Screw-Home Movement of the Tibiofemoral Joint during Normal Gait: Three-Dimensional Analysis

Background

The purpose of this study was to evaluate the screw-home movement at the tibiofemoral joint during normal gait by utilizing the 3-dimensional motion capture technique.

Methods

Fifteen young males and fifteen young females (total 60 knee joints) who had no history of musculoskeletal disease or a particular gait problem were included in this study. Two more markers were attached to the subject in addition to the Helen-Hayes marker set. Thus, two virtual planes, femoral coronal plane (P_f) and tibial coronal plane (P_t), were created by Skeletal Builder software. This study measured the 3-dimensional knee joint movement in the sagittal, coronal, and transverse planes of these two virtual planes (P_f and P_t) during normal gait.

Results

With respect to kinematics and kinetics, both males and females showed normal adult gait patterns, and the mean difference in the temporal gait parameters was not statistically significant (p > 0.05). In the transverse plane, the screw-home movement occurred as expected during the pre-swing phase and the late-swing phase at an angle of about 17°. However, the tibia rotated externally with respect to the femur, rather than internally, while the knee joint started to flex during the loading response (paradoxical screw-home movement), and the angle was 6°.

Conclusions

Paradoxical screw-home movement may be an important mechanism that provides stability to the knee joint during the remaining stance phase. Obtaining the kinematic values of the knee joint during gait can be useful in diagnosing and treating the pathological knee joints.     

Kinematics of fast wrist movements in manic-depressive illness chronically treated with lithium carbonate

Abstract

Lithium salts have been shown to impair kinematics of fast voluntary movements during acute intoxication. The aim of the present study was to determine whether lithium carbonate affected the kinematics of fast movements in patients chronically treated and who did not exhibit signs of neurotoxicity. We analysed fast wrist flexion movements in 6 healthy subjects, in 5 patients presenting a manic-depressive illness without treatment, and in 8 patients receiving lithium carbonate for a manic-depressive disease. The mean duration of treatment was 3.9±4.1 years, the mean daily dose 837±341 mg and the mean serum level 0.95±0. 15 mEq/l. Although mean movement amplitudes were similar in the 3 groups, the variability of fast movements was increased in patients receiving lithium salts. The ratio of maximum to average velocities (VmNaveJ was significantly higher in patients treated, and their movements were temporally asymmetrical, with a ratio ofacceleration duration divided by deceleration duration being lower than in the 2 other groups. These kinematic abnormalities show that a chronic treatment with lithium salts is associated with an impairment of the cerebellar control of fast single-joint movements. [Neural Res 1998; 20: 320-326]     

Comparison of glenohumeral and humerothoracical range of motion in healthy controls,osteoarthritic patients and patients after total shoulder arthroplasty performing different activities of daily living

PurposeThe purpose of this study was to examine how total shoulder arthroplasty improves performance of activities of daily living compared to patients with glenohumeral osteoarthritis and how they perform compared to healthy controls.MethodsGlenohumeral and humerothoracical elevation used by patients with primary osteoarthritis (12 participants, 16 shoulders), after total shoulder arthroplasty (16 participants, 24 shoulders) and healthy controls (11 participants, 22 shoulders) for four different activities of daily living were assessed using 3D motion analysis. Analysis of range of motion and angle time series was performed.ResultsRange of motion used for activities of daily living was better in patients treated with anatomical total shoulder arthroplasty than in patients with primary glenohumeral osteoarthritis. Although it was still reduced compared to healthy individuals. Angle time series showed improved kinematics in patients with total shoulder arthroplasty compared to patients with glenohumeral osteoarthritis. Both glenohumeral and humerothoracical elevation kinematic time series were in almost all cases in between the control group’s and the osteoarthritis group’s.ConclusionTotal shoulder arthroplasty improves performance of activities of daily living in patients with primary glenohumeral osteoarthritis but cannot restore the full range of Motion compared to healthy controls. A prospective study with pre- and postoperative examinations is necessary to understand to understand how preoperative status influences the postoperative results.     

Postural adjustments and reaching in 4- and 6-month-old infants: an EMG and kinematical study

Adequate postural control is a prerequisite for daily activities such as reaching for an object. However, knowledge on the relationship between postural adjustments and the quality of reaching movements during human ontogeny is scarce. Therefore we evaluated the development of the relationship between the kinematic features of reaching movements and the accompanying postural adjustments in young infants. Twelve typically developing (TD) infants were assessed twice, i.e. at 4 and 6 months of age, in supine and supported sitting position. Reaching was elicited by presenting toys in the midline at an arm-length distance while simultaneously surface EMG-activity was recorded from multiple arm-, neck-, trunk- and leg muscles. Concurrently kinematics of reaching were recorded with an ELITE system; kinematic analysis was restricted to the behaviour of so-called movement units, which are sub movements of reaching determined with the help of peaks in the velocity profile of the hand, maximum movement velocity and movement duration. A computer-algorithm determined significant phasic muscle activity. Activity in neck and trunk muscles (postural activity) was related to the onset of the prime mover, which was the arm muscle being activated first. The results indicated that about 50% of reaching movements in lying and sitting infants aged 4 and 6 months were accompanied by direction-specific postural adjustments. At 4 months variation dominated, but at 6 months a preference to recruit muscles in a top-down order (during sitting) and in the configuration of the complete pattern, i.e. the pattern in which all dorsal neck- and trunk muscles are activated in concert, (both conditions) emerged. Interestingly, the postural characteristics such as the presence of direction-specificity, recruitment of the complete pattern and top-down recruitment, were related to how successful the reaching was and the kinematics of reaching. It was concluded that the presence of direction-specific activity is not a prerequisite for the emergence of reaching movements. Nevertheless, already from 4 months onwards a better postural control is associated with a larger success and a better quality of reaching.     

Multimodal reference frame for the planning of vertical arms movements

In this study we investigated the reference frames used to plan arm movements. Specifically, we asked whether the body axis, visual cues and graviception can each play a role in defining "up" and "down" in the planning and execution of movements along the vertical axis. Horizontal and vertical pointing movements were tested in two postures (upright and reclined) and two visual conditions (with and without vision) to identify possible effects of each of these cues on kinematics of movement. Movements were recorded using an optical 3D tracking system and analysis was conducted on velocity profiles of the hand. Despite a major effect of gravity, our analysis shows an effect of the movement direction with respect to the body axis when subjects were reclined with eyes closed. These results suggest that our CNS takes into account multimodal information about vertical in order to compute an optimal motor command that anticipates the effects of gravity.     

The association of equinus and primary genu recurvatum gait in cerebral palsy

Primary genu recurvatum (GR) is less investigated and data presenting the prevalence among patients with bilateral spastic cerebral palsy (BSCP) is lacking in the literature. Equinus is mentioned as one of the main underlying factors in GR, but its influence on the severity and onset type of GR is mainly unanswered, yet. Hence, the purpose of this retrospective study was to assess the prevalence of GR in a large sample size in children with BSCP and to investigate sagittal plane kinematics to evaluate the influence of equinus on different GR types using data of three-dimensional gait analysis. GR was defined as a knee hyperextension of more than one standard deviation of an age matched control group during stance phase in either one or both of the limbs. Primary GR was defined as a GR without having previous surgery regarding the lower extremity, no selective dorsal rhizotomy and/or interventions like botulinum toxin injection, shock wave therapy or serial casting during the last 6 months in the patient history. In a retrospective study 463 patients with BSCP (GMFCS Level I–III) received three-dimensional gait analysis and were scanned for the presence of primary GR. Finally, 37 patients (23 males, 14 females) matched the determined inclusion criteria and were therefore included for further analysis in this study. Out of those patients seven walked with orthoses or a walker and were excluded from further statistical comparison: Kinematics of the lower limbs were compared between patients having severe (knee hyperextension > 15°) and moderate (knee hyperextension 5–15°) GR and between patients showing an early (first half of stance phase) and a late (second half of stance phase) GR. Primary GR was present in 37 patients/52 limbs (prevalence 8.0/5.6%). Severe GR was associated with a decreased ankle dorsiflexion compared with moderate GR. Early GR showed an increased knee hyperextension compared to late GR. In conclusion GR is less frequent compared with crouch or stiff gait. Our findings support the importance of equinus as a major underlying factor in primary GR. In this context the influence of equinus seems to be more important in early GR.     

Recovery of locomotion after chronic spinalization in the adult cat

Cats were spinalized (T13) as adults and were trained to walk with the hindlimbs on a treadmill. After 3 weeks to 3 months and up to 1 year depending on the animal, all were capable of walking on the plantar surface of the feet and support the weight of the hindquarters. Interactive training appeared to accelerate the recovery of locomotion and maintain smooth locomotor movements. Despite the obvious loss of voluntary control and equilibrium which the experimenter partially compensated for by maintaining the thorax and/or the tail, the cats could walk with a regular rhythm and a well-coordinated hindlimb alternation at speeds of 0.1-1.2 m/s. Cycle duration as well as stance and swing duration resembled those of normal cats at comparable speeds. The range of angular motion was also similar to that observed in intact cats as was the coupling between different joints. The EMG activity of the hindlimb and lumbar axial muscles also retained the characteristics observed in the intact animal. Some deficits such as a dragging of the foot in early swing and diminution of the angular excursion in the knee were seen at later stages. Thus, the adult spinal cat preparation is considered as a useful model to study the influence of different types of training and of different drugs or other treatments in the process of locomotor recovery after injury to the spinal cord.     

Idiopathic toe walking—A follow-up survey of gait analysis assessment

BackgroundToe-walking is a normal variant in children up to 3 years of age but beyond this a diagnosis of idiopathic toe-walking (ITW) must be considered. ITW is an umbrella term that covers all cases of toe-walking without any diagnosed underlying medical condition and before assigning these diagnosis potential differential diagnoses such as cerebral palsy, peripheral neuropathy, spinal dysraphism and myopathy must be ruled out. Gait laboratory assessment (GLA) is thought to be useful in the evaluation of ITW, and kinematic, kinetic and electromyography features associated with ITW have been described. However, the longer term robustness of a diagnosis based on GLA has not been investigated. The primary aim of this study was to examine if a diagnosis of ITW based on GLA features persisted.MethodsAll patients referred to a national gait laboratory service over a ten year period with queried ITW were sent a postal survey to establish if a diagnosis of ITW which had been offered following GLA persisted over time. The gait and clinical parameters differentiating those reported as typical ITW and not-typical-ITW following GLA were examined in the survey respondents.ResultsOf 102 referrals to the laboratory with queried ITW, a response rate of 40.2% (n = 41) was achieved. Of the respondents, 78% (n = 32) were found to be typical of ITW following GLA and this diagnosis persisted in the entire group at an average of 7 years post GLA. The other nine subjects were reported as not typical of ITW following GLA and 44.4% (n = 4) received a subsequent differential diagnosis. The clinical examination and gait analysis features differentiating these groups were consistent with previous literature.ConclusionGLA appears to be a useful objective tool in the assessment of ITW and a diagnosis based on described features persists in the long-term.     

Mechanical work,kinematics, and kinetics during sit-to-stand in children with and without spastic diplegic cerebral palsy

BackgroundSit-to-stand (STS) is one of the most common fundamental activity in daily life. The pathology of the neuromuscular control system in children with spastic diplegic cerebral palsy (SDCP) could contribute to atypical movement patterns leading to the inefficiency performance including the STS task. However, there was also a lack of evidence about kinematics, kinetics, and especially mechanical work during the STS task in children with SDCP aged 7–12 years old.Research questionWhat were the differences in mechanical work, kinematics and kinetics during STS task between children with SDCP and typically developing (TD) children?MethodsEleven children with SDCP (GMFCS I-II) and eleven age and gender-matched control TD children with an age range of 7–12 years were enrolled. Motion analysis and force plate systems were used to collect data. All participants performed the STS task from an adjustable chair. Independent sample t-test and two-way analysis of variance were used in this study.ResultsThe children with SDCP took a longer time and used more mechanical work during STS than TD children. At the beginning of the STS task, children with SDCP showed more trunk flexion and posterior pelvic tilting; in addition, during the STS task they also presented more trunk, hip, and knee flexion than TD children. However, the children with SDCP showed less ankle dorsiflexion compared with TD children. For the kinetic variables, asymmetry was found in children with SDCP. The maximum hip and knee extension moment, plantar flexion moment, and peak vertical ground reaction force (GRF) of the non-dominant leg were higher than the values of the dominant leg in these children.SignificanceEven though, children with SDCP who are able to independently STS. They were also a mechanically less efficient performance during STS task. Therefore, this task still needs to be trained during rehabilitation sessions.     

Achilles tendon loading during weight bearing exercises

ObjectiveCompare the estimated Achilles tendon (AT) loading using a musculoskeletal model during commonly performed weight bearing therapeutic exercises.DesignControlled laboratory study.SettingUniversity biomechanics laboratory.ParticipantsEighteen healthy males (Age:22.1 ± 1.8 years, height:177.7 ± 8.4 cm, weight = 74.29 ± 11.3 kg).Main outcome measure(s)AT loading was estimated during eleven exercises: tandem, Romberg, and unilateral standing, unilateral and bilateral heel raising, unilateral and bilateral jump landing, squat, lunge, walking, and running. Kinematic and kinetic data were recorded at 180 Hz and 1800 Hz respectively. These data were then used in a musculoskeletal model to estimate force in the triceps surae. AT cross-sectional images were measured by ultrasound to determine AT stress. A repeated measure multivariate analysis of variance (α = 0.05) was used on AT loading variables.ResultsSquat and unilateral jump landing were the most different in AT stress. Peak AT stress variables were generally greater during more dynamic, unilateral exercises compared to more static, bilateral exercises.ConclusionsBilateral, more static exercises resulted in less AT loading and may serve as a progression during the rehabilitation compared to more dynamic, unilateral exercises.