Biomechanical assessment of sitting pivot transfer tasks using a newly developed instrumented transfer system among long-term wheelchair users

This paper describes the technical characteristics of a transfer assessment system, along with details on three-dimensional (3D) upper extremity (U/E) kinematics required to compute U/E joint forces and moments using inverse dynamics during a displacement of the body in a sitting position from an initial surface to a target one (sitting pivot transfer (SPT)). This system includes five instrumented surfaces designed to measure position (center of pressure (COP)), magnitude and direction of the tri-axial force components underneath the feet, hands (leading and trailing) and buttocks (initial and target seats) during SPTs. Linearity, COP position and natural frequency tests were performed to confirm the accuracy of the transfer assessment system outcomes. Preliminary data of one person with spinal cord injury performing SPTs toward a target seat of same height (50 cm) and additional ones toward a raised target seat (60 cm) are presented. The transfer assessment system was found to be safe, versatile in terms of height- and width-adjustment ranges, portable within a laboratory environment, easy for experienced rehabilitation scientists to use, and allowed for valid quantification of reaction forces during SPTs as confirmed by the overall accuracy test results. Combined with the 3D U/E kinematic and anthropometric parameters, the transfer assessment system outcomes allowed for the quantification of U/E joint forces and moments. Preliminary results highlight the kinematic and kinetic specificities of the leading and trailing shoulders and elbows during SPTs. The impact of modifying target seat heights on the kinematic and kinetic outcomes during SPTs is explored. The transfer assessment framework proposed is useful for research and offers a wide spectrum of possibilities for acquiring new biomechanical knowledge on SPTs that may strengthen clinical practice guidelines, targeting the preservation of U/E integrity following SCI.     

Reduction of neuromuscular redundancy for postural force generation using an intrinsic stability criterion

Postural control requires the coordination of multiple muscles to achieve both endpoint force production and postural stability. Multiple muscle activation patterns can produce the required force for standing, but the mechanical stability associated with any given pattern may vary, and has implications for the degree of delayed neural feedback necessary for postural stability. We hypothesized that muscular redundancy is reduced when muscle activation patterns are chosen with respect to intrinsic musculoskeletal stability as well as endpoint force production. We used a three-dimensional musculoskeletal model of the cat hindlimb with 31 muscles to determine the possible contributions of intrinsic muscle properties to limb stability during isometric force generation. Using dynamic stability analysis we demonstrate that within the large set of activation patterns that satisfy the force requirement for posture, only a reduced subset produce a mechanically stable limb configuration. Greater stability in the frontal-plane suggests that neural control mechanisms are more highly active for sagittal-plane and for ankle joint control. Even when the limb was unstable, the time-constants of instability were sufficiently great to allow long-latency neural feedback mechanisms to intervene, which may be preferential for movements requiring maneuverability versus stability. Local joint stiffness of muscles was determined by the stabilizing or destabilizing effects of moment-arm versus joint angle relationships. By preferentially activating muscles with high local stiffness, muscle activation patterns with feedforward stabilizing properties could be selected. Such a strategy may increase intrinsic postural stability without co-contraction, and may be useful criteria in the force-sharing problem.     

The push force pattern in manual wheelchair propulsion as a balance between cost and effect

We investigate the hypothesis that the direction of the propulsion force in manual wheelchair propulsion can be interpreted as a result of the balance between the mechanical task requirements and the driver's biomechanical possibilities. We quantify the balance at the joint level in the form of an effect-cost criterion, from which we predict the force direction that results in an optimal compromise. Kinematic and dynamic data were collected from nine habitual wheelchair users driving at four velocities (0.83, 1.11, 1.39, 1.67 m/s) and three external power levels (10, 20, 30 W). Experimental data and predictions are in good agreement in the middle and final part of the push; the effect-cost value in this region approximates the achievable maximum. Early in the push the effect-cost criterion predicts an upwards propulsion force whereas the experimental force is downwards, the difference probably being mainly attributable to the force generation dynamics of the muscles. As a result of the geometric features of large-rim manual wheelchairs, the mechanically required and biomechanically preferred force directions are not in accordance during a substantial part of the push, making even the best compromise a poor one. This may contribute to the low mechanical efficiency of manual wheelchair propulsion and the high incidence of shoulder complaints.     

Postural and dynamic balance while walking in adults with incomplete spinal cord injury

The purpose of this study was to characterize balance in individuals with and without an incomplete spinal cord injury (ISCI) during the single support phase of gait. Thirty-four individuals (17 with a ISCI, 17 able-bodied) walked at their self-selected walking speed. Among those, eighteen individuals (9 with ISCI, 9 able-bodied) with a similar walking speed were also analyzed. Stabilizing and destabilizing forces quantified balance during the single support phase of gait. The biomechanical factors included in the equation of the stabilizing and destabilizing forces served as explanatory factors. Individuals with ISCI had a lower stabilizing force and a higher destabilizing force compared to able-bodied individuals. The main explanatory factors of the forces extracted from the equations were the speed of the center of mass (maximal stabilizing force) and the distance between the center of pressure and the base of support (minimal destabilizing force). Only the minimal destabilizing force was significantly different among subgroups with a similar walking speed. The stabilizing and destabilizing forces suggest that individuals with ISCI were more stable than able-bodied, which was achieved by walking more slowly – which decrease the speed of the center of mass – and keeping the center of pressure away from the margin of the base of support in order to maintain balance within their range of physical ability.     

Association between knee extensor force steadiness and postural stability against mechanical perturbation in patients with Parkinson’s disease

ObjectiveLower extremity force steadiness has been shown to decrease with aging and neuromotor dysfunction and to be associated with physical function and fall. Although patients with Parkinson’s disease (PD) experience decreased force steadiness, whether the extent of force steadiness differs according to target force or whether this steadiness is associated with postural control remain unclear. Therefore, this study aimed to compare the force steadiness while steadily exerting low and moderate levels of knee extensor force between individuals with and without PD and to examine the association between force steadiness and postural instability against mechanical perturbation in PD.MethodsA total of 33 patients with PD (mean age, 71.7 years) and 33 healthy controls (72.2 years) participated in this study. Participants with PD were classified into postural stability or instability groups based on the Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale motor exam item 12. Participants performed steady task of the knee isometric extension at two levels (10% and 50% of maximal voluntary contraction [MVC]).ResultsForce steadiness at 10% MVC was lower in postural instability group than that in the control and postural stability groups (P < 0.05) after adjusting for age, sex, and body mass index, whereas it was not significantly different at 50% MVC among the three groups.DiscussionThese results suggest that the knee extensor force steadiness is affected in patients with PD having postural instability against mechanical perturbation during low intensity force exertion and is not affected regardless of the presence of postural instability during moderate intensity force exertion.     

Molecular characterization of membrane-associated soluble serine palmitoyltransferases from Sphingobacterium multivorum and Bdellovibrio stolpii

Serine palmitoyltransferase (SPT) is a key enzyme in sphingolipid biosynthesis and catalyzes the decarboxylative condensation of l-serine and palmitoyl coenzyme A (CoA) to form 3-ketodihydrosphingosine (KDS). Eukaryotic SPTs comprise tightly membrane-associated heterodimers belonging to the pyridoxal 5'-phosphate (PLP)-dependent alpha-oxamine synthase family. Sphingomonas paucimobilis, a sphingolipid-containing bacterium, contains an abundant water-soluble homodimeric SPT of the same family (H. Ikushiro et al., J. Biol. Chem. 276:18249-18256, 2001). This enzyme is suitable for the detailed mechanistic studies of SPT, although single crystals appropriate for high-resolution crystallography have not yet been obtained. We have now isolated three novel SPT genes from Sphingobacterium multivorum, Sphingobacterium spiritivorum, and Bdellovibrio stolpii, respectively. Each gene product exhibits an approximately 30% sequence identity to both eukaryotic subunits, and the putative catalytic amino acid residues are conserved. All bacterial SPTs were successfully overproduced in Escherichia coli and purified as water-soluble active homodimers. The spectroscopic properties of the purified SPTs are characteristic of PLP-dependent enzymes. The KDS formation by the bacterial SPTs was confirmed by high-performance liquid chromatography/mass spectrometry. The Sphingobacterium SPTs obeyed normal steady-state ordered Bi-Bi kinetics, while the Bdellovibrio SPT underwent a remarkable substrate inhibition at palmitoyl CoA concentrations higher than 100 microM, as does the eukaryotic enzyme. Immunoelectron microscopy showed that unlike the cytosolic Sphingomonas SPT, S. multivorum and Bdellovibrio SPTs were bound to the inner membrane of cells as peripheral membrane proteins, indicating that these enzymes can be a prokaryotic model mimicking the membrane-associated eukaryotic SPT.     

Drag force mechanical power during an actual propulsion cycle on a manual wheelchair

The object of this study was to compute the mechanical power of the resultant braking force during an actual propulsion cycle with a manual wheelchair on the field. The resultant braking force was calculated from a mechanical model taking into account the rolling resistances of the front and rear wheels. Both the resultant braking force and the wheelchair velocity were not constant during the propulsion cycle and varied according to the subject's fore-and-aft and vertical movements in the wheelchair. These variations had logical repercussions on the braking force mechanical power, which ranged from 20.6 to 34.5 W (mean = 29.6 W) during the propulsion cycle. The mechanical power was also calculated from the conditions of a classical drag test, by the product of the cycle mean velocity and a constant braking force corresponding to a 60% rear wheels distribution of the subject-and-wheelchair's weight. This second mechanical power (32.4 W) was 10% higher than the average of the instantaneous power. Beyond the need of a clear definition of the two phases of the propulsion cycle, this study showed that the assumption on wheelchair locomotion usually admitted on laboratory ergometers cannot be applied in field studies, and that the kinetic energy variations during the cycle propulsive phase should be considered for evaluating the subject's mechanical work and power.     

Postural control of trunk during unstable sitting

A method for quantifying postural control of the lumbar spine during unstable sitting was developed. The unstable seat apparatus was equipped with leg and foot supports to isolate the control of the lumbar spine and trunk from the adjustments in the lower body joints. Polyester resin hemispheres with decreasing diameters were attached to the bottom of the seat to achieve increasing levels of task difficulty. The seat was placed on a force plate at the edge of a table and the participating subjects were instructed to maintain their balance while sitting on the seat. Coordinates of center of pressure (CoP) were recorded and quantified with summary statistics and random walk analysis. The CoP movement increased significantly with increased seat instability (task difficulty) (p<0.01). Stabilogram plots of the CoP movement revealed short and long-term regions consistent with the hypothesis that the two regions reflect open and closed-loop postural control mechanisms. Repeatability of the CoP parameters was excellent for the summary statistics and the short-term random walk coefficients (0.77<R<0.96). It was fair for the long-term diffusion coefficients (0.56<R<0.57) and poor for the long-term scaling exponents (0.14<R<0.40). Summary statistics of the CoP movement were positively correlated with body weight (0.69<R<0.73) and the T9 to L4/L5 distance (0.43<R<0.54) of the subjects. This method can be applied to study the deficits in postural control of the lumbar spine in low-back pain population.     

Electromyographic patterns of upper extremity muscles during sitting pivot transfers performed by individuals with spinal cord injury

Although substantial upper extremity (U/E) muscular efforts are required when individuals with spinal cord injury (SCI) perform sitting pivot transfers, little is known about the electromyographic (EMG) activation patterns of key shoulder and elbow muscles solicited during the performance of this functional task. The aims of this study were to examine the EMG activation patterns of U/E muscles in 10 males with SCI, and to compare them across sitting pivot transfers performed toward seats of different heights (low, same, high). EMG data from the biceps, triceps, deltoid, pectoralis major and latissimus dorsi were recorded bilaterally. Transfers were divided into pre-lift, lift, and post-lift phases. Each phase was time- and amplitude-normalized using a mean dynamic EMG approach. Similar EMG activation patterns were found across the different transfers for all muscles (r_mean = 0.942–0.991), whereas moderate to high inter-subject variability (CV: 20.9–70.6%) was reported for the different muscles and transfers. Peak EMG occurred earlier at the trailing U/E compared to the leading one, and was observed around seat-off for most of the muscles. When transfer to a high target seat was compared to transfer to one of the same height, significantly higher relative EMG values were observed at the biceps (mean: 1.64 vs. 1.00) of the leading U/E as well as the deltoid (mean: 1.20 vs. 1.00) and pectoralis major (mean: 1.20 vs. 1.00; peak: 2.27 vs. 1.79) of the trailing U/E. Transferring to a low target seat did not lead to lower muscular demand than transferring to one of the same height (P > 0.05). These results indicate that coordinated and higher muscular efforts were generated at the trailing deltoid and pectoralis major when transferring to a high target seat compared to one of similar height. Higher muscular efforts were also developed at the leading biceps when transferring to a high target seat compared to a leveled one. Lowering the target seat with respect to the initial seat had no favorable effect on muscular demand.     

Structural, mechanistic and regulatory studies of serine palmitoyltransferase

SLs (sphingolipids) are composed of fatty acids and a polar head group derived from L-serine. SLs are essential components of all eukaryotic and many prokaryotic membranes but S1P (sphingosine 1-phosphate) is also a potent signalling molecule. Recent efforts have sought to inventory the large and chemically complex family of SLs (LIPID MAPS Consortium). Detailed understanding of SL metabolism may lead to therapeutic agents specifically directed at SL targets. We have studied the enzymes involved in SL biosynthesis; later stages are species-specific, but all core SLs are synthesized from the condensation of L-serine and a fatty acid thioester such as palmitoyl-CoA that is catalysed by SPT (serine palmitoyltransferase). SPT is a PLP (pyridoxal 5'-phosphate)-dependent enzyme that forms 3-KDS (3-ketodihydrosphingosine) through a decarboxylative Claisen-like condensation reaction. Eukaryotic SPTs are membrane-bound multi-subunit enzymes, whereas bacterial enzymes are cytoplasmic homodimers. We use bacterial SPTs (e.g. from Sphingomonas) to probe their structure and mechanism. Mutations in human SPT cause a neuropathy [HSAN1 (hereditary sensory and autonomic neuropathy type?1)], a rare SL metabolic disease. How these mutations perturb SPT activity is subtle and bacterial SPT mimics of HSAN1 mutants affect the enzyme activity and structure of the SPT dimer. We have also explored SPT inhibition using various inhibitors (e.g. cycloserine). A number of new subunits and regulatory proteins that have a direct impact on the activity of eukaryotic SPTs have recently been discovered. Knowledge gained from bacterial SPTs sheds some light on the more complex mammalian systems. In the present paper, we review historical aspects of the area and highlight recent key developments.     

Wheelchair propulsion demands during outdoor community ambulation

ObjectiveQuantify manual wheelchair propulsion effort during outdoor community ambulation.DesignCase series.SubjectsThirteen individuals (12 with SCI, 1 with spina bifida) who were experienced manual wheelchair users and had no current upper extremity injury or pain complaints.MethodsMeasurements were obtained from instrumented wheelchair rims during steady-state propulsion as subjects traversed outdoor concrete sidewalk terrain that included smooth level, aggregate level, and a ramp with a smooth surface. Propulsion effort was assessed using the average propulsion moment, average instantaneous power, and work for both upper extremities.ResultsPropulsion effort, captured by the propulsion moment, work and power, varied across ground conditions (p < 0.001). Propulsion effort was greater as the rolling resistance increased (i.e., smooth versus aggregate surfaces) and as the inclination angle progressed from level to inclined surfaces. There were no side-to-side differences across ground conditions for the propulsion moment or work. Power generation was significantly greater on the dominant compared to the non-dominant extremity during the more challenging aggregate surface and ramp conditions.ConclusionsPropulsion effort varies with demands imposed by different ground conditions. Quantification of wheelchair propulsion demands provides rehabilitations specialists with objective information to guide treatment of patients adapting to manual wheelchair use.     

Support force measures of midsized men in seated positions

Two areas not well researched in the field of seating mechanics are the distribution of normal and shear forces, and how those forces change with seat position. The availability of these data would be beneficial for the design and development of office, automotive and medical seats. To increase our knowledge in the area of seating mechanics, this study sought to measure the normal and shear loads applied to segmental supports in 12 seated positions, utilizing three inclination angles and four levels of seat back articulation that were associated with automotive driving positions. Force data from six regions, including the thorax, sacral region, buttocks, thighs, feet, and hand support were gathered using multi-axis load cells. The sample contained 23 midsized subjects with an average weight of 76.7 kg and a standard deviation of 4.2 kg, and an average height of 1745 mm with a standard deviation of 19 mm. Results were examined in terms of seat back inclination and in terms of torso articulation for relationships between seat positions and support forces. Using a repeated measures analysis, significant differences (p<0.05) were identified for normal forces relative to all inclination angles except for forces occurring at the hand support. Other significant differences were observed between normal forces behind the buttocks, pelvis, and feet for torso articulations. Significant differences in the shear forces occurred under the buttocks and posterior pelvis during changes in seat back inclination. Significant differences in shear forces were also identified for torso articulations. These data suggest that as seat back inclination or torso articulation change, significant shifts in force distribution occur.     

Destabilizing and stabilizing forces to assess equilibrium during everyday activities

Postural stability is essential to functional activities. This paper presents a new model of dynamic stability which takes into account both the equilibrium associated with the body position over the base of support (destabilizing force) and the effort the subject needs to produce to keep his/her centre of mass inside the base of support (stabilizing force). The ratio between these two forces (destabilizing over stabilizing) is calculated to provide an overall index of stability for an individual. Preliminary results from data collected during walking at preferred and maximal safe speed in four older adults (aged from 64 to 84 yr) showed that both forces are lower for subjects with reduced maximal gait speed. In addition, the stabilizing force increases by 2–3 times from preferred to maximal speed, while the destabilizing force barely changes with gait speed. Overall, the model through the index of stability attributes lower dynamic stability to subjects with lower maximal gait speed. These preliminary results call for larger-scale studies to pursue the development and validation of the model and its application to different functional tasks.     

Ascending curbs of progressively higher height increases forward trunk flexion along with upper extremity mechanical and muscular demands in manual wheelchair users with a spinal cord injury

High upper extremity (U/E) demands are required when manual wheelchair users (MWUs) with spinal cord injury (SCI) ascend curbs; this may contribute to the risk of developing U/E musculoskeletal impairments. The aim of this study was to compare movement strategies (kinematics), mechanical loads (kinetics) and muscular demand (EMG) at the non-dominant U/E among 15 MWUs with SCI when ascending curbs of 4 cm (3 trials), 8 cm (3 trials) and 12 cm high (3 trials) from a starting line set 3 m before the curb. Biomechanical data was collected during three trials for each height. The curb ascent task was divided into three adjustment phases: caster pop, rear-wheel ascent and post-ascent. The greatest effort was generated by the shoulder flexors and internal rotators as well as the elbow flexors. A significant difference (p < 0.0167) between the curb heights was found for most outcome measures studied: movement excursion, net joint moments and muscular utilization ratio (MUR) of the main muscles increased with the higher curb heights, mainly around the shoulder joint. These results provide insight that aside from adhering to a highly structured training method for wheelchair curb ascent, rehabilitation professionals need to propose task-specific strength training programs based on the demands documented in this study and continue to advocate for physically accessible environments.     

Predicting helical segments in proteins by a helix-coil transition theory with parameters derived from a structural database of proteins

A novel helix-coil transition theory has been developed. This new theory contains more types of interactions than similar theories developed earlier. The parameters of the models were obtained from a database of 351 nonhomologous proteins. No manual adjustment of the parameters was performed. The interaction parameters obtained in this manner were found to be physically meaningful, consistent with current understanding of helix stabilizing/destabilizing interactions. Novel insights into helix stabilizing/destabilizing interactions have also emerged from this analysis. The theory developed here worked well in sorting out helical residues from amino acid sequences. If the theory was forced to make prediction on every residue of a given amino acid sequence, its performance was the best among ten other secondary structural prediction algorithms in distinguishing helical residues from nonhelical ones. The theory worked even better if one only required it to make prediction on residues that were “predictable” (identifiable by the theory); >90% predictive reliability could be achieved. The helical residues or segments identified by the helix-coil transition theory can be used as secondary structural contraints to speed up the prediction of the three-dimensional structure of a protein by reducing the dimension of a computational protein folding problem. Possible further improvements of this helix-coil transition theory are also discussed. Proteins 28:344–359, 1997. © 1997 Wiley-Liss, Inc.     

The role of motor unit rate modulation versus recruitment in repeated submaximal voluntary contractions performed by control and spinal cord injured subjects.

The relative roles of motor unit firing rate modulation and recruitment were evaluated when individuals with cervical spinal cord injury (SCI) and able-bodied controls performed a brief (6 s), 50% maximal voluntary contraction (50% MVC; target contraction) of triceps brachii every 10 s until it required maximal effort to achieve the target force. Mean (+/-SD) endurance times for SCI and control subjects were 34+/-26 and 15+/-5 min, respectively, at which point significant reductions in maximal triceps force had occurred. Twitch occlusion analysis in controls indicated that force declines resulted largely from peripheral contractile failure. In SCI subjects, triceps surface EMG and motor unit potential amplitude declined in parallel suggesting failure at axon branch points and/or alterations in muscle membrane properties. The force of low threshold units, measured by spike-triggered averaging, declined in SCI but not control subjects, suggesting that higher threshold units fatigued in controls. Central fatigue was also obvious after SCI. Mean (+/-SD) MVC motor unit firing rates declined significantly with fatigue for control (24.6+/-7.1 to 17.3+/-5.1Hz), but not SCI subjects (25.9+/-12.7 to 20.1+/-9.7Hz). Unit firing rates were unchanged during target contractions for each subject group, but with the MVC rate decreases, units of SCI and control subjects were activated intensely at endurance time (88% and 99% MVC rates, respectively). New unit recruitment also maintained the target contractions although it was limited after SCI because many descending inputs to triceps motoneurons were disrupted. This resulted in sparse EMG, even during MVCs, but allowed the same unit to be recorded throughout. These EMG data showed that both unit recruitment and rate modulation were important for maintaining force during repeated submaximal intermittent contractions of triceps brachii muscles performed by SCI subjects. Similar results were found for control subjects. Muscles weakened by SCI may therefore provide a useful model in which to directly study motor unit rate modulation and recruitment during weak or strong voluntary contractions.     

Role of a conserved arginine residue during catalysis in serine palmitoyltransferase

All sphingolipid-producing organisms require the pyridoxal 5'-phosphate (PLP)-dependent serine palmitoyltransferase (SPT) to catalyse the first reaction on the de novo sphingolipid biosynthetic pathway. SPT is a member of the alpha oxoamine synthase (AOS) family that catalyses a Claisen-like condensation of palmitoyl-CoA and L-serine to form 3-ketodihydrosphingosine (KDS). Protein sequence alignment across various species reveals an arginine residue, not involved in PLP binding, to be strictly conserved in all prokaryotic SPTs, the lcb2 subunits of eukaryotic SPTs and all members of the AOS family. Here we use UV-vis spectroscopy and site-directed mutagenesis, in combination with a substrate analogue, to show that the equivalent residue (R370) in the SPT from Sphingomonas wittichii is required to form the key PLP:L-serine quinonoid intermediate that condenses with palmitoyl-CoA and thus plays an essential role enzyme catalysis.