脑瘫患儿步态时空和运动学参数的可靠性分析

目的:对脑瘫患儿步态的时空及运动学参数进行可靠性分析,确定不同类型脑瘫患儿步态参数的最佳测试次数。方法:利用三维步态分析系统采集45例脑瘫患儿(26例偏瘫和19例双瘫)步态的时空及运动学参数,采集有效测试8次;利用组内相关系数(Intra-class correlation coefficients,ICC)对步态参数进行可靠性分析。结果:偏瘫患儿重复测试5次、双瘫重复4次可使各时空参数的ICC值均达到0.9以上;偏瘫患儿重复测试6次、双瘫重复5次可使运动学各参数的ICC值均达到0.9以上。结论:脑瘫患儿时空参数的可靠性高于运动学参数,双瘫患儿时空和运动学参数的可靠性均高于偏瘫患儿;偏瘫患儿重复测试6次、双瘫患儿重复测试5次能使其时空和运动学参数达到较高的可靠性。     

肺炎患儿血小板参数的变化及其临床意义

目的观察细菌、病毒、支原体所致轻、重症肺炎患儿血小板参数的变化并分析其临床意义。方法回顾性研究2010年11月—2012年3月我科收治的180例细菌性、病毒性及支原体肺炎(各60例,其中重症肺炎62例,轻症肺炎118例)急性期和恢复期血小板计数(PLT)、血小板压积(PCT)、平均血小板体积(MPV)、血小板宽度(PDW)的变化,并与50例对照组进行比较。结果三组肺炎患儿血小板参数均高于对照组,细菌性肺炎组患儿血小板参数明显高于病毒性肺炎组和支原体肺炎组(P<0.01);急性期重症肺炎患儿血小板参数明显高于轻症肺炎者(P<0.01),且两者均明显高于对照组;恢复期重症及轻症肺炎患儿血小板参数均明显降低,与对照组无差异。结论肺炎患儿血小板数量及功能状态通常异常,以细菌性肺炎更易于发生;血小板参数的变化可作为肺炎严重程度及病情变化的一项参考指标。     

脑干听觉诱发电位诊断脑瘫患儿听觉损伤效果观察

目的:观察脑干听觉诱发电位(BAEP)诊断脑瘫患儿听觉损伤的效果。方法:选择确诊脑瘫患儿120例为观察组,选择正常儿童40例为对照组,均进行BAEP检查,并比较各组间听觉诱发电位的差异。结果:观察组BAEP异常36例,异常率30.0%;观察组各波潜伏期及波间距均较对照组显著或非常显著延长(P<0.05,P<0.01)。结论:脑瘫患儿合并听神经传导通路损伤发生率较高,BAEP应作为其常规检查之一。     

儿童痉挛性脑瘫的内侧腓肠肌的动态弹性超声成像表现

正摘要目的研究痉挛性脑瘫患儿的内侧腓肠肌(GCM)的弹性特点。方法研究方案经医院研究伦理委员会批准,并获取了每例患儿家属的知情同意。15例痉挛性脑瘫患儿(组1)和13例无神经系统及骨骼肌肉系统疾病的儿童(组2)被纳入研究。由于组1包括3例偏瘫患儿,故组115例共研究了27条腿。     

血液动力学对预测急性高原病易感人群价值的初步探讨

作者对一组急进高海拔区(>5000m)进行国防施工的青年战士,结合急性高原病易感人群予测课题的研究,应用阻抗血流图及其一阶微分波检测血流动力学各项参数,经统计学处理,发现血流动力学许多参数,在发病组与未发病组之间都有显著性改变。其中DP、MAP、RVET、CCO及TPR等参数发病组均较未发病组高,且具有显著性差异(P<0.05)和非常显著性差异(P<0.01)唯有RSV及C较未发病组低,且差异性非常显著(P<0.01)。因此肯定了血流动力学各项参数对急性高原病易感人群的预测价值。     

基于Anybody的足球运动员大角度侧切下肢生物力学仿真分析北大核心CSCD

目的:对足球运动员大角度(135°、180°)侧切下肢运动学、动力学、肌肉活动度以及肌肉受力进行分析,探讨大角度侧切下肢膝关节损伤风险,通过比较不同角度侧切生物力学特征,为足球侧切防伤训练方案的制定提供理论依据。方法:招募12名男性足球二级运动员,运用Vicon三维动作捕捉系统、Kistler三维测力台同步采集受试者135°、180°侧切的下肢运动学、动力学数据。通过Anybody逆动力学计算,获取并分析膝关节力矩以及下肢主要肌群肌肉活动度和肌肉受力,同时采用Noraxon表面肌电同步采集运动过程中电生理学数据,以验证模型的有效性。结果:(1)135°、180°侧切肌肉活性仿真结果与表面肌电肌肉活性具有高度相关性(R>0.75)。(2)与135°侧切相比,180°侧切膝关节屈曲触地时刻(initial contact,IC)角变大,膝关节屈曲最大角变大(P<0.05);髋关节屈曲/伸展IC角、内旋/外旋IC角变小(P<0.05);髋关节外展/内收IC角无显著性差异(P>0.05);180°和135°侧切踝关节跖屈/背伸IC角无显著性差异(P>0.05);与135°侧切相比,180°侧切完成时间增加(P<0.05)。(3)与135°侧切相比,180°侧切水平地面反作用力(HGRF)峰值变大(P<0.05),垂直地面反作用力(VGRF)峰值无显著性差异,膝关节内/外翻力矩峰值和伸/屈膝力矩峰值无显著性差异;与135°侧切相比,180°侧切内/外旋力矩峰值减小(P<0.05)。(4)135°侧切与180°侧切腓肠肌外侧头、胫骨前肌、腓骨短肌、股外侧肌、半腱肌、阔筋膜张肌肌肉活动度均超过1;与135°侧切相比,180°侧切腓骨短肌、梨状肌肌肉活动度降低,且梨状肌肌肉活动度小于1(P<0.05),缝匠肌、长收肌肌肉活动度增高,但并未超过1;两种角度侧切时下肢相关肌肉除股二头肌长头和大收肌受力有显著性差异外,其他肌肉受力无显著性差异。结论:运用Anybody仿真分析侧切可行、有效;随着侧切角度增大,人体需要更长的缓冲时间、更大的屈膝角度以吸收冲击。大角度侧切属于高损伤风险动作,其易损伤肌肉为腓肠肌外侧头、胫骨前肌、腓骨短肌、股外侧肌、半腱肌、阔筋膜张肌,进行足球防伤训练时应重点加强。     

人体跖趾关节活动受限对行走时下肢生物力学特征的影响

目的:分析跖趾关节活动受限对行走时下肢生物力学特征的影响。方法:10名普通男性大学生分别完成正常和跖趾关节受限情况下的步行,同步采集运动学、动力学及下肢主要肌肉的表面肌电信号。计算髋、膝、踝的三维角度、关节净力矩、关节功率和关节功,计算各肌肉摆动相和支撑相的肌电均方根振幅(RMS)并获得肌电的线性包络线。结果:与正常步行比较,限制跖趾关节行走时步宽显著增大(P=0.032),摆动相百分比显著增大(P=0.002),支撑相百分比显著减小(P=0.002),步长、步频两组之间无显著性差异(P>0.05)。跖趾关节受限情况下,踝最大背屈角度显著增大(P<0.001),最大跖屈角度显著减小(P<0.001);踝关节最大跖屈力矩(P<0.001)、最大背屈力矩(P=0.029)显著增大;踝关节功率最大值增大(P<0.001)、最小值显著减小(P<0.001);踝关节负功显著增大(P<0.001),正功受限和正常两种情况无显著性差异(P>0.05)。膝关节和髋关节各指标在受限和正常两种情况下均无显著性差异(P>0.05)。支撑相腓肠肌内侧头RMS值受限情况显著大于正常情况(P=0.009),其他肌肉两组间均无显著性差异(P>0.05)。结论:在跖趾关节运动受到约束后,人体主要是通过踝关节增大背屈角度、增加做功和增大周围肌肉的活动水平来代偿,以保持步长、步速和运动中的动态平衡。限制跖趾关节会增加行走时人体足踝部分的能量消耗,长期受限,可能会导致小腿后群肌肉的疲劳或损伤。     

观察康复技术与神经节苷酯结合治疗脑瘫患儿的效果

目的 探究观察康复技术与神经节苷酯结合治疗脑瘫患儿的效果.方法 选取接收的脑瘫患儿82例作为研究的对象,随机分成两组,对照组采用康复技术,而研究组则在对照组的基础上采用神经节苷酯治疗,对比两组治疗效果.结果 研究组治疗后,患者的治疗总有效率明显高于对照组;且各项发育指标评分均优于对照组,组间对比差异显著,存在统计学方面的意义(P<0.05).结论 在脑瘫患儿中采用观察康复技术与神经节苷酯结合治疗,能够取得良好的疗效,并促进患儿各方面的发育.     

脑瘫患儿术前口服氯胺酮和咪唑安定混合液的临床观察

 目的比较脑瘫患儿术前口服氯胺酮、咪唑安定混合液与单纯肌注氯胺酮的优缺点.方法选择脑瘫患儿60例,随机分为观察组30例和对照组30例.观察组术前口服氯胺酮(6.0 mg/kg)和咪唑安定(0.3mg/kg)混合液,对照组肌肉注射氯胺酮(5.0 mg/kg).观察用药前和用药后5、10、15 min时患儿的心率、呼吸、脉搏、血氧饱和度,以及术后精神状态和有无并发症.结果观察组94%的患儿给药时合作,对照组仅有10%,两组间差异非常显著(P＜0.01).而对照组患儿的呼吸频率和心率较观察组明显增快,两组间差异显著(P＜0.05).两组患儿麻醉诱导前脉搏、血氧饱和度正常,也无恶心、呕吐等并发症;术后清醒时间及其他与麻醉有关的并发症,两组间无显著差异.术后随访有恐惧和抵触情绪的患儿观察组为9%,对照组为83%,两组间差异非常显著(P＜0.01).结论患儿术前口服氯胺酮和咪唑安定混合液,镇痛和镇静效果良好.术中血流动力学稳定,围手术期并发症无增加,术后患儿心理和精神状态稳定.口服氯胺酮和咪唑安定混合液作为脑瘫患儿术前用药是安全和可靠的.     

肌电生物反馈疗法与痉挛肌治疗痉挛型脑瘫儿童的疗效比较

目的比较肌电生物反馈疗法与痉挛肌在痉挛型脑瘫儿童康复中的疗效。方法将48例痉挛型脑瘫患儿随机分为2组;肌电生物反馈(EMGBF)组、痉挛肌(STE)组。2组均给予运动疗法等常规治疗,EMGBF组加用Myo Trac生物刺激反馈系统治疗,STE组加用痉挛肌治疗。分别在治疗前后进行腓肠肌痉挛评分(改良Ashworth分值,MAS)、踝关节被动活动度(ROM)比较。结果治疗后2组患儿的MAS量化评分均降低,踝关节ROM提高,与治疗前相比,差异均有统计学意义(P均<0.05);EMGBF组MAS量化评分、踝关节ROM指标均治优于STE组(P均<0.05)。结论肌电生物反馈疗法较痉挛肌更能显著痉挛型脑瘫患儿下肢痉挛。     

Kinematic adaptation and changes in gait classification in running compared to walking in children with unilateral spastic cerebral palsy

BackgroundClassification of sagittal gait patterns in unilateral spastic cerebral palsy (CP) provides direct implication for treatment. Five types are described: type 0 has minor gait deviation; type 1 has inadequate ankle dorsiflexion in swing; type 2 has inadequate ankle dorsiflexion throughout the gait cycle; types 3 and 4 have abnormal function of the knee and hip joint respectively. During gait analysis of children with unilateral spastic CP we observed frequently that a knee flexion deficit disappeared during running. That may have an impact on classification and treatment.Research questionDoes the classification type change while running and how do patients’ kinematics adapt to running?Methods64 children with unilateral spastic CP were classified using instrumented gait analysis for walking and running. The deviation of four parameters from typically developing children (TD) were used to distinguish between types: peak ankle dorsiflexion in swing for type 1, peak ankle dorsiflexion in stance for type 2, knee range of motion for type 3, and hip range of motion for type 4. A three-factor ANOVA for factors group (CP/TD), locomotion (walk/run) and limb side (in-/uninvolved) was conducted.ResultsThe number of patients with type 1, 3 and 4 decreased considerably from walking to running, whereas, the number of type 0 and 2 patients increased. The ANOVA showed that three of four parameters of patients’ pathologic limb adapt similarly to TD to running, except for the ankle dorsiflexion in stance.SignificanceRunning shows that there is a natural way to resolve abnormalities. Therefore, recommended treatments of hip and knee joint abnormalities based on the walking classification can be questioned and additional running analysis may be important for surgical decision making.     

The effect of serial casting on gait in children with cerebral palsy: preliminary results from a crossover trial

Serial casting aims to improve an equinus gait pattern in children with spastic cerebral palsy (SCP). We evaluated the effect of short-term stretch casting on gait in children with SCP, compared to the natural history. A crossover trial, consisting of a control phase and a casting phase, was conducted with children randomised into two groups. Both groups were assessed clinically, and using 3D gait analysis, at 0, 5 and 12 weeks. Subjects in one group had the 3 month casting phase first and in the other had the 3 month control period first. Casts were changed weekly and set at maximum available ankle dorsiflexion. The mean changes at 5 weeks and 12 weeks from baseline measurements in the casting phase were compared with the change within the same time interval in the control phase. Significant improvements in passive ankle dorsiflexion (knee flexed) were found at 5 and 12 weeks. Passive ankle dorsiflexion (knee extended), ankle dorsiflexion in single support, ankle dorsiflexion in swing and minimum hip flexion in stance improved significantly at 5 weeks but not at 12 weeks from baseline. Other kinematic parameters, the score on the Gillette Functional Assessment Questionnaire, and maximum reported walking distance were not changed by casting. Casting to improve range appears to improve passive and dynamic ankle dorsiflexion, but the changes are small, short lived and do not appear to affect function.     

Minimal detectable change for gait variables collected during treadmill walking in individuals post-stroke

Post-stroke gait impairments are common and result in slowed walking speeds and decreased community participation post-stroke. Treadmill training has recently emerged as an effective gait rehabilitation intervention. Furthermore, kinematic and kinetic data collected during treadmill walking are commonly used for assessing gait performance. The minimal detectable change (MDC) for gait variables provides a useful index to determine whether the magnitude of change in gait produced after an intervention is greater than the amount of change attributable to day-to-day variability in gait or test-retest measurement errors. The MDC values for kinematic, ground reaction force (GRF), spatial, and temporal variables collected during treadmill walking post-stroke have not been previously reported. The objective of this study was, therefore, to compute MDCs for post-stroke gait kinematics, GRF indices, temporal, and spatial measures during treadmill walking. Nineteen individuals with chronic post-stroke hemiparesis (12 males; age=47-75 years; 72.6±63.4 months since stroke) participated in 2 testing sessions separated by 20.7±26.8 days. Our results showed that test-retest reliability was excellent for all gait variables tested (intraclass correlation coefficients=0.799-0.986). MDCs were reported for hip, knee, and ankle joint angles (range 3.8° for trailing limb angles to 11.5° for hip extension), peak anterior GRF (2.85% body weight), mean vertical GRF (4.65% body weight), all temporal variables (range 3.2-4.2% gait cycle), and paretic step length (6.7 cm). These MDCs provide a useful reference to help interpret the magnitudes of changes in post-stroke gait variables.     

Juvenile idiopathic arthritis,gait characteristics and relation to function

BackgroundJuvenile Idiopathic Arthritis (JIA) is a chronic inflammatory arthritis that impacts biomechanical features of gait. This systematic review describes the effects of JIA on gait motion parameters and walking performance.MethodsSix databases were searched (PubMed/Medline, Cochrane, the EBSCOHost database SPORTDiscus, Web of Science, and Embase). Studies were restricted to children with any subtype of JIA who were assessed for gait motion features (kinematic, kinetic, temporalspatial) or walking performance (velocity or distance covered); could include intervention or treatment exposure with measures of gait and gait speed; could involve comparison of gait in JIA to healthy controls. Quality of evidence was assessed using the GRADE system. This systematic review was registered at PROSPERO (CRD42018109582)ResultsThe search yielded 625 papers, 23 of which described biomechanical features of gait and/or assessed walking performance. Twenty studies measured walking velocity and walking ability using simple field tests or laboratory methods. Eleven studies measured temporalspatial parameters such as cadence, step length, stride length, step width, single and double support time. Nine studies evaluated kinetic measurements including joint power, flexion and extension and joint moments. Nine studies evaluated kinematic parameters including range of motion, pelvic tilt, center of motion and trunk sway.ConclusionsKey features of gait in children with JIA include slower gait velocity, shortened step length, decreased range of motion at the hip, knee and ankle with trend towards flexion, decreased joint power, anteriorly tilted pelvis and trunk with shifted center of motion. There is a potential to ameliorate JIA-related gait changes with exercise and/or pharmaceutical interventions.     

慢性膝关节前交叉韧带损伤患者步态的运动学分析

目的:探讨慢性膝关节前交叉韧带(ACL)损伤患者下肢关节运动学变化特点。方法:30名慢性ACL损伤患者为损伤组,30名健康人为对照组,利用三维运动分析系统对实验对象进行步态分析,比较两组的时间距离指标;比较两组在预承重期髋、膝关节最大屈曲角度和踝关节最大跖屈角度,以及膝关节最大外旋角度。结果:同对照组比较,损伤组步频、步速显著减小,步态周期时间显著增加(P<0.05)。在预承重期,损伤组最大屈髋角度同对照组相比无明显差异,最大屈膝角度显著小于对照组(P<0.05),最大跖屈角度显著小于对照组(P<0.05),最大胫骨外旋角度显著大于对照组(P<0.05)。结论:慢性ACL损伤患者行走时步态出现膝关节屈曲、踝关节跖屈角度的改变,同时,膝关节旋转角度也发生改变。     

The effects of direction and speed on treadmill walking in typically developing children

BackgroundBackward walking and fast walking have distinctive gait patterns in adults; however, there is minimal literature describing these gait modifications in typically developing children. Additionally, most of previous research focused on overground backward walking, but not on a treadmill.Research questionHow do typically developing children adapt their gait patterns, including spatiotemporal parameters, joint kinematics, and muscle activation, to changes in direction and speed during treadmill walking?MethodsWe recruited 19 children (10 M/9 F) aged 6–12 years. Treadmill conditions included forward and backward walking at three speeds: slow (75 % of normal speed), normal speed, and fast (125 % of normal speed). Subjects completed a 2-minute trial under each condition. Spatiotemporal, kinematic, kinetic and electromyography data were collected and analyzed. Correlations between forward and time-reversed backward walking were calculated for joint angles and vertical ground reaction force.ResultsDuring backward walking, children (a) decreased step lengths and increased step widths and foot clearance, (b) decreased peak hip and knee flexion and increased peak ankle dorsiflexion, and (c) increased muscle activity at the vastus lateralis, rectus femoris, and tibialis anterior. At faster speeds, children increased step lengths and inconsistently increased overall muscle activity. Both the hip and knee showed high correlation between forward and time-reversed backward walking, while correlation at the ankle was low.SignificanceOverall, children adapt their gait to changes in direction and speed of treadmill walking in similar ways to adults. However, notable differences emerged in that children limited their ankle range of motion. Our results suggest that, while many aspects of gait are mature enough by this age to adapt to backward walking on a treadmill, neuromuscular control at the ankle may still be lacking in children while walking backward on a treadmill.     

Elderly unilateral transtibial amputee gait on an inclined walkway: a biomechanical analysis

The greatest population of amputees in developed nations are elderly dysvascular transtibial amputees. Conventional prostheses, e.g. the solid ankle cushioned heel (SACH) foot, create difficulties in walking on inclines. The aim of this study was to analyse the gait characteristics of elderly amputees walking on an incline, through quantitative three-dimensional biomechanical analysis, by comparing them to age-matched controls. Participants walked up and down an inclined (5 degrees) instrumented walkway at a self-selected pace. A Vicon System 370 was used to acquire gait data, including temporo-spatial characteristics, ground reaction forces (GRF), electromyography (EMG), kinematics, and kinetics of the lower limb. Compared to the age-matched controls, the amputees demonstrated reduced speed, knee and hip range of motion, hip moments, vertical GRF, along with increased amplitude and periods of muscle activation. The residual limb also had shorter single support stance phase, small stance phase knee moments, and the smallest moments and powers. These differences demonstrate instability in stance of the residual limb. The sources of this instability include the prosthesis' limited range of ankle motion and ankle power generation, coupled with the residual limb's limited proprioception and tolerance of force. For these amputees to regain a gait pattern equivalent to their able-bodied counterparts on inclined walkways, they must be equipped with a prosthesis that has a full range of ankle motion and active power generation at the ankle. Prosthesis design and rehabilitation training should also improve the proprioception of their residual limb and increase their tolerance of force through the residual limb.     

Does lower limb preference influence gait initiation?

Gait initiation (GI) has been the focus of many investigations in order to determine the kinematic and kinetic parameters associated with this process. In these studies, the parameters are observed during GI with the preferential lower limb. However, none of these studies have looked at the impact on GI parameters when the start is achieved with the non-preferential limb. This investigation focused on the effects of lower limb preference on the kinematic and kinetic parameters of GI. Upon display of a visual cue, subjects stepped with preferential limb or non-preferential limb at natural speed. The duration of GI phases, the medio-lateral component of the center of mass (CM) displacement, the medio-lateral distance between the center of pressure and the CM, the step width as well as the medio-lateral impulse, were observed. When subjects started with the non-preferential limb, the bodyweight transfer was facilitated by a greater impulse during the anticipatory postural adjustment (APA) phase. Conversely, a more lateral CM displacement during the execution phase and a more lateral step in preferential start were observed. Asymmetry in frontal plane body motion was observed during weight transfer following APA, as well as during assistive control of ballistic body motion during the execution phase of the first step. In both conditions, the non-preferential limb provided the greater lateral impulse on the ground. This may have clinical relevance especially in individuals with unilateral limb dyscontrol and postural asymmetry that may require rehabilitation.     

Effectiveness of robotic exoskeletons for improving gait in children with cerebral palsy: A systematic review

BackgroundRobotic exoskeletons have been developed to assist locomotion and address gait abnormalities in children with cerebral palsy (CP). These wearable assistive devices provide powered assistance to the lower-extremity joints, as well as support and stability.Research QuestionDoes exoskeleton-assisted walking improve gait in children with CP?MethodsThe PRISMA guidelines were used to conduct this systematic review. Articles were obtained in a search of the following electronic databases: Embase, CINAHL Complete, PubMed, Web of Science and MEDLINE. Studies investigating spatiotemporal, kinematic, kinetic, muscle activity and/or physiological parameters during exoskeleton-assisted walking in children with CP were included. All articles were assessed for methodological quality using an adapted version of the Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group, provided by the National Institutes of Health (NIH).ResultsThirteen studies were included. They involved the use of the following exoskeletons: tethered knee exoskeleton, pediatric knee exoskeleton (P.REX), untethered ankle exoskeleton, WAKE-Up ankle module, WAKE-Up ankle & knee module and unilateral ankle exosuit. Methodological quality varied, with key limitations in sample size and allocated time to adapt to the exoskeleton. There was a consensus that robotic exoskeletons improve gait given careful optimisation of exoskeleton torque and sufficient exoskeleton practice time for each participant. Improvements in gait included reduced metabolic cost of walking, increased walking speed, and increased knee and hip extension during stance. Furthermore, exoskeletons with an actuated ankle module were shown to promote normal ankle rocker function.SignificanceRobotic exoskeletons have the potential to improve the mobility of CP children and may therefore increase community participation and improve quality of life. Future work should involve larger controlled intervention studies utilising robotic exoskeletons to improve gait in children with CP. These studies should ensure sufficient exoskeleton practice time for each participant.     

Gait pattern in rheumatoid arthritis

The purpose of this study was to analyse kinematic and kinetic gait changes in rheumatoid arthritis (RA) patients in comparison to healthy controls and to examine whether levels of functional disability (Health Assessment Questionnaire (HAQ)-scores) were associated with gait parameters. Using a three-dimensional motion analysis system, kinematic and kinetic gait parameters were measured in 50 RA patients and 37 healthy controls. There was a significant reduction in joint motions, joint moments and work in the RA cohort compared with healthy controls. The following joint motions were decreased: hip flexion-extension range (Delta6 degrees ), hip abduction (Delta4 degrees ), knee flexion-extension range (Delta8 degrees ) and ankle plantarflexion (Delta10 degrees ). The following joint moments were reduced: hip extensor (Delta0.30Nm/kg) and flexor (Delta0.20Nm/kg), knee extensor (Delta0.11Nm/kg) and flexor (Delta0.13Nm/kg), and ankle plantarflexor (Delta0.44Nm/kg). Work was lower in hip positive work (Delta0.07J/kg), knee negative work (Delta0.08J/kg) and ankle positive work (Delta0.15J/kg). Correlations were fair although significant between HAQ and hip flexion-extension range, hip abduction, knee flexion-extension range, hip abductor moment, stride length, step length and single support (r=-0.30 to -0.38, p<0.05). Our findings suggest that RA patients have overall less joint movement and specifically restricted joint moments and work across the large joints of the lower limbs during walking than healthy controls. There were only fair associations between levels of functional disability and gait parameters. The findings of this study help to improve the understanding how RA affects gait changes in the lower limbs.