Isolating the energetic and mechanical consequences of imposed reductions in ankle and knee flexion during gait.
Isolating the energetic and mechanical consequences of imposed reductions in ankle and knee flexion during gait.
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DOI：
10.1186/s12984-021-00812-8
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发表时间：
2021-02-01
影响因子：
5.1
通讯作者：
Lewek MD
中科院分区：
文献类型：
--
作者：
McCain EM;Libera TL;Berno ME;Sawicki GS;Saul KR;Lewek MD
踝关节和膝关节肌肉组织在受伤或疾病后的虚弱导致与代谢昂贵的步态补偿相关的关节运动减少，以实现肢体支撑和前进。然而，踝关节和膝关节之间的神经机械耦合使得难以辨别这些限制在关节运动中对补偿力学和代谢惩罚的独立作用。我们试图确定踝关节和膝关节损伤对代偿性步态策略和能量结果的相对影响，使用未受损队列（N = 15），施加单侧关节活动范围限制作为步态病理导致的运动减少的替代。参与者以0.8 m s-1的速度在双带仪器跑步机上行走，使用3D打印的踝关节支撑和膝关节支撑系统地限制踝关节运动（限制-ank），膝关节运动（限制-膝关节）以及踝关节和膝关节运动（限制-a + k）。此外，参与者行走时没有任何踝关节或膝关节支撑（对照组）和膝关节支撑佩戴但不受限制（支撑）。当踝关节运动受到限制（限制-ank，限制-a + k），我们观察到减少峰值推进相对于限制肢体的支撑条件。减少膝关节运动（限制膝关节，限制-a + k）增加限制肢体回旋相对于限制-ank条件，通过同侧髋关节远足。有趣的是，限制肢体平均正髋功率在限制ank条件下增加，但在限制a + k和限制膝条件下减少，这表明锁定膝关节阻碍髋关节补偿。正如预期的那样，减少踝关节运动，无论是没有（限制-ank）或除了膝关节限制（限制-a + k）产生了显着增加净代谢率相比，支撑条件。此外，与限制膝关节条件相比，限制a + k的代谢成本的相对增加显著更大。我们的方法允许再现不对称的步态特征，包括减少推进对称性和增加回旋。代谢后果增强了康复期间针对脚踝功能的潜在能量益处。N/A.
Weakness of ankle and knee musculature following injury or disorder results in reduced joint motion associated with metabolically expensive gait compensations to enable limb support and advancement. However, neuromechanical coupling between the ankle and knee make it difficult to discern independent roles of these restrictions in joint motion on compensatory mechanics and metabolic penalties. We sought to determine relative impacts of ankle and knee impairment on compensatory gait strategies and energetic outcomes using an unimpaired cohort (N = 15) with imposed unilateral joint range of motion restrictions as a surrogate for reduced motion resulting from gait pathology. Participants walked on a dual-belt instrumented treadmill at 0.8 m s−1 using a 3D printed ankle stay and a knee brace to systematically limit ankle motion (restricted-ank), knee motion (restricted-knee), and ankle and knee motion (restricted-a + k) simultaneously. In addition, participants walked without any ankle or knee bracing (control) and with knee bracing worn but unrestricted (braced). When ankle motion was restricted (restricted-ank, restricted-a + k) we observed decreased peak propulsion relative to the braced condition on the restricted limb. Reduced knee motion (restricted-knee, restricted-a + k) increased restricted limb circumduction relative to the restricted-ank condition through ipsilateral hip hiking. Interestingly, restricted limb average positive hip power increased in the restricted-ank condition but decreased in the restricted-a + k and restricted-knee conditions, suggesting that locking the knee impeded hip compensation. As expected, reduced ankle motion, either without (restricted-ank) or in addition to knee restriction (restricted-a + k) yielded significant increase in net metabolic rate when compared with the braced condition. Furthermore, the relative increase in metabolic cost was significantly larger with restricted-a + k when compared to restricted-knee condition. Our methods allowed for the reproduction of asymmetric gait characteristics including reduced propulsive symmetry and increased circumduction. The metabolic consequences bolster the potential energetic benefit of targeting ankle function during rehabilitation. N/A.
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