Individuals with stroke have neuromuscular weakness or paralysis on one side of the body caused by some muscles disengaging and overexciting other muscles. Hyperextension of the knee joint and complete lack of plantar flexion of the ankle joint are common symptoms of stroke. This thesis encompasses the simulation of hemiparetic function using both a knee orthosis with variable impedance, specifically in terms of stiffness and damping, and the Proprioception Interference Apparatus. The section regarding the knee orthosis with variable impedance focuses on the creation and implementation of a small, lightweight, and adjustable orthotic device to be positioned around the knee of an able-bodied person to simulate hemiparetic gait. Force and range of motion data from able-bodied subjects fitted with the orthosis, inducing hemiparetic gait, was collected using the Computer Assisted Rehabilitation ENvironment (CAREN) system. The four parameters that the design focused on are damping, catch, hysteresis, and stiffness. The main goal of the project was to discern whether this device could be utilized as a viable research instrument to simulate hemiparetic gait. It was hypothesized that the device has the potential to be utilized in the future as a research device to be used on able-bodied persons to study asymmetries in gait and eventually quantify the Modified Ashworth Scale. It was also believed that it could serve as a possible rehabilitation device for people with stroke since it has been designed to induce larger knee flexion as an after effect. However, this would require the proper clinical evaluation and experimentation procedures to be successfully concluded. A comparison between how the dominant leg was affected by the orthosis and how the non-dominant leg was affected was investigated as well. The results show that the device affected the velocities, knee angles, and force profiles of the subject’s gait. The second section involving the Proprioception Interference Apparatus involved the creation and implementation of a haptic apparatus that utilizes vibration as well as transcutaneous electrical nerve stimulation (TENS) in various combinations with and without visual feedback to induce a proprioceptive illusion around the knee joint, as if a subject has a version of hemiparesis. The main goal of the project was to discern whether a device of relatively the same design could be utilized as a viable research instrument to simulate stroke-like balance in able-bodied subjects. Comparison between how the root mean square (RMS) values of each marker location, the average of the standard deviations of the forces, and RMS of the center of pressure affected the various conditions was investigated as well. It was hypothesized and concluded that the RMS values and average of the standard deviations when subjects had no visual feedback would have a significant difference from when they had visual feedback. It was also hypothesized that Proprioceptive Interference Apparatus (PIA) would have a significant effect on the RMS and standard deviation values since it was meant to disrupt the motor control function of the knee, however, this was proved false after data analysis. It was also surmised that the application of the TENS had more of an effect on the RMS and standard deviation values, whether it was used on its own or in combination with the vibrations, than the vibration stimulation alone. However, once again, this was not statistically significant.

This paper describes a three part analysis to characterize the interaction between the female upper extremity and a helicopter cockpit side airbag system and to develop dynamic hyperextension injury criteria for the female elbow joint. Part I involved a series of 10 experiments with an original Army Black Hawk helicopter side airbag. A 5th percentile female Hybrid III instrumented upper extremity was used to demonstrate side airbag upper extremity loading. Two out of the 10 tests resulted in high elbow bending moments of 128 Nm and 144 Nm. Part II included dynamic hyperextension tests on 24 female cadaver elbow joints. The energy source was a drop tower utilizing a three-point bending configuration to apply elbow bending moments matching the previously conducted side airbag tests. Post-test necropsy showed that 16 of the 24 elbow joint tests resulted in injuries. Injury severity ranged from minor cartilage damage to more severe joint dislocations and transverse fractures of the distal humerus. Peak elbow bending moments ranged from 42.4 Nm to 146.3 Nm. Peak bending moment proved to be a significant indicator of any elbow injury (p=0.02) as well as elbow joint dislocation (p=0.01). Logistic regression analyses were used to develop single and multivariate injury risk functions. Using peak moment data for the entire test population, a 50% risk of obtaining any elbow injury was found at 56 Nm while a 50% risk of sustaining an elbow joint dislocation was found at 93 Nm for the female population. These results indicate that the peak elbow bending moments achieved in Part I are associated with a greater than 90% risk for elbow injury. Subsequently, the airbag was re-designed in an effort to mitigate this as well as the other upper extremity injury risks. Part III assessed the enhanced side airbag module to ensure injury risks had been reduced prior to implementing the new system. To facilitate this, 12 enhanced side airbag deployments were conducted using the same procedures as Part I. Results indicate that the re-designed side airbag has effectively mitigated elbow injury risks induced by the original side airbag design. It is anticipated that this study will provide researchers with additional injury criteria for assessing upper extremity injury risk caused by both military and automotive side airbag deployments. / Master of Science

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Title: Methods of prevention in hyperextension trauma to the elbow of the handball goalkeeper. Objectives: The main objective of this thesis is to determine whether the muscle strengthening exercises stabilizers of the elbow affect the stability of the elbow joint and also draw attention to the issue of hyperextension trauma to the elbow joint of the handball goalkeeper. Another objective is to evaluate the possibility of prevention of hyperextension trauma to the elbow joint of the handball goalkeeper. Methods: Rating angular deviations observed in the elbow before and after completing the intervention. Deviations were recorded using a 3D analysis system Qualysis and were processed in software Qualisys Track Manager. Results: Strengthening the dynamic stabilizers of the elbow helps to improve stability of the elbow joint load into hyperextension. Active exercise can be used as a possible prevention of hyperextension trauma to the elbow joint of handball goalkeepers. Keywords: elbow joint, hyperextension trauma, goalkeeper, handball, strengthening

Cette étude vise à décrire le rôle de l’héritage et de la segmentation associés au rifting pour la réactivation ainsi qu’à étudier l’importance de l’asymétrie tectonique sur l’évolution thermique syn-rift, en utilisant le système pyrénéo-cantabrique comme laboratoire naturel. L’étude de la jonction entre les segments pyrénéen et cantabrique infirme l’hypothèse d’une faille transformante de Pampelune et met en évidence une zone d’accommodation où les segments de rifts se propagent au nord et au sud des massifs basques, associée à une direction d’extension nord-sud. Lors de la convergence, cette segmentation et le niveau de découplage associé aux évaporites triasiques contrôlent fortement la réactivation ainsi que l’architecture orogénique locale. Enfin, cette étude démontre que l’asymétrie lors de l’hyper-étirement est associée à une évolution thermique asymétrique et diachrone, et souligne l’importance de l’évolution tectonique pour l’architecture thermique. / This study aims to describe the role of rift-inheritance and segmentation for reactivation and to investigate the influence of asymmetric rifting on the syn-rift thermal evolution, using the Pyrenean-Cantabrian system as a natural laboratory. The study of the Pyrenean-Cantabrian junction discards the existence of a Pamplona transform fault between the two rift segments and argues for an accommodation zone where rift segments overlap north and south of the Basque massifs in relation with north-south direction of extension. During convergence, rift segmentation and the Triassic evaporite decoupling horizon controlled the reactivation and the local orogenic architecture. Finally, this study shows that asymmetric hyperextension is associated with asymmetric and diachronous thermal evolution, and highlights the importance of understanding the tectonic evolution to define the thermal architecture.

Clinicians working on motor skill learning interventions often find that improvements observed during training are not sustained and do not transfer to very similar tasks. Research suggests that strategies such as real-time biofeedback and learner's focus of attention seem to facilitate motor skill learning. However, research on the implications of these strategies in rehabilitation is limited and has not been investigated in healthy individuals. The motor learning effects of these strategies need to be assessed as they offer the possibility of enhancing rehabilitation regimens. The purpose of this study was to investigate the generalizability of real-time biofeedback and learner's focus of attention to a treadmill gait retraining program aimed at correcting knee hyperextension insidious gait patterns in healthy young women. Assessing the acquisition, retention, and transfer of kinematic improvements was the focus of this study. 1.Knee sagittal plane kinematics could be influenced with dynamic gait training using real-time biofeedback. Gained proficiency in controlling knee hyperextension during treadmill training was evident during overground walking immediately and 1 month after training. 2.The effectiveness of real-time biofeedback in improving performance does not seem to be influenced by the focus of attention, internal or external, induced during treadmill training. Participants in both intervention groups improved in a similar way as a consequence of practice. However, there were trends in the data that pointed that the external focus of attention group had better long-term retention. It is not known if participants actively switched to an external focus of attention despite the instructions provided during training. Tests to ensure instructional compliance should be used. 3.A treadmill gait retraining program using learner's focus of attention indicated that that there were not differences in learning acquisition, short and long-term retention, and transfer to overground walking and obstacle crossing between intervention groups. It is not known if these changes persist beyond the 4-month follow-up included in this study. The results of this study will help to reduce knee hyperextension gait patterns in women. Future studies may also use the methodology used in this study to further investigate the implications of learner's focus of attention in rehabilitation. Similarly, the findings of this study could offer an additional strategy for rehabilitation regimens.

Objective: To determine the ability of the Tibial Plateau Leveling Osteotomy (TPLO) to restore normal joint kinematics in a cranial cruciate ligament (CrCL)-deficient stifle through a loaded range of motion. Methods: Paired pelvic limbs from 12 dogs were compared in an in vitro biomechanical study. Each limb was placed in a custom designed jig at 120° of stifle extension under an axial load of 20% body weight. Electromagnetic motion tracking sensors were placed on the distal femur and proximal tibia. A force was applied at approximately 10 N/sec to mimic the action of the quadriceps muscle. Force application allowed the limb to move from 120° to maximal extension. Positional data was acquired at 60 points/second. Each limb was tested under normal, CrCL-deficient, and TPLO-treated conditions. Results: The TPLO failed to normalize CTT within the CrCL-deficient stifle; however, values trended towards intact values throughout the range of motion. No significant differences were noted in internal rotation in any of the three conditions from 120° – 137°. Hyperextension values did not differ significantly between conditions. Conclusion: Data from this biomechanical model suggests that the TPLO fails to neutralize CTT throughout a loaded range of motion. Internal rotation and hyperextension values were not found to differ significantly between intact, CrCL-deficient and TPLO repaired stifles. The effectiveness of the TPLO in restoring normal biomechanics is more significant at greater angles of flexion. / Master of Science