Nuno Oliveira1, Naphtaly Ehrenberg2, JenFu Cheng3, Sheila Blochlinger4, Peter Barrance5. 1. Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States; Children's Specialized Hospital Research Center, New Brunswick, NJ, United States; School of Kinesiology and Nutrition, University of Southern Mississippi, Hattiesburg, MS, United States. Electronic address: Nuno.Oliveira@usm.edu. 2. Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States; Children's Specialized Hospital Research Center, New Brunswick, NJ, United States. Electronic address: nehrenberg@kesslerfoundation.org. 3. Physiatry Section (Medical), Children's Specialized Hospital, Mountainside, NJ, United States; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States; Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States. Electronic address: jcheng@childrens-specialized.org. 4. Rehabilitation Technology Department, Children's Specialized Hospital, Mountainside, NJ, United States. Electronic address: sblochlinger@childrens-specialized.org. 5. Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States; Children's Specialized Hospital Research Center, New Brunswick, NJ, United States; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States. Electronic address: pbarrance@kesslerfoundation.org.
Abstract
BACKGROUND: Altered knee motion is one of the most common gait deviations in pediatric populations with gait disorders. The potential for pediatric gait retraining using visual feedback based on knee kinematic patterns is under-explored. RESEARCH QUESTION: This study investigated whether pediatric participants could successfully modify knee flexion patterns in response to a visual kinematic feedback system (VKFS). METHODS: Knee flexion angles from twelve typically developing children and adolescents (6 M, 6 F; 11.9 ± 2.7 years) were calculated using wearable inertial measurement units. Participants were tested while walking on a treadmill using pattern based visual feedback (FB). Four novel target patterns which amplified or attenuated swing phase peak knee flexion were tested. No feedback (NFB) tests assessed the participant's ability to independently reproduce the patterns. Mean absolute cycle error (MACE) and magnitude of peak knee flexion error (PK) were calculated during the last 10 strides of FB and NFB trials. Pre-exposure reference values (R) were also calculated. RESULTS AND SIGNIFICANCE: PK-FB was significantly smaller (p < 0.05) than PK-R for all targets. Average values for PK-NFB were higher than for PK-FB, although PK-NFB remained significantly lower than PK-R for two targets. Contrary to one of the study's hypotheses, MACE-FB and MACE-NFB were larger than MACE-R. The study provided evidence that pediatric participants were able to modify peak knee flexion during gait in the sense targeted by the VKFS. Analysis suggested that MACE increases were explained by increases in gait cycle deviation outside of the changed region.
BACKGROUND: Altered knee motion is one of the most common gait deviations in pediatric populations with gait disorders. The potential for pediatric gait retraining using visual feedback based on knee kinematic patterns is under-explored. RESEARCH QUESTION: This study investigated whether pediatric participants could successfully modify knee flexion patterns in response to a visual kinematic feedback system (VKFS). METHODS: Knee flexion angles from twelve typically developing children and adolescents (6 M, 6 F; 11.9 ± 2.7 years) were calculated using wearable inertial measurement units. Participants were tested while walking on a treadmill using pattern based visual feedback (FB). Four novel target patterns which amplified or attenuated swing phase peak knee flexion were tested. No feedback (NFB) tests assessed the participant's ability to independently reproduce the patterns. Mean absolute cycle error (MACE) and magnitude of peak knee flexion error (PK) were calculated during the last 10 strides of FB and NFB trials. Pre-exposure reference values (R) were also calculated. RESULTS AND SIGNIFICANCE: PK-FB was significantly smaller (p < 0.05) than PK-R for all targets. Average values for PK-NFB were higher than for PK-FB, although PK-NFB remained significantly lower than PK-R for two targets. Contrary to one of the study's hypotheses, MACE-FB and MACE-NFB were larger than MACE-R. The study provided evidence that pediatric participants were able to modify peak knee flexion during gait in the sense targeted by the VKFS. Analysis suggested that MACE increases were explained by increases in gait cycle deviation outside of the changed region.