Michael R. Pierrynowski

A physiological model for the evaluation of muscular forces in human locomotion: theoretical aspects

Abstract In this paper a model capable of predicting individual muscle forces in the right lower limb is formulated. The approach developed is a physiological hierarchical model the lowest level of which concerns itself with the data necessary to define the musculoskeletal system. These include the muscles moment arms, lengths, and velocities. Data describing the muscle anatomy and bone structure are also included. The middle level, the muscle model, defines the force-length-velocity-activation relationship of a single muscle unit. These data, with those from the anatomical model, are used to estimate the maximum and minimum force a muscle can exert given its previous force history, current kinematics, and previous stimulation level. The stimulation needed to generate any intermediate force is also defined. At the top of the hierarchy the control model provides a singular solution of the muscle forces, within the constraints defined in the muscle and anatomical models, by stimulating the muscles. The control model selects the muscle stimuli, based on a simple neurophysiological model of pattern generators, to satisfy the measured net muscle moments about those axes for which a large range of movement exist. It is assumed that one pattern generator exists for each major degree of freedom in the lower extremity. The discussion is focused upon the limitations of the model.

Enhancing the ability of gait analyses to differentiate between groups: scaling gait data to body size

One goal of gait analysis is to distinguish clearly between a set of abnormal gait values measured from a patient referenced to a comparable population. However, the comparable population is often composed of individuals of various heights and weights, which increases inter-subject gait value variation which reduces the ability of a statistical test to identify a set of gait data outcomes with evaluative properties. Therefore, scaling gait data, based on subject leg length and mass, is commonly used to decrease the inter-subject variation but the efficacy of these methods is unknown. In this paper each of eight scaling strategies (none, ad hoc, dimensionless numbers, and five connected strategies based on similarity, dimensional analysis and muscle properties) were used to modify a set of gait data outcomes acquired from 10 individuals spanning a wide range of height (1.33-1.96 m) and mass (42.3-148.8 kg). These data were then examined to select that strategy and those scaling factors which maximally reduced inter-subject variation. The ad hoc, dimensionless numbers, and dynamic/mechanical/elastic (diameter of a limb (D) proportional to its length (L) to the 1.5 power; time proportional to L(2) D(-1)) scaling strategies reduced the global inter-subject gait data outcome variation to 44% of its un-scaled value. Considering ten commonly reported gait data outcomes (temporal and spatial (stride time, stride length, progression velocity), kinematic (angles in the sagittal and frontal planes, angles in the transverse plane), external kinetic (ground reaction force and moment), and internal kinetic (joint force, moment, and power)) these three scaling strategies provided the largest number of minimum inter-subject variations (10, 10, and 9, respectively). Reduced inter-subject variation in gait data outcomes increases the ability of a statistical tool to detect a difference between a patient and a comparable group. With a statistically significant difference a clinician can then decide if this patients gait pattern clinically deviates from that of the comparable group and an appropriate intervention warranted. The ad hoc, dimensionless numbers, and the dynamic/mechanical/elastic scaling strategies all reduce maximally the inter-subject variation in gait data outcomes.

REAR FOOT INVERSION/EVERSION DURING GAIT RELATIVE TO THE SUBTALAR JOINT NEUTRAL POSITION

Clinicians often fabricate foot orthotic devices at the subtalar joint neutral position (STNP) to mimic the position of the rear foot during midstance. However, rear foot motion during gait, relative to the resting standing foot position, not the STNP, is often reported in the literature. The motion of the rear foot relative to a valid estimate of the STNP is unknown. In this study, six experienced foot care specialists manually placed the rear part of the feet of nine subjects at the STNP seven or eight times to obtain a valid estimate of each subjects STNP. The worst-case mean and 95% confidence interval of the STNP estimate for any one subject was 0.0° ± 0.7°. These nine subjects then walked on a motor-driven treadmill, set at 0.89 meters/sec, and three-dimensional estimates of each subjects rear foot inversion/eversion motion were obtained, then averaged over 6 to 26 strides. For most subjects, the rear foot was always everted during stance with mean and standard deviation maximal eversion (7.2° ± 1.2°) occurring at 44% of the total gait cycle. The inversion/eversion orientation during swing was characterized by 1 ° to 2° of eversion, with a small amount of inversion in early swing. These findings have implications for the fabrication of foot orthoses, since the rear foot is rarely near the STNP during stance.

Use of orthoses lowers the O2 cost of walking in children with spastic cerebral palsy

PURPOSE The aim of this study was to assess the effects of hinged ankle foot orthoses (AFO) on the metabolic and cardiopulmonary cost of walking and gross motor skills of children with cerebral palsy (CP). METHODS Ten habitual users of hinged AFO with spastic diplegic CP (9.01 yr +/- 2.10) participated in the study. Expired gas and heart rate (HR) were measured during sitting and with AFO on and off during steady state treadmill walking at three speeds: 3 km.h(-1), comfortable walking speed (CWS), and 90% of their fastest walking speed (FWS). Comfortable and fastest ground walking speed and Gross Motor Function Measure scores were also assessed with AFO on and off and analyzed with ANOVA. Because not all children could walk at all speeds on the treadmill, an ANOVA was performed on data for children who walked at 3 km.h(-1) and CWS (N = 8 for HR; N = 9 for pulmonary ventilation and metabolic variables) and a t-test on data at 90% of FWS (N = 9 for HR; N = 8 for pulmonary ventilation and metabolic variables). RESULTS When children wore their AFO net oxygen uptake (L.min(-1), absolute--sitting values) was significantly (P < 0.05) reduced by 8.9% at 3 km.h(-1) and by 5.9% at 90% of FWS. Net pulmonary ventilation (L.min(-1)) was significantly (P < 0.05) lower with AFO on by 10.3% but only at 3 km.h(-1). AFO did not affect net HR (beats.min(-1)) nor the respiratory exchange ratio at any speed, nor any physiologic variable at CWS, nor gross motor skills. CONCLUSIONS Use of hinged AFO reduces the oxygen and ventilatory cost of walking in children with spastic diplegic CP.

Exploring children's movement characteristics during virtual reality video game play.

There is increasing interest in the use of commercially-available virtual reality video gaming systems within pediatric rehabilitation, yet little is known about the movement characteristics of game play. This study describes quantity and quality of movement during Nintendo Wii and Wii Fit game play, explores differences in these movement characteristics between games and between novice and experienced players, and investigates whether motivation to succeed at the game impacts movement characteristics. Thirty-eight children (aged 7-12) with and without previous game experience played Wii (boxing and tennis) and Wii Fit (ski slalom and soccer heading) games. Force plate data provided center of pressure displacement (quantity) and processed pelvis motion indicated smoothness of pelvic movement (quality). Children rated their motivation to succeed at each game. Movement quantity and quality differed between games (p<.001). Children with previous experience playing Wii Fit games demonstrated greater movement quantity during Wii Fit game play (p<.001); quality of movement did not differ between groups. Motivation to succeed did not influence the relationship between experience and outcomes. Findings enhance clinical understanding of this technology and inform the development of research questions to explore its potential to improve movement skills in children with motor impairments.

Relationship between pain and vertebral motion in chronic low-back pain subjects

OBJECTIVES To investigate the relationship between intervertebral motion, intravertebral deformation and pain in chronic low-back pain patients. DESIGN This study measured vertebral motion of the lumbar spine and associated pain in a select group of chronic low-back pain patients as they performed a standard battery of motions in all planes. BACKGROUND Numerous studies have demonstrated that individuals with low-back pain have impaired spinal motion, yet few studies have examined the specific relationship between pain and motion parameters. Although it is accepted that the pain in mechanical low-back patients is due to specific spinal motions, no studies have related specific motions to pain measures. METHODS Percutaneous intra-pedicle screws were placed into the right and left L4 (or L5) and S1 segments of nine chronic low-back pain patients. The external fixator frame was removed following the clinical external fixation test. The 3D locations of the pedicle screws and the level of pain were recorded as the subjects performed a battery of motions. The relationship between the pain and motion parameters was assessed using linear discriminant analysis and neural network models. RESULTS The neural network model showed a strong relationship between observed and predicted pain (R(2)=0.997). The discriminant analysis showed a weak relationship (R(2)=0.5). CONCLUSIONS Vertebral motion parameters are strongly predictive of pain in this select group of chronic low-back pain patients. The nature of the relationship is nonlinear and involves interactions; neural networks are able to effectively describe these relationships. RELEVANCE Specific patterns of intervertebral motion and intravertebral deformation result in pain in chronic low-back pain patients. This substantiates the mechanical back pain aetiology.

Arm strength and impulse generation: Initiation of wheelchair movement by the physically disabled

The initiation of wheelchair movement is a function of starting technique, upper extremity strength and the stabilizing potential of the trunk musculature. This study examined the relation between arm strength, activity level, degree of disability and the maximum impulse generated from a resting position while seated in a wheelchair. Two starting techniques were examined using a force platform. Sixteen male paraplegic adults (age 28·1 ±6·9 year, supine length l·62±0·16m, total body mass 61·2±16·2 kg) performed three grab starts and three strike starts on a Kistler force platform. For each technique, the processed data were averaged together and impulse in the forward/backward and vertical directions was determined. Isokinetic shoulder flexion and elbow extension moments of force were measured at an angular velocity of 60 degs−1. Peak power and average power were calculated from digitized values of the moment of force-time curves. Subjects were classified as highly active (HA, >2 exercise periods per week,...

Lower extremity kinematics of females with patellofemoral pain syndrome while stair stepping.

STUDY DESIGN Cross-sectional case-control design. BACKGROUND Although the etiology of patellofemoral pain syndrome (PFPS) is not completely understood, there is some evidence to suggest that hip position during weight-bearing activities contributes to the disorder. OBJECTIVE To compare the knee and hip motions (and their coordination) during stair stepping in female athletes with and without PFPS. METHODS Two groups of female recreational athletes, 1 group with PFPS (n = 10) and a control group without PFPS (n = 10), were tested. All participants ascended and descended stairs (condition) at 2 speeds (self-selected comfortable and taxing [defined as 20% faster than the comfortable speed]), while the knee and hip angles were measured with a magnetic-based kinematic data acquisition system. Angle-angle diagrams were used to examine the relationship between flexion/extension of the knee and flexion/extension, adduction/abduction, and internal/external rotation of the hip. The angle of the knee and the 3 angles of the hip at foot contact on the third step were compared between groups by means of 3-way analyses of variance (ANOVA), with repeated measures on speed and condition. RESULTS Group-by-speed interaction for knee angle was significant, with knee flexion being greater for the PFPS group for stair ascent and descent at a comfortable speed. Both the angle-angle diagrams and ANOVA demonstrated greater adduction and internal rotation of the hip in the individuals with PFPS compared to control participants during stair descent. CONCLUSION Compared to control participants, females with PFPS descend stairs with the knee in a more flexed position and have the hip in a more adducted and internally rotated position at foot contact during stair stepping at a comfortable speed.

Effect of load, cadence, and fatigue on tibio-femoral joint force during a half squat

Ten male university student volunteers were selected to investigate the 3D articular force at the tibio-femoral joint during a half squat exercise, as affected by cadence, different barbell loads, and fatigue. Each subject was required to perform a half squat exercise with a barbell weight centered across the shoulders at two different cadences (1 and 2 s intervals) and three different loads (15, 22 and 30% of the one repetition maximum). Fifty repetitions at each experimental condition were recorded with an active optoelectronic kinematic data capture system (WATSMART) and a force plate (Kistler). Processing the data involved a photogrammetric technique to obtain subject tailored anthropometric data. The findings of this study were: 1) the maximal antero-posterior shear and compressive force consistently occurred at the lowest position of the weight, and the forces were very symmetrically disposed on either side of this halfway point; 2) the medio-lateral shear forces were small over the squat cycle with few peaks and troughs; 3) cadence increased the antero-posterior shear (50%) and the compressive forces (28%); 4) as a subject fatigues, load had a significant effect on the antero-posterior shear force; 5) fatigue increased all articular force components but it did not manifest itself until about halfway through the 50 repetitions of the exercise; 6) the antero-posterior shear force was most affected by fatigue; 7) cadence had a significant effect on fatigue for the medio-lateral shear and compressive forces.

Estimating the muscle forces generated in the human lower extremity when walking: a physiological solution

Abstract A model capable of estimating individual muscle activity during human lower extremity activity has been developed. This model was implemented and applied to normal gait. Both 3D cinematography and force platform records were collected to define the kinematics of the lower limb segments and the ground reaction forces. From these data the lengths, velocities, and moment arms of the muscles and the net muscle moments were calculated. These data were then used to estimate the output from a set of pattern generators which specified the neural input to and hence the force generated in each muscle. Results were obtained which demonstrate that it is feasible to construct a hierarchical physiological model which will estimate individual muscle forces. This statement must be tempered somewhat in that better anatomical and neurophysiological data must be made available and that this model, and all others attempting to estimate individual muscle forces, must be rigorously tested before being applied in a research, sports, or clinical setting.