Research Proposal Osteoarthritis of Knee

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RESEARCH – Winner #1, Netherlands, Engineering
Biomechanics of a Functional Task in Arthritic Subjects

          My interest in biomedical engineering is in the area of biomechanics, specifically the
biomechanics of human movement. The most common disease that impairs movement in people
is arthritis, a painful, degenerative joint disease. Biomechanical analyses are among the most
effective means of tracking the progression of impaired function caused by arthritis as well as
evaluating the effectiveness of treatment regimes designed to improve function and reduce pain
in arthritic patients. Over the past eight months I have been working as a Pratt School of
Engineering Undergraduate Fellow in the lab of Dr. Farshid Guilak, a leading osteoarthritis
researcher. I have been studying the activity levels and biomechanics of locomotion of arthritic
and non-arthritic mice to develop new non-invasive behavioral biomarkers for evaluating
disease progression in mouse models of osteoarthritis. By conducting my own research project I
was able to explore my interests in both biomechanics and osteoarthritis and see how they were
related. In the future I would like to expand my research to include the study of human
locomotion and examine how arthritis and other musculoskeletal diseases affect human
movement. Spending a year doing research in the laboratory of Dr. Maarten Bobbert at the V
rije Universiteit (VU University) in Amsterdam would be an ideal next step for me in my
research career.
          The Netherlands is renowned in the scientific community for both its focus on
biomechanics research and its population level studies of arthritisi,ii. This will be an excellent
environment to build upon my current research experiences. Dr. Bobbert's lab is part of the
Institute for Fundamental and Clinical Human Movement Sciences (lFKB). This institute
includes researchers and clinicians from the Faculty of Human Movement Sciences at the VU
University, the Medical Center of the VU University of Amsterdam, and the Faculty of
Medical Sciences and Hospital of the University of Nijmegen. This type of organized
collaboration between biomechanics researchers and doctors is rare in the United States and
thus will be a
great opportunity for me to explore my interest in human movement science as it relates to
clinical applications. As Dr. Bobbert says, "Although the primary objective is to gain
fundamental insights, the results are translated whenever possible into recommendations for
rehabilitation programs in health care." In the Amsterdam lab, I will be able to expand my
knowledge of biomechanics through the emphasis they place on the fundamentals of human
movement and at the same time see the immediate clinical applications of the research through
their close partnership with the VU University's Medical Center. In order to incorporate some of
my current research interests into a meaningful Fulbright project, I discussed with Dr. Bobbert
the possibility of doing a project that had clinical applications specifically for arthritis patients.
The IFKB is only a few years old, and thus my interest of a more clinically applied project
aligned well with Dr. Bobbert's interests of developing more clinical ties as part of the IFKB.
He has located a clinical partner from the IFKB, Dr. Willem Lems, a highly regarded
rheumatologist, who has joined us in this project and will help us locate the arthritic subjects for
our study and assist us in getting approval from the appropriate committee in order to do research
with human subjects.
          Many different clinical methods are used to assess disease progression, pain, and
function in arthritic patients. A standard clinical test to evaluate functional impairment is the sit-
to-stand (STS) test, where a patient sits in an armless, backless chair and is asked to rise to a
standing position while being timed, without using his arms for support. The STS movement is a
very common movement used in a domestic setting and one of the first functional tasks that
arthritic patients have difficulty with, due to the large loads placed on the joints during this
taskiii. I propose to observe the movement pattern, ground reaction forces, muscle activity, and
selfreported pain during the STS test in patients with unilateral arthritis of the knee and compare
them with those of age- and sex-matched healthy controls. I hypothesize that the arthritis
patients will use a different movement pattern in order to minimize the compression forces in the
knee in an attempt to minimize pain in the knee. To lend further support to our hypothesis, I will
also use my computer programming experience and the resources available in the Amsterdam
lab to develop a computer simulation (using both forward and inverse dynamics modeling) that
allows for estimation of the compression forces in the knee and for prediction of a movement
pattern that helps to minimize these forces. While the STS is a commonly used clinical test, very
few studies have made a biomechanical comparison of the execution of this test by arthritic
versus non-arthritic patients or used a simulation model to support their results. I am confident
that this project will give us better insight into an already widely used medical assessment as it
relates to arthritic patients. By providing clinicians in the IFKB, such as Dr. Lems, with further
scientific understanding of the movement patterns utilized by arthritic patients during the STS
test, this project will facilitate the design of better treatment regimes to improve function and
minimize pain in these patients.
           Successful results of nine months of research in Dr. Bobbert's lab would include a better
understanding of the tools used to characterize human movement, knowledge of how to
successfully apply my simulation skills to biomechanical projects, an appreciation of the
organization of a Dutch research institute such as the IFKB, and a publication of my research in a
scientific journal. In addition, I plan to take classes at the VU to increase my knowledge of
anatomy, physiology, and movement control, and to increase my interaction with the wider
University community. Taking one class a semester, such as "Simulation Models of
Neuromuscular Systems" and "Theory and History of Movement Sciences", will help
supplement my learning experience while I am conducting my research. Conducting this work
in Dr. Bobbert's lab, with the support of Dr. Lems, will make this project a success. Dr.
Bobbert's lab has a wide range of biomechanical testing equipment, including an Optotrak
system for kinematic analysis, force-plates, and EMG equipment, which will be necessary for
my clinical study, as well as previously developed simulation models for various locomotor
activities, which will be helpful in creating my simulation models of the STS test.
           The opportunity to conduct this research in Dr. Bobbert's lab and to be involved in this
innovative Dutch scientific community will be invaluable to my development as a successful
biomechanics researcher.

i Van Tuyl et al. Why are Dutch rheumatologists reluctant to use the COBRA treatment
strategy in early rheumatoid arthritis? Ann Rheum Dis. 2007 Jul; 66(7):974-6.
ii Van Jaarsveld et al. Effects of rheumatoid arthritis on employment and social participation
during the first years of disease in The Netherlands. Br J Rheumatol. 1998 Aug; 37(8):848-53.
iii Yoshioka et al. Computation of the kinematics and the minimum peak joint moments of sit-
tostand movements. Biomed Eng Online. 2007 July; 6(1):26.

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