Knee Flexion-extension Movements Research Articles

Exploring Human-Exoskeleton Interaction Dynamics: An In-Depth Analysis of Knee Flexion-Extension Performance across Varied Robot Assistance-Resistance Configurations.

Knee rehabilitation therapy after trauma or neuromotor diseases is fundamental to restore the joint functions as best as possible, exoskeleton robots being an important resource in this context, since they optimize therapy by applying tailored forces to assist or resist movements, contributing to improved patient outcomes and treatment efficiency. One of the points that must be taken into account when using robots in rehabilitation is their interaction with the patient, which must be safe for both and guarantee the effectiveness of the treatment. Therefore, the objective of this study was to assess the interaction between humans and an exoskeleton during the execution of knee flexion-extension movements under various configurations of robot assistance and resistance. The evaluation encompassed considerations of myoelectric activity, muscle recruitment, robot torque, and performed movement. To achieve this, an experimental protocol was implemented, involving an individual wearing the exoskeleton and executing knee flexion-extension motions while seated, with the robot configured in five distinct modes: passive (P), assistance on flexion (FA), assistance on extension (EA), assistance on flexion and extension (CA), and resistance on flexion and extension (CR). Results revealed distinctive patterns of movement and muscle recruitment for each mode, highlighting the complex interplay between human and robot; for example, the largest RMS tracking errors were for the EA mode (13.72 degrees) while the smallest for the CR mode (4.47 degrees), a non-obvious result; in addition, myoelectric activity was demonstrated to be greater for the completely assisted mode than without the robot (the maximum activation levels for the vastus medialis and vastus lateralis muscles were more than double those when the user had assistance from the robot). Tracking errors, muscle activations, and torque values varied across modes, emphasizing the need for careful consideration in configuring exoskeleton assistance and resistance to ensure effective and safe rehabilitation. Understanding these human-robot interactions is essential for developing precise rehabilitation programs, optimizing treatment effectiveness, and enhancing patient safety.

Evaluation of ankle mobility in crossfit practitioners with and without patellofemoral pain

One of the most common knee injuries related to CrossFit is patellofemoral dysfunction. This dysfunction is characterized by an ill-defined pain of insidious onset, located in the anterior retropatellar region and/or peripatellar knee. Its etiology is multifactorial and can lead to a change in patellar alignment or kinematics during knee flexion-extension movements. The aim of this study was to determine whether there is a difference in ankle range of motion in Closed Kinetic Chain in CrossFit practitioners with and without anterior knee pain. This is a quantitative; cross-sectional; observational; analytical and comparative study and was carried out in CrossFit boxes in a city in the southwest of Bahia with the following stages: (1) recruitment of participants, invitation and referral as accepted or not; (2) selection of participants; (3) data collection that was carried out with each research participant; (4) data analysis and systematization of results. The Lunge Test was used to assess participants aged between 18 and 50. From the data collected, it was not possible to state that ankle mobility deficit in dorsiflexion is a risk factor for the development of patellofemoral dysfunction.

Musculoskeletal multibody dynamics investigation for the different medial-lateral installation position of the femoral component in unicompartmental knee arthroplasty

The surgical installation accuracy of the components in unicompartmental knee arthroplasty (UKA) is an important factor affecting the joint function and the implant life. Taking the ratio of the medial-lateral position of the femoral component relative to the tibial insert (a/A) as a parameter, and considering nine installation conditions of the femoral component, this study established the musculoskeletal multibody dynamics models of UKA to simulate the patients' walking gait, and investigated the influences of the medial-lateral installation positions of the femoral component in UKA on the contact force, joint motion and ligament force of the knee joint. The results showed that, with the increase of a/A ratio, the medial contact force of the UKA implant was decreased and the lateral contact force of the cartilage was increased; the varus rotation, external rotation and posterior translation of the knee joint were increased; and the anterior cruciate ligament force, posterior cruciate ligament force and medial collateral ligament force were decreased. The medial-lateral installation positions of the femoral component in UKA had little effect on knee flexion-extension movement and lateral collateral ligament force. When the a/A ratio was less than or equalled to 0.375, the femoral component collided with the tibia. In order to prevent the overload on the medial implant and lateral cartilage, the excessive ligament force, and the collision between the femoral component and the tibia, it is suggested that the a/A ratio should be controlled within the range of 0.427-0.688 when the femoral component is installed in UKA. This study provides a reference for the accurate installation of the femoral component in UKA.

Preparatory knee flexion movement facilitates faster sideways jumping execution in male collegiate soccer goalkeepers

ABSTRACT Preparatory lower-limb loading conditions may affect the jump-to-reach performance of soccer goalkeepers. This study investigated the effect of pre-jump lower-limb loading/unloading during bilateral knee flexion–extension movements on sideways jump-to-reach performance in 18 male collegiate soccer goalkeepers. Participants performed the two-choice (high and low targets) reaction-time single-leg jump-to-reach task under two conditions: without preparatory movements (no-prep) and with continuous alternating knee extension and flexion movements (prep). The ‘go’ cue was provided with different preparatory loading conditions during the pre-jump knee extension and flexion phases. Performance was assessed using three-dimensional kinematic data and ground reaction forces. A significant main effect of the preparatory condition was observed for the jump take-off time. Pairwise comparisons revealed that the jump take-off time was 3.4–4.4% faster when initiated during the knee flexion phase than the no-prep condition and the extension phase (p ≤ .028). Increasing lower-limb loading and downward body movement with knee flexion appeared to facilitate effective loading to take-off to reach the high target and faster downward-directed take-off to reach the low target, respectively. Pre-jump knee flexion movement could be utilised by soccer goalkeepers to facilitate faster take-off to maximise their chances of saving shots within the reach of single-leg side-jumping.

Preparatory Knee Flexion-Extension Movements Enhance Rapid Sidestepping Performance in Collegiate Basketball Players.

Lower-limb weight-bearing load distribution in stationary standing influences the timing of rapid first step initiation of importance for functional movement activities and agility performance in sports. This study investigated the effect of pre-step lower-limb loading and unloading with preparatory knee flexion-extension movements on sidestepping performance in fifteen male collegiate basketball players. Participants performed two-choice (step limb) reaction time sidestepping under two conditions: without preparatory movements before the go cue (no-prep–NP) and with continuous alternating knee extension and flexion movements (prep–P). The reaction signal was provided at the beginning of knee extension and flexion and during these movements which corresponded with the largest and smallest loading instants and the transition states between those instants. Sidestepping performance was assessed with three-dimensional kinematic data and ground reaction forces. Step initiation onset time was significantly faster by 13–15% than the NP condition when initiated in the knee flexion phase (p ≤ 0.028, r ≥ 0.70), whereas step-limb unloading interval from step initiation to step lift-off was significantly faster by 12–15% in the knee extension phase (p ≤ 0.01, r ≥ 0.74). The preparatory movements significantly shortened step lift-off by 10–12% (p ≤ 0.013, r ≥ 0.73) and step duration by 17–21% (p < 0.001, r ≥ 0.85) with 19–22% faster step velocity (p < 0.001, r ≥ 0.84), which resulted in 14–15% shorter overall time to step landing (p < 0.001, r ≥ 0.84), irrespective of the loading phases. These results indicated that lower-limb loading with pre-step knee flexion facilitated faster step initiation, while lower-limb unloading with knee extension facilitated faster step-limb unloading, both resulting in faster step lift-off. Bilateral knee flexion-extension movements as a preparatory action could be utilized by invasion sports players to facilitate reactive stepping performance for more effective movement initiation.

Integration of High Velocity Elastic Band for Hamstring Training in Pre-Season Routine of Football Players

Background. A need for other methods of hamstring strengthening are thus warranted with the main aim of reducing the risk of injury during the subsequent intense athletic activities. The study aimed to examine changes in hamstring strength in response to high velocity elastic band training when incorporated into regular training routine of football players.&#x0D; Methods. Research participants were professional top level football players (age 23.1 ± 5.7 years; weight 77.2 ± 7.7 kg, training experience 14.1 ± 5.8 years). In the pre-season, in addition to their routine training, the experimental group performed hamstring curls at maximal intensity while lying prone three times per week for five weeks, while control group continued their routine training. Concentric knee torque at 60°/s and 180°/s angular velocities, countermovement jump height, 30m sprint running performance from standing and flying start, and knee flexion-extension movement frequency were measured before and after the 5 weeks of training.&#x0D; Results. Hamstring curl frequency during lying prone increase by 10.5 % (p &lt; .05) in the experimental group and did not change in the control group. Peak torque for knee flexion and knee extension, jump height and sprint running performance did not change significantly in any group (p &gt; .05).&#x0D; Conclusion. High velocity elastic band training incorporated into regular pre-season routine is beneficial for football players to increase their knee extension-flexion maximal movement frequency with no evident effects on strength, jump and sprint running performance. Results might be related with concurrent training during preparatory training phase of the pre-season when several physical capacities are being developed simultaneously.&#x0D; Keywords: high speed movements; peak torque; sprint performance; prevention of hamstring injuries; knee flexion strength.

VALIDITY OF AN MRI-COMPATIBLE MOTION CAPTURE SYSTEM FOR USE WITH LOWER EXTREMITY NEUROIMAGING PARADIGMS.

Emergent linkages between musculoskeletal injury and the nervous system have increased interest to evaluate brain activity during functional movements associated with injury risk. Functional magnetic resonance imaging (fMRI) is a sophisticated modality that can be used to study brain activity during functional sensorimotor control tasks. However, technical limitations have precluded the precise quantification of lower-extremity joint kinematics during active brain scanning. The purpose of this study was to determine the validity of a new, MRI-compatible motion tracking system relative to a traditional multi-camera 3D motion capture system for measuring lower extremity joint kinematics. Fifteen subjects (9 females, 6 males) performed knee flexion-extension and leg press movements against guided resistance while laying supine. Motion tracking data were collected simultaneously using the MRI-compatible and traditional multi-camera 3D motion systems. Participants' sagittal and frontal plane knee angles were calculated from data acquired by both multi-camera systems. Resultant range of angular movement in both measurement planes were compared between both systems. Instrument agreement was assessed using Bland-Altman plots and intraclass correlation coefficients (ICC). The system demonstrated excellent validity in the sagittal plane (ICCs>0.99) and good to excellent validity in the frontal plane (0.84 < ICCs < 0.92). Mean differences between corresponding range of angular movement measurements ranged from 0.186 ° to 0.295 °. The present data indicate that this new, MRI-compatible system is valid for measuring lower extremity movements when compared to the gold standard 3D motion analysis system. As there is growing interest regarding the neural substrates of lower extremity movement, particularly in relation to injury and pathology, this system can now be integrated into neuroimaging paradigms to investigate movement biomechanics and its relation to brain activity. 3.

Motor imagery training speeds up gait recovery and decreases the risk of falls in patients submitted to total knee arthroplasty

With Motor imagery (MI), movements are mentally rehearsed without overt actions; this procedure has been adopted in motor rehabilitation, primarily in brain-damaged patients. Here we rather tested the clinical potentials of MI in purely orthopaedic patients who, by definition, should maximally benefit of mental exercises because of their intact brain. To this end we studied the recovery of gait after total knee arthroplasty and evaluated whether MI combined with physiotherapy could speed up the recovery of gait and even limit the occurrence of future falls. We studied 48 patients at the beginning and by the end of the post-surgery residential rehabilitation program: half of them completed a specific MI training supported by computerized visual stimulation (experimental group); the other half performed a non-motoric cognitive training (control group). All patients also had standard physiotherapy. By the end of the rehabilitation, the experimental group showed a better recovery of gait and active knee flexion-extension movements, and less pain. The number of falls or near falls after surgery was significantly lower in the experimental group. These results show that MI can improve gait abilities and limit future falls in orthopaedic patients, without collateral risks and with limited costs.

Assessment of the thigh skin and fascia strains during knee flexion-extension: an ex-vivo study

Fascia is a fibrous connective tissue present all over the body. This study focuses on the deep fascia that is overlying muscles of the outer thigh. Indeed, fascia lata is involved in various pathologies, such as iliotibial band syndrome, inflammatory lesions, traumatic injuries etc. (Huang et al. 2013). This fascia has a sheathing effect on muscles and a stabiliser effect on the knee and hip joints during movements (Eng et al. 2014); however, these sheathing and stabiliser effects have not been quantified yet. Skin is connected to the muscle via fascia and adipose tissues. It also plays a role of sheath on underlying tissues. Thus, body movements cause the stretching of all these tissues. To unserstand what are the involed mechanical phenomena in these tissues and how they interact, the objective of this study is to look at superfical strain fields of the skin and deep fascia of the thigh during knee flexion extension movements.

Accent Stabilizes 1:2 Sensorimotor Synchronization of Rhythmic Knee Flexion-Extension Movement in Upright Stance.

Numerous studies have shown the importance of metrical structure on beat perception and sensorimotor synchronization (SMS), which indicates why metrical structure has evolved as a widespread musical element. In the current study, we aimed to investigate the effect of metrical structure with or without accented sounds and the alignment of accent with flexion or extension movements on the stability of 1:2 SMS in rhythmic knee flexion-extension movement in upright stance (flexing the knee once every two sounds). Fourteen participants completed 1:2 rhythmic knee flexion-extension movements with a metronome beat that accelerated from 2 to 8 Hz (the frequency of the movement was 1–4 Hz). Three sound-movement conditions were provided: (1) combining the flexion phase with loud (accented) sound and the extension phase with soft (non-accented) sound, (2) the reverse combination, and (3) combining both movements with loud sound. ANOVA results showed that metrical structure with accented sounds stabilizes 1:2 SMS in the range of 3.5–7.8 Hz in terms of timing accuracy, and flexing on the accented sound is more globally stable (resistant to phase transition) than flexing on the non-accented sound. Furthermore, our results showed that metrical structure with accented sounds induces larger movement amplitude in the range of 4.6–7.8 Hz than does that without accented sounds. The present study demonstrated that metrical structure with accented sounds stabilizes SMS and induces larger movement amplitude in rhythmic knee flexion-extension movement in upright stance than does SMS with sequences without accents. In addition, we demonstrated that coordinating flexion movement with accented sound is more globally stable than coordinating extension movement with accented sound. Thus, whereas previous studies have revealed that metrical structure enhances the timing accuracy of SMS, the current study revealed that metrical structure enhances the global stability of SMS.

Differences in sprinting performance and kinematics between preadolescent boys who are fore/mid and rear foot strikers.

The purpose of this study was to clarify whether foot strike patterns are associated with different sprint performance and kinematics in preadolescent boys. The study enrolled 24 healthy 10–11-year-old boys in the fifth grade at public elementary schools in Japan. The participants performed the 50-m sprint with maximum effort. Sprint motion was recorded using a high-speed video camera (120 fps) placed in the sagittal plane on the left side of a line drawn at 35-m from the start line. Kinematic variables were calculated based on manually digitized body landmark coordinates. The participants were categorized into two groups according to their foot strike pattern (rearfoot strikers, RF group, n = 12; forefoot or midfoot strikers, FF/MF group, n = 12). The time taken to complete the 50-m sprint in the FF/MF group (9.08±0.52 s) was faster than that in the RF group (9.63±0.51 s). The FF/MF group had greater sprint speed, higher step frequency, and shorter foot contact time than the RF group. Regarding the association between foot strike pattern and sprint kinematics, we found that the RF group had a greater range of knee flexion during the support-leg phase, whereas the FF/MF group had shorter horizontal distance from the heel of the support leg to the centre of mass at the touchdown, greater maximal knee flexion velocity during the swing-leg phase, and higher the maximum hip extension velocity during the support-leg phase. The current results suggested that, in preadolescent boys, forefoot or midfoot strike (rather than rearfoot strike) is effective for obtaining a higher step frequency and sprint speed through greater magnitude of knee flexion and hip extension movement velocities during the swing and support phases, respectively. The current findings will be useful for understanding the characteristics of the development of sprinting performance in preadolescent children.

Knee joint vibroarthrography of asymptomatic subjects during loaded flexion-extension movements.

Vibroarthrography (VAG) has been proposed as a diagnostic tool for knee joint disorders. The methodological aspects of VAG assessments, such as sensor placement and outcomes measures have not been thoroughly investigated. The aim of this study was to investigate the effects of sensor placement and the effect of the knee extension and flexion movements using different added loads on six parameters extracted from VAGs of asymptomatic subjects. We hypothesized non-uniform distribution of VAGs during knee movement resulting from the underlying biomechanical features. Linear mixed model statistical analysis was carried out. Interpolation maps of the parameters were created to illustrate their spatial distribution over the knee joint. All parameters were significantly related to load, movement type, and location. There were significant load × movement type and location × movement type interaction for ARV and MPF, respectively. Further, the topographical maps of the six VAG parameters differed underlining the complementary information of the six VAG outcomes. The non-uniformity of the spatial distribution, movement type, and the knee joint load dependency of the investigate parameters open for new uses of VAG for joint diagnostic purposes including activities of daily living. Graphical abstract Visual summary of the main findings of the study. This figure shows that knee flexion-extension movement with various added external loads (0-1.25-2.5-5kg) were investigated, vibroarthrogaphic (VAG) signals from eight locations over the knee were recorded, linear and nonlinear analyses were conducted revealing non-uniformity of the spatial distribution of the VAGs.

Haptic feedback helps bipedal coordination.

The present study investigated whether special haptic or visual feedback would facilitate the coordination of in-phase, cyclical feet movements of different amplitudes. Seventeen healthy participants sat with their feet on sliding panels that were moved externally over the same or different amplitudes. The participants were asked to generate simultaneous knee flexion–extension movements, or to let their feet be dragged, resulting in reference foot displacements of 150 mm and experimental foot displacements of 150, 120, or 90 mm. Four types of feedback were given: (1) special haptic feedback, involving actively following the motions of the sliders manipulated by two confederates, (2) haptic feedback resulting from passive motion, (3) veridical visual feedback, and (4) enhanced visual feedback. Both with respect to amplitude assimilation effects, correlations and standard deviation of relative phase, the results showed that enhanced visual feedback did not facilitate bipedal independence, but haptic feedback with active movement did. Implications of the findings for movement rehabilitation contexts are discussed.

Evolution of knee kinematics three months after total knee replacement

In patients with debilitating knee osteoarthritis, total knee replacement is the most common surgical procedure. Numerous studies have demonstrated that knee kinematics one year after total knee replacement are still altered compared to the healthy joint. However, little is known regarding impairments and functional limitations of patients several months after total knee replacement. The aim of this study was to describe the evolution of the knee gait kinematic in patients with knee osteoarthritis before and three months after a total knee replacement.Ninety patients who were to undergo total knee replacement were included in this study. Twenty-three subjects were recruited as the control group. Three-dimensional gait analysis was performed before and three months after surgery. The spatio-temporal parameters and three-dimensional knee kinematics for the operated limb were evaluated during a comfortable gait and compared between groups (the before and after surgery groups and the control group).Three months after surgery, patients always walk with a slower gait velocity and lower knee flexion–extension movements compared to the control group. However, a degree of progress was observed in term of the stride and step length, gait velocity and knee alignment in the coronal plane.Our results suggest that the disability is still significant for most patients three months after total knee replacement. A better understand of the impairments and functional limitations following surgery would help clinicians design rehabilitation programs. Moreover, patients should be informed that rehabilitation after total knee replacement is a long process.

Mobile Sensor Application for Kinematic Detection of the Knees.

ObjectiveTo correctly measure the knee joint angle, this study utilized a Qualisys motion capture system and also used it as the reference to assess the validity of the study's Inertial Measurement Unit (IMU) system that consisted of four IMU sensors and the Knee Angle Recorder software. The validity was evaluated by the root mean square (RMS) of different angles and the intraclass correlation coefficient (ICC) values between the Qualisys system and the IMU system.MethodsFour functional knee movement tests for ten healthy participants were investigated, which were the knee flexion test, the hip and knee flexion test, the forward step test and the leg abduction test, and the walking test.ResultsThe outcomes of the knee flexion test, the hip and knee flexion test, the forward step test, and the walking test showed that the RMS of different angles were less than 6°. The ICC values were in the range of 0.84 to 0.99. However, the leg abduction test showed a poor correlation in the measurement of the knee abduction-adduction movement.ConclusionThe IMU system used in this study is a new good method to measure the knee flexion-extension movement.

ACL forces and knee kinematics produced by axial tibial compression during a passive flexion–extension cycle

Application of axial tibial force to the knee at a fixed flexion angle has been shown to generate ACL force. However, direct measurements of ACL force under an applied axial tibial force have not been reported during a passive flexion-extension cycle. We hypothesized that ACL forces and knee kinematics during knee extension would be significantly different than those during knee flexion, and that ACL removal would significantly increase all kinematic measurements. A 500 N axial tibial force was applied to intact knees during knee flexion-extension between 0° and 50°. Contact force on the sloping lateral tibial plateau produced a coupled internal + valgus rotation of the tibia, anterior tibial displacement, and elevated ACL forces. ACL forces during knee extension were significantly greater than those during knee flexion between 5° and 50°. During knee extension, ACL removal significantly increased anterior tibial displacement between 0° and 50°, valgus rotation between 5° and 50°, and internal tibial rotation between 5° and 15°. With the ACL removed, kinematic measurements during knee extension were significantly greater than those during knee flexion between 5° and 45°. The direction of knee flexion-extension movement is an important variable in determining ACL forces and knee kinematics produced by axial tibial force.

Isokinetic Strength and Endurance in Proximal and Distal Muscles in Patients With Peripheral Artery Disease

The objective of this study was to analyze the muscle strength and endurance of the proximal and distal lower-extremity muscles in peripheral artery disease (PAD) patients. Twenty patients with bilateral PAD with symptoms of intermittent claudication and nine control subjects without PAD were included in the study, comprising 40 and 18 legs, respectively. All subjects performed an isokinetic muscle test to evaluate the muscle strength and endurance of the proximal (knee extension and knee flexion movements) and distal (plantar flexion and dorsiflexion movements) muscle groups in the lower extremity. Compared with the control group, the PAD group presented lower muscle strength in knee flexion (-14.0%), dorsiflexion (-26.0%), and plantar flexion (-21.2%) movements (P < 0.05) but similar strength in knee extension movements (P > 0.05). The PAD patients presented a 13.5% lower knee flexion/extension strength ratio compared with the control subjects (P < 0.05), as well as lower muscle endurance in dorsiflexion (-28.1%) and plantar flexion (-17.0%) movements (P < 0.05). The muscle endurance in knee flexion and knee extension movements was similar between PAD patients and the control subjects (P > 0.05). PAD patients present lower proximal and distal muscle strength and lower distal muscle endurance than control patients. Therefore, interventions to improve muscle strength and endurance should be prescribed for PAD patients.

Efeitos da mobilização passiva nas respostas hemodinâmicas agudas em pacientes sob ventilação mecânica

To assess the effects of passive mobilization on acute hemodynamic responses in mechanically ventilated patients. This cross-sectional, quantitative, observational study enrolled patients who were admitted to the intensive care unit, sedated and mechanically ventilated. The infusion of sedative and analgesic drugs aimed to maintain a Ramsay scale sedation level of 4 to 6. Passive mobilization consisted of hip and knee flexion-extension movements for five minutes. After 10 minutes of rest, an additional five minutes of flexion-extension passive movements was performed for the shoulders. Hemodynamic assessments (heart rate and systolic, diastolic and mean blood pressure) were performed one minute before the mobilization protocol and one minute after each phase. The double product and myocardial oxygen consumption were calculated using appropriate formulas. A total of 13 patients (69.2% male, with a mean age of 69.1 ± 15.8 years) were admitted from June to December, 2011. Passive mobilization led to statistically significant increases in heart rate, double product and myocardial oxygen consumption. However, mean blood pressure was not significantly altered. Our results suggest that passive mobilization of mechanically ventilated and sedated patients is safe and provides beneficial effects on acute hemodynamic parameters, particularly heart rate, although mean blood pressure is not significantly altered.

Use of embedded strain gages for the in-vitro study of proximal tibial cancellous bone deformation during knee flexion-extension movement: development, reproducibility and preliminary results of feasibility after frontal low femoral osteotomy

BackgroundThis paper reports the development of an in-vitro technique allowing quantification of relative (not absolute) deformations measured at the level of the cancellous bone of the tibial proximal epiphysis (CBTPE) during knee flexion-extension. This method has been developed to allow a future study of the effects of low femoral osteotomies consequence on the CBTPE.MethodsSix strain gages were encapsulated in an epoxy resin solution to form, after resin polymerisation, six measurement elements (ME). The latter were inserted into the CBTPE of six unembalmed specimens, just below the tibial plateau. Knee motion data were collected by three-dimensional (3D) electrogoniometry during several cycles of knee flexion-extension. Intra- and inter-observer reproducibility was estimated on one specimen for all MEs. Intra-specimen repeatability was calculated to determine specimen's variability and the error of measurement. A varum and valgum chirurgical procedure was realised on another specimen to observed CBTPE deformation after these kind of procedure.ResultsAverage intra-observer variation of the deformation ranged from 8% to 9% (mean coefficient of variation, MCV) respectively for extension and flexion movement. The coefficient of multiple correlations (CMC) ranged from 0.93 to 0.96 for flexion and extension. No phase shift of maximum strain peaks was observed. Inter-observer MCV averaged 23% and 28% for flexion and extension. The CMC were 0.82 and 0.87 respectively for extension and flexion. For the intra-specimen repeatability, the average of mean RMS difference and the mean ICC were calculated only for flexion movement. The mean RMS variability ranged from 7 to 10% and the mean ICC was 0.98 (0.95 - 0.99). A Pearson's correlation coefficient was calculated showing that RMS was independent of signal intensity. For the chirurgical procedure, valgum and varum deviation seems be in agree with the frontal misalignment theory.ConclusionsResults show that the methodology is reproducible within a range of 10%. This method has been developed to allow analysis the indirect reflect of deformation variations in CBTPE before and after distal femoral osteotomies. The first results of the valgum and varum deformation show that our methodology allows this kind of measurement and are encourageant for latter studies. It will therefore allow quantification and enhance the understanding of the effects of this kind of surgery on the CBTPE loading.

Cortical activation changes induced by visual biofeedback tracking training in chronic stroke patients

We tried to examine whether visual biofeedback tracking training (VBTT) can improve both the gait performance and cortical activation pattern in chronic stroke patients. We enrolled 10 chronic hemiparetic patients with stroke(mean age 46.3 +/- 5.19 years). The patients were randomly assigned to the training group (5 patients) or the control group (5 patients). VBTT was to follow the PC-generated sine waves with the knee joint electrogoniometer, and the two sine waves should appear as close to overlapping as possible on the PC monitor. The training was performed for 39 minutes/day, 5 days/week, for 4 weeks. Pre-training and post-training accuracy of tracking, functional status of gait, and functional MRI (fMRI) were measured. fMRI was performed at 1.5 T in parallel with timed knee flexion-extension movements at a fixed rate. The accuracy of the tracking performance, walking speed, and motor scale for gait improved in the training group. Primary sensorimotor cortex (SM1) cortical activation shifted significantly from the unaffected to the affected hemisphere in the training group. We demonstrated that cortical activation changes occurred with gait function improvement in chronic stroke patients throughout the 4-week VBTT program. It seems that the cortical reorganization was induced by VBTT.