gait analysis

Effects of Transcutaneous Electrical Nerve Stimulation on Gait Kinetics in Individuals with Experimentally Induced Knee Joint Pain

Background: Knee joint pain (KJP) independently alters motor function and gait mechanics, and these alterations may accelerate chronic knee joint disease. While TENS restores motor function deficits, it is unclear whether TENS restores compensatory gait mechanics. The purpose was to examine the effects of KJP on lower-extremity joint moments, and the effects of TENS on the aforementioned variables. We hypothesized that KJP will result in altered gait patterns, and TENS will help restore these mechanical alterations. Methods: We randomly selected 15 subjects for the TENS group, after which subjects were matched for the placebo group. Subjects underwent 3 sessions (hypertonic, isotonic, control). A 20-gauge flexible catheter was inserted into the right infrapatellar fat pad, and an infusion pump infused a saline of 0.154 mL•min¯¹ for 50 min (total = 7.7 mL). A TENS protocol was set at a biphasic mode with 120 µs and 180 Hz for 20 min. To blind placebo treatment, subjects in the placebo group was told that an electrical stimulation had been set to sub-sensory level. High-speed video (240 Hz) and an instrumented treadmill (1200 Hz) were used for gait analysis. Functional analysis of variance were used to evaluate differences between groups over time for joint moments. The mean curve with 95% CIs is represented by polynomial functions, showing us the entire stance, rather than identifying discrete peak points. If 95% CIs did not cross zero, significant difference existed (P < 0.05). Discussion: KJP independently increase internal knee varus moments, which were consistent with previous finding using patients with osteoarthritic knee pain. These compensatory gait patterns may be a result of a pain-avoidance motor deficits strategies. Since observed patterns can create altered mechanical and biological stress patterns on articular surface, it may increase the risk of degenerative knee disease. However, attempting to reduce perceived pain and increase neuron activation through TENS can help overcome deficits in knee and hip joint moments.
Listed In: Biomechanics, Gait, Sports Science


Muscle force prediction of the lower limb compared to surface EMG at different walking speeds in individual healthy subjects.

BACKROUND: Recent developments in modelling have made it easier to use muscle force predictions to augment clinical gait analysis and enhance clinical decision making. OpenSim claims to provide a straight forward, standardised pipeline (SimTrack) to predict muscle forces implemented in routine processing. This project aims to test SimTrack’s potential in the context of clinical gait analysis by developing a standardised protocol which compares predicted muscle forces with surface EMG at a range of walking speeds. METHODS: 10 healthy participants walked at 3 different speeds (comfortable, ±20%). Kinematics, kinetics and surface EMG of the lower limb were captured. Joint angles and ground reaction forces serve as inputs to predict muscle forces using computed muscle control (CMC) within SimTrack. Predicted muscle forces were compared with EMG to validate the model outputs. RESULTS: Agreement between force prediction and EMG varies between muscles. Some muscles show a general agreement and similar variation with walking speed, others show large unexpected differences between CMC outputs and observed EMG. DISCUSSION: These results suggest that this protocol is running in general. For most walking speeds, CMC muscle forces can be predicted within a timeframe appropriate for clinical purposes. However using the default settings, the model predictions do not agree with EMG measurements. Furthermore, during pilot testing of quicker walking speeds (up to +40%) CMC crashed due the chosen musculoskeletal model being too weak. These findings suggest the need of either different generic parameters or subject specific parameters to obtain valid results. Work is continuing to identify these.
Listed In: Biomechanics, Gait, Other


Effect of Transcutaneous Electrical Nerve Stimulation on Gait Kinematics in Subjects with Anterior Knee Pain

Knee pain is 1 of 5 leading causes of disability by altering lower-extremity muscle function and gait mechanics. While transcutaneous electrical nerve stimulation (TENS) mitigates deficits of muscle function due to pain, it is unclear whether TENS improves gait mechanics. Each of 15 participant (24±3yrs, 71±12kg, 178±7cm) was assigned to the TENS or matched placebo group (23±2yrs, 72±14kg, 177±9cm). Participants underwent 3 different experimental saline infusion sessions (hypertonic, isotonic, control) in a counterbalanced order, separated by 48-h. Hypertonic (5% NaCl) or isotonic (0.9% NaCl) saline was infused into the infrapatellar fat pad for 50-min. No infusion was administered to the control session. Participants and investigators were blinded to the saline solution. A 20-min TENS or placebo treatment was administered, which was blinded to participants. Gait kinematic data were collected using the high-speed video (240 Hz) and force-sending tandem treadmill (1200 Hz) at each time interval (baseline, infusion, treatment, post-treatment). Functional ANOVA (α=0.05) were used to evaluate difference between 2 groups (TENS, placebo) over time. Pairwise comparison functions with 95% confidence interval were plotted to determine specific difference. Hypertonic saline infusion (pain) resulted in increased (1) ankle dorsiflexion (38-75% of stance), (2) knee valgus (20-40%), (3) knee flexion (40-90%), (4) hip adduction (72-100%), (5) hip flexion (50-90%). However, there was no group x time interaction for all kinematics. Altered gait strategies due to pain may play a role in long-term compensation that could have consequences for the joint. TENS treatment, however, did not acutely reduce the deficits in aforementioned kinematic variables.


Listed In: Biomechanics, Gait, Neuroscience, Physical Therapy


Joint loading during graded walking with different prostheses - a case study

For lower limb amputees graded walking imposes a high level of motor ability, due to the missing proprioceptive feedback of the limb, and the necessary compensation mechanisms. In order to facilitate gait a focus in prosthesis research is the development of the prostheses ankle joints from rigid to moveable. Therefore, the aim of this case study was to analyse the effects of three different prostheses with a rigid and a moveable ankle joint during graded walking of a unilateral amputee. One male unilateral transfemoral amputee was recruited for this study and a comparison of following three prostheses (endolite, Germany) was performed: Elan (movable ankle joint with flexible resistance), Echelon (movable ankle joint with steady resistance) and Esprit (rigid ankle joint). Kinematic (12 cameras, Vicon, UK, 250 Hz) and kinetic (2 force plates, AMTI, MA, 1000 Hz) data were recorded during self-paced walking on a 6 m ramp, which was set to the inclinations of -12°, -4°, 0°, 4° and 12°. Following gait parameters, ground reaction forces, joint angles and joint moments were calculated. Gait parameters, ground reaction forces and joint angles were marginally influenced by the different prosthetic designs, but major changes occurred on the joint moment level. The use of the rigid ankle prosthesis Esprit induced up to 10 times higher joint moments compared to the moveable ankle joint prostheses. This case study showed that a moveable ankle joint can reduce the joint moments during graded walking, which might be advantageous to use for transfemoral amputees in graded walking.
Listed In: Biomechanics, Gait