J.P.K. Halbertsma

Speed dependence of averaged EMG profiles in walking

Electromyogram (EMG) profiles strongly depend on walking speed and, in pathological gait, patients do not usually walk at normal speeds. EMG data was collected from 14 muscles in two groups of healthy young subjects who walked at five different speeds ranging from 0.75 to 1.75 ms(-1). We found that average EMG profiles varied in a predictable way with speed. The average EMG profile for each muscle at any speed could be estimated in a simple way from two functions, one constant and one proportionally increasing with walking speed. By taking into account the similarity among profiles within functional groups, the number of basic functions could be reduced further. Any average EMG profile among the 14 leg muscles studied at all speeds in the measured range could be predicted from six constant and ten speed-dependent basic patterns. These results can be interpreted in terms of a central pattern generator for human walking.

Sport stretching: Effect on passive muscle stiffness of short hamstrings

OBJECTIVE To evaluate the effects of one 10-minute stretch on muscle stiffness in subjects with short hamstrings. DESIGN Randomized control trial. SETTING Laboratory for human movement sciences in the department of rehabilitation of a university hospital. SUBJECTS Sixteen students from the Department of Human Movement Sciences participated with informed consent in the experiment. Subjects were limited to men and women without a history of neurological and orthopedic disorders. To select subjects with short hamstrings, the finger-ground distance had to be greater than 0cm (unable to touch the floor when bending forward) and the manual leg lifting was not to exceed 80 degrees. One group of 10 subjects performed static stretching exercises during 10 minutes interspersed with relaxing, whereas the untreated group of 6 subjects was used as a control. MAIN OUTCOME MEASURES The instrumental straight-leg-raising set-up enables the measurement of the force needed to lift the leg, range of motion (ROM), pelvic-femoral angle, and the electromyogram of the hamstrings. These variables provide information about the stiffness, elongation, and state of activity of the hamstring muscles. RESULTS. One 10-minute sport stretch resulted in a significant increase in passive muscle moment, ROM, and elongation of the hamstrings. There was no significant change in the course of the passive muscle stiffness curve with respect to the prestretch stiffness curve. CONCLUSIONS One session of static stretching does not influence the course of the passive muscle stiffness curve. The increased ROM, i.e., the extensibility of the hamstrings, results from an increase in the stretch tolerance.

Repeated passive stretching : acute effect on the passive muscle moment and extensibility of short hamstrings

OBJECTIVE To examine the response of short hamstring muscles to repeated passive stretching. DESIGN A repeated measures design. SETTING A university laboratory for human movement analysis in a department of rehabilitation. SUBJECTS Students (7 men, 10 women) from the Department of Human Movement Sciences. MAIN OUTCOME MEASURES The lift force, range of motion, pelvic-femoral angle, first sensation of pain, and electromyogram of the hamstrings were measured. RESULTS Comparison of the data of the test group (n = 17) after five successive passive stretch tests by means of an instrumental straight-leg raising test showed no significant change of the variables passive muscle stiffness and extensibility (p>.05). CONCLUSION The acute effect of repeated passive stretching of short hamstring muscles is negligible. With an instrumental straight-leg raising test, the relevant muscle variables can be examined noninvasively.

Balance control on a moving platform in unilateral lower limb amputees

OBJECTIVE To study balance control on a moving platform in lower limb amputees. DESIGN Observational cohort study. PARTICIPANTS Unilateral transfemoral and transtibial amputees and able-bodied control subjects. INTERVENTIONS Balance control on a platform that moved in the anteroposterior direction was tested with eyes open, blindfolded and while performing a dual task. MAIN OUTCOME MEASURES Weight bearing symmetry, anteroposterior ground reaction force and centre of pressure shift. RESULTS Compared to able-bodied subjects, in amputees the anteroposterior ground reaction force was larger in the prosthetic and non-affected limb, and the centre of pressure displacement was increased in the non-affected limb and decreased in the prosthetic limb. In amputees body weight was loaded more on the non-affected limb. Blindfolding or adding a dual task did not influence the outcome measures importantly. CONCLUSION The results of this study indicate that experienced unilateral amputees with a high activity level compensate for the loss of ankle strategy by increasing movements and loading in the non-affected limb. The ability to cope with balance perturbations is limited in the prosthetic limb. To enable amputees to manage all possible balance disturbances in real life in a safe manner, we recommend to improve muscle strength and control in the non-affected limb and to train complex balance tasks in challenging environments during rehabilitation.

Uphill and downhill walking in unilateral lower limb amputees

OBJECTIVE To study adjustment strategies in unilateral amputees in uphill and downhill walking. DESIGN Observational cohort study. SUBJECTS Seven transfemoral, 12 transtibial unilateral amputees and 10 able-bodied subjects. METHODS In a motion analysis laboratory the subjects walked over a level surface and an uphill and downhill slope. Gait velocity and lower limb joint angles were measured. RESULTS In uphill walking hip and knee flexion at initial contact and hip flexion in swing were increased in the prosthetic limb of transtibial amputees. In downhill walking transtibial amputees showed more knee flexion on the prosthetic side in late stance and swing. Transfemoral amputees were not able to increase prosthetic knee flexion in uphill and downhill walking. An important adjustment strategy in both amputee groups was a smaller hip extension in late stance in uphill and downhill walking, probably related with a shorter step length. In addition, amputees increased knee flexion in early stance in the non-affected limb in uphill walking to compensate for the shorter prosthetic limb length. In downhill walking fewer adjustments were necessary, since the shorter prosthetic limb already resulted in lowering of the body. CONCLUSION Uphill and downhill walking can be trained in rehabilitation, which may improve safety and confidence of amputees. Prosthetic design should focus on better control of prosthetic knee flexion abilities without reducing stability.

Atypical hamstrings electromyographic activity as a compensatory mechanism in anterior cruciate ligament deficiency

Anterior cruciate ligament (ACL) deficiency may cause functional instability of the knee (noncopers), while other patients compensate and perform at the same level as before injury (copers). This pilot study investigated whether there is a compensatory electromyographic (EMG) activity of the hamstrings in copers, noncopers and control patients. Ten patients with an ACL deficiency were equally divided into two groups of copers and noncopers. All patients underwent gait analysis with EMG of six muscles around the knee. Ten healthy young men formed the control group. In contrast to noncopers, copers showed an atypical semitendinosus activity during stance phase; the corresponding trend was found in biceps femoris activity. There was no difference between copers and controls in knee extension during stance phase. The noncopers had less knee extension. Atypical hamstring muscle activity may thus be a compensatory mechanism by which copers enable themselves to perform on a normal level.

Comparative roll-over analysis of prosthetic feet

A prosthetic foot is a key element of a prosthetic leg, literally forming the basis for a stable and efficient amputee gait. We determined the roll-over characteristics of a broad range of prosthetic feet and examined the effect of a variety of shoes on these characteristics. The body weight of a person acting on a prosthetic foot during roll-over was emulated by means of an inverted pendulum-like apparatus. Parameters measured were the effective radius of curvature, the forward travel of the center of pressure, and the instantaneous radius of curvature of the prosthetic feet. Finally, we discuss how these parameters relate to amputee gait.

Gait adjustments in obstacle crossing, gait initiation and gait termination after a recent lower limb amputation

Objective: To describe the adjustments in gait characteristics of obstacle crossing, gait initiation and gait termination that occur in subjects with a recent lower limb amputation during the rehabilitation process. Design: Prospective and descriptive study. Subjects: Fourteen subjects with a recent transfemoral, knee disarticulation or transtibial amputation. Methods: Subjects stepped over an obstacle and initiated and terminated gait at four different times during the rehabilitation process. Outcome measures: Success rate, gait velocity and lower limb joint angles in obstacle crossing, centre of pressure shift and peak anteroposterior ground reaction force in gait initiation and termination. Results: In obstacle crossing amputees increased success rate, gait velocity and swing knee flexion of the prosthetic limb. Knee flexion in transfemoral and knee disarticulation amputees was not sufficient for safe obstacle crossing, which resulted in a circumduction strategy. In gait initiation and termination amputees increased the anteroposterior ground reaction force and the centre of pressure shift in the mediolateral direction in both tasks. Throughout the rehabilitation process the centre of pressure was shifted anteriorly before single-limb stance on the trailing prosthetic limb in gait initiation, whereas in gait termination the centre of pressure in single-limb stance remained posterior when leading with the prosthetic limb. Conclusion: Subjects with a recent amputation develop adjustment strategies to improve obstacle crossing, gait initiation and gait termination. Innovations in prosthetic design or training methods may ease the learning process of these tasks.

The relation between electromyography and growth velocity of the spine in the evaluation of curve progression in idiopathic scoliosis

Study Design. A prospective study in which patients with idiopathic scoliosis were examined longitudinally by radiographic and electromyographic measurements according to a protocol. Objectives. To measure the growth velocity of the spine and the electromyographic ratio of the paraspinal muscles to determine their relation to progression of the scoliotic curve. Summary of Background Data. Several factors have been reported to be involved in the progression of idiopathic scoliosis. Possible factors may be growth disturbances and muscular abnormality. Methods. Thirty patients with idiopathic scoliosis were examined over periods of 4 to 5 months. The periods were scored for progression, defined as an increase in Cobb angle of >10°. Spinal growth velocity was measured as the length difference of the scoliotic spine between two consecutive radiographs. The electromyographic activity on both sides of the spine expressed as an electromyographic ratio was measured during relaxed upright standing using bipolar surface electrodes. Predictability of progression was evaluated with regression analysis and receiver operating characteristic analysis. Results. There was an independent association between both spinal growth velocity and electromyographic ratio and progression of the scoliotic curve. An equal sensitivity and specificity of spinal growth velocity for progression of 79.1% was observed at a growth velocity cutoff point of 11 mm/year. Similarly, a cutoff point of 1.25 for the electromyographic ratio could be determined with a predictive value for progression of 68.9%. In the presented nomogram, a spinal growth velocity >15 mm/year combined with an electromyographic ratio >2 gave an 89% probability of progression of the scoliotic deformity. Growth velocities 38 mm/year never resulted in progression. Conclusions. The combined measurement of spinal growth velocity and electromyographic ratio has significant predictive potential and may be valuable in the evaluation and treatment of idiopathic scoliosis.

Controlling Propulsive Forces in Gait Initiation in Transfemoral Amputees

During prosthetic gait initiation, transfemoral (TF) amputees control the spatial and temporal parameters that modulate the propulsive forces, the positions of the center of pressure (CoP), and the center of mass (CoM). Whether their sound leg or the prosthetic leg is leading, the TF amputees reach the same end velocity. We wondered how the CoM velocity build up is influenced by the differences in propulsive components in the legs and how the trajectory of the CoP differs from the CoP trajectory in able bodied (AB) subjects. Seven TF subjects and eight AB subjects were tested on a force plate and on an 8 m long walkway. On the force plate, they initiated gait two times with their sound leg and two times with their prosthetic leg. Force measurement data were used to calculate the CoM velocity curves in horizontal and vertical directions. Gait initiated on the walkway was used to determine the leg preference. We hypothesized that because of the differences in propulsive components, the motions of the CoP and the CoM have to be different, as ankle muscles are used to help generate horizontal ground reaction force components. Also, due to the absence of an active ankle function in the prosthetic leg, the vertical CoM velocity during gait initiation may be different when leading with the prosthetic leg compared to when leading with the sound leg. The data showed that whether the TF subjects initiated a gait with their prosthetic leg or with their sound leg, their horizontal end velocity was equal. The subjects compensated the loss of propulsive force under the prosthesis with the sound leg, both when the prosthetic leg was leading and when the sound leg was leading. In the vertical CoM velocity, a tendency for differences between the two conditions was found. When initiating gait with the sound leg, the downward vertical CoM velocity at the end of the gait initiation was higher compared to when leading with the prosthetic leg. Our subjects used a gait initiation strategy that depended mainly on the active ankle function of the sound leg; therefore, they changed the relative durations of the gait initiation anticipatory postural adjustment phase and the step execution phase. Both legs were controlled in one single system of gait propulsion. The shape of the CoP trajectories, the applied forces, and the CoM velocity curves are described in this paper.