Towards a precision rehabilitation approach for post-stroke stiff knee gait

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-06-06 DOI:10.1016/j.clinbiomech.2025.106587

Bente E. Bloks , Noël L.W. Keijsers , Wieneke van Oorschot , Alexander C. Geurts , Jorik Nonnekes

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引用次数: 0

Abstract

Background

Stiff knee gait, characterized by reduced knee flexion during swing, may arise from rectus femoris spasticity or inadequate pre-swing biomechanics. Difficulty in identifying each factor's contribution complicates clinical management. This study aimed to develop a predictive model for determining the contribution of inadequate pre-swing biomechanics to stiff knee gait in people with stroke.

Methods

This historic cohort study analyzed gait data of 122 people with stroke and 20 healthy controls walking at four speeds. Linear regression analyses examined the relationship between pre-swing biomechanics and peak knee flexion in healthy controls. The pre-swing biomechanical measure explaining most of the variance in peak knee flexion was used in the predictive model, which was then applied to stroke data.

Findings

Peak knee flexion angles of people with stroke were lower compared to healthy controls (stroke: 41 ± 16°; healthy controls: 61 ± 5°, 52 ± 8°, 57 ± 6°, and 61 ± 4° for self-selected walking speed, 0.4 m/s, 0.8 m/s, and 1.2 m/s, respectively). For healthy controls, peak knee flexion variance was best explained by combined pre-swing ankle and hip work (R² = 0.58). For 65 % of people with stroke, peak knee flexion fell above the lower bound of the regression model's prediction interval, suggesting stiff knee gait may primarily be caused by inadequate ankle push-off and hip pull-off.

Interpretation

Our predictive model holds the potential to improve treatment selection by determining the impact of inadequate pre-swing biomechanics on stiff knee gait. In many participants, peak knee flexion was explained by pre-swing biomechanics, highlighting their key role in stiff knee gait.

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卒中后膝关节僵硬步态的精准康复方法研究

背景：以摆动时膝关节屈曲减少为特征的膝关节僵硬步态，可能是由股直肌痉挛或摆动前生物力学不充分引起的。难以确定每个因素的贡献使临床管理复杂化。本研究旨在建立一个预测模型，以确定不充分的摆动前生物力学对中风患者膝关节僵硬步态的影响。方法对122名中风患者和20名健康对照者以四种速度行走的步态数据进行分析。线性回归分析检验了健康对照组摆动前生物力学与膝关节屈曲峰值之间的关系。在预测模型中使用了摆动前的生物力学测量，解释了膝关节屈曲峰值的大部分差异，然后将其应用于中风数据。与健康对照组相比，卒中患者的膝关节屈曲角度较低(卒中：41±16°；健康对照组：61±5°、52±8°、57±6°和61±4°，自行选择步行速度，分别为0.4 m/s、0.8 m/s和1.2 m/s)。对于健康对照组，膝关节屈曲峰值方差最好解释为摆动前踝关节和髋关节的联合运动（R2 = 0.58）。对于65%的中风患者，膝关节屈曲峰值落在回归模型预测区间的下界之上，这表明膝关节僵硬的步态可能主要是由于踝关节蹬离和髋关节蹬离不足引起的。我们的预测模型通过确定不充分的前摆生物力学对膝关节僵硬步态的影响，具有改善治疗选择的潜力。在许多参与者中，摆动前的生物力学解释了膝关节屈曲的峰值，强调了它们在僵硬的膝关节步态中的关键作用。

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.