Michael L. Madigan

Reliability of COP-based postural sway measures and age-related differences

The objectives of this study were to assess the within-day and between-day reliability of several center of pressure (COP)-based measures of postural sway and identify whether there were age-related differences in reliability. Thirty-two healthy individuals (16 younger and 16 older) participated. COP was recorded during quiet upright stance on 4 different days, and a variety of measures determined: mean velocity, median power frequency, RMS distance, sway area, and two fractal measures derived from Hurst rescaled range analysis (HR/S) and detrended fluctuation analysis (DFA). Intraclass correlation coefficient (ICC) and standard error of measurement (SEM) were used to quantify reliability. Mean velocity was the most reliable measure. DFA exponents had relatively better reliability than HR/S exponents. In general, within-day reliability was better than between-day. In comparison with younger participants, older participants exhibited better relative reliability (ICC) for all COP measures and comparable absolute reliability (SEM) except for mean velocity and sway area. These results may be useful in guiding the future selection and interpretation of COP-based measures.

Changes in landing biomechanics during a fatiguing landing activity

The objective of this study was to investigate the effects of LE fatigue on ground impact force, LE kinematics, and LE kinetics during landing. Ground reaction force (GRF), kinematic, and electromyogram (EMG) data were collected from 12 male subjects during a fatiguing landing activity (FLA). This activity allowed not only the biomechanical differences between unfatigued and fatigued landings to be determined, but also the time history of multiple biomechanical variables as fatigue progressed. EMG mean frequency analysis using data collected immediately before and after the FLA indicated that subjects experienced fatigue of the quadriceps muscles. Results indicated a decrease in ground impact force and an increase in maximum joint flexion during landing with fatigue. Joint impulse values were consistent with a distal to proximal redistribution of extensor moment production. Potential reasons for this redistribution are discussed. A trend reversal in hip and ankle impulse during the activity suggest a change in landing strategy as fatigue progressed. The data also suggest that the measured changes in landing biomechanics may have been influenced by other factors, in addition to fatigue, such as a neuromuscular protective mechanism to decrease impact force magnitude.

Influence of fatigue time and level on increases in postural sway

The purpose of this study was to investigate the influence of fatigue time and fatigue level on the increases in postural sway during quiet standing. Centre of pressure-based measures of postural sway were collected both before and after fatiguing participants using three different fatigue levels and two different fatigue times. Results showed increasing fatigue time increased sway velocity and sway area, and increasing fatigue level increased sway velocity. Fatigue time effects are important to consider when applying laboratory-based findings to the field given that the fatigue time can differ substantially between the two. Fatigue level effects imply a dose – response relationship between localized muscle fatigue and risk of falling that can have important implications in work/rest cycle scheduling for occupations at risk of injurious falls.

Disturbance and recovery of trunk stiffness and reflexive muscle responses following prolonged trunk flexion: influences of flexion angle and duration.

BACKGROUND Experimental studies suggest that flexed working postures reduce passive support of the spine, which could represent a significant risk factor for the development of occupational low back disorders. Neuromuscular compensations to reduced passive stiffness include increases in baseline activity or reflexive activation of trunk muscles. Yet, alterations and recovery of the synergy between active and passive tissues following prolonged flexion in humans are currently unknown. METHODS Twelve healthy participants were exposed to all combinations of two trunk flexion durations (2 and 16 min) and three flexion angles (33, 66, and 100% of individual flexion-relaxation angle). Load relaxation was recorded throughout exposures, whereas trunk stiffness and reflexive behaviors of the lumbar extensor muscles were investigated during dynamic responses to sudden perturbations. FINDINGS The magnitude of load relaxation increased with increasing flexion angle. Trunk stiffness decreased and reflex gains increased following flexion exposures; for both outcomes, acute changes were larger following exposure to increasing flexion angle. Reflex gains remained elevated one hour after exposure to maximum flexion. INTERPRETATION Exposure to prolonged trunk flexion changed trunk stiffness and reflex behavior in patterns consistent with epidemiological evidence linking such exposure with the risk of occupational low back disorders. Observed increases in reflex gains, at least among healthy individuals, may be a compensation for decreases in passive trunk stiffness following acute exposure to flexed postures. It remains to be determined whether the neuromuscular system can similarly respond to accumulated disturbances in passive structures following exposure to repeated flexion tasks.

Effects of localized muscle fatigue on recovery from a postural perturbation without stepping

Several investigations have demonstrated that localized muscle fatigue (LMF) causes an increase in postural sway measures during quiet stance. Since many falls are likely the result of a postural perturbation, this study investigated the effects of LMF on balance recovery from sagittal plane postural perturbations. Thirty-two participants (16 young, 16 older) were tested. Postural perturbations were administered with ballistic pendulums before and after exercises to fatigue the lumbar extensors and plantar flexors. Measures of balance recovery were based on the center of pressure (COP) and center of mass (COM) trajectories and the maximum perturbation that could be withstood without stepping. A covariate analysis that included initial conditions at the time of the perturbation was also performed. The results demonstrated changes in the COM trajectory that were consistent with an LMF-induced decrement in the ability to recover from the perturbations without stepping. Interpretation of the COP trajectory was presented in light of the COM and indicated a modified postural control strategy following LMF.

Disturbance and recovery of trunk mechanical and neuromuscular behaviours following prolonged trunk flexion: influences of duration and external load on creep-induced effects

Trunk flexion results in adverse mechanical effects on the spine and is associated with a higher incidence of low back pain. To examine the effects of creep deformation on trunk behaviours, participants were exposed to full trunk flexion in several combinations of exposure duration and external load. Trunk mechanical and neuromuscular behaviours were obtained pre- and post-exposure and during recovery using sudden perturbations. Intrinsic trunk stiffness decreased with increasing flexion duration and in the presence of the external load. Recovery of intrinsic stiffness required more time than the exposure duration and was influenced by exposure duration. Reflexive trunk responses increased immediately following exposure but recovered quickly (∼2.5 min). Alterations in reflexive trunk behaviour following creep deformation exposures may not provide adequate compensation to allow for complete recovery of concurrent reductions in intrinsic stiffness, which may increase the risk of injury due to spinal instability. Statement of relevance: An increased risk of low back injury may result from flexion-induced disturbances to trunk behaviours. Such effects, however, appear to depend on the type of flexion exposure, and have implications for the design of work involving trunk flexion.

Changes in body segment inertial parameters of obese individuals with weight loss

Forward dynamic simulation of human movement has the potential to investigate the biomechanical effects of weight loss in obese individuals. However, guidelines for altering body segment inertial parameters (BSIPs) of a biomechanical model to approximate changes that occur with weight loss are currently unavailable. Therefore, the goal of this study was to quantify three-dimensional changes in BSIPs with weight loss. Nineteen Caucasian men of age 43.6+/-7.5 years (mean+/-standard deviation) were evaluated. Body mass and body mass index prior to weight loss were 102.7+/-3.6 kg and 32.6+/-3.2 kg/m2, respectively. Both before and after weight loss, magnetic resonance imaging scans were acquired along the length of the body to discriminate muscle, bone, organ, and adipose tissues. Segment masses, center of mass (COM) positions, and radii of gyration were determined from these scans using published tissue densities and established methods. A number of significant changes in BSIPs occurred with the 13.8+/-2.4% average weight loss. Mass decreased in all segments. COM position moved distally for the thigh and upper arm, superiorly for the trunk, and inferiorly for the whole body. Radius of gyration, in general, decreased in all segments. The changes in BSIPs with weight loss reported here could be used in forward dynamic simulations investigating the biomechanical implications of weight loss.

Predicting peak oxygen consumption during a conservative ramping protocol implications for the heart failure population

PURPOSE A significant discrepancy between measured oxygen consumption (VO(2)) (via ventilatory expired gas analysis) and estimated VO(2) (via the imposed workload) frequently is reported in the heart failure (HF) population during symptom-limited exercise testing. The purpose of this investigation was to examine the difference between measured and estimated VO(2) (VO(2) discrepancy) during a highly conservative ramping protocol. METHODS For this study, 28 subjects with compensated HF (20 men and 8 women; age, 51.1 +/- 14.6 years) and 19 healthy control subjects (age-, gender-, and activity-matched to an HF subgroup) underwent symptom-limited exercise testing (treadmill) with ventilatory expired gas analysis. RESULTS Peak estimated and measured VO(2) values were significantly higher in the age-, gender-, and activity-matched control group than in the HF group, but the change in measured VO(2) per change in estimated VO(2) (Deltameasured/Deltaestimated VO(2) slope) and the VO(2) discrepancy did not reach statistical significance. Peak estimated VO(2) was a significant predictor of peak measured VO(2) in the overall HF group (R2 = 0.90; P <.001). CONCLUSIONS Although estimated VO(2) is not considered a replacement for measured VO(2), these results indicate that a highly conservative exercise protocol may allow for a more accurate prediction of peak measured VO(2) via the estimated oxygen cost for a given workload in patients with compensated HF.

The spectral content of postural sway during quiet stance: Influences of age, vision and somatosensory inputs

Maintenance of human upright stance requires the acquisition and integration of sensory inputs. Conventional measures of sway have had success in identifying age- and some disease-related changes, but remain unable to address the complexities and dynamics associated with postural control. We investigated the effects of vision, surface compliance, age, and gender on the spectral content of center of pressure (COP) time series. Sixteen healthy young (age 18-24) and older participants (age 55-65) performed trials of quiet, upright stance under different vision (eyes open vs. closed) and surface (hard vs. compliant) conditions. Spectral analyses were conducted to describe COP mean normalized power in discretized bands. Effects of the two sensory modalities and age were distinct in the antero-posterior and medio-lateral directions, and a reorganization of spectral content was evident with increasing task difficulty (eyes open vs. closed and hard vs. compliant surface) and among older adults. These results indicate that vision and surface compliance are predominantly associated with responses from musculature associated with antero-posterior and medio-lateral directions of sway, respectively. Finally, distinguishing between the contributions of different afferent systems to the postural control system using the spectral content of sway bi-directionally may help in diagnosing individuals with balance impairments.

Analysis of the ability of catcher's masks to attenuate head accelerations on impact with a baseball.

Objective:The goals of this study were to measure the ability of catchers masks to attenuate head accelerations on impact with a baseball and to compare these head accelerations to established injury thresholds for mild traumatic brain injury. Design:Testing involved using a pneumatic cannon to shoot baseballs at an instrumented Hybrid III headform (a 50th percentile male head and neck) with and without a catchers mask on the head. The ball speed was controlled from approximately 26.8 to 35.8 m/s (60-80 mph), and the regulation National Collegiate Athletic Association baseballs were used. Setting:Research laboratory. Patients:None. Independent Variables:Catchers masks and impact velocity. Main Outcome Measures:The linear and angular head accelerations of the Hybrid III headform. Results:Peak linear resultant acceleration was 140 to 180 g without a mask and 16 to 30 g with a mask over the range of balls speed investigated. Peak angular resultant acceleration was 19 500 to 25 700 rad/s2 without a mask and 2250 to 3230 rad/s2 with a mask. The Head Injury Criterion was 93 to 181 without a mask and 3 to 13 with a mask, and the Severity Index was 110 to 210 without a mask and 3 to 15 with a mask. Conclusions:Catchers masks reduced head acceleration metrics by approximately 85%. Head acceleration metrics with a catchers mask were significantly lower than contemporary injury thresholds, yet reports in the mass media clearly indicate that baseball impacts to the mask still occasionally result in mild traumatic brain injuries. Further research is needed to address this apparent contradiction.