User menu

Accès à distance ? S'identifier sur le proxy UCLouvain

Gait in adolescent idiopathic scoliosis: energy cost analysis.

Primary tabs

Mahaudens, Philippe [UCL] Detrembleur, Christine [UCL] Mousny, Maryline [UCL] Banse, Xavier [UCL]

(eng) Walking is a very common activity for the human body. It is so common that the musculoskeletal and cardiovascular systems are optimized to have the minimum energetic cost at 4 km/h (spontaneous speed). A previous study showed that lumbar and thoracolumbar adolescent idiopathic scoliosis (AIS) patients exhibit a reduction of shoulder, pelvic, and hip frontal mobility during gait. A longer contraction duration of the spinal and pelvic muscles was also noted. The energetic cost (C) of walking is normally linked to the actual mechanical work muscles have to perform. This total mechanical work (W(tot)) can be divided in two parts: the work needed to move the shoulders and lower limbs relative to the center of mass of the body (COM(b)) is known as the internal work (W(int)), whereas additional work, known as external work (W(ext)), is needed to accelerate and lift up the COM(b) relative to the ground. Normally, the COM(b) goes up and down by 3 cm with every step. Pathological walking usually leads to an increase in W (tot) (often because of increased vertical displacement of the COM(b)), and consequently, it increases the energetic cost. The goal of this study is to investigate the effects of scoliosis and scoliosis severity on the mechanical work and energetic cost of walking. Fifty-four female subjects aged 12 to 17 were used in this study. Thirteen healthy girls were in the control group, 12 were in scoliosis group 1 (Cobb angle [Cb] < or = 20 degrees), 13 were in scoliosis group 2 (20 degrees < Cb < 40 degrees), and 16 were in scoliosis group 3 (Cb > or = 40 degrees). They were assessed by physical examination and gait analysis. The 41 scoliotic patients had an untreated progressive left thoracolumbar or lumbar AIS. During gait analysis, the subject was asked to walk on a treadmill at 4 km h(-1). Movements of the limbs were followed by six infrared cameras, which tracked markers fixed on the body. W(int) was calculated from the kinematics. The movements of the COM(b) were derived from the ground reaction forces, and W(ext) was calculated from the force signal. W(tot) was equal to W(int) + W(ext). Oxygen consumption VO2 was measured with a mask to calculate energetic cost (C) and muscular efficiency (W(tot)/C). Statistical comparisons between the groups were performed using an analysis of variance (ANOVA). The external work (W(ext)) and internal work (W(int)) were both reduced from 7 to 22% as a function of the severity of the scoliosis curve. Overall, the total muscular mechanical work (W(tot)) was reduced from 7% to 13% in the scoliosis patients. Within scoliosis groups, the W(ext) for the group 1 (Cb > or = 20 degrees) and 2 (20 < or = Cb < or = 40 degrees) was significantly different from group 3 (Cb > or = 40 degrees). No significant differences were observed between scoliosis groups for the W(int). The W(tot) did not showed any significant difference between scoliosis groups except between group 1 and 3. The energy cost and VO2 were increased by around 30%. As a result Muscle efficiency was significantly decreased by 23% to 32%, but no significant differences related to the severity of the scoliosis were noted. This study shows that scoliosis patients have inefficient muscles during walking. Muscle efficiency was so severely decreased that it could be used as a diagnostic tool, since every scoliosis patient had an average muscle efficiency below 27%, whereas every control had an average muscle efficiency above 27%. The reduction of mechanical work found in scoliotic patients has never been observed in any pathological gait, but it is interpreted as a long term adaptation to economize energy and face poor muscle efficiency. With a relatively stiff gait, scoliosis patients also limit vertical movement of the COM(b) (smoothing the gait) and consequently, reduce W(ext) and W(int). Inefficiency of scoliosis muscles was obvious even in mild scoliosis (group 1, Cb < 20 degrees) and could be related to the prolonged muscle contract

Document type Article de périodique (Journal article) – Article de recherche – Journal Article, Research Support, Non-U.S. Gov't
Access type Accès restreint
Publication date 2009
Language Anglais
Journal information "European Spine Journal" - Vol. 18, no. 8, p. 1160-1168 (2009)
Peer reviewed yes
Publisher Springer ((Germany) Heidelberg)
issn 0940-6719
e-issn 1432-0932
Publication status Publié
Affiliations UCL - (SLuc) Service de médecine physique et de réadaptation motrice
UCL - MD/IEPR - Institut d'éducation physique et de réadaptation
UCL - MD/CHIR - Département de chirurgie
UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur
MESH Subject Walking - physiology ; Scoliosis - complications - physiopathology ; Muscle, Skeletal - physiology ; Muscle Contraction - physiology ; Locomotion - physiology ; Leg - physiology ; Humans ; Gait Disorders, Neurologic - etiology - physiopathology ; Gait - physiology ; Female ; Exercise Tolerance - physiology ; Energy Metabolism - physiology ; Child ; Biomechanics - physiology ; Adolescent ; Adaptation, Physiological - physiology
Links
  1. Barrios C, Perez-Encinas C, Maruenda JI, Laguia M (2005) Significant ventilatory functional restriction in adolescents with mild or moderate scoliosis during maximal exercise tolerance test. Spine 30:1610–1615
  2. Biewener AA, Farley CT, Roberts TJ, Temaner M (2004) Muscle mechanical advantage of human walking and running: implications for energy cost. J Appl Physiol 97:2266–2274
  3. Cavagna GA (1975) Force platforms as ergometers. J Appl Physiol 39:174–179
  4. Cavagna G. A., Kaneko M., Mechanical work and efficiency in level walking and running, 10.1113/jphysiol.1977.sp011866
  5. Cavagna G A, Thys H, Zamboni A, The sources of external work in level walking and running., 10.1113/jphysiol.1976.sp011613
  6. Cavagna GA, Willems PA, Legramandi MA, Heglund NC (2002) Pendular energy transduction within the step in human walking. J Exp Biol 205:3413–3422
  7. Cobb J (1948) Outline for study of scoliosis. Am Acad Orthop Surg 5:261–275
  8. Corcoran PJ, Brengelmann GL (1970) Oxygen uptake in normal and handicapped subjects, in relation to speed of waing beside velocity-controlled cart. Arch Phys Med Rehabil 51:78–87
  9. Della Croce U, Riley PO, Lelas JL, Kerrigan DC (2001) A refined view of the determinants of gait. Gait Posture 14:79–84
  10. Detrembleur C, Dierick F, Stoquart G, Chantraine F, Lejeune T (2003) Energy cost, mechanical work, and efficiency of hemiparetic walking. Gait Posture 18:47–55
  11. Detrembleur C, van den Hecke A, Dierick F (2000) Motion of the body centre of gravity as a summary indicator of the mechanics of human pathological gait. Gait Posture 12:243–250
  12. Detrembleur C, Vanmarsenille JM, De Cuyper F, Dierick F (2005) Relationship between energy cost, gait speed, vertical displacement of centre of body mass and efficiency of pendulum-like mechanism in unilateral amputee gait. Gait Posture 21:333–340
  13. Dierick Frédéric, Lefebvre Caroline, van den Hecke Adélaïde, Detrembleur Christine, Development of displacement of centre of mass during independent walking in children, 10.1017/s0012162204000891
  14. Dierick F, Penta M, Renaut D, Detrembleur C (2004) A force measuring treadmill in clinical gait analysis. Gait Posture 20:299–303
  15. Kavouras SA, Sarras SE, Tsekouras YE, Sidossis LS (2008) Assessment of energy expenditure in children using the RT3 accelerometer. J Sports Sci 26:959–966
  16. Kerrigan DC, Thirunarayan MA, Sheffler LR, Ribaudo TA, Corcoran PJ (1996) A tool to assess biomechanical gait efficiency; a preliminary clinical study. Am J Phys Med Rehabil 75:3–8
  17. Kerrigan DC, Viramontes BE, Corcoran PJ, LaRaia PJ (1995) Measured versus predicted vertical displacement of the sacrum during gait as a tool to measure biomechanical gait performance. Am J Phys Med Rehabil 74:3–8
  18. Lejeune TM, Willems PA, Heglund NC (1998) Mechanics and energetics of human locomotion on sand. J Exp Biol 201:2071–2080
  19. Lenke Lawrence G., Betz Randal R., Harms Jürgen, Bridwell Keith H., Clements David H., Lowe Thomas G., Blanke Kathy, Adolescent Idiopathic Scoliosis : A New Classification to Determine Extent of Spinal Arthrodesis, 10.2106/00004623-200108000-00006
  20. Mahaudens P, Banse X, Detrembleur C (2008) Effects of short-term brace wearing on the pendulum-like mechanism of walking in healthy subjects. Gait Posture 28 (4):703–707
  21. Massaad F, Dierick F, van den Hecke A, Detrembleur C (2004) Influence of gait pattern on the body’s centre of mass displacement in children with cerebral palsy. Dev Med Child Neurol 46:674–680
  22. McArdle WD, Katch FI, Katch VL (1996) Exercise physiology: energy, nutrition, and human performance, 4th edn. Williams & Wilkins, Baltimore
  23. McNeill Alexander R (2002) Energetics and optimization of human walking and running: the 2000 Raymond Pearl memorial lecture. Am J Hum Biol 14:641–648
  24. Monod H, Flandrois R (2003) Physiologie du sport. Bases physiologiques des activités physiques et sportives. Paris
  25. Saunders J. B. dec. M., Inman Verne T., Eberhart Howard D., THE MAJOR DETERMINANTS IN NORMAL AND PATHOLOGICAL GAIT : , 10.2106/00004623-195335030-00003
  26. Stoquart GG, Detrembleur C, Nielens H, Lejeune TM (2005) Efficiency of work production by spastic muscles. Gait Posture 22:331–337
  27. Tesio L, Lanzi D, Detrembleur C (1998) The 3-D motion of the centre of gravity of the human body during level walking. II. Lower limb amputees. Clin Biomech (Bristol, Avon) 13:83–90
  28. van den Hecke Adélaïde, Malghem Christine, Renders Anne, Detrembleur Christine, Palumbo Sara, Lejeune Thierry M., Mechanical Work, Energetic Cost, and Gait Efficiency in Children With Cerebral Palsy : , 10.1097/bpo.0b013e318093f4c3
  29. Waters R L, Barnes G, Husserl T, Silver L, Liss R, Comparable energy expenditure after arthrodesis of the hip and ankle. : , 10.2106/00004623-198870070-00011
  30. Waters R L, Campbell J, Thomas L, Hugos L, Davis P, Energy costs of walking in lower-extremity plaster casts. : , 10.2106/00004623-198264060-00013
  31. Waters RL, Hislop HJ, Thomas L, Campbell J (1983) Energy cost of walking in normal children and teenagers. Dev Med Child Neurol 25:184–188
  32. Waters R L, Lunsford B R, Energy cost of paraplegic locomotion. : , 10.2106/00004623-198567080-00016
  33. Waters RL, Mulroy S (1999) The energy expenditure of normal and pathologic gait. Gait Posture 9:207–231
  34. Willems PA, Cavagna GA, Heglund NC (1995) External, internal and total work in human locomotion. J Exp Biol 198:379–393
  35. Mahaudens P, Banse X, Mousny M, Detrembleur C (2009) Gait in adolescent idiopathic scoliosis: kinematics and electromyographic analysis. Eur Spine J 18(4):512–521
Bibliographic reference Mahaudens, Philippe ; Detrembleur, Christine ; Mousny, Maryline ; Banse, Xavier. Gait in adolescent idiopathic scoliosis: energy cost analysis.. In: European Spine Journal, Vol. 18, no. 8, p. 1160-1168 (2009)
Permanent URL http://hdl.handle.net/2078/22289