Limb Force Research Articles

Unravelling the speed-going relationship: A proof of concept study from British turf flat and jump race meetings

The maximum galloping speeds of racehorses during a race are influenced by the functional performance of the ground (‘going’) amongst other factors. For turf racecourses in Britain, the ground is descriptively classified and numerically quantified on the morning of a race meeting by the clerk of the course and subsequently published to assist decision making. Importantly, this includes deciding whether a horse should or should not run. The going is also assessed and classified during the meeting by racing analysts using the normalized winning times from each race result. Differences between going assessments are regularly reported, therefore this study aimed to evaluate whether an alternative method of measuring going could better predict going measured from performances. Measurement and performance data from 25 flat and 25 jump meetings were compared using linear and nonlinear regression models. A continuous two-phase polynomial model for cushioning was found to be the best predictor of performance going for all 50 meetings (adjusted r2=0.819, P<0.001). As cushioning can provide a going related indicator of the forces that the horse will experience at gallop, this measurement may be useful when evaluating racecourse going. This initial model suggests that there is little performance advantage at maximal galloping speeds above a cushioning value of approximately10 kN, possibly due to changes in limb contact timings to manage limb forces limits as the ground becomes firmer. An expansion of objective measurements of going that relate to performance across a wider geographic region, if not internationally are needed to confirm this limit.

Application of remote sensing navigation system in total knee arthroplasty

To explore clinical accuracy of remote sensing navigation alignment (RSNA) system in total knee arthroplasty (TKA) and its influence on postoperative clinical efficacy. From May 2021 to May 2022, 60 knee osteoarthritis (KOA) patients with Kellgren-Lawrence (K-L) grade Ⅲ to Ⅳ treated by unilateral primary TKA were selected and divided into RSNA group and traditional operation group according to treatment methods, and 30 patients in each group. There were 6 males and 24 females in RSNA group, aged from 55 to 86 years old with an average of (68.06±8.23) years old;body mass index (BMI) ranged from 22.15 to 34.58 kg·m-2 with an average of (28.20±3.01) kg·m-2;the courses of disease ranged from 2 to 60 months with an average of (18.80±14.80) months;13 patients with grade Ⅲ and 17 patients with grade Ⅳ according to K-L grading. In traditional operation group, there were 8 males and 22 females, aged from 57 to 85 years old with an average of (67.26±6.32) years old;BMI ranged from 23.94 to 34.55 kg·m-2 with an average of (27.49±2.32) kg·m-2;the courses of disease ranged from 3 to 60 months with an average of (21.30±16.44) months;14 patients with grade Ⅲ and 16 patients with grade Ⅳ according to K-L grading. Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and Knee Society score(KSS) were used to evaluate functional recovery of patients. Hip-knee-ankle angle (HKAA), distal femoral valgus angle (FVA) and distal fermoral flexion angle (DFFA) were measured before operation. HKAA and HKAA deviation angle were measured at 1 week after operation, and defective rate of lower limb force line, femur prosthesis valgus angle (FPVA) and femoral prosthesis flexion angle (FPFA), respectively, were calculated. There were no serious complications such as vascular and nerve injury during operation, and wound healed at stage Ⅰ. Both groups were followed up for 6 months. There were no significant difference in WOMAC index, KSS, HKAA, FVA and DFFA between two groups before operation (P>0.05). The force line defect rate, HKAA, HKAA deviation angle, FPVA deviation angle and FPFA of RSNA group were 6.7%, (178.74±1.56) °, (1.25±1.56) °, (1.84±0.16) ° and (4.85±2.46) °, respectively;while in traditional operation group were 20%, (176.73±3.46) °, (3.27±3.46) °, (2.44±0.26) °, (6.60±1.86) °;the difference between two groups were statistically significant (P<0.05). There were no significant difference in WOMAC index and KSS between two groups at 3 and 6 months after operation (P>0.05). RSNA system could reduce defective rate of lower limb force line, FPVA deviation angle and FPFA after TKA, which is more accurate and easy to operate than traditional intramedullary localization surgery while ensuring postoperative efficacy.

High tibial osteotomy on varus knee osteoarthritis with medial meniscus posterior root injury

To explore clinical effect of distal tibial tubercle-high tibial osteotomy (DTT-HTO) in treating knee osteoarthritis (KOA) with medial meniscus posterior root tear (MMPRT). A retrospective analysis was performed on 21 patients with varus KOA with MMPRT from May 2020 to December 2021, including 3 males and 18 females, aged from 49 to 75 years old with an average of (63.81±6.56) years old, the courses of disease ranged from 0.5 to 18.0 years with an average of(5.9±4.2) years, and 4 patients with grade Ⅱ, 14 patients with grade Ⅲ, and 3 patients with grade Ⅳ according to Kellgren-Lawrence;14 patients with type 1 and 7 patients with type 2 according to MMPRT damage classification. The distance of medial meniscusextrusion (MME) and weight-bearing line ratio (WBLR) of lower extremity were compared before and 12 months after operation. Visual analogue scale (VAS), Western Ontarioand and McMaster Universities (WOMAC) osteoarthritis index, and Lysholm knee score were used to evaluate knee pain and functional improvement before operation, 1, 6 and 12 months after operation, respectively. Twenty-one patients were followed up for 12 to 18 months with an average of (13.52±1.72) months. MME distance was improved from (4.99±1.05) mm before operation to (1.87±0.76) mm at 12 months after operation (P<0.05). WBLR was increased from (15.49±7.04)% before operation to (62.71±2.27)% at 12 months after operation (P<0.05). VAS was decreased from (7.00±1.14) before operation to (2.04±0.80), (0.90±0.62) and (0.61±0.50) at 1, 6 and 12 months after operation. WOMAC were decreased from preoperative (147.90±9.88) to postoperative (103.43±8.52), (74.00±9.54) and (47.62±9.53) at 1, 6 and 12 months, and the difference were statistically significant (P<0.05). Lysholm scores were increased from (46.04±7.34) before oepration to (63.19±8.93), (81.10±6.41) and (89.29±3.04) at 1, 6 and 12 months after operation(P<0.05). For the treatment of varus KOA with MMPRT, DTT-HTO could reduce medial meniscus protrusion distance, improve the ratio of lower limb force line, and effectively reduce knee pain and improve knee joint function.

A retrospective study on two different surgical robots to assist total knee arthroplasty

To compare early clinical and imaging results of domestic HURWA and imported Brainlab Knee3 surgical robot-assisted knee replacement. A retrospective analysis was performed on 93 patients with knee osteoarthritis (KOA) who underwent robot-assisted descending total knee arthroplasty(TKA) from January 2021 to July 2023, and they were divided into BRATKA group and HRATKA group according to use of robotic system. There were 40 patients in BRATKA group, including 16 males and 24 females, aged from 55 to 90 years old with an average of (64.3±7.0) years old;27 patients with grade Ⅲ and 13 patients with grade Ⅳ according to Kellgren-Lawrence(K-L);18 patients on the right side and 22 patients on the left side;the courses of disease ranged from 1 to 30 years with an average of (15.3±7.6) years;imported Brainlab Knee3 surgical robot assisted system was adopted. There were 53 patients in HRATKA group, including 18 males and 35 females, aged from 52 to 81 years old with an average of (64.4±8.5) years old;30 patients with grade Ⅲ and 23 patients with grade Ⅳ;21 patients on the right side and 32 patients on the left side;the courses of disease ranged from 1 to 32 years with an average of (16.4±7.9) years;HURWA surgical robot assisted system was adopted. Operation time, perioperative total blood loss, incision length and postoperative complications were compared between two groups. Deviation angle of hip-knee-ankle angle(HKAA) before operation and on the first day after operation was compared between two groups. Later tibal component (LTC), frontal femoral component (FFC), later femoral component (LFC) and frontal tibal component(FTC) at 1 day after on the first day after operation was compared between two groups. Knee Society score(KSS), visual analogue scale (VAS) and range of motion (ROM) of knee joint were compared between two groups before operation and on the 3rd and 90th day after operation. Both groups were followed up for 11 to 18 months with an average of (14.4±2.1) months, and the wounds of all patients healed well. Operation time and incision length of BRATKA group were (132.1±34.6) min and (12.9±1.9) cm, while (94.1±10.8) min and (14.8±2.1) cm in HRATKA group, respectively, and the differences between two groups were statistically significant(P<0.05). There were no significant difference in perioperative total blood loss and preoperative deviation angle of HKAA between two groups(P>0.05). Deviation angle of HKAA, FFC angle and LFC angle in BRATKA group were (1.90±0.91) °, (87.90±1.51) ° and(9.00±3.2) °, respectively;while (0.93±1.04) °, (89.03±0.96) ° and (7.63±0.59) ° in HRATKA group, respectively, and the differences between two groups were statistically significant (P<0.05). There were no significant differences in FTC and LTC between two groups(P>0.05). There were no significant differences in VAS of knee rest and exercise, KSS score and ROM of knee joint between two groups before operation and 3 days and 90 days after operation(P>0.05). There was no significant difference in complications between two groups (P>0.05). Postoperative imaging of two robot systems showed good lower limb force line. The domestic HRATKA group had better LFC, FFC angle and HKA deviation angle than the imported BRATKA group, but there were no significant difference in postoperative knee function and pain relief.

Horseshoe effects on equine gait-A systematic scoping review.

To provide an overview of available research about effects of horseshoes on equine kinetics and kinematics. The terms, "horse/equine," "hoof," "shoes/horseshoes," "kinetics," and "kinematics" were searched in PubMed, Web of Science, Center for Agriculture and Bioscience International, and United States Department of Agriculture National Agricultural Library for manuscripts from first availability to 2024. Independent reviewers used preferred reporting items for systematic reviews and meta-analyses guidelines to map and extract evidence-based data from sources. Metrics included participant demographics, research methods, major findings, and study limitations. Knowledge gaps were also identified. A total of 46 studies were included. Most utilized non-lame horses to compare original shoe designs or modifications to unshod or a standard open-heel shoe. Horse demographics and gait, study design and outcome measures varied widely. Prevalent data collection equipment included force platforms and pressure plates, wearable force measuring technology, and videography. Many studies reported shoeing effects on limb forces and motion, but there was little consensus among unrelated studies. Common limitations included insufficient data resolution, no randomization, small sample size, single breed, and outcome measures specific or unique to the study. Knowledge gaps included data collection from all limbs and the impact of conformation and limb and hoof morphology and health condition on outcomes. Information from manuscripts that met inclusion criteria confirmed distinct, variable effects of shoe characteristics on equine gait parameters. Details from published work can serve as resource for clinical decisions and to guide standardization among investigations on shoe configuration effects on equine motion.

The "blownknee" patient's stress fracture of distal tibial component after unilateral TKA: A case report.

Periprosthetic fractures (PPF) are rare complications of total knee arthroplasty (TKA). The most common PPF after TKA is supracondylar femoral fracture, which is a relatively rare complication that is usually associated with high-energy trauma, with a reported incidence ranging from 0.4 to 1.7% according to the AOANJRR. However, in TKA patients, it is rarer that the stress fracture around the tibial prosthesis occurs due to changes in the lower limb force line, increasing weight-bearing, and changes in walking gait. A 68-year-old woman visited our hospital with "both knees had aggravated pain and deformity for 8 years." TKA was performed first on the left knee and the patient was discharged within 1 week. Three months later, the patient complained of pain in the upper middle 1/3 part of the medial tibia for 2 weeks, which gradually worsened and affected weight-bearing. Physical examination showed that the left knee joint presented varus deformity, and the right valgus deformity, which diagnosed as osteoarthritis of both knees and was so-called "blownknee". The disease was initially diagnosed as osteoarthritis of both knees on first admission and PPF of the tibia in second. Three operations were performed on this patient. The first was TKA of the left knee, the second was open reduction and internal fixation of the PPF of the tibia 3 months after the first operation, and the third was TKA of the right knee. Until now, the patient has had no recurrent PPF, and the fracture is healing from the last X-ray. Clinicians should be aware of the possibility of PPF after TKA, especially in such patients, the most preferred surgical treatment method was open reduction and internal fixation of fractures using locking plates, and if the PPF with loosened implants, Revision TKA, or megaprosthesis was the better choice.

Finite element analysis of the impact of bone mass and volume of low-density area under tibial plateau on lower limb alignment

To investigate the impact of the bone mass and volume of the low-density area under the tibial plateau on the lower limb force line by finite element analysis, offering mechanical evidence for preventing internal displacement of the lower limb force line in conjunction with knee varus in patients with knee osteoarthritis (KOA) and reducing bone mass under the tibial plateau. A healthy adult was selected as the study subject, and X-ray film and CT imaging data were acquired. Mimics 21.0 software was utilized to reconstruct the complete knee joint model and three models representing low-density areas under the tibial plateau with equal volume but varying shapes. These models were then imported into Solidworks 2023 software for assembly and verification. Five KOA finite element models with 22%, 33%, 44%, 55%, and 66% bone mass reduction in the low-density area under tibial plateau and 5 KOA finite element models with 81%, 90%, 100%, 110%, and 121% times of the low-density area model with 66% bone mass loss were constructed, respectively. Under physiological loading conditions of the human lower limb, the distal ends of the tibia and fibula were fully immobilized. An axial compressive load of 1 860 N, following the lower limb force line, was applied to the primary load-bearing area on the femoral head surface. The maximum stress within the tibial plateau, as well as the maximum displacements of the tibial cortical bone and tibial subchondral bone, were calculated and analyzed using the finite element analysis software Abaqus 2022. Subsequently, predictions regarding the alteration of the lower limb force line were made based on the analysis results. The constructed KOA model accorded with the normal anatomical structure of lower limbs. Under the same boundary conditions and the same load, the maximum stress of the medial tibial plateau, the maximum displacement of the tibial cortical bone and the maximum displacement of the cancellous bone increased along with the gradual decrease of bone mass in the low-density area under the tibial plateau and the gradual increase in the volume of the low-density area under tibial plateau, with significant differences ( P<0.05). The existence of a low-density area under tibial plateau suggests a heightened likelihood of knee varus and inward movement of the lower limb force line. Both the volume and reduction in bone mass of the low-density area serve as critical initiating factors. This information can provide valuable guidance to clinicians in proactively preventing knee varus and averting its occurrence.

Improved multi-layer wavelet transform and blind source separation based ECG artifacts removal algorithm from the sEMG signal: in the case of upper limbs.

Introduction: Surface electromyogram (sEMG) signals have been widely used in human upper limb force estimation and motion intention recognition. However, the electrocardiogram(ECG) artifact generated by the beating of the heart is a major factor that reduces the quality of the EMG signal when recording the sEMG signal from the muscle close to the heart. sEMG signals contaminated by ECG artifacts are difficult to be understood correctly. The objective of this paper is to effectively remove ECG artifacts from sEMG signals by a novel method. Methods: In this paper, sEMG and ECG signals of the biceps brachii, brachialis, and triceps muscle of the human upper limb will be collected respectively. Firstly, an improved multi-layer wavelet transform algorithm is used to preprocess the raw sEMG signal to remove the background noise and power frequency interference in the raw signal. Then, based on the theory of blind source separation analysis, an improved Fast-ICA algorithm was constructed to separate the denoising signals. Finally, an ECG discrimination algorithm was used to find and eliminate ECG signals in sEMG signals. This method consists of the following steps: 1) Acquisition of raw sEMG and ECG signals; 2) Decoupling the raw sEMG signal; 3) Fast-ICA-based signal component separation; 4) ECG artifact recognition and elimination. Results and discussion: The experimental results show that our method has a good effect on removing ECG artifacts from contaminated EMG signals. It can further improve the quality of EMG signals, which is of great significance for improving the accuracy of force estimation and motion intention recognition tasks. Compared with other state-of-the-art methods, our method can also provide the guiding significance for other biological signals.

The Clinical Application of Double Taylor Spatial Frame in Segmental Tibial Fracture.

Multi-planar external fixation has been used for the management of segmental tibial fractures with severe soft tissue injuries. However, fewer specialized studies have been reported. The primary aim of this study was to describe our experience of treating fractures of this type using the Taylor Spatial Frame and Ilizarov external fixation methods. We retrospectively analyzed 33 patients with segmental tibial fracture treated at our institution between January 2016 and December 2020. The patients were divided into double Taylor Spatial Frame (D-TSF) and Ilizarov groups based on the external fixation structure. Baseline demographic data included sex, age, injury side and cause, open or closed fracture, time from injury to surgery, complications, and external frame removal and fracture healing time. The hip-knee-ankle angle (HKA) was measured from preoperative, immediate postoperative, and final follow-up full-length X-rays of bilateral lower limbs. We determined the degree of deviation in the HKA by calculating the difference between the measured angle and the ideal value of 180°; the absolute value was used to assess recovery of the lower limb force line. At the final follow-up, Johner-Wruhs tibial fracture outcome criteria (J-W TFOC) were used to classify the postoperative function of the affected limb as excellent, good, moderate, or poor. Count data were analyzed with the chi-square test or Fisher's exact test; the Mann-Whitney U test was used for rank data. No statistically significant differences were observed between the two groups in terms of sex, age, side of injury, cause of injury, closed or open fracture, or time between injury and surgery, which indicates that the groups were comparable (p > 0.05). A statistically significant difference was observed in external frame removal and fracture healing time between the D-TSF and Ilizarov groups (36.24 ± 8.34 vs 45.42 ± 10.21 weeks, p = 0.009; 33.33 ± 8.21 vs 42.00 ± 9.78 weeks, p = 0.011). The Johner-Wruhs criteria were used to assess the function of the affected limb, the D-TSF group performed better in correcting the lower limb force line than the Ilizarov group. A statistically significant difference in terms of excellent ratings was observed between the two groups (18/2/1/0 vs 5/5/1/1, p = 0.010). Postoperative follow-up X-rays demonstrated a significant improvement in the HKA in both groups immediately after surgery and at the final follow-up compared to the angle before surgery. At the final follow-up, a statistically significant difference was observed in the degree of deviation in the HKA between the two groups (1.58° ± 0.84° vs 2.37° ± 1.00°, p = 0.023). The D-TSF treatment is associated with minimal secondary damage to soft tissue, a straightforward and minimally invasive procedure, multiplanar stable fracture fixation, and optimization of fracture alignment and lower limb force lines, therefore, it is highly effective therapeutic option for segmental tibial fracture.

Comparative kinetics of humans and non-human primates during vertical climbing.

Climbing represents a critical behavior in the context of primate evolution. However, anatomically modern human populations are considered ill-suited for climbing. This adaptation can be attributed to the evolution of striding bipedalism, redirecting anatomical traits away from efficient climbing. Although prior studies have speculated on the kinetic consequences of this anatomical reorganization, there is a lack of data on the force profiles of human climbers. This study utilized high-speed videography and force plate analysis to assess single limb forces during climbing from 44 human participants of varying climbing experience and compared these data with climbing data from eight species of non-human primates (anthropoids and strepsirrhines). Contrary to expectations, experience level had no significant effect on the magnitude of single limb forces in humans. Experienced climbers did, however, demonstrate a predictable relationship between center of mass position and peak normal forces, suggesting a better ability to modulate forces during climbing. Humans exhibited significantly higher peak propulsive forces in the hindlimb compared with the forelimb and greater hindlimb dominance overall compared with non-human primates. All species sampled demonstrated exclusively tensile forelimbs and predominantly compressive hindlimbs. Strepsirrhines exhibited a pull-push transition in normal forces, while anthropoid primates, including humans, did not. Climbing force profiles are remarkably stereotyped across humans, reflecting the universal mechanical demands of this form of locomotion. Extreme functional differentiation between forelimbs and hindlimbs in humans may help to explain the evolution of bipedalism in ancestrally climbing hominoids.

Risk and related factors of elbow musculoskeletal diseases: A nationwide cross-sectional survey in China.

Although studies have shown that Work-related Musculoskeletal Disorders (WMSDs) are common and continue to be a main source of disability and work time loss, there are few reports on elbow WMSDs. The aim of this study was to explore the prevalence and associated factors of elbow WMSDs. The valid questionnaires of 57501 workers from 15 different industries nationwide were collected and the Chi-square test and logistic-regression-analysis were applied to reveal the prevalence and risk factors of elbow. The findings indicated that prevalence of elbow WMSDs among workers was 7.3%. The prevalence of elbow WMSDs in toy manufacturing was 21.3%, which significantly higher than that in other industries (P<0.05). Logistic regression analysis showed that aged 40 and above, married, very poor health, left-handed, lifting weights (more than 20 kg each time) , work requiring upper limb or hand force, work in an uncomfortable position, repetitive operations within one minute, using vibrating tools, work involves cold, cool winds or temperature changes, work being completed in the same workshop, work being done outdoors, frequent deal with customers , two shifts, often work overtime, staff shortage, often work for colleagues were the risk factors of elbow WMSDs.The higer education level and monthly income, and enough rest time were the protective factors of elbow WMSDs. The toy manufacturing is a high-risk industry for elbow WMSDs. The publicity and education of ergonomics knowledge should be strengthened, and the workers' ergonomics awareness should be improved to reduce the impact of WMSDs.

Generalizing Upper Limb Force Modeling With Transfer Learning: A Multimodal Approach Using EMG and IMU for New Users and Conditions.

In the field of EMG-based force modeling, the ability to generalize models across individuals could play a significant role in its adoption across a range of applications, including assistive devices, robotic and rehabilitation devices. However, current studies have predominately focused on intra-subject modeling, largely neglecting the burden of end-user data acquisition. In this work, we propose the use of transfer learning (TL) to generalize force modeling to a new user by first establishing a baseline model trained using other users' data, and then adapting to the end-user using a small amount of new data (only 10% , 20% , and 40% of the new user data). Using a deep multimodal convolutional neural network, consisting of two CNN models, one with high-density (HD) EMG and one with motion data recorded by an Inertial Measurement Unit (IMU), our proposed TL technique significantly improved force modeling compared to leave-one-subject-out (LOSO) and even intra-subject scenarios. The TL approach increased the average R squared values of the force modeling task by 60.81%, 190.53%, and 199.79% compared to the LOSO case, and by 13.4%, 36.88%, and 45.51% compared to the intra-subject case for isotonic, isokinetic and dynamic conditions, respectively. These results show that it is possible to adapt to a new user with minimal data while improving performance significantly compared to the intra-subject scenario. We also show that TL can be used to generalize on a new experimental condition for a new user.

Synergistic effects of transcutaneous spinal stimulation and neuromuscular electrical stimulation on lower limb force production: Time to deliver.

Transcutaneous spinal stimulation (TSS) and neuromuscular electrical stimulation (NMES) can facilitate self-assisted standing in individuals with paralysis. However, individual variability in responses to each modality may limit their effectiveness in generating the necessary leg extension force for full body weight standing. To address this challenge, we proposed combining TSS and NMES to enhance leg extensor muscle activation, with optimizing timing adjustment to maximize the interaction between the two modalities. To assess the effects of TSS and NMES on knee extension and plantarflexion force, ten neurologically intact participants underwent three conditions: (1) TSS control, (2) NMES control, and (3) TSS + NMES. TSS was delivered between the T10 and L2 vertebrae, while NMES was delivered to the skin over the right knee extensors and plantarflexors. TSS and NMES were administered using a 15 Hz train of three 0.5 ms biphasic pulses. During the TSS + NMES condition, the timing between modalities was adjusted in increments of ¼ the interval within a 15 Hz frequency, i.e., 66, 49.5, 33, 16.5, and 1 ms. NMES combined with TSS, produced synergistic effects even on non-targeted muscle groups, thereby promoting leg extension across multiple joints in the kinematic chain. The sequence of NMES or TSS trains relative to each other did not significantly impact motor output. Notably, a delay of 16.5 to 49.5 ms between interleaved TSS and NMES pulses, each delivered at 15 Hz, results in more robust and synergistic responses in knee extensors and plantarflexors. By adjusting the timing between TSS and NMES, we can optimize the combined use of these modalities for functional restoration. Our findings highlight the potential of integrated TSS and NMES protocols to enhance motor function, suggesting promising avenues for therapeutic applications, particularly in the rehabilitation of individuals with SCI.

Application of the "3-2-1" body surface localization method in intertrochanteric femoral fractures: a technical note.

In femoral intertrochanteric fractures, poor incision positioning may result in inaccurate intramedullary nail placement direction, which increases the difficulty of reduction and thus the size and number of incisions. Repeated intraoperative fluoroscopy not only increases the radiation exposure of the surgeon but also affects the operative outcomes. This technical note proposes a method of identifying incision positioning preoperatively using the "3-2-1" body surface localization method. This auxiliary positioning technique uses a body surface locator and the lower limb force axis. It can predict the incisions for the needle insertion point, spiral blade, and locking nails, create minimally invasive incisions, avoid incorrect incision position, facilitate accurate intraoperative intramedullary nail placement, reduce the incision size, intraoperative bleeding, and radiation exposure, and improve surgical efficiency and reduction quality.

CAN FORCE MEASUREMENTS TAKEN BY A STRAIN GAUGE ACT AS AN INDICATION OF BONE HEALING IN CIRCULAR EXTERNAL FIXATION FRAMES? A LABORATORY AND CLINICAL PILOT

AbstractOBJECTIVESTo determine if force measured using a strain gauge in circular external fixation frames is different for 1) different simulated stages of bone healing, and for 2) fractures clinically deemed either united or un-united.METHODSIn a laboratory study, 3 similar Ilizarov frame constructs were assembled using a Perspex bone analogue. Constructs were tested in 10 different clinical situations simulating different stages of bone healing including with the bone analogue intact, with 1,3 and 50mm gaps, and with 6 materials of varying stiffness's within the 50mm gap. A Bluetooth strain gauge was inserted across the simulated fracture focus, replacing one of the 4 threaded rods used to construct the frame. Constructs were loaded to 700N using an Instron testing machine and maximum force during loading was measured by the strain gauge. Testing was repeated with the strain gauge replacing each of the 4 threaded rods in turn, with measurements being repeated 3 times, across all 3 frame constructs for all 10 simulated clinical situations (n=360). Force measurements between the situations were compared using a Kruskal-Wallis test (KW) and a post-hoc Steel test was used for multiple comparison against control (intact bone model). Additionally, a pilot study has been initiated to assess clinical efficacy of the strain gauge measurement in patients with circular frames. The strain gauge replaced the anterior rod across the fracture focus for each patient. Patients were asked to step on a weighing scale with their affected limb, and maximum weight transfer through the limb and maximal force measured in the frame were recorded. This was repeated 3 times and a mean ratio of force to weight through affected limb was calculated for each patient. The clinical situation at each measurement was designated as united or un-united by one of the senior authors for analysis. Force measurements between the situations were compared using a Wilcoxon-Mann-Whitney test.RESULTSIn the laboratory study, including all constructs with the strain gauge in all positions, a statistically significant relationship between model stability and force measured was identified (KW test for overall relationship p&lt;0.0001). The largest force was measured in the model with a 50mm gap (median 170N, IQR 155–192, range 83–213) and the smallest in the intact bone model (median 3N, IQR 1–8, range 0–11). Multiple comparison testing found a significant difference between intact bone and all the unstable situations (p=0.002 or better). Examining initial results from our pilot clinical study, nine measurements were available in seven patients. Three of these were taken in patients with fractures yet to unite, six in patients where union has since been confirmed clinically. The median force measured was significantly greater where the fracture was not united (median 1.66 N/kg, range 1.07–1.99 vs 0.12 N/kg, range 0.05–0.73, p=0.02).CONCLUSIONSThis laboratory study demonstrates that force measurement may be different at different stages of healing, and although only limited data was available, a pilot clinical study showed a significant relationship between the force measured and clinical union of the patient's fracture.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Modulation of limb mechanics in alligators moving across varying grades.

Graded substrates require legged animals to modulate their limb mechanics to meet locomotor demands. Previous work has elucidated strategies used by cursorial animals with upright limb posture, but it remains unclear how sprawling species such as alligators transition between grades. We measured individual limb forces and 3D kinematics as alligators walked steadily across level, 15deg incline and 15deg decline conditions. We compared our results with the literature to determine how limb posture alters strategies for managing the energetic variation that accompanies shifts in grade. We found that juvenile alligators maintain spatiotemporal characteristics of gait and locomotor speed while selectively modulating craniocaudal impulses (relative to level) when transitioning between grades. Alligators seem to accomplish this using a variety of kinematic strategies, but consistently sprawl both limb pairs outside of the parasagittal plane during decline walking. This latter result suggests alligators and other sprawling species may use movements outside of the parasagittal plane as an axis of variation to modulate limb mechanics when transitioning between graded substrates. We conclude that limb mechanics during graded locomotion are fairly predictable across quadrupedal species, regardless of body plan and limb posture, with hindlimbs playing a more propulsive role and forelimbs functioning to dissipate energy. Future work will elucidate how shifts in muscle properties or function underlie such shifts in limb kinematics.

Digital twin-driven dynamic monitoring system of the upper limb force

Digital twin represents the core technology to realize the dynamic monitoring of complex industrial systems. However, the human body, as the most complex system in the physical world, digital twin is rarely applied in it. In this study, we successfully demonstrated a digital twin in the human biomedical application by proposing a dynamic monitoring system of the upper limb force. In this system, the real upper limb drives the motion of the virtual one in real-time and dynamically updates the force. Meanwhile, the virtual upper limb feeds back the monitoring-results of the force to the controller of the real upper limb via immersive virtual reality interaction. Experimental results of the typical motions of the upper limb revealed that the proposed system functioned interactively in real-time in a non-invasive manner, while ensuring the accurate solving of the muscle force. In conclusion, our digital twin-driven system is of great importance for rehabilitation medicine, biomechanical scientific research and physical training, promoting the application of the digital twin in the human biomedical field.

Biomechanical effects of typical lower limb movements of Chen-style Tai Chi on knee joint.

The load and stress distribution on cartilage and meniscus of the knee joint in typical lower limb movements of Chen-style Tai Chi (TC) and deep squat (DS) were analyzed using finite element (FE) analysis. The loadings for this analysis consisted of muscle forces and ground reaction force (GRF), which were calculated through the inverse dynamic approach based on kinematics and force plate measurements obtained from motion capture experiments. Thirteen experienced practitioners performed four typical TC movements, namely, single whip (SW), brush knee and twist step (BKTS), stretch down (SD), and part the wild horse's mane (PWHM), which exhibit lower posture and greater lower limb force compared to other TC styles. The results indicated that TC required greater lower limb muscle strength than DS, resulting in greater knee joint forces. The stress on the medial cartilage in SW and BKTS fell within a range conductive to maintaining the balance between anabolism and catabolism of cartilage matrix. This was due to the fact that SW and BKTS reduce the medial to total tibiofemoral contact force ratios through knee abduction, which may effectively alleviate mild medial knee osteoarthritis (KOA). However, the greater medial contact force ratios observed in SD and PWHM resulted in great contact stresses that may aggravate the pain of patients with KOA. To mitigate these effects, practitioners should consider elevating their postures appropriately to reduce knee flexion angles, especially during the single-leg support phase. This adjustment can decrease the required muscle strength, load and stress on the knee joint.

SIRT1 induction in the skeletal muscle of male mice partially preserves limb muscle mass but not contractile force in response to androgen deprivation.

In males, the factors that decrease limb muscle mass and strength in response to androgen deprivation are largely unknown. Sirtuin1 (SIRT1) protein levels are lower in the limb muscle of male mice subjected to androgen deprivation. The present study aimed to assess whether SIRT1 induction preserved limb muscle mass and force production in response to androgen deprivation. Physically mature male mice containing an inducible muscle-specific SIRT1 transgene were subjected to a sham or castration surgery and compared to sham and castrated male mice where the SIRT1 transgene was not induced. SIRT1 induction partially preserved whole-body lean mass, tibialis anterior (TA) mass and triceps surae muscle mass in response to castration. Further analysis of the TA muscle showed that muscle-specific SIRT1 induction partially preserved limb muscle soluble protein content and fibre cross-sectional area. Unilateral AAV9-mediated SIRT1 induction in the TA muscle showed that SIRT1 partially preserved mass by acting directly in the muscle. Despite those positive outcomes to limb muscle morphology, muscle-specific SIRT1 induction did not preserve the force generating capacity of the TA or triceps surae muscles. Interestingly, SIRT1 induction in females did not alter limb muscle mass or limb muscle strength even though females have naturally low androgen levels. SIRT1 also did not alter the androgen-mediated increase in limb muscle mass or strength in females. In all, these data suggest that decreases in SIRT1 protein in the limb muscle of males may partially contribute to the loss of limb muscle mass in response to androgen deprivation. KEY POINTS: SIRT1 induction in skeletal muscle of male mice subjected to androgen deprivation partially preserved limb muscle mass and fibre cross-sectional area. SIRT1 induction in skeletal muscle of male mice subjected to androgen deprivation did not prevent preserve limb muscle force generating capacity. SIRT1 induction in skeletal muscle of females did not alter baseline limb muscle mass, nor did it affect the androgen-mediated increase in limb muscle mass.

RELIABILITY AND VALIDITY OF VARIOUS FORCE-TIME INDICATORS FOR THE ASSESSMENT OF FINGER AND SHOULDER GIRDLE STRENGTH IN CLIMBING

The rate of upper limb force development (RFD) is one of the important performance factors in sport climbing. The aim of this study was to investigate the reliability and validity of various force-time indicators for the assessment of finger and shoulder girdle strength in climbing. Ten male lead climbers (climbing ability: advanced; IRCRA: 22 ± 2) performed two RFD and two maximal strength tests for the finger flexor and shoulder girdle muscles (one-arm finger hangs and lock-off s, respectively). The maximal strength tests were used to assess maximal force (Fmax). The RFD tests were used to assess: peak force (Fpeak); time for reaching force representing 25%, 50%, and 75% of the body weight (T25%BW, T50%BW, T75%BW); and absolute and relative RFD indicators (e.g., RFD at 200 ms and 95% Fpeak, respectively). The reliability of the finger flexor RFD indicators was high (intrasession intraclass correlation coefficients - ICC between .760 and .973; intersession ICC between .883 and .955). Intersession reliability of the finger flexor T50%BW and T75%BW reached excellent values (ICC = .949 and ICC = .978, respectively). Reliability of the finger flexor and lock-off Fpeak and Fmax was also high (ICC between .850 and .966). Consistency between Fpeak and Fmax was not satisfactory, though. These variables differed significantly (p = .035) in the finger flexor tests, and ICC was moderate (.605) in the lock-off tests. Most of the lock-off force-time indicators had moderate or poor reliability. Finger flexor and lock-off Fmax/kg and T50%BW correlated significantly (p &lt; .05) with the climbing ability (R = .805, R = .653, and R = -.703, respectively), while lock-off force-time indicators did not. T50%BW was the most reliable and valid force-time indicator in advanced climbers. RFD indicators were reliable, but muscle strength appeared more important than RFD in advanced climbers.