Generative design for COVID-19 and future pathogens using stochastic multi-agent simulation.

We propose a generative design workflow that integrates a stochastic multi-agent simulation with the intent of helping building designers reduce the risk posed by COVID-19 and future pathogens. Our custom simulation randomly generates activities and movements of individual occupants, tracking the amount of virus transmitted through air and surfaces from contagious to susceptible agents. The stochastic nature of the simulation requires that many repetitions be performed to achieve statistically reliable results. Accordingly, a series of initial experiments identified parameter values that balanced the trade-off between computational cost and accuracy. Applying generative design to a case study based on an existing office space reduced the predicted transmission by around 10% to 20% compared with a baseline set of layouts. Additionally, a qualitative examination of the generated layouts revealed design patterns that may reduce transmission. Stochastic multi-agent simulation is a computationally expensive yet plausible way to generate safer building designs.

Automatic three-dimensional reconstruction of fascicles in peripheral nerves from histological images.

Computational studies can be used to support the development of peripheral nerve interfaces, but currently use simplified models of nerve anatomy, which may impact the applicability of simulation results. To better quantify and model neural anatomy across the population, we have developed an algorithm to automatically reconstruct accurate peripheral nerve models from histological cross-sections. We acquired serial median nerve cross-sections from human cadaveric samples, staining one set with hematoxylin and eosin (H&E) and the other using immunohistochemistry (IHC) with anti-neurofilament antibody. We developed a four-step processing pipeline involving registration, fascicle detection, segmentation, and reconstruction. We compared the output of each step to manual ground truths, and additionally compared the final models to commonly used extrusions, via intersection-over-union (IOU). Fascicle detection and segmentation required the use of a neural network and active contours in H&E-stained images, but only simple image processing methods for IHC-stained images. Reconstruction achieved an IOU of 0.42±0.07 for H&E and 0.37±0.16 for IHC images, with errors partially attributable to global misalignment at the registration step, rather than poor reconstruction. This work provides a quantitative baseline for fully automatic construction of peripheral nerve models. Our models provided fascicular shape and branching information that would be lost via extrusion.

Three-dimensional assessment of the asymptomatic and post-stroke shoulder: intra-rater test-retest reliability and within-subject repeatability of the palpation and digitization approach.

Purpose: Altered three-dimensional (3D) joint kinematics can contribute to shoulder pathology, including post-stroke shoulder pain. Reliable assessment methods enable comparative studies between asymptomatic shoulders of healthy subjects and painful shoulders of post-stroke subjects, and could inform treatment planning for post-stroke shoulder pain. The study purpose was to establish intra-rater test-retest reliability and within-subject repeatability of a palpation/digitization protocol, which assesses 3D clavicular/scapular/humeral rotations, in asymptomatic and painful post-stroke shoulders. Methods: Repeated measurements of 3D clavicular/scapular/humeral joint/segment rotations were obtained using palpation/digitization in 32 asymptomatic and six painful post-stroke shoulders during four reaching postures (rest/flexion/abduction/external rotation). Intra-class correlation coefficients (ICCs), standard error of the measurement and 95% confidence intervals were calculated. Results: All ICC values indicated high to very high test-retest reliability (≥0.70), with lower reliability for scapular anterior/posterior tilt during external rotation in asymptomatic subjects, and scapular medial/lateral rotation, humeral horizontal abduction/adduction and axial rotation during abduction in post-stroke subjects. All standard error of measurement values demonstrated within-subject repeatability error ≤5° for all clavicular/scapular/humeral joint/segment rotations (asymptomatic ≤3.75°; post-stroke ≤5.0°), except for humeral axial rotation (asymptomatic ≤5°; post-stroke ≤15°). Conclusions: This noninvasive, clinically feasible palpation/digitization protocol was reliable and repeatable in asymptomatic shoulders, and in a smaller sample of painful post-stroke shoulders. Implications for Rehabilitation In the clinical setting, a reliable and repeatable noninvasive method for assessment of three-dimensional (3D) clavicular/scapular/humeral joint orientation and range of motion (ROM) is currently required. The established reliability and repeatability of this proposed palpation/digitization protocol will enable comparative 3D ROM studies between asymptomatic and post-stroke shoulders, which will further inform treatment planning. Intra-rater test-retest repeatability, which is measured by the standard error of the measure, indicates the range of error associated with a single test measure. Therefore, clinicians can use the standard error of the measure to determine the "true" differences between pre-treatment and post-treatment test scores.

Corticomotor excitability of arm muscles modulates according to static position and orientation of the upper limb.

OBJECTIVE: We investigated how multi-joint changes in static upper limb posture impact the corticomotor excitability of the posterior deltoid (PD) and biceps brachii (BIC), and evaluated whether postural variations in excitability related directly to changes in target muscle length. METHODS: The amplitude of individual motor evoked potentials (MEPs) was evaluated in each of thirteen different static postures. Four functional postures were investigated that varied in shoulder and elbow angle, while the forearm was positioned in each of three orientations. Posture-related changes in muscle lengths were assessed using a biomechanical arm model. Additionally, M-waves were evoked in the BIC in each of three forearm orientations to assess the impact of posture on recorded signal characteristics. RESULTS: BIC-MEP amplitudes were altered by shoulder and elbow posture, and demonstrated robust changes according to forearm orientation. Observed changes in BIC-MEP amplitudes exceeded those of the M-waves. PD-MEP amplitudes changed predominantly with shoulder posture, but were not completely independent of influence from forearm orientation. CONCLUSIONS: Results provide evidence that overall corticomotor excitability can be modulated according to multi-joint upper limb posture. SIGNIFICANCE: The ability to alter motor pathway excitability using static limb posture suggests the importance of posture selection during rehabilitation aimed at retraining individual muscle recruitment and/or overall coordination patterns.

Posture-dependent changes in corticomotor excitability of the biceps after spinal cord injury and tendon transfer.

Following tendon transfer of the biceps to triceps after cervical spinal cord injuries (SCI), individuals must learn to activate the transferred biceps muscle to extend the elbow. Corticomotor excitability of the transferred biceps may play a role in post-operative elbow extension strength. In this study, we evaluated whether corticomotor excitability of the transferred biceps is related to an individuals' ability to extend the elbow, and whether posture and muscle length affects corticomotor excitability after SCI and tendon transfer similarly to the nonimpaired biceps. Corticomotor excitability was assessed in twelve nonimpaired arms and six arms of individuals with SCI and biceps-to-triceps transfer using transcranial magnetic stimulation (TMS) delivered at rest. Maximum isometric elbow extensor moments were recorded in transferred arms and the fiber length of the transferred biceps was estimated using a musculoskeletal model. Across the SCI subjects, corticomotor excitability of the transferred biceps increased with elbow extension strength. Thus, rehabilitation to increase excitability may enhance strength. Excitability of the transferred biceps was not related to fiber length suggesting that similar to nonimpaired subjects, posture-dependent changes in biceps excitability are primarily centrally modulated after SCI. All nonimpaired biceps were most excitable in a posture in the horizontal plane with the forearm fully supinated. The proportion of transferred biceps in which excitability was highest in this posture differed from the nonimpaired group. Therefore, rehabilitation after tendon transfer may be most beneficial if training postures are tailored to account for changes in biceps excitability.

A simulation analysis of the combined effects of muscle strength and surgical tensioning on lateral pinch force following brachioradialis to flexor pollicis longus transfer.

Biomechanical simulations of tendon transfers performed following tetraplegia suggest that surgical tensioning influences clinical outcomes. However, previous studies have focused on the biomechanical properties of only the transferred muscle. We developed simulations of the tetraplegic upper limb following transfer of the brachioradialis (BR) to the flexor pollicis longus (FPL) to examine the influence of residual upper limb strength on predictions of post-operative transferred muscle function. Our simulations included the transfer, ECRB, ECRL, the three heads of the triceps, brachialis, and both heads of the biceps. Simulations were integrated with experimental data, including EMG and joint posture data collected from five individuals with tetraplegia and BR-FPL tendon transfers during maximal lateral pinch force exertions. Given a measured co-activation pattern for the non-paralyzed muscles in the tetraplegic upper limb, we computed the highest activation for the transferred BR for which neither the elbow nor the wrist flexor moment was larger than the respective joint extensor moment. In this context, the effects of surgical tensioning were evaluated by comparing the resulting pinch force produced at different muscle strength levels, including patient-specific scaling. Our simulations suggest that extensor muscle weakness in the tetraplegic limb limits the potential to augment total pinch force through surgical tensioning. Incorporating patient-specific muscle volume, EMG activity, joint posture, and strength measurements generated simulation results that were comparable to experimental results. Our study suggests that scaling models to the population of interest facilitates accurate simulation of post-operative outcomes, and carries utility for guiding and developing rehabilitation training protocols.

The effect of landmarks and bone motion on posture-related changes in carpal tunnel volume.

BACKGROUND: Deviated wrist postures have been linked to carpal tunnel syndrome development, yet the effect of posture on carpal tunnel volume remains unclear. The purposes of this study were (i) to evaluate the effect of boundary definitions on tunnel volume estimates in neutral and non-neutral (30 degrees flexion, 30 degrees extension) wrist postures and (ii) to develop a biomechanical wrist simulation to predict posture-related changes in tunnel volume. METHODS: Two carpal tunnel volume measures were calculated using (i) ulnar bony landmarks and (ii) radial and ulnar bony landmarks identified directly from magnetic resonance imaging (MRI) scans. A third volume measure combined computerized tunnel reconstructions with modelled bone surfaces to calculate an anatomically landmarked volume. Six individual simulations were then generated to predict volume in the flexed and extended postures based on individual carpal bone motions. FINDINGS: Boundary definitions influenced the absolute volume in each posture and the relative changes between postures. Relative to fully reconstructed volumes, radial and ulnar landmarked volumes were 15-25% larger across postures (681 (SD 467) mm(3); P=0.01), while the ulnar-only landmarked volumes were 10-20% smaller (562 (343) mm(3); P<0.01). Simulation predicted volumes were not significantly different from the reconstructed anatomically landmarked volumes, with less inter-individual variability between postures compared to MRI-based volumes. INTERPRETATION: Comparison of volume measures indicated the importance of capturing posture-related changes in the orientation of the proximal and distal tunnel boundaries, and revealed potential sources of error associated with volume reconstruction. Simulations can enable changes in tunnel dimensions to be related to bone movements throughout a range of motion.

Wrist splint effects on muscle activity and force during a handgrip task.

Wrist splints are commonly prescribed to limit wrist motion and provide support at night and during inactive periods but are often used in the workplace. In theory, splinting the wrist should reduce wrist extensor muscle activity by stabilizing the joint and reducing the need for co-contraction to maintain posture. Ten healthy volunteers underwent a series of 24 10-s gripping trials with surface electromyography on 6 forearm muscles. Trials were randomized between splinted and nonsplinted conditions with three wrist postures (30 degrees flexion, neutral, and 30 degrees extension) and four grip efforts. Custom-made Plexiglas splints were taped to the dorsum of the hand and wrist. It was found that when simply holding the dynamometer, use of a splint led to a small (<1% MVE) but significant reduction in activity for all flexor muscles and extensor carpi radialis (all activity <4% maximum). At maximal grip, extensor muscle activity was significantly increased with the splints by 7.9-23.9% MVE. These data indicate that splinting at low-to-moderate grip forces may act to support the wrist against external loading, but appears counterproductive when exerting maximal forces. Wrist bracing should be limited to periods of no to light activity and avoided during tasks that require heavy efforts.

Wrist and carpal tunnel size and shape measurements: effects of posture.

BACKGROUND: Wrist anthropometrics and posture have been implicated in the development of carpal tunnel syndrome, yet it remains unclear how external measurements relate to carpal tunnel parameters in neutral and non-neutral postures. The purposes of this study were (i) to evaluate the effect of slice orientation on several indices of carpal tunnel size and shape and (ii) to examine the relationship between carpal tunnel and external wrist dimensions. METHODS: Three-dimensional static models were generated to measure carpal tunnel and wrist parameters for six wrists in three wrist postures (30 degrees flexion, neutral and 30 degrees extension). A simulated imaging plane enabled measurement of four carpal tunnel dimensions and two shape indices throughout the tunnel length, using "axial" and "tunnel" slice orientations (perpendicular to forearm and tunnel, respectively). FINDINGS: Correction for tunnel orientation eliminated posture-related changes in tunnel size and shape noted at the distal end using "axial" alignment. "Tunnel" alignment reduced average carpal tunnel area and depth by nearly 15% in extension, but generally less than 5% in neutral and 2% in flexion. Subsequently, "tunnel" alignment also decreased carpal tunnel and non-circularity ratios to reveal a flatter, more elliptical shape throughout the tunnel in extension than neutral and flexion. Wrist dimensions correlated significantly with tunnel dimensions, but not tunnel shape, while wrist shape correlated significantly with tunnel shape, area and depth. INTERPRETATIONS: Slice alignment with the carpal tunnel may improve the consistency of findings within and between patient and control populations, and enhance the diagnostic utility of imaging in clinical settings.

Evaluation of the carpal tunnel based on 3-D reconstruction from MRI.

While deviated wrist postures have been linked to the development of carpal tunnel syndrome, the relative contributions of posture-related changes in size, shape and volume of the carpal tunnel contribute to median nerve compression are unclear. The purpose of this study was two-fold: (1) to reconstruct the carpal tunnel from MRI data in neutral and non-neutral (30 degrees extension, 30 degrees flexion) wrist postures, and (2) to evaluate errors associated with off-axis imaging. Three-dimensional reconstruction of the carpal tunnels of 8 volunteers from the university community revealed that the orientation of the carpal tunnel was not directly explained by external wrist angle. The average orientation of the carpal tunnel was extended in all postures, ranging from 25 degrees +/-9 degrees in extension, 13 degrees +/-5 degrees in neutral and 4 degrees +/-4 degrees in the flexed wrist. Changing the orientation of the imaging plane to be perpendicular to the reconstructed carpal tunnel revealed that axial images overestimated cross-sectional area by an average of nearly 10% in extension, 4% in neutral and less than 1% in flexion. Similarly, adjusting the imaging plane to be perpendicular to external wrist angle overestimated cross-sectional area by an average of 2% in extension, 4% in neutral and 24% in flexion. Distortion of the carpal tunnel shape also became evident with rotation of the imaging plane. The data suggest that correction for the orientation of the carpal tunnel itself to be more appropriate than relying on external wrist angle. Computerized reconstruction provided detailed anatomic visualization of the carpal tunnel, and has created the framework to develop a biomechanical model of the carpal tunnel. Similar reconstruction of the tissue structures passing through (median nerve and flexor tendons) and entering the carpal tunnel (muscle tissue) will enable evaluation and partitioning of median nerve injury mechanisms.

Prediction of forearm muscle activity during gripping.

Occupational exposure is typically assessed by measuring forces and body postures to infer muscular loading. Better understanding of workplace muscle activity levels would aid in indicating which muscles may be at risk for overexertion and injury. However, electromyography collection in the workplace is often not practical. Therefore, a set of equations was developed and validated using data from two separate days to predict forearm muscle activity (involving six wrist and finger muscles) from grip force and posture of the wrist (flexed, neutral and extended) and forearm (pronated, neutral, supinated). The error in predicting activation levels of each forearm muscle across the range of grip forces, using the first day data (root mean square error; RMSEmodel), ranged from 8.9% maximal voluntary electrical activation (MVE) (flexor carpi radialis) to 11% MVE (extensor digitorum communis). Grip force was the main contributor to predicting muscle activity levels, explaining over 70% of the variance in flexor activation levels and up to 60% in extensor activation levels, respectively. Inclusion of gender as a variable in the model improved estimates of flexor but not extensor activity. While posture itself explained minimal variance in activation without grip force (< 10% MVE), wrist and forearm posture were required (with grip force) to explain over 70% of the variance of all six muscles. The validation process indicated good day-to-day reliability of each equation, with similar error for flexor muscle models but slightly higher error in the extensor models when predicting activity levels for the second day of data (RMSEvalid ranging from 8.9% to 12.7% MVE). Detailed error analysis during validation revealed that inclusion of posture in the model effectively decreased error at grip forces above 25% maximum, but was detrimental at very low grip forces. This study presents a potential new tool to estimate forearm muscle loading in the workplace using grip force and posture, as a surrogate to use of a complex biomechanical model.

The development and validation of equations to predict grip force in the workplace: contributions of muscle activity and posture.

The inherent difficulty of measuring forces on the hand in ergonomic workplace assessments has led to the need for equations to predict grip force. A family of equations was developed, and validated, for the prediction of grip force using forearm electromyography (six finger and wrist muscles) as well as posture of the wrist (flexed, neutral and extended) and forearm (pronated, neutral, supinated). Inclusion of muscle activity was necessary to explain over 85% of the grip force variance and was further improved with wrist posture but not forearm posture. Posture itself had little predictive power without muscle activity (<1%). Nominal wrist posture improved predictive power more than the measured wrist angle. Inclusion of baseline muscle activity, the activity required to simply hold the grip dynamometer, greatly improved grip force predictions, especially at low force levels. While the complete model using six muscles and posture was the most accurate, the detailed validation and error analysis revealed that equations based on fewer components often resulted in a negligible reduction in predictive strength. Error was typically less than 10% under 50% of maximal grip force and around 15% over 50% of maximal grip force. This study presents detailed error analyses to both improve upon previous studies and to allow an educated decision to be made on which muscles to monitor depending on expected force levels, costs and error deemed acceptable by the potential user.

The effects of posture on forearm muscle loading during gripping.

The purpose of this study was to quantify the response of the forearm musculature to combinations of wrist and forearm posture and grip force. Ten healthy individuals performed five relative handgrip efforts (5%, 50%, 70% and 100% of maximum, and 50 N) for combinations of three wrist postures (flexed, neutral and extended) and three forearm postures (pronated, neutral and supinated). 'Baseline' extensor muscle activity (associated with holding the dynamometer without exerting grip force) was greatest with the forearm pronated and the wrist extended, while flexor activity was largest in supination when the wrist was flexed. Extensor activity was generally larger than that of flexors during low to mid-range target force levels, and was always greater when the forearm was pronated. Flexor activation only exceeded the extensor activation at the 70% and 100% target force levels in some postures. A flexed wrist reduced maximum grip force by 40-50%, but EMG amplitude remained elevated. Women produced 60-65% of the grip strength of men, and required 5-10% more of both relative force and extensor activation to produce a 50 N grip. However, this appeared to be due to strength rather than gender. Forearm rotation affected grip force generation only when the wrist was flexed, with force decreasing from supination to pronation (p < 0.005). The levels of extensor activation observed, especially during baseline and low level grip exertions, suggest a possible contributing mechanism to the development of lateral forearm muscle pain in the workplace.

Crosstalk in surface electromyography of the proximal forearm during gripping tasks.

Electromyographic (EMG) crosstalk was systematically analyzed to evaluate the magnitude of common signal present between electrode pairs around the forearm. Surface EMG was recorded and analyzed from seven electrode pairs placed circumferentially around the proximal forearm in six healthy individuals. The cross-correlation function was used to determine the amount of common signal, which was found to decrease as the distance between electrode pairs increased, but was not significantly altered by forearm posture (pronation, neutral, supination). Overall, approximately 40% common signal was detected between adjacent electrode pairs (3 cm apart), dropping to about 10% at 6 cm spacing and 2.5% at 9 cm. The magnitude of common signal approached 50% between adjacent electrode pairs over the extensor muscles, while over 60% was observed between neighbouring sites on the flexor aspect of the forearm. Although flexor and extensor EMG amplitude was similar, less than 2% common signal was present between flexor and extensor electrode pairs during both pinch and grasp tasks. Maximum grip force production was not affected by forearm rotation for pinch, but reduced 18% from neutral (mid-prone) to pronation during grasp (p=0.01). In spite of differences in grip force, mean muscle activity did not vary between the three forearm postures during maximum pinch or grasp trials. While this study improved our knowledge of crosstalk and electrode spacing issues, further examination of forearm EMG is required to improve understanding of muscle loading, EMG properties and motor control during gripping tasks.