Effects of an over-ground exoskeleton on external knee moments during stance phase of gait in healthy adults

McGibbon, Chris A.; Brandon, Scott C.E.; Brookshaw, Marcus; Sexton, Andrew

doi:10.1016/j.knee.2017.04.004

Cited by 29 publications

(18 citation statements)

References 72 publications

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“…Therefore, KJD could be a promising, clinically available therapy for OA patients, based on the reduction of mechanical stimuli to prevent OA development. In addition, exoskeletons have also shown promise in modifying the biomechanical environment of the knee in OA patients (Mcgibbon et al, 2017).…”

Section: Responders To Mechanical Stimulimentioning

confidence: 99%

Subchondral Bone Remodeling: A Therapeutic Target for Osteoarthritis

Zhu

Chan

Yung

et al. 2021

Front. Cell Dev. Biol.

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There is emerging awareness that subchondral bone remodeling plays an important role in the development of osteoarthritis (OA). This review presents recent investigations on the cellular and molecular mechanism of subchondral bone remodeling, and summarizes the current interventions and potential therapeutic targets related to OA subchondral bone remodeling. The first part of this review covers key cells and molecular mediators involved in subchondral bone remodeling (osteoclasts, osteoblasts, osteocytes, bone extracellular matrix, vascularization, nerve innervation, and related signaling pathways). The second part of this review describes candidate treatments for OA subchondral bone remodeling, including the use of bone-acting reagents and the application of regenerative therapies. Currently available clinical OA therapies and known responses in subchondral bone remodeling are summarized as a basis for the investigation of potential therapeutic mediators.

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Section: Responders To Mechanical Stimulimentioning

confidence: 99%

Subchondral Bone Remodeling: A Therapeutic Target for Osteoarthritis

Zhu

Chan

Yung

et al. 2021

Front. Cell Dev. Biol.

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“…A 3D inverse dynamics model of the lower-leg and foot (McGibbon et al, 2017) was used to compute net forces at the knee joint. Then, a sagittal plane model of the knee (O'Connor et al, 1989), as shown in Figure 2, was used to resolve muscle tendon forces, cruciate ligament forces, and joint contact forces in the sagittal plane.…”

Section: Lower Leg and Knee Modelmentioning

confidence: 99%

Biomechanical Study of a Tricompartmental Unloader Brace for Patellofemoral or Multicompartment Knee Osteoarthritis

McGibbon

Brandon

Bishop

et al. 2021

Front. Bioeng. Biotechnol.

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Objective: Off-loader knee braces have traditionally focused on redistributing loads away from either the medial or lateral tibiofemoral (TF) compartments. In this article, we study the potential of a novel “tricompartment unloader” (TCU) knee brace intended to simultaneously unload both the patellofemoral (PF) and TF joints during knee flexion. Three different models of the TCU brace are evaluated for their potential to unload the knee joint.Methods: A sagittal plane model of the knee was used to compute PF and TF contact forces, patellar and quadriceps tendon forces, and forces in the anterior and posterior cruciate ligaments during a deep knee bend (DKB) test using motion analysis data from eight participants. Forces were computed for the observed (no brace) and simulated braced conditions. A sensitivity and validity analysis was conducted to determine the valid output range for the model, and Statistical Parameter Mapping was used to quantify the effectual region of the different TCU brace models.Results: PF and TF joint force calculations were valid between ~0 and 100 degrees of flexion. All three simulated brace models significantly (p < 0.001) reduced predicted knee joint loads (by 30–50%) across all structures, at knee flexion angles >~30 degrees during DKB.Conclusions: The TCU brace is predicted to reduce PF and TF knee joint contact loads during weight-bearing activity requiring knee flexion angles between 30 and 100 degrees; this effect may be clinically beneficial for pain reduction or rehabilitation from common knee injuries or joint disorders. Future work is needed to assess the range of possible clinical and prophylactic benefits of the TCU brace.

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“…This is not surprising, considering the device has mass and inertia to overcome, and has some inherent stiffness, which has been documented in a biomechanical study of healthy adults using the Keeogo [34]. Even though it was found in healthy subjects that gait speed did not differ significantly between trials when wearing and not wearing the Keeogo, the small difference that did exist (.06 m/s) when extrapolated to a 6MWTwould result in a distance deficit of − 21.6 m. This is approximately the deficit we saw for the performance effect (− 22 m) for patients with MS 6MWT when initially using Keeogo.…”

Section: Discussionmentioning

confidence: 92%

Evaluation of the Keeogo exoskeleton for assisting ambulatory activities in people with multiple sclerosis: an open-label, randomized, cross-over trial

McGibbon

Sexton

Jayaraman

et al. 2018

J NeuroEngineering Rehabil

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BackgroundAlthough physical activity and exercise is known to benefit people with multiple sclerosis (MS), the ability of these individuals to participate in such interventions is difficult due to the mobility impairments caused by the disease. Keeogo is a lower-extremity powered exoskeleton that may be a potential solution for enabling people with MS to benefit from physical activity and exercise.MethodsAn open-label, randomized, cross-over trial was used to examine the immediate performance effects when using the device, and the potential benefits of using the device in a home setting for 2 weeks. Clinical performance tests with and without the device included the 6 min walk test, timed up and go test and the 10-step stair test (up and down). An activity monitor was also used to measure physical activity at home, and a patient-reported questionnaire was used to determine the amount and extent of home use. Generalized linear models were used to test for trial effects, and correlation analysis used to examine relationships between trial effects and usage.ResultsTwenty-nine patients with MS participated. All measures showed small decrements in performance while wearing the device compared to not wearing the device. However, significant improvements in unassisted (Rehab effect) performance were found after using the device at home for 2 weeks, compared to 2 weeks at home without the device, and participants improved their ability to use the device over the trial period (Training effect). Rehab and Training effects were related to the self-reported extent that participants used Keeogo at home.ConclusionsKeeogo appears to deliver an exercise-mediated benefit to individuals with MS that improved their unassisted gait endurance and stair climbing ability. Keeogo might be a useful tool for delivering physical activity interventions to individuals with mobility impairment due to MS.Trial registrationClinicalTrials.gov: NCT02904382. Registered 19 September 2016 - Retrospectively registered.

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Effects of an over-ground exoskeleton on external knee moments during stance phase of gait in healthy adults

Cited by 29 publications

References 72 publications

Subchondral Bone Remodeling: A Therapeutic Target for Osteoarthritis

Subchondral Bone Remodeling: A Therapeutic Target for Osteoarthritis

Biomechanical Study of a Tricompartmental Unloader Brace for Patellofemoral or Multicompartment Knee Osteoarthritis

Evaluation of the Keeogo exoskeleton for assisting ambulatory activities in people with multiple sclerosis: an open-label, randomized, cross-over trial

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