Coordination of lower limbs in patients with knee osteoarthritis during walking

Meta-analysis of the quantitative assessment of lower extremity motor function in elderly individuals based on objective detection

OBJECTIVE

To avoid deviation caused by the traditional scale method, the present study explored the accuracy, advantages, and disadvantages of different objective detection methods in evaluating lower extremity motor function in elderly individuals.

METHODS

Studies on lower extremity motor function assessment in elderly individuals published in the PubMed, Web of Science, Cochrane Library and EMBASE databases in the past five years were searched. The methodological quality of the included trials was assessed using RevMan 5.4.1 and Stata, followed by statistical analyses.

RESULTS

In total, 19 randomized controlled trials with a total of 2626 participants, were included. The results of the meta-analysis showed that inertial measurement units (IMUs), motion sensors, 3D motion capture systems, and observational gait analysis had statistical significance in evaluating the changes in step velocity and step length of lower extremity movement in elderly individuals (P < 0.00001), which can be used as a standardized basis for the assessment of motor function in elderly individuals. Subgroup analysis showed that there was significant heterogeneity in the assessment of step velocity [SMD=-0.98, 95%CI(-1.23, -0.72), I2 = 91.3%, P < 0.00001] and step length [SMD=-1.40, 95%CI(-1.77, -1.02), I2 = 86.4%, P < 0.00001] in elderly individuals. However, the sensors (I2 = 9%, I2 = 0%) and 3D motion capture systems (I2 = 0%) showed low heterogeneity in terms of step velocity and step length. The sensitivity analysis and publication bias test demonstrated that the results were stable and reliable.

CONCLUSION

observational gait analysis, motion sensors, 3D motion capture systems, and IMUs, as evaluation means, play a certain role in evaluating the characteristic parameters of step velocity and step length in lower extremity motor function of elderly individuals, which has good accuracy and clinical value in preventing motor injury. However, the high heterogeneity of observational gait analysis and IMUs suggested that different evaluation methods use different calculation formulas and indicators, resulting in the failure to obtain standardized indicators in clinical applications. Thus, multimodal quantitative evaluation should be integrated.

Biomechanical changes in lower extremity in individuals with knee osteoarthritis in the past decade: A scoping review

Biomechanic studies can provide a powerful theoretical and scientific basis for studies on knee osteoarthritis (OA), which is of great significance for clinical management as it provides new concepts and methods in clinical and research settings. This study aimed to discuss and summarize biomechanical research on lower extremities in individuals with knee OA in the past ten years. The methodology of this review followed the framework outlined in the Joanna Briggs Institute (JBI) guidelines and strictly followed the checklist for drafting the findings. A literature search was conducted using PubMed, Scopus, Cochrane Library, Embase, Web of Science, Grey literature search in Open Library, and Google Academic databases. Relevant literature was searched from 2011 to 2023. Sixteen studies were included in this scoping review. Biomechanical research on knee OA in the last decade demonstrates that the biomechanics of the hip, knee, and ankle have a profound influence on the pathogenesis and treatment of knee OA. Individuals with knee OA have biomechanical changes in hip, knee, and ankle joints such as a significant defect in the strength of ankle varus muscles, weakness of hip abductor muscle, walking with toes outwards, increased knee adduction moment and angle, and decreased knee extensor moment. As the severity of knee OA increases, the tendency of hip abduction positions also increases. Further research with a longitudinal study design should focus on the determination of the relative importance of different biomechanical and neuromuscular factors in the development and progression of the disease.

Age related progression of lower limb coordination during gait in children with cerebral palsy without a history of surgical intervention

Walking requires precise movement between body segments, referred to as intersegmental coordination, which is an important factor in efficient motor performance. For children with cerebral palsy (CP), who often demonstrate an impaired neuromuscular system, intersegmental coordination has been shown to be different when compared to their typically developed (TD) peers. However, how intersegmental coordination changes over time in these children is unclear. The aim of this study was to quantify age-related changes in intersegmental coordination in children with bilateral CP without a history of surgical intervention and to compare to control groups of children with TD of similar age, weight, and height. A retrospective analysis of 162 children with bilateral CP who had a baseline and follow-up 3D gait assessment, and no history of surgical intervention, was conducted. Two age, weight, and height control groups of children with TD were included. A full 3-dimensional kinematic analysis was performed, and continuous relative phase analysis of the thigh-shank and shank-foot, while walking at a self-selected walking speed, was used to measure intersegmental coordination. Differences were present for children with CP compared to children with TD at baseline for thigh-shank intersegmental coordination. However, children with CP demonstrated a change over time with a move towards TD patterns at follow-up assessment. This study provides insights into the acquisition and stabilisation of intersegmental coordination between children with CP and TD.

Multi-day monitoring of foot progression angles during unsupervised, real-world walking in people with and without knee osteoarthritis

BACKGROUND

Foot progression angle is a biomechanical target in gait modification interventions for knee osteoarthritis. To date, it has only been evaluated within laboratory settings.

METHODS

Adults with symptomatic knee osteoarthritis (n = 30) and healthy adults (n = 15) completed two conditions: 1) treadmill walking in the laboratory (5-min), and 2) real-world walking outside of the laboratory (1-week). Foot progression angle was estimated via shoe-embedded inertial sensing. We calculated the foot progression angle magnitude (median) and variability (interquartile range, coefficient of variation), and used mixed models to compare outcomes between the conditions, participant groups, and disease severities. Reliability was quantified by the intraclass correlation coefficient, standardized error of the measurement, and the minimum detectable change.

FINDINGS

Foot progression angle magnitude did not differ between groups or conditions but variability significantly higher in real-world walking (P < 0.001). Structural and symptomatic severity were unrelated to FPA in either walking condition, except for real-world coefficient of variation which was higher for moderate-severe structural osteoarthritis compared to the treadmill for those with mild structural severity (P < 0.034). All real-world outcomes showed excellent reliability including intraclass correlation coefficients above 0.95. The participants recorded a mean (standard deviation) of 298 (33) and 10,447 (5232) steps in the laboratory and real-world walking conditions, respectively.

INTERPRETATION

This study provides the first characterization of foot progression angles during real-world walking in people with and without symptomatic knee osteoarthritis. These results indicate that foot progression angles can be feasibly and reliably measured in unsupervised real-world walking conditions.

Lower limb inter-joint coordination in individuals with osteoarthritis before and after a total knee arthroplasty

BACKGROUND

Total knee arthroplasty is the most common treatment for severe knee osteoarthritis. Coordination and variability analyses are effective measures of the injury stage or rehabilitation process. This study compared the inter-joint coordination before and after arthroplasty, compared to controls.

METHODS

Twenty-seven patients were evaluated before and 12 months after surgery, compared to 27 controls. Coordination and variability in the sagittal plane between the hip-knee and knee-ankle were calculated using vector coding and circular statistics. Coordination was categorized as in-phase, anti-phase, or distal or proximal joint-phase. The gait cycle was divided into sub-phases for the coordination, variability, and range of motion results.

FINDINGS

Coordination and range of motion differed significantly between the patient groups and controls, while small differences between pre- and post-operative groups were also detected. The hip-knee showed a reduced in-phase frequency in the patient group compared to control during stance, particularly mid-stance: pre-operative 24.3% ± 33.9, post-operative 29.5 ± 29.7, and controls 70.7 ± 17.0. This difference was compensated for by increasing proximal-phase (hip) frequency in the patient groups. For knee-ankle coordination, the patient groups showed higher distal-phase (ankle) frequency during the early and mid-stance. Coordination variability was higher post-operatively during swing and terminal swing phases, compared to controls.

INTERPRETATION

The results indicated reduced degrees of freedom for the knee during stance phase with a reduced capacity to move the knee and hip in opposing directions before and one year after surgery. The patient group after the surgery increased knee range of motion and coordination compared to pre-operative during swing phase.

An Analysis of Lower Limb Coordination Variability in Unilateral Tasks in Healthy Adults: A Possible Prognostic Tool

Interlimb coordination variability analysis can shed light into the dynamics of higher order coordination and motor control. However, it is not clear how the interlimb coordination of people with no known injuries change in similar activities with increasing difficulty. This study aimed to ascertain if the interlimb coordination variability range and patterns of healthy participants change in different unilateral functional tasks with increasing complexity and whether leg dominance affects the interlimb coordination variability. In this cross-sectional study fourteen younger participants with no known injuries completed three repeated unilateral sit-to-stands (UniSTS), step-ups (SUs), and continuous-hops (Hops). Using four inertial sensors mounted on the lower legs and thighs, angular rotation of thighs and shanks were recorded. Using Hilbert transform, the phase angle of each segment and then the continuous relative phase (CRP) of the two segments were measured. The CRP is indicative of the interlimb coordination. Finally, the linear and the nonlinear shank-thigh coordination variability of each participant in each task was calculated. The results show that the linear shank-thigh coordination variability was significantly smaller in the SUs compared to both UniSTS and Hops in both legs. There were no significant differences found between the latter two tests in their linear coordination variability. However, Hops were found to have significantly larger nonlinear shank-thigh coordination variability compared to the SUs and the UniSTS. This can be due to larger vertical and horizontal forces required for the task and can reveal inadequate motor control during the movement. The combination of nonlinear and linear interlimb coordination variability can provide more insight into human movement as they measure different aspects of coordination variability. It was also seen that leg dominance does not affect the lower limb coordination variability in participants with no known injuries. The results should be tested in participants recovering from lower limb injuries.

Data-Mined Continuous Hip-knee Coordination Mapping with Motion Lag for Lower-limb Prosthesis Control

Trajectory planning of the knee joint plays an essential role in controlling the lower limb prosthesis. Nowadays, the idea of mapping the trajectory of the healthy limb to the motion trajectory of the prosthetic joint has begun to emerge. However, establishing a simple and intuitive coordination mapping is still challenging. This paper employs the method of experimental data mining to explore such a coordination mapping. The coordination indexes, i.e., the mean absolute relative phase (MARP) and the deviation phase (DP), are obtained from experimental data. Statistical results covering different subjects indicate that the hip motion possesses a stable phase difference with the knee, inspiring us to construct a hip-knee Motion-Lagged Coordination Mapping (MLCM). The MLCM first introduces a time lag to the hip motion to avoid conventional integral or differential calculations. The model in polynomials, which is proved more efficient than Gaussian process regression and neural network learning, is then constructed to represent the mapping from the lagged hip motion to the knee motion. In addition, a strong linear correlation between hip-knee MARP and hip-knee motion lag is discovered for the first time. By using the MLCM, one can generate the knee trajectory for the prosthesis control only via the hip motion of the healthy limb, indicating less sensing and better robustness. Numerical simulations show that the prosthesis can achieve normal gaits at different walking speeds.

Inter-segmental coordination amplitude and variability differences during gait in patients with Ehlers-Danlos syndrome and healthy adults

BACKGROUND

There is limited research examining gait and inter-segmental coordination in patients with Ehlers-Danlos syndrome. The objective was to compare lower extremity inter-segmental coordination amplitude and variability during gait between patients with Ehlers-Danlos syndrome and healthy adults.

METHODS

This cross-sectional study included participants with Ehlers-Danlos syndrome (n = 13) and healthy adults (n = 14). Gait data were acquired using a motion capture system and force plates. Participants ambulated at self-selected speeds for five trials. Inter-segmental coordination was quantified using continuous relative phase, which examined the dynamic interaction between the thigh-shank and shank-foot paired segments (i.e. phase space relation). A 2-way mixed analysis of variance examined the effects of groups (Ehlers-Danlos and healthy) and gait phases (stance and swing phase) on inter-segmental coordination amplitude and between-trial variability. Effect sizes were calculated using Cohen's d.

FINDINGS

The Ehlers-Danlos group had greater inter-segmental coordination variability compared to the healthy group for foot-shank and shank-thigh segment pairs in the sagittal plane over stance and swing phases (P = 0.04; small to large effect sizes). The Ehlers-Danlos group also had greater variability in the frontal plane at the foot-shank segment pair during stance phase (P = 0.03; large effect). There were no differences in inter-segmental coordination amplitude between groups (P = 0.06 to 0.85).

INTERPRETATION

Patients with Ehlers-Danlos syndrome have more variability between gait trials in lower limb motor coordination than healthy adults. This may be related to the impaired proprioception, reduced strength, pain, or slower gait speed seen in this population.

Intersegmental Coordination in Patients With Total Knee Arthroplasty During Walking

Precise identification of deficient intersegmental coordination patterns and functional limitations is conducive to the evaluation of surgical outcomes after total knee arthroplasty (TKA) and the design of optimal personalized rehabilitation protocols. However, it is still not clear how and when intersegmental coordination patterns change during walking, and what functional limitations are in patients with TKA. This study was designed to investigate lower limb intersegmental coordination patterns in patients with knee osteoarthritis before and after TKA and identify how intersegmental coordination of patients is altered during walking before and after TKA. It was hypothesized that 6-month after TKA, intersegmental coordination patterns of patients are improved compared with that before TKA, but still do not recover to the level of healthy subjects. Gait analysis was performed on 36 patients before and 6-month after TKA and on 34 healthy subjects. Continuous relative phase (CRP) derived from the angle-velocity phase portrait was used to measure the coordination between interacting segments throughout the gait cycle. Thigh-shank CRP and shank-foot CRP were calculated for each subject. Statistical parametric mapping (SPM), a one-dimensional analysis of the entire gait cycle curve, was performed directly to determine which periods of the gait cycle were different in patients and healthy subjects. Six-month after TKA, thigh-shank CRP was significantly higher during 5–12% of the gait cycle (p = 0.041) and lower during 44–95% of the gait cycle (p < 0.001) compared with healthy subjects, and was significantly higher during 62–91% of the gait cycle (p = 0.002) compared with pre-operation. Shank-foot CRP was significantly lower during 0–28% of the gait cycle (p < 0.001) and higher during 58–94% of the gait cycle (p < 0.001) compared with healthy subjects, and was significantly lower during 3–18% of the gait cycle (p = 0.005) compared with pre-operation. This study found that patients exhibited altered intersegmental coordination during the loading response and swing phase both before and after TKA. Six-month after TKA, the thigh-shank coordination was partially improved compared with pre-operation, but still did not recover to the level of healthy subjects, while there was no improvement in the shank-foot coordination pattern after TKA compared with pre-operation. CRP combined with SPM methods can provide insights into the evaluation of surgical outcomes and the design of rehabilitation strategy.

Walking Speed Alters Barefoot Gait Coordination and Variability

Using the dynamic system approach, we examined the pattern and variability of inter-joint coordination in barefoot and shod walking in 20 women at three speeds: SLOW, FAST, and comfortable walking speed (CWS). We found that barefoot and shod walking used different coordination strategies to cope with increasing walking speed. As walking speed increased, ankle-knee coordination patterns between shod and barefoot became less different (p < 0.00001), and ankle-hip coordination patterns became more different (p < 0.001). Compared to shod, barefoot walking had significantly lower coordination variability in mid stance of knee-hip at CWS and FAST and late swing of ankle-hip at SLOW and CWS with medium effect (effect size 0.61-0.74). Future research should investigate the connection between the decreased coordination variability and joint tissue stress to understand the impact of barefoot walking on the lower extremity joints.

Effects of motor skill level and speed on movement variability during running

Variability in movement is an informative biological feature. This study aimed to examine the effects of motor skill level and running speed on movement variability. Twenty-nine male college students (fourteen athletes and fifteen non-athletes) participated in this study. All participants performed three motor tasks: 3 m/s running, 5 m/s running, and sprint running. Lower-limb kinematic data were acquired using a 16-camera infrared motion capture system. Lower-limb coordination during the stance phase was quantified using a continuous relative phase (CRP) method for interlimb (hip-hip, knee-knee, ankle-ankle) and intralimb (hip-knee, knee-ankle). The variabilities of stride length, stride cadence, joint angles, intralimb CRP, and interlimb CRP were calculated as standard deviations of each measurement. The results revealed that there were significant interaction effects between motor skill level and speed on movement variability for stride length (p = 0.047), ankle angle during propulsive phase (p = 0.001), knee-ankle CRP during propulsive phase (p = 0.007) and knee-knee CRP during propulsive phase (p = 0.009). Athletes showed greater angle variability, coordination variability and lower stride length variability during sprinting (all p < 0.05). In contrast, no between groups variability difference was observed when jogging at fixed lower speeds (all p > 0.05). Movement variability was greater for sprinting compared to jogging. Skill level was found to differentially affect the role of coordination variability in sprint performance. For athletes, hip-knee deviation phase and hip-hip deviation phase during braking phase were negatively correlated with sprinting speed (r = -0.563 and -0.642, respectively; both p < 0.05). For non-athletes, hip-knee deviation phase was positively correlated with sprinting speed (r = 0.581, p = 0.023). In conclusion, stride length become more stable, joint angle and coordination become more variable with long-term training. Results of this study also suggest that the relationship between coordination variability and performance is complicated and may depend on motor skill level. More longitudinal studies are needed to definitively determine the relationship between movement variability and performance.