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Kage CC, Helwig NE, Ellingson AM. Normative cervical spine kinematics of a circumduction task. J Electromyogr Kinesiol 2021; 61:102591. [PMID: 34543984 DOI: 10.1016/j.jelekin.2021.102591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/26/2021] [Accepted: 09/02/2021] [Indexed: 11/22/2022] Open
Abstract
Neck pain is a prevalent condition and clinical examination techniques are limited and unable to assess out-of-plane motion. Recent works investigating cervical kinematics during neck circumduction (NC), a dynamic 3D task, has shown the ability to discern those with and without neck pain. The purposes of this study were to establish 1) confidence and prediction intervals of head-to-torso kinematics during NC in a healthy cohort, 2) a baseline summative metric to quantify the duration and magnitude of deviations outside the prediction interval, and 3) the reliability of NC. Thirty-nine participants (25.6 ± 6.3 years, 19F/20M) without neck pain completed left and right NC. A two-way smoothing spline analysis of variance was utilized to determine the mean-fitted values and 90% confidence and prediction intervals for NC. A standardized effect size was calculated and aggregated across all axes (Delta RMSD aggregate), as a summative metric of motion quality. Confidence and prediction intervals were comparable for left and right NC and demonstrated excellent reliability. The average sum of the Delta RMSD aggregate was 2.76 ± 0.55 for left NC and 2.74 ± 0.63 for right NC. The results of this study demonstrate the feasibility of utilizing normative intervals of a NC task to assess head-to-torso kinematics.
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Fan S, Padmore C, Kadar A, Chambers S, Langohr GDG, Suh N. The effect of four-corner fusion and proximal row carpectomy on uniplanar and multiplanar wrist motion: A biomechanical study. J Orthop 2021; 24:102-110. [PMID: 33679035 DOI: 10.1016/j.jor.2021.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/14/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose To compare changes in wrist kinematics after scaphoidectomy and four-corner fusion (4CF), and proximal row carpectomy (PRC). Methods Six cadaveric specimens underwent flexion-extension, radial-ulnar deviation and circumduction in an active motion wrist simulator. Native state, "anatomic 4CF", "radial 4CF", and PRC were compared. Results Radial 4CF reduced wrist extension, while PRC reduced radial deviation. Fusion groups had similar motion profiles. 44%, 41%, and 32% of native circumduction was maintained in PRC, anatomic, and radial 4CF. Conclusions Both fusion positions resulted in comparable motion outcomes. Anatomic 4CF was restricted in wrist extension compared to PRC but provided favourable radial deviation.
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Affiliation(s)
- Stacy Fan
- Division of Plastic and Reconstructive Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
| | - Clare Padmore
- Bioengineering Research Laboratory, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, ON, Canada
| | - Assaf Kadar
- Division of Orthopaedic Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
- Department of Orthopaedic Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Spencer Chambers
- Division of Plastic and Reconstructive Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
| | - G Daniel G Langohr
- Bioengineering Research Laboratory, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, ON, Canada
| | - Nina Suh
- Division of Plastic and Reconstructive Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
- Bioengineering Research Laboratory, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, ON, Canada
- Division of Orthopaedic Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
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Dean JC, Bowden MG, Kelly AL, Kautz SA. Altered post-stroke propulsion is related to paretic swing phase kinematics. Clin Biomech (Bristol, Avon) 2020; 72:24-30. [PMID: 31809919 PMCID: PMC7089813 DOI: 10.1016/j.clinbiomech.2019.11.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 09/12/2019] [Accepted: 11/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gait propulsion is often altered following a stroke, with clear effects on anterior progression. Changes in the pattern of propulsion could potentially also influence swing phase mechanics. The purpose of the present study was to investigate whether post-stroke variability in paretic propulsion magnitude or timing influence paretic swing phase kinematics. METHODS 29 chronic stroke survivors participated in this study, walking on an instrumented treadmill at their self-selected and fastest-comfortable speeds. For each participant, we calculated several propulsion-related metrics derived from anteroposterior ground reaction force or from center of mass power, as well as knee flexion angle and circumduction displacement during the swing phase. We performed a series of linear mixed model analyses to determine whether the propulsion metrics for the paretic leg were related to paretic swing phase mechanics. FINDINGS A subset of the stroke survivors exhibited unusual braking forces late in the paretic stance phase, when strong propulsion typically occurs among uninjured controls. Beyond the effects of walking speed or walking condition, these braking forces were significantly linked with altered paretic swing phase mechanics. Specifically, large braking impulses were associated with reduced paretic knee flexion (p = 0.039) and increased paretic circumduction (p = 0.023). INTERPRETATION The present results suggest that braking forces late in stance are particularly indicative of deficits in the production of typical swing phase kinematics. This relationship suggests that therapies designed to address altered swing kinematics should also consider altered force generation in late stance, as these behaviors appear to be coupled.
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Affiliation(s)
- Jesse C. Dean
- Ralph H. Johnson Veterans Affairs Medical Center; 109 Bee St. Charleston, SC, USA,Division of Physical Therapy, College of Health Professions, Medical University of South Carolina (MUSC); 151 Rutledge Ave. Charleston, SC, USA,Department of Health Sciences and Research, College of Health Professions, MUSC; 77 President St. Charleston, SC, USA
| | - Mark G. Bowden
- Ralph H. Johnson Veterans Affairs Medical Center; 109 Bee St. Charleston, SC, USA,Division of Physical Therapy, College of Health Professions, Medical University of South Carolina (MUSC); 151 Rutledge Ave. Charleston, SC, USA,Department of Health Sciences and Research, College of Health Professions, MUSC; 77 President St. Charleston, SC, USA
| | - Abigail L. Kelly
- Department of Public Health Sciences, College of Medicine, MUSC; 135 Cannon St. Charleston, SC, USA
| | - Steven A. Kautz
- Ralph H. Johnson Veterans Affairs Medical Center; 109 Bee St. Charleston, SC, USA,Division of Physical Therapy, College of Health Professions, Medical University of South Carolina (MUSC); 151 Rutledge Ave. Charleston, SC, USA,Department of Health Sciences and Research, College of Health Professions, MUSC; 77 President St. Charleston, SC, USA
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Shah DS, Middleton C, Gurdezi S, Horwitz MD, Kedgley AE. The effects of wrist motion and hand orientation on muscle forces: A physiologic wrist simulator study. J Biomech 2017; 60:232-237. [PMID: 28669547 PMCID: PMC5555257 DOI: 10.1016/j.jbiomech.2017.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 11/30/2022]
Abstract
Although the orientations of the hand and forearm vary for different wrist rehabilitation protocols, their effect on muscle forces has not been quantified. Physiologic simulators enable a biomechanical evaluation of the joint by recreating functional motions in cadaveric specimens. Control strategies used to actuate joints in physiologic simulators usually employ position or force feedback alone to achieve optimum load distribution across the muscles. After successful tests on a phantom limb, unique combinations of position and force feedback – hybrid control and cascade control – were used to simulate multiple cyclic wrist motions of flexion-extension, radioulnar deviation, dart thrower’s motion, and circumduction using six muscles in ten cadaveric specimens. Low kinematic errors and coefficients of variation of muscle forces were observed for planar and complex wrist motions using both novel control strategies. The effect of gravity was most pronounced when the hand was in the horizontal orientation, resulting in higher extensor forces (p < 0.017) and higher out-of-plane kinematic errors (p < 0.007), as compared to the vertically upward or downward orientations. Muscle forces were also affected by the direction of rotation during circumduction. The peak force of flexor carpi radialis was higher in clockwise circumduction (p = 0.017), while that of flexor carpi ulnaris was higher in anticlockwise circumduction (p = 0.013). Thus, the physiologic wrist simulator accurately replicated cyclic planar and complex motions in cadaveric specimens. Moreover, the dependence of muscle forces on the hand orientation and the direction of circumduction could be vital in the specification of such parameters during wrist rehabilitation.
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Affiliation(s)
- Darshan S Shah
- Department of Bioengineering, Imperial College London, London, United Kingdom.
| | - Claire Middleton
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Sabahat Gurdezi
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Maxim D Horwitz
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Angela E Kedgley
- Department of Bioengineering, Imperial College London, London, United Kingdom.
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Abstract
Humans tend to walk economically, with preferred step width and length corresponding to an energetic optimum. In the case of step width, it is costlier to walk with either wider or narrower steps than normally preferred. Wider steps require more mechanical work to redirect the body's motion laterally with each step, but the cost for narrower steps remains unexplained. Here we show that narrow steps are costly because they require the swing leg to be circumducted around the stance leg. Healthy adults (N=8) were tested walking with varying levels of circumduction, induced through lightweight, physical obstructions ("Fins") attached medially to the lower legs, during treadmill walking at fixed speed (1.25ms-1) and step width. The net rate of metabolic energy expenditure increased approximately with the square of circumduction amplitude, by about 50% for an amplitude (measured at mid-swing) of about 18cm. Subjects also generated greater stance leg torque and more arm motion to counter the circumduction, among other compensatory motions that may contribute to energy expenditure. The costs of producing and countering lateral leg motion partially explains the poorer economy of some gait pathologies where circumduction may occur, for example stiff-knee gait. And for healthy individuals, it explains how the energetically optimal average step width, along with the additional variability inherent with multiple steps, should be narrow enough to avoid excessive redirection of the body, yet wide enough to avoid costly circumduction. Humans appear to prefer a step width that compromises between the competing energetic costs for either wider or narrower steps.
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Affiliation(s)
- K Alex Shorter
- Department of Mechanical Engineering, University of Michigan, G.G. Brown Laboratory, 2350 Hayward Ann., Arbor, MI 48109, USA.
| | - Amy Wu
- Department of Mechanical Engineering, University of Michigan, G.G. Brown Laboratory, 2350 Hayward Ann., Arbor, MI 48109, USA.
| | - Arthur D Kuo
- Department of Mechanical Engineering, University of Michigan, G.G. Brown Laboratory, 2350 Hayward Ann., Arbor, MI 48109, USA; Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada.
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Stanhope VA, Knarr BA, Reisman DS, Higginson JS. Frontal plane compensatory strategies associated with self-selected walking speed in individuals post-stroke. Clin Biomech (Bristol, Avon) 2014; 29:518-22. [PMID: 24768223 PMCID: PMC4367535 DOI: 10.1016/j.clinbiomech.2014.03.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 03/28/2014] [Accepted: 03/31/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Approximately two out of three individuals post-stroke experience walking impairments. Frontal plane compensatory strategies (i.e. pelvic hiking and circumduction) are observed in post-stroke gait in part to achieve foot clearance in response to reduced knee flexion and ankle dorsiflexion. The objective of this study was to investigate the relationship between self-selected walking speed and the kinematic patterns related to paretic foot clearance during post-stroke walking. METHODS Gait analysis was performed at self-selected walking speed for 21 individuals post-stroke. Four kinematic variables were calculated during the swing phase of the paretic limb: peak pelvic tilt (pelvic hiking), peak hip abduction (circumduction), peak knee flexion, and peak ankle dorsiflexion. Paretic joint angles were analyzed across self-selected walking speed as well as between functionally relevant ambulation categories (Household <0.4m/s, Limited Community 0.4-0.8m/s, Community >0.8m/s). FINDINGS While all subjects exhibited similar foot clearance, slower walkers exhibited greater peak pelvic hiking and less knee flexion, ankle dorsiflexion, and circumduction compared to faster walkers (P<.05). Additionally, four of the fastest walkers compensated for poor knee flexion and ankle dorsiflexion through large amounts of circumduction. INTERPRETATION These findings suggest that improved gait performance after stroke, as measured by self-selected walking speed, is not necessarily always accomplished through gait patterns that more closely resemble healthy gait for all variables. It appears the ability to walk fast is achieved by either sufficient ankle dorsiflexion and knee flexion to achieve foot clearance or the employment of circumduction to overcome a deficit in either ankle dorsiflexion or knee flexion.
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Affiliation(s)
| | - Brian A. Knarr
- Delaware Rehabilitation Institute, University of Delaware Newark, DE
| | - Darcy S. Reisman
- Biomechanics and Movement Science, University of Delaware Newark, DE
| | - Jill S. Higginson
- Dept. of Physical Therapy, University of Delaware Newark, DE,Dept. of Mechanical Engineering, University of Delaware Newark, DE
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