KINEMATICS AND KINETICS OF HIGH RANGE OF MOTION ACTIVITIES OF DAILY LIVING

*Hemmerich, A; *Brown, H; **Marthandam, S S K; *Smith, S; *Wyss, U.

*Department of Mechanical and Materials Engineering, Queen’s University, Kingston, ON, Canada
**Sri Ramachandra Medical College and Hospital, Chennai, India
[email protected]

INTRODUCTION
Interestingly, only 6 of 30 subjects were comfortably able to kneel with
Orthopaedic devices, such as hip and knee replacements, have generally
ankles plantar-flexed; this may be attributable to religious customs in
been designed to accommodate the range of motion (ROM) required for
this region of India. Sources of error associated with the application of
activities common in Western cultures, including walking, stair
the rigid body model used to calculate the kinematics include soft tissue
climbing, and rising from a chair (Mulholland and Wyss, 2001).
movement and shifting of the sensors.
Accepted treatment of severe bone afflictions, such as OA, is often
rejected by people in non-Western cultures upon discovery that the
A typical plot of one phase of an individual activity in a single plane is
range of flexion following treatment would not accommodate activities
shown in Figure 1. The plot illustrates the knee flexion and
such as squatting, kneeling, and sitting cross-legged (Villar et al., 1988).
corresponding extension moment required to rise to a standing posture
A study by Noble and Weiss (2001) found that patients in North
from the squatting with heels flat position. When the flexion angle
America requiring a total knee replacement would also like to be able to
begins to decrease, a characteristic peak moment appears. This
perform activities of daily living (ADL) of high ROM, such as squatting
demonstrates the dynamic forces required to accelerate the body
while gardening. Unfortunately, they are rarely able to perform
upwards.
activities requiring a ROM of over 100º postoperatively. Furthermore,
little is known about the forces and moments that a device would be
200
200 0.2
0.20
required to withstand at these extreme ranges of motion. The purpose of
this study is to collect kinematic and kinetic data at the hip, knee, and

Angle (degrees)
ankle joints during squatting, kneeling, and cross-legged sitting activities 150
150 0.15
0.15

Moment (Nm/N)
from subjects in India, representing an ethnic group where high ROM in
ADL is important. 100
100 0.1
0.10
METHODS
50
50 0.05
0.05
Thirty subjects above the age of forty (20 male, 10 female) were
recruited for this study in Chennai, India. The average subject age was 00 0
48.2 years (SD 7.6), average height was 158.6 cm (SD 7.3), and average
weight was 57.1 kg (SD 10.2). Each subject was asked to perform 6
trials of each of the following activities that they carried out on a regular -50
-50 -0.05
-0.05
basis: squatting with heels up (i.e. balanced on flexed toes), squatting 00 20
20 40
40 60
60 80
80 100
100
with heels on the ground (i.e. foot flat), kneeling with ankles dorsi- Percentage of Cycle
flexed, kneeling with ankles plantar-flexed, and sitting cross-legged.
Kinematic data was collected using the Fastrak® by Polhemus with four
sensors placed at the foot, shank, thigh, and sacrum. A non-magnetic Flexion
FlexionAngle
Angle+/- ±
SDSD Extension Moment
Extension Moment +/- ±SD
SD
force plate (AMTI) was used to simultaneously collect ground reaction
Figure 1 Knee Flexion Angle [n=26] and Extension Moment [n=22]
forces during each trial. From the synchronized data, an inverse
during rise to stand from Squatting Heels Flat position.
dynamics approach using a link-segment model was used to calculate
the floating axis angles, joint reaction forces and moments at the ankle,
SUMMARY
knee, and hip. Each trial was split into two phases: getting into activity
position and returning to a standing position. Each phase was normalized For the 5 prescribed activities, mean hip and knee flexion ranges
to a 100% cycle. commonly exceeded the ranges of motion typically allowed by most
currently available joint replacements. It is essential to know the forces
RESULTS AND DISCUSSION and moments that occur at the joint under high range of motion
conditions in order to design and test prosthetic joints that will
From Table 1, it is apparent that knee range of motion can easily exceed
accommodate these extreme angles.
150º of flexion during the activities studied. Maximum hip flexion
values reached 120º for several subjects in various activities; however,
REFERENCES
the overall mean ROM angles are lower due to the high variability
between subjects. Mulholland,S.J. and Wyss,U.P. (2001). Int.J.Rehabil.Res. 24, 191-198.

Table 1 Maximum Joint Range of Flexion (SD) for Several Activities Noble, P., Weiss, G.M. et al. (2001) Does total knee replacement (TKR)
of Daily Living in India. restore the normal function of the knee. ORS.
Activity Ankle Knee Hip Villar,R.N., Solomon,V.K., and Rangam,J. (1988). Tropical Doctor 18,
[Number of Subjects]* [degrees] [degrees] [degrees] 21-24.
Squatting Heels Up [26] 36 (10) 154 (10) 99 (30)
ACKNOWLEDGEMENTS
Squatting Heels Flat [26] 35 (10) 157 (6) 94 (24)
This study was partially supported by Zimmer, Inc. (Centerpulse Ltd.),
Kneeling with ankles 37 (10) 155 (9) 77 (36) Switzerland and NSERC. Thanks also to Amanda Knutson and Vani
dorsi-flexed [26] Malar for their help with data collection and processing.
Kneeling with ankles 33 (7) 144 (13) 62 (16)
plantar-flexed [6]
Sitting Cross-legged [26] 30 (11) 150 (8) 87 (35)
* The number of subjects for the hip range of flexion differs from the
number of subjects for the ankle and knee range of flexion for the
following activities: squatting heels up [n=25], kneeling with ankles
dorsi-flexed [n=24], and sitting cross-legged [n=23].

51st Annual Meeting of the Orthopaedic Research Society

Poster No: 0555