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| Applied Biomechanics Laboratory |
Primary Focus: The overall purpose of the Applied Biomechanics Laboratoy is studying the biomechanical factors that contribute to injury and adaptation in patients with chronic disabilities. Current projects in the laboratory are aimed at understanding the mechanical factors contributing to the development, prevention, and alleviation of neuropathic ulcerations on the feet of patients with diabetes mellitus and peripheral neuropathy.
Current Projects:
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Effect of Weight-Bearing Exercise on People with Diabetes and Neuropathic Feet
Exercise and walking clearly help to control Type 2 diabetes mellitus and reduce subsequent complications. The American Diabetes Association (ADA) encourages exercise and walking programs for people with diabetes, but discourages walking programs for people with diabetes and peripheral neuropathy (DM+PN) due to risk of exercise-induced foot injury. No data support this guideline, and in fact, some evidence suggests that those who are most active are least likely to develop skin breakdown. Furthermore, people with DM+PN have substantial lower extremity impairments, functional limitations and disability, but it is not clear if they are able to improve these deficits through exercise.
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Therefore, the Primary Goal of this proposal is to conduct a randomized prospective controlled clinical trial to determine if people with DM+PN are able to increase their walking ability (steps/day) without increasing the incidence of foot lesions by participating in a supervised, graded weight-bearing (walking) exercise program (WP) compared to a non-weight-bearing exercise program (NWP) using a stationary bicycle. A secondary purpose is to determine the effect of the WP and NWP on measures of pathophysiology, impairments, functional limitations, and disability in people with DM+PN. |
| Visualizing Diabetic Feet to Optimize Orthotic Fitting – An NIH funded research project that combines CT images with plantar pressure data and plantar tissue characteristics with the goals of improving orthotics, developing a Finite Element Model of the foot, and gaining a better understanding of the causes of neuropathic ulcers. | 
FEA Model |
In-Shoe MultiSensory Data Analysis and Feedback Device – An NIH funded research project in which we are designing a shoe that measures and stores pressure, temperature, and humidity data for extended periods of time. We are in the process of applying for phase II funding of this SBIR project done in collaberation with Cleveland Medical Devices, Inc.
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| Pressure-Based Clinical Step Counter – An NIH funded research project aimed at designing a pressure-based clinical step counter that can time-tag steps for an extended period of time. We are currently in Phase II funding of this project with Cleveland Medical Devices, Inc. |  |
Completed Projects:
Achilles Tendon Lengthening on Patients with Diabetes – An NIH funded research project studying the effect of Achilles Tendon lengthening procedure in relation to diabetic foot ulcers.
Laboratory Resources
Representative Publications:
Zou D, Mueller MJ, Lott, DJ. Effect of peak pressure and pressure gradient on subsurface shear stresses in the neuropathic foot. J of Biomechanics. 2007;40:883-890 (Abstract)
Lott DJ, Hastings M, Commean P, Smith S, Mueller MJ. Effect of Footwear and Orthotic Devices on Stress Reduction and Soft Tissue Strain of the Neuropathic Foot. Clinical Biomechanics. 2007;22:352-359. (Abstract)
Hastings M, Mueller MJ, Pilgram TK, Lott DJ, Commean PK, Johnson JE. Effect of metatarsal pad placement on plantar pressure in people with diabetes and peripheral neuropathy. Foot & Ankle International. 2007; 28:84-88. (Abstract)
Mueller MJ, Lott DJ, Hasting MK, Commean P, Smith K, Pilgram T. Efficacy and mechanism of orthotic devices to unload metatarsals heads in people with diabetes and history of plantar ulcer. Physical Therapy. 2006;86:833-842. (Abstract)
Actis, RL, Ventura LB, Smith KE, Commean PK, Lott DJ, Pilgram TK, Mueller MJ. Numerical simulation of the plantar pressure distribution in the diabetic foot during the push-off stance. Medical & Biological Engineering & Computing. 2006;44:653-663. (Abstract)
Lott DJ, Maluf KS, Sinacore DR, Mueller MJ. Relationship Between Changes in Activity and Plantar Ulcer Recurrence in a Patient With Diabetes Mellitus. Physical Therapy. 2005;85:579-588. (Abstract)
Mercer Bolton NR, Smith KE, Pilgram TK, Mueller MJ, Bae KT. Computed tomography to visualize and quantify the plantar aponeurosis and flexor hallicus longus tendon in the diabetic foot. Clinical Biomechanics. 2005;20:540-546. (Abstract)
Mueller MJ, Zou D, Lott DJ. “Pressure Gradient”as an indicator of plantar skin injury. Diabetes Care. 2005;28:2908-2912. (Abstract)
Salsich GB, Mueller MJ, Hastings MK, Sinacore DR, Strube MJ, Johnson JE. Effect of Achilles tendon Lengthening on ankle muscle performance in people with diabetes and a neuropathic plantar ulcer. Physical Therapy, 85:34-43, 2005 (Abstract)
Mueller MJ, Sinacore DR, Hastings MK, Lott DJ, Strube MJ, Johnson JE. Impact of Achilles tendon lengthening on functional limitations and perceived disability in people with a neuropathic plantar ulcer. Diabetes Care, 27:1559-1564, 2004 (Abstract)
Maluf KS, Mueller MJ, Strube MJ, Engsberg JR, Johnson JE. Tendon Achilles lengthening for the treatment of neuropathic ulcers causes a temporary reduction in forefoot pressures associated with changes in plantar flexor power rather than ankle motion during gait. Journal of Biomechanics, 37:897-906, 2004 (Abstract)
Maluf KS, Morley RE, Richter EJ, Klaesner JW, Mueller MJ. Foot pressures during level walking are strongly associated with pressures during other ambulatory activities in subjects with diabetic neuropathy. Archives of Physical Medicine and Rehabilitation. 85:253-260, 2004 (Abstract)
Hastings MK, Commean PK, Smith KE, Pilgram TK, Mueller MJ. Aligning anatomical structure from spiral x-ray computed tomography with plantar pressure data. CLINICAL BIOMECHANICS, 18:877-882, 2003. (Abstract)
Mueller MJ, Sinacore DR, Hastings MK, Strube MJ, Johnson JE. Effect of Tendo Achilles Lengthening Procedure on Ulcer Healing, Plantar Pressures, and Ankle Impairments in People with Diabetes and a Neuropathic Plantar Ulcer: A Randomized Clinical Trial. Journal of Bone and Joint Surgery (Am). 2003; 85-A (8): 1436-1445. (Abstract)
Kwon OY, Minor SD, Maluf KS, Mueller MJ. Comparison of muscle activity during walking in subjects with and without diabetic neuropathy. Gait & Posture, 18:105-113, 2003 (Abstract)
Mueller MJ, Hastings M, Commean PK, Smith KE, Pilgram TK, Robertson D, Johnson JE. Forefoot structural predictors of plantar pressures during walking in people with diabetes and peripheral neuropathy. Journal of Biomechanics, 36:1009-1017, 2003 (Abstract)
Maluf KS, Mueller MJ. Novel Award, 2002.Comparison of physical activity and cumulative plantar tissue stress among subjects with and without Diabetes Mellitus and a history of recurrent plantar ulcers. Clinical Biomechanics, 18:567-575, 2003. (Abstract)
Mueller MJ, Maluf KS: Tissue Adaptation to Physical Stress: A Proposed “Physical Stress” Theory to Guide Physical Therapy Practice, Education, and Rehabilitation Research. Physical Therapy, 82:383-403, 2002. (Abstract)
Robertson DD, Mueller MJ, Smith KE, Commean PK, Pilgram T, Johnson JE: Structural Changes in the Forefoot of Individuals with Diabetes and a Prior Plantar Ulcer. Journal of Bone and Joint Surgery (Am), 84:1395-1404, 2002. (Abstract)
Klaesner JW, Hastings MK, Zou D, Lewis C and Mueller MJ. Plantar tissue stiffness in patients with diabetes mellitus and peripheral neuropathy. Archives of Physical Medicine and Rehabilitation 83: 1796-1801, 2002 (Abstract)
Commean PK, Mueller MJ, Smith KE, Hastings M, Klaesner J, Pilgram T and Robertson DD. Reliability and validity of combined imaging and pressures assessment methods for diabetic feet. Archives of Physical Medicine & Rehabilitation 83: 497-505, 2002 (Abstract)
Maluf KS, Morley RE, Richter EJ, Klaesner JW, Mueller MJ. Monitoring in-shoe plantar pressures, temperature, and humidity: reliability and validity of measures from a portable device. Archives of Physical Medicine and Rehabilitation. Vol. 82, August 2001, 1119-1127. (Abstract)
Klaesner JW, Commean PK, Hastings MK, Zou D, Mueller MJ. Accuracy and reliability of a portable soft tissue indentor. IEEE Transactions on Neural Systems and Rehabilitation Engineering. 2001; 9(2). (Abstract)
Morley RE, Richter EJ, Klaesner JW, Maluf KS, and Mueller MJ. In-shoe multi-sensory data acquisition system. IEEE Transactions on Biomedical Engineering. Vol. 48(7), 2001, 815-820. (Abstract)
Hastings MK, Mueller MJ, Sinacore DR, Salsich GB, Johnson JE, Engsberg JR: Effects of a Tendo-Achilles Lengthening Procedure on Muscle Function and Gait Characteristics in a Patient with Diabetes Mellitus. Journal Orthopedic Sports & Physical Therapy, 2000; 30:85-90. (Abstract)
Mueller MJ, Smith KE, Commean PK, Robertson DD, Johnson JE: Use of Spiral X-Ray Computed Tomography and Plantar Pressures for Management of Neuropathic Ulcers in Patients with Diabetes. Physical Therapy, 1999; 79:296-307. (Abstract)
Mueller MJ. Application of Plantar Pressure Assessment in Shoe Design. Journal Orthopaedic Sports & Physical Therapy, 1999; 29:747-755. (Abstract)
Mueller MJ, Strube MJ: Therapeutic Footwear: Enhanced Function in People with Diabetes and Transmetatarsal Amputation. Archives of Physical Medicine and Rehabilitation, 1997; 78:952-956. (Abstract)
Mueller MJ, Strube MJ, Allen BT: Therapeutic Footwear Can Reduce Plantar Pressures in Patients with Diabetes and Transmetatarsal Amputation. Diabetes Care, 1997; 20:637-641. (Abstract)
Mueller MJ, Strube MJ: Generalizability of In-Shoe Peak Pressure Measures Using the F-Scan System. Clinical Biomechanics, 1996; 11:159-164. (Abstract)
Mueller MJ, Host JV, Norton BJ: Navicular Drop as a Composite Measure of Excessive Pronation. Journal of the American Podiatric Medical Association, 1993; 83:198-202. (Abstract)
Dahle LK, Mueller MJ, Delitto A, Diamond JE: Visual Assessment of Foot Type and Relationship of Foot Type to Lower Extremity Injury. Journal of Orthopaedics and Sports Physical Therapy, 1991; 14:70-74.
Mueller MJ, Diamond JE, Sinacore DR, Delitto A, Blair VP, Drury DA, Rose SJ: Total Contact Casting in the Treatment of Diabetic Plantar Ulcers: A Controlled Clinical Trial. Diabetes Care, 1989; 12:304-388. (Abstract)
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