Lower functioning patients demonstrate atypical hip joint loading before and following total hip arthroplasty for osteoarthritis

Previous studies have established that up to 1 year post total hip arthroplasty (THA), patients do not recover normal function and the magnitude of hip joint loading remains reduced compared to healthy individuals. However, the temporal nature of the loading profile has not been considered to identify individuals who are at a greater risk of poor functional outcomes following THA. This study aimed to determine changes to the profile and magnitude of the resultant hip joint reaction force before and up to 6 months post-primary THA, and factors associated with atypical loading profiles. Hip joint loading was computed using a personalized lower-limb musculoskeletal model in 43 participants awaiting primary THA for osteoarthritis (mean age: SD = 65, 14 years; body mass index: SD = 30, 5 kg/m²) before and up to 6 months after THA. Atypical, single-peak loading profiles were observed for 11 patients before surgery, where four showed a single peak at 6 months. Patients displaying a single-peak profile walked slower (mean difference: −0.4 m/s) compared to individuals displaying double-peak profile (P = <.001) and had significantly reduced sagittal plane hip range of motion during gait (mean difference −9.6°, P = <.001). Self-reported pain, function, and stiffness did not differentiate between patients with a single or double-peak loading profile. Individuals with a single-peak force profile did not meet the minimal clinically important hip range of motion during gait and would be classified as low-functioning THA patients. Clinical Relevance: The temporal nature of the force profile may help to identify individuals who are at the greatest risk of poor functional outcomes after THA.     

Number of Segments Within Musculoskeletal Foot Models Influences Ankle Kinematics and Strains of Ligaments and Muscles

Multi‐segment foot models (MFMs) are becoming a common tool in musculoskeletal research on the ankle‐foot complex. The purpose of this study was to compare ankle joint kinematics as well as ligament and muscle strains that result from MFM with a different number of segments during vertical hopping. Ten participants were recruited and performed double‐limb vertical hops. Marker positions and ground reaction forces were collected. Two‐segment (2MFM), three‐segment (3MFM), and five‐segment MFM (5MFM) were used to calculate ankle kinematics and the strains of the anterior talofibular and calcaneofibular ligaments and of the soleus and gastrocnemius muscles. Ranges of motion and peak strains were analyzed with Kruskal–Wallis and post hoc tests, whereas the time‐series of the ankle kinematics and ligament and muscle strains were analyzed with statistical parametric mapping. There were significant main effects for MFM in the talocrural joint range of motion and peak strains of ligaments and muscles. In addition, there were significant main effects for MFM in time‐series data of the talocrural joint angle as well as for ligament and muscle strains. In all cases, the post hoc analyses showed that the 2MFM consistently overestimated the range of motion and tissue strains compared to the 3MFM and 5MFM, while 3MFM and 5MFM did not differ from each other in the most variables. This study showed that the number of segments in MFM significantly affects the biomechanical estimates of joint kinematics and tissue strains during hopping. Clinical significance: MFM that combine all foot structures beyond the talus into one segment likely overestimate ankle joint biomechanics. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2231–2240, 2019     

Design and Evaluation of a Simulation for Pediatric Dentistry in Virtual Worlds

Background

Three-dimensional virtual worlds are becoming very popular among educators in the medical field. Virtual clinics and patients are already used for case study and role play in both undergraduate and continuing education levels. Dental education can also take advantage of the virtual world’s pedagogical features in order to give students the opportunity to interact with virtual patients (VPs) and practice in treatment planning.

Objective

The objective of this study was to design and evaluate a virtual patient as a supplemental teaching tool for pediatric dentistry.

Methods

A child VP, called Erietta, was created by utilizing the programming and building tools that online virtual worlds offer. The case is about an eight-year old girl visiting the dentist with her mother for the first time. Communication techniques such as Tell-Show-Do and parents’ interference management were the basic elements of the educational scenario on which the VP was based. An evaluation of the simulation was made by 103 dental students in their fourth year of study. Two groups were formed: an experimental group which was exposed to the simulation (n=52) and a control group which did not receive the simulation (n=51). At the end, both groups were asked to complete a knowledge questionnaire and the results were compared.

Results

A statistically significant difference between the two groups was found by applying a t test for independent samples (P<.001), showing a positive learning effect from the VP. The majority of the participants evaluated the aspects of the simulation very positively while 69% (36/52) of the simulation group expressed their preference for using this module as an additional teaching tool.

Conclusions

This study demonstrated that a pediatric dentistry VP built in a virtual world offers significant learning potential when used as a supplement to the traditional teaching techniques.     

The effect of mono- versus multi-segment musculoskeletal models of the foot on simulated triceps surae lengths in pathological and healthy gait

BackgroundEstimating muscle-tendon complex (MTC) lengths is important for planning of soft tissue surgery and evaluating outcomes, e.g. in children with cerebral palsy (CP). Conventional musculoskeletal models often represent the foot as one rigid segment, called a mono-segment foot model (mono-SFM). However, a multi-segment foot model (multi-SFM) might provide better estimates of triceps surae MTC lengths, especially in patients with foot deformities.Research questionWhat is the effect of a mono- versus a multi-SFM on simulated ankle angles and triceps surae MTC lengths during gait in typically developing subjects and in children with CP with equinus, cavovarus or planovalgus foot deformities?Methods50 subjects were included, 10 non-affected adults, 10 typically developing children, and 30 children with spastic CP and foot deformities. During walking trials, marker trajectories were collected for two marker models, including a mono- and multi-segment foot; respectively Newington gait model and Oxford foot model. Two musculoskeletal lower body models were constructed in OpenSim with either a mono- or multi-SFM based on the corresponding marker models. Normalized triceps surae MTC lengths (soleus, gastrocnemius medialis and lateralis) and ankle angles were calculated and compared between models using statistical parametric mapping RM-ANOVAs. Root mean square error values between simulated MTC lengths were compared using Wilcoxon signed-rank and rank-sum tests.ResultsMono-SFM simulated significantly more ankle dorsiflexion (7.5 ± 1.2°) and longer triceps surae lengths (difference; soleus:2.6 ± 0.29 %, gastrocnemius medialis:1.7 ± 0.2 %, gastrocnemius lateralis:1.8 ± 0.2%) than a multi-SFM. Differences between models were larger in children with CP compared to typically developing children and larger in the stance compared to the swing phase of gait. Largest differences were found in children with CP presenting with planovalgus (4.8 %) or cavovarus (3.8 %) foot deformities.SignificanceIt is advisable to use a multi-SFM in musculoskeletal models when simulating triceps surae MTC lengths, especially in individuals with planovalgus or cavovarus foot deformities.     

Acute Vibration Feedback During Gait Reduces Mechanical Ankle Joint Loading in Chronic Ankle Instability Patients

BackgroundIndividuals with chronic ankle instability (CAI) exhibit altered vertical ground reaction forces (vGRF), a laterally shifted center of pressure, and an inverted foot position during walking. These neuromechanical alterations are linked with altered ankle joint loading in this population. Vibration-based gait retraining improves center of pressure positioning but effects on neuromechanical variables influencing joint loading remains unknown.Research QuestionDo patients with CAI exhibit altered vGRF and ankle joint contact forces (JCF) after receiving a single session of vibration-based gait retraining?MethodsTen individuals with CAI underwent a single session of vibration-based gait retraining. Kinematic and kinetic data were collected during walking on an instrumental treadmill with force plates embedded in it. Following a baseline gait assessment without feedback, participants walked at a self-selected speed for 10 minutes while receiving feedback. Data was collected during an early (1 st and 2 nd minute) and late adaptation phase (9 th and 10 th minute) and, compared to baseline values. Impact and propulsive vGRF variables (i.e. peak, time to peak, and loading rate) were obtained. Musculoskeletal modeling was used to calculate ankle JCF variables (peak, impulse, and loading rate) during stance phase.ResultsPropulsive vGRF and ankle JCF outcomes were significantly reduced during the early and late adaptation phases (p ≤ 0.039).SignificanceThese results indicate that vibration-based gait retraining can immediately reduce propulsive vGRF and ankle JCF and may represent a modality that could help restore appropriate ankle joint loading patterns in those with CAI.     

The different role of each head of the triceps brachii muscle in elbow extension

Objective

The aim of this study was to investigate the functional role of each head of the triceps brachii muscle, depending on the angle of shoulder elevation, and to compare each muscle force and activity by using a virtual biomechanical simulator and surface electromyography.

基于软件OpenSim的人体运动建模理论及其应用领域概述

红外捕捉系统、高速摄像、平面摄影、表面肌电测试等现行实验室测试手段不能显示人体运动时肌肉产生肌力的具体信息以及准确阐释神经-肌肉协调机制。因此,计算机模拟与仿真应运而生。目前,国内用来进行人体动作仿真的软件主要有Life MOD、Any Body、ANSYS等,这些软件有其自身的缺陷,如肌肉控制不够精确、价钱昂贵等。为了更好解决肌肉模拟问题,斯坦福大学团队研发了一款免费软件Open Sim,它是基于C++和JAVA语言开发的一款应用于肌肉模型开发、模拟仿真与分析神经肌肉系统的开放性软件。以计算机建模与数学理论推导为基础,对Open Sim建模理论和步骤进行详细介绍,为国内从事运动生物力学研究学者提供一些理论参考;同时,探讨未来利用Open Sim建模仿真研究的主要方向,例如通过Open Sim的模拟研究可以探求偏瘫步态、帕金森步态等异常步态的神经-肌肉机制,为异常步态康复手段的改进和完善提供依据。     

The importance of a consistent workflow to estimate muscle-tendon lengths based on joint angles from the conventional gait model

BackgroundMusculoskeletal models enable us to estimate muscle-tendon length, which has been shown to improve clinical decision-making and outcomes in children with cerebral palsy. Most clinical gait analysis services, however, do not include muscle-tendon length estimation in their clinical routine. This is due, in part, to a lack of knowledge and trust in the musculoskeletal models, and to the complexity involved in the workflow to obtain the muscle-tendon length.Research questionCan the joint angles obtained with the conventional gait model (CGM) be used to generate accurate muscle-tendon length estimates?MethodsThree-dimensional motion capture data of 15 children with cerebral palsy and 15 typically developing children were retrospectively analyzed and used to estimate muscle-tendon length with the following four modelling frameworks: (1) 2392-OSM-IK-angles: standard OpenSim workflow including scaling, inverse kinematics and muscle analysis; (2) 2392-OSM-CGM-angle: generic 2392-OpenSim model driven with joint angles from the CGM; (3) modif-OSM-IK-angles: standard OpenSim workflow including inverse kinematics and a modified model with segment coordinate systems and joint degrees-of-freedom similar to the CGM; (4) modif-OSM-CGM-angles: modified model driven with joint angles from the CGM. Joint kinematics and muscle-tendon length were compared between the different modelling frameworks.ResultsLarge differences in hip joint kinematics were observed between the CGM and the 2392-OpenSim model. The modif-OSM showed similar kinematics as the CGM. Muscle-tendon length obtained with modif-OSM-IK-angles and modif-OSM-CGM-angles were similar, whereas large differences in some muscle-tendon length were observed between 2392-OSM-IK-angles and 2392-OSM-CGM-angles.SignificanceThe modif-OSM-CGM-angles framework enabled us to estimate muscle-tendon lengths without the need for scaling a musculoskeletal model and running inverse kinematics. Hence, muscle-tendon length estimates can be obtained simply, without the need for the complexity, knowledge and time required for musculoskeletal modeling and associated software. An instruction showing how the framework can be used in a clinical setting is provided on https://github.com/HansUniVie/MuscleLength.     

基于影像学构建个体化OpenSim下肢肌骨模型的生物力学研究应用进展

由于OpenSim肌骨系统模拟平台开源性,近年来快速发展且被大量研究使用。个体化OpenSim肌骨模型可计算基础的运动学与动力学数据,揭示神经肌肉控制、肌肉力量和几何学变化及关节接触力等信息;结合影像学建模分析病理步态的神经肌肉控制及辅具的人机工效学评估等研究均表明其应用的可靠性与可行性,但存在耗时及足踝关节模拟的局限性。构建个体化病理肌骨模型,能提升临床生物力学及医学工程学研究的精准性和多样性,揭示不同病理特点,并为制定精准的诊断与康复方案、健康监测与评估状况及外部装置的工效学定制与测评提供科学依据,以及为未来该领域研究提供启示与方向。     

A comparison of slow,uphill and fast,level walking on lower extremity biomechanics and tibiofemoral joint loading in obese and nonobese adults

We determined if slow, uphill walking (0.75 m/s, 6°) reduced tibiofemoral (TF) loading compared to faster, level walking (1.50 m/s) in obese and nonobese adults. We collected kinematic, kinetic, and electromyographic data as 9 moderately obese and 10 nonobese participants walked on a dual‐belt instrumented treadmill. We used OpenSim to scale a musculoskeletal model and calculate joint kinematics, kinetics, muscle forces, and TF forces. Compressive TF forces were greater in the obese adults during both speed/grade combinations. During level walking, obese participants walked with a straighter leg than nonobese participants, resulting in early stance vasti muscle forces that were similar in the obese and nonobese participants. Early stance peak compressive TF forces were reduced by 23% in obese (2,352 to 1,811 N) and 35% in nonobese (1,994 to 1,303 N) individuals during slow, uphill walking compared to brisk level walking. Late stance peak TF forces were similar across speeds/grades, but were greater in obese (～2,900 N) compared to nonobese (～1,700 N) individuals. Smaller early stance TF loads and loading rates suggest that slow, uphill walking may be appropriate exercise for obese individuals at risk for musculoskeletal pathology or pain. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:324–330, 2014.