Short and long-term effects of gait retraining using real-time biofeedback to reduce knee hyperextension pattern in young women.

The use of real-time biofeedback has been shown to enable individuals to make changes to their gait patterns. It remains unknown whether the short-term improvements reported in previous studies are retained in the longer term. In this study, the paradigm used to investigate the short and long-term effects of real-time biofeedback was modifying knee range of motion during gait to prevent knee hyperextension in women. The purpose of this study was to investigate the short-term (1-month follow up) and long-term (8-month follow up) effects of a gait retraining program using real-time biofeedback to correct knee hyperextension in young women. Seventeen healthy women, ages 18-35 years, with asymptomatic knee hyperextension underwent a three-week (6 sessions) treadmill gait retraining program. Real-time feedback of kinematic data (Visual 3D) was provided during treadmill training. Knee extension range of motion was monitored during overground gait evaluations and training sessions. Gait evaluations were performed pretraining, posttraining (2days after), and 1-month, and 8-month after the last training session. This study showed significant reduction in knee hyperextension patterns immediately following training (mean±SD, 10.9°±4°), and at 1-month (7.5°±5°) and 8-month (6.3°±3.5°) follow ups. There was an increase in knee extension between posttraining and 1-month follow up (3.4°±5°). Reduction in knee hyperextension range of motion was retained at 8-month follow up evaluation. The present study shows the effects of real-time biofeedback in facilitating the acquisition and retention of proficiency in reducing knee hyperextension gait patterns, documenting that the retention is sustained for up to 8 months.

Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis.

OBJECTIVE: The objective of this study was to determine whether individualized gait training is more effective than usual care for reducing mobility disability and pain in individuals with symptomatic knee osteoarthritis. DESIGN: Adults aged 60 yrs or older with symptomatic knee osteoarthritis and mobility limitations were randomized to physical therapist-directed gait training on an instrumented treadmill, with biofeedback individualized to optimize knee movements, biweekly for 3 mos or usual care (control). Mobility disability was defined using Late Life Function and Disability Index Basic Lower Limb Function score (primary); mobility limitations, using timed 400-m walk, chair-stand, and stair-climb tests; and symptoms, using the Knee Injury/Osteoarthritis Outcome Score at baseline, as well as at 3, 6, and 12 mos. The analyses used longitudinal mixed models. RESULTS: There were no significant intergroup differences between the 35 gait-training (74.3% women; age, 69.7 ± 8.2 yrs) and 21 control (57.1% women; age, 68.9 ± 6.5 yrs) participants at baseline. At 3 mos, the gait-training participants had greater improvement in mobility disability (4.3 ± 1.7; P = 0.0162) and symptoms (8.6 ± 4.1; P = 0.0420). However, there were no intergroup differences detected for pain, 400-m walk, chair-stand, or stair-climb times at 3 mos or for any outcomes at 6 or 12 mos. CONCLUSIONS: Compared with usual care, individualized gait training resulted in immediate improvements in mobility disability knee symptoms in adults with symptomatic knee osteoarthritis, but these effects were not sustained.

Pregnancy leads to lasting changes in foot structure.

OBJECTIVE: Women are disproportionately affected by musculoskeletal disorders. Parous women seem to be at a particularly elevated risk for structural and functional changes in the lower limbs. The combination of increased weight on the joints with potentially greater laxity during pregnancy could lead to permanent structural changes in the feet. Although arches may become lax during pregnancy, it is unknown whether the changes persist. The objective of this study was to determine whether arch height loss persists postpartum. DESIGN: Forty-nine women completed this longitudinal study. Static and dynamic arch measurements were collected in the first trimester and at 19 wks postpartum. Linear mixed models were used to determine whether outcome measures significantly changed overall or by parity. RESULTS: Arch height and rigidity indices significantly decreased, with concomitant increases in foot length and arch drop. The first pregnancy accounted for the reduction in arch rigidity and the increases in foot length and arch drop. No changes were detected in the center of pressure excursion index. CONCLUSIONS: Pregnancy seems to be associated with a permanent loss of arch height, and the first pregnancy may be the most significant. These changes in the feet could contribute to the increased risk for musculoskeletal disorders in women. Further research should assess the efficacy of rehabilitative interventions for prevention of pregnancy-related arch drop.

Efficacy of gait training with real-time biofeedback in correcting knee hyperextension patterns in young women.

STUDY DESIGN: Single cohort study. OBJECTIVES: To investigate the efficacy of real-time biofeedback provided during treadmill gait training to correct knee hyperextension in asymptomatic females while walking. BACKGROUND: Knee hyperextension is associated with increased stress to the posterior capsule of the knee joint, anterior cruciate ligament, and the anterior compartment of the tibiofemoral joint. Previous methods aimed at correcting knee hyperextension have shown limited success. METHODS: Ten women, ages 18 to 39 years, with asymptomatic knee hyperextension during ambulation, were provided with 6 sessions of real-time feedback of kinematic data (Visual 3D) during treadmill training. Gait evaluations were performed pretraining, posttraining, and 1 month after the last training session. RESULTS: Participants showed improved control of knee hyperextension during overground walking at 1.3 m/s at posttraining and at 1 month posttraining. CONCLUSION: The present study demonstrated that knee sagittal plane kinematics may be influenced by gait retraining using real-time biofeedback.