Running footstrike pattern effect on lower extremity work in an individual with transtibial amputation.

Asymmetrical loading favoring the intact limb during running has been associated with increased prevalence of reported knee pain and potential risk factors of knee osteoarthritis in that limb for patients with amputation. Footstrike pattern alterations have been suggested to help alleviate some overloading of the knee, but little is known about how it affects the rest of the limb. The purpose of this case study was to evaluate the effect of footstrike pattern on the distribution of loading throughout the lower extremities during submaximal running of an individual with transtibial amputation (TTA). This study compared loading distribution among the lower extremity joints in a male patient who sustained a TTA and ran using both a rearfoot (RFS) and forefoot strike (FFS) pattern. The results of this case demonstrated that altering footstrike pattern minimally alters the total mechanical work being done by the lower extremities but more so affects the relative amount of work contributed by the individual joints. In the intact limb, the ankle contributes the most to power absorption using a FFS pattern while the knee has a larger role using a RFS pattern. This case suggests that the footstrike pattern affects lower extremity loading distribution at the joint level, and adopting a FFS pattern may alleviate overloading the knee, whereas a RFS pattern may reduce loading at the ankle in individuals with TTA.

Effect of a load distribution system on mobility and performance during simulated and field hiking while under load.

This study was conducted to test a modular scalable vest-load distribution system (MSV-LDS) against the plate carrier system (PC) currently used by the United States Marine Corps. Ten Marines engaged in 1.6 km load carriage trials in seven experimental conditions in a laboratory study. Kinematic, kinetic, and spatiotemporal gait parameters, muscle activity (electromyography), heart rate, caloric expenditure, shooting reaction times, and subjective responses were recorded. There was lower mean trapezius recruitment for the PC compared with the MSV-LDS for all conditions, and muscle activity was similar to baseline for the MSV-LDS. Twenty-seven Marines carrying the highest load were evaluated in the field, which measured an increase in energy expenditure with MSV-LDS; however, back discomfort was reduced. The field evaluation showed significantly reduced estimated ground reaction force on flat-ground segments with the MSV-LDS, and the data suggest both systems were comparable with respect to mobility and energy cost. Practitioner summary: This study found that a novel load distribution system appears to redistribute load for improved comfort as well as reduce estimated ground reaction force when engaged in hiking activities. Further, hiking with a load distribution system enables more neutral walking posture. Implications of load differences in loads carried are examined. Abbreviations: AGRF: anterior-posterior ground reaction forces; CAREN: Computer Assisted Rehabilitation Environment; GRF: ground reaction forces; HR: heart rate; ML-GRF: mediolateral ground reaction forces; MOLLE: Modular Lightweight Load-carrying Equipment; MSV-LDS: modular scalable vest-load distribution system; NHRC: Naval Health Research Center; PC: plate carrier; PPE: personal protective equipment; RPE: rating of perceived exertion; SAPI: small arms protective insert; sEMG: surface electromyography; USMC: United States Marine Corps; VGRF: Ground reaction forces in the vertical.

Age and sex related differences in shoulder abduction fatigue.

BACKGROUND: Injury prevalence data commonly indicate trends of higher rates of work-related musculoskeletal disorders in older workers over their younger counterparts, and for females more than males. The purpose of this study was to investigate age and sex-related differences in manifestations of shoulder muscle fatigue in a cohort of young and older working age males and females, in a single experiment design allowing for direct comparison of the fatigue effects between the target groups. METHODS: We report upper trapezius muscle fibre Conduction Velocity (CV) as an indicative measure of muscle fatigability, and isometric endurance time, at three levels of shoulder abduction lifting force set relative to participants' maximal strength. RESULTS: Upper trapezius conduction velocity was significantly different between the young and old groups (p = 0.002) as well as between males and females (p = 0.016). Shoulder abduction endurance time was affected by age (P = 0.024) but not sex (p = 0.170). CONCLUSIONS: The study identified age-related improvement in muscle fatigue resistance and increased resistance for females over males, contrary to injury prevalence trends. The muscle fatigue effects are most likely explained by muscle fibre type composition. Experimental fatigue treatments of the upper trapezius were tested at exposures relative to the participants' strength. Absolute strength is higher when young and is generally higher for males. The findings of this study point towards age and sex-related differences in strength rather than in muscle fatigue resistance as a primary cause for the differences in the injury trends.

Net ankle quasi-stiffness is influenced by walking speed but not age for older adult women.

BACKGROUND: Insufficient plantar flexor resistance due to plantar flexor weakness, an impairment common in patient populations, causes substantial gait deficits. The bending stiffness of passive-dynamic ankle-foot orthoses (PD-AFOs) has the capacity to replace lost plantar flexor resistance. Many patients who are prescribed PD-AFOs are older adults. While PD-AFO bending stiffness should be customized for patients, a method to objectively prescribe this stiffness does not exist. Quantifying natural plantar flexor resistance during non-pathological gait could provide a reference value for objectively prescribing PD-AFO bending stiffness. RESEARCH QUESTION: This study investigated the effect of age on plantar flexor resistance in 113 participants above the age of 65 years. We did so while also considering the confounding influence of gait speed, an aspect known to be reduced with old age. METHODS: Ambulatory, community-dwelling older adult women (ages 65-91 years) with no current or recent lower-extremity injuries or surgeries underwent an instrumented gait analysis at a self-selected speed. Plantar flexor resistance was quantified via net ankle quasi-stiffness (NAS) defined as the slope of ankle joint moment-angle curve during late stance. RESULTS: showed that NAS was not significantly influenced by age (r = -0.11, p = 0.12), and that the confounding factor of walking speed had a significant, positive relationship with NAS (r = 0.59, p < 0.001). SIGNIFICANCE: By determining that gait speed, not age, is related to NAS in older adults, this study represents the initial step towards objectively prescribing PD-AFO bending stiffness to achieve a targeted gait speed for older adults with plantar flexor weakness.

A mathematical analysis to address the 6 degree-of-freedom segmental power imbalance.

Segmental power is used in human movement analyses to indicate the source and net rate of energy transfer between the rigid bodies of biomechanical models. Segmental power calculations are performed using segment endpoint dynamics (kinetic method). A theoretically equivalent method is to measure the rate of change in a segment's mechanical energy state (kinematic method). However, these two methods have not produced experimentally equivalent results for segments proximal to the foot, with the difference in methods deemed the "power imbalance." In a 6 degree-of-freedom model, segments move independently, resulting in relative segment endpoint displacement and non-equivalent segment endpoint velocities at a joint. In the kinetic method, a segment's distal end translational velocity may be defined either at the anatomical end of the segment or at the location of the joint center (defined here as the proximal end of the adjacent distal segment). Our mathematical derivations revealed the power imbalance between the kinetic method using the anatomical definition and the kinematic method can be explained by power due to relative segment endpoint displacement. In this study, we tested this analytical prediction through experimental gait data from nine healthy subjects walking at a typical speed. The average absolute segmental power imbalance was reduced from 0.023 to 0.046 W/kg using the anatomical definition to ≤0.001 W/kg using the joint center definition in the kinetic method (95.56-98.39% reduction). Power due to relative segment endpoint displacement in segmental power analyses is substantial and should be considered in analyzing energetic flow into and between segments.

Tuberculosis in cattle: strategic planning for the future.

In the later stages of eradication of tuberculosis in cattle there is a need to take account of the fact that Mycobacterium bovis infection in cattle presents, not as cases of clinical disease but most commonly as apparently healthy animals showing an immunological response to tuberculin. This is an entirely different scenario to that seen when national eradication programmes were first devised, at a time when the protection of public health rather than animal health was the prime motivation. In countries with active programmes to eradicate bovine tuberculosis, it is critical for the programme's success that account is taken of this redefinition of tuberculosis, side by side with changes in modern animal production systems and their impact on the transmission of M. bovis. This paper highlights factors critical to the success of a national eradication programme, including a clear identification of the goals, of the policies that guide actions, and of the sequences of actions that are required within the programme to accomplish these goals. Experience has illustrated the adverse effects of compromise on outcome when the application of fundamental principles of disease control such as sound animal management, removal of known sources of infection, early diagnosis, quarantine, movement control and environmental hygiene are less than enthusiastically promoted and applied. The reality is that where these principles are applied in a sustained manner, the outcome is more likely to be successful. Therein lies the challenge for the risk manager.

Tuberculosis in cattle: the results of the four-area project.

: The four-area project was undertaken to further assess the impact of badger removal on the control of tuberculosis in cattle herds in Ireland. It was conducted between 1997 and 2002 in matched removal and reference areas in four counties, namely Cork, Donegal, Kilkenny and Monaghan, representing a wide range of Irish farming environments. In the removal areas, a proactive programme of badger removal was conducted, on two or three occasions each year, whereas in the reference areas, badger removal was entirely reactive following severe outbreaks of tuberculosis amongst cattle. A detailed statistical analysis of this study has already been presented by Griffin et al. 13; this paper presents further, mainly descriptive, findings from the study. In total, 2,360 badgers were captured in the removal areas of which 450 (19.5%) were considered positive for tuberculosis and 258 badgers were captured in the reference areas, with 57 (26.1%) positive for tuberculosis. The annual incidence of confirmed herd restrictions was lower in the removal area compared to the reference area in every year of the study period in each of the four counties. These empirical findings were consistent with the hazard ratios found by Griffin et al. 13. Further, the effect of proactive badger removal on cattle tuberculosis in the four-area project and in the earlier east-Offaly project, as measured using the number of reactors per 1,000 cattle tested, were very similar, providing compelling evidence of the role of badgers in the epidemiology of tuberculosis in Irish cattle herds. The validity of the four-area project was discussed in detail. Efforts to minimise badger-to-cattle transmission in Ireland must be undertaken in association with the current comprehensive control programme, which has effectively minimised opportunities for cattle-to-cattle transmission.

Analysis and prediction of the BSE incidence in Ireland.

Our purpose was to report the statistical methodology that was used to describe the nature of bovine spongiform encephalopathy (BSE) propagation in the Irish cattle population, to predict the number of future cases and to assess the risk to humans in terms of the number of infected animals that were processed. We used a nonlinear Poisson-regression model for the available birth-cohort data and an iterative method to compute the parameter estimates. Standard errors for the estimates were computed from the nonlinear model and these were validated using a bootstrap procedure. We illustrated the use of the model for prediction and risk assessment using the BSE incidence data between 1981 and 2000. The change in case ascertainment or reporting level was a crucial parameter that determined the observed pattern of clinical BSE. Significant propagation risk was detected from 1985 onwards, with peaks in 1986 and 1994. The trough in the propagation risk in 1990 coincided with a ban of the use of meat-and-bone meal for ruminant feed. Excluding the newly adopted active surveillance method in 2001, the predicted and observed data were comparable.