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Study of biomechanical patterns for identifying biomarkers for knee osteoarthritis

 Tatiana Bejarano1, Dinesh Bhatia1, Mario Novo2, Marcos Munoz2, Denis Brunt2, Ranu Jung1

1Adaptive Neural Systems Lab, College of Engineering & Computing: Department of Biomedical Engineering, 2College of Nursing & Health Sciences: Physical Therapy Department , Florida International University.

Abstract

Electromyography Results

Experimental Protocol

Methods

Research GoalDetermine the muscle recruitment patterns and neuromuscular efficiency in healthy individuals compared with knee OA patients while performing closed chain exercises in frontal plane.

Introduction

Methods

Conclusion

References

Comparison of average EMG and GFR in 4 inch (dotted) and 8 inch (line) Step Up/ Step Down task phases:

 1. Rana S. H, Bennel K. L., Metcalf B. R., Crossley K. M., 2002, “Delayed onset of Quadriceps activity and altered 

knee joint kinematics during stair stepping in individuals with knee Osteoarthritis” Arch Phys Med. Rehabilitation, 83, pp. 1080-1086.  

2. Bhatia D., Bansal G, Joshi D., Anand S., Tewari R.P. 2011, “Coordination between lower limb muscles in different locomotion activities” International Journal of Biomedical Engineering and Technology,  6 (2), pp. 23-30.

3. De Luca, C.J. 1997, ‘The use of surface electromyography in biomechanics’, Journal of Applied Biomechanics, 13 (2), pp.135–163.

4. Childs J.D., Sparto P.J., Fitzgerald G.K., Bizzzini M., Irrgang J.J., 2004 “Alterations in lower extremity movement and muscle activation patterns in individuals with knee osteoarthritis”  Elsevier Science Direct Clinical Biomechanics, 19, pp. 44-49.

5. Likivainio T. and Arokoski J.P.A, 2008 “Physical function and properties of Quadriceps femoris muscle in men with knee Osteoarthritis”   Arch Phys Med Rehabil, 89, pp. 2185-2193.

6. Rana S. H., Hunt M.A., Creaby M.A., Wrigley T.A., McManus F.J., and Bennell K.L., 2010 “Hip Muscle Weakness in Individuals with Medial Knee Osteoarthritis” Arthritis Care & Research, 62 (8), pp. 1190-1193.

7. Pai Y.C., Chang H.J., Sinacore J.M., Lewis J.L., 1994 “Alteration in multijoint dynamics in patients with bilateral knee osteoarthritis”, Arthritis Rheum. Sep., 37 (9), pp.1297-304. 

Acknowledgement

Analysis & Results

Three trials per subject  were recorded employing dual AMTI force plates for measuring the GRF and EMG was measured  using  an  8  channel Motion  Lab Corp.  system, with  both systems sampled at 1000 Hz (2nd order Butterworth filter with 20-500Hz cutoff).   

The subject stepped from one force plate to another with the stance leg being stationary. The recorded EMG data was averaged across these trials for each subject; full wave rectified and analyzed employing EMG signal processing techniques (3). The GRF data was used to identify the different phases of movement and matched with the subsequent EMG data in Visual 3D software. 

I would like to thank the ANS Lab for allowing me to be a part of this team and gain an insightful experience that I know will benefit me in my future. I would also like to thank Dr. Dinesh Bhatia  and Dr. Ranu  Jung who  have  been  very  supportive  throughout  the research.  Lastly,  I  would  like  to  thank  Dr.  Denis  Brunt  and  the  Physical  Therapy Department, FIU for providing support during data collection in the human performance lab and guidance during the research.

Osteoarthritis  (OA)  is  a  progressive  joint  diseases  characterized  by  joint inflammation, pain and disability  leading to  loss of  function and  is one of  the top five most disabling conditions  that affects more  than one-third of people greater than 65 years with an average estimation of about 30 million Americans currently affected by  this disease (1). The majority of osteoarthritis cases are observed at the knee, which is the most commonly affected joint of the lower limb. As has been previously discovered, different muscle groups work in synchronization to perform a given task, meaning the activity of one muscle may affect another (2, 3).  With these findings it became evident that investigation of muscle recruitment patterns and  neuromuscular  efficiency  in  healthy  individuals  compared  to  patients  with knee OA in simple closed chain exercises might lead to a better understanding of how  knee  OA  develops  (4).  Although  some  studies  have  reported  abnormal muscle  activity  in  patients  with  OA,  there  are  no  studies  that  describe  the modulation of this activity due to, for example, a change in velocity or distance of movement. change in time or distance (7) both in normal control and after OA.

Step-up (Figure 1) Step-down (Figure 2)

8 inch step showed greater increase in slope and peak GRF than the 4 inch step (Figure 1 A - B)

During step down GM was more active during initiation phase (Figure 2 B)

Figure 1 B shows that the 8 inch step force increased by 200% over the 4 inch step

The intensity of muscle activation increased for all muscles during the lateral stepping down from an 8 inch step compared with a 4 inch step (Figure 2)

Subjects completed the 8 inch step in relatively less time duration

GM EMG activity between 4 and 8 inch task increased by 42% (Figure 2 B)

GM and GMax were more active from initiation to end of stabilization phase (Figure 1 E)

GMax was active but to a lesser extent after the quadriceps activity (Figure 2 D)

RF was active from beginning of initiation to end of contact phase

RF, VL and VM activity from beginning of toe-off to completion of loading phase increased by 69% in the 8 inch task

SM and GAS showed insignificant activity BF, SM, and ST activity was quite insignificant throughout the task.

Mean integral values increased for most muscles (Figure 1 C - E) by approximately 50%

Quadriceps groups increased in duration of activity thereby becoming more dominantly active

Step Up Task Step Down Task

Osteoarthritis (OA) is a chronic joint disease, the most common musculoskeletal complaint  worldwide,  and  is  associated  with  significant  health  and  welfare  costs. Previous  research  indicates  that  co-activation  of muscles may  lead  to  the  onset  of knee OA. Therefore, investigation of muscle recruitment patterns and neuromuscular efficiency  in healthy  individuals compared to patients with knee OA in simple closed chain  exercises  using  electromyography  (EMG),  motion  analysis  system  and  force plates may lead to a better understanding of how knee OA develops (6). The present studies  chosen were  in  the  frontal  plane while  performing  lateral  step  up  and  step down tasks for a 4 inch and 8 inch step height. In the stepping tasks it was discovered that  there  is  a greater magnitude EMG and ground  reaction  force  (GRF)  for  8  inch rather than a 4 inch step. Additionally, a higher activation of gluteus medius, gluteus maximus and quadriceps muscles (rectus femoris  , vastus  lateralis  , vastus medius) was revealed in both the stepping tasks.

Figure 2: Comparison of EMG patterns (average trials of one subject) in different 4 inch (dotted) and 8 inch (solid) Step Down task phases:1. Initiation of movement, 2. Take off, 3. Landing,

4.Loading response, 5. StabilizationA. Contact Leg step down (Z) GRF B. EMG Vastus Lateralis, (maximum between 1-2)C. EMG Gluteus Medius, (maximum between 2-3)D. EMG Gluteus Maximus, (maximum between 3-4)

Figure 1: Comparison of 4 inch (dotted) and 8 inch (solid) Step Up task phases:1. Initiation of movement, 2. Toe- off, 3. Contact, 4.StabilityA. Stability Leg (Z) GRFB. Stability Leg (X) GRFC. EMG Vastus LateralisD. EMG Biceps FemorisE. EMG Gluteus Maximus

Initiation of

MovementToe-off Contact Stability

Step Up Task

Step Down Task

Initiation of

Movement

Take-offLanding Loading

ResponseStabiliza-

tionMean Weight: 75 kg

Mean Height: 165 cm

Age: 23-32 years old

7 Control Subjects

Placement of Electrodes

Higher muscle activity patterns in quadriceps, hamstrings, and hip abductor/extensor.

Results provide a baseline standard for understanding lower extremity muscle group activity patterns in lateral side stepping tasks

Future studies involving OA subjects could prove to show a notable phase shift in GRF and muscle activity patterns; which may be useful in defining kinematic and activation patterns for identifying an early onset of the disease.

Lateral Step down from 8 inch Step

Data capturing of raw EMG and GRF data

Signal Processing in Visual 3D(500 Hz LP, 20 Hz HP, 100 ms RMS)

Event marking and identification of task phases on the GRF and

EMG data

Data analysis using window graphing tool in Visual 3D

Result processing using Excel sheet

Vertical GRF