knee joint moments of transtibial amputees while cycling laura jones april 16, 2008
TRANSCRIPT
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Knee Joint Moments of Knee Joint Moments of Transtibial Amputees While Transtibial Amputees While CyclingCycling
Laura Jones
April 16, 2008
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INTRODUCTIONINTRODUCTION
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Main GoalMain Goal
Improve Quality of Life for Amputees– Rehabilitation– Exercise
Amputees less active than nonamputees [Bussmann, 2008]
– Recreation
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CyclingCycling
Currently used in Physical Therapy– Soft tissue injuries [Hunt 2004]
– Spinal cord injuries [Sinclair 1996, Scremin, 1999, Gerrits 2001]
– Cerebral palsy [Williams 2007]
– Chronic heart failure [Jonsdottir 2006]
Popular for general exercise and recreation
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Amputee CyclingAmputee Cycling
Popular among amputees– Recreational
– Competative
Possible for most amputation levels
Little research– 1 leg cycling [Chin 2001, Chin
2002]
– Effect of Prosthesis is unknown
[http://www.mtb-amputee.com]
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Cycling ResearchCycling Research
Performance Enhancement Injury Prevention Enhanced Physical Rehabilitation
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Cycling ResearchCycling Research
Various subject populations– Elite athlete– Rehabilitation population
Various aspects– Conditioning– Muscle coordination – EMG– Biomechanics – Force/Moment/Power– Equipment setup
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Cycling ResearchCycling Research
Biomechanics– Reaction force normal to the pedal [Gregor 1985]
– Moment about the ankle, knee, and hip [Gregor 1985]
– Limb asymmetry [Daly 1976, Hunt 2004]
– Effect of saddle height and foot position [Ericson 1986]
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PurposePurpose
Determine moment about the knee in persons with a trans-tibial amputation while cycling with a prosthesis.
Baseline data
[www.ronwilliams.com]
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GoalsGoals
Baseline values of common measurements
Understand how changes effect baseline
Relate previous research to amputee populations [http://picasaweb.google.com/stopmines/
CyclingAgainstLandminesAVLoContreLesMines]
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METHODSMETHODS
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MethodsMethods
3 subjects– 2 with unilateral transibial amputation
Experienced prosthetic user Use current prosthesis and suspension
– 1 intact– >6 months of cycling experience
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MethodsMethods
Vicon motion capture system
Instrumented pedals
Adjustable bicycle
Standardized prosthetic foot
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MethodsMethods
6 Cycling conditions– 3 loads
Self selected “Easy” Self selected “Hard” 100 W
– 2 pedaling velocities 60 rpm 90 rpm
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MethodsMethods
Knee moment calculation [Prilutsky 2000]
– Inverse dynamics
– Program used previously
Prosthesis characteristics– Inertial characteristics
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Expected DataExpected Data
[Gregor 1985]
160 Watts
60 RPM
Extension
Flexion
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Expected DataExpected Data
0% [100%]0° [360°]
25%90°
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Expected DataExpected Data
[Gregor 1985]
160 Watts
60 RPM
Extension
Flexion
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RESULTSRESULTS
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Intact Subject, Hard, 90 rpmIntact Subject, Hard, 90 rpm
Self selected ‘Hard’ = 209 Watts
Extension
Flexion
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Intact Subject, Hard, 90 rpmIntact Subject, Hard, 90 rpm
Self selected ‘Hard’ = 209 Watts
Extension
Flexion
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Amputee Subject, Hard, 90 rpmAmputee Subject, Hard, 90 rpm
Intact leg Residual limb
Self selected ‘Hard’ = 209 Watts
Extension
Flexion
Extension
Flexion
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Amputee Subject, Hard, 90 rpmAmputee Subject, Hard, 90 rpm
Self selected ‘Hard’ = 209 Watts
Extension
Flexion
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Hard, 90 rpm, 2 subjectsHard, 90 rpm, 2 subjects
Self selected ‘Hard’ = 209 Watts
Extension
Flexion
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Future ApplicationFuture Application
Understanding effect of the prosthesis– Improve amputee cycling
Safer More effective
May impact rehabilitation programs May impact configuration
– Prosthesis– Bike
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LimitationsLimitations
Few subjects Experienced cyclists Characteristics of residual limb
– Scan limb in future research
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ReferencesReferences
Bussmann J.B., Schrauwen H.J., & Stam H.J. (2008). Daily physical activity and heart rate response in people with a unilateral traumatic transtibial amputation. Arch Phys Med Rehabil, 89, 430-434.
Hunt M.A., Sanderson D.J., Moffet H., & Inglis J.T. (2004). Interlimb asymmetry in persons with and without anterior cruciate ligament deficiency during stationary cycling. Arch Phys Med Rehabil, 85, 1475-1478.
Sinclair P.J., Davis G.M., Smith R.M, Cheam B.S., & Sutton J.R. (1996). Pedal forces produced during neuromuscular electrical stimulation cycling in paraplegics. Clinical Biomechanics, 11(1), 51-57.
Scremin A.M.E., Kurta L., Gentili A., Wiseman B., Perell K., Kunkel C., & Scremin O.U. (1999). Increaseing muscle mass in spinal cord injured persons with a functional electrical stimulation exercise program. Arch Phys Med Rehabil, 80, 1531-1536.
Gerrits H.L., de Haan A., Sargeant A.J., van Langen H., & Hopman M.T. (2001). Peripheral vascular changes after electrically stimulated cycling training in people with spinal cord injury. Arch Phys Med Rehabil, 82, 832-830.
Williams H., & Pountney T. (2007). Effects of a static bicycling programme on the functional ability of young people with cerebral palsy who are non-ambulant. Developmental Medicine and Child Neurology, 49, 522-527.
Jonsdottir S., Andersen K.K., Sigurosson A.F., & Sigurosson S.B. (2006). The effect of physical training in chronic heart failure. The European Journal of Heart Failure, 8, 97-101.
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ReferencesReferences
Chin T., Sawamura S., Fujita H., Nakajima S., Ojima I., Oyabu H., Nagakura Y., Otsuka J, & Nakagawa A. (2001). Effect of endurance training program based on anaerobic threshold (AT) for lower limb amputees. JRRD, 38(1), 7-11.
Chin T., Sawamura S., Fujita H., Nakajima S., Oyabu H., Nagakura Y. Ojima I.,, Otsuka J, & Nakagawa A. (2002). Physical fitness of lower limb amputees. American Journal of Physical Medicine and Rehabilitation, 81(5), 321-325.
Gregor R.J., Cavanagh P.R., & LaFortune M. (1985). Knee flexor moments during propulsion in cycling – a creative solution to Lombard’s paradox. J Biomechanics, 18, 307-316.
Daly D.J., & Cavanagh P.R. (1976). Asymmetry in bicycle ergometer pedalling. Medicine and Science in Sports, 8(3), 204-208.
Ericson M.O., Bratt A., Nisell R., Nemeth G., & Ekholm J. (1986). Load moments about the hip and knee joints during ergometer cycling. Scand J Rehab Med, 18, 165-172.
Prilutsky B.I., & Gregor R.J. (2000). Analysis of muscle coordination strategies in cycling. IEEE Transactions on Rehabilitation Engineering, 8(3), 362-370.
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Questions?Questions?
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Amputee AnthropometricsAmputee Anthropometrics
Prosthesis– Moment of Inertia [Street 2007]
Pendulum method
– Center of Mass Theoretical “intact” body weight Residual limb
– Theoretical mass– Interial characteristics– Assumed elliptical parabaloid
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Expected DataExpected Data
[Ruby 1992]225 Watts, 90 RPM
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OverviewOverview
Introduction Purpose Methods Results
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Main GoalMain Goal
Modality– Walking– Running– Swimming– Bicycling
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Others – level walking, stairs, Others – level walking, stairs, etc.etc. Boccardi S, Pedotti A, Rodano R, Santambrogio GC.
Evaluation of muscular moments at the lower limb joints by an on-line processing of kinematic data and ground reaction. J Biomech 1981;14:35.
Andriacchi TP, Andersson Other
– Look into knee/muscle/cardio strength training/injuries in amputees
– Look at http://www.kneeguru.co.uk/insights/doku.php/rehab/cycling01
Ruby P, Hull ML, Hawkins D. Three-dimensional knee joint loading during seated cycling. J Biomechanics 1992;25(1):41-53.