Kinematic strategies in newly walking toddlers stepping over different support surfaces.

In adults, locomotor movements are accommodated to various support surface conditions by means of specific anticipatory locomotor adjustments and changes in the intersegmental coordination. Here we studied the kinematic strategies of toddlers at the onset of independent walking when negotiating various support surface conditions: stepping over an obstacle, walking on an inclined surface, and on a staircase. Generally, toddlers could perform these tasks only when supported by the arm. They exhibited strategies very different from those of the adults. Although adults maintained walking speed roughly constant, toddlers markedly accelerated when walking downhill or downstairs and decelerated when walking uphill or upstairs. Their coordination pattern of thigh-shank-foot elevation angles exhibited greater inter-trial variability than that in adults, but it did not undergo the systematic change as a function of task that was present in adults. Thus the intersegmental covariance plane rotated across tasks in adults, whereas its orientation remained roughly constant in toddlers. In contrast with the adults, the toddlers often tended to place the foot onto the obstacle or across the edges of the stairs. We interpret such foot placements as part of a haptic exploratory repertoire and we argue that the maintenance of a roughly constant planar covariance--irrespective of the surface inclination and height--may be functional to the exploratory behavior. The latter notion is consistent with the hypothesis proposed decades ago by Bernstein that, when humans start to learn a skill, they may restrict the number of degrees of freedom to reduce the size of the search space and simplify the coordination.

A protocol for clinical evaluation of the carrying angle of the elbow by anatomic landmarks.

The aim of this work was to present an in vivo protocol to estimate the carrying angle of the elbow in full extension. Forty-four arms were measured by using an electrogoniometer to acquire 3-dimensional coordinates of the landmarks. An algorithm based on the Cardan decomposition method was used to compute the carrying angle and the flexion and pronation angles of the elbow. The mean carrying angle was 12.42 degrees +/- 4.06 degrees , in agreement with the literature and with values obtained by a standard goniometer (r = 0.46; P = .000). Our protocol provided excellent repeatability (interclass correlation coefficient [ICC] = 0.85), greater than a goniometer (ICC = 0.76), and a standard error of measurement of only 1.62 degrees . Flexion was a significant factor (P = .01) in carrying angle estimation. This study suggests that the carrying angle cannot be estimated independently by the flexion angle, even when measured in apparently full extension, and it could be useful in elbow disorders, such as fractures or epicondylar disease management and evaluation of elbow reconstruction.

Investigation into the detection of marker movement by biplanar RSA.

Roentgen Stereophotogrammetric Analysis (RSA) is the most accurate technique to measure micromotion between rigid bodies and it has been widely used in the orthopedic field to investigate lower limb prostheses. The aim of this paper was to investigate the factors affecting the accuracy of measurements performed on the knee joint by the biplanar RSA system. Errors were assessed by means of a test object. A particular goal was to verify the reliability of the system when the patient cannot stand in the ideal position during the examination, i.e. in the centre of the calibration space. Results showed that detection of micromotion is not correlated to the position of markers inside the calibration space. The influence of different materials able to simulate human tissues, both hard and soft, on the data acquisition phase was also investigated. This additional exam was performed to assess whether the results obtained were similar also under as close as possible conditions to the clinical trials. Different experimental conditions were shown to not affect the acquisition phase of RSA procedure; markers were acquired with equal accuracy independently of tissues examined. Since the acquisition procedure is often performed by different operators, the difference between acquisitions made by different operators was compared. This study confirms the reliability of RSA and its accuracy, also in non-standard clinical setup and acquisition procedures.

Fixation of total knee arthroplasty improved by mobile-bearing design.

We examined the in vivo displacement of mobile-bearing polyethylene and its effect on prosthesis-bone fixation. Thirty-five patients with the Interax ISA mobile platform total knee arthroplasties were examined by roentgen stereophotogrammetric analysis. Our protocol included weightbearing to measure the range of motion of the mobile platform in relation to the tibial component. We also studied the micromotions of the tibial component in relation to the tibia during a 2-year followup. The analysis of micromotion (maximum total motion mean, 0.5 mm; subsidence mean, 0.15 mm) showed this mobile platform design is stable and improves fixation at the prosthesis-bone interface. Longitudinal rotations of the mobile platform occurred in all patients and followed a homogeneous pattern of motion, depending on the examination. However, anteroposterior translations did not show any patterns with specific examination. This suggests the meniscal movement adapts itself to different weightbearing conditions. We measured the in vivo mobile-bearing displacement under static loading conditions. We also observed improved fixation at the bone-prosthesis interface.