Preliminary study of reliability of transcutaneous sensors in measuring intraabdominal pressure.

Early recognition of elevated intraabdominal pressure (IAP) in critically ill patients is essential, since it can result in abdominal compartment syndrome, which is a life-threatening condition. The measurement of intravesical pressure is currently considered the gold standard for IAP assessment. Alternative methods have been proposed, where IAP assessment is based on measuring abdominal wall tension, which reflects the pressure in the abdominal cavity. The aim of this study was to evaluate the feasibility of using patch-like transcutaneous sensors to estimate changes in IAP, which could facilitate the monitoring of IAP in clinical practice. This study was performed with 30 patients during early postoperative care. All patients still had an indwelling urinary catheter postoperatively. Four wearable sensors were attached to the outer surface of the abdominal region to detect the changes in abdominal wall tension. Additionally, surface EMG was used to monitor the activity of the abdominal muscles. The thickness of the subcutaneous tissue was measured with ultrasound. Patients performed 4 cycles of the Valsalva manoeuvre, with a resting period in between (the minimal resting period was 30 s, with a prolongation as necessary to ensure that the fluid level in the measuring system had equilibrated). The IAP was estimated with intravesical pressure measurements during all resting periods and all Valsalva manoeuvres, while the sensors continuously measured changes in abdominal wall tension. The association between the subcutaneous thickness and tension changes on the surface and the intraabdominal pressure was statistically significant, but a large part of the variability was explained by individual patient factors. As a consequence, the predictions of IAP using transcutaneous sensors were not biased, but they were quite variable. The specificity of detecting intraabdominal pressure of 20 mmHg and above is 88%, with an NPV of 96%, while its sensitivity and PPV are currently far lower. There are inherent limitations of the chosen preliminary study design that directly caused the low sensitivity of our method as well as the poor agreement with the gold standard method; in spite of that, we have shown that these sensors have the potential to be used to monitor intraabdominal pressure. We are planning a study that would more closely resemble the intended clinical use and expect it to show more consistent results with a far smaller error.

Human Response to Longitudinal Perturbations of Standing Passengers on Public Transport During Regular Operation.

This study investigates the response of standing passengers on public transport who experience balance perturbations during non-collision incidents. The objective of the study was to analyse the effects of the perturbation characteristics on the initial responses of the passengers and their ability to maintain their balance. Sled tests were conducted on healthy volunteers aged 33.8 ± 9.2 years (13 males, 11 females) standing on a moving platform, facilitating measurements of the initial muscle activity and stepping response of the volunteers. The volunteers were exposed to five different perturbation profiles representing typical braking and accelerating manoeuvres of a public transport bus in the forward and backward direction. The sequence of muscle activations in lower-extremity muscles was consistent for the perturbation pulses applied. For the three acceleration pulses combining two magnitudes for acceleration (1.5 and 3.0 m/s2) and jerk (5.6 and 11.3 m/s3), the shortest muscle onset and stepping times for the passengers to recover their balance were observed with the higher jerk value, while the profile with the higher acceleration magnitude and longer duration induced more recovery steps and a higher rate of safety-harness deployment. The tendency for a shorter response time was observed for the female volunteers. For the two braking pulses (1.0 and 2.5 m/s2), only the lower magnitude pulse allowed balance recovery without compensatory stepping. The results obtained provide a reference dataset for human body modelling, the development of virtual test protocols, and operational limits for improving the safety of public transportation vehicles and users.

Identifying and Characterizing Types of Balance Recovery Strategies Among Females and Males to Prevent Injuries in Free-Standing Public Transport Passengers.

Free-standing passengers on public transport are subjected to perturbations during non-collision incidents caused by driver maneuvers, increasing the risk of injury. In the literature, the step strategy is described as a recovery strategy during severe perturbations. However, stepping strategies increase body displacement, ultimately subjecting passengers to higher risk of impacts and falls on public transport. This study investigates the influence of different recovery strategies on the outcome of balance recovery of free-standing public transport passengers, challenged in postural balance by the non-uniform vehicle dynamics. From high-speed video recordings, a qualitative investigation of the balance responses of volunteer participants in a laboratory experiment was provided. On a linearly moving platform, 24 healthy volunteers (11 females and 13 males) were subjected to perturbation profiles of different magnitude, shape and direction, mimicking the typical acceleration and deceleration behavior of a bus. A methodology categorizing the balancing reaction to an initial strategy and a recovery strategy, was used to qualitatively identify, characterize and, evaluate the different balance strategies. The effectiveness of different strategies was assessed with a grading criterion. Statistical analysis based on these ordinal data was provided. The results show that the current definition in the literature of the step strategy is too primitive to describe the different identified recovery strategies. In the volunteers with the most successful balancing outcome, a particularly effective balance recovery strategy not yet described in the literature was identified, labeled the fighting stance. High jerk perturbations seemed to induce faster and more successful balance recovery, mainly for those adopting the fighting stance, compared to the high acceleration and braking perturbation profiles. Compared to the pure step strategy, the characteristics of the fighting stance seem to increase the ability to withstand higher perturbations by increasing postural stability to limit body displacement.

Material properties of human patellar-ligament grafts from the elderly population.

The aim of the presented study was to estimate the material properties of human patellar ligaments from the elderly population by means of tensile tests. The experimental part was conducted on a custom tensile-testing device, with a built-in enclosure to simulate in-vivo conditions, using 25 (15 female, 10 male) bone-ligament-bone samples from elderly (age 83 (8)) human donors. During the tensile tests, the resultant force and displacement of the sample attachments were recorded. With this data and the values of the initial length and the initial cross-sectional area of the samples, the engineering stress and strain, the Young's modulus and the toughness at rupture were calculated for each sample. The results were then averaged and presented for all the samples together and for the female and male populations separately. The measured Young's modulus and the failure stress values were found to be significantly higher for the female samples compared to the male (p < 0.05). All the other measured properties did not show a significant difference. The toe region's material properties for the patellar ligament were also presented as valuable information for the anterior cruciate ligament reconstruction. The tensile-test results were compared to other research carried on human patellar ligaments using samples from younger donors. The comparison showed that the samples from the elderly population exhibit lower values of strain at the end of the toe region and have a lower failure strain for the patellar ligament. The Young's modulus and the failure stress of the samples in this study were in the range of other research conducted on patellar ligaments.

Estimating the Effects of Awareness on Neck-Muscle Loading in Frontal Impacts with EMG and MC Sensors.

Critical traffic situations, such as vehicle collisions and emergency manoeuvres, can cause an occupant to respond with reflex and voluntary actions. These affect the occupant's position and dynamic loading during interactions with the vehicle's restraints, possibly compromising their protective function. Electromyography (EMG) is a commonly used method for measuring active muscle response and can also provide input parameters for computer simulations with models of the human body. The recently introduced muscle-contraction (MC) sensor is a wearable device with a piezo-resistive element for measuring the force of an indenting tip pressing against the surface of the body. The study aimed to compare how data collected simultaneously with EMG, video motion capture, and the novel MC sensor are related to neck-muscle loading. Sled tests with low-severity frontal impacts were conducted, assuming two different awareness conditions for seated volunteers. The activity of the upper trapezius muscle was measured using surface EMG and MC sensors. The neck-muscle load F was estimated from an inverse dynamics analysis of the head's motion captured in the sagittal plane. The volunteers' response to impact was predominantly reflexive, with significantly shorter onset latencies and more bracing observed when the volunteers were aware of the impact. Cross-correlations between the EMG and MC, EMG and F, and F and MC data were not changed significantly by the awareness conditions. The MC signal was strongly correlated (r = 0.89) with the neck-muscle loading F in the aware and unaware conditions, while the mean ΔF-MC delays were 21.0 ± 15.1 ms and 14.6 ± 12.4 ms, respectively. With the MC sensor enabling a consistent measurement-based estimation of the muscle loading, the simultaneous acquisition of EMG and MC signals improves the assessment of the reflex and voluntary responses of a vehicle's occupant subjected to low-severity loading.

Analysis of the mechanical response of damaged human cervical spine ligaments.

BACKGROUND: Cervical spine ligaments that protect the spinal cord and stabilize the spine are frequently injured in motor vehicle collisions and other traumatic situations. These injuries are usually incomplete, and often difficult to notice. The focus of the presented study is placed on analysis of the effect of subfailure load on the mechanical response of the three main cervical spine ligaments: the anterior and the posterior longitudinal ligament and the ligamentum flavum. METHODS: A total of 115 samples of human cadaveric ligaments removed within 24-48 h after death have been tested. Uniaxial tension tests along the fiber direction were performed in physiological conditions on a custom designed test equipment. The ligaments were loaded into an expected damage zone at two different subfailure values (based on previously reported reference group of 46 samples), and then reloaded to failure. FINDINGS: The main effect of a high subfailure load has proven to be the toe elongation change. The toe elongation increase is affected by the subfailure load value. While anterior and posterior longitudinal ligament showed similar changes, the smallest subfailure effect was found in ligamentum flavum. INTERPRETATIONS: The normal physiological region of the cervical spine ligaments mechanical response is modified by a high subfailure load. The observed ligament injury significantly compromises ligament ability to give tensile support within physiological spinal motion.

A Novel Approach to Measuring Muscle Mechanics in Vehicle Collision Conditions.

The aim of the study was to evaluate a novel approach to measuring neck muscle load and activity in vehicle collision conditions. A series of sled tests were performed on 10 healthy volunteers at three severity levels to simulate low-severity frontal impacts. Electrical activity-electromyography (EMG)-and muscle mechanical tension was measured bilaterally on the upper trapezius. A novel mechanical contraction (MC) sensor was used to measure the tension on the muscle surface. The neck extensor loads were estimated based on the inverse dynamics approach. The results showed strong linear correlation (Pearson's coefficient = 0.821) between the estimated neck muscle load and the muscle tension measured with the MC sensor. The peak of the estimated neck muscle force delayed 0.2 ± 30.6 ms on average vs. the peak MC sensor signal compared to the average delay of 61.8 ± 37.4 ms vs. the peak EMG signal. The observed differences in EMG and MC sensor collected signals indicate that the MC sensor offers an additional insight into the analysis of the neck muscle load and activity in impact conditions. This approach enables a more detailed assessment of the muscle-tendon complex load of a vehicle occupant in pre-impact and impact conditions.

Loading rate effect on mechanical properties of cervical spine ligaments.

Mechanical properties of cervical spine ligaments are of great importance for an accurate finite element model when analyzing the injury mechanism. However, there is still little experimental data in literature regarding fresh human cervical spine ligaments under physiological conditions. The focus of the present study is placed on three cervical spine ligaments that stabilize the spine and protect the spinal cord: the anterior longitudinal ligament, the posterior longitudinal ligament and the ligamentum flavum. The ligaments were tested within 24-48 hours after death, under two different loading rates. An increase trend in failure load, failure stress, stiffness and modulus was observed, but proved not to be significant for all ligament types. The loading rate had the highest impact on failure forces for all three ligaments (a 39.1% average increase was found). The observed increase trend, compared to the existing increase trends reported in literature, indicates the importance of carefully applying the existing experimental data, especially when creating scaling factors. A better understanding of the loading rate effect on ligaments properties would enable better case-specific human modelling.