The understanding of individual muscle impairments that affect swing phase in stroke gait will lead to better rehabilitation strategies for this population. We used induced acceleration analysis to evaluate the potential each muscle has to accelerate the hip and knee joints of the swing limb, using kinematics from three stroke subjects and five healthy subjects. To determine the influence of altered limb position on muscle function, we augmented hip extension by 10° in swing phase for all subjects. We found that in early swing, healthy subjects had greater potential to accelerate the knee into flexion than stroke subjects, whereas stroke subjects had greater potential to accelerate the hip into flexion. Perturbing the hip flexion angle into greater extension increased the potential of biarticular muscles to flex the knee in swing phase. The potential of muscles to improve swing phase dynamics depends on the initial posture of the limb and highlights the importance of subject-specific evaluations in the design of appropriate therapeutic interventions.
Debra G. George-Reichley and Jill S. Higginson
Alan R. Needle, Thomas W. Kaminski, Jochen Baumeister, Jill S. Higginson, William B. Farquhar and C. Buz Swanik
Rolling sensations at the ankle are common after injury and represent failure in neural regulation of joint stiffness. However, deficits after ankle injury are variable and strategies for optimizing stiffness may differ across patients.
To determine if ankle stiffness and muscle activation differ between patients with varying history of ankle injury.
Fifty-nine individuals were stratified into healthy (CON, n = 20), functionally unstable (UNS, n = 19), and coper (COP, n = 20) groups.
Main Outcome Measures:
A 20° supination perturbation was applied to the ankle as position and torque were synchronized with activity of tibialis anterior, peroneus longus, and soleus. Subjects were tested with muscles relaxed, while maintaining 30% muscle activation, and while directed to react and resist the perturbation.
No group differences existed for joint stiffness (F = 0.07, P = .993); however, the UNS group had higher soleus and less tibialis anterior activation than the CON group during passive trials (P < .05). In addition, greater early tibialis anterior activation generally predicted higher stiffness in the CON group (P ≤ .03), but greater soleus activity improved stiffness in the UNS group (P = .03).
Although previous injury does not affect the ability to stiffen the joint under laboratory conditions, strategies appear to differ. Generally, the COP has decreased muscle activation, whereas the UNS uses greater plantar-flexor activity. The results of this study suggest that clinicians should emphasize correct preparatory muscle activation to improve joint stiffness in injury-rehabilitation efforts.
Stephen John Thomas, Charles Buz Swanik, Thomas W. Kaminski, Jill S. Higginson, Kathleen A. Swanik and Levon N. Nazarian
Subacromial impingement is a common injury in baseball players and has been linked to a reduction in the subacromial space. In addition, it has been suggested that decreases in scapular upward rotation will lead to decreases in the subacromial space and ultimately impingement syndrome.
The objective of this study was to evaluate the relationship between acromiohumeral distance and scapular upward rotation in healthy college baseball players.
Posttest-only study design.
Controlled laboratory setting.
24 healthy college baseball players.
Participants were measured for all dependent variables at preseason.
Main Outcome Measures:
Acromiohumeral distance at rest and 90° of abduction was measured with a diagnostic ultrasound unit. Scapular upward rotation at rest and 90° of abduction was measured with a digital inclinometer.
Dominant-arm acromiohumeral distance at rest and 90° of abduction (P = .694, P = .840) was not significantly different than in the nondominant arm. In addition, there was not a significant correlation between acromiohumeral distance and scapular upward rotation at rest and 90° of abduction for either the dominant or the nondominant arm.
These results indicate that the acromiohumeral distance is not adapting in the dominant arm in healthy throwing athletes. In addition, a relationship was not identified between acromiohumeral distance and scapular upward rotation, which was previously suggested. These results may suggest that changes that are typically seen in an injured population may be occurring due to the injury and are not preexisting. In addition, scapular upward rotation may not be the only contributing factor to acromiohumeral distance.
R. Tyler Richardson, Elizabeth A. Rapp, R. Garry Quinton, Kristen F. Nicholson, Brian A. Knarr, Stephanie A. Russo, Jill S. Higginson and James G. Richards
Musculoskeletal modeling is capable of estimating physiological parameters that cannot be directly measured, however, the validity of the results must be assessed. Several models utilize a scapular rhythm to prescribe kinematics, yet it is unknown how well they replicate natural scapular motion. This study evaluated kinematic errors associated with a model that employs a scapular rhythm using 2 shoulder movements: abduction and forward reach. Two versions of the model were tested: the original MoBL ARMS model that utilizes a scapular rhythm, and a modified MoBL ARMS model that permits unconstrained scapular motion. Model estimates were compared against scapulothoracic kinematics directly measured from motion capture. Three-dimensional scapulothoracic resultant angle errors associated with the rhythm model were greater than 10° for abduction (mean: 16.4°, max: 22.4°) and forward reach (mean: 11.1°, max: 16.5°). Errors generally increased with humerothoracic elevation with all subjects reporting greater than 10° differences at elevations greater than 45°. Errors associated with the unconstrained model were less than 10°. Consequently, use of the original MoBL ARMS model is cautioned for applications requiring precise scapulothoracic kinematics. These findings can help determine which research questions are suitable for investigation with these models and assist in contextualizing model results.