The present work represents an exploratory study that aims to perform a qualitative and quantitative analysis for the spine and lower limbs kinematics, in children with neurological and neuromuscular diseases. Among neurological pathologies, cerebral palsy (CP) and hereditary spastic paraparesis (HSP) were considered, while for the neuromuscular ones Charcot-Marie Tooth disease (CMT) and Duchenne muscular dystrophy (DMD). Despite the different etiologies, at the clinical level all these disorders share a motor impairment, so the purpose of this analysis is to identify distinctive signs for each pathology. 5 CP, 8 HSP, 5 CMT, 5 DMD and 12 healthy peers were recruited for the study. Gait analyses were performed at the "Laboratorio per l’Analisi del Movimento nel Bambino”, using the LAMB protocol. The calculation of the spatiotemporal and kinematic parameters was conducted with ad hoc Matlab® scripts. In detail, with regard to the spine kinematic, the parameters extracted were: the spinal length, the kyphosis and the lordosis angles, the trunk angles and the shoulder-pelvis angles. Instead, to describe the kinematic of the lower limbs were extracted: the pelvis absolute angles, the hip angles projected in the sagittal and frontal planes and the angles of both knee and ankle projected in the sagittal plane. The analysis of the spatiotemporal parameters revealed some differences. Gait speed, reduced in all the pathological groups, seems to be more impaired for the neurological disorders with also a reduced stride length. On the other hand, DMD patients seem to increase their base of support. From kinematics, it was possible to find characteristic trends such as the double bump in the pelvic tilt, similar for CP and HSP and in anti-phase for DMD and CMT. This could be a good predictor to differentiate neurological and neuromuscular pathologies. On the contrary, knee flexion-extension seems to differentiate CP from HSP. As a future perspective, in addition to increasing the sample size, we could find out if there are muscle activities related to the identified characteristic trends.
Il presente lavoro di tesi rappresenta uno studio esplorativo che ha come obiettivo quello di effettuare un’analisi qualitativa e quantitativa della cinematica del rachide e degli arti inferiori, in bambini affetti da patologie neurologiche e neuromuscolari. Tra le patologie neurologiche sono state considerate la paralisi cerebrale infantile (PCI) e la paraparesi spastica ereditaria (HSP) mentre tra le patologie neuromuscolari la malattia di Charcot-Marie Tooth (CMT) e la distrofia muscolare di Duchenne (DMD). Tali malattie, pur avendo una diversa localizzazione del deficit, presentano simili output motori, per cui lo scopo di tale analisi è quello di individuare segni distintivi per ciascuna patologia. Per l’analisi sono stati reclutati 5 bambini PCI, 8 HSP, 5 CMT, 5 DMD e 12 coetanei sani. Le prove del cammino sono state effettuate presso il “Laboratorio per l’Analisi del Movimento nel Bambino”, utilizzando il protocollo LAMB. Per il calcolo dei parametri spazio-temporali e cinematici sono stati realizzati degli script in Matlab®. Nel dettaglio, le grandezze cinematiche estratte sono state: lunghezza del rachide, angoli di lordosi e cifosi, angoli del tronco, angoli di spalle, angoli delle pelvi, angoli di flesso-estensione e di ab-adduzione di anca, e, infine, gli angoli di flesso-estensione di ginocchio e caviglia. Dall’analisi dei parametri spazio-temporali, la velocità, ridotta in tutti i gruppi patologici, si è rivelata un parametro maggiormente compromesso nel caso delle patologie neurologiche a cui si associa anche una ridotta lunghezza del passo. I pazienti DMD sembrano invece incrementare maggiormente la loro base di appoggio. Dall’analisi cinematica è stato possibile riscontrare andamenti caratteristici come il double bump nel tilt pelvico, simile per PCI e HSP e in anti-fase per DMD e CMT, ciò potrebbe essere un buon predittore per differenziare patologie neurologiche e neuromuscolari. La flesso-estensione del ginocchio sembra invece differenziare PCI da HSP. In prospettiva futura, oltre all’incremento del campione, si potrebbe scoprire se ci sono attività muscolari connesse agli andamenti caratteristici individuati.
Analisi cinematica del cammino in bambini affetti da malattie neurologiche e neuromuscolari
Abbruzzino, Francesca;GIURO, VALERIA
2022/2023
Abstract
The present work represents an exploratory study that aims to perform a qualitative and quantitative analysis for the spine and lower limbs kinematics, in children with neurological and neuromuscular diseases. Among neurological pathologies, cerebral palsy (CP) and hereditary spastic paraparesis (HSP) were considered, while for the neuromuscular ones Charcot-Marie Tooth disease (CMT) and Duchenne muscular dystrophy (DMD). Despite the different etiologies, at the clinical level all these disorders share a motor impairment, so the purpose of this analysis is to identify distinctive signs for each pathology. 5 CP, 8 HSP, 5 CMT, 5 DMD and 12 healthy peers were recruited for the study. Gait analyses were performed at the "Laboratorio per l’Analisi del Movimento nel Bambino”, using the LAMB protocol. The calculation of the spatiotemporal and kinematic parameters was conducted with ad hoc Matlab® scripts. In detail, with regard to the spine kinematic, the parameters extracted were: the spinal length, the kyphosis and the lordosis angles, the trunk angles and the shoulder-pelvis angles. Instead, to describe the kinematic of the lower limbs were extracted: the pelvis absolute angles, the hip angles projected in the sagittal and frontal planes and the angles of both knee and ankle projected in the sagittal plane. The analysis of the spatiotemporal parameters revealed some differences. Gait speed, reduced in all the pathological groups, seems to be more impaired for the neurological disorders with also a reduced stride length. On the other hand, DMD patients seem to increase their base of support. From kinematics, it was possible to find characteristic trends such as the double bump in the pelvic tilt, similar for CP and HSP and in anti-phase for DMD and CMT. This could be a good predictor to differentiate neurological and neuromuscular pathologies. On the contrary, knee flexion-extension seems to differentiate CP from HSP. As a future perspective, in addition to increasing the sample size, we could find out if there are muscle activities related to the identified characteristic trends.File | Dimensione | Formato | |
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2023_12_Abbruzzino_Giuro_Tesi_01.pdf
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Descrizione: Testo della tesi
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2023_12_Abbruzzino_Giuro_ExecutiveSummary_02.pdf
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Descrizione: Executive Summary
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https://hdl.handle.net/10589/215484