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Age-related changes in lower trunk coordination and energy transfer during gait.

The effects of aging on lower trunk (trunk-low-back joint-pelvis) coordination and energy transfer during locomotion has received little attention; consequently, there are scant biomechanical data available for comparison with patient populations whose upper body movements may be impaired by orthopaedic or neurologic disorders. To address this problem, we analyzed gait data from a cross-sectional sample of healthy adults (n = 93) between 20 and 90 yr old (n = 44 elderly, >50 yr old; n = 49 young, <50 yr old). Gait characteristics of elders were mostly typical: gait speed of elders (1.13 +/- 0.20 m/s) was significantly (P = 0.007) lower than gait speed of young subjects (1.20 +/- 0.18 m/s). Although elders had less low-back (trunk relative to pelvis) range of motion (ROM; P = 0.013) during gait than young subjects, no age-related differences were detected in absolute trunk and pelvis ROM or peak pitch angles during gait. Despite similar upper body postures, there was a strong association between age and pelvis-trunk angular velocity phase angle (r = 0.48, P < 0.001) with zero phase occurring at approximately 55 yr of age; young subjects lead with the pelvis while elderly subjects lead with the trunk. Age related changes in gait speed and low-back ROM were unable to explain the above findings. The trunk-leading strategy used by elders resulted in a sense reversal of the low-back joint power curve and increased (P = 0.013) the mechanical energy expenditure required for eccentric control of the lower trunk musculature during stance phase of gait. These data suggest an age-related change in the control of lower trunk movements during gait that preserves upper body posture and walking speed but requires a leading trunk and higher mechanical energy demands of lower trunk musculature-two factors that may reduce the ability to recover from dynamic instabilities. The behavioral and motor control aspects of these findings may be important for understanding locomotor impairment compensations in aging humans and in quantifying falls risk.

Abdominal Muscles↗

Improvements in trunk sway observed for stance and gait tasks during recovery from an acute unilateral peripheral vestibular deficit.

OBJECTIVES: Our aim was to track improvements in postural control during recovery from an acute unilateral peripheral vestibular deficit (UVL), presumably due to vestibular neuritis, and to determine if recovery rates were different for stance and gait tasks. Postural control was quantified using simple measurements of trunk sway: amplitudes of trunk sway angle and angular velocity, in the roll and pitch directions as well as task duration, were examined for a battery of stance and gait tasks. These measures were collected at the onset of the deficit and then 3 weeks and 3 months later. STUDY DESIGN: A repeated-measures design was used for UVL subjects and age-matched healthy controls. Stance tasks involved standing on 1 or 2 legs with eyes open or closed. Gait tasks consisted of tandem gait, walking normally with eyes closed, or with the head rotating or head pitching, walking up and down stairs and walking over a series of low barriers. Stance and tandem gait tasks were repeated using a foam support surface instead of a normal floor. PATIENTS: Twenty-eight patients with acute UVL were examined. MAIN OUTCOME MEASURES: The range of trunk sway angular displacement and angular velocity in the pitch and roll directions was measured for each task in addition to task duration. The measures were compared with those of normal subjects. RESULTS: The amplitudes of pitch trunk sway for 2-legged stance tasks with eyes closed underwent the greatest reduction 3 weeks after UVL onset. At 3 months, trunk sway was almost normal for all 2-legged stance tasks. One-legged stance tasks with eyes open showed a similar but slower improvement. Stance time without a fall showed a very rapid improvement for 1-legged tasks but was still shorter than that of normal subjects at 3 months. Trunk sway for the simple gait tasks was within normal range at 3 months; however, task duration was still longer than normal. More complex gait tasks, such as walking 8 tandem steps on foam or walking up and down stairs, showed no improvement in trunk roll sway at 3 months. A mix of variables from mainly gait tasks best identified a balance deficit due to UVL, with complex gait tasks becoming more important for identification purposes as compensation progressed. The accuracy of UVL identification with durations alone was 75% of the accuracy with combined trunk sway and duration measures. CONCLUSIONS: These data suggest that recovery of normal trunk control during the compensation process for unilateral vestibular hypofunction is more rapid for stance tasks than gait tasks. Even at 3 months, trunk sway for complex gait tasks was not normal. Thus, trunk sway for gait tasks provides a better insight into remaining deficits in balance control of vestibular-loss patients than the sway of stance tasks.

Acute Disease↗

Short-term effects of practice with trunk restraint on reaching movements in patients with chronic stroke: a controlled trial.

BACKGROUND AND PURPOSE: In prehension tasks with objects placed within arm's reach, patients with hemiparesis caused by stroke use excessive trunk movement to compensate for arm motor impairments. Compensatory trunk movements may improve motor function in the short term but may limit arm recovery in the long term. Previous studies showed that restriction of trunk movements during reach-to-grasp movements results in immediate increases in active arm joint ranges and improvement in interjoint coordination. To evaluate the potential of this technique as a therapeutic intervention, we compared the effects of short-term reach-to-grasp training (60-trial training session) with and without physical trunk restraint on arm movement patterns in patients with chronic hemiparesis. METHODS: A total of 28 patients with hemiparesis were assigned to 2 groups: 1 group practiced reach-to-grasp movements during which compensatory movement of the trunk was prevented by a harness (trunk restraint), and the second group practiced the same task while verbally instructed not to move the trunk (control). Kinematics of reaching and grasping an object placed within arm's length were recorded before, immediately after, and 24 hours after training. RESULTS: The trunk restraint group used more elbow extension, less anterior trunk displacement, and had better interjoint coordination than the control group after training, and range of motion was maintained 24 hours later in only the trunk restraint group. CONCLUSIONS: Restriction of compensatory trunk movements during practice may lead to greater improvements in reach-to-grasp movements in patients with chronic stroke than practice alone, and longer-term effects of this intervention should be evaluated.

Aged↗

Biometric study of the width, length and depth of the root trunk groove of human lower second molars.

One hundred human lower second molars, 51 from the left side and 49 from the right side, extracted due to their poor clinical and radiographic conditions were utilized in this study. Using a Contracer apparatus, the profiles of the buccal and lingual root surfaces of these teeth were traced on a millimeter-scaled paper. The profiles were registered from the cementoenamel junction (CEJ), millimeter by millimeter, up to the entrance of the furcation. The width, length and depth of the root trunk groove, as well as the length of the root trunk, were studied. After statistical analysis (p < 0.05) it was possible to conclude that: a) the mean width of the root trunk groove on the buccal surface was 3.6 mm and, on the lingual surface, 3.3 mm; b) the mean depth of the root trunk groove on the buccal surface was 0.88 mm and, on the lingual surface, 0.77 mm; c) the mean length of the root trunk groove on the buccal surface was 2.93 mm and, on the lingual surface, 3.61 mm. The mean length of the root trunk on the buccal surface was 3.09 mm and, on the lingual surface, 3.91 mm (p < 0.025). There was a coincidence between the length of the root trunk and that of its groove in 90.2% of the buccal surfaces of the samples from the left side, and in 77.5% of the samples from the right side; on the lingual surface, the coincidence occurred in 77.5% of the teeth from the left side, and on 88.3% of the teeth from the right side. This work revealed that there is a concavity on the root trunk region of the lower second molar, whose depth and width were greater on the buccal surface and whose length was greater on the lingual surface. The depth of the root trunk groove increased in the apical direction, with maximum depth in the last millimeter of the root trunk. The root trunk was longer on the lingual surface than it was on the buccal surface.

Anthropometry↗

Perception of horizontal head and trunk rotation in patients with loss of vestibular functions.

In patients with loss of vestibular functions, we studied psychophysically the self-motion perception for 'trunk in space' and 'head in space' during various combinations of horizontal head and trunk rotation in the dark. The results were compared to those of normal subjects. For their 'trunk in space' perception, the subjects relied on their internal image of space, derived from the vestibular receptors in the head, and referred their trunk to this as a reference by adding to it a nuchal trunk-to-head signal. The patients, by contrast, always considered the trunk as stationary. Obviously because they were devoid of any space cues, they abandoned or suppressed a neck contribution to their 'trunk in space' perception, which, in fact, would yield an erroneous perception in almost all conditions in the dark. Both the patients and the subjects based their 'head in space' perception on their internal representation of 'trunk in space' and added to this a nuchal head-to-trunk signal. However, the patients' head-to-trunk signal, unlike that of the subjects, was considerably larger than the actual head-to-trunk rotation at low stimulus frequency. We relate this finding to some unconscious modification of their neck muscle activity during passive head rotation. It appears that the patients' gain of the neck input per se is not increased, but rather that subsets of this input are modified according to the particular function they serve.

Adolescent↗

Vestibular contribution to combined arm and trunk motion.

Recent studies have shown that the hand-pointing movements within arm's reach remain invariant whether the trunk is recruited or not or its motion is unexpectedly prevented. This suggests the presence of compensatory arm-trunk coordination minimizing the deflections of the hand from the intended trajectory. It has been postulated that vestibular signals elicited by the trunk motion and transmitted to the arm motor system play a major role in the compensation. One prediction of this hypothesis is that vestibular stimulation should influence arm posture and movement during reaching. It has been demonstrated that galvanic vestibular stimulation (GVS) can influence the direction of pointing movements when body motion is restrained. In the present study, we analyzed the effects of GVS on trunk-assisted pointing movements. Subjects either moved the hand to a target or maintained a steady-state posture near the target, while moving the trunk forward with the eyes closed. When GVS was applied, the final position of the hand was deviated in the lateral and sagittal direction in both tasks. This was the result of two independent effects: a deviation of the trunk trajectory and a modification of the arm position relative to the trunk. Thus, the vestibular system might be directly involved not only in the control of trunk motion but also in the arm-trunk coordination during trunk-assisted reaching movements.

Adult↗

The effects of trunk stiffness on postural control during unstable seated balance.

This paper focused on the relationship between trunk stiffness and postural control during unstable seated balancing. We hypothesized that an increase in trunk stiffness would degrade postural control, and further hypothesized that signal dependent noise (SDN), resulting in increased muscle force variability, was responsible for this impairment. Ten subjects balanced on an unstable seat during four randomized conditions: normal balancing (control condition), trunk muscle co-activation (active stiffness), arm muscle co-activation (attention control), and belt (passive stiffness). Center of pressure (CoP) and EMG data were collected during three 20 s trials. Postural control was quantified by CoP velocity (total path divided by sample time in seconds). Trunk muscle co-activation resulted in significantly higher CoP velocity than the control (P < 0.001) and arm co-activation (P < 0.001) conditions. EMG data confirmed that the trunk co-activation condition had significantly higher muscle activity than the control (P = 0.001) and arm co-activation (P = 0.001) conditions. The belt condition, which increases passive trunk stiffness, showed no degraded postural control, but interestingly produced slightly lower levels of trunk muscle activity than the control condition (P < 0.001). Increased active trunk stiffness from muscle co-activation degraded postural control. Since the arm co-activation condition showed no impairment, attention demands cannot explain this result. Furthermore, since passive trunk stiffness from wearing a belt did not affect performance, it is believed that SDN from increased trunk muscle recruitment, and not an altered postural control strategy from increased joint stiffness, was responsible for the impairment.

Adult↗

Trunk muscle activity during the simultaneous performance of two motor tasks.

A unique feature of trunk muscles is that they can be activated to meet functional requirements for combined behaviors, including those related to posture and breathing. Trunk muscles therefore may have developed mechanisms for dealing with simultaneous inputs for different task requirements. This study was designed to test the hypothesis that a linear addition in trunk muscle activities would occur when an isometric trunk task and a pulsed expiration task was performed simultaneously. Surface electromyograms (EMG) were recorded from four trunk regions (medial and lateral back, upper and lower lateral abdomen) in sitting during the performance of the individual isometric trunk task, the individual pressure task, and the combined task (isometric trunk and pressure task). The direction of static holding for the isometric trunk task was varied between flexion and extension positions. For the pressure task subjects produced two consecutive pressure pulses (2/s) to a target oral pressure. For each muscle recording, a linear prediction was calculated from the mathematical addition of the EMG recorded from the individual trunk and pressure tasks. This linear prediction was compared to the actual muscle activity recorded during the combined task. Typically the EMG from two muscles showed linear addition, such that the relative contribution of muscle activity did not change for the combined task. This suggests that the motor commands for each task reached these motor neuron pools essentially unmodified. The other two muscles showed nonlinear combination of two EMG patterns. That is, qualitatively both EMG patterns, specific to each command, were evident in the measured EMG traces for the combined task, but quantitatively the muscle did not meet all criteria for linear addition. Linear addition may provide a simple mechanism for combining breathing-related behaviors (expiratory efforts) with other trunk behaviors (holding against gravity). This suggests that some muscles can be shared for two different voluntary tasks without changing their contribution to either component task. At the same time, nonlinear combination suggests that some muscles are shared, but their contribution to either component task may be modulated, thus avoiding the construction of a third new and unique plan.

Abdominal Muscles↗

Radiologic anatomy of the superior mesenteric vein and branching patterns of the first jejunal trunk: evaluation using multi-detector row CT venography.

The purpose of this study was to describe radiologic anatomy of the superior mesenteric vein (SMV) and to evaluate branching patterns of the first jejunal trunk on axial CT images and multi-detector row CT (MDCT) venography in adults. Two hundred and twenty consecutive patients who underwent abdominal CT examinations were enrolled in this study. Appearance of the SMV, branching patterns of the first jejunal trunk, and drainage site of the inferior mesenteric vein (IMV) were assessed on axial CT images and MDCT venography. The SMV and first jejunal trunk were identified in all patients. A single trunk of the SMV was present in 95% (210/220) and absent in 5% (10/220). First jejunal trunk crossed dorsal to the superior mesenteric artery (SMA) towards the left abdomen in 64% (141/220) and first jejunal trunk crossed ventral to the SMA in 19% (41/220). First jejunal trunk crossed dorsal to the SMA and abruptly turned towards the right abdomen in 17% (38/220). Among these 38 patients, biliary-enteric bypass surgery (n = 9) and large hematoma in left abdomen (n = 1) were present. The IMV was identified in 213 patients and was observed to drain into splenic vein in 112 patients (53%), SMV in 67 (31%), splenoportal confluence in 26 (12%), and first jejunal trunk in 8 (4%). In conclusion, the first jejunal trunk, abruptly turning toward the right abdomen, may be an anatomic variant or indirect finding of biliary-enteric anastomosis. The IMV may drain into the first jejunal trunk as well as splenic vein, splenoportal confluence, and SMV.

Adult↗

Prehension with trunk assisted reaching.

For prehensile tasks, where objects are located beyond the normal reaching space, the trunk is bent forward to assist in the transport of the wrist to the object. Such task behaviors raise complex motor control issues such as how is the trunk movement incorporated into the motor plan. In this experiment, seated subjects were asked to reach and grasp a small and a large object placed on a table located beyond their maximal reach. Forward trunk bending was required to extend the reach distance. For such reaching movements, the wrist velocity consisted of a bell shape profile similar to those seen when the arm is the sole transport agent. In most trials, the trunk was the first to initiate movement, although there was no strict pattern of initiation order. The transport data showed that trunk and arm movement components were decoupled at the end of the reach. While the object was being grasped and lifted, the trunk continued moving for approximately 180 ms after the grasp. Wrist deceleration time expressed in absolute and relative values was sensitive to object size. The time from maximum peak aperture to the end of wrist movement also was significantly longer for grasping the small compared to the large object. No such relationships were observed for the trunk. Temporal coupling was only observed between the grip and wrist transport component. Time to maximum aperture was significantly correlated with time to peak wrist deceleration and only rarely with time to trunk deceleration peak. When the trunk participates in the transport of the wrist to an object, these findings suggest that only the wrist component is directly related to the achievement of the grasp. While the trunk assisted the arm to reach the object, the kinematic parameter recorded did not reveal any evidence of direct coupling. The presented data suggests that the planning takes place at the level of the hand and that endpoint is the primary variable controlled.

Acceleration↗

Angiographic study of the tibioperoneal trunks in patients with aorto-iliac occlusive disease.

Knowledge of the normal anatomic characterization of the popliteal artery and its branches is essential as a guide in vascular surgery below the knee. Using radiologic, digital and statistical methods tibioperoneal trunks were studied on 76 preoperative arteriograms, visualizing bilateral configurations of the popliteal artery division, from 46 men and 30 women, with aorto-iliac occlusive disease. The aim of this study has been to evaluate tibioperoneal trunks as to typological (types, frequency of existence, gender and syntopic dimorphisms) and angiometric (length, internal diameter and capacity) aspects. The statistical analysis of tibioperoneal trunks (types, angiometric parameters) did not reveal any gender or syntopic dimorphisms (p > or = 0.05). In both the posterior tibioperoneal trunk (89.47%) or the anterior tibioperoneal trunk (7.89%) short and long ones were found. High correlation coefficients of the symmetry of the left and right vascular patterns were observed (r = 0.80-0.83). In 2.64% of cases tibioperoneal trunks were absent. Two types of posterior tibioperoneal trunk were longer (p < or = 0.01) but they were thinner (p < or = 0.05) than similarly named types of anterior tibioperoneaL trunk. In anterior and posterior tibioperoneal trunks of the short type the diameter of the vessel was statistically larger (p < or = 0.05) than in its long type. The largest capacity was found in the long type and the smallest in the short type of anterior tibioperoneal trunk (p < or = 0.01). These findings have implications in vascular grafting below the knee.

Aorta, Abdominal↗

Maintenance of upright standing posture during trunk rotation elicited by rapid and asymmetrical movements of the arms.

Nine healthy subjects standing upright, initiated small, medium and large (S, M and L conditions, respectively) forward movements of their right (Rt) arm together with backward movements of their left (Lt) arm. They also performed medium-size movements while holding a 3 kg dumbbell in each hand (D condition). Movements started with the arm hanging alongside the body and ended when the shoulder reached a desired orientation. The arm and trunk movements were videotaped and recorded by accelerometers taped to the wrists, shoulders, and hips bilaterally. The torque around the vertical axis was measured using a force-plate on which the subjects stood. EMGs were recorded with surface electrodes bilaterally from the shoulder, trunk, and thigh muscles. Trajectories of the center of foot pressure were measured in additional experiments. In association with arm movements, there was a small counterclockwise (ccw: the Rt shoulder forward and the Lt backward) rotation of the trunk, followed by large alternate rotations of the trunk, first clockwise (cw) and subsequently ccw. The intervals from the hand acceleration to the shoulder and hip accelerations were, respectively, 0+/-15 ms (mean and S.D. for all subjects) and -17+/-15 ms. The force-plate showed initial cw and later ccw torques 63+/-41 ms after hand acceleration. The EMGs of the Rt hamstrings (Ham) and Lt rectus femoris (RFem) were followed by those of the Lt Ham and Rt RFem which, respectively preceded the alternate trunk rotations. The integrated EMGs and torques increased with increasing amplitude of arm movement and load. The integrated torques increased in the order of S, M, L, and D conditions. The integrated EMGs of the thigh muscles correlated with the integrated torques (medians: r=0.880, 0.696, 0.785, and 0.688, respectively, in the Rt Ham, Lt Ham, Rt RFem, and Lt RFem). The trajectories of the center of foot pressure showed variations, initially toward the Rt side and then the Lt side which, respectively coincided with the initial and later phases of the trunk rotations and the muscle activation. The trunk muscles were generally coactivated between the Rt and Lt muscles, and the integrated EMGs increased with increasing the integrated torques. Our results showed that alternate rotations of the upper trunk, produced by rapid arm movements, were transmitted to the hip in part due to cocontraction of trunk muscles, and each pair of hip joint muscles contributed to the maintenance of the standing posture by stabilizing the hip joints against alternating trunk rotations.

Adaptation, Physiological↗

The influence of artificially increased trunk stiffness on the balance recovery after a trip.

Falls occur frequently in the growing population of elderly. Since trunk control is critical for maintaining balance, the higher trunk stiffness in elderly people compared to the general population has been associated with their increased fall-risk. Theoretically, trunk stiffness may be beneficial for balance recovery in walking, i.e. after a trip. A stiff joint may provide a torque that restricts the perturbation effects and thereby reduces the probability of a fall. The aim of this study was to test whether trunk stiffness impaired or assisted balance recovery after a trip during walking. An orthopedic corset was used to simulate trunk stiffness in 11 young male adults. Subjects walked over a platform, with or without the corset on, and were occasionally tripped over a hidden obstacle. Kinematics of the tripping reaction were measured. Initial trunk accelerations were significantly attenuated by the corset, which indicates a positive effect of the stiffening corset. However, no subsequent effects on peak trunk inclination and on the peak moment arm of gravity on the trunk were found. The pattern of trunk motion allowed ample time for triggered or voluntary muscle responses to be generated, before a substantial inclination occurred. It appears that such active responses were sufficient in the young subjects tested to obtain a similar net effect with or without the increased trunk stiffness induced by the corset.

Accidental Falls↗

Trunk stiffness increases with steady-state effort.

Trunk stiffness was measured in healthy human subjects as a function of steady-state preload efforts in different horizontal loading directions. Since muscle stiffness increases with increased muscle activation associated with increasing effort, it is believed that coactivation of muscles helps to stiffen and stabilize the trunk. This paper tested whether increased steady-state preload effort increases trunk stiffness. Fourteen young healthy subjects each stood in an apparatus with the pelvis immobilized. They were loaded horizontally at directions of 0, 45, 90, 135 and 180 degrees to the forward direction via a thoracic harness. Subjects first equilibrated with a steady-state load of 20 or 40% of their maximum extension effort. Then a sine-wave force perturbation of nominal amplitude of 7.5 or 15% of maximum effort and nominal period of 250ms was applied. Both the applied force and subsequent motion were recorded. Effective trunk mass and trunk-driving point stiffness were estimated by fitting the experimental data to a second-order differential equation of the trunk dynamic behavior. The mean effective trunk mass was 14.1kg (s.d.=4.7). The trunk-driving point stiffness increased on average 36.8% (from 14.5 to 19.8N/mm) with an increase in the nominal steady-state preload effort from 20 to 40% (F(1,13)=204.96, p<0.001). There was a smaller, but significant variation in trunk stiffness with loading direction. The measured increase in trunk stiffness probably results from increased muscle stiffness with increased muscle activation at higher steady-state efforts.

Adult↗

Trunk muscle activities during asymmetric twisting motions.

Axial twisting of the torso has been identified via epidemiologic studies as a significant risk factor for occupationally-related low back disorders. However, only recently have biomechanical studies been able to describe how twisting is accomplished through the use of the trunk musculature. These studies have been performed on subjects whose torso twists were performed in an upright posture. In this study, the electromyographic activity of ten trunk muscles was observed while 12 subjects performed twisting exertions in three different trunk postures. These postures included upright twisting, twisting while the trunk was flexed in the sagittal plane, and twisting while the trunk was flexed and rotated asymmetrically. In addition, twisting velocity and direction of motion were changed under the experimental conditions. Under upright twisting conditions, the twisting torque was generated easily and relatively efficiently through the employment of the oblique (internal and external) and latissimus dorsi muscles. When the trunk was flexed the activity of erector spinae muscles increased (about 10-15%) while the external oblique activity decreased (about 3-5%). Twisting while in asymmetric bent postures was accomplished with a reduction in oblique and latissimus dorsi muscle activities (approximately 5%) while the erector spinae muscle activity remained elevated. The change in muscle activity needed to balance the torso during twisting while bending also increased the amount of lateral torque that was produced by the trunk. These findings suggest that studies observing trunk muscle activities and trunk loading while subjects were in upright postures should be interpreted with caution when evaluating the activity of the trunk during occupational activities. Since many occupational twisting tasks are performed in awkward, asymmetric postures, application of results from upright twisting studies might underestimate the risk of these activities.

Abdominal Muscles↗

Valves in the subsidiary lymph trunks in the neck.

INTRODUCTION: The thoracic duct drains both lymph and chyle into the confluence of the great veins in the root of the neck. The venous termination of the duct is protected from retrograde flow of blood by valves. However, little attention has been focused on the presence or absence of valves in the subsidiary lymph trunks in the neck. AIMS: The aim of this study was to determine whether there are valves in the subsidiary lymphatic system in the neck. MATERIAL AND METHODS: The left side of the neck was explored in ten formalin-fixed cadavers. Subsidiary lymphatic trunks were carefully preserved for stereomicroscopic examination. RESULTS: Eight subsidiary trunks were identified comprising four jugular, two subclavian and two bronchomediastinal trunks. Both subclavian lymph trunks drained directly into a vein. A bicuspid ostial valve was present at the termination of the trunks. The bronchomediastinal and jugular trunks drained into the thoracic duct prior to its venous termination. Valvular structures were identified along the bronchomediastinal trunks and at their termination with the thoracic duct. No valves were identified in the jugular trunks. CONCLUSION: The absence of valves in the jugular lymph trunks is proposed as a possible contributory factor in the creation of chyle leaks following neck dissections.

Humans↗

Impairment magnification during dynamic trunk motions.

STUDY DESIGN: An examination of a group of patients with low back disorder and a group of healthy (asymptomatic) individuals asked to produce trunk motions under sincere and insincere experimental conditions. Trunk motion components were examined to determine which combination of motion components could best distinguish between sincere and insincere efforts. OBJECTIVE: To determine whether examination of trunk motion components could be used to identify impairment magnification during unresisted repeated bending tasks. SUMMARY OF BACKGROUND DATA: Trunk motion measures can be used to assess and "benchmark" the status of the low back. However, these measures typically are clinically useful only if the individual is producing an effort that does not magnify the impairment during the functional evaluation. This study addressed the issue of impairment magnification during the production of free dynamic trunk motion. METHODS: The trunk motion characteristics of 100 healthy individuals and 100 patients with chronic low back disorders were documented. All participants were asked to produce the trunk motions in two different types of conditions. In the one experimental condition, they were asked to produce sincere trunk motions. In the other experimental condition they were asked to pretend either that they were experiencing low back pain (the asymptomatic group) or that their pain was worse than it actually was (group with low back pain). RESULTS: A combination of trunk motion measures was able to distinguish well between the conditions. Sensitivity and specificity for the asymptomatic group were 92%, whereas they were 75% for the group with low back pain. Overall, sensitivity and specificity were 81.5% for all the participants combined. CONCLUSIONS: These results indicate that motion measures can be used to help assess impairment magnification during functional trunk motion testing. These measures can provide a means by which to scrutinize the quality of quantitative measures indicating the extent of a low back disorder. These objective motion measures also can be used to complement other subjective observational methods for the assessment of impairment.

Acceleration↗

Lumbar back muscle activity during locomotion: effects of voluntary modifications of normal trunk movements.

The mechanisms of adaptation of the trunk to changed mechanical conditions were studied during locomotion in man. The myoelectrical (EMG) activity in lumbar back muscles and the movements of the trunk were recorded in nine healthy subjects during walking and running on a motor-driven treadmill. Two different types of voluntary modifications of the movement pattern were used: (1) The trunk was kept in an extreme forward or backward tilted position. In both these situations the basic EMG pattern with two periods of activity per stride cycle was maintained during walking, whereas a major shift relative to the stride cycle (25% of the stride cycle duration) occurred in running with the trunk tilted backwards. The synchrony of the back muscle activation at both sides increased when locomotion was performed with the trunk tilted forwards. The relative duration of the EMG bursts was similar to normal locomotion and corresponded to 15-26% of the stride cycle duration in walking and 23-37% in running. (2) In the other type of modification the subjects were instructed to exaggerate the angular trunk movements either in the sagittal or in the frontal plane. The basic EMG pattern and phase relationships remained in most cases unchanged. One exception was running with exaggerated lateral movements, in which only one period of back muscle activity per stride cycle was observed. The relative duration of the bursts was longer in trials with exaggerated trunk movements as compared to normal locomotion. In walking and running with the trunk tilted forwards or backwards the lumbar back muscles were not always involved as prime movers of the trunk. This was in contrast to the more dynamic situations, in which the back muscle activity appeared to be directly involved in braking and reversing the exaggerated trunk movements.

Adaptation, Physiological↗