Hip-ankle Coordination Research Articles

Clustering classification of diabetic walking abnormalities: a new approach taking into account intralimb coordination patterns

BackgroundIt is well recognized that diabetes and peripheral neuropathy have a detrimental effect on gait. However, there are large variations in the results of studies addressing this aspect due to the heterogeneity of diabetic population in relation to presence and severity of diabetes complications. The aim of this study is to adopt an unsupervised classification technique to better elucidate the gait changes throughout the entire spectrum of diabetes and neuropathy. MethodsSixty subjects were assessed and classified into four groups using a fuzzy logic model: 13 controls (55 ± 7years), 18 diabetics subjects without neuropathy (59 ± 6 years, 11 ± 7 diabetes years), 7 with mild neuropathy (56 ± 4years, 19 ± 7 diabetes years), and 22 with moderate to severe neuropathy (57 ± 5 years, 14 ± 8 diabetes years). Data were gathered by six infrared cameras at 100 Hz regarding lower limb joint kinematics (angles and angular velocities) and the relative phase for the hip-ankle, hip-knee, and knee-ankle were calculated. The K-means clustering algorithm was adopted to classify subjects considering the whole kinematics time series. A one-way ANOVA test was used to compare both clinical and kinematics parameters across clusters. ResultsOnly the classification based on the intralimb coordination variables succeeded in defining 5 well separated clusters with the following clinical characteristics: controls were grouped mainly in Cluster 2, diabetics in Cluster 4, and neuropathic subjects in Cluster 5 (which included various degrees of severity). Hip-ankle coordination in Clusters 4 and 5 were significantly different (p < 0.05) with respect to Cluster 2, mainly in the stance phase. During the swing phase, differences were observed in the ankle-knee coordination (p < 0.05) across clusters. ConclusionClassification based on intralimb coordination patterns succeeded in efficiently categorize gait alterations in diabetic subjects. It can be speculated that variables extracted from sagittal plane kinematics might be adopted as a support to clinical decision making in diabetes.

Improvements in skilled walking associated with kinematic adaptations in people with spinal cord injury

IntroductionIndividuals with motor-incomplete SCI (m-iSCI) remain limited community ambulators, partly because they have difficulty with the skilled walking requirements of everyday life that require adaptations in inter-joint coordination and range of motion of the lower limbs. Following locomotor training, individuals with SCI show improvements in skilled walking and walking speed, however there is limited understanding of how adaptations in lower limb kinematics following training contribute to improvements in walking.ObjectiveTo determine the relationship between changes in lower limb kinematics (range of motion and inter-joint coordination) and improvements in walking function (walking speed and skilled walking) following locomotor training.MethodsLower limb kinematics were recorded from 8 individuals with chronic m-iSCI during treadmill walking before and after a 3-month locomotor training program. Data were also collected from 5 able-bodied individuals to provide normative values. In individuals with SCI, muscle strength was used to define the stronger and weaker limb. Motion analysis was used to determine, hip, knee and ankle angles. Joint angle-angle plots (cyclograms) were used to quantify inter-joint coordination. Shape differences between pre-and post-training cyclograms were used to assess the changes in coordination and their relation to improvements in walking function. Walking function was assessed using the 10MWT for walking speed and the SCI-FAP for skilled walking. Comparing pre- and post-training cyclograms to the able-bodied pattern was used to understand the extent to which changes in coordination involved the recovery of normative motor patterns.ResultsFollowing training, improvements in skilled walking were significantly related to changes in hip-ankle coordination (ρ = − .833, p = 0.010) and knee range of motion (ρ = .833, p = 0.010) of the weaker limb. Inter-joint coordination tended to revert towards normative patterns, but not completely. No relationships were observed with walking speed.ConclusionLarger changes in hip-ankle coordination and a decrease in knee range of motion in the weaker limb during treadmill walking were related to improvements in skilled walking following locomotor training in individuals with SCI. The changes in coordination seem to reflect some restoration of normative patterns and the adoption of compensatory strategies, depending on the participant.

Human-Inspired Eigenmovement Concept Provides Coupling-Free Sensorimotor Control in Humanoid Robot.

Control of a multi-body system in both robots and humans may face the problem of destabilizing dynamic coupling effects arising between linked body segments. The state of the art solutions in robotics are full state feedback controllers. For human hip-ankle coordination, a more parsimonious and theoretically stable alternative to the robotics solution has been suggested in terms of the Eigenmovement (EM) control. Eigenmovements are kinematic synergies designed to describe the multi DoF system, and its control, with a set of independent, and hence coupling-free, scalar equations. This paper investigates whether the EM alternative shows “real-world robustness” against noisy and inaccurate sensors, mechanical non-linearities such as dead zones, and human-like feedback time delays when controlling hip-ankle movements of a balancing humanoid robot. The EM concept and the EM controller are introduced, the robot's dynamics are identified using a biomechanical approach, and robot tests are performed in a human posture control laboratory. The tests show that the EM controller provides stable control of the robot with proactive (“voluntary”) movements and reactive balancing of stance during support surface tilts and translations. Although a preliminary robot-human comparison reveals similarities and differences, we conclude (i) the Eigenmovement concept is a valid candidate when different concepts of human sensorimotor control are considered, and (ii) that human-inspired robot experiments may help to decide in future the choice among the candidates and to improve the design of humanoid robots and robotic rehabilitation devices.

Hip-ankle coordination during gait in individuals with chronic ankle instability

Individuals with chronic ankle instability (CAI) may have sensorimotor impairments that affect control at the hip in addition to the ankle. The purpose of this study was to compare hip-ankle coordination and coordination variability between individuals with CAI and healthy individuals during walking. Ten healthy subjects and 10 subjects with CAI were recruited to walk on a treadmill. Hip-ankle coordination was quantified using vector coding, and coordination variability was quantified using coefficient of correspondence. We found significant between-group differences in hip-ankle coordination in the frontal plane around loading response (Control: 165.9±18.4°; CAI: 127.6±48.6°, p=0.04) and in the sagittal plane around the first half of mid stance (Control: 307.2±9.8°; CAI: 291.8±11.4°, p<0.01), terminal stance (Control: 301.1±13°; CAI: 313.4±10.9°, p=0.04), and pre-swing (Control: 243.9±35.2°; CAI: 329.9±57.8°, p<0.01). We also found significant between-group differences in hip-ankle coordination variability in the frontal plane around the second half of mid stance (Control: 0.54±0.06; CAI: 0.45±0.07, P<0.01). CAI is associated with alteration of hip-ankle coordination and coordination variability in stance phase during walking. Gait training is important in CAI rehabilitation, and the training should address altered hip-ankle coordination to reduce the risk of recurrent injuries.

Prospectively identified deficits in sagittal plane hip–ankle coordination in female athletes who sustain a second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport

BackgroundAthletes who return to sport after anterior cruciate ligament reconstruction are at increased risk of future ACL injury. Altered coordination of lower extremity motion may increase this risk. The purpose of this study was to prospectively determine if altered lower extremity coordination patterns exist in athletes who go on to sustain a 2nd anterior cruciate ligament injury. MethodsSixty-one female athletes who were cleared to return to sport after anterior cruciate ligament reconstruction were included. Hip–ankle coordination was assessed prior to return to sport with a dynamic postural coordination task. Within 12months, 14 patients sustained a 2nd ACL injury. Fourteen matched subjects were selected for comparative analysis. Cross-recurrence quantification analysis characterized hip–ankle coordination patterns. A group×target speed (slow vs. fast)×leg (involved vs. uninvolved) analysis of variance was used to identify differences. FindingsA main effect of group (P=0.02) indicated that the single injury group exhibited more stable hip–ankle coordination [166.2 (18.9)] compared to the 2nd injury group [108.4 (10.1)]. A leg×group interaction was also observed (P=.04). The affected leg of the single injury group exhibited more stable coordination [M=187.1 (23.3)] compared to the affected leg of the 2nd injury group [M=110.13 (9.8)], P=0.03. InterpretationHip–ankle coordination was altered in female athletes who sustained a 2nd anterior cruciate ligament injury after return to sport. Failure to coordinate lower extremity movement in the absence of normal knee proprioception may place the knee at risk.

Human hip–ankle coordination emerging from multisensory feedback control

Human sensorimotor control involves inter-segmental coordination to cope with the complexity of a multi-segment system. The combined activation of hip and ankle muscles during upright stance represents the hip–ankle coordination. This study postulates that the coordination emerges from interactions on the sensory levels in the feedback control. The hypothesis was tested in a model-based approach that compared human experimental data with model simulations. Seven subjects were standing with eyes closed on an anterior–posterior tilting motion platform. Postural responses in terms of angular excursions of trunk and legs with respect to vertical were measured and characterized using spectral analysis. The presented control model consists of separate feedback modules for the hip and ankle joints, which exchange sensory information with each other. The feedback modules utilize sensor-derived disturbance estimates rather than ‘raw’ sensory signals. The comparison of the human data with the simulation data revealed close correspondence, suggesting that the model captures important aspects of the human sensory feedback control. For verification, the model was re-embodied in a humanoid robot that was tested in the human laboratory. The findings show that the hip–ankle coordination can be explained by interactions between the feedback control modules of the hip and ankle joints.

Deficits in Hip-Ankle Coordination in Female Athletes who Suffer a Second Anterior Cruciate Ligament (ACL) Injury after ACL Reconstruction and Return to Sport

Objectives:Athletes who return to sport after ACL reconstruction (ACLR) are at increased risk of future ACL injury. Proprioceptive deficits at the knee, known to be present at thetime of ACL injury, may persist for up to 2 years after ACLR. Coordinated movements of the hip and ankle are critical in the absence of normal knee proprioception during dynamic athletic movements. Failure to optimally position the knee may make the passive structures susceptible to pathologic stresses that increase the risk of subsequent ligament or graft failure. The purpose of this work was to prospectively determine if altered lower extremity coordination patterns exist in female athletes, who go on to suffer a second ACL injury to either limb, after ACLR and return to sport (RTS). The study tested the hypothesis that female athletes who sustained a second ACL injury would demonstrate altered lower extremity coordination patterns indicative of persistent neuromuscular deficits at the time of return to sport compared to female athletes who would not subsequently sustain a second ACL injury.Methods:Sixty-one female athletes, who sustained an ACL injury, underwent ACLR, completed rehabilitation and were medically cleared for RTS were enrolled in this study. Hip-ankle coordination was assessed on all athletes prior to RTS as they performed a dynamic postural coordination task. The task required participants to stand on a single leg and track the anterior-posterior (AP) movement of an oscillating 3-D square target displayed on a computer monitor. Participants tracked the target with the head so as to maintain a constant perceived distance between their head and the target by matching the amplitude and frequency of the target oscillations. Fourteen patients sustained a second ACL injury within 12 months of RTS (ACLR2). Fourteen matched subjects after ACLR, who did not suffer a second ACL injury (ACLR1), were selected for comparative analysis. Cross-recurrence quantification analysis (Figure 1) was used to characterize hip-ankle coordination patterns through the variable cross-maxline (CML). A group (ACLR1 vs. ACLR2) X target speed (slow vs. fast) X leg (affected vs. unaffected) mixed-model analysis of variance was used to identify coordination differences.Results:A significant main effect of group was observed (p = 0.02), and indicated that the ACLR1 group exhibited more stable hip-ankle coordination overall (M = 166.2 ± 18.9) compared to the ACLR2 group (M = 108.4 ± 10.1), irrespective of target speed or tested leg. A leg x group interaction was also observed (p = .04). A Mann-Whitney test was employed due to unequal variances between groups, and indicated that the affected leg of the ACLR1 group exhibited more stable coordination (M = 187.1 ± 23.3)compared to the affected leg of the ACLR2 group (M = 110.13 ± 9.8), p = 0.03.Conclusion:Hip-ankle coordination was altered in female athletes who subsequently sustain a second ACL injury after initial ACLR and RTS. Failure to appropriately coordinate lower extremity movement between the adjoining proximal and distal hip and ankle in the absence of normal knee proprioception, may place the knee in a high-risk position and increase the likelihood of a second ACL injury in this population.

Hip-ankle coordination strategy of stroke patients in dynamic condition

Hip-ankle coordination strategy of stroke patients in dynamic condition

A model of postural coordination dynamics

Prior research has shown that voluntary postural movement is characterized by stable in-phase and antiphase hip–ankle coordination modes. Prior modeling of coordination dynamics does not capture the stable fixed-points, phase transitions and hysteresis found in hip–ankle coordination. In this article a model was created to capture the dynamics of hip–ankle postural coordination. The present model follows the synergetic approach and uses two nonlinear oscillators to capture the dynamics of hip–ankle coordination. Terms for symmetry breaking and additive stochastic noise are included in the model. The model captures phase transitions from in-phase to antiphase coordination as movement frequency is scaled up and from antiphase to in-phase coordination as movement frequency is scaled down. The model also exhibits hysteresis, with phase transitions occurring at different movement frequencies as the control parameter is scaled up and down.

Hierarchical control in redundant and non-redundant postural tasks

Prior studies of postural coordination have shown inconsistencies between hip-ankle coordination in redundant and non-redundant coordination tasks as well as predictions of the HKB model. These inconsistencies were investigated by testing the hypothesis that there are different hierarchical control structures for redundant (multiple potential task solutions) and non-redundant (a single task solution) coordination tasks (Bernstein, 1996). The transfer between a non-redundant postural tracking task and a redundant scanning task consisting of 16 hip-ankle relative phase patterns from 0° to 337.5° was investigated. The results showed that the transfer between the tasks was transitory, negative and occurred only from the non-redundant to the redundant task. This finding supports the hypothesis that inconsistencies between redundant and non-redundant coordination dynamics may be due to a hierarchical relation between control structures for the performance of these types of tasks.

Coupling of head and body movement with motion of the audible environment.

The authors asked whether standing posture could be controlled relative to audible oscillation of the environment. Blindfolded sighted adults were exposed to acoustic flow in a moving room, and were asked to move so as to maintain a constant distance between their head and the room. Acoustic flow had direct (source) and indirect (reflected) components. Participants exhibited strong coupling of postural motion with room motion, even when direct information about room motion was masked and was available only in reflected sound. Patterns of hip-ankle coordination closely resembled patterns observed in previous research involving coupling of sway with a visible moving room. The results demonstrate that blindfolded adults can control the dynamics of stance relative to motion of the audible environment.

Postural coordination in looking and tracking tasks

Participants stood in a moving room and looked at a target that was attached to the front wall of the room. They were instructed either to look at the target or to track it, that is, to move so as to maintain a constant distance between the target and their head. Previous research (e.g. Bardy, Oullier, Bootsma, & Stoffregen, Journal of Experimental Psychology: Human Perception and Performance, 2002) has documented stable modes of coordination of the hip and ankle joints that emerge during the tracking task. In the present study our main goal was to determine the effects of task variation (tracking versus looking) on these postural coordination modes. Within trials, we varied the frequency of room motion between 0.10 and 0.75 Hz. The results revealed that in both the tracking and looking tasks, posture was characterized by the emergence of in-phase and anti-phase modes, although the modes were more prominent in the tracking task. For both tasks the coordination mode adopted depended on the frequency of motion of the moving room. Coupling between motion of the room and motion of the head was stronger in the tracking task than in the looking task. Overall, the dynamics of hip–ankle coordination were qualitatively similar during the looking and tracking tasks. This similarity has consequences for the development of a general theory of the visual regulation of stance.

Postural coordination modes considered as emergent phenomena.

The coordination of multiple body segments (torso and legs) in the control of standing posture during a suprapostural task was studied. The analysis was motivated by dynamical theories of motor coordination. In 2 experiments it was found that multisegment postural coordination could be described by the relative phase of rotations around the hip and ankle joints. The effective length of the feet, the height of the center of mass, and the amplitude of head motions in a visual tracking task were varied. Across these variations, 2 modes of hip-ankle coordination were observed: in-phase and anti-phase. The emergence of these modes was influenced by constraints imposed by the suprapostural tracking task, supporting the idea that such tasks influence postural control in an adaptive manner. Results are interpreted in terms of a dynamical approach to coordination in which postural coordination modes can be viewed as emergent phenomena.

Postural coordination modes considered as emergent phenomena.

The coordination of multiple body segments (torso and legs) in the control of standing posture during a suprapostural task was studied. The analysis was motivated by dynamical theories of motor coordination. In 2 experiments it was found that multisegment postural coordination could be described by the relative phase of rotations around the hip and ankle joints. The effective length of the feet, the height of the center of mass, and the amplitude of head motions in a visual tracking task were varied. Across these variations, 2 modes of hip-ankle coordination were observed: in-phase and anti-phase. The emergence of these modes was influenced by constraints imposed by the suprapostural tracking task, supporting the idea that such tasks influence postural control in an adaptive manner. Results are interpreted in terms of a dynamical approach to coordination in which postural coordination modes can be viewed as emergent phenomena.