Martins Maria, Santos Cristina, Costa Lino, Frizera Anselmo
a UM , Guimarães , Portugal and.
b Electrical Engineering Department, Federal University of Espirito Santo , Vitória , Brazil.
Disabil Rehabil Assist Technol. 2016;11(3):202-18. doi: 10.3109/17483107.2015.1079652. Epub 2015 Sep 4.
Total knee arthroplasty (TKA) is a surgical procedure used in patients with Osteoarthritis to improve their state. An understanding about how gait patterns differ from patient to patient and are influenced by the assistive device (AD) that is prescribed is still missing. This article focuses on such purpose. Standard walker, crutches and rollator were tested. Symmetric indexes of spatiotemporal and postural control features were calculated. In order to select the important features which can discriminate the differences among the ADs, different techniques for feature selection are investigated. Classification is handled by Multi-class Support Vector Machine. Results showed that rollator provides a more symmetrical gait and crutches demonstrated to be the worst. Relatively to postural control parameters, standard walker is the most stable and crutches are the worst AD. This means that, depending on the patient's problem and the recovery goal, different ADs should be used. After selecting a set of 16 important features, through correlation, it was demonstrated that they provide important quantitative information about the functional capacity, which is not represented by velocity, cadence and clinical scales. Also, they were capable of distinguishing the gait patterns influenced by each AD, showing that each patient has different needs during recovery. Implications of Rehabilitation An understanding about how gait patterns of post-surgical patients differ from person to person and how they are influenced by the type of device that is prescribed during their recovery might help in physical therapy. Research specifically addressing these issues is still missing. Inter-limb asymmetry and postural control features can be evaluated in an outpatient setting, supplying important additional information about individual gait pattern, which is not represented by gait velocity, cadence and scales usually used. The features calculated in this study are able to provide complementary information to gait velocity, cadence and clinical scales to assess the functional capacity of patients that passed through TKA. The selected parameters make a new clinical tool useful for tracking the evolution of patients' recovery after TKA.
全膝关节置换术（TKA）是一种用于骨关节炎患者以改善其状况的外科手术。目前仍缺乏对患者之间步态模式如何不同以及如何受到所开辅助装置（AD）影响的了解。本文聚焦于这一目的。对标准助行器、拐杖和滚动助行器进行了测试。计算了时空和姿势控制特征的对称指数。为了选择能够区分不同辅助装置之间差异的重要特征，研究了不同的特征选择技术。分类由多类支持向量机处理。结果表明，滚动助行器提供了更对称的步态，而拐杖表现最差。相对于姿势控制参数，标准助行器是最稳定的辅助装置，而拐杖是最差的。这意味着，根据患者的问题和恢复目标，应使用不同的辅助装置。在选择了一组16个重要特征后，通过相关性分析表明，它们提供了有关功能能力的重要定量信息，而这些信息并非由速度、步频和临床量表所体现。此外，它们能够区分受每种辅助装置影响的步态模式，表明每位患者在恢复过程中有不同的需求。康复的意义了解术后患者的步态模式如何因人而异以及它们在恢复过程中如何受到所开装置类型的影响，可能有助于物理治疗。专门针对这些问题的研究仍然缺乏。肢体间不对称和姿势控制特征可以在门诊环境中进行评估，提供有关个体步态模式的重要额外信息，而这些信息并非由步态速度、步频和通常使用的量表所体现。本研究中计算出的特征能够为步态速度、步频和临床量表提供补充信息，以评估接受全膝关节置换术患者的功能能力。所选参数构成了一种新的临床工具，可用于跟踪全膝关节置换术后患者恢复的进展情况。
