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Mattar LT, Mahboobin AB, Popchak AJ, Anderst WJ, Musahl V, Irrgang JJ, Debski RE. Individuals with rotator cuff tears unsuccessfully treated with exercise therapy have less inferiorly oriented net muscle forces during scapular plane abduction. J Biomech 2024; 162:111859. [PMID: 37989027 PMCID: PMC10843663 DOI: 10.1016/j.jbiomech.2023.111859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/29/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023]
Abstract
Exercise therapy for individuals with rotator cuff tears fails in approximately 25.0 % of cases. One reason for failure of exercise therapy may be the inability to strengthen and balance the muscle forces crossing the glenohumeral joint that act to center the humeral head on the glenoid. The objective of the current study was to compare the magnitude and orientation of the net muscle force pre- and post-exercise therapy between subjects successfully and unsuccessfully (e.g. eventually underwent surgery) treated with a 12-week individualized exercise therapy program. Twelve computational musculoskeletal models (n = 6 successful, n = 6 unsuccessful) were developed in OpenSim (v4.0) that incorporated subject specific tear characteristics, muscle peak isometric force, in-vivo kinematics and bony morphology. The models were driven with experimental kinematics and the magnitude and orientation of the net muscle force was determined during scapular plane abduction at pre- and post-exercise therapy timepoints. Subjects unsuccessfully treated had less inferiorly oriented net muscle forces pre- and post-exercise therapy compared to subjects successfully treated (p = 0.039 & 0.045, respectively). No differences were observed in the magnitude of the net muscle force (p > 0.05). The current study developed novel computational musculoskeletal models with subject specific inputs capable of distinguishing between subjects successfully and unsuccessfully treated with exercise therapy. A less inferiorly oriented net muscle force in subjects unsuccessfully treated may increase the risk of superior migration leading to impingement. Adjustments to exercise therapy programs may be warranted to avoid surgery in subjects at risk of unsuccessful treatment.
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Affiliation(s)
- Luke T Mattar
- Orthopaedic Robotics Laboratory, University of Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States
| | - Arash B Mahboobin
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, United States
| | - Adam J Popchak
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, United States
| | - William J Anderst
- Biodynamics Laboratory, University of Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, University of Pittsburgh, United States; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States
| | - James J Irrgang
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States; Department of Physical Therapy, University of Pittsburgh, Pittsburgh, United States
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, University of Pittsburgh, United States; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States.
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Pohlman C, Pardee A, Friedman M, Rutherford D, Vannatta CN, Kernozek TW. Effects of Body Weight Support in Running on Achilles Tendon Loading. Int J Sports Med 2023; 44:913-918. [PMID: 37336504 DOI: 10.1055/a-2113-1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Achilles tendon (AT) tendinopathy is common in runners. Repetitive AT loading may play a role in etiology. Interventions such as body weight support (BWS) may reduce loading on the AT in running. Examine how ground reaction force, AT loading, foot strike, and cadence variables change in running with BWS. Twenty-four healthy female runners free from injury were examined. Participants ran on an instrumented treadmill with and without BWS using a harness-based system at a standardized speed. The system has 4 elastic cords affixed to a harness that is attached to a frame-like structure. Kinematic data and kinetic data were used in a musculoskeletal model (18 segments and 16 degrees of freedom) to determine AT loading variables, foot strike angle, and cadence. Paired t-tests were used to compare each variable between conditions. Ground reaction force was 9.0% lower with BWS (p<.05). Peak AT stress, force, and impulse were 9.4, 11.7%, and 14.8% lower when using BWS in running compared to no support (p<.05). Foot strike angle was similar (p<.05) despite cadence being reduced (p<.05). BWS may reduce AT loading and impulse variables during running. This may be important in rehabilitation efforts.
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Affiliation(s)
- Callie Pohlman
- Health Professions, Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, United States
- Sports Physical Therapy, Gundersen Health System, La Crosse, United States
| | - Andrew Pardee
- Health Professions, Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, United States
- Sports Physical Therapy, Gundersen Health System, La Crosse, United States
| | - Mikey Friedman
- Health Professions, Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, United States
- Sports Physical Therapy, Gundersen Health System, La Crosse, United States
| | - Drew Rutherford
- Health Professions, Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, United States
- Sports Physical Therapy, Gundersen Health System, La Crosse, United States
| | - Charles Nathan Vannatta
- La Crosse Institute for Movement Science, University of Wisconsin-La Crosse, La Crosse, United States
| | - Thomas W Kernozek
- Health Professions, La Crosse Institute for Movement Science (LIMS), La Crosse, United States
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Jing Z, Han J, Zhang J. Comparison of biomechanical analysis results using different musculoskeletal models for children with cerebral palsy. Front Bioeng Biotechnol 2023; 11:1217918. [PMID: 37823025 PMCID: PMC10562727 DOI: 10.3389/fbioe.2023.1217918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023] Open
Abstract
Introduction: Musculoskeletal model-based simulations have gained popularity as a tool for analyzing human movement biomechanics. However, when examining the same gait, different models with varying anatomical data and assumptions may produce inconsistent biomechanical results. This inconsistency is particularly relevant for children with cerebral palsy, who often exhibit multiple pathological gait patterns that can impact model outputs. Methods: The aim of this study was to investigate the effect of selecting musculoskeletal models on the biomechanical analysis results in children with cerebral palsy. Gait data were collected from multiple participants at slow, medium, and fast velocities. Joint kinematics, joint dynamics, and muscle activation were calculated using six popular musculoskeletal models within a biomechanical simulation environment. Results: The degree of inconsistency, measured as the root-mean-square deviation, in kinematic and kinetic results produced by the different models ranged from 4% to 40% joint motion range and 0%-28% joint moment range, respectively. The correlation between the results of the different models (both kinematic and kinetic) was good (R> 0.85, P < 0.01), with a stronger correlation observed in the kinetic results. Four of the six models showed a positive correlation between the simulated muscle activation of rectus femoris and the surface EMG, while all models exhibited a positive correlation between the activation of medial gastrocnemius and the surface EMG (P < 0.01). Discussion: These results provide insights into the consistency of model results, factors influencing consistency, characteristics of each model's outputs, mechanisms underlying these characteristics, and feasible applications for each model. By elucidating the impact of model selection on biomechanical analysis outcomes, this study advances the field's understanding of musculoskeletal modeling and its implications for clinical gait analysis model decision-making in children with cerebral palsy.
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Affiliation(s)
- Zhibo Jing
- Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, China
- Institute of Robotics and Automatic Information System, Nankai University, Tianjin, China
- College of Artificial Intelligence, Nankai University, Tianjin, China
| | - Jianda Han
- Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, China
- Institute of Robotics and Automatic Information System, Nankai University, Tianjin, China
- College of Artificial Intelligence, Nankai University, Tianjin, China
- Smart Sensing Interdisciplinary Science Center, Nankai University, Tianjin, China
| | - Juanjuan Zhang
- Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, China
- Institute of Robotics and Automatic Information System, Nankai University, Tianjin, China
- College of Artificial Intelligence, Nankai University, Tianjin, China
- Smart Sensing Interdisciplinary Science Center, Nankai University, Tianjin, China
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Lavikainen J, Vartiainen P, Stenroth L, Karjalainen PA. Open-source software library for real-time inertial measurement unit data-based inverse kinematics using OpenSim. PeerJ 2023; 11:e15097. [PMID: 37038471 PMCID: PMC10082569 DOI: 10.7717/peerj.15097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/28/2023] [Indexed: 04/12/2023] Open
Abstract
Background Inertial measurements (IMUs) facilitate the measurement of human motion outside the motion laboratory. A commonly used open-source software for musculoskeletal simulation and analysis of human motion, OpenSim, includes a tool to enable kinematics analysis of IMU data. However, it only enables offline analysis, i.e., analysis after the data has been collected. Extending OpenSim's functionality to allow real-time kinematics analysis would allow real-time feedback for the subject during the measurement session and has uses in e.g., rehabilitation, robotics, and ergonomics. Methods We developed an open-source software library for real-time inverse kinematics (IK) analysis of IMU data using OpenSim. The software library reads data from IMUs and uses multithreading for concurrent calculation of IK. Its operation delays and throughputs were measured with a varying number of IMUs and parallel computing IK threads using two different musculoskeletal models, one a lower-body and torso model and the other a full-body model. We published the code under an open-source license on GitHub. Results A standard desktop computer calculated full-body inverse kinematics from treadmill walking at 1.5 m/s with data from 12 IMUs in real-time with a mean delay below 55 ms and reached a throughput of more than 90 samples per second. A laptop computer had similar delays and reached a throughput above 60 samples per second with treadmill walking. Minimal walking kinematics, motion of lower extremities and torso, were calculated from treadmill walking data in real-time with a throughput of 130 samples per second on the laptop and 180 samples per second on the desktop computer, with approximately half the delay of full-body kinematics. Conclusions The software library enabled real-time inverse kinematical analysis with different numbers of IMUs and customizable musculoskeletal models. The performance results show that subject-specific full-body motion analysis is feasible in real-time, while a laptop computer and IMUs allowed the use of the method outside the motion laboratory.
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Guérin M, Sijobert B, Zaragoza B, Cambon F, Boyer L, Patte K. Combining intensive rehabilitation with a non-functional isokinetic strengthening program in adolescents with cerebral palsy: a study protocol for a randomized controlled trial. JMIR Res Protoc 2022; 12:e43221. [PMID: 36790338 DOI: 10.2196/43221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/16/2022] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is the most common brain injury in the pediatric population. CP patients present different affectations such as decreased muscle strength, gait deviations, impaired proprioception, and spasticity. Isokinetic strengthening programs combined with an intensive rehabilitation may improve muscle strength and therefore gait efficiency. Clinical Trials: The protocol has been accepted by the French National Ethics Committee (IDRCB: 2022-A00431-42). OBJECTIVE The primary aim of this randomized controlled trial is to compare the effect of an intensive rehabilitation combined with a non-functional isokinetic progressive strengthening program to an intensive rehabilitation alone on gait parameters and muscle strength in CP patients. Another goal of the current study is to determine whether adding an isokinetic program to an intensive rehabilitation is more effective than an intensive reha-bilitation alone on decreasing spasticity and improving joint position sense in CP patients. METHODS Thirty adolescents with spastic diplegia CP (GMFCS level I to III) will be randomized, by an independent researcher, into a 3-week intensive rehabilitation and isokinetic pro-gressive strengthening group or an intensive rehabilitation control group. Gait param-eters, muscle strength, spasticity and knee joint position sense will be assessed. These variables will be evaluated at baseline (T0) and at the end of the intervention (T1). The intensive rehabilitation will consist of physiotherapy sessions twice a day and hydro-therapy and virtual reality gait training once a day. The isokinetic training group will have a total of 9 supervised isokinetic strength training focusing on knee flexors and extensors with different execution speeds. RESULTS The protocol has been accepted by the French National Ethics Committee in October 2022. Inclusion of patients will start in November 2022. CONCLUSIONS The combination of an intensive rehabilitation with an isokinetic program on knee flexors and extensors have not been studied yet. The findings of this study may determine if an isokinetic strength training program of knee flexors and extensors is benefic to improve gait parameters, muscle strength, spasticity, and joint position sense in adolescents with spastic diplegia. CLINICALTRIAL The protocol has been accepted by the French National Ethics Committee (IDRCB: 2022-A00431-42).
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Affiliation(s)
- Mathias Guérin
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
| | - Benoit Sijobert
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
| | - Benjamin Zaragoza
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
| | - Flore Cambon
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
| | - Laurence Boyer
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
| | - Karine Patte
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
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Tomasi M, Artoni A, Mattei L, Di Puccio F. On the estimation of hip joint loads through musculoskeletal modeling. Biomech Model Mechanobiol 2022; 22:379-400. [PMID: 36571624 DOI: 10.1007/s10237-022-01668-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/04/2022] [Indexed: 12/27/2022]
Abstract
Noninvasive estimation of joint loads is still an open challenge in biomechanics. Although musculoskeletal modeling represents a solid resource, multiple improvements are still necessary to obtain accurate predictions of joint loads and to translate such potential into practical utility. The present study, focused on the hip joint, is aimed at reviewing the state-of-the-art literature on the estimation of hip joint reaction forces through musculoskeletal modeling. Our literature inspection, based on well-defined selection criteria, returned seventeen works, which were compared in terms of methods and results. Deviations between predicted and in vivo measured hip joint loads, taken from the OrthoLoad database, were assessed through quantitative deviation indices. Despite the numerous modeling and computational improvements made over the last two decades, predicted hip joint loads still deviate from their experimental counterparts and typically overestimate them. Several critical aspects have emerged that affect muscle force estimation, hence joint loads. Among them, the physical fidelity of the musculoskeletal model, with its parameters and geometry, plays a crucial role. Also, predicted joint loads are markedly affected by the selected muscle recruitment strategy, which reflects the underlying motor control policy. Practical guidelines for researchers interested in noninvasive estimation of hip joint loads are also provided.
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Affiliation(s)
- Matilde Tomasi
- Department of Civil and Industrial Engineering, Università di Pisa, Pisa, Italy
| | - Alessio Artoni
- Department of Civil and Industrial Engineering, Università di Pisa, Pisa, Italy
| | - Lorenza Mattei
- Department of Civil and Industrial Engineering, Università di Pisa, Pisa, Italy.,Sport and Anatomy Centre, Università di Pisa, Pisa, Italy
| | - Francesca Di Puccio
- Department of Civil and Industrial Engineering, Università di Pisa, Pisa, Italy. .,Sport and Anatomy Centre, Università di Pisa, Pisa, Italy.
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Oudenhoven LM, Kerkum YL, Buizer AI, van der Krogt MM. How does a systematic tuning protocol for ankle foot orthosis-footwear combinations affect gait in children in cerebral palsy? Disabil Rehabil 2022; 44:6867-6877. [PMID: 34506245 DOI: 10.1080/09638288.2021.1970829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate the effects of a systematic tuning protocol for ankle foot orthosis footwear combinations (AFO-FC) using incrementing heel height on gait in children with cerebral palsy (CP). METHODS Eighteen children with CP (10.8 ± 3 years, Gross Motor Function Classification System (GMFCS) I-II) underwent 3D gait analysis on a treadmill, while the AFO heel surface was systematically incremented with wedges. Children were subdivided based on their gait pattern, i.e., knee hyperextension (EXT) and excessive knee flexion (FLEX). Outcome measures included sagittal hip and knee angles and moments, shank to vertical angle (SVA), foot to horizontal angle, and gait profile score (GPS). RESULTS For both groups, incrementing heel height resulted in increased knee flexion, more inclined SVA, and increased knee extension moments. This resulted in gait improvements for some children of the EXT-group, but not in FLEX. High variation was found between individuals and within-subject effects were not always consistent for kinematic and kinetics. CONCLUSIONS A systematic AFO-FC tuning protocol using incremented heel height can be effective to improve gait in children with CP walking with EXT. The current results emphasise the importance of including kinematics as well as kinetics of multiple instances throughout the gait cycle for reliable interpretation of the effect of AFO tuning on gait.Implications for rehabilitationA systematic ankle foot orthosis footwear combinations (AFO-FC) tuning protocol using incremented heel height can improve gait in children walking with knee hyperextension.Tuning results in changes throughout the gait cycle.Little evidence is found for an optimal SVA of 10-12° at midstance.For clinical interpretation, both joint kinematic and kinetic parameters should be considered throughout the gait cycle and evaluation should not be based on SVA only.
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Affiliation(s)
- Laura M Oudenhoven
- Department of Rehabilitation Medicine, Amsterdam, Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Yvette L Kerkum
- Faculty of Rehabilitation Sciences, REVAL, Hasselt University, Hasselt University, Diepenbeek, Belgium.,Research & Development, OIM Orthopedie, Assen, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam, Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam, Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Visch L, Oudenhoven LM, Timmermans ST, Beckerman H, Rietberg MB, de Groot V, van der Krogt MM. The relationship between energy cost of walking, ankle push-off and walking speed in persons with multiple sclerosis. Gait Posture 2022; 98:160-166. [PMID: 36126536 DOI: 10.1016/j.gaitpost.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The energy cost of walking (ECw) is an important indicator of walking dysfunction in persons with multiple sclerosis (PwMS). However, its underlying causes and its relation with ankle push-off and walking speed are not well understood. RESEARCH QUESTION What is the contribution of ankle push-off and walking speed to increased ECw in PwMS? METHODS Ten PwMS with walking limitations and 10 individually gender- and age-matched healthy controls (HC) were included. All participants performed two 6-min walking trials on a treadmill at comfortable walking speed (CWS of PwMS) and fast walking speed (FWS, 130 % of CWS of PwMS). Kinetics and metabolic cost were evaluated. Generalized estimating equations were performed to investigate effects of group and walking speed, and their interaction. Spearman correlations were conducted to examine whether ECw was related to ankle push-off in PwMS, controlling for differences in walking speed in PwMS. RESULTS ECw at matched walking speed was significantly higher in PwMS compared to HC. Kinetic parameters were not different between the most impaired leg in PwMS and HC at matched walking speed, but asymmetry between both legs of PwMS was observed. At FWS, ECw reduced and ankle push-off increased similarly in both groups. ECw was inversely related to peak ankle power of the most impaired leg in PwMS at CWS. SIGNIFICANCE Slow walking speed is one factor that contributes to increased ECw in PwMS. Furthermore, PwMS who had a higher ECw showed a lower peak ankle power, independent of walking speed. This indicates that ankle push-off could be a contributor to increased ECw.
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Affiliation(s)
- Lara Visch
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, the Netherlands.
| | - Laura M Oudenhoven
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands.
| | - Sjoerd T Timmermans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands.
| | - Heleen Beckerman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands.
| | - Marc B Rietberg
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands.
| | - Vincent de Groot
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands.
| | - Marjolein M van der Krogt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, the Netherlands.
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Senden R, Marcellis R, Meijer K, Willems P, Lenssen T, Staal H, Janssen Y, Groen V, Vermeulen RJ, Witlox M. Comparison of sagittal plane gait characteristics between the overground and treadmill approach for gait analysis in typically developing children. PeerJ 2022; 10:e13752. [PMID: 35898943 PMCID: PMC9310770 DOI: 10.7717/peerj.13752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/28/2022] [Indexed: 01/17/2023] Open
Abstract
Background Instrumented treadmills have become more mainstream in clinical assessment of gait disorders in children, and are increasingly being applied as an alternative to overground gait analysis. Both approaches differ in multiple elements of set-up (e.g., overground versus treadmill, Pug-in Gait versus Human Body Model-II), workflow (e.g., limited amount of steps versus many successive steps) and post-processing of data (e.g., different filter techniques). These individual elements have shown to affect gait. Since the approaches are used in parallel in clinical practice, insight into the compound effect of the multiple different elements on gait is essential. This study investigates whether the outcomes of two approaches for 3D gait analysis are interchangeable in typically developing children. Methods Spatiotemporal parameters, sagittal joint angles and moments, and ground reaction forces were measured in typically developing children aged 3-17 years using the overground (overground walking, conventional lab environment, Plug-In Gait) and treadmill (treadmill walking in virtual environment, Human Body Model-II) approach. Spatiotemporal and coefficient of variation parameters, and peak values in kinematics and kinetics of both approaches were compared using repeated measures tests. Kinematic and kinetic waveforms from both approaches were compared using statistical parametric mapping (SPM). Differences were quantified by mean differences and root mean square differences. Results Children walked slower, with lower stride and stance time and shorter and wider steps with the treadmill approach than with the overground approach. Mean differences ranged from 0.02 s for stride time to 3.3 cm for step width. The patterns of sagittal kinematic and kinetic waveforms were equivalent for both approaches, but significant differences were found in amplitude. Overall, the peak joint angles were larger during the treadmill approach, showing mean differences ranging from 0.84° (pelvic tilt) to 6.42° (peak knee flexion during swing). Mean difference in peak moments ranged from 0.02 Nm/kg (peak knee extension moment) to 0.32 Nm/kg (peak hip extension moment), showing overall decreased joint moments with the treadmill approach. Normalised ground reaction forces showed mean differences ranging from 0.001 to 0.024. Conclusion The overground and treadmill approach to 3D gait analysis yield different sagittal gait characteristics. The systematic differences can be due to important changes in the neuromechanics of gait and to methodological choices used in both approaches, such as the biomechanical model or the walkway versus treadmill. The overview of small differences presented in this study is essential to correctly interpret the results and needs to be taken into account when data is interchanged between approaches. Together with the research/clinical question and the context of the child, the insight gained can be used to determine the best approach.
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Affiliation(s)
- Rachel Senden
- Department of Physical Therapy, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Rik Marcellis
- Department of Physical Therapy, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Paul Willems
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Ton Lenssen
- Department of Physical Therapy, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Heleen Staal
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Yvonne Janssen
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, Limburg, The Netherlands,Department of Rehabilitation Medicine, School for Public Health and Primary Care, Maastricht University, Maastricht, Limburg, The Netherlands,Department of Neurology, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Vincent Groen
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Roland Jeroen Vermeulen
- Department of Neurology, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
| | - Marianne Witlox
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, Limburg, The Netherlands
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Steingrebe H, Stetter BJ, Sell S, Stein T. Effects of Hip Bracing on Gait Biomechanics, Pain and Function in Subjects With Mild to Moderate Hip Osteoarthritis. Front Bioeng Biotechnol 2022; 10:888775. [PMID: 35898647 PMCID: PMC9309805 DOI: 10.3389/fbioe.2022.888775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Hip Osteoarthritis (HOA) is a common joint disease with serious impact on the quality of life of the affected persons. Additionally, persons with HOA often show alterations in gait biomechanics. Developing effective conservative treatment strategies is of paramount importance, as joint replacement is only indicated for end-stage HOA. In contrast to knee osteoarthritis, little is known about the effectiveness of hip bracing for the management of HOA. Studies analysing mechanically unloading hip braces partly showed beneficial results. However, methodological limitations of these studies, such as small sample sizes or lack of control groups, limit the applicability of the results. Additionally, mechanically unloading braces might impose restrictions on motion and comfort and thus, might not be suitable for people with only mild or moderate symptoms. The aim of this study was to comprehensively quantify the effects of unilateral HOA as well as functional hip bracing on gait biomechanics, pain, proprioception and functional capacity in people with mild to moderate HOA. Hip and pelvis biomechanics during walking were analysed in 21 subjects with mild to moderate HOA under three bracing conditions: unbraced, immediately after brace application and after 1 week of brace usage. Additionally, pain, hip proprioception and functional capacity were assessed. A matched group of 21 healthy subjects was included as reference. Kinematic and kinetic data were collected using a 16-camera infrared motion capturing system and two force plates. Visual analogue scales, an angle reproduction test and a 6-min walking test were applied to measure pain, hip proprioception and functional capacity, respectively. Subjects with HOA walked slower, with reduced step length, sagittal hip range of motion and peak extension angle and had a reduced functional capacity. After 1 week of brace application step length, walking speed and functional capacity were significantly increased. Additionally, pain perception was significantly lower in the intervention period. These results encourage the application of functional hip braces in the management of mild to moderate HOA. However, as key parameters of HOA gait such as a reduced peak extension angle remained unchanged, the underlying mechanisms remain partly unclear and have to be considered in the future.
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Affiliation(s)
- Hannah Steingrebe
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- *Correspondence: Hannah Steingrebe,
| | - Bernd J. Stetter
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Stefan Sell
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Joint Center Black Forest, Hospital Neuenbürg, Neuenbürg, Germany
| | - Thorsten Stein
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
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11
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Ren X, Lutter C, Kebbach M, Bruhn S, Yang Q, Bader R, Tischer T. Compensatory Responses During Slip-Induced Perturbation in Patients With Knee Osteoarthritis Compared With Healthy Older Adults: An Increased Risk of Falls? Front Bioeng Biotechnol 2022; 10:893840. [PMID: 35782515 PMCID: PMC9240265 DOI: 10.3389/fbioe.2022.893840] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/30/2022] [Indexed: 02/03/2023] Open
Abstract
Background: Functional impairment of the knee joint affected by osteoarthritis and loss of muscle strength leads to a significant increase in the number of falls. Nevertheless, little is known about strategies for coping with gait perturbations in patients with knee osteoarthritis (KOA). Thus, this study aimed to examine the compensatory strategies of patients with KOA in response to a backward slip perturbation compared with healthy older adults. Methods: An automated perturbation program was developed by using D-Flow software based on the Gait Real-time Analysis Interactive Lab, and an induced backward slip perturbation was implemented on nine patients with severe KOA (68.89 ± 3.59 years) and 15 age-matched healthy older adults (68.33 ± 3.29 years). Step length, gait speed, range of motion, vertical ground reaction forces, lower extremity joint angles, and joint moments were computed and analyzed. Results: Compared with older adults, patients with KOA had significantly lower step length, gait speed, and vertical ground reaction forces in both normal walking and the first recovery step following backward slip perturbations. Inadequate flexion and extension of joint angles and insufficient generation of joint moments predispose patients with KOA to fall. Hip extension angle and flexion moment, knee range of motion, and vertical ground reaction forces are key monitoring variables. Conclusion: The risk of falls for patients with KOA in response to backward slip perturbations is higher. Patients with KOA should focus not only on quadriceps muscle strength related to knee range of motion but also on improving hip extensor strength and activation through specific exercises. Targeted resistance training and perturbation-based gait training could be better options.
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Affiliation(s)
- Xiping Ren
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Christoph Lutter
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Maeruan Kebbach
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Sven Bruhn
- Institute of Sport Science, Faculty of Philosophy, University of Rostock, Rostock, Germany
| | - Qining Yang
- Department of Joint Surgery, The affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Rainer Bader
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | - Thomas Tischer
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
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12
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Ertman B, Dade R, Vannatta CN, Kernozek TW. Offloading Effects on Impact Forces and Patellofemoral Joint Loading During Running in Females. Gait Posture 2022; 93:212-217. [PMID: 35183838 DOI: 10.1016/j.gaitpost.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Structure-specific loading is being increasingly recognized as playing a role in running related injuries. The use of interventions targeted at reducing patellofemoral joint loads have shown effectiveness in reducing symptoms of patellofemoral pain. Use of bodyweight support (BWS) has the potential to reduce loading on the patellofemoral joint during running to augment rehabilitation efforts. RESEARCH QUESTION How is patellofemoral joint loading different when using a harness-based BWS system during running? METHODS Twenty-five healthy females free from lower extremity injury were included. Participants completed four running trials on an instrumented treadmill with varying amounts of BWS using a commercially available harness system. Kinematic data from a 3D motion capture system and kinetic data from the treadmill were combined in a computer model to estimate measures of patellofemoral joint loading, knee kinematics, ground reaction force, and stride frequency. RESULTS Peak patellofemoral joint stress and time-integral were reduced when running under BWS conditions compared to control conditions. Incremental decreases in patellofemoral loading were not observed with incremental increases in BWS. Peak knee flexion angle was reduced in all BWS conditions compared to control but was not different between BWS conditions. Knee flexion excursion was reduced in only the high BWS condition. Peak ground reaction force and stride frequency incrementally decreased with increased amounts of BWS. SIGNIFICANCE Harness-based BWS systems may provide a simple means to reduce patellofemoral joint loading to assist in rehabilitation efforts, such as addressing patellofemoral pain.
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Affiliation(s)
- Bryce Ertman
- Department of Health Professions, Physical Therapy Program, University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States; La Crosse Institute for Movement Science (LIMS), University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States
| | - Renee Dade
- Department of Health Professions, Physical Therapy Program, University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States; La Crosse Institute for Movement Science (LIMS), University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States
| | - C N Vannatta
- La Crosse Institute for Movement Science (LIMS), University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States; Gundersen Health System, Sports Medicine Department, 311 Gundersen Drive, Onalaska, WI, United States
| | - Thomas W Kernozek
- Department of Health Professions, Physical Therapy Program, University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States; La Crosse Institute for Movement Science (LIMS), University of Wisconsin, 1300 Badger Street, La Crosse, WI, United States.
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13
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Falisse A, Afschrift M, De Groote F. Modeling toes contributes to realistic stance knee mechanics in three-dimensional predictive simulations of walking. PLoS One 2022; 17:e0256311. [PMID: 35077455 PMCID: PMC8789163 DOI: 10.1371/journal.pone.0256311] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022] Open
Abstract
Physics-based predictive simulations have been shown to capture many salient features of human walking. Yet they often fail to produce realistic stance knee and ankle mechanics. While the influence of the performance criterion on the predicted walking pattern has been previously studied, the influence of musculoskeletal mechanics has been less explored. Here, we investigated the influence of two mechanical assumptions on the predicted walking pattern: the complexity of the foot model and the stiffness of the Achilles tendon. We found, through three-dimensional muscle-driven predictive simulations of walking, that modeling the toes, and thus using two-segment instead of single-segment foot models, contributed to robustly eliciting physiological stance knee flexion angles, knee extension torques, and knee extensor activity. Modeling toes also slightly decreased the first vertical ground reaction force peak, increasing its agreement with experimental data, and improved stance ankle kinetics. It nevertheless slightly worsened predictions of ankle kinematics. Decreasing Achilles tendon stiffness improved the realism of ankle kinematics, but there remain large discrepancies with experimental data. Overall, this simulation study shows that not only the performance criterion but also mechanical assumptions affect predictive simulations of walking. Improving the realism of predictive simulations is required for their application in clinical contexts. Here, we suggest that using more complex foot models might contribute to such realism.
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Affiliation(s)
- Antoine Falisse
- Department of Bioengineering, Stanford University, Stanford, California, United States of America
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
- * E-mail:
| | - Maarten Afschrift
- Department of Mechanical Engineering, Robotics Core Lab of Flanders Make, KU Leuven, Leuven, Belgium
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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14
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Lai Y, Sutjipto S, Carmichael MG, Paul G. Preliminary Validation of Upper Limb Musculoskeletal Model using Static Optimization. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4509-4512. [PMID: 34892220 DOI: 10.1109/embc46164.2021.9629494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Musculoskeletal models are powerful analogues to simulate human motion through kinematic and dynamic analysis. When coupled with feature-rich software, musculoskeletal models form an attractive platform for the integration of machine learning for human motion analysis. Performing realistic simulations using these models provide an avenue to overcome constraints when collecting real-world data sets. This motivates the need to further investigate the validity, efficacy, and accuracy of each available model to ensure that the resultant simulations are transferable to real-world applications. Using the open-source software, OpenSim, the primary aim of this paper is to validate an upper limb musculoskeletal model widely used in research. Muscle activation results from static optimization are evaluated against real-world data. A secondary aim is to investigate the effects of two muscle force generation constraints when evaluating the model's validity. Results show an agreement between the optimized muscle activation trends and real-world sEMG readings. However, it was found that static optimization of the musculoskeletal model is unable to identify voluntary co-contractions since the redundant model has more muscles than the system's degrees of freedom. Thus, future work will look to utilize additional channels of information to incorporate this during analysis.
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15
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Bini R, Lock M, Hommelhoff G. Lower limb muscle and joint forces during front and back squats performed on a Smith machine. ISOKINET EXERC SCI 2021. [DOI: 10.3233/ies-202168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Comparison of knee loads on a Smith machine, which is utilised for maintenance of health and rehabilitation, has not been attempted. OBJECTIVE: This study compared lower limb muscle and knee joint forces during front and back squats performed on a Smith Machine. METHODS: Eleven participants performed front and back squats with loads at 40%, 60% and 80% of their back squat 1-RMs. Ground reaction forces and three-dimensional full body motion were collected and used for modelling lower limb muscle and knee joint forces. RESULTS: Larger loads increased tibiofemoral compressive force during back squat at 80% compared to 40% (p< 0.01; d= 1.58) and to 60% (p< 0.01; d= 1.37). Patellofemoral compressive (p= 0.96) and tibiofemoral shear forces (p= 0.55) were not influenced by external load or type of squat. Gluteus medius and minimus produced more force at 80% compared to 60% (p= 0.01; d= 1.10) and to 40% (p< 0.01; d= 1.87) without differences for other muscles (p= 0.09–0.91). CONCLUSIONS: Greater external load was associated with increase in gluteus medius and minimus force and with increased tibiofemoral compressive force without effects on tibiofemoral shear force, patellofemoral compressive force or other lower limb muscle forces.
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16
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Real-Time Musculoskeletal Kinematics and Dynamics Analysis Using Marker- and IMU-Based Solutions in Rehabilitation. SENSORS 2021; 21:s21051804. [PMID: 33807832 PMCID: PMC7961635 DOI: 10.3390/s21051804] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/23/2021] [Accepted: 03/03/2021] [Indexed: 02/07/2023]
Abstract
This study aims to explore the possibility of estimating a multitude of kinematic and dynamic quantities using subject-specific musculoskeletal models in real-time. The framework was designed to operate with marker-based and inertial measurement units enabling extensions far beyond dedicated motion capture laboratories. We present the technical details for calculating the kinematics, generalized forces, muscle forces, joint reaction loads, and predicting ground reaction wrenches during walking. Emphasis was given to reduce computational latency while maintaining accuracy as compared to the offline counterpart. Notably, we highlight the influence of adequate filtering and differentiation under noisy conditions and its importance for consequent dynamic calculations. Real-time estimates of the joint moments, muscle forces, and reaction loads closely resemble OpenSim's offline analyses. Model-based estimation of ground reaction wrenches demonstrates that even a small error can negatively affect other estimated quantities. An application of the developed system is demonstrated in the context of rehabilitation and gait retraining. We expect that such a system will find numerous applications in laboratory settings and outdoor conditions with the advent of predicting or sensing environment interactions. Therefore, we hope that this open-source framework will be a significant milestone for solving this grand challenge.
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17
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Goulette D, Griffith P, Schiller M, Rutherford D, Kernozek TW. Patellofemoral joint loading during the forward and backward lunge. Phys Ther Sport 2020; 47:178-184. [PMID: 33310585 DOI: 10.1016/j.ptsp.2020.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine patellofemoral joint (PFJ) loading in two lunge movements: Forward Lunge (FL) and Backward Lunge (BL). DESIGN Repeated Measures. SETTING University Biomechanics Laboratory. PARTICIPANTS 20 asymptomatic females. MAIN OUTCOME MEASURES Six trials of two lunge movements (FL and BL) to a depth of 75% of leg length were performed. 3-D motion capture and force platforms were used to collect data as input into a musculoskeletal model to determine quadriceps force, PFJ reaction force, PFJ stress, and knee flexion angle. RESULTS Multivariate analysis indicated differences in PFJ loading variables and joint angles between the lunge movements (Forward vs. Backward) and phases (Down vs. Up). Quadriceps force, PFJ reaction force, and knee flexion angle were larger in the FL movement and Up phases. PFJ loading rate was greater in the FL movement along with a lower forward trunk tilt. CONCLUSION The FL produced greater PFJ loading variables compared to the BL. Further research is needed to examine a population of individuals who have patellofemoral pain (PFP) to see if their symptoms may be reduced when using the BL.
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Affiliation(s)
- Danielle Goulette
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, Health Science Center, 1300 Badger Street, La Crosse, WI, 54601, USA
| | - Patrick Griffith
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, Health Science Center, 1300 Badger Street, La Crosse, WI, 54601, USA
| | - Michael Schiller
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, Health Science Center, 1300 Badger Street, La Crosse, WI, 54601, USA
| | - Drew Rutherford
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, Health Science Center, 1300 Badger Street, La Crosse, WI, 54601, USA
| | - Thomas W Kernozek
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, Health Science Center, 1300 Badger Street, La Crosse, WI, 54601, USA.
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In Silico-Enhanced Treatment and Rehabilitation Planning for Patients with Musculoskeletal Disorders: Can Musculoskeletal Modelling and Dynamic Simulations Really Impact Current Clinical Practice? APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10207255] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the past decades, the use of computational physics-based models representative of the musculoskeletal (MSK) system has become increasingly popular in many fields of clinically driven research, locomotor rehabilitation in particular. These models have been applied to various functional impairments given their ability to estimate parameters which cannot be readily measured in vivo but are of interest to clinicians. The use of MSK modelling and simulations allows analysis of relevant MSK biomarkers such as muscle and joint contact loading at a number of different stages in the clinical treatment pathway in order to benefit patient functional outcome. Applications of these methods include optimisation of rehabilitation programs, patient stratification, disease characterisation, surgical pre-planning, and assistive device and exoskeleton design and optimisation. This review provides an overview of current approaches, the components of standard MSK models, applications, limitations, and assumptions of these modelling and simulation methods, and finally proposes a future direction.
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19
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Flux E, van der Krogt M, Cappa P, Petrarca M, Desloovere K, Harlaar J. The Human Body Model versus conventional gait models for kinematic gait analysis in children with cerebral palsy. Hum Mov Sci 2020; 70:102585. [DOI: 10.1016/j.humov.2020.102585] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/06/2019] [Accepted: 01/15/2020] [Indexed: 11/25/2022]
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20
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Vannatta CN, Almonroeder TG, Kernozek TW, Meardon S. Muscle force characteristics of male and female collegiate cross-country runners during overground running. J Sports Sci 2020; 38:542-551. [PMID: 31924128 DOI: 10.1080/02640414.2020.1713689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Males and females demonstrate unique running mechanics that may contribute to sex-related differences in common running related injuries. Understanding differences in muscle forces during running may inform intervention approaches, such as gait retraining addressing muscle force distribution. The purpose of this study was to compare muscle force characteristics and inter-trial variability between males and females during running. Twenty female and 14 male collegiate cross-country runners were examined. Three-dimensional kinetic and kinematic data were collected during overground running and used to estimate muscle forces via musculoskeletal modelling. Principle components analysis was used to capture the primary sources of variance from the muscle force waveforms. The magnitude of the forces for the hamstrings, gastrocnemius, and soleus muscles were higher across the majority of stance in male runners regardless of footstrike pattern. Males also demonstrated greater inter-trial variability in the timing of the peak gluteus maximus force and the magnitude of local peaks in the gastrocnemius force waveform. Male and female collegiate cross-country runners appear to employ unique lower extremity muscle force characteristics during overground running.
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Affiliation(s)
- C Nathan Vannatta
- Sports Physical Therapy Department, Gundersen Health System, Onalaska, WI, USA.,La Crosse Institute for Movement Science, University of Wisconsin, La Crosse, WI, USA
| | - Thomas G Almonroeder
- La Crosse Institute for Movement Science, University of Wisconsin, La Crosse, WI, USA.,Health Professions Department, University of Wisconsin, La Crosse, WI, USA
| | - Thomas W Kernozek
- La Crosse Institute for Movement Science, University of Wisconsin, La Crosse, WI, USA.,Health Professions Department, University of Wisconsin, La Crosse, WI, USA
| | - Stacey Meardon
- Department of Physical Therapy, College of Allied Health Science, East Carolina University, Greenville, NC, USA
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21
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Booth ATC, van der Krogt MM, Harlaar J, Dominici N, Buizer AI. Muscle Synergies in Response to Biofeedback-Driven Gait Adaptations in Children With Cerebral Palsy. Front Physiol 2019; 10:1208. [PMID: 31611807 PMCID: PMC6776587 DOI: 10.3389/fphys.2019.01208] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 09/04/2019] [Indexed: 12/26/2022] Open
Abstract
Background Children with cerebral palsy (CP) often show impaired selective motor control (SMC) that induces limitations in motor function. Children with CP can improve aspects of pathological gait in an immediate response to visual biofeedback. It is not known, however, how these gait adaptations are achieved at the neural level, nor do we know the extent of SMC plasticity in CP. Aim Investigate the underlying SMC and changes that may occur when gait is adapted with biofeedback. Methods Twenty-three ambulatory children with CP and related (hereditary) forms of spastic paresis (Aged: 10.4 ± 3.1, 6–16 years, M: 16/F: 9) were challenged with real-time biofeedback to improve step length, knee extension, and ankle power while walking on an instrumented treadmill in a virtual reality environment. The electromyograms of eight superficial muscles of the leg were analyzed and synergies were further decomposed using non-negative matrix factorization (NNMF) using 1 to 5 synergies, to quantify SMC. Total variance accounted for (tVAF) was used as a measure of synergy complexity. An imposed four synergy solution was investigated further to compare similarity in weightings and timing patterns of matched paired synergies between baseline and biofeedback trials. Results Despite changes in walking pattern, changes in synergies were limited. The number of synergies required to explain at least 90% of muscle activation increased significantly, however, the change in measures of tVAF1 from baseline (0.75 ± 0.08) were less than ±2% between trials. In addition, within-subject similarity of synergies to baseline walking was high (>0.8) across all biofeedback trials. Conclusion These results suggest that while gait may be adapted in an immediate response, SMC as quantified by synergy analysis is perhaps more rigidly impaired in CP. Subtle changes in synergies were identified; however, it is questionable if these are clinically meaningful at the level of an individual. Adaptations may be limited in the short term, and further investigation is essential to establish if long term training using biofeedback leads to adapted SMC.
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Affiliation(s)
- Adam T C Booth
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Clinical Applications and Research, Motek Medical BV, Amsterdam, Netherlands
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jaap Harlaar
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Nadia Dominici
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Institute for Brain and Behavior Amsterdam & Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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22
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Falisse A, Serrancolí G, Dembia CL, Gillis J, Jonkers I, De Groote F. Rapid predictive simulations with complex musculoskeletal models suggest that diverse healthy and pathological human gaits can emerge from similar control strategies. J R Soc Interface 2019; 16:20190402. [PMID: 31431186 PMCID: PMC6731507 DOI: 10.1098/rsif.2019.0402] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Physics-based predictive simulations of human movement have the potential to support personalized medicine, but large computational costs and difficulties to model control strategies have limited their use. We have developed a computationally efficient optimal control framework to predict human gaits based on optimization of a performance criterion without relying on experimental data. The framework generates three-dimensional muscle-driven simulations in 36 min on average—more than 20 times faster than existing simulations—by using direct collocation, implicit differential equations and algorithmic differentiation. Using this framework, we identified a multi-objective performance criterion combining energy and effort considerations that produces physiologically realistic walking gaits. The same criterion also predicted the walk-to-run transition and clinical gait deficiencies caused by muscle weakness and prosthesis use, suggesting that diverse healthy and pathological gaits can emerge from the same control strategy. The ability to predict the mechanics and energetics of a broad range of gaits with complex three-dimensional musculoskeletal models will allow testing novel hypotheses about gait control and hasten the development of optimal treatments for neuro-musculoskeletal disorders.
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Affiliation(s)
| | - Gil Serrancolí
- Department of Mechanical Engineering, Universitat Politècnica de Catalunya, Barcelona, Catalunya, Spain
| | | | - Joris Gillis
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium.,DMMS Lab, Flanders Make, Leuven, Belgium
| | - Ilse Jonkers
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
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Suwarganda EK, Diamond LE, Lloyd DG, Besier TF, Zhang J, Killen BA, Savage TN, Saxby DJ. Minimal medical imaging can accurately reconstruct geometric bone models for musculoskeletal models. PLoS One 2019; 14:e0205628. [PMID: 30742643 PMCID: PMC6370181 DOI: 10.1371/journal.pone.0205628] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/18/2019] [Indexed: 12/12/2022] Open
Abstract
Accurate representation of subject-specific bone anatomy in lower-limb musculoskeletal models is important for human movement analyses and simulations. Mathematical methods can reconstruct geometric bone models using incomplete imaging of bone by morphing bone model templates, but the validity of these methods has not been fully explored. The purpose of this study was to determine the minimal imaging requirements for accurate reconstruction of geometric bone models. Complete geometric pelvis and femur models of 14 healthy adults were reconstructed from magnetic resonance imaging through segmentation. From each complete bone segmentation, three sets of incomplete segmentations (set 1 being the most incomplete) were created to test the effect of imaging incompleteness on reconstruction accuracy. Geometric bone models were reconstructed from complete sets, three incomplete sets, and two motion capture-based methods. Reconstructions from (in)complete sets were generated using statistical shape modelling, followed by host-mesh and local-mesh fitting through the Musculoskeletal Atlas Project Client. Reconstructions from motion capture-based methods used positional data from skin surface markers placed atop anatomic landmarks and estimated joint centre locations as target points for statistical shape modelling and linear scaling. Accuracy was evaluated with distance error (mm) and overlapping volume similarity (%) between complete bone segmentation and reconstructed bone models, and statistically compared using a repeated measure analysis of variance (p<0.05). Motion capture-based methods produced significantly higher distance error than reconstructions from (in)complete sets. Pelvis volume similarity reduced significantly with the level of incompleteness: complete set (92.70±1.92%), set 3 (85.41±1.99%), set 2 (81.22±3.03%), set 1 (62.30±6.17%), motion capture-based statistical shape modelling (41.18±9.54%), and motion capture-based linear scaling (26.80±7.19%). A similar trend was observed for femur volume similarity. Results indicate that imaging two relevant bone regions produces overlapping volume similarity >80% compared to complete segmented bone models, and improve analyses and simulation over current standard practice of linear scaling musculoskeletal models.
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Affiliation(s)
- Edin K. Suwarganda
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast Orthopaedic Research, Engineering and Education Alliance, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- * E-mail: (EKS); (DJS)
| | - Laura E. Diamond
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast Orthopaedic Research, Engineering and Education Alliance, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David G. Lloyd
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast Orthopaedic Research, Engineering and Education Alliance, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Thor F. Besier
- Auckland Bioengineering Institute and Department of Engineering Science, University of Auckland, Auckland, Auckland, New Zealand
| | - Ju Zhang
- Auckland Bioengineering Institute and Department of Engineering Science, University of Auckland, Auckland, Auckland, New Zealand
| | - Bryce A. Killen
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast Orthopaedic Research, Engineering and Education Alliance, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Trevor N. Savage
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast Orthopaedic Research, Engineering and Education Alliance, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Department of Rheumatology, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, New South Wales, Australia
| | - David J. Saxby
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast Orthopaedic Research, Engineering and Education Alliance, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- * E-mail: (EKS); (DJS)
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