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Inflicted knee flexion contracture and its compensatory mechanisms in the gait of normal individuals
Abstracts / Gait & Posture 30S (2009) S1–S153
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Table 1 Mean rank differences of kinematic parameters between age groups (first group minus second group). 4–8 vs. 9–17 Percentage of stance Pelvic tilt range Pelvic rotation range Maximum hip flexion Maximum hip extensiona Knee flexion at initial contact Knee loading response Maximum knee extension in midstancea Maximum knee flexion in swing Knee flexion range a
9.59 15.24 – – −1.99 −9.84 −15.85 −12.16 – 12.95
4–6 vs. 7–8
4–6 vs. 9–13
– – – 6.94 – – – – 7.68 8.12
– – – – – – – −7.28 7.50 9.60
4–6 vs. 14–17 – 9.72 7.33 – – −4.58 – – – 7.33
7–8 vs. 9–13 – – – −7.32 −9.37 – −8.88 – – –
7–8 vs. 14–17 −8.64 11.19 – – – −7.86 −1.42 – – –
9–13 vs. 14–17 7.73 – – – – – – – – –
Negative values indicate increased parameters on the first group. Only parameters with a 0.05 significance level are presented.
Reference [1] Stansfield, et al. Gait Posture 2006;23:288–94.
doi:10.1016/j.gaitpost.2009.08.070 O67 Inflicted knee flexion contracture and its compensatory mechanisms in the gait of normal individuals Andy Roche ∗ , Daniele Trinca, Gill Holmes, Alf Bass North West Movement Analysis Centre, Alder Hey Childrens NHS Foundation Trust, Liverpool, United Kingdom Summary This study identifies compensatory mechanisms adopted by normal individuals with a simulated “true” knee flexion contracture. Conclusions Findings confirm the hypothesis that gait abnormalities in patients with knee flexion contractures are a normal response to an underlying defect. Introduction Knee flexion contracture is commonly encountered in patients with cerebral palsy. This study determines the compensations adopted by normal individuals with simulated bilateral knee flexion contractures. Patients/materials and methods Fifteen individuals (11 male, 4 female. Mean age 31.6 years (24–47). Mean BMI 24.5 (17.4–33.4)) were recruited with no lower limb pathology. Research ethics approval was obtained and subjects gave informed consent. An adjustable pelvic brace was fitted and a figure of eight strap at each ankle. A non-stretch nylon webbing strap connected the two bands, which was adjusted to produce the knee flexion deformity. Reflective markers were applied using the Davis protocol. 3D gait analysis was performed using a 6 camera motion measurement system (BTS, Milan, Italy) and 5 successful trials were collected at: 0◦ , 30◦ and 50◦ knee flexion. GaitEliclinic software calculated kinematic/kinetic data. Results Temporal parameters demonstrated a statistically significant difference in step and stride length at 30◦ and 50◦ ; mean stride length: 0.766 m at 30◦ and 0.71 m at 50◦ (p = 0.05). Mean step length: 0.39 m at 30◦ and 0.35 m at 50◦ (p = 0.017). Walking velocity decreased as the contracture increased but was not statistically significant from 30◦ to 50◦ . Minimum and maximum posterior pelvic tilt increased significantly as the contracture increased. Pelvic rotation did not change significantly. Peak hip flexion increased with the degree of contracture but was not statistically significant. Peak hip
extension decreased as the contracture increased (mean 13.5–7.5◦ , p = 0.02). Peak knee extension in stance was significantly reduced with increased knee flexion (means 22.4–36.5◦ flexion, p < 0.0001). Peak knee extension decreased significantly in terminal swing (mean 31.7–44.2◦ flexion, p < 0.0001). Peak dorsiflexion in stance did not change significantly nor did its timing during the stance phase. There was no significant change in peak plantarflexion at terminal stance between 30◦ and 50◦ but subjects had increased dorsiflexion at this point (means 5.2◦ and 5.4◦ ). From 30◦ and 50◦ there was a significant increase in the floor/foot angle (4.4–11.7◦ , p < 0.0001). Most subjects had an initial toe contact, 3 subjects had heel strike at initial contact at 30◦ and 50◦ . Discussion This study induced a true knee flexion contracture on normal individuals. Other studies [1] simulated shortened hamstrings, but results did not produce such gross knee flexion during gait. This study demonstrates simulated knee flexion contractures adversely affect gait by reducing walking speed, step and stride length. The plane most affected is the sagittal plane with reduced peak knee extension in stance and terminal swing; increased hip flexion at initial contact with reduced extension at pre-swing. A further compensation is increased dorsiflexion at the ankle with reduced plantarflexion at push-off. Reference [1] Whitehead, et al. Gait Posture 2007;26(June (1)):90–6.
doi:10.1016/j.gaitpost.2009.08.071 O68 Body size and walking cadence affect mechanical power in children’s gait Sarah Shultz 1,∗ , Michael Sitler 2 , Howard Hillstrom 3 , Andrew Hills 1 , Ryan Tierney 2 , Jinsup Song 2 1
Queensland University of Technology, Kelvin Grove, QLD, Australia Temple University, Philadelphia, PA, United States 3 Hospital for Special Surgery, New York, NY, United States 2
Summary The results of a cross-sectional study of lower extremity gait parameters in obese and normal-weight children are presented for two walking cadences. Increases in mass and walking cadence primarily influenced mechanical power at the hip, with significant differences also found during energy absorption by the knee extensors.
S47
Table 1 Mean rank differences of kinematic parameters between age groups (first group minus second group). 4–8 vs. 9–17 Percentage of stance Pelvic tilt range Pelvic rotation range Maximum hip flexion Maximum hip extensiona Knee flexion at initial contact Knee loading response Maximum knee extension in midstancea Maximum knee flexion in swing Knee flexion range a
9.59 15.24 – – −1.99 −9.84 −15.85 −12.16 – 12.95
4–6 vs. 7–8
4–6 vs. 9–13
– – – 6.94 – – – – 7.68 8.12
– – – – – – – −7.28 7.50 9.60
4–6 vs. 14–17 – 9.72 7.33 – – −4.58 – – – 7.33
7–8 vs. 9–13 – – – −7.32 −9.37 – −8.88 – – –
7–8 vs. 14–17 −8.64 11.19 – – – −7.86 −1.42 – – –
9–13 vs. 14–17 7.73 – – – – – – – – –
Negative values indicate increased parameters on the first group. Only parameters with a 0.05 significance level are presented.
Reference [1] Stansfield, et al. Gait Posture 2006;23:288–94.
doi:10.1016/j.gaitpost.2009.08.070 O67 Inflicted knee flexion contracture and its compensatory mechanisms in the gait of normal individuals Andy Roche ∗ , Daniele Trinca, Gill Holmes, Alf Bass North West Movement Analysis Centre, Alder Hey Childrens NHS Foundation Trust, Liverpool, United Kingdom Summary This study identifies compensatory mechanisms adopted by normal individuals with a simulated “true” knee flexion contracture. Conclusions Findings confirm the hypothesis that gait abnormalities in patients with knee flexion contractures are a normal response to an underlying defect. Introduction Knee flexion contracture is commonly encountered in patients with cerebral palsy. This study determines the compensations adopted by normal individuals with simulated bilateral knee flexion contractures. Patients/materials and methods Fifteen individuals (11 male, 4 female. Mean age 31.6 years (24–47). Mean BMI 24.5 (17.4–33.4)) were recruited with no lower limb pathology. Research ethics approval was obtained and subjects gave informed consent. An adjustable pelvic brace was fitted and a figure of eight strap at each ankle. A non-stretch nylon webbing strap connected the two bands, which was adjusted to produce the knee flexion deformity. Reflective markers were applied using the Davis protocol. 3D gait analysis was performed using a 6 camera motion measurement system (BTS, Milan, Italy) and 5 successful trials were collected at: 0◦ , 30◦ and 50◦ knee flexion. GaitEliclinic software calculated kinematic/kinetic data. Results Temporal parameters demonstrated a statistically significant difference in step and stride length at 30◦ and 50◦ ; mean stride length: 0.766 m at 30◦ and 0.71 m at 50◦ (p = 0.05). Mean step length: 0.39 m at 30◦ and 0.35 m at 50◦ (p = 0.017). Walking velocity decreased as the contracture increased but was not statistically significant from 30◦ to 50◦ . Minimum and maximum posterior pelvic tilt increased significantly as the contracture increased. Pelvic rotation did not change significantly. Peak hip flexion increased with the degree of contracture but was not statistically significant. Peak hip
extension decreased as the contracture increased (mean 13.5–7.5◦ , p = 0.02). Peak knee extension in stance was significantly reduced with increased knee flexion (means 22.4–36.5◦ flexion, p < 0.0001). Peak knee extension decreased significantly in terminal swing (mean 31.7–44.2◦ flexion, p < 0.0001). Peak dorsiflexion in stance did not change significantly nor did its timing during the stance phase. There was no significant change in peak plantarflexion at terminal stance between 30◦ and 50◦ but subjects had increased dorsiflexion at this point (means 5.2◦ and 5.4◦ ). From 30◦ and 50◦ there was a significant increase in the floor/foot angle (4.4–11.7◦ , p < 0.0001). Most subjects had an initial toe contact, 3 subjects had heel strike at initial contact at 30◦ and 50◦ . Discussion This study induced a true knee flexion contracture on normal individuals. Other studies [1] simulated shortened hamstrings, but results did not produce such gross knee flexion during gait. This study demonstrates simulated knee flexion contractures adversely affect gait by reducing walking speed, step and stride length. The plane most affected is the sagittal plane with reduced peak knee extension in stance and terminal swing; increased hip flexion at initial contact with reduced extension at pre-swing. A further compensation is increased dorsiflexion at the ankle with reduced plantarflexion at push-off. Reference [1] Whitehead, et al. Gait Posture 2007;26(June (1)):90–6.
doi:10.1016/j.gaitpost.2009.08.071 O68 Body size and walking cadence affect mechanical power in children’s gait Sarah Shultz 1,∗ , Michael Sitler 2 , Howard Hillstrom 3 , Andrew Hills 1 , Ryan Tierney 2 , Jinsup Song 2 1
Queensland University of Technology, Kelvin Grove, QLD, Australia Temple University, Philadelphia, PA, United States 3 Hospital for Special Surgery, New York, NY, United States 2
Summary The results of a cross-sectional study of lower extremity gait parameters in obese and normal-weight children are presented for two walking cadences. Increases in mass and walking cadence primarily influenced mechanical power at the hip, with significant differences also found during energy absorption by the knee extensors.