Should the instructions issued to the subject in traditional static posturography be standardised?

The postural ability of a subject is usually evaluated through the observation of the centre of pressure parameters obtained through posturography. These parameters are known to be sensitive to various factors and standards have consequently been proposed for data acquisition and analysis. A factor usually not taken into due consideration but likely to influence the postural exam is the kind of standing posture (e.g. natural or immobile) a subject is instructed to maintain. This study aimed at investigating whether instructions issued in a traditional static posturographic test influence its outcome and hence should be considered in the standardisation of the posturography protocols. Two groups of young healthy subjects were each issued one of two common instructions, "stand quietly" or "stand as still as possible", by means of projected instructions. Differences between the two groups were investigated for commonly calculated centre of pressure parameters. All these parameters, but the mean frequency, were significantly different, with variations in the range between 8% (mean velocity) and 71% (confidence circle area). These results suggest that instructions given to the subjects strongly influence the outcome of posturography and should, hence, be standardised.

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.

Mobility assessment of patients with facioscapulohumeral dystrophy.

BACKGROUND: Facioscapulohumeral muscular dystrophy is the third most common form of inherited myopathies with a prevalence of 1:20,000. Since both muscle involvement and disease progression are heterogeneous and unpredictable, quantitative assessment tools are needed to evaluate the effects of pharmacological and physical training treatments. METHODS: The instrumented movement analysis of 12 patients with facioscapulohumeral dystrophy and 12 control subjects was conducted using a 9-camera stereophotogrammetric system and 2 force platforms. Subjects performed four tasks of different difficulties: arm movement, level walking, step ascending, and squatting. Manual muscle test, clinical severity scale and magnetic resonance imaging were used to clinically assess the patients. FINDINGS: Walking speed and centre of mass vertical displacement during squatting were reduced in patients and can be used to assess their motor capacity. Features common in the patient sample were: the reduction of shoulder range of motion, the excessive ankle plantar-flexion during walking and step ascending, and the reduction of knee flexion-extension moment during squatting. These parameters were correlated with magnetic resonance imaging results at relevant structure level and can be used to assess the corresponding body functioning. Furthermore, instrumented movement analysis was able to distinguish from normal controls also a group of patients in which clinical assessments did not show any obvious abnormalities and had been evaluated as normal. INTERPRETATION: The quantitative assessment tool devised in this study provides suitable information in terms of both motor capacity and impairment severity of patients with facioscapulohumeral dystrophy, and, thus, encouraging its use for the evaluation of therapeutic trial outcomes for this disease.

Soft tissue displacement over pelvic anatomical landmarks during 3-D hip movements.

The position, in a pelvis-embedded anatomical coordinate system, of skin points located over the following anatomical landmarks (AL) was determined while the hip assumed different spatial postures: right and left anterior superior and posterior superior iliac spines, and the sacrum. Postures were selected as occurring during walking and during a flexion-extension and circumduction movement, as used to determine the hip joint centre position (star-arc movement). Five volunteers, characterised by a wide range of body mass indices (22-37), were investigated. Subject-specific MRI pelvis digital bone models were obtained. For each posture, the pose of the pelvis-embedded anatomical coordinate system was determined by registering this bone model with points digitised over bony prominences of the pelvis, using a wand carrying a marker-cluster and stereophotogrammetry. The knowledge of how the position of the skin points varies as a function of the hip posture provided information regarding the soft tissue artefact (STA) that would affect skin markers located over those points during stereophotogrammetric movement analysis. The STA was described in terms of amplitude (relative to the position of the AL during an orthostatic posture), diameter (distance between the positions of the AL which were farthest away from each other), and pelvis orientation. The STA amplitude, exhibited, over all postures, a median [inter-quartile] value of 9[6] and 16[11]mm, for normal and overweight volunteers, respectively. STA diameters were larger for the star-arc than for the walking postures, and the direction was predominantly upwards. Consequent errors in pelvic orientation were in the range 1-9 and 4-11 degrees, for the two groups respectively.

A constrained extended Kalman filter for the optimal estimate of kinematics and kinetics of a sagittal symmetric exercise.

This paper presents a method for real-time estimation of the kinematics and kinetics of a human body performing a sagittal symmetric motor task, which would minimize the impact of the stereophotogrammetric soft tissue artefacts (STA). The method is based on a bi-dimensional mechanical model of the locomotor apparatus the state variables of which (joint angles, velocities and accelerations, and the segments lengths and inertial parameters) are estimated by a constrained extended Kalman filter (CEKF) that fuses input information made of both stereophotogrammetric and dynamometric measurement data. Filter gains are made to saturate in order to obtain plausible state variables and the measurement covariance matrix of the filter accounts for the expected STA maximal amplitudes. We hypothesised that the ensemble of constraints and input redundant information would allow the method to attenuate the STA propagation to the end results. The method was evaluated in ten human subjects performing a squat exercise. The CEKF estimated and measured skin marker trajectories exhibited a RMS difference lower than 4mm, thus in the range of STAs. The RMS differences between the measured ground reaction force and moment and those estimated using the proposed method (9N and 10Nm) were much lower than obtained using a classical inverse dynamics approach (22N and 30Nm). From the latter results it may be inferred that the presented method allows for a significant improvement of the accuracy with which kinematic variables and relevant time derivatives, model parameters and, therefore, intersegmental moments are estimated.

Rigid and non-rigid geometrical transformations of a marker-cluster and their impact on bone-pose estimation.

When stereophotogrammetry and skin-markers are used, bone-pose estimation is jeopardised by the soft tissue artefact (STA). At marker-cluster level, this can be represented using a modal series of rigid (RT; translation and rotation) and non-rigid (NRT; homothety and scaling) geometrical transformations. The NRT has been found to be smaller than the RT and claimed to have a limited impact on bone-pose estimation. This study aims to investigate this matter and comparatively assessing the propagation of both STA components to bone-pose estimate, using different numbers of markers. Twelve skin-markers distributed over the anterior aspect of a thigh were considered and STA time functions were generated for each of them, as plausibly occurs during walking, using an ad hoc model and represented through the geometrical transformations. Using marker-clusters made of four to 12 markers affected by these STAs, and a Procrustes superimposition approach, bone-pose and the relevant accuracy were estimated. This was done also for a selected four marker-cluster affected by STAs randomly simulated by modifying the original STA NRT component, so that its energy fell in the range 30-90% of total STA energy. The pose error, which slightly decreased while increasing the number of markers in the marker-cluster, was independent from the NRT amplitude, and was always null when the RT component was removed. It was thus demonstrated that only the RT component impacts pose estimation accuracy and should thus be accounted for when designing algorithms aimed at compensating for STA.

A model of the soft tissue artefact rigid component.

When using stereophotogrammetry and skin-markers, the reconstruction of skeletal movement is affected by soft-tissue artefact (STA). This may be described by considering a marker-cluster as a deformable shape undergoing a geometric transformation formed by a non-rigid (change in size and shape) and a rigid component (translation and rotation displacements). A modal decomposition of the STA, relative to an appropriately identified basis, allows the separation of these components. This study proposes a mathematical model of the STA that embeds only its rigid component and estimates the relevant six mode amplitudes as linear functions of selected proximal and distal joint rotations during the analysed task. This model was successfully calibrated for thigh and shank using simultaneously recorded pin- and skin-marker data of running volunteers. The root mean square difference between measured and model-estimated STA rigid component was 1.1(0.8)mm (median (inter-quartile range) over 3 subjects × 5 trials × 33 markers coordinates), and it was mostly due to the wobbling not included in the model. Knee joint kinematics was estimated using reference pin-marker data and skin-marker data, both raw and compensated with the model-estimated STA. STA compensation decreased inaccuracy on average from 6% to 1% for flexion/extension, from 43% to 18% for the other two rotations, and from 69% to 25% for the linear displacements. Thus, the proposed mathematical model provides an STA estimate which can be effectively used within optimal bone pose and joint kinematics estimators for artefact compensation, and for simulations aimed at their comparative assessments.

Compressive loads in the lumbar vertebral column during normal level walking.

The longitudinal compressive load acting on the L3-L4 spinal motion segment was investigated during normal level walking for a range of speeds of progression. Forces were predicted using experimental data from photogrammetric measurements of upper body segmental motion and inertial properties, along with a biomechanical model of the trunk. A partial validation of the results was obtained using records of the electrical activity of the trunk muscles and intradiscal pressure information available in the literature. Experiments were carried out in five normal young male subjects. Results showed that the L3-L4 motion segment is subjected to cyclic compressive loads. The maximum and minimum values of this load vary with walking speed from approximately 1.0 to 2.5 and from 0.8 to 0.2 times body weight, respectively. Relevant peaks occur with a frequency ranging approximately from 1.3 to 2.5 Hz. Muscular action is mostly concentrated in the trunk extensors, which show a burst of activity at the time of ipsilateral toe-off.

Lumbar spine loading during half-squat exercises.

Evaluation of the compressive load acting on the lumbar spine (L3-L4) during half-squat exercises executed with a barbell resting on the subject's shoulders was undertaken. The kinematics of the upper body segments of two male and two female subjects as well as the barbell were described using data obtained by means of an optoelectronic system (CoSTEL). L3-L4 compressive load was calculated using a model of the anatomy of the trunk musculoskeletal system. Filtered surface electromyographic trunk flexor recordings from the obliquus externus and rectus abdominis and trunk extensor erectores spinae muscles as well as measurement of the ground reaction forces were also carried out for predicted result validation. During half-squat exercises with barbell loads in the range 0.8 to 1.6 times body weight the compressive loads on the L3-L4 segment vary between 6 and 10 times body weight. Erectores spinae contraction force was predicted to be between 30 and 50% of the relevant maximal isometric force. The magnitude of trunk flexion was found to be the variable which influenced most spinal compression load.

Low frequency self-generated vibration during ambulation in normal men.

An assessment was made of the upper body low frequency steady-state vibration in five normal male subjects during level walking in a straight line. Speed of progression ranged from 0.99 to 2.35 m/s. Through a stereophotogrammetric technique, a three-dimensional measurement of the linear displacement of the longitudinal axis of the trunk and head was done. The relevant accelerations were obtained by double differentiation and described both in the time and frequency domains. The data were compared with those available on the biodynamic properties of body tissues and on the subjective response of humans to externally generated whole-body vibration. The comparison yielded a consistent indication of the characteristics of the vibration stimulus to which the human body may be adapted. As walking speed approached its maximum, the vertical acceleration spectrum increased in magnitude and shifted critically close to frequencies at which body organs are known to undergo resonance. A coordinated movement of the trunk with respect to the pelvis helped to reduce to a minimum the value of the acceleration to which the head was submitted in the antero-posterior direction and to shift the relevant spectrum towards the lower frequencies.

The forces and couples in the human trunk during level walking.

The intersegmental force and couple exchanged between upper and lower body across a transverse section passing through the fourth lumbar vertebra were estimated during level walking on a straight line at speeds ranging from 0.99 to 2.23 ms-1. This was done using 3-D kinematic information relative to the head, upper limbs, and upper torso, obtained through a stereophotogrammetric technique, and the relevant inertial parameters obtained using anthropometric measurements and estimation techniques provided in the literature. Twenty walking cycles of five normal adult male subjects were analysed. The intersegmental force and couple components are presented as referenced to both a laboratory and pelvic set of axes. Using these results some considerations are made concerning the variations which the overall trunk muscles effort undergoes because of mean walking speed changes. The muscular action on the trunk is inferred from the intersegmental couple components. The various factors that contribute to the build-up of the intersegmental force and couple are analysed and their relative importance assessed.

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 telescopic inverted-pendulum model of the musculo-skeletal system and its use for the analysis of the sit-to-stand motor task.

For field applicability of biomechanical methodologies aiming at assessing motor ability in disabled, or at risk of disablement (e.g. elderly), subjects, measurements must be carried out using a least perceivable to the subject and essential experimental apparatus. Since data thus obtained do not necessarily lend themselves to straightforward interpretation, they should be fed to a model of the portion of the musculo-skeletal system involved that already embodies the invariant aspects of both the modelled system and the motor task. Through such a minimum measured-input model, richer, physiology-related, and thus easier to interpret, information may be expected. In this framework, the present study investigated the sit-to-stand motor task using information obtained only from a force plate located under seat and subject's feet, a seat uniaxial load-cell and basic anthropometric parameters. Data were collected in a sample of 12 able-bodied subjects while executing the motor task at different speeds. The musculo-skeletal system was modelled as a telescopic inverted pendulum (TIP) that could vary its length (shortening or elongation) by effect of a force actuator and its orientation in space by effect of two couple actuators that were looked upon as muscle equivalent effectors. The TIP model output consisted in the kinematics and dynamics of these actuators. It allowed the identification of four functional phases in which the seat-to-stand motor task could be divided, and a detailed description of the relevant mechanics in terms of balance control and centre of mass elevation. Motor strategy modifications associated with speed variation could also be identified. For a global evaluation of the motor act it showed to be no less informative than more demanding multi-segment models. Although it is true that specific musculo-articular functions can only be inferred, the more compact information yielded by the TIP model is expected to facilitate subject and/or disability classification.

Comparative evaluation of techniques for the harmonic analysis of human motion data.

Four mathematical techniques for the estimation of the Fourier coefficients of pseudoperiodic non-exact discrete functions were submitted to comparative evaluation. These techniques were devised within the following basic procedures: (1) numerical harmonic analysis applied either directly or after redistribution of the data points through some interpolation procedure, so that they be evenly spaced in time and exactly fit on cycle period; (2) fitting of the empirical data with an analytical model followed by the calculation of the Fourier integrals of this model. The evaluation was carried out with special reference to the use of these techniques for processing human motion photogrammetric data. The following criteria were used: (1) accuracy of the Fourier coefficient estimates, (2) capability of yielding information about this accuracy, (3) a priori information needed regarding the statistical properties of the experimental error, (4) factors concerning implementation in digital computers. Practical information was obtained for the non-specialist user with regard to the choice of one technique among the several possible in particular circumstances.

Skin movement artefact assessment and compensation in the estimation of knee-joint kinematics.

In three dimensional (3-D) human movement analysis using close-range photogrammetry, surface marker clusters deform and rigidly move relative to the underlying bone. This introduces an important artefact (skin movement artefact) which propagates to bone position and orientation and joint kinematics estimates. This occurs to the extent that those joint attitude components that undergo small variations result in totally unreliable values. This paper presents an experimental and analytical procedure, to be included in a subject-specific movement analysis protocol, which allows for the assessment of skin movement artefacts and, based on this knowledge, for their compensation. The effectiveness of this procedure was verified with reference to knee-joint kinematics and to the artefacts caused by the hip movements on markers located on the thigh surface. Quantitative validation was achieved through experimental paradigms whereby prior reliable information on the target joint kinematics was available. When position and orientation of bones were determined during the execution of a motor task, using a least-squares optimal estimator, but the rigid artefactual marker cluster movement was not dealt with, then knee joint translations and rotations were affected by root mean square errors (r.m.s.) up to 14 mm and 6 degrees, respectively. When the rigid artefactual movement was also compensated for, then r.m.s errors were reduced to less than 4 mm and 3 degrees, respectively. In addition, errors originally strongly correlated with hip rotations, after compensation, lost this correlation.

Effects of hip joint centre mislocation on gait analysis results.

Methods to determine the hip joint centre (HJC) location are necessary in gait analysis. It has been demonstrated that the methods proposed in the literature involve large mislocation errors. The choice should be made according to the extent by which HJC location errors distort the estimates of angles and resultant moments at the hip and knee joints. This study aimed at quantifying how mislocation errors propagate to these gait analysis results. Angles and moments at the hip and knee joint were calculated for five able-bodied subjects during level walking. The nominal position of the HJC was determined as the position of the pivot point of a 3D movement of the thigh relative to the pelvis. Angles and moments were then re-calculated after having added to HJC co-ordinates errors in the range of +/-30 mm. Angles and moments at both hip and knee joints were affected by HJC mislocation. The hip moments showed the largest propagation error: a 30 mm HJC anterior mislocation resulted in a propagated error into flexion/extension component of about -22%. The hip abduction/adduction moment was found the second largest affected quantity: a 30 mm lateral HJC mislocation produced a propagated error of about -15%. Finally, a 30 mm posterior HJC mislocation produced a delay of the flexion-to-extension timing in the order of 25% of the stride duration. HJC estimation methods with minimum antero-posterior error should therefore be preferred.

Validation of a functional method for the estimation of hip joint centre location.

The present study assesses the accuracy with which the subject specific coordinates of the hip joint centre (HJC) in a pelvic anatomical frame can be estimated using different methods. The functional method was applied by calculating the centre of the best sphere described by the trajectory of markers placed on the thigh during several trials of hip rotations. Different prediction methods, proposed in the literature and in the present investigation, which estimate the HJC of adult subjects using regression equations and anthropometric measurements, were also assessed. The accuracy of each of the above-mentioned methods was investigated by comparing their predictions with measurements obtained on a sample of 11 male adult able-bodied volunteers using roentgen stereophotogrammetric analysis (RSA), assumed to provide the true HJC locations. Prediction methods estimated the HJC location at an average rms distance of 25-30 mm. The functional method performed significantly better and estimated HJCs within a rms distance of 13 mm on average. This result may be confidently generalised if the photogrammetric experiment is carefully conducted and an optimal analytical approach used. The method is therefore suggested for use in motion analysis when the subject's hip range of motion is not limited. In addition, the facts that it is not an invasive technique and that it has relatively small and un-biased errors, make it suitable for regression equations identification with no limit to sample size and population typology.

Surface-marker cluster design criteria for 3-D bone movement reconstruction.

When three-dimensional (3-D) human or animal movement is recorded using a photogrammetric system, bone-embedded frame positions and orientations are estimated from reconstructed surface marker trajectories using either nonoptimal or optimal algorithms. The effectiveness of these mathematical procedures in accommodating for both photogrammetric errors and skin movement artifacts depends on the number of markers associated with a given bone as well as on the size and shape characteristics of the relevant cluster. One objective of this paper deals with the identification of marker-cluster design criteria aimed at the minimization of error propagation from marker coordinates to bone-embedded frame position and orientation. Findings allow for the quantitative estimation of these errors for any given cluster configuration and suggest the following main design criteria. A cluster made up of four markers represents a good practical compromise. Planar clusters are acceptable, provided in quasi-isotropic distribution. The root mean square distance of the markers from their centroid should be greater than ten times the standard deviation of the marker position error. The second objective of this paper deals with the identification of the optimal cluster position and orientation on the limb aimed at the minimization of error propagation to anatomical landmark laboratory coordinates. Cluster position should be selected to minimize skin movement artifacts. The longest principal axis of the marker distribution should be oriented toward the relevant anatomical landmark position.

Hemodynamics as a possible internal mechanical disturbance to balance.

The postural control system is assessed by observing body sway while the subject involved aims at maintaining a specified up-right posture. Internal masses generate internal reaction forces that constitute an internal mechanical stimulus that may contribute to cause segmental displacements, i.e. body sway. Thus, gaining knowledge about the amplitude and direction of these reaction forces would contribute to gain insights into the mechanisms that influence the maintenance of balance and into its control. The 3-D force vector that acts on the body centre of mass (COM) and is associated with the transient blood movement at each cardiac cycle was assessed in a population sample of 20 young adults during the maintenance of a quiet up-right posture. Typical patterns of the three components of this force vector were identified. Relevant parameters were selected and submitted to sample statistics. For a number of them, linear correlation with subject-specific parameters was found. The antero-posterior force component was characterised by a triphasic major wave, the peaks of which had values up to 0.40 N. The vertical component showed a repeatable triphasic wave with peak-to-peak values in the range 1.3-3.0 N. The medio-lateral component showed relatively low peak-to-peak values (in the range 0.05-0.10 N). The resultant vector had an amplitude that underwent several oscillations during the cardiac cycle and reached its maximal value in the range 0.6-1.7 N.

A spot check for estimating stereophotogrammetric errors.

Good practice rules in the management of a movement analysis laboratory recommend that photogrammetric measurement errors are assessed, prior to every experimental session, using an ad hoc experiment referred to as a spot check. The paper proposes an inexpensive and easy to make spot check. The test uses a rigid rod carrying two markers and a target point taken on the line joining them and coinciding with the rod tip. The latter point is placed in a fixed and measured position in the laboratory frame and the markers are tracked while the rod is kept stationary and while it is manually made to rotate about the target point. Several target points are used within the measurement volume. The instantaneous errors with which the laboratory co-ordinates of the latter points are reconstructed are determined and submitted to statistical analysis. A normalisation procedure is illustrated that aims at making the test results independent from the geometry of the test object. The experimental and analytical methods underlying the proposed spot check were validated experimentally in two movement analysis laboratories using repeated tests. A rod, 1.5 m long, carrying four markers was used. In this way, several test-object geometries were tested. Results confirmed that the photogrammetric error could be divided into a zero-mean random and a systematic component. It was shown that the normalisation procedure was effective for the standard deviation of both error components when the two markers were located at a distance between them 1.5 times larger than the distance of their centroid from the tip of the rod. The systematic component bias could not be normalised, however a conservative value of it could be estimated. The two above-mentioned normalised standard deviations and the bias value can be taken as descriptors of the photogrammetric error of the specific measuring system tested. These parameters may also be used to assess the precision and the accuracy with which the laboratory position of a target point, defined relative to any specified marker cluster, may be reconstructed during movement analysis.