information about multi-segmental lower limbs that generate oscillatory CoM behaviors and their corresponding ground reaction forces. Considering that the dynamics of the CoM are simply achieved by mass-spring mechanics, we wondered whether any of the multi-joint motions could be demonstrated by simple mechanics. In this study, we expand a SLIP model of human locomotion with an off-centered curvy foot connected to the leg by a springy segment that emulates the asymmetric kinematics and kinetics of the ankle joint. The passive dynamics of the proposed expansion of the SLIP model demonstrated the empirical data of ground reaction forces, center of mass trajectories, ankle joint kinematics and corresponding ankle joint torque at various gait speeds. From the mechanically simulated trajectories of the ankle joint and CoM, the motion of lower-limb segments, such as thigh and shank angles, could be estimated from inverse kinematics. The estimation of lower limb kinematics showed a qualitative match with empirical data of walking at various speeds. The representability of passive compliant mechanics for the kinetics of the CoM and ankle joint and lower limb joint kinematics implies that the coordination of multi-joint lower limbs during gait can be understood with a mechanical framework.     

Differences in whole-body angular momentum between below-knee amputees and non-amputees across walking speeds

Unilateral, below-knee amputees have an increased risk of falling compared to non-amputees. The regulation of whole-body angular momentum is important for preventing falls, but little is known about how amputees regulate angular momentum during walking. This study analyzed three-dimensional, whole-body angular momentum at four walking speeds in 12 amputees and 10 non-amputees. The range of angular momentum in all planes significantly decreased with increasing walking speed for both groups. However, the range of frontal-plane angular momentum was greater in amputees compared to non-amputees at the first three walking speeds. This range was correlated with a reduced second vertical ground reaction force peak in both the intact and residual legs. In the sagittal plane, the amputee range of angular momentum in the first half of the residual leg gait cycle was significantly larger than in the non-amputees at the three highest speeds. In the second half of the gait cycle, the range of sagittal-plane angular momentum was significantly smaller in amputees compared to the non-amputees at all speeds. Correlation analyses suggested that the greater range of angular momentum in the first half of the amputee gait cycle is associated with reduced residual leg braking and that the smaller range of angular momentum in the second half of the gait cycle is associated with reduced residual leg propulsion. Thus, reducing residual leg braking appears to be a compensatory mechanism to help regulate sagittal-plane angular momentum over the gait cycle, but may lead to an increased risk of falling.     

Muscle and prosthesis contributions to amputee walking mechanics: A modeling study

Unilateral, below-knee amputees have altered gait mechanics, which can significantly affect their mobility. Below-knee amputees lose the functional use of the ankle muscles, which are critical during walking to provide body support, forward propulsion, leg-swing initiation and mediolateral balance. Thus, either muscles must compensate or the prosthesis must provide the functional tasks normally provided by the ankle muscles. Three-dimensional (3D) forward dynamics simulations of amputee and non-amputee walking were generated to identify muscle and prosthesis contributions to amputee walking mechanics, including the subtasks of body support, forward propulsion, leg-swing initiation and mediolateral balance. Results showed that the prosthesis provided body support in the absence of the ankle muscles. The prosthesis contributed to braking from early to mid-stance and propulsion in late stance. The prosthesis also functioned like the uniarticular soleus muscle by transferring energy from the residual leg to the trunk to provide trunk propulsion. The residual-leg vasti and rectus femoris reduced their contributions to braking in early stance, which mitigated braking from the prosthesis during this period. The prosthesis did not replace the function of the gastrocnemius, which normally generates energy to the leg to initiate swing. As a result, lower overall energy was delivered to the residual leg. The prosthesis also acted to accelerate the body laterally in the absence of the ankle muscles. These results provide further insight into muscle and prosthesis function in below-knee amputee walking and can help guide rehabilitation methods and device designs to improve amputee mobility.     

Leg stiffness increases with speed to modulate gait frequency and propulsion energy

Bipedal walking models with compliant legs have been employed to represent the ground reaction forces (GRFs) observed in human subjects. Quantification of the leg stiffness at varying gait speeds, therefore, would improve our understanding of the contributions of spring-like leg behavior to gait dynamics. In this study, we tuned a model of bipedal walking with damped compliant legs to match human GRFs at different gait speeds. Eight subjects walked at four different gait speeds, ranging from their self-selected speed to their maximum speed, in a random order. To examine the correlation between leg stiffness and the oscillatory behavior of the center of mass (CoM) during the single support phase, the damped natural frequency of the single compliant leg was compared with the duration of the single support phase. We observed that leg stiffness increased with speed and that the damping ratio was low and increased slightly with speed. The duration of the single support phase correlated well with the oscillation period of the damped complaint walking model, suggesting that CoM oscillations during single support may take advantage of resonance characteristics of the spring-like leg. The theoretical leg stiffness that maximizes the elastic energy stored in the compliant leg at the end of the single support phase is approximated by the empirical leg stiffness used to match model GRFs to human GRFs. This result implies that the CoM momentum change during the double support phase requires maximum forward propulsion and that an increase in leg stiffness with speed would beneficially increase the propulsion energy. Our results suggest that humans emulate, and may benefit from, spring-like leg mechanics.     

A novel design for an instrumented stairway

Kinetics during stair ambulation is currently studied via either the use of sensing elements embedded in the steps of the stairway or simple rigid blocks of different height positioned on top of existing force platforms, typically embedded in a walkway for gait analysis. Neither of these approaches is truly satisfactory for gait analysis laboratories. The first one is expensive and requires setting up a dedicated space. The second approach is limited by the number of platforms utilized in the laboratory for evaluating level walking. This communication proposes a novel design, referred to as "interlaced stairway", that allows one to measure ground reaction force and position of the center of pressure (CoP) for four foot contacts during stair ambulation using only two force platforms embedded in a walkway. Accuracy and precision of the CoP estimates and natural frequency of the stairway structure were derived from experimental data. Test results indicate that the interlaced stairway structure does not appreciably reduce the quality of the measures gathered by the existing force platforms. Specifically, the estimated CoP coordinates show good agreement with the horizontal coordinates of the geometric center of the calibration object utilized to assess accuracy and precision of the CoP estimates (max difference < 6 mm). The natural frequency of the stairway structure is lower than the one for the unloaded force platform but higher than the frequency components of interest in stair ambulation analysis.     

Estimation of unmeasured ground reaction force data based on the oscillatory characteristics of the center of mass during human walking

To enhance the wearability of portable motion-monitoring devices, the size and number of sensors are minimized, but at the expense of quality and quantity of data collected. For example, owing to the size and weight of low-frequency force transducers, most currently available wearable gait measurement systems provide only limited, if any, elements of ground reaction force (GRF) data. To obtain the most GRF information possible with a minimal use of sensors, we propose a GRF estimation method based on biomechanical knowledge of human walking. This includes the dynamics of the center of mass (CoM) during steady human gait resembling the oscillatory behaviors of a mass-spring system. Available measurement data were incorporated into a spring-loaded inverted pendulum with translating pivot. The spring stiffness and simulation parameters were tuned to match, as accurately as possible, the available data and oscillatory characteristics of walking. Our results showed that the model simulation estimated reasonably well the unmeasured GRF. Using the vertical GRF and CoP profile for gait speeds ranging from 0.93 to 1.89 m/s, the anterior-posterior (A-P) GRF was estimated and resulted in an average correlation coefficient of R = 0.982 ± 0.009. Even when the ground contact timing and gait speed information were alone available, our method estimated GRFs resulting in R = 0.969 ± 0.022 for the A-P and R = 0.891 ± 0.101 for the vertical GRFs. This research demonstrates that the biomechanical knowledge of human walking, such as inherited oscillatory characteristics of the CoM, can be used to gain unmeasured information regarding human gait dynamics.     

The influence of limb alignment on the gait of above-knee amputees.

Biomechanical gait tests on above-knee amputees were conducted in which the alignment of the prosthesis was changed systematically. An eight-segment biomechanical model of the above-knee amputee was developed to analyse and present the three-dimensional kinematic and kinetic data obtained. The effects of alignment changes on the above-knee amputees' gait were studied in terms of the angular displacements of the lower limbs, ground reactions and intersegmental moments. It was found that following the alignment changes the angular displacement at the hip joint on the prosthetic side showed compensatory actions by the amputee. The ground reaction force was sensitive to alignment changes, and in particular, the changes in the characteristics of the fore-aft component of the ground force could be related to the alignment changes. The antero-posterior intersegmental moments at the prosthetic ankle and knee joints were evidently influenced by alignment.     

Local dynamic stability of amputees wearing a torsion adapter compared to a rigid adapter during straight-line and turning gait

Lower limb amputees have decreased balance during daily ambulation compared to nonamputees. An optimally compliant torsion adapter, which enables transverse plane rotation at the socket–pylon junction may reduce limb asymmetries and improve comfort leading to increased confidence and stability during gait. The purpose of this study was to determine if the presence of a torsion adapter affects amputee sensitivity to local perturbations (local dynamic stability) during straight-line walking and during a turning task. Ten unilateral transtibial amputees were fit with a torsion and rigid adapter in random order and blinded to the condition. After a 3-week acclimation period, kinematic data were collected while subjects walked in a straight-line on a treadmill and around a 1-m radius circular path at constant speed. Maximum finite-time Lyapunov exponents (λ), an estimator of local dynamic stability, were calculated for the amputee’s sagittal plane hip, knee and ankle angles for each condition. The prosthetic limb λ was greater during a turn compared to straight-line walking, suggesting amputees are less stable while turning. There were no statistically significant differences found in λ between adapters during both walking conditions, suggesting the torsion adapter had no effect on amputee stability; however, high inter-subject variability due to the examined population and turning task may have masked a small decrease in prosthetic limb hip and knee stability for the torsion adapter during straight-line gait. Therefore, the torsion adapter’s added degree of freedom may have a small adverse effect on prosthetic limb stability during straight-line walking and no effect on turning.     

Walk-, run- and gallop-like gait patterns in human sideways locomotion

The purpose of this study is to examine the characteristics of gait patterns in human preferred sideways locomotion at increasing speeds. Fifteen healthy young males were asked to step sideways on a treadmill at various speeds of 1.3–6.1 km/h. The times of foot contact and take-off were analyzed. Three gait patterns were observed. At slow speeds, all of the subjects performed a walk-like pattern. When the treadmill speed exceeded approximately 3.5 km/h, the subjects preferred gait patterns with a flight phase. Most of the subjects performed an asymmetric gait pattern that was similar to a forward gallop, whereas only two out of fifteen subjects performed a run-like gait pattern. Because the left and right legs are positioned along the movement direction, it might be more efficient to divide roles between the leading and trailing limbs at high speeds: the leading limb functions to produces breaking and vertical force, and the trailing limb mainly absorbs the impact of foot contact and generates propulsive forces.     

Surgical treatment of scoliosis: a review of techniques currently applied

Background Context

Research employing gait measurements indicate asymmetries in ground reaction forces and suggest relationships between these asymmetries, neurological dysfunction and spinal deformity. Although, studies have documented the use of centre of pressure (CoP) and net joint moments in gait assessment and have assessed centre of mass (CoM)-CoP distance relationships in clinical conditions, there is a paucity of information relating to the moments about CoM. It is commonly considered that CoM is situated around S2 vertebra in normal upright posture and hence this study uses S2 vertebral prominence as reference point relative to CoM.

Purpose

To assess and establish asymmetry in the CoP pattern and moments about S2 vertebral prominence during level walking and its relationship to spinal deformity in adolescents with scoliosis.

Patient sample

Nine Adolescent Idiopathic Scoliosis subjects (8 females and 1 male with varying curve magnitudes and laterality) scheduled for surgery within 2–3 days after data collection, took part in this study.

Outcome measures

Kinetic and Kinematic Gait assessment was performed with an aim to estimate the CoP displacement and the moments generated by the ground reaction force about the S2 vertebral prominence during left and right stance during normal walking.

Methods

The study employed a strain gauge force platform to estimate the medio-lateral and anterior-posterior displacement of COP and a six camera motion analysis system to track the reflective markers to assess the kinematics. The data were recorded simultaneously.

Results

Results indicate wide variations in the medio lateral direction CoP, which could be related to the laterality of both the main and compensation curves. This variation is not evident in the anterior-posterior direction. Similar results were recorded for moments about S2 vertebral prominence. Subjects with higher left compensation curve had greater displacement to the left.

Conclusion

Although further longitudinal studies are needed, results indicate that the variables identified in this study are applicable to initial screening and surgical evaluation of scoliosis.