Three-Dimensional Imaging of the Patellofemoral Joint Improves Understanding of Trochlear Anatomy and Pathology and Planning of Realignment.

Three-dimensional (3D) modeling using digital or printed models provides a unique perspective that caters to cognitive spatial ability in a way that can add to our understanding and mental representations of human anatomy. This is particularly useful in the setting of trochlear dysplasia, where the morphology of the groove can exhibit substantial variability and complexity. Using 3D reformatted images and models, a pragmatic understanding of how morphology influences patellofemoral pathology can be gleaned. Further, this perspective facilitates cognition of what patellar tracking may look like after realignment procedures. Using 3D modeling, concepts such as patella alta, trochlear depth, lateralization of the patellar entry point, trochlear curvature, and the presence of a proximal trochlear spur can help afford a better understanding of how trochlear anatomy may influence tracking while also providing insight as to the ideal tracking path. The use of 3D has recently emerged as a useful tool in multiple surgical subspecialties, particularly in situations involving surgical planning or complex anatomy. Given the complexity and variation in trochlear morphology in patients with trochlear dysplasia who develop either patellar instability or focal overloading, 3D modeling is well-suited to provide a perspective that can add to our understanding of trochlear dysplasia, and potentially even how we diagnose and treat it. LEVEL OF EVIDENCE: Level V, expert opinion.

How human runners regulate footsteps on uneven terrain.

Running stably on uneven natural terrain takes skillful control and was critical for human evolution. Even as runners circumnavigate hazardous obstacles such as steep drops, they must contend with uneven ground that is gentler but still destabilizing. We do not know how footsteps are guided based on the uneven topography of the ground and how those choices influence stability. Therefore, we studied human runners on trail-like undulating uneven terrain and measured their energetics, kinematics, ground forces, and stepping patterns. We find that runners do not selectively step on more level ground areas. Instead, the body's mechanical response, mediated by the control of leg compliance, helps maintain stability without requiring precise regulation of footsteps. Furthermore, their overall kinematics and energy consumption on uneven terrain showed little change from flat ground. These findings may explain how runners remain stable on natural terrain while devoting attention to tasks besides guiding footsteps.

Finger stability in precision grips.

Stable precision grips using the fingertips are a cornerstone of human hand dexterity. However, our fingers become unstable sometimes and snap into a hyperextended posture. This is because multilink mechanisms like our fingers can buckle under tip forces. Suppressing this instability is crucial for hand dexterity, but how the neuromuscular system does so is unknown. Here we show that people rely on the stiffness from muscle contraction for finger stability. We measured buckling time constants of 50 ms or less during maximal force application with the index finger­quicker than feedback latencies­which suggests that muscle-induced stiffness may underlie stability. However, a biomechanical model of the finger predicts that muscle-induced stiffness cannot stabilize at maximal force unless we add springs to stiffen the joints or people reduce their force to enable cocontraction. We tested this prediction in 38 volunteers. Upon adding stiffness, maximal force increased by 34 ± 3%, and muscle electromyography readings were 21 ± 3% higher for the finger flexors (mean ± SE). Muscle recordings and mathematical modeling show that adding stiffness offloads the demand for muscle cocontraction, thus freeing up muscle capacity for fingertip force. Hence, people refrain from applying truly maximal force unless an external stabilizing stiffness allows their muscles to apply higher force without losing stability. But more stiffness is not always better. Stiff fingers would affect the ability to adapt passively to complex object geometries and precisely regulate force. Thus, our results show how hand function arises from neurally tuned muscle stiffness that balances finger stability with compliance.

Reprogrammable soft actuation and shape-shifting via tensile jamming.

The emerging generation of robots composed of soft materials strives to match biological motor adaptation skills via shape-shifting. Soft robots often harness volumetric expansion directed by strain limiters to deform in complex ways. Traditionally, strain limiters have been inert materials embedded within a system to prescribe a single deformation. Under changing task demands, a fixed deformation mode limits adaptability. Recent technologies for on-demand reprogrammable deformation of soft bodies, including thermally activated variable stiffness materials and jamming systems, presently suffer from long actuation times or introduce unwanted bending stiffness. We present fibers that switch tensile stiffness via jamming of segmented elastic fibrils. When jammed, tensile stiffness increases more than 20× in less than 0.1 s, but bending stiffness increases only 2×. When adhered to an inflating body, jamming fibers locally limit surface tensile strains, unlocking myriad programmable deformations. The proposed jamming technology is scalable, enabling adaptive behaviors in emerging robotic materials that interact with unstructured environments.

Stiffness of the human foot and evolution of the transverse arch.

The stiff human foot enables an efficient push-off when walking or running, and was critical for the evolution of bipedalism1-6. The uniquely arched morphology of the human midfoot is thought to stiffen it5-9, whereas other primates have flat feet that bend severely in the midfoot7,10,11. However, the relationship between midfoot geometry and stiffness remains debated in foot biomechanics12,13, podiatry14,15 and palaeontology4-6. These debates centre on the medial longitudinal arch5,6 and have not considered whether stiffness is affected by the second, transverse tarsal arch of the human foot16. Here we show that the transverse tarsal arch, acting through the inter-metatarsal tissues, is responsible for more than 40% of the longitudinal stiffness of the foot. The underlying principle resembles a floppy currency note that stiffens considerably when it curls transversally. We derive a dimensionless curvature parameter that governs the stiffness contribution of the transverse tarsal arch, demonstrate its predictive power using mechanical models of the foot and find its skeletal correlate in hominin feet. In the foot, the material properties of the inter-metatarsal tissues and the mobility of the metatarsals may additionally influence the longitudinal stiffness of the foot and thus the curvature-stiffness relationship of the transverse tarsal arch. By analysing fossils, we track the evolution of the curvature parameter among extinct hominins and show that a human-like transverse arch was a key step in the evolution of human bipedalism that predates the genus Homo by at least 1.5 million years. This renewed understanding of the foot may improve the clinical treatment of flatfoot disorders, the design of robotic feet and the study of foot function in locomotion.

Dynamics and stability of running on rough terrains.

Stability of running on rough terrain depends on the propagation of perturbations due to the ground. We consider stability within the sagittal plane and model the dynamics of running as a two-dimensional body with alternating aerial and stance phases. Stance is modelled as a passive, impulsive collision followed by an active, impulsive push-off that compensates for collisional losses. Such a runner has infinitely many strategies to maintain periodic gaits on flat ground. However, these strategies differ in how perturbations due to terrain unevenness are propagated. Instabilities manifest as tumbling (orientational instability) or failing to maintain a steady speed (translational instability). We find that open-loop strategies that avoid sensory feedback are sufficient to maintain stability on step-like terrains with piecewise flat surfaces that randomly vary in height. However, these open-loop runners lose orientational stability on rough terrains whose slope also varies randomly. The orientational instability is significantly mitigated by minimizing the tangential collision, which typically requires sensory information and anticipatory strategies such as leg retraction. By analysing the propagation of perturbations, we derive a single dimensionless parameter that governs stability. This parameter provides guidelines for the design and control of both biological and robotic runners.

Active Viscoelasticity of Sarcomeres.

The perturbation response of muscle is important for the versatile, stable and agile control capabilities of animals. Muscle resists being stretched by developing forces in the passive tissues and in the active crossbridges. This review focuses on the active perturbation response of the sarcomere. The active response exhibits typical stress relaxation, and thus approximated by a Maxwell material that has a spring and dashpot arranged in series. The ratio of damping to stiffness in this approximation defines the relaxation timescale for dissipating stresses that are developed in the crossbridges due to external perturbations. Current understanding of sarcomeres suggests that stiffness varies nearly linearly with neural excitation, but not much is known about damping. But if both stiffness and damping have the same functional (linear or not) dependence on neural excitation, then the stress relaxation timescale cannot be varied depending on the demands of the task. This implies an unavoidable and biologically unrealistic trade-off between how freely the crossbridges can yield and dissipate stresses when stretched (injury avoidance in agile motions) vs. how long they can maintain perturbation-induced stresses and behave like a solid material (stiffness maintenance for stability). We hypothesize that muscle circumvents this trade-off by varying damping in a nonlinear manner with neural excitation, unlike stiffness that varies linearly. Testing this hypothesis requires new experimental and mathematical characterization of muscle mechanics, and also identifies new design goals for robotic actuators.

Curvature-induced stiffening of a fish fin.

How fish modulate their fin stiffness during locomotive manoeuvres remains unknown. We show that changing the fin's curvature modulates its stiffness. Modelling the fin as bendable bony rays held together by a membrane, we deduce that fin curvature is manifested as a misalignment of the principal bending axes between neighbouring rays. An external force causes neighbouring rays to bend and splay apart, and thus stretches the membrane. This coupling between bending the rays and stretching the membrane underlies the increase in stiffness. Using three-dimensional reconstruction of a mackerel (Scomber japonicus) pectoral fin for illustration, we calculate the range of stiffnesses this fin is expected to span by changing curvature. The three-dimensional reconstruction shows that, even in its geometrically flat state, a functional curvature is embedded within the fin microstructure owing to the morphology of individual rays. As the ability of a propulsive surface to transmit force to the surrounding fluid is limited by its stiffness, the fin curvature controls the coupling between the fish and its surrounding fluid. Thereby, our results provide mechanical underpinnings and morphological predictions for the hypothesis that the spanned range of fin stiffnesses correlates with the behaviour and the ecological niche of the fish.

Dynamical feature extraction at the sensory periphery guides chemotaxis.

Behavioral strategies employed for chemotaxis have been described across phyla, but the sensorimotor basis of this phenomenon has seldom been studied in naturalistic contexts. Here, we examine how signals experienced during free olfactory behaviors are processed by first-order olfactory sensory neurons (OSNs) of the Drosophila larva. We find that OSNs can act as differentiators that transiently normalize stimulus intensity-a property potentially derived from a combination of integral feedback and feed-forward regulation of olfactory transduction. In olfactory virtual reality experiments, we report that high activity levels of the OSN suppress turning, whereas low activity levels facilitate turning. Using a generalized linear model, we explain how peripheral encoding of olfactory stimuli modulates the probability of switching from a run to a turn. Our work clarifies the link between computations carried out at the sensory periphery and action selection underlying navigation in odor gradients.

Elastic energy storage in the shoulder and the evolution of high-speed throwing in Homo.

Some primates, including chimpanzees, throw objects occasionally, but only humans regularly throw projectiles with high speed and accuracy. Darwin noted that the unique throwing abilities of humans, which were made possible when bipedalism emancipated the arms, enabled foragers to hunt effectively using projectiles. However, there has been little consideration of the evolution of throwing in the years since Darwin made his observations, in part because of a lack of evidence of when, how and why hominins evolved the ability to generate high-speed throws. Here we use experimental studies of humans throwing projectiles to show that our throwing capabilities largely result from several derived anatomical features that enable elastic energy storage and release at the shoulder. These features first appear together approximately 2 million years ago in the species Homo erectus. Taking into consideration archaeological evidence suggesting that hunting activity intensified around this time, we conclude that selection for throwing as a means to hunt probably had an important role in the evolution of the genus Homo.

Controlling instabilities in manipulation requires specific cortical-striatal-cerebellar networks.

Dexterous manipulation requires both strength, the ability to produce fingertip forces of a specific magnitude, and dexterity, the ability to dynamically regulate the magnitude and direction of fingertip force vectors and finger motions. Although cortical activity in fronto-parietal networks has been established for stable grip and pinch forces, the cortical regulation in the dexterous control of unstable objects remains unknown. We used functional magnetic resonance imaging (fMRI) to interrogate cortical networks engaged in the control of four objects with increasing instabilities but requiring constant strength. In addition to expected activity in fronto-parietal networks we find that dexterous manipulation of increasingly unstable objects is associated with a linear increase in the amplitude of the BOLD signal in the basal ganglia (P = 0.007 and P = 0.023 for 2 compression tasks). A computational regression (connectivity) model identified independent subsets of cortical networks whose connection strengths were mutable and associated with object instability (P < 0.001). Our results suggest that in the presence of object instability, the basal ganglia may modulate the activity of premotor areas and subsequent motor output. This work, therefore, provides new evidence for the selectable cortical representation and execution of dynamic multifinger manipulation for grasp stability.

Foot strike patterns and collision forces in habitually barefoot versus shod runners.

Humans have engaged in endurance running for millions of years, but the modern running shoe was not invented until the 1970s. For most of human evolutionary history, runners were either barefoot or wore minimal footwear such as sandals or moccasins with smaller heels and little cushioning relative to modern running shoes. We wondered how runners coped with the impact caused by the foot colliding with the ground before the invention of the modern shoe. Here we show that habitually barefoot endurance runners often land on the fore-foot (fore-foot strike) before bringing down the heel, but they sometimes land with a flat foot (mid-foot strike) or, less often, on the heel (rear-foot strike). In contrast, habitually shod runners mostly rear-foot strike, facilitated by the elevated and cushioned heel of the modern running shoe. Kinematic and kinetic analyses show that even on hard surfaces, barefoot runners who fore-foot strike generate smaller collision forces than shod rear-foot strikers. This difference results primarily from a more plantarflexed foot at landing and more ankle compliance during impact, decreasing the effective mass of the body that collides with the ground. Fore-foot- and mid-foot-strike gaits were probably more common when humans ran barefoot or in minimal shoes, and may protect the feet and lower limbs from some of the impact-related injuries now experienced by a high percentage of runners.

Maximal voluntary fingertip force production is not limited by movement speed in combined motion and force tasks.

Numerous studies of limbs and fingers propose that force-velocity properties of muscle limit maximal voluntary force production during anisometric tasks, i.e., when muscles are shortening or lengthening. Although this proposition appears logical, our study on the simultaneous production of fingertip motion and force disagrees with this commonly held notion. We asked eight consenting adults to use their dominant index fingertip to maximize voluntary downward force against a horizontal surface at specific postures (static trials), and also during an anisometric "scratching" task of rhythmically moving the fingertip along a 5.8 +/- 0.5 cm target line. The metronome-timed flexion-extension movement speed varied 36-fold from "slow" (1.0 +/- 0.5 cm/s) to "fast" (35.9 +/- 7.8 cm/s). As expected, maximal downward voluntary force diminished (44.8 +/- 15.6%; p = 0.001) when any motion (slow or fast) was added to the task. Surprisingly, however, a 36-fold increase in speed did not affect this reduction in force magnitude. These remarkable results for such an ordinary task challenge the dominant role often attributed to force-velocity properties of muscle and provide insight into neuromechanical interactions. We propose an explanation that the simultaneous enforcement of mechanical constraints for motion and force reduces the set of feasible motor commands sufficiently so that force-velocity properties cease to be the force-limiting factor. While additional work is necessary to reveal the governing mechanisms, the dramatic influence that the simultaneous enforcement of motion and force constraints has on force output begins to explain the vulnerability of dexterous function to development, aging, and even mild neuromuscular pathology.

Structured variability of muscle activations supports the minimal intervention principle of motor control.

Numerous observations of structured motor variability indicate that the sensorimotor system preferentially controls task-relevant parameters while allowing task-irrelevant ones to fluctuate. Optimality models show that controlling a redundant musculo-skeletal system in this manner meets task demands while minimizing control effort. Although this line of inquiry has been very productive, the data are mostly behavioral with no direct physiological evidence on the level of muscle or neural activity. Furthermore, biomechanical coupling, signal-dependent noise, and alternative causes of trial-to-trial variability confound behavioral studies. Here we address those confounds and present evidence that the nervous system preferentially controls task-relevant parameters on the muscle level. We asked subjects to produce vertical fingertip force vectors of prescribed constant or time-varying magnitudes while maintaining a constant finger posture. We recorded intramuscular electromyograms (EMGs) simultaneously from all seven index finger muscles during this task. The experiment design and selective fine-wire muscle recordings allowed us to account for a median of 91% of the variance of fingertip forces given the EMG signals. By analyzing muscle coordination in the seven-dimensional EMG signal space, we find that variance-per-dimension is consistently smaller in the task-relevant subspace than in the task-irrelevant subspace. This first direct physiological evidence on the muscle level for preferential control of task-relevant parameters strongly suggest the use of a neural control strategy compatible with the principle of minimal intervention. Additionally, variance is nonnegligible in all seven dimensions, which is at odds with the view that muscle activation patterns are composed from a small number of synergies.

Effects of neuromuscular lags on controlling contact transitions.

We present a numerical exploration of contact transitions with the fingertip. When picking up objects our fingertips must make contact at specific locations, and-upon contact-maintain posture while producing well-directed force vectors. However, the joint torques for moving the fingertip towards a surface (tau(m)) are different from those for producing static force vectors (tau(f)). We previously described the neural control of such abrupt transitions in humans, and found that unavoidable errors arise because sensorimotor time delays and lags prevent an instantaneous switch between different torques. Here, we use numerical optimization on a finger model to reveal physical bounds for controlling such rapid contact transitions. Resembling human data, it is necessary to anticipatorily switch joint torques to tau(f )at about 30 ms before contact to minimize the initial misdirection of the fingertip force vector. This anticipatory strategy arises in our deterministic model from neuromuscular lags, and not from optimizing for robustness to noise/uncertainties. Importantly, the optimal solution also leads to a trade-off between the speed of force magnitude increase versus the accuracy of initial force direction. This is an alternative to prevailing theories that propose multiplicative noise in muscles as the driver of speed-accuracy trade-offs. We instead find that the speed-accuracy trade-off arises solely from neuromuscular lags. Finally, because our model intentionally uses idealized assumptions, its agreement with human data suggests that the biological system is controlled in a way that approaches the physical boundaries of performance.

Neural control of motion-to-force transitions with the fingertip.

The neural control of tasks such as rapid acquisition of precision pinch remains unknown. Therefore, we investigated the neural control of finger musculature when the index fingertip abruptly transitions from motion to static force production. Nine subjects produced a downward tapping motion followed by vertical fingertip force against a rigid surface. We simultaneously recorded three-dimensional fingertip force, plus the complete muscle coordination pattern using intramuscular electromyograms from all seven index finger muscles. We found that the muscle coordination pattern clearly switched from that for motion to that for isometric force approximately 65 ms before contact (p = 0.0004). Mathematical modeling and analysis revealed that the underlying neural control also switched between mutually incompatible strategies in a time-critical manner. Importantly, this abrupt switch in underlying neural control polluted fingertip force vector direction beyond what is explained by muscle activation-contraction dynamics and neuromuscular noise (p < or = 0.003). We further ruled out an impedance control strategy in a separate test showing no systematic change in initial force magnitude for catch trials where the tapping surface was surreptitiously lowered and raised (p = 0.93). We conclude that the nervous system predictively switches between mutually incompatible neural control strategies to bridge the abrupt transition in mechanical constraints between motion and static force. Moreover because the nervous system cannot switch between control strategies instantaneously or exactly, there arise physical limits to the accuracy of force production on contact. The need for such a neurally demanding and time-critical strategy for routine motion-to-force transitions with the fingertip may explain the existence of specialized neural circuits for the human hand.

Manipulating the edge of instability.

We investigate the integration of visual and tactile sensory input for dynamic manipulation. Our experimental data and computational modeling reveal that time-delays are as critical to task-optimal multisensory integration as sensorimotor noise. Our focus is a dynamic manipulation task "at the edge of instability." Mathematical bifurcation theory predicts that this system will exhibit well-classified low-dimensional dynamics in this regime. The task was using the thumbpad to compress a slender spring prone to buckling as far as possible, just shy of slipping. As expected from bifurcation theory, principal components analysis gives a projection of the data onto a low dimensional subspace that captures 91-97% of its variance. In this subspace, we formulate a low-order model for the brain+hand+spring dynamics based on known mechanical and neurophysiological properties of the system. By systematically occluding vision and anesthetically blocking thumbpad sensation in 12 consenting subjects, we found that vision contributed to dynamic manipulation only when thumbpad sensation was absent. The reduced ability of the model system to compress the spring with absent sensory channels closely resembled the experimental results. Moreover, we found that the model reproduced the contextual usefulness of vision only if we took account of time-delays. Our results shed light on critical features of dynamic manipulation distinct from those of static pinch, as well as the mechanism likely responsible for loss of manual dexterity and increased reliance on vision when age or neuromuscular disease increase noisiness and/or time-delays during sensorimotor integration.

The strength-dexterity test as a measure of dynamic pinch performance.

We have developed a method to quantify the dynamic interaction between fingertip force magnitude (strength) and directional control (dexterity) during pinch with a novel strength-dexterity (S-D) test based on the principle of buckling of compression springs. The test consists of asking participants to use key and opposition pinch to attempt to fully compress springs, in random order, with a wide range of combinations of strength and dexterity requirements. The minimum force required to fully compress the spring and the propensity of the spring to buckle define the strength and dexterity requirements, respectively. The S-D score for each pinch style was the sum of the strength values of all springs successfully compressed fully. We tested 3 participant groups: 18 unimpaired young adults (40yr), and 14 adults diagnosed with carpo-metacarpal osteoarthritis (CMC OA) (>or = 36yr). We investigated the repeatability of the S-D test with 74 springs by testing 14 young adults twice on different days. The per-spring repeatability across subjects was >or = 94%. A minimum performance score for young adults was found as they all could compress a subset of 39 springs. Using this subset of springs, we compared the ability of the S-D score vs. maximal pinch force values to distinguish unimpaired hands from those with CMC OA of the thumb. The score for this 39-spring S-D test distinguished between CMC OA and asymptomatic older adults, whereas pinch meter readings did not (p<0.05). We conclude that the S-D test is repeatable and applicable to clinical research. We propose including the S-D test in studies aiming to quantify impairment and compare treatment outcomes in orthopaedic and neurological afflictions that degrade dynamic manipulation.