Authors (including presenting author) :
Tang CY(1), Au TK(1), Cheng CW(1), Cheung WYW(2), Fung YK(1), IP YC(1), Leung YF(2), So KY(1), Tam KS(1)
Affiliation :
(1)Physiotherapy Department, TKOH
(2)Department of Orthopaedics and Traumatology, TKOH
Introduction :
Different outcome measures were used to assess TKR patients’ progression. With technological advancement, instrumental gait analysis together with surface-EMG makes an objective, convenient and evidence-based assessment for patients’ movement performance by providing additional clinical information. For bilateral-TKR patients, we faced difficulties in patient’s rehabilitation training and monitoring progression by traditional method in the absence of a normal knee as reference. Therefore, instrumental treadmill was used in this pilot study for bilateral-TKR gait analysis and training.
Objectives :
To (1) implement advanced technology in assessing mobility and providing training to bilateral-TKR; (2) facilitate formulation of physiotherapy treatment plan through gait parameters.
Methodology :
Gait analysis with surface-EMG measurement using instrumental treadmill at comfortable walking speed was done pre-TKR and 4-month post-TKR to observe the changes after TKR and initial phase of physiotherapy training. Measurement will be taken at 8-month post-TKR to measure effectiveness of physiotherapy training.
Centre of pressure and kinematics parameters were measured. Besides, surface-EMG from rectus femoris (RF) and biceps femoris (BF) were recorded to observe muscle recruitment pattern in gait cycle.
Result & Outcome :
A 68-year-old gentleman with same-session bilateral-TKR received gait analysis 1-week before and 4-month post-TKR. Comparing data achieved pre- and post-TKR, patient walked faster (1.5km/hr vs 0.8km/hr) with longer stride length (51cm vs 36cm) and better weight-shifting. Recruitment of BF in stance-phase, especially left-side, was improved. There was also more activation of bilateral RF during swing-phase which was not shown before TKR (Right-side: 62.9uV vs 12.2uV; Left-side: 62.7uV vs 19.1uV). However, comparing data of bilateral lower limbs post-TKR, activation of left-RF and right-BF during stance-phase was less than other side. Physiotherapy treatment plan was adjusted according to the results and aimed at further improvement in weight-shifting and corresponding muscles recruitment using visual-feedback provided by instrumental treadmill. Besides, simulated gait training, including overcome obstacles, can be performed using Virtual-Reality-supported instrumental treadmill.
Instrumental treadmill with surface-EMG demonstrated to be an objective, convenient measuring tool to analyze gait after bilateral-TKR. Data collected provided extra information in evaluating patients’ progression and enhancing physiotherapy services in a more effective way. In future, this practice will be promulgated to unilateral-TKR and osteoarthritis knee patient.
