ORIGINAL ARTICLE   Open access

European Journal of Physical and Rehabilitation Medicine 2023 December;59(6):669-81

DOI: 10.23736/S1973-9087.23.07979-0

Copyright © 2023 THE AUTHORS

This is an open access article distributed under the terms of the CC BY-NC-ND 4.0 license which allows users to copy and distribute the manuscript, as long as this is not done for commercial purposes and further does not permit distribution of the manuscript if it is changed or edited in any way, and as long as the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI) and provides a link to the license.

language: English

ToulGaitViz: a tool for the systematic description of lower limb clearance during the swing phase of hemiparetic gait after stroke. A cohort study

Emmeline MONTANÉ ¹, Camille CORMIER ^{1, 2}, Marino SCANDELLA ³, Adrian CANGELOSI ¹, Philippe MARQUE ^{2, 4}, Florent MOISSENET ⁵, David GASQ ^{1, 2} ✉

¹ Toulouse University Hospital Center, Department of Physiological Explorations, Toulouse, France; ² Toulouse NeuroImaging Center (ToNIC), Inserm, Toulouse University3, Toulouse III - Paul Sabatier University, Toulouse, France; ³ Gait Analysis Laboratory, Toulouse University Hospital, Toulouse, France; ⁴ Department of Physical and Rehabilitation Medicine, Toulouse University Hospital, Toulouse, France; ⁵ Kinesiology Laboratory, Geneva University Hospitals, Geneva University, Geneva, Switzerland

BACKGROUND: In post-stroke hemiparetic subjects, a systematic and quantified description of the shortening default and compensatory movements during the swing phase of gait is essential to guide treatments and assess the impact of therapeutic interventions. However, such a systematic approach does not exist in the current clinical practice.
AIM: The aim of this study was to present a method improving the quantification and visualization of the kinematics of both lower limbs during the swing phase of gait, more specifically the origin of shortening default and the weight of compensations, based on a tool specifically developed: ToulGaitViz.
DESIGN: Observational cohort study.
SETTING: Three-dimensional kinematic gait analyses of outpatients evaluated in Toulouse university hospital.
POPULATION: ToulGaitViz was applied to 151 post-stroke hemiparetic participants and 48 healthy control participants.
METHODS: ToulGaitViz is a standalone software allowing to compute 1) limb clearance as the sum of the shortening related to hip, knee and ankle flexion in the sagittal plane; 2) compensations related to the abduction of the limb and hip hiking at mid-swing. Both centimetric and angular values of the clearance were reported as well as their correlations with walking speed.
RESULTS: Overall, the contribution of compensations in clearance was higher in post-stroke hemiparetic subjects than in healthy control participants with both centimetric (130% vs. 33%; P<0.001) and angular methods (23% vs. 1.4%; P<0.001). The centimetric method better represents the specific contribution of each segment to the clearance than the angular method. Symbolically, mean kinematic data from the cohort supports the claim that 2° of pelvic obliquity is equivalent to 10° of knee flexion to increase clearance by 1 cm, emphasizing the non-proportionality between the angular values and the actual contribution to the shortening. ToulGaitViz allows visualization of clearance, segmental shortening and compensation evolution before and after any therapeutic intervention with quantitative and comprehensive data.
CONCLUSIONS: The ToulGaitViz could be systematically used in clinical practice to extract relevant kinematic data from the origin of shortening default and the weight of compensations.
CLINICAL REHABILITATION IMPACT: This tool allows better understanding of the mechanisms of action of treatments to better link them to the subjects’ needs.

KEY WORDS: Gait analysis; Hemiplegia; Neurologic gait disorders; Biomechanical phenomena