Trunk kinematic,kinetic, and neuro-muscular response to foot center of pressure translation along the medio-lateral foot axis during gait

Footwear devices that shift foot center of pressure (COP), thereby impacting lower-limb biomechanics to produce clinical benefit, have been studied regarding degenerative diseases of knee and hip joints, exhibiting evidence of clinical success. Ability to purposefully affect trunk biomechanics has not been investigated for this type of footwear. Fifteen healthy young male subjects underwent gait and electromyography analysis using a biomechanical device that shifts COP via moveable convex elements attached to the shoe sole. Analyses were performed in three COP configurations for pairwise comparison: (1) neutral (control) (2) laterally deviated, and (3) medially deviated. Sagittal and frontal-plane pelvis and spine kinematics, external oblique activity, and frontal and transverse-plane lumbar moments were affected by medio-lateral COP shift. Transverse-plane trunk kinematics, activity of the lumbar longissimus, latissimus dorsi, rectus abdominus, and quadratus lumborum, and sagittal-plane lumbar moment, were not significantly impacted. Two linear mixed effects models assessed predictive impact of (I) COP location, and (II) trunk kinematics and neuromuscular activity, on the significant lumbar moment parameters. The COP was a significant predictor of all modeled frontal and transverse-plane lumbar moment parameters, while pelvic and spine rotation, and lumbar longissimus activity were significant predictors of one frontal-plane lumbar moment parameter. Model results suggest that, although trunk biomechanics and muscle activity were altered by COP shift, COP offset influences lumbar kinetics directly, or via lower-limb changes not assessed in this study, but not by means of alteration of trunk kinematics or muscle activity. Further study may reveal implications in treatment of low back pain.     

Implications of increased medio-lateral trunk sway for ambulatory mechanics

The purposes of this study was to test a mechanism to reduce the knee adduction moment by testing the hypothesis that increased medio-lateral trunk sway can reduce the knee adduction moment during ambulation in healthy subjects, and to examine the possibility that increasing medio-lateral trunk sway can produce similar potentially adverse secondary gait changes previously associated with reduced knee adduction moments in patients with knee osteoarthritis. Nineteen healthy adults performed walking trials with normal and increased medio-lateral trunk sway at a self-selected normal walking speed. Standard gait analysis was used to calculate three-dimensional lower extremity joint kinematics and kinetics. Knee and hip adduction moments were lower (-65.0% and -57.1%, respectively) for the increased medio-lateral trunk sway trials than for the normal trunk sway trials. Knee flexion angle at heel-strike was 3 degrees higher for the increased than for the normal trunk sway trials. Knee and hip abduction moments were higher for the increased medio-lateral trunk sway trials, and none of the other variables differed between the two conditions. Walking with increased medio-lateral trunk sway substantially reduces the knee adduction moment during walking in healthy subjects without some of the adverse secondary effects such as increased axial loading rates at the major joints of the lower extremity. This result supports the potential of using gait retraining for walking with increased medio-lateral trunk sway as treatment for patients with degenerative joint disease such as medial compartment knee osteoarthritis.     

Trunk acceleration for neuroprosthetic control of standing: a pilot study

This pilot study investigated the potential of using trunk acceleration feedback control of center of pressure (COP) against postural disturbances with a standing neuroprosthesis following paralysis. Artificial neural networks (ANNs) were trained to use three-dimensional trunk acceleration as input to predict changes in COP for able-bodied subjects undergoing perturbations during bipedal stance. Correlation coefficients between ANN predictions and actual COP ranged from 0.67 to 0.77. An ANN trained across all subject-normalized data was used to drive feedback control of ankle muscle excitation levels for a computer model representing a standing neuroprosthesis user. Feedback control reduced average upper-body loading during perturbation onset and recovery by 42% and peak loading by 29% compared with optimal, constant excitation.     

How do non-muscular torques contribute to the kinetics of postural recovery following a support surface translation?

The common platform translation paradigm used in balance control studies employs a disturbance event that applies non-muscular forces to the body for the duration of the disturbance. Previous research has explored the process of constructing the balance recovery by considering these perturbations to be trigger events, not events with an ongoing force application timeline. The purpose of this study was to quantify the effect of muscular and non-muscular torques on post-perturbation balance with particular interest in the role of the external perturbation in balance recovery. Five young adult males experienced backward translations of the support surface at three different speeds. Integration intervals were defined for each segment and angular impulses were calculated for a period of increasing angular momentum (destabilization), and a period of decreasing angular momentum (restabilization). Destabilization of distal segments was primarily due to impulse generated by the motion of the support surface. For the trunk, however, muscle and motion-dependent sources contributed most to increasing momentum. Restabilization of distal segments was achieved by muscle and platform impulses while trunk restabilization was achieved by muscle and motion-dependent terms in opposition to gravity. Increased platform speed resulted in increased muscular contribution only in the control of the trunk, while demand on distal musculature decreased with change in platform speed as the platform contribution to restabilization increased in these segments. Therefore, impulses from non-muscular sources, including the perturbation itself, are significant modifiers of the response to balance disturbances and must be accounted for in balance research.     

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.     

Effects of tibialis anterior vibration on postural control when exposed to support surface translations

The sensory re-weighting theory suggests unreliable inputs may be down-weighted to favor more reliable sensory information and thus maintain proper postural control. This study investigated the effects of tibialis anterior (TA) vibration on center of pressure (COP) motion in healthy individuals exposed to support surface translations to further explore the concept of sensory re-weighting. Twenty healthy young adults stood with eyes closed and arms across their chest while exposed to randomized blocks of five trials. Each trial lasted 8?s, with TA vibration either on or off. After 2?s, a sudden backward or forward translation occurred. Anterior–posterior (A/P) COP data were evaluated during the preparatory (first 2?s), perturbation (next 3?s), and recovery (last 3?s) phases to assess the effect of vibration on perturbation response features. The knowledge of an impending perturbation resulted in reduced anterior COP motion with TA vibration in the preparatory phase relative to the magnitude of anterior motion typically observed during TA vibration. During the perturbation phase, vibration did not influence COP motion. However, during the recovery phase vibration induced greater anterior COP motion than during trials without vibration. The fact that TA vibration produced differing effects on COP motion depending upon the phase of the perturbation response may suggest that the immediate context during which postural control is being regulated affects A/P COP responses to TA vibration. This indicates that proprioceptive information is likely continuously re-weighted according to the context in order to maintain effective postural control.     

Experimental verification of a computational technique for determining ground reactions in human bipedal stance

We have developed a three-dimensional (3D) biomechanical model of human standing that enables us to study the mechanisms of posture and balance simultaneously in various directions in space. Since the two feet are on the ground, the system defines a kinematically closed-chain which has redundancy problems that cannot be resolved using the laws of mechanics alone. We have developed a computational (optimization) technique that avoids the problems with the closed-chain formulation thus giving users of such models the ability to make predictions of joint moments, and potentially, muscle activations using more sophisticated musculoskeletal models. This paper describes the experimental verification of the computational technique that is used to estimate the ground reaction vector acting on an unconstrained foot while the other foot is attached to the ground, thus allowing human bipedal standing to be analyzed as an open-chain system. The computational approach was verified in terms of its ability to predict lower extremity joint moments derived from inverse dynamic simulations performed on data acquired from four able-bodied volunteers standing in various postures on force platforms. Sensitivity analyses performed with model simulations indicated which ground reaction force (GRF) and center of pressure (COP) components were most critical for providing better estimates of the joint moments. Overall, the joint moments predicted by the optimization approach are strongly correlated with the joint moments computed using the experimentally measured GRF and COP (0.78 < or = r(2) < or = 0.99,median,0.96) with a best-fit that was not statistically different from a straight line with unity slope (experimental=computational results) for postures of the four subjects examined. These results indicate that this model-based technique can be relied upon to predict reasonable and consistent estimates of the joint moments using the predicted GRF and COP for most standing postures.     

Muscle contributions to recovery from forward loss of balance by stepping

The purpose of this study was to determine the muscular contributions to the stepping phase of recovery from forward loss of balance in 5 young and 5 older adults that were able to recover balance in a single step, and 5 older adults that required multiple steps. Forward loss of balance was achieved by releasing participants from a static forward lean angle. All participants were instructed to attempt to recover balance by taking a rapid single step. A scalable anatomical model consisting of 36 degrees-of-freedom was used to compute kinematics and joint moments from motion capture and force plate data. Forces for 94 muscle actuators were computed using static optimisation and induced acceleration analysis was used to compute individual muscle contributions to net lumbar spine joint, and stepping side hip joint and knee joint accelerations during recovery. Older adults that required multiple recovery steps used a significantly shorter and faster initial recovery step and adopted significantly more trunk flexion throughout recovery compared to the older single steppers. Older multiple steppers also produced significantly more force in the stance side hamstrings, which resulted in significantly higher hamstring induced flexion accelerations at the lumbar spine and extension accelerations at the hip. However since the net joint lumbar spine and hip accelerations remained similar between older multiple steppers and older single steppers, we suggest that the recovery strategy adopted by older multiple steppers was less efficient as well as less effective than for older single steppers.     

Balancing on a narrow ridge: biomechanics and control.

The balance of standing humans is usually explained by the inverted pendulum model. The subject invokes a horizontal ground-reaction force in this model and controls it by changing the location of the centre of pressure under the foot or feet. In experiments I showed that humans are able to stand on a ridge of only a few millimetres wide on one foot for a few minutes. In the present paper I investigate whether the inverted pendulum model is able to explain this achievement. I found that the centre of mass of the subjects sways beyond the surface of support, rendering the inverted pendulum model inadequate. Using inverse simulations of the dynamics of the human body, I found that hip-joint moments of the stance leg are used to vary the horizontal component of the ground-reaction force. This force brings the centre of mass back over the surface of support. The subjects generate moments of force at the hip-joint of the swing leg, at the shoulder-joints and at the neck. These moments work in conjunction with a hip strategy of the stance leg to limit the angular acceleration of the head-arms-trunk complex. The synchrony of the variation in moments suggests that subjects use a motor programme rather than long latency reflexes.     

Mechanical model of the recovery from stumbling

Several strategies have been described as a reaction to a stumble during gait. The elevating strategy, which tries to proceed with the perturbed step, was executed as a response to a perturbation during early swing. The lowering strategy, bringing the perturbed leg to the ground and overtaking the obstacle with the contralateral limb, was executed more frequently when the perturbation appeared at mid or late swing. The goal of this paper is to analyze which mechanical factors determine the most advantageous strategy. In order to determine these factors, a mechanical model of the recovery was developed and used to analyze a series of perturbation experiments. It was assumed that the goal of the recovery reaction was to control the trunk as an inverted pendulum during the double-stance phase. In order to be able to control the trunk angle, one foot should be up front and one foot should be behind the hips; otherwise it would be impossible to generate the required trunk torques. The trunk dynamics were expressed in terms of the ground reaction forces and their application point. A larger step (elevation strategy) gives the opportunity to dissolve the perturbation in one step. A small step (lowering strategy) necessarily results in a second quick step, after which the perturbation energy can be dissipated in the second double-stance phase. If a recovery step is too slow, it becomes impossible to counteract the forward flexion of the trunk. It is suggested that a measure of the ability to recover from a stumble could be based on the ability to perform quick steps.     

Evidence for an exposure-response relationship between trunk flexion and impairments in trunk postural control

Prolonged trunk flexion alters passive and active trunk tissue behaviors, and exposure-response relationships between the magnitude of trunk flexion exposure and changes in these behaviors have been reported. This study assessed whether similar exposure-response relationships exist between such exposures and impairments in trunk postural control. Twelve participants (6 M, 6 F) were exposed to three distinct trunk flexion conditions (and a no-flexion control condition), involving different flexion durations with/without an external load, and which induced differing levels of passive tissue creep. Trunk postural control was assessed prior to and immediately following trunk flexion exposures, and during 10 min of standing recovery, by tracking center of pressure (COP) movements during a seated balance task. All COP-based sway measures increased following each flexion exposure. In the anteroposterior direction, these increases were larger with increasing exposure magnitude, whereas such a relationship was not evident for mediolateral sway measures. All measures were fully recovered following 10 min of standing. The present results provide evidence for an exposure-response relationship between trunk flexion exposures and impairments in trunk postural control; specifically, larger impairments following increased exposures (i.e., longer flexion duration and presence of external load). Such impairments in trunk postural control may result from some combination of reduced passive trunk stiffness and altered/delayed trunk reflex responses, and are generally consistent with prior evidence of exposure-dependent alterations in trunk mechanical and neuromuscular behaviors assessed using positional trunk perturbations. Such evidence suggests potential mechanistic pathways through which trunk flexion exposures may contribute to low-back injury risk.     

Individual muscle contributions to knee joint impedance following a sudden perturbation: An in vivo inverted pendulum model

Previous research has suggested that muscle forces, generated by reflexes, contribute to joint stability prior to the more coordinated voluntary muscle forces. The purpose of the current study was to quantify the behaviour of the leg muscles, through the calculation of individual muscle contributions to joint rotational impedance (MJRI), with a specific interest in the neuromuscular contribution in the period following shortly after a sudden knee extension perturbation. The knee was selected as an in vivo system to represent an inverted pendulum model. Kinematic and sEMG data were collected while subjects were in a prone position and exposed to sudden knee extension perturbations. A biomechanical model was used to estimate muscle forces and moments about the knee and these data were then used to calculate instantaneous MJRI. Data indicated that pre-voluntary muscle forces do contribute significantly to MJRI following a sudden knee extension perturbation as there was a 40% increase in total MJRI in the flexion/extension and valgus/varus axes immediately following the perturbation, suggesting their importance in stabilizing the joint immediately after a disturbance. Additionally, knowledge of perturbation timing was shown to increase anticipatory MJRI levels, pre-perturbation (p < 0.05), indicating that it is advantageous for the neuromuscular system to prepare for a sudden disturbance. In conclusion, the data show that the neuromuscular feedback system significantly contributes to MJRI and it is believed that this behaviour enhances joint impedance following a sudden knee extension perturbation.     

Is the trunk movement more perturbed after an asymmetric than after a symmetric perturbation during lifting?

Low back injury is associated with sudden movements and loading. Trunk motion after sudden loading depends on the stability of the spine prior to loading and on the trunk muscle activity in response to the loading. Both factors are not axis-symmetric. Therefore, it was hypothesized that the effects on trunk dynamics would be larger after an asymmetric than after a symmetric perturbation. Ten subjects lifted a crate in which, prior to lifting, a mass was displaced to the front or to the side without the subjects being aware of this. Crate and subject movements, crate reaction forces and muscle activity were recorded. From this, the stability prior to the perturbation was estimated, and the trunk angular kinematics and moments at the lumbo-sacral joint were calculated. Both perturbations only minimally affected the trunk kinematics, although the stability of the spine prior to the lifting movement was higher in the sagittal plane than in the frontal plane. In both conditions the stability appeared to be sufficient to absorb the applied perturbation.     

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.     

Stumbling corrective responses in healthy human subjects to rapid reversal of treadmill direction.

The kinematics of stumbling and recovery induced by a rapidly reversing treadmill is described for eight healthy adults. Stability was achieved in approximately 400 ms following treadmill reversal (initiated at heel-strike) and the ensuing stumble. It appeared to be accomplished primarily by rapid flexion of the thigh and knee of the stance limb, which prevented damage to the knee joint and lowered the trunk, and by extension of the contralateral joints (swing limb), which contacted the ground presumably to deliver an impulsive thrust to counter the backward lean of the trunk. The movements of the ankle also contributed to the recovery from the stumble, but its movements were markedly more variable among the subjects than those of the thigh and knee. The observed kinematics to some extent resembled a crossed-extension reflex, which may have been triggered by muscle, joint, cutaneous or vestibular afferents. These data should provide a baseline by which to compare groups in which recovery from stumbling is known to be deficient (e.g., the elderly).     

Coordination of the leg muscles in backlift and leglift.

Net joint moments are often used to quantify the loading of structures (e.g. the intervertebral disc at L5S1) during lifting. This quantification method is also used to evaluate the loading of the knee, for instance, to determine the effect of backlifting as opposed to leglifting. However, the true loading of the joint as derived from net joint moments can be obscured by a possible co-contraction of antagonists. To unravel the mechanisms that determine the net joint moments in the knee, the leglift was compared to the backlift. Although a completely different net knee moment curve was found when comparing the two lifting techniques, it appeared to be closely related to the ground reaction force vector and its orientation with respect to the joint centre of rotation (R > 0.995). This close relation was established by co-contraction of both flexors and extensors of the knee. Furthermore, a close relation appeared to exist between the joint moment difference between hip and knee and the activity difference between rectus femoris muscle and hamstring (R = 0.72 and 0.83 in leglift and backlift, respectively). The knee-ankle joint moment difference and the activity of the gastrocnemius showed a close relation as well (R = -0.89 and 0.96 in leglift and backlift, respectively). These relations can be interpreted as a mechanism to distribute net moments across joints. It is concluded that during lifting tasks the intermuscular coordination is aimed at coupling of joint moments, such that the ground reaction force points in a direction that provides balance during the movement. The use of net joint moments as direct indicators for joint loading (e.g. knee) seems, therefore, questionable.     

Kinematic, kinetic and EMG patterns during downward squatting.

The aim of this study was to investigate the kinematic, kinetic, and electromyographic pattern before, during and after downward squatting when the trunk movement is restricted in the sagittal plane. Eight healthy subjects performed downward squatting at two different positions, semisquatting (40 degrees knee flexion) and half squatting (70 degrees knee flexion). Electromyographic responses of the vastus medialis oblique, vastus medialis longus, rectus femoris, vastus lateralis, biceps femoris, semitendineous, gastrocnemius lateralis, and tibialis anterior were recorded. The kinematics of the major joints were reconstructed using an optoelectronic system. The center of pressure (COP) was obtained using data collected from one force plate, and the ankle and knee joint torques were calculated using inverse dynamics. In the upright position there were small changes in the COP and in the knee and ankle joint torques. The tibialis anterior provoked the disruption of this upright position initiating the squat. During the acceleration phase of the squat the COP moved posteriorly, the knee joint torque remained in flexion and there was no measurable muscle activation. As the body went into the deceleration phase, the knee joint torque increased towards extension with major muscle activities being observed in the four heads of the quadriceps. Understanding these kinematic, kinetic and EMG strategies before, during and after the squat is expected to be beneficial to practitioners for utilizing squatting as a task for improving motor function.     

Single and multiple step balance recovery responses can be different at first step lift-off following lateral waist-pull perturbations in older adults

An inability to recover lateral balance with a single step is predictive of future falls in older adults. This study investigated if balance stability at first step lift-off (FSLO) would be different between multiple and single stepping responses to lateral perturbations. 54 healthy older adults received left and right waist-pulls at 5 different intensities (levels 1–5). Crossover stepping responses at and above intensity level 3 that induced both single and multiple steps were analyzed. Whole-body center of mass (COM) and center of pressure (COP) positions in the medio-lateral direction with respect to the base of support were calculated. An inverted pendulum model was used to define the lateral stability boundary, which was also adjusted using the COP position at FSLO (functional boundary). No significant differences were detected in the COP positions between the responses at FSLO (p ≥ 0.075), indicating no difference in the functional boundaries between the responses. Significantly smaller stability margins were observed at first step landing for multiple steps at all levels (p ≤ 0.024), while stability margins were also significantly smaller at FSLO for level 3 and 4 (p ≤ 0.048). These findings indicate that although reduced stability at first foot contact would be associated with taking additional steps, stepping responses could also be attributable to the COM motion state as early as first step lift-off, preceding foot contact. Perturbation-based training interventions aimed at improving the reactive control of stability would reduce initial balance instability at first step lift-off and possibly the consequent need for multiple steps in response to balance perturbations.     

Factors underlying the perturbation resistance of the trunk in the first part of a lifting movement

In the first part of lifting movements, the trunk movement is surprisingly resistant to perturbations. This study examined which factors contribute to this perturbation resistance of the trunk during lifting. Three possible mechanisms were studied: force-length-velocity characteristics of muscles, the momentum of the trunk as well as the effect of passive extending of the elbows. A forward dynamics modelling and simulation approach was adopted with two different input signals: (1) stimulation of Hill-type muscles versus (2) net joint moments. Experimental data collected during an unperturbed lifting movement were used as a reference, which a simulated lifting movement had to resemble. Subsequently, the simulated lifting movement was perturbed by applying 10 kg extra mass at the wrist (both before and after lift-off and with/without a fixed elbow), without modifying the input signals. The momentum of the trunk appeared to be insufficient to explain the perturbation resistance of trunk movements as found experimentally. In addition to the momentum of the trunk, the force-length-velocity characteristics of the muscles are necessary to account for the observed perturbation resistance. Initial extension of the elbow due to the mass perturbation delayed the propagation of the load to the shoulder. However, this delay is reduced due to the impedance at the elbow provided by the characteristics of muscles spanning the elbow. So, the force-length-velocity characteristics of the muscles spanning the elbow joint increase the perturbation at the trunk.