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Δευτέρα 22 Μαΐου 2017
Measuring cortical motor hemodynamics during assisted stepping – An fNIRS feasibility study of using a walker
Publication date: July 2017
Source:Gait & Posture, Volume 56
Author(s): Andrea Cristina de Lima-Pardini, Guilherme A. Zimeo Morais, Joana Bisol Balardin, Daniel Boari Coelho, Nametala Maia Azzi, Luis Augusto Teixeira, João Ricardo Sato
Walkers are commonly prescribed worldwide to individuals unable to walk independently. Walker usage leads to improved postural control and voluntary movement during step. In the present study, we aimed to provide a concept-proof on the feasibility of an event-related protocol integrating the analyses of biomechanical variables of step initiation and functional near-infrared spectroscopy (fNIRS) to measure activation of the supplementary motor area (SMA) while using a walker. Healthy young participants were tested while stepping with versus without the use of the walker. Behavioral analysis showed that anticipatory postural adjustments (APA) decreased when supporting the body weight on the walker. Delta (without–with) of activation magnitude of the muscle tibialis anterior was positively correlated to the delta of deoxyhemoglobin concentration changes in the SMA. The novelty of this study is the development of a protocol to assess brain function together with biomechanical analysis during the use of a walker. The method sheds light to the potential utility of combining fNIRS and biomechanical assessment during assistive step initiation, which can represent a new opportunity to study populations with mobility deficits.
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Source:Gait & Posture, Volume 56
Author(s): Andrea Cristina de Lima-Pardini, Guilherme A. Zimeo Morais, Joana Bisol Balardin, Daniel Boari Coelho, Nametala Maia Azzi, Luis Augusto Teixeira, João Ricardo Sato
Walkers are commonly prescribed worldwide to individuals unable to walk independently. Walker usage leads to improved postural control and voluntary movement during step. In the present study, we aimed to provide a concept-proof on the feasibility of an event-related protocol integrating the analyses of biomechanical variables of step initiation and functional near-infrared spectroscopy (fNIRS) to measure activation of the supplementary motor area (SMA) while using a walker. Healthy young participants were tested while stepping with versus without the use of the walker. Behavioral analysis showed that anticipatory postural adjustments (APA) decreased when supporting the body weight on the walker. Delta (without–with) of activation magnitude of the muscle tibialis anterior was positively correlated to the delta of deoxyhemoglobin concentration changes in the SMA. The novelty of this study is the development of a protocol to assess brain function together with biomechanical analysis during the use of a walker. The method sheds light to the potential utility of combining fNIRS and biomechanical assessment during assistive step initiation, which can represent a new opportunity to study populations with mobility deficits.
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The influence of shoe aging on children running biomechanics
Publication date: July 2017
Source:Gait & Posture, Volume 56
Author(s): Alexis Herbaut, Pascale Chavet, Maxime Roux, Nils Guéguen, Franck Barbier, Emilie Simoneau-Buessinger
Athletic children are prone to overuse injuries, especially at the heel and knee. Since footwear is an extrinsic factor of lower limb injury risk, the aim of this study was to assess the influence of shoe aging on children running biomechanics. Fourteen children active in sports participated in a laboratory biomechanical evaluation. A new pair of shoes was provided to each participant at an inclusion visit. Four months later, the participants performed a running task and their kinematics and kinetics were assessed both with their used shoes and with a new pair of shoes identical to the first. Furthermore, mechanical cushioning properties of shoes were evaluated before and after in-vivo aging. After 4months of use, the sole stiffness increased by 16% and the energy loss capacity decreased by 18% (p<0.001). No ankle or knee kinematic adjustment was found at foot strike in used shoes but changes were observed later during stance. Running with used shoes produced a higher loading rate of the vertical ground reaction force (+23%, p=0.016), suggesting higher compressive forces under the heel and placing children at risk to experience impact-related injuries. Nevertheless, the decreased peak ankle and knee power absorption in used shoes (−11%, p=0.010 and −12%, p=0.029, respectively) suggests a lower ankle and knee joints loading during the absorption phase that may be beneficial regarding stretch-related injuries.
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Source:Gait & Posture, Volume 56
Author(s): Alexis Herbaut, Pascale Chavet, Maxime Roux, Nils Guéguen, Franck Barbier, Emilie Simoneau-Buessinger
Athletic children are prone to overuse injuries, especially at the heel and knee. Since footwear is an extrinsic factor of lower limb injury risk, the aim of this study was to assess the influence of shoe aging on children running biomechanics. Fourteen children active in sports participated in a laboratory biomechanical evaluation. A new pair of shoes was provided to each participant at an inclusion visit. Four months later, the participants performed a running task and their kinematics and kinetics were assessed both with their used shoes and with a new pair of shoes identical to the first. Furthermore, mechanical cushioning properties of shoes were evaluated before and after in-vivo aging. After 4months of use, the sole stiffness increased by 16% and the energy loss capacity decreased by 18% (p<0.001). No ankle or knee kinematic adjustment was found at foot strike in used shoes but changes were observed later during stance. Running with used shoes produced a higher loading rate of the vertical ground reaction force (+23%, p=0.016), suggesting higher compressive forces under the heel and placing children at risk to experience impact-related injuries. Nevertheless, the decreased peak ankle and knee power absorption in used shoes (−11%, p=0.010 and −12%, p=0.029, respectively) suggests a lower ankle and knee joints loading during the absorption phase that may be beneficial regarding stretch-related injuries.
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The influence of continuous versus interval walking exercise on knee joint loading and pain in patients with knee osteoarthritis
Publication date: July 2017
Source:Gait & Posture, Volume 56
Author(s): Shawn Farrokhi, Prakash Jayabalan, Jonathan A. Gustafson, Brian A. Klatt, Gwendolyn A. Sowa, Sara R. Piva
ObjectiveTo evaluate whether knee contact force and knee pain are different between continuous and interval walking exercise in patients with knee osteoarthritis (OA).MethodsTwenty seven patients with unilateral symptomatic knee OA completed two separate walking exercise sessions on a treadmill at 1.3m/s on two different days: 1) a continuous 45min walking exercise session, and 2) three 15min bouts of walking exercise separated by 1h rest periods for a total of 45min of exercise in an interval format. Estimated knee contact forces using the OpenSim software and knee pain were evaluated at baseline (1st minute of walking) and after every 15min between the continuous and interval walking conditions.ResultsA significant increase from baseline was observed in peak knee contact force during the weight-acceptance phase of gait after 30 and 45min of walking, irrespective of the walking exercise condition. Additionally, whereas continuous walking resulted in an increase in knee pain, interval walking did not lead to increased knee pain.ConclusionWalking exercise durations of 30min or greater may lead to undesirable knee joint loading in patients with knee OA, while performing the same volume of exercise in multiple bouts as opposed to one continuous bout may be beneficial for limiting knee pain.
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Source:Gait & Posture, Volume 56
Author(s): Shawn Farrokhi, Prakash Jayabalan, Jonathan A. Gustafson, Brian A. Klatt, Gwendolyn A. Sowa, Sara R. Piva
ObjectiveTo evaluate whether knee contact force and knee pain are different between continuous and interval walking exercise in patients with knee osteoarthritis (OA).MethodsTwenty seven patients with unilateral symptomatic knee OA completed two separate walking exercise sessions on a treadmill at 1.3m/s on two different days: 1) a continuous 45min walking exercise session, and 2) three 15min bouts of walking exercise separated by 1h rest periods for a total of 45min of exercise in an interval format. Estimated knee contact forces using the OpenSim software and knee pain were evaluated at baseline (1st minute of walking) and after every 15min between the continuous and interval walking conditions.ResultsA significant increase from baseline was observed in peak knee contact force during the weight-acceptance phase of gait after 30 and 45min of walking, irrespective of the walking exercise condition. Additionally, whereas continuous walking resulted in an increase in knee pain, interval walking did not lead to increased knee pain.ConclusionWalking exercise durations of 30min or greater may lead to undesirable knee joint loading in patients with knee OA, while performing the same volume of exercise in multiple bouts as opposed to one continuous bout may be beneficial for limiting knee pain.
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Contents List
Publication date: June 2017
Source:Gait & Posture, Volume 55
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Source:Gait & Posture, Volume 55
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Editorial Board
Publication date: June 2017
Source:Gait & Posture, Volume 55
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Source:Gait & Posture, Volume 55
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Measuring cortical motor hemodynamics during assisted stepping – An fNIRS feasibility study of using a walker
Publication date: July 2017
Source:Gait & Posture, Volume 56
Author(s): Andrea Cristina de Lima-Pardini, Guilherme A. Zimeo Morais, Joana Bisol Balardin, Daniel Boari Coelho, Nametala Maia Azzi, Luis Augusto Teixeira, João Ricardo Sato
Walkers are commonly prescribed worldwide to individuals unable to walk independently. Walker usage leads to improved postural control and voluntary movement during step. In the present study, we aimed to provide a concept-proof on the feasibility of an event-related protocol integrating the analyses of biomechanical variables of step initiation and functional near-infrared spectroscopy (fNIRS) to measure activation of the supplementary motor area (SMA) while using a walker. Healthy young participants were tested while stepping with versus without the use of the walker. Behavioral analysis showed that anticipatory postural adjustments (APA) decreased when supporting the body weight on the walker. Delta (without–with) of activation magnitude of the muscle tibialis anterior was positively correlated to the delta of deoxyhemoglobin concentration changes in the SMA. The novelty of this study is the development of a protocol to assess brain function together with biomechanical analysis during the use of a walker. The method sheds light to the potential utility of combining fNIRS and biomechanical assessment during assistive step initiation, which can represent a new opportunity to study populations with mobility deficits.
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Source:Gait & Posture, Volume 56
Author(s): Andrea Cristina de Lima-Pardini, Guilherme A. Zimeo Morais, Joana Bisol Balardin, Daniel Boari Coelho, Nametala Maia Azzi, Luis Augusto Teixeira, João Ricardo Sato
Walkers are commonly prescribed worldwide to individuals unable to walk independently. Walker usage leads to improved postural control and voluntary movement during step. In the present study, we aimed to provide a concept-proof on the feasibility of an event-related protocol integrating the analyses of biomechanical variables of step initiation and functional near-infrared spectroscopy (fNIRS) to measure activation of the supplementary motor area (SMA) while using a walker. Healthy young participants were tested while stepping with versus without the use of the walker. Behavioral analysis showed that anticipatory postural adjustments (APA) decreased when supporting the body weight on the walker. Delta (without–with) of activation magnitude of the muscle tibialis anterior was positively correlated to the delta of deoxyhemoglobin concentration changes in the SMA. The novelty of this study is the development of a protocol to assess brain function together with biomechanical analysis during the use of a walker. The method sheds light to the potential utility of combining fNIRS and biomechanical assessment during assistive step initiation, which can represent a new opportunity to study populations with mobility deficits.
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The influence of shoe aging on children running biomechanics
Publication date: July 2017
Source:Gait & Posture, Volume 56
Author(s): Alexis Herbaut, Pascale Chavet, Maxime Roux, Nils Guéguen, Franck Barbier, Emilie Simoneau-Buessinger
Athletic children are prone to overuse injuries, especially at the heel and knee. Since footwear is an extrinsic factor of lower limb injury risk, the aim of this study was to assess the influence of shoe aging on children running biomechanics. Fourteen children active in sports participated in a laboratory biomechanical evaluation. A new pair of shoes was provided to each participant at an inclusion visit. Four months later, the participants performed a running task and their kinematics and kinetics were assessed both with their used shoes and with a new pair of shoes identical to the first. Furthermore, mechanical cushioning properties of shoes were evaluated before and after in-vivo aging. After 4months of use, the sole stiffness increased by 16% and the energy loss capacity decreased by 18% (p<0.001). No ankle or knee kinematic adjustment was found at foot strike in used shoes but changes were observed later during stance. Running with used shoes produced a higher loading rate of the vertical ground reaction force (+23%, p=0.016), suggesting higher compressive forces under the heel and placing children at risk to experience impact-related injuries. Nevertheless, the decreased peak ankle and knee power absorption in used shoes (−11%, p=0.010 and −12%, p=0.029, respectively) suggests a lower ankle and knee joints loading during the absorption phase that may be beneficial regarding stretch-related injuries.
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Source:Gait & Posture, Volume 56
Author(s): Alexis Herbaut, Pascale Chavet, Maxime Roux, Nils Guéguen, Franck Barbier, Emilie Simoneau-Buessinger
Athletic children are prone to overuse injuries, especially at the heel and knee. Since footwear is an extrinsic factor of lower limb injury risk, the aim of this study was to assess the influence of shoe aging on children running biomechanics. Fourteen children active in sports participated in a laboratory biomechanical evaluation. A new pair of shoes was provided to each participant at an inclusion visit. Four months later, the participants performed a running task and their kinematics and kinetics were assessed both with their used shoes and with a new pair of shoes identical to the first. Furthermore, mechanical cushioning properties of shoes were evaluated before and after in-vivo aging. After 4months of use, the sole stiffness increased by 16% and the energy loss capacity decreased by 18% (p<0.001). No ankle or knee kinematic adjustment was found at foot strike in used shoes but changes were observed later during stance. Running with used shoes produced a higher loading rate of the vertical ground reaction force (+23%, p=0.016), suggesting higher compressive forces under the heel and placing children at risk to experience impact-related injuries. Nevertheless, the decreased peak ankle and knee power absorption in used shoes (−11%, p=0.010 and −12%, p=0.029, respectively) suggests a lower ankle and knee joints loading during the absorption phase that may be beneficial regarding stretch-related injuries.
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The influence of continuous versus interval walking exercise on knee joint loading and pain in patients with knee osteoarthritis
Publication date: July 2017
Source:Gait & Posture, Volume 56
Author(s): Shawn Farrokhi, Prakash Jayabalan, Jonathan A. Gustafson, Brian A. Klatt, Gwendolyn A. Sowa, Sara R. Piva
ObjectiveTo evaluate whether knee contact force and knee pain are different between continuous and interval walking exercise in patients with knee osteoarthritis (OA).MethodsTwenty seven patients with unilateral symptomatic knee OA completed two separate walking exercise sessions on a treadmill at 1.3m/s on two different days: 1) a continuous 45min walking exercise session, and 2) three 15min bouts of walking exercise separated by 1h rest periods for a total of 45min of exercise in an interval format. Estimated knee contact forces using the OpenSim software and knee pain were evaluated at baseline (1st minute of walking) and after every 15min between the continuous and interval walking conditions.ResultsA significant increase from baseline was observed in peak knee contact force during the weight-acceptance phase of gait after 30 and 45min of walking, irrespective of the walking exercise condition. Additionally, whereas continuous walking resulted in an increase in knee pain, interval walking did not lead to increased knee pain.ConclusionWalking exercise durations of 30min or greater may lead to undesirable knee joint loading in patients with knee OA, while performing the same volume of exercise in multiple bouts as opposed to one continuous bout may be beneficial for limiting knee pain.
from #Audiology via ola Kala on Inoreader http://ift.tt/2qaVY9R
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Source:Gait & Posture, Volume 56
Author(s): Shawn Farrokhi, Prakash Jayabalan, Jonathan A. Gustafson, Brian A. Klatt, Gwendolyn A. Sowa, Sara R. Piva
ObjectiveTo evaluate whether knee contact force and knee pain are different between continuous and interval walking exercise in patients with knee osteoarthritis (OA).MethodsTwenty seven patients with unilateral symptomatic knee OA completed two separate walking exercise sessions on a treadmill at 1.3m/s on two different days: 1) a continuous 45min walking exercise session, and 2) three 15min bouts of walking exercise separated by 1h rest periods for a total of 45min of exercise in an interval format. Estimated knee contact forces using the OpenSim software and knee pain were evaluated at baseline (1st minute of walking) and after every 15min between the continuous and interval walking conditions.ResultsA significant increase from baseline was observed in peak knee contact force during the weight-acceptance phase of gait after 30 and 45min of walking, irrespective of the walking exercise condition. Additionally, whereas continuous walking resulted in an increase in knee pain, interval walking did not lead to increased knee pain.ConclusionWalking exercise durations of 30min or greater may lead to undesirable knee joint loading in patients with knee OA, while performing the same volume of exercise in multiple bouts as opposed to one continuous bout may be beneficial for limiting knee pain.
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Contents List
Publication date: June 2017
Source:Gait & Posture, Volume 55
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Source:Gait & Posture, Volume 55
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Editorial Board
Publication date: June 2017
Source:Gait & Posture, Volume 55
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Source:Gait & Posture, Volume 55
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Measuring cortical motor hemodynamics during assisted stepping – An fNIRS feasibility study of using a walker
Publication date: July 2017
Source:Gait & Posture, Volume 56
Author(s): Andrea Cristina de Lima-Pardini, Guilherme A. Zimeo Morais, Joana Bisol Balardin, Daniel Boari Coelho, Nametala Maia Azzi, Luis Augusto Teixeira, João Ricardo Sato
Walkers are commonly prescribed worldwide to individuals unable to walk independently. Walker usage leads to improved postural control and voluntary movement during step. In the present study, we aimed to provide a concept-proof on the feasibility of an event-related protocol integrating the analyses of biomechanical variables of step initiation and functional near-infrared spectroscopy (fNIRS) to measure activation of the supplementary motor area (SMA) while using a walker. Healthy young participants were tested while stepping with versus without the use of the walker. Behavioral analysis showed that anticipatory postural adjustments (APA) decreased when supporting the body weight on the walker. Delta (without–with) of activation magnitude of the muscle tibialis anterior was positively correlated to the delta of deoxyhemoglobin concentration changes in the SMA. The novelty of this study is the development of a protocol to assess brain function together with biomechanical analysis during the use of a walker. The method sheds light to the potential utility of combining fNIRS and biomechanical assessment during assistive step initiation, which can represent a new opportunity to study populations with mobility deficits.
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Source:Gait & Posture, Volume 56
Author(s): Andrea Cristina de Lima-Pardini, Guilherme A. Zimeo Morais, Joana Bisol Balardin, Daniel Boari Coelho, Nametala Maia Azzi, Luis Augusto Teixeira, João Ricardo Sato
Walkers are commonly prescribed worldwide to individuals unable to walk independently. Walker usage leads to improved postural control and voluntary movement during step. In the present study, we aimed to provide a concept-proof on the feasibility of an event-related protocol integrating the analyses of biomechanical variables of step initiation and functional near-infrared spectroscopy (fNIRS) to measure activation of the supplementary motor area (SMA) while using a walker. Healthy young participants were tested while stepping with versus without the use of the walker. Behavioral analysis showed that anticipatory postural adjustments (APA) decreased when supporting the body weight on the walker. Delta (without–with) of activation magnitude of the muscle tibialis anterior was positively correlated to the delta of deoxyhemoglobin concentration changes in the SMA. The novelty of this study is the development of a protocol to assess brain function together with biomechanical analysis during the use of a walker. The method sheds light to the potential utility of combining fNIRS and biomechanical assessment during assistive step initiation, which can represent a new opportunity to study populations with mobility deficits.
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The influence of shoe aging on children running biomechanics
Publication date: July 2017
Source:Gait & Posture, Volume 56
Author(s): Alexis Herbaut, Pascale Chavet, Maxime Roux, Nils Guéguen, Franck Barbier, Emilie Simoneau-Buessinger
Athletic children are prone to overuse injuries, especially at the heel and knee. Since footwear is an extrinsic factor of lower limb injury risk, the aim of this study was to assess the influence of shoe aging on children running biomechanics. Fourteen children active in sports participated in a laboratory biomechanical evaluation. A new pair of shoes was provided to each participant at an inclusion visit. Four months later, the participants performed a running task and their kinematics and kinetics were assessed both with their used shoes and with a new pair of shoes identical to the first. Furthermore, mechanical cushioning properties of shoes were evaluated before and after in-vivo aging. After 4months of use, the sole stiffness increased by 16% and the energy loss capacity decreased by 18% (p<0.001). No ankle or knee kinematic adjustment was found at foot strike in used shoes but changes were observed later during stance. Running with used shoes produced a higher loading rate of the vertical ground reaction force (+23%, p=0.016), suggesting higher compressive forces under the heel and placing children at risk to experience impact-related injuries. Nevertheless, the decreased peak ankle and knee power absorption in used shoes (−11%, p=0.010 and −12%, p=0.029, respectively) suggests a lower ankle and knee joints loading during the absorption phase that may be beneficial regarding stretch-related injuries.
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Source:Gait & Posture, Volume 56
Author(s): Alexis Herbaut, Pascale Chavet, Maxime Roux, Nils Guéguen, Franck Barbier, Emilie Simoneau-Buessinger
Athletic children are prone to overuse injuries, especially at the heel and knee. Since footwear is an extrinsic factor of lower limb injury risk, the aim of this study was to assess the influence of shoe aging on children running biomechanics. Fourteen children active in sports participated in a laboratory biomechanical evaluation. A new pair of shoes was provided to each participant at an inclusion visit. Four months later, the participants performed a running task and their kinematics and kinetics were assessed both with their used shoes and with a new pair of shoes identical to the first. Furthermore, mechanical cushioning properties of shoes were evaluated before and after in-vivo aging. After 4months of use, the sole stiffness increased by 16% and the energy loss capacity decreased by 18% (p<0.001). No ankle or knee kinematic adjustment was found at foot strike in used shoes but changes were observed later during stance. Running with used shoes produced a higher loading rate of the vertical ground reaction force (+23%, p=0.016), suggesting higher compressive forces under the heel and placing children at risk to experience impact-related injuries. Nevertheless, the decreased peak ankle and knee power absorption in used shoes (−11%, p=0.010 and −12%, p=0.029, respectively) suggests a lower ankle and knee joints loading during the absorption phase that may be beneficial regarding stretch-related injuries.
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The influence of continuous versus interval walking exercise on knee joint loading and pain in patients with knee osteoarthritis
Publication date: July 2017
Source:Gait & Posture, Volume 56
Author(s): Shawn Farrokhi, Prakash Jayabalan, Jonathan A. Gustafson, Brian A. Klatt, Gwendolyn A. Sowa, Sara R. Piva
ObjectiveTo evaluate whether knee contact force and knee pain are different between continuous and interval walking exercise in patients with knee osteoarthritis (OA).MethodsTwenty seven patients with unilateral symptomatic knee OA completed two separate walking exercise sessions on a treadmill at 1.3m/s on two different days: 1) a continuous 45min walking exercise session, and 2) three 15min bouts of walking exercise separated by 1h rest periods for a total of 45min of exercise in an interval format. Estimated knee contact forces using the OpenSim software and knee pain were evaluated at baseline (1st minute of walking) and after every 15min between the continuous and interval walking conditions.ResultsA significant increase from baseline was observed in peak knee contact force during the weight-acceptance phase of gait after 30 and 45min of walking, irrespective of the walking exercise condition. Additionally, whereas continuous walking resulted in an increase in knee pain, interval walking did not lead to increased knee pain.ConclusionWalking exercise durations of 30min or greater may lead to undesirable knee joint loading in patients with knee OA, while performing the same volume of exercise in multiple bouts as opposed to one continuous bout may be beneficial for limiting knee pain.
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Source:Gait & Posture, Volume 56
Author(s): Shawn Farrokhi, Prakash Jayabalan, Jonathan A. Gustafson, Brian A. Klatt, Gwendolyn A. Sowa, Sara R. Piva
ObjectiveTo evaluate whether knee contact force and knee pain are different between continuous and interval walking exercise in patients with knee osteoarthritis (OA).MethodsTwenty seven patients with unilateral symptomatic knee OA completed two separate walking exercise sessions on a treadmill at 1.3m/s on two different days: 1) a continuous 45min walking exercise session, and 2) three 15min bouts of walking exercise separated by 1h rest periods for a total of 45min of exercise in an interval format. Estimated knee contact forces using the OpenSim software and knee pain were evaluated at baseline (1st minute of walking) and after every 15min between the continuous and interval walking conditions.ResultsA significant increase from baseline was observed in peak knee contact force during the weight-acceptance phase of gait after 30 and 45min of walking, irrespective of the walking exercise condition. Additionally, whereas continuous walking resulted in an increase in knee pain, interval walking did not lead to increased knee pain.ConclusionWalking exercise durations of 30min or greater may lead to undesirable knee joint loading in patients with knee OA, while performing the same volume of exercise in multiple bouts as opposed to one continuous bout may be beneficial for limiting knee pain.
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Contents List
Publication date: June 2017
Source:Gait & Posture, Volume 55
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Source:Gait & Posture, Volume 55
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Editorial Board
Publication date: June 2017
Source:Gait & Posture, Volume 55
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Source:Gait & Posture, Volume 55
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Botanaudiology
With bills flying around the DC beltway and opinions creating a tornado of whispers, there is a worry about the future of audiology in the air. Will the corner pharmacy be the latest competition we have to deal with? Will all the talk about the cost of hearing aids drown out the real cost of hearing loss? Will an ill-fitting device create a lifetime of distance between a person with a hearing loss and actual help? Or will this tsunami of attention and publicity finally turn our nation’s attention to hearing loss as a public health conundrum?
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