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Petterson, Stephanie Christine. "Knee osteoarthritis and total knee arthroplasty quadriceps weakness, rehabilitation, and recovery /." Access to citation, abstract and download form provided by ProQuest Information and Learning Company; downloadable PDF file 1.02 Mb., 222 p, 2006. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:3205435.
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Schrader, Kate. "Knee Surgery: Total Knee Replacement or Partial Knee Replacement." University of Toledo Honors Theses / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=uthonors1305216135.
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Wilson, Julie Kay. "A comparative study of rehabilitation on total knee replacement." Virtual Press, 1995. http://liblink.bsu.edu/uhtbin/catkey/1014843.
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The purpose of this study was to determine the effectiveness of the Augmented Soft Tissue Mobilization (A.S.T.M.) Rehabilitation Technique on total knee replacement patients. The specific measurements assessed were stride length (SL), stride frequency (SF), walking velocity, support time (ST), total time (TT), static and walking range of motion (ROM) of the hip, knee, and ankle, ground reaction forces (GRF), and torques. Fourteen subjects (Female = 7, Male = 7) completed the study. Subjects were randomly assigned to two experimental groups, the Traditional Therapy treatment or the A.S.T.M. treatment. There were five testing sessions: pre operation, 8 weeks, 12 weeks, 16 weeks, and 24 weeks post operation. On the 12 week test, the subject had completed their assigned of treatment protocol. Static ROM was derived from gonimetric measurements before each testing session. Stride length, stride frequency, velocity, time, and walking ROM were derived from accelerometer data. Statistical analysis using ANOVA revealed a significant change in all static ROM, SL, and ST. The data indicated that both groups of the Total Knee Replacement patients did improve their functional status from their status prior to surgery. In addition, the data indicated that the Augmented Soft Tissue Mobilization program and the Traditional Therapy program are equally acceptable rehabilitation techniques.School of Physical Education
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Murray, Amanda Megan. "The Effects of High-Velocity Power Training on Knee Joint Mechanics in Knee Osteoarthritis." University of Toledo / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1404391903.
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Cobian, Daniel Garrett. "Lower extremity power and knee extensor rapid force development after knee injury, surgery, and rehabilitation." Diss., University of Iowa, 2015. https://ir.uiowa.edu/etd/5923.
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Typical rehabilitation strategies and performance tests after knee surgery are often based on peak lower extremity strength. However, people rarely generate maximal knee force in both daily and sports activities, which are characterized by brief periods of rapid muscle activation and relaxation. Thus, the ability to rapidly develop or modulate force may be more meaningful and more relevant to function. It is unclear how knee surgery influences the neuromuscular mechanisms controlling the ability to rapidly develop leg muscle force and produce power, or the functional relevance of these characterizations of muscle performance in relation to injury, surgery, and recovery.
The primary purpose of this collection of studies was to assess rapid quadriceps muscle activation and lower extremity force production in people undergoing arthroscopic knee surgery for meniscal debridement and anterior cruciate ligament (ACL) reconstruction.
People undergoing arthroscopic partial meniscectomy (APM) presented with significant deficits in knee extensor rate of torque development (RTD), leg press power, and rapid quadriceps muscle activation both prior to and in the initial month following surgery. Subjective knee function was significantly correlated with RTD variables but not with peak strength or quadriceps volume. Limitations in the ability to rapidly activate the involved quadriceps suggests that impaired centrally mediated neural function of the involved quadriceps may limit RTD and lower extremity power post-surgery.
Next, the speed and intensity of quadriceps exercise performed in the early post-surgical period of patients post-APM and the relationships between training parameters, strength, quadriceps RTD, and subjective knee function were investigated. Subjects performed high intensity quadriceps contractions 2-3x/week in the first month following surgery. All subjects increased quadriceps strength, but people who trained with greater RTD following APM demonstrated greater improvements in RTD and had better patient-based outcomes scores than those who trained with a slower rate of torque rise.
Finally, power and rate of force development (RFD) in people ≤ 1 year following ACL reconstruction were evaluated along with movement biomechanics, typical clinical measures of readiness to return to activity, and patient-based outcomes. Significant side-to-side asymmetries in quadriceps strength, RFD, leg press strength and power, and knee joint kinetics were noted. Deficits in voluntary quadriceps strength paralleled the deficits in early phase RFD, indicating that in this population RFD was limited by the intrinsic properties and force production capacity of the quadriceps, not the ability to rapidly activate the muscle. However, strong to very strong correlations were found between quadriceps RFD, movement biomechanics and subjective knee function, which were predominantly stronger than the correlations with peak quadriceps strength. Leg press strength, power, and acceleration were very strongly correlated with movement biomechanics and subjective knee function.
In summary, this series of studies provides important insight into the neuromuscular mechanisms related to rapid lower extremity force development and muscle activation in the context of knee joint injury and recovery after arthroscopic knee surgery. Collectively, this work suggests that the inability to quickly develop or modulate quadriceps force may have significant functional consequences, and that rehabilitation efforts following arthroscopic knee surgery to incorporate both specific dosage of and earlier performance of rapid leg muscle contractions should be explored.
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Ramsay, Dan. "Assessment of functional knee bracing: An in vivo three-dimensional kinematic analysis of the anterior cruciate deficient knee." Thesis, University of Ottawa (Canada), 1999. http://hdl.handle.net/10393/8950.
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The aim of this investigation was to determine whether application of a functional brace reduced rotational and linear tibial displacements during the performance of a One Legged Jump (OLJ). Steinmann traction pins were surgically implanted into the femur and tibia of six young normal healthy subjects having either a partial or complete anterior cruciate ligament (ACL) rupture. Stereophotogrammetric radiographs (RSA) were taken once target markers were affixed to the pins. Angular and translation measurements were recorded using the MacReflex motion analysis system sampling at 120 Hz. A Kistler force plate was synchronised to collect ground reaction forces simultaneously at 960 Hz. Patients were required to jump for distance to sufficiently stress the ACL. Subjects were randomly assigned to start with either the braced or unbraced condition. Analysis focused on differences in magnitudes and changes in the shape of the curves between bracing conditions. (Abstract shortened by UMI.)
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Beard, David John. "Hamstring contraction latency following anterior cruciate ligament rupture, reconstruction and rehabilitation." Thesis, University of Oxford, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.308448.
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Mikkelsen, Christina. "Rehabilitation following bone-patellar tendon-bone graft ACL reconstruction /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-913-0/.
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Kovaleski, John Edward. "Influence of age on rehabilitation after arthroscopic meniscectomy of the knee." Virtual Press, 1986. http://liblink.bsu.edu/uhtbin/catkey/457956.
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Thigh muscle strength and endurance were measured following partial arthroscopic meniscectomy of the knee in 24 patients divided into group 1 (age < 20 yr), group 2 (age 24-40 yr), and group 3 (age > 50 yr). Subjects were studied during and after release from isokinetic rehabilitation. Isokinetic testing was performed at 1.04, 2.09, 3.14, 4.19, and 5.24 radians/second, with release from rehabilitation when quadriceps strength achieved 85% recovery of the non-surgical leg.No significant difference existed among the 3 groups in days from the time of surgery to the start of the first test or for the weeks to release from rehabilitation. Approximately 50% quadricep muscle strength loss was observed at the time of the initial isokinetic test. Quadriceps torque (mean + SE) measured in newton-meters for group 1 at the 1.04 rad/sec speed showed the surgical leg significantly weaker (P<0.001) than the non-surgical leg when tested at the initial test (101.6 +18.2 vs. 189.6 +17.2) and at release from rehabilitation (157.4 +13.3 vs. 176.3 +15.2). Torque measured at the other 4 speeds reached non-significance by the second or third week of rehabilitation. Isokinetic testing for groups 2 and 3 showed surgical leg strength significantly weaker (P<0.05) at the initial test and at week 1 of rehabilitation for the 5 testing speeds, with 85% return of strength by weeks 2 or 3. Strength recovery for all 3 groups showed no significant weakness between legs for hamstring torque after the initial or after the first week of rehabilitation. Percent of knee extensor torque achieved by the knee flexor muscles of the surgical leg for the 3 groups showed significantly greater (P<0.001) values only for the initial test at speeds 1.04 and 2.09 rad/sec. Measures of total work, average power, and endurance calculated from work tests showed little change in muscle endurance between legs.These data indicate that quadricep muscle function is negatively affected following arthroscopic meniscectomy. Release from rehabilitation when surgical to non-surgical leg strength is between 85% to 90X appears to be a valid measure for most patients, which indicates age alone does not appear to be a limiting factor in regaining strength.
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Tagesson, Sofi. "Dynamic knee stability after anterior cruciate ligament injury : emphasis on rehabilitation /." Linköping : Univ, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-10498.
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Toutoungi, Danielle Emma. "The mechanics of rehabilitation exercises for the cruciate ligament-injured knee." Thesis, University of Oxford, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.360555.
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Tagesson, (Sonesson) Sofi. "Dynamic knee stability after anterior cruciate ligament injury : Emphasis on rehabilitation." Doctoral thesis, Linköpings universitet, Sjukgymnastik, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-10498.
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Anterior cruciate ligament injury leads to increased sagittal tibial translation, and perceptions of instability and low confidence in the knee joint are common. Many patients have remaining problems despite treatment and are forced to lower their activity level and prematurely end their career in sports. The effect of ACL reconstruction and/or rehabilitation on dynamic knee stability is not completely understood. The overall aim of this thesis was to study the dynamic knee stability during and after rehabilitation in individuals with ACL injury. More specific aims were 1) to elaborate an evaluation method for muscle strength, 2) to evaluate the effect of exercises in closed and open kinetic chain, and 3) to evaluate dynamic knee stability in patients with ACL deficiency or ACL reconstruction. Sagittal tibial translation and knee flexion angle were measured using the CA‐4000 computerised goniometer linkage. Muscle activation was registered with electromyography. The intra‐ and inter‐rater reliability of 1 repetition maximum (RM) of seated knee extension was clinically acceptable. The inter‐rater reliability of 1RM of squat was also acceptable, but the intra‐rater reliability was lower. The systematic procedure for the establishment of 1RM that was developed can be recommended for use in the clinic. One specific exercise session including cycling and a maximum number of knee extensions and heel raises did not influence static or dynamic sagittal tibial translation in uninjured individuals. A comprehensive rehabilitation program with isolated quadriceps training in OKC led to significantly greater isokinetic quadriceps strength compared to CKC rehabilitation in patients with ACL deficiency. Hamstring strength, static and dynamic translation, and functional outcome were similar between groups. Five weeks after ACL reconstruction, seated knee extension produced more anterior tibial translation compared to the straight leg raise and standing on one leg. All exercises produced less or equal amount of anterior tibial translation as the 90N Lachman test. Five weeks after the ACL reconstruction the static and dynamic tibial translation in the ACL reconstructed knee did not differ from the tibial translation on the uninjured leg. Patients in the early phase after ACL injury or ACL reconstruction used a joint stiffening strategy including a reduced peak knee extension angle during gait and increased hamstring activation during activity, which reduces the dynamic tibial translation. Patients with ACL deficiency that completed a four months rehabilitation program used a movement pattern that was more close to normal.
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Byrne, Ceara Ann. "Design of an e-Textile sleeve for tracking knee rehabilitation for older adults." Thesis, Georgia Institute of Technology, 2013. http://hdl.handle.net/1853/49047.
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The occurrence of total knee replacements is increasing in the United States for persons over the age of 45 because they are inexpensive and a very effective method for treating degenerative joint diseases. Rehabilitation requires regular access to a wide variety of resources and personnel and, as the demand for post-operative, rehabilitative care increases, the ability to marginally relieve the healthcare system by offloading resources to the patient is necessary. Tools to enable tracking a patient’s rehabilitative progress at home are an essential method to help unload the healthcare system. The purpose of this project is to design and develop a wearable home rehabilitation device for knee replacement. This thesis utilizes design ethnography tools such as expert interviews, rehabilitation observation, a participatory design workshop, iterative development, and an idea feedback study. Leveraging advancements in technology and the field of eTextiles, this study investigates the product feasibility and acceptance of discreet on-body sensors to provide a product that enables patients to better perform rehabilitation on their own, but also to allow for a feedback loop for physicians and therapists to view patient progress.
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Hurley, Michael V. "Muscle function, inhibition and rehabilitation following traumatic and degenerative joint damage." Thesis, King's College London (University of London), 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.321690.
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Smale, Kenneth. "Relating Subjective and Objective Knee Function After Anterior Cruciate Ligament Injury Through Biomechanical and Neuromusculoskeletal Modelling Approaches." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/37947.
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Background: Knee injuries have a considerable impact on both the person’s psychological and physical health. We currently have tools to address each of these aspects but they are often considered independent of each other. Little work has been done to consolidate the subjective and objective functional ability of anterior cruciate ligament (ACL) injured individuals, which can be detrimental when implementing a return-to-play decision-making scheme. The lack of understanding concerning the relationship of these two measures may account for the high incidence of re-injury rates and lower quality of life exhibited by so many of these patients.
Purpose: The purpose of this doctoral thesis is to investigate the relationship between subjective and objective measures of functional ability in ACL deficient and ACL reconstructed conditions through biomechanical and neuromusculoskeletal modelling approaches.
Methods: This thesis is comprised of five studies based on a single in vivo data collection protocol, medical imaging and in silico data analyses. The in vivo data collection was of test-retest design where ACL deficient patients participated prior to their operation and approximately ten months post-reconstruction. This experimental group was matched to a healthy, uninjured control group, which was tested a single time.
The first study of this thesis involved a descriptive analysis of spatiotemporal, neuromuscular, and biomechanical patterns during hopping and side cut tasks in addition to subjective functional ability questionnaires. Then, two novel measures of dynamic knee joint control were developed and applied along with a third measure to determine if changes in joint control exist between the three groups (Study 2). The relationships of these objective measures of functional ability to subjective measures were then examined through correlation and regression models (Study 3). Following this, a method of including magnetic resonance imaging to construct patient-specific models was developed and implemented to determine realistic kinematic and ligament lengthening profiles (Study 4). These patient-specific models were then applied to quantify knee joint loading in the form of contact and ligament forces, which were correlated to subjective measures of functional ability (Study 5).
Results: Even though no major differences in neuromuscular patterns were observed between all three groups, it was found that subjective patient-reported outcome measures scores and biomechanical measures in the form of knee flexion angles and extensor moments were lower in the ACL deficient group compared to healthy controls. These differences continued to exist 10 months post-operation as the ACL reconstructed group had not fully recovered to patterns observed in the healthy controls. The current findings also suggest a possible hierarchy in the relationships between objective and subjective measures of functional ability. Basic kinematic objective measures such as knee flexion angle show small to moderate correlations, while more comprehensive measures such as stiffness and joint compressive force show moderate to strong correlations to subjective questionnaires. Finally, this thesis developed patient-specific OpenSim models that were used to produce appropriate kinematics and ligament lengthening with the reduction in soft tissue artefact.
Conclusion:
This thesis demonstrated that patients who are high-functioning in the ACL deficient state show greater improvements in subjective outcome scores after ACL reconstruction compared to objective measures. Biomechanical and neuromusculoskeletal modelling approaches identified important differences between the healthy and ACL deficient groups that were not resolved post-operatively. Our results also demonstrate that certain subjective and objective measures of functional ability are strongly correlated. The knowledge gained from this test-retest design and novel patient-specific in silico models aids clinicians in managing their expectations regarding the effectiveness of reconstruction and the respective long-term sequelae.
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Walters, Yelena. "Task-orientated rehabilitation can improve knee function and satisfaction in patients 12 months after knee replacement surgery for osteoarthritis." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10045118/.
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End-stage osteoarthritis (OA) requires joint replacement surgery. Although total knee arthroplasty (TKA) usually relieves pain, some patients are disappointed with their mobility, which may result from an abnormal gait. Post-operative physiotherapy following TKA is essential, although little consensus exists regarding longer-term rehabilitation. Typical rehabilitation has an internal focus on specific muscles and joints, but task-orientated rehabilitation (TOR) may be more effective. This study tested the hypothesis that TOR can improve gait and patient reported functional outcome following TKA. Seventy six patients were studied 12 months after TKA during follow up at the Royal National Orthopaedic Hospital, Stanmore. Patient reported functional outcome was assessed using the Oxford Knee Score (OKS) and gait characteristics were measured using inertial measurement units (IMUs). A subset of 21 patients, exhibiting abnormal gait, entered a 4-week TOR programme, based on daily walking and stair climbing. Patients were re-assessed with OKS and IMUs, and gait quantity compared pre- and post-intervention using pedometers. A subset of 4 patients’ baseline gaits was compared to 5 controls, and to their own gait following the TOR, while subjected to differing treadmill conditions. Multiple regression analysis showed that stride duration significantly predicted OKS (p < 0.0001, n=76). Higher OKS was observed in patients who have shorter stride duration, which was in turn a result of greater RoM of the leg joints and segments in the sagittal plane. TKA patients’ response to the varying treadmill conditions was similar, but inferior in the gait parameters’ values as compared to the healthy participants. Following TOR, 21 patients exhibited a significantly higher OKS (p=0.001, n=21). Stride duration, thigh, knee and calf sagittal range of motion and knee flexion in stance significantly increased in both limbs following TOR. In conclusion, the results indicate that there is scope to improve rehabilitation of patients after TKA. TOR improves gait quality and therefore has the potential to improve satisfaction in TKA patients.
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Ebert, Jay Robert. "Post-operative load bearing rehabilitation following autologous chondrocyte implantation." University of Western Australia. School of Sport Science, Exercise and Health, 2008. http://theses.library.uwa.edu.au/adt-WU2008.0196.
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[Truncated abstract] Autologous Chondrocyte Implantation (ACI) has shown early clinical success as a repair procedure to address focal articular cartilage defects in the knee, and involves isolating and culturing a patient's own chondrocytes in vitro and re-implantation of those cells into the cartilage defect. Over time, repair tissue can develop and remodel into hyaline-like cartilage. A progressive partial weight bearing (PWB) program becomes the critical factor in applying protection and progressive stimulation of the implanted cells, to promote best chondrocyte differentiation and development, without overloading the graft. The aim of this thesis was to investigate whether patients could replicate this theoretical load bearing model to possibly render the best quality tissue development. In addition, this proposed external load progression is only a means to loading the articular surface. Several factors, including those that may result from pathology, have the potential to influence gait patterns, and therefore, articular loading. The association between increasing external loads (ground reaction forces - GRF) and knee joint kinetics during partial and full weight bearing gait was, therefore, investigated in the ACI patient group, as was the contribution of other gait variables to these knee joint kinetics which may be modified by the clinician. Finally, current weight bearing (WB) protocols have been based on early ACI surgical techniques. With advancement in the surgical procedure and ongoing clinical experience, we employed a randomised controlled clinical trial to assess the effectiveness of an 'accelerated' load bearing program, compared with the traditionally 'conservative' post-operative protocol. ... Although similar spatio-temporal, knee kinematic and external loading parameters were observed between the traditional and accelerated rehabilitation groups, the accelerated group was 'more comparable' to the controls in their external knee adduction and flexion moments, where the traditional group had lower knee moments. Knee moments greatly affect knee articular loading, and large adduction moments have been related to poor clinical outcomes after surgery. Therefore, the return of normal levels may be ideal for graft stimulation, however, may overload the immature chondrocytes. Acceleration of the intensive rehabilitation program will enable the patient to return to normal activities earlier, whilst reducing time and expenses associated with the rehabilitative process, and may enhance long-term tissue development. However, continued follow-up is required to determine if there are any detrimental effects that may emerge as a result of the accelerated load bearing program, and assess the recovery of normal gait patterns and whether longer term graft outcomes are affected by the recovery time course of normal gait function, and/or abnormal loading mechanics in gait. Furthermore, analysis at all levels of PWB is needed to identify a more complete set of variables attributing to the magnitude of external knee joint kinetics and, therefore, knee articular loading, while the influence muscle activation patterns may have on articular loading needs to be investigated. This becomes critical when you consider loads experienced by the articular surface throughout the early post-operative period following ACI may be important to short- and long-term graft development.
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Ayoade, Mobolaji. "Interactive visualisation and videoconferencing for home-based rehabilitation of knee replacement patients." Thesis, Glasgow Caledonian University, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.688302.
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Armshaw, Brennan P. "Contingency Management of Physical Rehabilitation: The Role of Feedback." Thesis, University of North Texas, 2018. https://digital.library.unt.edu/ark:/67531/metadc1404528/.
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Modern advances in technology have allowed for an increase in the precision with which we are able to measure, record, and affect behavior. These developments suggest that the domains in which behavior analysis might contribute are considerably broader than previously appreciated, for instance the area of behavioral medicine. One way the field of behavior analysis can begin to address problems in behavioral medicine is with biosensor technology, like surface electromyography (sEMG). For sEMG technology to be useful in behavioral medicine, specifically recovery from total knee arthroplasty, a reference value (the maximum voluntary individual contraction-MVIC) must be established. The MVIC value allows for the comparison of data across days and may allow the programming of contingencies. However, current MVIC methods fall short. Study 1 compares MVIC values produced by a participant given the typical instruction only method with two alternative methods: instruction + feedback, and instruction + feedback in a game context. Across 10 participants both feedback conditions lead to higher MVIC values then the instruction only condition. Study 2 applies the MVIC techniques developed during Study 1 to an exercise procedure. Using an MVIC value as the criteria for feedback Study 2 compares the same three conditions, however this time assessing for the conditions under which exercise performance is optimal. Across all 9 participants the instruction + feedback in a game context lead to the participant ‘working harder' and 8 out of 9 participants exceeded the MVIC value more often during this condition then in the other two conditions.
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Davison, Andrew Charles. "Development of a smart knee brace for early gait rehabilitation of stroke patients /." Access to citation, abstract and download form provided by ProQuest Information and Learning Company; downloadable PDF file, 68 p, 2007. http://proquest.umi.com/pqdweb?did=1251900481&sid=2&Fmt=2&clientId=8331&RQT=309&VName=PQD.
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Thesis (M.S.M.E.)--University of Delaware, 2006Principal faculty advisors: Sun, Jian-Qiao, Dept. of Mechanical Engineering; Katherine Rudolph, Dept. of Physical Therapy. Includes bibliographical references.
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Xu, Daquan 1965. "Epidemiology of pain and pain management after knee surgery : arthroplasty and arthroscopy." Thesis, McGill University, 2003. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=80899.
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Background. Pain after knee surgery has been reported as a common problem. It is highly ranked in terms of intensity and has important consequences on both quality of life and psychological well-being. However, assessment and management of postoperative pain remain a key clinical problem.Objectives. To describe the occurrence of pain after total knee arthroplasty (TKA) and knee arthroscopy; identify the predictors of postoperative pain and evaluate the consequences of pain on quality of life and on depression status.
Methods. Patients were recruited from nine university and regional hospitals in the province of Quebec and were followed for three months after knee surgery. Time points of postoperative day 7 and month 3 were our prime interest. We used a prospective cohort design to investigate characteristics of postoperative pain and a case-control design to identify the impact of postoperative pain on quality of life and on depression. Both logistic regression and multiple linear regression models were used to analyze postoperative pain intensity and the impact of postoperative pain respectively. (Abstract shortened by UMI.)
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Testa, Daniele. "KNEE MONITOR: Monitoring knee angles and physical activity in daily life using a dual-sensor wearable." Master's thesis, Alma Mater Studiorum - Università di Bologna, 2020. http://amslaurea.unibo.it/19905/.
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Physical activity (PA) can be used as a parameter for the diagnosis, treatment or evaluation of the results of correct health care. The evaluation of physical activity becomes essential after a knee joint surgery as it provides clinicians and physiotherapists with essential information on the patient's motor health and on the effectiveness of rehabilitation. Although the gold standard for the evaluation of subject’s performance during PA is represented by measures taken in gait laboratories, or through force plates and electromyography, recent advances in wearable sensors, especially Inertial Measurements Units (IMU), have opened up a promising future for out-of-the-lab gait analysis. The IMUs are generally composed by an accelerometer, a gyroscope and magnetometer and they are becoming widely used both in scientific and clinical fields. The project on which this thesis is based envisages the construction of a new system for monitoring knee activity in daily life. This new monitoring system consists of two 3D IMUs and an algorithm based on quaternions. The performances of the first prototype of this system have been compared with those of a motion capture laboratory. What emerged is that the new system produced results comparable to those of the gold-standard system in all types of movements performed. Finally, a detailed description of the limits, improvements and future applications of this system was reported
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White, Joseph Paul. "Real time event detection and control of a smart knee brace for gait rehabilitation." Access to citation, abstract and download form provided by ProQuest Information and Learning Company; downloadable PDF file, 90 p, 2007. http://proquest.umi.com/pqdweb?did=1400964091&sid=16&Fmt=2&clientId=8331&RQT=309&VName=PQD.
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Thesis (M.S.M.E.)--University of Delaware, 2007.Principal faculty advisors: Jian-Qiao Sun, Dept. of Mechanical Engineering; and Katherine Rudolph, Dept. of Physical Therapy. Includes bibliographical references.
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De, Garie Luc. "Effects of banked-curves on ankle and knee kinematics during running." Thesis, McGill University, 2006. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=97940.
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Given that a greater injury incidence has been shown for indoor versus outdoor running tracks, attention to mechanical differences in curve running is warranted. Hence, the main objective of this study was to compare knee and ankle kinematics of runners while running on an indoor track with a flat curve and a banked-curve in young elite runners. Six elite runners participated in the study. Knee and ankle kinematics were measured while the subjects ran on a flat curve and a 19% banked-curve. No significant differences were observed in left and right knee and ankle peak angular displacements between the two different curves. Angular displacements measured have demonstrated similar profiles to those presented in previous studies. However, significant differences were found in body lean angle between speeds but not between curve inclinations. In conclusion, the results suggest that curve inclination does not perturb lower limb kinematics for elite runners.
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Highsmith, Michael Jason. "Comparative Outcomes Assessment of the C-Leg and X2 Knee Prosthesis." Scholar Commons, 2012. http://scholarcommons.usf.edu/etd/4333.
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Background
There are more than 300,000 persons in the U.S. living with transfemoral amputation (TFA). Persons with TFA use a knee prosthesis for gait and mobility. Presently, the C-Leg microprocessor knee prosthesis is the standard of care. C-Leg has significantly improved safety and cost efficacy and has created modest gains in gait efficiency. Recently, a new prosthesis has introduced a new sensor array and processor that reportedly improves knee motion, stair function and standing stability. Early claims of the reported functional benefits of the new Genium knee (formerly X2) have not been validated in a rigorous clinical trial. Therefore, the purpose of this project was to determine if the Genium knee improves safety, function and quality of life compared to the current standard of care (C-Leg).
Methods
The study is a randomized AB crossover with a control group. Subjects must have used (and still be using) a C-Leg for a minimum of 1yr prior to enrollment. Inclusion criteria beyond this are unilateral transfemoral or knee disarticulation amputation for any etiology, community level ambulation (Medicare level 3 or above), independent ambulation and ability to independently provide written, informed consent. Once enrolled subjects utilize their same socket but receive a study foot (Trias or Axtion). Subjects are randomly assigned to either stay with their C-Leg or be fit with a Genium knee. Subjects accommodate and test (A phase) then crossover to the other knee condition and repeat the testing (B phase). A follow up phase of the study beyond the B phase is ongoing to study longer term preference. For AB assessment, three domains were assessed: Safety, function and quality of life. For safety, the PEQ-A survey of stumbles and falls, posturography (Biodex SD limits of stability and postural stability tests), 4 square step test and 2 minute ramp stand test were completed. For function, a series of timed walking tests, the amputee mobility predictor, kinematic gait assessment and physical functional performance-10 tests were conducted. For quality of life, the socioemotional and situational satisfaction domains of the population specific and validated PEQ (prosthesis evaluation questionnaire) were completed.
Results
Safety: Posturographic assessment revealed impairment between transfemoral amputees and non-amputees. Stumbles and semi-controlled falls decreased with Genium but were not significantly different. Four square step testing was significantly (p 0.05) improved from 12.2s(3.3) to 11.1s(3.4) for the C-Leg and Genium respectively.
Function: Kinematic asymmetry was minimally different between knee conditions. The AMP mean(SD) scores while subjects used C-Leg was 40.8(3.6; 33-45) and 43.3(2.6) [p<0.001]. PFP scores (cumulative), upper body function and endurance scores were improved with Genium compared with C-Leg at 9.1%(p=0.03), 8.7%(0.01) and 10.3%(0.04) respectively.
Quality of Life: For quality of life, situational satisfaction favored Genium (p<0.001) which included subject's satisfaction with gait, training and quality of life in general.
Conclusion
C-Leg and Genium promote static weight bearing beyond asymmetric values reported in the literature. In terms of limits of stability, TFA's are clearly impaired, primarily over the amputated side posteriorly however the Genium seems to enable posterior compensations that coincide with multi-directional stepping improvements. Anteriorly, the C-Leg's toe triggering requirements seem to improve limits of stability but come at the cost of discomfort on ramp ascent. With regard to safety, it seems that both knee systems represent good options for the community ambulating TFA.
The largest improvements with Genium were in the activities of daily living assessment; predominantly balance and upper body function. It seems that the combination of multi-direction stepping with starts and stops and stair ascent are key areas of improvement. In conclusion, the sensor array in the Genium knee prosthesis promotes improved function in activities of daily living. Specifically improved in this context were balance, endurance, multi-directional stepping, stair ascent and upper limb function in highly active transfemoral amputees.
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Bailey, Andrea Kay. "Enhancing rehabilitation following anterior cruciate ligament reconstruction." Thesis, University of Exeter, 2015. http://hdl.handle.net/10871/17475.
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Thesis Title: Enhancing rehabilitation following anterior cruciate ligament reconstruction. Context: Physical training with a neuromuscular focus has been shown to reduce anterior cruciate ligament (ACL) injury. However, ACL injury remains prevalent and often leads to joint instability, which requires surgical reconstruction. Following reconstructive surgery, a minimum of 6 months supervised rehabilitation is recommended with associated with financial cost implications to the National Health Service (NHS), the patient and society. Traditionally rehabilitation is offered in a concurrent format, whereby strength and cardio-vascular endurance exercises are performed in the same session. However, accumulating evidence from healthy populations, suggests that the development of strength might be attenuated by cardio-vascular endurance conditioning performed in close temporal proximity. This thesis comprises an entirely novel investigation of potential attenuation of strength gains in rehabilitating clinical populations that is associated with temporal incompatibility of physiological conditioning stimuli. No study has previously investigated this phenomenon, whether it might compromise the efficacy of treatment or recovery, or its potential influence on objectively-measured and patients’ perception of functional, musculoskeletal and neuromuscular performance capabilities. Objectives: The purpose of this thesis was to assess the effects of reconstruction surgery and 24 weeks of non-concurrent strength and endurance rehabilitation (with 48 week post-operative follow-up) on (a) subjective (IKDC; KOOS; PP [Chapter 4]) and objective measures of function (HOP [Chapter 5]) (primary outcome measures for this thesis), and (b) objective measures of musculoskeletal (ATFD) and neuromuscular performance (PF, EMD, RFD, SMP [Chapter 5]) (secondary outcome measures), in patients with anterior cruciate ligament deficiency. The secondary aim was to evaluate the relationships amongst a subjective outcome of function (IKDC), an objective outcome of function (HOP), and the secondary objective outcomes of musculoskeletal (ATFD) and neuromuscular (PF, RFD, EMD, SMP) performance at pre-surgery and at 24 weeks post-surgery (Chapter 6). Setting: Orthopaedic Hospital NHS Foundation Trust. Design: Prospective random-allocation to group trial involving iso-volume rehabilitative intervention versus contemporary practice, using contralateral limb assessment and clinico-social approbation controls. The design compared the effects of experimental post-surgical rehabilitation comprising non-concurrent strength and endurance conditioning with two conditions of control reflecting contemporary clinical practice (matched versus minimal assessment interaction). Participants: Eighty two patients (69♂, 13♀, age: 35.4 ± 8.6 yr; time from injury to surgery 9.4 ± 6.9 months [mean ± SD]) electing to undergo unilateral ACL reconstructive surgery (semitendinosus and gracilis graft [n = 57]; central third, bone-patella tendon-bone graft [n = 25]); were allocated to groups (2:2:1 purposive sampling ratio, respectively). Nineteen patients were lost to follow-up. Intervention: A standardised traditional concurrent (CON) ACL rehabilitation programme acted as the control versus an experimental non-concurrent (NCON) ACL rehabilitation programme that involved separation of strength and cardio-vascular endurance conditioning. An additional control group (Limited testing CON) matched the CON group rehabilitation applied within contemporary clinical practice. Outcome Measures: Chapter 4: The self-perceived primary outcome measures of function IKDC, KOOS and PP were assessed on five separate occasions (pre-surgery, and at 6, 12, 24 and 48 weeks post-surgery). However, assessment occasions were purposefully reduced to pre-operative and 48 weeks post-operative for the Limited testing CON group. Chapter 5: The primary objective outcome of function was HOP; the secondary outcomes were ATFD, PF, RFD, EMD and SMP associated with the knee extensors and flexors of the injured and non-injured legs. These objective outcomes were assessed on five separate occasions (pre-surgery, and at 6, 12, 24 and 48 weeks post-surgery). However, assessment occasions were purposefully reduced to pre-operative and at 48 weeks post-operative only for the Limited testing CON group. Chapter 6 Self-perceived (IKDC) subjective knee evaluation and the objective outcome of function (HOP), and selected objective outcomes of musculoskeletal and neuromuscular performance including ATFD, PF, RFD, EMD and SMP of the knee extensors and flexors of the injured and non-injured legs where applicable; measured at pre-surgery and at 24 weeks post-surgery were analysed for association, using Pearson product-moment correlation coefficients. A priori alpha levels were set at p<0.05. Results: Chapter 4: Factorial analyses of variance (ANOVAs) with repeated-measures investigating the primary aim showed significant group (NCON; CON) by test occasion (pre-surgery, 6, 12. 24 and 48 weeks post-surgery) interactions for self-perceived outcomes of function IKDC, KOOS and PP confirmed increased clinical effectiveness of NCON conditioning (F(2.0, 82.9)GG = 4.0 p<0.05, F(2.2, 134.7)GG = 5.5 p<0.001, F(1.9, 121.4)GG = 14.6 p<0.001, respectively) and the group mean peak relative difference in improvement for NCON was ~5.9% - 12.7% superior to CON. The greatest interaction effect was found to occur between pre-surgery and the 12 weeks post-operative test occasion for IKDC and KOOS, and between pre-surgery and the 24 week test occasion for PP. Patterns of improvements in self-perceived fitness over time were represented by a relative effect size range of 0.71 to 1.92. Improvement patterns were not significantly different between control groups offering matched or minimised assessor-patient interaction (CON vs. Limited testing CON; pre-surgery vs. 48 weeks post-surgery) indicating that clinical approbation by patients had not contributed to the outcome. Chapter 5: Factorial analyses of variance (ANOVAs) with repeated-measures showed significant group (NCON; CON) by leg (injured/non-injured) by test occasion (pre-surgery, 6, 12, 24 and 48 weeks post-surgery) interactions of the objective measure of function (HOP) together with the secondary outcomes of ATFD, PF, RFD, EMD and SMP. Similar responses were noted for the knee extensors and flexors of the injured and non-injured legs (F(2.1, 248) GG = 4.5 to 6.6; p<0.01) and confirmed increased clinical effectiveness of NCON conditioning (range ~4.7% - 15.3% [10.8%]) better than CON between 12 and 48 weeks. Patterns of improvements in physical fitness capabilities over time were represented by a relative effect size range of 1.92 to 2.89. Improvement patterns were not significantly different between control groups offering matched or minimised assessor-patient interaction (CON vs. Limited testing CON; pre-surgery versus 48 weeks post-surgery) indicating that clinical approbation by patients had not contributed to the outcome. Chapter 6: Two-tailed probabilities were used due to the exploratory nature of this study. A limited number of weak to moderate statistically significant correlations were confirmed (ranging from r = 0.262 – 0.404; p<0.05; n=48 [amalgamated NCON and CON groups] ) between IKDC and most notably, the neuromuscular performance outcome of EMD. Conclusion: Overall, the patterning and extent of changes amongst self-perceived, functional, musculoskeletal and neuromuscular performance scores offer support for the efficacy of using non-concurrent strength and endurance conditioning to enhance post-surgery rehabilitation. The limited robustness of relationships amongst the validated and frequently-used self-perceived outcome of function [IKDC], and objectively-measured outcomes of function and musculoskeletal and neuromuscular performance suggested that each might properly reflect an important but separate aspect of clinical response and should be deployed to detect change.
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Heiden, Tamika Louise. "Neuromuscular-biomechanical outcomes of different types of resistance training on people with knee osteoarthritis." University of Western Australia. School of Sport Science, Exercise and Health, 2009. http://theses.library.uwa.edu.au/adt-WU2010.0066.
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[Truncated abstract] Knee osteoarthritis (OA) patients have high levels of pain, functional and strength deficits of the quadriceps, decreased proprioceptive acuity, and increased co-contraction and knee joint loading in gait, compared to age matched controls. The increased knee joint loading in this population occurs most commonly in the medial tibio-femoral compartment, due to increased external adduction moments, and with increasing disease severity there is a concomitant increase in the knee adduction moments. A key finding within the knee OA literature is that dynamic loading in gait, due to increased external adduction moments, strongly predicts pain and radiographic disease progression. Current research has shown that exercise interventions reduce pain and time to complete functional activities; however, the effect of these interventions on knee joint loading and muscular activation in gait is still unclear. In addition, the need for specific knee joint strengthening to cause these alterations has not been investigated and it remains unknown if improvements occur due to specific muscle strengthening or due to some general effect of exercise. Therefore, the primary aim of this research study was to examine the effects of general (upper body) and specific (lower body) resistance training interventions on self-perceived outcomes, neuromuscular function and kinematic, kinetic and muscle activation during gait of OA patients compared with asymptomatic controls. ... The examination of gait data following exercise (Study 4) showed trends for changes in the muscle co-contraction ratios. Specifically, the medial/lateral co-contraction ratio (MLCCR) displayed a trend in early stance where the upper body exercise group increased their lateral muscle activity and the lower body group reduced their lateral muscle activity, and the medial/lateral hamstring co-contraction ratio (HAMCCR) displayed this same trend during loading. The trend toward reduced lateral muscle activation, following lower body resistance training, suggests that specific muscle strengthening may have the ability to alter the load distribution. The kinematic and kinetic variables of gait were unchanged by the exercise interventions, highlighting the sensitivity of muscle activation pattern changes due to muscle strengthening. This thesis provides new insights into the co-contraction strategies utilised by knee OA patients. The directed co-contraction strategy employed by knee OA patients and its relationship to the external adduction moment in gait suggest an attempt to redistribute the loading within the knee joint, most likely in response to pain. Further, we have separated the effects of exercise and found differences in self-perceived outcomes based on exercise specificity. This first examination into muscle co-contraction following resistance training of knee OA patients has highlighted the possibility of alterations to the co-contraction patterns following lower body exercise. However, the implications of altering this muscle activation strategy and the consequent effect on distribution of load within the knee joint requires further consideration.
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Teran-Yengle, Patricia Cecilia. "Training strategies to reduce knee hyperextension gait patterns in healthy women." Diss., University of Iowa, 2013. https://ir.uiowa.edu/etd/5065.
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Clinicians working on motor skill learning interventions often find that improvements observed during training are not sustained and do not transfer to very similar tasks. Research suggests that strategies such as real-time biofeedback and learner's focus of attention seem to facilitate motor skill learning. However, research on the implications of these strategies in rehabilitation is limited and has not been investigated in healthy individuals. The motor learning effects of these strategies need to be assessed as they offer the possibility of enhancing rehabilitation regimens. The purpose of this study was to investigate the generalizability of real-time biofeedback and learner's focus of attention to a treadmill gait retraining program aimed at correcting knee hyperextension insidious gait patterns in healthy young women. Assessing the acquisition, retention, and transfer of kinematic improvements was the focus of this study.
1.Knee sagittal plane kinematics could be influenced with dynamic gait training using real-time biofeedback. Gained proficiency in controlling knee hyperextension during treadmill training was evident during overground walking immediately and 1 month after training.
2.The effectiveness of real-time biofeedback in improving performance does not seem to be influenced by the focus of attention, internal or external, induced during treadmill training. Participants in both intervention groups improved in a similar way as a consequence of practice. However, there were trends in the data that pointed that the external focus of attention group had better long-term retention. It is not known if participants actively switched to an external focus of attention despite the instructions provided during training. Tests to ensure instructional compliance should be used.
3.A treadmill gait retraining program using learner's focus of attention indicated that that there were not differences in learning acquisition, short and long-term retention, and transfer to overground walking and obstacle crossing between intervention groups. It is not known if these changes persist beyond the 4-month follow-up included in this study.
The results of this study will help to reduce knee hyperextension gait patterns in women. Future studies may also use the methodology used in this study to further investigate the implications of learner's focus of attention in rehabilitation. Similarly, the findings of this study could offer an additional strategy for rehabilitation regimens.
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Crews, Daniel J. "Real-Time Estimation of Knee Angle, Heel-Strike, and Toe-Off Events for Gait Rehabilitation Devices." Thesis, California State University, Long Beach, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10603978.
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The ability to estimate knee angle and detect heel-strike and toe-off events in real-time will greatly benefit current research being performed in training and rehabilitation devices for stroke and neurological disorder patients. This work set out to accomplish this by developing algorithms to detect heel-strike and toe-off in various stroke patients, and estimate knee angle on an able bodied individual using inertial measurement units (IMUs).
The algorithms developed were able to detect every heel-strike and toe-off point in real-time from all six trials of six different stroke patients, yielding a correlation of 0.97 and above compared to commercial software. The knee angle was also successfully estimated in real-time with a RMSE of 8° compared to motion capture software.
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Lahiff, Christina-Anne Kathleen. "Simulation of Hemiparetic Function Using a Knee Orthosis with Variable Impedance and a Proprioception Interference Apparatus." Scholar Commons, 2017. http://scholarcommons.usf.edu/etd/6623.
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Individuals with stroke have neuromuscular weakness or paralysis on one side of the body caused by some muscles disengaging and overexciting other muscles. Hyperextension of the knee joint and complete lack of plantar flexion of the ankle joint are common symptoms of stroke. This thesis encompasses the simulation of hemiparetic function using both a knee orthosis with variable impedance, specifically in terms of stiffness and damping, and the Proprioception Interference Apparatus.
The section regarding the knee orthosis with variable impedance focuses on the creation and implementation of a small, lightweight, and adjustable orthotic device to be positioned around the knee of an able-bodied person to simulate hemiparetic gait. Force and range of motion data from able-bodied subjects fitted with the orthosis, inducing hemiparetic gait, was collected using the Computer Assisted Rehabilitation ENvironment (CAREN) system. The four parameters that the design focused on are damping, catch, hysteresis, and stiffness. The main goal of the project was to discern whether this device could be utilized as a viable research instrument to simulate hemiparetic gait. It was hypothesized that the device has the potential to be utilized in the future as a research device to be used on able-bodied persons to study asymmetries in gait and eventually quantify the Modified Ashworth Scale. It was also believed that it could serve as a possible rehabilitation device for people with stroke since it has been designed to induce larger knee flexion as an after effect. However, this would require the proper clinical evaluation and experimentation procedures to be successfully concluded. A comparison between how the dominant leg was affected by the orthosis and how the non-dominant leg was affected was investigated as well. The results show that the device affected the velocities, knee angles, and force profiles of the subject’s gait.
The second section involving the Proprioception Interference Apparatus involved the creation and implementation of a haptic apparatus that utilizes vibration as well as transcutaneous electrical nerve stimulation (TENS) in various combinations with and without visual feedback to induce a proprioceptive illusion around the knee joint, as if a subject has a version of hemiparesis. The main goal of the project was to discern whether a device of relatively the same design could be utilized as a viable research instrument to simulate stroke-like balance in able-bodied subjects.
Comparison between how the root mean square (RMS) values of each marker location, the average of the standard deviations of the forces, and RMS of the center of pressure affected the various conditions was investigated as well. It was hypothesized and concluded that the RMS values and average of the standard deviations when subjects had no visual feedback would have a significant difference from when they had visual feedback. It was also hypothesized that Proprioceptive Interference Apparatus (PIA) would have a significant effect on the RMS and standard deviation values since it was meant to disrupt the motor control function of the knee, however, this was proved false after data analysis. It was also surmised that the application of the TENS had more of an effect on the RMS and standard deviation values, whether it was used on its own or in combination with the vibrations, than the vibration stimulation alone. However, once again, this was not statistically significant.
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Roper, Jaimie. "Effects of Underwater Treadmill Exercise on Mobility of People with Knee Osteoarthritis." DigitalCommons@USU, 2010. https://digitalcommons.usu.edu/etd/686.
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Gait, pain, and self-efficacy alterations in osteoarthritis (OA) patients may be precursors for pathological alterations and are important variables to examine in an aquatic therapy study aimed at improving mobility. A greater understanding of these alterations will be useful for the treatment of OA and the prevention of OA progression. The purpose of this thesis was twofold: to review the effects of certain land and aquatic therapies on gait kinematics and mobility of people with osteoarthritis, and to examine the effects of short-term aquatic treadmill exercise on gait kinematics, perception of pain, and mobility in OA patients. A direct comparison of water versus land treadmill exercise was used to determine the acute effectiveness of aquatic therapy on gait kinematics, pain, and self-efficacy. Fourteen participants diagnosed with osteoarthritis of the knee performed three consecutive exercise sessions for each mode of exercise. Gait kinematics, pain, and self-efficacy were measured before and after each intervention. Angular velocity gain score during stance for left knee extension was significantly higher for aquatic treadmill exercise compared to land treadmill exercise by 38.1% (p = 0.004). Similarly, during swing, the gain scores for angular velocity were also greater for left knee internal rotation and extension by 65% and 20%, respectively (p = 0.004, p = 0.008). During stance, the joint angle gain score for left hip flexion was greater for land exercise by 7.23% (p = 0.007). Similarly, during swing, the angular velocity gain score for right hip extension was significantly greater for aquatic exercise by 28% (p = 0.01). Only the joint angle gain score for left ankle abduction during stance was significantly higher for land exercise by 4.72% (p = 0.003). No other joint angle gain scores for either stance or swing were significantly different for either aquatic or land treadmill exercise (p = 0.06-0.96). Perceived pain was 100% greater for land than aquatic treadmill exercise (p = 0.02) and self-efficacy gain scores were not different between conditions (p = 0.37). The present study demonstrated that an acute training period on an aquatic treadmill did influence joint angular velocity and arthritis-related joint pain. Although acute effects of training (i.e., pain, angular velocity) improve after aquatic rather than land training, it is unclear whether or not aquatic exercise is a better long-term alternative to land exercise, and further longitudinal research is needed to examine gait kinematic changes after an increased training period of aquatic exercise.
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Ithurburn, Matthew P. "Associations among Knee Impairments, Patient-Reported Function, Landing Mechanics, and Knee Cartilage Integrity over Time after Anterior Cruciate Ligament Reconstruction." The Ohio State University, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=osu1503059931724191.
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Johnson, Aaron W. "Whole-Body Vibration Compared to Traditional Physical Therapy in Individuals with Total Knee Arthroplasty." BYU ScholarsArchive, 2007. https://scholarsarchive.byu.edu/etd/837.
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The purpose of the present study was to compare total knee arthroplasty (TKA) rehabilitation with and without whole-body vibration (WBV) to 1) understand if WBV is a useful treatment during TKA rehabilitation to increase quadriceps strength and function, and 2) to investigate the effect of WBV on quadriceps voluntary muscle activation. Subject and Methods. Individuals post TKA (WBV n=8, control n=8) received physical therapy with and without WBV for four weeks. Quadriceps strength and muscle activation, function, perceived pain, and knee range of motion were measured. Results. No adverse side effects were reported in either group. There was a significant increase in strength and function for both groups (P<0.01). There was no difference pre to posttest between groups for strength, muscle activation, or pain (Hotelling’s T2=0.42, P=.80) or for function (F=0.54, P=0.66). Discussion and Conclusion. In individuals with TKA, WBV showed equal strength and function improvement to physical therapy directed progressive resistive exercise. Influence of WBV on muscle activation remains unclear, as initial muscle activation was near established normal quadriceps levels and remained so post treatment.
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Laveson, Rachel E. "Design and Prototype of a Robotic Knee Brace for Individuals with Post-Stroke Hemiparesis." Case Western Reserve University School of Graduate Studies / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=case1558035861978562.
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Toonstra, Jenny L. "THE RELATIONSHIP BETWEEN PATIENT EXPECTATIONS, FUNCTIONAL OUTCOME, SELF-EFFICACY, AND REHABILITATION ADHERENCE FOLLOWING CARTILAGE REPAIR OF THE KNEE: A SEQUENTIAL EXPLANATORY ANALYSIS." UKnowledge, 2014. http://uknowledge.uky.edu/rehabsci_etds/20.
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Patient expectations have been shown to be a major predictor of outcomes. Furthermore, fulfilled expectations have been linked to increased patient satisfaction and rehabilitation adherence. Expectations may be influenced by a variety of factors, including patient characteristics, pre-operative function, or disease characteristics. However, it is currently unknown what factors and to what degree they may influence patient expectations prior to knee surgery. Furthermore, understanding the importance and values of those expectations for recovery using qualitative methods has not previously been conducted in this patient population.
A mixed methods design was used. Twenty-one participants scheduled to undergo cartilage repair of the knee, including autologous chondrocyte implantation, osteochondral allograft transplantation, or meniscal transplant were included. During their pre-operative visit, participants completed an expectations survey (Hospital for Special Surgery (HSS) Knee Surgery Expectations Survey) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) as a measure of functional ability. At their first post-operative visit, patients completed the Self-Efficacy for Rehabilitation Scale (SER). Rehabilitation adherence was collected by the participant’s rehabilitation provider. A selected sample of 6 participants participated in a semi-structured interview 6 months following surgery to better understand their expectations for recovery. Pearson correlation coefficients were used to determine relationships between expectations and KOOS scores, SER scores, and measures of adherence.
Results demonstrated that patients have moderate expectations for recovery and these expectations were positively associated with pre-operative pain, activities of daily living, and knee-related quality of life as measured by the KOOS. In addition, a negative relationship was found between patient expectations and adherence with home exercises, use of a brace, and weight-bearing restrictions. Four qualitative themes emerged as participants’ described how previous recovery experiences shaped their recovery following cartilage repair of the knee. Patient education, pre-habilitation, and the use of psychological skills during rehabilitation may help to manage patient expectations, improve rehabilitation adherence, and assist clinicians in providing more focused and individualized patient care.
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Wallace, Linda S. "Self-efficacy expectations and functional ability in everyday activities in clients undergoing total knee arthroplasty." Virtual Press, 2000. http://liblink.bsu.edu/uhtbin/catkey/1180777.
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This longitudinal, descriptive study based on Bandura's self-efficacy theory (1977), examined the effects of educational activities on self-efficacy and of self-efficacy on functional ability in everyday activities in clients undergoing elective, primary, unilateral, total knee arthroplasty (TKA). Educational activities included: attending a joint replacement class and a physical therapy session, performing exercises, and reading educational materials. Other sources of client information were also discussed. Self efficacy was assessed regarding confidence in ability to perform activities required for discharge home. Cronbach's alpha for the self-efficacy scale was .94 (pre-education) and .81 (post-education). Functional ability in everyday activities was operationalized as length of hospital stay, discharge placement, and perceived health status. Perceived health status was assessed using the three-scale Western Ontario McMasters University Osteoarthritis Index (WOMAC). Cronbach's alpha was: pain .85, joint stiffness .76, and physical function .94 (preoperatively); and pain .86, joint stiffness .80, and physical function .94 (postoperatively).Evidence was collected from a convenience sample of 31 participants: (a) when the process of scheduling surgery began; (b) before surgery, after the client had opportunities to participate in educational activities, and (c) approximately six weeks after surgery. The orthopedic surgeon and professional staff reviewed instruments for validity. Five clients reviewed the questionnaires for understandability and readability. Data were analyzed using Pearson r correlation coefficients, independent samples t-tests, analyses of variance and chi-square tests. An alpha level of .05 was designated as significant.Higher self-efficacy scores were associated with more expected benefits, previous TKA, and greater pain relief. Lower self-efficacy scores correlated with greater improvement in self-efficacy. Shorter lengths of hospital stay were associated with greater joint stiffness reduction, younger age and previous TKA. Discharge home was associated with younger age and living with someone else. Participants that were "very sure" of the need for TKA exhibited higher self-efficacy scores than participants that were "unsure". Improved outcomes were not associated with any one type of educational activity.This study highlighted the need for further refinement of context sensitive self-efficacy instruments, more sophisticated means of assessing the impact of an increasing array of information sources and more longitudinal studies with larger sample sizes.Department of Educational Leadership
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Weber, Lars. "Hüft-TEP und Knie-TEP in der ambulanten Rehabilitation." Doctoral thesis, Humboldt-Universität zu Berlin, Philosophische Fakultät IV, 2011. http://dx.doi.org/10.18452/16298.
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Untersuchungsziel: Untersucht wurden Auswirkungen einer ambulanten orthopädischen Rehabilitation nach der Implantation einer Hüft- bzw. Knieendoprothese auf die individuelle Lebensqualität. Um zu erkennen, ob Zusammenhänge von individuellen Parametern wie Geschlecht, Alter, Bildungsstand und dem Rehabilitationsverlauf bzw. –ergebnis bestehen, wurden medizinisch-funktionelle und psychosoziale Daten erhoben, sowie ergänzende Variablen durch Schichtenindices und mittels eines strukturierten Interviews erfasst. Methode: Systematische Datenerhebung von medizinisch funktionellen (Gelenkbeweglichkeit, Muskelkraft) und psychosozialen (Aktivitäten des täglichen Lebens) Daten von n=60 Pat. mit Knie-TEP und n=61 Pat. mit Hüft-TEP zu vier Messzeitpunkten (Anfang Reha=t0, Ende Reha=t1, 6 Monate nach Reha= t2 und 24 Monate nach Reha= t3) und strukturiertes Interview zur Erfassung von soziodemographischen Merkmalen, Motivation und Behandlungszuversicht. Analysemethoden: Signifikanzanalyse und Berechnung der Effektstärke (Cohens d) der Veränderungen zwischen t0 – t1 für abhängige Stichproben (getrennt nach Indikation), Längsschnittdarstellung der funktionellen und psychosozialen Parameter mit deskriptivstatistischen Analysen getrennt nach Indikation und Geschlecht. Ergebnisse: Für beide Indikationen ergaben sich hohe Effekte für Verbesserungen der funktionellen Parameter und mittlere (teilhabebezogen) bzw. hohe (aktivitätsbezogen) Effekte bei den psychosozialen Parametern am Ende der Rehabilitation. Die teilstandardisierten Rehabilitationsmaßnahmen wirken sich indikations- und geschlechtsbezogen unterschiedlich aus. Unter Beachtung der psychophysischen Leistungsvoraussetzungen und sozialen Rahmenbedingungen ist die ambulante Rehabilitation gut geeignet für Patienten im höheren Lebensalter.Study objective: Effects of an outpatient orthopedic rehabilitation after the implantation of a hip or knee replacement on the individual quality of life were studied. In order to analyze the existence of significant relationships between individual parameters such as gender, age, education and the rehabilitation outcome medical-functional and psychosocial data were collected, and additional layers of indices and variables by using a structured interview were applied. Method: Systematic data collection from medical functional (joint mobility, muscle strength) and psychosocial (activities of daily living) data of n = 60 patient with total knee replacement and n = 61 patient with total hip replacement to four time points (beginning of rehabilitation = t0, end rehab = t1, t2 = 6 months after rehabilitation and 24 months after discharge = t3) and structured interview for socio-demographic characteristics, motivation and confidence in treatment Analysis: Significance analysis and calculation of effect size (Cohen''s d) of the changes between t0 and t1 for dependent samples (separated by indication), longitudinal section view of the functional and psychosocial parameters with descriptive-statistical analyses apart from indication and sex Results: For both indications high effects of improvement in functional parameters, mean effects (participatory based) and high (activity-related) effects on the psycho-social parameters at the end of rehabilitation could be identified. The semi-standardized rehabilitation measures had shown differences by indication just like gender. In accordance with the psychophysical performance conditions and social environment outpatient rehabilitation is well suited for patients in advanced age.
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Westby, Marie D. "First steps in developing clinical practice guidelines for post-acute rehabilitation afater primary total hip and knee arthroplasty." Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/23734.
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Total hip (THA) and total knee arthroplasty (TKA) are cost-effective interventions for advanced osteoarthritis (OA) of the knee and hip. With the rapidly growing number of these procedures performed annually in Canada and the United States, greater attention needs to be directed to identify rehabilitation practices that optimize outcomes and minimize cost. Currently, there is no consensus on rehabilitation best practice and no evidence-based clinical practice guidelines to inform clinical decision-making on post-acute rehabilitation following THA and TKA.
A multi-phase, mixed-method project integrated stakeholder perspectives, research evidence and expert opinion to develop best practice recommendations for THA and TKA rehabilitation. Chapter 2 involved 11 focus groups and eight interviews to identify key themes related from North American patients and health care professionals on rehabilitation practices and outcomes. Chapters 3-4 are Cochrane systematic reviews examining the strength of the evidence for post-acute physiotherapy after THA and TKA. Chapter 5-6 involved two parallel Delphi surveys with consumers, clinicians and researchers to develop consensus on a range of rehabilitation topics to inform best practice for THA and TKA rehabilitation.
Chapter 2: Six key themes emerged relating to communication, patient expectations, patient attitude, forms of support, barriers to recovery, and diversity of outcomes. Chapters 3-4: Systematic reviews of THA (n=8) and TKA (n=7) trials revealed limited, low to high quality evidence with mixed findings for various forms of post-acute physiotherapy on pain, function and health-related quality of life. Trial heterogeneity prevented meta-analysis. Chapters 5-6: Consensus (80% agreement) was reached on the need for post-acute rehabilitation, types of interventions, rehabilitation providers, treatment settings, outcomes and outcome measurement. Consensus was not reached regarding timing and dosage of rehabilitation. Sub-group analysis revealed few differences comparing responses by profession, primary role and country.
This thesis has taken important first steps in identifying appropriate rehabilitation interventions and health care resources to optimize individuals’ activity, participation and health-related quality of life after THA and TKA. Further, it highlights the need for more high quality research to address the knowledge gaps and inform policy on this important and understudied aspect of arthroplasty surgery.
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Herbold, Janet Anne. "Gait analysis following Total Knee Arthroplasty during Inpatient Rehabilitation: Can findings predict LOS, ambulation device, and discharge disposition?" Diss., NSUWorks, 2017. https://nsuworks.nova.edu/hpd_pt_stuetd/71.
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Background: Total knee arthroplasty (TKA) is the treatment of choice for end-stage knee osteoarthritis. Growth in the number of procedures performed annually in the United States is expected to increase steadily. Post-operative rehabilitation settings vary and include both institutional and community based physical therapy (PT) services. Despite access to PT, deficits in gait often persist for months and even years after surgery. Slow gait speed, asymmetrical walking patterns, and prolonged time in double-limb support following the TKA often lead to the need for an assistive device for walking and prolong the rehabilitation phase. Purpose: The purpose of this study is to analyze early gait during inpatient rehabilitation to quantify both the improvements made and deficits that remain in important gait variables. This study identifies predictor variables that contribute to the variance in discharge ambulation device use and IRF length of stay. Subjects: A convenience sample of 230 patients discharged to an IRF following a TKA (160 following a single TKA and 70 following a bilateral procedure) was used for this analysis. Method: Paired t-tests were used to compare temporal and spatial gait variables from the initial gait assessment compared to the discharge gait assessment in patients following single TKA to determine remaining deficits. Right vs left comparisons were made for patients following a bilateral procedure. A binary logistic regression was used to identify predictors associated with the need for a two-handed ambulation device at discharge. A multiple linear regression developed a model to assess predictors of the inpatient rehabilitation length of stay. Finally, a self-assessment to evaluate patient confidence with walking (mGES scale) was correlated to actual gait speed performed on the gait analysis in a sample of patients from our study population. Findings: Deficits in step length, step time and percent of single limb support remained in the involved limb compared to uninvolved limb at discharge from inpatient rehabilitation following single TKA; no limb differences between the right and left side were noted in patients after bilateral TKA. The discharge gait speed of 54.6 cm/sec for single TKA patients and discharge speed of 61.5 cm/sec for bilateral TKA patients is within the classification of limited community ambulators and making them appropriate for a home discharge. But despite improvement from admission to discharge, the gait speed for both groups in our study remain below the gait speed identified by prior studies 3-months following TKA surgery where speed reached 135 cm/sec. The need for a two-handed ambulation device, such as bilateral canes or a walker, was associated with slow walking speed and prior use of a device before surgery. A longer rehabilitation length of stay was associated with slower initial gait speed, lower motor FIM scores and reduced knee extension at admission. The mGES patient self-report conducted at the time of the discharge gait assessment showed a moderate correlation to the discharge gait speed; however, the pairing of the admission mGES with the admission gait speed was not significantly correlated.
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Westby, Marie D. "First steps in developing clinical practice guidelines for post-acute rehabilitation after primary total hip and knee arthroplasty." Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/23734.
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Total hip (THA) and total knee arthroplasty (TKA) are cost-effective interventions for advanced osteoarthritis (OA) of the knee and hip. With the rapidly growing number of these procedures performed annually in Canada and the United States, greater attention needs to be directed to identify rehabilitation practices that optimize outcomes and minimize cost. Currently, there is no consensus on rehabilitation best practice and no evidence-based clinical practice guidelines to inform clinical decision-making on post-acute rehabilitation following THA and TKA.
A multi-phase, mixed-method project integrated stakeholder perspectives, research evidence and expert opinion to develop best practice recommendations for THA and TKA rehabilitation. Chapter 2 involved 11 focus groups and eight interviews to identify key themes related from North American patients and health care professionals on rehabilitation practices and outcomes. Chapters 3-4 are Cochrane systematic reviews examining the strength of the evidence for post-acute physiotherapy after THA and TKA. Chapter 5-6 involved two parallel Delphi surveys with consumers, clinicians and researchers to develop consensus on a range of rehabilitation topics to inform best practice for THA and TKA rehabilitation.
Chapter 2: Six key themes emerged relating to communication, patient expectations, patient attitude, forms of support, barriers to recovery, and diversity of outcomes. Chapters 3-4: Systematic reviews of THA (n=8) and TKA (n=7) trials revealed limited, low to high quality evidence with mixed findings for various forms of post-acute physiotherapy on pain, function and health-related quality of life. Trial heterogeneity prevented meta-analysis. Chapters 5-6: Consensus (80% agreement) was reached on the need for post-acute rehabilitation, types of interventions, rehabilitation providers, treatment settings, outcomes and outcome measurement. Consensus was not reached regarding timing and dosage of rehabilitation. Sub-group analysis revealed few differences comparing responses by profession, primary role and country.
This thesis has taken important first steps in identifying appropriate rehabilitation interventions and health care resources to optimize individuals’ activity, participation and health-related quality of life after THA and TKA. Further, it highlights the need for more high quality research to address the knowledge gaps and inform policy on this important and understudied aspect of arthroplasty surgery.Medicine, Faculty of
Graduate
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Silver, Madison D. "Insight into the dominant personality traits and preferred coping methods of a female basketball player undergoing knee rehabilitation." Thesis, California State University, Long Beach, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10111159.
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How well an athlete copes with his/her injury can improve their quality of life on and off of the playing field. Previous research has suggested that personality traits might be linked to an individual’s preferred coping method (Johnson, 1997; Karimzade & Besharat, 2011; Nicholls & Polman, 2007). Therefore, the purpose of this study was to gather insight into a female basketball player’s dominant personality traits and coping methods while undergoing knee rehabilitation. The study included a Big Five personality assessment and a semi-structured interview. The participant was an 18-year-old female Division 1 basketball player rehabilitating an anterior cruciate ligament and meniscus repair. Agreeableness, conscientiousness, and openness to experience received equal dominance scores, and the transcript revealed four major themes: Aids to coping, inhibitors to coping, challenges, and positive characteristics. Problem-focused and emotion-focused coping were of almost equal use. The study revealed a trait combination that literature has yet been discussed.
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Dreyer, Sonette. "An investigation into the immediate effect of patellar taping on knee control in patients with adult acquired hemiplegia due to stroke." Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/1671.
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Thesis (MScPhysio (Physiotherapy))--University of Stellenbosch, 2009.The ability to walk has been rated by stroke patients as one of the most important goals of their rehabilitation. Knee control is a key element in normal gait. Currently, treatment options aimed at improving poor knee control in stroke patients are often costly, need specialised equipment and have poor patient compliance. The purpose of the current study was to assess whether medial patellar taping could improve knee control in stroke patients. Gait speed, dynamic standing balance, knee alignment and whether the subjects experienced any subjective stabilising effect on the knee after taping were tested. Twenty subjects diagnosed with hemiplegia after a stroke served as their own controls in a repeated measures experimental study. Results indicated that dynamic standing balance as tested by the Step Test (p=0.063) and the Timed-up-and-go test (p=0.099) (Wilcoxon test) showed marginal improvement after taping. This improvement in dynamic standing balance may indicate that neuro-motor control and/or eccentric knee control had improved. There was no change in walking speed and knee alignment as tested by change in the Q-angle (Wilcoxon test). However, a decrease in the Q-angle correlated with an improvement in dynamic standing balance as tested by the Step Test (p=0.029) (Spearman‟s test). Participants with decreased Q-angles after taping possibly had better knee alignment and were more willing to accept weight on their affected leg indicating a change in quadriceps activation. No change in walking speed (p=0.351) (Wilcoxon test) before and after taping may indicate that there was no change in the magnitude of contraction and/or concentric activity in the quadriceps muscle. Thirty percent of the participants reported a subjective change in knee stability after taping. Subjective change did not, however, significantly correlate with either of the balance tests, walking speed or Q-angle measurements. The possibility that medial patellar taping may be useful in treating poor knee control in stroke patients during dynamic balance activities should be investigated further.
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Nathan, M. "Post-menisectomy atrophy of the quadriceps femoris : the role of the pneumatic tourniquet and the effects of exercise rehabilitation." Thesis, University of Cape Town, 1985. http://hdl.handle.net/11427/26341.
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Del, Bel Michael. "Knee Stabilisation Strategies During an Isometric Weight-Bearing Force-Matching Task in Males and Females After ACL Injury." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/35897.
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The anterior cruciate ligament (ACL) plays an important role in knee joint stability, and unfortunately is one of the most commonly injured knee joint structures. The muscles surrounding the knee are also critical for stabilising the knee joint and their activations are altered following ACL injury. Despite the fact that ACL injuries are up to 8 times more likely to occur in females compared to males, there is limited research evaluating the effects of sex on how ACL-deficient individuals adjust neuromuscular control strategies during varying loading conditions. In order to have clinicians implement optimal rehabilitation strategies for ACL-deficient males and females, it is crucial to understand the adaptive functional strategies that are taking place once an ACL injury has occurred. The purpose of this thesis was therefore to provide objective and quantitative measurements describing the functional roles of muscles surrounding the knee. This was accomplished and outlined in this thesis through two chapters in manuscript format and summarised below.
i) Sex and ACL-deficiency influence functional muscle roles during an isometric, weight-bearing, force-generation task
First, the functional roles of muscles were quantified through the assessment of muscle activations during a series of multi-directional force-production tasks in ACL-deficient males and females while weight bearing. A highly controlled, isometric, force-matching task, whereby participants modulated ground reaction forces in various combinations of sagittal and frontal plane loads was used to quantify force-generation strategies (muscle activations and functional role) of the knee joint. Mean activation magnitudes and profile patterns from 10 muscles in the lower extremity (rectus femoris, vastus lateralis, vastus medialis, biceps femoris, semitendinosus, lateral gastrocnemius, medial gastrocnemius, tensor fascia latae, adductor muscle group, and gluteus medius) were recorded using wireless electromyography (EMG) sensors. Their activations were quantified with an orientation analysis to determine if differences in functional muscle roles existed between four groups; healthy female controls, healthy male controls, ACL-deficient females, and ACL-deficient males.
Overall, different functional muscle roles were found between groups. Healthy male controls activated their muscles the most specifically; females with ACL-deficiency activated their muscles the least specifically, while healthy female controls and males with ACL-deficiency shared similar functional muscle roles. This suggests that there was a specificity hierarchy in the ability, or efficiency, to modulate the activation of muscles about the knee joint when exposed to various directional loading conditions.
ii) Associations between subjective measures of knee dysfunction and measures of ground reaction forces in ACL-deficient males and females
Correlational relationships were evaluated between perceived knee joint function and functional capacity of the knee joint. These relationships were calculated between patient reported outcome measures (PROM) from commonly used knee assessment scoring scales maximal generated forces in the sagittal and frontal planes.
Both ACL-deficient groups had significantly lower perceived knee joint function compared to healthy controls. A trend towards significance was observed in the ability to generate maximum forces in the sagittal and frontal planes, with ACL-deficient females generating smaller maximal posterior GRFs compared to healthy females. Only two statistically significant correlations (both for ACL-deficient females) were found between maximal medial GRFs and patient reported outcome measures from the Lysholm and Tegner scoring scales. This indicates that there may be a discrepancy in the sensitivity of subjective outcome measures between sexes and their corresponding ability to generate maximum GRFs.
In conclusion, sex differences exist in subjective outcome measures and the functional strategy of neuromuscular control of the knee joint both before and after ACL-injury. The results of this thesis indicate the need for sex-specific tailoring of rehabilitation programs, thus providing an opportunity to improve the success rate of rehabilitation following ACL-injury. Moreover, sensitivity of subjective outcome measures and their relation to simple, practical, functional tasks between sexes warrants further investigations.
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Joss, Brendan Keith. "Clinical and biomechanical outcomes following unicondylar knee arthroplasty with Preservation fixed and mobile bearing tibial components." University of Western Australia. School of Surgery and Pathology, 2007. http://theses.library.uwa.edu.au/adt-WU2007.0079.
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[Truncated abstract] Unicondylar knee arthroplasty (UKA) has re-emerged as a successful treatment option for isolated single compartment tibio-femoral joint osteoarthritis. However despite its increasing use, controversy still remains over fixed or mobile bearing tibial components, as there is a lack to prospective randomised studies reported in the literature. In addition, the theoretical advantages of the mobile bearing for knee kinematics, kinetics and clinical outcome have not been evaluated in vivo. The aim of this research study was to explore the clinical and biomechanical outcomes of the fixed and mobile bearing UKA. . . . When the results for the both studies were combined, utilising the Preservation and MG fixed bearing prostheses, there was a significant relationship between knee adduction moment, and a poor prognosis predicted from RSA. Those patients with translation or rotation of the tibial component in any direction above 1mm and 1.5 degrees respectively were considered to have a poor prognosis for long term fixation. Of the 28 patients, the 8 patients considered to have a poor prognosis, had increased knee adduction moments post-surgery (mean difference = 1.66Nm.kg-1, p = 0.007). There was no difference between the groups for knee flexion moment (mean difference 0.16Nm.kg-1, p = 0.844). Pre-surgery gait was unable to predict the post-surgery outcome, due to the significant changes in gait from pre- to post-surgery. Care must taken when implanting the Preservation mobile bearing prosthesis, as long term outcome is questionable. The mobile bearing prosthesis also produced the worst clinical outcome, however the theoretical advantages of the mobile bearing does not affect gait. Gait analysis is a useful tool to identify patient who are overloading their prosthesis, leading to potential early failure. Identification of these gait patterns can allow for early intervention to reduce joint load, and possible extend the longevity of the prosthesis.
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Brink, Marisa. "The effects of backward locomotion as part of a rehabilitation program on the functional ability of patients following knee injury." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/5392.
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Thesis (M Sport Sc (Sport Science)--University of Stellenbosch, 2010.ENGLISH ABSTRACT: Knee injuries are common among the physically active population and are often severe enough that it requires surgery. Rehabilitation specialists are on the constant look-out for the most efficient and cost-effective treatment alternatives to provide athletes with an early return to sport. The inclusion of backward locomotion in knee rehabilitation programs has been proposed since it is considered a safe closed kinetic chain exercise which has been found to increase quadriceps strength and power as well as cardiorespiratory fitness. The primary aim of the study was to establish the efficacy of backward locomotion training during a knee rehabilitation program. Thirty nine men and women (aged 18 to 59 years) with knee pathologies volunteered for the study and were randomly assigned to the experimental group (EXP, n = 20) and control group (CON, n = 19). All participants underwent a 24 session knee rehabilitation program which included 20 – 30 minutes of cardiorespiratory training, either in backward mode (EXP), or forward mode (CON). Aerobic fitness, quadriceps and hamstrings strength and power, single leg balance, lower limb circumferences, and lower limb flexibility were measured before and after the rehabilitation program. Backward locomotion training resulted in a borderline statistical significant improvement in ventilatory threshold (VT) (p = 0.07) and a statistical significant improvement in peak power output (PPO) (p < 0.05). The VT and PPO of the backward locomotion group increased by 9 and 14%, respectively, compared to 0 and 4% in the forward locomotion group. Both groups showed statistically significant improvements in quadriceps and hamstrings strength, except the quadriceps of the uninvolved leg of the forward locomotion group. Similarly, both groups showed a statistically significant improvement in quadriceps and hamstrings average power, except the quadriceps of the uninvolved leg of the forward locomotion group. Single leg balance of the involved and uninvolved legs improved statistically significantly in both groups (p < 0.05). The differences in change between the two interventions were not statistically significantly different (p > 0.05) and the practical differences were small (ES ± 0.2). No statistically significant differences in the change in leg circumferences were observed between the two groups. Only the change in flexibility of the involved soleus was significantly different between the EXP and CON groups. The results show that backward locomotion training result in greater improvements in aerobic fitness and equal or greater improvements in quadriceps and hamstrings muscle strength and power, compared to forward locomotion training. Backward locomotion as well as forward locomotion contributes to the recovery of knee injuries, however, the practical significance of backward locomotion is greater than for forward locomotion. The conclusion of this is that backward locomotion is a better alternative rehabilitation program for athletes as this will affect a quicker return to their sport.
AFRIKAANSE OPSOMMING: Kniebeserings kom algemeen voor in die fisiek aktiewe bevolking en is dikwels so ernstig dat dit chirurgie vereis. Rehabilitasie-spesialiste is voortdurend op soek na die mees doeltreffende en koste-effektiewe alternatief vir behandeling om die atlete vinnig te laat terugkeer na hul sport. Die insluiting van agteruitbeweging in knie-rehabilitasieprogramme is al in die verlede voorgestel, aangesien dit beskou word as 'n veilige geslote-kinetieseketting oefening wat al geskik bevind is om quadriceps sterkte en krag, asook kardiorespiratoriese fiksheid te verbeter. Die hoofdoel van die studie was om die effektiwiteit van agteruitbewegingoefening in 'n knierehabilitasieprogram te bepaal. Nege-en-dertig mans en vroue (tussen die ouderdom van 18 en 59 jaar) met kniepatologieë het vrywillig ingestem om aan die studie deel te neem en is lukraak verdeel in die eksperimentele groep (EXP, n = 20) en kontrole groep (CON, n = 19). Alle deelnemers het 24 sessies voltooi waarvan 20 – 30 minute kardiorespiratoriese oefeninge was. Dit het óf in die agteruitrigting (EXP), óf vorentoe-rigting (CON) plaasgevind. Aërobiese fiksheid, quadriceps en hamstrings sterkte en krag, eenbeenbalans, omtrekke van die onderste ledemaat, en soepelheid van die onderste ledemaat is gemeet, voor en na die rehabilitasieprogram. Agteruitbeweging-oefening het 'n geringe verbetering in ventilatoriese draaipunt (VT) (p = 0.07) opgelewer wat grens aan 'n statisties betekenisvolle verbetering, asook 'n statisties betekenisvolle verbetering in piek kraguitset (PPO) (p <0.05). Die VT en PPO van die agteruitbeweging groep het onderskeidelik verbeter met 9 en 14%, in vergelyking met 0 en 4% in die vorentoe-beweging groep. Beide groepe het statisties betekenisvolle verbeteringe in quadriceps en hamstrings sterkte getoon, behalwe die quadriceps van die onbeseerde been van die vorentoe-beweging groep. Soortgelyk daaraan het beide groepe statisties betekenisvolle verbeteringe in quadriceps en hamstrings gemiddelde krag getoon, behalwe die quadriceps van die onbeseerde been van die vorentoe-beweging groep. Eenbeenbalans van die beseerde en onbeseerde bene het statisties betekenisvol verbeter in beide groepe (p < 0.05). Die verskil in verandering tussen die twee intervensies was nie statisties betekenisvol verskillend nie en die praktiese verskil was klein (ES ± 0.2). Geen statisties betekenisvolle verskille is waargeneem tussen die twee groepe in die verandering in beenomtrekke nie. Slegs die soepelheid van die beseerde soleus van die EXP groep het statisties betekenisvol verbeter tussen die twee groepe. Die resultate toon dat agteruitbeweging-oefening tot groter verbetering gelei het in aërobiese fiksheid en gelyke of groter verbetering in quadriceps en hamstrings sterkte en krag, in vergelyking met vorentoe-beweging oefening. Agteruitbeweging-oefening sowel as vorentoe-beweging oefening dra by tot die herstel van kniebeserings, maar die praktiese beduidendheid van agteruitbeweging-oefening is groter as vorentoe-beweging oefening. Die gevolgtrekking van die studie is dat agteruitbeweging 'n beter alternatiewe rehabilitasieprogram vir atlete is, met 'n gevolglike vinniger terugkeer na hul sport.
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Hoglund, Lisa T. "The Biomechanics of Sit-to-Stand and Physical Performance in Patellofemoral Osteoarthritis." Diss., Temple University Libraries, 2009. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/28196.
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Physical TherapyPh.D.
Osteoarthritis (OA) of the knee is common in Western society. OA of the patellofemoral (PF) compartment of the knee is prevalent in adults greater than 55 years of age. Isolated radiographic PFOA is present in 13.6-24% of females and 11-15.4% of males with knee pain. Biomechanical factors such as tibiofemoral alignment and high joint stress are associated with the development and progression of PFOA. PF joint stress is high when the quadriceps contracts with the knee in a position of extreme flexion, such as rising from sitting. The purposes of this study were to determine 1) the triplanar biomechanics of the hips and knees during sit-to-stand (STS) for persons with PFOA versus age- and gender-matched control subjects, 2) the impact of PFOA on physical performance, perceived functional status, and pain, and 3) the relationship between knee kinematics during STS and physical performance. The biomechanics of STS was examined using a video-based motion analysis system and two force plates. Physical performance was measured with the Timed Up and Go (TUG) and Fifty-Foot Walk (FFW) tests. Perceived functional status, pain, and stiffness were measured using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire. Knee pain was measured with a Visual Analog Scale (VAS) following STS, TUG, and FFW. Persons with PFOA required a significantly longer time to perform STS and the TUG as compared to healthy controls. The PFOA group demonstrated greater hip flexion and knee abduction versus the control group. The hip and knee moments were significantly different with the PFOA group demonstrating greater hip extension, hip abduction, hip external rotation, knee extension, and knee adduction moments. Persons with PFOA were found to have significantly less perceived physical function, greater stiffness, and greater pain. Pain following STS, TUG, and FFW were all greater in the PFOA group. No significant association was found between any knee angle and time to perform the TUG or the FFW. These results indicate that dynamic malalignment of the TF joint is present during STS in persons with PFOA. This may contribute to the increased pain and decreased function in persons with PFOA.
Temple University--Theses
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Shepherd, J. "Factors affecting perceived exertion and task duration during intermittent isometric fatiguing exercise and their implications for rehabilitation following knee surgery." Thesis, Nottingham Trent University, 2012. http://irep.ntu.ac.uk/id/eprint/132/.
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It has been theorised that self-perception is integral to the regulation of exercise and production of an optimal performance. This concept has not been examined in an anterior cruciate ligament (ACL) reconstructed population where the consequences of injury and surgery may provide a substantive perturbation to perceptual capabilities. Ratings of perceived exertion (RPE) have previously been shown to enable prediction of exercise task duration (TD) during running and cycling activities in healthy individuals, but this has yet to be explored in intermittent and isolated muscle exercise that is typically utilised during resistance training and ACL rehabilitation. Accordingly, this thesis investigated: i) the relationship between self-perceived knee function and objective measures of musculoskeletal performance at a range of time-points across the ACL-rehabilitation period; ii) the relationship between two paradigms of self-perception (RPE; perceived TD) and TD in healthy individuals during an intermittent isometric fatigue task (IIF) under various conditions of increasing exercise stress. Self-perceived knee function measured via subjective rating scales was only moderately correlated with objective performance towards the latter stages of the rehabilitation period, highlighting a disparity between perceived and actual capabilities during the early to intermediate stages of recovery (pre-surgery to 24 weeks). In contrast to previous research in running and cycling exercise, the investigation of self-perception and TD during an IIF revealed evidence of both linear and curvilinear trends in perceptual response. Linear trends were observed at exercise intensities of 60% to 80% of baseline volitional peak force, whilst curvilinear patterns of response were apparent at intensities of 60% peak force, and under conditions of exercise-induce muscle damage. Evidence of a negatively accelerating curvilinear response may reflect an underestimation of performance, and questions the utility of self-perception to predict TD in isolated muscle exercise. These combined findings highlight a need for further research before confirming the efficacy of self-perception with regard to regulating exercise during rehabilitative-type activities.
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McDonald, David A. "Does the peri-operative analgesic method affect rehabilitation outcomes as part of an enhanced recovery programme following total knee arthroplasty?" Thesis, Glasgow Caledonian University, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.688311.
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Tiškienė, Živilė. "Kineziterapija gydant kelio sąnario osteoartrozę ambulatorinės reabilitacijos metu." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2008. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2007~D_20080206_144146-57334.
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Osteoartrozė – viena dažniausių vyresnio amžiaus žmones varginančių ligų. Progresuojanti liga luošina ligonius, labai nukenčia jų gyvenimo kokybė ir yra viena neįgalumo priežasčių. Ligos gydymas reikalauja ypatingos sveikatos apsaugos sistemos dėmesio ir lėšų. Kadangi ligos paplitimas tiesiogiai susijęs su amžiumi, prognozuojama, kad ateityje, didėjant vyresnio amžiaus žmonių skaičiui, sergamumas osteoartroze dar labiau padidės, atitinkamai didės ir gydymo išlaidos.
Gydant ligą, kartu su kitais metodais, taikoma kineziterapija. Sergant kelių sąnarių osteoartroze, ligonių mokymas ir kineziterapijos taikymas mažina skausmo intensyvumą ir gerina funkcines galimybes (Dieppe et al, 2001).
Tyrimo metodai ir organizavimas. Tyrime dalyvavo sergantieji kelių sąnarių osteoartroze, savanoriškai sutikę dalyvauti. Jiems taikytas ambulatorinės reabilitacijos gydymo kompleksas. Tiriamieji buvo suskirstyti į dvi skirtingo amžiaus grupes: iki 60 metų (n=12) ir virš 60 metų (n=18). Abiem grupėms taikyta tokia pati kineziterapijos programa. Tiriamiesiems skirtos 5 kineziterapijos procedūros po 30 min. Dėl mažo kineziterapijos procedūrų skaičiaus ir tiriamųjų nesistemingo procedūrų lankymo, rekomenduota kineziterapiją atlikti ir savarankiškai, namuose. Vertintas skausmo stiprumas pagal VAS skalę, funkcinė būklė – pagal modifikuotą Keitel indeksą, kelio sąnario lenkimo judesio amplitudė, blauzdos raumenų – tiesėjų jėga – pagal 5 balų Lovett skalę. Visi tyrimai atlikti per pirmą ir pakartoti per... [toliau žr. visą tekstą]Osteoarthritis is one the most common illnesses amongst elderly people. An ingravescent illness maims patients, exacerbating quality of their lives and therefore this is one of the causes of their physical disability. Treatment of this illness requires a special attention of the health service system and funds. Since pervasion of the illness is directly related with age, there are some predictions that with an increasing number of the elderly people, morbidity of osteoarthritis will increase also; medical costs will be increasing respectively. This illness, together with the other methods, is being cured by the physiotherapy. If the patients suffer of the kneel joints osteoarthritis, patients training and application of the physiotherapy decreases intensity of the pain and improves functional capabilities. (Dieppe et al, 2001). Methods of the research and organization. Volunteers, having knee joint osteoarthritis, attended this research process. They received an ambulatory treatment complex. Exploratory group was divided into two parts: under 60 years (n =12) and over 60 years (n =18). Both groups received the same type of the program – 5 physiotherapy procedures up to 30 minutes. Due to the little number of the procedures and facultative attendance of the patients, there were made recommendations to perform physiotherapy procedures at home. There were evaluated the following facets – pain intensity according to the VAS scale, functional state according to the modified... [to full text]