Gait analysis is recognized as a useful assessment tool in the field of human movement research. However, doubts remain on its real effectiveness as a clinical tool, i.e. on its capability to change the diagnostic-therapeutic practice. In particular, the conditions in which evidence of a favorable cost-benefit ratio is found and the methodology for properly conducting and interpreting the exam are not identified clearly. To provide guidelines for the use of Gait Analysis in the context of rehabilitation medicine, SIAMOC (the Italian Society of Clinical Movement Analysis) promoted a National Consensus Conference which was held in Bologna on September 14th, 2013. The resulting recommendations were the result of a three-stage process entailing i) the preparation of working documents on specific open issues, ii) the holding of the consensus meeting, and iii) the drafting of consensus statements by an external Jury. The statements were formulated based on scientific evidence or experts' opinion, when the quality/quantity of the relevant literature was deemed insufficient. The aim of this work is to disseminate the consensus statements. These are divided into 13 questions grouped in three areas of interest: 1) General requirements and management, 2) Methodological and instrumental issues, and 3) Scientific evidence and clinical appropriateness. SIAMOC hopes that this document will contribute to improve clinical practice and help promoting further research in the field.

Purpose of reviewWe provide a practical guide on the use of electromyography (EMG) and ultrasound (US) to assist botulinum neurotoxin (BoNT) treatment in patients with cervical dystonia (CD).Recent findingsUS and EMG guidance improve BoNT treatment in CD. Their use is particularly valuable for targeting deep neck muscles and managing complex cases. There is also evidence that adverse events are reduced when superficial or intermediate layer muscles are injected with assisted guidance.SummaryA structured clinical approach, based on functional neck anatomy, guides CD assessment and BoNT treatment. Muscles are selected according to clinical, EMG and US findings. US provides anatomical visualization, while EMG complements by detecting muscle activity. We review here the current practice for assisted treatment of CD through BoNT cycles. We also describe how to recognize and manage the main adverse events.

Gait analysis has demonstrated to efficaciously support clinical investigations. The patterns of the outcome variables (joint angles, moments and powers) are characterized by an intrinsic and extrinsic variability. Particularly, extrinsic variability is induced by operator-dependent differences in markers' placement, with errors propagating non-linearly to alter outcome variable patterns. The aims of this study are (1) to consider a specific gait analysis protocol named LAMB and provide a description of its procedures, (2) to experimentally assess the between-operator and within-operator variability induced by operator-dependent marking of required anatomical landmarks and (3) to evidence how such inaccuracies propagates to the gait analysis kinematic and kinetic outcome variables. Six expert gait analysis operators performed LAMB anatomical landmarks marking on three healthy adult participants; moreover, one operator repeated three times the marking on one participant. The participants then performed a set of locomotor tasks including stair negotiation and heel-and toe-walking. An anatomical calibration approach let to register each marking and to compute, starting from one single raw data set, a set of outcome variables for each marking/operator. The between-operator variability of gait analysis outcome was assessed in terms of mean absolute variability to quantify offsets and minimal correlation coefficient to quantify patterns' similarity. The results evidence average minimal correlation coefficient ranging from 0.857 for moments to 0.907 for angles and average mean absolute variability accounted for few degrees in angular variables (worst between-operator mean absolute variability is 7.3°), while dynamic variables mean absolute variability, relative to the variable range, was below 5% for moment and below 10% for powers. The variability indexes are comparable to those related to previously published protocols and are independent from the considered task, thus suggesting that the LAMB is a reliable protocol suitable for the analysis of different locomotor tasks.