Gait

Muscle force prediction of the lower limb compared to surface EMG at different walking speeds in individual healthy subjects.

BACKROUND: Recent developments in modelling have made it easier to use muscle force predictions to augment clinical gait analysis and enhance clinical decision making. OpenSim claims to provide a straight forward, standardised pipeline (SimTrack) to predict muscle forces implemented in routine processing. This project aims to test SimTrack’s potential in the context of clinical gait analysis by developing a standardised protocol which compares predicted muscle forces with surface EMG at a range of walking speeds. METHODS: 10 healthy participants walked at 3 different speeds (comfortable, ±20%). Kinematics, kinetics and surface EMG of the lower limb were captured. Joint angles and ground reaction forces serve as inputs to predict muscle forces using computed muscle control (CMC) within SimTrack. Predicted muscle forces were compared with EMG to validate the model outputs. RESULTS: Agreement between force prediction and EMG varies between muscles. Some muscles show a general agreement and similar variation with walking speed, others show large unexpected differences between CMC outputs and observed EMG. DISCUSSION: These results suggest that this protocol is running in general. For most walking speeds, CMC muscle forces can be predicted within a timeframe appropriate for clinical purposes. However using the default settings, the model predictions do not agree with EMG measurements. Furthermore, during pilot testing of quicker walking speeds (up to +40%) CMC crashed due the chosen musculoskeletal model being too weak. These findings suggest the need of either different generic parameters or subject specific parameters to obtain valid results. Work is continuing to identify these.
Listed In: Biomechanics, Gait, Other


The Effects of Knee Taping Techniques on Lower Extremity Kinematics During Running

Introduction: Running is a popular form of physical activity linked to various lower extremity injuries. A commonly used technique for injury prevention and rehabilitation is taping. There is considerable research investigating running biomechanics, however, there has been limited to no research examining the effects of gender, speed, and the type of tape used on two-dimensional lower extremity kinematics. Therefore, the purpose of this pilot study was to investigate the effects of gender, speed, and tape on two-dimensional lower extremity kinematics and stride characteristics during running. Method: Eight healthy runners participated (4 males, 4 females). Taping interventions (Leukotape, Kinesio Tape, no tape) and speeds (2.35 m/s, 3.35 m/s) were randomized and lower extremity stride kinematics were obtained using the Peak Motus System at initial contact, midstance, and toe off of running. Comparisons were made using descriptive statistics. Results: Females exhibited greater hip (FIC= 164.04+1.99°; MIC= 167.54+2.12°) and knee flexion (FIC= 167.73+0.93°; MIC= 170.42+1.65°; FPK= 142.83+1.28°; MPK= 146.35+1.21°), while males had greater ankle dorsiflexion (FIC= 88.60+1.00°; MIC= 84.14+1.08°) and plantarflexion (FTO= 51.90+1.01°; MTO= 55.99+0.825°). Females spent more time in support (FCT= 0.28+0.03s; MCT= 0.26+0.02s) while males spent more time in the air (FFT= 0.45+0.02s; MFT= 0.48+0.01s). Faster speed was associated with greater hip flexion and extension (SIC= 167.57+1.95°; FIC= 164.01+2.11°; STO= 197.14+1.23°; FTO= 201.28+0.74°), peak knee flexion (SPK= 145.39+1.82°; FPK= 143.79+2.39°), and less time during contact (SIC = 0.30+0.01s; FIC= 0.25+0.00s). Conclusion: Gender and speed seem to have effects on lower extremity stride kinematics, whereas type of tape does not.
Listed In: Biomechanics, Gait, Other


Effect of Transcutaneous Electrical Nerve Stimulation on Gait Kinematics in Subjects with Anterior Knee Pain

Knee pain is 1 of 5 leading causes of disability by altering lower-extremity muscle function and gait mechanics. While transcutaneous electrical nerve stimulation (TENS) mitigates deficits of muscle function due to pain, it is unclear whether TENS improves gait mechanics. Each of 15 participant (24±3yrs, 71±12kg, 178±7cm) was assigned to the TENS or matched placebo group (23±2yrs, 72±14kg, 177±9cm). Participants underwent 3 different experimental saline infusion sessions (hypertonic, isotonic, control) in a counterbalanced order, separated by 48-h. Hypertonic (5% NaCl) or isotonic (0.9% NaCl) saline was infused into the infrapatellar fat pad for 50-min. No infusion was administered to the control session. Participants and investigators were blinded to the saline solution. A 20-min TENS or placebo treatment was administered, which was blinded to participants. Gait kinematic data were collected using the high-speed video (240 Hz) and force-sending tandem treadmill (1200 Hz) at each time interval (baseline, infusion, treatment, post-treatment). Functional ANOVA (α=0.05) were used to evaluate difference between 2 groups (TENS, placebo) over time. Pairwise comparison functions with 95% confidence interval were plotted to determine specific difference. Hypertonic saline infusion (pain) resulted in increased (1) ankle dorsiflexion (38-75% of stance), (2) knee valgus (20-40%), (3) knee flexion (40-90%), (4) hip adduction (72-100%), (5) hip flexion (50-90%). However, there was no group x time interaction for all kinematics. Altered gait strategies due to pain may play a role in long-term compensation that could have consequences for the joint. TENS treatment, however, did not acutely reduce the deficits in aforementioned kinematic variables.


Listed In: Biomechanics, Gait, Neuroscience, Physical Therapy


Joint loading during graded walking with different prostheses - a case study

For lower limb amputees graded walking imposes a high level of motor ability, due to the missing proprioceptive feedback of the limb, and the necessary compensation mechanisms. In order to facilitate gait a focus in prosthesis research is the development of the prostheses ankle joints from rigid to moveable. Therefore, the aim of this case study was to analyse the effects of three different prostheses with a rigid and a moveable ankle joint during graded walking of a unilateral amputee. One male unilateral transfemoral amputee was recruited for this study and a comparison of following three prostheses (endolite, Germany) was performed: Elan (movable ankle joint with flexible resistance), Echelon (movable ankle joint with steady resistance) and Esprit (rigid ankle joint). Kinematic (12 cameras, Vicon, UK, 250 Hz) and kinetic (2 force plates, AMTI, MA, 1000 Hz) data were recorded during self-paced walking on a 6 m ramp, which was set to the inclinations of -12°, -4°, 0°, 4° and 12°. Following gait parameters, ground reaction forces, joint angles and joint moments were calculated. Gait parameters, ground reaction forces and joint angles were marginally influenced by the different prosthetic designs, but major changes occurred on the joint moment level. The use of the rigid ankle prosthesis Esprit induced up to 10 times higher joint moments compared to the moveable ankle joint prostheses. This case study showed that a moveable ankle joint can reduce the joint moments during graded walking, which might be advantageous to use for transfemoral amputees in graded walking.
Listed In: Biomechanics, Gait


Influence of femur rotation and knee valgus on patellofemoral stress

Background: Patellofemoral pain (PFP) is a common condition seen in orthopedic practice. A commonly cited hypothesis as to the cause of PFP is increased patellofemoral joint (PFJ) stress secondary to abnormal lower extremity kinematics (ie. excessive hip internal rotation and knee valgus). However, the influence of these motions on PFJ contact mechanics is unknown. Purpose: To assess the influence of hip rotation and knee valgus on PFJ stress using finite element (FE) analysis. Methods: Patella cartilage stress profiles for a healthy participant were quantified utilizing a subject-specific FE model. Input parameters included: joint geometry, quadriceps muscle forces, and weight-bearing PFJ kinematics. Using a nonlinear FE solver, quasi-static loading simulations were performed to quantify patella cartilage stress during a static squatting maneuver (45° knee flexion). To simulate hip rotation (0-8°) and knee valgus (0-12°), the femur and tibia were rotated in the transverse and frontal plane respectively in 2° increments. Results: Increasing hip rotation resulted in a linear increase in patella cartilage stress. In contrast, increasing knee valgus resulted in a decrease in patella cartilage stress. The combination of hip rotation and knee valgus did not result in higher PFJ cartilage stress compared to isolated hip rotation. Conclusions: Patella cartilage stress appears to be influenced to a greater degree by hip internal rotation as opposed to knee valgus. Surprisingly, higher degrees of knee valgus resulted in decreased cartilage stress (in the absence of hip rotation). Our finding supports the premise that persons exhibiting excessive hip internal rotation may be pre-disposed to elevated patella cartilage stress.
Listed In: Biomechanics, Gait, Physical Therapy


Improved Prosthetic Gait Following Amputee-Specific Physical Therapy.

Following amputation, an amputee must learn to walk again using a prosthesis. A goal of prosthetic rehabilitation is to reduce and eliminate asymmetries between the prosthetic leg and sound leg which may decrease the negative effects of long term force and work demands on the sound leg. An amputee-specific physical therapy program provides structured motor learning to aid in developing proper gait mechanics. However, physical therapy is not standard of care for all individuals receiving their first prosthesis due to limited evidence showing improved gait. Thus, the purpose of this study was to determine whether amputees receiving physical therapy have better gait mechanics than those that do not. It was hypothesized that those who underwent an amputee-specific physical therapy program would display a more symmetrical gait pattern. Transtibial amputees walked overground at self-selected pace while kinetic (600Hz) and kinematic (60Hz) data were collected. The therapy group had previously received 2-3 therapy sessions per week for 3 months. Asymmetries were determined through dependent t-tests (α=0.05) comparing sound leg and prosthetic leg kinetic variables. Of the 23 kinetic variables tested, 17 variables showed significant difference between the sound leg and prosthetic leg for the group that did not receive the amputee-specific physical therapy. For the group that had previously received the therapy, only 4 variables showed differences between the sound and prosthetic leg. Thus, we showed that individuals partaking in amputee-specific physical therapy have a more symmetrical gait which results on less force and energy demands on the sound leg.
Listed In: Biomechanics, Gait, Physical Therapy


Stud Type Affects Knee Biomechanics on Infilled Synthetic Turf during a 180° Cut, but not during a Single-Leg Land-Cut Task

Higher ACL injury frequencies have been reported on synthetic turfs compared to natural turfs. However, assessments of cleat stud type on lower extremity biomechanics worn on these surfaces are limited. The purpose of this study was to examine the knee biomechanics of a non-studded running shoe (RS), a football shoe with natural turf studs (NTS), and with synthetic turf studs (STS) during single-leg land-cut and 180°-cut tasks on synthetic turf. Fourteen recreational football players performed five trials of 180°-cut and land-cut tasks in the three shoe conditions on an infilled synthetic turf. Knee biomechanics were analyzed using a 2x3 (task x shoe) repeated measures ANOVA followed by post-hoc paired samples t-tests (p<0.05). For the 180° cut, 1st peak internal knee adduction moments were increased in RS and STS compared to NTS (Table) and in 1st peak knee extensor moments in RS compared NTS and STS. The peak negative knee extensor power was increased in RS compared to NTS and STS. The land-cut had significantly greater peak extensor moments, sagittal plane powers, and abduction angles, and significantly lower adduction moments compared to the 180°-cut. As expected, the land-cut movement involved increased power absorption, power generation, and extensor moment compared to the 180°-cut. However, shoe effects lie only in the 180°-cut. Decreased medial ground reaction force1, knee adduction and extensor moments in NTS suggest the knee may be in a safer environment using these studs during cutting maneuvers. Reduced knee adduction moments in NTS could have implications in non-contact ACL injury.
Listed In: Biomechanics, Gait, Sports Science


Effects of Adiposity on Walking Muscle Function in Children: Implications for Bio-Feedback and Assistive Devices

Altered gait biomechanics associated with pediatric obesity may increase the risk of musculoskeletal injury/pathology during physical activity and/or diminish a child’s ability to engage in sufficient physical activity. The biomechanical mechanisms responsible for the altered gait in obese children are not well understood, particularly as they relate to increases in adipose tissue. The purpose of this study was to investigate the role of adiposity (i.e. body fat percentage, BF%) on lower extremity kinematics, muscle force requirements and their individual contributions to the acceleration of the center of mass (COM) during walking. We scaled a musculoskeletal model to the anthropometrics of each participant (n=14, 8-12 years old, BF%: 16-41%) and generated dynamic simulations of walking to predict muscle forces and their contributions to the acceleration of the COM. Muscle force output was normalized to muscle mass. BF% was correlated with average knee flexion angle during stance (r=−0.54) and pelvic obliquity range of motion (r=0.78), as well as with relative vasti (r=−0.60), gluteus medius (r=0.65) and soleus (r=0.59) force production. Contributions to COM acceleration from the vasti were negatively correlated to BF% (vertical: r=−0.75, posterior: r=−0.68, respectively), but there was no correlation between BF% and COM accelerations produced by the gluteus medius. The functional demands and relative force requirements of the hip abductors during walking in pediatric obesity may contribute to altered gait kinematics. Our results provide insight into the muscle force requirements during walking in pediatric obesity that may be used to improve the quality/quantity of locomotor activity in this population.
Listed In: Biomechanical Engineering, Biomechanics, Gait


Are static and dynamic squatting activities comparable?

Background: Numerous studies have described 3D kinematics, 3D kinetics and electromyography (EMG) of the lower limb during quasi-static or dynamic squatting activities. However there is only little information on the comparison of these two squatting conditions. Only one study compared these activities in terms of 3D kinematics, but no information was available on 3D kinetics and EMG. The purpose of this study was to compare simultaneous recordings of 3D kinematics, 3D kinetics and EMG of the lower limb during quasi-static and fast dynamic squats. Methods: Ten subjects were recruited. 3D knee kinematics was recorded with a motion capture system, 3D kinetics was recorded with a force plate, and EMG of 8 muscles was recorded with surface electrodes. Each subject performed a quasi-static squat and several fast dynamic squats from 0° to 70° of knee flexion. Findings: Mean differences between quasi-static and dynamic squats were 1.6° for rotations, 1.8 mm for translations, 38 N ground reaction forces (2.1 % of subjects’ body weight), 6 Nm for torques, 13.0 mm for center of pressure, and 7 µV for EMG (6.3% of the maximum dynamic electromyographic activities ). Some significant differences (P < 0.05) were found in anterior-posterior translation, vertical forces and EMG. Interpretation: All differences found between quasi-static and fast dynamic squats can be considered small. 69.5% of the compared data were equivalent. In conclusion, this study show for the first time that quasi-static and dynamic squatting activities are comparable in terms of 3D kinematics, 3D kinetics and EMG.


Listed In: Biomechanical Engineering, Biomechanics, Gait, Orthopedic Research, Posturography


Impacts of Stifle Joint Remodeling on Vertical Ground Reaction Forces Following MCL Transection and Medial Meniscectomy

Functional demands placed on the human knee’s anterior cruciate ligament (ACL) vary with activity but remain impossible to measure directly in-vivo. Our lab is characterizing these demands in the sheep model by recording in vivo knee kinematics and ACL transducer voltages during activities of daily living (ADLs), reproducing these motions using the instrumented limb, and measuring the 3D forces in the ligament. However, up to 13% of patients sustaining ACL injuries will also sustain dual medial meniscus (MM) injuries and up to 10% will sustain dual medial collateral ligament (MCL) injuries. These structures are frequently left unrepaired, which may alter the ACL’s functional demands, resulting in inadequate ACL reconstruction outcomes for patients with dual injuries. Although these structures have been shown to alter ACL loading in cadaveric studies, the extent to which they impact ACL functionality during in vivo ADLs remains unknown. Moreover, changes in ACL functionality over time due to joint healing and remodeling have yet to be investigated. In this study, we aimed to track stifle joint remodeling in response to surgically imposed MCL transections and medial meniscectomies through monitoring vertical ground reaction forces (VGRFs) for three ADLs over 12 weeks. Results of this study may then be used in conjunction with future robotic studies as a tool to estimate in vivo load requirements for ACL reconstructions in patients with dual injuries.


Listed In: Biomechanical Engineering, Biomechanics, Gait, Orthopedic Research