Individuals with rotator cuff tears unsuccessfully treated with exercise therapy have less inferiorly oriented net muscle forces during scapular plane abduction.

Exercise therapy for individuals with rotator cuff tears fails in approximately 25.0 % of cases. One reason for failure of exercise therapy may be the inability to strengthen and balance the muscle forces crossing the glenohumeral joint that act to center the humeral head on the glenoid. The objective of the current study was to compare the magnitude and orientation of the net muscle force pre- and post-exercise therapy between subjects successfully and unsuccessfully (e.g. eventually underwent surgery) treated with a 12-week individualized exercise therapy program. Twelve computational musculoskeletal models (n = 6 successful, n = 6 unsuccessful) were developed in OpenSim (v4.0) that incorporated subject specific tear characteristics, muscle peak isometric force, in-vivo kinematics and bony morphology. The models were driven with experimental kinematics and the magnitude and orientation of the net muscle force was determined during scapular plane abduction at pre- and post-exercise therapy timepoints. Subjects unsuccessfully treated had less inferiorly oriented net muscle forces pre- and post-exercise therapy compared to subjects successfully treated (p = 0.039 & 0.045, respectively). No differences were observed in the magnitude of the net muscle force (p > 0.05). The current study developed novel computational musculoskeletal models with subject specific inputs capable of distinguishing between subjects successfully and unsuccessfully treated with exercise therapy. A less inferiorly oriented net muscle force in subjects unsuccessfully treated may increase the risk of superior migration leading to impingement. Adjustments to exercise therapy programs may be warranted to avoid surgery in subjects at risk of unsuccessful treatment.

Effects of Student Interests on Engagement and Performance in Biomechanics.

There is a need for pedagogical techniques that increase student engagement among underrepresented groups in engineering. Relating engineering content to student interests, particularly through biomechanics applications, shows promise toward engaging a diverse group of students. This study investigates the effects of student interests on engagement and performance in 10th grade students enrolled in a summer program for students underrepresented in the science, technology, engineering, and mathematics fields. The authors assessed the effects of interest-tailored lectures on student engagement and performance in a 5-week program with bioengineering workshops, focusing on the delivery of biomechanics content. A total of 31 students received interest-tailored lectures (intervention) and 23 students received only generic lectures (control) in biomechanics. In addition, the authors assessed the effects of teaching method (lecture, classroom activities, and laboratory tours) on student engagement. The authors found interest-tailored lectures to significantly increase student engagement in lecture compared with generic lectures. Students that received interest-tailored lectures had an insignificant, but meaningful 5% increase in student performance. Students rated laboratory tours higher in engagement than other teaching methods. This study provides detailed examples that can directly assist student teaching and outreach in biomechanics. Furthermore, the pedagogical techniques in this study can be used to increase engagement of underrepresented students in engineering.

Effects of acute peripheral/central visual field loss on standing balance.

Vision impairments such as age-related macular degeneration (AMD) and glaucoma are among the top risk factors for geriatric falls and falls-related injuries. AMD and glaucoma lead to loss of the central and peripheral visual fields, respectively. This study utilized a custom contact lens model to occlude the peripheral or central visual fields in healthy adults, offering a novel within-subject approach to improve our understanding of the etiology of balance impairments that may lead to an increased fall risk in patients with visual field loss. Two dynamic posturography tests, including an adapted version of the Sensory Organization Test and a virtual reality environment with the visual scene moving sinusoidally, were used to evaluate standing balance. Balance stability was quantified by displacement and time-normalized path length of the center of pressure. Nine young and eleven older healthy adults wore visual field occluding contact lenses during posturography assessments to compare the effects of acute central and peripheral visual field occlusion. The results found that visual field occlusion had greater impact on older adults than young adults, specifically when proprioceptive cues are unreliable. Furthermore, the results suggest that both central and peripheral visions are important in postural control; however, peripheral vision may be more sensitive to movement in the environment.

Designing vibrotactile balance feedback for desired body sway reductions.

Vibrotactile feedback about body position and velocity has been shown to be effective at reducing low frequency body sway (below about 0.5 Hz) in response to balance perturbations while standing. However, current devices cause an undesirable increase in high frequency body sway. In addition, unlike other sensory prostheses such as hearing aids, which are fine-tuned to the user, current vibrotactile balance prostheses largely employ a "one size fits all" approach, in that they use the same settings (i.e. parameter values) for all subjects. Rather than using a fixed design consisting of position and velocity feedback for all subjects, we propose a "custom design" approach that employs system identification methods to identify the feedback required to achieve a desired body sway frequency response for the subject. Our derivations and simulations show that in order to accomplish this objective, feedback consisting of a subject-specific filtered combination of body position, velocity and acceleration is required. Simulation results are provided to illustrate the results.

A mechanism for sensory re-weighting in postural control.

A key finding of human balance experiments has been that the integration of sensory information utilized for postural control appears to be dynamically regulated to adapt to changing environmental conditions and the available sensory information, a process referred to as "sensory re-weighting." We propose a postural control model that includes automatic sensory re-weighting. This model is an adaptation of a previously reported model of sensory feedback that included manual sensory re-weighting. The new model achieves sensory re-weighting that is physiologically plausible and readily implemented. Model simulations are compared to previously reported experimental results to demonstrate the automated sensory re-weighting strategy of the modified model. On the whole, the postural sway time series generated by the model with automatic sensory re-weighting show good agreement with experimental data, and are capable of producing patterns similar to those observed experimentally.

Sensory adaptation in human balance control: lessons for biomimetic robotic bipeds.

This paper describes mechanisms used by humans to stand on moving platforms, such as a bus or ship, and to combine body orientation and motion information from multiple sensors including vision, vestibular, and proprioception. A simple mechanism, sensory re-weighting, has been proposed to explain how human subjects learn to reduce the effects of inconsistent sensors on balance. Our goal is to replicate this robust balance behavior in bipedal robots. We review results exploring sensory re-weighting in humans and describe implementations of sensory re-weighting in simulation and on a robot.

A model-based approach to attention and sensory integration in postural control of older adults.

We conducted a dual-task experiment that involved information processing (IP) tasks concurrent with postural perturbations to explore the interaction between attention and sensory integration in postural control in young and older adults. A postural control model incorporating sensory integration and the influence of attention was fit to the data, from which parameters were then obtained to quantify the interference of attention on postural control. The model hypothesizes that the cognitive processing and integration of sensory inputs for balance requires time, and that attention influences this processing time, as well as sensory selection by facilitating specific sensory channels. Performing a concurrent IP task had an overall effect on the time delay. Differences in the time delay of the postural control model were found for the older adults. The results suggest enhanced vulnerability of balance processes in older adults to interference from concurrent cognitive IP tasks.

A model-based approach to attention and sensory integration in postural control of older adults.

We conducted a dual-task experiment that involved information processing (IP) tasks concurrent with postural perturbations to explore the interaction between attention and sensory integration in postural control in young and older adults. Data were fit to a postural control model incorporating sensory integration and the influence of attention. This model hypothesizes that the cognitive processing and integration of sensory inputs for balance requires time, and that attention influences this processing time, as well as sensory selection by facilitating specific sensory channels. Differences in the time delay of the postural control model were found for age and IP task, suggesting enhanced vulnerability of balance processes in older adults to interference from interfering cognitive IP tasks.

Sensory re-weighting in human postural control during moving-scene perturbations.

The aim of the current study was to further investigate a recently proposed "sensory re-weighting" hypothesis, by evoking anterior-posterior (AP) body sway using visual stimuli during sway-referencing of the support surface. Twelve healthy adults participated in this study. Subjects stood on the platform while looking at a visual scene that encompassed the full horizontal field of view. A sequence of scene movements was presented to the subjects consisting of multiple visual push/pull perturbations; in between the first two push/pull sequences, the scene either moved randomly or was stationary. The peak-squared velocity of AP center-of-pressure (COP) was computed within a 6 s window following each push and pull. The peak-squared velocity was lowest for the push/pull sequence immediately following the random moving scene. These results are consistent with the sensory re-weighting hypothesis, wherein the sensory integration process reduced the contribution of visual sensory input during the random moving scene interval. We also found evidence of habituation to moving scene perturbations with repeated exposure.