Quantifying Asymmetry in Gait: The Weighted Universal Symmetry Index to Evaluate 3D Ground Reaction Forces

Though gait asymmetry is used as a metric of functional recovery in clinical rehabilitation, there is no consensus on an ideal method for its evaluation. Various methods have been proposed to analyze single bilateral signals but are limited in scope, as they can often use only positive signals or discrete values extracted from time-scale data as input. By defining five symmetry axioms, a framework for benchmarking existing methods was established and a new method was described here for the first time: the weighted universal symmetry index (wUSI), which overcomes limitations of other methods. Both existing methods and the wUSI were mathematically compared to each other and in respect to their ability to fulfill the proposed symmetry axioms. Eligible methods that fulfilled these axioms were then applied using both discrete and continuous approaches to ground reaction force (GRF) data collected from healthy gait, both with and without artificially induced asymmetry using a single instrumented elbow crutch. The wUSI with a continuous approach was the only symmetry method capable of identifying GRF asymmetry differences in different walking conditions in all three planes of motion. When used with a continuous approach, the wUSI method was able to detect asymmetries while avoiding artificial inflation, a common problem reported in other methods. In conclusion, the wUSI is proposed as a universal method to quantify three-dimensional GRF asymmetries, which may also be expanded to other biomechanical signals

A survey of formal methods for determining functional joint axes

Axes of rotation e.g. at the knee, are often generated from clinical gait analysis data to be used in the assessment of kinematic abnormalities, the diagnosis of disease, or the ongoing monitoring of a patient's condition. They are additionally used in musculoskeletal models to aid in the description of joint and segment kinematics for patient specific analyses. Currently available methods to describe joint axes from segment marker positions share the problem that when one segment is transformed into the coordinate system of another, artefacts associated with motion of the markers relative to the bone can become magnified. In an attempt to address this problem, a symmetrical axis of rotation approach (SARA) is presented here to determine a unique axis of rotation that can consider the movement of two dynamic body segments simultaneously, and then compared its performance in a survey against a number of previously proposed techniques. Using a generated virtual joint, with superimposed marker error conditions to represent skin movement artefacts, fitting methods (geometric axis fit, cylinder axis fit, algebraic axis fit) and transformation techniques (axis transformation technique, mean helical axis, Schwartz approach) were classified and compared with the SARA. Nearly all approaches were able to estimate the axis of rotation to within an RMS error of 0.1 cm at large ranges of motion (90°). Although the geometric axis fit produced the least RMS error of approximately 1.2 cm at lower ranges of motion (5°) with a stationary axis, the SARA and Axis Transformation Technique outperformed all other approaches under the most demanding marker artefact conditions for all ranges of motion. The cylinder and algebraic axis fit approaches were unable to compute competitive AoR estimates. Whilst these initial results using the SARA are promising and are fast enough to be determined “on-line”, the technique must now be proven in a clinical environment

Muskuloskeletale belastungen im schafshinterlauf: mechanische rahmenbedingungen der heilung

Although the sheep is a standard model for the analysis of biological healing processes after surgical intervention at the knee and shank, the in vivo tibio-femoral joint contact forces and the resulting musculoskeletal loading conditions have yet to be studied in detail.The three-dimensional kinematics of three Merino-mix sheep right hind limbs were recorded using reflective markers that were attached to Schanz’ screws, firmly anchored in the bone. This motion data was used together with the simultaneously measured external loading (ground reaction forces) to calculate the muscle and joint contact forces, as well as the internal loads within the bones. Whilst the motion mainly occurred in the sagittal plane, significant out of plane motion was observed, especially at the hip and knee joint (ab/adduction hip: 13°, knee: 10°; internal/external rotation hip: 12°, knee: 14°). The axial component of the tibio-femoral contact force was 2.1 times body weight (BW). The medio-lateral and anterior-posterior shear forces amounted to only 0.7 times BW. The loading in the diaphysis of the tibia under physiological musculoskeletal conditions was mainly axial compression (0.89 BW) together with only small shear forces (0.15 BW). The results of the musculoskeletal analyses presented here add to the understanding of the mechanical loading conditions in sheep. This expanded knowledge aids in the interpretatio

On the influence of soft tissue coverage in the determination of bone kinematics using skin markers

Accurate measurement of underlying bone positions is important for the understanding of normal movement and function, as well as for addressing clinical musculoskeletal or post-injury problems. Non-invasive measurement techniques are limited by the analysis technique and movement of peripheral soft tissues that can introduce significant measurement errors in reproducing the kinematics of the underlying bones when using external skin markers. Reflective markers, skeletally mounted to the right hind limb of three Merino-mix sheep were measured simultaneously with markers attached to the skin of each segment, during repetitions of gait trials. The movement of the skin markers relative to the underlying bone positions was then assessed using the Point Cluster Technique (PCT), raw averaging and the Optimal Common Shape Technique (OCST), a new approach presented in this manuscript. Errors in the position of the proximal joint centre, predicted from the corresponding skin markers, were shown to be phasic and strongly associated with the amount soft tissue coverage, averaging 8.5 mm for the femur, 2.8 for the tibia and 2.0 for the metatarsus. Although the results show a better prediction of bone kinematics associated with the Optimal Common Shape Technique, these errors were large for all three assessment techniques and much greater than the differences between the various techniques. Whilst individual markers moved up to 4 mm from the optimal marker set configuration, average peak errors of up to 16, 5 and 3 mm (hip, knee and metatarso-phalangeal joints respectively) were observed, suggesting that a large amount of kinematic noise is produced from the synchronous shifting of marker sets as a result of underlying muscle firing and the inertial effects of heel impact. Current techniques are therefore limited in their ability to determine the kinematics of underlying bones based on skin markers, particularly in segments with more pronounced soft tissue coverage

The medial-lateral force distribution in the ovine stifle joint during walking

Knowledge of the load distribution in the knee is essential for understanding the interaction between mechanics and biology in both the healthy and diseased joint. While the sheep stifle joint is a predominant model for better understanding regeneration after injury, little is known about the compartmental force distribution between the medial and lateral condyles. By including sheep specific anatomy and gait analyses, we used computational musculoskeletal analyses to estimate the medial–lateral joint contact force distribution in ovine stifle joints during walking by simplifying the system of equations into a 2D problem that was solved directly. Gait analysis was conducted using bone markers in three female Merino-mix sheep. Joint contact forces were computed with respect to the specific anatomy of the ovine tibia, resulting in low (<0.13 bodyweight) mean anteroposterior shear forces throughout the gait cycle, with mean peak contact forces perpendicular to the tibial plateau of 2.2 times bodyweight. The medial–lateral compartmental load distribution across the tibial condyles was determined and revealed loading predominantly on the medial condyle, bearing approximately 75% of the total load during phases of peak loading. By considering the anatomical characteristics of the ovine stifle joint, together with the dynamic forces during gait, this study provides evidence for predominantly medial loading in sheep, somewhat similar to the distribution reported in man. However, the exact conditions under which the loading in the ovine stifle joint is representative of the human situation will need to be elucidated in further studie

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A survey of formal methods for determining the centre o

Anterior cruciate ligament-deficient patients with passive knee joint laxity have a decreased range of anterior-posterior motion during active movements

The reduced range of active tibiofemoral translation suggests overloading of the passive structures in passively lax knees, either through excessive muscular action or joint subluxation, and could provide a plausible mechanism for explaining posttraumatic degeneration of cartilage in the join