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.     

All joint moments significantly contribute to trunk angular acceleration

Computationally advanced biomechanical analyses of gait demonstrate the often counter-intuitive roles of joint moments on various aspects of gait such as propulsion, swing initiation, and balance. Each joint moment can produce linear and angular acceleration of all body segments (including those on which the moment does not directly act) due to the dynamic coupling inherent in the interconnected musculoskeletal system. This study presents quantitative relationships between individual joint moments and trunk control with respect to balance during gait to show that the ankle, knee, and hip joint moments all affect the angular acceleration of the trunk. We show that trunk angular acceleration is affected by all joints in the leg with varying degrees of dependence during the gait cycle. Furthermore, it is shown that inter-planar coupling exists and a two-dimensional analysis of trunk balance neglects important out-of-plane joint moments that affect trunk angular acceleration.     

Use of whole body vibration in individuals with chronic stroke: Transmissibility and signal purity

This study examined (1) the influence of whole body vibration (WBV) frequency (20 Hz, 30 Hz, 40 Hz), amplitude (low: 0.8 mm and high: 1.5 mm) and body postures (high-squat, deep-squat, tip-toe standing) on WBV transmissibility and signal purity, and (2) the relationship between stroke motor impairment and WBV transmissibility/signal purity. Thirty-four participants with chronic stroke were tested under 18 different conditions with unique combinations of WBV frequency, amplitude, and body posture. Lower limb motor function and muscle spasticity were assessed using the Fugl-Meyer Assessment and Modified Ashworth Scale respectively. Nine tri-axial accelerometers were used to measure acceleration at the WBV platform, and the head, third lumbar vertebra, and bilateral hips, knees, and ankles. The results indicated that WBV amplitude, frequency, body postures and their interactions significantly influenced the vibration transmissibility and signal purity among people with chronic stroke. In all anatomical landmarks except the ankle, the transmissibility decreased with increased frequency, increased amplitude or increased knee flexion angle. The transmissibility was similar between the paretic and non-paretic side, except at the ankle during tip-toe standing. Less severe lower limb motor impairment was associated with greater transmissibility at the paretic ankle, knee and hip in certain WBV conditions. Leg muscle spasticity was not significantly related to WBV transmissibility. In clinical practice, WBV amplitude, frequency, body postures need to be considered regarding the therapeutic purpose. Good contact between the feet and vibration platform and symmetrical body-weight distribution pattern should be ensured.     

Acute effects of whole-body vibration on neuromuscular responses in older individuals: implications for prescription of vibratory stimulation

The aim of this study was to analyze surface electromyography activity (sEMG) and rating of perceived exertion (RPE) responses in different muscles while standing on a vibrating platform producing oscillations of different frequencies and amplitudes. Twenty community-dwelling older adults (79.6 ± 3.2 years) took part in the research. Subjects were exposed to 12 different vibration treatments of 15 seconds separated by 1 minute of rest in random order to check the influence of frequency (25, 35, and 45 Hz) and amplitude (1 mm [low] and 3.1 mm [high]) vibration on sEMG signal and RPE. Additionally, the use of a soft pad was also examined for its influence on these measures. Three-factor analysis of variance for RPE and both lower and whole-body sEMGs revealed a significant amplitude main effect (p < 0.01), and soft mat effect (p < 0.01), and a significant frequency main effect (p < 0.01). The major findings were that sEMG and RPE increased with the acceleration of the vibration; moreover, the increments of sEMG were highly correlated with RPE. The results of this study suggest that using the RPE method after each exercise would allow exercise and health professionals to assess the intensity levels that correspond to the level of the vibratory program in older adults.     

How early reactions in the support limb contribute to balance recovery after tripping

Tripping causes a forward angular momentum that has to be arrested to prevent a fall. The support limb, contralateral to the obstructed swing limb, can contribute to an adequate recovery by providing time and clearance for proper positioning of the recovery limb, and by restraining the angular momentum of the body during push-off. The present study investigated how such a contribution is achieved by the support limb in terms of response times and muscle moment generation, in order to provide more insight in the requirements for successful recovery after tripping. Twelve young adults repeatedly walked over a platform in which 21 obstacles were hidden. Each subject was tripped over one of these obstacles during mid-swing in at least five trials. Kinematics, dynamics and muscle activity were measured. Very rapid responses were seen in the muscles of the support limb (approximately 65 ms), causing fast increases in muscle moments in the joints during the primary phase of recovery. Especially a large ankle plantar flexion moment (204 Nm), a knee flexion moment (-54 Nm) and a hip extension moment (52 Nm), generated by triceps surae and hamstring muscle activity, brought about the necessary push-off reaction and simultaneously caused a restraining of the forward angular momentum of the body. These required joint moments could be a problem for the elderly, who might not be able to generate such powerful moments. Strength training in these muscle groups may be indicated in elderly subjects to reduce the risk of falling after a trip.     

Apparent mass of the standing human body when using a whole-body vibration training machine: Effect of knee angle and input frequency

Several studies have investigated the transmission of vibration from the vibrating plate of a whole-body vibration training machine (WBVTM) to different locations on the human body. No known work has investigated the interface force between the vibrating plate of the machine and the human body. This paper investigates the effect of bending the knees and the vibration frequency on the interface force (presented as apparent mass (AM)) between the vibrating plate and the body. Twelve male subjects stood with four different knee angles (180, 165, 150 and 135°) and were exposed to sinusoidal vertical vibration at eight frequencies in the range of 17–42 Hz. The vertical acceleration and the interface force between the body and the vibrating plate were measured and used to calculate the AM. The acceleration and force depended on the frequency and were found to vary with both the adopted posture and subject. The AM generally decreased with increasing the frequency but showed a peak at 24 Hz which was clearer when the knees were bent. Bending the knees showed an effect similar to increasing the damping of a system with base excitation; increasing the damping reduced the AM in the resonance region but increased the AM at higher frequencies. Users of WBVTMs have to be careful when choosing the training posture: although, as shown in previous studies, bending the knees reduces the transmission of vibration to the spine, it increases the interface forces which might indicate increased stresses on the lower legs and joints.     

Effects of turn angle and pivot foot on lower extremity kinetics during walk and turn actions

This study examined lower extremity joint moments during walk and turn with different turn angles and pivot feet. Seven young adults (age 21+/-1.3 yrs) were asked to walk at a self-selected speed (1.35+/-0.15 m/s) and to turn to the right using right (spin turn) and left (step turn) pivot feet at turn angles of 0 degrees (walking straight), 45 degrees, and 90 degrees. Video and forceplate systems were employed for kinematic and kinetic data collection. Inverse dynamics approach was used to compute joint moments using segmental kinematics, ground reaction forces, and moments. The participants decreased their forward speed by increasing the ankle plantar flexion moment as the turn angle increased. The peak ankle plantar flexion moment during the braking phase increased with increasing turn angle for both spin and step turns. Ankle invertor moments were observed only in spin turns, suggesting that more ankle muscles are involved in spin turns than in step turns. The turn angle had a significant effect on the transverse plane moment profiles at the different lower extremity joints. The results suggest that the loading patterns of different anatomical structures in the lower extremity are affected by both turn angle and pivot foot during walk and turn actions.     

Effects of low-pass filter combinations on lower extremity joint moments in distance running

Inverse dynamics is a standard tool in biomechanics, which requires low-pass filtering of external force and kinematic signals. Unmatched filtering procedures are reported to affect joint moment amplitudes in high impact movements, like landing or cutting, but are also common in the analysis of distance running. We analyzed the effects of cut-off frequencies in 94 rearfoot runners at a speed of 3.5 m/s. Additionally, we investigated whether the evaluation of footwear interventions is affected by the choice of cut-off frequencies. We performed 3D inverse dynamics for the hip, knee and ankle joints using different low-pass filter cut-off frequency combinations for a recursive fourth-order Butterworth filter. We observed fluctuations of joint moment curves in the first half of stance, which were most pronounced for the most unmatched cut-off frequency combination (kinematics: 10 Hz; ground reaction forces (GRFs): 100 Hz) and for more proximal joints. Peak sagittal plane hip joint moments were altered by 94% on average. We observed a change in the ranking of subjects based on joint moment amplitude. We found significant (p < 0.001) footwear by cut-off frequency combination interaction effects for most peak joint moments. These findings highlight the importance of cut-off frequency choice in the analysis of joint moments and the assessment of footwear interventions in distance running. Based on our results, we propose to use matched cut-off frequencies around 20 Hz in order to avoid large artificial fluctuations in joint moment curves while at the same time avoiding a severe removal of physiological high-frequency signal content from the GRF signals.     

An induced acceleration index for examining joint couplings

A muscle produces moments at the joints it crosses, but these moments can also cause accelerations at joints not crossed by the muscle. This phenomenon, the acceleration of a joint caused by a muscle not crossing the joint, is referred to as induced acceleration. For a system of rigid bodies this study examines how system configuration, and segmental inertial properties dictate the potential of one joint to cause the acceleration of other joints in the system. From the equations of motion for a series of rigid bodies, an induced acceleration index (IAI) was developed. The IAI permits quantification of the relative potential of moments produced at joints in the kinematic chain to accelerate other joints in the kinematic chain. The IAI is a function of system orientation, segment lengths, and inertial properties. The IAI was used to examine the roles of the ankle and hip joints in quiet standing. The ankle joint had over 12 times the ability to accelerate the hip joint, than the hip had to accelerate the ankle joint. These results in part explain the relative merits of the two strategies predominantly used to maintain upright stance: the ankle and hip strategies. This index permits an understanding of how the induced accelerations are dependent on system configuration and inertial properties. The IAI is also useful in situations where the inertial properties of the system under investigation changes, for example due to the fitting of a new prostheses to a trans-tibial amputee.     

The demands of stair descent relative to maximum capacities in elderly and young adults.

In this study, we aimed to establish the joint moment and joint range of motion requirements of stair descent and the demands relative to maximal capacities in elderly and young adults. Participants descended a custom-built standard dimension four-step staircase, at their self-selected speed in a step-over manner. Kinetic data were acquired from force platforms embedded into each of the steps and into the floor at the base of the stairs. A motion analysis system was used to acquire kinematic data and joint moments were calculated using the kinematic and kinetic data. Maximum capacities (joint moment and joint range of motion) were assessed using a dynamometer. During stair descent the elderly generated lower absolute ankle joint moments than the young, which enabled them to operate at a similar relative proportion of their maximal capacity compared to young adults (75%). The knee joint moments during stair descent were similar between groups, but the elderly operated at a higher proportion of their maximal capacity (elderly: 42%; young: 30%). Ankle plantarflexion-dorsiflexion angle changes were similar between groups, which meant that the elderly operated at a higher proportion of their maximal assisted dorsiflexion angle. These results indicate that the elderly redistribute the joint moments in order to maintain the task demands within 'safe' limits.     

Joint moments and contact forces in the foot during walking

The net force and moment of a joint have been widely used to understand joint disease in the foot. Meanwhile, it does not reflect the physiological forces on muscles and contact surfaces. The objective of the study is to estimate active moments by muscles, passive moments by connective tissues and joint contact forces in the foot joints during walking. Joint kinematics and external forces of ten healthy subjects (all males, 24.7 ± 1.2 years) were acquired during walking. The data were entered into the five-segment musculoskeletal foot model to calculate muscle forces and joint contact forces of the foot joints using an inverse dynamics-based optimization. Joint reaction forces and active, passive and net moments of each joint were calculated from muscle and ligament forces. The maximum joint reaction forces were 8.72, 4.31, 2.65, and 3.41 body weight (BW) for the ankle, Chopart’s, Lisfranc and metatarsophalangeal joints, respectively. Active and passive moments along with net moments were also obtained. The maximum net moments were 8.6, 8.4, 5.4 and 0.8%BW∙HT, respectively. While the trend of net moment was very similar between the four joints, the magnitudes and directions of the active and passive moments varied between joints. The active and passive moments during walking could reveal the roles of muscles and ligaments in each of the foot joints, which was not obvious in the net moment. This method may help narrow down the source of joint problems if applied to clinical studies.     

Whole-body vibration induced adaptation in knee extensors; consequences of initial strength, vibration frequency, and joint angle

It was hypothesized that both vibration frequency and muscle length modulate the strengthening of muscles that is assumed to result from whole-body vibration (WBV). Length of knee extensor muscles during vibration is affected by the knee joint angle; the lengths of the knee extensors increase with more flexed knee joint angles. In an intervention study 28 volunteers were randomly assigned to 1 of 4 groups. Each group received 4 weeks of WBV at 1 of 3 different frequencies (20, 27, or 34 Hz) or 1 of 2 different lengths of knee extensors. Voluntary, isometric knee extension moment-angle relationship was determined. Initially, stronger subjects reacted differently to WBV than weaker participants. In stronger subjects knee extension moment did not improve; in the weaker subjects considerable improvements were observed ranging from 10 to 50%. Neither vibration frequency nor muscle length during the intervention affected the improvements. In addition to strength, the knee joint angle at which the maximal joint moment was generated (optimal joint angle) was affected. When trained at short muscle lengths, optimal angle shifted to more extend joint position. WBV training at long muscle lengths tended to induce an opposite shift. The amount of this shift tended to be influenced by vibration frequency; the lower the vibration frequency the larger the shift. Shifts of optimal lengths occurred in both weaker and stronger subjects. This study shows that muscle length during training affects the angle of knee joint at which the maximal extension moment was generated. Moreover, in weaker subjects WBV resulted in higher maximal knee joint extension moments. Vibration frequency and muscle length during vibration did not affect this joint moment gain.     

Differences in lower limb transverse plane joint moments during gait when expressed in two alternative reference frames

When comparing previous studies that have measured the three-dimensional moments acting about the lower limb joints (either external moments or opposing internal joint moments) during able-bodied adult gait, significant variation is apparent in the profiles of the reported transverse plane moments. This variation cannot be explained on the basis of adopted convention (i.e. external versus internal joint moment) or inherent variability in gait strategies. The aim of the current study was to determine whether in fact the frame in which moments are expressed has a dominant effect upon transverse plane moments and thus provides a valid explanation for the observed inconsistency in the literature. Kinematic and ground reaction force data were acquired from nine able-bodied adult subjects walking at a self-selected speed. Three-dimensional hip, knee and ankle joint moments during gait were calculated using a standard inverse dynamics approach. In addition to calculating internal joint moments, the components of the external moment occurring in the transverse plane at each of the lower limb joints were calculated to determine their independent effects. All moments were expressed in both the laboratory frame (LF) as well as the anatomical frame (AF) of the distal segment. With the exception of the ankle rotation moment in the foot AF, lower limb transverse plane joint moments during gait were found to display characteristic profiles that were consistent across subjects. Furthermore, lower limb transverse plane joint moments during gait differed when expressed in the distal segment AF compared to the LF. At the hip, the two alternative reference frames produced near reciprocal joint moment profiles. The components of the external moment revealed that the external ground reaction force moment was primarily responsible for this result. Lower limb transverse plane joint moments during gait were therefore found to be highly sensitive to a change in reference frame. These findings indicate that the different transverse plane joint moment profiles during able-bodied adult gait reported in the literature are likely to be explained on this basis.     

Older adults employ alternative strategies to operate within their maximum capabilities when ascending stairs

Older people may operate much closer to their maximum capabilities than young adults when ascending stairs due to their lower maximum musculoskeletal capabilities. The purpose of this study was to establish the joint moment and range of motion demands of stair ascent relative to maximum capabilities in elderly and young adults. Fifteen elderly (mean age 75 years) and 17 young adult (mean age 25 years) participants ascended a purpose-built 4-step staircase with force platforms embedded into the steps and kinematic data was acquired using motion capture. Maximum musculoskeletal capabilities were assessed using a dynamometer. This study showed for the first time that stair ascent approaches the joint moment limits at the ankle in both young and older participants (～90%). One of the most important and novel findings of this study was that elderly people were only capable of meeting the high demands by adopting a number of alternative strategies not observed in young adults: (i) applying the joint moments differently than young adults across the knee and ankle, (ii) translocating energy from the knee to the ankle, thereby enhancing the ankle joint moment upon maximum demand and (iii) by enabling the plantarflexors to act over a more favourable portion of the moment–angle relation upon maximum ankle joint moment demand. The elderly displayed a more cautious strategy to optimize positional stability during stair ascent, by maintaining a smaller separation between the centre of mass and centre of pressure in the frontal plane. It seems that elderly people may meet the demands of unaided stair ascent by adopting a number of alternative strategies to compensate for their reduced musculoskeletal capabilities.     

Difference in Postural Control during Quiet Standing between Young Children and Adults: Assessment with Center of Mass Acceleration

The development of upright postural control has often been investigated using time series of center of foot pressure (COP), which is proportional to the ankle joint torque (i.e., the motor output of a single joint). However, the center of body mass acceleration (COM_acc), which can reflect joint motions throughout the body as well as multi-joint coordination, is useful for the assessment of the postural control strategy at the whole-body level. The purpose of the present study was to investigate children’s postural control during quiet standing by using the COM_acc. Ten healthy children and 15 healthy young adults were instructed to stand upright quietly on a force platform with their eyes open or closed. The COM_acc as well as the COP in the anterior–posterior direction was obtained from ground reaction force measurement. We found that both the COM_acc and COP could clearly distinguish the difference between age groups and visual conditions. We also found that the sway frequency of COM_acc in children was higher than that in adults, for which differences in biomechanical and/or neural factors between age groups may be responsible. Our results imply that the COM_acc can be an alternative force platform measure for assessing developmental changes in upright postural control.     

Footwear affects the gearing at the ankle and knee joints during running

The objective of the study was to investigate the adjustment of running mechanics by wearing five different types of running shoes on tartan compared to barefoot running on grass focusing on the gearing at the ankle and knee joints. The gear ratio, defined as the ratio of the moment arm of the ground reaction force (GRF) to the moment arm of the counteracting muscle tendon unit, is considered to be an indicator of joint loading and mechanical efficiency. Lower extremity kinematics and kinetics of 14 healthy volunteers were quantified three dimensionally and compared between running in shoes on tartan and barefoot on grass. Results showed no differences for the gear ratios and resultant joint moments for the ankle and knee joints across the five different shoes, but showed that wearing running shoes affects the gearing at the ankle and knee joints due to changes in the moment arm of the GRF. During barefoot running the ankle joint showed a higher gear ratio in early stance and a lower ratio in the late stance, while the gear ratio at the knee joint was lower during midstance compared to shod running. Because the moment arms of the counteracting muscle tendon units did not change, the determinants of the gear ratios were the moment arms of the GRF's. The results imply higher mechanical stress in shod running for the knee joint structures during midstance but also indicate an improved mechanical advantage in force generation for the ankle extensors during the push-off phase.     

Joint axes of rotation and body segment parameters of pig limbs

To enable a quantification of net joint moments and joint reaction forces, indicators of joint loading, this study aimed to locate the mediolateral joint axes of rotation and establish the body segment parameters of the limbs of pigs (Sus scrofa). To locate the joint axes of rotation the scapulohumeral, humeroradial, carpal complex, metacarpophalangeal, coxofemoral, femorotibial, tarsal, and metatarsophalangeal joints from 12 carcasses were studied. The joints were photographed in three positions, bisecting lines drawn at fixed landmarks with their intersection marking the joint axes of rotation. The body segment parameters, i.e. the segment mass, center of mass and moment of inertia were measured on the humerus, radius/ulna, metacarpus, forepastern, foretoe, femur, tibia, metatarsus, hindpastern, and hindtoe segments from five carcasses. The segments were weighed, and their center of mass was found by balancing them. The moments of inertia of the humerus, radius/ulna, femur and tibia were found by rotating the segments. The moments of inertia of the remaining segments were calculated. Generally, the joint axes of rotation were near the attachment site of the lateral collateral ligaments. The forelimb, with segments taken as one, was significantly lighter and shorter than the hindlimb (P < 0.001). In all segments the center of mass was located 31 to 50% distal to the proximal segment end. The segment mass decreased with distance from the trunk, as did the segment moment of inertia. The results may serve as reference on the location of the joint axes of rotation and on the body segment parameters for inverse dynamic modeling of pigs.     

Somatosensory graviception inhibits the soleus H-reflexin standing man - an underwater experiment-

H-reflexes were elicited in the soleus muscle in subjects standing on a force platform in a water tank, under different loading conditions at the ankle joint. The joint loading was altered by changing the combination of buoys and weights attached to lower limb segments, while the total body mass was kept the same. The results revealed that as the joint load was reduced the H-reflex was significantly enhanced as compared to that under the control condition, while it decreased as the joint load was increased, despite the same background EMG activity level. It was demonstrated that the augmented load information from the lower limb joints has an inhibitory effect on the soleus H-reflex, suggesting that this might be one of underlying neural mechanisms responsible for the suppression of H-reflex during human upright standing.     

Whole-body vibration increases upper and lower body muscle activity in older adults: potential use of vibration accessories

The current study examined the effects of whole-body vibration (WBV) on upper and lower body muscle activity during static muscle contractions (squat and bicep curls). The use of WBV accessories such as hand straps attached to the platform and a soft surface mat were also evaluated. Surface electromyography (sEMG) was measured for the medial gastrocnemius (MG), vastus lateralis (VL), and biceps brachii (BB) muscles in fourteen healthy older adults (74.8±4.5 years; mean±SD) with a WBV stimulus at an acceleration of 40 m s(-2) (30 Hz High, 2.5 mm or 46 Hz Low, 1.1 mm). WBV increased lower body (VL and MG) sEMG vs baseline (no WBV) though this was decreased with the use of the soft mat. The addition of the bicep curl with hand straps had no effect on lower body sEMG. WBV also increased BB sEMG vs baseline which was further increased when using the hand straps. There was no upper body effect of the soft mat. This study demonstrates WBV increases both lower and upper body muscle activity in healthy older adults. Moreover, WBV accessories such as hand straps attached to the platform or a soft surface mat may be used to alter exercise intensity.     

Biomechanical attributes of lunging activities for older adults

The purpose of this study was to characterize the mechanical demands of the lower-extremity musculature during the standing forward lunge (FL) and the standing lateral lunge (LL) exercises performed by older adults. Twenty healthy older adults (9 men, 11 women, mean age 75.0 +/- 4.4 years) performed FL and LL while instrumented for biomechanical analysis. Lower-extremity net joint moments, powers, impulse, and mechanical energy expenditure were determined using standard inverse dynamics techniques. The FL preferentially targeted the hip extensors, producing a greater flexion angle (12.8%), peak joint moment (13.6%), joint power (56.5%), and mechanical energy expenditure (25.1%). Conversely, LL targeted the ankle plantar flexors, producing greater dorsiflexion angles (19.3%), joint moments (40.9%), impulse (87.0%), and mechanical energy expenditure (61.1%). Kinetic differences at the knee were less consistent. Fitness professionals may use this information to better match the biomechanical attributes of FL and LL activities with the needs of the trainee.