Development of a feedback-controlled elbow simulator: design validation and clinical application

This work involves three topics that advance the functionality of an elbow simulator in the Orthopaedic Biomechanics Laboratory at Allegheny General Hospital. To draw clinically and scientifically meaningful conclusions from future cadaver studies conducted with the simulator, its design must be validated and the accuracy of the data collection methods demonstrated. The simulator was designed to offer physiologically-correct adjustable moment arms throughout the elbow's range of motion. To validate this, muscle moment arms were measured in three cadaver elbow specimens. Flexion-extension moment arms were measured at three different pronation/supination angles: fully pronated, fully supinated, and neutral. Pronation-supination moment arms for four elbow muscles were measured at three different flexion-extension angles: 30°, 60°, and 90°. The numeric results compared well with those previously reported. The biceps and pronator teres flexion-extension moment arms varied with pronation-supination position, and vice versa. This represents the first use of closed-loop feedback control in an elbow simulator, one of the first reports of both flexion-extension and pronation-supination moment arms in the same specimens, and demonstrates the adjustability of the moment arms that the elbow simulator can produce.Towards accurate motion analysis of the radial head, two areas were investigated. The first identified the phenomena of camera-switching, which occurs in motion analysis when data from one or more cameras is temporarily excluded from the computation of a marker's three-dimensional position. Tests with static markers showed that camera-switching could cause up to 3.7 mm of perceived movement. The second area of investigation set the stage for future studies with cadaver elbows. A protocol was developed to quantify both the travel of the native radial head, radial head implants, and the finite helical axis during pronation-supination movement. The tracking of implant motion employs a unique circle-fitting algorithm to determine the implant's center. A video-based motion analysis system was used to collect marker position coordinates actuated by a precision micrometer table. MATLAB code was designed and implemented to compute both the radial head position and finite helical axis from these data. Immediate future work will use these algorithms to evaluate radial head implants in comparison to the native radial head

Validation of a feedback-controlled elbow simulator design: Elbow muscle moment arm measurement

The Allegheny General Hospital (AGH) elbow simulator was designed to be a closed-loop physiologic simulator actuating movement in cadaveric elbow specimens via servoelectric motors that attach to the tendons of the biceps, brachialis, triceps, and pronator teres muscles. A physiologic elbow simulator should recreate the appropriate moment arms throughout the elbow's range of motion. To validate this design goal, muscle moment arms were measured in three cadaver elbow specimens using the simulator. Flexion-extension moment arms of four muscles were measured at three different pronation/supination angles: fully pronated, fully supinated, and neutral; pronation-supination moment arms were measured at three different flexion-extension angles: 30 deg, 60 deg, and 90 deg. The tendon-displacement method was used in these measurements, in which the ratio of the change in musculotendon length to the change in joint angle was computed. The numeric results compared well with those previously reported; the biceps and pronator teres flexion-extension moment arms varied with pronation-supination position, and vice versa. This is one of the few reports of both flexion-extension and pronation-supination moment arms in the same specimens, and represents the first use of closed-loop feedback control in the AGH elbow simulator. The simulator is now ready for use in clinical studies such as in analyses of radial head replacement and medial ulnar collateral ligament repair. Copyright © 2009 by ASME

Challenges and New Approaches to Proving the Existence of Muscle Synergies of Neural Origin

Muscle coordination studies repeatedly show low-dimensionality of muscle activations for a wide variety of motor tasks. The basis vectors of this low-dimensional subspace, termed muscle synergies, are hypothesized to reflect neurally-established functional muscle groupings that simplify body control. However, the muscle synergy hypothesis has been notoriously difficult to prove or falsify. We use cadaveric experiments and computational models to perform a crucial thought experiment and develop an alternative explanation of how muscle synergies could be observed without the nervous system having controlled muscles in groups. We first show that the biomechanics of the limb constrains musculotendon length changes to a low-dimensional subspace across all possible movement directions. We then show that a modest assumption—that each muscle is independently instructed to resist length change—leads to the result that electromyographic (EMG) synergies will arise without the need to conclude that they are a product of neural coupling among muscles. Finally, we show that there are dimensionality-reducing constraints in the isometric production of force in a variety of directions, but that these constraints are more easily controlled for, suggesting new experimental directions. These counter-examples to current thinking clearly show how experimenters could adequately control for the constraints described here when designing experiments to test for muscle synergies—but, to the best of our knowledge, this has not yet been done