Dynamic balance control during sit-to-stand movement: an examination with the center of mass acceleration

The purpose of this study was to establish the region of stability of balance control using the center of mass (COM) acceleration and to characterize age-related differences during sit-to-stand (STS) movement. Whole body motion data were collected from 10 young and 10 elderly subjects while performing STS at their self-selected manners. In addition, young subjects were asked to perform another block of trials with their trunk purposely bent forward prior to seat-off. With the use of a single-link-plus-foot inverted pendulum model, boundaries for the region of stability were determined based on the COM position at seat-off and its instantaneous velocity or its peak acceleration (ROSv or ROSa, respectively). No significant group differences were detected in COM velocities at seat-off. However, peak COM accelerations differed significantly between groups and conditions. This suggested that even though a similar COM momentum was observed at seat-off, this momentum was controlled differently prior to seat-off. Young and elderly subjects utilized similar strategies but with different COM acceleration profiles to perform STS. Furthermore, data from an elderly subject who complained of difficulty in STS during the experiment were located outside the forward boundary of the ROSa, demonstrating a potential use of ROSa to differentiate individuals with declined balance control ability. The ROSa could provide insights into how the COM is controlled prior to seat-off, which may allow us to better identify elderly individuals who are most likely at a risk for imbalance or falls.     

Mechanics of a constrained chair-rise

A sit-to-stand task is analyzed by a method which estimates the segmental and whole body center of mass (CoM) kinematics and kinetics using bilateral whole body kinematic data from nine healthy young female subjects. The sit-to-stand, or chair-rise, task is constrained with regard to chair height, pace, initial lower limb position and arm use. The chair-rise maneuver is divided into four phases; (1) the flexion momentum phase; (2) the momentum transfer phase; (3) the vertical extension phase; and (4) the stabilization phase; the first three are examined in detail here. The momentum transfer phase, which immediately follows lift-off from the seat of the chair, is the most dynamic portion of the event, demanding a high degree of coordination. This maneuver is analyzed in order to determine if trunk movement is used only to position the body center of gravity or if the trunk motion generates momentum which is important during the brief but critical period of dynamic equilibrium immediately following lift-off from the chair. Our evidence points to the latter case and indicates that inter-segmental momentum transfer is possible during this period.     

Determinants of sit-to-stand capability in the motor impaired elderly.

Among the healthy elderly, sit-to-stand (STS) movement largely depends on: (a) trunk bending momentum, (b) centre of gravity (CG) position before the body rises and (c) lower limb extensor muscle strength. Because determining whether (c) improvement would affect STS capability in the motor impaired elderly (MIE) has been recommended, we studied the relative importance of (a), (b) and (c) in determining a successful fast STS movement comparing the healthy elderly with MIE with orthopaedic disorders studied before and after a rehabilitation program. Force platform was used to measure body's posture and kinematics during a STS test and therefore to assess (a), (b) and maximum vertical velocity (VVpeak), assumed as outcome measurement. Knee extensor maximal isometric voluntary contraction normalized by body mass (nMVC) was an indicator of (c). A multiple regression model was built to predict VVpeak from the three determinants of STS movement. In both groups, the model significantly determined VVpeak, with (a) and (c) being significant predictors of VVpeak and (a) being the major predictor. Rehabilitation was effective in improving nMVC. This process resulted in a change of the relative importance of (a) and (c), strength becoming the major predictor of VVpeak. In conclusion the present study demonstrates that a rehabilitative intervention aimed at increasing strength is effective in improving STS capability in MIE.     

Biomechanical influence of TKA designs with varying radii on bilateral TKA patients during sit-to-stand

Background

Compared to the design of a traditional multi-radius (MR) total knee arthroplasty (TKA), the single-radius (SR) implant investigated has a fixed flexion/extension center of rotation. The biomechanical effectiveness of an SR for functional daily activities, i.e., sit-to-stand, is not well understood. The purpose of the study was to compare the biomechanics underlying functional performance of the sit-to-stand (STS) movement between the limbs containing an MR and an SR TKA of bilateral TKA participants.

Methods

Sagittal plane kinematics and kinetics, and EMG data for selected knee flexor and extensor muscles were analyzed for eight bilateral TKA patients, each with an SR and an MR TKA implant.

Results

Compared to the MR limb, the SR limb demonstrated greater peak antero-posterior (AP) ground reaction force, higher AP ground reaction impulse, less vastus lateralis and semitendinosus EMG during the forward-thrust phase of the STS movement. No significant difference of knee extensor moment was found between the two knees.

Conclusion

Some GRF and EMG differences were evident between the MR and SR limbs during STS movement. Compensatory adaptations may be used to perform the STS.

     

Differences between grab rail position and orientation during the assisted sit-to-stand for able-bodied older adults

The aim of this study was to compare the effects of grab rail position, orientation, and number of hands used on the kinetics of assisted sit-to-stand transfers. Participants were 12 able-bodied older adults between the ages of 69 and 88 years. While each one performed the sit-to-stand transfer, a motion analysis system with 9 cameras recording at 60 Hz tracked the 3-D trajectories of retroreflective markers. Bilateral 37-D platform, grab rail, and seat force data were collected at 200 Hz and normalized to participant body weight. Four lateral conditions were tested: vertical, 45 degrees inclined, and horizontal with the hand placed at 150 mm and 400 mm forward of the seat front edge. Four anterior conditions were tested: vertical and horizontal orientations with the use of one hand and two hands. Posterior grab rail force increased with anterior assistance and with two-hand use compared to lateral assistance and single hand use, respectively. The selection of grab rail position and the number of hands incorporated during assistance also determined the symmetry of anteroposterior net joint forces, net joint moments, and joint powers. Grab rail orientation determined the height of the gripping hand which influenced the assistance strategy. Grab rail position, orientation, and the amount of upper body contribution influenced the assisted sit-to-stand transfer. These kinetic responses to grab rail location require careful consideration in order to optimize grab rail assistance during the sit-to-stand transfer.     

The minimum required muscle force for a sit-to-stand task

The purpose of this study was to reveal the minimum required muscle force for a sit-to-stand task. Combining experimental procedures and computational processing, movements of various sit-to-stand patterns were obtained. Muscle forces and activations during a movement were calculated with an inverse dynamics method and a static numerical optimization method. The required muscle force for each movement was calculated with peak muscle activation, muscle physiological cross sectional area and specific tension. The robustness of the results was quantitatively evaluated with sensitivity analyses. From the results, a distinct threshold was found for the total required muscle force of the hip and knee extensors. Specifically, two findings were revealed: (1) the total force of hip and knee extensors is appropriate as the index of minimum required muscle force for a sit-to-stand task and (2) the minimum required total force is within the range of 35.3-49.2 N/kg. A muscle is not mechanically independent from other muscles, since each muscle has some synergetic or antagonistic muscles. This means that the mechanical threshold of one muscle varies with the force exertion abilities of other muscles and cannot be evaluated independently. At the same time, some kinds of mechanical threshold necessarily exist in the sit-to-stand task, since a muscle force is an only force to drive the body and people cannot stand up from a chair without muscles. These indicate that the existence of the distinct threshold in the result of the total required muscle force is reasonable.     

Increased hip adductor activation during sit-to-stand improves muscle activation timing and rising-up mechanics in individuals with hemiparesis

Long sit-to-stand (STS) time has been identified as a feature of impaired functional mobility. The changes in biomechanics of STS performance with simultaneous hip adductor contraction have not been studied, which may limit indications for use of hip adductor activation during STS training.Ten individuals with hemiplegia (mean age 61.8 years, injury time 29.8 ± 15.2 months) performed the STS with and without squeezing a ball between two legs. The joint moments, ground reaction force (GRF), chair reaction force and movement durations and temporal index of electromyography were calculated from the control condition for comparison with those from the ball squeezing condition.Under the squeeze condition, reduced peak vertical GRF during the ascension phase with increased loading rate was observed in the nonparetic limb, and the peak knee extensor moment occurred earlier in the paretic. Earlier activation of tibialis anterior and gluteus maximus, and gluteus medius were found in squeeze STS.Squeezing a ball between limbs during STS increased the contraction timing of tibialis anterior, gluteus maximus, gluteus medius, and soleus as well as a more symmetric rising mechanics encourage the use of squeezing a ball between limbs during STS for individuals with hemiparesis.     

RELIABILITY AND VALIDITY OF AN ACCELEROMETRIC SYSTEM FOR ASSESSING VERTICAL JUMPING PERFORMANCE

The validity of an accelerometric system (Myotest©) for assessing vertical jump height, vertical force and power, leg stiffness and reactivity index was examined. 20 healthy males performed 3ד5 hops in place”, 3ד1 squat jump” and 3× “1 countermovement jump” during 2 test-retest sessions. The variables were simultaneously assessed using an accelerometer and a force platform at a frequency of 0.5 and 1 kHz, respectively. Both reliability and validity of the accelerometric system were studied. No significant differences between test and retest data were found (p < 0.05), showing a high level of reliability. Besides, moderate to high intraclass correlation coefficients (ICCs) (from 0.74 to 0.96) were obtained for all variables whereas weak to moderate ICCs (from 0.29 to 0.79) were obtained for force and power during the countermovement jump. With regards to validity, the difference between the two devices was not significant for 5 hops in place height (1.8 cm), force during squat (-1.4 N · kg⁻¹) and countermovement (0.1 N · kg⁻¹) jumps, leg stiffness (7.8 kN · m⁻¹) and reactivity index (0.4). So, the measurements of these variables with this accelerometer are valid, which is not the case for the other variables. The main causes of non-validity for velocity, power and contact time assessment are temporal biases of the takeoff and touchdown moments detection.     

Computation of the kinematics and the minimum peak joint moments of sit-to-stand movements

Background  

A sit-to-stand (STS) movement requires muscle strength higher than that of other daily activities. There are many elderly people, who experience difficulty when standing up from a chair. The muscle strength required (or the load on the joints) during a STS task is determined by the kinematics (movement pattern). The purpose of this study was to evaluate the kinematics and resultant joint moments of people standing up from a chair in order to determine the minimum peak joint moments required for a STS task.     

Whole-body angular momentum during stair walking using passive and powered lower-limb prostheses*

Individuals with a unilateral transtibial amputation have a greater risk of falling compared to able-bodied individuals, and falling on stairs can lead to serious injuries. Individuals with transtibial amputations have lost ankle plantarflexor muscle function, which is critical for regulating whole-body angular momentum to maintain dynamic balance. Recently, powered prostheses have been designed to provide active ankle power generation with the goal of restoring biological ankle function. However, the effects of using a powered prosthesis on the regulation of whole-body angular momentum are unknown. The purpose of this study was to use angular momentum to evaluate dynamic balance in individuals with a transtibial amputation using powered and passive prostheses relative to able-bodied individuals during stair ascent and descent. Ground reaction forces, external moment arms, and joint powers were also investigated to interpret the angular momentum results. A key result was that individuals with an amputation had a larger range of sagittal-plane angular momentum during prosthetic limb stance compared to able-bodied individuals during stair ascent. There were no significant differences in the frontal, transverse, or sagittal-plane ranges of angular momentum or maximum magnitude of the angular momentum vector between the passive and powered prostheses during stair ascent or descent. These results indicate that individuals with an amputation have altered angular momentum trajectories during stair walking compared to able-bodied individuals, which may contribute to an increased fall risk. The results also suggest that a powered prosthesis provides no distinct advantage over a passive prosthesis in maintaining dynamic balance during stair walking.     

Keep on your toes: gait initiation from toe-standing

Gait initiation from toe-standing is common in patients with upper motor neurone (UMN) pathology as well as in able-bodied subjects during certain dance and athletic situations. It is unclear whether balance problems in patients who toe-walk are due to the underlying pathology, or due to initiating gait from toe-standing. The aim of this study was to compare the biomechanics of gait initiation from toe-standing to that from heel-toe standing in healthy able-bodied subjects. Data were collected for three seconds prior to, and three seconds after, a visual signal to initiate gait. Ground reaction force and centre of pressure (COP) data were collected with an AMTI force platform, and electromyographic and kinematic data were collected from each limb with a Vicon motion analysis system. When initiating gait from toe-standing, there was a smaller backward displacement of the COP compared to heel-toe standing. In addition, greater forward momentum was generated, and there was an increase in gastrocnemius, rectus femoris and biceps femoris muscle activity. There were no differences in COP displacement or momentum generated in the mediolateral direction for the two conditions. Thus, initiating gait from toe-standing allows one to generate greater amounts of forward momentum but not at the expense of generating excessive stance-side momentum. This may be an advantageous method of initiating movement for dancers and athletes in certain situations. This work also suggests that balance problems in patients with UMN pathology are likely due to the underlying pathology and are not due to initiating gait from toe-standing.     

Feature Selection for Wearable Smartphone-Based Human Activity Recognition with Able bodied,Elderly, and Stroke Patients

Human activity recognition (HAR), using wearable sensors, is a growing area with the potential to provide valuable information on patient mobility to rehabilitation specialists. Smartphones with accelerometer and gyroscope sensors are a convenient, minimally invasive, and low cost approach for mobility monitoring. HAR systems typically pre-process raw signals, segment the signals, and then extract features to be used in a classifier. Feature selection is a crucial step in the process to reduce potentially large data dimensionality and provide viable parameters to enable activity classification. Most HAR systems are customized to an individual research group, including a unique data set, classes, algorithms, and signal features. These data sets are obtained predominantly from able-bodied participants. In this paper, smartphone accelerometer and gyroscope sensor data were collected from populations that can benefit from human activity recognition: able-bodied, elderly, and stroke patients. Data from a consecutive sequence of 41 mobility tasks (18 different tasks) were collected for a total of 44 participants. Seventy-six signal features were calculated and subsets of these features were selected using three filter-based, classifier-independent, feature selection methods (Relief-F, Correlation-based Feature Selection, Fast Correlation Based Filter). The feature subsets were then evaluated using three generic classifiers (Naïve Bayes, Support Vector Machine, j48 Decision Tree). Common features were identified for all three populations, although the stroke population subset had some differences from both able-bodied and elderly sets. Evaluation with the three classifiers showed that the feature subsets produced similar or better accuracies than classification with the entire feature set. Therefore, since these feature subsets are classifier-independent, they should be useful for developing and improving HAR systems across and within populations.     

Ontoaenetic correlates of diet in anthropoid primates

This study assesses ontogenetic correlates of diet in anthropoid primates. Associations between body weight growth, adult size, and diet are evaluated for a sample of 42 primate species, of which 8 are classifiable as “folivores.” The hypothesis that folivores show a pattern of growth that differs from “nonfolivores” is tested. Ontogenetic variation is summarized through use of parametric and nonparametric regression analysis. Several analytical techniques, including broad interspecific and detailed comparisons among species of similar adult size, are applied. This investigation indicates a clear association between body weight ontogeny and diet: folivorous species grow more rapidly over a shorter duration than comprably sized nonfolivorus species. A positive correlation between adult size and diet is not unambiguously established in this sample. A threshold (at around 1 kg) below which insectivory is very common may adequately characterize the association between adult size and diet in anthropoid primates. Above this threshold, adult size does not appear to covary predictably with diet. Evolutionary correlates of the ontogenetic pattern seen in folivores may include a variety of factors. The distinctive pattern of development in folivores may relate to the profile of ecological and social risks that these species face. Morphophysiological advantages to rapid growth may relate to a need for accelerated alimentary (dental and gut) development. The implications of ontogenetic variation in folivores are discussed. © 1994 Wiley-Liss, Inc.     

Sit-to-stand motor strategies investigated in able-bodied young and elderly subjects

For the execution of a certain motor task, a motor strategy is chosen by each individual among those that are consistent with the structural and functional constraints of his/her locomotor system, and that tends to maximise the effectiveness of the motor act. The identification of this strategy allows for the assessment of the individual's functional status. This study aimed at identifying the motor strategies adopted for the execution of the sit-to-stand motor task, at different speeds and initial postures, in a sample of 35 community-dwelling elders and in a sample of 16 young able-bodied individuals. This was done using a method, least perceivable to the test subject and "economical" for the experimenter, which entailed the recording of external forces only. A musculo-skeletal system model, based on a telescopic inverted-pendulum (TIP) moved by a linear and two rotational muscle-equivalent actuators, was then used. Parameters describing the kinematics and dynamics of these actuators were extracted and submitted to statistical analysis. Different motor strategies were identified in the two age groups, as well as associated with both a different initial posture (ankle dorsiflexion angle) and speed of execution of the motor task. In particular, the elder group, as compared with the young group, prior to seat-off tended to flex the trunk more, thus bringing the CM closer to the base of support, and at a higher velocity, thus gaining a higher momentum. After seat-off, elders rotated the body forward and, only after having brought their CM over the base of support, effectively started elevation. Both global muscular effort and coordination effort associated with the achievement of balance and raising were lower. However, maximal speed was also lower. The above results indicated that the elders could count on a lower functional reserve than the young individuals and, from the methodological viewpoint, that the TIP approach is a good candidate for subject-specific functional evaluation in a clinical context.     

A Procedure for the Design of Novel Assisting Devices for the Sit-to-Stand

The Sit-to-Stand （STS） is an activity most people perform numerous times daily. Standing up deals with the transition from two stabilized postures, namely seated to standing, with movement of all body segments except the feet. During the STS the body＇s Center of Gravity （COG） is moved upward from a sitting position to a standing position without losing balance and requiring a good coordination of many muscles. Three main phases of the STS movement can be recognized. One begins to stand up by inclining the upper body forward, which moves body mass toward the feet in order to maintain balance after lift-off. Prior to leaving the chair, hip and knee extensor muscles are activated to provide antigravity support for these joints, this action is commonly referred to as ＂weight shift＂. Finally; after leaving the chair, the leg and trunk joints are straightened to achieve upright stance. The STS task can be considered of major importance for impaired and elderly people to achieve minimal mo- bility and independence. In this paper we detail a procedure for the design of assisting devices to be used for the STS. In par- ticular, an experimental procedure is described firstly to track and record point trajectories and the orientation of the trunk during the STS. This analysis is then used to get information for the design of assisting devices. A proposal and simulation results are presented for a novel mechatronic system. In particular, for the case under study experimental tests are used to drive the actua- tion system for the reported simulation. A functional mechatronic scheme is then proposed to control the device during its operation.     

Reliability and validity of three strength measures obtained from community-dwelling elderly persons

The purpose of this study was to describe the reliability and validity of 3 strength measures obtained from community-dwelling elderly individuals. The strength of 10 elders was tested initially and 6 and 12 weeks later using the MicroFET 2 hand-held dynamometer (knee extension strength), the Jamar dynamometer (grip strength), and the sit-to-stand (STS) test. Mobility was tested using the timed up-and-go (TUG) test and a timed walk test. Intraclass correlation coefficients, which were used to characterize the reliability of the strength tests, ranged from 0.807 to 0.981. Pearson correlations between the lower extremity strength measures and the TUG and gait speed ranged from 0.635 to -0.943. Our examination of the 3 measures for 12 weeks extends previous evidence of the stability of these strength measures and justifies the use of hand-held dynamometry and the STS test when investigating limitations in mobility.     

Age-related change in sit-to-stand power in Japanese women aged 50 years or older

Background

This study examined whether the age-related change in power, calculated from the score of a sit-to-stand (STS) test, corresponds to those in knee extension torque and leg lean tissue mass in Japanese women aged 50 years or older.

Findings

Time for a 10-times-repeated STS test and knee extension torque were determined in 556 Japanese women aged 50 to 94 years. STS power was calculated using an equation reported previously. In addition, leg lean tissue mass was estimated using muscle thicknesses determined at thigh and lower leg. STS power, knee extension torque, and lean tissue mass were negatively correlated to age. STS power and knee extension torque, expressed as the percentages of the mean value of the corresponding variable for the subjects aged 50 to 54 years were lower than that of lean tissue mass in the subjects aged 60 years or over, and were similar in those aged under 75 years. However, the relative value of STS power was lower than that of knee extension torque in the subjects aged over 75 years.

Conclusions

In Japanese women aged 50 to 74 years, STS power can be a convenient measure for assessing the age-related decline in knee extension torque, but not for leg lean tissue mass. At over 75 years old, the magnitude of the age-related decline in STS power does not parallel to that in the force generation capability of knee extensor muscles.     

A neurofuzzy inference system based on biomechanical features for the evaluation of the effects of physical training

The current study aimed to evaluate physical training effects. For this purpose, a classifier was implemented by taking into account biomechanical features selected from force-plate measurements and a neurofuzzy algorithm for data management and relevant decision-making. Measurements included two sets of sit-to-stand (STS) trials involving two homogeneous groups, experimental and control, of elders. They were carried out before and after a 12-week heavy resistance strength-training program undergone by the experimental group. Pre- and post-training differences were analysed, and percentages of membership to "trained" and "untrained" fuzzy sets calculated. The method was shown to be appropriate for detecting significant training-related changes. Detection accuracy was higher than 87%. Slightly weaker results were obtained using a neural approach, suggesting the need for a larger sample size. In conclusion, the use of a set of biomechanical features and of a neurofuzzy algorithm allowed to propose a global score for evaluating the effectiveness of a specific training program.     

Dynamic Frequency Analyses of Lower Extremity Muscles during Sit-To-Stand Motion for the Patients with Knee Osteoarthritis

Objective

Muscle activities during the sit-to-stand motion (STS) are characterized by coordinated movements between hip extensors and knee extensors. However, previous reports regarding the STS and lower extremity muscle activities have focused on some quantitative assessment, but little qualitative research. This study aimed to examine the muscle activities of the lower extremity both quantitatively and qualitatively.

Methods

Study participants included 13 patients with knee osteoarthritis (knee OA) and 11 age-matched asymptomatic controls. The task was STS from a chair with a height-adjustable seat. EMG activities were acquired using surface electromyogram. The root mean square signals normalized as a percentage of maximum voluntary isometric contraction values (RMS%MVC) and the mean power frequency (MPF) were calculated.

Results

During STS, knee OA patients had increased RMS%MVC of the vastus medialis and raised MPF of the rectus femoris before buttocks-off.

Conclusion

These findings suggest that STS of knee OA patients not only increased relative muscle activity of the vastus medialis, but also enlisted the rectus femoris in knee extension to improve muscle contraction force by activating more type II fibers to accomplish buttocks-off.     

Muscular Weakness in Individuals with HIV Associated with a Disorganization of the Cortico-Spinal Tract: A Multi-Modal MRI Investigation

Motor impairment is highly prevalent in HIV-infected patients. Here, we assess associations between peripheral muscular deficits as evaluated by the 5 sit-to-stand test (5STS) and structural integrity of the motor system at a central level. Eighty-six HIV-infected patients receiving combination antiretroviral therapy and with no major cerebral events, underwent an MRI scan and the 5STS. Out of 86 participants, forty presented a score greater than two standard deviations above mean normative scores calculated for the 5STS and were therefore considered as motor-impaired. MRI-structural cerebral parameters were compared to the unimpaired participants. Fractional Anisotropy (FA), Axial Diffusivity (AD) and Radial Diffusivity (RD), reflecting microstructural integrity, were extracted from Diffusion-Tensor MRI. Global and regional cerebral volumes or thicknesses were extracted from 3D-T1 morphological MRI. Whereas the two groups did not differ for any HIV variables, voxel-wise analysis revealed that motor-impaired participants present low FA values in various cortico-motor tracts and low AD in left cortico-spinal tract. However, they did not present reduced volumes or thicknesses of the precentral cortices compared to unimpaired participants. The absence of alterations in cortical regions holding motor-neurons might argue against neurodegenerative process as an explanation of White Matter (WM) disorganization.