Acquisition of Lower-Limb Motion Characteristics with a Single Inertial Measurement Unit-Validation for Use in Physiotherapy.

In physiotherapy, there is still a lack of practical measurement options to track the progress of therapy or rehabilitation following injuries to the lower limbs objectively and reproducibly yet simply and with minimal effort and time. We aim at filling this gap with the design of an IMU (inertial measurement unit) system with only one sensor placed on the tibia edge. In our study, the IMU system evaluated a set of 10 motion tests by a score value for each test and stored them in a database for a more reliable longitudinal assessment of the progress. The sensor analyzed the different motion patterns and obtained characteristic physiological parameters, such as angle ranges, and spatial and angular displacements, such as knee valgus under load. The scores represent the patient's coordination, stability, strength and speed. To validate the IMU system, these scores were compared to corresponding values from a simultaneously recorded marker-based 3D video motion analysis of the measurements from five healthy volunteers. Score differences between the two systems were almost always within 1-3 degrees for angle measurements. Timing-related measurements were nearly completely identical. The tests on the valgus stability of the knee showed equally small deviations but should nevertheless be repeated with patients, because the healthy subjects showed no signs of instability.

Evaluating the Effect of Shoes with Varying Mass on Vertical Ground Reaction Force Parameters in Short-Term Running.

Past investigations have revealed that running shoes affect ground reaction force parameters. However, these studies are unclear as to whether these changes, which occur while running in different shoe types of differing masses, are the result of the structural design or the mass of the shoe. The main aim of this study is to evaluate the effect of shoe mass on vertical ground reaction force parameters: active peak and impulse. Methods. 21 male runners (24.52 years old (± 3.09) and 77.13kg (± 7.9)) participated in the experiment. A baseline shoe (BS) = 283g and four weighted shoes (shoe 2 = 333g, shoe 3 = 433g, shoe 4 = 533g and shoe 5 = 598g) were compared for 8 minutes of running on the instrumented treadmill. Each shoe was compared in a repeated measurement with the BS. Results showed that active peaks and impulses differed significantly (p < .05) between the BS and weighted shoes, except for shoe 2. From the threshold of 433g (shoe 3, which is 1.5 times heavier than the BS), we observed a significant increase in the vertical ground reaction force peak (1.86%) and impulse (1.84%). Other shoes such as shoe 4 and shoe 5, produced increasingly active peaks (N) of 2.08% N and 2.45% N compared to the BS. Increase of shoe masses in shoe 3, shoe 4, and shoe 5 resulted in an increase of impulse up to 1.84% Nm, 1.85% Nm and 2.49% Nm compared to the BS. Our determination of the shoe masses influencing these kinetic parameters may be a step towards reducing running-related injuries that result from accumulated microtrauma.

Development of congenital clubfoot during growth: a long-term study on the basis of pedobarography, biomechanics, and magnetic resonance imaging measurements of muscle volumes.

The aim of this study was to clarify the degree to which the operated congenital asymptomatic clubfoot still shows malpositions or whether it approaches a physiological development with increasing age. Clubfeet of 12 children were examined repeatedly over up to 10 years using pedobarography. The muscle volumes of the lower legs were investigated with MRI and compared with those of a healthy control group. Although some characteristics of clubfoot remained in the plantar pressure distribution, a gradual decrease in the heel and metatarsus load accompanied by an increase in the forefoot load could be registered as is typical for a developing healthy child's foot. The MRI showed a reduced volume of all muscles of the affected lower leg. A correlation was detected between the measured moments in the upper and lower ankle joints and the volumes of the muscles that move these joints. Even though a functional and anatomical separation between the two groups existed, the general developmental changes during growth were similar. The combination of pedobarographic data and derived joint moments with MRI-measured muscle volumes indicated that higher ankle joint moments in clubfoot were associated with smaller muscle volume and were therefore generated by higher joint rigidity.

MRT-measurements of muscle volumes of the lower extremities of youths with spastic hemiplegia caused by cerebral palsy.

After long term of studies from our gait lab, the typical muscular dysbalances by all of our patients with cerebral palsy where pointed out. Now we wanted to examine using the MRT, weather the dysbalances of the hemiparetic musculoskeletal system also show up in discrepancies of the muscle volumes. The MRT slices of the lower extremities were segmented. From this cross sections the muscles volumes were derived. These where analyzed particularly with regard to asymmetries between spastic and healthy side. Hemiparetic patients showed reduced volumes of all muscles on the paretic leg in comparison to the healthy side. The muscles of the thigh of the paretic leg were reduced to 84% in the mean over all muscles and in comparison to the healthy leg. The volume of the muscles of the shank was reduced to 72%, significantly more than the muscles of the thigh. Concerning flexor and extensor muscles located at thigh and shank of the paretic leg there was found significantly the same relative deficit of the muscle volume. Examining the muscle volumes of subjects with different neurogene foot deformities, significant differences of the volume reduction of single muscles appeared within the lower leg.

Piano training in youths with hand motor impairments after damage to the developing brain.

Damage to the developing brain may lead to impairment of the hand motor function and negatively impact on patients' quality of life. Development of manual dexterity and finger and hand motor function may be promoted by learning to play the piano. The latter brings together music with the intensive training of hand coordination and fine finger mobility. We investigated if learning to play the piano helped to improve hand motor skills in 18 youths with hand motor disorders resulting from damage during early brain development. Participants trained 35-40 minutes twice a week for 18 months with a professional piano teacher. With the use of a Musical Instrument Digital Interface piano, the uniformity of finger strokes could be objectively assessed from the timing of keystrokes. The analysis showed a significant improvement in the uniformity of keystrokes during the training. Furthermore, the youths showed strong motivation and engagement during the study. This is nevertheless an open study, and further studies remain needed to exclude effects of growth and concomitant therapies on the improvements observed and clarify which patients will more likely benefit from learning to play the piano.

Influence of orthopaedic-technical aid on the kinematics and kinetics of the knee joint of patients with neuro-orthopaedic diseases.

In our gait laboratory, the gait pattern of 18 youths with neurogenic foot deformities as a result of spina bifida or cerebral palsy was examined. The influence of technical orthopaedic devices for the foot and ankle on kinematics and kinetics of the gait and especially of the knee joint were analyzed. Kinematic data were derived from 3D-video analysis, kinetic data from force plates and pressure distribution plates. Muscle activities were measured with eight-channel EMG. The data were examined to see if there were differences when using the technical devices. All patients had already been supported externally with the different devices like orthopaedic shoes, insoles, Nancy Hilton orthoses and orthoses for the lower leg extremity. The devices restricted to the foot and the ankle joint improved the feeling of gait stability of the patients. In this investigation, the different supports had various but little effects on the kinematics and kinetics of the knee joint, depending on the type of orthoses used and the kind of handicap of the youths. Because of the great expenditure, the data obtained in this study were taken from a small number of patients. Therefore, they are individual findings and are of restricted general significance.

Research on the performance of the spastic calf muscle of young adults with cerebral palsy.

BACKGROUND: The aim of this study was to find an objective graduation of pes equinus in infantile cerebral palsy, especially with regard to functional aspects, to allow a differentiated choice of the therapeutic options. Very often raises the question of whether a surgical lengthening of the Achilles tendon may let expect a functional improvement. METHODS: For this documentation 17 patients with pes equinus and a diagnosis of spastic cerebral palsy, primarily of the lower limbs, and hemiplegia were examined first clinically and then by a procedure for calculating the functional kinetic parameters from an in-shoe plantar pressure distribution measurement (novel pedar-X system), which is used in many orthopedic practices and clinics as a standard measuring device. Using additional video motion analysis, the flexion in the ankle joint and the ankle joint torque were determined. From this the physical performance of the spastically shortened calf muscle was calculated. The course of the curves of torque and joint performance allows a functional classification of the pes equinus. RESULTS: Approximately three quarters of all pes equinus demonstrated functional activity of the most part of the normal push-off propulsion power. Even the rigid pes equinus was capable of performing push-off propulsion work, provided it converted energy that was absorbed during the heel-strike phase and released it again during the push-off phase. This suggests that the function of paretic ankle joint is better than its kinematics of motion. CONCLUSIONS: A heel strike with a pes equinus triggers via stretching stimuli in the muscle-ligament structure reflex motor functions, thereby causing the typical spastic gait pattern. This remarkable gait pattern is often evaluated as dysfunctional and as absolutely requiring correction. However, an aspect possibly neglected in this instance is the fact that this gait pattern may be efficient for the patient and may in fact be a suitable means allowing for economic locomotion despite the cerebral control deficits. KEYWORDS: Pes equinus; Cerebral palsy; Pedography; Ankle joint performance.

Complementary limb motion estimation for the control of active knee prostheses.

To restore walking after transfemoral amputation, various actuated exoprostheses have been developed, which control the knee torque actively or via variable damping. In both cases, an important issue is to find the appropriate control that enables user-dominated gait. Recently, we suggested a generic method to deduce intended motion of impaired or amputated limbs from residual human body motion. Based on interjoint coordination in physiological gait, statistical regression is used to estimate missing motion. In a pilot study, this complementary limb motion estimation (CLME) strategy is applied to control an active knee exoprosthesis. A motor-driven prosthetic knee with one degree of freedom has been realized, and one above-knee amputee has used it with CLME. Performed tasks are walking on a treadmill and alternating stair ascent and descent. The subject was able to walk on the treadmill at varying speeds, but needed assistance with the stairs, especially to descend. The promising results with CLME are compared with the subject's performance with her own prosthesis, the C-Leg from Otto Bock.

Correction versus bedding: wheelchair pressure distribution measurements in children with cerebral palsy.

PURPOSE: Most children with cerebral palsy classification Levels IV and V in the Gross Motor Function Classification System (GMFCS) are unable to walk and, therefore, spend almost all day in a sitting position in their wheelchairs. As a result of the spastic muscle contraction, malpositions of joints or a scoliosis develop, which require a decision to be made on whether to correct the posture or simply find the best soft bedding position. METHODS: The distribution of pressure on the seat while sitting in a wheelchair was measured with a pressure distribution measuring mat. The different distribution patterns were analyzed. RESULTS: Pressure distribution measurement allows to find a compromise between posture correction and soft bedding. Additionally, pressure-reducing seats were examined on their effectiveness. We also focused our measurements and data analyses on recognizing the causes for pain. Sometimes, the origin of the problems and pain of children in wheelchairs is not clear. CONCLUSIONS: Using the above-mentioned measuring equipment, the causes of these problems can be detected much more easily than just by clinical examination. The pressure measuring mat can help to optimize the seating position for the spastically handicapped children and adapt technical aids. Examples demonstrate the most frequently occurring problems of these children in their wheelchairs which are typical for neuro-orthopedic diseases.

Noninvasive diagnostic methods for perceptual and motor disabilities in children with cerebral palsy.

The field of neuroorthopedics centers on chronic diseases demanding close clinical monitoring. We shall use several examples to show how the various noninvasive diagnostic instruments can be used to obtain insight into the central nervous system as well as into the musculoskeletal system and its morphology. The choice of the most appropriate method depends on the problem; that is, whether the method is to be applied for clinical use or for basic research. In this report we introduce various technical examination methods that are being used successfully in the fields of pediatrics, orthopedics, and neurology. The major examination instrument in pediatric diagnostics is sonography, which is being used in this report as a research instrument for the biomechanics of the musculoskeletal system, but which also gives insight into neurofunctional sequences. In orthopedics, pedography is used for diagnosing deformities of the feet. In neuroorthopedics for children pedography acts as a functional monitor for apraxia and thus allows, for example, a classification of the degree of neurological malfunctions in the lower extremities. The 3D bodyscan is used to minimize x-raying in patients with neurogenic scoliosis. This report introduces examples of the application of MRI and fMRI for basic research. The biometric measuring methods introduced provide precise data in the areas of diagnostics and monitoring and are highly valuable for further neuroorthopedic basic research. In future we expect the ever-evolving technical measuring methods to enable a deeper understanding of the primary neurological causes of and the implications for patients with cerebral palsy and other neuroorthopedic conditions. This may allow the development of new forms of therapy not necessarily predictable today.