Cortical function, gait alterations, and central sensitization in people with knee osteoarthritis
OA Version
Citation
Abstract
For healthy individuals, walking is an automatic locomotion. However, for people with knee osteoarthritis (OA) who often have chronic knee pain and reduced physical function, walking can be less automatic movement that accompanies altered patterns and requires fine motor control. Over-recruitment of the prefrontal cortex (PFC), a region of executive function, during walking can be the underlying neurobiology of disrupted gait automaticity. Therefore, the aim of the Study 1 was to determine the association between the over-recruitment of PFC and altered gait patterns in single- and dual-task walking paradigms. We found that higher activation in subregions of PFC is associated with low variability in step duration (better gait automaticity) during dual-task walking in people with knee OA. In Study 2, we investigated whether the presence of central sensitization, a major biological cause of chronic knee pain, is related to the over-recruitment of PFC and the loss of gait automaticity. Since central pain sensitization involves alterations in activity and connectivity across multiple brain regions, including PFC, central sensitization could be one mechanism by which chronic pain leads to plasticity in brain function and less automatic gait patterns. Study 2 has found that people with a low-pressure pain threshold (PPT) at the unaffected joint (indicating the presence of central sensitization) show greater activation in subregions of the PFC and higher stride length variability (worse gait automaticity) compared to those with a high-PPT during walking. Overall, these findings suggest that people with knee OA may require greater executive control through PFC modulation during complex walking conditions to maintain gait automaticity. Additionally, Study 2 suggests that individuals with knee OA and central pain sensitization may need enhanced executive control during walking compared to those without, highlighting central sensitization as a potential therapeutic target for restoring normal walking function.
Description
2025
License
Attribution-NonCommercial-NoDerivatives 4.0 International