Design of patient-specific gait modifications for knee osteoarthritis rehabilitation
Design of patient-specific gait modifications for knee osteoarthritis rehabilitation
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DOI：
10.1109/tbme.2007.891934
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发表时间：
2007-09-01
影响因子：
4.6
通讯作者：
Chmielewski, Terese L.
中科院分区：
文献类型：
--
作者：
Fregly, Benjamin J.;Reinbolt, Jeffrey A.;Chmielewski, Terese L.
步态改变是一种非手术方法，用于减少膝关节骨关节炎（OA）患者的膝关节外收扭矩。特别是第一内收扭矩峰值的大小与膝关节OA进展密切相关。虽然已证明脚趾外伸可以减少第二个峰值，但尚未发现临床上现实的步态调整可以同时有效减少两个峰值。这项研究预测了新的患者特定的步态修改，实现这一目标，而不改变脚path.The修改后的步态运动设计为一个单一的患者与膝关节OA使用动态优化的患者特定的，全身步态模型。成本函数最小化膝关节内收扭矩的约束限制多少新的步态运动可以偏离患者的正常步态运动。优化预测了一种“中间推力”步态模式，该模式将第一个内收扭矩峰值降低了32%至54%，将第二个峰值降低了34%至56%。新的运动涉及三个协同运动学变化：骨盆弯曲度略有下降，腿部屈曲略有增加，骨盆轴向旋转略有增加。步态再训练后，患者实现了内收。扭矩在第一个峰值中减少39%至50%，在第二个峰值中减少37%至55%。这些减少与胫骨高位截骨术后报告的减少相当。相关的运动学变化与预测一致，除了骨盆的弹性，这表明变化不大。这项研究表明，它是可行的，设计新的患者特定的步态修改与潜在的临床效益，使用动态优化的患者特定的，全身步态模型。需要进一步研究以评估类似的步态改变对其他膝关节OA患者的有效程度。
Gait modification is a nonsurgical approach for reducing the external knee adduction torque in patients with knee osteoarthritis (OA). The magnitude of the first adduction torque peak in particular is strongly associated with knee OA progression. While toeing out has been shown to reduce the second peak, no clinically realistic gait modifications have been identified that effectively reduce both peaks simultaneously. This study predicts novel patient-specific gait modifications that achieve this goal without changing the foot path. The modified gait motion was designed for a single patient with knee OA using dynamic optimization of a patient-specific, full-body gait model. The cost function minimized the knee adduction torque subject to constraints limiting how much the new gait motion could deviate from the patient's normal gait motion. The optimizations predicted a '' medial-thrust '' gait pattern that reduced the first adduction torque peak between 32% and 54% and the second peak between 34% and 56%. The new motion involved three synergistic kinematic changes: slightly decreased pelvis obliquity, slightly increased leg flexion, and slightly increased pelvis axial rotation. After gait retraining, the patient achieved adduction. torque reductions of 39% to 50% in the first peak and 37% to 55% in the second one. These reductions are comparable to those reported after high tibial osteotomy surgery. The associated kinematic changes were consistent with the predictions except for pelvis obliquity, which showed little change. This study demonstrates that it is feasible to design novel patient-specific gait modifications with potential clinical benefit using dynamic optimization of patient-specific, full-body gait models. Further investigation is needed to assess the extent to which similar gait modifications may be effective for other patients with knee OA.