example: clinical gait analysis cerebral...

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TRAMA: Bruxelles (15 janvier 2008) "Motion analysis and clinics: why to set up a motion analysis lab". J. Duysens A gait lab to study more than gait Motor Control Laboratory Research Center for Movement Control and Neuroplasticity Dep. of Biomedical Kinesiology (FaBeR) K.U. Leuven, Belgium And : SMK-RDE, Nijmegen , The Netherlands Example: clinical gait analysis Cerebral Palsy

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Page 1: Example: clinical gait analysis Cerebral Palsytrama.deib.polimi.it/allegati/course_january_2008/...Example: clinical gait analysis Cerebral Palsy AMTI force plate Nijmegen Motor Unit

TRAMA: Bruxelles (15 janvier 2008)"Motion analysis and clinics: why to set up a motion analysis lab".

J. Duysens

A gait lab to study more than gait

Motor Control Laboratory

Research Center for Movement Control and

NeuroplasticityDep. of Biomedical Kinesiology (FaBeR)

K.U. Leuven, Belgium

And : SMK-RDE,

Nijmegen , The Netherlands

Example: clinical gait analysis

Cerebral Palsy

Page 2: Example: clinical gait analysis Cerebral Palsytrama.deib.polimi.it/allegati/course_january_2008/...Example: clinical gait analysis Cerebral Palsy AMTI force plate Nijmegen Motor Unit

AMTI force plate

Nijmegen Motor Unit

SPLIT-BELT

Page 3: Example: clinical gait analysis Cerebral Palsytrama.deib.polimi.it/allegati/course_january_2008/...Example: clinical gait analysis Cerebral Palsy AMTI force plate Nijmegen Motor Unit

EMGEMGEMGEMG

EMG stands for electromyography. It is the study of muscle electrical signals.

Electrodes are placed on the skin overlying the muscle. Alternatively, wire or needle electrodes are used and these can be placed directly in the muscle.

When EMG is acquired from electrodes mounted directly on the skin, the signal is a composite of all the muscle fiber action potentials occurring in the muscle(s) underlying the skin. These action potentials occur at somewhat random intervals so at any one moment, the EMG signal may be either positive or negative voltage. Individual muscle fiber action potentials are sometimes acquired using wire or needle electrodes placed directly in the muscle.

EMGEMGEMGEMG

EMG stands for electromyography. It is the study of muscle electrical signals.

Electrodes are placed on the skin overlying the muscle. Alternatively, wire or needle electrodes are used and these can be placed directly in the muscle.

When EMG is acquired from electrodes mounted directly on the skin, the signal is a composite of all the muscle fiber action potentials occurring in the muscle(s) underlying the skin. These action potentials occur at somewhat random intervals so at any one moment, the EMG signal may be either positive or negative voltage. Individual muscle fiber action potentials are sometimes acquired using wire or needle electrodes placed directly in the muscle.

Telemetric EMG

Page 4: Example: clinical gait analysis Cerebral Palsytrama.deib.polimi.it/allegati/course_january_2008/...Example: clinical gait analysis Cerebral Palsy AMTI force plate Nijmegen Motor Unit

VICON

Simi motion : digitale video

TRAMA: Bruxelles (15 janvier 2008)"Motion analysis and clinics: why to set up a motion analysis lab".

J. Duysens

A gait lab to study more than gait

Motor Control Laboratory

Research Center for Movement Control and

NeuroplasticityDep. of Biomedical Kinesiology (FaBeR)

K.U. Leuven, Belgium

And : SMK-RDE,

Nijmegen , The Netherlands

Page 5: Example: clinical gait analysis Cerebral Palsytrama.deib.polimi.it/allegati/course_january_2008/...Example: clinical gait analysis Cerebral Palsy AMTI force plate Nijmegen Motor Unit

Project 1 Freezing in PD

Anke Snijders 16-01-07

Anke Snijders 16-01-07

Research question

• How to INDUCE freezing of gait on a treadmill?

– Obstacles

Page 6: Example: clinical gait analysis Cerebral Palsytrama.deib.polimi.it/allegati/course_january_2008/...Example: clinical gait analysis Cerebral Palsy AMTI force plate Nijmegen Motor Unit

Project 2: EM-SCI

• International Multi-Center study

Peroneus Longus

Project3: SPORTS injury nr 1

Ankle sprains

REFLEXES AS DEFENSE?

Page 7: Example: clinical gait analysis Cerebral Palsytrama.deib.polimi.it/allegati/course_january_2008/...Example: clinical gait analysis Cerebral Palsy AMTI force plate Nijmegen Motor Unit

PREVIOUS STUDIES: STANDING

INVERSION 30 DEG.

JOHNSON ET JOHNSON,1993

ISAKOV ET AL., 1986

50% inverting, 50 % non-inverting

Grüneberg, Nieuwenhuijzen and Duysens, JPhysiol., 2003

10

cm

2

20

cm

Closer to real life

50% inverting, 50 % non-inverting

Nieuwenhuijzen and Duysens, 2007 (JN, in press)

10

cm

2

20

cm

Page 8: Example: clinical gait analysis Cerebral Palsytrama.deib.polimi.it/allegati/course_january_2008/...Example: clinical gait analysis Cerebral Palsy AMTI force plate Nijmegen Motor Unit

No inversion

Project 4

Project 4: Falls/ Eurokinesis

Page 9: Example: clinical gait analysis Cerebral Palsytrama.deib.polimi.it/allegati/course_january_2008/...Example: clinical gait analysis Cerebral Palsy AMTI force plate Nijmegen Motor Unit

Project 4: Eurokinesis

Learn how to fall

Project 5: Balance

(Lars Oude Nijhuis/Bas Bloem)

Page 10: Example: clinical gait analysis Cerebral Palsytrama.deib.polimi.it/allegati/course_january_2008/...Example: clinical gait analysis Cerebral Palsy AMTI force plate Nijmegen Motor Unit

Commissaris et al., 2002

Examples : postural responses

Project 6

ANTICIPATION PASSIVE STIFFNESS REFLEX

ACTUAL LOAD = EXPECTED LOAD

EXPECTED CONTACT

ACTUAL CONTACT

Page 11: Example: clinical gait analysis Cerebral Palsytrama.deib.polimi.it/allegati/course_january_2008/...Example: clinical gait analysis Cerebral Palsy AMTI force plate Nijmegen Motor Unit

ANTICIPATION PASSIVE STIFFNESS REFLEX

E

R

R

O

R

ACTUAL LOAD < EXPECTED LOAD

EXPECTED CONTACT

ACTUAL CONTACT

• Lowering of support surface

• Lower visual field occluded

• Cadence standardized

• Infrared beam to detect expected

foot contact

• Pressure plate detects touchdown

Protocol

Expected Level EL EL 1… EL 10

Unexpected

Level

UL UL 1…. UL 7-10

UD 1, UL 1…. UL 7-10

UD 2, UL 1…. UL 7-10

:UD 10Unexpected

DownUD

Expected Down ED ED 1 … ED 10

}

Page 12: Example: clinical gait analysis Cerebral Palsytrama.deib.polimi.it/allegati/course_january_2008/...Example: clinical gait analysis Cerebral Palsy AMTI force plate Nijmegen Motor Unit

CONTROL subject HH 44 y

ANTICIPATION PASSIVE STIFFNESS REFLEX

E

R

R

O

R

ACTUAL LOAD < EXPECTED LOAD

EXPECTED CONTACT

ACTUAL CONTACT

90 ms

Young adults

Page 13: Example: clinical gait analysis Cerebral Palsytrama.deib.polimi.it/allegati/course_january_2008/...Example: clinical gait analysis Cerebral Palsy AMTI force plate Nijmegen Motor Unit

Actual HC

ED

Expected HC

Medial Gastrocnemius

UD

Actual HC

ED

Expected HC

in UD

(-90 ms)

Medial Gastrocnemius

MGi

UD

-0.3

0.3

0.9

Actual HC

N = 1

N = 9

ED

Subtracted (UD-ED)

Medial Gastrocnemius

Extra activation starting some 40 ms after passing through the expected contact level

Page 14: Example: clinical gait analysis Cerebral Palsytrama.deib.polimi.it/allegati/course_january_2008/...Example: clinical gait analysis Cerebral Palsy AMTI force plate Nijmegen Motor Unit

-0.5

0.5

1.5

-0.5

0.5

1.5

-0.5

0.5

1.5

TA MG

-0.5

0.5

1.5

Ipsilateral

Contralateral10 ms

HC HC

10 ms

Similar responses are seen in the contralateral TA

-0.5

0.5

1.5

-0.5

0.5

1.5

-0.5

0.5

1.5

TA MG

-0.5

0.5

1.5

Ipsilateral

Contralateral

1 bin = 10 ms

10 ms

HC HC

10 ms

Similar responses are seen in the contralateral TA

Functional significance?

Hase and Stein, 1998

Page 15: Example: clinical gait analysis Cerebral Palsytrama.deib.polimi.it/allegati/course_january_2008/...Example: clinical gait analysis Cerebral Palsy AMTI force plate Nijmegen Motor Unit

Experiments on adults

-age-matched controls

-hereditary motor and sensory

neuropathy; HMSNIa

Do these fast responses depend on fast afferents?

Project 6: Hereditary motor and sensory neuropathy

Why frequent falls?

HMSNIa subjectRM 44y

Page 16: Example: clinical gait analysis Cerebral Palsytrama.deib.polimi.it/allegati/course_january_2008/...Example: clinical gait analysis Cerebral Palsy AMTI force plate Nijmegen Motor Unit

RTA

-0,4

0,1

0,6

1,1

1,6

-10

0

-80

-60

-40

-20 0

20

40

60

80

10

0

12

0

14

0

16

0

18

0

HMSN 1a

Healthy subjects

Onset Latencies

0

20

40

60

80

100

120

140

LTA LGM LRF LBF RTA RGM RRF RBF

On

se

t la

ten

cy

(m

s)

HMSN

Healthy subjects

* * * * *

Onset latencies of the responses after expected contactwere increased in the HMSNIa patient group

Co-workers:

M. Van der Linden

P.H.J.A. Nieuwenhuijzen

V. Weerdesteyn

C. Bastiaanse

C. Grüneberg

B. Smits-Engelsman

G.P. van Galen,

B. Nienhuis,

B. Groen,

R. Den Otter

I. Schillings

C. Hofstad

Page 17: Example: clinical gait analysis Cerebral Palsytrama.deib.polimi.it/allegati/course_january_2008/...Example: clinical gait analysis Cerebral Palsy AMTI force plate Nijmegen Motor Unit

The EndThe End