Clinical Biomechanics最新文献_第4页

Cognitive-motor dual task to reveal gait impairments in multiple sclerosis patients at an early stage: A systematic review 认知-运动双重任务可早期发现多发性硬化症患者的步态障碍：系统综述。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-07-02 DOI: 10.1016/j.clinbiomech.2024.106300

David Péron , Sébastien Leteneur , Bruno Lenne , Ghassan Ido , Cécile Donzé , Franck Barbier , Caroline Massot

Background

Multiple sclerosis can cause locomotor and cognitive impairments even at lower levels of disability, which can impact daily life. The cognitive-motor dual task is commonly used to assess everyday locomotion. Thus, this study aimed to examine the effect of cognitive-motor dual tasks on gait parameters among patients with multiple sclerosis in the early disease stages and to determine whether dual tasks could be used as a clinical test to detect locomotion impairments.

Methods

A systematic search of five databases was conducted in May 2024. The population of interest was patients with multiple sclerosis with an Expanded Disability Status Scale score of 4 or less. The following outcome measures were examined: spatiotemporal and kinematic parameters. The Newcastle–Ottawa Scale was used to assess the quality of the studies.

Findings

Eleven studies including 270 patients with multiple sclerosis and 221 healthy controls. Three spatiotemporal parameters were modified both in patients with multiple sclerosis and healthy controls during dual-task performance: gait speed, stride length and the double support phase. No spatiotemporal parameter was affected during dual-task performance in patients with multiple sclerosis alone.

Interpretation

Dual-task performance could be useful for assessing gait impairments in patients with multiple sclerosis provided that assessments and protocols are standardized. Nevertheless, the spatiotemporal parameters did not allow discrimination between patients with multiple sclerosis at an early stage and healthy controls. Three-dimensional gait analysis during dual-task performance could be a useful approach for detecting early gait impairments in patients with multiple sclerosis, assessing their progression and adjusting rehabilitation programs.

背景：多发性硬化症会导致运动和认知障碍，即使残疾程度较轻，也会影响日常生活。认知-运动双重任务常用于评估日常运动。因此，本研究旨在探讨认知-运动双重任务对疾病早期多发性硬化症患者步态参数的影响，并确定双重任务是否可用作检测运动障碍的临床测试：方法：2024 年 5 月对五个数据库进行了系统检索。方法：2024 年 5 月，对五个数据库进行了系统性检索，研究对象为残疾状况扩展量表评分为 4 分或 4 分以下的多发性硬化症患者。研究了以下结果指标：时空参数和运动参数。纽卡斯尔-渥太华量表用于评估研究质量：11项研究包括270名多发性硬化症患者和221名健康对照者。多发性硬化症患者和健康对照者在完成双重任务时，有三个时空参数发生了变化：步速、步幅和双支撑阶段。多发性硬化症患者在执行双任务时，没有任何时空参数受到影响：只要评估和方案标准化，双任务表现对于评估多发性硬化症患者的步态障碍是有用的。然而，时空参数并不能区分早期多发性硬化症患者和健康对照组。双任务执行过程中的三维步态分析可能是检测多发性硬化症患者早期步态障碍、评估其进展和调整康复计划的有用方法。

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引用次数: 0

Age- and Parkinson-related differences in trunk and lower-limb muscle activation during four balance tasks: A case-control pilot study 四项平衡任务中躯干和下肢肌肉激活与年龄和帕金森病相关的差异：病例对照试验研究

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-07-01 DOI: 10.1016/j.clinbiomech.2024.106298

Jérôme Bouchard-Tremblay , Michael Théberge , Tamami Ayoub , Gabrielle Martel-Brosseau , Marie-Pier Levasseur-Ouellet , Maxim Tremblay , Alexandra Houde-Thibeault , Enafa Anais Wotto , Fernando Rezende Carezolli , Luc J. Hébert , Rubens A. da Silva

Background

Poor postural control has been reported in people with Parkinson's disease, which could be explained by the changes in muscular activation patterns related to antigravitational muscles. This study aims to measure the muscle activation of antigravitational muscles during balance tasks in individuals, with and without Parkinson's.

Methods

Sixteen (16) participants (9 with Parkinson's), aged ≥65 yrs., performed 2 × 30-s trials of 4 balance tasks (bipodal and semi-tandem opened eyes and closed eyes) on a force platform (center of pressure measurement); while surface electromyography measurements were obtained bilaterally on the multifidus at L5, biceps femoris and medialis gastrocnemius. Electromyography amplitude analysis was processed by the Root Mean Square (250 ms window epochs) and normalized by the peak of activation during the balance task, to determine each muscle's activity level.

Findings

The Parkinson's group reported lower muscle activation than control across tasks (in mean for multifidus = 8%, biceps femoris = 16%, gastrocnemius = 7%), although not statistically significant. Parkinson's reported significantly poorer postural control than control, mainly for the center of pressure sway ellipse area (p = 0.016) from challenge balance tasks such as semi-tandem.

Interpretation

Poor postural control was confirmed in the Parkinson's group, but not significantly associated by the changes from muscle activation of trunk and lower limbs, during balance performance.

背景：据报道，帕金森病患者的姿势控制能力较差，这可能与反重力肌肉激活模式的变化有关。本研究旨在测量帕金森病患者和非帕金森病患者在完成平衡任务时反重力肌的肌肉激活情况：16名年龄≥65岁的参与者（9名患有帕金森症）在测力平台上进行了2×30秒的4项平衡任务试验（睁眼和闭眼的双足和半双足）（压力中心测量）；同时对双侧L5多裂肌、股二头肌和腓肠肌内侧进行了表面肌电图测量。肌电图振幅分析采用均方根（250 毫秒窗口历时）处理，并根据平衡任务中的激活峰值进行归一化处理，以确定每块肌肉的活动水平：帕金森氏症组报告的肌肉激活水平低于对照组（平均多裂肌=8%，股二头肌=16%，腓肠肌=7%），但无统计学意义。帕金森病患者的姿势控制能力明显低于对照组，主要是在挑战平衡任务（如半串联）中的压力中心摇摆椭圆区域（p = 0.016）：帕金森病组的姿势控制能力较差得到证实，但与平衡表现过程中躯干和下肢肌肉激活的变化无明显关联。

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引用次数: 0

Biomechanical testing of a computationally optimized far cortical locking plate versus traditional implants for distal femur fracture repair 用于股骨远端骨折修复的计算优化远皮质锁定钢板与传统植入物的生物力学测试。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-07-01 DOI: 10.1016/j.clinbiomech.2024.106296

Pawel Brzozowski , Clayton Inculet , Emil H. Schemitsch , Radovan Zdero

Background

This study experimentally validated a computationally optimized screw number and screw distribution far cortical locking distal femur fracture plate and compared the results to traditional implants.

Methods

24 artificial femurs were osteotomized with a 10 mm fracture gap 60 mm proximal to the intercondylar notch. Three fixation constructs were used. (i) Standard locking plates secured with three far cortical locking screws inserted according to a previously optimized distribution in the femur shaft (n = 8). (ii) Standard locking plates secured with four standard locking screws inserted in alternating plate holes in the femur shaft (n = 8). (iii) Retrograde intramedullary nail secured proximally with one anterior-posterior screw and distally with two oblique screws (n = 8). Axial hip forces (700 and 2800 N) were applied while measuring axial interfragmentary motion, shear interfragmentary motion, and overall stiffness.

Findings

Experimental far cortical locking plate results compared well to published computational findings. Far cortical locking femurs contained the highest axial motion within the potential ideal range of 0.2–1 mm and a sheer-to-axial motion ratio < 1.6 at toe-touch weight-bearing (700 N). At full weight-bearing (2800 N), Standard locking-plated femurs had the only axial motion within 0.2–1 mm but had an excess shear-to-axial motion ratio. Nail-implanted femurs underperformed at both forces.

Interpretation

For toe-touch weight-bearing, the far cortical locking construct provided optimal biomechanics to allow moderate motion, which has been suggested to encourage early callus formation. Conversely, at full weight-bearing, the standard locking construct offered the biomechanical advantage on fracture motion.

背景：本研究通过实验验证了经过计算优化的螺钉数量和螺钉分布远皮质锁定股骨远端骨折钢板，并将结果与传统植入物进行了比较。使用了三种固定结构。(i) 根据先前优化的股骨轴分布，用三根远端皮质锁定螺钉固定标准锁定钢板（n = 8）。(ii) 在股骨轴上交替插入四颗标准锁定螺钉，固定标准锁定钢板（n = 8）。(iii) 逆行髓内钉，近端用一颗前后螺钉固定，远端用两颗斜螺钉固定（n = 8）。在测量轴向节间运动、剪切节间运动和整体刚度的同时，施加轴向髋关节力（700 和 2800 N）：实验结果：远皮质锁定钢板的实验结果与已发表的计算结果比较吻合。在 0.2-1 毫米的潜在理想范围内，远端皮质锁定股骨的轴向运动最大，剪切运动与轴向运动的比率也最大：在脚趾接触负重的情况下，远皮质锁定结构提供了最佳的生物力学，允许适度的运动，这被认为能促进早期胼胝的形成。相反，在完全负重时，标准锁定结构在骨折运动方面具有生物力学优势。

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引用次数: 0

Effects of three-dimensional femur and tibia postures on the parameters of standing long-leg radiographs for osteoarthritic knees in elderly female subjects 股骨和胫骨三维姿势对老年女性骨关节炎膝关节站立长腿X光片参数的影响

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-07-01 DOI: 10.1016/j.clinbiomech.2024.106297

Kazutaka Otani , Takashi Sato , Koichi Kobayashi , Tomoharu Mochizuki , Osamu Tanifuji , Ryota Katsumi , Hiroyuki Kawashima

Background

Long-leg frontal radiographs of the lower extremities are used to assess knee osteoarthritis. Given the three-dimensional (3D) nature of alignment changes in osteoarthritis, postural alterations in the femur and tibia extend beyond the coronal plane (in-plane) to include the transverse and sagittal planes (out-of-plane). This study investigates the impact of these out-of-plane factors on in-plane knee alignment parameters observed in frontal radiographs.

Methods

A total of 97 osteoarthritic knees in women were examined. Using a 3D-to-two-dimensional (2D) image matching technique, we evaluated the 3D postures of the femur and tibia in the standing position as viewed from frontal radiographs in the world coordinate system. Statistical analyses were conducted to explore associations between these 3D postures and 2D alignment parameters obtained from frontal radiographs under identical conditions.

Findings

The femur exhibited a medial inclination of 2.7°, a posterior inclination of 3.9°, and an internal rotation of 4.2°, whereas the tibia showed a lateral inclination of 6.4°, an anterior inclination of 6.7°, and an internal rotation of 6.7°. Both coronal and rotational postures of femur and tibia influenced the hip-knee-ankle angle, mechanical axis percentage, and medial proximal tibial angle. However, only coronal factors of tibia impacted tibial joint line obliquity relative to the floor.

Interpretation

Attention should be paid to the potential impact of the out-of-plane postures of the femur and tibia on parameters assessed in plain frontal radiographs of the lower extremities.

背景下肢长腿正面X光片用于评估膝关节骨关节炎。鉴于骨关节炎中对位变化的三维（3D）性质，股骨和胫骨的姿势改变超出了冠状面（平面内），还包括横向和矢状面（平面外）。本研究调查了这些平面外因素对正面X光片上观察到的膝关节平面内排列参数的影响。我们使用三维到二维（2D）图像匹配技术，在世界坐标系中评估了从正面X光片观察到的股骨和胫骨在站立位置的三维姿势。研究结果股骨显示内倾2.7°，后倾3.9°，内旋4.2°，而胫骨显示外倾6.4°，前倾6.7°，内旋6.7°。股骨和胫骨的冠状姿势和旋转姿势都会影响髋-膝-踝角度、机械轴百分比和胫骨内侧近端角度。释义应注意股骨和胫骨平面外姿势对下肢普通正面X光片评估参数的潜在影响。

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引用次数: 0

Prolonged quadriceps latency during gait early after anterior cruciate ligament injury predicts radiographic knee osteoarthritis 6-years after anterior cruciate ligament reconstruction 前交叉韧带损伤后早期步态中长期股四头肌潜伏期可预测前交叉韧带重建6年后膝关节骨关节炎的影像学表现。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-07-01 DOI: 10.1016/j.clinbiomech.2024.106301

Naoaki Ito , Jacob J. Capin , Elanna K. Arhos , Elizabeth Wellsandt , Ryan T. Pohlig , Thomas S. Buchanan , Lynn Snyder-Mackler

Background

The purpose was to explore quadriceps electromechanical function (quadriceps latency) during gait after anterior cruciate ligament injury as a predictor for radiographic knee osteoarthritis 6-years after anterior cruciate ligament reconstruction. Change in latency after preoperative physical therapy was also examined.

Methods

Quadriceps latency (time between peak knee moment and quadriceps electromyography) was calculated before preoperative physical therapy (2.4 [0.5–7.5] months after anterior cruciate ligament injury) and after preoperative physical therapy in 24 athletes. Participants were dichotomized into osteoarthritis (Kellgren and Lawrence grade ≥ 2) and non-osteoarthritis groups at 6-years. Forward selection logistic regression was performed using z-score normalized quadriceps latency and demographics. A 2 × 2 repeated measure ANOVA was performed for quadriceps latency between groups before and after preoperative physical therapy.

Findings

Quadriceps latency before preoperative physical therapy was the only predictor of 6-year radiographic osteoarthritis (p = 0.014, odds ratio [95% confidence interval] = 5.859 [1.435–23.924]). Time by group interaction was observed for quadriceps latency (p = 0.039, η²p = 0.179). In the osteoarthritis group, latency may reduce after training (before preoperative physical therapy = 115.7 ± 20.6 ms, after preoperative physical therapy = 99.5 ± 24.0 ms, p = 0.082).

Interpretation

Prolonged latency after anterior cruciate ligament injury may predict post-traumatic knee osteoarthritis 6-years after anterior cruciate ligament reconstruction. Latency may shorten with preoperative physical therapy, yet athletes still moved on to develop osteoarthritis. Quadriceps function may need intervention immediately following anterior cruciate ligament injury for prevention of post-traumatic knee osteoarthritis.

研究背景目的：探讨前交叉韧带损伤后步态过程中股四头肌机电功能（股四头肌潜伏期）对前交叉韧带重建6年后膝关节骨关节炎影像学表现的预测作用。此外，还研究了术前物理治疗后潜伏期的变化：计算了 24 名运动员术前物理治疗前（前交叉韧带损伤后 2.4 [0.5-7.5] 个月）和术前物理治疗后的股四头肌潜伏期（膝关节峰值力矩与股四头肌肌电图之间的时间）。参与者在 6 年后被分为骨关节炎组（Kellgren 和 Lawrence 分级≥ 2）和非骨关节炎组。使用 z 评分归一化股四头肌潜伏期和人口统计学数据进行前向选择逻辑回归。对术前物理治疗前后两组间的股四头肌潜伏期进行了 2 × 2 重复测量方差分析：结果：术前物理治疗前的股四头肌潜伏期是 6 年放射骨关节炎的唯一预测因素（p = 0.014，几率比[95% 置信区间] = 5.859 [1.435-23.924]）。在股四头肌潜伏期方面，观察到了时间与组别的交互作用（p = 0.039，η2p = 0.179）。在骨关节炎组，训练后潜伏期可能会缩短（术前理疗前 = 115.7 ± 20.6 ms，术前理疗后 = 99.5 ± 24.0 ms，p = 0.082）：前交叉韧带损伤后潜伏期延长可能预示着前交叉韧带重建6年后的创伤后膝关节骨关节炎。术前物理治疗可缩短潜伏期，但运动员仍会发展成骨关节炎。前交叉韧带损伤后可能需要立即干预股四头肌功能，以预防创伤后膝关节骨性关节炎。

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引用次数: 0

Kinematic upper limb analysis outperforms electromyography at grading the severity of dystonia in children with cerebral palsy 在对脑瘫儿童肌张力障碍的严重程度进行分级时，上肢运动学分析优于肌电图分析

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-07-01 DOI: 10.1016/j.clinbiomech.2024.106295

Melissa Gar Yee Louey , Adrienne Harvey , Elyse Passmore , David Grayden , Morgan Sangeux

Background

Severity of dyskinesia in children with cerebral palsy is often assessed using observation-based clinical tools. Instrumented methods to objectively measure dyskinesia have been proposed to improve assessment accuracy and reliability. Here, we investigated the technique and movement features that were most suitable to objectively measure the severity of dystonia in children with cerebral palsy.

Methods

A prospective observational study was conducted with 12 participants with cerebral palsy with a predominant motor type of dyskinesia, spasticity, or mixed dyskinesia/spasticity who had upper limb involvement (mean age: 12.6 years, range: 6.7–18.2 years). Kinematic and electromyography data were collected bilaterally during three upper limb tasks. Spearman rank correlations of kinematic or electromyography features were calculated against dystonia severity, quantified by the Dyskinesia Impairment Scale.

Findings

Kinematic features were more influential compared to electromyography features at grading the severity of dystonia in children with cerebral palsy. Kinematic measures quantifying jerkiness of volitional movement during an upper limb task with a reaching component performed best (|r_s| = 0.78–0.9, p < 0.001).

Interpretation

This study provides guidance on the types of data, features of movement, and activity protocols that instrumented methods should focus on when objectively measuring the severity of dystonia in children with cerebral palsy.

背景脑性瘫痪儿童运动障碍的严重程度通常通过基于观察的临床工具进行评估。为了提高评估的准确性和可靠性，有人提出了客观测量运动障碍的仪器方法。在此，我们研究了最适合客观测量脑瘫儿童肌张力障碍严重程度的技术和运动特征。方法我们对 12 名上肢受累的脑瘫患者（平均年龄：12.6 岁，范围：6.7-18.2 岁）进行了前瞻性观察研究，这些患者的主要运动类型为肌张力障碍、痉挛或肌张力障碍/痉挛混合型。在进行三项上肢任务时，收集了双侧的运动学和肌电图数据。通过运动障碍损害量表计算运动学或肌电图特征与肌张力障碍严重程度的斯皮尔曼等级相关性。研究结果与肌电图特征相比，运动学特征对脑瘫儿童肌张力障碍严重程度的分级更具影响力。这项研究为客观测量脑瘫儿童肌张力障碍严重程度时，仪器测量方法应关注的数据类型、运动特征和活动方案提供了指导。

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引用次数: 0

The effect of stroboscopic visual disruption on static stability measures in anterior cruciate ligament reconstructed individuals 频闪视觉干扰对前十字韧带重建者静态稳定性测量的影响。

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-07-01 DOI: 10.1016/j.clinbiomech.2024.106299

Nathan J. Robey , Otto Buchholz , Shane P. Murphy , Gary D. Heise

Background

Those who undergo ACL reconstruction are at an increased risk of suffering a second ACL injury. A suggested rationale for the increased injury risk is sensory reweighting to the visual system to compensate for a lack of somatosensory information from the knee. Understanding this proposed visual reliance may help clinicians improve return to sport outcomes and reduce the risk of a subsequent ACL injury.

Methods

Thirteen ACL reconstructed individuals and thirteen matched controls completed two common static postural control assessments under three different visual conditions; eyes open, low visual disruption, and high visual disruption. Center of pressure data was collected for 30 s using force plates. Static postural stability was evaluated using the following: 1) root mean square distance, 2) mean velocity, 3) sway area, and 4) mean frequency.

Findings

No significant interactions between group and vision were observed. Significant differences between groups were observed for mean frequency in the double-limb stance (p < .05). Additionally, significant differences were observed for visual conditions in both double-limb (mean velocity; p < .05) and single-limb stances (root mean square distance, mean velocity, sway area, and mean frequency; p < .05).

Interpretation

The findings of the current study suggest that ACL reconstructed individuals, who are at least two years removed from surgery, do not rely on visual information to a greater extent than controls during static postural stability assessments. Stroboscopic glasses may be a cost-effective alternative for rehabilitation purposes compared to the traditional binary eyes open vs. eyes closed methods.

背景：接受前交叉韧带重建手术的患者再次发生前交叉韧带损伤的风险会增加。损伤风险增加的一个原因是视觉系统的感觉重负，以弥补膝关节躯体感觉信息的不足。了解这种视觉依赖可能有助于临床医生改善恢复运动的结果，并降低前交叉韧带再次受伤的风险：方法：13 名前交叉韧带重建者和 13 名匹配对照者在三种不同的视觉条件下完成了两种常见的静态姿势控制评估：睁眼、低视觉干扰和高视觉干扰。使用测力板收集 30 秒钟的压力中心数据。静态姿势稳定性的评估方法如下：1) 均方根距离；2) 平均速度；3) 摇摆面积；4) 平均频率：没有观察到组别与视力之间存在明显的交互作用。在双腿站立的平均频率方面，观察到了组间的显著差异（p 解释：目前的研究结果表明，在静态姿势稳定性评估中，至少术后两年的前交叉韧带重建者对视觉信息的依赖程度并不比对照组高。与传统的睁眼与闭眼二选一方法相比，频闪眼镜可能是一种具有成本效益的康复替代方法。

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引用次数: 0

Changes in functional characteristics of heel fat pad with age 足跟脂肪垫功能特征随年龄的变化

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics

Pub Date : 2024-06-17 DOI: 10.1016/j.clinbiomech.2024.106294

Toshihiro Maemichi , Masatomo Matsumoto , Takumi Okunuki , Tsukasa Kumai

Background

This study aimed to investigate age-related changes in the heel fat pad's microchamber and macrochamber layers, particularly focusing on load-induced alterations. Understanding these changes is crucial for elucidating age-related differences in foot mechanics and their potential implications for mobility and comfort.

Methods

Fifty-five healthy individuals were divided into three age groups: young adults (≤29 years), middle-aged adults (30–44 years), and elderly individuals (≥45 years). Ultrasonic imaging was utilized to measure the thickness of the heel fat pad's microchamber and macrochamber layers under varying load conditions. Thickness, percentage changes, and ratios of load-induced thickness changes were calculated to assess age-related differences.

Findings

Under no-load conditions, both microchamber and macrochamber layers of the heel fat pad were significantly thicker in middle-aged and elderly individuals than in young adults. When load was applied middle-aged and elderly participants exhibited smaller changes in the macrochamber layer and larger changes in the microchamber layer compared to young adults.

Interpretation

Our findings suggest that age influences the structural characteristics and response of the heel fat pad to mechanical loading. Thicker heel fat pad layers in middle-aged and elderly individuals under no-load conditions may reflect age-related changes in fat distribution or composition. Moreover, differences in load-induced thickness changes indicate altered mechanical properties with age, potentially affecting shock absorption and overall foot function. Understanding these age-related variations can help develop interventions aimed at preserving foot health and mobility across the lifespan.

背景本研究旨在调查跟部脂肪垫微腔和大腔层与年龄有关的变化，尤其关注负荷引起的变化。方法将 55 名健康人分为三个年龄组：青壮年（≤29 岁）、中年人（30-44 岁）和老年人（≥45 岁）。利用超声波成像技术测量不同负荷条件下足跟脂肪垫微腔和大腔层的厚度。结果在无负荷条件下，中老年人足跟脂肪垫的微腔层和大腔层都明显比年轻人厚。我们的研究结果表明，年龄会影响足跟脂肪垫的结构特征和对机械负荷的反应。在无负荷条件下，中老年人较厚的足跟脂肪垫层可能反映了与年龄相关的脂肪分布或组成的变化。此外，负荷引起的厚度变化差异表明，随着年龄的增长，机械性能也会发生变化，从而可能影响冲击吸收和足部的整体功能。了解这些与年龄相关的变化有助于制定干预措施，以保护足部健康和整个生命周期的活动能力。

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引用次数: 0

The effect of foot orientation modifications on knee joint biomechanics during daily activities in people with and without knee osteoarthritis 调整脚的方向对膝关节骨关节炎患者和非患者日常活动中膝关节生物力学的影响

IF 1.8 3区医学 Q2 Medicine

Clinical Biomechanics

Pub Date : 2024-06-10 DOI: 10.1016/j.clinbiomech.2024.106287

Yi Wan , Polly McGuigan , James Bilzon , Logan Wade

Background

Altered gait could influence knee joint moment magnitudes and cumulative damage over time. Gait modifications have been shown to reduce knee loading in people with knee osteoarthritis during walking, although this has not been explored in multiple daily activities. Therefore, this study investigated the effect of different foot orientations on knee loading during multiple daily activities in people with and without knee osteoarthritis.

Methods

Thirty people with knee osteoarthritis and twenty-nine without (control) performed walking, stair ambulation and sit-to-stand across a range of foot progression angles (neutral, toe-in, toe-out and preferred). Peak knee adduction moment, knee adduction moment impulse and knee pain were compared across a continuous range of foot orientations, between activities, and groups.

Findings

Increased foot progression angle (more toe-in) reduced 1st peak knee adduction moment across all activities in both knee osteoarthritis and control (P < 0.001). There was a greater reduction in knee adduction moment in the control group during walking and stair ambulation (P ≤ 0.006), where the knee osteoarthritis group already walked preferably less toe-out than the control group. Under preferred condition, stair descent had the greatest knee loading and knee pain compared to other activities.

Interpretation

Although increased foot progression angle (toward toe-in) appeared to be more effective in reducing knee loading for all activities, toe-in modification might not benefit stair ambulation. Future gait modification should likely be personalised to each patient considering the individual difference in preferred gait and knee alignment required to shift the loading medially or laterally.

背景步态的改变可能会影响膝关节力矩的大小，并随着时间的推移产生累积性损伤。已有研究表明，步态调整可减轻膝关节骨性关节炎患者在行走时的膝关节负荷，但尚未对其在多种日常活动中的表现进行研究。因此，本研究调查了膝关节骨性关节炎患者和非膝关节骨性关节炎患者在进行多种日常活动时，不同的足部方向对膝关节负荷的影响。在连续的足向范围内、不同活动和不同组别之间，对膝关节内收力矩峰值、膝关节内收力矩脉冲和膝关节疼痛进行了比较。研究结果在所有活动中，膝关节骨性关节炎患者和对照组的足向角度增加（更多的趾内收）会降低膝关节内收力矩的第一峰值（P < 0.001）。对照组在步行和下楼梯时膝关节内收力矩的减少幅度更大（P ≤ 0.006），而膝关节骨性关节炎组在步行时已经比对照组更倾向于减少足尖外展。在首选条件下，与其他活动相比，下楼梯的膝关节负荷最大，膝关节疼痛也最严重。释义虽然在所有活动中，增加脚的前进角度（趾入式）似乎更能有效减少膝关节负荷，但趾入式步态的改变可能不会有利于下楼梯。考虑到每位患者在偏好的步态和膝关节对齐方式上的个体差异，未来的步态调整应根据每位患者的具体情况进行个性化调整，以实现负荷的内侧或外侧转移。

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引用次数: 0

Gait classification of knee osteoarthritis patients using shoe-embedded internal measurement units sensor 使用鞋内嵌入式测量单元传感器对膝关节骨性关节炎患者进行步态分类

IF 1.8 3区医学 Q2 Medicine

Clinical Biomechanics

Pub Date : 2024-06-04 DOI: 10.1016/j.clinbiomech.2024.106285

Ahmed Raza , Yusuke Sekiguchi , Haruki Yaguchi , Keita Honda , Kenichiro Fukushi , Chenhui Huang , Kazuki Ihara , Yoshitaka Nozaki , Kentaro Nakahara , Shin-Ichi Izumi , Satoru Ebihara

Background

Knee osteoarthritis negatively affects the gait of patients, especially that of elderly people. However, the assessment of wearable sensors in knee osteoarthritis patients has been under-researched. During clinical assessments, patients may change their gait patterns under the placebo effect, whereas wearable sensors can be used in any environment.

Methods

Sixty patients with knee osteoarthritis and 20 control subjects were included in the study. Wearing shoes with an IMU sensor embedded in the insoles, the participants were required to walk along a walkway. The sensor data were collected during the gait. To discriminate between healthy and knee osteoarthritis patients and to classify different subgroups of knee osteoarthritis patients (patients scheduled for surgery vs. patients not scheduled for surgery; bilateral knee osteoarthritis diagnosis vs. unilateral knee osteoarthritis diagnosis), we used a machine learning approach called the support vector machine. A total of 88 features were extracted and used for classification.

Findings

The patients vs. healthy participants were classified with 71% accuracy, 85% sensitivity, and 56% specificity. The “patients scheduled for surgery” vs. “patients not scheduled for surgery” were classified with 83% accuracy, 83% sensitivity, and 81% specificity. The bilateral knee osteoarthritis diagnosis vs. unilateral knee osteoarthritis diagnosis was classified with 81% accuracy, 75% sensitivity, and 79% specificity.

Interpretation

Gait analysis using wearable sensors and machine learning can discriminate between healthy and knee osteoarthritis patients and classify different subgroups with reasonable accuracy, sensitivity, and specificity. The proposed approach requires no complex gait factors and is not limited to controlled laboratory settings.

背景膝关节骨关节炎对患者的步态有负面影响，尤其是老年人。然而，对膝关节骨关节炎患者使用可穿戴传感器进行评估的研究一直不足。在临床评估中，患者可能会在安慰剂效应下改变步态，而可穿戴传感器可以在任何环境下使用。受试者穿上鞋垫内嵌 IMU 传感器的鞋子，在人行道上行走。在步态过程中收集传感器数据。为了区分健康膝关节骨关节炎患者和膝关节骨关节炎患者，并对膝关节骨关节炎患者的不同亚组（计划手术患者与未计划手术患者；诊断为双侧膝关节骨关节炎与诊断为单侧膝关节骨关节炎）进行分类，我们使用了一种名为支持向量机的机器学习方法。结果患者与健康参与者的分类准确率为 71%，灵敏度为 85%，特异性为 56%。计划手术患者 "与 "未计划手术患者 "的分类准确率为 83%，灵敏度为 83%，特异性为 81%。使用可穿戴传感器和机器学习进行步态分析，可以区分健康患者和膝关节骨关节炎患者，并以合理的准确性、灵敏度和特异性对不同亚组进行分类。所提出的方法不需要复杂的步态因素，也不局限于受控实验室环境。

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引用次数: 0