{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:53:21Z","timestamp":1790790801353,"version":"4.1.0"},"reference-count":52,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T00:00:00Z","timestamp":1683158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Research Council of Science &amp; Technology (NST) grant by the Korea government (MSIT)","award":["CAP20000-000"],"award-info":[{"award-number":["CAP20000-000"]}]},{"name":"National Research Council of Science &amp; Technology (NST) grant by the Korea government (MSIT)","award":["K1804361"],"award-info":[{"award-number":["K1804361"]}]},{"name":"Intramural Program of Korea University","award":["CAP20000-000"],"award-info":[{"award-number":["CAP20000-000"]}]},{"name":"Intramural Program of Korea University","award":["K1804361"],"award-info":[{"award-number":["K1804361"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFMK"],"abstract":"<jats:p>Basic human ambulation relies on a bipedal gait, which has been reported to be directly related to quality of life. However, injuries to the lower limb can cause an inability to walk and require non-weightbearing periods to heal. Among the many ambulatory aids, standard axillary crutches are prescribed. However, due to the disadvantages of having to use both hands, a slow gait, pain, nerve damage, and gait patterns that differ from that of healthy subjects, currently, a new generation of ambulatory aids has emerged. Among such aids, hands-free crutches (HFCs) are of particular interest due to their form factor, which does not require the use of the hands and facilitates a bipedal gait. In this study, we present an assessment of whether any different gait patterns, compared to overground gait, appeared on the unaffected limb during walking with an HFC. The spatiotemporal parameters, plantar force, lower-limb joint angles, and EMG patterns were evaluated. In conclusion, the results from 10 healthy subjects suggest that wearing an HFC causes only slight changes in the biomechanical gait patterns examined in the unaffected limb compared with overground walking without an HFC.<\/jats:p>","DOI":"10.3390\/jfmk8020056","type":"journal-article","created":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T02:56:51Z","timestamp":1683255411000},"page":"56","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Biomechanical Analysis of the Unaffected Limb While Using a Hands-Free Crutch"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6727-9101","authenticated-orcid":false,"given":"Jaewook","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, Korea University College of Medicine, Seoul 02841, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8817-4448","authenticated-orcid":false,"given":"Yekwang","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Korea University College of Medicine, Seoul 02841, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6657-3299","authenticated-orcid":false,"given":"Juhui","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Korea University College of Medicine, Seoul 02841, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joo","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Korea University College of Medicine, Seoul 02841, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Jong","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Korea University College of Medicine, Seoul 02841, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.3233\/NRE-182467","article-title":"The Effects of Balance and Gait Function on Quality of Life of Stroke Patients","volume":"44","author":"Park","year":"2019","journal-title":"NeuroRehabilitation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.apmr.2007.08.142","article-title":"Gait Asymmetry in Community-Ambulating Stroke Survivors","volume":"89","author":"Patterson","year":"2008","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1586\/14737175.7.10.1417","article-title":"Gait Training Strategies to Optimize Walking Ability in People with Stroke: A Synthesis of the Evidence","volume":"7","author":"Eng","year":"2007","journal-title":"Expert. Rev. Neurother."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1001\/jamaneurol.2014.753","article-title":"Prevalence, Determinants, and Effect on Quality of Life of Freezing of Gait in Parkinson Disease","volume":"71","author":"Damier","year":"2014","journal-title":"JAMA Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.gaitpost.2009.10.003","article-title":"Speeding up Gait Initiation and Gait-Pattern with a Startling Stimulus","volume":"31","author":"Queralt","year":"2010","journal-title":"Gait Posture"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e11023","DOI":"10.2196\/11023","article-title":"Walking with a Robotic Exoskeleton Does Not Mimic Natural Gait: A within-Subjects Study","volume":"6","author":"Swank","year":"2019","journal-title":"JMIR Rehabil. Assist. Technol."},{"key":"ref_7","first-page":"1121","article-title":"Temporal Variation Quantification During Cognitive Dual-Task Gait Using Two IMU Sensors","volume":"Volume 2022","author":"Hutabarat","year":"2022","journal-title":"Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS"},{"key":"ref_8","first-page":"215","article-title":"Gait and Dual-Task: Definition, Interest, and Perspectives in the Elderly","volume":"4","author":"Beauchet","year":"2006","journal-title":"Psychol. Neuropsychiatr. Vieil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1179\/108331905X43463","article-title":"Automaticity of Walking\u2013Implications for Physiotherapy Practice","volume":"10","author":"Paul","year":"2005","journal-title":"Phys. Ther. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"109489","DOI":"10.1016\/j.jbiomech.2019.109489","article-title":"Walking Assistance Using Crutches: A State of the Art Review","volume":"98","author":"Rasouli","year":"2020","journal-title":"J. Biomech."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1038\/sj.sc.3100850","article-title":"Analysis of assisted-gait characteristics in persons with incomplete spinal cord injury","volume":"37","author":"Melis","year":"1999","journal-title":"Spinal Cord"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1002\/pmrj.12514","article-title":"Injuries Associated with Crutch Use: A Narrative Review","volume":"13","author":"Manocha","year":"2021","journal-title":"PM&R"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"697","DOI":"10.2340\/16501977-0427","article-title":"Mobility Devices to Promote Activity and Participation: A Systematic Review","volume":"41","author":"Salminen","year":"2009","journal-title":"J. Rehabil. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"88","DOI":"10.26659\/pm3.2020.21.2.88","article-title":"Monitoring Healing of Orthopedic Ailments with an Original Instrumented Crutch","volume":"21","author":"Bernardo","year":"2020","journal-title":"Health Sport. Rehabil. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1992","DOI":"10.25083\/rbl\/25.5\/1992.1997","article-title":"Development of an Electronic Assistive Walking Device","volume":"25","author":"Bernardo","year":"2020","journal-title":"Rom. Biotechnol. Lett."},{"key":"ref_16","first-page":"250","article-title":"Energy Cost of Ambulation with Crutches","volume":"62","author":"Fisher","year":"1981","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Bellenfant, K.B., Robbins, G.L., Rogers, R.R., Kopec, T.J., and Ballmann, C.G. (2021). Effects of Dominant and Nondominant Limb Immobilization on Muscle Activation and Physical Demand during Ambulation with Axillary Crutches. J. Funct. Morphol. Kinesiol., 6.","DOI":"10.3390\/jfmk6010016"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1093\/ptj\/70.8.487","article-title":"Energy cost, exercise intensity, and gait efficiency of standard versus rocker-bottom axillary crutch walking","volume":"70","author":"Nielsen","year":"1990","journal-title":"Phys. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/24730114221139800","article-title":"Energy Expenditure and Substrate Utilization with Hands-Free Crutches Compared to Conventional Lower-Extremity Injury Mobility Devices","volume":"7","author":"Hackney","year":"2022","journal-title":"Foot Ankle Orthop."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"537","DOI":"10.2519\/jospt.1993.18.4.537","article-title":"The effects of assistive devices on the oxygen cost, cardiovascular stress, and perception of nonweight-bearing ambulation","volume":"18","author":"Holder","year":"1993","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1016\/S0003-9993(98)90247-7","article-title":"Crutch handle design: Effect on palmar loads during ambulation","volume":"79","author":"Sala","year":"1998","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1016\/S0003-9993(98)90185-X","article-title":"Low back pain caused by a duodenal ulcer","volume":"79","author":"Weiss","year":"1998","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1152\/jappl.1992.72.4.1493","article-title":"Skeletal Muscle Responses to Lower Limb Suspension in Humans","volume":"72","author":"Hather","year":"1992","journal-title":"J. Appl. Physiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/2473011420939875","article-title":"Comparison of Lower Extremity EMG Muscle Testing With Hands-Free Single Crutch vs Standard Axillary Crutches","volume":"5","author":"Dewar","year":"2020","journal-title":"Foot Ankle Orthop."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1053\/apmr.2001.16347","article-title":"Three-Point Gait Crutch Walking: Variability in Ground Reaction Force during Weight Bearing","volume":"82","author":"Li","year":"2001","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/0021-9290(74)90065-7","article-title":"Biomechanics of crutch locomotion","volume":"7","author":"Shoup","year":"1974","journal-title":"J. Biomech."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11044-020-09751-z","article-title":"Prediction of Three-Dimensional Crutch Walking Patterns Using a Torque-Driven Model","volume":"51","author":"Fregly","year":"2021","journal-title":"Multibody Syst. Dyn."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1097\/MRR.0b013e3282f1fecf","article-title":"The use of a hands-free crutch in patients with musculoskeletal injuries: Randomized control trial","volume":"30","author":"Rambani","year":"2007","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1177\/1071100719862743","article-title":"Patient Preference and Physical Demand for Hands-Free Single Crutch vs Standard Axillary Crutches in Foot and Ankle Patients","volume":"40","author":"Martin","year":"2019","journal-title":"Foot Ankle Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/j.clinbiomech.2012.08.005","article-title":"Coordination of the Non-Paretic Leg during Hemiparetic Gait: Expected and Novel Compensatory Patterns","volume":"27","author":"Raja","year":"2012","journal-title":"Clin. Biomech."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.gaitpost.2017.10.026","article-title":"EMG Normalization Method Based on Grade 3 of Manual Muscle Testing: Within- and between-Day Reliability of Normalization Tasks and Application to Gait Analysis","volume":"60","author":"Pittet","year":"2018","journal-title":"Gait Posture"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s40648-020-00185-y","article-title":"Pose Estimation by Extended Kalman Filter Using Noise Covariance Matrices Based on Sensor Output","volume":"7","author":"Saito","year":"2020","journal-title":"Robomech J."},{"key":"ref_33","unstructured":"Bakhshi, S., Mahoor, M.H., and Davidson, B.S. (September, January 30). Development of a Body Joint Angle Measurement System Using IMU Sensors. Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS, Boston, MA, USA."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Kim, J., Kim, Y., Kang, S., and Kim, S.J. (2022). Biomechanical Analysis Suggests Myosuit Reduces Knee Extensor Demand during Level and Incline Gait. Sensors, 22.","DOI":"10.3390\/s22166127"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.gaitpost.2011.05.023","article-title":"Gait, balance and plantar pressures in older people with toe deformities","volume":"34","author":"Mickle","year":"2011","journal-title":"Gait Posture"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/19424280.2011.653990","article-title":"Effects of Changes in Plantar Sensory Feedback on Human Gait Characteristics: A Systematic Review","volume":"4","author":"Alfuth","year":"2012","journal-title":"Footwear Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1007\/s10072-011-0827-6","article-title":"Energy Cost of Spontaneous Walking in Parkinson\u2019s Disease Patients","volume":"33","author":"Maggioni","year":"2012","journal-title":"Neurol. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2452","DOI":"10.1016\/j.cub.2015.08.016","article-title":"Humans Can Continuously Optimize Energetic Cost during Walking","volume":"25","author":"Selinger","year":"2015","journal-title":"Curr. Biol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1098\/rspb.2001.1761","article-title":"Mechanical and Metabolic Determinants of the Preferred Step Width in Human Walking","volume":"268","author":"Donelan","year":"2001","journal-title":"Proc. R. Soc. B: Biol. Sci."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/0021-9290(76)90011-7","article-title":"Analysis of instantaneous energy of normal gait","volume":"9","author":"Winter","year":"1976","journal-title":"J. Biomech."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/S0966-6362(99)00008-9","article-title":"A mechanical energy analysis of gait initiation","volume":"9","author":"Miller","year":"1999","journal-title":"Gait Posture"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2189","DOI":"10.1016\/j.apmr.2005.05.012","article-title":"Center of Mass Movement and Energy Transfer during Walking in Children with Cerebral Palsy","volume":"86","author":"Bennett","year":"2005","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.jsams.2016.04.008","article-title":"Biomechanics of Running with Rocker Shoes","volume":"20","author":"Sobhani","year":"2017","journal-title":"J. Sci. Med. Sport"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"3162","DOI":"10.1109\/TBME.2012.2216263","article-title":"Heel and Toe Clearance Estimation for Gait Analysis Using Wireless Inertial Sensors","volume":"59","author":"Mariani","year":"2012","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"ref_45","first-page":"78","article-title":"A review of gait cycle and its parameters","volume":"13","author":"Kharb","year":"2011","journal-title":"IJCEM Int. J. Comput. Eng. Manag."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/24730114211060054","article-title":"EMG Activity With Use of a Hands-Free Single Crutch vs a Knee Scooter","volume":"6","author":"Dewar","year":"2021","journal-title":"Foot Ankle Orthop."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"630","DOI":"10.3389\/fneur.2018.00630","article-title":"Electromyography Assessment during Gait in a Robotic Exoskeleton for Acute Stroke","volume":"9","author":"Androwis","year":"2018","journal-title":"Front. Neurol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Kim, J.J., Cho, H., Park, Y., Jang, J., Kim, J.W., and Ryu, J.S. (2020). Biomechanical Influences of Gait Patterns on Knee Joint: Kinematic & EMG Analysis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0233593"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Pellegrini, B., Peyr\u00e9-Tartaruga, L.A., Zoppirolli, C., Bortolan, L., Bacchi, E., Figard-Fabre, H., and Schena, F. (2015). Exploring Muscle Activation during Nordic Walking: A Comparison between Conventional and Uphill Walking. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0138906"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.jare.2019.09.005","article-title":"Walking on the Moon: A Randomized Clinical Trial on the Role of Lower Body Positive Pressure Treadmill Training in Post-Stroke Gait Impairment","volume":"21","author":"Billeri","year":"2020","journal-title":"J. Adv. Res."},{"key":"ref_51","first-page":"25","article-title":"Gait parameters following stroke: A practical assessment. J. Rehabil","volume":"32","author":"Coutts","year":"1995","journal-title":"Res. Dev."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1049\/el.2020.0090","article-title":"Practical Method for Predicting Intended Gait Speed via Soleus Surface EMG Signals","volume":"56","author":"Kim","year":"2020","journal-title":"Electron. Lett."}],"container-title":["Journal of Functional Morphology and Kinesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2411-5142\/8\/2\/56\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:29:22Z","timestamp":1760124562000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2411-5142\/8\/2\/56"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,4]]},"references-count":52,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["jfmk8020056"],"URL":"https:\/\/doi.org\/10.3390\/jfmk8020056","relation":{},"ISSN":["2411-5142"],"issn-type":[{"value":"2411-5142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,4]]}}}