Lower impulsive loadings following intensive weight loss after bariatric surgery in level and stair walking: a preliminary study.

BACKGROUND: There are currently very few of studies which have evaluated the role of bariatric surgery in joint loadings and changes in gait. We wanted to examine how impulsive loading would change level and stair walking in severely or morbidly obese subjects after they had undergone bariatric surgery and weight loss. METHODS: Thirteen female and three male adults aged between 30 and 63 years, cleared for Roux-en-Y gastric bypass, were recruited into this study. All subjects were severely or morbidly obese i.e., body mass index was >35 kg/m(2). The measurement methods consisted of triaxial skin mounted accelerometers and ground reaction force (GRF); conducted at two different predetermined gait speeds. RESULTS: The average weight loss was 27.4 (SD8.7) kg after 8.8 (SD3.9) months of follow-up period. Most of the absolute GRF parameters decreased in proportion to weight loss. However, medio-lateral GRF parameters decreased more than expected. The general trend in the knee accelerations demonstrated lower impulsive loadings in both axial and horizontal directions after weight loss. We did not observe any significant changes in stair walking. CONCLUSIONS: Weight loss after bariatric surgery not only induces a simple mass-related adaptation in gait but also achieves mechanical plasticity in gait strategy.

Kinematic and kinetic changes in obese gait in bariatric surgery-induced weight loss.

This study examines the effects of a radical bariatric surgery-induced weight loss on the gait of obese subjects. We performed a three-dimensional motion analysis of lower limbs, and collected force platform data in the gait laboratory to calculate knee and hip joint moments. Subjects (n=13) performed walking trials in the laboratory before and 8.8 months (SD 4.2) after the surgical procedure at two gait speeds (1.2m/s and 1.5m/s). The average weight loss was 26.7kg (SD 9.2kg), corresponding to 21.5% (SD 6.8%) of the initial weight. We observed a decrease in step width at both gait speeds, but no changes in relative double support or swing time or stride length. A significant decrease was noted in the absolute values of peak knee abductor, peak knee flexor and peak hip extensor moments. However, the moment values normalized by the body weight and height remained unchanged in most cases. Thus, we conclude that weight loss reduces hip and knee joint moments in proportion to the amount of weight lost.

Method for testing motion analysis laboratory measurement systems.

This paper proposes a method for comparing data from accelerometers, optical based 3D motion capture systems, and force platforms (FPs) in the context of spatial and temporal differences. Testing method is based on the motion laboratory accreditation test (MLAT), which can be used to test FP and camera based motion capture components of a motion analysis laboratory. This study extends MLAT to include accelerometer data. Accelerometers were attached to a device similar to the MLAT rod. The elevation of the rod from the plane of the floor is computed and compared with the force platform vector orientation and the rod orientation obtained by optical motion capture system. Orientation of the test device is achieved by forming nonlinear equation group, which describes the components of the measured accelerations. Solution for this equation group is estimated by using the Gauss-Newton method. This expanded MLAT procedure can be used in the laboratory setting were either FP, camera based motion capture, or any other motion capture system is used along with accelerometer measurements.

Postural control and thigh muscle activity in men with knee osteoarthritis.

The aim of this study was to examine the standing balance and the function of vastus medialis (VM) and biceps femoris (BF) muscles with surface electromyography (EMG). Fifty-four subjects with uni- or bilateral knee osteoarthritis (OA) (aged 50-69 years) and 53 age-matched randomly selected clinically and radiologically healthy men participated in this study. Postural control was assessed on a force platform with a bipedal stance with eyes open (EO) and closed (EC) and a monopedal stance with EO. The balance parameters, mean sway velocity, velocity along AP and ML axes, elliptical area, standard deviation of center of pressure, average radial displacement, mean frequency and frequency domain balance parameters and different power spectral density frequency bands were determined. Root mean square (RMS) for EMG amplitude, mean EMG frequency (f(EMG,mean)) and median EMG frequency (f(EMG,med)) of motor unit activity were calculated from the normalized EMG data. During bipedal stance with EC and EO, there were no significant differences in balance parameters between groups, but during bipedal stance with EO, the RMS in VM was about 56% higher (p<0.05) in subjects with knee OA than in the control subjects and the values of f(EMG,mean) and f(EMG,med) were about 48% higher (p<0.05) in control subjects than subjects with knee OA. It is concluded that subjects with knee OA do not have any standing balance deficit, but they do exhibit increased muscle activity in VM muscle compared to control subjects.

Gait and muscle activation changes in men with knee osteoarthritis.

The aim was to examine the biomechanics of level- and stair-walking in men with knee osteoarthritis (OA) at different pre-determined gait speeds and to compare the results with those obtained from healthy control subjects. Special emphasis was placed on the estimation of joint loading. Fifty-four men with knee OA (50-69 years) and 53 healthy age- and sex-matched controls were enrolled in the study. The participants walked barefoot in the laboratory (1.2 m/s+/-5%), corridor (1.2; 1.5 and 1.7 m/s+/-5%), and climbing and coming down stairs (0.5 and 0.8 m/s+/-5%) separately. Joint loading was assessed with skin mounted accelerometers (SMAs) attached just above and below the more affected knee joint. The 3-D ground reaction forces (GRFs) and muscle activation with surface-electromyography (EMG) from vastus medialis (VM) and biceps femoris (BF) were also measured simultaneously. There were no differences in SMA variables between groups during level-walking, but maximal loading rate (LR(max)) was higher bilaterally in the controls (P<.05). Patients loaded their lower extremity more forcefully especially during stair descent at faster speed. The distinctions in muscle activation both at level- and stair ambulation in VM and BF muscles revealed that the patients used different strategies to execute the same walking tasks. It is concluded that the differences in measured SMA and GRF parameters between the knee OA patients and the controls were only minor at constant gait speeds. It is speculated that the faster speeds in the stair descent subjected the compensatory mechanisms to the maximum highlighting the differences between groups.

Reproducibility of loading measurements with skin-mounted accelerometers during walking.

OBJECTIVE: To examine reproducibility of load measurements with skin-mounted accelerometers (SMAs) during walking. DESIGN: Reliability study. SETTING: A motion analysis laboratory. PARTICIPANTS: Ten healthy young men. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Two triaxial accelerometers were fixed to the subjects' skin above and below the knee joint. The subjects walked barefoot at their preferred speed and at a constant speed (1.3m/s, +/-5%) in a gait laboratory and along a corridor. The same protocol was repeated over 2 days. Initial peak acceleration (IPA), peak-to-peak (PP) acceleration, and maximal and average acceleration transient rates (ATRs) were calculated. The coefficient of variation (CV) and Pearson linear correlation coefficient were calculated to measure reproducibility of SMA load measurements. RESULTS: IPA and PP acceleration had good interday repeatability (CV <15%). The repeatability of average ATR and maximal ATR parameters was generally not acceptable. The loading variables obtained from ground reaction forces and SMA measurements during gait revealed high linear correlations, indicating that with SMA measurements it is possible to predict certain ground reaction force loading parameters. CONCLUSIONS: SMAs are practical for use in clinical environments to collect acceleration data that may be used to estimate joint loads.