Development of a Novel Soft Tissue Measurement Device for Individualized Finite Element Modeling in Custom-Fit CPAP Mask Evaluation.

PURPOSE: Individual facial soft tissue properties are necessary for creating individualized finite element (FE) models to evaluate medical devices such as continuous positive airway pressure (CPAP) masks. There are no standard tools available to measure facial soft tissue elastic moduli, and techniques in literature require advanced equipment or custom parts to replicate. METHODS: We propose a simple and inexpensive soft tissue measurement (STM) indenter device to estimate facial soft tissue elasticity at five sites: chin, cheek near lip, below cheekbone, cheekbone, and cheek. The STM device consists of a probe with a linear actuator and force sensor, an adjustment system for probe orientation, a head support frame, and a controller. The device was validated on six ballistics gel samples and then tested on 28 subjects. Soft tissue thickness was also collected for each subject using ultrasound. RESULTS: Thickness and elastic modulus measurements were successfully collected for all subjects. The mean elastic modulus for each site is Ec = 53.04 ± 20.97 kPa for the chin, El = 16.33 ± 8.37 kPa for the cheek near lip, Ebc = 27.09 ± 11.38 kPa for below cheekbone, Ecb = 64.79 ± 17.12 kPa for the cheekbone, and Ech = 16.20 ± 5.09 kPa for the cheek. The thickness and elastic modulus values are in the range of previously reported values. One subject's measured soft tissue elastic moduli and thickness were used to evaluate custom-fit CPAP mask fit in comparison to a model of that subject with arbitrary elastic moduli and thickness. The model with measured values more closely resembles in vivo leakage results. CONCLUSION: Overall, the STM provides a first estimate of facial soft tissue elasticity and is affordable and easy to build with mostly off-the-shelf parts. These values can be used to create personalized FE models to evaluate custom-fit CPAP masks.

Soft tissue material properties based on human abdominal in vivo macro-indenter measurements.

Simulations of human-technology interaction in the context of product development require comprehensive knowledge of biomechanical in vivo behavior. To obtain this knowledge for the abdomen, we measured the continuous mechanical responses of the abdominal soft tissue of ten healthy participants in different lying positions anteriorly, laterally, and posteriorly under local compression depths of up to 30 mm. An experimental setup consisting of a mechatronic indenter with hemispherical tip and two time-of-flight (ToF) sensors for optical 3D displacement measurement of the surface was developed for this purpose. To account for the impact of muscle tone, experiments were conducted with both controlled activation and relaxation of the trunk muscles. Surface electromyography (sEMG) was used to monitor muscle activation levels. The obtained data sets comprise the continuous force-displacement data of six abdominal measurement regions, each synchronized with the local surface displacements resulting from the macro-indentation, and the bipolar sEMG signals at three key trunk muscles. We used inverse finite element analysis (FEA), to derive sets of nonlinear material parameters that numerically approximate the experimentally determined soft tissue behaviors. The physiological standard values obtained for all participants after data processing served as reference data. The mean stiffness of the abdomen was significantly different when the trunk muscles were activated or relaxed. No significant differences were found between the anterior-lateral measurement regions, with exception of those centered on the linea alba and centered on the muscle belly of the rectus abdominis below the intertubercular plane. The shapes and areas of deformation of the skin depended on the region and muscle activity. Using the hyperelastic Ogden model, we identified unique material parameter sets for all regions. Our findings confirmed that, in addition to the indenter force-displacement data, knowledge about tissue deformation is necessary to reliably determine unique material parameter sets using inverse FEA. The presented results can be used for finite element (FE) models of the abdomen, for example, in the context of orthopedic or biomedical product developments.

Generation of Mechanical Characteristics in Workpiece Subsurface Layers through Milling.

The generation of mechanical characteristics in workpiece subsurface layers as a result of the cutting process has a predominant influence on the performance properties of machined parts. The effect of the end milling process on the mechanical characteristics of the machined subsurface layers was evaluated using nondestructive methods: instrumented nanoindentation and sclerometry (scratching). In this paper, the influence of one of the common processes of materials processing by cutting-the process of end tool milling-on the generation of mechanical characteristics of workpiece machined subsurface layers is studied. The effect of the end milling process on the character of mechanical property formation was evaluated through the coincidence of the cutting process energy characteristics with the mechanical characteristics of the machined subsurface layers. The total cutting power and cutting work in the tertiary cutting zone area were used as energy characteristics of the end milling process. The modes of the end milling process are considered as the main parameters affecting these energy characteristics. The mechanical characteristics of the workpiece machined subsurface layers were the microhardness of the subsurface layers and the total work of indenter penetration, determined by instrumental nanoindentation, and the maximum depth of indenter penetration, determined by sclerometry. Titanium alloy Ti10V2Fe3Al (Ti-1023) was used as the machining material. Based on the evaluation of the coincidence of the cutting process energy characteristics with the specified mechanical characteristics of the machined subsurface layers, the milling mode effect of the studied titanium alloy, in particular the cutter feed and cutting speed, on the generated mechanical characteristics was established.

Evaluation of the (Baha) technique of scleral indentation using a self-retained scleral indenter during vitrectomy surgery: a randomized trial.

AIMS: The current study compared a novel technique of scleral indentation using the self-retaining Leyla retractor to the conventional scleral self-indentation with the chandelier light. METHODS: Patients with rhegmatogenous retinal detachment were randomized on a 1:1 basis to either have the (Baha) indentation using a tip of a thimble scleral indenter welded to the support for the Leyla retractor system or to have the conventional scleral indentation while using a 25-gauge chandelier light. A video was recorded for the surgery of all the cases and reviewed by another consultant masked to the type of indentation. The indentation duration (i.e., the time in seconds between the first appearance of a hump due to scleral indentation in the recorded video until its final disappearance) was measured for every case. RESULTS: The current study included 60 eyes of 60 adults with a mean age of 59.6 ± 9.8 years. Thirty-nine of the eyes were phakic and 21 were pseudophakic. The mean indentation time was 618 ± 87 and 696 ± 72 s in (Baha) indentation and conventional indentation groups, respectively. The difference was not statistically significant (p = 38). There was a positive correlation between the vertical palpebral fissure height and the indentation duration for both (Baha) indentation (r = 0.58) and conventional indentation groups (r = 0.42). Readjustment of the chandelier endo-illumination was required in 19 cases (63.3%) in the conventional indentation group. Iatrogenic breaks or accidental crystalline lens touch did not occur in any case. CONCLUSION: The (Baha) technique is effective and safe, especially in patients with a larger palpebral fissure.

Anthropomorphic model rigid loading indenter with embedded sensor development for wheelchair cushion standard testing.

Develop an anthropomorphic model cushion rigid loading indenter with embedded sensors (AMCRLI-ES) to assess compression and shear forces at key locations such as trochanters and ischial tuberosities. The sensor design was optimized using finite element analysis. The AMCRLI-ES was designed with the same dimensions as specified in ISO 16840-2 tests. The AMCRLI-ES is divided into eight independent sections, and each section consists of one 3-axis load cell sensor to measure compression and shear forces normal to the compression direction. Six commercial cushions were tested using the AMCRLI-ES with standard ISO 16840-2 testing procedures. Statistical differences were found for energy dissipation between cushions. Statistical differences (p < 0.001) were found in all stiffness values. Test results showed that energy dissipation (ED) was correlated with hysteresis at 500 N with moderate to high Pearson product correlation r = -0.537, p = 0.022. The hysteresis at 250 N did not show a statistical correlation with ED. The AMCRLI-ES demonstrated the ability to measure compression and shear forces at key locations on the cushion including the thigh, trochanter, ischial tuberosity, and sacral area. It provides in-depth information about how the weight was distributed on the cushions.

Evaluation of the Fracture Toughness KIc for Selected Magnetron Sputtering Coatings by Using the Laugier Model.

Nanoindentation is one of the methods that allows for determining the fracture properties of brittle materials. In this article, the authors present the possibility of the fracture toughness coefficient calculation of ceramic-based coatings doped by metal (W, Cr) by using the nanoindentation method with the Berkovich diamond indenter. The mechanical properties of selected coatings, such as hardness and Young's modulus, were investigated from nanohardness experiments. We analyzed the brittle fracture, which includes changes in hardness (H), Young's modulus (E), plasticity index H/E and resistance to plastic deformation H3/E2, enabled the concentration of tungsten and chromium. Due to the size of the indentation and the size of the initial cracks, it is necessary to use Scanning Electron Microscopy (SEM) to observe and measure the indentations made and the generated cracks. For evaluation of the fracture toughness in mode I, the Laugier model was chosen experimentally. The fracture toughness analysis showed that doping with concentrations of 10% W and 10% Cr causes an increase in the fracture toughness for KIc = 4.98 for TiBW (10%) and KIc = 6.23 for TiBCr (10%).

Effect of Indenter Nose Shape and Layer Configuration on the Quasi-Static Perforation Behaviour of Metal-Plastic Laminates.

This study investigated the perforation resistance behaviour of metal-plastic laminates (MPLs) when they are indented by different nose shapes. Aluminium (Al) and HDPE (high-density polyethylene) layers were bonded with a suitable adhesive in an alternative manner to prepare bilayer and trilayer MPL configurations. Quasi-static perforation experiments were performed with hemispherical, conical and blunt indenters. The effects of nose shape, layer configuration and adhesive on the force-deformation profile, perforation resistance capacity and failure mechanisms were evaluated. The results indicate that for a monolithic layer, the blunt indenter showed the highest perforation energy capacity. The conical and blunt indenters facing Al backed by HDPE gave higher perforation energy. The hemispherical indenter facing HDPE backed by Al was found to be more effective in perforation resistance. Trilayer Al-HDPE-Al showed higher perforation resistance than HDPE-Al-HDPE. Circumferential cracking, radial symmetric cracking and shear plugging were the main failure modes for Al under hemispherical, conical and blunt indenters, respectively. The adhesive contributed to an increase in the perforation energy and peak force to failure in laminates. The adhesive was shown to detach from the Al surface after Al fracturing through crack propagation, and this effect was more pronounced when the indenter faced HDPE at the front of the laminate.

Atomistic Insights into the Phase Transformation of Single-Crystal Silicon during Nanoindentation.

The influence of the indenter angle on the deformation mechanisms of single-crystal Si was analyzed via molecular dynamics simulations of the nanoindentation process. Three different types of diamond conical indenters with semi-angles of 45°, 60°, and 70° were used. The load-indentation depth curves were obtained by varying the indenter angles, and the structural phase transformations of single-crystal Si were observed from an atomistic view. In addition, the hardness and elastic modulus with varying indenter angles were evaluated based on the Oliver-Pharr method and Sneddon's solution. The simulation results showed that the indenter angle had a significant effect on the load-indentation depth curves, which resulted from the strong dependence of the elastic and plastic deformation ratios on the indenter angle during indentations.

Comparison of the Indentation Processes Using the Single Indenter and Indenter Array: A Molecular Dynamics Study.

Fabrication of periodic nanostructures has drawn increasing interest owing to their applications of such functional structures in optics, biomedical and power generation devices. Nano-indentation technique has been proven as a method to fabricate periodic nanostructures. In this study, the molecular dynamic simulation approach is employed to investigate the nano-indentation process for fabricating periodic nano-pit arrays using a single indenter and an indenter array. The morphologies of indentations that machined using these two kinds of indenters are compared. The indentation force and the defect evolution during the nano-indentation process are further studied. Results show that indentation morphologies obtained by single indenter are mainly depended on the spacing of indenters, and a nano-pit array with a better shape and consistency can be obtained easier using the indenter array compared with using a single indenter. The stacking faults and dislocations induced by indentation are depended on the spacing of the indenters. Our findings are significant for understanding the differences of indentation processes using a single indenter and an indenter array and machining a high-quality periodic nano-pit array with high machining efficiency.

Indenting soft samples (hydrogels and cells) with cantilevers possessing various shapes of probing tip.

The identification of cancer-related changes in cells and tissues based on the measurements of elastic properties using atomic force microscopy (AFM) seems to be approaching clinical application. Several limiting aspects have already been discussed; however, still, no data have shown how specific AFM probe geometries are related to the biomechanical evaluation of cancer cells. Here, we analyze and compare the nanomechanical results of mechanically homogenous polyacrylamide gels and heterogeneous bladder cancer cells measured using AFM probes of various tip geometry, including symmetric and non-symmetric pyramids and a sphere. Our observations show large modulus variability aligned with both types of AFM probes used and with the internal structure of the cells. Altogether, these results demonstrate that it is possible to differentiate between compliant and rigid samples of kPa elasticity; however, simultaneously, they highlight the strong need for standardized protocols for AFM-based elasticity measurements if applied in clinical practice including the use of a single type of AFM cantilever.

Effect of indenter material on reliability of all-ceramic crowns.

OBJECTIVES: Controversy exists about whether the elastic modulus (E) mismatch between the loading indenter and ceramic materials influences fatigue testing results. The research hypotheses were that for porcelain veneered Y-TZP crowns 1) A low modulus Steatite indenter (SB) leads to higher fatigue reliability compared to a high modulus tungsten carbide indenter (WC); 2) Different surface damage patterns are expected between low and high modulus indenters after sliding contact fatigue testing. All ceramic crowns will exhibit similar step-stress accelerated life testing (SSALT) contact fatigue reliability (hypothesis 1) and failure characteristics (hypothesis 2) when using high stiffness tungsten carbide (WC, E = 600 GPa) vs. enamel like steatite (SB, E = 90 GPa) indenters. METHODS: Manufacturer (3M Oral Care) prepared Y-TZP-veneered all-ceramic molar crowns were bonded to aged resin composite reproductions of a standard tooth preparation and subjected to mouth-motion SSALT fatigue (n = 18 per indenter type). Failure was defined either as initial inner cone crack (IC), or final fracture (FF) when porcelain fractured (chipping). Selected IC specimens that did not progress to FF were embedded in epoxy resin and sectioned for fractographic analysis. RESULTS: The distribution of failures across the load and cycle profiles lead to similar calculated Weibull Use Level Probability Plots with overlap of the 2-sided 90% confidence bounds. The calculated reliability for IC and FF was equivalent at a mission of 300 N or 700 N load and 50,000 cycles, although the WC indenter had a trend for lower reliability for IC at 700 N. Both indenters produced similar patterns of wear and cracking on crown surfaces. Fractographic landmarks showed competing failure modes, but sliding contact partial inner cone cracks were the most dominant for both groups. SIGNIFICANCE: The more compliant Steatite indenter had similar veneered crown fatigue reliability and failure modes to those found with use of a high stiffness tungsten carbide indenter (hypotheses 1 and 2 rejected).

CCM PILOT STUDY OVERVIEW: GEOMETRICAL MEASUREMENT OF THE ROCKWELL DIAMOND INDENTER.

This paper describes an overview of the capability of the NMIs that participated on the CCM Pilot Study measurement systems, conducted by the CIPM/CCM/Working Group on Hardness, to characterize the Rockwell hardness diamond indenter geometry, by measuring the included cone angle, the straightness of the generatrix, the spherical tip radius, the deviation of the local radius and the tilt angle. Nine NMIs took part in this study: INMETRO (Brazil); INRiM (Italy); KRISS (South Korea); NIM/PR (China); NIMT (Thailand); NIST (USA); PTB (Germany); TUBITAK UME (Turkey); VNIIFTRI (Russia), where INMETRO (Brazil) served as pilot laboratory.

Analysis of O-Ring Seal Failure under Static Conditions and Determination of End-of-Lifetime Criterion.

Determining a suitable and reliable end-of-lifetime criterion for O-ring seals is an important issue for long-term seal applications. Therefore, seal failure of ethylene propylene diene rubber (EPDM) and hydrogenated nitrile butadiene rubber (HNBR) O-rings aged in the compressed state at 125 °C and at 150 °C for up to 1.5 years was analyzed and investigated under static conditions, using both non-lubricated and lubricated seals. Changes of the material properties were analyzed with dynamic-mechanical analysis and permeability experiments. Indenter modulus measurements were used to investigate DLO effects. It became clear that O-rings can remain leak-tight under static conditions even when material properties have already degraded considerably, especially when adhesion effects are encountered. As a feasible and reliable end-of-lifetime criterion for O-ring seals under static conditions should include a safety margin for slight dimensional changes, a modified leakage test involving a small and rapid partial decompression of the seal was introduced that enabled determining a more realistic but still conservative end-of-lifetime criterion for an EPDM seal.

Modeling and Experiment of the Critical Depth of Cut at the Ductile-Brittle Transition for a 4H-SiC Single Crystal.

In this paper, a theoretical model of the critical depth of cut of nanoscratching on a 4H-SiC single crystal with a Berkovich indenter is proposed, and a series of scratch tests in a nanomechanical test system was performed. Through nanoindentation experimentation on fused quartz, the Berkovich indenter nose radius was indirectly confirmed using least squares. The range of critical depths of cut at the ductile-brittle transition was obtained by SEM observation, and the size of cracks was amplified with increasing scratching depth. The theoretical result of the critical depth of cut at the ductile-brittle transition for a 4H-SiC single crystal is 91.7 nm, which is close to the first obvious pop-in point of the relation curve between tangential force and lateral displacement. Repeated experimental results show good consistency and good agreement with other references.

Development of an Advanced Dynamic Microindentation System to Determine Local Viscoelastic Properties of Polymers.

This study presents a microindentation system which allows spatially resolved local as well as bulk viscoelastic material information to be obtained within one instrument. The microindentation method was merged with dynamic mechanical analysis (DMA) for a tungsten cone indenter. Three tungsten cone indenters were investigated: tungsten electrode, tungsten electrode + 2% lanthanum, and tungsten electrode + rare earth elements. Only the tungsten electrode + 2% lanthanum indenter showed the sinusoidal response, and its geometry remained unaffected by the repeated indentations. Complex moduli obtained from dynamic microindentation for high-density polyethylene, polybutylene terephthalate, polycarbonate, and thermoplastic polyurethane are in agreement with the literature. Additionally, by implementing a specially developed x-y-stage, this study showed that dynamic microindentation with a tungsten cone indenter was an adequate method to determine spatially resolved local viscoelastic surface properties.

Mechanical Behavior of Undoped n-Type GaAs under the Indentation of Berkovich and Flat-Tip Indenters.

In this research, the mechanical behavior of undoped n-type GaAs was investigated by nanoindentation experiments using two types of indenters-Berkovich and flat-tip-with force applied up to 1000 mN. From the measured force-depth curves, an obvious pop-in phenomenon occurred at force of 150 mN with the flat-tip indenter representing elastic-plastic transition. The Young's modulus and hardness of GaAs were calculated to be 60-115 GPa and 6-10 GPa, respectively, under Berkovich indenter. Based on the observation of indent imprints, the fracture characteristics of GaAs were also discussed. A recovery of crack by the next indentation was observed at 1000 mN with Berkovich indenter. In the case of flat-tip indentation, however, surface material sank into a wing shape from 400 mN. In this sinking region, a density of fork-shaped sinking, slip lines, and crossed pits contributed to the slip bands, and converging crossed twinning deformations inside the GaAs material were generated. Since cracks and destructions on GaAs surface took place more easily under the flat-tip indentation than that of Berkovich, a machining tool with a sharp tip is recommended for the mechanical machining of brittle materials like GaAs.

Effect of Thickness of Molybdenum Nano-Interlayer on Cohesion between Molybdenum/Titanium Multilayer Film and Silicon Substrate.

Titanium (Ti) film has been used as a hydrogen storage material. The effect of the thickness of a molybdenum (Mo) nano-interlayer on the cohesive strength between a Mo/Ti multilayer film and a single crystal silicon (Si) substrate was investigated by X-ray diffraction (XRD), scanning electron microscopy (SEM), and nano-indenter. Four groups of Si/Mo/Ti multilayer films with different thicknesses of Mo and Ti films were fabricated. The XRD results showed that the introduction of the Mo layer suppressed the chemical reaction between the Ti film and Si substrate. The nano-indenter scratch results demonstrated that the cohesion between the Mo/Ti film and Si substrate decreased significantly with increasing Mo interlayer thickness. The XRD stress analysis indicated that the residual stress in the Si/Mo/Ti film was in-plane tensile stress which might be due to the lattice expansion at a high film growth temperature of 700 °C and the discrepancy of the thermal expansion coefficient between the Ti film and Si substrate. The tensile stress in the Si/Mo/Ti film decreased with increasing Mo interlayer thickness. During the cooling of the Si substrate, a greater decrease in tensile stress occurred for the thicker Mo interlayer sample, which became the driving force for reducing the cohesion between the Mo/Ti film and Si substrate. The results confirmed that the design of the Mo interlayer played an important role in the quality of the Ti film grown on Si substrate.

Evaluation of Food Fineness by the Bionic Tongue Distributed Mechanical Testing Device.

In this study, to obtain a texture perception that is closer to the human sense, we designed eight bionic tongue indenters based on the law of the physiology of mandibular movements and tongue movements features, set up a bionic tongue distributed mechanical testing device, performed in vitro simulations to obtain the distributed mechanical information over the tongue surface, and preliminarily constructed a food fineness perception evaluation model. By capturing a large number of tongue movements during chewing, we analyzed and simulated four representative tongue movement states including the tiled state, sunken state, raised state, and overturned state of the tongue. By analyzing curvature parameters and the Gauss curvature of the tongue surface, we selected the regional circle of interest. With that, eight bionic tongue indenters with different curvatures over the tongue surface were designed. Together with an arrayed film pressure sensor, we set up a bionic tongue distributed mechanical testing device, which was used to do contact pressure experiments on three kinds of cookies-WZ Cookie, ZL Cookie and JSL Cookie-with different fineness texture characteristics. Based on the distributed mechanical information perceived by the surface of the bionic tongue indenter, we established a food fineness perception evaluation model by defining three indicators, including gradient, stress change rate and areal density. The correlation between the sensory assessment and model result was analyzed. The results showed that the average values of correlation coefficients among the three kinds of food with the eight bionic tongue indenters reached 0.887, 0.865, and 0.870, respectively, that is, a significant correlation was achieved. The results illustrate that the food fineness perception evaluation model is effective, and the bionic tongue distributed mechanical testing device has a good practical significance for obtaining food texture mouthfeel information.

Articular cartilage response to a sliding load using two different-sized spherical indenters1.

BACKGROUND: Cartilage surface contact geometry influences the deformational behavior and stress distribution throughout the extracellular matrix (ECM) under load. OBJECTIVE: To test the correlation between the mechanical and cellular response of articular cartilage when loaded with two different-sized spherical indenters under dynamic reciprocating sliding motion. METHODS: Articular cartilage explants were subjected to a reciprocating sliding load using a 17.6 mm or 30.2 mm spherical ball for 2000 cycles at 10 mm/s and 4 kg axial load. Deformation of the cartilage was recorded and contact parameters were calculated according to Hertzian theory. After mechanical loading cartilage samples were collected and analyzed for ECM collagen damage, gene regulation and proteoglycan (PG) loss. RESULTS: Significantly higher ECM deformation and strain and lower dynamic effective modulus were found for explants loaded with the smaller diameter indenter whereas contact radius and stress remained unaffected. Also, the 17.6 mm indenter increased PG loss and significantly upregulated genes for ECM proteins and enzymes as compared to the 30.2 mm indenter. CONCLUSION: Sliding loads that increase ECM deformation/strain were found to induce enzyme-mediated catabolic processes in articular cartilage explants. These observations provide further understanding of how changes in cartilage contact mechanics under dynamic conditions can affect the cellular response.

Use of two test methods to ensure accurate surface firmness and stability measurements for accessibility.

PURPOSE: The firmness and stability of indoor and outdoor surfacing are critical to the accessibility and safety of all environments for people with mobility impairments and/or who use mobility devices. ASTM F1951 laboratory test procedures include pass/fail criteria for determining playground surface accessibility by comparing the work to propel up a 1:14 (7.1%) grade ramp to that of the test surface in a wheelchair. A portable instrumented surface indenter (ISI) was developed to validate that accessibility results obtained in the laboratory are maintained in the field where the surface is installed and used. METHODS: Accessibility measurements have been made on indoor and outdoor surfaces tested in the laboratory using both the ASTM F1951 and the ISI over 13 years. Correlations between these two methods were calculated. RESULTS: A strong correlation has been demonstrated for the sum of the ISI firmness and stability results compared to the sum of the ASTM F1951 straight propulsion and turning results (R2=0.9006). CONCLUSIONS: The portable ISI can be used to verify that the firmness and stability of an installed surface in the field correlates to the accessibility results of the surface tested in the laboratory concurrently according to ASTM F1951 and the ISI. Implications for Rehabilitation The Instrumented Surface Indenter (ISI) allows for surfaces in all environments to be tested for firmness and stability, which is critical for wheelchair user safety, especially during rehabilitation when learning to use a wheelchair. The ISI allows for surfaces in all environments to be tested for firmness and stability, which increases access to all indoor and outdoor surfaces, thereby improving the quality of life for people who have mobility impairments and/or use mobility devices, such as canes, crutches, walkers, and wheelchairs. Using the ISI to test the firmness and stability of installed playground surfaces increases access to playgrounds for children with mobility impairments, facilitating developmentally critical peer-play opportunities for children who use mobility devices. Using the ISI to test the firmness and stability of installed playground surfaces increases access to playgrounds for people with mobility impairments, allowing adults who use a mobility device to supervise and play with children in their lives.