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People with knee Osteoarthritis (OA) often develop negative psychosocial beliefs like pain catastrophizing and fear avoidance that can interfere with engagement in physical activity and adherence to exercise. This can lead to further pain and disability since exercise and physical activity are the first line treatment for knee OA. Therefore, there is a need for interventions that address negative psychosocial beliefs related to exercise and low adherence along with addressing physical impairments of knee OA. This dissertation examined the safety, feasibility, and acceptability of a novel telehealth mindful exercise intervention for people with knee OA. The mindful exercise intervention trains individuals to incorporate concepts of mindfulness into strengthening exercises recommended for knee OA. The intervention was delivered via telehealth to facilitate access. Study 1 used a decentralized randomized controlled trial (RCT) of mindful exercise (n=21) vs. exercise alone (n=19) in people with knee OA. Mindful exercise was safe with 0 adverse events (vs. 4 in exercise group) and lower use of oral analgesics. The design was feasible for recruitment and retention, but adherence was suboptimal (53% in mindful exercise group) and the cohort was not racially diverse. Participants in the mindful exercise group reported larger clinically meaningful improvements in pain intensity, interference, catastrophizing, quality of life, and global assessment of knee OA compared to the exercise group. Study 2 was to qualitatively determine the acceptability of the mindful exercise intervention. Participants in the mindful exercise group of the RCT (n = 13 of 21) participated in individual interviews that were informed by the Theoretical Framework of Acceptability. Participants valued the content (exercise and mindfulness) and format (telehealth, group) of the intervention. Areas for further refinement included exercise selection and equipment, additional support and education on mindfulness, and greater flexibility with timing and nature of intervention sessions. Study 3 investigated the association between telehealth satisfaction and ehealth literacy in both groups. Participants in this cohort had high ehealth literacy (mean = 31.3 on a 8–40 scale) at baseline and high satisfaction with telehealth (mean = 5.6 on a 1–7 scale) at the end of the intervention. There was no association between ehealth literacy and telehealth satisfaction (R2=0.01, p=0.61). In conclusion, telehealth mindful exercise could be a safe and feasible intervention for people with knee OA. However, further refinement to improve adherence and acceptability are needed prior to efficacy studies.

Women are more likely to sustain knee injuries (e.g., ACL tears) than their male counterparts. The mechanisms responsible for this disparity are unclear. However fluctuating hormones during the menstrual cycle may be an influencing factor since more ACL injuries have been observed preceding ovulation when estrogen levels increase. Previous research shows females to have increased muscle strength and altered neuromuscular activation prior to ovulation. These findings have not been replicated in females using oral contraceptives (OC). To date, no study has examined all of these factors simultaneously. The purpose of this study was to determine the effect of sex, hormones, and contraceptive use on neuromuscular function at 3 points during a menstrual cycle. A prospective cohort design with independent variables of group [male (n=10), female no-OC (n=10), female OC (n=10)], and testing session (1,2,3) was used to assess knee function (i.e., tibial translation, isometric strength, vertical leg stiffness, and neuromuscular activation) on physically active college-aged participants. Three testing sessions were scheduled throughout a typical menstrual cycle. Tibial translation was measured at the start of each testing session to assess ACL laxity, for handgrip, knee extensors and knee flexors strength. Area EMG activity of the rectus femoris (representing quadriceps) and biceps femoris (representing hamstrings) was recorded over 3 46cm drop jumps, and vertical leg stiffness was calculated based on measurements obtained by a force plate. A 3 (group) x 3 (testing session) MANOVA (p ≤ 0.05) was used to assess knee function, as defined by tibial translation, strength, EMG activation and vertical leg stiffness. A significant difference was found with respect to strength, as males overall displayed greater strength than both female groups. No other significant differences were found. Although this study attempted to explain the effect of estrogen on strength and neuromuscular function with an improved design, no conclusive evidence was found to further explain this relationship. Future studies should use more sensitive and objective measures to explore this dynamic on a greater sample size over multiple menstrual cycle phases. / Kinesiology

Running injuries have been linked to poor lower extremity dynamic alignment, increased whole body and joint loading, and insufficient modulation of stiffness throughout stance phase. Upper body muscle activity and movement have a relationship to lower body dynamics; however, the literature has largely neglected their role during running. To date, biomechanical gait analysis has primarily focused on lower extremity mechanics and muscle activation patterns with no studies investigating the role of functional muscle synergies on stability and loading during running. Therefore, the primary objective of this project is to determine the role of the Back Functional Line (BFL), via measure of latissimus dorsi (LD), gluteus maximus (GM), and vastus lateralis (VL) muscle activity, during running and to determine their influence on lower extremity kinematics and kinematic predictors of loading that are linked to running-related injuries (RRI). We used conditions of arm swing constraint to manipulate the action of the LD and investigate the response in GM and VL muscles. Our main variables of interest include: 1) BFL muscle activity, specifically mean and peak amplitude, onset, and co-activation of the LD and GM 2) frontal plane lower extremity kinematics, and 3) kinematic predictors of kinetics, specifically foot inclination angle at initial contact and vertical COM displacement. Twenty healthy recreational runners (10 M; 10 F) participated in this study. Male runners tended to be slighter older with a higher weekly running mileage and longer running history. All participants were between the ages of 18 and 55 years old and consistently ran at least once per week. Participants ran under three arm conditions - free arm swing, unilateral arm swing constraint, and bilateral arm swing constraint. During the running trials, surface EMG and lower extremity kinematics were collected over the gait cycle. We operationally defined the primary BFL as the muscle synergy composed of the non-dominant upper extremity (i.e., constrained side during unilateral condition) LD muscle, the dominant GM muscle, and the dominant VL muscle. The secondary BFL was defined as the dominant upper extremity (i.e., unconstrained during unilateral condition) LD muscle, the non-dominant GM muscle, and the non-dominant VL muscle. Primary and secondary BFL muscle synergy activity were analyzed during two specific phases of gait - the pre-activation (PA) phase and the loading response (LR) phase. In support of the hypothesis, the primary BFL LD mean amplitude decreased during both the PA and LR phases of gait. GM and VL muscle mean amplitude demonstrated a varied response. During the PA phase, both the GM and VL muscles increased during the unilateral condition and decreased during the bilateral condition. During LR phase, GM and VL muscles increased during both arm swing constraint conditions. The highest increase in amplitude was seen during the unilateral condition. Peak amplitudes for each muscle did not change dramatically across conditions for either the PA or LR phases of gait. Secondary BFL LD and GM mean and peak amplitude increased during both the PA and LR phases of gait, with changes during the LR phase reaching significance for both muscles. Secondary BFL VL also increased in mean and peak amplitude during the bilateral constraint condition. GM and VL mean and peak muscle amplitude were significantly correlated during the LR phase, but not for the PA phase. This indicates that the lower extremity muscles of the BFL (GM and VL) may not be preparing for impact similarly but are adjusting muscle activity in a similar fashion as the lower limb is loaded. The increase in muscle amplitude for secondary BFL muscles, particularly during the LR phase of gait, may have resulted from a difference between lower limb strength or lower extremity single leg stability. Onset of muscle activity during loading response did not significantly differ across conditions for the LD, GM, or VL muscles, however, analysis of co-activation demonstrated that LD and GM were in-phase throughout the gait cycle. This suggests that this portion of the BFL may be acting together to stabilize the lumbopelvic-hip complex (LPHC) during running. LD and GM appeared to be co-activated throughout the gait cycle regardless of arm swing variation. Instability, either from asymmetrical movement patterns or poor single leg stability may contribute to the activation of the BFL muscle synergy. GM increased during the unilateral arm swing constraint during both phase and for both BFL synergies, indicating that asymmetrical movement patterns may induce a potential instability or an unstable state requiring the need for greater stability around the LPHC. Knee frontal plane kinematics changed significantly across conditions. Knee abduction angle showed the greatest increase during the unilateral arm swing constraint condition suggesting that asymmetrical movement patterns effect lower extremity mechanics more so than symmetrical patterns (i.e., bilateral arm swing restriction or free arm swing). Hip adduction and contralateral pelvic drop angles did not differ significantly across conditions. Our study did not find a significant relationship between BFL muscle activity and knee abduction angles. Participants demonstrated larger knee abduction angles on their non-dominant limb at midstance. The corresponding (secondary) BFL LD and GM demonstrated a significant increase during the LR phase. This may indicate that BFL muscle activity is engaged when the need for lower limb stability is greater, either due to poor single leg dynamic control or abnormal frontal plane mechanics. Kinematic predictors of joint and whole-body loading differed across conditions. Vertical COM displacement was significantly decreased during the bilateral arm swing constraint condition. Foot inclination angle at initial contact did not significantly change with arm swing constraint. Differences were found between right and left lower extremity foot strikes (i.e., foot inclination angle) across all conditions; the non-dominant limb demonstrated greater plantarflexion during initial contact. Knee flexion angle at initial contact and peak knee flexion during stance did not demonstrate a significant change. Muscle activity was not significantly correlated to kinematic predictors. Spatiotemporal measures altered with arm swing suppression. Stride length decreased and step rate increased significantly. Taken together, these results suggest that runners alter spatiotemporal measures more so than sagittal plane kinematics when adjusting to arm swing suppression. The role of the BFL muscle synergy during running remains unclear. Asymmetrical movement patterns and arm swing restriction appear to influence BFL muscle activity and lower extremity kinematics. Single leg stability, particularly during the LR phase, may alter BFL muscle activity due to the need for increased stabilization of the loaded limb and the LPHC. Future research is needed to determine how these variables impact BFL muscle activation and whether injured runners respond differently to arm swing constraint during running. / Physical Therapy

No description available.

Decreased gait symmetry has been correlated with an increased fall risk, abnormal joint loading and decreased functional outcomes. Therefore, symmetry is focused on in the rehabilitation of many patient populations. Currently, load based symmetry is collected using expensive and immobile devices that are not clinically accessible, but there is a clinical need for an objective measure of loading symmetry during daily tasks like walking. Therefore, the purpose of this dissertation was to 1) assess the validity and reliability of the loadsol® to capture ground reaction force data, 2) use the loadsol® to determine the differences in symmetry between adults with a TKA and their healthy peers and 3) explore the potential of a commercially available biofeedback system to acutely improve gait symmetry in adults. The results of this work indicate that the loadsol® is a valid and reliable method of collecting loading measures during walking in both young and older adults. TKA patients who are 12-24 months post-TKA have lower symmetry in the weight acceptance peak force, propulsive peak force and impulse when compared to their healthy peers. Finally, a case study with four asymmetric adults demonstrated that a 10-minute biofeedback intervention with the loadsol® resulted in an acute improvement in symmetry. Future work is needed to determine the potential of this intervention to improve symmetry in patient populations and to determine whether the acute response is retained following the completion of the intervention. / Doctor of Philosophy / Symmetry during walking is a valuable attribute as asymmetry has been correlated with an increased fall risk and decreased mobility. Currently, load based symmetry is collected using expensive and immobile devices that are not clinically accessible. As a result, there is a critical need for a system that can objectively measure load and loading symmetry during rehabilitation and everyday tasks in a variety of settings. A new device has been developed (loadsol®) that could potentially fill this need. Before it can be used to assess and treat patients, the loadsol® needed to be assessed for accuracy and reliability in both older and younger adults and at various speeds. Then we needed to determine if the loadsol® can be used to look at the levels of symmetry in patients who have had a knee replacement compared to their healthy peers. Finally, we tested a visual biofeedback intervention with the loadsol® to see if this intervention was able to improve symmetry. We found that the loadsol® is accurate and reliable. Patients with a knee replacement were less symmetric than their age matched peers. Finally, in a small study, the visual biofeedback intervention improved symmetry during walking in a group of people with less than 90% symmetry. Future work is needed to explore the potential of this biofeedback intervention to improve symmetry in various patient populations and to determine the extent to which patients are able to retain these improvements.