STEPS FORWARD IN HUMAN PERFORMANCE STUDIES

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by Nathaniel Ordway, MS, PE, Suchita Kulkarni-Lambore, PhD, PT, and Ronald Seymour, PhD, PT

Background on IHP

The Institute for Human Performance, Rehabilitation, and Biomedical Research (IHP) officially opened its doors in January 2000. The $50 million, 200,000 square foot facility is part of the State University of New York Upstate Medical University (SUNY Upstate) in Syracuse, New York, USA. The four storey structure features two storeys of clinical and applied research space and two storeys of basic science laboratories. The concept of the IHP is to bring researchers, clinicians and patients under one roof to lessen the limitations of aging, disease, and disability, and extend the reaches of human performance. Key features of the clinical and applied research space include a four lane, eleven lap per mile indoor track, a twenty-five metre, temperature controlled pool with an adjustable hydraulic floor, a SwimEx aquatherapy pool, a 1.5 tesla MRI, a radiographic suite with radiostereometric analysis capabilities, and motion analysis capabilities.

Motion Analysis at IHP

Motion analysis capabilities at IHP were designed with flexibility in mind. There are two main areas to conduct studies - a clinical motion analysis lab on the first floor and the applied research area on the second floor (track and pool). The equipment available includes a Vicon 512 motion analysis system with 12 M series cameras (6 in the track area and 6 in the clinical motion analysis lab), 10 Kistler force platforms (6 in the track area and 4 in the clinical motion analysis lab), a Cosmed metabolic cart (portable and stand alone), and a Noraxon EMG system (telemetry for the track area and hard wired for the clinical motion analysis lab). The focus of these facilities
will be on applied and clinical research studies, although clinical patients are analyzed and referred as part of a commitment to the Children's Miracle Network of Central New York. In addition to clinical
and research purposes, the motion analysis capabilities are important teaching tools for students at SUNY Upstate and Syracuse University.
Some recent and ongoing projects are described overleaf.

Figure 2: Layout of Second Floor

Kinematic Gait Analysis of an Individual with Cerebral Palsy Before and After Hippotherapy

There are different ways to determine how successful the various treatments are at meeting the functional goals of ambulatory children with cerebral palsy (CP). Computerized motion analysis has allowed for an improved understanding of the physiology of gait and has also proven to be successful in evaluating individuals with conditions such as CP, before and after interventions. When reviewing the literature, few scientific studies were found that have utilized a quantitative method of computerized gait analysis to measure the effects and benefits of hippotherapy on the various aspects of ambulation in individuals with CP. The purpose of this investigation was to document changes in the kinematic gait analysis in individuals with CP after eight sessions of hippotherapy.
Gait analysis was performed on the subject before and after receiving eight sessions of hippotherapy. Data collected were used to calculate joint angles at the pelvis, hip, knee and ankles as well as to calculate the temporal data including step length, stride length, cycle time, velocity, cadence, and % of stance and swing phase. A comparison was made between the pre- and post- intervention gait analyses data in order to document any changes in the kinematic parameters of the subject's gait.
The post hippotherapy gait analysis demonstrated significant changes in the joint angles of the right hip in the sagittal and coronal plane as well at the right knee and ankle joint angles in the sagittal plane. Pelvic tilt, rotation and obliquity angles were also closer to the normal values in the post hippotherapy analysis. Overall, eight hippotherapy sessions administered over a period of 5 weeks demonstrated an improvement in the kinematic parameters of gait in a subject with right hemiparesis as measured by a computerized gait analysis system.
This study opens the door for further research concerning the benefits of therapeutic horseback riding on the gait of individuals with cerebral palsy using computerized gait analysis. Kinematic gait analysis may be a useful outcome measure to evaluate the effects of hippotherapy in children with conditions such as CP. The study will be continued with a larger sample size so definitive statements can be made regarding the benefits of therapeutic horseback riding on children with CP.

Figure 3: Some of the faculty and staff involved in motion analysis studies at IHP

Functional Analysis Following Muscle Excision During Soft Tissue Sarcoma (STS) Surgery and Radiation

Surgical procedures for soft tissue sarcomas vary depending on factors such as the type, location and grade of tumor. In the lower extremity, the surgeon may choose to perform a local excision, a wide margin excision, a compartmental resection, or in extreme cases, a limb amputation. The ability to utilize a limb after surgery and radiation therapy for STS has a direct effect on patients' functional abilities including ambulation. It has been suggested that the most significant functional impairment following this procedure is mobility, which includes ambulation.
The present study was undertaken to establish a treatment protocol for patients with soft tissue sarcoma based on the functional outcome of the various treatment combinations available e.g. surgery alone, surgery with pre-operative radiation therapy and surgery with post-operative radiation. On reviewing the literature it was found that there was controversy among surgeons about the various treatments. The efficacy of the treatment has not been objectively measured. There have been no documented studies investigating functional status and ambulation for patients who have undergone limb-sparing surgery for soft tissue sarcoma. The results of this preliminary study will justify the need for continuation of the study by recruiting more patients thereby arriving at a decision about the efficacy of the different combinations. Also if one treatment combination is found to yield better functional outcomes, the results may help the oncologists and surgeons in clinical decision making.

Figure 4: Students analyse data following a motion analysis session in the track area on the Second Floor

Functional Analysis of a Computerized Leg (C-Leg)

Few studies have been performed that compare the conventional hydraulic knee with the new Otto Bock 3C100. The 3C100 C leg system has an onboard sensor that can adapt to an individual's gait. The purpose of this study was to compare the objective gait analysis (kinematics, kinetics, and EMG) and physiological parameters (oxygen consumption) between hydraulic prostheses and the C-Leg in a group of higher functioning transfemoral amputees (Grade 4). Two speeds were investigated, a natural and fast pace.
Preliminary results show there was an increase in stance time on the intact limb and an increase in step length with hydraulic prosthesis compared to the C leg at a comfortable speed. In addition, all subjects noted increased security and safety with the C leg specifically in regards to the frequency of falling.
Once completed, this comparison will help to determine whether a computerized prosthesis will allow for an increase in functional mobility in contrast to traditional hydraulic prostheses. In addition, this analysis will provide justification for the approval of the C leg to third party payers.

Other Motion Analysis Studies

A variety of other sports performance motions have been analyzed to date at the IHP. These motions include a vertical jump analysis of female collegiate varsity volleyball athletes, a recreational rollerblading exercise, and a drop landing of a snowboarder.

Summary

The Institute for Human Performance represents an evolution of a mission. That mission is best explained by a plaque located in the entrance atrium of IHP. The plaque is titled Expanding Horizons and states "The skylit structure of IHP represents the combined efforts of many people dedicated to one vision - defining and dissolving the current limits of human performance. Researchers, practitioners, and educators work together to cast light on the complexities of our physical existence." Keeping this mission in mind, the team of individuals associated with the motion analysis unit will continue to analyze a diversity of problems and work towards solutions.