The interaction between muscle pathophysiology, body mass, walking speed and ankle foot orthosis stiffness on walking energy cost: a predictive simulation study.

Autor: Waterval NFJ; Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands. n.f.waterval@amsterdamumc.nl.; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands. n.f.waterval@amsterdamumc.nl., van der Krogt MM; Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands.; Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands.; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands., Veerkamp K; Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands.; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands.; School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, and Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, Australia., Geijtenbeek T; Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands., Harlaar J; Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.; Department of Orthopaedics, Erasmus Medical Center, Rotterdam, The Netherlands., Nollet F; Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands.; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands., Brehm MA; Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands.; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Journal of neuroengineering and rehabilitation [J Neuroeng Rehabil] 2023 Sep 07; Vol. 20 (1), pp. 117. Date of Electronic Publication: 2023 Sep 07.
DOI: 10.1186/s12984-023-01239-z
Abstrakt: Background: The stiffness of a dorsal leaf AFO that minimizes walking energy cost in people with plantarflexor weakness varies between individuals. Using predictive simulations, we studied the effects of plantarflexor weakness, passive plantarflexor stiffness, body mass, and walking speed on the optimal AFO stiffness for energy cost reduction.
Methods: We employed a planar, nine degrees-of-freedom musculoskeletal model, in which for validation maximal strength of the plantar flexors was reduced by 80%. Walking simulations, driven by minimizing a comprehensive cost function of which energy cost was the main contributor, were generated using a reflex-based controller. Simulations of walking without and with an AFO with stiffnesses between 0.9 and 8.7 Nm/degree were generated. After validation against experimental data of 11 people with plantarflexor weakness using the Root-mean-square error (RMSE), we systematically changed plantarflexor weakness (range 40-90% weakness), passive plantarflexor stiffness (range: 20-200% of normal), body mass (+ 30%) and walking speed (range: 0.8-1.2 m/s) in our baseline model to evaluate their effect on the optimal AFO stiffness for energy cost minimization.
Results: Our simulations had a RMSE < 2 for all lower limb joint kinetics and kinematics except the knee and hip power for walking without AFO. When systematically varying model parameters, more severe plantarflexor weakness, lower passive plantarflexor stiffness, higher body mass and walking speed increased the optimal AFO stiffness for energy cost minimization, with the largest effects for severity of plantarflexor weakness.
Conclusions: Our forward simulations demonstrate that in individuals with bilateral plantarflexor the necessary AFO stiffness for walking energy cost minimization is largely affected by severity of plantarflexor weakness, while variation in walking speed, passive muscle stiffness and body mass influence the optimal stiffness to a lesser extent. That gait deviations without AFO are overestimated may have exaggerated the required support of the AFO to minimize walking energy cost. Future research should focus on improving predictive simulations in order to implement personalized predictions in usual care. Trial Registration Nederlands Trial Register 5170. Registration date: May 7th 2015.  http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5170.
(© 2023. BioMed Central Ltd., part of Springer Nature.)
Databáze: MEDLINE
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