Impaired gait in ankylosing spondylitis

  • Silvia Del Din
  • Elena Carraro
  • Zimi Sawacha
  • Annamaria Guiotto
  • Lara Bonaldo
  • Stefano Masiero
  • Claudio Cobelli
Original Article

Abstract

Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease. The spine becomes rigid from the occiput to the sacrum, leading to a stooped position. This study aims at evaluating AS subjects gait alterations. Twenty-four subjects were evaluated: 12 normal and 12 pathologic in stabilized anti-TNF-alpha treatment (mean age 49.42 (10.47), 25.44 (3.19) and mean body mass index 55.75 (3.19), 23.73 (2.7), respectively). Physical examination and gait analysis were performed. A motion capture system synchronized with two force plates was used. Three-dimensional kinematics and kinetics of trunk, pelvis, hip, knee and ankle were determined during gait. A trend towards reduction was found in gait velocity and stride length. Gait analysis results showed statistically significant alterations in the sagittal plane at each joint for AS patients (P < 0.049). Hip and knee joint extension moments showed a statistically significant reduction (P < 0.044). At the ankle joint, a decreased plantarflexion was assessed (P < 0.048) together with the absence of the heel rocker. Gait analysis, through gait alterations identification, allowed planning-specific rehabilitation intervention aimed to prevent patients’ stiffness together with improve balance and avoid muscles’ fatigue.

Keywords

Ankylosing spondylitis Kinematics Kinetics Three dimensional Gait analysis 

References

  1. 1.
    Aydog E, Depedibi R, Bal A, Ekşioglu E, Unlu E, Çakci A (2006) Dynamic postural balance in ankylosing spondylitis patients. Rheumatology 45:445–448PubMedCrossRefGoogle Scholar
  2. 2.
    Barkham N, Kong KO, Tennant A et al (2005) The unmet need for anti-tumour necrosis factor (anti-TNF) therapy in ankylosing spondylitis. Rheumatology 44:1277–1281PubMedCrossRefGoogle Scholar
  3. 3.
    Bot SDM, Caspers M, Van Royen BJ, Toussaint HM, Kingma I (1999) Biomechanical analysis of posture in patients with spinal kyphosis due to ankylosing spondylitis: a pilot study. Rheumatology 38:441–443PubMedCrossRefGoogle Scholar
  4. 4.
    Braun J, Bollow M, Remlinger G, Eggens U, Rudwaleit M, Distler A et al (1998) Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 41:58–67PubMedCrossRefGoogle Scholar
  5. 5.
    Braun J, Brandt J, Listing J et al (2002) Treatment of active ankylosing spondylitis with infliximab—a double-blind placebo controlled multicenter trial. Lancet 359:1187–1193PubMedCrossRefGoogle Scholar
  6. 6.
    Braun J, Brandt J, Listing J, Rudwaleit M, Sieper J (2003) Biologic therapies in the spondyloarthritis: new opportunities, new challenges. Curr Opin Rheumatol 15(4):394–407PubMedCrossRefGoogle Scholar
  7. 7.
    Calin A, Garrett S, Whitelock H, Gail Kennedy L, O’Hea J, Mallorie P, Jenkinson T (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath ankylosing spondylitis functional Index. J Rheumatol 21(12):2281–2285PubMedGoogle Scholar
  8. 8.
    Cappozzo A, Catani F, Della Croce U, Leardini A (1995) Position and orientation in space of bones during movement, anatomical frame definition and determination. Clin Biomech 10:171–178CrossRefGoogle Scholar
  9. 9.
    Cutti AG, Ferrari A, Garofalo P, Raggi M, Cappello A, Ferrari A (2009) ‘Outwalk’: a protocol for clinical gait analysis based on inertial and magnetic sensors. Med Biol Eng Comput 48(1):17–25PubMedCrossRefGoogle Scholar
  10. 10.
    De Filippis LG, Balestrieri A, Furfari P, Caliri A, Africa A, Bagnato G (2006) Muscle activation patterns and gait biomechanics in patients with ankylosing spondylitis. Reumatismo 58:132–137PubMedGoogle Scholar
  11. 11.
    Della Croce U, Leardini A, Chiari L, Cappozzo A (2005) Human movement analysis using stereophotogrammetry: Part 4: assessment of anatomical landmark misplacement and its effects on joint kinematics. Gait Posture 21(2):226–237PubMedCrossRefGoogle Scholar
  12. 12.
    Ferrari A, Cutti AG, Garofalo P, Raggi M, Heijboer M, Cappello A, Davalli A (2010) First in vivo assessment of “Outwalk”: a novel protocol for clinical gait analysis based on inertial and magnetic sensors. Med Biol Eng Comput 48(1):1–15PubMedCrossRefGoogle Scholar
  13. 13.
    Gage JR (1994) The role of gait analysis in the treatment of cerebral palsy. J Pediatr Orthop 14(6):701–702PubMedCrossRefGoogle Scholar
  14. 14.
    Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21(12):2286–2291PubMedGoogle Scholar
  15. 15.
    Greene BR, McGrath D, O’Neill R, O’Donovan KJ, Burns A, Caulfield B (2010) An adaptive gyroscope-based algorithm for temporal gait analysis. Med Biol Eng Comput 48(12):1251–1260PubMedCrossRefGoogle Scholar
  16. 16.
    Grood ES, Suntay WJ (1983) A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 105(2):136–144PubMedCrossRefGoogle Scholar
  17. 17.
    Helliwell PS, Smeathers JE, Wright V (1989) Shock absorption by the spinal column in normals and in ankylosing spondylitis. Proc Inst Mech Eng Part H 203:187–190CrossRefGoogle Scholar
  18. 18.
    Jenkinson TR, Mallorie PA, Whitelock HC, Gail Kennedy L, Garrett SL, Calin A (1994) Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS metrology index. J Rheumatol 21(9):1694–1698PubMedGoogle Scholar
  19. 19.
    Khan MA (2002) Update on spondyloarthropathies. Ann Intern Med 136:896–907PubMedGoogle Scholar
  20. 20.
    Leardini A, Sawacha Z, Paolini G, Nativo R, Ingrosso S, Benedetti MG (2007) A new anatomical based protocol for gait analysis in children. Gait Posture 26:560–571PubMedCrossRefGoogle Scholar
  21. 21.
    Maynard V, Bakheit AMO, Oldham J, Freeman J (2003) Intra-rater and interrater reliability of gait measurements with CODA mpx30 motion analysis system. Gait Posture 17(1):59–67PubMedCrossRefGoogle Scholar
  22. 22.
    Murray HC, Elliott C, Barton SE, Murray A (2000) Do patients with ankylosing spondylitis have poorer balance than normal subjects? Rheumatology 39:497–500PubMedCrossRefGoogle Scholar
  23. 23.
    Perry J (1992) Gait analysis, normal and pathological function. McGraw-Hill, New York, pp 435–436Google Scholar
  24. 24.
    Picerno P, Cereatti A, Cappozzo A (2008) Joint kinematics estimate using wearable inertial and magnetic sensing modules. Gait Posture 28(4):588–595PubMedCrossRefGoogle Scholar
  25. 25.
    Sawacha Z, Guarneri G, Cristoferi G, Guiotto A, Avogaro A, Cobelli C (2009) Diabetic gait and posture abnormalities: a biomechanical investigation through three dimensional gait analysis. Clin Biomech 24:722–728CrossRefGoogle Scholar
  26. 26.
    Sieper J, Braun J, Rudwaleit M, Boonen A, Zink A (2002) Ankylosing spondylitis: an overview. Ann Rheum Dis 61(Suppl 3):iii8–iii18PubMedGoogle Scholar
  27. 27.
    Swinkels A, Dolan P (2004) Spinal position sense and disease progression in ankylosing spondylitis—a longitudinal study. Spine 29(11):1240–1245PubMedCrossRefGoogle Scholar
  28. 28.
    Turan Y, Duruöz MT, Bal S, Guvenc A, Cerrahoglu L, Gurgan A (2007) Assessment of fatigue in patients with ankylosing spondylitis. Rheumatol Int 27(9):847–852PubMedCrossRefGoogle Scholar
  29. 29.
    van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27:361–368PubMedCrossRefGoogle Scholar
  30. 30.
    Zebouni L, Helliwell PS, Howe A, Wright V (1992) Gait analysis in ankylosing spondylitis. Ann Rheum Dis 51:898–899PubMedCrossRefGoogle Scholar
  31. 31.
    Zochling J, van der Heijde D, Burgos-Vargas R, Collantes E, Davis JC, Dijkmans B Jr, Dougados M, Géher P, Inman RD, Khan MA, Kvien TK, Leirisalo-Repo M, Olivieri I, Pavelka K, Sieper J, Stucki G, Sturrock RD, van der Linden S, Wendling D, Böhm H, van Royen BJ, Braun J (2006) ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 65:442–452PubMedCrossRefGoogle Scholar

Copyright information

© International Federation for Medical and Biological Engineering 2011

Authors and Affiliations

  • Silvia Del Din
    • 1
  • Elena Carraro
    • 2
  • Zimi Sawacha
    • 1
  • Annamaria Guiotto
    • 1
  • Lara Bonaldo
    • 2
  • Stefano Masiero
    • 2
  • Claudio Cobelli
    • 1
  1. 1.Department of Information EngineeringUniversity of PadovaPaduaItaly
  2. 2.Department of Rehabilitation MedicineUniversity of PadovaPaduaItaly

Personalised recommendations