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Naaim A.,French Institute of Health and Medical Research | Naaim A.,University Claude Bernard Lyon 1 | Moissenet F.,Laboratoire Danalyse Du Mouvement Et Of La Posture | Duprey S.,University Claude Bernard Lyon 1 | And 4 more authors.
Journal of Biomechanics | Year: 2017

Soft tissue artefacts (STA) introduce errors in joint kinematics when using cutaneous markers, especially on the scapula. Both segmental optimisation and multibody kinematics optimisation (MKO) algorithms have been developed to improve kinematics estimates. MKO based on a chain model with joint constraints avoids apparent joint dislocation but is sensitive to the biofidelity of chosen joint constraints. Since no recommendation exists for the scapula, our objective was to determine the best models to accurately estimate its kinematics. One participant was equipped with skin markers and with an intracortical pin screwed in the scapula. Segmental optimisation and MKO for 24-chain models (including four variations of the scapulothoracic joint) were compared against the pin-derived kinematics using root mean square error (RMSE) on Cardan angles. Segmental optimisation led to an accurate scapula kinematics (1.1°. ≤. RMSE. ≤. 3.3°) even for high arm elevation angles. When MKO was applied, no clinically significant difference was found between the different scapulothoracic models (0.9°. ≤. RMSE. ≤. 4.1°) except when a free scapulothoracic joint was modelled (1.9°. ≤. RMSE. ≤. 9.6°). To conclude, using MKO as a STA correction method was not more accurate than segmental optimisation for estimating scapula kinematics. © 2017 Elsevier Ltd.


Cheze L.,University Claude Bernard Lyon 1 | Moissenet F.,Laboratoire Danalyse Du Mouvement Et Of La Posture | Dumas R.,University Claude Bernard Lyon 1
Movement and Sports Sciences - Science et Motricite | Year: 2015

The prediction of musculo-tendon forces developed during daily living tasks is essential to assess movement control and joint reaction forces, and then provide insight to improve diagnosis and treatment follow-up of neurological and orthopedic disorders. Direct measurement of the musculo-tendon forces is hardly possible and the redundancy inherent in the musculo-skeletal system yields not enough equilibrium equations to compute these forces. Different methods have been proposed to overcome this problem, requiring numerous input parameters, most of them difficult or impossible to adjust to a specific subject. These methods will be exposed and their limits pointed out. Anyway, further development is needed in order that the model-based prediction of musculo-tendon forces can be used for clinical purposes. © ACAPS, EDP Sciences, 2012.


Moissenet F.,Laboratoire Danalyse Du Mouvement Et Of La Posture | Cheze L.,University Claude Bernard Lyon 1 | Cheze L.,University of Lyon | Dumas R.,University Claude Bernard Lyon 1 | Dumas R.,University of Lyon
Journal of Biomechanics | Year: 2014

Musculo-tendon forces and joint reaction forces are typically estimated using a two-step method, computing first the musculo-tendon forces by a static optimization procedure and then deducing the joint reaction forces from the force equilibrium. However, this method does not allow studying the interactions between musculo-tendon forces and joint reaction forces in establishing this equilibrium and the joint reaction forces are usually overestimated. This study introduces a new 3D lower limb musculoskeletal model based on a one-step static optimization procedure allowing simultaneous musculo-tendon, joint contact, ligament and bone forces estimation during gait. It is postulated that this approach, by giving access to the forces transmitted by these musculoskeletal structures at hip, tibiofemoral, patellofemoral and ankle joints, modeled using anatomically consistent kinematic models, should ease the validation of the model using joint contact forces measured with instrumented prostheses. A blinded validation based on four datasets was made under two different minimization conditions (i.e., C1 - only musculo-tendon forces are minimized, and C2 - musculo-tendon, joint contact, ligament and bone forces are minimized while focusing more specifically on tibiofemoral joint contacts). The results show that the model is able to estimate in most cases the correct timing of musculo-tendon forces during normal gait (i.e., the mean coefficient of active/inactive state concordance between estimated musculo-tendon force and measured EMG envelopes was C1: 65.87% and C2: 60.46%). The results also showed that the model is potentially able to well estimate joint contact, ligament and bone forces and more specifically medial (i.e., the mean RMSE between estimated joint contact force and in vivo measurement was C1: 1.14BW and C2: 0.39BW) and lateral (i.e., C1: 0.65BW and C2: 0.28BW) tibiofemoral contact forces during normal gait. However, the results remain highly influenced by the optimization weights that can bring to somewhat aphysiological musculo-tendon forces. © 2013 Elsevier Ltd.


PubMed | Laboratoire Danalyse Du Mouvement Et Of La Posture, University Claude Bernard Lyon 1, French Institute of Health and Medical Research and University of Montréal
Type: | Journal: Journal of biomechanics | Year: 2016

Soft tissue artefact (STA), i.e. the motion of the skin, fat and muscles gliding on the underlying bone, may lead to a marker position error reaching up to 8.7cm for the particular case of the scapula. Multibody kinematics optimisation (MKO) is one of the most efficient approaches used to reduce STA. It consists in minimising the distance between the positions of experimental markers on a subject skin and the simulated positions of the same markers embedded on a kinematic model. However, the efficiency of MKO directly relies on the chosen kinematic model. This paper proposes an overview of the different upper limb models available in the literature and a discussion about their applicability to MKO. The advantages of each joint model with respect to its biofidelity to functional anatomy are detailed both for the shoulder and the forearm areas. Models capabilities of personalisation and of adaptation to pathological cases are also discussed. Concerning model efficiency in terms of STA reduction in MKO algorithms, a lack of quantitative assessment in the literature is noted. In priority, future studies should concern the evaluation and quantification of STA reduction depending on upper limb joint constraints.


PubMed | Laboratoire Danalyse Du Mouvement Et Of La Posture and University Claude Bernard Lyon 1
Type: Journal Article | Journal: Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine | Year: 2014

One of the open issues in musculoskeletal modelling remains the choice of the objective function that is used to solve the muscular redundancy problem. Some authors have recently proposed to introduce joint reaction forces in the objective function, and the question of the weights associated with musculo-tendon forces and joint reaction forces arose. This question typically deals with a multi-objective optimisation problem. The aim of this study is to illustrate, on a planar elbow model, the ensemble of optimal solutions (i.e. Pareto front) and the solution of a global objective method that represent different compromises between musculo-tendon forces, joint compression force, and joint shear force. The solutions of the global objective method, based either on the minimisation of the sum of the squared musculo-tendon forces alone or on the minimisation of the squared joint compression force and shear force together, are in the same range. Minimising either the squared joint compression force or shear force alone leads to extreme force values. The exploration of the compromises between these forces illustrates the existence of major interactions between the muscular and joint structures. Indeed, the joint reaction forces relate to the projection of the sum of the musculo-tendon forces. An illustration of these interactions, due to the projection relation, is that the Pareto front is not a large surface, like in a typical three-objective optimisation, but almost a curve. These interactions, and the possibility to take them into account by a multi-objective optimisation, seem essential for the application of musculoskeletal modelling to joint pathologies.


Schreiber C.,Laboratoire Danalyse Du Mouvement Et Of La Posture | Remacle A.,Laboratoire Danalyse Du Mouvement Et Of La Posture | Chantraine F.,Laboratoire Danalyse Du Mouvement Et Of La Posture | Kolanowski E.,Laboratoire Danalyse Du Mouvement Et Of La Posture | Moissenet F.,Laboratoire Danalyse Du Mouvement Et Of La Posture
Gait and Posture | Year: 2016

The direct effects of a rhythmic auditory stimulation (RAS) on the gait of asymptomatic subjects are not clear. Previous studies only showed modifications in the gastrocnemius activity, inconsistent effects on temporal parameters, and no modification of spatial parameters. Furthermore, the influence of RAS on kinematics and kinetics has only been reported in pathological gait. The objective of this study was to perform a full comparison of gait characteristics in asymptomatic subjects at preferred and reduced walking speed between without and with RAS conditions. Spatiotemporal parameters, kinematics, kinetics and EMG signals datasets were collected for each condition. RAS conditions were obtained by asking subjects to walk on metronomic beats. 17 asymptomatic subjects were included in the study (12M/5W, 37.4 ± 15.7 years, 74.0 ± 14.8 kg, 1.77 ± 0.09 m). Comparisons between without and with RAS conditions were then performed using the Statistical Parametric Mapping method. For all combined subjects, the effect of RAS was limited whatever the walking speed. Meanwhile, global effects were observed for kinematics, kinetics and EMG at both spontaneous and reduced walking speed, which can only be explained by covariances (i.e., no effect on individual time-series). The use of RAS to impose a specific cadence matching the desired walking speed (e.g., to collect normative data) appears thus possible, as none parameters were modified individually. However, RAS should be used with caution taking into account covariances (i.e., muscle synergy or joint coordination patterns). This study has to be extended to a larger number of subjects to confirm these observations. © 2016 Elsevier B.V.


Chantraine F.,Laboratoire Danalyse Du Mouvement Et Of La Posture | Schreiber C.,Laboratoire Danalyse Du Mouvement Et Of La Posture | Kolanowski E.,Laboratoire Danalyse Du Mouvement Et Of La Posture | Moissenet F.,Laboratoire Danalyse Du Mouvement Et Of La Posture
Journal of Neurologic Physical Therapy | Year: 2016

Background and Purpose: Abnormal knee hyperextension during the stance phase (genu recurvatum) is a common gait abnormality in persons with hemiparesis due to stroke. While ankle-foot orthoses (AFOs) are often used to prevent genu recurvatum by maintaining ankle dorsiflexion during the stance phase, AFOs reduce ankle joint mobility. Functional electrical stimulation (FES) is an alternative to the use of AFO for producing appropriately timed ankle dorsiflexion and with prolonged timing may also have value for reducing genu recurvatum. Case Description: A 51-year-old man with chronic stroke was the subject of this case study. The patient had excessive plantarflexion during stance phase (ie, dynamic equinus foot), with associated genu recurvatum. Intervention: Evaluation included clinical examination, instrumented gait analysis, 10-meter walk test, and 6-minute walk test. The patient underwent a trial of botulinum toxin to the plantarflexor muscles that was not effective for controlling the genu recurvatum. A subsequent trialwith surface FES to elicit dorsiflexion during gaitwas effective, and he subsequently received an implanted FES system. Outcomes: Stimulation-induced contraction of the dorsiflexors during terminal swing phase resulted in improved ankle dorsiflexion at initial contact. Moreover, extension of stimulation into the loading phase ensured tibial advancement, which limited knee hyperextension. The patient was reevaluated 12 months following implantation with continued positive outcomes. Discussion: This case study illustrates the potential value of prolonged timing of dorsiflexor FES to manage genu recurvatum attributed to a dynamic equinus foot in a stroke survivor. Copyright © 2016 Academy of Neurologic Physical Therapy.


Chantraine F.,Laboratoire Danalyse Du Mouvement Et Of La Posture | Filipetti P.,Laboratoire Danalyse Du Mouvement Et Of La Posture | Schreiber C.,Laboratoire Danalyse Du Mouvement Et Of La Posture | Remacle A.,Laboratoire Danalyse Du Mouvement Et Of La Posture | And 2 more authors.
PLoS ONE | Year: 2016

Background: Patients who have developed hemiparesis as a result of a central nervous system lesion, often experience reduced walking capacity and worse gait quality. Although clinically, similar gait patterns have been observed, presently, no clinically driven classification has been validated to group these patients' gait abnormalities at the level of the hip, knee and ankle joints. This study has thus intended to put forward a new gait classification for adult patients with hemiparesis in chronic phase, and to validate its discriminatory capacity. Methods and Findings: Twenty-six patients with hemiparesis were included in this observational study. Following a clinical examination, a clinical gait analysis, complemented by a video analysis, was performed whereby participants were requested to walk spontaneously on a 10m walkway. A patient's classification was established from clinical examination data and video analysis. This classification was made up of three groups, including two sub-groups, defined with key abnormalities observed whilst walking. Statistical analysis was achieved on the basis of 25 parameters resulting from the clinical gait analysis in order to assess the discriminatory characteristic of the classification as displayed by the walking speed and kinematic parameters. Results revealed that the parameters related to the discriminant criteria of the proposed classification were all significantly different between groups and subgroups. More generally, nearly two thirds of the 25 parameters showed significant differences (p<0.05) between the groups and sub-groups. However, prior to being fully validated, this classification must still be tested on a larger number of patients, and the repeatability of inter-operator measures must be assessed. Conclusions: This classification enables patients to be grouped on the basis of key abnormalities observed whilst walking and has the advantage of being able to be used in clinical routines without necessitating complex apparatus. In the midterm, this classification may allow a decision-tree of therapies to be developed on the basis of the group in which the patient has been categorised. © 2016 Chantraine et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


PubMed | Laboratoire Danalyse Du Mouvement Et Of La Posture
Type: Journal Article | Journal: Journal of neurologic physical therapy : JNPT | Year: 2016

Abnormal knee hyperextension during the stance phase (genu recurvatum) is a common gait abnormality in persons with hemiparesis due to stroke. While ankle-foot orthoses (AFOs) are often used to prevent genu recurvatum by maintaining ankle dorsiflexion during the stance phase, AFOs reduce ankle joint mobility. Functional electrical stimulation (FES) is an alternative to the use of AFO for producing appropriately timed ankle dorsiflexion and with prolonged timing may also have value for reducing genu recurvatum.A 51-year-old man with chronic stroke was the subject of this case study. The patient had excessive plantarflexion during stance phase (ie, dynamic equinus foot), with associated genu recurvatum.Evaluation included clinical examination, instrumented gait analysis, 10-meter walk test, and 6-minute walk test. The patient underwent a trial of botulinum toxin to the plantarflexor muscles that was not effective for controlling the genu recurvatum. A subsequent trial with surface FES to elicit dorsiflexion during gait was effective, and he subsequently received an implanted FES system.Stimulation-induced contraction of the dorsiflexors during terminal swing phase resulted in improved ankle dorsiflexion at initial contact. Moreover, extension of stimulation into the loading phase ensured tibial advancement, which limited knee hyperextension. The patient was reevaluated 12 months following implantation with continued positive outcomes.This case study illustrates the potential value of prolonged timing of dorsiflexor FES to manage genu recurvatum attributed to a dynamic equinus foot in a stroke survivor.


PubMed | Laboratoire Danalyse Du Mouvement Et Of La Posture
Type: Journal Article | Journal: PloS one | Year: 2016

Patients who have developed hemiparesis as a result of a central nervous system lesion, often experience reduced walking capacity and worse gait quality. Although clinically, similar gait patterns have been observed, presently, no clinically driven classification has been validated to group these patients gait abnormalities at the level of the hip, knee and ankle joints. This study has thus intended to put forward a new gait classification for adult patients with hemiparesis in chronic phase, and to validate its discriminatory capacity.Twenty-six patients with hemiparesis were included in this observational study. Following a clinical examination, a clinical gait analysis, complemented by a video analysis, was performed whereby participants were requested to walk spontaneously on a 10m walkway. A patients classification was established from clinical examination data and video analysis. This classification was made up of three groups, including two sub-groups, defined with key abnormalities observed whilst walking. Statistical analysis was achieved on the basis of 25 parameters resulting from the clinical gait analysis in order to assess the discriminatory characteristic of the classification as displayed by the walking speed and kinematic parameters. Results revealed that the parameters related to the discriminant criteria of the proposed classification were all significantly different between groups and subgroups. More generally, nearly two thirds of the 25 parameters showed significant differences (p<0.05) between the groups and sub-groups. However, prior to being fully validated, this classification must still be tested on a larger number of patients, and the repeatability of inter-operator measures must be assessed.This classification enables patients to be grouped on the basis of key abnormalities observed whilst walking and has the advantage of being able to be used in clinical routines without necessitating complex apparatus. In the midterm, this classification may allow a decision-tree of therapies to be developed on the basis of the group in which the patient has been categorised.

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