Article

Pathologies that lead to biomechanical restrictions in human gait interfere with
the tightly regulated muscle activation patterns that control the external
moments. In order to maintain proper function, secondary mechanisms are required.
The aims of this systematic review were (1) to identify secondary mechanisms in
pathologic gait that have been described throughout the scientific literature by
means of instrumented gait analysis, (2) to distinguish between active
compensatory mechanisms and passive physical effects and (3) to identify common
compensatory mechanisms that appear to be independent from the underlying
disease. A comprehensive literature search revealed 4080 citations for review,
whereof 148 studies entered the full-text review. Thirty-six studies were
included and the quality of these studies was assessed by two independent
reviewers (kappa=0.83). The quality of the included studies showed large
variation and several methodological issues were identified. Five studies were
further identified describing only passive physical effects, leaving a total of
31 studies reporting on compensations. The qualitative analysis revealed common
compensations that appeared to be independent from the underlying pathology. In
clinical practice, distinguishing primary from secondary gait deviations can be
considered highly important since unnecessary treatment may be avoided. However,
given the introduction of general principles of compensatory mechanisms and the
fact that certain presumed "compensations" were identified as simple passive
physical effects, secondary gait deviations have to be further investigated.
Computer simulation studies are valuable, especially in respect of the distinction between compensations and physical effects. Furthermore, the need for
a uniform terminology was highlighted.
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Langue : ANGLAIS