Reliability in measurement of three-dimensional anterior pelvic plane orientation by registration with an inertial measurement unit.

It is strongly challenging to obtain functional movement of the pelvis based on the three-dimensional (3D) dynamic anterior pelvic plane (APP) orientation information. This study provided the 3D APP orientation measurement technique by registration with an inertial measurement unit (IMU), and its reliability was tested. The local coordinate systems of the APP and the IMU sensor were registered using two images of the pelvic part from the frontal and left sagittal views in a neutral standing posture. Then, the measurement errors in the APP orientation were analyzed by comparing the values obtained from manually measured four points in the IMU sensor and the known exact values in 10 different postures. Moreover, the errors between values obtained from manually measured three anatomical points and the known exact values were also compared. The average errors were quite small (less than 0.6°) when measuring from three anatomical points and were acceptable (1.6°-3.4°) when measuring from four points in the IMU sensor. These results indicate that the measurement of APP direction using four points in the IMU sensor could be considered reliable in terms of intra-participant and inter-participant. The present technique to register the IMU sensor position and the APP direction by taking X-ray images from the frontal and sagittal directions can be fundamental information to measure the APP direction during dynamic motion when the IMU position is obtained from the IMU sensor data instead of the four-point location information.

Contribution of a distal radioulnar joint stabilizer on forearm stability: A modeling study.

Instability of the forearm is a complex problem that leads to pain and limited motions. Up to this time, no universal consensus has yet been reached as regards the optimal treatment for forearm instability. In some cases, conservative treatments are recommended for forearm instability injuries. However, quantitative studies on the conservative treatment of forearm instability are lacking. The present study developed a finite element model of the forearm to investigate the contribution of the distal radioulnar joint stabilizer on forearm stability. The stabilizer was designed to provide stability between the radius and ulna. The forearm model with and without the stabilizer was tested using the pure transverse separation and radial pull test for the different ligament sectioned models. The percentage contribution of the stabilizer and ligament structures resisting the load on the forearm was estimated. For the transverse stability of the forearm, the central band resisted approximately 50% of the total transverse load. In the longitudinal instability, the interosseous membrane resisted approximately 70% of the axial load. With the stabilizer, models showed that the stabilizer provided the transverse stability and resisted almost 1/4 of the total transverse load in the ligament sectioned models. The stabilizer provided transverse stability and reduced the loading on the ligaments. We suggested that a stabilizer can be applied in the conservative management of patients who do not have the gross longitudinal instability with the interosseous membrane and the triangular fibrocartilage complex disruption.

Investigation of lumbar spine biomechanics using global convergence optimization and constant loading path methods.

Computational models and inverse dynamic optimization methods are used to predict in-vivo spinal loading. Spinal force is conventionally predicted using the constant loading path method, which is based on the concept that the physiological directions of the spine loads follow the same path of the spinal curve. However, the global convergence optimization method, in which the instantaneous center of rotation of the joint should be also predicted, is necessary for accurate prediction of joint forces of the human body. In this study, we investigate the joint forces, instantaneous centers of rotation, and muscle forces of the human lumbar spine using both global convergence optimization method and constant loading path method during flexion, upright standing, and extension postures. The joint forces predicted using the constant loading path method were 130%, 234%, and 253% greater than those predicted using the global convergence optimization method for the three postures. The instantaneous centers of rotation predicted using the global convergence optimization method were segment level-dependent and moved anteriorly in the flexion and posteriorly in the extension, whereas those predicted using the constant loading path method moved posteriorly in both the flexion and extension. The data indicated that compared to the global convergence optimization method, the constant loading path method introduces additional constraints to the spinal joint model, and thus, it results in greater joint and muscle forces.

Kinematic determinants of performance parameters during golf swing.

In golf, the trunk and pelvis kinematic variables are often related to measures of performance due to the highly complex and multi-joint movements involved in swings. However, it is unclear how specific body segments or joints contributed to the golf performance parameters. Therefore, the purpose of this study was to identify the key joints, including those of the upper and lower trunk, that are associated with golf performance parameters, such as X-Factor and pelvis motion. A motion capture system was used to obtain three-dimensional kinematics of golf swings performed by 10 low handicap male golfers. Based on regression analysis, right knee adduction, right shoulder external rotation and left elbow extension in ball address to top of the backswing and left knee adduction and lower trunk right bending with left rotation in top of the backswing to end of follow-through were presented as predictor variables for the X-Factor. For pelvis movement, a greater number of joint angles were associated with pelvis posterior tilt during backswing and pelvis motion to target with right rotation during downswing/follow-through. This study provides fundamental details of the movement mechanisms of major joints, as well as their relationships with performance parameters. Such understanding can be combined with training to improve the golfing skill and prevent possible injuries.

New method to evaluate three-dimensional push-off angle during short-track speed skating using wearable inertial measurement unit sensors.

The push-off mechanism to generate forward movement in skating has been analyzed by using high-speed cameras and specially designed skates because it is closely related to skater performance. However, using high-speed cameras for such an investigation, it is hard to measure the three-dimensional push-off force, and a skate with strain gauges is difficult to implement in the real competitions. In this study, we provided a new method to evaluate the three-dimensional push-off angle in short-track speed skating based on motion analysis using a wearable motion analysis system with inertial measurement unit sensors to avoid using a special skate or specific equipment insert into the skate for measurement of push-off force. The estimated push-off angle based on motion analysis data was very close to that based on push-off force with a small root mean square difference less than 6% when using the lateral marker in the left leg and the medial marker in the right leg regardless of skating phase. These results indicated that the push-off angle estimation based on motion analysis data using a wearable motion capture system of inertial measurement unit sensors could be acceptable for realistic situations. The proposed method was shown to be feasible during short-track speed skating. This study is meaningful because it can provide a more acceptable push-off angle estimation in real competitive situations.

Effects of medial collateral ligament release, limb correction, and soft tissue laxity on knee joint contact force distribution after medial opening wedge high tibial osteotomy: a computational study.

In this study, the effects of medial collateral ligament (MCL) release and the limb correction strategies with pre-existing MCL laxity on tibiofemoral contact force distribution after high tibial osteotomy (HTO) were investigated. The medial and lateral contact forces of the knee were quantified during simulated standing using computational modeling techniques. MCL slackness had a primary influence on contact force distribution of the knee, while there was little effect of simulated limb correction. Anterior and middle bundle release, which involved the partial release of two-thirds of the superficial MCL, was shown to be an optimal surgical method in HTO, achieving balanced contact distribution in simulated weight-bearing standing.

Intra-auditory integration between pitch and loudness in humans: Evidence of super-optimal integration at moderate uncertainty in auditory signals.

When a person plays a musical instrument, sound is produced and the integrated frequency and intensity produced are perceived aurally. The central nervous system (CNS) receives defective afferent signals from auditory systems and delivers imperfect efferent signals to the motor system due to the noise in both systems. However, it is still little known about auditory-motor interactions for successful performance. Here, we investigated auditory-motor interactions as multi-sensory input and multi-motor output system. Subjects performed a constant force production task using four fingers in three different auditory feedback conditions, where either the frequency (F), intensity (I), or both frequency and intensity (FI) of an auditory tone changed with sum of finger forces. Four levels of uncertainty (high, moderate-high, moderate-low, and low) were conditioned by manipulating the feedback gain of the produced force. We observed performance enhancement under the FI condition compared to either F or I alone at moderate-high uncertainty. Interestingly, the performance enhancement was greater than the prediction of the Bayesian model, suggesting super-optimality. We also observed deteriorated synergistic multi-finger interactions as the level of uncertainty increased, suggesting that the CNS responded to increased uncertainty by changing control strategy of multi-finger actions.

Biomechanical Effects on Cervical Spinal Cord and Nerve Root Following Laminoplasty for Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: A Comparison Between Open-Door and Double-Door Laminoplasty Using Finite Element Analysis.

Many clinical case series have reported the predisposing factors for C5 palsy and have presented comparisons of the two types of laminoplasty. However, there have been no biomechanical studies focusing on cervical spinal cord and nerve root following laminoplasty. The purpose of this study is to investigate biomechanical changes in the spinal cord and nerve roots following the two most common types of laminoplasty, open-door and double-door laminoplasty, for cervical ossification of the posterior longitudinal ligament (OPLL). A finite element (FE) model of the cervical spine and spinal cord with nerve root complex structures was developed. Stress changes in the spinal cord and nerve roots, posterior shift of the spinal cord, and displacement of the cervical nerve roots were analyzed with two types of cervical laminoplasty models for variations in the degree of canal occupying ratio and shape of the OPLL. The shape and degree of spinal cord compression caused by the OPLL had more influence on the changes in stress, posterior shift of the spinal cord, and displacement of the nerve root than the type of laminoplasty. The lateral-type OPLL resulted in imbalanced stress on the nerve roots and the highest nerve root displacement. Type of laminoplasty and shape and degree of spinal cord compression caused by OPLL were found to influence the changes in stress and posterior displacement of the cervical spinal cord and nerve roots. Lateral-type OPLL might contribute to the development of C5 palsy due to the imbalanced stress and tension on the nerve roots after laminoplasty.

Comparative Evaluation Between Anatomic and Nonanatomic Lateral Ligament Reconstruction Techniques in the Ankle Joint: A Computational Study.

Biomechanical studies have indicated that the conventional nonanatomic reconstruction techniques for lateral ankle sprain (LAS) tend to restrict subtalar joint motion compared to intact ankle joints. Excessive restriction in subtalar motion may lead to chronic pain, functional difficulties, and development of osteoarthritis (OA). Therefore, various anatomic surgical techniques to reconstruct both the anterior talofibular and calcaneofibular ligaments (CaFL) have been introduced. In this study, ankle joint stability was evaluated using multibody computational ankle joint model to assess two new anatomic reconstruction and three popular nonanatomic reconstruction techniques. An LAS injury, three popular nonanatomic reconstruction models (Watson-Jones, Evans, and Chrisman-Snook) and two common types of anatomic reconstruction models were developed based on the intact ankle model. The stability of ankle in both talocrural and subtalar joint were evaluated under anterior drawer test (150 N anterior force), inversion test (3 N·m inversion moment), internal rotational test (3 N·m internal rotation moment), and the combined loading test (9 N·m inversion and internal moment as well as 1800 N compressive force). Our overall results show that the two anatomic reconstruction techniques were superior to the nonanatomic reconstruction techniques in stabilizing both talocrural and subtalar joints. Restricted subtalar joint motion, which is mainly observed in Watson-Jones and Chrisman-Snook techniques, was not shown in the anatomical reconstructions. Evans technique was beneficial for subtalar joint as it does not restrict subtalar motion, though Evans technique was insufficient for restoring talocrural joint inversion. The anatomical reconstruction techniques best recovered ankle stability.

Influence of ankle joint plantarflexion and dorsiflexion on lateral ankle sprain: A computational study.

Understanding the mechanism of injury involved in lateral ankle sprain is essential to prevent injury, to establish surgical repair and reconstruction, and to plan reliable rehabilitation protocols. Most studies for lateral ankle sprain posit that ankle inversion, internal rotation, and plantarflexion are involved in the mechanism of injury. However, recent studies indicated that ankle dorsiflexion also plays an important role in the lateral ankle sprain mechanism. In this study, the contributions of ankle plantarflexion and dorsiflexion on the ankle joint were evaluated under complex combinations of internal and inversion moments. A multibody ankle joint model including 24 ligaments was developed and validated against two experimental cadaveric studies. The effects of ankle plantarflexion (up to 60°) and dorsiflexion (up to 30°) on the lateral ankle sprain mechanism under ankle inversion moment coupled with internal rotational moment were investigated using the validated model. Lateral ankle sprain injuries can occur during ankle dorsiflexion, in which the calcaneofibular ligament and anterior talofibular ligament tears may occur associated with excessive inversion and internal rotational moment, respectively. Various combinations of inversion and internal moment may lead to anterior talofibular ligament injuries at early ankle plantarflexion, while the inversion moment acts as a primary factor to tear the anterior talofibular ligament in early plantarflexion. It is better to consider inversion and internal rotation as primary factors of the lateral ankle sprain mechanism, while plantarflexion or dorsiflexion can be secondary factor. This information will help to clarify the lateral ankle sprain mechanism of injury.

Wrist Resistance Training Improves Motor Control and Strength.

Chu, E, Kim, Y-S, Hill, G, Kim, YH, Kim, CK, and Shim, JK. Wrist resistance training improves motor control and strength. J Strength Cond Res 32(4): 962-969, 2018-The aim of this study was to investigate the effects of a 6-week direction-specific resistance training program on isometric torque control and isokinetic torque strength of the wrist joint. Nineteen subjects were randomly assigned to either the wrist training group (n = 9) or the control group (n = 10). The training group performed wrist exercises in 6 directions (flexion, extension, pronation, supination, radial deviation, and ulnar deviation), whereas the control group did not. Data were collected on the isometric torque control, 1-repetition maximum (1RM) strength, and isokinetic maximum torque (angular velocity of 60° per second wrist movements) before and after 6 weeks of resistance training and at 2-week intervals during training. The training group showed significant decreases in isometric torque control error in all 6 directions after 2 weeks of resistance training, whereas the control group did not show significant increase or decrease. After 4 weeks of training, the training group showed significant increases in maximum strength in all 6 directions as assessed by 1RM strength and isokinetic strength tests, whereas the control group did not show any statistically significant changes. This study shows that motor control significantly improves within the first 2 weeks of resistance training, whereas the wrist strength significantly improves within the first 4 weeks of resistance training. Based on the findings of this study, coaches and trainers should consider wrist resistance training to improve athletes' muscular strength and control of the wrist muscles.

Interjoint coordination of the lower extremities in short-track speed skating.

In short-track speed skating, the three-dimensional kinematics of the lower extremities during the whole skating cycle have not been studied. Kinematic parameters of the lower extremities during skating are presented as joint angles versus time. However, the angle-time presentation is not sufficient to describe the relationship between multi-joint movement patterns. Thus, angle-angle presentations were developed and used to describe interjoint coordination in sport activities. In this study, 15 professional male skaters' full body motion data were recorded using a wearable motion capture system during short-track speed skating. We investigated the three-dimensional kinematics of the lower extremities and then established the interjoint coordination between hip-knee and knee-ankle for both legs during the whole skating cycle. The results demonstrate the relationship between multi-joint movements during different phases of short-track speed skating. This study provides fundamentals of the movement mechanism of the lower extremities that can be integrated with physiotherapy to improve skating posture and prevent injuries from repetitive stress since physiological characteristics play an important role in skating performance.

Increased stress and strain on the spinal cord due to ossification of the posterior longitudinal ligament in the cervical spine under flexion after laminectomy.

Myelopathy in the cervical spine due to cervical ossification of the posterior longitudinal ligament could be induced by static compression and/or dynamic factors. It has been suggested that dynamic factors need to be considered when planning and performing the decompression surgery on patients with the ossification of the posterior longitudinal ligament. A finite element model of the C2-C7 cervical spine in the neutral position was developed and used to generate flexion and extension of the cervical spine. The segmental ossification of the posterior longitudinal ligament on the C5 was assumed, and laminectomy was performed on C4-C6 according to a conventional surgical technique. For various occupying ratios of the ossified ligament between 20% and 60%, von-Mises stresses, maximum principal strains in the spinal cord, and cross-sectional area of the cord were investigated in the pre-operative and laminectomy models under flexion, neutral position, and extension. The results were consistent with previous experimental and computational studies in terms of stress, strain, and cross-sectional area. Flexion leads to higher stresses and strains in the cord than the neutral position and extension, even after decompression surgery. These higher stresses and strains might be generated by residual compression occurring at the segment with the ossification of the posterior longitudinal ligament. This study provides fundamental information under different neck positions regarding biomechanical characteristics of the spinal cord in cervical ossification of the posterior longitudinal ligament.

Biomechanical investigation of post-operative C5 palsy due to ossification of the posterior longitudinal ligament in different types of cervical spinal alignment.

Post-operative C5palsies are among the most common complications seen after cervical surgery for ossification of the posterior longitudinal ligament (OPLL). Although C5 palsy is a well-known complication of cervical spine surgery, its pathogenesis is poorly understood and depends on many other factors. In this study, a finite element model of the cervical spine and spinal cord-nerve roots complex structures was developed. The changes in stress in the cord and nerve roots, posterior shift of the spinal cord, and displacement and elongation of the nerve roots after laminectomy for cervical OPLL were analyzed for three different cervical sagittal alignments (lordosis, straight, and kyphosis). The results suggest that high stress concentrated on the nerve roots after laminectomy could be the main cause of C5 palsy because ossification of ligaments increases spinal cord shifting and root displacement. The type of sagittal alignment had no influence on changes in cord stress after laminectomy, although cases of kyphosis with a high degree of occupying ratio resulted in greater increases in nerve root stress after laminectomy. Therefore, kyphosis with a high OPLL occupying ratio could be a risk factor for poor surgical outcomes or post-operative complications and should be carefully considered for surgical treatment.

Fatigue injury risk in anterior cruciate ligament of target side knee during golf swing.

A golf-related ACL injury can be linked with excessive golf play or practice because such over-use by repetitive golf swing motions can increase damage accumulation to the ACL bundles. In this study, joint angular rotations, forces, and moments, as well as the forces and strains on the ACL of the target-side knee joint, were investigated for ten professional golfers using the multi-body lower extremity model. The fatigue life of the ACL was also predicted by assuming the estimated ACL force as a cyclic load. The ACL force and strain reached their maximum values within a short time just after ball-impact in the follow-through phase. The smaller knee flexion, higher internal tibial rotation, increase of the joint compressive force and knee abduction moment in the follow-through phase were shown as to lead an increased ACL loading. The number of cycles to fatigue failure (fatigue life) in the ACL might be several thousands. It is suggested that the excessive training or practice of swing motion without enough rest may be one of factors to lead to damage or injury in the ACL by the fatigue failure. The present technology can provide fundamental information to understand and prevent the ACL injury for golf players.

Intra-Auditory Integration Improves Motor Performance and Synergy in an Accurate Multi-Finger Pressing Task.

Humans detect changes in the air pressure and understand the surroundings through the auditory system. The sound humans perceive is composed of two distinct physical properties, frequency and intensity. However, our knowledge is limited how the brain perceives and combines these two properties simultaneously (i.e., intra-auditory integration), especially in relation to motor behaviors. Here, we investigated the effect of intra-auditory integration between the frequency and intensity components of auditory feedback on motor outputs in a constant finger-force production task. The hierarchical variability decomposition model previously developed was used to decompose motor performance into mathematically independent components each of which quantifies a distinct motor behavior such as consistency, repeatability, systematic error, within-trial synergy, or between-trial synergy. We hypothesized that feedback on two components of sound as a function of motor performance (frequency and intensity) would improve motor performance and multi-finger synergy compared to feedback on just one component (frequency or intensity). Subjects were instructed to match the reference force of 18 N with the sum of all finger forces (virtual finger or VF force) while listening to auditory feedback of their accuracy. Three experimental conditions were used: (i) condition F, where frequency changed; (ii) condition I, where intensity changed; (iii) condition FI, where both frequency and intensity changed. Motor performance was enhanced for the FI conditions as compared to either the F or I condition alone. The enhancement of motor performance was achieved mainly by the improved consistency and repeatability. However, the systematic error remained unchanged across conditions. Within- and between-trial synergies were also improved for the FI condition as compared to either the F or I condition alone. However, variability of individual finger forces for the FI condition was not significantly decreased as compared to I condition alone. This result indicates an improvement in motor performance is consistent with Bayesian estimation, and changes in multi-finger interaction mostly result in the enhanced motor performance. These findings provide evidence that the central nervous system can take advantage of the intra-auditory integration in a statistically optimal (Bayesian) fashion to enhance motor performance by improving multi-finger synergy.

Improvements in spinal alignment after high tibial osteotomy in patients with medial compartment knee osteoarthritis.

Since the correlation between spinal and lower extremity alignments is high, high tibial osteotomy (HTO) surgery may also affect spinal alignment, where the spinal alignment parameters are the most important parameters for the evaluation of spinal disorders. In this study, the effect of HTO surgery on spinal alignment during gait was investigated by comparing spinal alignment parameters between patients with knee osteoarthritis (OA) and healthy young controls. Eight patients (age, 55.0±5.1years; height, 160.3±7.0cm; weight, 71.3±14.1kg) with a medial compartment knee OA participated in the gait experiment two times approximately one week before and one year after HTO surgery and eight healthy young controls (age, 26.7±1.7years; height, 163.4±6.5cm; weight, 58.4±11.3kg) participated only once. Cervical curvature angle, thoracic curvature angle, lumbar curvature angle, coronal vertical axis, and coronal pelvic tilt in the coronal plane and cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis, and sagittal pelvic tilt in the sagittal plane were estimated using motion analysis system with skin markers. All spinal alignment parameters after HTO surgery were significantly closer to those of healthy young subjects than those before HTO, especially in the coronal plane. These findings suggest that the HTO had a positive effect on spinal alignment, as well as lower extremity alignment, and moreover, reduced the abnormality that may result in spinal problems such as degeneration or pain.

Amputee Locomotion: Ground Reaction Forces During Submaximal Running With Running-Specific Prostheses.

Individuals with lower extremity amputation must adapt the mechanical interactions between the feet and ground to account for musculoskeletal function loss. However, it is currently unknown how individuals with amputation modulate three-dimensional ground reaction forces (GRFs) when running. This study aimed to understand how running with running-specific prostheses influences three-dimensional support forces from the ground. Eight individuals with unilateral transtibial amputations and 8 control subjects ran overground at 2.5, 3.0, and 3.5 m/s. Ten force plates measured GRFs at 1000 Hz. Peak and average GRFs and impulses in each plane were compared between limbs and groups. Prosthetic limbs generated reduced vertical impulses, braking forces and impulses, and mediolateral forces while generating similar propulsive impulses compared with intact and control limbs. Intact limbs generated greater peak and average vertical forces and average braking forces than control subjects' limbs. These data indicate that the nonamputated limb experiences elevated mechanical loading compared with prosthetic and control limbs. This may place individuals with amputation at greater risk of acute injury or joint degeneration in their intact limb. Individuals with amputation adapted to running-specific prosthesis force production limitations by generating longer periods of positive impulse thus producing propulsive impulses equivalent to intact and control limbs.

Effect of posterior decompression extent on biomechanical parameters of the spinal cord in cervical ossification of the posterior longitudinal ligament.

Ossification of the posterior longitudinal ligament is a common cause of the cervical myelopathy due to compression of the spinal cord. Patients with ossification of the posterior longitudinal ligament usually require the decompression surgery, and there is a need to better understand the optimal surgical extent with which sufficient decompression without excessive posterior shifting can be achieved. However, few quantitative studies have clarified this optimal extent for decompression of cervical ossification of the posterior longitudinal ligament. We used finite element modeling of the cervical spine and spinal cord to investigate the effect of posterior decompression extent for continuous-type cervical ossification of the posterior longitudinal ligament on changes in stress, strain, and posterior shifting that occur with three different surgical methods (laminectomy, laminoplasty, and hemilaminectomy). As posterior decompression extended, stress and strain in the spinal cord decreased and posterior shifting of the cord increased. The location of the decompression extent also influenced shifting. Laminectomy and laminoplasty were very similar in terms of decompression results, and both were superior to hemilaminectomy in all parameters tested. Decompression to the extents of C3-C6 and C3-C7 of laminectomy and laminoplasty could be considered sufficient with respect to decompression itself. Our findings provide fundamental information regarding the treatment of cervical ossification of the posterior longitudinal ligament and can be applied to patient-specific surgical planning.

Prediction of medial and lateral contact force of the knee joint during normal and turning gait after total knee replacement.

The computational modeling approach has commonly been used to predict knee joint contact forces, muscle forces, and ligament loads during activities of daily living. Knowledge of these forces has several potential applications, for example, within design of equipment to protect the knee joint from injury and to plan adequate rehabilitation protocols, although clinical applications of computational models are still evolving and one of the limiting factors is model validation. The objective of this study was to extend previous modeling technique and to improve the validity of the model prediction using publicly available data set of the fifth "Grand Challenge Competition to Predict In Vivo Knee Loads." A two-stage modeling approach, which combines conventional inverse dynamic analysis (the first stage) with a multi-body subject-specific lower limb model (the second stage), was used to calculate medial and lateral compartment contact forces. The validation was performed by direct comparison of model predictions and experimental measurement of medial and lateral compartment contact forces during normal and turning gait. The model predictions of both medial and lateral contact forces showed strong correlations with experimental measurements in normal gait (r = 0.75 and 0.71) and in turning gait trials (r = 0.86 and 0.72), even though the current technique over-estimated medial compartment contact forces in swing phase. The correlation coefficient, Sprague and Geers metrics, and root mean squared error indicated that the lateral contact forces were predicted better than medial contact forces in comparison with the experimental measurements during both normal and turning gait trials.