In clinical settings, dynamic foot function is commonly inferred from static and passive foot measurements; however, there is little evidence that static foot structure can predict dynamic foot function during walking gait. Previous research seeking to find correlations between the two have focused primarily on sagittal plane midfoot angles even though the midfoot has triplanar motion, which misses potentially important information. Additionally, the focus on kinematics alone may miss the contributions that forces play in midfoot mechanics. To address the angle limitations, a novel Signed Helical Angle (SHA) was developed to capture the triplanar motion of the midfoot from a multi-segment foot model. This was combined with foot segmental force measurements and inverse dynamics to capture dynamic midfoot stiffness. The SHA method and static-dynamic analysis were evaluated on 40 healthy subjects walking at a controlled speed. Subjects were divided into three structural groups based on static arch height (high, normal, low) and stiffness (stiff, normal, flexible). One-way ANOVA was used to evaluate differences among groups in dynamic motion and stiffness and a multiple regression was employed to evaluate relationships across the sample. Calculating the SHA resulted in a greater range of motion (ROM) compared to the sagittal Euler angle commonly used, showing that the motion in the other planes are captured in the SHA. The Finite Helical Axis (FHAx) associated with the SHA also showed that on average the population had a clear distinction between pronation and supination during the stance phase, although individual subjects exhibited substantial variability. While there were visual distinctions in the SHA and the midfoot stiffness among the three stiffness groups and the three arch height groups, the differences were not statistically significant. The only measurement achieving statistical significance was the mean of the sagittal plane midfoot Euler angles among the three AHI groups (p = 0.015); however, this is a postural measure which simply confirms that a high arch will remain high and a low arch will remain low throughout the gait cycle. The lack of any relationships between static foot structure and dynamic foot function, despite advanced modeling and measurements, further confirms that other factors play a large role in foot mechanics. Future studies should focus on evaluating the role of the intrinsic foot musculature (e.g., muscle strength, activation, and redundancy) during gait, and replacing traditional shoe and orthotic recommendations.

Three-dimensional movement analysis was used to evaluate head and neck movement in patients with neck pain and matched controls. The aims were to further develop biomechanical models of head and neck kinematics, to investigate differences between subjects with non-specific neck pain and whiplash associated disorders (WAD), and to evaluate the potential of objective movement analysis as a decision support during diagnosis and follow-up of patients with neck pain. Fast, repetitive head movements (flexion, extension, rotation to the side) were studied in a group of 59 subjects with WAD and 56 controls. A back propagation artificial neural network classified vectors of collected movement variables from each individual according to group membership with a predictivity of 89%. The helical axis for head movement were analyzed in two groups of neck pain patients (21 with non-specific neck pain and 22 with WAD) and 24 matched controls. A moving time window with a cut-off angle of 4° was used to calculate finite helical axes. The centre of rotation of the finite axes (CR) was derived as the 3D intersection point of the finite axes. A downward migration of the axis during flexion/extension and a change of axis direction towards the end of the movements were observed. CR was at its most superior position during side rotations and at its most inferior during ball catching. This could relate to that side rotation was mainly done in the upper spine, while all cervical vertebrae were recruited to stabilize the head in the more complex catching task. Changes in movement strategy were observed in the neck pain groups: Neck pain subjects had lower mean velocities and ranges of movements as compared with controls during ball catching, which could relate to a stiffer body position in neck pain patients in order to stabilize the neck. In addition, the WAD group had a displaced axis position during head repositioning after flexion, while CR was displaced during fast side rotations in the non-specific neck pain group. Pain intensity correlated with axis and CR position, and may be one reason for the movement strategy changes. Increased amount of irregularities in the trajectory of the axis was found in the WAD group during head repositioning, fast repetitive head movements and catching. This together with an increased constant repositioning error during repositioning after flexion indicated motor control disturbances. A higher group standard deviation in neck pain groups indicated heterogeneity among subjects in this disturbance. Wireless motion sensors and electro-oculography was used simultaneously, as an initial step towards a portable system and towards a method to quantify head-eye co-ordination deficits in individuals with WAD. Twenty asymptomatic control subjects and six WAD subjects with eye disturbances (e.g. dizziness and double vision) were studied. The trial-to-trial repeatability was moderate to high for all evaluated variables (single intraclass correlation coefficients >0.4 in 28 of 32 variables). The WAD subjects demonstrated decreased head velocity, decreased range of head movement during gaze fixation and lowered head stability during head-eye co-ordination as possible deficits. In conclusion, kinematical analyses have a potential to be used as a support for physicians and physiotherapists for diagnosis and follow-up of neck pain patients. Specifically, the helical axis method gives information about how the movement is performed. However, a flexible motion capture system (for example based on wireless motion sensors) is needed. Combined analysis of several variables is preferable, as patients with different neck pain disorders seem to be a heterogeneous group.

[ES] El hombro es una articulación compleja en la que interaccionan múltiples estructuras, lo que permite la realización de movimientos de gran amplitud. Debido a esta característica, puede ser fácilmente alterada si alguno de los componentes falla. Las patologías del hombro son variadas, así como diversa es la sintomatología y el nivel de alteración funcional. El grado de afectación funcional puede ser valorado ya sea mediante escalas clínicas, o con pruebas biomecánicas basadas en el análisis cinemático, que añaden objetividad a los resultados. No obstante, los modelos cinemáticos disponibles en la actualidad no ofrecen una representación realista del movimiento articular, lo que supone una importante limitación a la hora de desarrollar sistemas de valoración funcional. El objetivo principal de esta tesis fue describir el movimiento del hombro mediante técnicas cinemáticas avanzadas que incluyeran el uso de variables funcionales asociadas a la posición, velocidad y aceleración, así como la descripción de la trayectoria del eje instantáneo de rotación, con la finalidad de desarrollar un nuevo enfoque en las técnicas de valoración funcional del hombro. La muestra de estudio estuvo compuesta por 41 sujetos sanos y 15 sujetos con patología de hombro. Se analizaron los movimientos de abducción en el plano frontal y escapular, sin peso y con una maza de 1kg. Se utilizó la escala EVA (Escala Visual Analógica), para determinar el nivel de dolor percibido y la escala DASH (Disabilities of the arm, shoulder and hand), para definir el grado funcional. Se realizó un análisis de variables numéricas, variables funcionales, reproducibilidad y armonía del movimiento y descripción de la trayectoria del eje instantáneo de rotación (EIR). Como resultado, se ha demostrado la alta fiabilidad del procedimiento. Las diferencias encontradas entre los sujetos sanos y patológicos, solo eran evidentes a nivel de grupos, además la dispersión de la muestra era considerable. Los valores de reproducibilidad y armonía fueron similares para los dos grupos. En promedio, los sujetos patológicos tenían menor ángulo, velocidad y aceleración, pérdida que se producía de forma continua a lo largo del ciclo, como se observa en el análisis de las funciones del movimiento. Se encontró que la escala DASH guardaba una relación con las variables cinemáticas funcionales, si bien, era moderada. Por otra parte, al aumentar el nivel de afectación, se observaba una clara disminución de la velocidad angular, y un cambio en el patrón de movimiento. Con respecto al efecto de la carga, no se encontraron diferencias claras en la población de estudio. Finalmente, la trayectoria del EIR describía una ruta de inicio por debajo del acromion, seguido de un desplazamiento vertical y medio-lateral, con un patrón que aunque era similar entre los grupos, se veía afectado de forma diferente por el dolor o el nivel de afectación funcional en la muestra de patológicos. En conclusión, los resultados indican que las variables funcionales son más sensibles a los cambios que las variables numéricas clásicas basadas en rangos o valores máximos. Por otra parte, las diferencias encontradas entre los sujetos patológicos y los sanos, solo son claras a nivel de conjunto, pero no separan de forma nítida a los individuos de cada grupo, pudiendo ser solo evidentes en caso de afectaciones muy severas, pero no con niveles moderados o bajos. El estudio del EIR es novedoso y proporciona información acerca de la coordinación del movimiento, aspecto de especial relevancia dada la composición del complejo articular del hombro. Finalmente, de los resultados se extrae el interés del uso de medidas repetidas usando el sujeto como factor y utilizando las escalas de valoración funcional, ya que el uso solo de datos biomecánicos no parece ser suficiente. / [CA] El muscle és una articulació complexa en la qual interaccionen múltiples estructures, la qual cosa permet la realització de moviments de gran amplitud. A causa d'aquesta característica, pot ser facilment alterada si algun dels components falla. Les patologies del muscle són variades, així com diversa és la simptomatologia i el nivell d'alteració funcional. El grau d'afectació funcional pot ser valorat ja siga mitjanvant escales clíniques, o amb proves biomecaniques basades en l'analisi cinematica, que afigen objectivitat als resultats. No obstant aixo, els models cinematics disponibles en l'actualitat no ofereixen una representació realista del moviment articular, la qual cosa suposa una important limitació a l'hora de desenvolupar sistemes de valoració funcional. L'objectiu principal d'aquesta tesi va ser descriure el moviment del muscle mitjanvant tecniques cinematiques avanvades que inclogueren l'ús de variables funcionals associades a la posició, velocitat i acceleració, així com la descripció de la trajectoria de l'eix instantani de rotació, amb la finalitat de desenvolupar un nou enfocament en les tecniques de valoració funcional del muscle. La mostra d'estudi va estar composta per 41 subjectes sans i 15 subjectes amb patología de muscle. Es van analitzar els moviments d'abducció en el pla frontal i en el pla escapular, amb pes d'1 quilogram i sense pes. Es va utilitzar l'escala EVA (escala visual analogica), per a determinar el nivell de dolor percebut i l'escala DASH (Disabilities of the arm, shoulder and hand), per a definir el grau funcional. Es va realitzar una analisi de variables numeriques, variables funcionals, reproducibilitat i harmonia del moviment i descripció de la trajectoria de l'eix instantani de rotació. Com a resultat, s'ha demostrat l'alta fiabilitat del procediment. Les diferencies oposades entre els subjectes sans i patologics, només eren evidents a nivell de grups, a més la dispersió de la mostra era considerable. Els valors de reproducibilitat i harmonia van ser similars per als dos grups. En mitjana, els subjectes patologics tenien menor angle, velocitat i acceleració, perdua que es produia de forma contínua al llarg del cicle, com s'observa en l'analisi de les funcions del moviment. Es va trobar que l'escala DASH guardava una relació con les variables cinematiques funcionals, si bé, era moderada. D'altra banda, en augmentar el nivell d'afectació, s'observava una clara disminució de la velocitat angular, i un canvi en el patró de moviment. Respecte a l'efecte de la carrega, no es van trobar diferencies clares en la població d'estudi. Finalment, la trajectoria del EIR descrivia una ruta d'inici per davall de l'acromi, seguit d'un desplavament vertical i mig-lateral, amb un patró que encara que era similar entre els grups, es veia afectat de forma diferent pel dolor o el nivell d'afectació funcional en la mostra de patologics. En conclusió, els resultats indiquen que les variables funcionals són més sensibles als canvis que les variables numeriques classiques basades en rangs o valors maxims. D'altra banda, les diferencies oposades entre els subjectes patologics i els sans, només són clares a nivell de conjunt, pero no separen de forma nítida als individus de cada grup, podent ser només evidents en cas d'afectacions molt severes, pero no amb nivells moderats o baixos. L'estudi del EIR és nou i proporciona informació sobre la coordinació del moviment, aspecte d'especial rellevancia donada la composició del complex articular del muscle. Finalment, dels resultats s'extrau l'interés de l'ús de mesures repetides usant el subjecte com a factor i utilitzant les escales de valoració funcional, ja que l'ús sol de dades biomecanics no sembla ser suficient. / [EN] The shoulder complex is a structure of joints with the largest range of motion. Consequently, it is susceptible to injury. Shoulder pathologies involve different levels of functional impairment that can be assessed either by clinical scales or by objective methods such as kinematic analysis. However, currently available kinematic models do not offer a realistic representation of joint movement, which is an important limitation when developing functional assessment systems. The main goal of current dissertation is to describe the movement of the shoulder, using advanced kinematic techniques that include the use of position, velocity and acceleration variables, as well as the use of the instantaneous helical axis, in order to develop new techniques of functional assessment. This study included 41 healthy subjects and 15 subjects with shoulder pathology. Subjects performed humeral elevation in 2 planes (frontal and scapular) and 2 conditions (loaded and unloaded). The VAS (visual analog scale) was used to determine the level of perceived pain and the DASH scale (Disabilities of the arm, shoulder and hand) to define the functional impairment. An analysis of numerical variables, functional variables, reproducibility and harmony of the movement and description of the trajectory of the instantaneous helical axis (IHA) was carried out. As a result, the high reliability of the procedure has been demostrated. Significative differences were found between healthy and pathological subjects. However, it was only evident about groups, in addition the dispersion was considerable. Reproducibility and harmony values were similar for both. The functional analysis showed that the pathological group had lower angle, velocity and acceleration throughout the entire cycle. It was found that the DASH scale had a moderate relation with the functional kinematic variables. On the other hand, when increasing the level of affectation, an obvious decrease of the angular velocity, and a change in the movement pattern was observed. Regarding the effect of loading, no clear differences were found in the study population. Finally, the IHA described a vertical and mid-lateral displacement, with an initial point below the acromion. The pattern was similar in both groups, however it was affected by the level of pain and functional impairment. In conclusion, these findings suggest that functional variables are more sensitive to changes than classical numerical variables. On the other hand, differences between healthy and pathological subjects are only evident at group level. It seems that it is only evident in highly affected patients, not in those with a mild or intermediate impairment. Moreover, the study of the IHA is novel and provides relevant information about the shoulder joint coordination. Finally, we concluded that the use of repeated measurements using the subject as a factor along with the use of scales of functional assessment provides a better description of the movement since the exclusive use of biomechanical data, does not seem to be sufficient. / Cáceres Cáceres, ML. (2019). Aplicación de la cinemática articular a la valoración funcional del hombro [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/133994

No description available.

Background Spinal pain is one of humanity’s most frequent complaints with high costs for the individual and society, and is commonly related to spinal disorders. There are many origins behind these disorders e.g., trauma, disc hernia or of other organic origins. However, for many of the disorders, the origin is not known. Thus, more knowledge is needed about how pain affects the neck and neural function in pain affected regions. The purpose of this dissertation was to improve the medical examination of patients suffering from chronic whiplash-associated disorders or other pain related neck-disorders. Methods A new assessment tool for objective movement analysis was developed. In addition, basic aspects of proprioceptive information transmission, which can be of relevance for muscular tension and pain, are investigated by studying the coding of populations of different types of sensory afferents by using a new spike sorting method. Both experiments in animal models and humans were studied to accomplish the goals of this dissertation. Four cats where were studied in acute animal experiments. Mixed ensembles of afferents were recorded from L7-S1 dorsal root filaments when mechanical stimulating the innervated muscle. A real-time spike sorting method was developed to sort units in a multi-unit recording. The quantification of population coding was performed using a method based on principal component analysis. In the human studies, 3D neck movement data were collected from 59 subjects with whiplash-associated disorders (WAD) and 56 control subjects. Neck movement patterns were identified by processing movement data into parameters describing the rotation of the head for each subject. Classification of neck movement patterns was performed using a neural network using processed collected data as input. Finally, the effect of marker position error on the estimated rotation of the head was evaluated by computer simulations. Results Animal experiments showed that mixed ensembles of different types of afferents discriminated better between different muscle stimuli than ensembles of single types of these afferents. All kinds of ensembles showed an increase in discriminative ability with increased ensemble size. It is hypothesized that the main reason for the greater discriminative ability might be the variation in sensitivity tuning among the individual afferents of the mixed ensemble will be larger than that for ensembles of only one type of afferent. In the human studies, the neural networks had a predictivity of 0.89, a sensitivity of 0.90 and a specificity of 0.88 when discriminating between control and WAD subjects. Also, a systematic error along the radial axis of the rigid body added to a single marker had no affect on the estimated rotation of the head. Conclusion The developed spike sorting method, using neural networks, was suitable for sorting a multiunit recording into single units when performing neurophysiological experiments. Also, it was shown that neck movement analysis combined with a neural network could build the basis of a decision support system for classifying suspected WAD or other pain related neck-disorders.

La respiration est un phénomène vital qui implique une synergie entre diverses structures anatomiques qui constituent le thorax. La physiologie articulaire reste un parent pauvre de la physiologie et la littérature concernant la quantification de la cinématique 3D des articulations du thorax durant le mouvement respiratoire est rare. Ce travail se concentre sur le développement et l'application d'une méthodologie permettant de répondre à cet objectif. La méthode développée combine le traitement de données tomodensitométriques réalisées à trois volumes pulmonaires différents et des techniques d'infographies. Les amplitudes (ROMs) et axes de mouvements (axe hélicoïdaux moyen, AHMs) ont été obtenus au niveau des articulations costo-vertébrales de 12 sujets asymptomatiques. En résumé, les amplitudes diminuent graduellement dans les étages inférieurs ; le volume pulmonaire et l'étage costal influencent significativement les amplitudes costales ; l'orientation des AHMs ne diffère pas entre les étages costaux. En complément, la méthode a été appliquée pour un échantillon de 10 patients atteints de mucoviscidose. La condition pathologique influençait significativement les amplitudes de mouvements mais pas l'orientation des AHMs. Enfin, le déplacement sternal, les variations de l'angle sternal et la cinématique des articulations sternocostales a été analysée. Les déplacements angulaires des côtes par rapport au sternum diminuaient dans les étages inférieurs comme au niveau des articulations costo-vertébrales. L'orientation des AHMs des articulations sternocostales ne différait pas entre les étages. Une corrélation linéaire a été mise en évidence entre les déplacements verticaux du sternum et les amplitudes de mouvement costales au niveau costo-vertébral et sternocostal. Ce travail contribue de façon substantielle à la modélisation 3D du thorax humain durant le mouvement respiratoire d'un point de vue qualitatif et quantitatif / Breathing is a vital phenomenon that implies synergy of various anatomical structures that constitute the thorax. Joint physiology remains a relatively poorly-known component of the overall thorax physiology. Quantitative literature related to in vivo thorax kinematics during breathing is scarce. The present work focuses specifically on developing and applying a methodology to reach this goal. The developed method combined processing of CT data obtained at different lung volumes and infographic techniques. Detailed ranges of motion (ROMs) and axes of movement (mean helical axes, MHAs) were obtained at costovertebral joints in 12 asymptomatic subjects; rib ROMs gradually decrease with increasing rib number; lung volume and rib level have a significant influence on rib ROM; MHAs did not differ between rib levels. In addition, the method was applied on a sample of 10 patients with cystic fibrosis. The pathological condition significantly influenced CVJ ROMs while the orientation of the MHAs did not differ. Finally, the sternal displacement, sternal angle variations and sternocostal joints (SCJ at rib1 to 7) kinematics during breathing motion were analyzed. Rib ranges of motion relative to sternum decreased with increasing rib number similarly to CVJ. Orientation of the MHAs did not differ between SCJ levels. A significant linear correlation was demonstrated between sternum vertical displacement and rib ranges of motion at both CVJ and SCJ. The present work substantially contributes to 3D modelling of human thorax in breathing at a joint level both qualitatively and quantitatively

Breathing is a vital phenomenon that implies synergy of various anatomical structures that constitute the thorax. Joint physiology remains a relatively poorly-known component of the overall thorax physiology. Quantitative literature related to in vivo thorax kinematics during breathing is scarce. The present work focuses specifically on developing and applying a methodology to reach this goal. The developed method combined processing of CT data obtained at different lung volumes and infographic techniques. Detailed ranges of motion (ROMs) and axes of movement (mean helical axes, MHAs) were obtained at costovertebral joints in 12 asymptomatic subjects; rib ROMs gradually decrease with increasing rib number; lung volume and rib level have a significant influence on rib ROM; MHAs did not differ between rib levels. In addition, the method was applied on a sample of 10 patients with cystic fibrosis. The pathological condition significantly influenced CVJ ROMs while the orientation of the MHAs did not differ. Finally, the sternal displacement, sternal angle variations and sternocostal joints (SCJ at rib1 to 7) kinematics during breathing motion were analyzed. Rib ranges of motion relative to sternum decreased with increasing rib number similarly to CVJ. Orientation of the MHAs did not differ between SCJ levels. A significant linear correlation was demonstrated between sternum vertical displacement and rib ranges of motion at both CVJ and SCJ. The present work substantially contributes to 3D modelling of human thorax in breathing at a joint level both qualitatively and quantitatively. / Doctorat en Sciences biomédicales et pharmaceutiques (Médecine) / info:eu-repo/semantics/nonPublished

Ce travail de thèse porte sur l’étude de la cinématique 3D du rachis cervical supérieur ainsi que<p>sur l’analyse des bras de levier des muscles sous-occipitaux postérieurs, par le développement<p>de différentes méthodes contribuant à la modélisation anatomique du mouvement.<p>La première partie de ce travail s’oriente vers l’étude des mouvements de flexion extension, de<p>rotation axiale et de flexion latérale ainsi que des axes qui y sont rapportés. Pour ce faire, deux<p>protocoles ont été développés sur préparations anatomiques, l’un visant à analyser les<p>mouvements discrets à partir de différentes attitudes du rachis cervical supérieur et l’autre<p>s’intéressant aux mouvements instantanés. Ceux-ci ont permis de mettre en évidence une<p>orientation et une position de l’axe hélicoïdal dépendantes du mouvement, du segment étudié<p>et de sa position spatiale.<p>En deuxième intention, nous nous sommes intéressés aux propriétés biomécaniques musculaires<p>de cette région, et en particulier à l’étude des bras de levier. Deux méthodes de calcul<p>distinctes ont été utilisées, montrant chacune des résultats différents d’un point de vue<p>quantitatif mais relativement similaires au niveau qualitatif.<p>Pour terminer, nous avons exploité ces méthodes afin d’apprécier leur faisabilité dans le cadre<p>d’une évaluation fonctionnelle in vivo. Il en ressort une concordance de résultats cinématiques<p>par rapport aux études susmentionnées, permettant d’entrevoir des perspectives cliniques<p>encourageantes.<p>Par ailleurs, la modélisation musculo-squelettique 3D pourrait également contribuer à la<p>compréhension du dysfonctionnement cinématique du rachis cervical supérieur./ <p><p>This thesis concerns 3D kinematics analysis of the upper cervical spine (UCS) and computation of the posterior suboccipital muscle moment arms as well the development of different methods contributing to anatomical modeling and motion representation. The first part of this work is focused on the kinematics of flexion extension, axial rotation and lateral bending of the UCS. Two protocols were developed and applied in anatomical specimens, one to analyze discrete movements in different attitudes of upper cervical spine and the second concerned instantaneous motions. In addition to usual range of motion data, orientation and position of helical axes was computed for each motion type and UCS joint segment.<p>In the second part, we were interested in posterior suboccipital muscle biomechanical properties, particularly in the study of moment arms. Two different calculation methods were used, each showing different results from a quantitative point of view but quite similar in quality. Finally, we used these methods to assess their feasibility for in vivo functional assessment. The latter showed a concordance of kinematic results compared to the above studies, offering insight and clinical perspectives. In addition, musculoskeletal modelling 3D could also contribute to understanding of the kinematic features of upper cervical spine disorders.<p> / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished