Development and Evaluation of a Mechanical Stance-Controlled Orthotic Knee Joint With Stance Flexion
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Stance-control orthotic knee joints stabilize the knee joint during the weight-bearing portion of gait without restricting swing-phase flexion, thus achieving a more normal gait for individuals with quadriceps muscle weakness. These devices must be designed around well-defined stance-control strategies that enable or hinder joint motion at specific events during the gait cycle. This paper presents a new type of stance-control strategy and a novel stance-controller design. Pilot clinical testing was performed on a prototype, demonstrating feasibility of this approach for providing reliable knee stability while facilitating swing-phase flexion. In particular, 44 deg of swing-phase flexion and 15 deg of stance-phase flexion were achieved during level walking. Further testing is needed in situ to provide additional validation and assess other mobility conditions.Keywords:
Knee flexion
Gait cycle
Individuals with knee osteoarthritis are restricted in their daily activity because of walking difficulty. The purpose of this investigation was to examine the association between self-reported walking difficulty and knee flexion excursion during gait in Japanese patients with knee osteoarthritis.Twenty-eight patients with knee osteoarthritis participated in this study. Knee flexion excursions in loading response and swing during gait were measured through an inertial measurement unit-based motion capture system. The walking difficulty was assessed by a subitem in the Japanese Knee Osteoarthritis Measure. Pain intensity was assessed by a visual analog scale. Characteristics and gait variables were compared between groups that were determined a priori using the results of the walking difficulty assessment. The relationship between knee flexion excursion during gait and walking difficulty were analyzed using logistic regression.The participants with walking difficulty had significantly small knee flexion excursion in both loading response and swing with large pain. After controlling the effect of pain, only knee flexion excursion in the swing was significantly related to the walking difficulty.This study suggested that the knee flexion excursion in swing during gait is helpful for understanding the walking difficulty experienced in Japanese patients with knee osteoarthritis.
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Knee pain
Knee flexion
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The aims of this study were to evaluate the variables found in the alteration of the load-response mechanism on 3-dimensional kinematic analysis of the knee joint during hemiparetic gait following stroke.We evaluated 66 adult patients (33 men and 33 women), aged 45.4 +/- 8.5 years (mean +/- SD), with a diagnosis of ischemic cerebrovascular accident either right or left hemiparesis and brachial prevalence. All the participants underwent 3-dimensional gait evaluation with a Vicon 370, and the values of the angular kinematics of the knee joint were selected for analysis.There were no statistically significant differences (by the Kruskal-Wallis test) between the subjects regarding the following variables: angular knee position at initial contact and time of peak knee flexion in the stance. The clinically relevant characteristics found were: an increase in knee joint flexion during the initial contact and a movement amplitude below that anticipated in this phase of the walking cycle. These should be taken into account when choosing the best treatment, because they are the ones which exhibit the most important alteration in the load-response mechanism in all patients.There is still no consensus among the different specialists regarding the variations in kinematics during the hemiparetic gait. One of the most frequently discussed joints is the knee--the way the main changes take place during the gait cycle and whether the gait velocity changes the patterns of joint mobility.
Hemiparesis
Stroke
Gait cycle
Biomechanics
Knee flexion
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In the previous studies, contradictory results were reported on walking symmetry. The walking symmetry is important in the study of the evolution of bipedalism and gait therapy. This study investigated the effects of laterality and walking speed on gait symmetry during three conditions of walking on a treadmill, namely pushing while walking, walking with arm-swing, and walking while holding on a handlebar. All conditions were performed at three speeds: 1.5, 3, and 4 km/h. Symmetry was measured from bilateral gait cycle duration and cross-correlation function analysis performed in one gait cycle. Left-handers showed different characteristics from right-handers in various variables measured and not in mirror characteristics. Walking holding condition in general produced the greatest symmetry, confirmed the importance of this posture in gait therapy for improving symmetry among hemiparetic patients.
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Treadmill
Biomechanics
Power walking
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Development and Evaluation of a Mechanical Stance-Controlled Orthotic Knee Joint With Stance Flexion
Stance-control orthotic knee joints stabilize the knee joint during the weight-bearing portion of gait without restricting swing-phase flexion, thus achieving a more normal gait for individuals with quadriceps muscle weakness. These devices must be designed around well-defined stance-control strategies that enable or hinder joint motion at specific events during the gait cycle. This paper presents a new type of stance-control strategy and a novel stance-controller design. Pilot clinical testing was performed on a prototype, demonstrating feasibility of this approach for providing reliable knee stability while facilitating swing-phase flexion. In particular, 44 deg of swing-phase flexion and 15 deg of stance-phase flexion were achieved during level walking. Further testing is needed in situ to provide additional validation and assess other mobility conditions.
Knee flexion
Gait cycle
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Summary A new gait analysis system is described which is microcomputer‐based, of low cost and both suitable for and acceptable to children with neurological motor disorders. A variety of different gait abnormalities and neurological conditions have been analysed and quantitative gait information is illustrated from this equipment which provides, after a short walk, an immediate profile of the objective measurements of the main spatial and temporal parameters of the gait cycle, i.e. step length, stride time, double support time, cadence, average walking speed and maximum velocity of the foot during the swing phase.
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Abstract Individuals with cerebral palsy often exhibit crouch gait, a debilitating and inefficient walking pattern marked by excessive knee flexion that worsens with age. To address the need for improved treatment, we sought to evaluate if providing external knee extension assistance could reduce the excessive burden placed on the knee extensor muscles as measured by knee moments. We evaluated a novel pediatric exoskeleton designed to provide appropriately-timed extensor torque to the knee joint during walking in a multi-week exploratory clinical study. Seven individuals (5–19 years) with mild-moderate crouch gait from cerebral palsy (GMFCS I-II) completed the study. For six participants, powered knee extension assistance favorably reduced the excessive stance-phase knee extensor moment present during crouch gait by a mean of 35% in early stance and 76% in late stance. Peak stance-phase knee and hip extension increased by 12° and 8°, respectively. Knee extensor muscle activity decreased slightly during exoskeleton-assisted walking compared to baseline, while knee flexor activity was elevated in some participants. These findings support the use of wearable exoskeletons for the management of crouch gait and provide insights into their future implementation.
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Hemiparesis
Treadmill
Stroke
STRIDE
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Users of traditional knee-ankle-foot orthoses (KAFOs) walk with either locked or unlocked knee joints depending on the level of stability required. Some users may benefit from new stance-control KAFOs that prevent stance-phase knee flexion but allow swing-phase flexion. We collected data from nine nondisabled adults who walked with KAFOs that incorporated the Horton Stance-Control Orthotic Knee Joint (SCOKJ) in the locked, unlocked, and auto (which provides knee stability during stance phase and knee flexion during swing phase) modes to investigate the biomechanical and energetic effects of stance-control orthoses. Studying nondisabled subjects allowed us to analyze the effects of stance-control orthoses in a homogenous population. In general, gait kinematics for the auto and unlocked modes were more similar than for the auto and locked modes. Despite the elimination of hip hiking in the auto mode, oxygen cost was not different between the auto and locked modes (p > 0.99). The SCOKJ allowed our nondisabled subjects to walk with a more normal gait pattern; however, future research should explore the effect of stance-control orthoses on persons with gait pathology.
Knee flexion
Biomechanics
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Hemiparesis
Knee flexion
Stroke
Gait cycle
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The knee joints of trans-femoral prostheses play an important role in compensating for the normal knee joint by controlling the swing phase. Even when the amputee changes the gait pattern, such as through changing speed or stride length, trans-femoral prostheses must perform a lower-leg swing that is similar to that of a normal person. Thus, in recent years, electronically controlled knee joints have been developed, and methods to dynamically reproduce the flexion angle of the knee joint have been proposed. However, since amputees wearing electronically controlled knee joints can only walk in accordance with the control parameters set in advance by the prosthetist, they cannot respond to changes in the gait pattern in real time. This leads to disrupted gaits. Therefore, in this study, in order to follow changes in gait patterns in real time and ensure a stable gait, we developed a robotic knee prosthesis. For this purpose, we proposed a walking model based on adaptive finite state machine that refers to the gait characteristics of the previous gait cycle. Finally, we conducted walking experiments with an amputee and showed the effectiveness of the proposed method by stabilizing the subject's gait.
Artificial limbs
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