THERAPEUTIC INDICATIONS FOR THE RECOVERY OF GAIT PERTURBATION AND FALL PREVENTING

M. Petrarca¹, M. Favetta¹, S. Summa¹

¹"Bambino Gesù" Children's Hospital, Neurorehabilitation and Robotics, Rome, Italy

Background: Technological solutions are expanding the knowledge of the dynamic aspect of function that are useful for its prevention and recovery. The Centre of Pression (CoP) detection employing force platforms demonstrates efficacy in detecting the risk of falls [1]. Despite that, the information given by the CoP do not help to address a therapeutic indication.

Purpose: This study aims to analyze the full body adaptation to a perturbation during natural walking to extract specific therapeutic indications.

Methods: Twelve typically developed young adults and ten children with cerebral palsy walked on a walkway with a camouflaged robotic platform at floor level. The robotic platform was developed ad-hoc in house and controlled in force [2]. The platform descends 10% of the limb length when the participants step on it. This solution was adopted to guarantee the same difficulty for each subject. Was made possible by adapting the stiffness of each participant to their weight and leg length. A 3d motion capture system (Vicon MX, UK) reconstructed the full-body biomechanical model of the participants. A protocol was defined to assess three different conditions, unperturbed gait and expected and unexpected perturbation. Three trials for each conditions was gathered for each participant. Data were analyzed using Matlab tools.

Results: The Linear Fit Method [3] was utilized to detect the statistical differences in the serial time concerning the joint rotation of the body articulation by comparing the three conditions: unperturbed, expected and unexpected perturbation of gait. In such a way, it was possible to analyze the role of the anticipation of the perturbation (expected perturbation) concerning its prediction during the ongoing adaptation to unexpected perturbation.

Conclusions: It was possible to discern between distal to prossimal strategies. Furthermore, while typically developed participants adapt on the platform in all the conditions using a distal approach (ankle and knee), children with Cerebral palsy also adjust the gait in the half stride after the perturbation with a more distal involvement (pelvis)

Implications: The comparison of the anticipatory and predictive (ongoing) strategies lets to analyze the cause of the risk of falls and define the specific district on which to concentrate the therapeutic indications with specific dynamic treatments.
References: Flavien Quijoux et al. Center of pressure displacement characteristics differentiate fall risk in older people: A systematic review with meta-analysis. doi.org/10.1016/j.arr.2020.101117.
Susanna Summa et al. Development of a Dynamic Oriented Rehabilitative Integrated System (DORIS) and Preliminary Tests. doi:10.3390/s19153402.
Marco Iosa et al. Assessment of Waveform Similarity in Clinical Gait Data: The Linear Fit Method. doi.org/10.1155/2014/214156.

Funding acknowledgements: Supported by Pegaso Onlus (Grant numbers: opbg-201603×003858) and by the Italian Ministry of Health (Grant numbers: CO-2011-02351627)

Keywords:
Gait Recovery
Anticipatory and predictive strategies
Neurological diseases

Topics:
Disability & rehabilitation
Innovative technology: robotics
Paediatrics: cerebral palsy

Did this work require ethics approval? Yes

Institution: Bambino gesù Children's Hospital

Committee: Ethical Committee of the Bambino Gesù Children's Hospital

Ethics number: 201501X003626