Do Athletes With a Reconstructed Anterior Cruciate Ligament Respond Differently Than Controls to Visual Challenges When Dynamic Postural Stability is Assessed?

Individuals returning to sport after anterior cruciate ligament reconstruction (ACLR) are at an increased risk of sustaining a subsequent ACL injury. It is suspected that increased reliance on visual information to maintain stability may factor into this increased risk. The connection between visual reliance and ACLR is not well understood during dynamic tasks. Examination of the proposed visual reliance may help improve returning to sport standards and reduce subsequent ACL injury risk. A total of 12 ACLR individuals and 12 age- and sex-matched controls completed several trials of a normalized dynamic hop task on both limbs under 3 different visual conditions (eyes open, low visual disruption, and high visual disruption). Stroboscopic eyewear were worn by each participant to disrupt vision during testing. Ground reaction force data were collected during landing. Dynamic postural stability was assessed using 2 separate calculations: dynamic postural stability index and time to stability. No significant statistical interactions or group differences were observed. The stroboscopic eyewear did increase the medial-lateral stability index from the eyes open to the low visual disruption condition (P < .05). These findings suggest that ACLR individuals do not rely on visual information more than controls during a dynamic hop task.

Averaging Trials Versus Averaging Trial Peaks: Impact on Study Outcomes.

Gait data are commonly presented as an average of many trials or as an average across participants. Discrete data points (eg, maxima or minima) are identified and used as dependent variables in subsequent statistical analyses. However, the approach used for obtaining average data from multiple trials is inconsistent and unclear in the biomechanics literature. This study compared the statistical outcomes of averaging peaks from multiple trials versus identifying a single peak from an average profile. A series of paired-samples t tests were used to determine whether there were differences in average dependent variables from these 2 methods. Identifying a peak value from the average profile resulted in significantly smaller magnitudes of dependent variables than when peaks from multiple trials were averaged. Disagreement between the 2 methods was due to temporal differences in trial peak locations. Sine curves generated in MATLAB confirmed this misrepresentation of trial peaks in the average profile when a phase shift was introduced. Based on these results, averaging individual trial peaks represents the actual data better than choosing a peak from an average trial profile.

The effect of stroboscopic visual disruption on static stability measures in anterior cruciate ligament reconstructed individuals.

BACKGROUND: Those who undergo ACL reconstruction are at an increased risk of suffering a second ACL injury. A suggested rationale for the increased injury risk is sensory reweighting to the visual system to compensate for a lack of somatosensory information from the knee. Understanding this proposed visual reliance may help clinicians improve return to sport outcomes and reduce the risk of a subsequent ACL injury. METHODS: Thirteen ACL reconstructed individuals and thirteen matched controls completed two common static postural control assessments under three different visual conditions; eyes open, low visual disruption, and high visual disruption. Center of pressure data was collected for 30 s using force plates. Static postural stability was evaluated using the following: 1) root mean square distance, 2) mean velocity, 3) sway area, and 4) mean frequency. FINDINGS: No significant interactions between group and vision were observed. Significant differences between groups were observed for mean frequency in the double-limb stance (p < .05). Additionally, significant differences were observed for visual conditions in both double-limb (mean velocity; p < .05) and single-limb stances (root mean square distance, mean velocity, sway area, and mean frequency; p < .05). INTERPRETATION: The findings of the current study suggest that ACL reconstructed individuals, who are at least two years removed from surgery, do not rely on visual information to a greater extent than controls during static postural stability assessments. Stroboscopic glasses may be a cost-effective alternative for rehabilitation purposes compared to the traditional binary eyes open vs. eyes closed methods.

The effect of jump-landing directions on dynamic stability.

Dynamic stability is often measured by time to stabilization (TTS), which is calculated from the dwindling fluctuations of ground reaction force (GRF) components over time. Common protocols of dynamic stability research have involved forward or vertical jumps, neglecting different jump-landing directions. Therefore, the purpose of the present investigation was to examine the influence of different jump-landing directions on TTS. Twenty healthy participants (9 male, 11 female; age = 28 ± 4 y; body mass = 73.3 ± 21.5 kg; body height = 173.4 ± 10.5 cm) completed the Multi-Directional Dynamic Stability Protocol hopping tasks from four different directions--forward, lateral, medial, and backward--landing single-legged onto the force plate. TTS was calculated for each component of the GRF (ap = anterior-posterior; ml = medial-lateral; v = vertical) and was based on a sequential averaging technique. All TTS measures showed a statistically significant main effect for jump-landing direction. TTSml showed significantly longer times for landings from the medial and lateral directions (medial: 4.10 ± 0.21 s, lateral: 4.24 ± 0.15 s, forward: 1.48 ± 0.59 s, backward: 1.42 ± 0.37 s), whereas TTSap showed significantly longer times for landings from the forward and backward directions (forward: 4.53 ± 0.17 s, backward: 4.34 0.35 s, medial: 1.18 ± 0.49 s, lateral: 1.11 ± 0.43 s). TTSv showed a significantly shorter time for the forward direction compared with all other landing directions (forward: 2.62 ± 0.31 s, backward: 2.82 ± 0.29 s, medial: 2.91 ± 0.31 s, lateral: 2.86 ± 0.32 s). Based on these results, multiple jump-landing directions should be considered when assessing dynamic stability.

Influence of weight distribution asymmetry on the biomechanics of a barbell back squat.

The purpose of this study was to investigate the influence of weight distribution (WtD) asymmetry on the biomechanics of a barbell back squat. This study included 2 groups of trained individuals who were separated based on a WtD test (n = 14 in each group). They performed the barbell back squats with 2 resistance levels (60 and 75% of 1 repetition maximum) to measure vertical ground reaction force (GRF), tilting, and rotational angular bar displacements. A symmetry index (SI) score of the vertical GRF and the 2 bar displacements were examined to identify the group difference. Results showed that the unequal WtD group displayed a higher vertical GRF SI score (p < 0.05) and greater degrees of the tilting (p < 0.05) and rotational (p < 0.05) angular bar displacements. The 2 resistances did not influence the magnitude of the dependent variables, and no interactions were found. The unequal WtD captured at the WtD test carried over to the SI score during the back squat test. The unequal WtD was also a partial factor of displaying greater bar displacements. The lack of postural control to distribute body weight evenly should be treated properly to gain levelness before participating in high volume of resistance training, and coaches should be conscious of moving in a symmetrical fashion with minimal bar displacements in tilting and rotational manner.

Lower extremity mechanical work during stance phase of running partially explains interindividual variability of metabolic power.

Recent attention given to the mechanical work of the lower extremity joints, the emerging importance of the stance phase of running, and the lack of consensus regarding the biomechanical correlates to economical running were primary justifications for this study. The purpose of this experiment was to identify the correlations between metabolic power and the positive and negative mechanical work at lower extremity joints during stance. Recreational runners (n = 16) ran on a treadmill at 3.35 m s(-1) for physiological measures and overground for biomechanical measures. Inverse dynamics were used to calculate net joint moments and powers at the ankle, knee, and hip. Joint powers were then integrated over the stance phase so that positive and negative joint mechanical work were correlated with metabolic power (r = 0.60-0.69). Positive work at the hip and ankle during stance was positively correlated to metabolic power. In addition to these results, more economical runners (lower metabolic power) exhibited greater negative work at the hip, greater positive work at the knee, and less negative work at the ankle. Between the most and least economical runners, different mechanical strategies were present at the hip and knee, whereas the kinetics of the ankle joint differed only in magnitude.

The impact of shod vs unshod walking on center of pressure variability.

BACKGROUND: The variability of center of pressure (COP) is a measure of stability commonly examined during quiet standing. While more recent research has examined the variability of COP during walking, an adequate comparison between shod and unshod walking conditions has yet to be made. RESEARCH QUESTION: What is the influence of athletic footwear on the variability of COP displacement during walking? METHODS: In this intervention study, twenty healthy women (age 18-30 years) completed 2, 10-min walking trials, 1 shod and 1 unshod, during which ground reaction forces (GRF) and COP movement were collected by an instrumental treadmill. COP displacement was examined in the medial-lateral (ML) and anterior-posterior (AP) directions after being divided into quadrants based on the peaks and trough of each steps associated vertical GRF. A single MANOVA was used to determine effects of footwear and limb for each quadrant with the probability of a Type I error set at 0.05. RESULTS: Significant differences in variability were seen between footwear conditions in all quadrants in the AP direction and quadrants one and four in the ML direction. These results may be due to the structure of footwear, including midsole cushioning, altering the dynamics of the foot during walking. SIGNIFICANCE: The results of this study suggest that on average, athletic footwear reduces the variability of COP displacement in ML and AP directions. This may have implications for populations for whom variability of COP is determined to be undesirable.

Biomechanical analysis of curb ascent in persons with Ertl and non-Ertl transtibial amputations.

BACKGROUND: Persons with transtibial amputation report curb negotiation is more challenging than negotiating stairs. It is unknown if amputation technique influences curb negotiation ability. Traditional transtibial amputation surgical techniques do not join the distal tibia and fibula (non-Ertl), whereas a transtibial osteomyoplastic amputation (Ertl) creates a "bone bridge" connection. The Ertl may facilitate ambulation through greater residual end load bearing. OBJECTIVES: To determine if ability to negotiate a curb differs between Ertl and non-Ertl groups. STUDY DESIGN: Cross-sectional study. METHODS: Non-Ertl (n = 7) and Ertl (n = 5) participants ascended a 16-cm curb using their amputated and intact limb as the lead limb. Motion data and ground reaction forces were used to calculate ankle, knee, hip, and total limb work for ground and curb steps. RESULTS: On the ground, the amputated limb of both groups produced less work than the intact limb. In contrast, on the curb step, the Ertl amputated limb generated more net hip work than the non-Ertl amputated limb. As a result, the net limb work of the Ertl amputated limb did not differ from the non-amputated limbs. CONCLUSION: Comparisons between the amputated limb of Ertl and non-Ertl groups suggest use of a different curb stepping pattern between groups. CLINICAL RELEVANCE: These findings suggest that surgical technique may influence curb negotiation ability in individuals with transtibial amputation. Specifically, the Ertl group is able to produce more hip power than the non-Ertl group while negotiation a curb which may be attributed to the increased ability to end-load bear on the residual limb.

Obese adults walk differently in shoes than while barefoot.

BACKGROUND: Some comparisons between walking gait of obese and non-obese adults have been made during barefoot conditions, and others while shod. Methodological differences, footwear conditions, and gait speed disparities among the research done on overweight individuals were the factors motivating the present study. RESEARCH QUESTION: The present study was designed to compare gait kinematics and kinetics of obese adults between two footwear conditions (barefoot versus shod) at a set walking speed. METHODS: Ten obese (body mass index > 30 kg.m-2), but otherwise healthy adults (age = 26 ±â€¯3 years, height = 1.79 ±â€¯0.10 m, mass = 108.46 ±â€¯13.25 kg) participated in this study. Ground reaction forces and 3D kinematic data were simultaneously collected as participants walked overground at 1.5 m.s-1 in barefoot and shod conditions. RESULTS: Walking barefoot reduced ankle, knee, and hip ranges of motion, and stride length, stance time, and double support time were also reduced. Kinetic outcomes included smaller peak vertical and anterior-posterior ground reaction forces and knee joint moments while barefoot. SIGNIFICANCE: Footwear condition significantly influences key gait variables in obese adults. Conflicting conclusions from previous investigations of gait in obese adults may be a consequence of differing footwear conditions.

Ertl and Non-Ertl amputees exhibit functional biomechanical differences during the sit-to-stand task.

BACKGROUND: People with transtibial amputation stand ~50times/day. There are two general approaches to transtibial amputation: 1) distal tibia and fibula union using a "bone-bridge" (Ertl), 2) non-union of the tibia and fibula (Non-Ertl). The Ertl technique may improve functional outcomes by increasing the end-bearing ability of the residual limb. We hypothesized individuals with an Ertl would perform a five-time sit-to-stand task faster through greater involvement/end-bearing of the affected limb. METHODS: Ertl (n=11) and Non-Ertl (n=7) participants sat on a chair with each foot on separate force plates and performed the five-time sit-to-stand task. A symmetry index (intact vs affected limbs) was calculated using peak ground reaction forces. FINDINGS: The Ertl group performed the task significantly faster (9.33s (2.66) vs 13.27 (2.83)s). Symmetry index (23.33 (23.83)% Ertl, 36.53 (13.51)% Non-Ertl) indicated the intact limb for both groups produced more force than the affected limb. Ertl affected limb peak ground reaction forces were significantly larger than the Non-Ertl affected limb. Peak knee power and net work of the affected limb were smaller than their respective intact limb for both groups. The Ertl intact limb produced significantly greater peak knee power and net work than the Non-Ertl intact knee. INTERPRETATION: Although loading asymmetries existed between the intact and affected limb of both groups, the Ertl group performed the task ~30% faster. This was driven by greater power and work production of the Ertl intact limb knee. Our results suggest that functional differences exist between the procedures.

A general model for estimating lower extremity inertial properties of individuals with transtibial amputation.

Lower extremity joint moment magnitudes during swing are dependent on the inertial properties of the prosthesis and residual limb of individuals with transtibial amputation (TTA). Often, intact limb inertial properties (INTACT) are used for prosthetic limb values in an inverse dynamics model even though these values overestimate the amputated limb's inertial properties. The purpose of this study was to use subject-specific (SPECIFIC) measures of prosthesis inertial properties to generate a general model (GENERAL) for estimating TTA prosthesis inertial properties. Subject-specific mass, center of mass, and moment of inertia were determined for the shank and foot segments of the prosthesis (n=11) using an oscillation technique and reaction board. The GENERAL model was derived from the means of the SPECIFIC model. Mass and segment lengths are required GENERAL model inputs. Comparisons of segment inertial properties and joint moments during walking were made using three inertial models (unique sample; n=9): (1) SPECIFIC, (2) GENERAL, and (3) INTACT. Prosthetic shank inertial properties were significantly smaller with the SPECIFIC and GENERAL model than the INTACT model, but the SPECIFIC and GENERAL model did not statistically differ. Peak knee and hip joint moments during swing were significantly smaller for the SPECIFIC and GENERAL model compared with the INTACT model and were not significantly different between SPECIFIC and GENERAL models. When subject-specific measures are unavailable, using the GENERAL model produces a better estimate of prosthetic side inertial properties resulting in more accurate joint moment measurements for individuals with TTA than the INTACT model.

Comparison of posture and balance in cancer survivors and age-matched controls.

BACKGROUND: The combination of peripheral neuropathy and other treatment-associated side effects is likely related to an increased incidence of falls in cancer survivors. The purpose of this study was to quantify differences in postural stability between healthy age-matched controls and cancer survivors. METHODS: Quiet standing under four conditions (eyes open/closed, rigid/compliant surface) was assessed in 34 cancer survivors (2 males, 32 females; age: 54(13) yrs., height: 1.62(0.07) m; mass: 78.5(19.5) kg) and 34 age-matched controls (5 males, 29 females; age: 54(15) yrs.; height: 1.62(0.08) m; mass: 72.8(21.1) kg). Center of pressure data were collected for 30s and the trajectories were analyzed (100Hz). Three-factor (group*surface*vision) mixed model MANOVAs with repeated measures were used to determine the effect of vision and surface on postural steadiness between groups. FINDINGS: Cancer survivors exhibited larger mediolateral root-mean square distance and velocity of the center of pressure, as well as increased 95% confidence ellipse area (P<0.01) when compared with their age-matched counterparts. For example, when removing visual input, cancer survivors had an average increase in 95% confidence ellipse area of 91.8mm2 while standing on a rigid surface compared to a 68.6mm2 increase for the control group. No frequency-based center of pressure measures differed between groups. INTERPRETATION: Cancer survivors exhibit decreased postural steadiness when compared with age-matched controls. For cancer survivors undergoing rehabilitation focused on existing balance deficits, a small subset of the center of pressure measures presented here can be used to track progress throughout the intervention and potentially mitigate fall risk.

Oscillation and reaction board techniques for estimating inertial properties of a below-knee prosthesis.

The purpose of this study was two-fold: (1) demonstrate a technique that can be used to directly estimate the inertial properties of a below-knee prosthesis, and (2) contrast the effects of the proposed technique and that of using intact limb inertial properties on joint kinetic estimates during walking in unilateral, transtibial amputees. An oscillation and reaction board system was validated and shown to be reliable when measuring inertial properties of known geometrical solids. When direct measurements of inertial properties of the prosthesis were used in inverse dynamics modeling of the lower extremity compared with inertial estimates based on an intact shank and foot, joint kinetics at the hip and knee were significantly lower during the swing phase of walking. Differences in joint kinetics during stance, however, were smaller than those observed during swing. Therefore, researchers focusing on the swing phase of walking should consider the impact of prosthesis inertia property estimates on study outcomes. For stance, either one of the two inertial models investigated in our study would likely lead to similar outcomes with an inverse dynamics assessment.

Changes in intersegmental dynamics over time due to increased leg inertia.

The purpose of this study was to investigate the effects of asymmetrical loading on the intersegmental dynamics of the swing phase. Participants were asked to walk on a treadmill for 20min under three loading conditions: (a) unloaded baseline, (b) 2kg attached to the dominant limb's ankle, and (c) post-load, following load removal. Sagittal plane motion data of both legs were collected and an intersegmental dynamics analysis of each swing phase was performed. Comparisons of steady-state responses across load conditions showed that absolute angular impulses of the loaded limb's hip and knee increased significantly after load addition, and returned to baseline following load removal. Unloaded leg steady-state responses were not different across load conditions. However, after a change in leg inertia both legs experienced a period of adaptation that lasted approximately 40 strides before a steady state walking pattern was achieved. These findings suggest that the central nervous system refined the joint moments over time to account for the altered limb inertia and to maintain the underlying kinematic walking pattern. Maintaining a similar kinematic walking pattern resulted in altered moment profiles of the loaded leg, but similar moment profiles of the unloaded leg compared with the unloaded baseline condition.