Ageing effects on knee and ankle joint angles at key events and phases of the gait cycle.

The objective of this research was to determine whether joint angles at critical gait events and during major energy generation/absorption phases of the gait cycle would reliably discriminate age-related degeneration during unobstructed walking. The gaits of 24 healthy adults (12 young and 12 elderly) were analysed using the PEAK Motus motion analysis system. The elderly participants showed significantly greater single (60.3% versus 62.3%, p < 0.01) and double ( p < 0.05) support times, reduced knee flexion (47.7° versus 43.0°, p < 0.05) and ankle plantarflexion (16.8° compared to 3.3°, p = 0.053) at toe off, reduced knee flexion during push-off and reduced ankle dorsiflexion (16.8° compared to 22.0°, p < 0.05) during the swing phase. The plantarflexing ankle joint motion during the stance to swing phase transition (A₂) for the young group (31.3°) was about twice ( p < 0.05) that of the elderly (16.9°). Reduced knee extension range of motion suggests that the elderly favoured a flexed-knee gait to assist in weight acceptance. Reduced dorsiflexion by the elderly in the swing phase implies greater risk of toe contact with obstacles. Overall, the results suggest that joint angle measures at critical events/phases in the gait cycle provide a useful indication of age-related degeneration in the control of lower limb trajectories during unobstructed walking.

Radiographic measurement of tibial joint angles in sheep

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Shoes that restrict metatarsophalangeal dorsiflexion cause proximal joint compensations

To describe barefoot, shod and in-shoe kinematics during stance phase of walking gait in a normal arched adult population. An equal sample of males and females (n = 24) was recruited. In order to quantify the effect of footwear independent of technical design features, an ASICS shoe (Onitsuka Tiger-Mexico 66, Japan) was used in this study. Markers were applied to three conditions; barefoot, shod, and in-shoe. The calibration markers were used to define static pose. The order of testing was randomised. Participants completed five trials in each condition. Kinematic data were captured using a 12 camera VICON MX40 motion capture system at 100 Hz and processed in Visual3D. A previously developed model was used to describe joint angles [1]. A univariate two-way ANOVA was used to identify any differences between the pairs of conditions. Post-hoc Sheffé tests were used to further interrogate the data for differences. At peak hallux dorsiflexion (Figure 1), during propulsion, the metatarsophalangeal joint (MPTJ) was significantly more dorsiflexed in the barefoot condition compared to the shod condition (p = 0.004). At the same gait event, the tibiocalcaneal joint (TCJ) was significantly more plantarflexed than both the shod and in-shoe conditions (p < 0.001), and the tarsometatarsal joint (TMTJ) was significantly less dorsiflexed in the barefoot condition compared to the shod and in-shoe conditions (p < 0.001). The findings of the current study demonstrate that footwear has significant effects on sagittal plane MPTJ joint dorsiflexion at peak hallux dorsiflexion, which results in compensations at proximal foot joints.

"Influence of lower-limb joint models on subject-specific musculoskeletal model predictions during gait" ( "modelli muscoloscheletrici personalizzati dell'arto inferiore: Analisi dell'effetto della modellazione dei giunti sulla predizione dei carichi agenti sul sistema scheletrico durante il cammino").

The aim of the present thesis was to investigate the influence of lower-limb joint models on musculoskeletal model predictions during gait. We started our analysis by using a baseline model, i.e., the state-of-the-art lower-limb model (spherical joint at the hip and hinge joints at the knee and ankle) created from MRI of a healthy subject in the Medical Technology Laboratory of the Rizzoli Orthopaedic Institute. We varied the models of knee and ankle joints, including: knee- and ankle joints with mean instantaneous axis of rotation, universal joint at the ankle, scaled-generic-derived planar knee, subject-specific planar knee model, subject-specific planar ankle model, spherical knee, spherical ankle. The joint model combinations corresponding to 10 musculoskeletal models were implemented into a typical inverse dynamics problem, including inverse kinematics, inverse dynamics, static optimization and joint reaction analysis algorithms solved using the OpenSim software to calculate joint angles, joint moments, muscle forces and activations, joint reaction forces during 5 walking trials. The predicted muscle activations were qualitatively compared to experimental EMG, to evaluate the accuracy of model predictions. Planar joint at the knee, universal joint at the ankle and spherical joints at the knee and at the ankle produced appreciable variations in model predictions during gait trials. The planar knee joint model reduced the discrepancy between the predicted activation of the Rectus Femoris and the EMG (with respect to the baseline model), and the reduced peak knee reaction force was considered more accurate. The use of the universal joint, with the introduction of the subtalar joint, worsened the muscle activation agreement with the EMG, and increased ankle and knee reaction forces were predicted. The spherical joints, in particular at the knee, worsened the muscle activation agreement with the EMG. A substantial increase of joint reaction forces at all joints was predicted despite of the good agreement in joint kinematics with those of the baseline model. The introduction of the universal joint had a negative effect on the model predictions. The cause of this discrepancy is likely to be found in the definition of the subtalar joint and thus, in the particular subject’s anthropometry, used to create the model and define the joint pose. We concluded that the implementation of complex joint models do not have marked effects on the joint reaction forces during gait. Computed results were similar in magnitude and in pattern to those reported in literature. Nonetheless, the introduction of planar joint model at the knee had positive effect upon the predictions, while the use of spherical joint at the knee and/or at the ankle is absolutely unadvisable, because it predicted unrealistic joint reaction forces.

Three-dimensional joint kinematics of swimming using body-worn inertial and magnetic sensors

Wearable inertial and magnetic measurements units (IMMU) are an important tool for underwater motion analysis because they are swimmer-centric, they require only simple measurement set-up and they provide the performance results very quickly. In order to estimate 3D joint kinematics during motion, protocols were developed to transpose the IMMU orientation estimation to a biomechanical model. The aim of the thesis was to validate a protocol originally propositioned to estimate the joint angles of the upper limbs during one-degree-of-freedom movements in dry settings and herein modified to perform 3D kinematics analysis of shoulders, elbows and wrists during swimming. Eight high-level swimmers were assessed in the laboratory by means of an IMMU while simulating the front crawl and breaststroke movements. A stereo-photogrammetric system (SPS) was used as reference. The joint angles (in degrees) of the shoulders (flexion-extension, abduction-adduction and internal-external rotation), the elbows (flexion-extension and pronation-supination), and the wrists (flexion-extension and radial-ulnar deviation) were estimated with the two systems and compared by means of root mean square errors (RMSE), relative RMSE, Pearson’s product-moment coefficient correlation (R) and coefficient of multiple correlation (CMC). Subsequently, the athletes were assessed during pool swimming trials through the IMMU. Considering both swim styles and all joint degrees of freedom modeled, the comparison between the IMMU and the SPS showed median values of RMSE lower than 8°, representing 10% of overall joint range of motion, high median values of CMC (0.97) and R (0.96). These findings suggest that the protocol accurately estimated the 3D orientation of the shoulders, elbows and wrists joint during swimming with accuracy adequate for the purposes of research. In conclusion, the proposed method to evaluate the 3D joint kinematics through IMMU was revealed to be a useful tool for both sport and clinical contexts.

Joint-specific changes in locomotor complexity in the absence of muscle atrophy following incomplete spinal cord injury

ackground Following incomplete spinal cord injury (iSCI), descending drive is impaired, possibly leading to a decrease in the complexity of gait. To test the hypothesis that iSCI impairs gait coordination and decreases locomotor complexity, we collected 3D joint angle kinematics and muscle parameters of rats with a sham or an incomplete spinal cord injury. Methods 12 adult, female, Long-Evans rats, 6 sham and 6 mild-moderate T8 iSCI, were tested 4 weeks following injury. The Basso Beattie Bresnahan locomotor score was used to verify injury severity. Animals had reflective markers placed on the bony prominences of their limb joints and were filmed in 3D while walking on a treadmill. Joint angles and segment motion were analyzed quantitatively, and complexity of joint angle trajectory and overall gait were calculated using permutation entropy and principal component analysis, respectively. Following treadmill testing, the animals were euthanized and hindlimb muscles removed. Excised muscles were tested for mass, density, fiber length, pennation angle, and relaxed sarcomere length. Results Muscle parameters were similar between groups with no evidence of muscle atrophy. The animals showed overextension of the ankle, which was compensated for by a decreased range of motion at the knee. Left-right coordination was altered, leading to left and right knee movements that are entirely out of phase, with one joint moving while the other is stationary. Movement patterns remained symmetric. Permutation entropy measures indicated changes in complexity on a joint specific basis, with the largest changes at the ankle. No significant difference was seen using principal component analysis. Rats were able to achieve stable weight bearing locomotion at reasonable speeds on the treadmill despite these deficiencies. Conclusions Decrease in supraspinal control following iSCI causes a loss of complexity of ankle kinematics. This loss can be entirely due to loss of supraspinal control in the absence of muscle atrophy and may be quantified using permutation entropy. Joint-specific differences in kinematic complexity may be attributed to different sources of motor control. This work indicates the importance of the ankle for rehabilitation interventions following spinal cord injury.

MIMU sensors for joint kinematic estimation: anatomical landmarking and frame correction

The ability to capture human motion allows researchers to evaluate an individual’s gait. Gait can be measured in different ways, from camera-based systems to Magnetic and Inertial Measurement Units (MIMU). The former uses cameras to track positional information of photo-reflective markers, while the latter uses accelerometers, gyroscopes, and magnetometers to measure segment orientation. Both systems can be used to measure joint kinematics, but the results vary because of their differences in anatomical calibrations. The objective of this thesis was to study potential solutions for reducing joint angle discrepancies between MIMU and camera-based systems. The first study worked to correct the anatomical frame differences between MIMU and camera-based systems via the joint angles of both systems. This study looked at full lower body correction versus correcting a single joint. Single joint correction showed slightly better alignment of both systems, but does not take into account that body segments are generally affected by more than one joint. The second study explores the possibility of anatomical landmarking using a single camera and a pointer apparatus. Results showed anatomical landmark position could be determined using a single camera, as the anatomical landmarks found from this study and a camera-based system showed similar results. This thesis worked on providing a novel way for obtaining anatomical landmarks with a single point-and-shoot camera, as well aligning anatomical frames between MIMUs and camera-based systems using joint angles.

Optical Enhancement of Exoskeleton-Based Estimation of Glenohumeral Angles

In Robot-Assisted Rehabilitation (RAR) the accurate estimation of the patient limb joint angles is critical for assessing therapy efficacy. In RAR, the use of classic motion capture systems (MOCAPs) (e.g., optical and electromagnetic) to estimate the Glenohumeral (GH) joint angles is hindered by the exoskeleton body, which causes occlusions and magnetic disturbances. Moreover, the exoskeleton posture does not accurately reflect limb posture, as their kinematic models differ. To address the said limitations in posture estimation, we propose installing the cameras of an optical marker-based MOCAP in the rehabilitation exoskeleton. Then, the GH joint angles are estimated by combining the estimated marker poses and exoskeleton Forward Kinematics. Such hybrid system prevents problems related to marker occlusions, reduced camera detection volume, and imprecise joint angle estimation due to the kinematic mismatch of the patient and exoskeleton models. This paper presents the formulation, simulation, and accuracy quantification of the proposed method with simulated human movements. In addition, a sensitivity analysis of the method accuracy to marker position estimation errors, due to system calibration errors and marker drifts, has been carried out. The results show that, even with significant errors in the marker position estimation, method accuracy is adequate for RAR.

Real-time measurement of radiocarpal joint angle during dart-thrower's movement

Recently, a renewed attention has been drawn into the dart-thrower's motion as the radiocarpal joint is unique to humans and this is believed to have played a pivotal role in human evolution. Considering the importance of the motion and the complexity of the wrist joint, there have been many articles discussing the kinematics behind this movement. CT scan techniques have been used in a number of these research activities. Due to limitations in the speed of the image acquisition, the positions of the wrist were recorded in static postures. To our knowledge, a data acquisition for the motion with realtime capturing has not been reported. This paper presents the use of a 3D vision-based motion capture device. Leap Motion Controller (LMC), for measuring the radiocarpal joint angles during the dart-thrower's motion in a real-time analysis. The practical capability of the LMC in measuring dart-thrower's motion was examined in a trial involving four subjects and the angles were compared to the angles acquired from an inertial measurement unit (IMU). The results confirmed the LMC can successfully be used in the application of measuring radiocarpal kinematics" of dart-thrower's motion.

On analysing and interpreting variability in motor output

A recent article in the Journal of Science and Medicine in Sport by Chapman et al.1 reported data from an empirical investigation comparing lower extremity joint motions, joint coordination and muscle recruitment in expert and novice cyclists. 3D kinematic and intramuscular electromyographic (EMG) analyses revealed no differences between expert and novice cyclists for normalised joint angles and velocities of the pelvis, hip, knee and ankle. However, significant differences in the strength of sagittal plane kinematics for hip–ankle and knee–ankle joint couplings were reported, with expert cyclists displaying tighter coupling relationships than novice cyclists. Furthermore, significant differences between expert and novice cyclists for all muscle recruitment parameters, except timing of peak EMG amplitude, were also reported.

The role of vision in obese and normal-weight children's gait control

Previous research has suggested that perceptual-motor difficulties may account for obese children's lower motor competence; however, specific evidence is currently lacking. Therefore, this study examined the effect of altered visual conditions on spatiotemporal and kinematic gait parameters in obese versus normal-weight children. Thirty-two obese and normal-weight children (11.2 ± 1.5 years) walked barefoot on an instrumented walkway at constant self-selected speed during LIGHT and DARK conditions. Three-dimensional motion analysis was performed to calculate spatiotemporal parameters, as well as sagittal trunk segment and lower extremity joint angles at heel-strike and toe-off. Self-selected speed did not significantly differ between groups. In the DARK condition, all participants walked at a significantly slower speed, decreased stride length, and increased stride width. Without normal vision, obese children had a more pronounced increase in relative double support time compared to the normal-weight group, resulting in a significantly greater percentage of the gait cycle spent in stance. Walking in the DARK, both groups showed greater forward tilt of the trunk and restricted hip movement. All participants had increased knee flexion at heel-strike, as well as decreased knee extension and ankle plantarflexion at toe-off in the DARK condition. The removal of normal vision affected obese children's temporal gait pattern to a larger extent than that of normal-weight peers. Results suggest an increased dependency on vision in obese children to control locomotion. Next to the mechanical problem of moving excess mass, a different coupling between perception and action appears to be governing obese children's motor coordination and control.

The acute adaptations of normal and pathological human Achilles tendons to eccentric and concentric exercise

Eccentric exercise is the conservative treatment of choice for mid-portion Achilles tendinopathy. While there is a growing body of evidence supporting the medium to long term efficacy of eccentric exercise in Achilles tendinopathy treatment, very few studies have investigated the short term response of the tendon to eccentric exercise. Moreover, the mechanisms through which tendinopathy symptom resolution occurs remain to be established. The primary purpose of this thesis was to investigate the acute adaptations of the Achilles tendon to, and the biomechanical characteristics of, the eccentric exercise protocol used for Achilles tendinopathy rehabilitation and a concentric equivalent. The research was conducted with an orientation towards exploring potential mechanisms through which eccentric exercise may bring about a resolution of tendinopathy symptoms. Specifically, the morphology of tendinopathic and normal Achilles tendons was monitored using high resolution sonography prior to and following eccentric and concentric exercise, to facilitate comparison between the treatment of choice and a similar alternative. To date, the only proposed mechanism through which eccentric exercise is thought to result in symptom resolution is the increased variability in motor output force observed during eccentric exercise. This thesis expanded upon prior work by investigating the variability in motor output force recorded during eccentric and concentric exercises, when performed at two different knee joint angles, by limbs with and without symptomatic tendinopathy. The methodological phase of the research focused on establishing the reliability of measures of tendon thickness, tendon echogenicity, electromyography (EMG) of the Triceps Surae and the standard deviation (SD) and power spectral density (PSD) of the vertical ground reaction force (VGRF). These analyses facilitated comparison between the error in the measurements and experimental differences identified as statistically significant, so that the importance and meaning of the experimental differences could be established. One potential limitation of monitoring the morphological response of the Achilles tendon to exercise loading is that the Achilles tendon is continually exposed to additional loading as participants complete the walking required to carry out their necessary daily tasks. The specific purpose of the last experiment in the methodological phase was to evaluate the effect of incidental walking activity on Achilles tendon morphology. The results of this study indicated that walking activity could decrease Achilles tendon thickness (negative diametral strain) and that the decrease in thickness was dependent on both the amount of walking completed and the proximity of walking activity to the sonographic examination. Thus, incidental walking activity was identified as a potentially confounding factor for future experiments which endeavoured to monitor changes in tendon thickness with exercise loading. In the experimental phase of this thesis the thickness of Achilles tendons was monitored prior to and following isolated eccentric and concentric exercise. The initial pilot study demonstrated that eccentric exercise resulted in a greater acute decrease in Achilles tendon thickness (greater diametral strain) compared to an equivalent concentric exercise, in participants with no history of Achilles tendon pain. This experiment was then expanded to incorporate participants with unilateral Achilles tendinopathy. The major finding of this experiment was that the acute decrease in Achilles tendon thickness observed following eccentric exercise was modified by the presence of tendinopathy, with a smaller decrease (less diametral strain) noted for tendinopathic compared to healthy control tendon. Based on in vitro evidence a decrease in tendon thickness is believed to reflect extrusion of fluid from the tendon with loading. This process would appear to be limited by the presence of pathology and is hypothesised to be a result of the changes in tendon structure associated with tendinopathy. Load induced fluid movement may be important to the maintenance of tendon homeostasis and structure as it has the potential to enhance molecular movement and stimulate tendon remodelling. On this basis eccentric exercise may be more beneficial to the tendon than concentric exercise. Finally, EMG and motor output force variability (SD and PSD of VGRF) were investigated while participants with and without tendinopathy performed the eccentric and concentric exercises. Although between condition differences were identified as statistically significant for a number of force variability parameters, the differences were not greater than the limits of agreement for repeated measures. Consequently the meaning and importance of these findings were questioned. Interestingly, the EMG amplitude of all three Triceps Surae muscles did not vary with knee joint angle during the performance of eccentric exercise. This raises questions pertaining to the functional importance of performing the eccentric exercise protocol at each of the two knee joint angles as it is currently prescribed. EMG amplitude was significantly greater during concentric compared to eccentric muscle actions. Differences in the muscle activation patterns may result in different stress distributions within the tendon and be related to the different diametral strain responses observed for eccentric and concentric muscle actions.