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Vandenberg NW, Wheatley BB, Carpenter RD, Christiansen CL, Stoneback JW, Gaffney BMM. Feasibility of predicting changes in gait biomechanics following muscle strength perturbations using optimal control in patients with transfemoral amputation. Comput Methods Biomech Biomed Engin 2024:1-15. [PMID: 39256913 DOI: 10.1080/10255842.2024.2399038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/04/2024] [Accepted: 08/20/2024] [Indexed: 09/12/2024]
Abstract
Bone-anchored limbs (BALs) are socket prosthesis alternatives, directly fixing to residual bone via osseointegrated implant. There is a need to quantify multi-level effects of rehabilitation for transfemoral BAL users (i.e. changes in joint loading and movement patterns). Our primary objective was determining feasibility of using optimal control to predict gait biomechanics compared to ground-truth experimental data from transfemoral BAL users. A secondary objective was examining biomechanical effects from estimated changes in hip abductor muscle strength. We developed and validated a workflow for predicting gait biomechanics in four transfemoral BAL users and investigated the biomechanical effects of altered hip abductor strengths.
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Affiliation(s)
- Nicholas W Vandenberg
- Department of Mechanical Engineering, University of Colorado Denver, University to Colorado Bone-Anchored Limb Research Group, Denver, Colorado, USA
| | - Benjamin B Wheatley
- Department of Mechanical Engineering, Bucknell University, Lewisburg, Pennsylvania, USA
| | - R Dana Carpenter
- Department of Mechanical Engineering, University of Colorado Denver, University to Colorado Bone-Anchored Limb Research Group, Denver, Colorado, USA
| | - Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, University to Colorado Bone-Anchored Limb Research Group, Aurora, Colorado, USA
- Department of Veterans Affairs Eastern Colorado Healthcare System, University to Colorado Bone-Anchored Limb Research Group, Aurora, Colorado, USA
| | - Jason W Stoneback
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, University to Colorado Bone-Anchored Limb Research Group, Aurora, Colorado, USA
| | - Brecca M M Gaffney
- Department of Mechanical Engineering, University of Colorado Denver, University to Colorado Bone-Anchored Limb Research Group, Denver, Colorado, USA
- Department of Veterans Affairs Eastern Colorado Healthcare System, University to Colorado Bone-Anchored Limb Research Group, Aurora, Colorado, USA
- Center for Bioengineering, University of Colorado Denver, University to Colorado Bone-Anchored Limb Research Group, Aurora, Colorado, USA
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Ravari R, Rehani M, Hebert JS. Biomechanical characteristics of transfemoral bone-anchored prostheses during gait: A review of literature. Prosthet Orthot Int 2024; 48:412-421. [PMID: 37639566 DOI: 10.1097/pxr.0000000000000263] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/09/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Osseointegration (OI) is an emerging technique that allows a direct connection between the bone and a titanium metal implant, allowing the direct attachment of bone-anchored prostheses (BAP) to address the problems associated with socket prostheses. This review article aims to compare the biomechanical features of gait when using a transfemoral BAP in comparison to healthy gait, and in comparison to the gait of traditional transfemoral socket prosthesis users. METHODS A computer-based literature search of electronic databases since inception (ranging from 1967 to 2004 depending on the database) to June 14, 2022, identified peer-reviewed articles focusing on the temporal-spatial, kinematic, kinetic, and electromyography data related to transfemoral BAP gait. Eight articles were included that focused on these biomechanical features of gait in adults with BAP and were compared with socket prosthesis users or healthy gait. RESULTS Compared with healthy participants, prosthesis users after OI surgery have slower speed and cadence, lower symmetry, longer duration of swing phase, increased pelvic and trunk motion, more hip extension, larger moments on the intact limb, and lower forces on the prosthetic side. Compared with transfemoral socket prosthesis gait, BAP gait shows faster cadence and longer duration of support phase. There are limited and inconsistent data on changes in trunk, pelvic, and hip motion with OI. CONCLUSION Based on this review, transfemoral BAP improve spatial-temporal parameters closer to normal gait when compared to socket gait, but there are persisting deficits compared with healthy gait. Additional studies are needed to confirm the changes in kinematics and kinetics when walking with a BAP.
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Affiliation(s)
- Reihaneh Ravari
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mayank Rehani
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jacqueline S Hebert
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta, Canada
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Jang J, Franz JR, Pietrosimone BG, Wikstrom EA. Muscle contributions to reduced ankle joint contact force during drop vertical jumps in patients with chronic ankle instability. J Biomech 2024; 163:111926. [PMID: 38183761 DOI: 10.1016/j.jbiomech.2024.111926] [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: 08/10/2023] [Revised: 12/05/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
Chronic ankle instability is a condition linked to progressive early ankle joint degeneration. Patients with chronic ankle instability exhibit altered biomechanics during gait and jump landings and these alterations are believed to contribute to aberrant joint loading and subsequent joint degeneration. Musculoskeletal modeling has the capacity to estimate joint loads from individual muscle forces. However, the influence of chronic ankle instability on joint contact forces remains largely unknown. The objective of this study was to compare tri-axial (i.e., compressive, anterior-posterior, and medial-lateral) ankle joint contact forces between those with and without chronic ankle instability during the ground contact phase of a drop vertical jump. Fifteen individuals with and 15 individuals without chronic ankle instability completed drop vertical jump maneuvers in a research laboratory. We used those data to drive three-dimensional musculoskeletal simulations and estimate muscle forces and tri-axial joint contact force variables (i.e., peak and impulse). Compared to those without chronic ankle instability, the ankles of patients with chronic ankle instability underwent lower compressive ankle joint contact forces as well as lower anterior-posterior and medial-lateral shearing forces during the weight acceptance phase of landing (p <.05). These findings suggest that patients with chronic ankle instability exhibit lower ankle joint loading patterns than uninjured individuals during a drop vertical jump, which may be considered in rehabilitation to potentially reduce the risk of early onset of ankle joint degeneration.
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Affiliation(s)
- Jaeho Jang
- Department of Kinesiology, University of Texas at El Paso, El Paso, TX, United States.
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States
| | - Brian G Pietrosimone
- MOTION Science Institute, Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, NC, United States
| | - Erik A Wikstrom
- MOTION Science Institute, Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, NC, United States
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Ma T, Zhang Y, Choi SD, Xiong S. Modelling for design and evaluation of industrial exoskeletons: A systematic review. APPLIED ERGONOMICS 2023; 113:104100. [PMID: 37490791 DOI: 10.1016/j.apergo.2023.104100] [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: 03/14/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 07/27/2023]
Abstract
Industrial exoskeletons are developed to relieve workers' physical demands in the workplace and to alleviate ergonomic issues associated with work-related musculoskeletal disorders. As a safe and economical alternative to empirical/experimental methods, modelling is considered as a powerful tool for design and evaluation of industrial exoskeletons. This systematic review aims to provide a comprehensive understanding of the current literature on the design and evaluation of industrial exoskeletons through modelling. A systematic study was conducted by general keyword searches of five electronic databases over the last two decades (2003-2022). Out of the 701 records initially retrieved, 33 eligible articles were included and analyzed in the final review, presenting a variety of model inputs, model development, and model outputs used in the modelling. This systematic review study revealed that existing modelling methods can evaluate the biomechanical and physiological effects of industrial exoskeletons and provide some design parameters. However, the modelling method is currently unable to cover some of the main evaluation metrics supported by experimental assessments, such as task performance, user experience/discomfort, change in metabolic costs etc. Standard guidelines for model construction and implementation, as well as validation of human-exoskeleton interactions, remain to be established.
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Affiliation(s)
- Tiejun Ma
- Human Factors and Ergonomics Laboratory, Department of Industrial & Systems Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, South Korea
| | - Yanxin Zhang
- Department of Exercise Sciences, University of Auckland, 4703906, Newmarket, Auckland, New Zealand
| | - Sang D Choi
- Department of Global and Community Health, George Mason University, Fairfax, VA, 22030, USA
| | - Shuping Xiong
- Human Factors and Ergonomics Laboratory, Department of Industrial & Systems Engineering, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, South Korea.
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Raveendranathan V, Kooiman VGM, Carloni R. Musculoskeletal model of osseointegrated transfemoral amputees in OpenSim. PLoS One 2023; 18:e0288864. [PMID: 37768981 PMCID: PMC10538745 DOI: 10.1371/journal.pone.0288864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 07/03/2023] [Indexed: 09/30/2023] Open
Abstract
This study presents a generic OpenSim musculoskeletal model of people with an osseointegrated unilateral transfemoral amputation wearing a generic prosthesis. The model, which consists of seventy-six musculotendon units and two ideal actuators at the knee and ankle joints of the prosthesis, is tested by designing an optimal control strategy that guarantees the tracking of experimental amputee data during level-ground walking while finding the actuators' torques and minimizing the muscle forces. The model can be made subject-specific and, as such, is able to reproduce the kinematics and dynamics of both healthy and amputee subjects. The model provides a tool to analyze the biomechanics of level-ground walking and to understand the contribution of the muscles and of the prosthesis' actuators. The proposed OpenSim musculoskeletal model is released as support material to this study.
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Affiliation(s)
- Vishal Raveendranathan
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - Vera G. M. Kooiman
- Orthopaedic Research Laboratory and Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Raffaella Carloni
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
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Vandenberg NW, Stoneback JW, Davis-Wilson H, Christiansen CL, Awad ME, Melton DH, Gaffney BMM. Unilateral transfemoral osseointegrated prostheses improve joint loading during walking. J Biomech 2023; 155:111658. [PMID: 37276681 PMCID: PMC10330663 DOI: 10.1016/j.jbiomech.2023.111658] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
People with unilateral transfemoral amputation using socket prostheses are at increased risk for developing osteoarthritis in both the residual hip and intact lower-limb joints. Osseointegrated prostheses are a surgical alternative to socket prostheses that directly attach to the residual femur via a bone-anchored implant, however their multi-joint loading effect is largely unknown. Our objective was to establish how osseointegrated prostheses influence joint loading during walking. Motion capture data (kinematics, ground reaction forces) were collected from 12 participants at baseline, with socket prostheses, and 12-months after prosthesis osseointegration during overground walking at self-selected speeds. Subject-specific musculoskeletal models were developed at each timepoint relative to osseointegration. Internal joint moments were calculated using inverse dynamics, muscle and joint reaction forces (JRFs) were estimated with static optimization. Changes in internal joint moments, JRFs, and joint loading-symmetry were compared using statistical parametric mapping (p≤ 0.05) before and after osseointegration. Amputated limb hip flexion moments and anterior JRFs decreased during terminal stance (p = 0.002, <0.001; respectively), while amputated limb hip abduction moments increased during mid-stance (p < 0.001), amputated hip rotation moment changed from internal to external throughout early stance (p < 0.001). Intact limb hip extension and knee flexion moments (p = 0.028, 0.032; respectively), superior and resultant knee JRFs (p = 0.046, 0.049; respectively) decreased during the loading response following prosthesis osseointegration. These results may indicate that the direct loading transmission of these novel prostheses create a more typical mechanical environment in bilateral joints, which is comparable with loading observed in able-bodied individuals and could decrease the risk of development or progression of osteoarthritis.
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Affiliation(s)
- Nicholas W Vandenberg
- Department of Mechanical Engineering, University of Colorado Denver, Denver CO, United States
| | - Jason W Stoneback
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Hope Davis-Wilson
- Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, United States; Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, United States
| | - Cory L Christiansen
- Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, United States; Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, United States
| | - Mohamed E Awad
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, United States
| | - Danielle H Melton
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, United States
| | - Brecca M M Gaffney
- Department of Mechanical Engineering, University of Colorado Denver, Denver CO, United States; Center for Bioengineering, University of Colorado Denver, Aurora, CO, United States.
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Ravari R, Lewicke J, Vette AH, Hebert JS. Differences in angular kinematics when using thigh, implant, or medial knee markers in osseointegrated transfemoral prosthetic gait. Clin Biomech (Bristol, Avon) 2023; 105:105976. [PMID: 37127007 DOI: 10.1016/j.clinbiomech.2023.105976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 04/12/2023] [Accepted: 04/23/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND The Helen Hayes anatomical model is commonly used in clinical gait analysis with standard medial/lateral knee and thigh markers. METHODS To quantify soft-tissue artifacts associated with the thigh marker following osseointegration surgery, we added an "implant marker" on the implant extending from the femur, with the objective of identifying the differences in the angular kinematics when using the standard versus implant marker. One female adult with an osseointegrated transfemoral prosthesis walked overground for three trials, and common kinematic measures were calculated from motion capture data. FINDINGS The results indicated that, when using the thigh marker, a peak of knee varus occurred during the swing phase on the prosthetic side, which is unusual during gait and not feasible for hinge joint prostheses. When using the implant marker, knee varus/valgus was closer to normative. Using the thigh marker, the results showed an internal hip rotation at the start of stance and during the mid and terminal swing phases. In contrast, external hip rotation occurred in both stance and swing phases using the implant marker. Moreover, when selecting the medial knee marker instead of the thigh marker, the angular kinematics and range of motion of knee varus/valgus and hip rotation were comparable to those for the implant marker. INTERPRETATION This finding suggests that when studying osseointegration gait, using an implant marker will result in more accurate femoral and knee joint motion than using the thigh marker. Changing the selection of markers can reduce the errors of knee varus/valgus and hip kinematics in osseointegrated transfemoral prosthetic gait.
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Affiliation(s)
- Reihaneh Ravari
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Justin Lewicke
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Albert H Vette
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada; Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Jacqueline S Hebert
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
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Di Paolo S, Barone G, Alesi D, Mirulla AI, Gruppioni E, Zaffagnini S, Bragonzoni L. Longitudinal Gait Analysis of a Transfemoral Amputee Patient: Single-Case Report from Socket-Type to Osseointegrated Prosthesis. SENSORS (BASEL, SWITZERLAND) 2023; 23:4037. [PMID: 37112378 PMCID: PMC10143735 DOI: 10.3390/s23084037] [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: 02/13/2023] [Revised: 03/24/2023] [Accepted: 04/07/2023] [Indexed: 06/19/2023]
Abstract
The aim of the present case report was to provide a longitudinal functional assessment of a patient with transfemoral amputation from the preoperative status with socket-type prosthesis to one year after the osseointegration surgery. A 44 years-old male patient was scheduled for osseointegration surgery 17 years after transfemoral amputation. Gait analysis was performed through 15 wearable inertial sensors (MTw Awinda, Xsens) before surgery (patient wearing his standard socket-type prosthesis) and at 3-, 6-, and 12-month follow-ups after osseointegration. ANOVA in Statistical Parametric Mapping was used to assess the changes in amputee and sound limb hip and pelvis kinematics. The gait symmetry index progressively improved from the pre-op with socket-type (1.14) to the last follow-up (1.04). Step width after osseointegration surgery was half of the pre-op. Hip flexion-extension range significantly improved at follow-ups while frontal and transverse plane rotations decreased (p < 0.001). Pelvis anteversion, obliquity, and rotation also decreased over time (p < 0.001). Spatiotemporal and gait kinematics improved after osseointegration surgery. One year after surgery, symmetry indices were close to non-pathological gait and gait compensation was sensibly decreased. From a functional point of view, osseointegration surgery could be a valid solution in patients with transfemoral amputation facing issues with traditional socket-type prosthesis.
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Affiliation(s)
- Stefano Di Paolo
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy
| | - Giuseppe Barone
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy
| | - Domenico Alesi
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Agostino Igor Mirulla
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy
- Department of Engineering, University of Palermo, 40126 Palermo, Italy
| | - Emanuele Gruppioni
- Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Centro Protesi Inail, 40054 Vigorso di Budrio, Italy
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy
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Saini H, Klotz T, Röhrle O. Modelling motor units in 3D: influence on muscle contraction and joint force via a proof of concept simulation. Biomech Model Mechanobiol 2022; 22:593-610. [PMID: 36572787 PMCID: PMC10097764 DOI: 10.1007/s10237-022-01666-2] [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: 07/18/2022] [Accepted: 12/02/2022] [Indexed: 12/28/2022]
Abstract
AbstractFunctional heterogeneity is a skeletal muscle’s ability to generate diverse force vectors through localised motor unit (MU) recruitment. Existing 3D macroscopic continuum-mechanical finite element (FE) muscle models neglect MU anatomy and recruit muscle volume simultaneously, making them unsuitable for studying functional heterogeneity. Here, we develop a method to incorporate MU anatomy and information in 3D models. Virtual fibres in the muscle are grouped into MUs via a novel “virtual innervation” technique, which can control the units’ size, shape, position, and overlap. The discrete MU anatomy is then mapped to the FE mesh via statistical averaging, resulting in a volumetric MU distribution. Mesh dependency is investigated using a 2D idealised model and revealed that the amount of MU overlap is inversely proportional to mesh dependency. Simultaneous recruitment of a MU’s volume implies that action potentials (AP) propagate instantaneously. A 3D idealised model is used to verify this assumption, revealing that neglecting AP propagation results in a slightly less-steady force, advanced in time by approximately 20 ms, at the tendons. Lastly, the method is applied to a 3D, anatomically realistic model of the masticatory system to demonstrate the functional heterogeneity of masseter muscles in producing bite force. We found that the MU anatomy significantly affected bite force direction compared to bite force magnitude. MU position was much more efficacious in bringing about bite force changes than MU overlap. These results highlight the relevance of MU anatomy to muscle function and joint force, particularly for muscles with complex neuromuscular architecture.
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Affiliation(s)
- Harnoor Saini
- Institute of Modelling and Simulation of Biomechanical Systems, University of Stuttgart, Pfaffenwaldring 5a, 70569 Stuttgart, BW Germany
| | - Thomas Klotz
- Institute of Modelling and Simulation of Biomechanical Systems, University of Stuttgart, Pfaffenwaldring 5a, 70569 Stuttgart, BW Germany
| | - Oliver Röhrle
- Institute of Modelling and Simulation of Biomechanical Systems, University of Stuttgart, Pfaffenwaldring 5a, 70569 Stuttgart, BW Germany
- Stuttgart Center for Simulation Technology (SC SimTech), University of Stuttgart, Pfaffenwaldring 5a, 70569 Stuttgart, BW Germany
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Gaffney BMM, Vandenberg NW, Davis-Wilson HC, Christiansen CL, Roda GF, Schneider G, Johnson T, Stoneback JW. Biomechanical compensations during a stand-to-sit maneuver using transfemoral osseointegrated prostheses: A case series. Clin Biomech (Bristol, Avon) 2022; 98:105715. [PMID: 35839740 DOI: 10.1016/j.clinbiomech.2022.105715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/24/2022] [Accepted: 07/05/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with transfemoral amputation and socket prostheses are at a heightened risk of developing musculoskeletal overuse injuries, commonly due to altered joint biomechanics. Osseointegrated prostheses, which involve direct anchorage of the prosthesis to the residual limb through a bone anchored prosthesis, are a novel alternative to sockets yet their biomechanical effect is largely unknown. METHODS Four patients scheduled to undergo unilateral transfemoral prosthesis osseointegration completed two data collections (baseline with socket prosthesis and 12-months after prosthesis osseointegration) in which whole-body kinematics and ground reaction forces were collected during stand-to-sit tasks. Trunk, pelvis, and hip kinematics, and the surrounding muscle forces, were calculated using subject-specific musculoskeletal models developed in OpenSim. Peak joint angles and muscle forces were compared between timepoints using Cohen's d effect sizes. FINDINGS Compared to baseline with socket prostheses, patients with osseointegrated prostheses demonstrated reduced lateral trunk bending (d = 1.46), pelvic obliquity (d = 1.09), and rotation (d = 1.77) toward the amputated limb during the stand to sit task. This was accompanied by increased amputated limb hip flexor, abductor, and rotator muscle forces (d> > 0.8). INTERPRETATION Improved lumbopelvic movement patterns and stabilizing muscle forces when using an osseointegrated prosthesis indicate that this novel prosthesis type likely reduces the risk of the development and/or progression of overuse injuries, such as low back pain and osteoarthritis. We attribute the increased muscle hip muscle forces to the increased load transmission between the osseointegrated prosthesis and residual limb, which allows a greater eccentric ability of the amputated limb to control lowering during the stand-to-sit task.
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Affiliation(s)
- Brecca M M Gaffney
- Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, United States of America; Center for Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America.
| | - Nicholas W Vandenberg
- Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, United States of America
| | - Hope C Davis-Wilson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; VA Eastern Colorado Healthcare System, Aurora, CO, United States of America
| | - Cory L Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; VA Eastern Colorado Healthcare System, Aurora, CO, United States of America
| | - Galen F Roda
- Department of Mechanical Engineering, University of Colorado Denver, Denver, CO, United States of America
| | - Gary Schneider
- University of Colorado Hospital, Aurora, CO, United States of America
| | - Tony Johnson
- University of Colorado Hospital, Aurora, CO, United States of America
| | - Jason W Stoneback
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
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