Scapular kinematics during unloaded and maximal loaded isokinetic concentric and eccentric shoulder flexion and extension movements

Characterization of scapular kinematics under demanding load conditions might aid to distinguish between physiological and clinically relevant alterations. Previous investigations focused only on submaximal external load situations. How scapular movement changes with maximal load remains unclear. Therefore, the present study aimed to evaluate 3D scapular kinematics during unloaded and maximal loaded shoulder flexion and extension. Twelve asymptomatic individuals performed shoulder flexion and extension movements under unloaded and maximal concentric and eccentric loaded isokinetic conditions. 3D scapular kinematics assessed with a motion capture system was analyzed for 20° intervals of humeral positions from 20° to 120° flexion. Repeated measures ANOVAs were used to evaluate kinematic differences between load conditions for scapular position angles, scapulohumeral rhythm and scapular motion extent. Increased scapular upward rotation was seen during shoulder flexion and extension as well as decreased posterior tilt and external rotation during eccentric and concentric arm descents of maximal loaded compared to unloaded conditions. Load effects were further seen for the scapulohumeral rhythm with greater scapular involvement at lower humeral positions and increased scapular motion extent under maximal loaded shoulder movements. With maximal load applied to the arm physiological scapular movement pattern are induced that may imply both impingement sparing and causing mechanisms.     

Effect of unilateral load carriage on postures and gait symmetry in ground reaction force during walking

Unilateral load carriage is more hazardous to the musculoskeletal system than bilateral load. The purpose of this study was to examine the effect of such asymmetric carriage on postures and gait symmetry in ground reaction force (GRF) during walking. Kinematics and GRF of 19 adults were recorded while they walked under five load conditions: no load, dumbbell (10 and 20% body weight) held in right and left hand, respectively. After loading, the trunk bent towards the loaded or unloaded side in right- and left-hand trials and under different load weight conditions. The amplitude of trunk bend increased with load, accompanied by decreased stride width, progressively inclined legs towards unloaded side and higher level of asymmetry in medial/lateral GRF (GRFm/l) and free vertical moment GRF (GRFm). The findings indicate the postural adjustment is likely related to the characteristics of load and the task experience and handedness of subject and the unilateral load increases the gait asymmetry in GRFm/l and GRFm.     

Men and women adopt similar walking mechanics and muscle activation patterns during load carriage

Although numerous studies have investigated the effects of load carriage on gait mechanics, most have been conducted on active military men. It remains unknown whether men and women adapt differently to carrying load. The purpose of this study was to compare the effects of load carriage on gait mechanics, muscle activation patterns, and metabolic cost between men and women walking at their preferred, unloaded walking speed. We measured whole body motion, ground reaction forces, muscle activity, and metabolic cost from 17 men and 12 women. Subjects completed four walking trials on an instrumented treadmill, each five minutes in duration, while carrying no load or an additional 10%, 20%, or 30% of body weight. Women were shorter (p<0.01), had lower body mass (p=0.01), and had lower fat-free mass (p=0.02) compared to men. No significant differences between men and women were observed for any measured gait parameter or muscle activation pattern. As load increased, so did net metabolic cost, the duration of stance phase, peak stance phase hip, knee, and ankle flexion angles, and all peak joint extension moments. The increase in the peak vertical ground reaction force was less than the carried load (e.g. ground force increased approximately 6% with each 10% increase in load). Integrated muscle activity of the soleus, medial gastrocnemius, lateral hamstrings, vastus medialis, vastus lateralis, and rectus femoris increased with load. We conclude that, despite differences in anthropometry, men and women adopt similar gait adaptations when carrying load, adjusted as a percentage of body weight.     

Physiological modulation of gait variables by an active partial body weight support system

Partial body weight support (PBWS) systems used for rehabilitation status post-neurological and musculoskeletal pathologies and injuries are traditionally passive. Our purpose was to demonstrate the ability of an actively controlled PBWS system to provide a clinically relevant modulated support condition while investigating the impact of such a condition on the dynamics of gait. Using an instrumented treadmill and a motion capture system, we compared gait parameters of six healthy young adults (age 24-31 years) during unsupported walking to those under the assistance of two support conditions (a constant 20% body weight support, and a modulated support providing 20% body weight support during the loading response of each leg while allowing for an unsupported terminal stance). The modulated condition achieved support synchronized to gait cycle events with mean and maximum loading errors at the 20% body weight support level equal to 1.01 and 2.44 kg, respectively. Constant support significantly reduced sagittal plane hip angle range of motion and increased ankle platarflexion as compared to unsupported walking (p < 0.05). Also, a clear trend of decreased stride length was observed for constant support. No significant differences in these parameters were evident between the modulated support condition and unsupported walking. Ankle power generation and absorption both significantly decreased under constant support. The modulated support condition significantly increased ankle power absorption though showed no change in ankle power generation. The ability of the presented active PBWS device to provide individualized support schemes may offer new and possibly improved applications of PBWS rehabilitation.     

Computational evaluation of load carriage effects on gait balance stability

Evaluating the effects of load carriage on gait balance stability is important in various applications. However, their quantification has not been rigorously addressed in the current literature, partially due to the lack of relevant computational indices. The novel Dynamic Gait Measure (DGM) characterizes gait balance stability by quantifying the relative effects of inertia in terms of zero-moment point, ground projection of center of mass, and time-varying foot support region. In this study, the DGM is formulated in terms of the gait parameters that explicitly reflect the gait strategy of a given walking pattern and is used for computational evaluation of the distinct balance stability of loaded walking. The observed gait adaptations caused by load carriage (decreased single support duration, inertia effects, and step length) result in decreased DGM values (p < 0.0001), which indicate that loaded walking motions are more statically stable compared with the unloaded normal walking. Comparison of the DGM with other common gait stability indices (the maximum Floquet multiplier and the margin of stability) validates the unique characterization capability of the DGM, which is consistently informative of the presence of the added load.     

Effects of load carriage and fatigue on gait characteristics

The objective of this study was to determine the main and interactive effects of load carriage and fatigue on gait characteristics. Twelve young male participants were recruited in this study. Fatiguing protocol involved a running exercise, and fatigue was considered to be induced when the participants first gave an RPE rating at or above 17. Gait data were collected when the participants walked on a medical treadmill at their self-selected comfortable speed, both before and right after the fatiguing exercise. Different back-carrying loads (i.e. 0, 7.5, and 15 kg) were applied separately to the participants during the walking trials. Gait variability measures and kinematic measures were used to quantify gait characteristics. The results showed that gait width variability, hip range of motion, and trunk range of motion increased with fatigue and with the application of the heavy load. These findings suggest that both fatigue and load carriage compromise gait. Findings from this study can help better understand how fatigue and load carriage affect gait, and further aid in developing interventions that are able to minimize fall risks especially with the application of fatigue and/or external load.     

Validation of a smart shoe for estimating foot progression angle during walking gait

The foot progression angle is an important measurement related to knee loading, pain, and function for individuals with knee osteoarthritis, however current measurement methods require camera-based motion capture or floor-embedded force plates confining foot progression angle assessment to facilities with specialized equipment. This paper presents the validation of a customized smart shoe for estimating foot progression angle during walking. The smart shoe is composed of an electronic module with inertial and magnetometer sensing inserted into the sole of a standard walking shoe. The smart shoe charges wirelessly, and up to 160 h of continuous data (sampled at 100 Hz) can be stored locally on the shoe. For validation testing, fourteen healthy subjects were recruited and performed treadmill walking trials with small, medium, and large toe-in (internal foot rotation), small, medium, and large toe-out (external foot rotation) and normal foot progression angle at self-selected walking speeds. Foot progression angle calculations from the smart shoe were compared with measurements from a standard motion capture system. In general, foot progression angle values from the smart shoe closely followed motion capture values for all walking conditions with an overall average error of 0.1 ± 1.9 deg and an overall average absolute error of 1.7 ± 1.0 deg. There were no significant differences in foot progression angle accuracy across the seven different walking gait patterns. The presented smart shoe could potentially be used for knee osteoarthritis or other clinical applications requiring foot progression angle assessment in community settings or in clinics without specialized motion capture equipment.     

Dynamic analysis of load carriage biomechanics during level walking

This paper describes an investigation into the biomechanical effects of load carriage dynamics on human locomotion performance. A whole body, inverse dynamics gait model has been developed which uses only kinematic input data to define the gait cycle. To provide input data, three-dimensional gait measurements have been conducted to capture whole body motion while carrying a backpack. A nonlinear suspension model is employed to describe the backpack dynamics. The model parameters for a particular backpack system can be identified using a dynamic load carriage test-rig. Biomechanical assessments have been conducted based on combined gait and pack simulations. It was found that the backpack suspension stiffness and damping have little effect on human locomotion energetics. However, decreasing suspension stiffness offers important biomechanical advantages. The peak values of vertical pack force, acting on the trunk, and lower limb joint loads are all moderated. This would reduce shoulder strap pressures and the risk of injury when heavy loads are carried.     

On the estimation of joint kinematics during gait.

In gait analysis, the concepts of Euler and helical (screw) angles are used to define the three-dimensional relative joint angular motion of lower extremities. Reliable estimation of joint angular motion depends on the accurate definition and construction of embedded axes within each body segment. In this paper, using sensitivity analysis, we quantify the effects of uncertainties in the definition and construction of embedded axes on the estimation of joint angular motion during gait. Using representative hip and knee motion data from normal subjects and cerebral palsy patients, the flexion-extension axis is analytically perturbed +/- 15 degrees in 5 degrees steps from a reference position, and the joint angles are recomputed for both Euler and helical angle definitions. For the Euler model, hip and knee flexion angles are relatively unaffected while the ab/adduction and rotation angles are significantly affected throughout the gait cycle. An error of 15 degrees in the definition of flexion-extension axis gives rise to maximum errors of 8 and 12 degrees for the ab/adduction angle, and 10-15 degrees for the rotation angles at the hip and knee, respectively. Furthermore, the magnitude of errors in ab/adduction and rotation angles are a function of the flexion angle. The errors for the ab/adduction angles increase with increasing flexion angle and for the rotation angle, decrease with increasing flexion angle. In cerebral palsy patients with flexed knee pattern of gait, this will result in distorted estimation of ab/adduction and rotation. For the helical model, similar results are obtained for the helical angle and associated direction cosines.(ABSTRACT TRUNCATED AT 250 WORDS)     

Background ventilatory stimulus as a determinant of load compensation

Compensation for inspiratory flow-resistive loading was compared during progressive hypercapnia and incremental exercise to determine the effect of changing the background ventilatory stimulus and to assess the influence of the interindividual variability of the unloaded CO2 response on evaluation of load compensation in normal subjects. During progressive hypercapnia, ventilatory response was incompletely defended with loading (mean unloaded delta VE/delta PCO2 = 3.02 +/- 2.29, loaded = 1.60 +/- 0.67 1.min-1.Torr-1 CO2, where VE is minute ventilation and PCO2 is CO2 partial pressure; P less than 0.01). Furthermore the degree of defense of ventilation with loading was inversely correlated with the magnitude of the unloaded CO2 response. During exercise, loading produced no depression in ventilatory response (mean delta VE/delta VCO2 unloaded = 20.5 +/- 1.9, loaded = 19.2 +/- 2.5 l.min-1.l-1.min-1 CO2 where VCO is CO2 production; P = NS), and no relationship was demonstrated between degree of defense of the exercise ventilatory response and the unloaded CO2 response. Differences in load compensation during CO2 rebreathing and exercise suggest the presence of independent ventilatory control mechanisms in these states. The type of background ventilatory stimulus should therefore be considered in load compensation assessment.     

Effect of load on preferred speed and cost of transport.

Horses have a tendency to utilize a relatively narrow set of speeds near the middle of a much broader range they are capable of using within a particular gait, i.e., a preferred speed. Possible explanations for this behavior include minimizing musculoskeletal stresses and maximizing metabolic economy. If metabolic economy (cost of transport, CT) and preferred speeds are linked, then shifts in CT should produce shifts in preferred speed. To test this hypothesis, preferred speed was measured in trotting horses (n = 7) unloaded on the level and loaded with 19% of their body weight on the level. The preferred speed on the level was 3.33 +/- 0.09 (SE) m/s, and this decreased to 3.13 +/- 0.11 m/s when loaded. In both conditions (no load and load), the rate of O2 consumption (n = 3) was a curvilinear function of speed that produced a minimum CT (i.e., speed at which trotting is most economical). When unloaded, the speed at which CT was minimum was very near the preferred speed. With a load, CT decreased and the minimum was also near the preferred speed of horses while carrying a load.     

Joint contact stresses calculated for acetabular dysplasia patients using discrete element analysis are significantly influenced by the applied gait pattern

Gait modifications in acetabular dysplasia patients may influence cartilage contact stress patterns within the hip joint, with serious implications for clinical outcomes and the risk of developing osteoarthritis. The objective of this study was to understand how the gait pattern used to load computational models of dysplastic hips influences computed joint mechanics. Three-dimensional pre- and post-operative hip models of thirty patients previously treated for hip dysplasia with periacetabular osteotomy (PAO) were developed for performing discrete element analysis (DEA). Using DEA, contact stress patterns were calculated for each pre- and post-operative hip model when loaded with an instrumented total hip, a dysplastic, a matched control, and a normal gait pattern. DEA models loaded with the dysplastic and matched control gait patterns had significantly higher (p = 0.012 and p < 0.001) average pre-operative maximum contact stress than models loaded with the normal gait. Models loaded with the dysplastic and matched control gait patterns had nearly significantly higher (p = 0.051) and significantly higher (p = 0.008) average pre-operative contact stress, respectively, than models loaded with the instrumented hip gait. Following PAO, the average maximum contact stress for DEA models loaded with the dysplastic and matched control patterns decreased, which was significantly different (p < 0.001) from observed increases in maximum contact stress calculated when utilizing the instrumented hip and normal gait patterns. The correlation between change in DEA-computed maximum contact stress and the change in radiographic measurements of lateral center-edge angle were greatest (R² = 0.330) when utilizing the dysplastic gait pattern. These results indicate that utilizing a dysplastic gait pattern to load DEA models may be a crucial element to capturing contact stress patterns most representative of this patient population.     

The effect of kinematic and kinetic changes on meniscal strains during gait

The menisci play an important role in load distribution, load bearing, joint stability, lubrication, and proprioception. Partial meniscectomy has been shown to result in changes in the kinematics and kinetics at the knee during gait that can lead to progressive meniscal degeneration. This study examined changes in the strains within the menisci associated with kinematic and kinetic changes during the gait cycle. The gait changes considered were a 5 deg shift toward external rotation of the tibia with respect to the femur and an increased medial-lateral load ratio representing an increased adduction moment. A finite element model of the knee was developed and tested using a cadaveric specimen. The cadaver was placed in positions representing heel-strike and midstance of the normal gait, and magnetic resonance images were taken. Comparisons of the model predictions to boundaries digitized from images acquired in the loaded states were within the errors produced by a 1 pixel shift of either meniscus. The finite element model predicted that an increased adduction moment caused increased strains of both the anterior and posterior horns of the medial meniscus. The lateral meniscus exhibited much lower strains and had minimal changes under the various loading conditions. The external tibial rotational change resulted in a 20% decrease in the strains in the posterior medial horn and increased strains in the anterior medial horn. The results of this study suggest that the shift toward external tibial rotation seen clinically after partial medial meniscectomy is not likely to cause subsequent degenerative medial meniscal damage, but the consequence of this kinematic shift on the pathogenesis of osteoarthritis following meniscectomy requires further consideration.     

Effect of resistive loading on ventilatory response to hypoxia.

Ventilatory responses to hypoxia, with and without an inspiratory resistive load, were measured in eight normal subjects, using a rebreathing technique. During the studies, the end-tidal P-CO2 was kept constant at mixed venous level (Pv-CO2) by drawing expired gas through a variable CO2-absorbing bypass. The initial bag O2 concentration was 24% and rebreathing was continued until the O2 concentration in the bag fell to 6% or the subject's arterial oxygen saturation (Sa-O2), monitored continuously by ear oximetry, fell to 70%. Studies with and without the load were performed in a formally randomized order for each subject. Linear regressions for rise in ventilation against fall in Sa-O2 were calculated. The range of unloaded responses was 0.78-3.59 1/min per 1% fall in Sa-O2 and loaded responses 0.37-1.68 1/min per 1% fall in Sa-O2. In each subject, the slope of the response curve during loading fell by an almost constant fraction of the unloaded response, such that the ratio of loaded to unloaded slope in all subjects ranged from 0.41 to 0.48. However, the extrapolated intercept of the response curve on the Sa-O2 axis did not alter significantly indicating that the P-CO2 did not alter between experiments. These results suggest that the change in ventilatory response to hypoxia during inspiratory resistive loading is related to the mechanical load applied, with the loaded slope being directly proportional to the unloaded one.     

Application of principal component analysis in clinical gait research: Identification of systematic differences between healthy and medial knee-osteoarthritic gait

For a successful completion of a movement task the motor control system has to observe a multitude of internal constraints that govern the coordination of its segments. The purpose of this study was to apply principal component (PC) analysis to detect differences in the segmental coordination between healthy subjects and patients with medial knee osteoarthritis (OA). It was hypothesized that (1) systematic differences in patterns of whole body movement would be identifiable with this method even in small sample sized groups and that (2) these differences will include compensatory movements in the OA patients in both the lower and upper body segments. Marker positions and ground reaction forces of three gait trials of 5 healthy and 5 OA participants with full body marker sets were analyzed using a principal component analysis. Group differences in the PC-scores were determined for the first 10 PC-vectors and a linear combination of those PC-vectors where differences were found defined a discriminant vector. Projecting the original trials onto this discriminant vector yielded significant group differences (t(d=8)=3.011; p=0.017) with greater upper body movement in patients with knee OA that was correlated with the medial–lateral ground reaction force. These results help to characterize the adaptation of whole-body gait patterns to knee OA in a relatively small population and may provide an improved basis for the development of interventions to modify knee load. The PC-based motion analysis offered a highly sensitive approach to identify characteristic whole body patterns of movement associated with pathological gait.     

Effect of Trunk Sagittal Attitude on Shoulder,Thorax and Pelvis Three-Dimensional Kinematics in Able-Bodied Subjects during Gait

It has been shown that an original attitude in forward or backward inclination of the trunk is maintained at gait initiation and during locomotion, and that this affects lower limb loading patterns. However, no studies have shown the extent to which shoulder, thorax and pelvis three-dimensional kinematics are modified during gait due to this sagittal inclination attitude. Thirty young healthy volunteers were analyzed during level walking with video-based motion analysis. Reflecting markers were mounted on anatomical landmarks to form a two-marker shoulder line segment, and a four-marker thorax and pelvis segments. Absolute and relative spatial rotations were calculated, for a total of 11 degrees of freedom. The subjects were divided into two groups of 15 according to the median of mean thorax inclination angle over the gait cycle. Preliminary MANOVA analysis assessed whether gender was an independent variable. Then two-factor nested ANOVA was used to test the possible effect of thorax inclination on body segments, planes of motion and gait periods, separately. There was no significant difference in all anthropometric and spatio-temporal parameters between the two groups, except for subject mass. The three-dimensional kinematics of the thorax and pelvis were not affected by gender. Nested ANOVA revealed group effect in all segment rotations apart those at the pelvis, in the sagittal and frontal planes, and at the push-off. Attitudes in sagittal thorax inclination altered trunk segments kinematics during gait. Subjects with a backward thorax showed less thorax-to-pelvis motion, but more shoulder-to-thorax and thorax-to-laboratory motion, less motion in flexion/extension and in lateral bending, and also less motion during push-off. This contributes to the understanding of forward propulsion and sideways load transfer mechanisms, fundamental for the maintenance of balance and the risk of falling.     

Development of a statistical model of knee kinetics for applications in pre-clinical testing

Pre-clinical computational testing of total knee replacements (TKRs) often only considers a single patient model with simplified applied loads. In studies of multiple patients, most only take into account geometric differences, especially in studies on the knee. Limited availability of kinetic data means that it is difficult to account for inter-patient variability. Principal component analysis (PCA) based statistical models have been used to capture the variation of a set of data and generate new instances of the data. This study presents a method to create a statistical model of kinetic waveform data. A PCA based statistical model was created of the tibiofemoral joint loads for level gait of preoperative TKR patients using data predicted from a musculoskeletal model. A reconstruction test showed that, using principal components (PCs) representing 95% variance, the median root-mean-squared (RMS) error was <0.1 body weight (BW) for the forces and <0.001 BWm for the moments. Leave-one-out tests were also performed and although the median RMS error increased for each load in comparison to the reconstruction error (maximum was 0.2 BW for the axial force and 0.012 BWm for the varus-valgus moment) these were considered within an acceptable limit. The purpose of creating a statistical model is to be able to sample a large set of data representing a population from a small set of clinical data. Such models can potentially be used in population based studies of TKRs incorporating inter-patient variability.     

Physiological Loading Can Restore the Proteoglycan Content in a Model of Early IVD Degeneration

A hallmark of early IVD degeneration is a decrease in proteoglycan content. Progression will eventually lead to matrix degradation, a decrease in weight bearing capacity and loss of disc height. In the final stages of IVD degradation, fissures appear in the annular ring allowing extrusion of the NP. It is crucial to understand the interplay between mechanobiology, disc composition and metabolism to be able to provide exercise recommendations to patients with early signs of disc degeneration. This study evaluates the effect of physiological loading compared to no loading on matrix homeostasis in bovine discs with induced degeneration. Bovine discs with trypsin-induced degeneration were cultured for 14 days in a bioreactor under dynamic loading with maintained metabolic activity. Chondroadherin abundance and structure was used to confirm that a functional matrix was preserved in the chosen loading environment. No change was observed in chondroadherin integrity and a non-significant increase in abundance was detected in trypsin-treated loaded discs compared to unloaded discs. The proteoglycan concentration in loaded trypsin-treated discs was significantly higher than in unloaded disc and the newly synthesised proteoglycans were of the same size range as those found in control samples. The proteoglycan showed an even distribution throughout the NP region, similar to that of control discs. Significantly more newly synthesised type II collagen was detected in trypsin-treated loaded discs compared to unloaded discs, demonstrating that physiological load not only stimulates aggrecan production, but also that of type II collagen. Taken together, this study shows that dynamic physiological load has the ability to repair the extracellular matrix depletion typical of early disc degeneration.     

Effect of stable and unstable load carriage on walking gait variability,dynamic stability and muscle activity of older adults

Load carriage perturbs the neuromuscular system, which can be impaired due to ageing. The ability to counteract perturbations is an indicator of neuromuscular function but if the response is insufficient the risk of falls will increase. However, it is unknown how load carriage affects older adults. Fourteen older adults (65 ± 6 years) attended a single visit during which they performed 4 min of walking in 3 conditions, unloaded, stable backpack load and unstable backpack load. During each walking trial, 3-dimensional kinematics of the lower limb and trunk movements and electromyographic activity of 6 lower limb muscles were recorded. The local dynamic stability (local divergence exponents), joint angle variability and spatio-temporal variability were determined along with muscle activation magnitudes. Medio-lateral dynamic stability was lower (p = 0.018) and step width (p = 0.019) and step width variability (p = 0.015) were greater in unstable load walking and step width variability was greater in stable load walking (p = 0.009) compared to unloaded walking. However, there was no effect on joint angle variability. Unstable load carriage increased activity of the Rectus Femoris (p = 0.001) and Soleus (p = 0.043) and stable load carriage increased Rectus Femoris activity (p = 0.006). These results suggest that loaded walking alters the gait of older adults and that unstable load carriage reduces dynamic stability compared to unloaded walking. This can potentially increase the risk of falls, but also offers the potential to use unstable loads as part of fall prevention programmes.