Investigating the Effect of Real-Time Center of Pressure (CoP) Feedback Training on the Swing Phase of Lower Limb Kinematics in Transfemoral Prostheses with SACH foot

2021 ◽  
Author(s):  
Ashutosh Tiwari ◽  
Abhijeet Kujur ◽  
Jyoti Kumar ◽  
Deepak Joshi
Keyword(s):  
Real Time ◽  
Lower Limb ◽  
Knee Flexion ◽  
Center Of Pressure ◽  
Feedback System ◽  
Swing Phase ◽  
Flexion Angle ◽  
Heel Strike ◽  
Knee Flexion Angle ◽  
Joint Angles

Abstract Transfemoral amputee often encounters reduced toe clearance resulting in trip-related falls. Swing phase joint angles have been shown to influence the toe clearance therefore, training intervention that targets shaping the swing phase joint angles can potentially enhance toe clearance. The focus of this study was to investigate the effect of the shift in the location of the center of pressure (CoP) during heel strike on modulation of the swing phase joint angles in able-bodied participants (n=6) and transfemoral amputees (n=3). We first developed a real-time CoP-based visual feedback system such that participants could shift the CoP during treadmill walking. Next, the kinematic data were collected during two different walking sessions- baseline (without feedback) and feedback (shifting the CoP anteriorly/posteriorly at heel strike to match the target CoP location). Primary swing phase joint angle adaptations were observed with feedback such that during the mid-swing phase, posterior CoP shift feedback significantly increases (p<0.05) the average hip and knee flexion angle by 11.55 degrees and 11.86 degrees respectively in amputees, whereas a significant increase (p<0.05) in ankle dorsiflexion, hip and knee flexion angle by 3.60 degrees, 3.22 degrees, and 1.27 degrees respectively compared to baseline was observed in able-bodied participants. Moreover, an opposite kinematic adaptation was seen during anterior CoP shift feedback. Overall, results confirm a direct correlation between the CoP shift and the modulation in the swing phase lower limb joint angles.

scholarly journals Effect of Leg Extension Angle on Knee Flexion Angle during Swing Phase in Post-Stroke Gait

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1222
Author(s):  
Yuta Matsuzawa ◽  
Takasuke Miyazaki ◽  
Yasufumi Takeshita ◽  
Naoto Higashi ◽  
Hiroyuki Hayashi ◽  
...  
Keyword(s):  
Correlation Analysis ◽  
Lower Limb ◽  
Knee Flexion ◽  
Swing Phase ◽  
Flexion Angle ◽  
Knee Flexion Angle ◽  
Stroke Patients ◽  
Leg Extension ◽  
Post Stroke ◽  
The Relationship

Background and Objectives: Leg extension angle is important for increasing the propulsion force during gait and is a meaningful indicator for evaluating gait quality in stroke patients. Although leg extension angle during late stance might potentially also affect lower limb kinematics during the swing phase, the relationship between these two remains unclear. This study aimed to investigate the relationship between leg extension angle and knee flexion angle during pre-swing and swing phase in post-stroke gait. Materials and Methods: Twenty-nine stroke patients walked along a 16 m walkway at a self-selected speed. Tilt angles and acceleration of pelvis and paretic lower limb segments were measured using inertial measurement units. Leg extension angle, consisting of a line connecting the hip joint with the ankle joint, hip and knee angles, and increments of velocity during pre-swing and swing phase were calculated. Correlation analysis was conducted to examine the relationships between these parameters. Partial correlation analysis adjusted by the Fugl-Meyer assessment-lower limb (FMA-LL) was also performed. Results: On the paretic side, leg extension angle was positively correlated with knee flexion angle during the swing phase (r = 0.721, p < 0.001) and knee flexion angle and increments of velocity during the pre-swing phase (r = 0.740–0.846, p < 0.001). Partial correlation analysis adjusted by the FMA-LL showed significant correlation between leg extension angle and knee flexion angle during the swing phase (r = 0.602, p = 0.001) and knee flexion angle and increments of velocity during the pre-swing phase (r = 0.655–0.886, p < 0.001). Conclusions: Leg extension angle affected kinematics during the swing phase in post-stroke gait regardless of the severity of paralysis, and was similar during the pre-swing phase. These results would guide the development of effective gait training programs that enable a safe and efficient gait for stroke patients.

scholarly journals Kinematic Comparison between Medially Congruent and Posterior-Stabilized Third-Generation TKA Designs

2021 ◽  
Vol 6 (1) ◽  
pp. 27
Author(s):  
Stefano Ghirardelli ◽  
Jessica L. Asay ◽  
Erika A. Leonardi ◽  
Tommaso Amoroso ◽  
Thomas P. Andriacchi ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Knee Kinematics ◽  
Primary Total Knee Arthroplasty ◽  
Flexion Angle ◽  
Heel Strike ◽  
Third Generation ◽  
Knee Flexion Angle ◽  
Posterior Stabilized ◽  
Rotational Angle ◽  
Peak Knee

Background: This study compares knee kinematics in two groups of patients who have undergone primary total knee arthroplasty (TKA) using two different modern designs: medially congruent (MC) and posterior-stabilized (PS). The aim of the study is to demonstrate only minimal differences between the groups. Methods: Ten TKA patients (4 PS, 6 MC) with successful clinical outcomes were evaluated through 3D knee kinematics analysis performed using a multicamera optoelectronic system and a force platform. Extracted kinematic data included knee flexion angle at heel-strike (KFH), peak midstance knee flexion angle (MSKFA), maximum and minimum knee adduction angle (KAA), and knee rotational angle at heel-strike. Data were compared with a group of healthy controls. Results: There were no differences in preferred walking speed between MC and PS groups, but we found consistent differences in knee function. At heel-strike, the knee tended to be more flexed in the PS group compared to the MC group; the MSKFA tended to be higher in the PS group compared to the MC group. There was a significant fluctuation in KAA during the swing phase in the PS group compared to the MC group, PS patients showed a higher peak knee flexion moment compared to MC patients, and the PS group had significantly less peak internal rotation moments than the MC group. Conclusions: Modern, third-generation TKA designs failed to reproduce normal knee kinematics. MC knees tended to reproduce a more natural kinematic pattern at heel-strike and during axial rotation, while PS knees showed better kinematics during mid-flexion.

scholarly journals Relationship between Quadriceps Tendon Young’s Modulus and Maximum Knee Flexion Angle in the Swing Phase of Gait in Patients with Severe Knee Osteoarthritis

Medicina ◽  
2020 ◽  
Vol 56 (9) ◽  
pp. 437
Author(s):  
Bungo Ebihara ◽  
Takashi Fukaya ◽  
Hirotaka Mutsuzaki
Keyword(s):  
Young’S Modulus ◽  
Gait Speed ◽  
Knee Flexion ◽  
Young's Modulus ◽  
Quadriceps Tendon ◽  
Swing Phase ◽  
Flexion Angle ◽  
Knee Flexion Angle ◽  
Knee Oa ◽  
Analysis System

Background and objectives: Decreased knee flexion in the swing phase of gait can be one of the causes of falls in severe knee osteoarthritis (OA). The quadriceps tendon is one of the causes of knee flexion limitation; however, it is unclear whether the stiffness of the quadriceps tendon affects the maximum knee flexion angle in the swing phase. The purpose of this study was to clarify the relationship between quadriceps tendon stiffness and maximum knee flexion angle in the swing phase of gait in patients with severe knee OA. Materials and Methods: This study was conducted from August 2018 to January 2020. Thirty patients with severe knee OA (median age 75.0 (interquartile range 67.5–76.0) years, Kellgren–Lawrence grade: 3 or 4) were evaluated. Quadriceps tendon stiffness was measured using Young’s modulus by ShearWave Elastography. The measurements were taken with the patient in the supine position with the knee bent at 60° in a relaxed state. A three-dimensional motion analysis system measured the maximum knee flexion angle in the swing phase. The measurements were taken at a self-selected gait speed. The motion analysis system also measured gait speed, step length, and cadence. Multiple regression analysis by the stepwise method was performed with maximum knee flexion angle in the swing phase as the dependent variable. Results: Multiple regression analysis identified quadriceps tendon Young’s modulus (standardized partial regression coefficients [β] = −0.410; p = 0.013) and gait speed (β = 0.433; p = 0.009) as independent variables for maximum knee flexion angle in the swing phase (adjusted coefficient of determination = 0.509; p < 0.001). Conclusions: Quadriceps tendon Young’s modulus is a predictor of the maximum knee flexion angle. Clinically, decreasing Young’s modulus may help to increase the maximum knee flexion angle in the swing phase in those with severe knee OA.

scholarly journals Influence of body mass and lower limb length on knee flexion angle during walking in humans

2012 ◽  
Vol 61 (3-4) ◽  
pp. 330-339 ◽  
Author(s):  
Martin Hora ◽  
Vladimír Sládek ◽  
Libor Soumar ◽  
Kateřina stráníková ◽  
Tomáš Michálek
Keyword(s):  
Body Mass ◽  
Lower Limb ◽  
Knee Flexion ◽  
Limb Length ◽  
Flexion Angle ◽  
Knee Flexion Angle

Patient-Reported Outcomes and Knee Mechanics Correlate With Patellofemoral Deep Cartilage UTE-T2* 2 Years After Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652098260
Author(s):  
Ashley A. Williams ◽  
Jennifer C. Erhart-Hledik ◽  
Jessica L. Asay ◽  
Gordhan B. Mahtani ◽  
Matthew R. Titchenal ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Patient Reported Outcomes ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Flexion Angle ◽  
Heel Strike ◽  
Knee Flexion Angle ◽  
Patient Reported ◽  
Flexion Moment ◽  
Anterior Cruciate

Background: Patellofemoral joint degeneration and dysfunction after anterior cruciate ligament reconstruction (ACLR) are increasingly recognized as contributors to poor clinical outcomes. Purpose: To determine if greater deep cartilage matrix disruption at 2 years after ACLR, as assessed by elevated patellofemoral magnetic resonance imaging (MRI) ultrashort echo time–enhanced T2* (UTE-T2*), is correlated with (1) worse patient-reported knee function and pain and (2) gait metrics related to patellofemoral tracking and loading, such as greater external rotation of the tibia at heel strike, reduced knee flexion moment (as a surrogate of quadriceps function), and greater knee flexion angle at heel strike. Study Design: Cross-sectional study; Level of evidence, 3. Methods: MRI UTE-T2* relaxation times in patellar and trochlear deep cartilage were compared with patient-reported outcomes and ambulatory gait metrics in 60 patients with ACLR at 2 years after reconstruction. ACLR gait metrics were compared with those of 60 uninjured reference patients matched by age, body mass index, and sex. ACLR UTE-T2* values were compared with those of 20 uninjured reference patients. Results: Higher trochlear UTE-T2* values were associated with worse Knee injury and Osteoarthritis Outcome Scores (KOOS) Sport/Recreation subscale scores (rho = −0.32; P = .015), and showed a trend for association with worse KOOS Pain subscale scores (rho = −0.26; P = .045). At 2 years after ACLR, greater external rotation of the tibia at heel strike was associated with higher patellar UTE-T2* values ( R = 0.40; P = .002); greater knee flexion angle at heel strike was associated with higher trochlear UTE-T2* values (rho = 0.39; P = .002); and greater knee flexion moment showed a trend for association with higher trochlear UTE-T2* values (rho = 0.30; P = .019). Patellar cartilage UTE-T2* values, knee flexion angle at heel strike, and external rotation of the tibia at heel strike were all elevated in ACLR knees as compared with reference knees ( P = .029, .001, and .044, respectively). Conclusion: Patellofemoral deep cartilage matrix disruption, as assessed by MRI UTE-T2*, was associated with reduced sports and recreational function and with gait metrics reflective of altered patellofemoral loading. As such, the findings provide new mechanistic information important to improving clinical outcomes related to patellofemoral dysfunction after ACLR.

Functional stretching decreases knee joint loading in male athletes with gastroc--soleus tightness

2021 ◽  
Keyword(s):  
Knee Joint ◽  
Knee Flexion ◽  
Functional Group ◽  
Daily Activities ◽  
Flexion Angle ◽  
Heel Strike ◽  
Knee Flexion Angle ◽  
Joint Loading ◽  
Male Athletes ◽  
Knee Joint Loading

Background and objective: Tightness of the gastroc--soleus muscle complex is one of the limiting factors of the ankle joint's range of motion (ROM) during daily activities. The aim of this study was to investigate the effectiveness of functional and extra-functional stretching of the gastrocnemius--soleus complex on knee joint loading in athletes with limited ankle dorsiflexion. Material and methods: In this cross-sectional study, 30 male athletes with gastrocnemius--soleus shortness were recruited and randomly divided into three equal-size groups of functional stretching, extra-functional stretching, and a control group. The extra-functional stretching group performed stretching exercises three times per day for eight weeks. The functional stretching group was instructed to change their gait pattern via increased heel strike during daily activities. Results: None of the stretching programs reduced the knee flexion angle in heel contact (p > 0.05). The knee flexion angle was significantly increased in the stance phase in the functional group (p ≤ 0.05). Walking speed was increased significantly in the extra-functional group (p ≤ 0.05). The knee adductor moment and external rotation moment decreased significantly in the functional group (p ≤ 0.05). Conclusion: An eight-week functional stretching program in this study led to a reduction of knee loading in the frontal and horizontal planes in comparison to the extra-functional stretching group, demonstrating the effectiveness of functional stretching in improving knee joint biomechanics during walking.

Joint Torques and Patellofemoral Force During Single-Leg Assisted and Unassisted Cycling

2016 ◽  
Vol 25 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Rodrigo R. Bini ◽  
Tiago C. Jacques ◽  
Marco A. Vaz
Keyword(s):  
Outcome Measures ◽  
Lower Limb ◽  
Knee Flexion ◽  
Compressive Force ◽  
Flexion Angle ◽  
Knee Flexion Angle ◽  
Joint Torques ◽  
Custom Made ◽  
Peak Knee ◽  
Leg Cycling

Context:Unassisted single-leg cycling should be replaced by assisted single-leg cycling, given that this last approach has potential to mimic joint kinetics and kinematics from double-leg cycling. However, there is need to test if assisting devices during pedaling effectively replicate joint forces and torque from double-leg cycling.Objectives:To compare double-leg, single-leg assisted, and unassisted cycling in terms of lower-limb kinetics and kinematics.Design:Cross-sectional crossover.Setting:Laboratory.Participants:14 healthy nonathletes.Interventions:Two double-leg cycling trials (240 ± 23 W) and 2 single-leg trials (120 ± 11 W) at 90 rpm were performed for 2 min using a bicycle attached to a cycle trainer. Measurements of pedal force and joint kinematics of participants’ right lower limb were performed during double- and single-leg trials. For the single-leg assisted trial, a custom-made adaptor was used to attach 10 kg of weight to the contralateral crank.Main Outcome Measures:Peak hip, knee, and ankle torques (flexors and extensors) along with knee-flexion angle and peak patellofemoral compressive force.Results:Reduced peak hip-extensor torque (10%) and increased peak knee-flexor torque (157%) were observed at the single-leg assisted cycling compared with the double-leg cycling. No differences were found for peak patellofemoral compressive force or knee-flexion angle comparing double-leg with single-leg assisted cycling. However, single-leg unassisted cycling resulted in larger peak patellofemoral compressive force (28%) and lower knee-flexion angle (3%) than double-leg cycling.Conclusions:These results suggest that although single-leg assisted cycling differs for joint torques, it replicates knee loads from double-leg cycling.

The Efficacy of Simultaneously Training 2 Motion Targets During a Squat Using Auditory Feedback

2020 ◽  
pp. 1-7
Author(s):  
Rena F. Hale ◽  
Sandor Dorgo ◽  
Roger V. Gonzalez ◽  
Jerome Hausselle
Keyword(s):  
Auditory Feedback ◽  
Knee Flexion ◽  
Center Of Pressure ◽  
Low Cost ◽  
Flexion Angle ◽  
Control Group ◽  
Knee Flexion Angle ◽  
Trained Group ◽  
Performance Development ◽  
And Performance

Auditory feedback is a simple, low-cost training solution that can be used in rehabilitation, motor learning, and performance development. The use has been limited to the instruction of a single kinematic or kinetic target. The goal of this study was to determine if auditory feedback could be used to simultaneously train 2 lower-extremity parameters to perform a bodyweight back squat. A total of 42 healthy, young, recreationally active males participated in a 4-week training program to improve squat biomechanics. The Trained group (n = 22) received 4 weeks of auditory feedback. Feedback focused on knee flexion angle and center of pressure under the foot at maximum squat depth. The Control group (n = 20) performed squats without feedback. Subjects were tested pre, post, and 1 week after training. The Trained group achieved average target knee flexion angle within 1.73 (1.31) deg (P < .001) after training and 5.36 (3.29) deg (P < .01) at retention. While achieving target knee flexion angle, the Trained group maintained target center of pressure (P < .001). The Control group improved knee range of motion, but were not able to achieve both parameter targets at maximum squat depth (P < .90). Results from this study demonstrate that auditory feedback is an effective way to train 2 independent biomechanical targets simultaneously.

scholarly journals A high degree of knee flexion after TKA promotes the ability to perform high-flexion activities and patient satisfaction in Asian population

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hyuk-Soo Han ◽  
Jong Seop Kim ◽  
Bora Lee ◽  
Sungho Won ◽  
Myung Chul Lee
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Clinical Data ◽  
Knee Flexion ◽  
Male Gender ◽  
Flexion Angle ◽  
Knee Flexion Angle ◽  
High Flexion ◽  
Standing Up

Abstract Background This study investigated whether achieving a higher degree of knee flexion after TKA promoted the ability to perform high-flexion activities, as well as patient satisfaction and quality of life. Methods Clinical data on 912 consecutive primary TKA cases involving a single high-flexion posterior stabilized fixed-bearing prosthesis were retrospectively analyzed. Demographic and clinical data were collected, including knee flexion angle, the ability to perform high-flexion activities, and patient satisfaction and quality of life. Results Of the cases, 619 (68%) achieved > 130° of knee flexion after TKA (high flexion group). Knee flexion angle and clinical scores showed significant annual changes, with the maximum improvement seen at 5 years and slight deterioration observed at 10 years postoperatively. In the high flexion group, more than 50% of the patients could not kneel or squat, and 35% could not stand up from on the floor. Multivariate analysis revealed that > 130° of knee flexion, the ability to perform high-flexion activities (sitting cross-legged and standing up from the floor), male gender, and bilateral TKA were significantly associated with patient satisfaction after TKA, while the ability to perform high-flexion activities (sitting cross-legged and standing up from the floor), male gender, and bilateral TKA were significantly associated with patient quality of life after TKA. Conclusions High knee flexion angle (> 130°) after TKA increased the ease of high-flexion activities and patient satisfaction. The ease of high-flexion activities also increased quality of life after TKA in our Asian patients, who frequently engage in these activities in daily life.

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