Gait characteristics and falls in Parkinson's disease: A systematic review and meta-analysis

Introduction: Given the high rate of falls during walking in people with idiopathic Parkinson's disease (PD), identifying at risk individuals and developing targeted interventions to reduce falls incidence is paramount. Numerous studies have investigated gait-related risk factors for falls in PD, however findings are inconsistent across studies, and thus a synthesis of the current evidence is needed to guide clinical practice and the development of interventions to reduce falls risk. The objective of this study was to systematically review the literature regarding the association between walking biomechanics and falls in people with PD, and where possible, perform meta-analyses. Methods: The study was performed in accordance with the PRISMA guidelines. Databases were searched until January 2018 to identify articles that reported on the association between walking biomechanics and prospective or retrospective falls in people with PD. Results: Twenty-six articles were included (15 prospective studies, 11 retrospective studies). Articles reported on spatiotemporal and kinematic characteristics, and muscle activation patterns. Meta-analyses revealed slower walking speed, lower cadence, shorter strides and more mediolateral head and pelvis motion in those at higher risk of future falls. Findings from prospective and retrospective articles were largely consistent. Conclusion: Our findings identify spatiotemporal and kinematic characteristics of gait that are risk factors for falls in PD. Modification of these characteristics may have the potential to mediate falls risk, and future research to investigate this possibility is merited. The influence of body and ground reaction forces, and muscle activation patterns on falls risk in PD is currently under-researched

Gait biofeedback training in people with Parkinson’s disease : A pilot study

Background People with Parkinson’s disease (PD) are at a high risk of falls, with ~ 60% experiencing a fall each year. Greater mediolateral head and pelvis motion during gait are known to increase the risk of falling in PD, however the ability to modify these aspects of gait has not been examined. Thus, this study aimed to examine whether mediolateral trunk, head and pelvis motion during walking could be successfully decreased in people with PD using real-time biofeedback. Methods Participants were provided with real-time biofeedback regarding their mediolateral trunk lean via a visual projection whilst walking along an 8-m indoor walkway. Using the feedback provided, they were asked to reduce the magnitude of their mediolateral trunk lean. Gait was recorded for four conditions (i) Baseline, (ii) Intervention, (iii) immediately Post-Intervention, and (iv) 1-week Follow-Up. Biomechanical variables associated with falls risk were compared between conditions, including normalised mediolateral motion, gait velocity and stride length. Results A reduction in mediolateral trunk lean, step length and gait velocity from Baseline to the Intervention and Post-intervention conditions was observed. Contrary to this, increased normalised ML pelvis and trunk motion was observed between the Baseline and Intervention conditions, but returned to Baseline levels in the Post-Intervention condition. Conclusions Results from the current study suggest that real-time visual biofeedback may be effective at modifying specific gait characteristics that are associated with falls in PD. Further research is required to better understand the influence of this intervention approach on falls incidence. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12620000994987. Registered 10 June 2020 - Retrospectively registered, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=38032

Changes in total lower limb support moment in middle-aged patients undergoing arthroscopic partial meniscectomy – a longitudinal observational cohort

Background Patients with a meniscal tear are frequently treated with arthroscopic partial meniscectomy (APM) which may alter the net extension moment across the entire lower limb – known as the total support moment (TSM). Purpose To investigate changes in TSM during walking in patients undergoing APM. Methods Three-dimensional motion analysis of walking was performed in individuals with meniscal tear prior to APM and 12 months after. Peak TSM, positive ankle (ASM), knee (KSM), and hip (HSM) moments at the time of peak TSM were calculated together with corresponding angular impulses. Results Patients (n = 20) were middle aged (45.9 ± 6.3 years) and the majority male (70%). At baseline a lower KSM (mean [95%CI]; 0.59 Nm/BM · HT% [− 1.93; 3.11], P = 0.048) and a trend towards lower peak TSM (0.46 Nm/BM · HT% [− 1.82; 2.78], P = 0.099) were observed for the APM leg compared with the contralateral. Pre- versus post-APM change scores indicated a relative decrease in loading of the contralateral leg for peak TSM (− 0.49 Nm/BM · HT% [− 0.96; − 0.01], P = 0.047) and a trend towards a relative increase in loading of the APM leg for peak KSM (− 0.41 Nm/BM · HT% [− 0.92; 0.09], P = 0.105). No differences were observed in angular impulse variables. Conclusions Prior to APM a strategy to unload the injured knee was manifested by reduced KSM and a tendency to a reduced peak TSM. A more equal distribution of joint moments between injured and contralateral legs was observed 12 months following APM

Factors affecting knee abduction during weight-bearing activities in individuals with anterior cruciate ligament reconstruction

Objective To investigate if muscle strength and muscle activation patterns are associated with increased knee abduction during two functional tasks, commonly used in rehabilitation for individuals with anterior cruciate ligament reconstruction (ACLR). Design Cross-sectional study. Setting Laboratory. Participants 24 women and 29 men approximately 7 months after ACLR. Main outcome measures Isometric peak torque of the trunk and lower extremity muscles were determined during maximal voluntary contractions. Trunk and lower extremity average muscle activation amplitude and peak knee abduction were evaluated during the single-leg squat (SLS) and the single-leg hop for distance (SLHD) for the injured side. Separate backward regressions were performed for men and women. Results In women, lower knee flexion and extension strength were associated with greater peak knee abduction during the SLS (B = 4.63–18.26, p ≤ 0.036); lower knee flexion strength and iliocostalis activation on the non-injured side were associated with greater peak knee abduction during the SLHD (B = 0.60–20.48, p ≤ 0.043). No associations between muscle function and peak knee abduction were found in men. Conclusions Muscle function may contribute differently to knee abduction in men and women after ACLR. This should be considered when designing rehabilitation programs to reduce knee abduction in these patients

Sex differences in postural orientation errors and association with objective and patient-reported function in patients with ACL injury : An exploratory cross-sectional study

Objectives: There is limited research on sex differences in postural orientation (ie, alignment between body segments) in people with knee injury measured with a clinically applicable method. An understanding of the relationship between postural orientation and physical function may help guide decision making in rehabilitation. The aims were to evaluate (1) sex differences in visual assessment of Postural Orientation Errors (POEs) and (2) the association between POEs and objective and patient-reported physical function, in men and women with anterior cruciate ligament reconstruction (ACLR). Methods: Twenty-four women and 29 men (mean 26.7 (SD 6.5) years) with ACLR were included. Six POEs (lower extremity and trunk) were scored from a video of five tasks with varying difficulty to compute POE scores (total and subscores). Objective physical function was evaluated with the single-leg hop for distance and side hop. Patient-reported physical function was evaluated using patient-reported outcome measures (PROMs). Results: Women had significantly more POEs than men (median difference 5.5–25, p≤0.028). More POEs were associated with shorter hop distance and fewer side hops in women (rs= −0.425 to −0.518, p0.05). No associations were found between POE scores and PROMs, in either sex (rs0.05). Conclusions: Women with ACLR seem to have more POEs compared with men, indicating worse postural orientation. More POEs were associated with worse hop performance, suggesting that POE scores may be used as criteria for rehabilitation progression. The lack of associations between POE scores and PROMs indicate that these measures complement each other

The role of lower limb biomechanics in stress fracture risk

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Do knee abduction kinematics and kinetics predict future anterior cruciate ligament injury risk? A systematic review and meta-analysis of prospective studies

Background To systematically review the association between knee abduction kinematics and kinetics during weight-bearing activities at baseline and the risk of future anterior cruciate ligament (ACL) injury. Methods Systematic review and meta-analysis according to PRISMA guidelines. A search in the databases MEDLINE (PubMed), CINAHL, EMBASE and Scopus was performed. Inclusion criteria were prospective studies including people of any age, assessing baseline knee abduction kinematics and/or kinetics during any weight-bearing activity for the lower extremity in individuals sustaining a future ACL injury and in those who did not. Results Nine articles were included in this review. Neither 3D knee abduction angle at initial contact (Mean diff: -1.68, 95%CI: − 4.49 to 1.14, ACL injury n = 66, controls n = 1369), peak 3D knee abduction angle (Mean diff: -2.17, 95%CI: − 7.22 to 2.89, ACL injury n = 25, controls n = 563), 2D peak knee abduction angle (Mean diff: -3.25, 95%CI: − 9.86 to 3.36, ACL injury n = 8, controls n = 302), 2D medial knee displacement (cm; Mean diff:: -0.19, 95%CI: − 0,96 to 0.38, ACL injury n = 72, controls n = 967) or peak knee abduction moment (Mean diff:-10.61, 95%CI: - 26.73 to 5.50, ACL injury n = 54, controls n = 1330) predicted future ACL injury. Conclusion Contrary to clinical opinion, our findings indicate that knee abduction kinematics and kinetics during weight-bearing activities may not be risk factors for future ACL injury. Knee abduction of greater magnitude than that observed in the included studies as well as factors other than knee abduction angle or moment, as possible screening measures for knee injury risk should be evaluated in future studies

Extended Version of a Test Battery for Visual Assessment of Postural Orientation Errors: Face Validity, Internal Consistency, and Reliability

Objective Undesirable postural orientation may be a risk factor for a second anterior cruciate ligament (ACL) injury. The purpose of this study was to evaluate face validity, internal consistency, and interrater reliability of an extended version of a previous test battery for visual assessment of postural orientation errors (POEs) in patients during the late phase of rehabilitation following ACL reconstruction (ACLR) (ie, when they have initiated jumping exercises). Methods This study used a cross-sectional design. Fifty-three patients (45% women) in the late phase of ACLR rehabilitation performed 5 functional tasks of varying difficulty. POEs of the lower extremity and trunk were visually assessed from video and scored on a scale from 0 (good) to 2 (poor). Results The side-hop and 2 new POEs (femur medial to shank, femoral valgus) were added to the test battery after expert focus group discussions. Internal consistency was calculated for all tasks (α = .712–.823). Interrater reliability showed fair to substantial agreement for femur medial to shank and femoral valgus during all tasks (K = 0.31–0.815) and almost perfect agreement for side-hop (intraclass correlation coefficient = 0.88). Conclusions The good internal consistency and reliability after adding side-hop, femur medial to shank, and femoral valgus suggests that this test battery is a suitable tool to quantify postural orientation throughout ACLR rehabilitation. Impact This test battery for visual assessment of POEs was evaluated in a heterogeneous group of patients in different phases of ACLR battery and can be used in clinical practice to measure POEs in patients with ACLR, including in the late phase of rehabilitation to return to sport. This study encourages research on more demanding tasks and additional POEs to cover the entire rehabilitation period after ACL injury or reconstruction