Arm reactions in response to an unexpected slip—Impact of aging

Slips and falls represent a serious public safety concern in older adults, with the segment of the United States population over the age of 65 accounting for about three quarters of all fall related deaths. The majority of falls in older adults are due to trips and slips. The objective of this study was to investigate how age affects arm reactions generated in response to unexpected slips. Thirty-three participants divided into two age groups (16 young, 17 old) participated in this study. Participants were exposed to two conditions: known dry walking (baseline) and an unexpected slip initiated when stepping onto a glycerol-contaminated floor. The upper extremity parameters of interest included the timing and amplitude of the shoulder flexion moment generated in response to the slip as well as the resulting angular kinematics (trajectories). The analysis of the kinetic data revealed a delayed shoulder flexion reaction to slips in older adults compared to their young counterparts, as well as a greater flexion moment magnitude. Knowledge of such upper body reaction mechanisms to unexpected slips may help to improve balance recovery training in older adults, as well as aid in the implementation of environmental modifications, e.g. handrails, to reduce falls-related injuries.     

Effects of Forefoot Shoe on Knee and Ankle Loading during Running in Male Recreational Runners

Objectives: Although overuse running injury risks for the ankle and knee are high, the effect of different shoe designs on Achilles tendon force (ATF) and Patellofemoral joint contact force (PTF) loading rates are unclear. Therefore, the primary objective of this study was to compare the ATF at the ankle and the PTF and Patellofemoral joint stress force (PP) at the knee using different running shoe designs (forefoot shoes vs. normal shoes). Methods: Fourteen healthy recreational male runners were recruited to run over a force plate under two shoe conditions (forefoot shoes vs. normal shoes). Sagittal plane ankle and knee kinematics and ground reaction forces were simultaneously recorded. Ankle joint mechanics (ankle joint angle, velocity, moment and power) and the ATF were calculated. Knee joint mechanics (knee joint angle velocity, moment and power) and the PTF and PP were also calculated. Results: No significant differences were observed in the PTF, ankle plantarflexion angle, ankle dorsiflexion power, peak vertical active force, contact time and PTF between the two shoe conditions. Compared to wearing normal shoes, wearing the forefoot shoes demonstrated that the ankle dorsiflexion angle, knee flexion velocity, ankle dorsiflexion moment extension, knee extension moment, knee extension power, knee flexion power and the peak patellofemoral contact stress were significantly reduced. However, the ankle dorsiflexion velocity, ankle plantarflexion velocity, ankle plantarflexion moment and Achilles tendons force increased significantly. Conclusions: These findings suggest that wearing forefoot shoes significantly decreases the patellofemoral joint stress by reducing the moment of knee extension, however the shoes increased the ankle plantarflexion moment and ATF force. The forefoot shoes effectively reduced the load on the patellofemoral joint during the stance phase of running. However, it is not recommended for new and novice runners and patients with Achilles tendon injuries to wear forefoot shoes.     

Fatigue effects on the coordinative pattern during cycling: Kinetics and kinematics evaluation

The aim of the present study was to analyze the net joint moment distribution, joint forces and kinematics during cycling to exhaustion. Right pedal forces and lower limb kinematics of ten cyclists were measured throughout a fatigue cycling test at 100% of PO_MAX. The absolute net joint moments, resultant force and kinematics were calculated for the hip, knee and ankle joint through inverse dynamics. The contribution of each joint to the total net joint moments was computed. Decreased pedaling cadence was observed followed by a decreased ankle moment contribution to the total joint moments in the end of the test. The total absolute joint moment, and the hip and knee moments has also increased with fatigue. Resultant force was increased, while kinematics has changed in the end of the test for hip, knee and ankle joints. Reduced ankle contribution to the total absolute joint moment combined with higher ankle force and changes in kinematics has indicated a different mechanical function for this joint. Kinetics and kinematics changes observed at hip and knee joint was expected due to their function as power sources. Kinematics changes would be explained as an attempt to overcome decreased contractile properties of muscles during fatigue.     

The function of gastrocnemius as a knee flexor at selected knee and ankle angles.

The gastrocnemius has been viewed as an important contributor at the knee joint as a joint flexor and stabilizer across all the knee and ankle joint angles. The purpose of this study was to investigate the influence of knee and ankle joint angles on the knee flexor function of the gastrocnemius. Seventeen participants were tested on a Biodex dynamometer with the gastrocnemius muscle selectively stimulated at a standardized level of electrical current. The results indicated that both ankle and knee joint angle influence the knee joint flexion moment produced by the gastrocnemius. Further analysis revealed that the flexion moment was greatest with the knee joint straight (180 degrees ) across all ankle joint angles. The greatest reduction in knee flexion moment occurred between 180 and 165 degrees of knee angle. No significant difference was observed in the knee flexion moment between 165 degrees and 115 degrees knee flexion, and little knee flexion moment was observed at knee angles of 90 degrees and 75 degrees. The dramatic reduction of moment between 180 degrees and 165 degrees knee angle is possibly due to the change of moment arm while the little moment production during extreme flexion (90 degrees and 75 degrees ) may be due to the reduction of muscle length.     

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

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

Multi-functionality of the cat medical gastrocnemius during locomotion

The functional role of biarticular muscles was investigated based on direct force measurement in the cat medial gastrocnemius (MG) and analysis of hindlimb kinematics and kinetics for the stance phase of level, uphill, and downhill walking. Four primary functional roles of biarticular muscles have been proposed in the past. These functional roles have typically been discussed independently of each other, and biarticular muscles have rarely been assigned more than one functional roles for different phases of the work cycle. The purpose of this study was to elucidate the functional role of the biarticular cat MG during locomotion. It was found that MG forces were primarily associated with the moment requirements at the ankle for most of the stance phase, but also helped to satisfy the moments at the knee in the initial phase of stance. In the second half of stance, MG transferred mechanical energy from the knee to the ankle from the knee to the ankle, while simultaneously producing a substantial amount of mechanical work. Based on these results, we hypothesize that MG's primary function is that of an ankle extensor. However, because of the coupling of the ankle extensor moment with a knee flexor moment in the initial, and a knee extensor moment in the final phase of stance, MG satisfies two joint moments in early stance, and transfers mechanical energy from the knee to the ankle in late stance. We conclude that cat MG has multiple functional roles during the stance phase of locomotion, and speculate that such multi-functionality also exists in other bi- and multi-articular muscles.     

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).     

Neuromuscular changes for hopping on a range of damped surfaces.

Humans hopping and running on elastic and damped surfaces maintain similar center-of-mass dynamics by adjusting stance leg mechanics. We tested the hypothesis that the leg transitions from acting like an energy-conserving spring on elastic surfaces to a power-producing actuator on damped surfaces during hopping due to changes in ankle mechanics. To test this hypothesis, we collected surface electromyography, video kinematics, and ground reaction force while eight male subjects (body mass: 76.2 +/- 1.7 kg) hopped in place on a range of damped surfaces. On the most damped surface, most of the mechanical work done by the leg appeared at the ankle (52%), whereas 23 and 25% appeared at the knee and hip, respectively. Hoppers extended all three joints during takeoff further than they flexed during landing and thereby did more net positive work on more heavily damped surfaces. Also, all three joints reached peak flexion sooner after touchdown on more heavily damped surfaces. Consequently, peak moment occurred during joint extension rather than at peak flexion as on elastic surfaces. These strategies caused the positive work during extension to exceed the negative work during flexion to a greater extent on more heavily damped surfaces. At the muscle level, surface EMG increased by 50-440% in ankle and knee extensors as surface damping increased to compensate for greater surface energy dissipation. Our findings, and those of previous studies of hopping on elastic surfaces, show that the ankle joint is the key determinant of both springlike and actuator-like leg mechanics during hopping in place.     

Predicting the metabolic cost of incline walking from muscle activity and walking mechanics

The goal of this study was to identify which muscle activation patterns and gait features best predict the metabolic cost of inclined walking. We measured muscle activation patterns, joint kinematics and kinetics, and metabolic cost in sixteen subjects during treadmill walking at inclines of 0%, 5%, and 10%. Multivariate regression models were developed to predict the net metabolic cost from selected groups of the measured variables. A linear regression model including incline and the squared integrated electromyographic signals of the soleus and vastus lateralis explained 96% of the variance in metabolic cost, suggesting that the activation patterns of these large muscles have a high predictive value for metabolic cost. A regression model including only the peak knee flexion angle during stance phase, peak knee extension moment, peak ankle plantarflexion moment, and peak hip flexion moment explained 89% of the variance in metabolic cost; this finding indicates that kinematics and kinetics alone can predict metabolic cost during incline walking. The ability of these models to predict metabolic cost from muscle activation patterns and gait features points the way toward future work aimed at predicting metabolic cost when gait is altered by changes in neuromuscular control or the use of an assistive technology.     

Toe-out gait in patients with knee osteoarthritis partially transforms external knee adduction moment into flexion moment during early stance phase of gait: a tri-planar kinetic mechanism

Altered gait kinematics and kinetics are observed in patients with medial compartment knee osteoarthritis. Although various kinematic adaptations are proposed to be compensatory mechanisms that unload the knee, the nature of these mechanisms is presently unclear. We hypothesized that an increased toe-out angle during early stance phase of gait shifts load away from the knee medial compartment, quantified as the external adduction moment about the knee. Specifically, we hypothesized that by externally rotating the lower limb anatomy, primarily about the hip joint, toe-out gait alters the lengths of ground reaction force lever arms acting about the knee joint in the frontal and sagittal planes and transforms a portion of knee adduction moment into flexion moment. To test this hypothesis, gait data from 180 subjects diagnosed with medial compartment knee osteoarthritis were examined using two frames of reference. The first frame was attached to the tibia (reporting actual toe-out) and the second frame was attached to the laboratory (simulating no-toe-out). Four measures were compared within subjects in both frames of reference: the lengths of ground reaction force lever arms acting about the knee joint in the frontal and sagittal planes, and the adduction and flexion components of the external knee moment. The mean toe-out angle was 11.4 degrees (S.D. 7.8 degrees , range -2.2 degrees to 28.4 degrees ). Toe-out resulted in significant reductions in the frontal plane lever arm (-6.7%) and the adduction moment (-11.7%) in early stance phase when compared to the simulated no-toe-out values. These reductions were coincident with significant increases in the sagittal plane lever arm (+33.7%) and flexion moment (+25.0%). Peak adduction lever arm and moment were also reduced significantly in late stance phase (by -22.9% and -34.4%, respectively) without a corresponding increase in sagittal plane lever arm or flexion moment. These results indicate that toe-out gait in patients with medial compartment knee osteoarthritis transforms a portion of the adduction moment into flexion moment in early stance phase, suggesting that load is partially shifted away from the medial compartment to other structures.     

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

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

Resultant lower extremity joint moments in below-knee amputees during running stance

Resultant flexion/extension lower extremity joint moments of four below-knee amputees running between 2.5 and 5.7 m s-1 were computed during stance on their intact and prosthetic limbs. All subjects wore patellar tendon-bearing prostheses with either a SACH or Greissinger foot component. During stance on the prosthesis, the resultant hip extensor moment on the amputated side was greater in magnitude and duration than its counterpart on the intact limb during its corresponding stance period. Since the artificial foot was planted on the ground, such a moment may help control knee flexion and promote knee extension of the residual limb. For the three subjects whose knees continued to flex at the beginning of stance, there was a dominant extensor moment about the knee joint during stance on the prosthesis. By contrast, for the fourth subject whose knee remained straight or hyperextended throughout stance on the prosthesis, a flexor moment was dominant.     

Biomechanical characterization and clinical implications of artificially induced crouch walking: Differences between pure iliopsoas, pure hamstrings and combination of iliopsoas and hamstrings contractures

The purpose of this study was to characterize biomechanically three different crouch walking patterns, artificially induced in eight neurologically intact subjects and to compare them to selected cases of pathological crouch walking. The subjects were equipped with a lightweight mechanical exoskeleton with artificial muscles that acted in parallel with hamstrings and iliopsoas muscles. They walked at a speed of approximately 1m/s along the walkway under four experimental conditions: normal walking (NW), hamstrings contracture emulation (HAM), iliopsoas contracture emulation (IPS) and emulation of both hamstrings and iliopsoas contractures (IPSHAM). Reflective markers and force platform data were collected and ankle, knee and hip-joint angles, moments and powers were calculated. HAM and IPSHAM shifted ankle-angle rotation profiles into dorsiflexion during midstance compared to IPS and NW where ankle-angle trajectories were similar. HAM, IPS and IPSHAM shifted the knee angle of rotation profiles into flexion during stance, compared to NW. IPS and IPSHAM shifted hip angle of rotation profiles toward pronounced flexion while HAM shifted hip angle of rotation profile toward extension, compared to NW. HAM and IPSHAM significantly increased ankle moment during midstance, compared to IPS and NW where ankle moment profiles were similar. All experimental conditions exhibited similar behavior in the knee-moment profiles during midstance while IPS and IPSHAM knee-moment profiles exhibited significantly higher knee-extension moment during terminal stance and pre-swing. In the hip joint all experimental conditions exhibited similar shape of hip moment profiles throughout the gait cycle. HAM and IPS kinematic and kinetic patterns were qualitatively compared to two selected clinical cases, showing considerable similarity. This implies that distinct differences in kinematics and kinetics between HAM, IPS and IPSHAM may be clinically relevant in helping determine the relative contribution of hamstrings and iliopsoas muscles contractures to particular crouch walking.     

Adaptive changes in running kinematics as a function of head stability demands and their effect on shock transmission

This study aimed to identify adaptive changes in running kinematics and impact shock transmission as a function of head stability requirements. Fifteen strides from twelve recreational runners were collected during preferred speed treadmill running. Head stability demands were manipulated through real-time visual feedback that required head-gaze orientation to maintain within boxes of different sizes, ranging from 21° to 3° of visual angle with 3° decrements. The main outcome measures were tibial and head peak accelerations in the time and frequency domains (impact and active phases), shock transmission from tibia to head, stride parameters, and sagittal plane joint kinematics. Increasing head stability requirements resulted in decreases in the amplitude and integrated power of head acceleration during the active phase of stance. During the impact portion of stance tibial and head acceleration and shock transmission remained similar across visual conditions. In response to increased head stability requirements, participants increased stride frequency approximately 8% above preferred, as well as hip flexion angle at impact; stance time and knee and ankle joint angles at impact did not change. Changes in lower limb joint configurations (smaller hip extension and ankle plantar-flexion and greater knee flexion) occurred at toe-off and likely contributed to reducing the vertical displacement of the center of mass with increased head stability demands. These adaptive changes in the lower limb enabled runners to increase the time that voluntary control is allowed without embedding additional impact loadings, and therefore active control of the head orientation was facilitated in response to different visual task constraints.     

Mechanisms of limb collapse following a slip among young and older adults

Recovery from a large perturbation, such as a slip, can be successful when stability of movement can be reestablished with protective stepping. Nevertheless, one dilemma for executing a protective step is that its liftoff can weaken support against limb collapse. This study investigated whether failures in limb support leading to falls after a protective step result from insufficient joint moment generation, and whether such insufficiency is greater among older fallers. A novel, unexpected slip was induced immediately following seat-off during a sit-to-stand. Joint work and mechanical energy were calculated for 43 young (9 falls, 34 recoveries) and 22 older (13 falls, 9 recoveries) adults who responded with a protective step. Comparisons of the work produced at three joints of the bilateral lower limbs revealed that insufficient concentric knee and hip extensor work prior to step liftoff was a primary differentiating factor between falling and recovery, regardless of age. Also, during stepping, fallers regardless of age failed to limit the eccentric knee extensor work at their stance limb sufficiently to retard rapid knee flexion and the consequent potential energy loss. We concluded that young and older fallers had comparable weak limb support. The greater fall incidence among the older adults likely resulted from a greater proportion of subjects who responded to the slip with insufficient knee extensor support, possibly attributable to age-differences in chair-rising. One strategy to address this dilemma may rely on task-specific training to enhance feedforward control that improves movement stability, and thus lessens the reliance on protective stepping.     

All leg joints contribute to quiet human stance: A mechanical analysis

According to the state of the art model (single inverted pendulum) the regulation of quiet human stance seems to be dominated by ankle joint actions. Recent findings substantiated both in-phase and anti-phase fluctuations of ankle and hip joint kinematics can be identified in quiet human stance. Thus, we explored in an experimental study to what extent all three leg joints actually contribute to the balancing problem of quiet human stance. We also aimed at distinguishing kinematic from torque contributions. Thereto, we directly measured ankle, knee, and hip joint kinematics with high spatial resolution and ground reaction forces. Then, we calculated the six respective joint torques and, additionally, the centre of mass kinematics. We searched for high cross-correlations between all these mechanical variables. Beyond confirming correlated anti-phase kinematics of ankle and hip, the main results are: (i) ankle and knee joint fluctuate tightly (torque) coupled and (ii) the bi-articular muscles of the leg are well suited to fulfil the requirements of fluctuations around static equilibrium. Additionally, we (iii) identified high-frequency oscillations of the shank between about 4 and 8 Hz and (iv) discriminated potentially passive and active joint torque contributions. These results demonstrate that all leg joints contribute actively and concertedly to quiet human stance, even in the undisturbed case. Moreover, they substantiate the single inverted pendulum paradigm to be an invalid model for quiet human stance.     

Influence of figure skating skates on vertical jumping performance

The purpose of this study was to investigate the influence of wearing figure skating skates on vertical jump performance and interjoint co-ordinations described in terms of sequencing and timing of joint rotations. Ten national to international figure skaters were filmed while performing a squat jump (SJ) on a force platform. Three experimental conditions were successively realized: barefoot (BF), lifting a 1.5 kg weight (LW) corresponding to the skates' mass, attached on the distal extremity of each leg and wearing skates (SK). Jump height, angular kinematics as well as joints kinetics were calculated. Relative to the SJ height reached in the BF condition, SJ performance was significantly decreased by 2.1 and 5.5 cm in the LW and SK conditions, respectively. The restriction of ankle amplitude imposed by wearing skates was found to significantly limit the knee joint amplitude while the hip angular motion was not affected. Neither the skates' mass nor the limited ankle angular motion modified the proximo-distal organization of joint co-ordination observed when jumping barefoot. However, with plantar flexion restriction, the delay between hip and knee extensions increased while it was reduced between knee and ankle extensions. Work output at the knee and ankle joints were significantly lowered when wearing skates. The decrease of work at the knee was shown to result from an early flexing moment causing a premature deceleration of the knee and from a reduction of knee amplitude. Taken together, these results show a minimization of the participation of the knee when plantar flexion is limited. It was proposed that constraining the distal joint causes a reorganization of interjoint co-ordinations and a redistribution of the energy produced by knee extensors to the hip and ankle joints.     

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.     

A practical solution to reduce soft tissue artifact error at the knee using adaptive kinematic constraints

Musculoskeletal modeling and simulations have vast potential in clinical and research fields, but face various challenges in representing the complexities of the human body. Soft tissue artifact from skin-mounted markers may lead to non-physiological representation of joint motions being used as inputs to models in simulations. To address this, we have developed adaptive joint constraints on five of the six degree of freedom of the knee joint based on in vivo tibiofemoral joint motions recorded during walking, hopping and cutting motions from subjects instrumented with intra-cortical pins inserted into their tibia and femur. The constraint boundaries vary as a function of knee flexion angle and were tested on four whole-body models including four to six knee degrees of freedom. A musculoskeletal model developed in OpenSim simulation software was constrained to these in vivo boundaries during level gait and inverse kinematics and dynamics were then resolved. Statistical parametric mapping indicated significant differences (p < 0.05) in kinematics between bone pin constrained and unconstrained model conditions, notably in knee translations, while hip and ankle flexion/extension angles were also affected, indicating the error at the knee propagates to surrounding joints. These changes to hip, knee, and ankle kinematics led to measurable changes in hip and knee transverse plane moments, and knee frontal plane moments and forces. Since knee flexion angle can be validly represented using skin mounted markers, our tool uses this reliable measure to guide the five other degrees of freedom at the knee and provide a more valid representation of the kinematics for these degrees of freedom.