A systematic review of instrumented assessments for upper limb function in cerebral palsy: current limitations and future directions.

INTRODUCTION: Recently, interest in quantifying upper limb function in cerebral palsy has grown. However, the lack of reference tasks and protocols, have hindered the development of quantified movement analysis in clinical practice. This study aimed to evaluate existing instrumented assessments of upper limb function in cerebral palsy, with a focus on their clinical applicability, to identify reasons for the lack of adoption and provide recommendations for improving clinical relevance and utility. METHODS: A systematic review was conducted by a multidisciplinary team of researchers and clinicians (Prospero CRD42023402382). PubMed and Web of Science databases were searched using relevant keywords and inclusion/exclusion criteria. RESULTS: A total of 657 articles were initially identified, and after the selection process, 76 records were included for analysis comprising a total of 1293 patients with cerebral palsy. The quality assessment of the reviewed studies revealed a moderate overall quality, with deficiencies in sample size justification and participant information. Optoelectronic motion capture systems were predominantly used in the studies (N = 57/76). The population mainly consisted of individuals with spastic cerebral palsy (834/1293) with unilateral impairment (N = 1092/1293). Patients with severe functional impairment (MACS IV and V) were underrepresented with 3.4% of the 754 patients for whom the information was provided. Thirty-nine tasks were used across the articles. Most articles focused on unimanual activities (N = 66/76) and reach or reach and grasp (N = 51/76). Bimanual cooperative tasks only represented 3 tasks present in 4 articles. A total of 140 different parameters were identified across articles. Task duration was the most frequently used parameter and 23% of the parameters were used in only one article. CONCLUSION: Further research is necessary before incorporating quantified motion analysis into clinical practice. Existing protocols focus on extensively studied populations and rely on costly equipment, limiting their practicality. Standardized unimanual tasks provide limited insights into everyday arm use. Balancing methodological requirements and performance evaluation flexibility is a challenge. Exploring the correlation between outcome parameters and therapeutic guidance could facilitate the integration of quantified movement assessment into treatment pathways.

Bow-Side Kinematics Studies in Violinists: An Experimental Design Tracking Intra- and Inter-Musician Variability by Bow Stroke, String Played, and Tempo.

Comparison of bow-side kinematics in violinists is hindered by the scarcity of studies available. This makes meta-analysis impossible. This paper assesses the effect of music-based variables (bow stroke, tempo, and string played) on intra- and inter-participant variability in joint kinematics. The joint kinematics of nine high-level violinists were acquired via a motion capture system while they played a standardized piece of music involving contrasting bow strokes and strings at different tempi. Results were compared using linear mixed models using the root mean square (RMS) for each joint. We found highly individualized patterns of play, deduced from a low intra- but high inter-musician variability (4.2° vs 13.1° of normalized RMS) in joint kinematics. String played and bow stroke had the greatest effect on joint kinematics. The string played had the greatest impact on shoulder kinematics, and the bow stroke had the greatest impact on elbow and wrist kinematics. Based on these results, we propose guidelines for future research designed to study bow kinematics in the field of biomechanics of violin movements. For ease of comparison between studies and to limit the time and resources required, our main suggestions are to use repeated measures designs with a legato reference condition and to choose pieces of music spanning multiple strings.

Upper Limb Kinematics Using Inertial and Magnetic Sensors: Comparison of Sensor-to-Segment Calibrations.

Magneto-Inertial Measurement Unit sensors (MIMU) display high potential for the quantitative evaluation of upper limb kinematics, as they allow monitoring ambulatory measurements. The sensor-to-segment calibration step, consisting of establishing the relation between MIMU sensors and human segments, plays an important role in the global accuracy of joint angles. The aim of this study was to compare sensor-to-segment calibrations for the MIMU-based estimation of wrist, elbow, and shoulder joint angles, by examining trueness ("close to the reference") and precision (reproducibility) validity criteria. Ten subjects performed five sessions with three different operators. Three classes of calibrations were studied: segment axes equal to technical MIMU axes (TECH), segment axes generated during a static pose (STATIC), and those generated during functional movements (FUNCT). The calibrations were compared during the maximal uniaxial movements of each joint, plus an extra multi-joint movement. Generally, joint angles presented good trueness and very good precision in the range 5°-10°. Only small discrepancy between calibrations was highlighted, with the exception of a few cases. The very good overall accuracy (trueness and precision) of MIMU-based joint angle data seems to be more dependent on the level of rigor of the experimental procedure (operator training) than on the choice of calibration itself.

Three-Dimensional Rotations of the Scapula During Arm Abduction: Evaluation of the Acromion Marker Cluster Method in Comparison With a Model-Based Approach Using Biplanar Radiograph Images.

Noninvasive methods enabling measurement of shoulder bone positions are paramount in clinical and ergonomics applications. In this study, the acromion marker cluster (AMC) method is assessed in comparison with a model-based approach allowing scapula tracking from low-dose biplanar radiograph images. Six healthy male subjects participated in this study. Data acquisition was performed for 6 arm abduction positions (0°, 45°, 90°, 120°, 150°, 180°). Scapula rotations were calculated using the coordinate systems and angle sequence was defined by the ISB. The comparison analysis was based on root mean square error (RMSE) calculation and nonparametric statistical tests. RMSE remained under 8° for 0° to 90° arm abduction and under 13.5° for 0° to 180° abduction; no significant differences were found between the 2 methods. Compared with previous works, an improved accuracy of the AMC approach at high arm abduction positions was obtained. This could be explained by the different sources of data used as the "gold standard."

An experimental investigation on push force and its perception during a flexible hose insertion task encountered in a truck assembly line.

The push force and its perception when inserting a flexible hose laterally into a connector were investigated. Effects of hose diameter, glove, target position and obstacle condition were studied. Maximum voluntary insertion forces (MVFs) under similar working conditions were also measured. The larger the diameter, the higher the force required. The peak axial forces for the hoses of 6, 12 and 16 mm in diameter were on average respectively 94, 122 and 184 N, representing 45%, 61% and 93% of MVF. Glove condition, target position and obstacle did not significantly affect the axial insertion force and moment, but they did affect effort perception. Lower effort was perceived with gloves and high and near position. High intra- and inter-individual variability in insertion force for a given hose may suggest that feedback of successful insertion was insufficient. The recognition of a successful insertion must be ensured to avoid unnecessary extra force exertion. PRACTITIONER SUMMARY: The effects of glove, hose diameter, target location and obstacle on push force and its perception were studied when inserting a flexible hose. Solutions for improving the recognition of a successful insertion and the hose/connector system design must be found to reduce force exertion to safe levels.

Finite Element Model of the Shoulder with Active Rotator Cuff Muscles: Application to Wheelchair Propulsion.

The rotator cuff is prone to injury, remarkably so for manual wheelchair users. To understand its pathomechanisms, finite element models incorporating three-dimensional activated muscles are needed to predict soft tissue strains during given tasks. This study aimed to develop such a model to understand pathomechanisms associated with wheelchair propulsion. We developed an active muscle model associating a passive fiber-reinforced isotropic matrix with an activation law linking calcium ion concentration to tissue tension. This model was first evaluated against known physiological muscle behavior; then used to activate the rotator cuff during a wheelchair propulsion cycle. Here, experimental kinematics and electromyography data was used to drive a shoulder finite element model. Finally, we evaluated the importance of muscle activation by comparing the results of activated and non-activated rotator cuff muscles during both propulsion and isometric contractions. Qualitatively, the muscle constitutive law reasonably reproduced the classical Hill model force-length curve and the behavior of a transversally loaded muscle. During wheelchair propulsion, the deformation and fiber stretch of the supraspinatus muscle-tendon unit pointed towards the possibility for this tendon to develop tendinosis due to the multiaxial loading imposed by the kinematics of propulsion. Finally, differences in local stretch and positions of the lines of action between activated and non-activated models were only observed at activation levels higher than 30%. Our novel finite element model with active muscles is a promising tool for understanding the pathomechanisms of the rotator cuff for various dynamic tasks, especially those with high muscle activation levels.

Trunk and glenohumeral joint adaptations to manual wheelchair propulsion over a cross-slope: An exploratory study.

BACKGROUND: Cross-slopes are often encountered by manual wheelchair users propelling within an urban setting. While propulsion over cross-slopes is more difficult than on level surfaces, little is known about how the users counter the downhill turning tendency of the wheelchair over cross-slopes. This study aimed to identify the adaptations of the manual wheelchair users to the presence of cross-slopes and examine how these might impact shoulder injury. METHODS: Nine manual wheelchair users propelled themselves across a cross-slope and over a level surface. The trunk and glenohumeral joint kinematics, as well as the handrim contact tangential force were compared between both conditions for the uphill and downhill limbs. FINDINGS: The uphill arm technique used to counter the downhill turning tendency varied greatly in terms of potential injury risk and efficiency between participants. Trunk flexion increased the turning tendency of the manual wheelchair, yet only one participant decreased his flexion when rolling over the cross-slope. Various potential pathomecanisms related to the trunk lateral flexion and the glenohumeral kinematics over a cross-slope were identified. INTERPRETATION: Both the uphill arm technique and trunk kinematics are important to propel over a cross-slope both efficiently and safely. Accordingly, tips about posture and kinematics are needed to teach this skill to manual wheelchair users. Additionally, as wheelchair positioning seems to influence the cross-slope skill, more research is needed to explore the impact of positioning devices (e.g., lateral supports) and wheelchair modifications (e.g., power assist wheels, handrim projections) on this skill.

How does moderate upper limb activity modify sitting forces for able-bodied persons and wheelchair users?

INTRODUCTION: Most people with a spinal cord injury are concerned by pressure injuries (PrI). Since dynamic activities may involve distributions of forces over time that are different from static and given the significant impact of PrIs on healthcare costs, it is, important to study these sitting forces. We aim to investigate sitting forces (overall normal, shear forces and Peak Pressure Index (PPI)) assessed in both able-bodied and wheelchair users (WCU) under static and dynamic conditions. Our hypothesis is that wheelchair sitting forces encountered by able-bodied participants are significantly different from those of WCUs. MATERIAL AND METHODS: An experimental seat and a pressure mapping system were used to investigate forces in two different populations, 102 able-bodied and 15 WCUs, in static conditions and during synchronised hand-cycling. The analysis includes statistical comparisons of the sitting conditions (static/dynamic) and of the populations (able-bodied/WCUs). RESULTS AND DISCUSSION: Significant differences in normal forces and PPI were observed between able-bodied and WCUs; conversely, differences in shear forces were non-significant. This suggests that contrary to shear forces, no conclusion on normal forces drawn from trials with healthy participants can directly be applied to WCUs. Secondly, the present results indicate significant reduced averaged: normal force, PPI, and shear forces for able-bodied performing a dynamic activity compared to static sitting. WCUs experienced non-significant lower averaged normal force and PPI but significant lower averaged shear forces. CONCLUSION: While the present results seem to indicate lower forces for able-bodied performing a dynamic activity compared to static sitting, due to reduced averaged forces, this conclusion is less clear-cut for WCUs.

The present observational study can help understand the specific characteristics of wheelchair users concerning the biomechanical sitting load in rest and during propulsive activity: the shear forces are reduced during activity compared to static conditions.From the data collected in the present study, it seems that no conclusion on normal sitting forces drawn from trials with healthy participants can directly be applied to wheelchair users.

Studying mechanical load at body-seat interface during dynamic activities such as wheelchair propulsion: a scoping review.

BACKGROUND: The increasing number of wheelchair users and their risk of medical complications such as pressure ulcers (PU) make it important to have a better understanding of their seating characteristics. However, while most studies tackling this issue are based on static measurements, wheelchair users are active in their wheelchairs when performing daily life activities. This suggests the need to assess the mechanical loads at the wheelchair user's body-seat interface during dynamic activities. OBJECTIVES: A scoping review was conducted to explore the existing data (shear load and pressure) and highlight significant parameters, relevant conditions and methodological strategies when studying wheelchair users performing a dynamic task. MATERIALS AND METHODS: The literature search was performed by applying the PRISMA methodology. RESULTS: A total of 11 articles met the inclusion criteria. Differences between static and dynamic data were found in the literature for peak pressure values, pressure distribution and the location of peak pressure. None measured tangential load at the seat/body interface, although two studies measured the shift of the ischial region. A significant impact of the type of pathology has been quantified, showing the need to perform experimental studies on diverse populations. The protocol and the pressure parameters studied were very diverse. CONCLUSION: Further studies carefully choosing interface pressure mapping parameters and investigating a broader range of pathologies are required. Additionally, researchers should focus on finding a way to measure seated tangential load.

Slouched and Erect Sitting Postures Affect Upper Limb Maximum Voluntary Force Levels and Fatiguability: A Randomized Experimental Study.

OCCUPATIONAL APPLICATIONSModifying the spinal curvature is an empirical approach to treating upper limb musculoskeletal disorders, often attributed to the balance between physical stress and individual functional capacities. We completed an experimental biomechanical study to quantify the effect of seated spinal posture on upper limb functional capacities. Isometric maximum muscle voluntary forces (MVFs) were measured at participants' shoulder, elbow, and wrist. Fatiguability was also assessed during a repetitive painting task. Participants were asked to assume both slouched and erect spinal postures, in a random order. In the erect posture, participants achieved higher shoulder and elbow isometric MVF levels and took longer to reach a fatigue threshold. Thus, spinal posture tends to remotely influence upper limb functional capacities, especially at the shoulder and elbow. Ergonomists should consider spinal posture even when focusing on musculoskeletal disorders of the upper limb.

Background Musculoskeletal disorders are a major public health issue, and current treatments often remain unsatisfactory. Treatments based on spinal curvature modifications are empirically used for upper limb musculoskeletal disorders.Purpose To determine whether a slouched or erect sitting posture has an effect on upper limb functional capacities, with tests and outcomes focused on the risk of upper limb musculoskeletal disorders.Methods Randomized experimental study, crossover design. Twenty-two right-handed healthy participants from the local area were assessed in a research laboratory. Participants' spinal curvatures were increased or decreased, through verbal instructions and light touch, to place them in a slouched or an erect posture that was stable and easily maintained, in a random order. Isometric maximum muscle voluntary forces (MVFs) were measured. Participants also performed a repetitive task that simulated painting, with fatigue level assessed using the CR10 Borg scale. Upper limb positioning, task setting, and instructions to participants were standardized, and the investigator was blind to the results of MVF measurements. The main outcomes were normalized differences in MVF values and time-to-reach "7" on the CR10 scale.Results There were significantly higher MVF values in the erect posture for the shoulder and elbow, with respective mean (SD) normalized differences of 11.4 (18.2)% and 11.8 (19.2)%; differences approached significance at the wrist [7.7 (18.5)%]. The normalized difference in time-to-reach "7" on the CR10 scale was significantly higher in the erect posture (by 11.4%).Conclusions Spinal posture modified individual upper limb functional capacities and could thus influence the risk of upper limb musculoskeletal disorders.

Moment arms of the deltoid, infraspinatus and teres minor muscles for movements with high range of motion: A cadaveric study.

BACKGROUND: Moment arms are an indicator of the role of the muscles in joint actuation. An excursion method is often used to calculate them, even though it provides 1D results. As shoulder movement occurs in three dimensions (combination of flexion, abduction and axial rotation), moment arms should be given in 3D. Our objective was to assess the 3D moment arms of the rotator cuff (infraspinatus and teres minor) and deltoid muscles for movements with high arm elevation. METHODS: The 3D moment arms (components in plane of elevation, elevation and axial rotation) were assessed using a geometric method, enabling to calculate the moment arms in 3D, on five fresh post-mortem human shoulders. Movement with high range of motion were performed (including overhead movement). The humerus was elevated until it reaches its maximal posture in different elevation plane (flexion, scaption, abduction and elevation in a plane 30° posterior to frontal plane). FINDINGS: We found that the anterior deltoid was a depressor and contributes to move the elevation plane anteriorly. The median deltoid was a great elevator and the posterior deltoid mostly acted in moving the elevation plane posteriorly. The infraspinatus and teres minor were the greatest external rotator of the shoulder. The position of the glenohumeral joint induces changes in the muscular moment arms. The maximal shoulder elevation was 144° (performed in the scapular plane). INTERPRETATION: The knowledge of 3D moment arms for different arm elevations might help surgeons in planning tendon reconstructive surgery and help validate musculoskeletal models.

A Case Study on the Effects of Foam and Seat Pan Inclination on the Deformation of Seated Buttocks Using MRI.

OCCUPATIONAL APPLICATIONSWe investigated the effects of seat pan inclination and foam on the deformation of the seated buttocks using an upright MRI system. From observations among four healthy males, we found that soft tissue deformation under the ischial tuberosity (IT) could be reduced not only by using a soft cushion, but also by decreasing the shear force on the seat pan surface. These results suggest that soft tissue deformation could be used as an objective measure for assessing seating discomfort and injury risk, by accounting for the effects of both contact pressure and shear. We also confirmed that the gluteus maximus (GM) muscle displaced away from the IT once seated. As peak pressure and shear are most likely located below the IT, more realistic computational human body models in this region are needed that consider muscle sliding.

TECHNICAL ABSTRACTBackground: A full understanding of soft tissue deformations, particularly in the gluteal region in a seated position, would be helpful for improving seat comfort and reducing the injury risk of seated people. Thanks to recent developments in medical imaging, direct observations of soft-tissue deformations under realistic loading conditions is now possible using open MRI.Purpose: The purpose of this work was to investigate the effects of seat pan inclination and foam on the deformation of soft tissues in the gluteal region using an open MRI.Methods: Four healthy male participants completed the experiment, in which a positional MRI scanner was used to scan the buttocks and part of the thighs. Three seating conditions were tested by varying the seat pan angle (A_SP) and cushion material while the backrest was fixed at 22 degrees from the vertical: 1) A_SP = 7° without foam (Reference); 2) A_SP = 0° without foam (Shear); 3) A_SP = 7° with a 50 mm thick foam on the seat pan (Foam). In addition, one configuration (Unloaded), with the buttocks being unsupported, was also scanned for comparison. After segmenting images, we calculated the volumes of the gluteus maximus (GM) muscle and subcutaneous fat in three regions of interest under the ischial tuberosity (IT) for each condition.Results: Once seated, the GM displaced away from the IT laterally and posteriorly. For all participants, the largest tissue deformation was observed in the Shear condition, while the smallest was found in the Foam condition.Conclusions: The present study provides quantitative data needed for validating buttock-thigh finite element models. Future work is needed to link soft tissue deformation with discomfort perception.

Glenohumeral joint and muscles functions during a lifting task.

The mobility of the healthy shoulder depends on complex interactions between the muscles spanning its glenohumeral joint. These interactions ensure the stability of this joint. While previous studies emphasized the complexity of the glenohumeral stability, it is still not clear how the kinematics and muscles interact and adapt to ensure a healthy function of the glenohumeral joint. To understand the function of each muscle and degree of freedom of the glenohumeral joint in executing an above-the shoulder box handling task while ensuring stability, we adapted an index-based approach previously used to characterize the functions of the lower limb joints and muscles during locomotion. Forty participants lifted two loads (6 Vs. 12 kg) from hip to eye level. We computed the mechanical powers of the glenohumeral joint and its spanning muscles. We characterized the function of muscles and degrees of freedom using function indices. The function of the glenohumeral joint underlined its compliancy and design for a large range of motion, while the rotator cuff indices emphasized their stabilizing function. The overall muscle functions underlined the complexity of the glenohumeral stability that goes beyond the rotator cuff. Additionally, the load increase was compensated with changes in the functions that seem to favor joint stability. The implemented approach represents a synthetized tool that could quantify the glenohumeral joint and muscles behavior during tridimensional upper limb tasks, which might offer additional insight into motor control strategies and functional alterations related to pathologies or external parameters (e.g., load).

Effect of Bow Camber and Mass Distribution on Violinists' Preferences and Performance.

Little is known about how bow mechanical characteristics objectively and quantitatively influence violinists' preferences and performance. Hypothesizing that the bow shape (i.e., camber) and mass distribution modifications would alter both violinists' appreciations of a bow and objective assessments of their performance, we recruited 10 professional violinists to play their own violin using 18 versions of a single bow, modified by combining three cambers and six mass distributions, in random order. A musical phrase, composed for this study, was played legato and spiccato at three octaves and two tempi. Each violinist scored all 18 bows. Then, experts assessed the recorded performances according to criteria inspired by basic musical analysis. Finally, 12 audio-descriptors were calculated on the same note from each trial, to objectivise potential acoustic differences. Statistical analysis (ANOVA) reveals that bow camber impacted the violinists' appreciations (p < 0.05), and that heavier bow tips gave lower scores for spiccato playing (p < 0.05). The expert evaluations reveal that playing with a lighter bow (tip or frog), or with a bow whose camber's maximum curvature is close to the frog, had a positive impact on some violinists' performance (NS to p < 0.001). The "camber-participant" interaction had significant effects on the violinists' appreciations (p < 0.01 to p < 0.001), on the expert's evaluation and on almost all the audio-descriptors (NS to p < 0.001). While trends were identified, multiple camber-participant interactions suggest that bow makers should provide a variety of cambers to satisfy different violinists.

Distal biceps tendon repair via new knotless endobutton fixation: A biomechanical study.

BACKGROUND: Distal biceps tendon repair using endobutton fixation has shown the best biomechanical results in terms of pullout strength. Here, we compared Sethi's enhanced tension adjustable endobutton technique known as the "tension slide technique" to a new knotless endobutton fixation technique without a post-fixation screw. Our new approach is as effective as the tension slide technique in terms of pullout strength and gapping after early mobilization. METHODS: A biomechanical cadaveric study with 16 paired arms was performed. With the radius held in place, the distal biceps tendon was loaded at 100 N for 500 cycles and the load was then increased until failure. Gapping after loading cycles and maximum load to failure were recorded and compared. RESULTS: Median bone-tendon gapping was 5.77 mm (interquartile range (IQR) 4.84-9.11) for tension slide technique and 4.72 mm (IQR 1.77-6.16) for the knotless fixation (p = 0.047). Median load to failure was 257.87 N (IQR 222.07-325.35) in the tension slide technique group and 407.78 N (IQR 358.54-485.20) in the knotless group (p = 0.047). DISCUSSION: The knotless endobutton provides better pullout strength and elongation results compared to the tension slide technique without the use of an interference screw, allowing early mobilization in order to faster return to daily living activities.Level of evidence: Basic science study.

Three-Dimensional Upper Body Kinematics and Inter-articular Kinematic Sequence During a Canoe Polo Throw.

Canoe polo is an increasingly popular discipline requiring both kayaking and ball-handling skills. While the kinematics of the upper body during throw has been investigated for several overhead sports, the canoe polo throw has still to be studied. Therefore, the aim of this study is to analyze the canoe polo throw kinematics in terms of angles and inter-articular sequencing to understand its specificity. A secondary aim was to investigate whether adding pelvis mobility has an impact. Nineteen male players of canoe polo were equipped with reflective body markers for the throw analysis. They performed 5 throws with the pelvis fixed and 5 throws with additional pelvic mobility in rotation around a vertical axis. Inverse kinematics was performed with OpenSim providing pelvis, trunk, and glenohumeral rotations. Angular velocities were calculated to build the inter-articular sequences relative to these throws. Statistical parametric mapping was used to assess the effect of pelvis mobility on the throwing kinematics. Similar kinematics patterns as in other overhead sports were observed, however, a different inter-articular sequence was found for the canoe polo throw with a maximal angular velocity occurring sooner for the thorax in axial rotation than for the pelvis in rotation. While the limitation of rotation of the pelvis around a vertical axis has an influence on the pelvis and trunk kinematics, it did not modify the kinematic sequence.

Clavicle fracture prediction: simulation of shoulder lateral impacts with geometrically personalized finite elements models.

BACKGROUND: Human body numerical models can help to develop protection devices against effects of road crashes. In the context of a side impact, a shoulder model able to predict shoulder injuries and more especially clavicle fracture would be helpful. METHODS: A shoulder model derived from an existing finite element model of the human body representing an average male (50th percentile), HUMOS1, has been upgraded. An isolated clavicle model was assessed thanks to experimental corridors derived from dynamic tests up to failure. Then, the whole upgraded shoulder model was evaluated by comparison with results from experimental side impact tests on the shoulder. Eventually, the upgraded model was geometrically personalized toward the anthropometry of the subjects and its ability to simulate fractures was assessed. RESULTS: The isolated clavicle model was assessed as validated. The upgraded 50th percentile shoulder model provided accurate results in the subinjurious domain. At higher velocities, the personalized models produced realistic shoulder injuries: clavicle fracture was accurately predicted in four cases of six, the model was conservative for the two other cases. CONCLUSION: The upgraded shoulder model presented here was successfully submitted to a rigorous assessment process. Once geometrically personalized, it provided positive results for clavicle fracture prediction. As clavicle fracture is the major shoulder injury, this model could help the design of safety devices for shoulder protection. Furthermore, this study enhances the need for geometrical personalization methods when using finite element model for injury risk prediction.

Pelvis and femur shape prediction using principal component analysis for body model on seat comfort assessment. Impact on the prediction of the used palpable anatomical landmarks as predictors.

A personalized pelvis and femur shape is required to build a finite element buttock thigh model when experimentally investigating seating discomfort. The present study estimates the shape of pelvis and femur using a principal component analysis (PCA) based method with a limited number of palpable anatomical landmarks (ALs) as predictors. A leave-one-out experiment was designed using 38 pelvises and femurs from a same sample of adult specimens. As expected, prediction errors decrease with the number of ALs. Using the maximum number of easily palpable ALs (13 for pelvis and 4 for femur), average errors were 5.4 and 4.8 mm respectively for pelvis and femur. Better prediction was obtained when the shapes of pelvis and femur were predicted separately without merging the data of both bones. Results also show that the PCA based method is a good alternative to predict hip and lumbosacral joint centers with an average error of 5.0 and 9.2 mm respectively.

Influence of geometrical personalization on the simulation of clavicle fractures.

Finite element body models enable the evaluation of car occupant protection. In general, these models represent average males and inter-individual geometry variability is not taken into account. As the most frequent shoulder injury during car lateral accidents is a clavicle fracture, the purpose of this study is to investigate whether clavicle geometry has an influence on bone response until failure, and whether geometrical personalization of clavicle models is required. Eighteen clavicles from 9 subjects (5 males and 4 females, mean age: 76 +/- 12 years) were harvested. Six clavicles were scanned, enabling the development of subject-specific models and the quantification of geometrical features defining shape and cortical thickness. Bone mineral densities (BMD) were measured through double X-ray absorptiometry. Then, the general clavicle responses to dynamic compression until failure were studied. Simulations of the compression tests were carried out with the subject-specific models to assess the sensitivity of force-deflection clavicle responses to geometrical features. Clavicle fractures occurred at an average velocity of 1.41 +/- 0.4 ms(-1), with a fracture force of 1.48 +/- 0.46 kN and a deflection of 5.4 +/- 1.1 mm. A significant difference was found between male and female clavicle force values at rupture although their BMDs were not significantly different. Simulations with subject-specific models led to the conclusion that cortical bone thickness and bone shape have large effects on bone responses until failure and on fracture location. This study highlights the need for a geometrical personalization of clavicle models in order to take into account both gender discrepancies concerning clavicle shape and aging effects affecting cortical thickness.

Finite element models of the thigh-buttock complex for assessing static sitting discomfort and pressure sore risk: a literature review.

Being seated for long periods, while part of many leisure or occupational activities, can lead to discomfort, pain and sometimes health issues. The impact of prolonged sitting on the body has been widely studied in the literature, with a large number of human-body finite element models developed to simulate sitting and assess seat-induced discomfort or to investigate the biomechanical factors involved. Here, we review the finite element models developed to investigate sitting discomfort or risk of pressure sores. Our study examines finite element models from twenty-seven papers, seventeen dedicated to assessing seating discomfort and ten dedicated to investigating pressure ulcers caused by prolonged sitting. The models' mesh composition and material properties are found to differ widely. These models share a lack of validation and generally make little allowance for anthropometric diversity.