Abstract

BackgroundStrength and coordination of lower muscle groups typically identified in healthy subjects are two prerequisites to performing functional activities. These physical qualities can be impaired following a neurological insult. A static dynamometer apparatus that measures lower limb joint moments during directional efforts at the foot was developed to recruit different patterns of muscular activity. The objectives of the present study were to 1) validate joint moments estimated by the apparatus, and 2) to characterize lower limb joint moments and muscular activity patterns of healthy subjects during progressive static efforts. Subjects were seated in a semi-reclined position with one foot attached to a force platform interfaced with a laboratory computer. Forces and moments exerted under the foot were computed using inverse dynamics, allowing for the estimation of lower limb joint moments.To achieve the study’s first objective, joint moments were validated by comparing moments of various magnitudes of force applied by turnbuckles on an instrumented leg equipped with strain gauges with those estimated by the apparatus. Concurrent validity and agreement were assessed using Pearson correlation coefficients and Bland and Altman analysis, respectively. For the second objective, joint moments and muscular activity were characterized for five healthy subjects while exerting progressive effort in eight sagittal directions. Lower limb joint moments were estimated during directional efforts using inverse dynamics. Muscular activity of eight muscles of the lower limb was recorded using surface electrodes and further analyzed using normalized root mean square data.ResultsThe joint moments estimated with the instrumented leg were correlated (r > 0.999) with those measured by the dynamometer. Limits of agreement ranged between 8.5 and 19.2% of the average joint moment calculated by both devices. During progressive efforts on the apparatus, joint moments and patterns of muscular activity were specific to the direction of effort. Patterns of muscular activity in four directions were similar to activation patterns reported in the literature for specific portions of gait cycle.ConclusionThis apparatus provides valid joint moments exerted at the lower limbs. It is suggested that this methodology be used to recruit muscular activity patterns impaired in neurological populations.

Highlights

  • Strength and coordination of lower muscle groups typically identified in healthy subjects are two prerequisites to performing functional activities

  • Joint moments and EMG recordings change according to effort of direction The results indicate that joint moments and patterns of muscular activity recorded during progressive static efforts on the apparatus change according to the direction of effort

  • Potential of the methodology to be incorporated into a rehabilitation program A rehabilitation program using this methodology could be used to train muscular activity patterns identified during gait using four (D3, D4, D5 and D8) of the eight directions identified. This methodology has the potential to provide feedback about joint moments during progressive, static, directional efforts to replicate precise joint moments previously described during gait. This methodology could be improved by providing feedback on joint moments exerted at the ankle, knee and hip to better replicate gait kinetics and EMG during the early stance, terminal stance and initial swing phases of gait

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Summary

Introduction

Strength and coordination of lower muscle groups typically identified in healthy subjects are two prerequisites to performing functional activities. The objectives of the present study were to 1) validate joint moments estimated by the apparatus, and 2) to characterize lower limb joint moments and muscular activity patterns of healthy subjects during progressive static efforts. Systematic reviews have provided evidence that progressive resistive training increases muscle strength in stroke patients [6,7,8] These gains may not translate into improved functional performance [6]. The training programs used in three studies focused on multi-articular strengthening exercises, which suggests that improved functional performance could be related to the reinforcement of multi-articular muscles In another recent meta-analysis, it was shown that the use of an isokinetic dynamometer is a suitable strategy for improving multi-articular muscle strength and functional mobility during walking in stroke patients [8]

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