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Ceker E, Fadiloglu A, Cataltepe E, Sendur HN, Allahverdiyeva S, Varan HD. Predictive ability of Achilles tendon elastography for frailty in older adults. Eur Geriatr Med 2024:10.1007/s41999-024-01023-9. [PMID: 39090315 DOI: 10.1007/s41999-024-01023-9] [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: 05/31/2024] [Accepted: 07/12/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE The Achilles tendon (AT) is the largest and strongest tendon in the human body, and its elasticity is known to be affected by the aging process. However, the relation between AT stiffness and frailty in older individuals remains uncertain. This study aims to explore the potential of Achilles tendon shear wave elastography (AT-SWE) as a tool for assessing physical frailty in older adults. METHODS A total of 148 patients aged 65 years and over were included in this cross-sectional study. Patients with heart failure, AT injury, stroke history, active malignancy, and claudication were excluded. All patients underwent a comprehensive geriatric assessment. Physical frailty assessment was performed with the fried frailty phenotype. Achilles tendon elastography was measured by ultrasound. RESULTS The mean age of the participants was 73.8 years and 62.2% were female. 30.4% of the participants were defined as frail. Achilles tendon shear wave elastography measurements were statistically lower in the frail group (p < 0.05). In the multivariate regression analysis, AT-SWE demonstrated a statistically significant association with frailty independent of confounding factors (OR 0.982, 95% CI 0.965-0.999, p value = 0.038). In the ROC curve analysis, the area under the curve for AT-SWE was 0.647 (95% CI, 0.564-0.724, p < 0.01) and the optimum cut-off point was 124.1 kilopascals. CONCLUSION These findings highlight the value of AT-SWE as a non-invasive and objective tool for predicting frailty in older adults.
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Affiliation(s)
- Eda Ceker
- Faculty of Medicine, Department of Geriatric Medicine, Gazi University, 06560, Ankara, Turkey.
| | - Ayse Fadiloglu
- Faculty of Medicine, Department of Geriatric Medicine, Gazi University, 06560, Ankara, Turkey
| | - Esra Cataltepe
- Faculty of Medicine, Department of Geriatric Medicine, Gazi University, 06560, Ankara, Turkey
| | - Halit Nahit Sendur
- Faculty of Medicine, Department of Radiology, Gazi University, Ankara, Turkey
| | | | - Hacer Dogan Varan
- Faculty of Medicine, Department of Geriatric Medicine, Gazi University, 06560, Ankara, Turkey
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2
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Smith RE, Shelton AD, Sawicki GS, Franz JR. The effects of plantarflexor weakness and reduced tendon stiffness with aging on gait stability. PLoS One 2024; 19:e0302021. [PMID: 38625839 PMCID: PMC11020829 DOI: 10.1371/journal.pone.0302021] [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: 09/27/2023] [Accepted: 03/26/2024] [Indexed: 04/18/2024] Open
Abstract
Falls among older adults are a costly public health concern. Such falls can be precipitated by balance disturbances, after which a recovery strategy requiring rapid, high force outputs is necessary. Sarcopenia among older adults likely diminishes their ability to produce the forces necessary to arrest gait instability. Age-related changes to tendon stiffness may also delay muscle stretch and afferent feedback and decrease force transmission, worsening fall outcomes. However, the association between muscle strength, tendon stiffness, and gait instability is not well established. Given the ankle's proximity to the onset of many walking balance disturbances, we examined the relation between both plantarflexor strength and Achilles tendon stiffness with walking-related instability during perturbed gait in older and younger adults-the latter quantified herein using margins of stability and whole-body angular momentum including the application of treadmill-induced slip perturbations. Older and younger adults did not differ in plantarflexor strength, but Achilles tendon stiffness was lower in older adults. Among older adults, plantarflexor weakness associated with greater whole-body angular momentum following treadmill-induced slip perturbations. Weaker older adults also appeared to walk and recover from treadmill-induced slip perturbations with more caution. This study highlights the role of plantarflexor strength and Achilles tendon stiffness in regulating lateral gait stability in older adults, which may be targets for training protocols seeking to minimize fall risk and injury severity.
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Affiliation(s)
- Ross E. Smith
- Joint Dept. of Biomedical Engineering, UNC Chapel Hill and NC State University, Chapel Hill, North Carolina, United States of America
| | - Andrew D. Shelton
- Joint Dept. of Biomedical Engineering, UNC Chapel Hill and NC State University, Chapel Hill, North Carolina, United States of America
| | - Gregory S. Sawicki
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Jason R. Franz
- Joint Dept. of Biomedical Engineering, UNC Chapel Hill and NC State University, Chapel Hill, North Carolina, United States of America
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3
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Beck ON, Schroeder JN, Sawicki GS. Habitually wearing high heels may improve user walking economy in any footwear. J Appl Physiol (1985) 2024; 136:567-572. [PMID: 38299222 PMCID: PMC11212819 DOI: 10.1152/japplphysiol.00016.2024] [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: 01/08/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/02/2024] Open
Abstract
The habitual use of high-heeled footwear may structurally remodel user leg muscle tendons, thereby altering their functional capabilities. High heels set users' ankles in relatively plantarflexed positions, causing calf muscle tendons to operate at relatively short lengths. Habitually operating muscle tendons at relatively short lengths induces structural remodeling that theoretically affects muscle metabolism. Because structural changes occur within the body, the user's locomotor metabolism may change in any footwear condition (e.g., conventional shoes, barefoot). Here, we studied the influence of habitual high-heel use on users' leg muscle-tendon structure and metabolism during walking in flat-soled footwear. We tested eight participants before and after 14 wk of agreeing to wear high heels as their daily shoes. Overall, participants who wore high heels >1,500 steps per day, experienced a 9% decrease in their net metabolic power during walking in flat-soled footwear (d = 1.66, P ≤ 0.049), whereas participants who took <1,000 daily steps in high heels did not (d = 0.44; P = 0.524). Across participants, for every 1,000 daily steps in high heels, net metabolic power during walking in flat-soled footwear decreased 5.3% (r = -0.73; P = 0.040). Metabolic findings were partially explained (r2 = 0.43; P = 0.478) by trending shorter medial gastrocnemius fascicle lengths (d = 0.500, P = 0.327) and increased Achilles tendon stiffness (d = 2.889, P = 0.088). The high-heel intervention did not alter user walking stride kinematics in flat-soled footwear (d ≤ 0.567, P ≥ 0.387). While our limited dataset is unable to establish the mechanisms underlying the high-heel-induced walking economy improvement, it appears that prescribing specific footwear use can be implemented to alter user muscle-tendon properties and augment their function in any shoes.NEW & NOTEWORTHY Habitually wearing high-heeled footwear structurally remodels leg muscle tendons and improves user walking economy, regardless of worn attire.
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Affiliation(s)
- Owen N Beck
- Department of Kinesiology and Health Education, University of Texas, Austin, Texas, United States
| | - Jordyn N Schroeder
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States
| | - Gregory S Sawicki
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, United States
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4
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Domroes T, Weidlich K, Bohm S, Mersmann F, Arampatzis A. Personalized tendon loading reduces muscle-tendon imbalances in male adolescent elite athletes. Scand J Med Sci Sports 2024; 34:e14555. [PMID: 38268075 DOI: 10.1111/sms.14555] [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: 09/14/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Abstract
An imbalanced adaptation of muscle strength and tendon stiffness in response to training may increase tendon strain (i.e., the mechanical demand on the tendon) and consequently tendon injury risk. This study investigated if personalized tendon loading inducing tendon strain within the effective range for adaptation (4.5%-6.5%) can reduce musculotendinous imbalances in male adolescent handball athletes (15-16 years). At four measurement time points during a competitive season, we assessed knee extensor muscle strength and patellar tendon mechanical properties using dynamometry and ultrasonography and estimated the tendon's structural integrity with a peak spatial frequency (PSF) analysis of proximal tendon ultrasound scans. A control group (n = 13) followed their usual training routine, an intervention group (n = 13) integrated tendon exercises into their training (3x/week for ~31 weeks) with a personalized intensity corresponding to an average of ~6.2% tendon strain. We found a significant time by group interaction (p < 0.005) for knee extensor muscle strength and normalized patellar tendon stiffness with significant increases over time only in the intervention group (p < 0.001). There were no group differences or time-dependent changes in patellar tendon strain during maximum voluntary contractions or PSF. At the individual level, the intervention group demonstrated lower fluctuations of maximum patellar tendon strain during the season (p = 0.005) and a descriptively lower frequency of athletes with high-level tendon strain (≥9%). The findings suggest that the personalized tendon loading program reduced muscle-tendon imbalances in male adolescent athletes, which may provide new opportunities for tendon injury prevention.
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Affiliation(s)
- Theresa Domroes
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kolja Weidlich
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
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5
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Ateş F, Marquetand J, Zimmer M. Detecting age-related changes in skeletal muscle mechanics using ultrasound shear wave elastography. Sci Rep 2023; 13:20062. [PMID: 37974024 PMCID: PMC10654699 DOI: 10.1038/s41598-023-47468-z] [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: 05/23/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023] Open
Abstract
Aging leads to a decline in muscle mass and force-generating capacity. Ultrasound shear wave elastography (SWE) is a non-invasive method to capture age-related muscular adaptation. This study assessed biceps brachii muscle (BB) mechanics, hypothesizing that shear elastic modulus reflects (i) passive muscle force increase imposed by length change, (ii) activation-dependent mechanical changes, and (iii) differences between older and younger individuals. Fourteen healthy volunteers aged 60-80 participated. Shear elastic modulus, surface electromyography, and elbow torque were measured at five elbow positions in passive and active states. Data collected from young adults aged 20-40 were compared. The BB passive shear elastic modulus increased from flexion to extension, with the older group exhibiting up to 52.58% higher values. Maximum elbow flexion torque decreased in extended positions, with the older group 23.67% weaker. Significant effects of elbow angle, activity level, and age on total and active shear elastic modulus were found during submaximal contractions. The older group had 20.25% lower active shear elastic modulus at 25% maximum voluntary contraction. SWE effectively quantified passive and activation-dependent BB mechanics, detecting age-related alterations at rest and during low-level activities. These findings suggest shear elastic modulus as a promising biomarker for identifying altered muscle mechanics in aging.
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Affiliation(s)
- Filiz Ateş
- Institute of Structural Mechanics and Dynamics in Aerospace Engineering, University of Stuttgart, Stuttgart, Germany.
| | - Justus Marquetand
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Neural Dynamics and Magnetoencephalography, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- MEG-Center, University of Tübingen, Tübingen, Germany
| | - Manuela Zimmer
- Institute of Structural Mechanics and Dynamics in Aerospace Engineering, University of Stuttgart, Stuttgart, Germany
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Cone SG, Kim H, Thelen DG, Franz JR. 3D characterization of the triple-bundle Achilles tendon from in vivo high-field MRI. J Orthop Res 2023; 41:2315-2321. [PMID: 37366039 PMCID: PMC10686703 DOI: 10.1002/jor.25654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/06/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023]
Abstract
The Achilles tendon consists of three subtendons that transmit force from the triceps surae muscles to the calcaneus. Individual differences have been identified in Achilles subtendon morphology and twist in cadavers, which may have implications for triceps surae mechanics and function. High-field magnetic resonance imaging (MRI) can be used to identify boundaries within multi-bundle tissues, which could then enable studies of subtendon structure-function relationships in humans. The objective of this study was to use high-field MRI (7T) to image and reconstruct Achilles subtendons arising from the triceps surae muscles. We imaged the dominant lower leg of a cohort of healthy human subjects (n = 10) using a tuned musculoskeletal sequence (double echo steady state sequence, 0.4 mm isotropic voxels). We then characterized the cross-sectional area and orientation of each subtendon between the MTJ and calcaneal insertion. Image collection and segmentation was repeated to assess repeatability. Subtendon morphometry varied across subjects, with average subtendon areas of 23.5 ± 8.9 mm2 for the medial gastrocnemius, 25.4 ± 8.9 mm2 for the lateral gastrocnemius, and 13.7 ± 5.9 mm2 for the soleus subtendons. Repeatable subject-specific variations in size and position of each subtendon were identified over two visits, expanding on prior knowledge that high variability exists in Achilles subtendon morphology across subjects.
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Affiliation(s)
- Stephanie G Cone
- Department of Biomedical Engineering, University of Delaware, Newark, DE, 19713
- Department of Mechanical Engineering, University of Wisconsin, Madison, WI, 53706
| | - Hoon Kim
- Department of Sports Medicine, Soonchunhyang University, Asan, South Korea
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin, Madison, WI, 53706
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, 53706
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC 27599
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7
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Finni T, Vanwanseele B. Towards modern understanding of the Achilles tendon properties in human movement research. J Biomech 2023; 152:111583. [PMID: 37086579 DOI: 10.1016/j.jbiomech.2023.111583] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/21/2023] [Accepted: 04/04/2023] [Indexed: 04/24/2023]
Abstract
The Achilles tendon (AT) is the strongest tendon in humans, yet it often suffers from injury. The mechanical properties of the AT afford efficient movement, power amplification and power attenuation during locomotor tasks. The properties and the unique structure of the AT as a common tendon for three muscles have been studied frequently in humans using in vivo methods since 1990's. As a part of the celebration of 50 years history of the International Society of Biomechanics, this paper reviews the history of the AT research focusing on its mechanical properties in humans. The questions addressed are: What are the most important mechanical properties of the Achilles tendon, how are they studied, what is their significance to human movement, and how do they adapt? We foresee that the ongoing developments in experimental methods and modeling can provide ways to advance knowledge of the complex three-dimensional structure and properties of the Achilles tendon in vivo, and to enable monitoring of the loading and recovery for optimizing individual adaptations.
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Affiliation(s)
- Taija Finni
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Finland.
| | - Benedicte Vanwanseele
- Faculty of Movement and Rehabilitation Science, Human Movement Biomechanics Research Group, KU Leuven, Belgium
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8
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Promsri A, Cholamjiak P, Federolf P. Walking Stability and Risk of Falls. Bioengineering (Basel) 2023; 10:bioengineering10040471. [PMID: 37106658 PMCID: PMC10135799 DOI: 10.3390/bioengineering10040471] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Walking stability is considered a necessary physical performance for preserving independence and preventing falls. The current study investigated the correlation between walking stability and two clinical markers for falling risk. Principal component analysis (PCA) was applied to extract the three-dimensional (3D) lower-limb kinematic data of 43 healthy older adults (69.8 ± 8.5 years, 36 females) into a set of principal movements (PMs), showing different movement components/synergies working together to accomplish the walking task goal. Then, the largest Lyapunov exponent (LyE) was applied to the first five PMs as a measure of stability, with the interpretation that the higher the LyE, the lower the stability of individual movement components. Next, the fall risk was determined using two functional motor tests-a Short Physical Performance Battery (SPPB) and a Gait Subscale of Performance-Oriented Mobility Assessment (POMA-G)-of which the higher the test score, the better the performance. The main results show that SPPB and POMA-G scores negatively correlate with the LyE seen in specific PMs (p ≤ 0.009), indicating that increasing walking instability increases the fall risk. The current findings suggest that inherent walking instability should be considered when assessing and training the lower limbs to reduce the risk of falling.
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Affiliation(s)
- Arunee Promsri
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand
| | - Prasit Cholamjiak
- Department of Mathematics, School of Sciences, University of Phayao, Phayao 56000, Thailand
| | - Peter Federolf
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
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Boyer KA, Hayes KL, Umberger BR, Adamczyk PG, Bean JF, Brach JS, Clark BC, Clark DJ, Ferrucci L, Finley J, Franz JR, Golightly YM, Hortobágyi T, Hunter S, Narici M, Nicklas B, Roberts T, Sawicki G, Simonsick E, Kent JA. Age-related changes in gait biomechanics and their impact on the metabolic cost of walking: Report from a National Institute on Aging workshop. Exp Gerontol 2023; 173:112102. [PMID: 36693530 PMCID: PMC10008437 DOI: 10.1016/j.exger.2023.112102] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/09/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
Changes in old age that contribute to the complex issue of an increased metabolic cost of walking (mass-specific energy cost per unit distance traveled) in older adults appear to center at least in part on changes in gait biomechanics. However, age-related changes in energy metabolism, neuromuscular function and connective tissue properties also likely contribute to this problem, of which the consequences are poor mobility and increased risk of inactivity-related disease and disability. The U.S. National Institute on Aging convened a workshop in September 2021 with an interdisciplinary group of scientists to address the gaps in research related to the mechanisms and consequences of changes in mobility in old age. The goal of the workshop was to identify promising ways to move the field forward toward improving gait performance, decreasing energy cost, and enhancing mobility for older adults. This report summarizes the workshop and brings multidisciplinary insight into the known and potential causes and consequences of age-related changes in gait biomechanics. We highlight how gait mechanics and energy cost change with aging, the potential neuromuscular mechanisms and role of connective tissue in these changes, and cutting-edge interventions and technologies that may be used to measure and improve gait and mobility in older adults. Key gaps in the literature that warrant targeted research in the future are identified and discussed.
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Affiliation(s)
- Katherine A Boyer
- Department of Kinesiology, University of Massachusetts Amherst, MA, USA; Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Kate L Hayes
- Department of Kinesiology, University of Massachusetts Amherst, MA, USA
| | | | | | - Jonathan F Bean
- New England GRECC, VA Boston Healthcare System, Boston, MA, USA; Department of PM&R, Harvard Medical School, Boston, MA, USA; Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute and the Department of Biomedical Sciences, Ohio University, Athens, OH, USA
| | - David J Clark
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA; Department of Physiology and Aging, University of Florida, Gainesville, FL, USA
| | - Luigi Ferrucci
- Intramural Research Program of the National Institute on Aging, NIH, Baltimore, MD, USA
| | - James Finley
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Yvonne M Golightly
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA; Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Tibor Hortobágyi
- Hungarian University of Sports Science, Department of Kinesiology, Budapest, Hungary; Institute of Sport Sciences and Physical Education, University of Pécs, Hungary; Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary; Center for Human Movement Sciences, University of Groningen Medical Center, Groningen, the Netherlands
| | - Sandra Hunter
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
| | - Marco Narici
- Neuromuscular Physiology Laboratory, Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Barbara Nicklas
- Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, USA
| | - Thomas Roberts
- Department of Ecology and Evolutionary Biology, Brown University, USA
| | - Gregory Sawicki
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, USA
| | - Eleanor Simonsick
- Intramural Research Program of the National Institute on Aging, NIH, Baltimore, MD, USA
| | - Jane A Kent
- Department of Kinesiology, University of Massachusetts Amherst, MA, USA
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10
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Gionfrida L, Nuckols RW, Walsh CJ, Howe RD. Age-Related Reliability of B-Mode Analysis for Tailored Exosuit Assistance. SENSORS (BASEL, SWITZERLAND) 2023; 23:1670. [PMID: 36772710 PMCID: PMC9921922 DOI: 10.3390/s23031670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
In the field of wearable robotics, assistance needs to be individualized for the user to maximize benefit. Information from muscle fascicles automatically recorded from brightness mode (B-mode) ultrasound has been used to design assistance profiles that are proportional to the estimated muscle force of young individuals. There is also a desire to develop similar strategies for older adults who may have age-altered physiology. This study introduces and validates a ResNet + 2x-LSTM model for extracting fascicle lengths in young and older adults. The labeling was generated in a semimanual manner for young (40,696 frames) and older adults (34,262 frames) depicting B-mode imaging of the medial gastrocnemius. First, the model was trained on young and tested on both young (R2 = 0.85, RMSE = 2.36 ± 1.51 mm, MAPE = 3.6%, aaDF = 0.48 ± 1.1 mm) and older adults (R2 = 0.53, RMSE = 4.7 ± 2.51 mm, MAPE = 5.19%, aaDF = 1.9 ± 1.39 mm). Then, the performances were trained across all ages (R2 = 0.79, RMSE = 3.95 ± 2.51 mm, MAPE = 4.5%, aaDF = 0.67 ± 1.8 mm). Although age-related muscle loss affects the error of the tracking methodology compared to the young population, the absolute percentage error for individual fascicles leads to a small variation of 3-5%, suggesting that the error may be acceptable in the generation of assistive force profiles.
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Affiliation(s)
- Letizia Gionfrida
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Science and Engineering Complex, 150 Western Ave, Boston, MA 02134, USA
| | - Richard W. Nuckols
- Department of Systems Design Engineering, University of Waterloo, University Ave W, Waterloo, ON N2L 3G1, Canada
| | - Conor J. Walsh
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Science and Engineering Complex, 150 Western Ave, Boston, MA 02134, USA
| | - Robert D. Howe
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Science and Engineering Complex, 150 Western Ave, Boston, MA 02134, USA
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Hart DA, Ahmed AS, Ackermann P. Optimizing repair of tendon ruptures and chronic tendinopathies: Integrating the use of biomarkers with biological interventions to improve patient outcomes and clinical trial design. Front Sports Act Living 2023; 4:1081129. [PMID: 36685063 PMCID: PMC9853460 DOI: 10.3389/fspor.2022.1081129] [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: 10/26/2022] [Accepted: 12/09/2022] [Indexed: 01/09/2023] Open
Abstract
Tendons are dense connective tissues of the musculoskeletal system that link bones with muscles to foster mobility. They have complex structures and exist in varying biomechanical, metabolic and biological environments. In addition, tendon composition and mechanical properties can change over the lifespan as an individual ages. Many tendons function in high stress conditions with a low vascular and neuronal supply, conditions often leading to development of chronic tendinopathies, and in some cases, overt rupture of the tissues. Given their essential nature for human mobility and navigation through the environment, the effective repair and regeneration of different tendons after injury or damage is critical for quality of life, and for elite athletes, the return to sport participation at a high level. However, for mainly unknown reasons, the outcomes following injury are not always successful and lead to functional compromise and risk for re-injury. Thus, there is a need to identify those patients who are at risk for developing tendon problems, as well those at risk for poor outcomes after injury and to design interventions to improve outcomes after injury or rupture to specific tendons. This review will discuss recent advances in the identification of biomarkers prognostic for successful and less successful outcomes after tendon injury, and the mechanistic implications of such biomarkers, as well as the potential for specific biologic interventions to enhance outcomes to improve both quality of life and a return to participation in sports. In addition, the implication of these biomarkers for clinical trial design is discussed, as is the issue of whether such biomarkers for successful healing of one tendon can be extended to all tendons or are valid only for tendons in specific biomechanical and biological environments. As maintaining an active lifestyle is critical for health, the successful implementation of these advances will benefit the large number of individuals at risk.
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Affiliation(s)
- David A. Hart
- Department of Surgery, Faculty of Kinesiology, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada,Correspondence: David A. Hart
| | - Aisha S. Ahmed
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Paul Ackermann
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Crawford SK, Thelen D, Yakey JM, Heiderscheit BC, Wilson JJ, Lee KS. Regional shear wave elastography of Achilles tendinopathy in symptomatic versus contralateral Achilles tendons. Eur Radiol 2023; 33:720-729. [PMID: 35760909 PMCID: PMC9771859 DOI: 10.1007/s00330-022-08957-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Ultrasound often corroborates clinical diagnosis of Achilles tendinopathy (AT). Traditional measures assess macromorphological features or use qualitative grading scales, primarily focused within the free tendon. Shear wave imaging can non-invasively quantify tendon elasticity, yet it is unknown if proximal structures are affected by tendon pathology. The purpose of the study was to determine the characteristics of both traditional sonographic measures and regional shear wave speed (SWS) between limbs in patients with AT. METHODS Twenty patients with chronic AT were recruited. Traditional sonographic measures of tendon structure were measured. Regional SWS was collected in a resting ankle position along the entire length of the tendon bilaterally. SWS measures were extracted and interpolated across evenly distributed points corresponding to the free tendon (FT), soleus aponeurosis (SA), and gastrocnemius aponeurosis (GA). Comparisons were made between limbs in both traditional sonographic measures and regional SWS. RESULTS Symptomatic tendons were thicker (10.2 (1.9) vs. 6.8 (1.8) mm; p < 0.001) and had more hyperemia (p = 0.001) and hypoechogenicity (p = 0.002) than the contralateral tendon. Regional SWS in the FT was lower in the symptomatic limb compared to the contralateral limb (11.53 [10.99, 12.07] vs. 10.97 [10.43, 11.51]; p = 0.03). No differences between limbs were found for the SA (p = 0.13) or GA (p = 0.99). CONCLUSIONS Lower SWS was only observed in the FT in AT patients, indicating that alterations in tendon elasticity associated with AT were localized to the FT and did not involve the proximal passive tendon structures. KEY POINTS • Baseline characteristics of a pilot sample of 20 subjects suffering from chronic Achilles tendinopathy showed differences in conventional sonographic measures of tendon thickness, qualitatively assessed hypoechogenicity, hyperemia, and quantitative measures of shear wave speed. • Regional shear wave speeds were lower in the free tendon but not in the proximal regions of the soleus or gastrocnemius aponeuroses in Achilles tendinopathy patients. • Using shear wave imaging to estimate tendon stiffness may prove beneficial for clinical validation studies to address important topics such as return to activity and the effectiveness of rehabilitation protocols.
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Affiliation(s)
- Scott K Crawford
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Darryl Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Janice M Yakey
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, E3/311, 600 Highland Ave, Madison, WI, 53792, USA
| | - Bryan C Heiderscheit
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
| | - John J Wilson
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Kenneth S Lee
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, E3/311, 600 Highland Ave, Madison, WI, 53792, USA.
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Herssens N, Cowburn J, Albracht K, Braunstein B, Cazzola D, Colyer S, Minetti AE, Pavei G, Rittweger J, Weber T, Green DA. Movement in low gravity environments (MoLo) programme-The MoLo-L.O.O.P. study protocol. PLoS One 2022; 17:e0278051. [PMID: 36417480 PMCID: PMC9683620 DOI: 10.1371/journal.pone.0278051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Exposure to prolonged periods in microgravity is associated with deconditioning of the musculoskeletal system due to chronic changes in mechanical stimulation. Given astronauts will operate on the Lunar surface for extended periods of time, it is critical to quantify both external (e.g., ground reaction forces) and internal (e.g., joint reaction forces) loads of relevant movements performed during Lunar missions. Such knowledge is key to predict musculoskeletal deconditioning and determine appropriate exercise countermeasures associated with extended exposure to hypogravity. OBJECTIVES The aim of this paper is to define an experimental protocol and methodology suitable to estimate in high-fidelity hypogravity conditions the lower limb internal joint reaction forces. State-of-the-art movement kinetics, kinematics, muscle activation and muscle-tendon unit behaviour during locomotor and plyometric movements will be collected and used as inputs (Objective 1), with musculoskeletal modelling and an optimisation framework used to estimate lower limb internal joint loading (Objective 2). METHODS Twenty-six healthy participants will be recruited for this cross-sectional study. Participants will walk, skip and run, at speeds ranging between 0.56-3.6 m/s, and perform plyometric movement trials at each gravity level (1, 0.7, 0.5, 0.38, 0.27 and 0.16g) in a randomized order. Through the collection of state-of-the-art kinetics, kinematics, muscle activation and muscle-tendon behaviour, a musculoskeletal modelling framework will be used to estimate lower limb joint reaction forces via tracking simulations. CONCLUSION The results of this study will provide first estimations of internal musculoskeletal loads associated with human movement performed in a range of hypogravity levels. Thus, our unique data will be a key step towards modelling the musculoskeletal deconditioning associated with long term habitation on the Lunar surface, and thereby aiding the design of Lunar exercise countermeasures and mitigation strategies.
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Affiliation(s)
- Nolan Herssens
- Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany
| | - James Cowburn
- Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, United Kingdom
| | - Kirsten Albracht
- Centre for Health and Integrative Physiology in Space, German Sport University, Cologne, Germany
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
- Department of Medical Engineering and Technomathematics, University of Applied Sciences Aachen, Aachen, Germany
| | - Bjoern Braunstein
- Centre for Health and Integrative Physiology in Space, German Sport University, Cologne, Germany
- Institute of Movement and Neuroscience, German Sport University, Cologne, Germany
- Institute of Biomechanics and Orthopaedics, German Sport University, Cologne, Germany
- German Research Centre of Elite Sport Cologne, Cologne, Germany
| | - Dario Cazzola
- Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, United Kingdom
| | - Steffi Colyer
- Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, United Kingdom
| | - Alberto E. Minetti
- Laboratory of Physiomechanics of Locomotion, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gaspare Pavei
- Laboratory of Physiomechanics of Locomotion, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Jörn Rittweger
- Division of Muscle and Bone Metabolism, Institute of Aerospace Medicine DLR, Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Tobias Weber
- Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany
- KBR, Cologne, North Rhein-Westphalia, Germany
| | - David A. Green
- Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany
- KBR, Cologne, North Rhein-Westphalia, Germany
- Centre of Human and Applied Physiological Sciences, King’s College London, London, United Kingdom
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MacLean MK, Ferris DP. Effects of simulated reduced gravity and walking speed on ankle, knee, and hip quasi-stiffness in overground walking. PLoS One 2022; 17:e0271927. [PMID: 35944021 PMCID: PMC9362947 DOI: 10.1371/journal.pone.0271927] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 07/10/2022] [Indexed: 12/04/2022] Open
Abstract
Quasi-stiffness characterizes the dynamics of a joint in specific sections of stance-phase and is used in the design of wearable devices to assist walking. We sought to investigate the effect of simulated reduced gravity and walking speed on quasi-stiffness of the hip, knee, and ankle in overground walking. 12 participants walked at 0.4, 0.8, 1.2, and 1.6 m/s in 1, 0.76, 0.54, and 0.31 gravity. We defined 11 delimiting points in stance phase (4 each for the ankle and hip, 3 for the knee) and calculated the quasi-stiffness for 4 phases for both the hip and ankle, and 2 phases for the knee. The R2 value quantified the suitability of the quasi-stiffness models. We found gravity level had a significant effect on 6 phases of quasi-stiffness, while speed significantly affected the quasi-stiffness in 5 phases. We concluded that the intrinsic muscle-tendon unit stiffness was the biggest determinant of quasi-stiffness. Speed had a significant effect on the R2 of all phases of quasi-stiffness. Slow walking (0.4 m/s) was the least accurately modelled walking speed. Our findings showed adaptions in gait strategy when relative power and strength of the joints were increased in low gravity, which has implications for prosthesis and exoskeleton design.
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Affiliation(s)
- Mhairi K. MacLean
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
- * E-mail:
| | - Daniel P. Ferris
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
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Peñin-Franch A, García-Vidal JA, Martínez CM, Escolar-Reina P, Martínez-Ojeda RM, Gómez AI, Bueno JM, Minaya-Muñoz F, Valera-Garrido F, Medina-Mirapeix F, Pelegrín P. Galvanic current activates the NLRP3 inflammasome to promote type I collagen production in tendon. eLife 2022; 11:73675. [PMID: 35199642 PMCID: PMC8896827 DOI: 10.7554/elife.73675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/23/2022] [Indexed: 11/25/2022] Open
Abstract
The NLRP3 inflammasome coordinates inflammation in response to different pathogen- and damage-associated molecular patterns, being implicated in different infectious, chronic inflammatory, metabolic and degenerative diseases. In chronic tendinopathic lesions, different non-resolving mechanisms produce a degenerative condition that impairs tissue healing and which therefore complicates their clinical management. Percutaneous needle electrolysis consists of the application of a galvanic current and is an emerging treatment for tendinopathies. In the present study, we found that galvanic current activates the NLRP3 inflammasome and induces an inflammatory response that promotes a collagen-mediated regeneration of the tendon in mice. This study establishes the molecular mechanism of percutaneous electrolysis that can be used to treat chronic lesions and describes the beneficial effects of an induced inflammasome-related response.
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Tomc M, Matjačić Z. Harnessing Energy of a Treadmill for Push-Off Assistance During Walking: In-Silico Feasibility Study. Front Bioeng Biotechnol 2022; 10:832087. [PMID: 35252141 PMCID: PMC8889039 DOI: 10.3389/fbioe.2022.832087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Regaining efficient push-off is a crucial step in restitution of walking ability in impaired individuals. Inspired by the elastic nature of ankle plantarflexor muscle-tendon complex, we propose a novel rehabilitation device: Ankle Exoskeleton using Treadmill Actuation for Push-off assistance (AN-EXTRA-Push). Using a brake and an elastic tendon, it harnesses energy of a moving treadmill during stance phase, then releases it during push-off to aid with plantarflexion torque generation. We studied the feasibility of such a device and explored some key design and control parameters. A parameter sweep of three key parameters (brake engagement timing, brake disengagement timing and elastic tendon stiffness) was conducted in-silico. Results suggest that such a device is feasible and might inherently possess some features that simplify its control. Brake engagement timing and elastic tendon stiffness values determine the level of exoskeleton assistance. Our study affirms that timing of assistive torque is crucial, especially the timing of assistance termination which is determined by brake disengagement timing. Insights acquired by this study should serve as a basis for designing an experimental device and conducting studies on effects of AN-EXTRA-Push in humans.
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Affiliation(s)
- Matej Tomc
- Research and Development Unit, University Rehabilitation Institute Republic of Slovenia, Ljubljana, Slovenia
- Laboratory of Robotics, Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
- *Correspondence: Matej Tomc,
| | - Zlatko Matjačić
- Research and Development Unit, University Rehabilitation Institute Republic of Slovenia, Ljubljana, Slovenia
- Laboratory of Robotics, Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
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