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Method Article

Lower Limb Biomechanical Analysis of Healthy Participants

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DOI:

10.3791/60720

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April 15th, 2020

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1Orthopaedic Research Institute, Bournemouth University

In This Article

Summary

This article introduces a comprehensive experimental methodology on two of the latest technologies available to measure the lower limb biomechanics of individuals.

Abstract

Biomechanical analysis techniques are useful in the study of human movement. The aim of this study was to introduce a technique for the lower limb biomechanical assessment in healthy participants using commercially available systems. Separate protocols were introduced for the gait analysis and muscle strength testing systems. To ensure maximum accuracy for gait assessment, attention should be given to the marker placements and self-paced treadmill acclimatization time. Similarly, participant positioning, a practice trial, and verbal encouragement are three critical stages in muscle strength testing. The current evidence suggests that the methodology outlined in this article may be effective for the assessment of lower limb biomechanics.

Introduction

The discipline of biomechanics primarily involves the study of stress, strain, loads and motion of biological systems - solid and fluid alike. It also involves the modelling of mechanical effects on the structure, size, shape and movement of the body1. For many years, developments in this field have improved our understanding of normal and pathologic gait, mechanics of neuromuscular control, and mechanics of growth and form2.

The main objective of this article is to present a comprehensive methodology on two of the latest technologies available to measure lower limb biomechanics of individuals. The gait analysis system measures and quantifies gait biomechanics by using a self-paced (SP) treadmill in combination with an augmented reality environment, which integrates a SP algorithm to regulate the treadmill's speed, as described by Sloot et al3. The muscle strength testing equipment is used as an assessment and a treatment tool for upper extremity rehabilitation4. This device can objectively assess a variety of physiological patterns of movement or job simulation tasks in isometric and isotonic modes. It is currently recognized as the gold standard for upper limb strength measurement5 but the evidence related specifically to the lower limb remains unclear. This paper explains the detailed protocol for completing an assessment of gait and isometric strength for the lower extremity.

Within biomechanical analysis, it is useful to combine assessments of functional performance (such as gait analysis) with specific tests of muscular performance. This is because whilst it may be assumed that increased muscle strength improves functional performance, this may not always be apparent6. This understanding is required for the improved future design of rehabilitation protocols and research strategies to assess these approaches.

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Protocol

The method reported was followed in a study that received ethical approval from the Bournemouth University Research Ethics Committee (Reference 15005).

1. Participants

  1. Recruit healthy adults (aged from 23 to 63 years, mean ± S.D.; 42.0 ± 13.4, body mass 70.4 ± 15.3 kg, height 175.5 ± 9.8 cm; 15 males, 15 females) to participate in the study. Thirty participants were recruited for this study.
  2. Ensure that there is no self-reported history of dizziness, balance problems or walking difficulties in the participants.
  3. Ensure that participants did not suffer from any known neuromuscular injury or condition affecting balance or walking.

2. Setup and procedures for gait analysis

  1. Use a gait analysis system (Figure 1) comprised of a dual-belt force plate-instrumented treadmill, a 10-camera motion capture system and a virtual environment that provides optic flow.
  2. Ensure that the participant is wearing very tight non-reflective clothing such as cycling shorts or leggings.
  3. Using double sided adhesive tapes attach 25 passive reflective markers and place according to the lower body configuration of the Human Body Model (HBM)7 as detailed in Table 1 and Figure 2. The information in this document is taken from the HBM Reference Manual8.
  4. Use a joint ruler to take measurements of the required knee and ankle widths for the HBM6.
  5. Secure participant to a safety harness that is fastened to an overhead frame.
  6. Start a new session in the database and make sure it is active (highlighted).
  7. Using the subject tab, create a new participant from the Labeling Skeleton button.
  8. Browse to the 'LowerLimb HBM_N2.vst' file and then enter the name of the participant. The new participant appears in the Subjects pane.
  9. Go to the Tools pane and open the Subject Preparation tab.
  10. Zero level the forceplates via the Hardware tab. Make sure that no weight is exerted on the force plates.
  11. Prepare the participant for the ROM trial by having them ready in the middle of the treadmill.
  12. To ensure the participant can accustom themselves to the self-paced treadmill, ask them to walk at a comfortable speed for 5 min at the beginning of the session9,10.
  13. Following the acclimatization and without any delay time, ask the participant to walk for a minimum of 5 min10,11.
  14. Ensure participants are blinded to the timing of the recordings.
  15. Ensure to start the treadmill and start data recordings by clicking the Start recording button12. This can be done with integrated software (Table of Materials).
  16. Stop the recording after acquiring the desired amount of data. It is recommended to collect three sets of 25 cycles.
  17. Open the processing software (Table of Materials) and remove the high-frequency noise on data, by selecting a low-pass filter to the marker data such as a second order Butterworth filter with a cut-off frequency of 6 Hz.
  18. Go to File, and then select Export to save as a .csv.
  19. Determine individual strides from vertical force data and use the foot markers to ascertain gait events13.
  20. Analyze the gait parameters such as kinematic, kinetic and spatial-temporal data in Matlab R2017a (Supplementary File).

3. Setup and procedures for muscle strength test

  1. Use the muscle strength testing equipment (multimodal dynamometer) (Figure 3), to measure participants' muscle strength based on Maximum Voluntary Isometric Contraction (MVIC)14.
  2. Attach the tool/pad number 701 to the dynamometer exercise head.
  3. Test participant's right and left knee isometric muscle strength.
  4. Test participants in a seated position on a chair with a backrest.
  5. Using the up/down switch, align the dynamometer axis with the knee joint's anatomical axis of rotation. Place the pad of the tool centrally at the lower part of the shin of the tibia.
  6. Keep the knee at 90° flexion, the hip in neutral rotation and abduction, and the foot in plantar flexion.
  7. Place the participant's hands on their abdomen and stabilize the trunk, hips, and mid-thigh on the chair with Velcro straps.
  8. Run a practice trial for participants to get accustomed to the testing maneuver.
  9. Instruct the participant to extend their knee (exert pressure upwards on the pad) followed by flex (exert pressure downwards on the pad) to exert a maximum contraction on the command Go for 3 s.
  10. Provide verbal prompts and encouragement ("Push" for upwards and "Pull" for downwards) during the strength testing.
  11. Ensure that participants are aware they can stop the test immediately if they experience any unusual pain or discomfort.
  12. Allow participants to rest for 2 min.
  13. Repeat steps 3.1 - 3.12, three times for the left leg and right leg and record the data in newtons (N).
  14. Save all the data and export as a report for the analysis.

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Results

The mean and standard deviation of the spatial-temporal, kinematics, and kinetic gait parameters are given in Table 2. MVIC data for all 30 participants are summarized in Table 3. A typical set of data for the left and right side of one participant showing graphical representation of gait parameters is provided in Figure 4 and Figure 5, respectively.

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Discussion

The contribution of this study is to accurately and comprehensively describe within one protocol the techniques for combined gait analysis and muscle strength testing that have not previously been described together.

In order to achieve accurate results for gait analysis, there are two areas that require maximum attention: 1) marker placements and 2) acclimatization time. The accuracy of the measured data is heavily dependent on the accuracy of the model used. The other key factors that affect...

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Disclosures

The authors have nothing to disclose.

Acknowledgements

We would like to thank Dr. Johnathan Williams for his advice on MATLAB data processing.

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Materials

List of materials used in this article
NameCompanyCatalog NumberComments
701 Small leverBaltimore Therapeutic Equipment Company (BTE)Not Available - Online link provided in descriptionThe unique attachment designed for the Primus RS to measure Knee Extension/Flexion - https://store.btetech.com/collections/primus/products/701-small-lever
D-Flow Software - Vresion 3.26Motekforce LinkNot Available - Online link provided in descriptionSoftware used to control GRAIL system - https://summitmedsci.co.uk/products/motek-dflow-hbm-software/
Gait Offline Analysis (GOAT) - Version 2.3Motekforce LinkNot Available - Online link provided in descriptionSoftware used for the analysis of the gait parameters - https://www.motekmedical.com/product/grail/
Gait Real-time Analysis Interactive Lab (GRAIL)Motekforce LinkNot Available - Online link provided in descriptionGRAIL system measures and quantifies gait biomechanics by using a virtual reality based self-paced (SP) treadmill - https://www.motekmedical.com/product/grail/
Leg Pad for 701Baltimore Therapeutic Equipment Company (BTE)Not Available - Online link provided in descriptionThe unique attachment designed for the Primus RS to measure Knee Extension/Flexion - https://store.btetech.com/collections/primus/products/701-802-leg-pad
Positioning ChairBaltimore Therapeutic Equipment Company (BTE)Not Available - Online link provided in descriptionParticipant Positioning Chair is designed for assessment and treatment of the lower exteremeties. The chair is designed for multiple positions. https://www.btetech.com/product/primus/
Primus RSBaltimore Therapeutic Equipment Company (BTE)Not Available - Online link provided in descriptionPrimus RS equipment captures and reports real time objective data in Isotonic, Isometric, and Isokinetic resistance modes - https://www.btetech.com/wp-content/uploads/BTE-Rehabilitation-Equipment-PrimusRS-Brochure-1.pdf

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Lower Limb BiomechanicsGait AnalysisMuscle Strength TestingMarker PlacementTreadmill AcclimatizationForce Plate CalibrationIsometric ContractionKinematic AnalysisKinetic AnalysisSpatial Temporal Data
Lower Limb Biomechanical Analysis of Healthy Participants
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