Animal and human research have shown that the drug 4-aminopyridine (4-AP) may improve gait in spinal cord lesions by enhancing nerve transmission to affected muscles. Study design: Prospective, randomized, double-blind, placebo-controlled, crossover trial. Objectives: To determine the efficacy of 4-AP in improving lower limb muscle strength and biomechanical gait patterns of chronic spinal cord injuries (SCI). Setting: The Rehabilitation Centre (Ottawa, Canada). Methods: In all, 15 chronic, ambulatory SCI persons were randomized to an initial 2 weeks of 40 mg/day, oral medication of either placebo or immediate-release, 4-AP and subsequently crossed over to the alternate medication for the following 2 weeks. Evaluations were conducted at baseline (before starting 4-AP or placebo medication), 2 weeks, and 4 weeks. Measures included dynamometer lower limb isometric muscle force and biomechanical gait measures including temporal-spatial parameters, electromyographic activation patterns, joint kinematics and kinetics. Subjective impressions of the drug by the participants were obtained from an exit survey. Results: Despite some positive comments from subjects, statistical and clinical analyses showed no within-subject differences between placebo and 4-AP measures of lower limb muscle force and objective gait analyses (ANOVA statistic P40.05). Conclusion: Results demonstrated the importance of placebo-controlled trials and quantitative outcome measures for the evaluation of 4-AP aimed to enhance gait for chronic, ambulatory SCI persons. Energy expenditure measures and mood may relate more to subjective comments and is suggested for future investigations.
Purpose: The foot progression angle (FPA) is an important biomechanical measure for people with knee osteoarthritis (OA), and changing it through gait modification can reduce knee loading and pain in this patient population. However, certain barriers are limiting clinical uptake of FPA gait modification for knee OA patients; for example, 1) lab-based gait analysis and modification confine the benefit to a small number of people, and 2) there is currently no method to provide realtime feedback of performance in real-world settings. We have developed and validated a smart shoe capable of estimating FPA and Abstracts / Osteoarthritis and Cartilage 27 (2019) S23eS91 S64
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