SOFIE, a bicycle that supports older cyclists?

Older cyclists remain at high risk of sustaining an injury after a fall with their bicycle. A growing awareness for the need and possibilities to support safety of older cyclists has been leading to bicycle design ideas. However, the effectiveness and acceptance of such designs has not been studied yet. This study aims to analyse the effect of 3 support systems: an automatic adjustable saddle height, optimised frame and wheel geometry and drive-off assistance. The support systems are integrated on the SOFIE bicycle, a prototype bicycle designed to support older cyclists during (dis-)mounting and at lower cycling speeds. Nine older cyclists (65-80 years) were asked to cycle on a 'normal' and on the 'SOFIE' bicycle. They cycled on a parking lot to avoid interaction with traffic. The following tasks were analysed: cycling at comfortable and low speed avoiding an obstacle and (dis-)mounting the bicycle. Bicycle and cyclist motions were recorded with 10 Inertial Measurement Units and by 2 video cameras. FUSION software (LABVIEW) was used to assess kinematic parameters. First, a subjective analysis of the different cycling tasks was made, supported by video analysis. Second, differences in cyclist and bicycle kinematic parameters between the normal and SOFIE bicycle were studied for the various cycling tasks. The SOFIE bicycle was experienced as a 'supportive' and comfortable bicycle and objectively performed 'safer' on various cycling tasks. For example: The optimised frame geometry with low step-in enabled a faster (dis-)mounting time and less sternum roll angle and angular acceleration. The adjustable saddle height enabled the participants to keep both feet on the ground till they started cycling with the 'drive-off' support. The latter reduces steering activity: maximum steer angle and angular acceleration. During sudden obstacle avoidance, less upper body and thigh accelerations are recorded. In conclusion, the SOFIE bicycle was able to support older cyclists during various cycling tasks and may reduce fall risk.

Can shoulder joint reaction forces be estimated by neural networks?

To facilitate the development of future shoulder endoprostheses, a long term load profile of the shoulder joint is desired. A musculoskeletal model using 3D kinematics and external forces as input can estimate the mechanical load on the glenohumeral joint, in terms of joint reaction forces. For long term ambulatory measurements, these 3D kinematics can be measured by means of Inertial Magnetic Measurement Systems. Recording of external forces under daily conditions is not feasible; estimations of joint loading should preferably be independent of this input. EMG signals reflect the musculoskeletal response and can easily be measured under daily conditions. This study presents the use of a neural network for the prediction of glenohumeral joint reaction forces based upon arm kinematics and shoulder muscle EMG. Several setups were examined for NN training, with varying combinations of type of input, type of motion, and handled weights. When joint reaction forces are predicted by a trained NN, for motion data independent of the training data, results show a high intraclass correlation (ICC up to 0.98) and relative SEM as low as 3%, compared to similar output of a musculoskeletal model. A convenient setup in which kinematics and only one channel of EMG were used as input for the NN׳s showed comparable predictive power as more complex setups. These results are promising and enable long term estimation of shoulder joint reaction forces outside the motion lab, independent of external forces.

Determining a long term ambulatory load profile of the shoulder joint: neural networks predicting input for a musculoskeletal model.

To gain more insight in the development of joint damage, a long term load profile of the shoulder joint under daily living conditions is desirable. Standard musculoskeletal models estimate joint load using kinematics and exerted force. However, the latter cannot be measured continuously in ambulatory settings, hampering the use of these models. This paper describes a method for obtaining such a load profile, by training a Neural Network (NN), using kinematics and EMG. A small data set of specified movements with known exerted forces is used in two ways. First, the model calculates several variables of joint load, and a set of Generalized Forces and Net Moments (GFNM) around the model's degrees of freedom. Second, using kinematics and EMG, an NN is trained to predict these GFNM, which can concurrently be used as input for the model, resulting in full model output independent of exerted force. The method is validated with an independent trial. The NN could predict GFNM within 10% relative RMS, compared to output of the model. The NN-model combination estimated joint reaction forces with relative RMS values of 7 to 17%, enabling the estimation of a detailed load profile of the shoulder under daily conditions.

Functionally interpretable local coordinate systems for the upper extremity using inertial & magnetic measurement systems.

BACKGROUND: Inertial Magnetic Measurement Systems (IMMS) are becoming increasingly popular by allowing for measurements outside the motion laboratory. The latest models enable long term, accurate measurement of segment motion in terms of joint angles, if initial segment orientations can accurately be determined. The standard procedure for definition of segmental orientation is based on the measurement of positions of bony landmarks (BLM). However, IMMS do not deliver position information, so an alternative method to establish IMMS based, anatomically understandable segment orientations is proposed. METHODS: For five subjects, IMMS recordings were collected in a standard anatomical position for definition of static axes, and during a series of standardized motions for the estimation of kinematic axes of rotation. For all axes, the intra- and inter-individual dispersion was estimated. Subsequently, local coordinate systems (LCS) were constructed on the basis of the combination of IMMS axes with the lowest dispersion and compared with BLM based LCS. FINDINGS: The repeatability of the method appeared to be high; for every segment at least two axes could be determined with a dispersion of at most 3.8 degrees. Comparison of IMMS based with BLM based LCS yielded compatible results for the thorax, but less compatible results for the humerus, forearm and hand, where differences in orientation rose to 17.2 degrees. INTERPRETATION: Although different from the 'gold standard' BLM based LCS, IMMS based LCS can be constructed repeatable, enabling the estimation of segment orientations outside the laboratory. CONCLUSIONS: A procedure for the definition of local reference frames using IMMS is proposed.

Magnetic distortion in motion labs, implications for validating inertial magnetic sensors.

BACKGROUND: Ambulatory 3D orientation estimation with Inertial Magnetic Sensor Units (IMU's) use the earth magnetic field. The magnitude of distortion in orientation in a standard equipped motion lab and its effect on the accuracy of the orientation estimation with IMU's is addressed. METHODS: Orientations of the earth magnetic field vectors were expressed in the laboratory's reference frame. The effect of a distorted earth magnetic field on orientation estimation with IMU's (using both a quaternion and a Kalman fusing algorithm) was compared to orientations derived from an optical system. FINDINGS: The magnetic field varied considerably, with the strongest effects at 5 cm above floor level with a standard deviation in heading of 29 degrees , decreasing to 3 degrees at levels higher than 100 cm. Orientation estimation was poor with the quaternion filter, for the Kalman filter results were acceptable, despite a systematic deterioration over time (after 20-30s). INTERPRETATION: Distortion of the earth magnetic field is depending on construction materials used in the building, and should be taken into account for calibration, alignment to a reference system, and further measurements. Mapping the measurement volume to determine its ferromagnetic characteristics in advance of planned experiments can be the rescue of the data set. CONCLUSIONS: To obtain valid data, "mapping" of the laboratory is essential, although less critical with the Kalman filter and at larger distances (>100 cm) from suspect materials. Measurements should start in a "safe" area and continue no longer than 20-30s in a heavily distorted earth magnetic field.

Ambulatory measurement of arm orientation.

In order to evaluate the impact of neuromuscular disorders affecting the upper extremities, the functional use of the arm need to be evaluated during daily activities. A system suitable for measuring arm kinematics should be ambulatory and not interfere with activities of daily living. A measurement system based on miniature accelerometers and gyroscopes is adequate because the sensors are small and do not suffer from line of sight problems. A disadvantage of such sensors is the cumulative drift around the vertical and the problems with aligning the sensor with the segment. A method that uses constraints in the elbow to measure the orientation of the lower arm with respect to the upper arm is described. This requires a calibration method to determine the exact orientation of each of the sensors with respect to the segment. Some preliminary measurements were analyzed and they indicated a strong reduction in orientation error around the vertical. It seemed that the accuracy of the method is limited by the accuracy of the sensor to segment calibration.

The effect of an ergonomic computer device on muscle activity of the upper trapezius muscle during typing.

OBJECTIVE: Investigate whether an ergonomic computer device, characterised by an inclined working area and keyboard localisation close to the screen (the Up-Line), decreases the muscle activity of the upper trapezius muscle. METHODS: In a crossover design 19 healthy subjects and 19 patients with Whiplash Associated Disorder (WAD) typed during 10 min at the Up-Line and at a standard workstation with 15 min of rest in between. During typing surface EMG was measured of the trapezius muscle. The subjects were asked to rate sitting comfort and complaints. RESULTS: Although most subjects subjectively preferred the Up-Line, on average no significant differences were found in muscle activity between the two workstations for both patients and healthy subjects. Individually in 5 healthy subjects (25%) and in 6 patients (31%) muscle activity was lower when working at the Up-Line. CONCLUSION: Although some subjects subjectively prefer the Up-Line in sitting comfort, on average the Up-Line did not decrease the muscle activity, both in healthy subjects as in patients with WAD.

Lumbar loading during lifting: a comparative study of three measurement techniques.

Low back loading during occupational lifting is thought to be an important causative factor in the development of low back pain. In order to regulate spinal loading in the workplace, it is necessary to measure it accurately. Various methods have been developed to do this, but each has its own limitations, and none can be considered a "gold standard". The purpose of the current study was to compare the results of three contrasting techniques in order to gain insight into possible sources of error to which each is susceptible. The three techniques were a linked segment model (LSM), an electromyographic (EMG)-based model, and a neural network (NN) that used both EMG and inertial sensing techniques. All three techniques were applied simultaneously to calculate spinal loading when eight volunteers performed a total of eight lifts in a laboratory setting. Averaged results showed that, in comparison with the LSM, the EMG technique calculated a 25.5+/-33.4% higher peak torque and the NN technique a 17.3+/-10.5% lower peak torque. Differences between the techniques varied with lifting speed and method of lifting, and could be attributed to differences in anthropometric assumptions, antagonistic muscle activity, damping of transient force peaks by body tissues, and, specific to the NN, underestimation of trunk flexion. The results of the current study urge to reconsider the validity of other models by independent comparisons.

An EMG technique for measuring spinal loading during asymmetric lifting.

OBJECTIVES: To compare two methods of calibrating the erector spinae electromyographic signal against moment generation in order to predict extensor moments during asymmetric lifting tasks, and to compare the predicted moments with those obtained using a linked-segment model. METHODS: Eight men lifted loads of 6.7 and 15.7 kg at two speeds, in varying amounts of trunk rotation. For each lift, the following were recorded at 60 Hz; the rectified and averaged surface electromyographic signal, bilaterally at T10 and L3, lumbar curvature using the 3-Space Isotrak, movement of body segments using a 4-camera Vicon system, and ground reaction forces using a Kistler force-plate. Electromyographic (EMG) and Isotrak data were used to calculate lumbosacral extensor moments using the electromyographic model, whereas movement analysis data and ground reaction forces were used to estimate net moments using the linked-segment model. For the electromyographic technique, predictions of extensor moment were based on two different sets of EMG-extensor moment calibrations: one performed in pure sagittal flexion and the other in flexion combined with 45 degrees of trunk rotation. RESULTS: Extensor moments predicted by the electromyographic technique increased significantly with load and speed of lifting but were not influenced by the method of calibration. These moments were 7-40%greater than the net moments obtained with the linked-segment model, the difference increasing with load and speed. CONCLUSIONS: The calibration method does not influence extensor moments predicted by the electromyographic technique in asymmetric lifting, suggesting that simple, sagittal-plane calibrations are adequate for this purpose. Differences in predicted moments between the electromyographic technique and linked-segment model may be partly due to different anthropometric assumptions and different amounts of smoothing and filtering in the two models, and partly due to antagonistic muscle forces, the effects of which cannot be measured by linked-segment models. RelevanceAsymmetric lifting is a significant risk factor for occupationally-related low back pain. Improved techniques for measuring spinal loading during such complex lifting tasks may help to identify work practices which place the spine at risk of injury.

Cervical muscle dysfunction in the chronic whiplash associated disorder grade II (WAD-II).

STUDY DESIGN: In a cross-sectional study, surface electromyography measurements of the upper trapezius muscles were obtained during different functional tasks in patients with a chronic whiplash associated disorder Grade II and healthy control subjects. OBJECTIVES: To investigate whether muscle dysfunction of the upper trapezius muscles, as assessed by surface electromyography, can be used to distinguish patients with whiplash associated disorder Grade II from healthy control subjects. SUMMARY OF BACKGROUND INFORMATION: In the whiplash associated disorder, there is need to improve the diagnostic tools. Whiplash associated disorder Grade II is characterized by the presence of "musculoskeletal signs." Surface electromyography to assess these musculoskeletal signs objectively may be a useful tool. METHODS: Normalized smoothed rectified electromyography levels of the upper trapezius muscles of patients with whiplash associated disorder Grade II (n = 18) and healthy control subjects (n = 19) were compared during three static postures, during a unilateral dynamic manual exercise, and during relaxation after the manual exercise. Coefficients of variation were computed to identify the measurement condition that discriminated best between the two groups. RESULTS: The most pronounced differences between patients with whiplash associated disorder Grade II and healthy control subjects were found particularly in situations in which the biomechanical load was low. Patients showed higher coactivation levels during physical exercise and a decreased ability to relax muscles after physical exercise. CONCLUSIONS: Patients with whiplash associated disorder Grade II can be distinguished from healthy control subjects according to the presence of cervical muscle dysfunction, as assessed by surface electromyography of the upper trapezius muscles. Particularly the decreased ability to relax the trapezius muscles seems to be a promising feature to identify patients with whiplash associated disorder Grade II. Assessment of the muscle (dys)function by surface electromyography offers a refinement of the whiplash associated disorder classification and provides an indication to a suitable therapeutic approach.

Trunk muscle activation and low back loading in lifting in the absence of load knowledge.

People who know the actual mass of an object to be lifted normally prepare themselves before attempting a lift to control the movement and to minimize low back loading. In this study, the trunk muscular reactions and low back torque were investigated in the situation in which the individual did not know the actual mass but only had some idea of the range within which the mass lay. Nine males lifted boxes weighing 6.5 or 16.5 kg under the condition in which they knew the actual mass before attempting a lift (the 'known' condition) and the condition in which they only had the information that the mass would be within the range of 6.5-16.5 kg (the 'unknown' condition). The ground reaction forces and body movements were measured in the trials and, from these, the L5/S1 torques were calculated. The activation of back and abdominal muscles was also measured. For the 6.5 kg weight, a higher (16%) back muscle activation in grasping the box and a higher (10%) peak L5/S1 torque in actual lifting were observed in the 'unknown' compared with the 'known' weight condition. For the 16.5 kg weight, the back muscle activation was lower (10%) during grasping, and higher (10%) during lifting in the 'unknown' compared with the 'known' weight condition. Knowledge of the load had no effect on the activation of the abdominal muscles. It was concluded that in the so-called 'unknown' conditions, the risks of low back injury were increased in comparison with the conditions where the actual weight was known in advance.

Usability of thenar eminence orthoses: report of a comparative study.

OBJECTIVE: To determine the difference in the usability of three types of thenar eminence (TE) orthoses. DESIGN: Prospective comparative pre-experimental study with randomized cross-over design. SETTING: Rehabilitation centre. SUBJECTS: Ten patients with osteoarthritis of the carpometacarpal I joint confirmed by X-ray. INTERVENTION: Three types of TE orthoses, made of either supple elastic material, elastic material with a semi-rigid thumb busk or a semi-rigid (polyethylene) material. MAIN OUTCOME MEASUREMENTS: Pain at the thenar eminence, pinch force, hand function, cosmesis, comfort and function of the TE orthosis. RESULTS: The supple elastic TE orthosis scores significantly better than the more rigid types on the subjects 'comfort', 'function' and the Green Test, while the semi-rigid orthosis scores best on 'cosmesis'. The score on the subject 'pain reduction' shows no significant difference between the three types of TE orthoses. The scores obtained correspond with the outcome of structured interviews about the usability of the TE orthoses. CONCLUSION: Eight out of 10 patients prefer the permanent use of a TE orthosis. Six patients chose the supple elastic orthosis and two chose the semi-rigid orthosis.

Dynamic forces acting on the lumbar spine during manual handling. Can they be estimated using electromyographic techniques alone?

STUDY DESIGN: Compressive loading of the lumbar spine was analyzed using electromyographic, movement analysis, and force-plate techniques. OBJECTIVES: To evaluate the inertial forces that cannot be detected by electromyographic techniques alone. SUMMARY OF BACKGROUND DATA: Links between back pain and manual labor have stimulated attempts to measure spine compressive loading. However, direct measurements of intradiscal pressure are too invasive, and force plates too cumbersome for use in the workplace. Electromyographic techniques are noninvasive and portable, but ignore certain inertial forces. METHODS: Eight men lifted boxes weighing 6.7 and 15.7 kg from the ground, while joint moments acting about L5-S1 were quantified 1) by using a linked-segment model to analyze data from Kistler force plates and a Vicon movement-analysis system, and 2) by measuring the electromyographic activity of the erector spinae muscles, correcting it for contraction speed and comparing it to moment generation during static contractions. The linked-segment model was used to calculate the "axial thrust," defined as the component of the L5-S1 reaction force that acts along the axis of the spine and that is unrelated to trunk muscle activity or static body weight. RESULTS: Peak extensor moments predicted by the two techniques were similar and equivalent to spinal compressive forces of 2.9-4.8 kN. The axial thrust "hidden" from the electromyographic technique was negligible during slow lifts, and remained below 4% of peak spinal compression even during fast heavy lifts. Peak axial thrust was proportional to the peak vertical ground reaction (R2 = 0.74). CONCLUSIONS: Electromyographic techniques can measure dynamic spinal loading, but additional force-plate data would improve accuracy slightly during lifts requiring a vigorous upward thrust from the legs.

When is a lifting movement too asymmetric to identify low-back loading by 2-D analysis?

In ergonomics research, two-dimensional (2-D) biomechanical models are often used to study the mechanical loading of the low back in lifting movements. When lifting movements are asymmetric, errors of unknown size may be introduced in a 2-D analysis. In the current study, an estimation of these errors was made by comparing the outcome of a 2-D analysis to the results of a recently developed and validated 3-D model. Four subjects made two repetitions of five lifting movements, differing in the amount of asymmetry. The results showed a significant underestimation of the peak torque by 20, 36 and 61% when the initial position of a box was rotated 30, 60 and 90 degrees with respect to the sagittal plane of the subject. The main cause of this underestimation was a pelvic twist, resulting in an erroneous projection of a pelvic marker on to the sagittal plane due to pelvic twist. It is suggested that from 30 degrees box rotation a 2-D analysis may easily lead to wrong conclusions when it is used to study asymmetric lifting.

Asymmetric low back loading in asymmetric lifting movements is not prevented by pelvic twist.

Asymmetric lifting is associated with an increased risk of low back disorders. Especially in lifting movements, characterized by a small amount of asymmetry, it is still the question if asymmetric lumbosacral torques occur, or if subjects try to avoid asymmetric back loading by twisting their pelvis with respect to the feet. An increase of the lifting speed or the box weight might amplify the lumbar torques but might also result in an attempt to limit further increase of asymmetric torques by increasing pelvic twist. In the current study, asymmetrical lifting movements were analyzed with the aid of a 3D linked segment model, using cuffs mounted to the body segments. Eight subjects performed lifting movements with five different asymmetry conditions, ranging from 0 to 90 degrees lifting asymmetry with respect to the sagittal plane, using two lifting speeds and two box weights. A significant increase in lateral flexing and twisting low back torque was found for each increase in asymmetry of the lifting movement. Pelvic twist accounted more or less constantly for about 25% of the lifting asymmetry and was hardly influenced by lifting speed or box weight. Even for 10 or 30 degrees of lifting asymmetry, subjects did not twist their pelvis far enough to avoid asymmetric loading of the low back. Assuming that asymmetric loading of the low back is more strenuous to the spine than symmetric loading, the current results indicate that even small deviations of a lifting movement from the sagittal plane can explain an increased risk of low back disorders.

The median frequency of the surface EMG power spectrum in relation to motor unit firing and action potential properties.

Three components determine the power spectrum of the surface EMG signal: the auto- and cross-power spectra of the firing processes and the power spectra of the motor unit action potential (MUAP). To clarify the relative contribution of these components to the median frequency (MF) of the power spectrum, a stochastic simulation model was used in which most input parameters [e.g., MUAP peak-peak time (PPT), mean interpulse interval time, and synchronization parameters] were described in terms of distribution functions. Simulation clearly predicts that MF is especially sensitive to variations in MUAP shape, the MUAP PPT, and synchronization. The influence of the firing process parameters was predicted to be marginal. To obtain values for the MUAP parameters, a needle-triggered averaging technique was used to gather surface MUAPs from the m. biceps brachii. With use of these MUAPs as input for the model, it was found that intrasubject variability of MF is caused by variations in both MUAP PPT and MUAP shape, whereas intersubject variability in MF is caused primarily by variations in PPT.

Electromyogram power spectra frequencies associated with motor unit recruitment strategies.

The isolated contributions of motor unit recruitment and firing rate variations to the median frequency of the electromyogram's power density spectrum were determined. Orderly stimulation of the cat gastrocnemius motor units via nerve electrodes gave rise to linearly increasing median frequency regardless of the action potential firing rate of the active motor units. Increase in the discharge rate of all the motor units resulted in nearly constant median frequency. It was concluded that the increasing average conduction velocity during motor unit recruitment is the major contributor to variations in the electromyogram median frequency. The possibility of using the median frequency as the index to identify the recruitment control strategies employed by various muscles during increasing force contraction is suggested.