Biomedical subjects

Eric Watelain

Publications and source records attributed to Eric Watelain.

5 recordsLinked to original sources

PubMed2006

Linking clinical measurements and kinematic gait patterns of toe-walking using fuzzy decision trees.

Toe-walking is one of the most prevalent gait deviations and has been linked to many diseases. Three major ankle kinematic patterns have been identified in toe-walkers, but the relationships between the causes of toe-walking and these patterns remain unknown. This study aims to identify these relationships. Clearly, such knowledge would increase our understanding of this gait deviation, and could help clinicians plan treatment. The large quantity of data provided by gait analysis often makes interpretation a difficult task. Artificial intelligence techniques were used in this study to facilitate interpretation as well as to decrease subjective interpretation. Of the 716 limbs evaluated, 240 showed signs of toe-walking and met inclusion criteria. The ankle kinematic pattern of the evaluated limbs during gait was assigned to one of three toe-walking pattern groups to build the training data set. Toe-walker clinical measurements (range of movement, muscle spasticity and muscle strength) were coded in fuzzy modalities, and fuzzy decision trees were induced to create intelligible rules allowing toe-walkers to be assigned to one of the three groups. A stratified 10-fold cross validation situated the classification accuracy at 81%. Twelve rules depicting the causes of toe-walking were selected, discussed and characterized using kinematic, kinetic and EMG charts. This study proposes an original approach to linking the possible causes of toe-walking with gait patterns.

Biomechanical Phenomena↗

PubMed2006

Identification and classification of toe-walkers based on ankle kinematics, using a data-mining method.

A database of 1,736 patients and 2,511 gait analyses was reviewed to identify for trials where the first rocker was absent. A fuzzy c-means algorithm was used to identify sagittal ankle kinematic patterns and three groups were identified. The first showed a progressive dorsiflexion during the stance phase, while the second had a short-lived dorsiflexion, followed by a progressive plantarflexion. The third group exhibited a double bump pattern, moving successively from a short-lived dorsiflexion to a short-lived plantarflexion and then returning to a further short-lived dorsiflexion before ending with plantarflexion until toe-off. The three patterns were linked to different neurological conditions. Myopathy, neuropathy and arthogryposis essentially revealed group 1 patterns, whereas idiopathic toe-walkers mainly displayed group 2 patterns. Cerebral palsy patients, however, were relatively homogeneously distributed amongst the three groups. Able-bodied subjects walking on their toes showed a high proportion of unclassifiable ankle patterns, due to a variable gait whilst toe walking. Despite the variety of neurological conditions included in this meta-analysis repeatable biomechanical patterns appeared that could influence therapeutic management.

Adolescent↗

PubMed2005

A comparison of gait in spinal muscular atrophy, type II and Duchenne muscular dystrophy.

This study investigated and compared the gait of two patients with spinal muscular atrophy, type II (SMA II) and two patients with Duchenne muscular dystrophy (DMD). These diseases cause a progressive and proximal to distal muscular weakness resulting in the loss of ambulation. The DMD cases had comparable muscle weakness with the SMA II cases on manual muscle testing and patients were assessed using kinematics, kinetics, electromyography and video analysis. SMA II and DMD patients employed different gait strategies for forward movement. SMA II patients used pelvic rotation initiated by the upper body to propel the leg forward and produce the necessary step-length whereas the DMD patients tended to use hip flexion and plantar flexion. Management of SMA II patients would include preservation of hip abductor and flexor strength to maintain mobility.

Biomechanical Phenomena↗

PubMed2005

Variability of video-based clinical gait analysis in hemiplegia as performed by practitioners in diverse specialties.

OBJECTIVE: Clinical gait analysis is widely used by different therapists working with hemiplegic patients. The purpose of this study was to assess the reliability of video-based clinical gait assessment, as performed by practitioners in diverse specialties. DESIGN: Five neurologists, 5 physiotherapists, and 5 doctors of physical medicine and rehabilitation (physiatrists) were asked to study a videotape of 6 patients with hemiplegia in the act of walking. This activity was chosen due to the wide use of gait information for therapeutic prescription and medical decision-making during medical consultations, at conventions, or in exchanges between therapists. RESULTS: Results highlighted a certain inconsistency in the use of the gait description indicators. The 15 therapists used 396 different locutions to describe the gaits of the 6 patients. These locutions yielded 60 general indicators, or gait disorders, which were grouped in 5 categories. Eleven of them were classified as "controversial" due to the significant inter-subject variability of the evaluations. CONCLUSION: The study identified a large number of indicators that were used relatively inconsistently by the 3 specialties studied. The results of this study would appear to indicate that greater caution is needed when dealing with some of the "controversial" indicators, as well as with the "unusual" gait patterns observed in some patients.

Adult↗

PubMed2003

Comparison of clinical gait analysis strategies by French neurologists, physiatrists and physiotherapists.

Clinical and functional gait analysis is used widely by different professionals dealing with patients with hemiplegia. The aim of this study was to examine the gait analysis strategies of neurologists, specialists in physical and rehabilitation medicine (physiatrists) and physiotherapists. Differences in global analysis strategy and choice of indicators between different clinicians have not previously been studied precisely, and we believe that a standardized approach would enhance the training of young practitioners. The knowledge acquisition phase (specialists' expertise identification) was completed by an identified expert with a subject groups of 5 neurologists, 5 specialists in physical and rehabilitation medicine and 5 physiotherapists, who were asked to comment on a videotape of patients with hemiplegia walking, followed by a semi-directed interview. The results show that specialists use a wide variety of gait indicators. The total number of different medical vocabulary and expressions used to describe gait was 396, semantically grouped as 60 general indicators. Specialists highlighted an analysis strategy (order, type and number of indicators) typical to each professional specialty. The neurologists tried to identify the elements allowing localization of lesions and characterized the hemiplegia globally,while the specialists in physical and rehabilitation medicine conducted a bio-mechanical analysis and the physiotherapists were highly descriptive. The differences in strategies adopted by each specialty contribute to an enrichment of gait analysis. This should be taken into account in teaching and determining gait assessment scales.

Adult↗