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Biomechanical evaluation of independent transfers and pressure relief tasks in persons with SCI

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Title:
Biomechanical evaluation of independent transfers and pressure relief tasks in persons with SCI pilot study
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Cresta, Tony J
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University of South Florida
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Motion analysis
Paraplegia
Force transducers
EMG
Wheelchair transfer
Dissertations, Academic -- Biomedical Engineering -- Masters -- USF
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bibliography   ( marcgt )
theses   ( marcgt )
non-fiction   ( marcgt )

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Abstract:
ABSTRACT: Persons with paraplegia who use a manual wheelchair for mobility are at high risk for overuse injuries in the upper extremities. Years of shoulder overuse performing transfers, wheelchair propulsion, dressing, bathing, and household chores, (activities of daily living or ADL) leads to an increased incidence of cumulative trauma to the shoulders. Few studies have addressed the stressful task of wheelchair transfers among SCI individuals. The goal of this pilot study is to develop valid and reliable measurement technologies to quantify shoulder musculoskeletal stressors during wheelchair transfers and pressure relief tasks among individuals with SCI. Using a standard wheelchair, 10 participants were asked to perform 3 typical pairs of independent transfer tasks: wheelchair to/from bed, wheelchair to/from commode, and wheelchair to/from vehicle. Also, two pressure relief tasks (P/R) were performed sitting in a wheelchair, one using the armrest and one using the wheels.^ By observation, the transfers in descending order from the most demanding to the least demanding were as follows: vehicle, commode, and bed. During a P/R using the wheels there is a 40% greater max shoulder force and a 47% greater mean shoulder force than when using the armrest. The max shoulder force of over 1000 N is generated at the initial push off, during a P/R using the wheels, then the force drops 45% to an average of 558 N. The max shoulder force of 722 N at the initial push off, during a P/R using the Armrest, drops 48% and then averages 378 N. During a P/R using the wheels there is a 104% greater max shoulder torque and a 17% greater mean shoulder torque than when using the armrest. As in the initial large amount of shoulder force there is also a large amount of shoulder torque that drops 77% during a P/R using the wheels. The shoulder torque decreases 62% during a P/R using the armrest.^ Because of the greater distance the body's Center of Mass (COM) travels during the P/R using the armrest, 24% more work is done.
Thesis:
Thesis (M.S.B.E.)--University of South Florida, 2006.
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Includes bibliographical references.
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by Tony J. Cresta.
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Biomechanical Evaluation of Independent Transfers and Pressure Relief Tasks in Persons with SCI: Pilot Study by Tony J. Cresta A thesis submitted in partial fulfillment of the requirement s for the degree of Master of Science in Biomedical Engineering Department of Chemical Engineering College of Engineering University of South Florida Major Professor: W illiam E. Lee, Ph.D. John D. Lloyd, Ph.D. Edward Quigley, Ph.D. Ronald Gironda, Ph.D. Date of Approval: November 1, 2006 Keywords: motion analysis, paraplegia force transducers, EMG, wheelchair transfers Copyright 2006, Tony J. Cresta

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i Table of Contents List of Tables iii List of Figures iv Abstract v Chapter 1 Introduction 1 1.1 Overview 1 1.2 Statement of the Problem 2 1.3 Missing Elements in the Research Knowledge 3 1.4 Anatomy 3 Chapter 2 Current Stat us of the Work 7 2.1 Pain Demographic Studies 7 2.2 Radiological Studies 9 2.3 Body Composition and its Effect on SCI Persons 10 2.4 Muscle Kinetics and Kinematics 10 2.5 Summary 16 Chapter 3 Methods and Procedures 17 3.1 Research Design 17 3.2 Sample 17 3.2.1 Inclusion Criteria 17 3.2.2 Exclusion Criteria 18 3.3 Subject Recruitment, Screeni ng, and Selection Criteria 18 3.3.1 Recruitment 18 3.3.2 Screening 18 3.3.3 Selection 19 3.4 Study Population Characteristics 19 3.4.1 Subject Demographics 19 3.4.2 Subject Anthropometry 20 3.5 Measurement 20 3.5.1 Vicon Motion Analysis 20 3.5.1.1 Hardware 20 3.5.1.2 Software 21 3.5.2 Gloves with Force Sensing Resistors 23 3.5.3 EMG System 23 3.6 Description of Biomechanics Research Laboratory 24 3.7 Data Collection Protocol 25 3.8 Data Management 31

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ii Chapter 4 Results 32 Chapter 5 Discussion 41 5.1 Limitations of Laborator y Devices and Equipment and the Recommended Changes 41 5.2 Discussion 43 Chapter 6 Conclusions 48 6.1 Significance of this Study 48 6.2 Future Work 49 References 51 Appendices 53 Appendix A. Manual Muscle Testing 54 Appendix B. Active Range of Motion Testing 56 Appendix C. FABQ-P 57 Appendix D. Physician Evaluation 58 Appendix E. Demogr aphic Questionnaire 60 Appendix F. Health Questionnaire 61 Appendix G. Anthropometry Survey 62 Appendix H. Data Collecti on Protocol Checklist 63 Appendix I. Order of Transfer Tasks 65 Appendix J. Vicon BodyBuilder Program 66

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iii List of Tables Table 1. Subject Anthr opometric Measurements 32 Table 2. Demographic Characteristics of Subjects 33 Table 3. Shoulder Range of Motion and Strength of Subjects 34 Table 4. Pressure Relief Comparison 37 Table 5. Subjects Hand Posi tion for Data Collection 39 Table 6. Manual Muscle Testing Data 54 Table 7. Active Range of Motion Testing Data 56 Table 8. Physician Evaluation Data 58 Table 9. Anthropometry Survey Data 62 Table 10. Data Collection Protocol Checklist 63 Table 11. Order of Transfer Tasks 65

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iv List of Figures Figure 1. Shou lder Anatomy 4 Figure 2. Muscles of the Rotator Cuff 5 Figure 3. Posterior Muscula ture of the Upper Torso 6 Figure 4. Vicon Bo dyBuilder Software 22 Figure 5. Instrumented Gloves 23 Figure 6. Biomechanics Research Laboratory 25 Figure 7. Data Collection Materi als Worn by Participants 26 Figure 8. Pressure Relief: Armrest and Wheels 27 Figure 9. Transfer from Wheelchair to Bed and from Bed to Wheelchair 28 Figure 10. Transfer from Wheelchair to Toilet and Toilet to Wheelchair 29 Figure 11. Transfer from Wheelchair to Vehicle Seat and Vehicle Seat to Wheelchair 30 Figure 12. Pressure Relief Wheels Glove Force to Subject Weight Comparison 35 Figure 13. Pressure Relief Armrest Glove Force to Subject Weight Comparison 36

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v Biomechanical Evaluation of Independent Transfers and Pressure Relief Tasks in Persons with SCI: Pilot Study Tony J. Cresta ABSTRACT Persons with paraplegia who use a manual wheelchair for mobility are at high risk for overuse injuries in the upper ex tremities. Years of shoulder overuse performing transfers, wheelchair propulsi on, dressing, bathing, and household chores, (activities of daily living or ADL) leads to an increased incidence of cumulative trauma to the shoulders. Few studies have addressed the stressful task of wheelchair transfers among SCI individuals. The goal of this p ilot study is to develop valid and reliable measurement technologies to quantify shoul der musculoskeletal stressors during wheelchair transfers and pressure re lief tasks among individuals with SCI. Using a standard wheelchair, 10 participant s were asked to perform 3 typical pairs of independent transfer tasks: wheel chair to/from bed, wheelchair to/from commode, and wheelchair to/from vehicle. Also, two pressure relief tasks (P/R) were performed sitting in a wheelchair, one using the armrest and one using the wheels. By observation, the transfers in descendi ng order from the most demanding to the least demanding were as follows: v ehicle, commode, and bed. During a P/R using the wheels there is a 40% greater max shoulder force and a 47% greater

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vi mean shoulder force than when using the armrest. The max sh oulder force of over 1000 N is generated at t he initial push off, during a P/R using the wheels, then the force drops 45% to an average of 558 N. The max shoulder force of 722 N at the initial push off, during a P/R using the Armres t, drops 48% and then averages 378 N. During a P/R using the wheels there is a 104% greater max shoulder torque and a 17% greater mean shoulder torque than when using the armrest. As in the initial large amount of shoulder force there is also a large amount of shoulder torque that drops 77% dur ing a P/R using the wheels. The shoulder torque decreases 62% during a P/R using the armr est. Because of the greater distance the bodys Center of Mass (COM) travel s during the P/R using the armrest, 24% more work is done.

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1 Chapter 1 Introduction 1.1 Overview In the past individuals with spinal cord injury (SCI) did not enjoy long productive lives. Since most patients that incur an SCI are young and are living longer lives, concerns exist about maintaining independe nce with activities of daily living (ADL) over a longer period of time. With advances in medicine and US legislation (The Americans with Disabili ties Act 1990) that address the needs of the physically challenged, f unding was made available to allow these individuals to work and enjoy activities just the sa me as the general population. Longer life spans and increased activities, caused indi viduals with SCI to be concerned with maintaining their ability to perform trans fers, wheelchair propulsion, dressing, bathing, and household chores -their activities of daily living (ADL). Deterioration of the upper extremity (UE) has a detrimental effect on the independence, quality of life, and even the life expectancy of individuals following SCI. Few studies have addressed transfe rs among SCI individuals. Increased incidence of cumulative UE trauma fo llowing years of biomechanical loading dramatically affects the quality of lif e of persons with SCI, adding to their disability and diminishing their independence.

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21.2 Statement of the Problem It is estimated that the annual incidence of SCI is approximately 11,000 cases each year. [1, 2] The number of people in the United States who were alive in July 2004 who have SCI has been estima ted to be 247,000 persons, with a range of 222,000 to 285,000 persons. 47% of the people in this group have lesions below T-1 (paraplegia). The National Health Interview Survey on Disability reported in 1999 that more than 2.3 million individuals in this country have disabilities requiring the use of a wheelchair [1]. Manual wheelchair us ers (MWCUs) are included within the disability groups of spinal cord injury (SCI) -lower-limb amputation, stroke, multiple sclerosis, rheumatoid arthritis, spina bifida, poliomyelitis, and hip fracture, as well as other groups. More than 176,000 veterans use manual wheelchairs for mobility, with 44,000 manual wheelchairs distributed annually at a cost of over $28 million, according to the Veterans Health Administration Individuals with paraplegia must perform ADL without the use of their lower extremities. As such, these tasks are primarily performed with the use of the upper extremities (UE), mainly the shoulder girdles. Following the SCI, the UE must be able to withstand the cumulative forces of weight bearing during mobility and transfers. Many wheelchair users experience upper extremity pain that interferes with essential activities of daily living such as wheelchair propulsion, driving, dressing, and transfers. Upper extremity weightbearing activities and chronic overuse have both been implicated in the develop ment of soft tissue disorders and degenerative changes in the shoulder joints.

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31.3 Missing Elements in th e Research Knowledge Previous studies of SCI subjects whee lchair mobility and transfers have relied on electromyographic [3-7], kinematic[8, 9], or ground reaction force data[10]. Comparatively few studies have address ed transfers other then pressure relief tasks, a simple posterior transfer, and a transfer to a 10 cm. elevated, or lower surface [7, 10]. A review of the liter ature revealed no investigation which integrated each of these data collection modes, or analyzed the joint moments of SCI subjects during transfers. This dat a is needed to accurately evaluate the UE joint stresses, muscular contributions, and the inter-relationship between trunk position and UE functional demands of SC I patients. Recent innovations in motion analysis, mathematical modeli ng and computer simulation methods provide researchers with additional analytical tools to help strengthen intervention planning for UE preservati on in SCI patients. Through advanced technology, comprehensive clinical eval uation, and experi mental research, clinical interventions to help ameliora te shoulder pain and injuries can be developed. 1.4 Anatomy The shoulder consist of 2 main bones -the scapula and humerus -which form a ball and socket joint. The motion of the scapula and humerus are simultaneously continuous at both flexi on and abduction of the shoulder joint. During the first 30 to 60 degrees of elevat ion, the scapula seeks, in relationship to the humerus, a position of stability. Therefore the early phase of motion is irregular, and is characteristic for each individual. It seems to depend upon the location the scapula occupies in the subject when at rest. This phase is termed the setting phase since it is related to the setting action of the muscles. After this phase the relationship of humeral and scapular motion are constant with the ratio being 2:1 in degrees, respectively. T he total range of scapular motion is not more than 60 and the humerus, not more than 120.

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4 Figure 1. Sh oulder Anatomy The deltoid muscle consists of three heads : anterior, medial, and posterior. On both sides, the deltoid muscles are important in attaching the shoulder girdle to the arm. They originate from the: infe rior surface of the lateral third of the clavicle, acromion, and spine of the scapul a. They insert into the deltoid tuberosity. Acting as a unit, the del toid acts to abduct the arm at the glenohumeral joint. However, the anterior fibers assist in flexing and medially rotating the arm, whereas the posterior fibers extend and laterally rotate. On the anterior of the chest is the pectora lis major muscle. The pectoralis major flexes, adducts, and rotates the humerus medially.

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5 Figure 2. Muscles of the Rotator Cuff The rotator cuff muscles are called the s upraspinatus, infraspinatus, teres minor, and subscapularis. The rotator cuff connects the humerus with the scapula (shoulder blade) and helps raise and rotate the arm. As the arm is raised, the rotator cuff also keeps the humerus tightly in the socket (glenoid) of the scapula. The supraspinatus assists the middle deltoid in ab ducting the humerus. The infraspinatus, subscapularis and teres mino r assist the latissi mus dorsi muscle by pulling the humerus down and to the rear. The scapula rotators -upper trapez ius, levator scapulae, and upper serratus anterior, constitute a unit which performs three functions, passive support of the shoulder, active elevations of the s houlder, and the upper co mponent of the force necessary for scapular rotation. With el evation of the arm, both in flexion and abduction, there is a linear rise in forc e reaching its maximum when the arm is above the head slightly above 90 degrees.

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6 Figure 3. Posterior Musculature of the Upper Torso The inferior part of the trapezius, subc lavius, and pectoralis minor contribute to the downward motion of the scapula. The rhomboid muscles, much like the middle trapezius are most active during sc apular adduction, but also contribute to inward rotation and elevation.

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7 Chapter 2 Current Status of the Work 2.1 Pain Demographic Studies Paraplegic patients rely on t heir upper extremitie s for transport activities such as wheelchair propulsion and transfers. Unlike the joints of the lower extremities (LEs), with structures spec ialized for strength under load the joints of the UEs are characterized by structures speciali zed for range of motion, which predispose them to injury when used to replace LE functions. This is known as overuse syndrome. Several studies have document ed pain as a consequence of overuse syndrome of the UEs associ ated with paraplegia. Howeve r, whether this is due to wheelchair propulsion or trans fer activities is undetermined. Gellman et al studied 84 paraplegic patient s whose injury level was T2 or below and who were at least 1 year from spinal co rd injury (SCI). [11] 57 (67.8%) of the patients had complaints of pain in one or more areas of their UEs. The most common complaints were shoulder pain and/or wrist pain, with 25 (30%) complaining of shoulder pain during transfer activities. Symptoms were found to increase with time from SCI. Curtis et al compared the prevalence and intensity of shoulder pain experienced during daily functional activities in i ndividuals with tetraplegia and individuals with paraplegia. [1] There were 195 subjects of whom 52 were women, who met inclusion criteria of 3 hours per week of manual wheelchair use and at least 1 year since onset of spinal cord injury More than two-thirds of the sample

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8reported shoulder pain since beginning whee lchair use, of which 59% of the subjects had tetraplegia and 42% of the subjects had paraplegia. Dalyan et al. administered a questionnair e to 170 persons with SCI designed to describe the frequency and severity of UE pain in persons with SCI, the association with specific activities, and the therapy received. [12] Of the 130 persons (38 paraplegic, 38 tetraplegic pat ients) who responded, 76 (58.5%) reported UE pain -71% had shoulder pai n, 53% had wrist pain, 43% had hand pain, and 35% had elbow pain. Pain interf ered with transfers in 65% (36/55) of the patients who were performing them. Th e functional activities associated with pain were pressure relief movements, transfers, and wheelchair mobility. 63% sought medical treatment for pain and, of those, 90% received physical therapy, drug treatment or massage. Alt hough only 27% had wheelchair or home modification or joint protection educati on, these approaches were helpful for almost all, and were extremely helpful for 63.6% of the patients. [12] Subbarao et al surveyed 451 SCI patients by questionnaire. In addition, 30 patients were available for clinical obs ervation and evaluation. [13] Results indicated that wrist and shoulder pain were more prevalent than previously indicated. 72.7 percent of respondents reported some degree of chronic pain in one or both of these areas. Wheelchair pr opulsion and transfers caused most of the pain and also increased the degree of pai n. They concluded that alternative methods for wheelchair propulsion and tr ansfers, which would lessen stress and cumulative trauma, need to be developed for SCI patients in order to diminish the incidence of chronic upper limb pain. Finley et al looked at 52 manual w heelchair users -26 athletes and 26 nonathletes -and no difference was found in t he incidence of shoulder pain, past or present, between athletes and non-athletes. [ 14] 61.5% (32/52) of the subjects reported experiencing shoulder pain. Year s since onset of disability and duration of wheelchair use were found to be greater in individuals who reported a history of shoulder pain. Of the painful shoulde rs tested, 44% revealed clinical signs

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9and symptoms of rotator cuff impingement, while 50% revealed signs of biceps tendonitis. Instability was found in 28% of the painful shoulders. Bayley et al examined 94 persons wit h paraplegia for pain during transfer activities.[15] Thirty-one patients report ed pain on transferring, and twenty-three of these patients were found to hav e a chronic impingement syndrome with subacromial bursitis. Arthrography of the shoulder was done for each of these twenty-three patients, fifteen of which were found to have a tear of the rotator cuff. Five of the thirty -one patients were found to have aseptic necrosis of the head of the humerus. They m easured the intra-articular pressure in the shoulder during transfers, and found that this pressure exceeded the arterial pressure by a factor of 2.5. Gironda et al. surveyed 1675 veterans with paraplegia (PP).[16] Of the 46% who answered, approximately 81% of the respondents report ed at least a minimal level of ongoing unspecified pain and 69% experienced current UE pain. Shoulder pain intensity was most seve re during the performance of wheelchairrelated mobility and transport activities suggesting that UE pain may have a significant impact on functional independ ence. Duration of wheelchair use modestly predicted shoulder pain preval ence and intensity, but age and the interaction between age and duration of wheelchair use did not. 2.2 Radiological Studies As reported by Barber, D. B. & Gall, N.G. in their ar ticle in Paraplegia, the shoulder of the wheelchair dependent paraplegi c is subject to overuse injury with subsequent pain. [17] The major ov eruse syndromes observed include soft tissue injuries and secondary degenerative arth ritis. This report presents a case in which bilateral osteonecrosis of the humeral heads was found to be the source of pain in the shoulders of an active par aplegic without any evidence of disease or medical treatment associated wit h the development of osteonecrosis.

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10Osteonecrosis should be entertained in t he differential diagnosis of overuse injuries of the shoulder in paraplegia. 2.3 Body Composition and its Effect on SCI Persons The prevalence of diseases associated with obesity, such as cardiovascular disease and diabetes mellitus, is higher in the spinal cord injury (SCI) population. The mortality rate for cardiovascular disease is 228% higher in the SCI population which is related to physical activi ty level, the level of the spinal cord lesion, and time post injury. [18] Ph ysically active SCI men and women have above-average fat mass (16 to 24% and 24 to 32%, respectively, compared with 15% for able-bodied men and 23% for ablebodied women), while sedentary SCI individuals have 'at-risk' levels of body fat (above 25% and 32%, respectively). 2.4 Muscle Kinetics and Kinematics Bayley et al reported that paraplegic patients with a lower lesion level may be able to partially support their bodyweight during transfers using functional abdominal or spinal muscles. [15] They considered this capacity vital to relieving the shoulder girdle of excessive transfe r forces. Pressure measurements were taken in the subacromial area of the shoul der joint. The position of the catheter was verified, arthrographically. Cont inuous pressure measurements were recorded, while the pati ent performed 6 different tasks, one being an active transfer from a wheelchair to a bed. Unweighted active, gentle flexion and extension activity produced peaks of pressure in the range of 543 kg/m2 1087 kg/m2. During the transfer the peak pre ssures rose to as much as 3606 kg/m2. During a transfer from a wheelchair to any object, the weight of the body is transferred from the trunk through the clavicle and scapula across the glenohumeral joint to the humerus. The pressure in the shoulder joint during transfers exceeds the mean arterial pressu re by more than 2 times. The belief is that this high pressure in c onjunction with abnormal stress across the

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11subacromial area during a transfer or propul sion of a wheelchair, contributes to the high rate of shoulder problems in par aplegic patients. Mo st of the problems involve the muscles and ligaments around the shoulder joint, especially the rotator cuff. Perry et al in evaluat ing 12 asymptomatic, low level paraplegic patients for the activation of 12 shoulder muscles (on the right side) during the performance of depression transfers, repor ted 3 transfer phases -preparatory, lift and descent. [5] Muscle ac tivity was categorized by intensity high (> 50%), Moderate (25-50%), and low (< 25%). The lift phase required the greatest muscular effort by the lead arm, with peak activity of the pectoralis major (81% manual muscle test (MMT)) and moderate ac tion of the serratus anterior (47% MMT), latissimus dorsi (40% MMT), and infr aspinatus (37% MMT). In the trailing arm there was strong serratus anterior ac tivity (54% MMT), while the pectoralis major (49% MMT), infraspinatus (45% MMT), anterior deltoid (44% MMT), and supraspinatus (38% MMT) exerted moderate effort. The descent phase displayed the least intense muscle acti vation, consistent with the greater efficiency of eccentric mu scular activation. Of parti cular note was the minimal activity in the middle and posterior heads of the deltoid as well as the middle trapezius during all phases of the transfer and the low activity of the long head of the triceps in both arms throughout t he tasks. Perry proposed that trunk elevation was accomplished mainly by st ernal pectoralis major and latissimus dorsi activity. Lateral body displacement required other muscles to control the elevated body. Rotator cuff muscles, together with the anter ior deltoid, provided anterior glenohumeral wall protection. Lower serratus anterior stabilized the scapulothoracic joint and contributed to lateral movement. Assessment of depression transfer skill should not be based on the ability to lift body weight. Movement of the trunk required strong activity of key shoulder muscles. Differences in leading and trailing arm EMG intensities will assist in modifying transfer methodologies in individuals wit h weakness, strengt h imbalances, and shoulder pathologies.

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12Reyes et al set out to define the dem and on the shoulder musculature during performance of a weight relief raise. Intr amuscular electromyographic activity of 12 shoulder muscles was recorded in 13 pa in-free subjects with paraplegia while elevating the trunk from a sitting position. [4] The weight relief took an average of 2.6 sec for a subject to complete the 3 phases of the raise maneuver (load, lift, and hold). Trunk elevation and b ilateral elbow extension (85 17 degrees flexion) were the primary movements while the latissimus dorsi (58% MMT), the long head of triceps brachii (54% MMT), and t he sternal portion of pectoralis major (32% MMT) were the most ac tive muscles. Strong lati ssimus dorsi activity was noted during the hold phase (51% MMT), while the triceps and sternal pectoralis major demonstrated only moderate activa tion. (Again another study that has lower tricep activity than one would expect.) With the exception of the subscapularis (16% MMT during loading) and the lower serratus anterior (12% MMT during the lift), none of the rotato r cuff, deltoid, or scapular muscles exceeded 10% MMT. Thoracohumeral muscle activity, by transferring the load on the humerus directly to the trunk, functionally ci rcumvented the glenohumeral joint. This would reduce the potential for impingement of t he rotator cuff. Seelen et al reported that the increased lati ssimus dorsi and trapezius muscle activation observed in sitting SCI subjec ts served to stabilize their sitting posture.[19] Gagnon et al studied three-dimensional kinematic analysis and surface EMG of 10 male adults with complete spinal cord injury (C7 to L2) to examine movement patterns and muscular demands in individuals with SCI during posterior transfers. [7] The first transfer was a backwar d movement on an even surface with hands placed symmetrically alongside the body (even task). For the second transfer the subjects had to raise themselves in a backward movement to an elevated surface of 10 cm in height. For this elev ated task subjects had to use three hand placement strategies: both hands on t he lower surface, both hands on the elevated surface, and one hand on each of t hese surfaces. Kinematic variables

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13that described the positi ons and angular displacement s of the head, trunk, shoulder and elbow were obtained by videotaping markers placed on the subject segments. To quantify the mu scular demand, subjects were seated on the chair of the Biodex dynamometer and performed activities to stimulate the six muscles of the shoulder girdle to establish EMG max. The joint positions selected for these tasks corresponded to the joint posit ions used by the subject during the experimental tasks. EMG data were reco rded for the biceps, triceps, anterior deltoid, pectoralis major, latissimus dorsi and trapezius muscles of the dominant upper extremity during posterior transfers using surface electrodes. The mean muscular demands were calculated for ev ery muscle during the lift phase of the transfers. The lift phase was determined by pressure-sensitive contacts. All subjects were able to execute the poste rior transfers on an even surface, whereas nine subjects completed at leas t one of the transf ers to the elevated surface. A forward-flex ion pattern at the head and trunk was observed when either one or two hands remained on the lo wer surface, whereas a lift strategy was seen when both hands were placed on the elevated surface. Transferring to the elevated surface with hands on the lower surface required an inferior electromyographic muscular utilization ra tio (EMUR) than the transfer on the even surface for all muscles. The EM UR was obtained by dividing the EMG recorded during the transfer by the EM G max obtained on t he dynamometer. The result was multiplied by 100 to give a percentage. The lowest EMURs were calculated for the transfer to the elev ated surface with hands on the lower surface (triceps (18%), pectoralis majo r (53.8%), trapezius (66%) and latissimus dorsi (24.5%) while performing the same transfer with hands on the elevated surface generated the highest EMURs (triceps (40.2%), anterior deltoid (73.2%), trapezius (83.6%) and latissimus dorsi (55. 3%). Subjects presented different movement characteristics and muscular demands during the posterior transfers. It is suggested that the forward-flexi on pattern improves the dynamic trunk stability and reduces the muscular dem and required to transfer. The high muscular demand developed when hands were positioned on the elevated

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14surface might be due to increased postu ral control demands on the upper limb and reduced angular momentum. Finley et al wanted to compare scapul ar kinematics and muscle function during the performance of transfers in gr oups of MWCUs with and without shoulder impingement. [8] It was hypothesiz ed that (1) MWCUs with shoulder impingement would demonstrate diffe rent scapular kinematics and muscle activity compared to MWCUs without t he pathology and (2) muscle activation patterns would be different between the two transfer tasks. MWCUs with impingement performed transfers with less t horacic flexion, increased scapular internal and reduced humeral internal rotation as compared with those without the pathology. The scapular function dur ing a leading limb and trailing limb transfer is different. T he trailing limb had increased serratus anterior and lower trapezius activity with downward sc apular rotation and reduced scapular posterior tipping compared with the lead limb transfer. In an effort to further understand the mechanism of shoulder impi ngement in this population, factors such as the task repetition, magnitude of joint loading and specific impairment and disability factors need to be investigated. Wang et al, in assessing wheelchair to seat transfers of varying heights among six asymptomatic non-impair ed subjects, reported that transfers to lower height seats generated greater ground reaction forc es and greater triceps brachii and posterior deltoid activation to "overcome th e force of the body gravity".[10] This study explored how the reaction force and muscle activity change when transferring from a wheelchai r to three different height s. Six able-bodied male subjects, ages ranging from 20 to 25 year s old, who had their legs tied together to help control movement, performed the three transfer tasks (they still had the use of trunk stabilizing muscles, so it was not truly representative of SCI Population). The three seat heights us ed were 40 cm (toilet height), 50 cm (wheelchair height), and 60 cm (bed height). Transfers to a higher seat resulted in a shift of the "friction force" from primarily anterio r-posterior to more medial-

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15lateral and required a greater muscular c ontribution from the biceps brachii muscle. Wang et al reported that equal wheelchair and destination heights required less muscular effort during transfers. Musculoskeletal injuries can result fr om overuse or incorrect use of manual wheelchairs, and can hinder rehabilitation e fforts. Rodgers et al investigated wheelchair propulsion biomec hanics of spinal-cord-injured, non-athletic wheelchair users. They noted that with fatiguing wh eelchair propulsion, the subjects physical characteristics and the state of fatigue influences the risk of injury. Twenty male paraplegic patient s were videotaped during propulsion to fatigue on a stationary, instrumented wheelchair positioned on a roller with adjustable frictional resistance. Peak handrim force was significantly correlated with concentric shoulder flexion and elbow extension isokinetic torques. Significant changes (p < 0.05) with fatigue were found in increased peak handrim force, decreased ulnar/radial deviation range of motion, and increased trunk forward lean. Of the thr ee upper extremity joints, the highest calculated joint moments were found in shoulder flexion (p < 0.05). These biomechanical results suggest that potentially harmful changes oc cur with fatigue, and that the shoulder may be the most prone to musculotendi nous-type overuse injury.[20] Hobson et al reported that decreased tr unk stability combined with the posture imposed by wheelchair seat configuration necessitated that SCI subjects assume a biomechanically abnormal sitting positi on characterized by a "C" shaped spinal kyphosis, an extended cervical spine, a fl attened lumbar spine, and a posteriorly tilted pelvis. They reported that, in general, SCI subjects sit in a neutral posture with approximately 15 degree more posterior pelvic tilt than non-spinal cord injured subjects. It has been postulated t hat loss of voluntar y trunk stability, combined with the posture imposed by the configuration of the wheelchair seat, biomechanically necessitates that a pers on with diminished trunk control assume an abnormal sitting posture.[21]

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162.5 Summary Recent innovations in mathematical modeling and motion analysis, provides researchers with additional analytical tools to help strengthen intervention planning for UE preservation in SCI pat ients. Through advanced technology, comprehensive clinical evaluation, and experimental research, clinical interventions to help lessen shoulder pain and injuries can be developed. Deterioration of the UE has the potentia l to be extremely detrimental to the independence, quality of life, and even the life expecta ncy of SCI subjects. Transfer studies among SCI subjects s hould consider factors including age, overall medical status, length of time since disability, wheelchair transfer strategies, muscular strength, ph ysical strain of ADL, body mass and composition, and UE injury history. Bi odynamic SCI subject transfer strategy studies should combine three di mensional kinematic, kinetic and electromyographic data. The combinati on of these data sets will enable a more accurate depiction of the demands placed on the UE, particularly at the shoulder joint.

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17 Chapter 3 Methods and Procedures 3.1 Research Design This was a descriptive study to quant ify the biomechanical stresses on persons with paraplegia while performi ng independent transfers and pressure relief tasks. A convenience sample of 10 subjects who met the inclusion criteria was selected. Transfers were performed between a wheelchair and; bed, commode, and vehicle mock-up. Data was captured using the Vicon 460 Motion Analysis System, EMG, force gloves, and questionnaires. 3.2 Sample A convenience sample of 10 persons with paraplegia (T3-L3) wa s recruited from the James A Haley Veterans Hospital Tampa. No adverse events were experienced by any of the participants, nor did any elect to remove themselves from the study. 3.2.1 Inclusion Criteria The inclusion criteria for the subjects included the following: 1. Veterans with paraplegia who use manual wheelchairs for mobility. 2. Age range limited to 18 to 65 years, representative of an adult population. 3. Candidates should be at least 6 months post-SCI to have developed experience in transfers.

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184. Level of spinal cord injury was limited to ASIA a classification at T2 through L5 level to standardize physical capabilities. 5. Candidates must be able to per form independent transfers, with or without use of assistive devices. 3.2.2 Exclusion Criteria The exclusion criteria for the subjects included the following: 1. Candidates who presented clinical evidence of severe musculoskeletal disorders of the upper ex tremity or other physiol ogical impairment which would limit their performance of the required transfer tasks were precluded from participating in this pilot study. 2. Candidates with significant cogni tive impairment were excluded as evaluated in clinical screening. 3.3 Subject Recruitment, Screeni ng, and Selection Criteria 3.3.1 Recruitment Potential candidates were selected from the list of 1,100 veterans in the SCI Registry at the Tampa VAMC and were invi ted to participate. Additionally posters were displayed in the foyer of the SCI building of the James A Haley Veterans Hospital inviting SCI outpatients to contact us for more information. 3.3.2 Screening The candidates were pre-screened over the telephone. Potential candidates were screened in the lab to assure the vete rans met inclusion/exclusion criteria. Manual muscle testing was performed wit h the aid of a handheld dynamometer to quantify muscular force output (Nichol as Manual Muscle Tester, Lenox Hill,

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19NY). Shoulder strength was measured in: abduction, flexion and extension, internal and external rotation (A ppendix A). Range of motion (ROM) was measured by an occupational therapist using a hand held goniometer (Appendix B). Subjects were asked to complete a pai n questionnaire (end range descriptors of no pain, extreme pain), which was modified to consider only shoulder, arm, and hand-related pain (Appendix C). The 4-item Physical In terference Subscale of the Fear Avoidance Beliefs Questionnaire (FABQ) was used. Recent empirical findings suggest that the FABQ is a p sychometrically superior measure of the same construct assessed by the TSK. 3.3.3 Selection A board certified physician who practices in Spinal Cord Injury Medicine performed a physical evaluation of each c andidate to verify upper extremity and spine integrity and thereby determine their eligibility in the study, which included of a review of the candidates historical file, functional strength testing and ROM (Appendix D). The first 10 candidates who met the inclusion criteria participated in the study. 3.4 Study Population Characteristics 3.4.1 Subject Demographics Following informed consent, all subjec ts completed a general demographic questionnaire (Appendix E). This onepage questionnaire includes standard questions pertaining to age, gender, race, oc cupational history and participation in recreational activities. A health questionnaire was completed by each participant (Appendix F), which specifically addressed historical considerations,

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20including, level of injury, duration of injury, medication usage and secondary conditions. 3.4.2 Subject Anthropometry A series of anthropometri c measures were taken and recorded. Standard anthropometry measures of body segment link lengths, such as arm length, seated height, leg length, etc. were reco rded using an anthropomet er (Appendix G). Height and weight were measured, from which Body Mass Index (BMI) was computed. 3.5 Measurement Objective data was captured using the Vicon 460 Motion Analysis System, EMG, force gloves, and questionnaires. Each of these is described in detail below. 3.5.1 Vicon Motion Analysis Motion of the subjects was captured by the Vicon 460 Motion Analysis System (www.vicon.com). This system uses an array of near-infrared stroboscopes and cameras to capture reflections from re flective spheres that are adhered to the body. Position data from these sensor s was used to drive a 3-dimensional computer representation. Force data was collected simultaneously using force sensing resistors incorporated into t he palm area of gloves worn by the participants. 3.5.1.1 Hardware The Vicon 460 Motion Analysis System is a technology that is used to capture dynamic human motion. Optical-reflecti ve markers were placed on the skin of the participants. The marker was track ed by a matrix of six wall-mounted near

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21infra-red cameras and computed on a frame-by -frame basis at 120Hz. Since this is an optical technology, the integrity of this system may have been compromised due to occlusions. Typically, the works pace is cleared to ensure minimal visual interference between the markers and came ras. However, the proposed study required the utilization of bulky hospital equipment, such as a hospital bed, a simulated vehicle/van seat cabin, and a commode, which occasionally caused occlusions. A new marker set was devised for the Vicon 460 Motion Analysis System used in this study -triad marker sets that were placed on rigid body segments, such as the upper and lower extr emities. These triads raised the reflective markers above the surface of the skin by approximately fifteen millimeters. This had dramatic implications for improvin g line-of-site to multiple cameras within the array. These tr iads also afforded marker redundancy and thereby the opportunity to replace tem porarily occluded adjacent markers by using a programmable replacement functi on in the Vicon BodyBuilder program code. 3.5.1.2 Software Computational biomechanics pr ograms are afforded by the manufacturer, Vicon, for Gait and Balance clinicians as well as the motion picture industry, as these are the principal markets for this tec hnology. Dr. John Lloyd has developed new computational biomechanics programs usi ng the Vicon BodyBuilder software to specifically calculate in ternal biomechanics of the human musculoskeletal system that are more appropriate fo r patient handling operations.

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22 Figure 4. Vicon Bo dyBuilder Software The new program code defined how sets of markers were linked to represent rigid body segments, including head, torso, pelvis, etc. (Appendix I). Calculations were then performed within the model to accurately compute internal joint centers. Static anthropom etry of the human participant can be calculated by the model. Distances between adjacent joint centers were used to compute segment lengths. Segment weights were determined as a function of total body mass. Segment center of mass locations we re then computed as a proportion of segment length. Joint Angles betw een adjacent rigid body segments were computed within the model on a frame-by-fra me basis. Velocity and acceleration derivatives of linear and angul ar motions were also co mputed with hi-fidelity. Loads applied at the hands were measur ed dynamically using a pair of force sensing resistors. Data was captur ed at 120Hz and streamed into the Vicon software for further analysis. Joint forces were thus computed dynamically within

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23the model as a function of externally app lied loads and the sum of distal segment weights. 3.5.2 Gloves with Force Sensing Resistors Instrumented gloves were developed us ing force-sensing resistor (FSR) technology built into the palmar surface of fingerless gloves. These were used to dynamically capture external loading at the hands. Output from the FSRs was carefully calibrated using a Chatillon force gauge and was interfaced to the Vicon system through an A/D board. Figure 5. Instrumented Gloves 3.5.3 EMG System An eight-channel electromyography data acquisition technology was incorporated into the Vicon 460 Motion Analysis S ystem so that researchers could simultaneously capture muscle activity data for up to eight major muscle groups, 4 on the left side and 4 on the right side of the body, and integrate this data with biomechanical information from the Vicon BodyBuilder program.

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243.6 Description of Biomechanics Research Laboratory All data collection for this study was per formed in the biomechanics research lab at the VISN8 Patient Safety Center, in Tampa FL. This research lab, which occupies 1000 sq. ft., was orig inated in 1998 with funding from VHA Rehabilitation R&D serv ice and includes the follo wing state-of-the-art measurement systems: VICON 460 and HumanTRAC 3D human motion tracking, Fasstech digital electromyogr aphy, X-sensor pressure mapping, video thermography, laser Doppler measuremen t, Polar heart rate monitor, force measurement system, and LabView virtual inst rumentation. This lab is staffed with a PhD ergonomist, a PhD biomechanis t, a MS biomechanist and graduate students. The lab serves as a magnet to attract graduate students and faculty from the USF, College of Engineering, Department of Biomedical Engineering. These laboratory capabilities are used to scientifically examin e patient, provider, and technology defenses to prevent fa lls, bedrail entrapments, wandering, and pressure ulcers, while promoting safe patient handling and movement.

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25 Figure 6. Biomechanics Research Laboratory 3.7 Data Collection Protocol All subjects were fitted with 68 optical re flective markers that were applied to anatomical landmarks as per a carefully designed protocol. Additionally 8 EMG electrodes were affixed to pertinent majo r muscle groups: bilateral pectoralis major, deltoids, latisimus dorsi, and triceps Force sensing gloves were worn on left and right hands.

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26 Figure 7. Data Collection Mate rials Worn by Participants A data collection checklist was created to aid investigators in completing each of the complex data collection steps without e rror (Appendix H). Participants were asked to perform a series of independent acti vities. This included two stationary pressure relief tasks, one using the wheelchair armrests and one using the wheels, and three typical transfers between the standardi zed wheelchair and bed, commode, and vehicle. The order of task presentation was randomized (as per Appendix I). Data was collected using the Vicon motion capture system, EMG, and force gloves throughout task per formance for subsequent analysis. After performing each task, the subjects were asked to verbally rate the extent of pain experience during the per formance of each experiment task. A 5-minute period for rest and recovery was permitted between tasks.

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27 Figure 8. Pressure Relief: Armrest and Wheels Two pressure reliefs were performed: one using the armrest and one using the wheels. The subject pressed on the armrest, lifted buttock off the seat, held this position for 3 seconds, and then lowered back into the seat. This same process was repeated using the wheelchair wheels.

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28 Figure 9. Transfer from Wheelchair to Bed and from Bed to Wheelchair The subject transferred from a wheelchair to a bed, which was set at a distance of 45 cm. from the floor to the bed. The subject waited 10 seconds and transferred back into the wheelchair. T he subjects used their dominant right arm as the leading arm to transfer to the bed. This transfer was to simulate a level transfer.

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29 Figure 10. Transfer from Wheelchair to Toilet and Toilet to Wheelchair The wheelchair seat was 45 cm to the gr ound. The toilet seat was 38 cm to the ground. The wheelchair was positioned at approximately 90 to the toilet. The position was to simulate the bathroom si tuation. The subject transferred using his dominant right arm as the leading a rm. The subject transferred from the wheelchair to the toilet. For safety reas ons the subject was allowed to use the grab bar or seat, and transfer at his own pac e. After a 30 second rest the subject then transferred back to the wheelchair. The rest period was so short because the subjects wanted to spend as little time as possible on the toilet seat due to comfort reasons.

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30 Figure 11. Transfer from Wheelchair to Vehicle Seat and Vehicle Seat to Wheelchair The mock-up drivers seat was at a height of 58 cm above the ground. The wheelchair was positioned as close to t he seat as possible trying to simulate working around the door as an obstacle. T he total horizontal distance to transfer was approximately 30 cm. The subject tr ansferred at his own speed using the vehicle seat and the over head hand grip. The subject transferred using his right arm as the leading arm. After a 1 minute rest the s ubject transferred back into the wheelchair.

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313.8 Data Management Biomechanical analyses were applied to the model to compute joint angles, torques and moments acting on key body segments, such as the shoulders. Electromyography recordings were refer enced to a calibration measure so that muscle effort could be computed both as a direct force measurement and as a percentage of maximum voluntary contraction (MVC). Objective findings were compiled and analyzed across participants to identify those components of the transfer tasks t hat imposed the greatest biomechanical stresses on the musculoskeletal system, in particular, the shoulders.

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32 Chapter 4 Results Table 1. Subject Anth ropometric Measurements Variable Statistic Weight (kg) M (SD) 74.7 (12.7) kg Range 52-100 kg Stature (mm) M (SD) 1744.8 (61.0) kg Range 1651-1854 kg Body Mass Index M (SD) 24.7 (4.2) kg Range 19-33 kg Note M = Mean; SD = Standard Deviation; kg = kilograms; mm = millimeters.

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33Table 2. Demographic Characteristics of Subjects Variable Statistic Age M (SD) 47.8 (11.1) yrs Range 21-57 yrs Race African-American 20.0% Caucasian 50.0% Hispanic 30.0% SCI duration M (SD) 22.7 (11.9) yrs Range 1-37 yrs Level of injury T2 T6 60.0% T7 T12 20.0% L1-L2 10.0% Completeness Incomplete 10.0% Complete 90.0% Note M = Mean; SD = Standard Deviation; SCI = spinal cord injury.

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34Table 3. Shoulder Range of Motion and Strength of Subjects Left Right Variable Statistic ROM () Strength (lbs.) ROM () Strength (lbs.) Flexion M (SD) 166.0 (22.9) 12.7 (5.8) lbs 167.5 (17.6) 13.8 (6.4) lbs Range 125-180 2-22 lbs 133-180 2-27 lbs Extension M (SD) 49.3 (13.4) 14.6 (6.9) lbs 53.1 (15.5) 15.2 (6.8) lbs Range 23-65 6-25 lbs 16-66 5-24 lbs Abduction M (SD) 163.3 (28.0) 14.5 (6.9) lbs 164.8 (23.0) 14.6 (6.2) lbs Range 100-180 2-27 lbs 125-180 7-27 lbs External rotation M (SD) 78.5 (19.2) 6.4 (3.0) lbs 81.1 (17.1) 5.9 (3.3) lbs Range 42-90 3-13 lbs 48-90 1-10 lbs Note ROM = range of motion; M = Mean; SD = Standard Deviation.

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35 Figure 12. Pressure Relief Wheels Glove Force to Subject Weight Comparison This measurement (pressure relief wheels gl ove force) was a check to see if the subjects were squeezing with their hands, thus applying more force than just their body weight. The subjects mean fo rce data for a 3 second time interval was used to allow for the initial spike in force needed to lift the subject to the appropriate height. Seven subjects weight s were greater than the force at their gloves, which is what was desired. Subjects 6 and 7 had forces slightly greater than their body weight, and subject 9 had a 38 % greater force at his glove than his bodyweight. Subject 9 was squeezing much more than the other subjects. P/R-Wheels glove force to subject weight comparison 0.00 20.00 40.00 60.00 80.00 100.00 120.00 123456789 10 subject kg R&L GL/9.8 Weight kg

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36 Figure 13. Pressure Relief Armrest Glov e Force to Subject Weight Comparison This measurement (pressure relief armrest glove force) was also a check to see if the subjects were squeezing with thei r hands, thus applying more force than just their body weight. This pressure relief reading was much better. The bodyweights were approximately 50% higher t han the forces at the gloves. Only subject 7 had a force 17 % higher than his bodyweight, so was still squeezing with his hands. P/R-armrests glove force to subject weight comparison 0.00 20.00 40.00 60.00 80.00 100.00 120.00 123456789 10 subject kg R&L GL/9.8 Weight kg

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37Table 4. Pressure Relief Comparison Max L Shoulder Force N Max R Shoulder Force N Total Max Shoulder Force N Mean L Shoulder Force N Mean R Shoulder Force N Total Mean Shoulder Force N P/R Wheels 633.41 376.211009.62377.56180.42 557.98 P/R Armrest 320.65 402.09722.74192.63185.65 378.28 Totals 954.06 778.3 570.19366.07 Max L Shoulder Torque N Max R Shoulder Torque N Total Max Shoulder Torque N Mean L Shoulder Torque N Mean R Shoulder Torque N Total Mean Shoulder Torque N P/R Wheels 45867.08 19023.6464890.726238.848328.46 14567.3 P/R Armrest 15700.51 16002.3631702.873810.248207.09 12017.33 Totals 61567.59 35026 10049.0816535.55 Mean Shoulder work Nmm P/R Wheels 205 P/R Armrest 254 During the P/R using the wheels there was a 40% greater max shoulder force and a 47% greater mean shoulder force t han when using the armrest. The max shoulder force of over 1000 N was generated at the initial push off, during a P/R using the wheels, then the force dropped 45% to an average of 558 N. The max shoulder force of 722 N at the initial pus h off, during a P/R, using the Armrest, dropped 48% and then averaged 378 N.

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38During the P/R using the wheels there was a 104% greater max shoulder torque and a 17% greater mean shoulder torque than when using the armrest. As in the initial large amount of shoulder force there was al so a large amount of shoulder torque that dropped 77% during the P/R using the wheel s. The shoulder torque decreased 62% during the P/R using the armrest. Because of the greater distance the bodys Center of Mass (C OM) traveled during the P/R using the armrest, 24% more work was done. During the P/R using the wheels, the s ubjects mean shoulder force on the left side was 110% greater than the right side mean shoulder force. The P/R using the armrests was approximately even. During the P/R using the wheels, the torque on the right shoulder was 34% greater than on the left shoulder. During the P/R using the armrests, the right side torque was 115% greater than the left side torque.

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39Table 5. Subjects Hand Position for Data Collection Patient w/c to bed w/c to commode Pressure Relief wheels Pressure Relief armrests Kinematics X Ok ok X Kinetics X X X X LGlove F ok Ok ok ok RGlove F ok ok ok ok LHand ok ok ok ok 2 Sub 1 RHand ok ok ok ok Kinematics X X X X Kinetics ok ok ok ok LGlove F LOW ok ok ok RGlove F LOW ok ok ok LHand KNUCKLES ok ok ok 3 Sub 2 RHand FINGERTIPS ok ok ok Kinematics X X ok X Kinetics ok ok ok ok LGlove F ok LOW ok ok RGlove F UNFILTERED?ok ok ok LHand ok FINGERTIPSok ok 4 Sub 3 RHand KNUCKLES ok ok ok Kinematics X X X X Kinetics ok ok ok ok LGlove F ok LOW ok ok RGlove F ok ok ok ok LHand ok ok ok ok 5 Sub 4 RHand ok ok ok ok Kinematics X X X ok Kinetics RSIDE Y AXIS L&R MISSING SOME DATA ok ok LGlove F ok ok ok ok RGlove F X X ok ok LHand ok ok ok ok 6 Sub 5 RHand KNUCKLES ok ok ok Kinematics X X ok ok Kinetics ok NO DATA ok ok LGlove F ok ok ok ok RGlove F NOISY ok ok ok LHand ok ok ok ok 7 Sub 6 RHand KNUCKLES ok ok ok

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40Table 5. (Continued) Kinematics X X ok ok Kinetics ok ok ok ok LGlove F ok ok ok ok RGlove F LOW ok ok ok LHand ok ok ok ok 8 Sub 7 RHand KNUCKLES ok ok ok Kinematics X X ok X Kinetics ok ok ok ok LGlove F ok ok ok ok RGlove F ok HIGH ok ok LHand KNUCKLES ok ok ok 9 Sub 9 RHand ok Ok tight grip ok ok Kinematics x NO DATA ok x Kinetics ok NO DATA ok ok LGlove F ok NO DATA ok ok RGlove F ok NO DATA ok ok LHand KNUCKLES NO DATA ok ok 10 Sub 10 RHand KNUCKLES NO DATA ok ok Kinematics x x ok x Kinetics ok ok ok ok LGlove F ok ok ok ok RGlove F ok ok ok ok LHand KNUCKLES ok ok ok 11 Sub 8 RHand ok ok ok ok X = false reading Transfer data and EMG data were not able to be reported due to reasons that are discussed in section 5.1 (Limitati ons of Laboratory Devices and Equipment and the Recommended Changes.)

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41 Chapter 5 Discussion 5.1 Limitations of Laboratory Devices and Equipment and the Recommended Changes Since this was a pilot study attempti ng to use the Tekscan pads and the gloves, there was no information available to indi cate how durable they were. It was found that they varied in durability, and had to be replaced numerous times throughout the study. The force pads had to be hardwired with a 22 gauge wire as wireless was not possible. The data processing could not be viewed in realtime. All the data had to be gathered befor e the results could be calculated and any decisions could be made. The dat a processing included the motion analysis data, the force data, and the EMG data. The computers used in this study, which we re state-of-the-art at the time, could not easily handle trials of extended length. At best this was an inconvenience, but at worst certain trials could not even be opened after they were recorded. The capabilities of the 6-ca mera Vicon 460 Motion Analysis System used in this study were such that the automatic mark er labeling function worked correctly for the lower extremities but did not work correctly for the upper-body. This necessitated the time-consuming task of manually labeling every trial. Complicating the task of m anual labeling was the problem of the impaired marker visibility. With only six cameras, at leas t two of which are required to resolve the marker positions, marker positions were o ften obscured. Markers were difficult to label accurately when they disapp eared and reappeared. Furthermore, when enough markers were not visible, the kinematics and kinetics could not be

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42calculated. The wheelchair-vehicle trans fers, while the most interesting to examine, were also the most difficult for which to obtain adequate data. The wide cross-section of the wooden 2x4s used to construct the vehicle mock-up obscured most of the markers during the tr ial. For future st udies, a new vehicle mock-up should be built out of metal tubi ng with a much smaller cross-sectional area that would allow the recording of Vi con data without obscuring the markers. The marker resolving problems encountered during this study suggest that a 12camera Vicon MX system should be used in future studies. This new system should be able to resolve markers more accurately and reliably and should be able to auto-label more reliably than the 6-camera Vicon 460 system used for this study. The superior capabilities of this system should permit accurate data to be collected for all tasks and should require fa r less time for post-processing. The Vicon MX system comes with an upgraded com puter system that can handle all the anticipated processing needs. The force-detecting gloves worked well for simple tasks such as pressure relief, but performed inadequately for other tasks due to the following unforeseen complications: Surface of the hand was not always us ed. The subjects often preferred their fingertips or knuckles (which we re not instrumented) to the palm of the hand (which was instrumented). Direction of the force vector coul d not be accurately determined with single sensor force gloves. This may have resulted in inaccurate kinetics. Resistive sensors broke down wi th repeated use and did not measure forces accurately. Gloves that incorporate force sensors capable of meeting the demand of repeated use should be used in the future. Load cells were not present. Load cells should be used in newly designed devices, to supplement force data. With the advent of the new LifeMod program, from Vic on Motion Analysis, forces and torques may be calculated using only motion capture.

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43The EMG system used in this study presented problems in cluding poor data communication through telemetry, the re ference electrode positioning may not have been electrically neutral and may have biased the data, and the MVC tasks were not similar enough to functional mo tions utilized for the transfers. The specific direction and speed (static) of the muscle contraction during the MVC trial did not necessarily correspond to the orientation and speed (dynamic) of the muscle during the trials. A wired 16-c hannel EMG system should be utilized in future studies which would resolve these technological issues and allow accurate EMG data to be obtained. Another option would be to record MVCs while a subject is performing a maximum repet ition in a custom made device that incorporates a load cell and matches the task to be performed as closely as possible. 5.2 Discussion Under the original guidelines, this wheel chair study was to be completed in a one-year time frame. The VA was planning to purchase the Vicon 460 Motion Analysis System by March of 2003. D ue to purchasing constraints the Vicon system was installed in October of 2003. The purchaser, Dr. John Lloyd of the VA, was told that the Vicon software would process the input data and produce the force, moments, and torques necessa ry to do a complete biomechanical analysis. But, in actuality, the software was structured mainly for gait analysis. The upper body, specifically the shoulde r joint, was too complicated for the software program that had been supplied. To complicate matters further, the subjects were in wheelchairs, which bloc ked the markers from the cameras. Dr. Lloyd spent the next six months rewrit ing the supplied program while this researcher worked on new markers and triads that would allow us to capture the necessary body parts. Because of this time delay it was decided to add a transfer into a vehicle seat, which it was believed would simulate the most stressful transfer that a par aplegic would encounter duri ng the course of a day.

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44The subjects from the pool of VA paraplegics in Tam pa, Florida were to be supplied by a physician in the spinal co rd injury department. Due to unforeseen circumstances this researcher had to take over this task. Instead of gathering data in June of 2004 as originally plann ed, the months of June and July were spent obtaining subjects. The actual dat a gathering started in September of 2004. Since the original timeline for th is study had September of 2004 as the completion date, extensi ons were submitted. Transfers out of the wheelchair took ov er 6 times longer t han anticipated and it required twice as many hand positions than the transfers back into the chair. Among subjects there was an immense amount of variability in time and number of hand positions required for the transfers. Across all s ubjects for the identical transfer, the standard deviation of the ti me required was 118% of the mean and the standard deviation of the number of hand positions was 56% of the mean. A possible reason for this may have been that the wheelchair users tested appeared to be very cautious in transfe rring to unknown surfaces. This was observed by noting the multiple hand pl acements used before the subject felt comfortable enough to begin the transfer. The pressure reliefs were the best exam ples in the data gathering experiments. The limitations on the force gloves were still evident, but not as noticeable as in the transfers. The most useful readings were obtained from pressure reliefs performed using the armrest. The subj ects were able to keep their hands relatively flat on the armrest. When s ubjects used the wheels for the pressure relief, the tendency to grab the wheel was higher, probably due to a smaller round surface that was easier to grasp and was further away from the body. The peak shoulder forces when performing a pr essure relief were approximately 40% higher using the wheels then when usi ng the armrests. The peak shoulder torques when performing a pressure relief using the wheels were 100% greater than when using the armrest. There was a large difference when comparing right shoulder to left shoulder. When performi ng the P/R using the wheels the right

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45was 34% greater than the left. When per forming the P/R using the armrest the right was 115% greater than the left. The reason why the right shoulder has a higher torque value than the left shoulder is not clear. There is a possibility the right glove data was not accurate. Fu rther study on this issue is needed. Work performed during seated pressure reliefs using the armrests was 24% greater than when using the wheels, due to greater distance through which the center of mass (COM) was mo ved. While pressure relief using the wheels may seem easier to patients due to a reduced workload, pressure relief using the armrests is preferred for long-term use, as joint forces and torques are lower at the shoulder, elbow and wrist. It is benefic ial to keep the arms as close to the body as possible, such as when using the armrests, which reduces joint torques. Thus, the risk of injury due to cumulative trauma would be expected to be lower for pressure relief using the armrests t han for pressure relief using the wheels. However, a design modification to the w heelchair armrests that allows them to drop down to a height sufficient enough to al low the user to clear their buttocks off the seat for pressure relief shoul d provide the benefit s of both reduced workload and lower peak forces and torques. The vehicle transfers, in general, took more than twice as long and required almost twice as many hand positions as the other transfers. This was due to a number of factors -the v ehicle seat was 20 cm higher than the wheelchair seat resulting in an uphill transfer (no height difference for other transfers); the horizontal distance to the seat from t he wheelchair was relatively large at approximately 30 cm; subjects could not use anything on the vehicle door as a handhold, since it was not structurally as sound as a real vehicle door; and the mockup had no steering wheel, which many s ubjects said they use for transfers into and out of vehicles. It was obser ved that the three individuals with the greatest muscular strength in relation to their body mass could more easily lift their bodies up into the vehicle seat com pared to the difficult experience of the other subjects. These three stronger subj ects regularly participate in weight

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46training programs. The importance of tr aining and diet are especially important for SCI patients who place high demands on their UEs during ADLs. The strength needed is reduced as mass is reduc ed, if greater strength is present then more mass can be lifted or transferred. The difficulty of these transfers indicates a need for better technology to a ssist the wheelchair user to get into and out of a vehicle. Existing technolog ies include slide boards and vehicle lifts, which require a sling and works similar to that of a floor based lift. A vehicle lift does not allow for independent vehicle transfers, as assistance is needed to bring the lift to the vehicle. Vehicle s eats are also available which rotate out allowing the wheelchair user to safe ly transfer independently. Perhaps a consideration for addressing uphill transfe rs may be to design base wheelchairs so that they are height adj ustable and could be raised to the level of the vehicle, facilitating an easier and quicker transfe r for wheelchair dependent patients. Future studies are needed to evaluat e technologies for vehicle ingress and egress, and how much muscular strength in relation to body composition are factors for a patient to safe ly transfer into a vehicle if no assistive devices are available. When subjects transferred from the wheelchair to the commode they used the grab bar more often than the seat. While the grab bar is a more secure and safe handhold for immediate use, its position and distance from the subjects body required more effort by the subject. T he reach necessary imposed greater stress on the active shoulder joint. The strain to the shoulder is similar to a gymnast performing an iron cross on the rings, and t hese subjects were no gymnasts. The subjects that attempted this transfe r by using the comm ode seat rather than the grab bars were more able and confident in their abilities and likely perceived the threat to their hand slip ping off the seat edge or t he seat breaking under the hand forces to be minimal. Results indicate that grasping the comm ode seat instead of t he grab bar may be biomechanically preferable, although unconventional practice for public washrooms. These results indicate t hat the grab bar may actually be more

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47dangerous in terms of long term cumulative trauma injury, but further research in this area is required to verify this. By using the toilet seat, the patient reduces shoulder torque by keeping the arms as close to the torso as possible. A potential solution may be in the design of handles for the commode. Two handles could be provided in the front of the bo wl at approximately 50 degrees from the center of the bowl, one handle on each side. These handles would need to be strong enough to accommodate a persons bodyweight. The handles could be built into the seat so as to enable retro fi tting toilets that ar e already in place. Patients should be trained on the best techni que to transfer from a wheelchair to a bed. The patient will then usually adopt the best transfer technique depending on their functional ability and strength. Strength training should be performed with all new wheelchair depend ent patients to develop muscles key in transfers. These muscle groups are pectoralis ma jor, trapezius, biceps and triceps, post/anterior deltoids, and rhomboids. Strengthening these muscles in new wheelchair users will prepare them to per form wheelchair transfers easier and safer. Training should be facilitated with and without an assistive device and patients should practice both methods. Another factor that makes wheelchair to bed transfers challenging is transferring to specialty mattresses. Some mattresse s air features make hand placement difficult and uneven, thus creating an uns table surface to use for support. To solve this issue, there is a feature av ailable called perimeter edge or bolster on mattresses, which provide a firm surface fa cilitating an easier lateral transfer. This feature is commercially available. Another option would be to inflate the mattress to its maximum setting so that the entire surface becomes as firm as possible prior to performing the transfer.

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48 Chapter 6 Conclusions 6.1 Significance of this Study A lot of information during this study ca me from observing the subjects while trying to perform the transfer and pre ssure relief tasks. The transfers in descending order from the most dem anding to the least demanding were as follows: vehicle, commode, and bed. The s ubjects were able to perform pressure relief tasks with minimal effort even t hough some of the forces and torques, especially pressure relief using wheels, were considerably higher than using armrests. It seems that t he key element is to keep the task as close to a linear, single plane activity as possible. T he reaching out away from the body while twisting and trying to lift or lower ones elf (abduction, adduction, internal and external rotation of the humerus) makes it very easy to go past the capabilities of the individual. The pressure relief ta sk, if done properly, while having some high forces, could actually be beneficial as a strengthening tool for the shoulder, chest, and tricep muscles. If ones body mass or lack of strength prevents the pressure relief from being performed, then the individual cannot perform a transfer without risk of injury. The subjec ts who weight trained regularly were able to easily perform the pressure relief tasks and while more difficult, could do all the transfers.

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496.2 Future Work It is very difficult to capture a paraplegic individual during the cour se of a transfer. To use a motion capture system such as t he Vicon 460, it would be necessary to eliminate the marker occl usion problem. This could be done by increasing to a 10-camera system and also by constructi ng the van or vehicle simulator using small .5 inch tubular steel that reduces the diameter of the support structure by 95 %. An instrumented steering wheel that coul d capture forces would be of great benefit since all of the subj ects stated that they use the steering wheel to help them transfer into the vehicle. Brian Schulz, Ph.D., at the V.A. ha s been researching alternatives to the Tekscan force sensors. One technolog y that was found promising was the Quantum tunneling composites (QTC) which are available in 5 and 13 mm circles and 40 mm squares, but custom sizes are available. The company claims "significant benefits over existing technologi es, in reliability, ruggedness, flexibility and cost". Multiple sensors on the palma r surface of the hand should be used to quantify gripping forces from opposing digi ts. The knuckle sensor is required because prior research has shown that a closed hand posture is utilized during various independent transfer tasks. A future study should compare the strengt h training component in two groups of SCI wheelchair users to observe if there is a significant benefit. Both groups of users would be taught similar technique in te rms of how to safely transfer out of a wheelchair, but the experimental group woul d receive additional strength training on key muscles groups in addition to tec hnique. This stud y design will benefit and may potentially affect the rehabilitative component of SCI patients at early onset of injury.

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50Measuring an individuals strength, re lative to body mass, and endurance would help to better know what the shoulder, c hest, and arm soft tissue limits are when lifting and transferring bodyweight many times throughout the day. A possible question to study would be -are pressure reliefs detrimental or can they be used as a training aid? With the advent of the new LifeMod program, forces and torques are able to be calculated using only motion capture. After observing th e varied difficulty levels during all tasks, the benefit of knowing the strength and flex ibility of a subject, in relation to their body mass, would benef it the patient and the therapist. Measuring the patients str ength both statically and dyna mically with a Biodex or similar piece of equipment would be usef ul, to have a baseline to which to compare the forces and moments. Tissue damage occurs when it is subjected to a certain loading threshold. As one trains and gets stronger, this loading threshold increases. Not only do the th resholds for muscle and ligament damage increase, but work load capacity also increases. The increased work load capacity decreases the fatigue factor -muscle fatigue is a gradual linear reduction of muscular force generating capacit y, which is a result of inadequate muscle recovery time. When muscles ar e fatigued and can no longer contract or function properly, other muscles must now be utilized, that can lead to injury because of a task being performed improper ly. Concentrating on these areas can also improve overall healt h and build self confidence.

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51 References 1. Curtis, K.A., et al., Shoulder pain in wheelchair users with tetraplegia and paraplegia. Arch Phys Med Rehabil, 1999. 80(4): p. 453-7. 2. Center, N.S.C.I.S., Spinal Cord Injury Facts and Figures at a Glance 2004. 3. Mulroy, S.J., et al., Electromyographic activity of shoulder muscles during wheelchair propulsion by paraplegic persons. Arch Phys Med Rehabil, 1996. 77(2): p. 187-93. 4. Reyes, M.L., et al., Electromyographic analysis of shoulder muscles of men with low-level paraplegia during a weight relief raise. Arch Phys Med Rehabil, 1995. 76( 5): p. 433-9. 5. Perry, J., et al., Electromyographic analysis of the shoulder muscles during depression transfers in subj ects with low-level paraplegia. Arch Phys Med Rehabil, 1996. 77(4): p. 350-5. 6. Gronley, J.K., et al., Electromyographic and kinematic analysis of the shoulder during four activities of daily living in men with C6 tetraplegia. J Rehabil Res Dev, 2000. 37(4): p. 423-32. 7. Gagnon, D., et al., Movement patterns and muscular demands during posterior transfers toward an elevated surface in individuals with spinal cord injury. Spinal Cord, 2005. 43(2): p. 74-84. 8. Finley, M.A., K.J. McQuade, and M.M. Rodgers, Scapular kinematics during transfers in manual wheelc hair users with and without shoulder impingement. Clin Biomech (Bristol, Av on), 2005. 20(1): p. 32-40. 9. Mulroy, S.J., et al., Effects of spinal cord injury level on the activity of shoulder muscles during wheelchair propulsion: an electromyographic study. Arch Phys Med Rehabil, 2004. 85(6): p. 925-34. 10. Wang, Y.T., et al., Reaction force and EMG analyses of wheelchair transfers. Percept Mot Skills, 1994. 79(2): p. 763-6.

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5211. Gellman, H., I. Sie, and R.L. Waters, Late complications of the weightbearing upper extremity in the paraplegic patient. Clin Orthop, 1988(233): p. 132-5. 12. Dalyan, M., D.D. Cardenas, and B. Gerard, Upper extremity pain after spinal cord injury. Spinal Cord, 1999. 37(3): p. 191-5. 13. Subbarao, J.V., J. Klopfstein, and R. Turpin, Prevalence and impact of wrist and shoulder pain in patient s with spinal cord injury. J Spinal Cord Med, 1995. 18(1): p. 9-13. 14. Finley, M.A. and M.M. Rodgers, Prevalence and identification of shoulder pathology in athletic and nonathletic wheelchair users with shoulder pain: A pilot study. J Rehabil Res Dev, 2004. 41(3B): p. 395-402. 15. Bayley, J.C., T.P. Co chran, and C.B. Sledge, The weight-bearing shoulder. The impingement syndrome in paraplegics. J Bone Joint Surg Am, 1987. 69(5): p. 676-8. 16. Gironda, R.J., et al., Upper limb pain in a national sample of veterans with paraplegia. J Spinal Cord Med, 2004. 27(2): p. 120-7. 17. Barber, D.B. and N.G. Gall, Osteonecrosis: an overuse injury of the shoulder in paraplegia: case report. Paraplegia, 1991. 29(6): p. 423-6. 18. Kocina, P., Body composition of spinal cord injured adults. Sports Med, 1997. 23(1): p. 48-60. 19. Seelen, H.A. and E.F. Vuurman, Compensatory muscle ac tivity for sitting posture during upper extremity task performance in paraplegic persons. Scand J Rehabil Med, 1991. 23(2): p. 89-96. 20. Rodgers, M.M., et al., Biomechanics of wheelchair propulsion during fatigue. Arch Phys Med Rehabil, 1994. 75(1): p. 85-93. 21. Hobson, D.A. and R.E. Tooms, Seated lumbar/pelvic alignment. A comparison between spinal cord-injured and noninjured groups. Spine, 1992. 17(3): p. 293-8.

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53 Appendices

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54Appendix A. Manual Muscle Testing SUBJ# _____ Name: _____________________ _________ Date: ______/______/2004 Table 6. Manual Muscle Testing Data Muscle group Action MMT1 (kg) MMT2 (kg) MMT3 (kg) Pain Score (0-10) Elevation Depression Protraction Left Scapula Retraction Elevation Depression Protraction Right Scapula Retraction Flexion Extension Abduction Adduction Ext rotation Left Glenohumeral Int rotation Right Glenohumeral Flexion

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55Appendix A. (Continued) Table 6. (Continued) Extension Abduction Adduction Ext rotation Int rotation Flexion Right elbow Extension Flexion Left elbow Extension Left wrist Extension Right wrist Extension LHand Power Grip Flexion RHand Power Grip Flexion

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56Appendix B. Active Range of Motion Testing SUBJ# _____ Name: _____________________ _________ Date: ______/______/2004 Table 7. Active Range of Motion Testing Dada Location AROM Measure Deficit Pain (degrees) (comp to norm) (0-10) Left Shoulder Flexion Extension Abduction Adduction Internal rotation External rotation Right Shoulder Flexion Extension Abduction Adduction Internal rotation External rotation

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57Appendix C. FABQ-P SUBJ# _____ Name: _____________________ _________ Date: ______/______/2004 Here are some of the things which other patients have told us about their pain. For each statement, please circle any number from 0 to 4 to say how much physical activities such as bending, lifting, walking or driving affect or w ould affect your back pain. 1. Physical activity makes my pain worse 0 1 2 3 4 NA 2. Physical activity mi ght harm me 0 1 2 3 4 NA 3. I should not do physical activities which (might) make my pain worse 0 1 2 3 4 NA 4. I cannot do physical activities which (might) make my pain worse 0 1 2 3 4 NA

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58Appendix D. Physi cian Evaluation SUBJ# _____ Name: ____________ __________________ Date: _____/_____/2004 Table 8. Physician Evaluation Data Acceptable Unacceptable Informed Consent Demographic Questionnaire Health Questionnaire Pain Rating Scale Review from medical file: Medications ASIA level Cardiac: Pulmonary: Peripheral vascular Endocrine Rheumatology PT: Anthropometry Survey PT: Range-of-Motion Testing PT: Manual Muscle Testing

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59Appendix D. (Continued) Table 8. (Continued) After evaluating the subjects history and pertinent physical findings, this subject may safely participate in the wheelchair transfer study. Signature of physician: Date: Subject not recommended for participation. Reason: Signature of physician: Date:

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60Appendix E. Demographic Questionnaire SUBJ# _____ Name: ____________ __________________ Date: _____/_____/2004 Age: __________ yrs. Gender: Male / Female (please circle) Race (please circle): White / Afric an American / Asian / Hispanic / Native American / Other Dominant Hand (please circ le): Left / Right Are you a smoker (please circle )? Yes / No If Yes, please indicate: [L ight (1-5 /day); Medium(520 /day); Heavy (20+/day)] What is your occupation? _______________________ ____________________ What physical activities does your job involve? ________________________ _____________________ ___________________ ________________________ __________________ ______________________ ________________________ _____________________ ___________________ What leisure / recreational activi ties do you pursue? How often? ________________________ _____________________ ___________________ ________________________ __________________ ______________________ ________________________ _____________________ ___________________

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61Appendix F. Health Questionnaire SUBJ# _____ Name: ___________________________ ___ Date: _____/_____/2004 What is the level of your Spinal Cord Injury? Is your injury: Complete or Incomplete (please circle) What is the duration since initial injury? Have you developed any secondary conditions? Any current or recent decubitus ul cers / pressure sores? YES / NO (please circle) If Yes, please describe: ________________________ _____________________ _______________ Any current or recent Upper Extremit y injuries or surgeries? YES / NO (please circle) If Yes, please describe: ________________________ _____________________ _______________ What medications are you presently taking?

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62Appendix G. Anthropometry Survey SUBJ# _____ Name: Date: ______/______/2004 Table 9. Anthropometry Survey Data Anthropometry Measures 1 Weight (ask) kg lb 2 Stature (ask) mm ft/in 3 Body Mass Index (calculated) 4 Abdominal Depth mm in 5 Inter-Asis Distance mm in 6 Upper Leg Length (popliteal to trochanter) mm in 7 Lower Leg Length (ankle to popliteal) mm in 8 Footrest to Popliteal height (no shoe) mm in 9 Hand length (fingertip to wrist crease) mm in 10 Hand Thickness mm in

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63Appendix H. Data Collect ion Protocol Checklist Table 10. Data Collection Protocol Checklist Check Item Time/min Informed Consent 15 Demographic Questionnaire 5 Health Questionnaire 5 Pain Rating Scale 5 Anthropometry Survey 10 Range-of-Motion Testing 20 Manual Muscle Testing 20 Evaluation subtotal 80 min Restroom break Recycle all power Vicon co mputer, Desktop computer, camera, EMG, A/D Power Supply 2 Calibrate Vicon system 15 Install EMG Telemetry pack 3 Install EMG Electrodes: 1&2=L/ R Anterior Deltoid; 3&4=L/R Pectoralis Major; 5&6=Lattisimu s Dorsi; 7&8=L/R Triceps; [Alt 7&8=L/r Biceps for Trapeze] 10 Install Vicon Triads 15 Last chance for restroom break Install Gloves 5 Install Markers 30 Vicon setup subtotal 80 min Static Vicon Data Capture Laying 5 Static Vicon Data Ca pture: 0,120,240 degrees 5 MVC: in order as presented above 15 Transfers (order randomized as per following table) Pressure Relief Task (using wheelchair wheels) 5 Pressure Relief Task (using wheelchair armrests) 5

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64Appendix H. (Continued) Table 10. (Continued) Wheelchair to Bed / Bed to Wheelchair 15 Wheelchair to Vehi cle / Vehicle to Wheelchair 15 Wheelchair to Co mmode / Commode to Wheelchair 15 Switch EMG electrodes 7&8 (L/R Triceps) to Alt 7&8 (L/R Biceps) 5 MVC: L/R Biceps 5 Transfer to Bed in Supine position (not evaluated) 5 Repositioning using Tr apeze Bar: 2-handed; 1-handed (dominant side) 10 Data collection subtotal 105 min TOTAL 200 min

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65Appendix I. Order of Transfer Tasks Table 11. Order of Transfer Tasks Task1 Task2 Task3 Subject 0 Vehicle Bed Commode Subject 1 Bed Vehicle Commode Subject 2 Bed Commode Vehicle Subject 3 Commode Vehicle Bed Subject 4 Commode Bed Vehicle Subject 5 Commode Vehicle Bed Subject 6 Vehicle Bed Commode Subject 7 Commode Vehicle Bed Subject 8 Vehicle Bed Commode Subject 9 Bed Commode Vehicle Subject 10 Vehicle Commode Bed Subject 11 Bed Commode Vehicle

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66Appendix J. Vicon Bo dyBuilder Program !MKR#2 [Autolabel] GLAB Glabellum LTEM Left Temple RTEM Right Temple LMAS Left Mastoid Process RMAS Right Mastoid Process CSPN C7 Posterior vertebral prominance CLAV Clavicle STRN Sternum CHST (Optional Asymmetry Marker) LSCS Left Scapula Superior Prominence LSCI Left Scapula Inferior Prominence RSCS Right Scapula Superior Prominence RSCI Right Scapula Inferior Prominence LACR Left Acromium LHT1 Left Humerus Triad Marker 1 LHT2 Left Humerus Triad Marker 2 LHT3 Left Humerus Triad Marker 3 LELB Left Lateral Elbow LMEL Left Medial Elbow LRT1 Left Radius Triad Marker 1 LRT2 Left Radius Triad Marker 2 LRT3 Left Radius Triad Marker 3 LRAD Left Radius LULN Left Ulnar LFIN Left Hand 2nd Meta-Carpal LLFI Left Hand 5th Meta-Carpal RACR Right Acromium RHT1 Right Humerus Triad Marker 1 RHT2 Right Humerus Triad Marker 2 RHT3 Right Humerus Triad Marker 3

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67Appendix J. (Continued) RELB Right Lateral Elbow RMEL Right Medial Elbow RRT1 Right Radius Triad Marker 1 RRT2 Right Radius Triad Marker 2 RRT3 Right Radius Triad Marker 3 RRAD Right Radius RULN Right Ulnar RFIN Right Hand 2nd Meta-Carpal RLFI Right Hand 5th Meta-Carpal MPEL Mid-Pelvis LASI Left Anterior Illiac Spine RASI Right Anterior Illiac Spine LSIS Left Superior Illiac Spine RSIS Right Superior Illiac Spine LFT1 Left Femur Triad Marker 1 LFT2 Left Femur Triad Marker 2 LFT3 Left Femur Triad Marker 3 LKNE Left Lateral Knee LMKN Left Medial Knee LTT1 Left Tibia Triad Marker 1 LTT2 Left Tibia Triad Marker 2 LTT3 Left Tibia Triad Marker 3 LANK Left Ankle LMAN Left Medial Ankle LTOE Left Foot 2nd Meta-Tarsal LLTO Left Foot 5th Meta-Tarsal RFT1 Right Femur Triad Marker 1 RFT2 Right Femur Triad Marker 2 RFT3 Right Femur Triad Marker 3 RKNE Right Lateral Knee RMKN Right Medial Knee RTT1 Right Tibia Triad Marker 1 RTT2 Right Tibia Triad Marker 2 RTT3 Right Tibia Triad Marker 3 RANK Right Ankle RMAN Right Medial Ankle

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68Appendix J. (Continued) RTOE Right Foot 2nd Meta-Tarsal RLTO Right Foot 5th Meta-Tarsal Head = GLAB,LTEM,RTEM,LMAS,RMAS Thorax = CSPN,CL AV,STRN,LACR,RACR,CHST Abdomen = STRN,LASI,RASI LeftScapula = LACR,LSCS,LSCI RightScapula = RACR,RSCS,RSCI Pelvis = MPEL,LASI,RASI,LSIS,RSIS LeftHumerus = LACR,LELB,LMEL,LHT1,LHT2,LHT3 LeftRadius = LELB,LMEL,LRAD,LULN,LRT1,LRT2,LRT3 LeftHand = LRAD,LULN,LFIN,LLFI RightHumerus = RACR,RELB,RMEL,RHT1,RHT2,RHT3 RightRadius = RELB,RME L,RRAD,RULN,RRT1,RRT2,RRT3 RightHand = RRAD,RULN,RFIN,RLFI LeftFemur = LASI,LSIS,LKNE,LMKN,LFT1,LFT2,LFT3 LeftTibia = LKNE,LMKN,LANK,LMAN,LTT1,LTT2,LTT3 LeftFoot = LANK,LMAN,LTOE,LLTO RightFemur = RASI,RSIS,RKNE,RMKN,RFT1,RFT2,RFT3 RightTibia = RKNE,RMKN,RANK,RMAN,RTT1,RTT2,RTT3 RightFoot = RANK,RMAN,RTOE,RLTO Head,Thorax Thorax,Abdomen Abdomen,Pelvis Thorax, LeftScapula Thorax,LeftHumerus LeftHumerus,LeftRadius LeftRadius,LeftHand Thorax, RightScapula Thorax,RightHumerus RightHumerus,RightRadius RightRadius,RightHand Pelvis,LeftFemur LeftFemur,LeftTibia LeftTibia,LeftFoot Pelvis,RightFemur RightFemur,RightTibia RightTibia,RightFoot [Axis Visualization] ORIGINHead AXISXHead AXISYHead

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69Appendix J. (Continued) AXISZHead ORIGINHead,AXISXHead ORIGINHead,AXISYHead ORIGINHead,AXISZHead ORIGINCSpine AXISXCSpine AXISYCSpine AXISZCSpine ORIGINCSpine,AXISXCSpine ORIGINCSpine,AXISYCSpine ORIGINCSpine,AXISZCSpine ORIGINThorax AXISXThorax AXISYThorax AXISZThorax ORIGINThorax,AXISXThorax ORIGINThorax,AXISYThorax ORIGINThorax,AXISZThorax ORIGINPelvis AXISXPelvis AXISYPelvis AXISZPelvis ORIGINPelvis,AXISXPelvis ORIGINPelvis,AXISYPelvis ORIGINPelvis,AXISZPelvis ORIGINLClavicle AXISXLClavicle AXISYLClavicle AXISZLClavicle ORIGINLClavicle,AXISXLClavicle ORIGINLClavicle,AXISYLClavicle ORIGINLClavicle,AXISZLClavicle ORIGINRClavicle AXISXRClavicle AXISYRClavicle AXISZRClavicle ORIGINRClavicle,AXISXRClavicle ORIGINRClavicle,AXISYRClavicle ORIGINRClavicle,AXISZRClavicle

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70Appendix J. (Continued) ORIGINLScapula AXISXLScapula AXISYLScapula AXISZLScapula ORIGINLScapula,AXISXLScapula ORIGINLScapula,AXISYLScapula ORIGINLScapula,AXISZLScapula ORIGINRScapula AXISXRScapula AXISYRScapula AXISZRScapula ORIGINRScapula,AXISXRScapula ORIGINRScapula,AXISYRScapula ORIGINRScapula,AXISZRScapula ORIGINLHumerus AXISXLHumerus AXISYLHumerus AXISZLHumerus ORIGINLHumerus,AXISXLHumerus ORIGINLHumerus,AXISYLHumerus ORIGINLHumerus,AXISZLHumerus ORIGINRHumerus AXISXRHumerus AXISYRHumerus AXISZRHumerus ORIGINRHumerus,AXISXRHumerus ORIGINRHumerus,AXISYRHumerus ORIGINRHumerus,AXISZRHumerus ORIGINLRadius AXISXLRadius AXISYLRadius AXISZLRadius ORIGINLRadius,AXISXLRadius ORIGINLRadius,AXISYLRadius ORIGINLRadius,AXISZLRadius ORIGINRRadius AXISXRRadius AXISYRRadius AXISZRRadius

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71Appendix J. (Continued) ORIGINRRadius,AXISXRRadius ORIGINRRadius,AXISYRRadius ORIGINRRadius,AXISZRRadius ORIGINLHand AXISXLHand AXISYLHand AXISZLHand ORIGINLHand,AXISXLHand ORIGINLHand,AXISYLHand ORIGINLHand,AXISZLHand ORIGINRHand AXISXRHand AXISYRHand AXISZRHand ORIGINRHand,AXISXRHand ORIGINRHand,AXISYRHand ORIGINRHand,AXISZRHand ORIGINLFemur AXISXLFemur AXISYLFemur AXISZLFemur ORIGINLFemur,AXISXLFemur ORIGINLFemur,AXISYLFemur ORIGINLFemur,AXISZLFemur ORIGINRFemur AXISXRFemur AXISYRFemur AXISZRFemur ORIGINRFemur,AXISXRFemur ORIGINRFemur,AXISYRFemur ORIGINRFemur,AXISZRFemur ORIGINLTibia AXISXLTibia AXISYLTibia AXISZLTibia ORIGINLTibia,AXISXLTibia ORIGINLTibia,AXISYLTibia ORIGINLTibia,AXISZLTibia

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72Appendix J. (Continued) ORIGINRTibia AXISXRTibia AXISYRTibia AXISZRTibia ORIGINRTibia,AXISXRTibia ORIGINRTibia,AXISYRTibia ORIGINRTibia,AXISZRTibia ORIGINLFoot AXISXLFoot AXISYLFoot AXISZLFoot ORIGINLFoot,AXISXLFoot ORIGINLFoot,AXISYLFoot ORIGINLFoot,AXISZLFoot ORIGINRFoot AXISXRFoot AXISYRFoot AXISZRFoot ORIGINRFoot,AXISXRFoot ORIGINRFoot,AXISYRFoot ORIGINRFoot,AXISZRFoot [Joint Centers] LSJC Left Shoulder Joint Center RSJC Right Shoulder Joint Center LEJC Left Elbow Joint Center REJC Right Elbow Joint Center LWJC Left Wrist Joint Center RWJC Right Wrist Joint Center LFIN Left ForeFinger RFIN Right ForeFinger LHJC Left Hip Joint Center RHJC Right Hip Joint Center LKJC Left Knee Joint Center RKJC Right Knee Joint Center LAJC Left Ankle Joint Center RAJC Right Ankle Joint Center LSID L5S1 Intervertebral Disc LTOE Left Toe RTOE Right Toe

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73Appendix J. (Continued) LSJC,LEJC LEJC,LWJC LWJC,LFIN RSJC,REJC REJC,RWJC RWJC,RFIN LSJC,RSJC LSJC,LSID RSJC,LSID LSID,LHJC LSID,RHJC LHJC,RHJC LHJC,LKJC LKJC,LAJC LAJC,LTOE RHJC,RKJC RKJC,RAJC RAJC,RTOE [Centers of Mass] HEDCM Head CoM THRCM Thorax CoM PELCM Pelvis CoM LHUCM Left Humerus CoM RHUCM Right Humerus CoM LRACM Left Radius CoM RRACM Right Radius CoM LHACM Left Hand CoM RHACM Right Hand CoM LFECM Left Femur CoM RFECM Right Femur CoM LTICM Left Tibia CoM RTICM Right Tibia CoM LFOCM Left Foot CoM RFOCM Right Foot CoM WBCOM Whole Body CoM HEDCM,WBCOM THRCM,WBCOM PELCM,WBCOM LHUCM,WBCOM LRACM,WBCOM LHACM,WBCOM

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74Appendix J. (Continued) RHUCM,WBCOM RRACM,WBCOM RHACM,WBCOM LFECM,WBCOM LTICM,WBCOM LFOCM,WBCOM RFECM,WBCOM RTICM,WBCOM RFOCM,WBCOM [Joint Centers & CoM] LSJC Left Shoulder Joint Center RSJC Right Shoulder Joint Center LEJC Left Elbow Joint Center REJC Right Elbow Joint Center LWJC Left Wrist Joint Center RWJC Right Wrist Joint Center LFIN Left ForeFinger RFIN Right ForeFinger LHJC Left Hip Joint Center RHJC Right Hip Joint Center LKJC Left Knee Joint Center RKJC Right Knee Joint Center LAJC Left Ankle Joint Center RAJC Right Ankle Joint Center LSID L5S1 Intervertebral Disc LTOE Left Toe RTOE Right Toe HEDCM Head CoM THRCM Thorax CoM PELCM Pelvis CoM LHUCM Left Humerus CoM RHUCM Right Humerus CoM LRACM Left Radius CoM RRACM Right Radius CoM LHACM Left Hand CoM RHACM Right Hand CoM LFECM Left Femur CoM RFECM Right Femur CoM LTICM Left Tibia CoM RTICM Right Tibia CoM LFOCM Left Foot CoM

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75Appendix J. (Continued) RFOCM Right Foot CoM WBCOM Whole Body CoM LSJC,LEJC LEJC,LWJC LWJC,LFIN RSJC,REJC REJC,RWJC RWJC,RFIN LSJC,RSJC LSJC,LSID RSJC,LSID LSID,LHJC LSID,RHJC LHJC,RHJC LHJC,LKJC LKJC,LAJC LAJC,LTOE RHJC,RKJC RKJC,RAJC RAJC,RTOE [Kinematics1-Joint Angles] Neck_Angle Neck Angle Spine_Angle Lumbar Spine Angle LClavicle_Angle Left Clavicle Angle RClavicle_Angle Right Clavicle Angle LScapula_Angle Left Scapula Angle RScapula_Angle Right Scapula Angle LShoulder_Angle Left Shoulder Angle RShoulder_Angle Ri ght Shoulder Angle LElbow_Angle Left Elbow Angle RElbow_Angle Right Elbow Angle LWrist_Angle Left Wrist Angle RWrist_Angle Right Wrist Angle LHip_Angle Left Hip Angle RHip_Angle Right Hip Angle LKnee_Angle Left Knee Angle RKnee_Angle Right Knee Angle LAnkle_Angle Left Ankle Angle RAnkle_Angle Right Ankle Angle

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76Appendix J. (Continued) [Kinematics2-Linear Velocity] Head_LinVel Linear Velocity Head CoM Thorax_LinVel Linear Velocity Thorax CoM Pelvis_LinVel Linear Velocity Pelvis CoM LHumerus_LinVel Linear Ve locity Left Humerus CoM RHumerus_LinVel Linear Velocity Right Humerus CoM LRadius_LinVel Linear Ve locity Left Radius CoM RRadius_LinVel Linear Velo city Right Radius CoM LHand_LinVel Linear Velocity Left Hand CoM RHand_LinVel Linear Velo city Right Hand CoM LFemur_LinVel Linear Velocity Left Femur CoM RFemur_LinVel Linear Velo city Right Femur CoM LTibia_LinVel Linear Velocity Left Tibia CoM RTibia_LinVel Linear Velo city Right Tibia CoM LFoot_LinVel Linear Ve locity Left Foot CoM RFoot_LinVel Linear Velo city Right Foot CoM [Kinematics3-Absolute Linear Velocity] Head_AbsLinVel Absolute Linear Velocity Head CoM Thorax_AbsLinVel Absolute Linear Velocity Thorax CoM Pelvis_AbsLinVel Absolute Linear Velocity Pelvis CoM LHumerus_AbsLinVel Absolute Li near Velocity Left Humerus CoM RHumerus_AbsLinVel Absolute Linear Velocity Right Humerus CoM LRadius_AbsLinVel Absolute Li near Velocity Left Radius CoM RRadius_AbsLinVel Absolute Linear Velocity Right Radius CoM LHand_AbsLinVel Absolute Linear Velocity Left Hand CoM RHand_AbsLinVel Absolute Linear Velocity Right Hand CoM LFemur_AbsLinVel Absolute Li near Velocity Left Femur CoM RFemur_AbsLinVel Absolute Linear Velocity Right Femur CoM LTibia_AbsLinVel Absolute Li near Velocity Left Tibia CoM RTibia_AbsLinVel Absolute Li near Velocity Right Tibia CoM LFoot_AbsLinVel Absolute Linear Velocity Left Foot CoM RFoot_AbsLinVel Absolute Linear Velocity Right Foot CoM [Kinematics4-Linear Acceleration] Head_LinAcc Linear Acceleration Head CoM Thorax_LinAcc Linear Acceleration Thorax CoM Pelvis_LinAcc Linear Acceleration Pelvis CoM LHumerus_LinAcc Linear Acce leration Left Humerus CoM RHumerus_LinAcc Linear Acceleration Right Humerus CoM LRadius_LinAcc Linear Acceleration Left Radius CoM RRadius_LinAcc Linear Acceleration Right Radius CoM LHand_LinAcc Linear Acceleration Left Hand CoM

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77Appendix J. (Continued) RHand_LinAcc Linear Acceleration Right Hand CoM LFemur_LinAcc Linear Acceleration Left Femur CoM RFemur_LinAcc Linear Acceleration Right Femur CoM LTibia_LinAcc Linear Acceleration Left Tibia CoM RTibia_LinAcc Linear Acceleration Right Tibia CoM LFoot_LinAcc Linear Acceleration Left Foot CoM RFoot_LinAcc Linear Acceleration Right Foot CoM [Kinematics5-Absolute Linear Acceleration] Head_AbsLinAcc Absolute Linear Acceleration Head CoM Thorax_AbsLinAcc Absolute Li near Acceleration Thorax CoM Pelvis_AbsLinAcc Absolute Linear Acceleration Pelvis CoM LHumerus_AbsLinAcc Absolute Li near Acceleration Left Humerus CoM RHumerus_AbsLinAcc Absolute Linear Acceleration Right Humerus CoM LRadius_AbsLinAcc Absolute Linear Acceleration Left Radius CoM RRadius_AbsLinAcc Absolute Linear Acceleration Right Radius CoM LHand_AbsLinAcc Absolute Li near Acceleration Left Hand CoM RHand_AbsLinAcc Absolute Linear Acceleration Right Hand CoM LFemur_AbsLinAcc Absolute Li near Acceleration Left Femur CoM RFemur_AbsLinAcc Absolute Linear Acceleration Right Femur CoM LTibia_AbsLinAcc Absolute Linear Acceleration Left Tibia CoM RTibia_AbsLinAcc Absolute Linear Acceleration Right Tibia CoM LFoot_AbsLinAcc Absolute Linear Acceleration Left Foot CoM RFoot_AbsLinAcc Absolute Linear Acceleration Right Foot CoM [Kinematics6-Angular Velocity (radians/s)] Neck_AngVel Angular Velocity Cervical Spine Joint (radians/s) LSpine_AngVel Angular Velocity Lumbar-Sacral Joint (radians/s) LClav_AngVel Angular Velocity LCla vicle-Thoracic Joint (radians/s) RClav_AngVel Angular Velocity RClavicle-Thoracic Joint (radians/s) LScap_AngVel Angular Velocity LS capular-Thoracic Joint (radians/s) RScap_AngVel Angular Velocity RS capular-Thoracic Joint (radians/s) LShoulder_AngVel Angular Velocity Le ft Shoulder Joint Center (radians/s) RShoulder_AngVel Angular Velocity Rig ht Shoulder Joint Center (radians/s) LElbow_AngVel Angular Velocity Le ft Elbow Joint Center (radians/s) RElbow_AngVel Angular Velocity Right Elbow Joint Center (radians/s) LWrist_AngVel Angular Velocity Le ft Wrist Joint Center (radians/s) RWrist_AngVel Angular Velocity Right Wrist Joint Center (radians/s) LHip_AngVel Angular Velocity Left Hip Joint Center (radians/s) RHip_AngVel Angular Velocity Rig ht Hip Joint Center (radians/s) LKnee_AngVel Angular Velocity Le ft Knee Joint Center (radians/s) RKnee_AngVel Angular Velocity Rig ht Knee Joint Center (radians/s)

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78Appendix J. (Continued) LAnkle_AngVel Angular Velocity Le ft Ankle Joint Cent er (radians/s) RAnkle_AngVel Angular Velocity Right Ankle Joint Center (radians/s) [Kinematics7-Angular Velocity (degrees/s)] Neck_AngVelDeg Angular Velocity Cervical Spine Joint (degrees/s) LSpine_AngVelDeg Angular Velocity Lumbar-Sacral Joint (degrees/s) LClav_AngVelDeg Angular Velocity LC lavicle-Thoracic Joint (degrees/s) RClav_AngVelDeg Angular Velocity RClavicle-Thoracic Joint (degrees/s) LScap_AngVelDeg Angular Velocity LScapular-Thoracic Joint (degrees/s) RScap_AngVelDeg Angular Velocity RS capular-Thoracic Joint (degrees/s) LShoulder_AngVelDeg Angular Velocity Le ft Shoulder Joint Center (degrees/s) RShoulder_AngVelDeg A ngular Velocity Right Shoulde r Joint Center (degrees/s) LElbow_AngVelDeg Angular Velocity Left Elbow Joint Center (degrees/s) RElbow_AngVelDeg Angular Velocity Rig ht Elbow Joint Center (degrees/s) LWrist_AngVelDeg Angular Velocity Le ft Wrist Joint Center (degrees/s) RWrist_AngVelDeg Angular Velocity Rig ht Wrist Joint Center (degrees/s) LHip_AngVelDeg Angular Velocity Le ft Hip Joint Center (degrees/s) RHip_AngVelDeg Angular Velocity Rig ht Hip Joint Center (degrees/s) LKnee_AngVelDeg Angular Velocity Left Knee Joint Center (degrees/s) RKnee_AngVelDeg Angular Velocity Rig ht Knee Joint Center (degrees/s) LAnkle_AngVelDeg Angular Velocity Left Ankle Joint Center (degrees/s) RAnkle_AngVelDeg Angular Velocity Right Ankle Joint Center (degrees/s) [Kinematics8-Angular Acceleration (radians/s2)] Neck_AngAcc Angular Accleration Ce rvical Spine Joint (radians/s2) LSpine_AngAcc Angular Accleration Lumbar-Sacral Joint (radians/s2) LClav_AngAcc Angular Accleration LCla vicle-Thoracic Joint (radians/s2) RClav_AngAcc Angular Accleration RCla vicle-Thoracic Joint (radians/s2) LScap_AngAcc Angular Accleration LS capular-Thoracic Joint (radians/s2) RScap_AngAcc Angular Accleration RS capular-Thoracic Joint (radians/s2) LShoulder_AngAcc Angular Accleration Le ft Shoulder Joint Center (radians/s2) RShoulder_AngAcc Angular Accleration Ri ght Shoulder Joint Center (radians/s2) LElbow_AngAcc Angular Accleration Le ft Elbow Joint Center (radians/s2) RElbow_AngAcc Angular Accleration Ri ght Elbow Joint Center (radians/s2) LWrist_AngAcc Angular Accleration Le ft Wrist Joint Center (radians/s2) RWrist_AngAcc Angular Accleration Ri ght Wrist Joint Center (radians/s2) LHip_AngAcc Angular Accleration Le ft Hip Joint Center (radians/s2) RHip_AngAcc Angular Acclerati on Right Hip Joint Center (radians/s2) LKnee_AngAcc Angular Accleration Le ft Knee Joint Center (radians/s2) RKnee_AngAcc Angular Accleration Ri ght Knee Joint Center (radians/s2) LAnkle_AngAcc Angular Accleration Le ft Ankle Joint Center (radians/s2)

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79Appendix J. (Continued) RAnkle_AngAcc Angular Accleration Ri ght Ankle Joint Center (radians/s2) [Kinematics9-Angular Acceleration (degrees/s2)] Neck_AngAccDeg Angular Accleration Cervical Spine Joint (degrees/s2) LSpine_AngAccDeg Angular Acclerati on Lumbar-Sacral Joint (degrees/s2) LClav_AngAccDeg Angular Accleration L Clavicle-Thoracic Joint (degrees/s2) RClav_AngAccDeg Angular Accleration RCla vicle-Thoracic Joint (degrees/s2) LScap_AngAccDeg Angular Accleration LScapular-Thoracic Joint (degrees/s2) RScap_AngAccDeg Angular Accleration RScapular-Thoracic Joint (degrees/s2) LShoulder_AngAccDeg Angular Accler ation Left Shoulder Joint Center (degrees/s2) RShoulder_AngAccDeg Angular Acclerat ion Right Shoulder Joint Center (degrees/s2) LElbow_AngAccDeg Angular Accler ation Left Elbow Joint Center (degrees/s2) RElbow_AngAccDeg Angular Acclerat ion Right Elbow Joint Center (degrees/s2) LWrist_AngAccDeg Angular Accleration Left Wrist Joint Center (degrees/s2) RWrist_AngAccDeg Angular Accleration Right Wrist Joint C enter (degrees/s2) LHip_AngAccDeg Angular Accleration Left Hip Joint Center (degrees/s2) RHip_AngAccDeg Angular Accleration Ri ght Hip Joint Center (degrees/s2) LKnee_AngAccDeg Angular Accleration Left Knee Joint Center (degrees/s2) RKnee_AngAccDeg Angular Accleration Right Knee Joint Center (degrees/s2) LAnkle_AngAccDeg Angular Accleration Left Ankle Joint Center (degrees/s2) RAnkle_AngAccDeg Angular Accler ation Right Ankle Joint Center (degrees/s2) [Kinetics1-Forces] LWrist_Force Internal Forces acting at Left Wrist Joint Center RWrist_Force Internal Forces acting at Right Wrist Joint Center LElbow_Force Internal Forces acting at Left Elbow Joint Center RElbow_Force Internal Forces ac ting at Right Elbow Joint Center LShoulder_Force Internal Forces ac ting at Left Shoulder Joint Center RShoulder_Force Internal Forces ac ting at Right Shoulder Joint Center Spine_Force Internal Forces acting at Lumbar-Sacral Intervertebral Disc LHip_Force Internal Forces acting at Left Hip Joint Center RHip_Force Internal Forces acting at Right Hip Joint Center LKnee_Force Internal Forces acting at Left Knee Joint Center RKnee_Force Internal Forces acting at Right Knee Joint Center LAnkle_Force Internal Forces acting at Left Ankle Joint Center RAnkle_Force Internal Forces acting at Right Ankle Joint Center

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80Appendix J. (Continued) [Kinetics2-Moments] LWrist_Moment Internal Moment ac ting at Left Wrist Joint Center RWrist_Moment Internal Moment ac ting at Right Wrist Joint Center LElbow_Moment Internal Moment ac ting at Left Elbow Joint Center RElbow_Moment Internal Moment ac ting at Right Elbow Joint Center LShoulder_Moment Internal Moment acting at Left Shoulder Joint Center RShoulder_Moment Internal Moment acti ng at Right Shoulder Joint Center Spine_Moment Internal Moment acting at the Lumbar-Sacral Intervertebral Disc LHip_Moment Internal Moment acting at Left Hip Joint Center RHip_Moment Internal Moment acti ng at Right Hip Joint Center LKnee_Moment Internal Moment ac ting at Left Knee Joint Center RKnee_Moment Internal Moment ac ting at Right Knee Joint Center LAnkle_Moment Internal Moment ac ting at Left Ankle Joint Center RAnkle_Moment Internal Moment ac ting at Right Ankle Joint Center [Kinetics3-Powers] LWrist_Power Power acting at Left Wrist Joint Center RWrist_Power Power acting at Right Wrist Joint Center LElbow_Power Power acting at Left Elbow Joint Center RElbow_Power Power acting at Right Elbow Joint Center LShoulder_Power Power acting at Left Shoulder Joint Center RShoulder_Power Power acting at Right Shoulder Joint Center Spine_Power Power acting at the Lumbar-Sacral Intervertebral Disc LHip_Power Power acting at Left Hip Joint Center RHip_Power Power acting at Right Hip Joint Center LKnee_Power Power acting at Left Knee Joint Center RKnee_Power Power acting at Right Knee Joint Center LAnkle_Power Power acting at Left Ankle Joint Center RAnkle_Power Power acting at Right Ankle Joint Center [Bones] HEADbone_O HEADbone_P HEADbone_A HEADbone_L CSPINEbone_O CSPINEbone_P CSPINEbone_A CSPINEbone_L

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81Appendix J. (Continued) THORAXbone_O THORAXbone_P THORAXbone_A THORAXbone_L PELVISbone_O PELVISbone_P PELVISbone_A PELVISbone_L SACRUMbone_O SACRUMbone_P SACRUMbone_A SACRUMbone_L LCLAVbone_O LCLAVbone_P LCLAVbone_A LCLAVbone_L RCLAVbone_O RCLAVbone_P RCLAVbone_A RCLAVbone_L LHUMbone_O LHUMbone_P LHUMbone_A LHUMbone_L RHUMbone_O RHUMbone_P RHUMbone_A RHUMbone_L LRADbone_O LRADbone_P LRADbone_A LRADbone_L RRADbone_O RRADbone_P RRADbone_A RRADbone_L LHANDbone_O LHANDbone_P

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82Appendix J. (Continued) LHANDbone_A LHANDbone_L RHANDbone_O RHANDbone_P RHANDbone_A RHANDbone_L LFEMURbone_O LFEMURbone_P LFEMURbone_A LFEMURbone_L RFEMURbone_O RFEMURbone_P RFEMURbone_A RFEMURbone_L LTIBIAbone_O LTIBIAbone_P LTIBIAbone_A LTIBIAbone_L RTIBIAbone_O RTIBIAbone_P RTIBIAbone_A RTIBIAbone_L LFOOTbone_O LFOOTbone_P LFOOTbone_A LFOOTbone_L RFOOTbone_O RFOOTbone_P RFOOTbone_A RFOOTbone_L Head = HEADbone_O,HEAD bone_P,HEADbone_A,HEADbone_L CSpine = CSPINEbone_O,CSPINEbone_P,C SPINEbone_A,CSPINEbone_L Thorax = THORAXbone_O,THO RAXbone_P,THORAXbone_A, THORAXbone_L Pelvis = PELVISbone_O,PELVISbon e_P,PELVISbone_A,PELVISbone_L Sacrum = SACRUMbone_O, SACRUMbone_P,SACRUMbone_A, SACRUMbone_L LeftClavicle = LCLAVbone_O,LCL AVbone_P,LCLAVbone_A,LCLAVbone_L

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83Appendix J. (Continued) RightClavicle = RCLAVbone_O,RCLAVb one_P,RCLAVbone_ A,RCLAVbone_L LeftHumerus = LHUMbone_O,L HUMbone_P,LHUMbone_A,LHUMbone_L RightHumerus = RHUMbone_O,RHUMbone_P,RHUMbone_A,RHUMbone_L LeftRadius = LRADbone_O,LRA Dbone_P,LRADb one_A,LRADbone_L RightRadius = RRADbone_O,RRA Dbone_P,RRADbone_A,RRADbone_L LeftHand = LHANDbone_O,LHANDb one_P,LHANDbone_A ,LHANDbone_L RightHand = RHANDbone_O,RHA NDbone_P,RHANDbone_A ,RHANDbone_L LeftFemur = LFEMURbone_O,LFE MURbone_P,LFEMURbone_A, LFEMURbone_L RightFemur = RFEMURbone_O,R FEMURbone_P,RFEMURbone_A, RFEMURbone_L LeftTibia = LTIBIAbone_O,LTIBIA bone_P,LTIBIAbone _A,LTIBIAbone_L RightTibia = RTIBIAbone_O,RTIBI Abone_P,RTIBIAbone_A,RTIBIAbone_L LeftFoot = LFOOTbone_O,LFOOTbone_P,LFOOTbone_A,LFOOTbone_L RightFoot = RFOOTbone_O,RFOOTbone_P,RFOOTbone_A,RFOOTbone_L [Left Muscle Attachments] LMastoidProcess LOcciput LPostT1 LPostT7 LMidSternum LAntT12 LLatClavicle LMedClavicle LSupraGlenoidTubercle LUppAntHumerus LUppPostHumerus LLowAntHumerus LLowLatHumerus LMedHumeralEpicondyle LLatHumeralEpicondyle LUlnarOlecranon LUlnarTuberosity LRadialTuberosity LUppMedUlna LMidLatRadius LLowLatRadius

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84Appendix J. (Continued) LFlexorRetinaculum LExtensorRetinaculum LPal2MetaCarpal LPal5MetaCarpal LPal3DistalPhalanx LDor3DistalPhalanx LIliacCrest LIliacFossa LAntInfIliacSpine LPelvicBrim LPostSacrum LIschialTuberosity LGreaterTrochanter LLesserTrochanter LUppFemoralShaft LMidFemoralShaft LLatFemoralCondyle LMedFemoralCondyle LPatella LMedTibialCondyle LHeadFibula LTibialTubercle LUppLatTibia LMidFibula LInfExtensorRetinaculum LCalcaneous LMedCuneiform LOcciput,LLatClavicle LMastoidProcess,LPostT1 LMastoidProcess,LMedClavicle LSupraGlenoidTubercl e,LRadialTuberosity LLowAntHumerus,LUlnarTuberosity LLowLatHumerus,LLowLatRadius LUppPostHumerus,LUlnarOlecranon LMedHumeralEpicondy le,LMidLatRadius LUppMedUlna,LMidLatRadius LMedHumeralEpicondyle ,LPal5MetaCarpal LMedHumeralEpicondyle ,LPal2MetaCarpal LUppMedUlna,LFlexorRetinaculum LFlexorRetinaculum ,LPal3DistalPhalanx

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85Appendix J. (Continued) LLatHumeralEpicondyle,LExtensorRetinaculum LExtensorRetinaculum,L Dor3DistalPhalanx LPostT1,LLatClavicle LPostT7,LLatClavicle LMidSternum,LUppAntHumerus LPostT7,LUppPostHumerus LPostSacrum,LUppPostHumerus LAntT12,LPelvicBrim LIliacFossa,LPelvicBrim LPelvicBrim,LLesserTrochanter LIliacCrest,LGreaterTrochanter LAntInfIliacSpine,LPatella LIschialTuberosity,LMedTibialCondyle LIschialTuberosity,LHeadFibula LIschialTuberosity,LMidFemoralShaft LIschialTuberosity,LMedFemoralCondyle LUppFemoralShaft,LPatella LPatella,LTibialTubercle LLatFemoralCondyle,LCalcaneous LMedFemoralCondyle,LCalcaneous LUppLatTibia,LInfExtensorRetinaculum LInfExtensorRetinaculum,LMedCuneiform LMidFibula,LInfExtensorRetinaculum [Right Muscle Attachments] RMastoidProcess ROcciput RPostT1 RPostT7 RMidSternum RAntT12 RLatClavicle RMedClavicle RSupraGlenoidTubercle RUppAntHumerus RUppPostHumerus RLowAntHumerus

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86Appendix J. (Continued) RLowLatHumerus RMedHumeralEpicondyle RLatHumeralEpicondyle RUlnarOlecranon RUlnarTuberosity RRadialTuberosity RUppMedUlna RMidLatRadius RLowLatRadius RFlexorRetinaculum RExtensorRetinaculum RPal2MetaCarpal RPal5MetaCarpal RPal3DistalPhalanx RDor3DistalPhalanx RIliacCrest RIliacFossa RAntInfIliacSpine RPelvicBrim RPostSacrum RIschialTuberosity RGreaterTrochanter RLesserTrochanter RUppFemoralShaft RMidFemoralShaft RLatFemoralCondyle RMedFemoralCondyle RPatella RMedTibialCondyle RHeadFibula RTibialTubercle RUppLatTibia RMidFibula RInfExtensorRetinaculum RCalcaneous RMedCuneiform ROcciput,RLatClavicle RMastoidProcess,RPostT1 RMastoidProcess,RMedClavicle RSupraGlenoidTubercl e,RRadialTuberosity

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87Appendix J. (Continued) RLowAntHumerus,RUlnarTuberosity RLowLatHumerus,RLowLatRadius RUppPostHumerus,RUlnarOlecranon RMedHumeralEpicondy le,RMidLatRadius RUppMedUlna,RMidLatRadius RMedHumeralEpicondyle ,RPal5MetaCarpal RMedHumeralEpicondyle ,RPal2MetaCarpal RUppMedUlna,RFlexo rRetinaculum RFlexorRetinaculum ,RPal3DistalPhalanx RLatHumeralEpicondyle,RExtensorRetinaculum RExtensorRetinaculum, RDor3DistalPhalanx RPostT1,RLatClavicle RPostT7,RLatClavicle RMidSternum,RUppAntHumerus RPostT7,RUppPostHumerus RPostSacrum,RUppPostHumerus RAntT12,RPelvicBrim RIliacFossa,RPelvicBrim RPelvicBrim,RLesserTrochanter RIliacCrest,RGreaterTrochanter RAntInfIliacSpine,RPatella RIschialTuberosity, RMedTibialCondyle RIschialTuberosity,RHeadFibula RIschialTuberosity,RMidFemoralShaft RIschialTuberosity, RMedFemoralCondyle RUppFemoralShaft,RPatella RPatella,RTibialTubercle RLatFemoralCondyle,RCalcaneous RMedFemoralCondyle,RCalcaneous RUppLatTibia,RInfEx tensorRetinaculum RInfExtensorRetinaculum,RMedCuneiform RMidFibula,RInfExtensorRetinaculum [Left Muscle Lengths] LUppTrapeziusLength Length of Left Upper Trapezius LUppSpleniusCapitisLength Length of Left Upper Splenius Capitis LSternoMastoidLength Length of Left SternoMastoid LBicepsBrachiiLength Length of Left Biceps Brachii LBrachialisLength Length of Left Brachialis

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88Appendix J. (Continued) LBrachioradialisLength Lengt h of Left Brachioradialis LTricepsBrachiiLength Length of Left Triceps Brachii LLongHeadPronatorTeresLength Length of Left Long Head Pronator Teres LShortHeadPronatorTeresLength Length of Left Short Head Pronator Teres LFlexorCarpiUlnarisLe ngth Length of Left Flexor Carpi Ulnaris LFlexorCarpiRadialisL ength Length of Left Flexor Carpi Radialis LFlexorDigitorumLength Length of Left Flexor Digitorum LExtensorDigitorumLengt h Length of Left Extensor Digitorum LMidTrapeziusLength Length of Le ft Mid Section of Trapezius LLowTrapeziusLength Length of Le ft Lower Section of Trapezius LPectoralisMajorLength Length of Left Pectoralis Major LUppLatissimusDorsiLength Lengt h of Left Upper Section of Latissimus Dorsi LLowLatissimusDorsiLength Length of Left Lower Section of Latissimus Dorsi LPsoasLength Length of Left Psoas LIliacusLength Length of Left Iliacus LGluteusMediusLength Length of Left Gluteus Medius LRectusFemorisLength Length of Left Rectus Femoris LSemimembranosusLength Length of Left Semimembranosus LBicepsFemorisLength Length of Left Biceps Femoris LAdductorMagnusLength Length of Left Adductor Magnus LGracilisLength Length of Left Gracilis LVastiLength Length of Left Vasti LLatHeadGastrocnemiusLength Length of Le ft Lateral Head of Gastrocnemius LMedHeadGastrocnemiusLength Length of Le ft Medial Head of Gastrocnemius LTibialisAntLength Length of Left Tibialis Anterior LExtensorHallucisLongusLen gth Length of Left Extensor Hallucis Longus [Right Muscle Lengths] RUppTrapeziusLength Length of Right Upper Trapezius RUppSpleniusCapitisLength Length of Right Upper Splenius Capitis RSternoMastoidLength Length of Right SternoMastoid RBicepsBrachiiLength Length of Right Biceps Brachii RBrachialisLength Length of Right Brachialis RBrachioradialisLength Length of Right Brachioradialis RTricepsBrachiiLength Length of Right Triceps Brachii RLongHeadPronatorTeresLength Length of Right Long Head Pronator Teres RShortHeadPronatorTeresLength Length of Right Short Head Pronator Teres

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89Appendix J. (Continued) RFlexorCarpiUlnarisLengt h Length of Right Flexor Carpi Ulnaris RFlexorCarpiRadialisL ength Length of Right Flexor Carpi Radialis RFlexorDigitorumLength Length of Right Flexor Digitorum RExtensorDigitor umLength Length of Right Extensor Digitorum RMidTrapeziusLength Length of Right Mid Section of Trapezius RLowTrapeziusLength Length of Ri ght Lower Section of Trapezius RPectoralisMajorLength Length of Right Pectoralis Major RUppLatissimusDorsiLength Length of Right Upper Section of Latissimus Dorsi RLowLatissimusDorsiLength Length of Right Lower Section of Latissimus Dorsi RPsoasLength Length of Right Psoas RIliacusLength Lengt h of Right Iliacus RGluteusMediusLength Length of Right Gluteus Medius RRectusFemorisLength Length of Right Rectus Femoris RSemimembranosusLength Length of Right Semimembranosus RBicepsFemorisLength Length of Right Biceps Femoris RAdductorMagnusLength Length of Right Adductor Magnus RGracilisLength Length of Right Gracilis RVastiLength Length of Right Vasti RLatHeadGastrocnemiusLength Length of Ri ght Lateral Head of Gastrocnemius RMedHeadGastrocnemiusLength Length of Ri ght Medial Head of Gastrocnemius RTibialisAntLength Length of Right Tibialis Anterior RExtensorHallucisLongusLen gth Length of Right Extensor Hallucis Longus [Output Data] LShoulder_Angle RShoulder_Angle LElbow_Angle RElbow_Angle LWrist_Angle RWrist_Angle LShoulder_Force RShoulder_Force LElbow_Force RElbow_Force LWrist_Force RWrist_Force LShoulder_Moment

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90Appendix J. (Continued) RShoulder_Moment LElbow_Moment RElbow_Moment LWrist_Moment RWrist_Moment LShoulder_Power RShoulder_Power LElbow_Power RElbow_Power LWrist_Power RWrist_Power

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91Appendix J. (Continued) {* ================================ ============================= =========== *} Whole-body biomechanical model for 3D dynamic kinematic and kinetic analysis of human motion 2005 John D Lloyd, Ph.D. VA Patient Safety Research Center, Tampa, Florida {* ================================ ============================= =========== *} {* ================================ ============================= =========== *} PART 1 REPLACE STATIC AND OCCLUDED MARKERS {* ================================ ============================= =========== *} {* ===================== =============== *} {* MACROS *} {* ===================== =============== *} macro REPLACE4(p1,p2,p3,p4) {*Replaces any point missing from se t of four fixed in a segment *} s234=[p3,p2-p3,p3-p4] p1V=Average(p1/s234)*s234 s341=[p4,p3-p4,p4-p1] p2V=Average(p2/s341)*s341 s412=[p1,p4-p1,p1-p2] p3V=Average(p3/s412)*s412 s123=[p2,p1-p2,p2-p3] p4V=Average(p4/s123)*s123 p1= p1 ? p1V p2= p2 ? p2V p3= p3 ? p3V p4= p4 ? p4V OUTPUT(p1,p2,p3,p4) endmacro {* ===================== =============== *}

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92Appendix J. (Continued) macro REPLACE5(p1,p2,p3,p4,p5) {*Replaces any point missing from se t of five fixed in a segment*} {*SECTION FOR INITIALISATION OF VIRTUAL POINTS*} {*REPLACE4*} s123=[p2,p1-p2,p2-p3] p4V1=Average(p4/s123)*s123 s124=[p2,p1-p2,p2-p4] p3V1=Average(p3/s124)*s124 s134=[p3,p1-p3,p3-p4] p2V1=Average(p2/s134)*s134 s234=[p3,p2-p3,p3-p4] p1V1=Average(p1/s234)*s234 {*Addition required for REPLACE5*} s123=[p2,p1-p2,p2-p3] p5V1=Average(p5/s123)*s123 s124=[p2,p1-p2,p2-p4] p5V2=Average(p5/s124)*s124 s125=[p2,p1-p2,p2-p5] p3V2=Average(p3/s125)*s125 p4V2=Average(p4/s125)*s125 s134=[p3,p1-p3,p3-p4] p5V3=Average(p5/s134)*s134 s135=[p3,p1-p3,p3-p5] p2V2=Average(p2/s135)*s135 p4V3=Average(p4/s135)*s135 s145=[p4,p1-p4,p4-p5] p2V3=Average(p2/s145)*s145 p3V3=Average(p3/s145)*s145 s234=[p3,p2-p3,p3-p4] p5V4=Average(p5/s234)*s234 s235=[p3,p2-p3,p3-p5] p1V2=Average(p1/s235)*s235 p4V4=Average(p4/s235)*s235 s245=[p4,p2-p4,p4-p5] p1V3=Average(p1/s245)*s245 p3V4=Average(p3/s245)*s245 s345=[p4,p3-p4,p4-p5] p1V4=Average(p1/s345)*s345 p2V4=Average(p2/s345)*s345

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93Appendix J. (Continued) {*SECTION FOR SPECIFICATION OF VIRTUAL POINTS*} p1= p1 ? p1V1 ? p1V2 ? p1V3 ? p1V4 p2= p2 ? p2V1 ? p2V2 ? p2V3 ? p2V4 p3= p3 ? p3V1 ? p3V2 ? p3V3 ? p3V4 p3= p3 ? p3V1 ? p3V2 ? p3V3 ? p3V4 p4= p4 ? p4V1 ? p4V2 ? p4V3 ? p4V4 p5= p5 ? p5V1 ? p5V2 ? p5V3 ? p5V4 OUTPUT(p1,p2,p3,p4,p5) endmacro {* ===================== =============== *} macro REPLACE6(p1,p2,p3,p4,p5,p6) {*Replaces any point missing from set of six fixed in a segment*} {*SECTION FOR INITIALISATION OF VIRTUAL POINTS*} {*REPLACE4*} s123=[p2,p1-p2,p2-p3] p4V1=Average(p4/s123)*s123 s124=[p2,p1-p2,p2-p4] p3V1=Average(p3/s124)*s124 s134=[p3,p1-p3,p3-p4] p2V1=Average(p2/s134)*s134 s234=[p3,p2-p3,p3-p4] p1V1=Average(p1/s234)*s234 {*Addition required for REPLACE5*} s123=[p2,p1-p2,p2-p3] p5V1=Average(p5/s123)*s123 s124=[p2,p1-p2,p2-p4] p5V2=Average(p5/s124)*s124 s125=[p2,p1-p2,p2-p5] p3V2=Average(p3/s125)*s125 p4V2=Average(p4/s125)*s125 s134=[p3,p1-p3,p3-p4] p5V3=Average(p5/s134)*s134 s135=[p3,p1-p3,p3-p5] p2V2=Average(p2/s135)*s135 p4V3=Average(p4/s135)*s135 s145=[p4,p1-p4,p4-p5] p2V3=Average(p2/s145)*s145 p3V3=Average(p3/s145)*s145 s234=[p3,p2-p3,p3-p4]

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94Appendix J. (Continued) p5V4=Average(p5/s234)*s234 s235=[p3,p2-p3,p3-p5] p1V2=Average(p1/s235)*s235 p4V4=Average(p4/s235)*s235 s245=[p4,p2-p4,p4-p5] p1V3=Average(p1/s245)*s245 p3V4=Average(p3/s245)*s245 s345=[p4,p3-p4,p4-p5] p1V4=Average(p1/s345)*s345 p2V4=Average(p2/s345)*s345 {*Addition requiredfor REPLACE6*} s123=[p2,p1-p2,p2-p3] p6V1=Average(p6/s123)*s123 s124=[p2,p1-p2,p2-p4] p6V2=Average(p6/s124)*s124 s125=[p2,p1-p2,p2-p5] p6V3=Average(p6/s125)*s125 s126=[p2,p1-p2,p2-p6] p3V5=Average(p3/s126)*s126 p4V5=Average(p4/s126)*s126 p5V5=Average(p5/s126)*s126 s134=[p3,p1-p3,p3-p4] p6V4=Average(p6/s134)*s134 s135=[p3,p1-p3,p3-p5] p6V5=Average(p6/s135)*s135 s136=[p3,p1-p3,p3-p6] p2V5=Average(p2/s136)*s136 p4V6=Average(p4/s136)*s136 p5V6=Average(p5/s136)*s136 s145=[p4,p1-p4,p4-p5] p6V6=Average(p6/s145)*s145 s146=[p4,p1-p4,p4-p6] p2V6=Average(p2/s146)*s146 p3V6=Average(p3/s146)*s146 p5V7=Average(p5/s146)*s146 s156=[p5,p1-p5,p5-p6] p2V7=Average(p2/s156)*s156 p3V7=Average(p3/s156)*s156 p4V7=Average(p4/s156)*s156 s234=[p3,p2-p3,p3-p4] p6V7=Average(p6/s234)*s234 s235=[p3,p2-p3,p3-p5]

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95Appendix J. (Continued) p6V8=Average(p6/s235)*s235 s236=[p3,p2-p3,p3-p6] p1V5=Average(p1/s236)*s236 p4V8=Average(p4/s236)*s236 p5V8=Average(p5/s236)*s236 s245=[p4,p2-p4,p4-p5] p6V9=Average(p6/s245)*s245 s246=[p4,p2-p4,p4-p6] p1V6=Average(p1/s246)*s246 p3V8=Average(p3/s246)*s246 p5V9=Average(p5/s246)*s246 s256=[p5,p2-p5,p5-p6] p1V7=Average(p1/s256)*s256 p3V9=Average(p3/s256)*s256 p4V9=Average(p4/s256)*s256 s345=[p4,p3-p4,p4-p5] p6V10=Average(p6/s345)*s345 s346=[p4,p3-p4,p4-p6] p1V8=Average(p1/s346)*s346 p2V8=Average(p2/s346)*s346 p5V10=Average(p5/s346)*s346 s356=[p5,p3-p5,p5-p6] p1V9=Average(p1/s356)*s356 p2V9=Average(p2/s356)*s356 p4V10=Average(p4/s356)*s356 s456=[p5,p4-p5,p5-p6] p1V10=Average(p1/s456)*s456 p2V10=Average(p2/s456)*s456 p3V10=Average(p3/s456)*s456 {*SECTION FOR SPECIFICATION OF VIRTUAL POINTS*} p1= p1 ? p1V1 ? p1V2 ? p1V3 ? p1V4 ? p1V5 ? p1V6 ? p1V7 ? p1V8 ? p1V9 ? p1V10 p2= p2 ? p2V1 ? p2V2 ? p2V3 ? p2V4 ? p2V5 ? p2V6 ? p2V7 ? p2V8 ? p2V9 ? p2V10 p3= p3 ? p3V1 ? p3V2 ? p3V3 ? p3V4 ? p3V5 ? p3V6 ? p3V7 ? p3V8 ? p3V9 ? p3V10 p3= p3 ? p3V1 ? p3V2 ? p3V3 ? p3V4 ? p3V5 ? p3V6 ? p3V7 ? p3V8 ? p3V9 ? p3V10 p4= p4 ? p4V1 ? p4V2 ? p4V3 ? p4V4 ? p4V5 ? p4V6 ? p4V7 ? p4V8 ? p4V9 ? p4V10 p5= p5 ? p5V1 ? p5V2 ? p5V3 ? p5V4 ? p5V5 ? p5V6 ? p5V7 ? p5V8 ? p5V9 ? p5V10

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96Appendix J. (Continued) p6= p6 ? p6V1 ? p6V2 ? p6V3 ? p6V4 ? p6V5 ? p6V6 ? p6V7 ? p6V8 ? p6V9 ? p6V10 OUTPUT(p1,p2,p3,p4,p5,p6) endmacro {* ===================== =============== *} {* OPTIONAL MARKERS *} {* ===================== =============== *} OptionalPoints(GLAB,LT EM,RTEM,LMAS,RMAS) OptionalPoints(CSPN,CLAV,STRN,CHST) OptionalPoints(LSCS,LSCI,RSCS,RSCI) OptionalPoints(MPEL,LASI,RASI,LSIS,RSIS) OptionalPoints(LACR,LHT1,LHT2,LHT3) OptionalPoints(LELB,LMEL,LRT1,LRT2,LRT3) OptionalPoints(LRAD,LULN,LFIN,LLFI) OptionalPoints(RACR,RHT1,RHT2,RHT3) OptionalPoints(RELB,RMEL,RRT1,RRT2,RRT3) OptionalPoints(RRAD,RULN,RFIN,RLFI) OptionalPoints(LFT1,LFT2,LFT3) OptionalPoints(LKNE,LMKN,LTT1,LTT2,LTT3) OptionalPoints(LANK,LMAN,LTOE,LLTO) OptionalPoints(RFT1,RFT2,RFT3) OptionalPoints(RKNE,RMKN,RTT1,RTT2,RTT3) OptionalPoints(RANK,RMAN,RTOE,RLTO) {* ===================== =============== *} {* REPLACE OCCLUDED MARKERS 1 *} {* ===================== =============== *} {* Head *} Replace5(GLAB,LTEM,RTEM,LMAS,RMAS) {* Thorax *} Replace6(CSPN,CLAV,STRN,CHST,LACR,RACR) {* Pelvis *} Replace5(MPEL,LASI,RASI,LSIS,RSIS) {* Humeri *} Replace5(LHT1,LHT2,LHT3,LELB,LMEL)

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97Appendix J. (Continued) Replace5(RHT1,RHT2,RHT3,RELB,RMEL) {* Radii *} Replace6(LELB,LRT1,LRT2,LRT3,LRAD,LULN) Replace6(RELB,RRT1,RRT2,RRT3,RRAD,RULN) {* Hands *} Replace4(LRAD,LULN,LFIN,LLFI) Replace4(RRAD,RULN,RFIN,RLFI) {* Femuri *} Replace5(LFT1,LFT2,LFT3,LKNE,LMKN) Replace5(RFT1,RFT2,RFT3,RKNE,RMKN) {* Tibiae *} Replace6(LKNE,LTT1,LTT2,LTT3,LANK,LMAN) Replace6(RKNE,RTT1,RTT2,RTT3,RANK,RMAN) {* Feet *} Replace4(LANK,LMAN,LTOE,LLTO) Replace4(RANK,RMAN,RTOE,RLTO) {* ================================ ============================= =========== *} {* REPLACE STATIC MARKERS *} {* ================================ ==+========================== =========== *} {* Head Segment*} PreHead=[GLAB,LTEM-RTEM,LTEM-GLAB] If $Static==1 Then $%LMAS=LMAS/PreHead $%RMAS=RMAS/PreHead PARAM($%LMAS,$%RMAS) EndIf LMASV=$%LMAS*PreHead RMASV=$%RMAS*PreHead RMAS=RMAS ? RMASV LMAS=LMAS ? LMASV OUTPUT(LMAS,RMAS)

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98Appendix J. (Continued) {*Left Scapula Segment*} PreLScapula=[LACR,LACR-CLAV,CLAV-STRN] If $Static==1 Then $%LSCS=LSCS/PreLScapula $%LSCI=LSCI/PreLScapula PARAM($%LSCS,$%LSCI) EndIf LSCSV=$%LSCS*PreLScapula LSCIV=$%LSCI*PreLScapula LSCS=LSCS ? LSCSV LSCI=LSCI ? LSCIV OUTPUT(LSCS,LSCI) {*Right Scapula Segment*} PreRScapula=[RACR,RA CR-CLAV,CLAV-STRN] If $Static==1 Then $%RSCS=RSCS/PreRScapula $%RSCI=RSCI/PreRScapula PARAM($%RSCS,$%RSCI) EndIf RSCSV=$%RSCS*PreRScapula RSCIV=$%RSCI*PreRScapula RSCS=RSCS ? RSCSV RSCI=RSCI ? RSCIV OUTPUT(RSCS,RSCI) {*Pelvis Segment1*} PrePelvis1=[STRN,STRN-CLAV,CLAV-CSPN] If $Static==1 Then $%MPEL=MPEL/PrePelvis1 $%LASI=LASI/PrePelvis1 $%RASI=RASI/PrePelvis1 PARAM($%MPEL,$%LASI,$%RASI) EndIf MPELV=$%MPEL*PrePelvis1 LASIV=$%LASI*PrePelvis1 RASIV=$%RASI*PrePelvis1 MPEL=MPEL ? MPELV LASI=LASI ? LASIV RASI=RASI ? RASIV OUTPUT(MPEL,LASI,RASI)

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99Appendix J. (Continued) {*Pelvis Segment2*} PrePelvis2=[MPEL,LASI-RASI,LASI-MPEL] If $Static==1 Then $%LSIS=LSIS/PrePelvis2 $%RSIS=RSIS/PrePelvis2 PARAM($%LSIS,$%RSIS) EndIf LSISV=$%LSIS*PrePelvis2 RSISV=$%RSIS*PrePelvis2 LSIS=LSIS ? LSISV RSIS=RSIS ? RSISV OUTPUT(LSIS,RSIS) {* ===================== =============== *} {* REPLACE OCCLUDED MARKERS 2 *} {* ===================== =============== *} {* Head *} Replace5(GLAB,LTEM,RTEM,LMAS,RMAS) {* Thorax *} Replace6(CSPN,CLAV,STRN,CHST,LACR,RACR) {* Pelvis *} Replace5(MPEL,LASI,RASI,LSIS,RSIS) {* Humeri *} Replace5(LHT1,LHT2,LHT3,LELB,LMEL) Replace5(RHT1,RHT2,RHT3,RELB,RMEL) {* Radii *} Replace6(LELB,LRT1,LRT2,LRT3,LRAD,LULN) Replace6(RELB,RRT1,RRT2,RRT3,RRAD,RULN) {* Hands *} Replace4(LRAD,LULN,LFIN,LLFI) Replace4(RRAD,RULN,RFIN,RLFI) {* Femuri *} Replace5(LFT1,LFT2,LFT3,LKNE,LMKN) Replace5(RFT1,RFT2,RFT3,RKNE,RMKN)

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100Appendix J. (Continued) {* Tibiae *} Replace6(LKNE,LTT1,LTT2,LTT3,LANK,LMAN) Replace6(RKNE,RTT1,RTT2,RTT3,RANK,RMAN) {* Feet *} Replace4(LANK,LMAN,LTOE,LLTO) Replace4(RANK,RMAN,RTOE,RLTO) {* ===================== =============== *} {* END OF MODEL *} {* ===================== =============== *} {*============================= =============================== ============ *} Whole-body biomechanical model for 3D dynamic kinematic and kinetic analysis of human motion 2005 John D Lloyd, Ph.D. VA Patient Safety Research Center, Tampa, Florida {* ================================ ============================= =========== *} {* ================================ ============================= =========== *} PART 2 BIOMECHANICAL MODELING {* ================================ ============================= =========== *} {* ============================ *} {* MACROS *} {* ============================ *} macro AXISVISUALISATION(Segment) ORIGIN#Segment=O(Segment) AXISX#Segment={200, 0,0}*Segment AXISY#Segment={0,1 50,0}*Segment AXISZ#Segment={0,0,100}*Segment output(ORIGIN#Segment,AXISX#Segmen t,AXISY#Segment,AXISZ#Segment)

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101Appendix J. (Continued) ENDMACRO {* ========== *} macro LINVELACC(Point,Name) {* Calculates linear velocity in m/s and linear acceleration in m/s^2 of a point, using numerical differentiation *} {* Ref: Hildebrand, 1974; Kreyszig, 1983; Yakowitz, Sydney & Szidarovsky 1989 *} $FrameTimeLength=1/$SamplingRate Name#_LinVel=((Point[-2]-(8* Point[-1])+(8*Point[1])Point[2])/(12*$FrameTimeLength))/1000 Name#_LinAcc=((Name#_LinV el[-2]-(8*Name#_LinVel[1])+(8*Name#_LinVel[1] )-Name#_LinVel[2])/(12* $FrameTimeLength)) Name#_AbsLinVel=sqrt((Name#_LinVel(1 )*Name#_LinVel(1))+(Name#_LinVel(2 )*Name#_LinVel(2))+(Name#_L inVel(3)*Name#_LinVel(3))) Name#_AbsLinAcc=sqrt((Name#_LinAcc( 1)*Name#_LinAcc(1 ))+(Name#_LinAcc (2)*Name#_LinAcc(2))+(Name#_Li nAcc(3)*Name#_LinAcc(3))) OUTPUT(Name#_LinVel,Name#_LinAcc,Na me#_AbsLinVel,Name#_AbsLinAcc) ENDMACRO {* ========== *} macro ANGVELACC(ch ild,parent,Joint) {* Calculates angular velocity in rad/ s and angular acceleration in rad/s^2 at a joint, using numerical differentiation *} $FrameTimeLength=1/$SamplingRate pi=3.1415927 Joint#Angle= Joint={Joint#Angle(1),Joint #Angle(2),Joint#Angle(3)} Rad#Joint=Joint*pi/180 Joint#_AngVel=((Rad#Joint[-2]-(8*R ad#Joint[-1])+(8*Rad#Joint[1])Rad#Joint[2])/(12*$FrameTimeLength)) Joint#_AngAcc=((Joint#_AngVel[-2]-(8*J oint#_AngVel[-1])+(8*Joint#_AngVel[1])Joint#_AngVel[2])/( 12*$FrameTimeLength)) Joint#_AngVelDeg=Join t#_AngVel*(180/pi) Joint#_AngAccDeg=Join t#_AngAcc*(180/pi) OUTPUT(Joint#_AngVel,Joint#_AngAcc,Jo int#_AngVelDeg,Joint#_AngAccDeg) ENDMACRO {* ==================== *} {* ORIGIN *}

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102Appendix J. (Continued) {* ==================== *} Gorigin={0,0,0} Global=[Gorigin,{1,0 ,0},{0,0,1},xyz] Lnowrap={0,0,0} Rnowrap={0,0,0} {* ==================== *} {* OPTIONAL MARKERS *} {* ==================== *} OptionalPoints(GLAB,LT EM,RTEM,LMAS,RMAS) OptionalPoints(CSPN,CLAV,STRN,CHST) OptionalPoints(LSCS,LSCI,RSCS,RSCI) OptionalPoints(MPEL,LASI,RASI,LSIS,RSIS) OptionalPoints(LACR,LHT1,LHT2,LHT3) OptionalPoints(LELB,LMEL,LRT1,LRT2,LRT3) OptionalPoints(LRAD,LULN,LFIN,LLFI) OptionalPoints(RACR,RHT1,RHT2,RHT3) OptionalPoints(RELB,RMEL,RRT1,RRT2,RRT3) OptionalPoints(RRAD,RULN,RFIN,RLFI) OptionalPoints(LFT1,LFT2,LFT3) OptionalPoints(LKNE,LMKN,LTT1,LTT2,LTT3) OptionalPoints(LANK,LMAN,LTOE,LLTO) OptionalPoints(RFT1,RFT2,RFT3) OptionalPoints(RKNE,RMKN,RTT1,RTT2,RTT3) OptionalPoints(RANK,RMAN,RTOE,RLTO) OptionalPoints(HEDCM,THRCM,PELCM ,LHUCM,LRACM,LHACM,RHUCM,RRA CM,RHACM,LFECM,LTICM,LFOCM ,RFECM,RTICM,RFOCM,WBCOM) {* ==================== *} {* HEADSEGMENT *} {* ==================== *} FHED=(LTEM+RTEM)/2 BHED=(LMAS+RMAS)/2 LHED=(LTEM+LMAS)/2 RHED=(RTEM+RMAS)/2 {*Head CoM *} HEDCM=(GLAB+LMAS+RMAS)/3

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103Appendix J. (Continued) OUTPUT(HEDCM) Head=[HEDCM,LMAS-RM AS,FHED-BHED,yzx] AXISVISUALISATION(Head) If $Static==1 $HeadSize=DIST(FHED,BHED) {*Create a head offset angle from static trial*} $HeadOffset = PARAM($HeadOffset,$HeadSize) EndIf Head=ROT(Head,Head(2),$HeadOffset(2)) HeadSize=$HeadSize HeadScale={1.4,1.4,1.4} HeadShift={0,0,0} {* ====================== *} {* THORACIC SPINE SEGMENT *} {* ====================== *} LSID=(LSIS+RSIS)/2 OUTPUT(LSID) {*Trunk CoM *} THRCM=(CSPN-LSID)*0.63+LSID {* Ref: Dempster, 1955; Winter, 1990; Pitt, 1997 *} OUTPUT(THRCM) Thorax=[THRCM,STRN-THRCM,LACR-RACR,xzy] AXISVISUALISATION(Thorax) If $Static==1 Then $ThoraxSize=DIST(LACR,RACR)/2 PARAM($ThoraxSize) EndIf ThoraxSize=0.9*$ThoraxSize ThoraxScale={1.2,1.2,1.2} ThoraxShift={0,0,0}

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104Appendix J. (Continued) {* ============================ *} {* CERVICAL SPINE SEGMENT *} {* ============================ *} CSPine=[(CSPN+CLAV)/2,LAC R-RACR,CLAV-CSPN,yzx] AXISVISUALISATION(CSpine) CSpineSize=0.5*$ThoraxSize PARAM(CSpineSize) CSpineScale={0.8,0.8,0.8} CSpineShift={0,0,0} {* ============================ *} {* PELVIS AND HIP JOINT CENTERS *} {* ============================ *} PelvisTemp=[LSID,LSIS-RSIS,MPEL-LSID,yzx] {* Define Asis-Trochanter Dist (ATD) as function of leg length *} LegLength=$LegLength LATD=0.1288*Leglength-48.56 RATD=LATD If $InterAsisDistance ==0 Then InterAsisDist=DIST(LASI,RASI) Else InterAsisDist=$InterAsisDistance EndIf {* Parameters used to work out posi tion of hip joint centres (Davis)*} C =(LegLength)*0.115-15.3 aa=InterAsisDist/2 mm=($MarkerDiameter+$MarkerExtension)/2 COSBETA=cos(18) SINBETA=sin(18) COSTHETA=cos(28.4) SINTHETA=sin(28.4) LHJC = {C*COSTHETA*SINB ETA-(LATD+mm)*COSBETA, -C*SINTHETA+ aa, -C*COSTHETA*COSBET A-(LATD+mm)*SINBETA}*PelvisTemp RHJC = {C*COSTHETA*SIN BETA-(RATD+mm)*COSBETA,

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105Appendix J. (Continued) C*SINTHETAaa, -C*COSTHETA*COSBET A-(RATD+mm)*SINBETA}*PelvisTemp OUTPUT(LHJC,RHJC) {* Pelvis CoM *} PELV=(LHJC+RHJC)/2 PELCM=(LSID-PELV)*0.135+PELV {* Ref: Dempster, 1955; Winter, 1990; Pitt, 1997 *} OUTPUT(PELCM) Pelvis=[PELCM,LSIS-RSIS,MPEL-LSID,yzx] AXISVISUALISATION(Pelvis) If $Static==1 Then $PelvisSize=DIST(LHJC,RHJC) PARAM($PelvisSize) EndIf PelvisSize=$PelvisSize PelvisScale={0.8,0.8,0.8} PelvisShift={0,0,0} {* HipJoints *} LHipJoint=LHJC+Attitude(Pelvis) RHipJoint=RHJC+Attitude(Pelvis) {* Sacrum *} SAC0=MPEL+$PelvisSize*{-1,0,0}*Attitude(Pelvis) Sacrum=SAC0+Attitude(Pelvis) SacrumSize=PelvisSize/2 PARAM(SacrumSize) SacrumScale={1,1,1} SacrumShift={0,0,0} {* ============================ *} {* SHOULDER JOINT CENTERS *} {* ============================ *} ShoulderOffset=30 MarkerExtension={0,0,($MarkerDiameter/ 2)+$MarkerExtension}*Attitude(Thorax) LSJC=LACR-MarkerExtension-Shoulde rOffset*($Stature/1760)*Thorax(3)

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106Appendix J. (Continued) RSJC=RACR-MarkerExtens ion-ShoulderOffset*($Stature/1760)*Thorax(3) OUTPUT(LSJC,RSJC) {* ============================ *} {* ELBOW JOINT CENTERS *} {* ============================ *} If $Static==1 Then If ExistAtAll(LELB,LMEL) Then $LElbowWidth=DIST(LELB,LMEL) Else $LElbowWidth=$MeanElbowWidth EndIf If ExistAtAll(RELB,RMEL) Then $RElbowWidth=DIST(RELB,RMEL) Else $RElbowWidth=$MeanElbowWidth EndIf $ElbowWidth=($LElbow Width+$RElbowWidth)/2 PARAM($ElbowWidth) EndIf ElbowOffset=($MarkerDiameter+$ElbowWidth)/2 If ExistAtAll(LMEL) Then LEJC=(LELB+LMEL)/2 Else LEJC=CHORD(ElbowOffset,LELB,LSJC,LHT1) EndIf If ExistAtAll(RMEL) Then REJC=(RELB+RMEL)/2 Else REJC=CHORD(ElbowOffset,RELB,RSJC,RHT1) EndIf OUTPUT(LEJC,REJC) {* ============================ *} {* WRIST JOINT CENTERS *} {* ============================ *} If $Static==1 Then If ExistAtAll(LRAD,LULN) Then

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107Appendix J. (Continued) $LWristWidth=DIST(LRAD,LULN) Else $LWristWidth=$MeanWristWidth EndIf If ExistAtAll(RRAD,RULN) Then $RWristWidth=DIST(RRAD,RULN) Else $RWristWidth=$MeanWristWidth EndIf $WristWidth=($LWristWidth+$RWristWidth)/2 PARAM($WristWidth) EndIf WristOffset=($MarkerDiameter+$M arkerExtension+$WristWidth)/2 If ExistAtAll(LULN) Then LWJC=(LRAD+LULN)/2 Else LWJC=CHORD(WristOffset,LRAD,LEJC,LRT1) EndIf If ExistAtAll(RULN) Then RWJC=(RRAD+RULN)/2 Else RWJC=CHORD(WristOffset,RRAD,REJC,RRT1) EndIf OUTPUT(LWJC,RWJC) {* ============================ *} {* CLAVICLE SEGMENTS *} {* ============================ *} LCLCM=(LACR+CLAV)/2 RCLCM=(RACR+CLAV)/2 LClavicle=[LCLCM,LACR-CLAV,LSJC-LACR,zxy] RClavicle=[RCLCM,RACR-CLAV,RACR-RSJC,zxy] AXISVISUALISATION(LClavicle) AXISVISUALISATION(RClavicle) LClavicleSize=DIST(0(LClavicle),0(Thorax)) LClavicleScale={1,1,1} LClavicleShift={0,0,0} RClavicleSize=DIST(0(RClavicle),0(Thorax)) RClavicleScale={1,1,1}

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108Appendix J. (Continued) RClavicleShift={0,0,0} {* ============================ *} {* SCAPULA SEGMENTS *} {* ============================ *} LSCCM=(LACR+LSCS+LSCI)/3 RSCCM=(RACR+RSCS+RSCI)/3 LScapula=[LSCCM,LSCS-LSCI,LACR-CSPN,zxy] RScapula=[RSCCM,RSCS-RSCI,CSPN-RACR,zxy] AXISVISUALISATION(LScapula) AXISVISUALISATION(RScapula) LScapulaSize=DIST(0(LScapula),0(Thorax)) LScapulaScale={1,1,1} LScapulaShift={0,0,0} RScapulaSize=DIST(0( RScapula),0(Thorax)) RScapulaScale={1,1,1} RScapulaShift={0,0,0} {* ============================ *} {* HUMERUS SEGMENTS *} {* ============================ *} {* Humerus CoM *} LHUCM=(LSJC-LEJC)*0.523+LEJC {* de Leva, 1996 *} RHUCM=(RSJC-REJC)*0.523+REJC OUTPUT(LHUCM,RHUCM) LHumerus=[LHUCM,LSJC-LEJC,LELB-LEJC,zxy] RHumerus=[RHUCM,RSJC-REJC,REJC-RELB,zxy] AXISVISUALISATION(LHumerus) AXISVISUALISATION(RHumerus) LHumerusSize=DIST(0(LHumerus),0(LClavicle)) LHumerusScale={1,1,1} LHumerusShift={0,0,0} RHumerusSize=DIST(0(RHumerus),0(RClavicle)) RHumerusScale={1,1,1} RHumerusShift={0,0,0}

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109Appendix J. (Continued) {* ============================ *} {* RADIUS SEGMENTS *} {* ============================ *} {*Radius CoM *} LRACM=(LEJC-LWJC)*0.543+LW JC {* de Leva, 1996 *} RRACM=(REJC-RWJC)*0.543+RWJC OUTPUT(LRACM,RRACM) LRadius=[LRACM,LEJC-LWJC,LELB-LEJC,zxy] RRadius=[RRACM,REJC-RWJC,REJC-RELB,zxy] AXISVISUALISATION(LRadius) AXISVISUALISATION(RRadius) LRadiusSize=DIST(0(LRadius),0(LHumerus)) LRadiusScale={0.75,0.75,0.75} LRadiusShift={0,0,0} RRadiusSize=DIST(0(RRadius),0(RHumerus)) RRadiusScale={0.75,0.75,0.75} RRadiusShift={0,0,0} {* ============================ *} {* HAND SEGMENTS *} {* ============================ *} {*Hand CoM *} L3MC=(LFIN+LLFI)/2 R3MC=(RFIN+RLFI)/2 LHACM=(LWJC-L3MC)*-0.79+LW JC {* de Leva, 1996 *} RHACM=(RWJC-R3MC)*-0.79+RWJC OUTPUT(LHACM,RHACM) LHand=[LHACM,LWJC-LHACM,LWJC-LRAD,zxy] RHand=[RHACM,RWJC-RHACM,RRAD-RWJC,zxy] AXISVISUALISATION(LHand) AXISVISUALISATION(RHand) If $HandLength==0 AND $Static==1 Then $HandLength=0.35*(DIST(LWJC ,LEJC)+DIST(RWJC,REJC)) PARAM($HandLength) Else

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110Appendix J. (Continued) HandLength=$HandLength EndIf LHandSize=RHand Size=HandLength LHandScale={1,1,1} LHandShift={0,0,0} RHandScale={1,1,1} RHandShift={0,0,0} {* ============================ *} {* KNEE JOINT CENTERS *} {* ============================ *} If $Static==1 Then If ExistAtAll(LKNE,LMKN) Then $LKneeWidth=DIST(LKNE,LMKN) Else $LKneeWidth=$MeanKneeWidth EndIf If ExistAtAll(RKNE,RMKN) Then $RKneeWidth=DIST(RKNE,RMKN) Else $RKneeWidth=$MeanKneeWidth EndIf $KneeWidth=($LKneeWidth+$RKneeWidth)/2 PARAM($KneeWidth) EndIf KneeOffset=($MarkerDiameter+$KneeWidth)/2 If ExistAtAll(LMKN) Then LKJC=(LKNE+LMKN)/2 Else LKJC=CHORD(KneeOffset,LKNE,LHJC,LFT1) EndIf If ExistAtAll(RMKN) Then RKJC=(RKNE+RMKN)/2 Else RKJC=CHORD(KneeOffset,RKNE,RHJC,RFT1) EndIf OUTPUT(LKJC,RKJC) {* ============================ *}

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111Appendix J. (Continued) {* ANKLE JOINT CENTERS *} {* ============================ *} If $Static==1 Then If ExistAtAll(LANK,LMAN) Then $LAnkleWidth=DIST(LANK,LMAN) Else $LAnkleWidth=$MeanAnkleWidth EndIf If ExistAtAll(RANK,RMAN) Then $RAnkleWidth=DIST(RANK,RMAN) Else $RAnkleWidth=$MeanAnkleWidth EndIf $AnkleWidth=($LAnkleWidth+$RAnkleWidth)/2 PARAM($AnkleWidth) EndIf AnkleOffset=($MarkerDiameter+$AnkleWidth)/2 If ExistAtAll(LMAN) Then LAJC=(LANK+LMAN)/2 Else LAJC=CHORD(AnkleOffset,LANK,LKJC,LTT1) EndIf If ExistAtAll(RMAN) Then RAJC=(RANK+RMAN)/2 Else RAJC=CHORD(AnkleOffset,RANK,RKJC,RTT1) EndIf OUTPUT(LAJC,RAJC) {* ============================ *} {* FEMUR SEGMENTS *} {* ============================ *} {*Femur CoM *} LFECM=(LHJC-LKJC)*0.590+LKJC {* de Leva, 1996 *} RFECM=(RHJC-RKJC)*0.590+RKJC OUTPUT(LFECM,RFECM) LFemur=[LFECM,LHJC-LKJC,LKNE-LKJC,zxy] RFemur=[RFECM,RHJC-R KJC,RKJC-RKNE,zxy] AXISVISUALISATION(LFemur)

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112Appendix J. (Continued) AXISVISUALISATION(RFemur) LFemurSize=DIST(0(LFemur),0(LHipJoint)) LFemurScale={1.8,1.8,1.8} LFemurShift={0,0,0} RFemurSize=DIST(0(RFemur),0(RHipJoint)) RFemurScale={1.8,1.8,1.8} RFemurShift={0,0,0} {* ============================ *} {* TIBIA SEGMENTS *} {* ============================ *} {* Tibia CoM *} LTICM=(LKJC-LAJC)*0.561+LAJC {* de Leva, 1996 *} RTICM=(RKJC-RAJC)*0.561+RAJC OUTPUT(LTICM,RTICM) LTibia=[LTICM,LKJC-LAJC,LKNE-LKJC,zxy] RTibia=[RTICM,RKJC-R AJC,RKJC-RKNE,zxy] AXISVISUALISATION(LTibia) AXISVISUALISATION(RTibia) LTibiaSize=DIST(0(LTibia),0(LFemur)) LTibiaScale={0.9,0.93,0.93} LTibiaShift={0,0,0} RTibiaSize=DIST(0( RTibia),0(RFemur)) RTibiaScale={0 .93,0.93,0.93} RTibiaShift={0,0,0} {* ============================ *} {* FOOT SEGMENTS *} {* ============================ *} {* Foot CoM *} LFOCM=(LAJC-LTOE)*0.5+LTOE RFOCM=(RAJC-RTOE)*0.5+RTOE OUTPUT(LFOCM,RFOCM) LFoot=[LFOCM,LAJC-LTOE,LANK-LAJC,zxy] RFoot=[RFOCM,RAJC-RTO E,RAJC-RANK,zxy] AXISVISUALISATION(LFoot)

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113Appendix J. (Continued) AXISVISUALISATION(RFoot) $FootLength=1.34*(DIST(LTOE,LAJC)+DIST(RTOE,RAJC))/2 LFootSize=RFootSize=0.76*$FootLength LFootScale={1,1,1} LFootShift={0,0,0} RFootScale={1,1,1} RFootShift={0,0,0} {* ============================ *} {* ANTHROPOMETRY *} {* ============================ *} If $Static==1 Then {* Segment Lengths *} HeadNeckLength=$Stature*0.182 TorsoLength=DIST(CSPN,LSID) PelvisLength=DIST(LSID,PELV) PARAM(HeadNeckLength,To rsoLength,PelvisLength) HumerusLength=(DIST(LSJC,L EJC)+DIST(RSJC,REJC))/2 RadiusLength=(DIST(LEJC,L WJC)+DIST(REJC,RWJC))/2 HandLength=$HandLength PARAM(HumerusLength, RadiusLength,HandLength) FemurLength=(DIST(LHJC,LK JC)+DIST(RHJC,RKJC))/2 TibiaLength=(DIST(LKJC,LAJC)+DIST(RKJC,RAJC))/2 FootLength=$FootLength PARAM(FemurLength,Tibi aLength,FootLength) {* Segment Masses Ref: de Leva, 1996 *} {* Corrections to normal segment masses offered for duration since SCI Lloyd, 2005 *} $HeadMass=$BodyMass*0.0694 $ThoraxMass=$BodyMass*(0.15 96+(0.0022*$SCI_duration)) $LumbarMass=$BodyMass*(0.1633+(0.0022*$SCI_duration)) $TorsoMass=$ThoraxMass+$LumbarMass

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114Appendix J. (Continued) $PelvisMass=$BodyMass*(0.1117-(0.0012*$SCI_duration)) $HumerusMass=$BodyMass*(0.0271+ (0.0004*$SCI_duration)) $RadiusMass=$BodyMass*(0.01 62+(0.0002*$SCI_duration)) $HandMass=$BodyMass*(0.0061+ (0.00008*$SCI_duration)) $FemurMass=$BodyMass*(0.1416-(0.0016*$SCI_duration)) $TibiaMass=$BodyMass*(0. 0433-(0.0005*$SCI_duration)) $FootMass=$BodyMass*(0.0137 -(0.0002*$SCI_duration)) PARAM($HeadMass,$ThoraxMass,$Lumba rMass,$TorsoMass,$PelvisMass) PARAM($HumerusMass,$RadiusMass,$HandMass) PARAM($FemurMass,$TibiaMass,$FootMass) $HeadMass%=$HeadMass/$BodyMass $TorsoMass%=$TorsoMass/$BodyMass $PelvisMass%=$PelvisMass/$BodyMass $HumerusMass%=$HumerusMass/$BodyMass $RadiusMass%=$RadiusMass/$BodyMass $HandMass%=$HandMass/$BodyMass $FemurMass%=$FemurMass/$BodyMass $TibiaMass%=$TibiaMass/$BodyMass $FootMass%=$FootMass/$BodyMass PARAM($HeadMass%,$TorsoMass%,$PelvisMass%) PARAM($HumerusMass%,$RadiusMass%,$HandMass%) PARAM($FemurMass%,$TibiaMass%,$FootMass%) EndIf {* ============================ *} {* WHOLE BODY CENTER OF MASS *} {* ============================ *} {* Computed as a function of CoM for t he 12 key body segments, exc. Pelvis *} WBCOM=($HeadMass%*HEDCM)+($To rsoMass%*THRCM)+($PelvisMass%*P ELCM) +($HumerusMass%*LHUCM)+($Hume rusMass%*RHUCM)+($RadiusMas s%*LRACM)+($RadiusMass%*RRACM)+($HandMass%*LHACM)+($HandMass %*RHACM) +($FemurMass%*LFECM)+($Femu rMass%*RFECM)+($TibiaMass%*LTI CM)+($TibiaMass%*RTICM)+($Foot Mass%*LFOCM)+($FootMass%*RFOCM)

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115Appendix J. (Continued) OUTPUT(WBCOM) {* ============================ *} {* KINEMATICS *} {* ============================ *} {* Angles presented in order of tokeny(flex/ext),x(ab/aduction),z(rotation) *} {* Neck: Head > Thorax *} Neck_Angle=- {* Spine: Pelvis> Thorax *} Spine_Angle=- {* Clavicle: Thorax> Clavicle *} LClavicle_Angle=- RClavicle_Angle=(-1) {* Scapula: Thorax> Scapula *} LScapula_Angle=- RScapula_Angle=(-1) {* Shoulders: Thorax> Humeri *} LShoulder_Angle=- RShoulder_Angle=(-1) {* Elbows: Humeri> Radii *} LElbow_Angle=-(-1) RElbow_Angle=-(-1) {* Wrists: Radii> Hands *} LWrist_Angle=(-3) LWrist_Angle=<-LWrist_Angle(1),LWr ist_Angle(2),LWrist_Angle(3)> RWrist_Angle=- {* Hips: Pelvis> Femora *} LHip_Angle= RHip_Angle=-(-1) {* Knees: Femora> Tibiae *} LKnee_Angle=(-1) RKnee_Angle=-

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116Appendix J. (Continued) {* Ankles: Tibiae> Feet *} LAA=- LAnkle_Angle =<-90-1(L AA),-3(LAA),-2(LAA)> RAA=- RAnkle_Angle=<-90-1(RAA),3(RAA),2(RAA)> OUTPUT(Neck_Angle,Spine_Angle) OUTPUT(LClavicle_Angle,RClavicle_Angle) OUTPUT(LScapula_Angle,RScapula_Angle) OUTPUT(LShoulder_Angl e,RShoulder_Angle) OUTPUT(LElbow_Angl e,RElbow_Angle) OUTPUT(LWrist_Angle,RWrist_Angle) OUTPUT(LHip_Angle,RHip_Angle) OUTPUT(LKnee_Angl e,RKnee_Angle) OUTPUT(LAnkle_Angle,RAnkle_Angle) LINVELACC(HEDCM,Head) LINVELACC(THRCM,Thorax) LINVELACC(PELCM,Pelvis) LINVELACC(LHUCM,LHumerus) LINVELACC(RHUCM,RHumerus) LINVELACC(LRACM,LRadius) LINVELACC(RRACM,RRadius) LINVELACC(LHACM,LHand) LINVELACC(RHACM,RHand) LINVELACC(LFECM,LFemur) LINVELACC(RFECM,RFemur) LINVELACC(LTICM,LTibia) LINVELACC(RTICM,RTibia) LINVELACC(LFOCM,LFoot) LINVELACC(RFOCM,RFoot) ANGVELACC(Head,Thorax,Neck) ANGVELACC(Pelvis,Thorax,LSpine) ANGVELACC(LClavicle,Thorax,LClav) ANGVELACC(RClavicl e,Thorax,RClav) ANGVELACC(LScapula,Thorax,LScap) ANGVELACC(RScapula,Thorax,RScap) ANGVELACC(LHumerus ,Thorax,LShoulder) ANGVELACC(RHumerus ,Thorax,RShoulder) ANGVELACC(LRadius, LHumerus,LElbow)

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117Appendix J. (Continued) ANGVELACC(RRadius,RHumerus,RElbow) ANGVELACC(LHand, LRadius,LWrist) ANGVELACC(RHand, RRadius,RWrist) ANGVELACC(LFemur,Pelvis,LHip) ANGVELACC(RFemur,Pelvis,RHip) ANGVELACC(LTibia,LFemur,LKnee) ANGVELACC(RTibia,RFemur,RKnee) ANGVELACC(LFoot,LTibia,LAnkle) ANGVELACC(RFoot,RTibia,RAnkle) {* ============================ *} {* KINETICS *} {* ============================ *} {* Segment Definitions & Heir archy [body,inboard body,mass,COM position,{Ix,Iy,Iz(axial)}] *} Head=[Head,Thorax,CSPN,$HeadMass, {0,0,0},$HeadMass*{0.0992,0.0992,0.06 81}] Thorax=[Thorax,Pelvis,LS ID,$ThoraxMass,{0,0,0},$T horaxMass*{0.0961,0.0961, 0}] Pelvis=[Pelvis,$PelvisMass,{0,0,0 },$PelvisMass*{0.25,0.25,0.09}] LHumerus=[LHumerus,Thor ax,LSJC,$HumerusMass,{0 ,0,0},$HumerusMass*{0. 0724,0.0724,0.025}] RHumerus=[RHumerus,Thorax,RSJC,$Hum erusMass,{0,0,0},$HumerusMass*{0. 0724,0.0724,0.025}] LRadius=[LRadius,LHumerus,LEJC,$Ra diusMass,{0,0,0},$R adiusMass*{0.0702, 0.0702,0.0146}] RRadius=[RRadius,RHumerus,REJC,$RadiusMass,{0,0,0},$RadiusMass*{0.070 2,0.0702,0.0146}] LHand=[LHand,LRadius,LW JC,$HandMass,{0,0,0},$HandMass*{0.0552,0.0552, 0.0339}] RHand=[RHand,RRadius,RWJC,$HandMas s,{0,0,0},$HandMass*{0.0552,0.0552 ,0.0339}] LFemur=[LFemur,Pelvis,LHJC,$FemurMa ss,{0,0,0},$FemurMass*{0.1082,0.1082 ,0.0222}] RFemur=[RFemur,Pelvis,RHJC,$FemurMa ss,{0,0,0},$FemurMass*{0.1082,0.108 2,0.0222}] LTibia=[LTibia,LFemur,LKJC,$TibiaMa ss,{0,0,0},$TibiaMass*{0.0605,0.0605,0.0 104}] RTibia=[RTibia,RFemur,RKJC,$TibiaMa ss,{0,0,0},$TibiaMass*{0.0605,0.0605,0. 0104}] LFoot=[LFoot,LTibia,LAJC,$FootMass, {0,0,0},$FootMass*{0.06,0.06,0.0154}]

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118Appendix J. (Continued) RFoot=[RFoot,RTibia,RAJC,$FootMass,{0 ,0,0},$FootMass*{0.06,0.06,0.0154}] OptionalReactions(ForcePlate1,ForceP late2,ForcePlate3,ForcePlate4) If ExistAtAll (ForcePlate1,ForcePla te2,ForcePlate3,ForcePlate4) Then TrapezeForce=ForcePlate1(1) VanHandleForce=ForcePlate2(1) LGloveForce=ForcePlate3(1) RGloveForce=ForcePlate4(1) LForceDirect=[LHACM,LSJ C-LHACM,LRAD-LWJC,zxy] RForceDirect=[RHACM,RSJC-RHACM,LWJC-LRAD,zxy] LGloveForceNew={LGloveForce(1),LG loveForce(2),LGloveForce(3)}*Attit ude(LForceDirect) ForcePlate3=|LGloveForceNew,Fo rcePlate3(2),{LHACM(1),LHACM(2),LH ACM(3)}| CONNECT(LHand,ForcePlate3,1) RGloveForceNew={RGloveForce(1),RG loveForce(2),RGloveForce(3)}*Atti tude(RForceDirect) ForcePlate4=|RGloveForceNew,Fo rcePlate4(2),{RHACM(1),RHACM(2),R HACM(3)}| CONNECT(RHand,Fo rcePlate4,1) EndIf ReactLWrist=REACTION(LHand) ReactRWrist=REACTION(RHand) ReactLElbow=REACTION(LRadius) ReactRElbow=REACTION(RRadius) ReactLShoulder=REAC TION(LHumerus) ReactRShoulder=REAC TION(RHumerus) ReactLSID=REACTION(Thorax) ReactLHip=REACTION(LFemur) ReactRHip=REACTION(RFemur) ReactLKnee=REACTION(LTibia) ReactRKnee=REACTION(RTibia) ReactLAnkle=REACTION(LFoot) ReactRAnkle=REACTION(RFoot) LWrist_F=ReactLWrist(1) RWrist_F=ReactRWrist(1)

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119Appendix J. (Continued) LElbow_F=ReactLElbow(1) RElbow_F=ReactRElbow(1) LShoulder_F=ReactLShoulder(1) RShoulder_F=ReactRShoulder(1) Spine_F=ReactLSID(1) LHip_F=ReactLHip(1) RHip_F=ReactRHip(1) LKnee_F=ReactLKnee(1) RKnee_F=ReactRKnee(1) LAnkle_F=ReactLAnkle(1) RAnkle_F=ReactRAnkle(1) LWrist_Force={SQRT(LWrist_F(1)*LWrist _F(1)),SQRT(LWrist_F(2)*LWrist_F(2)), SQRT(LWrist_F(3)*LWrist_F(3))} RWrist_Force={SQRT(RWrist_F(1)*RWrist _F(1)),SQRT(RWrist_F(2)*RWrist_F(2 )),SQRT(RWrist_F(3)*RWrist_F(3))} LElbow_Force={SQRT(LElbow_F(1)*LElb ow_F(1)),SQRT(LElbow_F(2)*LElbow_ F(2)),SQRT(LElbow_F( 3)*LElbow_F(3))} RElbow_Force={SQRT(RElbow_F(1)*RElbow_F(1)),SQRT(RElbow_F(2)*RElbo w_F(2)),SQRT(RElbow_F(3)*RElbow_F(3))} LShoulder_Force={SQRT(LShoulder_F(1 )*LShoulder_F(1)),SQRT(LShoulder_F( 2)*LShoulder_F(2)),SQRT(LShou lder_F(3)*LShoulder_F(3))} RShoulder_Force={SQRT(RShoulder_F(1 )*RShoulder_F(1)),SQRT(RShoulder_ F(2)*RShoulder_F(2)),SQRT(RS houlder_F(3)*RShoulder_F(3))} Spine_Force={SQRT(Spine_F(1)*Spine_ F(1)),SQRT(Spine_F(2)*Spine_F(2)),S QRT(Spine_F(3)*Spine_F(3))} LHip_Force={SQRT(LHip_F(1)*LHip_F(1 )),SQRT(LHip_F(2)*LHip_F(2)),SQRT(L Hip_F(3)*LHip_F(3))} RHip_Force={SQRT(RHip_F(1)*RHip_F(1 )),SQRT(RHip_F(2)*RHip_F(2)),SQRT (RHip_F(3)*RHip_F(3))} LKnee_Force={SQRT(LKnee_F(1)*LKnee_F (1)),SQRT(LKnee_F(2)*LKnee_F(2)) ,SQRT(LKnee_F(3)*LKnee_F(3))} RKnee_Force={SQRT(RKnee_F(1)*RK nee_F(1)),SQRT(RKnee_F(2)*RKnee_F( 2)),SQRT(RKnee_F(3)*RKnee_F(3))} LAnkle_Force={SQRT(LAnkle_F(1)*LAnk le_F(1)),SQRT(LAnkle_F(2)*LAnkle_F( 2)),SQRT(LAnkle_F(3)*LAnkle_F(3))} RAnkle_Force={SQRT(RAnkle_F(1)*RAnk le_F(1)),SQRT(RAnkle_F(2)*RAnkle_ F(2)),SQRT(RAnkle_F(3)*RAnkle_F(3))} OUTPUT(LWrist_Force,RWrist_Force,LEl bow_Force,RElbow_Force,LShoulder_ Force,RShoulder_Force) OUTPUT(Spine_Force,LHip_Force,RHip_Force,LKnee_Force,RKnee_Force,LAn kle_Force,RAnkle_Force)

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120Appendix J. (Continued) LWrist_Moment=ReactLWrist(2) RWrist_Moment=ReactRWrist(2) LElbow_Moment=ReactLElbow(2) RElbow_Moment=ReactRElbow(2) LShoulder_Moment=ReactLShoulder(2) RShoulder_Moment=ReactRShoulder(2) Spine_Moment=ReactLSID(2) LHip_Moment=ReactLHip(2) RHip_Moment=ReactRHip(2) LKnee_Moment=ReactLKnee(2) RKnee_Moment=ReactRKnee(2) LAnkle_Moment=ReactLAnkle(2) RAnkle_Moment=ReactRAnkle(2) OUTPUT(LWrist_Moment,RWrist_Mom ent,LElbow_Momen t,RElbow_Moment,L Shoulder_Moment,RShoulder_Moment) OUTPUT(Spine_Moment,LHip_Moment, RHip_Moment,LKnee_Moment,RKnee_ Moment,LAnkle_Moment,RAnkle_Moment) LWrist_Power=POWER(LRadius,LHand) RWrist_Power=POWER(RRadius,RHand) LElbow_Power=POWER (LHumerus,LRadius) RElbow_Power=POWER(RHumerus,RRadius) LShoulder_Power=POWER(Thorax,LHumerus) RShoulder_Power=POWER(Thorax,RHumerus) Spine_Power=POWER(Thorax,Pelvis) LHip_Power=POWER(Pelvis,LFemur) RHip_Power=POWER(Pelvis,RFemur) LKnee_Power=POWER(LFemur,LTibia) RKnee_Power=POWER(RFemur,RTibia) LAnkle_Power=POWER(LTibia,LFoot) RAnkle_Power=POWER(RTibia,RFoot) OUTPUT(LWrist_Power,RWrist_Power,L Elbow_Power,RElbow_Power,LShoulde r_Power,RShoulder_Power) OUTPUT(Spine_Power,LHip_Power,RHi p_Power,LKnee_Power,RKnee_Power, LAnkle_Power,RAnkle_Power) {* ============================ *} {* END OF MODEL *} {* ============================ *}

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121Appendix J. (Continued) {* ================================ ============================= =========== *} Whole-body biomechanical model for 3D dynamic kinematic and kinetic analysis of human motion 2005 John D Lloyd, Ph.D. VA Patient Safety Research Center, Tampa, Florida {* ================================ ============================= =========== *} {* ================================ ============================= =========== *} PART 3 POLYGON & SCALING {* ================================ ============================= =========== *} {* ============================ *} {* MACROS *} {* ============================ *} macro DRAWBONE(Bone,BoneLabel) {*Outputs segment definition ma rkers in Polygon format *} LL=Bone#Size DD=LL/10 WW=DD BoneLabel#O=0(Bone)+LL*Bon e#Shift*Attitude(Bone) BoneLabel#P=BoneLabel#O+LL* 3(Bone#Scale)*3(Bone) BoneLabel#A=BoneLabel#O+DD* 1(Bone#Scale)*1(Bone) BoneLabel#L=BoneLabel#O+WW* 2(Bone#Scale)*2(Bone) OUTPUT(BoneLabel#O,BoneLabel#P ,BoneLabel#A,BoneLabel#L) ENDMACRO {* ========== *} macro RESIZE(Segment) {*Segment scale and shift*} Segment#Axes=[Segment#O,S egment#P-Segment#O,Segment#LSegment#O,zxy]

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122Appendix J. (Continued) Segment#O = Segment#O + ($Shift# Segment*Attitude(Segment#Axes)) Segment#P = Segment#P + ($Shift# Segment*Attitude(Segment#Axes)) Segment#A = Segment#A + ($Shift# Segment*Attitude(Segment#Axes)) Segment#L = Segment#L + ($Shift# Segment*Attitude(Segment#Axes)) Segment#Axes=[Segment#O,S egment#P-Segment#O,Segment#LSegment#O,zxy] Segment#P = {0,0,($PSize#Segment*DIST(Segm ent#P,Segment#O))}*Segment#Axes Segment#A = {($AAxisLength#Segment*DIST(Segment#A ,Segment#O)),0,0}*Segment#Axes Segment#L = {0,($LAxisLength#Segment*DIST(Segm ent#L,Segment#O)), 0}*Segment#Axes OUTPUT(Segment#O,Segment#P ,Segment#A,Segment#L) ENDMACRO {* ========== *} macro ATTACH1(Attachment,Bone) {*Attaches Left and Right muscles to one mid-line bone *} L#Attachment = {(1(Attachment )+1(Bone#Shift))*1(Bone#Scale), (2(Attachment)+2(Bone#Shift))*2(Bone#Scale), (3(Attachment)+3(Bone#Shift) )*3(Bone#Scale)}*Bone#Size*Bone R#Attachment = {(1(Attachment )+1(Bone#Shift))*1(Bone#Scale), -(2(Attachment)+2(Bone#Shift))*2(Bone#Scale), (3(Attachment)+3(Bone#Shift) )*3(Bone#Scale)}*Bone#Size*Bone ENDMACRO {* ========== *} macro ATTACH2(Attachment,Bone) {*Attaches Left and Right muscles to Left and Right bones *} L#Attachment = {(1(Attachment)+ 1(L#Bone#Shift))*1(L#Bone#Scale), (2(Attachment)+2(L# Bone#Shift))*2(L#Bone#Scale), (3(Attachment)+3(L#Bone#Shift))*3(L#B one#Scale)}*L#Bone#Size*L#Bone R#Attachment = {(1(Attachment)+ 1(R#Bone#Shift))*1(R#Bone#Scale), -(2(Attachment)+2(R#B one#Shift))*2(R#Bone#Scale), (3(Attachment)+3(R#Bone#Shift))*3( R#Bone#Scale)}*R#Bone#Size*R#Bone ENDMACRO {* ========== *}

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123Appendix J. (Continued) macro DRAWMUSCLE(Muscle,Orig in,Insertion,wrap1,wrap2) {*Outputs muscle length, origin, inst ertion, and up to 2 "wrap points" *} If DIST(L#wrap1,{0,0,0})>= 0.0001 Then If DIST(L#wrap2,{0,0,0})>= 0.0001 Then L#Muscle#Length=DIST(L#Origin, L#wrap1)+DIST(L#wrap1,L#wrap2)+DI ST(L#wrap2,L#Insertion) OUTPUT(L#wrap1,L#wrap2) Else L#Muscle#Length=DIST( L#Origin,L#wrap1)+DIST( L#wrap1,L#Insertion) OUTPUT(L#wrap1) EndIf Else L#Muscle#Length=DIST( L#Origin,L#Insertion) EndIf If DIST(R#wrap1,{0,0,0})>= 0.0001 Then If DIST(R#wrap2,{0,0,0})>= 0.0001 Then R#Muscle#Length=DIST(R#Origin,R# wrap1)+DIST(R#wrap1,R#wrap2)+D IST(R#wrap2,R#Insertion) OUTPUT(R#wrap1,R#wrap2) Else R#Muscle#Length=DIST(R#Origin,R#wr ap1)+DIST(R#wrap1,R#Insertion) OUTPUT(R#wrap1) EndIf Else R#Muscle#Length=DIST(R#O rigin,R#Insertion) EndIf If $MuscleLengthsOutput ==1 Then OUTPUT(L#Origin,L#Ins ertion,L#Muscle#Length) OUTPUT(R#Origin,R#Inse rtion,R#Muscle#Length) Else OUTPUT(L#Origin,L#Insertion) OUTPUT(R#Origin,R#Insertion) EndIf ENDMACRO {* ==================== *}

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124Appendix J. (Continued) {* ORIGIN *} {* ==================== *} Gorigin={0,0,0} Global=[Gorigin,{1,0 ,0},{0,0,1},xyz] Lnowrap={0,0,0} Rnowrap={0,0,0} {* ==================== *} {* OPTIONAL MARKERS *} {* ==================== *} OptionalPoints(GLAB,LT EM,RTEM,LMAS,RMAS) OptionalPoints(CSPN,CLAV,STRN,CHST) OptionalPoints(LSCS,LSCI,RSCS,RSCI) OptionalPoints(MPEL,LASI,RASI,LSIS,RSIS) OptionalPoints(LACR,LHT1,LHT2,LHT3) OptionalPoints(LELB,LMEL,LRT1,LRT2,LRT3) OptionalPoints(LRAD,LULN,LFIN,LLFI) OptionalPoints(RACR,RHT1,RHT2,RHT3) OptionalPoints(RELB,RMEL,RRT1,RRT2,RRT3) OptionalPoints(RRAD,RULN,RFIN,RLFI) OptionalPoints(LFT1,LFT2,LFT3) OptionalPoints(LKNE,LMKN,LTT1,LTT2,LTT3) OptionalPoints(LANK,LMAN,LTOE,LLTO) OptionalPoints(RFT1,RFT2,RFT3) OptionalPoints(RKNE,RMKN,RTT1,RTT2,RTT3) OptionalPoints(RANK,RMAN,RTOE,RLTO) OptionalPoints(HEDCM,THRCM,PELCM ,LHUCM,LRACM,LHACM,RHUCM,RRA CM,RHACM,LFECM,LTICM,LFOCM ,RFECM,RTICM,RFOCM,WBCOM) {* ==================== *} {* HEADSEGMENT *} {* ==================== *} FHED=(LTEM+RTEM)/2 BHED=(LMAS+RMAS)/2 LHED=(LTEM+LMAS)/2 RHED=(RTEM+RMAS)/2 {*Head CoM *}

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125Appendix J. (Continued) HEDCM=(GLAB+LMAS+RMAS)/3 OUTPUT(HEDCM) Head=[HEDCM,LMAS-RM AS,FHED-BHED,yzx] If $Static==1 $HeadSize=DIST(FHED,BHED) {*Create a head offset angle from static trial*} $HeadOffset = PARAM($HeadOffset,$HeadSize) EndIf Head=ROT(Head,Head(2),$HeadOffset(2)) HeadSize=$HeadSize HeadScale={1.4,1.4,1.4} HeadShift={0,0,0} {* ====================== *} {* THORACIC SPINE SEGMENT *} {* ====================== *} LSID=(LSIS+RSIS)/2 OUTPUT(LSID) {*Trunk CoM *} THRCM=(CSPN-LSID)*0.63+LSID {* Ref: Dempster, 1955; Winter, 1990; Pitt, 1997 *} OUTPUT(THRCM) Thorax=[THRCM,STRN-THRCM,LACR-RACR,xzy] If $Static==1 Then $ThoraxSize=DIST(LACR,RACR)/2 PARAM($ThoraxSize) EndIf ThoraxSize=0.9*$ThoraxSize ThoraxScale={1.2,1.2,1.2} ThoraxShift={0,0,0}

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126Appendix J. (Continued) {* ============================ *} {* CERVICAL SPINE SEGMENT *} {* ============================ *} CSPine=[(CSPN+CLAV)/2,LAC R-RACR,CLAV-CSPN,yzx] CSpineSize=0.5*$ThoraxSize PARAM(CSpineSize) CSpineScale={0.8,0.8,0.8} CSpineShift={0,0,0} {* ============================ *} {* PELVIS AND HIP JOINT CENTERS *} {* ============================ *} PelvisTemp=[LSID,LSIS-RSIS,MPEL-LSID,yzx] {* Define Asis-Trochanter Dist (ATD) as function of leg length *} LegLength=$LegLength LATD=0.1288*Leglength-48.56 RATD=LATD If $InterAsisDistance ==0 Then InterAsisDist=DIST(LASI,RASI) Else InterAsisDist=$InterAsisDistance EndIf {* Parameters used to work out posi tion of hip joint centres (Davis)*} C =(LegLength)*0.115-15.3 aa=InterAsisDist/2 mm=($MarkerDiameter+$MarkerExtension)/2 COSBETA=cos(18) SINBETA=sin(18) COSTHETA=cos(28.4) SINTHETA=sin(28.4) LHJC = {C*COSTHETA*SINB ETA-(LATD+mm)*COSBETA, -C*SINTHETA+ aa, -C*COSTHETA*COSBET A-(LATD+mm)*SINBETA}*PelvisTemp RHJC = {C*COSTHETA*SIN BETA-(RATD+mm)*COSBETA,

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127Appendix J. (Continued) C*SINTHETAaa, -C*COSTHETA*COSBET A-(RATD+mm)*SINBETA}*PelvisTemp OUTPUT(LHJC,RHJC) {* Pelvis CoM *} PELV=(LHJC+RHJC)/2 PELCM=(LSID-PELV)*0.135+PELV {* Re f: Dempster, 1955; Winter, 1990; Pitt, 1997 *} OUTPUT(PELCM) Pelvis=[PELCM,LSIS-RSIS,MPEL-LSID,yzx] If $Static==1 Then $PelvisSize=DIST(LHJC,RHJC) PARAM($PelvisSize) EndIf PelvisSize=$PelvisSize PelvisScale={0.8,0.8,0.8} PelvisShift={0,0,0} {* HipJoints *} LHipJoint=LHJC+Attitude(Pelvis) RHipJoint=RHJC+Attitude(Pelvis) {* Sacrum *} SAC0=MPEL+$PelvisSize*{-1,0,0}*Attitude(Pelvis) Sacrum=SAC0+Attitude(Pelvis) SacrumSize=PelvisSize/2 PARAM(SacrumSize) SacrumScale={1,1,1} SacrumShift={0,0,0} {* ============================ *} {* SHOULDER JOINT CENTERS *} {* ============================ *} ShoulderOffset=30 MarkerExtension={0,0,($MarkerDiameter/ 2)+$MarkerExtension}*Attitude(Thorax) LSJC=LACR-MarkerExtension-Shoulde rOffset*($Stature/1760)*Thorax(3) RSJC=RACR-MarkerExtens ion-ShoulderOffset*($Stature/1760)*Thorax(3)

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128Appendix J. (Continued) OUTPUT(LSJC,RSJC) {* ============================ *} {* ELBOW JOINT CENTERS *} {* ============================ *} If $Static==1 Then If ExistAtAll(LELB,LMEL) Then $LElbowWidth=DIST(LELB,LMEL) Else $LElbowWidth=$MeanElbowWidth EndIf If ExistAtAll(RELB,RMEL) Then $RElbowWidth=DIST(RELB,RMEL) Else $RElbowWidth=$MeanElbowWidth EndIf $ElbowWidth=($LElbow Width+$RElbowWidth)/2 PARAM($ElbowWidth) EndIf ElbowOffset=($MarkerDiameter+$ElbowWidth)/2 If ExistAtAll(LMEL) Then LEJC=(LELB+LMEL)/2 Else LEJC=CHORD(ElbowOffset,LELB,LSJC,LHT1) EndIf If ExistAtAll(RMEL) Then REJC=(RELB+RMEL)/2 Else REJC=CHORD(ElbowOffset,RELB,RSJC,RHT1) EndIf OUTPUT(LEJC,REJC) {* ============================ *} {* WRIST JOINT CENTERS *} {* ============================ *} If $Static==1 Then If ExistAtAll(LRAD,LULN) Then $LWristWidth=DIST(LRAD,LULN)

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129Appendix J. (Continued) Else $LWristWidth=$MeanWristWidth EndIf If ExistAtAll(RRAD,RULN) Then $RWristWidth=DIST(RRAD,RULN) Else $RWristWidth=$MeanWristWidth EndIf $WristWidth=($LWristWidth+$RWristWidth)/2 PARAM($WristWidth) EndIf WristOffset=($MarkerDiameter+$M arkerExtension+$WristWidth)/2 If ExistAtAll(LULN) Then LWJC=(LRAD+LULN)/2 Else LWJC=CHORD(WristOffset,LRAD,LEJC,LRT1) EndIf If ExistAtAll(RULN) Then RWJC=(RRAD+RULN)/2 Else RWJC=CHORD(WristOffset,RRAD,REJC,RRT1) EndIf OUTPUT(LWJC,RWJC) {* ============================ *} {* CLAVICLE SEGMENTS *} {* ============================ *} LCLCM=(LACR+CLAV)/2 RCLCM=(RACR+CLAV)/2 LClavicle=[LCLCM,LACR-CLAV,LSJC-LACR,zxy] RClavicle=[RCLCM,RACR-CLAV,RACR-RSJC,zxy] LClavicleSize=DIST(0(LClavicle),0(Thorax)) LClavicleScale={1,1,1} LClavicleShift={0,0,0} RClavicleSize=DIST(0(RClavicle),0(Thorax)) RClavicleScale={1,1,1} RClavicleShift={0,0,0} {* ============================ *}

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130Appendix J. (Continued) {* SCAPULA SEGMENTS *} {* ============================ *} LSCCM=(LACR+LSCS+LSCI)/3 RSCCM=(RACR+RSCS+RSCI)/3 LScapula=[LSCCM,LSCS-LSCI,LACR-CSPN,zxy] RScapula=[RSCCM,RSCS-RSCI,CSPN-RACR,zxy] LScapulaSize=DIST(0(LScapula),0(Thorax)) LScapulaScale={1,1,1} LScapulaShift={0,0,0} RScapulaSize=DIST(0( RScapula),0(Thorax)) RScapulaScale={1,1,1} RScapulaShift={0,0,0} {* ============================ *} {* HUMERUS SEGMENTS *} {* ============================ *} {* Humerus CoM *} LHUCM=(LSJC-LEJC)*0.523+LEJC {* de Leva, 1996 *} RHUCM=(RSJC-REJC)*0.523+REJC OUTPUT(LHUCM,RHUCM) LHumerus=[LHUCM,LSJC-LEJC,LELB-LEJC,zxy] RHumerus=[RHUCM,RSJC-REJC,REJC-RELB,zxy] LHumerusSize=DIST(0(LHumerus),0(LClavicle)) LHumerusScale={1,1,1} LHumerusShift={0,0,0} RHumerusSize=DIST(0(RHumerus),0(RClavicle)) RHumerusScale={1,1,1} RHumerusShift={0,0,0} {* ============================ *} {* RADIUS SEGMENTS *} {* ============================ *} {*Radius CoM *} LRACM=(LEJC-LWJC)*0.543+LW JC {* de Leva, 1996 *}

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131Appendix J. (Continued) RRACM=(REJC-RWJC)*0.543+RWJC OUTPUT(LRACM,RRACM) LRadius=[LRACM,LEJC-LWJC,LELB-LEJC,zxy] RRadius=[RRACM,REJC-RWJC,REJC-RELB,zxy] LRadiusSize=DIST(0(LRadius),0(LHumerus)) LRadiusScale={0.75,0.75,0.75} LRadiusShift={0,0,0} RRadiusSize=DIST(0(RRadius),0(RHumerus)) RRadiusScale={0.75,0.75,0.75} RRadiusShift={0,0,0} {* ============================ *} {* HAND SEGMENTS *} {* ============================ *} {*Hand CoM *} L3MC=(LFIN+LLFI)/2 R3MC=(RFIN+RLFI)/2 LHACM=(LWJC-L3MC)*-0.79+LW JC {* de Leva, 1996 *} RHACM=(RWJC-R3MC)*-0.79+RWJC OUTPUT(LHACM,RHACM) LHand=[LHACM,LWJC-LHACM,LWJC-LRAD,zxy] RHand=[RHACM,RWJC-RHACM,RRAD-RWJC,zxy] If $HandLength==0 AND $Static==1 Then $HandLength=0.35*(DIST(LWJC ,LEJC)+DIST(RWJC,REJC)) PARAM($HandLength) Else HandLength=$HandLength EndIf LHandSize=RHand Size=HandLength LHandScale={1,1,1} LHandShift={0,0,0} RHandScale={1,1,1} RHandShift={0,0,0} {* ============================ *}

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132Appendix J. (Continued) {* KNEE JOINT CENTERS *} {* ============================ *} If $Static==1 Then If ExistAtAll(LKNE,LMKN) Then $LKneeWidth=DIST(LKNE,LMKN) Else $LKneeWidth=$MeanKneeWidth EndIf If ExistAtAll(RKNE,RMKN) Then $RKneeWidth=DIST(RKNE,RMKN) Else $RKneeWidth=$MeanKneeWidth EndIf $KneeWidth=($LKneeWidth+$RKneeWidth)/2 PARAM($KneeWidth) EndIf KneeOffset=($MarkerDiameter+$KneeWidth)/2 If ExistAtAll(LMKN) Then LKJC=(LKNE+LMKN)/2 Else LKJC=CHORD(KneeOffset,LKNE,LHJC,LFT1) EndIf If ExistAtAll(RMKN) Then RKJC=(RKNE+RMKN)/2 Else RKJC=CHORD(KneeOffset,RKNE,RHJC,RFT1) EndIf OUTPUT(LKJC,RKJC) {* ============================ *} {* ANKLE JOINT CENTERS *} {* ============================ *} If $Static==1 Then If ExistAtAll(LANK,LMAN) Then $LAnkleWidth=DIST(LANK,LMAN) Else $LAnkleWidth=$MeanAnkleWidth EndIf If ExistAtAll(RANK,RMAN) Then $RAnkleWidth=DIST(RANK,RMAN)

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133Appendix J. (Continued) Else $RAnkleWidth=$MeanAnkleWidth EndIf $AnkleWidth=($LAnkleWidth+$RAnkleWidth)/2 PARAM($AnkleWidth) EndIf AnkleOffset=($MarkerDiameter+$AnkleWidth)/2 If ExistAtAll(LMAN) Then LAJC=(LANK+LMAN)/2 Else LAJC=CHORD(AnkleOffset,LANK,LKJC,LTT1) EndIf If ExistAtAll(RMAN) Then RAJC=(RANK+RMAN)/2 Else RAJC=CHORD(AnkleOffset,RANK,RKJC,RTT1) EndIf OUTPUT(LAJC,RAJC) {* ============================ *} {* FEMUR SEGMENTS *} {* ============================ *} {*Femur CoM *} LFECM=(LHJC-LKJC)*0.590+LKJC {* de Leva, 1996 *} RFECM=(RHJC-RKJC)*0.590+RKJC OUTPUT(LFECM,RFECM) LFemur=[LFECM,LHJC-LKJC,LKNE-LKJC,zxy] RFemur=[RFECM,RHJC-R KJC,RKJC-RKNE,zxy] LFemurSize=DIST(0(LFemur),0(LHipJoint)) LFemurScale={1.8,1.8,1.8} LFemurShift={0,0,0} RFemurSize=DIST(0(RFemur),0(RHipJoint)) RFemurScale={1.8,1.8,1.8} RFemurShift={0,0,0} {* ============================ *} {* TIBIA SEGMENTS *} {* ============================ *}

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134Appendix J. (Continued) {* Tibia CoM *} LTICM=(LKJC-LAJC)*0.561+LAJC {* de Leva, 1996 *} RTICM=(RKJC-RAJC)*0.561+RAJC OUTPUT(LTICM,RTICM) LTibia=[LTICM,LKJC-LAJC,LKNE-LKJC,zxy] RTibia=[RTICM,RKJC-R AJC,RKJC-RKNE,zxy] LTibiaSize=DIST(0(LTibia),0(LFemur)) LTibiaScale={0.9,0.93,0.93} LTibiaShift={0,0,0} RTibiaSize=DIST(0( RTibia),0(RFemur)) RTibiaScale={0 .93,0.93,0.93} RTibiaShift={0,0,0} {* ============================ *} {* FOOT SEGMENTS *} {* ============================ *} {* Foot CoM *} LFOCM=(LAJC-LTOE)*0.5+LTOE RFOCM=(RAJC-RTOE)*0.5+RTOE OUTPUT(LFOCM,RFOCM) LFoot=[LFOCM,LAJC-LTOE,LANK-LAJC,zxy] RFoot=[RFOCM,RAJC-RTO E,RAJC-RANK,zxy] $FootLength=1.34*(DIST(LTOE,LAJC)+DIST(RTOE,RAJC))/2 LFootSize=RFootSize=0.76*$FootLength LFootScale={1,1,1} LFootShift={0,0,0} RFootScale={1,1,1} RFootShift={0,0,0} {* ============================ *} {* DRAW BONES *} {* ============================ *} DrawBone(Head,HEADbone_) DrawBone(CSpine, CSPINEbone_) DrawBone(Thorax,THORAXbone_)

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135Appendix J. (Continued) DrawBone(Pelvis,PELVISbone_) DrawBone(Sacrum,SACRUMbone_) DrawBone(LClavicl e,LCLAVbone_) DrawBone(RClavicle,RCLAVbone_) DrawBone(LHumerus,LHUMbone_) DrawBone(RHumerus,RHUMbone_) DrawBone(LRadiu s,LRADbone_) DrawBone(RRadius,RRADbone_) DrawBone(LHand, LHANDbone_) DrawBone(RHand,RHANDbone_) DrawBone(LFemur,LFEMURbone_) DrawBone(RFemur ,RFEMURbone_) DrawBone(LTibia,LTIBIAbone_) DrawBone(RTibia,RTIBIAbone_) DrawBone(LFoot,LFOOTbone_) DrawBone(RFoot,RFOOTbone_) {* ============================ *} {* RESIZE BONE SEGMENTS *} {* ============================ *} RESIZE(HEADbone_) RESIZE(CSPINEbone_) RESIZE(THORAXbone_) RESIZE(PELVISbone_) RESIZE(SACRUMbone_) RESIZE(LCLAVbone_) RESIZE(RCLAVbone_) RESIZE(LHUMbone_) RESIZE(RHUMbone_) RESIZE(LRADbone_) RESIZE(RRADbone_) RESIZE(LHANDbone_) RESIZE(RHANDbone_) RESIZE(LFEMURbone_) RESIZE(RFEMURbone_) RESIZE(LTIBIAbone_) RESIZE(RTIBIAbone_) RESIZE(LFOOTbone_) RESIZE(RFOOTbone_) {* ============================ *}

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136Appendix J. (Continued) {* ATTACH MUSCLES *} {* ============================ *} Attach1(MastoidProcess,Head) Attach1(Occiput,Head) Attach1(PostT1,Thorax) Attach1(PostT7,Thorax) Attach1(MidSternum,Thorax) Attach1(AntT12,Thorax) Attach1(IliacCrest,Pelvis) Attach1(IliacFossa,Pelvis) Attach1(AntInfIliacSpine,Pelvis) Attach1(PelvicBrim,Pelvis) Attach1(PostSacrum,Pelvis) Attach1(IschialTuberosity,Pelvis) Attach2(LatClavicle,Clavicle) Attach2(MedClavicle,Clavicle) Attach2(SupraGlenoidTubercle,Clavicle) Attach2(UppAntHumerus,Humerus) Attach2(UppPostHumerus,Humerus) Attach2(LowAntHumerus,Humerus) Attach2(LowLatHumerus,Humerus) Attach2(MedHumeralEpicondyle,Humerus) Attach2(LatHumeralEpicondyle,Humerus) Attach2(UlnarOlecranon,Radius) Attach2(UlnarTuberosity,Radius) Attach2(RadialTuberosity,Radius) Attach2(UppMedUlna,Radius) Attach2(MidLatRadius,Radius) Attach2(LowLatRadius,Radius) Attach2(FlexorRetinaculum,Radius) Attach2(ExtensorRetinaculum,Radius) Attach2(Pal2MetaCarpal,Hand) Attach2(Pal5MetaCarpal,Hand) Attach2(Pal3DistalPhalanx,Hand) Attach2(Dor3DistalPhalanx,Hand)

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137Appendix J. (Continued) Attach2(GreaterTrochanter,Femur) Attach2(LesserTrochanter,Femur) Attach2(UppFemoralShaft,Femur) Attach2(MidFemoralShaft,Femur) Attach2(LatFemoralCondyle,Femur) Attach2(MedFemoralCondyle,Femur) Attach2(Patella,Femur) Attach2(MedTibialCondyle,Tibia) Attach2(UppLatTibia,Tibia) Attach2(HeadFibula,Tibia) Attach2(TibialTubercle,Tibia) Attach2(MidFibula,Tibia) Attach2(InfExtensorRetinaculum,Tibia) Attach2(Calcaneous,Foot) Attach2(MedCuneiform,Foot) {* ============================ *} {* DRAW MUSCLES *} {* ============================ *} DrawMuscle(UppTrapezius,Occipu t,LatClavicle,no wrap,nowrap) DrawMuscle(UppSpleniusCapitis,Mast oidProcess,PostT1,nowrap,nowrap) DrawMuscle(SternoMastoid,MastoidPr ocess,MedClavicle,nowrap,nowrap) DrawMuscle(BicepsBrachii, SupraGlenoidTubercle,Radi alTuberosity,nowrap,nowr ap) DrawMuscle(Brachialis,LowAntHumer us,UlnarTuberosit y,nowrap,nowrap) DrawMuscle(Brachioradia lis,LowLatHumerus,LowLatR adius,nowrap,nowrap) DrawMuscle(TricepsBrachii,UppPostHum erus,UlnarOlecr anon,nowrap,nowrap) DrawMuscle(LongHeadPronatorTeres,MedHum eralEpicondyle,MidLatRadius,no wrap,nowrap) DrawMuscle(ShortHeadPr onatorTeres,UppMedUlna,Mi dLatRadius,nowrap,nowr ap) DrawMuscle(FlexorCarpiUlnaris,MedHum eralEpicondyle,Pal5MetaCarpal,nowra p,nowrap) DrawMuscle(FlexorCarpiRadialis,MedHum eralEpicondyle,Pal2MetaCarpal,nowra p,nowrap) DrawMuscle(FlexorDigitorum,UppMedUln a,Pal3DistalPhalanx, FlexorRetinaculu m,nowrap)

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138Appendix J. (Continued) DrawMuscle(ExtensorDigitor um,LatHumeralEpicondyle, Dor3DistalPhalanx,Exten sorRetinaculum,nowrap) DrawMuscle(MidTrapezius,PostT 1,LatClavicle,nowrap,nowrap) DrawMuscle(LowTrapezius,PostT7 ,LatClavicle,nowrap,nowrap) DrawMuscle(PectoralisMajor,MidSte rnum,UppAntHumerus,nowrap,nowrap) DrawMuscle(UppLatissimusDorsi,PostT 7,UppPostHumerus,nowrap,nowrap) DrawMuscle(LowLatissimusDorsi,PostSac rum,UppPostHumerus,nowrap,nowrap ) DrawMuscle(Psoas,AntT12,LesserT rochanter,PelvicBrim,nowrap) DrawMuscle(Iliacus,IliacFossa,Le sserTrochanter,PelvicBrim,nowrap) DrawMuscle(GluteusMedius,IliacCres t,GreaterTrochanter,nowrap,nowrap) DrawMuscle(RectusFemoris,AntInfI liacSpine,Patella,nowrap,nowrap) DrawMuscle(Semimembranosus,IschialTub erosity,MedTibialCondyle,nowrap,no wrap) DrawMuscle(BicepsFemoris,IschialTuber osity,HeadFibula,nowrap,nowrap) DrawMuscle(AdductorMagnus,IschialTuberos ity,MidFemoralSh aft,nowrap,nowra p) DrawMuscle(Gracilis,IschialTuberosity ,MedFemoralCondyle,nowrap,nowrap) DrawMuscle(Vasti,UppF emoralShaft,TibialTubercle,Patella,nowrap) DrawMuscle(LatHeadGastrocnemius,Lat FemoralCondyle,Calcaneous,nowrap,no wrap) DrawMuscle(MedHeadGastrocnemius,M edFemoralCondyle,Calcaneous,nowrap, nowrap) DrawMuscle(TibialisAnt,UppLatTibia,MedC uneiform,InfExtensorRetinaculum,now rap) {* ============================ *} {* END OF MODEL *} {* ============================ *}


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Cresta, Tony J.
0 245
Biomechanical evaluation of independent transfers and pressure relief tasks in persons with SCI :
b pilot study
h [electronic resource] /
by Tony J. Cresta.
260
[Tampa, Fla] :
University of South Florida,
2006.
3 520
ABSTRACT: Persons with paraplegia who use a manual wheelchair for mobility are at high risk for overuse injuries in the upper extremities. Years of shoulder overuse performing transfers, wheelchair propulsion, dressing, bathing, and household chores, (activities of daily living or ADL) leads to an increased incidence of cumulative trauma to the shoulders. Few studies have addressed the stressful task of wheelchair transfers among SCI individuals. The goal of this pilot study is to develop valid and reliable measurement technologies to quantify shoulder musculoskeletal stressors during wheelchair transfers and pressure relief tasks among individuals with SCI. Using a standard wheelchair, 10 participants were asked to perform 3 typical pairs of independent transfer tasks: wheelchair to/from bed, wheelchair to/from commode, and wheelchair to/from vehicle. Also, two pressure relief tasks (P/R) were performed sitting in a wheelchair, one using the armrest and one using the wheels.^ By observation, the transfers in descending order from the most demanding to the least demanding were as follows: vehicle, commode, and bed. During a P/R using the wheels there is a 40% greater max shoulder force and a 47% greater mean shoulder force than when using the armrest. The max shoulder force of over 1000 N is generated at the initial push off, during a P/R using the wheels, then the force drops 45% to an average of 558 N. The max shoulder force of 722 N at the initial push off, during a P/R using the Armrest, drops 48% and then averages 378 N. During a P/R using the wheels there is a 104% greater max shoulder torque and a 17% greater mean shoulder torque than when using the armrest. As in the initial large amount of shoulder force there is also a large amount of shoulder torque that drops 77% during a P/R using the wheels. The shoulder torque decreases 62% during a P/R using the armrest.^ Because of the greater distance the body's Center of Mass (COM) travels during the P/R using the armrest, 24% more work is done.
502
Thesis (M.S.B.E.)--University of South Florida, 2006.
504
Includes bibliographical references.
516
Text (Electronic thesis) in PDF format.
538
System requirements: World Wide Web browser and PDF reader.
Mode of access: World Wide Web.
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Title from PDF of title page.
Document formatted into pages; contains 138 pages.
590
Adviser: William E. Lee, Ph.D.
653
Motion analysis.
Paraplegia.
Force transducers.
EMG.
Wheelchair transfer.
690
Dissertations, Academic
z USF
x Biomedical Engineering
Masters.
773
t USF Electronic Theses and Dissertations.
4 856
u http://digital.lib.usf.edu/?e14.1807