Exploring whole-body kinematics when eating real foods with the dominant hand in healthy adults

Jun Nakatake; Koji Totoribe; Hideki Arakawa; Etsuo Chosa

doi:10.1371/journal.pone.0259184

. 2021 Oct 28;16(10):e0259184. doi: 10.1371/journal.pone.0259184

Exploring whole-body kinematics when eating real foods with the dominant hand in healthy adults

Jun Nakatake ^1,^*, Koji Totoribe ², Hideki Arakawa ^1,³, Etsuo Chosa ^1,³

Editor: Bernadette Ann Murphy⁴

PMCID: PMC8553040 PMID: 34710151

Abstract

Despite the importance of eating movements to the rehabilitation of neurological patients, information regarding the normal kinematics of eating in a realistic setting is limited. We aimed to quantify whole-body three-dimensional kinematics among healthy individuals by assessing movement patterns in defined phases while eating real food with the dominant hand in a seated position. Our cross-sectional study included 45 healthy, right-hand dominant individuals with a mean age of 27.3 ± 5.1 years. Whole-body kinematics (joint angles of the upper limb, hip, neck, and trunk) were captured using an inertial sensor motion system. The eating motion was divided into four phases for analysis: reaching, spooning, transport, and mouth. The mean joint angles were compared among the phases with Friedman’s analysis of variance. The maximum angles through all eating phases were 129.0° of elbow flexion, 32.4° of wrist extension, 50.4° of hip flexion, 6.8° of hip abduction, and 0.2° of hip rotation. The mean shoulder, elbow, and hip joint flexion angles were largest in the mouth phase, with the smallest being the neck flexion angle. By contrast, in the spooning phase, the shoulder, elbow, and hip flexion were the smallest, with the largest being the neck flexion angle. These angles were significantly different between the mouth and spooning phases (p < 0.008, Bonferroni post hoc correction). Our results revealed that characteristic whole-body movements correspond to each phase of realistic eating in healthy individuals. This study provides useful kinematic data regarding normal eating movements, which may inform whole-body positioning and movement, improve the assessment of eating abilities in clinical settings, and provide a basis for future studies.

Introduction

Rehabilitation of eating is an important component of the care of patients with neurological impairments, such as individuals with cerebral palsy or who have had a stroke [1, 2]. Eating-related impairments, which are not limited to dysphagia, have a negative impact on physical and psychosocial well-being and participation within the wider context of culture and the environment. Various interventional approaches have been used to address eating impairments, including environmental changes, adequate positioning, use of adaptive equipment, rehabilitation of motor components of chewing and swallowing, and education of patients and caregivers [3, 4].

Eating is usually performed in a seated position and requires movement of the dominant upper limb, neck, and trunk, with the lower limbs and trunk providing stability. Knowledge of whole-body kinematics, including posture, minimum-maximum joint angles, and movement patterns, would be important to assess impairments and to inform intervention. Furthermore, capturing this information in near-natural settings would be useful, as the kinematics of eating movements in daily living are different from those measured in simulated tasks [5].

The upper limb joint angles in an unimpaired population when eating with a spoon have previously been reported using three-dimensional motion analysis [6–13]. The neck, lumbar spine, and trunk angles have also been studied, although to a lesser extent [6, 9, 14, 15]. Beaudette and Chester [6] and Klotz et al. [9] comprehensively described the upper limb, trunk, and neck angles during realistic eating. However, eating-related whole-body kinematics that include the lower limb, whose position as a stable base of upper limb motion should be assessed in practice, have not been reported in detail.

Evaluation of the change in joint angles over time is important to identify kinematic patterns of eating. Waveform analyses of upper limb joint movements, which provide only a subjective visual assessment of upper limb motion for eating, have been previously reported [6, 11, 13]. However, the time-dependent kinematics of the neck, trunk, and lower limbs have not been clearly defined. Moreover, to the best of our knowledge, no comparison of single points or phases during eating with respect to objective parameters of whole-body kinematics has been reported. Realistic eating consists of specific phases that require concurrent whole-body movements. Due to the complexity of these realistic movements, clinicians in practice may have a limited understanding of the normal kinematics of eating. Establishing whole-body kinematic variables and movement patterns, which could be described as differences in joint positions, the extent of motion, and motion directions between eating phases in patients with eating limitations, would therefore constitute useful information that could be applied in clinical settings. Thus, our study aimed to determine the whole-body joint angles and movement patterns necessary for realistic eating in healthy individuals.

Materials and methods

Participants

The inclusion criteria for this cross-sectional study were as follows: 1) age 20–39 years; 2) right-handed; and 3) no neurological, sensory, or musculoskeletal abnormalities. Individuals who used the left hand to eat with a spoon were excluded. Fifty participants (23 men, 27 women; age, mean 27.3, standard deviation [SD] 5.0 years; height, mean 164.7, SD 8.2 cm) were recruited between April 2013 and October 2017 from among the medical staff of our institution, who responded of their own free will to a request for study participants. To ensure normal kinematic data and exclude age effects resulting from neurological immaturity or decline, children [6, 16] and older adults [17] were not selected as their upper limb reaching movements during activities of daily living differ from those of young adults. Left-handers were excluded since manipulations of their dominant hand may not simply mirror those of right-handers [18].

Instruments and measurements

Three-dimensional joint angle data were acquired in the rehabilitation room of our institution using the Xsens MVN system (Xsens Technologies B.V., The Netherlands), as previously described [19], and captured at a frequency of 120 Hz. This system contains 17 inertial sensor units (ISUs) and two Xbus Masters (Xsens Technologies B.V.). The kinematic parameters of the eating movement were calculated from raw ISU data using built-in software (Xsens MVN Studio 3.1, Xsens Technologies B.V.). The whole-body model was defined by 23 kinematic data points, with axes and origins defined using the recommendations of the International Society of Biomechanics [20, 21]. Of these points, one neck, four spine, and two toe points were not directly measured but were calculated using ISU data and other data points with respect to global and local references. Joint angles were defined by the position of the distal segment relative to the proximal segment. The neutral (zero) position in joint angles for the model was defined as the joint angles when standing upright, in a relaxed posture, with feet parallel, one-foot width apart, upper limbs alongside the body, palms facing forward, and the head oriented forward. The accuracy of the Xsens MTx and MVN systems used has previously been confirmed against an optical system [22–26].

Eating yogurt with a spoon was chosen as it represents a widely used eating behavior, namely moving the spoon from the bowl to the mouth for eating through movement of the upper limb. One spoon (length, 17.5 cm; weight, 41 g; stainless steel) and bowl (top diameter, 15.5 cm; bottom diameter, 7.0 cm; height, 4.5 cm; weight, 246 g; ceramic) were used.

The participants donned a Lycra suit with attached ISU sensors. After calibration and definition of body dimensions, participants sat comfortably without trunk fixation to allow free motion on a 40-cm high seat behind a table (10 cm from the participant’s trunk, at the height of the right elbow), with the right upper limb placed alongside the body at baseline and their feet fully on the floor. To standardize the relative position between the participants and the bowl, a participant’s right shoulder, forearm, wrist, and finger joints were placed in the anatomically neutral position, with the right elbow in 90° flexion and the right hand placed on the table. The center of the bowl was aligned with the midline of the body for each participant. Participants held a spoon with their right hand and received the task instruction, “please eat three spoons full of yogurt without a break, using habitual whole-body movements and speed, not looking away, and with your left hand resting on your left thigh.” For realistic conditions, the eating movements were performed with no absolute start and end positions defined.

Data processing

One eating cycle was defined as the movement of the spoon from the bowl to the mouth and was subdivided into four phases by visually partitioning the recorded movie: reaching (moving the spoon to the bowl), spooning (getting yogurt into the spoon), transport (moving the spoon from the bowl to the mouth), and mouth (placing the yogurt into the mouth). These phases were subsequently filtered to identify phase recordings that were suitable for further analyses. This cycle was chosen as a realistic eating movement according to the study aims but was not completely realistic because using the non-dominant hand to hold the bowl or to gather food was not permitted. Up to three sequential movement cycles were recorded to provide participants with the opportunity to produce two cycles with all four eating phases. The first cycle, including all four standard phases, was included in the between-subject analysis. Cycles containing the following motions were not accepted because they conflict with our definition of an eating movement: excessive elevation of the upper limb during transport in an exaggerated or unnecessary manner, looking away from the bowl, extraneous movement of the head along the sagittal plane during reaching, more than one spoon movement in the bowl, using the spoon to separate the yogurt before spooning, and shaking yogurt off the spoon during transport. The data of participants unable to produce all four standard phases were also excluded.

The joint angles and direction of movements used to describe the kinematics of the movement are listed in Table 1. Of these, the C7–T1 joint was selected as the neck joint, whereas the T8–T9 and L5–S1 joints were selected as the spine joints. Joint angles during each phase of the movement were extracted from the kinematic data. Using Microsoft Excel (version 16.0, Microsoft Corporation, Redmond, WA), the between-subject mean, SD, and 95% confidence interval (CI) of the maximum and minimum joint angles were calculated for the four phases of the eating movement. Joint motion directions, in which the difference between the minimum and maximum joint angles was >5.0°, were identified for further analyses as these are clinically detectable. To compare and characterize the joint angles of each phase, the following variables were calculated: mean angles, calculated from the cumulative sequential data over each phase to provide the average position; range of motion (ROM), calculated as the difference between the minimum and maximum angles in each phase to quantify the motion [27]; and joint angles normalized to 101 points, corresponding to 0–100% of the movement time in each phase. The normalized data were then represented as the mean (SD) for each point in each phase, and waveforms of normalized joint angles were calculated for the visual analysis of the joint motion direction.

Table 1. Whole-body joint angles across the four eating phases.

Joint	Motion direction (+)/(-)	Maximum angle		Minimum angle
		Mean (SD)	95% CI	Mean (SD)	95% CI
Shoulder	Flexion/Extension	42.0 (11.6)	38.5–45.5	17.0 (8.4)	14.5–19.5
	Abduction/Adduction	41.0 (9.7)	38.0–43.9	26.2 (7.4)	24.0–28.4
	Internal/External rotation	13.0 (9.6)	10.1–15.9	-0.5 (9.0)	-3.2–2.2
Elbow	Flexion/Extension	129.0 (9.4)	126.2–131.8	95.7 (10.2)	92.6–98.7
Forearm	Pronation/Supination	103.7 (18.8)	98.0–109.3	22.9 (15.9)	18.2–27.7
Wrist	Flexion/Extension	-16.7 (15.2)	-21.3–-12.1	-32.4 (12.7)	-36.2–-28.6
	Radial/Ulnar deviation	4.6 (10.0)	1.6–7.6	-13.9 (7.5)	-16.1–-11.6
C7–T1	Flexion/Extension	26.2 (3.6)	25.1–27.3	16.9 (5.7)	15.2–18.6
	Right/Left lateral flexion	4.8 (3.3)	3.8–5.8	-1.7 (2.0)	-2.3–-1.1
	Left/Right rotation	0.4 (1.6)	-0.1–0.9	-4.0 (2.8)	-4.8–-3.2
T8–T9	Flexion/Extension	11.9 (4.1)	10.7–13.1	10.5 (3.9)	9.3–11.6
	Right/Left lateral flexion	0.3 (0.8)	0.0–0.5	-0.4 (0.8)	-0.6–-0.1
	Left/Right rotation	-0.6 (0.7)	-0.8–-0.4	-1.2 (0.9)	-1.4–-0.9
L5–S1	Flexion/Extension	14.5 (4.2)	13.2–15.8	12.7 (4.2)	11.4–13.9
	Right/Left lateral flexion	0.6 (1.0)	0.3–1.0	-0.2 (1.1)	-0.5–0.1
	Left/Right rotation	-0.6 (0.8)	-0.9–-0.4	-1.4 (1.0)	-1.7–-1.1
Hip	Flexion/Extension	50.4 (10.9)	47.1–53.7	44.1 (10.1)	41.1–47.1
	Abduction/Adduction	6.8 (10.9)	3.5–10.0	5.7 (10.9)	2.4–9.0
	Internal/External rotation	0.2 (6.3)	-1.6–2.1	-1.2 (6.0)	-3.0–0.6

Open in a new tab

All values are reported in degrees. CI, confidence interval; SD, standard deviation.

Statistical analysis

The Shapiro–Wilk test was used to determine the normality of minimum and maximum joint angle data distribution with the significance level set at p < 0.05. The mean, SD, and 95% CI values were calculated to determine the between-subject consistency in joint angles. Friedman’s analysis of variance (ANOVA) (p < 0.05) with Bonferroni adjustment for multiple comparisons (p < 0.008) was used to compare the mean angles and ROMs among the four phases. The effect size (r) was calculated and defined as follows: |r| = 0.10–0.29, small effect; |r| = 0.30–0.49, medium effect; and |r| ≥ 0.50, large effect [28]. All statistical analyses were performed using SPSS statistics (version 23, IBM Japan, Japan).

Results

Study sample

After screening for exclusion, the data of 45 participants from the 50 enrolled were included: 37 first cycles and 8 second cycles. The relevant characteristics of our study group were as follows: 23 men, mean (SD) age of 27.3 (5.1) years, and mean (SD) height of 164.8 (8.6) cm. Of note, a rest period in upper limb motion, i.e., the reaching movement paused within several seconds and started again, was frequently observed during the reaching phase (26 of 37 first cycles) and was therefore included in the analysis.

Necessary joint angles for eating movements

Detailed whole-body joint angles for all four phases are summarized in Table 1. A difference of >5.0° between the maximum and minimum was identified across all four phases for the shoulder, elbow, forearm, and wrist joint angles, flexion and right lateral flexion angles of C7–T1, and the flexion angle of the right hip joint. Accordingly, the mean angles, ROMs, and waveforms of normalized joint angles in each phase were used for comparison among the phases.

Comparison of mean angles among eating phases

The mean angles for all four phases are presented in Fig 1. The highest mean angles (upper limb, C7–T1, and hip) were identified in the spooning and mouth phases, except for shoulder internal rotation and wrist flexion. Overall, the mean angles were significantly different across all four phases (Friedman’s ANOVA, p < 0.05). Significant between-phase differences after Bonferroni correction with a large effect size (p < 0.008, |r| ≥ 0.5) are described as follows (Fig 1 and S4 Table). At the shoulder, the flexion and abduction mean angles were largest in the mouth phase and larger in the transport than in the reaching and spooning phases, with greater mean internal rotation angles in the spooning, transport, and mouth phases than in the reaching phase. Elbow flexion was largest in the mouth phase and smallest in the spooning phase. The position of forearm pronation decreased from the spooning phase through the reaching, transport, and mouth phases. The mean angle of wrist flexion was greater for the mouth than for the reaching phase, whereas the mean angle of radial deviation was greater for the reaching and spooning phases than for the transport and mouth phases. The largest mean flexion angle at C7–T1 was observed during the spooning phase, with the smallest mean angle during the mouth phase. By contrast, the largest mean angle of right lateral flexion of C7–T1 was detected in the mouth phase, with the mean angle being smaller in the spooning than in the transport and mouth phases. The largest mean hip flexion angle was observed during the mouth phase, with the smallest during the spooning phase.

Comparison of ROMs among eating phases

The ROMs of the upper extremity, C7–T1, and hip were larger during the reaching and transport phases than during the spooning and mouth phases, except for wrist flexion and radial deviation (Fig 2). Overall, ROMs were significantly different across all four phases (Friedman’s ANOVA, p > 0.05). Significant between-phase differences after Bonferroni correction with a large effect size (p < 0.008, |r| ≥ 0.5) are described as follows (Fig 2 and S6 Table). The flexion ROM at the shoulder decreased from the reaching phase to the transport, mouth, and spooning phases. The ROM of shoulder abduction was greater in the reaching and transport phases than in the spooning and mouth phases, whereas shoulder internal rotation was greatest during the reaching phase. The ROM of elbow flexion was greatest during the reaching and transport phases than in the spooning and mouth phases. The ROM of forearm pronation decreased from the reaching phase through the transport, spooning, and mouth phases, with the difference between the spooning and transport phases being of medium effect size (p < 0.008, r = -0.408). The ROM of wrist flexion was greater during the reaching, spooning, and transport phases than during the mouth phase, whereas radial deviation was greater during the reaching and spooning phases than during the transport and mouth phases, with the smallest ROM being observed in the mouth phase. The C7–T1 flexion ROM decreased from the transport phase through the reaching, mouth, and spooning phases, with only a medium effect size of the difference between the reaching phase and the transport and mouth phases (p < 0.008, r = -0.367 and p < 0.008, r = -0.374, respectively). The C7–T1 right lateral flexion ROM decreased from the reaching phase through the transport, mouth, and spooning phases, with only a small effect size of the difference between the transport and mouth phases (p < 0.008, r = -0.276). The hip flexion ROM was larger for the reaching and transport phases than for the spooning and mouth phases. Whole-body changes in joint angles over time across all four phases are shown in Fig 3.

Fig 2 — Eating phases are shown on the horizontal axis. *, significant difference (p < 0.008) compared to the reaching phase; ^†, significant difference (p < 0.008) compared to the spooning phase; ^‡, significant difference (p < 0.008) compared to the transport phase; ^§, significant difference (p < 0.008) compared to the mouth phase.

Fig 3 — Solid, dotted, and dashed lines show the mean angles, with shaded areas showing the corresponding standard deviations.

Discussion

We presented an analysis of the three-dimensional whole-body kinematics during a realistic eating movement among healthy young adults and evaluated changes in the movement patterns across the four eating phases. Our findings can provide a reference for clinical assessment and inform the treatment of individuals with neurological impairments affecting the motor control for eating.

A previous study of realistic eating movement reported angles of 130° of elbow flexion, 40° of wrist extension, and 18° of neck flexion [6], with these findings being comparable to ours. In our study, we additionally report the angles of the right hip joint, with a range of 44.1–50.4° of flexion (95% CI, 41.1–53.7°), 5.7–6.8° of abduction (95% CI, 2.4–10.0°), and -1.2–0.2° of rotation (95% CI, -3.0–2.1°). A neutral trunk position has been associated with faster eating movements compared to kyphotic or laterally flexed positions [29]. Other studies have reported greater movement of the trunk and elbow flexion during a drinking task among individuals who have had a stroke compared to that among controls; however, reports of between-group comparisons during eating have been lacking [30, 31]. The trunk position is supported by the lower limbs in seated eating, and the control of the lower limbs is accomplished in the normal hip joint angles. The regulation of the hip angles and the reduction in elbow extension during eating should therefore be investigated in future studies. Although the hip angle varied little among our study group, the compensatory coordination of this position along with reduced elbow extension could have an important clinical effect on eating in populations with neurological problems.

Shoulder flexion, abduction and internal rotation, elbow flexion, and wrist flexion angles have previously been reported to increase when placing food in the mouth and to decrease when moving the hand away from the mouth, with opposite patterns found for forearm pronation and wrist radial deviation [6, 11, 13]. Our findings are consistent with these results, with differences in most mean angles being between the mouth and reaching or transport phases. The large effect sizes of these differences suggest that this is the typical upper limb movement pattern when eating with a spoon.

Beaudette and Chester [6], however, reported a different movement pattern for shoulder joint abduction; this difference likely resulted from their combination of data from both the dominant and non-dominant hand. In the spooning phase of our study, the mean angles in shoulder flexion and abduction, as well as elbow flexion, were small overall with large mean angles of forearm pronation and wrist radial deviation. Of note, upper limb joint angles in the spooning phases were approximately opposite to those in the mouth phase. The movement patterns of the neck, trunk, and lower limb were specific to each eating phase. Especially, the C7–T1 flexion angle was large, whereas the C7–T1 right lateral flexion and the hip flexion angles were small in the spooning phase, with these angles being respectively reversed in the mouth phase.

We also demonstrated that ROMs of the upper limb, neck, and hip were generally larger during the reaching and transport phases than during the spooning and mouth phases. Combining the results of the mean angles and ROMs, our study highlighted that the upper limb, neck, and hip simultaneously move during the reaching and transport phases, reversing in direction during the spooning and mouth phases. Although the ROMs at these joints are small, the positions of these joints are at their maxima. The different movements from this pattern, especially the reaching phase, and the mean angles of the shoulder internal rotation and the wrist flexion were the smallest. The spooning phase also required large ROMs of forearm pronation (decreasing angles) as well as of wrist flexion (increasing and decreasing angles) and radial deviation (decreasing angles). Knowledge of the movement patterns that we have described may be useful for the comprehensive assessment of eating and optimization of upper and lower limb, neck, and trunk movements during eating. To facilitate or compensate for the normal positions and movements for each eating phase, appropriate positioning, seating equipment, upper extremity and posture control, and orthotics [3, 4] referring to the mean angles, the ROMs, and the changes in joint angles of the present study could be provided in practice.

With regard to the trunk, C7–T1 left rotation, T8–T9 and L5–S1 flexion, lateral flexion, and rotation, as well as hip abduction and rotation were quasi-invariable across the four phases of eating. This may reflect the conditions of our task that used yogurt and required maintenance of the position of the bowl. This is an important finding for practice. Specifically, our standardized task could be used to determine the need for support through equipment or practitioner manipulation in individuals with impairments in the motor control of eating.

The existence of head and trunk motion when placing food in the mouth has been previously reported [32, 33]. Among our study group, the mouth phase was characterized by minimum neck flexion but maximum right neck lateral flexion and hip flexion. These movements are thought to facilitate directing the mouth to the food [4]. The neck and lower limb movement patterns when food approaches the mouth from the left side when eating with the left hand or when food is brought to the mouth using assistance should be addressed in future studies.

Inter-subject differences may have contributed to the high variability in joint angles shown in Fig 3, such that the SD values of all joint angles and phases do not converge. There was no clear difference in movement strategies among the four defined eating phases analyzed in this study, even after the exclusion of outliers with excessive deviation. However, as the aim of the study was to analyze habitual whole-body movements, movements at the participant’s own speed without constraints from a backrest were allowed, and the seat height, as well as the bowl and spoon sizes, were not adapted to the participant’s body size. The start and stop positions were also defined within uninterrupted eating movements. Thus, measurements of realistic eating behavior can easily vary. The influence of body constitution and muscle strength, which may have caused movement differences in the current study, should be examined in clinical settings by future studies. In contrast, a comparison of eating phases could foster an understanding of typical whole-body movement patterns in a realistic condition, such as that described above, allowing movement patterns that reflect realistic eating to be adopted in clinical practice.

Increased maximal shoulder abduction and reduced maximal elbow flexion of healthy pediatric participants compared to those of healthy young adults were reported previously [6]. Since these maximal angles were shown during the mouth phase in our study with healthy young adults, larger shoulder abduction and lower elbow flexion may be able to be assessed as normal pediatric motions in the mouth phase. Although the effects of aging on eating movements remain unclear, the reaching movement during eating may be affected in older individuals. Healthy older adults have an increased number of jerky and undirected movements during reaching tasks [17], possibly resulting in increased joint angles of the upper limb compared to our results. Maximal shoulder flexion and abduction angles in individuals with rotator cuff impingement are approximately the same as those in healthy individuals [7]; thus, these two groups’ shoulder movements would not be different in the mouth phase examined here. The severe upper extremity function in children with unilateral cerebral palsy and their maximal forearm pronation angle during eating are positively correlated [9], which could be observed in our spooning phase.

The limitations of our study need to be acknowledged. We constrained the task by not allowing the individual to hold the bowl, only used yogurt, and excluded some movements such as the excessive raising of upper limbs during the transporting phase that was not predefined in the study task. Although this standardized our assessment, realistic eating movements still had wide variability as described above. This limitation is important to be considered for any clinical application of our study results. The findings also may not be generalizable to other types of food, utensils other than a spoon, and other eating movements, such as stirring, cutting, and gathering food. In addition, we only investigated young healthy adults who were right-hand dominant. Clinical assessments according to our experimental protocol should be considered, with guidance to use the strict instructions demonstrated in the study. Evaluation of left-handed individuals and other age groups, as well as clinical populations, is warranted considering previous findings of differences in the kinematics of eating due to injury [7, 8], disease [9], individual characteristics [6], and equipment used [11, 12, 33]. The number of participants should also be increased in future studies, and more factors that cause individual eating movement patterns should be investigated. The current study had no preplanned sample size and the study power had not been calculated because the significance level and power of differences in measured joint angle data between phases were not known prior to the study. Finally, validation of our kinematic model and the ISU measurements used would be indicated for reliable implementation in practice.

Conclusions

Our study regarding the three-dimensional kinematics of eating in healthy young adults highlighted the combined movement of the upper limb, neck, and hip in the same direction during the reaching and transport phases, with a change in the direction of motion at these joints during the spooning and mouth phases. This information can be used in clinical practice to facilitate education on adequate positioning and movements to improve eating, as well as to evaluate the prognosis of patients with eating impairments. Our findings may also provide a base for future kinematic studies on eating in different populations and to inform interventions.

Supporting information

S1 Table. Individual values of maximum whole-body joint angles across all four phases of eating.

(XLSX)

Click here for additional data file.^{(19.3KB, xlsx)}

S2 Table. Individual values of minimum whole-body joint angles across all four phases of eating.

(XLSX)

Click here for additional data file.^{(19.3KB, xlsx)}

S3 Table. Individual values of mean angles in each phase of eating.

(XLSX)

Click here for additional data file.^{(43KB, xlsx)}

S4 Table. Effect size of differences in mean angles among the four eating phases.

(XLSX)

Click here for additional data file.^{(10.6KB, xlsx)}

S5 Table. Individual values of ranges of motion in each phase of eating.

(XLSX)

Click here for additional data file.^{(33.8KB, xlsx)}

S6 Table. Effect size of differences in ranges of motion among the four eating phases.

(XLSX)

Click here for additional data file.^{(10.6KB, xlsx)}

S7 Table. Time-normalized integrated values of joint angles for each phase of eating.

(XLSX)

Click here for additional data file.^{(128.4KB, xlsx)}

Acknowledgments

We would like to thank Editage for English language editing.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Funding Statement

This study was partly funded by a grant from the University of Miyazaki Hospital. The funder had a role in the preparation of the manuscript. There was no additional external funding received for this study.

References

1.Lemmens RJ, Janssen-Potten YJ, Timmermans AA, Defesche A, Smeets RJ, Seelen HA. Arm hand skilled performance in cerebral palsy: activity preferences and their movement components. BMC Neurol. 2014;14:52. doi: 10.1186/1471-2377-14-52 [DOI] [PMC free article] [PubMed] [Google Scholar]
2.Timmermans AA, Seelen HA, Willmann RD, Bakx W, de Ruyter B, Lanfermann G, et al. Arm and hand skills: Training preferences after stroke. Disabil Rehabil. 2009;31:1344–1352. doi: 10.1080/09638280902823664 [DOI] [PubMed] [Google Scholar]
3.Howe TH, Wang TN. Systematic review of interventions used in or relevant to occupational therapy for children with feeding difficulties ages birth–5 years. Am J Occup Ther. 2013;67:405–412. doi: 10.5014/ajot.2013.004564 [DOI] [PubMed] [Google Scholar]
4.American Occupational Therapy Association. The practice of occupational therapy in feeding, eating, and swallowing. Am J Occup Ther. 2017;71:7112410015p1–7112410015p13. doi: 10.5014/ajot.2017.716S04 [DOI] [PubMed] [Google Scholar]
5.Taylor SA, Kedgley AE, Humphries A, Shaheen AF. Simulated activities of daily living do not replicate functional upper limb movement or reduce movement variability. J Biomech. 2018;76:119–128. doi: 10.1016/j.jbiomech.2018.05.040 [DOI] [PubMed] [Google Scholar]
6.Beaudette B, Chester VL. Upper extremity kinematics in pediatric and young adult populations during activities of daily living. J Med Biol Eng. 2014;34:448–454. doi: 10.5405/JMBE.1697 [DOI] [Google Scholar]
7.Hall LC, Middlebrook EE, Dickerson CR. Analysis of the influence of rotator cuff impingements on upper limb kinematics in an elderly population during activities of daily living. Clin Biomech (Bristol, Avon). 2011;26:579–584. doi: 10.1016/j.clinbiomech.2011.02.006 [DOI] [PubMed] [Google Scholar]
8.Kasten P, Rettig O, Loew M, Wolf S, Raiss P. Three-dimensional motion analysis of compensatory movements in patients with radioulnar synostosis performing activities of daily living. J Orthop Sci. 2009;14:307–312. doi: 10.1007/s00776-009-1332-0 [DOI] [PubMed] [Google Scholar]
9.Klotz MC, van Drongelen S, Rettig O, Wenger P, Gantz S, Dreher T, et al. Motion analysis of the upper extremity in children with unilateral cerebral palsy—an assessment of six daily tasks. Res Dev Disabil. 2014;35:2950–2957. doi: 10.1016/j.ridd.2014.07.021 [DOI] [PubMed] [Google Scholar]
10.Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am. 1981;63:872–877. [PubMed] [Google Scholar]
11.Nagao T. Joint motion analysis of the upper extremity required for eating activities. Bull Health Sci Kobe. 2003;19:13–31. doi: 10.24546/00391929 [DOI] [Google Scholar]
12.Safaee-Rad R, Shwedyk E, Quanbury AO, Cooper JE. Normal functional range of motion of upper limb joints during performance of three feeding activities. Arch Phys Med Rehabil. 1990;71:505–509. [PubMed] [Google Scholar]
13.van Andel CJ, Wolterbeek N, Doorenbosch CA, Veeger DH, Harlaar, J. Complete 3D kinematics of upper extremity functional tasks. Gait Posture. 2008;27:120–127. doi: 10.1016/j.gaitpost.2007.03.002 [DOI] [PubMed] [Google Scholar]
14.Bible JE, Biswas D, Miller CP, Whang PG, Grauer JN. Normal functional range of motion of the cervical spine during 15 activities of daily living. J Spinal Disord Tech. 2010;23:15–21. doi: 10.1097/BSD.0b013e3181981632 [DOI] [PubMed] [Google Scholar]
15.Bible JE, Biswas D, Miller CP, Whang PG, Grauer JN. Normal functional range of motion of the lumbar spine during 15 activities of daily living. J Spinal Disord Tech. 2010;23:106–112. doi: 10.1097/BSD.0b013e3181981823 [DOI] [PubMed] [Google Scholar]
16.Petuskey K, Bagley A, Abdala E, James MA, Rab G. Upper extremity kinematics during functional activities: Three-dimensional studies in a normal pediatric population. Gait Posture. 2007;25:573–579. doi: 10.1016/j.gaitpost.2006.06.006 [DOI] [PubMed] [Google Scholar]
17.Ketcham CJ, Seidler RD, Van Gemmert AW, Stelmach GE. Age-related kinematic differences as influenced by task difficulty, target size, and movement amplitude. J Gerontol B Psychol Sci Soc Sci. 2002;57:54–64. doi: 10.1093/geronb/57.1.p54 [DOI] [PubMed] [Google Scholar]
18.Steenhuis RE. The relation between hand preference and hand performance: What you get depends on what you measure. Laterality. 1999;4:3–26. doi: 10.1080/713754324 [DOI] [PubMed] [Google Scholar]
19.Roetenberg D, Luinge H, Slycke P. Xsens MVN: Full 6DOF human motion tracking using miniature inertial sensors. Xsens Technologies. 3 April 2013. (cited 19 March 2020). Available online: https://pdfs.semanticscholar.org/dd11/614195c0252f16a14e33ab9869d9da3054df.pdf [Google Scholar]
20.Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, et al. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion—Part I: ankle, hip, and spine. J Biomech. 2002;35:543–548. doi: 10.1016/s0021-9290(01)00222-6 [DOI] [PubMed] [Google Scholar]
21.Wu G, van der Helm FC, Veeger HD, Makhsous M, Van Roy P, Anglin C, et al. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion—Part II: shoulder, elbow, wrist and hand. J Biomech. 2005:38:981–992. doi: 10.1016/j.jbiomech.2004.05.042 [DOI] [PubMed] [Google Scholar]
22.Ferrari A, Cutti AG, Garofalo P, Raggi M, Heijboer M, Cappello A, et al. First in vivo assessment of “Outwalk”: a novel protocol for clinical gait analysis based on inertial and magnetic sensors. Med Biol Eng Comput. 2010;48:1–15. doi: 10.1007/s11517-009-0544-y [DOI] [PubMed] [Google Scholar]
23.Kim S, Nussbaum MA. Performance evaluation of a wearable inertial motion capture system for capturing physical exposures during manual material handling tasks. Ergonomics. 2013;56:314–326. doi: 10.1080/00140139.2012.742932 [DOI] [PubMed] [Google Scholar]
24.Lebel K, Boissy P, Hamel M, Duval C. Inertial measures of motion for clinical biomechanics: comparative assessment of accuracy under controlled conditions–changes in accuracy over time. PLoS One. 2015;10:e0118361. doi: 10.1371/journal.pone.0118361 [DOI] [PMC free article] [PubMed] [Google Scholar]
25.Robert-Lachaine X, Mecheri H, Larue C, Plamondon A. Validation of inertial measurement units with an optoelectronic system for whole-body motion analysis. Med Biol Eng Comput. 2017;55:609–619. doi: 10.1007/s11517-016-1537-2 [DOI] [PubMed] [Google Scholar]
26.Zhang JT, Novak AC, Brouwer B, Li Q. Concurrent validation of Xsens MVN measurement of lower limb joint angular kinematics. Physiol Meas. 2013;34:N63–N69. doi: 10.1088/0967-3334/34/8/N63 [DOI] [PubMed] [Google Scholar]
27.Guan X, Kuai S, Song L, Liu W, Liu Y, Ji L, et al. Effects of ankle joint motion on pelvis-hip biomechanics and muscle activity patterns of healthy individuals in knee immobilization gait. J Healthc Eng. 2019;2019:3812407. doi: 10.1155/2019/3812407 [DOI] [PMC free article] [PubMed] [Google Scholar]
28.Fritz CO, Morris PE, Richler JJ. Effect size estimates: current use, calculations, and interpretation. J Exp Psychol Gen. 2012;141:2–18. doi: 10.1037/a0024338 [DOI] [PubMed] [Google Scholar]
29.Gillen G, Boiangiu C, Neuman M, Reinstein R, Schaap Y. Trunk posture affects upper extremity function of adults. Percept Mot Skills. 2007;104:371–380. doi: 10.2466/pms.104.2.371-380 [DOI] [PubMed] [Google Scholar]
30.Murphy MA, Willén C, Sunnerhagen KS. Kinematic variables quantifying upper-extremity performance after stroke during reaching and drinking from a glass. Neurorehabil Neural Repair. 2011;25:71–80. doi: 10.1177/1545968310370748 [DOI] [PubMed] [Google Scholar]
31.Santos GL, Russo TL, Nieuwenhuys A, Monari D, Desloovere K. Kinematic analysis of a drinking task in chronic hemiparetic patients using features analysis and statistical parametric mapping. Arch Phys Med Rehabil. 2018;99:501–511. doi: 10.1016/j.apmr.2017.08.479 [DOI] [PubMed] [Google Scholar]
32.Inada E, Saitoh I, Nakakura-Ohshima K, Maruyama T, Iwasaki T, Murakami D, et al. Association between mouth opening and upper body movement with intake of different-size food pieces during eating. Arch Oral Biol. 2012;57:307–313. doi: 10.1016/j.archoralbio.2011.08.023 [DOI] [PubMed] [Google Scholar]
33.van der Kamp J, Steenbergen B. The kinematics of eating with a spoon: bringing the food to the mouth, or the mouth to the food? Exp Brain Res. 1999;129:68–76. doi: 10.1007/s002210050937 [DOI] [PubMed] [Google Scholar]

PLoS One. doi: 10.1371/journal.pone.0259184.r001

Decision Letter 0

Bernadette Ann Murphy

21 May 2021

PONE-D-20-39538

Exploring whole-body kinematics when eating real foods with the dominant hand in healthy adults

PLOS ONE

Dear Dr. Nakatake,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

As you can see both reviewers were concerned that you have not articulated clearly the need for this research. If you wish to revise, please carefully address all reviewer concerns, particularly the reason why this work was needed.

Please submit your revised manuscript by Jul 05 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Bernadette Ann Murphy, PhD

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. In your Methods section, please provide additional information about the participant recruitment method and the demographic details of your participants. Please ensure you have provided sufficient details to replicate the analyses such as: aa) a description of how participants were recruited, and b) descriptions of where participants were recruited and where the research took place.

3. Please provide a sample size and power calculation in the Methods, or discuss the reasons for not performing one before study initiation.

4. We note that Figure 1 includes an image of a participant in the study.

As per the PLOS ONE policy (http://journals.plos.org/plosone/s/submission-guidelines#loc-human-subjects-research) on papers that include identifying, or potentially identifying, information, the individual(s) or parent(s)/guardian(s) must be informed of the terms of the PLOS open-access (CC-BY) license and provide specific permission for publication of these details under the terms of this license. Please download the Consent Form for Publication in a PLOS Journal (http://journals.plos.org/plosone/s/file?id=8ce6/plos-consent-form-english.pdf). The signed consent form should not be submitted with the manuscript, but should be securely filed in the individual's case notes. Please amend the methods section and ethics statement of the manuscript to explicitly state that the patient/participant has provided consent for publication: “The individual in this manuscript has given written informed consent (as outlined in PLOS consent form) to publish these case details”.

If you are unable to obtain consent from the subject of the photograph, you will need to remove the figure and any other textual identifying information or case descriptions for this individual.

5. Thank you for stating in your Funding Statement:

"JN was partly funded by a grant from University of Miyazaki hospital. The funder had a role in preparation of the manuscript."

5.1. Please provide an amended statement that declares *all* the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now. Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement.

5.2. Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

If this statement is not correct you must amend it as needed.

Please include your amended Funding Statement and Role of Funder statement within your cover letter. We will change the online submission form on your behalf.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The study provides a comprehensive dataset of kinematic data of the body in an eating task for a cohort of healthy individuals. The dataset is useful for biomechanical and clinical research (although I don’t think this has been articulated particularly well in the discussion section). The methods used are appropriate but sometimes lack clarity.

My main comments are related to the discussion section, I don’t feel that it has discussed the important aspects of having a dataset like this to a great extent and instead focussed on the differences between the eating phases. Please see my comments in detail below.

I am not clear on what what S3 and S4 are showing. Would the authors also be willing to make the raw data available to the readers? I understand that this is difficult to upload as an excel sheet because of the volume, but perhaps a statement to get in touch with the authors or placing them in an open repository would be useful.

Abstract line 30 -34

The following sentence is quite vague “The averaged shoulder, elbow, and hip joint flexion angles were significantly the largest in the mouth phase, with the smallest being the neck flexion angle “, It is also not clear why you would compare the various joint rotations to each other i.e. what is the clinical or otherwise importance of this?

The results and conclusion sections of the abstract needs rewording, the main finding of ththe study are not clear from the sentences here.

The introduction section is written clearly and is well structured.

The methods

Line 78 – not clear why you have this age range (looks like a very narrow range), why only include right-handed individuals ?

Line 122- 127 – The paper is based on the premise that it would analyse natural movement during eating, yet there are a series of restrictions on how the movement is conducted. I understand that this is a necessity in studies of this sort, but for example, it is not clear to me what is an excessive upper limb elevation and why that would be excluded? It begs the question – are you artificially reducing the variation in movement?

Can you also clarify whether participants were made aware of these 4 phase and restrictions? Or were these simply filtered afterwards? Can you provide a clear description of the instructions given to the participants?

Lines 133-134

It is not clear why and what is meant by “Phases in which the difference between the minimum and maximum joint angle was >5.0° were identified”

Results

Line 157 – why were 5 excluded?

Table 3 provides a summary of the differences between phases, I am struggling to see how this information can be useful. It is expected that there would be differences between the phases. I would have much preferred plots of the rotations of the 4 phases and a visual representation of the change in angles i.e Figure 1 .

Discussion

The discussion section is focussed on the differences between the phases, again I am struggling here to see how this would be useful clinically or otherwise (biomechanical modelling for example). I would have expected more in-depth discussion of the following:

- Differences between individuals and whether there were clear differences in movement strategy leading to the large variation shown in Fig 1

- How the movements compare to children and older adults * you made the reference to these group earlier

- How the movements compare to pathological populations

- The limitations of these methods and data in identifying deviations from normal movement because of the large variability

- Limitations related to applying this experimental protocol with strict instructions to individuals with impairments.

Reviewer #2: The purpose of this study was to establish normative movement kinematics of the upper extremity, trunk and hip during realistic eating with a spoon. The major issue with the paper is the lack of sufficient motivation or gap they are filling. The authors argue that little work has been done to quantify motion when people actually eat versus simulate eating (though other studies have done this) and that no studies explore lower limb kinematics. As the individuals do not use their lower limbs when sitting to eat, it is hard to understand why this gap is important. The introduction could do more to establish the gaps of prior findings and to remove portions that repeat (like the end of paragraph 1). The final paragraph also indicates that an area of focus should be on the waveform analysis or analysis over time. It is unclear what either statement means as no waveforms are included (no figures or assessment of the trajectory) and this is done at a single point in time. If this refers instead to splitting analysis into the phases of movement, that should be more clear.

The lack of clear question also contributes to a lack of focus in the outcome measures and description. It is not clear why the authors measure the mean for a phase in addition to the range of motion. It is also unclear why the phases are statistically compared to one another (i.e. what does it mean that the mean is significantly higher for spooning versus reaching?). Presenting range of motion seems that it would be sufficient to state which motion is used more.

Specific Comments

Abstract, Line 33-34: The sentence “Our results revealed that coordination of whole-body movement patterns correspond to each realistic eating phase in healthy individuals” does not make sense as the authors did not quantify coordination

Introduction, Line 46: ‘rehabilitation’ not ‘rehabilitating’

Line 54:suggest replacing ‘normal’ to ‘for an unimpaired population’

Line 112: It is unclear how the task was separated into phases (i.e. was this done purely visually or using a threshold for some variable?)

The description of the imu system set-up should be more detailed and provide accuracy measures (line 96) for each angle measured. In particular, it is unclear what the angle is in the spine measured between only two segments (e.g. C7T1) or if this with respect to global? Assuming the latter, but it is unclear.

Line 139: it is unclear what ‘integrated for each phase’ means as no areas are presented.

Line 152: Effect size descriptions should use ranges rather than equal signs ‘>=’ rather than ‘=’

The hip angles are quite small (50 deg). Was the chair height standardized to each participant? Could they keep their feet fully on the floor?

Line 157: suggest ‘participants’ rather than ‘patients’

Line 160: What is meant by a rest period?

Suggest ‘mean angle’ rather than AVA

Results would benefit from a figure of the trajectory rather than simply tables.

Suggest removing all stats comparing phases as the purpose is not clear

The discussion notes that the kinematic model is not validated, while the methods indicate that it is. Which is correct?

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2021 Oct 28;16(10):e0259184. doi: 10.1371/journal.pone.0259184.r002

Author response to Decision Letter 0

19 Jul 2021

Manuscript ID: PONE-D-20-39538

Title: Exploring whole-body kinematics when eating real foods with the dominant hand in healthy adults

Point-by-Point Response

Thank you for reviewing our manuscript and providing thoughtful comments. We have revised our manuscript accordingly. Please note that the changes made do not influence the content, conclusions, or framework of the paper. We have not listed below all minor changes made; however, these can be viewed as “tracked changes” in the revised manuscript.

Academic Editor: Critique and Responses

Comment: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming.

Response: The supporting file title names were changed on page 29, and the file names are now “S1_Table–S7_Table.”

Comment: 2. In your Methods section, please provide additional information about the participant recruitment method and the demographic details of your participants. Please ensure you have provided sufficient details to replicate the analyses such as: aa) a description of how participants were recruited, and b) descriptions of where participants were recruited and where the research took place.

Response: The following text was added:

page 5 line 86: “…among the medical staff of our institution, who responded of their own free will to a request for study participation”

page 6 line 94 “…in the rehabilitation room of our institution.”

Comment: 3. Please provide a sample size and power calculation in the Methods, or discuss the reasons for not performing one before study initiation.

Response: In the Discussion (page 21, line 347), the following sentence was added: “The current study had no preplanned sample size and the study power had not been calculated because the significance level and power of differences in measured joint angle data between phases were not known prior to the study.

Comment: 4. We note that Figure 1 includes an image of a participant in the study. ~If you are unable to obtain consent from the subject of the photograph, you will need to remove the figure and any other textual identifying information or case descriptions for this individual.

Response: We have removed the images of the participant from the manuscript, as we could not obtain written consent from the subject of the photograph.

Comment: 5. Thank you for stating in your Funding Statement: "JN was partly funded by a grant from University of Miyazaki hospital. The funder had a role in preparation of the manuscript."

If this statement is not correct you must amend it as needed.

Please include your amended Funding Statement and Role of Funder statement within your cover letter. We will change the online submission form on your behalf.

Response: We have provided an amended Funding Statement and Role of Funder statement within the cover letter.

Reviewer #1: Critique and Responses

Comment: I am not clear on what what S3 and S4 are showing.

Response: Tables S3 and S4 (revised S5) show the mean angles and ROMs, respectively, of each eating phase for each participant. The table titles were added on page 29.

Comment: Would the authors also be willing to make the raw data available to the readers? I understand that this is difficult to upload as an excel sheet because of the volume, but perhaps a statement to get in touch with the authors or placing them in an open repository would be useful.

Response: We agree that the availability of the raw kinematic data in public repositories would be valuable as you suggested. We would like to consider this point positively in the future.

Comment: Abstract line 30 -34

Response: The aim of the study was clarified (page 2, line 20) as follows: “…by assessing movement patterns in defined phases.”

The Methods and Results were revised as follows:

“The mean joint angles were compared among the phases with Friedman’s analysis of variance.” (page 2, line 25)

“The mean shoulder, elbow, and hip joint flexion angles were largest in the mouth phase, with the smallest being the neck flexion angle. By contrast, in the spooning phase, the shoulder, elbow, and hip flexion were the smallest, with the largest being the neck flexion angle. These angles were significantly different between the mouth and spooning phases (p < 0.008, Bonferroni post hoc correction).” (page 2, line 27)

The following sentences were modified and added to the conclusion: “Our results revealed that characteristic whole-body movements correspond to each phase of realistic eating in healthy individuals. This study provides useful kinematic data regarding normal eating movements, which may inform whole-body positioning and movement, improve the assessment of eating abilities in clinical settings, and provide a basis for future studies. (page 2, line 32)

Comment: The methods

Line 78 – not clear why you have this age range (looks like a very narrow range), why only include right-handed individuals ?

Response: The following words were added to the participants section: “To ensure normal kinematic data and exclude age effects resulting from neurological immaturity or decline, children [6,16] and older adults [17] were not selected as their upper limb reaching movements during activities of daily living differ from those of young adults. Left-handers were excluded since manipulations of their dominant hand may not simply mirror those of right-handers [18].” (page 5, line 87)

Comment: Line 122- 127 – The paper is based on the premise that it would analyse natural movement during eating, yet there are a series of restrictions on how the movement is conducted. I understand that this is a necessity in studies of this sort, but for example, it is not clear to me what is an excessive upper limb elevation and why that would be excluded? It begs the question – are you artificially reducing the variation in movement?

Response: The following words were added to the data processing section:

“This cycle was chosen as a realistic eating movement according to the study aims, but was not completely realistic because using the non-dominant hand to hold the bowl or to gather food was not permitted.” (page 8, line 131)

“Cycles containing the following motions were not accepted because they conflict with our definition of an eating movement: excessive elevation of the upper limb during transport in an exaggerated or unnecessary manner, looking away from the bowl, …”(page 8, line 136)

Comment: Can you also clarify whether participants were made aware of these 4 phase and restrictions? Or were these simply filtered afterwards? Can you provide a clear description of the instructions given to the participants?

Response: These following sentences were modified or added: ‘Participants received the task instruction “please eat without a break three spoonfuls of yogurt with the right hand, using habitual whole-body movements and speed, not looking away, with the left hand resting on the left thigh.” (page 7, line 121)

“These phases were subsequently filtered to identify phase recordings that were suitable for further analyses.” (page 8, line 130)

Comment: Lines 133-134

It is not clear why and what is meant by “Phases in which the difference between the minimum and maximum joint angle was >5.0° were identified”

Response: The sentence was revised as follows: “Joint motion directions, in which the difference between the minimum and maximum joint angles was >5.0°, were identified for further analyses as these are clinically detectable.” (page 9, line 149)

Comment: Results

Line 157 – why were 5 excluded?

Response: The following sentence was revised in the data processing section: “Cycles containing the following motions were not accepted because they conflict with our definition of an eating movement: …” (page 8, line 136)

Comments: Table 3 provides a summary of the differences between phases, I am struggling to see how this information can be useful. It is expected that there would be differences between the phases. I would have much preferred plots of the rotations of the 4 phases and a visual representation of the change in angles i.e Figure 1 .

Response: The tables were changed to Figs 1 and 2 with Table S4 and S6 provided as supporting files.

Comment: Discussion

- Differences between individuals and whether there were clear differences in movement strategy leading to the large variation shown in Fig 1

Response: The following paragraph was added to the Discussion: “Inter-subject differences may have contributed to the high variability in joint angles shown in Fig 3, such that the SD values of all joint angles and phases do not converge. There was no clear difference in movement strategies among the four defined eating phases analyzed in this study, even after the exclusion of outliers with excessive deviation. However, as the aim of the study was to analyze habitual whole-body movements, movements at the participant’s own speed without constraints from a backrest were allowed, and the seat height, as well as the bowl and spoon sizes, were not adapted to the participant’s body size. The start and stop positions were also defined within uninterrupted eating movements. Thus, measurements of realistic eating behavior can easily vary. The influence of body constitution and muscle strength, which may have caused movement differences in the current study, should be examined in clinical settings by future studies. In contrast, a comparison of eating phases could foster an understanding of typical whole-body movement patterns in a realistic condition such as that described above, allowing movement patterns that reflect realistic eating to be adopted in clinical practice.” (page 19, line 310)

Comment: - How the movements compare to children and older adults * you made the reference to these group earlier

Response: The following sentences were added to the Discussion: “Increased maximal shoulder abduction and reduced maximal elbow flexion of healthy pediatric participants compared to those of healthy young adults were reported previously [6]. Since these maximal angles were shown during the mouth phase in our study with healthy young adults, larger shoulder abduction and lower elbow flexion may be able to be assessed as normal pediatric motions in the mouth phase. Although the effects of aging on eating movements remain unclear, the reaching movement during eating may be affected in older individuals. Healthy older adults have an increased number of jerky and undirected movements during reaching tasks [17], possibly resulting in increased joint angles of the upper limb compared to our results.” (page 20, line 324)

Comment: - How the movements compare to pathological populations

Response: The following sentences were revised in the Discussion: “Other studies have reported greater movement of the trunk and elbow flexion during a drinking task among individuals who have had a stroke compared to controls; however, reports of between-group comparisons during eating have been lacking [30,31]. The trunk position is supported by the lower limbs in seated eating, and the control of the lower limbs is accomplished in the normal hip joint angles. The regulation of the hip angles and the reduction in elbow extension during eating should therefore be investigated in future studies. Although the hip angle varied little among our study group, the compensatory coordination of this position along with reduced elbow extension could have an important clinical effect on eating in populations with neurological problems.” (page 16, line 262)

Comment: - The limitations of these methods and data in identifying deviations from normal movement because of the large variability

Response: The following sentences were revised in the limitations section: “We constrained the task by not allowing the individual to hold the bowl, only used yogurt, and excluded some movements like the excessive raising of upper limb during the transporting phase that was not predefined in the study task. Although this standardized our assessment, realistic eating movements still had wide variability as described above. This limitation is important to be considered for any clinical application of our study results. The findings also may not be generalizable to other types of food, utensils other than a spoon, and other eating movements, such as stirring, cutting, and gathering food. (page 20, line 333)

Comment: - Limitations related to applying this experimental protocol with strict instructions to individuals with impairments.

Response: The following sentence was added to the limitations section: “Clinical assessments according to our experimental protocol should be considered, with guidance to use the strict instructions demonstrated in the study.” (page 20, line 341)

Reviewer #2: Critique and Responses

Comment: The major issue with the paper is the lack of sufficient motivation or gap they are filling. The authors argue that little work has been done to quantify motion when people actually eat versus simulate eating (though other studies have done this) and that no studies explore lower limb kinematics. As the individuals do not use their lower limbs when sitting to eat, it is hard to understand why this gap is important. The introduction could do more to establish the gaps of prior findings~

Response: The following words were added to the Introduction: “whose position as a stable base of upper limb motion should be assessed in practice” (page 4, line 59)

Comment: and to remove portions that repeat (like the end of paragraph 1).

Response: We removed the following text from the Introduction: “Of these studies, only Beaudette and Chester [6] performed the eating task under realistic conditions.”

Comment: The final paragraph also indicates that an area of focus should be on the waveform analysis or analysis over time. It is unclear what either statement means as no waveforms are included (no figures or assessment of the trajectory) and this is done at a single point in time. If this refers instead to splitting analysis into the phases of movement, that should be more clear.

Response: The following underlined text was added to the last paragraph of the Introduction:

“Waveform analyses of upper limb joint movements, which provide only a subjective visual assessment of upper limb motion for eating, have been previously reported [6,11,13].... Moreover, to the best of our knowledge, no comparison of single points or phases during eating in regards to objective parameters of whole-body kinematics have been reported. Realistic eating consists of specific phases that require concurrent whole-body movements. Due to the complexity of these realistic movements, clinicians in practice may have a limited understanding of the normal kinematics of eating. (page 4, line 62)

Comment: The lack of clear question also contributes to a lack of focus in the outcome measures and description. It is not clear why the authors measure the mean for a phase in addition to the range of motion. It is also unclear why the phases are statistically compared to one another (i.e. what does it mean that the mean is significantly higher for spooning versus reaching?). Presenting range of motion seems that it would be sufficient to state which motion is used more.

Response: The following underlined text was added to the last paragraph of the Introduction: “Establishing whole-body kinematic variables and movement patterns, which could be described as differences in joint positions, the extent of motion, and motion directions between eating phases in patients with eating limitations would therefore constitute useful information that could be applied in clinical settings. Thus, the aim of our study was to determine the whole-body joint angles and movement patterns necessary for realistic eating in healthy individuals.” (page 4, line 69)

Similarly, the following sentences were modified in the data processing section : “ To compare and characterize the joint angles of each phase, the following variables were calculated: mean angles, calculated from the cumulative sequential data over each phase to provide the average position; range of motion (ROM), calculated as the difference between the minimum and maximum angles in each phase to quantify the motion [27]; and joint angles normalized to 101 points, corresponding to 0–100% of the movement time in each phase. The normalized data were then represented as the mean (SD) for each point in each phase, and waveforms of normalized joint angles were calculated for the visual analysis of the joint motion direction. (page 9, line 151)

Comment:

Response: The following underlined text was modified: “Our results revealed that characteristic whole-body movements correspond to each phase of realistic eating in healthy individuals.” (page 2, line 32)

Comment: Introduction, Line 46: ‘rehabilitation’ not ‘rehabilitating’

Response: The word “rehabilitating” was changed to “rehabilitation” on page 3, line 45.

Comment: Line 54:suggest replacing ‘normal’ to ‘for an unimpaired population’

Response: The sentence was revised as follows: “The upper limb joint angles in an unimpaired population when eating with a spoon have previously been reported using three-dimensional motion analysis [6–13].” (page 4, line 54)

Comment: Line 112: It is unclear how the task was separated into phases (i.e. was this done purely visually or using a threshold for some variable?)

Response: The following words were added to the data processing section: “…by visually partitioning the recorded movie:…” (page 8, line 127)

Comment: The description of the imu system set-up should be more detailed and provide accuracy measures (line 96) for each angle measured. In particular, it is unclear what the angle is in the spine measured between only two segments (e.g. C7T1) or if this with respect to global? Assuming the latter, but it is unclear.

Response: The following sentence was added to the instruments and measurements section: “Of these points, one neck, four spine, and two toe points were not directly measured but were calculated using ISU data and other data points with respect to global and local references.” (page 6, line 101)

Comment: Line 139: it is unclear what ‘integrated for each phase’ means as no areas are presented.

Response: The following text was modified in the data processing section: “The normalized data were then represented as the mean (SD) for each point in each phase, and waveforms of normalized joint angles were calculated for the visual analysis of the joint motion direction.” (page 9, line 156)

Comment: Line 152: Effect size descriptions should use ranges rather than equal signs ‘>=’ rather than ‘=’

Response: Accordingly, the description was revised from |r| = 0.1 to |r| = 0.10–0.29, from |r| = 0.3 to |r| = 0.30–0.49, and from |r| =0.5 to |r| ≥ 0.50 (page 11, line 169).

Comment: The hip angles are quite small (50 deg). Was the chair height standardized to each participant? Could they keep their feet fully on the floor?

Response: The following underlined words were added to the instruments and measurements section: “After calibration and definition of body dimensions, participants sat comfortably without trunk fixation to allow free motion on a 40-cm high seat behind a table (10 cm from the participant’s trunk, at the height of the right elbow), with the right upper limb placed alongside the body at baseline and their feet fully on the floor.” (page 7, line 113)

Comment: Line 157: suggest ‘participants’ rather than ‘patients’

Response: The word “patients” was revised to “participants” (page 11, line 175).

Comment: Line 160: What is meant by a rest period?

Response: The following words were added to the study sample section: “…, i.e., the reaching movement paused within several seconds and started again,…” (page 11, line 178)

Comment: Suggest ‘mean angle’ rather than AVA

Response: All terms containing “AVA” were revised to “mean angle.”

Comment: Results would benefit from a figure of the trajectory rather than simply tables.

Response: The tables presenting the mean angles and ROMs of the eating phases were changed to figures Fig 1 and Fig 2.

Comment: Suggest removing all stats comparing phases as the purpose is not clear

Response: All p-values were removed, and only the significance levels (e.g., p < 0.008) are provided in the Results and the legends of Figs 1 and 2.

Comment: The discussion notes that the kinematic model is not validated, while the methods indicate that it is. Which is correct?

Response: To enhance clarity for the reader, the last sentence of the Discussion was removed.

Attachment

Submitted filename: Response to reviewers.docx

Click here for additional data file.^{(35.9KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0259184.r003

Decision Letter 1

Bernadette Ann Murphy

27 Sep 2021

PONE-D-20-39538R1Exploring whole-body kinematics when eating real foods with the dominant hand in healthy adultsPLOS ONE

Dear Dr. Nakatake,

Please submit your revised manuscript by Nov 11 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Bernadette Ann Murphy, PhD

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

There are a couple of minor corrections needed to finalize the manuscript.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: Yes

**********

6. Review Comments to the Author

Reviewer #1: The authors have made significant improvement to the manuscript and have attamepted to address all the comments made by the reviewers.

There is still limited justification for the the compasiron between the four different phases - it does not seem necessary and it is not clear what added value is gained from doing this. I think the presentation of movement patterns and ranges of motion in the different phases is what is important here and I was glad to see the new figures that replaced the tables. Nevertheless, the comparison between the different phases have been considerably watered down in this version and are not made to be the focus which is good in my opinion.

One minor comment: The sentence describing the instructions given to the participants is quite complex, was this the language used to describe this? Or does it sound complex because it is a literal translation of the instructions?

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

PLoS One. 2021 Oct 28;16(10):e0259184. doi: 10.1371/journal.pone.0259184.r004

Author response to Decision Letter 1

13 Oct 2021

Manuscript ID: PONE-D-20-39538R1

Title: Exploring whole-body kinematics when eating real foods with the dominant hand in healthy adults

Point-by-Point Response

Reviewer #1: Critique and Responses

Comment: There is still limited justification for the comparison between the four different phases - it does not seem necessary and it is not clear what added value is gained from doing this. I think the presentation of movement patterns and ranges of motion in the different phases is what is important here and I was glad to see the new figures that replaced the tables. Nevertheless, the comparison between the different phases have been considerably watered down in this version and are not made to be the focus which is good in my opinion.

Response: The following underlined parts were added to the Discussion section.

“The different movements from this pattern, especially the reaching phase, and the mean angles of the shoulder internal rotation and the wrist flexion were the smallest. The spooning phase also required large ROMs of forearm pronation (decreasing angles) as well as of wrist flexion (increasing and decreasing angles) and radial deviation (decreasing angles). Knowledge of the movement patterns that we have described may be useful for the comprehensive assessment of eating and optimization of upper and lower limb, neck, and trunk movements during eating. To facilitate or compensate for the normal positions and movements for each eating phase, appropriate positioning, seating equipment, upper extremity and posture control, and orthotics [3, 4] referring to the mean angles, the ROMs, and the changes in joint angles of the present study could be provided in practice.” (page 18)

“Maximal shoulder flexion and abduction angles in individuals with rotator cuff impingement are approximately the same as those in healthy individuals [7]; thus, these two groups’ shoulder movements would not be different in the mouth phase examined here. The severe upper extremity function in children with unilateral cerebral palsy and their maximal forearm pronation angle during eating are positively correlated [9], which could be observed in our spooning phase.” (page 20)

Comment: The sentence describing the instructions given to the participants is quite complex, was this the language used to describe this? Or does it sound complex because it is a literal translation of the instructions?

Response: The following were the approximate instructions provided to the participants. Underlined sections underwent minor revisions.

“Participants held a spoon with their right hand and received the task instruction, “please eat three spoons full of yogurt without a break, using habitual whole-body movements and speed, not looking away, and with your left hand resting on your left thigh.” (page 7)

Attachment

Submitted filename: Response to Reviewers.docx

Click here for additional data file.^{(21.5KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0259184.r005

Decision Letter 2

Bernadette Ann Murphy

15 Oct 2021

Exploring whole-body kinematics when eating real foods with the dominant hand in healthy adults

PONE-D-20-39538R2

Dear Dr. Nakatake,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Bernadette Ann Murphy, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

PLoS One. doi: 10.1371/journal.pone.0259184.r006

Acceptance letter

Bernadette Ann Murphy

20 Oct 2021

PONE-D-20-39538R2

Exploring whole-body kinematics when eating real foods with the dominant hand in healthy adults

Dear Dr. Nakatake:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Bernadette Ann Murphy

Academic Editor

PLOS ONE

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

S1 Table. Individual values of maximum whole-body joint angles across all four phases of eating.

(XLSX)

Click here for additional data file.^{(19.3KB, xlsx)}

S2 Table. Individual values of minimum whole-body joint angles across all four phases of eating.

(XLSX)

Click here for additional data file.^{(19.3KB, xlsx)}

S3 Table. Individual values of mean angles in each phase of eating.

(XLSX)

Click here for additional data file.^{(43KB, xlsx)}

S4 Table. Effect size of differences in mean angles among the four eating phases.

(XLSX)

Click here for additional data file.^{(10.6KB, xlsx)}

S5 Table. Individual values of ranges of motion in each phase of eating.

(XLSX)

Click here for additional data file.^{(33.8KB, xlsx)}

S6 Table. Effect size of differences in ranges of motion among the four eating phases.

(XLSX)

Click here for additional data file.^{(10.6KB, xlsx)}

S7 Table. Time-normalized integrated values of joint angles for each phase of eating.

(XLSX)

Click here for additional data file.^{(128.4KB, xlsx)}

Attachment

Submitted filename: Response to reviewers.docx

Click here for additional data file.^{(35.9KB, docx)}

Attachment

Submitted filename: Response to Reviewers.docx

Click here for additional data file.^{(21.5KB, docx)}

Data Availability Statement

All relevant data are within the paper and its Supporting Information files.

[pone.0259184.ref001] 1.Lemmens RJ, Janssen-Potten YJ, Timmermans AA, Defesche A, Smeets RJ, Seelen HA. Arm hand skilled performance in cerebral palsy: activity preferences and their movement components. BMC Neurol. 2014;14:52. doi: 10.1186/1471-2377-14-52 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0259184.ref002] 2.Timmermans AA, Seelen HA, Willmann RD, Bakx W, de Ruyter B, Lanfermann G, et al. Arm and hand skills: Training preferences after stroke. Disabil Rehabil. 2009;31:1344–1352. doi: 10.1080/09638280902823664 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref003] 3.Howe TH, Wang TN. Systematic review of interventions used in or relevant to occupational therapy for children with feeding difficulties ages birth–5 years. Am J Occup Ther. 2013;67:405–412. doi: 10.5014/ajot.2013.004564 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref004] 4.American Occupational Therapy Association. The practice of occupational therapy in feeding, eating, and swallowing. Am J Occup Ther. 2017;71:7112410015p1–7112410015p13. doi: 10.5014/ajot.2017.716S04 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref005] 5.Taylor SA, Kedgley AE, Humphries A, Shaheen AF. Simulated activities of daily living do not replicate functional upper limb movement or reduce movement variability. J Biomech. 2018;76:119–128. doi: 10.1016/j.jbiomech.2018.05.040 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref006] 6.Beaudette B, Chester VL. Upper extremity kinematics in pediatric and young adult populations during activities of daily living. J Med Biol Eng. 2014;34:448–454. doi: 10.5405/JMBE.1697 [DOI] [Google Scholar]

[pone.0259184.ref007] 7.Hall LC, Middlebrook EE, Dickerson CR. Analysis of the influence of rotator cuff impingements on upper limb kinematics in an elderly population during activities of daily living. Clin Biomech (Bristol, Avon). 2011;26:579–584. doi: 10.1016/j.clinbiomech.2011.02.006 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref008] 8.Kasten P, Rettig O, Loew M, Wolf S, Raiss P. Three-dimensional motion analysis of compensatory movements in patients with radioulnar synostosis performing activities of daily living. J Orthop Sci. 2009;14:307–312. doi: 10.1007/s00776-009-1332-0 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref009] 9.Klotz MC, van Drongelen S, Rettig O, Wenger P, Gantz S, Dreher T, et al. Motion analysis of the upper extremity in children with unilateral cerebral palsy—an assessment of six daily tasks. Res Dev Disabil. 2014;35:2950–2957. doi: 10.1016/j.ridd.2014.07.021 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref010] 10.Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am. 1981;63:872–877. [PubMed] [Google Scholar]

[pone.0259184.ref011] 11.Nagao T. Joint motion analysis of the upper extremity required for eating activities. Bull Health Sci Kobe. 2003;19:13–31. doi: 10.24546/00391929 [DOI] [Google Scholar]

[pone.0259184.ref012] 12.Safaee-Rad R, Shwedyk E, Quanbury AO, Cooper JE. Normal functional range of motion of upper limb joints during performance of three feeding activities. Arch Phys Med Rehabil. 1990;71:505–509. [PubMed] [Google Scholar]

[pone.0259184.ref013] 13.van Andel CJ, Wolterbeek N, Doorenbosch CA, Veeger DH, Harlaar, J. Complete 3D kinematics of upper extremity functional tasks. Gait Posture. 2008;27:120–127. doi: 10.1016/j.gaitpost.2007.03.002 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref014] 14.Bible JE, Biswas D, Miller CP, Whang PG, Grauer JN. Normal functional range of motion of the cervical spine during 15 activities of daily living. J Spinal Disord Tech. 2010;23:15–21. doi: 10.1097/BSD.0b013e3181981632 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref015] 15.Bible JE, Biswas D, Miller CP, Whang PG, Grauer JN. Normal functional range of motion of the lumbar spine during 15 activities of daily living. J Spinal Disord Tech. 2010;23:106–112. doi: 10.1097/BSD.0b013e3181981823 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref016] 16.Petuskey K, Bagley A, Abdala E, James MA, Rab G. Upper extremity kinematics during functional activities: Three-dimensional studies in a normal pediatric population. Gait Posture. 2007;25:573–579. doi: 10.1016/j.gaitpost.2006.06.006 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref017] 17.Ketcham CJ, Seidler RD, Van Gemmert AW, Stelmach GE. Age-related kinematic differences as influenced by task difficulty, target size, and movement amplitude. J Gerontol B Psychol Sci Soc Sci. 2002;57:54–64. doi: 10.1093/geronb/57.1.p54 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref018] 18.Steenhuis RE. The relation between hand preference and hand performance: What you get depends on what you measure. Laterality. 1999;4:3–26. doi: 10.1080/713754324 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref019] 19.Roetenberg D, Luinge H, Slycke P. Xsens MVN: Full 6DOF human motion tracking using miniature inertial sensors. Xsens Technologies. 3 April 2013. (cited 19 March 2020). Available online: https://pdfs.semanticscholar.org/dd11/614195c0252f16a14e33ab9869d9da3054df.pdf [Google Scholar]

[pone.0259184.ref020] 20.Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, et al. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion—Part I: ankle, hip, and spine. J Biomech. 2002;35:543–548. doi: 10.1016/s0021-9290(01)00222-6 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref021] 21.Wu G, van der Helm FC, Veeger HD, Makhsous M, Van Roy P, Anglin C, et al. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion—Part II: shoulder, elbow, wrist and hand. J Biomech. 2005:38:981–992. doi: 10.1016/j.jbiomech.2004.05.042 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref022] 22.Ferrari A, Cutti AG, Garofalo P, Raggi M, Heijboer M, Cappello A, et al. First in vivo assessment of “Outwalk”: a novel protocol for clinical gait analysis based on inertial and magnetic sensors. Med Biol Eng Comput. 2010;48:1–15. doi: 10.1007/s11517-009-0544-y [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref023] 23.Kim S, Nussbaum MA. Performance evaluation of a wearable inertial motion capture system for capturing physical exposures during manual material handling tasks. Ergonomics. 2013;56:314–326. doi: 10.1080/00140139.2012.742932 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref024] 24.Lebel K, Boissy P, Hamel M, Duval C. Inertial measures of motion for clinical biomechanics: comparative assessment of accuracy under controlled conditions–changes in accuracy over time. PLoS One. 2015;10:e0118361. doi: 10.1371/journal.pone.0118361 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0259184.ref025] 25.Robert-Lachaine X, Mecheri H, Larue C, Plamondon A. Validation of inertial measurement units with an optoelectronic system for whole-body motion analysis. Med Biol Eng Comput. 2017;55:609–619. doi: 10.1007/s11517-016-1537-2 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref026] 26.Zhang JT, Novak AC, Brouwer B, Li Q. Concurrent validation of Xsens MVN measurement of lower limb joint angular kinematics. Physiol Meas. 2013;34:N63–N69. doi: 10.1088/0967-3334/34/8/N63 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref027] 27.Guan X, Kuai S, Song L, Liu W, Liu Y, Ji L, et al. Effects of ankle joint motion on pelvis-hip biomechanics and muscle activity patterns of healthy individuals in knee immobilization gait. J Healthc Eng. 2019;2019:3812407. doi: 10.1155/2019/3812407 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0259184.ref028] 28.Fritz CO, Morris PE, Richler JJ. Effect size estimates: current use, calculations, and interpretation. J Exp Psychol Gen. 2012;141:2–18. doi: 10.1037/a0024338 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref029] 29.Gillen G, Boiangiu C, Neuman M, Reinstein R, Schaap Y. Trunk posture affects upper extremity function of adults. Percept Mot Skills. 2007;104:371–380. doi: 10.2466/pms.104.2.371-380 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref030] 30.Murphy MA, Willén C, Sunnerhagen KS. Kinematic variables quantifying upper-extremity performance after stroke during reaching and drinking from a glass. Neurorehabil Neural Repair. 2011;25:71–80. doi: 10.1177/1545968310370748 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref031] 31.Santos GL, Russo TL, Nieuwenhuys A, Monari D, Desloovere K. Kinematic analysis of a drinking task in chronic hemiparetic patients using features analysis and statistical parametric mapping. Arch Phys Med Rehabil. 2018;99:501–511. doi: 10.1016/j.apmr.2017.08.479 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref032] 32.Inada E, Saitoh I, Nakakura-Ohshima K, Maruyama T, Iwasaki T, Murakami D, et al. Association between mouth opening and upper body movement with intake of different-size food pieces during eating. Arch Oral Biol. 2012;57:307–313. doi: 10.1016/j.archoralbio.2011.08.023 [DOI] [PubMed] [Google Scholar]

[pone.0259184.ref033] 33.van der Kamp J, Steenbergen B. The kinematics of eating with a spoon: bringing the food to the mouth, or the mouth to the food? Exp Brain Res. 1999;129:68–76. doi: 10.1007/s002210050937 [DOI] [PubMed] [Google Scholar]

PERMALINK

Exploring whole-body kinematics when eating real foods with the dominant hand in healthy adults

Jun Nakatake

Koji Totoribe

Hideki Arakawa

Etsuo Chosa

Roles

Abstract

Introduction

Materials and methods

Participants

Instruments and measurements

Data processing

Table 1. Whole-body joint angles across the four eating phases.

Statistical analysis

Results

Study sample

Necessary joint angles for eating movements

Comparison of mean angles among eating phases

Fig 1. Mean angles in each phase with Bonferroni correction.

Comparison of ROMs among eating phases

Fig 2. Ranges of motion in each of the four eating phases with Bonferroni correction.

Fig 3. Changes in whole-body joint angles over time for all four eating phases.

Discussion

Conclusions

Supporting information

Acknowledgments

Data Availability

Funding Statement

References

Decision Letter 0

Bernadette Ann Murphy

Roles

Author response to Decision Letter 0

Decision Letter 1

Bernadette Ann Murphy

Roles

Author response to Decision Letter 1

Decision Letter 2

Bernadette Ann Murphy

Roles

Acceptance letter

Bernadette Ann Murphy

Roles

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

Similar articles

Cited by other articles

Links to NCBI Databases