PODIUM. Journal of Science and Technology in Physical Culture, September-December 2022; 17(3):1028-1039
Translated from the original in spanish
Biokinematic analysis of gait in patients with hemiplegia
Análisis biocinemático de la marcha en pacientes con hemiplejia
Análise biocinética da marcha em pacientes com hemiplegia
Robiel Jesús Pozo-Sánchez1* https://orcid.org/0000-0002-5298-1870
Amada Plácida Gómez-Zoquez1 https://orcid.org/0000-0003-4918-7569
Jacqueline Medrano-Montero2 https://orcid.org/0000-0001-8631-5991
Pablo Alejandro Curay-Carrera3 https://orcid.org/0000-0001-5315-6621
Darwin Manuel Abalco Farinango4 https://orcid.org/0000-0003-2257-2512
1Faculty of Physical Culture. University of Holguin. Holguin.
2 Provincial Center for Rehabilitation of Hereditary Ataxias. Cuba.
3Central University of Ecuador. Ecuador.
4Millennium Educational Unit "Katun Kuraka Otavalo". Ecuador.
Corresponding author: firstname.lastname@example.org
Introduction: A biokinematic analysis of gait was performed in patients with hemiplegia, which
is the paralysis of one side of the body, recognized in the context of medical sciences and
therapeutic physical culture as hemiplegic syndrome.
Objective: It consisted of determining the biokinematic modifications that are manifested in the gait of patients with hemiplegia in the "Pedro Díaz Coello" health area of Holguín.
Materials and methods: The sample consisted of five patients who received systematic care in the rehabilitation room of the health area of the " Pedro Díaz Coello" polyclinic in the municipality of Holguín. The interviews conducted with medical and physical rehabilitation personnel who work in the health area, with researchers from the Faculty of Physical Culture and Sports of the University of Holguín, the review of normative documents on multidisciplinary work and the observation of rehabilitation sessions, showed the need to address the issue from biomechanics, given the limited quantification of its indicators. In order to analyze the behavior of biokinematic indicators of pathological gait, the videographic technique was used. With the Kinovea software, in version 0.8.27, the controlled indicators were quantified.
Results: Together with the qualitative study for each patient, it allowed a comparison of the characteristics of their gait with the normal pattern and the elaboration of a group of recommendations to be considered during the physical rehabilitation process.
Conclusions: It was possible to analyze the behavior of the biokinematic indicators of hemiplegic gait in the patients studied, their comparison with normal gait, as well as a set of recommendations to be taken into account in the rehabilitation process
Keywords: Biomechanical control; Gait; Hemiplegia; Rehabilitation; Videography.
Introducción: Se realizó un análisis biocinemático de la marcha en pacientes con hemiplejia,
que es la parálisis de un hemicuerpo, reconocida en el contexto de las ciencias médicas y de la
cultura física terapéutica como síndrome
Objetivo: Consistió en determinar las modificaciones biocinemáticas que se manifiestan en la marcha de los pacientes con hemiplejia del área de salud "Pedro Díaz Coello" de Holguín.
Materiales y métodos: La muestra estuvo constituida por cinco pacientes que recibieron atención sistemática en la sala de rehabilitación del área de salud del policlínico" Pedro Díaz Coello" del municipio de Holguín. Las entrevistas realizadas a personal médico y de rehabilitación física que trabaja en el área de salud, a investigadores de la Facultad de Cultura Física y Deportes de la Universidad de Holguín, la revisión de documentos normativos sobre el trabajo multidisciplinar y la observación a sesiones de rehabilitación, evidenciaron la necesidad de abordar el tema desde la biomecánica, dada la limitada cuantificación de sus indicadores. Con el objetivo de analizar del comportamiento de los indicadores biocinemáticos de la marcha patológica, se usó la técnica videográfica. Con el software Kinovea, en la versión 0.8.27, se cuantificaron los indicadores controlados.
Resultados: Permitió, unido al estudio cualitativo para cada paciente, realizar una comparación de las características de su marcha con el patrón normal y elaborar un grupo de recomendaciones a considerar durante el proceso de rehabilitación física.
Conclusiones: Se pudo analizar elcomportamiento de los indicadores biocinem áticos de la marcha hemipléjica en los pacientes estudiados, su comparación con la marcha normal, así como un conjunto de recomendaciones a tener en cuenta en el proceso de rehabilitación
Palabra clave: Control biomecánico; Marcha; Hemiplejia; Rehabilitación; Videografía.
Introdução: Foi realizada uma análise biocinética da marcha em pacientes com hemiplegia, que é a paralisia de um hemibody, reconhecida no contexto das ciências médicas e da cultura física terapêutica como síndrome hemiplégica.
Objetivo: O objetivo era determinar as modificações biocinéticas que se manifestam na marcha de pacientes com hemiplegia na área de saúde "Pedro Díaz Coello" de Holguín.
Materiais e métodos: A amostra consistiu de cinco pacientes que receberam cuidados sistemáticos na sala de reabilitação da área de saúde da policlínica "Pedro Díaz Coello", no município de Holguín. As entrevistas com o pessoal médico e de reabilitação física que trabalha na área da saúde, com pesquisadores da Faculdade de Cultura Física e Esporte da Universidade de Holguín, a revisão de documentos normativos sobre trabalho multidisciplinar e a observação de sessões de reabilitação, mostraram a necessidade de abordar o tema do ponto de vista biomecânico, dada a quantificação limitada de seus indicadores. A fim de analisar o comportamento dos indicadores biocinéticos da marcha patológica, foi utilizada a técnica videográfica. Com o software Kinovea, versão 0.8.27, os indicadores controlados foram quantificados.
Resultados: Permitiu, juntamente com o estudo qualitativo para cada paciente, fazer uma comparação das características de sua marcha com o padrão normal e elaborar um grupo de recomendações a serem consideradas durante o processo de reabilitação física.
Conclusões: Foi possível analisar o comportamento dos indicadores biocinéticos da marcha hemiplégica nos pacientes estudados, sua comparação com a marcha normal, assim como um conjunto de recomendações a serem levadas em conta no processo de reabilitação.
Palavras-chave: Controle biomecânico; Andamento; Hemiplegia; Reabilitação; Videografia.
Hemiplegia means complete paralysis of one half of the body, including the arm and leg. One of the most frequent causes of hemiplegia is a cerebrovascular accident, an injury caused by the interruption of the blood supply to any of the parts of the brain." A stroke can lead the person who suffers it to a great disability and limitation in activities of daily living, especially in motor activity" (Dutill, Echemendía, Núñez, 2020. P.2). It is also called brain attack, brain attack, brain infarction, stroke, embolism or cerebral thrombosis, which interrupts the blood supply to a certain region of the brain and, as a consequence, causes death of the brain tissue corresponding to the affected artery. However, there are other causes that produce it such as: cerebral hemorrhage, arterial thrombosis, arterial embolism and trauma. "One of the main sequelae caused by cerebrovascular diseases is the decrease in voluntary motor function and strength in the hemibody contralateral to the injured hemisphere, known as hemiparesis or hemiplegia" (Fitz-Allan, Lozada. 2022. P 58).
Hemiplegia is defined as a sequela of cerebrovascular accident (CVA) characterized by loss of voluntary movements in one half of the body together with postural tone disorder that may be increased (spasticity), decreased (flaccidity), or both at the same time (Taro and Gómez, 2019. p 73). Hemiplegia "should be approached as the beginning of a set of changes in the neurological condition, functional and social capacity of the individual, subject to modifications by multiple factors" (Lombillo at al., 2014).
The most relevant affectations of the person with hemiplegia are the stability, alignment and posture of the body, which is why difficulties appear in walking. Since these people must undergo a rehabilitation process, from the physical point of view, it is necessary to know the behavior of the biokinematic indicators that characterize walking.
On the human walk, a large number of research have been carried out. In the bibliographic search, many works appear aimed at improving the social life of patients with hemiplegia. Within physical activity, there are the works of Martínez and Hernández (2012), related to therapeutic physical exercises for the rehabilitation of adult patients with hemiplegia in Santa Rita de Zulia; Dominguez, et al. (2013), related to cerebral palsy and cerebrovascular accidents; Taro, Gómez and Hernández (2018), on the training of physical activity professionals at work with people suffering from hemiplegia; Dutill, et al. (2020), on exercises to improve strength and balance in patients with ischemic stroke, as well as Mushett, et al. (2021), on physical-therapeutic exercises to rehabilitate hemiplegic patients. More recently Herrera and Gómez (2018) studied from the biokinematic point of view a case with hemiplegia operated on a benign tumor in the right parietal. Other works have been reported: Novo et al. (2016) and Ramírez et al., (2019) related to biomechanical studies of gait, but in patients with spinocerebellar ataxia type 2.
As can be seen, the study of this type of gait, from Biomechanics, is still insufficient. This, together with the results of interviews with medical and physical rehabilitation personnel who work in health areas of the " Pedro Díaz Coello" polyclinic in Holguín and with researchers from the Faculty of Physical Culture and Sports of the University of Holguín, the review of normative documents on the multidisciplinary work complemented by observations to rehabilitation sessions of patients with Hemiplegia allows to show that there are deficiencies, such as:
The foregoing evidences a problematic situation given between the need to know the behavior of the kinematic indicators of gait in patients with hemiplegia and its comparison with the normal gait pattern in order to characterize them from the physical point of view, in order to individualize their process. rehabilitation. Thus, the purpose of the research lies in determining the biokinematic modifications that are manifested in the gait of patients with hemiplegia in the "Pedro Díaz Coello" health area of Holguín. Thus, their results can be taken into account to propose more objective and personalized rehabilitation programs, given that, as we know, not all patients with the same diagnosis walk with the same gait pattern.
MATERIALS AND METHODS
In coordination with the rehabilitators, it was worked with the five patients who participate in the rehabilitation services of the aforementioned health area. All of them present hemiplegia where the involvement of the right lower limb predominates, caused by an ischemic (1) and hemorrhagic (4) stroke. The time of evolution of the disease ranges between 9 and 14 months.
In the following table, a set of data is collected that shows some characteristics of the population, which offer information to complement the study carried out (Table 1).
Table 1. - Some characteristic data of the sample to be studied
Videography was used as an analysis technique that allows obtaining a film record from a real movement and studying different parameters of the movement performed, previously defined. It made it possible to collect information for data processing with the help of Kinovea 0.8.27 software for movement analysis. Using this technique, functional alterations can be assessed in the different segments of the lower and upper extremities, the spine and different phases of walking.
The results obtained by this method also allow comparisons to be made and assessments to be made regarding the evolution of prescribed rehabilitation treatments, which make it possible to know whether they have been effective or not, from its own quantification.
Video recording process and data collection
To obtain the video record of the patients during the gait, the necessary means and resources were selected:
Fig. 1. - Simplified diagram showing the arrangement of the cameras with respect to the subject under study for filming
RESULTS AND DISCUSSION
For data collection, patients were asked to walk back and forth, a reasonable distance (approximately 4 m.) indicated by the researcher, just as they do in daily life, with the aim of being able to use the most useful part of filming. This process was performed three times, as indicated above.
Once the useful video for the study was selected, using the Kinovea 0.8.27 human movement analysis software, the following previously selected indicators were measured:
Fig. 2. - Illustrative example of a stride and some of the kinematic indicators of normal human walking
On the other hand, it is necessary to limit that, according to the currently most widespread criterion regarding the time spent during each phase of the gait cycle, at a normal speed, it is approximately 60 % of the cycle in the support phase and 40 % % of the cycle in the oscillation or swing phase (Table 2).
Table 2. - Values of the general biokinematic indicators determined in movement and their references for normal walking
To illustrate part of the measurements made, the following figure is included (Figure 3).
Fig. 3. - Representative example of some of the measurements made using the filmic record of the patients and the Kinovea 0.8.27 movement analysis software
From the analysis of the previous results, it was possible to infer that:
Methodological recommendations derived from the analysis of the behavior of biokinematic indicators in gait in patients with hemiplegia.
The previous results show the main factors that, from the physical point of view, determine the affectations of gait in hemiplegic patients. They were discussed with the medical and physical culture personnel who work in the rehabilitation room.
In order to improve the process of gait involvement in the patients studied, the following methodological recommendations are proposed to be taken into account for their inclusion in the physical rehabilitation process:
As no references were found for biomechanical studies, in this case kinematic, aimed at carrying out a quantitative evaluation of gait indicators in hemiplegic patients, as stated in the introduction, the comparison made was with normal walk, taking as reference the set of values proposed by Ramírez, Gómez, Vázquez and Ramírez (2019), for each indicator studied and which are listed in Table 2.
Summarizing the above on the basis of the results obtained in the research, it was possible to analyze the behavior of the biokinematic indicators of hemiplegic gait in the patients studied, their comparison with normal gait, as well as a set of recommendations to be taken into account in the rehabilitation process, with what will be achieved, from the physical point of view Therapeutic, a functional re-education of your physical state, for example, corrections in posture, greater self-control of movements, better coordination in a general sense (static and dynamic balance), together with the modification of psychological factors that affect your personality.
Domínguez, J; Lemos, R., y Vizaguirre, R. (2013). Conocimiento de la población sobre Accidentes Cerebro Vasculares. Biblioteca Digital UNCUYO. Mendoza. Universidad nacional de cuyo. Facultad de ciencias médicas. Escuela de enfermería. https://bdigital.uncu.edu.ar/5915
Dutill, Y., Echemendía, A., y Núñez, I. (2020). Ejercicios para mejorar la fuerza y equilibrio en pacientes con ictus isquémico. Acción, 16. http://accion.uccfd.cu/index.php/accion/article/view/115
Fitz-Allan, D., y Lozada, M. (2022). Estudio de la hemiplejia en San Vicente y las Granadinas. Olimpia, 19 (1), 56-67. https://revistas.udg.co.cu/index.php/olimpia/citationstylelanguage/get/ieee?submissionId=2908
Herrera, M., y Gómez, M. (2018). Análisis biomecánico de la marcha patológica: un estudio de caso. Deporvida, 15(35). https://deporvida.uho.edu.cu/index.php/deporvida/article/view/431
Lombillo, L., Martínez, S., Serra, Y., y Rodríguez, L. (2014). Complicaciones en pacientes hemipléjicos por ictus. Revista Cubana de Medicina 53(2). http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75232014000200004
Martínez, J., y Hernández, A. (2012) Alternativa de ejercicios físicos en la rehabilitación a pacientes adultos con hemiplejía por infarto cerebral en el municipio Santa Rita. Estado Zulia. Deporvida, 9(17). https://deporvida.uho.edu.cu/index.php/deporvida/article/view/183
Mushett, I., Gómez, E., y Romero, C. (2021). Ejercicios físico terapéuticos para rehabilitar pacientes hemipléjicos. Famadeportes, 11(20)
Novo, C., Gámez, O., Montoya, P., Zulueta, A., y Zamora, L. (diciembre 2016). Descripción cinemática de la marcha en pacientes con ataxia espinocerebelosa tipo 2. Versión On-line ISSN 1029-3019. MEDISAN 20(12), Santiago de Cuba. http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1029-30192016001200003
Ramírez, S; Gómez, A: Vázquez, Y., y Ramírez, D. (2019). Indicadores biomecánicos para el estudio de la marcha en pacientes con ataxia espinocerebelosa tipo 2, en estadio I. Olimpia, 16(57). https://redib.org/Record/oai_articulo2407180-indicadores-biomec%C3%A1nicos-para-el-estudio-de-la-marcha-en-pacientes-con-ataxia-espinocerebelosa-tipo-2-en-estadio-i-original
Taro, J., y Gómez, A. (2019). Rehabilitación de la Hemiplejia Crónica. Un modelo de superación desde la actividad física adaptada. Deporvida, 16(39), 72-88. https://deporvida.uho.edu.cu/index.php/deporvida/article/view/693
Taro, J., Gómez, A., y Hernández, M. (2018). Formación de profesionales de la actividad física en el trabajo con personas aquejadas de hemiplejia. Efdeportes, 23 (245). https://efdeportes.com/efdeportes/index.php/EFDeportes/article/view/341
Conflict of interest statement:
The authors declare that there are no conflicts of interest.
Robiel Jesús Pozo-Sánchez: Conception of the idea, search and review of literature, preparation of instruments, application of instruments, collection of information resulting from the instruments applied, statistical analysis, preparation of database, drafting of the original (first version), authorship coordinator, review of the application of the bibliographic standard applied.
Amada Plácida Gómez-Zoquez: Conception of the idea, literature search and review, compilation of the information resulting from the instruments applied, preparation of tables, graphs and images, preparation of the database, general advice on the topic addressed, review and final version of the article, correction of the article, review of the application of the bibliographic standard applied.
Jacqueline Medrano-Montero: Conception of the idea, literature search and review, general advice on the subject matter, correction of the article, translation of terms or information obtained, review of the application of the bibliographic standard applied.
Pablo Alejandro Curay-Carrera: Search and review of literature, preparation of instruments, statistical analysis, preparation of database, correction of the article, translation of terms or information obtained, review of the application of the bibliographic standard applied.
Darwin Manuel Abalco Farinango: Search and review of literature, preparation of instruments, statistical analysis, preparation of database, writing of the original (first version), translation of terms or information obtained.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2022 Robiel Jesús Pozo-Sánchez, Amada Plácida Gómez-Zoquez, Jacqueline Medrano-Montero, Pablo Alejandro Curay-Carrera, Darwin Manuel Abalco Farinango