Gait analysis in patients with idiopathic scoliosis

Introduction: The goal of this study was to observe scoliotic subjects during level walking to identify asymmetries—which may be related to a neurological dysfunction or the spinal deformity itself—and to correlate these to the severity of the scoliotic curve. Methods: We assessed the gait pattern of ten females (median age 14.4) with idiopathic scoliosis characterised by a left-lumbar and a right-thoracic curve component. Gait analysis consisted of 3D kinematic (VICON) and kinetic (Kistler force plates) measurements. The 3D-segment positions of the head, trunk and pelvis, as well as the individual joint angles of the upper and lower extremities, were computed during walking and static standing. Calculation of pertinent kinetic and kinematic parameters allowed statistical comparison. Results: All subjects walked at a normal velocity (median: 1.22m/s; range:1.08-1.30m/s; height-adjusted velocity: 0.75m/s; range: 0.62-0.88m/s). The timing of the individual gait phases was normal and symmetrical for the whole group. Sagittal plane hip, knee and ankle motion followed a physiological pattern. Significant asymmetry was observed in the trunk's rotational behaviour in the transverse plane. During gait, the pelvis and the head rotated symmetrically to the line of progression, whereas trunk rotation was asymmetric, with increased relative forward rotation of the right upper body in relation to the pelvis. This produced a torsional offset to the line of progression. Minimal torsion (at right heel strike) measured: median 1.0° (range: 5.1°-8.3°), and maximal torsion (at left heel strike) measured 11.4° (range 6.9°-17.9°). The magnitude of the torsional offset during gait correlated to the severity of the thoracic deformity and to the standing posture, whereas the range of the rotational movement was not affected by the severity of the deformity. The ground reaction forces revealed a significant asymmetry of [Msz], the free rotational moment around the vertical axis going through the point of equivalent force application. On the right side, the initial endo-rotational moment was lower, followed by a higher exo-rotational moment than on the left. All the other force parameters (vertical, medio-lateral, anterior-posterior), did not show a significant side difference for the whole group. The use of a brace stiffened torsional motion. However the torsional offset and the asymmetry of the free rotational moment remained unchanged. Conclusion: The most significant and marked asymmetry was seen in the transverse plane, denoted as a torsional offset of the upper trunk in relation to the symmetrically rotating pelvis. This motion pattern was reflected by a ground-reaction-force asymmetry of the free rotational moment. Further studies are needed to investigate whether this behaviour is solely an expression of the structural deformity or whether it could enhance the progression of the torsional deformit

COMPARISON OF ANGLES AND THE CORRESPONDING MOMENTS IN KNEE AND HIP DURING RESTRICTED AND UNRESTRICTED SQUATS

The aim of this study is the comparison of angles and the corresponding moments in knee and hip during squatting. The five subjects performed restricted and unrestricted squats. The experimental set-up consisted of a motion capture system and two force plates. The loading conditions were 0, ¼ and ½ BW. The moments and the force were calculated using inverse dynamics. Overall, the maximal moments were observed in the knee during unrestricted squats and in the hip during restricted squats. Comparing the moments at a knee angle of 60º, the loading conditions have a larger influence than the type of execution. The moment in the knee is 10.4%, respectively 11.2% lower with ¼ and ½ body weight during restricted squats. In the hip, the moment is 15.5 %, respectively 14 % higher for the same conditions. The angle of the hip remains rather constant. This most likely implies a higher load to the lower back. Hence, the exercise instruction should be adapted to the aims and the training condition of the athlete

Effects of Foot Orthoses on Skeletal Motion During Running

Objective. To quantify the effects of medial foot orthoses on skeletal movements of the calcaneus and tibia during the stance phase in running. Design. Kinematic effects of medial foot orthoses (anterior, posterior, no support) were tested using skeletal (and shoe) markers at the calcaneus and tibia. Background. Previous studies using shoe and skin markers concluded that medially placed orthoses control/reduce foot eversion and tibial rotation. However, it is currently unknown if such orthoses also affect skeletal motion at the lower extremities. Methods. Intracortical Hofman pins with reflective marker triads were inserted under standard local anesthetic into the calcaneus and tibia of five healthy male subjects. The three-dimensional tibiocalcaneal rotations were determined using a joint coordinate system approach. Eversion (skeletal and shoe) and tibial rotation were calculated to study the foot orthoses effects. Results. Orthotic effects on eversion and tibial rotations were found to be small and unsystematic over all subjects. Differences between the subjects were significantly larger (pp\u3c0.05). Conclusions. This in vivo study showed that medially placed foot orthoses did not change tibiocalcaneal movement patterns substantially during the stance phase of running. Relevance Orthoses may have only small kinematic effects on the calcaneus and tibia (measured with bone pins) as well as on the shoes (measured with shoe markers) during running of normal subjects. Present results showed that orthotic effects were subject specific and unsystematic across conditions. It is speculated that orthotic effects during the stance phase of running may be mechanical as well as proprioceptive

Biomechanical testing of a polymer-based biomaterial for the restoration of spinal stability after nucleotomy

<p>Abstract</p> <p>Background</p> <p>Surgery for disc herniations can be complicated by two major problems: painful degeneration of the spinal segment and re-herniation. Therefore, we examined an absorbable poly-glycolic acid (PGA) biomaterial, which was lyophilized with hyaluronic acid (HA), for its utility to (a) re-establish spinal stability and to (b) seal annulus fibrosus defects. The biomechanical properties range of motion (ROM), neutral zone (NZ) and a potential annulus sealing capacity were investigated.</p> <p>Methods</p> <p>Seven bovine, lumbar spinal units were tested in vitro for ROM and NZ in three consecutive stages: (a) intact, (b) following nucleotomy and (c) after insertion of a PGA/HA nucleus-implant. For biomechanical testing, spinal units were mounted on a loading-simulator for spines. In three cycles, axial loading was applied in an excentric mode with 0.5 Nm steps until an applied moment of ± 7.5 Nm was achieved in flexion/extension. ROM and NZ were assessed. These tests were performed without and with annulus sealing by sewing a PGA/HA annulus-implant into the annulus defect.</p> <p>Results</p> <p>Spinal stability was significantly impaired after nucleotomy (p < 0.001). Intradiscal implantation of a PGA-HA nucleus-implant, however, restored spinal stability (p < 0.003). There was no statistical difference between the stability provided by the nucleus-implant and the intact stage regarding flexion/extension movements (p = 0.209). During the testing sequences, herniation of biomaterial through the annulus defect into the spinal canal regularly occurred, resulting in compression of neural elements. Sewing a PGA/HA annulus-implant into the annulus defect, however, effectively prevented herniation.</p> <p>Conclusion</p> <p>PGA/HA biomaterial seems to be well suited for cell-free and cell-based regenerative treatment strategies in spinal surgery. Its abilities to restore spinal stability and potentially close annulus defects open up new vistas for regenerative approaches to treat intervertebral disc degeneration and for preventing implant herniation.</p

Non-linear analysis of two-layer timber beams considering interlayer slip and uplift

A new mathematical model and its finite element formulation for the non-linear analysis of mechanical behaviour of a two-layer timber planar beam is presented. A modified principle of virtual work is employed in formulating the finite element method. The basic unknowns are strains. The following assumptions are adopted in the mathematical model: materials are taken to be non-linear and can differ from layer to layer; interacting shear and normal contact tractions between layers are derived from the non-linear shear contact traction-slip and the non-linear normal contact traction-uplift characteristics of the connectors; the geometrically linear and materially non-linear Bernoulli's beam theory is assumed for each layer. The formulation is found to be accurate, reliable and computationally effective. The suitability of the theory is validated by the comparison of the numerical solution and the experimental results of full-scale laboratory tests on a simply supported beam. An excellent agreement between measured and calculated results is observed for all load levels. The further objective of the paper is the analysis of the effect of different normal contact traction-uplift constitutive relationships on the kinematic and static quantities in a statically determined and undetermined structure. While the shear contact traction-slip constitutive relationship dictates the deformability of the composite beam and has a substantial influence on most of the static and kinematic quantities of the composite beam, a variable normal contact traction-uplift constitutive relationship is in most cases negligible

How well can skin marker analysis detect the kinematics of a total ankle arthroplasty? - a comparison to videofluoroscopy

ISSN:1757-114

Recombinant C1 inhibitor in the prevention of severe COVID-19: a randomized, open-label, multi-center phase IIa trial.

BACKGROUND Conestat alfa (ConA), a recombinant human C1 inhibitor, may prevent thromboinflammation. METHODS We conducted a randomized, open-label, multi-national clinical trial in which hospitalized adults at risk for progression to severe COVID-19 were assigned in a 2:1 ratio to receive either 3 days of ConA plus standard of care (SOC) or SOC alone. Primary and secondary endpoints were day 7 disease severity on the WHO Ordinal Scale, time to clinical improvement within 14 days, and safety, respectively. RESULTS The trial was prematurely terminated because of futility after randomization of 84 patients, 56 in the ConA and 28 in the control arm. At baseline, higher WHO Ordinal Scale scores were more frequently observed in the ConA than in the control arm. On day 7, no relevant differences in the primary outcome were noted between the two arms (p = 0.11). The median time to defervescence was 3 days, and the median time to clinical improvement was 7 days in both arms (p = 0.22 and 0.56, respectively). Activation of plasma cascades and endothelial cells over time was similar in both groups. The incidence of adverse events (AEs) was higher in the intervention arm (any AE, 30% with ConA vs. 19% with SOC alone; serious AE, 27% vs. 15%; death, 11% vs. 0%). None of these were judged as being related to the study drug. CONCLUSION The study results do not support the use of ConA to prevent COVID-19 progression. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov, identifier NCT04414631

Veränderte Aktivierung der Vasti während dem Laufen als Merkmal des PFPS

Current literature discusses whether an earlier activation of the Vastus lateralis (VL) compared to the Vastus edialis obliquus (VMO) calculated relative to the heelstrike during running can be associated with the Patellofemoral Pain Syndrome (PFPS). The present study investigated the onset of the activity of both Vasti for a healthy control group (n = 12) and subjects suffering from PFPS (n = 14) during barefoot, shod running, and running with insoles (if available). Based on repeated measurements of the healthy subjects it was estimated that time differences between individual onsets of muscle activation and the later activation of the VMO related to the VL should be at least 25–30 ms to exclude to a high probability an interpretation biased by the given variance of the measurement performed with surface electrodes. The present results show that time differences of the onset of the activity of the Vasti between the two investigated groups were all between 5 and 10 ms on average, not significant, and not clearly distinguishable from the given variance of the measurement. Furthermore, using insoles did not result in a more simultaneous activation of the Vasti before heelstrike. Thus, an earlier activation of the VL compared to the VMO can not be considered as a single characteristic of patellofemoral pain. However, future work should investigate whether the muscular coordination of the Vasti in combination with the kinematics and kinetics of the lower extremity can biomechanically explain the occurrence of individual patellofemoral pain