Trajectory of the center of rotation in non-articulated energy storage and return prosthetic feet

Non-articulated energy storage and return prosthetic feet lack any true articulation or obvious point of rotation. This makes it difficult to select a joint center about which to estimate their kinetics. Despite this absence of any clear point of rotation, methods for estimating the kinetic performance of this class of prosthetic feet typically assume that they possess a fixed center of rotation and that its location is well approximated by the position of the contralateral lateral malleolus. To evaluate the validity of this assumption we used a finite helical axis approach to determine the position of the center of rotation in the sagittal plane for a series of non-articulated energy storage and return prosthetic feet. We found that over the course of stance phase, the sagittal finite helical axis position diverged markedly from the typically assumed fixed axis location. These results suggest that researchers may need to review center of rotation assumptions when assessing prosthetic foot kinetics, while clinicians may need to reconsider the criteria by which they prescribe these prosthetic feet.     

Joint moment and muscle power output characteristics of below knee amputees during running: the influence of energy storing prosthetic feet

Stance phase joint moments, muscle power outputs and mechanical energy characteristics were determined in five normal and five below knee amputee subjects running at 2.8 m s-1. The amputees were studied sequentially on three different prosthetic feet: the SACH foot (solid ankle cushion heel), and two energy storing feet, Seattle and Flex. While wearing the SACH foot, the amputees exhibited major alterations in the distribution and magnitude of muscle power output and muscle work: (1) the total work done by the lower extremity was reduced; (2) the hip extensors became the main source of energy absorption and generation, while in normal subjects the ankle plantarflexors were the major energy generators and the knee extensors the major energy absorbers; (3) the eccentric and concentric knee extensor power outputs were reduced and an abnormal concentric knee flexor power output was noted immediately after heel contact. In four of the amputees, energy storing feet resulted in improvements in the power output and mechanical work characteristics of the lower extremity: (1) the energy storing prosthetic feet generated 2-3 times greater energy than the SACH foot; (2) with the Flex foot the amputees exhibited a more normal pattern and magnitude of hip and knee extensor muscle work. One of the subjects, however, exhibited increased abnormalities with the energy storing prosthetic feet. The amount of energy restored relative to the amount of energy absorbed by each of the prosthetic feet was greater with the energy storing feet than the SACH foot (Flex 84%, Seattle 52%, SACH 31%).     

A methodology for studying the effects of various types of prosthetic feet on the biomechanics of trans-femoral amputee gait.

This paper reports on a methodology developed for studying the effects of various types of prosthetic feet on the gait of trans-femoral amputees. It is shown that an analysis in three planes of motion of not only the prosthetic, but also the sound limb provides important information on the performance of prosthetic feet. Two male trans-femoral amputees were tested with four different prosthetic feet; the Springlite II, Carbon Copy III, Seattle LightFoot and the Multiflex foot. A detailed analysis of the results of one amputee and a summary of the most important results of a second subject is presented. The tests were carried out at normal (1.16 m s(-1)) and fast (1.56 m s(-1)) walking speeds. Three dimensional gait analysis was carried out to derive the time curves of the joint angles, intersegmental moments and power at the ankle, knee and hip joints at both the prosthetic and sound sides. A higher first peak of the ground reaction force at the sound side with the Seattle LightFoot compared to that with the Springlite II, may be the result of the lower late stance dorsiflexion angle with the former. Compared to the other two feet, the Carbon Copy III and the Springlite II showed higher prosthetic dorsiflexing moments and positive power at late stance, which could assist in the push-off. The 3D intersegmental loads at the ankle and knee can be used as a guide for design and for compilation of standards for testing of lower limb prostheses incorporating flexible feet.     

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.     

Significance of nonsagittal power terms in analysis of a dynamic elastic response prosthetic foot.

Dynamic elastic response prosthetic feet generally utilize a solid ankle, limiting dominant motion to the sagittal plane. However, researchers often use total rotational ankle joint power in the analysis of these feet. This investigation measured joint power terms in each plane for the Carbon Copy High Performance prosthetic foot. The significance of the frontal and transverse plane terms was assessed. Addition of these terms to the dominant sagittal power term revealed only slight differences, indicating that the sagittal power term is likely sufficient.     

Influence of the 3D inverse dynamic method on the joint forces and moments during gait

The joint forces and moments are commonly used in gait analysis. They can be computed by four different 3D inverse dynamic methods proposed in the literature, either based on vectors and Euler angles, wrenches and quaternions, homogeneous matrices, or generalized coordinates and forces. In order to analyze the influence of the inverse dynamic method, the joint forces and moments were computed during gait on nine healthy subjects. A ratio was computed between the relative dispersions (due to the method) and the absolute amplitudes of the gait curves. The influence of the inverse dynamic method was negligible at the ankle (2%) but major at the knee and the hip joints (40%). This influence seems to be due to the dynamic computation rather than the kinematic computation. Compared to the influence of the joint center location, the body segment inertial parameter estimation, and more, the influence of the inverse dynamic method is at least of equivalent importance. This point should be confirmed with other subjects, possibly pathologic, and other movements.     

Ankle and foot power in gait analysis: Implications for science,technology and clinical assessment

In human gait analysis studies, the entire foot is typically modeled as a single rigid-body segment; however, this neglects power generated/absorbed within the foot. Here we show how treating the entire foot as a rigid body can lead to misunderstandings related to (biological and prosthetic) foot function, and distort our understanding of ankle and muscle-tendon dynamics. We overview various (unconventional) inverse dynamics methods for estimating foot power, partitioning ankle vs. foot contributions, and computing combined anklefoot power. We present two case study examples. The first exemplifies how modeling the foot as a single rigid-body segment causes us to overestimate (and overvalue) muscle-tendon power generated about the biological ankle (in this study by up to 77%), and to misestimate (and misinform on) foot contributions; corroborating findings from previous multi-segment foot modeling studies. The second case study involved an individual with transtibial amputation walking on 8 different prosthetic feet. The results exemplify how assuming a rigid foot can skew comparisons between biological and prosthetic limbs, and lead to incorrect conclusions when comparing different prostheses/interventions. Based on analytical derivations, empirical findings and prior literature we recommend against computing conventional ankle power (between shank-foot). Instead, we recommend using an alternative estimate of power generated about the ankle joint complex (between shank-calcaneus) in conjunction with an estimate of foot power (between calcaneus-ground); or using a combined anklefoot power calculation. We conclude that treating the entire foot as a rigid-body segment is often inappropriate and ill-advised. Including foot power in biomechanical gait analysis is necessary to enhance scientific conclusions, clinical evaluations and technology development.     

Biomechanical attributes of lunging activities for older adults

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

Walking with increased ankle pushoff decreases hip muscle moments

In a simple bipedal walking model, an impulsive push along the trailing limb (similar to ankle plantar flexion) or a torque at the hip can power level walking. This suggests a tradeoff between ankle and hip muscle requirements during human gait. People with anterior hip pain may benefit from walking with increased ankle pushoff if it reduces hip muscle forces. The purpose of our study was to determine if simple instructions to alter ankle pushoff can modify gait dynamics and if resulting changes in ankle pushoff have an effect on hip muscle requirements during gait. We hypothesized that changes in ankle kinetics would be inversely related to hip muscle kinetics. Ten healthy subjects walked on a custom split-belt force-measuring treadmill at 1.25m/s. We recorded ground reaction forces and lower extremity kinematic data to calculate joint angles and internal muscle moments, powers and angular impulses. Subjects walked under three conditions: natural pushoff, decreased pushoff and increased pushoff. For the decreased pushoff condition, subjects were instructed to push less with their feet as they walked. Conversely, for the increased pushoff condition, subjects were instructed to push more with their feet. As predicted, walking with increased ankle pushoff resulted in lower peak hip flexion moment, power and angular impulse as well as lower peak hip extension moment and angular impulse (p<0.05). Our results emphasize the interchange between hip and ankle kinetics in human walking and suggest that increased ankle pushoff during gait may help to compensate for hip muscle weakness or injury and reduce hip joint forces.     

Ground reaction forces and lower-limb joint kinetics of turning gait in typically developing children

Turning is a common locomotor task essential to daily activity; however, very little is known about the forces and moments responsible for the kinematic adaptations occurring relative to straight-line gait in typically developing children. Thus, the aims of this study were to analyse ground reaction forces (GRFs), ground reaction free vertical torque (T_Z), and the lower-limb joint kinetics of 90° outside (step) and inside (spin) limb turns. Step, spin, and straight walking trials from fifty-four typically developing children were analysed. All children were fit with the Plug-in Gait and Oxford Foot Model marker sets while walking over force plates embedded in the walkway. Net internal joint moments and power were computed via a standard inverse dynamics approach. All dependent variables were statistically analysed over the entire curves using the mean difference 95% bootstrap confidence band approach. GRFs were directed medially for step turns and laterally for spin turns during the turning phase. Directions were reversed and magnitudes decreased during the approach phase. Step turns showed reduced ankle power generation, while spin turns showed large T_Z. Both strategies required large knee and hip coronal and transverse plane moments during swing. These kinetic differences highlight adaptations required to maintain stability and reorient the body towards the new walking direction during turning. From a clinical perspective, turning gait may better reveal weaknesses and motor control deficits than straight walking in pathological populations, such as children with cerebral palsy, and could potentially be implemented in standard gait analysis sessions.     

Ankle and midfoot kinetics during normal gait: a multi-segment approach

Multi-segment foot models are increasingly being used to evaluate intra and inter-segment foot kinematics such as the motion between the hindfoot/tibia (ankle) and the forefoot/hindfoot (midfoot) during walking. However, kinetic analysis have been mainly restricted to one-segment foot models and could be improved by considering a multi-segment approach. Therefore, the aims of this study were to (1) implement a kinetic analysis of the ankle and theoretical midfoot joints using the existing Oxford Foot Model (OFM) through a standard inverse dynamics approach using only marker, force plate and anthropometric data and (2) to compare OFM ankle joint kinetics to those output by the one-segment foot plugin-gait model (PIG). 10 healthy adolescents fitted with both the OFM and PIG markers performed barefoot comfortable speed walking trials over an instrumented walkway. The maximum ankle power generation was significantly reduced by approximately 40% through OFM calculations compared to PIG estimates (p<0.001). This result was not caused by a decrease in OFM computed joint moments, but by a reduction in the angular velocity between the tibia/hindfoot (OFM) compared to the tibia/foot (PIG) (p<0.001). Additionally, analysis revealed considerable midfoot loading. One-segment foot models overestimate ankle power, and may also overestimate the contribution of the triceps surae. A multi-segment approach may help quantify the important contribution of the midfoot ligaments and musculature to power generation. We therefore recommend the use of multi-segment foot models to estimate ankle and midfoot kinetics, especially when surgical decision-making is based on the results of three-dimensional gait analysis.     

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

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

Higher medially-directed joint reaction forces are a characteristic of dysplastic hips: A comparative study using subject-specific musculoskeletal models

Acetabular dysplasia is a known cause of hip osteoarthritis. In addition to abnormal anatomy, changes in kinematics, joint reaction forces (JRFs), and muscle forces could cause tissue damage to the cartilage and labrum, and may contribute to pain and fatigue. The objective of this study was to compare lower extremity joint angles, moments, hip JRFs and muscle forces during gait between patients with symptomatic acetabular dysplasia and healthy controls. Marker trajectories and ground reaction forces were measured in 10 dysplasia patients and 10 typically developing control subjects. A musculoskeletal model was scaled in OpenSim to each subject and subject-specific hip joint centers were determined using reconstructions from CT images. Joint kinematics and moments were calculated using inverse kinematics and inverse dynamics, respectively. Muscle forces and hip JRFs were estimated with static optimization. Inter-group differences were tested for statistical significance (p ≤ 0.05) and large effect sizes (d ≥ 0.8). Results demonstrated that dysplasia patients had higher medially directed JRFs. Joint angles and moments were mostly similar between the groups, but large inter-group effect sizes suggested some restriction in range of motion by patients at the hip and ankle. Higher medially-directed JRFs and inter-group differences in hip muscle forces likely stem from lateralization of the hip joint center in dysplastic patients. Joint force differences, combined with reductions in range of motion at the hip and ankle may also indicate compensatory strategies by patients with dysplasia to maintain joint stability.     

Knee moment outcomes using inverse dynamics and the cross product function in moderate knee osteoarthritis gait: A comparison study

Inverse dynamics are the cornerstone of biomechanical assessments to calculate knee moments during walking. In knee osteoarthritis, these outcomes have been used to understand knee pathomechanics, but the complexity of an inverse dynamic model may limit the uptake of joint moments in some clinical and research structures. The objective was to determine whether discrete features of the sagittal and frontal plane knee moments calculated using inverse dynamics compare to knee moments calculated using a cross product function. Knee moments from 74 people with moderate knee osteoarthritis were assessed after ambulating at a self-selected speed on an instrumented dual belt treadmill. Standardized procedures were used for surface marker placement, gait speed determination and data processing. Net external frontal and sagittal plane knee moments were calculated using inverse dynamics and the three-dimensional position of the knee joint center with respect to the center of pressure was crossed with the three-dimensional ground reaction forces in the cross product function. Correlations were high between outcomes of the moment calculations (r > 0.9) and for peak knee adduction moment, knee adduction moment impulse and difference between peak flexion and extension moments, the cross product function resulted in absolute values less than 10% of those calculated using inverse dynamics in this treadmill walking environment. This computational solution may allow the integration of knee moment calculations to understand knee osteoarthritis gait without data collection or computational complexity.     

Kinematics of lower limbs during walking are emulated by springy walking model with a compliantly connected,off-centered curvy foot

The dynamics of the center of mass (CoM) during walking and running at various gait conditions are well described by the mechanics of a simple passive spring loaded inverted pendulum (SLIP). Due to its simplicity, however, the current form of the SLIP model is limited at providing any further information about multi-segmental lower limbs that generate oscillatory CoM behaviors and their corresponding ground reaction forces. Considering that the dynamics of the CoM are simply achieved by mass-spring mechanics, we wondered whether any of the multi-joint motions could be demonstrated by simple mechanics. In this study, we expand a SLIP model of human locomotion with an off-centered curvy foot connected to the leg by a springy segment that emulates the asymmetric kinematics and kinetics of the ankle joint. The passive dynamics of the proposed expansion of the SLIP model demonstrated the empirical data of ground reaction forces, center of mass trajectories, ankle joint kinematics and corresponding ankle joint torque at various gait speeds. From the mechanically simulated trajectories of the ankle joint and CoM, the motion of lower-limb segments, such as thigh and shank angles, could be estimated from inverse kinematics. The estimation of lower limb kinematics showed a qualitative match with empirical data of walking at various speeds. The representability of passive compliant mechanics for the kinetics of the CoM and ankle joint and lower limb joint kinematics implies that the coordination of multi-joint lower limbs during gait can be understood with a mechanical framework.     

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

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

An efficient probabilistic methodology for incorporating uncertainty in body segment parameters and anatomical landmarks in joint loadings estimated from inverse dynamics

Inverse dynamics is a standard approach for estimating joint loadings in the lower extremity from kinematic and ground reaction data for use in clinical and research gait studies. Variability in estimating body segment parameters and uncertainty in defining anatomical landmarks have the potential to impact predicted joint loading. This study demonstrates the application of efficient probabilistic methods to quantify the effect of uncertainty in these parameters and landmarks on joint loading in an inverse-dynamics model, and identifies the relative importance of the parameters and landmarks to the predicted joint loading. The inverse-dynamics analysis used a benchmark data set of lower-extremity kinematics and ground reaction data during the stance phase of gait to predict the three-dimensional intersegmental forces and moments. The probabilistic analysis predicted the 1-99 percentile ranges of intersegmental forces and moments at the hip, knee, and ankle. Variabilities, in forces and moments of up to 56% and 156% of the mean values were predicted based on coefficients of variation less than 0.20 for the body segment parameters and standard deviations of 2 mm for the anatomical landmarks. Sensitivity factors identified the important parameters for the specific joint and component directions. Anatomical landmarks affected moments to a larger extent than body segment parameters. Additionally, for forces, anatomical landmarks had a larger effect than body segment parameters, with the exception of segment masses, which were important to the proximal-distal joint forces. The probabilistic modeling approach predicted the range of possible joint loading, which has implications in gait studies, clinical assessments, and implant design evaluations.     

Coordination of leg muscles during speed skating

Five speed skaters of elite performance level and six speed skaters of trained level were subjected to an inverse dynamical analysis during speed skating. Push-off forces were registered by means of special skates. Myoelectric activity (EMG) of ten leg muscles and cinematographic data were recorded. Linked segment modelling yielded net joint moments and joint powers. The speed skating technique is characterized by a typical horizontal position of the trunk and a suppression of a plantar flexion during the push-off. This technique, necessary to reduce external friction, constrains the transfer of rotation in joints to translation of the mass center of the body. In spite of constrained push-off, the EMG levels of the leg muscles show a proximo-distal temporal order which to a certain extent is comparable to that previously found in an unconstrained vertical jump. This proximo-distal sequence is also reflected by the time courses of the net moment and net power output in hip, knee and ankle joints. The temporal sequence in activation levels of activated muscles is not different between elite and trained speed skaters. The difference in performance level between these groups obviously has an origin in the ability of the elite speed skaters to realise larger net joint moments. Differences in net joint moments and in kinematics result in a higher power output and a lower air frictional force for the elite than for the trained speed skaters.     

The role of intersegmental dynamics during rapid limb oscillations

The interactive dynamic effects of muscular, inertial and gravitational moments on rapid, multi-segmented limb oscillations were studied. Using three-segment, rigid-body equations of motion, hip, knee and ankle intersegmental dynamics were calculated for the steady-state cycles of the paw-shake response in adult spinal cats. Hindlimb trajectories were filmed to obtain segmental kinematics, and myopotentials of flexors and extensors at each of the three joints were recorded synchronously with the ciné film. The segmental oscillations that emerged during the paw-shake response were a consequence of an interplay between active and passive musculotendinous forces, inertial forces, and gravity. During steady-state oscillations, the amplitudes of joint excursions, peak angular velocities, and peak angular accelerations increased monotonically and significantly in magnitude from the proximal joint (hip) to the most distal joint (ankle). In contrast to these kinematic relationships, the maximal values of net moments at the hip and knee were equal in magnitude, but of significantly lower magnitude than the large net moment at the ankle joint. At both the ankle and the knee, the flexor and extensor muscle moments were equal, but at the hip the magnitude of the peak flexor muscle moment was significantly greater than the extensor muscle moment. Muscle moments at the hip not only acted to counterbalance accelerations of the more distal segments, but also acted to maintain the postural orientation of the hindlimb. Large muscle moments at the knee functioned to counterbalance the large inertial moments generated by the large angular accelerations of the paw. At the ankle, the muscle moments dominated the generation of the paw accelerations. At the ankle and the knee, muscle moments controlled limb dynamics by slowing and reversing joint motions, and the active muscle forces contributing to ankle and knee moments were derived from lengthening of active musculotendinous units. In contrast to the more distal joints, the active muscles crossing the hip predominantly shortened as a result of the interplay among inertial forces and gravitational moments. The muscle function and kinetic data explain key features of the complex interactions that occur between central control mechanisms and multi-segmented, oscillating limb segments during the paw-shake response.     

Biomechanical evaluation of walking and cycling in children

Physical activity in children is important as it leads to healthy growth due to physiological benefits. However, a physiological benefit can be partially negated by excessive or unphysiological loads within the joints. To gain an initial understanding into this, the present study sought to compare joint loading between walking and cycling in children. With institutional ethical approval, 14 pre-pubertal children aged 8–12 walked on an instrumented treadmill and cycled on a stationary ergometer. Two methods were used to match physiological load. Cardiovascular loads between walking and cycling were matched using heart rate. Metabolic load was normalised by matching estimates of oxygen consumption. Joint reaction forces during cycling and walking as well as joint moments were derived using inverse dynamics. Peak compressive forces were greater on the knees and ankles during walking than during cycling. Peak shear peak forces at the knee and ankle were also significantly larger during walking than during cycling, independent of how physiological load was normalised. For both cycling conditions, ankle moments were significantly smaller during cycling than walking. No differences were found for knee moments. At equivalent physiological intensities, cycling results in less joint loading than walking. It can be speculated that for certain populations and under certain conditions cycling might be a more suitable mode of exercise than weight bearing activities to achieve a given metabolic load.