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The AnyBody™ Modeling System (AMS) [1], is an universally used musculoskeletal simulation software using inverse dynamics. Until now, no complete human hand model is known in the AMS. Also considering other musculoskeletal software platforms, just one detailed entire hand model is recently published [2] but is only based on one subject. The aim of this work is to implement a full detailed hand model for the AMS including all extrinsic and intrinsic muscles using data by the UWB gained through an anatomical study of ten cadaver hands.
Regarding the prevention of injuries and rehabilitation of the human hand, musculoskeletal simulations using an inverse dynamics approach allow for insights of the muscle recruitment and thus acting forces on the hand. Currently, several hand models from various research groups are in use, which are mainly validated by the comparison of numerical and anatomical moment arms. In contrast to this validation and model-building technique by cadaver studies, the aim of this study is to further validate a recently published hand model [1] by analyzing numerically calculated muscle activities in comparison to experimentally measured electromyographical signals of the muscles. Therefore, the electromyographical signals of 10 hand muscles of five test subjects performing seven different hand movements were measured. The kinematics of these tasks were used as input for the hand model, and the numerical muscle activities were computed. To analyze the relationship between simulated and measured activities, the time difference of the muscle on- and off-set points was calculated, which resulted in a mean on- and off-set time difference of 0.58 s between the experimental data and the model. The largest differences were detected for movements that mainly addressed the wrist. One major issue comparing simulated and measured muscle activities of the hand is cross-talk. Nevertheless, the results show that the hand model fits the experiment quite accurately despite some limitations and is a further step toward patient-specific modeling of the upper extremity.
Musculoskeletal lower back load of accoucheurs during childbirth – A pilot and feasibility study
(2021)
Introduction: Back problems represent one of the leading causes of accouchers' work-related musculoskeletal morbidities. The correct execution of birth-related maneuvers including manual perineal protection is crucial not only for the mother and child but also for obstetricians and midwives to reduce any strain on their musculoskeletal system. Therefore, the overall aim of this study was to test the feasibility of determining the effect of different accouchers' postures (standing and kneeling) on their musculoskeletal system.
Methods: The biomechanical analysis is based on musculoskeletal simulations that included motion recordings of real deliveries as well as deliveries conducted on a birthing simulator. These simulations were then used to determine individual joints' loads.
Results: In the kneeling posture, both a low intra-operator variability and a lower average maximum load of the lower back was observed. For the standing position the spine load was reduced by pivoting the elbow on the accouchers' thigh, which in turn was associated with a significantly greater load on the shoulder joint.
Conclusion: The study demonstrated the feasibility of our technique to assess joints loads. It also provided initial data indicating that a posture that reduces spinal flexion and tilt, achieved in this study by the kneeling, can significantly reduce the strain on the practitioner's musculoskeletal system.
With the progress in modern medicine, it was possible to significantly reduce the risks of birth for mother and child. One aspect that has received less attention so far is the risk of injury to the accoucheurs (obstetricians and midwives) during the birth process. Indeed, studies indicate that 92% of midwives suffer from musculoskeletal disorders, with the lower back being the main cause of complaints (72%). The aim of this study was to investigate two commonly used postural techniques used by accoucheurs during childbirth and to analyze the resulting load on the lower back using the AnyBodyTM musculoskeletal simulation software.
Elbow stability is derived from a combination of muscular, ligamentous, and bony structures. After an elbow trauma the stability of the joint is an important decision criterion for the subsequent treatment. The decision regarding non-operative/operative care depends mostly on subjective assessments of medical experts. Therefore, the aim of this study is to use musculoskeletal simulations as an objective assessment tool to investigate the extent to which failure of different stabilizers affects the elbow stability and how these observations correspond to the assessment from clinical practice. A musculoskeletal elbow simulation model was developed for this aim. To investigate the stability of the elbow, varus/valgus moments were applied under 0°, 45°and 90° flexion while the respective cubital angle was analyzed. This was performed for nine different injury scenarios, which were also evaluated for stability by clinical experts. With the results, it can be determined by which injury pattern and under which flexion angle the elbow stability is impaired regarding varus/valgus moments. The scenario with a complete failure of the medial and lateral ligaments and a fracture of the radial head was identified as having the greatest instability. The study presented a numerical determination of elbow stability against varus/valgus moments regarding clinical injury patterns, as well as a comparison of the numerical outcome with experience gained in clinical practice. The numerical predictions agree well with the assessments of the clinical specialists. Thus, the results from musculoskeletal simulation can make an important contribution to a more objective assessment of the elbow stability.
Outputs of musculoskeletal models should be considered probabilistic rather than deterministic as they are affected by inaccuracies and estimations associated with the development of the model. One of these uncertainties being critical for modeling arises from the determination of the muscles' line of action and the physiological cross-sectional area. Therefore, the aim of this study was to evaluate the outcome sensitivity of model predictions from a musculoskeletal hand model in comparison to the uncertainty of these input parameters. For this purpose, the kinematics and muscle activities of different hand movements (abduction of the fingers, abduction of the thumb, and flexion of the thumb) were recorded. One thousand simulations were calculated for each movement using the Latin hypercube sampling method with a corresponding variation of the muscle origin/insertion points and the cross-sectional area. Comparing the standard hand to simulations incorporating uncertainties of input parameters shows no major deviations in on- and off-set time point of muscle activities. About 60% of simulations are located within a ± 30% interval around the standard model concerning joint reaction forces. The comparison with the variation of the input data leads to the conclusion that the standard hand model is able to provide not over-scattered outcomes and, therefore, can be considered relatively stable. These results are of practical importance to the personalization of a musculoskeletal model with subject-specific bone geometries and hence changed muscle line of action.
Introduction:
Neointimal hyperplasia after percutaneous coronary intervention remains a major determinant of in-stent restenosis (ISR). The extent of mechanical vessel injury correlates with ISR. A new ex vivo porcine stent model was introduced and evaluated comparing different stent designs.
Methods:
Coronary arteries were prepared from pig hearts from the slaughterhouse and used for ex vivo implantations of coronary stents. One basic stent design in two configurations (dogbone, DB; non-dogbone, NDB) was used. Vascular injury was determined according to a modified injury score (IS).
Results:
Standardized experimental conditions ensured comparable vessel dimensions and overstretch data. DB stents caused more severe IS compared to NDB stents. The mean IS and the IS at the distal end of all stents were significantly reduced for NDB stents (ISMean, DB, 1.16 ±0.12; NDB, 1.02 ±0.12; p=0.018; ISDist, DB, 1.39 ±0.28; NDB, 1.13 ±0.24; p=0.03).
Discussion/Conclusion:
The introduced ex-vivo model allowed the evaluation of different stent designs exclude unfavorable stent designs.
Brain lesions in language-related cortical areas remain a challenge in the clinical routine. In recent years, the resting-state fMRI (RS-fMRI) was shown to be a feasible method for preoperative language assessment. The aim of this study was to examine whether language-related resting-state components, which have been obtained using a data-driven independent-component-based identification algorithm, can be supportive in determining language dominance in the left or right hemisphere. Twenty patients suffering from brain lesions close to supposed language-relevant cortical areas were included. RS-fMRI and task-based (TB-fMRI) were performed for the purpose of preoperative language assessment. TB-fMRI included a verb generation task with an appropriate control condition (a syllable switching task) to decompose language-critical and language-supportive processes. Subsequently, the best fitting ICA component for the resting-state language network (RSLN) referential to general linear models (GLMs) of the TB-fMRI (including models with and without linguistic control conditions) was identified using an algorithm based on the Dice index. Thereby, the RSLNs associated with GLMs using a linguistic control condition led to significantly higher laterality indices than GLM baseline contrasts. LIs derived from GLM contrasts with and without control conditions alone did not differ significantly. In general, the results suggest that determining language dominance in the human brain is feasible both with TB-fMRI and RS-fMRI, and in particular, the combination of both approaches yields a higher specificity in preoperative language assessment. Moreover, we can conclude that the choice of the language mapping paradigm is crucial for the mentioned benefits.
In the last few years, increasingly kicks to the head were observed as a criminal offense. This study examined the
influence of age, shoe type and kicking direction on the severity of head trauma.
Male test persons were divided into two groups “Old” and “Young”. Both groups were equipped with light
sneakers and combat boots. A standard laboratory crash dummy was used to simulate the victim’s body. First, the
dummy’s head, free floating above the ground, was kicked vertically. Second, the dummy’s head was kicked
horizontally. Established injury criteria were used to quantify the injury risk.
No influence concerning the type of foot wear and no difference between the groups “Old” and “Young” could be
found. For all analyses, kicking vertically generally lead to a higher risk for the subject compared to kicking
horizontally.
In this study, only the integral effect of the kicks could be analyzed. A detailed injury pattern cannot directly be
derived from the data. Nevertheless, the presented data show the massive potential of injuries associated with head
kicks.
PURPOSE:
The purpose of this study was to find a suitable method of labelling cartilage samples for the measurement of distraction distances in biomechanical testing.
METHODS:
Samples of bovine cartilage were labelled using five different methods: hydroquinone and silver nitrate (AgNO3), potassium permanganate (KMnO4) with sodium thiosulphate (Na2S2O3), India ink, heat, and laser energy. After the labelling, we analysed the cartilage samples with regard to cytotoxity by histochemical staining with ethidiumbromide homodimer (EthD-1) and calcein AM. Furthermore, we tested cartilages labelled with India ink and heat in a T-peel test configuration to analyse possible changes in the mechanical behaviour between marked and unlabelled samples.
RESULTS:
Only the labelling methods with Indian ink or a heated needle showed acceptable results in the cytotoxity test with regard to labelling persistence, accuracy, and the influence on consistency and viability of the chondrocytes. In the biomechanical T-peel configuration, heat-labelled samples collapsed significantly earlier than unlabelled samples.
CONCLUSION:
Labelling bovine cartilage samples with Indian ink in biomechanical testing is a reliable, accurate, inexpensive, and easy-to-perform method. This labelling method influenced neither the biomechanical behaviour nor the viability of the tissue compared to untreated bovine cartilage.
Over the past decade, veno-venous extracorporeal membrane oxygenation (vvECMO) has been increasingly utilized in respiratory failure in patients. This study presents our institution´s experience focusing on the life span of ECMO systems reflecting the performance of a particular system. A retrospective review of our ECMO database identified 461 adult patients undergoing vvECMO (2010-2017). Patients that required more than one system and survived the first exchange >24 hours (n = 139) were included. Life span until the first exchange and exchange criteria were analyzed for all systems (PLS, Cardiohelp HLS-set, both Maquet Cardiopulmonary, Rastatt, Germany; Deltastream/Hilite7000LT, iLA-activve, Xenios/NovaLung, Heilbronn, Germany; ECC.O5, LivaNova, Mirandola, Italy). At our ECMO center, the frequency of a system exchange was 30%. The median (IQR) life span was 9 (6-12) days. There was no difference regarding the different systems (p = 0.145 and p = 0.108, respectively). However, the Deltastream systems were exchanged more frequently due to elective technical complications (e. g. worsened gas transfer, development of coagulation disorder, increased bleedings complications) compared to the other exchanged systems (p = 0.013). In summary, the used ECMO systems are safe and effective for acute respiratory failure. There is no evidence for the usage of a specific system. Only the increased predictability of an imminent exchange preferred the usage of a Deltastream system. However, the decision to use a particular system should not depend solely on the possible criteria for an exchange.
Patients with age-related macular degeneration (AMD) or hereditary macular dystrophies (JMD) rely on an efficient use of their peripheral visual field. We trained eight AMD and five JMD patients to perform a texture-discrimination task (TDT) at their preferred retinal locus (PRL) used for fixation. Six training sessions of approximately one hour duration were conducted over a period of approximately 3 weeks. Before, during and after training twelve patients and twelve age-matched controls (the data from two controls had to be discarded later) took part in three functional magnetic resonance imaging (fMRI) sessions to assess training-related changes in the BOLD response in early visual cortex. Patients benefited from the training measurements as indexed by significant decrease (p = 0.001) in the stimulus onset asynchrony (SOA) between the presentation of the texture target on background and the visual mask, and in a significant location specific effect of the PRL with respect to hit rate (p = 0.014). The following trends were observed: (i) improvement in Vernier acuity for an eccentric line-bisection task; (ii) positive correlation between the development of BOLD signals in early visual cortex and initial fixation stability (r = 0.531); (iii) positive correlation between the increase in task performance and initial fixation stability (r = 0.730). The first two trends were non-significant, whereas the third trend was significant at p = 0.014, Bonferroni corrected. Consequently, our exploratory study suggests that training on the TDT can enhance eccentric vision in patients with central vision loss. This enhancement is accompanied by a modest alteration in the BOLD response in early visual cortex.
Vitamin C is an essential nutrient for humans and is involved in a plethora of health-related functions. Several studies have shown a connection between vitamin C intake and an improved resistance to infections that involves the immune system. However, the body cannot store vitamin C and both the elevated oral intake, and the intravenous application have certain disadvantages. In this study, we wanted to show a new formulation for the liposomal packaging of vitamin C. Using freeze etching electron microscopy, we show the formed liposomes. With a novel approach of post-processing procedures of real-time sonography that combines enhancement effects by contrast-like ultrasound with a transducer, we wanted to demonstrate the elevated intestinal vitamin C resorption on four participants. With the method presented in this study, it is possible to make use of the liposomal packaging of vitamin C with simple household materials and equipment for intake elevation. For the first time, we show the enhanced resorption of ingested liposomes using microbubble enhanced ultrasound imaging.
Background:
Lipofilling is one of the most often performed surgical procedures in plastic and reconstructive surgery. Lipoaspirates provide a ready source of stem cells and secreted factors that contribute to neoangiogenesis and fat graft survival. However, the regulations about the enrichment of these beneficial cells and factors are ambiguous. In this study, the authors tested whether a combination of centrifugation and homogenization allowed the enrichment of viable stem cells in lipoaspirates through the selective removal of tumescent solution, blood, and released lipids without significantly affecting the cell secretome.
Methods:
Human lipoaspirate was harvested from six different patients using water jet–assisted liposuction. Lipoaspirate was homogenized by first centrifugation (3584 rpm for 2 minutes), shear strain (10 times intersyringe processing), and second centrifugation (3584 rpm for 2 minutes). Stem cell enrichment was shown by cell counting after stem cell isolation. Lipoaspirate from different processing steps (unprocessed, after first centrifugation, after homogenization, after second centrifugation) was incubated in serum-free cell culture medium for mass spectrometric analysis of secreted proteins.
Results:
Lipoaspirate homogenization leads to a significant 2.6 ± 1.75-fold enrichment attributable to volume reduction without reducing the viability of the stem cells. Protein composition of the secretome did not change significantly after tissue homogenization. Considering the enrichment effects, there were no significant differences in the protein concentration of the 83 proteins found in all processing steps.
Conclusions:
Stem cells can be enriched mechanically without significantly affecting the composition of secreted proteins. Shear-assisted enrichment of lipoaspirate constitutes no substantial manipulation of the cells’ secretome.
The good availability and the large content of adult stem cells in adipose tissue has made it one of the most interesting tissues in regenerative medicine. Although lipofilling is one of the most frequent procedures in plastic surgery, the method still struggles with high absorption rates and volume losses of up to 70%. Therefore, many efforts have been made to optimize liposuction and to process the harvested tissue in order to increase fat graft retention. Because of their immunomodulatory properties, their cytokine secretory activity, and their differentiation potential, enrichment with adipose tissue-derived stem cells was identified as a promising tool to promote transplant survival. Here, we review the important parameters for lipofilling optimization. Finally, we present a new method for the enrichment of lipoaspirate with adipose tissue-derived stem cells and discuss the parameters that contribute to fat graft survival.
Anatomical differences between individuals are often neglected in musculoskeletal models, but they are necessary in case of subject-specific questions regarding the lumbar spine. A modification of models to each subject is complex and the effects on lumbar loading are difficult to assess. One objective of this work is to create a validated musculoskeletal human model, which facilitates a subject-specific modification of the lumbar geometry. In a second step, important parameters are identified in sensitivity studies and at last, a case study regarding multifidus muscle atrophy after a disc herniation is conducted.
The results of the studies indicate that lumbar motion and loading is dependent on lumbar ligament stiffness. Furthermore, subject-specific modelling of the lumbar spine should include at least the vertebral height, disc height and lumbar lordosis. The results of the case study suggest that an overloading of the multifidus muscle could follow disc herniation. Additionally, a subsequent atrophy of the muscles could expose adjacent levels to an increased loading, but these findings are highly dependent on the individual.
Anatomical differences between individuals are often neglected in musculoskeletal models, but they are necessary in case of subject-specific questions regarding the lumbar spine. A modification of models to each subject is complex and the effects on lumbar loading are difficult to assess. The objective of this thesis is to create a validated musculoskeletal model of the human body, which facilitates a subject-specific modification of the geometry of the lumbar spine. Furthermore, important parameters are identified in sensitivity studies and a case study regarding multifidus muscle atrophy after a disc herniation is conducted. Therefore, a generic model is heavily modified and a semi-automatic process is implemented. This procedure remodels the geometry of the lumbar spine to a subject-specific one on basis of segmented medical images. The resulting five models are validated with regard to the lumbar loading at the L4/L5 level. The influence of lumbar ligament stiffness is determined by changing the stiffness values of all lumbar ligaments in eleven steps during a flexion motion. Sensitivities of lumbar loading to an altered geometry of the lumbar spine are identified by varying ten lumbar parameters in simulations with each model in four postures. The case study includes an analysis of the loading of the multifidus muscle and of the lumbar discs throughout various stages of disc herniation. This time each model performs four motions with two different motion rhythms. The results indicate that lumbar motion and loading is dependent on lumbar ligament stiffness. Furthermore, subject-specific modelling of the lumbar spine should include at least the vertebral height, disc height and lumbar lordosis. The results of the case study suggest that an overloading of the multifidus muscle could follow disc herniation. Additionally, a subsequent atrophy of the muscles could expose adjacent levels to an increased loading, but these findings are highly dependent on the individual.
Background
There is a wide range of mechanical properties of spinal ligaments documented in literature. Due to the fact that ligaments contribute in stabilizing the spine by limiting excessive intersegmental motion, those properties are of particular interest for the implementation in musculoskeletal models. The aim of this study was to investigate the effect of varying ligament stiffness on the kinematic behaviour of the lumbar spine.
Methods
A musculoskeletal model with a detailed lumbar spine was modified according to fluoroscopic recordings and corresponding data files of three different subjects. For flexion, inverse dynamics analysis with a variation of the ligament stiffness matrix were conducted. The influence of several degrees of ligament stiffness on the lumbar spine model were investigated by tracking ligament forces, disc forces and resulting moments generated by the ligaments. Additionally, the kinematics of the motion segments were evaluated.
Results
An increase of ligament stiffness resulted in an increase of ligament and disc forces, whereas the relative change of disc force increased at a higher rate at the L4/L5 level (19 %) than at the L3/L4 (10 %) level in a fully flexed posture. The same behaviour applied to measured moments with 67 % and 45 %. As a consequence, the motion deflected to the lower levels of the lumbar spine and the lower discs had to resist an increase in loading.
Conclusions
Higher values of ligament stiffness over all lumbar levels could lead to a shift of the loading and the motion between segments to the lower lumbar levels. This could lead to an increased risk for the lower lumbar parts.
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.
Subject-specific Musculoskeletal Simulation of Hip Dislocation Risk in Activities of Daily Living
(2011)
Statement of problems: Computer-aided design/computer-assisted machining systems offer the possibility of fabricating restorations from one machinable ceramic block. Whether multishaded blocks improve esthetic results and are a viable alternative to individually stained ceramics has not been fully determined.
Purpose: The aim of this investigation was to examine the effect of multishaded blocks on the esthetic appearance of all-ceramic CEREC crowns and compare these crowns with single-shade and stained restorations.
Material and methods: Ten subjects were included in this study. For each subject, 6 different crowns were milled with the use of a CEREC machine. One crown was milled from each of the following machinable ceramic materials: CEREC Vitablocs Mark II in classic colors; Vitablocs Mark II in 3D-Master colors; Vitablocs Mark II in either classic or 3D-Master colors, with additional staining; Megadenta Bloxx multishaded; Mark II experimental multilayer; and an experimental multilayer leucite ceramic. Three independent examiners assessed the esthetic appearance of crowns fabricated to match each subject's anterior tooth shade. A scale of 1 to 6 was used to score the shade match and esthetic adaptation of each crown, with 1 representing excellent characteristics and 3.5 serving as the threshold for clinical acceptability. The examiners' scores were averaged, and the mean values were analyzed with the Wilcoxon signed rank test (P<or=.05).
Results: Only individually stained Mark II restorations achieved a mean score below the threshold of 3.5 for all 10 subjects. These restorations were significantly more esthetic (P<or=.05) than restorations fabricated from all other materials except the Mark II experimental multilayer ceramic. The second best results were obtained for crowns made from single-shaded Mark II 3D-Master blocks: 6 out of 10 restorations were scored below 3.5. Two of the layered materials (Mark II experimental and Bloxx) followed with 5 acceptable restorations out of 10.
Conclusion: Within the limitations of this study, the results provide no evidence that multicolored machinable ceramics improve the esthetics of all-ceramic crowns.
Osteoporosis is a common disease of old age. However, in many cases, it can be very well prevented and counteracted with physical activity, especially high-impact exercises. Wearables have the potential to provide data that can help with continuous monitoring of patients during therapy phases or preventive exercise programs in everyday life. This study aimed to determine the accuracy and reliability of measured acceleration data at different body positions compared to accelerations at the pelvis during different jumping exercises. Accelerations at the hips have been investigated in previous studies with regard to osteoporosis prevention. Data were collected using an IMU-based motion capture system (Xsens) consisting of 17 sensors. Forty-nine subjects were included in this study. The analysis shows the correlation between impacts and the corresponding drop height, which are dependent on the respective exercise. Very high correlations (0.83–0.94) were found between accelerations at the pelvis and the other measured segments at the upper body. The foot sensors provided very weak correlations (0.20–0.27). Accelerations measured at the pelvis during jumping exercises can be tracked very well on the upper body and upper extremities, including locations where smart devices are typically worn, which gives possibilities for remote and continuous monitoring of programs.
We report the kinematic and early clinical results of a patient- and observer-blinded randomised controlled trial in which CT scans were used to compare potential impingement-free range of movement (ROM) and acetabular component cover between patients treated with either the navigated 'femur-first' total hip arthroplasty (THA) method (n = 66; male/female 29/37, mean age 62.5 years; 50 to 74) or conventional THA (n = 69; male/female 35/34, mean age 62.9 years; 50 to 75). The Hip Osteoarthritis Outcome Score, the Harris hip score, the Euro-Qol-5D and the Mancuso THA patient expectations score were assessed at six weeks, six months and one year after surgery. A total of 48 of the patients (84%) in the navigated 'femur-first' group and 43 (65%) in the conventional group reached all the desirable potential ROM boundaries without prosthetic impingement for activities of daily living (ADL) in flexion, extension, abduction, adduction and rotation (p = 0.016). Acetabular component cover and surface contact with the host bone were > 87% in both groups. There was a significant difference between the navigated and the conventional groups' Harris hip scores six weeks after surgery (p = 0.010). There were no significant differences with respect to any clinical outcome at six months and one year of follow-up. The navigated 'femur-first' technique improves the potential ROM for ADL without prosthetic impingement, although there was no observed clinical difference between the two treatment groups.
We aimed to investigate the relationship between postoperative leg length/offset (LL/OS) reconstruction and gait performance after total hip arthroplasty (THA). In the course of a prospective randomized controlled trial, 60 patients with unilateral hip arthrosis received cementless THA through a minimally-invasive anterolateral surgical approach. One year post-operatively, LL and global OS restoration were analyzed and compared to the contralateral hip on AP pelvic radiographs. The combined postoperative limb length/OS reconstruction of the operated hip was categorized as restored (within 5 mm) or non-restored (more than 5 mm reduction or more than 5 mm increment). The acetabular component inclination, anteversion and femoral component anteversion were evaluated using CT scans of the pelvis and the femur. 3D gait analysis of the lower extremity and patient related outcome measures (HHS, HOOS, EQ-5D) were obtained pre-operatively, six months and twelve months post-operatively by an observer blinded to radiographic results. Component position of cup and stem was comparable between the restored and non-restored group. Combined LL and OS restoration within 5 mm resulted in higher Froude number (p < 0.001), normalized walking speed (p < 0.001) and hip range-of-motion (ROM) (p = 0.004) during gait twelve months postoperatively, whereas gait symmetry was comparable regardless of LL and OS reconstruction at both examinations. Clinical scores did not show any relevant association between the accuracy of LL or OS reconstruction and gait six/twelve months after THA. In summary, postoperative LL/OS discrepancies larger than 5 mm relate to unphysiological gait kinematics within the first year after THA. DRKS00000739, German Clinical Trials Register.
A 3-point skeletal anchorage with taping screws for distraction osteogenesis after a Le Fort III osteotomy was applied for the first time in a severely mentally impaired patient where intraoral devices had to be avoided. All 3-force application points included the center of resistance, which allowed an optimal control on the resulting moment. A novel device for skeletal long-term retention into the nasal dorsum prevented a relapse, whereas adjustment of the midface position was observed. Fusioned three-dimensional computed tomography analysis revealed real movements not accessible by a conventional cephalometry.
Biomechanical Analysis of the Right Elevated Glenohumeral Joint in Violinists during Legato-Playing
(2021)
BACKGROUND:
Many statistics reveal that violin players suffer most often from musculoskeletal disorders compared to musicians of other instrument groups. A common phenomenon, especially observed in violin beginners, is the tendency to elevate the right shoulder during playing the violin. This can probably lead to serious disorders in long-term practice with repetitive movements.
OBJECTIVE:
For this reason, this study investigated the relationship between the right shoulder elevation and the force in the right glenohumeral joint during violin playing. It was hypothesized that the forces in the right glenohumeral joint are higher during playing with the right shoulder raised compared to playing in normal posture.
METHODS:
Motion capture data from four experienced violinists was recorded and processed by means of musculoskeletal simulation to get the force and elevation angle while playing with raised shoulder and in normal position.
RESULTS:
The results indicate that the absolute values of the resulting force, as well as the forces in the mediolateral, inferosuperior, and anteroposterior directions, are higher in playing the violin with the shoulder raised than in a normal posture.
CONCLUSIONS: Elevating the right shoulder while playing the violin may pose a potential problem.
Biomechanical analysis of the right elevated glenohumeral joint in violinists during legato-playing
(2022)
BACKGROUND:
Many statistics reveal that violin players suffer most often from musculoskeletal disorders compared to musicians of other instrument groups. A common phenomenon, especially observed in violin beginners, is the tendency to elevate the right shoulder during playing the violin. This can probably lead to serious disorders in long-term practice with repetitive movements.
OBJECTIVE:
For this reason, this study investigated the relationship between the right shoulder elevation and the force in the right glenohumeral joint during violin playing. It was hypothesized that the forces in the right glenohumeral joint are higher during playing with the right shoulder raised compared to playing in normal posture.
METHODS:
Motion capture data from four experienced violinists was recorded and processed by means of musculoskeletal simulation to get the force and elevation angle while playing with raised shoulder and in normal position.
RESULTS:
The results indicate that the absolute values of the resulting force, as well as the forces in the mediolateral, inferosuperior, and anteroposterior directions, are higher in playing the violin with the shoulder raised than in a normal posture.
CONCLUSIONS:
Elevating the right shoulder while playing the violin may pose a potential problem.
In the treatment of hand injuries in the context of orthopedic care, movable wrist hand orthoses are used in numerous instances. Early motion therapy is in most cases advantageous for adequate, rapid and successful long-term healing of the hand. Conventional dynamic wrist hand orthoses can only be used for movement therapy to a limited extent since they represent the wrist as a simple rotating joint and neglect the complexity of the hand movement possibilities. In this paper, a preliminary concept for dynamic wrist hand orthoses based on prestressed compliant structures is presented. The distinctive feature of this concept lies in the enabling of multiaxial motion capabilities of the human hand without applying conventional joints. According to the concept the wrist region is surrounded by a prestressed compliant structure. Besides the derivation and description of the concept, a first three-dimensional computer-aided design is shown. Additionally, the necessary steps in the development of such a novel dynamic wrist orthosis are discussed.
In the treatment of hand injuries in the context of orthopedic care, movable hand orthoses are used in many cases. Early motion therapy is in most cases advantageous for adequate, rapid, and successful long-term healing of the hand. Conventional mobile hand orthoses can only be used for movement therapy to a limited extent since they represent the wrist as a simple rotating joint and neglect the complexity of the movement possibilities of the hand. In this paper, a novel concept for movable hand orthoses based on prestressed compliant structures is presented. The advantage with this concept is that it replicates the multiaxial motion capabilities without the need for conventional joints. Besides the derivation and description of the concept, a first three-dimensional CAD design is shown. Additionally, the next planned steps in the development of such a novel dynamic hand orthosis are described.
Theoretical considerations on a 2D compliant tensegrity joint in context of a biomedical application
(2023)
In this paper, a two-dimensional compliant tensegrity joint was investigated for potential biomedical applications such as orthotics or exoskeletons. The structure consists of two compressed members connected by five compliant tensioned members. The concept is based on the tensegrity principle, which allows the realization of dynamic orthoses without conventional hinge joints. Another advantage is the adaptability to the individual needs of the patient through a suitable design of the structure and the careful selection of the characteristics of the elements. Using geometric nonlinear analysis, the mechanical behavior of the structure was investigated, focusing on mechanical compliance. The main objective was to determine the influence of the initial length and stiffness of the tensioned members and the influence of the magnitude of external forces on the overall stiffness of the movable member of the structure. The results highlight the significant impact of member parameters on the structure's stiffness and movability under varying load magnitudes. The research laid the foundation for future development of dynamic orthoses based on this structure.
In diesem Beitrag erfolgt die theoretische Untersuchung einer zweidimensionalen nachgiebigen Tensegrity-Struktur in Hinsicht auf ihre potenzielle Eignung als Basisstruktur für eine dynamische Handorthese. Translatorische und rotatorische relative Bewegungsmöglichkeiten zwischen den Drucksegmenten der Struktur sind möglich, da diese Segmente durch nachgiebige Zugsegmente miteinander verbunden sind. Die Form der Struktur und ihre Vorspannung in einer statisch stabilen Gleichgewichtskonfiguration werden mit Hilfe der Minimierung des Kräfte- und Momentenungleichgewichts, der Betrachtung der potentiellen Energie der Struktur und einem Ansatz mittels statischer Finite-Elemente-Methode (FEM) in Abhängigkeit der Segmentparameter untersucht.
Preliminary considerations on the form-finding of a tensegrity joint to be used in dynamic orthoses
(2024)
Early motion therapy plays an important role for effective long-term healing of joint injuries. In many cases, conventional dynamic orthoses fail to address the intricate movement possibilities of the underlying joints, limited by their simplistic joint representations, often represented by revolute joints, enabling rotations by only one axis. In this paper, a two-dimensional compliant tensegrity joint for use in biomedical applications is investigated. It consists of two compressed members and five compliant tensioned members. Relative movement possibilities are realized by the intrinsic compliance of the structure. In the development of these systems, the first step is the determination of the static stable equilibrium. This analysis is conducted in this paper by considering the potential energy approach or by using the geometric nonlinear finite element method. The mechanical behavior of the structure is assessed with a specific emphasis on its mechanical compliance. The primary objective of this study is the investigation of the influence of structural parameters on the overall stiffness and movability of the structure. The results underscore the significant effect of member parameters on the stiffness and movability of the compliant tensegrity joint, particularly under varying load magnitudes. These findings provide insights for optimizing the joint’s performance, contributing to its potential application in advanced orthotic and exoskeleton devices.
Resting motor threshold and magnetic field output of the figure-of-8 and the double-cone coil
(2020)
The use of the double-cone (DC) coil in transcranial magnetic stimulation (TMS) is promoted with the notion that the DC coil enables stimulation of deeper brain areas in contrast to conventional figure-of-8 (Fo8) coils. However, systematic comparisons of these two coil types with respect to the spatial distribution of the magnetic field output and also to the induced activity in superficial and deeper brain areas are limited. Resting motor thresholds of the left and right first dorsal interosseous (FDI) and tibialis anterior (TA) were determined with the DC and the Fo8 coil in 17 healthy subjects. Coils were orientated over the corresponding motor area in an angle of 45 degrees for the hand area with the handle pointing in posterior direction and in medio-lateral direction for the leg area. Physical measurements were done with an automatic gantry table using a Gaussmeter. Resting motor threshold was higher for the leg area in contrast to the hand area and for the Fo8 in contrast to the DC coil. Muscle by coil interaction was also significant providing higher differences between leg and hand area for the Fo8 (about 27%) in contrast to the DC coil (about 15%). Magnetic field strength was higher for the DC coil in contrast to the Fo8 coil. The DC coil produces a higher magnetic field with higher depth of penetration than the figure of eight coil.