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Cerebral palsy (CP) is a neurologic injury that impacts control of movement. Individuals with CP also often develop secondary impairments like weakness and contracture. Both altered motor control and secondary impairments influence how an individual walks after neurologic injury. However, understanding the complex interactions between and relative effects of these impairments makes analyzing and improving walking capacity in CP challenging. We used a sagittal-plane musculoskeletal model and neuromuscular control framework to simulate crouch and nondisabled gait. We perturbed each simulation by varying the number of synergies controlling each leg (altered control), and imposed weakness and contracture. A Bayesian Additive Regression Trees (BART) model was also used to parse the relative effects of each impairment on the muscle activations required for each gait pattern. By using these simulations to evaluate gait-pattern specific effects of neuromuscular impairments, we identified some advantages of crouch gait. For example, crouch tolerated 13 % and 22 % more plantarflexor weakness than nondisabled gait without and with altered control, respectively. Furthermore, BART demonstrated that plantarflexor weakness had twice the effect on total muscle activity required during nondisabled gait than crouch gait. However, crouch gait was also disadvantageous in the presence of vasti weakness: crouch gait increased the effects of vasti weakness on gait without and with altered control. These simulations highlight gait-pattern specific effects and interactions between neuromuscular impairments. Utilizing computational techniques to understand these effects can elicit advantages of gait deviations, providing insight into why individuals may select their gait pattern and possible interventions to improve energetics. [ABSTRACT FROM AUTHOR]

Abstract Achilles tendon ruptures have been linked with detrimental changes in muscle-tendon structure, which may help explain long-term functional deficits. However, the causal effects of muscle-tendon structure on joint function have not been tested in a controlled setting. Therefore, the purpose of this study was to test the implications of muscle-tendon unit parameters on simulated single-leg heel raise height. We hypothesized that muscle fiber length and resting ankle angle – a clinical surrogate measure of tendon slack length – would predict single-leg heel raise height more strongly than other parameters. To test this hypothesis, we developed a two-part simulation paradigm that recreated clinically relevant muscle-tendon scenarios and then tested these parameters on single-leg heel raise height. We found that longer muscle fibers had the greatest positive effect on single-leg heel raise height. However, tendon slack length, determined by simulating resting ankle angles in a secondary analysis, revealed a stronger negative correlation with heel raise height. Our findings support previous clinical observations that both muscle fascicle length and resting tendon length are important muscle-tendon parameters for patient function. In addition to minimizing tendon elongation following rupture, treatment plans should focus on preserving plantarflexor muscle structure to mitigate functional loses following Achilles tendon ruptures. [ABSTRACT FROM AUTHOR]

Abstract Background Numerous biomechanical studies have addressed normal shoulder function and the factors that affect it. While these investigations include a mix of in-vivo clinical reports, ex-vivo cadaveric studies, and computer-based simulations, each has its own strengths and limitations. A robust methodology is essential in cadaveric work but does not always come easily. Precise quantitative measurements are difficult in in-vivo studies, and simulation studies require validation steps. This review focuses on ex-vivo cadaveric studies to emphasize the best research methodologies available to simulate physiologically and clinically relevant shoulder motion. Methods A PubMed and Web of Science search was conducted in March 2017 (and updated in May 2018) to identify the cadaveric studies focused on the shoulder and its function. The key words for this search included rotator cuff (RC) injuries, RC surgery, and their synonyms. The protocol of the study was registered on PROSPERO and is accessible at CRD42017068873. Results Thirty one studies consisting of 167 specimens with various biomechanical methods met our inclusion criteria. All studies were level V cadaveric studies. Cadaveric biomechanical models are widely used to study shoulder instability and RC repair. These models are commonly limited to the glenohumeral joint by a fixed scapula, passively and discretely move the humerus, and statically load the RC without regard for the integrity of the glenohumeral capsule. Conclusion All studies captured in this review evaluated shoulder biomechanics. Recent studies in patients suggest that some assumptions made in this space may not fully characterize motion of the human shoulder. With reproducible scapular positioning, dynamic RC activation, and preservation of glenohumeral capsule integrity, cadaveric studies can facilitate proper validation for simulation models and broaden our understanding of the shoulder environment during motion in healthy and disease states. [ABSTRACT FROM AUTHOR]

Inertial sensing and computer vision are promising alternatives to traditional optical motion tracking, but until now these data sources have been explored either in isolation or fused via unconstrained optimization, which may not take full advantage of their complementary strengths. By adding physiological plausibility and dynamical robustness to a proposed solution, biomechanical modeling may enable better fusion than unconstrained optimization. To test this hypothesis, we fused video and inertial sensing data via dynamic optimization with a nine degree-of-freedom model and investigated when this approach outperforms video-only, inertial-sensing-only, and unconstrained-fusion methods. We used both experimental and synthetic data that mimicked different ranges of video and inertial measurement unit (IMU) data noise. Fusion with a dynamically constrained model significantly improved estimation of lower-extremity kinematics over the video-only approach and estimation of joint centers over the IMU-only approach. It consistently outperformed single-modality approaches across different noise profiles. When the quality of video data was high and that of inertial data was low, dynamically constrained fusion improved estimation of joint kinematics and joint centers over unconstrained fusion, while unconstrained fusion was advantageous in the opposite scenario. These findings indicate that complementary modalities and techniques can improve motion tracking by clinically meaningful margins and that data quality and computational complexity must be considered when selecting the most appropriate method for a particular application. [ABSTRACT FROM AUTHOR]

Chronic injury- or disease-induced joint impairments result in asymmetric gait deviations that may precipitate changes in joint loading associated with pain and osteoarthritis. Understanding the impact of gait deviations on joint reaction forces (JRFs) is challenging because of concurrent neurological and/or anatomical changes and because measuring JRFs requires medically invasive instrumented implants. Instead, we investigated the impact of joint motion limitations and induced asymmetry on JRFs by simulating data recorded as 8 unimpaired participants walked with bracing to unilaterally and bilaterally restrict ankle, knee, and simultaneous ankle + knee motion. Personalized models, calculated kinematics, and ground reaction forces (GRFs) were input into a computed muscle control tool to determine lower limb JRFs and simulated muscle activations guided by electromyography-driven timing constraints. Unilateral knee restriction increased GRF peak and loading rate ipsilaterally but peak values decreased contralaterally when compared to walking without joint restriction. GRF peak and loading rate increased with bilateral restriction compared to the contralateral limb of unilaterally restricted conditions. Despite changes in GRFs, JRFs were relatively unchanged due to reduced muscle forces during loading response. Thus, while joint restriction results in increased limb loading, reductions in muscle forces counteract changes in limb loading such that JRFs were relatively unchanged. [ABSTRACT FROM AUTHOR]

Medical device regulatory standards are increasingly incorporating computational modelling and simulation to accommodate advanced manufacturing and device personalization. We present a method for robust testing of engineered soft tissue products involving a digital twin paradigm in combination with robotic systems. We developed and validated a digital twin framework for calibrating and controlling robotic-biological systems. A forward dynamics model of the robotic manipulator was developed, calibrated, and validated. After calibration, the accuracy of the digital twin in reproducing the experimental data improved in the time domain for all fourteen tested configurations and improved in frequency domain for nine configurations. We then demonstrated displacement control of a spring in lieu of a soft tissue element in a biological specimen. The simulated experiment matched the physical experiment with 0.09 mm (0.001%) root-mean-square error for a 2.9 mm (5.1%) length change. Finally, we demonstrated kinematic control of a digital twin of the knee through 70-degree passive flexion kinematics. The root-mean-square error was 2.00°, 0.57°, and 1.75° degrees for flexion, adduction, and internal rotations, respectively. The system well controlled novel mechanical elements and generated accurate kinematics in silico for a complex knee model. This calibration method could be applied to other situations where the specimen is poorly represented in the model environment (e.g., human or animal tissues), and the control system could be extended to track internal parameters such as tissue strain (e.g., control knee ligament strain). Further development of this framework can facilitate medical device testing and innovative biomechanics research. [ABSTRACT FROM AUTHOR]

TAVI devices are manufactured with cylindrical frames. However, the frames are rarely cylindrical post-deployment since deformation due to localised under expansion can be induced by calcified material on the native valve leaflets exerting irregular forces upon the frame. Consequently, the leaflets within a deformed TAVI device may undergo elevated stress during operation, which may lead to premature device failure. Using computational analysis a complete TAVI device model was simulated undergoing deployment into an aortic root model derived from CT data for a patient with severe calcific aortic stenosis, followed by a pressure simulated cardiac cycle. The complete analysis was performed eight times, each with the device at a different rotational orientation relative to the native valve, with an increment spacing of 15°. The TAVI device frames consistently featured significant distortions associated with bulky calcified material at the base of the non-coronary sinus. It was found that the average von Mises stress in the prosthetic valves was only increased in one of the cases relative to an idealised device. However, the maximum von Mises stress in the prosthetic valves was elevated in the majority of the cases. Furthermore, it was found that there were preferable orientations to deploy the prosthetic device, in this case, when the prosthetic leaflets were aligned with the native leaflets. As device orientation deviated from this orientation, the stresses in the valve increased because the distance between the prosthetic commissures decreased. This potentially could represent a sufficient increase in stress to induce variation in device lifespan. [ABSTRACT FROM AUTHOR]

The analysis is based on a finite element procedure to extract the contact forces between an implanted Nitinol stent and the surrounding host tissue using postoperative CT images. The methodology was applied for patients ( N =46) which have undergone a TAVI procedure with the Medtronic CoreValve Revalving System (MCRS) to obtain corresponding deformation and force maps. The postoperative CT data were recorded for each patient in both systolic and diastolic phase of the heart cycle. Scalar parameters were defined, which map deformed geometry and contact force field to mechanically relevant quantities: radial dilatation, radial shape distortion, non-convex points, mean force, a force deviation measure and a pressure equivalent. The latter demonstrates that in the area of the aortic root, the added circumferential loading is of the same order as the baseline average blood pressure, thus leading to a doubling of the local mechanical load. Generally the force distribution along the stent is non-homogeneous. A comparison of systolic and diastolic data revealed slightly higher contact forces during the diastole, indicating that the stent has to carry more load in this phase. The geometrical and mechanical parameters were compared for two types of clinical complication: para-valvular leakage (PVL) and permanent pacemaker requirement (PPM). It was found that an increase in mean force can be associated with both complications; significantly for PVL and as a trend for PPM. [ABSTRACT FROM AUTHOR]

Ankle inversion sprains are the most frequent acute musculoskeletal injuries occurring in physical activity. Interventions that retrain muscle coordination have helped rehabilitate injured ankles, but it is unclear which muscle coordination strategies, if any, can prevent ankle sprains. The purpose of this study was to determine whether coordinated activity of the ankle muscles could prevent excessive ankle inversion during a simulated landing on a 30° incline. We used a set of musculoskeletal simulations to evaluate the efficacy of two strategies for coordinating the ankle evertor and invertor muscles during simulated landing scenarios: planned co-activation and stretch reflex activation with physiologic latency (60-ms delay). A full-body musculoskeletal model of landing was used to generate simulations of a subject dropping onto an inclined surface with each coordination condition. Within each condition, the intensity of evertor and invertor co-activity or stretch reflexes were varied systematically. The simulations revealed that strong preparatory co-activation of the ankle evertors and invertors prior to ground contact prevented ankle inversion from exceeding injury thresholds by rapidly generating eversion moments after initial contact. Conversely, stretch reflexes were too slow to generate eversion moments before the simulations reached the threshold for inversion injury. These results suggest that training interventions to protect the ankle should focus on stiffening the ankle with muscle co-activation prior to landing. The musculoskeletal models, controllers, software, and simulation results are freely available online at http://simtk.org/home/ankle-sprains , enabling others to reproduce the results and explore new injury scenarios and interventions. [ABSTRACT FROM AUTHOR]

The aims of this study were to: (i) establish a new criterion method to validate inertia tensor estimates by setting the experimental angular velocity data of an airborne objects as ground truth against simulations run with the estimated tensors, and (ii) test the sensitivity of the simulations to changes in the inertia tensor components. A rigid steel cylinder was covered with reflective kinematic markers and projected through a calibrated motion capture volume. Simulations of the airborne motion were run with two models, using inertia tensor estimated with geometric formula or the compound pendulum technique. The deviation angles between experimental (ground truth) and simulated angular velocity vectors and the root mean squared deviation angle were computed for every simulation. Monte Carlo analyses were performed to assess the sensitivity of simulations to changes in magnitude of principal moments of inertia within ±10% and to changes in orientation of principal axes of inertia within ±10° (of the geometric-based inertia tensor). Root mean squared deviation angles ranged between 2.9° and 4.3° for the inertia tensor estimated geometrically, and between 11.7° and 15.2° for the compound pendulum values. Errors up to 10% in magnitude of principal moments of inertia yielded root mean squared deviation angles ranging between 3.2° and 6.6°, and between 5.5° and 7.9° when lumped with errors of 10° in principal axes of inertia orientation. The proposed technique can effectively validate inertia tensors from novel estimation methods of body segment inertial parameter. Principal axes of inertia orientation should not be neglected when modelling human/animal mechanics. [ABSTRACT FROM AUTHOR]

Simple, lumped-parameter musculoskeletal models may be more adaptable and practical for clinical real-time control applications, such as prosthesis control. In this study, we determined whether a lumped-parameter, EMG-driven musculoskeletal model with four muscles could predict wrist and metacarpophalangeal (MCP) joint flexion/extension. Forearm EMG signals and joint kinematics were collected simultaneously from 5 able-bodied (AB) subjects. For one subject with unilateral transradial amputation (TRA), joint kinematics were collected from the sound arm during bilateral mirrored motion. Twenty-two model parameters were optimized such that joint kinematics predicted by EMG-driven forward dynamic simulation closely matched measured kinematics. Cross validation was employed to evaluate the model kinematic predictions using Pearson׳s correlation coefficient ( r ). Model predictions of joint angles were highly to very highly positively correlated with measured values at the wrist (AB mean r =0.94, TRA r =0.92) and MCP (AB mean r =0.88, TRA r =0.93) joints during single-joint wrist and MCP movements, respectively. In simultaneous multi-joint movement, the prediction accuracy for TRA at the MCP joint decreased ( r =0.56), while r -values derived from AB subjects and TRA wrist motion were still above 0.75. Though parameters were optimized to match experimental sub-maximal kinematics, passive and maximum isometric joint moments predicted by the model were comparable to reported experimental measures. Our results showed the promise of a lumped-parameter musculoskeletal model for hand/wrist kinematic estimation. Therefore, the model might be useful for EMG control of powered upper limb prostheses, but more work is needed to demonstrate its online performance. [ABSTRACT FROM AUTHOR]

Although standing balance is important in many daily activities, there has been little effort in developing detailed musculoskeletal models and simulations of balance control compared to other whole-body motor activities. Our objective was to develop a musculoskeletal model of human balance that can be used to predict movement patterns in reactive balance control. Similar to prior studies using torque-driven models, we investigated how movement patterns during a reactive balance response are affected by high-level task goals (e.g., reducing center-of-mass movement, maintaining vertical trunk orientation, and minimizing effort). We generated 23 forward dynamics simulations where optimal muscle excitations were found using cost functions with different weights on minimizing these high-level goals. Variations in hip and ankle angles observed experimentally (peak hip flexion=7.9−53.1°, peak dorsiflexion=0.5−4.7°) could be predicted by varying the priority of these high-level goals. More specifically, minimizing center-of-mass motion produced a hip strategy (peak hip flexion and ankle dorsiflexion angles of 45.5° and 2.3°, respectively) and the response shifted towards an ankle strategy as the priority to keep the trunk vertical was increased (peak hip and ankle angles of 13.7° and 8.5°, respectively). We also found that increasing the priority to minimize muscle stress always favors a hip strategy. These results are similar to those from sagittal-plane torque-driven models. Our muscle-actuated model facilitates the investigation of neuromechanical interactions governing reactive balance control to predict muscle activity and movement patterns based on interactions between neuromechanical elements such as spinal reflexes, muscle short-range stiffness, and task-level sensorimotor feedback. [ABSTRACT FROM AUTHOR]

The Achilles tendon (AT) is a complex structure, consisting of distinct fascicle bundles arising from each triceps surae muscle that may act as mechanically independent structures. Advances in tissue imaging are rapidly accelerating our understanding of the complexities of functional Achilles tendon behavior, with potentially important implications for musculoskeletal injury and performance. In this overview of our recent contributions to these efforts, we present the results of complementary experimental and computational approaches to investigate AT behavior during walking and its potential relevance to reduced triceps surae mechanical performance due to aging. Our experimental evidence reveals that older tendons exhibit smaller differences in tissue deformations than young adults between regions of the AT presumed to arise from the gastrocnemius and soleus muscles. These observations are consistent with a reduced capacity for inter-fascicle sliding within the AT, which could have implications for the mechanical independence of the triceps surae muscles. More uniform AT deformations are also correlated with hallmark biomechanical features of elderly gait – namely, a loss of net ankle moment, power, and positive work during push-off. Simulating age-related reductions in the capacity for inter-fascicle sliding in the AT during walking predicts detriments in gastrocnemius muscle-tendon mechanical performance coupled with underlying shifts in fascicle kinematics during push-off. AT compliance, also suspected to vary due to age, systematically modulates those effects. By integrating in vivo imaging with computational modeling, we have gained theoretical insight into multi-scale biomechanical changes due to aging, hypotheses regarding their functional effects, and opportunities for experiments that validate or invalidate these assertions. [ABSTRACT FROM AUTHOR]

This study provides a forward-muscular inverse-skeletal dynamics framework for musculoskeletal simulations. The simulation framework works based on solving the muscle redundancy problem forward in time parallel to a torque tracking between the musculotendon net torques and joint moments from inverse dynamics. The proposed framework can be used by any musculoskeletal modeling software package; however, just to exemplify, here in this study it is wrapped around OpenSim and the optimization is done in MATLAB. The novel simulation framework was highly robust for repeated runs and produced relatively high correlations between predicted muscle excitations and experimental EMGs for level gait trials. This simulation framework represents an efficient and robust approach to predict muscle excitation, musculotendon unit force, and to estimate net joint torque. [ABSTRACT FROM AUTHOR]

The ability of a biomechanical simulation to produce results that can translate to real-life situations is largely dependent on the physiological accuracy of the musculoskeletal model. There are a limited number of freely-available, full-body models that exist in OpenSim, and those that do exist are very limited in terms of trunk musculature and degrees of freedom in the spine. Properly modeling the motion and musculature of the trunk is necessary to most accurately estimate lower extremity and spinal loading. The objective of this study was to develop and validate a more physiologically accurate OpenSim full-body model. By building upon three previously developed OpenSim models, the full-body lumbar spine (FBLS) model, comprised of 21 segments, 30 degrees-of-freedom, and 324 musculotendon actuators, was developed. The five lumbar vertebrae were modeled as individual bodies, and coupled constraints were implemented to describe the net motion of the spine. The eight major muscle groups of the lumbar spine were modeled (rectus abdominis, external and internal obliques, erector spinae, multifidus, quadratus lumborum, psoas major, and latissimus dorsi), and many of these muscle groups were modeled as multiple fascicles allowing the large muscles to act in multiple directions. The resulting FBLS model׳s trunk muscle geometry, maximal isometric joint moments, and simulated muscle activations compare well to experimental data. The FBLS model will be made freely available ( https://simtk.org/home/fullbodylumbar ) for others to perform additional analyses and develop simulations investigating full-body dynamics and contributions of the trunk muscles to dynamic tasks. [ABSTRACT FROM AUTHOR]

Musculoskeletal simulations of lumbar spine loading rely on a geometrical representation of the anatomy. However, this data has an inherent inaccuracy. This study evaluates the influence of defined geometrical parameters on lumbar spine loading utilising five parametrised musculoskeletal lumbar spine models for four different postures. The influence of the dimensions of vertebral body, disc, posterior parts of the vertebrae as well as the curvature of the lumbar spine was studied. Additionally, simulations with combinations of selected parameters were conducted. Changes in L4/L5 resultant joint force were used as outcome variable. Variations of the vertebral body height, disc height, transverse process width and the curvature of the lumbar spine were the most influential. These parameters can be easily acquired from X-rays and should be used to morph a musculoskeletal lumbar spine model for subject-specific approaches with respect to bone geometry. Furthermore, the model was very sensitive to uncommon configurations and therefore, it is advised that stiffness properties of discs and ligaments should be individualised. [ABSTRACT FROM AUTHOR]

Turning while walking requires substantial joint kinematic and kinetic adaptations compared to straight walking in order to redirect the body centre of mass (COM) towards the new walking direction. The role of muscles and external forces in controlling and redirecting the COM during turning remains unclear. The aim of this study was to compare the contributors to COM medio-lateral acceleration during 90° pre-planned turns about the inside limb (spin) and straight walking in typically developing children. Simulations of straight walking and turning gait based on experimental motion data were implemented in OpenSim. The contributors to COM global medio-lateral acceleration during the approach (outside limb) and turn (inside limb) stance phase were quantified via an induced acceleration analysis. Changes in medio-lateral COM acceleration occurred during both turning phases, compared to straight walking ( p <0.001). During the approach, outside limb plantarflexors (soleus and medial gastrocnemius) contribution to lateral (away from the turn side) COM acceleration was reduced ( p <0.001), whereas during the turn, inside limb plantarflexors (soleus and gastrocnemii) contribution to lateral acceleration (towards the turn side) increased ( p ≤0.013) and abductor (gluteus medius and minimus) contribution medially decreased ( p <0.001), compared to straight walking, together helping accelerate the COM towards the new walking direction. Knowledge of the changes in muscle contributions required to modulate the COM position during turning improves our understanding of the control mechanisms of gait and may be used clinically to guide the management of gait disorders in populations with restricted gait ability. [ABSTRACT FROM AUTHOR]

Walking requires active control of frontal plane balance through adjustments to mediolateral foot placement and ground reaction forces. Previous work on mediolateral balance perturbations and control of foot placement has often focused on the bilateral gluteus medius muscles. However, additional leg and trunk muscles can influence foot placement by transferring power to the foot and pelvis during swing. Thus, the purpose of this study was to determine individual muscle contributions to balance control following medial and lateral foot placement perturbations. Ten participants performed treadmill walking trials which included perturbations immediately before randomized heel strikes. Muscle contributions to foot placement, ground reaction forces, trunk power and frontal plane external moments during representative perturbed and unperturbed gait cycles were estimated using musculoskeletal modeling and simulation. Net muscle contributions to foot placement were 61 ± 50% more medial during the first recovery step following lateral perturbations and 28 ± 14% less medial in the second recovery step following medial perturbations. Following lateral perturbations, the swing gluteus medius performed 57 ± 50% more lateral work and the stance gluteus medius performed 61 ± 50% more medial work on the foot. Following medial perturbations, the erector spinae performed 39 ± 33% less lateral work on the foot. Changes in net muscle work on the foot were inconsistent with changes in step width, suggesting that changes in step width were not due to active muscle control but rather the mechanical effect of the perturbation. These outcomes provide a foundation for future studies analyzing balance control in populations at risk of falling. [ABSTRACT FROM AUTHOR]

The use of biodegradable synthetic grafts to repair injured ligaments may overcome the disadvantages of other solutions. Apart from biological compatibility, these devices shall also be functionally compatible and temporarily displayed, during the healing process, adequate mechanical support. Laxity of these devices is an important concern. This can cause failure since it may result in joint instability. Laxity results from a progressive accumulation of plastic strain during the cyclic loading. The functional compatibility of a biodegradable synthetic graft and, therefore, the global mechanical properties of the scaffold during degradation, can be optimised using computer-aiding and numerical tools. Therefore, in this work, the ability of numerical tools to predict the mechanical behaviour of the device during its degradation is discussed. Computational approaches based on elastoplastic and viscoplastic constitutive models are also presented. These models enable to simulate the plastic strain accumulation. These computational approaches, where the material model parameters depend on the hydrolytic degradation damage, are calibrated using experimental data measured from biodegradable suture fibres at different degradation steps. Due to durability requirements the selected materials are polydioxone (PDO) and polylactic acid and poly-caprolactone blend (PLA–PCL). Computational approaches investigated are able to predict well the experimental results for both materials, in full strain range until rupture and for different degradation steps. These approaches can be further used in more complex fibrous structures, to predict its global mechanical behaviour during degradation process. [ABSTRACT FROM AUTHOR]

The performance criterion in maximum vertical jumping has typically been assumed to simply raise the center of mass as high as possible. In many sporting activities minimizing movement time during the jump is likely also critical to successful performance. The purpose of this study was to examine maximum height jumps performed while minimizing jump time. A direct dynamics model was used to examine squat jump performance, with dual performance criteria: maximize jump height and minimize jump time. The muscle model had activation dynamics, force–length, force–velocity properties, and a series of elastic component representing the tendon. The simulations were run in two modes. In Mode 1 the model was placed in a fixed initial position. In Mode 2 the simulation model selected the initial squat configuration as well as the sequence of muscle activations. The inclusion of time as a factor in Mode 1 simulations resulted in a small decrease in jump height and moderate time savings. The improvement in time was mostly accomplished by taking off from a less extended position. In Mode 2 simulations, more substantial time savings could be achieved by beginning the jump in a more upright posture. However, when time was weighted more heavily in these simulations, there was a more substantial reduction in jump height. Future work is needed to examine the implications for countermovement jumping and to examine the possibility of minimizing movement time as part of the control scheme even when the task is to jump maximally. [ABSTRACT FROM AUTHOR]

Turning is an activity of daily living that involves both the acceleration of the body center-of-mass (COM) towards the center of curvature and rotation of the pelvis towards the new heading. The purpose of this study was to understand which muscles contribute to turning using experimentation, musculoskeletal modeling and simulation. Ten healthy adults consented to walk around a 1-m radius circular path at their self-selected walking speed and then along a straight line at the same speed. Forward dynamics simulations of the individual subjects during the turning and straight-line walking tasks were generated to identify the contributions of individual muscle groups to the body mediolateral and anterior-posterior COM acceleration impulse and to the pelvis angular acceleration impulse. The stance leg gluteus medius and ankle plantarflexor muscles and the swing leg adductor muscles were the primary contributors to redirect the body's COM relative to straight-line walking. In some cases, contributions to mediolateral COM acceleration were modulated through changes in leg orientation rather than through changes in muscle force. While modulation of the muscle contributions generally occurred in both the inner and outer legs, greater changes were observed during inner single-leg support than during outer single-leg support. Total pelvis angular acceleration was minimal during the single-support phase, but the swing leg muscles contributed significantly to balancing the internal and external rotation of the pelvis. The understanding of which muscles contribute to turning the body during walking may help guide the development of more effective locomotor therapies for those with movement impairments. [ABSTRACT FROM AUTHOR]

A method was developed to adjust the posture of a human numerical model to match the pre-impact posture of a human subject. The method involves pulling cables to prescribe the position and orientation of the head, spine and pelvis during a simulation. Six postured models matching the pre-impact posture measured on subjects tested in previous studies were created from a human numerical model. Posture scalars were measured on pre- and after applying the method to evaluate its efficiency. The lateral leaning angle ΘL defined between T1 and the pelvis in the coronal plane was found to be significantly improved after application with an average difference of 0.1±0.1° with the PMHS (4.6±2.7° before application). This method will be applied in further studies to analyze independently the contribution of pre-impact posture on impact response using human numerical models. [ABSTRACT FROM AUTHOR]

Simulating factors affecting human athletic performance, including fatigue, requires a dynamic model of the bioenergetic capabilities of the athlete. To address general cases, the model needs inputs, outputs, and states with a set of differential equations describing how the inputs affect the states and outputs as functions of time. We improve an existing phenomenological muscle model, removing unnecessarily fast dynamic behavior, adding force-velocity dependence, and generalizing it to task level activities. This makes it more suitable for simulating and calculating optimal strategies of athletic events of medium duration (longer than a sprint but shorter than a marathon). To examine the validity and limitations of the model, parameters have been identified from numerical fits to published experimental data. [ABSTRACT FROM AUTHOR]

Patient-specific simulations of bone remodelling could enable predicting how bone micro-structural integrity would be affected by bone diseases, drugs or other factors, and, ultimately could help clinicians to improve their prognoses. To simulate load-adaptive remodelling, however, knowledge about the physiological external loading acting on the bone is required. Assuming that load adaptation leads to homogeneous tissue loading, we previously developed a method to estimate the physiological loading history from bone micro-structural morphology. We were able to reconstruct the loading history of a simple load case that was applied in an animal experiment. However, we found considerable inhomogeneity in tissue loading suggesting that the bones were not fully adapted. Also, we noted differences in bone micro-architecture between animals despite common loading history, possibly due to differences caused by the stochastic nature of the bone remodelling process. In the present study, we aim at validating the load estimation algorithm in a well-controlled environment in which more complicated loading conditions are applied. Specifically, we want to test its accuracy for partially and fully developed bone structures and for differences in bone micro-architectures as they can occur due to stochastic events, even for bones with a common loading history. This was possible by using synthetic micro-architectures obtained from bone remodelling simulations as the basis for our load estimation algorithm. Loading histories based on fully adapted structures were predicted with a maximum error of 4.4% and predictions were not affected by differences in bone micro-architecture. These results show that our load estimation algorithm produces reasonable predictions and might be a suitable tool to define in vivo loading for patient-specific bone remodelling studies. [ABSTRACT FROM AUTHOR]

Tricuspid regurgitation (TR) is associated with increased mortality in patients undergoing mitral valve repair. In recent decades, TR has been addressed using annuloplasty concomitantly with mitral valve repair by some surgeons. However, repair efficacy and durability are often suboptimal. Increased understanding of tricuspid valve coaptation and the effects of pathological and repair conditions may be useful to inform future repair design. In the present study, we propose a two-dimensional in vitro technique, available coaptation area (ACA), to quantify the area of each tricuspid leaflet available for coaptation. Preliminary results showed that annular dilatation caused a significant (p < 0.05) decrease in anterior leaflet ACA (0.92 ± 0.18 cm²), and combined annular dilatation and papillary muscle (PM) displacement resulted in a significant decrease in posterior leaflet ACA (0.87 ± 0.15 cm ²). Isolated PM displacement did not have a significant effect on ACA, and the septal leaflet showed no changed in ACA under the conditions tested. In addition to quantifying ACA, our technique allows for the detailed mapping of leaflet coaptation, which may be used to reveal specific sites of malcoaptation on each leaflet. Application of the ACA method in future studies may lead to the development of specialized tricuspid repair strategies and annuloplasty ring designs that target specific regions of the tricuspid valve based on underlying pathological conditions. [ABSTRACT FROM AUTHOR]

High-resolution in vivo bone micro-architecture assessment, as possible now for the distal forearm, in combination with bone remodelling simulation algorithms could, eventually, predict patient-specific bone morphology changes. To simulate load-adaptive bone remodelling, however, physiological loading conditions must be defined. In this paper we test a previously developed algorithm to estimate such physiological loading conditions from the bone micro-architecture. The aims of this study were to investigate if realistic boundary forces and moments are predicted for the scanned distal radius section and how these predicted forces and moments should be distributed to the scanned section in order to obtain a load transfer similar to that in situ. Images at in vivo resolution were generated for the clinically measured section of nine distal radius cadaver bones, converted to micro-finite element models and used for load estimation. Models of the full distal radius were created to analyse tissue loading distributions of the sections in situ. It was found that predicted forces and moments at the boundaries of the scanned region varied considerably but, when translated to equivalent radiocarpal joint forces, agreed well with values reported in the literature. Bone tissue loading distribution was in best agreement with in situ distributions when loading was applied to an extra layer of material at both ends of the clinical scan region. The agreement of the predicted loading to previous studies and the wide range of predicted loading values indicate that subject-specific bone loading estimation is possible and necessary. [ABSTRACT FROM AUTHOR]

Abstract: Muscle weakness is commonly cited as a cause of crouch gait in individuals with cerebral palsy; however, outcomes after strength training are variable and mechanisms by which muscle weakness may contribute to crouch gait are unclear. Understanding how much muscle strength is required to walk in a crouch gait compared to an unimpaired gait may provide insight into how muscle weakness contributes to crouch gait and assist in the design of strength training programs. The goal of this study was to examine how much muscle groups could be weakened before crouch gait becomes impossible. To investigate this question, we first created muscle-driven simulations of gait for three typically developing children and six children with cerebral palsy who walked with varying degrees of crouch severity. We then simulated muscle weakness by systematically reducing the maximum isometric force of each muscle group until the simulation could no longer reproduce each subject’s gait. This analysis indicated that moderate crouch gait required significantly more knee extensor strength than unimpaired gait. In contrast, moderate crouch gait required significantly less hip abductor strength than unimpaired gait, and mild crouch gait required significantly less ankle plantarflexor strength than unimpaired gait. The reduced strength required from the hip abductors and ankle plantarflexors during crouch gait suggests that weakness of these muscle groups may contribute to crouch gait and that these muscle groups are potential targets for strength training. [Copyright &y& Elsevier]

Abstract: Impaired control of mediolateral body motion during walking is an important health concern. Developing treatments to improve mediolateral control is challenging, partly because the mechanisms by which muscles modulate mediolateral ground reaction force (and thereby modulate mediolateral acceleration of the body mass center) during unimpaired walking are poorly understood. To investigate this, we examined mediolateral ground reaction forces in eight unimpaired subjects walking at four speeds and determined the contributions of muscles, gravity, and velocity-related forces to the mediolateral ground reaction force by analyzing muscle-driven simulations of these subjects. During early stance (0–6% gait cycle), peak ground reaction force on the leading foot was directed laterally and increased significantly (p<0.05) with walking speed. During early single support (14–30% gait cycle), peak ground reaction force on the stance foot was directed medially and increased significantly (p<0.01) with speed. Muscles accounted for more than 92% of the mediolateral ground reaction force over all walking speeds, whereas gravity and velocity-related forces made relatively small contributions. Muscles coordinate mediolateral acceleration via an interplay between the medial ground reaction force contributed by the abductors and the lateral ground reaction forces contributed by the knee extensors, plantarflexors, and adductors. Our findings show how muscles that contribute to forward progression and body-weight support also modulate mediolateral acceleration of the body mass center while weight is transferred from one leg to another during double support. [Copyright &y& Elsevier]

Abstract: Unilateral, below-knee amputees have altered gait mechanics, which can significantly affect their mobility. Below-knee amputees lose the functional use of the ankle muscles, which are critical during walking to provide body support, forward propulsion, leg-swing initiation and mediolateral balance. Thus, either muscles must compensate or the prosthesis must provide the functional tasks normally provided by the ankle muscles. Three-dimensional (3D) forward dynamics simulations of amputee and non-amputee walking were generated to identify muscle and prosthesis contributions to amputee walking mechanics, including the subtasks of body support, forward propulsion, leg-swing initiation and mediolateral balance. Results showed that the prosthesis provided body support in the absence of the ankle muscles. The prosthesis contributed to braking from early to mid-stance and propulsion in late stance. The prosthesis also functioned like the uniarticular soleus muscle by transferring energy from the residual leg to the trunk to provide trunk propulsion. The residual-leg vasti and rectus femoris reduced their contributions to braking in early stance, which mitigated braking from the prosthesis during this period. The prosthesis did not replace the function of the gastrocnemius, which normally generates energy to the leg to initiate swing. As a result, lower overall energy was delivered to the residual leg. The prosthesis also acted to accelerate the body laterally in the absence of the ankle muscles. These results provide further insight into muscle and prosthesis function in below-knee amputee walking and can help guide rehabilitation methods and device designs to improve amputee mobility. [Copyright &y& Elsevier]

Abstract: The kinematic mechanisms associated with elevated externally applied valgus knee moments during non-contact sidestepping and subsequent anterior cruciate ligament (ACL) injury risk are not well understood. To address this issue, the residual reduction algorithm (RRA) in OpenSim was used to create nine subject-specific, full-body (37 degrees of freedom) torque-driven simulations of athletic males performing unplanned sidestep (UnSS) sport tasks. The RRA was used again to produce an optimized kinematic solution with reduced peak valgus knee torques during the weight acceptance phase of stance. Pre-to-post kinematic optimization, mean peak valgus knee moments were significantly reduced by 44.2Nm (p=0.045). Nine of a possible 37 upper and lower body kinematic changes in all three planes of motion were consistently used during the RRA to decrease peak valgus knee moments. The generalized kinematic strategy used by all nine simulations to reduce peak valgus knee moments and subsequent ACL injury risk during UnSS was to redirect the whole-body center of mass medially, towards the desired direction of travel. [Copyright &y& Elsevier]