Research Papers

J Biomech Eng. 2017;139(10):101001-101001-11. doi:10.1115/1.4037222.

Pelvic organ prolapse (POP), downward descent of the pelvic organs resulting in a protrusion of the vagina, is a highly prevalent condition, responsible for 300,000 surgeries in the U.S. annually. Rectocele, a posterior vaginal wall (PVW) prolapse of the rectum, is the second most common type of POP after cystocele. A rectocele usually manifests itself along with other types of prolapse with multicompartment pelvic floor defects. To date, the specific mechanics of rectocele formation are poorly understood, which does not allow its early stage detection and progression prediction over time. Recently, with the advancement of imaging and computational modeling techniques, a plethora of finite element (FE) models have been developed to study vaginal prolapse from different perspectives and allow a better understanding of dynamic interactions of pelvic organs and their supporting structures. So far, most studies have focused on anterior vaginal prolapse (AVP) (or cystocele) and limited data exist on the role of pelvic muscles and ligaments on the development and progression of rectocele. In this work, a full-scale magnetic resonance imaging (MRI) based three-dimensional (3D) computational model of the female pelvic anatomy, comprising the vaginal canal, uterus, and rectum, was developed to study the effect of varying degrees (or sizes) of rectocele prolapse on the vaginal canal for the first time. Vaginal wall displacements and stresses generated due to the varying rectocele size and average abdominal pressures were estimated. Considering the direction pointing from anterior to posterior side of the pelvic system as the positive Y-direction, it was found that rectocele leads to negative Y-direction displacements, causing the vaginal cross section to shrink significantly at the lower half of the vaginal canal. Besides the negative Y displacements, the rectocele bulging was observed to push the PVW downward toward the vaginal hiatus, exhibiting the well-known “kneeling effect.” Also, the stress field on the PVW was found to localize at the upper half of the vaginal canal and shift eventually to the lower half with increase in rectocele size. Additionally, clinical relevance and implications of the results were discussed.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(10):101002-101002-7. doi:10.1115/1.4037399.

Concussion, or mild traumatic brain injury (mTBI), is frequently associated with sports activities. It has generally been accepted that neck strengthening exercises are effective as a preventive strategy for reducing sports-related concussion risks. However, the interpretation of the link between neck strength and concussion risks remains unclear. In this study, a typical helmeted head-to-head impact in American football was simulated using the head and neck complex finite element (FE) model. The impact scenario selected was previously reported in lab-controlled incident reconstructions from high-speed video footages of the National Football League using two head-neck complexes taken from Hybrid III dummies. Four different muscle activation strategies were designed to represent no muscle response, a reactive muscle response, a pre-activation response, and response due to stronger muscle strength. Head kinematics and various head/brain injury risk predictors were selected as response variables to compare the effects of neck muscles on the risk of sustaining the concussion. Simulation results indicated that active responses of neck muscles could effectively reduce the risk of brain injury. Also, anticipatory muscle activation played a dominant role on impact outcomes. Increased neck strength can decrease the time to compress the neck and its effects on reducing brain injury risks need to be further studied.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(10):101003-101003-10. doi:10.1115/1.4037400.

Homografts and synthetic grafts are used in surgery for congenital heart disease (CHD). Determining these materials' mechanical properties will aid in understanding tissue behavior when subjected to abnormal CHD hemodynamics. Homograft tissue samples from anterior/posterior aspects, of ascending/descending aorta (AA, DA), innominate artery (IA), left subclavian artery (LScA), left common carotid artery (LCCA), main/left/right pulmonary artery (MPA, LPA, RPA), and synthetic vascular grafts, were obtained in three orientations: circumferential, diagonal (45 deg relative to circumferential direction), and longitudinal. Samples were subjected to uniaxial tensile testing (UTT). True strain-Cauchy stress curves were individually fitted for each orientation to calibrate Fung model. Then, they were used to calibrate anisotropic Holzapfel–Gasser model (R2 > 0.95). Most samples demonstrated a nonlinear hyperelastic strain–stress response to UTT. Stiffness (measured by tangent modulus at different strains) in all orientations were compared and shown as contour plots. For each vessel segment at all strain levels, stiffness was not significantly different among aspects and orientations. For synthetic grafts, stiffness was significantly different among orientations (p < 0.042). Aorta is significantly stiffer than pulmonary artery at 10% strain, comparing all orientations, aspects, and regions (p = 0.0001). Synthetic grafts are significantly stiffer than aortic and pulmonary homografts at all strain levels (p < 0.046). Aortic, pulmonary artery, and synthetic grafts exhibit hyperelastic biomechanical behavior with anisotropic effect. Differences in mechanical properties among vascular grafts may affect native tissue behavior and ventricular/arterial mechanical coupling, and increase the risk of deformation due to abnormal CHD hemodynamics.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(10):101004-101004-8. doi:10.1115/1.4037401.

When simulating or conducting land mine blast tests on armored vehicles to assess potential occupant injury, the preference is to use the Hybrid III anthropomorphic test device (ATD). In land blast events, neither the effect of body-borne equipment (BBE) on the ATD response nor the dynamic response index (DRI) is well understood. An experimental study was carried out using a drop tower test rig, with a rigid seat mounted on a carriage table undergoing average accelerations of 161 g and 232 g over 3 ms. A key aspect of the work looked at the various lumbar spine assemblies available for a Hybrid III ATD. These can result in different load cell orientations for the ATD which in turn can affect the load measurement in the vertical and horizontal planes. Thirty-two tests were carried out using two BBE mass conditions and three variations of ATDs. The latter were the Hybrid III with the curved (conventional) spine, the Hybrid III with the pedestrian (straight) spine, and the Federal Aviation Administration (FAA) Hybrid III which also has a straight spine. The results showed that the straight lumbar spine assemblies produced similar ATD responses in drop tower tests using a rigid seat. In contrast, the curved lumbar spine assembly generated a lower pelvis acceleration and a higher lumbar load than the straight lumbar spine assemblies. The maximum relative displacement of the lumbar spine occurred after the peak loading event, suggesting that the DRI is not suitable for assessing injury when the impact duration is short and an ATD is seated on a rigid seat on a drop tower. The peak vertical lumbar loads did not change with increasing BBE mass because the equipment mass effects did not become a factor during the peak loading event.

Topics: Stress , Lumbar spine
Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(10):101005-101005-6. doi:10.1115/1.4037402.

The anatomically correct testbed (ACT) hand mechanically simulates the musculoskeletal structure of the fingers and thumb of the human hand. In this work, we analyze the muscle moment arms (MAs) and thumb-tip force vectors in the ACT thumb in order to compare the ACT thumb's mechanical structure to the human thumb. Motion data are used to determine joint angle-dependent MA models, and thumb-tip three-dimensional (3D) force vectors are experimentally analyzed when forces are applied to individual muscles. Results are presented for both a nominal ACT thumb model designed to match human MAs and an adjusted model that more closely replicates human-like thumb-tip forces. The results confirm that the ACT thumb is capable of faithfully representing human musculoskeletal structure and muscle functionality. Using the ACT hand as a physical simulation platform allows us to gain a better understanding of the underlying biomechanical and neuromuscular properties of the human hand to ultimately inform the design and control of robotic and prosthetic hands.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(10):101006-101006-13. doi:10.1115/1.4037403.

The present study aims to accurately estimate inertial, physical, and dynamic parameters of human body vibratory model consistent with physical structure of the human body that also replicates its dynamic response. A 13 degree-of-freedom (DOF) lumped parameter model for standing person subjected to support excitation is established. Model parameters are determined from anthropometric measurements, uniform mass density, elastic modulus of individual body segments, and modal damping ratios. Elastic moduli of ellipsoidal body segments are initially estimated by comparing stiffness of spring elements, calculated from a detailed scheme, and values available in literature for same. These values are further optimized by minimizing difference between theoretically calculated platform-to-head transmissibility ratio (TR) and experimental measurements. Modal damping ratios are estimated from experimental transmissibility response using two dominant peaks in the frequency range of 0–25 Hz. From comparison between dynamic response determined form modal analysis and experimental results, a set of elastic moduli for different segments of human body and a novel scheme to determine modal damping ratios from TR plots, are established. Acceptable match between transmissibility values calculated from the vibratory model and experimental measurements for 50th percentile U.S. male, except at very low frequencies, establishes the human body model developed. Also, reasonable agreement obtained between theoretical response curve and experimental response envelop for average Indian male, affirms the technique used for constructing vibratory model of a standing person. Present work attempts to develop effective technique for constructing subject specific damped vibratory model based on its physical measurements.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(10):101007-101007-9. doi:10.1115/1.4037405.

Soft connective tissues sustain large strains of viscoelastic nature. The rate-independent component is frequently modeled by means of anisotropic hyperelastic models. The rate-dependent component is usually modeled through linear rheological models or quasi-linear viscoelastic (QLV) models. These viscoelastic models are unable, in general, to capture the strain-level dependency of the viscoelastic properties present in many viscoelastic tissues. In linear viscoelastic models, strain-level dependency is frequently accounted for by including the dependence of multipliers of Prony series on strains through additional evolution laws, but the determination of the material parameters is a difficult task and the obtained accuracy is usually not sufficient. In this work, we introduce a model for fully nonlinear viscoelasticity in which the instantaneous and quasi-static behaviors are exactly captured and the relaxation curves are predicted to a high accuracy. The model is based on a fully nonlinear standard rheological model and does not necessitate optimization algorithms to obtain material parameters. Furthermore, in contrast to most models used in modeling the viscoelastic behavior of soft tissues, it is valid for the large deviations from thermodynamic equilibrium typically observed in soft tissues.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(10):101008-101008-5. doi:10.1115/1.4037404.

Epithelial cells form quasi-two-dimensional sheets that function as contractile media to effect tissue shape changes during development and homeostasis. Endogenously generated intrasheet tension is a driver of such changes, but has predominantly been measured in the presence of directional migration. The nature of epithelial cell-generated forces transmitted over supracellular distances, in the absence of directional migration, is thus largely unclear. In this report, we consider large epithelial cell colonies which are archetypical multicell collectives with extensive cell–cell contacts but with a symmetric (circular) boundary. Using the traction force imbalance method (TFIM) (traction force microscopy combined with physical force balance), we first show that one can determine the colony-level endogenous sheet forces exerted at the midline by one half of the colony on the other half with no prior assumptions on the uniformity of the mechanical properties of the cell sheet. Importantly, we find that this colony-level sheet force exhibits large variations with orientation—the difference between the maximum and minimum sheet force is comparable to the average sheet force itself. Furthermore, the sheet force at the colony midline is largely tensile but the shear component exhibits significantly more variation with orientation. We thus show that even an unperturbed epithelial colony with a symmetric boundary shows significant directional variation in the endogenous sheet tension and shear forces that subsist at the colony level.

Topics: Tension , Traction
Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(10):101009-101009-11. doi:10.1115/1.4037560.

The linear quadratic regulator (LQR) is a classical optimal control approach that can regulate gait dynamics about target kinematic trajectories. Exoskeletons to restore gait function have conventionally utilized time-varying proportional-derivative (PD) control of leg joints. But, these PD parameters are not uniquely optimized for whole-body (full-state) performance. The objective of this study was to investigate the effectiveness of LQR full-state feedback compared to PD control to maintain bipedal walking of a sagittal-plane computational model against force disturbances. Several LQR controllers were uniquely solved with feedback gains optimized for different levels of tracking capability versus control effort. The main implications to future exoskeleton control systems include (1) which LQR controllers out-perform PD controllers in walking maintenance and effort, (2) verifying that LQR desirably produces joint torques that oppose rapidly growing joint state errors, and (3) potentially equipping accurate sensing systems for nonjoint states such as hip-position and torso orientation. The LQR controllers capable of longer walk times than respective PD controllers also required less control effort. During sudden leg collapse, LQR desirably behaved like PD by generating feedback torques that opposed the direction of leg-joint errors. Feedback from nonjoint states contributed to over 50% of the LQR joint torques and appear critical for whole-body LQR control. While LQR control poses implementation challenges, such as more sensors for full-state feedback and operation near the desired trajectories, it offers significant performance advantages over PD control.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(10):101010-101010-10. doi:10.1115/1.4037562.

Historical emphasis on increased intraocular pressure (IOP) in the pathogenesis of glaucoma has been challenged by the recognition that many patients lack abnormally elevated IOP. We employed finite element analysis (FEA) to infer contribution to optic neuropathy from tractional deformation of the optic nerve head (ONH) and lamina cribrosa (LC) by extraocular muscle (EOM) counterforce exerted when optic nerve (ON) redundancy becomes exhausted in adduction. We characterized assumed isotropic Young's modulus of fresh adult bovine ON, ON sheath, and peripapillary and peripheral sclera by tensile elongation in arbitrary orientations of five specimens of each tissue to failure under physiological temperature and humidity. Physical dimensions of the FEA were scaled to human histological and magnetic resonance imaging (MRI) data and used to predict stress and strain during adduction 6 deg beyond ON straightening at multiple levels of IOP. Young's modulus of ON sheath of 44.6 ± 5.6 MPa (standard error of mean) greatly exceeded that of ON at 5.2 ± 0.4 MPa, peripapillary sclera at 5.5 ± 0.8 MPa, and peripheral sclera at 14.0 ± 2.3 MPa. FEA indicated that adduction induced maximum stress and strain in the temporal ONH. In the temporal LC, the maximum stress was 180 kPa, and the maximum strain was ninefold larger than produced by IOP elevation to 45 mm Hg. The simulation suggests that ON sheath traction by adduction concentrates far greater mechanical stress and strain in the ONH region than does elevated IOP, supporting the novel concept that glaucomatous optic neuropathy may result at least partly from external traction on the ON, rather than exclusively on pressure on the ON exerted from within the eye.

Commentary by Dr. Valentin Fuster

Technical Brief

J Biomech Eng. 2017;139(10):104501-104501-8. doi:10.1115/1.4037224.

Dislocation is the most common, and severe, spinal cord injury (SCI) mechanism in humans, yet there are few preclinical models. While dislocation in the rat model has been shown to produce unique outcomes, like other closed column models it exhibits higher outcome variability. Refinement of the dislocation model will enhance the testing of neuroprotective strategies, further biomechanical understanding, and guide therapeutic decisions. The overall objective of this study is to improve biomechanical repeatability of a dislocation SCI model in the rat, through the following specific aims: (i) design new injury clamps that pivot and self-align to the vertebrae; (ii) measure intervertebral kinematics during injury using the existing and redesigned clamps; and (iii) compare relative motion at the vertebrae–clamp interface to determine which clamps provide the most rigid connection. Novel clamps that pivot and self-align were developed based on the quantitative rat vertebral anatomy. A dislocation injury was produced in 34 rats at C4/C5 using either the existing or redesigned clamps, and a high-speed X-ray device recorded the kinematics. Relative motion between the caudal clamp and C5 was significantly greater in the existing clamps compared to the redesigned clamps in dorsoventral translation and sagittal rotation. This study demonstrates that relative motions can be of magnitudes that likely affect injury outcomes. We recommend such biomechanical analyses be applied to other SCI models when repeatability is an issue. For this dislocation model, the results show the importance of using clamps that pivot and self-align to the vertebrae.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(10):104502-104502-5. doi:10.1115/1.4037561.

In this study, the fatigue characteristics of femoral and tibial locking compression plate (LCP) implants are determined accounting for the knee biomechanics during the gait. A biomechanical model for the kinematics and kinetics of the knee joint during the complete gait cycle is proposed. The rotations of the femur, tibia, and patella about the knee joint during the gait are determined. Moreover, the patellar-tendon force (PT), quadriceps-tendon force (QT), the tibiofemoral joint force (TFJ), and the patellofemoral joint force (PFJ) through the standard gait cycle are obtained as functions of the body weight (BW). On the basis of the derived biomechanics of the knee joint, the fatigue factors of safety along with the fatigue life of 316L stainless steel femoral and tibial LCP implants are reported as functions of the BW and bone fracture location, for the first time. The reported results reveal that 316L stainless steel LCP implants for femoral surgeries are preferred for conditions in which the bone fracture is close to the knee joint and the BW is less than 80 kg. For tibial surgeries, 316L stainless steel LCP implants can be used for conditions in which the bone fracture is close to the knee joint and the BW is less than 100 kg. This study presents a critical guide for the determination of the fatigue characteristics of LCP implants. The obtained results reveal that the fatigue analyses should be performed on the basis of the body biomechanics to guarantee accurate designs of LCP implants for femoral and tibial orthopedic surgeries.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(10):104503-104503-5. doi:10.1115/1.4037558.

Radiographic data, including computed tomography (CT) and planar X-ray, is increasingly used for human and animal kinematic studies. There is a tendency toward using as high-resolution imaging as possible. Higher resolution imaging is one factor (in conjunction with the reconstruction algorithm), which may increase the precision of reconstructed three-dimensional (3D) surface models in representing true bone shape. However, to date no study has tested the effects of scan resolution, threshold, and 3D model reconstruction algorithm on the accuracy of bone kinematic results. The present study uses a novel method to do this where canine tarsal bones were positioned on a radiolucent Lego board and scanned before and after undergoing known translations and/or rotations. The digital imaging and communications in medicine (DICOM) images were acquired using two different CT scanning resolutions and processed using three different segmentation threshold levels and three different reconstruction algorithms. Using one bone as the reference bone, an iterative closest point (ICP) algorithm was used to register bones to a global co-ordinate system and allow measurement of other bone kinematics in terms of translations and rotations in and around the x-, y-, and z-axes. The measured kinematics were compared to the “known” kinematics, which were obtained from the Lego board's manufacturing standards and tolerances, to give accuracy error metrics for all bones. The results showed error in accuracy of measured kinematics was at subvoxel levels (less than 0.5 mm). Despite altering the volume and surface area of the 3D bone models, variation in resolution, segmentation threshold and reconstruction algorithm had no significant influence upon the accuracy of the calculated tarsal bone kinematics.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(10):104504-104504-8. doi:10.1115/1.4037559.

Progress toward understanding the underlying mechanisms of pelvic organ prolapse (POP) is limited, in part, due to a lack of information on the biomechanical properties and microstructural composition of the vaginal wall. Compromised vaginal wall integrity is thought to contribute to pelvic floor disorders; however, normal structure–function relationships within the vaginal wall are not fully understood. In addition to the information produced from uniaxial testing, biaxial extension–inflation tests performed over a range of physiological values could provide additional insights into vaginal wall mechanical behavior (i.e., axial coupling and anisotropy), while preserving in vivo tissue geometry. Thus, we present experimental methods of assessing murine vaginal wall biaxial mechanical properties using extension–inflation protocols. Geometrically intact vaginal samples taken from 16 female C57BL/6 mice underwent pressure–diameter and force–length preconditioning and testing within a pressure-myograph device. A bilinear curve fit was applied to the local stress–stretch data to quantify the transition stress and stretch as well as the toe- and linear-region moduli. The murine vaginal wall demonstrated a nonlinear response resembling that of other soft tissues, and evaluation of bilinear curve fits suggests that the vagina exhibits pseudoelasticity, axial coupling, and anisotropy. The protocols developed herein permit quantification of biaxial tissue properties. These methods can be utilized in future studies in order to assess evolving structure–function relationships with respect to aging, the onset of prolapse, and response to potential clinical interventions.

Commentary by Dr. Valentin Fuster

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