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hors submitted their contribution of the article to the editorial board.

JournalofHumanKineticsvolume262010,5155

SectionII ExercisePhysiology&SportsMedicine

51

ExercisePhysiology&

SportsMedicine

HipandKneeKinematicsinSagittalPlaneduringStairAscent

andDescentinChildren,AdolescentsandYoungAdults

by

MagorzataSyczewska1,EwaSzczerbik1,MagorzataKalinowska1

Ascendinganddescendingstairsisafrequentactivityineverydayliving.Availabledatausuallydescribetheas

entanddescentpatternofyounghealthyadults,orelderlypeople.

Inordertoassesstheproblemsofpeadiatricpatientsduringstairascentanddescent,andtoevaluatehowtreatment

hangesthispattern,anormativedatabaseisneeded.Thisdataislackingintheliterature.Therefore,theaimofthis

tudywastocollectthekinematicdataofhealthychildren,adolescentsandyoungadultsduringstairlocomotionandto

ssessthechangesinrangeofmovementinhipandkneejointsinthesagittalplane. Twentysevenhealthysubjects,

ged6to21yearsold,participatedinthestudy.Thesubjectswereclimbingstairswithdimensionscomparabletosteps

npublicbuilding.

ThedatawerecollectedusingoptoelectronicmotionsystemVICON460.HelenHayesmarkersetandPlugInGait

modelwereused.ThedatawerefurtherprocessedusingPolygonandMatlabsoftwares.Thesubjectsweredividedinto

subgroups,accordingtotheirbodystature.

Hipandkneekinematicsinsagittalplaneduringstairascentanddescentarereportedforall6subgroups.

Themainfactordeterminingthedynamicrangeofmovementinthehipandkneejointsduringstairlocomotionis

hebodystature/stepheightratio.Thepresentpaperpresentsdetaileddata,whichcouldbeusedasreferencedataforssessmentofstairlocomotionofpaediatricpatients.

Keywords:stairlocomotion,children,adolescentsandyoungadults,referencedata

pt. Paediatric Rehabilitation, The Childrens Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warszawa, Poland

roductionAscendinganddescending stairs isa frequentac

yineveryday,normalliving.Availabledatausu

describetheascentanddescentpatternofyoung

thyadults,orelderlypeople.Afewpapersinves

ted the changes occurring in kinematics and ki

csduringstairascentinhealthysubjects(Yuetal.,

7;Nadeauetal.,2003;Protopapadakietal.,2007).

r climbing is a demanding task, which could in

setheriskoffallsinelderlypopulation;therefore,

e studies focused on stratergies used by older

ple tosafelyascendanddescend thestairs (Mian

l., 2007; Larsen et al., 2008; Reeves et al., 2008;

amanidisetal.,2009).

Althoughadultsandchildrenencounterthetaskof

stairlocomotionineverydaylifeinasimilarway,the

number of studies dealing with stair locomotion in

childrenislimited.Somestudiesfocusedontheinflu

enceoforthoticsonwalkingpatternsofcerebralpalsy

(CP) patients and healthy children (Nahorniak et al.,

1999; Sienko et al., 2002). In these studies,barefoot

walkingofthesubjectswasthecontrolcondition,and

stair climbing with anklefoot orthoses (AFOs) was

usedforexperimentalcomparisons.Onestudyinves

tigatedthe influenceofbackpackweightonthekine

matics of stair ascent using the pressure insole re

cordings for measurements (Hong & Li, 2005). An

other study assessed how specific training changed

thekinematicsofchildrenwithDownsyndromedur

ingstairascentanddescent(Lafferty&Hons,2005).


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52 HipandKneeKinematicsinSagittalPlaneduringStairAscentandDescentinChildren,AdolescentsandYoungAdults

JournalofHumanKineticsvolume262010, http://www.johk.awf.katowice.pl

ExercisePhysiolog

y&

SportsMedicine

Thedesignofthestairs(stepheightandwidth,and

stairsinclination)couldinfluencethebehaviourofthe

people who use them; therefore, this influence was

also investigated (Mueller et al., 1998; Roys, 2001).

Healthysubjects,beforeclimbingthestairs,determine

the relevant information about them. If subjects can

choosebetween several types of stairs, they tend to

keep

certain

parameters

constant:

the

angle

defined

by

theratiobetweentheheightofthestairsand thedis

tance taken from the foot to the topedge of the stair

before the initiation of the movement (Cesari et al.,

2003;Bertucco&Cesari,2009).Therealityofstairde

signs, however, is based upon state regulations for

privateandpublicbuildings,andtheirdimensionsare

restrictedwithinnarrowlimits.Therefore,childrenof

differentageandbodydimensions have to climb the

samestairs,despitetheirpreferences.

Clinical practice reveals that some patients who

walk relatively well on flat surfaces encounter prob

lems while using the stairs. In order to assess the

problemsofpeadiatricpatientsduringstairascentand

descent, and to evaluate how treatment changes this

pattern, normative database is needed. This data is

lacking in the literature. Therefore, the aim of this

study was to collect the kinematic data of healthy

children, adolescents and young adults during stair

locomotion and to assess the changes in range of

movementinhipandkneejointsinsagittalplane.

MaterialsandMethodsSubjects

Twentyfive healthy children and adolescents,

aged 6 to 18 years, both sexes, participated in the

study.Thedataof3students,aged20to21yearsold

were also included into the database. The exclusion

criteria were: any neurological problems in the past,

diabetes, cardiac or pulmonary diseases, fractures or

soft tissue trauma in the lower extremities, trunk or

pelvis in the past. The study was approvedby the

local

Ethical

Committee

and

the

participants

and

their

parents(ifneeded)signed the informedconsentform

priortothestudy.

Thesubjectsbodystaturerangedfrom125to183.5

cm. The participants were divided into 6 groups, ac

cording to theirbody stature. In each group thestat

urerangewas5cm(apartfromthehighest,wherethe

rangewas8.5cm).

Methods

Thesubjectswereclimbingstairsofstepheight20

cm,

and

step

width

29.5

cm

(dimensions

of

the

steps

in

publicbuilding,according toPolishregulations).The

stairswereconstructedespeciallyforthisstudy.

The data were collected using optoelectronic mo

tion system VICON 460 with 6 cameras. Data were

collected with 60 Hz sampling frequency. Helen

HayesmarkersetandPlugInGaitmodelwereused.

The data were further processed using Polygon

andMatlabsoftwares.Gaiteventswereidentifiedand

all data were presented within the (stair) gait cycle.

Thedatafromleftandrightlegswerepooledtogether

in each subgroup, and the mean knee and hip kine

maticsinsagittalplanewascalculated.

Results

Figure1

Hipkinematicsduringstairascent,Hbodystature

Figure2

Kneekinematicsduringstairascent,Hbodystature


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M.Syczewskaetal. 53

ditorialCommitteeofJournalofHumanKinetics

ExercisePhysiology&S

portsMedicine

Figures14showtheresultsofhipandkneekine

icswhileascendinganddescendingthestairs.The

ults of all subgroups of differentbody stature are

played on the same graph. Figures 1 and 2 show

ematics of the hip and knee while ascending the

rs;andfigures3and4diagramthesamevariables

ledescendingthestairs.

Tables1and2summarizethedataofhipandknee

ion during ascending and descending the stairs:

ximum and minimum flexion, dynamic range of

vement, maximum difference between the sub

ups.

DiscussionTheresultsshowclearlythatthebodystature/step

heightratioinchildren,adolescentsandyoungadults

influencethehipandkneekinematicswhileascending

and descending stairs. Thebiggest difference in the

dynamicjointrangewasbetweenthesubgroupsofthe

shortest and tallestbody stature. Stair negotiation in

the shorter group required much higher dynamic

rangeofmotioninthesejoints.

Theresultspresented inTables IandIIshowthat

the differencebetween the peak flexion in the sub

gure3

Hipkinematicsduringstairdescent,Hbodystature

Figure4

Kneekinematicsduringstairdescent,Hbodystature

Table 1

Summaryofhipmotionduringascendinganddescendingstairsinchildren,adolescentsandyoungadults

Resultsinhipjoint

maxhipflexion

[]

minhipflexion

[]

%ofgaitcycle

withminhip

flexion

hiprange

difference

inmaxhip

flexion

between

groups

(diffhip)

Diffhip/range

[%]

body

tature

[cm]

125

130

177

185.5

125

130

177

185.5

125

130

177

185.5

125

130

177

185.5

125

130

177

185.5

Body

tature/

step

height

ratio

6.3

6.58.9 9.3

6.3

6.58.9 9.3

6.3

6.58.9 9.3

6.3

6.58.9 9.3

6.3

6.58.9 9.3

stair

ascent80 65 10 5 5070 4060 70 60 15 21 25

stair

escent 45 35 20 10 3040 3040 25 25 10 40 40


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54 HipandKneeKinematicsinSagittalPlaneduringStairAscentandDescentinChildren,AdolescentsandYoungAdults

JournalofHumanKineticsvolume262010, http://www.johk.awf.katowice.pl

ExercisePhysiolog

y&

SportsMedicine

groupsoftheshortestandtallestbodystaturereaches

15 degrees during ascent and 10 degrees during de

scent in the hipjoint, and 20 degrees during ascent

and 10 degrees during descent in knee flexion. This

impliesthatthisdifferenceconstitutes20 40%ofthe

wholerange ofmotion inhipjoint,and 1524 % in

kneejoint, which was not reported previously in the

literature. This could explain the fact that some pa

tients who do not have many difficulties in level

walkinghaveproblemswithstairlocomotion.

Our results suggest, that the main factor deter

mining the dynamic range of movement in the hip

and kneejoints during stair locomotion is thebody

stature/stepheightratio.Thispaperpresentsdetailed

data, which couldbe used as reference data for as

sessmentofstair locomotionofpaediatricandyoung

adultpatients.

ReferencesBertuccoM,CesariP.Dimesionalanalysisandgroundreactionforcesforstairclimbing:Effectsofageandtask

difficulty.Gait&Posture2009;29:326331

CesariP,FormentiF,OlivatoP.Acommonperceptualparameterforstairclimbingforchildren,young,andold

adults.HumMovSci2003;22:111124

HongY,LiJX.Influenceofloadandcarryingmethodsongaitphaseandgroundreactionsinchildrensstairwalking.

Gait&Posture2005;22:6368

KaramanidisK,ArampatizdisA.Evidenceformechanicalloadredistributionatthekneejointintheelderlywhen

ascendingstairsandramps.AnnBiomedEng2009;37:467476

LaffertyME,HonsBA.AstairwalkinginterventionstratergyforchildrenwithDownssyndrome.JBodyworkand

MovTherapies2005;9:6574

LarsenAL,PuggaardL,HamalainenU,AagaardP.Comparisonofgroundreactionforcesandantagonistmuscle

coactivationduringstairwalkingwithaging.JEMGKinesiol2008;18:568580

MianOS,NariciMV,MinettiAE,BaltzopoulosV.Centreofmassmotionduringstairnegotiationinyoungandolder

men.Gait&Posture2007;26:463469

Table 2

Summaryofhipmotionduringascendinganddescendingstairsinchildren,adolescentsandyoungadults

Resultsinkneejoint

maxknee

flexion[]

minknee

flexion[]

%ofgait

cyclewith

minknee

flexion

%ofcycle

withmax

kneeflexion

kneerange

difference

inmaxknee

flexion

between

groups

(diffknee)

%diffknee/range

body

stature

[cm]

125

130

177

185.5

125

130

177

185.5

125

130

177

185.5

125

130

177

185.5

125

130

177

185.5

125

130

177

185.5

Body

stature/

step

height

ratio

6.3

6.5

8.9

9.3

6.3

6.5

8.9

9.3

6.3

6.5

8.9

9.3

6.3

6.5

8.9

9.3

6.3

6.5

8.9

9.3

6.3

6.58.9 9.3

stair

ascent110 90 10 5 4070 4565 85 85 100 85 20 20 24

stair

descent 95 85 20 20 1545 1525 65 70 75 65 10 13 15


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M.Syczewskaetal. 55

itorialCommitteeofJournalofHumanKinetics

ExercisePhysiology&S

portsMedicine

nOS,ThomJT,NariciMV,BalzopoulosV.Kinematicsofstairdescentinyoungandolderadultsandtheimpact

oftheexerciseandtraining.Gait&Posture2007;25:917

ellerR,BisigA,KramersI,StuessiE.Influenceofstairinclinationonmuscleactivityinnormals.11thConf.ESB

1998;Touluse

deauS,McFaydenBJ,MalouinF.Frontalandsagittalplaneanalysesofthestairclimbingtaskinhealthyadults

agedover40years:whatarethechallengescomparedtolevelwalking?ClinBiomech2003;18:950959

horniakMT,GortonGEIII,GannottiME,MassoPD.Kinematiccompensationsaschildrenreciprocallyascendand

descendstairswithunilateralandbilateralsolidAFOs.Gait&Posture1999;9:199206

topapadakiA,DrechslerWI,CrampMC,CouttsFJ,ScottOM(2007)Hip,knee,andanklekinematicsandkinetics

duringstairascentanddescentinhealthyyoungindividuals.ClinBiomech22:203210

vesND,SpanjaardM,MohagheghiAA,BaltzopoulosV,MaganarisCN.Influenceoflighthandrailuseonthe

biomechanicsofstairnegotiationinoldage.Gait&Posture2008;28:327336

sMS.Seriousstairsinjuriescanbepreventedbyimprovedstairdesign.Appl.Ergonomics2001;32:135139

nkoTomasS,BuckonCE,JakobsonHustonS,SussmanMD,AionaMD.Stairlocomotioninchildrenwithspastic

hemiplegia:

the

impact

of

three

different

ankle

foot

orthosis

(AFOs)

configuration.

Gait

&

Posture

2001;

16:

180

187

knowledgements

ThisstudywassupportedbytheinternalresearchgrantofCMHI145/06.

orrespondingauthor

MagorzataSyczewska,PhD

Dept.PaediatricRehabilitation

TheChildrensMemorialHealthInstitute

Al.DzieciPolskich20,04730Warszawa,Poland

Phone:+48228151748

Fax:+48228151538

Email:[email protected]

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