Development and Preliminary Evaluation of a Bimodal Foot Prosthesis for Walking and Running.

People often alternate between bouts of walking and running, for instance, when adults participate in recreational activities. Transitioning between activities can be challenging for prosthesis users because existing prosthetic feet are not well-suited for both tasks. Meanwhile, switching between prostheses for different tasks is often impractical. Collectively, these challenges can present barriers to physical activity participation for people with limb loss, which can negatively impact social or physical health. This work describes the development and evaluation of a passive bimodal prosthetic foot prototype with different configurations and stiffnesses for walking and running. Users rated the bimodal prosthesis higher for standing and walking compared to a running prosthesis (+2.3 for both tasks on a seven-point Likert scale). Users rated the bimodal prosthesis higher for running compared to a walking prosthesis (+1.7 and +0.5 for 2.0 and 2.5 m/s running, respectively). Changing from walking to running mode increased the device's stiffness by 23-84%, depending on the user's preference. Users could switch between bimodal prosthesis walking and running modes quickly (21.3 ± 12.0 s). Overall, the preliminary results were encouraging in terms of user satisfaction, stiffness change between modes, and mode-switching speed. These findings motivate future exploration of this bimodal prosthesis concept.

Integration of auditory and visual information about objects in superior temporal sulcus.

Two categories of objects in the environment-animals and man-made manipulable objects (tools)-are easily recognized by either their auditory or visual features. Although these features differ across modalities, the brain integrates them into a coherent percept. In three separate fMRI experiments, posterior superior temporal sulcus and middle temporal gyrus (pSTS/MTG) fulfilled objective criteria for an integration site. pSTS/MTG showed signal increases in response to either auditory or visual stimuli and responded more to auditory or visual objects than to meaningless (but complex) control stimuli. pSTS/MTG showed an enhanced response when auditory and visual object features were presented together, relative to presentation in a single modality. Finally, pSTS/MTG responded more to object identification than to other components of the behavioral task. We suggest that pSTS/MTG is specialized for integrating different types of information both within modalities (e.g., visual form, visual motion) and across modalities (auditory and visual).

Parallel visual motion processing streams for manipulable objects and human movements.

We tested the hypothesis that different regions of lateral temporal cortex are specialized for processing different types of visual motion by studying the cortical responses to moving gratings and to humans and manipulable objects (tools and utensils) that were either stationary or moving with natural or artificially generated motions. Segregated responses to human and tool stimuli were observed in both ventral and lateral regions of posterior temporal cortex. Relative to ventral cortex, lateral temporal cortex showed a larger response for moving compared with static humans and tools. Superior temporal cortex preferred human motion, and middle temporal gyrus preferred tool motion. A greater response was observed in STS to articulated compared with unarticulated human motion. Specificity for different types of complex motion (in combination with visual form) may be an organizing principle in lateral temporal cortex.

Capsular ligament involvement in the development of mechanical hyperalgesia after facet joint loading: behavioral and inflammatory outcomes in a rodent model of pain.

Whiplash injury can produce pain in the neck, arm, and hand, and has been associated with inflammation. However, the relationship between inflammatory responses and pain symptoms remains unknown, hindering the development of appropriate therapeutics for whiplash symptoms. Two joint loading paradigms were used separately in an established rat model of painful cervical facet joint distraction to apply: (1) gross failure, and (2) subfailure distraction of the facet capsular ligament. Behavioral outcomes were compared to determine whether more severe mechanical loading produces greater pain by measuring mechanical hyperalgesia in the shoulder and forepaws. Inflammatory mediators (glia and cytokines) were quantified in the spinal cord and dorsal root ganglion (DRG) after injury. Subfailure loading produced sustained hyperalgesia in the shoulder and forepaw that was significantly greater (p < 0.042) than sham, while an induced capsule failure produced only transient, yet significant (p < 0.021), mechanical hyperalgesia. The absence of hyperalgesia after ligament failure suggests this type of injury may interrupt nociceptive input from the capsule, which is likely necessary to produce sustained pain symptoms. Glial mRNA was significantly increased (p < 0.043) in the spinal cord after ligament failure, but remained unchanged in the DRG. Cytokine mRNA levels in the spinal cord and DRG were also significantly elevated after facet ligament failure, but not after painful subfailure loading. Findings suggest that different joint loading scenarios produced varied inflammatory responses in the CNS. These data support existing clinical reports suggesting that therapeutic interventions directed at the facet capsule may be effective in treating this painful injury.

Tensile cervical facet capsule ligament mechanics: failure and subfailure responses in the rat.

Clinical, epidemiological, and biomechanical studies suggest the involvement of the cervical facet joint in neck pain. Mechanical studies have suggested the facet capsular ligament to be at risk for subfailure tensile injury during whiplash kinematics of the neck. Ligament mechanical properties can be altered by subfailure injury and such loading can induce cellular damage. However, at present, there is no clear understanding of the physiologic context of subfailure facet capsular ligament injury and mechanical implications for whiplash-related pain. Therefore, this study aimed to define a relationship between mechanical properties at failure and a subfailure condition associated with pain for tension in the rat cervical facet capsular ligament. Tensile failure studies of the C6/C7 rat cervical facet capsular ligament were performed using a customized vertebral distraction device. Force and displacement at failure were measured and stiffness and energy to failure were calculated. Vertebral motions and ligament deformations were tracked and maximum principal strains and their directions were calculated. Mean tensile force at failure (2.96 +/- 0.69 N) was significantly greater (p < 0.005) than force at subfailure (1.17 +/- 0.48 N). Mean ligament stiffness to failure was 0.75 +/- 0.27 N/mm. Maximum principal strain at failure (41.3 +/- 20.0%) was significantly higher (p = 0.003) than the corresponding subfailure value (23.1 +/- 9.3%). This study determined that failure and a subfailure painful condition were significantly different in ligament mechanics and findings provide preliminary insight into the relationship between mechanics and pain physiology for this ligament. Together with existing studies, these findings offer additional considerations for defining mechanical thresholds for painful injuries.

A novel rodent neck pain model of facet-mediated behavioral hypersensitivity: implications for persistent pain and whiplash injury.

Clinical, epidemiological, and biomechanical studies suggest involvement of cervical facet joint injuries in neck pain. While bony motions can cause injurious tensile facet joint loading, it remains speculative whether such injuries initiate pain. There is currently a paucity of data explicitly investigating the relationship between facet mechanics and pain physiology. A rodent model of tensile facet joint injury has been developed using a customized loading device to apply two separate tensile deformations (low, high; n = 5 each) across the C6/C7 joint, or sham (n = 6) with device attachment only. Microforceps were rigidly coupled to the vertebrae for distraction and joint motions tracked in vivo. Forepaw mechanical allodynia was measured postoperatively for 7 days as an indicator of behavioral sensitivity. Joint strains for high (33.6 +/- 3.1%) were significantly elevated (P < 0.005) over low (11.1 +/- 2.3%). Digitization errors (0.17 +/- 0.20%) in locating bony markers were small compared to measured strains. Allodynia was significantly elevated for high over low and sham for all postoperative days. However, allodynia for low injury was not different than sham. A greater than three-fold increase in total allodynia resulted for high compared to low, corresponding to the three-fold difference in injury strain. Findings demonstrate tensile facet joint loading produces behavioral sensitivity that varies in magnitude according to injury severity. These results suggest that a facet joint tensile strain threshold may exist above which pain symptoms result. Continued investigation into the relationship between injury mechanics and nociceptive physiology will strengthen insight into painful facet injury mechanisms.

Joint distraction magnitude is associated with different behavioral outcomes and substance P levels for cervical facet joint loading in the rat.

UNLABELLED: The facet joint is a common source of pain in both the neck and low back, and can be injured by abnormal loading of the spinal joints. Whereas a host of nociceptive changes including neuronal activation, neuropeptide expression, and inflammatory mediator responses has been reported for rat models of joint pain, no such responses have been explicitly investigated or quantified for painful mechanical injury to the facet joint. Two magnitudes of joint loading were separately imposed in a rat model of cervical facet joint distraction: Painful and nonpainful distractions. Behavioral outcomes were defined by assessing mechanical hyperalgesia in the shoulders and forepaws. Substance P (SP) mRNA and protein levels were quantified in the dorsal root ganglion (DRG) and spinal cord at days 1 and 7 following distraction. Painful distraction produced mechanical hyperalgesia that was significantly greater (P < .010) than that for a nonpainful distraction. Painful distraction significantly increased spinal SP mRNA (P = .048) and SP protein expression in the DRG (P = .013) at day 7 compared to nonpainful distraction. However, spinal SP protein for painful distraction was significantly less (P = .024) than that for nonpainful distraction at day 1. Joint distractions producing different behavioral outcomes modulate SP mRNA and protein in the DRG and spinal cord, suggesting that SP responses may be involved with different temporal responses in painful joint loading. PERSPECTIVE: SP mRNA and protein in the DRG and spinal cord are quantified at 2 time points after cervical facet joint distractions that separately do or do not produce mechanical hyperalgesia. Studies describe a role for SP to contribute to pain produced by mechanical joint loading.

Cytokine mRNA expression in painful radiculopathy.

UNLABELLED: Inflammatory cytokines contribute to lumbar radiculopathy. Regulation of cytokines for transient cervical injuries, with or without longer-lasting inflammation, remains to be defined. The C7 root in the rat underwent compression (10gf), chromic gut suture exposure (chr), or their combination (10gf+chr). Ipsilateral C7 spinal cord and dorsal root ganglia (DRG) were harvested at 1 hour after injury for real-time PCR analysis of IL-1beta, IL-6, and TNF-alpha. Cytokine mRNA increased after all 3 injuries. TNF-alpha mRNA in the DRG was significantly increased over sham after 10gf+chr (P = .026). Spinal IL-1beta was significantly increased over sham after 10gf and 10gf+chr (P < .024); IL-6 was significantly increased after 10gf+chr (P < .024). In separate studies, the soluble TNF-alpha receptor was administered at injury and again at 6 hours in all injury paradigms. Allodynia was assessed and tissue samples were harvested for cytokine PCR. Allodynia significantly decreased with receptor administration for 10gf and 10gf+chr (P < .005). Treatment also significantly decreased IL-1beta and TNF-alpha mRNA in the DRG for 10gf+chr (P < .028) at day 1. Results indicate an acute, robust cytokine response in cervical nerve root injury with varying patterns, dependent on injury type, and that early increases in TNF-alpha mRNA in the DRG may drive pain-related signaling for transient cervical injuries. PERSPECTIVE: Inflammatory cytokine mRNA in the DRG and spinal cord are defined after painful cervical nerve root injury. Studies describe a role for TNF-alpha in mediating behavioral sensitivity and inflammatory cytokines in transient painful radiculopathy. Results outline an early response of inflammatory cytokine upregulation in cervical pain.

Structural changes in the cervical facet capsular ligament: potential contributions to pain following subfailure loading.

While studies have demonstrated the cervical facet capsule is at risk for tensile injury during whiplash, the relationship between joint loading, changes in the capsule's structure, and pain is not yet fully characterized. Complementary approaches were employed to investigate the capsule's structure-function relationship in the context of painful joint loading. Isolated C6/C7 facet joints (n=8) underwent tensile mechanical loading, and measures of structural modification were compared for two distraction magnitudes: 300 m (PV) and 700 m (SV). In a matched in vivo study, C6/C7 facet joints (n=4) were harvested after the same SV distraction and the tissue was sectioned to analyze collagen fiber organization using polarized light microscopy. Laxity following SV distraction (7.30+/-3.01%) was significantly greater (p<0.001) than that produced following PV distraction (0.99+/-0.44%). Also, SV distractions produced significantly higher maximum principal strain (p<0.001) in the capsule and resulted in significantly greater decreases in stiffness (p=0.002) when compared to PV distraction. After SV distraction in vivo, mean angular deviation of the fiber direction (16.8+/-2.6 degrees) was significantly increased (p=0.004) relative to naive samples in the lateral region of the capsule, indicating collagen fiber disorganization. These findings demonstrate that certain subfailure loading conditions are associated with altered joint mechanics and collagen fiber disorganization and imply ligament damage. Damage in the capsule has the potential to both directly modulate nerve fiber signaling and produce sustained physiologic modifications that may initiate persistent pain.

FMRI responses to video and point-light displays of moving humans and manipulable objects.

We used fMRI to study the organization of brain responses to different types of complex visual motion. In a rapid event-related design, subjects viewed video clips of humans performing different whole-body motions, video clips of manmade manipulable objects (tools) moving with their characteristic natural motion, point-light displays of human whole-body motion, and point-light displays of manipulable objects. The lateral temporal cortex showed strong responses to both moving videos and moving point-light displays, supporting the hypothesis that the lateral temporal cortex is the cortical locus for processing complex visual motion. Within the lateral temporal cortex, we observed segregated responses to different types of motion. The superior temporal sulcus (STS) responded strongly to human videos and human point-light displays, while the middle temporal gyrus (MTG) and the inferior temporal sulcus responded strongly to tool videos and tool point-light displays. In the ventral temporal cortex, the lateral fusiform responded more to human videos than to any other stimulus category while the medial fusiform preferred tool videos. The relatively weak responses observed to point-light displays in the ventral temporal cortex suggests that form, color, and texture (present in video but not point-light displays) are the main contributors to ventral temporal activity. In contrast, in the lateral temporal cortex, the MTG responded as strongly to point-light displays as to videos, suggesting that motion is the key determinant of response in the MTG. Whereas the STS responded strongly to point-light displays, it showed an even larger response to video displays, suggesting that the STS integrates form, color, and motion information.

In vivo cervical facet capsule distraction: mechanical implications for whiplash and neck pain.

While extensive research points to mechanical injury of the cervical facet joint as a mechanism of whiplash injury, findings remain speculative regarding its potential for causing pain. The purpose of this study was to examine the relationship between facet joint distraction, capsular ligament strain, cellular nociceptive responses, and pain. A novel rat model of in vivo facet joint injury was used to impose C6/C7 joint distraction in separate studies of subcatastrophic and physiologic vertebral distraction, as well as sham procedures. A common clinical measure of behavioral hypersensitivity (allodynia) was measured for 14 days after injury, as quantification of resulting pain symptoms. Also, on day 14, spinal activation of microglia and astrocytes was quantified to examine the potential role of glial activation as a physiologic mechanism of facet-mediated painful injury. Vertebral distractions of 0.90+/-0.53 mm across the rat facet joint reliably produced symptoms of persistent pain. Allodynia results showed immediate and sustained behavioral sensitivity following subcatastrophic vertebral distractions; pain symptoms were significantly greater (p<0.008) than those for other injury groups. Further, spinal astrocytic activation was also greater (p=0.049) for subcatastrophic injuries compared to lower distraction magnitudes. The mean maximum principal strain in the capsular ligament for joint distractions of 0.57+/-0.11 mm was 27.7+/-11.9%. Findings suggest that facet capsule strains comparable to those previously reported for whiplash kinematics and subcatastrophic failures of this ligament have the potential to produce pain symptoms and alter one element of nociception. Results further suggest that a mechanical threshold likely exists for painful joint distraction, providing behavioral and physiologic evidence of the cervical facet joint's mechanical injury as a source of neck pain.