1
|
Wilcox M, Brown H, Johnson K, Sinisi M, Quick TJ. An assessment of co-contraction in reinnervated muscle. Regen Med 2024; 19:161-170. [PMID: 37955237 DOI: 10.2217/rme-2023-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
Aim: To investigate co-contraction in reinnervated elbow flexor muscles following a nerve transfer. Materials & methods: 12 brachial plexus injury patients who received a nerve transfer to reanimate elbow flexion were included in this study. Surface electromyography (EMG) recordings were used to quantify co-contraction during sustained and repeated isometric contractions of reinnervated and contralateral uninjured elbow flexor muscles. Reuslts: For the first time, this study reveals reinnervated muscles demonstrated a trend toward higher co-contraction ratios when compared with uninjured muscle and this is correlated with an earlier onset of muscle fatigability. Conclusion: Measurements of co-contraction should be considered within muscular function assessments to help drive improvements in motor recovery therapies.
Collapse
Affiliation(s)
- Matthew Wilcox
- Peripheral Nerve Injury Research Unit, Royal National Orthopaedic Hospital, London, HA7 4LP, UK
- University College London Centre for Nerve Engineering, London, WC1E 6BT, UK
- Department of Pharmacology, University College London, School of Pharmacy, London, WC1N 1AX, UK
| | - Hazel Brown
- Peripheral Nerve Injury Research Unit, Royal National Orthopaedic Hospital, London, HA7 4LP, UK
- University College London Centre for Nerve Engineering, London, WC1E 6BT, UK
| | - Kathryn Johnson
- Peripheral Nerve Injury Research Unit, Royal National Orthopaedic Hospital, London, HA7 4LP, UK
| | - Marco Sinisi
- Peripheral Nerve Injury Research Unit, Royal National Orthopaedic Hospital, London, HA7 4LP, UK
| | - Tom J Quick
- Peripheral Nerve Injury Research Unit, Royal National Orthopaedic Hospital, London, HA7 4LP, UK
- University College London Centre for Nerve Engineering, London, WC1E 6BT, UK
| |
Collapse
|
2
|
Taniguchi M, Umehara J, Yamagata M, Yagi M, Motomura Y, Okada S, Okada S, Nakazato K, Fukumoto Y, Kobayashi M, Kanemitsu K, Ichihashi N. Understanding muscle coordination during gait based on muscle synergy and its association with symptoms in patients with knee osteoarthritis. Clin Rheumatol 2024; 43:743-752. [PMID: 38133793 DOI: 10.1007/s10067-023-06852-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/03/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE We aimed to investigate the muscle coordination differences between a control group and patients with mild and severe knee osteoarthritis (KOA) using muscle synergy analysis and determine whether muscle coordination was associated with symptoms of KOA. METHOD Fifty-three women with medial KOA and 19 control patients participated in the study. The gait analyses and muscle activity measurements of seven lower limb muscles were assessed using a motion capture system and electromyography. Gait speed and knee adduction moment impulse were calculated. The spatiotemporal components of muscle synergy were extracted using non-negative matrix factorization, and the dynamic motor control index during walking (walk-DMC) was computed. The number of muscle synergy and their spatiotemporal components were compared among the mild KOA, severe KOA, and control groups. Moreover, the association between KOA symptoms with walk-DMC and other gait parameters was evaluated using multi-linear regression analysis. RESULTS The number of muscle synergies was lower in mild and severe KOA compared with those in the control group. In synergy 1, the weightings of biceps femoris and gluteus medius in severe KOA were higher than that in the control group. In synergy 3, the weightings of higher tibial anterior and lower gastrocnemius lateralis were confirmed in the mild KOA group. Regression analysis showed that the walk-DMC was independently associated with knee-related symptoms of KOA after adjusting for the covariates. CONCLUSIONS Muscle coordination was altered in patients with KOA. The correlation between muscle coordination and KOA may be attributed to the knee-related symptoms. Key points • Patients with knee osteoarthritis (OA) experienced a deterioration in muscle coordination when walking. • Loss of muscle coordination was associated with severe knee-related symptoms in knee OA. • Considering muscle coordination as a knee OA symptom-related factor may provide improved treatment.
Collapse
Affiliation(s)
- Masashi Taniguchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Jun Umehara
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Momoko Yamagata
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiki Motomura
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Kobayashi Orthopaedic Clinic, Kyoto, Japan
| | - Sayaka Okada
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shogo Okada
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kaede Nakazato
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshihiro Fukumoto
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | | | | | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| |
Collapse
|
3
|
Katmah R, Shehhi AA, Jelinek HF, Hulleck AA, Khalaf K. A Systematic Review of Gait Analysis in the Context of Multimodal Sensing Fusion and AI. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4189-4202. [PMID: 37847624 DOI: 10.1109/tnsre.2023.3325215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Neurological diseases are a leading cause of disability and mortality. Gait, or human walking, is a significant predictor of quality of life, morbidity, and mortality. Gait patterns and other kinematic, kinetic, and balance gait features are accurate and powerful diagnostic and prognostic tools. OBJECTIVE This review article focuses on the applicability of gait analysis using fusion techniques and artificial intelligence (AI) models. The aim is to examine the significance of mixing several types of wearable and non-wearable sensor data and the impact of this combination on the performance of AI models. METHOD In this systematic review, 66 studies using more than two modalities to record and analyze gait were identified. 40 studies incorporated multiple gait analysis modalities without the use of artificial intelligence to extract gait features such as kinematic, kinetic, margin of stability, temporal, and spatial gait parameters, as well as cerebral activity. Similarly, 26 studies analyzed gait data using multimodal fusion sensors and AI algorithms. RESULTS The research summarized here demonstrates that the quality of gait analysis and the effectiveness of AI models can both benefit from the integration of data from many sensors. Meanwhile, the utilization of EMG signals in fusion data is especially advantageous. CONCLUSION The findings of this review suggest that a smart, portable, wearable-based gait and balance assessment system can be developed using multimodal sensing of the most cutting-edge, clinically relevant tools and technology available. The information presented in this article may serve as a vital springboard for such development.
Collapse
|
4
|
Marriott KA, Birmingham TB. Fundamentals of osteoarthritis. Rehabilitation: Exercise, diet, biomechanics, and physical therapist-delivered interventions. Osteoarthritis Cartilage 2023; 31:1312-1326. [PMID: 37423596 DOI: 10.1016/j.joca.2023.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
Insights related to the pathogenesis of osteoarthritis (OA) have informed rehabilitative treatments that aim to mitigate the influence of several known impairments and risk factors for OA, with the goal to improve pain, function, and quality of life. The purpose of this invited narrative review is to provide fundamental knowledge to non-specialists about exercise and education, diet, biomechanical interventions, and other physical therapist-delivered treatments. In addition to summarizing the rationale for common rehabilitative therapies, we provide a synthesis of current core recommendations. Robust evidence based on randomized clinical trials supports exercise with education and diet as core treatments for OA. Structured, supervised exercise therapy is advised. The mode of exercise may vary but should be individualized. The dose should be based on an initial assessment, the desired physiological changes, and progressed when appropriate. Diet combined with exercise is strongly recommended and studies demonstrate a dose-response relationship between the magnitude of weight loss and symptom improvement. Recent evidence suggests the use of technology to remotely deliver exercise, diet and education interventions is cost-effective. Although several studies support the mechanisms for biomechanical interventions (e.g., bracing, shoe inserts) and physical therapist-delivered (passive) treatments (e.g., manual therapy, electrotherapeutic modalities) fewer rigorous randomized trials support their clinical use; these therapies are sometimes recommended as adjuncts to core treatments. The mechanisms of action for all rehabilitative interventions include contextual factors such as attention and placebo effects. These effects can challenge our interpretation of treatment efficacy from clinical trials, yet also provide opportunities to maximize patient outcomes in clinical practice. When evaluating rehabilitative interventions, the field may benefit from increased emphasis on research that considers contextual factors while evaluating mechanistic, longer-term, clinically-important and policy-relevant outcome measures.
Collapse
Affiliation(s)
- Kendal A Marriott
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.
| |
Collapse
|
5
|
Johnson MB, Cohen RG. Altered coordination strategies during upright stance and gait in teachers of the Alexander Technique. FRONTIERS IN AGING 2023; 4:1090087. [PMID: 37214774 PMCID: PMC10192613 DOI: 10.3389/fragi.2023.1090087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/20/2023] [Indexed: 05/24/2023]
Abstract
Deterioration in movement and posture often occurs with aging. Yet there may be approaches to movement training that can maintain posture and movement coordination patterns as we age. The Alexander Technique is a non-exercise-based approach that aims to improve everyday movement and posture by increasing awareness and modulating whole-body postural muscle activity. This study assessed whether nineteen 55-72-year-old Alexander Technique teachers showed different posture and movement coordination patterns than twenty age-matched controls during a standing and walking protocol using 3D inertial sensors. During upright stance, Alexander Technique teachers showed lower centroidal sway frequency at the ankle (p = .04) and lower normalized jerk at the sternum (p = .05) than controls. During gait, Alexander Technique teachers had more symmetrical gait cycles (p = .04), more symmetrical arm swing velocity (p = .01), greater arm swing velocity (p < .01), greater arm swing range of motion (p = .02), and lower range of acceleration of the torso in the frontal plane (p = .03) than controls. Smoother control of upright posture, more stable torso motion, and less restrained arm mobility suggest that Alexander Technique training may counter movement degradation that is found with aging. Results highlight the important balance between mobility and stability within the torso and limbs.
Collapse
Affiliation(s)
- Molly B. Johnson
- Trauma and Injury Research Center, Dell Children’s Medical Center, Austin, TX, United States
- Kinesiology Department, University of the Incarnate Word, San Antonio, TX, United States
| | - Rajal G. Cohen
- Mind in Movement Laboratory, Department of Psychology and Communication, University of Idaho, Moscow, ID, United States
| |
Collapse
|
6
|
Effect of functional weightbearing versus non-weightbearing quadriceps strengthening exercise on contact force in varus-malaligned medial knee osteoarthritis: A secondary analysis of a randomized controlled trial. Knee 2022; 39:50-61. [PMID: 36162143 DOI: 10.1016/j.knee.2022.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/30/2022] [Accepted: 09/10/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee osteoarthritis progression may be related to altered knee loads, particularly in those with varus malalignment. Using randomized controlled trial data, this secondary analysis of complete datasets (n = 67) compared the effects of a functional weightbearing (WB) and non-weightbearing quadriceps strengthening exercise (NWB) program on measures of medial tibiofemoral joint contact force (MTCF) during walking. METHODS Participants aged ≥50 years and with medial knee osteoarthritis and varus malalignment were randomly allocated to a 12-week, home-based, physiotherapist-prescribed exercise program comprised of WB exercises (n = 31), or NWB exercise (n = 36). Three-dimensional lower-body motion, ground reaction forces, and surface electromyograms from six lower-limb muscles were acquired during walking at baseline and at 12-weeks follow-up. An electromyogram-informed neuromusculoskeletal model estimated bodyweight (BW) normalized MTCF (peak and impulse), including external and muscular contributions to MTCF. RESULTS There was no between-group difference in the change in peak MTCF (-0.02 [-0.12, 0.09] BW) or MTCF impulse (-0.01 [-0.06, 0.03] BW·s). There was a between-group difference in the muscle contribution to peak MTCF (-0.08 [-0.15, -0.00] BW) and MTCF impulse (-0.04 [-0.08, -0.00] BW·s), whereby the muscle contribution reduced more in the NWB group over time compared to the WB group. There was also a between group-difference in the external contribution to peak MTCF (0.09 [0.01, 0.18] BW), but this reduced more in the WB group than in the NWB group. CONCLUSIONS Our findings suggest no difference in MTCF between the two exercise programs, but differences in the contribution to MTCF between the two exercise programs were observed in those with medial knee osteoarthritis and varus malalignment.
Collapse
|
7
|
Functional Changes in Cortical Activity of Patients Submitted to Knee Osteoarthritis Treatment: An Exploratory Pilot Study. Am J Phys Med Rehabil 2022; 101:920-930. [PMID: 34799508 DOI: 10.1097/phm.0000000000001931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION There is evidence that brain plasticity is the central mechanism involved in the functional recovery process of patients with knee osteoarthritis. Studies involving the analysis of central nervous system mechanisms of pain control and recovery could provide more data on future therapeutic approaches. OBJECTIVE The aim of the study was to explore possible functional changes in cortical activity of patients submitted to knee osteoarthritis standardized pain treatment using electroencephalography. METHODOLOGY Ten patients with clinical and radiological diagnosis of painful knee unilateral or bilateral osteoarthritis were recruited to participate in clinical (Pain's Visual Analog Scale), radiological (Kellgren-Lawrence Scale), and neurophysiological (electroencephalography) assessments to evaluate cortical activity during cortical pain modulation activity. The clinical and neurophysiological analyses were performed before and after standardized pain treatment. RESULTS Eight patients participated in this study. A significant improvement in pain perception and relative increase in interhemispheric connectivity after therapies was observed. In electroencephalography analysis, tests with real movement showed a relative increase in density directed at Graph's analysis. CONCLUSIONS Relative increase density directed measures at connectivity analysis in electroencephalography after pain treatment can be possible parameters to be explored in future research with a larger number of patients.
Collapse
|
8
|
STARKEY SCOTTC, DIAMOND LAURAE, HINMAN RANAS, SAXBY DAVIDJ, KNOX GABRIELLE, HALL MICHELLE. Muscle Forces during Weight-Bearing Exercises in Medial Knee Osteoarthritis and Varus Malalignment: A Cross-Sectional Study. Med Sci Sports Exerc 2022; 54:1448-1458. [DOI: 10.1249/mss.0000000000002943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
9
|
Rashid SA, Hussain ME, Bhati P, Veqar Z, Parveen A, Amin I, Rashid SM. Muscle activation patterns around knee following neuromuscular training in patients with knee osteoarthritis: secondary analysis of a randomized clinical trial. Arch Physiother 2022; 12:19. [PMID: 35799287 PMCID: PMC9264689 DOI: 10.1186/s40945-022-00140-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Objective To compare the effects of neuromuscular training (NMT) to a quadriceps strength training (QT) program on co-contraction index (CCI) of knee muscles in patients with knee osteoarthritis (OA). Methods Sixty-six knee OA patients with varus malalignment were recruited from the physiotherapy outpatient department of the university. After baseline measurements, they were randomly assigned into two groups: NMT (n = 33) and QT (n = 33). Patients in NMT group received neuromuscular exercises whereas QT group received conventional strengthening exercises for a period of 12 weeks, three times per week. Electromyographic (EMG) activity of quadriceps, hamstring and gastrocnemius muscle was evaluated during treadmill walking before and after 12 weeks of intervention period and CCI of medial quadriceps-medial hamstring (med QH), lateral quadriceps-lateral hamstring (lat QH), medial quadriceps-medial gastrocnemius (med QG) and, lateral quadriceps and lateral gastrocnemius (lat QG) was calculated. Results There was a significantly greater reduction in CCI of med QH (p = 0.02) and lat QH (p = 0.01) in the NMT group than the QT group. Whereas both NMT and QT led to statistically similar reductions in CCI of med QG (p = 0.08) and lat QG (p = 0.66). Conclusion Findings of this study suggest that NMT led to a greater reduction in CCI of knee muscles than QT which indicates that enhanced sensori-motor control attained by NMT could reduce knee loading in knee OA patients with varus malalignment.
Collapse
Affiliation(s)
- Shahzada Aadil Rashid
- Center for Physiotherapy & Rehabilitation Center, Jamia Millia Islamia, New Delhi, India
| | | | - Pooja Bhati
- Faculty of Physiotherapy, SGT University Gurugram, Gurgaon, India
| | - Zubia Veqar
- Center for Physiotherapy & Rehabilitation Center, Jamia Millia Islamia, New Delhi, India
| | - Adila Parveen
- Center for Physiotherapy & Rehabilitation Center, Jamia Millia Islamia, New Delhi, India
| | - Insha Amin
- Division of Veterinary Biochemistry, Faculty of Veterinary Sciences (SKUAST-K), Shuhama, Alusteng, Srinagar, Kashmir, 190006, India
| | - Shahzada Mudasir Rashid
- Division of Veterinary Biochemistry, Faculty of Veterinary Sciences (SKUAST-K), Shuhama, Alusteng, Srinagar, Kashmir, 190006, India.
| |
Collapse
|
10
|
Muscle Co-Contraction Detection in the Time-Frequency Domain. SENSORS 2022; 22:s22134886. [PMID: 35808382 PMCID: PMC9269699 DOI: 10.3390/s22134886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 01/27/2023]
Abstract
Background: Muscle co-contraction plays a significant role in motion control. Available detection methods typically only provide information in the time domain. The current investigation proposed a novel approach for muscle co-contraction detection in the time–frequency domain, based on continuous wavelet transform (CWT). Methods: In the current study, the CWT-based cross-energy localization of two surface electromyographic (sEMG) signals in the time–frequency domain, i.e., the CWT coscalogram, was adopted for the first time to characterize muscular co-contraction activity. A CWT-based denoising procedure was applied for removing noise from the sEMG signals. Algorithm performances were checked on synthetic and real sEMG signals, stratified for signal-to-noise ratio (SNR), and then validated against an approach based on the acknowledged double-threshold statistical algorithm (DT). Results: The CWT approach provided an accurate prediction of co-contraction timing in simulated and real datasets, minimally affected by SNR variability. The novel contribution consisted of providing the frequency values of each muscle co-contraction detected in the time domain, allowing us to reveal a wide variability in the frequency content between subjects and within stride. Conclusions: The CWT approach represents a relevant improvement over state-of-the-art approaches that provide only a numerical co-contraction index or, at best, dynamic information in the time domain. The robustness of the methodology and the physiological reliability of the experimental results support the suitability of this approach for clinical applications.
Collapse
|
11
|
Koch K, Semciw AI, Commean PK, Hillen TJ, Fitzgerald GK, Clohisy JC, Harris-Hayes M. Comparison between movement pattern training and strengthening on muscle volume, muscle fat, and strength in patients with hip-related groin pain: An exploratory analysis. J Orthop Res 2022; 40:1375-1386. [PMID: 34370330 PMCID: PMC8825882 DOI: 10.1002/jor.25158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/29/2021] [Accepted: 08/03/2021] [Indexed: 02/04/2023]
Abstract
The purpose of this exploratory analysis was to compare the impact of movement pattern training (MoveTrain) and standard strength and flexibility training (Standard) on muscle volume, strength and fatty infiltration in patients with hip-related groin pain (HRGP). We completed a secondary analysis of data collected during an assessor-blinded randomized control trial. Data were used from 27 patients with HRGP, 15-40 years, who were randomized into MoveTrain or Standard groups. Both groups participated in their training protocol (MoveTrain, n = 14 or Standard, n = 13) which included 10 supervised sessions over 12 weeks and a daily home exercise program. Outcome measures were collected at baseline and immediately after treatment. Magnetic resonance images data were used to determine muscle fat index (MFI) and muscle volume. A hand-held dynamometer was used to assess isometric hip abductor and extensor strength. The Standard group demonstrated a significant posttreatment increase in gluteus medius muscle volume compared to the MoveTrain group. Both groups demonstrated an increase in hip abductor strength and reduction in gluteus minimus and gluteus maximus MFI. The magnitude of change for all outcomes were modest. Statement of Clinical Significance: Movement pattern training or a program of strength/flexibility training may be effective at improving hipabductor strength and reducing fatty infiltration in the gluteal musculature among those with HRGP. Further research is needed to betterunderstand etiology of strength changes and impact of muscle volume and MFI in HRGP and the effect of exercise on muscle structure andfunction.
Collapse
Affiliation(s)
- Kristen Koch
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Adam I. Semciw
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora, Victoria, Australia,Northern Centre for Health Education and Research, Northern Health, Epping, Victoria, Australia
| | - Paul K. Commean
- Electronic Radiology Lab in Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA,Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Travis J. Hillen
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - G. Kelley Fitzgerald
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John C. Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Marcie Harris-Hayes
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA,Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| |
Collapse
|
12
|
Tung EV, Marriott KA, Laing AC, Mourtzakis M, Maly MR. The relationship between muscle capacity utilization during gait and pain in people with symptomatic knee osteoarthritis. Gait Posture 2022; 94:58-66. [PMID: 35247826 DOI: 10.1016/j.gaitpost.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Muscle capacity utilization reflects the percentage of maximal knee extensor strength required to complete physical activities. RESEARCH QUESTION Is pain associated with muscle capacity utilization during walking in older adults with knee osteoarthritis? Secondarily, is muscle capacity utilization in older adults with knee osteoarthritis sex-specific? METHODS Twenty-three participants (15 females) with symptomatic knee OA completed this study [age 67 ( ± 8) years, body mass index 29.7 ( ± 3.9) kg/m2, gait speed during the Six Minute Walk test 1.25 ( ± 0.25) m/s]. Pain was measured using the Knee injury and Osteoarthritis Outcome Score. Muscle capacity utilization was quantified as the peak external knee flexor moment during level walking normalized to knee extensor maximum voluntary isometric contraction. The knee flexor moment was calculated from kinematic and kinetic data during barefoot level walking at a self-selected speed and at 1.1 m/s. Knee extensor maximum voluntary isometric contraction was measured on a dynamometer. Multiple linear regressions were used to determine the relationship between pain and muscle capacity utilization after adjusting for age, sex, body mass index, and gait speed. Independent sample t-tests examined sex differences. RESULTS Pain was not associated with muscle capacity utilization during self-selected and standardized walking speeds (p = 0.38 and p = 0.36, respectively). Females did not require a greater muscle capacity utilization than males to complete gait at self-selected and standardized speeds (p = 0.28, and p = 0.40, respectively). SIGNIFICANCE Muscle capacity utilization was not associated with pain during walking in people with knee osteoarthritis. Future work should explore more challenging activities of daily living in knee OA.
Collapse
Affiliation(s)
- Emma V Tung
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Kendal A Marriott
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Andrew C Laing
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Marina Mourtzakis
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
| | - Monica R Maly
- University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| |
Collapse
|
13
|
Iuamoto LR, Ito FLK, Tomé TA, Hsing WT, Meyer A, Imamura M, Battistella LR. Effects of neuroplasticity in people with knee osteoarthritis: A systematic review of the literature. Medicine (Baltimore) 2022; 101:e28616. [PMID: 35060535 PMCID: PMC8772630 DOI: 10.1097/md.0000000000028616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 01/03/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is associated with chronic inflammation in somatic structures, which alters sensory afferents and leads to plastic changes in the nervous system. METHODS A systematic literature review was carried out, without language restrictions, period, or status of publication. The database used were Medline, EMBASE, Cochrane Library and clinicaltrials.gov. Extra bibliographic references were extracted through the discussion with specialists, and through scientific researches in conference papers. RESULTS The electronic search found 938 articles. When excluding duplicates and applying the inclusion/exclusion criteria, 5 studies were considered: 2 using EEG and 3 using TMS. Significant reduction of EEG activity in the cingulate medium cortex, reduction of conditioned pain modulation (CPM) in studies with EEG, as well as the occurrence of an association between pain and motor response threshold/intracortical pain facilitation in studies with TMS were observed. CONCLUSIONS The study contributes to a better understanding of the neurophysiological changes seen in the cingulate medium cortex, decrease in CPM and motor response threshold/intracortical pain facilitation. Advances in neuroplasticity studies may aid in the screening for early diagnosis of knee OA in the future. However, more studies are necessary.
Collapse
Affiliation(s)
- Leandro Ryuchi Iuamoto
- Centro de Pesquisa Clinica, Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil
| | | | | | - Wu Tu Hsing
- Center of Acupuncture, Department of Orthopaedics and Traumatology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil
| | - Alberto Meyer
- Department of Gastroenterology, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil
| | - Marta Imamura
- Faculdade de Medicina FMUSP, Department of Legal Medicine, Medical Ethics, Social and Work Medicine, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Linamara Rizzo Battistella
- Faculdade de Medicina FMUSP, Department of Legal Medicine, Medical Ethics, Social and Work Medicine, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| |
Collapse
|
14
|
Roelker SA, Koehn RR, Caruthers EJ, Schmitt LC, Chaudhari AMW, Siston RA. Effects of age and knee osteoarthritis on the modular control of walking: A pilot study. PLoS One 2021; 16:e0261862. [PMID: 34965270 PMCID: PMC8716059 DOI: 10.1371/journal.pone.0261862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background Older adults and individuals with knee osteoarthritis (KOA) often exhibit reduced locomotor function and altered muscle activity. Identifying age- and KOA-related changes to the modular control of gait may provide insight into the neurological mechanisms underlying reduced walking performance in these populations. The purpose of this pilot study was to determine if the modular control of walking differs between younger and older adults without KOA and adults with end-stage KOA. Methods Kinematic, kinetic, and electromyography data were collected from ten younger (23.5 ± 3.1 years) and ten older (63.5 ± 3.4 years) adults without KOA and ten adults with KOA (64.0 ± 4.0 years) walking at their self-selected speed. Separate non-negative matrix factorizations of 500 bootstrapped samples determined the number of modules required to reconstruct each participant’s electromyography. One-way Analysis of Variance tests assessed the effect of group on walking speed and the number of modules. Kendall rank correlations (τb) assessed the association between the number of modules and self-selected walking speed. Results The number of modules required in the younger adults (3.2 ± 0.4) was greater than in the individuals with KOA (2.3 ± 0.7; p = 0.002), though neither cohorts’ required number of modules differed significantly from the unimpaired older adults (2.7 ± 0.5; p ≥ 0.113). A significant association between module number and walking speed was observed (τb = 0.350, p = 0.021) and individuals with KOA walked significantly slower (0.095 ± 0.21 m/s) than younger adults (1.24 ± 0.15 m/s; p = 0.005). Individuals with KOA also exhibited altered module activation patterns and composition (which muscles are associated with each module) compared to unimpaired adults. Conclusion These findings suggest aging alone may not significantly alter modular control; however, the combined effects of knee osteoarthritis and aging may together impair the modular control of gait.
Collapse
Affiliation(s)
- Sarah A. Roelker
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail:
| | - Rebekah R. Koehn
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio, United States of America
| | - Elena J. Caruthers
- Department of Engineering, Otterbein University, Westerville, Ohio, United States of America
| | - Laura C. Schmitt
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, United States of America
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, United States of America
| | - Ajit M. W. Chaudhari
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio, United States of America
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, United States of America
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, United States of America
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States of America
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, United States of America
| | - Robert A. Siston
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio, United States of America
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, United States of America
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States of America
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, United States of America
| |
Collapse
|
15
|
Preece SJ, Alghamdi W. Increased trunk flexion may underlie elevated knee flexor activity in people with knee osteoarthritis. Knee 2021; 33:216-225. [PMID: 34717093 DOI: 10.1016/j.knee.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/06/2021] [Accepted: 10/03/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous research has demonstrated elevated activation of the knee flexor muscles in people with knee osteoarthritis. People with this condition have also been observed to walk with increased trunk flexion; this may alter biomechanical loading patterns and change muscle activation profiles. Therefore, the aim of this study was to understand the biomechanical effect of increasing trunk flexion during walking. METHODS Kinetic and EMG data were collected from a sample of 20 people with knee osteoarthritis and a sample of 20 healthy matched controls during normal walking. Using a biofeedback protocol, participants were subsequently instructed to walk with a 5° increase in trunk flexion. Sagittal moments, muscle activations and co-contractions were then compared across a window in early stance with a two-way ANOVA test. RESULTS When trunk flexion was increased, there was a corresponding increase in activity of the medial and lateral hamstrings and gastrocnemius muscles as well as a rise in medial co-contraction. This effect was consistent across the two groups. The most pronounced effect was observed for semitendinosus, which showed a dramatic change in activation profile in the healthy group and a 127% increase in activation during early stance. CONCLUSIONS This is the first study to demonstrate that increased trunk flexion in people with knee osteoarthritis may explain, to some degree, the elevated knee flexor activity and medial co-contraction which is associated with this disease. These findings motivate further work to understand the therapeutic potential of interventions designed to improve postural alignment.
Collapse
Affiliation(s)
- Stephen J Preece
- Centre for Health Sciences Research, University of Salford, Salford, Manchester M6 6PU, UK.
| | - Wael Alghamdi
- Centre for Health Sciences Research, University of Salford, Salford, Manchester M6 6PU, UK; Al Baha University, Al Baha, Saudi Arabia.
| |
Collapse
|
16
|
The Relationship Between Changes in Movement and Activity Limitation or Pain in People With Knee Osteoarthritis: A Systematic Review. J Orthop Sports Phys Ther 2021; 51:492-502. [PMID: 34592828 DOI: 10.2519/jospt.2021.10418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To report whether changes in knee joint movement parameters recorded during functional activities relate to change in activity limitation or pain after an exercise intervention in people with knee osteoarthritis (OA). DESIGN Etiology systematic review. LITERATURE SEARCH Four databases (MEDLINE, Embase, CINAHL, and AMED) were searched up to January 22, 2021. STUDY SELECTION CRITERIA Randomized controlled trials or cohort studies of exercise interventions for people with knee OA that assessed change in knee joint movement parameters (moments, kinematics, or muscle activity) and clinical outcomes (activity limitation or pain). DATA SYNTHESIS A descriptive synthesis of functional activities, movement parameters, and clinical outcomes. RESULTS From 3182 articles, 22 studies met the inclusion criteria, and almost all were of low quality. Gait was the only investigated functional activity. After exercise, gait parameters changed 26% of the time, and clinical outcomes improved 90% of the time. A relationship between group-level changes in gait parameters and clinical outcomes occurred 24.5% of the time. Two studies directly investigated an individual-level relationship, reporting only 1 significant association out of 8 correlations tested. CONCLUSION Most studies reported no change in gait-related movement parameters despite improvement in clinical outcomes, challenging the belief that changing movement parameters is always clinically important in people with knee OA. J Orthop Sports Phys Ther 2021;51(10):492-502. doi:10.2519/jospt.2021.10418.
Collapse
|
17
|
Preece SJ, Brookes N, Williams AE, Jones RK, Starbuck C, Jones A, Walsh NE. A new integrated behavioural intervention for knee osteoarthritis: development and pilot study. BMC Musculoskelet Disord 2021; 22:526. [PMID: 34103040 PMCID: PMC8188786 DOI: 10.1186/s12891-021-04389-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/30/2021] [Indexed: 01/04/2023] Open
Abstract
Background Exercise-based approaches have been a cornerstone of physiotherapy management of knee osteoarthritis for many years. However, clinical effects are considered small to modest and the need for continued adherence identified as a barrier to clinical efficacy. While exercise-based approaches focus on muscle strengthening, biomechanical research has identified that people with knee osteoarthritis over activate their muscles during functional tasks. Therefore, we aimed to create a new behavioural intervention, which integrated psychologically informed practice with biofeedback training to reduce muscle overactivity, and which was suitable for delivery by a physiotherapist. Methods Through literature review, we created a framework linking theory from pain science with emerging biomechanical concepts related to overactivity of the knee muscles. Using recognised behaviour change theory, we then mapped a set of intervention components which were iteratively developed through ongoing testing and consultation with patients and physiotherapists. Results The underlying framework incorporated ideas related to central sensitisation, motor responses to pain and also focused on the idea that increased knee muscle overactivity could result from postural compensation. Building on these ideas, we created an intervention with five components: making sense of pain, general relaxation, postural deconstruction, responding differently to pain and functional muscle retraining. The intervention incorporated a range of animated instructional videos to communicate concepts related to pain and biomechanical theory and also used EMG biofeedback to facilitate visualization of muscle patterns. User feedback was positive with patients describing the intervention as enabling them to “create a new normal” and to be “in control of their own treatment.” Furthermore, large reductions in pain were observed from 11 patients who received a prototype version of the intervention. Conclusion We have created a new intervention for knee osteoarthritis, designed to empower individuals with capability and motivation to change muscle activation patterns and beliefs associated with pain. We refer to this intervention as Cognitive Muscular Therapy. Preliminary feedback and clinical indications are positive, motivating future large-scale trials to understand potential efficacy. It is possible that this new approach could bring about improvements in the pain associated with knee osteoarthritis without the need for continued adherence to muscle strengthening programmes. Trial registration ISRCTN51913166 (Registered 24-02-2020, Retrospectively registered). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04389-0.
Collapse
Affiliation(s)
- Stephen J Preece
- Centre for Health Sciences Research, University of Salford, Manchester, M6 6PU, UK.
| | - Nathan Brookes
- Centre for Health Sciences Research, University of Salford, Manchester, M6 6PU, UK.,Physiotherapy Department, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK
| | - Anita E Williams
- Centre for Health Sciences Research, University of Salford, Manchester, M6 6PU, UK
| | - Richard K Jones
- Centre for Health Sciences Research, University of Salford, Manchester, M6 6PU, UK
| | - Chelsea Starbuck
- Centre for Health Sciences Research, University of Salford, Manchester, M6 6PU, UK
| | - Anthony Jones
- Human Pain Research Group, University of Manchester, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK
| | - Nicola E Walsh
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1DD, UK
| |
Collapse
|
18
|
Cabral ALCES, Jorge JG, Dionisio VC. Biomechanical analysis during single-leg squat in individuals with knee osteoarthritis. Knee 2021; 28:362-370. [PMID: 33494018 DOI: 10.1016/j.knee.2020.12.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 02/02/2023]
Abstract
UNLABELLED Backgroud: The single-leg squat (SLS) is a functional task to evaluate the abnormal movement patterns and potential neuromuscular deficits in the lower limbs. Still, it is unknown if SLS could provide information to older adults with knee osteoarthritis (KOA). The study's objective was to analyze the EMG pattern, kinematics, and postural control in individuals with and without KOA during SLS. METHODS Participated in this study, 60 volunteers of both sexes, 30 had KOA (allocated into the KOA group - KOAG), and 30 were healthy (allocated into the Healthy Group - HG) performing the single-leg squat. Surface electromyography (EMG) was assessed for the gastrocnemius medialis (GM), biceps femoris (BF), gluteus medius (GLM), rectus femoris (RF), vastus medialis (VM), vastus lateralis (VL), and tibialis anterior (TA) in two phases (downward - P1 and upward - P2). The kinematic data was evaluated using an electrogoniometer. The center of pressure (CoP) was obtained using data collected from a force plate. RESULTS EMG activity was increased for GM and TA muscles during the P1 of the movement and the GM and GLM muscles during P2 of the movement. The angular displacement of the KOAG was lower when compared with the HG. There was no statistical difference for the co-contraction and postural control data. CONCLUSIONS The SLS analysis showed that EMG activity of the muscles TA, GM, and GLM was increased in the KOAG, but this pattern could be affected by fear of movement leading to reduced knee angular displacement.
Collapse
Affiliation(s)
- Ana Luiza Costa E Silva Cabral
- Laboratory of Neuromechanics and Physiotherapy (LANEF), Faculty of Physical Education and Physiotherapy, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
| | - Jéssica Garcia Jorge
- Laboratory of Neuromechanics and Physiotherapy (LANEF), Faculty of Physical Education and Physiotherapy, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Valdeci Carlos Dionisio
- Laboratory of Neuromechanics and Physiotherapy (LANEF), Faculty of Physical Education and Physiotherapy, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| |
Collapse
|
19
|
Starkey SC, Lenton GK, Saxby DJ, Hinman RS, Bennell KL, Wrigley T, Lloyd D, Hall M. Effect of exercise on knee joint contact forces in people following medial partial meniscectomy: A secondary analysis of a randomised controlled trial. Gait Posture 2020; 79:203-209. [PMID: 32438267 DOI: 10.1016/j.gaitpost.2020.04.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/26/2020] [Accepted: 04/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Arthroscopic partial meniscectomy may cause knee osteoarthritis, which may be related to altered joint loading. Previous research has failed to demonstrate that exercise can reduce medial compartment knee loads following meniscectomy but has not considered muscular loading in their estimates. RESEARCH QUESTION What is the effect of exercise compared to no intervention on peak medial tibiofemoral joint contact force during walking using an electromyogram-driven neuromusculoskeletal model, following medial arthroscopic partial meniscectomy? METHODS This is a secondary analysis of a randomized controlled trial (RCT). 41 participants aged between 30-50 years with medial arthroscopic partial meniscectomy within the past 3-12 months, were randomly allocated to either a 12-week, home-based, physiotherapist-guided exercise program or to no exercise (control group). Three-dimensional lower-body motion, ground reaction forces, and surface electromyograms from eight lower-limb muscles were acquired during self-selected normal- and fast-paced walking at baseline and follow-up. An electromyogram-driven neuromusculoskeletal model estimated medial compartment contact forces (body weight). Linear regression models evaluated between-group differences (mean difference (95% CI)). RESULTS There were no significant between-group differences in the change (follow-up minus baseline) in first peak medial contact force during self-selected normal- or fast-paced walking (0.07 (-0.08 to 0.23), P = 0.34 and 0.01 (-0.19 to 0.22), P = 0.89 respectively). No significant between-group difference was found for change in second peak medial contact force during normal- or fast-paced walking (0.09 (-0.09 to 0.28), P = 0.31 and 0.02 (-0.17 to 0.22), P = 0.81 respectively). At the individual level, variability was observed for changes in first (range -26.2% to +31.7%) and second (range -46.5% to +59.9%) peak tibiofemoral contact force. SIGNIFICANCE This is the first study to apply electromyogram-driven neuromusculoskeletal modelling to an exercise intervention in a RCT. While our results suggest that a 12-week exercise program does not alter peak medial knee loads after meniscectomy, within-participant variability suggests individual-specific muscle activation patterns that warrant further investigation.
Collapse
Affiliation(s)
- Scott C Starkey
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia
| | - Gavin K Lenton
- Gold Coast Orthopaedics Research, Engineering and Education Alliance, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David J Saxby
- Gold Coast Orthopaedics Research, Engineering and Education Alliance, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia
| | - Tim Wrigley
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia
| | - David Lloyd
- Gold Coast Orthopaedics Research, Engineering and Education Alliance, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Michelle Hall
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia.
| |
Collapse
|
20
|
Alghamdi W, Preece SJ. How does normal variability in trunk flexion affect lower limb muscle activity during walking? Hum Mov Sci 2020; 72:102630. [PMID: 32452386 DOI: 10.1016/j.humov.2020.102630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/27/2022]
Abstract
A large proportion of the mass of the body is contained within the trunk segment. Therefore, small changes in the inclination of this segment have the potential to influence the direction of the ground reaction force and alter lower limb joint moments and muscle activation patterns during walking. The aim of this study was to investigate if variability in sagittal trunk inclination in healthy participants is associated with differences in lower limb biomechanics. Gait analysis data was collected on 41 healthy participants during walking. Two groups were defined based on habitual trunk flexion angle during normal walking, a forward lean group (n = 18) and a backward lean group (n = 17). Lower limb moments, muscle activation patterns and co-contraction levels were compared between the two groups using independent t-tests. The forward lean group walked with 5° more trunk flexion than the backward lean group. This difference was associated with a larger peak hip moment (effect size = 0.7) and higher activation of the lateral gastrocnemius (effect size =0.6) and the biceps femoris (effect size =0.7) muscles. The forward lean group also exhibited greater co-contraction in late stance (effect size =0.7). This is the first study to demonstrate that small differences in trunk flexion are associated with pronounced alterations in the activation of the lateral knee flexor muscles. This is important because people with knee osteoarthritis have been observed to walk with increased trunk flexion. It is possible that increased sagittal trunk inclination may be associated with elevated joint loads in people with knee osteoarthritis.
Collapse
Affiliation(s)
| | - Stephen J Preece
- Centre for Health Sciences Research, University of Salford, Salford, Manchester, M6 6PU, UK.
| |
Collapse
|
21
|
Cohen RG, Baer JL, Ravichandra R, Kral D, McGowan C, Cacciatore TW. Lighten Up! Postural Instructions Affect Static and Dynamic Balance in Healthy Older Adults. Innov Aging 2020; 4:igz056. [PMID: 32226825 PMCID: PMC7092748 DOI: 10.1093/geroni/igz056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Indexed: 02/01/2023] Open
Abstract
Background and Objectives Increased fall risk in older adults is associated with declining balance. Previous work showed that brief postural instructions can affect balance control in older adults with Parkinson's disease. Here, we assessed the effects of brief instructions on static and dynamic balance in healthy older adults. Research Design and Methods Nineteen participants practiced three sets of instructions, then attempted to implement each instructional set during: (1) quiet standing on foam for 30 s with eyes open; (2) a 3-s foot lift. "Light" instructions relied on principles of reducing excess tension while encouraging length. "Effortful" instructions relied on popular concepts of effortful posture correction. "Relax" instructions encouraged minimization of effort. We measured kinematics and muscle activity. Results During quiet stance, Effortful instructions increased mediolateral jerk and path length. In the foot lift task, Light instructions led to the longest foot-in-air duration and the smallest anteroposterior variability of the center of mass, Relax instructions led to the farthest forward head position, and Effortful instructions led to the highest activity in torso muscles. Discussion and Implications Thinking of upright posture as effortless may reduce excessive co-contractions and improve static and dynamic balance, while thinking of upright posture as inherently effortful may make balance worse. This may partly account for the benefits of embodied mindfulness practices such as tai chi and Alexander technique for balance in older adults. Pending larger-scale replication, this discovery may enable physiotherapists and teachers of dance, exercise, and martial arts to improve balance and reduce fall risk in their older students and clients simply by modifying how they talk about posture.
Collapse
Affiliation(s)
- Rajal G Cohen
- Department of Psychology and Communication, University of Idaho, Moscow, Idaho.,Department of Biological Sciences, University of Idaho, Moscow, Idaho
| | - Jason L Baer
- Department of Psychology and Communication, University of Idaho, Moscow, Idaho.,Department of Biological Sciences, University of Idaho, Moscow, Idaho
| | - Ramyaa Ravichandra
- Department of Psychology and Communication, University of Idaho, Moscow, Idaho
| | - Daniel Kral
- Department of Psychology and Communication, University of Idaho, Moscow, Idaho
| | - Craig McGowan
- Department of Biological Sciences, University of Idaho, Moscow, Idaho.,WWAMI Medical Education Program, University of Idaho, Moscow, Idaho
| | - Timothy W Cacciatore
- Sobell Department of Motor Neuroscience, Institute of Neurology, University College London, London, UK
| |
Collapse
|
22
|
Lin PE, Sigward SM. Influence of Hamstrings on Knee Moments During Loading Response of Gait in Individuals Following ACL Reconstruction. J Orthop Res 2020; 38:378-386. [PMID: 31502699 DOI: 10.1002/jor.24465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 08/23/2019] [Indexed: 02/04/2023]
Abstract
Biomechanical studies consistently report smaller knee extensor moments in the surgical limb during loading response (LR) of gait following ACL reconstruction (ACLr). However, this reduction in knee loading is quantified by net joint moments (NJM). As a result, in the presence of greater hamstring activity, the true contribution from the knee extensors may not be reduced. The purpose of this study is to compare hamstring activity and strength and knee joint moments between individuals post-ACLr and controls. Eighteen individuals 3 months post-ACLr and matched controls walked and net knee extensor moment peak and impulse and hamstring activity were identified during LR, as well as maximal hamstring strength. A hybrid musculoskeletal model estimated knee flexor moments from joint kinematics and hamstring electromyography. Flexor moments (SIMM) were scaled based on strength. Knee extensor moments were estimated from the sum of the net knee moment and estimated knee flexor moment; estimated extensor moment peaks and impulse were calculated during LR. Repeated measures analysis of variance compared groups and limbs. Smaller net knee extensor moment and greater hamstring activity, as well as deficits in maximal hamstring strength, were observed in the surgical limb (all p < 0.05). When accounting for the torque-producing capabilities of the knee flexors, estimated knee extensor moment peak and impulse were smaller in the surgical limb. These findings suggest that net knee moments accurately reflect smaller knee extensor loading post-ACLr. Statement of Clinical Significance: Rehabilitation programs should target increasing knee extensor loading to restore gait mechanics during early rehabilitation. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:378-386, 2020.
Collapse
Affiliation(s)
- Paige E Lin
- Human Performance Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St, CHP 155, Los Angeles, California, 90089-9006
| | - Susan M Sigward
- Human Performance Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St, CHP 155, Los Angeles, California, 90089-9006
| |
Collapse
|
23
|
Cruz-Montecinos C, Pérez-Alenda S, Querol F, Cerda M, Maas H. Changes in Muscle Activity Patterns and Joint Kinematics During Gait in Hemophilic Arthropathy. Front Physiol 2020; 10:1575. [PMID: 32076411 PMCID: PMC7006441 DOI: 10.3389/fphys.2019.01575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022] Open
Abstract
Hemophilic arthropathy is the result of repetitive intra-articular bleeding and synovial inflammation. In people with hemophilic arthropathy (PWHA), very little is known about the neural control of individual muscles during movement. The aim of the present study was to assess if the neural control of individual muscles and coordination between antagonistic muscle pairs and joint kinematics during gait are affected in PWHA. Thirteen control subjects (CG) walked overground at their preferred and slow velocity (1 m/s), and 14 PWHA walked overground at the preferred velocity (1 m/s). Joint kinematics and temporal gait parameters were assessed using four inertial sensors. Surface electromyography (EMG) was collected from gluteus maximus (GMAX), gluteus medius (GMED), vastus medialis (VM), vastus lateralis (VL), rectus femoris (RF), medial gastrocnemius (MG), lateral gastrocnemius (LG), soleus (SOL), tibialis anterior (TA), semitendinosus (ST), and biceps femoris (BF). Waveforms were compared using the time-series analysis through statistical parametric mapping. In PWHA compared to CG, EMG amplitude during the stance phase was higher for LG (for both velocities of the CG), BF (slow velocity only), and ST (preferred velocity only) (p < 0.05). Co-contraction during the stance phase was higher for MG-TA, LG-TA, VL-BF, VM-ST, LG-VL, and MG-VM (both velocities) (p < 0.05). MG and LG were excited earlier (preferred velocity only) (p < 0.05). A later offset during the stance phase was found for VL, BF, and ST (both velocities), and BF and GMAX (preferred velocity only) (p < 0.05). In addition, the range of motion in knee and ankle joints was lower in PWHA (both velocities) and hip joint (preferred velocity only) (p < 0.05). In conclusion, the neural control of individual muscles and coordination between antagonistic muscles during gait in PWHA differs substantially from control subjects.
Collapse
Affiliation(s)
- Carlos Cruz-Montecinos
- Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | | | - Felipe Querol
- Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Mauricio Cerda
- SCIAN-Lab, Anatomy and Developmental Biology Program, Faculty of Medicine, Institute of Biomedical Sciences, Universidad de Chile, Santiago, Chile.,Biomedical Neuroscience Institute, Santiago, Chile
| | - Huub Maas
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
24
|
Davies J. Alexander Technique classes improve pain and performance factors in tertiary music students. J Bodyw Mov Ther 2020; 24:1-7. [PMID: 31987527 DOI: 10.1016/j.jbmt.2019.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/02/2019] [Accepted: 04/06/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Professional and student instrumental musicians experience high rates of playing-related pain (PR pain) and other playing-related musculoskeletal disorders (PRMDs). This significant occupational health risk signals an urgent need for preventive education at the college level. During tertiary studies however, music students may be more focused on musical skill development than health outcomes. Alexander Technique (AT) is reputed to be beneficial for factors relating to both PR pain and the improvement of performance quality in musicians, therefore AT training for music students could be relevant for prevention. OBJECTIVES To examine the effects of AT classes for tertiary music students on PR pain, associated risk factors for PR pain, and factors associated with improvements in music performance quality. METHODS Responses were collected from 23 volunteer music performance students at an Australian University who undertook weekly AT classes for one semester using a curriculum specifically designed for music students. RESULTS The majority of participants rated AT classes as beneficial for all factors, particularly reduction of PR pain, posture, ability to release excess muscle tension, improvements in instrumental technique, and improvements in performance level. Benefits to practice effectiveness and a reduction in non-playing-related pain, stress levels and performance anxiety were also reported. CONCLUSIONS Purpose-designed AT classes may contribute to the management of PR pain and pertinent risk factors in music students, thus further investigation of the potential role of AT classes in pain prevention programs is warranted. Reports of benefit across a range of performance-related skills strengthen relevance to music practice and performance.
Collapse
Affiliation(s)
- Janet Davies
- Sydney Conservatorium, University of Sydney, Macquarie St, Sydney, NSW, 2000, Australia.
| |
Collapse
|
25
|
Spinoso DH, Carvalho MVDS, Trentin ACDS, Navega MT. Acute effect of partial body weight suspension on the level of cocontraction and gait biomechanics in women with knee osteoarthritis. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.033.ao26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Knee osteoarthritis (OAK) is one of the most prevalent rheumatic diseases in the population, characterized by functional limitation and gait difficulties with profound clinical relevance, as walking is the most frequently performed daily activity. These functional limitations may be more pronounced when the disease is associated with obesity. Objective: To investigate the effect of different body weight suspension percentages on gait biomechanical variables and co-contraction percentages in women with OAK. Method: Fourteen women aged 50-75 years, with a body mass index between 26 and 35 and radiological diagnosis of OAK participated in the study. On the first day, anamnesis and familiarization with gait on the treadmill was performed. On the second day, treadmill gait assessment was performed using partial body weight support (SPPC) in three conditions-15%, 30%, and 45% suspension. During the evaluation, electromyographic and kinematic data were collected. The variables analyzed were percentage of hip (gluteus maximus/rectus femoris), knee (femoral biceps/vastus lateralis), and ankle (anterior tibial/lateral gastrocnemius), and length and step widths. A one-way analysis of variance was conducted, with a significance level of p < 0.05. Results: There was no significant difference in the length and step width and the level of co-contraction between the running conditions analyzed. Conclusion: Body weight suspension using SPPC during treadmill running did not alter the biomechanical variables of the gait of women with OAK.
Collapse
|
26
|
Preece SJ, Algarni AS, Jones RK. Trunk flexion during walking in people with knee osteoarthritis. Gait Posture 2019; 72:202-205. [PMID: 31254772 DOI: 10.1016/j.gaitpost.2019.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 06/13/2019] [Accepted: 06/18/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Over 50% of the body's mass is concentrated within the head, arms and trunk. Thus, small deviations in the orientation of the trunk, during normal walking, could influence the position of the centre of mass relative to the lower limb joint centres and impact on lower limb biomechanics. However, there are minimal data available on sagittal kinematics of the trunk in people with knee osteoarthritis (OA) during walking. RESEARCH QUESTION Do people with knee OA have altered kinematic patterns of the trunk, pelvis or hip compared with healthy control participants during walking? METHODS Statistical parametric mapping was used to compare sagittal and frontal plane kinematic patterns, during walking, between a healthy group and cohort of people with knee OA. RESULTS Individuals with knee OA walked with a mean increase in trunk flexion of 2.6°. Although this difference was more pronounced during early stance, it was maintained across the whole of stance phase. There were no differences, between the groups, in sagittal plane pelvic or hip kinematics. There were also no differences in trunk, pelvic or hip kinematics in the frontal plane. SIGNIFICANCE Most previous gait research investigating trunk motion in people with knee OA has focused on the frontal plane. However, our data suggest that an increase in sagittal trunk flexion may be a clinical hallmark of people with this disease. Altered trunk flexion could affect joint moments and muscle patterns and therefore our results motivate further research in this area.
Collapse
Affiliation(s)
- Stephen J Preece
- Centre for Health Sciences Research, University of Salford, Salford, Manchester, M6 6PU, United Kingdom.
| | - Ali Saad Algarni
- Centre for Health Sciences Research, University of Salford, Salford, Manchester, M6 6PU, United Kingdom; General Directorate of Medical Rehabilitation, Ministry of Health (MOH), Saudi Arabia.
| | - Richard K Jones
- Centre for Health Sciences Research, University of Salford, Salford, Manchester, M6 6PU, United Kingdom.
| |
Collapse
|
27
|
Baer JL, Vasavada A, Cohen RG. Neck posture is influenced by anticipation of stepping. Hum Mov Sci 2019; 64:108-122. [PMID: 30710861 DOI: 10.1016/j.humov.2019.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 12/31/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Postural deviations such as forward head posture (FHP) are associated with adverse health effects. The causes of these deviations are poorly understood. We hypothesized that anticipating target-directed movement could cause the head to get "ahead of" the body, interfering with optimal head/neck posture, and that the effect may be exacerbated by task difficulty and/or poor inhibitory control. METHOD We assessed posture in 45 healthy young adults standing quietly and when they anticipated walking to place a tray: in a simple condition and in conditions requiring that they bend low or balance an object on the tray. We defined FHP as neck angle relative to torso; we also measured head angle relative to neck and total neck length. We assessed inhibitory control using a Go/No-Go task, Stroop task, and Mindful Attention Awareness Scale (MAAS). RESULTS FHP increased when participants anticipated movement, particularly for more difficult movements. Worse Stroop performance and lower MAAS scores correlated with higher FHP. False alarms on the Go/No-Go task correlated with a more extended head relative to the neck and with shortening of the neck when anticipating movement. CONCLUSIONS Maintaining neutral posture may require inhibition of an impulse to put the head forward of the body when anticipating target-directed movement.
Collapse
Affiliation(s)
- Jason L Baer
- Department of Psychology & Communication Studies, University of Idaho, Moscow, ID, United States.
| | - Anita Vasavada
- Voiland School of Chemical Engineering and Bioengineering, Washington State University, Pullman, WA, United States; Department of Integrative Physiology and Neuroscience, WSU, United States
| | - Rajal G Cohen
- Department of Psychology & Communication Studies, University of Idaho, Moscow, ID, United States
| |
Collapse
|
28
|
Yoshikawa K, Mutsuzaki H, Sano A, Koseki K, Fukaya T, Mizukami M, Yamazaki M. Training with Hybrid Assistive Limb for walking function after total knee arthroplasty. J Orthop Surg Res 2018; 13:163. [PMID: 29970139 PMCID: PMC6029050 DOI: 10.1186/s13018-018-0875-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Hybrid Assistive Limb (HAL, CYBERDYNE) is a wearable robot that provides assistance to patients while walking, standing, and performing leg movements based on the intended movement of the wearer. We aimed to assess the effect of HAL training on the walking ability, range of motion (ROM), and muscle strength of patients after total knee arthroplasty (TKA) for osteoarthritis and rheumatoid arthritis, and to compare the functional status after HAL training to the conventional training methods after surgery. METHODS Nine patients (10 knees) underwent HAL training (mean age 74.1 ± 5.7 years; height 150.4 ± 6.5 cm; weight 61.2 ± 8.9 kg), whereas 10 patients (11 knees) underwent conventional rehabilitation (mean age 78.4 ± 8.0 years; height 150.5 ± 10.0 cm; weight 59.1 ± 9.8 kg). Patients underwent HAL training during 10 to 12 (average 14.4 min a session) sessions over a 4-week period, 1 week after TKA. There was no significant difference in the total physical therapy time including HAL training between the HAL and control groups. Gait speed, step length, ROM, and muscle strength were evaluated. RESULTS The nine patients completed the HAL training sessions without adverse events. The walking speed and step length in the self-selected walking speed condition, and the walking speed in the maximum walking speed condition were greater in the HAL group than in the control group at 4 and 8 weeks (P < 0.05). The step length in the maximum walking speed condition was greater in the HAL group than in the control group at 2, 4, and 8 weeks (P < 0.05). The extension lag and knee pain were lower in the HAL group than in the control group at 2 weeks (P < 0.05). The muscle strength of knee extension in the HAL group was greater than that in the control group at 8 weeks (P < 0.05). CONCLUSION HAL training after TKA can improve the walking ability, ROM, and muscle strength compared to conventional physical therapy for up to 8 weeks after TKA. Since the recovery of walking ability was earlier in the HAL group than in the control group and adverse events were not observed in this pilot study, HAL training after TKA can be considered a safe and effective rehabilitation intervention. TRIAL REGISTRATION UMIN, UMIN000017623 . Registered 19 May 2015.
Collapse
Affiliation(s)
- Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4773 Ami, Ami-machi, Inashiki-gun, Ibaraki, 300-0331, Japan
| | - Hirotaka Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki, 300-0394, Japan.
| | - Ayumu Sano
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4773 Ami, Ami-machi, Inashiki-gun, Ibaraki, 300-0331, Japan
| | - Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, 4773 Ami, Ami-machi, Inashiki-gun, Ibaraki, 300-0331, Japan
| | - Takashi Fukaya
- Department of Physical Therapy, Faculty of Health Sciences, Tsukuba International University, 6-8-33 Manabe, Tsuchiura, Ibaraki, 300-0051, Japan
| | - Masafumi Mizukami
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki, 300-0394, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| |
Collapse
|
29
|
Becker JJ, Copeland SL, Botterbusch EL, Cohen RG. Preliminary evidence for feasibility, efficacy, and mechanisms of Alexander technique group classes for chronic neck pain. Complement Ther Med 2018; 39:80-86. [PMID: 30012397 DOI: 10.1016/j.ctim.2018.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVES To determine feasibility and potential of Alexander technique (AT) group classes for chronic neck pain and to assess changes in self-efficacy, posture, and neck muscle activity as potential mechanisms for pain reduction. DESIGN A single-group, multiple-baseline design, with two pre-tests to control for regression toward the mean, a post-test immediately after the intervention, and another post-test five weeks later to examine retention of benefits. Participants were predominately middle-aged; all had experienced neck pain for at least six months. INTERVENTION Participants attended ten one-hour group classes in AT, an embodied mindful approach that may reduce habitual overactivation of muscles, including superficial neck muscles, over five weeks. OUTCOME MEASURES (1) self-reports: Northwick Park Questionnaire (to assess neck pain and associated disability) and Pain Self-Efficacy Questionnaire; (2) superficial neck flexor activation and fatigue (assessed by electromyography and power spectral analysis) during the cranio-cervical flexion test; (3) posture during a video game task. RESULTS There were no significant changes in outcomes between pre-tests. All participants completed the intervention. After the intervention: (1) participants reported significantly reduced neck pain; (2) fatigue of the superficial neck flexors during the cranio-cervical flexion test was substantially lower; (3) posture was marginally more upright, as compared to the second pre-intervention values. Changes in pain, self-efficacy, and neck muscle fatigue were retained at the second post-test and tended to be correlated with one another. CONCLUSIONS Group AT classes may provide a cost-effective approach to reducing neck pain by teaching participants to decrease excessive habitual muscle contraction during everyday activity.
Collapse
Affiliation(s)
- Jordan J Becker
- Department of Psychology & Communication, University of Idaho, USA
| | | | | | - Rajal G Cohen
- Department of Psychology & Communication, University of Idaho, USA.
| |
Collapse
|
30
|
Wenham A, Atkin K, Woodman J, Ballard K, MacPherson H. Self-efficacy and embodiment associated with Alexander Technique lessons or with acupuncture sessions: A longitudinal qualitative sub-study within the ATLAS trial. Complement Ther Clin Pract 2018; 31:308-314. [PMID: 29705473 PMCID: PMC5941320 DOI: 10.1016/j.ctcp.2018.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/14/2018] [Indexed: 11/30/2022]
Abstract
Background and purpose A large randomised controlled trial found that the provision of either Alexander Technique lessons or acupuncture, for those with chronic neck pain, resulted in significantly increased self-efficacy when compared with usual care alone. In turn, enhanced self-efficacy was associated with significant reductions in neck pain at 6 and 12 months. In this analysis we explore the perspectives of participants within the trial, with the aim of gaining a better understanding of how these interventions had an impact. Methods We used a longitudinal qualitative approach; in-depth interviews, informed by a topic guide, were conducted with a sample of the trial population. Participants were interviewed twice: at around six months (n = 30) and twelve months (n = 26) after trial entry. Analysis was guided by the principles of grounded theory, and key themes were developed. Results Five key themes emerged: pre-trial experiences of biomedical treatment against which subsequent interventions were compared; emergence of tangible benefits from the interventions; factors that contributed to the observed benefits, notably growing self-care and self-efficacy; a developing sense of embodiment as an integral part of the transformative process; and contribution of these factors to sustaining benefits over the longer term. Conclusions In-depth interviews revealed a rich array of experiences. They gave insight into the positive impact of the interventions on development of self-care, self-efficacy and embodiment. These findings complement the quantitative trial data, providing a more nuanced understanding of the factors that underpin the previously quantified improvement in self-efficacy and its association with longer-term reductions in pain.
Collapse
Affiliation(s)
- Aniela Wenham
- Department of Social Policy & Social Work, University of York, York, YO10 5DD, UK
| | - Karl Atkin
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Julia Woodman
- Department of Health Sciences, University of York, York, YO10 5DD, UK; Society of Teachers of the Alexander Technique, Grove Business Centre, Unit W48, 560-568 High Road, London, N17 9TA, UK
| | - Kathleen Ballard
- Society of Teachers of the Alexander Technique, Grove Business Centre, Unit W48, 560-568 High Road, London, N17 9TA, UK
| | - Hugh MacPherson
- Department of Health Sciences, University of York, York, YO10 5DD, UK.
| |
Collapse
|
31
|
Song YS, Ha S, Hsu H, Ting LH, Liu CK. Stair negotiation made easier using novel interactive energy-recycling assistive stairs. PLoS One 2017; 12:e0179637. [PMID: 28700719 PMCID: PMC5507489 DOI: 10.1371/journal.pone.0179637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 06/01/2017] [Indexed: 11/19/2022] Open
Abstract
Here we show that novel, energy-recycling stairs reduce the amount of work required for humans to both ascend and descend stairs. Our low-power, interactive, and modular steps can be placed on existing staircases, storing energy during stair descent and returning that energy to the user during stair ascent. Energy is recycled through event-triggered latching and unlatching of passive springs without the use of powered actuators. When ascending the energy-recycling stairs, naive users generated 17.4 ± 6.9% less positive work with their leading legs compared to conventional stairs, with the knee joint positive work reduced by 37.7 ± 10.5%. Users also generated 21.9 ± 17.8% less negative work with their trailing legs during stair descent, with ankle joint negative work reduced by 26.0 ± 15.9%. Our low-power energy-recycling stairs have the potential to assist people with mobility impairments during stair negotiation on existing staircases.
Collapse
Affiliation(s)
- Yun Seong Song
- Department of Mechanical Engineering, Missouri University of Science and Technology, Rolla, Missouri, United States of America
| | - Sehoon Ha
- Disney Research, Pittsburgh, Pennsylvania, United States of America
| | - Hsiang Hsu
- Department of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Lena H. Ting
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, United States of America
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, Georgia, United States of America
| | - C. Karen Liu
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- * E-mail:
| |
Collapse
|
32
|
The relationship between external knee moments and muscle co-activation in subjects with medial knee osteoarthritis. J Electromyogr Kinesiol 2017; 33:64-72. [DOI: 10.1016/j.jelekin.2017.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 11/19/2022] Open
|