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Ventura J.D.,Gordon College | Klute G.K.,Puget Sound Health Care System | Neptune R.R.,University of Texas at Austin
Journal of Biomechanics | Year: 2015

Turning is an activity of daily living that involves both the acceleration of the body center-of-mass (COM) towards the center of curvature and rotation of the pelvis towards the new heading. The purpose of this study was to understand which muscles contribute to turning using experimentation, musculoskeletal modeling and simulation. Ten healthy adults consented to walk around a 1-m radius circular path at their self-selected walking speed and then along a straight line at the same speed. Forward dynamics simulations of the individual subjects during the turning and straight-line walking tasks were generated to identify the contributions of individual muscle groups to the body mediolateral and anterior-posterior COM acceleration impulse and to the pelvis angular acceleration impulse. The stance leg gluteus medius and ankle plantarflexor muscles and the swing leg adductor muscles were the primary contributors to redirect the body's COM relative to straight-line walking. In some cases, contributions to mediolateral COM acceleration were modulated through changes in leg orientation rather than through changes in muscle force. While modulation of the muscle contributions generally occurred in both the inner and outer legs, greater changes were observed during inner single-leg support than during outer single-leg support. Total pelvis angular acceleration was minimal during the single-support phase, but the swing leg muscles contributed significantly to balancing the internal and external rotation of the pelvis. The understanding of which muscles contribute to turning the body during walking may help guide the development of more effective locomotor therapies for those with movement impairments. © 2015 Elsevier Ltd. Source

Bittner N.,Tacoma Valley Radiation Oncology Centers | Butler W.M.,Wheeling Jesuit University | Reed J.L.,Wheeling Jesuit University | Murray B.C.,Wheeling Jesuit University | And 3 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2010

Purpose: To evaluate intrafraction prostate displacement among patients immobilized in the prone position using real-time monitoring of implanted radiofrequency transponders. Methods and Materials: The Calypso localization system was used to track prostate motion in patients receiving external beam radiation therapy (XRT) for prostate cancer. All patients were treated in the prone position and immobilized with a thermoplastic immobilization device. Real-time measurement of prostate displacement was recorded for each treatment fraction. These measurements were used to determine the duration and magnitude of displacement along the three directional axes. Results: The calculated centroid of the implanted transponders was offset from the treatment isocenter by ≥2 mm, ≥3 mm, and ≥4 mm for 38.0%, 13.9%, and 4.5% of the time. In the lateral dimension, the centroid was offset from the treatment isocenter by ≥2 mm, ≥3 mm, and ≥4 mm for 2.7%, 0.4%, and 0.06% of the time. In the superior-inferior dimension, the centroid was offset from the treatment isocenter by ≥2 mm, ≥3 mm, and ≥4 mm for 16.1%, 4.7%, and 1.5% of the time, respectively. In the anterior-posterior dimension, the centroid was offset from the treatment isocenter by ≥2 mm, ≥3 mm, and ≥4 mm for 13.4%, 3.0%, and 0.5% of the time. Conclusions: Intrafraction prostate displacement in the prone position is comparable to that in the supine position. For patients with large girth, in whom the supine position may preclude accurate detection of implanted radiofrequency transponders, treatment in the prone position is a suitable alternative. © 2010 Elsevier Inc. All rights reserved. Source

Fang L.C.,University of Texas M. D. Anderson Cancer Center | Merrick G.S.,Schiffler Cancer Center | Merrick G.S.,Wheeling Jesuit University | Wallner K.E.,Puget Sound Health Care System
ONCOLOGY | Year: 2010

Androgen deprivation therapy (ADT) has been used in the management of prostate cancer for more than four decades. Initially, hormone therapy was given largely for palliation of symptomatic metastases. Following several randomized trials of patients with intermediate- to high-risk prostate cancer that demonstrated improvements in biochemical control and survival with the addition of ADT to external beam radiotherapy, there was a dramatic increase in the use of hormone therapy in the definitive setting. More recently, the safety of ADT has been questioned, as some studies have suggested an association of hormone therapy with increased cardiovascular morbidity and mortality. This is particularly worrisome in light of practice patterns that show ADT use extrapolated to situations for which there has been no proven benefit. In the setting of dose escalation with modern radiotherapy, in conjunction with the latest concerns about cardiovascular morbidity with ADT, the magnitude of expected benefit along with potential risks of ADT use must be carefully considered for each patient. Source

Fey N.P.,University of Texas at Austin | Klute G.K.,Puget Sound Health Care System | Neptune R.R.,University of Texas at Austin
Journal of Biomechanical Engineering | Year: 2012

Unilateral below-knee amputees develop abnormal gait characteristics that include bilateral asymmetries and an elevated metabolic cost relative to non-amputees. In addition, long-term prosthesis use has been linked to an increased prevalence of joint pain and osteoarthritis in the intact leg knee. To improve amputee mobility, prosthetic feet that utilize elastic energy storage and return (ESAR) have been designed, which perform important biomechanical functions such as providing body support and forward propulsion. However, the prescription of appropriate design characteristics (e.g., stiffness) is not well-defined since its influence on foot function and important in vivo biomechanical quantities such as metabolic cost and joint loading remain unclear. The design of feet that improve these quantities could provide considerable advancements in amputee care. Therefore, the purpose of this study was to couple design optimization with dynamic simulations of amputee walking to identify the optimal foot stiffness that minimizes metabolic cost and intact knee joint loading. A musculoskeletal model and distributed stiffness ESAR prosthetic foot model were developed to generate muscle-actuated forward dynamics simulations of amputee walking. Dynamic optimization was used to solve for the optimal muscle excitation patterns and foot stiffness profile that produced simulations that tracked experimental amputee walking data while minimizing metabolic cost and intact leg internal knee contact forces. Muscle and foot function were evaluated by calculating their contributions to the important walking subtasks of body support, forward propulsion and leg swing. The analyses showed that altering a nominal prosthetic foot stiffness distribution by stiffening the toe and mid-foot while making the ankle and heel less stiff improved ESAR foot performance by offloading the intact knee during early to mid-stance of the intact leg and reducing metabolic cost. The optimal design also provided moderate braking and body support during the first half of residual leg stance, while increasing the prosthesis contributions to forward propulsion and body support during the second half of residual leg stance. Future work will be directed at experimentally validating these results, which have important implications for future designs of prosthetic feet that could significantly improve amputee care. © 2012 American Society of Mechanical Engineers. Source

Ventura J.D.,University of Texas at Austin | Klute G.K.,Puget Sound Health Care System | Neptune R.R.,University of Texas at Austin
Gait and Posture | Year: 2011

In an effort to improve amputee gait, energy storage and return (ESAR) prosthetic feet have been developed to provide enhanced function by storing and returning mechanical energy through elastic structures. However, the effect of ESAR feet on muscle activity in amputee walking is not well understood. Previous studies have analyzed commercial prosthetic feet with a wide range of material properties and geometries, making it difficult to associate specific ESAR properties with changes in muscle activity. In contrast, prosthetic ankles offer a systematic way to manipulate ESAR properties while keeping the prosthetic heel and keel geometry intact. In the present study, ESAR ankles were added to a Seattle Lightfoot2 to carefully control the energy storage and return by altering the ankle stiffness and orientation in order to identify its effect on lower extremity muscle activity during below-knee amputee walking. A total of five foot conditions were analyzed: solid ankle (SA), stiff forward-facing ankle (FA), compliant FA, stiff reverse-facing ankle (RA) and compliant RA. The ESAR ankles decreased the activity of muscles that contribute to body forward propulsion and increased the activity of muscles that provide body support. The compliant ankles generally caused a greater change in muscle activity than the stiff ankles, but without a corresponding increase in energy return. Ankle orientation also had an effect, with RA generally causing a lower change in muscle activity than FA. These results highlight the influence of ESAR stiffness on muscle activity and the importance of prescribing appropriate prosthetic foot stiffness to improve rehabilitation outcomes. © 2010 Elsevier B.V. Source

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