Does joint impedance improve dynamic leg simulations with explicit and implicit solvers?

The nervous system predicts and executes complex motion of body segments actuated by the coordinated action of muscles. When a stroke or other traumatic injury disrupts neural processing, the impeded behavior has not only kinematic but also kinetic attributes that require interpretation. Biomechanical models could allow medical specialists to observe these dynamic variables and instantaneously diagnose mobility issues that may otherwise remain unnoticed. However, the real-time and subject-specific dynamic computations necessitate the optimization these simulations. In this study, we explored the effects of intrinsic viscoelasticity, choice of numerical integration method, and decrease in sampling frequency on the accuracy and stability of the simulation. The bipedal model with 17 rotational degrees of freedom (DOF)-describing hip, knee, ankle, and standing foot contact-was instrumented with viscoelastic elements with a resting length in the middle of the DOF range of motion. The accumulation of numerical errors was evaluated in dynamic simulations using swing-phase experimental kinematics. The relationship between viscoelasticity, sampling rates, and the integrator type was evaluated. The optimal selection of these three factors resulted in an accurate reconstruction of joint kinematics (err < 1%) and kinetics (err < 5%) with increased simulation time steps. Notably, joint viscoelasticity reduced the integration errors of explicit methods and had minimal to no additional benefit for implicit methods. Gained insights have the potential to improve diagnostic tools and accurize real-time feedback simulations used in the functional recovery of neuromuscular diseases and intuitive control of modern prosthetic solutions.

Does joint impedance improve dynamic leg simulations with explicit and implicit solvers?

The nervous system predicts and executes complex motion of body segments actuated by the coordinated action of muscles. When a stroke or other traumatic injury disrupts neural processing, the impeded behavior has not only kinematic but also kinetic attributes that require interpretation. Biomechanical models could allow medical specialists to observe these dynamic variables and instantaneously diagnose mobility issues that may otherwise remain unnoticed. However, the real-time and subject-specific dynamic computations necessitate the optimization these simulations. In this study, we explored the effects of intrinsic viscoelasticity, choice of numerical integration method, and decrease in sampling frequency on the accuracy and stability of the simulation. The bipedal model with 17 rotational degrees of freedom (DOF)-describing hip, knee, ankle, and standing foot contact-was instrumented with viscoelastic elements with a resting length in the middle of the DOF range of motion. The accumulation of numerical errors was evaluated in dynamic simulations using swing-phase experimental kinematics. The relationship between viscoelasticity, sampling rates, and the integrator type was evaluated. The optimal selection of these three factors resulted in an accurate reconstruction of joint kinematics (err < 1%) and kinetics (err < 5%) with increased simulation time steps. Notably, joint viscoelasticity reduced the integration errors of explicit methods and had minimal to no additional benefit for implicit methods . Gained insights have the potential to improve diagnostic tools and accurize real-time feedback simulations used in the functional recovery of neuromuscular diseases and intuitive control of modern prosthetic solutions.

Daily physical activity in children enrolled in extracurricular activity / Atividade física diária em crianças participantes de atividade extrecurricular

ABSTRACT This study aimed to verify and compare the physical activity practices of children enrolled and non-enrolled on different days of week in a specific program offered at school. Seventy-eight children comprised two groups: children with extra physical activity (EPA; n=39; 15 females and 24 males; age: 9.2±0.8 years) and those with no involvement in extra physical activity (NPA; n=39; 21 females and 18 males; age: 9.0±0.4 years). To infer caloric expenditure, number of steps per day, and total distance traveled, children were monitored with pedometers during three nonconsecutive days: a day with a physical education class at school, a normal activity weekday, and a weekend day. Children enrolled in extra activities at school presented higher levels of caloric expenditure (EPA=132±61, NPA=61±25), performed more steps per day (EPA=7742±2473, NPA=5245±2306) and traveled longer distances (EPA=4201±1318, NPA=2799±1269), with boys (calories=154.1±91.6; steps=9763±3804; traveled distance=5114±2205) more active than girls (calories=94.4±46.7; steps=6691±2394; traveled distance=3726±1387). In the extracurricular physical activity day, children expended more calories (155.8±88.3), performed mores steps (10133±3724) and traveled longer distance (5442±2118) than in the physical education day (calories=127.2±79.3; steps=8409±3283; traveled distance=4478±1864) and in the weekend (calories=96.8±58.8; steps=6493±2687; traveled distance=3500±1466). Extracurricular physical activity at school leads to an increase of physical activity of boys and girls, even on days when the extracurricular activity is not offered.

RESUMO O objetivo deste estudo foi verificar e comparar a prática de atividade física de crianças em diferentes dias da semana envolvidas e não envolvidas em um programa de atividade física extracurricular. Setenta e oito crianças formaram dois grupos: crianças com atividade física extracurricular (CAF; n=39; 15 meninas e 24 meninos; idade: 9,2±0,8 anos) e crianças sem atividade física extracurricular (NAF; n=39; 21 meninas e 18 meninos; idade: 9,0±0,4 anos). Foram estimados o dispêndio calórico, o número de passos por dia e a distância percorrida, por meio de pedômetros em dias não consecutivos: um dia com aula de educação física, um dia com atividades cotidianas e um dia de final de semana. Crianças envolvidas em atividades extracurriculares na escola apresentaram maior dispêndio calórico (CAF=132±61, NAF=61±25), número de passos (CAF=7742±2473, NAF=5245±2306) e distância percorrida (CAF=4201±1318, NAF=2799±1269), sendo ainda meninos (calorias=154,1±91,6; passos=9763±3804; distância=5114±2205) mais ativos que meninas (calorias=94,4±46,7; passos=6691±2394; distância=3726±1387). No dia de atividade extracurricular, crianças dispendem mais calorias (155,8±88,3), realizam mais passos (10133±3724) e percorrem maior distância (5442±2118) do que nos dias de educação física (calorias=127,2±79,3; passos=8409±3283; distância=4478±1864) e final de semana (calorias=96,8±58,8; passos=6493±2687; distância=3500±1466). Atividade física extracurricular na escola promove aumento de atividade física de meninos e meninas, mesmo nos dias em que a atividade física extracurricular não foi oferecida.

EVALUATION OF SCAPULAR DYSKINESIS IN CROSSFIT®- PRACTICING ATHLETES.

Objective: Evaluate the scapular movement of Crossfit® practitioners and identify whether they present an increased incidence of scapular dyskinesis (SD) compared to non-practitioners. Method: A transversal study was evaluated quantitatively and dynamically, using retro-reflective spherical markers, the scapular movements of ten volunteers composing the control group, and 11 Crossfit® practitioners. The control group's results were used as a normality parameter and compared to those of the Crossfit® practitioner's group. Results: It was identified that the superior scapular rotation in the ascending phase is inferior in the group of Crossfit® practitioners (p = 0.02). Conclusion: The regular practice of Crossfit® causes scapular dyskinesis (SD), with alteration in the scapular superior rotation movement. Level of Evidence III: Retrospective comparative .

Objetivo: Avaliar o movimento escapular de praticantes de Crossfit® e identificar se apresentam incidência aumentada de discinese escapular (DE) quando comparados a não praticantes. Método: Estudo transversal que avaliou de forma quantitativa e dinâmica, utilizando marcadores retro-refletivos esféricos, os movimentos escapulares de dez voluntários, compondo o grupo controle, e 11 praticantes de Crossfit®. Os resultados do grupo controle foram utilizados como parâmetro de normalidade e comparados aos do grupo de praticantes de Crossfit®. Resultados: Identificou-se que a rotação superior escapular na fase ascendente é inferior no grupo de praticantes de Crossfit® (p = 0,02). Conclusão: A prática regular de Crossfit® causa discinese escapular (DE), com alteração no movimento de rotação superior da escápula. Nível de Evidência III: Retrospectivo comparativo .

EVALUATION OF SCAPULAR DYSKINESIA IN PATIENTS THAT UNDERWENT A LATARJET PROCEDURE.

Objective: To quantitatively assess the scapular movement of patients who underwent Latarjet surgery and to identify if they present scapular dyskinesia (SD), as well as correlate with the clinic state and the elevation degree of the shoulder. Methods: A cross-sectional study was carried out at the Movement Analysis Laboratory (LAM), at the Institute of Physical Activity and Sport Sciences, that quantitatively evaluated, using spherical retroreflective markers, the scapular movements of the control group (10 volunteers) and 22 patients (23 operated shoulders) that had been submitted to Latarjet surgery, between 2011 and 2016, with at least one year postoperative. The results of the control group were used as a parameter of normality and compared to those of the operated group. Posterior inclination, superior rotation, and medial rotation of the scapula were evaluated at angles of 60°, 90°, and 120° of elevation, both in ascending and descending phases. The statistical analysis used was the multivariate variance (MANOVA), comparing the right and left sides of the control group and, subsequently, the control group with the postoperative group (p = 0.05 in all tests). Results: When comparing the mean of the results of the quantitative evaluation of the control group with the operated group, no statistically significant differences were found between the two groups and between the dominant and non-dominant sides of the control group. Conclusion: Latarjet surgery does not cause SD, although there are alterations in some plane of the scapular movements in the ascending and/or descending phase. Level of Evidence III, Retrospective Comparative Study.

Objetivo: Avaliar, de forma quantitativa, o movimento escapular dos pacientes submetidos à cirurgia de Latarjet e identificar se apresentam discinesia escapular (DE). Além disso, correlacionar com a clínica e com o grau de elevação do ombro. Método: Estudo transversal realizado no Laboratório de Análise do Movimento (LAM), no Instituto de Ciências da Atividade Física e Esporte que avaliou de forma quantitativa, utilizando marcadores retro-refletivos esféricos, os movimentos escapulares do grupo controle (10 voluntários) e 22 pacientes (23 ombros operados), submetidos à cirurgia de Latarjet, entre os anos de 2011 e 2016, com pelo menos um ano de pós-operatório. Foram utilizados os resultados do grupo controle como parâmetro de normalidade e posteriormente comparados aos do grupo de pacientes operados. Avaliadas a inclinação posterior, rotação superior e rotação medial das escápulas nos ângulos de 60°, 90° e 120° de elevação, tanto na fase ascendente quanto na descendente. A análise estatística utilizada foi a multivariada da variância (MANOVA) comparando os lados direito e esquerdo do grupo controle e posteriormente o grupo controle com o grupo pós-operatório (p = 0,05 em todos os testes). Resultados: Ao compararmos a média dos resultados da avaliação quantitativa do grupo controle com o grupo dos operados, não foram evidenciadas diferenças estatisticamente significativas entre os dois grupos, assim como os lados dominante e o não dominante do grupo controle. Conclusão: A cirurgia de Latarjet não causa DE, apesar de haver alterações em algum plano dos movimentos escapulares na fase ascendente e/ou descendente. Nível de Evidência III, Estudo Retrospectivo Comparativo.

Compensatory Strategies Due to Knee Flexion Constraint during Gait of Non-Disabled Adults.

Constraining knee flexion of non-disabled individuals could further our understanding regarding the importance of knee joint during gait, which is a common disturbance in individuals with gait impairment. In this study we investigated whether a mechanical constraint of knee flexion in non-disabled adults would lead to compensatory strategies. Eleven non-disabled male adults walked without and with an orthosis that permitted full extension and limited knee flexion up to either 45° or 30°. We analyzed the temporal organization of lower limb kinematics and electromyograms of the rectus femoris, vastus medialis and lateralis, tibialis anterior, semitendinosus, biceps femoris, and gastrocnemius medialis and lateralis. Non-disabled adults compensated for the reduced knee flexion by increasing hip and ankle joint excursions and ankle flexor activation amplitude. Also, these adults shortened pre-swing and lengthened swing duration in the constrained limb and increased the activity of bifunctional hip extensor and knee flexor muscles in the constrained limb in relation to the unconstrained limb. The use of an orthosis that limited knee flexion in non-disabled adults leaded to compensatory strategies in the temporal organization of joint excursions and muscle activations in the constrained limb. The compensatory effects were correlated with the extent of knee flexion constraint.

Evaluation of scapular dyskinesia in patients that underwent a latarjet procedure / Avaliação da discinesia escapular em pacientes submetidos à cirurgia de latarjet

ABSTRACT Objective: To quantitatively assess the scapular movement of patients who underwent Latarjet surgery and to identify if they present scapular dyskinesia (SD), as well as correlate with the clinic state and the elevation degree of the shoulder. Methods: A cross-sectional study was carried out at the Movement Analysis Laboratory (LAM), at the Institute of Physical Activity and Sport Sciences, that quantitatively evaluated, using spherical retroreflective markers, the scapular movements of the control group (10 volunteers) and 22 patients (23 operated shoulders) that had been submitted to Latarjet surgery, between 2011 and 2016, with at least one year postoperative. The results of the control group were used as a parameter of normality and compared to those of the operated group. Posterior inclination, superior rotation, and medial rotation of the scapula were evaluated at angles of 60°, 90°, and 120° of elevation, both in ascending and descending phases. The statistical analysis used was the multivariate variance (MANOVA), comparing the right and left sides of the control group and, subsequently, the control group with the postoperative group (p = 0.05 in all tests). Results: When comparing the mean of the results of the quantitative evaluation of the control group with the operated group, no statistically significant differences were found between the two groups and between the dominant and non-dominant sides of the control group. Conclusion: Latarjet surgery does not cause SD, although there are alterations in some plane of the scapular movements in the ascending and/or descending phase. Level of Evidence III, Retrospective Comparative Study.

RESUMO Objetivo: Avaliar, de forma quantitativa, o movimento escapular dos pacientes submetidos à cirurgia de Latarjet e identificar se apresentam discinesia escapular (DE). Além disso, correlacionar com a clínica e com o grau de elevação do ombro. Método: Estudo transversal realizado no Laboratório de Análise do Movimento (LAM), no Instituto de Ciências da Atividade Física e Esporte que avaliou de forma quantitativa, utilizando marcadores retro-refletivos esféricos, os movimentos escapulares do grupo controle (10 voluntários) e 22 pacientes (23 ombros operados), submetidos à cirurgia de Latarjet, entre os anos de 2011 e 2016, com pelo menos um ano de pós-operatório. Foram utilizados os resultados do grupo controle como parâmetro de normalidade e posteriormente comparados aos do grupo de pacientes operados. Avaliadas a inclinação posterior, rotação superior e rotação medial das escápulas nos ângulos de 60°, 90° e 120° de elevação, tanto na fase ascendente quanto na descendente. A análise estatística utilizada foi a multivariada da variância (MANOVA) comparando os lados direito e esquerdo do grupo controle e posteriormente o grupo controle com o grupo pós-operatório (p = 0,05 em todos os testes). Resultados: Ao compararmos a média dos resultados da avaliação quantitativa do grupo controle com o grupo dos operados, não foram evidenciadas diferenças estatisticamente significativas entre os dois grupos, assim como os lados dominante e o não dominante do grupo controle. Conclusão: A cirurgia de Latarjet não causa DE, apesar de haver alterações em algum plano dos movimentos escapulares na fase ascendente e/ou descendente. Nível de Evidência III, Estudo Retrospectivo Comparativo.

Evaluation of scapular dyskinesis in crossfit®- practicing athletes / Avaliação da discinese escapular em atletas praticantes de crossfit®

ABSTRACT Objective Evaluate the scapular movement of Crossfit® practitioners and identify whether they present an increased incidence of scapular dyskinesis (SD) compared to non-practitioners. Method A transversal study was evaluated quantitatively and dynamically, using retro-reflective spherical markers, the scapular movements of ten volunteers composing the control group, and 11 Crossfit® practitioners. The control group's results were used as a normality parameter and compared to those of the Crossfit® practitioner's group. Results It was identified that the superior scapular rotation in the ascending phase is inferior in the group of Crossfit® practitioners (p = 0.02). Conclusion The regular practice of Crossfit® causes scapular dyskinesis (SD), with alteration in the scapular superior rotation movement. Level of Evidence III: Retrospective comparative.

RESUMO Objetivo Avaliar o movimento escapular de praticantes de Crossfit® e identificar se apresentam incidência aumentada de discinese escapular (DE) quando comparados a não praticantes. Método Estudo transversal que avaliou de forma quantitativa e dinâmica, utilizando marcadores retro-refletivos esféricos, os movimentos escapulares de dez voluntários, compondo o grupo controle, e 11 praticantes de Crossfit®. Os resultados do grupo controle foram utilizados como parâmetro de normalidade e comparados aos do grupo de praticantes de Crossfit®. Resultados Identificou-se que a rotação superior escapular na fase ascendente é inferior no grupo de praticantes de Crossfit® (p = 0,02). Conclusão A prática regular de Crossfit® causa discinese escapular (DE), com alteração no movimento de rotação superior da escápula. Nível de Evidência III: Retrospectivo comparativo.

Parkinson's disease delays predictable visual cue processing without affecting complex and unpredictable visual cue processing in postural control.

This study examined the influence of visual information of different complexities and predictability on the body sway of individuals with Parkinson's disease (PD) during upright stance. Twenty-one individuals at initial stages of PD (62.1 ± 7.2 years), under dopaminergic medication, and 21 controls (62.3 ± 7.1 years) stood inside a moving room, performing 10 trials of 60 s. In the first trial, the room remained motionless. Then, the room oscillated in an anterior-posterior direction. There were three blocks of three trials. In the first block, the room oscillated at 0.2 Hz (periodic simple condition); in the second block, periodic frequencies of 0.1, 0.3, and 0.5 Hz were combined (periodic complex condition); in the third block, non-periodic frequencies of 0.1, 0.3, and 0.5 Hz were combined (non-periodic complex condition). Participants were not informed about the room movement. The displacement of the room and trunk were registered using an OPTOTRAK system. Postural sway was examined using mean sway amplitude, and the relationship between visual information and body sway used coherence, gain, and phase. There was no group difference when the room remained motionless. Upon visual manipulation, the PD group displayed larger sway magnitude in the non-periodic complex condition. Individuals with PD also lagged behind the moving room (lower phase values) compared to controls, only in the periodic simple condition. In the remaining measures, there was no group difference. These results suggest that individuals with PD use complex and unpredictable visual information, similar to controls, during upright stance. However, PD might affect the predictable visual cues processing.

Relationship between postural control in upright stance and virtual reality in post-stroke individuals / Relação entre desempenho do controle postural em pé e em realidade virtual em indivíduos pós-AVC

Abstract Introduction: Considered the second leading cause of death worldwide, stroke leads to several consequences resulting from the injury in regions responsible for the processing of sensorimotor information, leading to deficits in the maintenance and performance of postural control. Objective: To relate the performance of postural control during upright stance and a virtual reality task in post-stroke individuals. Method: Nine post-stroke individuals, aged 30 to 76 years, characterized by the Berg balance scale, Fugl - Meyer scale and Mini Mental State Examination participated in this study. Postural performance was measured by the center of pressure under bipedal conditions, in anteroposterior and mediolateral directions and unipedal with the affected and unaffected sides, using a force platform. Virtual reality performance was measured by distance and time required to perform a task in the Nintendo Wii®. Results: Revealed significant correlations between distance and displacement time of the affected side (distance x disc_affected = 0.667 - p = 0.025; time x disc_affected = 0.683 - p = 0.021) and between variables time and mean amplitude of mediolateral oscillation (time x amo_ml = -0.733 - p = 0.012), time and mediolateral and anteroposterior mean velocity (time x vm_ml = -0.617 - p = 0.038; time x vm_ap = -0.833 - p = 0.003) and between time and area (time x area = -0.633 - p = 0.034). Conclusion: the performance of standing postural control in post-stroke individuals, represented by measures of weight discharge and variables of postural control, presented a significant relation with the variables of virtual reality.

Resumo Introdução: Tido como a segunda maior causa de morte no mundo, o Acidente Vascular Cerebral tem suas consequências resultantes da lesão em regiões responsáveis pelo processamento das informações sensório-motoras, acarretando déficits na manutenção e desempenho do Controle Postural. Objetivo: Relacionar o desempenho do controle postural em pé e uma tarefa em realidade virtual em indivíduos pós-AVC. Método: Participaram 9 indivíduos em condição de pós-AVC com idades entre 30 a 76 anos, caracterizados por meio da escala de equilíbrio de Berg, Escala de Fugl-Meyer e Mini-Exame de Estado Mental. O desempenho postural foi medido através do deslocamento do centro de pressão nas condições bipodal, nas direções ântero-posterior e médio-lateral, e unipodal, com o lado afetado e não afetado, por meio de uma plataforma de força. O desempenho em realidade virtual, medido por distância e tempo, foi realizado por meio do console Nintendo Wii®. Resultados: Revelaram correlações significativas entre as variáveis distância e tempo de deslocamento do lado afetado (distância x desc_afetado=0,667 - p=0,025; tempo x desc_afetado=0,683 - p=0,021) e entre as variáveis tempo e amplitude média de oscilação médio-lateral (tempo x amo_ml= -0,733 - p=0,012), tempo e velocidade média médio-lateral e ântero-posterior (tempo x vm_ml= -0,617 - p=0,038; tempo x vm_ap= -0,833 - p=0,003) e entre tempo e área (tempo x área= -0,633 - p=0,034). Conclusão: Há relação entre o desempenho do controle postural, mensurado quantitativamente a partir de uma plataforma de força, e o desempenho em tarefa virtual pé em indivíduos pós-AVC.

Effects of water immersion on gait initiation: part II of a case series after incomplete spinal cord injury.

Study design: Case series. Objectives: This case series describes how the aquatic environment influences gait initiation in terms of the center of pressure (COP) excursion, impulses, trunk acceleration, and perceptions of participants with incomplete spinal cord injury (iSCI). Setting: Tertiary Rehabilitation Hospital, Ontario, Canada. Methods: Five individuals with iSCI (four cervical injuries/one thoracic injury, AIS D) participated in the study. Baseline clinical balance was evaluated by Berg Balance Scale and Mini-Balance Evaluation System Test. Participants initiated gait on a waterproof force plate and walked ~4 steps, in water and on land. COP trajectories during anticipatory and execution phases, impulses, and trunk acceleration parameters were investigated. Perceptions of walking in both environments were obtained using an interview. Results: COP trajectory was prominently longer when individuals stepped forward. A decrease in velocity of COP was observed predominantly in the AP direction during stepping. Non-normalized vertical impulses decreased as the AP impulses increased, in water compared to land. Upper to lower trunk acceleration ratios showed how water resistance influenced the lower trunk acceleration. Most of participants reported that walking in water was challenging, but safer than on land. Conclusions: Participants with higher balance function seemed to have more pronounced changes in anticipatory and execution phases' duration, length and velocity of COP. A faster anticipatory phase and a slower execution phase were observed in water than on land. Participants walked in water using a different trunk control strategy than on land and reported no fear of falling when walking in water versus land.

Correlation between eccentric training and functional tests in subjects with reconstructed acl / Correlação entre treino excêntrico e testes funcionais em sujeitos com lca reconstruído / Correlación entre entrenamiento excéntrico y pruebas funcionales en sujetos con lca reconstruido

INTRODUCTION: Eccentric training and jump tests are widely used to recover and measure deficits in knee strength and functionality after anterior cruciate ligament (ACL) reconstruction. OBJECTIVE: To correlate knee extension and flexion torque generated by eccentric isokinetic training, with functional jump tests in subjects with reconstructed ACL. METHOD: Sixteen men with unilateral ACL reconstruction were assessed before and after 12 weeks of eccentric isokinetic training of knee flexors and extensors (3×10 MVC, 2x/week) at 30°/s for extension and flexion torque (isometric; concentric and eccentric at 30 and 120°/s) and functional jump tests (single, triple, cross and figure of 8). Inter- and intra-limb pre- and post-training mean peak torque (MPT), distance and jump test times were compared along with the correlations between these variables, considering P<0.05. RESULTS: The affected limb (AL) showed significant gain of extension and flexion torque (P<0.01) in the different test categories and velocities evaluated. In the non-affected limb (NAL), this only occurred in the eccentric category (30 and 120°/s), in the extension (P<0.01) and flexion (P<0.05 and P<0.01) torques, respectively. In the jumps, there was an increase in distance (single and triple; P<0.05) and a decrease in time (crossed and figure of 8; P<0.01), however, MPT x Jump correlations were weak (r<0.3) in the pre and post-training period in both limbs. CONCLUSION: Despite the gain in knee extension and flexion torque and jumping performance, the expected correlation was not satisfactory, suggesting that knee functionality involves other variables inherent to motor control. Level of Evidence IV; Type of study: Case series.

INTRODUÇÃO: O treino excêntrico e testes de saltos são muito utilizados para recuperar e aferir déficits de força e funcionalidade do joelho, após reconstrução do ligamento cruzado anterior (LCA). OBJETIVO: Correlacionar o torque extensor e flexor do joelho, gerados pelo treino isocinético excêntrico, com testes funcionais de saltos em sujeitos com LCA reconstruído. MÉTODO: Foram avaliados 16 homens, com reconstrução unilateral do LCA, antes e depois de 12 semanas de treino isocinético excêntrico de extensores e flexores do joelho (3 × 10 CEVM, 2x/semana) a 30°/s, quanto ao torque extensor e flexor (isométrico; concêntrico e excêntrico a 30°/s e 120°/s) e aos testes funcionais de saltos (simples, triplo, cruzado e figura em 8). As médias dos picos de torque (MPT), a distância e os tempos dos testes de salto inter e intramembros, pré e pós-treino foram comparados, além das correlações entre essas variáveis, considerando P< 0,05. RESULTADOS: O membro acometido (MA) mostrou ganho significativo de torque extensor e flexor (P< 0,01) nos modos e velocidades avaliados. No membro não acometido (MNA), isso ocorreu apenas para o modo excêntrico (30°/s e 120°/s), do torque extensor (P< 0,01) e flexor (P< 0,05 e P<0,01), respectivamente. Nos saltos, houve aumento da distância (simples e triplo; P< 0,05) e diminuição do tempo (cruzado e figura em 8; P< 0,01), porém, as correlações entre MPT e saltos mostraram-se fracas nos dois membros (r< 0,3) antes e depois do treino. CONCLUSÃO: Apesar do ganho no torque extensor e flexor do joelho e no rendimento dos saltos, a correlação esperada não foi satisfatória, sugerindo que a funcionalidade do joelho envolve outras variáveis inerentes ao controle motor. Nível de evidência IV; Tipo de estudo: Série de casos.

INTRODUCCIÓN: El entrenamiento excéntrico y las pruebas de saltos son muy utilizados para recuperar y medir los déficits de fuerza y funcionalidad de la rodilla, después de la reconstrucción del ligamento cruzado anterior (LCA). OBJETIVO: Correlacionar el torque extensor y flexor de la rodilla, generados por el entrenamiento isocinético excéntrico, con pruebas funcionales de saltos en sujetos con LCA reconstruido. MÉTODO: Fueron evaluados 16 hombres, con reconstrucción unilateral del LCA, antes y después de 12 semanas de entrenamiento isocinético excéntrico de extensores y flexores de la rodilla (3x10 CEVM, 2x/semana) a 30°/s, cuanto al torque extensor y flexor (isométrico, concéntrico y excéntrico a 30 y 120°/s) y a las pruebas funcionales de saltos (simple, triple, cruzado y figura en 8). Se compararon promedios de los picos de torque (MPT), distancia y tiempos de las pruebas de salto, inter e intra-miembros, pre y post-entrenamiento, además de las correlaciones entre estas variables, considerando P<0,05. RESULTADOS: El miembro acometido (MA) mostró aumento significativo del torque extensor y flexor (P<0,01) en los modos y velocidades evaluados. En el miembro no acometido (MNA), eso ocurrió sólo para el modo excéntrico (30 y 120°/s), del torque extensor (P<0,01) y flexor (P<0,05 y P<0,01), respectivamente. En los saltos, hubo aumento en la distancia (simple y triple; P<0,05) y disminución del tiempo (cruzado y figura en 8; P<0,01), sin embargo, las correlaciones MPT x saltos se mostraron débiles (r<0,3) en el pre y post-entrenamiento, en los dos miembros. CONCLUSIÓN: A pesar del aumento en el torque extensor y flexor de la rodilla y en el rendimiento de los saltos, la correlación esperada no fue satisfactoria, sugiriendo que la funcionalidad de la rodilla involucra otras variables inherentes al control motor. Nivel de evidencia IV; Tipo de estudio: Serie de casos

Strategies adopted by younger and older adults while operating a non-pedal tricycle.

BACKGROUND: Exercises that could prevent gait impairment of older adults should be implemented in such a way that practitioners can keep motivation and adherence independent of older adults fitness levels. OBJECTIVE: This study describes how younger and older adults use a non-pedal tricycle to transport their bodies along a pathway. METHODS: Nine younger (24±4.9y) and nine older (66±4.0y) adults participated in this study. They moved along a straight pathway at a self-selected comfortable speed with reflective markers on their main lower limb landmarks. A computerized gait analysis system with infrared cameras was used to obtain kinematic data to calculate spatial-temporal parameters and lower limb angles. RESULTS: Overall, participants from both groups were able to perform the task moving at a similar mean speed, with similar stride length and ankle joint excursion. Older adults had higher cadence (mean difference of 17steps/min; 95% CI=0.99-1.15) and hip excursion (mean difference of 12°; 95% CI=28-33), longer stance duration (mean difference of 3.4%; 95% CI=56.2-59.5), and lower knee excursion (mean difference of 6°; 95% CI=47.9-53.8) than younger adults. CONCLUSION: Older adults were able to transport their body with a non-pedal tricycle with more hip and less knee excursion than younger adults. Professionals that work with the older population should look at and take into consideration the use of non-pedal tricycles in exercise protocols and investigate the long-term impacts.

The Influence of the Aquatic Environment on Gait Initiation: A Pilot Study.

Aquatic therapies are used to restore step initiation in people with locomotor disabilities. However, there is lack of evidence of underlining mechanisms of gait initiation in water. We investigated center of pressure (CoP), vertical and anterior-posterior impulse forces, and kinematics of the first step performed in water in comparison with overground walking. The peaks of anticipatory postural adjustment (APA) and the sections of CoP trajectories were longer in water than on land. Impulse forces were increased in water compared with land. Range of motion (ROM) of ankle joint increased in water while knee joint ROM did not change. We suggest that the aquatic environment may facilitate gait initiation training by allowing a longer step execution with greater stimuli and imposed resistance for the phases of gait initiation.

Attentional artifacts in sensorimotor coupling in the postural control of young adults.

Although postural control requires the integration of different sensory cues, little is known about the role of attentional artifacts on the individual's ability to properly respond to postural challenges. This study investigated the effects of concomitant tasks (cognitive and postural) on the relationship between visual information and body sway. Thirty healthy adults were asked to stand still inside of a moving room on normal and reduced bases of support. Initially, the participants were not aware of any visual manipulation and were asked to perform tasks that required concomitant attentional demands. Then, all participants were informed about the visual manipulation and were requested to resist it. The results showed that information about visual manipulation changed the coupling between visual information and body sway, but only in a less demanding task, and that it was affected by the concomitant task. The coupling between visual information and body sway for postural control does not demand attention on a regular basis, but any change in this relationship demands attention and occurs in less demanding postural tasks.

Effects of isokinetic eccentric training on knee extensor and flexor torque and on gait of individuals with long term ACL reconstruction: a controlled clinical trial / Efeitos do treinamento isocinético excêntrico de extensores de joelho e torque flexor na marcha de indivíduos com reconstrução do LCA: um ensaio clínico controlado / Efectos del entrenamiento excéntrico isocinético en extensor de la rodilla y el par flexor y sobre la marcha de las personas con reconstrucción ACL: un ensayo clínico controlado

This study investigated the effects of the isokinetic eccentric training (IET) on the knee extensor and flexor torque and kinematic gait parameters in individuals with ACL reconstruction. Sixteen men with ACL reconstructed (ACLr) whose torque and the gait were evaluated, before and after 12 weeks of IET, was compared to a control group (14 individuals). Student t, MANOVA and ANOVA tests were performed with 5% of significance. The training increased the isometric, concentric at 30 and 120º/s (p < .05) and eccentric at 30º/s (p < .01) extensor torque on the affected limb (AL), and eccentric at 30 and 120º/s (p < .01), on the non-affected limb (NAL). In the flexors, there was an increase on the torque: isometric, concentric at 30º/s and eccentric at 30 and 120º/s (p < .01) in AL and in eccentric at 30 (p < .05) and 120º/s (p < .01) in NAL. With respect to the angular and spatio-temporal variables gait, there was no difference between pre-and post-training in LCAr group. Compared to control group, the cycle time, in two members, was lower in LCAr group, and stride length and cadence were higher in the AL of the LCAr (p < .05). Moreover, the knee flexion-extension angles (minimum and maximum) remained lower in LCAr, pre- and post-training (p < .01). The torque gain associated with eccentric isokinetic training did not affect the kinematic parameters of gait in patients undergoing ACL reconstruction...

"Efeitos do treinamento isocinético excêntrico de extensores de joelho e torque flexor na marcha de indivíduos com reconstrução do LCA: Um ensaio clínico controlado." Este estudo investigou os efeitos do treinamento isocinético excêntrico (TIE) sobre o torque extensor e flexor do joelho e parâmetros cinemáticos da marcha de indivíduos com reconstrução do LCA. Dezesseis homens com LCA reconstruído (LCAr), foram avaliados quanto ao torque e marcha, antes e após 12 semanas de TIE e comparados com um grupo controle (14 indivíduos). Testes t Student, MANOVA e ANOVA foram realizados com 5% de significância. O treinamento aumentou o torque extensor isométrico, concêntrico a 30 e 120º/s (p < 0,05) e excêntrico a 30º/s (p < 0,01) no membro afetado (MA), e excêntrico a 30 e 120º/s (p < 0,01), no membro não afetado (MNA). Nos flexores, houve um aumento no torque: isométrico, concêntrico a 30º/s e excêntrico a 30 e 120º/s (p < 0,01) no MA, e excêntrico a 30 (p < 0,05) e 120º/s (p < 0,01) no MNA. Com relação às variáveis espaço-temporais e angulares da marcha, não houve diferença entre as avaliações pré e pós-treino no grupo LCAr. Comparado ao controle, a duração do ciclo, nos dois membros, foi menor no LCAr, e comprimento da passada e cadência foram maiores no MA do grupo LCAr (p < 0,05). Além disso, os ângulos (mínimo e máximo) de flexão-extensão do joelho permaneceram menores no LCAr, pré e pós-treino (p < 0,01). O ganho de torque associado ao treinamento isocinético excêntrico não modificou os parâmetros cinemáticos da marcha nos indivíduos submetidos à reconstrução do LCA...

"Efectos del entrenamiento excéntrico isocinético en extensor de la rodilla y el par flexor y sobre la marcha de las personas con reconstrucción ACL: Un ensayo clínico controlado." Este estudio investigó los efectos del entrenamiento isocinético excéntrico (EIE) en el torque del extensor y del flexor de la rodilla y parámetros cinemáticos de la marcha de personas con la reconstrucción del LCA. Dieciséis hombres con LCA reconstruido (LCAr), fueron evaluados para el par y la marcha antes y después de 12 semanas de EIE y se compararon con un grupo control (14 personas). Prueba t Student, ANOVA y MANOVA se realizaron con 5 % de significación. La formación aumentó extensor torque isométrico, concéntrico 30 y 120°/s (p < 0,05) y la excéntrica 30°/s (p < 0,01) en el miembro afectado (MA), y la excéntrica 30 y 120°/s (p < 0,01) en el miembro no afectado (MNA). Flexor, hubo un aumento en el par motor: isométrica , concéntrica 30°/s excéntrica 30 y 120°/s (p < 0,01) en MA, excéntrico y 30 (p < 0,05 ) y 120°/ s (p < 0,01) en el MNA. Con respecto a las variables angulares y espacio-temporal de andar, no hubo diferencia entre pre y post-entrenamiento en grupo LCAr. En comparación con el grupo control, el tiempo de ciclo, em los dos miembros, fue menor en LCAr, y la longitud del paso y cadencia fueron mayores en el LCAr del MA (p < 0,05). Por otra parte, los ángulos de flexión-extensión de la rodilla (mínimo y máximo) se mantuvieron bajos en LCAr, pre y post-entrenamiento (p < 0,01). El aumento del torque asociado con el entrenamiento isocinético excéntrico no afectó los parámetros cinemáticos de la marcha en las personas sometidas a la reconstrucción del LCA...

Influence of body weight unloading and support surface during walking of children with cerebral palsy / Influência do alívio de peso corporal e da superfície de suporte durante o andar de crianças com paralisia cerebral espástica

Introduction Partial body weight support (BWS) systems have been employed for gait training of children with cerebral palsy (CP). Therefore, it would be important to analyze if the type of walking surface and the amount of body weight unloading over lower limbs change the way these children walk. Objectives Investigate the influence of walking surface and amount of body weight unloading on the spatial temporal characteristics during walking of children with CP. Materials and methods Seven children with spastic CP between four and eight years old and GMFCS (Gross Motor Function Classification System) between I and IV, were videotaped walking with 0%, 15% and 30% of BWS on both dynamic (treadmill) and static (ground level) surfaces. Walking spatial temporal variables were calculated. Results Children walked with similar velocity in all experimental conditions. While stance duration decreased as the percentage of BWS increased, no differences were found for stance and swing periods and cadence. Children walked with longer steps and strides and with faster strides on static surface compared to dynamic surface. Conclusion Children with CP presenting different levels of motor impairment presented some alterations in the spatial temporal walking parameters as they walked with body unloading. However, such alterations might be due mainly to the type of walking surface than the percentage of body weight unloading on lower limbs.

Introdução Sistemas de suporte parcial de peso corporal (SPPC) têm sido utilizados para treinamento do andar de crianças com paralisia cerebral (PC). Sendo assim, seria importante analisar se o tipo de superfície e a quantidade de alívio de peso corporal sobre os membros inferiores interferem na forma como essas crianças andam. Objetivo Investigar a influência do tipo de superfície e da porcentagem de alívio de peso corporal sobre as características espaço-temporais durante o andar de crianças com PC. Materiais e métodos Sete crianças com PC espástica, entre quatro e oito anos de idade, e GMFCS (Gross Motor Function Classification System) entre I e IV, foram filmadas andando com 0%, 15% e 30% de SPPC em superfícies móvel (esteira motorizada) e fixa (chão). Variáveis espaço-temporais do andar foram calculadas. Resultados As crianças andaram com velocidade semelhante em todas as condições experimentais. Enquanto que a duração do período de apoio diminuiu conforme a porcentagem de SPPC aumentou, nenhuma diferença para as fases de apoio e balanço e cadência foi encontrada. As crianças andaram com passos e passadas mais longos e passadas mais rápidas na superfície fixa do que na superfície móvel. Conclusão Crianças com PC com diferentes níveis de acometimento motor apresentaram algumas alterações nos parâmetros espaço-temporais durante o andar com alívio de peso corporal em superfícies móvel e fixa. Entretanto, tais alterações podem ser atribuídas principalmente ao tipo de superfície em que as crianças andam do que às porcentagens de alívio de peso corporal proporcionadas aos membros inferiores.

Static postural balance in healthy individuals: comparisons between three age groups / Equilíbrio postural estático em indivíduos saudáveis: comparações entre três grupos etários / Equilibrio postural estático en individuos sanos: las comparaciones entre los tres grupos de edad

The aim of the study was to compare static postural balance of healthy individuals of three age groups in different conditions of support and vision. Seventy one individuals, divided into 3 groups, were analyzed: young group (YG: 22.2 ± 2.1 years), middle aged group (MAG: 50.7 ± 5.7 years) and older individuals group (EG: 66.8 ± 5.4 years). Their balance was tested on a force platform, under 3 support and 3 visual conditions. Measures included: total (TD), anterior-posterior (APD) and mediolateral displacement (MLD) of the center of pressure (CoP). ANOVA revealed significant differences for interactions between group X support conditions and group X visual conditions for the 3 variables (p<0.01), with greater displacements for the MAG and EG groups during single-leg stance with partial and occluded vision (p<0.05). Static postural balance decreased over time in healthy individuals, and conditions of support and visual negatively affected balance with the increment of age.

O objetivo do estudo foi comparar o equilíbrio postural estático de indivíduos saudáveis de três faixas etárias em diferentes condições de apoio e de visão. Foram analisados 71 sujeitos, divididos em 3 grupos: jovens (GJ: 22,2±2,1 anos); meia idade (GMI: 50,7±5,7 anos) e idosos (GI: 66,8±5,4 anos). O equilíbrio foi testado numa plataforma de força, em 3 condições de apoio e 3 condições de visão, avaliando-se o deslocamento total (DT), ântero-posterior (DAP) e médio-lateral (DML) do centro de pressão (CP). ANOVA mostrou interação grupo X condições de apoio e grupo X condições visuais, nas 3 variáveis estudadas (p<0,01), com maiores deslocamentos no GMI e GI no apoio unipodal com visão parcial e ausente (p<0,05). O equilíbrio postural estático em indivíduos saudáveis diminuiu ao longo do tempo e que as condições de apoio e de visão podem afetá-lo negativamente com o avançar da idade.

El objetivo del estudio fue comparar el equilibrio postural estático de individuos sanos de tres grupos de edad em diferentes condiciones de apoyo y visón. Fueran analizados 71 sujetos, divididos en 3 grupos: jóvenes (GJ: 22,2±2,1 años), de mediana edad (GME: 50,7±5,7 años) y ancianos (GA: 66,8±5,4 años). El equilibrio fue probado en una plataforma de fuerza, em 3 condiciones de apoyo y 3 condiciones de visión, evaluando el desplazamiento total (DT), anteroposterior (DAP) y mediolateral (DML) del centro de presión (CP). ANOVA mostró interacción grupo X condiciones de apoyo y grupo X condiciones visuales, en las 3 variables (p<0,01), con grandes desplazamientos en GME y GA en apoyo unipodal con visión parcial y ausente (p<0,05). El equilibrio postural estático disminuyó en individuos sanos con el tiempo y que las condiciones de apoyo y de visión pueden afectarle negativamente con la edad.

Avaliação do padrão postural e marcha de pacientes amputados vasculares transtibiais protetizados / Postural pattern evaluation and gait of unilateral transtibial dysvascular amputees with prosthesis

Objetivo: Avaliar o padrão postural e a marcha de pacientes amputados transtibiais unilaterais, de etiologia vascular que realizaram o processo de protetização e reabilitação no setor de Fisioterapia do Lar Escola São Francisco - Centro de Reabilitação. Método: Trata-se de um estudo Observacional Prospectivo Transversal. Participaram do estudo oito sujeitos com média de idade de 60, 4 anos, submetidos à amputação transtibial unilateral até 5 anos da data da análise, por etiologia vascular e que concluíram o processo de protetização com alta da reabilitação até 24 meses. Foi avaliado o padrão postural com o paciente em ortostatismo, sobre uma plataforma de força com os olhos abertos e olhos fechados alternadamente, e também foi avaliada a marcha em uma passarela de 6 metros utilizando uma plataforma de força nivelada e escondida no meio da passarela. Foram colocados marcadores reflexivos no quinto metatarso, maléolo lateral, côndilo lateral do fêmur e trocânter maior, pois duas filmadoras foram dispostas lateralmente para a obtenção das imagens e sendo sincronizadas com a plataforma de força. Resultados: Os dados achados para controle postural em amplitude média de oscilação MANOVA revelaram diferença na visão (olhos abertos e olhos fechados) para direções ântero-posterior (F1,7 = 13.223 p < 0,05) e médio-lateral (F1,7 = 7.872 p < 0,05). Na análise de marcha, a velocidade média foi de 0,72 (m/s) ± 0,18, e não foram achadas diferenças significativas na comparação entre os dois membros nos dados analisados. Conclusão: O estudo demonstrou aumento significativo da oscilação em ortostatismo dos indivíduos com os olhos fechados em comparação com olhos abertos. Parâmetros da marcha não tiveram diferença significativa entre o membro protético e o não protético.

Objetive: Evaluate the postural pattern and gait of unilateral transtibial amputees of vascular etiology who underwent the process of fitting and rehabilitation in the sector of Physical Therapy Lar Escola São Franscisco - Rehabilitation Center. Method: This is a Transversal Prospective Observational study. The study was performed with the participation of eight people with a mean age 60,4 years old, underwent to unilateral transtibial amputation within five (05) years from the date of analysis, by vascular etiology and which have concluded the process of fitting with high rehabilitation up to 24 months. It was evaluated the postural pattern with the patients standing on a force platform with their eyes open and closed alternately. It was also evaluated the gait on a 6-meter footbridge where it was leveled the force platform hidden in the middle of the footbridge. Reflective markers were placed on the fifth metatarsal, lateral malleolus, lateral condyle of the femur and greater trochanter, because two video cameras had been placed laterally for the obtainment of the images in synchronism with the force plataform. Results: The data found for postural pattern in the mean amplitude of oscillation MANOVA revealed a difference in vision (eyes open and eyes closed) to anteroposterior direction (F1,7 = 13,223 p < 0.05) and mediolateral (F1,7 = 7,872 p < 0.05). From gait analysis the average speed was 0.72 (m/s) ± 0.18, no significant differences were found if compared to the two members in any of the analyzed data. Conclusion: The study showed a significant increase of the oscillation in the standing position for the individuals with eyes closed compared to individuals with eyes open. Gait parameters showed no significant difference between the prosthetic and non-prosthetic limb.

Influência de calços na orientação postural de indivíduos com escoliose idiopática / Influence of the shoe lift in the postural orientation in individuals with idiopathic scoliosis

INTRODUÇÃO: A relação entre a orientação dos segmentos e os ajustes que podem ser desencadeados por calços e palmilhas em pacientes escolióticos durante a manutenção da posição ortostática é pouco conhecida. OBJETIVO: Verificar alterações estáticas e associadas com mudanças unilaterais de calços na orientação postural de indivíduos com escoliose idiopática. MATERIAIS E MÉTODOS: Grupo experimental com dez indivíduos com escoliose idiopática com curva dupla (menor 10°) e grupo controle com dez indivíduos sem escoliose (faixa etária de 13 a 24 anos). Participantes foram filmados na posição ortostática sem calço, com calço baixo (1 cm) e com calço alto (3 cm); estes foram colocados sob o pé direito e pé esquerdo dos indivíduos. Em cada condição, o participante manteve a posição estática durante 15 segundos e marcadores refletivos foram colocados em pontos anatômicos específicos. Foram calculados ângulos posturais: torácico alto; torácico médio; toracolombar e lombar e ângulos segmentares: ombro; escápula; pelve e joelho. RESULTADOS: Na condição sem calço, diferenças foram observadas entre grupos para os ângulos posturais toracolombar e lombar e para o ângulo segmentar do ombro. Com calço baixo e alto, sob o pé direito, diferença foi observada entre calços para os ângulos lombar, da pelve e do joelho. Com calço baixo e alto, sob o pé esquerdo, diferença foi observada entre grupos para o ângulo toracolombar e entre calços para os ângulos da pelve e do joelho. CONCLUSÕES: A utilização de calço promove reorientação nas regiões mais baixas da coluna e nos segmentos da pelve e do joelho. Estes resultados sugerem que nas escolioses duplas, manipulação da base de apoio modifica o alinhamento do tronco que pode provocar reorganização das estruturas e busca de um novo arranjo entre segmentos em indivíduos com escoliose idiopática.

INTRODUCTION: The relationship between the orientation of the segments and the adjustments that can be triggered by shoe lift and insoles in scoliotic patients during maintenance of standing position is unclear. OBJECTIVE: To verify static changes and those associated with unilateral manipulations of shoe lift in the postural orientation in people with idiopathic scoliosis. MATERIALS AND METHODS: Experimental group composed of ten patients with idiopathic scoliosis with double curve (less 10°) and control group with ten participants without scoliosis (aging from 13 to 24 years). Participants were videotaped in upright stance, standing with no, low (1 cm), and high (3 cm) shoe lift, which were placed under right and left shoe. In each condition, the participant maintain upright stance for 15 seconds and reflective markers were affixed on specific anatomical places. Postural angles were obtained: high thoracic; medium thoracic; thoracolumbar; and lumbar, as well segmental angles: shoulder; scapula; pelvis; and knee. RESULTS: In the no shoe lift condition, differences were observed between groups for high and medium thoracic angles and for shoulder. With low and high shoe lift under the right foot, difference was observed between shoe lift heights for high thoracic, for pelvis and knee angles. With low and high shoe lift under the left foot, differences between groups were observed for thoracolumbar angle and between shoe lift heights for pelvis and knee angles. CONCLUSIONS: The shoe lift promotes reorientation in the lower regions of the spine and segments of pelvis and knee. It might be suggested that in the scoliosis with double curves, manipulation in the basis of support changes the alignment of the trunk that might promote structural reorganization and the search of new adjustments among segments in individuals with idiopathic scoliosis.