Citation

Haddas R, Lieberman IH, Kakar RS. Spine Deform. 2019; 7(3): 454-466.

Affiliation

Ithaca College, 953 Danby Rd, 14850, Ithaca, NY, USA.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.jspd.2018.09.067

PMID

31974839

Abstract

STUDY DESIGN: A repeated measurement, single-center, prospective study.

OBJECTIVE: The purpose of this study is to compare and contrast the benefits of walking sticks versus a walker on the trunk and lower extremity muscular control in patients with adult degenerative scoliosis (ADS). ADS patients demonstrate an altered gait pattern. Walking aids help maintain mobility in those patients. Whereas a walker forces patients into kyphosis, the higher grips of walking sticks allows for more upright posture, arm swing, and improved sagittal alignment.

METHODS: Twenty ADS patients with symptomatic degenerative scoliosis performed over-ground walking at self-selected speed under 3 testing conditions: 1) with walking sticks (WS); 2) with walker (WR); and 3) without any device (ND). Trunk and lower extremity peak muscle activation, time to peak muscle activity, muscle duration, muscle onset, and integrated electromyography (iEMG) were measured and compared.

RESULTS: The use of WS produced increases in muscle activity in the external oblique (WS: 44.3% vs. WR: 7.4% of submaximum voluntary contraction [sMVC], p =.007) and medial gastrocnemius (WS: 78.8% vs ND: 43.7% of sMVC, p =.027) in comparison to the walker and no device, respectively. When using WS, shorter muscle activity time was observed for rectus femoris (WS: 62.9% vs. WR: 88.8% of gait cycle, p =.001), semitendinosus (WS: 64.3% vs. WR: 93.0% of gait cycle, p =.003), tibialis anterius (WS: 59.4% vs. WR: 85.1% of gait cycle, p =.001), and medial gastrocnemius (WS: 67.3% vs. WR: 98.0% of gait cycle, p =.006) in comparison to the walker.

CONCLUSIONS: The use of walking sticks can potentially promote trunk and lower extremity neuromuscular control and gait mechanics comparable to gait without any assistive devices. Although the differences in magnitudes between comparisons were small and should be cautiously interpreted on a case-by-case basis, based on this study's results and our anecdotal experience treating patients with ADS, we recommend the use of walking sticks to assist with their gait prior to and after surgical intervention. LEVEL OF EVIDENCE: Level III.

Language: en

Keywords

Electromyography; Integrated electromyography; Muscle duration; Muscle onset; Neuromuscular control; Peak muscle activation; Walking aids