Efficacy of Gait Training With Real-Time Biofeedback in Correcting Knee Hyperextension Patterns in Young Women

Abstract

Study Design Single cohort study. Objectives To investigate the efficacy of real-time biofeedback provided during treadmill gait training to correct knee hyperextension in asymptomatic females while walking. Background Knee hyperextension is associated with increased stress to the posterior capsule of the knee joint, anterior cruciate ligament, and the anterior compartment of the tibiofemoral joint. Previous methods aimed at correcting knee hyperextension have shown limited success. Methods Ten women, ages 18 to 39 years, with asymptomatic knee hyperextension during ambulation, were provided with 6 sessions of real-time feedback of kinematic data (Visual 3D) during treadmill training. Gait evaluations were performed pretraining, posttraining, and 1 month after the last training session. Results Participants showed improved control of knee hyperextension during overground walking at 1.3 m/s at posttraining and at 1 month posttraining. Conclusion The present study demonstrated that knee sagittal plane kinematics may be influenced by gait retraining using real-time biofeedback. J Orthop Sports Phys Ther 2011;41(12):948–952, Epub 25 October 2011. doi:10.2519/jospt.2011.3660

A real-time system for biomechanical analysis of human movement and muscle function

“…To make real-time computation feasible, approximations are often used that neglect certain mechanical effects, such as inertial terms in the equations of motion [25]. Real-time commercial systems are currently limited to kinematic variables (joint angles) [3, 27] and possibly joint moments, but do not include muscle variables. Although angles and moments can be a useful surrogate for tissue loads and muscle recruitment that are relevant to orthopedic or neurological rehabilitation, an analysis at the muscle level is needed for a full understanding [8, 9].…”

Virtual Sensory Feedback for Gait Improvement in Neurological Patients

“…The advantage of closed-loop over open-loop control of arm motion has been noted (10). More recently, closed-loop sensory feedback strategies have been implemented in such specific motor control functions, related to locomotion, as stationary balance (22), planar pelvis and trunk movement (23), step symmetry (24), knee hyperextension (25), and partial weight-bearing (26). Yet, closed-loop virtual sensory feedback of whole-body forward movement in locomotion, as presently reviewed, does not appear to have been implemented, tested, or analyzed in other works.…”

Training strategies to reduce knee hyperextension gait patterns in healthy women

“…Previous studies addressing correction of knee hyperextension have shown that gait patterns tend to be overcorrected after using verbal feedback with observation gait analysis (68), and maintained within a more normal extension angle (+/-5°) after using real-time biofeedback (80). The results of the present study show that after the 6 sessions of treadmill gait retraining, using internal and external focus of attention, participants reduced the amount of knee hyperextension during treadmill walking at posttraining (2-5 days after training), and 4-month follow-up evaluations (Figure 4.15).…”

“…Gained proficiency in controlling knee hyperextension during treadmill training was evident during overground walking immediately and 1 month after training. This study helped to validate the effectiveness of real-time kinematic biofeedback in informing individuals with knee hyperextension patterns about specific and subtle aspects of the knee movement pattern that may otherwise be difficult to perceive and appropriately modify (internal focus)(80). Given this theoretical framework, we asked the question: would training individuals to control knee hyperextension be more effective if the augmented feedback was linked to a focus of attention that was internal or external?The purpose of this study was to examine if an external or internal focus of attention influenced the effectiveness of real-time visual biofeedback, during treadmill gait training for correcting knee hyperextension patterns, in young, asymptomatic, female subjects.…”

“…Testing Protocol Participants underwent a physical evaluation to assess: knee passive range of motion (using conventional goniometric techniques); lower limb isometric muscular strength (using manual muscle techniques); joint mobility index (using Beighton Joint Mobility Index BJMI); and knee range of motion during overground walking, obstacle crossing, and level treadmill walking. Previous work on knee joint kinematics during functional activities in women with knee hyperextension showed that young females with knee hyperextension tend to hyperextend during overground and treadmill walking and during obstacle crossing, when the limb is the trailing limb (Appendix chapter, Figure A.2).Knee kinematics were collected during walking tasks using a three-dimensional motion analysis system (Optotrak™, Northern Digital Inc. Waterloo, Ontario -Canada)(80). Three non-collinear infrared markers were used to track each of the following body segments: feet, legs, thighs, pelvis, and trunk.…”