Identifying the location of human skeletal landmarks: why standardized definitions are necessary--a proposal.
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Biomechanical Phenomena↗
Biomedical subjects
Ugo Della Croce
Publications and source records attributed to Ugo Della Croce.
Moderate-heeled shoes and knee joint torques relevant to the development and progression of knee osteoarthritis.
OBJECTIVE: To determine if women's dress shoes with heels of just 1.5 in (3.8 cm) in height increases knee joint torques, which are thought to be relevant to the development and/or progression of knee osteoarthritis (OA) in both the medial and patellofemoral compartments. DESIGN: Randomized controlled trial. SETTING: A 3-dimensional motion analysis gait laboratory. PARTICIPANTS: Twenty-nine healthy young women (age, 26.7+/-5.0 y) and 20 healthy elderly adult women (age, 75.3+/-6.5 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak external varus knee torque in early and late stance and prolongation of flexor knee torque in early stance. Three-dimensional data on lower-extremity torques and motion were collected during walking while (1) wearing shoes with 1.5-in high heels and (2) wearing control shoes without any additional heel. Data were plotted and qualitatively compared; major peak values and timing were statistically compared between the 2 conditions using paired t tests. RESULTS: Peak knee varus torque during late stance was statistically significantly greater with the heeled shoes than with the controls, with increases of 14% in the young women and 9% in the elderly women. With the heeled shoes, the early stance phase knee flexor torque was significantly prolonged, by 19% in the young women and by 14% in elderly women. Also, the peak flexor torque was 7% higher with the heeled shoe in the elderly women. CONCLUSIONS: Even shoes with moderately high heels (1.5 in) significantly increase knee torques thought to be relevant in the development and/or progression of knee OA. Women, particularly those who already have knee OA, should be advised against wearing these types of shoes.
Adult↗
Human movement analysis using stereophotogrammetry. Part 1: theoretical background.
This paper sets the stage for a series of reviews dealing with the problems associated with the reconstruction and analysis of in vivo skeletal system kinematics using optoelectronic stereophotogrammetric data. Instantaneous bone position and orientation and joint kinematic variable estimations are addressed in the framework of rigid body mechanics. The conceptual background to these exercises is discussed. Focus is placed on the experimental and analytical problem of merging the information relative to movement and that relative to the morphology of the anatomical body parts of interest. The various global and local frames that may be used in this context are defined. Common anatomical and mathematical conventions that can be used to describe joint kinematics are illustrated in a comparative fashion. The authors believe that an effort to systematize the different theoretical and experimental approaches to the problems involved and related nomenclatures, as currently reported in the literature, is needed to facilitate data and knowledge sharing, and to provide renewed momentum for the advancement of human movement analysis.
Biomechanical Phenomena↗
Human movement analysis using stereophotogrammetry. Part 2: instrumental errors.
This paper reviews the main aspects involved with the management of instrumental errors associated with video-based optoelectronic stereophotogrammetry. Insights on how such errors propagate to kinematic quantities are of great interest in the field of human movement analysis to improve the precision and reliability of measurements. The review focuses on the technical assessment and analytical compensation procedures to cope with instrumental errors. Relevant contributions dealing with intrinsic sources of systematic and random errors, such as the issues concerning camera calibration and filtering and smoothing of marker position data, are presented. Procedures for marker imaged processing, and missing marker recovery are also surveyed. Methods for checking the accuracy and precision of stereophotogrammetric systems are then reviewed. Finally, since the desired outcome of the movement measurements is a reliable estimate of body segment kinematics, state-of-the-art techniques proposed for minimization of error propagation arising from a cluster of external markers are described.
Biomechanical Phenomena↗
Human movement analysis using stereophotogrammetry. Part 3. Soft tissue artifact assessment and compensation.
When using optoelectronic stereophotogrammetry, skin deformation and displacement causes marker movement with respect to the underlying bone. This movement represents an artifact, which affects the estimation of the skeletal system kinematics, and is regarded as the most critical source of error in human movement analysis. A comprehensive review of the state-of-the-art for assessment, minimization and compensation of the soft tissue artifact (STA) is provided. It has been shown that STA is greater than the instrumental error associated with stereophotogrammetry, has a frequency content similar to the actual bone movement, is task dependent and not reproducible among subjects and, of lower limb segments, is greatest at the thigh. It has been shown that in in vivo experiments only motion about the flexion/extension axis of the hip, knees and ankles can be determined reliably. Motion about other axes at those joints should be regarded with much more caution as this artifact produces spurious effects with magnitudes comparable to the amount of motion actually occurring in those joints. Techniques designed to minimize the contribution of and compensate for the effects of this artifact can be divided up into those which model the skin surface and those which include joint motion constraints. Despite the numerous solutions proposed, the objective of reliable estimation of 3D skeletal system kinematics using skin markers has not yet been satisfactorily achieved and greatly limits the contribution of human movement analysis to clinical practice and biomechanical research. For STA to be compensated for effectively, it is here suggested that either its subject-specific pattern is assessed by ad hoc exercises or it is characterized from a large series of measurements on different subject populations. Alternatively, inclusion of joint constraints into a more general STA minimization approach may provide an acceptable solution.
Adipose Tissue↗
Human movement analysis using stereophotogrammetry. Part 4: assessment of anatomical landmark misplacement and its effects on joint kinematics.
Estimating the effects of different sources of error on joint kinematics is crucial for assessing the reliability of human movement analysis. The goal of the present paper is to review the different approaches dealing with joint kinematics sensitivity to rotation axes and the precision of anatomical landmark determination. Consistent with the previous papers in this series, the review is limited to studies performed with video-based stereophotogrammetric systems. Initially, studies dealing with estimates of precision in determining the location of both palpable and internal anatomical landmarks are reviewed. Next, the effects of anatomical landmark position uncertainty on anatomical frames are shown. Then, methods reported in the literature for estimating error propagation from anatomical axes location to joint kinematics are described. Interestingly, studies carried out using different approaches reported a common conclusion: when joint rotations occur mainly in a single plane, minor rotations out of this plane are strongly affected by errors introduced at the anatomical landmark identification level and are prone to misinterpretation. Finally, attempts at reducing joint kinematics errors due to anatomical landmark position uncertainty are reported. Given the relevance of this source of errors in the determination of joint kinematics, it is the authors' opinion that further efforts should be made in improving the reliability of the joint axes determination.
Biomechanical Phenomena↗
Sequencing sit-to-stand and upright posture for mobility limitation assessment: determination of the timing of the task phases from force platform data.
The identification of quantitative tools to assess an individual's mobility limitation is a complex and challenging task. Several motor tasks have been designated as potential indicators of mobility limitation. In this study, a multiple motor task obtained by sequencing sit-to-stand and upright posture was used. Algorithms based on data obtained exclusively from a single force platform were developed to detect the timing of the motor task phases (sit-to-stand, preparation to the upright posture and upright posture). To test these algorithms, an experimental protocol inducing predictable changes in the acquired signals was designed. Twenty-two young, able-bodied subjects performed the task in four different conditions: self-selected natural and high speed with feet kept together, and self-selected natural and high speed with feet pelvis-width apart. The proposed algorithms effectively detected the timing of the task phases, the duration of which was sensitive to the four different experimental conditions. As expected, the duration of the sit-to-stand was sensitive to the speed of the task and not to the foot position, while the duration of the preparation to the upright posture was sensitive to foot position but not to speed. In addition to providing a simple and effective description of the execution of the motor task, the correct timing of the studied multiple task could facilitate the accurate determination of variables descriptive of the single isolated phases, allowing for a more thorough description of the motor task and therefore could contribute to the development of effective quantitative functional evaluation tests.
Adult↗
Knowledge discovery in databases of biomechanical variables: application to the sit to stand motor task.
ABSTRACT : BACKGROUND : The interpretation of data obtained in a movement analysis laboratory is a crucial issue in clinical contexts. Collection of such data in large databases might encourage the use of modern techniques of data mining to discover additional knowledge with automated methods. In order to maximise the size of the database, simple and low-cost experimental set-ups are preferable. The aim of this study was to extract knowledge inherent in the sit-to-stand task as performed by healthy adults, by searching relationships among measured and estimated biomechanical quantities. An automated method was applied to a large amount of data stored in a database. The sit-to-stand motor task was already shown to be adequate for determining the level of individual motor ability. METHODS : The technique of search for association rules was chosen to discover patterns as part of a Knowledge Discovery in Databases (KDD) process applied to a sit-to-stand motor task observed with a simple experimental set-up and analysed by means of a minimum measured input model. Selected parameters and variables of a database containing data from 110 healthy adults, of both genders and of a large range of age, performing the task were considered in the analysis. RESULTS : A set of rules and definitions were found characterising the patterns shared by the investigated subjects. Time events of the task turned out to be highly interdependent at least in their average values, showing a high level of repeatability of the timing of the performance of the task. CONCLUSIONS : The distinctive patterns of the sit-to-stand task found in this study, associated to those that could be found in similar studies focusing on subjects with pathologies, could be used as a reference for the functional evaluation of specific subjects performing the sit-to-stand motor task.
Journal Article↗
Total body centre of mass displacement estimated using ground reactions during transitory motor tasks: application to step ascent.
A double integration technique is presented that estimates whole body centre of mass (CoM) displacement from signals of a single force platform, compensating for the drift and low frequency noise inherent in the signals. The technique is composed of two different integration techniques, which may also be used separately, and is applied to transitory motor tasks with known initial and final conditions such as step ascent and descent, single step, etc. First, the lowest frequencies within the force platform signals and considered not to be associated with actual movement are filtered out. Second, a regular and a time-reversed double integration are performed and weighted against each other. The technique's accuracy was assessed using computer generated force platform signals that were artificially perturbed. Experimental data were used to compare the estimated CoM displacement to that obtained from a regular double integration and from segmental analysis performed on stereophotogrammetric data. It was shown that the proposed technique's CoM displacement estimates were more repeatable and up to 50% more accurate than those of a regular double integration. Moreover, the CoM displacement estimated using a single force platform and the proposed technique was found to be not statistically different from that obtained with more demanding measurement and processing techniques such as stereophotogrammetry and segmental analysis.
Adult↗
Reliability of EMG time-frequency measures of fatigue during repetitive lifting.
PURPOSE: To test the short-term and long-term reliability of time-frequency electromyographic (EMG) measures of fatigue during repetitive dynamic lifting and compare it with the reliability of median frequency (MF) EMG measures of fatigue during static lifting. METHODS: Fourteen' healthy male subjects (26 +/- 5 years) repetitively (12 lifts/min) lifted and lowered a box (29 x 25 x 23 cm, 13 kg) for 4.5 min during 3 different tests on 2 different days. EMG data and the biomechanics of motion were recorded. Before and after dynamic lifting, static maximum lifting tests were performed. At the end of each of the two sessions, subjects performed a static lift at 80% of their maximum lifting force for 30 s. RESULTS: Significant fatigue-related changes were observed during the lifting exercise via EMG time-frequency analysis at the paravertebral L5, L2, T10, and vastus lateralis (VL) electrode sites. Two parameters for assessing fatigue during dynamic contractions [i.e., the Instantaneous Median Frequency (IMDF) and its time dependent change] were shown to be reproducible both in the short-term (2 h) and long-term (2 wk). The corresponding ICCs reflecting the reproducibility of values between sessions were 96.9% (L5), 98.1% (L2), 90.1% (T10), 96.4% (UT), 98.0% (GM), 89.5% (VL), and 99.0% (BF), respectively. For most EMG recording sites, the reliability of the IMDF measures was not dependent upon the postural strategy that the subject used to accomplish the lifting task or on the subject's strength as measured via the static maximum lifting test. A comparison between the ICC values of the IMDF measures and those of the parameters utilized to assess fatigue during static sustained lifts [i.e., the Median Frequency (MDF) and its change during the test] revealed equally good reproducibility for most EMG recording sites. The respective ICC values that took into account time dependent trends for the IMDF parameter were 87.1% (L5), 62.4% (L2), 90.1% (T10), 0% (UT), 72.7% (GM), 45.4% (VL), and 100% (BF), and for the MDF parameter 94.9% (L5), 73.0% (L2), 80.9% (T10), 100% (UT), 89% (GM), 91.7% (VL), and 90.9% (BF), respectively. CONCLUSIONS: The time-frequency approach allows one to derive EMG spectral parameters that can be used to monitor muscle fatigue during dynamic real-world tasks such as lifting.
Adult↗
Changes in the surface EMG signal and the biomechanics of motion during a repetitive lifting task.
The analysis of surface electromyographic (EMG) data recorded from the muscles of the back during isometric constant-force contractions has been a useful tool for assessing muscle deficits in patients with lower back pain (LBP). Until recently, extending the technique to dynamic tasks, such as lifting, has not been possible due to the nonstationarity of the EMG signals. Recent developments in time-frequency analysis procedures to compute the instantaneous median frequency (IMDF) were utilized in this study to overcome these limitations. Healthy control subjects with no history of LBP (n = 9; mean age 26.3 +/- 6.7) were instrumented for acquisition of surface EMG data from six electrodes on the thoraco-lumbar region and whole-body kinematic data from a stereo-photogrammetric system. Data were recorded during a standardized repetitive lifting task (load = 15% body mass; 12 lifts/min; 5-min duration). The task resulted in significant decreases in IMDF for six of the nine subjects, with a symmetrical pattern of fatigue among contralateral muscles and greater decrements in the lower lumbar region. For those subjects with a significant decrease in IMDF, a lower limb and/or upper limb biomechanical adaptation to fatigue was observed during the task. Increases in the peak box acceleration were documented. In two subjects, the acceleration doubled its value from the beginning to the end of the exercise, which lead to a significant increase in the torque at L4/L5. This observation suggests an association between muscle fatigue at the lumbar region and the way the subject manipulates the box during the exercise. Fatigue-related biomechanical adaptations are discussed as a possible supplement to functional capacity assessments among patients with LBP.
Adaptation, Biological↗