The energy expenditure of normal and pathologic gait

Waters, Robert L.; Mulroy, Sara J.

doi:10.1016/s0966-6362(99)00009-0

Cited by 910 publications

(851 citation statements)

References 103 publications

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“…The mechanical efficiency of children with CP is low as a result of a loss of motor control, co-contraction, spasticity of muscles, and reduced range of motion (Waters and Mulroy 1999). The metabolic cost of a task is affected by speed of movement, work rate, and fiber type recruitment.…”

Section: Discussionmentioning

confidence: 99%

Comparison of efficacy of Adeli suit and neurodevelopmental treatments in children with cerebral palsy

Bar-Haim

Harries

Belokopytov

et al. 2006

Develop Med Child Neuro

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This study compared the efficacy of Adeli suit treatment (AST) with neurodevelopmental treatment (NDT) in children with cerebral palsy (CP). Twenty-four children with CP, Levels II to IV according to the Gross Motor Function Classification System (GMFCS), were matched by age and functional status and randomly assigned to the AST or NDT treatment groups. In the AST group (n=12; eight males, four females; mean age 8.3y [SD 2.0]), six children had spastic/ataxic diplegia, one triplegia and five spastic/mixed quadriplegia. In the NDT group (n=12; nine males, three females; mean age 8.1y [SD 2.2]), five children had spastic diplegia and seven had spastic/mixed quadriplegia. Both groups were treated for 4 weeks (2 hours daily, 5 days per week, 20 sessions). To compare treatments, the Gross Motor Function Measure (GMFM-66) and the mechanical efficiency index (EI HB ) during stair-climbing were measured at baseline, immediately after 1 month of treatment, and 10 months after baseline. The small but significant time effects for GMFM-66 and EI HB that were noted after 1 month of both intensive physiotherapy courses were greater than expected from natural maturation of children with CP at this age. Improvements in motor skills and their retention 9 months after treatment were not significantly different between the two treatment modes. Post hoc analysis indicated a greater increase in EI HB after 1 month (p=0.16) and 10 months (p=0.004) in AST than that in NDT, predominantly in the children with higher motor function (GMFCS Levels II and III). The results suggest that AST might improve mechanical efficiency without a corresponding gain in gross motor skills, especially in children with higher levels of motor function.

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Section: Discussionmentioning

confidence: 99%

Comparison of efficacy of Adeli suit and neurodevelopmental treatments in children with cerebral palsy

Bar-Haim

Harries

Belokopytov

et al. 2006

Develop Med Child Neuro

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“…Gait is hindered by limited plantarflexor power [26,27] for which the hip generally compensates [24,26]. The resulting gait is mechanically inefficient [8,22] and leads to elevated energy cost [29,39]. Most passive-dynamic AFOs help compensate by functioning as a spring that stores energy when initially deformed in midstance and returns energy at the end of stance [2,12,42].…”

Section: Introductionmentioning

confidence: 99%

How Does Ankle-foot Orthosis Stiffness Affect Gait in Patients With Lower Limb Salvage?

Esposito

Blanck

Harper

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Ankle-foot orthoses (AFOs) are commonly prescribed during rehabilitation after limb salvage. AFO stiffness is selected to help mitigate gait deficiencies. A new custom dynamic AFO, the Intrepid Dynamic Exoskeletal Orthosis (IDEO), is available to injured service members but prescription guidelines are limited. Questions/purposes In this study we ask (1) does dynamic AFO stiffness affect gait parameters such as joint angles, moments, and powers; and (2) can a given dynamic AFO stiffness normalize gait mechanics to noninjured control subjects? Methods Thirteen patients with lower limb salvage (ankle arthrodesis, neuropathy, foot/ankle reconstruction, etc) after major lower extremity trauma and 13 control subjects who had no lower extremity trauma and wore no orthosis underwent gait analysis at a standardized speed. Patients wore their custom IDEO with posterior struts of three different stiffnesses: nominal (clinically prescribed stiffness), compliant (20% less stiff), and stiff (20% stiffer). Joint angles, moments, powers, and ground reaction forces were compared across the varying stiffnesses of the orthoses tested and between the patient and control groups. Results An increase in AFO compliance resulted in 20% to 26% less knee flexion relative to the nominal (p = 0.003) and stiff (p = 0.001) conditions, respectively. Ankle range of motion and power generation were, on average, 56% (p \ 0.001) and 63% (p \ 0.001), respectively, less than controls as a result of the relatively fixed ankle position. Conclusions Patients with limb salvage readily adapted to different dynamic AFO stiffnesses and demonstrated few Support was provided by

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“…This intervention has been shown to result in a reduced walking speed and step length (Waters & Mulroy, 1999, Wu et al, 2000, movement compensation in the adjacent tarsal joints (Wu et al, 2000) and increased energy demand during walking (Waters, Campbell, Thomas, Hugos, & Davis, 1988). As an alternative to surgical fixation, in this group of patients ankle motion can be partially preserved with the use of an endoprosthesis, i.e., total ankle arthroplasty (TAA).…”

Section: Introductionmentioning

confidence: 99%

“…The metabolic cost of walking is regarded to be an important characteristic of gait, which determines the ability of people to engage in prolonged walking activities (Waters & Mulroy, 1999). Restriction of ankle function has been shown to affect metabolic cost of walking both in practice and theory.…”

Section: Introductionmentioning

confidence: 99%

Metabolic cost and mechanical work for the step-to-step transition in walking after successful total ankle arthroplasty

Doets

Vergouw

Veeger

et al. 2009

Human Movement Science

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The aim of this study was to investigate whether impaired ankle function after total ankle arthroplasty (TAA) affects the mechanical work during step-to-step transition and the metabolic cost of walking. Respiratory and force plate data were recorded in 11 patients and 11 healthy controls while they walked barefoot at a fixed walking speed (FWS, 1.25 m/s) and at their self-selected speed (SWS). At FWS metabolic cost of transport was 28% higher for the TAA group, but at SWS there was no significant increase. During the stepto-step transition, positive mechanical work generated by the trailing TAA leg was lower and negative mechanical work in the leading intact leg was larger. Despite the increase in mechanical work dissipation during double support, no significant differences in total mechanical work were found over a complete stride. This might be a result of methodological limitations of calculating mechanical work. Nevertheless, mechanical work dissipated during the step-to-step transition at FWS correlated significantly with metabolic cost of transport: r = .540. It was concluded that patients after successful TAA still experienced an impaired lower leg function, which contributed to an increase in mechanical energy dissipation during the step-to-step transition, and to an increase in the metabolic demand of walking.

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The energy expenditure of normal and pathologic gait

Cited by 910 publications

References 103 publications

Comparison of efficacy of Adeli suit and neurodevelopmental treatments in children with cerebral palsy

Comparison of efficacy of Adeli suit and neurodevelopmental treatments in children with cerebral palsy

How Does Ankle-foot Orthosis Stiffness Affect Gait in Patients With Lower Limb Salvage?

Metabolic cost and mechanical work for the step-to-step transition in walking after successful total ankle arthroplasty

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