Postural adaptations to unilateral knee joint hypomobility induced by orthosis wear during gait initiation

Balance control and whole-body progression during gait initiation (GI) involve knee-joint mobility. Single knee-joint hypomobility often occurs with aging, orthopedics or neurological conditions. The goal of the present study was to investigate the capacity of the CNS to adapt GI organization to single knee-joint hypomobility induced by the wear of an orthosis. Twenty-seven healthy adults performed a GI series on a force-plate in the following conditions: without orthosis ("control"), with knee orthosis over the swing leg ("orth-swing") and with the orthosis over the contralateral stance leg ("orth-stance"). In orth-swing, amplitude of mediolateral anticipatory postural adjustments (APAs) and step width were larger, execution phase duration longer, and anteroposterior APAs smaller than in control. In orth-stance, mediolateral APAs duration was longer, step width larger, and amplitude of anteroposterior APAs smaller than in control. Consequently, step length and progression velocity (which relate to the "motor performance") were reduced whereas stability was enhanced compared to control. Vertical force impact at foot-contact did not change across conditions, despite a smaller step length in orthosis conditions compared to control. These results show that the application of a local mechanical constraint induced profound changes in the global GI organization, altering motor performance but ensuring greater stability.