Influence of calibration protocols for a pressure-sensing walkway on kinetic and temporospatial parameters

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Plantar enthesopathy : thickening of the enthesis is correlated with energy dissipation of the plantar fat pad during walking

Background: The enthesis of the plantar fascia is thought to play an important role in stress dissipation. However, the potential link between entheseal thickening characteristic of enthesopathy and the stress-dissipating properties of the intervening plantar fat pad have not been investigated. Purpose: This study was conducted to identify whether plantar fat pad mechanics explain variance in the thickness of the fascial enthesis in individuals with and without plantar enthesopathy. Study Design: Case-control study; Level of evidence, 3. Methods: The study population consisted of 9 patients with unilateral plantar enthesopathy and 9 asymptomatic, individually matched controls. The thickness of the enthesis of the symptomatic, asymptomatic, and a matched control limb was acquired using high-resolution ultrasound. The compressive strain of the plantar fat pad during walking was estimated from dynamic lateral radiographs acquired with a multifunction fluoroscopy unit. Peak compressive stress was simultaneously acquired via a pressure platform. Principal viscoelastic parameters were estimated from subsequent stress-strain curves. Results: The symptomatic fascial enthesis (6.7 ± 2.0 mm) was significantly thicker than the asymptomatic enthesis (4.2 ± 0.4 mm), which in turn was thicker than the enthesis (3.3 ± 0.4 mm) of control limbs (P < .05). There was no significant difference in the mean thickness, peak stress, peak strain, or secant modulus of the plantar fat pad between limbs. However, the energy dissipated by the fat pad during loading and unloading was significantly lower in the symptomatic limb (0.55 ± 0.17) when compared with asymptomatic (0.69 ± 0.13) and control (0.70 ± 0.09) limbs (P < .05). The sonographic thickness of the enthesis was correlated with the energy dissipation ratio of the plantar fat pad (r = .72, P < .05), but only in the symptomatic limb. Conclusion: The energy-dissipating properties of the plantar fat pad are associated with the sonograpic appearance of the enthesis in symptomatic limbs, providing a previously unidentified link between the mechanical behavior of the plantar fat pad and enthesopathy.

Reliability of spatiotemporal and kinetic gait parameters determined by a new instrumented treadmill system

Background Despite the emerging use of treadmills integrated with pressure platforms as outcome tools in both clinical and research settings, published evidence regarding the measurement properties of these new systems is limited. This study evaluated the within– and between–day repeatability of spatial, temporal and vertical ground reaction forces measured by a treadmill system instrumented with a capacitance–based pressure platform. Methods Thirty three healthy adults (mean age, 21.5 ± 2.8 years; height, 168.4 ± 9.9 cm; and mass, 67.8 ± 18.6 kg), walked barefoot on a treadmill system (FDM–THM–S, Zebris Medical GmbH) on three separate occasions. For each testing session, participants set their preferred pace but were blinded to treadmill speed. Spatial (foot rotation, step width, stride and step length), temporal (stride and step times, duration of stance, swing and single and double support) and peak vertical ground reaction force variables were collected over a 30–second capture period, equating to an average of 52 ± 5 steps of steady–state walking. Testing was repeated one week following the initial trial and again, for a third time, 20 minutes later. Repeated measures ANOVAs within a generalized linear modelling framework were used to assess between–session differences in gait parameters. Agreement between gait parameters measured within the same day (session 2 and 3) and between days (session 1 and 2; 1 and 3) were evaluated using the 95% repeatability coefficient. Results There were statistically significant differences in the majority (14/16) of temporal, spatial and kinetic gait parameters over the three test sessions (P < .01). The minimum change that could be detected with 95% confidence ranged between 3% and 17% for temporal parameters, 14% and 33% for spatial parameters, and 4% and 20% for kinetic parameters between days. Within–day repeatability was similar to that observed between days. Temporal and kinetic gait parameters were typically more consistent than spatial parameters. The 95% repeatability coefficient for vertical force peaks ranged between ± 53 and ± 63 N. Conclusions The limits of agreement in spatial parameters and ground reaction forces for the treadmill system encompass previously reported changes with neuromuscular pathology and footwear interventions. These findings provide clinicians and researchers with an indication of the repeatability and sensitivity of the Zebris treadmill system to detect changes in common spatiotemporal gait parameters and vertical ground reaction forces.

Force-deformation properties of the human heel pad during barefoot walking

Introduction: The plantar heel pad is a specialized fibroadipose tissue that attenuates and, in part, dissipates the impact energy associated with heel strike. Although near maximal deformation of the heel pad has been shown during running, in vivo measurement of the deformation and structural properties of the heel pad during walking remains largely unexplored. This study employed a fluoroscope, synchronized with a pressure platform, to obtain force–deformation data for the heel pad during walking. Methods: Dynamic lateral foot radiographs were acquired from 6 male and 10 female adults (age, 45 ± 10 yrs; height, 1.66 ± 0.10 m; and weight, 80.7 ± 10.8 kg), while walking barefoot at preferred speeds. The inferior aspect of the calcaneus was digitized and the sagittal thickness and deformation of the heel pad relative to the support surface calculated. Simultaneous measurement of the peak force beneath the heel was used to estimate the principal structural properties of the heel pad. Results: Transient loading profiles associated with walking induced rapidly changing deformation rates in the heel pad and resulted in irregular load–deformation curves. The initial stiffness (32 ± 11 N.mm-1) of the heel pad was an order of magnitude lower than its final stiffness (212 ± 125 N.mm-1) and on average, only 1.0 J of energy was dissipated by the heel pad with each step during walking. Peak deformation (10.3 mm) approached that predicted for the limit of pain tolerance (10.7 mm). Conclusion: These findings suggest the heel pad operates close to its pain threshold even at speeds encountered during barefoot walking and provides insight as to why barefoot runners may adopt ‘forefoot’ strike patterns that minimize heel loading.

Analysis of the footprint in school age of 8-10 years old

Biomechanical problems in children, is an important subject currently, existing controversy in different areas, for example, the majority of children have a flattened footprint, or the hypermobility joint is linked to a musculoskeletal pain. The objective of the study was to determine what kind of footprint is most frequent in school-age children (8-10 years) in the area of Plasencia. This was taken as a sign 50 children, of whom 28 were males and 22 females. All the subjects in the study underwent an assessment of footprint planted in static as well as an exploration of different parameters through inspection in a standing position (formula digital, rearfoot). The results show that excavated footprint is present in a 72% cases of the population, 16% was belonging to an excavated footprint in which we find a higher percentage of weight related.For the digital formula we find that the most common is the Egyptian foot by 40% of the cases and that the prevalence in the rearfoot, is a normal hindfoot. In relation with the hypermobility joint, we check that it is more common in girls and that none of them presents an association to musculoskeletal pain. As a future line we could establish a more comprehensive study with new techniques and valuingchild’s statics and dynamics, to have a more accurate study of the different variables in the sample population studied.

Variabilidade dos limites de estabilidade na posição ortostática em utentes com Acidente Vascular Encefálico

Introdução: O controlo postural (CP), intimamente ligado aos limites de estabilidade, é fundamental nas atividades da vida diária e encontra-se comprometido após Acidente Vascular Encefálico (AVE). Objectivo: Descrever as alterações nos limites de estabilidade, na posição ortostática, em utentes com AVE, face à aplicação de um programa de intervenção baseado num processo de raciocínio clínico. Métodos: Estudo de série de casos, de três indivíduos com alterações do CP do tronco e/ou das grandes articulações, decorrentes de AVE, mas capazes de assumir e manter a posição ortostática. Para avaliar os limites de estabilidade foram utilizados a plataforma de pressões Emed (coordenadas do centro de pressão, COPx e COPy) e o MultidirectionalReachTest (MDRT). Foram também aplicadas, a Fugl-Meyer Assessmentof Sensoriomotor Recovery After Stroke (FMA) e a Berg Balance Scale (BBS). Os instrumentos de avaliação foram aplicados antes e após a intervenção (M0 e M1), de 8 semanas, baseada nos princípios do conceito de Bobath. Resultados: Os valores dos testes de alcance no MDRT aumentaram em todos os utentes. Os limites e os deslocamentos médio-lateral (COPx) e, ântero-posterior (COPy) dos valores do CPr aumentaram, entre M0 e M1. No que se refere à FMA e a BBS, verificou-se que todos apresentaram um aumento dos scores. Conclusão: Os utentes modificaram os seus limites de estabilidade no sentido do aumento, assim como, da função motora e do equilíbrio. Deste modo, a intervenção de acordo com os princípios do conceito de Bobath aparenta introduzir os estímulos necessários à reorganização funcional do sistema nervoso central lesado.

Influência do alinhamento do pé nos Ajustes Posturais Antecipatórios em crianças com Paralisia Cerebral

Introdução: A dificuldade na organização dos ajustes posturais antecipatórios (APAs) é frequentemente associada ao défice de controlo postural (CP) em crianças/jovens com um quadro motor de hemiplegia espástica, resultante de paralisia cerebral. As alterações biomecânicas da tibiotársica e do pé são características comummente observadas nestas crianças/jovens e influenciam o CP na sua globalidade. Objectivo(s): descrever o comportamento dos APAs associados ao início da marcha, face à modificação do alinhamento do pé em crianças/jovens com hemiplegia espástica, após 12 semanas de intervenção, segundo o Conceito Bobath-TND e aplicação de uma Ligadura Funcional (LF). Métodos: Foram avaliadas quatro crianças/jovens num momento inicial (M0) e após 12 semanas de intervenção e de aplicação de uma LF (M1). Recorrendo à eletromiografia de superfície, registaram-se os timings de activação dos músculos tibial anterior, solear, recto abdominal e erector da espinha (bilateralmente). O início do movimento foi calculado a partir da alteração do sinal obtido através da plataforma de pressões. Recorreu-se à aplicação da TMFM-88 para avaliar a função motora global e à aplicação da CIF-CJ para classificar a funcionalidade mediante as actividades e a participação. Procedeu-se ao registo de imagem para facilitar a observação/avaliação das componentes de movimento das crianças/jovens em estudo. Resultados: Após o período de intervenção, verificou-se uma modificação nos valores dos timings de ativação dos músculos em análise, que se aproximaram da janela temporal definida como APAs, bem como na distribuição de carga na base de suporte, nos scores da TMFM-88 e nos qualificadores das “Actividades e Participação”, sugestivos de uma melhor organização dos mecanismos de controlo postural. Conclusão: As crianças/jovens em estudo evidenciaram, após uma intervenção de fisioterapia baseada no Conceito Bobath- TND e aplicação de uma LF, uma evolução favorável tanto ao nível do CP da tibiotársica e do pé, apresentando timings de ativação muscular temporalmente mais ajustados à tarefa, com repercussões positivas nas actividades e participação.

Análise do equilíbrio em pacientes hemiparéticos após o treino com o programa Wii Fit

OBJETIVO: A hemiparesia é um comprometimento parcial do hemicorpo que altera o equilíbrio, sendo este essencial para as atividades funcionais. OBJETIVO: Avaliar o equilíbrio em pacientes hemiparéticos submetidos ao treino de equilíbrio com o programa Wii Fit, que atuou como um recurso de biofeedback visual. MÉTODO: Foram selecionados 12 pacientes hemiparéticos pós AVE, 5 do sexo masculino e 7 do sexo feminino, com idade média de 58 ± 12,57 anos, divididos aleatoriamente em dois grupos. Um deles realizou a fisioterapia convencional (GC) pelo período de uma hora, o outro realizou por trinta minutos e mais trinta minutos de treino de equilíbrio com auxílio do Wii Fit (GW), duas vezes por semana durante cinco semanas, completando dez sessões. O equilíbrio foi avaliado antes e após as intervenções, por meio da aplicação da Escala de Equilíbrio de Berg (EEB) e pela estabilometria, que mensura a oscilação do centro de pressão (COP), nos eixos ântero-posterior (AP) e médio-lateral (ML), por uma plataforma de pressão em duas condições: de olhos abertos (OA) e olhos fechados (OF). RESULTADOS: de acordo com a EEB, os pacientes, tanto do GC quanto o do GW, obtiveram maior controle do equilíbrio estático e dinâmico. Na avaliação do COP no eixo ML, os indivíduos do GC e do GW tiveram diminuição na oscilação ML após a intervenção proposta para cada grupo, nas condições de OA e OF. No eixo AP do COP, o GC não teve diminuição na oscilação AP de OA e OF, e o GW apresentou diminuição na oscilação AP de OA e OF. CONLUSÃO: O presente estudo demonstra que a fisioterapia associada ao treino de equilíbrio com o Wii Fit apresenta resultados significantes na reabilitação dos indivíduos hemiparéticos, obtendo, assim, mais um recurso terapêutico na fisioterapia.

Static balance and function in children with cerebral palsy submitted to neuromuscular block and neuromuscular electrical stimulation: Study protocol for prospective, randomized, controlled trial

Background: The use of botulinum toxin A (BT-A) for the treatment of lower limb spasticity is common in children with cerebral palsy (CP). Following the administration of BT-A, physical therapy plays a fundamental role in potentiating the functionality of the child. The balance deficit found in children with CP is mainly caused by muscle imbalance (spastic agonist and weak antagonist). Neuromuscular electrical stimulation (NMES) is a promising therapeutic modality for muscle strengthening in this population. The aim of the present study is to describe a protocol for a study aimed at analyzing the effects of NMES on dorsiflexors combined with physical therapy on static and functional balance in children with CP submitted to BT-A.Methods/Design: Protocol for a prospective, randomized, controlled trial with a blinded evaluator. Eligible participants will be children with cerebral palsy (Levels I, II and III of the Gross Motor Function Classification System) between five and 12 years of age, with independent gait with or without a gait-assistance device. All participants will receive BT-A in the lower limbs (triceps surae). The children will then be randomly allocated for either treatment with motor physical therapy combined with NMES on the tibialis anterior or motor physical therapy alone. The participants will be evaluated on three occasions: 1) one week prior to the administration of BT-A; 2) one week after the administration of BT-A; and 3) four months after the administration of BT-A (end of intervention). Spasticity will be assessed by the Modified Ashworth Scale and Modified Tardieu Scale. Static balance will be assessed using the Medicapteurs Fusyo pressure platform and functional balance will be assessed using the Berg Balance Scale.Discussion: The aim of this protocol study is to describe the methodology of a randomized, controlled, clinical trial comparing the effect of motor physical therapy combined with NMES on the tibialis anterior muscle or motor physical therapy alone on static and functional balance in children with CP submitted to BT-A in the lower limbs. This study describes the background, hypotheses, methodology of the procedures and measurement of the results.

Analise dos pés através da baropodometria e da classificação plantar em escolares de Guaratinguetá

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Pressure distribution beneath the human foot

A descriptive study was undertaken to establish the 95 percentile limits (proposed normal reference range) for pressure beneath the hallux, metatarsal heads, and heel in a group of healthy adult subjects. A new force plate device capable of accurately measuring discrete areas of pressure beneath the human foot with high temporal and spatial resolution was used. The system is capable of accurately measuring plantar foot pressure during dynamic and static foot function. The results of this research are in close agreement with other published studies of plantar foot pressure measurement with comparable systems.

Development of atmospheric pressure ionization ion mobility spectrometry and ion mobility spectrometry mass spectrometry

This study is focused on the development and evaluation of ion mobility instrumentation with various atmospheric pressure ionization techniques and includes the following work. First, a high-resolution drift tube ion mobility spectrometer (IMS), coupled with a commercial triple quadrupole mass spectrometer (MS), was developed. This drift tube IMS is compatible with the front-end of commercial Sciex mass spectrometers (e.g., Sciex API-300, 365, and 3000) and also allows easy (only minor modifications are needed) installation between the original atmospheric pressure ion source and the triple quadrupole mass spectrometer. Performance haracteristics (e.g.,resolving power, detection limit, transmission efficiency of ions) of this IMS-MS instrument were evaluated. Development of the IMS-MS instrument also led to a study where a proposal was made that tetraalkylammonium ions can be used as chemical standards for ESI-IMS. Second, the same drift tube design was also used to build a standalone ion mobility spectrometer equipped with a Faraday plate detector. For this highresolution (resolving power about 100 shown) IMS device, a multi-ion source platform was built, which allows the use of a range of atmospheric pressure ionization methods, such as: corona discharge chemical ionization (CD-APCI), atmospheric pressure photoionization (APPI), and radioactive atmospheric pressure chemical ionization (R-APCI). The multi-ion source platform provides easy switching between ionization methods and both positive and negative ionization modes can be used. Third, a simple desorpion/ionization on silicon (DIOS) ion source set-up for use with the developed IMS and IMS-MS instruments was built and its operation demonstrated. Fourth, a prototype of a commercial aspiration-type ion mobility spectrometer was mounted in front of a commercial triple quadrupole mass spectrometer. The set-up, which is simple, easy to install, and requires no major modifications to the MS, provides the possibility of gathering fundamental information about aspiration mobility spectrometry.

Age-related differences in time-limit performance and force platform-based balance measures during one-leg stance

Poor posture control has been associated with an increased risk of falls and mobility disability among older adults. This study was conducted to assess the test-retest reliability and sensitivity to group differences regarding the time-limit (TLimit) of one-leg standing and selected balance parameters obtained with a force platform in older and young adults. A secondary purpose was to assess the relationship between TLimit and these balance parameters. Twenty-eight healthy older adults (age: 69±5years) and thirty young adults (age: 21±4years) participated in this study. Two one-leg stance tasks were performed: (1) three trials of 30s maximum and (2) one TLimit trial. The following balance parameters were computed: center of pressure area, RMS sway amplitude, and mean velocity and mean frequency in both the anterio-posterior and medio-lateral directions. All balance parameters obtained with the force platform as well as the TLimit variable were sensitive to differences in balance performance between older and young adults. The test-retest reliability of these measures was found to be acceptable (ICC: 0.40-0.85), with better ICC scores observed for mean velocity and mean frequency in the older group. Pearson correlations coefficients (r) between balance parameters and TLimit ranged from -0.16 to -0.54. These results add to the current literature that can be used in the development of measurement tools for evaluating balance in older and young adults. © 2013 Elsevier Ltd.

Experimental study on vortex-induced motions of a semi-submersible platform with four square columns, Part I: Effects of current incidence angle and hull appendages

An experimental study on Vortex-Induced Motion (VIM) of the semi-submersible platform concept with four square columns is presented. Model tests were carried out to check the influence of different headings and hull appendages (riser supports located at the pontoons; fairleads and the mooring stretches located vertically at the external column faces; and hard pipes located vertically at the internal column faces). The results comprise in-line, transverse and yaw motions, as well as combined motions in the XY plane, drag and lift forces and spectral analysis. The main results showed that VIM in the transverse direction occurred in a range of reduced velocity 4.0 up to 14.0 with amplitude peaks around reduced velocities around 7.0 and 8.0. The largest transverse amplitudes obtained were around 40% of the column width for 30 degrees and 45 degrees incidences. Another important result observed was a considerable yaw motion oscillation, in which a synchronization region could be identified as a resonance phenomenon. The largest yaw motions were verified for the 0 degrees incidence and the maxima amplitudes around 4.5 degrees. The hull appendages located at columns had the greatest influence on the VIM response of the semi-submersible. (C) 2012 Elsevier Ltd. All rights reserved.

New Library-curated Faculty Profile Platform Launches Through bepress

As faculty needs evolve and become increasingly digital, libraries are feeling the pressure to provide relevant new services. At the same time, faculty members are struggling to create and maintain their professional reputations online. We at bepress are happy to announce the new SelectedWorks, the fully hosted, library-curated faculty profile platform that positions the library to better support faculty as well as the institution at large. Beverly Lysobey, Digital Commons and Resource Management Librarian, at Sacred Heart University, says: “Both faculty and administration have been impressed with the services we provide through SelectedWorks; we’re able to show how much our faculty really publishes, and it’s great for professors to get that recognition. We’ve had several faculty members approach us for help making sure their record was complete when they were up for tenure, and we’ve even found articles that authors themselves no longer had access to.” With consistent, organized, institution-branded profiles, SelectedWorks increases campus-wide exposure and supports the research mission of the university. As the only profile platform integrated with the fully hosted Digital Commons suite of publishing and repository services, it also ensures that the institution retains management of its content. Powerful integration with the Digital Commons platform lets the home institution more fully capture the range of scholarship produced on campus, and hosted services facilitate resource consolidation and reduces strain on IT. The new SelectedWorks features a modern, streamlined design that provides compelling display options for the full range of faculty work. It beautifully showcases streaming media, images, data, teaching materials, books – any type of content that researchers now produce as part of their scholarship. Detailed analytics tools let authors and librarians measure global readership and track impact for a variety of campus stakeholders: authors can see the universities, agencies, and businesses that are reading their work, and can easily export reports to use in tenure and promotion dossiers. Janelle Wertzbeger, Assistant Dean and Director of Scholarly Communications at Gettysburg College’s Musselman Library, says, “The new author dashboard maps and enhanced readership are SO GOOD. Every professor up for promotion & tenure should use them!” And of course, SelectedWorks is fully backed by the continual efforts of the bepress development team to provide maximum discoverability to search engines, increasing impact for faculty and institutions alike: Reverend Edward R. Udovic, Vice President for Teaching and Learning Resources at DePaul University, says, “In the last several months downloads of my scholarship from my [SelectedWorks] site have far surpassed the total distribution of all my work in the previous twenty five years.”