Three-dimensional knee joint contact forces during walking in unilateral transtibial amputees

Individuals with unilateral transtibial amputations have greater prevalence of osteoarthritis in the intact knee joint relative to the residual leg and non-amputees, but the cause of this greater prevalence is unclear. The purpose of this study was to compare knee joint contact forces and the muscles contributing to these forces between amputees and non-amputees during walking using forward dynamics simulations. We predicted that the intact knee contact forces would be higher than those of the residual leg and non-amputees. In the axial and mediolateral directions, the intact and non-amputee legs had greater peak tibio-femoral contact forces and impulses relative to the residual leg. The peak axial contact force was greater in the intact leg relative to the non-amputee leg, but the stance phase impulse was greater in the non-amputee leg. The vasti and hamstrings muscles in early stance and gastrocnemius in late stance were the largest contributors to the joint contact forces in the non-amputee and intact legs. Through dynamic coupling, the soleus and gluteus medius also had large contributions, even though they do not span the knee joint. In the residual leg, the prosthesis had large contributions to the joint forces, similar to the soleus in the intact and non-amputee legs. These results identify the muscles that contribute to knee joint contact forces during transtibial amputee walking and suggest that the peak knee contact forces may be more important than the knee contact impulses in explaining the high prevalence of intact leg osteoarthritis.     

Mechanical energetic contributions from individual muscles and elastic prosthetic feet during symmetric unilateral transtibial amputee walking: a theoretical study

Energy storage and return (ESAR) foot-ankle prostheses have been developed in an effort to improve gait performance in lower-limb amputees. However, little is known about their effectiveness in providing the body segment mechanical energetics normally provided by the ankle muscles. The objective of this theoretical study was to use muscle-actuated forward dynamics simulations of unilateral transtibial amputee and non-amputee walking to identify the contributions of ESAR prostheses to trunk support, forward propulsion and leg swing initiation and how individual muscles must compensate in order to produce a normal, symmetric gait pattern. The simulation analysis revealed the ESAR prosthesis provided the necessary trunk support, but it could not provide the net trunk forward propulsion normally provided by the plantar flexors and leg swing initiation normally provided by the biarticular gastrocnemius. To compensate, the residual leg gluteus maximus and rectus femoris delivered increased energy to the trunk for forward propulsion in early stance and late stance into pre-swing, respectively, while the residual iliopsoas delivered increased energy to the leg in pre- and early swing to help initiate swing. In the intact leg, the soleus, gluteus maximus and rectus femoris delivered increased energy to the trunk for forward propulsion in the first half of stance, while the iliopsoas increased the leg energy it delivered in pre- and early swing. Thus, the energy stored and released by the ESAR prosthesis combined with these muscle compensations was able to produce a normal, symmetric gait pattern, although various neuromuscular and musculoskeletal constraints may make such a pattern non-optimal.     

Muscle contributions to support and progression over a range of walking speeds

Muscles actuate walking by providing vertical support and forward progression of the mass center. To quantify muscle contributions to vertical support and forward progression (i.e., vertical and fore-aft accelerations of the mass center) over a range of walking speeds, three-dimensional muscle-actuated simulations of gait were generated and analyzed for eight subjects walking overground at very slow, slow, free, and fast speeds. We found that gluteus maximus, gluteus medius, vasti, hamstrings, gastrocnemius, and soleus were the primary contributors to support and progression at all speeds. With the exception of gluteus medius, contributions from these muscles generally increased with walking speed. During very slow and slow walking speeds, vertical support in early stance was primarily provided by a straighter limb, such that skeletal alignment, rather than muscles, provided resistance to gravity. When walking speed increased from slow to free, contributions to support from vasti and soleus increased dramatically. Greater stance-phase knee flexion during free and fast walking speeds caused increased vasti force, which provided support but also slowed progression, while contralateral soleus simultaneously provided increased propulsion. This study provides reference data for muscle contributions to support and progression over a wide range of walking speeds and highlights the importance of walking speed when evaluating muscle function.     

Muscle and prosthesis contributions to amputee walking mechanics: A modeling study

Unilateral, below-knee amputees have altered gait mechanics, which can significantly affect their mobility. Below-knee amputees lose the functional use of the ankle muscles, which are critical during walking to provide body support, forward propulsion, leg-swing initiation and mediolateral balance. Thus, either muscles must compensate or the prosthesis must provide the functional tasks normally provided by the ankle muscles. Three-dimensional (3D) forward dynamics simulations of amputee and non-amputee walking were generated to identify muscle and prosthesis contributions to amputee walking mechanics, including the subtasks of body support, forward propulsion, leg-swing initiation and mediolateral balance. Results showed that the prosthesis provided body support in the absence of the ankle muscles. The prosthesis contributed to braking from early to mid-stance and propulsion in late stance. The prosthesis also functioned like the uniarticular soleus muscle by transferring energy from the residual leg to the trunk to provide trunk propulsion. The residual-leg vasti and rectus femoris reduced their contributions to braking in early stance, which mitigated braking from the prosthesis during this period. The prosthesis did not replace the function of the gastrocnemius, which normally generates energy to the leg to initiate swing. As a result, lower overall energy was delivered to the residual leg. The prosthesis also acted to accelerate the body laterally in the absence of the ankle muscles. These results provide further insight into muscle and prosthesis function in below-knee amputee walking and can help guide rehabilitation methods and device designs to improve amputee mobility.     

Differences in whole-body angular momentum between below-knee amputees and non-amputees across walking speeds

Unilateral, below-knee amputees have an increased risk of falling compared to non-amputees. The regulation of whole-body angular momentum is important for preventing falls, but little is known about how amputees regulate angular momentum during walking. This study analyzed three-dimensional, whole-body angular momentum at four walking speeds in 12 amputees and 10 non-amputees. The range of angular momentum in all planes significantly decreased with increasing walking speed for both groups. However, the range of frontal-plane angular momentum was greater in amputees compared to non-amputees at the first three walking speeds. This range was correlated with a reduced second vertical ground reaction force peak in both the intact and residual legs. In the sagittal plane, the amputee range of angular momentum in the first half of the residual leg gait cycle was significantly larger than in the non-amputees at the three highest speeds. In the second half of the gait cycle, the range of sagittal-plane angular momentum was significantly smaller in amputees compared to the non-amputees at all speeds. Correlation analyses suggested that the greater range of angular momentum in the first half of the amputee gait cycle is associated with reduced residual leg braking and that the smaller range of angular momentum in the second half of the gait cycle is associated with reduced residual leg propulsion. Thus, reducing residual leg braking appears to be a compensatory mechanism to help regulate sagittal-plane angular momentum over the gait cycle, but may lead to an increased risk of falling.     

Pattern of reflex responses in lower limb muscles to a resistance in walking man

Reflex responses in the lower limbs were investigated using electromyographic and kinematic techniques in man walking on a treadmill. A momentary resistance was applied to one leg at three selected points in the step cycle. The responses to such stimuli, as well as the locomotor activity, were picked up electromyographically and displayed on a four channel oscilloscope. Four superficial muscles viz: gluteus medius, vastus lateralis, rectus femoris and tibialis anterior were studied in both ipsilateral and contralateral legs. In general it was found that the ipsilateral leg muscles produced a response throughout the step cycle regardless of whether the muscle was active or silent at the time the reflex occurred. In contrast, contralateral leg muscles showed a different pattern of response which depended on where the resistance was applied in the step cycle. The long reflex latency, of the order of 80 ms, was a consistent feature of the responses and suggests the possible involvement of supra-spinal pathways. The latencies for a particular muscle were identical on the ipsi- and contralateral sides. The durations of the swing and stance phases of the step cycle were also recorded but showed no change due to application of the resistance. In general, the results indicate that the body has the inherent ability to reinforce the ongoing locomotor muscle activity in response to external stimuli in order to maintain upright balanced walking.     

Muscle contributions to mediolateral and anteroposterior foot placement during walking

Foot placement is critical to balance control during walking and is primarily controlled by muscle force generation. Although gluteus medius activity has been associated with mediolateral foot placement, how other muscles contribute to foot placement is not clear. Furthermore, although dynamic walking models have suggested that anteroposterior foot placement can be passively controlled, the extent to which muscles actively contribute to anteroposterior foot placement has not been determined. The objective of this study was to identify individual muscle contributions to mediolateral and anteroposterior foot placement during walking in healthy adults. Dynamic simulations of walking were developed for six older adults and a segmental power analysis was performed to determine the individual muscle contributions to the mediolateral and anteroposterior power delivered to the foot segment. The simulations revealed the ipsilateral swing limb gluteus medius, iliopsoas, rectus femoris and hamstrings and the contralateral stance limb gluteus medius and ankle plantarflexors were primary contributors to both mediolateral and anteroposterior foot placement. Muscle contributions to foot placement were found to be highly influenced by their contributions to pelvis power, which was dominated by those muscles crossing the hip joint. Thus, impaired balance control may be improved by focusing rehabilitation interventions on optimizing the coordination of those muscles crossing the hip joint and the ankle plantarflexors.     

Association between walking ability and trunk and lower-limb muscle atrophy in institutionalized elderly women: a longitudinal pilot study

Background

The aim of this study was to investigate the association between walking ability and muscle atrophy in the trunk and lower limbs.

Methods

Subjects in this longitudinal study were 21 elderly women who resided in nursing homes. The thicknesses of the following trunk and lower-limb muscles were measured using B-mode ultrasound: rectus abdominis, external oblique, internal oblique, transversus abdominis, erector spinae, lumbar multifidus, psoas major, gluteus maximus, gluteus medius, gluteus minimus, rectus femoris, vastus lateralis, vastus intermedius, biceps femoris, gastrocnemius, soleus, and tibialis anterior. Maximum walking speed was used to represent walking ability. Maximum walking speed and muscle thickness were assessed before and after a 12-month period.

Results

Of the 17 measured muscles of the trunk and lower limbs, age-related muscle atrophy in elderly women was greatest in the erector spinae, rectus femoris, vastus lateralis, vastus intermedius, and tibialis anterior muscles. Correlation coefficient analyses showed that only the rate of thinning of the vastus lateralis was significantly associated with the rate of decline in maximum walking speed (r = 0.518, p < 0.05).

Conclusions

This longitudinal study suggests that reduced walking ability may be associated with muscle atrophy in the trunk and lower limbs, especially in the vastus lateralis muscle, among frail elderly women.     

Development of EMG-based mode and intent recognition algorithms for a computer-controlled above-knee prosthesis

Conventional above-knee prostheses are unable to replace normal leg function due to the lack of adaptive control. Computer-controlled prostheses offer the possibility to implement such adaptive control. For a particular locomotion mode, control algorithms can generate appropriate damping profiles as a function of selected sensory inputs and stored information on normal walking. However, it is essential in such systems that the locomotor modes can be determined accurately from the inputs of the control system. Recognition of the intent to change from one mode to another is also a necessity because the control system has to account for such transitions. The possibility of using EMG signals from hip muscles and muscle residuals of the stump for this purpose is investigated. The modes tested are level walking, ramp ascent and ramp descent with slopes of 6° and 9°. EMG activity curves for three muscles: gluteus maximus, gluteus medius and tensor fasciae latae, are presented for the different modes. The results are obtained from two reference groups of 12 normal individuals and from a prosthetic patient. The results show the possibility of discriminating between modes. A discussion is made of the implementation of the results obtained by a finite state approach and the difficulties relating to the use of EMG signals for control purposes.     

Effect of pre-exhaustion exercise on lower-extremity muscle activation during a leg press exercise

The purpose of this study was to investigate the effect of pre-exhaustion exercise on lower-extremity muscle activation during a leg press exercise. Pre-exhaustion exercise, a technique frequently used by weight trainers, involves combining a single-joint exercise immediately followed by a related multijoint exercise (e.g., a knee extension exercise followed by a leg press exercise). Seventeen healthy male subjects performed 1 set of a leg press exercise with and without pre-exhaustion exercise, which consisted of 1 set of a knee extension exercise. Both exercises were performed at a load of 10 repetitions maximum (10 RM). Electromyography (EMG) was recorded from the rectus femoris, vastus lateralis, and gluteus maximus muscles simultaneously during the leg press exercise. The number of repetitions of the leg press exercise performed by subjects with and without pre-exhaustion exercise was also documented. The activation of the rectus femoris and the vastus lateralis muscles during the leg press exercise was significantly less when subjects were pre-exhausted (p < 0.05). No significant EMG change was observed for the gluteus maximus muscle. When in a pre-exhausted state, subjects performed significantly (p < 0.001) less repetitions of the leg press exercise. Our findings do not support the popular belief of weight trainers that performing pre-exhaustion exercise is more effective in order to enhance muscle activity compared with regular weight training. Conversely, pre-exhaustion exercise may have disadvantageous effects on performance, such as decreased muscle activity and reduction in strength, during multijoint exercise.     

Dynamics and stability of muscle activations during walking in healthy young and older adults

To facilitate stable walking, humans must generate appropriate motor patterns and effective corrective responses to perturbations. Yet most EMG analyses do not address the continuous nature of muscle activation dynamics over multiple strides. We compared muscle activation dynamics in young and older adults by defining a multivariate state space for muscle activity. Eighteen healthy older and 17 younger adults walked on a treadmill for 2 trials of 5 min each at each of 5 controlled speeds (80–120% of preferred). EMG linear envelopes of v. lateralis, b. femoris, gastrocnemius, and t. anterior of the left leg were obtained. Interstride variability, local dynamic stability (divergence exponents), and orbital stability (maximum Floquet multipliers; FM) were calculated. Both age groups exhibited similar preferred walking speeds (p=0.86). Amplitudes and variability of individual EMG linear envelopes increased with speed (p<0.01) in all muscles but gastrocnemius. Older adults also exhibited greater variability in b. femoris and t. anterior (p<0.004). When comparing continuous multivariate EMG dynamics, older adults demonstrated greater local and orbital instability of their EMG patterns (p<0.01). We also compared how muscle activation dynamics were manifested in kinematics. Local divergence exponents were strongly correlated between kinematics and EMG, independent of age and walking speed, while variability and max FM were not. These changes in EMG dynamics may be related to increased neuromotor noise associated with aging and may indicate subtle deterioration of gait function that could lead to future functional declines.     

Muscle contributions to support and progression during single-limb stance in crouch gait

Pathological movement patterns like crouch gait are characterized by abnormal kinematics and muscle activations that alter how muscles support the body weight during walking. Individual muscles are often the target of interventions to improve crouch gait, yet the roles of individual muscles during crouch gait remain unknown. The goal of this study was to examine how muscles contribute to mass center accelerations and joint angular accelerations during single-limb stance in crouch gait, and compare these contributions to unimpaired gait. Subject-specific dynamic simulations were created for ten children who walked in a mild crouch gait and had no previous surgeries. The simulations were analyzed to determine the acceleration of the mass center and angular accelerations of the hip, knee, and ankle generated by individual muscles. The results of this analysis indicate that children walking in crouch gait have less passive skeletal support of body weight and utilize substantially higher muscle forces to walk than unimpaired individuals. Crouch gait relies on the same muscles as unimpaired gait to accelerate the mass center upward, including the soleus, vasti, gastrocnemius, gluteus medius, rectus femoris, and gluteus maximus. However, during crouch gait, these muscles are active throughout single-limb stance, in contrast to the modulation of muscle forces seen during single-limb stance in an unimpaired gait. Subjects walking in crouch gait rely more on proximal muscles, including the gluteus medius and hamstrings, to accelerate the mass center forward during single-limb stance than subjects with an unimpaired gait.     

Experimentally reduced hip abductor function during walking: Implications for knee joint loads

Hip and knee functions are intimately connected and reduced hip abductor function might play a role in development of knee osteoarthritis (OA) by increasing the external knee adduction moment during walking. The purpose of this study was to test the hypothesis that reduced function of the gluteus medius (GM) muscle would lead to increased external knee adduction moment during level walking in healthy subjects. Reduced GM muscle function was induced experimentally, by means of intramuscular injections of hypertonic saline that produced an intense short-term muscle pain and reduced muscle function. Isotonic saline injections were used as non-painful control. Fifteen healthy subjects performed walking trials at their self-selected walking speed before and immediately after injections, and again after 20 min of rest, to ensure pain recovery. Standard gait analyses were used to calculate three-dimensional trunk and lower extremity joint kinematics and kinetics. Surface electromyography (EMG) of the glutei, quadriceps, and hamstring muscles were also measured. The peak GM EMG activity had temporal concurrence with peaks in frontal plane moments at both hip and knee joints. The EMG activity in the GM muscle was significantly reduced by pain (?39.6%). All other muscles were unaffected. Peaks in the frontal plane hip and knee joint moments were significantly reduced during pain (?6.4% and ?4.2%, respectively). Lateral trunk lean angles and midstance hip joint adduction and knee joint extension angles were reduced by ?1°. Thus, the gait changes were primarily caused by reduced GM function. Walking with impaired GM muscle function due to pain significantly reduced the external knee adduction moment. This study challenge the notion that reduced GM function due to pain would lead to increased loads at the knee joint during level walking.     

Modular control of human walking: A simulation study

Recent evidence suggests that performance of complex locomotor tasks such as walking may be accomplished using a simple underlying organization of co-active muscles, or “modules”, which have been assumed to be structured to perform task-specific biomechanical functions. However, no study has explicitly tested whether the modules would actually produce the biomechanical functions associated with them or even produce a well-coordinated movement. In this study, we generated muscle-actuated forward dynamics simulations of normal walking using muscle activation modules (identified using non-negative matrix factorization) as the muscle control inputs to identify the contributions of each module to the biomechanical sub-tasks of walking (i.e., body support, forward propulsion, and leg swing). The simulation analysis showed that a simple neural control strategy involving five muscle activation modules was sufficient to perform the basic sub-tasks of walking. Module 1 (gluteus medius, vasti, and rectus femoris) primarily contributed to body support in early stance while Module 2 (soleus and gastrocnemius) contributed to both body support and propulsion in late stance. Module 3 (rectus femoris and tibialis anterior) acted to decelerate the leg in early and late swing while generating energy to the trunk throughout swing. Module 4 (hamstrings) acted to absorb leg energy (i.e., decelerate it) in late swing while increasing the leg energy in early stance. Post-hoc analysis revealed an additional module (Module 5: iliopsoas) acted to accelerate the leg forward in pre- and early swing. These results provide evidence that the identified modules can act as basic neural control elements that generate task-specific biomechanical functions to produce well-coordinated walking.     

Muscles that support the body also modulate forward progression during walking

The purpose of this study was to characterize the contributions of individual muscles to forward progression and vertical support during walking. We systematically perturbed the forces in 54 muscles during a three-dimensional simulation of walking, and computed the changes in fore-aft and vertical accelerations of the body mass center due to the altered muscle forces during the stance phase. Our results indicate that muscles that provided most of the vertical acceleration (i.e., support) also decreased the forward speed of the mass center during the first half of stance (vasti and gluteus maximus). Similarly, muscles that supported the body also propelled it forward during the second half of stance (soleus and gastrocnemius). The gluteus medius was important for generating both forward progression and support, especially during single-limb stance. These findings suggest that a relatively small group of muscles provides most of the forward progression and support needed for normal walking. The results also suggest that walking dynamics are influenced by non-sagittal muscles, such as the gluteus medius, even though walking is primarily a sagittal-plane task.     

Phase-dependent responses in locomotor muscles of walking man

Bilateral reflex responses in locomotor muscles were studied in normal human subjects walking on a treadmill. Reflex responses were elicited in response to a momentary resistance applied to one leg. The responses were recorded electromyographically from superficial muscles of both lower limbs: the vastus lateralis, gluteus medius and tibialis anterior. A four-channel storage oscilloscope displayed a quartet record which consisted of phases of the walking cycle and patterns of EMG activity. Resistance and response data were collected for comparison. The appearance of reflex responses was found to be conditioned. The following two observations provide the phase-dependent characteristics of those responses: muscles of the ipsilateral limb elicited responses throughout the walking cycle regardless of whether the muscles were active or silent and muscles of the contralateral limb produced responses that depended on the point at which resistance occurred during the walking cycle. Discusion follows concerning inhibition of the response that may be responsible for this phase-dependent phenomenon.     

Differences in lower-extremity muscular activation during walking between healthy older and young adults

Previous studies have identified differences in gait kinetics between healthy older and young adults. However, the underlying factors that cause these changes are not well understood. The objective of this study was to assess the effects of age and speed on the activation of lower-extremity muscles during human walking. We recorded electromyography (EMG) signals of the soleus, gastrocnemius, biceps femoris, medial hamstrings, tibialis anterior, vastus lateralis, and rectus femoris as healthy young and older adults walked over ground at slow, preferred and fast walking speeds. Nineteen healthy older adults (age, 73 ± 5 years) and 18 healthy young adults (age, 26 ± 3 years) participated. Rectified EMG signals were normalized to mean activities over a gait cycle at the preferred speed, allowing for an assessment of how the activity was distributed over the gait cycle and modulated with speed. Compared to the young adults, the older adults exhibited greater activation of the tibialis anterior and soleus during mid-stance at all walking speeds and greater activation of the vastus lateralis and medial hamstrings during loading and mid-stance at the fast walking speed, suggesting increased coactivation across the ankle and knee. In addition, older adults depend less on soleus muscle activation to push off at faster walking speeds. We conclude that age-related changes in neuromuscular activity reflect a strategy of stiffening the limb during single support and likely contribute to reduced push off power at fast walking speeds.     

Electromyographic characterization of walking behavior initiated spontaneously in crayfish

Crayfish initiate walking behavior not only reflexively in response to external stimuli but also spontaneously in the absence of any specific stimulus. In order to analyze the initiation mechanism underlying these different types of walking, we made simultaneous electromyographic (EMG) recordings from thoracic legs when animals initiated walking, either reflexively or spontaneously, and video recorded their movements synchronously with the EMG recording. Two different stimuli, mechanical and chemical, were used to reflexively induce walking. A non-rhythmic, sustained activation of leg muscles was found to precede the behavioral initiation of either type of walking. The duration of this non-rhythmic muscle activation was significantly longer in the spontaneously initiated walking than in the mechanical stimulus-evoked walking, although no difference was observed between the spontaneous and chemical stimulus-evoked walking. EMG recordings from all eight legs revealed that their non-rhythmic muscle activation occurred almost simultaneously prior to initiation of rhythmical stepping movements. When an animal was suspended without a leg substratum, the timing of muscle activation was more variable among the legs than in the free condition on the substratum. When the circumesophageal commissures were both severed to eliminate signals descending from the brain to the thoracic ganglia, the bilaterally coordinated rhythmic burst activity was not observed in the walking legs. These findings suggest that the spontaneous initiation of walking behavior requires sensory feedback signals from leg proprioceptors, subserved by a different descending activation mechanism from that for stimulus-driven initiation of walking.     

Reliability of surface electromyography for the gluteus medius muscle during gait in people with and without chronic nonspecific low back pain

The purpose of this study was to determine the intratester reliability of surface electromyography (EMG) assessment of the gluteus medius muscle in healthy people and people with chronic nonspecific low back pain (CNLBP) during barefoot walking. Gluteus medius muscle activity was measured twice in 40 people without and 30 people with CNLBP approximately 7 days apart. Walking gluteus medius muscle activity was normalised to maximal voluntary isometric contractions during side-lying hip abduction with manual resistance. Good intratester reliability (ICC > 0.75) was found for mean, peak, and peak to peak amplitude for healthy people. Only mean amplitude demonstrated good intratester reliability in those with CNLBP. Peak amplitude and peak to peak amplitude of the gluteus medius muscle of those with CNLBP, and the time of peak amplitude in both groups, demonstrated moderate reliability (ICC ranged from 0.50 to 0.58). Moderate to large standard error of measurement and minimal detectable change values were reported for outcome measurements. These results suggest that potentially large levels of random error can occur between sessions. Future research can build on this study for those with pathology and attempt to establish change values for EMG that are clinically meaningful.     

Does gender influence neuromotor control of the knee and hip?

Patellofemoral pain (PFP) is a common condition that occurs more frequently in females. Anatomical, hormonal and neuromuscular factors have been proposed to contribute to the increased incidence of PFP in females, with neuromuscular factors considered to be of particular importance. This cross-sectional study aimed to evaluate differences in the neuromotor control of the knee and hip muscles between genders and to investigate whether clinical measures of hip rotation range and strength were associated with EMG measures of hip and thigh motor control. Twenty-nine (16 female and 13 male) asymptomatic participants completed a visual choice reaction-time stair stepping task. EMG activity was recorded from vastus medialis oblique, vastus lateralis, anterior and posterior gluteus medius muscles. In addition hip rotation range of motion and hip external rotation, abduction and trunk strength were assessed. There were no differences in the timing or peak of EMG activation of the vasti or gluteus medius muscle between genders during the stepping task. There were however significant associations between EMG measures of motor control of the vasti and hip strength in both females and males. These findings are suggestive of a link between hip muscle control and vasti neuromotor control.