Compensatory Gait Research Articles

Coactivation pattern in leg muscles during treadmill walking in patients suffering from intermittent claudication

BackgroundIn patients with peripheral arterial disease and presenting intermittent claudication (PAD-IC), the pain due to ischemia impacts gait parameters, particularly in cases of unilateral disease. Deterioration of gait parameters in a pathological context is frequently associated with increased coactivation (simultaneous activation of agonist and antagonist muscles around a joint). Research questionDoes unilateral PAD-IC affect the coactivation pattern during walking? Does the coactivation pattern change with increasing pain intensity? MethodWe evaluated symptomatic and asymptomatic legs in 17 subjects with unilateral PAD-IC and 16 without PAD-IC (control group), during walking. Tibialis anterior (TA) and gastrocnemius medialis (GM) electromyographic activity, and peaks of vertical ground reaction force were recorded in this prospective study. We analyzed the coactivation index (CI(GM/TA)) during three periods (pain-free, pain and maximum pain) and phases of the gait cycle. Statistical analysis was carried out using the ANOVA procedure. ResultsDuring single support, CI(GM/TA) increases in the symptomatic leg during the pain period (+28 %) and in the asymptomatic leg during the maximum pain period (+29 %). During second double support, CI(GM/TA) increases in the symptomatic leg only (+49 %). In these gait phases, pain elicits differences in CI(GM/TA) between legs (p < 0.05). Second peak force decreases in the symptomatic leg only (−9%) and is negatively correlated with CI(GM/TA) during the three periods (r = −0.57; −0.76 and −0.78 respectively, p < 0.05). No difference is found in the control group. SignificanceThe appearance and development of pain in the lower limbs is associated with a higher level of CI(GM/TA), revealing a compensatory gait pattern in PAD-IC patients. Optimal prevention, rehabilitation and re-training strategies for PAD-IC patients should take into consideration neuromuscular compensatory mechanisms between asymptomatic and symptomatic legs.

Spatiotemporal Alterations in Gait in Humanized Transgenic Sickle Mice.

Sickle cell disease (SCD) is a hemoglobinopathy affecting multiple organs and featuring acute and chronic pain. Purkinje cell damage and hyperalgesia have been demonstrated in transgenic sickle mice. Purkinje cells are associated with movement and neural function which may influence pain. We hypothesized that Purkinje cell damage and/or chronic pain burden provoke compensatory gait changes in sickle mice. We found that Purkinje cells undergoe increased apoptosis as shown by caspase-3 activation. Using an automated gait measurement system, MouseWalker, we characterized spatiotemporal gait characteristics of humanized transgenic BERK sickle mice in comparison to control mice. Sickle mice showed alteration in stance instability and dynamic gait parameters (walking speed, stance duration, swing duration and specific swing indices). Differences in stance instability may reflect motor dysfunction due to damaged Purkinje cells. Alterations in diagonal and all stance indices indicative of hesitation during walking may originate from motor dysfunction and/or arise from fear and/or anticipation of movement-evoked pain. We also demonstrate that stance duration, diagonal swing indices and all stance indices correlate with both mechanical and deep tissue hyperalgesia, while stance instability correlates with only deep tissue hyperalgesia. Therefore, objective analysis of gait in SCD may provide insights into neurological impairment and pain states.

Preoperative gait compensation patterns in unilateral hip osteoarthritis patients: Do they persist one year postoperatively?

This study tested the hypothesis that men and women have different preoperative and postoperative gait impairment relative to sex-matched healthy controls, and that the extent of gait improvement after total hip arthroplasty (THA) is different between men and women. A group of 124 THA subjects was identified from a motion analysis data repository; age and BMI-matched male and female control groups were then identified from the same repository. Dynamic sagittal plane hip range of motion (HROM) and peak 3D external moments at subjects’ normal walking speeds were analyzed. Each hypotheses was tested using linear regression models, to adjust for potential confounding effects of walking speed. Preoperatively, the THA vs. control group differences in the HROM and peak adduction moments were larger in women than they were in men (p=0.007). The THA group vs. control group difference in the peak external rotation moment was larger in men (p=0.004). After surgery, HROM increased more in women than in men (p=0.020). However, peak adduction moment decreased in men but increased in women (−0.11±0.93 vs. 0.28±1.3%BWH, p=0.045). Accordingly, postoperatively the THA group vs. control group differences in the peak external rotation moment remained larger in men than in women (p=0.016). There were no other sex-specific differences (p=0.072–0.876). This study suggests that men and women have slightly different patterns of gait recovery after THA and may benefit from sex-specific rehabilitation strategies. These differences also underscore the importance of accounting for sex in biomechanical studies.

How Do Concussions Affect National Basketball Association Player Performance Measurements?

Following a concussion, athletes typically display increased reaction time, compensatory gait mechanics, and altered postural control. Although commonly studied in collegiate athletics, there is a lack in the literature regarding post-concussive effects in the National Basketball Association (NBA), and how they affect player performance outcomes. PURPOSE: The purpose of this study was to determine if NBA player performance statistics were different 28 days post-concussion compared to their pre-concussion metrics. METHODS: NBA player performance statistics were obtained from a public website for thirty-six NBA players (age = 24.22±5.44 years, years in league = 4.08±3.38 years) who sustained a concussion between 2014 and 2018. Players were excluded if they played less than five games pre-injury, or if they did not return to play within four weeks post-concussion. Performance statistics included both attempted and made field goals, three-pointers, and free throws. Additional performance metrics included total points scored, turnovers, rebounds, gamescore and plus/minus scores. Within-subjects performance metrics were compared from 28-days prior to concussion to 28-days after the date of injury. All variables were normalized by seconds played per game to reduce variability between bench, rotational, and starting players. To compare differences in player performance measures before and after concussion, we utilized paired t-tests with alpha levels set to 0.05. RESULTS:Our analyses produced mostly nonsignificant mean differences between groups (p’s>0.05), however, we found a decrease in mean attempted free throws post-concussion (mean difference: -0.37±0.36 free throws, p=0.042). Although the remainder of the performance metrics did not yield significance, a majority of the variables indicated a negative trend post-concussion. CONCLUSIONS: Our results suggest player performance is not significantly affected up to 28-days post-concussion as compared to their pre-injury measures. Because we chose to compare 28-days before and after concussion, we potentially missed greater changes in player performance during the acute phase of recovery. Future analyses will stratify these findings by blocking time into seven day series to determine differences throughout typical recovery timelines.

Evaluating Immediate Benefits of Assisting Knee Extension With a Soft Inflatable Exosuit

Wearable robots such as powered exoskeletons and exosuits have been developed for gait assistance and rehabilitation. However, effects of knee extension assistance during the swing phase and initial stance of walking remains largely unknown. This work studies the changes in gait patterns for seven healthy participants and three impaired participants when knee extension in the swing and initial stance phases is assisted by a soft inflatable exosuit. The kinematics, surface electromyographic (sEMG) activity, and ground reaction forces (GRFs) for seven healthy participants during treadmill walking are recorded. Reductions in knee angle and sEMG activity of the quadriceps are observed. The knee angles, GRFs, spatiotemporal parameters, and compensatory gait patterns are studied for the three impaired participants for treadmill walking. Reductions in the knee angle, hip flexion, step length, and step time are observed. Compensatory gait patterns for the three participants varied for all participants. A timed up-and-go (TUG) test is also performed with the impaired participants during overground walking. A reduced TUG execution time is observed, indicating potential improvement in functional mobility. Overall, this work provides preliminary evidence on the benefits of a soft-exosuit in supporting healthy individuals and improving the rehabilitation of stroke survivors by assisting knee extension in the swing and initial stance phases.

Relationship of gait complexity to subsequent knee buckling and falls: the most study

Purpose: Stable gait relies on the flexibility and adaptability of the neuromuscular control system. A loss of physiological complexity is a characteristic of pathological conditions as well as decreased ability with senescence to adapt to daily stressors. Knee OA is often accompanied by compensatory gait patterns, such as repetition of a specific motion pattern indicating a loss of gait complexity and reduced adaptability. Prior studies show that reduced gait complexity is associated with falls in frail elders and people with neurodegenerative diseases, as well as with worsening physical function in persons with, or at increased risk for, knee OA.

Evidence a shared mechanism mediates ipsi- and contralesional compensatory saccades and gait after unilateral vestibular deafferentation

The study objective was to understand how the contralesional labyrinth contributes to gaze and gait stability after unilateral vestibular deafferentation (UVD). Head impulse testing (vHIT) was completed in 37 individuals [22 women (59%); age 52.13 ± 11.59 yr, mean ± SD] with UVD from vestibular schwannoma resection. Compensatory saccades (CS) and vestibulo-ocular reflex (VOR) gain were analyzed for both ipsilesional and contralesional impulses. Gait speed (10-m walk test) and endurance (2-min walk test) were collected for 35 individuals. CS were recruited during contralesional head rotation regardless of VOR gain on either the ipsilesional [ρ = 0.21 (-0.14, 0.57); Spearman rank (95% confidence interval)] or contralesional side [ρ = -0.04 (-0.42, 0.35)]. Additionally, the latency of these CS (151.19 ± 52.41 ms) was similar to that of CS generated during ipsilesional rotation (165.65 ± 21.62 ms; P = 0.159). CS recruited during ipsilesional vHIT were of a higher velocity (P < 0.001) and greater frequency (P < 0.001) compared with contralesional CS. VOR gain asymmetry was significantly correlated with gait speed [ρ = -0.37 (-0.73, -0.01)], yet individual VOR gain was not correlated [ipsilesional: ρ = 0.17 (-0.20, 0.55); contralesional: ρ = -0.18 (-0.52, 0.15)]. Our data reveal CS are recruited at similar latencies without correlation to VOR gain or direction of head rotation, and that the central integration of ipsilesional and contralesional vestibular afference correlates with gait. Together, our data suggest the brain considers vestibular afference from both sides when generating related behavioral output after UVD.NEW & NOTEWORTHY After unilateral vestibular deafferentation, compensatory saccades (CS) have similar latencies regardless of the direction of head rotation, and those CS generated during contralesional head rotation are unrelated to extent of vestibular loss. Additionally, the extent of asymmetry in residual vestibular function, not the extent of vestibular loss, correlates with gait speed. Our data suggest a common mechanism is responsible for the generation of CS and restoration of gait speed in vestibular compensation.

Lower Limb Joint Kinetics During Walking in Middle-Aged Runners With Low or High Lifetime Running Exposure.

Aging is associated with a distal-to-proximal shift in joint kinetics during walking. This plasticity of gait is amplified rather than attenuated in old adults with high physical capacity. Because running is associated with greater kinetic demands at the ankle, older individuals with more versus less lifetime running exposure may retain a larger proportion of their ankle kinetics. The purpose of the study was to compare lower-extremity joint kinetics during walking between middle-aged runners with high and low lifetime running exposure. Eighteen middle-aged runners (9 per group) participated. Joint kinetics were calculated from kinematic and ground reaction force data during overground walking at 1.3m·s-1 and compared between groups. High exposure runners produced 50% greater positive hip work (P = .03; Cohen d = 1.02) during walking compared with low exposure runners, but ankle kinetics were not different between groups. No other differences in joint kinetics or kinematics were observed between groups. These findings suggest that the age-related increase in hip joint kinetics during walking could be a compensatory gait strategy that is not attenuated by lifetime running exposure alone. Finally, the amount of lifetime running exposure did not affect ankle kinetics during walking in middle-aged runners.

Compensatory gait deviations in patients with increased outward tibial torsion pre and post tibial derotation osteotomy

BackgroundTibial torsion describes the rotation between the proximal and distal joint axis along the shaft, which can be, as rotational deformity, pathologically increased or decreased. Some patients might increase hip internal rotation during walking to compensate increased outward tibial torsion. Research questionThe aim of this study was to assess the effect of tibial derotation osteotomy on gait deviations in patients with increased outward tibial torsion. MethodsThirteen patients (13.5 ± 1.4 yrs, 22 limbs) with increased tibial torsion (CT confirmed 49.2 ± 4.8°) were analyzed pre and post tibial derotation osteotomy and compared with 17 typically developing children (TDC, 13.5 ± 2.3 yrs, 32 limbs). Kinematic and kinetic data were recorded. Subgroup analyses were performed whether patients showed compensatory hip internal rotation (Comp) or not (NoComp). Principal component (PC) analysis was used to achieve data transformation. A linear mixed model was used to estimate the main effect of PC-scores of retained PCs explaining 90% of the cumulative variance. ResultsCompensatory hip internal rotation (Comp, present in 45.5% of limbs analyzed) led to a lower external foot progression angle compared to patients without compensatory hip internal rotation (NoComp). In both patient groups foot progression angle was normalized after tibial derotation osteotomy. Post-operative NoComp had normalized frontal plane joint loadings, while Comp showed an increased hip and knee adduction moment. SignificanceFuture studies should investigate if more time is needed for Comp to normalize gait patterns post-operative or if a pre and post-operative gait training might help. Otherwise the increased knee adduction moment might be clinically relevant due to previous studies reporting a possible association with knee osteoarthritis.

Measuring Lower Extremity Rotational Alignment: A Review of Methods and Case Studies of Clinical Applications.

➣ Underdetection and undertreatment of transverse plane malalignment of the tibia and femur result from challenges with accuracy and reliability of both physical examination and imaging.➣ Excessive femoral and tibial torsion both impair joint moment generation, with potential adverse effects on joint health directly as well as indirectly as a result of gait compensation.➣ Static computed tomography measurements of rotational alignment are limited by variable reference axes, expense, radiation exposure, and inability to measure dynamic compensation, and to date they have not been applicable intraoperatively.➣ Kinematics derived from functional modeling in 3-dimensional (3D) gait analysis provide subject-specific data and can detect not only static but also functional alignment.➣ The use of 3D data generated by EOS radiography holds promise for assessing biplanar limb alignment.

Diabetic Gait Is Not Just Slow Gait: Gait Compensations in Diabetic Neuropathy.

Background Neuropathic complications from diabetes mellitus affect multiple nerve types and may manifest in gait. However, gait compensations are still poorly understood, as narrow analyses and lack of speed controls have contributed to conflicting or equivocal results. Purpose To evaluate gait mechanics and energetics in diabetic peripheral polyneuropathy. Methods Instrumented gait analysis was performed on 14 participants with diabetic peripheral polyneuropathy and 14 matched controls, walking at 1.0 m/s. A full-body model with a multisegment foot was used to calculate inverse dynamics and analyze sagittal plane metrics and time series waveforms across stance phase. Results Alterations included increased hip and knee flexion in early stance followed by a prolonged hip extension moment in midstance. Late stance ankle dorsiflexion and power absorption were increased, and final push-off was delayed and truncated. Conclusion A neuropathic diabetic gait shares important similarities to a mild crouch gait with weakness/dysfunction in the foot and ankle. This study highlights two main compensation mechanisms that have been overlooked in previous literature. First, increased triceps surae stretch in terminal stance may be used to increase proprioception and/or energy storage, while a prolonged hip extension moment in midstance compensates for a limited push-off. These result in an overall workload shift from distal to proximal joints. Clinical assessment, monitoring, and treatment of neuropathy may benefit by focusing on these specific functional alterations.

Compensatory sagittal plane ankle gait mechanics: Are they present in patients with a weak or stiff hip?

IntroductionSimulations suggest that subjects with reduced hip range of motion (ROM) and/or weakness can achieve more normal walking mechanics through compensations at the ankle. The aims of this study were to assess whether subjects with reduced hip ROM (Stiff hip) or hip flexor weakness (Weak hip) exhibit ankle compensations during walking and investigate redistribution of power in the lower extremity joints. MethodsRetrospective gait data were reviewed (IRB-approved hip registry). Preoperative kinematic/kinetic walking data were collected in patients with: adolescent hip dysplasia (AHD), femoral acetabular impingement (FAI), and Legg-Calvé Perthes disease (Perthes). AHD patients with significantly weak hip flexors on their affected side were included (Weak hip group). The Gait Profile Score (GPS) was calculated on the affected side of the FAI and Perthes groups to identify patients who had a Stiff hip. Patients who had undergone a hip arthrodesis (Fusion) were also included (Stiff hip group). Ankle kinematics/kinetics were compared to healthy participants (Control). The total positive work of sagittal plane hip, knee and ankle power were compared along with the distribution of power. ResultsPatients in the Weak/Stiff hip groups did not walk with greater ankle plantarflexion, peak push-off power or positive ankle work on their affected sides compared to Control. Ankle work contribution (percentage of total positive work) on the affected or unaffected sides was greater in the Perthes and Hip Fusion patients compared to Control. Significant gait abnormalities on the unaffected side were observed. ConclusionsPatients with a weak or stiff hip did exhibit altered ankle mechanics during walking. Greater percent ankle work contribution appeared to correspond with hip stiffness. In patients with hip pathology the redistribution of power among the lower extremity joints can highlight the importance of preserving ankle function.

Instantaneous Segmental Energy Symmetry Index as Gait Compensation Indicator in Asymmetrical Walking

Purpose: Human body constantly adapts to optimise the energy expenditure. A better understanding of the mechanical energetic costs in lower extremities helps identify the compensatory mechanism adopted in asymmetrical gait. This paper proposes the use of instantaneous segmental energy and normalised symmetry index (SInorm) to examine asymmetrical gait. This approach can provide better overview of gait quality allowing identification of change in segmental energy during different gait phases and contribution of each segment in compensating abnormal walking. Method: An experimental study was carried out to validate this method. Twenty healthy subjects were recruited. Asymmetrical gait was simulated by restricting knee motion during walking using a knee brace. Mechanical energy was determined for each segment of the left and right limbs. Normalised Symmetry Index (SInorm) was then calculated to examine bilateral differences in segmental energy during stance phase and swing phase. Statistical analysis using ANOVA and Tukey-Kramer multiple comparison test to identify asymmetry of the segmental energy (p-value < 0.05). Result: Significant asymmetry of segmental energy occurred during swing phase. Greater asymmetry was observed in kinetic energy than in potential energy. The affected limb segments produced lower kinetic energy than the normal limb. At asymmetrical state, potential energy of the affected limb’s foot and thigh were lower than that of the normal segments while the inverse was true for thigh segment. Conclusion: These results suggested that in asymmetrical gait, a form of compensatory mechanism is adopted to walk. This can be observed in the change of instantaneous segmental energy during walking.

High tibial osteotomy results in improved frontal plane knee moments, gait patterns and patient-reported outcomes

PurposeThe purpose of this study was to quantify changes in knee loading in the three clinical planes, compensatory gait adaptations and patient-reported outcome measures (PROMS) resulting from opening wedge high tibial osteotomy (HTO).MethodsGait analysis was performed on 18 participants (19 knees) with medial osteoarthritis (OA) and varus alignment pre- and post-HTO, along with 18 controls, to calculate temporal, kinematic and kinetic measures. Oxford Knee Score, Knee Outcome Survey and visual analogue pain scores were collected. Paired and independent sample tests identified changes following surgery and deviations from controls.ResultsHTO restored frontal and transverse plane knee joint loading to that of the control group, while reductions remained in the sagittal plane. Elevated frontal plane trunk sway (p = 0.031) and reduced gait speed (p = 0.042), adopted as compensatory gait changes pre-HTO, were corrected by the surgery. PROMs significantly improved (p ≤ 0.002). Centre of pressure (COP) was lateralised relative to the knee post-HTO (p < 0.001). Energy absorbed in the sagittal plane significantly increased post-HTO (p = 0.007), whilst work done in the transverse plane reduced (p ≤ 0.008). Pre-operative gait deviations from the control group that were retained post-HTO included smaller sagittal (p = 0.003) knee range of motion during gait, greater stance duration (p = 0.008) and altered COP location (anterior to the knee) in early stance (p = 0.025).ConclusionsHTO surgery restored frontal and transverse plane knee loading to normal levels and improved PROMs. Gait adaptations known to reduce knee loading employed pre-HTO were not retained post-HTO. Some gait features were found to differ between post-HTO subjects and controls.Level of evidenceII

Comparison of gait with and without ankle-foot orthoses after lower limb surgery in children with unilateral cerebral palsy.

PurposeChildren with spastic unilateral cerebral palsy (SUCP) frequently undergo lower limb surgery to improve gait. Postoperatively, ankle-foot orthoses (AFOs) are used to maintain the surgical corrections and provide adequate mechanical support. Our aim was to evaluate changes in gait and impacts of AFOs one-year postoperativelyMethodsIn all, 33 children with SUCP, 17 girls and 16 boys, mean age 9.2 years (5 to 16.5) were measured by 3D gait analysis walking barefoot preoperatively and walking barefoot and with AFOs one-year postoperatively. Changes in Gait Profile Scores (GPS), kinematic, kinetic and temporal spatial variables were examined using linear mixed models, with gender, gross motor function and AFO type as fixed effects.ResultsThe results confirm significant gait improvements in the GPS, kinematics and kinetics walking barefoot one year after surgery. Comparing AFOs with barefoot walking postoperatively, there was additionally reduced ankle plantarflexion by an average of 5.1° and knee flexion by 4.7° at initial contact, enhanced ankle moments during loading response, increased velocity, longer steps and inhibited push-off power generation. Stance and swing phase dorsiflexion increased in children walking with hinged AFOs versus children walking with ground reaction AFOs. Changes in the non-affected limbs indicated less compensatory gait postoperatively.ConclusionMajor changes were found between pre- and postoperative barefoot conditions. The main impact of AFOs was correction of residual drop foot and improved prepositioning for initial contact, which could be considered as indications for continued use after the one-year follow-up.Level of EvidenceLevel II - Therapeutic

Gait and electromyographic alterations due to early onset of injury and eventual rupture of the cranial cruciate ligament in dogs: A pilot study.

Identify relevant electromyography (EMG), kinematic, and kinetic changes resulting from monopolar radiofrequency energy (MRFE)-induced cranial cruciate ligament (CCL) injury and eventual rupture in dogs. Experimental, repeated measures. Five purpose-bred female dogs free of orthopedic and neurologic disease. Surface EMG, joint kinematics, and ground reaction forces were assessed at a trot in the pelvic limbs at baseline, at 2 and 4 weeks after unilateral MRFE-induced CCL injury, and at 4, 8, and 16 weeks after CCL rupture (CCLR). After MRFE-induced injury, average hip joint range of motion (ROM) during stance decreased within the untreated pelvic limb. After CCLR, stifle flexion angles decreased within the treated limb at 8 weeks and within the untreated pelvic limb at all time points, whereas average tarsal joint ROM decreased in the treated limb and increased in the untreated limb. Peak vertical ground reaction force and impulse decreased within the treated limb. Qualitative alterations of many EMG values were noted after MRFE-induced injury and CCLR, although significant differences between limbs or from baseline values were not detected. Monopolar radiofrequency energy-induced injury altered contralateral hip kinematics, suggesting early regional compensatory gait alterations. After CCLR, additional compensatory gait patterns occurred in both pelvic limbs. The qualitative analysis of trial-averaged EMG data in this small population supports a relationship between neuromuscular function and induced CCL injury leading to rupture.

Evaluasi Knee Ankle Foot Ortosis Dengan Parameter Spatiotemporal Dan Keseimbangan Pada Pengguna dengan Polio

The knee-ankle-foot orthosis (KAFO) tool is commonly described for patients with a history of poliomyelitis and serves to improve gait and prevent degeneration of the knee joint. However, at present the effect of using knee ankle foot orthosis in monoplegia polio patients when walking has never been evaluated. The purpose of this study was to analyze biomechanical adaptation especially in spatiotemporal parameters and stability when the subjects walked with and without KAFO aids. Methods: Fifteen monoplegia subjects with poliomyelitis were tested with two gait analyzes (i.e. with and without KAFO aids). Spatiotemporal parameters were tested using the 10 Meter Walk Test (10MWT) instrument, while stability when running was tested with the Timed up and Go (TUG) test instrument. Data from the spatiotemporal parameters obtained were analyzed using paired T tests, and the McNemar test was used to analyze the stability variables while walking. Both analyzes will analyze differences in parameters tested when subjects are in line with and without KAFO tools. Significant level used is p &lt;0.05. Results: The results showed that there were significant differences in spatiotemporal parameters and stability when subjects walked with and without KAFO aids. This tool increases spatiotemporal parameters and stability when the subject runs using KAFO compared to when they did not use orthosis at all. When the stance phase in the leg is paralysis, hyperextension in the knee and excessive flexion of the knee is reduced, while flexion in the hip joint increases. Walking stability increased in 60% of subjects when they used KAFO when walking. This study found that gait compensation was also reduced when subjects walked using KAFO, and through direct feedback the subject stated that walking using KAFO made them not easily tired and could go further.

Kinesiophobia, but not strength is associated with altered movement in women with patellofemoral pain

BackgroundEvidence indicates the presence of both kinesiophobia and knee extension strength deficits in women with patellofemoral pain (PFP). Both impairments may contribute to apparent compensatory gait patterns including reduced cadence and peak knee flexion during stair negotiation. Research questionIs kinesiophobia or knee extension strength associated with movement pattern in women with patellofemoral pain? MethodsForty women with PFP were assessed with three-dimensional kinematic analyses during stair descent; isokinetic dynamometry of the knee extensors (isometric, concentric and eccentric); and the Tampa scale for kinesiophobia. Pearson coefficients were calculated to determine relationship among variables. ResultsKinesiophobia correlated significantly with cadence (r = −0.62, p < 0.001), and peak knee flexion (r = −0.76, p < 0.001). No significant correlations were found between any knee extensor strength variables and kinematics (cadence or peak knee flexion); or kinesiophobia (p > 0.05). SignificanceFindings of this study could suggest addressing strength impairments alone may not adequately address kinesiophobia and movement pattern impairments in women with PFP. However, high-quality randomised controlled trials are needed to test this assumption. Further value may be added if currently evidence-based knee strengthening exercise is combined with education and/or graded exposure to address kinesiophobia, and consideration to gait retraining to address altered movement patterns at the knee.

THE IMPORTANCE OF ADDITIONAL MID SWING TOE CLEARANCE FOR AMPUTEES

Increased prosthetic hip to toe distance and insufficient mid swing toe clearance of a prosthetic foot is a well-recognized inadequacy for lower limb prosthesis users with wide and possible grave consequences on their ambulation capabilities. Most important are increased risk of falls and abnormal compensatory gait patterns with secondary unwanted physical effect like generally deceased mobility, muscular-skeletal pain and joint degeneration, i.e. osteoarthritis, with possible significant health economic effect. Even though insufficient toe clearance can be device related and technically or even intentionally induced for attaining equal length of the lower extremities in a neutral standing position or the stance phase, it is important to be aware of available technical solutions that can counteract the problem, like swing phase dorsiflexing feet, vacuum suspension systems, polycentric axis knees rather than single-axis knees and adequate knee flexion in early swing and swing-flexion assistance in the case of bionic knees.&#x0D; Article PDf Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/30813/23259&#x0D; How to cite: Lechler K, and Kristjansson K. The importance of additional mid swing toe clearance for amputees. Canadian Prosthetics &amp; Orthotics Journal. Volume1, Issue2, No.1, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.30813

Wearable technology reveals gait compensations, unstable walking patterns and fatigue in people with multiple sclerosis

Objective: People with multiple sclerosis (PwMS) often experience a decline in gait performance, which can compromise their independence and increase falls. Ankle joint contractures in PwMS are common and often result in compensatory gait patterns to accommodate reduced ankle range of motion (ROM). Approach: Using advances in wearable technology, the aim of this study was to quantify head and pelvis movement patterns that occur in PwMS with disability and determine how these secondary gait compensations impact on gait stability. Twelve healthy participants and 12 PwMS participated in the study. Head and pelvis movements were measured using two tri-axial accelerometers. Measures of gait compensation, mobility, variability, asymmetry, stability and fatigue were assessed during a 6 min walking test. Main results: Compared to healthy controls, PwMS had greater vertical asymmetry in their head and pelvic movements (Cohen’s d = 1.85 and 1.60). Lower harmonic ratios indicated that PwMS were more unstable than controls (Cohen’s d = −1.61 to −3.06), even after adjusting for their slower walking speeds. In the PwMS, increased compensatory movements were correlated with reduced ankle active ROM (r = −0.71), higher disability (EDSS) scores (r = 0.58), unstable gait (r = −0.76), reduced mobility (r = −0.76) and increased variability (r = 0.83). Significance: Wearable device technology provides an efficient and reliable way to screen for excessive compensatory movements often present in PwMS and provides clinically important information that impacts on mobility, stride time variability and gait stability. This information may help clinicians identify PwMS at high risk of falling and develop better rehabilitation interventions that, in addition to improving mobility, may help target the underlying causes of unstable gait.