Dissertations / Theses on the topic 'Knee lever'

Fast pushing like forms of knee extension were previously studied (van Ingen Schenau, 1994, Bobbert 1994). From these the role of mono and bi-articular muscles was established for this type of pushing like motion patterns. The way whipping like forms of knee extension are controlled is however less understood. This study investigated the impact of skill level in modulating fast forms of knee extension. The investigation was carried out by using a Taekwondo fast front kicking action, mean peak leg angular velocity 18.65 rads/s, as the subject task. A total of 40 healthy male and female participants volunteered to take part in this study. Of these, 20 were skilled martial arts athletes while the remaining 20 were unskilled. Expert and novice groups were randomly divided into treatment and control groups. A ten week intervention program aimed at increasing the skill level of participants of the expert and novice groups was conducted. The kinematic profile of the execution of a fast front kick performed under various settings of velocity, range of motion and degrees of freedom was obtained by a high speed camera. The myoelectrical activity of selected muscle units was simultaneously obtained while kicks were video recorded. Expert and novice participants were tested pre and post intervention program. Of the available kinematic variables such as segmental angular velocities, joint linear velocities and intersegmental timing and coordination, it was found that only: peak ankle linear and leg angular velocities, intersegmental timing, thigh to leg peak angular velocity ratio and a calculated performance index, have the potential to discriminate differences in skill level in this form of kicking. Pre and post intervention differences between groups were assessed from these variables. It was of interest to this study to identify the sources of these differences. To this end, an inverse dynamics analysis of the interaction between segments during the execution of a front kick was performed. It was found that the interaction between segments evolves with increases in skill level. Expert athletes utilize a i) precursor knee flexion moment to assist hip flexion moment during the initial stages of the kicking action and ii) a late hip flexion moment to assist further increases of kicking speed. These moments were absent in the execution of a front kick by novice athletes. These findings were also obtained form an optimization approach to the analysis of interactive moments during kicking. An important conclusion from these analyses is that the view of a front kick as a proximal to distal motion pattern is inadequate. Evidence from this study suggests that this action is best defined as a distal-proximal-distal motion pattern in an expert population. It then indicates that skill gains rely on the utilization of intrinsic muscle properties to assist the execution of tasks like a front kick.

Knee function after more than 20 years post injury is rarely described and none of the few follow-up studies have evaluated functional performance tasks. This thesis investigated self-reported knee function, physical activity level, physical capacity and movement pattern in the long-term perspective (on average 23 years) in persons who had suffered a unilateral ACL injury, treated either with physiotherapy in combination with surgery (ACLR, n=33) or physiotherapy alone (ACLPT, n=37) and compared to age-and-gender matched controls (n=33).  This thesis shows that regardless of treatment, there are significant negative long-term consequences on self-reported knee function and physical activity more than 20 years after injury. In comparison to the controls, the ACL-groups (ACLR and ACLPT) had lower knee function as measured by the Lysholm score and the Knee injury and Osteoarthritis Outcome Score (KOOS). The persons with an ACL injury also had a lower knee-specific physical activity level (Tegner activity scale), while no differences were seen in general physical activity level (International Physical Activity Questionnaire, IPAQ) compared to healthy controls. Regarding physical capacity, both ACL groups showed inferior jump capacity in the injured leg compared to the non-injured leg. However, compared to controls the ACL-injured had a relatively good jump performance. Knee extension peak torque, concentric and eccentric, was also lower for the injured leg compared to the non-injured leg for both ACLR and ACLPT. In addition, the ACLPT group showed reduced eccentric knee flexion torque of the injured leg. The non-injured leg, on the other hand, showed almost equal jump capacity and strength as controls. Balance in single-limb stance (30s) was inferior in persons who had an ACL injury. This was true for both the injured and non-injured leg and regardless of treatment. Movement pattern during the one-leg hop was analysed by a set of kinematic variables consisting of knee angles (flexion, abduction, rotation) and Centre of Mass (CoM) placement in relation to the knee and ankle joints. Both ACLR and ACLPT displayed movement pattern asymmetries between injured and non-injured legs. In comparison to controls, the ACLR group had a similar movement pattern with the exception of larger external knee rotation at Initial contact and less maximum internal rotation during the Landing. ACLPT showed several differences compared to controls both regarding knee angles and CoM placement. The ACL-injured persons with no-or-low knee osteoarthritis (OA) had better knee function as reflected by higher scores on Lysholm and KOOS subscale ‘symptom’ compared to those with moderate-to-high OA. The degree of OA had no influence on reported physical activity level, jump capacity, peak torque or the kinematic variables.  In conclusion, this thesis indicates that persons with a unilateral ACL injury, regardless of treatment, have some negative long-term consequences e.g. self-reported knee function, knee-specific activity level, strength and balance deficits, when compared to age-and-gender matched controls. The results, however, also indicate that the ACL-injured can manage reasonably well in some jumps and general activity level but have an inferior performance in more knee-demanding tasks. The ACLR group had similar movement pattern with the exception of knee rotation, indicating that a reconstruction may restore the knee biomechanics to some extent. The ACLPT group on the other hand, seem to use compensatory movement strategies showing several differences compared to controls.

It´s important to consider all the risks that the players are exposed to and have a holistic view on the matter. The conclusions from my sponsor and looking through research in the area I came to the conclusion that surface and shoes have minimal consequences and are not an area of interest for me in this project.

Background: Osteoarthritis (OA) is the most common form of arthritis and is a major cause of disability and impaired quality of life (QoL). The prevalence of OA is rapidly increasing affecting approximately 15% of the world’s population. Currently, there are no disease modifying treatments available. Non-steroidal anti-inflammatory drugs, the most widely prescribed medications for patients with knee OA (KOA), are associated with serious side effects, including bleeding and gastric ulceration. As a result, both patients and professional societies are looking for alternative therapies, with good effects,and less toxicity, to control pain sufficiently. Low-level laser therapy (LLLT) is a non-invasive treatment modality in the field of physiotherapy for pain management. Nonetheless,the effectiveness of LLLT in the treatment of OA is debatable. Objectives and Design: A randomised, double-blind, controlled trial was conducted to evaluate the efficacy of LLLT when it is applied on specific acupuncture points (APs) at the knee joint in combination with exercises and advice in patients with KOA. Participants: Forty-nine patients with KOA were randomly assigned into two groups; active laser group (n= 26) and placebo laser group(n= 23). Intervention: Using a gallium-aluminium-arsenide laser device,patients received either active or placebo LLLT treatment at five APs (ST 35,Xiyan, ST 36, SP9, and SP10) on the affected knee. All participants received a series of 9 treatment sessions over a period of three weeks by using LLLT(active or placebo) in addition to strengthening exercise and advice. Outcome Measures: Visual analogue scale (VAS), Saudi knee function scale (SKFS), active range of motion (ROM), knee circumference (KC), and patient satisfaction were assessed at baseline, at the 5th treatment session,at the last (9th) treatment session, after six weeks and then six months after the last treatment session. Result: There was a statistically (but not clinically) significant improvement in the laser group compared to the placebo group in the primary outcome VAS after six weeks (P=0.014) and after six months of the last session of treatment (P= 0.003). There was a statistically (but not clinically) significant improvement in the laser group compared to the placebo group in the SKFS scores at the last treatment session (P= 0.035), and after six months (P= 0.006); in ROM only after six months (P= 0.019); inpatient satisfaction at the 5th session (P= 0.033) and after six months. No significant difference between both groups was noted in the KC at any time. Within both groups there was statistically significant improvement in most outcomes. Conclusions: The results demonstrate that the short-period application of LLLT on specific APs associated with exercises and advice is effective in reducing pain and improving the QoL in patients with KOA.

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This study aimed to compare neuromuscular aspects, such as antagonist co-activation during knee extension (Coext) and flexion (Coflex), functional ratio of the maximum concentric hamstring strength to the maximum eccentric quadriceps strenght for knee flexion (Icon:Qexc), knee extensor torque in concentric (PTcon_ext) and eccentric (PTexc_ext) ways, the concentric knee flexor torque (PTcon_flex) and physical function, in different knee OA degrees. It was also objective of this dissertation investigate the center of pressure (COP) behavior (amplitude and velocity of the anterior-posterior and medial-lateral displacement) during a task involving eccentric quadriceps contraction, and the correlation between center of pressure and variables related to muscle performance and physical function. These objectives comprise two studies, with different methodologies. Study I: 20 subjects with knee OA (GOA) and 20 healthy subjects (GC) performed a postural stability evaluation, standing on two force platforms (Bertec Mod) with 45 degrees of knee flexion. PTcon_flex and PTexc_ext were evaluated in a speed of 90°/s. Subjects answered Physical Function and Stiffness subscales of the questionnaire Western Ontario MacMaster Universities Osteoarthritis Index (WOMAC). Intergroup statistical analysis shown that subjects of the GOA, compared to GC, had no difference in postural control parameters, had lower Icon: Qexc (p = 0.004) and poorer selfreported physical function (p = 0.00) and stiffness (p = 0.001). Antero-posterior COP displacement was moderately and negatively correlated with the physical function subscale (ρ = -0.480, p = 0.02). Antero-posterior COP speed was moderately and negatively correlated with the physical function WOMAC subscale (ρ =-0.52, p = 0,01) and stiffness WOMAC subscale (ρ = -0.44, p = 0.03). Study II: 20 subjects with knee OA grade II (GOAII), 15 with knee OA grade III (GOAIII) and 19 healthy subjects (GC) performed isokinetic knee extension and flexion at 60 °/s, simultaneously to the electromyographic assessment of muscles quadriceps (vastus lateralis, rectus femoris, vastus) and hamstrings (biceps femoris and semitendinosus). Subjects answered Physical Function WOMAC subscale and performed functional tests 30-s chair-stand test (STS30s), 40mfast-paced walk test (Caminhada40m) and a stair-climb test (Escada). After intergroup analysis, GOAII showed higher Coflex (p = 0.001), higher Icon:Qexc (p = 0.000), Σemgflex_flex (p = 0.000), lower PTcon_ext (p = 0:02) and PTexc_ext (p = 0.008) and worse self reported physical function (p= 0.000). In GOAIII were identified greater Icon:Qexc (p = 0.000), lower PTcon_ext (p = 0.000), PTexc_ext (p = 0.000) and PTcon_flex (p = 0.04), worse self-reported Physical Function (p = 0.000) and worse performance in the functional tests: STS30s Caminhada40m e Escada (p = 0.017 p = 0.000 and p = 0.001, respectively). There was no difference between the GOAII and GOAIII for all variables (p ≥ 0.05). Together, these results suggest a neuromuscular adaptation present in individuals with knee OA, justifies the need for intervention from the early degrees of the disease and highlight the importance of taking into account different forms of assessment of physical function.
Foi objetivo desta dissertação comparar aspectos neuromusculares, como coativação do antagonista durante a extensão (Coext) e flexão (Coflex) do joelho, relação funcional de força concêntrica de isquiotibiais e excêntrica de quadríceps para flexão de joelho (Icon:Qexc), torque extensor do joelho nos modos concêntrico (PTcon_ext) e excêntrico (PTexc_ext), o torque flexor do joelho no modo concêntrico (PTcon_flex) e a função física nos diferentes graus da OA do joelho. Também foi objetivo dessa dissertação investigar o comportamento do centro de pressão (amplitude e velocidade do deslocamento ântero-posterior e médio-lateral) durante uma tarefa envolvendo contração excêntrica do quadríceps e correlaciona-lo às variáveis relacionadas ao desempenho muscular e função física. Estes objetivos compõem dois estudos, com metodologias distintas. Estudo I: 20 indivíduos com OA de joelhos (GOA) e 20 sujeitos saudáveis (GC) realizaram avaliação da estabilidade postural, em pé sobre duas plataformas de força (Bertec Mod) e flexão de joelhos de 45 graus. Também foram avaliados PTcon_flex e PTexc_ext na velocidade de 90°/s e os sujeitos responderam às seções função física e rigidez do questionário Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC). Após análise estatística intergrupo, não foi observada diferença estatística para as variáveis do controle postural entre os sujeitos com OA e o GC. No entanto, foram identificados menor PTexc_ext (p=0.01), menor Icon:Qexc (p=0.004), pior auto-relato de função física (p=0,00) e rigidez (p=0,001). A análise de correlação indicou correlação entre o controle postural e função física e rigidez. Estudo II: Vinte indivíduos com OA do joelho grau II (GOAII), 15 com OA do joelho grau III (GOAIII) e 19 saudáveis (GC) realizaram teste isocinético de extensão do joelho a 60°/s, simultaneamente à avaliação eletromiográfica dos músculos do quadríceps (vasto lateral, reto femural e vasto medial) e isquiotibiais (bíceps femural e semitendíneo). Os sujeitos responderam à seção Função Física do qustionário WOMAC e realizaram testes funcionais de sentar e levantar de uma cadeira por 30 segundos (STS30s), caminhada de 40 metros (Caminhada40m) e subida e descida de escada (Escada). Após análise intergrupo, o GOAII apresentou maior Coflex (p = 0.001), maior Icon:Qexc (p = 0.000), Ʃemgflex_flex (p = 0.000), menores PTcon_ext (p = 0.02) e PTexc_ext (p = 0.008) e pior auto-relato de função física (p = 0.000 ). No GOAIII foram identificados maior Icon:Qexc (p = 0.000), menores PTcon_ext (p = 0.000), PTexc_ext (p = 0.000) e PTcon_flex (p = 0.04), pior auto-relato de função física (p = 0.000) e pior desempenho nos testes STS30s, Caminhada40m e Escada (p = 0.017 p = 0.000 e p = 0.001, respectivamente). Não houve diferença entre o GOAII e GOAIII para nenhuma das variáveis (p ≥ 0.05). Em conjunto, os resultados sugerem uma adaptação neuromuscular presente nos indivíduos com OA do joelho, necessidade de intervenção desde os graus iniciais da doença e destacam a importância de levar em conta diferentes formas de avaliação da função física.

Introdução: A osteoartrite (OA) é uma doença degenerativa que atinge as articulações sinoviais, sendo uma das causas mais comuns dalimitação funcional. Objetivo: Investigar os efeitos do Laser de Baixa Intensidade (LBI) associado a exercícios na dor, amplitude de movimento, força muscular, funcionalidade, mobilidade e qualidade de vida de pacientes com osteoartrite de joelhos. Métodos: Quarenta e seis indivíduosde ambos os sexos, entre 50 e 75 anos, com OA de joelho (graus 2-4), foram randomizados em dois grupos: Grupo Laser- LBI ativo com dose de 3J mais exercícios e Grupo Placebo- LBI placebo e exercícios. A avaliação foi realizada antes de iniciar o tratamento (AV1), três semanas após o tratamento com o laser (AV2), oito semanas após o tratamento com exercícios (AV3), três e seis meses após o término do tratamento (AV4 e AV5). A dor foi avaliada com a Escala Visual Analógica (EVA), amplitude de movimento com goniômetro universal, força muscular com dinamômetro, funcionalidade com a Escala AlgofuncionalLequesne, a mobilidade pela TimedGetUpandGo(TGUG) e qualidade de vida com a Western Ontario andMcMasterUniversitiesOsteoarthritis (WOMAC). A intervenção foi realizada três vezes por semana durante 11 semanas, sendo que nas três primeiras foi aplicado o laser e nas demais somente os exercícios. Os dados foram analisados com os testes não paramétricos de Friedman e Mann- Whitney, com nível de significância de 5%.Resultados: Na análise intragrupo, o Grupo Laser apresentou melhora significativa na dor (p<0,001), amplitude de movimento (p=0,032), funcionalidade (p=0,003), mobilidade (p<0,001), WOM-dor (p=0,001), WOM-função (p<0,001) e WOM-total (p<0,001), enquanto o Grupo Placebo apresentou diferença significativa na mobilidade (p=0,013), WOM-função (p=0,017) e WOM-total (p=0,02). Na análise intergrupo foi constatada diferença significativa entre os grupos na AV2 para as variáveis WOM-função (p=0,01) e WOM-total (p=0,02) e na AV3 para as variáveis WOM-dor (p<0,01), WOM-função (p=0,01) e WOM-total (p=0,02), indicando melhora no Grupo Laser. Neste, também foi observado maior ganho relativo em quase todas as variáveis ao longo das avaliações, quando comparado ao Grupo Placebo. Conclusão:A Laserterapia de Baixa Intensidade associada a um programa de exercícios mostra-se efetiva na melhora da dor, funcionalidade, amplitude de movimento e qualidade de vida de pacientes com osteoartrite de joelhos
Introduction:Osteoarthritis(OA) is adegenerative diseasethat affectssynovial joints, one of the most common causesoffunctional limitation. Objectives:To estimate the effects of Low-Level Laser Therapy (LLLT),in combination with a program of exercises on pain, range of motion, muscular strength, functionality, mobility and quality of life in patients with osteoarthritis of the knee. Methods: Sample consisted of 40 participants of both genders, ages ranging from 50 to 75 years. All had level 2-4 OA. Participants were randomized into two groups: Laser Group(low-level laser, 3 Joules dose and exercises), and Placebo Group (placebo-laser and exercises). Pain was assessed using visual analogical scale (VAS), range of motion with the universal goniometer, muscular strength using a dynamometer, functionality using the LequesneQuestionnaire, mobility using Timed Get Up and Go (TGUG)and quality using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) of life in five moments: (T1) baseline, (T2) after at the end of laser therapy (3rd week), (T3) after the end of exercises (11th week), (T4) three and six monthsafter thetreatment (T4 and T5). The intervention was performedduring three weeks; patients received laser therapy or placebo three times a week; for the remaining 8 weeks, all patients exercised three times a week.Data was assessed through Friedman and Mann-Whitney non-parametrical tests, with 5% significance. Results:In theintragroup analysis, the Laser Groupshowed significant improvementin pain (p<0.001), range of motion (p=0.032), functionality (p=0.003), mobility (p<0.001), WOM-pain (p=0.001), WOM-function (p<0.001) and WOM-total (p<0.001), while the Placebo Group showeda significant difference inmobility (p=0.013), WOM-function (p=0.017) andWOM-total (p=0.02). In the analysisbetween groupsthere wassignificant differenceinAV2between groupsfor variables WOM-function (p=0.01) andWOM-total (p=0.02) and in AV3for variablesWOM-pain (p<0.01), WOM-function (p=0.01) andWOM-total (p=0.02), indicating an improvement inthe Laser Group. Therewas alsoobserved a greaterrelative gainin almostall variablesthroughout the evaluations, when comparedto the Placebo Group.Conclusion: TheLow- Level Laser Therapycombined withanexercise program iseffective in improvingpain, function, range of motion and qualityof life of patientswith knee osteoarthritis

Objetivo: Investigar o efeito da laserterapia de baixa intensidade (LBI) e do alongamento estático, combinados ou não, em pessoas com osteoartrite de joelho (OAJ). Método: Foram randomizados 145 sujeitos de 50 a 75 anos com OAJ em cinco grupos de intervenção (n=29 cada): Laserativo+Along; Laserplacebo+Along; Along; Laserativo e controle. A laserterapia (GaAs; 904nm; 40mW; 3J/ponto; 27J/joelho) consistiu de nove sessões nos grupos de terapia combinada e 24 quando monoterapia. O alongamento foi composto por sete exercícios repetidos por 24 sessões. O controle recebeu uma cartilha educacional. A frequência de tratamento foi de 3x/sem. A variável primária foi a intensidade da dor medida pela Escala Visual Analógica e as variáveis secundárias incluídas foram domínios dor, função, rigidez e escore total do questionário Western Ontario and McMaster Universities Arthritis Index (WOMAC), funcionalidade avaliado pelo Lequesne, mobilidade pelo Timed Up and Go, amplitude de movimento do joelho (ADMJ) pela goniometria e encurtamento de isquiotibiais (IQT) pelo ângulo poplíteo. O nível de significância foi de ?=0,05. Resultados: Nos grupos de terapia combinada, não foi observada diferença entre o laser ativo e placebo (p>0,05). Ao final do estudo, os grupos demonstraram, em média, ganho relativo significativo na dor durante AVDs (50%), WOMAC total (39%), funcionalidade (30%) e mobilidade (20%) em comparação ao controle (p < 0,001). Houve melhora de 43% no encurtamento de IQT e de 9% no ganho de ADMJ nos grupos de terapia combinada em relação ao controle (p < 0,001 e p=0,02, respectivamente). Conclusão: LBI e alongamento estático, quando isolados, foram efetivos na melhora da dor, funcionalidade, mobilidade e nos domínios dor, função e escore total do WOMAC. A LBI nos grupos de terapia combinada não foi superior à aplicação placebo. Portanto, não devemos desconsiderar a contribuição do efeito placebo no resultado do tratamento isolado. A LBI combinada ao alongamento não promoveu benefícios adicionais em relação ao alongamento de forma isolada
Objective: To investigate the effect of low-level laser therapy (LLLT) and static stretching, in combination and as monotherapy, in people with knee osteoarthritis (KOA). Methods: 145 people aged 50-75 years with KOA were randomly allocated to five groups (each n=29): Laseractive+Stretch, Laserplacebo+Stretch, Stretch, Laseractive and control. The laser therapy (GaAs; 904nm; 40mW; 3J/point; 27J/knee) consisted of nine sessions in the combined treatment groups and 24 when used as monotherapy. Stretching consisted of seven exercises repeated for 24 sessions. The control group received an educational booklet. Treatment frequency was 3 times/week. The primary outcome was pain intensity measured by Visual Analogue Scale and the secondary outcomes included pain, function and stiffness\' domains and total score of Western Ontario and McMaster Universities Arthritis Index (WOMAC), function assessed by Lequesne, mobility by Timed Up and Go, knee range of motion (KROM) by goniometry and hamstring shortening by popliteal angle. Results: In the combined treatment groups, there was no difference between the laser active and placebo (p > 0.05). At the end of the study, the treatment groups demonstrated, on average, a significant relative gain in pain (50%), total WOMAC (39%), function (30%) and mobility (20%) when compared to control (p < .001). For the combined treatment groups there was a 43% improvement in hamstring shortening (p <.001) and 9% improvement in KROM (p=0.02) when compared to control group. Conclusion: LLLT and stretching exercises, as monotherapy, were effective in reducing pain and improving function, mobility and the domains pain and function as well as the total score of WOMAC. The LLLT in the combined groups was not superior to the placebo application. Thus, we should not discard the contribution of the placebo effect in the result of the LLLT as monotherapy. The LLLT combined with stretching did not promote additional benefits compared to stretching alone

Le but de ce travail était de déterminer l’effet de déviations planaires tridimensionnelles in vitro du fémur sur l’évolution des variables biomécaniques de l’articulation du genou lors d’un mouvement de flexion de celle-ci. La cinématique du compartiment fémoro-tibial, les bras de levier de certains muscles de la cuisse ainsi que l’évolution du régime de contrainte de l’os sous-glénoïdien ont été étudiés.

Du point de vue de l’étude du régime de contrainte de l’os sous-glénoïdien, une méthodologie originale utilisant la jauge de contrainte enrobée d’une résine époxyde a été développée. Un électrogoniomètre à 6 DDL ainsi que 6 LVDT ont permis de mesurer respectivement la cinématique fémoro-tibiale et la course tendineuse des principaux muscles de la cuisse.

Trois designs expérimentaux ont été entrepris sur un total de 15 spécimens. Ces différents designs ont permis de réaliser des déviations de l’extrémité distale du fémur selon les plans transversal, frontal et sagittal suite à une ostéotomie fémorale localisée 10 cm au dessus de l’interligne articulaire fémoro-tibiale. Les variables biomécaniques ont été enregistrées avant section osseuse et suite à l’application de déviations par step de 6° compris entre des angulations de -18° à 18° selon les différents plans anatomiques. Les données des variables biomécaniques ont été obtenues lors du mouvement de flexion du genou.

Même si nous sommes conscients des limitations de nos travaux expérimentaux, les résultats de ceux-ci nous permettent d’apporter une réflexion nouvelle par rapport aux conséquences sur l’articulation du genou d’un désalignement du membre inférieur en intégrant la notion des tissus péri-articulaires (capsulaire, ligamentaire et musculaire) généralement absents des modèles théoriques employés.

Doctorat en Sciences biomédicales et pharmaceutiques
info:eu-repo/semantics/nonPublished

L'objectif de ce travail était de déterminer i) l'influence du niveau de force absolue sur la durée du temps de maintien, et les altérations neuromusculaires subséquentes chez un même individu à l'issue d'un exercice réalisé à la même intensité relative, avec un ou deux membres ; ii) l'influence de la commande nerveuse sur la capacité de production de force de chacun des muscles extenseurs du genou lors de contractions unilatérales (UL) vs. bilatérales (BL); iii) l'évolution des mécanismes d'activation pendant une série de contractions sous-maximales évoquées par électromyostimulation (EMS).Les résultats de la première étude confirment que le temps limite est dépendant du niveau de force absolu pour un même individu, la durée de la contraction en UL étant 20% plus longue qu'en BL. De plus, une corrélation a été trouvée entre la force lors d'une contraction maximale volontaire (CMV) et le temps limite en UL et BL. Toutefois, d'autres mécanismes semblent être également mis en jeu, car dans un cas les mécanismes sont d'origine nerveux et musculaire (UL), alors que dans l'autre cas les mécanismes sont seulement nerveux (BL). Les résultats de la deuxième étude montrent que la force maximale développée lors d'une contraction BL est inférieure à la somme des forces des contractions UL (i.e. présence d'un déficit bilatéral). Les temps d'apparition des pics de force lors des CMV de chacune des jambes ne sont pas différents de celui de la CMV BL, mais la force développée au cours de celle-ci est inférieure à la somme des CMV de chacune des jambes durant la CMV BL, c'est-à-dire à la force maximale produite par chacune des jambes lors de la CMV BL. Néanmoins, aucune différence d'activité EMG, d'amplitude d'onde M, de doublet et de niveau d'activation n'a été observée entre les conditions UL et BL. Les résultats de la troisième étude montrent que l'estimation de la commande descendante, par la technique de la secousse surimposée, lors d'un effort sous-maximal fatigant présente des biais méthodologiques. Toutefois, l'estimation des mécanismes nerveux par les deux méthodes classiques (niveau d'activation volontaire (NAV) et ratio d'activation centrale (CAR)) reste néanmoins pertinente pendant des contractions maximales volontaires. L'ensemble de nos travaux met en évidence l'intervention de mécanismes d'origine nerveux différents entre les contractions UL et BL

Introducción. El objetivo del presente estudio es determinar si existe correlación entre los conocimientos sobre las consecuencias de la obesidad y el grado de actividad física de las personas. Métodos. Se realizó un estudio transversal analítico durante los años 2013 y 2014. Participaron 215 alumnos de pregrado seleccionados por conveniencia no relacionados a carreras del campo de la salud en una universidad de Lima, Perú. Se evaluó el grado de actividad física utilizando el International Physical Activity Questionnaire (IPAQ) y el nivel de conocimientos sobre consecuencias de la obesidad utilizando la escala Obesity Risk Knowledge-10 (ORK-10). También, se consignó las fuentes de información de donde obtuvieron el conocimiento para responder dicho cuestionario. Resultados. La mediana de edad fue 20 (rango intercuartílico=4) y 63% eran mujeres. De acuerdo al IPAQ, 53,9% realizaban actividad física alta, 35,4%, moderada y 10,7%, leve. Se encontró una correlación muy baja (rs=0,06) entre el puntaje del ORK-10 y la cantidad de equivalentes metabólicos/minuto consumidos por semana, pero no era significativa (p=0,38). Las personas informadas por medios de comunicación y por personal de salud obtuvieron mayores puntajes en el ORK- 10 que quienes se informaron por otras vías (p<0,05). Conclusiones. La correlación entre los conocimientos sobre consecuencias de la obesidad y el grado de actividad física es muy baja. Es necesario utilizar enfoques multidisciplinarios que incluyan todos los determinantes de la realización de actividad física para poder lograr cambios en la conducta de la población.

This doctoral submission comprises two volumes and is entitled ‘Notated and Implied Piano Pedalling c.1780–1830’. Volume One consists of six CDs and contains performances of works composed between 1781 and 1832, recorded on historical instruments housed in the collection at Cornell University, Ithaca, NY. The repertoire includes works by C.P.E. Bach, Mozart, Haydn, Beethoven, Hyacinthe Jadin, Clementi, Dussek, Field, Voří!ek, Schubert, Felix Mendelssohn, Chopin, Robert Schumann and Liszt. The works are performed on seven different pianos, six replicas and one original instrument, dating from 1780–1827. Volume Two is the Exegesis. While the history of pedal mechanisms and various forms of pedal notation have already been expertly researched and documented, it is often difficult to understand the composer’s intentions with regard to the appropriate use of the damper pedal in performance, especially in works from the Classical period. The Exegesis examines the documentation of damper pedal techniques from c.1780–1830 and articulates decisions made with regard to the use of pedal in the performance of this repertoire on historical instruments. The research is performance based, and draws heavily on primary sources and existing scholarship. Comparisons are made between the English, French and Viennese instruments and the schools of piano playing that developed, and the repertoire has been selected to highlight the growing significance of pedalling as an integral part of the performance. The primary outcome of this research resides in the recorded performances themselves. They represent the first fully detailed investigation of the various types of pedalling found in a comprehensive range of repertoire and documented through recordings made on the appropriate instruments.
Thesis (Ph.D.) -- University of Adelaide, Elder Conservatorium of Music, 2011

碩士
國立成功大學
醫學工程學系
81
The purpose of this study was to evaluate the influence of two currently available rehabilitative knee braces on knee motion and to evaluate their ability of protection against the postoperative tissue. By the theory of Euler angle and finite helical axis and the use of 3-D motion analysis system,we could measure all six degrees of freedom (DOF) of knee motion during level walking. The experimental group consisted of seven left ACL-deficient patients. Six of them had received ligament reconstruction and the other one had received partial meniscectomy only because of partial tear of the ACL. Six normal subjects comprised the control group and all of them were free of any pathological change on the back or lower limbs that might have an effect of their gait. Four test conditions were investigated:(1) injured limb, (2) control limb, (3) injured limb with ROM splint, (4)injured limb with 4-Point brace. There were no apparent differences in the graphical patterns and amplitude values for any of the six DOF of knee movement between the two unbraced conditions. Among the three rotational angles,the change in knee flexion/extension was the largest and that in knee abduction/adduction was the smallest one. Among the three translational components,the change in the anterior/posterior translation was the largest and that in the medial/lateral translation was the smallest. We could note that the graphical patterns of five of the parameters(DOF)all had swing phase peaks that appeared time related to flexion/ extension. Both brace applications were shown to significantly reduce the values of all six parameters of knee motion ,which seemed to be more marked when ROM splint was used,but no noticeable changes could be found in the graphical patterns ,walking velocity and percentage of left or right stance phase in the gait cycle.

碩士
國立成功大學
電腦與通信工程研究所
96
In radiography treatment planning, MR image is one of the most widely-used radiographic techniques. Many athletes would take MR images once they get hurt in the game. Doctors can obtain detail information around the patient’s joints, organs, or muscle by observing the MR images. All the time, people suffer from the anterior knee pain due to aging or degeneracy. Doctors do numbers of examinations hoping to find out the possible reasons causing the knee pain. In tradition, static MR images are often used to observe the situation of the soft tissue adhering to the femur, patella, and tibia. Recently, kinetic observation techniques are also developed. Observing the kinetic changes of the tissues can help even more in perceiving the reason why pain happens. In our research, we observe the interaction between the femur and patella during the bending process of the knee. To quantify the observed interaction, doctors set some landmark points on the boundaries of the femur and patella, which determine the calculation of two defined angles. The angle variation curves collected from normal knees can construct a normal range. The variation curve comes from abnormal knee exceeds the normal range. By the statistics of the variation of these angles calculated, we can help the doctor examine patient’s knee condition. But it takes lots of time to locate the landmarks and to calculate the corresponding angles manually. Here in this thesis, we propose a system combining neural network techniques and level set evolution algorithm to segment the femur and patella, locate landmarks and calculate the angles.

碩士
國立臺灣大學
醫學工程學研究所
94
Osteoarthritis (OA) is one of the common degenerative joint diseases and the prevalence has been increased in the population. The knee is most involved joint of the lower extremity despite the hip and ankle joint may be involved, too. Degenerative changes of knee OA are commonly observed in the medial compartment than in the lateral compartment of the knee. In the present study used the 3-D motion analysis system to acquire the kinematics of the lower extremity of the subjects with bilateral medial knee OA and the forceplates to obtain the ground reaction force data. The kinetics of the normal elderly were be estimated firstly and investigated the biomechanics of the lower extremities in mild knee OA, severe knee OA and normal elderly during level walking. Our results suggested that knee adduction angle of both mild and severe knee OA subjects increased due to the deformation of medial knee of knee OA. The hip joint and ankle joint increased their abduction and adduction to compensate this knee excessive adduction. The mild and severe knee OA subjects both increased hip abductor moment. But only the knee abductor moment of the mild knee OA subjects had no different significantly with the knee abductor moment of normal elderly during stance phase. The concept of global leg stiffness was used to investigate the relationship between ground reaction force and change of leg length. Our result suggested that the global leg stiffness of the severe knee OA subjects represented bigger stiffness than normal elderly significantly during midstance phase and might be due to decrease the trajectory change of COM at vertical direction.

碩士
國立臺灣大學
職能治療研究所
100
Medial knee osteoarthritis (MKOA), the most common joint disease among the middle-aged adults and the elderly, seriously affects the function of daily living. The patients tend to adopt toe-out gait to reduce knee joint pain. Laterally-wedged insole may reduce knee joint moments and joint pain through laterally-shifting COP and decreasing lever arm between knee joint center and ground reaction force; furthermore, the arch support might enhance these effects. The aims of the current study were investigate that the differences in effect of reducing knee abductor moments in patients with mild-to-moderate MKOA between hind-laterally-wedged and fore-medially-wedged insole with arch support (HFW), the new-designed insole for increasing foot progression angle, and full-length laterally-wedged insole with arch support (FLW) through motion analysis techniques. The results indicated that FLW would reduce peak knee abductor moment through increasing foot progression angle and lateral-shifted COP. Also, it was helpful to the stability. Furthermore, ankle invertor moments were increased. In contrast, although increasing foot progression angle, HFW would increase peak knee abductor moment through increased lever arm between knee joint center and ground reaction force due to failing to make COP lateral-shifted induced by medial wedge. Therefore, compared with HFW, it is recommended that FLW is suitable for patients with mild-to-moderate MKOA but with cautioned about increased ankle loading.

A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Doctor of Philosophy Johannesburg, 2019
Background Evidence shows that the global prevalence of knee osteoarthritis (KOA) is high, with limited data on the management of the disease. The use of novel modalities to treat the condition is low due to poor understanding of their clinical effects. Therefore there are gaps in the knowledge on the prevalence and treatment modalities for patients diagnosed with KOA. Aim: The aim was threefold; (i) to determine the prevalence of KOA in South Africa aged 45yrs-75yrs; (ii) to determine the current management of KOA; and (iii) to determine the effect of Low Level Laser therapy (LLLT) on the structural and functional components related to KOA in a South African cohort, aged 45-75yrs. Methods: The methodology will be discussed in terms of the three specified objectives; (i) prevalence study data - a self-reported data collection sheet listing 19 relevant ICD 10 codes; completed by South African medical aid providers. (ii) The treatment paradigm study, which encompassed a deemed KOA management paradigm validated questionnaire sent electronically to 742 general, specialist and allied practitioners, identifying the incidence of KOA and deemed efficacy and compliance of various management tool. These practitioners were identified from a database of medical and allied practitioners in both the private and public sector of South Africa. The questionnaire consisted of two close ended questions indicating the incidence of KOA and bilateral KOA patients consulted at the practice; one choice question indicating the most suggested mode of therapy from a choice of pharmaceutical, surgical, homeopathic, physical exercise therapy and LLLT and finally, 3 Likert type scale questions on the deemed efficacy and compliance of the modes of therapy as stated above. (iii) The intervention study which was a randomized controlled trial (RCT) utilizing pre marked questionnaire sheets on 111 participants. Participants were randomized into one of three intervention groups; (1) exercise group (n=39), (2) LLLT group (n=40), and (3) combined exercise-LLLT group (n=32). Data on knee circumference, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee range of motion (ROM) and the one minute timed sit–to-stand test was used. These tests were done at four time points: (T1) baseline, (T2) post-12 session intervention, (T3) one month post intervention and (T4) three months post intervention. Results: The results will be discussed in terms of the three specified objectives; (i) The prevalence of KOA was reported as 17.5%, 28.0% and 38.5% in a South African population over 45yrs. (ii) Four hundred and thirteen clinicians completed the questionnaire, reporting a KOA patient intake of 53%. Pharmacology (36.3%) and physical exercise (35.3%) was the most common management protocols compared to surgical intervention, homeopathy and LLLT. Pharmacotherapy (73%) and physical exercise (92%) were observed as effective treatments. Seventy five percent of all practitioners responded with an answer of “no comment” when asked the deemed efficacy of LLLT. Practitioners viewed patients with KOA to have low compliance with physical exercise and pharmacotherapy (iii) the participant demographic included 86 females and 25 males, the average age reported was 61.8 ± 5.6yrs. At 12-week follow-up, knee circumference decreased significantly in all groups (p<0.05), the effect was highest in the LLLT group. All groups experienced improvements in the WOMAC pain scale, but the LLLT group showed the greatest improvement (p<0.05). Knee ROM values improved significantly across all three groups; however, the effect of the intervention was most significant (p<0.005) in the combined LLLT-exercise group. Physical functionality scores showed a greater improvement in the combined LLLTexercise group at all three data collection points. Conclusions: The estimated prevalence of KOA is 17-35% based on data collected from a specified South African cohort. Pharmacotherapy is a commonly suggested KOA management mode, whilst clinicians view physical exercise as effective. LLLT was not a known tool for the treatment of KOA. In addition to the improved functionality observed, pain was lowered significantly, particularly in the combined exercise-LLLT group. Study results have shown that LLLT used in isolation or in combination with physical exercise is an effective management tool.
MT 2020

博士
國立成功大學
醫學工程研究所碩博士班
90
Amputations not only caused the loss of limb but also accompanied with inconvenience of physical mobility for the patients. The newly developed prosthetic designs make possible the replacement of amputated limbs, thus greatly improve the body mobility and life independence of the patients. However, the real manifestation of the prosthetic gait and the discrepancy between the prosthetic and normal gaits needs further investigations, especially the effects of walking speeds and on walking surfaces. In Taiwan, the sockets of most prosthetic devices are made of resin. The ventilation of this type of socket is poor. In the summer time, the air temperature in Taiwan can rise to 34℃ or higher at humidity levels of 60 % or higher, the kind of weather called muggy or steamy. Heavy sweating is a typical condition in such a climate. For amputees, heavy sweating is a major problem since the socket becomes wet and fill with sweat. Consequently, prosthetic socket devices have a tendency to come loose or fall off during locomotion. Moreover, the constant moisture can cause skin complications such as eczema, blisters, dermatitis, ulcers or infection in the residual limb. Some amputees may have to be hospitalized because of these complications. Some patients even require further amputation. However, to date, there are very few studies in this subject. In last decades many researchers have tried to improve socket material. Although these new prosthesis materials can improve the feeling of comfort, they cannot solve the sweating problem. Therefore it is very important to develop a socket system to facilitate ventilation, cooling and the elimination of sweat. In our study a new prosthesis design equipped with an electric automatic air ventilation system have been tested and the sweat due to high temperature and humidity inside the socket can be reduced. The total AVS, including fan and battery, weighted only about 95g. New prosthetic materials and designs have broadened the range of availability in artificial feet. As a result, it is becoming more difficult for prosthetists and clinic physicians to select the best foot for individual amputees. Much of the research evaluating the dynamics of prosthetic feet is subjective. Quantitative research on below-knee amputee gait has been performed in the following areas : dynamic evaluation of the foot through motion analysis, evaluation of forces created by and acting on the body while wearing a prosthetic foot, and amputees’ energy consumption with various foot designs The purposes of this thesis are to scientifically measure the dynamic gait characteristics of the amputee by using motion analysis and to measure the energy consumption for the below-knee amputee when wearing the SACH, single-axis and multiple-axis prosthetic feet on ground, slopes and stairs. First, the walking condition for patient with below-knee amputees is analyzed. Twenty patients who severed the shank are selected and divide into two groups to wear three different types of prosthetic foot : SACH foot (traditional type), single-axis foot, and multiple-axis foot, These patients on ground, slopes (5, 10 and 16 degrees) and stairs. These research results provide an objective for clinic physicians to select the proper type of prosthetic feet for the individual patient. Second, the energy consumption of three different types of prosthetic foot is conducted for the same twenty subjects. These subjects walk at speeds of 1 mile per hour, 1.5 mile per hour and 2 mile per hour on slope of 0, 3 and 6 degrees. Energy consumption is detected while walking by metabolic measurement cart and heavy-duty treadmill. Subjective results are additionally determined via questionnaire after testing. A survey is conducted to determine the comfort level of prosthetic foot with patients after the experiment. The records provide a objective and subjective records for physician’s prescription for amputees.

碩士
中國醫藥大學
醫學研究所碩士班
94
Objective： The knee joints are most frequently involved degenerative arthritis for the patients in the older society. The patients with knee osteoarthritis (OA) may have the following complaints： knee joint pain, stiffness of the knee joint, limited range of motion (ROM), wasting of the lower limb muscle, and decreased walking speed. These symptoms can decrease the performance of some activities of daily life obviously and followed a potential dangerousness. This research attempts to explain the changes of the kinetics and kinematics of the lower limbs while knee OA patients performing level walking. Lateral-wedge insole has been used to treat knee OA, but the biomechanical nature has not been well studied, and its side effect is unclear. In this study, the influence and the side-effect of the lateral-wedge insole will be investigated. Finally, we expected to apply the insole clinically to slow the degenerative process of the knee joint, to maintain life quality of the elder, and to reduce the medical costs （medicine, physical therapy, and surgery）. Methods： Twelve outpatients (eight female and four male, mean age, 70.7; standard deviation, 5.9) with knee OA involving the medial compartment were prospectively treated with an inserted wedged insole with lateral elevation of 12 mm for twelve weeks. The visual analog scale (VAS) scores for subjective knee pain and the remission score of the Lequesne index of severity for knee OA were assessed before and 3-months after treatment. Standing radiographs with and without insoles were used to analyze the femorotibial, talocalcaneal and talar tilt angles at baseline, immediate and final assessment. Three-dimensional motion analysis system and force platform were used to calculate kinematic and kinetic gait parameters in level walking, including spatiotemporal parameters, range of motion (in lower limbs, trunk and head), forces and moments in hip, knee and ankle joints and sway range of the center of gravity. Difference in all parameters between baseline assessments and immediate or final assessments were compared using a paired t test. Results： The 12 patients who completed the 12-weeks study were evaluated. Participants wearing the inserted lateral wedged insole had significantly improved VAS pain score and remission score of the Lequesne index (P<0.0001). No significant differences were found in femorotibial, talocalcaneal and talar tilt angles while comparison among values at baseline, immediate and 3-months after treatment. Patients using a lateral wedged insole had an immediate and significant increase in step width, heel maximum height, and swing phase time, but reduced stance phase of the gait cycle as compared with the baseline data. Beside, increased ROM in ankle inversion-eversion and decreased ankle plantar-dorsiflexion ROM were found. They also generated more ankle invertor moment, internal rotator moment, knee extensor moment, and less ankle plantar flexor moment, ankle evertor moment and hip flexor and abductor moment. Conclusion： The inserted lateral wedged insole may induce symptomatic relief in patients with medial compartment knee OA, but not make any significant changes in the radiographs taken in the static position. The therapeutic effects were further evaluated during the dynamic phase with motion analysis system and force plates to determine the kinematic & kinetic effects. Longer-term clinical follow up should be addressed in future studies.