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Research Papers

Gait Modification via Verbal Instruction and an Active Feedback System to Reduce Peak Knee Adduction Moment

[+] Author and Article Information
Ariel V. Dowling

Department of Mechanical Engineering, Stanford University, Durand Building 061, 496 Lomita Mall, Stanford, CA 94305-4308adowling@stanford.edu

David S. Fisher

Department of Mechanical Engineering, Rose-Hulman Institute of Technology, Rose-Hulman CM 4003, 5500 Wabash Avenue, Terre Haute, IN 47803David.Fisher@Rose-Hulman.edu

Thomas P. Andriacchi

Department of Mechanical Engineering, Stanford University, Durand Building 061, 496 Lomita Mall, Stanford, CA 94305-4308; Department of Orthopedic Surgery, Stanford University Medical Center, 300 Pasteur Drive, R144, MC 5341, Stanford, CA 94305-5341; and  Bone and Joint Center, Palo Alto, VA, 3801 Miranda Avenue, Palo Alto, CA 94304-1290tandriac@stanford.edu

J Biomech Eng 132(7), 071007 (May 26, 2010) (5 pages) doi:10.1115/1.4001584 History: Received March 22, 2010; Revised March 24, 2010; Posted April 14, 2010; Published May 26, 2010; Online May 26, 2010

The purpose of this study was to introduce a simple gait training method using real-time gait modification to reduce the peak knee adduction moment during walking by producing a subtle weight bearing shift to the medial side of the foot. The hypothesis of this study was that this weight shift could be achieved via either verbal instruction or an active feedback system, and that the weight shift would result in a reduction in the first peak knee adduction moment compared with the control tests. Nine individuals were tested during walking using two intervention methods: verbal instruction and an active feedback system placed on the right shoe. The first peak of the knee adduction moment for each condition was assessed using a motion capture system and force plate. The active feedback system significantly reduced (14.2%) the peak knee adduction moment relative to the control. This study demonstrated that a subtle weight bearing shift to the medial side of the foot produced with an active feedback system during walking reduced the first peak of the knee adduction moment and suggests the potential application of this method to slow the rate of progression of medial compartment knee osteoarthritis.

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Copyright © 2010 by American Society of Mechanical Engineers
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Figures

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Figure 1

(a) Active feedback gait modification intervention (b) with the force sensor placed under the lateral side of the shoe and (c) the pager motor tucked inside the shoe, where it could be detected by afferent nerves on the top of the foot

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Figure 2

A subject demonstrating how the active feedback gait modification intervention is worn during testing; the force sensor is placed under the lateral side of the shoe, the pager motor tucked inside the shoe, and the control box is on top of the shoe

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Figure 3

First peak knee adduction moment (% Bw∗Ht) for all four test conditions. Each intervention test is matching with its corresponding control.

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Figure 4

Average percent reductions in the first peak knee adduction moment (mean±S.D.) for verbal intervention and active feedback system for all subjects.  ̂ indicates the trend toward significant reduction with verbal instruction intervention compared with the corresponding control (p=0.08).  ∗ indicates a significant reduction with the active feedback system compared with the corresponding control (p<0.01).

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