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Xu D, Zhou H, Wang M, Ma X, Gusztav F, Chon TE, Fernandez J, Baker JS, Gu Y. Contribution of ankle motion pattern during landing to reduce the knee-related injury risk. Comput Biol Med 2024; 180:108965. [PMID: 39084051 DOI: 10.1016/j.compbiomed.2024.108965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/04/2024] [Accepted: 07/27/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Single-leg landing (SL) is an essential technique in sports such as basketball, soccer, and volleyball, which is often associated with a high risk of knee-related injury. The ankle motion pattern plays a crucial role in absorbing the load shocks during SL, but the effect on the knee joint is not yet clear. This work aims to explore the effects of different ankle plantarflexion angles during SL on the risk of knee-related injury. METHODS Thirty healthy male subjects were recruited to perform SL biomechanics tests, and one standard subject was selected to develop the finite element model of foot-ankle-knee integration. The joint impact force was used to evaluate the impact loads on the knee at various landing angles. The internal load forces (musculoskeletal modeling) and stress (finite element analysis) around the knee joint were simulated and calculated to evaluate the risk of knee-related injury during SL. To more realistically revert and simulate the anterior cruciate ligament (ACL) injury mechanics, we developed a knee musculoskeletal model that reverts the ACL ligament to a nonlinear short-term viscoelastic mechanical mechanism (strain rate-dependent) generated by the dense connective tissue as a function of strain. RESULTS As the ankle plantarflexion angle increased during landing, both the peak knee vertical impact force (p = 0.001) and ACL force (p = 0.001) decreased significantly. The maximum von Mises stress of ACL, meniscus, and femoral cartilage decreased as the ankle plantarflexion angle increased. The overall range of variation in ACL stress was small and was mainly distributed in the femoral and tibial attachment regions, as well as in the mid-lateral region. CONCLUSION The current findings revealed that the use of larger ankle plantarflexion angles during landing may be an effective solution to reduce knee impact load and the risk of rupture of the medial femoral attachment area in the ACL. The findings of this study have the potential to offer novel perspectives in the optimized application of landing strategies, thus giving crucial theoretical backing for decreasing the risk of knee-related injury.
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Affiliation(s)
- Datao Xu
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Huiyu Zhou
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Meizi Wang
- Faculty of Sports Science, Ningbo University, Ningbo, China; Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong, China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Fekete Gusztav
- Department of Material Science and Technology, Audi Hungaria Faculty of Automotive Engineering, Széchenyi István University, Gyor, Hungary
| | - Teo-Ee Chon
- Faculty of Sports Science, Ningbo University, Ningbo, China; School of Chemical and Biomedical Engineering, Nanyang Technological University, 639798, Singapore
| | - Justin Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Julien S Baker
- Faculty of Sports Science, Ningbo University, Ningbo, China; Department of Sport and Physical Education, Hong Kong Baptist University, Hong Kong, China
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China.
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Zhang Z, Xu D, Gao X, Liang M, Baker JS, Gu Y. The Effect of Different Degrees of Ankle Dorsiflexion Restriction on the Biomechanics of the Lower Extremity in Stop-Jumping. Appl Bionics Biomech 2024; 2024:9079982. [PMID: 39234300 PMCID: PMC11374426 DOI: 10.1155/2024/9079982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 07/22/2024] [Indexed: 09/06/2024] Open
Abstract
Purpose The functional status of the ankle joint is critical during dynamic movements in high-intensity sports like basketball and volleyball, particularly when performing actions such as stopping jumps. Limited ankle dorsiflexion is associated with increased injury risk and biomechanical changes during stop-jump tasks. Therefore, this study aims to investigate how restricting ankle dorsiflexion affects lower extremity biomechanics during the stop-jump phase, with a focus on the adaptive changes that occur in response to this restriction. Initially, 18 participants during stop-jumping with no wedge plate (NW), 10° wedge plate (10 W), and 20° wedge plate (20 W) using dominant leg data were collected to explore the relationship between limiting ankle mobility and lower extremity biomechanics. Following this, a musculoskeletal model was developed to simulate and calculate biomechanical data. Finally, one-dimensional parametric statistical mapping (SPM1D) was utilized to evaluate between-group variation in outcome variables using a one-way repeated measures analysis of variance (ANOVA). Results As the ankle restriction angle increased, knee external rotation angles, knee extension angular velocities, hip extension angle, and angular velocity increased and were significantly different at different ankle restriction angles (p < 0.001 and p=0.001), coactivation of the peripatellar muscles (BF/RF and BF/VM) increased progressively, and patellofemoral joint contact force (PTF) increased progressively during the 3%-8% phase (p=0.015). These results highlight the influence of ankle joint restriction on lower limb kinematics and patellofemoral joint loading during the stop-jump maneuver. Conclusion As the angle of ankle restriction increased, there was an increase in coactivation of the peripatellar muscles and an increase in PTF, possibly because a person is unable to adequately adjust their body for balance when the ankle valgus angle is restricted. The increased coactivation of the peripatellar muscles and increased patellofemoral contact force may be a compensatory response to the body's adaptation to balance adjustments.
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Affiliation(s)
- Zanni Zhang
- Faculty of Sport Science Ningbo University, Ningbo, China
| | - Datao Xu
- Faculty of Sport Science Ningbo University, Ningbo, China
- Faculty of Engineering University of Pannonia, Veszprem, Hungary
| | - Xiangli Gao
- Faculty of Sport Science Ningbo University, Ningbo, China
- Department of Radiology Ningbo No. 2 Hospital, Ningbo, China
| | - Minjun Liang
- Faculty of Sport Science Ningbo University, Ningbo, China
| | - Julien S Baker
- Faculty of Sport Science Ningbo University, Ningbo, China
- Department of Radiology Ningbo No. 2 Hospital, Ningbo, China
| | - Yaodong Gu
- Faculty of Sport Science Ningbo University, Ningbo, China
- Department of Radiology Ningbo No. 2 Hospital, Ningbo, China
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Doğan K, Selçuk T, Yılmaz A. A Novel Model Based on CNN-ViT Fusion and Ensemble Learning for the Automatic Detection of Pes Planus. J Clin Med 2024; 13:4800. [PMID: 39200942 PMCID: PMC11355061 DOI: 10.3390/jcm13164800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/30/2024] [Accepted: 08/08/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Pes planus, commonly known as flatfoot, is a condition in which the medial arch of the foot is abnormally low or absent, leading to the inner part of the foot having less curvature than normal. Symptom recognition and errors in diagnosis are problems encountered in daily practice. Therefore, it is important to improve how a diagnosis is made. With the availability of large datasets, deep neural networks have shown promising capabilities in recognizing foot structures and accurately identifying pes planus. Methods: In this study, we developed a novel fusion model by combining the Vgg16 convolutional neural network (CNN) model with the vision transformer ViT-B/16 to enhance the detection of pes planus. This fusion model leverages the strengths of both the CNN and ViT architectures, resulting in improved performance compared to that in reports in the literature. Additionally, ensemble learning techniques were employed to ensure the robustness of the model. Results: Through a 10-fold cross-validation, the model demonstrated high sensitivity, specificity, and F1 score values of 97.4%, 96.4%, and 96.8%, respectively. These results highlight the effectiveness of the proposed model in quickly and accurately diagnosing pes planus, making it suitable for deployment in clinics or healthcare centers. Conclusions: By facilitating early diagnosis, the model can contribute to the better management of treatment processes, ultimately leading to an improved quality of life for patients.
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Affiliation(s)
- Kamil Doğan
- Radiology Department, Bursa City Hospital, 16110 Bursa, Turkey;
| | - Turab Selçuk
- Department of Electrical and Electronics Engineering, Kahramanmaras Sutcu Imam University, 46200 Kahramanmaraş, Turkey
| | - Abdurrahman Yılmaz
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Hacettepe University, 06100 Ankara, Turkey;
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Gao X, Jie T, Xu D, Gál J, Fekete G, Liang M, Gu Y. Adaptive Adjustments in Lower Limb Muscle Coordination during Single-Leg Landing Tasks in Latin Dancers. Biomimetics (Basel) 2024; 9:489. [PMID: 39194468 DOI: 10.3390/biomimetics9080489] [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: 06/20/2024] [Revised: 08/09/2024] [Accepted: 08/12/2024] [Indexed: 08/29/2024] Open
Abstract
Previous research has primarily focused on evaluating the activity of individual muscles in dancers, often neglecting their synergistic interactions. Investigating the differences in lower limb muscle synergy during landing between dancers and healthy controls will contribute to a comprehensive understanding of their neuromuscular control patterns. This study enrolled 22 Latin dancers and 22 healthy participants, who performed a task involving landing from a 30 cm high platform. The data were collected using Vicon systems, force plates, and electromyography (EMG). The processed EMG data were subjected to non-negative matrix factorization (NNMF) for decomposition, followed by classification using K-means clustering algorithm and Pearson correlation coefficients. Three synergies were extracted for both Latin dancers and healthy participants. Synergy 1 showed increased contributions from the tibialis anterior (p < 0.001) and medial gastrocnemius (p = 0.024) in Latin dancers compared to healthy participants. Synergy 3 highlighted significantly greater contributions from the vastus lateralis in healthy participants compared to Latin dancers (p = 0.039). This study demonstrates that Latin dancers exhibit muscle synergies similar to those observed in healthy controls, revealing specific adjustments in the tibialis anterior and medial gastrocnemius muscles among dancers. This research illustrates how dancers optimize control strategies during landing tasks, offering a novel perspective for comprehensively understanding dancers' neuromuscular control patterns.
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Affiliation(s)
- Xiangli Gao
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Tianle Jie
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Datao Xu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
- Faculty of Engineering, University of Pannonia, 8201 Veszprem, Hungary
| | - János Gál
- Department of Communication, Faculty of Electronics, Telecommunications and Information Technologies, Politehnica University of Timisoara, 300223 Timisoara, Romania
| | - Gusztáv Fekete
- Department of Material Science and Technology, AUDI Hungária Faculty of Vehicle Engineering, Széchenyi István University, 9026 Győr, Hungary
| | - Minjun Liang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
- Faculty of Engineering, University of Szeged, 6720 Szeged, Hungary
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Blanco-Coloma L, García-González L, Sinovas-Alonso I, Torio-Álvarez S, Martos-Hernández P, González-Expósito S, Gil-Agudo Á, Herrera-Valenzuela D. Validation of inertial measurement units based on waveform similarity assessment against a photogrammetry system for gait kinematic analysis. Front Bioeng Biotechnol 2024; 12:1449698. [PMID: 39193230 PMCID: PMC11348432 DOI: 10.3389/fbioe.2024.1449698] [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: 06/15/2024] [Accepted: 07/30/2024] [Indexed: 08/29/2024] Open
Abstract
When assessing gait analysis outcomes for clinical use, it is indispensable to use an accurate system ensuring a minimal measurement error. Inertial Measurement Units (IMUs) are a versatile motion capture system to evaluate gait kinematics during out-of-lab activities and technology-assisted rehabilitation therapies. However, IMUs are susceptible to distortions, offset and drifting. Therefore, it is important to have a validated instrumentation and recording protocol to ensure the reliability of the measurements, to differentiate therapy effects from system-induced errors. A protocol was carried out to validate the accuracy of gait kinematic assessment with IMUs based on the similarity of the waveform of concurrent signals captured by this system and by a photogrammetry reference system. A gait database of 32 healthy subjects was registered synchronously with both devices. The validation process involved two steps: 1) a preliminary similarity assessment using the Pearson correlation coefficient, and 2) a similarity assessment in terms of correlation, displacement and gain by estimating the offset between signals, the difference between the registered range of motion (∆ROM), the root mean square error (RMSE) and the interprotocol coefficient of multiple correlation (CMCP). Besides, the CMCP was recomputed after removing the offset between signals (CMCPoff). The correlation was strong (r > 0.75) for both limbs for hip flexion/extension, hip adduction/abduction, knee flexion/extension and ankle dorsal/plantar flexion. These joint movements were studied in the second part of the analysis. The ∆ROM values obtained were smaller than 6°, being negligible relative to the minimally clinically important difference (MCID) estimated for unaffected limbs, and the RMSE values were under 10°. The offset for hips and ankles in the sagittal plane reached -9° and -8°, respectively, whereas hips adduction/abduction and knees flexion/extension were around 1°. According to the CMCP, the kinematic pattern of hip flexion/extension (CMCP > 0.90) and adduction/abduction (CMCP > 0.75), knee flexion/extension (CMCP > 0.95) and ankle dorsi/plantar flexion (CMCP > 0.90) were equivalent when captured by each system synchronously. However, after offset correction, only hip flexion/extension (CMCPoff = 1), hip adduction/abduction (CMCPoff > 0.85) and knee flexion/extension (CMCPoff > 0.95) satisfied the conditions to be considered similar.
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Affiliation(s)
- Laura Blanco-Coloma
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
| | - Lucía García-González
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
| | - Isabel Sinovas-Alonso
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
| | - Silvia Torio-Álvarez
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
| | | | - Sara González-Expósito
- Biorobotics Group, CAR-Centre of Automation and Robotics, CSIC-Spanish National Research Council, Madrid, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
| | - Diana Herrera-Valenzuela
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
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Ulman S, Loewen A, Erdman A, Õunpuu S, Chafetz R, Tulchin-Francis K, Wren TAL. Model variations for tracking the trunk during sports testing in a motion capture lab. Front Sports Act Living 2024; 6:1429822. [PMID: 39101153 PMCID: PMC11294157 DOI: 10.3389/fspor.2024.1429822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/10/2024] [Indexed: 08/06/2024] Open
Abstract
Introduction As motion capture technology becomes more popular for athlete monitoring and return-to-play evaluation, it is imperative that trunk mechanics are modeled similarly across participants. The purpose of this study was to determine how adjusting marker placement at the sternum or removing potentially occluded markers for purposes of tracking the trunk segment influences trunk kinematics during gait and a drop vertical jump (DVJ). Methods Sagittal plane trunk angles of 18 participants were computed for a Definition Model and three trunk model variations. Model variations were specifically chosen to avoid difficulties with placement of the sternum and/or thorax markers in female participants due to sports bra coverage and/or occlusion. Intraclass correlation coefficients were computed per trunk model variation to determine agreement with the Definition Model. Results The Mid-Sternum model, in which the xiphoid process marker was adjusted to the midpoint of the xiphoid process and jugular notch, exhibited the least discrepancies and excellent agreement with the Definition Model across both tasks. Alternatively, the No-Thorax model, in which the thorax marker was removed, exhibited the greatest kinematic differences during the DVJ and moderate to excellent agreement across both tasks. Conclusion The marker set chosen to track trunk motion during dynamic tasks must include locations that can be placed similarly on all participants. Based on these findings, the xiphoid process marker may be adjusted superiorly prior to the collection of dynamic trials. The recommended model for tracking the trunk segment includes marker placements on the jugular notch, mid-sternum, and 1st and 10th thoracic spinous processes.
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Affiliation(s)
- Sophia Ulman
- Orthopedic and Sports Medicine Center, Scottish Rite for Children, Dallas, TX, United States
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Alex Loewen
- Orthopedic and Sports Medicine Center, Scottish Rite for Children, Dallas, TX, United States
| | - Ashley Erdman
- Orthopedic and Sports Medicine Center, Scottish Rite for Children, Dallas, TX, United States
| | - Sylvia Õunpuu
- Center for Motion Analysis, Connecticut Children’s Medical Center, Hartford, CT, United States
| | - Ross Chafetz
- Motion Analysis Center, Shriners Hospital for Children, Philadelphia, PA, United States
| | - Kirsten Tulchin-Francis
- Department of Orthopedic Surgery, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Tishya A. L. Wren
- Jackie and Gene Autry Orthopedic Center, Children’s Hospital of Los Angeles, Los Angeles, CA, United States
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Zhang L, Zhang Q, Zhong Y, Hortobagyi T, Gu Y. Effect of forefoot transverse arch stiffness on foot biomechanical response--based on finite element method. Front Bioeng Biotechnol 2024; 12:1387768. [PMID: 39040495 PMCID: PMC11260739 DOI: 10.3389/fbioe.2024.1387768] [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: 02/18/2024] [Accepted: 06/19/2024] [Indexed: 07/24/2024] Open
Abstract
Background The plantar vault, comprising the transverse and longitudinal arches of the human foot, is essential for impact absorption, elastic energy storage, and propulsion. Recent research underscores the importance of the transverse arch, contributing over 40% to midfoot stiffness. This study aimed to quantify biomechanical responses in the ankle-foot complex by varying the stiffness of the deep metatarsal transverse ligament (DTML). Methods Using CT image reconstruction, we constructed a complex three-dimensional finite element model of the foot and ankle joint complex, accounting for geometric complexity and nonlinear characteristics. The focus of our study was to evaluate the effect of different forefoot transverse arch stiffness, that is, different Young's modulus values of DTML (from 135 MPa to 405 MPa), on different biomechanical aspects of the foot and ankle complex. Notably, we analyzed their effects on plantar pressure distribution, metatarsal stress patterns, navicular subsidence, and plantar fascial strain. Results Increasing the stiffness of the DTML has significant effects on foot biomechanics. Specifically, higher DTML stiffness leads to elevate von Mises stress in the 1st, 2nd, and 3rd metatarsals, while concurrently reducing plantar pressure by 14.2% when the Young's modulus is doubled. This stiffening also impedes navicular bone subsidence and foot lengthening. Notably, a 100% increase in the Young's modulus of DTML results in a 54.1% decrease in scaphoid subsidence and a 2.5% decrease in foot lengthening, which collectively contribute to a 33.1% enhancement in foot longitudinal stiffness. Additionally, doubling the Young's modulus of DTML can reduce the strain stretch of the plantar fascia by 38.5%. Conclusion Preserving DTML integrity sustains the transverse arch, enhancing foot longitudinal stiffness and elastic responsiveness. These findings have implications for treating arch dysfunction and provide insights for shoe developers seeking to enhance propulsion.
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Affiliation(s)
- Linjie Zhang
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo, China
- Department of Kinesiology, Hungarian University of Sports Science, Budapest, Hungary
| | - Qiaolin Zhang
- Doctoral School of Safety and Security Sciences, Obuda University, Budapest, Hungary
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Yilin Zhong
- Faculty of Sport Science, Ningbo University, Ningbo, China
| | - Tibor Hortobagyi
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo, China
- Department of Kinesiology, Hungarian University of Sports Science, Budapest, Hungary
| | - Yaodong Gu
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo, China
- Faculty of Sport Science, Ningbo University, Ningbo, China
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Ma S, Soh KG, Japar SB, Liu C, Luo S, Mai Y, Wang X, Zhai M. Effect of core strength training on the badminton player's performance: A systematic review & meta-analysis. PLoS One 2024; 19:e0305116. [PMID: 38865415 PMCID: PMC11168634 DOI: 10.1371/journal.pone.0305116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/23/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Core strength training (CST) has been shown to improve performance in several sports disciplines. CST is recognized as one of the crucial elements that enhance athletic performance, particularly impacting badminton skills. Despite its popularity as a strength training method among badminton players, there is a lack of comprehensive studies examining the effectiveness of CST on the performance of these athletes. OBJECTIVE This study aims to ascertain CST's effects on badminton players' performance. METHOD This study followed PRISMA principles and conducted comprehensive searches in well-known academic databases (SCOPUS, Pubmed, CNKI, Web of Science, Core Collection, and EBSCOhost) up to August 2023. The inclusive criteria were established using the PICOS framework. Following their inclusion based on PICOS criteria, the selected studies underwent literature review and meta-analysis. The methodological quality of the assessments was evaluated using Cochrane Collaboration's risk of bias tools bias risk tools and recommendations for a graded assessment, development, and evaluation. RESULTS The analysis included participants aged 10-19 years from 13 studies of moderate quality, totaling 208 individuals. The CST intervention s lasted between 4 to 16 weeks, with a frequency of 1 to 4 sessions per week and each session lasting 20 to 120 minutes. Sample sizes across these studies ranged from 8 to 34 participants. According to the meta-analysis, CST significantly influenced badminton performance, particularly in areas of explosive power (ES = 0.03 P = 0.04), front-court skill (ES = 2.53, P = 0.003), and back-court skill (ES = 2.33, P = 0.002). CONCLUSION CST enhances badminton players' fitness (strength, power, balance, and stability), in situ (front/back-court) skills, and movement position hitting. However, its effects on speed, endurance, agility, flexibility, and coordination are unclear, revealing a research gap. The precise benefits of CST, especially on flexibility and specific hitting skills (smashes, clears, drives, net shots, crosscourt, push, and lift shots), need more investigation. Additionally, research on CST's impact on female athletes is significantly lacking.
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Affiliation(s)
- Shuzhen Ma
- Department of Sports Studies, Faculty of Educational Studies, Universiti Putra Malaysia, Selangor, Malaysia
- School of Public Administration, Guilin University of Technology, Guilin, China
| | - Kim Geok Soh
- Department of Sports Studies, Faculty of Educational Studies, Universiti Putra Malaysia, Selangor, Malaysia
| | - Salimah Binti Japar
- Department of Sports Studies, Faculty of Educational Studies, Universiti Putra Malaysia, Selangor, Malaysia
| | - Chunqing Liu
- Department of Sports Studies, Faculty of Educational Studies, Universiti Putra Malaysia, Selangor, Malaysia
| | - Shengyao Luo
- School of Physical Education and Arts, Jiangxi University of Science and Technology, Ganzhou, China
| | - Yiqiang Mai
- Department of Sports Studies, Faculty of Educational Studies, Universiti Putra Malaysia, Selangor, Malaysia
| | - Xinzhi Wang
- Department of Sports Studies, Faculty of Educational Studies, Universiti Putra Malaysia, Selangor, Malaysia
| | - Mengze Zhai
- Physical Education Department, Tianjin Binhai Automotive Engineering Vocational College, Tianjin, China
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Santilli G, Vetrano M, Mangone M, Agostini F, Bernetti A, Coraci D, Paoloni M, de Sire A, Paolucci T, Latini E, Santoboni F, Nusca SM, Vulpiani MC. Predictive Prognostic Factors in Non-Calcific Supraspinatus Tendinopathy Treated with Focused Extracorporeal Shock Wave Therapy: An Artificial Neural Network Approach. Life (Basel) 2024; 14:681. [PMID: 38929665 PMCID: PMC11205102 DOI: 10.3390/life14060681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
The supraspinatus tendon is one of the most involved tendons in the development of shoulder pain. Extracorporeal shockwave therapy (ESWT) has been recognized as a valid and safe treatment. Sometimes the symptoms cannot be relieved, or a relapse develops, affecting the patient's quality of life. Therefore, a prediction protocol could be a powerful tool aiding our clinical decisions. An artificial neural network was run, in particular a multilayer perceptron model incorporating input information such as the VAS and Constant-Murley score, administered at T0 and at T1 after six months. It showed a model sensitivity of 80.7%, and the area under the ROC curve was 0.701, which demonstrates good discrimination. The aim of our study was to identify predictive factors for minimal clinically successful therapy (MCST), defined as a reduction of ≥40% in VAS score at T1 following ESWT for chronic non-calcific supraspinatus tendinopathy (SNCCT). From the male gender, we expect greater and more frequent clinical success. The more severe the patient's initial condition, the greater the possibility that clinical success will decrease. The Constant and Murley score, Roles and Maudsley score, and VAS are not just evaluation tools to verify an improvement; they are also prognostic factors to be taken into consideration in the assessment of achieving clinical success. Due to the lower clinical improvement observed in older patients and those with worse clinical and functional scales, it would be preferable to also provide these patients with the possibility of combined treatments. The ANN predictive model is reasonable and accurate in studying the influence of prognostic factors and achieving clinical success in patients with chronic non-calcific tendinopathy of the supraspinatus treated with ESWT.
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Affiliation(s)
- Gabriele Santilli
- Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Mario Vetrano
- Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Andrea Bernetti
- Department of Biological and Environmental Science and Technologies, University of Salento, 73100 Lecce, Italy
| | - Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padua, 35122 Padua, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Teresa Paolucci
- Department of Oral Medical Science and Biotechnology, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Eleonora Latini
- Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Flavia Santoboni
- Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Sveva Maria Nusca
- Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Maria Chiara Vulpiani
- Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
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Albarova-Corral I, Segovia-Burillo J, Malo-Urriés M, Ríos-Asín I, Asín J, Castillo-Mateo J, Gracia-Tabuenca Z, Morales-Hernández M. A New Quantitative Tool for the Ultrasonographic Assessment of Tendons: A Reliability and Validity Study on the Patellar Tendon. Diagnostics (Basel) 2024; 14:1067. [PMID: 38893594 PMCID: PMC11171978 DOI: 10.3390/diagnostics14111067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Ultrasound is widely used for tendon assessment due to its safety, affordability, and portability, but its subjective nature poses challenges. This study aimed to develop a new quantitative analysis tool based on artificial intelligence to identify statistical patterns of healthy and pathological tendons. Furthermore, we aimed to validate this new tool by comparing it to experts' subjective assessments. A pilot database including healthy controls and patients with patellar tendinopathy was constructed, involving 14 participants with asymptomatic (n = 7) and symptomatic (n = 7) patellar tendons. Ultrasonographic images were assessed twice, utilizing both the new quantitative tool and the subjective scoring method applied by an expert across five regions of interest. The database contained 61 variables per image. The robustness of the clinical and quantitative assessments was tested via reliability analyses. Lastly, the prediction accuracy of the quantitative features was tested via cross-validated generalized linear mixed-effects logistic regressions. These analyses showed high reliability for quantitative variables related to "Bone" and "Quality", with ICCs above 0.75. The ICCs for "Edges" and "Thickness" varied but mostly exceeded 0.75. The results of this study show that certain quantitative variables are capable of predicting an expert's subjective assessment with generally high cross-validated AUC scores. A new quantitative tool for the ultrasonographic assessment of the tendon was designed. This system is shown to be a reliable and valid method for evaluating the patellar tendon structure.
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Affiliation(s)
- Isabel Albarova-Corral
- PhysiUZerapy Health Sciences Research Group, Department of Physiatry and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
| | - José Segovia-Burillo
- Fluid Mechanics, Instituto de Investigación en Ingeniería de Aragón (I3A), University of Zaragoza, 50018 Zaragoza, Spain
| | - Miguel Malo-Urriés
- PhysiUZerapy Health Sciences Research Group, Department of Physiatry and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
| | - Izarbe Ríos-Asín
- PhysiUZerapy Health Sciences Research Group, Department of Physiatry and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
| | - Jesús Asín
- Modelos Estocásticos Research Group, Department of Statistical Methods, University of Zaragoza, 50009 Zaragoza, Spain
| | - Jorge Castillo-Mateo
- Modelos Estocásticos Research Group, Department of Statistical Methods, University of Zaragoza, 50009 Zaragoza, Spain
| | - Zeus Gracia-Tabuenca
- Modelos Estocásticos Research Group, Department of Statistical Methods, University of Zaragoza, 50009 Zaragoza, Spain
| | - Mario Morales-Hernández
- Fluid Mechanics, Instituto de Investigación en Ingeniería de Aragón (I3A), University of Zaragoza, 50018 Zaragoza, Spain
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11
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Jie T, Xu D, Zhang Z, Teo EC, Baker JS, Zhou H, Gu Y. Structural and Organizational Strategies of Locomotor Modules during Landing in Patients with Chronic Ankle Instability. Bioengineering (Basel) 2024; 11:518. [PMID: 38790384 PMCID: PMC11117571 DOI: 10.3390/bioengineering11050518] [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: 04/23/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Human locomotion involves the coordinated activation of a finite set of modules, known as muscle synergy, which represent the motor control strategy of the central nervous system. However, most prior studies have focused on isolated muscle activation, overlooking the modular organization of motor behavior. Therefore, to enhance comprehension of muscle coordination dynamics during multi-joint movements in chronic ankle instability (CAI), exploring muscle synergies during landing in CAI patients is imperative. METHODS A total of 22 patients with unilateral CAI and 22 healthy participants were recruited for this research. We employed a recursive model for second-order differential equations to process electromyographic (EMG) data after filtering preprocessing, generating the muscle activation matrix, which was subsequently inputted into the non-negative matrix factorization model for extraction of the muscle synergy. Muscle synergies were classified utilizing the K-means clustering algorithm and Pearson correlation coefficients. Statistical parameter mapping (SPM) was employed for temporal modular parameter analyses. RESULTS Four muscle synergies were identified in both the CAI and healthy groups. In Synergy 1, only the gluteus maximus showed significantly higher relative weight in CAI compared to healthy controls (p = 0.0035). Synergy 2 showed significantly higher relative weights for the vastus lateralis in the healthy group compared to CAI (p = 0.018), while in Synergy 4, CAI demonstrated significantly higher relative weights of the vastus lateralis compared to healthy controls (p = 0.030). Furthermore, in Synergy 2, the CAI group exhibited higher weights of the tibialis anterior compared to the healthy group (p = 0.042). CONCLUSIONS The study suggested that patients with CAI exhibit a comparable modular organizational framework to the healthy group. Investigation of amplitude adjustments within the synergy spatial module shed light on the adaptive strategies employed by the tibialis anterior and gluteus maximus muscles to optimize control strategies during landing in patients with CAI. Variances in the muscle-specific weights of the vastus lateralis across movement modules reveal novel biomechanical adaptations in CAI, offering valuable insights for refining rehabilitation protocols.
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Affiliation(s)
- Tianle Jie
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Datao Xu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
- Faculty of Engineering, University of Pannonia, 8201 Veszprem, Hungary
| | - Zanni Zhang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Ee-Chon Teo
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Julien S. Baker
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Huiyu Zhou
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
- Faculty of Engineering, University of Szeged, 6720 Szeged, Hungary
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12
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Zhu C, Song Y, Xu Y, Zhu A, Baker JS, Liu W, Gu Y. Toe Box Shape of Running Shoes Affects In-Shoe Foot Displacement and Deformation: A Randomized Crossover Study. Bioengineering (Basel) 2024; 11:457. [PMID: 38790324 PMCID: PMC11118738 DOI: 10.3390/bioengineering11050457] [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: 04/07/2024] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Long-distance running is popular but associated with a high risk of injuries, particularly toe-related injuries. Limited research has focused on preventive measures, prompting exploration into the efficacy of raised toe box running shoes. PURPOSE This study aimed to investigate the effect of running shoes with raised toe boxes on preventing toe injuries caused by distance running. METHODS A randomized crossover design involved 25 male marathon runners (height: 1.70 ± 0.02 m, weight: 62.6 + 4.5 kg) wearing both raised toe box (extended by 8 mm along the vertical axis and 3 mm along the sagittal axis) and regular toe box running shoes. Ground reaction force (GRF), in-shoe displacement, and degree of toe deformation (based on the distance change between the toe and the metatarsal head) were collected. RESULTS Wearing raised toe box shoes resulted in a significant reduction in vertical (p = 0.001) and antero-posterior (p = 0.015) ground reaction forces during the loading phase, with a notable increase in vertical ground reaction force during the toe-off phase (p < 0.001). In-shoe displacement showed significant decreased movement in the forefoot medial (p < 0.001) and rearfoot (medial: p < 0.001, lateral: p < 0.001) and significant increased displacement in the midfoot (medial: p = 0.002, lateral: p < 0.001). Impact severity on the hallux significantly decreased (p < 0.001), while impact on the small toes showed no significant reduction (p = 0.067). CONCLUSIONS Raised toe box running shoes offer an effective means of reducing toe injuries caused by long-distance running.
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Affiliation(s)
- Chengyuan Zhu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Yang Song
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Faculty of Engineering, University of Szeged, 6700 Szeged, Hungary
| | - Yufan Xu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Aojie Zhu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Julien S. Baker
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Wei Liu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
- Faculty of Engineering, University of Szeged, 6700 Szeged, Hungary
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13
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Liu T, Dimitrov A, Jomha N, Adeeb S, El-Rich M, Westover L. Development and validation of a novel ankle joint musculoskeletal model. Med Biol Eng Comput 2024; 62:1395-1407. [PMID: 38194185 DOI: 10.1007/s11517-023-03010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
An improved understanding of contact mechanics in the ankle joint is paramount for implant design and ankle disorder treatment. However, existing models generally simplify the ankle joint as a revolute joint that cannot predict contact characteristics. The current study aimed to develop a novel musculoskeletal ankle joint model that can predict contact in the ankle joint, together with muscle and joint reaction forces. We modelled the ankle joint as a multi-axial joint and simulated contact mechanics between the tibia, fibula and talus bones in OpenSim. The developed model was validated with results from experimental studies through passive stiffness and contact. Through this, we found a similar ankle moment-rotation relationship and contact pattern between our study and experimental studies. Next, the musculoskeletal ankle joint model was incorporated into a lower body model to simulate gait. The ankle joint contact characteristics, kinematics, and muscle forces were predicted and compared to the literature. Our results revealed a comparable peak contact force and the same muscle activation patterns in four major muscles. Good agreement was also found in ankle dorsi/plantar-flexion and inversion/eversion. Thus, the developed model was able to accurately model the ankle joint and can be used to predict contact characteristics in gait.
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Affiliation(s)
- Tao Liu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Andrea Dimitrov
- School of Medicine, Nursing & Health Sciences, University of Galway, Galway, Ireland
| | - Nadr Jomha
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Samer Adeeb
- Faculty of Civil and Environmental Engineering, University of Alberta, Edmonton, AB, Canada
| | - Marwan El-Rich
- Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Lindsey Westover
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
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14
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Zhang L, Yu R, Chen K, Zhang Y, Li Q, Chen Y. Enhancing deep vein thrombosis prediction in patients with coronavirus disease 2019 using improved machine learning model. Comput Biol Med 2024; 173:108294. [PMID: 38537565 DOI: 10.1016/j.compbiomed.2024.108294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/21/2024] [Accepted: 03/12/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Deep vein thrombosis (DVT) is a significant complication in coronavirus disease 2019 patients, arising from coagulation issues in the deep venous system. Among 424 scheduled patients, 202 developed DVT (47.64%). DVT increases hospitalization risk, and complications, and impacts prognosis. Accurate prognostication and timely intervention are crucial to prevent DVT progression and improve patient outcomes. METHODS This study introduces an effective DVT prediction model, named bSES-AC-RUN-FKNN, which integrates fuzzy k-nearest neighbor (FKNN) with enhanced Runge-Kutta optimizer (RUN). Recognizing the insufficient effectiveness of RUN in local search capability and its convergence accuracy, spherical evolutionary search (SES) and differential evolution-inspired knowledge adaptive crossover (AC) are incorporated, termed SES-AC-RUN, to enhance its optimization capability. RESULTS Based on the benchmark set by CEC 2017 and comparative analyses with several peers, it is evident that SES-AC-RUN significantly enhances search performance compared to traditional RUN, even standing comparably against leading championship algorithms. The proposed bSES-AC-RUN-FKNN model was applied to predict a dataset comprising 424 cases of DVT patients, totaling 7208 records. Remarkably, the model demonstrates outstanding accuracy, reaching 91.02%, alongside commendable sensitivity at 91.07%. CONCLUSIONS The bSES-AC-RUN-FKNN emerges as a robust and efficient predictive tool, significantly enhancing the accuracy of DVT prediction. This model can be used to manage the risk of thrombosis in the care of COVID-19 patients. Nursing staff can combine the model's predictions with clinical judgment to formulate comprehensive treatment approaches.
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Affiliation(s)
- Lufang Zhang
- The First Clinical College, Wenzhou Medical University, Wenzhou, 325000, China.
| | - Renyue Yu
- Cardiac Care Unit, Sir RUN RUN Shaw Hospital, Hangzhou, 310000, China.
| | - Keya Chen
- The First Clinical College, Wenzhou Medical University, Wenzhou, 325000, China.
| | - Ying Zhang
- Wenzhou Medical University School of Nursing, 325000, Wenzhou, 325000, China; Cixi Biomedical Research Institute, Wenzhou Medical University, Cixi, 315300, China.
| | - Qiang Li
- School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China.
| | - Yu Chen
- Nursing Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
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15
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Gao X, Xu D, Baker JS, Ee-Chon T, Liang M, Gu Y. Exploring biomechanical variations in ankle joint injuries among Latin dancers with different stance patterns: utilizing OpenSim musculoskeletal models. Front Bioeng Biotechnol 2024; 12:1359337. [PMID: 38659647 PMCID: PMC11039862 DOI: 10.3389/fbioe.2024.1359337] [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: 12/21/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Background: Dancers represent the primary demographic affected by ankle joint injuries. In certain movements, some Latin dancers prefer landing on the Forefoot (FT), while others prefer landing on the Entire foot (ET). Different stance patterns can have varying impacts on dancers' risk of ankle joint injuries. The purpose of this study is to investigate the differences in lower limb biomechanics between Forefoot (FT) dancers and Entire foot (ET) dancers. Method: A group of 21 FT dancers (mean age 23.50 (S.D. 1.12) years) was compared to a group of 21 ET dancers (mean age 23.33 (S.D. 0.94) years), performing the kicking movements of the Jive in response to the corresponding music. We import data collected from Vicon and force plates into OpenSim to establish musculoskeletal models for computing kinematics, dynamics, muscle forces, and muscle co-activation. Result: In the sagittal plane: ankle angle (0%-100%, p < 0.001), In the coronal plane: ankle angle (0%-9.83%, p = 0.001) (44.34%-79.52%, p = 0.003), (88.56%-100%, p = 0.037), ankle velocity (3.73%-11.65%, p = 0.017) (94.72-100%, p = 0.031); SPM analysis revealed that FT dancers exhibited significantly smaller muscle force than ET dancers around the ankle joint during the stance phase. Furthermore, FT dancers displayed reduced co-activation compared to ET dancers around the ankle joint during the descending phase, while demonstrating higher co-activation around the knee joint than ET dancers. Conclusion: This study biomechanically demonstrates that in various stance patterns within Latin dance, a reduction in lower limb stance area leads to weakened muscle strength and reduced co-activation around the ankle joint, and results in increased ankle inversion angles and velocities, thereby heightening the risk of ankle sprains. Nevertheless, the increased co-activation around the knee joint in FT dancers may be a compensatory response for reducing the lower limb stance area in order to maintain stability.
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Affiliation(s)
- Xiangli Gao
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Datao Xu
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Faculty of Engineering, University of Pannonia, Veszprem, Hungary
| | | | - Teo Ee-Chon
- Faculty of Sports Science, Ningbo University, Ningbo, China
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Minjun Liang
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo, China
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16
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Ferhi H, Magtouf E, Attia A, Durand S, Boyas S, Beaune B, Chortane SG, Maktouf W. Does Obesity Affect the Rate of Force Development in Plantar Flexor Muscles among Older Adults? Sports (Basel) 2024; 12:89. [PMID: 38668557 PMCID: PMC11054987 DOI: 10.3390/sports12040089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/16/2024] [Accepted: 03/21/2024] [Indexed: 04/29/2024] Open
Abstract
The literature offers limited information on the effect of obesity on the rate of force development (RFD), a critical parameter for mobility in older adults. The objectives of this study were to explore the influence of obesity on the RFD in older adults and to examine the association between this neuromuscular parameter and walking speed. The participants (42 older adults) were classified into two groups: the control group (CG, n = 22; mean age = 81.13 ± 4.02 years; body mass index (BMI) = 25.13 ± 3.35 kg/m2), and the obese group (OG, n = 20; mean age = 77.71 ± 2.95 years; BMI = 34.46 ± 3.25 kg/m2). Walking speed (m/s) was measured using the 10 m walking test. Neuromuscular parameters of the plantar flexors were evaluated during a maximal voluntary contraction test using a dynamometer. The RFD was calculated from the linear slop of the force-time curve in the following two phases: from the onset of the contraction to 50 ms (RFD0-50) and from 100 to 200 ms (RFD100-200). The gait speed was lower in the OG compared to the CG (p < 0.001). The RFD50/100 and RFD100/200 were lower in the OG compared to the CG (p < 0.001). The RFD50/100 was found to be the predominant influencer on gait speed in the OG. In conclusion, obesity negatively impacts the RFD in older adults and RFD stands out as the primary factor among the studied parameters influencing gait speed.
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Affiliation(s)
- Hamza Ferhi
- Research Laboratory (LR23JS01) Sport Performance, Health & Society, Higher Institute of Sport and Physical Education of Ksar Saîd, University of La Manouba, Tunis 2010, Tunisia; (H.F.); (E.M.); (A.A.); (S.G.C.)
| | - Elmoetez Magtouf
- Research Laboratory (LR23JS01) Sport Performance, Health & Society, Higher Institute of Sport and Physical Education of Ksar Saîd, University of La Manouba, Tunis 2010, Tunisia; (H.F.); (E.M.); (A.A.); (S.G.C.)
| | - Ahmed Attia
- Research Laboratory (LR23JS01) Sport Performance, Health & Society, Higher Institute of Sport and Physical Education of Ksar Saîd, University of La Manouba, Tunis 2010, Tunisia; (H.F.); (E.M.); (A.A.); (S.G.C.)
| | - Sylvain Durand
- Laboratory Movement, Interactions, Performance (UR 4334), Department of Sport Sciences, Faculty of Sciences and Technologies, Le Mans University, 72000 Le Mans, France; (S.D.); (S.B.); (B.B.)
| | - Sébastien Boyas
- Laboratory Movement, Interactions, Performance (UR 4334), Department of Sport Sciences, Faculty of Sciences and Technologies, Le Mans University, 72000 Le Mans, France; (S.D.); (S.B.); (B.B.)
| | - Bruno Beaune
- Laboratory Movement, Interactions, Performance (UR 4334), Department of Sport Sciences, Faculty of Sciences and Technologies, Le Mans University, 72000 Le Mans, France; (S.D.); (S.B.); (B.B.)
| | - Sabri Gaied Chortane
- Research Laboratory (LR23JS01) Sport Performance, Health & Society, Higher Institute of Sport and Physical Education of Ksar Saîd, University of La Manouba, Tunis 2010, Tunisia; (H.F.); (E.M.); (A.A.); (S.G.C.)
| | - Wael Maktouf
- Bioengineering, Tissues and Neuroplasticity, UR 7377, Faculty of Health/EPISEN, University of Paris-Est Créteil, 8 rue du Général Sarrail, 94010 Créteil, France
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17
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Sato H, Kijima H, Iwami T, Tsukamoto H, Saito H, Kudo D, Kimura R, Kasukawa Y, Miyakoshi N. Unicompartmental Knee Arthroplasty for Osteoarthritis Eliminates Lateral Thrust: Associations between Lateral Thrust Detected by Inertial Measurement Units and Clinical Outcomes. SENSORS (BASEL, SWITZERLAND) 2024; 24:2019. [PMID: 38610231 PMCID: PMC11014390 DOI: 10.3390/s24072019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024]
Abstract
The purpose of this study was to investigate the relationship between clinical outcomes and lateral thrust before and after unicompartmental knee arthroplasty (UKA) using inertial measurement sensor units. Eleven knees were evaluated with gait analysis. The varus angular velocity was used to evaluate lateral thrust. The femorotibial angle (FTA) and hip-knee-ankle angle (HKA) were used to evaluate lower-limb alignment, and the Oxford Knee Score (OKS) and Japanese Orthopaedic Association Score (JOA) were used to evaluate clinical outcomes. The mean pre-UKA peak varus velocity was 37.1 ± 9.8°/s, and that for post-UKA was 28.8 ± 9.1°/s (p = 0.00003), such that instabilities clearly improved. Assuming the definition of lateral thrust is when the varus angular velocity is more than 28.1°/s, 81.8% of patients had lateral thrust preoperatively, but this decreased to 55.6% postoperatively, such that the symptoms and objective findings improved. Both OKS and JOA improved after surgery. In addition, HKA was -7.9° preoperatively and -5.8° postoperatively (p = 0.024), and FTA was 181.4° preoperatively and 178.4° postoperatively (p = 0.012). There was a positive correlation between postoperative JOA and FTA, indicating that changes in postoperative alignment affected clinical outcomes. This study quantitatively evaluated the disappearance of lateral thrust by UKA, and it found that the stability can be achieved by UKA for unstable knees with lateral thrust.
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Affiliation(s)
- Hikaru Sato
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Hiroaki Kijima
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Takehiro Iwami
- Department of System Design Engineering, Faculty of Engineering Science, Akita University Graduate School of Engineering Science, 1-1 Tegatagakuenmachi, Akita 010-8502, Japan
| | - Hiroaki Tsukamoto
- Noshiro Kousei Medical Center, Ochiaiazakamimaedachinai, Noshiro 016-0014, Japan
| | - Hidetomo Saito
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Daisuke Kudo
- Division of Rehabilitation Medicine, Akita University Hospital, 44-2, Hiroomote Hasunuma, Akita 010-8543, Japan
| | - Ryota Kimura
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Yuji Kasukawa
- Division of Rehabilitation Medicine, Akita University Hospital, 44-2, Hiroomote Hasunuma, Akita 010-8543, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
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18
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Fiori L, Castiglia SF, Chini G, Draicchio F, Sacco F, Serrao M, Tatarelli A, Varrecchia T, Ranavolo A. The Lower Limb Muscle Co-Activation Map during Human Locomotion: From Slow Walking to Running. Bioengineering (Basel) 2024; 11:288. [PMID: 38534562 DOI: 10.3390/bioengineering11030288] [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: 01/16/2024] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
The central nervous system (CNS) controls movements and regulates joint stiffness with muscle co-activation, but until now, few studies have examined muscle pairs during running. This study aims to investigate differences in lower limb muscle coactivation during gait at different speeds, from walking to running. Nineteen healthy runners walked and ran at speeds ranging from 0.8 km/h to 9.3 km/h. Twelve lower limb muscles' co-activation was calculated using the time-varying multi-muscle co-activation function (TMCf) with global, flexor-extension, and rostro-caudal approaches. Spatiotemporal and kinematic parameters were also measured. We found that TMCf, spatiotemporal, and kinematic parameters were significantly affected by gait speed for all approaches. Significant differences were observed in the main parameters of each co-activation approach and in the spatiotemporal and kinematic parameters at the transition between walking and running. In particular, significant differences were observed in the global co-activation (CIglob, main effect F(1,17) = 641.04, p < 0.001; at the transition p < 0.001), the stride length (main effect F(1,17) = 253.03, p < 0.001; at the transition p < 0.001), the stride frequency (main effect F(1,17) = 714.22, p < 0.001; at the transition p < 0.001) and the Center of Mass displacement in the vertical (CoMy, main effect F(1,17) = 426.2, p < 0.001; at the transition p < 0.001) and medial-lateral (CoMz, main effect F(1,17) = 120.29 p < 0.001; at the transition p < 0.001) directions. Regarding the correlation analysis, the CoMy was positively correlated with a higher CIglob (r = 0.88, p < 0.001) and negatively correlated with Full Width at Half Maximum (FWHMglob, r = -0.83, p < 0.001), whereas the CoMz was positively correlated with the global Center of Activity (CoAglob, r = 0.97, p < 0.001). Positive and negative strong correlations were found between global co-activation parameters and center of mass displacements, as well as some spatiotemporal parameters, regardless of gait speed. Our findings suggest that walking and running have different co-activation patterns and kinematic characteristics, with the whole-limb stiffness exerted more synchronously and stably during running. The co-activation indexes and kinematic parameters could be the result of global co-activation, which is a sensory-control integration process used by the CNS to deal with more demanding and potentially unstable tasks like running.
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Affiliation(s)
- Lorenzo Fiori
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
- Behavioral Neuroscience PhD Program, Department of Physiology and Pharmacology, Sapienza University, Viale dell'Università 30, 00185 Rome, Italy
| | - Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Franco Faggiana 1668, 04100 Latina, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100 Pavia, Italy
| | - Giorgia Chini
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
| | - Floriana Sacco
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Franco Faggiana 1668, 04100 Latina, Italy
| | - Antonella Tatarelli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
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19
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Xu D, Zhou H, Quan W, Ugbolue UC, Gusztav F, Gu Y. A new method applied for explaining the landing patterns: Interpretability analysis of machine learning. Heliyon 2024; 10:e26052. [PMID: 38370177 PMCID: PMC10869904 DOI: 10.1016/j.heliyon.2024.e26052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/20/2024] Open
Abstract
As one of many fundamental sports techniques, the landing maneuver is also frequently used in clinical injury screening and diagnosis. However, the landing patterns are different under different constraints, which will cause great difficulties for clinical experts in clinical diagnosis. Machine learning (ML) have been very successful in solving a variety of clinical diagnosis tasks, but they all have the disadvantage of being black boxes and rarely provide and explain useful information about the reasons for making a particular decision. The current work validates the feasibility of applying an explainable ML (XML) model constructed by Layer-wise Relevance Propagation (LRP) for landing pattern recognition in clinical biomechanics. This study collected 560 groups landing data. By incorporating these landing data into the XML model as input signals, the prediction results were interpreted based on the relevance score (RS) derived from LRP. The interpretation obtained from XML was evaluated comprehensively from the statistical perspective based on Statistical Parametric Mapping (SPM) and Effect Size. The RS has excellent statistical characteristics in the interpretation of landing patterns between classes, and also conforms to the clinical characteristics of landing pattern recognition. The current work highlights the applicability of XML methods that can not only satisfy the traditional decision problem between classes, but also largely solve the lack of transparency in landing pattern recognition. We provide a feasible framework for realizing interpretability of ML decision results in landing analysis, providing a methodological reference and solid foundation for future clinical diagnosis and biomechanical analysis.
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Affiliation(s)
- Datao Xu
- Research Academy of Medicine Combining Sports, Ningbo No. 2 Hospital, Ningbo, China
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Faculty of Engineering, University of Pannonia, Veszprém, Hungary
| | - Huiyu Zhou
- Research Academy of Medicine Combining Sports, Ningbo No. 2 Hospital, Ningbo, China
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Wenjing Quan
- Research Academy of Medicine Combining Sports, Ningbo No. 2 Hospital, Ningbo, China
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Ukadike Chris Ugbolue
- School of Health and Life Sciences, University of the West of Scotland, Scotland, United Kingdom
| | - Fekete Gusztav
- Vehicle Industry Research Center, Széchenyi István University, Gyor, Hungary
| | - Yaodong Gu
- Research Academy of Medicine Combining Sports, Ningbo No. 2 Hospital, Ningbo, China
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo, China
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20
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Han X, Nishida N, Morita M, Sakai T, Jiang Z. Compensation Method for Missing and Misidentified Skeletons in Nursing Care Action Assessment by Improving Spatial Temporal Graph Convolutional Networks. Bioengineering (Basel) 2024; 11:127. [PMID: 38391613 PMCID: PMC10886177 DOI: 10.3390/bioengineering11020127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
With the increasing aging population, nursing care providers have been facing a substantial risk of work-related musculoskeletal disorders (WMSDs). Visual-based pose estimation methods, like OpenPose, are commonly used for ergonomic posture risk assessment. However, these methods face difficulty when identifying overlapping and interactive nursing tasks, resulting in missing and misidentified skeletons. To address this, we propose a skeleton compensation method using improved spatial temporal graph convolutional networks (ST-GCN), which integrates kinematic chain and action features to assess skeleton integrity and compensate for it. The results verified the effectiveness of our approach in optimizing skeletal loss and misidentification in nursing care tasks, leading to improved accuracy in calculating both skeleton joint angles and REBA scores. Moreover, comparative analysis against other skeleton compensation methods demonstrated the superior performance of our approach, achieving an 87.34% REBA accuracy score. Collectively, our method might hold promising potential for optimizing the skeleton loss and misidentification in nursing care tasks.
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Affiliation(s)
- Xin Han
- Faculty of Engineering, Yamaguchi University Graduate School of Sciences and Technology for Innovation, 2-16-1 Tokiwadai, Ube City 755-0097, Yamaguchi Prefecture, Japan
| | - Norihiro Nishida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City 755-8505, Yamaguchi Prefecture, Japan
| | - Minoru Morita
- Faculty of Engineering, Yamaguchi University Graduate School of Sciences and Technology for Innovation, 2-16-1 Tokiwadai, Ube City 755-0097, Yamaguchi Prefecture, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube City 755-8505, Yamaguchi Prefecture, Japan
| | - Zhongwei Jiang
- Faculty of Engineering, Yamaguchi University Graduate School of Sciences and Technology for Innovation, 2-16-1 Tokiwadai, Ube City 755-0097, Yamaguchi Prefecture, Japan
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21
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Salaorni F, Bonardi G, Schena F, Tinazzi M, Gandolfi M. Wearable devices for gait and posture monitoring via telemedicine in people with movement disorders and multiple sclerosis: a systematic review. Expert Rev Med Devices 2024; 21:121-140. [PMID: 38124300 DOI: 10.1080/17434440.2023.2298342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Wearable devices and telemedicine are increasingly used to track health-related parameters across patient populations. Since gait and postural control deficits contribute to mobility deficits in persons with movement disorders and multiple sclerosis, we thought it interesting to evaluate devices in telemedicine for gait and posture monitoring in such patients. METHODS For this systematic review, we searched the electronic databases MEDLINE (PubMed), SCOPUS, Cochrane Library, and SPORTDiscus. Of the 452 records retrieved, 12 met the inclusion/exclusion criteria. Data about (1) study characteristics and clinical aspects, (2) technical, and (3) telemonitoring and teleconsulting were retrieved, The studies were quality assessed. RESULTS All studies involved patients with Parkinson's disease; most used triaxial accelerometers for general assessment (n = 4), assessment of motor fluctuation (n = 3), falls (n = 2), and turning (n = 3). Sensor placement and count varied widely across studies. Nine used lab-validated algorithms for data analysis. Only one discussed synchronous patient feedback and asynchronous teleconsultation. CONCLUSIONS Wearable devices enable real-world patient monitoring and suggest biomarkers for symptoms and behaviors related to underlying gait disorders. thus enriching clinical assessment and personalized treatment plans. As digital healthcare evolves, further research is needed to enhance device accuracy, assess user acceptability, and integrate these tools into telemedicine infrastructure. PROSPERO REGISTRATION CRD42022355460.
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Affiliation(s)
- Francesca Salaorni
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giulia Bonardi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Schena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Verona, Italy
- Neurorehabilitation Unit - Azienda Ospedaliera Universitaria Integrata, Verona
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22
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Rodríguez J, Marín J, Royo AC, Padrón L, Pérez-Soto M, Marín JJ. KeepRunning: A MoCap-Based Rapid Test to Prevent Musculoskeletal Running Injuries. SENSORS (BASEL, SWITZERLAND) 2023; 23:9336. [PMID: 38067707 PMCID: PMC10708810 DOI: 10.3390/s23239336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/10/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023]
Abstract
The worldwide popularisation of running as a sport and recreational practice has led to a high rate of musculoskeletal injuries, usually caused by a lack of knowledge about the most suitable running technique for each runner. This running technique is determined by a runner's anthropometric body characteristics, dexterity and skill. Therefore, this study aims to develop a motion capture-based running analysis test on a treadmill called KeepRunning to obtain running patterns rapidly, which will aid coaches and clinicians in assessing changes in running technique considering changes in the study variables. Therefore, a review and proposal of the most representative events and variables of analysis in running was conducted to develop the KeepRunning test. Likewise, the minimal detectable change (MDC) in these variables was obtained using test-retest reliability to demonstrate the reproducibility and viability of the test, as well as the use of MDC as a threshold for future assessments. The test-retest consisted of 32 healthy volunteer athletes with a running training routine of at least 15 km per week repeating the test twice. In each test, clusters of markers were placed on the runners' body segments using elastic bands and the volunteers' movements were captured while running on a treadmill. In this study, reproducibility was defined by the intraclass correlation coefficient (ICC) and MDC, obtaining a mean value of ICC = 0.94 ± 0.05 for all variables and MDC = 2.73 ± 1.16° for the angular kinematic variables. The results obtained in the test-retest reveal that the reproducibility of the test was similar or better than that found in the literature. KeepRunning is a running analysis test that provides data from the involved body segments rapidly and easily interpretable. This data allows clinicians and coaches to objectively provide indications for runners to improve their running technique and avoid possible injury. The proposed test can be used in the future with inertial motion capture and other wearable technologies.
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Affiliation(s)
- Javier Rodríguez
- IDERGO (Research and Development in Ergonomics), I3A (Instituto de Investigación en Ingeniería de Aragón), University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain (A.C.R.); (L.P.); (M.P.-S.); (J.J.M.)
| | - Javier Marín
- IDERGO (Research and Development in Ergonomics), I3A (Instituto de Investigación en Ingeniería de Aragón), University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain (A.C.R.); (L.P.); (M.P.-S.); (J.J.M.)
- Department of Design and Manufacturing Engineering, University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain
| | - Ana C. Royo
- IDERGO (Research and Development in Ergonomics), I3A (Instituto de Investigación en Ingeniería de Aragón), University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain (A.C.R.); (L.P.); (M.P.-S.); (J.J.M.)
- Department of Design and Manufacturing Engineering, University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain
| | - Luis Padrón
- IDERGO (Research and Development in Ergonomics), I3A (Instituto de Investigación en Ingeniería de Aragón), University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain (A.C.R.); (L.P.); (M.P.-S.); (J.J.M.)
- Department of Biomedical Engineering, University of Zaragoza, C/Mariano Esquillor s/n, 50018 Zaragoza, Spain
| | - Manuel Pérez-Soto
- IDERGO (Research and Development in Ergonomics), I3A (Instituto de Investigación en Ingeniería de Aragón), University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain (A.C.R.); (L.P.); (M.P.-S.); (J.J.M.)
- Department of Design and Manufacturing Engineering, University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain
| | - José J. Marín
- IDERGO (Research and Development in Ergonomics), I3A (Instituto de Investigación en Ingeniería de Aragón), University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain (A.C.R.); (L.P.); (M.P.-S.); (J.J.M.)
- Department of Design and Manufacturing Engineering, University of Zaragoza, C/María de Luna, 3, 50018 Zaragoza, Spain
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