Changes in Muscle Activity Patterns and Joint Kinematics During Gait in Hemophilic Arthropathy

Targeting higher factor VIII levels for prophylaxis in haemophilia A: a narrative review

INTRODUCTION

The standard of care in severe haemophilia A is prophylaxis, which has historically aimed for a factor VIII (FVIII) trough level of ≥1%. However, despite prophylactic treatment, people with haemophilia remain at risk of bleeds that have physical and quality of life implications, and that impact everyday life.

AIM

The aim of this review was to evaluate evidence supporting the relationship between targeting higher FVIII activity levels with prophylaxis and improved outcomes in people with haemophilia A.

METHODS

We conducted a narrative review that defined the unmet needs and treatment goals in people with haemophilia A, evaluated evidence to support targeting higher FVIII activity levels, and highlighted therapies that may support higher and sustained FVIII activity levels and improved outcomes for people with haemophilia A.

RESULTS

Despite recent advances in treatment, unmet needs remain, and people with haemophilia continue to experience joint and functional impairment, acute and chronic pain, and poor mental health. All these negatively impact their health-related quality of life. Evidence suggests that FVIII activity levels of up to 50% may be needed to achieve a near-zero joint bleed rate. However, achieving high FVIII activity levels with current standard and extended half-life (EHL) FVIII replacement therapies is associated with a high treatment burden. Innovative treatment options may provide high sustained FVIII activity levels and improved patient outcomes.

CONCLUSION

Evidence suggests that FVIII activity levels in people with haemophilia A should be sustained at higher levels to improve joint and patient outcomes and enable progression towards health equity.

Biomechanical comparison of human trunk and thigh muscle activity during walking and horseback riding activity

INTRODUCTION

Hippotherapy is a physical therapy tool that utilizes horseback riding to improve strength, coordination, gait, and balance. These benefits may be linked to similarities in kinematics and muscle activation between horseback riding and normal human gait, but this is not well represented in the literature, especially for muscle activation. The purpose of this study was to investigate the relationships between muscle activation of horseback riding and healthy human gait.

METHODS

The muscle activation of nine healthy female participants (age 18-22) were recorded during walking and horseback riding trials using surface electromyography (EMG). Muscles analyzed include rectus abdominis, lumbar erector spinae, rectus femoris and biceps femoris. Activation waveforms during walking and riding were generated, and from this average and maximum contraction magnitudes were recorded.

RESULTS

Average muscle activation was significantly greater in riding for the left (p = 0.008) and right (p = 0.04) biceps femoris. Additionally, average and maximal activation of the left erector spinae were significantly greater in riding (W = 4; critical value for W at n = 9 is 5). Remaining differences in muscle activation between walking and riding were non-significant.

DISCUSSION

Peak and average muscle activation magnitude across the gait cycle were similar for most muscle groups. When present, differences were greater in riding. Despite these similarities, EMG waveforms displayed more predictable temporal patterns in walking.

CONCLUSION

These findings suggest that hippotherapy could be used to elicit muscle excitation similar to that of normal gait, which may have promising implications for rehabilitation targeting gait correction.

Determine the kinematics and kinetics parameters associated with bilateral gait patterns among healthy, overweight, and obese adults

BACKGROUND AND AIM

Biomechanical analysis of gait is important to obtain information regarding the lower limb impairments and dysfunction during locomotion. This study aimed to determine the potential difference among healthy, overweight, and obese participants and their impact on gait parameters by observing the kinematic and kinetics parameters.

METHODS

A cross-sectional study conducted with forty (15 healthy, 12, overweight, 13 obese) male participants. All participants were non-smokers, and their physical activity level was 7000±2142 steps per day. Participants anthropometric characteristics were age:21.57±1.46 years; height:173. 63±6.43 cm, body mass;86.15±23.36 kg., body mass index (BMI) :28.57±7.68 kg/m2, body fat:29.93±9.44%. A bioelectrical impedance device was used to determine participants' body composition and health status. A portable pressure sensor mat (Walkway) from Tekscan was used to measure bilateral gait parameters kinematically and kinetically. One-way analysis of variance was used to determine the differences between groups.

RESULTS

Significant differences were found between health, overweight, and obese participant for different bilateral gait's kinematic and kinetic parameters as cadence, gait velocity, step time, step length, step velocity, step width, stride time, stride length, stride velocity, maximum force, maximum peak pressure, active propulsion, and passive propulsion except impulse at .05 level of significance.

CONCLUSIONS

The findings shows that kinematics and kinetics parameters of gait were affected by the status of their BMI. Current research suggests that increased body weight interferes with normal musculoskeletal function via a range of kinematic and kinetic deficits. More research is required to accurately understand the structural and functional restriction imposed by overweight and obese individuals.

Abnormal synergistic gait mitigation in acute stroke using an innovative ankle-knee-hip interlimb humanoid robot: a preliminary randomized controlled trial

Abnormal spasticity and associated synergistic patterns are the most common neuromuscular impairments affecting ankle–knee–hip interlimb coordinated gait kinematics and kinetics in patients with hemiparetic stroke. Although patients with hemiparetic stroke undergo various treatments to improve gait and movement, it remains unknown how spasticity and associated synergistic patterns change after robot-assisted and conventional treatment. We developed an innovative ankle–knee–hip interlimb coordinated humanoid robot (ICT) to mitigate abnormal spasticity and synergistic patterns. The objective of the preliminary clinical trial was to compare the effects of ICT combined with conventional physical therapy (ICT-C) and conventional physical therapy and gait training (CPT-G) on abnormal spasticity and synergistic gait patterns in 20 patients with acute hemiparesis. We performed secondary analyses aimed at elucidating the biomechanical effects of Walkbot ICT on kinematic (spatiotemporal parameters and angles) and kinetic (active force, resistive force, and stiffness) gait parameters before and after ICT in the ICT-C group. The intervention for this group comprised 60-min conventional physical therapy plus 30-min robot-assisted training, 7 days/week, for 2 weeks. Significant biomechanical effects in knee joint kinematics; hip, knee, and ankle active forces; hip, knee, and ankle resistive forces; and hip, knee, and ankle stiffness were associated with ICT-C. Our novel findings provide promising evidence for conventional therapy supplemented by robot-assisted therapy for abnormal spasticity, synergistic, and altered biomechanical gait impairments in patients in the acute post-stroke recovery phase.

Trial Registration: Clinical Trials.gov identifier NCT03554642 (14/01/2020).

Developing and exploring a methodology for multi-modal indoor and outdoor gait assessment

Gait assessment is emerging as a prominent way to understand impaired mobility and underlying neurological deficits. Various technologies have been used to assess gait inside and outside of laboratory settings, but wearables are the preferred option due to their cost-effective and practical use in both. There are robust conceptual gait models developed to ease the interpretation of gait parameters during indoor and outdoor environments. However, these models examine uni-modal gait characteristics (e.g., spatio-temporal parameters) only. Previous studies reported that understanding the underlying reason for impaired gait requires multi-modal gait assessment. Therefore, this study aims to develop a multi-modal approach using a synchronized inertial and electromyography (EMG) signals. Firstly, initial contact (IC), final contact (FC) moments and corresponding time stamps were identified from inertial data, producing temporal outcomes e.g., step time. Secondly, IC/FC time stamps were used to segment EMG data and define onset and offset times of muscle activities within the gait cycle and its subphases. For investigation purposes, we observed notable differences in temporal characteristics as well as muscle onset/offset timings and amplitudes between indoor and outdoor walking of three stroke survivors. Our preliminary analysis suggests a multi-modal approach may be important to augment and improve current inertial conceptual gait models by providing additional quantitative EMG data.

SIMULATION OF THE RELATIONSHIP BETWEEN JOINT MOTION AMPLITUDE AND MOTION DAMAGE BASED ON ALGORITHM

ABSTRACT Introduction: With the continuous development of society and the continuous improvement of the economic level, the willingness of Chinese people to participate in sports is also showing an upward trend. However, how to reduce sports damage as much as possible during exercise should be a hot issue of particular concern to athletes in the sports world. Objective: It aimed to discuss the simulation of the relationship between joint motion amplitude (JMA) and motion damage (MD) via a rough set decision-making algorithm to avoid MD. Based on the rough set decision algorithm, JMA and MD models were constructed, and a motion data decision table was established. Methods: Joint change parameters and constraint conditions were set, and joint change parameters were analyzed. Moreover, the changing parameters, feature strength, and algorithm partition accuracy of the simulation model were analyzed. Results: The feature strength and the division accuracy of the rough set decision algorithm all showed good accuracy. The model constructed by such a method can well describe the relationship between JMA and MD. Conclusion: The proposed rough set decision algorithm can describe the relationship between JMA and MD scientifically and effectively, which provided reference value for sports. Level of evidence II; Therapeutic studies - investigation of treatment results.

Quantitative measurements of haemophilic joint tissues by point-of-care musculoskeletal ultrasound: Associations with clinical and functional joint outcome parameters

Background

Painful arthropathy is a long‐term complication in patients with hemophilia (PWH), affecting mobility and quality of life. A major barrier for the appraisal of joint health is the absence of point‐of‐care (POC) imaging modalities to promptly identify and manage arthropathic changes. Accordingly, we developed the Joint tissue Activity and Damage Exam (JADE) POC musculoskeletal ultrasound (MSKUS) protocol. JADE is validated for haemophilic joint tissue recognition with high intra/inter‐rater and inter‐operator reliability.

Aims

Evaluate associations of JADE with clinical (Hemophilia Joint Health Score, [HJHS]) and functional (total arc [combined flexion and extension range of motion [ROM]]) parameters.

Methodology

In this multi‐centre prospective study, we recruited PWH A or B with at least one arthropathic joint. We evaluated joint health (both elbows, knees, and ankles) by comparing JADE measurements (soft tissue and cartilage thickness, and osteochondral alterations) with HJHS and total arc.

Results

Of 44 PWH, most had hemophilia A (35/44), were severe (36/44) and had a median age of 36 years. Increasing HJHSs and declining total arc, indicating worsening arthropathy, were associated with JADE measurements in the expected direction, including (1) increasing length of osteochondral alterations, (2) diminished cartilage thickness, and (3) greater soft tissue expansion. The ankles had the highest proportion of joints without measurable (missing) cartilage. In multivariable models MSKUS measurements explained 68% and 71% of the variation in HJHS and total arc respectively for the elbow, 55% and 29% respectively for the knee, and 50% and 73% for the ankle.

Conclusions

This study highlights the associations of direct intra‐articular ultrasonography measurements using the JADE protocol with clinical and functional parameters. Our findings underscore the clinical value of POC MSKUS using the JADE protocol as a complementary instrument for the diagnosis and management of haemophilic arthropathy.

Modular reorganization of gait in chronic but not in artificial knee joint constraint

It is currently unknown if modular reorganization does occur if not the central nervous system, but the musculoskeletal system is affected. The aims of this study were to investigate 1) the effects of an artificial knee joint constraint on the modular organization of gait in healthy subjects; and 2) the differences in modular organization between healthy subjects with an artificial knee joint constraint and people with a similar but chronic knee joint constraint. Eleven healthy subjects and eight people with a chronic knee joint constraint walked overground at 1 m/s. The healthy subjects also walked with a constraint limiting knee joint movement to 20°. The total variance accounted (tVAF) for one to four synergies and modular organization were assessed using surface electromyography from 11 leg muscles. The distribution of number of synergies were not significantly different between groups. The tVAF and the motor modules were not significantly affected by the artificial knee constraint. A higher tVAF for one and two synergies, as well as merging of motor modules were observed in the chronic knee constraint group. We conclude that in the short-term a knee constraint does not affect the modular organization of gait, but in the long-term a knee constraint results in modular reorganization. These results indicate that merging of motor modules may also occur when changes in the mechanics of the musculoskeletal system is the primary cause of the motor impairment.NEW & NOTEWORTHY It is currently unknown if modular reorganization does occur if not the central nervous system, but the musculoskeletal system is affected. This study showed that in the short-term a knee constraint does not affect the modular organization of gait, but in the long-term a knee constraint results in modular reorganization. These results indicate that modular reorganization may also occur when changes in the mechanics of the musculoskeletal system is the primary cause of the motor impairment.

Effects of performing dual tasks on postural sway and postural control complexity in people with haemophilic arthropathy

INTRODUCTION

People with haemophilic arthropathy (PWHA) have impairments in postural control. However, little is known about the effects of demanding conditions, including the unipedal stance and dual tasks, on postural control in PWHA.

AIM

Determine the effects of performing dual tasks while in the one-leg stance on postural sway and postural control complexity in PWHA vs. healthy active (HAG) and non-active (HNAG) groups of individuals.

METHODS

Fifteen PWHA and 34 healthy subjects (18 active and 16 non-active) were recruited. Vertical (V), mediolateral (ML) and anteroposterior (AP) centre of mass signals were acquired using a 3-axis accelerometer placed at the L3/L4 vertebrae of subjects as they performed the one-leg stance under single and dual-task conditions. Sway balance and the complexity of postural control were studied via root mean square (RMS) acceleration and sample entropy, respectively. Increased complexity of postural sway was attributed to increased automatism of postural control.

RESULTS

RMS values for PWHA were higher than HAG under both conditions for the V and ML axes, and higher than HNAG under the dual-task condition for the ML axis. Sample entropy was lower in PWHA than healthy individuals under the dual-task condition for V and ML axes, and the single-task condition for the ML axis (P < .05).

CONCLUSION

PWHA had poorer postural sway and decreased postural control complexity when performing a one-leg stance than healthy people, especially when the dual-task condition was applied. These results may help to design new approaches to assess and improve postural control in PWHA.