Biomechanics

Biomechanics is a vast discipline within the field of Biomedical Engineering. It explores the underlying mechanics of how biological and physiological systems move. It encompasses important clinical applications to address questions related to medicine using engineering mechanics principles. Biomechanics includes interdisciplinary concepts from engineers, physicians, therapists, biologists, physicists, and mathematicians. Through their collaborative efforts, biomechanics research is ever changing and expanding, explaining new mechanisms and principles for dynamic human systems. Biomechanics is used to describe how the human body moves, walks, and breathes, in addition to how it responds to injury and rehabilitation. Advanced biomechanical modeling methods, such as inverse dynamics, finite element analysis, and musculoskeletal modeling are used to simulate and investigate human situations in regard to movement and injury. Biomechanical technologies are progressing to answer contemporary medical questions. The future of biomechanics is dependent on interdisciplinary research efforts and the education of tomorrow’s scientists

Neuroprosthetic Technologies to Evaluate and Train Leg Motor Control in Neurologically Impaired Individuals

Spinal cord injury (SCI) disrupts many essential sensorimotor and autonomic functions. Consequently, individuals with SCI can face decades with permanent disabilities. Advances in clinical management have decreased morbidity, but no clinical trial has yet demonstrated the efficacy of a repair strategy. In the past decade, Courtine lab has developed neurotechnologies that restored volitional control of locomotion in animal models of SCI. The intervention acts over two-time windows. In the short-term, the delivery of epidural electrical stimulation (EES) targeting the posterior lumbar roots with timing that mimics the natural activation of the spinal cord enables stepping in otherwise paralyzed rats. In the long-term, this targeted EES with intensive robot-assisted overground training triggers a reorganization of descending pathways that reestablished voluntary control of the paralyzed legs, even without EES. These results in animal models encouraged the transfer of these technologies and concepts to clinical applications. My contribution to this translational research program forms the core of my thesis. The first section presents a software that I developed in order to enable a comprehensive yet semi-automated analysis of kinematics and muscle activity underlying locomotor functions in humans. This toolbox allows to evaluate gait features of people with neuromotor deficits, quantify locomotor performance compared to healthy people or to monitor changes in different experimental conditions or over the time course of interventions, and automatically generate comprehensive gait reports directly understandable by scientists and clinicians. The second section introduces a paradigm shift in robotic postural assistance: the gravity-assist. We demonstrated the detrimental impact of high levels of body weight support on gravity-dependent interactions during standing and walking. We developed a gravity-assist algorithm that fine-tunes the forward and upward body weight support to reestablish these interactions based on each patientâs residual capacities. We validated the personalized gravity-assist in 30 individuals with SCI or stroke. Compared to other conditions of support, the gravity-assist enabled all the patients to improve their locomotion performance. This platform establishes refined conditions to empower and train overground locomotion in a safe yet ecological environment. The third section reports the development of targeted EES in patients with chronic SCI, and the impact of an intensive 5-month rehabilitation with gravity-assist and targeted EES on the recovery of motor functions. The key findings can be summarized as follows: We established procedures to configure targeted EES that immediately enabled voluntary control of weak or paralyzed muscles; Targeted EES boosts the residual supraspinal inputs to the lumbar spinal cord, enabling all the patients to adapt their gait to specific tasks; Locomotor performance improved during the rehabilitation; All the patients regained voluntary control over previously paralyzed muscles without EES. These combined results establish the proof-of-concept on the therapeutic potential of targeted EES and intensive, robot-assisted rehabilitation to restore locomotion after SCI. Together with similar results obtained in the US in patients with severe SCI, our findings are establishing a pathway towards the development of a viable treatment to support motor functions and improve recovery after SCI

System Identification of Bipedal Locomotion in Robots and Humans

The ability to perform a healthy walking gait can be altered in numerous cases due to gait disorder related pathologies. The latter could lead to partial or complete mobility loss, which affects the patients’ quality of life. Wearable exoskeletons and active prosthetics have been considered as a key component to remedy this mobility loss. The control of such devices knows numerous challenges that are yet to be addressed. As opposed to fixed trajectories control, real-time adaptive reference generation control is likely to provide the wearer with more intent control over the powered device. We propose a novel gait pattern generator for the control of such devices, taking advantage of the inter-joint coordination in the human gait. Our proposed method puts the user in the control loop as it maps the motion of healthy limbs to that of the affected one. To design such control strategy, it is critical to understand the dynamics behind bipedal walking. We begin by studying the simple compass gait walker. We examine the well-known Virtual Constraints method of controlling bipedal robots in the image of the compass gait. In addition, we provide both the mechanical and control design of an affordable research platform for bipedal dynamic walking. We then extend the concept of virtual constraints to human locomotion, where we investigate the accuracy of predicting lower limb joints angular position and velocity from the motion of the other limbs. Data from nine healthy subjects performing specific locomotion tasks were collected and are made available online. A successful prediction of the hip, knee, and ankle joints was achieved in different scenarios. It was also found that the motion of the cane alone has sufficient information to help predict good trajectories for the lower limb in stairs ascent. Better estimates were obtained using additional information from arm joints. We also explored the prediction of knee and ankle trajectories from the motion of the hip joints

Evaluating footwear “in the wild”: Examining wrap and lace trail shoe closures during trail running

Trail running participation has grown over the last two decades. As a result, there have been an increasing number of studies examining the sport. Despite these increases, there is a lack of understanding regarding the effects of footwear on trail running biomechanics in ecologically valid conditions. The purpose of our study was to evaluate how a Wrap vs. Lace closure (on the same shoe) impacts running biomechanics on a trail. Thirty subjects ran a trail loop in each shoe while wearing a global positioning system (GPS) watch, heart rate monitor, inertial measurement units (IMUs), and plantar pressure insoles. The Wrap closure reduced peak foot eversion velocity (measured via IMU), which has been associated with fit. The Wrap closure also increased heel contact area, which is also associated with fit. This increase may be associated with the subjective preference for the Wrap. Lastly, runners had a small but significant increase in running speed in the Wrap shoe with no differences in heart rate nor subjective exertion. In total, the Wrap closure fit better than the Lace closure on a variety of terrain. This study demonstrates the feasibility of detecting meaningful biomechanical differences between footwear features in the wild using statistical tools and study design. Evaluating footwear in ecologically valid environments often creates additional variance in the data. This variance should not be treated as noise; instead, it is critical to capture this additional variance and challenges of ecologically valid terrain if we hope to use biomechanics to impact the development of new products

The biomechanics of human locomotion

Includes bibliographical references. The thesis on CD-ROM includes Animate, GaitBib, GaitBook and GaitLab, four quick time movies which focus on the functional understanding of human gait. The CD-ROM is available at the Health Sciences Library

Musculoskeletal adaptation to PWS

Thesis (Ph. D.)--Harvard-MIT Division of Health Sciences and Technology, 2007.Includes bibliographical references.As human spaceflight extends in both duration and scope, it is critical to better understand the physiologic effects of this novel environment. In the weight bearing structures of the body, bone loss and muscle atrophy far in excess of age-related declines are hallmarks of microgravity adaptation. However, while the physiological effects of such disuse unloading are well-described, the effects of partial weight bearing, such as expected on the moon (16% of Earth's gravity) and Mars (38% of Earth's gravity), have yet to be quantified. In these environments, the risks of musculoskeletal atrophy and accompanying orthopedic injury are uncertain, and a means of further investigation is needed. To address this need, we developed a novel model of Partial Weight Suspension (PWS) that supports investigation of the physiologic effects of chronically reduced quadrupedal loading in mice. Validation of the PWS system was conducted using a gait analysis treadmill and high-precision force platform. These studies showed that peak ground reaction forces were significantly reduced under conditions of partial weightbeari:ng, and changes in gait dynamics were consistent with previous studies of human locomotion. Using the PWS system, we conducted the first known studies of chronic musculoskeletal adaptation to Mars and lunar levels of weight bearing. Adult female BALB/cByJ mice underwent 21 days of partial weight bearing or control treatment. Relative to controls, suspended animals showed significant bone and muscle loss. In particular, bone formation rate was decreased, leading to deterioration of both cortical and trabecular bone structure in mice exposed to weight bearingtbearing. Although material properties of the bone were largely unaffected, structural and geometric changes resulted in lower bone strength.weight bearinged weight bearing at Mars and lunar levels led to similar losses of muscle and bone relative to controls. Comparison with previous literature suggests that adaptation to partial weight-bearing associated with both Mars and lunar loading provided some protection relative to the deconditioning seen in full unloading. Although additional studies are needed, the data also indicated that the musculoskeletal deterioration was not linearly related to the degree of unloading. Altogether, this model provides a validated, controlled system for investigaweight bearingof partial weightbearing and countermeasures on musculoskeletal deconditioning. Our initial findings have practical applications for bioastronautics, suggesting that physiological investigations on the surface of the moon may not be fully predictive for future Mars exploration.by Erika Brown Wagner.Ph.D

Somatosensory stimulation to improve lower-limb recovery after stroke

Introduction Increasing lower-limb sensation could improve walking post-stroke but evidence for this is limited. This thesis reports: 1) Review of published literature on somatosensory stimulation of the foot to enhance lower-limb function post-stroke. 2) Development of standardised intervention protocols for testing in a feasibility trial. 3) Feasibility trial of somatosensory stimulation interventions combined with functional activity. Methods 1) Systematic review with narrative synthesis of somatosensory stimulation to the foot to improve balance and gait post-stroke. 2) Modified Nominal Group Technique with experienced therapists, informed by literature, to develop and seek consensus on three standardised therapy protocols. a) lower-limb mobilization and tactile stimulation (MTS) b) textured insole wearing (TI) c) task-specific gait training (TSGT) 3) Mixed-methods, single-blind feasibility study explored: recruitment, participant characteristics, attrition, intervention and outcome measures acceptability (responses, feasibility, costs), sample size requirements, and participants’ experiences. Adults 42–112 days post-stroke were randomized to either TIs+TSGT or MTS+TSGT. Lower-limb sensorimotor and functional outcomes were measured pre-randomization, post-intervention, and one-month later. Participants’ experiences and acceptability of interventions and outcomes were explored in focus groups, with qualitative data analysed thematically. Quantitative feasibility outcomes were analysed using descriptive statistics, and within-group changes calculated. Results 1) Seventeen trials included in the review confirmed that evidence for somatosensory stimulation to improve lower-limb function post-stroke is limited. 2) Validated trial intervention protocols for MTS, TIs and TSGT were developed, with consensus. 3) Thirty-four stroke survivors were recruited and completed the trial, with acceptable recruitment (48.57%) and attrition (5.88%) rates. Feasibility of outcomes, costs, delivery and acceptability of interventions and outcome measures were confirmed. Potential response to treatment was noted. Conclusion Somatosensory stimulation of the foot post-stroke warrants investigation. Feasibility of a larger trial of somatosensory stimulation interventions was confirmed. Participant characteristics, response over time, and variance of outcome measures will inform a future larger trial

Epidemiology of Injury in English Women's Super league Football: A Cohort Study

INTRODUCTION: The epidemiology of injury in male professional football has been well documented (Ekstrand, Hägglund, & Waldén, 2011) and used as a basis to understand injury trends for a number of years. The prevalence and incidence of injuries occurring in womens super league football is unknown. The aim of this study is to estimate the prevalence and incidence of injury in an English Super League Women’s Football squad. METHODS: Following ethical approval from Leeds Beckett University, players (n = 25) signed to a Women’s Super League Football club provided written informed consent to complete a self-administered injury survey. Measures of exposure, injury and performance over a 12-month period was gathered. Participants were classified as injured if they reported a football injury that required medical attention or withdrawal from participation for one day or more. Injuries were categorised as either traumatic or overuse and whether the injury was a new injury and/or re-injury of the same anatomical site RESULTS: 43 injuries, including re-injury were reported by the 25 participants providing a clinical incidence of 1.72 injuries per player. Total incidence of injury was 10.8/1000 h (95% CI: 7.5 to 14.03). Participants were at higher risk of injury during a match compared with training (32.4 (95% CI: 15.6 to 48.4) vs 8.0 (95% CI: 5.0 to 10.85)/1000 hours, p 28 days) of which there were three non-contact anterior cruciate ligament (ACL) injuries. The epidemiological incidence proportion was 0.80 (95% CI: 0.64 to 0.95) and the average probability that any player on this team will sustain at least one injury was 80.0% (95% CI: 64.3% to 95.6%) CONCLUSION: This is the first report capturing exposure and injury incidence by anatomical site from a cohort of English players and is comparable to that found in Europe (6.3/1000 h (95% CI 5.4 to 7.36) Larruskain et al 2017). The number of ACL injuries highlights a potential injury burden for a squad of this size. Multi-site prospective investigations into the incidence and prevalence of injury in women’s football are require

Obiter Dicta

"Stitched together over five years of journaling, Obiter Dicta is a commonplace book of freewheeling explorations representing the transcription of a dozen notebooks, since painstakingly reimagined for publication. Organized after Theodor Adorno’s Minima Moralia, this unschooled exercise in aesthetic thought—gleefully dilettantish, oftentimes dangerously close to the epigrammatic—interrogates an array of subject matter (although inescapably circling back to the curiously resemblant histories of Western visual art and instrumental music) through the lens of drive-by speculation. Erick Verran’s approach to philosophical inquiry follows the brute-force literary technique of Jacques Derrida to exhaustively favor the material grammar of a signifier over hand-me-down meaning, juxtaposing outer semblances with their buried systems and our etched-in-stone intuitions about color and illusion, shape and value, with lessons stolen from seemingly unrelatable disciplines. Interlarded with extracts of Ludwig Wittgenstein but also Wallace Stevens, Cormac McCarthy as well as Roland Barthes, this cache of incidental remarks eschews what’s granular for the biggest picture available, leaving below the hyper-specialized fields of academia for a bird’s-eye view of their crop circles. Obiter Dicta is an unapologetic experiment in intellectual dot-connecting that challenges much long-standing wisdom about everything from illuminated manuscripts to Minecraft and the evolution of European music with lyrical brevity; that is, before jumping to the next topic.