@misc{MuellerCarlsohnMuelleretal.2016,
  author    = {M{\"u}ller, Steffen and Carlsohn, Anja and M{\"u}ller, Juliane and Baur, Heiner and Mayer, Frank},
  title     = {Influence of Obesity on Foot Loading Characteristics in Gait for Children Aged 1 to 12 Years},
  url       = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-90108},
  year      = {2016},
  abstract  = {Background Overweight and obesity are increasing health problems that are not restricted to adults only. Childhood obesity is associated with metabolic, psychological and musculoskeletal comorbidities. However, knowledge about the effect of obesity on the foot function across maturation is lacking. Decreased foot function with disproportional loading characteristics is expected for obese children. The aim of this study was to examine foot loading characteristics during gait of normal-weight, overweight and obese children aged 1-12 years. Methods A total of 10382 children aged one to twelve years were enrolled in the study. Finally, 7575 children (m/f: n = 3630/3945; 7.0 +/- 2.9yr; 1.23 +/- 0.19m; 26.6 +/- 10.6kg; BMI: 17.1 +/- 2.4kg/m(2)) were included for (complete case) data analysis. Children were categorized to normalweight (>= 3rd and <90th percentile; n = 6458), overweight (>= 90rd and <97th percentile; n = 746) or obese (>97th percentile; n = 371) according to the German reference system that is based on age and gender-specific body mass indices (BMI). Plantar pressure measurements were assessed during gait on an instrumented walkway. Contact area, arch index (AI), peak pressure (PP) and force time integral (FTI) were calculated for the total, fore-, mid-and hindfoot. Data was analyzed descriptively (mean +/- SD) followed by ANOVA/Welch-test (according to homogeneity of variances: yes/no) for group differences according to BMI categorization (normal-weight, overweight, obesity) and for each age group 1 to 12yrs (post-hoc Tukey Kramer/Dunnett's C; alpha = 0.05). Results Mean walking velocity was 0.95 +/- 0.25 m/s with no differences between normal-weight, overweight or obese children (p = 0.0841). Results show higher foot contact area, arch index, peak pressure and force time integral in overweight and obese children (p< 0.001). Obese children showed the 1.48-fold (1 year-old) to 3.49-fold (10 year-old) midfoot loading (FTI) compared to normal-weight. Conclusion Additional body mass leads to higher overall load, with disproportional impact on the midfoot area and longitudinal foot arch showing characteristic foot loading patterns. Already the feet of one and two year old children are significantly affected. Childhood overweight and obesity is not compensated by the musculoskeletal system. To avoid excessive foot loading with potential risk of discomfort or pain in childhood, prevention strategies should be developed and validated for children with a high body mass index and functional changes in the midfoot area. The presented plantar pressure values could additionally serve as reference data to identify suspicious foot loading patterns in children.},
  language  = {en}
}
@article{MuellerCarlsohnMuelleretal.2016,
  author    = {M{\"u}ller, Steffen and Carlsohn, Anja and M{\"u}ller, Juliane and Baur, Heiner and Mayer, Frank},
  title     = {Influence of Obesity on Foot Loading Characteristics in Gait for Children Aged 1 to 12 Years},
  series = {PLoS one},
  volume    = {11},
  journal   = {PLoS one},
  number    = {2},
  publisher = {Public Library of Science},
  address   = {Lawrence, Kan.},
  issn      = {1932-6203},
  doi       = {10.1371/journal.pone.0149924},
  year      = {2016},
  abstract  = {Background Overweight and obesity are increasing health problems that are not restricted to adults only. Childhood obesity is associated with metabolic, psychological and musculoskeletal comorbidities. However, knowledge about the effect of obesity on the foot function across maturation is lacking. Decreased foot function with disproportional loading characteristics is expected for obese children. The aim of this study was to examine foot loading characteristics during gait of normal-weight, overweight and obese children aged 1-12 years. Methods A total of 10382 children aged one to twelve years were enrolled in the study. Finally, 7575 children (m/f: n = 3630/3945; 7.0 +/- 2.9yr; 1.23 +/- 0.19m; 26.6 +/- 10.6kg; BMI: 17.1 +/- 2.4kg/m(2)) were included for (complete case) data analysis. Children were categorized to normalweight (>= 3rd and <90th percentile; n = 6458), overweight (>= 90rd and <97th percentile; n = 746) or obese (>97th percentile; n = 371) according to the German reference system that is based on age and gender-specific body mass indices (BMI). Plantar pressure measurements were assessed during gait on an instrumented walkway. Contact area, arch index (AI), peak pressure (PP) and force time integral (FTI) were calculated for the total, fore-, mid-and hindfoot. Data was analyzed descriptively (mean +/- SD) followed by ANOVA/Welch-test (according to homogeneity of variances: yes/no) for group differences according to BMI categorization (normal-weight, overweight, obesity) and for each age group 1 to 12yrs (post-hoc Tukey Kramer/Dunnett's C; alpha = 0.05). Results Mean walking velocity was 0.95 +/- 0.25 m/s with no differences between normal-weight, overweight or obese children (p = 0.0841). Results show higher foot contact area, arch index, peak pressure and force time integral in overweight and obese children (p< 0.001). Obese children showed the 1.48-fold (1 year-old) to 3.49-fold (10 year-old) midfoot loading (FTI) compared to normal-weight. Conclusion Additional body mass leads to higher overall load, with disproportional impact on the midfoot area and longitudinal foot arch showing characteristic foot loading patterns. Already the feet of one and two year old children are significantly affected. Childhood overweight and obesity is not compensated by the musculoskeletal system. To avoid excessive foot loading with potential risk of discomfort or pain in childhood, prevention strategies should be developed and validated for children with a high body mass index and functional changes in the midfoot area. The presented plantar pressure values could additionally serve as reference data to identify suspicious foot loading patterns in children.},
  language  = {en}
}
@article{MuellerMuellerStolletal.2016,
  author    = {M{\"u}ller, Juliane and M{\"u}ller, Steffen and Stoll, Josefine and Rector, Michael V. and Baur, Heiner and Mayer, Frank},
  title     = {Influence of Load on Three-Dimensional Segmental Trunk Kinematics in One-Handed Lifting: A Pilot Study},
  series = {Journal of applied biomechanics},
  volume    = {32},
  journal   = {Journal of applied biomechanics},
  publisher = {Human Kinetics Publ.},
  address   = {Champaign},
  issn      = {1065-8483},
  doi       = {10.1123/jab.2015-0227},
  pages     = {520 -- 525},
  year      = {2016},
  abstract  = {Stability of the trunk is relevant in determining trunk response to different loading in everyday tasks initiated by the limbs. Descriptions of the trunk's mechanical movement patterns in response to different loads while lifting objects are still under debate. Hence, the aim of this study was to analyze the influence of weight on 3-dimensional segmental motion of the trunk during 1-handed lifting. Ten asymptomatic subjects were included (29 ± 3 y; 1.79 ± 0.09 m; 75 ± 14 kg). Subjects lifted 3× a light and heavy load from the ground up onto a table. Three-dimensional segmental trunk motion was measured (12 markers; 3 segments: upper thoracic area [UTA], lower thoracic area [LTA], lumbar area [LA]). Outcomes were total motion amplitudes (ROM;[°]) for anterior flexion, lateral flexion, and rotation of each segment. The highest ROM was observed in the LTA segment (anterior flexion), and the smallest ROM in the UTA segment (lateral flexion). ROM differed for all planes between the 3 segments for both tasks (P < .001). There were no differences in ROM between light and heavy loads (P > .05). No interaction effects (load × segment) were observed, as ROM did not reveal differences between loading tasks. Regardless of weight, the 3 segments did reflect differences, supporting the relevance of multisegmental analysis.},
  language  = {en}
}
@article{MuellerMuellerEngeletal.2016,
  author    = {M{\"u}ller, Juliane and M{\"u}ller, Steffen and Engel, Tilman and Reschke, Antje and Baur, Heiner and Mayer, Frank},
  title     = {Stumbling reactions during perturbed walking: Neuromuscular reflex activity and 3-D kinematics of the trunk - A pilot study},
  series = {Journal of biomechanics},
  volume    = {49},
  journal   = {Journal of biomechanics},
  publisher = {Elsevier},
  address   = {Oxford},
  issn      = {0021-9290},
  doi       = {10.1016/j.jbiomech.2015.09.041},
  pages     = {933 -- 938},
  year      = {2016},
  abstract  = {Stumbling led to an increase in ROM, compared to unperturbed gait, in all segments and planes. These increases ranged between 107 +/- 26\% (UTA/rotation) and 262 +/- 132\% (UTS/lateral flexion), significant only in lateral flexion. EMG activity of the trunk was increased during stumbling (abdominal: 665 +/- 283\%; back: 501 +/- 215\%), without significant differences between muscles. Provoked stumbling leads to a measurable effect on the trunk, quantifiable by an increase in ROM and EMG activity, compared to normal walking. Greater abdominal muscle activity and ROM of lateral flexion may indicate a specific compensation pattern occurring during stumbling. (C) 2015 Elsevier Ltd. All rights reserved.},
  language  = {en}
}
@article{MuellerCarlsohnMuelleretal.2016,
  author    = {Mueller, Steffen and Carlsohn, Anja and Mueller, Juliane and Baur, Heiner and Mayer, Frank},
  title     = {Influence of Obesity on Foot Loading Characteristics in Gait for Children Aged 1 to 12 Years},
  series = {PLoS one},
  volume    = {11},
  journal   = {PLoS one},
  publisher = {PLoS},
  address   = {San Fransisco},
  issn      = {1932-6203},
  doi       = {10.1371/journal.pone.0149924},
  pages     = {1710 -- 1717},
  year      = {2016},
  abstract  = {Background Overweight and obesity are increasing health problems that are not restricted to adults only. Childhood obesity is associated with metabolic, psychological and musculoskeletal comorbidities. However, knowledge about the effect of obesity on the foot function across maturation is lacking. Decreased foot function with disproportional loading characteristics is expected for obese children. The aim of this study was to examine foot loading characteristics during gait of normal-weight, overweight and obese children aged 1-12 years. Methods Results Mean walking velocity was 0.95 +/- 0.25 m/s with no differences between normal-weight, overweight or obese children (p = 0.0841). Results show higher foot contact area, arch index, peak pressure and force time integral in overweight and obese children (p< 0.001). Obese children showed the 1.48-fold (1 year-old) to 3.49-fold (10 year-old) midfoot loading (FTI) compared to normal-weight. Conclusion Additional body mass leads to higher overall load, with disproportional impact on the midfoot area and longitudinal foot arch showing characteristic foot loading patterns. Already the feet of one and two year old children are significantly affected. Childhood overweight and obesity is not compensated by the musculoskeletal system. To avoid excessive foot loading with potential risk of discomfort or pain in childhood, prevention strategies should be developed and validated for children with a high body mass index and functional changes in the midfoot area. The presented plantar pressure values could additionally serve as reference data to identify suspicious foot loading patterns in children.},
  language  = {en}
}
@article{MuellerEngelMuelleretal.2016,
  author    = {Mueller, Juliane and Engel, Tilman and Mueller, Steffen and Kopinski, Stephan and Baur, Heiner and Mayer, Frank},
  title     = {Neuromuscular response of the trunk to sudden gait disturbances: Forward vs. backward perturbation},
  series = {Journal of electromyography and kinesiology},
  volume    = {30},
  journal   = {Journal of electromyography and kinesiology},
  publisher = {Elsevier},
  address   = {Oxford},
  issn      = {1050-6411},
  doi       = {10.1016/j.jelekin.2016.07.005},
  pages     = {168 -- 176},
  year      = {2016},
  abstract  = {The study aimed to analyse neuromuscular activity of the trunk comparing four different perturbations during gait. Thirteen subjects (28 +/- 3 yrs) walked (1 m/s) on a split-belt treadmill, while 4 (belt) perturbations (F1, F2, B1, B2) were randomly applied. Perturbations differed, related to treadmill belt translation, in direction (forward (F)/backward (B)) and amplitude (20 m/s(2) (1)/40 m/s(2) (2)). Trunk muscle activity was assessed with a 12-lead-EMG. EMG-RMS [\%] (0-200 ms after perturbation; normalized to RMS of normal gait) was analyzed for muscles and four trunk areas (ventral left/right; dorsal left/right). Ratio of ventral: dorsal muscles were calculated. Muscle onset [ms] was determined. Data analysis was conducted descriptively, followed by ANOVA (post hoc Tukey-Kramer (alpha = 0.05)). All perturbations lead to an increase in EMG-RMS (428 +/- 289\%). F1 showed the lowest and F2 the highest increase for the flexors. B2 showed the highest increase for the extensors. Significant differences between perturbations could be observed for 6 muscles, as well as the 4 trunk areas. Ratio analysis revealed no significant differences (range 1.25 (B1) to 1.71 (F2) between stimuli. Muscle response time (ventral: 87.0 +/- 21.7 ms; dorsal: 88.4 +/- 17.0 ms) between stimuli was only significant (p = 0.005) for the dorsal muscles. Magnitude significantly influences neuromuscular trunk response patterns in healthy adults. Regardless of direction ventral muscles always revealed higher relative increase of activity while compensating the walking perturbations. (C) 2016 Elsevier Ltd. All rights reserved.},
  language  = {en}
}