Name: lower limb biomechanical analysis of healthy participants
Uploaded: 2020-04-15T14:00:00
Description: Watch this Scientific Journal Video about Lower Limb Biomechanical Analysis of Healthy Participants at JoVE.com

We would like to thank Dr. Johnathan Williams for his advice on MATLAB data processing.

The method reported was followed in a study that received ethical approval from the Bournemouth University Research Ethics Committee (Reference 15005).
1. Participants
<ol>
	<li>Recruit healthy adults (aged from 23 to 63 years, mean &#177; S.D.; 42.0 &#177; 13.4, body mass 70.4 &#177; 15.3 kg, height 175.5 &#177; 9.8 cm; 15 males, 15 females) to participate in the study. Thirty participants were recruited for this study.</li>
	<li>Ensure that there is no self-reported history of dizziness, b...

<ol>
	<li>Lu, T. W., Chang, C. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Biomechanics+of+human+movement+and+its+clinical+applications.">Biomechanics of human movement and its clinical applications.</a> The Kaohsiung Journal of Medical Sciences. 28 (2 Suppl), S13-S25 (2012).</li><li>Kaufman, K., An, K., Firestein, G. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Kelley and Firestein's Textbook of Rheumatology (Tenth Edition). , 78-89 (2017).</li><li>Sloot, L. H., van der Krogt, M. 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C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Muscle+strength+differences+in+healthy+young+adults+with+and+without+generalized+joint+hypermobility:+a+cross-sectional+study.">Muscle strength differences in healthy young adults with and without generalized joint hypermobility: a cross-sectional study.</a> BMC Sports Science, Medicine &amp; Rehabilitation. 8, 12 (2016).</li><li>Muehlbauer, T., Granacher, U., Borde, R., Hortob&#225;gyi, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Non-Discriminant+Relationships+between+Leg+Muscle+Strength,+Mass+and+Gait+Performance+in+Healthy+Young+and+Old+Adults.">Non-Discriminant Relationships between Leg Muscle Strength, Mass and Gait Performance in Healthy Young and Old Adults.</a> Gerontology. 64 (1), 11-18 (2018).</li><li>van den Bogert, A. 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H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+method+for+the+reduction+of+skin+marker+artifacts+during+walking+:+Application+to+the+knee.">A method for the reduction of skin marker artifacts during walking : Application to the knee.</a> KSME International Journal. 17 (6), 825-835 (2003).</li><li>Liu, P. C., Liu, J. F., Chen, L. Y., Xia, K., Wu, X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intermittent+pneumatic+compression+devices+combined+with+anticoagulants+for+prevention+of+symptomatic+deep+vein+thrombosis+after+total+knee+arthroplasty:+a+pilot+study.">Intermittent pneumatic compression devices combined with anticoagulants for prevention of symptomatic deep vein thrombosis after total knee arthroplasty: a pilot study.</a> Therapeutics and Clinical Risk Management. 13, 179-183 (2017).</li><li>Al-Amri, M., Al Balushi, H., Mashabi, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intra-rater+repeatability+of+gait+parameters+in+healthy+adults+during+self-paced+treadmill-based+virtual+reality+walking.">Intra-rater repeatability of gait parameters in healthy adults during self-paced treadmill-based virtual reality walking.</a> Computer Methods in Biomechanics and Biomedical Engineering. 20 (16), 1669-1677 (2017).</li><li>Zeni, J., Richards, J., Higginson, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Two+simple+methods+for+determining+gait+events+during+treadmill+and+overground+walking+using+kinematic+data.">Two simple methods for determining gait events during treadmill and overground walking using kinematic data.</a> Gait &amp; Posture. 27 (4), 710-714 (2008).</li><li>Tsaopoulos, D. E., Baltzopoulos, V., Richards, P. J., Maganaris, C. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanical+correction+of+dynamometer+moment+for+the+effects+of+segment+motion+during+isometric+knee-extension+tests.">Mechanical correction of dynamometer moment for the effects of segment motion during isometric knee-extension tests.</a> Journal of Applied Physiology. 111 (1), 68-74 (2011).</li><li>Abernethy, P., Wilson, G., Logan, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Strength+and+power+assessment.+Issues,+controversies+and+challenges.">Strength and power assessment. Issues, controversies and challenges.</a> Sports Medicine. 19 (6), 401-417 (1995).</li><li>Kroll, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+a+Selected+Measure+of+Human+Strength.">Reliability of a Selected Measure of Human Strength.</a> Research Quarterly, American Association for Health, Physical Education and Recreation. 33 (3), 410-417 (1962).</li><li>Anzak, A., Tan, H., Pogosyan, A., Brown, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Doing+better+than+your+best:+loud+auditory+stimulation+yields+improvements+in+maximal+voluntary+force.">Doing better than your best: loud auditory stimulation yields improvements in maximal voluntary force.</a> Experimental Brain Research. 208 (2), 237-243 (2011).</li><li>Belkhiria, C., De Marco, G., Driss, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+verbal+encouragement+on+force+and+electromyographic+activations+during+exercise.">Effects of verbal encouragement on force and electromyographic activations during exercise.</a> Journal of Sports Medicine and Physical Fitness. 58 (5), 750-757 (2018).</li><li>Bickers, M. 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The contribution of this study is to accurately and comprehensively describe within one protocol the techniques for combined gait analysis and muscle strength testing that have not previously been described together.
In order to achieve accurate results for gait analysis, there are two areas that require maximum attention: 1) marker placements and 2) acclimatization time. The accuracy of the measured data is heavily dependent on the accuracy of the model used. The other key factors that affect...

The discipline of biomechanics primarily involves the study of stress, strain, loads and motion of biological systems - solid and fluid alike. It also involves the modelling of mechanical effects on the structure, size, shape and movement of the body1. For many years, developments in this field have improved our understanding of normal and pathologic gait, mechanics of neuromuscular control, and mechanics of growth and form2.
The main objective of this article is to present a comprehensive methodology on two of the latest technologies available to measure lower limb biomechanics of individuals. The gait analysis system measures and quantifies gait biomechanics by using a self-paced (SP) treadmill in combination with an augmented reality environment, which integrates a SP algorithm to regulate the treadmill&#39;s speed, as described by Sloot et al3. The muscle strength testing equipment is used as an assessment and a treatment tool for upper extremity rehabilitation4. This device can objectively assess a variety of physiological patterns of movement or job simulation tasks in isometric and isotonic modes. It is currently recognized as the gold standard for upper limb strength measurement5 but the evidence related specifically to the lower limb remains unclear. This paper explains the detailed protocol for completing an assessment of gait and isometric strength for the lower extremity.
Within biomechanical analysis, it is useful to combine assessments of functional performance (such as gait analysis) with specific tests of muscular performance. This is because whilst it may be assumed that increased muscle strength improves functional performance, this may not always be apparent6. This understanding is required for the improved future design of rehabilitation protocols and research strategies to assess these approaches.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>701 Small lever</td>
			<td>Baltimore Therapeutic Equipment Company (BTE)</td>
			<td>Not Available - Online link provided in description</td>
			<td>The unique attachment designed for the Primus RS to measure Knee Extension/Flexion - <a href="https://store.btetech.com/collections/primus/products/701-small-lever" target="_blank">https://store.btetech.com/collections/primus/products/701-small-lever</a></td>
		</tr>
		<tr>
			<td>D-Flow Software - Vresion 3.26</td>
			<td>Motekforce Link</td>
			<td>Not Available - Online link provided in description</td>
			<td>Software used to control GRAIL system - <a href="https://summitmedsci.co.uk/products/motek-dflow-hbm-software/" target="_blank">https://summitmedsci.co.uk/products/motek-dflow-hbm-software/</a></td>
		</tr>
		<tr>
			<td>Gait Offline Analysis (GOAT) - Version 2.3</td>
			<td>Motekforce Link</td>
			<td>Not Available - Online link provided in description</td>
			<td>Software used for the analysis of the gait parameters - <a href="https://www.motekmedical.com/product/grail/" target="_blank">https://www.motekmedical.com/product/grail/</a></td>
		</tr>
		<tr>
			<td>Gait Real-time Analysis Interactive Lab (GRAIL)</td>
			<td>Motekforce Link</td>
			<td>Not Available - Online link provided in description</td>
			<td>GRAIL system measures and quantifies gait biomechanics by using a virtual reality based self-paced (SP) treadmill - <a href="https://www.motekmedical.com/product/grail/" target="_blank">https://www.motekmedical.com/product/grail/</a></td>
		</tr>
		<tr>
			<td>Leg Pad for 701</td>
			<td>Baltimore Therapeutic Equipment Company (BTE)</td>
			<td>Not Available - Online link provided in description</td>
			<td>The unique attachment designed for the Primus RS to measure Knee Extension/Flexion - <a href="https://store.btetech.com/collections/primus/products/701-802-leg-pad" target="_blank">https://store.btetech.com/collections/primus/products/701-802-leg-pad</a></td>
		</tr>
		<tr>
			<td>Positioning Chair</td>
			<td>Baltimore Therapeutic Equipment Company (BTE)</td>
			<td>Not Available - Online link provided in description</td>
			<td>Participant Positioning Chair is designed for assessment and treatment of the lower exteremeties. The chair is designed for multiple positions. <a href="https://www.btetech.com/product/primus/" target="_blank">https://www.btetech.com/product/primus/</a></td>
		</tr>
		<tr>
			<td>Primus RS</td>
			<td>Baltimore Therapeutic Equipment Company (BTE)</td>
			<td>Not Available - Online link provided in description</td>
			<td>Primus RS equipment captures and reports real time objective data in Isotonic, Isometric, and Isokinetic resistance modes - <a href="https://www.btetech.com/wp-content/uploads/BTE-Rehabilitation-Equipment-PrimusRS-Brochure-1.pdf" target="_blank">https://www.btetech.com/wp-content/uploads/BTE-Rehabilitation-Equipment-PrimusRS-Brochure-1.pdf</a></td>
		</tr>
	</tbody>
</table>

lower limb biomechanical analysis of healthy participants

Biomechanical analysis techniques are useful in the study of human movement. The aim of this study was to introduce a technique for the lower limb biomechanical assessment in healthy participants using commercially available systems. Separate protocols were introduced for the gait analysis and muscle strength testing systems. To ensure maximum accuracy for gait assessment, attention should be given to the marker placements and self-paced treadmill acclimatization time. Similarly, participant positioning, a practice trial, and verbal encouragement are three critical stages in muscle strength testing. The current evidence suggests that the methodology outlined in this article may be effective for the assessment of lower limb biomechanics.

The mean and standard deviation of the spatial-temporal, kinematics, and kinetic gait parameters are given in Table 2. MVIC data for all 30 participants are summarized in Table 3. A typical set of data for the left and right side of one participant showing graphical representation of gait parameters is provided in Figure 4 and Figure 5, respectively.
<p class="jove_content" fo:keep-together.w...

Watch this Scientific Journal Video about Lower Limb Biomechanical Analysis of Healthy Participants at JoVE.com

Lower Limb Biomechanical Analysis of Healthy Participants

This article introduces a comprehensive experimental methodology on two of the latest technologies available to measure the lower limb biomechanics of individuals.

Biomechanical analysis techniques are useful in the study of human movement. The aim of this study was to introduce a technique for the lower limb ...

Biomechanical analysis techniques are useful in the study of human movement. This technique can be used for leveling biomechanical assessment in healthy participants using commercially available systems. In biomechanical analysis, it's useful to have specific test of function like gait analysis combined with tests looking at muscular performance.Understanding the relationship between muscle strength and the ability to perform functional tasks such as walking is needed in the future design of research studies and rehabilitation protocols. Demonstrating our protocol today is Francesco Ferraro, trial manager in our team. Before beginning the analysis, confirm that the participant is wearing tight non-reflective clothing such as cycling shorts or leggings and use double-sided adhesive tape to attach 25 passive reflective markers onto the participant according to the lower body configuration of the human body model as illustrated.Use a joint ruler to take measurements of the required knee and ankle widths for the model and secure the participant to a safety harness that is fastened to an overhead frame. Start a new session in the database and make sure the session is active. Under the Subject tab, click the Labeling Skeleton button and navigate to the Lower Limb HBM N2 VST file to create a new participant.Enter the name of the participant and click OK.The name of the participant will appear in the subjects window. In the tools windows, open the Subject Preparation tab. Click to zero level the force plates and ask the participant to stand in the middle of the treadmill while walking at a comfortable speed for five minutes immediately following the acclimatization and click Start Recording in the software to begin recording the gait data.Stop the recording after acquiring the desired amount of data. To remove the high-frequency noise in the data, open the processing software, select a low-pass filter for the marker data, and determine the individual strides from the vertical force data using the foot markers to ascertain the gain events. Export the data as a CSV file.The gait parameters such as the kinematic, kinetic, and spatial temporal data can then be analyzed. To measure the participant's muscle strength based on the maximum voluntary isometric contraction, first attach the tool pad number 701 to the dynamometer exercise head and have the participant sit on the chair with a back rest. To test the knee isometric muscle strength, use the up/down switch to align the dynamometer axis with the anatomical axis of rotation of the knee and place the pad of the tool centrally at the lower part of the shin of the tibia.Have the participant position the knee at a 90 degree flexion with the hip in neutral rotation and abduction and the foot in plantar flexion. Then have the participant place their hands on their abdomen and stabilize the trunk, hips, and mid thigh on the chair with Velcro straps. To familiarize the participant with the testing maneuver, have the participant extend their knee before flexing to exert a maximum contraction on the command go for three seconds while providing verbal prompts and encouragement.When the participant is comfortable with the procedure, ensure the participant that they can stop the test immediately if they experience any unusual pain or discomfort and allow the participant for rest for two minutes. Then repeat the trial three times for the left leg and three times for the right leg as just demonstrated recording and exporting the data in Newtons. Here, the mean and standard deviation of the spatial temporal, kinematics, and kinetic gait parameters of 30 participants from a representative analysis are shown.As observed in this table summarizing the mean and standard deviation of the maximum voluntary isometric contraction for the knee joints of the participants, on average, the right knee demonstrated a slightly more robust extension and flexion in the assessed participants. In this offline analysis of the gait assessment of one participant, the spatial temporal data and kinematic and kinetic gait cycle for the left side of the participant can be observed. These data were similarly reproduced when the spatial temporal data and kinematic and kinetic gait cycle for the right side of the participant were assessed.Clinical research has identified clear links between human biomechanics characteristics and different medical conditions. This protocol can be used for the accurate and comprehensive testing of combined gait analysis and muscle strength in a way that has not been previously described. Future research in orthopedic surgery will require accurate and repeatable techniques to measure gait.The data collected through the technique described is consistent with international reference data for gait analysis and isometric muscle strength testing.

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