Cranial electrotherapy stimulation and transcranial pulsed current stimulation: a computer based high-resolution modeling study.

The field of non-invasive brain stimulation has developed significantly over the last two decades. Though two techniques of noninvasive brain stimulation--transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS)--are becoming established tools for research in neuroscience and for some clinical applications, related techniques that also show some promising clinical results have not been developed at the same pace. One of these related techniques is cranial electrotherapy stimulation (CES), a class of transcranial pulsed current stimulation (tPCS). In order to understand further the mechanisms of CES, we aimed to model CES using a magnetic resonance imaging (MRI)-derived finite element head model including cortical and also subcortical structures. Cortical electric field (current density) peak intensities and distributions were analyzed. We evaluated different electrode configurations of CES including in-ear and over-ear montages. Our results confirm that significant amounts of current pass the skull and reach cortical and subcortical structures. In addition, depending on the montage, induced currents at subcortical areas, such as midbrain, pons, thalamus and hypothalamus are of similar magnitude than that of cortical areas. Incremental variations of electrode position on the head surface also influence which cortical regions are modulated. The high-resolution modeling predictions suggest that details of electrode montage influence current flow through superficial and deep structures. Finally we present laptop based methods for tPCS dose design using dominant frequency and spherical models. These modeling predictions and tools are the first step to advance rational and optimized use of tPCS and CES.

Assessment of finite element human body and ATD models in estimating injury risk in far-side impacts using field-based injury risk.

The objective of this study was to assess the ability of finite element human body models (FEHBMs) and Anthropometric Test Device (ATD) models to estimate occupant injury risk by comparing it with field-based injury risk in far-side impacts. The study used the Global Human Body Models Consortium midsize male (M50-OS+B) and small female (F05-OS+B) simplified occupant models with a modular detailed brain, and the ES-2Re and SID-IIs ATD models in the simulated far-side crashes. A design of experiments (DOE) with a total of 252 simulations was conducted by varying lateral ΔV (10-50kph; 5kph increments), the principal direction of force (PDOF 50°, 60°, 65°, 70°, 75°, 80°, 90°), and occupant models. Models were gravity-settled and belted into a simplified vehicle model (SVM) modified for far-side impact simulations. Acceleration pulses and vehicle intrusion profiles used for the DOE were generated by impacting a 2012 Camry vehicle model with a mobile deformable barrier model across the 7 PDOFs and 9 lateral ΔV's in the DOE for a total of 63 additional simulations. Injury risks were estimated for the head, chest, lower extremity, pelvis (AIS 2+; AIS 3+), and abdomen (AIS 3+) using logistic regression models. Combined AIS 3+ injury risk for each occupant was calculated using AIS 3+ injury risk estimations for the head, chest, abdomen, and lower extremities. The injury risk calculated using computational models was compared with field-based injury risk derived from NASS-CDS by calculating their correlation coefficient. The field-based injury risk was calculated using risk curves that were created based on real-world crash data in a previous study (Hostetler et al., 2020). Occupant age (40 years), seatbelt use (belted occupant), collision deformation classification, lateral ΔV, and PDOF of the crash event were used in these curves to estimate field injury risk. Large differences in the kinematics were observed between HBM and ATD models. ATD models tended to overestimate risk in almost every case whereas HBMs yielded better risk estimates overall. Chest and lower extremity risks were the least correlated with field injury risk estimates. The overall risk of AIS 3+ injury risk was the strongest comparison to the field data-based risk curves. The HBMs were still not able to capture all the variance but future studies can be carried out that are focused on investigating their shortfalls and improving them to estimate injury risk closer to field injury risk in far-side crashes.

A detailed finite element model of a mid-sized male for the investigation of traffic pedestrian accidents.

The pedestrian is one of the most vulnerable road users and comprises approximately 23% of the road crash-related fatalities in the world. To protect pedestrians during Car-to-Pedestrian Collisions (CPC), subsystem impact tests are used in regulations. These tests provide insight but cannot characterize the complex vehicle-pedestrian interaction. The main purpose of this study was to develop and validate a detailed pedestrian Finite Element (FE) model corresponding to a 50th percentile male to predict CPC induced injuries. The model geometry was reconstructed using a multi-modality protocol from medical images and exterior scan data corresponding to a mid-sized male volunteer. To investigate injury response, this model included internal organs, muscles and vessels. The lower extremity, shoulder and upper body of the model were validated against Post Mortem Human Surrogate (PMHS) test data in valgus bending, and lateral/anterior-lateral blunt impacts, respectively. The whole-body pedestrian model was validated in CPC simulations using a mid-sized sedan and simplified generic vehicles bucks and previously unpublished PMHS coronal knee angle data. In the component validations, the responses of the FE model were mostly within PMHS test corridors and in whole body validations the kinematic and injury responses predicted by the model showed similar trends to PMHS test data. Overall, the detailed model showed higher biofidelity, especially in the upper body regions, compared to a previously reported simplified pedestrian model, which recommends using it in future pedestrian automotive safety research.

Validated thoracic vertebrae and costovertebral joints increase biofidelity of a human body model in hub impacts.

Objective: A recent emphasis on nontraditional seating and omnidirectional impact directions has motivated the need for deformable representation of the thoracic spine (T-spine) in human body models. The goal of this study was to develop and validate a deformable T-spine for the Global Human Body Models Consortium (GHBMC) M50-O (average male occupant) human model and to demonstrate improved biofidelity.Methods: Eleven functional spinal units (FSUs) were developed with deformable vertebrae (cortical and trabecular), spinal and costovertebral ligaments, and intervertebral discs. Material properties for all parts were obtained from the literature.FSUs were subjected to quasistatic loads per Panjabi et al. (1976) in 6 degrees of freedom. Stiffness values were calculated for each moment (Nm/°) and translational force (N/µm). Updated costovertebral (CV) joints of ribs 2, 6, and 10 were subjected to moments along 3 axes per Duprey et al. (2010). The response was optimized by maximum force and laxity in the ligaments. In both cases, updated models were compared to the baseline approach, which employed rigid bodies and joint-like behavior. The deformable T-spine and CV joints were integrated into the full M50-O model Ver. 5.0ß and 2 full-body cases were run: (1) a rear pendulum impact per Forman et al. (2015) at speeds up to 5.5 m/s. and (2) a lateral shoulder impact per Koh (2005) at 4.5 m/s. Quantitative evaluation protocols were used to evaluate the time history response vs. experimental data, with an average correlation and analysis (CORA) score of 0.76.Results: All FSU responses showed reduced stiffness vs. baseline. Tension, extension, torsion, and lateral bending became more compliant than experimental data. Like the experimental results, no trend was observed for joint response by level. CV joints showed good biofidelity. The response at ribs 2, 6, and 10 generally followed the experimental data.Conclusions: Deformable T-spine and CV joint validation has not been previously published and yielded high biofidelity in rear impact and notable improvement in lateral impact at the full body level. Future work will focus on localized T-spine injury criteria made possible by the introduction of this fully deformable representation of the anatomy.

A finite element model of a six-year-old child for simulating pedestrian accidents.

Child pedestrian protection deserves more attention in vehicle safety design since they are the most vulnerable road users who face the highest mortality rate. Pediatric Finite Element (FE) models could be used to simulate and understand the pedestrian injury mechanisms during crashes in order to mitigate them. Thus, the objective of the study was to develop a computationally efficient (simplified) six-year-old (6YO-PS) pedestrian FE model and validate it based on the latest published pediatric data. The 6YO-PS FE model was developed by morphing the existing GHBMC adult pedestrian model. Retrospective scan data were used to locally adjust the geometry as needed for accuracy. Component test simulations focused only the lower extremities and pelvis, which are the first body regions impacted during pedestrian accidents. Three-point bending test simulations were performed on the femur and tibia with adult material properties and then updated using child material properties. Pelvis impact and knee bending tests were also simulated. Finally, a series of pediatric Car-to-Pedestrian Collision (CPC) were simulated with pre-impact velocities ranging from 20km/h up to 60km/h. The bone models assigned pediatric material properties showed lower stiffness and a good match in terms of fracture force to the test data (less than 6% error). The pelvis impact force predicted by the child model showed a similar trend with test data. The whole pedestrian model was stable during CPC simulations and predicted common pedestrian injuries. Overall, the 6YO-PS FE model developed in this study showed good biofidelity at component level (lower extremity and pelvis) and stability in CPC simulations. While more validations would improve it, the current model could be used to investigate the lower limb injury mechanisms and in the prediction of the impact parameters as specified in regulatory testing protocols.

A Method to Quantify Supine to Prone Thoracoabdominal Deformation and Organ Migration in a Set of Healthy Young Adults.

Medical image data used for the development of computational human body models are often retrospectively acquired, and researchers are unlikely to encounter scans of healthy individuals in specific postures. We prospectively acquired scans in both prone and supine postures from 22 healthy young adults; M:F 1:1, with age, height, and weight of 28.8±7.0 years, 173.0±7.8 cm, and 70.6±10.9 kg. While prone, subjects’ arms were superior to the head and supported by a foam insert at axilla. Breath held, T1-weighted MRI scans were acquired using a Siemen’s Skyra 3T with an in-plane resolution of 1.56 mm (TR: 4.10 ms, TE: 1.23 ms, thickness: 2 mm, matrix: 256x256, FOV: 400 mm). Gross thoraco-abdominal compression was considered as the change in perpendicular distance in the transverse plane measured from the anterior margin of L4/L5 to the table (for prone) or exterior body surface (for supine). Gross thoraco-abdominal, liver and spleen compression were found to be 8.5% (71.6±12.9 mm prone vs. 78.7±12.4 mm supine; p=0.0013), 17.7% (110.4±4.1 mm prone vs. 134.8±2.6 mm supine; p<0.0001), and 3.5% (53.8±1.9 mm prone vs. 57.3±2.9 mm supine) respectively. Gender and spleen compression differences were not noted. The liver and spleen migrated on average 8.3 mm posteriorly, 11.4 mm rightward, 15.1 mm superiorly and 4.1 mm anteriorly, 6.1 mm rightward, 1.7 mm superiorly respectively. The data obtained from this set may be of use in computational biomechanics, surgical simulation, and medical device design.

Development of a computationally efficient full human body finite element model.

INTRODUCTION: A simplified and computationally efficient human body finite element model is presented. The model complements the Global Human Body Models Consortium (GHBMC) detailed 50th percentile occupant (M50-O) by providing kinematic and kinetic data with a significantly reduced run time using the same body habitus. METHODS: The simplified occupant model (M50-OS) was developed using the same source geometry as the M50-O. Though some meshed components were preserved, the total element count was reduced by remeshing, homogenizing, or in some cases omitting structures that are explicitly contained in the M50-O. Bones are included as rigid bodies, with the exception of the ribs, which are deformable but were remeshed to a coarser element density than the M50-O. Material models for all deformable components were drawn from the biomechanics literature. Kinematic joints were implemented at major articulations (shoulder, elbow, wrist, hip, knee, and ankle) with moment vs. angle relationships from the literature included for the knee and ankle. The brain of the detailed model was inserted within the skull of the simplified model, and kinematics and strain patterns are compared. RESULTS: The M50-OS model has 11 contacts and 354,000 elements; in contrast, the M50-O model has 447 contacts and 2.2 million elements. The model can be repositioned without requiring simulation. Thirteen validation and robustness simulations were completed. This included denuded rib compression at 7 discrete sites, 5 rigid body impacts, and one sled simulation. Denuded tests showed a good match to the experimental data of force vs. deflection slopes. The frontal rigid chest impact simulation produced a peak force and deflection within the corridor of 4.63 kN and 31.2%, respectively. Similar results vs. experimental data (peak forces of 5.19 and 8.71 kN) were found for an abdominal bar impact and lateral sled test, respectively. A lateral plate impact at 12 m/s exhibited a peak of roughly 20 kN (due to stiff foam used around the shoulder) but a more biofidelic response immediately afterward, plateauing at 9 kN at 12 ms. Results from a frontal sled simulation showed that reaction forces and kinematic trends matched experimental results well. The robustness test demonstrated that peak femur loads were nearly identical to the M50-O model. Use of the detailed model brain within the simplified model demonstrated a paradigm for using the M50-OS to leverage aspects of the M50-O. Strain patterns for the 2 models showed consistent patterns but greater strains in the detailed model, with deviations thought to be the result of slightly different kinematics between models. The M50-OS with the deformable skull and brain exhibited a run time 4.75 faster than the M50-O on the same hardware. CONCLUSIONS: The simplified GHBMC model is intended to complement rather than replace the detailed M50-O model. It exhibited, on average, a 35-fold reduction in run time for a set of rigid impacts. The model can be used in a modular fashion with the M50-O and more broadly can be used as a platform for parametric studies or studies focused on specific body regions.

Reduced discomfort during high-definition transcutaneous stimulation using 6% benzocaine.

BACKGROUND: High-Definition transcranial Direct Current Stimulation (HD-tDCS) allows for non-invasive neuromodulation using an array of compact (approximately 1 cm(2) contact area) "High-Definition" (HD) electrodes, as compared to conventional tDCS (which uses two large pads that are approximately 35 cm(2)). In a previous transcutaneous study, we developed and validated designs for HD electrodes that reduce discomfort over >20 min session with 2 mA electrode current. OBJECTIVE: The purpose of this study was to investigate the use of a chemical pretreatment with 6% benzocaine (topical numbing agent) to further reduce subjective discomfort during transcutaneous stimulation and to allow for better sham controlled studies. METHODS: Pre-treatment with 6% benzocaine was compared with control (no pretreatment) for 22 min 2 mA of stimulation, with either CCNY-4 or Lectron II electroconductive gel, for both cathodal and anodal transcutaneous (forearm) stimulation (eight different combinations). RESULTS: RESULTS show that for all conditions and polarities tested, stimulation with HD electrodes is safe and well tolerated and that pretreatment further reduced subjective discomfort. CONCLUSION: Pretreatment with a mild analgesic reduces discomfort during HD-tDCS.

Classification of methods in transcranial electrical stimulation (tES) and evolving strategy from historical approaches to contemporary innovations.

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.