Biomechanical analysis of different back-supporting exoskeletons regarding musculoskeletal loading during lifting and holding.

Industrial back support exoskeletons (BSEs) are a promising approach to addressing low back pain (LBP) which still affect a significant proportion of the workforce. They aim to reduce lumbar loading, the main biomechanical risk factor for LBP, by providing external support to the lumbar spine. The aim of this study was to determine the supporting effect of one active (A1) and two passive (P1 and P2) BSEs during different manual material handling tasks. Kinematic data and back muscle activity were collected from 12 subjects during dynamic lifting and static holding of 10 kg. Mean and peak L5/S1 extension moments, L5/S1 compression forces and muscle activation were included in the analysis. During dynamic lifting all BSEs reduced peak (12-26 %) and mean (4-17 %) extension moments and peak (10-22 %) and mean (4-15 %) compression forces in the lumbar spine. The peak (13-28 %) and mean (4-32 %) activity of the back extensor muscles was reduced accordingly. In the static holding task, analogous mean reductions for P1 and P2 of L5/S1 extension moments (12-20 %), compression forces (13-23 %) and muscular activity (16-23 %) were found. A1 showed a greater reduction during static holding for extension moments (46 %), compression forces (41 %) and muscular activity (54 %). This pronounced difference in the performance of the BSEs between tasks was attributed to the actuators used by the different BSEs.

Stability recovery performance in adults over a wide age range: A multicentre reliability analysis using different lean-and-release test protocols.

The ability to effectively increase the base of support is crucial to prevent from falling due to stability disturbances and has been commonly assessed using the forward-directed lean-and-release test. With this multicentre study we examined whether the assessment of stability recovery performance using two different forward lean-and-release test protocols is reliable in adults over a wide age range. Ninety-seven healthy adults (age from 21 to 80 years) were randomly assigned to one out of two lean angle protocols: gradual increase to maximal forward-lean angle (maximal lean angle; n = 43; seven participants were excluded due to marker artefacts) or predefined lean angle (single lean angle; n = 26; 21 participants needed to be excluded due to multiple stepping after release or marker artefacts). Both protocols were repeated after 0.5 h and 48 h to investigate intra- and inter-session reliability. Stability recovery performance was examined using the margin of stability at release (MoSRL) and touchdown (MoSTD) and increase in base of support (BoSTD). Intraclass correlation coefficients (confidence intervals at 95%) for the maximal lean angle and for the single lean angle were respectively 0.93 (0.89-0.96) and 0.94 (0.89-0.97) in MoSRL, 0.85 (0.77-0.91) and 0.67 (0.48-0.82) in MoSTD and 0.88 (0.81-0.93) and 0.80 (0.66-0.90) in BoSTD, with equivalence being revealed for each parameter between all three measurements (p < 0.01). We concluded that the assessment of stability recovery performance parameters in adults over a wide age range with the means of the forward lean-and-release test is reliable, independent of the used lean angle protocol.

The effect of force-controlled biting on human posture control.

Several studies have confirmed the neuromuscular effects of jaw motor activity on the postural stability of humans, but the mechanisms of functional coupling of the craniomandibular system (CMS) with human posture are not yet fully understood. The purpose of our study was, therefore, to investigate whether submaximum biting affects the kinematics of the ankle, knee, and hip joints and the electromyographic (EMG) activity of the leg muscles during bipedal narrow stance and single-leg stance. Twelve healthy young subjects performed force-controlled biting (FB) and non-biting (NB) during bipedal narrow stance and single-leg stance. To investigate the effects of FB on the angles of the hip, knee, and ankle joints, a 3D motion-capture system (Vicon MX) was used. EMG activity was recorded to enable analysis of the coefficient of variation of the muscle co-contraction ratios (CVR) of six pairs of postural muscles. Between FB and NB, no significant differences were found for the mean values of the angles of the ankle, knee, and hip joints, but the standard deviations were significantly reduced during FB. The values of the ranges of motion and the mean angular velocities for the three joints studied revealed significant reduction during FB also. CVR was also significantly reduced during FB for five of the six muscle pairs studied. Although submaximum biting does not change the basic strategy of posture control, it affects neuromuscular co-contraction patterns, resulting in increased kinematic precision.

Motion analysis of patients after knee arthroplasty during activities of daily living--a systematic review.

BACKGROUND: Motion analysis with optoelectronic systems is a frequently used method to analyze the patient's gait as well as further relevant activities of daily living before and after knee arthroplasty. The aim of this systematic review was to identify the investigated activities of daily living and to show an extensive presentation of gait analysis studies with patients after knee arthroplasty surgery. METHODS: The articles were searched in electronic databases: MEDPILOT, EMBASE. To identify articles that potentially met the inclusion criteria the titles and abstracts were screened. The level of evidence was analyzed for the included articles. RESULTS: Overall 3989 abstracts were reviewed and 87 full text articles were included. Ten activities of daily living were identified. Level walking was the most frequently investigated activity (78.2%). In 94.6% the sagittal plane kinematics were analyzed and 5.3% presented the results in all three planes. Knee adduction moments were determined in 33.3% of the included articles. At least two joints were investigated in 40.2%, including the impaired knee and further body parts (ankle, hip, pelvis, trunk). Unicondylar knee arthroplasty was addressed in 14.1%. CONCLUSIONS: Besides level walking, it is necessary to examine physical more demanding activities of daily living to detect potential kinematic and kinetic abnormalities. Further research should imply the evaluation of sagittal, frontal and transverse plane joint and muscle function based on accurate inverse-dynamic techniques. More motion analysis studies are necessary that address unicondylar knee arthroplasty in comparison to total knee arthroplasty and healthy controls.

Reproducibility of spatio-temporal and dynamic parameters in various, daily occurring, turning conditions.

OBJECTIVE: This study aims to assess the test-retest reproducibility of specific spatio-temporal (foot placement, foot contact time) and dynamic (resultant horizontal and vertical ground reaction force) gait parameters of three different, everyday occurring, turning conditions. The subjects were tested at two subsequent days. Out of this setting the purpose of this study is to clarify, if turning locomotion is stable when performed at different test occurrences. METHODS: Eight subjects completed three different daily occurring turning conditions along turns with a given walking velocity of 5 km/h (± 10%). Subjects had to complete the turns three times clockwise and counter clockwise. The measurements were recorded with a 3D motion analysis system (Vicon(®)) and two force sensitive platforms (AMTI(®)), connected to the motion analysis system. RESULTS: The analysis yields for most of the parameters and turning conditions ICCs from good (r = 0.72; p = .06) to high (r = 0.96; p < .01) magnitude for the measured spatio-temporal and dynamic parameters. CONCLUSIONS: Based on our findings it can be assumed that locomotion strategies, related to the measured gait parameters of common daily turning tasks, are stable and reproducible.

Force-controlled biting alters postural control in bipedal and unipedal stance.

Human posture is characterised by inherent body sway which forces the sensory and motor systems to counter the destabilising oscillations. Although the potential of biting to increase postural stability has recently been reported, the mechanisms by which the craniomandibular system (CMS) and the motor systems for human postural control are functionally coupled are not yet fully understood. The purpose of our study was, therefore, to investigate the effect of submaximum biting on postural stability and on the kinematics of the trunk and head. Twelve healthy young adults performed force-controlled biting (FB) and non-biting (NB) during bipedal narrow stance and single-leg stance. Postural stability was quantified on the basis of centre of pressure (COP) displacements, detected by use of a force platform. Trunk and head kinematics were investigated by biomechanical motion analysis, and bite forces were measured using a hydrostatic system. The results revealed that FB significantly improved postural control in terms of reduced COP displacements, providing additional evidence for the functional coupling of the CMS and human posture. Our study also showed, for the first time, that reductions in the sway of the COP were accompanied by reduced trunk and head oscillations, which might be attributable to enhanced trunk stiffness during FB. This physiological response to isometric activation of the masticatory muscles raises questions about the potential of oral motor activity as a strategy to reduce the risk of falls among the elderly or among patients with compromised postural control.

Relative movements between the tibia and femur induced by external plantar shocks are controlled by muscle forces in vivo.

The purpose of this study was to investigate the role of muscle activation on the relative motion between tibia and femur. Impacts were initiated under the heels of four volunteers in three different activation levels of muscles crossing the extended knee joint: 0%, 30% and 60% of previously performed maximal voluntary isometric contractions. Impact forces were measured and tibial and femoral accelerations and displacements were determined by means of accelerometry. The accelerometers were mounted on the protruding ends of intracortical pins, inserted into the distal aspect of the femur and proximal aspect of the tibia. Under the 0%-condition the impact force (475±64N) led to 2.3±1.2mm knee compression and to 2.4±1.9mm medio-lateral and 4.4±1.1mm antero-posterior shear. The impact forces increased significantly with higher activation levels (619±33N (30%), 643±147N (60%)), while the knee compression (1.5±1.2, 1.4±1.3mm) and both medio-lateral shear (1.8±1.4, 1.5±1.1mm) and antero-posterior shear (2.6±1.3, 1.5±1.1mm) were significantly reduced. This study indicated that muscles are effective in controlling the relative motion between tibia and femur when the knee is subjected to external forces.