Friso Hagman

Effects of hallux limitus on plantar foot pressure and foot kinematics during walking.

The effects of hallux limitus on plantar foot pressure and foot kinematics have received limited attention in the literature. Therefore, a study was conducted to assess the effects of limited first metatarsophalangeal joint mobility on plantar foot pressure. It was equally important to identify detection criteria based on plantar pressures and metatarsophalangeal joint kinematics, enabling differentiation between subjects affected by hallux limitus and people with normal hallux function. To further our understanding of the relation between midtarsal collapse and hallux limitus, kinematic variables relating to midtarsal pronation were also included in the study. Two populations of 19 subjects each, one with hallux limitus and the other free of functional abnormalities, were asked to walk at their preferred speed while plantar foot pressures were recorded along with three-dimensional foot kinematics. The presence of hallux limitus, structural or functional, caused peak plantar pressure under the hallux to build up significantly more and at a faster rate than under the first metatarsal head. Additional discriminators for hallux limitus were peak dorsiflexion of the first metatarsophalangeal joint, time to this peak value, peak pressure ratios of the first metatarsal head and the more lateral metatarsal heads, and time to maximal pressure under the fourth and fifth metatarsal heads. Finally, in approximately 20% of the subjects, with and without hallux limitus, midtarsal pronation occurred after heel lift, validating the claim that retrograde midtarsal pronation does occur.

Differences in balance strategies between nonspecific chronic low back pain patients and healthy control subjects during unstable sitting.

Study Design. A 2-group experimental design. Objective. To investigate differences in postural control strategies of pelvis and trunk movement between nonspecific chronic low back pain (CLBP) patients and healthy control subjects using 3-dimensional motion analysis. Summary of Background Data. Increased postural sway assessed by center of pressure displacements have been documented in patients with low back pain (LBP). The 3-dimensional movement strategies used by patients with LBP to keep their balance are not well documented. Methods. Nineteen CLBP patients and 20 control subjects were included based on detailed clinical criteria. Every subject was submitted to a postural control test in an unstable sitting position. A 3-dimensional motion analysis system, equipped with 7 infrared M1 cameras, was used to track 9 markers attached to the pelvis and trunk to estimate their angular displacement in the 3 cardinal planes. Results. The total angular deviation in all 3 directions of pelvis and trunk was higher in the CLBP group compared with the control group. In 4 of the 6 calculated differences, a significant higher deviation was found in the CLBP group (significant P-values between 0.013 and 0.047). Subjects of both groups mostly used rotation compared with lateral flexion and flexion/extension displacements of pelvis and trunk to adjust balance disturbance. The CLBP group showed a high correlation (Pearson: 0.912-0.981) between movement of pelvis and trunk, compared with the control group. Conclusion. A higher postural sway and high correlation between pelvis and trunk displacements was found in the LBP group compared with healthy controls.

From block clearance to sprint running: Characteristics underlying an effective transition

Abstract The aim of this study was to characterize the specifics of the sprint technique during the transition from start block into sprint running in well-trained sprinters. Twenty-one sprinters (11 men and 10 women), equipped with 74 spherical reflective markers, executed an explosive start action. An opto-electronic motion analysis system consisting of 12 MX3 cameras (250 Hz; 325,000 pixels) and two Kistler force plates (1000 Hz) was used to collect the three-dimensional (3D) marker trajectories and ground reaction forces (Nexus, Vicon). The 3D kinematics, joint kinetics, and power were calculated (Opensim) and were time normalized to 100% from the first action after gunshot until the end of second stance after block clearance (Matlab). The results showed that during the first stance, power generation at the knee plays a significant role in obtaining an effective transition, representing 31% of power generation in the lower limb, in the absence of preceding power absorption. Furthermore, the sprinter actively searches a more forward leaning position to maximize horizontal velocity. Since success during sprinting from the second stance onwards involves high hip and ankle activation, the above-mentioned three characteristics are specific skills required to successfully conclude the transition from start block into sprint running.

Reproducibility of postural control measurement during unstable sitting in low back pain patients

BackgroundPostural control tests like standing and sitting stabilometry are widely used to evaluate neuromuscular control related to trunk balance in low back pain patients. Chronic low back pain patients have lesser postural control compared to healthy subjects. Few studies have assessed the reproducibility of the centre of pressure deviations and to our knowledge no studies have investigated the reproducibility of three-dimensional kinematics of postural control tests in a low back pain population. Therefore the aim of this study was to assess the test-retest reproducibility of a seated postural control test in low back pain patients.MethodsPostural control in low back pain patients was registered by a three dimensional motion analysis system combined with a force plate. Sixteen chronic low back pain patients having complaints for at least six months, were included based on specific clinical criteria. Every subject performed 4 postural control tests. Every test was repeated 4 times and lasted 40 seconds. The force plate registered the deviations of the centre of pressure. A Vicon-612-datastation, equipped with 7 infra-red M1 cameras, was used to track 13 markers attached to the torso and pelvis in order to estimate their angular displacement in the 3 cardinal planes.ResultsAll Intraclass Correlation Coefficients (ICC) calculated for the force plate variables did not exceed 0.73 (ranging between 0.11 and 0.73). As for the torso, ICCs of the mean flexion-extension and rotation angles ranged from 0.65 to 0.93 and of the mean lateral flexion angle from 0.50 to 0.67. For the pelvis the ICC of the mean flexion-extension angle varied between 0.66 and 0.83, the mean lateral flexion angle between 0.16 and 0.81 and the mean rotation angle between 0.40 and 0.62.Consecutive data suggest that the low test-retest reproducibility is probably due to a learning effect.ConclusionThe test-retest reproducibility of these postural control tests in an unstable sitting position can globally be considered as rather moderate. In order to improve the test-retest reproducibility, a learning period may be advisable at the beginning of the test.

Decrease in Postural Sway and Trunk Stiffness During Cognitive Dual-Task in Nonspecific Chronic Low Back Pain Patients, Performance Compared to Healthy Control Subjects

Study Design. A 2-group experimental design. Objective. To investigate the effect of a cognitive dual-task on postural sway of pelvis and trunk during unstable sitting in nonspecific chronic patients with low back pain (CLBP) compared to healthy control subjects. Summary of Background Data. Higher cognitive systems as well as sensory processes contribute to postural control. An increase in postural sway due to a cognitive dual task could mean more need of cognitive systems to control balance. Methods. A total of 21 CLBP patients and 21 control subjects were included based on detailed clinical criteria. Every subject was submitted to 2 postural control tests in an unstable sitting position (easy test position: 2 feet on the ground and difficult test position: 1 foot lifted). Both tests were performed with and without cognitive dual-task. A 3-dimensional motion analysis system was used measure angular displacement of trunk and pelvis in the 3 cardinal planes. Results. In the most difficult balance position, postural sway increases in the control group when the cognitive dual-task is added, for 50% of the variables the increase is significant (P between 0.02 and 0.05). On the contrary, postural sway decreases, not significantly, in the CLBP group when the dual-task is added. These findings are the same for trunk as for pelvis deviations. The Pearson correlation coefficient between trunk and pelvis movement from the CLBP group are lower for all 3 movement directions in the dual-task condition (r between 0.441 and 0.988) compared to the single task condition (r between 0.982 and 0.995). Conclusion. In nonspecific CLBP patients, a cognitive dual-task reduces both postural sway and trunk stiffness due to the distracting effect of the dual-task. This effect is only visible when the balance task is difficult.

Human–Robot Interaction: Kinematics and Muscle Activity Inside a Powered Compliant Knee Exoskeleton

Until today it is not entirely clear how humans interact with automated gait rehabilitation devices and how we can, based on that interaction, maximize the effectiveness of these exoskeletons. The goal of this study was to gain knowledge on the human-robot interaction, in terms of kinematics and muscle activity, between a healthy human motor system and a powered knee exoskeleton (i.e., KNEXO). Therefore, temporal and spatial gait parameters, human joint kinematics, exoskeleton kinetics and muscle activity during four different walking trials in 10 healthy male subjects were studied. Healthy subjects can walk with KNEXO in patient-in-charge mode with some slight constraints in kinematics and muscle activity primarily due to inertia of the device. Yet, during robot-in-charge walking the muscular constraints are reversed by adding positive power to the leg swing, compensating in part this inertia. Next to that, KNEXO accurately records and replays the right knee kinematics meaning that subject-specific trajectories can be implemented as a target trajectory during assisted walking. No significant differences in the human response to the interaction with KNEXO in low and high compliant assistance could be pointed out. This is in contradiction with our hypothesis that muscle activity would decrease with increasing assistance. It seems that the differences between the parameter settings of low and high compliant control might not be sufficient to observe clear effects in healthy subjects. Moreover, we should take into account that KNEXO is a unilateral, 1 degree-of-freedom device.

Effects of Simulated Genu Valgum and Genu Varum on Ground Reaction Forces and Subtalar Joint Function During Gait

The mechanical effects of genu valgum and varum deformities on the subtalar joint were investigated. First, a theoretical model of the forces within the foot and lower extremity during relaxed bipedal stance was developed predicting the rotational effect on the subtalar joint due to genu valgum and varum deformities. Second, a kinetic gait study was performed involving 15 subjects who walked with simulated genu valgum and genu varum over a force plate and a plantar pressure mat to determine the changes in the ground reaction force vector within the frontal plane and the changes in the center-of-pressure location on the plantar foot. These results predicted that a genu varum deformity would tend to cause a subtalar pronation moment to increase or a supination moment to decrease during the contact and propulsion phases of walking. With genu valgum, it was determined that during the contact phase a subtalar pronation moment would increase, whereas in the early propulsive phase, a subtalar supination moment would increase or a pronation moment would decrease. However, the current inability to track the spatial position of the subtalar joint axis makes it difficult to determine the absolute direction and magnitudes of the subtalar joint moments.

Comparison of anthropometric characteristics and sprint start performance between elite adolescent and adult sprint athletes

Abstract The aim of this study was to examine the physical characteristics and somatotype of junior and senior athletes in relation to sprint start and acceleration performance. Nineteen female junior, 23 male junior, 9 female senior, and 16 male senior sprint athletes performed three maximal 20-m sprints. The starting blocks were instrumented to measure forward propulsion forces. Running velocity was measured by a laser positioned behind the athlete at 1 m height. Anthropometric measures were used to calculate somatotype and skeletal muscle mass. Body composition was estimated by underwater weighing densitometry. Junior and senior athletes were of similar height in both sexes. Male seniors were heavier, had larger limb circumferences, and a higher skeletal muscle mass than male juniors. Only the limb circumferences of the female seniors were larger than those of the female juniors. Female juniors were balanced ectomorphs, while female seniors were situated centrally on the somatochart (2.7–2.2–3.9 vs. 2.6–3.1–3.1; P=0.772, 0.047, and 0.066 respectively). Male juniors were mesomorphic ectomorphs, while male seniors were ectomorphic mesomorphs (1.8–3.3–3.6 vs. 1.6–4.2–2.8; P=0.148, 0.002, and 0.002 respectively). All sprint starts were similar for the junior and senior athletes of both sexes. Senior athletes accelerated more than the junior athletes, which resulted in higher running velocities after 5 m (senior vs. junior: females, 5.51±0.32 vs. 6.01±0.27 m · s–1, P=0.001; males, 5.85±0.38 vs. 6.13±0.44 m · s–1, P=0.043). The greater muscularity of senior compared with junior athletes did not result in better sprint start dynamics, but they did accelerate more and ran faster. These results show that late-adolescent boys in particular are still developing their muscularity. The technical complexity of the sprint start and the negative influence of a higher body mass may partly explain the comparable sprint start dynamics of the junior and senior athletes. We suggest that strength training should be combined with sufficient attention to technical skills to allow a positive transfer.

Control of propulsion and body lift during the first two stances of sprint running: a simulation study

Abstract The aim of this study was to relate the contribution of lower limb joint moments and individual muscle forces to the body centre of mass (COM) vertical and horizontal acceleration during the initial two steps of sprint running. Start performance of seven well-trained sprinters was recorded using an optoelectronic motion analysis system and two force plates. Participant-specific torque-driven and muscle-driven simulations were conducted in OpenSim to quantify, respectively, the contributions of the individual joints and muscles to body propulsion and lift. The ankle is the major contributor to both actions during the first two stances, with an even larger contribution in the second compared to the first stance. Biarticular gastrocnemius is the main muscle contributor to propulsion in the second stance. The contribution of the hip and knee depends highly on the position of the athlete: During the first stance, where the athlete runs in a forward bending position, the knee contributes primarily to body lift and the hip contributes to propulsion and body lift. In conclusion, a small increase in ankle power generation seems to affect the body COM acceleration, whereas increases in hip and knee power generation tend to affect acceleration less.

Forefoot deformation during stance: Does the forefoot collapse during loading?

This study presents a specific description of forefoot deformation during the stance phase of normal human walking based on the combined analysis of pressure and three-dimensional optoelectronic measurements. Forefoot deformation is measured in forty healthy subjects using (1) a six-camera motion capture system (sampled at 250 Hz) tracking five reflective skin markers attached to the forefoot, (2) a pressure platform (sampled at 500 Hz) and (3) a forceplate (sampled at 1250 Hz). Forefoot deformation is characterized by the forefoot width, the mediolateral metatarsal arch height and the plantar pressure under the metatarsal heads. Using this setup, a typical pattern of forefoot motion is described during stance phase: From a flexible, compliant configuration at the beginning of stance phase, characterized by a decrease in mediolateral metatarsal arch height and a controlled increase in forefoot width, the forefoot turns into a stable configuration during midstance. Subsequently, the increase in mediolateral arch height and the decrease in forefoot width describe the transformation into a tight configuration during final stance. This transfer from a compliant into a rigid configuration through stance phase rejects the idea of the forefoot as a collapsing structure under increased loading.