Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Thermography is a non-invasive imaging diagnostic technique that records thermal patterns generated by infrared emission of heat from the body surface based on the local cutaneous perfusion. These thermal patterns are converted and displayed on a color map. In horses, since the 60s have been used for the detection of various orthopedic injuries and, in recent years studies in dogs have been published. Locomotion is the process by which the animal moves from one geographic location to another. The study of locomotion is essential to establish methods for treating disorders of the locomotor apparatus. Examination of the gait is the first step for the diagnostic in the evaluation of a patient with claudication. The aim of this study was to establish the thermal patterns of the paw prints of dogs with lameness compared to healthy dogs. It was verified also if there are differences in the temperature of paw print of the lame limb versus normal limb of normal dog and weight bearing limb of lame dog versus normal limb of normal dog. It was used 14 dogs with unilateral pelvic limb lameness due to rupture of the cranial cruciate ligament (lame limb versus weight bearing limb) and 14 healthy dogs (right limb versus left limb). Thermographic images of the paw print were made after the dog remained in an orthostatic position on foam mat for 30 seconds. It was analyzed average temperatures and thermal patterns. Gait analysis was performed on a force platform in the same position to measure the peak vertical force (PVF). It was calculated mean, standard deviation, percentage of average, and asymmetry index for this variable of the gait. There were no significant differences in the temperature of the paw print between groups. Analysis of the pattern of thermal images showed 80% success in differentiating lame limb versus weight bearing limb (abnormal group) and 100 % in the identification of the same thermal pattern between right limb compared to the left limb (normal group). The mean of the PVF showed 10.0 % difference in normal dogs and 72.4 % in abnormal dogs. Analysis of asymmetry index showed 5 % in the normal group and 36.2 % in the abnormal group. It is conclude that the thermal paw print can be successfully used as an additional tool for the detection of the pelvic limb lameness in dogs. / Termografia é uma técnica não invasiva de diagnósticos por imagem, que registra padrões térmicos gerados pela emissão infravermelha de calor da superfície corporal baseado na perfusão cutânea local. Estes padrões térmicos são convertidos e visualizados em um mapa de cores. Em equinos, desde os anos 60 têm sido utilizada para a detecção de várias lesões ortopédicas e, nos últimos anos, estudos em cães têm sido publicados. A locomoção é o processo pelo qual o animal se move de uma posição geográfica para outra. O estudo da locomoção é essencial para estabelecer métodos de tratamento de desordens do aparato locomotor. Exame da marcha representa o primeiro passo para o diagnóstico na avaliação de um paciente com claudicação. O objetivo deste estudo foi estabelecer o padrão da impressão termográfica da pegada de cães com claudicação comparada a cães saudáveis. Verificou-se também se há diferenças na temperatura da pegada de membro claudicante versus membro normal de cão normal e membro que suporta o peso de cão claudicante versus membro normal de cão normal. Foram utilizados 14 cães com claudicação unilateral do membro pélvico devido à ruptura do ligamento cruzado cranial (membro claudicante versus membro que suporta o peso) e 14 cães saudáveis (membro direito versus membro esquerdo). As imagens termográficas das pegadas foram feitas após o cão permanecer em posição ortostática sobre tapete de espuma durante 30 segundos. Foram analisados padrões térmicos de imagens e médias de temperatura. Análise da marcha foi realizada em plataforma de força na mesma posição para medir o pico de força vertical (PFV). Calculou-se média, desvio padrão, porcentagem da média e índice de assimetria para esta variável da marcha. Não houve diferença significativa na temperatura da pegada entre os grupos. Análises do padrão térmico das imagens mostraram sucesso de 80 % na diferenciação do membro claudicante contra o membro que suporta o peso (grupo anormal) e de 100% na identificação do mesmo padrão térmico entre o membro direito em relação ao esquerdo (grupo normal). A média do PFV mostrou 10,0% de diferença nos cães normais e 72,4% nos cães anormais. Análise de índice de assimetria mostrou 5% no grupo normal e 36,2% no grupo anormal. Conclui-se que a impressão termográfica da pegada pode ser utilizada com sucesso como ferramenta complementar para a detecção de claudicação dos membros pélvicos em cães.

The aim of the thesis is a realization of advanced analysis of signals from gait laboratory. The introductory part deals with the gait cycle and its relation to the joints kinematic is discussed. Additionally, the work is focused on the description of the gait laboratory and the definition of the indexes in order to quantify patient´s overall gait in kinematic analysis. In the practical part, kinematic data analysis was implemented in the MATLAB environment and the results of healthy individuals and patients with cerebral palsy were compared. Kinematic analysis included peak detection in specific kinematic variables. In the last part a graphical user interface for visualization was implemented.

L’évaluation classique de la posture rachidienne chez les patients porteurs d’une scoliose idiopathique de l’adolescent (SIA) se fait habituellement dans une position contrainte et statique en radiographie standard. Les conséquences sur la fonction rachidienne dynamique de ces déformations sont mal connues. Par ailleurs, les changements de la posture rachidienne au cours de la croissance et avec l’acquisition d’une marche stable n’ont encore jamais été explorés. L’analyse quantifiée du mouvement (AQM) d’une cohorte d’enfants sains a permis de mettre en évidence des modifications de la posture rachidienne dynamique au cours de la croissance, avec une augmentation de la gîte du tronc vers l’avant. Ces modifications s’accompagnaient de modifications anatomiques, en particulier au niveau des facettes articulaires cervicales. En AQM, les patients porteurs d’une SIA avaient des modifications du schéma de marche avec un décalage de phase à la marche entre la rotation des épaules et du bassin chez les patients scoliotiques. Il n’y avait pas de différence dans le schéma de marche entre les patients ayant une courbure thoracique droite et ceux ayant une courbure lombaire gauche. L’analyse de ces patients à 11 mois postopératoire a montré une restauration de certains paramètres grâce à la fusion vertébrale. Notamment, l’arthrodèse rachidienne postérieure de la courbure scoliotique a pour effet de faire disparaître le décalage de phase dans le plan transversal. L’AQM permet de mettre en évidence des modifications de la posture rachidienne chez ces patients et apparait comme un outil d’évaluation fondamental, qui pourrait nous permettre de mieux évaluer les traitements de la SIA. / In adolescent idiopathic scoliosis (AIS) patients, spinal posture is usually assessed in a constraint position with radiographic evaluation. However, the consequences of spinal deformity in these patients on the daily functioning of the spine remains unclear. On the other hand, spinal posture changes with normal growth and mature gait achievement have never been explored.A gait analysis was performed on a cohort of healthy children and highlighted changes in dynamic spinal posture with growth, showing that the trunk was increasingly leaning forward with mature gait achievement. These modifications were associated with anatomical changes, especially in the cervical spine.Changes in gait pattern were also observed in AIS patients thanks to gait analysis. In particular, there was a modification of upper trunk and pelvic rotation during gait. There was no difference in gait pattern according to major curve location. Eleven month postoperatively, our results showed that spinal fusion allowed restoration of a normal gait pattern, especially in the transversal plane.Gait analysis was able to highlight changes in dynamic spinal posture that occur in AIS patients, and thus appears as a major tool for spinal posture assessment in these patients. It could help us to improve the evaluation of the treatments that are proposed for spinal deformity correction.

The thesis evaluates the immediate effect of one therapeutic unit that using Dynamic Neuromuscular Stabilization (DNS) on the foot support function. The aim of the experiment was to verify effect of a single DNS therapeutic unit would to the determined parameters. The main expected effect was the optimization of the dynamic function of the foot and achieving better stability during the stance phase of a gait cycle. Methods: For the study, the asymptomatic group of 30 probands aged 24-36 years, 10 men and 20 women was selected. Fifteen probands were randomly divided to two groups - fifteen experimental group and fifteen to the control group. Subjects enrolled in the experimental group were measured before and after one forty minute therapeutic unit of DNS concept. The control group underwent two measurements at the same time interval, but without the therapeutic unit. The Senno Gait instrument was used for measuring. It contains insoles with motion sensors. It collects the data at a 100 Hz sampling rate for 1 minute while walking at its own normal speed. Results: Compared to initial examination, the significant shortening of the standing phase in the left lower limb (p = 0.003) and in the right lower limb (p = 0.034) was observed. The gait rate was unchanged after the DNS therapy in the...

Der Riss des vorderen Kreuzbandes ist die häufigste Lahmheitsursache der Hintergliedmaße beim Hund. In der Literatur werden verschiedene Operations-methoden zur Therapie des Kreuzbandrisses beschrieben. Ein dynamisches Verfah-ren stellt hierbei die TTA (Tibial Tuberosity Advancement) dar. Bei dieser Operation wird die Crista tibiae kranial verlagert, um einen Patellarsehnenwinkel (PTA) von 90° zum Tibiaplateau zu erreichen. In in vitro Untersuchungen konnte damit eine Aufhebung der kranio-kaudalen Scherkräfte, welche bei einem kreuzbandinsuffizienten Kniegelenk vorliegen, erreicht und die Stabilität des Kniegelenkes nach TTA wieder hergestellt werden. Ungeachtet dessen bestehen Hinweise auf eine persistierende Instabilität in vivo. Anhand der fluoroskopischen Kinematografie erfolgte eine Bewegungsanalyse der Kniegelenke von Hunden in vivo nach klassischer TTA sowie TTA-2. Zudem wurden mögliche Einflussfaktoren hinsichtlich des Erfolges der TTA-Technik untersucht. Die Arbeit ist in zwei Studien unterteilt. In der 1. Studie erfolgte die retrospektive Untersuchung von 10 Hundekniegelenken nach traditioneller TTA. Im Gegensatz dazu bezog sich die prospektive Studie 2 auf Kniegelenke nach einer TTA-2 Operation (n = 15). Die Hunde wurden orthopädisch untersucht und wiesen praeoperativ einen kompletten kranialen Kreuzbandriss auf. In der Arthroskopie bestätigte sich der komplette Riss und es erfolgte eine Untersuchung der Menisken, gegebenenfalls mit anschließender Meniskuschirurgie. In beiden Studien wurden die Hunde unilateral und uniplanar fluoroskopisch-kinematografisch untersucht, während sie im Schritt auf einem Laufband geführt wurden. Je Patient erfolgte eine Ganganalyse prae- und eine weitere 6-8 Wochen post operationem. Die Röntgenvideoaufnahmen wurden visuell von drei verschiedenen Untersuchern auf das Vorliegen einer kranio-kaudalen Translation beurteilt. Weiterhin wurden von allen Tieren der prae- und postoperative PTA sowie der Extensionswinkel bestimmt. Da ein aus der Literatur bekannter möglicher Einflussfaktor eine Unterkorrektur (PTA > 90°, zu kleine Cage-Größe) ist, wurde in der Studie 2 bei der Operationsplanung auf das Erreichen eines PTA ≤ 90° geachtet. In Studie 1 lag das mittlere Alter der Patienten bei 4,7 Jahren und das Gewicht bei 27,3 kg. Bei der arthroskopischen Untersuchung wiesen vier Gelenke Meniskusläsionen auf. Die postoperative Ganganalyse zeigte bei 90 % (9 von 10) eine persistierende Instabilität nach TTA, wobei der mittlere PTA 92,4° betrug. In der Studie 2 hatten die Tiere ein mittleres Alter von 7,0 Jahren und ein Gewicht von 31,2 kg. Bei der Mehrzahl der Patienten (n = 11) konnte ein Meniskusschaden diagnostiziert werden, wobei hauptsächlich mediale Korbhenkelrisse eine Rolle spielten. Die fluoroskopische Kinematografie zeigte bei 73,3 % der Patienten eine bestehende Instabilität nach TTA-2. Der mittlere PTA lag bei 88,5°. Im Gegensatz zu den Ergebnissen der in vitro Untersuchungen ist die überwiegende Anzahl der Kniegelenke nach Versorgung eines kranialen Kreuzbandrisses mit TTA bzw. TTA-2 persistierend instabil. Ungeachtet dessen wiesen alle Patienten eine klinische Verbesserung der Lahmheit auf. Während die Er-gebnisse der Studie 1 noch eine Unterkorrektur (postoperativer PTA > 90°) als mögliche Ursache für die Kniegelenksinstabilität nahelegen, konnte dies im Rahmen der Studie 2 wiederlegt werden. Inwieweit die Menisken als stabilisierender Faktor eine Rolle spielen, kann anhand der vorliegenden Arbeit nicht eindeutig geklärt werden. / Cranial cruciate ligament ruptures are the most common cause of hind limb lameness in dogs. Various surgical therapeutical methods are described in the literature to successful cure the cranial cruciate ligament rupture. Amongst those the dynamic technique TTA (tibial tuberosity advancement) is described. During this procedure, the Crista tibiae is shifted cranially to produce a patellar tendon angle (PTA) of 90°. It has been shown during in vitro studies that cranio-caudal shear forces that occur after cranial cruciate ligament rupture are clearly neutralized. This results in a completely stable stifle after TTA. However, evidence for persistent instabilities after TTA exist in vivo. Fluoroscopic gait analysis of the canine stifle in vivo after treatment with classical TTA and TTA-2 was performed. Furthermore, potential factors influencing a successful outcome of the TTA-technique were examined. This study is subdivided in two parts. During the 1st study a retrospective analysis of 10 canine stifles after classical TTA was undertaken, while the 2nd study was performed prospectively on stifles treated with a TTA-2 (n = 15). The dogs were examined orthopedically prior to surgery and suffered from a complete cranial cruciate ligament rupture. This was confirmed by arthroscopy which was further used to evaluate the meniscal status and to perform a meniscal surgery, if necessary. Fluoroscopic-kinematographic gait analyses were carried out prior to and 6-8 weeks after TTA by unilateral and uniplanar recording on all dogs while they were walking on a treadmill. The video sequences were analysed regarding the presence or absence of cranio-caudal movement by three independent investigators. Moreover, the pre- and post-surgical PTA and stifle angle were recorded. According to the literature undercorrected stifles (PTA > 90°, inappropriate small cage size) were identified as a possible cause of post-surgical instability. Therefore, special emphasis paid on surgical planning during study 2 to achieve a PTA ≤ 90° by TTA-2. The mean age of the patients in the 1st study was 4.7 years and their mean body weight 27.3 kg. Four joints showed meniscal lesions during the arthroscopic examination. During fluoroscopic gait analysis a persistent instability after TTA was present in 90 % (9 of 10) of the stifles. The median PTA was 92.4°. In the 2nd study the mean body weight was 31.2 kg and the mean age 7.0 years. Meniscal injuries were diagnosed in the majority of the patients (n = 11). Most of them were suffering from medial bucket handle tears. After performing TTA-2 73.3 % of the stifles showed a persistent instability during the fluoroscopic gait analysis. The mean PTA was 88.5°. Contrary to the results of in vitro studies, the majority of stifles after treatment of a cranial cruciate ligament rupture with a TTA or TTA-2 remain to be persistently instable. Nevertheless, all dogs clinically improved regarding the degree of lameness. While the results of the 1st study suggest an undercorrection (post-surgical PTA > 90°) as a possible cause of stifle instability, this could not be proven during the 2nd study. The role of the menisci as a stabilizer of the canine stifle could not be finally elucidated by the present work.

Bakgrund: I Sverige är den generella uppfattningen att det vid val av vardagssko är rekommenderat att välja en sportsko framför en canvas tennissko. Tidigare studier har jämfört hur olika skomodeller påverkar gången, men ingen har studerat skillnader mellan sportskor och canvas tennisskor. Syfte: Undersöka hur en sko med instabil läst och platt bindsula (canvas tennissko) samt en sko med en stadig läst, en sula med bra stötdämpning och avrullning (sportsko) påverkar den mediolaterala stabiliteten olika under stödfasen. Metod: Gånganalys på fem kvinnliga deltagare. Kinetisk och kinematisk data samlades in med hjälp av ett 3D-rörelseanalyssystem. Resultat: Rörelseomfånget skiljer sig mer mellan deltagare än skomodeller. Sportskor har ett försumbart lägre rörelseomfång än canvas tennisskor. Sportskor ger mer inverterad gång än Canvas tenniskor. Steglängden och stödfasen (stance time) skiljer inte mellan de två skomodellerna. Slutsats: Fotens rörelseomfång i frontalplanet skiljer sig inte mellan canvas tennisskor och sportskor under stödfasen, men sportskon har en mer inverterad rörelse. / Background: In Sweden it is a general perception that a sports shoe is a better choice than a canvas tennis shoe for everyday use. Previous studies have investigated how different shoe models affect the gait, but none have studied the differences between sport shoes and canvas tennis shoes. Aim: Investigate how a shoe with unstable last and a flat insole (canvas tennis shoe) and a shoe with steady last, a sole with good shock absorbing and roll off (sport shoe) affect the mediolateral stability differently during stance. Methods: Gait analysis on five female participants. Kinetic and kinematic data collected with3D-modionanalysis system. Results: The range of motion differs more between participants than between shoe models. The sport shoe have a negligible lower range of motion than the canvas tennis shoe. Walking in sport shoe shows a more inverted gait than gait in canvas tennis shoe. Step length and stance time are the same in both shoe models. Conclusion: The range of motion and motion pattern of the foot in the coronal plane does not differ between canvas tennis shoes and sport shoes during stance phase, but the sport shoe has a more inverted motion.

A system that enables a cheap and accurate method to objectively measure the gait of patients has been developed at the university hospital of Umeå, and is undergoing clinical testing during the writing of this thesis. Presented in this thesis are the theory, process, and results of the development of a prototype and user interface, used for the analysis and presentation of the data from these gait measurements. Ideally, the physiotherapists conducting the examinations will be able to analyze and edit the data from these measurements themselves. The focus was therefore lain on optimizing the usability and understandability of the prototype for physiotherapists. Because of the optimization of usability for physiotherapists, the development of the prototype was based on the design processes of Design thinking and User centered design. It was an iterative process broken down into three iterations. Each iteration included the development of a prototype that increased in fidelity with each iteration. Tests and interviews were also included and they laid the foundation for the tuning of the prototypes. A final prototype was developed and it consisted of three main parts. In the first part (1) the user inserts information about the examination and patient, as well as retrieves the measurement data from the external measurement device. In the second part (2) the user analyses and edits the data from the measurement, and in the third part the user is shown a summary of the results from the measurement and calculations. Functions that show the correlation between graphs to ease the editing of the data were added to the prototype. Help-pages were also added, which enabled the users to get help when needed during the analysis of the data. The prototype was evaluated by the participants in the user tests using the system usability scale, and the prototype scored an average of 79.58 points (A-) with a median of 83.75 points (A). Which ranks the usability of the prototype as good to excellent. This shows that the usability of the prototype has been optimized for physiotherapists. It has been done by chunking the analysis and editing of the measurement-data in into separate sections and also by adding functions that show the correlation between the different graphs in the prototype. The optimization was also made possible by following established design processes and concepts within user experience and user interface design. / På Umeå universitetssjukhus har ett system för gångmätningar tagits fram som möjliggör för billiga och exakta mätningar. Systemet gör det även möjligt att utföra objektiva bedömningar av patienternas gång. Detta system genomgick klinisktestning under tiden då detta examensarbete genomfördes. I detta examensarbete så presenteras teorin, processen och resultatet av utvecklingen av en prototyp för ett an-vändargränssnitt, som ska användas för analys och bedömning av mätdatat från dessa gångmätningar med det nya mätsystemet. Datat från gångmätningarna ska kunna analyseras och redigeras av de fysioterapeuter som genomför gångmätningarna. Användargränssnittet har därför utformats för att optimera användarvänligheten motfysioterapeuter och underlätta deras förståelse för hur mätdatat ska redigeras och analyseras. Användargränssnittet har tagits fram med hjälp av designprocesserna "Design thinking" och användarcentrerad design. Tre iterationer genomfördes och i varje iteration så utvecklades och förbättrades en prototyp för användargränssnittet. Användartester och intervjuer ingick också i dessa iterationer. En slutgiltig prototyp togs from och bestod av tre huvuddelar. En första del (1) där användaren kan skriva in information om mätningen och patienten, samt hämta data från mätningen från en extern mätenhet. En andra del (2) där användaren kan analysera och redigera data från mätningen, samt en tredje del (3) som visar en summering av resultatet från mätningen och beräkningarna. Funktioner som visade korrelationen mellan grafer för att underlätta redigeringen av data lades till i prototypen. Hjälpsidor lades också till vilket möjliggjorde för användaren att få hjälp vid behov. Prototypens användarvänlighet evaluerades av deltagarna i användartesten medhjälp av en skala som kallas "System Usability Scale". Prototypen fick en snittpoäng på 79.58 (A-) på denna skala, med en median på 83.75 poäng (A). Detta rankar användarvänlighet för denna prototyp som god till utmärkt. Den uppnådda poängen visar att en optimering av användarvänlighet mot fysioterapeuter har lyckats för den framtagna prototypen. Denna optimering av användarvänligheten har uppnåtts genom att dela upp analysen och redigering av mätdatat i flera delar, och genom att addera funktioner som visar korrelationen mellan olika grafer i prototypen. Optimeringen har även kunnat genomföras med hjälp av etablerade designmetoder så som design thinking.

No description available.

Robotic exoskeletons are designed to assist patients with motor dysfunctions. Recent researches focus on extending the robotic assistance to patient activities other than ground level walking. This study aims to analyse the lower limb muscle activity during inclined slope walking contrasting with that of ground level walking. Two different angles of inclination were chosen: 9 degrees and 18 degrees. 9 degrees inclined slope is the universal ramp size for wheelchairs. The hypothesis is that muscle activation, and ultimately metabolic cost, in inclined slope walking is different from that of ground level walking. Collected motion data and simulation in OpenSim prove that the difference in metabolic cost is because of increased activity of ankle dorsiflexors and hip extensors and reduced activity of knee extensors. Finally, muscle activities along with other criteria such as kinematic alignment and joint range of motion are summed up as biomechanical considerations for robotic exoskeleton design.

Osteoarthritis (OA) is a degenerative condition of articular cartilage that affects more than 25 million people in the US. Joint injuries, like anterior cruciate ligament (ACL) tears, can lead to OA due to a change in articular cartilage loading. Gait analysis combined with knee joint finite element modeling (FEM) has been used to predict the articular cartilage loading. To predict the change of articular cartilage loading during gait due to various ACL injuries, a tibiofemoral FEM was developed from magnetic resonance images (MRIs) of a 33 year male, with no prior history of knee injuries. The FEM was validated for maximum contact pressure and anterior tibial translation using cadaver knee studies. The FEM was used to model gait of knees with an intact ACL, anteromedial (AM) bundle injury, posterolateral (PL) bundle injury, complete ACL injury, AM deficiency, PL deficiency, complete ACL rupture, as well as a bone-patellar tendon-bone (BPTB) graft. Generally, the predicted maximum contact pressure and contact area increased for all the ACL injuries when compared to intact ACLs. While an increase in maximum contact pressure and contact area is an indication of an increased risk of the development of OA, the percent of increase was typically small suggesting that walking is a safe activity for individuals with ACL injuries.