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Biomedical subjects

C Frigo

Publications and source records attributed to C Frigo.

At least 19 recordsLinked to original sources

The heel-contact gait pattern of habitual toe walkers.

We used kinematic, kinetic and EMG analysis to compare the spontaneous heel-contact gait patterns of 13 children classified as habitual toe walkers (HTWs) and age-matched controls. In the HTWs, the incidence of spontaneous heel-contact strides during a single recording session ranged from 15% to 92%, with no correlation with age, passive ankle joint excursion, walking speed and trial order. Hallmarks of the heel-contact strides were premature heel-rise, reversal of the second rocker, relative shortening of the loading response and anticipation and enhancement of the electromyographic (EMG) activity normally observed in the triceps surae (TS) during the first half of the stance phase. This variant of the locomotor program is different from the walking patterns observed in normally developing toddlers and children with cerebral palsy (CP). It does not necessarily reflect a functional adaptation to changes in the rheological properties of the muscle-tendon complex.

Analysis of Variance↗

Evaluation of an ambulatory system for gait analysis in hip osteoarthritis and after total hip replacement.

Spatial and temporal parameters of gait have clinical relevance in the assessment of motor pathologies, particularly in orthopaedics. A new gait analysis system is proposed which consists of (a) an ambulatory device (Physilog) including a set of miniature gyroscopes and a portable datalogger, and (b) an algorithm for gait analysis. The aim of this study was the validation of this system, for accuracy and clinical applicability. Eleven patients with coxarthrosis, eight patients with total hip arthroplasty and nine control subjects were studied using this portable system and also a reference motion analyzer and force plate. The small differences in the stance period (19 +/- ms), stride length and velocity (0.4 +/- 9.6 cm and 2.5 +/- 8.3 cm/s, respectively), as well as thigh and shank rotations (2.4 +/- 4.3 degrees and 0.3 +/- 3.3 degrees, respectively), confirmed good agreement of the proposed system with the reference system. In addition, nearly the same accuracy was obtained for all three groups. Gait analysis based on Physilog was also in agreement with their Harris Hip Scores (HHS): the subjects with lower scores had a greater limp, a slower walking speed and a shorter stride. This ambulatory gait analysis system provides an easy, reproducible and objective method of quantifying changes in gait after joint replacement surgery for coxarthrosis.

Aged↗

The upper body segmental movements during walking by young females.

OBJECTIVES: To characterise the physiological pattern of trunk and shoulders movements during walking and provide a reference for further studies on spine deformities. DESIGN: Implementation of a model for measuring spine and shoulder girdle movements during gait. Data collection on a population of eighteen, young, healthy, female subjects. BACKGROUND: The analysis of gait modifications in subjects with idiopathic scoliosis could offer an insight to better understand the functional relationship with the pathology. METHODS: Retroreflective markers were positioned on the main spine processes and acromions to be detected by a TV-based motion analysis system. A model of kinematic computation was implemented and integrated in a previously developed protocol for multifactorial gait analysis. Movements in the main reference planes and in relation to pelvis were analysed. RESULTS: The trunk was on average bent forward by 3.4 degrees with respect to standing; of the two physiological curves in the sagittal plane only lordosis changed during walking; in the frontal plane, a dynamic spine deformation appeared, that was maximum at heel strike-early stance; the trunk was bent controlaterally of the foot on the ground, while the shoulders remained stable; in the horizontal plane, the shoulders rotated contralaterally to the pelvis. CONCLUSIONS: In our population all the segmental movements analysed were smaller than 5 degrees during gait, except the angle of proximal curvature in the frontal plane, shoulder rotation, and angle between shoulders and pelvis; all the measured angles were far below their possible ranges of motion. RELEVANCE: Quantitative data on upper body kinematics as a complement to gait analysis can help understanding movement disorders and compensation strategies in several pathologies.

Adolescent↗

Standing-up exerciser based on functional electrical stimulation and body weight relief.

The goal of the present work was to develop and test an innovative system for the training of paraplegic patients when they are standing up. The system consisted of a computer-controlled stimulator, surface electrodes for quadricep muscle stimulation, two knee angle sensors, a digital proportional-integrative-derivative (PID) controller and a mechanical device to support, partially, the body weight (weight reliever (WR)). A biomechanical model of the combined WR and patient was developed to find an optimum reference trajectory for the PID controller. The system was tested on three paraplegic patients and was shown to be reliable and safe. One patient completed a 30-session training period. Initially he was able to stand up only with 62% body weight relief, whereas, after the training period, he performed a series of 30 standing-up/sitting-down cycles with 45% body weight relief. The closed-loop controller was able to keep the patient standing upright with minimum stimulation current, to compensate automatically for muscle fatigue and to smooth the sitting-down movement. The limitations of the controller in connection with a highly non-linear system are considered.

Adult↗

Ground reaction: intrinsic and extrinsic variability assessment and related method for artefact treatment.

Ground reaction (GR) components measured by a dynamometric platform represent the dynamic interaction of the moving human body with the ground and depend on the subject-platform relative position and orientation. The observed variability among the GR measurements of the walking trials of an individual is either due to variability in the motor performance (intrinsic variability) or due to changes in the direction of walking and in the position and orientation of the striking foot relative to the platform (extrinsic variability). A method, based on the median operator, is presented here which lets us quantify the two components of variability. The application of the method to a large data set of normal subjects evidenced changes in progression direction/foot orientation (95th percentile value is 6.9 degrees ), which can dramatically change the patterns of GR components. This result warns about improper analysis of ground reaction measurement. An algorithm for restoring GR measurements affected by artefact was derived from the above method. This tool can be of valuable aid in clinical practice where patients' conditions suggest to not insist on repetition of trials even if the required number of correct foot placements has not been achieved. The artefact correction algorithm has been applied to a large data set artificially corrupted to evaluate its robustness.

Adult↗

SHV-16, a beta-lactamase with a pentapeptide duplication in the omega loop.

A clinical isolate of Klebsiella pneumoniae was found to be resistant to ampicillin (MIC of 128 microg/ml), ticarcillin (MIC of 512 microg/ml), and ceftazidime (MIC of 128 microg/ml) and susceptible to all other beta-lactams; a synergistic effect between clavulanate and ceftazidime suggested the presence of an extended-spectrum beta-lactamase (ESBL). Transconjugants in Escherichia coli were obtained at low levels (10(-7) per donor cell) and exhibited a similar beta-lactam resistance pattern (resistant to ampicillin, ticarcillin, and ceftazidime at 64 microg/ml). The ESBL, pI 7.6, was encoded by a large plasmid (>100 kb) which did not carry any other resistance determinant. The ESBL-encoding gene was amplified by PCR using bla(SHV)-specific primers and was sequenced. The deduced amino acid sequence of the SHV-16 ESBL showed that it differed from SHV-1 by only a pentapeptide insertion (163DRWET167) corresponding to a tandem duplication in the omega loop. The implication of the 163a-DRWET163b-DRWET sequence in ceftazidime resistance was confirmed by cloning either bla(SHV-1) or bla(SHV-16) in the same vector, subsequently introduced in the same E. coli strain. Under these isogenic conditions, SHV-16 conferred a 32-fold increase in ceftazidime MIC compared to that with SHV-1. Furthermore, site-directed mutagenesis experiments modifying either E166aA or E166bA revealed that the functional glutamic residue was that located in the first copy of the duplicated sequence. But surprisingly, the second E166b also conferred a low-level resistance to ceftazidime. This work is the first description of a class A enzyme exhibiting an extended substrate specificity due to an insertion instead of a nucleotide substitution(s) in a clinical isolate.

Amino Acid Sequence↗

Nosocomial outbreak due to a multiresistant strain of Pseudomonas aeruginosa P12: efficacy of cefepime-amikacin therapy and analysis of beta-lactam resistance.

Over a 3-year period, 67 patients of the Hospital of Pau (Pau, France), including 64 patients hospitalized in the adult intensive care unit (ICU), were colonized and/or infected by strains of Pseudomonas aeruginosa P12, resistant to all potentially active antibiotics except colistin. Most patients were mechanically ventilated and presented respiratory tract infections. Since cefepime and amikacin were the least inactive antibiotics by MIC determination, all ICU patients were treated with this combination, and most of them benefited. Cefepime-amikacin was found highly synergistic in vitro. Ribotyping and arbitrary primer-PCR analysis confirmed the presence of a single clonal isolate. Isoelectrofocusing revealed that the epidemic strain produced large amounts of the chromosomal cephalosporinase and an additional enzyme with a pI of 5.7, corresponding to PSE-1, as demonstrated by PCR and sequencing. Outer membrane protein profiles on sodium dodecyl sulfate-polyacrylamide gel electrophoresis showed the absence of a ca. 46-kDa protein, likely to be OprD, and increased production of two ca. 49- and 50-kDa proteins, consistent with the outer membrane components of the efflux systems, MexAB-OprM and MexEF-OprN. Thus, we report here a nosocomial outbreak due to multiresistant P. aeruginosa P12 exhibiting at least four mechanisms of beta-lactam resistance, i.e., production of the penicillinase PSE-1, overproduction of the chromosomal cephalosporinase, loss of OprD, and overexpression of efflux systems, associated with a better activity of cefepime than ceftazidime.

Adult↗

EMG signals detection and processing for on-line control of functional electrical stimulation.

The surface EMG signal detected from voluntarily activated muscles can be used as a control signal for functional neuromuscular electrical stimulation. A proper positioning of the recording electrodes in relation to the stimulation electrodes, and a proper processing of the recorded signals is required to reduce the stimulus artefact and the non-voluntary contribution (M-wave). Six orientations and six locations of the recording electrodes were investigated in the present work. A comb filter (with and without a blanking windowing) was applied to remove the signal components synchronously correlated to the stimulus. An operative definition of the signal to noise ratio and an efficiency index were implemented. It resulted that when the recording electrodes were located within the two stimulation electrodes the best orientation was perpendicular to the longitudinal line. However the best absolute indexes were obtained when the recording electrodes were located externally of the stimulation electrodes, and in that case the best orientation was longitudinal. Concerning the filtering procedure, the use of a blanking window before the application of the comb filter, gave the best performance.

Artifacts↗

Instrumented staircase for ground reaction measurement.

A staircase was developed to record ground reactions during stair climbing at different slopes (inclinations). Each step is instrumented with six strain-gauge-based force transducers which allow the measurement of three-dimensional ground reaction force and moment as well as the centre of pressure (COP) location. A specific sensor arrangement permits accurate recording, especially of the COP location. The overall design of the staircase and details of a single instrumented step are presented. Static and dynamic characteristics have been evaluated by different experimental procedures. Preliminary results of ground reaction forces are shown.

Biomechanical Phenomena↗

Functional control of the hand in tetraplegics based on residual synergistic EMG activity.

A microprocessor controlled device (MeCFES) was used for the investigation of the possibility of restoring hand function in C5 tetraplegics with paralysis of the hand. To date, 3 tetraplegics have been testing the system. The myoelectric signals from wrist extension were recorded and used as control signals for functional electrical stimulation (FES) of thumb adduction/flexion. The results have shown that the device can improve the hand function of tetraplegics. In this part of the work, a hand function test was designed and used to assess the results.

Electric Stimulation Therapy↗

Multifactorial estimation of hip and knee joint centres for clinical application of gait analysis.

Estimation of joint centres is required in gait analysis for kinematic and kinetic elaboration. In general, the method is based on regression equations and palpation of bone prominences. A kinematic approach can also be used at the hip joint but appears to be more demanding for the patients. The method presented here combines different independent approaches and is aimed at reducing the estimation errors caused by from skin motion artefacts and statistical variance of anthropometric data. It is based on minimising an optimisation function in which data from gait kinematics, anthropometric measurements and statistically derived morphological parameters are properly weighted. The procedure is suitable for clinical applications where the range of motion might be reduced and the patients can not perform complicated exercises. Validation has been made on ten normal subjects and ten patients with spina bifida. The results show that the reproducibility of the estimation and the congruency with the external measurements is improved with respect to both the morphologically based approach and the kinematic method. Copyright 1998 Elsevier Science B.V.

Journal Article↗

Electromyographic signals during gait: criteria for envelope filtering and number of strides.

The use of linear envelopes to represent the electromyographic (EMG) measurements obtained during locomotion has become common practice. Guidelines for designing envelope filters and specifying the minimum number of strides needed to produce valid EMG profiles have been developed. Electromyograms from eight major muscles of the lower leg are measured from five normal young adults during self-selected slow, free and fast walking speeds. 30 strides per task are measured. The 'ideal' EMG profile is defined from the ensemble average of the rectified EMG signal. An error measure is defined and used as a criterion to assess the appropriateness of various cut-off frequencies for envelope filters and the number of strides required for establishing a good EMG profile. It is found that between six and ten strides are needed to form a representative profile, and an envelope filter with a minimum cut-off frequency of approximately 9 Hz is necessary.

Adult↗

Functionally oriented and clinically feasible quantitative gait analysis method.

A protocol for clinical gait analysis is described, and data from 30 normal adult female subjects are presented. Extensive application to pathologic subjects has proven to be feasible and sufficiently accurate. The method is based on a particular location and attachment of retro-reflective markers on the body and on a particular arrangement of four TV cameras. A motion analyser measures the 3D coordinates of each marker. A modelling approach, based on individual anthropometric measurements, and a functional approach, based on kinematical considerations, are used to estimate the location of hip, knee, and ankle joint centers and the orientation of the flexion-extension axis of the knee. 3D relative and absolute movements of pelvis and lower limbs are obtained and shown to be consistent with functional anatomy.

Adult↗

Changes in the excitability of soleus muscle short latency stretch reflexes during human hopping after 4 weeks of hopping training.

Changes in the excitability of the human triceps surae muscle short latency stretch reflexes were investigated in six male subjects before and after 4 weeks of progressive two-legged hopping training. During the measurements the subjects performed 2-Hz hopping with: preferred contact time (PCT) and short contact time. The following reflex parameters were examined before and after the training period: the soleus muscle (SOL) Hoffmann-reflex (H-reflex) at rest and during hopping, the short latency electromyogram (EMG) components of the movement induced stretch reflex (MSR) in SOL and medial gastrocnemius muscle (MG), and the EMG amplitude of the SOL and MG tendon reflexes (T-reflexes) elicited at rest. The main results can be summarized as follows: the SOL T-reflex had increased by about 28% (P < 0.05) after training while the MG T-reflex was unchanged; the SOL MSR (always evident) and the MG MSR (when observable) did not change in amplitude with training, and before training the SOL H-reflex in both hopping situations was significantly depressed to about 40% of the reference value at standing rest (P < 0.05). After training the H-reflex during PCT hopping was no longer depressed. As the value of the measured mechanical parameters (the total work rate, joint angular velocity and the ankle joint work rate) was unchanged after training in both hopping situations, the reflex changes observed could not be ascribed to changes in the movement pattern. To explain the observed changes, hypotheses of changes in the excitability of the stretch reflex caused by the training were taken into consideration and discussed.

Adult↗

Analysis of the gait of adults who had residua of congenital dysplasia of the hip.

Twenty-one adult subjects who had symptomatic residua of unilateral congenital dysplasia of the hip, with various degrees of degenerative changes, were studied with respect to the physical and radiographic findings and gait performance. Three-dimensional body reconstruction; the Trendelenburg sign; spatiotemporal parameters of stride; ground-reaction forces; kinematics of the hip, knee, and ankle; moments of forces; and joint powers were evaluated bilaterally. The kinematic and kinetic parameters of the affected limb were compared with those of the unaffected limb and with those of the limbs of normal control subjects. Correlations between changes in selected gait parameters and the clinical and radiographic signs of impairment of the hip were demonstrated. The results are discussed in relation to the possible mechanisms underlying the observed alterations and in view of possible operative interventions.

Adult↗

Lower extremity angle measurement with accelerometers--error and sensitivity analysis.

Closed-loop control techniques for the restoration of locomotion of paraplegic subjects are expected to improve the quality of functional neuromuscular stimulation (FNS). We investigated the use of accelerometers for the assessment of feedback parameters. Previously, the possibility of angle assessment of the lower extremities using accelerometers, but without integration, was demonstrated. The current paper evaluates and assesses this method by an error and sensitivity analysis using healthy subject data. Of three potential error sources, the reference system, the accelerometers, and the model assumptions, the last was found to be the most important. Model calculations based on data obtained by the Elite video motion analysis system showed the rigid-body assumption error to be dominant for high frequencies (greater than 10 Hz), with vibrations in the order of 1 mm resulting in errors of one radial or more. For low frequencies (less than 5 Hz), the imperfect fixation of the accelerometers combined with a nonhinge type knee joint gave an error contribution of +/- 0.03 rad. The walking pattern was assumed to be two-dimensional which was shown to result in an error of +/- 0.04 rad. Accelerations due to rotations of the segments could be neglected. The total error computed for low frequencies (+/- 0.07 rad) was comparable to the experimental difference between the current and the reference system.

Acceleration↗

A motor programme for the initiation of forward-oriented movements in humans.

1. The EMG sequence activated before the initiation of a number of fast forward-oriented voluntary movements was analysed quantitatively in normal subjects. 2. The sequence consisted of an initial inhibitory component directed to the soleus motor nucleus, followed by a second excitatory one directed to the tibialis anterior (TA). 3. The spectrum of functional utilization included motor tasks in which the prime movers are leg and thigh muscles (initiation of gait, rising on tip-toes), thigh and trunk muscles (fast-forward bending of the trunk, standing up) and upper-limb muscles (forward throw or catch). 4. In a same motor task and across the different motor tasks, performed at various speeds, the latency of soleus inhibition and TA activation with respect to the onset of movement co-varied according to a linear function, indicating a close temporal correlation between the two components. 5. In all the movements investigated, the earliest mechanical effect was a backward displacement of the centre of foot pressure in the sagittal plane. 6. Soleus inhibition alone and TA burst alone were each able to produce a backward displacement of the centre of foot pressure, but the effect was significantly slower after soleus inhibition. 7. The spatio-temporal parameters of the sequence were modulated according to the pre-existing postural conditions. For the gait initiation protocol, increasing initial forward leaning led to a decrease in the amplitude of soleus inhibition and the TA burst, and to a change in their relative time delays. Modulation was different on the two sides. We could define a postural boundary as the degree of forward leaning beyond which the full sequence is no longer called into action. 8. The spatio-temporal parameters of the sequence were pre-set according to the requirements of the forthcoming movement. In the gait initiation protocol, the amplitude and synchronization of the TA burst were directly correlated with velocity of movement, while the relative delay between soleus inhibition and TA activation was inversely correlated. Modulation on the two sides differed. We could define a velocity boundary as the velocity of movement below which the full sequence is no longer called into action. 9. We suggest that the EMG sequence described can be considered a motor programme that, through direct action on the position of the centre of foot pressure (the variable primarily controlled), will precisely adjust the configuration of forces external to the body, allowing the contraction of the prime mover(s) to interact appropriately with them for the production of a specific, forward-oriented movement.

Adult↗

Postural synergies in axial movements: short and long-term adaptation.

Fast backward trunk movements are accompanied by hip, knee and ankle rotation which compensate for the backward shift of the center of gravity. The electromyographic pattern associated with the performance of these movements and the associated synergies consists of a fairly synchronous activation of the prime mover (erectores spinae) and the muscles situated at the back of the leg (hamstring, calf muscles). This pattern is called the "non anticipated pattern". The effect of training on the EMG pattern and on the subjects' mechanical performances was investigated by comparing a population of untrained subjects with one of highly trained gymnasts. A new EMG pattern was observed in the highly trained gymnasts, the "distally anticipated pattern" consisting of an early activation of the gastrocnemius, and in some subjects also of the hamstring, indicating that a long term adaptation had taken place. Performances expressed as a ratio between the displacement of the center of gravity projection onto the ground and the velocity of the movement were clearly better in the gymnasts. Short term adaptation was found to occur in the gymnasts and not in the untrained group when the movement was performed while standing on a narrow support. A suppression of the distal gastrocnemius burst occurred in the gymnasts from the first trial under the constrained standing condition whereas no change occurred in the untrained group. The flexibility of the EMG patterns associated with axial movements occurring either spontaneously or as a result of long or short term training is discussed.

Adaptation, Physiological↗