The Influence of Mechanically and Physiologically Imposed Stiff-Knee Gait Patterns on the Energy Cost of Walking

doi:10.1016/j.apmr.2011.08.019

Archives of Physical Medicine and Rehabilitation

Volume 93, Issue 1, January 2012, Pages 123-128

Presented to the Gait and Clinical Movement Analysis Society, April 26-29, 2011, Bethesda, MD.

https://doi.org/10.1016/j.apmr.2011.08.019 Get rights and content

Abstract

Lewek MD, Osborn AJ, Wutzke CJ. The influence of mechanically and physiologically imposed stiff-knee gait patterns on the energy cost of walking.

Objective

To investigate the relative roles of mechanically imposed and physiologically imposed stiff-knee gait (SKG) patterns on energy cost.

Design

Repeated-measures, within-subjects design.

Setting

Research laboratory.

Participants

Individuals (N=20) without musculoskeletal, neuromuscular, or cardiorespiratory limitations.

Interventions

Participants walked on an instrumented treadmill at their self-selected overground gait speed for 3 randomly ordered conditions: (1) control, (2) mechanically imposed stiff-knee gait (SKG-M) using a lockable knee brace, and (3) physiologically imposed stiff-knee gait (SKG-P) using electrical stimulation to the quadriceps. Each condition was performed with 0% and 20% body weight support. Indirect calorimetry determined net metabolic power, and motion capture measured lower extremity joint kinematics and kinetics.

Main Outcome Measures

Net metabolic power, knee flexion angle, circumduction, hip hiking, and hip flexion and ankle plantarflexion moments.

Results

Participants walked at 1.25±.09m/s. Net metabolic power was significantly increased by 17% in SKG-M and 37% in SKG-P compared with control (mean increase: .66±.60W/kg for SKG-M; 1.39±.79W/kg for SKG-P; both P<.001). Furthermore, SKG-P required greater net metabolic power than SKG-M (P<.001). Simulated SKG was associated with increased circumduction and hip hiking. Despite no change in ankle plantarflexion moments (P=.280), the hip flexion moment was increased during SKG-P (.43±.15Nm/kg·m) compared with control (.31±.08Nm/kg·m; P<.001).

Conclusions

The increase in energy cost associated with simulated SKG was due in part to abnormal mechanical compensations, and in part to an increase in quadriceps activity. Understanding the mechanisms underlying the increase in quadriceps activity will enable a reduction in the energy cost of walking with SKG.

Section snippets

Participants

Twenty unimpaired individuals (10 males, 10 females; mean age ± SD, 21.7±1.4y; mean height ± SD, 1.74±.10m; mean weight ± SD, 70.5±15.6kg; 19 right-leg dominant) were recruited to undergo testing. Participants were not included if they were pregnant, had a history of ligament deficiency, cardiovascular disease, neurologic impairment, impaired balance or history of unexplained falls, or other orthopedic problems in the lower extremities or spine. All subjects gave informed consent that was

Results

Subjects walked at 1.25±.09m/s (range, 1.10–1.50m/s) on the treadmill for testing. Swing phase knee flexion was significantly altered by the brace (SKG-M) and electrical stimulation protocol (SKG-P) (fig 1). Specifically, subjects flexed their knee to 64.8°±4.4° during control walking, whereas only 26.7°±6.1° was achieved during SKG-M (t test, P<.001) and 29.7°±10.5° during SKG-P (t test, P<.001). No difference in swing phase knee flexion was observed between SKG-M and SKG-P (t test, P=.349).

Discussion

These data confirm our hypothesis that simulated SKG has a greater energy cost than control walking, and extends the work of others8, 9, 10 by demonstrating that approximately half of the increased energy cost arises from the abnormal mechanics (SKG-M), with the remaining increase in energy cost attributable to a combination of abnormal quadriceps activity during the late stance/early swing phase of gait and abnormal mechanics (SKG-P). The compensatory movements in our intact subjects are

Conclusions

In summary, we observed that the increase in energy cost associated with simulated SKG is due in part to the abnormal mechanical compensations, and in part to an increase in quadriceps muscle activity. The use of 20%BWS did not alter the energy cost associated with simulated SKG. Understanding the mechanisms underlying the increase in knee extension activity for remediation will enable a reduction in the energy cost of walking associated with SKG.

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Ankle–foot orthoses with plantarflexion resistance (AFO-Ps) improve knee flexion in the stance phase on the paretic side in patients with hemiparesis. However, AFO-Ps decrease ankle power generation in the late stance phase and do not improve the knee flexion in the swing phase based on insufficient push-off at the late stance, resulting in lower toe clearance.
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: Supported in part by the University of North Carolina's Division of Physical Therapy and the University of North Carolina Summer Undergraduate Research Fellowship program.

: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

: Reprints are not available from the authors.

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Original articleThe Influence of Mechanically and Physiologically Imposed Stiff-Knee Gait Patterns on the Energy Cost of Walking

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Participants

Results

Discussion

Conclusions

Suppliers

Gait Posture

J Biomech

J Biomech

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Gait Posture

J Biomech

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Gait Posture

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Gait Posture

Clin Neurophysiol

Gait Posture

Stiff-legged gait in spastic paresisA study of quadriceps and hamstrings muscle activity

Am J Phys Med Rehabil

Prevalence of specific gait abnormalities in children with cerebral palsy: influence of cerebral palsy subtype, age, and previous surgery

J Pediatr Orthop

Gait pattern in the early recovery period after stroke

J Bone Joint Surg Am

Common gait abnormalities of the knee in cerebral palsy

Clin Orthop Relat Res

Energy costs of walking in lower-extremity plaster casts

J Bone Joint Surg Am

Manipulations of leg mass and moment of inertia: effects on energy cost of walking

Med Sci Sports Exerc

Original article
The Influence of Mechanically and Physiologically Imposed Stiff-Knee Gait Patterns on the Energy Cost of Walking