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The Effects of Simulated Muscle Weakness on Lower Extremity Muscle Function During

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The Effects of Simulated Muscle Weakness on Lower Extremity Muscle Function During The Effects of Simulated Muscle Weakness on Lower Extremity Muscle Function during Gait in Healthy, Older Subjects Thesis Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Amanda Nicole Strube, B.S. Graduate Program in Mechanical Engineering The Ohio State University 2012 Thesis Committee: Robert A. Siston, Advisor Laura C. Schmitt Copyright by Amanda Nicole Strube 2012 Abstract As the human body ages, key physiological changes take place that affect a person’s ability to perform daily functional tasks such as walking. Some of these changes associated with aging are loss of muscle mass (sarcopenia), muscle atrophy, and generalized muscle weakness. Studies have shown that muscle weakness in the lower extremity due to aging make it more difficult for older individuals to walk. Additionally, it is known that elderly adults have altered gait kinematics and kinetics, which is related to losses in lower extremity strength. However, no studies have looked at how lower extremity muscles contribute to gait in elderly adults and the effects of specific muscle group weakness on gait in elderly adults. Another contributor to increased difficulty walking is knee osteoarthritis. Osteoarthritis is a degenerative joint disease that most often affects the cartilage in joints. Some of the major side effects associated with knee osteoarthritis include pain, swelling, and loss of motion in the affected joint. One of the most disabling limitations associated with knee osteoarthritis is weakness in the quadriceps femoris muscle, which can in turn affect how an individual walks. Together, all of these side effects can contribute to decreased walking speed or increased difficulty walking. The quadriceps muscles are known to contribute to vertical support and slowing of the body in the early part of the stance phase during gait in healthy, young adults. However, it is unknown how lower ii extremity muscles in healthy, elderly adults contribute to a normal gait pattern. While weakened quadriceps have been strongly correlated with functional limitations in patients with knee osteoarthritis, the important cause-effect relationships between abnormal lower extremity muscle function and patient function remain unknown. This study has three purposes: to 1) characterize the gait kinematics and kinetics of healthy, older adults, 2) determine how individual lower extremity muscles produce force during gait in healthy, older subjects, and 3) determine how individual lower extremity muscles compensate for simulated lower extremity weakness in the stance phase of gait in healthy, older subjects. I have used OpenSim, an open source software package that can be used to generate inverse dynamic simulations, to simulate weakened quadriceps, plantarflexors, and gluteus muscles in gait trials from healthy, older subjects. As I systematically weakened the quadriceps to 70% and 40% of their original strength, the gluteus maximus increased its peak force by 2.3% and 10.9%, respectively. As I systematically weakened the plantarflexors to 70% and 40% of their original strength, the soleus, iliopsoas, knee flexors, hamstrings, and minor ankle plantarflexors increased their peak force in late stance and the gastrocnemius, rectus femoris, tibialis anterior, and minor ankle dorsiflexors decreased their peak force in late stance. Additionally, as the gluteus muscles were systematically weakened, the gluteus muscles, iliopsoas, and the hip adductors produced less force and the hip external rotators, sartorius, knee extensors, tensor fasciae latae, hamstrings, and minor ankle plantarflexors and dorsiflexors produced more force. iii The results from these simulations have determined which other lower extremity muscles naturally increase their contributions to force production during gait in response to weakened lower extremity muscles, which are characteristic of knee osteoarthritis and aging. This information can then be used to inform physical therapy programs to specifically target certain muscles to compensate for weak quadriceps muscles. iv Acknowledgements I would like to thank my advisor, Dr. Rob Siston. My first contact with Dr. Siston was two years ago in my senior capstone design class. During my time with Dr. Siston, I have learned what being an engineer means and I greatly appreciate that he continues to challenge me to achieve more each day. I am extremely grateful for his guidance, support, and confidence in me. I would also like to thank the other member of my Masters committee, Dr. Laura Schmitt. She has provided me much insight and guidance on this project. She has been an excellent resource and I know this project would have been much more difficult without her. She has also graciously provided me with data to analyze. Dr. Schmitt collected this data at the University of Delaware as part of her PhD dissertation and has always made herself available to me as I analyzed this data. Next, I would like to thank Julie Thompson and the rest of my NMBL labmates. Julie has shared all of her knowledge of OpenSim and Matlab coding with me and I am extremely grateful for all the help and guidance she has given me. Julie has been a great mentor to me during this project and has always been willing to sit down with me and work through any problems I may have had. I would also like to thank the rest of my NMBL labmates for all of the encouragement, advice, and laughs they have offered the past year. v I would like to thank my fiancé, Zachary Hinger, and my loving family and friends. Zack has been there with me every step of the way, always providing me with unconditional love and encouragement. Your words of wisdom have gotten me through many tough times. I would also like to thank my parents, Ronald and Patricia Strube, for all of their love and support. They have helped me grow into the person that I am today. Thank you for being there for me always and being the best role models I have. And to all of my family and friends, thank you for all of your love, support, and prayers. Finally, I would like to thank the First-Year Engineering Program at Ohio State. Not only has this program provided me with funding, but they have also helped me develop as an engineer and as a person the past six years. vi Vita June 2007………………………Mount Notre Dame High School 2011………………....................B.S. Mechanical Engineering, The Ohio State University 2011 to present……..………….First Year Engineering Graduate Teaching Associate Fields of Study Major Field: Mechanical Engineering vii Table of Contents Abstract ............................................................................................................................... ii Acknowledgements ............................................................................................................. v Vita .................................................................................................................................... vii Table of Contents ............................................................................................................. viii List of Tables ...................................................................................................................... x List of Figures ................................................................................................................... xii Chapter 1: Introduction ....................................................................................................... 1 1.1. Focus of Thesis..................................................................................................... 8 1.2. Significance of Research ...................................................................................... 9 1.3. Overview of Thesis ............................................................................................ 10 Chapter 2: Methods ........................................................................................................... 11 2.1. Data Collection ................................................................................................... 12 2.2. Data Analysis ..................................................................................................... 15 2.3. Subject Specific Simulations .............................................................................. 15 2.4. Lower Extremity Muscle Weakness .................................................................. 18 Chapter 3: Results ............................................................................................................. 21 3.1. Full Strength Model ........................................................................................... 21 3.2. Simulated Atrophy of Quadriceps Femoris ........................................................ 32 3.3. Simulated Atrophy of Plantarflexors ................................................................. 38 3.4. Simulated Atrophy of Gluteus Maximus, Medius, and Minimus ...................... 51 Chapter 4: Discussion ....................................................................................................... 65 4.1. Full Strength Model ........................................................................................... 65 4.2. Simulated Atrophy of Quadriceps Femoris ........................................................ 76 4.3. Simulated Atrophy of Plantarflexors ................................................................. 78 4.4. Simulated Atrophy of Gluteus
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