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Waterval NFJ, Nollet F, Brehm MA. Effect of stiffness-optimized ankle foot orthoses on joint work in adults with neuromuscular diseases is related to severity of push-off deficits. Gait Posture 2024; 111:162-168. [PMID: 38703445 DOI: 10.1016/j.gaitpost.2024.04.034] [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: 06/27/2023] [Revised: 01/19/2024] [Accepted: 04/30/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND People with plantar flexor weakness generate less ankle push-off work during walking, resulting in inefficient proximal joint compensations. To increase push-off work, spring-like ankle foot orthoses (AFOs) can be provided. However, whether and in which patients AFOs increase push-off work and reduce compensatory hip and knee work is unknown. METHODS In 18 people with bilateral plantar flexor weakness, we performed a 3D gait analysis at comfortable walking speed with shoes-only and with AFOs of which the stiffness was optimized. To account for walking speed differences between conditions, we compared relative joint work of the hip, knee and ankle joint. The relationships between relative work generated with shoes-only and changes in joint work with AFO were tested with Pearson correlations. RESULTS No differences in relative ankle, knee and hip work over the gait cycle were found between shoes-only and AFO (p>0.499). Percentage of total ankle work generated during pre-swing increased with the AFO (AFO: 85.3±9.1% vs Shoes: 72.4±27.1%, p=0.026). At the hip, the AFO reduced relative work in pre-swing (AFO: 31.9±7.4% vs Shoes: 34.1±10.4%, p=0.038) and increased in loading response (AFO: 18.0±11.0% vs Shoes: 11.9±9.8%, p=0.022). Ankle work with shoes-only was inversely correlated with an increase in ankle work with AFO (r=-0.839, p<0.001) and this increase correlated with reduction in hip work with AFO (r=-0.650, p=0.004). DISCUSSION Although stiffness-optimized AFOs did not alter the work distribution across the ankle, knee and hip joint compared to shoes-only walking, relative more ankle work was generated during push-off, causing a shift in hip work from pre-swing to loading response. Furthermore, larger ankle push-off deficits when walking with shoes-only were related with an increase in ankle work with AFO and reduction in compensatory hip work, indicating that more severely affected individuals benefit more from the energy storing-and-releasing capacity of AFOs.
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Affiliation(s)
- N F J Waterval
- Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands.
| | - F Nollet
- Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
| | - M A Brehm
- Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
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Kiss B, Waterval NFJ, van der Krogt MM, Brehm MA, Geijtenbeek T, Harlaar J, Seth A. Minimization of metabolic cost of transport predicts changes in gait mechanics over a range of ankle-foot orthosis stiffnesses in individuals with bilateral plantar flexor weakness. Front Bioeng Biotechnol 2024; 12:1369507. [PMID: 38846804 PMCID: PMC11153850 DOI: 10.3389/fbioe.2024.1369507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/15/2024] [Indexed: 06/09/2024] Open
Abstract
Neuromuscular disorders often lead to ankle plantar flexor muscle weakness, which impairs ankle push-off power and forward propulsion during gait. To improve walking speed and reduce metabolic cost of transport (mCoT), patients with plantar flexor weakness are provided dorsal-leaf spring ankle-foot orthoses (AFOs). It is widely believed that mCoT during gait depends on the AFO stiffness and an optimal AFO stiffness that minimizes mCoT exists. The biomechanics behind why and how an optimal stiffness exists and benefits individuals with plantar flexor weakness are not well understood. We hypothesized that the AFO would reduce the required support moment and, hence, metabolic cost contributions of the ankle plantar flexor and knee extensor muscles during stance, and reduce hip flexor metabolic cost to initiate swing. To test these hypotheses, we generated neuromusculoskeletal simulations to represent gait of an individual with bilateral plantar flexor weakness wearing an AFO with varying stiffness. Predictions were based on the objective of minimizing mCoT, loading rates at impact and head accelerations at each stiffness level, and the motor patterns were determined via dynamic optimization. The predictive gait simulation results were compared to experimental data from subjects with bilateral plantar flexor weakness walking with varying AFO stiffness. Our simulations demonstrated that reductions in mCoT with increasing stiffness were attributed to reductions in quadriceps metabolic cost during midstance. Increases in mCoT above optimum stiffness were attributed to the increasing metabolic cost of both hip flexor and hamstrings muscles. The insights gained from our predictive gait simulations could inform clinicians on the prescription of personalized AFOs. With further model individualization, simulations based on mCoT minimization may sufficiently predict adaptations to an AFO in individuals with plantar flexor weakness.
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Affiliation(s)
- Bernadett Kiss
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
| | - Niels F. J. Waterval
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, Netherlands
| | - Marjolein M. van der Krogt
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, Netherlands
| | - Merel A. Brehm
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, Netherlands
| | - Thomas Geijtenbeek
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Jaap Harlaar
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
- Department of Orthopaedics, Erasmus Medical Center, Rotterdam, Netherlands
| | - Ajay Seth
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
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van Duijnhoven E, van der Veen M, Koopman FS, Nollet F, Bruijn SM, Brehm MA. Gait stability and the relationship with energy cost of walking in polio survivors with unilateral plantarflexor weakness. Gait Posture 2024; 107:104-111. [PMID: 37801868 DOI: 10.1016/j.gaitpost.2023.09.016] [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: 02/06/2023] [Revised: 09/13/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Polio survivors often exhibit plantarflexor weakness, which impairs gait stability, and increases energy cost of walking. Quantifying gait stability could provide insights in the control mechanisms polio survivors use to maintain gait stability and in whether impaired gait stability is related to the increased energy cost of walking. RESEARCH QUESTION Is gait stability impaired in polio survivors with plantarflexor weakness compared to able-bodied individuals, and does gait stability relate to energy cost of walking? METHODS We retrospectively analyzed barefoot biomechanical gait data of 31 polio survivors with unilateral plantarflexor weakness and of 24 able-bodied individuals. We estimated gait stability by calculating variability (SD) of step width, step length, double support time, and stance time, and by the mean and variability (SD) of the mediolateral and anteroposterior margin of stability (MoSML and MoSAP). In addition, energy cost of walking (polio survivors only) at comfortable speed was analyzed. RESULTS Comfortable speed was 31% lower in polio survivors compared to able-bodied individuals (p < 0.001). Corrected for speed differences, step width variability was significantly larger in polio survivors (+41%), double support time variability was significantly smaller (-27%), MoSML (affected leg) was significantly larger (+80%), and MoSAP was significantly smaller (affected leg:-17% and non-affected leg:-15%). Step width and step length variability (affected leg) were positively correlated with energy cost of walking (r = 0.502 and r = 0.552). MoSAP (non-affected leg) was negatively correlated with energy cost of walking (r = -0.530). SIGNIFICANCE Polio survivors with unilateral plantarflexor weakness demonstrated an impaired gait stability. Increased step width and step length variability and lower MoSAP could be factors related to the elevated energy cost of walking in polio survivors. These findings increase our understanding of stability problems due to plantarflexor weakness, which could be used for the improvement of (orthotic) interventions to enhance gait stability and reduce energy cost in polio survivors.
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Affiliation(s)
- Elza van Duijnhoven
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands.
| | - Marit van der Veen
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - Fieke S Koopman
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Frans Nollet
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Sjoerd M Bruijn
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Merel-Anne Brehm
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
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Piming G, Yaming Y, Hai S, Xia L, Xiaobing L. Three-dimensional ankle kinematics of the full gait cycle in patients with chronic ankle instability: A case-control study. Heliyon 2023; 9:e22265. [PMID: 38053855 PMCID: PMC10694306 DOI: 10.1016/j.heliyon.2023.e22265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023] Open
Abstract
Objectives The ankle kinematic characteristics of chronic ankle instability (CAI) at different gait phases and dimensions were not directly and overall explained. These characteristics have yet to be established. This study aimed to observe ankle kinematic changes of CAI, and explore their mechanisms, at different gait phases and dimensions in full gait cycle. Methods A three-dimensional (3D) motion capture system measured the 3D ankle movements of 53 individuals with CAI (meanage = 25.11 ± 6.01years, meanheight = 170.77 ± 7.80 cm, meanmass = 64.28 ± 9.28 kg) and 53 healthy controls (meanage = 24.66 ± 6.32 years, meanheight = 169.98 ± 9.00 cm, meanmass = 63.11 ± 9.62 kg) during barefoot walking overground at a self-selected speed. Once the acquisition results were processed with visual 3D software, the kinematics data were exported, and the eight phases of the gait cycle were identified. Results As compared with the control group, individuals with CAI displayed a significantly smaller plantarflexion in toe off (P = 0.049, Cohen's d = 0.387), a significantly increased inversion in heel strike (P = 0.007, Cohen's d = 0.271) and initial swing (P = 0.035, Cohen's d = 0.233), mid-swing (P = 0.019, Cohen's d = 0.232) and end-swing (P = 0.021, Cohen's d = 0.214), and significantly smaller eversion in mid stance(P = 0.010, Cohen's d = 0.288)and heel off (P = 0.033, Cohen's d = 0.089). Significant between-group differences in ankle kinematics were observed in the sagittal and frontal planes, but not in the horizontal plane, during walking. Conclusion When walking, patients with CAI have altered sagittal- and frontal-plane kinematics during different stance and swing phases. These kinematic changes require multi-dimensional, dynamic, continuous functional assessment and specialized rehabilitation intervention.
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Affiliation(s)
- Gao Piming
- Department of Sports Injury Prevention and Treatment, Sichuan Province Orthopedic Hospital, Chengdu, China
- Department of Sports Medicine, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Yu Yaming
- Department of Sports Injury Prevention and Treatment, Sichuan Province Orthopedic Hospital, Chengdu, China
- Department of Sports Medicine, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Shen Hai
- Department of Sports Medicine, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Li Xia
- Department of Medicine, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Luo Xiaobing
- Department of Sports Injury Prevention and Treatment, Sichuan Province Orthopedic Hospital, Chengdu, China
- Department of Sports Medicine, Sichuan Province Orthopedic Hospital, Chengdu, China
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Major MJ, Stine RL. Sensorimotor function and standing balance in older adults with transtibial limb loss. Clin Biomech (Bristol, Avon) 2023; 109:106104. [PMID: 37757679 DOI: 10.1016/j.clinbiomech.2023.106104] [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: 01/10/2023] [Revised: 08/25/2023] [Accepted: 09/21/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Limited research has focused on older prosthesis users despite the expected compounded effects of age and amputation on sensorimotor function, balance, and falls. This study compared sensorimotor factors and standing balance between older individuals with and without transtibial amputation, hypothesizing that prosthesis users would demonstrate worse sensorimotor function. Secondarily we assessed the relationship between standing balance and somatosensation in prosthesis users. METHODS Thirteen persons with unilateral transtibial amputation (71.7 years) and 10 able-bodied controls (71.7 years) participated in this cross-sectional observational study. Passive joint range-of-motion, muscle strength, proprioception (joint position sense), tactile sensitivity, and standing balance (center-of-pressure sway) were compared between groups. A multiple linear regression analysis assessed the relationship between proprioception and balance (without vision) in prosthesis users. FINDINGS Our hypotheses were generally not supported, with the only differences being reduced joint range-of-motion and strength in prosthesis users (with large effect sizes), but comparable sensation and balance. Notably, prosthesis users demonstrated better proprioception than controls as reflected through better joint position sense when the limb was non-weight bearing. Worse amputated limb proprioception was associated with better standing balance in prosthesis users. INTERPRETATION Older prosthesis users have impaired passive joint motion and muscle strength compared to controls that could challenge their ability to position and control the amputated limb to avoid falls during daily activities. However, their better amputated limb proprioception might help counteract those limitations by leveraging sensory feedback from the suspended limb. The relationship between amputated limb proprioception and standing balance suggests a nuanced relationship that warrants further study.
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Affiliation(s)
- Matthew J Major
- Jesse Brown VA Medical Center, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA; Department of Biomedical Engineering, Northwestern University, McCormick School of Engineering, Evanston, IL, USA.
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Waterval NFJ, van der Krogt MM, Veerkamp K, Geijtenbeek T, Harlaar J, Nollet F, Brehm MA. The interaction between muscle pathophysiology, body mass, walking speed and ankle foot orthosis stiffness on walking energy cost: a predictive simulation study. J Neuroeng Rehabil 2023; 20:117. [PMID: 37679784 PMCID: PMC10483766 DOI: 10.1186/s12984-023-01239-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND The stiffness of a dorsal leaf AFO that minimizes walking energy cost in people with plantarflexor weakness varies between individuals. Using predictive simulations, we studied the effects of plantarflexor weakness, passive plantarflexor stiffness, body mass, and walking speed on the optimal AFO stiffness for energy cost reduction. METHODS We employed a planar, nine degrees-of-freedom musculoskeletal model, in which for validation maximal strength of the plantar flexors was reduced by 80%. Walking simulations, driven by minimizing a comprehensive cost function of which energy cost was the main contributor, were generated using a reflex-based controller. Simulations of walking without and with an AFO with stiffnesses between 0.9 and 8.7 Nm/degree were generated. After validation against experimental data of 11 people with plantarflexor weakness using the Root-mean-square error (RMSE), we systematically changed plantarflexor weakness (range 40-90% weakness), passive plantarflexor stiffness (range: 20-200% of normal), body mass (+ 30%) and walking speed (range: 0.8-1.2 m/s) in our baseline model to evaluate their effect on the optimal AFO stiffness for energy cost minimization. RESULTS Our simulations had a RMSE < 2 for all lower limb joint kinetics and kinematics except the knee and hip power for walking without AFO. When systematically varying model parameters, more severe plantarflexor weakness, lower passive plantarflexor stiffness, higher body mass and walking speed increased the optimal AFO stiffness for energy cost minimization, with the largest effects for severity of plantarflexor weakness. CONCLUSIONS Our forward simulations demonstrate that in individuals with bilateral plantarflexor the necessary AFO stiffness for walking energy cost minimization is largely affected by severity of plantarflexor weakness, while variation in walking speed, passive muscle stiffness and body mass influence the optimal stiffness to a lesser extent. That gait deviations without AFO are overestimated may have exaggerated the required support of the AFO to minimize walking energy cost. Future research should focus on improving predictive simulations in order to implement personalized predictions in usual care. Trial Registration Nederlands Trial Register 5170. Registration date: May 7th 2015. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5170.
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Affiliation(s)
- N. F. J. Waterval
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
| | - M. M. van der Krogt
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
| | - K. Veerkamp
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, and Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, Australia
| | - T. Geijtenbeek
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - J. Harlaar
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
- Department of Orthopaedics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - F. Nollet
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
| | - M. A. Brehm
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
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7
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Waterval NFJ, Brehm MA, Veerkamp K, Geijtenbeek T, Harlaar J, Nollet F, van der Krogt MM. Interacting effects of AFO stiffness, neutral angle and footplate stiffness on gait in case of plantarflexor weakness: A predictive simulation study. J Biomech 2023; 157:111730. [PMID: 37480732 DOI: 10.1016/j.jbiomech.2023.111730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/02/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
To maximize effects of dorsal leaf ankle foot orthoses (AFOs) on gait in people with bilateral plantarflexor weakness, the AFO properties should be matched to the individual. However, how AFO properties interact regarding their effect on gait function is unknown. We studied the interaction of AFO bending stiffness with neutral angle and footplate stiffness on the effect of bending stiffness on walking energy cost, gait kinematics and kinetics in people with plantarflexor weakness by employing predictive simulations. Our simulation framework consisted of a planar 11 degrees of freedom model, containing 11 muscles activated by a reflex-based neuromuscular controller. The controller was optimized by a comprehensive cost function, predominantly minimizing walking energy cost. The AFO bending and footplate stiffness were modelled as torsional springs around the ankle and metatarsal joint. The neutral angle of the AFO was defined as the angle in the sagittal plane at which the moment of the ankle torsional spring was zero. Simulations without AFO and with AFO for 9 bending stiffnesses (0-14 Nm/degree), 3 neutral angles (0-3-6 degrees dorsiflexion) and 3 footplate stiffnesses (0-0.5-2.0 Nm/degree) were performed. When changing neutral angle towards dorsiflexion, a higher AFO bending stiffness minimized energy cost of walking and normalized joint kinematics and kinetics. Footplate stiffness mainly affected MTP joint kinematics and kinetics, while no systematic and only marginal effects on energy cost were found. In conclusion, the interaction of the AFO bending stiffness and neutral angle in bilateral plantarflexor weakness, suggests that these should both be considered together when matching AFO properties to the individual patient.
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Affiliation(s)
- N F J Waterval
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands.
| | - M A Brehm
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
| | - K Veerkamp
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands; School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia; Griffith Centre of Biomedical & Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, and Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, Australia
| | - T Geijtenbeek
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - J Harlaar
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; Department of Orthopaedics, Rotterdam, Erasmus Medical Center, the Netherlands
| | - F Nollet
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
| | - M M van der Krogt
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
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de Koning LE, Scheper MC, Ploeger HE, Warnink-Kavelaars J, Oosterlaan J, Bus SA, Engelbert RHH. An exploratory study of clinical characteristics and gait features of adolescents with hypermobility disorders. Gait Posture 2023; 100:222-229. [PMID: 36638668 DOI: 10.1016/j.gaitpost.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/21/2022] [Accepted: 01/04/2023] [Indexed: 01/06/2023]
Abstract
BACKGROUND In adolescents with non-pathological and pathological joint hypermobility, gait deviations have been associated with pain and fatigue. It remains unclear what distinguishes the non-pathological form of joint hypermobility (JH) from pathological forms (i.e. hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorders (HSD). Our objective was to identify discriminative clinical characteristics and biomechanical gait features between adolescents with hEDS/HSD, JH, and healthy controls (HC). METHODS Thirty-two adolescents were classified into three subgroups (hEDS/HSD=12, JH=5, HC=15). Clinical characteristics (e.g. pain intensity and surface, fatigue, functional disability) were inventoried. The gait pattern was assessed using a three-dimensional, eight-camera VICON MX1.3 motion capture system, operating at a sample rate of 100 Hz (VICON, Oxford, UK). Spatiotemporal parameters, joint angles (sagittal plane), joint work, joint impulse, ground reaction force and gait variability expressed as percentage using Principal Component Analysis (PCA) were assessed and analysed using multivariate analysis. Multivariate analysis data is expressed in mean differences(MD), standard error(SE) and P-values. RESULTS The hEDS/HSD-group had significantly higher fatigue score (+51.5 points, p = <0.001) and functional disability (+1.6, p < .001) than the HC-group. Pain intensity was significantly higher in the hEDS/HSD-group than the other subgroups (JH; +37 mm p = .004, HC; +38 mm, p = .001). The hEDS/HSD-group showed significantly more gait variability (JH; +7.2(2.0)% p = .003, HC; + 7.8(1.4)%, p = <0.001) and lower joint work (JH; -0.07(0.03)J/kg, p = .007, HC; - 0.06(0.03)J/kg, p = .013) than the other subgroups. The JH-group showed significantly increased ankle dorsiflexion during terminal stance (+5.0(1.5)degree, p = .001) compared to hEDS/HSD-group and knee flexion during loading response compared to HC-group (+5.7(1.8) degree, p = .011). SIGNIFICANCE A distinctive difference in gait pattern between adolescents with non-pathological and pathological joint hypermobility is found in gait variability, rather than in the biomechanical features of gait. This suggests that a specific gait variability metric is more appropriate than biomechanical individual joint patterns for assessing gait in adolescents with hEDS/HSD.
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Affiliation(s)
- Lisanne E de Koning
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Mark C Scheper
- Rotterdam University of Applied Sciences, Institute for Health, (pediatric) Physical Therapy, Rochussenstraat 198, 3015 Rotterdam, the Netherlands; Research Center Innovations In Care, Transitions in Care / Data-supported Healthcare, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 Rotterdam, the Netherlands; Department of Health Professions, Faculty of Medicine and Health, Macquarie University, Macquarie Park, Sydney, NSW 2109, Australia.
| | - Hilde E Ploeger
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands.
| | - Jessica Warnink-Kavelaars
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands.
| | - Jaap Oosterlaan
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow-Me Program & Emma Neuroscience Group, Amsterdam Reproduction & Development, Amsterdam, the Netherlands.
| | - Sicco A Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands.
| | - Raoul H H Engelbert
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands.
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9
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van Duijnhoven E, Koopman FS, Ploeger HE, Nollet F, Brehm MA. Effects of specialist care lower limb orthoses on personal goal attainment and walking ability in adults with neuromuscular disorders. PLoS One 2023; 18:e0279292. [PMID: 36652463 PMCID: PMC9847977 DOI: 10.1371/journal.pone.0279292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/04/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Lower limb orthoses intend to improve walking in adults with neuromuscular disorders (NMD). Yet, reported group effects of lower limb orthoses on treatment outcomes have generally been small and heterogeneous. We propose that guideline-based orthotic care within a multidisciplinary expert setting may improve treatment outcomes. AIM To examine the effectiveness of specialist care orthoses compared to usual care orthoses on personal goal attainment and walking ability. DESIGN Cohort study. POPULATION Adults with NMD who experienced walking problems due to calf and/or quadriceps muscle weakness and were provided with a specialist care lower limb orthosis between October 2011 and January 2021. METHODS Three months after provision, the specialist care orthosis was compared to the usual care orthosis worn at baseline in terms of personal goal attainment (Goal Attainment Scaling (GAS)), comfortable walking speed (m/s), net energy cost (J/kg/m) (both assessed during a 6-minute walk test), perceived walking ability and satisfaction. RESULTS Sixty-four adults with NMD were eligible for analysis. The specialist care orthoses comprised 19 dorsiflexion-restricting ankle-foot orthoses (AFOs), 22 stance-control knee-ankle-foot orthoses (KAFOs) and 23 locked KAFOs. Overall, 61% of subjects showed a clinically relevant improvement in GAS score. Perceived safety, stability, intensity, fear of falling and satisfaction while walking all improved (p≤0.002), and subjects were satisfied with their specialist care orthosis and the services provided. Although no effects on walking speed or net energy cost were found in combined orthosis groups, specialist care AFOs significantly reduced net energy cost (by 9.5%) compared to usual care orthoses (from mean (SD) 3.81 (0.97) to 3.45 (0.80) J/kg/m, p = 0.004). CONCLUSION Guideline-based orthotic care within a multidisciplinary expertise setting could improve treatment outcomes in adults with NMD compared to usual orthotic care by improvements in goal attainment and walking ability. A randomized controlled trial is now warranted to confirm these results.
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Affiliation(s)
- Elza van Duijnhoven
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
- * E-mail:
| | - Fieke S. Koopman
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Hilde E. Ploeger
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Merel-Anne Brehm
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
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10
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Visch L, Oudenhoven LM, Timmermans ST, Beckerman H, Rietberg MB, de Groot V, van der Krogt MM. The relationship between energy cost of walking, ankle push-off and walking speed in persons with multiple sclerosis. Gait Posture 2022; 98:160-166. [PMID: 36126536 DOI: 10.1016/j.gaitpost.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The energy cost of walking (ECw) is an important indicator of walking dysfunction in persons with multiple sclerosis (PwMS). However, its underlying causes and its relation with ankle push-off and walking speed are not well understood. RESEARCH QUESTION What is the contribution of ankle push-off and walking speed to increased ECw in PwMS? METHODS Ten PwMS with walking limitations and 10 individually gender- and age-matched healthy controls (HC) were included. All participants performed two 6-min walking trials on a treadmill at comfortable walking speed (CWS of PwMS) and fast walking speed (FWS, 130 % of CWS of PwMS). Kinetics and metabolic cost were evaluated. Generalized estimating equations were performed to investigate effects of group and walking speed, and their interaction. Spearman correlations were conducted to examine whether ECw was related to ankle push-off in PwMS, controlling for differences in walking speed in PwMS. RESULTS ECw at matched walking speed was significantly higher in PwMS compared to HC. Kinetic parameters were not different between the most impaired leg in PwMS and HC at matched walking speed, but asymmetry between both legs of PwMS was observed. At FWS, ECw reduced and ankle push-off increased similarly in both groups. ECw was inversely related to peak ankle power of the most impaired leg in PwMS at CWS. SIGNIFICANCE Slow walking speed is one factor that contributes to increased ECw in PwMS. Furthermore, PwMS who had a higher ECw showed a lower peak ankle power, independent of walking speed. This indicates that ankle push-off could be a contributor to increased ECw.
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Affiliation(s)
- Lara Visch
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, the Netherlands.
| | - Laura M Oudenhoven
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands.
| | - Sjoerd T Timmermans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands.
| | - Heleen Beckerman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands.
| | - Marc B Rietberg
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands.
| | - Vincent de Groot
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands.
| | - Marjolein M van der Krogt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, the Netherlands.
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11
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Hazra P, Gibbs S, Arnold G, Nasir S, Wang W. Analysis of Joint Power and Work During Gait in Children With and Without Cerebral Palsy. Indian J Orthop 2022; 56:1647-1656. [PMID: 36046224 PMCID: PMC9385940 DOI: 10.1007/s43465-022-00691-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023]
Abstract
Purpose To compare joint work in the lower limb joints during different sub-phases of the gait cycle between Cerebral Palsy (CP) and healthy children. Methods Eighteen CP and 20 healthy children's gait data were collected. The CP group included orthoses, intra-muscular injection of botulinum toxin and surgery groups. A motion capture system was used to collect gait data. Joint work was calculated as positive and negative components in six subphases during gait and normalised by speed when comparing the groups. Results The CP group had a slower walking speed, smaller stride length and longer stance phase than the healthy group. Hip max positive work was 0.12 ± 0.02 Jkg-1/ms-1 for the CP group in pre-mid-stance but 0.07 ± 0.01 Jkg-1/ms-1 for the healthy group during the terminal phase. In terminal stance, ankle positive work was significantly lower in the CP group (0.12 ± 0.01) than in the healthy group (0.18 ± 0.01). The knee showed a similar distribution of positive work in the stance phase for the two groups. In the ankle and hip, the CP group had energy generation mainly in midstance while the healthy group was mainly in terminal stance. In the ankle, the CP group had larger energy absorption in mid-stance than the healthy children group, while the CP group showed lower energy generation in the terminal stance phase than seen in the healthy group. Conclusion The qualitative and quantitative analysis of joint work provides useful information for clinicians in the treatment and rehabilitation of CP patients.
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Affiliation(s)
- Priyam Hazra
- Institute of Motion Analysis and Research (IMAR), Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY UK
| | - Sheila Gibbs
- Institute of Motion Analysis and Research (IMAR), Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY UK
| | - Graham Arnold
- Institute of Motion Analysis and Research (IMAR), Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY UK
| | - Sadiq Nasir
- Institute of Motion Analysis and Research (IMAR), Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY UK
| | - Weijie Wang
- Institute of Motion Analysis and Research (IMAR), Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY UK
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12
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Waterval NFJ, Meekes VL, Hooijmans MT, Froeling M, Jaspers RT, Oudeman J, Nederveen AJ, Brehm MA, Nollet F. The relationship between quantitative magnetic resonance imaging of the ankle plantar flexors, muscle function during walking and maximal strength in people with neuromuscular diseases. Clin Biomech (Bristol, Avon) 2022; 94:105609. [PMID: 35247697 DOI: 10.1016/j.clinbiomech.2022.105609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Progression of plantar flexor weakness in neuromuscular diseases is usually monitored by muscle strength measurements, although they poorly relate to muscle function during walking. Pathophysiological changes such as intramuscular adipose tissue affect dynamic muscle function independent from isometric strength. Diffusion tensor imaging and T2 imaging are quantitative MRI measures reflecting muscular pathophysiological changes, and are therefore potential biomarkers to monitor plantar flexor functioning during walking in people with neuromuscular diseases. METHODS In fourteen individuals with plantar flexor weakness diffusion tensor imaging and T2 scans of the plantar flexors were obtained, and the diffusion indices fractional anisotropy and mean diffusivity calculated. With a dynamometer, maximal isometric plantar flexor strength was measured. 3D gait analysis was used to assess maximal ankle moment and power during walking. FINDINGS Fractional anisotropy, mean diffusivity and T2 relaxation time all moderately correlated with maximal plantar flexor strength (r > 0.512). Fractional anisotropy and mean diffusivity were not related with ankle moment or power (r < 0.288). T2 relaxation time was strongly related to ankle moment (r = -0.789) and ankle power (r = -0.798), and moderately related to maximal plantar flexor strength (r < 0.600). INTERPRETATION In conclusion, T2 relaxation time, indicative of multiple pathophysiological changes, was strongly related to plantar flexor function during walking, while fractional anisotropy and mean diffusivity, indicative of fiber size, only related to maximal plantar flexor strength. This indicates that these measures may be suitable to monitor muscle function and gain insights into the pathophysiological changes underlying a poor plantar flexor functioning during gait in people with neuromuscular diseases.
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Affiliation(s)
- N F J Waterval
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
| | - V L Meekes
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - M T Hooijmans
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - M Froeling
- University Medical Center Utrecht, Department of Radiology, Heidelberglaan 100, Utrecht, the Netherlands
| | - R T Jaspers
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands
| | - J Oudeman
- University Medical Center Utrecht, Department of Radiology, Heidelberglaan 100, Utrecht, the Netherlands
| | - A J Nederveen
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - M A Brehm
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - F Nollet
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
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13
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Waterval NFJ, Brehm MA, Harlaar J, Nollet F. Energy cost optimized dorsal leaf ankle-foot-orthoses reduce impact forces on the contralateral leg in people with unilateral plantar flexor weakness. Gait Posture 2022; 92:71-76. [PMID: 34826696 DOI: 10.1016/j.gaitpost.2021.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND In individuals with unilateral plantar flexor weakness, the second peak of the vertical ground reaction force (GRF) is decreased. This leads to a higher ground reaction force, e.g. impact, of the contralateral leg, potentially explaining quadriceps muscle and/or knee joint pain. Energy cost optimized dorsal leaf ankle-foot-orthoses (AFOs) may increase the push-off ground reaction force, which in turn could lead to lower impact forces on the contralateral leg. RESEARCH QUESTIONS 1) Are impact forces increased in the contralateral leg of people with unilateral plantar flexor weakness compared to healthy subjects? 2) Do energy cost optimized AFOs reduce impact forces and improve leg impact symmetry compared to walking without AFO in people with unilateral plantar flexor weakness? METHODS Nine subjects with unilateral plantar flexor weakness were provided a dorsal leaf AFO with a stiffness primarily optimized for energy cost. Using 3D gait analyses peak vertical GRF during loading response with and without AFO, and the symmetry between the legs in peak GRF were calculated. Peak GRF and symmetry were compared with reference data of 23 healthy subjects. RESULTS The contralateral leg showed a significant higher peak vertical GRF (12.0 ± 0.9 vs 11.2 ± 0.6 N/kg, p = 0.005) compared to healthy reference data. When walking with AFO, the peak vertical GRF of the contralateral leg significantly reduced (from 12.0 ± 0.9 to 11.4 ± 0.7 N/kg, p = 0.017) and symmetry improved compared to no AFO (from 0.93 ± 0.06 to 1.01 ± 0.05, p < 0.001). CONCLUSION In subjects with unilateral plantar flexor weakness, impact force on the contralateral leg was increased when compared to healthy subjects and dorsal leaf AFOs optimized for energy cost substantially reduced this force and improved impact symmetry when compared to walking without AFO. This indicates that dorsal leaf AFOs may reduce pain resulting from increased impact forces during gait in the contralateral leg in people with unilateral plantar flexor weakness.
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Affiliation(s)
- N F J Waterval
- Amsterdam UMC, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands.
| | - M A Brehm
- Amsterdam UMC, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - J Harlaar
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands; Department of Orthopaedics, Erasmus Medical Center, Rotterdam, Netherlands
| | - F Nollet
- Amsterdam UMC, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
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14
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van Duijnhoven E, Waterval NF, Koopman FS, Esquenazi A, Tyson S, Nollet F, Brehm MA. Ankle-foot orthoses for improving walking in people with calf muscle weakness due to neuromuscular disorders. Hippokratia 2021. [DOI: 10.1002/14651858.cd014871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Elza van Duijnhoven
- Amsterdam UMC, University of Amsterdam; Department of Rehabilitation Medicine, Amsterdam Movement Sciences; Amsterdam Netherlands
| | - Niels F Waterval
- Amsterdam UMC, University of Amsterdam; Department of Rehabilitation Medicine, Amsterdam Movement Sciences; Amsterdam Netherlands
| | - Fieke Sophia Koopman
- Amsterdam UMC, University of Amsterdam; Department of Rehabilitation Medicine, Amsterdam Movement Sciences; Amsterdam Netherlands
| | - Alberto Esquenazi
- Department of Rehabilitation Medicine; Jefferson University School of Medicine; Elkins Park PA USA
| | - Sarah Tyson
- Division of Nursing, Midwifery & Social Work; University of Manchester; Manchester UK
| | - Frans Nollet
- Amsterdam UMC, University of Amsterdam; Department of Rehabilitation Medicine, Amsterdam Movement Sciences; Amsterdam Netherlands
| | - Merel-Anne Brehm
- Amsterdam UMC, University of Amsterdam; Department of Rehabilitation Medicine, Amsterdam Movement Sciences; Amsterdam Netherlands
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15
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Waterval NFJ, Brehm MA, Harlaar J, Nollet F. Individual stiffness optimization of dorsal leaf spring ankle-foot orthoses in people with calf muscle weakness is superior to standard bodyweight-based recommendations. J Neuroeng Rehabil 2021; 18:97. [PMID: 34103064 PMCID: PMC8186056 DOI: 10.1186/s12984-021-00890-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In people with calf muscle weakness, the stiffness of dorsal leaf spring ankle-foot orthoses (DLS-AFO) needs to be individualized to maximize its effect on walking. Orthotic suppliers may recommend a certain stiffness based on body weight and activity level. However, it is unknown whether these recommendations are sufficient to yield the optimal stiffness for the individual. Therefore, we assessed whether the stiffness following the supplier's recommendation of the Carbon Ankle7 (CA7) dorsal leaf matched the experimentally optimized AFO stiffness. METHODS Thirty-four persons with calf muscle weakness were included and provided a new DLS-AFO of which the stiffness could be varied by changing the CA7® (Ottobock, Duderstadt, Germany) dorsal leaf. For five different stiffness levels, including the supplier recommended stiffness, gait biomechanics, walking energy cost and speed were assessed. Based on these measures, the individual experimentally optimal AFO stiffness was selected. RESULTS In only 8 of 34 (23%) participants, the supplier recommended stiffness matched the experimentally optimized AFO stiffness, the latter being on average 1.2 ± 1.3 Nm/degree more flexible. The DLS-AFO with an experimentally optimized stiffness resulted in a significantly lower walking energy cost (- 0.21 ± 0.26 J/kg/m, p < 0.001) and a higher speed (+ 0.02 m/s, p = 0.003). Additionally, a larger ankle range of motion (+ 1.3 ± 0.3 degrees, p < 0.001) and higher ankle power (+ 0.16 ± 0.04 W/kg, p < 0.001) were found with the experimentally optimized stiffness compared to the supplier recommended stiffness. CONCLUSIONS In people with calf muscle weakness, current supplier's recommendations for the CA7 stiffness level result in the provision of DLS-AFOs that are too stiff and only achieve 80% of the reduction in energy cost achieved with an individual optimized stiffness. It is recommended to experimentally optimize the CA7 stiffness in people with calf muscle weakness in order to maximize treatment outcomes. Trial registration Nederlands Trial Register 5170. Registration date: May 7th 2015. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5170 .
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Affiliation(s)
- Niels F J Waterval
- Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Merel-Anne Brehm
- Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jaap Harlaar
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Orthopaedics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frans Nollet
- Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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16
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Waterval NFJ, Veerkamp K, Geijtenbeek T, Harlaar J, Nollet F, Brehm MA, van der Krogt MM. Validation of forward simulations to predict the effects of bilateral plantarflexor weakness on gait. Gait Posture 2021; 87:33-42. [PMID: 33882437 DOI: 10.1016/j.gaitpost.2021.04.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bilateral plantarflexor muscle weakness is a common impairment in many neuromuscular diseases. However, the way in which severity of plantarflexor weakness affects gait in terms of walking energy cost and speed is not fully understood. Predictive simulations are an attractive alternative to human experiments as simulations allow systematic alterations in muscle weakness. However, simulations of pathological gait have not yet been validated against experimental data, limiting their applicability. RESEARCH QUESTION Our first aim was to validate a predictive simulation framework for walking with bilateral plantarflexor weakness by comparing predicted gait against experimental gait data of patients with bilateral plantarflexor weakness. Secondly, we aimed to evaluate how incremental levels of bilateral plantarflexor weakness affect gait. METHODS We used a planar musculoskeletal model with 9 degrees of freedom and 9 Hill-type muscle-tendon units per leg. A state-dependent reflex-based controller optimized for a function combining energy cost, muscle activation squared and head acceleration was used to simulate gait. For validation, strength of the plantarflexors was reduced by 80 % and simulated gait compared with experimental data of 16 subjects with bilateral plantarflexor weakness. Subsequently, strength of the plantarflexors was reduced stepwise to evaluate its effect on gait kinematics and kinetics, walking energy cost and speed. RESULTS Simulations with 80 % weakness matched well with experimental hip and ankle kinematics and kinetics (R > 0.64), but less for knee kinetics (R < 0.55). With incremental strength reduction, especially beyond a reduction of 60 %, the maximal ankle moment and power decreased. Walking energy cost and speed showed a strong quadratic relation (R2>0.82) with plantarflexor strength. SIGNIFICANCE Our simulation framework predicted most gait changes due to bilateral plantarflexor weakness, and indicates that pathological gait features emerge especially when bilateral plantarflexor weakness exceeds 60 %. Our framework may support future research into the effect of pathologies or assistive devices on gait.
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Affiliation(s)
- N F J Waterval
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
| | - K Veerkamp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Gold Coast Centre for Orthopaedic Research, Engineering and Education (GCORE), Menzies Health Institute Queensland, and Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, Australia
| | - T Geijtenbeek
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - J Harlaar
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; Department of Orthopaedics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - F Nollet
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - M A Brehm
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - M M van der Krogt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands
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Vogrin M, Ličen T, Kljaić Dujić M. Ischiofemoral Impingement Syndrome: An Overview for Strength and Conditioning Professionals. Strength Cond J 2021. [DOI: 10.1519/ssc.0000000000000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Waterval NFJ, Brehm MA, Altmann VC, Koopman FS, Den Boer JJ, Harlaar J, Nollet F. Stiffness-Optimized Ankle-Foot Orthoses Improve Walking Energy Cost Compared to Conventional Orthoses in Neuromuscular Disorders: A Prospective Uncontrolled Intervention Study. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2296-2304. [DOI: 10.1109/tnsre.2020.3018786] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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19
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Waanders JB, Murgia A, Hortobágyi T, DeVita P, Franz JR. How age and surface inclination affect joint moment strategies to accelerate and decelerate individual leg joints during walking. J Biomech 2020; 98:109440. [PMID: 31690458 PMCID: PMC7245140 DOI: 10.1016/j.jbiomech.2019.109440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 11/22/2022]
Abstract
A joint moment also causes motion at other joints of the body. This joint coupling-perspective allows more insight into two age-related phenomena during gait. First, whether increased hip kinetic output compensates for decreased ankle kinetic output during positive joint work. Second, whether preserved joint kinetic patterns during negative joint work in older age have any functional implication. Therefore, we examined how age and surface inclination affect joint moment strategies to accelerate and/or decelerate individual leg joints during walking. Healthy young (age: 22.5 ± 4.1 years, n = 18) and older (age: 76.0 ± 5.7 years, n = 22) adults walked at 1.4 m/s on a split-belt instrumented treadmill at three grades (0%, 10%, -10%). Lower-extremity moment-induced angular accelerations were calculated for the hip (0% and 10%) and knee (0% and -10%) joints. During level and uphill walking, both age groups showed comparable ankle moment-induced ipsilateral (p = 0.774) and contralateral (p = 0.047) hip accelerations, although older adults generated lower ankle moments in late stance. However, ankle moment-induced contralateral hip accelerations were smaller (p = 0.001) in an older adult subgroup (n = 13) who showed larger hip extension moments in early stance than young adults. During level and downhill walking, leg joint moment-induced knee accelerations were unaffected by age (all p > 0.05). These findings suggest that during level and uphill walking increased hip flexor mechanical output in older adults does not arise from reduced ankle moments, contrary to increased hip extensor mechanical output. Additionally, results during level and downhill walking imply that preserved eccentric knee extensor function is important in maintaining knee stabilization in older age.
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Affiliation(s)
- Jeroen B Waanders
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands.
| | - Alessio Murgia
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands
| | - Tibor Hortobágyi
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands
| | - Paul DeVita
- East Carolina University, Greenville, NC, United States
| | - Jason R Franz
- University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States
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