Gait retraining using real-time feedback in patients with medial knee osteoarthritis: Feasibility and effects of a six-week gait training program

Richards, R.; Noort, Josien C. van den; Esch, M. van der; Booij, M.J.; Harlaar, Jaap

doi:10.1016/j.knee.2018.05.014

Cited by 55 publications

(35 citation statements)

References 60 publications

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“…15 Many of the interventions for KOA aim to reduce the KAM and the load transferred through the medial compartment of the knee. These interventions include weight-bearing, 17 gait-training, [18][19][20] and neuromuscular exercises. 21 Most exercises concentrated on strengthening the muscles in the sagittal plane, failed to demonstrated significant decreases of KAM, 17,18,21,22 while a few concentrated on frontal plane movement, like walking in a toe-in or a wider base gait, showed a significant decrease of KAM.…”

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confidence: 99%

“…21 Most exercises concentrated on strengthening the muscles in the sagittal plane, failed to demonstrated significant decreases of KAM, 17,18,21,22 while a few concentrated on frontal plane movement, like walking in a toe-in or a wider base gait, showed a significant decrease of KAM. 19,20 Strengthening lower extremity muscles in the frontal 22 or horizontal 18 planes may be an effective and noninvasive treatment for KOA.…”

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confidence: 99%

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Proprioceptive neuromuscular facilitation improves pain and descending mechanics among elderly with knee osteoarthritis

Song

Shen

Mao

et al. 2020

Scandinavian Med Sci Sports

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Purpose Knee osteoarthritis (KOA) is a common disease that causes pain and limits functionality in the elderly during daily activities, especially during stair descent. Proprioceptive neuromuscular facilitation (PNF) practices promote multiple‐plane joint movements, which relieve pain and increase joint range of motion (ROM). This study aims to examine the effects of a 12‐week PNF intervention on pain relief, passive and active joint ROM, external knee adduction moment (KAM), and hip adduction moment (HAM) in the elderly with KOA during stair descent. Materials and Methods Seventy‐six elderly who were diagnosed with KOA were assessed for eligibility and, 36 of them met the inclusive criteria, were randomly divided into two groups: the twelve‐week PNF intervention group and the control group. Pain score was measured by the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Passive joint ROM was measured using a goniometer. Active joint ROM, KAM, and HAM during stair descent were measured using a motion analysis system with a force platform. All the data were recorded at weeks 0, 6, and 12. Results Compared to the control group, the PNF group showed a decreased pain score; increased passive hip, knee, and ankle ROM; a decreased minimum knee flexion angle, and increased HAM during stair descent. Perspective Proprioceptive neuromuscular facilitation intervention is a successful method to relieve symptoms of KOA. It relieves pain without increasing KAM, enhances passive ROM, increases active knee flexion ROM, and increases HAM during stair descent in the elderly with KOA.

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Proprioceptive neuromuscular facilitation improves pain and descending mechanics among elderly with knee osteoarthritis

Song

Shen

Mao

et al. 2020

Scandinavian Med Sci Sports

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“…Biofeedback gait retraining has been shown to be effective in reducing KAM [5], [13]. There are two primary approaches to biofeedback gait retraining to reduce the KAM: direct biofeedback of the KAM and indirect biofeedback of secondary gait parameters that influence the KAM.…”

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confidence: 99%

Mapping-Based Dosage of Gait Modification Selection for Multi-Parameter, Subject-Specific Gait Retraining

Cao

Shi

et al. 2020

IEEE Access

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Gait retraining to reduce knee loading has been proposed as a conservative treatment option for early-stage knee osteoarthritis. Mounting evidence suggests that a subject-specific approach may be most effective for ensuring consistent knee loading reductions across all individuals within a population. However, it is currently unclear how to determine the required gait modification dosage selection type and amount to both reduce knee loading and satisfy individual preferences. To overcome this challenge, we introduce a novel, mapping-based dosage selection approach to systematically determine multi-parameter gait modifications to reduce knee loading while maintaining individual user preference. In this approach, individuals first explore different dosages of multi-parameter gait modifications, and then a resulting visual map is displayed with a subject-specific dosage selection zone for the target knee loading reduction. Subjects then self-select a preferred gait within their dosage selection zone. To evaluate the feasibility of this approach, fifteen healthy subjects and one knee OA patient performed walking trials on a treadmill involving various dosages of gait modifications to foot progression angle and step width. Subjects quickly selected the subject-specific gait modifications via mapping-based dosage selection during a single 6 min trial, which reduced the knee adduction moment by an average of 14.2%. Resulting subject-specific gait modifications varied, with 6 subjects selecting only toe-in, 5 subjects selecting both toe-in and increased step width, 2 subjects selecting only toe-out, 1 subject selecting both toe-out and increased step width and 1 subject selecting only increased step width. Average perceived exertion was "fairly light" (index was 10.5±2.2). The knee OA patient selected only toe-in and reduced the knee adduction moment by 12.8%. The presented mapping-based dosage selection approach could provide a systematic and practical means to determine subject-specific gait modifications while maintaining individual preferences.

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“…This permitted us to examine the use of such a system for gait retraining to provide real-time 423 biofeedback to the user. The added value of a gait retraining system needs to be further examined in the long-run, especially for reducing joint reaction loads in patients with osteoarthritis [25,38]. the muscle forces in real-time is the most computationally expensive operation presented in this 479 pipeline.…”

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Real-Time Musculoskeletal Kinematics and Dynamics Analysis Using Marker- and IMU-based Solutions in Rehabilitation

Stanev¹,

Filip²,

Bitzas³

et al. 2021

Preprint

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This study aims to explore the possibility of estimating a multitude of kinematic and dynamic quantities using subject-specific musculoskeletal models in real-time. The framework was designed to operate with marker-based and inertial measurement units enabling extensions far beyond dedicated motion capture laboratories. We present the technical details for calculating the kinematics, generalized forces, muscle forces, joint reaction loads, and predicting ground reaction wrenches during walking. Emphasis was given to reduce computational latency while maintaining accuracy as compared to the offline counterpart. Notably, we highlight the influence of adequate filtering and differentiation under noisy conditions and its importance for consequent dynamic calculations. Real-time estimates of the joint moments, muscle forces, and reaction loads closely resemble OpenSim's offline analyses. Model-based estimation of ground reaction wrenches demonstrates that even a small error can negatively affect other estimated quantities. An application of the developed system is demonstrated in the context of rehabilitation and gait retraining. We expect that such a system will find numerous applications in laboratory settings and outdoor conditions with the advent of predicting or sensing environment interactions. Therefore, we hope that this open-source framework will be a significant milestone for solving this grand challenge.

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Gait retraining using real-time feedback in patients with medial knee osteoarthritis: Feasibility and effects of a six-week gait training program

Cited by 55 publications

References 60 publications

Proprioceptive neuromuscular facilitation improves pain and descending mechanics among elderly with knee osteoarthritis

Proprioceptive neuromuscular facilitation improves pain and descending mechanics among elderly with knee osteoarthritis

Mapping-Based Dosage of Gait Modification Selection for Multi-Parameter, Subject-Specific Gait Retraining

Real-Time Musculoskeletal Kinematics and Dynamics Analysis Using Marker- and IMU-based Solutions in Rehabilitation

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