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Repeatability of three-dimensional knee kinematics for eleven motor tasks
Abstracts / Gait & Posture 36 (2012) S1–S101
References [1] Sutherland D, et al. The pathomechanics of gait in DMD. Dev Med Child Neurol 1981;23:3–22. [2] Bakker J, et al. Predictive factors of cessation of ambulation in patients with DMD. Am J Phys Med Rehabil 2002;81:906–12. [3] Siegel IM. Kinematics of gait in Duchenne muscular dystrophy: implications for orthotic management. J Neurol 1997;11:169–73. [4] Owen E. ‘Shank angle floor measures’ and tuning of ‘Ankle foot orthosis footwear combinations’ for children with cerebral palsy, spina bifida and other conditions. MSc thesis. University of Strathclyde; 2004.
doi:10.1016/j.gaitpost.2011.10.342 P71 Repeatability of three-dimensional knee kinematics for eleven motor tasks B. Callewaert 1,∗ , L. Scheys 2 , A. Leardini 3 , P. Wong 2 , J. Bellemans 4 , K. Desloovere 5 1 Clinical Motion Analysis Laboratory, University Hospital Pellenberg, Leuven, Belgium 2 European Centre For Knee Research, Smith & Nephew, Leuven, Belgium 3 Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy 4 Department of Musculoskeletal Sciences, Katholieke Universiteit, Leuven, Belgium 5 Department of Rehabilitation Sciences, K.U. Leuven, Leuven, Belgium
Introduction: Numerous studies have demonstrated the role of gait analysis in the evaluation of the knee, but most confine their research to flexion–extension during typical walking. Furthermore, very little is known about three-dimensional kinematics of the knee during more complex motor tasks, inducing greater motion at the knee [1]. Also, repeatability data on 3D knee motions during these tasks are not widely available. Therefore, the present study describes the kinematics of the knee in healthy subjects for 11 daily motor tasks, in particular the repeatability both within and between subjects. Patients/materials and methods: Ten adult subjects (29 ± 9years, BMI24 ± 5) participated in this study. Kinematic data were obtained using a 14 camera motion capture system tracking the 3D positions of 23 retro-reflective markers (Plug-in-Gait, Vicon, Oxford). A knee alignment device was used to identify the knee flexion/extension axis. During 3 sessions, 11 motor tasks, 3 repetitions each were performed; gait tasks: walking, walk and crossover turn (WCO) and sidestep turn (WSS), ascent onto a step (SA), descent off a step (SD), descent with crossover turn (SDCO) and sidestep turn (SDSS); nongait tasks: chair rise (CR), mild (MS) and deep squat (DS), lunge (L). Within and between repeatability, was quantified by means of coefficient-of-multiple-correlation (CMC), root-mean-squared difference (RMS) against the average. Inter-subject variability was characterized by the standard deviation (SD), coefficient of variation (CV), and the two-way-mixed-model intraclass-correlation coefficient (ICC). Measurements were considered to have “good” repeatability presenting a high ICC (0.8–1), low SD (<5◦ ), low CV (<15%), or any combination of the three.
S95
Results: Crossover turns (17◦ ) and high-flexion tasks (17–25◦ ) showed the largest internal rotation, while WSS, SDSS (11.1◦ and 12.0◦ ) presented with the largest external rotation. Crossover turns also showed smaller adduction peaks (5.7◦ and 6.4◦ ), compared to typical walking (8.7◦ ). Consistent coupling between flexion–extension and axial rotation curves were recognized in non-gait tasks. Other studies confirm internal rotation while flexing the knee [1]. Gait tasks showed repeatable kinematics among all anatomical planes, most clearly for flexion–extension (Table 1). Crossover and sidestep turns increased the range of axial rotation by factors of 1.5 and 2, respectively, compared to walking, resulting in higher relative repeatability. The large physiological axial rotation during turning tasks thereby increased the measurementto-error ratio [2]. Furthermore, the range of knee abduction–adduction for highflexion tasks was small compared to the gait tasks. This was unexpected, since the larger flexion ranges of these tasks were hypothesized to lead to more crosstalk errors. Instead this may be attributed to the stabilization of the knee during these tasks. A number of parameters with good intra-subject repeatability were found for gait and non-gait tasks, with most tasks showing CV under 10% and ICCs above 0.90. Discussion and conclusion: The different motor tasks revealed a large spectrum of inter-subject repeatability and variability, and also different patterns and ranges of knee joint motion, in flexion–extension but also in out-of-sagittal plane rotations. The least constrained motor tasks, such as lunge and squat, were also the least repeatable. Finally, larger joint rotations were more repeatable. Disclosure: No significant relationships. References [1] Moro-oka, et al. J Orthop Res 2008;26:428–34. [2] Desloovere, et al. Gait Posture 2010;32(4):597–660.
doi:10.1016/j.gaitpost.2011.10.343
Table 1
Flexion/extension
CMCintra CMCinter RMSintra (◦ ) RMSinter (◦ )
Abduction/adduction
Endorotation/exorotation
Worst
Best
Worst
Best
Worst
Best
0.93 (MS) 0.84 (MS) 10.7 (DS) 18.3 (DS)
0.99 (W) 0.97 (W) 2.8 (W) 5.1 (W)
0.35 (L) 0.06 (L) 3.7 (L) 7.0 (L)
0.81 (W) 0.45 (SDCO) 1.4 (W) 3.0 (WCO)
0.63 (SD) 0.35 (SA) 4.9 (DS) 6.7 (DS)
0.92 (SDSS) 0.79 (SDSS) 2.9 (W) 4.5 (W)
References [1] Sutherland D, et al. The pathomechanics of gait in DMD. Dev Med Child Neurol 1981;23:3–22. [2] Bakker J, et al. Predictive factors of cessation of ambulation in patients with DMD. Am J Phys Med Rehabil 2002;81:906–12. [3] Siegel IM. Kinematics of gait in Duchenne muscular dystrophy: implications for orthotic management. J Neurol 1997;11:169–73. [4] Owen E. ‘Shank angle floor measures’ and tuning of ‘Ankle foot orthosis footwear combinations’ for children with cerebral palsy, spina bifida and other conditions. MSc thesis. University of Strathclyde; 2004.
doi:10.1016/j.gaitpost.2011.10.342 P71 Repeatability of three-dimensional knee kinematics for eleven motor tasks B. Callewaert 1,∗ , L. Scheys 2 , A. Leardini 3 , P. Wong 2 , J. Bellemans 4 , K. Desloovere 5 1 Clinical Motion Analysis Laboratory, University Hospital Pellenberg, Leuven, Belgium 2 European Centre For Knee Research, Smith & Nephew, Leuven, Belgium 3 Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy 4 Department of Musculoskeletal Sciences, Katholieke Universiteit, Leuven, Belgium 5 Department of Rehabilitation Sciences, K.U. Leuven, Leuven, Belgium
Introduction: Numerous studies have demonstrated the role of gait analysis in the evaluation of the knee, but most confine their research to flexion–extension during typical walking. Furthermore, very little is known about three-dimensional kinematics of the knee during more complex motor tasks, inducing greater motion at the knee [1]. Also, repeatability data on 3D knee motions during these tasks are not widely available. Therefore, the present study describes the kinematics of the knee in healthy subjects for 11 daily motor tasks, in particular the repeatability both within and between subjects. Patients/materials and methods: Ten adult subjects (29 ± 9years, BMI24 ± 5) participated in this study. Kinematic data were obtained using a 14 camera motion capture system tracking the 3D positions of 23 retro-reflective markers (Plug-in-Gait, Vicon, Oxford). A knee alignment device was used to identify the knee flexion/extension axis. During 3 sessions, 11 motor tasks, 3 repetitions each were performed; gait tasks: walking, walk and crossover turn (WCO) and sidestep turn (WSS), ascent onto a step (SA), descent off a step (SD), descent with crossover turn (SDCO) and sidestep turn (SDSS); nongait tasks: chair rise (CR), mild (MS) and deep squat (DS), lunge (L). Within and between repeatability, was quantified by means of coefficient-of-multiple-correlation (CMC), root-mean-squared difference (RMS) against the average. Inter-subject variability was characterized by the standard deviation (SD), coefficient of variation (CV), and the two-way-mixed-model intraclass-correlation coefficient (ICC). Measurements were considered to have “good” repeatability presenting a high ICC (0.8–1), low SD (<5◦ ), low CV (<15%), or any combination of the three.
S95
Results: Crossover turns (17◦ ) and high-flexion tasks (17–25◦ ) showed the largest internal rotation, while WSS, SDSS (11.1◦ and 12.0◦ ) presented with the largest external rotation. Crossover turns also showed smaller adduction peaks (5.7◦ and 6.4◦ ), compared to typical walking (8.7◦ ). Consistent coupling between flexion–extension and axial rotation curves were recognized in non-gait tasks. Other studies confirm internal rotation while flexing the knee [1]. Gait tasks showed repeatable kinematics among all anatomical planes, most clearly for flexion–extension (Table 1). Crossover and sidestep turns increased the range of axial rotation by factors of 1.5 and 2, respectively, compared to walking, resulting in higher relative repeatability. The large physiological axial rotation during turning tasks thereby increased the measurementto-error ratio [2]. Furthermore, the range of knee abduction–adduction for highflexion tasks was small compared to the gait tasks. This was unexpected, since the larger flexion ranges of these tasks were hypothesized to lead to more crosstalk errors. Instead this may be attributed to the stabilization of the knee during these tasks. A number of parameters with good intra-subject repeatability were found for gait and non-gait tasks, with most tasks showing CV under 10% and ICCs above 0.90. Discussion and conclusion: The different motor tasks revealed a large spectrum of inter-subject repeatability and variability, and also different patterns and ranges of knee joint motion, in flexion–extension but also in out-of-sagittal plane rotations. The least constrained motor tasks, such as lunge and squat, were also the least repeatable. Finally, larger joint rotations were more repeatable. Disclosure: No significant relationships. References [1] Moro-oka, et al. J Orthop Res 2008;26:428–34. [2] Desloovere, et al. Gait Posture 2010;32(4):597–660.
doi:10.1016/j.gaitpost.2011.10.343
Table 1
Flexion/extension
CMCintra CMCinter RMSintra (◦ ) RMSinter (◦ )
Abduction/adduction
Endorotation/exorotation
Worst
Best
Worst
Best
Worst
Best
0.93 (MS) 0.84 (MS) 10.7 (DS) 18.3 (DS)
0.99 (W) 0.97 (W) 2.8 (W) 5.1 (W)
0.35 (L) 0.06 (L) 3.7 (L) 7.0 (L)
0.81 (W) 0.45 (SDCO) 1.4 (W) 3.0 (WCO)
0.63 (SD) 0.35 (SA) 4.9 (DS) 6.7 (DS)
0.92 (SDSS) 0.79 (SDSS) 2.9 (W) 4.5 (W)