Knee Buckling Research Articles

Quadriceps muscle activity during walking with a knee ankle foot orthosis is associated with improved gait ability in acute hemiplegic stroke patients with severe gait disturbance.

A knee-ankle-foot orthosis (KAFO) prevents knee buckling during walking and enables gait training for acute hemiplegic stroke patients with severe gait disturbances. Although the goal of gait training with a KAFO is to improve gait ability, that is, to acquire walking with an ankle-foot orthosis (AFO), it is not clear how gait training with a KAFO contributes to improving gait ability. Therefore, this study aimed to investigate the relationship between muscle activities during walking with a KAFO and the improvement of gait ability in hemiplegic stroke patients with severe gait disturbance. A prospective cohort study was conducted. Fifty acute hemiplegic stroke patients who could not walk with an AFO participated. Muscle activities of the paretic rectus femoris, biceps femoris, tibialis anterior, and soleus were assessed with surface electromyogram during walking with a KAFO. Electromyograms were assessed at the beginning of gait training and at the time the Ambulation Independence Measure score improved by 3 or higher, or discharge. Even in patients with complete hemiplegia, paretic rectus femoris, biceps femoris, and soleus showed periodic muscle activity during walking with a KAFO. Twenty-three patients improved to an Ambulation Independence Measure score of 3 or higher and were able to walk with an AFO (good recovery group). At the beginning of gait training, paretic rectus femoris muscle activity during the first double-limb support phase was significantly higher in the good recovery group than in the poor recovery group. The rectus femoris muscle activity significantly increased from before to after acute rehabilitation, which consisted mainly of gait training with a KAFO. For acute hemiplegic stroke patients with severe disturbance, the induction and enhancement of paretic quadriceps muscle activity during walking with a KAFO play an important role in acquiring walking with an AFO.

Factors Mediating or Moderating the Effects of Obesity on Walking: Targeting Areas for Rehabilitation

Increased physical activity, such as walking, is often prescribed to address obesity. Several factors that may influence the connection between obesity and walking include the biomechanics of gait, pain, depressive symptoms, physical health, and activity. The objective of this study was to assess the moderation and mediation effects of knee pain and buckling, depressive symptoms, physical activity, and physical health on spatiotemporal gait parameters in individuals with obesity. Forty participants with obesity performed a task in which they walked on flat ground and crossed an obstacle. Measures of knee pain and buckling, depressive symptoms, physical activity, and physical health were collected. We conducted mediation analyses with knee buckling and pain as mediators of the effect of the BMI on spatiotemporal gait parameters. Moderation analyses were performed with depressive symptoms, physical activity, and physical health as moderators of the effect of BMI on spatiotemporal gait parameters. We found that depressive symptoms and physical health moderated the relationship between BMI and Step Width in people with obesity. These effects were pronounced when participants crossed an obstacle. In conclusion, depressed mood and physical health influence the relationship between obesity and walking. These factors present potential avenues for rehabilitation interventions to aid individuals with obesity.

Priming locomotor training with transspinal stimulation in people with spinal cord injury: study protocol of a randomized clinical trial

BackgroundThe seemingly simple tasks of standing and walking require continuous integration of complex spinal reflex circuits between descending motor commands and ascending sensory inputs. Spinal cord injury greatly impairs standing and walking ability, but both improve with locomotor training. However, even after multiple locomotor training sessions, abnormal muscle activity and coordination persist. Thus, locomotor training alone cannot fully optimize the neuronal plasticity required to strengthen the synapses connecting the brain, spinal cord, and local circuits and potentiate neuronal activity based on need. Transcutaneous spinal cord (transspinal) stimulation alters motoneuron excitability over multiple segments by bringing motoneurons closer to threshold, a prerequisite for effectively promoting spinal locomotor network neuromodulation and strengthening neural connectivity of the injured human spinal cord. Importantly, whether concurrent treatment with transspinal stimulation and locomotor training maximizes motor recovery after spinal cord injury is unknown.MethodsForty-five individuals with chronic spinal cord injury are receiving 40 sessions of robotic gait training primed with 30 Hz transspinal stimulation at the Thoracic 10 vertebral level. Participants are randomized to receive 30 min of active or sham transspinal stimulation during standing or active transspinal stimulation while supine followed by 30 min of robotic gait training. Over the course of locomotor training, the body weight support, treadmill speed, and leg guidance force are adjusted as needed for each participant based on absence of knee buckling during the stance phase and toe dragging during the swing phase. At baseline and after completion of all therapeutic sessions, neurophysiological recordings registering corticospinal and spinal neural excitability changes along with clinical assessment measures of standing and walking, and autonomic function via questionnaires regarding bowel, bladder, and sexual function are taken.DiscussionThe results of this mechanistic randomized clinical trial will demonstrate that tonic transspinal stimulation strengthens corticomotoneuronal connectivity and dynamic neuromodulation through posture-dependent corticospinal and spinal neuroplasticity. We anticipate that this mechanistic clinical trial will greatly impact clinical practice because, in real-world clinical settings, noninvasive transspinal stimulation can be more easily and widely implemented than invasive epidural stimulation. Additionally, by applying multiple interventions to accelerate motor recovery, we are employing a treatment regimen that reflects a true clinical approach.Trial registrationClinicalTrials.gov NCT04807764. Registered on March 19, 2021.

Brain and spinal cord paired stimulation coupled with locomotor training facilitates motor output in human spinal cord injury.

Combined interventions for neuromodulation leading to neurorecovery have gained great attention by researchers to resemble clinical rehabilitation approaches. In this randomized clinical trial, we established changes in the net output of motoneurons innervating multiple leg muscles during stepping when transcranial magnetic stimulation (TMS) of the primary motor cortex was paired with transcutaneous spinal (transspinal) stimulation over the thoracolumbar region during locomotor training. TMS was delivered before (TMS-transspinal) or after (transspinal-TMS) transspinal stimulation during the stance phase of the less impaired leg. Ten individuals with chronic incomplete or complete SCI received at least 20 sessions of training. Each session consisted of 240 paired stimuli delivered over 10-min blocks for 1 h during robotic assisted step training on a motorized treadmill. Body weight support, leg guidance force and treadmill speed were adjusted based on each subject's ability to step without knee buckling or toe dragging. Most transspinal evoked potentials (TEPs) recorded before and after each intervention from ankle and knee muscles during assisted stepping were modulated in a phase-dependent pattern. Transspinal-TMS and locomotor training affected motor neuron output of knee and ankle muscles with ankle TEPs to be modulated in a phase-dependent manner. TMS-transspinal and locomotor training increased motor neuron output for knee but not for ankle muscles. Our results support that targeted brain and spinal cord stimulation alters responsiveness of neurons over multiple spinal segments in people with chronic SCI. Noninvasive stimulation of the brain and spinal cord along with locomotor training is a novel neuromodulation method that can become a promising modality for rehabilitation in humans after SCI.

Brain and spinal cord paired stimulation coupled with locomotor training affects polysynaptic flexion reflex circuits in human spinal cord injury.

Neurorecovery from locomotor training is well established in human spinal cord injury (SCI). However, neurorecovery resulting from combined interventions has not been widely studied. In this randomized clinical trial, we established the tibialis anterior (TA) flexion reflex modulation pattern when transcranial magnetic stimulation (TMS) of the primary motor cortex was paired with transcutaneous spinal cord (transspinal) stimulation over the thoracolumbar region during assisted step training. Single pulses of TMS were delivered either before (TMS-transspinal) or after (transspinal-TMS) transspinal stimulation during the stance phase of the less impaired leg. Eight individuals with chronic incomplete or complete SCI received at least 20 sessions of paired stimulation during assisted step training. Each session consisted of 240 paired stimuli delivered over 10-min blocks for 1h during robotic-assisted step training with the Lokomat6 Pro®. Body weight support, leg guidance force and treadmill speed were adjusted based on each participant's ability to step without knee buckling or toe dragging. Both the early and late TA flexion reflex remained unaltered after TMS-transspinal and locomotor training. In contrast, the early and late TA flexion reflexes were significantly depressed during stepping after transspinal-TMS and locomotor training. Reflex changes occurred at similar slopes and intercepts before and after training. Our findings support that targeted brain and spinal cord stimulation coupled with locomotor training reorganizes the function of flexion reflex pathways, which are a part of locomotor networks, in humans with varying levels of sensorimotor function after SCI.Trial registration number NCT04624607; Registered on November 12, 2020.

Development of a Length-Actuated Lower Limb Prosthesis: Functional Prototype and Pilot Study

ABSTRACT Introduction The functional goal for unilateral transfemoral prosthesis users during ambulation is to restore the proper biomechanics and minimize the compensatory actions caused by limb asymmetries. These goals can often lead to embedded design elements that assume the prosthetic limb to look and move like the intact limb. An unconventional artificial limb design can transfer the focus from mimicking the skeletal structure to producing functional symmetry between limbs. In this pilot study, we introduce a length-actuated prosthesis design with the goal of functional biomimicry and collect qualitative feedback from two prosthesis users. Materials and Methods The length-actuated apparatus is attached to the distal end of a transfemoral prosthetic socket and consists of an external motor and a cam and Bowden cable system for powering and dynamically adjusting the prosthesis' length in synchronization with the gait cycle. Two transfemoral prosthesis users ambulated on a treadmill with the length-actuated prosthesis and gave anecdotal feedback. Results The prosthesis was able to support the patient's full weight and adjust to the lengths needed during the gait cycle, including toe clearance. The overall response to the prosthesis and concept was positive; prosthesis users stated that the prosthesis and the action of the knee seemed “comfortable,” and physicians concluded a sufficient and confident ambulation by the prosthesis users. The next iteration will address specific concerns of the prosthesis users by incorporating a more compact electromechanical system with sensors. This will aid in matching and continuously adjusting the prosthesis' length change timing with the cadence of the user's ambulation. Conclusions Overall, the prototype and study proved that linear motion could replace the leg shortening functions of lower-joint rotations, with anecdotal improvements in kinematics and comfort. Future work will consist of a quantitative evaluation of center of gravity displacement, ground reaction forces, toe clearance distance, and the possibilities of knee buckling. Clinical Relevance There are no commercially available lower-limb prostheses that control leg length with dynamic linear motion rather than user flexion and extension of a knee joint. Possible benefits that may come from a length-actuated prosthesis include improved loading symmetry and balance, as well as decreased muscle activity.

Short-term pain trajectories in patients with knee osteoarthritis.

It is unknown if pain in knee osteoarthritis (KOA) follows distinct patterns over the short term. Therefore, the aim of this study was to identify whether persons with a previous history of KOA pain fluctuations have distinct trajectories of pain over 90days and to examine associations between baseline characteristics and pain trajectories. People with a previous history of KOA were selected from a web-based longitudinal study. Baseline variables were sex, age, being obese/overweight, years of KOA, knee injury, knee buckling, satisfactory Lubben Social Support Score, pain and stress scales, Intermittent Constant Osteoarthritis Pain Score (ICOAP), medication use, and physical activity. Participants completed a Knee Injury and Osteoarthritis Outcomes Score (KOOS) pain subscale (KOOS-p, rated 0=extreme to 100=no knee problems) at 10-day intervals for 90days. Short-term KOOS-p trajectories were identified using latent growth mixture modeling and the baseline risk factors for these pain trajectories were examined. Participants (n=313) had a mean age of 62.2 (SD ± 8.1) years and and a body mass index of 29.8 (SD ± 6.6) kg/m2 . The three-class latent growth mixture modeling quadratic model with best fit indices was chosen (based on lowest sample-size-adjusted Bayesian Information Criterion, high probability of belonging, interpretability). Three distinct pain trajectory clusters (over 90days) were identified: low-moderate pain at baseline with large improvement (n=11), minimal change in pain over 90days (n=248), and moderate-high pain with worsening (n=46). Higher ICOAP (intermittent scale), perceived stress, negative affect score, and knee buckling at baseline were associated with a worse knee pain trajectory (P<0.05). Persons with KOA showed unique short-term pain trajectories over 90days, with distinct characteristics at baseline associated with each trajectory.

Biomechanical Measures for Fall Risk Assessment and Fall Detection in People with Transfemoral Amputations for the Next-Generation Prostheses: A Scoping Review

ABSTRACT Introduction Transfemoral amputations are known to compromise balance control capabilities, thus increasing the probability of falling. Current research in robotic prostheses is exploring novel strategies to assess the risk of fall and, if required, enable assistive strategies to promote balance recovery. Objectives The aim of this study was to identify a set of biomechanical variables associated with fall risk and fall detection in people with transfemoral amputation (pwTFA), which can be potentially assessed through the next generation of sensorized powered prostheses. Study Design The study design was scoping review. Methods Screening of the literature (CINAHL, PubMed, Scopus, and Web of Science) carried out in February 2020 (quality assessment of retained articles through Downs and Black checklist; retrieved information: measurement tests and biomechanical variables). Results From the initial 595 documents, only 25 citations met eligibility criteria. The pwTFA's fall risk assessment and fall detection are usually carried out by using different measurement tests. Conclusions Two classes of biomechanical markers for fall risk assessment have the potential to be incorporated in self-contained transfemoral powered prostheses equipped with sensory network and suitable computational capabilities. The first consists of kinematic/kinetic variables of some prosthesis components (e.g., foot acceleration, force loading the pylon, knee angle) to detect either an abrupt lack of balance or a fall-related occurrence as a consequence of knee buckling, slipping, or tripping. The second involves implementing automatic procedures to allow pwTFA to routinely carry out clinical tests, such as the timed up and go test and/or the Four Square Step Test to monitor the decline of sensory motor capabilities, likely documenting an increased fall risk. Clinical Relevance The next generation of powered prostheses could both monitor decline on neuromuscular capabilities and gather early signs of an acute lack of balance based on a suitable network of sensors on board. This approach is expected to prevent the fall risk in pwTFA.

Functional gait disorders: Demographic and clinical correlations

ObjectiveWe aimed to describe the prevalence and clinical-demographical features of patients with functional gait disorders (FGDs) and to compare them to patients with functional motor disorders (FMDs) without FGDs (No-FGDs). MethodsIn this multicenter observational study, we enrolled patients with a clinically definite diagnosis of FMDs in 25 tertiary movement disorders centers in Italy. Each subject with FMDs underwent a comprehensive clinical assessment, including screening for different subtypes of functional gait disorders. Multivariate regression models were implemented in order to estimate the adjusted odds ratio (OR; 95% confidence interval) of having FGDs in relation to sociodemographic and clinical characteristics. ResultsOut of 410 FMDs, 26.6% (n = 109) of patients exhibited FGDs. The most frequent FGDs were slow gait (n = 43, 39.4%), astasia-abasia (n = 26, 23.8%), and knee buckling (n = 24, 22%). They exhibited single FGDs in 51.4% (n = 56) or complex FGDs (more than one type of FGDs) in 48.6% (n = 53) of cases. On multivariate regression analysis, the presence of FGDs was more likely associated with older age (OR 1.03, 95% CI 1.01–1.04), functional visual symptoms (OR 2.19, 95% CI 1.08–4.45), and the diagnosis of somatic symptoms disorder (OR 2.97, 95% CI 1.08–8.17). FGDs were also more likely to undergo physiotherapy (OR 1.81, 95% CI 1.08–3.03). ConclusionsPeople with FMDs may present with different and overlapping types of FGDs, which may occur in older age. The association of FGDs with functional visual symptoms and somatic symptoms disorder opens up to new avenues to the understanding of the neural mechanisms of these disorders.

Knee extension moment arm variations relate to mechanical function in walking and running.

The patellofemoral joint plays a crucial mechanical role during walking and running. It increases the knee extensor mechanism's moment arm and reduces the knee extension muscle forces required to generate the extension moment that supports body weight, prevents knee buckling and propels the centre of mass. However, the mechanical implications of moment arm variation caused by patellofemoral and tibiofemoral motion remain unclear. We used a data-driven musculoskeletal model with a 12-degree-of-freedom knee to simulate the knee extension moment arm during walking and running. Using a geometric method to calculate the moment arm, we found smaller moment arms during running than during walking in the swing phase. Overall, knee flexion causes differences between running and walking moment arms as increased flexion causes a posterior shift in the tibiofemoral rotation axis and patella articulation with the distal femur. Moment arms were also affected by knee motion direction and best predicted by separating by direction instead of across the entire gait cycle. Furthermore, we found high inter-subject variation in the moment arm that was largely explained by out-of-plane motion. Our results are consistent with the concept that shorter moment arms increase the effective mechanical advantage of the knee and may contribute to increased running velocity.

Knee Injury - Motorcycling

HISTORY: A 29-year-old male presented to our sports medicine clinic with right knee pain. Three months ago, he had an accident during motorcycle racing in which he fell off the bike. He sustained multiple lacerations including a large laceration on the right knee that was managed nonoperatively. He developed pain and numbness over the anterolateral aspect of the right knee interfering with mobility. He also reported mild right knee weakness and frequent knee buckling. PHYSICAL EXAMINATION: Examination revealed healed laceration with significant scar tissue growth over the anterolateral aspect of the distal third of right thigh. There was moderate tenderness to palpation along borders of the scar, quadriceps tendon, and lateral femoral condyle. Neurologic exam was intact with normal sensation, reflexes, and strength of bilateral lower extremities. There was full active range of motion of right knee but with discomfort at end range of flexion. There was midline tracking of patella throughout range of motion. DIFFERENTIAL DIAGNOSIS: 1. Hypertrophic/Keloid scar pain 2. Arthrofibrosis 3. Chronic patellar dislocation 4. Quadriceps and patellar tendinosis 5. Lateral femoral condyle contusion 6. Patella alta TEST AND RESULTS: Right knee anterior-posterior, lateral and patella radiographs: —there is no evidence of displaced fracture or dislocation.—the patellofemoral alignment is maintained. Right knee magnetic resonance imaging: —patterns of contusion and stress response involving the anterior and lateral aspects of the lateral femoral condyle and inferior pole of the patella, findings suspect for patellar dislocation with subsequent reduction.—medial and lateral collateral ligament scarring. Medial and lateral retinacular sprains.—patella alta with limited arthrosis.—quadriceps and patellar tendinosis. FINAL WORKING DIAGNOSIS: Hypertrophic/Keloid scar pain TREATMENT AND OUTCOMES: 1. Home exercises with quadriceps strengthening for 12-15 weeks, no improvement in pain or function. 2. Two courses of physical therapy with quadriceps and vastus medialis oblique strengthening, range of motion exercises, improvement in range of motion but limited improvement in pain. 3. Ultrasound-guided intralesional corticosteroid injection to the right knee, notable reduction in pain.

Triggers for acute flare in adults with, or at risk of, knee osteoarthritis: a web-based case-crossover study in community-dwelling adults

SummaryObjectiveTo identify proximate causes (‘triggers’) of flares in adults with, or at risk of, knee osteoarthritis (OA), estimate their course and consequences, and determine higher risk individuals.MethodsIn this 13-week web-based case-crossover study adults aged ≥40 years, with or without a recorded diagnosis of knee OA, and no inflammatory arthropathy who self-reported a knee flare completed a questionnaire capturing information on exposure to 21 putative activity-related, psychosocial and environmental triggers (hazard period, ≤72 h prior). Comparisons were made with identical exposure measurements at four 4-weekly scheduled time points (non-flare control period) using conditional logistic regression. Flare was defined as a sudden onset of worsening signs and symptoms, sustained for ≥24 h. Flare characteristics, course and consequence were analysed descriptively. Associations between flare frequency and baseline characteristics were estimated using Poisson regression.ResultsOf 744 recruited participants (mean age [SD] 62.1 [10.2] years; 61% female), 376 reported 568 flares (hazards) and provided 867 valid control period measurements. Thirteen exposures (eight activity-related, five psychosocial/environmental) were positively associated with flare onset within 24 h (strongest odds ratio estimate, knee buckling: 9.06: 95% confidence interval [CI] 5.86, 13.99; weakest, cold/damp weather: 1.45: 95%CI 1.12, 1.87). Median flare duration was 5 days (IQR 3, 8), less common if older (incident rate ratio [IRR] 0.98: 95%CI 0.97, 0.99), more common if female (IRR 1.85: 95%CI 1.43, 2.39).ConclusionsMultiple activity-related, psychosocial and environmental exposures are implicated in triggering flares. This evidence can help inform prevention and acute symptom management for patients and clinicians.

Is knee buckling, knee injury, squatting and kneeling associated with pain flares in knee osteoarthritis?

Purpose: Knee osteoarthritis pain episodes (flares) (KOAF) are disabling and negatively impact quality of life. It is postulated that knee injuries/insults predispose to KOAF. This study was carried out to identify whether the following knee related insults; knee buckling, knee injury, kneeling, squatting are associated with KOAF in a Sri Lankan cohort.

Can pain flares in knee osteoarthritis be predicted?

Objectives: This study examined whether risk factors for knee osteoarthritis (KOA) pain such as age, gender, body mass index (BMI), baseline pain, and other putative risk factors for knee osteoarthritis pain flares (KOAF) (e.g. knee buckling, injury, mood/stress/social support scores, and footwear) could predict KOAF. Method: People with KOA and previous history of KOAF were selected from a 3 month web-based longitudinal study. KOAF was defined as an increase of ≥ 2 points on a numeric rating scale (compared with background pain) which resolved within 20 days. Predictors assessed at baseline were gender, age, duration of KOA, BMI, pain, knee injury (7 days before), knee buckling (2 days before), Lubben Social Support, Knee Injury and Osteoarthritis Outcome Score, Intermittent and Constant Osteoarthritis Pain score (ICOAP), Positive/Negative Affect Score, and footwear stability/heel height. Outcome was occurrence of any KOAF during the ensuing 30 days. The combined ability of the above variables to predict occurrence of any KOAF was evaluated by multiple logistic regression with a 10-fold cross-validation method to build and internally validate the model. Variables that assessed similar domains were eliminated using receiver operating characteristics curve assessment for best fit. Results: Complete data were available for 313 people (66.6% female, mean ± sd age 62.3 ± 8.2 years, BMI 29.7 ± 6.5 kg/m2). Increasing age, years of osteoarthritis, BMI, background/worst levels of pain, knee injury, knee buckling, ICOAP, and footwear category/heel height significantly predicted the occurrence of KOAF during the following 30 days, with an area under the curve of 0.73 (95% confidence interval 0.67–0.80). Conclusion: A combination of risk factors assessed at baseline, including exposures with potential to vary, successfully predicts the KOAF in the ensuing 30 days.

Using a Simple Walking Model to Optimize Transfemoral Prostheses for Prosthetic Limb Stability—A Preliminary Study

The interaction between the prescribed prosthetic knee and foot is critical to the safety of transfemoral prosthesis users primarily during the stance phase of the gait, when knee buckling can result in a fall. Nonetheless, there is still a need for standardized approaches to quantify the effects of prosthetic component interactions and associated mechanical function on user gait biomechanics. A numerical model was defined to simulate sagittal plane prosthetic limb stance based on a single inverted pendulum and predict effects of prosthetic knee alignment and foot stiffness on knee moment to identify optimal solutions. Model validation against laboratory gait data suggests it is appropriate to preliminary simulate prosthetic gait during single-limb support, when prosthetic knee stability may be most at risk given reliance on the prosthetic limb and proximal anatomy, but only for knees with flexion smaller than 4°. Model predictions identify a solution space containing those combinations of knee alignment and foot stiffness (via roll-over shape radius) guaranteeing knee stability in early and mid- single-limb support, whilst facilitating knee break at the end of it. Specifically, a posterior to in-line knee alignment should be combined with low to medium ankle-foot stiffness, whereas anterior knee alignments and rigid feet should likely be avoided. Clinicians can use these solution spaces to optimize transfemoral prostheses including knees with little to no change in stance flexion, ensuring the safety of users. Model prediction can further inform in-vivo investigations on commercial device interactions, providing evidence for future Clinical Practice Guidelines on transfemoral prostheses design.

Annals for Educators - 20 October 2020

Annals for Educators - 20 October 2020

The effect of Total resistance exercise vs. aquatic training on self-reported knee instability, pain, and stiffness in women with knee osteoarthritis: a randomized controlled trial

BackgroundKnee Instability (KI) is described as a sense of knee buckling, shifting, or giving way during the weight bearing activities. High prevalence (60–80%) has been reported for KI amongst the patients with knee osteoarthritis (KOA). In this line, the present study targeted the effect of two interventions on self-reported KI and affected factors.MethodsIn this single blind, randomized, and controlled trial, 36 patients with radiographic grading (Kellgren–Lawrence ≥ II) of KOA were selected. Patients were divided into three groups namely, aquatic (n = 12), Total Resistance exercises (TRX) (n = 12) and control (n = 12) by random. Then both 8-week TRX and aquatic exercises were carried out by experimental groups. The following measure were taken before and after interventions: Pain by visual analog scale (VAS), balance by Berg Balance Scale (BBS), quadriceps strength by dynamometer, knee flexion range of motion (ROM) by inclinometer, knee stiffness with Western Ontario and McMaster Universities Osteoarthritis (WOMAC), and self-reported KI with Felson’s questionnaire.ResultsThe results demonstrated that KI, VAS, BBS improved over time both in TRX and aquatic groups significantly (p < 0.05), but WOMAC(stiffness), knee flexion ROM, and quadriceps strength were significantly improved over time only for TRX (p < 0.05). Post hoc test, also, showed that there were significant differences between interventions and control groups (p < 0.05) for the VAS, KI, BBS, but for WOMAC(stiffness), a significant difference was observed only between TRX and control groups (p = 0.05).ConclusionsAlthough TRX and aquatic interventions had a similar effect on the patients’ balance, pain and KI, TRX had more effect on WOMAC(stiffness), quadriceps strength, and knee flexion ROM than aquatic exercises.Trial registrationThis study was registered in the Iranian Clinical Trial Center with the number IRCT20181222042070N1, http://www.irct.ir/trial/36221, registered 02 February 2019.

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.

Factors associated with a risk of prosthetic knee buckling during walking in unilateral transfemoral amputees

BackgroundWalking and mobility are essential for a satisfactory quality of life. However, individuals with transfemoral amputations have difficulties in preventing falls due to prosthetic knee buckling, defined as the sudden loss of postural support during weight-bearing activities. The risk of prosthetic knee buckling can be evaluated by determining the prosthetic knee angular impulse (PKAI) during the early stance phase. However, little is known about the factors associated with PKAI in individuals with unilateral transfemoral amputations. Research questionWhat are the demographic factors that can be associated with the risk of prosthetic knee buckling, quantified by PKAI, during walking in individuals with unilateral transfemoral amputations? MethodsThirteen individuals with unilateral transfemoral amputations were instructed to perform level walking at a comfortable, self-selected speed on a straight, 10-m walkway. PKAI was calculated as the time integral of the prosthetic knee external flexion–extension moment during the initial 40 % of the prosthetic gait cycle. We used Pearson’s correlation coefficients to examine the relationship of PKAI with the following variables: the subject’s body height, body mass, and age; the time since amputation; and the current prosthesis use history. Furthermore, an independentt-test was used to compare PKAI according to the sex (male vs. female) and etiology (trauma vs. nontrauma). ResultsPKAI exhibited a significant negative linear relationship with the subject’s body height and body mass. However, it showed no significant correlation with age, the time since amputation, and the current prosthesis use history. It was also significantly greater in women than in men and was not significantly influenced by the etiology. SignificanceAwareness about demographic factors associated with PKAI during walking can contribute to fall assessments in gait rehabilitation programs for individuals with unilateral transfemoral amputations.

Functional gait disorders, clinical phenomenology, and classification.

Functional gait disorders (FGDs) are relatively common in patients presenting for evaluation of a functional movement disorder (FMD). The diagnosis and classification of FGDs is complex because patients may have a primary FGD or a FMD interfering with gait. We performed a detailed evaluation of clinical information and video recordings of gait in patients diagnosed with FMDs. We studied a total of 153 patients with FMDs, 68% females, with a mean age at onset of 36.4years. A primary FGD was observed in 39.2% of patients; among these patients, 13 (8.5%) had an isolated FGD (a gait disorder without other FMDs). FMDs presented in 34% of patients with otherwise normal gait. Tremor was the most common FMD appearing during gait, but dystonia was the most common FMD interfering with gait. Patients with FGD had a higher frequency of slow-hesitant gait, astasia-abasia, bouncing, wide-based gait and scissoring compared with patients with FMDs occurring during gait. Bouncing gait with knee buckling was more frequently observed in patients with isolated FGD (P = 0.017). Patients with FGDs had a trend for higher frequency of wheelchair dependency (P = 0.073) than those with FMDs interfering with gait. Abnormal gait may be observed as a primary FGD or in patients with other FMDs appearing during gait; both conditions are common and may cause disability.