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Ferraresi C, De Benedictis C, Franco W, Maffiodo D, Leardini A. In-vivo analysis of ankle joint movement for patient-specific kinematic characterization. Proc Inst Mech Eng H 2017; 231:831-838. [DOI: 10.1177/0954411917709492] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Carlo Ferraresi
- Department of Mechanical and Aerospace Engineering (DIMEAS), Politecnico di Torino, Torino, Italy
| | - Carlo De Benedictis
- Department of Mechanical and Aerospace Engineering (DIMEAS), Politecnico di Torino, Torino, Italy
| | - Walter Franco
- Department of Mechanical and Aerospace Engineering (DIMEAS), Politecnico di Torino, Torino, Italy
| | - Daniela Maffiodo
- Department of Mechanical and Aerospace Engineering (DIMEAS), Politecnico di Torino, Torino, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
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Maggioni S, Melendez-Calderon A, van Asseldonk E, Klamroth-Marganska V, Lünenburger L, Riener R, van der Kooij H. Robot-aided assessment of lower extremity functions: a review. J Neuroeng Rehabil 2016; 13:72. [PMID: 27485106 PMCID: PMC4969661 DOI: 10.1186/s12984-016-0180-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 07/21/2016] [Indexed: 01/01/2023] Open
Abstract
The assessment of sensorimotor functions is extremely important to understand the health status of a patient and its change over time. Assessments are necessary to plan and adjust the therapy in order to maximize the chances of individual recovery. Nowadays, however, assessments are seldom used in clinical practice due to administrative constraints or to inadequate validity, reliability and responsiveness. In clinical trials, more sensitive and reliable measurement scales could unmask changes in physiological variables that would not be visible with existing clinical scores.In the last decades robotic devices have become available for neurorehabilitation training in clinical centers. Besides training, robotic devices can overcome some of the limitations in traditional clinical assessments by providing more objective, sensitive, reliable and time-efficient measurements. However, it is necessary to understand the clinical needs to be able to develop novel robot-aided assessment methods that can be integrated in clinical practice.This paper aims at providing researchers and developers in the field of robotic neurorehabilitation with a comprehensive review of assessment methods for the lower extremities. Among the ICF domains, we included those related to lower extremities sensorimotor functions and walking; for each chapter we present and discuss existing assessments used in routine clinical practice and contrast those to state-of-the-art instrumented and robot-aided technologies. Based on the shortcomings of current assessments, on the identified clinical needs and on the opportunities offered by robotic devices, we propose future directions for research in rehabilitation robotics. The review and recommendations provided in this paper aim to guide the design of the next generation of robot-aided functional assessments, their validation and their translation to clinical practice.
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Affiliation(s)
- Serena Maggioni
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zürich, Zürich, Switzerland.
- Hocoma AG, Volketswil, Switzerland.
- Spinal Cord Injury Center, Balgrist University Hospital, University Zürich, Zürich, Switzerland.
| | - Alejandro Melendez-Calderon
- Hocoma AG, Volketswil, Switzerland
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Edwin van Asseldonk
- Laboratory of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Verena Klamroth-Marganska
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zürich, Zürich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, University Zürich, Zürich, Switzerland
| | | | - Robert Riener
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zürich, Zürich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, University Zürich, Zürich, Switzerland
| | - Herman van der Kooij
- Laboratory of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
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Zhang M, Davies TC, Zhang Y, Xie S. Reviewing effectiveness of ankle assessment techniques for use in robot-assisted therapy. ACTA ACUST UNITED AC 2014; 51:517-34. [DOI: 10.1682/jrrd.2013.03.0066] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 12/13/2013] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Yanxin Zhang
- Sport and Exercise Science, University of Auckland, Auckland, New Zealand
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Arsene C, Gabrys B. Probabilistic finite element predictions of the human lower limb model in total knee replacement. Med Eng Phys 2013; 35:1116-32. [DOI: 10.1016/j.medengphy.2012.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 11/11/2012] [Accepted: 11/30/2012] [Indexed: 11/16/2022]
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Fong DTP, Chung MML, Chan YY, Chan KM. A mechanical jig for measuring ankle supination and pronation torque in vitro and in vivo. Med Eng Phys 2012; 34:791-4. [PMID: 22472526 DOI: 10.1016/j.medengphy.2012.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 02/14/2012] [Accepted: 03/11/2012] [Indexed: 11/25/2022]
Abstract
This study presents the design of a mechanical jig for evaluating the ankle joint torque on both cadaver and human ankles. Previous study showed that ankle sprain motion was a combination of plantarflexion and inversion. The device allows measurement of ankle supination and pronation torque with one simple axis in a single step motion. More importantly, the ankle orientation allows rotation starting from an anatomical position. Six cadaveric specimens and six human subjects were tested with simulated and voluntary rotation respectively. The presented mechanical jig makes possible the determination of supination torque for studying ankle sprain injury and the estimation of pronation torque for examining peroneal muscle response.
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Affiliation(s)
- Daniel Tik-Pui Fong
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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Differences in end-point force trajectories elicited by electrical stimulation of individual human calf muscles. J Appl Biomech 2010; 25:330-9. [PMID: 20095454 DOI: 10.1123/jab.25.4.330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to investigate the end-point force trajectories of the fibularis longus (FIB), lateral gastrocnemius (LG), and medial gastrocnemius (MG) muscles. Most information about individual muscle function has come from studies that use models based on electromyographic (EMG) recordings. In this study (N = 20 subjects) we used electrical stimulation (20 Hz) to elicit activity in individual muscles, recorded the end-point forces at the foot, and verified the selectivity of stimulation by using magnetic resonance imaging. Unexpectedly, no significant differences were found between LG and MG force directions. Stimulation of LG and MG resulted in downward and medial or lateral forces depending on the subject. We found FIB end-point forces to be significantly different from those of LG and MG. In all subjects, stimulation of FIB resulted in downward and lateral forces. Based on our results, we suggest that there are multiple factors determining when and whether LG or MG will produce a medial or lateral force and FIB consistently plays a significant role in eversion/abduction and plantar flexion. We suggest that the intersubject variability we found is not simply an artifact of experimental or technical error but is functionally relevant and should be addressed in future studies and models.
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Giacomozzi C, D'Ambrogi E, Cesinaro S, Macellari V, Uccioli L. Muscle performance and ankle joint mobility in long-term patients with diabetes. BMC Musculoskelet Disord 2008; 9:99. [PMID: 18601723 PMCID: PMC2453126 DOI: 10.1186/1471-2474-9-99] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 07/04/2008] [Indexed: 11/17/2022] Open
Abstract
Background Long-term patients with diabetes and peripheral neuropathy show altered foot biomechanics and abnormal foot loading. This study aimed at assessing muscle performance and ankle mobility in such patients under controlled conditions. Methods Forty six long-term diabetes patients with (DN) and without (D) peripheral neuropathy, and 21 controls (C) were examined. Lower leg muscle performance and ankle mobility were assessed by means of a dedicated equipment, with the patient seated and the examined limb unloaded. 3D active ranges of motion and moments of force were recorded, the latter during maximal isometric contractions, with the foot blocked in different positions. Results All patients showed reduced ankle mobility. In the sagittal and transversal planes reduction vs C was 11% and 20% for D, 20% and 21% for DN, respectively. Dorsal-flexing moments were significantly reduced in all patients and foot positions, the highest reduction being 28% for D and 37% for DN. Reductions of plantar-flexing moments were in the range 12–15% for D (only with the foot blocked in neutral and in dorsal-flexed position), and in the range 10–24% for DN. In all patients, reductions in the frontal and transversal planes ranged 14–41%. Conclusion The investigation revealed ankle functional impairments in patients with diabetes, with or without neuropathy, thus suggesting that other mechanisms besides neuropathy might contribute to alter foot-ankle biomechanics. Such impairments may then play a role in the development of abnormal gait and in the onset of plantar ulcers.
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Affiliation(s)
- Claudia Giacomozzi
- Department of Technology and Health, Istituto Superiore di Sanità, Rome, Italy.
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Suponitsky Y, Verbitsky O, Peled E, Mizrahi J. Effect of selective fatiguing of the shank muscles on single-leg-standing sway. J Electromyogr Kinesiol 2007; 18:682-9. [PMID: 17350288 DOI: 10.1016/j.jelekin.2007.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 01/25/2007] [Accepted: 01/25/2007] [Indexed: 11/20/2022] Open
Abstract
Control of standing requires the continuous activity of the leg muscles. In single leg standing the system is less redundant and muscular activity is more intensive. The objective of this study was to examine the effect of force imbalance of the shank muscles, evoked by their selective fatiguing, on postural control in single-leg standing. Five healthy subjects performed two single-leg standing trials, lasting as long as the subject could maintain steady balance, and separated by a 240s quasi-isotonic sustained effort to induce fatigue of the Tibialis Anterior and Peroneus muscles. The following were on-line monitored: sway-related parameters, e.g., ground reaction force and center of pressure in the standing trials; and electromyogram of the Tibialis Anterior, Peroneus and Gastrocnemius muscles in all experiments. Simple and multiple linear regressions served to study the fatigue effects on the relationship between muscle activity and postural sway. The results indicate that the evoked muscle imbalance leads to (a) increased postural sway; (b) increased correlation between muscle activity, and sway-related parameters. Thus, with the reduction of the level of redundancy the system becomes more synchronized. These results have potential relevance for cases of muscle impairment, in which electrical stimulation is required to augment muscle activity.
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Affiliation(s)
- Y Suponitsky
- Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa 32000, Israel
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Di Gregorio R, Parenti-Castelli V, O'Connor JJ, Leardini A. Mathematical models of passive motion at the human ankle joint by equivalent spatial parallel mechanisms. Med Biol Eng Comput 2007; 45:305-13. [PMID: 17295023 DOI: 10.1007/s11517-007-0160-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Accepted: 01/03/2007] [Indexed: 12/26/2022]
Abstract
The paper presents a theoretical model of the ankle joint, i.e. tibio-talar articulation, which shows how the articular surfaces and the ligaments, acting together as a mechanism, can control the passive kinematics of the joint. The authors had previously shown that, in virtually unloaded conditions, the ankle behaves as a single degree-of-freedom system, and that two ligament fibres remain nearly isometric throughout the flexion arc. Two different equivalent spatial parallel mechanisms together with corresponding kinematic models were formulated. These assumed isometricity of fibres within the calcaneal-fibular and tibio-calcaneal ligaments and rigidity of the articulating surfaces, taken as three sphere-plane contacts in one model, and as a single spherical pair in the other. Geometry parameters for the models were obtained from three specimens. Motion predictions compare quite well with the measured motion of the specimens. The differences are accounted for by the simplifications adopted to represent the complex anatomical structures, and might be reduced by future more realistic representations of the natural articular surfaces.
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Affiliation(s)
- R Di Gregorio
- Department of Engineering, University of Ferrara, Ferrara, Italy
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Valderrabano V, von Tscharner V, Nigg BM, Hintermann B, Goepfert B, Fung TS, Frank CB, Herzog W. Lower leg muscle atrophy in ankle osteoarthritis. J Orthop Res 2006; 24:2159-69. [PMID: 16921525 DOI: 10.1002/jor.20261] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of this study was to determine changes in the lower leg muscles associated with ankle osteoarthritis. Fifteen unilateral ankle osteoarthritis patients and fifteen age-gender-matched normal subjects were assessed with clinical [osteoarthritis latency time, pain, alignment, AOFAS ankle score, ankle range of motion (ROM), calf circumference], radiological (ankle osteoarthritis grading), and muscular-physiological parameters [isometric maximal voluntary ankle torque, surface electromyography of the anterior tibial (AT), medial gastrocnemius (MG), soleus (SO), and peroneus longus (PL) muscle]. The osteoarthritis patients had increased pain (6.8 points) and reduced AOFAS score (33.7 points) compared to the control group. Compared to the contralateral healthy leg, the arthritic leg showed reduced mean dorsi-/plantar flexion ROM (16.0 degrees), reduced mean calf circumference (2.1 cm), smaller mean dorsiflexion (16.4 Nm) and plantar flexion (15.8 Nm) torques, lower mean electromyography frequency for all muscles (AT -22.6 Hz; MG -27.3 Hz; SO -25.9 Hz; PL -28.5 Hz), and lower mean electromyography intensity in the AT [-28.0x10(3) (microv)2], MG [-13.3x10(3) (microv)2], and PL [-12.8x10(3) (microv)2]. SO mean electromyography intensity was not significantly changed [+2.0x10(3) (microv)2]. Unilateral ankle osteoarthritis is associated with atrophic changes of the lower leg muscles. This study supports previous observations on muscle dysfunction in knee osteoarthritis.
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Affiliation(s)
- Victor Valderrabano
- Human Performance Laboratory, University of Calgary, and Orthopaedic Department & McCaig Centre for Joint Injury and Arthritis Research, University Foothills Hospital, Calgary, Alberta, Canada.
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Giacomozzi C, Martelli F. Peak pressure curve: an effective parameter for early detection of foot functional impairments in diabetic patients. Gait Posture 2006; 23:464-70. [PMID: 16043353 DOI: 10.1016/j.gaitpost.2005.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Revised: 03/23/2005] [Accepted: 06/07/2005] [Indexed: 02/02/2023]
Abstract
A clinical investigation was conducted on 61 diabetic patients and 22 healthy volunteers. Joint mobility, muscular function of the foot-ankle complex and plantar pressure measurements were characterised. A clustering algorithm was applied to obtain patient classification based on the shape and amplitude of the time curve of the instantaneous maximum pressure the foot experienced during gait. Results indicate that a screening test based on the peak pressure curve might be an effective way to detect diabetic patients at risk of foot ulceration.
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Affiliation(s)
- Claudia Giacomozzi
- Department of Technology and Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
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