Thomas M. Kepple

Relative contributions of the lower extremity joint moments to forward progression and support during gait

Abstract A method, which was found to be accurate within 0.54 m/s 2 , was developed to estimate the relative contributions of the net joint moments to forward progression and support in the gait of five normal subjects. Forward progression was produced primarily by the ankle plantar flexors with a significant assist from the knee extensors. Support was produced largely by the plantar flexors during single limb support and by a combination of ankle plantar flexors, knee extensors and hip extensors during double limb support.

Surface movement errors in shank kinematics and knee kinetics during gait

Abstract The movement of surface mounted targets (SMT) on a shell at the mid-shank and of bone mounted targets attached to the distal shank using a Percutaneous Skeletal Tracker (PST) were simultaneously measured during free-speed walking of three adult subjects having different body types. Surface movement errors in shank kinematic estimates were determined by expressing the segmental motion derived from the SMT relative to the PST-based segment coordinate system (SCS) located at the segment center of gravity. The greatest errors were along and around the shank longitudinal axis, with peak magnitudes of 10 mm of translation and 8° of rotation in one subject. Estimates of knee joint center locations differed by less than 11 mm in each SCS direction. Differences in estimates of net knee joint forces and moments were most prominent during stance phase, with magnitudes up to 39 N in the shank mediolateral direction and 9 N.m about the mediolateral axis. The differences in kinetics were primarily related to the effect of segment position and orientation on the expression of joint forces and on the magnitude and expression of joint moments.

Joint moment control of mechanical energy flow during normal gait

The study purpose was to estimate the ability of joint moments to transfer mechanical energy through the leg and trunk during gait. A segmental power analysis of five healthy adult subjects revealed that internal joint extensor moments removed energy from the leg and added energy to the trunk, while flexor moments and gravity produced the opposite effects. The only exception to this pattern was during the push off phase of gait when the ankle plantar flexor moment added energy to both the leg and the trunk. Pairs of joint moments with opposite energetic effects (knee extensor vs gravity, hip flexor vs ankle plantar flexor) worked together to balance energy flows through the segments. This intralimb coordination suggests that moments with contradictory effects are generated simultaneously to control mechanical energy flow within the body during walking.

A technique to evaluate foot function during the stance phase of gait.

A technique to measure foot function during the stance phase of gait is described. Advantages of the method include its three-dimensional approach with anatomically based segment coordinate systems. This allows variables such as ground reaction forces and center of pressure location to be expressed in a local foot coordinate system, which gives more anatomical meaning to the interpretation of results. Application of the measurement technique to case examples of patients with rheumatoid arthritis demonstrated its ability to discriminate normal from various levels of pathological function. Future studies will utilize this technique to study the impact of pathology and treatment on foot function.

Translational and rotational joint power terms in a six degree-of-freedom model of the normal ankle complex

We hypothesized that defining joint power (JP) merely on the basis of joint rotations ignores important translational power terms, and may not adequately represent the energy flow profile for a given muscle group. A novel six degree-of-freedom (6 DOF) model of the ankle complex was implemented, accounting for previously ignored joint translations as well as traditional rotations. Foot and shank kinematic and kinetic data were collected over a stride cycle on five male and five female adults, walking five trials each at 0.69 statures s-1. During intra-subject analyses, ensemble averages were calculated (n = 5) for JP associated with each DOF, and for related velocity and force/moment data. Translational joint velocities typically peaked below 10% of the mean walking velocity. The largest peak in JP occurred for the rotational DOF associated with dorsi/plantar flexion (360 W). The next largest peak in JP was for the vertical translational DOF, and was nearly 10% of the predominant peak. Positive work during push-off was significantly less p < or = 0.05) for the 6 DOF model (27.9 J) than for either 1 or 3 DOF rotational models (30.3 and 29.9 J, respectively). Negative work during early stance was significantly less for the 6 DOF model (-10.3 J) than for either the 1 or 3 DOF models (-13.1 and -12.6 J, respectively). Inter-subject analyses (n = 50) were conducted for JP data only, with similar results. We conclude that translational JP terms are of practical importance in mechanical energy studies, and may be of particular concern when evaluating energy storing prostheses, when summing total power at several joints, and when studying pathologies that disturb joint geometry.

Improved agreement of foot segmental power and rate of energy change during gait: Inclusion of distal power terms and use of three-dimensional models

Traditional models used to calculate foot segmental power have yielded poor agreement between foot power and the rate of energy change during the stance phase of gait and limited the applicability of foot segmental power analyses to swing phase only. The purpose of this study was to improve the agreement of foot segmental power and rate of energy change by using more inclusive models to calculate foot segmental power and energy. The gait of 15 adult subjects was studied and models were used to calculate foot segmental power that included either the proximal terms only (Model P, the most common method in the literature) or both proximal and distal terms (Model PD, a mathematically complete model). Power and energy terms were computed in two ways, from sagittal plane vector components only (two-dimensional condition) and from complete three-dimensional components (three-dimensional condition). Results revealed that the more inclusive the model, the higher the agreement of foot power and rate of energy change. During stance phase, Model P produced poor agreement (r(c) = 0.108) for both two-dimensional and three-dimensional conditions, Model PD-2D yielded higher agreement (r(c) = 0.645), and Model PD-3D exhibited nearly perfect agreement (r(c) = 0.956). The advantages of a segmental power analysis include the ability to identify the mechanisms of energy transfer into and out of the foot during movement. The results of this study suggest that foot power analyses are valid when using Model PD-3D to describe foot function during locomotion.

A unified deformable (UD) segment model for quantifying total power of anatomical and prosthetic below-knee structures during stance in gait.

Anatomically-relevant (AR) biomechanical models are traditionally used to quantify joint powers and segmental energies of lower extremity structures during gait. While AR models contain a series of rigid body segments linked together via mechanical joints, prosthetic below-knee structures are often deformable objects without a definable ankle joint. Consequently, the application of AR models for the study of prosthetic limbs has been problematic. The purpose of this study was to develop and validate a unified deformable (UD) segment model for quantifying the total power of below-knee structures. Estimates of total below-knee power derived via the UD segment model were compared to those derived via an AR model during stance in gait of eleven healthy subjects. The UD segment model achieved similar results to the AR model. Differences in peak power, total positive work, and total negative work were 1.91±0.31%, 3.97±0.49%, and 1.39±0.33%, relative to the AR model estimates. The main advantage of the UD segment model is that it does not require the definition of an ankle joint or foot structures. Therefore, this technique may be valuable for facilitating direct comparisons between anatomical and disparate prosthetic below-knee structures in future studies.

Assessment of a method to estimate muscle attachments from surface landmarks: A 3D computer graphics approach

A method for estimating the locations of muscle origins and insertions from the measurement of surface landmarks was evaluated using two indirect accuracy tests and a three-dimensional computer graphics program. For each of four lower extremity anatomical segments, a least-squares technique was used to map the measured locations of three landmark targets to their anatomically based locations. The residual errors, obtained from the applications of the least squares, supplied the first indirect accuracy test. These residual errors were between 6 and 12 mm for the four anatomical segments when averaged over ten subjects. The second indirect accuracy test was conducted by comparing the predicted locations of end points on two adjacent segments forming a joint. Errors in aligning adjacent end points were between 12 and 29 mm for three anatomical joints when averaged over ten subjects. A three-dimensional computer graphics program was developed by the authors and demonstrated that the static testing techniques alone were insufficient to evaluate the quality of the muscle origin and insertion estimates. Any evaluation of muscle lengths, velocities and lines-of-action from surface landmarks should examine the estimates made from motion data, and should address both the ability of the model to fit the subjects as well as models ability to represent the geometry of the musculoskeletal system.

Joint moments’ contributions to vertically accelerate the center of mass during stair ambulation in the elderly: An induced acceleration approach

Falls are a serious problem faced by the elderly. Older adults report mostly to fall while performing locomotor activities, especially the ones requiring stair negotiation. During these tasks, older adults, when compared with young adults, seem to redistribute their lower limb joint moments. This may indicate that older adults use a different strategy to accelerate the body upward during these tasks. The purposes of this study were to quantify the contributions of each lower limb joint moment to vertically accelerate the center of mass during stair ascent and descent, in a sample of community-dwelling older adults, and to verify if those contributions were correlated with age and functional fitness level. A joint moment induced acceleration analysis was performed in 29 older adults while ascending and descending stairs at their preferred speed. Agreeing with previous studies, during both tasks, the ankle plantarflexor and the knee extensor joint moments were the main contributors to support the body. Although having a smaller contribution to vertically accelerate the body, during stair descent, the hip joint moment contribution was related with the balance score. Further, older adults, when compared with the results reported previously for young adults, seem to use more their knee extensor moment than the ankle plantarflexor moment to support the body when the COM downward velocity is increasing. By contributing for a better understanding of stair negotiation in community dwelling older adults, this study may help to support the design of interventions aiming at fall prevention and/or mobility enhancement within this population.