Associations among knee adduction moment, frontal plane ground reaction force, and lever arm during walking in patients with knee osteoarthritis

The adduction moment about the knee during walking gait has been proposed as an indirect measure of dynamic knee joint load. However, the relative contributions of the variables primarily used to calculate the knee adduction moment have not been investigated. The objectives of this paper were to: (1) describe and compare the magnitude and temporal characteristics of the knee adduction moment, frontal plane lever arm, and frontal plane ground reaction force (GRF) during gait in patients with knee osteoarthritis (OA) and, (2) examine the associations among these variables. Results indicated that both the knee adduction moment and the frontal plane GRF varied considerably throughout stance and exhibited the characteristic "double-hump" pattern, while the frontal plane lever arm magnitude varied only slightly during stance. Knees with OA had significantly greater peak knee adduction moments and frontal plane lever arms, but significantly less peak frontal plane GRF than knees without OA. Pearson product moment correlations indicated a higher association between peak knee adduction moment and peak frontal plane lever arm than between peak knee adduction moment and peak frontal plane GRF, particularly in knees with OA. These results suggest that the frontal plane lever arm assessed during walking is an important variable in the examination of knee OA, and warrants further investigation.     

Synthesis of natural arm swing motion in human bipedal walking

It has historically been believed that the role of arm motion during walking is related to balancing. Arm motion during natural walking is distinguished in that each arm swing is with the motion of the opposing leg. Although this arm swing motion is generated naturally during bipedal walking, it is interesting to note that the arm swing motion is not necessary for stable walking. This paper attempts to explain the contribution of out-of-phase arm swing in human bipedal walking. Consequently, a human motion control methodology that generates this arm swing motion during walking is proposed. The relationship between arm swing and reaction moment about the vertical axis of the foot is explained in the context of the dynamics of a multi-body articulated system. From this understanding, it is reasoned that arm swing is the result of an effort to reduce the reaction moment about the vertical axis of the foot while the torso and legs are being controlled. This idea is applied to the generation of walking motion. The arm swing motion can be generated, not by designing and tracking joint trajectories of the arms, but by limiting the allowable reaction moment at the foot and minimizing whole-body motion while controlling the lower limbs and torso to follow the designed trajectory. Simulation results, first with the constraint on the foot vertical axis moment and then without, verify the relationship between arm swing and foot reaction moment. These results also demonstrate the use of the dynamic control method in generating arm swing motion.     

Aging effects on the Achilles tendon moment arm during walking

The Achilles tendon (AT) moment arm transforms triceps surae muscle forces into a moment about the ankle which is critical for functional activities like walking. Moreover, the AT moment arm changes continuously during walking, as it depends on both ankle joint rotation and triceps surae muscle loading (presumably due to bulging of the muscle belly). Here, we posit that aging negatively effects the architecturally complex AT moment arm during walking, which thereby contributes to well-documented reductions in ankle moment generation during push-off. We used motion capture-guided ultrasound imaging to quantify instantaneous variations in the AT moment arms of young (23.9 ± 4.3 years) and older (69.9 ± 2.6 years) adults during walking, their dependence on triceps surae muscle loading, and their association with ankle moment generation during push-off. Older adults walked with 11% smaller AT moment arms and 11% smaller peak ankle moments during push-off than young adults. Moreover, as hypothesized, these unfavourable changes were significantly and positively correlated (r² = 0.38, p < 0.01). More surprisingly, aging attenuated load-dependent increases in the AT moment arm (i.e., those between heel-strike and push-off at the same ankle angle); only young adults exhibited a significant increase in their AT moment arm due to triceps surae muscle-loading. Age-associated reductions in triceps surae volume or activation, and thus muscle bulging during force generation, may compromise the mechanical advantage of the AT during the critical push-off phase of walking in older adults. Thus, strategies to restore and/or improve locomotor performance in our aging population should consider these functionally important changes in musculoskeletal behavior.     

Dynamic arm swinging in human walking

Humans tend to swing their arms when they walk, a curious behaviour since the arms play no obvious role in bipedal gait. It might be costly to use muscles to swing the arms, and it is unclear whether potential benefits elsewhere in the body would justify such costs. To examine these costs and benefits, we developed a passive dynamic walking model with free-swinging arms. Even with no torques driving the arms or legs, the model produced walking gaits with arm swinging similar to humans. Passive gaits with arm phasing opposite to normal were also found, but these induced a much greater reaction moment from the ground, which could require muscular effort in humans. We therefore hypothesized that the reduction of this moment may explain the physiological benefit of arm swinging. Experimental measurements of humans (n = 10) showed that normal arm swinging required minimal shoulder torque, while volitionally holding the arms still required 12 per cent more metabolic energy. Among measures of gait mechanics, vertical ground reaction moment was most affected by arm swinging and increased by 63 per cent without it. Walking with opposite-to-normal arm phasing required minimal shoulder effort but magnified the ground reaction moment, causing metabolic rate to increase by 26 per cent. Passive dynamics appear to make arm swinging easy, while indirect benefits from reduced vertical moments make it worthwhile overall.     

Attempts to optimise functional electrical stimulation of antagonistic muscles by mathematical modelling

The mathematical relationship between the kinetic data of joint motion and the functional electrical stimulation (FES) voltage of the corresponding antagonistic pair of muscles is given on the basis of a dynamic ankle joint model. The mathematical model is solved with the aid of state variables, while the resulting electrical stimulation voltage is found as a solution of the Volterra integral equation. The calculated stimulation voltage was applied to the plantar and dorsiflexors of the ankle joint of a hemiplegic patient. The measured ground reaction forces and goniograms during walking with and without electrical stimulation showed a significant improvement of the patient's gait. The problems of low saturation muscle force during FES, the need for individual determination of model parameters, nonlinearities of the system and the variability of gait are discussed.     

Effect of arm swinging on lumbar spine and hip joint forces

During level walking, arm swing plays a key role in improving dynamic stability. In vivo investigations with a telemeterized vertebral body replacement showed that spinal loads can be affected by differences in arm positions during sitting and standing. However, little is known about how arm swing could influence the lumbar spine and hip joint forces and motions during walking. The present study aims to provide better understanding of the contribution of the upper limbs to human gait, investigating ranges of motion and joint reaction forces.A three-dimensional motion analysis was carried out via a motion capturing system on six healthy males and five patients with hip instrumented implant. Each subject performed walking with different arm swing amplitudes (small, normal, and large) and arm positions (bound to the body, and folded across the chest). The motion data were imported in a commercial musculoskeletal analysis software for kinematic and inverse dynamic investigation.The range of motion of the thorax with respect to the pelvis and of the pelvis with respect to the ground in the transversal plane were significantly associated with arm position and swing amplitude during gait. The hip external-internal rotation range of motion statistically varied only for non-dominant limb. Unlike hip joint reaction forces, predicted peak spinal loads at T12-L1 and L5-S1 showed significant differences at approximately the time of contralateral toe off and contralateral heel strike.Therefore, arm position and swing amplitude have a relevant effect on kinematic variables and spinal loads, but not on hip loads during walking.     

Comparative analysis of methods for estimating arm segment parameters and joint torques from inverse dynamics

A common problem in the analyses of upper limb unfettered reaching movements is the estimation of joint torques using inverse dynamics. The inaccuracy in the estimation of joint torques can be caused by the inaccuracy in the acquisition of kinematic variables, body segment parameters (BSPs), and approximation in the biomechanical models. The effect of uncertainty in the estimation of body segment parameters can be especially important in the analysis of movements with high acceleration. A sensitivity analysis was performed to assess the relevance of different sources of inaccuracy in inverse dynamics analysis of a planar arm movement. Eight regression models and one water immersion method for the estimation of BSPs were used to quantify the influence of inertial models on the calculation of joint torques during numerical analysis of unfettered forward arm reaching movements. Thirteen subjects performed 72 forward planar reaches between two targets located on the horizontal plane and aligned with the median plane. Using a planar, double link model for the arm with a floating shoulder, we calculated the normalized joint torque peak and a normalized root mean square (rms) of torque at the shoulder and elbow joints. Statistical analyses quantified the influence of different BSP models on the kinetic variable variance for given uncertainty on the estimation of joint kinematics and biomechanical modeling errors. Our analysis revealed that the choice of BSP estimation method had a particular influence on the normalized rms of joint torques. Moreover, the normalization of kinetic variables to BSPs for a comparison among subjects showed that the interaction between the BSP estimation method and the subject specific somatotype and movement kinematics was a significant source of variance in the kinetic variables. The normalized joint torque peak and the normalized root mean square of joint torque represented valuable parameters to compare the effect of BSP estimation methods on the variance in the population of kinetic variables calculated across a group of subjects with different body types. We found that the variance of the arm segment parameter estimation had more influence on the calculated joint torques than the variance of the kinematics variables. This is due to the low moments of inertia of the upper limb, especially when compared with the leg. Therefore, the results of the inverse dynamics of arm movements are influenced by the choice of BSP estimation method to a greater extent than the results of gait analysis.     

Biarticular hip extensor and knee flexor muscle moment arms of the feline hindlimb

Moment arms are important for understanding muscular behavior and for calculating internal muscle forces in musculoskeletal simulations. Biarticular muscles cross two joints and have moment arms that depend on the angle of both joints the muscles cross. The tendon excursion method was used to measure the joint angle-dependence of hamstring (biceps femoris, semimembranosus and semitendinosus) moment arm magnitudes of the feline hindlimb at the knee and hip joints. Knee angle influenced hamstring moment arm magnitudes at the hip joint; compared to a flexed knee joint, the moment arm for semimembranosus posterior at the hip was at most 7.4 mm (25%) larger when the knee was extended. On average, hamstring moment arms at the hip increased by 4.9 mm when the knee was more extended. In contrast, moment arm magnitudes at the knee varied by less than 2.8 mm (mean=1.6 mm) for all hamstring muscles at the two hip joint angles tested. Thus, hamstring moment arms at the hip were dependent on knee position, while hamstring moment arms at the knee were not as strongly associated with relative hip position. Additionally, the feline hamstring muscle group had a larger mechanical advantage at the hip than at the knee joint.     

Interlimb interactions during cyclic in-phase and antiphase movements of arms and legs and their dependence on afferent influences

Coordinated arm and leg movements imply neural interactions between the rhythmic generators of the upper and lower extremities. In ten healthy subjects in the lying position, activity of the muscles of the upper and lower extremities was recorded during separate and joint cyclic movements of the arms and legs with different phase relationships between the movements of the limbs and under various conditions of the motor task. Antiphase active arm movements were characterized by higher muscle activity than during the inphase mode. The muscle activity during passive arm movements imposed by the experimentalist was significantly lower than muscle activity during passive arm movements imposed by the other arm. When loading one arm, the muscle activity in the other, passively moving, arm increased independently from the synergy of arm movements. During a motor task implementing joint antiphase movements of both upper and lower extremities, compared to a motor task implementing their joint in-phase movements, we observed a significant increase in activity in the biceps brahii muscle, the tibialis anterior muscle, and the biceps femoris muscle. Loading of arms in these motor tasks has been accompanied by increased activity in some leg muscles. An increase in the frequency of rhythmic movements resulted in a significant growth of the muscle activity of the arms and legs during their cooperative movements with a greater rate of rise in the flexor muscle activity of the arms and legs during joint antiphase movements. Thus, both the spatial organization of movements and the type of afferent influences are significant factors of interlimb interactions, which, in turn, determine the type of neural interconnections that are involved in movement regulation.     

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.     

Activity of upper limb muscles during human walking

The EMG activity of upper limb muscles during human gait has rarely been studied previously. It was examined in 20 normal volunteers in four conditions: walking on a treadmill (1) with unrestrained natural arm swing (Normal), (2) while volitionally holding the arms still (Held), (3) with the arms immobilized (Bound), and (4) with the arms swinging in phase with the ipsilateral legs, i.e. opposite-to-normal phasing (Anti-Normal). Normal arm swing involved weak rhythmical lengthening and shortening contractions of arm and shoulder muscles. Phasic muscle activity was needed to keep the unrestricted arms still during walking (Held), indicating a passive component of arm swing. An active component, possibly programmed centrally, existed as well, because some EMG signals persisted when the arms were immobilized during walking (Bound). Anti-Normal gait involved stronger EMG activity than Normal walking and was uneconomical. The present results indicate that normal arm swing has both passive and active components.     

The interaction of muscle moment arm,knee laxity,and torque in a multi-scale musculoskeletal model of the lower limb

IntroductionMusculoskeletal modeling allows insight into the interaction of muscle force and knee joint kinematics that cannot be measured in the laboratory. However, musculoskeletal models of the lower extremity commonly use simplified representations of the knee that may limit analyses of the interaction between muscle forces and joint kinematics. The goal of this research was to demonstrate how muscle forces alter knee kinematics and consequently muscle moment arms and joint torque in a musculoskeletal model of the lower limb that includes a deformable representation of the knee.MethodsTwo musculoskeletal models of the lower limb including specimen-specific articular geometries and ligament deformability at the knee were built in a finite element framework and calibrated to match mean isometric torque data collected from 12 healthy subjects. Muscle moment arms were compared between simulations of passive knee flexion and maximum isometric knee extension and flexion. In addition, isometric torque results were compared with predictions using simplified knee models in which the deformability of the knee was removed and the kinematics at the joint were prescribed for all degrees of freedom.ResultsPeak isometric torque estimated with a deformable knee representation occurred between 45° and 60° in extension, and 45° in flexion. The maximum isometric flexion torques generated by the models with deformable ligaments were 14.6% and 17.9% larger than those generated by the models with prescribed kinematics; by contrast, the maximum isometric extension torques generated by the models were similar. The change in hamstrings moment arms during isometric flexion was greater than that of the quadriceps during isometric extension (a mean RMS difference of 9.8 mm compared to 2.9 mm, respectively).DiscussionThe large changes in the moment arms of the hamstrings, when activated in a model with deformable ligaments, resulted in changes to flexion torque. When simulating human motion, the inclusion of a deformable joint in a multi-scale musculoskeletal finite element model of the lower limb may preserve the realistic interaction of muscle force with knee kinematics and torque.     

Resonant frequencies of arms and legs identify different walking patterns

The present study is aimed at investigating changes in the coordination of arm and leg movements in young healthy subjects. It was hypothesized that with changes in walking velocity there is a change in frequency and phase coupling between the arms and the legs. In addition, it was hypothesized that the preferred frequencies of the different coordination patterns can be predicted on the basis of the resonant frequencies of arms and legs with a simple pendulum model. The kinematics of arms and legs during treadmill walking in seven healthy subjects were recorded with accelerometers in the sagittal plane at a wide range of different velocities (i.e., 0.3-1. 3m/s). Power spectral analyses revealed a statistically significant change in the frequency relation between arms and legs, i.e., within the velocity range 0.3-0.7m/s arm movement frequencies were dominantly synchronized with the step frequency, whereas from 0.8m/s onwards arm frequencies were locked onto stride frequency. Significant effects of walking speed on mean relative phase between leg and arm movements were found. All limb pairs showed a significantly more stable coordination pattern from 0.8 to 1.0m/s onwards. Results from the pendulum modelling demonstrated that for most subjects at low-velocity preferred movement frequencies of the arms are predicted by the resonant frequencies of individual arms (about 0.98Hz), whereas at higher velocities these are predicted on the basis of the resonant frequencies of the individual legs (about 0.85Hz). The results support the above-mentioned hypotheses, and suggest that different patterns of coordination, as shown by changes in frequency coupling and phase relations, can exist within the human walking mode.     

The interplay between speed,kinetics, and hand postures during primate terrestrial locomotion

Nonprimate terrestrial mammals may use digitigrade postures to help moderate distal limb joint moments and metapodial stresses that may arise during high‐speed locomotion with high‐ground reaction forces (GRF). This study evaluates the relationships between speed, GRFs, and distal forelimb kinematics in order to evaluate if primates also adopt digitigrade hand postures during terrestrial locomotion for these same reasons. Three cercopithecine monkey species (Papio anubis, Macaca mulatta, Erythrocebus patas) were videotaped moving unrestrained along a horizontal runway instrumented with a force platform. Three‐dimensional forelimb kinematics and GRFs were measured when the vertical force component reached its peak. Hand posture was measured as the angle between the metacarpal segment and the ground (MGA). As predicted, digitigrade hand postures (larger MGA) are associated with shorter GRF moment arms and lower wrist joint moments. Contrary to expectations, individuals used more palmigrade‐like (i.e. less digitigrade) hand postures (smaller MGA) when the forelimb was subjected to higher forces (at faster speeds) resulting in potentially larger wrist joint moments. Accordingly, these primates may not use their ability to alter their hand postures to reduce rising joint moments at faster speeds. Digitigrady at slow speeds may improve the mechanical advantage of antigravity muscles crossing the wrist joint. At faster speeds, greater palmigrady is likely caused by joint collapse, but this posture may be suited to distribute higher GRFs over a larger surface area to lower stresses throughout the hand. Thus, a digitigrade hand posture is not a cursorial (i.e. high speed) adaptation in primates and differs from that of other mammals. Am J Phys Anthropol 2010. © 2009 Wiley‐Liss, Inc.     

Acquisition of the lateral inconsistency in involuntary behaviour of upper limbs in 12-year-old children during walking at moderate speed.

The aim of this work was to investigate possible lateralisation in the behaviour of periodic motion of the human upper limb, during normal walking at a comfortable speed of locomotion. Ten healthy pre-adolescent, strongly right-handed, 12-year-old males participated in the experiment. Participants were walking on a treadmill with a standardised velocity of 1.1m/s (comfortable speed for all of them). A video analysis system with Silicon software was used to synchronically measure various angles of arms and forearms. The initial, final and interim angular positions of both arms and forearms in 10 cycles of each participant were compared in terms of variations (cycle to cycle) between both upper extremities at corresponding phases of each cycle for distal and proximal segments, respectively. We compared the coefficients of variation in relation to the spatial and temporal data of both limbs and their angular velocities. In addition we investigated the level of cycle-to-cycle regularity (constancy) of behaviour in relation to various positions, periods and velocities of movement of upper extremities (specifically arms and forearms) using the Eta non-linear method of correlation. All participants exhibited a lower level of regularity for the distal segments. The spatial and temporal variations in the dominant limb were also greater than the non-dominant limb for all participants. This may be due to a larger contribution from the right-sided muscles that are considered to be the main contributing factor to the motion of the dominant upper limb during walking, rather than simply gravity force acting alone. A possible practical application of this information may be useful in the objective clinical identification of the level of dominance of the upper extremity (arm plus forearm), in addition to 'traditional' handedness.     

Comparison of lower limb kinetics,kinematics and muscle activation during drop jumping under shod and barefoot conditions

This study was to investigate the acute effects of wearing shoes on lower limb kinetics, kinematics and muscle activation during a drop jump. Eighteen healthy men performed a drop jump under barefoot and shod conditions. Vertical ground reaction force (GRF) was measured on a force plate during the contact phase of a drop jump, and GRF valuables were calculated for each condition. The angles of the knee and ankle joints, and the foot strike angle (the angle between the plantar surface of the foot and the ground during ground contact) as well as the electromyography of 7 muscles were measured. The shod condition showed a significant larger first peak GRF, longer time to first peak GRF from the initial ground contact and lower initial loading rate than the barefoot condition. The shod condition showed a significant larger ankle joint angle at initial ground contact, smaller knee joint angle between the second peak GRF and take-off as well as smaller foot strike angle at both initial ground contact and take-off than the barefoot condition. There were significant correlations between relative differences in ankle joint at the initial ground contact and relative differences in the initial loading rate. The muscle activity of all muscles during foot ground contact did not differ between two conditions; however, in the shod condition, muscle activation of 150 ms before foot ground contact was significantly higher in the rectus femoris, whereas it was lower in the biceps femoris and tibialis anterior muscles than the barefoot condition. These results indicate that wearing shoes alternates the GRF variables at initial ground contact, joint kinematics at the ground contact and muscle activation before foot ground contact during a drop jump, suggesting that the effects of wearing shoes on drop jump training differ from being barefoot.     

Chimpanzee thumb muscle cross sections, moment arms and potential torques, and comparisons with humans.

This study investigates the morphological basis of differences between humans and chimpanzees in the kinematical and dynamical parameters of the musculature of the thumb. It is partly intended to test an hypothesis that human thumb muscles can exert significantly greater torques, due to larger muscle cross-sectional areas or to longer tendon moment arms or to both. We focus on the estimation of the potentials of thumb muscles to exert torques about joint axes in a sample of eight chimpanzee cadaver hands. The potential torque of a muscle is estimated by taking the product of a muscle's physiological cross-sectional area (an estimator of force) with its dynamical moment arm (derived from the slope of tendon excursion versus joint angular displacement, obtained during passive movements of cadaver thumb joints). Comparison of our results with similar data obtained for humans at the same Mayo Clinic laboratory shows significant differences between humans and chimpanzees in potential torque of most thumb muscles, those of humans generally exhibiting larger values. The primary reason for the larger torques in humans is that their average moment arms are significantly longer, permitting greater torque for a given muscle size. An additional finding is that chimpanzees and humans differ in the direction of secondary thumb metacarpal movements elicited by contraction of some muscles, as shown by differences in moment arm signs for a given movement in the same muscle. The differences appear to be related to differences in the musculo-skeletal structures of the trapeziometacarpal joint.     

Longer moment arm results in smaller joint moment development, power and work outputs in fast motions

Effects of moment arm length on kinetic outputs of a musculoskeletal system (muscle force development, joint moment development, joint power output and joint work output) were evaluated using computer simulation. A skeletal system of the human ankle joint was constructed: a lower leg segment and a foot segment were connected with a hinge joint. A Hill-type model of the musculus soleus (m. soleus), consisting of a contractile element and a series elastic element, was attached to the skeletal system. The model of the m. soleus was maximally activated, while the ankle joint was plantarflexed/dorsiflexed at a variation of constant angular velocities, simulating isokinetic exercises on a muscle testing machine. Profiles of the kinetic outputs (muscle force development, joint moment development, joint power output and joint work output) were obtained. Thereafter, the location of the insertion of the m. soleus was shifted toward the dorsal/ventral direction by 1cm, which had an effect of lengthening/shortening the moment arm length, respectively. The kinetic outputs of the musculoskeletal system during the simulated isokinetic exercises were evaluated with these longer/shorter moment arm lengths. It was found that longer moment arm resulted in smaller joint moment development, smaller joint power output and smaller joint work output in the larger plantarflexion angular velocity region (>120 degrees/s). This is because larger muscle shortening velocity was required with longer moment arm to achieve a certain joint angular velocity. Larger muscle shortening velocity resulted in smaller muscle force development because of the force-velocity relation of the muscle. It was suggested that this phenomenon should be taken into consideration when investigating the joint moment-joint angle and/or joint moment-joint angular velocity characteristics of experimental data.     

The mechanisms that enable arm motion to enhance vertical jump performance-a simulation study

The reasons why using the arms can increase standing vertical jump height are investigated by computer simulations. The human models consist of four/five segments connected by frictionless joints. The head-trunk-arms act as a fourth segment in the first model while the arms become a fifth segment in the second model. Planar model movement is actuated by joint torque generators. Each joint torque is the product of three variable functions of activation level, angular velocity dependence, and maximum isometric torque varying with joint angle. Simulations start from a balanced initial posture and end at jump takeoff. Jump height is maximized by finding the optimal combination of joint activation timings. Arm motion enhances jumping performance by increasing mass center height and vertical takeoff velocity. The former and latter contribute about 1/3 and 2/3 to the increased height, respectively. Durations in hip torque generation and ground contact period are lengthened by swinging the arms. Theories explaining the performance enhancement caused by arms are examined. The force transmission theory is questionable because shoulder joint force due to arm motion does not precisely reflect the change in vertical ground reaction force. The joint torque/work augmentation theory is acceptable only at the hips but not at the knees and ankles because only hip joint work is considerably increased. The pull/impart energy theory is also acceptable because shoulder joint work is responsible for about half of the additional energy created by arm swings.     

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.