Sagittal and frontal lower limb joint moments during stair ascent and descent in young and older adults

Novak, Alison C.; Brouwer, Brenda

doi:10.1016/j.gaitpost.2010.09.024

Cited by 103 publications

(81 citation statements)

References 27 publications

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“…For peak joint moment magnitudes, values of both limbs in our study were within the range of values reported for young and healthy older adults [10,18,29,31] (Table 4). Patients with UKA, regardless of limb or operated compartment, also demonstrated moment patterns typical of those reported in the literature [10,18,24,25,28,29,31]. We believe that the two joint moment patterns displayed for each axis are not atypical, as they have been observed in other stair ascent studies of healthy, younger (Pattern 1) and older (Pattern 2) adults [10,18,24,25,28,29,31].…”

Section: Discussionsupporting

confidence: 80%

“…Patients with UKA, regardless of limb or operated compartment, also demonstrated moment patterns typical of those reported in the literature [10,18,24,25,28,29,31]. We believe that the two joint moment patterns displayed for each axis are not atypical, as they have been observed in other stair ascent studies of healthy, younger (Pattern 1) and older (Pattern 2) adults [10,18,24,25,28,29,31]. The presence of Pattern 2 has been attributed to lack of muscle strength in older populations [8,29].…”

Section: Discussionsupporting

confidence: 76%

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Knee Moments After Unicompartmental Knee Arthroplasty During Stair Ascent

Simpson

Brown

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background For unicompartmental knee arthroplasty (UKA), abnormal loading on the tibiofemoral joint could exacerbate knee osteoarthritis or implant wear. Joint moments are an indirect measure of such loading. However, little is known about knee moments of patients with UKA, tempering enthusiasm for its use. Questions/purposes In patients with UKAs performing stair ascent, we (1) determined whether interlimb differences for knee moments are demonstrated, (2) described the knee kinetics of patients with medial and lateral UKAs, and (3) investigated possible factors that might influence the knee abductor moments. Methods In our cross-sectional study, we recruited 26 patients with UKA with nondiseased contralateral limbs who performed stair ascent. Seventeen patients had medial UKAs and nine had lateral UKAs. Paired t-tests and CIs were applied to determine interlimb differences within each UKA group for peak knee moments and times to peak moments. Results During stair ascent, the medial UKA group displayed greater peak extensor moments for the nondiseased compared to the UKA limb (p = 0.030), whereas the lateral UKA group did not (p = 0.087). For both medial and lateral UKA groups, the UKA limb demonstrated greater internal peak abductor moments (p = 0.005 and 0.013, respectively). Both UKA groups exhibited knee moments similar to those in the literature. Limb dominance and postoperative time were correlated for both UKA groups. Conclusions Reduced knee extensor moments of limbs with UKA displayed by some participants may indicate less compressive loading on the tibiofemoral joint surfaces,

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 76%

Knee Moments After Unicompartmental Knee Arthroplasty During Stair Ascent

Simpson

Brown

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…During stair walking, the ankle and knee extensors are the primary muscles controlling the motion of the body (14)(15)(16). The timing of when these muscles are switched on (activated) is therefore key to the safe performance of these movements.…”

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confidence: 99%

Contributory Factors to Unsteadiness During Walking Up and Down Stairs in Patients With Diabetic Peripheral Neuropathy

et al. 2014

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OBJECTIVEAlthough patients with diabetic peripheral neuropathy (DPN) are more likely to fall than age-matched controls, the underlying causative factors are not yet fully understood. This study examines the effects of diabetes and neuropathy on strength generation and muscle activation patterns during walking up and down stairs, with implications for fall risk. RESEARCH DESIGN AND METHODSSixty-three participants (21 patients with DPN, 21 diabetic controls, and 21 healthy controls) were examined while walking up and down a custom-built staircase. The speed of strength generation at the ankle and knee and muscle activation patterns of the ankle and knee extensor muscles were analyzed. RESULTSPatients with neuropathy displayed significantly slower ankle and knee strength generation than healthy controls during stair ascent and descent (P < 0.05). During ascent, the ankle and knee extensor muscles were activated significantly later by patients with neuropathy and took longer to reach peak activation (P < 0.05). During descent, neuropathic patients activated the ankle extensors significantly earlier, and the ankle and knee extensors took significantly longer to reach peak activation (P < 0.05). CONCLUSIONSPatients with DPN are slower at generating strength at the ankle and knee than control participants during walking up and down stairs. These changes, which are likely caused by altered activations of the extensor muscles, increase the likelihood of instability and may be important contributory factors for the increased risk of falling. Resistance exercise training may be a potential clinical intervention for improving these aspects and thereby potentially reducing fall risk.Diabetic peripheral neuropathy (DPN) is a chronic complication of diabetes, affecting up to 50% of older patients (1,2). It is characterized by sensory loss in the lower limbs, altered sense of joint position, and impaired muscular function, which can result in alterations to gait (1-5). Patients with neuropathy are five times more likely to fall than age-matched controls, with over half of patients reporting at least one fall per year (6,7). Falls while walking down stairs account for 60% of all fall-related deaths, making this activity 10 times more hazardous than level-ground walking (8).

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“…The temporospatial analysis of level walking, climbing ramps of different angles, and stair climbing showed there were significant differences in velocity, stride length, cadence, support time, step length, and double support time. In previous research, cadence and step length significantly decreased as the ramp angle increased 19) , and both cadence and support time significantly increased in the elderly compared to young adults during ramp gait 18) . In the present study, when the ramp angle increased to 1:6, velocity and cadence showed significant differences, and all variables differed significantly when the subjects climbed the stairs.…”

Section: Discussionmentioning

confidence: 67%

“…Going up stairs is an essential skill for functional, independent movement, but the high risk of fall makes it a difficult task 18) . In this study, the angles of the ramps were 1:12, 1:8, and 1:6, in order to investigate the gait patterns of different external conditions.…”

Section: Discussionmentioning

confidence: 99%

A Kinematic Analysis of Patients with Knee Osteoarthritis during Gait on Level Ground, Ramps and Stairs

Son

Kim

2013

J Phys Ther Sci

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Abstract.[Purpose] The purpose of this study was to examine the biomechanical changes in the lower extremities of patients with degenerative knee osteoarthritis during gait on level ground, ramps, and stairs. [Methods] Fourteen elderly patients with degenerative osteoarthritis walked on flat ground, ramps of varying angles (1:12, 1:8, 1:6), and climbed stairs. Gait analysis equipment was used for kinematic analysis of the lower extremities to assess the temporospatial variables and the kinematic variables.[Results] The velocity, stride length, cadence, support time, step length, and double support time but not stride width of degenerative arthritis patients significantly differed among level walking, ramp climbing, and stair climbing. In terms of the kinematic variables, the flexion angles of the hip joints, knee joints, and ankle joints differed significantly according to the timing of the gait. [Conclusion] The results show that patients with degenerative osteoarthritis had more difficulty with gait on stairs or ramps of high inclination than on flat ground. This study provides data for use in basic research into safe gait on stairs and ramps for patients with degenerative osteoarthritis.

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Sagittal and frontal lower limb joint moments during stair ascent and descent in young and older adults

Cited by 103 publications

References 27 publications

Knee Moments After Unicompartmental Knee Arthroplasty During Stair Ascent

Knee Moments After Unicompartmental Knee Arthroplasty During Stair Ascent

Contributory Factors to Unsteadiness During Walking Up and Down Stairs in Patients With Diabetic Peripheral Neuropathy

A Kinematic Analysis of Patients with Knee Osteoarthritis during Gait on Level Ground, Ramps and Stairs

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