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Wasser JG, Hendershot BD, Acasio JC, Krupenevich RL, Pruziner AL, Miller RH, Goldman SM, Valerio MS, Senchak LT, Murphey MD, Heltzel DA, Fazio MG, Dearth CL, Hager NA. A Comprehensive, Multidisciplinary Assessment for Knee Osteoarthritis Following Traumatic Unilateral Lower Limb Loss in Service Members. Mil Med 2024; 189:581-591. [PMID: 35803867 DOI: 10.1093/milmed/usac203] [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: 04/12/2022] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Knee osteoarthritis (KOA) is a primary source of long-term disability and decreased quality of life (QoL) in service members (SM) with lower limb loss (LL); however, it remains difficult to preemptively identify and mitigate the progression of KOA and KOA-related symptoms. The objective of this study was to explore a comprehensive cross-sectional evaluation, at the baseline of a prospective study, for characterizing KOA in SM with traumatic LL. MATERIALS AND METHODS Thirty-eight male SM with traumatic unilateral LL (23 transtibial and 15 transfemoral), 9.5 ± 5.9 years post-injury, were cross-sectionally evaluated at initial enrollment into a prospective, longitudinal study utilizing a comprehensive evaluation to characterize knee joint health, functionality, and QoL in SM with LL. Presences of medial, lateral, and/or patellofemoral articular degeneration within the contralateral knee were identified via magnetic resonance imaging(for medically eligible SM; Kellgren-Lawrence Grade [n = 32]; and Outerbridge classification [OC; n = 22]). Tri-planar trunk and pelvic motions, knee kinetics, along with temporospatial parameters, were quantified via full-body gait evaluation and inverse dynamics. Concentrations of 26 protein biomarkers of osteochondral tissue degradation and inflammatory activity were identified via serum immunoassays. Physical function, knee symptoms, and QoL were collected via several patient reported outcome measures. RESULTS KOA was identified in 12 of 32 (37.5%; KL ≥ 1) SM with LL; however, 16 of 22 SM presented with patellofemoral degeneration (72.7%; OC ≥ 1). Service members with versus without KOA had a 26% reduction in the narrowest medial tibiofemoral joint space. Biomechanically, SM with versus without KOA walked with a 24% wider stride width and with a negative correlation between peak knee adduction moments and minimal medial tibiofemoral joint space. Physiologically, SM with versus without KOA exhibited elevated concentrations of pro-inflammatory biomarker interleukin-7 (+180%), collagen breakdown markers collagen II cleavage (+44%), and lower concentrations of hyaluronic acid (-73%) and bone resorption biomarker N-telopeptide of Type 1 Collagen (-49%). Lastly, there was a negative correlation between patient-reported contralateral knee pain severity and patient-reported functionality and QoL. CONCLUSIONS While 37.5% of SM with LL had KOA at the tibiofemoral joint (KL ≥ 1), 72.7% of SM had the presence of patellofemoral degeneration (OC ≥ 1). These findings demonstrate that the patellofemoral joint may be more susceptible to degeneration than the medial tibiofemoral compartment following traumatic LL.
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Affiliation(s)
- Joseph G Wasser
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Brad D Hendershot
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Julian C Acasio
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Rebecca L Krupenevich
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Alison L Pruziner
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Ross H Miller
- Department of Kinesiology, University of Maryland, College Park, MD 20742, USA
| | - Stephen M Goldman
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Michael S Valerio
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Lien T Senchak
- Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Mark D Murphey
- Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- American Institute for Radiologic Pathology, Silver Spring, MD 20910, USA
| | - David A Heltzel
- Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Michael G Fazio
- Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Christopher L Dearth
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Nelson A Hager
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Wasser JG, Hendershot BD, Acasio JC, Dodd LD, Krupenevich RL, Pruziner AL, Miller RH, Goldman SM, Valerio MS, Senchak LT, Murphey MD, Heltzel DA, Fazio MG, Dearth CL, Hager NA. Exploring relationships among multi-disciplinary assessments for knee joint health in service members with traumatic unilateral lower limb loss: a two-year longitudinal investigation. Sci Rep 2023; 13:21177. [PMID: 38040780 PMCID: PMC10692131 DOI: 10.1038/s41598-023-48662-9] [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: 05/06/2023] [Accepted: 11/29/2023] [Indexed: 12/03/2023] Open
Abstract
Motivated by the complex and multifactorial etiologies of osteoarthritis, here we use a comprehensive approach evaluating knee joint health after unilateral lower limb loss. Thirty-eight male Service members with traumatic, unilateral lower limb loss (mean age = 38 yr) participated in a prospective, two-year longitudinal study comprehensively evaluating contralateral knee joint health (i.e., clinical imaging, gait biomechanics, physiological biomarkers, and patient-reported outcomes); seventeen subsequently returned for a two-year follow-up visit. For this subset with baseline and follow-up data, outcomes were compared between timepoints, and associations evaluated between values at baseline with two-year changes in tri-compartmental joint space. Upon follow-up, knee joint health worsened, particularly among seven Service members who presented at baseline with no joint degeneration (KL = 0) but returned with evidence of degeneration (KL ≥ 1). Joint space narrowing was associated with greater patellar tilt (r[12] = 0.71, p = 0.01), external knee adduction moment (r[13] = 0.64, p = 0.02), knee adduction moment impulse (r[13] = 0.61, p = 0.03), and CTX-1 concentration (r[11] = 0.83, p = 0.001), as well as lesser KOOSSport and VR-36General Health (r[16] = - 0.69, p = 0.01 and r[16] = - 0.69, p = 0.01, respectively). This longitudinal, multi-disciplinary investigation highlights the importance of a comprehensive approach to evaluate the fast-progressing onset of knee osteoarthritis, particularly among relatively young Service members with lower limb loss.
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Affiliation(s)
- Joseph G Wasser
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Brad D Hendershot
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA.
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
- Research and Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Research and Engineering Directorate, Defense Health Agency, Falls Church, VA, USA.
| | - Julian C Acasio
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Research and Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Research and Engineering Directorate, Defense Health Agency, Falls Church, VA, USA
| | - Lauren D Dodd
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Rebecca L Krupenevich
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Alison L Pruziner
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Research and Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Research and Engineering Directorate, Defense Health Agency, Falls Church, VA, USA
| | - Ross H Miller
- Department of Kinesiology, University of Maryland, College Park, MD, USA
| | - Stephen M Goldman
- Research and Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Research and Engineering Directorate, Defense Health Agency, Falls Church, VA, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Michael S Valerio
- Research and Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Research and Engineering Directorate, Defense Health Agency, Falls Church, VA, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Lien T Senchak
- Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Mark D Murphey
- Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - David A Heltzel
- Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Michael G Fazio
- Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Christopher L Dearth
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Research and Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Research and Engineering Directorate, Defense Health Agency, Falls Church, VA, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Nelson A Hager
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Krawczyk P, Uchytil J, Rygelova M, Buzga M, Zemkova D, Sykora A, Marik I. Effect of transtibial prosthesis weight on the contralateral knee joint in relation to the risk of osteoarthritis. Prosthet Orthot Int 2023; 47:499-504. [PMID: 36977189 DOI: 10.1097/pxr.0000000000000229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 01/18/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Individuals with transtibial amputation place more load on the contralateral lower extremity. A higher adduction moment at the knee joint has been shown to have an effect on the risk of osteoarthritis. OBJECTIVE The aim of this study was to investigate the effect of weight-bearing of lower-limb prosthesis on the biomechanical parameters associated with the risk of contralateral knee osteoarthritis. STUDY DESIGN Cross-sectional. METHODS The experimental group of 14 subjects with unilateral transtibial amputation (13 males). The mean age was 52.7 ± 14.2 years, height 175.6 ± 6.3 cm, weight 82.3 ± 12.5 kg, and duration of prosthesis use 16.5 ± 9.1 years. The control group consisted of 14 healthy subjects with identical anthropometric parameters. Dual emission X-ray absorptiometry was used to determine the weight of the amputated limb. For gait analysis, 10 Qualisys infrared cameras and a motion sensing system on 3 Kistler force platforms were used. Gait was analyzed with the original, lighter, commonly used prosthesis, as well as the prosthesis loaded to the original limb weight. RESULTS The gait cycle and kinetic parameters of the amputated and healthy limbs were more similar to those of the control group when using the weighted prosthesis. CONCLUSIONS We recommend further research to more accurately specify the weight of the lower-limb prosthesis with respect to the prosthesis design and duration of use of the heavier prosthesis during the day.
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Affiliation(s)
- Petr Krawczyk
- Department of Anatomy and Biomechanics, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
- PROTEOR CZ LLC, Ostrava, Czech Republic
| | - Jaroslav Uchytil
- Department of Human Movement Studies, Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
| | - Marketa Rygelova
- Department of Human Movement Studies, Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
| | - Marek Buzga
- Department of Human Movement Studies, Human Motion Diagnostic Centre, University of Ostrava, Ostrava, Czech Republic
| | - Daniela Zemkova
- Department of Paediatrics, Charles University Hospital Motol, Prague, Czech Republic
- Centre for Defects of Locomotor Apparatus LLC, Prague, Czech Republic
| | | | - Ivo Marik
- Centre for Defects of Locomotor Apparatus LLC, Prague, Czech Republic
- Faculty of Medical Studies, West Bohemia University, Pilsen, Czech Republic
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Garcia GL, Caminita M, Hunter JG, Miller RH, Shim JK. Dorsiflexion shoes affect joint-level landing mechanics related to lower extremity injury risk in females. Sports Biomech 2023:1-15. [PMID: 36948644 DOI: 10.1080/14763141.2023.2191867] [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] [Indexed: 03/24/2023]
Abstract
Athletic shoes that induce dorsiflexion in standing can improve jump height compared to traditional athletic shoes that induce plantarflexion, but it is unknown if dorsiflexion shoes (DF) also affect landing biomechanics associated with lower extremity injury risk. Thus, the purpose of this study was to investigate if DF adversely affect landing mechanics related to patellofemoral pain and anterior cruciate ligament injury risk compared to neutral (NT) and plantarflexion (PF) shoes. Sixteen females (21.65 ± 4.7 years, 63.69 ± 14.3 kg, 1.60 ± 0.05 m) performed three maximum vertical countermovement jumps in DF (-1.5°), NT (0°) and PF (8°) shoes as 3D kinetics and kinematics were recorded. One-way repeated-measures ANOVAs revealed peak vertical ground reaction force, knee abduction moment and total energy absorption were similar between conditions. At the knee, peak flexion and joint displacement were lower in DF and NT, while relative energy absorption was greater in PF (all p < .01). Conversely, relative ankle energy absorption was greater in DF and NT compared to PF (p < .01). Both DF and NT induce landing patterns that may increase strain on passive structures in the knee, emphasising the need for landing mechanics to be considered when testing footwear as gains in performance could come at the cost of injury risk.
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Affiliation(s)
- Gina L Garcia
- Department of Kinesiology, University of Maryland, College Park, MD, USA
| | - Mia Caminita
- Department of Kinesiology, University of Maryland, College Park, MD, USA
| | - Jessica G Hunter
- Department of Kinesiology, University of Maryland, College Park, MD, USA
| | - Ross H Miller
- Department of Kinesiology, University of Maryland, College Park, MD, USA
- Neuroscience & Cognitive Science Program, University of Maryland, College Park, MD, USA
| | - Jae Kun Shim
- Department of Kinesiology, University of Maryland, College Park, MD, USA
- Neuroscience & Cognitive Science Program, University of Maryland, College Park, MD, USA
- Department of Mechanical Engineering, Kyung Hee University, Seoul, South Korea
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
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5
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Ding Z, Henson DP, Sivapuratharasu B, McGregor AH, Bull AMJ. The effect of muscle atrophy in people with unilateral transtibial amputation for three activities: Gait alone does not tell the whole story. J Biomech 2023; 149:111484. [PMID: 36791515 DOI: 10.1016/j.jbiomech.2023.111484] [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: 09/06/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023]
Abstract
Amputation imposes significant challenges in locomotion to millions of people with limb loss worldwide. The decline in the use of the residual limb results in muscle atrophy that affects musculoskeletal dynamics in daily activities. The aim of this study was to quantify the lower limb muscle volume discrepancy based on magnetic resonance (MR) imaging and to combine this with motion analysis and musculoskeletal modelling to quantify the effects in the dynamics of key activities of daily living. Eight male participants with traumatic unilateral transtibial amputation were recruited who were at least six months after receiving their definitive prostheses. The muscle volume discrepancies were found to be largest at the knee extensors (35 %, p = 0.008), followed by the hip abductors (17 %, p = 0.008). Daily activities (level walking, standing up from a chair and ascending one step) were measured in a motion analysis laboratory and muscle and joint forces quantified using a detailed musculoskeletal model for people with unilateral transtibial amputation which was calibrated in terms of the muscle volume discrepancies post-amputation at a subject-specific level. Knee extensor muscle forces were lower at the residual limb than the intact limb for all activities (p ≤ 0.008); residual limb muscle forces of the hip abductors (p ≤ 0.031) and adductors (p ≤ 0.031) were lower for standing-up and ascending one step. While the reduced knee extensor force has been reported by other studies, our results suggest a new biomechanically-based mitigation strategy to improve functional mobility, which could be achieved through strengthening of the hip abd/adductor muscles.
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Affiliation(s)
- Ziyun Ding
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, United Kingdom; Centre for Blast Injury Studies, Imperial College London, London, SW7 2AZ, United, Kingdom.
| | - David P Henson
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, United Kingdom; Centre for Blast Injury Studies, Imperial College London, London, SW7 2AZ, United, Kingdom
| | - Biranavan Sivapuratharasu
- Centre for Blast Injury Studies, Imperial College London, London, SW7 2AZ, United, Kingdom; Department of Surgery and Cancer, Imperial College London, W12 0BZ, United Kingdom
| | - Alison H McGregor
- Centre for Blast Injury Studies, Imperial College London, London, SW7 2AZ, United, Kingdom; Department of Surgery and Cancer, Imperial College London, W12 0BZ, United Kingdom
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, United Kingdom; Centre for Blast Injury Studies, Imperial College London, London, SW7 2AZ, United, Kingdom
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Javanfar A, Bamdad M. A developed multibody knee model for unloading knee with cartilage penetration depth control. Proc Inst Mech Eng H 2022; 236:1528-1540. [DOI: 10.1177/09544119221122067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Unloader knee braces could relieve pain by decreasing the medial knee loading. Particularly for knee osteoarthritis (KOA) patients, this study investigates the relevance of the knee model after identifying the most influential parameter. Since KOA causes the cartilage in a joint to lose its elasticity and thickness, the lack of normal bone-to-bone separation can be painful. We believe that cartilage penetration depth control is an impactful strategy in this research. Moreover, the knee contact force in KOA is fewer than in healthy knees, confirming that the contact force control cannot be a straight factor. Therefore, a biomechanical human knee model is developed, and a generic procedure for dynamic analysis of contact problems in combination with the musculoskeletal model is introduced. The developed model includes the geometric expression of collision curves and an algorithm for determining collision points. This presentation addresses cartilage penetration depth and contact force calculation through nonlinear discontinuous contact law. In view of this, femur and tibia’s relative motion is analyzed through the combined collision reactions of cartilage and bone in the knee. In the simulation, maximum penetration depth in a healthy knee is reported to be 0.795 mm, while in a 75% KOA is 0.521 mm, including 0.5 mm cartilage-cartilage contact and 0.021 mm bone-bone contact. The top unloading 852 N is achieved, reducing penetration depth to 0.45 mm, avoiding bone-bone contact. This proposed procedure with low computation gives us a suitable analysis method for designing knee assistive devices.
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Affiliation(s)
- Amirhosein Javanfar
- Corrective Exercise and Rehabilitation Laboratory, School of Mechanical and Mechatronics Engineering, Shahrood University of Technology, Shahrood, Iran
| | - Mahdi Bamdad
- Corrective Exercise and Rehabilitation Laboratory, School of Mechanical and Mechatronics Engineering, Shahrood University of Technology, Shahrood, Iran
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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7
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Johnson RT, Lakeland D, Finley JM. Using Bayesian inference to estimate plausible muscle forces in musculoskeletal models. J Neuroeng Rehabil 2022; 19:34. [PMID: 35321736 PMCID: PMC8944069 DOI: 10.1186/s12984-022-01008-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background Musculoskeletal modeling is currently a preferred method for estimating the muscle forces that underlie observed movements. However, these estimates are sensitive to a variety of assumptions and uncertainties, which creates difficulty when trying to interpret the muscle forces from musculoskeletal simulations. Here, we describe an approach that uses Bayesian inference to identify plausible ranges of muscle forces for a simple motion while representing uncertainty in the measurement of the motion and the objective function used to solve the muscle redundancy problem. Methods We generated a reference elbow flexion–extension motion and computed a set of reference forces that would produce the motion while minimizing muscle excitations cubed via OpenSim Moco. We then used a Markov Chain Monte Carlo (MCMC) algorithm to sample from a posterior probability distribution of muscle excitations that would result in the reference elbow motion. We constructed a prior over the excitation parameters which down-weighted regions of the parameter space with greater muscle excitations. We used muscle excitations to find the corresponding kinematics using OpenSim, where the error in position and velocity trajectories (likelihood function) was combined with the sum of the cubed muscle excitations integrated over time (prior function) to compute the posterior probability density. Results We evaluated the muscle forces that resulted from the set of excitations that were visited in the MCMC chain (seven parallel chains, 500,000 iterations per chain). The estimated muscle forces compared favorably with the reference forces generated with OpenSim Moco, while the elbow angle and velocity from MCMC matched closely with the reference (average RMSE for elbow angle = 2°; and angular velocity = 32°/s). However, our rank plot analyses and potential scale reduction statistics, which we used to evaluate convergence of the algorithm, indicated that the chains did not fully mix. Conclusions While the results from this process are a promising step towards characterizing uncertainty in muscle force estimation, the computational time required to search the solution space with, and the lack of MCMC convergence indicates that further developments in MCMC algorithms are necessary for this process to become feasible for larger-scale models. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01008-4.
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Affiliation(s)
- Russell T Johnson
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
| | | | - James M Finley
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.,Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA.,Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA
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8
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Kobayashi T, Koh MWP, Hu M, Murata H, Hisano G, Ichimura D, Hobara H. Effects of step frequency during running on the magnitude and symmetry of ground reaction forces in individuals with a transfemoral amputation. J Neuroeng Rehabil 2022; 19:33. [PMID: 35321725 PMCID: PMC8944140 DOI: 10.1186/s12984-022-01012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with unilateral transfemoral amputation are prone to developing health conditions such as knee osteoarthritis, caused by additional loading on the intact limb. Such individuals who can run again may be at higher risk due to higher ground reaction forces (GRFs) as well as asymmetric gait patterns. The two aims of this study were to investigate manipulating step frequency as a method to reduce GRFs and its effect on asymmetric gait patterns in individuals with unilateral transfemoral amputation while running. METHODS This is a cross-sectional study. Nine experienced track and field athletes with unilateral transfemoral amputation were recruited for this study. After calculation of each participant's preferred step frequency, each individual ran on an instrumented treadmill for 20 s at nine different metronome frequencies ranging from - 20% to + 20% of the preferred frequency in increments of 5% with the help of a metronome. From the data collected, spatiotemporal parameters, three components of peak GRFs, and the components of GRF impulses were computed. The asymmetry ratio of all parameters was also calculated. Statistical analyses of all data were conducted with appropriate tools based on normality analysis to investigate the main effects of step frequency. For parameters with significant main effects, linear regression analyses were further conducted for each limb. RESULTS Significant main effects of step frequency were found in multiple parameters (P < 0.01). Both peak GRF and GRF impulse parameters that demonstrated significant main effects tended towards decreasing magnitude with increasing step frequency. Peak vertical GRF in particular demonstrated the most symmetric values between the limbs from - 5% to 0% metronome frequency. All parameters that demonstrated significant effects in asymmetry ratio became more asymmetric with increasing step frequency. CONCLUSIONS For runners with a unilateral transfemoral amputation, increasing step frequency is a viable method to decrease the magnitude of GRFs. However, with the increase of step frequency, further asymmetry in gait is observed. The relationships between step frequency, GRFs, and the asymmetry ratio in gait may provide insight into the training of runners with unilateral transfemoral amputation for the prevention of injury.
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Affiliation(s)
- Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Mark W P Koh
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Mingyu Hu
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Hiroto Murata
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Waterfront 3F, 2-3-26, Aomi, Koto-ku, Tokyo, 135-0064, Japan.,Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Genki Hisano
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Waterfront 3F, 2-3-26, Aomi, Koto-ku, Tokyo, 135-0064, Japan.,Department of Systems and Control Engineering, Tokyo Institute of Technology, Tokyo, Japan.,Research Fellow of Japan Society for the Promotion of Science (JSPS), Tokyo, Japan
| | - Daisuke Ichimura
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Waterfront 3F, 2-3-26, Aomi, Koto-ku, Tokyo, 135-0064, Japan
| | - Hiroaki Hobara
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Waterfront 3F, 2-3-26, Aomi, Koto-ku, Tokyo, 135-0064, Japan.
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9
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Jang J, Migel KG, Kim H, Wikstrom EA. Acute Vibration Feedback During Gait Reduces Mechanical Ankle Joint Loading in Chronic Ankle Instability Patients. Gait Posture 2021; 90:261-266. [PMID: 34536690 DOI: 10.1016/j.gaitpost.2021.09.171] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/05/2021] [Accepted: 09/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with chronic ankle instability (CAI) exhibit altered vertical ground reaction forces (vGRF), a laterally shifted center of pressure, and an inverted foot position during walking. These neuromechanical alterations are linked with altered ankle joint loading in this population. Vibration-based gait retraining improves center of pressure positioning but effects on neuromechanical variables influencing joint loading remains unknown. RESEARCH QUESTION Do patients with CAI exhibit altered vGRF and ankle joint contact forces (JCF) after receiving a single session of vibration-based gait retraining? METHODS Ten individuals with CAI underwent a single session of vibration-based gait retraining. Kinematic and kinetic data were collected during walking on an instrumental treadmill with force plates embedded in it. Following a baseline gait assessment without feedback, participants walked at a self-selected speed for 10 minutes while receiving feedback. Data was collected during an early (1 st and 2 nd minute) and late adaptation phase (9 th and 10 th minute) and, compared to baseline values. Impact and propulsive vGRF variables (i.e. peak, time to peak, and loading rate) were obtained. Musculoskeletal modeling was used to calculate ankle JCF variables (peak, impulse, and loading rate) during stance phase. RESULTS Propulsive vGRF and ankle JCF outcomes were significantly reduced during the early and late adaptation phases (p ≤ 0.039). SIGNIFICANCE These results indicate that vibration-based gait retraining can immediately reduce propulsive vGRF and ankle JCF and may represent a modality that could help restore appropriate ankle joint loading patterns in those with CAI.
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Affiliation(s)
- Jaeho Jang
- MOTION Science Institute, Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, NC, USA.
| | - Kimmery G Migel
- MOTION Science Institute, Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, NC, USA
| | - Hoon Kim
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Erik A Wikstrom
- MOTION Science Institute, Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, NC, USA
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10
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Milner CE, Meardon SA, Hawkins JL, Willson JD. Walking velocity and step length adjustments affect knee joint contact forces in healthy weight and obese adults. J Orthop Res 2018; 36:2679-2686. [PMID: 29704285 DOI: 10.1002/jor.24031] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 04/19/2018] [Indexed: 02/04/2023]
Abstract
Knee osteoarthritis is a major public health problem and adults with obesity are particularly at risk. One approach to alleviating this problem is to reduce the mechanical load at the joint during daily activity. Adjusting temporospatial parameters of walking could mitigate cumulative knee joint mechanical loads. The purpose of this study was to determine how adjustments to velocity and step length affects knee joint loading in healthy weight adults and adults with obesity. We collected three-dimensional gait analysis data on 10 adults with a normal body mass index and 10 adults with obesity during over ground walking in nine different conditions. In addition to preferred velocity and step length, we also conducted combinations of 15% increased and decreased velocity and step length. Peak tibiofemoral joint impulse and knee adduction angular impulse were reduced in the decreased step length conditions in both healthy weight adults (main effect) and those with obesity (interaction effect). Peak knee joint adduction moment was also reduced with decreased step length, and with decreased velocity in both groups. We conclude from these results that adopting shorter step lengths during daily activity and when walking for exercise can reduce mechanical stimuli associated with articular cartilage degenerative processes in adults with and without obesity. Thus, walking with reduced step length may benefit adults at risk for disability due to knee osteoarthritis. Clinical Significance: Adopting a shorter step length during daily walking activity may reduce knee joint loading and thus benefit those at risk for knee cartilage degeneration. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2679-2686, 2018.
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Affiliation(s)
- Clare E Milner
- ReHAB Group, Department of Physical Therapy and Rehabilitation Science, Drexel University, Philadelphia, Pennsylvania, 19102
| | - Stacey A Meardon
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina, 27834
| | - Jillian L Hawkins
- ReHAB Group, Department of Physical Therapy and Rehabilitation Science, Drexel University, Philadelphia, Pennsylvania, 19102
| | - John D Willson
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina, 27834
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11
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Krupenevich RL, Miller RH, Hendershot BD, Schnall BL, Pruziner AL. Knee adduction moment peak and impulse do not change during the first six months of walking with a prosthesis. Gait Posture 2018; 63:86-90. [PMID: 29727776 DOI: 10.1016/j.gaitpost.2018.04.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/27/2018] [Accepted: 04/25/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with unilateral lower limb loss are at increased risk for developing knee osteoarthritis in their contralateral limb. The mechanisms underlying this phenomenon are unknown, but large or unusual loads on the limb are thought to contribute to osteoarthritis development. Yet, to our knowledge, there have been no longitudinal assessments of knee joint kinetics to assist with identifying the origin or progression of such loads. RESEARCH QUESTION This study aimed to examine knee joint kinetics of individuals with lower limb loss as a function of time from independent ambulation. METHODS Eight male Service Members with unilateral lower limb loss (3 transfemoral/5 transtibial) completed gait analyses, walking at self-selected speed and cadence, at 0, 2, and 6 months following initial independent ambulation. RESULTS Although there was a significant time effect on stride length (p = 0.047), there were no pairwise differences (all p ≥ 0.152). Additionally, there was not a significant effect of time on the peak (p = 0.666), loading rate (p = 0.336), or impulse (p = 0.992) of knee adduction moment (KAM), peak knee flexion moment (KFM) (p = 0.128), or the peak (p = 0.485) or loading rate (p = 0.130) of vertical ground reaction force (VGRF). SIGNIFICANCE The results of the current study demonstrate that major features of knee joint loading do not change over the first 6 months of independently walking with a prosthesis. The magnitude of these loads are similar to loads observed in individuals with lower limb loss further from injury/initial ambulation, but the present results do not imply that no changes occur after 6 months.
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Affiliation(s)
- Rebecca L Krupenevich
- University of Maryland,College Park, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | | | - Brad D Hendershot
- Walter Reed National Military Medical Center, Bethesda, MD, USA; DoD-VA Extremity Trauma and Amputation Center of Excellence, USA; Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Barri L Schnall
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Alison L Pruziner
- Walter Reed National Military Medical Center, Bethesda, MD, USA; DoD-VA Extremity Trauma and Amputation Center of Excellence, USA; Uniformed Services University of Health Sciences, Bethesda, MD, USA
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12
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Incidence of Overuse Musculoskeletal Injuries in Military Service Members With Traumatic Lower Limb Amputation. Arch Phys Med Rehabil 2018; 99:348-354.e1. [DOI: 10.1016/j.apmr.2017.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/02/2017] [Accepted: 10/08/2017] [Indexed: 11/20/2022]
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