Evaluation methods to assess the efficacy of equinovarus foot surgery on the gait of post-stroke hemiplegic patients: A literature review

l’Escalopier, Nicolas de; Voisard, Cyril; Michaud, Mona; Moreau, Albane; Jung, Sylvain; Tervil, Brian; Vayatis, Nicolas; Oudre, Laurent; Ricard, Damien

doi:10.3389/fneur.2022.1042667

Cited by 7 publications

(8 citation statements)

References 82 publications

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“…Gait analysis using IMU has gained widespread popularity, and several algorithms have been developed and demonstrated their efficacy in detecting gait events (GEs) of healthy individuals [ 4 , 13 , 24 , 44 ]. In clinical settings, measuring gait performance provides valuable additional information about walking activity and spontaneous gait characteristics, such as in the follow-up of neurological patients [ 5 , 18 , 45 ] or in preoperative examinations [ 46 , 47 ]. While some teams use only trunk wearable sensors that provide global features such as smoothness [ 48 ], a more precise analysis requires GE detection, which can be done with two separate IMUs on each lower limb [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Automatic gait events detection with inertial measurement units: healthy subjects and moderate to severe impaired patients

Voisard,

de l’Escalopier,

Ricard

et al. 2024

J NeuroEngineering Rehabil

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Background Recently, the use of inertial measurement units (IMUs) in quantitative gait analysis has been widely developed in clinical practice. Numerous methods have been developed for the automatic detection of gait events (GEs). While many of them have achieved high levels of efficiency in healthy subjects, detecting GEs in highly degraded gait from moderate to severely impaired patients remains a challenge. In this paper, we aim to present a method for improving GE detection from IMU recordings in such cases. Methods We recorded 10-meter gait IMU signals from 13 healthy subjects, 29 patients with multiple sclerosis, and 21 patients with post-stroke equino varus foot. An instrumented mat was used as the gold standard. Our method detects GEs from filtered acceleration free from gravity and gyration signals. Firstly, we use autocorrelation and pattern detection techniques to identify a reference stride pattern. Next, we apply multiparametric Dynamic Time Warping to annotate this pattern from a model stride, in order to detect all GEs in the signal. Results We analyzed 16,819 GEs recorded from healthy subjects and achieved an F1-score of 100%, with a median absolute error of 8 ms (IQR [3–13] ms). In multiple sclerosis and equino varus foot cohorts, we analyzed 6067 and 8951 GEs, respectively, with F1-scores of 99.4% and 96.3%, and median absolute errors of 18 ms (IQR [8–39] ms) and 26 ms (IQR [12–50] ms). Conclusions Our results are consistent with the state of the art for healthy subjects and demonstrate a good accuracy in GEs detection for pathological patients. Therefore, our proposed method provides an efficient way to detect GEs from IMU signals, even in degraded gaits. However, it should be evaluated in each cohort before being used to ensure its reliability.

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Section: Discussionmentioning

confidence: 99%

Automatic gait events detection with inertial measurement units: healthy subjects and moderate to severe impaired patients

Voisard,

de l’Escalopier,

Ricard

et al. 2024

J NeuroEngineering Rehabil

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“…As previously shown in a literature review [7], the impact on patients' overall gait is very di cult to quantify clinicall, making it di cult to establish a standardized method for evaluating the e cacy of SEVF surgery after stroke. Most of the scales lack speci city, and the most promising option appears to be the Goal Attainment Scale [5,9,39,40].…”

Section: Evaluation Methods In Sevf Surgerymentioning

confidence: 99%

“…Gait assessment of hemiplegic post-stroke patients with SEVF is a real challenge in clinical practice. There is currently no simple, reproducible, objective, and quanti able way to assess gait in its entirety in clinical practice [7]. For this reason the evaluation of the result is therefore mainly based today on a subjective functional evaluation, with the Goal Attainment Scale appearing as the most reliable tool [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…Neuro orthopaedic surgery for SEVF encompasses a combination of tendon and nerve procedures performed by a single team [5,6]. It provides a satisfactory functional result in most cases, even if precise assessment remains di cult and complex to reproduce [7].…”

Section: Introductionmentioning

confidence: 99%

“…In order to assess the reliability and consistency of semiogram in the peri-operative evaluation of post-stroke SEVF, we compare in this article the results obtained with the semiogram and the functional evaluation usually performed [7]. Our main objective is to evaluate the gait analysis obtained by IMU before and after surgical management of SEVF in hemiplegic post-stroke patients and to compare it with the functional results obtained in a monocentric prospective cohort.…”

Section: Introductionmentioning

confidence: 99%

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Inertial Measurement Units to evaluate the efficacity of Equino Varus Foot surgery in post stroke hemiparetic patients

de l'Escalopier,

Voisard,

Jung

et al. 2023

Preprint

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Introduction This study evaluates the gait analysis obtained by IMU before and after surgical management of Spastic Equino Varus Foot in hemiplegic post-stroke patients and to compare it with the functional results obtained in a monocentric prospective cohort. Methods Patients with post-stroke equinovarus foot, who underwent surgery in a single hospital between November 2019 and December 2021 were included. The follow-up duration was 6 months and included a functional analysis using Goal Atteinment Scale and a Gait analysis using an innovative Multidimensional Gait Evaluation using IMU: the semiogram. Results 20 patients had a gait analysis preoperatively and at 6 months postoperatively. 90% (18/20) patients had a functional improvement and 50% (10/20) had an improvement in walking technique as evidenced by the cessation of the use of a walking aid. Considering the semiogram, the measurement of the area weighted by average speed demonstrated very good reproducibility (ICC(1, 3) = 0.80). In the group with a positive functional outcome (GAS T score ≥ 50), the change in the area was + 9.5%, sd = 27.5% for the group with modification of walking aid, and + 15.4%, sd = 28% in the group without change of walking aid. For the 3 experiences (two patients) with unfavorable results, the area under the curve changed by + 2.3%, -10.2% and − 9.5%. Discussion IMUs appear to be a promising solution for the assessment of post-stroke hemiplegic patients who have undergone SEVF surgery. They can provide a quantified, objective, reliable in individual longitudinal follow up automated gait analysis solution for routine clinical use. Combined with a functional scale such as the GAS, they can provide a global analysis of the effect of surgery.

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Plantar pressure in relation to hindfoot varus in people with unilateral upper motor neuron syndrome

Bloks,

Wilders,

Louwerens

et al. 2024

Journal of Foot and Ankle Research

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IntroductionHindfoot varus deformity is common in people with unilateral upper motor neuron syndrome (UMNS) and can be dynamic or persistent. The aims of this study were (1) to gain insight into plantar pressure characteristics of people with chronic UMNS in relation to hindfoot varus and (2) to propose a quantitative outcome measure, based on plantar pressure, for the scientific evaluation of surgical interventions.MethodsIn this retrospective study, a cohort comprising plantar pressure data of 49 people with UMNS (22 “no hindfoot varus”, 18 “dynamic hindfoot varus”, and 9 “persistent hindfoot varus”), and 586 healthy controls was analyzed. As an indication of plantigrade foot contact, the ratio between the plantar contact area of the affected and the non‐affected foot was calculated. To investigate spatial and temporal aspects of plantar pressure, normalized plantar pressure patterns and center of pressure trajectories were computed.ResultsPeople with UMNS had lower plantar pressure area ratios compared to healthy controls. Additionally, increased plantar pressure underneath the lateral foot was found in people with a persistent hindfoot varus. Center of pressure trajectories were more lateral during the first 26% of the stance phase in people with a dynamic hindfoot varus and during the first 82% of the stance phase in people with a persistent hindfoot varus compared to healthy controls.ConclusionSpatial and temporal differences in plantar pressure were found in people with dynamic or persistent hindfoot varus deformity. We propose to primarily use the medio‐lateral center of pressure trajectory as outcome measure for the scientific evaluation of surgical interventions targeting hindfoot varus.

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Evaluation methods to assess the efficacy of equinovarus foot surgery on the gait of post-stroke hemiplegic patients: A literature review

Cited by 7 publications

References 82 publications

Automatic gait events detection with inertial measurement units: healthy subjects and moderate to severe impaired patients

Automatic gait events detection with inertial measurement units: healthy subjects and moderate to severe impaired patients

Inertial Measurement Units to evaluate the efficacity of Equino Varus Foot surgery in post stroke hemiparetic patients

Plantar pressure in relation to hindfoot varus in people with unilateral upper motor neuron syndrome

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