Name: the lower body positive pressure treadmill for knee osteoarthritis rehabilitation
Uploaded: 2019-07-22T13:30:00.000+00:00
Duration: 9 min 10 s
Description: Watch this Scientific Journal Video about The Lower Body Positive Pressure Treadmill for Knee Osteoarthritis Rehabilitation at JoVE.com

This study was funded by Guangzhou Medical University (Grant Number 2018A053).

The clinical project was approved by the Medical Ethics Association of the Fifth Affiliated Hospital of Guangzhou Medical University and has been registered at the China Clinical Trial Registration Center (No. ChiCTR1800017677 and entitled &#8220;Effect and Mechanism of Anti-gravity Treadmill on Lower Limb Motor Function in Patients with Knee Osteoarthritis&#8221;).
1. Recruitment
<ol>
	<li>Recruit patients presenting with radiographic evidence of mild-to-moderate (Kellgren &#38; Lawrence grades II or III) knee OA in one or both knees and knee pain when walking, squatting, and/or kneeling (the minimum level 3/10 on numerical pain rating scale [NPRS] before inclusion).</li>
	<li>Ensure that these patients have no severe knee OA (Kellgren &#38; Lawrence grade IV), retropatellar arthritis or any medical condition that would prevent them from tolerating progressive training.</li>
	<li>Obtain written informed consent from each patient before their participation.</li>
</ol>
2. Pre-training evaluation
<ol>
	<li>Complete demographic forms of the patient including weight, height, past medical history and any past or current medications.</li>
	<li>Clinical assessment
	<ol>
		<li>Conduct the numerical rating scale (NRS)14. Ask the patient to describe the pain intensity with 11 numbers from 0 to 10, where 0 is no pain and 10 is the worst pain.</li>
		<li>Conduct the active/passive knee joint range-of-motion (ROM) assessment15 using a handheld 2-arm goniometer (26-cm arms with 2&#176; markings).</li>
		<li>Conduct the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)16. Ask the patient to mark the corresponding position of pain or limited function on a straight line for 5 pain-related items, 2 stiffness items, and 17 functional items. &#8220;0&#8221; indicates no pain or no function limitation. &#8220;10&#8221; indicates severe pain or extreme limited function.</li>
		<li>Conduct the Knee Injury and Osteoarthritis Outcome Score (KOOS)17 (optional). Ask the patient to finish the self-evaluation questionnaire with five-level for each item in five subscales: pain, other symptoms, activities of daily living, sports, and recreation.</li>
		<li>Conduct the European five-dimensional health scale (EQ-5D)18 (optional). Ask the patient to mark the three-level for five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.</li>
		<li>Conduct the 10-meter walk test (10 MWT)19. Ask the patient to perform three consecutive 10 MWT trials at a self-selected pace for safety and comfort. Ask the patient to walk without assistance for 10 m and measure the time taken for the middle 6 m (to exclude acceleration and deceleration effects).</li>
		<li>Conduct the timed up and go (TUG) test20. Ask the patient to perform three consecutive TUG trials (stand up, walk 3 m, turn, walk back, and sit down) at a self-selected pace (for safety and comfort).</li>
	</ol>
	</li>
	<li>Perform the three-dimensional (3D) gait analysis (optional). 
	NOTE: 3D gait and concurrent electromyography (EMG) analyses are not required for this LBPP training protocol, but can be used for further objective assessments as needed.
	<ol>
		<li>Position twenty-two spherical markers on the patient&#8217;s anatomical landmarks based on the Davis protocol21.</li>
		<li>Position six surface EMG electrodes on the bilateral rectus femoris, semitendinosus, and long head biceps femoris of the patient.</li>
		<li>Perform calibration in the standing position. Ask the patient to hold an orthostatic position for at least 3&#8722;5 s with the feet aligned in order to avoid having one foot in a more anterior or posterior position with respect to the other.</li>
		<li>Instruct the patient to walk with a self-selected speed along the 5-m walkway, five times.</li>
		<li>Remove all the spherical markers and EMG electrodes from the patient. Save all the collected data for data processing later following the instructions in section.</li>
	</ol>
	</li>
</ol>
3. LBPP training
NOTE: An anti-gravity treadmill (Table of Materials) was used for this LBPP training protocol and shown in Figure 1. For patient safety, a therapist is required to set up the patient in the LBPP and supervise the whole treatment process.
<ol>
	<li>Preparation
	<ol>
		<li>Patient preparation
		<ol>
			<li>Introduce the specific LBPP treadmill training process and related precautions to the patient.</li>
			<li>Check the patient&#8217;s blood pressure (BP) and heart rate (HR) before training (60 bpm &#8804; HR &#8804; 120 bpm and 90/60 mmHg &#8804; BP &#8804; 160/100 mmHg).</li>
			<li>Determine the size of the air seal shorts according to the waist circumference of the patient and ask the patient to put on the shorts.</li>
		</ol>
		</li>
		<li>Anti-gravity treadmill setting up
		<ol>
			<li>Turn on the treadmill by operating the switch located on the front cover of the system and run the self-testing of the anti-gravity treadmill.</li>
			<li>Lower the cockpit and have the patient step into the fabric enclosure of the anti-gravity treadmill.</li>
			<li>Lift the cockpit to the appropriate height according to the LBPP training model: the cockpit height should be at the anterior superior iliac spine for the walking model and slightly below the femur&#8217;s greater trochanter for the squatting model. Once the cockpit is in place, zip the patient into the anti-gravity treadmill.</li>
			<li>Use the safety lanyard supplied with the machine to secure the clip onto patient&#8217;s clothing, which is essential for emergency stopping during the training process (in case the patient falls or does not feel well).</li>
			<li>Instruct the patient to stand still on the surface of the treadmill belt to allow the system to hold and weigh the patient&#8217;s full body weight (BW) without any support from any part of the system and then press the start button to perform an anti-gravity treadmill system calculation for accurate unweighting.</li>
			<li>Place three cameras supplied with the machine (in front and bilaterally, Figure 1) and adjust the positions to obtain the synchronized video feedback during the training process; this will help the patient correct abnormal movement patterns.</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Training session 
	NOTE: The whole training session is performed for 30 min, six times a week for two weeks. The main parameters that need to be adjusted with the &#8220;+&#8221; and &#8220;&#8211;&#8221; button controls in the LBPP console are speed (miles per hour, mph), BW support (%), incline (%) and knee&#8217;s active range-of-motion (AROM).
	<ol>
		<li>Start the warm-up session with the following settings: 5 min (speed = 0&#8722;2.0 mph, BW = 65%, incline = 0%). Increase speed by 0.4 mph and BW support in 7% increments per minute.</li>
		<li>Perform the walking model session with the following settings: 15 min (speed = 2.0 mph, BW = 65%, incline = 0%).</li>
		<li>Perform the cool-down session with the following settings: 5 min (speed = 2.0&#8722;0 mph, BW = 65%&#8722;100%, incline = 0%). Decrease speed by 0.4 mph and BW support in 7% decrements per minute.</li>
		<li>End up with the squatting model session with the following settings: 5 min (speed = 0 mph, BW = 50%, incline = 0%, AROM = 0&#176;&#8722;50&#176; or the maximum tolerable joint range of motion within 50&#176;, 30 s of squatting followed by a 30 s rest period).		 NOTE: In the clinical application, this LBPP training session should be adjusted according to the patient&#8217;s tolerance. Moreover, if the patient cannot tolerate the squatting training model, only the walking mode is performed.</li>
	</ol>
	</li>
</ol>
4. Post-training evaluation
NOTE: The same therapist completes each patient&#39;s pre- and post-evaluation.
<ol>
	<li>Re-evaluate the patient after 2 weeks of the LBBP training session, including NRS, active/passive ROM, WOMAC, KOOS, EQ-5D, 10 MWT, TUG and 3D gait analysis.</li>
	<li>Record patient&#8217;s satisfaction and feedback on this LBPP protocol including the degree of enjoyment and self-conscious improvement, desire to continue, and suggestions.</li>
</ol>
5. 3D gait analysis data processing
<ol>
	<li>Run the gait analysis software (Table of Materials) included with the 3D gait analysis system.</li>
	<li>Define the events of heel-strike (right/left foot initial ground contact) and toe-off (right/left toes are lifted off the ground) in gait cycle for each walking trial (Figure 2).</li>
	<li>Obtain the spatiotemporal parameters, knee joint kinematics and surface EMG activity parameters.</li>
</ol>

<ol>
	<li>McAlindon, T. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=OARSI+guidelines+for+the+non-surgical+management+of+knee+osteoarthritis.">OARSI guidelines for the non-surgical management of knee osteoarthritis.</a> Osteoarthritis Cartilage. 22, 363-388 (2014).</li><li>Luyten, F. P., Denti, M., Filardo, G., Kon, E., Engebretsen, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Definition+and+classification+of+early+osteoarthritis+of+the+knee.">Definition and classification of early osteoarthritis of the knee.</a> Knee Surgery Sports Traumatology Arthroscopy. 20, 401-406 (2012).</li><li>Lankhorst, G. J., Van de Stadt, R. J., Van der Korst, J. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+relationships+of+functional+capacity,+pain,+and+isometric+and+isokinetic+torque+in+osteoarthrosis+of+the+knee.">The relationships of functional capacity, pain, and isometric and isokinetic torque in osteoarthrosis of the knee.</a> Scandinavian Journal of Rehabilitation Medicine. 17, 167-172 (1985).</li><li>Waugh, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Physical+activity+intervention+in+primary+care+and+rheumatology+for+the+management+of+knee+osteoarthritis:+A+review.">Physical activity intervention in primary care and rheumatology for the management of knee osteoarthritis: A review.</a> Arthritis Care &amp; Research. 71 (2), 189-197 (2019).</li><li>Segal, N. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+quadriceps+strength+and+proprioception+on+risk+for+knee+osteoarthritis.">Effect of quadriceps strength and proprioception on risk for knee osteoarthritis.</a> Medicine &amp; Science in Sports &amp; Exercise. 42, 2081 (2010).</li><li>Linda, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=EULAR+recommendations+for+the+non-pharmacological+core+management+of+hip+and+knee+osteoarthritis.">EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis.</a> Annals of the Rheumatic Diseases. 72, 1125-1135 (2013).</li><li>Watanabe, S., Someya, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+Body+Weight-supported+Walking+on+Exercise+Capacity+and+Walking+Speed+in+Patients+with+Knee+Osteoarthritis:+A+Randomized+Controlled+Trial.">Effect of Body Weight-supported Walking on Exercise Capacity and Walking Speed in Patients with Knee Osteoarthritis: A Randomized Controlled Trial.</a> Journal of the Japanese Physical Therapy Association. 16, 28-35 (2013).</li><li>Takacs, J., Anderson, J. E., Leiter, J. R., MacDonald, P. B., Peeler, J. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lower+body+positive+pressure:+an+emerging+technology+in+the+battle+against+knee+osteoarthritis?.">Lower body positive pressure: an emerging technology in the battle against knee osteoarthritis?.</a> Clinical Interventions in Aging. 8, 983-991 (2013).</li><li>Ruckstuhl, H., Kho, J., Weed, M., Wilkinson, M. W., Hargens, A. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparing+two+devices+of+suspended+treadmill+walking+by+varying+body+unloading+and+Froude+number.">Comparing two devices of suspended treadmill walking by varying body unloading and Froude number.</a> Gait &amp; Posture. 30, 446-451 (2009).</li><li>Peeler, J., Christian, M., Cooper, J., Leiter, J., MacDonald, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Managing+Knee+Osteoarthritis:+The+Effects+of+Body+Weight+Supported+Physical+Activity+on+Joint+Pain,+Function,+and+Thigh+Muscle+Strength.">Managing Knee Osteoarthritis: The Effects of Body Weight Supported Physical Activity on Joint Pain, Function, and Thigh Muscle Strength.</a> Clinical Journal of Sport Medicine. 25, 518-523 (2015).</li><li>Patil, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anti-gravity+treadmills+are+effective+in+reducing+knee+forces.">Anti-gravity treadmills are effective in reducing knee forces.</a> Journal of Orthopaedic Research. 31, 672-679 (2013).</li><li>Nicolas-Alonso, L. F., Gomez-Gil, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Brain+computer+interfaces,+a+review.">Brain computer interfaces, a review.</a> Sensors (Basel). 12, 1211-1279 (2012).</li><li>Webber, S. C., Horvey, K. J., Yurach Pikaluk, M. T., Butcher, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiovascular+responses+in+older+adults+with+total+knee+arthroplasty+at+rest+and+with+exercise+on+a+positive+pressure+treadmill.">Cardiovascular responses in older adults with total knee arthroplasty at rest and with exercise on a positive pressure treadmill.</a> European Journal of Applied Physiology. 114, 653-662 (2014).</li><li>Dolphin, N. W., Crue, B. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pain:+Clinical+Manual+For+Nursing+Practice.">Pain: Clinical Manual For Nursing Practice.</a> Clinical Journal of Pain. 5, 363 (1989).</li><li>Lavernia, C., D'Apuzzo, M., Rossi, M. D., Lee, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+of+Knee+Range+of+Motion+Assessment+After+Total+Knee+Arthroplasty.">Accuracy of Knee Range of Motion Assessment After Total Knee Arthroplasty.</a> The Journal of Arthroplasty. 23, 85-91 (2008).</li><li>Bellamy, N., Buchanan, W. W., Goldsmith, C. H., Campbell, J., Stitt, L. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+study+of+WOMAC:+a+health+status+instrument+for+measuring+clinically+important+patient+relevant+outcomes+to+antirheumatic+drug+therapy+in+patients+with+osteoarthritis+of+the+hip+or+knee.">Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee.</a> Journal of Rheumatology. 15, 1833-1840 (1988).</li><li>Collins, N. J., Misra, D., Felson, D. T., Crossley, K. M., Roos, E. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measures+of+knee+function:+International+Knee+Documentation+Committee+(IKDC)+Subjective+Knee+Evaluation+Form,+Knee+Injury+and+Osteoarthritis+Outcome+Score+(KOOS),+Knee+Injury+and+Osteoarthritis+Outcome+Score+Physical+Function+Short+Form+(KOOS-PS)+Knee+O.">Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS) Knee O.</a> Arthritis Care &amp; Research. 63, S208-S228 (2011).</li><li>Rabin, R., De-Charro, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=EQ-5D:+a+measure+of+health+status+from+the+EuroQol+Group.">EQ-5D: a measure of health status from the EuroQol Group.</a> Annals of Medicine. 33, 337-343 (2001).</li><li>Wirz, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effectiveness+of+automated+locomotor+training+in+patients+with+chronic+incomplete+spinal+cord+injury:+a+multicenter+trial.">Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: a multicenter trial.</a> Archives of Physical Medicine and Rehabilitation. 86, 672-680 (2005).</li><li>Shumway-Cook, A., Baldwin, M., Polissar, N. L., Gruber, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Predicting+the+probability+for+falls+in+community-dwelling+older+adults.">Predicting the probability for falls in community-dwelling older adults.</a> Physical Therapy. 77, 812-819 (1997).</li><li>Iii, R. B. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+gait+analysis+data+collection+and+reduction+technique.">A gait analysis data collection and reduction technique.</a> Human Movement Science. 10, 575-587 (1991).</li><li>Peeler, J., Ripat, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+low-load+exercise+on+joint+pain,+function,+and+activities+of+daily+living+in+patients+with+knee+osteoarthritis.">The effect of low-load exercise on joint pain, function, and activities of daily living in patients with knee osteoarthritis.</a> Knee. 25 (1), 135-145 (2018).</li><li>Escamilla, R. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Knee+biomechanics+of+the+dynamic+squat+exercise.">Knee biomechanics of the dynamic squat exercise.</a> Medicine &amp; Science in Sports &amp; Exercise. 33, 127-141 (2001).</li><li>Linschoten, R. V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+PEX+study+&#8211;+Exercise+therapy+for+patellofemoral+pain+syndrome:+design+of+a+randomized+clinical+trial+in+general+practice+and+sports+medicine+[ISRCTN83938749].">The PEX study &#8211; Exercise therapy for patellofemoral pain syndrome: design of a randomized clinical trial in general practice and sports medicine [ISRCTN83938749].</a> BMC Musculoskeletal Disorders. 7, 31 (2006).</li></ol>

The authors have nothing to disclose.

We proposed an LBPP treadmill intervention protocol, which includes both clinical assessment and treatment models, for the rehabilitation of lower extremity motor function in knee OA. Meanwhile, in response to the clinical symptoms and knee OA dysfunction, the treatment model includes not only a training section for walking in the LBPP protocol but also an innovative squatting training section, which aims to solve the daily dysfunction due to thigh muscle weakness and squatting difficulties in knee OA patients. To the best of our knowledge, this protocol is the first to include a squatting exercise regimen with un-weighting technology in knee OA patients.
The design of this protocol was based on five main points. First, pain and the resulting break are the main problem of patients with knee OA. This protocol aims to explore the potential effect of an anti-gravity treadmill for increasing the amount of exercise by reducing knee load and pain during exercise in knee OA patients22. Therefore, the inclusion criteria focused on knee OA patients with knee pain when walking, squatting, and/or kneeling. Second, WOMAC and KOOS are both widely used in clinics to assess the physical function of knee OA patients. WOMAC is used to assess symptoms associated with the condition of patients with OA of the knee and hip (five pain items, two stiffness items, and 17 joint function items) and to reflect the severity and therapeutic effects of arthritis16. The KOOS is a self-administered instrument used for evaluating knee-associated problems including knee joint injury and OA (42 items in five subscales: pain, other symptoms, activities of daily living, sports and recreation)17. Moreover, the EQ-5D is used to assess the general condition of patients, which includes five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression)18. Although this protocol is mainly focused on pain and physical function of mild to moderate knee OA patients, the KOOS and EQ-5D for a comprehensive evaluation of health is optional and recommended. Third, the LBPP training session consists of the walking and squatting modules. The walking module focuses on improving walking function and knee activity, and the squatting module focuses on the enhancement of the tight muscle strength23. It is noticeable, however, that retropatellar arthritis should be excluded from our LBBP training protocol due to tight anatomical structures (mis-tracking of the patella through the femoral groove) and the squatting-induced heavy physical loading pressure, which can aggravate pain24. Meanwhile, if the patient cannot tolerate the squatting training model, only the walking mode is performed. Fourth, gradual warm-up and cool-down periods are important for better adaptation with high exercise intensity at the beginning of exercise session and restoration of full body weight slowly before stopping the exercise session. Lastly, in our protocol, the frequency of alter-gravity treadmill training is six times per week for two weeks, but the training frequency can be adjusted according to the specific situation of the patient and their Medicare payments, such as one session of treatment with two to three times per week for three&#8722;four weeks.
Comparing the results at pre-training and the 2-week post-training, which is presented in the representative results section, the functional improvement was mainly reflected in three aspects. First, the improvement in walking ability, which is reflected in the decrease in time cost of the 10 MWT and TUG tests (the reduction of TUG also indicates a reduction in the risk of falling) (Table 1) in addition to improvement in 3D gait analysis parameters, including an increase in the mean velocity (%height) and cadence and decrease in step width (Figure 4). Second, an increase in muscle strength in thigh muscles, including the rectus femoris, semitendinosus, and long head biceps femoris on both sides (Figure 6). Third, a reduction in knee pain (although the overall NRS pain score was not apparent at pre-training under resting conditions, the patient complained that the main pain was induced during functional activities, such as walking or climbing up and down stairs). Moreover, after two weeks of the LBPP training, the WOMCA assessment showed a significant reduction in pain during functional exercise (Table 1). Additionally, the results collected from the 3D gait motion analysis system at pre and post LBPP training sessions were consistent with the results of the clinical evaluation scales in our study. It is worth noting that the active knee joint mobility did not improve significantly before and after treatment, but the 3D gait motion analysis showed that both sides of knee joint movement trajectories were closer to the normal reference in the sagittal plane at post-training than at pre-training (Figure 5). Meanwhile, the patient has no restriction in AROM, no resting pain. This could explain why knee ROM did not change.
We must address certain limitations in this article. First, this article aims to provide a protocol for anti-gravity treadmills in knee OA patients based on our past clinical experience and previous research reports10,11,22. However, our findings are only valid in this case report (due to the lack of objective evaluation methods in our past clinical applications, such as 3D gait analysis and the conventional control group). The clinical efficacy of this approach requires further investigation. Second, neither the protocol nor the case report involved multiple sessions or follow-up. Considering the irreversibility and progress of the knee OA disease, we recommend that this cohort should be followed up as part of future studies.

Knee osteoarthritis (OA) is a progressive degenerative joint condition and a major cause of pain and locomotor disability in people all over the world1. Knee OA is characterized by osteophyte and cyst formation, narrow joint spacing, and subchondral bone sclerosis2. These pathological changes make it difficult to perform essential activities of daily living such as walking, squatting, and going up and down stairs3. However, physical activity is recommended as an essential component of first-line knee OA management4. Exercise intervention for knee OA rehabilitation is affected by several factors: (1) limited knee joint movement caused by pain and minor knee structural changes; (2) muscle atrophy associated with maintaining knee stability and a decrease in muscle strength5; and (3) the above reasons lead to a reduction in exercise and an increase in body mass index (BMI), which further increases the burden on the knees, thus creating a vicious cycle6.
In response to the above mentioned issues, the body weight-supported training system (BWSTT) has gradually addressed bone and joint disease-related rehabilitation7. In recent years, one of the emerging body weight-supported training technologies is called the lower body positive pressure (LBPP) treadmill7. This technology uses a waist-high inflatable balloon to achieve positive lower limb pressure and accurately adjust the air pressure to regulate body weight with the aim of achieving weight reduction. The system is also equipped with a running platform that can concurrently perform treadmill-related activities under the control of body weight8. Meanwhile, the pressure generated in the inflated enclosure provides a lifting force against the body. Because the pressure is only slightly above atmospheric pressure and is evenly distributed, the force on the lower body is almost imperceptible. Thus, the LBPP running platform provides a higher level of comfort and is more suitable for long-term training compared with the traditional BWSTT9. Peeler et al. performed an LBPP treadmill intervention on 32 knee OA patients and showed that the LBPP treadmill can effectively relieve knee pain, improve daily life functions, and produce an increase in thigh muscle strength10. The potential mechanism might be related to achievement of effective knee joint activity while reducing knee joint torque11. On the other hand, since the age of onset of knee OA patients is mostly over 45 years old12, onset may also be associated with cardio-pulmonary diseases. Studies have shown that LBPP allows people to achieve walking as exercise with relatively low heart rate, blood pressure, and oxygen consumption and achieve safer and more effective aerobic exercise than full-weight flat walking; this type of walking is another advantage of LBPP when compared with traditional BWSTT13.
However, due to the relatively new application of this system to knee OA intervention, the relatively few existing studies have greatly limited the clinical application of this technology in knee OA rehabilitation. The LBPP protocol proposed in this article aimed to explore the clinical non-drug and surgical knee OA treatment using the LBPP treadmill.

<table><tbody><tr><td>AlterG Anti-Gravity Treadmill M320</td><td>AlterG Inc, Fremont, CA, USA</td><td>1</td><td>LBBP training</td></tr><tr><td>BTS Smart DX system</td><td>Bioengineering Technology System, Milan, Italy</td><td>2</td><td>Temporospatial data collection</td></tr><tr><td>BTS FREEEMG</td><td>Bioengineering Technology System, Milan, Italy</td><td>3</td><td>Surface EMG data collection</td></tr><tr><td>BTS SMART-Clinic software</td><td>Bioengineering Technology System, Milan, Italy</td><td>4</td><td>Data processing</td></tr></tbody></table>

the lower body positive pressure treadmill for knee osteoarthritis rehabilitation

Here, based on a clinician&rsquo;s point-of-view, we propose a two-model lower body positive pressure (LBPP) protocol (walking and squatting models) in addition to a clinical, functional assessment methodology, including details for further encouragement of the development of non-drug surgical intervention strategies in knee osteoarthritis patients. However, we only present the effect of LBPP training in improvement of pain and knee function in one patient through three-dimensional gait analysis. The exact, long-term effects of this approach should be explored in future studies.

We show results from a knee OA patient, who was a 60-year-old female (BMI = 22.9) undergoing &#8220;more than 3 years of knee osteoarthritis&#8221; and severe pain when she was walking (visual analog scale [VAS] = 8/10) and participated in a 2-week LBPP training program at our facility. During the entire intervention, the patient did not take any painkillers to relieve knee pain. The radiological image of her knee joints and the results of clinical function assessments are shown in Figure 3 and Table 1.
The 10 MWT decreased from 4.1 s at pre-training to 3.3 s at post-training. The TUG test decreased from 9.1 s at pre-training to 8.2 s at post-raining. After two weeks of LBPP training, patients showed an improvement in total WOMAC scores (15 versus 8), pain subscales (8 versus 3), stiffness subscales (1 versus 0), and function subscales (6 versus 5). The total VAS pain scores or the knee flex-extension AROM did not change after two weeks of treatment.
The gait parameter results are shown in Figure 4. The right swing phase (%height) increased from 40.75 at pre-training to 41.51 at post-training (Figure 4A). The left swing phase (%height) decreased from 41.11 at pre-training to 40.33 at post-training (Figure 4B). The right stride length (%height) decreased from 77.00 at pre-training to 74.10 at post-training (Figure 4C). In contrast, the left stride length (%height) increased from 74.1 at pre-training to 75.68 at post-training (Figure 4C). The mean velocity (%height) increased from 74.44 at pre-training to 74.97 at post-training (Figure 4D). The cadence (steps/min) increased from 117.2 at pre-training to 119.8 at post-training (Figure 4E). The step width decreased from 0.08 m at pre-training to 0.06 m at post-training (Figure 4F).
Knee joint movement trajectories in the frontal, sagittal, and transverse planes are shown in Figure 5. Both right and left trajectories of the knees&#8217; AROMs were closer to normal reference values at post-training than at pre-training, especially during the swing phase of knee AROM in the sagittal plane.
The results of tight muscle EMG activities are shown in Figure 6. The mean root-mean-square (RMS) of the left long head biceps femoris muscles, left rectus femoris, and left semitendinosus increased from 0.160 &#177; 0.069, 0.130 &#177; 0.054, and 0.259 &#177; 0.138 mV, respectively, at pre-training to 0.194 &#177; 0.136, 0.317 &#177; 0.215, and 0.315 &#177; 0.204 mV, respectively, at post-training (Figure 6A). The mean RMS of the right long head biceps femoris muscles, right rectus femoris, and right semitendinosus increased from 0.160 &#177; 0.022, 0.136 &#177; 0.013, and 0.259 &#177; 0.021 mV, respectively, at pre-training to 0.234 &#177; 0.018, 0.206 &#177; 0.009, and 0.438 &#177; 0.017 mV, respectively, at post-training (Figure 6C). The peak RMS of the left long head biceps femoris muscles, left rectus femoris, and left semitendinosus increased from 0.342 &#177; 0.094, 0.256 &#177; 0.245, and 0.528 &#177; 0.197 mV, respectively, at pre-training to 0.540 &#177; 0.032, 0.797 &#177; 0.116, and 0.784 &#177; 0.074 mV, respectively, at post-training (Figure 6B). The peak RMS of the right long head biceps femoris muscles, right rectus femoris, and right semitendinosus increased from 0.388 &#177; 0.078, 0.286 &#177; 0.036, and 0.855 &#177; 0.055 mV, respectively, at pre-training to 0.576 &#177; 0.098, 0.390 &#177; 0.024, and 1.300 &#177; 0.140 mV at post-training, respectively (Figure 6D).
The patient claimed that she was satisfied with the whole LBPP training process without any discomfort and would like to accept another session in the future.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/59829/59829fig01.jpg" /> 
Figure 1: Diagram of the LBPP setup and LBBP training protocol. 
(A) Walking model; (B) squatting model; (C) The protocol and parameter setting of the LBPP training. AROM = active range of motion, BW = body weight. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/59829/59829fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/59829/59829fig02.jpg" /> 
Figure 2: Example of definition of the right foot initial contact with the floor (green vertical lines) and right toe off (blue vertical line). 
The knee flexion-extension angle (green) and the ankle dorsi-plantarflexion angle (red) are shown. R = right. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/59829/59829fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/59829/59829fig03.jpg" /> 
Figure 3: The digital radiography image of the knee OA patient at pre-training. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/59829/59829fig03large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/59829/59829fig04.jpg" /> 
Figure 4: The spatial-temporal parameters of the patient with knee at pre and post LBPP training intervention. 
(A) The percentage of right stand phase (dark green) versus swing phase (light green) in the gait cycle. (B) The percentage of left stand phase (dark red) versus swing phase (light red) in the gait cycle. (C) The stride length (%height) of right side (green) versus left side (red). Panels (D), (E), and (F) show mean velocity (%height/s), cadence, and step width, respectively. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/59829/59829fig04large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/59829/59829fig05.jpg" /> 
Figure 5: Knee joint movement trajectories in gait cycle at frontal, sagittal and transversal plane. 
The knee movement trajectory of a normal subject as the normal reference (grey) is also shown, which refers to the motion capture system (Table of Materials). <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/59829/59829fig05large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 6" class="xfigimg" src="/files/ftp_upload/59829/59829fig06.jpg" /> 
Figure 6: The synchronized EMG activity of the patient with knee OA in the gait cycle at pre and post LBBP training intervention. 
Panels (A) and (C) show the mean RMS of muscle activity in biceps femoris caput longus, rectus femoris and semitendinosus, respectively; panels (B) and (D) show the peak RMS of muscle activity in biceps femoris caput longus, rectus femoris and semitendinosus, respectively. RMS = root mean square; mV = microvolt; L = left; R = right. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/59829/59829fig06large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Clinical Assessment</td>
			<td>Pre-training</td>
			<td>Post-training</td>
		</tr>
		<tr>
			<td>10MWT (SPP)</td>
			<td>4.1 s</td>
			<td>3.3 s</td>
		</tr>
		<tr>
			<td>TUG</td>
			<td>9.1 s</td>
			<td>8.2 s</td>
		</tr>
		<tr>
			<td>WOMAC-pain</td>
			<td>8</td>
			<td>3</td>
		</tr>
		<tr>
			<td>WOMAC-stiffness</td>
			<td>1</td>
			<td>0</td>
		</tr>
		<tr>
			<td>WOMAC-functionality</td>
			<td>6</td>
			<td>5</td>
		</tr>
		<tr>
			<td>NRS (pain at rest)</td>
			<td>0</td>
			<td>0</td>
		</tr>
		<tr>
			<td rowspan="2">Knee flex-extension AROM</td>
			<td>Left: 0&#176;&#8722;130&#176;</td>
			<td>Left: 0&#176;&#8722;130&#176;</td>
		</tr>
		<tr>
			<td>Right: 0&#176;&#8722;130&#176;</td>
			<td>Right: 0&#176;&#8722;130&#176;</td>
		</tr>
	</tbody>
</table>
Table 1: Clinical assessment results. 
10MWT = 10-meter walk test; SSP = self-selected pace; TUGT = timed up and go test; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index; NRS = the numerical rating scale; AROM = active range of motion; s = second.

Watch this Scientific Journal Video about The Lower Body Positive Pressure Treadmill for Knee Osteoarthritis Rehabilitation at JoVE.com

The Lower Body Positive Pressure Treadmill for Knee Osteoarthritis Rehabilitation

Here, based on a clinician&#8217;s point-of-view, we propose a two-model lower body positive pressure (LBPP) protocol (walking and squatting models) in addition to a clinical, functional assessment methodology, including details for further encouragement of the development of non-drug surgical intervention strategies in knee osteoarthritis patients. However, we only present the effect of LBPP training in improvement of pain and knee function in one patient through three-dimensional gait analysis. The exact, long-term effects of this approach should be explored in future studies.

Here, based on a clinician&rsquo;s point-of-view, we propose a two-model lower body positive pressure (LBPP) protocol (walking and squatting models) in ...

the-lower-body-positive-pressure-treadmill-for-knee-osteoarthritis

Nanyang Technological University

Research

JoVE Journal

Medicine

10.4K Views.  The Fifth Affiliated Hospital of Guangzhou Medical University. Pijn en de daaruit voortvloeiende gang zijn de belangrijkste problemen van patiënten met knieartrose. Hier stellen we the Lower Body Positive Pressure Treadmill Intervention Protocol voor, dat zowel klinische beoordelings- als behandelingsmodellen bevat voor de revalidatie van motorische functies in de knieartrose. De LBPP loopband protocol stelt mensen in staat om oefeningen te bereiken met een relatief lage hartslag, bloeddruk en zuurstofverbruik, dus het is veiliger en effectiever dan ful...

Video: The Lower Body Positive Pressure Treadmill for Knee Osteoarthritis Rehabilitation

Vascular Occlusion Training for Inclusion Body Myositis: A Novel Therapeutic Approach

Inclusion body myositis (IBM) is a rare idiopathic inflammatory myopathy. It is known to produces remarkable muscle weakness and to greatly compromise function and quality of life. Moreover, clinical practice suggests that, unlike other inflammatory myopathies, the majority of IBM patients are not responsive to treatment with immunosuppressive or immunomodulatory drugs to counteract disease progression1. Additionally, conventional resistance training programs have been proven ineffective in restoring muscle function and muscle mass in these patients2,3. Nevertheless, we have recently observed that restricting muscle blood flow using tourniquet cuffs in association with moderate intensity resistance training in an IBM patient produced a significant gain in muscle mass and function, along with substantial benefits in quality of life4. Thus, a new non-pharmacological approach for IBM patients has been proposed. Herein, we describe the details of a proposed protocol for vascular occlusion associated with a resistance training program for this population.

The present article presents the details pertaining to the application of resistance training associated to vascular occlusion in IBM patients.

Inclusion body myositis (IBM) is a rare idiopathic inflammatory myopathy. It is known to produces remarkable muscle weakness and to greatly compromise ...

Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance

Orthostatic tolerance (OT) refers to the ability to maintain cardiovascular stability when upright, against the hydrostatic effects of gravity, and hence to maintain cerebral perfusion and prevent syncope (fainting). Various techniques are available to assess OT and the effects of gravitational stress upon the circulation, typically by reproducing a presyncopal event (near-fainting episode) in a controlled laboratory environment. The time and/or degree of stress required to provoke this response provides the measure of OT. Any technique used to determine OT should: enable distinction between patients with orthostatic intolerance (of various causes) and asymptomatic control subjects; be highly reproducible, enabling evaluation of therapeutic interventions; avoid invasive procedures, which are known to impair OT1.
In the late 1980s head-upright tilt testing was first utilized for diagnosing syncope2. Since then it has been used to assess OT in patients with syncope of unknown cause, as well as in healthy subjects to study postural cardiovascular reflexes2-6. Tilting protocols comprise three categories: passive tilt; passive tilt accompanied by pharmacological provocation; and passive tilt with combined lower body negative pressure (LBNP). However, the effects of tilt testing (and other orthostatic stress testing modalities) are often poorly reproducible, with low sensitivity and specificity to diagnose orthostatic intolerance7.
Typically, a passive tilt includes 20-60 min of orthostatic stress continued until the onset of presyncope in patients2-6. However, the main drawback of this procedure is its inability to invoke presyncope in all individuals undergoing the test, and corresponding low sensitivity8,9. Thus, different methods were explored to increase the orthostatic stress and improve sensitivity.
Pharmacological provocation has been used to increase the orthostatic challenge, for example using isoprenaline4,7,10,11 or sublingual nitrate12,13. However, the main drawback of these approaches are increases in sensitivity at the cost of unacceptable decreases in specificity10,14, with a high positive response rate immediately after administration15. Furthermore, invasive procedures associated with some pharmacological provocations greatly increase the false positive rate1.
Another approach is to combine passive tilt testing with LBNP, providing a stronger orthostatic stress without invasive procedures or drug side-effects, using the technique pioneered by Professor Roger Hainsworth in the 1990s16-18. This approach provokes presyncope in almost all subjects (allowing for symptom recognition in patients with syncope), while discriminating between patients with syncope and healthy controls, with a specificity of 92%, sensitivity of 85%, and repeatability of 1.1&plusmn;0.6 min16,17. This allows not only diagnosis and pathophysiological assessment19-22, but also the evaluation of treatments for orthostatic intolerance due to its high repeatability23-30. For these reasons, we argue this should be the "gold standard" for orthostatic stress testing, and accordingly this will be the method described in this paper.

We describe a "gold standard" for evaluating orthostatic tolerance (OT) using tilt testing with combined lower body negative pressure (LBNP). This can be combined with non-invasive evaluations of cardiovascular reflex control. Normal and abnormal responses are defined.

Orthostatic tolerance (OT)  refers to the ability to maintain cardiovascular stability when upright,  against the hydrostatic effects of gravity, and ...

Movement Retraining using Real-time Feedback of Performance

Any modification of movement - especially movement patterns that have been honed over a number of years - requires re-organization of the neuromuscular patterns responsible for governing the movement performance. This motor learning can be enhanced through a number of methods that are utilized in research and clinical settings alike. In general, verbal feedback of performance in real-time or knowledge of results following movement is commonly used clinically as a preliminary means of instilling motor learning. Depending on patient preference and learning style, visual feedback (e.g. through use of a mirror or different types of video) or proprioceptive guidance utilizing therapist touch, are used to supplement verbal instructions from the therapist. Indeed, a combination of these forms of feedback is commonplace in the clinical setting to facilitate motor learning and optimize outcomes.
Laboratory-based, quantitative motion analysis has been a mainstay in research settings to provide accurate and objective analysis of a variety of movements in healthy and injured populations. While the actual mechanisms of capturing the movements may differ, all current motion analysis systems rely on the ability to track the movement of body segments and joints and to use established equations of motion to quantify key movement patterns. Due to limitations in acquisition and processing speed, analysis and description of the movements has traditionally occurred offline after completion of a given testing session.
This paper will highlight a new supplement to standard motion analysis techniques that relies on the near instantaneous assessment and quantification of movement patterns and the display of specific movement characteristics to the patient during a movement analysis session. As a result, this novel technique can provide a new method of feedback delivery that has advantages over currently used feedback methods.

Retraining abnormal movement patterns following injury or disease is a key component of physical rehabilitation. Recent advances in technology have permitted accurate assessment of movement during a variety of tasks, with near instantaneous quantification of results. This provides new opportunities for modification of faulty movement patterns in real time.

Any modification of movement - especially movement patterns that have been honed over a number of years - requires re-organization of the neuromuscular ...

Comparative Analysis of Lower Limb Kinematics between the Initial and Terminal  Phase  of 5km Treadmill Running

Running is beneficial for physical health, but it is also accompanied by many injuries. However, the main factors leading to running injury remain unexplained. This study investigated the effects of long running distance on lower-limb kinematic variables and the lower limb kinematic difference of between the initial (IR) and terminal phase (TR) of 5 km running was compared. Ten amateur runners ran on a treadmill at the speed of 10 km/h. Dynamic kinematic data was collected at the phase of IR (0.5 km) and TR (5 km), respectively. The peak angle, peak angular velocities, and range of motion were recorded in this experiment. The main results demonstrated the following: ankle eversion and knee abduction were increased at TR; ROMs of ankle and knee were increased in the frontal plane at TR than IR; a larger peak angular velocity of ankle dorsiflexion and hip interrotation were found in TR compared to IR. These changes during the long distance running may provide some specific details for exploring potential reasons of running injuries.

This study investigated the biomechanical characteristics of the lower extremity kinematic variables between the initial and terminal phase of 5 km treadmill running. The lower-limb kinematic data of 10 runners were collected using a three-dimensional motion capture system on a treadmill at the initial phase (0.5 km) and the terminal phase (5 km), respectively.

Running is beneficial for physical health, but it is also accompanied by many injuries. However, the main factors leading to running injury remain ...

Behavior

Activity-based Training on a Treadmill with Spinal Cord Injured Wistar Rats

Spinal cord injury (SCI) results in lasting deficits that include both mobility and a multitude of autonomic-related dysfunctions. Locomotor training (LT) on a treadmill is widely used as a rehabilitation tool in the SCI population with many benefits and improvements to daily life. We utilize this method of activity-based task-specific training (ABT) in rodents after SCI to both elucidate the mechanisms behind such improvements and to enhance and improve upon existing clinical rehabilitation protocols. Our current goal is to determine the mechanisms underlying ABT-induced improvements in urinary, bowel, and sexual function in SCI rats after a moderate to severe level of contusion. After securing each individual animal in a custom-made adjustable vest, they are secured to a versatile body weight support mechanism, lowered to a modified three-lane treadmill and assisted in step-training for 58 minutes, once a day for 10 weeks. This setup allows for the training of both quadrupedal and forelimb-only animals, alongside two different non-trained groups. Quadrupedal-trained animals with body weight support are aided by a technician present to assist in stepping with proper hind limb placement as necessary, while forelimb-only trained animals are raised at the caudal end to ensure no hind limb contact with the treadmill and no weight-bearing. One non-trained SCI group of animals is placed in a harness and rests next to the treadmill, while the other control SCI group remains in its home cage in the training room nearby. This paradigm allows for the training of multiple SCI animals at once, thus making it more time-efficient in addition to ensuring that our pre-clinical animal model mimics the clinical representation as close as possible, particularly with respect to the body weight support with manual assistance.

This protocol demonstrates our model of activity-based locomotor treadmill training for rats with spinal cord injury (SCI). Included is both quadrupedal and forelimb-only groups, in addition to two distinct types of non-trained control groups. Investigators are able to assess training effects on SCI rats using this protocol.

Spinal cord injury (SCI) results in lasting deficits that include both mobility and a multitude of autonomic-related dysfunctions. Locomotor training (LT) ...

Neuroscience

Evaluation of Patients' Posture and Gait Profile After Lumbar Fusion Surgery by Video Rasterstereography and Treadmill Gait Analysis

This protocol provides guidance on how to perform high resolution video rasterstereography and treadmill gait analysis on patients after lumbar fusion surgery to obtain results about altered variables of gait and posture. These observed changes can then be correlated with the patient-reported outcome measure of pain relief. The rasterstereographic device projects lines of parallel light onto the surface of the tested subject&#39;s back. The deformation of these lines is recognized by the device. From these data, a special software then generates a 3-D profile based on the principle of triangulation. With an inaccuracy of only 0.2 mm it can measure changes in posture at very high precision. Gait and stance parameters are recorded using a treadmill equipped with an electric sensor mat that contains 10,200 miniature force sensors in the registering zone under the belt. Initial walking speed on the treadmill is 0.5 km/h. Speed is then gradually increased by increments of 0.1 km/h until each subject reaches his or her individual maximum well tolerable walking speed. At this speed, parameters are recorded during a 20 s measurement interval. Subjects are tested barefoot and without holding a handrail. Among various other parameters, stride width, step length, stance phase and foot rotation are measured. Both methods used reportedly have a high intra- and inter-observer reliability. The advantage of these highly accurate techniques is that they offer an objective and very detailed perspective on changes in the patient&#39;s posture and gait. Due to the amount of data generated, these techniques are, however, not so much suitable for everyday routine use, but rather interesting to scientifically evaluate long term alterations in posture and gait in patients like for example after lumbar fusion surgery.

Here, we present a protocol to analyze the posture and the gait of patients after lumbar fusion surgery by means of high-resolution video rasterstereography and a treadmill equipped with an integrated sensor mat. Allowing critical functional postoperative evaluation on a less subjective level may enhance accuracy and reliability of indication for surgery.

This protocol provides guidance on how to perform high resolution video rasterstereography and treadmill gait analysis on patients after lumbar fusion ...

FSN Therapy for Knee Osteoarthritis Pain Management

Fu's Subcutaneous Needling for Knee Osteoarthritis Pain

Fu's subcutaneous needling (FSN) is a new acupuncture and dry needling technique based on traditional Chinese medicine. It rapidly produces long-lasting effects in soft tissue injuries, particularly in painful musculoskeletal conditions, by providing stimulation primarily in the subcutaneous area. Osteoarthritis (OA) is the most common joint disease in adults worldwide and is often accompanied by a painful syndrome of structural changes in the peripheral joints of the knee. However, the etiology of OA pain is not fully understood, though myofascial trigger points (MTrPs) are commonly found in the lower limb muscles (so-called "tightened muscles") of patients with knee OA. 
FSN has been used in many fields for the treatment of acute pain problems and can relieve muscle contraction from MTrPs, thereby improving the local circulation. This study recruited patients with pain from knee OA into an FSN group or a transcutaneous electrical nerve stimulation (TENS) group with three treatment sessions and a follow-up over the course of 2 weeks. The results showed that FSN was effective in treating soft tissue pain around the knee with OA. This study aimed to establish and visualize three key technical indicators during FSN therapy, including the FSN needle insertion point and layer; the frequency and duration of the swaying movement; and the manipulation of the reperfusion approach. These findings have great potential for future applications in myofascial pain treatment, especially for pain management. Following this protocol could enhance FSN skills.

Author Spotlight: Fu's Subcutaneous Needling for Knee Osteoarthritis Pain  

We present a protocol for using Fu's subcutaneous needling for knee osteoarthritis pain, which combines swaying movement and reperfusion approach techniques. This protocol has great potential for future applications in myofascial pain treatment and could enhance Fu's subcutaneous needling (FSN) manipulation skills.

Fu's subcutaneous needling (FSN) is a new acupuncture and dry needling technique based on traditional Chinese medicine. It rapidly produces long-lasting ...

Evaluating Brain Activation by fNIRS During a Lower Limb Robotic Therapy Session

An Experiment Using Functional Near-Infrared Spectroscopy and Robot-Assisted Multi-Joint Pointing Movements of the Lower Limb

Stroke affects approximately 17 million individuals worldwide each year and is a leading cause of long-term disability. Robotic therapy has shown promise in helping stroke patients regain lost motor functions. One potential avenue for increasing the understanding of how motor recovery occurs is to study brain activation during the movements that are targeted by therapy in healthy individuals. Functional Near-Infrared Spectroscopy (fNIRS) has emerged as a promising neuroimaging technique for examining neural underpinnings of motor function. This study aimed to investigate fNIRS neural correlates of complex lower limb movements in healthy subjects. Participants were asked to perform cycles of rest and movement for 6 min using a robotic device for motor rehabilitation. The task required coordinated knee and ankle joint movements to point to targets displayed on a computer screen. Two experimental conditions with different levels of movement assistance provided by the robot were explored. The results showed that the fNIRS protocol effectively detected brain regions associated with motor control during the task. Notably, all subjects exhibited greater activation in the contralateral premotor area during the no-assistance condition compared to the assisted condition. In conclusion, fNIRS appears to be a valuable approach for detecting changes in oxyhemoglobin concentration associated with multi-joint pointing movements of the lower limb. This research might contribute to the understanding of stroke motor recovery mechanisms and might pave the way for improved rehabilitation treatments for stroke patients. However, further research is needed to fully elucidate the potential of fNIRS in studying motor function and its applications in clinical settings.

Author Spotlight: Assessing Brain Activity in Robotic-Assisted Lower Limb Rehabilitation Using fNIRS

It is estimated that 1 in 6 individuals worldwide will have a stroke in their lifetime, causing long-term disability, whose rehabilitation mechanisms are still poorly understood. This study proposes a protocol to evaluate brain activation by functional near-infrared spectroscopy (fNIRS) during a lower limb robotic therapy session.

Stroke affects approximately 17 million individuals worldwide each year and is a leading cause of long-term disability. Robotic therapy has shown promise ...

Developing an Exercise Program for Rheumatoid Arthritis Patients

Evaluation of Changes in Hydration and Body Cell Mass with Bioelectrical Impedance Analysis after Exercise Program for Rheumatoid Arthritis Patients

Rheumatoid arthritis (RA) is a debilitating disease that can result in complications such as rheumatoid cachexia. While physical exercise has shown benefits for RA patients, its impact on hydration and body cell mass remains uncertain. The presence of pain, inflammation, and joint changes often restrict activity and make traditional body composition assessments unreliable due to altered hydration levels. Bioelectrical impedance is a commonly used method for estimating body composition, but it has limitations since it was primarily developed for the general population and does not consider changes in body composition. On the other hand, bioelectrical impedance vectorial analysis (BIVA) offers a more comprehensive approach. BIVA involves graphically interpreting resistance (R) and reactance (Xc), adjusted for height, to provide valuable information about hydration status and the integrity of the cell mass.
Twelve women with RA were included in this study. At the beginning of the study, hydration and body cell mass measurements were obtained using the BIVA method. Subsequently, the patients participated in a six-month dynamic exercise program encompassing cardiovascular capacity, strength, and coordination training. To evaluate changes in hydration and body cell mass, the differences in the R and Xc parameters, adjusted for height, were compared using BIVA confidence software. The results showed notable changes: resistance decreased after the exercise program, while reactance increased. BIVA, as a classification method, can effectively categorize patients into dehydration, overhydration, normal, athlete, thin, cachectic, and obese categories. This makes it a valuable tool for assessing RA patients, as it provides information independent of body weight or prediction equations. Overall, the implementation of BIVA in this study shed light on the effects of the exercise program on hydration and body cell mass in RA patients. Its advantages lie in its ability to provide comprehensive information and overcome the limitations of traditional body composition assessment methods.

Author Spotlight: Implementation of BIVA for Analyzing Disease Risk Factors in Patients with Low Body Cell Mass 

This protocol assesses alterations in hydration and body cell mass status using bioelectrical impedance vectorial analysis following a dynamic exercise program designed for patients with rheumatoid arthritis. The dynamic exercise program itself is detailed, highlighting its components focused on cardiovascular capacity, strength, and coordination. The protocol details steps, instruments, and limitations.

Rheumatoid arthritis (RA) is a debilitating disease that can result in complications such as rheumatoid cachexia. While physical exercise has shown ...

Treating Knee Osteoarthritis with Tuina in a Rabbit Model

Tuina Intervention in Rabbit Model of Knee Osteoarthritis

Knee osteoarthritis (KOA) is mainly characterized by degenerative changes in the knee joint's cartilage and surrounding soft tissues. The efficacy of Tuina in treating KOA has been confirmed, but the underlying mechanism needs to be investigated. This study aims to establish a scientifically feasible KOA rabbit model treated with Tuina to reveal the underlying mechanisms. For this, 18, 6-month-old normal-grade male New Zealand rabbits were randomly divided into sham, model, and Tuina groups, with 6 rabbits in each group. The KOA model was established by injecting 4% papain solution into the knee joint cavity. The Tuina group was intervened with Tuina combined with the knee joint rotary correction method for 4 weeks. Only the standard grasping and fixation were performed in sham and model groups. At the end of the 1-week intervention, the knee joint range of motion (ROM) was observed, and cartilage hematoxylin-eosin (HE) staining was done. The study shows that Tuina could inhibit chondrocyte apoptosis, repair cartilage tissue, and restore knee joint ROM. In conclusion, this study demonstrates the scientific feasibility of Tuina treatment for KOA model rabbits, highlighting its potential application in the study of KOA and similar knee joint-related conditions.

Author Spotlight: Using a Rabbit Model to Explore the Efficacy of Tuina in Treating Knee Osteoarthritis 

The protocol describes a method for Tuina intervention in a rabbit model of knee osteoarthritis.

Knee osteoarthritis (KOA) is mainly characterized by degenerative changes in the knee joint's cartilage and surrounding soft tissues. The efficacy of ...

The Lower Body Positive Pressure Treadmill for Knee Osteoarthritis Rehabilitation

Samenvatting

Meer video's verkennen

Hoofdstukken in deze video