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Kim J, Lee HJ, Lee SH, Lee J, Chang WH, Ryu GH, Kim YH. Correlation between cardiopulmonary metabolic energy cost and lower-limb muscle activity during inclined treadmill gait in older adults. BMC Geriatr 2021; 21:469. [PMID: 34425788 PMCID: PMC8383420 DOI: 10.1186/s12877-021-02401-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inclined walking requires more cardiopulmonary metabolic energy and muscle strength than flat-level walking. This study sought to investigate changes in lower-limb muscle activity and cardiopulmonary metabolic energy cost during treadmill walking with different inclination grades and to discern any correlation between these two measures in older adults. METHODS Twenty-four healthy older adults (n = 11 males; mean age: 75.3 ± 4.0 years) participated. All participants walked on a treadmill that was randomly inclined at 0% (condition 1), 10% (condition 2), and 16% (condition 3) for five minutes each. Simultaneous measurements of lower-limb muscle activity and cardiopulmonary metabolic energy cost during inclined treadmill walking were collected. Measured muscles included the rectus abdominis (RA), erector spinae (ES), rectus femoris (RF), biceps femoris (BF), vastus medialis (VM), tibialis anterior (TA), medial head of the gastrocnemius (GCM), and soleus (SOL) muscles on the right side. RESULTS As compared with 0% inclined treadmill gait, the 10% inclined treadmill gait increased the net cardiopulmonary metabolic energy cost by 22.9%, while the 16% inclined treadmill gait increased the net cardiopulmonary metabolic energy cost by 44.2%. In the stance phase, as the slope increased, activity was significantly increased in the RA, RF, VM, BF, GCM, and SOL muscles. In the swing phase, As the slope increased activity was significantly increased in the RA, RF, VM, BF, and TA muscles. SOL muscle activity was most relevant to the change in cardiopulmonary metabolic energy cost in the stance phase of inclined treadmill walking. The relationship between the increase in cardiopulmonary metabolic energy cost and changes in muscle activity was also significant in the VM, GCM, and RF. CONCLUSION This study demonstrated that changes in SOL, VM, GCM, and RA muscle activity had a significant relationship with cardiopulmonary metabolic energy cost increment during inclined treadmill walking. These results can be used as basic data for various gait-training programs and as an indicator in the development of assistive algorithms of wearable walking robots for older adults. TRIAL REGISTRATION Clinical trials registration information: ClinicalTrials.gov Identifier: NCT04614857 (05/11/2020).
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Affiliation(s)
- Jihye Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hwang-Jae Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Su-Hyun Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jungsoo Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Gyu-Ha Ryu
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Department of Health Science and Technology, Department of Digital Health, SAIHST, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Knee loading in OA subjects is correlated to flexion and adduction moments and to contact point locations. Sci Rep 2021; 11:8594. [PMID: 33883591 PMCID: PMC8060429 DOI: 10.1038/s41598-021-87978-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 03/29/2021] [Indexed: 11/29/2022] Open
Abstract
This study evaluated the association of contact point locations with the knee medial and lateral contact force (Fmed, Flat) alterations in OA and healthy subjects. A musculoskeletal model of the lower limb with subject-specific tibiofemoral contact point trajectories was used to estimate the Fmed and Flat in ten healthy and twelve OA subjects during treadmill gait. Regression analyses were performed to evaluate the correlation of the contact point locations, knee adduction moment (KAM), knee flexion moment (KFM), frontal plane alignment, and gait speed with the Fmed and Flat. Medial contact point locations in the medial–lateral direction showed a poor correlation with the Fmed in OA (R2 = 0.13, p = 0.01) and healthy (R2 = 0.24, p = 0.001) subjects. Anterior–posterior location of the contact points also showed a poor correlation with the Fmed of OA subjects (R2 = 0.32, p < 0.001). Across all subjects, KAM and KFM remained the best predictors of the Fmed and Flat, respectively (R2 between 0.62 and 0.69). Results suggest different mechanisms of contact force distribution in OA joints. The variations in the location of the contact points participate partially to explains the Fmed variations in OA subjects together with the KFM and KAM.
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Dumas R, Barré A, Moissenet F, Aissaoui R. Can a reduction approach predict reliable joint contact and musculo-tendon forces? J Biomech 2019; 95:109329. [PMID: 31522745 DOI: 10.1016/j.jbiomech.2019.109329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/10/2019] [Accepted: 08/30/2019] [Indexed: 10/26/2022]
Abstract
Musculoskeletal models generally solve the muscular redundancy by numerical optimisation. They have been extensively validated using instrumented implants. Conversely, a reduction approach considers only one flexor or extensor muscle group at the time to equilibrate the inter-segmental joint moment. It is not clear if such models can still predict reliable joint contact and musculo-tendon forces during gait. Tibiofemoral contact force and gastrocnemii, quadriceps, and hamstrings musculo-tendon forces were estimated using a reduction approach for five subjects walking with an instrumented prosthesis. The errors in the proximal-distal tibiofemoral contact force fell in the range (0.3-0.9 body weight) reported in the literature for musculoskeletal models using numerical optimisation. The musculo-tendon forces were in agreement with the EMG envelops and appeared comparable to the ones reported in the literature with generic musculoskeletal models. Although evident simplifications and limitations, it seems that the reduction approach can provided quite reliable results. It can be a useful pedagogical tool in biomechanics, e.g. to illustrate the theoretical differences between inter-segmental and contact forces, and can provide a first estimate of the joint loadings in subjects with limited musculoskeletal deformities and neurological disorders.
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Affiliation(s)
- Raphael Dumas
- Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, LBMC, F69622 Lyon, France.
| | | | - Florent Moissenet
- Willy Taillard Laboratory of Kinesiology, University Geneva Hospitals and Geneva University, Geneva, Switzerland
| | - Rachid Aissaoui
- Laboratoire de Recherche en Imagerie et Orthopédie, Centre de Recherche du CHUM, Canada; Département de génie des systèmes, École de Technologie Supérieure, Montréal, Canada
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Moissenet F, Bélaise C, Piche E, Michaud B, Begon M. An Optimization Method Tracking EMG, Ground Reactions Forces, and Marker Trajectories for Musculo-Tendon Forces Estimation in Equinus Gait. Front Neurorobot 2019; 13:48. [PMID: 31379547 PMCID: PMC6646662 DOI: 10.3389/fnbot.2019.00048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/24/2019] [Indexed: 11/22/2022] Open
Abstract
In the context of neuro-orthopedic pathologies affecting walking and thus patients' quality of life, understanding the mechanisms of gait deviations and identifying the causal motor impairments is of primary importance. Beside other approaches, neuromusculoskeletal simulations may be used to provide insight into this matter. To the best of our knowledge, no computational framework exists in the literature that allows for predictive simulations featuring muscle co-contractions, and the introduction of various types of perturbations during both healthy and pathological gait types. The aim of this preliminary study was to adapt a recently proposed EMG-marker tracking optimization process to a lower limb musculoskeletal model during equinus gait, a multiphase problem with contact forces. The resulting optimization method tracking EMG, ground reactions forces, and marker trajectories allowed an accurate reproduction of joint kinematics (average error of 5.4 ± 3.3 mm for pelvis translations, and 1.9 ± 1.3° for pelvis rotation and joint angles) and ensured good temporal agreement in muscle activity (the concordance between estimated and measured excitations was 76.8 ± 5.3 %) in a relatively fast process (3.88 ± 1.04 h). We have also highlighted that the tracking of ground reaction forces was possible and accurate (average error of 17.3 ± 5.5 N), even without the use of a complex foot-ground contact model.
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Affiliation(s)
- Florent Moissenet
- Centre National de Rééducation Fonctionnelle et de Réadaptation-Rehazenter, Luxembourg, Luxembourg
| | - Colombe Bélaise
- Laboratory of Simulation and Movement Modeling, School of Kinesiology and Exercise Sciences, Université de Montréal, Montreal, QC, Canada
| | - Elodie Piche
- Laboratory of Simulation and Movement Modeling, School of Kinesiology and Exercise Sciences, Université de Montréal, Montreal, QC, Canada
| | - Benjamin Michaud
- Laboratory of Simulation and Movement Modeling, School of Kinesiology and Exercise Sciences, Université de Montréal, Montreal, QC, Canada.,Sainte-Justine Hospital Research Center, Montreal, QC, Canada
| | - Mickaël Begon
- Laboratory of Simulation and Movement Modeling, School of Kinesiology and Exercise Sciences, Université de Montréal, Montreal, QC, Canada.,Sainte-Justine Hospital Research Center, Montreal, QC, Canada
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Ding Z, Azmi NL, Bull AMJ. Validation and Use of a Musculoskeletal Gait Model to Study the Role of Functional Electrical Stimulation. IEEE Trans Biomed Eng 2019; 66:892-897. [DOI: 10.1109/tbme.2018.2865614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lee SH, Lee HJ, Chang WH, Choi BO, Lee J, Kim J, Ryu GH, Kim YH. Gait performance and foot pressure distribution during wearable robot-assisted gait in elderly adults. J Neuroeng Rehabil 2017; 14:123. [PMID: 29183379 PMCID: PMC5706419 DOI: 10.1186/s12984-017-0333-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/03/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A robotic exoskeleton device is an intelligent system designed to improve gait performance and quality of life for the wearer. Robotic technology has developed rapidly in recent years, and several robot-assisted gait devices were developed to enhance gait function and activities of daily living in elderly adults and patients with gait disorders. In this study, we investigated the effects of the Gait-enhancing Mechatronic System (GEMS), a new wearable robotic hip-assist device developed by Samsung Electronics Co, Ltd., Korea, on gait performance and foot pressure distribution in elderly adults. METHODS Thirty elderly adults who had no neurological or musculoskeletal abnormalities affecting gait participated in this study. A three-dimensional (3D) motion capture system, surface electromyography and the F-Scan system were used to collect data on spatiotemporal gait parameters, muscle activity and foot pressure distribution under three conditions: free gait without robot assistance (FG), robot-assisted gait with zero torque (RAG-Z) and robot-assisted gait (RAG). RESULTS We found increased gait speed, cadence, stride length and single support time in the RAG condition. Reduced rectus femoris and medial gastrocnemius muscle activity throughout the terminal stance phase and reduced effort of the medial gastrocnemius muscle throughout the pre-swing phase were also observed in the RAG condition. In addition, walking with the assistance of GEMS resulted in a significant increase in foot pressure distribution, specifically in maximum force and peak pressure of the total foot, medial masks, anterior masks and posterior masks. CONCLUSION The results of the present study reveal that GEMS may present an alternative way of restoring age-related changes in gait such as gait instability with muscle weakness, reduced step force and lower foot pressure in elderly adults. In addition, GEMS improved gait performance by improving push-off power and walking speed and reducing muscle activity in the lower extremities. TRIAL REGISTRATION NCT02843828 .
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Affiliation(s)
- Su-Hyun Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
| | - Hwang-Jae Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
- Department of Health Science and Technology, Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
| | - Byung-Ok Choi
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
| | - Jusuk Lee
- Samsung Advanced Institute of Technology, Samsung Electronics, 130 Samsung-ro, Yeongtong-gu Gyeonggi-do, Suwon-si, 16678 Republic of Korea
| | - Jeonghun Kim
- Samsung Advanced Institute of Technology, Samsung Electronics, 130 Samsung-ro, Yeongtong-gu Gyeonggi-do, Suwon-si, 16678 Republic of Korea
| | - Gyu-Ha Ryu
- Office of Biomechanical science, Research Center for Future Medicine, Samsung Medical Center, Sungkyunkwan University, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
- Department of Health Science and Technology, Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Irwon-ro 81, Gangnam-gu, Seoul, 06351 Republic of Korea
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Lee HJ, Lee S, Chang WH, Seo K, Shim Y, Choi BO, Ryu GH, Kim YH. A Wearable Hip Assist Robot Can Improve Gait Function and Cardiopulmonary Metabolic Efficiency in Elderly Adults. IEEE Trans Neural Syst Rehabil Eng 2017; 25:1549-1557. [PMID: 28186902 DOI: 10.1109/tnsre.2017.2664801] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aims of this paper were to investigate the effectiveness of a newly developed wearable hip assist robot, that uses an active assist algorithm to improve gait function, muscle effort, and cardiopulmonary metabolic efficiency in elderly adults. Thirty elderly adults (15 males/ 15 females) participated in thispaper. The experimental protocol consisted of overground gait at comfortable speed under three different conditions: free gait without robot assistance, robot-assisted gait with zero torque (RAG-Z), and full RAG. Under all conditions, muscle effort was analyzed using a 12-channel surface electromyography system. Spatio-temporal data were collected at 120 Hz using a 3-D motion capture system with six infrared cameras. Metabolic cost parameters were collected as oxygen consumption per unit (ml/min/kg) and aerobic energy expenditure (Kcal/min). In the RAG condition, participants demonstrated improved gait function, decreased muscle effort, and reduced metabolic cost. Although the hip assist robot only provides assistance at the hip joint, our results demonstrated a clear reduction in knee and ankle muscle activity in addition to decreased hip flexor and extensor activity. Our findings suggest that this robot has the potential to improve stabilization of the trunk during walking in elderly adults.
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Ding Z, Nolte D, Kit Tsang C, Cleather DJ, Kedgley AE, Bull AMJ. In Vivo Knee Contact Force Prediction Using Patient-Specific Musculoskeletal Geometry in a Segment-Based Computational Model. J Biomech Eng 2016; 138:021018. [DOI: 10.1115/1.4032412] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Indexed: 11/08/2022]
Abstract
Segment-based musculoskeletal models allow the prediction of muscle, ligament, and joint forces without making assumptions regarding joint degrees-of-freedom (DOF). The dataset published for the “Grand Challenge Competition to Predict in vivo Knee Loads” provides directly measured tibiofemoral contact forces for activities of daily living (ADL). For the Sixth Grand Challenge Competition to Predict in vivo Knee Loads, blinded results for “smooth” and “bouncy” gait trials were predicted using a customized patient-specific musculoskeletal model. For an unblinded comparison, the following modifications were made to improve the predictions: further customizations, including modifications to the knee center of rotation; reductions to the maximum allowable muscle forces to represent known loss of strength in knee arthroplasty patients; and a kinematic constraint to the hip joint to address the sensitivity of the segment-based approach to motion tracking artifact. For validation, the improved model was applied to normal gait, squat, and sit-to-stand for three subjects. Comparisons of the predictions with measured contact forces showed that segment-based musculoskeletal models using patient-specific input data can estimate tibiofemoral contact forces with root mean square errors (RMSEs) of 0.48–0.65 times body weight (BW) for normal gait trials. Comparisons between measured and predicted tibiofemoral contact forces yielded an average coefficient of determination of 0.81 and RMSEs of 0.46–1.01 times BW for squatting and 0.70–0.99 times BW for sit-to-stand tasks. This is comparable to the best validations in the literature using alternative models.
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Affiliation(s)
- Ziyun Ding
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK e-mail:
| | - Daniel Nolte
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK e-mail:
| | - Chui Kit Tsang
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK e-mail:
| | - Daniel J. Cleather
- School of Sport, Health and Applied Science, St Mary's University, Waldegrave Road, Twickenham TW1 4SX, UK e-mail:
| | - Angela E. Kedgley
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK e-mail:
| | - Anthony M. J. Bull
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK e-mail:
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Moissenet F, Giroux M, Chèze L, Dumas R. Validity of a musculoskeletal model using two different geometries for estimating hip contact forces during normal walking. Comput Methods Biomech Biomed Engin 2015; 18 Suppl 1:2000-1. [PMID: 26241128 DOI: 10.1080/10255842.2015.1069596] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- F Moissenet
- a CNRFR - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture , Luxembourg
| | - M Giroux
- b Université de Lyon , Lyon , France.,c Université Claude Bernard Lyon 1 , Villeurbanne , France.,d IFSTTAR, UMR_T9406, LBMC Laboratoire de Biomécanique et Mécanique des Chocs , Bron , France
| | - L Chèze
- b Université de Lyon , Lyon , France.,c Université Claude Bernard Lyon 1 , Villeurbanne , France.,d IFSTTAR, UMR_T9406, LBMC Laboratoire de Biomécanique et Mécanique des Chocs , Bron , France
| | - R Dumas
- b Université de Lyon , Lyon , France.,c Université Claude Bernard Lyon 1 , Villeurbanne , France.,d IFSTTAR, UMR_T9406, LBMC Laboratoire de Biomécanique et Mécanique des Chocs , Bron , France
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Moissenet F, Chèze L, Dumas R. Introduction of a set of EMG-based muscular activations in a multi-objective optimisation when solving the muscular redundancy problem during gait. Comput Methods Biomech Biomed Engin 2014; 17 Suppl 1:132-3. [PMID: 25074200 DOI: 10.1080/10255842.2014.931542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- F Moissenet
- a Laboratoire d'Analyse du Mouvement et de la Posture , CNRFR - Rehazenter , 1 rue André Vésale, L-2647 , Luxembourg , Luxembourg
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A 3D lower limb musculoskeletal model for simultaneous estimation of musculo-tendon, joint contact, ligament and bone forces during gait. J Biomech 2014; 47:50-8. [DOI: 10.1016/j.jbiomech.2013.10.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 10/11/2013] [Accepted: 10/12/2013] [Indexed: 11/22/2022]
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