| Author: | Chen, Li Kwok |
| Title: | Biomechanical gait characteristics of individuals with unilateral knee osteoarthritis on spilt belt treadmill with unilateral speed variations |
| Advisors: | Kwong, Patrick (RS) Cheing, Gladys (RS) |
| Degree: | DHSc |
| Year: | 2025 |
| Department: | Faculty of Health and Social Sciences |
| Pages: | ii, 120 pages : color illustrations |
| Language: | English |
| Abstract: | Introduction Knee osteoarthritis (OA) is one of the most common degenerative joint conditions, causing functional disability in the elderly. The gait asymmetry is believed to be compensatory in people with symptomatic knee OA, normalizing the asymmetry could be beneficial. The effect of unilaterally modifying the walking speed seems promising in reducing the gait asymmetry, in step length, in people with stroke and people with hip OA; however, no previous study has evaluated the immediate effects of unilateral walking speed modification with Split Belt Training (SBT) on biomechanical gait characteristics, pain and functional performance in individuals with knee OA. Two studies have been done, and the findings may help provide more precise individualized assessment and provide insight on using this approach as treatment in managing individuals with knee OA. Study One This study explored the knee OA-specific gait kinetics and kinematics during split-belt walking. hypothesizing that 1) Unilateral split-belt speed modification on affected side will normalize the gait asymmetry by altering the coordination of joints between the limbs, 2) Unilateral split-belt speed modification on affected side will reduce the knee joint loading by improving gait asymmetry and 3) Unilateral split-belt speed modification will not increase the knee joint loading on unaffected side when knee joint loading of affected side reduced. The effects correlated to gait speed, age, gender, anthropometry, and duration of knee pain were also explored. A cross-sectional biomechanical study was conducted comparing gait patterns between individuals with knee OA and those without. Ten participants with primary symptomatic radiographic knee OA were recruited from hospitals, while another ten individuals without lower limb symptoms or gait disorders were recruited from the local community. Participants underwent treadmill walking trials under various conditions (affected leg at 33% faster or slower than unaffected leg), with kinetic and kinematic data recorded throughout. The results showed that split-belt walking can selectively alter gait asymmetry of individuals with knee OA and is a safe, non-painful, and potentially therapeutic strategy of gait retraining. Also, the more affected leg in most of Knee OA participants had longer step length, longer duration of loading response and lower first peak of vertical ground reaction force than the better leg. When the more affected leg was accelerated for 33%, its relative step length decreased, whereas the opposite occurred when the more affected leg was decelerated. The Knee adduction angular impulse (KAAI) was also reduced in the accelerated split-belt paradigm implying reduced medial compartment load throughout stance. During 33% accelerated split-belt walking, the KAM1, KAAI and vGRF1 of unaffected side was not significantly different from baseline, therefore better side knee joint loading does not increase even more affected leg reduced Study Two Previous study did not evaluate the feasibility and effects of repetitive split-belt gait retraining. This study aims to evaluate the effects of repetitive accelerated split-belt training as an adjunct to conventional physiotherapy for knee OA to determine its effectiveness as gait retraining. This study implemented a randomized controlled trial (RCT) with two arms, assigning participants equally to a control or treatment group. Participants received either 4 weeks of split-belt walking training or were placed on a waiting list. The primary outcome measured was gait kinematics, with secondary outcomes including pain levels and functional performance. Training sessions occurred three times per week at the gait laboratory, lasting 45 minutes each. Warm-up exercises preceded treadmill walking, where participants adjusted to self-paced and 33% elevated speeds on the affected side. Each session comprised three 5-minute bouts with 2-minute rests. Pain intensity, exertion, and limb perception were monitored, with cool-down stretches concluding sessions. Training progression depended on participants' responses, with duration adjusted weekly. Home exercises supplemented laboratory sessions. The 4-week Split Belt Walking program in this study demonstrated safety and positive impact for individuals with knee osteoarthritis, as evidenced by completed sessions without accidents or increased pain. Reductions in Knee Adduction Moment and Knee Adduction Angular Impulse, alongside decreased Knee Pain Intensity Scores and improved mobility, imply the potential therapeutic value of split belt training. Conclusion The results and implications of these studies suggest that split-belt walking holds promise as a gait training intervention for individuals with knee OA. Its safety, feasibility, and potential to immediately impact gait asymmetry and joint loading make it a consideration in knee OA management. |
| Rights: | All rights reserved |
| Access: | restricted access |
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| File | Description | Size | Format | |
|---|---|---|---|---|
| 8649.pdf | For All Users (off-campus access for PolyU Staff & Students only) | 2.08 MB | Adobe PDF | View/Open |
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