Biomechanical comparison between manual and motorless device assisted patient handling: sitting to and from standing position.

Although lots of assistive devices have been studied to fight against caregivers' work-related musculoskeletal disorders, stand-and-turn devices effects on biomechanical constraints are still unknown. The aim of this study is to provide and compare quantitative data on loads in the low back area resulting from the use of a motorless stand-and-turn device and from manual patient handling. Nine caregivers participated to motion capture and ground reaction forces measurement sessions of three cases of handling: manual handling with one caregiver, manual handling with two caregivers, motorless device assisted handling. Forces and torques at the L5/S1 joint were computed through Inverse Dynamics process. Motorless device assisted handling required the smallest loads whereas manual handling with one caregiver required the biggest loads, the latter being in some cases twice as big as the former. Caregivers should use a stand-and-turn device when handling a patient from sitting/standing to standing/sitting position whenever it is possible.

ILIOTIBIAL BAND SYNDROME IN CYCLING: A COMBINED EXPERIMENTAL-SIMULATION APPROACH FOR ASSESSING THE EFFECT OF SADDLE SETBACK.

BACKGROUND: Despite abundant literature, the treatment of iliotibial band syndrome (ITBS) in cyclists remains complicated as it lacks evidence-based recommendations. PURPOSE: The aim of this study was to develop a musculoskeletal modelling approach that investigates three potential biomechanical determinants of ITBS (strain, strain rate and compression force) and to use this approach to investigate the effect of saddle setback. DESIGN: Cross-sectional. METHODS: An existing 3D lower-body musculoskeletal model was adapted to cycling and to the computation of three putative pathomechanisms responsible for ITBS: ITB strain, ITB strain rate, and compression force between ITB and the lateral femoral epicondyle (LFE). Lower limb kinematics recorded from ten well-trained healthy cyclists served as input data of the model. Cyclists pedalled at a steady state (90rpm and 200W) on an ergometer, and three different saddle setback conditions were tested. The theoretical combined influence of hip and knee joint angles on ITBS was investigated and analysed through the lens of individual pedalling technique. RESULTS: ITB-LFE compression force was the only parameter significantly affected by saddle setback and supports the hypothesis that compression force is likely to be a determinant factor in ITBS etiology. Furthermore, results showed that ITB-LFE compression force increases in individuals whose pedalling technique exacerbates hip extension-adduction and/or knee extension-internal rotation. CONCLUSION: This approach has the potential to be advantageously implemented as an additional tool to help diagnose/correct potentially harmful sport techniques and optimize equipment setup/design. LEVEL OF EVIDENCE: 3b.

Biomechanical comparison of squatting and "optimal" supine birth positions.

In obstetric science, it is unknown whether the inherent biomechanical features of the squatting position can be achieved and/or transposed to the supine birth position. In this study Biomechanical features of the squatting position were compared with 2 hyperflexed supine positions for giving birth. Thirteen pregnant women past the 32 weeks of gestational age not in labor were assessed first in the squatting position with the feet flat on the floor, then in the hyperflexed supine position, and finally in the optimal supine position "crushing" the hand of the caregiver onto the bed. For each position, the flexion of the spine associated with the plane of the external conjugate (ANGce) and the pelvis, hip flexion, and abduction were quantified using an optoelectronic motion capture system. A non-invasive strain-gauge-based measuring system was used to track the lumbar curve. An optimal position was defined with a flat lumbar spine and a pelvic inlet plane perpendicular to the lumbar spine (ANGce = 0° ± 5°). For the 13 participants, hip flexion, hip abduction, and the lumbar curve did not differ significantly for the three positions (squatting position, hyperflexed supine position, and OS) in the post-hoc analyses. The optimal supine position induced an ANGce closer to the perpendicular plane than the squatting position (p = 0.002). In the squatting position or in hyperflexed supine position positions, none of the subjects fulfilled the two conditions considered necessary to reach the optimal position. The squatting position was not significantly different from the supine hyperflexed supine position with or without voluntary lordosis correction.

Influence of saddle setback on knee joint forces in cycling.

Knee functional disorders are one of the most common lower extremity non-traumatic injuries reported by cyclists. Incorrect bicycle configuration may predispose cyclist to injury but the evidence of an effect of saddle setback on knee pain remains inconclusive. The aim of this study was to determine the effect of saddle setback on knee joint forces during pedalling using a musculoskeletal modelling approach. Ten cyclists were assessed under three saddle setback conditions (range of changes in saddle position ~6 cm) while pedalling at a steady power output of 200 W and cadence of 90 rpm. A cycling musculoskeletal model was developed and knee joint forces were estimated using an inverse dynamics method associated with a static optimisation procedure. Our results indicate that moving the saddle forwards was not associated with an increase of patellofemoral joint forces. On the contrary, the tibiofemoral mean and peak compression force were 14 and 15% higher in the Backward than in the Forward condition, respectively. The peak compression force was related to neither pedal force nor quadriceps muscle force but coincided with the eccentric contraction of knee flexor muscles. These findings should benefit bike fitting practitioners and coaches in the design of specific training/rehabilitation protocols.

Assessment of Pelvic-Lumbar-Thigh Biomechanics to Optimize The Childbirth Position: An "In Vivo" Innovative Biomechanical Study.

The study aimed to assess the associations between the pelvis orientation, lumbar curve and thigh postures throughout pregnancy in a population of healthy women. Additionally, optimal mechanical birth conditions in terms of the pelvic inlet and lumbar curve were researched. The individuals' posture was assessed with three-dimensional motion analysis and the lumbar curve with the Epionics SPINE system. The association between the hip joint angles (flexion and abduction), the pelvis external conjugate, and lumbar curve position was assessed with a generalized linear mixed model (GLMM) adjusted to individuals' characteristics. Joint laxity was assessed with a modified Jobbin's extensometer. For all of the subjects, hip flexion and hip abduction were significantly associated with the angle between the external conjugate and spine, with higher correlation in the multivariate regression model. The association between hip flexion and the lumbar curve was less significant in multivariate than univariate regression analysis. Optimal birth conditions were never reached. The findings contribute to the understanding of the association between the hip position (flexion and abduction), pelvic orientation, and lumbar curve adjusted for joint laxity in healthy pregnant women. They lay the groundwork for future research in the field of obstetrical biomechanics.

Is there an impact of feet position on squatting birth position? An innovative biomechanical pilot study.

BACKGROUND: The squatting birth position is widely used for "natural" birth or in countries where childbirth occurs in non-medical facilities. Squatting birth positions, like others, are roughly defined so a biomechanical assessment is required with the availability of noninvasive technology in pregnant women. In practice, we can observe spontaneously two kinds of squatting birth position: on tiptoes and with feet flat. OBJECTIVE: To compare the impact of foot posture on biomechanical parameters considered essential in obstetrical biomechanics during a squatting birth position: on tiptoes versus with feet flat on the floor. STUDY DESIGN: Thirteen pregnant women beyond 32 weeks of gestational age who were not in labor were assessed during squatting birth position firstly spontaneously and secondly with the foot posture that was not taken spontaneously (on the tiptoes vs with feet flat). For each position, ANGle of flexion on the spine of the plane of the pelvis external conjugate (ANGec), hip flexion and abduction, and lumbar curve were assessed using an optoelectronic motion capture system and a biomechanical model adapted from the conventional gait model as well as a measuring system of the lumbar curve. RESULTS: Spontaneously, 11 out of 13 women squatted on tiptoe at the first test. On tiptoes the hip flexion was lower than with feet flat (p < 0.02), whereas hip abduction was not significantly different (p = 0.28). A lower ANGec angle (p = 0.003) was noticed for the tiptoe position than feet flat. The lumbar curve (lordosis) was more marked for the squatting position on tiptoes than for the position with feet flat (p < 0.001). On tiptoes no woman had a pelvic inlet plane perpendicular to the spine and none had a flat back or kyphosis. No woman on tiptoes fulfilled the two conditions necessary for the position that we consider optimal. CONCLUSION: In squatting birth position, foot posture has a biomechanical impact on lumbar curve and pelvic orientation. When comparing squatting positions (on tiptoes vs feet flat), feet flat on the ground is closer to optimal birth conditions than on tiptoes.

Comparative study between fully tethered and free swimming at different paces of swimming in front crawl.

Tethered swimming is a method often used to measure or enhance the physical and technical resources of swimmers. Although it is highlighted that the technique used in tethered swimming is probably different from that used in free conditions, there are few comparative studies on this subject. The current study aims to compare fully tethered and free swimming based on kinematic hand parameters (orientation, velocity and acceleration of the hand, sweepback and angle of attack), which are known to act directly on the generation of propulsive forces. The results show that there are significant differences during the stretch and catch phases but less during the insweep and upsweep phases. Tethered swimming makes it possible to estimate the propelling forces generated by the hand in free swimming at distance and middle-distance paces, but overestimates it at sprint pace. However, in view of the modifications of the kinematic parameters, it should not be used under repeated conditions of use, such as for the development of swimmers' capacity.

PLAViMoP: How to standardize and simplify the use of point-light displays.

The study of biological point-light displays (PLDs) has fascinated researchers for more than 40 years. However, the mechanisms underlying PLD perception remain unclear, partly due to difficulties with precisely controlling and transforming PLD sequences. Furthermore, little agreement exists regarding how transformations are performed. This article introduces a new free-access program called PLAViMoP (Point-Light Display Visualization and Modification Platform) and presents the algorithms for PLD transformations actually included in the software. PLAViMoP fulfills two objectives. First, it standardizes and makes clear many classical spatial and kinematic transformations described in the PLD literature. Furthermore, given its optimized interface, PLAViMOP makes these transformations easy and fast to achieve. Overall, PLAViMoP could directly help scientists avoid technical difficulties and make possible the use of PLDs for nonacademic applications.

Identification of Noise Covariance Matrices to Improve Orientation Estimation by Kalman Filter.

Magneto-inertial measurement units (MIMUs) are a promising way to perform human motion analysis outside the laboratory. To do so, in the literature, orientation provided by an MIMU is used to deduce body segment orientation. This is generally achieved by means of a Kalman filter that fuses acceleration, angular velocity, and magnetic field measures. A critical point when implementing a Kalman filter is the initialization of the covariance matrices that characterize mismodelling and input error from noisy sensors. The present study proposes a methodology to identify the initial values of these covariance matrices that optimize orientation estimation in the context of human motion analysis. The approach used was to apply motion to the sensor manually, and to compare the orientation obtained via the Kalman filter to a measurement from an optoelectronic system acting as a reference. Testing different sets of values for each parameter of the covariance matrices, and comparing each MIMU measurement with the reference measurement, enabled identification of the most effective values. Moreover, with these optimized initial covariance matrices, the orientation estimation was greatly improved. The method, as presented here, provides a unique solution to the problem of identifying the optimal covariance matrices values for Kalman filtering. However, the methodology should be improved in order to reduce the duration of the whole process.

Kinematic analysis of the shot-put: A method of assessing the mechanical work of the hand action force.

The aims of this study were to (1) propose a method for evaluating shot-putters mechanical power, (2) investigate the relationship between mechanical work of hand action force (WHAF), peak power output (PPO) of different limbs and shot-put performance and (3) show which of these two parameters (WHAF, PPO) were the most appropriate to characterize the explosive abilities of the shot-putter. Twelve junior right-handed shot-putters, practised glide technique shot-put throwers (personal best = 13.57 ± 1.72 m), participated in this study. Arm and leg force-velocity tests were performed to measure PPO. Kinematic analysis was conducted during a shot-putting event in regular conditions to quantify the WHAF at the release moment and shot-put performance. Significant correlations were found between absolute arm and leg PPO with upper and lower muscle volumes (r = .67; p = .03; r = .76; p = .01; r = .74, p = .01; r = .65, p = .04). Positive relationships were recorded between absolute arm and leg PPO and shot-put performance (r = .67, p = .02; r = .81, p = .004, respectively). Shot-put performance was also closely related to the WHAF (r = .93, p = .0001) and release velocity parameter (r = .86, p = .001). The present results confirm that force-velocity test and WHAF constitute useful tools for assessing mechanical power in throwing. The WHAF could be considered as more suitable than force-velocity test.

Simple and efficient thermal calibration for MEMS gyroscopes.

Gyroscopes are now becoming one of the most sold MEMS sensors, given that the many applications that require their use are booming. In the medical field, gyroscopes can be found in Inertial Measurement Units used for the development of clinical tools that are dedicated to human-movement monitoring. However, MEMS gyroscopes are known to suffer from a drift phenomenon, which is mainly due to temperature variations. This drift dramatically affects measurement capability, especially that of cheap MEMs gyroscopes. Calibration is therefore a key factor in achieving accurate measurements. However, traditional calibration procedures are often complex and require costly equipment. This paper therefore proposes an easy protocol for performing a thermal gyroscope calibration. In this protocol, accuracy over the angular velocity is evaluated by referring to an optoelectronic measurement, and is compared with the traditional calibration performed by the manufacturer. The RMSE between the reference angular velocity and that obtained with the proposed calibration was of 0.7°/s, which was slightly smaller than the RMSE of 1.1°/s achieved by the manufacturer's calibration. An analysis of uncertainty propagation shows that offset variability is the major source of error over the computed rate of rotation from the tested sensors, since it accounts for 97% of the error. It can be concluded that the proposed simple calibration method leads to a similar degree of accuracy as that achieved by the manufacturer's procedure.

Influence of slope steepness, foot position and turn phase on plantar pressure distribution during giant slalom alpine ski racing.

The purpose of this study was to investigate the evolution of ground reaction force during alpine skiing turns. Specifically, this study investigated how turn phases and slope steepness affected the whole foot normal GRF pattern while performing giant slalom turns in a race-like setting. Moreover, the outside foot was divided into different plantar regions to see whether those parameters affected the plantar pressure distribution. Eleven skiers performed one giant slalom course at race intensity. Runs were recorded synchronously using a video camera in the frontal plane and pressure insoles under both feet's plantar surface. Turns were divided according to kinematic criteria into four consecutive phases: initiation, steering1, steering2 and completion; both steering phases being separated by the gate passage. Component of the averaged Ground Reaction Force normal to the ski's surface([Formula: see text], /BW), and Pressure Time Integral relative to the entire foot surface (relPTI, %) parameters were calculated for each turn phases based on plantar pressure data. Results indicated that [Formula: see text] under the total foot surface differed significantly depending on the slope (higher in steep sections vs. flat sections), and the turn phase (higher during steering2 vs. three other phases), although such modifications were observable only on the outside foot. Moreover, [Formula: see text] under the outside foot was significantly greater than under the inside foot.RelPTI under different foot regions of the outside foot revealed a global shift from forefoot loading during initiation phase, toward heel loading during steering2 phase, but this was dependent on the slope studied. These results suggest a differentiated role played by each foot in alpine skiing turns: the outside foot has an active role in the turning process, while the inside foot may only play a role in stability.

Unsteady computational fluid dynamics in front crawl swimming.

The development of codes and power calculations currently allows the simulation of increasingly complex flows, especially in the turbulent regime. Swimming research should benefit from these technological advances to try to better understand the dynamic mechanisms involved in swimming. An unsteady Computational Fluid Dynamics (CFD) study is conducted in crawl, in order to analyse the propulsive forces generated by the hand and forearm. The k-ω SST turbulence model and an overset grid method have been used. The main objectives are to analyse the evolution of the hand-forearm propulsive forces and to explain this relative to the arm kinematics parameters. In order to validate our simulation model, the calculated forces and pressures were compared with several other experimental and numerical studies. A good agreement is found between our results and those of other studies. The hand is the segment that generates the most propulsive forces during the aquatic stroke. As the pressure component is the main source of force, the orientation of the hand-forearm in the absolute coordinate system is an important kinematic parameter in the swimming performance. The propulsive forces are biggest when the angles of attack are high. CFD appears as a very valuable tool to better analyze the mechanisms of swimming performance and offers some promising developments, especially for optimizing the performance from a parametric study.

Is levator hiatus distension associated with peripheral ligamentous laxity during pregnancy?

INTRODUCTION AND HYPOTHESIS: The impact of pregnancy on pelvic floor disorders remains poorly understood. During pregnancy, an increase in ligamentous laxity and pelvic organ mobility is often reported. Our main objective was to investigate a possible association between peripheral ligamentous laxity and levator hiatus (LH) distension during pregnancy. METHODS: This was a prospective longitudinal study of 26 pregnant women followed up from the first to the third trimester. We collected the following information: occurrence of pelvic organ prolapse (POP) symptoms (score higher than 0 for the POP section of the Pelvic Floor Distress Inventory 20 questions score), 4D perineal ultrasound scan results with LH distension assessment and measurement of metacarpophalangeal joint mobility (MCP laxity). The association between MCP laxity and LH distension was estimated by mixed multilevel linear regression. The associations between MCP laxity and categorical parameters were estimated in a multivariate analysis using a generalized estimating equation model. RESULTS: MCP laxity and LH distension were correlated with a correlation coefficient of 0.26 (p = 0.02), and 6.8% of the LH distension variance was explained by MCP laxity. In the multivariate analysis, MCP laxity was associated with POP symptoms with an odds ratio at 1.05 (95% CI 1.01-1.11) for an increase of 1° in MCP laxity. CONCLUSION: LH distension and peripheral ligamentous laxity are significantly associated during pregnancy. However, the relationship is weak, and the results need to be confirmed in larger populations and with more specific techniques such as elastography to directly assess the elastic properties of the pelvic floor muscles.

Position for labor and birth: State of knowledge and biomechanical perspectives.

This review aims to examine how childbirth position during labour affects maternal, fetal and neonatal outcomes. Epidemiological data suggest that vertical birthing positions have many benefits. But when we consider the players and mechanisms of delivery, including the forces generated to move the fetus and obstacles to its progression, many questions remain about the advantage of one position over another. Thus, childbirth could be considered in a way as an athletic feat that probably requires the choice of optimal positions. These should be individually suited to each woman at different stage of labour to improve its efficiency and effectiveness. Tweetable abstract: Beyond epidemiological data, biomechanical investigations is necessary to assess birth's position.

Comparison of calibration methods for accelerometers used in human motion analysis.

In the fields of medicine and biomechanics, MEMS accelerometers are increasingly used to perform activity recognition by directly measuring acceleration; to calculate speed and position by numerical integration of the signal; or to estimate the orientation of body parts in combination with gyroscopes. For some of these applications, a highly accurate estimation of the acceleration is required. Many authors suggest improving result accuracy by updating sensor calibration parameters. Yet navigating the vast array of published calibration methods can be confusing. In this context, this paper reviews and evaluates the main measurement models and calibration methods. It also gives useful recommendations for better selection of a calibration process with regard to a specific application, which boils down to a compromise between accuracy, required installation, algorithm complexity, and time.

Influence of saddle setback on pedalling technique effectiveness in cycling.

Besides its regulation by Union Cycliste Internationale, the evidence relating saddle setback to pedalling performance remains inconclusive. This study investigates the influence of saddle setback on pedalling effectiveness through two indexes: an index of pedalling force effectiveness and an index of pedalling work effectiveness. Eleven cyclists were assessed six saddle setback conditions while pedalling at a steady power output of 200 W and cadence of 90 rpm. A force sensor was integrated within the seat post to compute the centre of pressure on the saddle. From instrumented pedals, an index of force effectiveness (ratio between the force directed perpendicular to the crank arm and the total force applied to the pedal) and an index of work effectiveness (based on the minimisation of negative crank work) were calculated. In comparison with a forward position, sitting backward significantly decreased 5% cumulative total work, increased index of work effectiveness (84.2 ± 3.7 vs. 82.0 ± 4.7%), and increased index of force effectiveness (41.7 ± 2.9 vs. 39.9 ± 3.7 and 36.9 ± 0.7%). Thus, while it was previously reported that sitting more forward favours maximal power, this study demonstrates that it also leads to a decreased effectiveness in steady-state pedalling.

Kinematic hand parameters in front crawl at different paces of swimming.

The aim of this study was to investigate the evolution of kinematic hand parameters (sweepback angle, angle of attack, velocity, acceleration and orientation of the hand relative to the absolute coordinate system) throughout an aquatic stroke and to study the possible modifications caused by a variation of the swimming pace. Seventeen competitive swimmers swam at long distance, middle distance and sprint paces. Parameters were calculated from the trajectory of seven markers on the hand measured with an optoelectronic system. Results showed that kinematic hand parameters evolve differently depending on the pace. Angle of attack, sweepback angle, acceleration and orientation of the hand do not vary significantly. The velocity of the hand increases when the pace increases, but only during the less propulsive phases (entry and stretch and downsweep to catch). The more the pace increases and the more the absolute durations of the entry and stretch and downsweep to catch phases decrease. Absolute durations of the insweep and upsweep phases remain constant. During these phases, the propulsive hand forces calculated do not vary significantly when the pace increases. The increase of swimming pace is then explained by the swimmer's capacity to maintain propulsive phases rather than increasing the force generation within each cycle.

The role of the entry-and-stretch phase at the different paces of race in front crawl swimming.

The aim of this study was to determine the role played by the entry-and-stretch phase in the coordination of swimming, at the different paces of race. Three national level swimmers (two men and one woman) were recorded, in lateral and bottom views, in three swimming paces: sprint (50 m and 100 m), middle-distance (200 m and 400 m) and long-distance (800 m and 1500 m). Anatomical landmark positions were obtained by manual digitalisation of the videos. Computational fluid dynamics and experimental studies (with a strain gauge balance and particle image velocimetry method) were used to measure and to calculate the external forces applied to the hand and to the forearm and to visualise the flow around the profile. Entry-and-stretch is the phase which varies the most according to the swimming pace. This phase can be decomposed into two sub-phases: one, the extension forward coordinated with the insweep of the opposite arm, and another one, the rotation downward coordinated with the upsweep. Results show that, at the three paces, this phase is not propulsive and could contribute essentially to maintain the horizontal balance of the body.

Improvement of upper extremity kinematics estimation using a subject-specific forearm model implemented in a kinematic chain.

Human movement reconstruction is still difficult due to noise generated by the use of skin markers. The a priori definition of a kinematic chain associated with a global optimisation method allows reducing these deleterious effects. When dealing with the forearm, this approach can be improved by personalising the two axes of rotation because their common modelling is not representative of joint geometry. The aim of the present study is to evaluate the kinematic effects of personalising these two axes of rotation, determined by a functional method and implemented in a kinematic chain (AXIS model). The AXIS model was compared with a reference model (ISB model), in which the forearm axes of rotation were defined according to the recommendations of the International Society of Biomechanics. The kinematic comparison (15 subjects and 3 tasks) was based on marker residuals (actual versus model-determined), joint kinematic root mean square differences (AXIS versus ISB) and joint amplitudes (AXIS versus ISB). The AXIS model improved the pose of the forearm and hand. The reduction in marker residuals for these segments ranged between 23% and 60%. The use of a functional method was also beneficial in personalising the flexion-extension and pronation-supination axes of the forearm. The contribution of pronation-supination, in terms of joint amplitudes, was increased by 15% during the specific task. The approach developed in this study is all the more interesting since this forearm model could be integrated into a kinematic chain to be used with a global approach becoming increasingly popular in biomechanics.