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  • Author: Christopher M. Saliba x
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Christopher M. Saliba, Allison L. Clouthier, Scott C.E. Brandon, Michael J. Rainbow and Kevin J. Deluzio

Abnormal loading of the knee joint contributes to the pathogenesis of knee osteoarthritis. Gait retraining is a noninvasive intervention that aims to reduce knee loads by providing audible, visual, or haptic feedback of gait parameters. The computational expense of joint contact force prediction has limited real-time feedback to surrogate measures of the contact force, such as the knee adduction moment. We developed a method to predict knee joint contact forces using motion analysis and a statistical regression model that can be implemented in near real-time. Gait waveform variables were deconstructed using principal component analysis, and a linear regression was used to predict the principal component scores of the contact force waveforms. Knee joint contact force waveforms were reconstructed using the predicted scores. We tested our method using a heterogenous population of asymptomatic controls and subjects with knee osteoarthritis. The reconstructed contact force waveforms had mean (SD) root mean square differences of 0.17 (0.05) bodyweight compared with the contact forces predicted by a musculoskeletal model. Our method successfully predicted subject-specific shape features of contact force waveforms and is a potentially powerful tool in biofeedback and clinical gait analysis.

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Christopher Kuenze, Jay Hertel, Susan Saliba, David R. Diduch, Arthur Weltman and Joseph M. Hart

Context:

Normal, symmetrical quadriceps strength is a common clinical goal after anterior cruciate ligament reconstruction (ACLR). Currently, the clinical thresholds for acceptable unilateral quadriceps function and symmetry associated with positive outcomes after return to activity are unclear.

Objective:

To establish quadriceps-activation and knee-extension-torque cutoffs for clinical assessment after return to activity after ACLR.

Design:

Descriptive laboratory study.

Setting:

Laboratory.

Patients:

22 (10 female, 12 male; age = 22.5 ± 5.0 y, height = 172.9 ± 7.1 cm, mass = 74.1 ± 15.5 kg, months since surgery = 31.5 ± 23.5) recreationally active persons with a history of unilateral, primary ACLR at least 6 months prior and 24 (12 female/12 male, age = 21.7 ± 3.6 y, height = 168.0 ± 8.8 cm, mass = 69.3 ± 13.6 kg) recreationally active healthy participants.

Main Outcome Measures:

Patient-reported measures of pain, knee-related function, and physical activity level were recorded for all participants. Normalized knee-extension maximum-voluntary-isometric-contraction (MVIC) torque (Nm/kg) and quadriceps central-activation ratio (CAR, %) were measured bilaterally in all participants. Receiver-operator-characteristic (ROC) curves were used to establish thresholds for unilateral measures of normalized knee-extension MVIC torque and quadriceps CAR, as well as limb-symmetry indices (LSI). ROC curves then established clinical thresholds for normalized knee-extension MVIC torque and quadriceps CAR LSIs associated with healthy knee-related function.

Results:

Involved-quadriceps CAR above 89.3% was the strongest unilateral indicator of healthy-group membership, while quadriceps CAR LSI above 0.996 and knee-extension MVIC torque above 0.940 were the strongest overall indicators. Unilateral normalized knee-extension MVIC torque above 3.00 Nm/kg and quadriceps CAR LSI above 0.992 were the best indicators of good patient-reported knee-related outcomes.

Conclusions:

Threshold values established in this study may provide a guide for clinicians when making return-to-activity decisions after ACLR. Normalized knee-extension MVIC torque (>3.00 Nm/kg) and quadriceps CAR symmetry (>99.6%) are both strong indicators of good patient-reported outcomes after ACLR.

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Daniel H. Huffman, Brian G. Pietrosimone, Terry L. Grindstaff, Joseph M. Hart, Susan A. Saliba and Christopher D. Ingersoll

Context:

Motoneuron-pool facilitation after cryotherapy may be mediated by stimulation of thermoreceptors surrounding a joint. It is unknown whether menthol counterirritants, which also stimulate thermoreceptors, have the same effect on motoneuron-pool excitability (MNPE).

Objective:

To compare quadriceps MNPE after a menthol-counterirritant application to the anterior knee, a sham counterirritant application, and a control treatment in healthy subjects.

Design:

A blinded, randomized controlled laboratory study.

Setting:

Laboratory.

Participants:

Thirty healthy subjects (16 m, 14 f; 24.1 ± 3.9 y, 170.6 ± 11.4 cm, 72.1 ± 15.6 kg) with no history of lower extremity surgery volunteered for this study.

Intervention:

Two milliliters of menthol or sham counterirritant was applied to the anterior knee; control subjects received no intervention.

Main Outcome Measures:

The average vastus medialis normalized Hoffmann reflex (Hmax:Mmax ratio) was used to measure MNPE. Measurements were recorded at 5, 15, 25, and 35 minutes postintervention and compared with baseline measures.

Results:

Hmax:Mmax ratios for all groups significantly decreased over time (F 4,108 = 10.52, P < .001; menthol: baseline = .32 ± .20, 5 min = .29 ± .18, 15 min = .27 ± .18, 25 min = .28 ± .19, 35 min = .27 ± .18; sham: baseline = .46 ± .26, 5 min = .36 ± .20, 15 min = .35 ± .19, 25 min = .35 ± .20, 35 min = .34 ± .18; control: baseline = .48 ± .32, 5 min = .37 ± .27, 15 min = .37 ± .27, 25 min = .37 ± .29, 35 min = .35 ± .28). No significant Group × Time interaction or group differences in Hmax:Mmax were found.

Conclusions:

Menthol did not affect quadriceps MNPE in healthy subjects.