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Fehr KH, Kent JA, Major MJ, Adamczyk PG. Changes in Dynamic Mean Ankle Moment Arm in Unimpaired Walking Across Speeds, Ramps, and Stairs. J Biomech Eng 2024; 146:094501. [PMID: 38581371 DOI: 10.1115/1.4065269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/04/2024] [Indexed: 04/08/2024]
Abstract
Understanding the natural biomechanics of walking at different speeds and activities is crucial to develop effective assistive devices for persons with lower-limb impairments. While continuous measures such as joint angle and moment are well-suited for biomimetic control of robotic systems, whole-stride summary metrics are useful for describing changes across behaviors and for designing and controlling passive and semi-active devices. Dynamic mean ankle moment arm (DMAMA) is a whole-stride measure representing the moment arm of the ground reaction impulse about the ankle joint-effectively, how "forefoot-dominated" or "hindfoot-dominated" a movement is. DMAMA was developed as a target and performance metric for semi-active devices that adjust once per stride. However, for implementation in this application, DMAMA must be characterized across various activities in unimpaired individuals. In our study, unimpaired participants walked at "slow," "normal," and "fast" self-selected speeds on level ground and at a normal self-selected speed while ascending and descending stairs and a 5-degree incline ramp. DMAMA measured from these activities displayed a borderline-significant negative sensitivity to walking speed, a significant positive sensitivity to ground incline, and a significant decrease when ascending stairs compared to descending. The data suggested a nonlinear relationship between DMAMA and walking speed; half of the participants had the highest average DMAMA at their "normal" speed. Our findings suggest that DMAMA varies substantially across activities, and thus, matching DMAMA could be a valuable metric to consider when designing biomimetic assistive lower-limb devices.
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Affiliation(s)
- Katherine Heidi Fehr
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI 53705
| | - Jenny A Kent
- Department of Physical Therapy, University of Nevada Las Vegas, 4505 S Maryland Pkwy, Las Vegas, NV 89154
| | - Matthew J Major
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL 60611; Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208; Jesse Brown Department of Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, 680 N Lake Shore Dr, Suite 1100, Chicago, IL 60611
| | - Peter Gabriel Adamczyk
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Ave., Rm. 3039, Madison, WI 53705
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Kim J, Kim Y, Kang S, Kim SJ. Investigation with able-bodied subjects suggests Myosuit may potentially serve as a stair ascent training robot. Sci Rep 2023; 13:14099. [PMID: 37644147 PMCID: PMC10465530 DOI: 10.1038/s41598-023-35769-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/23/2023] [Indexed: 08/31/2023] Open
Abstract
Real world settings are seldomly just composed of level surfaces and stairs are frequently encountered in daily life. Unfortunately, ~ 90% of the elderly population use some sort of compensation pattern in order to negotiate stairs. Because the biomechanics required to successfully ascend stairs is significantly different from level walking, an independent training protocol is warranted. Here, we present as a preliminary investigation with 11 able-bodied subjects, prior to clinical trials, whether Myosuit could potentially serve as a stair ascent training robot. Myosuit is a soft wearable exosuit that was designed to assist the user via hip and knee extension during the early stance phase. We hypothesized that clinical studies could be carried out if the lower limb kinematics, sensory feedback via plantar force, and electromyography (EMG) patterns do not deviate from the user's physiological stair ascent patterns while reducing hip and knee extensor demand. Our results suggest that Myosuit conserves the user's physiological kinematic and plantar force patterns. Moreover, we observe approximately 20% and 30% decrease in gluteus maximus and vastus medialis EMG levels in the pull up phase, respectively. Collectively, Myosuit reduces the hip and knee extensor demand during stair ascent without any introduction of significant compensation patterns.
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Affiliation(s)
- Jaewook Kim
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul, 02841, Korea
| | - Yekwang Kim
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul, 02841, Korea
| | - Seonghyun Kang
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul, 02841, Korea
| | - Seung-Jong Kim
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul, 02841, Korea.
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Siebers HL, Eschweiler J, Michalik R, Migliorini F, Tingart M, Betsch M. Biomechanical compensation mechanisms during stair climbing - The effect of leg length inequalities. Gait Posture 2022; 91:290-296. [PMID: 34798420 DOI: 10.1016/j.gaitpost.2021.10.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 09/01/2021] [Accepted: 10/12/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Stair climbing is a complex and demanding daily activity with increased physical loads. Therefore, analyzing stair climbing abilities is a frequently used diagnostic tool. Leg length inequalities (LLIs) are a common condition in the population, with individual consequences like lower back pain, scoliosis, and osteoarthritis. Despite its high prevalence, the necessary treatment, for mild LLIs, is still controversial. Previously, the focus was to analyze the effects of LLIs during static standing and walking. To create a holistic view on the dynamic effects of LLIs, and since climbing stairs produces a similar biomechanical imbalance as LLIs, the compensation mechanics during stair climbing are of special interest. RESEARCH QUESTION What are the biomechanical compensation mechanisms of (simulated) LLIs during ascending and descending stairs? METHODS Thirty-five healthy participants were measured with the inertial measurement system MyoMotion during stair climbing with simulated LLIs of 0-3 cm. The maximum estimated lower limb joint angles of the long and short leg were analyzed with statistically repeated measurement models. RESULTS The long leg showed significantly increased hip and knee flexion, while the short leg showed decreased hip and knee flexion, decreased dorsiflexion, and significantly increased plantarflexion. Different mechanisms were found in the case of 1 cm LLI when compared to greater LLIs. In the former, increased hip and knee flexion in the short leg accompanied by increased dorsiflexion in the long leg was observed. In the latter, the dorsiflexion of the long leg was reduced. SIGNIFICANCE Except for the reduced dorsiflexion of the long leg (LLI >1 cm), during stair climbing compared compensation mechanisms as during walking were presented, with the long leg functionally shortened and the short leg lengthened. Although the feet were already on different levels, during stair climbing with the step-over-step technique, significant compensation mechanisms were found as a consequence of LLIs.
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Affiliation(s)
- Hannah Lena Siebers
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany.
| | - Jörg Eschweiler
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Roman Michalik
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of the University Heidelberg, Mannheim, Germany
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Siebers HL, Alrawashdeh W, Betsch M, Migliorini F, Hildebrand F, Eschweiler J. Comparison of different symmetry indices for the quantification of dynamic joint angles. BMC Sports Sci Med Rehabil 2021; 13:130. [PMID: 34666818 PMCID: PMC8527670 DOI: 10.1186/s13102-021-00355-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Symmetry is a sign of physiological and healthy movements, as pathologies are often described by increased asymmetries. Nevertheless, based on precisely measured data, even healthy individuals will show small asymmetries in their movements. However, so far there do not exist commonly accepted methods and reference values for gait symmetry in a healthy collective. Therefore, a comparison and presentation of reference values calculated by 3 different methods of symmetry indices for lower limb joint angles during walking, ascending, and descending stairs were shown. METHODS Thirty-five healthy participants were analyzed during walking, ascending, and descending stairs with the help of the inertial measurement system MyoMotion. Using the normalized symmetry index (SInorm), the symmetry index (SI) as the integral of the symmetry function, and another normalized symmetry index (NSI), the symmetry of joint angles was evaluated. For statistical evaluation of differences, repeated measurement models and Bland-Altman-Plots were used. RESULTS Apart from a bias between the symmetry indices, they were comparable in the predefined limits of 5%. For all parameters, significantly higher asymmetry was found for ankle dorsi/-plantarflexion, compared with the hip and knee flexion. Moreover, the interaction effect of the joint and movement factors was significant, with an increased asymmetry of the hip and knee during descending stairs greater than while ascending stairs or walking, but a reduced symmetry of the ankle during walking when compared to descending. The movement only showed significant effects when analyzing the SInorm. CONCLUSION Even for healthy individuals, small asymmetries of movements were found and presented as reference values using 3 different symmetry indices for dynamic lower limb joint angles during 3 different movements. For the quantification of symmetrical movements differences between the joints, movements, and especially their interaction, are necessary to be taken into account. Moreover, a bias between the methods should be noted. The potential for each presented symmetry index to identify pathological movements or track a rehabilitation process was shown but has to be proven in further research. TRIAL REGISTRATION DRKS00025878.
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Affiliation(s)
- Hannah Lena Siebers
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Waleed Alrawashdeh
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of the University Heidelberg, Mannheim, Germany
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
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Hessel AL, Raiteri BJ, Marsh MJ, Hahn D. Rightward shift of optimal fascicle length with decreasing voluntary activity level in the soleus and lateral gastrocnemius muscles. J Exp Biol 2021; 224:jeb235614. [PMID: 33257433 DOI: 10.1242/jeb.235614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022]
Abstract
Much of our understanding of in vivo skeletal muscle properties is based on studies performed under maximal activation, which is problematic because muscles are rarely activated maximally during movements such as walking. Currently, force-length properties of the human triceps surae at submaximal voluntary muscle activity levels are not characterized. We therefore evaluated plantar flexor torque- and force-ankle angle, and torque- and force-fascicle length properties of the soleus and lateral gastrocnemius muscles during voluntary contractions at three activity levels: 100, 30 and 22% of maximal voluntary contraction. Soleus activity levels were controlled by participants via real-time electromyography feedback and contractions were performed at ankle angles ranging from 10 deg plantar flexion to 35 deg dorsiflexion. Using dynamometry and ultrasound imaging, torque-fascicle length curves of the soleus and lateral gastrocnemius muscles were constructed. The results indicate that small muscle activity reductions shift the torque- and force-angle, and torque- and force-fascicle length curves of these muscles to more dorsiflexed ankle angles and longer fascicle lengths (from 3 to 20% optimal fascicle length, depending on ankle angle). The shift in the torque- and force-fascicle length curves during submaximal voluntary contraction have potential implications for human locomotion (e.g. walking) as the operating range of fascicles shifts to the ascending limb, where muscle force capacity is reduced by at least 15%. These data demonstrate the need to match activity levels during construction of the torque- and force-fascicle length curves to activity levels achieved during movement to better characterize the lengths that muscles operate at relative to their optimum during a specific task.
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Affiliation(s)
- Anthony L Hessel
- Ruhr University Bochum, Faculty of Sport Science, Human Movement Science, 44801 Bochum, Germany
- Institute for Physiology II, University of Muenster, 48149 Muenster, Germany
| | - Brent J Raiteri
- Ruhr University Bochum, Faculty of Sport Science, Human Movement Science, 44801 Bochum, Germany
| | - Michael J Marsh
- Ruhr University Bochum, Faculty of Sport Science, Human Movement Science, 44801 Bochum, Germany
| | - Daniel Hahn
- Ruhr University Bochum, Faculty of Sport Science, Human Movement Science, 44801 Bochum, Germany
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, 4072 Australia
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Bannwart M, Rohland E, Easthope CA, Rauter G, Bolliger M. Robotic body weight support enables safe stair negotiation in compliance with basic locomotor principles. J Neuroeng Rehabil 2019; 16:157. [PMID: 31870393 PMCID: PMC6929285 DOI: 10.1186/s12984-019-0631-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/11/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND After a neurological injury, mobility focused rehabilitation programs intensively train walking on treadmills or overground. However, after discharge, quite a few patients are not able to independently negotiate stairs, a real-world task with high physical and psychological demands and a high injury risk. To decrease fall risk and improve patients' capacity to navigate typical environments, early stair negotiation training can help restore competence and confidence in safe stair negotiation. One way to enable early training in a safe and permissive environment is to unload the patient with a body weight support system. We here investigated if unloaded stair negotiation complies with basic locomotor principles, in terms of enabling performance of a physiological movement pattern with minimal compensation. METHODS Seventeen able-bodied participants were unloaded with 0-50% bodyweight during self-paced ascent and descent of a 4-tread staircase. Spatio-temporal parameters, joint ranges of motion, ground reaction forces and myoelectric activity in the main lower limb muscles of participants were compared between unloading levels. Likelihood ratio tests of separated linear mixed models of the investigated outcomes assessed if unloading affects the parameters in general. Subsequent post-hoc testing revealed which levels of unloading differed from unsupported stair negotiation. RESULTS Unloading affected walking velocity, joint ranges of motion, vertical ground reaction force parameters and myoelectric activity in all investigated muscles for stair ascent and descent while step width and single support duration were only affected during ascent. A reduction with increasing levels of body weight support was seen in walking velocity (0.07-0.12 m/s), ranges of motion of the knee and hip (2-10°), vertical ground reaction force peaks (10-70%) and myoelectric activity (17-70%). An increase with unloading was only seen during ascent for ankle range of motion and tibialis anterior activity at substantial unloading. CONCLUSIONS Body weight support facilitates stair negotiation by providing safety and support against gravity. Although unloading effects are present in most parameters, up to 30% body weight support these changes are small, and no dysfunctional patterns are introduced. Body weight support therefore fulfills all the necessary requirements for early stair negotiation training.
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Affiliation(s)
- M. Bannwart
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
- Sensory Motor Systems Lab, Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - E. Rohland
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
| | - C. A. Easthope
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
- Cereneo Center for Interdisciplinary Research, Vitznau, Switzerland
| | - G. Rauter
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
- Sensory Motor Systems Lab, Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
- BIROMED-Lab, Department of Biomedical Engineering, University Basel, Gewerbestrasse 14, CH-4123 Basel, Allschwil Switzerland
| | - M. Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland
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De Vroey H, Staes F, Vereecke E, Vanrenterghem J, Deklerck J, Van Damme G, Hallez H, Claeys K. Lower extremity gait kinematics outcomes after knee replacement demonstrate arthroplasty-specific differences between unicondylar and total knee arthroplasty: A pilot study. Gait Posture 2019; 73:299-304. [PMID: 31401372 DOI: 10.1016/j.gaitpost.2019.07.196] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/10/2019] [Accepted: 07/15/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of the present study is to compare sagittal gait kinematics of ankle, knee and hip joints between subjects with unicondylar and total knee arthroplasty and age matched healthy controls. Since unicondylar knee replacement is a less invasive procedure, which more closely preserves knee joint anatomy, we hypothesized that one year post unicondylar knee arthroplasty patients would demonstrate more normal gait patterns than patients with total knee arthroplasty. RESEARCH QUESTION Do unicondylar and total knee arthroplasty patients display similar gait kinematics one year after surgery? METHODS Fourteen subjects (8 posterior stabilized and 6 medial unicondylar knee replacements) that were one year post surgery, and 6 healthy control subjects underwent a 3D gait analysis and a physical examination (range of motion, muscle strength). Statistical parametric mapping was used to compare gait kinematics of the lower limbs between groups. Additionally, differences in peak angles and clinical outcomes were assessed using a one-way ANOVA between subjects analysis. RESULTS Both knee replacement groups showed reduced knee flexion range of motion and reduced muscle strength at the operated leg compared to the control group. Subjects with TKA demonstrated reduced knee flexion at loading response and midstance of the gait cycle. Both UKA and TKA demonstrated significantly less knee flexion during swing. SIGNIFICANCE The results of this study demonstrate arthroplasty-specific differences in muscle strength, range of motion and gait kinematics of the lower limb one year after knee surgery. Future planning of post-surgery follow-up should addresses these arthroplasty-specific weaknesses and gait deviations.
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Affiliation(s)
- Henri De Vroey
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Spoorwegstraat 12, 8200 Bruges, Belgium.
| | - Filip Staes
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001 Heverlee, Belgium.
| | - Evie Vereecke
- Department of Development and Regeneration, KULAK, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium.
| | - Jos Vanrenterghem
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001 Heverlee, Belgium.
| | - Jan Deklerck
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Spoorwegstraat 12, 8200 Bruges, Belgium.
| | - Geert Van Damme
- Department of Orthopaedic Surgery, AZ Sint-Lucas, Sint-Lucaslaan 29, 8310 Bruges, Belgium.
| | - Hans Hallez
- Department of Computer Science, KU Leuven Campus Bruges, Spoorwegstraat 12, 8200 Bruges, Belgium.
| | - Kurt Claeys
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Spoorwegstraat 12, 8200 Bruges, Belgium; Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001 Heverlee, Belgium.
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Knee adduction moments are not increased in obese knee osteoarthritis patients during stair negotiation. Gait Posture 2019; 73:154-160. [PMID: 31336330 DOI: 10.1016/j.gaitpost.2019.07.192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Negotiating stairs is an important activity of daily living that is also associated with large loads on the knee joint. In medial compartment knee osteoarthritis, the knee adduction moment during level walking is considered a marker for disease severity. It could be argued that the discriminative capability of this parameter is even better if tested in a strenuous stair negotiation task. RESEARCH QUESTION What is the relation with knee osteoarthritis on the knee adduction moment during the stance phase of both stair ascent and descent in patients with and without obesity? METHODS This case control study included 22 lean controls, 16 lean knee osteoarthritis patients, and 14 obese knee osteoarthritis patients. All subjects ascended and descended a two-step staircase at a self-selected, comfortable speed. Three-dimensional motion analysis was performed to evaluate the knee adduction moment during stair negotiation. RESULTS Obese knee osteoarthritis patients show a prolonged stance time together with a more flattened knee adduction moment curve during stair ascent. Normalized knee adduction moment impulse, as well as the first and second peaks were not different between groups. During stair descent, a similar increase in stance time was found for both osteoarthritis groups. SIGNIFICANCE The absence of a significant effect of groups on the normalized knee adduction moment during stair negotiation may be explained by a lower ambulatory speed in the obese knee osteoarthritis group, that effectively lowers vertical ground reaction force. Decreasing ambulatory speed may be an effective strategy to lower knee adduction moment during stair negotiation.
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Lewerenz A, Wolf SI, Dreher T, Krautwurst BK. Performance of stair negotiation in patients with cerebral palsy and stiff knee gait. Gait Posture 2019; 71:14-19. [PMID: 30999269 DOI: 10.1016/j.gaitpost.2019.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/15/2019] [Accepted: 04/08/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Due to the limited knee range of motion, achieving adequate foot clearance while walking on level ground constitutes a major problem for patients with cerebral palsy and stiff knee gait. Stair negotiation as an activity of daily life requires a considerably higher knee range of motion than level ground walking, but little is known yet as to whether such patients are able to walk stairs. RESEARCH QUESTION The aim of this study was to investigate how patients with a limited knee range of motion negotiate stairs. Do they increase their peak knee flexion and use the same pattern as in walking on level ground? How do the muscles act during stair negotiation? METHODS In this explorative study, 17 adults with bilateral, spastic cerebral palsy and stiff knee gait and 25 healthy subjects were examined. 3D motion analysis, including electromyography, was performed while walking on level ground, upstairs, and downstairs. A linear mixed model was used for between- and within-group comparisons. RESULTS Walking upstairs and downstairs, patients increased their peak knee flexion by around 30° compared to level walking. Thus, increased knee flexion may be seen as the main mechanism for maintaining foot clearance on stairs. An increased pelvic obliquity (elevation) and hip flexion were also found and involved subjects showed a slight increase in rectus femoris activity when walking on stairs compared to level walking within the phases of high knee flexion. SIGNIFICANCE This study showed that patients with cerebral palsy and stiff knee gait are able to flex their knees more than would be required for level walking. Hence, the patients are able to adapt their rectus activity to stair walking to some extent. Therefore, further investigations might help to open up new therapeutic options to facilitate level walking and stair negotiation in patients with stiff knee gait.
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Affiliation(s)
- Annika Lewerenz
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Sebastian I Wolf
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - Thomas Dreher
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; Pediatric Orthopaedics and Traumatology, University, Children's Hospital Zurich - Eleonore Foundation, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
| | - Britta K Krautwurst
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; Pediatric Orthopaedics and Traumatology, University, Children's Hospital Zurich - Eleonore Foundation, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
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Caruthers EJ, Oxendale KK, Lewis JM, Chaudhari AMW, Schmitt LC, Best TM, Siston RA. Forces Generated by Vastus Lateralis and Vastus Medialis Decrease with Increasing Stair Descent Speed. Ann Biomed Eng 2018; 46:579-589. [PMID: 29340933 PMCID: PMC7942835 DOI: 10.1007/s10439-018-1979-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 01/05/2018] [Indexed: 11/24/2022]
Abstract
Stair descent (SD) is a common, difficult task for populations who are elderly or have orthopaedic pathologies. Joint torques of young, healthy populations during SD increase at the hip and ankle with increasing speed but not at the knee, contrasting torque patterns during gait. To better understand the sources of the knee torque pattern, we used dynamic simulations to estimate knee muscle forces and how they modulate center of mass (COM) acceleration across SD speeds (slow, self-selected, and fast) in young, healthy adults. The vastus lateralis and vastus medialis forces decreased from slow to self-selected speeds as the individual lowered to the next step. Since the vasti are primary contributors to vertical support during SD, they produced lower forces at faster speeds due to the lower need for vertical COM support observed at faster speeds. In contrast, the semimembranosus and rectus femoris forces increased across successive speeds, allowing the semimembranosus to increase acceleration downward and forward and the rectus femoris to provide more vertical support and resistance to forward progression as SD speed increased. These results demonstrate the utility of dynamic simulations to extend beyond traditional inverse dynamics analyses to gain further insight into muscle mechanisms during tasks like SD.
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Affiliation(s)
- Elena J Caruthers
- Department of Mechanical and Aerospace Engineering, The Ohio State University, E305 Scott Laboratory, 201 W 19th Ave, Columbus, OH, 43210-1142, USA.
- Department of Engineering, Otterbein University, Westerville, OH, USA.
| | | | | | - Ajit M W Chaudhari
- Department of Mechanical and Aerospace Engineering, The Ohio State University, E305 Scott Laboratory, 201 W 19th Ave, Columbus, OH, 43210-1142, USA
- Department of Orthopaedics, The Ohio State University, Columbus, OH, USA
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Laura C Schmitt
- Jameson Crane Sports Medicine Research Institute, The Ohio State University, Columbus, OH, USA
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Thomas M Best
- Departments of Orthopedics, Family Medicine, Biomedical Engineering, and Kinesiology, University Health Sports Medicine Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Robert A Siston
- Department of Mechanical and Aerospace Engineering, The Ohio State University, E305 Scott Laboratory, 201 W 19th Ave, Columbus, OH, 43210-1142, USA
- Department of Orthopaedics, The Ohio State University, Columbus, OH, USA
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
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Orozco-Chavez I, Mendez-Rebolledo G. Effect of squatting velocity on hip muscle latency in women with patellofemoral pain syndrome. J Phys Ther Sci 2018; 30:381-386. [PMID: 29581655 PMCID: PMC5857442 DOI: 10.1589/jpts.30.381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/12/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Neuromuscular activity has been evaluated in patellofemoral pain syndrome but movement velocity has not been considered. The aim was to determine differences in onset latency of hip and knee muscles between individuals with and without patellofemoral pain syndrome during a single leg squat, and whether any differences are dependent on movement velocity. [Subjects and Methods] Twenty-four females with patellofemoral pain syndrome and 24 healthy females participated. Onset latency of gluteus maximus, anterior and posterior gluteus medius, rectus femoris, vastus medialis, vastus lateralis and biceps femoris during a single leg squat at high and low velocity were evaluated. [Results] There was an interaction between velocity and diagnosis for posterior gluteus medius. Healthy subjects showed a later posterior gluteus medius onset latency at low velocity than high velocity; and also later than patellofemoral pain syndrome subjects at low velocity and high velocity. [Conclusion] Patellofemoral pain syndrome subjects presented an altered latency of posterior gluteus medius during a single leg squat and did not generate adaptations to velocity variation, while healthy subjects presented an earlier onset latency in response to velocity increase.
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Affiliation(s)
- Ignacio Orozco-Chavez
- Facultad de Ciencias, Magister en Medicina y Ciencias del Deporte, Universidad Mayor, Chile.,Human Motor Control Laboratory, Department of Human Movement Sciences, Faculty of Health Sciences, Universidad de Talca: Talca, Chile
| | - Guillermo Mendez-Rebolledo
- Human Motor Control Laboratory, Department of Human Movement Sciences, Faculty of Health Sciences, Universidad de Talca: Talca, Chile.,Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile
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