Research Papers

Real-Time Knee Adduction Moment Feedback for Gait Retraining Through Visual and Tactile Displays

[+] Author and Article Information
Jason W. Wheeler

 Sandia National Laboratories, P.O. Box 5800, Mail Stop 1010, Albuquerque, NM 87185-1010jwwheel@sandia.gov

Pete B. Shull

Department of Mechanical Engineering, Stanford University, 424 Panama Mall, Building 560, Stanford, CA 94305-4308pshull@stanford.edu

Thor F. Besier

Department of Orthopaedic Surgery, Stanford University, 341 Galvez Street, Stanford, CA 94305-4308besier@stanford.edu

J Biomech Eng 133(4), 041007 (Mar 15, 2011) (5 pages) doi:10.1115/1.4003621 History: Received June 02, 2010; Revised December 22, 2010; Posted February 09, 2011; Published March 15, 2011; Online March 15, 2011

The external knee adduction moment (KAM) measured during gait is an indicator of tibiofemoral joint osteoarthritis progression and various strategies have been proposed to lower it. Gait retraining has been shown to be an effective, noninvasive approach for lowering the KAM. We present a new gait retraining approach in which the KAM is fed back to subjects in real-time during ambulation. A study was conducted in which 16 healthy subjects learned to alter gait patterns to lower the KAM through visual or tactile (vibration) feedback. Participants converged on a comfortable gait in just a few minutes by using the feedback to iterate on various kinematic modifications. All subjects adopted altered gait patterns with lower KAM compared with normal ambulation (average reduction of 20.7%). Tactile and visual feedbacks were equally effective for real-time training, although subjects using tactile feedback took longer to converge on an acceptable gait. This study shows that real-time feedback of the KAM can greatly increase the effectiveness and efficiency of subject-specific gait retraining compared with conventional methods.

Copyright © 2011 by American Society of Mechanical Engineers
Topics: Feedback , Knee , Vibration
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Grahic Jump Location
Figure 1

Experimental setup. Reflective markers on the subject’s segments enable motions to be tracked. Force plates in the treadmill gather force data. Feedback is provided with a vibration device or a visual display.

Grahic Jump Location
Figure 2

Sample of visual feedback display. The peak moment from the current step and the previous nine were displayed to the subject.

Grahic Jump Location
Figure 3

Percent reduction in the average value of the first peak knee adduction moment from baseline to altered gait trials along with the awkwardness rating for each subject. Error bars are 1 standard deviation of the mean (over ten steps).



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