Osteoarthritis of the knee is most common in people over the age of 60, but it also affects a significant proportion of younger people, even those in their 40s. For reasons still unknown, women are more likely to develop osteoarthritis than men.

In osteoarthritis of the knee, the protective cartilage in the joint wears away over time, and can lead to bone rubbing on bone.

The disease is associated with aging, but it can also be caused by injury or other forms of physical stress to the cartilage.

Anatomical abnormalities and other inherited factors can also lead to a mechanical dysfunction of the knee. This may result in a misaligned knee joint, increasing stress on the cartilage.

It’s essential for clinicians to fully understand the dysfunction to correct it. Our research in biomechanics, chronic pain, radiology, epidemiology, physiotherapy and data science led us to develop and evaluate the clinical utility of a new technology called knee kinesiography, used to treat patients with osteoarthritis in Québec.

Knee kinesiography is performed using a harness attached to certain strategic areas of the leg. In the photo, athlete Bruny Surin is being evaluated using this technology. (Author provided)

Clinicians currently diagnose knee osteoarthritis through examination and X-rays, and assess mechanical dysfunction using a questionnaire and clinical observation of the knee.

But questionnaires are subjective and observations aren’t quantified. The clinician observes the leg with the naked eye, but does not take measurements.

This makes it difficult for the physician to assess exactly what’s wrong, to determine when the problems began and to identify what’s causing stress to the joint and its deterioration.

Knee movements in 3D

Health-care professionals can offer patients treatment to relieve pain, as well as physiotherapy exercises. But to correct knee dysfunctions, they must be able to target dysfunctions that are not visible to the naked eye.

Knee kinesiography, which was commercialized in 2011 after 15 years of research, could be a game changer. It is to the knee what the electrocardiogram is to the heart.

It is performed using a harness attached to specific areas of the leg to analyze the knee while it is in motion. This technology was developed by researchers from the École de technologie supérieure, the Centre de recherche du Centre hospitalier de l’Université de Montréal (CHUM) and Université TÉLUQ.

Because this technology measures three-dimensional movement of the knee in real time, as well as rotations that are not visible to the naked eye, it enables health professionals to assess the joint with precision and accuracy.

By providing motion analysis that detects deviations from what is considered normal movement, the technology allows health professionals to understand the source of the stresses on the cartilage.

Personalized care

Using this technology, professionals can offer personalized treatment for the source of the problem, such as neuromuscular exercises that can be done at home or under the supervision of a physiotherapist or kinesiologist.

According to results of our clinical study, conducted on 515 patients, this technology shows great promise. Patients who received knee kinesiography and an individualized care plan were able to correct several measured biomechanical dysfunctions.

Nearly nine out of 10 (88 per cent) of those who participated in the clinical study reported doing their exercises for at least three months, which demonstrated that they were committed to their treatment.

Exercise adherence is a major issue in studies that analyze the effect of an exercise program.

In addition, the researchers observed more improvement in the functional status of the knee for these patients, compared to the control group.

These patients reported less pain and symptoms, and felt better able to perform their daily activities. In addition, they reported greater satisfaction with their care and better results on functional tests.

Knee kinesiography is now offered in more than 100 clinics and hospitals in eight countries and is available in private clinics in Québec.

Studies are underway to evaluate the impact of this tool on private costs and public health services, with a view to offering it in the public system (hospitals and clinics).

In addition to offering hope to thousands of patients who suffer from osteoarthritis of the knee, this innovation demonstrates, once again, that Québec engineering fully deserves the praise it has earned.

The Conversation | Contributed

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In a medical first, researchers harnessed the brain waves of a paralyzed man unable to speak — and turned what he intended to say into sentences on a computer screen.

It will take years of additional research but the study, reported Wednesday, marks an important step toward one day restoring more natural communication for people who can’t talk because of injury or illness.

“Most of us take for granted how easily we communicate through speech,” said Dr. Edward Chang, a neurosurgeon at the University of California, San Francisco, who led the work. “It’s exciting to think we’re at the very beginning of a new chapter, a new field” to ease the devastation of patients who lost that ability.

Today, people who can’t speak or write because of paralysis have very limited ways of communicating. For example, the man in the experiment, who was not identified to protect his privacy, uses a pointer attached to a baseball cap that lets him move his head to touch words or letters on a screen. Other devices can pick up patients’ eye movements. But it’s a frustratingly slow and limited substitution for speech.

Tapping brain signals to work around a disability is a hot field. In recent years, experiments with mind-controlled prosthetics have allowed paralyzed people to shake hands or take a drink using a robotic arm — they imagine moving and those brain signals are relayed through a computer to the artificial limb.

Chang’s team built on that work to develop a “speech neuroprosthetic” — decoding brain waves that normally control the vocal tract, the tiny muscle movements of the lips, jaw, tongue and larynx that form each consonant and vowel.

Volunteering to test the device was a man in his late 30s who 15 years ago suffered a brain-stem stroke that caused widespread paralysis and robbed him of speech. The researchers implanted electrodes on the surface of the man’s brain, over the area that controls speech.

A computer analyzed the patterns when he attempted to say common words such as “water” or “good,” eventually becoming able to differentiate between 50 words that could generate more than 1,000 sentences.

Prompted with such questions as “How are you today?” or “Are you thirsty” the device eventually enabled the man to answer “I am very good” or “No I am not thirsty” — not voicing the words but translating them into text, the team reported in the New England Journal of Medicine.

It takes about three to four seconds for the word to appear on the screen after the man tries to say it, said lead author David Moses, an engineer in Chang’s lab. That’s not nearly as fast as speaking but quicker than tapping out a response.

In an accompanying editorial, Harvard neurologists Leigh Hochberg and Sydney Cash called the work a “pioneering demonstration.”

They suggested improvements but said if the technology pans out it eventually could help people with injuries, strokes or illnesses like Lou Gehrig’s disease whose “brains prepare messages for delivery but those messages are trapped.”

Chang’s lab has spent years mapping the brain activity that leads to speech. First, researchers temporarily placed electrodes in the brains of volunteers undergoing surgery for epilepsy, so they could match brain activity to spoken words.

Only then was it time to try the experiment with someone unable to speak. How did they know the device interpreted his words correctly? They started by having him try to say specific sentences such as, “Please bring my glasses,” rather than answering open-ended questions until the machine translated accurately most of the time.

Next steps include ways to improve the device’s speed, accuracy and vocabulary size — and maybe one day allow a computer-generated voice rather than text on a screen — while testing a small number of additional volunteers.

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Debuting in January, the laboratory tool, known as the Ethnic Focused genotyping array or DNA chip, will test more than 750,000 genetic variants, including over 300,000 that are more common in minority populations.

The tool was custom-built for VA’s Million Veteran Program (MVP) which studies how genes affect health.  

“This is potentially a game changer in medical research for Black and Hispanic Veterans and other members of minority ethnic and racial groups,” said Acting VA Under Secretary for Health Richard A. Stone, M.D. “Thanks to MVP, VA is leading the way in health research that will benefit communities that have traditionally been underserved by the health care system and underrepresented in medical research.”

A genotyping chip is a piece of glass about the size of postage stamp containing hundreds of thousands of tiny bits of synthetic DNA. These DNA probes allow researchers to identify genetic variants in the DNA of research volunteers.

The probes also associate certain health traits — like increased risk for a disease or unfavorable reactions to a drug with specific genetic patterns. This can lead to new treatment approaches for patients with those gene profiles.

 With more than 830,000 Veteran volunteers currently enrolled, MVP is one of the largest health and genetic databases in the world and has generated dozens of influential scientific publications.

 Currently, over 30 ongoing studies based on MVP data are examining conditions ranging from heart disease and diabetes to post-traumatic stress disorder, schizophrenia and suicide risk. In recent months, researchers have begun using MVP data to study the impacts of COVID-19 on Veterans.

 MVP is also one of the world’s most diverse genomic databases, with about a quarter of enrollees belonging to minority groups. MVP has been successful in engaging Veterans from minority communities in part thanks to VA’s Center for Minority Veterans. The two plan to collaborate this year and beyond ,to further boost the involvement of Black, Hispanic and other minority Veterans in the landmark genomic research program.

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