Forward continuation, balance, and sit-to-stand-and-walk (STSW) are three common movement strategies during sit-to-walk (STW) executions. Literature identifies these strategies through biomechanical parameters using gold standard laboratory equipment, which is expensive, bulky, and requires significant post-processing. STW strategy becomes apparent at gait-initiation (GI) and the hip/knee are primary contributors in STW, therefore, this study proposes to use the hip/knee joint angles at GI as an alternate method of strategy classification. To achieve this, K-means clustering was implemented using three clusters corresponding to the three STW strategies; and two feature sets corresponding to the hip/knee angles (derived from motion capture data); from an open access online database (age: 21-80 years; n = 10). The results identified forward continuation with the lowest hip/knee extension, followed by balance and then STSW, at GI. Using this classification, strategy biomechanics were investigated by deriving the established biomechanical quantities from literature. The biomechanical parameters that significantly varied between strategies (P
Prolonged disuse of the musculoskeletal system is associated with reduced mechanical loading and lack of anabolic stimulus. As a form of mechanical signal, the multidirectional orbital fluid shear stress transmits anabolic signal to bone forming cells in promoting cell differentiation, metabolism and proliferation. Signals are channeled through the cytoskeleton framework, directly modifying gene and protein expression. For that reason, we aimed to study the organization of Normal Human Osteoblast (NHOst) cytoskeleton with regards to orbital fluid shear (OFS) stress. Of special interest were the consequences of cytoskeletal reorganization on NHOst metabolism, proliferation, and osteogenic functional markers. Cells stimulated at 250 RPM in a shaking incubator resulted in the rearrangement of actin and tubulin fibers after 72 h. Orbital shear stress increased NHOst mitochondrial metabolism and proliferation, simultaneously preventing apoptosis. The ratio of RANKL/OPG was reduced, suggesting that orbital shear stress has the potential to inhibit osteoclastogenesis and osteoclast activity. Increase in ALP activity and OCN protein production suggests that stimulation retained osteoblast function. Shear stress possibly generated through actin seemed to hold an anabolic response as osteoblast metabolism and functional markers were enhanced. We hypothesize that by applying orbital shear stress with suitable magnitude and duration as a non-drug anabolic treatment can help improve bone regeneration in prolonged disuse cases.
BACKGROUND: Flexible flat foot is described as a reduction in the height of the medial longitudinal arch and may occur from abnormal foot pronation. A foot orthosis is thought to modify and control excessive pronation and improve arch height.
OBJECTIVE: To compare the immediate effect of three types of orthoses on foot mobility and the arch height index in subjects with flexible flat feet.
STUDY DESIGN: A quasi-experimental study.
METHOD: The dorsal arch height, midfoot width, foot mobility and arch height index were assessed in 20 participants with flexible flat feet (mean age = 23.2 ± 3 years) for three different foot orthosis conditions: soft, semi-rigid and rigid University of California Biomechanics Laboratory (UCBL).
RESULTS: Maximum midfoot width at 90% with arch mobility in the coronal plane was shown in the semi-rigid orthosis condition. The semi-rigid orthosis resulted in the highest mean foot mobility in 90% of weight bearing, and the rigid orthosis (UCBL) had the lowest mean foot mobility. The soft orthosis resulted in foot mobility between that of the rigid and the semi-rigid orthosis. UCBL orthosis showed the highest arch height index, and the semi-rigid orthosis showed the lowest mean arch height index.
CONCLUSION: Due to its rigid structure and long medial-lateral walls, the UCBL orthosis appears to limit foot mobility. Therefore, it is necessary to make an orthosis that facilitates foot mobility in the normal range of the foot arch. Future studies should address the dynamic mobility of the foot with using various types of foot orthoses.
CLINICAL RELEVANCE: Although there are many studies focussed on flat foot and the use of foot orthoses, the mechanism of action is still unclear. This study explored foot mobility and the influence of foot orthoses and showed that a more rigid foot orthosis should be selected based on foot mobility.
KEYWORDS: Foot orthosis; arch height index; foot mobility magnitude
In this paper, we present a general, fibril-based structural constitutive theory which accounts for three material aspects of crosslinked filamentous materials: the single fibrillar force response, the fibrillar network model, and the effects of alterations to the fibrillar network. In the case of the single fibrillar response, we develop a formula that covers the entropic and enthalpic deformation regions, and introduce the relaxation phase to explain the observed force decay after crosslink breakage. For the filamentous network model, we characterize the constituent element of the fibrillar network in terms its end-to-end distance vector and its contour length, then decompose the vector orientation into an isotropic random term and a specific alignment, paving the way for an expanded formalism from principal deformation to general 3D deformation; and, more important, we define a critical core quantity over which macroscale mechanical characteristics can be integrated: the ratio of the initial end-to-end distance to the contour length (and its probability function). For network alterations, we quantitatively treat changes in constituent elements and relate these changes to the alteration of network characteristics. Singular in its physical rigor and clarity, this constitutive theory can reproduce and predict a wide range of nonlinear mechanical behavior in materials composed of a crosslinked filamentous network, including: stress relaxation (with dual relaxation coefficients as typically observed in soft tissues); hysteresis with decreasing maximum stress under serial cyclic loading; strain-stiffening under uniaxial tension; the rupture point of the structure as a whole; various effects of biaxial tensile loading; strain-stiffening under simple shearing; the so-called "negative normal stress" phenomenon; and enthalpic elastic behaviors of the constituent element. Applied to compacted collagen gels, the theory demonstrates that collagen fibrils behave as enthalpic elasticas with linear elasticity within the gels, and that the macroscale nonlinearity of the gels originates from the curved fibrillar network. Meanwhile, the underlying factors that determine the mechanical properties of the gels are clarified. Finally, the implications of this study on the enhancement of the mechanical properties of compacted collagen gels and on the cellular mechanics with this model tissue are discussed.
Collagen and elastin networks make up the majority of the extracellular matrix in many organs, such as the skin. The mechanisms which are involved in the maintenance of homeostatic equilibrium of these networks are numerous, involving the regulation of genetic expression, growth factor secretion, signalling pathways, secondary messaging systems, and ion channel activity. However, many factors are capable of disrupting these pathways, which leads to an imbalance of homeostatic equilibrium. Ultimately, this leads to changes in the physical nature of skin, both functionally and cosmetically. Although various factors have been identified, including carcinogenesis, ultraviolet exposure, and mechanical stretching of skin, it was discovered that many of them affect similar components of regulatory pathways, such as fibroblasts, lysyl oxidase, and fibronectin. Additionally, it was discovered that the various regulatory pathways intersect with each other at various stages instead of working independently of each other. This review paper proposes a model which elucidates how these molecular pathways intersect with one another, and how various internal and external factors can disrupt these pathways, ultimately leading to a disruption in collagen and elastin networks.
This study provides an experimental and finite element analysis of knee-joint structure during extended-knee landing based on the extracted impact force, and it numerically identifies the contact pressure, stress distribution and possibility of bone-to-bone contact when a subject lands from a safe height.
This study aimed to objectively evaluate changes in gait kinematics, kinetics and symmetry among anterior cruciate ligament (ACL) reconstructed athletes during rehabilitation. Twenty-two national athletes with ACL reconstruction and 15 healthy athletes were recruited for the study. Gait data were collected between the weeks 4-5, 8-9, and 12-13 post-operation using three-dimensional motion analysis system. Five separate components, including knee range of motion (ROM), vertical ground reaction force (VGRF), their symmetries and knee extension moment were evaluated. One way and repeated measure multivariate analysis of variance (MANOVA) were used to analyze the knee ROMs. The VGRF and extension moment were tested using repeated measure ANOVA and independent sample t-test. Findings indicated significant alterations in all measured components between patients' Test 1 and control group. Repeated measure analysis revealed significant effect for time in components of knee angular and VGRF (P<0.001), their symmetry index (P=0.03) and knee extension moment (P=0.045). Univariate outcomes demonstrated significant improvement in the injured limb's stance and swing (P<0.001), and single-stance (P=0.005) ROMs over time. Symmetry indexes of stance and swing ROM, and VGRF reduced significantly by 26.3% (P=0.001), 17.9% (P<0.001), and 31.9% (P=0.03) respectively. After three months, symmetry indexes of single-stance ROM and VGRF along with operated knee extension moment were the only variables which showed significant differences with control group. The rehabilitation program allowed national athletes to restore the operated limb's gait parameters except knee extension moment by 12-13 weeks post-reconstruction; however, more time is required to normalize single-stance ROM and VGRF asymmetries.
In mechanomyography (MMG), crosstalk refers to the contamination of the signal from the muscle of interest by the signal from another muscle or muscle group that is in close proximity.
This study aimed to compare the effects of different suspension methods on the interface stress inside the prosthetic sockets of transtibial amputees when negotiating ramps and stairs.
The purpose of this study was to clarify the changes in the kinematics of the knee that result from isolated deficiency of the anteromedial (AM) or posterolateral (PL) bundle.
Previous investigators have speculated that applying additional external load throughout the eccentric phase of the jumping movement could amplify the stretch-shortening cycle mechanism and modulate jumping performance and jump exercise intensity. The aims of this study, therefore, were to determine the effect of increased eccentric phase loading, as delivered using an elastic device, on drop jumps (DJs) performed from different drop heights. Of specific interest were changes in (a) the kinetics; eccentric and concentric impulse, rate of force development (RFD), concentric velocity and (b) the electromyographic (EMG) activity of leg muscles. In a randomized repeated-measure study, 15 highly resistance trained male subjects performed DJs from 3 heights (20, 35, and 50 cm) under 3 different conditions: body weight only (free DJ) and with elastic bands providing downward force equivalent to 20% (+20% DJ) and 30% (+30% DJ) of body mass. All DJs were recorded using video and force plate data that were synchronized with EMG data. Results demonstrated that using additional tensile load during the airborne and eccentric phases of the DJ could enhance eccentric impulse (p = 0.042) and RFD (p < 0.001) and resulted in small to moderate effect size (ES) increases in quadriceps intergrated EMG across the eccentric phase (0.23 > ES > 0.51). The observed greater eccentric loading, however, did not immediately alter concentric kinetics and jump height nor did it alter muscle activation levels during this phase. The findings indicated that, in addition to the conventional technique of increasing drop height, using a tensile load during the airborne and eccentric phases of the DJ could further improve eccentric loading of DJs. As it has been suggested that eccentric impulse and RFD are indicators of DJ exercise intensity, these findings suggest that the loaded DJs, using additional elastic load, may be an effective technique for improving DJ exercise intensity without acute effects on the jumping performance and neuromuscular activation level in highly trained athletes.
A preponderance of evidence from systematic reviews supports the effectiveness of weight-bearing exercises on bone mass accrual, especially during the growing years. However, only one systematic review (limited to randomized controlled trials) examined the role of physical activity (PA) on bone strength. Thus, our systematic review extended the scope of the previous review by including all PA intervention and observational studies, including organized sports participation studies, with child or adolescent bone strength as the main outcome. We also sought to discern the skeletal elements (eg, mass, structure, density) that accompanied significant bone strength changes. Our electronic-database, forward, and reference searches yielded 14 intervention and 23 observational studies that met our inclusion criteria. We used the Effective Public Health Practice Project (EPHPP) tool to assess the quality of studies. Due to heterogeneity across studies, we adopted a narrative synthesis for our analysis and found that bone strength adaptations to PA were related to maturity level, sex, and study quality. Three (of five) weight-bearing PA intervention studies with a strong rating reported significantly greater gains in bone strength for the intervention group (3% to 4%) compared with only three significant (of nine) moderate intervention studies. Changes in bone structure (eg, bone cross-sectional area, cortical thickness, alone or in combination) rather than bone mass most often accompanied significant bone strength outcomes. Prepuberty and peripuberty may be the most opportune time for boys and girls to enhance bone strength through PA, although this finding is tempered by the few available studies in more mature groups. Despite the central role that muscle plays in bones' response to loading, few studies discerned the specific contribution of muscle function (or surrogates) to bone strength. Although not the focus of the current review, this seems an important consideration for future studies.
Patients with hand tremors may find routine activities such as writing and holding objects affected. In response to this problem, an active control technique has been examined in order to lessen the severity of tremors. In this article, an online method of a hybrid proportional-integral control with active force control strategy for tremor attenuation is presented. An intelligent mechanism using iterative learning control is incorporated into the active force control loop to approximate the estimation mass parameter. Experiments were conducted on a dummy hand model placed horizontally in a tremor test rig. When activated by a shaker in the vertical direction, this resembles a postural tremor condition. In the proportional-integral plus active force control, a linear voice coil actuator is used as the main active tremor suppressive element. A sensitivity analysis is presented to investigate the robustness of the proposed controller in a real-time control environment. The findings of this study demonstrate that the intelligent active force control and iterative learning controller show excellent performance in reducing tremor error compared to classic pure proportional, proportional-integral and hybrid proportional-integral plus active force control controllers.
The trapezium shape of the talar dome limits the use of 2-dimensional plain radiography for morphometric assessment because only 2 of the 4 required parameters can be measured. We used computed tomography data to measure the 4 morphologic parameters of the trochlea tali: anterior width, posterior width, trochlea tali length, and angle of trapezium shape. A total of 99 subjects underwent computed tomography scanning, and the left and right talus bones were both virtually modeled in 3 dimensions. The 4 morphologic parameters were measured 3 times each to obtain the intraclass correlation, and analysis of variance was used to check for any significant differences between the repeated measurements. The average intraclass correlation coefficient for the measurements for 2 to 3 trials was 0.94 ± 0.04. Statistical analyses were performed on the data from all 198 talus bones using SAS software, comparing male and female and left and right bones. All 4 morphometric values were greater in the male group. No significant differences were found between the left and right talus bones. A strong positive correlation was observed between the trochlea tali length and the anterior width. The angle of trapezium shape showed no correlation with the other 3 parameters. The measurements were compared with the dimensions of the current talar components of 4 total ankle arthroplasty implants. However, most of them did not perfectly match the trapezium shape of the talus from our population. We successfully analyzed the trapezium shape of the trochlea tali using reliable virtual 3-dimensional measurements. Compared with other published reports, our study showed a relatively smaller dimension of the trochlea tali than the European counterparts.
Ultrahigh-molecular-weight polyethylene/high-density polyethylene (UHMWPE/HDPE) blends prepared using polyethylene glycol PEG as the processing aid and hydroxyapatite (HA) as the reinforcing filler were found to be highly processable using conventional melt blending technique. It was demonstrated that PEG reduced the melt viscosity of UHMWPE/HDPE blend significantly, thus improving the extrudability. The mechanical and bioactive properties were improved with incorporation of HA. Inclusion of HA from 10 to 50 phr resulted in a progressive increase in flexural strength and modulus of the composites. The strength increment is due to the improvement on surface contact between the irregular shape of HA and polymer matrix by formation of mechanical interlock. The HA particles were homogenously distributed even at higher percentage showed improvement in wetting ability between the polymer matrix and HA. The inclusion of HA enhanced the bioactivity properties of the composite by the formation of calcium phosphate (Ca-P) precipitates on the composite surface as proven from SEM and XRD analysis.
One of the main indicators of the suspension system efficiency in lower limb prostheses is vertical displacement or pistoning within the socket. Decreasing pistoning and introducing an effective system for evaluating pistoning could contribute to the amputees' rehabilitation process.
Experimental findings indicate that in-situ chondrocytes die readily following impact loading, but remain essentially unaffected at low (non-impact) strain rates. This study was aimed at identifying possible causes for cell death in impact loading by quantifying chondrocyte mechanics when cartilage was subjected to a 5% nominal tissue strain at different strain rates. Multi-scale modelling techniques were used to simulate cartilage tissue and the corresponding chondrocytes residing in the tissue. Chondrocytes were modelled by accounting for the cell membrane, pericellular matrix and pericellular capsule. The results suggest that cell deformations, cell fluid pressures and fluid flow velocity through cells are highest at the highest (impact) strain rate, but they do not reach damaging levels. Tangential strain rates of the cell membrane were highest at the highest strain rate and were observed primarily in superficial tissue cells. Since cell death following impact loading occurs primarily in superficial zone cells, we speculate that cell death in impact loading is caused by the high tangential strain rates in the membrane of superficial zone cells causing membrane rupture and loss of cell content and integrity.
A real-time gait monitoring system that incorporates an immediate and periodical assessment of gait asymmetry is described. This system was designed for gait analysis and rehabilitation of patients with pathologic gait. It employs wireless gyroscopes to measure the angular rate of the thigh and shank in real time. Cross-correlation of the lower extremity (Cc(norm)), and normalized Symmetry Index (SI(norm)) are implemented as new approaches to periodically determine the gait asymmetry in each gait cycle. Cc(norm) evaluates the signal patterns measured by wireless gyroscopes in each gait cycle. SI(norm) determines the movement differences between the left and right limb. An experimental study was conducted to examine the viability of these methods. Artificial asymmetrical gait was simulated by placing a load on one side of the limbs. Results showed that there were significant differences between the normal gait and asymmetrical gait (p < 0.01). They also indicated that the system worked well in periodically assessing the gait asymmetry.
The use of open wedge high tibial osteotomy (HTO) to correct varus deformity of the knee is well established. However, the stability of the various implants used in this procedure has not been previously demonstrated. In this study, the two most common types of plates were analysed (1) the Puddu plates that use the dynamic compression plate (DCP) concept, and (2) the Tomofix plate that uses the locking compression plate (LCP) concept. Three dimensional model of the tibia was reconstructed from computed tomography images obtained from the Medical Implant Technology Group datasets. Osteotomy and fixation models were simulated through computational processing. Simulated loading was applied at 60:40 ratios on the medial:lateral aspect during single limb stance. The model was fixed distally in all degrees of freedom. Simulated data generated from the micromotions, displacement and, implant stress were captured. At the prescribed loads, a higher displacement of 3.25 mm was observed for the Puddu plate model (p<0.001). Coincidentally the amount of stresses subjected to this plate, 24.7 MPa, was also significantly lower (p<0.001). There was significant negative correlation (p<0.001) between implant stresses to that of the amount of fracture displacement which signifies a less stable fixation using Puddu plates. In conclusion, this study demonstrates that the Tomofix plate produces superior stability for bony fixation in HTO procedures.