Title

Effect of Specific Gait Modifications on Medial Knee Loading, Metabolic Cost and Perception of Task Difficulty

Document Type

Article

Publication Date

7-2013

Publication Source

Clinical Biomechanics

Abstract

Background: The metabolic cost and cognitive demand of altering natural gait have not been well studied. The purpose of this investigation was to assess three modified patterns – toe out, ipsilateral trunk lean and a medial weight shift at the foot – on the basis of 1) medial knee joint load reduction, 2) metabolic cost of performance and 3) subject perception of task difficulty.

Methods: 12 healthy individuals underwent 3 dimensional motion analysis and metabolic testing to assess the gait mechanics and energy expenditure of natural gait and the three experimental gait patterns, performed to a self-selected moderate degree. Walking speed was controlled. Perceived workload was assessed using the NASA Task Load Index.

Findings: Trunk lean significantly reduced first peak knee adduction moment (↓32%, P < 0.001) as well as KAM impulse (↓35%, P < 0.001), but was costly in terms of energy expenditure (↑11%, P < 0.001) and perceived workload (↑1178%, P < 0.001). A moderate toe-out pattern significantly reduced the second peak knee adduction moment (↓32%, P < 0.001) and KAM impulse (↓14%, P = 0.026), but had no effect on the first peak. Conversely, toe-out was least demanding in terms of additional energy expenditure (↑2%, P = 0.001) and perceived workload (↑314%, P = 0.001). Medial shift did not reduce knee adduction moment.

Interpretation: The prioritization of joint load reduction versus additional metabolic and cognitive demands could play a substantial role in the clinical decision making process of selecting a modified gait pattern.

Inclusive pages

649–654

ISBN/ISSN

0268-0033

Comments

Permission documentation on file.

Publisher

Elsevier

Volume

28

Issue

6

Peer Reviewed

yes

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