The effects of Müller-Lyer illusion on toe clearance height in stair ascent.

BACKGROUND: The appearance of a stair can impact the safe negotiation of stair climbing. Increasing toe clearance height is a common strategy for reducing the risk of tripping when stepping onto a raised surface. RESEARCH QUESTION: Can the Müller-Lyer illusion cause people to increase their toe clearance height when walking over a stair? METHODS: Indoors, 15 healthy individuals (9 women and 6 men) walked up a 3-step staircase with each step 60 cm wide, 18 cm tall, and 30.5 cm deep. Outdoors, 253 people walked up a 2-step staircase with each step 6 m wide, 15 cm tall, and 38 cm deep. Four visual conditions were displayed at both the indoor and outdoor locations: fins out, fins in, line, and control. RESULTS: While the fins out stairs were perceived taller than all the other displayed stair conditions, the toe clearance height was not different between display conditions when tested indoors. However, toe clearance height was greater in the fins out condition when compared to all other conditions for the outdoor stairs location. SIGNIFICANCE: In the natural environment when walkers were oblivious to themselves being filmed and not having any knowledge of the task demand, the Müller-Lyer illusion significantly impacted their toe clearance height.

Quantitative analysis of the Oculus Rift S in controlled movement.

PURPOSE: To assess the translational and rotational tracking performance of the Oculus Rift S using controlled robotic motion and a gold-standard motion tracking system. MATERIALS AND METHODS: An Oculus Rift S headset and controller were each placed in an industrial robot arm and had Vicon passive markers placed on them. The robotic arm was then translated in three perpendicular directions and performed three orthogonal rotations about three orthogonal axes while the spatial position of the headset and controller were recorded by Vicon motion capture cameras as well as Unity. Positional data was analyzed to determine the difference in tracking between Unity and Vicon to establish the accuracy of the Rift S' tracking capabilities. RESULTS: It was determined that the translational accuracy of the system was 1.66 ± 0.74 mm for the head-mounted display and 4.36 ± 2.91 mm for the controller, and the rotational accuracy of the system was 0.34 ± 0.38° for the HMD and 1.13 ± 1.23° for the controller. CONCLUSIONS: The high level of accuracy and precision combined with the low cost of the Oculus Rift S and its use of inside-out tracking make it a viable candidate for clinicians looking to incorporate virtual reality.Implications for RehabilitationThe Oculus Rift S can report the position and orientation of the user's headmounted display and controllers during gameplay.The Oculus Rift S provides a more portable VR system which does not require external sensors to track motion, allowing it to be used in a variety of rehabilitation scenarios while still providing adequate motion tracking.

How persons with transtibial amputation regulate lateral stepping while walking in laterally destabilizing environments.

BACKGROUND: Persons with lower limb amputation often experience decreased physical capacity, difficulty walking, and increased fall risk. To either prevent or recover from a loss of balance, one must effectively regulate their stepping movements. It is therefore critical to identify how well persons with amputation regulate stepping. Here, we used a multi-objective control framework based on Goal Equivalent Manifolds to identify how persons with transtibial amputation (TTA) regulate lateral stepping while walking without and with lateral perturbations. RESEARCH QUESTION: When walking in destabilizing environments, do otherwise healthy persons with TTA exhibit greater difficulty regulating lateral stepping due to impaired control? Or do they instead continue to use similar strategies to regulate lateral stepping despite their amputation? METHODS: Eight persons with unilateral TTA and thirteen able-bodied (AB) controls walked in a virtual environment under three conditions: no perturbations, laterally oscillating visual field, and laterally oscillating treadmill platform. We analyzed step-to-step time series of step widths and absolute lateral body positions. We computed means, standard deviations and Detrended Fluctuation Analysis scaling exponents for each time series and computed how much participants directly corrected step width and position deviations at each step. We compared our results to computational predictions to identify the underlying causes of our experimental findings. RESULTS: All participants exhibited significantly increased variability, decreased scaling exponents, and tighter direct control when perturbed. Simulations from our stepping regulation models revealed that people responded to the increased variability produced by the imposed perturbations by tightening their control of both step width and lateral position. Participants with TTA exhibited only a few minor differences from AB in lateral stepping regulation, even when subjected to substantially destabilizing lateral perturbations. SIGNIFICANCE: Since control of stepping is intrinsically multi-objective, developing effective interventions to reduce fall risk in persons with amputation will likely require strategies that adopt multi-objective approaches.

A quantitative method for evaluation of 6 degree of freedom virtual reality systems.

Modern virtual reality systems such as the HTC Vive enable users to be immersed in a virtual world. Validation of the HTC Vive and other contemporaneous systems for use in clinic, research, and industry applications will assure users and developers that games and applications made for these systems are accurate representations of the real world. The purpose of this study was to develop a standardized method for testing the translational and rotational capabilities of VR systems such as the HTC Vive. The translational and rotational capabilities of the HTC Vive were investigated using an industry grade robot arm and a gold standard motion capture system. It was found that the average difference between reported translational distances traveled was 0.74 ±â€¯0.42 mm for all room-scale calibration trials and 0.63 ±â€¯0.27 mm for all standing calibration trials. The mean difference in angle rotated was 0.46 ±â€¯0.46° for all room-scale calibration trials and 0.66 ±â€¯0.40° for all standing calibration trials. When tested using human movement, the average difference in distance traveled was 3.97 ±â€¯3.37 mm. Overall, the HTC Vive shows promise as a tool for clinic, research, and industry and its controllers can be accurately tracked in a variety of situations. The methodology used for this study can easily be replicated for other VR systems so that direct comparisons can be made as new systems become available.

Specificity and variability of trunk kinematics on a mechanical horse.

As perturbation training is gaining popularity, it is important to better understand postural control during complex three-dimensional stimuli. One clinically relevant and commonly used three-dimensional stimulus is found in hippotherapy and simulated hippotherapy on a mechanical horse. We tested nine healthy participants on a horse simulator, measured head and trunk kinematics, and characterized data in time (root-mean-square and variability) and frequency (amplitude spectra, gains, and phases) domains. We addressed three fundamental questions: 1) What is the specificity of postural responses to the simulator? 2) Which plane of motion is associated with the most and least variability (repeatable movements across repeated stimuli and across participants)? 3) To what extent are postural responses influenced by different degrees of stability (addition of pelvis straps and trunk support)? We found head and trunk responses were highly specific to the three-dimensional simulator perturbation direction and frequency. Frontal plane responses had the least variability across repetitions and participants whereas transverse motion was most variable. Head motion was more variable than the trunk at low frequencies and exhibited a marked decrease in tilt in the sagittal plane. Finally, the inclusion of pelvis straps had minimal effect on kinematics at low frequencies but altered higher frequencies; whereas added trunk support reduced head and trunk responses to perturbations and altered timing characteristics in all three planes. In conclusion, the present study suggests that frontal plane motion was under a high level of control, and results support the idea that specific head and trunk postural responses can be elicited from a complex three-dimensional stimuli, such as those found in hippotherapy. Researchers and clinicians can use results from this study to help interpret variability, implement mechanical adjustments to stability, and assess responses in pathological populations.

Use of Perturbation-Based Gait Training in a Virtual Environment to Address Mediolateral Instability in an Individual With Unilateral Transfemoral Amputation.

BACKGROUND AND PURPOSE: Roughly 50% of individuals with lower limb amputation report a fear of falling and fall at least once a year. Perturbation-based gait training and the use of virtual environments have been shown independently to be effective at improving walking stability in patient populations. An intervention was developed combining the strengths of the 2 paradigms utilizing continuous, walking surface angle oscillations within a virtual environment. This case report describes walking function and mediolateral stability outcomes of an individual with a unilateral transfemoral amputation following a novel perturbation-based gait training intervention in a virtual environment. CASE DESCRIPTION: The patient was a 43-year-old male veteran who underwent a right transfemoral amputation 7+ years previously as a result of a traumatic blast injury. He used a microprocessor-controlled knee and an energy storage and return foot. OUTCOMES: Following the intervention, multiple measures indicated improved function and stability, including faster self-selected walking speed and reduced functional stepping time, mean step width, and step width variability. These changes were seen during normal level walking and mediolateral visual field or platform perturbations. In addition, benefits were retained at least 5 weeks after the final training session. DISCUSSION: The perturbation-based gait training program in the virtual environment resulted in the patient's improved walking function and mediolateral stability. Although the patient had completed intensive rehabilitation following injury and was fully independent, the intervention still induced notable improvements to mediolateral stability. Thus, perturbation-based gait training in challenging simulated environments shows promise for improving walking stability and may be beneficial when integrated into a rehabilitation program.

Functional testing provides unique insights into the pathomechanics of femoroacetabular impingement and an objective basis for evaluating treatment outcome.

Femoroacetabular impingement (FAI) has been recognized as a significant clinical problem. While hip reshaping surgery for treating FAI has had positive clinical outcomes, there remains a need for objective functional outcomes of FAI treatment. We tested the hypothesis that during walking and stair climbing significant changes in hip kinematics would occur following hip reshaping surgery that indicate restoration of normal function post-operatively. Hip and pelvic kinematics were collected for 17 FAI patients pre- and 1 year post-operatively and compared to 17 healthy matched controls. Prior to surgery, FAI patients had significantly reduced hip internal rotation and hip sagittal plane range of motion during walking (p = 0.01, p < 0.001, respectively) and stair climbing (p = 0.01, p < 0.001, respectively) as compared with controls. Post-operatively, these motions were restored to normal during walking (p = 0.70, p = 0.46, respectively), but remained significantly reduced in the FAI patients during stair climbing (p = 0.03, p < 0.001, respectively). These results have important implications for understanding the functional pathomechanics of FAI and providing an objective basis for evaluating treatment outcome. The stair climbing results indicate that problems still exist in the hip joint for activities requiring higher ranges of hip motion and suggest a basis for exploring future improvements for the treatment of FAI.

Preoperative and postoperative sagittal plane hip kinematics in patients with femoroacetabular impingement during level walking.

BACKGROUND: Femoroacetabular impingement (FAI) has been linked to osteoarthritis. Treatment options range from nonoperative to operative, and current outcome measures are generally subjective or not conducted under actual activities of daily living. Thus, there is a need for the use of motion capture techniques to quantitatively assess the outcome of surgical intervention for those treated for FAI. HYPOTHESIS: The gait of FAI patients 1 year after operative treatment (arthroscopic hip reshaping) will be significantly closer to the normal range and pattern of hip flexion motion, relative to pretreatment. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Eleven patients between 18 and 44 years of age with diagnosed FAI were enrolled in this study. Kinematics and kinetics for this group of patients were collected using motion capture techniques before arthroscopic bone-reshaping surgery and again 1 year after surgery. Pain and perceived activity level (Tegner scale) were also collected. All collected data were compared using a paired t test. RESULTS: Overall hip sagittal plane range of motion increased on the affected side from 27.6° ± 5.0° to 30.7° ± 4.3° (P = .02). The presence of abnormal reversals (second-order change in the slope in the hip flexion/extension curve) that was present in 5 patients preoperatively disappeared or was reduced in prevalence and magnitude in 4 of the patients postoperatively. Additionally, pain decreased and activity level increased postoperatively. CONCLUSION: The results supported the hypothesis that surgical intervention for FAI restores more normal patterns of gait and provides objective support that the surgical procedure is useful. The results help establish motion capture as a potential method for quantitatively assessing the outcome in FAI surgical interventions. The presence of abnormal reversals in hip flexion has been reported in end-stage hip osteoarthritis, and the presence of these reversals in FAI patients reinforces the idea of FAI being a precursor to hip osteoarthritis.

Knee joint kinematics during walking influences the spatial cartilage thickness distribution in the knee.

The regional adaptation of knee cartilage morphology to the kinematics of walking has been suggested as an important factor in the evaluation of the consequences of alteration in normal gait leading to osteoarthritis. The purpose of this study was to investigate the association of spatial cartilage thickness distributions of the femur and tibia in the knee to the knee kinematics during walking. Gait data and knee MR images were obtained from 17 healthy volunteers (age 33.2 ± 9.8 years). Cartilage thickness maps were created for the femoral and tibial cartilage. Locations of thickest cartilage in the medial and lateral compartments in the femur and tibia were identified using a numerical method. The flexion-extension (FE) angle associated with the cartilage contact regions on the femur, and the anterior-posterior (AP) translation and internal-external (IE) rotation associated with the cartilage contact regions on the tibia at the heel strike of walking were tested for correlation with the locations of thickest cartilage. The locations of the thickest cartilage had relatively large variation (SD, 8.9°) and was significantly associated with the FE angle at heel strike only in the medial femoral condyle (R(2)=0.41, p<0.01). The natural knee kinematics and contact surface shapes seem to affect the functional adaptation of knee articular cartilage morphology. The sensitivity of cartilage morphology to kinematics at the knee during walking suggests that regional cartilage thickness variations are influenced by both loading and the number of loading cycles. Thus walking is an important consideration in the analysis of the morphological variations of articular cartilage, since it is the dominant cyclic activity of daily living. The sensitivity of cartilage morphology to gait kinematics is also important in understanding the etiology and pathomechanics of osteoarthritis.