Document Type : Research Paper
Authors
1
Department of Biomedical Engineering, Faculty of Technology and Engineering, Tehran Center, Islamic Azad University, Tehran, Iran.
2
Department of Biomedical Engineering, Faculty of Technology and Engineering, Islamshahr Branch, Islamic Azad University, Islamshahr, Iran.
3
Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
10.22080/jaep.2026.32616.2273
Abstract
Background and Objective: Chronic heart failure (CHF) is associated with reduced cardiac output, diminished muscle strength, and impaired balance. Conventional biomechanical studies often focus on discrete variables and may therefore overlook important continuous, time-dependent changes throughout the gait cycle. This study aimed to provide a more comprehensive biomechanical assessment using Statistical Parametric Mapping (SPM) to analyze kinetic and kinematic data during the stance phase of gait in patients with CHF compared with healthy individuals.
Materials and Methods: In this case-control study, 20 patients with CHF, characterized by an ejection fraction <40%, New York Heart Association functional class II–III, and independent walking ability, were compared with 20 healthy controls matched for age, sex, and body mass. Three-dimensional kinematic data and ground-reaction forces were collected during walking. Hip, knee, and ankle joint angles and moments were calculated using inverse dynamics, and joint moments were normalized to body mass. Stance-phase data were time-normalized to 101 points, and SPM{t} tests were used to compare time-series curves between groups. Where appropriate, gait speed was controlled for using analysis of covariance.
Results: Compared with healthy controls, patients with CHF demonstrated greater mediolateral ground-reaction force during 18–55% and 85–93% of the stance phase. Hip extension in the sagittal plane was greater during 42–53% of stance, while hip adduction in the frontal plane was greater during 10–100% of stance. In the transverse plane, hip internal-rotation moment was greater during early stance (3–8%) and lower during late stance (72–90%). Similarly, knee internal-rotation moment was greater during early stance (4–10%) and lower during late stance (78–90%). At the ankle, eversion moment was greater during 2–7% and 15–18% of stance, whereas internal-rotation moment was lower during 18–26% and 43–80% of the stance phase.
Conclusion: Patients with CHF exhibit significant alterations in whole-trajectory gait mechanics during the stance phase, including greater mediolateral ground-reaction force, increased hip adduction, and time-dependent alterations in hip, knee, and ankle joint moments. The direction of some joint-moment differences varied across the stance phase, highlighting temporal patterns that may be overlooked by conventional discrete analyses. SPM provides a useful approach for identifying the timing and duration of biomechanical alterations throughout the stance phase. Accounting for gait speed is also important when interpreting biomechanical differences in this population. These findings may inform rehabilitation interventions targeting lower-limb strength, balance, and neuromuscular control.
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