Neuromuscular control during gait in people with haemophilic arthropathy

Abstract

Introduction Effects of haemophilic arthropathy on neuromuscular control during gait are currently unknown. Aims (a) To assess how haemophilic arthropathy affects the complexity of neuromuscular control during gait; (b) To investigate the relationship between complexity of neuromuscular control and joint impairment. Methods Thirteen control subjects (CG) walked overground at their preferred and a slow velocity and thirteen people with haemophilic arthropathy (PWHA) walking at their preferred velocity. Surface electromyography (EMG) was collected from eleven leg muscles. Electromyography variance explained by muscle synergies (sets of co‐activated muscles that can be recruited by a single signal) was calculated by the total variance accounted (tVAF). Three measures were used to evaluate complexity of neuromuscular control: (a) the number of synergies required for tVAF > 90%, (b) tVAF as a function of the number of muscle synergies, and (c) the dynamic motor control index (Walk‐DMC). Impairment of ankle and knee joints was determined by the Haemophilia Joint Health Score (HJHS). Results The same number of the muscle synergies was found for each group (P > 0.05). For both walking velocities tested, tVAF1 was higher in PHWA (P < 0.05). The Walk‐DMC of PWHA was lower than that of the CG for both walking velocities (P < 0.05). For PWHA, no significant correlation was found between HJHS (sum knee and ankle) and Walk‐DMC index (r = −0.32, P = 0.28). Conclusions These results indicate differences between PWHA and CG in the neuromuscular control of gait. The Walk‐DMC and tVAF1 may be useful measures to assess changes in neuromuscular control in response to treatment.

Effects of performing dual tasks on postural sway and postural control complexity in people with haemophilic arthropathy

“…36 Increased sway balance in the V axis, which was observed in PWHA, may explained by impairments of proprioception and knee extensor force in these individuals [1,2], as well as altered coordination that occurs between knee extensors and flexors. 30,31 Regarding to complexity of postural control, we observed reduced values in PWHA exclusively in the V axis in comparison to HAG and HNAG. This suggests that PWHA require increased levels of attention to maintain the angular knee configurations, which may be due to impairments in knee muscle control.…”

“…Also, the value can be used to predict multiple falls in elderly individuals . Increased sway balance in the V axis, which was observed in PWHA, may explained by impairments of proprioception and knee extensor force in these individuals [1, 2], as well as altered coordination that occurs between knee extensors and flexors …”

“…The most affected leg assessed by HJHS was used for the one‐leg stance test in PWHA, while the dominant leg of each healthy individual was used. The dominant leg was determined by asking subjects which leg they preferred using to kick a ball …”

“…The dominant leg was determined by asking subjects which leg they preferred using to kick a ball. 30,31 For the one-leg stance test, subjects stood one metre from the wall, with their vision focused on a 3 × 3 cm mark that was placed on the wall at eye-level. Then, participants were instructed to stand on one leg with a straight knee by lifting their opposite foot for 30 seconds with their arms crossed at the chest and eyes open.…”

The Progression of Hemophilic Arthropathy: The Role of Biomarkers

“…As highlighted in a recent review [ 14 ], gait analysis is a promising tool to detect early walking changes with a non-invasive and well-tolerated examination especially in the pediatric population [ 15 , 16 , 17 , 18 , 19 , 20 ]. In adulthood, this technique may be also useful to help detect walking worsening in patients with a known diagnosis of arthropathy [ 21 , 22 , 23 ].…”