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Introduction: This study analysed femoral curvature in a population from Belgium in conjunction with other morphological characteristics by the use of three-dimensional (3D) quadric surfaces (QS) modelled from the bone surface., Methods: 3D models were created from computed tomography data of 75 femoral modern human bones. Anatomical landmarks (ALs) were palpated in specific bony areas of the femur (shaft, condyles, neck and head). QS were then created from the surface vertices which enclose these ALs. The diaphyseal shaft was divided into five QS shapes to analyse curvature in different parts of the shaft., Results: Femoral bending differs in different parts of the diaphyseal shaft. The greatest degree of curvature was found in the distal shaft (mean 4.5° range 0.2°-10°) followed by the proximal (mean 4.4° range 1.5°-10.2°), proximal intermediate (mean 3.7° range 0.9°-7.9°) and distal intermediate (mean 1.8° range 0.2°-5.6°) shaft sections. The proximal and distal angles were significantly more bowed than the intermediate proximal and the intermediate distal angle. There was no significant difference between the proximal and distal angle. No significant correlations were found between morphological characteristics and femoral curvature. An extremely large variability of femoral curvature with several bones displaying very high or low degrees of femoral curvature was also found., Conclusion: 3D QS fitting enables the creation of accurate models which can discriminate between different patterns in similar curvatures and demonstrates there is a clear difference between curvature in different parts of the shaft.

Background: Since 2010, an increasing interest in more portable and flexible hardware for balance and posture assessment led to previously published studies determining whether or not the Wii Balance Board could be used to assess balance and posture, both scientifically and clinically. However, no previous studies aimed at comparing results from different Wii Balance Boards for clinical balance evaluation exist., Objective: The objective of this crossover study is to assess the interchangeability of the Wii Balance Board., Methods: A total of 6 subjects participated in the study and their balance was assessed using 4 different Wii Balance Boards. Trials were recorded simultaneously with Wii Balance Boards and with a laboratory force plate. Nine relevant clinical parameters were derived from center of pressure displacement data obtained from Wii Balance Board and force plate systems. Intraclass correlation coefficients (ICC), F tests, and Friedman tests were computed to assess the agreement between trials and to compare the Wii Balance Board and force plate results., Results: Excellent correlations were found between the Wii Balance Board and force plate (mean ρ =.83). With the exception of 2 parameters, strong to excellent agreements were found for the 7 remaining parameters (ICC=.96). No significant differences were found between trials recorded with different Wii Balance Boards., Conclusions: Our results indicate that for most of the parameters analyzed, balance and posture assessed with one Wii Balance Board were statistically similar to results obtained from another. Furthermore, the good correlation between the Wii Balance Board and force plate results shows that Wii Balance Boards can be reliably used for scientific assessment using most of the parameters analyzed in this study. These results also suggest that the Wii Balance Board could be used in multicenter studies and therefore, would allow for the creation of larger populations for clinical studies., Trial Registration: Ethical Committee of the Erasme Hospital (CCB B406201215142)., (©Bruno Bonnechère, Bart Jansen, Lubos Omelina, Marcel Rooze, Serge Van Sint Jan. Originally published in JMIR Rehabilitation and Assistive Technology (http://rehab.jmir.org), 27.08.2015.)

The literature concerning quantification of costovertebral joint (CVJ) motion under in vivo conditions is scarce. Most papers concerning this topic are related to ex vivo loading conditions. In vivo protocols are available from the literature to determine rib and vertebra kinematics but new developments are needed to improve data processing concerning CVJ behaviour obtained from discrete breathing positions showing limiting ranges-of-motion and sensitive to noise. Data from previous work were used to implement a method analyzing mean helical axis (MHA) and pivot point parameters of the CVJ complexes. Several levels of noises were estimated within Monte-Carlo simulations to optimize MHA results. MHA parameters were then used to transform and define a CVJ-specific local coordinate system. This study proposes an improvement for CVJ kinematics processing and description from in vivo data obtained from computed tomography. This methodology emphasizes the possibility to work with variability of MHA parameters using Monte-Carlo procedures on anatomical landmark coordinates and to define a local coordinate system from this particular joint behaviour. Results from the CVJ joint model are closer to a hinge joint (secondary motions inferior to 3°) when anatomical frames are expressed from MHA orientation. MHA orientation and position data obtained from the proposed method are relevant according to angular dispersion obtained (from 7.5° to 13.9°) and therefore relevant to define behaviour of CVJ., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

A global coordinate system (GCS) method is proposed to estimate hip and lumbosacral joint centers (HJC and LSJC) from at least three distances between joint center of interest and target anatomic landmarks (ALs). The distances from HJC and LSJC to relevant pelvis and femur ALs were analyzed with respect to usual pelvis and femur scaling dimensions. Forty six pelves and related pairs of femurs from a same sample of adult specimens were examined. The corresponding regression equations were obtained. These equations can be used to estimate HJC and LSJC in conditions where a very limited number of ALs are available: for example, during seated posture analysis as performed in the automotive industry. Compared to currently existing HJC and LSJC methods from ALs, the proposed method showed better results with an average error less than 11 mm., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Gait analysis is used in daily clinics for patients' evaluation and follow-up. Stereophotogrammetric devices are the most used tool to perform these analyses. Although these devices are accurate results must be analyzed carefully due to relatively poor reproducibility. One of the major issues is related to skin displacement artifacts. Motion representation is recognized reliable for the main plane of motion displacement, but secondary motions, or combined, are less reliable because of the above artifacts. Model-based approach (MBA) combining accurate joint kinematics and motion data was previously developed based on a double-step registration method. This study presents an extensive validation of this MBA method by comparing results with a conventional motion representation model. Thirty five healthy subjects participated to this study. Gait motion data were obtained from a stereophotogrammetric system. Plug-in Gait model (PiG) and MBA were applied to raw data, results were then compared. Range-of-motion, were computed for pelvis, hip, knee and ankle joints. Differences between PiG and MBA were then computed. Paired-sample t-tests were used to compare both methods. Normalized root-mean square errors were also computed. Shapes of the curves were compared using coefficient of multiple correlations. The MBA and PiG approaches shows similar results for the main plane of motion displacement but statistically significative discrepancies appear for the combined motions. MBA appear to be usable in applications (such as musculoskeletal modeling) requesting better approximations of the joints-of-interest thanks to the integration of validated joint mechanisms., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Semitendinosus and gracilis muscles whose tendons are used in surgical reconstruction of the anterior cruciate ligament maintain their contractile ability, and a limited decrease of hamstring muscles force is observed postoperatively despite important changes. The goal was to quantify the influence of the myofascial structures on excursions and moment arms of knee muscles to attempt explaining the above-mentioned post-surgical observations., Methods: Hamstring harvesting procedures were performed by a senior orthopaedic surgeon on seven lower limbs from fresh-frozen specimens. Femoro-tibial kinematics and tendons excursion were simultaneously recorded at each steps of the surgery., Findings: No significant difference was demonstrated for excursions and moment arms after tenotomies and gracilis tendon harvesting (P≥0.05). The first significant semitendinosus excursion (P<1.17×10(-4)) and moment arm (P<6.88×10(-5)) decrease was observed after semitendinosus tendon harvesting (46% of the initial excursion)., Interpretation: Gracilis and semitendinosus myofascial pathway is crucial for force transmission towards the knee joint., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Purpose: The lacertus fibrosus (LF) is involved in various surgical procedures. However, the anatomy, morphometry, topography and biomechanical involvements of LF are not clear. The purpose of this study was to determine the anatomical and morphometric variations of LF, and to correlate this with anthropometric and morphometric measurements of the upper limb. Furthermore, the presence or absence of a deep layer of LF was verified using forearm cross-sections and dissections., Methods: This anatomical study was performed by observation of dissections and transverse sections obtained from 50 cadavers. Morphometric analyses [length and width of LF and biceps tendon, stature, length of upper limb, forearm, bi-epicondylar width, forearm perimeter, biceps brachii muscle perimeter (BBm)] were also performed., Results: The results demonstrated that there was no significant correlation between LF morphology and morphometric upper limb measurements. The deep layer of LF was observed in all specimens., Conclusion: Results of this paper indicate that the LF presents individual characteristics such as length and width. The deeper layer of LF was observed on all specimens. The possible role of LF in force transmission during flexion, BBm moment arm adjustment and supination reduction is discussed in view of these results.

The use of video games in rehabilitation is becoming more popular to clinicians. These games are embedded in off-the-shelf commercial entertainment applications or especially-developed for clinical purposes. Treatment of cerebral palsy (CP) children is a challenging task for clinicians. Lack of motivation and progress monitoring are two important factors clinicians need to deal with. The use of serious games (SG), sometimes referred to as Virtual Rehabilitation (VR), could therefore be an interesting adjuvant to conventional treatment for these patients. This is however a new discipline and many scientific issues remain to be solved. The aim of this paper is to describe available conventional treatment for CP children together with the level of evidence of each approach. A systematic review of the use of SG in rehabilitation is then conducted. 31 papers (7 randomized clinical trials, 16 cohort studies and 8 single-cases studies) were selected and analyzed, and their level of evidence compared to the conventional treatment. These studies reported outcomes for 352 patients. In summary, this review shows that it is difficult to compare those studies despite the large amount of patients. This is due to the lack of standardization in patient rehabilitation strategy and to the use of various clinical scales and scores. This non-standardization in patient follow-up between previously-published works make evidence-based conclusions difficult to obtain in order to support these techniques objectively. The use of SG for rehabilitation purposes currently meets similar issues. This paper proposes standardization strategies in order to improve treatment comparison and SG use in rehabilitation., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: The Kinect™ (Microsoft™, Redmond, WA) sensor, originally developed for gaming purposes, may have interesting possibilities for other fields such as posture and motion assessment. The ability of the Kinect sensor to perform biomechanical measurements has previously been studied and shows promising results. However, interday repeatability of the device is still not known., Materials and Methods: This study assessed the intra- and interday repeatability of the Kinect sensor compared with a standard stereophotogrammetric device during posture assessment for measuring segment lengths. Forty subjects took part in the study. Five motionless captures were performed in one session to assess posture. Data were simultaneously recorded with both devices., Results: Similar intraclass correlations coefficient (ICC) values were found for intraday (ICC=0.94 for the Kinect device and 0.98 for the stereophotogrammetric device) and interday (ICC=0.88 and 0.87, respectively) repeatability., Conclusions: Results of this study suggest that a cost-effective, easy-to-use, and portable single markerless camera offers the same repeatability during posture assessment as an expensive, time-consuming, and nontransportable marker-based device.

Despite the availability of the International Society of Biomechanics (ISB) recommendations for the orientation of anatomical frames, no consensus exists about motion representations related to finger kinematics. This paper proposes novel anatomical frames for motion representation of the phalangeal segments of the long fingers. A three-dimensional model of a human forefinger was acquired from a non-pathological fresh-frozen hand. Medical imaging was used to collect phalangeal discrete positions. Data processing was performed using a customized software interface ("lhpFusionBox") to create a specimen-specific model and to reconstruct the discrete motion path. Five examiners virtually palpated two sets of landmarks. These markers were then used to build anatomical frames following two methods: a reference method following ISB recommendations and a newly-developed method based on the mean helical axis (HA). Motion representations were obtained and compared between examiners. Virtual palpation precision was around 1mm, which is comparable to results from the literature. The comparison of the two methods showed that the helical axis method seemed more reproducible between examiners especially for secondary, or accessory, motions. Computed Root Mean Square distances comparing methods showed that the ISB method displayed a variability 10 times higher than the HA method. The HA method seems to be suitable for finger motion representation using discrete positions from medical imaging. Further investigations are required before being able to use the methodology with continuous tracking of markers set on the subject's hand., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: The costovertebral joint complex is mechanically involved in both respiratory function and thoracic spine stability. The thorax has been studied for a long time to understand its involvement in the physiological mechanism leading to specific gas exchange. Few studies have focused on costovertebral joint complex kinematics, and most of them focused on experimental in vitro analysis related to loading tests or global thorax and/or lung volume change analysis. There is however a clinical need for new methods allowing to process in vivo clinical data. This paper presents results from in vivo analysis of the costovertebral joint complex kinematics from clinically-available retrospective data., Methods: In this study, in vivo spiral computed tomography imaging data were obtained from 8 asymptomatic subjects at three different lung volumes (from total lung capacity to functional residual capacity) calibrated using a classical spirometer. Fusion methods including 3D modelling and kinematic analysis were used to provide 3D costovertebral joint complex visualization for the true ribs (i.e., first seven pairs of ribs)., Findings: The 3D models of the first seven pairs of costovertebral joint complexes were obtained. A continuous kinematics simulation was interpolated from the three discrete computerized tomography positions. Helical axis representation was also achieved., Interpretation: Preliminary results show that the method leads to meaningful and relevant results for clinical and pedagogical applications. Research in progress compares data from a sample of healthy volunteers with data collected from patients with cystic fibrosis to obtain new insights about the costovertebral joint complex range of motion and helical axis assessment in different pathological conditions., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The recent availability of the Kinect™ sensor, a low-cost Markerless Motion Capture (MMC) system, could give new and interesting insights into ergonomics (e.g. the creation of a morphological database). Extensive validation of this system is still missing. The aim of the study was to determine if the Kinect™ sensor can be used as an easy, cheap and fast tool to conduct morphology estimation. A total of 48 subjects were analysed using MMC. Results were compared with measurements obtained from a high-resolution stereophotogrammetric system, a marker-based system (MBS). Differences between MMC and MBS were found; however, these differences were systematically correlated and enabled regression equations to be obtained to correct MMC results. After correction, final results were in agreement with MBS data (p = 0.99). Results show that measurements were reproducible and precise after applying regression equations. Kinect™ sensors-based systems therefore seem to be suitable for use as fast and reliable tools to estimate morphology. Practitioner Summary: The Kinect™ sensor could eventually be used for fast morphology estimation as a body scanner. This paper presents an extensive validation of this device for anthropometric measurements in comparison to manual measurements and stereophotogrammetric devices. The accuracy is dependent on the segment studied but the reproducibility is excellent.

The hip bone is one of the most reliable indicators of sex in the human body due to the fact it is the most dimorphic bone. Probabilistic Sex Diagnosis (DSP: Diagnose Sexuelle Probabiliste) developed by Murail et al., in 2005, is a sex determination method based on a worldwide hip bone metrical database. Sex is determined by comparing specific measurements taken from each specimen using sliding callipers and computing the probability of specimens being female or male. In forensic science it is sometimes not possible to sex a body due to corpse decay or injury. Skeletalization and dissection of a body is a laborious process and desecrates the body. There were two aims to this study. The first aim was to examine the accuracy of the DSP method in comparison with a current visual sexing method on sex determination. A further aim was to see if it was possible to virtually utilise the DSP method on both the hip bone and the pelvic girdle in order to utilise this method for forensic sciences. For the first part of the study, forty-nine dry hip bones of unknown sex were obtained from the Body Donation Programme of the Université Libre de Bruxelles (ULB). A comparison was made between DSP analysis and visual sexing on dry bone by two researchers. CT scans of bones were then analysed to obtain three-dimensional (3D) virtual models and the method of DSP was analysed virtually by importing the models into a customised software programme called lhpFusionBox which was developed at ULB. The software enables DSP distances to be measured via virtually-palpated bony landmarks. There was found to be 100% agreement of sex between the manual and virtual DSP method. The second part of the study aimed to further validate the method by analysing thirty-nine supplementary pelvic girdles of known sex blind. There was found to be a 100% accuracy rate further demonstrating that the virtual DSP method is robust. Statistically significant differences were found in the identification of sex between researchers in the visual sexing method although both researchers identified the same sex in all cases in the manual and virtual DSP methods for both the hip bones and pelvic girdles., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Foot roll-over is commonly analyzed to evaluate gait pathologies. The current study utilized a dynamic foot scanner (DFS) to analyze foot roll-over. The right feet of ten healthy subjects were assessed during gait trials with a DFS system integrated into a walkway. A foot sole picture was computed by vertically projecting points from the 3D foot shape which were lower than a threshold height of 15 mm. A 'height' value of these projected points was determined; corresponding to the initial vertical coordinates prior to projection. Similar to pedobarographic analysis, the foot sole picture was segmented into anatomical regions of interest (ROIs) to process mean height (average of height data by ROI) and projected surface (area of the projected foot sole by ROI). Results showed that these variables evolved differently to plantar pressure data previously reported in the literature, mainly due to the specificity of each physical quantity (millimeters vs Pascals). Compared to plantar pressure data arising from surface contact by the foot, the current method takes into account the whole plantar aspect of the foot, including the parts that do not make contact with the support surface. The current approach using height data could contribute to a better understanding of specific aspects of foot motion during walking, such as plantar arch height and the windlass mechanism. Results of this study show the underlying method is reliable. Further investigation is required to validate the DFS measurements within a clinical context, prior to implementation into clinical practice., (Copyright © 2013 Elsevier B.V. All rights reserved.)

The recent availability of the Kinect™ sensor, a cost-effective markerless motion capture system (MLS), offers interesting possibilities in clinical functional analysis and rehabilitation. However, neither validity nor reproducibility of this device is known yet. These two parameters were evaluated in this study. Forty-eight volunteers performed shoulder abduction, elbow flexion, hip abduction and knee flexion motions; the same protocol was repeated one week later to evaluate reproducibility. Movements were simultaneously recorded by the Kinect (with Microsoft Kinect SDK v.1.5) MLS and a traditional marker-based stereophotogrammetry system (MBS). Considering the MBS as reference, discrepancies between MLS and MBS were evaluated by comparing the range of motion (ROM) between both systems. MLS reproducibility was found to be statistically similar to MBS results for the four exercises. Measured ROMs however were found different between the systems., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Modeling tools related to the musculoskeletal system have been previously developed. However, the integration of the real underlying functional joint behavior is lacking and therefore available kinematic models do not reasonably replicate individual human motion. In order to improve our understanding of the relationships between muscle behavior, i.e. excursion and motion data, modeling tools must guarantee that the model of joint kinematics is correctly validated to ensure meaningful muscle behavior interpretation. This paper presents a model-based method that allows fusing accurate joint kinematic information with motion analysis data collected using either marker-based stereophotogrammetry (MBS) (i.e. bone displacement collected from reflective markers fixed on the subject's skin) or markerless single-camera (MLS) hardware. This paper describes a model-based approach (MBA) for human motion data reconstruction by a scalable registration method for combining joint physiological kinematics with limb segment poses. The presented results and kinematics analysis show that model-based MBS and MLS methods lead to physiologically-acceptable human kinematics. The proposed method is therefore available for further exploitation of the underlying model that can then be used for further modeling, the quality of which will depend on the underlying kinematic model., (© 2013 Elsevier Ltd. All rights reserved.)

LhpFusionBox is a program originally designed for biomechanical and clinical studies relating to the musculoskeletal system of anatomically modern humans (AMH). The program has recently been adapted for paleontological purposes and used to reconstruct and biomechanically analyse a fossil hominid. There is no complete Neandertal skeleton in the fossil record. The aim of the study was to reconstruct a complete three-dimensional (3D) model of a Neandertal using the relatively complete Spy II Neandertal and to conduct biomechanical feasibility studies on the knee and hamstring moment arms of the skeleton. Different Neandertal specimens were scaled to the size of Spy II to replace incomplete or missing bones. Biomechanical feasibility studies performed on the knee seem to show that Neandertal and AMHh gait is similar and Neandertals were shown to have larger moment arms in the hamstring muscles, which would have given them a mechanical advantage. The complete Neandertal was printed in 3D and used as the base to create the artistic model of "Spyrou" housed at l'Espace de l'Homme de Spy (EHoS) museum., (© 2013 médecine/sciences – Inserm.)

The musculoskeletal system (MSS) is essential to allow us performing every-day tasks, being able to have a professional life or developing social interactions with our entourage. MSS pathologies have a significant impact on our daily life. It is therefore not surprising to find MSS-related health problems at the top of global statistics on professional absenteeism or societal health costs. The MSS is also involved in central nervous conditions, such as cerebral palsy (CP). Such conditions show complex etiology that complicates the interpretation of the observable clinical signs and the establishment of a wide consensus on the best practices to adopt for clinical monitoring and patient follow-up. These elements justify the organization of fundamental and applied research projects aiming to develop new methods to help clinicians to cope with the complexity of some MSS disorders. The ICT4Rehab project (www.ict4rehab.org) developed an integrated platform providing tools that enable easier management and visualization of clinical information related to the MSS of CP patients. This platform is opened to every interested clinical centre., (© 2013 médecine/sciences – Inserm.)

Purpose: Bilateral sagittal split osteotomy (BSSO) is the most common procedure used to treat mandibular deformities. BSSO procedures include the Epker technique and the Dal Pont technique which are the most frequently used. Because of the intramandibular pathway of the inferior alveolar nerve (IAN), neurosensory disturbance of the lower lip and chin is the most common complication of BSSO. This study performed quantitative measurements from computed tomographic (CT) data obtained on dry human mandibles. The main aim of the study was to evaluate if mandibular divergence can predict the position of the IAN and the mylohyoid nerve (MHN) to prevent nerve injury., Methods: After CT and 3D reconstruction of 65 dry mandibles, 30 measurements were made on 3 planes for each hemi-mandible. This allowed analysis of the IAN and MHN pathways. Three groups of hemi-mandibles were created depending on their divergence, and a statistical analysis was performed., Results: Eight out of the 30 measurements showed a significant difference among the 3 groups. There was no significant difference for the remaining 22 measurements., Conclusions: The IAN seems to have a more superior position in the groups of mandibular hypo- and hyper-divergence. Orthognathic surgeons should use a more superficial retromolar bone incision in these cases. Finally, the Epker technique would be safer for preserving the MHN in normo- and hypo-divergent patients.

Diagnosis and most of all classification of children with cerebral palsy (CP) remain a challenge for clinicians. To help them in this process, clinicians can rely on several clinical testing procedures as well as complementary investigations. The goal of this study was to determine which clinical tests found in the literature are the most frequently used in common practice in Belgium. Forty tests have been found in the literature. They have been sorted into five different categories: quantitative evaluation of motor function, spasticity evaluation, orthopaedic testing, upper limb evaluation and complementary investigations. Seven clinicians (five medical doctors and two physiotherapists) with a mean experience of sixteen years with CP children answered the questionnaire. Concerning the quantitative evaluation of motor function the most used tests are: Gross Motor Function Classification System, Manual Ability Classification System and the Pediatric Evaluation of Disability Inventory (PEDI). As regards spasticity, Ashworth scale is more frequently used than Tardieu test. No trend currently exist for the upper limb evaluation, but it was noted that these tests are rarely used in clinical practice. We observed a significant use of gait analysis at diagnosis and follow-up of CP children. We conclude that there are large differences between clinicians for clinical examination of CP children. This lack of consensus makes patient data comparison difficult between clinical centers. This seems to indicate that a homogenization effort should be organized if one wishes to better stimulate collaborations between centers.

Background: Lower limb torsion disorders have been considered as a factor inducing gonarthrosis and the three-dimensional effect of the surgical correction is not well reported yet. This paper reports an in vitro study aiming at quantifying the relationships between experimental femoral torsion disorders and moment arms of thigh muscles., Methods: Five unembalmed lower limbs were used and fixed on an experimental jig. Muscles were loaded and 6 Linear Variable Differential Transformers were used to measure tendon excursions. Experimental osteotomies were performed to simulate torsions by steps of 6° up to 18°. Moment arms of the main thigh muscles were estimated by the tendon excursion method during knee flexion., Findings: Moment arms of the tensor of fascia latae, the gracilis and the semitendinosus were significantly influenced by experimental conditions while the rectus femoris, the biceps femoris and the semimembranosus did not show modifications. Medial femoral torsion decreased the moment arm of both the gracilis and the semimembranosus. Opposite changes were observed during lateral femoral torsion. The moment arm of the tensor of fascia latae decreased significantly after 30° of knee flexion for 18° of medial femoral torsion., Interpretation: Our results showed that medial and lateral femoral torsion disorders induced alterations of the moment arms of the muscles located medially to the knee joint when applied in aligned lower limbs. These results highlight a potential clinical relevance of the effect of femoral torsion alterations on moment arms of muscles of the thigh which may be related, with knee kinematics modifications, to the development of long-term knee disease., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Many studies show good clinical results after proximal row carpectomy. Some biomechanical consequences are documented, but to our knowledge muscle moment arm variations have not previously been quantified., Methods: In five fresh-frozen wrist, kinematics and tendon excursions were measured using a 3D electrogoniometer and Linear Variable Differential Transformers (SOLARTRON Inc., AMETEK Advanced Measurement Technology, Inc, 801 South Illinois Avenue, Oak Ridge, TN 37831-2011, USA), respectively, in three conditions: intact wrist, after posterior capsulotomy and after proximal row carpectomy. Mean pivot point, defined as the point whose sum of the squared distances to the helical axes is minimum, wrist range of motion and mean moment arms were measured during dorso-palmar flexion, radioulnar deviation and circumduction movements., Findings: No alteration of the range of motion was observed. On the other hand, the mean pivot point shifted proximally (6.8-9.1mm) after proximal row carpectomy (p<0.05) for all motions tested and most muscle moment arms decreased significantly after proximal row carpectomy., Interpretation: The results of this study allow a better understanding of the biomechanical effects of this procedure. The important moment arm reduction and pivot point displacement suggest modifications of joint biomechanical parameters which could influence the functional outcome of PRC., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Purpose: Osteoarthritis (OA) of the knee is a degenerative disease mainly found in elderly population. Valgus deformity seems to be directly related to lateralised gonarthrosis. Contradictory outcomes of surgical series are published in the literature and report satisfactory and unsatisfactory long-term results. Lower limb torsions disorders have been considered as being another factor inducing gonarthrosis. This paper presents an in vitro study aiming at quantifying the relationships between experimental femoral torsion disorders (medial and lateral) and the deformation of the cancellous bone of the proximal tibial epiphysis (CB(TPE))., Methods: Five left fresh-frozen lower limbs were used. Specimens were mounted on an experimental jig and muscles were loaded. Six measurement elements, including strain gages, were introduced into CB(TPE) to measure relative deformation. Experimental osteotomy control was performed using a specially devised system allowing various amplitudes of medial and lateral torsion. CB(TPE) deformations were measured during knee flexion movement., Results: Intra-observer reproducibility of CB(TPE) deformations showed a mean coefficient of multiple correlation of 0.93 and a mean coefficient of variation of 9% for flexion. Intra-specimen repeatability showed a mean RMS difference ranging from 7 to 10% and a mean ICC of 0.98. CB(TPE) deformations were significantly influenced by femoral torsion disorder conditions and range-of-motion (ROM) for most measurement elements. No interaction between torsion condition and ROM was observed. Globally, CB(TPE) deformation in the lateral compartment increased during experimental lateral torsion disorder simulation and decreased during medial torsion simulation. The opposite behaviour was observed in the medial compartment. The decrease and/or increase were not always proportional to the degree of femoral torsional disorder simulated., Conclusion: Experimental results from this study do not fully agree with previously published clinical observations on the femoral torsion disorder. The present quantified results do not support that medial femoral torsion disorder induces an increased lateral tibial deformation, which could be linked to gonarthrosis observed in this compartment. In summary, our results showed that medial and lateral femoral torsion disorder conditions applied in normally aligned lower limb induced a deformation increase in the medial and in the lateral compartment, respectively.

Skeletal forces are fundamental information in predicting the risk of bone fracture. The neuromotor control system can drive muscle forces with various task- and health-dependent strategies but current modelling techniques provide a single optimal solution of the muscle load sharing problem. The aim of the present work was to study the variability of the hip load magnitude due to sub-optimal neuromotor control strategies using a subject-specific musculoskeletal model. The model was generated from computed tomography (CT) and dissection data from a single cadaver. Gait kinematics, ground forces and electromyographic (EMG) signals were recorded on a body-matched volunteer. Model results were validated by comparing the traditional optimisation solution with the published hip load measurements and the recorded EMG signals. The solution space of the instantaneous equilibrium problem during the first hip load peak resulted in 10(5) dynamically equivalent configurations of the neuromotor control. The hip load magnitude was computed and expressed in multiples of the body weight (BW). Sensitivity of the hip load boundaries to the uncertainty on the muscle tetanic stress (TMS) was also addressed. The optimal neuromotor control induced a hip load magnitude of 3.3 BW. Sub-optimal neuromotor controls induced a hip load magnitude up to 8.93 BW. Reducing TMS from the maximum to the minimum the lower boundary of the hip load magnitude varied moderately whereas the upper boundary varied considerably from 4.26 to 8.93 BW. Further studies are necessary to assess how far the neuromotor control can degrade from the optimal activation pattern and to understand which sub-optimal controls are clinically plausible. However we can consider the possibility that sub-optimal activations of the muscular system play a role in spontaneous fractures not associated with falls., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Study Design: In vitro and modeling study of upper cervical spine (UCS) three-dimensional (3D) kinematics and muscle moment arm (MA) during axial rotation (AR) and flexion extension (FE)., Objective: To create musculoskeletal models with movement simulation including helical axis (HA) and muscle features., Summary of Background Data: Integration of various kinematics and muscle data into specific-specimen 3D anatomical models with graphical representation of HA and muscle orientation and MA is not reported for the UCS musculoskeletal system., Methods: Kinematics, anatomical, and computed tomographic imaging data were sampled in 10 anatomical specimens. Using technical markers and anatomical landmarks digitizing, spatial position of segments was computed for five discrete positions of AR and FE using a 3D digitizer. To obtain musculoskeletal model simulation, a registration method was used to combine collected data. Processing was performed using orientation vector and HA computation and suboccipital muscle features (i.e., length and MA) relative to motion angle., Results: Range of motion and coupling were in agreement with previous in vitro studies. HA (i.e., location and orientation) showed low variation at the occipitoaxial and atlantoaxial levels for FE and AR, respectively. The main orientation of the HA was vertical at C1-C2 during AR and horizontal at C0-C1 during FE. For muscles MA, absolute peak value (ranging from 20 to 40 mm) occurred at different poses depending on the analyzed muscle and motion. Poor magnitude was found for obliquus capitis inferior and rectus capitis posterior minor in FE and AR, respectively., Conclusion: On the basis of previous methods, we developed a protocol to create UCS musculoskeletal modeling with motion simulation including HA and suboccipital muscles representation. In this study, simultaneous segmental movement displaying with HA and muscles features was shown to be feasible.

Background: This paper reports the development of an in-vitro technique allowing quantification of relative (not absolute) deformations measured at the level of the cancellous bone of the tibial proximal epiphysis (CB(TPE)) during knee flexion-extension. This method has been developed to allow a future study of the effects of low femoral osteotomies consequence on the CB(TPE)., Methods: Six strain gages were encapsulated in an epoxy resin solution to form, after resin polymerisation, six measurement elements (ME). The latter were inserted into the CB(TPE) of six unembalmed specimens, just below the tibial plateau. Knee motion data were collected by three-dimensional (3D) electrogoniometry during several cycles of knee flexion-extension. Intra- and inter-observer reproducibility was estimated on one specimen for all MEs. Intra-specimen repeatability was calculated to determine specimen's variability and the error of measurement. A varum and valgum chirurgical procedure was realised on another specimen to observed CB(TPE) deformation after these kind of procedure., Results: Average intra-observer variation of the deformation ranged from 8% to 9% (mean coefficient of variation, MCV) respectively for extension and flexion movement. The coefficient of multiple correlations (CMC) ranged from 0.93 to 0.96 for flexion and extension. No phase shift of maximum strain peaks was observed. Inter-observer MCV averaged 23% and 28% for flexion and extension. The CMC were 0.82 and 0.87 respectively for extension and flexion. For the intra-specimen repeatability, the average of mean RMS difference and the mean ICC were calculated only for flexion movement. The mean RMS variability ranged from 7 to 10% and the mean ICC was 0.98 (0.95-0.99). A Pearson's correlation coefficient was calculated showing that RMS was independent of signal intensity. For the chirurgical procedure, valgum and varum deviation seems be in agree with the frontal misalignment theory., Conclusions: Results show that the methodology is reproducible within a range of 10%. This method has been developed to allow analysis the indirect reflect of deformation variations in CB(TPE) before and after distal femoral osteotomies. The first results of the valgum and varum deformation show that our methodology allows this kind of measurement and are encourageant for latter studies. It will therefore allow quantification and enhance the understanding of the effects of this kind of surgery on the CB(TPE) loading.

Quadric surface fitting of joint surface areas is often performed to allow further processing of joint component size, location and orientation (pose), or even to determine soft tissue wrapping by collision detection and muscle moment arm evaluation. This study aimed to determine, for the femoral bone, if the position of its morphological joint centers and the shape morphology could be approximated using regression methods with satisfactory accuracy from a limited amount of palpable anatomical landmarks found on the femoral bone surface. The main aim of this paper is the description of the pipeline allowing on one hand the data collection and database storage of femoral bone characteristics, and on the other hand the determination of regression relationships from the available database. The femoral bone components analyzed in this study included the diaphysis, all joint surfaces (shape, location and orientation of the head, condyles and femoro-patellar surface) and their respective spatial relationships (e.g., cervico-diaphyseal angle, cervico-bicondylar angle, intercondylar angle, etc.). A total of 36 morphological characteristics are presented and can be estimated by regression method in in-vivo applications from the spatial location of 3 anatomical landmarks (lateral epicondyle, medial epicondyle and greater trochanter) located on the individual under investigation. The method does not require any a-priori knowledge on the functional aspect of the joint. In-vivo and in-vitro validations have been performed using data collected from medical imaging by virtual palpation and data collected directly on a volunteer using manual palpation through soft tissue. The prediction accuracy for most of the 36 femoral characteristics determined from virtual palpation was satisfactory, mean (SD) distance and orientation errors were 2.7(2.5)mm and 6.8(2.7)°, respectively. Manual palpation data allowed good accuracy for most femoral features, mean (SD) distance and orientation errors were 4.5(5.2)mm and 7.5(5.3)°, respectively. Only the in-vivo location estimation of the femoral head was worse (position error=23.2mm). In conclusion, results seem to show that the method allows in-vivo femoral joint shape prediction and could be used for further development (e.g., surface collision, muscle wrapping, muscle moment arm estimation, joint surface dimensions, etc.) in gait analysis-related applications., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Although stiffness and strength of lower limb bones have been investigated in the past, information is not complete. While the femur has been extensively investigated, little information is available about the strain distribution in the tibia, and the fibula has not been tested in vitro. This study aimed at improving the understanding of the biomechanics of lower limb bones by: (i) measuring the stiffness and strain distributions of the different low limb bones; (ii) assessing the effect of viscoelasticity in whole bones within a physiological range of strain-rates; (iii) assessing the difference in the behaviour in relation to opposite directions of bending and torsion. The structural stiffness and strain distribution of paired femurs, tibias and fibulas from two donors were measured. Each region investigated of each bone was instrumented with 8-16 triaxial strain gauges (over 600 grids in total). Each bone was subjected to 6-12 different loading configurations. Tests were replicated at two different loading speeds covering the physiological range of strain-rates. Viscoelasticity did not have any pronounced effect on the structural stiffness and strain distribution, in the physiological range of loading rates explored in this study. The stiffness and strain distribution varied greatly between bone segments, but also between directions of loading. Different stiffness and strain distributions were observed when opposite directions of torque or opposite directions of bending (in the same plane) were applied. To our knowledge, this study represents the most extensive collection of whole-bone biomechanical properties of lower limb bones., (Copyright (c) 2009 Elsevier Ltd. All rights reserved.)

Purpose: Registration of 3D-anatomical model and kinematics data is reported to be an accurate method to provide 3D-joint simulation. We applied this approach to discrete kinematics analysis of upper cervical spine (UCS) during axial rotation (AR) and flexion extension (FE) to create anatomical models with movement simulation including helical axis., Methods: Kinematics and CT imaging data were sampled in ten anatomical specimens. Using technical and anatomical marker digitizing, spatial position of segments was computed for five discrete positions of AR and FE using a 3D-digitizer. Computerized tomography was used to create anatomical models and to assure kinematics and imaging data registration for simulation. Kinematics was processed using orientation vector and helical axis (HA) computation., Results: Maximal standard error on marker digitizing was 0.47 mm. Range of motion and coupled movement during AR was in agreement with previous in vitro studies. HA location and orientation have shown low variation at the occipitoaxial and atlantoaxial levels for FE and AR, respectively., Conclusions: We developed a protocol to create UCS anatomical model simulations including three-dimensional discrete kinematics, using previously validated methods. In this study, simultaneous segmental movement simulation and display of HA variations was shown to be feasible. Although partially confirming previous results, helical axis computation showed variations of motion patterns dependent on movement, level and specimen. Further in vivo investigations are needed to confirm relevance of this method in the clinical field.

Accurate spatial location of joint center (JC) is a key issue in motion analysis since JC locations are used to define standardized anatomical frames, in which results are represented. Accurate and reproducible JC location is important for data comparison and data exchange. This paper presents a method for JC locations based on the multiple regression algorithms without preliminary assumption on the behavior of the joint-of-interest. Regression equations were obtained from manually palpable ALs on each bone-of-interest. Results are presented for all joint surfaces found on the clavicle, scapula and humeral bone. Mean accuracy errors on the JC locations obtained on dry bones were 5.2+/-2.5 mm for the humeral head, 2.5+/-1.1 mm for the humeral trochlea, 2.3+/-0.9 mm for the humeral capitulum, 8.2+/-3.9 mm for the scapula glenoid cavity, 7.2+/-3.2 mm for the scapular aspect of the acromio-clavicular joint, 3.5+/-1.8mm for the clavicular aspect of the sternoclavicular joint and 3.2+/-1.4 mm for the clavicular aspect of the acromio-clavicular joint. In-vitro and in-vivo validation accuracy was 5.3 and 8.5mm, respectively, for the humeral head center location. Regression coefficients for joint radius dimension and joint surface orientation were also processed and reported in this paper.

Background: The use of formalin fixed bone tissue is often avoided because of its assumed influence on the mechanical properties of bone. Fixed bone tissue would minimise biological risks and eliminate preservation issues for long duration experimental tests. This study aimed to determine the short- and long-term effects of embalming, using a solution with 4% formalin concentration, on the mechanical properties of human cortical bone., Methods: Three-millimetre cylindrical specimens of human cortical bone were extracted from two femoral diaphyses and divided in four groups. The first group was used as control, the remaining three groups were left in the embalming solution for 48 h, 4 week, and 8 week, respectively. Compressive mechanical properties, hardness and ash density were assessed. The last was used to check the homogeneity among the four groups., Findings: No significant differences were found among the four groups in yield stress, ultimate stress and hardness. The specimens stored for 8 week in the embalming solution had significant lower Young's modulus (-24%), higher yield strain (+20%) and ultimate strain (+53%) compared to the other groups., Interpretation: On a short-term perspective, embalming did not affect the compressive mechanical properties, nor hardness of human cortical bone, whereas a long-term preservation (8 week) did significantly affect Young's modulus, yield strain and ultimate strain in compression. Preserving bone segments for up to 4 week in an embalming solution with low formalin concentration seems to be an interesting alternative when collecting and/or managing fresh or fresh-frozen bone segments for biomechanical experiments is not possible.

The Virtual Physiological Human (VPH) is an initiative, strongly supported by the European Commission (EC), that seeks to develop an integrated model of human physiology at multiple scales from the whole body through the organ, tissue, cell and molecular levels to the genomic level. VPH had its beginnings in 2005 with informal discussions amongst like-minded scientists which led to the STEP project, a Coordination Action funded by the EC that began in early 2006. The STEP project greatly accelerated the progress of the VPH and proved to be a catalyst for wide-ranging discussions within Europe and for outreach activities designed to develop a broad international approach to the huge scientific and technological challenges involved in this area. This paper provides an overview of the VPH and the developments it has engendered in the rapidly expanding worldwide activities associated with the physiome. It then uses one particular project, the Living Human Project, to illustrate the type of advances that are taking place to further the aims of the VPH and similar initiatives worldwide.

Anatomical relationships between the radial nerve, the deltoid muscle insertions and several bony landmarks have been investigated to assess the feasibility of surgical transfer of the deltoid transfer during humeral osteotomy. Eleven embalmed human specimens were dissected. Each specimen included the whole thorax, both shoulders and upper limbs. Spatial position of the radial nerve along the radial groove, the deltoid muscle, and several anatomical landmarks was digitised using a three-dimensional (3D) digitiser. Sixteen distances and one angle characterizing the relationships between the path of the radial nerve and the landmarks were processed. Results showed that the average distance between the emergence of the radial nerve from the lateral intermuscular septum and the most distal insertion point of the deltoid muscle on the humeral bone shaft was 47.6 +/- 18.5 mm. The angle between a line extending from the entry of the radial nerve into the radial sulcus and its point of emergence (REN-REM line), and on the other hand a line running from the radial emergence and the deltoid muscle tip (REM-DELTIP line) was in average 23.5 +/- 6.7 degrees . The length of four lines running perpendicular to REM-DELTIP and crossing each quarter of the REN-REM line were interpolated. The length of these four lines was, from proximal to distal, 31.3 +/- 11.5 mm; 23.0 +/- 7.8 mm; 16.5 +/- 6.2 mm; and 7.6 +/- 2.6 mm, respectively. These results described in a quantitative way the path of the radial nerve in respect to the humeral bone and the deltoid muscle. These data will be used for further development of a humeral osteotomy protocol taking into account the spatial position of the radial nerve to orientate safely the surgical tools used to cut the humeral shaft.

Biomedical science and its allied disciplines are entering a new era in which computational methods and technologies are poised to play a prevalent role in supporting collaborative investigation of the human body. Within Europe, this has its focus in the virtual physiological human (VPH), which is an evolving entity that has emerged from the EuroPhysiome initiative and the strategy for the EuroPhysiome (STEP) consortium. The VPH is intended to be a solution to common infrastructure needs for physiome projects across the globe, providing a unifying architecture that facilitates integration and prediction, ultimately creating a framework capable of describing Homo sapiens in silico. The routine reliance of the biomedical industry, biomedical research and clinical practice on information technology (IT) highlights the importance of a tailor-made and robust IT infrastructure, but numerous challenges need to be addressed if the VPH is to become a mature technological reality. Appropriate investment will reap considerable rewards, since it is anticipated that the VPH will influence all sectors of society, with implications predominantly for improved healthcare, improved competitiveness in industry and greater understanding of (patho)physiological processes. This paper considers issues pertinent to the development of the VPH, highlighted by the work of the STEP consortium.

Background: The development of a multiscale model of the human musculoskeletal system able to accurately predict the risk of bone fracture is still a grand challenge. The aim of this paper is to present the Living Human Project, to describe the final system and to review the achievements obtained so far. The Living Human musculoskeletal supermodel is conceived as the interconnection of five interdependent sub-models: the continuum, the boundary condition, the constitutive equation, the remodelling history and the failure criterion sub-models., Methods: Methods are available to develop accurate subject-specific finite element models of bones that can incorporate the subject's tissue-density distribution and empirically derived constitutive laws. Anatomo-functional musculoskeletal models can be registered with gait analysis data to predict muscle and joint forces acting on the patient's skeleton during gait. These are the boundary conditions for the continuum models that showed an average error of 12% in the prediction of the failure load. Still, the entire supermodel is defined as a collection of procedural macros to predict the risk of fracture and should be improved., Findings: Even with these limitations, the organ-level model already found some clinically relevant applications, especially in the analysis of joint prostheses. Also, the body-organ level multiscale model finds some clinical applications in paediatric skeletal oncology. The tissue- and the cell-level models are not yet fully validated. Thus, they cannot be safely used in clinical applications., Interpretation: The continuum sub-model is the most mature model available. More powerful methods are needed for the generation of anatomo-functional musculoskeletal models. Muscle force prediction should be improved, investigating new probabilistic approaches to identify the neuro-motor strategy. The changes of the tissue properties in the various regions of the skeleton and predictive remodelling models should be included. An adequate information technology infrastructure should be developed to support collaborative work and integration of different sub-models.

Many studies related to three-dimensional facial reconstruction have been previously reported. On the other hand, no extensive work has been found in the literature about hand reconstruction as an identification method. In this paper, the feasibility of virtual reconstruction of hand skin based on (1) its skeleton and (2) another hand skin and skeleton used as template was assessed. One cadaver hand and one volunteer's hand have been used. For the two hands, computer models of the bones and skin were obtained from computerized tomography. A customized software allowed locating spatial coordinates of bony anatomical landmarks on the models. From these landmarks, the spatial relationships between the models were determined and used to interpolate the missing hand skin. The volume of the interpolated skin was compared to the real skin obtained from medical imaging for validation. Results seem to indicate that such a method is of interest to give forensic investigators morphological clues related to an individual hand skin based on its skeleton. Further work is in progress to finalize the method.

Nowadays biomedical engineers regularly have to combine data from multiple medical imaging modalities, biomedical measurements and computer simulations and this can demand the knowledge of many specialised software tools. Acquiring this knowledge to the depth necessary to perform the various tasks can require considerable time and thus divert the researcher from addressing the actual biomedical problems. The aim of the present study is to describe a new application called the Multimod Data Manager, distributed as a freeware, which provides the end user with a fully integrated environment for the fusion and manipulation of all biomedical data. The Multimod Data Manager is generated using a software application framework, called the Multimod Application Framework, which is specifically designed to support the rapid development of computer aided medicine applications. To understand the general logic of the Data Manager, we first introduce the framework from which it is derived. We then illustrate its use by an example--the development of a complete subject-specific musculo-skeletal model of the lower limb from the Visible Human medical imaging data to be used for predicting the stresses in the skeleton during gait. While the Data Manager is clearly still only at the prototype stage, we believe that it is already capable of being used to solve a large number of problems common to many biomedical engineering activities.

Background: The number of in vivo clinical biomedical experiments based on computed tomography is increasing. International radiation-protection bodies are promoting the use of low-dose computed tomography to reduce radiation absorption by the subject undergoing imaging. On the other hand no data exist in the literature to quantify whether or not low-dose computed tomography would lead to a decrease of result quality when used for three-dimensional bone modeling and related measurements., Methods: This paper aimed at finding a consensus between minimal X-ray radiation of the subject, and satisfactory image data quality, especially for accurate three-dimensional bone modeling. Several standard computed tomography and low-dose computed tomography sequences were analyzed in three tests and statistically compared., Findings: Absence of significant difference between standard and low-dose computed sequences indicated that the low-dose setting would not produce less accurate three-dimensional models, while it decreased the effective X-ray dose up to 90% compared to standard settings., Interpretation: Low-dose computed tomography seems suitable for accurate three-dimensional bone modeling, while the related effective X-ray radiation is low. Such setting is therefore advised for any in vivo medical imaging aiming to collect bone data.

The thoracic outlet includes three compartments (the interscalene triangle, costoclavicular space, and retropectoralis minor space), which extend from the cervical spine and mediastinum to the lower border of the pectoralis minor muscle. Dynamically induced compression of the neural, arterial, or venous structures crossing these compartments leads to thoracic outlet syndrome (TOS). The diagnosis is based on the results of clinical evaluation, particularly if symptoms can be reproduced when various dynamic maneuvers, including elevation of the arm, are undertaken. However, clinical diagnosis is often difficult; thus, the use of imaging is required to demonstrate neurovascular compression and to determine the nature and location of the structure undergoing compression and the structure producing the compression. Cervical plain radiography should be performed first to assess for bone abnormalities and to narrow the differential diagnosis. Computed tomographic (CT) angiography or magnetic resonance (MR) imaging performed in association with postural maneuvers is helpful in analyzing the dynamically induced compression. B-mode and color duplex ultrasonography (US) are good supplementary tools for assessment of vessel compression in association with postural maneuvers, especially in cases with positive clinical features of TOS but negative features of TOS at CT and MR imaging. US may also allow analysis of the brachial plexus. However, MR imaging remains the method of choice when searching for neurologic compression., (RSNA, 2006)

A multimodal visualization software, called the Data Manager (DM), has been developed to increase interdisciplinary communication around the topic of visualization and modeling of various aspects of the human anatomy. Numerous tools used in Radiology are integrated in the interface that runs on standard personal computers. The available tools, combined to hierarchical data management and custom layouts, allow analyzing of medical imaging data using advanced features outside radiological premises (for example, for patient review, conference presentation or tutorial preparation). The system is free, and based on an open-source software development architecture, and therefore updates of the system for custom applications are possible.

An in vivo method for joint kinematics visualization and analysis is described. Low-dose computed tomography allowed three-dimensional joint modeling, and electrogoniometry collected joint kinematic data. Data registration occurred using palpated anatomical landmarks to obtain interactive computer joint simulation. The method was applied on one volunteer's ankle, and reproducibility was tested (maximal discrepancy: 3.6 deg and 5.5 mm for rotation and translation respectively).

Standard registration techniques of bone morphology to motion analysis data often lead to unsatisfactory motion simulation because of discrepancies during the location of anatomical landmarks in the datasets. This paper describes an iterative registration method of a three-dimensional (3D) skeletal model with both 6 degrees-of-freedom joint kinematics and standard motion analysis data. The method is demonstrated in this paper on the lower limb. The method includes two steps. A primary registration allowed synchronization of in vitro kinematics of the knee and ankle joints using flexion/extension angles from in vivo gait analysis. Results from primary registration were then improved by a so-called advanced registration, which integrated external constraints obtained from experimental gait pre-knowledge. One cadaver specimen was analyzed to obtain both joint kinematics of knee and ankle joints using 3D electrogoniometry, and 3D bone morphology from medical imaging data. These data were registered with motion analysis data from a volunteer during the execution of locomotor tasks. Computer graphics output was implemented to visualize the results for a motion of sitting on a chair. Final registration results allowed the observation of both in vivo motion data and joint kinematics from the synchronized specimen data. The method improved interpretation of gait analysis data, thanks to the combination of realistic 3D bone models and joint mechanism. This method should be of interest both for research in gait analysis and medical education. Validation of the overall method was performed using RMS of the differences between bone poses estimated after registration and original data from motion analysis.

Computer-assisted learning (CAL) is growing quickly within academic programs. Although the anatomical commercial packages that are available for this learning have attractive advantages, they also have drawbacks: they are frequently not in the local language of the students, they do not perfectly answer the needs of the local academic program, and their cost is frequently more than students can afford. This study describes a relatively inexpensive method to create CAL tutorials, whose content can be fully customized to local academic needs in terms of both program and language. The study describes its use in creating multimedia learning modules (MLMs) about Osteology and joint kinematics. The pedagogical content in these modules was collected from objective experiments to give students the opportunity to access new scientific knowledge during their education. It can be replaced, as desired, by almost any content due to the flexibility of the production method. Each MLM consists of two complementary subelements: a multimedia theoretical lecture and a three-dimensional interactive laboratory. Such MLMs are in use at both the University of Brussels (ULB) and the National University of Rwanda (NUR). The development of this work was part of the VAKHUM project, and the pedagogical validation is currently being performed as part of the MULTIMOD project., (Copyright 2003 Wiley-Liss, Inc.)

Three-dimensional (3D) visualization is becoming increasingly frequent in both qualitative and quantitative biomechanical studies of anatomical structures involving multiple data sources (e.g. morphological data and kinematics data). For many years, this kind of experiment was limited to the use of bi-dimensional images due to a lack of accurate 3D data. However, recent progress in medical imaging and computer graphics has forged new perspectives. Indeed, new techniques allow the development of an interactive interface for the simulation of human motions combining data from both medical imaging (i.e., morphology) and biomechanical studies (i.e., kinematics). Fields of application include medical education, biomechanical research and clinical research. This paper presents an experimental protocol for the development of anatomically realistic joint simulation within a pedagogical context. Results are shown for the lower limb. Extension to other joints is straightforward. This work is part of the Virtual Animation of the Kinematics of the Human project (VAKHUM) (http://www.ulb.ac.be/project/vakhum).

The paper describes a method in which two data-collecting systems, medical imaging and electrogoniometry, are combined to allow the accurate and simultaneous modeling of both the spatial kinematics and the morphological surface of a particular joint. The joint of interest (JOI) is attached to a Plexiglas jig that includes four metallic markers defining a local reference system (R(GONIO)) for the kinematics data. Volumetric data of the JOI and the R(GONIO) markers are collected from medical imaging. The spatial location and orientation of the markers in the global reference system (R(CT)) of the medical-imaging environment are obtained by applying object-recognition and classification methods on the image dataset. Segmentation and 3D isosurfacing of the JOI are performed to produce a 3D model including two anatomical objects-the proximal and distal JOI segments. After imaging, one end of a custom-made 3D electrogoniometer is attached to the distal segment of the JOI, and the other end is placed at the R(GONIO) origin; the JOI is displaced and the spatial kinematics data is recorded by the goniometer. After recording, data registration from R(GONIO) to R(CT) occurred prior to simulation. Data analysis was performed using both joint coordinate system (JCS) and instantaneous helical axis (IHA).Finally, the 3D joint model is simulated in real time using the experimental kinematics data. The system is integrated into a computer graphics interface, allowing free manipulation of the 3D scene. The overall accuracy of the method has been validated with two other kinematics data collection methods including a 3D digitizer and interpolation of the kinematics data from discrete positions obtained from medical imaging. Validation has been performed on both superior and inferior radio-ulna joints (i.e. prono-supination motion). Maximal RMS error was 1 degrees and 1.2mm on the helical axis rotation and translation, respectively. Prono-supination of the forearm showed a total rotation of 132 degrees for 0.8mm of translation. The method reproducibility using JCS parameters was in average 1 degrees (maximal deviation=2 degrees ) for rotation, and 1mm (maximal deviation=2mm) for translation. In vitro experiments have been performed on both knee joint and ankle joint. Averaged JCS parameters for the knee were 109 degrees, 17 degrees and 4 degrees for flexion, internal rotation and abduction, respectively. Averaged maximal translation values for the knee were 12, 3 and 4mm posteriorly, medially and proximally, respectively. Averaged JCS parameters for the ankle were 43 degrees, 9 degrees and 3 degrees for plantarflexion, adduction and internal rotation, respectively. Averaged maximal translation values for the ankle were 4, 2 and 1mm anteriorly, medially and proximally, respectively.