Gait pattern analysis before and after periacetabular osteotomy in unilaterally affected dysplastic patients.

BACKGROUND: Patients with acetabular dysplasia have an abnormal acetabular geometry which results in insufficient coverage of the femoral head. This coverage deficiency reduces contact surfaces within the joint, accelerating the wear of the articular cartilage and predisposing patients to early osteoarthritis. Periacetabular osteotomy is a surgical treatment of acetabular dysplasia that aims to reorient the acetabulum relative to the femoral head, increasing coverage. METHODS: Pelvic kinematics and lower limbs joint kinematics and kinetics during the stance phase of gait were recorded using a 3D motion capture system and force plates, then compared pre- to post- and between limbs with a repeated measures 2-way ANOVA. Radiographic measurements and gait parameters were compared pre- to post-surgery using a t-test for dependant samples. To identify predictors of pelvic symmetry improvements during gait, a multivariate analysis was performed using a forward stepwise linear regression. FINDINGS: Radiographic measurements improved for all participants while gait parameters remained unchanged. Hip flexion symmetry was improved following surgery. The external rotation moment of the healthy hip was reduced after surgery (-29%) resulting in increased asymmetry. Pelvic tilt was significantly greater on the affected side (+0.5°) during the loading response, and the difference tended to be greater after surgery (+0.8°). INTERPRETATION: Unilaterally affected dysplastic patients have an asymmetrical gait pattern that is only partially corrected by periacetabular osteotomy even when radiographic and clinical targets are met. Differences between the limbs could be explained in part by a learned antalgic pattern and muscle weaknesses leading to complex compensation mechanisms.

Biomechanical differences in experts' and novices' footstep patterns during a palletizing task.

Very few studies have examined differences between experts' and novices' foot positioning and movements during manual materials handling tasks. The impact of footstep patterns on low back loading needs to be better understood. The goals of this study were to characterize foot placement and movements in novices and experts and to assess their impact on back loading considering the height of grasp. The task consisted in transferring 24 15 kg boxes from a pallet to another. Foot placement and movements were classified with a recently developed taxonomy. Results show that experts' feet remained static more often than novices' feet during the lifting phase. Positioning the feet towards the deposit site during lifting increased asymmetrical moments, especially for novices. Positioning one foot forward increased asymmetrical moments for novices. Overall, footstep strategies are an effective indicator of low back exposure and should be considered in ergonomic studies.

Inertial Motion Capture-Based Estimation of L5/S1 Moments during Manual Materials Handling.

Inertial motion capture (IMC) has gained popularity in conducting ergonomic studies in the workplace. Because of the need to measure contact forces, most of these in situ studies are limited to a kinematic analysis, such as posture or working technique analysis. This paper aims to develop and evaluate an IMC-based approach to estimate back loading during manual material handling (MMH) tasks. During various representative workplace MMH tasks performed by nine participants, this approach was evaluated by comparing the results with the ones computed from optical motion capture and a large force platform. Root mean square errors of 21 Nm and 15 Nm were obtained for flexion and asymmetric L5/S1 moments, respectively. Excellent correlations were found between both computations on indicators based on L5/S1 peak and cumulative flexion moments, while lower correlations were found on indicators based on asymmetric moments. Since no force measurement or load kinematics measurement is needed, this study shows the potential of using only the handler's kinematics measured by IMC to estimate kinetics variables. The assessment of workplace physical exposure, including L5/S1 moments, will allow more complete ergonomics evaluation and will improve the ecological validity compared to laboratory studies, where the situations are often simplified and standardized.

Knee braces and foot orthoses multimodal treatment of medial knee osteoarthritis.

BACKGROUND: Knee braces and lateral wedge foot orthoses are two treatment options recommended for medial knee osteoarthritis, but the combination of both of them could further improve their effectiveness. RESEARCH QUESTION: The aim was to evaluate whether the combination of lateral wedge foot orthoses with two types of knee brace enhances the biomechanical effects and pain relief during the stance phase of gait while maintaining comfort. METHODS: Ten patients with medial knee osteoarthritis were fitted with a standard valgus brace, an unloader brace with valgus and external rotation functions, and 7° lateral wedge foot orthoses. The pain relief, comfort, kinematics and kinetics of the lower limb were measured during walking without orthotics, with the combined and with the isolated treatments. RESULTS: The valgus and external rotation brace significantly reduced the knee adduction moment and allowed more knee flexion both in isolation and in combination to foot orthoses compared to the valgus brace or without treatment. Pain relief was not significant with the different orthotic treatment modalities. The valgus brace and combined treatment with either brace significantly increased the discomfort level, whereas the valgus and external rotation brace or foot orthoses in isolation did not induce significant discomfort. SIGNIFICANCE: Amongst the tested orthotic treatment modalities, the valgus and external rotation brace obtained better biomechanical outcomes while maintaining comfort. The combined treatment with foot orthoses enhanced the effectiveness of the valgus brace, however foot orthoses may be unnecessary with the valgus and external rotation brace.

New taxonomy for assessing manual material handlers' footstep patterns.

Current taxonomies for assessing foot strategies in manual material handling lack exhaustive classification of foot movements and foot positioning. They also fail to consider different instants of the task as checkpoints to relate foot strategies. The goal of the study was first to develop a new taxonomy to assess foot positions and motions considering those limitations. The second goal was to assess reliability and reproducibility using raw agreement percentages, Cohen's kappa, prevalence-adjusted, bias-adjusted kappa and Gwet's AC1. A filmed task consisted of transferring boxes from one pallet to another. Intra- and inter-rater reliability were assessed reviewing 23% and 10%, respectively, of video data. Reproducibility and reliability results are substantial and almost perfect on average. In comparison to similar studies, reproducibility and reliability were considered acceptable.

Combined influence of transfer distance, pace, handled mass and box height on spine loading and posture.

Work-related low back disorders are commonly associated with handling tasks. The objective of this study was to determine the combined influence of distance, pace, handled mass and height, on back loading and posture during free box transfer. Kinematics and kinetics of 17 handlers were recorded during a box transfer task between two pallets. Four-way repeated measures ANOVA were conducted on four lift-deposit height conditions (from lift and deposit of 0.16 or 1.16 m), three distances between pallets (1.5, 1.0 and 0.5 m), two handled masses (10 and 20 kg) and two paces (free and faster). The interaction between distance and height on back loading and posture (P < 0.001) showed that increasing distance to more than 1 m is not recommended to avoid unnecessary cumulative loading. The shorter distance of 0.5 m, which generally reduced the most spine loading, may increase it for transfers varying in height. The effect of pace to reduce spine cumulative loading and increase the peak asymmetric loading (P < 0.05) was accentuated by mass, height and distance. The combined factors revealed the importance of tradeoff between peak, cumulative and asymmetric loading.

Biomechanical effects of three types of foot orthoses in individuals with posterior tibial tendon dysfunction.

BACKGROUND: Posterior tibial tendon dysfunction (PTTD) is characterized by degeneration of this tendon leading to a flattening of the medial longitudinal arch of the foot. Foot orthoses (FOs) can be used as a treatment option, but their biomechanical effects on individuals with PTTD are not yet fully understood. RESEARCH QUESTION: The aim of this study was to investigate the effects of three types of FOs on gait biomechanics in individuals with PTTD. METHODS: Fourteen individuals were recruited with painful stage 1 or 2 PTTD based on Johnson and Strom's classification. Quantitative gait analysis of the affected limb was performed in four conditions: shoes only (Shoe), prefabricated FO (PFO), neutral custom FO (CFO) and custom varus FO (CVFO) with a 5° medial wedge and a 4 mm medial heel skive. A curve analysis, using 1D statistical parametric mapping, was undertaken to assess differences in lower limb joint motion, joint moments and muscle activity over the stance phase of gait across conditions. RESULTS: Decreased hindfoot eversion angles, decreased ankle inversion moments and increased ankle eversion moments were observed with custom FOs compared to the Shoe and PFO conditions (p < 0.001). CFOs and CVFOs induced an increased knee abduction moment compared to Shoe (p < 0.001). No changes in hip kinematics and kinetics or in EMG activity of tested muscles were observed between conditions. SIGNIFICANCE: Custom orthoses may be more suitable than PFOs to decrease the pathological biomechanical outcomes observed in PTTD. Decreased ankle inversion moments during the stance phase could explain why custom orthoses are effective at reducing pain in PTTD patients. However, clinicians should be careful when prescribing custom orthoses for PTTD since unwanted collateral biomechanical effects can be observed at the knee.

Back loading estimation during team handling: Is the use of only motion data sufficient?

Analyzing back loading during team manual handling tasks requires the measurement of external contacts and is thus limited to standardized tasks. This paper evaluates the possibility of estimating L5/S1 joint moments based solely on motion data. Ten subjects constituted five two-person teams and handling tasks were analyzed with four different box configurations. Three prediction methods for estimating L5/S1 joint moments were evaluated by comparing them to a gold standard using force platforms: one used only motion data, another used motion data and the traction/compression force applied to the box and one used motion data and the ground reaction forces of one team member. The three prediction methods were based on a contact model with an optimization-based method. Using only motion data did not allow an accurate estimate due to the traction/compression force applied by each team member, which affected L5/S1 joint moments. Back loading can be estimated using motion data and the measurement of the traction/compression force with relatively small errors, comparable to the uncertainty levels reported in other studies. The traction/compression force can be obtained directly with a force measurement unit built into the object to be moved or indirectly by using force platforms on which one of the two handlers stands during the handling task. The use of the proposed prediction methods allows team manual handling tasks to be analyzed in various realistic contexts, with team members who have different anthropometric measurements and with different box characteristics.

Three-month efficacy of three knee braces in the treatment of medial knee osteoarthritis in a randomized crossover trial.

Immediate biomechanical and functional effects of knee braces are often reported, however, the duration and type of knee brace treatment for knee osteoarthritis (KOA) remain unclear. The objective was to evaluate usage, comfort, pain, and knee adduction moment (KAM) of three knee braces each worn 3 months by patients. Twenty-four patients with KOA were assigned in a randomized crossover trial a valgus three-point bending system brace (V3P-brace), an unloader brace with valgus and external rotation functions (VER-brace) and a stabilizing brace used after ligament injuries (ACL-brace). Functional questionnaires and gait assessment were carried out before and after each brace wear period of 3 months. A Friedman test was applied between brace wear diary recordings. Repeated measures analyses of variance contrasted the factors brace type (ACL, V3P, and VER), time (pre and post) and wear (without and with) on comfort, pain, function, and KAM. Brace usage was similar, but the V3P-brace was slightly less worn. Discomfort was significantly lowered with the VER-brace. All knee braces relieved pain and symptoms from 10% to 40%. KAM angular impulse was reduced with the three braces, but the VER-brace obtained the lowest relative reduction of 9%. The interaction between time and wear indicated that part of the KAM reduction with brace wear was maintained post treatment. All three knee braces have great benefits for pain and function among the medial KOA population. The VER-brace offers additional advantages on daily use, comfort and KAM, which could improve compliance to brace treatment.

Feasibility of quantifying the physical exposure of materials handlers in the workplace with magnetic and inertial measurement units.

Handling tasks can expose workers to risk factors. The objective was to describe the feasibility of using magnetic and inertial measurement units (MIMUs) to quantify the physical exposure of materials handlers in the workplace. Full-body kinematics were obtained with MIMUs on 10 handlers gathering products ordered by retailers with a pallet truck. An observer classified the visual difference (VD) of segment orientation between a MIMUs avatar and video recordings in three categories (none, minor and major) for each product transfer. The feet, arms, shoulders and head were considered similar for ≥97% of observations. The trunk segment obtained the most differences with 9% of minor VD and 5% of major VD, which were related to the duration of the magnetic disturbances of the MIMUs. Estimating parameters of the physical exposure of handlers in the workplace is feasible with kinematics and an order list, but visual verification remains important for scientific rigour.Practitioner Summary: The feasibility of measuring physical exposure with magnetic and inertial measurement units was evaluated on materials handlers in the workplace. Visual observation of the postures indicated that most of the data is considered acceptable. Magnetic disturbances can increase the measurement error, so data must be verified to ensure validity.

Anatomical variants of the rectus femoris motor innervation.

Adult periacetabular osteotomy (PAO) was originally performed through the classic Smith-Petersen approach for optimal operative visibility and acetabular fragment correction. Evolution towards an abductor-sparing technique significantly lowered the post-operative morbidity. The rectus-sparing approach represents a step further, but the innervation of the rectus femoris is theoretically more at risk. Although the topographic anatomy of the femoral nerve has been well described, it was never studied with specificity to surgical landmarks. The femoral nerve's spatial relation with the anterior-inferior iliac spine (AIIS) and the amount of possible dissection in the rectus femoris and iliopsoas interval is uncertain. Seven formalin-preserved human cadaveric specimens without history of inguinal injury or surgery were dissected using the distal limb of an iliofemoral approach. The level of entry of motor innervation was measured and number of branches to the rectus femoris was noted. The average longitudinal distance from the AIIS to the first motor nerve to the rectus femoris was 8.6 ± 1.4 cm. The number of branches varied between 1 and 4 with the most common innervation pattern being composed of two segments. Dissection medial to the rectus femoris should not be carried out further than 7 cm distal to the AIIS and stretching of that interval during surgical exposure should be done cautiously. The clinical efficiency of the rectus-sparing approach should be studied further in order to confirm its advantage over the classic direct anterior approach. The study provides a better understanding of the localization and the anatomical variations of the structures encountered at the level of and below the AIIS. It also assesses the relative risk of denervation of the rectus femoris during PAO through the rectus-sparing approach. The authors recommend that the dissection medial to the rectus femoris should be carried out no further than 7 cm distal to the AIIS and stretching of that interval during surgical exposure should be done cautiously.

To what extent do paramedics apply safe handling principles when transferring patients from stair chairs to stretchers?

The efficiency of training programmes in handling designed to prevent injuries has rarely been demonstrated by studies in the workplace. This study aimed to identify factors that may favour or inhibit the application of safe handling principles by paramedics performing full-body transfers of patients from a stair chair to a stretcher. In an observational field study, handling methods used in 45 patient transfers from a stair chair to stretcher were characterised. Principles concerning the physical environment seem to be applied frequently, but those applicable during the transfer are neglected. Principles taught during training may not be applied due to the physical constraints of the workplace and the underestimation of risk exposure. The results suggest that training should be enhanced, not by focussing on handling techniques but by focussing on compromise and the capacity to adapt work techniques based on the working context and the team-mate.

Capsular plication in the non-deformity hip: impact on post-operative joint stability.

PURPOSE AND HYPOTHESIS: The aim of this study was to evaluate the hip joint range of motion after different capsular plication. The study hypothesis proposed that capsular plication after hip arthroscopy may reduce hip external rotation and thus prevent the hip joint instability created by arthroscopic capsulotomies. METHODS: Six fresh frozen human cadavers were studied in the intact state (5 males, 1 females) for a total of 12 non-deformity hips tested. They were fixed to the operating room table using a custom-made apparatus. Three Steinman pins were inserted, the first into ASIS, a parallel pin into the distal femur proximal to inter-epicondylar axis and the third pin into the lateral epicondyle. Simulation of arthroscopic capsulotomies was done progressively with simulation of three capsular plication techniques. The first plication technique consisted of a primary plication shift of the antero-lateral capsule. The distal-medial arm of the iliofemoral ligament was shifted toward the proximal-lateral arm. The second plication technique consisted in adding a longitudinal arm to the capsulotomy, between the lateral arm and the medial arm of the iliofemoral ligament, to create a T-shaped capsulotomy. The resulting two triangular capsular flaps were overlaid onto each other by approximately 5 mm, plicated fully and tighly sutured in a double-breast manner. The third plication technique, called redrapping, consisted in excising the inferior capsular triangular flap (previously made in the second technique), and suturing the latero-anterior superior capsular flap to the medial arm of the iliofemoral ligament, superimposing the capsular edges for closure. External rotation of the hip at 0°, 15° and 30° of flexion were obtained after the capsulotomy and each capsular plication technique to quantify the increase in hip stability after plication. Data were assessed using a two-way repeated measure analysis of variance (ANOVAs) and Student's T-test when necessary to determine if the change in external rotation was significantly different. RESULTS: After capsulotomy, external rotation averaged 26.3°, 29.1° and 31.1° at 0°, 15° and 30° of flexion. With the primary plication shift, external rotation averaged 24.9°, 30.3° and 34.0°. With the two-triangle technique, external rotation averaged 26.1°, 31.9° and 33.3°. With the re-draping technique, external rotation averaged 25.8°, 30.9° and 32.0°. A significant relationship was found between «Plication Technique¼ and «Angle of flexion¼ factors for the measured angle of external rotation (P = 0.04). A decomposition of the interaction showed that external rotation decreased at 0° of hip flexion and increased as the hip flexion angle increased. The only significant difference found corresponded to the two triangles technique at 15° flexion (mean difference compared to the non-repaired state = 2.8° ± 3.8° or 8.8% increase in external rotation; P = 0.03). CONCLUSIONS: Different techniques of capsular plication result in a non-significant increase in hip external rotation when compared to unrepaired capsulotomies. Therefore, special attention should be paid at the time of capsular plication, which could be disadvantageous when done overzealously aiming to increase postoperative stability.

Biomechanical analysis of manual material handling movement in healthy weight and obese workers.

The risk of back injury during work remains high today for manual materials handler. The purpose of this study is to identify the potential presence of compensatory strategies in obese and non-obese handlers and evaluate the impact these strategies have on trunk kinematics and kinetics. The biomechanical and ergonomic impacts in 17 obese and 20 healthy-weight handlers were evaluated. The task studied consisted in moving boxes from a conveyor to a hand trolley and back. The results show that the anthropometric characteristics of obese handlers are linked to a significant increase in peak lumbar loading during lifting and lowering of boxes. Few postural differences between the two groups were observed. These results suggest that the excess weight of an obese worker has a significant added effect on the musculoskeletal structures of the back, which exposes obese handlers to a higher risk of developing a musculoskeletal disorder during load handling.

Overall risk index for patient transfers in total assistance mode executed by emergency medical technician-paramedics in real work situations.

Few studies have quantified the risk of musculoskeletal disorders during patient transfers in total assistance mode in real-life prehospital emergency care situations. An index to assess the overall risk of patient transfers was created; it makes it possible to quantify risk based on the patient's position and the height of the patient's location. An analysis of 71 transfers executed by paramedics in actual work situations showed that moving a patient from the ground was characterized by acute sagittal flexions and axial rotations, respectively, 42% and 12% of the time. When the patient was lying on a raised surface, the lifting index and perceived exertion were the lowest (2.55; easy). According to the overall risk index, patient transfers from the ground are the riskiest. Paramedics execute many risky lifts even in favorable patient handling contexts.

A Randomized Trial of Oral and Transdermal Rivastigmine for Postural Instability in Parkinson Disease Dementia.

OBJECTIVES: The objective of this study was to compare the efficacy and safety of oral and transdermal rivastigmine for postural instability in patients with Parkinson disease dementia (PDD) who were candidates for a cholinesterase inhibitor. The primary outcome was the change in mean velocity of the center of pressure (CoP) after 6 months. Secondary outcomes included structural parameters of dynamic posturography, clinical rating scales, and adverse events requiring dose reduction. METHODS: Patients with PDD were randomized in a 1:1 ratio to oral or transdermal rivastigmine with target doses of 6 mg twice daily and 9.5 mg/10 cm daily, respectively. Outcomes were assessed at baseline and 6 months. Results were compared within and between groups. RESULTS: Nineteen patients completed the study (n = 8 oral, n = 11 transdermal). Mean daily doses of 9.4 (±1.5 mg) and 16.4 (±3.6 mg) were achieved in the oral and transdermal groups, respectively. The transdermal group demonstrated a significant 15.8% decrease in mean velocity of CoP (patch: P < 0.05; oral: 10.0% decrease, P = 0.16) in the most difficult scenario (eyes closed with sway-referenced support). There was no difference between groups (P = 0.27). For structural parameters, significant improvements were seen in the mean duration of peaks (patch) and interpeak distance (oral) in the most difficult condition. No changes were observed in clinical rating scales. Six patients experienced nonserious adverse events requiring dose reduction (n = 5 oral; n = 1 transdermal). CONCLUSIONS: Rivastigmine may improve certain elements of postural control, notably the mean velocity of CoP. Benefits appear to be more obvious under more taxing sensory conditions.

Effects of foot orthoses with medial arch support and lateral wedge on knee adduction moment in patients with medial knee osteoarthritis.

BACKGROUND: There is contradictory evidence regarding whether the addition of medial arch supports to laterally wedged insoles reduces knee adduction moment, improves comfort, and reduces knee pain during the late stance phase of gait. OBJECTIVES: To verify if such effects occur in participants with medial knee osteoarthritis. STUDY DESIGN: Randomized single-blinded study. METHODS: Gait analysis was performed on 18 patients affected by medial knee osteoarthritis. Pain and comfort scores, frontal plane kinematics and kinetics of ankle, knee, and hip were compared in four conditions: without foot orthosis, with foot orthoses, with medial arch support, and with foot orthoses with medial arch support and lateral wedge insoles with 6° and 10° inclination. RESULTS: Lower-extremity gait kinetics were characterized by a significant decrease, greater than 6%, in second peak knee adduction moment in laterally wedged insole conditions compared to the other conditions ( p < 0.001; effect size = 0.6). No significant difference in knee adduction moment was observed between laterally wedged insole conditions. In contrast, a significant increase of 7% in knee adduction moment during the loading response was observed in the customized foot orthoses without lateral inclination condition ( p < 0.001; effect size = 0.3). No difference was found in comfort or pain ratings between conditions. CONCLUSION: Our study suggests that customized foot orthoses with a medial arch support may only be suitable for the management of medial knee osteoarthritis when a lateral wedge is included. Clinical relevance Our data suggest that customized foot orthoses with medial arch support and a lateral wedge reduce knee loading in patients with medial knee osteoarthritis (KOA). We also found evidence that medial arch support may increase knee loading, which could potentially be detrimental in KOA patients.

Effect of natural trunk inclination on variability in soleus inhibition and tibialis anterior activation during gait initiation in young adults.

BACKGROUND: Anticipatory postural adjustments (APAs) of gait initiation (GI) permit first step execution. APAs are characterized by a structured pattern of soleus (SOL) inhibition followed by tibialis anterior (TA) activation. This pattern shows variability among young adults where SOL is not always inhibited before TA activation. Initial posture preceding GI could explain a part of this variability. The aim of the study was to investigate the effect of natural trunk inclination on APAs during GI. METHODS: Two groups of twelve subjects divided by natural trunk inclination angle performed five gait initiation trials. A regression model was computed to predict SOL inhibition and TA activation. RESULTS: Backward leaners showed less SOL inhibition in stance leg (25.8% of trials) compared to forward leaners (55.6% of trials). Regression model revealed that high tonic EMG activity in SOL in the stance leg is the variable that best explains SOL inhibition variation within trials but not TA activation. CONCLUSION: Slight variations in APAs are due to natural trunk inclination but more contribution in APAs is due to initial posture, future step speed and initial tonic soleus activity. Absence of SOL inhibition could be in part explained by natural trunk inclination, where the backward inclination leads to lower tonic SOL activity in quiet standing. These effects could be due to inherent and functional variability, which depend on postural variation, muscular coordination and limb roles.

Modulation of physical activity to optimize pain sensation following an intra-articular corticosteroid injection in patients with knee osteoarthritis.

BACKGROUND: Intra-articular corticosteroid injection is often used to relieve pain caused by knee osteoarthritis. This study aims to assess the impact after an intra-articular corticosteroid injection treatment on objective and subjective measurement of physical function in knee osteoarthritis patients. METHODS: Fourteen patients with unilateral knee osteoarthritis participated in this open-label uncontrolled trial. The intra-articular corticosteroid injection was given at the end of the second week. Physical activity was objectively measured by an accelerometer worn by the participants for eight weeks. Symptoms, quality of life and spatiotemporal parameters of gait were assessed every two weeks. RESULTS: From the injection until six weeks later, pain and stiffness were reduced by approximately 60%. Patients' daily physical activity time was significantly improved after injection: participation in light and moderate physical activities increased during four and two weeks, respectively. CONCLUSIONS: The beneficial effects after the intra-articular corticosteroid injection are visible in the duration and intensity of the knee osteoarthritis patients' daily physical activity. However, these effects declined gradually two weeks after injection. Modulating the intensity and duration of physical activity would allow patients to optimize pain sensation over a longer period following an intra-articular corticosteroid injection. Trial Registration. This trial was registered with ClinicalTrials: NCT02049879.