L’examen clinique et les radiographies standard des membres inférieurs et des pieds comportent des biais liés à la reproductibilité et à la projection en 2 dimensions d’unobjet en 3D. La reconstruction en 3D des segments anatomiques à partir d’images biplanes acquises en position debout doit permettre de s’affranchir de ces biais, au prixd’une irradiation modérée. La 1ère partie de ce travail a posé la question de l’utilisationen pratique clinique courante des reconstructions en 3D issues de ce système, et a permis de valider la reproductibilité de celles ci ainsi que de donner des valeurs de référence de ces paramètres mesurés en 3D. La 2ème partie a consisté en l’adaptationd’un modèle de reconstruction de pieds de l’adulte à ceux de l’enfant, a permis devérifier la reproductibilité des données obtenues, ainsi que de rapporter des valeurs préliminaires de paramètres de mesures radiologiques. Enfin, la 3ème partie a étudié l’analyse complète de pieds pathologiques (pied bot varus équin) associant l’examenclinique, la morphologie radiologique (obtenues par EOS®) et la fonction du pied lors d’une analyse de la marche. Nous en concluons que si cette analyse combinée paraîtcapitale, des difficultés persistent, en particulier dans le choix du modèle pour l’analyse de la marche, les modèles les plus complets actuels étant grévés d’une incertitude liée au placement des marqueurs trop importante. / Clinical examination and standard X-rays of the lower limbs and feet have biases related to reproducibility and to 2-dimensional projection of a 3D object. The 3Dreconstruction of the anatomical segments from biplanar images acquired in a standingposition should make possible to get rid of these biases, at the cost of moderate irradiation. The 1st part of this work asked the question of the use in current clinical practice of the reconstructions in 3D resulting from this system, and allowed validationof the reproducibility of these while giving reference values of the measured parameters in 3D. The 2nd part consisted in the adaptation of a model of reconstruction of the feet of the adult to those of the child, and aimed to check the reproducibility of the data obtained, and to report preliminary values of parameters of measurements. Finally, the 3rd part studied the feasibility of a complete analysis of pathological foot (congenital clubfoot) combining clinical examination, radiological morphology (EOS® images) andfoot function with gait analysis. We conclude that while this combined analysis appears to be critical, difficulties remain, particularly in the choice of the model for walkinganalysis, with the current full-scale models being overwhelmed by uncertainty related tothe placement of markers.

Orientador: Marcelo Augusto Assunção Sanches / Resumo: Neste trabalho é apresentado o desenvolvimento de um sistema de alinhamento referenciado de prótese de membro inferior, denominado PASyLL (Prosthesis Alignment System of Lower Limbs). A qualidade do alinhamento e ajuste de próteses de membros inferiores é fundamental no processo de reabilitação, principalmente porque contribui para que não ocorra o abandono do uso da prótese. Atualmente, muitos alinhamentos de próteses ainda são realizados de forma subjetiva, sem auxílio de equipamentos, ou seja, apenas com base na experiência e conhecimento do profissional de saúde. Diante disso, desenvolveu-se o PASyLL, um sistema para auxiliar o profissional da saúde no alinhamento de prótese. Este equipamento mede parâmetros importantes para um alinhamento adequado, fornece ao terapeuta dados objetivos, auxiliando-o na tomada de decisão. Com este sistema é possível medir e realizar ajustes no comprimento, medir a distribuição do peso no membro protetizado e não protetizado, verificar a posição do centro de pressão do paciente (COP), desta forma auxiliar no ajuste médio lateral e anteroposterior. O sistema possui fachos laser na horizontal e vertical, permitindo assim um alinhamento referenciado. O erro percentual na medição do peso foi inferior a 1% e na medida do COP, inferior a 5%. / Abstract: In this work the development of a referenced alignment system of lower limb prosthesis, called PASyLL (Prosthesis Alignment System of Lower Limbs), is presented. The quality of the alignment and adjustment of lower limb prostheies is fundamental in the rehabilitation process, mainly because it contributes to the abandonment of prosthesis use. Currently, many prosthesis alignments are still performed subjectively, without the aid of equipment, that is, only based on the experience and knowledge of the health professional. Therefore, the PASyLL, a system to assist the health professional in the prosthesis alignment, was developed. This equipment measures important parameters for proper alignment, provides the therapist with objective data, assisting him in decision making. With this system it is possible to measure and adjust the length, measure the weight distribution in the amputated and not amputated limb, verify the position of the patient pressure center (COP) in this way assist in the lateral lateral and anteroposterior adjustment. The system has horizontal and vertical laser beams, allowing a referenced alignment. The percentage error in weight measurement was less than 1% and in the COP, less than 5%. / Mestre

Introdução: Atletas de Powerlifting utilizam habitualmente em sua preparação física o Agachamento (AT) e o Box-Squat (BS). Conhecer as variáveis cinemáticas e eletromiográficas destes exercícios é relevante para sua prescrição. Objetivo: Comparar os efeitos agudos da utilização do Agachamento e do Box-Squat, em três diferentes amplitudes de movimento, sobre variáveis de desempenho neuromuscular, em atletas de Powerlifting. Materiais e Métodos: Dez atletas de Powerlifing (31,7±5,05 anos) participaram de duas sessões de avaliação: i) aplicação de questionário, realização de medidas antropométricas e testes de 1RM para Agachamento e Box-Squat nas condições Completo, Paralelo e Parcial; ii) Coleta do sinal eletromiográfico dos músculos Reto Femoral; Vasto Lateral; Vasto Medial; Bíceps Femoral; Glúteo Máximo; Gastrocnêmio Lateral e Eretores da Coluna, durante AT e BS com as cargas de 1RM previamente aferidas. Coleta de dados de cinemetria 2D para o cálculo da Potência Absoluta e Relativa. Resultados: A carga de 1RM (252±55 Kg) e o Índice de Força Relativa (2,66±0,43) do BS Parcial foram significativamente maiores que nas outras cinco variações de exercício. Potência Absoluta (613,25±194,80 W) e Relativa (6,48±1,86) foram maiores no AT Parcial quando comparado a BS Completo, AT Completo, AT Paralelo e BS Paralelo. A ativação EMG do Reto Femoral foi maior no BS Completo (95,48±46,82 %CIVM) comparada à AT Parcial e BS Parcial. O Glúteo Máximo foi mais ativado no AT Paralelo (175,36±101,79 %CIVM) comparado ao BS Completo (143,51±79,00 %CIVM). A ativação dos Eretores da Coluna no AT Paralelo (132,27±77,31 %CIVM) foi superior à do AT Parcial (92,09±38,28 %CIVM). Conclusão: As cargas de 1RM foram maiores em excursões articulares reduzidas, com vantagem do BS Parcial. O AT Parcial apresentou maiores valores de Potência Absoluta e Relativa. AT e BS mostraram-se equivalentes do ponto de vista da ativação muscular. / Introduction: Powerlifters commonly use Squats and Box-Squats in their training process. Knowing kinetics and kinematics of these exercises can help trainers when planning a training program. Objective: To compare kinetic and kinematics of full, parallel and partial Squats and Box-Squats performed by Powerlifters. Material and Methods: Ten Powerlifters (31,7±5,05 years) participated in two sessions of data collection: i) Survey about training and injury, Anthropometrical measures, 1RM testing for the full, parallel and partial Squats and Box-Squats; ii) Muscle activity of rectus femoris, vastus lateralis, vastus medialis, biceps femoris, gluteus maximus, lateral gastrocnemius and erector spinae over the six conditions at 100% of 1RM. Sagital plane video was recorded for power output measures. Results: Significantly higher loads were observed in Partial Box-Squat (252±55 Kg) compared to the other five situations. Overall (613,25±194,80 W) and Relative (6,48±1,86) Power Output were higher at Partial Squat when compared to Parallel and Full Squats and Box-Squats. Muscle activation of rectus femoris was significantly higher in Full Box-Squat (95,48±46,82 %MVC) compared to Partial Squats and Box-Squats. Gluteus maximus activation was higher at the Parallel Squat (175,36±101,79 %MVC) when compared to the Full Box-Squat (143,51±79,00 %MVC). Erector Spinae muscle activation was significantly higher in Parallel Squat (132,27±77,31 %MVC) in comparison to the Partial Squat (92,09±38,28 %MVC). Conclusion: Higher 1RM loads were found in Partial Range of Motion, especially in Box-Squat. Overall and Relative Power Output were higher at Partial Squats. Squats and Box-Squats showed similar muscle activation patterns.

The swimming track start is a complex motor skill that utilizes asymmetric lower limb action. The purpose of this study was to explore whether it could be optimized by applying the commonly accepted view that there are asymmetries in the function and behaviors of the lower limbs. Initially, the study aimed to examine the relationship between various measures of lower limb asymmetry and the swimmers' preferences for forward foot placement in the swimming track start. Participants underwent a 7 week training period whereby both the left foot forward (LFF) and the right foot forward (RFF) track starts were practiced. The philosophy behind this training protocol was to ensure that participants received equal practice with the preferred and non-preferred stance so that a dominant stance, if it existed, could emerge. Consequently, the relationships between the dominant track start stance and the lower limb asymmetry measures could be determined more accurately. Participants were male (N=11) and female (N=11) swimmers, aged 12-16 years, from the UWA-Uniswim National Age Squad. Kinetic and kinematic data were collected for the track start prior to and following the 7 week training intervention. The intervention was finished when a participant had completed approximately 14 dive sessions where both the LFF and RFF track starts were practiced. The performance criterion measure was time to 5 m. Despite significant differences in vertical force and velocity contributions following the intervention, time to 5 m did not improve for either the LFF or the RFF track start. Four different measures of lower limb asymmetry were collected, including footedness, the preferred track start stance, and the dominant take-off limb for the unilateral and bilateral counter-movement jump (CMJ). Sixteen of 22 participants displayed changes in their dominant track start stance. Eleven participants showed biases for one stance (6 for the LFF & 5 for the RFF), and 11 participants remained or became more symmetrical. Results indicated that the preferred track start stance was the only measure of asymmetry that was significantly related to track start performance (x2[2]= 6.71, p=.04 for pre-intervention & x2[2]=7.77, p=.02 for post-intervention). All other measures of lower limb asymmetry were shown to be unrelated to track start preference and performance. It was suggested that the 7 week training intervention did not provide a sufficient amount of time to see conclusive effects on 5 m time or to make conclusive comparisons between the dominant track start stance and measures of asymmetry. Since the preferred track start corresponded with better performance less than 50% of the time, it was suggested that swimmers and coaches experiment with different dive techniques to find the start which is most effective for them and spend more time on them during training.

Individuals with various lower-limb neuromuscular and musculoskeletal impairments are often prescribed passive-dynamic ankle-foot orthoses (PD-AFOs) to compensate for impaired ankle muscle weakness. Several studies have demonstrated the beneficial effects of PD-AFOs on pathological gait, but few studies have examined the influence of the AFO stiffness characteristics on gait performance. One challenge to performing such studies is the difficulty of manufacturing custom AFOs with a wide range of controlled stiffness levels. However, selective laser sintering (SLS) is a well-suited additive manufacturing technique for generating subject-specific PD-AFOs of varied stiffness. Therefore, the overall goal of this study was to use SLS manufactured PD-AFOs to identify the relationships between AFO stiffness and gait performance in patients with various lower-limb neuromuscular and musculoskeletal impairments. Six subjects with unilateral impairments were enrolled in this study. For each subject, one subject-specific PD-AFO equivalent to the subject’s clinically prescribed carbon fiber PD-AFO (nominal), one 20% more compliant and one 20% more stiff were manufactured using SLS. Three-dimensional kinematic and kinetic data were collected from each subject while ambulating with each PD-AFO at two different speeds to allow a comprehensive biomechanical analysis to assess the influence of PD-AFO stiffness on gait performance. The results showed that in the compliant AFO condition, the AFO limb vertical ground reaction force (GRF) impulse during loading and the non-AFO limb medial GRF impulse during push-off decreased. In addition, the AFO limb braking GRF impulse during loading and the non-AFO limb braking GRF impulse in early single-limb stance decreased. Furthermore, in the compliant AFO condition, negative knee work during early single-limb stance increased while positive hip work in early swing decreased in the AFO limb. Overall, as AFO stiffness decreased, the AFO limb contributed less to body support and braking. In addition, a decreased medial GRF impulse coupled with an increased vertical GRF impulse during non-AFO single-limb stance suggests that walking stability may be compromised as AFO stiffness decreases. Thus, a tradeoff may exist between preserving stability and increasing net propulsion, which should be considered when assessing the mobility needs of individuals prescribed PD-AFOs as a result of various neuromuscular and musculoskeletal impairments. / text

This thesis investigates coordination of the lower limb joints within the limb during walking. The researcher was motivated by her clinical experience as a paediatric physiotherapist. She observed that the pattern of lower limb coordination differed between normal children and those with cerebral palsy. Many of the currently used interventions did not appear to influence this patterning. As a precursor to evaluating the effectiveness of treatments in modifying coordination, a tool to measure coordination was required. The researcher initially investigated qualitative and then quantitative methods of measuring within limb coordination. A technique was developed that used relative angular velocity of two joints to determine when joints were in-phase, antiphasic or in stasis. The phasic parameters of hip/knee, knee/ankle and hip/ankle joints coordination were quantified. There were some significant differences between normal children and children with cerebral palsy. Asymmetry of these phasic parameters was identified, with children with cerebral palsy being more asymmetrical than normal children. The clinical utility of this technique was tested by comparing 2 groups of children before and after 2 surgical procedures. This showed some significant differences in phasic parameters between pre and post-operative data for one procedure. Low samples sizes mean that further work is required to confirm these findings. Data from this work has been used to calculate sample sizes to give an a priori power of 0.8 and further research is proposed and potential applications discussed. It is hoped that this technique will raise awareness of abnormal intra-limb coordination and allow therapists to identify key interactions between joints that need to be facilitated during walking training.

Background: Anterior cruciate ligament (ACL) injuries have become commonplace among female athletes in today’s society. With more than 70% of injuries resulting from noncontact mechanisms such as jump landing, the relationship between fatigue and altered movements patterns has become an important topic of research. Purpose: The main purpose of this study was to investigate the influence of residual fatigue on lower extremity kinematics and vertical leg stiffness at landing as experienced by female athletes. Method: The participants in this study were 12 NCAA female intercollegiate soccer players. Participants completed five single-leg drop jumps on their dominant leg every day for 4 days. The first day was completed without intervention to obtain pre-fatigue data and drop jumps on days two through four were completed after a fatigue protocol. Results: A repeated measures MANOVA did not reveal significant differences in post-fatigue peak knee flexion angle, vertical ground reaction forces, or vertical leg stiffness. Despite lack of statistical significance, vertical leg stiffness was increased during post-fatigue testing when compared to pre-fatigue values. Implications: The increased vertical leg stiffness may indicate altered landing techniques in post-fatigue states. If fatigue results in compromised movement patterns, it may explain the increased number of ACL injuries during the end of soccer matches. Suggestions for Future Research: Future research with a larger sample size should include post-fatigue dominant and nondominant leg comparison due to previous conflicting findings regarding which limb is most often injured. Future researchers should also quantify the magnitude of fatigue induced by the fatiguing protocol to document the strength of the independent variable. / text

With the general increase in Rugby union's popularity the past decade, there has been an increase in sport injuries, both from acute and overuse trauma. Approximately half of all sport injuries may be attributed to overuse or repetitive micro trauma rather than a single traumatic event. Although very few overuse injuries have an established aetiology, the fact that over 80% of these injuries occurs at or below the knee suggests that there may be some common mechanisms in the aetiology. It could only be stated with certainty that the aetiology of these injuries is multifactorial and diverse, with both extrinsic and intrinsic factors contributing. Many intrinsic factors (personal) predispose athletes to develop overuse injuries. Intervention of intrinsic injury risk factors is more problematic, as intrinsic risk factors are often difficult to examine and even more difficult to rehabilitate than external factors. Extrinsic risk factors (environmental) that are independent of the injured person can be influenced through the intervention of the extrinsic factors. Main attention should be paid not to the treatment of the site of injury but to the possible cause of the symptoms. It is therefore vital that coaches and medical teams have a complete understanding of the incidence, nature, severity, and causes of injuries in order to review the adequacy of their injury prevention, treatment and rehabilitation. The objectives of this study were to determine the effect of selected anthropometric parameters, biomechanical malalignment and flexibility on the prevalence of Medial tibial stress syndrome (MTSS) in U/19 university rugby players of the 2006 season of the North-West University (NWU) Rugby Institute (RI). A prospective once-off subject availability study was performed that included U/19 rugby union players of the RI of the NWU (n=91). Selected biomechanical and anthropometrical assessments were made. Biomechanical and anthropometrical assessments were preformed on all subjects before the start of the season. All existing injuries were recorded by means of an injury history questionnaire. Descriptive statistics (e.g. mean and standard deviations) and contingency tables were used to analyse the data. Effect sizes were used to decide on the practical significance of the findings. A cut-off point of 0.8 (large effect) was set for practical significance of differences between means. Players with MTSS had a wider Bi-iliocristal width than those without MTSS. There were leg length differences for both players with and without MTSS for Hiospinale, Trochanterion-Tibiale lateral and Tibial lateral length. Iliospinale- and Trochanterion-Tibiale lateral length differences presented with the largest length difference. Iliospinale, Trochanterion-Tibiale lateral and Tibial lateral length difference had a small effect. Only Bi-iliocristal width presented with a medium effect. Hamstrings, Gastrocnemius and Plantaris as well as Soleus and Popliteus flexibility of players without MTSS were tighter than those of players who suffered from MTSS. Only Hamstring tightness had a small effect. Gastrocnemius and Plantaris as well as Soleus and Popliteus presented with a medium effect. Players without MTSS had a more flexible TFL on their right side. All the other flexibility measurements of the Thomas test presented that players without MTSS had a more inflexible profile. Effect size was not analysed because of the small sample sizes in some of the cells. Players without MTSS presented with an overall more inflexible profile than those with MTSS. More players without MTSS supinated at heel contact on both their feet, compared to the players with MTSS. Players without MTSS supinated more on both their feet during mid stance. A small percentage of players with and without MTSS supinated during the propulsion phase. More players without MTSS had a neutral right foot mid stance compared to players with MTSS who had a more neutral mid stance on their right foot. Players with MTSS pronated more with both their feet during propulsion. Players with MTSS pronated mostly during the propulsion phase and mostly had flatter and higher arched feet than players without MTSS. More players with MTSS had a light flat foot, flat foot as well as a high arched foot than players without MTSS. Most of the players with MTSS had normal right arched foot type. None of the players with MTSS had either a light high right foot or a high arched left foot. / Thesis (M.A. (Human Movement Science))--North-West University, Potchefstroom Campus, 2009.

With the general increase in Rugby union's popularity the past decade, there has been an increase in sport injuries, both from acute and overuse trauma. Approximately half of all sport injuries may be attributed to overuse or repetitive micro trauma rather than a single traumatic event. Although very few overuse injuries have an established aetiology, the fact that over 80% of these injuries occurs at or below the knee suggests that there may be some common mechanisms in the aetiology. It could only be stated with certainty that the aetiology of these injuries is multifactorial and diverse, with both extrinsic and intrinsic factors contributing. Many intrinsic factors (personal) predispose athletes to develop overuse injuries. Intervention of intrinsic injury risk factors is more problematic, as intrinsic risk factors are often difficult to examine and even more difficult to rehabilitate than external factors. Extrinsic risk factors (environmental) that are independent of the injured person can be influenced through the intervention of the extrinsic factors. Main attention should be paid not to the treatment of the site of injury but to the possible cause of the symptoms. It is therefore vital that coaches and medical teams have a complete understanding of the incidence, nature, severity, and causes of injuries in order to review the adequacy of their injury prevention, treatment and rehabilitation. The objectives of this study were to determine the effect of selected anthropometric parameters, biomechanical malalignment and flexibility on the prevalence of Medial tibial stress syndrome (MTSS) in U/19 university rugby players of the 2006 season of the North-West University (NWU) Rugby Institute (RI). A prospective once-off subject availability study was performed that included U/19 rugby union players of the RI of the NWU (n=91). Selected biomechanical and anthropometrical assessments were made. Biomechanical and anthropometrical assessments were preformed on all subjects before the start of the season. All existing injuries were recorded by means of an injury history questionnaire. Descriptive statistics (e.g. mean and standard deviations) and contingency tables were used to analyse the data. Effect sizes were used to decide on the practical significance of the findings. A cut-off point of 0.8 (large effect) was set for practical significance of differences between means. Players with MTSS had a wider Bi-iliocristal width than those without MTSS. There were leg length differences for both players with and without MTSS for Hiospinale, Trochanterion-Tibiale lateral and Tibial lateral length. Iliospinale- and Trochanterion-Tibiale lateral length differences presented with the largest length difference. Iliospinale, Trochanterion-Tibiale lateral and Tibial lateral length difference had a small effect. Only Bi-iliocristal width presented with a medium effect. Hamstrings, Gastrocnemius and Plantaris as well as Soleus and Popliteus flexibility of players without MTSS were tighter than those of players who suffered from MTSS. Only Hamstring tightness had a small effect. Gastrocnemius and Plantaris as well as Soleus and Popliteus presented with a medium effect. Players without MTSS had a more flexible TFL on their right side. All the other flexibility measurements of the Thomas test presented that players without MTSS had a more inflexible profile. Effect size was not analysed because of the small sample sizes in some of the cells. Players without MTSS presented with an overall more inflexible profile than those with MTSS. More players without MTSS supinated at heel contact on both their feet, compared to the players with MTSS. Players without MTSS supinated more on both their feet during mid stance. A small percentage of players with and without MTSS supinated during the propulsion phase. More players without MTSS had a neutral right foot mid stance compared to players with MTSS who had a more neutral mid stance on their right foot. Players with MTSS pronated more with both their feet during propulsion. Players with MTSS pronated mostly during the propulsion phase and mostly had flatter and higher arched feet than players without MTSS. More players with MTSS had a light flat foot, flat foot as well as a high arched foot than players without MTSS. Most of the players with MTSS had normal right arched foot type. None of the players with MTSS had either a light high right foot or a high arched left foot. / Thesis (M.A. (Human Movement Science))--North-West University, Potchefstroom Campus, 2009.

The psychometric properties of a new high-level mobility outcome measure for Service Members (SMs) with traumatic lower limb loss called the Comprehensive High-level Activity Mobility Predictor (CHAMP) was developed in order objectively evaluate functional abilities and measure change in function throughout the rehabilitation process. The CHAMP was administered to a population of SMs with traumatic lower limb loss who were representative of those who have suffered limb loss in recent conflicts. In addition, a population of non-amputee Active Duty soldiers completed the CHAMP and provided normative data for high-level mobility and threshold levels of performance for those SMs with lower limb loss. A simple grading system, absent of floor and ceiling effects, generates a composite score providing a single numeric value representing the physical performance factors of high-level mobility in different plane of motion and under different conditions. The CHAMP was found to be a safe, reliable, valid, and responsive performance-based outcome measure of high-level mobility. It was found to have excellent interrater and test-retest reliability suggesting that it is a stable and repeatable measure of high-level mobility. Convergent construct validity and known group methods were utilized to establish the CHAMP as a valid measure of high-level mobility. Predictive models of CHAMP performance were established utilizing variables representing impairments of body structure and function and contextual factors by level of lower limb amputation. The CHAMP has the potential to be used for lower limb amputees throughout the rehabilitation process and could translate to the non-amputee population for assessment of high-level mobility capabilities.