Clinical biomechanics (Bristol, Avon) · 2013
Effect of specific gait modifications on medial knee loading, metabolic cost and perception of task difficulty.
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Caldwell Lydia K, Laubach Lloyd L, Barrios Joaquin A
Аннотация
BACKGROUND: The metabolic cost and cognitive demand of altering natural gait have not been well studied. The purpose of this investigation was to assess three modified patterns - toe out, ipsilateral trunk lean and a medial weight shift at the foot - on the basis of 1) medial knee joint load reduction, 2) metabolic cost of performance and 3) subject perception of task difficulty.
METHODS: 12 healthy individuals underwent 3 dimensional motion analysis and metabolic testing to assess the gait mechanics and energy expenditure of natural gait and the three experimental gait patterns, performed to a self-selected moderate degree. Walking speed was controlled. Perceived workload was assessed using the NASA Task Load Index.
FINDINGS: Trunk lean significantly reduced first peak knee adduction moment (↓32%, P<0.001) as well as KAM impulse (↓35%, P<0.001), but was costly in terms of energy expenditure (↑11%, P<0.001) and perceived workload (↑1178%, P<0.001). A moderate toe-out pattern significantly reduced the second peak knee adduction moment (↓32%, P<0.001) and KAM impulse (↓14%, P=0.026), but had no effect on the first peak. Conversely, toe-out was least demanding in terms of additional energy expenditure (↑2%, P=0.001) and perceived workload (↑314%, P=0.001). Medial shift did not reduce knee adduction moment.
INTERPRETATION: The prioritization of joint load reduction versus additional metabolic and cognitive demands could play a substantial role in the clinical decision making process of selecting a modified gait pattern.
METHODS: 12 healthy individuals underwent 3 dimensional motion analysis and metabolic testing to assess the gait mechanics and energy expenditure of natural gait and the three experimental gait patterns, performed to a self-selected moderate degree. Walking speed was controlled. Perceived workload was assessed using the NASA Task Load Index.
FINDINGS: Trunk lean significantly reduced first peak knee adduction moment (↓32%, P<0.001) as well as KAM impulse (↓35%, P<0.001), but was costly in terms of energy expenditure (↑11%, P<0.001) and perceived workload (↑1178%, P<0.001). A moderate toe-out pattern significantly reduced the second peak knee adduction moment (↓32%, P<0.001) and KAM impulse (↓14%, P=0.026), but had no effect on the first peak. Conversely, toe-out was least demanding in terms of additional energy expenditure (↑2%, P=0.001) and perceived workload (↑314%, P=0.001). Medial shift did not reduce knee adduction moment.
INTERPRETATION: The prioritization of joint load reduction versus additional metabolic and cognitive demands could play a substantial role in the clinical decision making process of selecting a modified gait pattern.