ANKLE, KNEE, AND HIP MOMENTS DURING STANDING WITH AND WITHOUT JOINT CONTRACTURES Simulation Study for Functional Electrical Stimulation

Kagaya, Hitoshi; Sharma, Monika; Kobetic, Rudi; Marsolais, E.B.

doi:10.1097/00002060-199801000-00009

Cited by 22 publications

(14 citation statements)

References 10 publications

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“…Patients with contractures are likely to have pain [10,26,37], pressure ulcers [8], and cognitive impairment [26]. Contractures also can contribute to impaired function and activity limitations [5,12,14,16,19,26]. Notably, the proportion of patients who have contractures develop in major joints 1 year after spinal cord injury ranges from 11% to 43%, and it is difficult to accurately predict those susceptible to contracture soon after injury [7].…”

Section: Introductionmentioning

confidence: 99%

Stretching After Heat But Not After Cold Decreases Contractures After Spinal Cord Injury in Rats

Iwasawa

Nomura

Sakitani

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Contractures are a prevalent and potentially severe complication in patients with neurologic disorders. Although heat, cold, and stretching are commonly used for treatment of contractures and/or spasticity (the cause of many contractures), the sequential effects of these modalities remain unclear. Questions/purposes Using an established rat model with spinal cord injury with knee flexion contracture, we sought to determine what combination of heat or cold before stretching is the most effective for treatment of contractures derived from spastic paralyses and investigated which treatment leads to the best (1) improvement in the loss of ROM; (2) restoration of deterioration in the muscular and articular factors responsible for contractures; and (3) amelioration of histopathologic features such as muscular fibrosis in biceps femoris and shortening of the joint capsule. Methods Forty-two adolescent male Wistar rats were used. After spasticity developed at 2 weeks postinjury, each animal with spinal cord injury underwent the treatment protocol daily for 1 week. Knee extension ROM was measured with a goniometer by two examiners blinded to each other's scores. The muscular and articular factors contributing to contractures were calculated by measuring ROM before and after the myotomies. We quantitatively measured the muscular fibrosis and the synovial intima length, and observed the distribution of collagen of skeletal muscle. The results were confirmed by a blinded observer. Results The ROM of heat alone (34°± 1°) and cold alone (34°± 2°) rats were not different with the numbers available from that of rats with spinal cord injury (35°± 2°) (p = 0.92 and 0.89, respectively). Stretching after heat (24°± 1°) was more effective than stretching alone (27°± 3°) at increasing ROM (p \ 0.001). Contrastingly, there was no difference between stretching after cold (25°± 1°) and stretching alone (p = 0.352). Stretching after heat was the most effective for percentage improvement of muscular (29%) and articular (50%) factors of contractures. Although quantification of muscular fibrosis in the rats with spinal cord injury (11% ± 1%) was higher than that of controls (9% ± 0.4%) (p = 0.01), no difference was found between spinal cord injury and each treatment protocol. The total synovial intima length of rats with spinal cord injury (5.9 ± 0.2 mm) became shorter than those of the controls (7.6 ± 0.2 mm) (p \ 0.001), and those of stretching alone (6.9 ± 0.4 mm), stretching after heat (7.1 ± 0.3 mm), and stretching after cold (6.7 ± 0.4 mm)

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Section: Introductionmentioning

confidence: 99%

Stretching After Heat But Not After Cold Decreases Contractures After Spinal Cord Injury in Rats

Iwasawa

Nomura

Sakitani

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…In addition, the contracture influences the physiological movements in other body parts such as the hip and ankle joints [2,3], as well as the spine [4]. Previous studies demonstrated the effect of knee flexion contracture using gait analysis [5,6]. Cerny et al investigated the effect of unilateral knee flexion contracture on gait using knee contracture simulation and showed that velocity and stride length significantly decreased [2].…”

Section: Introductionmentioning

confidence: 99%

A gait analysis of simulated knee flexion contracture to elucidate knee-spine syndrome

et al. 2008

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“…The objective function was defined to minimize the joint angle deviations from neutral and maximizing the posture height. The second level of optimization solved for the muscle activations (0 = minimum, 1 = maximum) necessary to satisfy the constraints of the joint moments required to statically hold each posture against gravity, plus bias extension moments at the knees and hips [21] and trunk [5] to ensure stable standing following SCI. The objective function was a physiologically-based criterion to predict minimized muscle forces during locomotion [22].…”

Section: Methodsmentioning

confidence: 99%

Simulating the restoration of standing balance at leaning postures with functional neuromuscular stimulation following spinal cord injury

Nataraj

Audu

Triolo

2015

Med Biol Eng Comput

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In this simulation study, we present and examine methods to develop a feedback controller for a neuroprosthesis that restores forward and side leaning function during standing following complete, thoracic-level spinal cord injury. Achieving leaning postures away from erect stance with functional neuromuscular stimulation (FNS) would allow users to extend their reaching capabilities. Utilizing a 3-D computer model of human stance, an FNS control system based on total-body center of mass (CoM) kinematics (position, acceleration) is developed and tested in simulation. CoM kinematics drive an artificial neural network to modulate muscle excitations and reduce the upper extremity loading, presumably against a walker or similar support surface, required to resist the effects of postural perturbations. Furthermore, a novel method to robustly estimate the feedback kinematics for standing applications is also presented while assuming 3-D accelerometer signals at locations consistent with a proposed implantable networked neuroprosthesis system. For shifting and balance at leaning postures, respectively, center of mass position and acceleration could be approximated to within 20% of the maximum value, with strong correlations (R>0.9) between values estimated by the proposed method and the true values derived from model dynamics. When utilizing the estimated feedback kinematics for FNS control, standing performance in terms of maximum upper extremity loading was still significantly reduced (p<0.001) compared to conventionally applying constant and maximal stimulation. In the future, these simulation-based methods will be employed to develop experimental approaches for restoring leaning standing function by FNS.

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ANKLE, KNEE, AND HIP MOMENTS DURING STANDING WITH AND WITHOUT JOINT CONTRACTURES Simulation Study for Functional Electrical Stimulation

Cited by 22 publications

References 10 publications

Stretching After Heat But Not After Cold Decreases Contractures After Spinal Cord Injury in Rats

Stretching After Heat But Not After Cold Decreases Contractures After Spinal Cord Injury in Rats

A gait analysis of simulated knee flexion contracture to elucidate knee-spine syndrome

Simulating the restoration of standing balance at leaning postures with functional neuromuscular stimulation following spinal cord injury

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