The effect of rectus femoris transfer on kinematics and functional outcomes in adult stroke patients walking with a stiff knee gait.

BACKGROUND: Stiff knee gait is characterized by a reduced peak knee flexion during swing. Overactivity of the rectus femoris is often cited as a main cause for stiff knee gait. Little is known about the effect of an isolated rectus femoris transfer treatment on kinematic and functional outcomes in a group of stroke survivors. OBJECTIVE: To perform an experimental study to evaluate the effect of an isolated rectus femoris transfer on knee and hip kinematics and functional outcomes in adult stroke patients walking with a stiff knee gait. METHOD: In this experimental study, 10 stroke survivors were included. During the surgical procedure, the distal rectus femoris tendon of the affected side was transferred to the medial knee flexors to improve knee flexion during swing. Knee and hip kinematics and a variety of functional outcomes were measured within 3 weeks before surgery and between 6 and 7 months after the surgery. RESULTS: We found a statistically significant improvements in peak knee flexion during swing and knee range of motion of 10.6° (sd 4.7, p=0.000) and 10.5° (sd 6.2, p=0.001) post-surgery, respectively. Hip kinematics showed no significant differences. In addition, we found statistically significant improvements on the 6-minute walk test (42.5, sd 36.7, p=0.008), 10-meter walk test (1.26, sd 1.4, p=0.030), Timed up-and-go test (1.34, sd 1.18, p=0.009), L-test (2.97 sd 2.85, p=0.014) and on a subjective BORG scoring of foot clearance (1.8, sd 0.6, p=0.006). No significant differences were found on other measured functional outcomes. CONCLUSIONS: Rectus femoris transfer is a valuable treatment option for stroke patients walking with a stiff knee gait to improve knee kinematics and a selection of functional outcomes. There are no detrimental side effects on hip kinematics.

Robot-assisted support combined with electrical stimulation for the lower extremity in stroke patients: a systematic review.

Objective. The incidence of stroke rising, leading to an increased demand for rehabilitation services. Literature has consistently shown that early and intensive rehabilitation is beneficial for stroke patients. Robot-assisted devices have been extensively studied in this context, as they have the potential to increase the frequency of therapy sessions and thereby the intensity. Robot-assisted systems can be combined with electrical stimulation (ES) to further enhance muscle activation and patient compliance. The objective of this study was to review the effectiveness of ES combined with all types of robot-assisted technology for lower extremity rehabilitation in stroke patients.Approach. A thorough search of peer-reviewed articles was conducted. The quality of the included studies was assessed using a modified version of the Downs and Black checklist. Relevant information regarding the interventions, devices, study populations, and more was extracted from the selected articles.Main results. A total of 26 articles were included in the review, with 23 of them scoring at least fair on the methodological quality. The analyzed devices could be categorized into two main groups: cycling combined with ES and robots combined with ES. Overall, all the studies demonstrated improvements in body function and structure, as well as activity level, as per the International Classification of Functioning, Disability, and Health model. Half of the studies in this review showed superiority of training with the combination of robot and ES over robot training alone or over conventional treatment.Significance. The combination of robot-assisted technology with ES is gaining increasing interest in stroke rehabilitation. However, the studies identified in this review present challenges in terms of comparability due to variations in outcome measures and intervention protocols. Future research should focus on actively involving and engaging patients in executing movements and strive for standardization in outcome values and intervention protocols.

The influence of a user-adaptive prosthetic knee across varying walking speeds: A randomized cross-over trial.

Previously conducted trials comparing the gait pattern of individuals with a transfemoral amputation using a user-adaptive and a non-microprocessor-controlled prosthetic knee (NMPK) found mixed and conflicting results. Few trials, however, have compared user-adaptive to non-adaptive prosthetic knees across different walking speeds. Because of the ability of variable damping, the effect of user-adaptive knees might be more pronounced at lower or higher walking speeds. Our aim was to compare the Rheo Knee II (a microprocessor-controlled prosthetic knee) with NMPKs across varying walking speeds. In addition, we studied compensatory mechanisms associated with non-optimal prosthetic knee kinematics, such as intact ankle vaulting and vertical acceleration of the pelvis. Nine persons with a transfemoral amputation or knee disarticulation were included and measured with their own NMPK and with the Rheo Knee II. Measurements were performed at three walking speeds: preferred walking speed, 70% preferred walking speed and 115% preferred walking speed. No differences on peak prosthetic knee flexion during swing were found between prosthetic knee conditions. In addition, prosthetic knee flexion increased significantly with walking speed for both prosthetic knee conditions. At 70% preferred walking speed we found that vaulting of the intact ankle was significantly decreased while walking with the Rheo Knee II compared to the NMPK condition (P=0.028). We did not find differences in peak vertical acceleration of the pelvis during initial and mid-swing of the prosthetic leg. In conclusion, comparison of walking with the Rheo Knee II to walking with a NMPK across different walking speeds showed limited differences in gait parameters.

Detection of the onset of gait initiation using kinematic sensors and EMG in transfemoral amputees.

In this study we determined if detection of the onset of gait initiation in transfemoral amputees can be useful for voluntary control of upper leg prostheses. From six transfemoral amputees inertial sensor data and EMG were measured at the prosthetic leg during gait initiation. First, initial movement was detected from the inertial sensor data. Subsequently it was determined whether EMG could predict initial movement before detection based on the inertial sensors with comparable consistency as the inertial sensors. From the inertial sensors the initial movement can be determined. If the prosthetic leg leads, the upper leg accelerometer data was able to detect initial movement best. If the intact leg leads the upper leg gyroscope data performed best. Inertial sensors at the upper leg in general showed detections at the same time or earlier than those at the lower leg. EMG can predict initial movement up to a 138 ms in advance, when the prosthetic leg leads. One subject showed consistent EMG onset up to 248 ms before initial movement in the intact leg leading condition. A new method to detect initial movement from inertial sensors was presented and can be useful for additional prosthetic control. EMG measured at the prosthetic leg can be used for prediction of gait initiation when the prosthetic leg is leading, but for the intact leg leading condition this will not be of additional value.

Different anthropometric adiposity measures and their association with cardiovascular disease risk factors: a meta-analysis.

OBJECTIVES: To investigate which anthropometric adiposity measure has the strongest association with cardiovascular disease (CVD) risk factors in Caucasian men and women without a history of CVD. DESIGN: Systematic review and meta-analysis. METHODS: We searched databases for studies reporting correlations between anthropometric adiposity measures and CVD risk factors in Caucasian subjects without a history of CVD. Body mass index (BMI), waist circumference, waist-to-hip ratio, waist-to-height ratio and body fat percentage were considered the anthropometric adiposity measures. Primary CVD risk factors were: systolic blood pressure, diastolic blood pressure, high density lipoprotein (HDL) cholesterol, triglycerides and fasting glucose. Two independent reviewers performed abstract, full text and data selection. RESULTS: Twenty articles were included describing 21,618 males and 24,139 females. Waist circumference had the strongest correlation with all CVD risk factors for both men and women, except for HDL and LDL in men. When comparing BMI with waist circumference, the latter showed significantly better correlations to CVD risk factors, except for diastolic blood pressure in women and HDL and total cholesterol in men. CONCLUSIONS: We recommend the use of waist circumference in clinical and research studies above other anthropometric adiposity measures, especially compared with BMI, when evaluating CVD risk factors.