Which lower-limb joints compensate for destabilising energy during walking in humans

Maintaining stability during perturbed locomotion requires coordinated responses across multiple levels of organization (e.g., legs, joints, muscle-tendon units). However, current approaches to investigating such responses lack a "common currency" that is both shared across scales and can be directly related to perturbation demands. We used mechanical energetics to investigate the demands imposed on a leg by a transient increase in unilateral treadmill belt speed targeted to either early or late stance. We collected full body kinematics and kinetics from 7 healthy participants during 222 total perturbations. From across-subject means, we found early stance perturbations elicited no change in net work exchanged between the perturbed leg and the treadmill but net positive work at the overall leg level, and late stance perturbations elicited positive work at the leg/treadmill interface but no change in net work at the overall leg level. Across all perturbations, changes in ankle and knee work from steady state best reflected changes in overall leg work on the perturbed and contralateral sides, respectively. Broadening this paradigm to include joint level (vs. leg level) perturbations and including muscle-tendon unit mechanical energetics may reveal neuromechanical responses used in destabilizing environments which could inform design of balance-assisting devices and interventions.

PCV13 Vaccination of Adults against Pneumococcal Disease: What We Have Learned from the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA)

The Community-Acquired Pneumonia immunization Trial in Adults (CAPiTA) evaluated older adult pneumococcal vaccination and was one of the largest vaccine clinical trials ever conducted. Among older adults aged ≥65 years, the trial established 13-valent pneumococcal conjugate vaccine (PCV13) efficacy in preventing first episodes of bacteremic and nonbacteremic pneumococcal vaccine serotype (VT) community acquired pneumonia (CAP), and of vaccine serotype invasive pneumococcal disease (VT-IPD). Since the publication of the original trial results, 15 additional publications have extended the analyses. In this review, we summarize and integrate the full body of evidence generated by these studies, contextualize the results in light of their public health relevance, and discuss their implications for the assessment of current and future adult pneumococcal vaccination. This accumulating evidence has helped to better understand PCV13 efficacy, serotype-specific efficacy, efficacy in subgroups, the interpretation of immunogenicity data, and the public health value of adult PCV vaccination.

The Subadult Virtual Anthropology Database (SVAD): An Accessible Repository of Contemporary Subadult Reference Data

The Subadult Virtual Anthropology Database (SVAD) is the largest available repository of contemporary (2010–2019) subadult reference data from around the world. It is composed of data collected from individuals aged between birth and 22 years. Data were collected from skeletal remains (n = 43, Colombia) and medical images (n = 4848) generated at medical examiner’s offices in the United States (full-body Computed Tomography (CT) scans), hospitals in France, The Netherlands, Taiwan (region-specific CT scans), and South Africa (full-body Lodox Statscans), a private clinic in Angola (region-specific conventional radiographs), and a dental practice in Brazil (panoramic radiographs). Available derivatives include individual demographics (age, sex) with standardized skeletal and/or dental growth and development indicators for all individuals from all samples, and segmented long bone and innominate surfaces from the CT scan samples. Standardized protocols for data collection are provided for download and derivatives are freely accessible for researchers and students.

Contributions of Body-Orientation to Mental Ball Dropping Task During Out-of-Body Experiences

Out-of-body experiences (OBEs) provide fascinating insights into our understanding of bodily self-consciousness and the workings of the brain. Studies that examined individuals with brain lesions reported that OBEs are generally characterized by participants experiencing themselves outside their physical body (i.e., disembodied feeling) (Blanke and Arzy, 2005). Based on such a characterization, it has been shown that it is possible to create virtual OBEs in immersive virtual environments (Ehrsson, 2007; Ionta et al., 2011b; Bourdin et al., 2017). However, the extent to which body-orientation influences virtual OBEs is not well-understood. Thus, in the present study, 30 participants (within group design) experienced a full-body ownership illusion (synchronous visuo-tactile stimulation only) induced with a gender-matched full-body virtual avatar seen from the first-person perspective (1PP). At the beginning of the experiment, participants performed a mental ball dropping (MBD) task, seen from the location of their virtual avatar, to provide a baseline measurement. After this, a full-body ownership illusion (embodiment phase) was induced in all participants. This was followed by the virtual OBE illusion phase of the experiment (disembodiment phase) in which the first-person viewpoint was switched to a third-person perspective (3PP), and participants' disembodied viewpoint was gradually raised to 14 m above the virtual avatar, from which altitude they repeated the MBD task. During the experiment, this procedure was conducted twice, and the participants were allocated first to the supine or the standing body position at random. Results of the MBD task showed that the participants experienced increased MBD durations during the supine condition compared to the standing condition. Furthermore, although the findings from the subjective reports confirmed the previous findings of virtual OBEs, no significant difference between the two postures was found for body ownership. Taken together, the findings of the current study make further contributions to our understanding of both the vestibular system and time perception during OBEs.

Gravity center estimation for evaluation of standing whole body compensation using virtual barycentremetry based on biplanar slot-scanning stereoradiography - validation by simultaneous force plate measurement

Background Whole body standing alignment (WBSA) in terms of biomechanics can be evaluated accurately only by referring the gravity line (GL) which lies on the gravity center (GC). Here, we introduce a method for estimating GL and simultaneous WBSA measurement using the EOS® imaging system and report on the reproducibility and reliability of the method. Methods A 3-dimensional (3D) avatar to estimate GC was created following three steps: 3D reconstruction of the bone based on EOS images; deformation into a generic morphotype (MakeHuman statistical model) before density integration with 3D rasterization of the full body into 1-mm3 voxels (the content of each voxel is considered homogeneous); computation of the density of all the voxels provides the center of mass, which can be projected onto the floor as the GC of the full body, providing the GL in relation to the WBSA. The repeatability, reproducibility, and accuracy of the estimated GC and body weight of the avatar were compared with clinical estimation using a force plate in healthy volunteers and patients with degenerative and deformative diseases. Results Statistical analyses of the data revealed that the repeatability and reproducibility of the estimation was high with intra-rater and inter-rater intraclass correlation coefficient. ≥0.999. The coordinate values of the GC and body weight estimation did not differ significantly between the avatar and force plate measurements, demonstrating the high accuracy of the method. Conclusion This new method of estimating GC and WBSA is reliable and accurate. Application of this method could allow clinicians to quickly and qualitatively evaluate WBSA with GL with various spinal malalignment pathologies.

Physical Therapy for Muscle Tension Dysphonia with Cervicalgia

Objectives This study investigated the effectiveness of a specialized manual physical therapy (PT) program at improving voice among patients diagnosed with concomitant muscle tension dysphonia (MTD) and cervicalgia at a tertiary care voice center. Materials and Methods Cervicalgia was determined by palpation of the anterior neck. Both voice therapy (VT) and PT was recommended for all patients diagnosed with MTD and cervicalgia. PT included full-body manual physical therapy with myofascial release. Patients underwent: 1) VT alone, 2) concurrent PT and VT (PT with VT), 3) PT alone, 4) VT, but did not have PT ordered by treating clinician (VT without PT order) or 5) VT followed by PT (VT then PT). The pairwise difference in post–Voice Handicap Index-10 (VHI-10) controlling for baseline variables was calculated with a linear regression model. Results 178 patients met criteria. All groups showed improvement with treatment. The covariate-adjusted differences in mean post–VHI-10 improvement comparing the VT alone group as a reference were as follows: PT with VT 9.95 (95% confidence interval 7.70, 12.20); PT alone 8.31 (6.16, 10.45); VT without PT order 8.51 (5.55, 11.47); VT then PT 5.47 (2.51, 8.42). Conclusion Among patients diagnosed with MTD with cervicalgia, treatment with a specialized PT program was associated with improvement in VHI-10 scores regardless of whether they had VT. While VT is the standard of care for MTD, PT may also offer benefit for MTD patients with cervicalgia.

Is There Any Effect of Symmetry on Velocity of the Four Swimming Strokes?

The different characteristics of the four swimming strokes affect the interplay between the four limbs, acting as a constraint to the force produced by each hand and foot. The purpose of this study was to analyze the symmetry of force production with a varying number of limbs in action and see its effect on velocity. Fifteen male swimmers performed four all-out bouts of 25-m swims in the four strokes in full-body stroke and segmental actions. A differential pressure system was used to measure the hands/feet propulsive force and a mechanical velocity meter was used to measure swimming velocity. Symmetry index was calculated based on the force values. All strokes and conditions presented contralateral limb asymmetries (ranging from 6.73% to 28% for the peak force and from 9.3% to 35.7% for the mean force). Backstroke was the most asymmetric stroke, followed-up by butterfly, front crawl, and breaststroke. Kicking conditions elicited the higher asymmetries compared with arm-pull conditions. No significant associations were found between asymmetries and velocity. The absence of such association suggests that, to a certain and unknown extent, swimming may benefit from contralateral limb asymmetry.