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Gait Asymmetry in Hip Osteoarthritis Patients

From EverybodyWiki Bios & Wiki



Gait asymmetry[edit]

Gait is a basic daily physical activity and is known to be one of the most universal and complex of all human activities.[1] It has to be accomplished by the complex and coordinated pattern of nerve signals sent to the muscles, which move the joints, limbs, and remainder of the body in an orderly, stable manner.

Gait symmetry has been defined as the perfect agreement of the external kinetics and kinematics of the left and right legs.[2] More precisely, some people suggest that “gait symmetry” is when there is no statistical differences are noted on parameters measured bilaterally.[3] Therefore, “gait asymmetry” can be defined that when both limbs behave distinctly.

Support for gait symmetry[edit]

Gait symmetry was assumed for a long time. In fact, simplification might be one of the main reasons that many gait studies relied on unilateral data collection. However, only a few studies using quantitative biomechanical data to support gait symmetry.

Kinematics[edit]

In the hip joint, the previous study used time and frequency domain analysis found joint motion symmetry in all three planes during normal walking.[4] In the knee joint, joint motion symmetry was found in the sagittal plane[4].

Ground reaction force (GRF)   [edit]

For the GRF, the similarity between the lower extremities has been found during gait for the vertical and horizontal reaction forces of 214 normal subjects.[5] Additionally, there are no significant differences between the limbs in 11 vertical, five anterior–posterior and four medio-lateral characteristics of the ground reaction forces during walking.[6]

 Electromyography (EMG)[edit]

For the EMG, the patterns of activity in both legs were identical in the normal subject during walking.[7] Moreover, the average EMG patterns for six knee muscle activities has been reported symmetry during free, slow, and fast gait.[8]

Support for gait asymmetry [edit]

Human gait seems to be naturally asymmetry. The asymmetrical behavior of the gait was observed not only in the spatiotemporal and kinematic parameters but also in the kinetic and electromyography (EMG) data during normal gait.

Spatial-temporal parameters[edit]

In the spatiotemporal parameters, velocity profiles, step length and stride length have frequently been reported. Previous studies have been found that step length and stride length were different between left and right leg.[9][10] The stride time was also different between left and right leg[4]. Combined the effect of the stride length and stride time, the velocity of stride was also different between left and right leg.[9][10] Additionally, the duration of initial and terminal double support periods was also has been found not identical in the young healthy subjects.[11]

Kinematics[edit]

In the kinematics parameters, it has been found different profiles of angular changes in the sagittal plane during normal gait in both male and female. The values of relative asymmetry index (RAI) was greatest for the ankle, and much lower for the knee and hip.[12]

Kinetics[edit]

Although spatio-temporal and kinematics parameters[13] can provide an overall impression of gait, from another perspective, they might provide only insight into the effect of the movement but not the cause. It would be reasonable to concentrate on more informative biomechanical parameters which provide insight into both effect and cause of the action (e.g. force).

The previous study investigated the variability and symmetry of ground reaction force during walking; it has been found that substantial asymmetries in time domain variables in the medio-lateral component of ground reaction force (GRF).[14] Additionally, the external knee adductor moment at the first peak was also found asymmetry in normal gait.[15]

EMG[edit]

Using EMG data, the soleus and rectus femoris muscles have been reported asymmetries in amplitude profiles.[16] Subsequently, the other research also found the gait asymmetry in medial hamstrings during push-off, soleus during the entire phase, and the medial gastrocnemius at push-off.[17] 

Step length asymmetry in hip osteoarthritis (OA) patients[edit]

Even though there is asymmetry in the normal gait, there is marked differences have been noted between the affected and unaffected limbs in pathological gait, and this difference is larger than in normal gait. For individuals with hip OA, their capacity to walk is often compromised. The most common gait deviation in hip OA population is small step length in the affected limb, large step length in contralateral limb, and significant step length asymmetry.[18] In the previous studies showed that individuals with hip OA had a smaller step length of the affected limb than controls in self-selected walking speed studies.[19][20][21][22][23][24][25][26][27][28] An important contributing factor that beside the gait limitation that is mainly due to the abnormalities in the affected limb, might be the impaired functions of the ankle musculature lead to propulsion weakness and will rely more on the contralateral limb.[29][30][31] It has been found that the step length in the affected limb compared to the contralateral limb in individual with hip OA was smaller.[21][32][33] Additionally, the step length of the contralateral limb of the individuals with hip OA was greater than controls in overground studies.[20][27] Therefore, these create the larger step length asymmetry index for the individuals with hip OA compared with the control group.[17]

Reference[edit]

  1. ↑ Pratt, D. J. (1994-02-01). "Some aspects of modern orthotics". Physiological Measurement. 15 (1): 1–27. ISSN 0967-3334. PMID 8161956.
  2. ↑ Herzog, W.; Nigg, B. M.; Read, L. J.; Olsson, E. (1989-02-01). "Asymmetries in ground reaction force patterns in normal human gait". Medicine and Science in Sports and Exercise. 21 (1): 110–114. ISSN 0195-9131. PMID 2927295.
  3. ↑ Hesse, S.; Reiter, F.; Jahnke, M.; Dawson, M.; Sarkodie-Gyan, T.; Mauritz, K. H. (1997-07-01). "Asymmetry of gait initiation in hemiparetic stroke subjects". Archives of Physical Medicine and Rehabilitation. 78 (7): 719–724. ISSN 0003-9993. PMID 9228874.
  4. ↑ 4.0 4.1 Hannah, R. E.; Morrison, J. B.; Chapman, A. E. (1984-04-01). "Kinematic symmetry of the lower limbs". Archives of Physical Medicine and Rehabilitation. 65 (4): 155–158. ISSN 0003-9993. PMID 6712430.
  5. ↑ Claeys, R. (1983-01-01). "The analysis of ground reaction forces in pathological gait secondary to disorders of the foot". International Orthopaedics. 7 (2): 113–119. ISSN 0341-2695. PMID 6543820.
  6. ↑ Hamill, J.; Bates, B. T.; Knutzen, K. M. (1984-09-01). "Ground Reaction Force Symmetry during Walking and Running". Research Quarterly for Exercise and Sport. 55 (3): 289–293. doi:10.1080/02701367.1984.10609367. ISSN 0270-1367.
  7. ↑ Marks, Morton; Hirschberg, Gerald G. (1958-09-01). "Analysis of the Hemiplegic Gait". Annals of the New York Academy of Sciences. 74 (1): 59–77. doi:10.1111/j.1749-6632.1958.tb39532.x. ISSN 1749-6632.
  8. ↑ Pierotti, S. E.; Brand, R. A.; Gabel, R. H.; Pedersen, D. R.; Clarke, W. R. (1991-09-01). "Are leg electromyogram profiles symmetrical?". Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society. 9 (5): 720–729. doi:10.1002/jor.1100090512. ISSN 0736-0266. PMID 1870036.
  9. ↑ 9.0 9.1 Law, H. T. (1987-04-01). "Microcomputer-based low-cost method for measurement of spatial and temporal parameters of gait". Journal of Biomedical Engineering. 9 (2): 115–120. ISSN 0141-5425. PMID 3573749.
  10. ↑ 10.0 10.1 Allard, Paul; Lachance, Régis; Aissaoui, Rachid; Duhaime, Morris (1996-06-01). "Simultaneous bilateral 3-D able-bodied gait". Human Movement Science. 15 (3): 327–346. doi:10.1016/0167-9457(96)00004-8.
  11. ↑ P., Rosenrot; C., Wall J.; J., Charteris (1980-02-03). "The relationship between velocity stride time support time and wing time during normal walking". Journal of Human Movement Studies. 6 (4).
  12. ↑ Forczek, Wanda; Staszkiewicz, Robert (2012-12-01). "An evaluation of symmetry in the lower limb joints during the able-bodied gait of women and men". Journal of Human Kinetics. 35: 47–57. doi:10.2478/v10078-012-0078-5. ISSN 1640-5544. PMC 3588688. PMID 23486255.
  13. ↑ Lugade, Vipul; Wu, Angela; Jewett, Brian; Collis, Dennis; Chou, Li-Shan (2010-08-01). "Gait asymmetry following an anterior and anterolateral approach to total hip arthroplasty". Clinical Biomechanics (Bristol, Avon). 25 (7): 675–680. doi:10.1016/j.clinbiomech.2010.05.003. ISSN 1879-1271. PMID 20542608.
  14. ↑ "Time and frequency domain analysis of ground reaction forces during walking: an investigation of variability and symmetry - ScienceDirect". www.sciencedirect.com. Retrieved 2017-04-17.
  15. ↑ Street, Brian D.; Gage, William (2013-04-01). "The effects of an adopted narrow gait on the external adduction moment at the knee joint during level walking: evidence of asymmetry". Human Movement Science. 32 (2): 301–313. doi:10.1016/j.humov.2012.08.007. ISSN 1872-7646. PMID 23623229.
  16. ↑ Arsenault, A. B.; Winter, D. A.; Marteniuk, R. G. (1986-02-01). "Bilateralism of EMG profiles in human locomotion". American Journal of Physical Medicine. 65 (1): 1–16. ISSN 0002-9491. PMID 3946590.
  17. ↑ 17.0 17.1 Ounpuu, S.; Winter, D. A. (1989-05-01). "Bilateral electromyographical analysis of the lower limbs during walking in normal adults". Electroencephalography and Clinical Neurophysiology. 72 (5): 429–438. ISSN 0013-4694. PMID 2469567.
  18. ↑ Constantinou, Maria; Barrett, Rod; Brown, Mark; Mills, Peter (2014-04-01). "Spatial-temporal gait characteristics in individuals with hip osteoarthritis: a systematic literature review and meta-analysis". The Journal of Orthopaedic and Sports Physical Therapy. 44 (4): 291–B7. doi:10.2519/jospt.2014.4634. ISSN 1938-1344. PMID 24450373.
  19. ↑ Fang, Meika A.; Heiney, Constance; Yentes, Jennifer M.; Harada, Nancy D.; Masih, Sulabha; Perell-Gerson, Karen L. (2012-01-01). "Clinical and spatiotemporal gait effects of canes in hip osteoarthritis". PM & R: the journal of injury, function, and rehabilitation. 4 (1): 30–36. doi:10.1016/j.pmrj.2011.08.534. ISSN 1934-1563. PMID 22088853.
  20. ↑ 20.0 20.1 Klausmeier, Virginia; Lugade, Vipul; Jewett, Brian A.; Collis, Dennis K.; Chou, Li-Shan (2017-04-17). "Is There Faster Recovery With an Anterior or Anterolateral THA? A Pilot Study". Clinical Orthopaedics and Related Research. 468 (2): 533–541. doi:10.1007/s11999-009-1075-4. ISSN 0009-921X. PMC 2806982. PMID 19763725.
  21. ↑ 21.0 21.1 Kyriazis, V.; Rigas, C. (2002-05-01). "Temporal gait analysis of hip osteoarthritic patients operated with cementless hip replacement". Clinical Biomechanics (Bristol, Avon). 17 (4): 318–321. ISSN 0268-0033. PMID 12034128.
  22. ↑ Macnicol, M. F.; McHardy, R.; Chalmers, J. (1980-08-01). "Exercise testing before and after hip arthroplasty". The Journal of Bone and Joint Surgery. British Volume. 62 (3): 326–331. ISSN 0301-620X. PMID 7410464.
  23. ↑ Reininga, Inge H. F.; Stevens, Martin; Wagenmakers, Robert; Bulstra, Sjoerd K.; Groothoff, Johan W.; Zijlstra, Wiebren (2012-01-20). "Subjects with hip osteoarthritis show distinctive patterns of trunk movements during gait-a body-fixed-sensor based analysis". Journal of Neuroengineering and Rehabilitation. 9: 3. doi:10.1186/1743-0003-9-3. ISSN 1743-0003. PMC 3274426. PMID 22264234.
  24. ↑ Tanaka, Riki; Shigematsu, Masamori; Motooka, Tsutomu; Mawatari, Masaaki; Hotokebuchi, Takao (2010-09-01). "Factors influencing the improvement of gait ability after total hip arthroplasty". The Journal of Arthroplasty. 25 (6): 982–985. doi:10.1016/j.arth.2009.06.009. ISSN 1532-8406. PMID 19646844.
  25. ↑ Watanabe, H.; Shimada, Y.; Kagaya, H.; Sato, K. (1999-01-01). "Gait analysis following varus osteotomy of the femur for hip osteoarthritis". Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association. 4 (2): 89–98. ISSN 0949-2658. PMID 10199986.
  26. ↑ Watanabe, H.; Shimada, Y.; Sato, K.; Tsutsumi, Y.; Sato, M. (1998-01-01). "Gait analysis before or after varus osteotomy of the femur for hip osteoarthritis". Bio-Medical Materials and Engineering. 8 (3–4): 177–186. ISSN 0959-2989. PMID 10065884.
  27. ↑ 27.0 27.1 Watelain, E.; Dujardin, F.; Babier, F.; Dubois, D.; Allard, P. (2001-12-01). "Pelvic and lower limb compensatory actions of subjects in an early stage of hip osteoarthritis". Archives of Physical Medicine and Rehabilitation. 82 (12): 1705–1711. doi:10.1053/apmr.2001.26812. ISSN 0003-9993. PMID 11733886.
  28. ↑ Aminian, K.; Trevisan, C.; Najafi, B.; Dejnabadi, H.; Frigo, C.; Pavan, E.; Telonio, A.; Cerati, F.; Marinoni, E. C. (2004-08-01). "Evaluation of an ambulatory system for gait analysis in hip osteoarthritis and after total hip replacement". Gait & Posture. 20 (1): 102–107. doi:10.1016/S0966-6362(03)00093-6. ISSN 0966-6362. PMID 15196527.
  29. ↑ Jonkers, I.; Delp, S.; Patten, C. (2009-01-01). "Capacity to increase walking speed is limited by impaired hip and ankle power generation in lower functioning persons post-stroke". Gait & Posture. 29 (1): 129–137. doi:10.1016/j.gaitpost.2008.07.010. ISSN 0966-6362. PMC 2929166. PMID 18789692.
  30. ↑ Peterson, Carrie L.; Hall, Allison L.; Kautz, Steven A.; Neptune, Richard R. (2010-08-26). "Pre-swing deficits in forward propulsion, swing initiation and power generation by individual muscles during hemiparetic walking". Journal of Biomechanics. 43 (12): 2348–2355. doi:10.1016/j.jbiomech.2010.04.027. ISSN 1873-2380. PMC 2922425. PMID 20466377.
  31. ↑ Chen, George; Patten, Carolynn; Kothari, Dhara H.; Zajac, Felix E. (2005-08-01). "Gait differences between individuals with post-stroke hemiparesis and non-disabled controls at matched speeds". Gait & Posture. 22 (1): 51–56. doi:10.1016/j.gaitpost.2004.06.009. ISSN 0966-6362. PMID 15996592.
  32. ↑ Cichy, Benedykt; Wilk, Magdalena (2006-12-01). "Gait analysis in osteoarthritis of the hip". Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 12 (12): CR507–513. ISSN 1234-1010. PMID 17136006.
  33. ↑ Cichy, Benedykt; Wilk, Magdalena; Sliwiński, Zbigniew (2008-03-01). "Changes in gait parameters in total hip arthroplasty patients before and after surgery". Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 14 (3): CR159–169. ISSN 1234-1010. PMID 18301360.



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