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Research Papers

J Biomech Eng. 2016;138(3):031001-031001-9. doi:10.1115/1.4032468.

Balance-recovery stepping is often necessary for both a human and humanoid robot to avoid a fall by taking a single step or multiple steps after an external perturbation. The determination of where to step to come to a complete stop has been studied, but little is known about the strategy for initiation of forward motion from the static position following such a step. The goal of this study was to examine the human strategy for stepping by moving the back foot forward from a static, double-support position, comparing parameters from normal step length (SL) to those from increasing SLs to the point of step failure, to provide inspiration for a humanoid control strategy. Healthy young adults instrumented with joint reflective markers executed a prescribed-length step from rest while marker positions and ground reaction forces (GRFs) were measured. The participants were scaled to the Gait2354 model in opensim software to calculate body kinematic and joint kinetic parameters, with further post-processing in matlab. With increasing SL, participants reduced both static and push-off back-foot GRF. Body center of mass (CoM) lowered and moved forward, with additional lowering at the longer steps, and followed a path centered within the initial base of support (BoS). Step execution was successful if participants gained enough forward momentum at toe-off to move the instantaneous capture point (ICP) to within the BoS defined by the final position of both feet on the front force plate. All lower extremity joint torques increased with SL except ankle joint. Front knee work increased dramatically with SL, accompanied by decrease in back-ankle work. As SL increased, the human strategy changed, with participants shifting their CoM forward and downward before toe-off, thus gaining forward momentum, while using less propulsive work from the back ankle and engaging the front knee to straighten the body. The results have significance for human motion, suggesting the upper limit of the SL that can be completed with back-ankle push-off before additional knee flexion and torque is needed. For biped control, the results support stability based on capture-point dynamics and suggest strategy for center-of-mass trajectory and distribution of ground force reactions that can be compared with robot controllers for initiation of gait after recovery steps.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2016;138(3):031002-031002-12. doi:10.1115/1.4032379.

Musculoskeletal models are powerful tools that allow biomechanical investigations and predictions of muscle forces not accessible with experiments. A core challenge modelers must confront is validation. Measurements of muscle activity and joint loading are used for qualitative and indirect validation of muscle force predictions. Subject-specific models have reached high levels of complexity and can predict contact loads with surprising accuracy. However, every deterministic musculoskeletal model contains an intrinsic uncertainty due to the high number of parameters not identifiable in vivo. The objective of this work is to test the impact of intrinsic uncertainty in a scaled-generic model on estimates of muscle and joint loads. Uncertainties in marker placement, limb coronal alignment, body segment parameters, Hill-type muscle parameters, and muscle geometry were modeled with a global probabilistic approach (multiple uncertainties included in a single analysis). 5–95% confidence bounds and input/output sensitivities of predicted knee compressive loads and varus/valgus contact moments were estimated for a gait activity of three subjects with telemetric knee implants from the “Grand Challenge Competition.” Compressive load predicted for the three subjects showed confidence bounds of 333 ± 248 N, 408 ± 333 N, and 379 ± 244 N when all the sources of uncertainty were included. The measured loads lay inside the predicted 5–95% confidence bounds for 77%, 83%, and 76% of the stance phase. Muscle maximum isometric force, muscle geometry, and marker placement uncertainty most impacted the joint load results. This study demonstrated that identification of these parameters is crucial when subject-specific models are developed.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2016;138(3):031003-031003-6. doi:10.1115/1.4032059.

The unconfined compression experiments are commonly used for characterizing the mechanical behavior of hydrated soft tissues such as articular cartilage. Several analytical constitutive models have been proposed over the years to analyze the unconfined compression experimental data and subsequently estimate the material parameters. Nevertheless, new mathematical models are still required to obtain more accurate numerical estimates. The present study aims at developing a linear transversely isotropic poroviscoelastic theory by combining a viscoelastic material law with the transversely isotropic biphasic model. In particular, an integral type viscoelastic model is used to describe the intrinsic viscoelastic properties of a transversely isotropic solid matrix. The proposed constitutive theory incorporates viscoelastic contributions from both the fluid flow and the intrinsic viscoelasticity to the overall stress-relaxation behavior. Moreover, this new material model allows investigating the biomechanical properties of tissues whose extracellular matrix exhibits transverse isotropy. In the present work, a comprehensive parametric study was conducted to determine the influence of various material parameters on the stress–relaxation history. Furthermore, the efficacy of the proposed theory in representing the unconfined compression experiments was assessed by comparing its theoretical predictions with those obtained from other versions of the biphasic theory such as the isotropic, transversely isotropic, and viscoelastic models. The unconfined compression behavior of articular cartilage as well as corneal stroma was used for this purpose. It is concluded that while the proposed model is capable of accurately representing the viscoelastic behavior of any hydrated soft tissue in unconfined compression, it is particularly useful in modeling the behavior of those with a transversely isotropic skeleton.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2016;138(3):031004-031004-8. doi:10.1115/1.4032126.

The goal of this study was to investigate the persistence of cold-induced vasoconstriction following cessation of active skin-surface cooling. This study demonstrates a hysteresis effect that develops between skin temperature and blood perfusion during the cooling and subsequent rewarming period. An Arctic Ice cryotherapy unit (CTU) was applied to the knee region of six healthy subjects for 60 min of active cooling followed by 120 min of passive rewarming. Multiple laser Doppler flowmetry perfusion probes were used to measure skin blood flow (expressed as cutaneous vascular conductance (CVC)). Skin surface cooling produced a significant reduction in CVC (P < 0.001) that persisted throughout the duration of the rewarming period. In addition, there was a hysteresis effect between CVC and skin temperature during the cooling and subsequent rewarming cycle (P < 0.01). Mixed model regression (MMR) showed a significant difference in the slopes of the CVC–skin temperature curves during cooling and rewarming (P < 0.001). Piecewise regression was used to investigate the temperature thresholds for acceleration of CVC during the cooling and rewarming periods. The two thresholds were shown to be significantly different (P = 0.003). The results show that localized cooling causes significant vasoconstriction that continues beyond the active cooling period despite skin temperatures returning toward baseline values. The significant and persistent reduction in skin perfusion may contribute to nonfreezing cold injury (NFCI) associated with cryotherapy.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2016;138(3):031005-031005-8. doi:10.1115/1.4032502.

The formation and progression of in-stent restenosis (ISR) in bifurcated vessels may vary depending on the technique used for stenting. This study evaluates the effect of a variety of mesh styles on the accuracy and reliability of computational fluid dynamics (CFD) models in predicting these regions, using an idealized stented nonbifurcated model. The wall shear stress (WSS) and the near-stent recirculating vortices are used as determinants. The meshes comprise unstructured tetrahedral and polyhedral elements. The effects of local refinement, as well as higher-order elements such as prismatic inflation layers and internal hexahedral core, have also been examined. The uncertainty associated with individual mesh style was assessed through verification of calculations using the grid convergence index (GCI) method. The results obtained show that the only condition which allows the reliable comparison of uncertainty estimation between different meshing styles is that the monotonic convergence of grid solutions is in the asymptotic range. Comparisons show the superiority of a flow-adaptive polyhedral mesh over the commonly used adaptive and nonadaptive tetrahedral meshes in terms of resolving the near-stent flow features, GCI value, and prediction of WSS. More accurate estimation of hemodynamic factors was obtained using higher-order elements, such as hexahedral or prismatic grids. Incorporating these higher-order elements, however, was shown to introduce some degrees of numerical diffusion at the transitional area between the two meshes, not necessarily translating into high GCI value. Our data also confirmed the key role of local refinement in improving the performance and accuracy of nonadaptive mesh in predicting flow parameters in models of stented artery. The results of this study can provide a guideline for modeling biofluid domain in complex bifurcated arteries stented in regards to various stenting techniques.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2016;138(3):031006-031006-12. doi:10.1115/1.4032381.

Since the meniscus has limited capacity to self-repair, creating a long-lasting meniscus replacement may help reduce the incidence of osteoarthritis (OA) after meniscus damage. As a first step toward this goal, this study evaluated the mechanical integrity of a decellularized, laser drilled (LD) meniscus as a potential scaffold for meniscal engineering. To evaluate the decellularization process, 24 porcine menisci were processed such that one half remained native tissue, while the other half was decellularized in sodium dodecyl sulphate (SDS). To evaluate the laser drilling process, 24 additional menisci were decellularized, with one half remaining intact while the other half was LD. Decellularization did not affect the tensile properties, but had significant effects on the cyclic compressive hysteresis and unconfined compressive stress relaxation. Laser drilling decreased the Young's modulus and instantaneous stress during unconfined stress relaxation and the circumferential ultimate strength during tensile testing. However, the losses in mechanical integrity in the LD menisci were generally smaller than the variance observed between samples, and thus, the material properties for the LD tissue remained within a physiological range. In the future, optimization of laser drilling patterns may improve these material properties. Moreover, reseeding the construct with cells may further improve the mechanical properties prior to implantation. As such, this work serves as a proof of concept for generating decellularized, LD menisci scaffolds for the purposes of meniscal engineering.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2016;138(3):031007-031007-8. doi:10.1115/1.4032550.

Endothelial cell (EC) morphology and functions can be highly impacted by the mechanical stresses that the cells experience in vivo. In most areas in the vasculature, ECs are continuously exposed to unsteady blood flow-induced shear stress and vasodilation-contraction-induced tensile stress/strain simultaneously. Investigations on how ECs respond to combined shear stress and tensile strain will help us to better understand how an altered mechanical environment affects EC mechanotransduction, dysfunction, and associated cardiovascular disease development. In the present study, a programmable shearing and stretching device that can apply dynamic fluid shear stress and cyclic tensile strain simultaneously to cultured ECs was developed. Flow and stress/strain conditions in the device were simulated using a fluid structure interaction (FSI) model. To characterize the performance of this device and the effect of combined shear stress–tensile strain on EC morphology, human coronary artery ECs (HCAECs) were exposed to concurrent shear stress and cyclic tensile strain in the device. Changes in EC morphology were evaluated through cell elongation, cell alignment, and cell junctional actin accumulation. Results obtained from the numerical simulation indicated that in the “in-plane” area of the device, both fluid shear stress and biaxial tensile strain were uniform. Results obtained from the in vitro experiments demonstrated that shear stress, alone or combined with cyclic tensile strain, induced significant cell elongation. While biaxial tensile strain alone did not induce any appreciable change in EC elongation. Fluid shear stress and cyclic tensile strain had different effects on EC actin filament alignment and accumulation. By combining various fluid shear stress and cyclic tensile strain conditions, this device can provide a physiologically relevant mechanical environment to study EC responses to physiological and pathological mechanical stimulation.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2016;138(3):031008-031008-11. doi:10.1115/1.4032380.

This study develops a macroscopic model of mass transport in electroporated biological tissue in order to predict the cellular drug uptake. The change in the macroscopic mass transport coefficient is related to the increase in electrical conductivity resulting from the applied electric field. Additionally, the model considers the influences of both irreversible electroporation (IRE) and the transient resealing of the cell membrane associated with reversible electroporation. Two case studies are conducted to illustrate the applicability of this model by comparing transport associated with two electrode arrangements: side-by-side arrangement and the clamp arrangement. The results show increased drug transmission to viable cells is possible using the clamp arrangement due to the more uniform electric field.

Commentary by Dr. Valentin Fuster

Technical Brief

J Biomech Eng. 2016;138(3):034501-034501-7. doi:10.1115/1.4032113.

Simulation of flow in the human lung is of great practical interest as a means to study the detailed flow patterns within the airways for many physiological applications. While computational simulation techniques are quite mature, lung simulations are particularly complicated due to the vast separation of length scales between upper airways and alveoli. Many past studies have presented numerical results for truncated airway trees, however, there are significant difficulties in connecting such results with respiratory airway models. This article presents a new modeling paradigm for flow in the full lung, based on a conjugate fluid–porous formulation where the upper airway is considered as a fluid region with the remainder of the lung being considered as a coupled porous region. Results are presented for a realistic lung geometry obtained from computed tomography (CT) images, which show the method's potential as being more efficient and practical than attempting to directly simulate flow in the full lung.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2016;138(3):034502-034502-6. doi:10.1115/1.4032445.

Current methods of quantifying foot kinematics during gait typically use markers placed externally on bony anatomic locations. These models are unable to analyze talocrural or subtalar motion because the talus lacks palpable landmarks to place external markers. Alternative methods of measuring these clinically relevant joint motions are invasive and have been limited to research purposes only. This study explores the use of fluoroscopy to noninvasively quantify talocrural and subtalar sagittal plane kinematics. A fluoroscopy system (FS) was designed and built to synchronize with an existing motion analysis system (MAS). Simultaneous fluoroscopic, marker motion, and ground reaction force (GRF) data were collected for five subjects to demonstrate system application. A hindfoot sagittal plane model was developed to evaluate talocrural and subtalar joint motion. Maximum talocrural plantar and dorsiflexion angles averaged among all the subjects occur at 12% and 83% of stance, respectively, with a range of motion of 20.1 deg. Maximum talocrural plantar and dorsiflexion angles averaged among all the subjects occur at toe-off and 67% of stance, respectively, with a range of motion of 8.7 deg. Based on the favorable comparison between the current fluoroscopically measured kinematics and previously reported results from alternative methods, it is concluded that fluoroscopic technology is well suited for measuring the sagittal plane hindfoot motion.

Topics: Kinematics
Commentary by Dr. Valentin Fuster
J Biomech Eng. 2016;138(3):034503-034503-6. doi:10.1115/1.4032413.

Detailed knowledge of the loading conditions within the human body is essential for the development and optimization of treatments for disorders and injuries of the musculoskeletal system. While loads in the major joints of the lower limb have been the subject of extensive study, relatively little is known about the forces applied to the individual bones of the foot. The objective of this study was to use a detailed musculoskeletal model to compute the loads applied to the metatarsal bones during gait across several healthy subjects. Motion-captured gait trials and computed tomography (CT) foot scans from four healthy subjects were used as the inputs to inverse dynamic simulations that allowed the computation of loads at the metatarsal joints. Low loads in the metatarsophalangeal (MTP) joint were predicted before terminal stance, however, increased to an average peak of 1.9 times body weight (BW) before toe-off in the first metatarsal. At the first tarsometatarsal (TMT) joint, loads of up to 1.0 times BW were seen during the early part of stance, reflecting tension in the ligaments and muscles. These loads subsequently increased to an average peak of 3.0 times BW. Loads in the first ray were higher compared to rays 2–5. The joints were primarily loaded in the longitudinal direction of the bone.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2016;138(3):034504-034504-7. doi:10.1115/1.4032501.

The transcatheter aortic valve implantation (TAVI) valve is a bioprosthetic valve within a metal stent frame. Like traditional surgical bioprosthetic valves, the TAVI valve leaflet tissue is expected to calcify and degrade over time. However, clinical studies of TAVI valve longevity are still limited. In order to indirectly assess the longevity of TAVI valves, an estimate of the mechanical wear and tear in terms of valvular deformation and strain of the leaflets under various conditions is warranted. The aim of this study was, therefore, to develop a platform for noncontact TAVI valve deformation analysis with both high temporal and spatial resolutions based on stereophotogrammetry and digital image correlation (DIC). A left-heart pulsatile in vitro flow loop system for mounting of TAVI valves was designed. The system enabled high-resolution imaging of all three TAVI valve leaflets simultaneously for up to 2000 frames per second through two high-speed cameras allowing three-dimensional analyses. A coating technique for applying a stochastic pattern on the leaflets of the TAVI valve was developed. The technique allowed a pattern recognition software to apply frame-by-frame cross correlation based deformation measurements from which the leaflet motions and the strain fields were derived. The spatiotemporal development of a very detailed strain field was obtained with a 0.5 ms time resolution and a spatial resolution of 72 μm/pixel. Hence, a platform offering a new and enhanced supplementary experimental evaluation of tissue valves during various conditions in vitro is presented.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2016;138(3):034505-034505-5. doi:10.1115/1.4032446.

The modular taper junction in total hip replacements has been implicated as a possible source of wear. The finite-element (FE) method can be used to study the wear potential at the taper junction. For such simulations it is important to implement representative contact parameters, in order to achieve accurate results. One of the main parameters in FE simulations is the coefficient of friction. However, in current literature, there is quite a wide spread in coefficient of friction values (0.15 − 0.8), which has a significant effect on the outcome of the FE simulations. Therefore, to obtain more accurate results, one should use a coefficient of friction that is determined for the specific material couple being analyzed. In this study, the static coefficient of friction was determined for two types of titanium-on-titanium stem-adaptor couples, using actual cut-outs of the final implants, to ensure that the coefficient of friction was determined consistently for the actual implant material and surface finish characteristics. Two types of tapers were examined, Biomet type-1 and 12/14, where type-1 has a polished surface finish and the 12/14 is a microgrooved system. We found static coefficients of friction of 0.19 and 0.29 for the 12/14 and type-1 stem-adaptor couples, respectively.

Commentary by Dr. Valentin Fuster

Errata

J Biomech Eng. 2016;138(3):037001-037001-1. doi:10.1115/1.4032686.
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Commentary by Dr. Valentin Fuster

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