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THE ROLE OF BIOMECHANICAL APPLICATIONS IN MUASCULOSKELETAL AND

NEUROLOGICAL REHABILITATION: REVIEW ARTICLE

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Volume 3, Issue 5 (May, 2014) Online ISSN-2277-1174

Published by: Abhinav Publication

Abhinav National Monthly Refereed Journal of Research in
Science & Technology
THE ROLE OF BIOMECHANICAL APPLICATIONS IN
MUASCULOSKELETAL AND NEUROLOGICAL
REHABILITATION: REVIEW ARTICLE
Gashaw Tesema
Lecturer, Mizan-Tepi University,
Tepi, Ethiopia
Email: gettsehay@gmail.com

ABSTRACT
This review is aimed to revise the essential role of biomechanics in musculoskeletal rehabilitation and
it also try to illustrate the application of biomechanics in neurological rehabilitation. In addition it
clarifies the application of biomechanics for evaluation and training normal walking and running gait.
By using different biomechanical sensors, accurate mathematical applications, biomechanical
applications are very necessary for neural and masculoskeletal rehabilitation as well as normal or
impaired gait/walk. Analysis in clinical assessment of injuries and the design of joint replacements
for degenerated joints, one of the most mature applications of computational biomechanics are
indicated in this review paper. Assessment of kinematic modeling developed for two to four sensors
that can monitor the rehabilitation of patients with neurological disorders are seen. Replacing
degenerated joints, detecting stress in bones, stress in inter vertebral discs, chest well deformations,
force induced by tendons and ligaments, angles between body segments during gait are some of the
biomechanical applications were seen as the necessary applications in rehabilitation science. Finally
this integrated biomechanical computation creates positive impact on orthopedic education, basic
research, device development generally and clinical patient care related to musculoskeletal joint
system reconstruction, trauma management, and rehabilitation as well are the most valuable
applications of biomechanics.
Keywords: Biomechanics; Gait; Masculoskeleta; Neurological; Rehabilitation

INTRODUCTION
Human locomotion has been studied, since the time of ancient Greece. Locomotion is a complex and
rapid activity and therefore, difficult to record visually. As a result, locomotion studies have been
heavily dependent on the available technology. The scientific observation of human locomotion
originated in the 19th century, with the introduction of the photographic camera. After the
application of force plate technology motion data could be gathered to give a full kinematic
and kinetic analysis of gait. This basic technology has improved to include television based camera
technology, inexpensive 3D force plates, latterly video cameras have come to existence (Philip
R., 2012).
In recent years, the expansion of science and technology, creating an overlap between the
biological sciences and engineering know-how has made the possibility of Virtual Human as a reality
rather than a visionary concept (Chao et al., 2007). This paper introduces the development and
applications of biomechanics for human musculoskeletal and neurological rehabilitation, which will

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 Abhinav National Monthly Refereed Journal of Research In
Science & Technology
enable the execution of a wide spectrum of biomechanical analyses under simulated or
experimentally measured functional environment. The basic and applied disciplines influencing
orthopedics and rehabilitation have experienced tremendous growth since their inception and
this has resulted in improved clinical care. Researches on dissected cadavers and experiment
animals can describe how bones, muscles, and tendons connect in a complicated geometry; how
muscles exert forces on joints; and even how impulse in the brain can trigger a muscle's contraction.
In the meantime, clinicians have been treating people for sports injuries, stroke, and movement
diseases such as cerebral palsy and osteoarthritis. Using trial and error, they were assessed which
rehabilitative strategies and surgical interventions work best. Clinical observations might miss the
interplay of forces that lead to an injured knee, while static equations regarding the flexion of a dead
man's knee may have a little help in treating a torn ligament. Researchers were missing the cause-and
effect models that linked the physical forces with the clinical outcomes. Now, computational models
are filling the gap between brain signals and gross Human movement. Recently, researchers and
clinicians are trying to bring biomechanics application knowledge from the grass root level (Regna N,
2007).
OBJECTIVE
The main aim of this review is
1. To revise the essential role of biomechanics in musculoskeletal rehabilitation.
2. To illustrate the application of biomechanics in neurological rehabilitation.
3. To clarify the application of biomechanics for evaluation and training normal walking and
running gait
Biomechanics in Rehabilitation
Over the past quarter century, extensive research has been done on musculoskeletal
biomechanics. As the number of older adults rapidly increases, so has concern about how to
manage conditions endemic to this population such as osteoarthritis of the hip and knee. For
younger active adults areas garnering considerable research focus have included management of
patella femoral disorders as well as prevention or subsequent repair of anterior cruciate ligament
ruptures, tendinopathies like Achilles, Tibialis Posterior and Patellar (Kulig and Burnfield, 2008). The
design of joint replacements for degenerated joints is one of the most mature applications of
computational biomechanics (Regna N, 2007). In addition corrections of gait and movement disorder
are the main objectives of biomechanics and rehabilitation sciences. Recently biomechanics and
rehabilitation sciences uses sensors like fiber Bragg gratings (FBGs) applications due to their
advantageous properties like small size, light weight, biocompatibility, chemical inertness,
multiplexing capability and immunity to electromagnetic interference (EMI). FBG-based sensors
demonstrated their feasibility for specific sensing applications in aeronautic, automotive, civil
engineering structure monitoring and undersea oil exploration; however, their use in the field of
biomechanics and rehabilitation applications is very recent. They are applied for detecting strain in
bones, pressure mapping in orthopedic joints, stresses in inter vertebral discs, chest wall
deformation, pressure distribution in Human Machine Interfaces (HMIs), forces induced by tendons
and ligaments, angles between body segments during gait, and many others in dental
biomechanics.(Osman et al., 2012)
Biomechanics in Musculoskeletal Rehabilitation
The biomechanics of the foot and ankle is important to the normal function of the lower
extremity. Proper arthrokinematic movement within the foot and ankle influences the ability of the
lower limb to attenuate the forces of weight bearing. It is important for the lower extremity to
distribute and dissipate compressive, tensile, shearing, and rotary forces during the different
phase of gait. Inadequate distribution of these forces could lead to abnormal stress and eventual

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breakdown of connective tissue and muscle. Some pathologies and injuries are the result of
abnormal mechanics of the foot and ankle. The use of orthotics to re-establish the normal
biomechanics of the foot and ankle have profound clinical applications for injuries due to abnormal
force distribution on the foot (Robert Donatelli, 1987). Biomechanics now is playing a great roll in
replacing artificial leg which can attract all eyes at Oscar pistorius in the 2012 Olympic game. The
biggest story in the 400-meter dash at the London Olympics was about the south African
runner Oscar Pistorius who is the "fastest man on no legs" and will be going up against
some very strong legs in the 400 and 4x400 relay. He was born without fibulas, leading to double
amputation below the knee. He's done pretty well for himself on his new legs, using cheetah
flex foot carbon fiber limbs to get around the track in 45.07 seconds recorded as his personal best
time (Blake D. 2012).
In clinical screening biomechanics have great place to assess joint biomechanical dysfunctions
and its co morbidities have been of interest for researchers and clinicians in recent years.
Research in the area of knee injury mechanics has elucidated some of the biomechanical
predisposing factors that lead to knee injury. Clinicians are still puzzled on how to translate these
findings to their clinical practice. Even though, highly instrumented, costly equipment and time
consuming data analyses are some of the difficulties of using 3-dimensional biomechanical
analysis in the clinics. Several biomechanical lower extremity assessment tools are available and
feasible to use in the clinic to guide proper clinical decision making that may impact prevention of
knee injuries in the physically active population (Ortiz and Micheo, 2011). Biomechanical principles
also provide a valuable perspective to our understanding of the mechanism of injury,
rehabilitation and joint replacement of the hip. An understanding of the biomechanics of the
hip is vital to advancing the diagnosis and treatment of many pathologic conditions. Some
areas that have benefited from advances in hip biomechanics include the evaluation of joint
function, the development of therapeutic programs for treatment of joint problems, procedures
for planning reconstructive surgeries and the design and development of total hip prostheses
(Johnston et al., 1998). A biomechanical model of the thumb can help researchers and clinicians
understand the clinical problem of how anatomical variability contributes to the variability of
outcomes of surgeries to restore thumb function if alternative kinematic descriptions of the thumb,
sensitivity of biomechanical models monitored for the exact musculoskeletal parameter values, good
choice of mathematical solution and uncertainties in published musculoskeletal parameter values are
avoided (Valero-Cuevas, 2003). The significance of studying the biomechanical properties of
ligaments stems have increased the understanding of ligament behavior which helped to identify key
ligaments requiring restoration after injury, and have assisted in identifying materials and tissues with
appropriate characteristics that can be used as replacements (Chimba et al., 2001). All the above
applications are the evidences of how we have to proceed in additional masculoskeletal rehabilitation
system by using different mechanical applications.
Biomechanics in Neural Rehabilitation
Neural rehabilitation principles and techniques have been developed to restore neuromotor function for
restoration of normal physiological movement patterns based on neurological gait rehabilitation
techniques like neurophysiological and motor learning (Belda-Lois et al, 2011). The physiotherapist
supports the correct patient’s movement patterns, acting as problem solver and this correct patients’
movement pattern will be monitored by gait analysis using biomechanical applications additional
sensors and movement monitoring instruments. For example patients with diabetes mellitus and
peripheral neuropathy have a big incidence of injuries while walking. Biomechanical analysis of their
walking may lead to treatments to reduce these injuries. According to the study on differences in the
gait characteristics of patients with diabetes and peripheral neuropathy compared with age-matched
controls, subjects with diabetes mellitus show less ankle mobility, ankle moment, ankle power,
velocity, and stride length during walking than subjects without diabetes mellitus. The research
shows that the diabetes mellitus group subjects appeared to pull their legs forward using hip

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flexor muscles (hip strategy) rather than pushing the legs forward using plantar-flexor muscles
(ankle strategy) as seen in the subjects without diabetes mellitus (James et al., 1994). Implications
for treatment are presented to attempt to reduce the number of injuries during walking in patients
with diabetes mellitus and peripheral neuropathy and it should be analyzed and monitored using
different sensors.
Assessment of kinematic modeling developed for two to four sensors can track position with an error
less than 0.1 cm in a 10 cm movement and can measure angle to 1° and this applications of inertial
sensors to monitor the rehabilitation of patients with neurological disorders helps in Preliminary
testing and data analysis on healthy volunteers & patients to get additional information based on
timing for each movement within a test, trajectory of joints in 3D space, changes in peak acceleration
can be an indication of improved function. For example timing for each movement may indicate
patient’s ability to grip and hold the object and the limb the range of motion value and time
dependence can be used to assess the patient’s response to rehabilitation (Lu Bai et al., 2012).
Biomechanics in Walking and Running Gait Training
The gait cycle is defined as the period from heel contact of one foot (for example, the left foot) to the
next heel contact of the same foot in other way we call it one stride ( Grimshaw et al., 2006). This
cycle is broken into two parts, stance phase and swing phase. On the average, the gait cycle is about
one second in duration with 60 percent in stance and 40 percent in swing. The stance phase is further
divided into an initial double stance, followed by a period of single stance and then a final
period of double stance. Double stance indicates that both feet are in contact with the ground; single
stance is the period when only one foot is in contact with the ground. When walking, there must be a
period of double stance and when running, this period is replaced by a flight phase during
which neither foot is in contact with the ground. During the early part of stance phase, the
heel is in contact with the ground, progressing to foot-flat during single stance and then to the
forefoot contact during the final double stance phase ending with toe-off. This would be the normal
contact areas of the plantar surface of the foot with the ground but may vary greatly with
pathological gait. For example, equines gait is characterized by the fore foot striking the ground first
and then the contact area, progressing to the posterior in some cases while in others the heel
never contacts the ground(Sarah et al., 2002). During double stance, the weight is transferred from
one foot to the other. During single stance, the center of mass of the body passes over the foot in
preparation for shifting to the other limb. Walking has been described as a series of falls from one limb
to the other and it is obvious that the greatest danger of an actual fall is during this period of
transferring weight. Gate can be measured by electromyography sensor in clinical setting. EMG
sensors record the electrical signal produced by a muscle during activation. At the same time it
shows the specific timing and relative intensity of muscle effort in larger superficial muscles
using surface electrodes and the activity of deeper muscles can be accurately documented
by fine wire electrodes (PERRY J., 1998). Like walking gait running gait analysis is done from real
time observational gait analysis to the use of high resolution cameras and video recording devices;
force plates; computer systems and other laboratory measurement instruments. There are five gait
measuring systems they include: Motion analysis, dynamic electromyography, Force plate recordings,
energy cost measurement or energetics, and measurement of stride characteristics. Kinetic analysis is
related to force production where as kinematics is the measure of movement itself and reflects the
effect of kinetics. Gait kinematic analysis is best done in a steady state outside of starting and stopping
and require enough space for the subject to start, walk/run, and stop( sheila and Krishna, 2005).
SUMMARY
Studying human motion from ancient Greece up to now with the advancement of technology like
photographic camera, force plates, video camera, magnetic resonance imaging, bone density
scan, electromyography and different sensors could result kinetic and kinematic analysis of gait as well
as clinical evaluation and rehabilitation of sport injuries, strokes and osteoarthritis. Now a day

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Science & Technology
biomechanics in musculoskeletal rehabilitation applied widely on tendenopathies like achilles,
tibialis posterior problems, and patellar, force distribution like compression, tensile, shearing and
rotary forces during different phases of gait. It also helps in replacing degenerated joints, detecting
stress in bones, stress in inter vertebral discs, chest well deformations, force induced by tendons and
ligaments, angles between body segments during gait. Biomechanics in neural rehabilitation plays a
great roll on patients with diabetes mellitus, peripheral neuropathy and cerebroplasty. It also helps
in evaluating and analysis of walking and running gait by the help of gait measurement
systems like motion analysis, dynamic electromyography, force plate recorders, energy cost
measurements and measurements of stride characteristics.
Adaptable anatomical models including prosthetic implants and fracture fixation devices and a
robust computational infrastructure for static, kinematic, kinetic, and stress analyses under
varying boundary and loading conditions are applied highly in rehabilitation science. This
integrated biomechanical computation creates positive impact on orthopedic education, basic
research, device development and applications including clinical patient care related to
musculoskeletal joint system reconstruction, trauma management, and rehabilitation. I have
provided a concise review of the biomechanical applications for the patients, physicians,
physiotherapists and biomechanical engineers in the science of rehabilitation to understand systematic
mechanical applications on human body which helps to current and future solutions.
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