Although millions of people with osteoarthritis (OA) have altered biomechanical alignment, movement, and knee joint pain during gait, there are no effective and sustainable interventions. To mitigate such impairments, we developed an untacted self-automated robotic and electromyography (EMG)-augmented upper-trunk-lower reciprocal locomotor training (SRGT) intervention.
OBJECTIVE:
To compare the effects of SRGT and conventional treadmill gait training (CTGT) on the medial knee joint space width (JSW), hip adduction moment (HAM), knee varus deformity, pain, and physical function in community-dwelling older adults with OA.
METHODS:
Older adults diagnosed with medial compartment knee OA (5 men, 35 women; mean age 78.50 9.10 years) were recruited and underwent either SRGT or CTGT, 30 min a day, 3 times a week, over a 4-week period. Outcome measurements included the JSW, HAM, knee varus angle (VA), and Western Ontario McMaster Universities osteoarthritis index (WOMAC).
RESULTS:
Analysis of covariance (ANCOVA) showed that SRGT ed to greater changes in medial knee JSW ( 0.00001), HAM ( 0.00001), VA ( 0.00001), and WOMAC ( 0.00001) scores.
CONCLUSION:
This study provides the first evidence for the long-term clinical and biomechanical effects of SRGT on JSW, knee joint kinematics, kinetics, and WOMAC scores in older adults with OA. Most importantly, self-automatic robotic gait training may be an alternative, effective, and sustainable treatment for the upper-trunk-lower reciprocal locomotor training in older adults with OA.
LS, et al. Does measurement of the anatomic axis consistently predict hip-knee-ankle angle (HKA) for knee alignment studies in osteoarthritis? Analysis of long limb radiographs from the multicenter osteoarthritis (MOST) study.Osteoarthritis Cartilage. 2011; 19(1): 58-64.
2.
GuermaziA, et al. Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: Population based observational study (Framingham Osteoarthritis Study).Bmj. 2012; 345.
3.
LimKLauCS. Perception is everything: OA is exciting.Int J Rheum Dis. 2011; 14(2): 111-112.
4.
RutherfordDHubley-KozeyCStanishW. Knee effusion affects knee mechanics and muscle activity during gait in individuals with knee osteoarthritis.Osteoarthritis Cartilage. 2012; 20(9): 974-81.
5.
Al-ZahraniKBakheitA. A study of the gait characteristics of patients with chronic osteoarthritis of the knee.Disability and Rehabilitation. 2002; 24(5): 275-280.
6.
MorrisonJ. The mechanics of the knee joint in relation to normal walking.J Biomech. 1970; 3(1): 51-61.
7.
SchippleinOAndriacchiT. Interaction between active and passive knee stabilizers during level walking.J Orthop Res. 1991; 9(1): 113-119.
8.
EMRHPRLSL. WOMAC Osteoarthritis Index-additional dimensions for use in subjects with post-traumatic osteoarthritis of the knee. Western Ontario and MacMaster Universities.Osteoarthritis Cartilage. 1999; 7(2): 216-21.
9.
PatsikaG, et al. Synergetic and antagonist muscle strength and activity in women with knee osteoarthritis.J Geriatr Phys Ther. 2014; 37(1): 17-23.
10.
BrandtKDieppePRadinE. Etiopathogenesis of osteoarthritis.Rheum Dis Clin North Am. 2008; 34(3): 531-59.
11.
JeffersonR, et al. The role of the quadriceps in controlling impulsive forces around heel strike.Proc Inst Mech Eng H. 1990; 204(1): 21-8.
12.
AlnahdiAZeniJSnyder-MacklerL. Muscle impairments in patients with knee osteoarthritis.Sports Health. 2012; 4(4): 284-92.
13.
Sylos-LabiniF, et al. EMG patterns during assisted walking in the exoskeleton.Front Hum Neurosci. 2014; 8: 423.
14.
ParkJH, et al. Comparative effects of robotic-assisted gait training combined with conventional physical therapy on paretic hip joint stiffness and kinematics between subacute and chronic hemiparetic stroke.NeuroRehabilitation. 2018; 42(2): 181-190.
15.
GuiKLiuHZhangD. A practical and adaptive method to achieve EMG-based torque estimation for a robotic exoskeleton.IEEE ASME Trans Mechatron. 2019; 24(2): 483-494.
16.
ChengPLaiP. Comparison of exoskeleton robots and end-effector robots on training methods and gait biomechanics. In Int Con Int Rob App. Springer. 2013.
17.
FangJ, et al. Modelling of the toe trajectory during normal gait using circle-fit approximation.Med Biol Eng Comput. 2016; 54(10): 1481-9.
18.
HewittBRefshaugeKKilbreathS. Kinesthesia at the knee: The effect of osteoarthritis and bandage application.Arthritis Rheum. 2002; 47(5): 479-483.
19.
RavaudP, et al. Knee joint space width measurement: An experimental study of the influence of radiographic procedure and joint positioning.Br J Rheumatol. 1996; 35(8): 761-766.
20.
Buckland-WrightJC, et al. Joint space width measures cartilage thickness in osteoarthritis of the knee: High resolution plain film and double contrast macroradiographic investigation.Ann Rheum Dis. 1995; 54(4): 263-268.
21.
LamineH, et al. Evaluation of calibrated kinect gait kinematics using a vicon motion capture system.Computer Methods in BiomeChaniCs and BiomediCal Engineering. 2017; 20(sup1): S111-S112.
22.
FurtadoJS, et al. Comparative analysis of optitrack motion capture systems. In Advances in Motion Sensing and Control for Robotic Applications. Springer. 2019. pp. 15-31.
23.
SalaffiF, et al. Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee.Osteoarthritis Cartilage. 2003; 11(8): 551-560.
24.
SouzaDGrossM. Comparison of vastus medialis obliquus: Vastus lateralis muscle integrated electromyographic ratios between healthy subjects and patients with patellofemoral pain.Phys Ther. 1991; 71(4): 310-6; discussion 317-20.
25.
MikeskyA, et al. Effects of strength training on the incidence and progression of knee osteoarthritis.Arthritis Rheum. 2006; 55(5): 690-9.
26.
DemircanE. A pilot study on locomotion training via biomechanical models and a wearable haptic feedback system.ROBOMECH Journal. 2020; 7: 1-13.
27.
ParkC, et al. Effects of innovative hip-knee-ankle interlimb coordinated robot training on ambulation, cardiopulmonary function, depression, and fall confidence in acute hemiplegia.NeuroRehabilitation. 2020; 46(4): 577-587.
28.
SharmaL, et al. Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis.Arthritis Rheum. 1998; 41(7): 1233-1240.
29.
ShullP, et al. Six-week gait retraining program reduces knee adduction moment, reduces pain, and improves function for individuals with medial compartment knee osteoarthritis.J Orthop Res. 2013; 31(7): 1020-5.
30.
ButlerR, et al. The effect of a subject-specific amount of lateral wedge on knee mechanics in patients with medial knee osteoarthritis.J Orthop Res. 2007; 25(9): 1121-1127.
31.
DraganichL, et al. The effectiveness of self-adjustable custom and off-the-shelf bracing in the treatment of varus gonarthrosis.J Bone Joint Surg Am. 2006; 88(12): 2645-52.
32.
HeZLiuTYiJ. A wearable sensing and training system: Towards gait rehabilitation for elderly patients with knee osteoarthritis.IEEE Sensors Journal. 2019; 19(14): 5936-5945.
33.
BennellK, et al. Relationship of knee joint proprioception to pain and disability in individuals with knee osteoarthritis.J Orthop Res. 2003; 21(5): 792-797.
34.
LangCMacDonaldJGnipC. Counting repetitions: An observational study of outpatient therapy for people with hemiparesis post-stroke.J Neurol Phys Ther. 2007; 31(1): 3-10.
35.
KimS, et al. Effects of innovative WALKBOT robotic-assisted locomotor training on balance and gait recovery in hemiparetic stroke: A prospective, randomized, experimenter blinded case control study with a four-week follow-up.IEEE Transactions on Neural Systems and Rehabilitation Engineering. 2015; 23(4): 636-642.
36.
PeelerJ, et al. Managing knee osteoarthritis: The effects of body weight supported physical activity on joint pain, function, and thigh muscle strength.Clin J Sport Med. 2015; 25(6): 518-523.
37.
RoperJBresselETillmanM. Acute aquatic treadmill exercise improves gait and pain in people with knee osteoarthritis.Arch Phys Med Rehabil. 2013; 94(3): 419-25.
38.
HaimA, et al. Six-week gait retraining program reduces knee adduction moment, reduces pain, and improves function for individuals with medial compartment knee osteoarthritis.J Orthop Res. 2014; 32(2): 351-352.
