The role of the ankle plantar flexor muscles in trip recovery during walking: a computational modeling study.

Background: Reactive lower limb muscle function during walking plays a role in balance, stability, and ultimately fall prevention. The objective of this study was to evaluate muscle and joint function used to regain balance after trip-based perturbations during walking. Research question: How are lower limb muscles used to recover from external tripping during walking? Method: The dominant legs of 20 healthy adult participants with similar athletic backgrounds were tripped using a split-belt instrumented treadmill. High- and medium-intensity trips were simulated by deceleration of the dominant leg at initial contact from the speed of 1.1 m/s to 0 m/s and back to 1.1 m/s in 0.4 s and 0.8 s, respectively. Lower limb kinematics, kinetics, and muscle forces following perturbations were computed to pre-perturbation values using statistical parametric mapping (SPM) paired t-test. Results: A greater ankle dorsiflexion angle (mean difference: 5.3°), ankle plantar flexion moment (mean difference: 0.6Nm/kg), and gastrocnemius and soleus muscle forces (mean difference: 4.27N/kg and 13.56N/kg for GAS and SOL, respectively) were observed post-perturbation step despite the magnitude of the perturbation. Significance: This study concludes that adequate timely response of ankle function during a compensatory step is required for a successful recovery after tripping during walking in young healthy adults. Weakness in plantar flexors suggests insufficient ankle moments, which ultimately can result in falls. The findings of this paper can be used as a reference for the joint moments and range of motion needed to recover trips in the design of assistive devices. In addition to that, clinicians can use the estimated values of muscle forces and the pattern of muscle activities to design targeted training in fall prevention among the elderly.

A method for measuring in vivo finger kinematics using electromagnetic tracking.

Accurate in vivo measurement of finger joint kinematics is important for evaluation of treatment methods, implant designs, and for the development and validation of computer models of the hand. The main objective of this project was to develop a standardized finger kinematic measurement system employing electromagnetic (EM) tracking to measure in vivo finger motion pathways. A landmark digitization protocol was developed and used in vivo, in a biomechanical study using EM trackers secured to the finger segments. In vivo results for finger flexion/extension showed no significant differences between EM and goniometer results, 5°±3°; p = 0.735.

Effect of Prophylactic Knee Bracing on Anterior Cruciate Ligament Agonist and Antagonist Muscle Forces During Perturbed Walking.

BACKGROUND: Anterior cruciate ligament (ACL) injuries most commonly occur after a perturbation. Prophylactic knee braces (PKBs) are off-the-shelf braces designed to prevent and reduce the severity of knee injuries during sports, yet their effectiveness has been debated. PURPOSE: To identify differences in ACL agonist and antagonist muscle forces, during braced and unbraced conditions, while walking with the application of unexpected perturbations. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 20 recreational athletes were perturbed during walking at a speed of 1.1 m/s, and motion analysis data were used to create patient-specific musculoskeletal models. Static optimization was performed to calculate the lower-limb muscle forces. Statistical parametric mapping was used to compare muscle forces between the braced and unbraced conditions during the stance phase of the perturbed cycle. RESULTS: The brace reduced muscle forces in the quadriceps (QUADS), gastrocnemius (GAS), and soleus (SOL) but not in the hamstrings. The peak QUADS muscle force was significantly lower with the brace versus without at 49% to 60% of the stance phase (28.9 ± 12.98 vs 14.8 ± 5.06 N/kg, respectively; P < .001) and again at 99% of the stance phase (1.7 ± 0.4 vs 3.6 ± 0.13 N/kg, respectively; P = .049). The SOL muscle force peak was significantly lower with the brace versus without at 25% of the stance phase (1.9 ± 1.7 vs 4.6 ± 3.4 N/kg, respectively; P = .031) and at 39% of the stance phase (1.9 ± 1.4 vs 5.3 ± 5.6 N/kg, respectively; P = .007). In the GAS, there were no significant differences between conditions throughout the whole stance phase except between 97% and 100%, where the braced condition portrayed a smaller peak force (0.23 ± 0.13 vs 1.4 ± 1.1 N/kg for unbraced condition; P = .024). CONCLUSION: These findings suggested that PKBs that restrict knee hyperextension and knee valgus/varus motion can alter neuromuscular patterns, which result in a reduction of QUADS force. CLINICAL RELEVANCE: Understanding the way PKBs alter muscle function and knee mechanics can provide invaluable information that will help in making decisions about their use. Further studies should investigate different types of braces and perturbations to evaluate the effectiveness of PKBs.

Anterior cruciate ligament agonist and antagonist muscle force differences between males and females during perturbed walking.

Anterior cruciate ligament (ACL) injuries most commonly occur following a perturbation. Perturbations make the athlete unbalanced or at loss of control, which ultimately can lead to injury. The purpose of this study was to identify differences in ACL agonist and antagonist muscle forces, between sexes, during unexpected perturbations. Twenty recreational athletes were perturbed during walking at a speed of 1.1 m/s. Motion analysis data were used to create subject-specific musculoskeletal models and static optimization was performed to calculate muscle forces in OpenSim. Statistical parametric mapping (SPM) was used to compare muscle forces between males and females during the stance phase of the perturbed cycle. Females illustrated higher ACL antagonist muscle forces (p < 0.05) and lower ACL agonist muscle forces, compared to their male counterparts. The quadriceps (QUADs) muscle group peak was about 1.4 times higher in females (35.50 ± 8.71 N/kg) than males (22.81 ± 5.83 N/kg during 57%-62% of the stance phase (p < 0.05). Females presented a larger peak of gastrocnemius (GAS) at two instances: 12.42 ± 4.5 N/kg vs. 8.10 ± 2.83 N/kg between 70% and 75% at p < 0.05 and 2.26 ± 0.55 N/kg vs. 0.52 ± 0.09 N/kg between 95% and 100% at p < 0.05. Conversely, males illustrated higher initial hamstrings (HAMS) peak of 10.67 ± 4.15 N/kg vs. 5.38 ± 1.1 N/kg between 8% and 11%. Finally, males showed almost double the soleus (SOL) peak at 30.63 ± 8.64 N/kg vs. 17.52 ± 3.62 N/kg between 83% and 92% of the stance phase at p < 0.001. These findings suggest that females may exhibit riskier neuromuscular control in unanticipated situations, like sports.

Individual muscle contributions to hip joint-contact forces during walking in unilateral transfemoral amputees with osseointegrated prostheses.

Direct skeletal attachment of prostheses in transfemoral amputees circumvents skin-interface complications associated with conventional sockets; however, joint pain and musculoskeletal disease is known to occur postoperatively. This study quantified hip contact forces and the roles of individual muscles in producing hip contact forces during walking in transfemoral amputees with osseointegrated prostheses. Musculoskeletal models were developed for four transfemoral amputees. Gluteus maximus and gluteus medius were the major contributors to the hip contact forces, and the intact limb hip muscles demonstrated greater contributions to hip contact forces than those of the residual limb. The findings may be useful for mitigating walking asymmetry.

Gait compensatory mechanisms in unilateral transfemoral amputees.

Individuals with unilateral transfemoral amputation depend on compensatory muscle and joint function to generate motion of the lower limbs, which can produce gait asymmetry; however, the functional role of the intact and residual limb muscles of transfemoral amputees in generating progression, support, and mediolateral balance of the body during walking is not well understood. The aim of this study was to quantify the contributions of the intact and the residual limb's contralateral muscles to body center of mass (COM) acceleration during walking in transfemoral amputees. Three-dimensional subject-specific musculoskeletal models of 6 transfemoral amputees fitted with a socket-type prosthesis were developed and used to quantify muscle forces and muscle contributions to the fore-aft, vertical, and mediolateral body COM acceleration using a pseudo-inverse ground reaction force decomposition method during over-ground walking. Anterior pelvic tilt and hip range of motion in the sagittal and frontal planes of the intact limb was significantly larger than those in the residual limb (p<0.05). The mean contributions of the intact limb hip muscles to body COM support, forward propulsion and mediolateral balance were significantly greater than those in the residual limb (p<0.05). Gluteus maximus contributed more to propulsion and support, while gluteus medius contributed more to balance than other muscles in the intact limb than the residual limb. The findings demonstrate the role of the intact limb hip musculature in compensating for reduced or absent muscles and joint function in the residual limb of transfemoral amputees during walking. The results may be useful in developing rehabilitation programs and design of prostheses to improve gait symmetry and mitigate post-operative musculoskeletal pathology.

Effect Of Arm Deweighting Using End-Effector Based Robotic Devices On Muscle Activity.

Deweighting of the limb is commonly performed for patients with a neurological injury, such as stroke, as it allows these patients with limited muscle activity to perform movements. Deweighting has been implemented in exoskeletons and other multi-contact devices, but not on an end-effector based device with single contact point between the assisting robot and the human limb being assisted. This study inves-tigates the effects of deweighting using an end-effector based device on healthy subjects. The muscle activity of five subjects was measured in both static postures and dynamic movements. The results indicate a decrease in the activity of muscles which typically act against gravity - such as the anterior deltoid and the biceps brachii - but also suggest an increase in activity in muscles which act with gravity - such as the posterior deltoid and the lateral triceps. This can be explained by both the change in required muscle-generated torques and a conscious change in approach by the participants. These observations have implications for neurorehabilitation, particularly with respect to the muscle activation patterns which are trained through rehabilitation exercises.

Postoperative healing patterns in elbow using electromyography: Towards the development of a wearable mechatronic elbow brace.

Musculoskeletal (MSK) conditions are the most common cause of severe long-term pain and physical disability. Current postoperative treatment for patients requires them to follow a long-term physiotherapy program customized for each specific case; however, this process can be complex, time-consuming and without the right therapy it may end up being ineffective. A possible solution involves the development of wearable mechatronic elbow braces that use electromyography (EMG) to identify patient intent. However, EMG characteristics change based on the health of the individual and therefore require further investigation. In order to quantify the progress of MSK injury patients and assess their neuromuscular health, EMG signals from 16 healthy individuals and 15 postoperative patients were collected and analyzed. The experiments conducted show that EMG can be used as a method for assessing MSK health. A normal range across the muscle groups has been identified to which the patient population was compared. This showed statistically significant differences in the magnitudes of muscle recruitment and activation between the two groups. Furthermore, a comparison within the patient population at the beginning of their therapy versus at the end of their therapy was conducted. Statistical differences arose in this second analysis further proving that patients' signals tend to change and show trends closer to those of the healthy population.