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Okada K, Haruyama K, Okuyama K, Tsuzuki K, Nakamura T, Kawakami M. Categorizing knee hyperextension patterns in hemiparetic gait and examining associated impairments in patients with chronic stroke. Gait Posture 2024; 113:18-25. [PMID: 38820765 DOI: 10.1016/j.gaitpost.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/08/2024] [Accepted: 05/22/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Post-stroke hemiparetic gait exhibits considerable variations in motion patterns and abnormal muscle activities, notably knee hyperextension during the stance phase. Existing studies have primarily concentrated on its joint angle or moment. However, the underlying causes remain unclear. Thus, the causes of knee hyperextension were explored from a new perspective based on temporal-durational factors. RESEARCH QUESTION Does the temporal-durational difference of knee hyperextension presence result from specific decreased motor functions? METHODS Barefoot gait at a comfortable speed was captured using a three-dimensional camera system. Scores of knee hyperextension used a metric with the temporal-durational factor of knee hyperextension presence in each of four stance phases (1st double support, DS1; early single-leg stance, ESS; late single-leg stance, LSS; 2nd double support, DS2). These scores were used in cluster analysis. The classification and regression tree analysis characterizing each knee hyperextension cluster used the clinical measures of the lower limb and trunk motor function, muscle strength, and spasticity as explanatory variables. RESULTS Thirty patients with hemiparetic chronic stroke who exhibited knee hyperextension during gait were included. Four knee hyperextension clusters were shown: Momentary (almost no hyperextension), Continuous (DS1-DS2), ESS-LSS, and ESS-DS2. Knee flexor strength was lower in the groups with long hyperextension durations (Continuous and ESS-DS2) compared with short durations (ESS-LSS and Momentary). ESS-DS2 exhibited higher trunk motor function than Continuous, whereas more severe spasticity was observed in ESS-LSS than in Momentary. SIGNIFICANCE This study successfully classified four hemiparetic gait patterns with knee hyperextension based on the temporal-durational factor, providing valuable perspectives for understanding and addressing specific functional physical impairments. These findings offer guidance for focusing on related physical functions when striving for gait improvement with knee hyperextension and are expected to serve as a reference for treatment decision-making.
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Affiliation(s)
- Kohsuke Okada
- Saiseikai Higashi-kanagawa Rehabilitation Hospital, Kanagawa 221-0822, Japan.
| | - Koshiro Haruyama
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo 113-8421, Japan
| | - Kohei Okuyama
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan; Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba 275-0026, Japan
| | - Keita Tsuzuki
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Takuya Nakamura
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan.
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Lu C, Ge R, Tang Z, Fu X, Zhang L, Yang K, Xu X. Multi-Channel FES Gait Rehabilitation Assistance System Based on Adaptive sEMG Modulation. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3652-3663. [PMID: 37695970 DOI: 10.1109/tnsre.2023.3313617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Functional electrical stimulation (FES) can be used to stimulate the lower-limb muscles to provide walking assistance to stroke patients. However, the existing surface electromyography (sEMG)-based FES control methods mostly only consider a single muscle with a fixed stimulation intensity and frequency. This study proposes a multi-channel FES gait rehabilitation assistance system based on adaptive myoelectric modulation. The proposed system collects sEMG of the vastus lateralis muscle on the non-affected side to predict the sEMG values of four targeted lower-limb muscles on the affected side using a bidirectional long short-term memory (BILSTM) model. Next, the proposed system modulates the real-time FES output frequency for four targeted muscles based on the predicted sEMG values to provide muscle force compensation. Fifteen healthy subjects were recruited to participate in an offline model-building experiment conducted to evaluate the feasibility of the proposed BILSTM model in predicting the sEMG values. The experimental results showed that the [Formula: see text] value of the best-obtained prediction result reached 0.85 using the BILSTM model, which was significantly higher than that using traditional prediction methods. Moreover, two patients after stroke were recruited in the online assisted-walking experiment to verify the effectiveness of the proposed walking-assistance system. The experimental results showed that the activation of the target muscles of the patients was higher after FES, and the gait movement data were significantly different before and after FES. The proposed system can be effectively applied to walking assistance for stroke patients, and the experimental results can provide new ideas and methods for sEMG-controlled FES rehabilitation applications.
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Uhlrich SD, Uchida TK, Lee MR, Delp SL. Ten steps to becoming a musculoskeletal simulation expert: A half-century of progress and outlook for the future. J Biomech 2023; 154:111623. [PMID: 37210923 PMCID: PMC10544733 DOI: 10.1016/j.jbiomech.2023.111623] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/05/2023] [Indexed: 05/23/2023]
Abstract
Over the past half-century, musculoskeletal simulations have deepened our knowledge of human and animal movement. This article outlines ten steps to becoming a musculoskeletal simulation expert so you can contribute to the next half-century of technical innovation and scientific discovery. We advocate looking to the past, present, and future to harness the power of simulations that seek to understand and improve mobility. Instead of presenting a comprehensive literature review, we articulate a set of ideas intended to help researchers use simulations effectively and responsibly by understanding the work on which today's musculoskeletal simulations are built, following established modeling and simulation principles, and branching out in new directions.
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Affiliation(s)
- Scott D Uhlrich
- Department of Bioengineering, Stanford University, 318 Campus Drive, Stanford, CA 94305, USA.
| | - Thomas K Uchida
- Department of Mechanical Engineering, University of Ottawa, 161 Louis-Pasteur, Ottawa, ON K1N 6N5, Canada.
| | - Marissa R Lee
- Department of Mechanical Engineering, Stanford University, 318 Campus Drive, Stanford, CA 94305, USA.
| | - Scott L Delp
- Department of Bioengineering, Stanford University, 318 Campus Drive, Stanford, CA 94305, USA; Department of Mechanical Engineering, Stanford University, 318 Campus Drive, Stanford, CA 94305, USA; Department of Orthopaedic Surgery, Stanford University, 318 Campus Drive, Stanford, CA 94305, USA.
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4
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Contesse MG, Hodges J, Staunton H, Lowes LP, Elmankabadi B, Elder SJ, Ormazabal MG, Dalle Pazze L, Leffler MG. Home-based video assessment of ease of movement for patients with Duchenne: Interviews with physical therapists to select movement tasks. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023; 28:e1993. [PMID: 36718112 DOI: 10.1002/pri.1993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 11/01/2022] [Accepted: 12/31/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Patients with Duchenne muscular dystrophy (DMD) change their movement patterns to compensate for muscle weakness. The Duchenne Video Assessment (DVA) measures ease of movement through evaluation of compensatory movements. The DVA directs caregivers to video record patients performing home-based movement tasks using a mobile application, and DVA-certified physical therapists evaluate the videos using scorecards with prespecified compensatory movement criteria. Two qualitative interview studies were conducted to select movement tasks for the DVA that are relevant to patients with DMD and able to reflect changes in function. METHODS Qualitative interviews with eligible physical therapists were conducted remotely. Physical therapists were asked to spontaneously suggest movement tasks prior to evaluating specific movement tasks selected a priori. Analysts conducted a content analysis to investigate whether movement tasks selected a priori were confirmed as relevant to the population of interest and able to show changes in function. RESULTS The studies included five physical therapists to select tasks for ambulatory patients with DMD and six for non-ambulatory patients. For an ambulatory population, all five experts confirmed Climb Five Stairs, Run, Stand Up from Sitting, Sit Up from Supine, and Jump Forward, and four (80%) confirmed Walk as relevant and able to show functional changes. For a non-ambulatory population, all six experts confirmed Eat 10 Bites, Roll Over in Bed, Shift Weight in Bed, Take T-Shirt Off, Put T-Shirt On, Put Arms on Armrest, and Reach Across Table to Grab Cell Phone, and five (83%) confirmed Raise Hands Above Head as relevant and able to show functional changes. DISCUSSION Physical therapists confirmed the DVA movement tasks as relevant to patients with DMD and able to reflect changes in function. The use of the DVA in clinical trials provides an opportunity to collect data not seen in clinic and reduce travel burden for families.
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Chan SY, Kuo CW, Liao TT, Peng CW, Hsieh TH, Chang MY. Time-course gait pattern analysis in a rat model of foot drop induced by ventral root avulsion injury. Front Hum Neurosci 2022; 16:972316. [PMID: 36601128 PMCID: PMC9806139 DOI: 10.3389/fnhum.2022.972316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Foot drop is a common clinical gait impairment characterized by the inability to raise the foot or toes during walking due to the weakness of the dorsiflexors of the foot. Lumbar spine disorders are common neurogenic causes of foot drop. The accurate prognosis and treatment protocols of foot drop are not well delineated in the scientific literature due to the heterogeneity of the underlying lumbar spine disorders, different severities, and distinct definitions of the disease. For translational purposes, the use of animal disease models could be the best way to investigate the pathogenesis of foot drop and help develop effective therapeutic strategies for foot drops. However, no relevant and reproducible foot drop animal models with a suitable gait analysis method were developed for the observation of foot drop symptoms. Therefore, the present study aimed to develop a ventral root avulsion (VRA)-induced foot drop rat model and record detailed time-course changes of gait pattern following L5, L6, or L5 + L6 VRA surgery. Our results suggested that L5 + L6 VRA rats exhibited changes in gait patterns, as compared to sham lesion rats, including a significant reduction of walking speed, step length, toe spread, and swing phase time, as well as an increased duration of the stance phase time. The ankle kinematic data exhibited that the ankle joint angle increased during the mid-swing stage, indicating a significant foot drop pattern during locomotion. Time-course observations displayed that these gait impairments occurred as early as the first-day post-lesion and gradually recovered 7-14 days post-injury. We conclude that the proposed foot drop rat model with a video-based gait analysis approach can precisely detect the foot drop pattern induced by VRA in rats, which can provide insight into the compensatory changes and recovery in gait patterns and might be useful for serving as a translational platform bridging human and animal studies for developing novel therapeutic strategies for foot drop.
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Affiliation(s)
- Shu-Yen Chan
- Department of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,Graduate Institute of Medical Science, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chi-Wei Kuo
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
| | - Tsai-Tsen Liao
- Graduate Institute of Medical Science, College of Medicine, Taipei Medical University, Taipei, Taiwan,Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Wei Peng
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan,International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Hsun Hsieh
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan,Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan,*Correspondence: Ming-Yuan Chang Tsung-Hsun Hsieh
| | - Ming-Yuan Chang
- Division of Neurosurgery, Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan,Graduate Institute of Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan,Discipline of Marketing, College of Management, Yuan Ze University, Taoyuan, Taiwan,*Correspondence: Ming-Yuan Chang Tsung-Hsun Hsieh
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6
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Moore U, Caldas de Almeida Araújo E, Reyngoudt H, Gordish‐Dressman H, Smith FE, Wilson I, James M, Mayhew A, Rufibach L, Day JW, Jones KJ, Bharucha‐Goebel DX, Salort‐Campana E, Pestronk A, Walter MC, Paradas C, Stojkovic T, Mori‐Yoshimura M, Bravver E, Pegoraro E, Mendell JR, Bushby K, Blamire AM, Straub V, Carlier PG, Diaz‐Manera J. Water T2 could predict functional decline in patients with dysferlinopathy. J Cachexia Sarcopenia Muscle 2022; 13:2888-2897. [PMID: 36058852 PMCID: PMC9745487 DOI: 10.1002/jcsm.13063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/18/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Water T2 (T2H2O ) mapping is increasingly being used in muscular dystrophies to assess active muscle damage. It has been suggested as a surrogate outcome measure for clinical trials. Here, we investigated the prognostic utility of T2H2O to identify changes in muscle function over time in limb girdle muscular dystrophies. METHODS Patients with genetically confirmed dysferlinopathy were assessed as part of the Jain Foundation Clinical Outcomes Study in dysferlinopathy. The cohort included 18 patients from two sites, both equipped with 3-tesla magnetic resonance imaging (MRI) systems from the same vendor. T2H2O value was defined as higher or lower than the median in each muscle bilaterally. The degree of deterioration on four functional tests over 3 years was assessed in a linear model against covariates of high or low T2H2O at baseline, age, disease duration, and baseline function. RESULTS A higher T2H2O at baseline significantly correlated with a greater decline on functional tests in 21 out of 35 muscles and was never associated with slower decline. Higher baseline T2H2O in adductor magnus, vastus intermedius, vastus lateralis, and vastus medialis were the most sensitive, being associated bilaterally with greater decline in multiple timed tests. Patients with a higher than median baseline T2H2O (>40.6 ms) in the right vastus medialis deteriorated 11 points more on the North Star Ambulatory Assessment for Dysferlinopathy and lost an additional 86 m on the 6-min walk than those with a lower T2H2O (<40.6 ms). Optimum sensitivity and specificity thresholds for predicting decline were 39.0 ms in adductor magnus and vastus intermedius, 40.0 ms in vastus medialis, and 40.5 ms in vastus lateralis from different sites equipped with different MRI systems. CONCLUSIONS In dysferlinopathy, T2H2O did not correlate with current functional ability. However, T2H2O at baseline was higher in patients who worsened more rapidly on functional tests. This suggests that inter-patient differences in functional decline over time may be, in part, explained by different severities of the active muscle damage, assessed by T2H2O measure at baseline. Significant challenges remain in standardizing T2H2O values across sites to allow determining globally applicable thresholds. The results from the present work are encouraging and suggest that T2H2O could be used to improve prognostication, patient selection, and disease modelling for clinical trials.
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Affiliation(s)
- Ursula Moore
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research InstituteNewcastle University and Newcastle Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Ericky Caldas de Almeida Araújo
- NMR Laboratory, Neuromuscular Investigation CenterInstitute of MyologyParisFrance
- NMR LaboratoryCEA/DRF/IBFJ/MIRCenParisFrance
| | - Harmen Reyngoudt
- NMR Laboratory, Neuromuscular Investigation CenterInstitute of MyologyParisFrance
- NMR LaboratoryCEA/DRF/IBFJ/MIRCenParisFrance
| | - Heather Gordish‐Dressman
- Center for Translational Science, Division of Biostatistics and Study MethodologyChildren's National Health SystemWashingtonDCUSA
- Pediatrics, Epidemiology and BiostatisticsGeorge Washington UniversityWashingtonDCUSA
| | - Fiona E. Smith
- Magnetic Resonance Centre, Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Ian Wilson
- Magnetic Resonance Centre, Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Meredith James
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research InstituteNewcastle University and Newcastle Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Anna Mayhew
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research InstituteNewcastle University and Newcastle Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | | | - John W. Day
- Department of Neurology and Neurological SciencesStanford University School of MedicineStanfordCAUSA
| | - Kristi J. Jones
- The Children's Hospital at Westmead and The University of SydneySydneyNSWAustralia
| | - Diana X. Bharucha‐Goebel
- Department of NeurologyChildren's National Health SystemWashingtonDCUSA
- National Institutes of Health (NINDS)BethesdaMDUSA
| | | | - Alan Pestronk
- Department of NeurologyWashington University School of MedicineSt. LouisMOUSA
| | - Maggie C. Walter
- Friedrich‐Baur‐Institute, Department of NeurologyLudwig‐Maximilians‐University of MunichMunichGermany
| | - Carmen Paradas
- Neuromuscular Unit, Department of NeurologyHospital U. Virgen del Rocío/Instituto de Biomedicina de SevillaSevillaSpain
| | - Tanya Stojkovic
- Centre de référence des maladies neuromusculairesInstitut de Myologie, AP‐HP, Sorbonne Université, Hôpital Pitié‐SalpêtrièreParisFrance
| | - Madoka Mori‐Yoshimura
- Department of NeurologyNational Center Hospital, National Center of Neurology and PsychiatryTokyoJapan
| | - Elena Bravver
- Neuroscience InstituteCarolinas Neuromuscular/ALS‐MDA Center, Carolinas HealthCare SystemCharlotteNCUSA
| | - Elena Pegoraro
- Department of NeuroscienceUniversity of PadovaPaduaItaly
| | - Jerry R. Mendell
- The Abigail Wexner Research Institute at Nationwide Children's HospitalColumbusOHUSA
| | | | - Kate Bushby
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research InstituteNewcastle University and Newcastle Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Andrew M. Blamire
- Magnetic Resonance Centre, Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Volker Straub
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research InstituteNewcastle University and Newcastle Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Pierre G. Carlier
- Université Paris‐Saclay, CEA, DRF, Service Hospitalier Frederic JoliotOrsayFrance
| | - Jordi Diaz‐Manera
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research InstituteNewcastle University and Newcastle Hospitals NHS Foundation TrustNewcastle upon TyneUK
- Neuromuscular Disorders Unit, Neurology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER)MadridSpain
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A Systematic Review of Muscle Synergies during a Walking Gait to Define Optimal Donor-Recipient Pairings for Lower Extremity Functional Reconstruction. Plast Reconstr Surg Glob Open 2022; 10:e4438. [PMID: 35983544 PMCID: PMC9377677 DOI: 10.1097/gox.0000000000004438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022]
Abstract
Functional lower extremity reconstruction primarily aims to restore independent ambulation. We sought to define the synergies recruited during a walking gait to inform donor selection for various motor deficits. With these findings, we discuss the functional neuromuscular components of independent gait with the goal of informing lower extremity reconstruction.
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8
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Pariser KM, Higginson J. Development and Validation of a Framework for Predictive Simulation of Treadmill Gait. J Biomech Eng 2022; 144:1141866. [PMID: 35748610 DOI: 10.1115/1.4054867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Indexed: 11/08/2022]
Abstract
Treadmill training is a common intervention to promote healthy walking function for individuals with pathological gait. However, because of the heterogeneity of many patient populations, determining how an individual will respond to new treadmill protocols may require extensive trial and error, causing increased patient fatigue. This article provides instructions for the development and validation of a framework for predictive simulation of treadmill gait, which may be used in the design of treadmill training protocols. This was accomplished through three steps: predict motion of a simple model of a block relative to a treadmill, create a predictive framework to estimate gait with a 2D lower limb musculoskeletal model on a treadmill, and validate the framework by comparing predicted kinematics, kinetics, and spatiotemporal parameters across three belts speeds and between speed-matched overground and treadmill predictive simulations. Predicted states and ground reaction forces for the block-treadmill model were consistent with rigid body dynamics, and lessons learned regarding ground contact model and treadmill motion definition were applied to the gait model. Treadmill simulations at 0.7, 1.2, and 1.8 m/s belt speeds resulted in predicted sagittal plane joint angles, ground reaction forces, step length, and step time that closely matched experimental data at similar speeds. Predicted speed-matched overground and treadmill simulations resulted in small RMSE values within standard deviations for healthy gait. These results suggest that this predictive simulation framework is valid and can be used to estimate gait adaptations to various treadmill training protocols.
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Affiliation(s)
- Kayla M Pariser
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA; University of Delaware, 540 S. College Ave., STAR Health Sciences Complex, Rm, 201, Newark, DE, USA
| | - Jill Higginson
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA; University of Delaware, 540 S. College Ave., STAR Health Sciences Complex, Rm, 201, Newark, DE, USA
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9
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A Conceptual Blueprint for Making Neuromusculoskeletal Models Clinically Useful. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11052037] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The ultimate goal of most neuromusculoskeletal modeling research is to improve the treatment of movement impairments. However, even though neuromusculoskeletal models have become more realistic anatomically, physiologically, and neurologically over the past 25 years, they have yet to make a positive impact on the design of clinical treatments for movement impairments. Such impairments are caused by common conditions such as stroke, osteoarthritis, Parkinson’s disease, spinal cord injury, cerebral palsy, limb amputation, and even cancer. The lack of clinical impact is somewhat surprising given that comparable computational technology has transformed the design of airplanes, automobiles, and other commercial products over the same time period. This paper provides the author’s personal perspective for how neuromusculoskeletal models can become clinically useful. First, the paper motivates the potential value of neuromusculoskeletal models for clinical treatment design. Next, it highlights five challenges to achieving clinical utility and provides suggestions for how to overcome them. After that, it describes clinical, technical, collaboration, and practical needs that must be addressed for neuromusculoskeletal models to fulfill their clinical potential, along with recommendations for meeting them. Finally, it discusses how more complex modeling and experimental methods could enhance neuromusculoskeletal model fidelity, personalization, and utilization. The author hopes that these ideas will provide a conceptual blueprint that will help the neuromusculoskeletal modeling research community work toward clinical utility.
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10
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Yue L, Chen L, Zhou R. The Efficacy of Whole-Body Vibration for Functional Improvement of
Stroke Patients: A Meta-Analysis of Randomized Controlled Trials. PHYSIKALISCHE MEDIZIN, REHABILITATIONSMEDIZIN, KURORTMEDIZIN 2020. [DOI: 10.1055/a-1023-4582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AbstractThe efficacy of whole-body vibration for functional improvement in stroke
patients remains controversial. We conduct a systematic review and meta-analysis
to explore the influence of whole-body vibration on functional improvement in
stroke patients.We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases
through June 2018 for randomized controlled trials (RCTs) assessing the effect
of whole-body vibration on functional improvement in stroke patients. This
meta-analysis is performed using the random-effect model.Eight RCTs are included in the meta-analysis. Overall, compared with control
group for stroke patients, whole-body vibration has no positive impact on
6 min walk test (6MWT) distance (standard mean difference (Std.
MD)=−0.28; 95% confidence interval
(CI)=−0.66 to 0.11; P=0.16), timed-up-and-go (TUG) test
(Std. MD=0.15; 95% CI=−0.54 to 0.84;
P=0.67), Fugl-Meyer assessment (Std. MD=0.33; 95%
CI=−0.23 to 0.89; P=0.25), Berg Balance Scale (Std.
MD=0.19; 95% CI=−0.43 to 0.80; P=0.55),
and activities specific balance (ABC) scale (Std. MD=−0.22;
95% CI=−0.62 to 0.17; P=0.26).Whole-body vibration shows no notable influence on 6MWT distance, TUG test,
Fugl-Meyer assessment, Berg Balance Scale, and ABC scale in stroke patients.
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Affiliation(s)
- Lin Yue
- Department of Emergency, Wenzhou People’s Hospital, The Wenzhou
Third Clinical Institute Affiliated To Wenzhou Medical University, Wenzhou
Maternal and Child Health Care Hospital, Wenzhou, Zhejiang, P. R.
China
| | - Linglong Chen
- Department of Emergency, Wenzhou People’s Hospital, The Wenzhou
Third Clinical Institute Affiliated To Wenzhou Medical University, Wenzhou
Maternal and Child Health Care Hospital, Wenzhou, Zhejiang, P. R.
China
| | - Rongrong Zhou
- Medical Skill Training Center, Wenzhou People’s Hospital, The
Wenzhou Third Clinical Institute Affiliated To Wenzhou Medical University,
Wenzhou Maternal and Child Health Care Hospital, Wenzhou, Zhejiang, P. R.
China
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11
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Reimann H, Ramadan R, Fettrow T, Hafer JF, Geyer H, Jeka JJ. Interactions Between Different Age-Related Factors Affecting Balance Control in Walking. Front Sports Act Living 2020; 2:94. [PMID: 33345085 PMCID: PMC7739654 DOI: 10.3389/fspor.2020.00094] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 07/12/2020] [Indexed: 12/30/2022] Open
Abstract
Maintaining balance during walking is a continuous sensorimotor control problem. Throughout the movement, the central nervous system has to collect sensory data about the current state of the body in space, use this information to detect possible threats to balance and adapt the movement pattern to ensure stability. Failure of this sensorimotor loop can lead to dire consequences in the form of falls, injury and death. Such failures tend to become more prevalent as people get older. While research has established a number of factors associated with higher risk of falls, we know relatively little about age-related changes of the underlying sensorimotor control loop and how such changes are related to empirically established risk factors. This paper approaches the problem of age-related fall risk from a neural control perspective. We begin by summarizing recent empirical findings about the neural control laws mapping sensory input to motor output for balance control during walking. These findings were established in young, neurotypical study populations and establish a baseline of sensorimotor control of balance. We then review correlates for deteriorating balance control in older adults, of muscle weakness, slow walking, cognitive decline, and increased visual dependency. While empirical associations between these factors and fall risk have been established reasonably well, we know relatively little about the underlying causal relationships. Establishing such causal relationships is hard, because the different factors all co-vary with age and are difficult to isolate empirically. One option to analyze the role of an individual factor for balance control is to use computational models of walking comprising all levels of the sensorimotor control loop. We introduce one such model that generates walking movement patterns from a short list of spinal reflex modules with limited supraspinal modulation for balance. We show how this model can be used to simulate empirical studies, and how comparison between the model and empirical results can indicate gaps in our current understanding of balance control. We also show how different aspects of aging can be added to this model to study their effect on balance control in isolation.
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Affiliation(s)
- Hendrik Reimann
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Rachid Ramadan
- Institute for Neural Computation, Ruhr University, Bochum, Germany
| | - Tyler Fettrow
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Jocelyn F. Hafer
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Hartmut Geyer
- Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, United States
| | - John J. Jeka
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
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Hwang NK, Kim HH, Shim JM, Park JS. Tongue stretching exercises improve tongue motility and oromotor function in patients with dysphagia after stroke: A preliminary randomized controlled trial. Arch Oral Biol 2019; 108:104521. [PMID: 31476522 DOI: 10.1016/j.archoralbio.2019.104521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/03/2019] [Accepted: 08/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study investigated the effect of tongue stretching exercises (TSE) on tongue motility and oromotor function in patients with dysphagia after stroke. DESIGN This study was designed as a 4-week, double-blind, two-group, block randomized controlled trial. A total of 25 patients were randomly allocated into either the experimental (n = 13) or the control group (n = 12). The experimental group received TSE from an occupational therapist. TSE were divided into dynamic and static passive stretching exercises (20 repetitions each). The intervention was performed five times a week for four weeks. Tongue motility was measured before and after the intervention as the distance from the lower lip to the tip of tongue during maximum protrusion of the tongue. Measurements were performed twice each time and the mean value recorded. Oromotor function was assessed using the oral phase events of the videofluoroscopic dysphagia scale (VDS) based on a videofluoroscopic swallowing study. RESULTS The experimental group showed significant differences in tongue motility, bolus formation, tongue to palate contact, premature bolus loss, and oral transit time in the oral phase of VDS (p < 0.05 for all) before and after the intervention, whereas the control group showed a significant difference only in lip closure (p < 0.05). CONCLUSION This study demonstrated that TSE have a positive effect on tongue motility and oromotor function in patients with dysphagia after stroke. Therefore, we recommend TSE as an effective treatment for dysphagia.
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Affiliation(s)
- Na-Kyoung Hwang
- Department of Occupational Therapy, Seoul North Municipal Hospital, Seoul, Republic of Korea
| | - Hwan-Hee Kim
- Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea
| | - Je-Myung Shim
- Department of Physical Therapy, Kangwon National University, Samcheok, Republic of Korea
| | - Ji-Su Park
- Advanced Human Resource Development Project Group for Health Care in Aging Friendly Industry, Dongseo University, Busan, Republic of Korea.
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Sohn MH, Smith DM, Ting LH. Effects of kinematic complexity and number of muscles on musculoskeletal model robustness to muscle dysfunction. PLoS One 2019; 14:e0219779. [PMID: 31339917 PMCID: PMC6655685 DOI: 10.1371/journal.pone.0219779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 07/01/2019] [Indexed: 11/19/2022] Open
Abstract
The robustness of motor outputs to muscle dysfunction has been investigated using musculoskeletal modeling, but with conflicting results owing to differences in model complexity and motor tasks. Our objective was to systematically study how the number of kinematic degrees of freedom, and the number of independent muscle actuators alter the robustness of motor output to muscle dysfunction. We took a detailed musculoskeletal model of the human leg and systematically varied the model complexity to create six models with either 3 or 7 kinematic degrees of freedom and either 14, 26, or 43 muscle actuators. We tested the redundancy of each model by quantifying the reduction in sagittal plane feasible force set area when a single muscle was removed. The robustness of feasible force set area to the loss of any single muscle, i.e. general single muscle loss increased with the number of independent muscles and decreased with the number of kinematic degrees of freedom, with the robust area varying from 1% and 52% of the intact feasible force set area. The maximum sensitivity of the feasible force set to the loss of any single muscle varied from 75% to 26% of the intact feasible force set area as the number of muscles increased. Additionally, the ranges of feasible muscle activation for maximum force production were largely unconstrained in many cases, indicating ample musculoskeletal redundancy even for maximal forces. We propose that ratio of muscles to kinematic degrees of freedom can be used as a rule of thumb for estimating musculoskeletal redundancy in both simulated and real biomechanical systems.
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Affiliation(s)
- M. Hongchul Sohn
- The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- * E-mail:
| | - Daniel M. Smith
- The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Lena H. Ting
- The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, United States of America
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, Georgia, United States of America
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Błażkiewicz M, Wit A. Compensatory strategy for ankle dorsiflexion muscle weakness during gait in patients with drop-foot. Gait Posture 2019; 68:88-94. [PMID: 30469105 DOI: 10.1016/j.gaitpost.2018.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 09/12/2018] [Accepted: 11/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pathological movement patterns are characterized by abnormal kinematics, kinetics and muscle activations that alter the distribution of muscle forces during walking. AIM The objective of this study was to identify what compensatory strategy is evident in muscle force distribution in patients with drop-foot, in response to weakness in the dorsiflexor muscles. METHODS A sample of 10 patients with drop-foot were evaluated by a computerized gait analysis system and compared to a group of 10 healthy subjects. Muscle-actuated simulations of normal and drop-foot walking were performed using OpenSim software. A musculoskeletal model with 43 muscles acting on one lower extremity was used in order to perform the simulations. In order to evaluate the difference between muscle force curves in the healthy and the drop-foot populations, an integrals of each muscle curve were computed. RESULTS The group of patients with drop-foot exhibited an increased force integral for all muscle groups, except for the ankle evertors. The highest increases were observed for hip adductors (112%), hip extensors (88%), knee and hip flexors (83% and 50%, respectively) and for the plantarflexor (47%). These results were mainly influenced by the following muscles: flexor digitorum and hallucius, tibialis posterior and semitendinosus. The force integral for these muscles increased by more than 200% in the drop-foot group as compared to the control group. In addition, significant changes (>100%) were noted for the posterior thigh muscle group (semitendinosus, biceps femoris long and short head), which are responsible for bending the knee joint and straightening the hip joint. CONCLUSIONS It was proved that the loss in muscle force in individual muscle groups of the ankle joint are compensated for by the increased force and activity in other muscles acting on this joint and another muscles in neighbouring joints. The results may have important implications for physiotherapy treatments.
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Affiliation(s)
- Michalina Błażkiewicz
- The Józef Piłsudski University of Physical Education, Faculty of Rehabilitation, Marymoncka 34, Warsaw, 00-968, Poland.
| | - Andrzej Wit
- The Józef Piłsudski University of Physical Education, Faculty of Rehabilitation, Marymoncka 34, Warsaw, 00-968, Poland
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15
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Understanding Symptoms of Muscle Tightness, Weakness, and Rigidity From a Nursing Perspective. Rehabil Nurs 2019; 44:271-281. [PMID: 30624311 DOI: 10.1097/rnj.0000000000000151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study examined the nature of muscle tightness from nurses' perspectives and explored how the symptoms of muscle tightness are communicated, managed, and differentiated from other conditions, such as muscle rigidity and muscle weakness. DESIGN An exploratory, descriptive qualitative design was used. METHODS Eight rehabilitation nurses described lexicons, care strategies, and communication for muscle tightness, weakness, and rigidity. FINDINGS Nurses used conflicting terms to describe muscle tightness, weakness, and rigidity. They identified medications and range of motion as the best strategies to manage muscle conditions. Nurses approach care holistically and do not differentiate care strategies that are based only on a symptoms lens. CONCLUSIONS Nurses were unable to clearly differentiate between muscle tightness and rigidity. CLINICAL RELEVANCE Nurses influence patients' choice of vocabulary; therefore, they must use simple but precise terminologies to educate their patients. Miscommunication between nurses and patients can lead to errors, which can have negative consequences.
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Souissi H, Zory R, Boudarham J, Pradon D, Roche N, Gerus P. Muscle force strategies for poststroke hemiparetic patients during gait. Top Stroke Rehabil 2018; 26:58-65. [DOI: 10.1080/10749357.2018.1536023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Hiba Souissi
- Université Côte d’Azur, Laboratoire Motricité Humaine Education Sport Santé (LAMHESS), Nice, France
| | - Raphael Zory
- Université Côte d’Azur, Laboratoire Motricité Humaine Education Sport Santé (LAMHESS), Nice, France
| | - Julien Boudarham
- INSERM 1179, CIC 1429, CHU Raymond Poincaré, APHP, University of Versailles Saint Quentin en Yvelines, Garches, France
| | - Didier Pradon
- INSERM 1179, CIC 1429, CHU Raymond Poincaré, APHP, University of Versailles Saint Quentin en Yvelines, Garches, France
| | - Nicolas Roche
- INSERM 1179, CIC 1429, CHU Raymond Poincaré, APHP, University of Versailles Saint Quentin en Yvelines, Garches, France
| | - Pauline Gerus
- Université Côte d’Azur, Laboratoire Motricité Humaine Education Sport Santé (LAMHESS), Nice, France
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17
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Ghamari N, Hosseini SA, Khanke HR, Layeghi F. Strategies used by patients with thoracic outlet syndrome to improve their quality of life: a qualitative study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.2.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Narges Ghamari
- PhD student, Department of Occupational Therapy, School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyed Ali Hosseini
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hamid Reza Khanke
- Research Center in Emergency and Disaster Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fereydoun Layeghi
- Hand surgeon, Department of Clinical Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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18
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Valente G, Crimi G, Vanella N, Schileo E, Taddei F. nmsBuilder: Freeware to create subject-specific musculoskeletal models for OpenSim. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 152:85-92. [PMID: 29054263 DOI: 10.1016/j.cmpb.2017.09.012] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/05/2017] [Accepted: 09/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Musculoskeletal modeling and simulations of movement have been increasingly used in orthopedic and neurological scenarios, with increased attention to subject-specific applications. In general, musculoskeletal modeling applications have been facilitated by the development of dedicated software tools; however, subject-specific studies have been limited also by time-consuming modeling workflows and high skilled expertise required. In addition, no reference tools exist to standardize the process of musculoskeletal model creation and make it more efficient. Here we present a freely available software application, nmsBuilder 2.0, to create musculoskeletal models in the file format of OpenSim, a widely-used open-source platform for musculoskeletal modeling and simulation. nmsBuilder 2.0 is the result of a major refactoring of a previous implementation that moved a first step toward an efficient workflow for subject-specific model creation. METHODS nmsBuilder includes a graphical user interface that provides access to all functionalities, based on a framework for computer-aided medicine written in C++. The operations implemented can be used in a workflow to create OpenSim musculoskeletal models from 3D surfaces. A first step includes data processing to create supporting objects necessary to create models, e.g. surfaces, anatomical landmarks, reference systems; and a second step includes the creation of OpenSim objects, e.g. bodies, joints, muscles, and the corresponding model. RESULTS We present a case study using nmsBuilder 2.0: the creation of an MRI-based musculoskeletal model of the lower limb. The model included four rigid bodies, five degrees of freedom and 43 musculotendon actuators, and was created from 3D surfaces of the segmented images of a healthy subject through the modeling workflow implemented in the software application. CONCLUSIONS We have presented nmsBuilder 2.0 for the creation of musculoskeletal OpenSim models from image-based data, and made it freely available via nmsbuilder.org. This application provides an efficient workflow for model creation and helps standardize the process. We hope this would help promote personalized applications in musculoskeletal biomechanics, including larger sample size studies, and might also represent a basis for future developments for specific applications.
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Affiliation(s)
- Giordano Valente
- Medical Technology Laboratory, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy.
| | - Gianluigi Crimi
- Medical Technology Laboratory, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy
| | - Nicola Vanella
- Medical Technology Laboratory, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy
| | - Enrico Schileo
- Computational Bioengineering Laboratory, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy
| | - Fulvia Taddei
- Medical Technology Laboratory, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy
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19
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Ardestani MM, Moazen M. How human gait responds to muscle impairment in total knee arthroplasty patients: Muscular compensations and articular perturbations. J Biomech 2016; 49:1620-1633. [DOI: 10.1016/j.jbiomech.2016.03.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 03/24/2016] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
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20
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Modulation of reactive response to slip-like perturbations: effect of explicit cues on paretic versus non-paretic side stepping and fall-risk. Exp Brain Res 2015; 233:3047-58. [PMID: 26289480 DOI: 10.1007/s00221-015-4367-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/20/2015] [Indexed: 10/23/2022]
Abstract
This study aimed to examine the effect of explicit cuing on reactive stepping with the paretic limb during slip-like perturbations in stroke survivors and to identify differences in postural stability and fall-risk while stepping with either limb. Eleven chronic hemiparetic stroke survivors received slip-like stance perturbations in no-cue (implicit, no instructions) and cued (explicit, instructions to step with paretic limb) conditions. Frequency of stepping with the paretic limb was recorded. Differences between non-paretic and paretic steps for falls, number of compensatory steps, relative center-of-mass position (X COM/BOS), and velocity (Ẋ(COM/BOS)), and vertical limb support (hip descent-Z hip) were analyzed. Stepping with the paretic limb increased from 6% in no-cue condition to 42% in cued condition with no significant difference in number of falls and steps regardless of stepping limb. At liftoff of the compensatory step, stability was greater (anterior X COM/BOS) with paretic than non-paretic limb stepping whereas, at touchdown (TD) of the step, stability with paretic limb reduced (posterior X COM/BOS and Ẋ(COM/BOS)) due to a smaller compensatory step taken with the paretic versus non-paretic limb. There was no significant difference in peak Z hip regardless of stepping limb; however, the timing of peak Z hip differed (occuring prior to TD during non-paretic stepping and post-TD during paretic stepping). Thus, fall onset was earlier with non-paretic versus paretic stepping. The results support that explicit cueing can facilitate initiation of reactive step from the paretic limb as compared with the no-cue condition. Stepping with the paretic limb in the cued condition however altered time of fall onset. Regardless of the stepping side, individuals demonstrated a fall risk suggesting the need for interventions focusing on reactive step training with both the limbs.
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21
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Ku JP, Hicks JL, Hastie T, Leskovec J, Ré C, Delp SL. The mobilize center: an NIH big data to knowledge center to advance human movement research and improve mobility. J Am Med Inform Assoc 2015; 22:1120-5. [PMID: 26272077 PMCID: PMC4639715 DOI: 10.1093/jamia/ocv071] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/15/2015] [Indexed: 12/04/2022] Open
Abstract
Regular physical activity helps prevent heart disease, stroke, diabetes, and other chronic diseases, yet a broad range of conditions impair mobility at great personal and societal cost. Vast amounts of data characterizing human movement are available from research labs, clinics, and millions of smartphones and wearable sensors, but integration and analysis of this large quantity of mobility data are extremely challenging. The authors have established the Mobilize Center (http://mobilize.stanford.edu) to harness these data to improve human mobility and help lay the foundation for using data science methods in biomedicine. The Center is organized around 4 data science research cores: biomechanical modeling, statistical learning, behavioral and social modeling, and integrative modeling. Important biomedical applications, such as osteoarthritis and weight management, will focus the development of new data science methods. By developing these new approaches, sharing data and validated software tools, and training thousands of researchers, the Mobilize Center will transform human movement research.
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Affiliation(s)
- Joy P Ku
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Jennifer L Hicks
- Department of Bioengineering, Stanford University, Stanford, California, USA
| | - Trevor Hastie
- Department of Statistics, Stanford University, Stanford, California, USA Department of Biostatistics, Stanford University, Stanford, California, USA
| | - Jure Leskovec
- Department of Computer Science, Stanford University, Stanford, California, USA
| | - Christopher Ré
- Department of Computer Science, Stanford University, Stanford, California, USA
| | - Scott L Delp
- Department of Bioengineering, Stanford University, Stanford, California, USA Department of Mechanical Engineering, Stanford University, Stanford, California, USA Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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22
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Practical approach to subject-specific estimation of knee joint contact force. J Biomech 2015; 48:2897-902. [PMID: 25952546 DOI: 10.1016/j.jbiomech.2015.04.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/02/2015] [Indexed: 11/23/2022]
Abstract
Compressive forces experienced at the knee can significantly contribute to cartilage degeneration. Musculoskeletal models enable predictions of the internal forces experienced at the knee, but validation is often not possible, as experimental data detailing loading at the knee joint is limited. Recently available data reporting compressive knee force through direct measurement using instrumented total knee replacements offer a unique opportunity to evaluate the accuracy of models. Previous studies have highlighted the importance of subject-specificity in increasing the accuracy of model predictions; however, these techniques may be unrealistic outside of a research setting. Therefore, the goal of our work was to identify a practical approach for accurate prediction of tibiofemoral knee contact force (KCF). Four methods for prediction of knee contact force were compared: (1) standard static optimization, (2) uniform muscle coordination weighting, (3) subject-specific muscle coordination weighting and (4) subject-specific strength adjustments. Walking trials for three subjects with instrumented knee replacements were used to evaluate the accuracy of model predictions. Predictions utilizing subject-specific muscle coordination weighting yielded the best agreement with experimental data; however this method required in vivo data for weighting factor calibration. Including subject-specific strength adjustments improved models' predictions compared to standard static optimization, with errors in peak KCF less than 0.5 body weight for all subjects. Overall, combining clinical assessments of muscle strength with standard tools available in the OpenSim software package, such as inverse kinematics and static optimization, appears to be a practical method for predicting joint contact force that can be implemented for many applications.
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Changes in predicted muscle coordination with subject-specific muscle parameters for individuals after stroke. Stroke Res Treat 2014; 2014:321747. [PMID: 25093141 PMCID: PMC4096388 DOI: 10.1155/2014/321747] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/06/2014] [Indexed: 11/17/2022] Open
Abstract
Muscle weakness is commonly seen in individuals after stroke, characterized by lower forces during a maximal volitional contraction. Accurate quantification of muscle weakness is paramount when evaluating individual performance and response to after stroke rehabilitation. The objective of this study was to examine the effect of subject-specific muscle force and activation deficits on predicted muscle coordination when using musculoskeletal models for individuals after stroke. Maximum force generating ability and central activation ratio of the paretic plantar flexors, dorsiflexors, and quadriceps muscle groups were obtained using burst superimposition for four individuals after stroke with a range of walking speeds. Two models were created per subject: one with generic and one with subject-specific activation and maximum isometric force parameters. The inclusion of subject-specific muscle data resulted in changes in the model-predicted muscle forces and activations which agree with previously reported compensation patterns and match more closely the timing of electromyography for the plantar flexor and hamstring muscles. This was the first study to create musculoskeletal simulations of individuals after stroke with subject-specific muscle force and activation data. The results of this study suggest that subject-specific muscle force and activation data enhance the ability of musculoskeletal simulations to accurately predict muscle coordination in individuals after stroke.
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Kajrolkar T, Yang F, Pai YC, Bhatt T. Dynamic stability and compensatory stepping responses during anterior gait-slip perturbations in people with chronic hemiparetic stroke. J Biomech 2014; 47:2751-8. [PMID: 24909333 DOI: 10.1016/j.jbiomech.2014.04.051] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 04/23/2014] [Accepted: 04/26/2014] [Indexed: 11/19/2022]
Abstract
To examine the control of dynamic stability and characteristics of the compensatory stepping responses to an unexpected anterior gait slip induced under the non-involved limb in people with hemi-paretic stroke (PwHS) and to examine any resulting adaptive changes in these on the second slip due to experience from prior slip exposure. Ten PwHS experienced overground slip (S1) during walking on the laboratory walkway after 5-8 regular walking (RW) trials followed by a second consecutive slip trial (S2). The slip outcome (backward loss of balance, BLOB and no loss of balance, NLOB) and COM state (i.e. its COM position and velocity) stability were examined between the RW and S1 and S1 and S2 at touchdown (TD) of non-involved limb and at liftoff (LO) of the contralateral limb. At TD there was no difference in stability between RW and S1, however at LO, subjects demonstrated a lower stability on S1 than RW resulting in a 100% backward loss of balance (BLOB) with compensatory stepping response (recovery step, RS, 4/10 or aborted step, AS, 6/10). On S2, although there was no change in stability at TD, there was a significant improvement in stability at LO with a 40% decrease in BLOB. There was also a change in step strategy with a decrease in AS response (60% to 35%, p<0.05) which was replaced by an increase in the ability to step (increased compensatory step length, p<0.05) either via a recovery step or a walkover step. PwHS have the ability to reactively control COM state stability to decrease fall-risk upon a novel slip; prior exposure to a slip did not significantly alter feedforward control but improved the ability to use such feedback control for improved slip outcomes.
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Affiliation(s)
- Tejal Kajrolkar
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Feng Yang
- Department of Kinesiology, University of Texas at El Paso, El Paso, TX 79968, USA
| | - Y-C Pai
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA.
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