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Eastman J, White H, Evans J, Augsburger S, Wallace J, Riley S, Iwinski H. What is the minimum torque required to obtain passive elbow end range of motion? Gait Posture 2022; 93:235-239. [PMID: 35190315 DOI: 10.1016/j.gaitpost.2022.02.010] [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: 01/05/2021] [Revised: 01/26/2022] [Accepted: 02/12/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Passive range of motion is a common clinical assessment. The point at which passive end range of motion is measured is typically described by the 'end-feel'of the joint. RESEARCH QUESTION What is the minimum amount of torque required to obtain passive elbow flexion and extension in children? METHODS Twenty-five children (age, 7.5 ± 1.6 years-old), who had previously sustained unilateral distal humeral fractures, participated in this prospective study.Passive elbow flexion and extension was measured at least 8 weeks and up to one year out of cast. Motion capture cameras were used to track twenty-one reflective markers placed on subjects and two markers attached to the pad of a force transducer.Five trials of passive range of motion (flexion and extension) were performed on both arms. Elbow joint moments were calculated as products of the forces applied and lengths to the elbow centers. A one way ANOVA was used to determine differences in moments for flexion and extension for both involved and uninvolved limbs. Pairedsamples t-tests were used to determine differences between the involved and the uninvolved limbs for both maximum flexion and extension. RESULTS There was no difference in the minimum mean joint moment (2.7 ± 1.1 Nm) at end range of motion. However, differences in passive range of motion was found between involved and uninvolved elbows (flexion p < .001; extension p = .001). SIGNIFICANCE The results demonstrate therapists obtained end range of passive elbow flexion and extension applying the same amount of minimum torque. A small torque is sufficient to achieve end range of elbow motion for children. This torque can be used in guiding clinical practice for assessing passive range of elbow motion in pediatric population. Because of a paucity of data for any joint, future research developing force data for other joints should be conducted.
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Affiliation(s)
- Joel Eastman
- Motion Analysis Center Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA
| | - Hank White
- Motion Analysis Center Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA.
| | - Jenn Evans
- Motion Analysis Center Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA
| | - Sam Augsburger
- Motion Analysis Center Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA
| | - Juanita Wallace
- Department of Health and Exercise Science, Transylvania University, 300 North Broadway, Lexington, KY 40508, USA
| | - Scott Riley
- Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA; University of Kentucky Department of Orthopaedic Surgery and Sports Medicine, 740 S. Limestone Street, Lexington, KY 40536, USA
| | - Henry Iwinski
- Shriners Hospitals for Children Medical Center, 110 Conn Terrace, Lexington, KY 40508, USA; University of Kentucky Department of Orthopaedic Surgery and Sports Medicine, 740 S. Limestone Street, Lexington, KY 40536, USA
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Li G, Shourijeh MS, Ao D, Patten C, Fregly BJ. How Well Do Commonly Used Co-contraction Indices Approximate Lower Limb Joint Stiffness Trends During Gait for Individuals Post-stroke? Front Bioeng Biotechnol 2021; 8:588908. [PMID: 33490046 PMCID: PMC7817819 DOI: 10.3389/fbioe.2020.588908] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022] Open
Abstract
Muscle co-contraction generates joint stiffness to improve stability and accuracy during limb movement but at the expense of higher energetic cost. However, quantification of joint stiffness is difficult using either experimental or computational means. In contrast, quantification of muscle co-contraction using an EMG-based Co-Contraction Index (CCI) is easier and may offer an alternative for estimating joint stiffness. This study investigated the feasibility of using two common CCIs to approximate lower limb joint stiffness trends during gait. Calibrated EMG-driven lower extremity musculoskeletal models constructed for two individuals post-stroke were used to generate the quantities required for CCI calculations and model-based estimation of joint stiffness. CCIs were calculated for various combinations of antagonist muscle pairs based on two common CCI formulations: Rudolph et al. (2000) (CCI1) and Falconer and Winter (1985) (CCI2). CCI1 measures antagonist muscle activation relative to not only total activation of agonist plus antagonist muscles but also agonist muscle activation, while CCI2 measures antagonist muscle activation relative to only total muscle activation. We computed the correlation between these two CCIs and model-based estimates of sagittal plane joint stiffness for the hip, knee, and ankle of both legs. Although we observed moderate to strong correlations between some CCI formulations and corresponding joint stiffness, these associations were highly dependent on the methodological choices made for CCI computation. Specifically, we found that: (1) CCI1 was generally more correlated with joint stiffness than was CCI2, (2) CCI calculation using EMG signals with calibrated electromechanical delay generally yielded the best correlations with joint stiffness, and (3) choice of antagonist muscle pairs significantly influenced CCI correlation with joint stiffness. By providing guidance on how methodological choices influence CCI correlation with joint stiffness trends, this study may facilitate a simpler alternate approach for studying joint stiffness during human movement.
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Affiliation(s)
- Geng Li
- Rice Computational Neuromechanics Laboratory, Department of Mechanical Engineering, Rice University, Houston, TX, United States
| | - Mohammad S Shourijeh
- Rice Computational Neuromechanics Laboratory, Department of Mechanical Engineering, Rice University, Houston, TX, United States
| | - Di Ao
- Rice Computational Neuromechanics Laboratory, Department of Mechanical Engineering, Rice University, Houston, TX, United States
| | - Carolynn Patten
- Biomechanics, Rehabilitation, and Integrative Neuroscience Lab, Department of Physical Medicine and Rehabilitation, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Benjamin J Fregly
- Rice Computational Neuromechanics Laboratory, Department of Mechanical Engineering, Rice University, Houston, TX, United States
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Chlebuś E, Wareńczak A, Miedzyblocki M, Lisiński P. The usefulness of isometric protocol for foot flexors and extensors in assessing the effects of 16-week rehabilitation regiment in poststroke patients. Biomed Eng Online 2019; 18:57. [PMID: 31088462 PMCID: PMC6518709 DOI: 10.1186/s12938-019-0678-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ankle joint function in a paretic limb has a fundamental impact on mobility. Return of joint function is a measure of early poststroke physical rehabilitation. This study aims to assess the suitability of using the isometric protocol for objective evaluation of flexor and extensor muscle strength in the paretic limb of poststroke patients. METHODS 34 patients (F: 9, M: 25) aged 51-79 years with hemiparesis following an acute ischemic stroke and 34 healthy controls were examined using the isometric protocol measured on the Biodex System®. The following parameters were analyzed: peak torque [PT], average torque [AVGT], average torque/body weight [AVGT/BW] for flexors and extensors, and AVGT flexor/AVGT extensor [agonist/antagonist ratio] of the paretic foot, the nonparetic foot and foot of healthy controls using three foot-shank positions (15°, 0°, and - 15°) prior to rehabilitation commencement and at its completion 16 weeks later. RESULTS Prior to rehabilitation commencement, nonparetic foot differed significantly (p < 0.05) from healthy foot controls in all parameters and all positions for flexors and in all positions for foot-shank positions of 0° and - 15° for extensors. At rehabilitation program completion the following parameters increased significantly for the paretic foot: PT, AVGT, and AVGT/BW for foot extensors in all tested positions, and PT for foot flexors in foot-shank position of - 15°. The nonparetic foot however, showed no significant difference following rehabilitation regardless parameter or foot position tested for flexors and extensors alike. Prior to rehabilitation agonist/antagonist ratio in the paretic foot differed significantly from corresponding parameter in the control group for the foot-shank positions of 15° and 0°, whereas at rehabilitation completion, the two groups showed significant difference only in foot-shank position of 0°. CONCLUSIONS In the early period following stroke, there is a significant strengthening of the paretic limb, but no improvement in the strength of nonparetic limb.
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Affiliation(s)
- Ewa Chlebuś
- Department of Rehabilitation and Physiotherapy Rehabilitation, University of Medical Sciences, 28 Czerwca 1956 Str., No 135/147, 60-545, Poznan, Poland.
| | - Agnieszka Wareńczak
- Department of Rehabilitation and Physiotherapy Rehabilitation, University of Medical Sciences, 28 Czerwca 1956 Str., No 135/147, 60-545, Poznan, Poland
| | - Margaret Miedzyblocki
- Department of Rehabilitation and Physiotherapy Rehabilitation, University of Medical Sciences, 28 Czerwca 1956 Str., No 135/147, 60-545, Poznan, Poland
| | - Przemysław Lisiński
- Department of Rehabilitation and Physiotherapy Rehabilitation, University of Medical Sciences, 28 Czerwca 1956 Str., No 135/147, 60-545, Poznan, Poland
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Kobayashi T, Singer ML, Orendurff MS, Gao F, Daly WK, Foreman KB. The effect of changing plantarflexion resistive moment of an articulated ankle-foot orthosis on ankle and knee joint angles and moments while walking in patients post stroke. Clin Biomech (Bristol, Avon) 2015; 30:775-80. [PMID: 26149007 PMCID: PMC4568124 DOI: 10.1016/j.clinbiomech.2015.06.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 06/19/2015] [Accepted: 06/23/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The adjustment of plantarflexion resistive moment of an articulated ankle-foot orthosis is considered important in patients post stroke, but the evidence is still limited. Therefore, the aim of this study was to investigate the effect of changing the plantarflexion resistive moment of an articulated ankle-foot orthosis on ankle and knee joint angles and moments in patients post stroke. METHODS Gait analysis was performed on 10 subjects post stroke under four different plantarflexion resistive moment conditions using a newly designed articulated ankle-foot orthosis. Data were recorded using a Bertec split-belt instrumented treadmill in a 3-dimensional motion analysis laboratory. FINDINGS The ankle and knee sagittal joint angles and moments were significantly affected by the amount of plantarflexion resistive moment of the ankle-foot orthosis. Increasing the plantarflexion resistive moment of the ankle-foot orthosis induced significant decreases both in the peak ankle plantarflexion angle (P<0.01) and the peak knee extension angle (P<0.05). Also, the increase induced significant increases in the internal dorsiflexion moment of the ankle joint (P<0.01) and significantly decreased the internal flexion moment of the knee joint (P<0.01). INTERPRETATION These results suggest an important link between the kinematic/kinetic parameters of the lower-limb joints and the plantarflexion resistive moment of an articulated ankle-foot orthosis. A future study should be performed to clarify their relationship further so that the practitioners may be able to use these parameters as objective data to determine an optimal plantarflexion resistive moment of an articulated ankle-foot orthosis for improved orthotic care in individual patients.
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Affiliation(s)
- Toshiki Kobayashi
- Orthocare Innovations, Mountlake Terrace, WA, USA; Department of Prosthetics and Orthotics, Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Hokkaido, Japan.
| | - Madeline L Singer
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
| | | | - Fan Gao
- Department of Health Care Sciences, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Wayne K Daly
- Orthocare Innovations, Mountlake Terrace, WA, USA
| | - K Bo Foreman
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
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Zhang M, Davies TC, Zhang Y, Xie S. Reviewing effectiveness of ankle assessment techniques for use in robot-assisted therapy. ACTA ACUST UNITED AC 2014; 51:517-34. [DOI: 10.1682/jrrd.2013.03.0066] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 12/13/2013] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Yanxin Zhang
- Sport and Exercise Science, University of Auckland, Auckland, New Zealand
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Kobayashi T, Leung AK, Hutchins SW. Design of a manual device to measure ankle joint stiffness and range of motion. Prosthet Orthot Int 2011; 35:478-81. [PMID: 22013156 DOI: 10.1177/0309364611425696] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIM Ankle joint stiffness and its range of motion (ROM) are commonly assessed to determine the appropriate mechanical characteristics required in an effective ankle-foot orthosis (AFO) prescription. The aim of this technical note is to present the design of a manual device that enables their convenient measurement in the clinical setting and to demonstrate its reliability. TECHNIQUE The manual device was designed with a torquemeter, a potentiometer, a steering wheel, a rotary plate, and a foot plate. The measurement of resistive torque at 0° (neutral), 5° (dorsiflexion) and 10° (dorsiflexion) ankle angular positions demonstrated the high reliability of the device with Intraclass Correlation Coefficient (ICC) (1,k) values over 0.97. DISCUSSION Quantitative measurement of ankle joint stiffness and ROM by this manual device would provide objective information that could potentially assist AFO prescriptions. A future study should investigate how to incorporate the measurement obtained from the device into the prescription of an AFO.
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Affiliation(s)
- Toshiki Kobayashi
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.
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Lee H, Ho P, Rastgaar MA, Krebs HI, Hogan N. Multivariable static ankle mechanical impedance with relaxed muscles. J Biomech 2011; 44:1901-8. [PMID: 21571278 DOI: 10.1016/j.jbiomech.2011.04.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 04/01/2011] [Accepted: 04/16/2011] [Indexed: 12/26/2022]
Abstract
Quantitative characterization of ankle mechanical impedance is important to understand how the ankle supports lower-extremity functions during interaction with the environment. This paper reports a novel procedure to characterize static multivariable ankle mechanical impedance. An experimental protocol using a wearable therapeutic robot, Anklebot, enabled reliable measurement of torque and angle data in multiple degrees of freedom simultaneously, a combination of inversion-eversion and dorsiflexion-plantarflexion. The measured multivariable torque-angle relation was represented as a vector field, and approximated using a method based on thin-plate spline smoothing with generalized cross validation. The vector field enabled assessment of several important characteristics of static ankle mechanical impedance, which are not available from prior single degree of freedom studies: the directional variation of ankle mechanical impedance, the extent to which the ankle behaves as a spring, and evidence of uniquely neural contributions. The method was validated by testing a simple physical "mock-up" consisting of passive elements. Experiments with young unimpaired subjects quantified the behavior of the maximally relaxed human ankle, showing that ankle mechanical impedance is spring-like but strongly direction-dependent, being weakest in inversion. Remarkably, the analysis was sufficiently sensitive to detect a subtle but statistically significant deviation from spring-like behavior if subjects were not fully relaxed. This method may provide new insight about the function of the ankle, both unimpaired and after biomechanical or neurological injury.
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Affiliation(s)
- Hyunglae Lee
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Room 3-147, 77 Massachusetts Avenue, Cambridge, MA 02139, USA.
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Kobayashi T, Leung AKL, Akazawa Y, Hutchins SW. Evaluating the contribution of a neural component of ankle joint resistive torque in patients with stroke using a manual device. Brain Inj 2011; 25:307-14. [DOI: 10.3109/02699052.2010.551647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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