Exploiting the Invariant Structure for Controlling Multiple Muscles in Anthropomorphic Legs: III. Reproducing Hemiparetic Walking from Equilibrium Point- Based Synergies

In the development of a robotic therapy system, tests must be first run to guarantee safety and performance of the system before actual human trials. Lower-limb robotic therapy system has an inherit injury risk and a human-like stunt robot is desirable. This study proposes such an alternative: anthropomorphic legs with a bio-inspired control method affording a human-like test bench for the robotic therapy system. Electromyography (EMG) of a mildly hemiparetic stroke patient was measured during body-weight-supported treadmill walking. The motor strategy of the hemiparetic gait was extracted from the EMG data and applied to the control of the anthropomorphic legs. We employed the concept of equilibrium point (EP) to extract motor synergies and strategy. The EP- based synergies expressed by the composites of muscle mechanical impedance clarified motor strategy including aspects related to the impedance and virtual trajectory. Results show that the EP-based synergies were able to characterize neuromuscular patterns of pathological gait. The anthropomorphic legs were able to reproduce patient's gait by mimicking the EP-based synergies.

Vibrotactile Feedback Improves Foot Placement Perception on Stairs for Lower-Limb Prosthesis Users

Lower-limb amputees demonstrate decreased performance in stair ambulation compared to their intact-limb counterparts. An estimated 21% of amputees can navigate stairs without a handrail; almost 33% do not use stairs at all. The absence of tactile sensation on the bottom of the foot, creating uncertainty in foot placement, may be overcome by integrating sensory feedback into prosthesis design. Here we describe the design and evaluation of a haptic feedback system worn on the thigh to provide vibrotactile cues of foot placement with respect to stair steps. Tactor discrimination and foot placement awareness tests were performed to analyze system efficacy. Control participants wearing ski boots (N=10) and below-knee amputees (N=2) could discriminate individual tactor vibrations with 95.4% and 90.1% accuracy, respectively. The use of vibrotactile feedback increased accuracy in reporting foot placement by 15% and 17.5%, respectively. These results suggest that using vibrotactile arrays for sensory feedback may improve stair descent performance in lower-limb amputees.

Using Step Size and Lower Limb Segment Orientation from Multiple Low-Cost Wearable Inertial/Magnetic Sensors for Pedestrian Navigation

This paper demonstrates the use of multiple low-cost inertial/magnetic sensors as a pedestrian navigation system for indoor positioning. This research looks at the problem of pedestrian navigation in a practical manner by investigating dead-reckoning methods using low-cost sensors. This work uses the estimated sensor orientation angles to compute the step size from the kinematics of a skeletal model. The orientations of limbs are represented by the tilt angles estimated from the inertial measurements, especially the pitch angle. In addition, different step size estimation methods are compared. A sensor data logging system is developed in order to record all motion data from every limb segment using a single platform and similar types of sensors. A skeletal model of five segments is chosen to model the forward kinematics of the lower limbs. A treadmill walk experiment with an optical motion capture system is conducted for algorithm evaluation. The mean error of the estimated orientation angles of the limbs is less than 6 degrees. The results show that the step length mean error is 3.2 cm, the left stride length mean error is 12.5 cm, and the right stride length mean error is 9 cm. The expected positioning error is less than 5% of the total distance travelled.

The association between the isokinetic muscle strength and lower extremity injuries in young male football players

BACKGROUND

Validating any screening test to predict and prevent football injuries is in need of identifying related risk factors through prospective designs. In spite of the extensive use of strength testing in football players, there are limited studies investigating the relationship between isokinetic muscle strength and injury risk in young football players. The present study aimed to evaluate the relationship between isokinetic strength and the risk of lower extremity injury among Iranian young football players.

METHOD

ology: seventy three U-21 football players participated in this study. Isokinetic strength of hip, knee and ankle muscles were measured using the Isokinetic system pro 4. Injuries and exposure in training and matches were registered prospectively by club medical staff for one season.

RESULTS

Significant relationships were revealed between the isokinetic strength of hip abductor and adductor muscles, and isokinetic strength ratio of hip abductor/adductor muscles at an angular speed of 30°/sec, the isokinetic strength of hip abductor muscles at 90°/sec, and isokinetic strength of knee flexor and extensor muscles at 60°/sec and knee flexor/extensor strength ratio at angular velocities of 60°/sec with the injury occurrence among football players.

CONCLUSION

lower extremity isokinetic strength indices are associated with injuries in young male football players.

Gait Phase Detection for Lower-Limb Exoskeletons using Foot Motion Data from a Single Inertial Measurement Unit in Hemiparetic Individuals

Due to the recent rise in the use of lower-limb exoskeletons as an alternative for gait rehabilitation, gait phase detection has become an increasingly important feature in the control of these devices. In addition, highly functional, low-cost recovery devices are needed in developing countries, since limited budgets are allocated specifically for biomedical advances. To achieve this goal, this paper presents two gait phase partitioning algorithms that use motion data from a single inertial measurement unit (IMU) placed on the foot instep. For these data, sagittal angular velocity and linear acceleration signals were extracted from nine healthy subjects and nine pathological subjects. Pressure patterns from force sensitive resistors (FSR) instrumented on a custom insole were used as reference values. The performance of a threshold-based (TB) algorithm and a hidden Markov model (HMM) based algorithm, trained by means of subject-specific and standardized parameters approaches, were compared during treadmill walking tasks in terms of timing errors and the goodness index. The findings indicate that HMM outperforms TB for this hardware configuration. In addition, the HMM-based classifier trained by an intra-subject approach showed excellent reliability for the evaluation of mean time, i.e., its intra-class correlation coefficient (ICC) was greater than 0 . 75 . In conclusion, the HMM-based method proposed here can be implemented for gait phase recognition, such as to evaluate gait variability in patients and to control robotic orthoses for lower-limb rehabilitation.

Effect of Two Different Pose Estimation Approaches on Lower Extremity Biomechanics in Professional Dancers

Different algorithms can be used to estimate the pose of musculoskeletal models in biomechanical studies. Visual 3D uses segment optimization whereas OpenSim uses global optimization. Thus, our purpose was to study whether the two approaches would influence the estimation of lower extremity biomechanical parameters. Marker trajectories and ground reaction forces of 6 professional dancers were collected during a single-leg forward jump-landing. The same data set was processed using both approaches. Our findings suggested that the sagittal knee and ankle angles and moments were highly comparable between the two approaches. The ankle sagittal angle and moment showed the lowest offset. On the other hand, the choice of a kinematic model was likely to affect the hip, more evident in the frontal and transverse planes. This may be due to different factors such as the pelvis and femur positions or larger amount of soft tissue in the thigh.

Does increased midsole bending stiffness of sport shoes redistribute lower limb joint work during running?

OBJECTIVES

To investigate if lower limb joint work is redistributed when running in a shoe with increased midsole bending stiffness compared to a control shoe.

DESIGN

Within-subject with two conditions: (1) commercially available running shoe and (2) the same shoe with carbon fibre inserts to increase midsole bending stiffness.

METHODS

Thirteen male, recreational runners ran on an instrumented treadmill at 3.5m/s in each of the two shoe conditions while motion capture and force platform data were collected. Positive and negative metatarsophalangeal (MTP), ankle, knee, and hip joint work were calculated and statistically compared between conditions.

RESULTS

Running in the stiff condition (with carbon fibre inserts) resulted in significantly more positive work and less negative work at the MTP joint, and less positive work at the knee joint.

CONCLUSIONS

Increased midsole bending stiffness resulted in a redistribution of positive lower limb joint work from the knee to the MTP joint. A larger MTP joint plantarflexor moment due to increased vGRF at the instant of peak positive power and an earlier onset of MTP joint plantarflexion velocity were identified as the reasons for lower limb joint work redistribution.

Estimation of Ankle Joint Power during Walking Using Two Inertial Sensors

(1) Background: Ankle joint power, as an indicator of the ability to control lower limbs, is of great relevance for clinical diagnosis of gait impairment and control of lower limb prosthesis. However, the majority of available techniques for estimating joint power are based on inverse dynamics methods, which require performing a biomechanical analysis of the foot and using a highly instrumented environment to tune the parameters of the resulting biomechanical model. Such techniques are not generally applicable to real-world scenarios in which gait monitoring outside of the clinical setting is desired. This paper proposes a viable alternative to such techniques by using machine learning algorithms to estimate ankle joint power from data collected by two miniature inertial measurement units (IMUs) on the foot and shank, (2) Methods: Nine participants walked on a force-plate-instrumented treadmill wearing two IMUs. The data from the IMUs were processed to train and test a random forest model to estimate ankle joint power. The performance of the model was then evaluated by comparing the estimated power values to the reference values provided by the motion tracking system and the force-plate-instrumented treadmill. (3) Results: The proposed method achieved a high accuracy with the correlation coefficient, root mean square error, and normalized root mean square error of 0.98, 0.06 w/kg, and 1.05% in the intra-subject test, and 0.92, 0.13 w/kg, and 2.37% in inter-subject test, respectively. The difference between the predicted and true peak power values was 0.01 w/kg and 0.14 w/kg with a delay of 0.4% and 0.4% of gait cycle duration for the intra- and inter-subject testing, respectively. (4) Conclusions: The results of this study demonstrate the feasibility of using only two IMUs to estimate ankle joint power. The proposed technique provides a basis for developing a portable and compact gait monitoring system that can potentially offer monitoring and reporting on ankle joint power in real-time during activities of daily living.

A Sensor Array for the Measurement of Relative Motion in Lower Limb Prosthetic Sockets

The relative motion between residual limb and prosthetic socket could be a relevant factor in quantifying socket fit. The measurement of these movements, particularly in dynamic gait situations, poses a challenging task. This paper presents the realization of a measurement concept based on multiple optical 2D-motion sensors. The performance of the system was evaluated on a test rig considering accuracy and precision as well as accomplished measurement frequency and reliability of the system. Additionally, results of a pilot study measuring the relative motion between residual limb and prosthetic socket at seven specific locations of one individual with transtibial amputation during straight level walking are presented. The sensor functionality of the array was confirmed and the test rig experiments were comparable to the previously tested functional model ( e r r rel = 0.52 ± 1.87 %). With a sampling frequency of 1.3 kHz to be distributed among the number of sensor units, the developed system is suitable for investigating the relative movement between residual limb and prosthetic socket in dynamic gait situations. Results of the pilot study show the majority of relative motion occurring during the second half of the gait cycle. The measured relative motions show the residual limb sinking deeper into the socket, extending in the Sagittal plane and rotating internally in the Transverse plane during stance phase. Data captured during swing phase indicate a lower limb extension in the Sagittal plane as well as an external rotation in the Transverse plane.

The Body's Compensatory Responses to Unpredictable Trip and Slip Perturbations Induced by a Programmable Split-Belt Treadmill

This paper investigates the influence of two types of gait perturbation (i.e., trip and slip) induced by a programmable split-belt treadmill on the body's compensatory responses. Our fall-inducing technology equipped with a commercially available programmable split-belt treadmill provides unpredictable trip and slip perturbations during walking. Two force plates beneath the split-belt treadmill and a motion capture system quantify the body's kinetic and kinematic behaviors, and a wireless surface electromyography (EMG) system evaluates the lower limb muscle activity. Twenty healthy young adults participated. The perturbations (i.e., trip and slip) were applied randomly to the participant's left foot between the 31st and 40th steps. The kinetic and kinematic behaviors and lower limb muscle activity were assessed during the standing, walking, and recovery periods. Compared with trip perturbations, stepping responses to slip perturbations were quicker and trunk, shoulder, and whole body center of mass movements after slip perturbations were higher; the EMG results showed that tibialis anterior, gastrocnemius, rectus femoris, and biceps femoris activities were also higher. The two common types of gait perturbation (i.e., trip and slip) induced by a commercially available programmable split-belt treadmill influenced the body's compensatory responses.

Strength and Function Across Maturational Levels in Young Athletes at the Time of Return to Sport After ACL Reconstruction

BACKGROUND

The impact of maturation on lower extremity strength and function after anterior cruciate ligament reconstruction (ACLR) may help guide future studies of age-specific rehabilitation.

HYPOTHESIS

Pediatric ACLR patients would demonstrate higher thigh strength symmetry and knee-related function at return to sport (RTS) compared with adolescent and young adult participants who underwent traditional ACLR.

STUDY DESIGN

Prospective cohort study.

LEVEL OF EVIDENCE

Level 2.

METHODS

A total of 144 young athletes at the time of RTS clearance post-ACLR were classified into 3 maturational groups (pediatric, n = 16 with physeal-sparing ACLR [mean age = 12.3 years; range = 9.2-14.6 years]; adolescent, n = 113 [mean age = 16.5 years; range = 14.1-19.8 years]; young adult, n = 15 [mean age = 22.0 years; range = 20.5-24.9 years]). Quadriceps and hamstring strength were measured using an electromechanical dynamometer. Knee-related function was measured using the International Knee Documentation Committee (IKDC) subjective form and single-leg hop tests. The Limb symmetry Index (LSI) was used in calculations for hop and strength tests. Group differences were compared with Kruskal-Wallis tests and Mann-Whitney U post hoc tests. Proportions of participants meeting literature-recommended RTS criterion cutoffs were compared among the groups using chi-square tests.

RESULTS

The pediatric group demonstrated higher quadriceps LSI (P = 0.01), IKDC scores (P < 0.01), single-hop LSI (P < 0.01), and crossover-hop LSI (P = 0.02) compared with the young adult group. In addition, the pediatric group demonstrated higher IKDC scores (P < 0.01) and single-hop LSI (P = 0.02) compared with the adolescent group. The adolescent group demonstrated higher IKDC scores (P < 0.01), single-hop LSI (P = 0.02), and crossover-hop LSI (P = 0.03) compared with the young adult group. The proportions of participants meeting all RTS criterion cutoffs were highest in the pediatric group and lowest in the young adult group (P = 0.03).

CONCLUSION

Young athletes at RTS clearance after pediatric ACLR demonstrated higher quadriceps strength symmetry and knee-related function than adolescents and young adults after traditional ACLR.

CLINICAL RELEVANCE

These findings demonstrate the need for further study regarding the impact of these group differences on longitudinal outcomes after ACLR, including successful RTS and risk of second ACL injury.

Audio-Based System for Automatic Measurement of Jump Height in Sports Science

Jump height tests are employed to measure the lower-limb muscle power of athletic and non-athletic populations. The most popular instruments for this purpose are jump mats and, more recently, smartphone apps, which compute jump height through manual annotation of video recordings to extract flight time. This study developed a non-invasive instrument that automatically extracts take-off and landing events from audio recordings of jump executions. An audio signal processing algorithm, specifically developed for this purpose, accurately detects and discriminates the landing and take-off events in real time and computes jump height accordingly. Its temporal resolution theoretically outperforms that of flight-time-based mats (typically 1000 Hz) and high-speed video rates from smartphones (typically 240 fps). A validation study was carried out by comparing 215 jump heights from 43 active athletes, measured simultaneously with the audio-based system and with of a validated, commercial jump mat. The audio-based system produced nearly identical jump heights than the criterion with low and proportional systematic bias and random errors. The developed audio-based system is a trustworthy instrument for accurately measuring jump height that can be readily automated as an app to facilitate its use both in laboratories and in the field.

Model-based control for exoskeletons with series elastic actuators evaluated on sit-to-stand movements

BACKGROUND

Currently, control of exoskeletons in rehabilitation focuses on imposing desired trajectories to promote relearning of motions. Furthermore, assistance is often provided by imposing these desired trajectories using impedance controllers. However, lower-limb exoskeletons are also a promising solution for mobility problems of individuals in daily life. To develop an assistive exoskeleton which allows the user to be autonomous, i.e. in control of his motions, remains a challenge. This paper presents a model-based control method to tackle this challenge.

METHODS

The model-based control method utilizes a dynamic model of the exoskeleton to compensate for its own dynamics. After this compensation of the exoskeleton dynamics, the exoskeleton can provide a desired assistance to the user. While dynamic models of exoskeletons used in the literature focus on gravity compensation only, the need for modelling and monitoring of the ground contact impedes their widespread use. The control strategy proposed here relies on modelling of the full exoskeleton dynamics and of the contacts with the environment. A modelling strategy and general control scheme are introduced.

RESULTS

Validation of the control method on 15 non-disabled adults performing sit-to-stand motions shows that muscle effort and joint torques are similar in the conditions with dynamically compensated exoskeleton and without exoskeleton. The condition with exoskeleton in which the compensating controller was not active showed a significant increase in human joint torques and muscle effort at the knee and hip. Motor saturation occurred during the assisted condition, which limited the assistance the exoskeleton could deliver.

CONCLUSIONS

This work presents the modelling steps and controller design to compensate the exoskeleton dynamics. The validation seems to indicate that the presented model-based controller is able to compensate the exoskeleton.

Prediction of Distal Lower-Limb Motion Using Ultrasound-Derived Features of Proximal Skeletal Muscle

Control of lower-limb assistive devices would benefit from predicting the intent of individuals in advance of upcoming motion, rather than estimating the current states of their motion. Human lower-limb motion estimation using ultrasound (US) image derived features of skeletal muscle has been demonstrated. However, predictability of motion in time remains an open question. The objective of this study was to assess the predictability of distal lower-limb motion using US image features of rectus femoris (RF) muscle during non-weight-bearing knee flexion/extension. A series of time shifts was introduced between the US features and the joint position in 67 ms steps from 0 ms (i.e., estimation, no prediction) up to predicting 467 ms in advance. A US-based algorithm to estimate lower-limb motion was then used to predict the knee joint position in time using the US features after introducing the time shifts. The accuracy of joint motion prediction after each time shift was compared to the accuracy of joint motion estimation. The reliability of the prediction was then assessed using an analysis of variance (ANOVA) test. The motion prediction accuracy was found to be reliable up to 200 ms, where the average root mean square error (RMSE) of prediction across 9 healthy subjects was 0.89 degrees greater than the average RMSE (7.39 degrees) of motion estimation for the same group of subjects. These findings suggest a reliable prediction of upcoming lower-limb motion is feasible using the US features of skeletal muscle up to a certain point. A reliable prediction may provide lower-limb assistive device control systems with a time-window for processing and control planning, and actuation hence improving the volitional control behaviors of lower-limb assistive devices.

Gait Phase Identification During Level, Incline and Decline Ambulation Tasks Using Portable Sonomyographic Sensing

Clinical viability of powered lower-limb assistive devices requires reliable and intuitive control strategies. Stance and swing are the main phases of the gait cycle across different locomotion tasks. Hence, a reliable method to accurately identify these phases can decrease sensing complexity and assist in enabling high-level control of assistive devices. Ultrasound (US) imaging has recently been introduced as a new sensing modality that may provide a solution for intuitive device control. US images of the rectus femoris and vastus intermedius muscles were collected in humans during level, incline, and decline ambulation tasks. Five low-level static (i.e. time-independent) features of US images were measured with respect to a reference image, including correlation coefficient, sum of absolute differences, structural similarity index, sum of squared differences, and image echogenicity. Time-derivatives of the static features were also calculated as temporal features. Support vector machine classifiers were trained using these static features to identify the gait phase both dependent and independent of the ambulation tasks. The results indicate an accuracy of 88.3% in identifying the gait phases for task-independent classifiers when trained using only the static features. Performance of the classifiers improved significantly to 92.8% after using the temporal features (p $\lt0.01)$. The algorithm was efficient and the average processing speed was faster than 100 Hz. This study is the first demonstration on use of US imaging to provide continuous estimates of ambulation phase, and on multiple surfaces. These findings suggest task-independent approaches may reliably identify the main phases of the gait cycle. Advancements in this area of study may provide simpler intuitive strategies for high-level assistive device control and increase their clinical relevance.

Energy System Contributions in Upper and Lower Body Wingate Tests in Highly Trained Athletes

PURPOSE

This study compared the energy system contributions and relationship between mechanical and energy system variables in upper and lower body Wingate tests (WAnT) in judo athletes.

METHOD

Eleven male judo athletes (18 ± 1 years, 174.3 ± 5.3 cm, 72.6 ± 9.9 kg, 11.8 ± 1.7% body fat) attended two laboratory sessions to perform two WAnT (upper and lower body) and two incremental tests (upper and lower body). The energy contributions of the oxidative, glycolytic, and phosphagen (ATP-PCr) systems were estimated based on oxygen consumption ( V˙O2 ) during WAnT, delta of lactate, and the fast phase of excess V˙O2 , respectively.

RESULTS

The upper and lower body presented similar results of oxidative (21 ± 4% vs 23 ± 3%) and ATP-PCr system contributions (29 ± 6% vs 32 ± 5%). The glycolytic system contribution (50 ± 5% vs 45 ± 4%) was higher in the upper body. The variance of mechanical variables in upper body was explained by glycolytic (R² = 0.49-0.62) and oxidative systems (R² = 0.44-0.49), whereas the variance of mechanical variables in lower body was explained by ATP-PCr (R² = 0.41-0.55) and glycolytic systems (R² = 0.62-0.94).

CONCLUSIONS

During WAnT, the glycolytic system presented the major energy contribution, being higher in the upper body. Moreover, mechanical and energy system variables presented a distinct relationship when comparing upper and lower body WAnT.

Vertical Jump Performance in Hungarian Male Elite Junior Soccer Players

PURPOSE

Vertical jump is a common test to measure impulsive ability in soccer; however, limited normative data have been published on young soccer players from vertical jump measurements on a force platform. The purpose of this study was to provide normative values for three chronological age groups of male junior soccer players (U16, U17 and, U18 years).

METHOD

Vertical jump performance of 365 soccer players (16.4 ± 0.8 years) was assessed using a force platform measurement system. Net impulse, force, power, jump height (impulse-momentum), jump height (flight time) were reported for each age group for squat jump (SJ) and countermovement jump (CMJ).

RESULTS

Mean values ± SD of jump height were 32.9 ± 4.1, 33.5 ± 4.0, and 33.9 ± 4.2 cm for the three age groups respectively in SJ and 36.3 ± 3.8, 37.5 ± 3.9, and 38.6 ± 4.4 cm in the CMJ. Mean values of all age groups for maximum force and maximum power were 1559 ± 211 N and 3261 ± 492 watt respectively for SJ and 1598 ± 241 N and 3287 ± 502 watt for CMJ. Based on descriptive data, percentiles were reported for all examined variables.

CONCLUSIONS

Jump height and relative values were less sensitive discriminator variables between age groups in the studied age range, while maximum impulse, maximum force, and maximum power were more sensitive to changes in maturational status. Normative values can be used by the coaches in the interpretation and evaluation of their athletes' performance and for training and talent identification purposes.

Individual Differences in Women During Walking Affect Tibial Response to Load Carriage: The Importance of Individualized Musculoskeletal Finite-Element Models

Subject-specific features can contribute to the susceptibility of an individual to stress fracture. Here, we incorporated tibial morphology and material properties into a standard musculoskeletal finite-element (M/FE) model and investigated how load carriage influences joint kinetics and tibial mechanics in women. We obtained the morphology and material properties of the tibia from computed tomography images for women of three distinctly different heights, 1.51 m (short), 1.63 m (medium), and 1.75 m (tall), and developed individualized M/FE models for each. Then, we calculated joint and muscle forces, and subsequently, tibial stress/strain for each woman walking at 1.3 m/s under various load conditions (0, 11.3, or 22.7 kg). Among the subjects investigated, using individualized and standard M/FE models, the joint reaction forces (JRFs) differed by up to 4 (hip), 22 (knee), and 26% (ankle), and the 90th percentile von Mises stress by up to 30% (tall woman). Load carriage evoked distinct biomechanical responses, with a 22.7-kg load decreasing the peak hip JRF during late stance by ∼18% in the short woman, while increasing it by ∼39% in the other two women. It also increased peak knee and ankle JRFs by up to ∼48 (tall woman) and ∼36% (short woman). The same load increased the 90th percentile von Mises stress (and corresponding cumulative stress) by 31 (28), 22 (30), and 27% (32%) in the short, medium, and tall woman, respectively. Our findings highlight the critical role of individualized M/FE models to assess mechanical loading in different individuals performing the same physical activity.

Walking and finger tapping can be done with independent rhythms

Rhythmic movements occur in many aspects of daily life. Examples include clapping the hands and walking. The production of two independent rhythms with multiple limbs is considered to be extremely difficult. In the present study we evaluated whether two different, independent rhythms that involved finger tapping and walking could be produced. In Experiment I, twenty subjects that had no experience of musical instrument training performed rhythmic finger tapping with the right index finger and one of four different lower limb movements; (1) self-paced walking, (2) given-paced walking, (3) alternative bilateral heel tapping from a sitting position, and (4) unilateral heel tapping with the leg ipsilateral to the tapping finger from a sitting position. The target intervals of finger tapping and heel strikes for walking step/heel tapping were set at 375 ms and 600 ms, respectively. The even distribution of relative phases between instantaneous finger tapping and heel strike was taken as the criteria of independency for the two rhythms. In the self-paced walking and given-paced walking tasks, 16 out of 20 subjects successfully performed finger tapping and walking with independent rhythms without any special practice. On the other hand, in the bipedal heels striking and unipedal heel striking tasks 19 subjects failed to perform the two movements independently, falling into interrelated rhythms with the ratio mostly being 2:1. In Experiment II, a similar independency of finger tapping and walking at a given pace was observed for heel strike intervals of 400, 600, and 800 ms, as well as at the constant 375 ms for finger tapping. These results suggest that finger tapping and walking are controlled by separate neural control mechanisms, presumably with a supra-spinal locus for finger tapping, and a spinal location for walking.

The ball kicking speed: A new, efficient performance indicator in youth soccer

Success in different soccer skills like kicking depends on motor abilities achieved. Kicking is a soccer fundamental, which depends on many different and complex factors (technique, foot-ball interaction, ball flight, etc.). Therefore, it is important to identify players that are able to perform faster kicks using both dominant and non-dominant leg. The current study investigated some basic variables of different soccer kicking speed and their relevance to success in youth soccer academy. 119 players from the first and the second division participated to this study. They were randomly divided into age groups (U-15, U-17, and U19) and team status (first team, reserves). The diagnostic ability of the different ball kicking speed tests in capturing differences between first team players and reserves among different age categories were computed using the receiver operating characteristics analysis. Results demonstrated that first team players achieved better results when comparing to reserves in each category. In addition, differences were greater in the U-15 and the U-17 than in the U-19 age group. In conclusion, ball kicking speed could be one of the possible identification tools to evaluate players' success in youth soccer.

Effects of anti-pronation shoes on lower limb kinematics and kinetics in female runners with pronated feet: The role of physical fatigue

Physical fatigue and pronated feet constitute two risk factors for running-related lower limb injuries. Accordingly, different running shoe companies designed anti-pronation shoes with medial support to limit over pronation in runners. However, there is little evidence on the effectiveness and clinical relevance of anti-pronation shoes. This study examined lower limb kinematics and kinetics in young female runners with pronated feet during running with anti-pronation versus regular (neutral) running shoes in unfatigued and fatigued condition. Twenty-six female runners aged 24.1±5.6 years with pronated feet volunteered to participate in this study. Kinetic (3D Kistler force plate) and kinematic analyses (Vicon motion analysis system) were conducted to record participants’ ground reaction forces and joint kinematics when running with anti-pronation compared with neutral running shoes. Physical fatigue was induced through an individualized submaximal running protocol on a motorized treadmill using rate of perceived exertion and heart rate monitoring. The statistical analyses indicated significant main effects of “footwear” for peak ankle inversion, peak ankle eversion, and peak hip internal rotation angles (p<0.03; d = 0.46–0.95). Pair-wise comparisons revealed a significantly greater peak ankle inversion angle (p<0.03; d = 0.95; 2.70°) and smaller peak eversion angle (p<0.03; d = 0.46; 2.53°) when running with anti-pronation shoes compared with neutral shoes. For kinetic data, significant main effects of “footwear” were found for peak ankle dorsiflexor moment, peak knee extensor moment, peak hip flexor moment, peak hip extensor moment, peak hip abductor moment, and peak hip internal rotator moment (p<0.02; d = 1.00–1.79). For peak positive hip power in sagittal and frontal planes and peak negative hip power in horizontal plane, we observed significant main effects of “footwear” (p<0.03; d = 0.92–1.06). Pairwise comparisons revealed that peak positive hip power in sagittal plane (p<0.03; d = 0.98; 2.39 w/kg), peak positive hip power in frontal plane (p = 0.014; d = 1.06; 0.54 w/kg), and peak negative hip power in horizontal plane (p<0.03; d = 0.92; 0.43 w/kg) were greater with anti-pronation shoes. Furthermore, the statistical analyses indicated significant main effects of “Fatigue” for peak ankle inversion, peak ankle eversion, and peak knee external rotation angles. Pair-wise comparisons revealed a fatigue-induced decrease in peak ankle inversion angle (p<0.01; d = 1.23; 2.69°) and a fatigue-induced increase in peak knee external rotation angle (p<0.05; d = 0.83; 5.40°). In addition, a fatigue-related increase was found for peak ankle eversion (p<0.01; d = 1.24; 2.67°). For kinetic data, we observed a significant main effect of “Fatigue” for knee flexor moment, knee internal rotator moment, and hip extensor moment (p<0.05; d = 0.83–1.01). The statistical analyses indicated significant a main effect of “Fatigue” for peak negative ankle power in sagittal plane (p<0.01; d = 1.25). Finally, we could not detect any significant footwear by fatigue interaction effects for all measures of joint kinetics and kinematics. Running in anti-pronation compared with neutral running shoes produced lower peak moments and powers in lower limb joints and better control in rear foot eversion. Physical fatigue increased peak moments and powers in lower limb joints irrespective of the type of footwear.

Remote muscle contraction enhances spinal reflexes in multiple lower-limb muscles elicited by transcutaneous spinal cord stimulation

Transcutaneous spinal cord stimulation (tSCS) is a useful technique for the clinical assessment of neurological disorders. However, the characteristics of the spinal cord circuits activated by tSCS are not yet fully understood. In this study, we examined whether remote muscle contraction enhances the spinal reflexes evoked by tSCS in multiple lower-limb muscles. Eight healthy men participated in the current experiment, which required them to grip a dynamometer as fast as possible after the presentation of an auditory cue. Spinal reflexes were evoked in multiple lower-limb muscles with different time intervals (50-400 ms) after the auditory signals. The amplitudes of the spinal reflexes in all the recorded leg muscles significantly increased at 50-250 ms after remote muscle activation onset. This suggests that remote muscle contraction simultaneously facilitates the spinal reflexes in multiple lower-limb muscles. In addition, eight healthy men performed five different tasks (i.e., rest, hand grip, pinch grip, elbow flexion, and shoulder flexion). Compared to control values recorded just before each task, the spinal reflexes evoked at 250 ms after the auditory signals were significantly enhanced by the above tasks except for the rest task. This indicates that such facilitatory effects are also induced by remote muscle contractions in different upper-limb areas. The present results demonstrate the existence of a neural interaction between remote upper-limb muscles and spinal reflex circuits activated by tSCS in multiple lower-limb muscles. The combination of tSCS and remote muscle contraction may be useful for the neurological examination of spinal cord circuits.

Effect of vitamin D supplementation on upper and lower limb muscle strength and muscle power in athletes: A meta-analysis

BACKGROUND

Vitamin D may play a role in skeletal muscle because of the discovery of VDR in skeletal muscle. However, vitamin D deficiency is a global problem, including athletes. Studies examining the effect of vitamin D supplementation on muscle function in athletes have inconsistent results. Therefore, we aimed to quantitatively summarize the evidence for the effect of vitamin D supplementation on skeletal muscle strength and explosive power of athletes using a meta-analysis.

METHODS

PubMed, EMBASE, Cochrane Library, and Web of Science were searched for studies to identify randomized controlled trials or controlled trials meeting the inclusion criteria. By a meta-analysis, effect sizes (standardized mean differences, SMD) with 95% confidence intervals (CI) was calculated to compare reported outcomes across studies, I2 index was used to assessing heterogeneity, and heterogeneity factors were identified by regression analysis. The potential publication and sensitivity analyses were also assessed.

RESULTS

Eight RCTs involving 284 athletes were included. The protocols used to evaluate the muscle strength of athletes were inconsistent across the included studies, and muscle explosive power was assessed via vertical jump tests. The results indicated that vitamin D supplementation had no impact on overall muscle strength outcomes (SMD 0.05, 95% CI: -0.39 to 0.48, p = 0.84). In subgroup analysis, vitamin D supplementation had an effect on lower-limb muscle strength (SMD 0.55, 95% CI:0.12 to 0.98, p = 0.01) but not upper-limb muscle strength (SMD -0.19, 95% CI:-0.73 to 0.36, p = 0.50) or muscle explosive power (SMD 0.05, 95% CI:-0.24 to 0.34, p = 0.73). Vitamin D supplementation was more effective for athletes trained indoors (SMD 0.48, 95% CI:0.06 to 0.90, p = 0.02).

CONCLUSIONS

Vitamin D supplementation positively affected lower limb muscle strength in athletes, but not upper limb muscle strength or muscle power. Different muscle groups and functions may respond differently to vitamin D supplementation. Additional studies should focus on determining the appropriate vitamin D supplementation methods and optimal serum 25(OH)D levels for athletes.

REGISTRATION

The protocol for our study is registered in the international prospective register of systematic reviews (PROSPERO registration number CRD42016045872).

An optimal control approach for blood pressure regulation during head-up tilt

This paper presents an optimal control approach to modeling effects of cardiovascular regulation during head-up tilt (HUT). Many patients who suffer from dizziness or light-headedness are administered a head-up tilt test to explore potential deficits within the autonomic control system, which maintains the cardiovascular system at homeostasis. This system is complex and difficult to study in vivo, and thus we propose to use mathematical modeling to achieve a better understanding of cardiovascular regulation during HUT. In particular, we show the feasibility of using optimal control theory to compute physiological control variables, vascular resistance and cardiac contractility, quantities that cannot be measured directly, but which are useful to assess the state of the cardiovascular system. A non-pulsatile lumped parameter model together with pseudo- and clinical data are utilized in the optimal control problem formulation. Results show that the optimal control approach can predict time-varying quantities regulated by the cardiovascular control system. Our results compare favorable to our previous study using a piecewise linear spline approach, less a priori knowledge is needed, and results were obtained at a significantly lower computational cost.

An ICA-EBM-Based sEMG Classifier for Recognizing Lower Limb Movements in Individuals With and Without Knee Pathology

Surface electromyography (sEMG) data acquired during lower limb movements has the potential for investigating knee pathology. Nevertheless, a major challenge encountered with sEMG signals generated by lower limb movements is the intersubject variability, because the signals recorded from the leg or thigh muscles are contingent on the characteristics of a subject such as gait activity and muscle structure. In order to cope with this difficulty, we have designed a three-step classification scheme. First, the multichannel sEMG is decomposed into activities of the underlying sources by means of independent component analysis via entropy bound minimization. Next, a set of time-domain features, which would best discriminate various movements, are extracted from the source estimates. Finally, the feature selection is performed with the help of the Fisher score and a scree-plot-based statistical technique, prior to feeding the dimension-reduced features to the linear discriminant analysis. The investigation involves 11 healthy subjects and 11 individuals with knee pathology performing three different lower limb movements, namely, walking, sitting, and standing, which yielded an average classification accuracy of 96.1% and 86.2%, respectively. While the outcome of this study per se is very encouraging, with suitable improvement, the clinical application of such an sEMG-based pattern recognition system that distinguishes healthy and knee pathological subjects would be an attractive consequence.