Malcolm B. Hawken

The effects of virtual reality game training on trunk to pelvis coupling in a child with cerebral palsy.

BackgroundGood control of trunk and pelvic movements is necessary for well controlled leg movements required to perform activities of daily living. The nature of movement coupling between the trunk and pelvis varies and depends on the type of activity. Children with cerebral palsy often have reduced ability to modulate coupling between the trunk and pelvis but movement patterns of the pelvis can be improved by training. The aim of this study was to examine how pelvis to trunk coupling changed while playing a computer game driven by pelvic rotations.MethodsOne boy with cerebral palsy diplegia played the Goblin Post Office game on the CAREN virtual rehabilitation system for six weeks. He navigated a flying dragon in a virtual cave towards randomly appearing targets by rotating the pelvis around a vertical axis. Motion of the pelvis and trunk was captured in real-time by a Vicon 612 optoelectronic system tracking two clusters of three markers attached to the sacrum and thoracic spine.ResultsConvex hull areas calculated from angle-angle plots of pelvic and trunk rotations showed that coupling increased over game training (F1,11 = 7.482, p = 0.019). Reaching to targets far from the midline required tighter coupling than reaching near targets (F1,12 = 10.619, p = 0.007).ConclusionsIncreasing coupling appears to be an initial compensation mechanism using the better controlled trunk to drive rotation of the pelvis. Co-contractions causing increased coupling are expected to reduce over longer exposure to training. The control scheme of the training game can be set to facilitate de-coupling of pelvic movements from the trunk. Using large ranges of pelvic rotation required more coupling suggesting that training of selective pelvic movements is likely to be more effective close to a neutral pelvic posture.

Rapid weight-loss impairs simulated riding performance and strength in jockeys: Implications for making-weight

Abstract Despite the performance concerns of dehydration in other sports, there are currently no data on the effects of rapid weight-loss on the physical and cognitive performance of jockeys in a sport-specific context. In a randomised crossover design, eight Great Britain (GB) male licensed jockeys were assessed for chest strength, leg strength, simulated riding performance (assessed by maximum pushing frequency on a mechanical riding simulator during the final two furlongs of a simulated 2 mile race) and simple reaction time after performing 45 min of exercise, during which euhydration was maintained (Control trial) or induced 2% dehydration (Rapid Weight-Loss trial). Reductions in both chest (–13.8 ± 3.03% vs. 0.62 ± 1.04%) and leg strength (–4.8 ± 4.8% vs. –0.56 ± 2.5%) were greater in Rapid Weight-Loss compared with Control (P < 0.01 and P = 0.04, respectively). Similarly, reductions in simulated riding performance were also greater (P = 0.05) in Rapid Weight-Loss (–2.8 ± 4.0%) compared with Control (–0.07 ± 1.5%), whereas there were no significant changes (P = 0.14) in simple reaction time. We conclude that a 2% reduction in body mass, as achieved by 45 min of moderate-intensity exercise undertaken in a sweatsuit (a common method of inducing acute dehydration by jockeys), significantly impairs maximum pushing frequency during a simulated race. In addition, the observed reductions in strength may also increase the occupational hazards associated with race riding.

Movement Deviation Profile: A measure of distance from normality using a self-organizing neural network

We introduce the Movement Deviation Profile (MDP), which is a single curve showing the deviation of an individuals movement from normality. Joint angles, recorded from typically developing children over one gait cycle, were used to train a self-organizing map (SOM) which then generated MDP curves for patients with gait problems. The mean MDP over the gait cycle showed a high correlation (r(2) = .927) with the Gait Deviation Index (GDI), a statistically significant difference between groups of patients with a range of functional levels (Gillette Functional Assessment Questionnaire Walking Scale 7-10) and a trend of increasing values for patients with cerebral palsy through hemiplegia I-IV, diplegia, triplegia, and quadriplegia. The small difference between the MDP and GDI can be explained by the SOMs method of operation comparing biomechanical patterns to the nearest abstract reference pattern, and its flexibility to compensate for temporal shifts in movement data. The MDP is an alternative method of processing complex biomechanical data, potentially supporting clinical interpretation. The electronic addendum accompanying this article is a standalone program, which can be used to calculate the MDP from gait data, and can also be used in other applications where the deviation of multi-channel temporal data from a reference is required.

Dynamic Neuromuscular Control of the Lower Limbs in Response to Unexpected Single-Planar versus Multi-Planar Support Perturbations in Young, Active Adults

Purpose An anterior cruciate ligament (ACL) injury involves a multi-planar injury mechanism. Nevertheless, unexpected multi-planar perturbations have not been used to screen athletes in the context of ACL injury prevention yet could reveal those more at risk. The objective of this study was to compare neuromuscular responses to multi-planar (MPP) and single-planar perturbations (SPP) during a stepping-down task. These results might serve as a basis for future implementation of external perturbations in ACL injury screening programs. Methods Thirteen young adults performed a single leg stepping-down task in eight conditions (four MPP and four SPP with a specified amplitude and velocity). The amplitudes of vastus lateralis (VL), vastus medialis (VM), hamstrings lateralis (HL), hamstrings medialis (HM) EMG activity, medio-lateral and anterior-posterior centre of mass (COM) displacements, the peak knee flexion and abduction angles were compared between conditions using an one-way ANOVA. Number of stepping responses were monitored during all conditions. Results Significantly greater muscle activity levels were found in response to the more challenging MPP and SPP compared to the less challenging conditions (p < 0.05). No differences in neuromuscular activity were found between the MPP conditions and their equivalents in the SPP. Eighteen stepping responses were monitored in the SPP versus nine in the MPP indicating that the overall neuromuscular control was even more challenged during the SPP which was supported by greater COM displacements in the SPP. Conclusion The more intense MPP and SPP evoked different neuromuscular responses resulting in greater muscle activity levels compared to small perturbations. Based on the results of COM displacements and based on the amount of stepping responses, dynamic neuromuscular control of the knee joint appeared less challenged during the MPP. Therefore, future work should investigate extensively if other neuromuscular differences (i.e. co-activation patterns and kinetics) exist between MPP and SPP. In addition, future work should examine the influence on the neuromuscular control of the magnitude of the perturbations and the magnitude of stepping height and stepping distance.

A gait index may underestimate changes of gait: a comparison of the Movement Deviation Profile and the Gait Deviation Index

The ability of the Movement Deviation Profile (MDP) and Gait Deviation Index (GDI) to detect gait changes was compared in a child with cerebral palsy who underwent game training. Conventional gait analysis showed that sagittal plane angles became mirrored about normality after training. Despite considerable gait changes, the GDI showed minimal change, while the MDP detected a difference equal to a shift between 10-9 on the Functional Assessment Questionnaire scale. Responses of the GDI and MDP were examined during a synthetic transition of the patients curves from before intervention to a state mirrored about normality. The GDI showed a symmetric response on the two opposite sides of normality but the neural network based MDP gave an asymmetric response reflecting faithfully the unequal biomechanical consequences of joint angle changes. In conclusion, the MDP can detect altered gait even if the changes are missed by the GDI.

Playing the Goblin Post Office game improves movement control of the core: A case study

Movement function of the core (trunk and pelvis) can be improved in cerebral palsy, potentially leading to benefits which transfer to activities of daily living. A single child with CP diplegia played our custom made game which runs on the CAREN system. Three playing postures gradually introduced more and more joints in the legs to be controlled. Vicon cameras tracked trunk and pelvic rotations which drove a dragon towards envelope targets. Forward speed of the game was adjusted by an adaptive algorithm leading to a maximum settled speed for the various conditions. Results showed that core control improved after the six week training period. The trunk was better controlled than the pelvis, sideways rotations were better controlled than fore-aft rotations of body segments, and single plane rotations were more efficient than cross-plane rotations of the core. The quantifiable improvements suggest a good potential for our technique to improve core control which is a prerequisite for good movement control of the legs and arms.

Age-Related Deviation of Gait from Normality in Alkaptonuria

Alkaptonuria is a rare metabolic disease leading to systemic changes including early and severe arthropathy which affects mobility. For unknown reasons, the onset of degenerative changes is delayed to around 30 years of age when both objective and subjective symptoms develop. In order to complement description of the structural changes in alkaptonuria with measures of movement function, clinical gait analysis was added to the list of assessments in 2013. The aim of this study was to describe the deviation of gait from normality as a function of age in patients with alkaptonuria. Three-dimensional movement of reflective markers attached to joints were captured during walking in 39 patients and 10 controls. Subsequent to processing the data to emphasise the shape of marker trajectories, the mean Movement Deviation Profile was generated for all participants. This single number measure gives the deviation of a patients gait from a distributed definition of gait normality. Results showed that gait deviation roughly follows a sigmoid profile with minimal increase of gait deviations in a younger patient group and an abrupt large increase around the second half of the 4th decade of life. Larger variations of gait deviations were found in the older group than in the younger group suggesting a complex interaction of multiple factors which determine gait function after symptoms manifest. Continued gait analysis of adults with AKU, extended to younger adults and children with AKU, is expected to complete understanding of both the natural history of alkaptonuria and how interventions can affect movement function.

Does outstretching the arms improve postural stability

We spontaneously outstretch our arms when standing upon challenging surfaces, yet the effect of stretching the arms upon postural stability is unknown. We investigated whether stretching out the arms laterally improves postural control during tandem stance on a narrow beam. Twelve healthy participants stood upon a beam, right foot in front of the left foot, for 30s with arms outstretched or down to the side, with eyes open and closed. Mediolateral head movement was characterised by Root Mean Square amplitude (RMS), sway path, velocity during the largest excursion and power spectrum. Spectra for lateral forces from a force platform beneath the beam were also recorded. Outstretching the arms significantly reduced RMS, sway path and velocity of maximum displacement of head movement with eyes closed but not with eyes open. A similar trend was present in the power spectra of head motion and sway platform lateral forces. In conclusion, outstretching the arms helps postural stability in challenging situations such as tandem stance on a narrow beam with eyes closed. Although the exact mechanisms require further investigation, the effects are most likely mediated by changes in segmental inertia and the ability to make corrective arm movements.

TETRA mobile radios interfere with electroencephalography recording equipment

We observed an anomaly in the human electroencephalogram (EEG) associated with exposure to terrestrial trunked radio (TETRA) Radiofrequency Fields (RF). Here, we characterize the time and frequency components of the anomaly and demonstrate that it is an artefact caused by TETRA RF interfering with the EEG recording equipment and not by any direct or indirect effect on the brain.

O014 Movement coordination of the pelvis in a virtual game environment

Movement training specifically targeted at rotation of the pelvis may help to improve/overcome the primary component of pelvic retraction in patients with cerebral palsy (CP). Healthy subjects when placed in a novel virtual environment provided evidence for a pre-established pattern of coordination, suggesting that well-practiced core control cannot be improved over a short period of time through movement of the pelvis.