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Kim J, McSweeney SC, Hollander K, Horstman T, Wearing SC. Adolescents running in conventional running shoes have lower vertical instantaneous loading rates but greater asymmetry than running barefoot or in partial-minimal shoes. J Sports Sci 2023; 41:774-787. [PMID: 37571975 DOI: 10.1080/02640414.2023.2240174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/17/2023] [Indexed: 08/13/2023]
Abstract
Footwear may moderate the transiently heightened asymmetry in lower limb loading associated with peak growth in adolescence during running. This repeated-measures study compared the magnitude and symmetry of peak vertical ground reaction force and instantaneous loading rates (VILRs) in adolescents during barefoot and shod running. Ten adolescents (age, 10.6 ± 1.7 years) ran at self-selected speed (1.7 ± 0.3 m/s) on an instrumented treadmill under three counter-balanced conditions; barefoot and shod with partial-minimal and conventional running shoes. All participants were within one year of their estimated peak height velocity based on sex-specific regression equations. Foot-strike patterns, peak vertical ground reaction force and VILRs were recorded during 20 seconds of steady-state running. Symmetry of ground reaction forces was assessed using the symmetry index. Repeated-measures ANOVAs were used to compare conditions (α=.05). Adolescents used a rearfoot foot-strike pattern during barefoot and shod running. Use of conventional shoes resulted in a lower VILR (P < .05, dz = 0.9), but higher VILR asymmetry (P < .05) than running barefoot (dz = 1.5) or in partial-minimal shoes (dz = 1.6). Conventional running shoes result in a lower VILR than running unshod or in partial-minimal shoes but may have the unintended consequence of increasing VILR asymmetry. The findings may have implications for performance, musculoskeletal development and injury in adolescents.
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Affiliation(s)
- Jae Kim
- Complete Rehab Allied Health Clinic, Brisbane, Australia
| | - Simon C McSweeney
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Karsten Hollander
- Institute of Exercise Science & Sports Medicine, Medical School Hamburg, Hamburg, Germany
| | - Thomas Horstman
- Conservative and Rehabilitative Orthopaedics, Technical University Munich, Munich, Germany
| | - Scott C Wearing
- Conservative and Rehabilitative Orthopaedics, Technical University Munich, Munich, Germany
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Gagnat Y, Brændvik SM, Ringheim I, Roeleveld K. The relation of energy cost of walking with gait deviation, asymmetry, and lower limb muscle co-activation in children with cerebral palsy: a retrospective cross-sectional study. BMC Musculoskelet Disord 2023; 24:111. [PMID: 36759806 PMCID: PMC9909982 DOI: 10.1186/s12891-023-06223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/20/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Compared to typically developing children, children with cerebral palsy (CP) have increased energy expenditure during walking, limiting activity and participation. Insight into whether the also deviating and more asymmetric gait with increased muscle co-activation contributes to this increased energy expenditure is important for clinical decision making. The aim of this study was to investigate the relation between energy cost of walking with gait deviation, asymmetry, and muscle co-activation in children with CP. METHODS Forty ambulant children with CP, with Gross Motor Function Classification System (GMFCS) level I (N = 35) and II (N = 5), aged between 5-17y, were tested at one or two occasions with 24 weeks in between, resulting in 71 observations. Gross energy cost (J/kg/m) was measured during a 5-min walk test at self-selected speed. From a 3-dimensional gait analyses, kinematic variables and electromyography were extracted to calculate the gait deviation index (GDI) and co-activation index. The relation between energy cost and GDI, GDI asymmetry, and co-activation index of the lower limb muscles was evaluated through mixed model analyses. Height was included to control for growth-related variation. RESULTS Gait deviation and height combined explained about 40% of the variance in gross energy cost. No significant contribution was found for gait asymmetry or co-activation index. CONCLUSIONS This cross-sectional study indicates that increased gait deviation contributes to increased energy cost of walking in children with GMFCS level I and II.
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Affiliation(s)
- Yngvild Gagnat
- Clinic for Orthopaedics, Rheumatology and Skin Diseases, Orthopaedic Research Center, St. Olavs University Hospital, Trondheim, Norway. .,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Siri Merete Brændvik
- grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Clinical Services, St. Olavs University Hospital, Trondheim, Norway
| | - Inge Ringheim
- grid.417292.b0000 0004 0627 3659Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway
| | - Karin Roeleveld
- grid.52522.320000 0004 0627 3560Clinic for Orthopaedics, Rheumatology and Skin Diseases, Orthopaedic Research Center, St. Olavs University Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Seth M, Coyle PC, Pohlig RT, Beisheim EH, Horne JR, Hicks GE, Sions JM. Gait asymmetry is associated with performance-based physical function among adults with lower-limb amputation. Physiother Theory Pract 2022; 38:3108-3118. [PMID: 34657569 PMCID: PMC9013390 DOI: 10.1080/09593985.2021.1990449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 06/10/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Adults with lower-limb amputation walk with an asymmetrical gait and exhibit poor functional outcomes, which may negatively impact quality-of-life. OBJECTIVE To evaluate associations between gait asymmetry and performance-based physical function among adults with lower-limb amputation. METHODS A cross-sectional study involving 38 adults with a unilateral transtibial (N = 24; 62.5 ± 10.5 years) or transfemoral amputation (N = 14; 59.9 ± 9.5 years) was conducted. Following gait analysis (capturing step length and stance time asymmetry at self-selected (SSWS) and fast walking speeds (FWS)), participants completed performance-based measures (i.e. Timed Up and Go (TUG), the 10-Meter Walk Test (10mwt), and the 6-Minute Walk Test (6MWT)). RESULTS Step length and stance time asymmetry (at SSWS and FWS) were significantly correlated with each performance-based measure (p < .001 to p = .035). Overall, models with gait measures obtained at SSWS explained 40.1%, 46.8% and 40.1% of the variance in TUG-time (p = .022), 10mwt-speed (p = .003) and 6MWT-distance (p = .010), respectively. Models with gait measures obtained at FWS explained 70.0%, 59.8% and 51.8% of the variance in TUG-time (p < .001), 10mwt-speed (p < .001), and 6MWT-distance (p < .001), respectively. CONCLUSIONS Increases in step length or stance time asymmetry are associated with increased TUG-time, slower 10mwt-speed, and reduced 6MWT-distance. Findings suggest gait asymmetry may be a factor in poor functional outcomes following lower-limb amputation.
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Affiliation(s)
- Mayank Seth
- Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, Newark DE
| | - Peter C Coyle
- Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark DE
| | - Ryan T Pohlig
- Biostatistics Core Facility, University of Delaware, Newark, DE
| | - Emma H Beisheim
- Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, Newark DE
| | - John R Horne
- Independence Prosthetics-Orthotics, Inc., Newark, DE
| | - Gregory E Hicks
- Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark DE
| | - Jaclyn Megan Sions
- Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, Newark DE
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Renner K, Delaney C, Hill C, Sands L, Queen R. Predicting post-total ankle arthroplasty walking speed based on preoperative gait mechanics. J Orthop Res 2022; 41:1070-1075. [PMID: 36116022 DOI: 10.1002/jor.25444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/01/2022] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
Decreased walking speed is associated with impaired physical performance and function in older adults. Following total ankle arthroplasty (TAA), walking speed continues to be slower than age matched controls. The purpose of this study was to determine if patients 1 year post-TAA can achieve walking speed benchmarks and investigate if gait metrics are predictive of achieved benchmarks. 191 TAA patients were recruited and assessed pre-TAA and 1 year post-TAA. Kinetic and kinematic data were collected during seven self-selected speed barefoot walking trials along a 30-m walkway. Receiver operator curves were generated for each variable to determine threshold values needed to achieve walking speeds of 0.8, 0.9, 1.1, and 1.3 m/s. Each variable's predictive ability was classified according to the area under the curve. Ninety one percent of participants achieved a walking speed > 0.8 m/s, 85.3% achieved ≥0.9 m/s, 64.9% walked at ≥1.1 m/s, and 24.1% achieved a walking speed of 1.3 m/s by 1 year post-TAA. Walking speed pre-TAA was the strongest predictor with ankle moment, power and GRF data showing mixed results. Clinical Significance: 75.9% of participants were unable to walk at 1.3 m/s-a speed indicative of safely crossing a street. Variables predictive of postoperative walking speed benchmarks could be useful in developing interventions for the TAA population. The strongest predictor across all walking speed benchmarks was preoperative walking speed. A walking speed > 0.71 m/s was predictive of achieving 0.8 m/s 1 year post-TAA, while >1.09 m/s predicted 1.3 m/s 1 year post-TAA.
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Affiliation(s)
- Kristen Renner
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA
| | - Caitlyn Delaney
- Department of Physical Therapy, Radford University Carilion, Roanoke, Virginia, USA
| | - Cherice Hill
- Clemson University-Medical University of South Carolina Joint Bioengineering Program, Charleston, South Carolina, USA
| | - Laura Sands
- Center for Gerontology, Virginia Tech, Blacksburg, Virginia, USA
| | - Robin Queen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
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Hill CN, Ross S, Peebles A, Queen RM. Continuous similarity analysis in patient populations. J Biomech 2021; 131:110916. [PMID: 34952349 DOI: 10.1016/j.jbiomech.2021.110916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Abstract
Decreased movement symmetry is associated with injury risk and accelerated disease progression. Methods to analyze continuous data either cannot be used in pathologic populations with abnormal movement patterns or are not defined in terms easily incorporated into clinical care. The purpose of this study was to develop a method of describing symmetry and movement quality in continuous time-series data that results in scores that can be readily incorporated into clinical care. Two scores were developed: (1) the symmetry score (SS) which evaluates similarities in time-series data between limbs and (2) the closeness-to-healthy score (CTHS) which evaluates the similarity of time-series data to a control population. Kinetic and kinematic data from 56 end-stage unilateral ankle arthritis (A-OA) patients and 56 healthy older adults, along with 16 anterior cruciate ligament reconstruction (ACLR) patients and 16 healthy young adults were used to test the ability for SS and CTHS to differentiate between healthy and patient groups. Unpaired t-tests, Cohen's D effect sizes, and receiver-operating-curve analyses assessed group differences [SPSS, V27, α = 0.05]. Patients had worse SS than controls and A-OA patients had worse CTHS compared to controls. SS had strong predictive capability, while the predictive capability of CTHS varied. Combined with clinically accessible data collection methods, the SS and CTHS could be used to evaluate patients' baseline movement quality, assess changes due to disease progression, and during recovery. Results could be utilized in clinical decision making to assess surgical intervention urgency and efficacy of surgical interventions or rehabilitation protocols to improve side-to-side limb symmetry.
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Affiliation(s)
- Cherice N Hill
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Shane Ross
- Department of Aerospace and Ocean Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Alexander Peebles
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Robin M Queen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA.
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Palmowski Y, Popovic S, Schuster SG, Hardt S, Damm P. In vivo analysis of hip joint loading on Nordic walking novices. J Orthop Surg Res 2021; 16:596. [PMID: 34649562 PMCID: PMC8515744 DOI: 10.1186/s13018-021-02741-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/21/2021] [Indexed: 01/26/2023] Open
Abstract
Objective To evaluate the influence of Nordic walking (NW) on hip joint loads in order to determine whether it can be safely performed during postoperative physiotherapy in patients after orthopeadic surgery of the hip. Methods Internal hip joint loads were directly measured in vivo in 6 patients using instrumented hip prostheses during NW and ordinary walking (OW). All patients received training in two different NW techniques (double-poling and the diagonal technique) by a certified NW instructor. Measurements were conducted on a treadmill at a speed of 4 km/h on level ground, at 10% inclination and at 10% slope as well as on a level lawn at a self chosen comfortable speed. Resultant contact force (Fres), bending moment (Mbend) and torsional torque (Mtors) were compared between NW and OW as well as between both NW techniques. Results Joint loads showed a double peak pattern during all setups. Neither NW technique significantly influenced hip joint loads at the time of the first load peak during contralateral toe-off (CTO), which was also the absolute load peak, in comparison to OW. Compared to OW, double-poling significantly reduced Fres and Mbend at the time of the second load peak during the contralateral heel strike (CHS) on level ground both on the treadmill (− 6% and − 7%, respectively) and on the lawn (− 7% and − 9%). At 10% inclination, the diagonal technique increased Fres and Mbend at CHS (by + 6% and + 7%), but did not increase the absolute load peak at CTO. Conclusion Joint loads during NW are comparable to those of OW. Therefore, NW can be considered a low-impact activity and seems to be safe for patients that are allowed full weight bearing, e.g. during postoperative rehabilitation after THA.
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Affiliation(s)
- Yannick Palmowski
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Chariteplatz 1, 10117, Berlin, Germany
| | - Srdan Popovic
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Simone G Schuster
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Chariteplatz 1, 10117, Berlin, Germany
| | - Philipp Damm
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany.
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Symmetry function - An effective tool for evaluating the gait symmetry of trans-femoral amputees. Gait Posture 2021; 90:9-15. [PMID: 34358849 DOI: 10.1016/j.gaitpost.2021.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/02/2021] [Accepted: 07/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prostheses can help persons with trans-femoral amputation (TFA) regain normal function, but such individuals still exhibit gait deviations expressed in gait asymmetries. We apply a specialised tool, the Symmetry Function (SF), to evaluate the symmetry of walking in terms of kinematic and dynamic variables and to identify areas with large side deviations (exceeding defined ±5% threshold) in the movement cycle. RESEARCH QUESTION Which movements and joints or GRF components revealed the most significant side deviations in the movement cycle? When exactly are they located in the gate cycle? METHODS In this retrospective observational study, an instrumented motion analysis system was used to register the gait of fourteen patients after unilateral TFA. Measurements involved evaluating the time series of gait variables characterising a range of motion and the ground reaction force components. Comparison of the prosthetic (involved) limb with the sound (uninvolved) limb in TFA patients was carried out on the basis of the Symmetry Function values. RESULTS The Symmetry Function proved to be an effective tool to localise the regions of asymmetry and limb dominance in the full gait cycle. The difference between sides revealed by the Symmetry Function was the highest for the pelvis and the hip. In the sagittal plane, the pelvis was asymmetrically tilted, reaching the highest SF value of more than 25 % at 60 % cycle time. In the transverse plane, the pelvis was even more asymmetrically positioned throughout the entire gait cycle (50 % difference). The hip in the frontal plane reached a 60 % difference throughout the single support phase for the involved and then for the uninvolved limb. SIGNIFICANCE The Symmetry Function allows for the detection of gait asymmetries, temporal shifts in the gait phases and may assess the precise in time adaptation of prostheses and rehabilitation monitoring, especially in unilateral impairments.
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Treadmill versus overground gait training in patients with lower limb burn injury: A matched control study. Burns 2021; 48:51-58. [PMID: 34154896 DOI: 10.1016/j.burns.2021.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/27/2021] [Accepted: 04/18/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Gait impairment is commonly seen in patients with a lower limb burn injury (LLBI). Therefore, the aim of this study was to investigate the effects of two different gait training modes on gait symmetry, functional mobility and kinesiophobia in patients with LLBI. METHODS This matched control study was conducted between January 2017 and August 2018. Patients with LLBI (n=28) were allocated to 2 different groups by matching according to burn localization, age, and gender. Group 1 (overground group: n=14) received overground gait training in addition to standard burn rehabilitation, and Group 2 (treadmill group: n=14) received treadmill gait training in addition to standard burn rehabilitation. The rehabilitation program and gait training were started when the patient was admitted to the hospital and ended on discharge. These physical therapy interventions were performed 5 days per week. The gait training intensity, including walking speed and duration, was determined according to patient tolerance. Gait parameters, functional mobility, kinesiophobia and pain values were evaluated with GAITRite, the timed up-and-go test (TUG), Tampa Kinesiophobia Scale and Visual Analogue Scale, respectively. These evaluations were made twice; on admission and immediately prior to discharge. Gait symmetry was calculated using the Symmetry Index. RESULTS The baseline characteristics of the groups and initial outcome values were similar. In the comparison of the differences between the overground and treadmill groups, the change in kinesiophobia and TUG values were significantly higher in the treadmill group (p=0.01, p=0.02, respectively). The intragroup comparisons showed significant differences in SI in respect of step length (p=0.004), swing (p=0.006), stance (p=0.008) and velocity (p=0.001), cadence (p=0.001), TUG (p=0.001), kinesiophobia (p=0.001) and pain (p=0.001) in the overground group. Statistically significant differences were determined in step length (p=0.01), swing (p=0.01), stance (p=0.02) and velocity (p=0.001), cadence (p=0.001), TUG (p=0.001), kinesiophobia (p=0.001) and pain (p=0.001) in the treadmill group, when pre and post-training values were compared. CONCLUSIONS The results of this study have shown that treadmill gait training was more effective in the improvement of functional mobility and reduction in kinesiophobia levels of patients with LLBI compared to overground gait training. Both overground and treadmill gait training also provide greater improvements in the velocity and cadence, and gait symmetry for step length, swing and stance in patients with LLBI. CLINICAL TRIAL REGISTRATION NUMBER NCT03217526.
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Brændvik SM, Goihl T, Braaten RS, Vereijken B. The Effect of Increased Gait Speed on Asymmetry and Variability in Children With Cerebral Palsy. Front Neurol 2020; 10:1399. [PMID: 32082235 PMCID: PMC7002475 DOI: 10.3389/fneur.2019.01399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/20/2019] [Indexed: 11/13/2022] Open
Abstract
Gait of children and adolescents with cerebral palsy (CP) is often reported to be more asymmetric and variable than gait of typically developing (TD) peers. As this may lead to less stable and less efficient gait, a relevant clinical question is how asymmetry may be improved and variability reduced in this population. The main objective of the current study was to investigate whether higher walking speed would affect gait symmetry and gait variability in children and adolescents with CP. Data from clinical gait analyses of 43 children and adolescents (29 males and 14 females) with unilateral (n = 28) or bilateral (n = 15) CP were included. Mean age was 11.3 ± 3.4 years, with level I (n = 26) or level II (n = 17) according to the Gross Motor Function Classification System (GMFCS). Corresponding data from 20 TD peers, matched in age and gender, were included as reference. Step time, step length, single support, and stance phase were studied at two different gait speeds: preferred and fast walking speed. Symmetry index and coefficient of variation were used as measures of asymmetry and variability, respectively. Results indicated that all participants managed to increase gait speed when instructed to do so. Overall, increased speed did not result in a more asymmetrical or variable gait, except for an increase in step length asymmetry and a difference in response between GMFCS levels I and II in variability. This implies that manipulation of gait speed may be useful clinically without necessarily making gait more unstable. However, some increase in step length asymmetry may be inevitable when gait speed is increased in people with CP.
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Affiliation(s)
- Siri Merete Brændvik
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Clinical services, St. Olavs University Hospital, Trondheim, Norway
| | - Tobias Goihl
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Trøndelag Orthopaedic Workshop, TOV, Trondheim, Norway
| | - Ragnhild Sunde Braaten
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Clinical services, St. Olavs University Hospital, Trondheim, Norway
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
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Relationship Between Energy Expenditure During Walking and Step Length in Patients With Heart Failure. TOPICS IN GERIATRIC REHABILITATION 2019. [DOI: 10.1097/tgr.0000000000000206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lindemann U. Spatiotemporal gait analysis of older persons in clinical practice and research : Which parameters are relevant? Z Gerontol Geriatr 2019; 53:171-178. [PMID: 30770991 DOI: 10.1007/s00391-019-01520-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/25/2019] [Accepted: 01/31/2019] [Indexed: 01/01/2023]
Abstract
For older persons walking is a basic activity of daily life which characterizes the person's functional mobility. Therefore, the improvement of walking performance is a major clinical outcome during geriatric rehabilitation. Furthermore, walking performance is relevant for several geriatric research issues. Quantitative gait analysis can describe walking performance in detail. Besides gait speed, various qualitative parameters related to different aspects of walking performance, such as symmetry, regularity, coordination, dynamic balance and foot movement during the swing phase, can serve as outcome parameters in geriatric research and in clinical practice. Clinicians and researchers have to decide which parameters are appropriate to be used as relevant outcome parameters in the investigated person or group of persons.
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Affiliation(s)
- Ulrich Lindemann
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.
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Wiik AV, Aqil A, Brevadt M, Jones G, Cobb J. Abnormal ground reaction forces lead to a general decline in gait speed in knee osteoarthritis patients. World J Orthop 2017; 8:322-328. [PMID: 28473960 PMCID: PMC5396017 DOI: 10.5312/wjo.v8.i4.322] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 01/01/2017] [Accepted: 01/16/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyse ground reaction forces at higher speeds using another method to be more sensitive in assessing significant gait abnormalities. METHODS A total of 44 subjects, consisting of 24 knee osteoarthritis (OA) patients and 20 healthy controls were analysed. The knee OA patients were recruited from an orthopaedic clinic that were awaiting knee replacement. All subjects had their gait patterns during stance phase at top walking speed assessed on a validated treadmill instrumented with tandem force plates. Temporal measurements and ground reaction forces (GRFs) along with a novel impulse technique were collected for both limbs and a symmetry ratio was applied to all variables to assess inter-limb asymmetry. All continuous variables for each group were compared using a student t-test and χ2 analysis for categorical variables with significance set at α = 0.05. Receiver operator characteristics curves were utilised to determine best discriminating ability. RESULTS The knee OA patients were older (66 ± 7 years vs 53 ± 9 years, P = 0.01) and heavier (body mass index: 31 ± 6 vs 23 ± 7, P < 0.001) but had a similar gender ratio when compared to the control group. Knee OA patients were predictably slower at top walking speed (1.37 ± 0.23 m/s vs 2.00 ± 0.20 m/s, P < 0.0001) with shorter mean step length (79 ± 12 cm vs 99 ± 8 cm, P < 0.0001) and broader gait width (14 ± 5 cm vs 11 ± 3 cm, P = 0.015) than controls without any known lower-limb joint disease. At a matched mean speed (1.37 ± 0.23 vs 1.34 ± 0.07), ground reaction results revealed that push-off forces and impulse were significantly (P < 0.0001) worse (18% and 12% respectively) for the knee OA patients when compared to the controls. Receiver operating characteristic curves analysis demonstrated total impulse to be the best discriminator of asymmetry, with an area under the curve of 0.902, with a cut-off of -3% and a specificity of 95% and sensitivity of 88%. CONCLUSION Abnormal GRFs in knee osteoarthritis are clearly evident at higher speeds. Analysing GRFs with another method may explain the general decline in knee OA patient's gait.
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Validity and sensitivity of the longitudinal asymmetry index to detect gait asymmetry using Microsoft Kinect data. Gait Posture 2017; 51:162-168. [PMID: 27776270 DOI: 10.1016/j.gaitpost.2016.08.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 08/17/2016] [Accepted: 08/22/2016] [Indexed: 02/02/2023]
Abstract
Gait asymmetry information is a key point in disease screening and follow-up. Constant Relative Phase (CRP) has been used to quantify within-stride asymmetry index, which requires noise-free and accurate motion capture, which is difficult to obtain in clinical settings. This study explores a new index, the Longitudinal Asymmetry Index (ILong) which is derived using data from a low-cost depth camera (Kinect). ILong is based on depth images averaged over several gait cycles, rather than derived joint positions or angles. This study aims to evaluate (1) the validity of CRP computed with Kinect, (2) the validity and sensitivity of ILong for measuring gait asymmetry based solely on data provided by a depth camera, (3) the clinical applicability of a posteriorly mounted camera system to avoid occlusion caused by the standard front-fitted treadmill consoles and (4) the number of strides needed to reliably calculate ILong. The gait of 15 subjects was recorded concurrently with a marker-based system (MBS) and Kinect, and asymmetry was artificially reproduced by introducing a 5cm sole attached to one foot. CRP computed with Kinect was not reliable. ILong detected this disturbed gait reliably and could be computed from a posteriorly placed Kinect without loss of validity. A minimum of five strides was needed to achieve a correlation coefficient of 0.9 between standard MBS and low-cost depth camera based ILong. ILong provides a clinically pragmatic method for measuring gait asymmetry, with application for improved patient care through enhanced disease, screening, diagnosis and monitoring.
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The Immediate Effects of Different Types of Ankle Support Introduced 6 Weeks After Surgical Internal Fixation for Ankle Fracture on Gait and Pain: A Randomized Crossover Trial. J Orthop Sports Phys Ther 2016; 46:157-67. [PMID: 26813753 DOI: 10.2519/jospt.2016.6212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Randomized 3-treatment, 3-period crossover trial. BACKGROUND There is variation in clinical practice regarding the type of ankle support used to aid recovery after ankle fracture internal fixation surgery. OBJECTIVE To determine the immediate effects of different ankle supports commonly issued to patients 6 weeks after surgery. METHODS Participants were 18 adults, 6 weeks after internal fixation for transsyndesmotic/infrasyndesmotic fracture, in a major trauma center in the UK. Interventions were a stirrup brace and walker boot compared with Tubigrip. Outcomes were (1) step-length and single-limb support time asymmetry (percentage comparing injured and uninjured limbs), (2) step width, (3) gait velocity, and (4) pain during walking (visual analog scale, 0-100). RESULTS Participants (mean ± SD age, 47 ± 14 years) included 8 women and 10 men, 6 weeks after surgical internal fixation for ankle fracture. Single-limb support time asymmetry reduced by 3% (95% confidence interval [CI]: 0%, 6%; P = .02) in the stirrup brace and by 5% (95% CI: 2%, 7%; P = .001) in the walker boot compared with Tubigrip. Step width was 1.2 cm (95% CI: 0.6, 1.7; P<.001) wider in the walker boot than in Tubigrip. Self-reported pain was lower in the walker boot (5/100) and in the stirrup brace (13/100) compared to the Tubigrip (18/100, P = .03). No significant differences were found in the effects of the supports on step-length asymmetry between the walker boot or stirrup brace and Tubigrip. CONCLUSION At 6 weeks after surgical internal fixation for ankle fracture, pain and single-limb support time asymmetry over a short distance and for a short-term walk were immediately reduced with the use of a walker boot use and, to a lesser extent, a stirrup-brace compared to Tubigrip. Step width also widened in a walker boot, which may confer some additional gait stability. These results apply to immediate effects, so studies with longer-term follow-up are now indicated. The trial was registered at http://www.isrctn.com/ (ISRCTN84536917). Level of Evidence Therapy, level 2b.
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Schmidt A, Stief F, Lenarz K, Froemel D, Lutz F, Barker J, Meurer A. Unilateral hip osteoarthritis: Its effects on preoperative lower limb muscle activation and intramuscular coordination patterns. Gait Posture 2016; 45:187-92. [PMID: 26979904 DOI: 10.1016/j.gaitpost.2016.01.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 12/21/2015] [Accepted: 01/30/2016] [Indexed: 02/02/2023]
Abstract
The objective of this study was to test if patients with unilateral hip osteoarthritis (OA) show greater muscle activity asymmetry between their affected and non-affected limbs than healthy controls between their left and right limbs. Seventeen patients with unilateral hip OA (7 females, 10 males) and 17 age-matched healthy controls (7 females, 10 males) participated in this study. Both groups performed instrumented gait analysis at comparable speeds. Muscle activity was recorded simultaneously for the tibialis anterior (TA), gastrocnemius medialis (GM), vastus lateralis (VL), semitendinosus (ST), tensor fasciae latae (TFL), and gluteus medius (GLM) muscles. In hip OA patients, EMG data showed greater activity of the TA muscle in the non-affected limb, and greater TFL muscle activity in the affected limb. Compared to healthy controls, greater asymmetries between paired limbs were observed for the TA and GM muscles. Finally, the TFL muscle of the affected limb contributed more to the total limb muscle activity than did the non-affected limb. The observed alterations in TA and GM muscle activity in hip OA patients may be due to the greater peak braking and peak vertical forces measured in the non-affected limb. Contrary to this, greater TLF muscle activity of the affected limb indicates the demands put on stabilizing the hip during stance phase. Further studies are necessary to test whether leg length discrepancy affects muscle activation alterations between the affected and non-affected limb in unilateral hip OA patients.
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Affiliation(s)
- André Schmidt
- Experimental Orthopedics & Trauma Surgery, Frankfurt Initiative for Regenerative Medicine, Johann Wolfgang Goethe University Frankfurt, Marienburgstraße 2, 60528 Frankfurt/Main, Germany; Orthopedic University Hospital Friedrichsheim gGmbH, Marienburgstraße 2, 60528 Frankfurt/Main, Germany.
| | - Felix Stief
- Orthopedic University Hospital Friedrichsheim gGmbH, Marienburgstraße 2, 60528 Frankfurt/Main, Germany
| | - Katharina Lenarz
- Department of Sports Medicine, Johann Wolfgang Goethe University Frankfurt, Ginnheimer Landstraße 39, 60487 Frankfurt/Main, Germany
| | - Dara Froemel
- Orthopedic University Hospital Friedrichsheim gGmbH, Marienburgstraße 2, 60528 Frankfurt/Main, Germany
| | - Frederick Lutz
- Frankfurt University of Applied Sciences, Nibelungenplatz 1, 60318 Frankfurt/Main, Germany
| | - John Barker
- Experimental Orthopedics & Trauma Surgery, Frankfurt Initiative for Regenerative Medicine, Johann Wolfgang Goethe University Frankfurt, Marienburgstraße 2, 60528 Frankfurt/Main, Germany
| | - Andrea Meurer
- Orthopedic University Hospital Friedrichsheim gGmbH, Marienburgstraße 2, 60528 Frankfurt/Main, Germany
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Scaglioni MF, Verdini F, Marchesini A, Neuendorf AD, Coccia D, Leo T, Riccio M. Assessment of functional outcomes of temporalis muscle transfers for patients with longstanding facial paralysis. Head Neck 2016; 38 Suppl 1:E1535-43. [PMID: 26752232 DOI: 10.1002/hed.24275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 07/09/2015] [Accepted: 09/13/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Usually, clinical evaluation of facial reanimation provides accurate information about contraction of the mimetic muscles and phonation but fails to identify smile recovery and to quantify the motility of the lower third of the face during a smile. The purpose of this study was to verify that, in longstanding facial palsy, the modified temporalis muscle transfer (MTMT) can result in the ability to smile, not only voluntarily with chewing, but also spontaneously with a sudden emotional stimulus, and to confirm that a symmetric smile can be obtained. METHODS Ten patients of the treated group (group T; 4 women and 6 men) were randomly selected from a population of 24 patients with longstanding facial palsy treated by MTMT. Five normal subjects of the control group (group C; 3 women and 2 men) were enrolled as the control population. Functional outcomes after transposed temporalis muscle were examined and measured through clinical assessment by using a scored smile symmetry grading system, video recording, and surface electromyography (sEMG). In addition, the voluntary smile test (VST) and the not-voluntary smile test (NVST) were performed to study voluntary and spontaneous smiling. RESULTS Subjects in the VST group (group T) were able to smile voluntarily and the expression was characterized by symmetry. In the NVST group, they were able to smile spontaneously and the symmetry of the smile was maintained for 8 subjects and only partially for 2 subjects. During both tests, the temporalis muscle of the treated side and the orbicularis oris muscle of the not-treated side were activated during smiling, indicating spontaneous activity of the transposed temporalis muscle with an emotional stimulus. For the control group, smiles during VST and NVST were symmetric and the temporalis muscles were not activated during smiling, whereas the orbicularis oris muscles were. CONCLUSION Our study shows that the Morrison MTMT is able to restore the voluntary smile ability. Particularly, this technique allows for recovery of the spontaneous smile with symmetry. This assessment would seem to suggest that the transposed temporalis muscle might adapt from a chewing to a mimetic muscle. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1535-E1543, 2016.
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Affiliation(s)
- Mario F Scaglioni
- Department of Reconstructive Surgery and Hand Surgery, AUO Ospedali Riuniti di Ancona, Univerista' Politecnica delle Marche, Ancona, Italy
| | - Federica Verdini
- Department of Informatics Engineering, Universita' Politecnica delle Marche, Ancona, Italy
| | - Andrea Marchesini
- Department of Reconstructive Surgery and Hand Surgery, AUO Ospedali Riuniti di Ancona, Univerista' Politecnica delle Marche, Ancona, Italy
| | - Alexander Dietrich Neuendorf
- Department of Reconstructive Surgery and Hand Surgery, AUO Ospedali Riuniti di Ancona, Univerista' Politecnica delle Marche, Ancona, Italy
| | - Daniele Coccia
- Department of Informatics Engineering, Universita' Politecnica delle Marche, Ancona, Italy
| | - Tommaso Leo
- Department of Informatics Engineering, Universita' Politecnica delle Marche, Ancona, Italy
| | - Michele Riccio
- Department of Reconstructive Surgery and Hand Surgery, AUO Ospedali Riuniti di Ancona, Univerista' Politecnica delle Marche, Ancona, Italy
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Keene DJ, Moe-Nilssen R, Lamb SE. The application of multilevel modelling to account for the influence of walking speed in gait analysis. Gait Posture 2016; 43:216-9. [PMID: 26602593 DOI: 10.1016/j.gaitpost.2015.09.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/17/2015] [Accepted: 09/23/2015] [Indexed: 02/02/2023]
Abstract
Differences in gait performance can be explained by variations in walking speed, which is a major analytical problem. Some investigators have standardised speed during testing, but this can result in an unnatural control of gait characteristics. Other investigators have developed test procedures where participants walking at their self-selected slow, preferred and fast speeds, with computation of gait characteristics at a standardised speed. However, this analysis is dependent upon an overlap in the ranges of gait speed observed within and between participants, and this is difficult to achieve under self-selected conditions. In this report a statistical analysis procedure is introduced that utilises multilevel modelling to analyse data from walking tests at self-selected speeds, without requiring an overlap in the range of speeds observed or the routine use of data transformations.
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Affiliation(s)
- David J Keene
- Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 9DU, UK.
| | - Rolf Moe-Nilssen
- Department of Public Health and Primary Health Care, Physiotherapy Science, University of Bergen, P.O. Box 7804, N-5020, Norway
| | - Sarah E Lamb
- Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 9DU, UK; Warwick Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK
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18
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Keene DJ, Willett K, Lamb SE. The effects of ankle supports on gait in adults: A randomized cross-over study. J Electromyogr Kinesiol 2015; 25:973-81. [PMID: 26337720 DOI: 10.1016/j.jelekin.2015.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 08/08/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022] Open
Abstract
We aimed to compare the effects of different ankle supports used after ankle injury/surgery on temporo-spatial gait characteristics. We conducted a randomized cross-over study including adult participants with no previous lower limb or neurological pathology, who underwent gait analysis on an electronic walkway in three different ankle supports, Tubigrip(®), a stirrup brace and a walker boot. The 18 participants were an average age of 42 (SD 13, range 24-62) years and 14 (88%) were female. Compared to Tubigrip(®), gait in the walker boot was slower (-0.19 m/s, 95%CI -0.23 to -0.16, P < 0.001), step length asymmetry was 10% (95%CI 9-12, P < 0.001) worse, single support time asymmetry was 5% (95%CI 3-7, P < 0.001) worse and participants also adopted a wider step width (4.1 cm, 95%CI 3.7-4.5, P < 0.001). There were no important differences in gait between the Tubigrip(®) and stirrup brace. The findings of this study suggest that there is a limit to the degree of normal walking characteristics in a walker boot in the absence of lower limb impairment. Further research is required to directly compare the effects of these ankle supports in clinical populations.
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Affiliation(s)
- David J Keene
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
| | - Keith Willett
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
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Rutherford D, Moreside J, Wong I. Knee joint motion and muscle activation patterns are altered during gait in individuals with moderate hip osteoarthritis compared to asymptomatic cohort. Clin Biomech (Bristol, Avon) 2015; 30:578-84. [PMID: 25900446 DOI: 10.1016/j.clinbiomech.2015.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/17/2015] [Accepted: 04/02/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Knee replacements are common after hip replacement for end stage osteoarthritis. Whether abnormal knee mechanics exist in moderate hip osteoarthritis remains undetermined and has implications for understanding early osteoarthritis joint mechanics. The purpose of this study was to determine whether three-dimensional (3D) knee motion and muscle activation patterns in individuals with moderate hip osteoarthritis differ from an asymptomatic cohort and whether these features differ between contra- and ipsilateral knees. METHODS 3D motions and medial and lateral quadriceps and hamstring surface electromyography were recorded on 20 asymptomatic individuals and 20 individuals with moderate hip osteoarthritis during treadmill walking, using standardized collection and processing procedures. Principal component analysis was used to derive electromyographic amplitude and temporal waveform features. 3D stance-phase range of motion was calculated. A 2-factor repeated analysis of variance determined significant within-group leg and muscle differences. Student's t-tests identified between group differences, with Bonferroni corrections where applicable (α=0.05). FINDINGS Lower sagittal plane motion between early and mid/late stance (5°, P=0.004, effect size: 0.96) and greater mid-stance quadriceps activity was found in the osteoarthritis group (P=0.01). Compared to the ipsilateral knee, a borderline significant increase in mid-stance hamstring activity was found in the contra-lateral knee of the hip osteoarthritis group (P=0.018). INTERPRETATION Bilateral knee mechanics were altered, suggesting potentially increased loads and knee muscle fatigue. There was no indication that one knee is more susceptible to osteoarthritis than the other, thus clinicians should include bilateral knee analysis when treating patients with hip osteoarthritis.
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Affiliation(s)
- Derek Rutherford
- School of Physiotherapy, Faculty of Health Professions, Dalhousie University, Halifax, NS, Canada; School of Health and Human Performance, Faculty of Health Professions, Dalhousie University, Halifax, NS, Canada; School of Biomedical Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS, Canada.
| | - Janice Moreside
- School of Physiotherapy, Faculty of Health Professions, Dalhousie University, Halifax, NS, Canada; School of Health and Human Performance, Faculty of Health Professions, Dalhousie University, Halifax, NS, Canada.
| | - Ivan Wong
- School of Physiotherapy, Faculty of Health Professions, Dalhousie University, Halifax, NS, Canada; School of Health and Human Performance, Faculty of Health Professions, Dalhousie University, Halifax, NS, Canada; Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, NS, Canada.
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Staab W, Hottowitz R, Sohns C, Sohns JM, Gilbert F, Menke J, Niklas A, Lotz J. Accelerometer and gyroscope based gait analysis using spectral analysis of patients with osteoarthritis of the knee. J Phys Ther Sci 2014; 26:997-1002. [PMID: 25140082 PMCID: PMC4135223 DOI: 10.1589/jpts.26.997] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 01/08/2014] [Indexed: 02/02/2023] Open
Abstract
[Purpose] A wide variety of accelerometer tools are used to estimate human movement, but
there are no adequate data relating to gait symmetry parameters in the context of knee
osteoarthritis. This study’s purpose was to evaluate a 3D-kinematic system using
body-mounted sensors (gyroscopes and accelerometers) on the trunk and limbs. This is the
first study to use spectral analysis for data post processing. [Subjects] Twelve patients
with unilateral knee osteoarthritis (OA) (10 male) and seven age-matched controls (6 male)
were studied. [Methods] Measurements with 3-D accelerometers and gyroscopes were compared
to video analysis with marker positions tracked by a six-camera optoelectronic system
(VICON 460, Oxford Metrics). Data were recorded using the 3D-kinematic system. [Results]
The results of both gait analysis systems were significantly correlated. Five parameters
were significantly different between the knee OA and control groups. To overcome time
spent in expensive post-processing routines, spectral analysis was performed for fast
differentiation between normal gait and pathological gait signals using the 3D-kinematic
system. [Conclusions] The 3D-kinematic system is objective, inexpensive, accurate and
portable, and allows long-term recordings in clinical, sport as well as ergonomic or
functional capacity evaluation (FCE) settings. For fast post-processing, spectral analysis
of the recorded data is recommended.
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Affiliation(s)
- Wieland Staab
- Institute for Diagnostic and Interventional Radiology, Heart Center, University Medical Center Goettingen, Germany ; DZHK, German Center for Heart Research, Germany ; Department of Sports Medicine, University Medical Center Goettingen, Germany
| | - Ralf Hottowitz
- Department of Sports Medicine, University Medical Center Goettingen, Germany
| | - Christian Sohns
- DZHK, German Center for Heart Research, Germany ; Department of Cardiology and Pneumology, Heart Center, University Medical Center Goettingen, Germany ; Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom
| | - Jan Martin Sohns
- Institute for Diagnostic and Interventional Radiology, Heart Center, University Medical Center Goettingen, Germany ; DZHK, German Center for Heart Research, Germany
| | - Fabian Gilbert
- Department of Orthopedics, University Medical Center Würzburg, Germany
| | - Jan Menke
- Institute for Diagnostic and Interventional Radiology, Heart Center, University Medical Center Goettingen, Germany
| | - Andree Niklas
- Department of Sports Medicine, University Medical Center Goettingen, Germany
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, Heart Center, University Medical Center Goettingen, Germany ; DZHK, German Center for Heart Research, Germany
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Spatial-temporal gait characteristics in individuals with hip osteoarthritis: a systematic literature review and meta-analysis. J Orthop Sports Phys Ther 2014; 44:291-B7. [PMID: 24450373 DOI: 10.2519/jospt.2014.4634] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Systematic literature review and meta-analysis. OBJECTIVE To systematically review and critically evaluate the literature to determine how basic gait characteristics are altered in individuals with hip osteoarthritis (OA). BACKGROUND Hip OA is a progressive musculoskeletal condition that leads to pain, stiffness, and functional limitation in activities such as walking. Understanding gait dysfunction in people with hip OA may contribute to more effective management of the disease. METHODS Eleven electronic research databases were searched. Studies comparing basic gait parameters in individuals with hip OA to healthy controls and the affected to the contralateral limb of individuals with hip OA were included. The studies were critically appraised for methodological quality. Available data were extracted, and meta-analysis was performed, with standardized effect sizes (Cohen d) and corresponding 95% confidence intervals computed for gait speed, cadence, step and stride length, stance, swing and double-stance duration, and step width. RESULTS The final analysis included 30 articles. Self-selected gait speed was 26% slower in individuals with hip OA relative to controls, which was explained by shorter stride length. Consistent evidence was found for greater asymmetry in individuals with hip OA than controls, with shorter step length and stance duration in the affected compared to the contralateral limb. CONCLUSION Individuals with hip OA walk at a slower speed and exhibit greater gait asymmetry than controls. Gait speed and asymmetry can be readily assessed clinically and represent a simple way of objectively evaluating gait dysfunction and monitoring treatment progress in individuals with hip OA.
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Minimizing preoperative and postoperative limping in patients after total hip arthroplasty: relevance of hip muscle strength and endurance. Am J Phys Med Rehabil 2014; 92:1060-9. [PMID: 23739275 DOI: 10.1097/phm.0b013e3182970fc4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to test the hypothesis that hip muscle function (strength and endurance) improves after total hip arthroplasty and is important for minimizing limping gait. DESIGN Fifty-two patients who underwent total hip arthroplasty were assessed before and 6 mos after receiving a unilateral total hip endoprosthesis (Adaptiva stem with a Harris-Galante acetabular component). Severity of limping was assessed using a 4-point ordinal scale. Pain was assessed using a standardized ordinal scale. Eccentric, concentric, and isometric muscle strength and endurance of the hip extensors, flexors, adductors, and abductors were measured using a dynamometer. RESULTS Postoperative limping severity and pain were significantly lower and postoperative muscle strength and endurance were significantly higher than the preoperative values (P < 0.05). The association between impaired muscle strength and endurance and limping severity was stronger postoperatively than preoperatively. This association was stronger for the hip extensor and flexor muscles than for the hip adductor and abductor muscles. Pain level was not associated with postoperative limping severity. CONCLUSIONS Hip extensor and flexor muscle strength and endurance seem to be relevant for minimizing postoperative limping in patients after total hip arthroplasty. Rehabilitation programs should include exercises aimed at improving hip extensor and flexor strength and endurance to improve gait function.
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Changes in gait patterns and muscle activity following total hip arthroplasty: a six-month follow-up. Clin Biomech (Bristol, Avon) 2013; 28:762-9. [PMID: 23906936 DOI: 10.1016/j.clinbiomech.2013.07.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 07/03/2013] [Accepted: 07/03/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Appropriate gait function is an important determinant of the outcome of total hip arthroplasty and relies on appropriate joint motion and muscle activity. The purpose of this study was to test the hypothesis that 6-month postoperative dynamic joint range of motion, time-distance measures and muscle activity in the operated limb in patients undergoing total hip arthroplasty differ from preoperative levels and are more similar to those observed postoperatively in the contralateral limb and in healthy subjects. METHODS Basic time-distance gait measurements, knee and hip kinematics and electromyographic activity from eight hip muscles were obtained preoperatively and 6 months postoperatively in 52 patients undergoing total hip arthroplasty and in 24 age-matched healthy subjects during treadmill walking. FINDINGS Postoperative dynamic hip range of motion for the operated limb (confidence interval differences [-3.9°; -2.3°]) and postoperative knee range of motion for both limbs (operated: [-8.4°; -5.6°]; contralateral: [-8.1°; -5.3°]) in patients with total hip arthroplasty were significantly lower than values for the control subjects (P<0.001). Postoperative gait in patients with total hip arthroplasty was more symmetric than preoperative gait. Preoperative and postoperative electromyographic intensities were higher in patients with total hip arthroplasty than values for the control subjects (P<0.001), and patients had different EMG patterns compared to the control group. INTERPRETATION Pre- and postoperative differences not only in hip but also in knee kinematics emphasize the importance of evaluating the dynamic outcome of total hip arthroplasty by assessing joint motion of all lower extremity joints in both legs.
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Allen KD, Mata BA, Gabr MA, Huebner JL, Adams SB, Kraus VB, Schmitt DO, Setton LA. Kinematic and dynamic gait compensations resulting from knee instability in a rat model of osteoarthritis. Arthritis Res Ther 2012; 14:R78. [PMID: 22510443 PMCID: PMC3446452 DOI: 10.1186/ar3801] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 02/08/2012] [Accepted: 04/17/2012] [Indexed: 12/20/2022] Open
Abstract
Introduction Osteoarthritis (OA) results in pain and disability; however, preclinical OA models often focus on joint-level changes. Gait analysis is one method used to evaluate both preclinical OA models and OA patients. The objective of this study is to describe spatiotemporal and ground reaction force changes in a rat medial meniscus transection (MMT) model of knee OA and to compare these gait measures with assays of weight bearing and tactile allodynia. Methods Sixteen rats were used in the study. The medial collateral ligament (MCL) was transected in twelve Lewis rats (male, 200 to 250 g); in six rats, the medial meniscus was transected, and the remaining six rats served as sham controls. The remaining four rats served as naïve controls. Gait, weight-bearing as measured by an incapacitance meter, and tactile allodynia were assessed on postoperative days 9 to 24. On day 28, knee joints were collected for histology. Cytokine concentrations in the serum were assessed with a 10-plex cytokine panel. Results Weight bearing was not affected by sham or MMT surgery; however, the MMT group had decreased mechanical paw-withdrawal thresholds in the operated limb relative to the contralateral limb (P = 0.017). The gait of the MMT group became increasingly asymmetric from postoperative days 9 to 24 (P = 0.020); moreover, MMT animals tended to spend more time on their contralateral limb than their operated limb while walking (P < 0.1). Ground reaction forces confirmed temporal shifts in symmetry and stance time, as the MMT group had lower vertical and propulsive ground reaction forces in their operated limb relative to the contralateral limb, naïve, and sham controls (P < 0.05). Levels of interleukin 6 in the MMT group tended to be higher than naïve controls (P = 0.072). Histology confirmed increased cartilage damage in the MMT group, consistent with OA initiation. Post hoc analysis revealed that gait symmetry, stance time imbalance, peak propulsive force, and serum interleukin 6 concentrations had significant correlations to the severity of cartilage lesion formation. Conclusion These data indicate significant gait compensations were present in the MMT group relative to medial collateral ligament (MCL) injury (sham) alone and naïve controls. Moreover, these data suggest that gait compensations are likely driven by meniscal instability and/or cartilage damage, and not by MCL injury alone.
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Affiliation(s)
- Kyle D Allen
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
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