Gait and plantar sensation changes following massage and textured insole application in patients after anterior cruciate ligament reconstruction

BackgroundGait impairments following anterior cruciate ligament reconstruction (ACLR) may contribute to reinjury or future osteoarthritis development. Recently, plantar cutaneous sensation deficits have been reported post-ACLR. These sensory deficits may influence gait and represent a mechanism through which to improve gait.Research questionCan established sensory interventions change sensation and gait in patients after ACLR and compared to healthy adults?MethodsTwenty-two adults (n = 11 post-ACLR, age:20.5 ± 1.9years, body mass index[BMI]:24.5 ± 3.6 kg/m²; n = 11 healthy, age:20.7 ± 1.4years, BMI:23.3 ± 2.7 kg/m²) completed two sessions separated by 48 h. Gait and plantar cutaneous sensation were assessed pre- and post-intervention (massage or textured insoles). Gait analysis was completed using 3D motion capture at 1.4 m/s ± 5% and standard inverse dynamics analysis. Plantar cutaneous sensation was assessed using Semmes Weinstein Monofilaments with a 4−2-1 stepping algorithm at the plantar aspect of the first metatarsal head, base of the fifth metatarsal, and lateral and medial malleoli. Plantar massage was a 5-minute massage to both feet. Textured insoles (coarse grit sandpaper) were worn while walking. Biomechanical data were assessed via mixed-models, repeated measures ANOVAs and 90 % confidence intervals. Wilcoxon Signed Rank tests and Mann-Whitney U tests evaluated plantar cutaneous sensation within and between groups, respectively.ResultsKnee adduction moment was lower in the ACLR versus the contralateral limb pre-massage. The vGRF was lower during the first half of stance but greater during the second half of stance in the ACLR versus the control group post-massage. Massage improved ACLR limb sensation over the first metatarsal head (P = 0.042) and medial malleolus (P = 0.027). Textured insole application improved ACLR limb sensation over the first (P = 0.043) and fifth (P = 0.027) metatarsals and medial malleolus (P = 0.028).SignificancePlantar massage and textured insoles improved plantar cutaneous sensation in the ACLR limb. Neither intervention influenced gait. Improving plantar sensation may be beneficial for patients after ACLR; however, sensory interventions to improve gait are necessary.     

Tester and testing procedure influence clinically determined gait speed

BackgroundThere is a clinical need to be able to reliably detect meaningful changes (0.1 to 0.2 m/s) in usual gait speed (UGS) considering reduced gait speed is associated with morbidity and mortality.Research questionWhat is the impact of tester on UGS assessment, and the influence of test repetition (trial 1 vs. 2), timing method (manual stopwatch vs. automated timing), and starting condition (stationary vs. dynamic start) on the ability to detect changes in UGS and fast gait speed (FGS)?MethodsUGS and FGS was assessed in 725 participants on a 8-m course with infrared timing gates positioned at 0, 2, 4 and 6 m. Testing was performed by one of 13 testers trained by a single researcher. Time to walk 4-m from a stationary start (i.e. from 0-m to 4-m) was measured manually using a stopwatch and automatically via the timing gates at 0-m and 4-m. Time taken to walk 4-m with a dynamic start was measured during the same trial by recording the time to walk between the timing gates at 2-m and 6-m (i.e. after 2-m acceleration).ResultsTesters differed for UGS measured using manual vs. automated timing (p = 0.02), with five and two testers recording slower and faster UGS using manual timing, respectively. 95% limits of agreement for trial 1 vs. 2, manual vs. automated timing, and dynamic vs. stationary start ranged from ±0.15 m/s to ±0.20 m/s, coinciding with the range for a clinically meaningful change. Limits of agreement for FGS were larger ranging from ±0.26 m/s to ±0.35 m/s.SignificanceRepeat testing of UGS should performed by the same tester or using an automated timing method to control for tester effects. Test protocol should remain constant both between and within participants as protocol deviations may result in detection of an artificial clinically meaningful change.     

Body weight support through a walking cane in inexperienced users with knee osteoarthritis

BackgroundWalking canes are a self-management strategy recommended for people with knee osteoarthritis (OA) by clinical practice guidelines. Ensuring that an adequate amount of body-weight support (%BWS) is taken through the walking cane is important as this reduces measures of knee joint loading.Research question1) How much body weight support do people with knee OA place through a cane? 2) Do measures of body weight support increase following a brief simple training session?MethodsSeventeen individuals with knee pain who had not used a walking cane before were recruited. A standard-grip aluminum cane was then used for 1 week with limited manufacturer instructions. Following this, participants were evaluated using an instrumented force-measuring cane to assess body weight support (% total body weight) through the cane. Force data were recorded during a 430-metre walk undertaken twice; once before 10 min of cane training administered by a physiotherapist, and once immediately after training. Measures of BWS (peak force, average force, impulse equal to the average cane force times duration, and cane-ground contact duration) were extracted. Using bathroom scales, training aimed to take at least 10% body weight support through the cane.ResultsBefore training, the average peak BWS was 7.2 ± 2.5% of total body weight. Following 10 min of training, there was a significant increase in average peak BWS by 28%, average BWS by 25%, and BWS impulse by 54% (p < 0.05). However, individual BWS responses to training were variable. Duration of cane placement increased by 22% after training (p = 0.02). Timing of peak BWS through the cane occurred at 51% of contact phase before training, and at 53% after training (p = 0.05).SignificanceA short training session can increase the transfer of body weight through a walking cane. However, more sophisticated feedback may be needed to achieve target levels of BWS.     

心绞痛PTCA术后患者以步行为主的康复训练

１４例不稳定性心绞痛患者，男性１２例，女性２例，平均年龄５５岁，均因药物治疗无效而进行ＰＴＣＡ治疗。总计１６个血管段、前降支９段，回旋支４段，右冠状动脉３段。术后执行以步行为主要内容的一周康复训练程度，全部病例均顺利完成，表明以步为主的非监护康复训练对不稳定性心绞痛ＰＴＣＡ术后和是安全可行的。     

Surface movement errors in shank kinematics and knee kinetics during gait

The movement of surface mounted targets (SMT) on a shell at the mid-shank and of bone mounted targets attached to the distal shank using a Percutaneous Skeletal Tracker (PST) were simultaneously measured during free-speed walking of three adult subjects having different body types. Surface movement errors in shank kinematic estimates were determined by expressing the segmental motion derived from the SMT relative to the PST-based segment coordinate system (SCS) located at the segment center of gravity. The greatest errors were along and around the shank longitudinal axis, with peak magnitudes of 10 mm of translation and 8° of rotation in one subject. Estimates of knee joint center locations differed by less than 11 mm in each SCS direction. Differences in estimates of net knee joint forces and moments were most prominent during stance phase, with magnitudes up to 39 N in the shank mediolateral direction and 9 N.m about the mediolateral axis. The differences in kinetics were primarily related to the effect of segment position and orientation on the expression of joint forces and on the magnitude and expression of joint moments.     

腰椎管狭窄动物模型的实验研究

目的：建立腰椎管狭窄(lumbar spinal canal stenosis，LSCS)的动物模型，在此基础上进行步态、知觉过敏、电生理及组织学研究。方法：LSCS组选用8周的Wistar大鼠28只，切除腰5腰椎棘突、椎弓，并移植碎骨片于此处。Sham手术组为6只，仅切除椎弓。对照组为3只，不作任何处理。术后8、9个月进行步态、知觉过敏及脊髓体感诱发电位的波幅(SSEP)的测定，同时，术后9个月进行组织学分析。结果：LSCS组，术后8个月步行距离明显减少，步容出现变化，Seep的振幅明显减小及知觉出现过敏。术后9个月步行距离明显减少、步容出现变化、知觉出现过敏及Seep的振幅明显减小的同时，椎管横断面积减少，粗纤维减少而细纤维增多。结论：腰椎管狭窄后，大鼠步行分析、电生理学及组织学均出现明显异常。为以后药物治疗的研究打下基础。     

The energy cost of walking or running on sand

Summary Oxygen uptake ( O₂) at steady state, heart rate and perceived exertion were determined on nine subjects (six men and three women) while walking (3–7 km · h^–1) or running (7–14 km · h^–1) on sand or on a firm surface. The women performed the walking tests only. The energy cost of locomotion per unit of distance (C) was then calculated from the ratio of O₂ to speed and expressed in J · kg^–1 · m^–1 assuming an energy equivalent of 20.9 J · ml O₂ ^–1. At the highest speedsC was adjusted for the measured lactate contribution (which ranged from approximately 2% to approximately 11% of the total). It was found that, when walking on sand,C increased linearly with speed from 3.1 J · kg^–1 · m^–1 at 3 km · h^–1 to 5.5 J · kg^–1 · m^–1 at 7 km · h^–1, whereas on a firm surfaceC attained a minimum of 2.3 J · kg^–1 · m^–1 at 4.5 km · h^–1 being greater at lower or higher speeds. On average, when walking at speeds greater than 3 km · h^–1,C was about 1.8 times greater on sand than on compact terrain. When running on sandC was approximately independent of the speed, amounting to 5.3 J · kg^–1 · m^–1, i.e. about 1.2 times greater than on compact terrain. These findings could be attributed to a reduced recovery of potential and kinetic energy at each stride when walking on sand (approximately 45% to be compared to approximately 65% on a firm surface) and to a reduced recovery of elastic energy when running on sand.     

Modulation of heteronymous reflexes from ankle dorsiflexors to hamstring muscles during human walking

In 16 human subjects, stimulation of the common peroneal nerve (CPN) was applied during walking and standing. The effect of the stimulation was evaluated from the rectified and averaged biceps femoris (BF) electromyographic (EMG) activity. In the swing phase of walking, the CPN stimulation evoked a suppression in the BF EMG in 12 of the subjects. In the early stance phase, the suppression was replaced by facilitation at a similar latency in 9 of the subjects. Of the other 3 subjects, in whom a suppression was observed during swing, a decrease in the suppression was observed in the stance phase in two of them. During a voluntary co-contraction of BF and tibialis anterior while standing, a suppression similar to that observed in the swing phase was observed. The thresholds of the suppression and facilitation were identical, suggesting that afferents of similar diameter were responsible. Cutaneous stimuli, which mimicked the sensation evoked by the CPN stimulation, but without activation of muscle afferents, did not produce similar effects in the BF EMG activity. It is suggested that the observed response and reflex reversal may reflect opening of an excitatory group I pathway in the early stance phase of walking with a concomitant shut-down of heteronymous group I inhibition.