Biomedical subjects

Nicholas Stergiou

Publications and source records attributed to Nicholas Stergiou.

At least 19 recordsLinked to original sources

PubMed2007

Tibial rotation is not restored after ACL reconstruction with a hamstring graft.

Recent research suggests ACL reconstruction does not restore tibial rotation to normal levels during high demand activities when a bone-patellar tendon-bone graft is used. We asked if an alternative graft, the semitendinosus-gracilis (ST/G) tendon graft, could restore tibial rotation during a high demand activity. Owing to its anatomic similarity with the normal ACL we hypothesized the ST/G graft could restore excessive tibial rotation to normal healthy levels along with a successful reinstatement of the clinical stability of the knee. We assessed tibial rotation in vivo, using gait analysis. We compared the knees of ACL reconstructed patients with an ST/G graft to their intact contralateral and healthy controls during a pivoting task that followed a stair descent. We also evaluated knee stability after ACL reconstruction with standard clinical tests. ACL reconstruction with the ST/G graft and with current techniques did not restore tibial rotation to previous physiological levels during an activity with increased rotational loading at the knee, although abnormal anteroposterior (AP) tibial translation was restored.

Adult↗

PubMed2006

Herodicus, the father of sports medicine.

Herodicus (fifth century BC: ) is the first person in the history of medicine who actually combined sports with medicine. He used to be a sports teacher, who later studied medicine and managed to succeed Euryphon in the medical school of Cnidos, one of the most prominent in ancient Greece together with its neighbor medical school of Cos (Hippocrates' home). In Cnidos Herodicus formed his own theoretical perspective of medicine. He considered, namely, bad health to be the result of imbalance between diet and physical activity and for this reason he recommended strict diet, constant physical activity and regular training. He believed that this combination was the ideal way to maintain good standards of health and he applied this type of treatment method to his patients. Unfortunately, Herodicus' works are lost today. However, excerpts of his medical system, which can be traced in ancient texts, support the fact that Herodicus can be considered as the father of sports medicine.

Diet↗

PubMed2006

A novel approach to measure variability in the anterior cruciate ligament deficient knee during walking: the use of the approximate entropy in orthopaedics.

OBJECTIVE: The evaluation of variability of biological rhythmic activities through measures such as Approximate Entropy (ApEn) has provided important information regarding pathology in disciplines such as cardiology and neurology. This research lead to the "loss of complexity hypothesis" where decreased variability is associated with loss of healthy flexibility rendering the system more rigid and unable to adapt to stresses. ApEn as a measure of variability and complexity, correlates well with pathology while, in some cases, it is predictive of subsequent clinical changes. The study of human gait could benefit from the application of ApEn since it is also a rhythmical oscillation. Our aim was to assess the variability of the ACL deficient knee, since ACL rupture is a common musculoskeletal injury and is accompanied by altered gait patterns and future pathology in the joint. We hypothesized that the ACL deficient knee will exhibit more regular and less variable walking patterns than the contralateral intact knee. METHODS: Ten subjects with unilateral deficiency walked on a treadmill at their self-selected speed, 20% faster, and 20% slower, while kinematics were collected (50 Hz) from 80 consecutive strides for each condition. The ApEn of the resulted knee joint flexion-extension time series was calculated. RESULTS: Significantly smaller ApEn values were found in the ACL deficient knee when compared with the contralateral intact (F = 5.57, p = 0.022), for all speeds. ApEn values significantly increased (F = 5.79, p = 0.005) with increases in walking speed. CONCLUSIONS: The altered properties of the ACL deficient knee, which exhibits more regular and less variable patterns than the contralateral intact knee, may decrease the adaptability of the system rendering it less able to adjust to perturbations. This could explain the increased future pathology found in the deficient knee. ApEn can be an important tool in assessing pathology and therapeutic interventions in orthopaedics.

Adult↗

PubMed2006

Original investigation correlated joint fluctuations can influence the selection of steady state gait patterns in the elderly.

This investigation utilized a Markov model to investigate the relationship of correlated lower extremity joint fluctuations and the selection of a steady state gait pattern in the young and elderly. Our model simulated the neuromuscular system by predicting the behavior of the joints for the next gait cycle based on the behavior exhibited in the preceding gait cycles. Such dependencies in the joint fluctuations have been noted previously in the literature. We speculated that compared to the young model, the characteristics of the correlated fluctuations in the elderly model would result in the selection of a different steady state gait pattern. The results of our simulation support the notion that correlated fluctuations in the joint kinematics influence the selection of a steady state gait pattern. The steady state gait pattern for the elderly model was dependent the ankle and hip. Conversely, the steady state gait pattern for the young control model was dependent on the behavior of the knee and hip. Based on our model, we suggested that the altered steady state gait patterns observed in the elderly may be due to an altered neuromuscular memory of prior joint behaviors.

Adult↗

PubMed2006

Follow-up evaluation 2 years after ACL reconstruction with bone-patellar tendon-bone graft shows that excessive tibial rotation persists.

OBJECTIVE: To investigate in vivo if the increased tibial rotation found in anterior cruciate ligament (ACL)-deficient patients before surgery is restored 2 years after the reconstruction, during 2 high-demanding activities. DESIGN: Prospective follow-up study. SETTING: A gait analysis laboratory. PARTICIPANTS: Nine subjects with unilateral ACL rupture, reconstructed with a bone-patellar tendon-bone (BPTB) graft, and 10 healthy control subjects. INTERVENTIONS: All the ACL-deficient patients underwent a unilateral ACL reconstruction after prereconstruction data acquisition. MAIN OUTCOME MEASUREMENTS: Using a 6-camera motion analysis system, kinematics were collected as subjects (1) descended from a stair and, after foot contact, pivoted on the landing leg at 90 degrees; and (2) jumped from a platform, landed with both feet on the ground and, after foot contact, pivoted on the right or left leg at 90 degrees in a similar fashion. The dependent variable examined was the maximum range of motion of tibial rotation during the pivoting period. RESULTS: For both activities, no significant differences were found between the control healthy knee and the intact knee of the patient group before and 2 years after the ACL reconstruction. Significant differences were found between the control healthy knee and the affected knee of the patients group for both activities, both before and 2 years after the ACL reconstruction. CONCLUSION: The increased tibial rotation found in the ACL-deficient knees was not restored with reconstruction using a BPTB graft, even 2 years postoperatively. The authors propose that this excessive tibial rotation over time may lead to further deterioration of the knee resulting from abnormal loading at areas of the cartilage that are not commonly loaded in a healthy knee.

Adult↗

PubMed2006

Optimal movement variability: a new theoretical perspective for neurologic physical therapy.

Variability is a natural and important feature of human movement. Using existing theoretical frameworks as a foundation, we propose a new model to explain movement variability as it relates to motor learning and health. We contend that mature motor skills and healthy states are associated with an optimal amount of movement variability. This variability also has form and is characterized by a chaotic structure. Less than optimal movement variability characterizes biological systems that are overly rigid and unchanging, whereas greater than optimal variability characterizes systems that are noisy and unstable. Both situations characterize systems that are less adaptable to perturbations, such as those associated with abnormal motor development or unhealthy states. From our perspective, the goal of neurologic physical therapy should be to foster the development of this optimal amount of movement variability by incorporating a rich repertoire of movement strategies. The development of such a repertoire can be enhanced by incorporating a multitude of experiences within the therapeutic milieu. Promoting complex variation in human movement allows either motor development or the recovery of function after injury not to be hard coded, but determined instead by the active engagement of the individual within their environment. Measurement tools derived from nonlinear dynamics that characterize the complexity of movement variability provide useful means of testing these propositions. To illustrate, we present 2 clinical case studies, one pediatric and one adult, where we applied our theoretical framework to measuring change in postural control.

Adolescent↗

PubMed2005

An improved surrogate method for detecting the presence of chaos in gait.

It has been suggested that the intercycle variability present in the time series of biomechanical gait data is of chaotic nature. However, the proper methodology for the correct determination of whether intercycle fluctuations in the data are deterministic chaos or random noise has not been identified. Our goal was to evaluate the pseudoperiodic surrogation (PPS) [Small et al., 2001. Surrogate test for pseudoperiodic time series data. Physical Review Letters 87(18), 188,101-188,104], and the surrogation algorithms of Theiler et al. [1992. Testing for nonlinearity in time series: the method of surrogate data. Physica D 58(1-4), 77-94] and of Theiler and Rapp [1996. Re-examination of the evidence for low-dimensional, nonlinear structure in the human electroencephalogram. Electroencephalography and Clinical Neurophysiology 98, 213-222], to determine which is the more robust procedure for the verification of the presence of chaos in gait time series. The knee angle kinematic time series from six healthy subjects, generated from a 2-min walk, were processed with both algorithms. The Lyapunov exponent (LyE) and the approximate entropy (ApEn) were calculated from the original data and both surrogates. Paired t-tests that compared the LyE and the ApEn values revealed significant differences between both surrogated time series and the original data, indicating the presence of deterministic chaos in the original data. However, the Theiler algorithm affected the intracycle dynamics of the gait time series by changing their overall shape. This resulted in significantly higher LyE and ApEn values for the Theiler-surrogated data when compared with both the original and the PPS-generated data. Thus, the discovery of significant differences was a false positive because it was not based on differences in the intercycle dynamics but rather on the fact that the time series was of a completely different shape. The PPS algorithm, on the other hand, preserved the intracycle dynamics of the original time series, making it more suitable for the investigation of the intercycle dynamics and the identification of the presence of chaos in the gait time series.

Algorithms↗

PubMed2005

An artificial neural network that utilizes hip joint actuations to control bifurcations and chaos in a passive dynamic bipedal walking model.

Chaos is a central feature of human locomotion and has been suggested to be a window to the control mechanisms of locomotion. In this investigation, we explored how the principles of chaos can be used to control locomotion with a passive dynamic bipedal walking model that has a chaotic gait pattern. Our control scheme was based on the scientific evidence that slight perturbations to the unstable manifolds of points in a chaotic system will promote the transition to new stable behaviors embedded in the rich chaotic attractor. Here we demonstrate that hip joint actuations during the swing phase can provide such perturbations for the control of bifurcations and chaos in a locomotive pattern. Our simulations indicated that systematic alterations of the hip joint actuations resulted in rapid transitions to any stable locomotive pattern available in the chaotic locomotive attractor. Based on these insights, we further explored the benefits of having a chaotic gait with a biologically inspired artificial neural network (ANN) that employed this chaotic control scheme. Remarkably, the ANN was quite robust and capable of selecting a hip joint actuation that rapidly transitioned the passive dynamic bipedal model to a stable gait embedded in the chaotic attractor. Additionally, the ANN was capable of using hip joint actuations to accommodate unstable environments and to overcome unforeseen perturbations. Our simulations provide insight on the advantage of having a chaotic locomotive system and provide evidence as to how chaos can be used as an advantageous control scheme for the nervous system.

Computer Simulation↗

PubMed2005

Excessive tibial rotation during high-demand activities is not restored by anterior cruciate ligament reconstruction.

PURPOSE: Recent in vitro research has suggested that anterior cruciate ligament (ACL) reconstruction does not restore control of tibial rotation. The purpose of this study was to explore these findings in vivo and investigate rotational knee stability during landing and subsequent pivoting. Such an activity places higher demands on the knee, almost similar to those found during high-level sports. TYPE OF STUDY: Case control series study. METHODS: We assessed 11 patients who had undergone ACL reconstruction with the same arthroscopic technique using a bone-patellar tendon-bone graft, 11 ACL-deficient subjects who had sustained the injury more than 1 year prior to testing, and 11 matched controls. Kinematic data were collected (50 Hz) with a 6-camera optoelectronic system while the subjects performed the following task: they jumped off a 40-cm platform and landed on the ground. After foot contact, the subjects were instructed to pivot at 90 degrees and walk away from the platform. The evaluation period was identified from initial foot contact with the ground with both legs, included the pivoting of the ipsilateral leg, and was completed on touchdown of the contralateral leg. RESULTS: Significant differences were found between the reconstructed leg of the ACL group and the healthy control, and between the deficient leg of the ACL-deficient group and the healthy control. We also found no significant differences between the deficient leg of the ACL-deficient group and the reconstructed leg of the ACL reconstructed group. CONCLUSIONS: It was concluded that, under high-stress activities, ACL reconstruction may not restore tibial rotation to the previous physiological level, even though anterior tibial translation is restored. Future research on ACL reconstruction should focus on the development of new surgical procedures and/or grafts to address this problem. LEVEL OF EVIDENCE: Level III.

Adult↗

PubMed2005

Baseline measures are altered in biomechanical studies.

The purpose of this investigation was to examine if baseline measures are altered between conditions in biomechanical studies and to determine the need for baseline measurements in biomechanics. Ten runners were asked to run at varying speeds and obstacle heights. Baseline measures were acquired between all conditions. Right lower extremity kinematic and kinetic data were collected for all baseline trials and evaluated by both a group and a single subject analysis. The group analysis revealed significant differences between baselines only for the obstacle perturbation. The single subject analysis indicated that baseline measures are altered in a greater degree for kinematics than kinetics. These findings suggested that baseline measures are altered between conditions in biomechanical studies, and they should be used when a repeated measures or a single subject experimental design is being utilized.

Biomechanical Phenomena↗

PubMed2005

A nonlinear dynamic approach for evaluating postural control: new directions for the management of sport-related cerebral concussion.

Recent research suggests that traditional biomechanical models of postural stability do not fully characterise the nonlinear properties of postural control. In sports medicine, this limitation is manifest in the postural steadiness assessment approach, which may not be sufficient for detecting the presence of subtle physiological change after injury. The limitation is especially relevant given that return-to-play decisions are being made based on assessment results. This update first reviews the theoretical foundation and limitations of the traditional postural stability paradigm. It then offers, using the clinical example of athletes recovering from cerebral concussion, an alternative theoretical proposition for measuring changes in postural control by applying a nonlinear dynamic measure known as 'approximate entropy'. Approximate entropy shows promise as a valuable means of detecting previously unrecognised, subtle physiological changes after concussion. It is recommended as an important supplemental assessment tool for determining an athlete's readiness to resume competitive activity.

Athletic Injuries↗

PubMed2004

The effect of anterior cruciate ligament reconstruction on lower extremity relative phase dynamics during walking and running.

The purpose of this investigation was to use relative phase dynamics to evaluate gait in individuals with a reconstructed anterior cruciate ligament (ACL) during walking and running. Relative phase dynamics can describe the coordination strategies between the interacting segments at the lower extremity. Ten subjects who had undergone ACL reconstruction using the central third of their patellar tendon and ten healthy controls walked and ran on a treadmill at a self-selected pace. Relative phase dynamics were calculated for the foot-shank and shank-thigh coordinative relationships. Statistical differences between the groups were noted for the foot-shank relationship (p < 0.05) during both walking and running and for the shank-thigh relationship (p < 0.05) during walking. Our results indicate that current ACL reconstructive techniques may result in altered relative phase dynamics. These changes in relative phase dynamics could be related to a loss of sensory information about joint position and velocity that is typically provided by the intact ACL. Additionally, relative phase adaptations could be a learned response from the early stages of postsurgical rehabilitation. Relative phase dynamics provide quantitative information about the dynamic status of the ACL-reconstructed knee that cannot be gained from the conventional time-series evaluation of gait analysis data. Relative phase dynamics measures should supplement the conventional gait analysis measures that are used today for the clinical evaluation of the functional dynamic stability of the reconstructed knee. The examination of relative phase dynamics could be clinically important for the quantification of new ACL surgical interventions and of patient performance at various stages of rehabilitation. Further research should incorporate relative phase dynamics to understand the influence of ACL reconstruction on coordination and functional patient outcomes.

Adult↗

PubMed2004

The effect of the walking speed on the stability of the anterior cruciate ligament deficient knee.

BACKGROUND: The reasons behind the development of future pathology in individuals with anterior cruciate ligament deficiency are unknown. This is due to the lack of appropriate methods to assess functional dynamic knee stability. In this study, we investigated the effect of walking speed on the functional dynamic stability of the anterior cruciate ligament deficient knee. We defined functional dynamic stability as local stability or the sensitivity of the knee to small perturbations. The natural stride-to-stride variations that exist during locomotion reflect exactly the presence of these perturbations. We hypothesized that speed will affect local stability in the deficient knee, especially when compared with the contralateral intact. METHODS: Ten subjects with unilateral deficiency walked on a treadmill at their self-selected speed, 20% faster, and 20% slower, while kinematic data were collected (50 Hz) for 100 consecutive footfalls for each condition. The largest Lyapunov Exponent of the resulted knee joint flexion-extension time series was calculated to quantify local stability. FINDINGS: The deficient knee was significantly more locally unstable than the contralateral knee. Furthermore, increases in walking speed did not affect local stability for our subject population. INTERPRETATIONS: The altered local stability may render the deficient knee less adaptable to the ever-changing environmental demands. This may explain the increased future pathology found in these knees. However, future efforts should attempt to evaluate this speculation using longitudinal studies. We also propose that the tools utilized in this study can be used eventually to assess functional dynamic knee stability in clinical gait analysis.

Adult↗

PubMed2003

The aging human neuromuscular system expresses less certainty for selecting joint kinematics during gait.

This investigation quantitatively characterized the certainty of the aging neuromuscular system in selecting a joint range of motion during gait based on the statistical concept of entropy. Elderly and young control groups walked on a treadmill at a self-selected pace. Joint angles were calculated for the ankle, knee and hip. We hypothesized that the aging group would exhibit less certainty in selecting a joint range of motion during gait. Our results supported this hypothesis, and indicated that aged individuals demonstrated statistically less certainty for the knee (16.8%) and hip (24.6%). We suggest that neurophysiological changes associated with aging may result in less certainty of the neuromuscular system in selecting a stable gait.

Adult↗

PubMed2003

Compensatory mechanisms in anterior cruciate ligament deficiency.

The literature cites numerous studies involving the analysis of movement patterns in anterior cruciate ligament deficient (ACLD) patients. Although several in vivo biomechanical studies have shown that ACLD patients develop protective mechanisms against degenerative diseases, it seems that these adaptations fail to protect the knee from future pathology. Some authors state that ACLD patients adapt to the injury by avoiding quadriceps contraction during gait when the knee is near full extension. However, others have found increased hamstrings and decreased gastrocnemius activity, which normally contribute to the stability of the knee. It seems that further in vivo biomechanical investigation is required to understand the mechanisms of pathological knee joint motions and develop rehabilitation programs, which would delay the progress of developing long-term degenerative diseases.

Adaptation, Physiological↗

PubMed2003

Nonlinear analysis of the development of sitting postural control.

The development of sitting postural control in five normal infants was examined longitudinally at three stages of sitting: Stage 1, when infants could hold up their head and upper trunk, but could not sit independently; Stage 2, when infants began to sit independently briefly; and Stage 3, when infants could sit independently. Methods from nonlinear dynamics were used to analyze center of pressure (COP) data during sitting in terms of stability of the neuromuscular system (Lyapunov Exponent), movement dimensionality (Correlation Dimension), and complexity/regularity (Approximate Entropy). Results indicated significant changes in the nonlinear measures over time, with increased stability and increased regularity revealing a more stable and periodic strategy of maintaining postural control. Dimensionality decreased from Stage 1 to 2, indicating a constraint of the degrees of freedom. Subsequently, dimensionality increased from Stage 2 to 3, indicating a release of the degrees of freedom as sitting independence emerged. Nonlinear analysis of the COP time series supports the perspective that the development of postural control is a dynamic process whereby the infant learns to control the body's degrees of freedom to achieve the sitting posture.

Child Development↗

PubMed2003

Nonlinear dynamics indicates aging affects variability during gait.

OBJECTIVE: To investigate the nature of variability present in time series generated from gait parameters of two different age groups via a nonlinear analysis. DESIGN: Measures of nonlinear dynamics were used to compare kinematic parameters between elderly and young females. BACKGROUND: Aging may lead to changes in motor variability during walking, which may explain the large incidence of falls in the elderly. METHODS: Twenty females, 10 younger (20-37 yr) and 10 older (71-79 yr) walked on a treadmill for 30 consecutive gait cycles. Time series from selected kinematic parameters of the right lower extremity were analyzed using nonlinear dynamics. The largest Lyapunov exponent and the correlation dimension of all time series, and the largest Lyapunov exponent of the original time series surrogated were calculated. Standard deviations and coefficient of variations were also calculated for selected discrete points from each gait cycle. Independent t-tests were used for statistical comparisons. RESULTS: The Lyapunov exponents were found to be significantly different from their surrogate counterparts. This indicates that the fluctuations observed in the time series may reflect deterministic processes by the neuromuscular system. The elderly exhibited significantly larger Lyapunov exponents and correlation dimensions for all parameters evaluated indicating local instability. The linear measures indicated that the elderly demonstrated significantly higher variability. CONCLUSIONS: The nonlinear analysis revealed that fluctuations in the time series of certain gait parameters are not random but display a deterministic behavior. This behavior may degrade with physiologic aging resulting in local instability. RELEVANCE: Elderly show increased local instability or inability to compensate to the natural stride-to-stride variations present during locomotion. We hypothesized that this may be the one of the reasons for the increases in falling due to aging. Future efforts should attempt to evaluate this hypothesis by making comparisons to pathological subjects (i.e. elderly fallers), and examine the sensitivity and specificity of the nonlinear methods used in this study to aid clinical assessment.

Adult↗

PubMed2003

The spanning set indicates that variability during the stance period of running is affected by footwear.

Sensory information the foot receives appears to be related to kinematic variability. Since footwear material densities affect sensory information, footwear may be an important factor that dictates variability. This study hypothesized that modifications in footwear would result in changes in kinematic variability during the running stance period. Subjects ran on a treadmill for three conditions: hard shoe, soft shoe and barefoot. The spanning sets of the mean ensemble curves of the knee and ankle changes for each condition were used to define variability. Variability was significantly larger in the barefoot condition in comparison with the two footwear conditions for both joints. These results suggest that variability can be affected by peripheral sensory information. The spanning set methodology can be utilized to examine changes in variability.

Adult↗