The contribution of lower-limb joint quasi-stiffness to theoretical leg stiffness during level, uphill and downhill running at different speeds.

Humans change joint quasi-stiffness (k joint) and leg stiffness (kleg) when running at different speeds on level ground and during uphill and downhill running. These mechanical properties can inform device designs for running such as footwear, exoskeletons and prostheses. We measured kinetics and kinematics from 17 runners (10 M; 7 F) at three speeds on 0°, ±2°, ±4° and ±6° slopes. We calculated ankle and knee k joint, the quotient of change in joint moment and angular displacement, and theoretical leg stiffness (klegT) based on the joint external moment arms and k joint. Runners increased k ankle at faster speeds (p < 0.01). Runners increased and decreased the ankle and knee contributions to klegT, respectively, by 2.89% per 1° steeper uphill slope (p < 0.01) during the first half of stance. Runners decreased and increased ankle and knee joint contributions to klegT, respectively, by 3.68% during the first half and 0.86% during the second half of stance per 1° steeper downhill slope (p < 0.01). Thus, biomimetic devices require stiffer k ankle for faster speeds, and greater ankle contributions and greater knee contributions to klegT during the first half of stance for steeper uphill and downhill slopes, respectively.

Effects of powered versus passive-elastic ankle foot prostheses on leg muscle activity during level, uphill and downhill walking.

People with transtibial amputation (TTA) using passive-elastic prostheses have greater leg muscle activity and metabolic cost during level-ground and sloped walking than non-amputees. Use of a stance-phase powered (BiOM) versus passive-elastic prosthesis reduces metabolic cost for people with TTA during level-ground, +3° and +6° walking. Metabolic cost is associated with muscle activity, which may provide insight into differences between prostheses. We measured affected leg (AL) and unaffected leg (UL) muscle activity from ten people with TTA (6 males, 4 females) walking at 1.25 m s-1 on a dual-belt force-measuring treadmill at 0°, ±3°, ±6° and ±9° using their own passive-elastic and the BiOM prosthesis. We compared stride average integrated EMG (iEMG), peak EMG and muscle activity burst duration. Use of the BiOM increased UL lateral gastrocnemius iEMG on downhill slopes and AL biceps femoris on +6° and +9° slopes, and decreased UL rectus femoris on uphill slopes, UL vastus lateralis on +6° and +9°, and soleus and tibialis anterior on a +9° slope compared to a passive-elastic prosthesis. Differences in leg muscle activity for people with TTA using a passive-elastic versus stance-phase powered prosthesis do not clearly explain differences in metabolic cost during walking on level ground and slopes.

Outcomes of posterior cervical fusion and decompression: a systematic review and meta-analysis.

BACKGROUND CONTEXT: Posterior cervical fusion (PCF) with decompression is a treatment option for patients with conditions such as spondylosis, spinal stenosis, and degenerative disc disorders that result in myelopathy or radiculopathy. The annual rate, number, and cost of PCF in the United States has increased. Far fewer studies have been published on PCF outcomes than on anterior cervical fusion (ACF) outcomes, most likely because far fewer PCFs than ACFs are performed. PURPOSE: To evaluate the patient-reported and clinical outcomes of adult patients who underwent subaxial posterior cervical fusion with decompression. STUDY DESIGN/SETTING: Systematic review and meta-analysis. PATIENT SAMPLE: The total number of patients in the 31 articles reviewed and included in the meta-analysis was 1,238 (range 7-166). OUTCOME MEASURES: Preoperative to postoperative change in patient-reported outcomes (visual analog scales for arm pain and neck pain, Neck Disability Index, Japanese Orthopaedic Association [JOA] score, modified JOA score, and Nurick pain scale) and rates of fusion, revision, and complications or adverse events. METHODS: This study was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a preapproved protocol. PubMed and Embase databases were searched for articles published from January 2001 through July 2018. Statistical analyses for patient-reported outcomes were performed on the outcomes' raw mean differences, calculated as postoperative value minus preoperative value from each study. Pooled rates of successful fusion, revision surgery, and complications or adverse events, and their 95% confidence intervals, were also calculated. Two subgroup analyses were performed: one for studies in which only myelopathy or radiculopathy (or both) were stated as surgical indications and the other for studies in which only myelopathy or ossification of the posterior longitudinal ligament (or both) were stated as surgical indications. This study was funded by Providence Medical Technology, Inc. ($32,000). RESULTS: Thirty-three articles were included in the systematic review, and 31 articles were included in the meta-analysis. For all surgical indications and for the 2 subgroup analyses, every cumulative change in patient-reported outcome improved. Many of the reported changes in patient-reported outcome also exceeded the minimal clinically important differences. Pooled outcome rates with all surgical indications were 98.25% for successful fusion, 1.09% for revision, and 9.02% for complications or adverse events. Commonly reported complications or adverse events were axial pain, C5 palsy, transient neurological worsening, and wound infection. CONCLUSIONS: Posterior cervical fusion with decompression resulted in significant clinical improvement, as indicated by the changes in patient-reported outcomes. Additionally, high fusion rates and low rates of revision and of complications and adverse events were found.

The contributions of ankle, knee and hip joint work to individual leg work change during uphill and downhill walking over a range of speeds.

The muscles surrounding the ankle, knee and hip joints provide 42, 16 and 42%, respectively, of the total leg positive power required to walk on level ground at various speeds. However, each joint's contribution to leg work when walking up/downhill at a range of speeds is not known. Determining each biological joint's contribution to leg work over a range of speeds and slopes can inform the design of biomimetic assistive devices (i.e. prostheses). Twenty healthy adults walked 1.00, 1.25 and 1.50 m s-1 on 0°, ±3°, ±6° and ±9° while we collected kinematic and kinetic data. We calculated sagittal plane joint work and individual leg work over the entire stance phase. The ratio of ankle joint to total individual leg positive work (summed ankle, knee and hip joint work) did not change (0.42) with speed or slope, but the ratio of ankle joint to individual leg negative work was 0.38 at -9°, 0.42 at 0° and 0.27 at +9° across all speeds. The ratio of ankle joint to total individual leg negative work was 0.41 at 1.00 m s-1 and 0.32 at 1.50 m s-1 across all slopes. The ratio of knee joint to total individual positive leg work (0.22) did not change with speed or slope. The ratio of knee joint to total individual leg negative work was 0.39 at 1.00 m s-1 and 0.45 at 1.50 m s-1 across all slopes. The ratio of hip joint to total individual leg positive work did not change with speed but was 0.34 at -9°, 0.33 at 0° and 0.37 at +9° across all speeds. The ratio of hip joint to total individual leg negative work was 0.21 at 1.00 m s-1, and 0.24 at 1.50 m s-1 across all slopes and 0.17 at -9°, 0.19 at 0° and 0.29 at +9° across all speeds. The ankle significantly contributes to walking on slopes and this contribution changes during sloped compared with level-ground walking, thus assistive devices that provide biomimetic ankle function must adapt to accommodate walking at different speeds and slopes; whereas assistive biomimetic devices for the knee only need to adapt at different speeds.

Individuals with sacroiliac joint dysfunction display asymmetrical gait and a depressed synergy between muscles providing sacroiliac joint force closure when walking.

Walking is often compromised in individuals with low back and hip disorders, such as sacroiliac joint dysfunction (SIJD). The disorder involves reduced coactivation of the gluteus maximus and contralateral latissimus dorsi, which together provide joint stability during walking. The purpose of our study was to compare the kinematics and contributions of selected muscles to identified synergies during walking between healthy individuals and those with SIJD. Six women with unilateral SIJD and six age-matched healthy controls walked on a force-measuring treadmill at 1 m/s while we recorded kinematics and the activity of 16 muscles with surface EMG. Non-negative matrix factorization was used to identify patterns of EMG activity (muscle synergies). Individuals with SIJD exhibited less hip extension and lower peak vertical ground reaction forces on the affected side than the unaffected side. In contrast to controls, the SIJD group also displayed a depressed muscle synergy between gluteus maximus on the affected side and the contralateral latissimus dorsi. The results indicate that individuals with SIJD exhibited both reduced activation of gluteus maximus during a loading synergy present in walking and greater asymmetry between legs when walking compared with age-matched controls.

Use of a powered ankle-foot prosthesis reduces the metabolic cost of uphill walking and improves leg work symmetry in people with transtibial amputations.

People with transtibial amputations (TTAs) who use a powered ankle-foot prosthesis have equivalent metabolic costs and step-to-step transition work for level-ground walking over a range of speeds compared to non-amputees. The effects of using a powered compared to passive-elastic prosthesis for sloped walking are unknown. We sought to understand how the use of passive-elastic compared to powered ankle-foot prostheses affect metabolic cost and step-to-step transition work during sloped walking. Ten people (six M, four F) with TTAs walked 1.25 m s-1 at 0°, ±3°, ±6° and ±9° using their own passive-elastic prosthesis and the BiOM powered ankle-foot prosthesis, while we measured metabolic rates, kinematics and kinetics. We calculated net metabolic power, individual leg step-to-step transition work and individual leg net work symmetry. The net metabolic power was 5% lower during walking on +3° and +6° uphill slopes when subjects used the BiOM compared to their passive-elastic prosthesis (p < 0.05). The use of the BiOM compared to a passive-elastic prosthesis did not affect individual leg step-to-step transition work (p > 0.05), but did improve individual leg net work symmetry on +6° and +9° uphill slopes (p < 0.01). People with TTAs who use a powered ankle-foot prosthesis have the potential to reduce metabolic costs and increase symmetry during walking on uphill slopes.