The effects of increased forward trunk lean during stair ascent on hip adduction and internal rotation in asymptomatic females

BackgroundIncreased hip adduction and internal rotation can lead to excessive patellofemoral joint stress and contribute to patellofemoral pain development. The gluteus maximus acts as a hip extensor, abductor, and external rotator. Improving hip extensor use by increasing one’s forward trunk lean in the sagittal plane may improve frontal and transverse plane hip kinematics during stair ascent.Research questionDoes increasing forward trunk lean during stair ascent affect peak hip adduction and internal rotation?MethodsTwenty asymptomatic females performed five stair ascent trials (96 steps/min) on an instrumented stair using their self-selected and forward trunk lean postures. Three-dimensional kinematics (200 Hz) and kinetics (2000 Hz) were recorded during the stance phase of stair ascent. Biomechanical dependent variables were calculated during the stance phase of stair ascent and included peak forward trunk lean, hip flexion, hip adduction, hip internal rotation angles, and the average hip extensor moment.ResultsDuring the forward trunk lean condition, decreases were observed for peak hip adduction (MD = 2.8˚; 95% CI = 1.9, 3.8; p < 0.001) and peak hip internal rotation (MD = 1.1˚; 95% CI = 0.1, 2.2; p = 0.04). In contrast, increases were observed during the forward trunk lean condition for the peak forward trunk lean angle (MD = −34.7˚; 95% CI = −39.1, −30.3; p < 0.001), average hip extensor moment (MD = −0.5 N·m/kg; 95% CI = −0.5, −0.4; p < 0.001), and stance time duration (MD = −0.02 s; 95% CI = −0.04, 0.00; p = 0.017).SignificanceIncreasing forward trunk lean and hip extensor use during stair ascent decreased peak hip adduction and internal rotation in asymptomatic females. Future studies should examine the effects of increasing forward trunk lean on hip kinematics, self-reported pain, and function in individuals with patellofemoral pain.     

Influence of using knee sleeve and lateral wedge insole on knee loading among healthy individuals during stair negotiation

BackgroundFor individuals with knee osteoarthritis (OA), stair negotiation is a challenging task and the first task during which they report pain due to the high knee loading required. The use of lateral wedge insole (LWI) has been found to reduce loading in patients with OA but not to reduce pain, whereas the use of knee sleeve has been shown to result in good pain reduction. Understanding the effect of combining LWI and knee sleeve use on healthy individuals before testing on individuals with knee OA is an important step.Research questionThe current study aimed to evaluate the effect of combining the use of LWI and knee sleeve and compare the results with the application of each treatment separately and with the control condition.MethodsThis randomised cross-over study included 17 healthy participants who underwent 3D gait analysis. Participants performed ascending and descending stair activities with the following four treatment conditions: five-degree LWI, off-the-shelf knee sleeve, both LWI and knee sleeve and control condition. External knee adduction moment (EKAM) and knee frontal plane range of motion (ROM) were evaluated as primary outcomes. Repeated measure ANOVA or the Friedman test was selected based on meeting the assumption followed by multiple pairwise comparisons with Bonferroni correction.ResultsIn general, the use of LWI reduced the first peak EKAM significantly (p < 0.001) compared to the control condition in stir ascending (12% reduction) but not in stair descending (p > 0.05). Interestingly, knee sleeve use did not result in any reduction in the first peak EKAM compared to the control or any other condition. However, knee sleeve use led to a significant reduction in the knee frontal plane ROM during stair descending. The combined treatment was not superior to the LWI use when compared to control in the EKAM reduction.SignificanceCombined knee sleeve and LWI use was not superior to LWI use alone in reducing the knee loading, but it may be beneficial for individuals with knee OA since it helped in reduction of the knee frontal plane ROM during stair descending. Importantly, the effect of LWI use or any other treatment must be investigated for each different activity, and the results found in one activity must not be generalised across other activities.     

鞋跟高度对青年女性下楼梯步态的影响

目的 研究鞋跟高度对青年女性下楼梯步态的影响,分析女性穿高跟鞋下楼梯时的风险因素。方法 利用红外高速运动捕捉系统测试17名青年女性穿4种不同鞋跟高度皮鞋下楼梯的步态,计算受试者的步态时空参数和下肢关节角度。结果 与穿平跟鞋相比,穿3、5、7 cm高跟鞋下楼梯时步态周期增大,支撑相和双支撑相所占步态周期比例减小,步宽显著减小。与穿平跟鞋相比,穿5、7 cm高跟鞋下楼梯时踝关节矢状面内关节活动幅度均较小,穿3、5、7 cm高跟鞋时踝关节水平面内关节活动幅度均较大。穿3、5 cm高跟鞋时膝关节矢状面内关节活动度显著小于穿平跟鞋,穿3、5、7 cm高跟鞋时膝关节水平面内关节活动幅度显著大于穿平跟鞋。穿5、7 cm高跟鞋时髋关节最大屈曲角度显著大于穿平跟鞋,穿3、5、7 cm高跟鞋时髋关节最小屈曲角度显著大于穿平跟鞋。结论 随着鞋跟高度的增加,下楼梯时摆动期占步态周期百分比和步态周期都增大,而支撑相占步态周期百分比、双支撑相（后期）占步态周期百分比和步宽都减小,增加了下楼梯时跌倒的危险;同时,踝、膝关节矢状面内的关节活动幅度逐渐减小,水平面内的关节活动幅度增大。研究结果有助于深入了解鞋跟高度对穿着者下楼梯步态的影响特征和规律,为分析下楼时可能出现的损伤危险提供依据。     

Kinetic comparison of older men and women during walk-to-stair descent transition

Stair walking is one of the most challenging tasks for older adults, with women reporting higher incidence of falls. The purpose of this study was to investigate the gender differences in kinetics during stair descent transition. Twenty-eight participants (12 male and 16 female; 68.5 and 69.0 years of mean age, respectively) performed stair descent from level walking in a step-over-step manner at a self-selected speed over a custom-made three-step staircase with embedded force plates. Kinematic and force data were combined using inverse dynamics to generate kinetic data for gender comparison. The top and the first step on the staircase were chosen for analysis. Women showed a higher trail leg peak hip abductor moment (−1.0 N m/kg), lower trail leg peak knee extensor moment and eccentric power (0.74 N m/kg and 3.15 W/kg), and lower peak concentric power at trail leg ankle joint (1.29 W/kg) as compared to men (p < 0.05; −0.82 N m/kg, 0.89 N m/kg, 3.83 W/kg, and 1.78 W/kg, respectively). The lead leg knee eccentric power was also lower in women (p < 0.05). This decreased ability to exert knee control during stair descent transition may predispose women to a higher risk of fall.     

Stair climbing ability in patients with early knee osteoarthritis: Defining the clinical hallmarks of early disease

BackgroundA growing clinical interest has been shown towards identifying knee osteoarthritis (OA) patients at earlier stages. The early detection of knee OA may allow for more effective interventions.Research questionThe aim of this study was to determine the discriminative ability of a stair-climb test (SCT) in identifying patients with early knee OA, and to determine if descending stair time during the SCT is better than ascending stair time for the identification of these patients.MethodsThis study was a secondary, cross-sectional analysis of baseline data from a randomized controlled trial. Adults with moderate to severe knee pain were enrolled (n = 57; mean age 58.9 years; 71.9% women). Each participant performed an 11-step SCT (11-SCT) while wearing shoes with a pressure sensor insole. A receiver operating characteristic analysis was used to examine the discriminative power of 11-SCT for identifying early knee OA (Kellgren and Lawrence grade 1). The discriminative power was also compared between the ascending and descending 11-SCT time as evaluated by the pressure sensor.ResultsThe 11-SCT time in patients with early knee OA was 0.55 s longer than that in those with symptomatic non-radiographic OA. A one-second increase in the 11-SCT time was significantly associated with 1.9-fold increased odds of early knee OA being present. The 11-SCT value with the best balance of sensitivity and specificity for identifying early knee OA was 8.33 s (area under the curve: 0.711). The descending time was not significantly better than the ascending time for identifying early knee OA.SignificanceThis study determined the time values of an 11-SCT that may be useful for identifying early knee OA patients. These preliminary findings may serve as the foundation for future studies investigating the clinical hallmarks associated with early knee OA.     

登楼试验预测肺叶切除术后心肺并发症的研究

目的:评价登楼试验预测肺癌患者肺叶切除术后心肺并发症的作用。方法:将需行肺叶切除术的418例肺癌患者行肺功能检查后随机分成两组,P组中ppoFEV1%>30%者205例行手术治疗,S组行登楼试验,于60s内可以登楼48级台阶、静息状态呼吸室内空气时SpO2>90%者200例经术前功能锻炼后行手术治疗,并将S组分为无并发症组和并发症组,对两组间的登楼试验结果进行比较。结果:405例患者接受手术,术后出现心肺并发症47例(11.6%),其中心律失常14例、心功能衰竭7例、心肌梗死1例、肺部感染14例、肺不张5例、肺动脉栓塞1例、呼吸衰竭5例(其中1例死亡)。P组出现心肺并发症25例(12.19%),S组出现并发症22例(11.00%),二组并发症发生率差异无统计学意义(P>0.05)。S组中的无并发症组和并发症组患者的ppoFEV1%、DLCO%、ΔHR差异有统计学意义,登楼时间和ΔSpO2差异无统计学意义。结论:登楼试验是一种简便、经济的预测肺癌患者肺叶切除术后心肺并发症的手段。     

医院楼梯扶手细菌污染情况的调查

目的了解医院楼梯扶手细菌污染情况,为医院感染控制提供依据。方法按照《消毒技术规范》,对医院88处楼梯扶手按物体表面进行消毒前后采样,做细菌学监测,用统计学χ2分析。结果医院楼梯扶手细菌污染严重,消毒前细菌污染率达100%,检出枯草芽胞杆菌、微球菌、葡萄球菌属、肠杆菌属、链球菌属、非发酵菌属、真菌等条件致病菌和致病菌共3650株;消毒后,只检出85株菌,细菌污染率下降了97.67%。结论医院扶手细菌污染情况严重,应加强日常清洁消毒监测工作,切断细菌传播途径,防止医院感染发生。     

Kinematics and kinetics with an adaptive ankle foot system during stair ambulation of transtibial amputees

Conventional prosthetic feet cannot adapt to specific conditions such as walking on stairs or ramps. Amputees are therefore forced to compensate their prosthetic deficits by modifying the kinematics and kinetics of their lower limbs. The Proprio-Foot™ (Ossur) intends to reduce these compensation mechanisms by automatically increasing dorsiflexion during stair ambulation thanks to an adaptive microprocessor-controlled ankle. The present investigation proposes to analyze the biomechanical effects of the dorsiflexion adaptation in transtibial (TT) amputees during stair ambulation.Sixteen TT amputees and sixteen healthy controls underwent conventional 3D gait analysis. Kinematics and kinetics of the lower limbs were compared during stair ascent and descent performed by patients with the prosthetic foot set to a neutral ankle angle and with an adapted dorsiflexion ankle angle of 4°. Norm distance as well as minimum and maximal values of sagittal kinematics and kinetics were calculated for comparisons between patients and control subjects.For both stair ascent and descent, an improvement of the knee kinematics and kinetics could particularly be noticed on the involved side with an increase of the knee flexion and an increase of the knee moment during stance.Therefore, despite its additional weight compared to a conventional prosthetic ankle, the Proprio-Foot™ should be beneficial to active TT amputees whose knee musculature strength does not constitute a handicap.     

Lower-extremity kinematics and postural stability during stair negotiation: Effects of two cognitive tasks

Background

Concurrent cognitive tasks were found to affect gait characteristics during level walking, such as decreasing speed, cadence, step length, etc. Given that many accidents occur during stair negotiation and people often perform cognitive tasks concurrently with stair negotiation in daily life, there is a need to study how cognitive tasks affect gait characteristics and postural stability during stair negotiation. This study aimed to determine cognitive task effects on lower-extremity kinematics and postural stability during stair negotiation. We also examined the difference in cognitive demands between ascent and descent.

Methods

Two cognitive tasks, i.e. ‘backward digit recall’ and ‘counting backward in threes’, were examined. There were three testing conditions corresponding to a baseline and the two cognitive tasks, respectively. In the baseline, no cognitive task was performed. In the cognitive task conditions, the cognitive task was performed continuously throughout the stair negotiation trial. Each participant performed six ascent trials and six descent trials under each testing condition. We measured the cognitive task performance. Lower-extremity kinematics and postural stability were calculated using the data collected from a complete stair gait cycle that was obtained for the dominant leg.

Findings

In general, concurrent cognitive tasks had adverse effects on lower-extremity kinematics and postural stability during both ascent and decent. No differences in dependent measures were found between cognitive tasks. Additionally, ascent and descent appeared to be equally cognitively demanding.

Interpretation

The findings from this study can help better understand inadequate postural reactions due to cognitive load that may cause stair accidents.