The passive elastic moment at the hip

A scoping review and evaluation of open-source transtibial amputation musculoskeletal models for female populations

Musculoskeletal modeling is often used to study people with transtibial amputations. Females in this population are of particular interest as they are underrepresented in research, experience unique challenges, and demonstrate gait biomechanics distinct from males. Because generic models often neglect innate variations between populations, it is important to determine whether data used to develop a model are representative of the population studied. The objective of this study was to review and analyze existing transtibial amputation musculoskeletal models, establish a database from the information compiled, and use the database to select the model most relevant for studying female populations. A scoping search was performed and a database was created based on data detailing the eligible models. Models were evaluated through a weighted decision process based on criteria of their representation of females with transtibial amputations, prosthetic functionality, development transparency, overall functionality, and experimental validation methods. The scoping review identified 3 studies, Willson et al., LaPrè et al., and Miller and Esposito. A database detailing these models was established. The Willson model scored highest on all criteria except overall functionality, where the LaPrè model outscored it. Based on the established weightings, the Willson model was classed most appropriate for the stated goals. The created database can be used by other researchers to guide their own modeling studies, irrespective of the population of focus. Of the 3, the Willson model was found most relevant for studying females with transtibial amputations. This model will be used in future work investigating and addressing challenges of females with transtibial amputations.

Investigating pelvic drop gait abnormality in adolescent hip pathology patients

BACKGROUND

Trendelenburg gait describes contralateral pelvic drop during single leg stance (SLS) with occasional lateral trunk lean compensation over the stance limb. However, quantitative research on 'uncompensated Trendelenburg' gait (pelvic drop independent of lateral trunk lean) remains sparse among populations that commonly utilize this gait pattern, such as adolescent hip pathology patients.

RESEARCH QUESTION

How prevalent is uncompensated Trendelenburg among various adolescent hip pathologies and how is it related to hip load, hip abduction strength, and self-reported hip pain?

METHODS

Gait, strength, and pain data were collected among 152 pre-operative patients clinically diagnosed with acetabular hip dysplasia, femoroacetabular impingement, Legg-Calvé-Perthes, or slipped capital femoral epiphysis (SCFE). Patients with ≥ 5.4° of dynamic pelvic drop in SLS were divided into a 'pelvic drop' group and screened to exclude those with excessive ipsilateral trunk lean. They were then compared to the 'stable pelvis' patients using a Mann-Whitney test.

RESULTS

Dysplasia patients represented the highest proportion of the pelvic drop group (46%). The pelvic drop group showed a significant increase in self-reported hip pain (p = 0.011), maximum hip abductor moment (p = 0.002), and peak coronal power absorption at the affected hip during SLS loading response, (p < 0.001) while showing no difference in abduction strength (p = 0.381).

SIGNIFICANCE

Uncompensated Trendelenburg gait may lead to increased loading of the affected hip in adolescent hip pathology patients. Disadvantageous hip biomechanics can create increased abductor muscle demand among these pathological populations, with dysplasia patients showing the highest prevalence. Maximal abduction strength did not correlate with pelvic drop. Future work should aim to identify and quantify causal factors. Increased coronal hip power absorption during weight acceptance warrants clinical attention, as there may be a detrimental, over-reliance on passive hip structures to support load among a population that that is already predisposed to hip osteoarthritis.

Scalable musculoskeletal model for dynamic simulations of upper body movement

A musculoskeletal (MSK) model is a valuable tool for assessing complex biomechanical problems, estimating joint torques during motion, optimizing motion in sports, and designing exoskeletons and prostheses. This study proposes an open-source upper body MSK model that supports biomechanical analysis of human motion. The MSK model of the upper body consists of 8 body segments (torso, head, left/right upper arm, left/right forearm, and left/right hand). The model has 20 degrees of freedom (DoFs) and 40 muscle torque generators (MTGs), which are constructed using experimental data. The model is adjustable for different anthropometric measurements and subject body characteristics: sex, age, body mass, height, dominant side, and physical activity. Joint limits are modeled using experimental dynamometer data within the proposed multi-DoF MTG model. The model equations are verified by simulating the joint range of motion (ROM) and torque; all simulation results have a good agreement with previously published research.

Scalable musculoskeletal model for dynamic simulations of lower body movement

A musculoskeletal (MSK) model is an important tool for analysing human motions, calculating joint torques during movement, enhancing sports activity, and developing exoskeletons and prostheses. To enable biomechanical investigation of human motion, this work presents an open-source lower body MSK model. The MSK model of the lower body consists of 7 body segments (pelvis, left/right thigh, left/right leg, and left/right foot). The model has 20 degrees of freedom (DoFs) and 28 muscle torque generators (MTGs), which are developed from experimental data. The model can be modified for different anthropometric measurements and subject body characteristics, including sex, age, body mass, height, physical activity, and skin temperature. The model is validated by simulating the torque within the range of motion (ROM) of isolated movements; all simulation findings exhibit a good level of agreement with the literature.

An EMG-to-Force Processing Approach to Estimating Knee Muscle Forces during Adult, Self-Selected Speed Gait

BACKGROUND

The purpose of this study was to determine the force production during self-selected speed normal gait by muscle-tendon units that cross the knee. The force of a single knee muscle is not directly measurable without invasive methods, yet invasive techniques are not appropriate for clinical use. Thus, an EMG-to-force processing (EFP) model was developed which scaled muscle-tendon unit (MTU) force output to gait EMG.

METHODS

An EMG-to-force processing (EFP) model was developed which scaled muscle-tendon unit (MTU) force output to gait EMG. Active muscle force power was defined as the product of MTU forces (derived from EFP) and that muscle's contraction velocity. Net knee EFP moment was determined by summing individual active knee muscle moments. Net knee moments were also calculated for these study participants via inverse dynamics (kinetics plus kinematics, KIN). The inverse dynamics technique used are well accepted and the KIN net moment was used to validate or reject this model. Closeness of fit of the moment power curves for the two methods (during active muscle forces) was used to validate the model.

RESULTS

The correlation between the EFP and KIN methods was sufficiently close, suggesting validation of the model's ability to provide reasonable estimates of knee muscle forces.

CONCLUSIONS

The EMG-to-force processing approach provides reasonable estimates of active individual knee muscle forces in self-selected speed walking in neurologically intact adults.

Thigh and Shank, Kinetic and Potential Energies during Gait Swing Phase in Healthy Adults and Stroke Survivors

Background/Problem. Given the treatment-resistant gait deficits after stroke and known elevated energy cost of gait after stroke, it is important to study the patterns of mechanical energies of the lower limb segments. There is a dearth of information regarding mechanical energies specifically for the thigh and shank across the gait cycle. Therefore, the purpose of the current work was to characterize the following: (1) relative patterns of oscillation kinetic energy (KE) and potential energy (PE) within lower limb segments and across lower limb segments in healthy adults during the swing phase at chosen and slow gait speeds; (2) KE and PE swing phase patterns and values for stroke survivors versus healthy adults walking at slow speed; and (3) KE and PE patterns during the swing phase for two different compensatory gait strategies after stroke,. Methods. This was a gait characterization study, a two-group, parallel-cohort study of fourteen stroke survivors with gait deficits, walking at <0.4 m/s and eight adults with no gait deficits. For testing, the eight healthy adults walked at their chosen speed, and then at the imposed slow speed of <0.04 m/s. We used a standard motion capture system and calculation methods to acquire, calculate, and characterize oscillation patterns of KE and PE of the limb segments (thigh and shank) across the gait cycle. Results. In healthy adults, we identified key energy conservation mechanisms inherent in the interactions of KE and PE, both within the thigh and shank segments and across those limb segments, partially explaining the low cost of energy of the normal adult chosen speed gait pattern, and the underlying mechanism affording the known minimal set of activated muscles during walking, especially during the early swing phase. In contrast, KE was effectively absent for both healthy adults at imposed slow walking speed and stroke survivors at their very slow chosen speed, eliminating the normal conservation of energy between KE and PE within the thigh and across the thigh and shank. Moreover, and in comparison to healthy adult slow speed, stroke survivors exhibited greater abnormalities in mechanical energies patterns, reflected in either a compensatory stepping strategy (over-flexing the hip) or circumducting strategy (stiff-legged gait, with knee extended throughout the swing phase). Conclusions and contribution to the field. Taken together, these findings support targeted training to restore normal balance control and normal activation and de-activation coordination of hip, knee, and ankle muscles, respectively (agonist/antagonist at each joint), so as to eliminate the known post-stroke abnormal co-contractions; this motor training is critical in order to release the limb to swing normally in response to mechanical energies and afford the use of conservation of KE and PE energies within the thigh and across thigh and shank.

Adaptations for bipedal walking: Musculoskeletal structure and three-dimensional joint mechanics of humans and bipedal chimpanzees (Pan troglodytes)

Humans are unique among apes and other primates in the musculoskeletal design of their lower back, pelvis, and lower limbs. Here, we describe the three-dimensional ground reaction forces and lower/hindlimb joint mechanics of human and bipedal chimpanzees walking over a full stride and test whether: 1) the estimated limb joint work and power during the stance phase, especially the single-support period, is lower in humans than bipedal chimpanzees, 2) the limb joint work and power required for limb swing is lower in humans than in bipedal chimpanzees, and 3) the estimated total mechanical power during walking, accounting for the storage of passive elastic strain energy in humans, is lower in humans than in bipedal chimpanzees. Humans and bipedal chimpanzees were compared at matched dimensionless and dimensional velocities. Our results indicate that humans walk with significantly less work and power output in the first double-support period and the single-support period of stance, but markedly exceed chimpanzees in the second double-support period (i.e., push-off). Humans generate less work and power in limb swing, although the species difference in limb swing power was not statistically significant. We estimated that total mechanical positive 'muscle fiber' work and power were 46.9% and 35.8% lower, respectively, in humans than in bipedal chimpanzees at matched dimensionless speeds. This is due in part to mechanisms for the storage and release of elastic energy at the ankle and hip in humans. Furthermore, these results indicate distinct 'heel strike' and 'lateral balance' mechanics in humans and bipedal chimpanzees and suggest a greater dissipation of mechanical energy through soft tissue deformations in humans. Together, our results document important differences between human and bipedal chimpanzee walking mechanics over a full stride, permitting a more comprehensive understanding of the mechanics and energetics of chimpanzee bipedalism and the evolution of hominin walking.

Predictive simulations of running gait reveal a critical dynamic role for the tail in bipedal dinosaur locomotion

Locomotion has influenced the ecology, evolution, and extinction of species throughout history, yet studying locomotion in the fossil record is challenging. Computational biomechanics can provide novel insight by mechanistically relating observed anatomy to whole-animal function and behavior. Here, we leverage optimal control methods to generate the first fully predictive, three-dimensional, muscle-driven simulations of locomotion in an extinct terrestrial vertebrate, the bipedal non-avian theropod dinosaur Coelophysis. Unexpectedly, our simulations involved pronounced lateroflexion movements of the tail. Rather than just being a static counterbalance, simulations indicate that the tail played a crucial dynamic role, with lateroflexion acting as a passive, physics-based mechanism for regulating angular momentum and improving locomotor economy, analogous to the swinging arms of humans. We infer this mechanism to have existed in many other bipedal non-avian dinosaurs as well, and our methodology provides new avenues for exploring the functional diversity of dinosaur tails in the future.

Contribution of passive moments to inter-segmental moments during gait: A systematic review

Inter-segmental moments computed by inverse dynamic during gait come from active moments, due to muscle contraction, but also from passive moments, resulting from the resistance of the periarticular structures to their deformation. The evaluation of the proportion of the inter-segmental moments that can be attributed to passive moments has led to divergent results. Thus, the purpose of this study was to systematically search and synthesize the evidence of the contribution of passive moments to inter-segmental moments during healthy and pathological gait. A broad systematic search was performed including four databases. Thirteen studies met all inclusion criteria. Results showed that passive moments participate to inter-segmental moments during gait in a non-negligible way. For the ankle, the evaluation of the proportion of inter-segmental moment attributed to passive structures is 5-20% around the push-off. For the knee, this proportion is 40-98% during late swing and 10-80% during the single support phase. For the hip, it is 20-50% at push-off. For pathological population, it has been shown that this contribution may sometimes be more important, either due to a smaller inter-segmental moment or a larger passive moment. These results suggest that passive mechanisms can contribute substantially to normal human gait, facilitating the propulsion or the braking of the joint. Passive structures, acting as elastic springs, thus help to reduce the energy cost of gait. For pathological gait, studying the contribution of passive moments to inter-segmental moments can help to better understand the aetiology of the pathology.

Predictive Simulations of Musculoskeletal Function and Jumping Performance in a Generalized Bird

Jumping is a common, but demanding, behavior that many animals employ during everyday activity. In contrast to jump-specialists such as anurans and some primates, jumping biomechanics and the factors that influence performance remains little studied for generalized species that lack marked adaptations for jumping. Computational biomechanical modeling approaches offer a way of addressing this in a rigorous, mechanistic fashion. Here, optimal control theory and musculoskeletal modeling are integrated to generate predictive simulations of maximal height jumping in a small ground-dwelling bird, a tinamou. A three-dimensional musculoskeletal model with 36 actuators per leg is used, and direct collocation is employed to formulate a rapidly solvable optimal control problem involving both liftoff and landing phases. The resulting simulation raises the whole-body center of mass to over double its standing height, and key aspects of the simulated behavior qualitatively replicate empirical observations for other jumping birds. However, quantitative performance is lower, with reduced ground forces, jump heights, and muscle–tendon power. A pronounced countermovement maneuver is used during launch. The use of a countermovement is demonstrated to be critical to the achievement of greater jump heights, and this phenomenon may only need to exploit physical principles alone to be successful; amplification of muscle performance may not necessarily be a proximate reason for the use of this maneuver. Increasing muscle strength or contractile velocity above nominal values greatly improves jump performance, and interestingly has the greatest effect on more distal limb extensor muscles (i.e., those of the ankle), suggesting that the distal limb may be a critical link for jumping behavior. These results warrant a re-evaluation of previous inferences of jumping ability in some extinct species with foreshortened distal limb segments, such as dromaeosaurid dinosaurs.

Simulations prédictives de la fonction musculo-squelettique et des performances de saut chez un oiseau généralisé Sauter est un comportement commun, mais exigeant, que de nombreux animaux utilisent au cours de leurs activités quotidiennes. Contrairement aux spécialistes du saut tels que les anoures et certains primates, la biomécanique du saut et les facteurs qui influencent la performance restent peu étudiés pour les espèces généralisées qui n’ont pas d’adaptations marquées pour le saut. Les approches de modélisation biomécanique computationnelle offrent un moyen d’aborder cette question de manière rigoureuse et mécaniste. Ici, la théorie du contrôle optimal et la modélisation musculo-squelettique sont intégrées pour générer des simulations prédictives du saut en hauteur maximal chez un petit oiseau terrestre, le tinamou. Un modèle musculo-squelettique tridimensionnel avec 36 actionneurs par patte est utilisé, et une méthode numérique nommée “direct collocation” est employée pour formuler un problème de contrôle optimal rapidement résoluble impliquant les phases de décollage et d’atterrissage. La simulation qui en résulte élève le centre de masse du corps entier à plus du double de sa hauteur debout, et les aspects clés du comportement simulé reproduisent qualitativement les observations empiriques d’autres oiseaux sauteurs. Cependant, les performances quantitatives sont moindres, avec une réduction des forces au sol, des hauteurs de saut et de la puissance musculo-tendineuse. Une manœuvre de contre-mouvement prononcée est utilisée pendant le lancement. Il a été démontré que l’utilisation d’un contre-mouvement est essentielle à l’obtention de hauteurs de saut plus importantes, et il se peut que ce phénomène doive exploiter uniquement des principes physiques pour réussir; l’amplification de la performance musculaire n’est pas nécessairement une raison immédiate de l’utilisation de cette manœuvre. L’augmentation de la force musculaire ou de la vitesse de contraction au-dessus des valeurs nominales améliore grandement la performance de saut et, fait intéressant, a le plus grand effet sur les muscles extenseurs des membres plus distaux (c'est-à-dire ceux de la cheville), ce qui suggère que le membre distal peut être un lien critique pour le comportement de saut. Ces résultats justifient une réévaluation des déductions précédentes de la capacité de sauter chez certaines espèces éteintes avec des segments de membres distaux raccourcis, comme les dinosaures droméosauridés.

Voorspellende simulaties van musculoskeletale functie en springprestaties bij een gegeneraliseerde vogel Springen is een veel voorkomend, maar veeleisend, gedrag dat veel dieren toepassen tijdens hun dagelijkse bezigheden. In tegenstelling tot de springspecialisten zoals de anura en sommige primaten, is de biomechanica van het springen en de factoren die de prestaties beïnvloeden nog weinig bestudeerd voor algemene soorten die geen uitgesproken adaptaties voor het springen hebben. Computationele biomechanische modelbenaderingen bieden een manier om dit op een rigoureuze, mechanistische manier aan te pakken. Hier worden optimale controle theorie en musculoskeletale modellering geïntegreerd om voorspellende simulaties te genereren van maximale hoogtesprong bij een kleine grondbewonende vogel, een tinamou. Een driedimensionaal musculoskeletaal model met 36 actuatoren per poot wordt gebruikt, en directe collocatie wordt toegepast om een snel oplosbaar optimaal controleprobleem te formuleren dat zowel de opstijg-als de landingsfase omvat. De resulterende simulatie verhoogt het lichaamszwaartepunt tot meer dan het dubbele van de stahoogte, en belangrijke aspecten van het gesimuleerde gedrag komen kwalitatief overeen met empirische waarnemingen voor andere springende vogels. De kwantitatieve prestaties zijn echter minder, met verminderde grondkrachten, spronghoogtes en spierpeeskracht. Tijdens de lancering wordt een uitgesproken tegenbewegingsmanoeuvre gebruikt. Aangetoond is dat het gebruik van een tegenbeweging van cruciaal belang is voor het bereiken van grotere spronghoogten, en dit fenomeen hoeft alleen op fysische principes te berusten om succesvol te zijn; versterking van de spierprestaties hoeft niet noodzakelijk een proximate reden te zijn voor het gebruik van deze manoeuvre. Het verhogen van de spierkracht of van de contractiesnelheid boven de nominale waarden verbetert de sprongprestatie aanzienlijk, en heeft interessant genoeg het grootste effect op de meer distale extensoren van de ledematen (d.w.z. die van de enkel), wat suggereert dat de distale ledematen een kritieke schakel kunnen zijn voor het springgedrag. Deze resultaten rechtvaardigen een herevaluatie van eerdere conclusies over springvermogen bij sommige uitgestorven soorten met voorgekorte distale ledematen, zoals dromaeosauride dinosauriërs.

Prädiktive Simulationen der muskuloskelettalen Funktion und Sprungleistung bei einem generalisierten Vogel Springen ist ein übliches jedoch anstrengendes Verhalten, das viele Tiere bei ihren täglichen Aktivitäten einsetzen. Im Gegensatz zu Springspezialisten, wie Fröschen und einigen Primaten, sind bei allgemeinen Arten, welche keine ausgeprägten Anpassung für Sprungverhalten aufweisen, die Biomechanik beim Springen und die Faktoren, welche die Leistungsfähigkeit beeinflussen, noch wenig untersucht. Computergestützte biomechanische Modellierungsverfahren bieten hier eine Möglichkeit, dies in einer gründlichen, mechanistischen Weise anzugehen. In dieser Arbeit werden die optimale Steuerungstheorie und Muskel-Skelett-Modellierung zusammen eingesetzt, um die maximale Sprunghöhe eines kleinen bodenlebenden Vogels, eines Perlsteisshuhns, zu simulieren und zu prognostizieren. Es wird ein dreidimensionales Muskel-Skelett-Modell mit 36 Aktuatoren pro Bein verwendet, und durch direkte Kollokation wird ein schnell lösbares optimales Steuerungsproblem formuliert, das sowohl die Abstoss- als auch die Landephase umfasst. Die daraus folgende Simulation bringt den Ganzkörperschwerpunkt auf mehr als das Doppelte seiner Standhöhe und entscheidende Aspekte des simulierten Verhaltens entsprechen qualitativ empirischen Beobachtungen für andere springende Vögel. Allerdings ist die quantitative Leistungsfähigkeit geringer, mit reduzierten Bodenkräften, Sprunghöhen und Muskel-Sehnen-Kräften. Beim Abstossen wird ein ausgeprägtes Gegenbewegungsmanöver durchgeführt. Die Durchführung einer Gegenbewegung ist nachweislich entscheidend für das Erreichen grösserer Sprunghöhen, wobei dieses Phänomen möglicherweise nur physikalische Prinzipien auszuschöpfen braucht, um erfolgreich zu sein. Die Verstärkung der Muskelleistung ist daher möglicherweise nicht zwingend ein unmittelbarer Grund für die Verwendung dieses Manövers. Eine Erhöhung der Muskelkraft oder der Kontraktionsgeschwindigkeit über die Nominalwerte hinaus führt zu einer erheblichen Zunahme der Sprungleistung und hat interessanterweise den grössten Effekt bei den weiter distal gelegenen Streckmuskeln der Beine (d.h. bei denjenigen des Sprunggelenks), was darauf hindeutet, dass die distale Gliedmasse ein entscheidendes Element für das Sprungverhalten sein könnte. Diese Ergebnisse geben Anlass zur Überprüfung früherer Schlussfolgerungen hinsichtlich der Sprungfähigkeit einiger ausgestorbener Arten mit verkürzten distalen Gliedmassen, wie beispielsweise bei dromaeosauriden Dinosauriern.

On the importance of the hip abductors during a clinical one legged balance test: A theoretical study

Background

The ability to balance on one foot for a certain time is a widely used clinical test to assess the effects of age and diseases like peripheral neuropathy on balance. While state-space methods have been used to explore the mechanical demands and achievable accelerations for balancing on two feet in the sagittal plane, less is known about the requirements for sustaining one legged balance (OLB) in the frontal plane.

Research question

While most studies have focused on ankle function in OLB, can age and/or disease-related decreases in maximum hip abduction strength also affect OLB ability?

Methods

A two-link frontal plane state space model was used to define and explore the ‘feasible balance region’ which helps reveal the requirements for maintaining and restoring OLB, given the adverse effects of age and peripheral neuropathy on maximum hip and ankle strengths.

Results

Maintaining quasistatic OLB required 50%-106% of the maximum hip abduction strength in young and older adults, and older patients with peripheral neuropathy. Effectiveness of a ‘hip strategy’ in recovering OLB was heavily dependent on the maximum hip abduction strength, and for healthy older women was as important as ankle strength. Natural reductions of strength due to healthy aging did not show a meaningful reduction in meeting the strength requirement of clinical OLB. However deficits in hip strength typical of patients with peripheral neuropathy did adversely affect both quasistatic OLB and recoverable OLB states.

Significance

The importance of hip muscle strength has been underappreciated in the clinical OLB test. This is partly because the passive tissues of the hip joint can mask moderate deficits in hip abduction strength until it is needed for recovering OLB. Adding a follow up OLB test with a slightly raised pelvis would be a simple way to check for adequate hip abductor muscle strength.

Neuromusculoskeletal Modeling-Based Prostheses for Recovery After Spinal Cord Injury

Concurrent stimulation and reinforcement of motor and sensory pathways has been proposed as an effective approach to restoring function after developmental or acquired neurotrauma. This can be achieved by applying multimodal rehabilitation regimens, such as thought-controlled exoskeletons or epidural electrical stimulation to recover motor pattern generation in individuals with spinal cord injury (SCI). However, the human neuromusculoskeletal (NMS) system has often been oversimplified in designing rehabilitative and assistive devices. As a result, the neuromechanics of the muscles is seldom considered when modeling the relationship between electrical stimulation, mechanical assistance from exoskeletons, and final joint movement. A powerful way to enhance current neurorehabilitation is to develop the next generation prostheses incorporating personalized NMS models of patients. This strategy will enable an individual voluntary interfacing with multiple electromechanical rehabilitation devices targeting key afferent and efferent systems for functional improvement. This narrative review discusses how real-time NMS models can be integrated with finite element (FE) of musculoskeletal tissues and interface multiple assistive and robotic devices with individuals with SCI to promote neural restoration. In particular, the utility of NMS models for optimizing muscle stimulation patterns, tracking functional improvement, monitoring safety, and providing augmented feedback during exercise-based rehabilitation are discussed.

Sex-specific walking kinematics and kinetics in individuals with unilateral, symptomatic hip osteoarthritis: A cross sectional study

BACKGROUND

Hip osteoarthritis (OA) is a significant cause of disability, with hip pain and reduced external hip moments during walking being key features of the condition. The external hip adduction moment is greater in healthy women than men, however these between-sex differences are not evident in those with end-stage hip OA. Whether sex-specific hip kinetics are associated with early-midstage hip OA has not been investigated and may be a potential target for directed treatment.

METHODS

Thirty-eight women and twenty-eight men with a diagnosis of symptomatic, unilateral, mild-to-moderate hip OA (Kellegren-Lawrence Grade 2 or 3) underwent three-dimensional gait analysis of normal walking gait using Vicon motion capture. Hip joint, trunk and pelvic angles and hip moments were calculated using the Plug-in-Gait model. The external peak flexion moment, and the first peak, second peak and mid-stance minimum of the hip adduction moment during the stance phase of walking as well as hip, trunk and pelvic kinematics occurring at the three moment time points were compared between groups using an analysis of covariance.

RESULTS

Women with hip OA exhibited a greater external hip adduction moment (mean difference 0.8-1.3 N m/BW.Ht(%), P < 0.05) and greater hip adduction angles (mean difference 2.8-4.9 degrees, P < 0.05) throughout stance than men. Men walked with a greater forward trunk lean than women during early to midstance (mean difference 2.9-3.5 degrees, P < 0.05) than women.

SIGNIFICANCE

In contrastto late stage hip OA, between-sex difference in hip joint kinematics and kinetics are preserved in early-midstage hip OA.

Contribution of passive actions to the lower limb joint moments and powers during gait: A comparison of models

The lower limb passive actions representing the actions of all the passive periarticular structures have been shown to have a significant contribution to the power generation and absorption during gait. However, the respective magnitude of its different components was not established, although models of ligament moment were implemented in some musculoskeletal models. These ligament moments have shown to have an influence on the musculo-tendon forces and contact forces but the models used were never specifically evaluated, that is, compared to the passive and net joint moments. Two models of passive joint moments and three models of ligament moments were selected from the literature. Ten subjects (23–29 years old, 79.8 ± 9.5 kg, 1.85 ± 0.06 m) participated in the study. Each subject performed three gait cycles in a gait laboratory to acquire the kinematics and ground reaction forces and to compute the ligament, passive and net moments of the right lower limb joints. The contributions of the passive joint moments to the net joint moments were in accordance with the literature, although time shifts appeared for peaks in the hip and knee powers. Two of the models of ligament moments seemed, in fact, to represent the passive joint moments as their contributions were very similar while the third model of ligament moments seemed to represent only penalty-based joint limits. As a conclusion, this study showed that the models of ligament moments existing in the literature do not seem reliable. This study also demonstrated that the use of non-subject-specific models of the passive joint moments could be a valid approach for healthy subjects.

Mild leg length discrepancy affects lower limbs, pelvis and trunk biomechanics of individuals with knee osteoarthritis during gait

BACKGROUND

Leg length discrepancy greater than 1cm increases odds of progressive knee osteoarthritis in the shorter limb.

METHODS

Biomechanical data of 15 knee osteoarthritis participants were collected while they walked under two conditions: (1) control - wearing thick sandals; (2) short limb - wearing a thin sandal on the osteoarthritic limb and a thick sandal on the contralateral limb. The thick and thin sandals had 1.45cm of thickness difference. The knee osteoarthritis limb was analyzed for both conditions. Ankle, knee, hip, pelvis and trunk kinematics and moments were measured with a motion and force capture system. Principal component analysis and mean hypothesis' tests were used to compare the conditions.

FINDINGS

The short limb condition reduced rearfoot plantarflexion in loading response and increased plantarflexion in late stance (p<0.001), increased ankle dorsiflexion moment (p=0.003), increased knee flexion angle in loading response and delayed knee flexion in late stance (p=0.001), increased knee extension moment in loading response and increased knee flexion moment in terminal stance (p=0.023), reduced hip extension moment in early stance and reduced hip flexion moment in late stance (p<0.001), reduced knee adduction moment (p=0.015), reduced hip adduction angle (p=0.001) and moment (p=0.012) and increased pelvic (p=0.023) and trunk (p=0.001) external rotation.

INTERPRETATION

Mild leg length discrepancy affects the entire kinetic chain of individuals with knee osteoarthritis during gait, increasing knee sagittal plane loading, which helps to explain why mild leg length discrepancy accelerates knee osteoarthritis progression. Mild leg length discrepancy should not be overlooked in knee osteoarthritis individuals.

The effect of three-dimensional postural change on shear elastic modulus of the iliotibial band

To understand and treat iliotibial band (ITB) syndrome, caused by excessive compression between the ITB and lateral femoral condyle, it is important to identify factors contributing to an increase in ITB stiffness. The purpose of this study was to clarify the factors that contribute to an increase in ITB stiffness by examining the relationship between three-dimensional postural changes and ITB stiffness. Fourteen healthy individuals performed one-leg standing under 7 conditions (including normal one-leg standing as a control condition) in which the pelvic position was changed in three planes. The shear elastic modulus in the ITB was measured using shear-wave elastography, as a measure of ITB stiffness. The three-dimensional joint angles and external joint moments in the hip and knee joints were also measured to confirm the changes in joint angles and external load. Compared to the normal one-leg standing condition, ITB stiffness was significantly increased in the pelvic posterior tilted position (i.e. hip extension), contralateral pelvic dropped position (i.e. hip adduction), and contralateral pelvic posterior rotated position (i.e. hip external rotation). The findings suggest that interventions to reduce hip extension, adduction, and external rotation might be useful if these excessive positional changes are detected in patients with ITB syndrome.

Kinematics and kinetics during walking in individuals with gluteal tendinopathy

BACKGROUND

Lateral hip pain during walking is a feature of gluteal tendinopathy but little is known how walking biomechanics differ in individuals with gluteal tendinopathy. This study aimed to compare walking kinematics and kinetics between individuals with and without gluteal tendinopathy.

METHODS

Three-dimensional walking-gait analysis was conducted on 40 individuals aged 35 to 70 years with unilateral gluteal tendinopathy and 40 pain-free controls. An analysis of covariance was used to compare kinematic and kinetic variables between groups. Linear regression was performed to investigate the relationship between kinematics and external hip adduction moment in the gluteal tendinopathy group.

FINDINGS

Individuals with gluteal tendinopathy demonstrated a greater hip adduction moment throughout stance than controls (standardized mean difference ranging from 0.60 (first peak moment) to 0.90 (second peak moment)). Contralateral trunk lean at the time of the first peak hip adduction moment was 1.2 degrees greater (P=0.04), and pelvic drop at the second peak hip adduction moment 1.4 degrees greater (P=0.04), in individuals with gluteal tendinopathy. Two opposite trunk and pelvic strategies were also identified within the gluteal tendinopathy group. Contralateral pelvic drop was significantly correlated with the first (R=0.35) and second peak (R=0.57) hip adduction moment, and hip adduction angle with the second peak hip adduction moment (R=-0.36) in those with gluteal tendinopathy.

INTERPRETATION

Individuals with gluteal tendinopathy exhibit greater hip adduction moments and alterations in trunk and pelvic kinematics during walking. Findings provide a basis to consider frontal plane pelvic control in the management of gluteal tendinopathy.

The effect of angle and moment of the hip and knee joint on iliotibial band hardness

Although several studies have described kinematic deviations such as excessive hip adduction in patients with iliotibial band (ITB) syndrome, the factors contributing to increased ITB hardness remains undetermined, owing to lack of direct in vivo measurement. The purpose of this study was to clarify the factors contributing to an increase in ITB hardness by comparing the ITB hardness between the conditions in which the angle, moment, and muscle activity of the hip and knee joint are changed. Sixteen healthy individuals performed the one-leg standing under five conditions in which the pelvic and trunk inclination were changed in the frontal plane. The shear elastic modulus in the ITB was measured as an indicator of the ITB hardness using shear wave elastography. The three-dimensional joint angle and external joint moment in the hip and knee joints, and muscle activities of the gluteus maximus, gluteus medius, tensor fasciae latae, and vastus lateralis, which anatomically connect to the ITB, were also measured. ITB hardness was significantly increased in the posture with pelvic and trunk inclination toward the contralateral side of the standing leg compared with that in all other conditions (increase of approximately 32% compared with that during normal one-leg standing). This posture increased both the hip adduction angle and external adduction moment at the hip and knee joint, although muscle activities were not increased. Our findings suggest that coexistence of an increased adduction moment at the hip and knee joints with an excessive hip adduction angle lead to an increase in ITB hardness.

Active functional stiffness of the knee joint during activities of daily living: a parameter for improved design of prosthetic limbs

BACKGROUND

Exploring knee joint physiological functional stiffness is crucial for improving the design of prosthetic legs that aim to mimic normal gait. This study hypothesizes that knee joint stiffness varies among different activities of daily living, additionally while the knee performs natural movements; the magnitude of the stiffness indicates the degree of energy storage element sufficiency in terms of harvesting/returning energy.

METHODS

This study examined sagittal plane knee moment vs. knee flexion angle curves from 12 able-bodied subjects during activities of daily living. Slopes of these curves were assessed to find the calculated stiffness during the peak energy return and harvest phases so that the activities, which can be performed when the prosthetic knee is supplemented by a spring, were identified.

FINDINGS

For the energy return and harvest phases, the stiffness varied between 0.006 and 0.046 Nm/kg deg. and 0 and 0.052 Nm/kg deg. respectively. The optimum energy return phase stiffness was 0.024 (SD 0.013) Nm/kg deg. and energy harvest phase stiffness was 0.011 (SD 0.018) Nm/kg deg.

INTERPRETATION

Knee joint stiffness varied significantly during activities of daily living, which indicated that a storage unit with a constant stiffness would not be sufficient in providing energy regenerative gait during all activities. However, by controlling the amount and timing of spring compression and release, an energy-regenerative prosthetic knee device could be developed during most of the activities. This study was directed to the development of a complete data set, which determined the torque-angle properties of the healthy knee joint.

Lower-limb multi-joint stiffness of knee and ankle

Lower-limb multi-joint (knee and ankle) stiffness may play an important role in functional activities such as walking, and may be significantly altered post stroke. Thus, determination of lower-limb multi joint stiffness matrix is important for better understanding of gait and of pathological changes post stroke. In this study, using novel dynamics decomposition, the knee and ankle joint stiffness matrix including cross-coupled stiffness terms between the two joints were determined and reported ever first. The determined stiffness matrix may be useful for gait studies, and can be served as a baseline for studying pathophysiological changes post stroke.

Developing a multi-joint upper limb exoskeleton robot for diagnosis, therapy, and outcome evaluation in neurorehabilitation

Arm impairments in patients post stroke involve the shoulder, elbow and wrist simultaneously. It is not very clear how patients develop spasticity and reduced range of motion (ROM) at the multiple joints and the abnormal couplings among the multiple joints and the multiple degrees-of-freedom (DOF) during passive movement. It is also not clear how they lose independent control of individual joints/DOFs and coordination among the joints/DOFs during voluntary movement. An upper limb exoskeleton robot, the IntelliArm, which can control the shoulder, elbow, and wrist, was developed, aiming to support clinicians and patients with the following integrated capabilities: 1) quantitative, objective, and comprehensive multi-joint neuromechanical pre-evaluation capabilities aiding multi-joint/DOF diagnosis for individual patients; 2) strenuous and safe passive stretching of hypertonic/deformed arm for loosening up muscles/joints based on the robot-aided diagnosis; 3) (assistive/resistive) active reaching training after passive stretching for regaining/improving motor control ability; and 4) quantitative, objective, and comprehensive neuromechanical outcome evaluation at the level of individual joints/DOFs, multiple joints, and whole arm. Feasibility of the integrated capabilities was demonstrated through experiments with stroke survivors and healthy subjects.

Predicting muscle forces in gait from EMG signals and musculotendon kinematics

An EMG-driven muscle model for determining muscle force-time histories during gait is presented. The model, based on Hill's equation (1938), incorporates morphological data and accounts for changes in musculotendon length, velocity, and the level of muscle excitation for both concentric and eccentric contractions. Musculotendon kinematics were calculated using three-dimensional cinematography with a model of the musculoskeletal system. Muscle force-length-EMG relations were established from slow isokinetic calibrations. Walking muscle force-time histories were determined for two subjects. Joint moments calculated from the predicted muscle forces were compared with moments calculated using a linked segment, inverse dynamics approach. Moment curve correlations ranged from r = 0.72 to r = 0.97 and the root mean square (RMS) differences were from 10 to 20 Nm. Expressed as a relative RMS, the moment differences ranged from a low of 23% at the ankle to a high of 72% at the hip. No single reason for the differences between the two moment curves could be identified. Possible explanations discussed include the linear EMG-to-force assumption and how well the EMG-to-force calibration represented excitation for the whole muscle during gait, assumptions incorporated in the muscle modeling procedure, and errors inherent in validating joint moments predicted from the model to moments calculated using linked segment, inverse dynamics. The closeness with which the joint moment curves matched in the present study supports using the modeling approach proposed to determine muscle forces in gait.

A QUASI-LINEAR VISCOELASTIC MODEL FOR THE PASSIVE PROPERTIES OF THE HUMAN HIP JOINT

Properties of passive elastic structures constituting the human hip joint can be exploited to increase efficiency of human locomotion. As studies estimating the passive contributions to the net joint moment often disregard damping properties of the joint such contributions overestimate the energy gained during leg retraction within swing and stance phase. We built an experimental apparatus to measure moment-angle-relations during motor guided cyclic movements over a wide range of angular velocities and step-like changes in hip angle. On the basis of the experimentally gained data set the objective of this study was to model the elastic as well as the damping characteristics of the joint in the sagittal plane utilizing the Quasi-Linear Viscoelastic theory (QLV). A double exponential function was conveniently employed to describe the elastic response. The dependency of the hip joint stiffness on biarticular muscles was incorporated by repeating the measurement protocol for different knee angles. Due to the fact that the stiffness characteristics of the elastic response were merely shifted over knee angles we introduced an equilibrium angle at the hip joint as exponential function of the knee angle eventually yielding an elastic response as a function of hip and knee angle. In order to cover the damping characteristics the reduced relaxation function comprising a continuous spectrum of relaxation was utilized. We exemplify the applicability of the QLV model on published kinematic data on human walking and estimated that approximately 27% of the energy passively stored at the hip dissipates during the gait cycle.

ANALYSIS OF THE BENDING BEHAVIOR OF THE LUMBAR SPINE DURING POSTEROANTERIOR MOBILIZATION

This research study aimed to measure the bending stiffness of the lumbar spine when subjected to posteroanterior mobilization. The lumbar spine was modeled as an initially curved beam column supported over the rib cage and the pelvis. Together with the posteroanterior mobilization force acted on the spine formed the three-point bending of the beam. The bending stiffness of the spine was derived from the mobilization force and the change in curvature of the spine. The mobilization force was measured by mounting a force plate onto the mobilization couch, and electromagnetic sensors were used to measure the change in spinal curvature. The mean bending stiffness of the spine was found to be 38.5 Nm2. The theoretical modelling suggested that the pelvic rotation produced by mobilization may be employed to provide an indicator of the magnitude of the mobilization force.

Adaptations for economical bipedal running: the effect of limb structure on three-dimensional joint mechanics

The purpose of this study was to examine the mechanical adaptations linked to economical locomotion in cursorial bipeds. We addressed this question by comparing mass-matched humans and avian bipeds (ostriches), which exhibit marked differences in limb structure and running economy. We hypothesized that the nearly 50 per cent lower energy cost of running in ostriches is a result of: (i) lower limb-swing mechanical power, (ii) greater stance-phase storage and release of elastic energy, and (iii) lower total muscle power output. To test these hypotheses, we used three-dimensional joint mechanical measurements and a simple model to estimate the elastic and muscle contributions to joint work and power. Contradictory to our first hypothesis, we found that ostriches and humans generate the same amounts of mechanical power to swing the limbs at a similar self-selected running speed, indicating that limb swing probably does not contribute to the difference in energy cost of running between these species. In contrast, we estimated that ostriches generate 120 per cent more stance-phase mechanical joint power via release of elastic energy compared with humans. This elastic mechanical power occurs nearly exclusively at the tarsometatarso-phalangeal joint, demonstrating a shift of mechanical power generation to distal joints compared with humans. We also estimated that positive muscle fibre power is 35 per cent lower in ostriches compared with humans, and is accounted for primarily by higher capacity for storage and release of elastic energy. Furthermore, our analysis revealed much larger frontal and internal/external rotation joint loads during ostrich running than in humans. Together, these findings support the hypothesis that a primary limb structure specialization linked to economical running in cursorial species is an elevated storage and release of elastic energy in tendon. In the ostrich, energy-saving specializations may also include passive frontal and internal/external rotation load-bearing mechanisms.

Determination of passive moment-angle relationships at the trapeziometacarpal joint

While modeling the trapeziometacarpal (TMC) joint for determination of tendon forces, the TMC has been considered frictionless and passive moments created by soft tissues neglected. This, however, becomes inaccurate when reaching the joint end range of motion and considering that the TMC is entirely crossed by a complex network of skin, ligaments, soft tissues, and tendons. The objective of this study was to evaluate the passive moments with respect to joint posture in order to further include this relationship in biomechanical modeling. An experimental method was proposed to estimate in vivo a global passive moment including the sum of the actions of each passive anatomical structure. An external force was applied at the level of the metacarpophalangeal joint in various directions ranging from neutral position to full extension and full adduction to full abduction. The passive moment was computed and expressed as a function of the adopted joint angles. An exponential regression was then developed to fit the experimental data and to propose a generic passive moment model. Results showed a good agreement between the proposed exponential regression model and the experimental measures. Moreover, it was shown that joint stiffness could represent more than 60% of the net joint moment during a typical pulp grip task. These results showed the necessity to include the data in biomechanical modeling. The results may help predict more realistic tendons force especially in abduction/adduction muscles.

A new method for gravity correction of dynamometer data and determining passive elastic moments at the joint

Moments measured by a dynamometer in biomechanics testing often include the gravitational moment and the passive elastic moment in addition to the moment caused by muscle contraction. Gravitational moments result from the weight of body segments and dynamometer attachment, whereas passive elastic moments are caused by the passive elastic deformation of tissues crossing the joint being assessed. Gravitational moments are a major potential source of error in dynamometer measurements and must be corrected for, a procedure often called gravity correction. While several approaches to gravity correction have been presented in the literature, they generally assume that the gravitational moment can be adequately modeled as a simple sine or cosine function. With this approach, a single passive data point may be used to specify the model, assuming that passive elastic moments are negligible at that point. A new method is presented here for the gravity correction of dynamometer data. Gravitational moment is represented using a generalized sinusoid, which is fit to passive data obtained over the entire joint range of motion. The model also explicitly accounts for the presence of passive elastic moments. The model was tested for cases of hip flexion-extension, knee flexion-extension, and ankle plantar flexion-dorsiflexion, and provided good fits in all cases.

The relationships between muscle, external, internal and joint mechanical work during normal walking

Muscle mechanical work is an important biomechanical quantity in human movement analyses and has been estimated using different quantities including external, internal and joint work. The goal of this study was to investigate the relationships between these traditionally used estimates of mechanical work in human walking and to assess whether they can be used as accurate estimates of musculotendon and/or muscle fiber work. A muscle-actuated forward dynamics walking simulation was generated to quantify each of the mechanical work measures. Total joint work (i.e. the time integral of absolute joint power over a full gait cycle) was found to underestimate total musculotendon work due to agonist-antagonist co-contractions, despite the effect of biarticular muscle work and passive joint work, which acted to decrease the underestimation. We did find that when the net passive joint work over the gait cycle is negligible, net joint work (i.e. the time integral of net joint power) was comparable to the net musculotendon work (and net muscle fiber work because net tendon work is zero over a complete gait cycle). Thus, during walking conditions when passive joint work is negligible, net joint work may be used as an estimate of net muscle work. Neither total external nor total internal work (nor their sum) provided a reasonable estimate of total musculotendon work. We conclude that joint work is limited in its ability to estimate musculotendon work, and that external and internal work should not be used as an estimation of musculotendon work.

Effect of hip flexibility on optimal stalder performances on high bar

In the optimisation of sports movements using computer simulation models, the joint actuators must be constrained in order to obtain realistic results. In models of a gymnast, the main constraint used in previous studies was maximum voluntary active joint torque. In the stalder, gymnasts reach their maximal hip flexion under the bar. The purpose of this study was to introduce a model of passive torque to assess the effect of the gymnast's flexibility on the technique of the straddled stalder. A three-dimensional kinematics driven simulation model was developed. The kinematics of the shoulder flexion, hip flexion and hip abduction were optimised to minimise torques for four hip flexion flexibilities: 100 degrees, 110 degrees, 120 degrees and 130 degrees. With decreased flexibility, the piked posture period is shorter and occurs later. Moreover the peaks of shoulder and hip torques increase. Gymnasts with low hip flexibility need to be stronger to achieve a stalder; hip flexibility should be considered by coaches before teaching this skill.

Mechanical efficiency of limb swing during walking and running in guinea fowl (Numida meleagris)

Understanding the mechanical determinants of the energy cost of limb swing is crucial for refining our models of locomotor energetics, as well as improving treatments for those suffering from impaired limb-swing mechanics. In this study, we use guinea fowl (Numida meleagris) as a model to explore whether mechanical work at the joints explains limb-swing energy use by combining inverse dynamic modeling and muscle-specific energetics from blood flow measurements. We found that the overall efficiencies of the limb swing increased markedly from walking (3%) to fast running (17%) and are well below the usually accepted maximum efficiency of muscle, except at the fastest speeds recorded. The estimated efficiency of a single muscle used during ankle flexion (tibialis cranialis) parallels that of the total limb-swing efficiency (3% walking, 15% fast running). Taken together, these findings do not support the hypothesis that joint work is the major determinant of limb-swing energy use across the animal's speed range and warn against making simple predictions of energy use based on joint mechanical work. To understand limb-swing energy use, mechanical functions other than accelerating the limb segments need to be explored, including isometric force production and muscle work arising from active and passive antagonist muscle forces.

Computational Models for Neuromuscular Function

Computational models of the neuromuscular system hold the potential to allow us to reach a deeper understanding of neuromuscular function and clinical rehabilitation by complementing experimentation. By serving as a means to distill and explore specific hypotheses, computational models emerge from prior experimental data and motivate future experimental work. Here we review computational tools used to understand neuromuscular function including musculoskeletal modeling, machine learning, control theory, and statistical model analysis. We conclude that these tools, when used in combination, have the potential to further our understanding of neuromuscular function by serving as a rigorous means to test scientific hypotheses in ways that complement and leverage experimental data.

The contribution of passive-elastic mechanisms to lower extremity joint kinetics during human walking

The purpose of this study was to investigate the contribution of passive mechanisms to lower extremity joint kinetics in normal walking at slow, comfortable, and fast speeds. Twenty healthy young adults participated in a passive testing protocol in which the relaxed lower limb was manipulated through full sagittal hip, knee, and ankle ranges of motion while kinematics and applied forces were simultaneously measured. The relationship between passive joint moments and angles was modeled by a set of exponential functions that accounted for the stretch of uniarticular structures and biarticular muscles. Subject specific walking kinematics (80%, 100%, and 120% of preferred speed) were input into the passive models to estimate joint moments, power, and work attributable to passive mechanisms. Passive hip flexion moments were substantial from late stance through early swing, absorbing approximately 40% of the net negative work done during hip extension and producing over half of the net positive work done during the hip flexor power burst (H3). Passive ankle plantarflexor moments were also produced during pre-swing, but generated a smaller percentage ( approximately 10%) of the net ankle plantarflexor power burst (A2). The joint work attributed to passive structures increased significantly (p<0.05) with walking speed. The biarticular rectus femoris and gastrocnemius allowed for net passive energy absorption at the knee and subsequent return at the hip and ankle (p<0.05). Together, these results suggest that passive-elastic mechanisms can contribute substantially to normal human walking and that biarticular muscles play a role in passively transferring energy between joints.

Terrain Negotiation of a Compliant Biped Robot Driven by Antagonistic Artificial Muscles

Human beings realize adaptive bipedal walking negotiating different terrain, which is still difficult for biped robots driven by electric motors. We developed a biped robot driven by antagonistic artificial muscles that negotiates several types of terrain. Antagonistic muscles combined with a simple feed-forward controller realize joint compliance without a time delay, enabling the robot to adapt to terrain changes and to sense terrain because walking behavior results from interaction between robot dynamics and the terrain. Experimental results demonstrate that the walking cycle changes based on joint compliance and the type of terrain. Using the relationship between the two, the robot regulates its walking cycle by changing its joint compliance. The compliance by such antagonistic muscles is a promising solution for realizing adaptive bipedal walking.

Maximum voluntary joint torque as a function of joint angle and angular velocity: model development and application to the lower limb

Measurements of human strength can be important during analyses of physical activities. Such measurements have often taken the form of the maximum voluntary torque at a single joint angle and angular velocity. However, the available strength varies substantially with joint position and velocity. When examining dynamic activities, strength measurements should account for these variations. A model is presented of maximum voluntary joint torque as a function of joint angle and angular velocity. The model is based on well-known physiological relationships between muscle force and length and between muscle force and velocity and was tested by fitting it to maximum voluntary joint torque data from six different exertions in the lower limb. Isometric, concentric and eccentric maximum voluntary contractions were collected during hip extension, hip flexion, knee extension, knee flexion, ankle plantar flexion and dorsiflexion. Model parameters are reported for each of these exertion directions by gender and age group. This model provides an efficient method by which strength variations with joint angle and angular velocity may be incorporated into comparisons between joint torques calculated by inverse dynamics and the maximum available joint torques.

Identification of passive elastic joint moment-angle relationships in the lower extremity

The purpose of this study was to develop a method for identifying subject-specific passive elastic joint moment-angle relationships in the lower extremity, which could subsequently be used to estimate passive contributions to joint kinetics during gait. Twenty healthy young adults participated in the study. Subjects were positioned side-lying with their dominant limb supported on a table via low-friction carts. A physical therapist slowly manipulated the limb through full sagittal hip, knee, and ankle ranges of motion using two hand-held 3D load cells. Lower extremity kinematics, measured with a passive marker motion capture system, and load cell readings were used to compute joint angles and associated passive joint moments. We formulated a passive joint moment-angle model that included eight exponential functions to account for forces generated via the passive stretch of uni-articular structures and bi-articular muscles. Model parameters were estimated for individual subjects by minimizing the sum of squared errors between model predicted and experimentally measured moments. The model predictions closely replicated measured joint moments with average root-mean-squared errors of 2.5, 1.4, and 0.7 Nm about the hip, knee, and ankle respectively. We show that the models can be coupled with gait kinematics to estimate passive joint moments during walking. Passive hip moments were substantial from terminal stance through initial swing, with energy being stored as the hip extended and subsequently returned during pre- and initial swing. We conclude that the proposed methodology could provide quantitative insights into the potentially important role that passive mechanisms play in both normal and abnormal gait.

A model-based study of passive joint properties on muscle effort during static stance

This study examined the impact of lower extremity joint stiffnesses and simulated joint contractures on the muscle effort required to maintain static standing postures after a spinal cord injury (SCI). Static inverse computer simulations were performed with a three-dimensional 15 degree of freedom musculoskeletal model placed in 1600 different standing postures. The required lower extremity muscle forces were calculated through an optimization routine that minimized the sum of the muscle stresses squared, which was used as an index of the muscle effort required for each standing posture. Joint stiffnesses were increased and decreased by 100 percent of their nominal values, and contractures were simulated to determine their effects on the muscle effort for each posture. Nominal muscle and passive properties for an individual with a SCI determined the baseline muscle effort for comparisons. Stiffness changes for the ankle plantar flexion/dorsiflexion, hip flexion/extension, and hip abduction/adduction directions had the largest effect on reducing muscle effort by more than 5 percent, while changes in ankle inversion/eversion and knee flexion/extension had the least effect. For erect standing, muscle effort was reduced by more than 5 percent when stiffness was decreased at the ankle plantar flexion/dorsiflexion joint or hip flexion/extension joint. With simulated joint contractures, the postural workspace area decreased and muscle effort was not reduced by more than 5 percent for any posture. Using this knowledge, methods can be developed through the use of orthoses, physical therapy, surgery or other means to appropriately augment or diminish these passive moments during standing with a neuroprosthesis.

Estimation of Passive Ankle Joint Moment during Standing and Walking

This study estimated the passive ankle joint moment during standing and walking initiation and its contribution to total ankle joint moment during that time. The decrement of passive joint moment due to muscle fascicle shortening upon contraction was taken into account. Muscle fascicle length in the medial gastrocnemius, which was assumed to represent muscle fascicle length in plantarflexors, was measured using ultrasonography during standing, walking initiation, and cyclical slow passive ankle joint motion. Total ankle joint moment during standing and walking initiation was calculated from ground reaction forces and joint kinematics. Passive ankle joint moment during the cyclical ankle joint motion was measured via a dynamometer. Passive ankle joint moment during standing and at the time (Tp) when the MG muscle-tendon complex length was longest in the stance phase during walking initiation were 2.3 and 5.4 Nm, respectively. The muscle fascicle shortened by 2.9 mm during standing compared with the length at rest, which decreased the contribution of passive joint moment from 19.9% to 17.4%. The muscle fascicle shortened by 4.3 mm at Tp compared with the length at rest, which decreased the contribution of passive joint moment from 8.0% to 5.8%. These findings suggest that (a) passive ankle joint moment plays an important role during standing and walking initiation even in view of the decrement of passive joint moment due to muscle fascicle shortening upon muscle contraction, and (b) muscle fascicle shortening upon muscle contraction must be taken into account when estimating passive joint moment during movements.

Adaptations to mass perturbations in transtibial amputees: Kinetic or kinematic invariance? 11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated

OBJECTIVE

To establish the adaptation strategy transtibial amputees use after mass perturbation of their prosthetic lower leg.

DESIGN

We investigated whether the measured adaptations to mass perturbation of the lower leg in transtibial amputees can better be described as (1) a kinetic invariance strategy in which kinetics (joint torques) remain the same while kinematics (joint angles) change or (2) a kinematic invariance strategy in which kinematics remain the same while kinetics change.

SETTING

A gait laboratory.

PARTICIPANTS

Ten transtibial amputees.

INTERVENTIONS

Five different mass conditions.

MAIN OUTCOME MEASURES

Measured joint torques and angles during the swing phase in the different mass conditions.

RESULTS

Mass perturbation induced more significant changes and larger effect sizes in joint torques than in joint angles.

CONCLUSIONS

Transtibial amputees adapt to mass perturbation primarily by maintaining the same kinematic pattern and adjusting their joint torques, that is, they use a kinematic invariance strategy. This implies that manipulating prosthetic inertial properties does not directly influence gait kinematics and that inertial properties should be evaluated in terms of the energetic cost of the swing phase.

Muscle force redistributes segmental power for body progression during walking

The ankle plantar flexors were previously shown to support the body in single-leg stance to ensure its forward progression [J. Biomech. 34 (2001) 1387]. The uni- (SOL) and biarticular (GAS) plantar flexors accelerated the trunk and leg forward, respectively, with each opposing the effect of the other. Around mid-stance their net effect on the trunk and the leg was negligible, consistent with the body acting as an inverted pendulum. In late stance, their net effect was to accelerate the leg and trunk forward, consistent with an active push-off. Because other muscles are active in the beginning and end of stance, we hypothesized that their active concentric and eccentric force generation also supports the body and redistributes segmental power to enable body forward progression. Muscle-actuated forward dynamical simulations that emulated observed walking kinematics and kinetics of young adult subjects were analyzed to quantify muscle contributions to the vertical and horizontal ground reaction force, and to the acceleration and mechanical power of the leg and trunk. The eccentric uniarticular knee extensors (vasti, VAS) and concentric uniarticular hip extensors (gluteus maximus, GMAX) were found to provide critical support to the body in the beginning of stance, before the plantar flexors became active. VAS also decelerated the forward motion of both the trunk and the leg. Afterwards when VAS shortens in mid-stance, it delivered the power produced to accelerate the trunk and also redistributed segmental power to the trunk by continuing to decelerate the leg. When present, rectus femoris (RF) activity in the beginning of stance had a minimal effect. But in late stance the lengthening RF accelerated the knee and hip into extension, which opposed swing initiation. Though RF was lengthening, it still accelerated the trunk forward by decelerating the leg and redistributing the leg segmental power to the trunk, as SOL does though it is shortening instead of lengthening. Force developed from highly stretched passive hip structures and active force produced by the uniarticular hip flexors assisted GAS in swing initiation. Hamstrings (HAM) decelerated the leg in late swing while lengthening and accelerated the leg in the beginning of stance while shortening. We conclude that the uniarticular knee and hip extensor muscles are critical to body support in the beginning of stance and redistribution of segmental power by muscles throughout the gait cycle is critical to forward progression of the trunk and legs.

Computer modeling and simulation of human movement

Recent interest in using modeling and simulation to study movement is driven by the belief that this approach can provide insight into how the nervous system and muscles interact to produce coordinated motion of the body parts. With the computational resources available today, large-scale models of the body can be used to produce realistic simulations of movement that are an order of magnitude more complex than those produced just 10 years ago. This chapter reviews how the structure of the neuromusculoskeletal system is commonly represented in a multijoint model of movement, how modeling may be combined with optimization theory to simulate the dynamics of a motor task, and how model output can be analyzed to describe and explain muscle function. Some results obtained from simulations of jumping, pedaling, and walking are also reviewed to illustrate the approach.

Manual examination of accessory movements--seeking R1

Movement diagrams are used by physiotherapists to depict the behaviour of resistance through the available range of accessory and physiological joint movement. It is generally accepted that for an asymptomatic joint, the resistance first felt by the therapist (R1) occurs towards the end of range. R1 is considered to be at the transition point between the toe and linear region of a load displacement curve. The aim of this study was to more accurately define R1 from force displacement curves of accessory movement to the spine and peripheral joints using a validated instrument, the Spinal Assessment Machine (SAM). Thirty archived force displacement curves obtained using the SAM, which applied a posteroanterior force of 100N at a frequency of 0.5 Hz to L3 spinous process, were examined. In addition force displacement curves were similarly obtained from the tibiofemoral joint, glenohumeral joint and radiocarpal joint of one asymptomatic individual. In all cases resistance to a PA movement commenced at the beginning of range, the curve ascending as soon as the force was applied. While in most cases there was a low stiffness 'toe' region there was no unambiguous point where it could be said that the toe region ended. It is concluded that for spinal and peripheral accessory movements both the onset of resistance and the toe occurs at the beginning of range. Therapists should therefore depict R1 at the beginning of range not toward the end of range as is current practice.

Loads in the lumbar spine during traction therapy

The purpose of the present study was to determine the loads acting on the lumbar spine when traction therapy was given in the Fowler's position. The study had two parts: a theoretical analysis which showed that traction produced a flexion moment on the spine as well as axial distraction; and an experimental study which measured the flexion moment induced by the adoption of the Fowler's position. The Fowler's position is clinically essential in that it flexes the spine and takes up the slack of the posterior tissues before the traction force is applied. Hence the axial tension and flexion moment generated by the traction force are more effective in stretching the posterior tissues. The angle of pull on the traction harness influences the friction between the body and the couch. However, this consideration is not necessary if a split traction table is used. The mechanical effects of traction are compared with those produced by postero-anterior mobilisation. The relative magnitude and direction of loads produced, and their variation with segmental level should be considered by therapists when choosing a technique for treating low back pain.

Intrinsic and extrinsic contributions to the passive moment at the metacarpophalangeal joint

The purpose of this investigation was to determine whether the passive range of motion at the finger joints is restricted more by intrinsic tissues (cross a single joint) or by extrinsic tissues (cross multiple joints). The passive moment at the metacarpophalangeal (MP) joint of the index finger was modeled as the sum of intrinsic and extrinsic components. The intrinsic component was modeled only as a function of MP joint angle. The extrinsic component was modeled as a function of MP joint angle and wrist angle. With the wrist fixed in seven different positions the passive moment at the MP joint of eight subjects was recorded as the finger was rotated through its range at a constant rate. The moment-angle data were fit by the model and the extrinsic and intrinsic components were calculated for a range of MP joint angles and wrist positions. With the MP joint near its extension limit, the median percent extrinsic contribution was 94% with the wrist extended 60 degrees and 14% with the wrist flexed 60 degrees. These percentages were 40 and 88%, respectively, with the MP joint near its flexion limit. Our findings indicate that at most wrist angles the extrinsic tissues offer greater restraint at the limits of MP joint extension and flexion than the intrinsic tissues. The intrinsic tissues predominate when the wrist is flexed or extended enough to slacken the extrinsic tissues. Additional characteristics of intrinsic and extrinsic tissues can be deduced by examining the parameter values calculated by the model.

Analysis of passive elastic joint moments in paraplegics

In the functional electrical stimulation of the lower extremity of paraplegics to achieve standing and walking, a mathematical model describing the passive elastic joint moments is essential in order to implement model-based control algorithms. In a previous investigation of ten normal persons we had found significant coupling of passive, elastic joint moments between neighboring joints due to muscle groups that span both joints (biarticular muscles). Thus, we now investigated the biarticular coupling in six paraplegic patients. A comparison to the averaged results of the ten normal persons showed that while the biarticular joint moment coupling due to the gastrocnemius muscle was well preserved in all patients, the coupling due to the rectus femoris was greatly reduced and the coupling due to the hamstring muscle group was negligible. We offer pathophysiologically based explanations for these characteristic differences including the speculation that the predominantly extensor-type spasticity in our patients exercises mainly the anti-gravity muscles such as the gastrocnemius and the rectus femoris, while permitting greater atrophy of the hamstring muscle group. A previously presented double-exponential equation that predicts the joint moments under consideration of the neighboring joint angles could be fitted well to the experimental data.

The swing phase of human walking is not a passive movement

Many studies have assumed that the swing phase of human walking at preferred velocity is largely passive and thus highly analogous to the swing of an unforced pendulum. In other words, while swing-phase joint moments are generally nonzero during swing, it was assumed that they were either zero or at least negligibly small compared to gravity. While neglect of joint moments does not invalidate a study by default, it remains that the limitations of such an assumption have not been explored thoroughly. This paper makes five arguments that the swing phase cannot be passive, using both original data and the literature: (1) Computer simulations of the swing phase require muscular control to be accurate. (2) Swing-phase joint moments, while smaller than those during stance, are still greater than those due to gravity. (3) Gravity accounts for a minority of the total kinetics of a swing phase. (4) The kinetics due to gravity do not have the pattern needed to develop a normal swing phase. (5) There is no correlation between pendular swing times and human walking periods in overground walking. The conclusion of this paper is that the swing phase must be an actively controlled process, and should be assumed to be passive only when a study does not require a quantitative result. This conclusion has significant implications for many areas of gait research, including clinical study, control theory, and mechanical modeling.

Passive moment about the hip in straight leg raising

OBJECTIVE

The purpose of this examine is to study the load-deformation characteristics of the hip in straight leg raising.

DESIGN

An experimental study in which passive moment about the hip was determined as a function of hip angle.

BACKGROUND

Straight leg raising is widely employed in clinical examination, and there is little information on its mechanical characteristics.

METHODS

Fourteen healthy volunteers were recruited for this study. Three trials of straight leg raise tests were performed while subjects lay supine on a plinth that was fitted with load cells. An electrogoniometer was employed to measure hip flexion during the test. Resistive moment at the hip was determined using a dynamic biomechanical model.

RESULTS

The present experimental method was shown to be highly reliable. The moment-angle curves of all subjects were shown to follow an exponential function.

CONCLUSION

Stiffness and strain energy of posterior hip tissues could be derived from the moment-angle curves. Evaluation of such elastic properties is clinically important as they may be altered with injuries of the tissues.

RELEVANCE

Clinically, contracture of hamstring muscles and other posterior hip tissues is evaluated by measuring the available range of hip flexion in straight leg raising. However, this does not provide any information on the elastic properties of the tissues. The present study reports a reliable method of evaluating such properties.

Identification of passive elastic joint moments in the lower extremities

Musculotendon actuators produce active and passive moments at the joints they span. Due to the existence of bi-articular muscles, the passive elastic joint moments are influenced by the angular positions of adjacent joints. To obtain quantitative information about this passive elastic coupling between lower limb joints, we examined the passive elastic joint properties of the hip, knee, and ankle joint of ten healthy subjects. Passive elastic joint moments were found to considerably depend on the adjacent joint angles. We present a simple mathematical model that describes these properties on the basis of a double-exponential expression. The model can be implemented in biomechanical models of the lower extremities, which are generally used for the simulation of multi-joint movements such as standing-up, walking, running, or jumping.