movement real world - liverpool emblog · 2020. 1. 5. · about us we are delighted to host the...

T H URS DA Y 9 T H JA NUA RY 2020

UNIVERSITY OF LIVERPOOL

MOV EMENT I N T H E

R EAL WOR LD S Y M P O S I U M

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About us

We are delighted to host the inaugural Movement in the Real World Symposium

(MRW) at the University of Liverpool.

As the first of its kind, this one-day symposium aims to further our understanding of how humans move and

visually process information from the real world. With the advancement of wireless technology and wearable

sensors, more research than ever before is being conducted outside of traditional laboratory settings.

Recognising that researchers from backgrounds including biomechanics, psychology and medicine are all

tackling these questions but rarely work together, this symposium will provide a platform to learn, interact

and network with world-class leaders in their respected fields.

With speakers from across the UK, spanning multiple disciplines, we hope that you enjoy the fantastic

research being presented here today. With a large range of topics discussed, all within the Movement in the

Real World theme, our aim is for you to leave today encouraged that the days of traditional lab-only research

are far behind us!

As well as our talks and posters sessions, we are delighted to have two keynote speakers here today; Ian

Craddock, Professor at the University of Bristol and Tim Adlam, Associate Professor at University College

London. Information on the programme, key-notes speakers and abstracts for talks and posters can be found

in this booklet.

We look forward to meeting you here in Liverpool.

Nicholas Thomas

Committee Chair of the Movement in the Real World Symposium

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Committee

Committee Chair

Nicholas Thomas

Chairs for Morning and Afternoon Session

Dr Kristiaan D’Août

Dr James Gardiner

Registration

Shirley Rawlings

Committee Members

Ali Allen

Marcella Cardenas Serna

Dr James Charles

Dominic Coe

Rory Curtis

Barbara Grant

Alice Maher

EMB members

Sponsors

We would like to thank the Institute of Ageing and Chronic Disease at The University of Liverpool for

sponsoring this event

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Overview P a g e s

P r o g r a m m e 4 – 5

K e y n o t e S p e a k e r s 6

T a l k A b s t r a c t s 7 – 1 6

P o s t e r A b s t r a c t s 1 7 – 3 0

Please note that this booklet is available online only and therefore if you wish to

have a physical copy, please print this booklet. Furthermore, although paper cups

will be available, we encourage you to bring your own reusable coffee cups.

For those presenting posters, please place your poster at the correct numbered poster board (see

Poster Abstracts). Anyone who wishes to be entered for the Poster prize, please stand by your poster

either in the morning coffee break (for those with even poster board numbers) or the afternoon coffee

break (for those with odd poster board numbers).

Follow us throughout the day on our twitter: @MRWSymposium

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Programme

M o r n i n g S e s s i o n

Time Event

9:00 – 9:30 Registration Upper Atrium, 502

9:30 – 9:40 Welcome opening

Mr. Nicholas Thomas & Dr Kris D’Aout

Lecture Theatre 3, 502

9:40 – 10:30 Keynote lecture #1

Prof Ian Craddock


10:30 – 10:50 Presentation #1

Dr Johnny Parr (LJMU)



Dr Tecla Bonci (Sheffield)


11:10 – 11:40 Coffee Break & Poster Session Upper Atrium, 502


Dr Tomasz Cudejko (UoL)



Dr Alix Chadwell (Salford)



Dr Ben Heller (Sheffield Hallam)


12:40 – 1:30 Lunch session First floor social space,

WHD Building

1:30– 2:15 Lab Tours Gait Lab, WHD Building

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A f t e r n o o n S e s s i o n

2:15 – 2:20 Welcome for afternoon session

Mr. Nicholas Thomas & Dr James Gardiner



Dr Graham Chapman (UCLAN)



Ms. Jignasa Mehta (UoL)



Dr Neil Thomas (LJMU)


3:20 - 3:50 Coffee Break & Poster Session Upper Atrium, 502

3:50 – 4:40 Keynote lecture #2

Prof Tim Adlam


4:40 – 4:50 Close, awards Lecture Theatre 3, 502

4:50 onward Symposium Social Pen Factory

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Keynote speakers

Professor Ian Craddock

Un i v e rs i t y o f B r i s t o l

Professor Ian Craddock is Institutional Lead for Digital Health at the University of Bristol,

Director of the flagship ”SPHERE” centre (funded at £16M from 2013 -2021 by EPSRC) and

Director of the Centre for Doctoral Training in Digital Health & Care. He has received over

£60M of funding from EPSRC, H2020, MRC and NERC and served for 5 years on EPSRC’s

Strategic Advisory Team for Healthcare Technology. He is a REF 2021 panel member for

Computer Science.

Professor T im Adlam

Un i v e rs i t y C o l l e ge L o n d o n

Tim Adlam is an Associate Professor of Global Disability Innovation in the UCL Global Di sability

Innovation Hub where he is researching physical support technology for children with complex

movement disorders, and developing methods for measuring movement. Tim is interested in

how children with movement disorders move, and is researching technology to enable them

to explore and develop their capability for functional movement – to learn to do what they

love to do. Other current work in its early stages includes powered mobility for preschool

children in low and middle income countries. Tim loves to teach people how to solve problems,

and is Director of the new MSc in Disability, Design and Innovation at UCL Here East. Tim

worked at Designability in Bath for over 20 years, creating devices and systems for people with

a wide range of physical and mental disabilities. Projects included the pioneering Gloucester

Smart House Project for people with dementia, the Wizzybug for preschool children and

CHIRON robotics for care. He has a PhD in seating for children with dystonia and is a Chartered

Mechanical Engineer and Clinical Scientist.

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Talk abstracts Presentation 1:

Can training children with Developmental Coordination Disorder where to look during walking reduce their risk of trips and falls? Dr Johnny Parr*1, Dr Richard Foster1, Dr Greg Wood & Prof Mark Hollands1. 1. Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.

2. Department of Sport and Exercise Science, Manchester Metropolitan University, Manchester, UK.

INTRO: This study investigated the relationship between gaze behaviour, stepping accuracy, and

anxiety in children with (N=22, 11±0.56 yrs) and without (TD, N=19, 10±0.42 yrs) developmental coordination disorder (DCD) in an adaptive locomotion task. An eye-movement intervention was

also implemented to determine whether optimal visual sampling can be encouraged to reduce the risk of falls.

METHODS: Participants walked along a pathway and stepped into a raised target followed by either

no obstacle, one obstacle, or two obstacles for a total of 15 trials (Pre-test). Participants were then split into control (TD-CN, DCD-CN) or gaze-training groups (TD-GT, DCD-GT) to receive generic

walking safety tips, or task-specific eye-movement instructions, respectively. A further 15 trials were then performed (Post-test) to assess the effectiveness of our intervention. State anxiety, gaze

behaviour, and kinematics were measured during performance. RESULTS: Preliminary results show that children with DCD display greater anteroposterior foot

placement error and variability compared to TD’s regardless of task difficulty or training. At post-test, gaze-training did not improve stepping accuracy despite encouraging longer route previewing

and decreased foot-placement velocity. The control groups increased approach speed and foot-placement velocity which increased accidental foot contacts in the DCD-CN group. No effects for

state anxiety were observed.

CONCLUSION: Children with DCD display a reduced ability to plan and guide safe stepping actions. Improved visual sampling of the environment does not appear to improve stepping accuracy but

may encourage a more cautious approach that minimises tripping. Further work is needed to determine the influence of elevated anxiety of stepping accuracy and gaze behaviour.

*[email protected]

mailto:*[email protected]

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Presentation 2:

Validity, acceptability, location, confounding factor – a trade-off for a 7-day movement monitoring solution

Bonci, T.*a, b, Scott, K. a, b, Mazzà, C.a, b

aDepartment of Mechanical Engineering, The University of Sheffield, Sir Frederick Mappin Building, Mappin Street, Sheffield S1 3JD, UK

b INSIGNEO Institute for In Silico Medicine, The University of Sheffield, The Pam Liversidge Building, Sir Frederick Mappin Building, Mappin Street, Sheffield S1 3JD, UK

Introduction. It is common knowledge that, overall, the world’s population is aging and more people are suffering from mobility loss. For targeting and preventing this issue, a tool that is able to detect,

measure, and eventually predict it, is therefore becoming essential. An innovative low-cost, easy-to-use and accurate approach that uses a technology that can operate in “real-world” scenario is hence mandatory for this aim and wearable inertial sensors are certainly ideal candidates.

The actual use and impact of such technology during daily life activities is affected by different factors (hereafter called “domains”):

o Concurrent validity (validity of the measurements);

o Human factors (the context of data capture, perception of the user towards the technology, data security and privacy, monitoring outside clinical settings);

o Wearability & usability for the user;

o Data capture process (users’ guidelines for an appropriate data capture).

Although several wearable solutions have been already proposed in the literature, when these have been tested and/or compared, the above-mentioned domains were either considered in isolation (Storm et al., 2018; Welk el al., 2000) or only for a subset of them (Panebianco et al., 2018; Rabinovich et al., 2013). This poses serious limitations when a specific sensor has to selected and all these domains should be considered, accounting for their relative importance. The latter, however, has not been previously established. The aim of this study was to define an objective methodology for combining these domains and allow optimal sensor choice.

An ad-hoc decision matrix has been developed, establishing the relevant importance (i.e., weighting system) of each domain for wearable solution evaluations. The weighting system is based on the responses provided by selected participants from a variety of backgrounds using a purposely developed questionnaire.

Methods. The collected opinions about the perceived level of importance of different domains was captured alongside the Respondents’ experience (assessed through specific questions) on the use of

inertial sensors in clinical practice. A Likert scale from 1 to 5 (1 = unimportant; 2 = of little importance; 3 = somewhat important; 4 =important; 5 = very important) was used; also a “do not know” option

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was available. Overall, for each domain, the normalised level of importance was obtained considering the distribution of the responses (modal value) and the relevant Respondent’ level of expertise.

Results. Preliminary results from 50 Respondents are presented in Table 1. Of these, 32%, 34%, and

34% had a clinical, technical and both clinical and technical background, respectively. Overall, 72% had experience in the use of inertial sensors in clinical settings; they also declared they have used

inertial sensors on patients and knew know how to identify/extract gait features and how to characterise patients’ mobility from inertial data, and therefore classified as experts.

Table 1 – Distribution of the responses (n = 50) of the different levels of importance for the four domains. Responses adjusted by the Respondents’ level of expertise are provided within squared brackets. The normalised levels of importance of the different domains are also shown.

Concurrent Validity

Human Factors

Wearability & Usability

Data Capture

Domains

very important 70% [69.3%] 40% [38.6%] 52% [52.2%] 34% [32.4%]

Level of

important 22% [22.7%] 42% [42.1%] 40% [39.2%] 36% [36.9%]

somewhat important 6% [6.2%] 14% [15.3%] 8% [8.5%] 20% [20.4%]

importance

of little importance – 4% [3.9%] – 10% [10.2%]

unimportant – – – –

Normalised Level of importance 37.5% 18.2% 28.3% 16%

Discussion and Conclusion. Both concurrent validity and wearability & usability domains are

perceived as “very important” for a seven-day mobility monitoring solution. The other two domains, instead, have been classified as “important”. Although the concurrent validity domain is usually the

one considered as being the most important (37.5%), the other domains, especially wearability & usability (28.3%), also seem to play an important role for the identification of the best wearable

solution for a 7-day mobility monitoring assessment. It is therefore evident that all the above-mentioned domains should be considered when such exercises are performed.

The proposed methodology appears to be effective for the purpose at hand. Data collection is still ongoing and further analysis have to be conducted before clear conclusions could be drawn.

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Acknowledgment. This study is part of Mobilise-D, a project funded from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 820820. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA.

References:

Panebianco, G.P., Bisi, M.C., Stagni, R. and Fantozzi, S., 2018. Analysis of the performance of 17

algorithms from a systematic review: Influence of sensor position, analysed variable and computational approach in gait timing estimation from IMU measurements. Gait & posture, 66, pp.76-82.

Rabinovich, R.A., Louvaris, Z., Raste, Y., Langer, D., Van Remoortel, H., Giavedoni, S., Burtin, C., Regueiro, E.M., Vogiatzis, I., Hopkinson, N.S. and Polkey, M.I., 2013. Validity of physical

activity monitors during daily life in patients with COPD. European Respiratory Journal, 42(5), pp.1205-1215.

Storm, F.A., Nair, K.P.S., Clarke, A.J., Van der Meulen, J.M. and Mazza, C., 2018. Free-living and laboratory gait characteristics in patients with multiple sclerosis. PloS one, 13(5), p.e0196463.

Welk, G.J., Blair, S.N., Wood, K., Jones, S. and Thompson, R.W., 2000. A comparative evaluation of

three accelerometry-based physical activity monitors. Medicine & Science in Sports & Exercise, 32(9), pp.S489-S497.

*[email protected]


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Presentation 3:

Minimal shoes in older people: Applications to knee osteoarthritis and falls in older people.

Tomasz Cudejko*

Affiliation:

Department of Musculoskeletal Biology II, University of Liverpool.

Abstract:

Minimal, also known as barefoot, shoes are intended to closely mimic walking unshod. They have reduced cushioning, thin soles, and are of lighter weight than conventional shoes . It is assumed that differences in these design features allow for more sensory contact of the foot on the ground and require more input from the intrinsic foot muscles during locomotion. These biomechanical

mechanisms are thought of eliciting beneficial effects on the human musculoskeletal system. Current research focuses mainly on the injury-reduction effects of running in minimal shoes in young populations. Effects of daily use of minimal shoes in older people are largely unknown. This presentation will try to answer the question whether walking in minimal shoes might be beneficial for older people suffering from two common conditions in this population: knee osteoarthritis and falls. Both, evidence from the literature and results from my own work will be presented.

*[email protected]


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Presentation 4:

Rethinking how we assess upper-limb prostheses – a question of can-do vs do-do

Alix Chadwell*, Laurence Kenney, Malcolm Granat, Sibylle Thies, John Head & Adam Galpin.

Health Sciences Research Centre, University of Salford

Evaluation of upper-limb prostheses falls into three many categories: (1) what the device was designed to be able to do, (2) what the person is able to do with the device, and (3) what the person actually does with the device. Up until recently, many evaluation methods concentrated on assessing the first two points (capacity for use), and if a clinician wanted to know the answer to number 3 (actual use) they were reliant on self-report from the user, or visual inspection of the state of the device (e.g. a worn-out cosmetic glove).

Here, methods developed using wrist-worn activity monitors to objectively assess patterns of prosthesis wear and use in the real-world are presented. Timeseries visualisations in the form of spirals allow quick identification of patterns in use throughout the week; these are accompanied by histograms providing summary measures relating to the symmetry of upper-limb activity and the level of reliance on the anatomically intact arm. Algorithms have also been developed for the automatic detection of prosthesis non-wear periods. Unsurprisingly, prosthesis users have been

shown to have an increased reliance on their unaffected arm compared to anatomically intact, healthy, control subjects. However, some of the more interesting findings from this research suggest

that wear may not be correlated with use, and real-world use may not correlate with lab-based measures of capacity. The methods presented here show potential for use beyond the field of

prosthetics, and could, for example be used to measure upper-limb asymmetry with respect to stroke, or other unilateral upper limb impairments.

Studies in the field of upper-limb prosthetics are often limited in size due to difficulty recruiting. Activity monitors offer the potential of large-scale data collection across multiple countries, thus

increasing our understanding of prosthesis use. So far data has been collected using these methods in the UK, Uganda, Jordan, and Australia. Interesting findings from these studies will also be presented.

*[email protected]


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Presentation 5:

A comparison of bilateral accelerometry with the Action Research Arm Test (ARAT) for assessing upper limb function in chronic post-stroke survivors.

Ben Heller* Sport and Physical Activity Research Centre, Sheffield Hallam University. Sue Mawson, School of Health and Related Research, University of Sheffield. Jack Parker, College of Life and Natural Sciences, University of Derby & Lauren Powell, School of Education, The University of Sheffield.

Up to 60% of stroke survivors still demonstrate upper limb impairment in the chronic phase (6

months post stroke and beyond). This impairment may severely limit employment opportunities or leisure and self-care activities. The level of upper limb function is typically assessed via clinical outcome measures such as the Action Research Arm Test (ARAT), which is a widely used test in stroke assessment.

We were interested in comparing ARAT scores with real-world arm use for stroke survivors. Fifteen

chronic stroke survivors and their partners (as controls) wore an IMU on each wrist which logged triaxial acceleration at 10 Hz for 96 hours as the wearers continued usual daily activities. The stroke

survivors were also evaluated using the ARAT test and self-reported their functional ability. Data were analysed to compare the ratio of total daytime activity (summed acceleration counts) for the

affected upper-limb versus the non-affected upper-limb. A comparison for the controls was non-dominant upper limb to dominant upper limb activity.

For stroke survivors, activity ratios for paretic vs. non paretic arms ranged from 0.136 to 0.977 with a mean of 0.58. For the control group activity ratios of non-dominant arm to dominant arm ranged

from 0.755 to 0.974 with a mean of 0.87. A correlation was found between the ARAT scores and movement ratios with an R2 value of 0.56. The ARAT demonstrated a floor and ceiling effect (only

4/15 scores were not 0 or maximum) which was not evident in the acceleration data. In addition, some participants with full ARAT scores (i.e. high function paretic arms) demonstrated low activity

ratios for their paretic arms. These were determined to be due to poor sensation, which didn’t preclude performance of the ARAT test, but did limit real-world arm use.

In summary, bilateral accelerometry provides a useful insight into the real-world upper limb activity of chronic stroke survivors. It may be both more sensitive to change than the ARAT, and also better reflect real-world impairment.

*[email protected]


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Presentation 6:

The need for a stratified approach to total hip replacements

Chapman GJ*1,2,3, Lunn DE2,3, De Pieri E4, Lund ME5, Rasmussen KP5, Ferguson SJ4. Redmond AC2,3

1 School of Health Sciences, University of Central Lancashire, Preston, PR1 2HE 2 Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK 3 NIHR Leeds Biomedical Research Centre, Leeds, UK 4 Institute for Biomechanics, ETH Zurich, Zurich, Switzerland 5 AnyBody Technologies A/S, Aalborg, Denmark

Abstract

Total hip replacement (THR) is one of the most effective forms of orthopaedic surgeries for end stage

hip osteoarthritis. Current regulatory tribology preclinical testing (ISO 14242-1) consists of a simplified kinematic waveform under a standardised loading condition, which does not represent in

vivo loads or motions of different patient populations. Patient characteristics (for example, age, gender, body mass, activity level, hip kinematic patterns) have been identified as factors that can

increase tribological wear of the THR prosthesis potentially leading to implant failure. Real -world hip joint contact forces from instrumented implants (Bergmann et al., 2016) demonstrated varied

loading patterns when performing different activities of daily living (ADLs) compared to ISO standards. As part of the EU funded, LifeLong Joints (LLJ) project, a large dataset of 137 THR post-

operative patients were recruited and undertook a series of ADLs whilst kinematics (Vicon MX; Oxford Metrics, UK) and kinetics were acquired. Marker trajectories and ground reaction forces were used as inputs to a detailed musculoskeletal model (AnyBody Modeling System, version 7.1, Aalborg,

Denmark) to calculate hip joint contact forces (HCF). Results from LLJ demonstrate that stratifying by patients characteristics (for example, age, body mass and activity level) results in large variation in

biomechanical/kinematic performance of the hip and alters HCF especially when compared to standardised ISO waveforms. From this large dataset of THR patients, there is large variation in how

hip replacement patients perform ADLs and not all patients are the same. Stratifying THR patients by patient characteristics demonstrates that functional performance and HCF differ between patient strata, which ultimately would be expected to affect the wear rate of the implant.

*[email protected]


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Presentation 7:

Visual function risk factors for falls in older adults.

J Mehta*, S Harding, D Newsham, G Czanner, J Robinson

Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool

Aim

Investigate the association of impaired visual function and falls in older adults.

Methods

Visual function risk factors; ETDRS visual acuity (VA), contrast sensitivity (CS), stereoacuity (SA), binocular vision (BV) and visual fields (VF) were measured in a prospective observational individually age matched case control study. Socio-demographic factors, general health, number of medications, health quality, fear of falling and physical activity data was also collected for each participant.

Results

Cases (n=83, falls typically

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Presentation 8:

Decorating stairs safely: influence of stair-tread patterns on confidence, dynamic balance and

visual sampling

Neil M. Thomas*, Timmion Skervin, Richard J. Foster, Thomas D. O’Brien, Mark G. Carpenter,

Constantinos N. Maganaris, Vasilious Baltzopoulos, Carolyn Lees, Mark A. Hollands.

Research to Improve Stair Climbing Safety Group, School of Sport and Exercise Sciences, Liverpool

John Moores University.

Introduction: Ambiguous stair-tread patterns have been associated with stair falls in young and older

adults. However, current guidelines for decorating stairs surfaces can differ widely between sources,

and seem not to be evidence-based.

Aims: Here we examined the influence of stair-tread patterns on stair descent safety in young and

older adults, with a view to generating preliminary evidence for appropriate stair-tread decoration.

Methods: Fourteen healthy older (>65 years) adults descended (3×trials per condition) a custom-

made seven-step instrumented staircase outfitted with 6 stair-tread patterns: plain grey (Uniform);

striped multicolour (Striped); and ambiguous greyscale (Busy), each implemented with and without

an edge-highlighter. Stair specific confidence was assessed prior to the first descent in each new

condition; whole-body 3D kinematics (Vicon) quantified margins of stability; and eye tracking (Pupil

labs) evidenced gaze allocation at each step surface.

Results: Use of Striped and Busy patterns led to lower self-reported confidence (p

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Poster abstracts Poster 1:

A protocol to gain digital gait biomarkers from 7 days of free-living accelerometer data in the assessment of a variety of neurodegenerative diseases.

Dr Christopher Buckley* representing the Brain and Movement team from Newcastle University

Translational and Clinical Research Institute, Clinical Ageing Research Unit Campus for Ageing and

Vitality Newcastle University Newcastle upon Tyne

Neurodegenerative diseases (NDD) such as Parkinson’s disease (PD) urgently need accurate, low-cost

diagnostic tools to aid timely diagnosis, disease stratification, predictive modelling and decision making for intervention optimisation. Gait is often termed ‘the 6th vital sign’ of brain health because

poor gait is associated with greater mortality, morbidity, cognitive decline, dementia and falls risk. Gait analysis is therefore receiving interest as a tool to discriminate and predict early disease, track disease progression and identify therapeutic response in NDD.

Free-living movement, due to being collected from participant’s naturalistic environments, is

proposed to be more sensitive to identify specific pathologies and individual trajectories of chang e.

Wearable technology offers a low cost unobtrusive solution to record the signals needed to extract comprehensive gait digital biomarkers in free-living scenarios. Algorithm development for accurate gait assessment as well as movement in general for clinical applications has lagged behind commercial use. This is partly because the tools for free-living gait analysis such as, validated algorithms, robust industry standards for gait analysis, and robust multivariate gait models for clinical application were lacking.

The BAM research group have developed a protocol for collecting seven-day free-living monitoring using wearable technology, that with the application of applied validated algorithms, can quantify macrostructural (e.g. volume of walking, number of steps) and Micro digital gait biomarkers (e.g. spatiotemporal gait variables). The proposed poster will demonstrate this pipeline and highlight its

potential combination with complex data analysis techniques for monitoring brain health for a variety of neurodegenerative diseases.

*[email protected]


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Poster 2:

How are gait and energetics modified in humans when walking over substrates of varying compliance?

Barbara Grant*, James Charles, James Gardiner, Kristiaan D’Août, Karl Bates.

Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool

Human walking depends on the ability of the foot to exert the appropriate pressures and forces

against the ground, at the appropriate phase of gait, to decelerate, balance and accelerate the body. Our current understanding of human gait and energetics is mostly based on studies on hard, level

surfaces in a laboratory environment. However, locomotion in the real-world requires humans to negotiate more challenging surfaces that necessitate adjustments to maintain stability and efficiency.

Previous studies have shown that walking on substrates of high compliance such as sand or uneven terrain, there is an increase in energy expenditure and muscle activity.

To better understand how gait mechanics and energetics are altered in response to substrates with different mechanical properties we compare energetic costs, muscle activity of the lower limb a nd

trunk and lower limb motion in 30 healthy human subjects (15 male, 15 female) walking on three artificial substrates: 2 compliant and 1 non-compliant. Whole-body kinematics were recorded using

surface marker motion capture, oxygen consumption measured using a wearable metabolic system and used to calculate cost of transport and muscle activities recorded using surface

electromyography (EMG).

As substrate compliancy increases, there is an increase in energy expenditure. Participants display greater degrees of torso flexion, hip and knee flexion and ankle dorsiflexion resulting in an increase

in the cost of mechanical work and subsequent energetic costs. Furthermore, participants show a decrease in step, stance and swing time and average walking speed, most likely an adaptation to

maintain gait stability. It is likely that similar gait adaptations would be adopted when walking over a range of substrates encountered by humans on a regular basis.

This project was funded by the Leverhulme Trust. *[email protected]

mailto:[email protected]

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Poster 3:

The influence of substrate on human footprint formation

Barbara Grant1*, James Charles1, Peter Falkingham2, Kristiaan D’Août1, Karl Bates1.

1Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool

2School of Biological and Environmental Sciences, Liverpool John Moores University

The transition to terrestrial bipedalism represents a defining episode in the evolutionary history of our species, but its first appearance in the hominin fossil record is strongly debated. To understand

how, when and why upright bipedalism evolved we have long relied on the shape of fossil footprints to infer locomotor behaviour used by our ancestors. However, the shape of footprints may vary

according to the mechanical properties of the substrate. Differences in dynamic underfoot deformation likely also lead to differences in lower limb kinematics and kinetics, such that a single

animal may utilise different limb motions and produce different footprint shapes in substrates with dissimilar rheological properties.

The aim of this study is to gain a better understanding of how anatomical, functional and sedimentary variables influence footprint formation and how these can be inferred from footprint morphology. We compare the muscle activity and lower limb motion in healthy human subjects who walk over sand-filled walkways and produce footprints in sediments of varying compliance. 5 trials were completed on each sand walkway and photographed to create three-dimensional models of the whole trackway using photogrammetry. From these models, metrics such as footprint shape and depth can be analysed. Whole-body kinematics are recorded using surface marker motion capture, muscle activities recorded using electromyography (EMG) and plantar pressures recorded using a pressure-sensing treadmill. It is predicted that in softer, more deformable substrates, participants will adopt a more bent-hip, bent-knee gait, a slower walking speed and shorter stride length and there will be an increase in muscle activity. Furthermore, footprints will be deeper and more variable in shape. Gait modifications would suggest the need to consider the influence of substrate mechanical properties when making conclusions to the evolution of bipedal locomotion from the analysis of fossil footprints

that vary considerably in overall depth as, like humans, early hominins would be expected to have altered their gait characteristics when walking across a range of natural surfaces. This project was funded by the Leverhulme Trust. *[email protected]


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Poster 4:

An 18-week Postural Stability Instruction programme reduces fall prevalence and risk factors for falling in community-dwelling older adults

Higgs, F. PhD*1, Winter, S.L. PhD1,2 & Chadderton, H. PhD1. 1Department of Sport and Exercise Science, Aberystwyth University, UK. 2School of Sport and Exercise Sciences, Kent University, UK.

Postural Stability Instruction (PSI) is an evidence-based 36-week targeted strength and balance

programme commonly delivered by community-based falls prevention services. Provision of such programmes can be restricted due to limited availability of appropriately trained professionals,

access and funding, particularly in rural areas. The purpose of this longitudinal study was to establish whether a shortened 18-week version of the PSI programme would be sufficient in duration to elicit

a significant reduction in falls prevalence and falls risk factors in community-dwelling older adults. The sample was formed of 22 volunteer participants (mean ± SD: age, 77.1 ± 7.2 years) – 20 were

female and two were male. All had experienced one or more falls in the six-months prior to being recruited in to the study from a local falls clinic service in rural Mid-Wales. Clinic-based tests were

administered before and after participants’ completion of the first six weeks of the PSI programme. These tests measured fear of falling (Falls Efficacy Scale International (FES-I)), upper limb strength

(Handgrip Dynamometry), balance (Romberg’s Balance Test), as well as lower l imb strength and balance combined (Sit-to-Stand Test) and walking speed (Timed-Get-Up-and-Go Test (TGUGT)). Laboratory-based tests also repeated after six and 18 weeks of PSI training comprised analysis of

walking gait to evaluate strength and balance changes, as well as individual balance trials to measure balance performance (both by three-dimensional motion analysis) and tests for health-related

quality of life (QoL; Short-form Health Survey (SF-12)). Whole body lean mass (Dual X-ray Absorptiometry (DXA)) was reassessed after completion of the 18-week programme to monitor

changes in body composition. Fall incidence and prevalence were monitored on a monthly basis in the six months following completion of the 18-week PSI programme. All 22 participants completed

all tests before and after the first six-weeks of the PSI programme. However, only 15 participants (all female) completed the tests after 18-weeks of PSI and the six-month follow-up calls. The results from

this study showed an overall reduction in falls prevalence of 31% between starting the PSI programme and at the final six-month follow-up. Furthermore, six weeks of PSI significantly improved

participants’ scores in all clinic-based tests (p < 0.05), with the exception of the TGUGT, which showed no significant change. A significant improvement in the mental component score of the SF-12

demonstrated an improvement in self-reported mental health-related QoL after completion of the 18-week programme (p = 0.02). No significant changes in walking gait were found. However, participants demonstrated some significant changes in temporal motion of the centre of pressure to the boundary of base of support, including ‘mean time to boundary’ (p < 0.05) in the balance trials following completion of the 18-week PSI programme. There was no significant change in whole body lean mass. These findings indicate that an 18-week PSI programme provides a sufficient duration to elicit a long-term reduction in fall prevalence, along with significant improvements in measures of a number of falls risk factors in those with a history of falling. As such, the authors suggest that a shortened 18-week PSI programme may be a feasible alternative to the full 36-week PSI programme.

This may assist local service providers in negotiating common barriers to provision, such as limited funding or resources. Low percentage of lean mass is a risk factor associated with frailty. Therefore, further research is needed to establish the optimal duration of PSI programme to elicit an increase in lean mass. Further opportunities for streamlining resources and costs may be identified by evaluating the effectiveness of individual PSI components.

*[email protected]


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Poster 5:

Digital characterisation of external foot shape during stance phase of walking

Ali Jabran*, Daniel Parker, Carina Price, Woratee Dacharux, Christopher Nester

School of Health and Society, University of Salford

The foot exhibits a complex kinematic chain during load transfer in gait which can often require

intervention via orthoses and footwear to control motion and improve stability. Clinical approaches

to the assessment of function during gait is dependent on static or simplified range of motion

observations. These approaches do not characterise the full extent of foot shape change during gait

and as such have limitations for the prescription of devices designed to control motion. This study

aimed to develop a database of and characterise dynamic 3D foot shape of healthy subjects during

stance phase of walking.

A total of 50 healthy participants (aged 19-48) were recruited. For each participant, three barefoot

static foot scans and three dynamic barefoot scans were captured using a 4D dynamic foot scanner

(NS4D Scanner system, Explius, Germany, Fig. 1a). During static scans participants stood with only

the specified foot on the transparent support plate, holding the hand rails in an upright posture,

distributing weight evenly across both feet. Dynamic trials were collected while the participant

walked along the platform and the scanner at a pre-determined self-selected natural walking speed

(±5%) (Fig. 1b).

Figure 1. a) Schematic of 4D scanner setup. b) Participant walking over walkway.

A semi-automatic computational workflow was developed to pre-process the scans. This involved

cleaning of scan geometry, alignment of global co-ordinate system to along the foot axis and the

detection of features such as heel apex and arch. This enabled the subsequent analysis of foot shape

and change in shape over stance. Foot shape data was then analysed on a frame by frame basis to

identify the following clinically relevant measurements: Foot length, foot length along foot axis, foot

width, weightbearing contact area, arch length, arch width, arch height and arch area (Fig. 2). The

mean of each measurements was calculated for each subject.

b) a)

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Figure 2. Schematic showing the typical parameters computed for analysis of each subject’s 3D and

4D scans.

Results

A database of 50 subjects consisting of over 3800 3D scans was been developed. Using the

computational workflow, all the scans were processed and they are ready for subsequent analysis. A

preliminary study was conducted to first explore the changes in foot weightbearing contact area

during stance phase and arch area during midstance (Fig. 3 and 4). Several key gait features were

detected from the contact area profiles.

Figure 3. Typical profile of weightbearing contact area for a subject during stance phase. Each line

indicates a single walk.

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Figure 4. Typical profile of arch area for a subject during midstance. Each line indicates a single walk.

Next, the percentage changes in foot length, foot length along foot axis, foot width and

weightbearing contact area during midstance were calculated for each subject (Fig. 5). Foot contact

area was found to undergo most changes during midstance, with a mean percentage change of 10%,

followed by the length along foot axis (6%).

Figure 5. Percentage change of foot contact area, length along foot axis, foot length and foot width

during midstance, for all subjects.

Implications

The database developed in this study will permit analyses of both the foot shape variation within

healthy individuals and the changes in foot shape which occur during gait. From this, a better

definition of ‘healthy’ foot movement could be derived, one that includes the foot surface geometry.

Results of these analyses will be evaluated in the context of current clinical evaluations used to assess

foot motion. They will also be used to inform treatments and for the development of orthotics which

act to control foot motion.

*[email protected]


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Poster 6:

Assistive technology and their efficacy for upper limb function in tetraplegia

Rosti Readioff*1, Zaha Kamran Siddiqui2, Caroline Stewart3, Louisa Fulbrook3, Rory J O’Connor2,

Edward K Chadwick4 1School of Pharmacy & Bioengineering, Keele University, Stoke-on-Trent, ST4 7QB.

2Academic Department of Rehabilitation Medicine, Faculty of Medicine & Health, University of Leeds, Leeds, LS2 9NL.

3The Orthotic Research & Locomotor Assessment Unit (ORLAU), the Robert Jones & Agnes Hunt

Orthopaedic Hospital, NHS Foundation Trust, Oswestry, SY10 7AG. 4School of Engineering, University of Aberdeen, Aberdeen, AB24 3UE.

1. Background

Each year in the UK 1,000 people sustain a traumatic spinal cord injury and 40,000 people live with a

spinal cord injury (SCI) [1]–[3]. More than half of all SCI occur at the cervical level leading to loss of upper limb function [4]. This complex impairment results in restricted activity and reduced

independence. In the absence of a cure, SCI remains a challenge to individuals living with an injury, their families and our society.

Several technologies have been developed to assist with motor control of the upper limbs for individuals with SCI including neuroprostheses, orthotics, robots and hybrid devices. There are no systematic reports summarising current assistive technologies and their efficacy for people living with tetraplegia due to SCI.

2. Aim and Objectives

This paper reviews the existing state-of-the-art assistive technology that uses the anatomy of the upper limb to improve function in people with cervical SCI. The objectives of this review are to: (1) describe the assistive technology, with a focus on devices that integrate with the upper limbs; and (2) describe the outcome measures used when testing the efficacy of the technologies. The conclusions from this review will be used to recommend future studies.

3. Methods

3.1. Search Strategy

An electronic search of databases, including (CINAHL, AMED, EMBASE, PUBMED, MEDLINE, EMCARE) from 1999 to 2019 was performed. Initially, three categories essential to assess assistive technologies

for clinical purposes were established: diagnostics, technology and body part. Combinations of search terms within the three categories were used, sometimes with truncation, to capture all possible variations (Table 1).

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3.2. Data Extraction and Quality Assessment

The main categories for data extraction were: type of assistive technology, outcome measure, functional ability without assistive device and functional ability with assistive device. The quality of

the selected studies for their methodology and results were assessed using a modified framework developed by Jerosch-Herold. Face validity and evidence of the test’s construct determined the

validity of the article. Articles showing evidence of the test-retest and inter-rater reliability were scored positively for reliability assessment. Responsiveness of results in the selected articles were

assessed by capturing clinical changes as a result of using the assistive technology. The quality assessment questions related to generalisation of data and population size were not included in this review due to large variabilities between individuals and the extent of paralysis.

4. Results and Discussion

4.1. Search Strategy

A total of 1770 articles were obtained from the database search. Following deduplication, discarding of low-level evidence, excluding terms or irrelevant results, 371 articles were forwarded for abstract

review. The titles and abstracts of the remaining 371 articles were screened for inclusion and 10% of these articles were blindly re-assessed by another assessor, generating 71% agreement between

both independent assessors. Following abstract and title screening, 37 articles were forwarded for full-text review. As shown in Figure 1, a total of 24 articles met the criteria for inclusion.

4.2. Data Extraction and Quality Assessment

As a result of data extraction, six assistive device categories were identified. These categories include invasive neuroprostheses, non-invasive neuroprostheses, orthotics, hybrid systems, robotics, and arm support or gravity-elimination devices. Characteristics of the assistive devices within each category were summarised.

Items 1, 2 and 3 of the quality assessment checklist scored positively for all the selected studies.

Studies following the framework of the International Classification of Functioning, Disability and Health (ICF) [6] to structure the design and interpretation of the outcome assessment were scored positively for validity. For example, the study by Kilgore et al. [7] evaluated the potential of second-

generation implantable neuroprosthesis by assessing the outcomes through the domains of ICF, namely: (i) body functions and structures, (ii) activities, and (iii) participation. Overall, 95.8% of the

selected articles showed positive score for validity. Most of the articles did not show robust reliability tests. However, it was not always possible to carry out test-retests in the studies without negatively

affecting the overall outcome of the study. For example, Bryden et al. [8] performed all of the impairment evaluations once for each participant without retest, because they perceived repetition

as a method to evaluate fatigue. However, when Peckham et al. [9] collected data, they evaluated inter-rater and test-retest reliability. For their inter-rater evaluation, they video recorded the grasp-

release and activity of daily living tests as they were measured by occupational or physical therapists and they were reviewed by an independent rater. The test-retest reliability was evaluated by repeating each test three times.

In addition, only 50% of the articles clearly reported responsiveness due to implementation of the assistive devices.

5. Conclusions

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This review highlights the available assistive technology and where possible its impact on populations with SCI and clinical change. Limited number of studies evaluated reliability of their results while this test might not always be possible, absence of such evaluation could result in inconsistency of data, hence misinterpretation of clinical change.

Figure 1: Study selection flow diagram for the searched databases. Abbreviations: NP,

neuroprostheses.

Table 1: Included and excluded terms for carrying out electronic database search.

Diagnostics Technology Body part

Search terms Spinal cord Assistive technology, assistive device, Upper limb, upper

for inclusion injury, SCI, orthotic device, splint, robotics, arm extremity, hand,

spinal cord support, mobile arm support, anti- arm, forearm,

lesion, gravity support, neuroprostheses, forelimb

tetraplegia, functional electrical stimulation, FES,

quadriplegia, neuromuscular electrical stimulation,

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tetraplegic, NMES, hybrid device, neuromuscular

quadriplegic, electrical stimulation, arm-weight

paralysis bearing, implanted electrical stimulator,

surface electrical stimulator,

percutaneous electrical stimulator.

Search terms Stroke, multiple Prosthesis, exoskeleton, passive Lower limb, lower

for exclusion sclerosis, polio, assistive device extremity, leg

poliomyelitis

References

1. NHS England, “NHS Standard Contract for Spinal Cord Injuries (All Ages),” NHS England, 2013. [Online]. Available: https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2014/04/d13-spinal-cord-0414.pdf. [Accessed: 12-Feb-2019].

2. F. Barr, “Preserving and Developing the National Spinal Cord Injury Service: Phase 2 - Seeking the Evidence,” Spinal Injuries Association, 2009.

3. A. Gall and L. Turner-Stokes, “Chronic spinal cord injury: Management of patients in acute hospital settings,” Clinical Medicine, Journal of the Royal College of Physicians of London. 2008.

4. M. B. Zimmer, K. Nantwi, and H. G. Goshgarian, “Effect of spinal cord injury on the respiratory system: Basic research and current clinical treatment options,” Journal of Spinal Cord Medicine. 2007.

5. C. Jerosch-Herold, “An Evidence-Based Approach to Choosing Outcome Measures: A Checklist for the

Critical Appraisal of Validity, Reliability and Responsiveness Studies,” British Journal of Occupational Therapy, vol. 68, no. 8, pp. 347–353, Aug. 2005.

6. World Health Organization, “World Health Organisation. (2001). International Classification of Functioning, Disability and Health (ICF). Geneva: World Health Organisation.,” International Classification, 2001.

7. K. L. Kilgore, H. A. Hoyen, A. M. Bryden, R. L. Hart, M. W. Keith, and P. H. Peckham, “An Implanted Upper-Extremity Neuroprosthesis Using Myoelectric Control,” Journal of Hand Surgery, 2008.

8. A. M. Bryden, W. D. Memberg, P. E. Crago, and L. Polacek, “Electrically stimulated elbow extension in persons with C5/C6 tetraplegia: A functional and physiological evaluation,” Archives of Physical Medicine and Rehabilitation, 2000.

9. P. H. Peckham et al., “Efficacy of an implanted neuroprosthesis for restoring hand grasp in tetraplegia: A multicenter study,” Archives of Physical Medicine and Rehabilitation, 2001.

*[email protected]


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Poster 7:

Immediate effect of exercises of scapular stabilisation on shoulder and forearm muscles activation while playing the violin

Céleste Rousseau*1, Ju-Yang Chi2, Bronwen J. Ackermann3

1Céleste ROUSSEAU, PhD student, MSc, PT, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, United Kingdom

2Ju-Yang CHI, PhD student, MSc, PT, University of Sydney, Discipline of Biomedical Science, Sydney Medical School, University of Sydney, Australia

3Bronwen J. ACKERMANN, PhD, PT, associate professor, Discipline of Biomedical Science, Sydney Medical School, University of Sydney, Australia

Introduction: Playing-related musculoskeletal disorders (PRMDs) have been described for the first time in 1998 by Zaza et al. as “pain, weakness, numbness, tingling, or other symptoms that interfere

with (their) ability to play (their) instrument at the level (they) are accustomed to” [1]. For several years, numerous authors have helped in understanding these PRMDs and in creating numerous

prevention programmes. Upper strings are known to be at high level of risk to develop these kinds of disorders. Violinists have to hold their instrument between their left shoulder and the chin whils t playing, thus creating a static muscular load, and potentially leading to scapular dyskinesia [2,3]. Scapular stabilization is reported to result from the synergistic contributions of several muscles, with middle and lower trapezius and serratus anterior in particular essential to this stability [4]. The aim

of the current study is to investigate the immediate effect of dynamic and static exercises of scapular stabilisation on shoulder and forearm muscles activation while playing the violin using surface electromyography (sEMG) [4,5].

Method: Twelve violinists (six females, six males) participated in this study, with an average age of

26.9 years (± 7.8), an average total playing time of 18.5 years (±8.3) with 7.2 years (±5.2) in orchestras, and currently played approximately 12.6 hours (±9.0) per week. The muscles included for sEMG were:

upper (UT), middle (MT) and lower trapezius (LT), serratus anterior (SA), pectoralis major, deltoid anterior, forearm flexors and extensors. Before performing maximal voluntary contraction and

playing the violin, physical examinations were conducted to evaluate scapular motor control and shoulder mobility, and participants were asked to complete three questionnaires: the

Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM), the Depression Anxiety and Stress Scale-21 (DASS-21) as well as a pre-questionnaire about life habits and knowledge towards scapular biomechanics and rehabilitation.

Participants were asked to play three octaves of C major scale up and down at three different tempi: 60 bpm, 120 bpm with the upper half of the bow and 120 bpm with the lower half of the bow. They were asked to play this task before and after being taught scapular stabilisation exercises. Six

different exercises were randomised, and then taught to the participants including: three instrument -specific scapula stability exercises (one bilateral, two unilateral) and three standard scapula stability exercises (bilateral external rotation of the shoulder, push-up and scapular orientation exercise). Finally, after each exercise and post-play, two questions were asked to investigate the perceived scapula action while performing the exercises and while playing.

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Results: Responses to the MPIIMQ revealed that 92% violinists reported a lifetime prevalence of pain, 58% during the past year, 50% past month and 42% past week. DASS-21 scores showed participants reported normal to moderate stress and anxiety. Concerning examination of the scapulae, outcomes were not significant but distance between acromion and wall was always greater on the left side

compared to the right. A lack of knowledge about perception of scapular ideal position has been observed (most of volunteers participated in this study to improve their knowledge about these muscles).

During the exercises, highest activation levels for UT and SA were observed during the wall push-up, and for MT and LT during bilateral specific and non-specific exercises. While playing, paired Student-

t tests showed higher activation for MT and LT after an instrument-specific unilateral exercise (p

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Poster 8:

Bumps on bones - what do they really mean? Vivien Shaw* and Isabelle Catherine Winder VS: School of Medical Sciences, Bangor University; ICW: School of Natural Sciences, Bangor University Scientific interpretations of hominin fossils use detailed descriptions of bony anatomy to reconstruct the movement ecology, and behaviour of the living animal. Some features seem especially tightly associated with particular locomotor styles. For instance, there are anatomical details of the wrist and digits in gorillas and chimpanzees that many primatologists would describe as “knuckl e-walking features”, and details of foot, knee and hip bones that are routinely interpreted as indicating habitual

bipedalism in other species. These may be used to assume locomotor behaviours from even quite fragmentary fossils.

When we look in detail at modern apes, however, it becomes clear that the relationship between

anatomy and behaviour is often much more complex. There is almost never a one-to-one correlation between a specific feature and an associated style of movement. Just because a given movement is

possible with a particular bony configuration does not necessarily mean it is the primary movement

that an animal uses. In fact, if we look at living species, there are very few who have a single, overwhelmingly dominant locomotor pattern. Humans may be an exception, but even our species can, in the right circumstances, do things with their bony anatomy that we would normally believe impossible (consider, for instance, contortionists!). Ligamentous connections between bones and the ranges of motion they allow seem at least as important in determining movement as the shape of bones - and potentially even more so.

Here we explore the potential of one widely used “indicator” of bipedalism, namely a pronounced intercondylar ridge on the tibia. This feature is associated with strong cruciate ligaments, and when it is found in a hominin or ape fossil is often interpreted as a sign of habitual extension at the knee. Taken in combination with a more vertically oriented femoral neck suggestive of extension at the hip, it may indicate upright bipedalism, as seen for instance in the newly described Danuvius guggenmosi.

We argue, using comparative evidence, that this may lead to over-interpretation of the anatomy. Instead of necessarily indicating upright walking, strong cruciate ligaments could have multiple implications for movement patterns - and, indeed, are found well beyond the typically bipedal members of Order Primates. This evidence, we propose, also implies that our approaches to

interpreting anatomy and behaviour in extinct species need re-evaluating in light of more detailed understandings of the behavioural, anatomical and ecological complexities inherent in living animals’ movements.

*[email protected]


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