The effect of musculoskeletal model scaling methods on ankle joint kinematics and muscle force prediction during gait for children with cerebral palsy and equinus gait.

Clinical gait analysis incorporated with neuromusculoskeletal modelling could provide valuable information about joint movements and muscle functions during ambulation for children with cerebral palsy (CP). This study investigated how imposing pre-calculated joint angles during musculoskeletal model scaling influence the ankle joint angle and muscle force computation. Ten children with CP and equinus gait underwent clinical gait analysis. For each participant, a "default" (scaled without pre-calculated joint angles) and a "PJA" (scaled with pre-calculated ankle joint angles) model were generated to simulate their gait. Ankle joint angles were calculated with an inverse kinematic (IK) and direct kinematic (DK) approach. Triceps surae and tibialis anterior muscle forces were predicted by static optimisation and EMG-assisted modelling. We found that PJA-derived ankle angles showed a better agreement with what derived from the DK approach. The tibialis anterior muscle prediction was more likely to be affected by the scaling methods for the static optimisation approach and the gastrocnemius muscle force prediction was more likely to be influenced for the EMG-assisted modelling. This study recommends using the PJA model since the good consistency between IK and DK-derived joint angles facilitates communication among different research disciplines.

Kinect V2-Based Gait Analysis for Children with Cerebral Palsy: Validity and Reliability of Spatial Margin of Stability and Spatiotemporal Variables.

Children with cerebral palsy (CP) have high risks of falling. It is necessary to evaluate gait stability for children with CP. In comparison to traditional motion capture techniques, the Kinect has the potential to be utilised as a cost-effective gait stability assessment tool, ensuring frequent and uninterrupted gait monitoring. To evaluate the validity and reliability of this measurement, in this study, ten children with CP performed two testing sessions, of which gait data were recorded by a Kinect V2 sensor and a referential Motion Analysis system. The margin of stability (MOS) and gait spatiotemporal metrics were examined. For the spatiotemporal parameters, intraclass correlation coefficient (ICC2,k) values were from 0.83 to 0.99 between two devices and from 0.78 to 0.88 between two testing sessions. For the MOS outcomes, ICC2,k values ranged from 0.42 to 0.99 between two devices and 0.28 to 0.69 between two test sessions. The Kinect V2 was able to provide valid and reliable spatiotemporal gait parameters, and it could also offer accurate outcome measures for the minimum MOS. The reliability of the Kinect V2 when assessing time-specific MOS variables was limited. The Kinect V2 shows the potential to be used as a cost-effective tool for CP gait stability assessment.

The Validity and Reliability of a Kinect v2-Based Gait Analysis System for Children with Cerebral Palsy.

The aim of this study is to evaluate if Kinect is a valid and reliable clinical gait analysis tool for children with cerebral palsy (CP), and whether linear regression and long short-term memory (LSTM) recurrent neural network methods can improve its performance. A gait analysis was conducted on ten children with CP, on two occasions. Lower limb joint kinematics computed from the Kinect and a traditional marker-based Motion Analysis system were investigated by calculating the root mean square errors (RMSE), the coefficients of multiple correlation (CMC), and the intra-class correlation coefficients (ICC2,k). Results showed that the Kinect-based kinematics had an overall modest to poor correlation (CMC-less than 0.001 to 0.70) and an angle pattern similarity with Motion Analysis. After the calibration, RMSE on every degree of freedom decreased. The two calibration methods indicated similar levels of improvement in hip sagittal (CMC-0.81 ± 0.10 vs. 0.75 ± 0.22)/frontal (CMC-0.41 ± 0.35 vs. 0.42 ± 0.37) and knee sagittal kinematics (CMC-0.85±0.07 vs. 0.87 ± 0.12). The hip sagittal (CMC-0.97±0.05) and knee sagittal (CMC-0.88 ± 0.12) angle patterns showed a very good agreement over two days. Modest to excellent reliability (ICC2,k-0.45 to 0.93) for most parameters renders it feasible for observing ongoing changes in gait kinematics.

Host Mesh Fitting of a Generic Musculoskeletal Model of the Lower Limbs to Subject-Specific Body Surface Data: A Validation Study.

Challenges remain in accurately capturing the musculoskeletal geometry of individual subjects for clinical and biomechanical gait analysis. The aim of this study was to use and validate the Host Mesh Fitting (HMF) technique for fitting a generic anatomically based musculoskeletal model to 3D body surface data of individual subjects. The HMF technique is based on the free-form idea of deforming geometrically complex structures according to the deformation of a surrounding volumetric mesh. Using the HMF technique, an anatomically based model of the lower limbs of an adult female subject (29 years) was customized to subject-specific skin surface data of five typically developing children (mean age 10.2 years) and six children with Cerebral Palsy (CP) (mean age 9.6 years). The fitted lengths and volumes of six muscle-tendon structures were compared against measures from Magnetic Resonance (MR) images for validation purposes. The HMF technique resulted in accurate approximations of the lower limb shapes of all subjects in both study groups. The average error between the MR data and the fitted muscle-tendon lengths from HMF was 4 ± 4% in children without CP and 7 ± 5% in children with CP, respectively. The average error between the MR data and the fitted muscle volumes from HMF was 28 ± 19% in children without CP and 27 ± 28% in children with CP, respectively. This study presents a crucial step towards personalized musculoskeletal modelling for gait analysis by demonstrating the feasibility of fitting a generic anatomically based lower limb model to 3D body surface data of children with and without CP using the HMF technique. Additional improvements in the quality of fit are expected to be gained by developing age-matched generic models for different study groups, accounting for subject-specific variations in subcutaneous body fat, as well as considering supplementary data from ultrasound imaging to better capture physiological muscle tissue properties.

Modal analysis of the thermal conductivity of nanowires: examining unique thermal transport features.

In this study, unique thermal transport features of nanowires over bulk materials are investigated using a combined analysis based on lattice dynamics and equilibrium molecular dynamics (EMD). The evaluation of the thermal conductivity (TC) of Lenard-Jones nanowires becomes feasible due to the multi-step normal mode decomposition (NMD) procedure implemented in the study. A convergence issue of the TC of nanowires is addressed by the NMD implementation for two case studies, which employ pristine nanowires (PNW) and superlattice nanowires. Interestingly, mode relaxation times at low frequencies of acoustic branches exhibit signs of approaching constant values, thus indicating the convergence of TC. The TC evaluation procedure is further verified by implementing EMD-based Green-Kubo analysis, which is based on a fundamentally different physical perspective. Having verified the NMD procedure, the non-monotonic trend of the TC of nanowires is addressed. It is shown that the principal cause for the observed trend is due to the competing effects of long wavelength phonons and phonon-surface scatterings as the nanowire's cross-sectional width is changed. A computational procedure is developed to decompose the different modal contribution to the TC of shell alloy nanowires (SANWs) using virtual crystal NMD and the Allen-Feldman theory. Several important conclusions can be drawn from the results. A propagons to non-propagons boundary appeared, resulting in a cut-off frequency (ω cut); moreover, as alloy atomic mass is increased, ω cut shifts to lower frequencies. The existence of non-propagons partly causes the low TC of SANWs. It can be seen that modes with low frequencies demonstrate a similar behavior to corresponding modes of PNWs. Moreover, lower group velocities associated with higher alloy atomic mass resulted in a lower TC of SANWs.

Trapeziometacarpal joint contact varies between men and women during three isometric functional tasks.

Trapeziometacarpal (TMC) joint osteoarthritis (OA) affects women two to six times more than men, and is influenced by stresses and strains in the cartilage. The purpose of this study was to characterise sex and age differences in contact area and peak stress location of the healthy TMC joint during three isometric tasks including pinch, grasp and jar twist. CT images of the hand from 50 healthy adult men and women were used to create a statistical shape model that was used to create finite element models for each subject and task. Force-driven simulations were performed to evaluate cartilage contact area and peak stress location. We tested for sex and age differences using Principal Component Analysis, linear regression, and Linear Discriminant Analysis. We observed sex differences in peak stress location during pinch (p = .0206), grasp (p = .0264), and jar twist (p = .0484). The greatest sex differences were observed during jar twist, where 94% of peak stresses in men were located in the centre compared with 50% in the central-volar region in women. These findings show that peak stress locations are more variable in women during grasp and jar twist than men, and suggest that women may employ different strategies to perform these tasks.

A finite element model to investigate the effect of ulnar variance on distal radioulnar joint mechanics.

Ulnocarpal impaction syndrome involves excessive loading of the ulnocarpal joint. Ulnar shortening osteotomies are an effective way to reduce ulnocarpal loading but alter contact mechanics at the distal radioulnar joint (DRUJ). This study used a computational model to investigate the relationship between ulnar length and DRUJ mechanics. Detailed, finite element models of the radius and ulna bones were constructed from magnetic resonance imaging data. The length of the ulna bone model was increased and decreased up to 5 mm in 1 mm increments. A computational model was used to predict joint contact at the DRUJ for each ulnar length. Lengthening the ulna caused a slight decrease in DRUJ contact pressure, with a more substantial decrease in contact area. Shortening the ulna caused a substantial increase in contact area, with a smaller increase in DRUJ contact pressure. The location of contact on the radial sigmoid notch changed with 2 mm lengthening and 3 mm shortening. The results of this study demonstrate the sensitivity of DRUJ contact to ulnar length changes, which may explain the DRUJ cartilage degeneration that often follows ulnar osteotomies. The joint contact model implemented in this study allowed the relationship between ulnar length and DRUJ contact to be examined systematically, in a way that is difficult to achieve through cadaveric experimentation. The results confirmed published experimental data showing an increased DRUJ contact pressure with ulnar shortening. It is important that clinicians consider the influence of ulnar osteotomies, not only on ulnocarpal loading but also on DRUJ mechanics. Copyright © 2016 John Wiley & Sons, Ltd.

Vector-based forearm rotation moment arms - A sensitivity analysis.

All existing moment arm data for muscles of the forearm derive from tendon excursion experiments. Moment arms determined this way are only valid for movement about the same generalised coordinate system as was used during the tendon excursion, which makes their implementation in more complex or realistic joint models problematic. This study used a vector-based method to calculate muscle moment arms in a three dimensional model of forearm rotation. It also evaluated the sensitivity of this method to errors in the input data. There was reasonably close agreement between the moment arms calculated in this study and those published using tendon excursion methods. Six out of eight muscles had moment arms within the range of values reported previously. However, the vector-based method was sensitive to the accuracy of the input data. This sensitivity varied between muscles and input variables. Generally, the calculations were more robust to the point of force application than the muscle lines of action and the joint's axis of rotation. A small change in these variables could produce substantial changes in the calculated moment arms. Consequently, accurate input data is important when using the vector-based method in a joint model.

Roadmap for cardiovascular circulation model.

Computational models of many aspects of the mammalian cardiovascular circulation have been developed. Indeed, along with orthopaedics, this area of physiology is one that has attracted much interest from engineers, presumably because the equations governing blood flow in the vascular system are well understood and can be solved with well-established numerical techniques. Unfortunately, there have been only a few attempts to create a comprehensive public domain resource for cardiovascular researchers. In this paper we propose a roadmap for developing an open source cardiovascular circulation model. The model should be registered to the musculo-skeletal system. The computational infrastructure for the cardiovascular model should provide for near real-time computation of blood flow and pressure in all parts of the body. The model should deal with vascular beds in all tissues, and the computational infrastructure for the model should provide links into CellML models of cell function and tissue function. In this work we review the literature associated with 1D blood flow modelling in the cardiovascular system, discuss model encoding standards, software and a model repository. We then describe the coordinate systems used to define the vascular geometry, derive the equations and discuss the implementation of these coupled equations in the open source computational software OpenCMISS. Finally, some preliminary results are presented and plans outlined for the next steps in the development of the model, the computational software and the graphical user interface for accessing the model.

Adaptive bill morphology for enhanced tool manipulation in New Caledonian crows.

Early increased sophistication of human tools is thought to be underpinned by adaptive morphology for efficient tool manipulation. Such adaptive specialisation is unknown in nonhuman primates but may have evolved in the New Caledonian crow, which has sophisticated tool manufacture. The straightness of its bill, for example, may be adaptive for enhanced visually-directed use of tools. Here, we examine in detail the shape and internal structure of the New Caledonian crow's bill using Principal Components Analysis and Computed Tomography within a comparative framework. We found that the bill has a combination of interrelated shape and structural features unique within Corvus, and possibly birds generally. The upper mandible is relatively deep and short with a straight cutting edge, and the lower mandible is strengthened and upturned. These novel combined attributes would be functional for (i) counteracting the unique loading patterns acting on the bill when manipulating tools, (ii) a strong precision grip to hold tools securely, and (iii) enhanced visually-guided tool use. Our findings indicate that the New Caledonian crow's innovative bill has been adapted for tool manipulation to at least some degree. Early increased sophistication of tools may require the co-evolution of morphology that provides improved manipulatory skills.

Examining the influence of distal radius orientation on distal radioulnar joint contact using a finite element model.

Distal radius malunion is a problem that is common to distal radius fractures and can affect the contact mechanics of the distal radioulnar joint (DRUJ). The goal of this study was to use a computational model of the DRUJ to investigate the influence distal radius orientation has on its contact mechanics. Detailed, finite element models of the radius and ulna bones were constructed from magnetic resonance imaging data. The orientation of the distal radius was rotated in 2° increments about three orthogonal axes representing dorsal-palmar rotation, radial-ulnar rotation and anteversion-retroversion. A computational model was used to predict joint contact at the DRUJ in each condition. Joint contact was found to be most sensitive to dorsal rotation of the distal radius, while radial and ulnar rotation did not substantially affect joint contact pressure. Slight retroversion was found to lower joint contact pressure. In most cases, more than 6° rotation in a given direction resulted in dislocation of the DRUJ, so that adaptation at the joint would be required to maintain articular contact. The joint contact model implemented in this study allowed the relationship between distal radius orientation and DRUJ contact to be examined systematically, in a way that is difficult to achieve using a cadaver-based approach. The results demonstrated the distal radius displacements most critical for maintaining healthy joint mechanics at the DRUJ. It is important that clinicians consider the influence of distal radius malunion and its treatment on DRUJ mechanics, in addition to its consequences for wrist function and forearm rotation. Copyright © 2016 John Wiley & Sons, Ltd.

The influence and biomechanical role of cartilage split line pattern on tibiofemoral cartilage stress distribution during the stance phase of gait.

This study presents an evaluation of the role that cartilage fibre 'split line' orientation plays in informing femoral cartilage stress patterns. A two-stage model is presented consisting of a whole knee joint coupled to a tissue-level cartilage model for computational efficiency. The whole joint model may be easily customised to any MRI or CT geometry using free-form deformation. Three 'split line' patterns (medial-lateral, anterior-posterior and random) were implemented in a finite element model with constitutive properties referring to this 'split line' orientation as a finite element fibre field. The medial-lateral orientation was similar to anatomy and was derived from imaging studies. Model predictions showed that 'split lines' are formed along the line of maximum principal strains and may have a biomechanical role of protecting the cartilage by limiting the cartilage deformation to the area of higher cartilage thickness.

Relationship between tissue stress during gait in healthy volunteers and patterns of urate deposition and bone erosion in gout: a biomechanical computational modelling study.

OBJECTIVES: To determine whether patterns of high internal tissue stress during gait are associated with patterns of monosodium urate crystal deposition and bone erosion in gout. METHODS: We compared patterns of foot von Mises stress predicted computationally during gait in volunteers of normal and high body mass index (BMI) with patterns of urate deposition in gout and asymptomatic hyperuricaemia, and bone erosion in gout using dual-energy and conventional CT data. RESULTS: The highest average and peak von Mises stress during gait was observed at the third metatarsal (MT) head. Similar stress patterns were observed for high and low BMI groups. In contrast, for both urate deposition and bone erosion, the first MT head was most frequently affected, with very infrequent involvement of the third MT head. There was no clear relationship between average or peak von Mises stress patterns with patterns of urate deposition or bone erosion (-0.29>r<0.16). Addition of BMI into linear regression models did not alter the findings. CONCLUSIONS: These data do not support the concept that elevated internal tissue stress during biomechanical loading plays an important role in patterns of monosodium urate crystal deposition or structural damage in gout.

On modelling large deformations of heterogeneous biological tissues using a mixed finite element formulation.

This study addresses the issue of modelling material heterogeneity of incompressible bodies. It is seen that when using a mixed (displacement-pressure) finite element formulation, the basis functions used for pressure field may not be able to capture the nonlinearity of material parameters, resulting in pseudo-residual stresses. This problem can be resolved by modifying the constitutive relation using Flory's decomposition of the deformation gradient. A two-parameter Mooney-Rivlin constitutive relation is used to demonstrate the methodology. It is shown that for incompressible materials, the modification does not alter the mechanical behaviour described by the original constitutive model. In fact, the modified constitutive equation shows a better predictability when compared against analytical solutions. Two strategies of describing the material variation (i.e. linear and step change) are explained, and their solutions are evaluated for an ideal two-material interfacing problem. When compared with the standard tied coupling approach, the step change method exhibited a much better agreement because of its ability to capture abrupt changes of the material properties. The modified equation in conjunction with integration point-based material heterogeneity is then used to simulate the deformations of heterogeneous biological structures to illustrate its applications.

Emulating facial biomechanics using multivariate partial least squares surrogate models.

A detailed biomechanical model of the human face driven by a network of muscles is a useful tool in relating the muscle activities to facial deformations. However, lengthy computational times often hinder its applications in practical settings. The objective of this study is to replace precise but computationally demanding biomechanical model by a much faster multivariate meta-model (surrogate model), such that a significant speedup (to real-time interactive speed) can be achieved. Using a multilevel fractional factorial design, the parameter space of the biomechanical system was probed from a set of sample points chosen to satisfy maximal rank optimality and volume filling. The input-output relationship at these sampled points was then statistically emulated using linear and nonlinear, cross-validated, partial least squares regression models. It was demonstrated that these surrogate models can mimic facial biomechanics efficiently and reliably in real-time.

Generating Facial Expressions Using an Anatomically Accurate Biomechanical Model.

This paper presents a computational framework for modelling the biomechanics of human facial expressions. A detailed high-order (Cubic-Hermite) finite element model of the human head was constructed using anatomical data segmented from magnetic resonance images. The model includes a superficial soft-tissue continuum consisting of skin, the subcutaneous layer and the superficial Musculo-Aponeurotic system. Embedded within this continuum mesh, are 20 pairs of facial muscles which drive facial expressions. These muscles were treated as transversely-isotropic and their anatomical geometries and fibre orientations were accurately depicted. In order to capture the relative composition of muscles and fat, material heterogeneity was also introduced into the model. Complex contact interactions between the lips, eyelids, and between superficial soft tissue continuum and deep rigid skeletal bones were also computed. In addition, this paper investigates the impact of incorporating material heterogeneity and contact interactions, which are often neglected in similar studies. Four facial expressions were simulated using the developed model and the results were compared with surface data obtained from a 3D structured-light scanner. Predicted expressions showed good agreement with the experimental data.

Estimating muscle activation patterns using a surrogate model of facial biomechanics.

Analyzing the muscle activities that drive the expressive facial gestures can be a useful tool in assessing one's emotional state of mind. Since the skin motion is much easier to measure in comparison to the actual electrical excitation signal of facial muscles, a biomechanical model of the human face driven by these muscles can be a useful tool in relating the geometric information to the muscle activity. However, long computational time often hinders its practicality. The objective of this study was to replace the precise but computationally demanding biomechanical model by a much faster multivariate meta-model (surrogate model), such that a significant speedup (real-time interactive speed) can be achieved and data from the biomechanical model can be practically exploited. Using the proposed surrogate, muscle activation patterns of six key facial expressions were estimated in the iterative fit from the structured-light scanned geometric information.

Numerical simulation of blood flow in an anatomically-accurate cerebral venous tree.

Although many blood flow models have been constructed for cerebral arterial trees, few models have been reported for their venous counterparts. In this paper, we present a computational model for an anatomically accurate cerebral venous tree which was created from a computed tomography angiography (CTA) image. The topology of the tree containing 42 veins was constructed with 1-D cubic-Hermite finite element mesh. The model was formulated using the reduced Navier-Stokes equations together with an empirical constitutive equation for the vessel wall which takes both distended and compressed states of the wall into account. A robust bifurcation model was also incorporated into the model to evaluate flow across branches. Furthermore, a set of hierarchal inflow pressure boundary conditions were prescribed to close the system of equations. Some assumptions were made to simplify the numerical treatment, e.g., the external pressure was considered as uniform across the venous tree, and a vein was either distended or partially collapsed but not both. Using such a scheme we were able to evaluate the blood flow over several cardiac cycles for the large venous tree. The predicted results from the model were compared with ultrasonic measurements acquired at several sites of the venous tree and agreements have been reached either qualitatively (flow waveform shape) or quantitatively (flow velocity magnitude). We then discuss the significance of this venous model, its potential applications, and also present numerical experiments pertinent to limitations of the proposed model.

OpenCMISS: a multi-physics & multi-scale computational infrastructure for the VPH/Physiome project.

The VPH/Physiome Project is developing the model encoding standards CellML (cellml.org) and FieldML (fieldml.org) as well as web-accessible model repositories based on these standards (models.physiome.org). Freely available open source computational modelling software is also being developed to solve the partial differential equations described by the models and to visualise results. The OpenCMISS code (opencmiss.org), described here, has been developed by the authors over the last six years to replace the CMISS code that has supported a number of organ system Physiome projects. OpenCMISS is designed to encompass multiple sets of physical equations and to link subcellular and tissue-level biophysical processes into organ-level processes. In the Heart Physiome project, for example, the large deformation mechanics of the myocardial wall need to be coupled to both ventricular flow and embedded coronary flow, and the reaction-diffusion equations that govern the propagation of electrical waves through myocardial tissue need to be coupled with equations that describe the ion channel currents that flow through the cardiac cell membranes. In this paper we discuss the design principles and distributed memory architecture behind the OpenCMISS code. We also discuss the design of the interfaces that link the sets of physical equations across common boundaries (such as fluid-structure coupling), or between spatial fields over the same domain (such as coupled electromechanics), and the concepts behind CellML and FieldML that are embodied in the OpenCMISS data structures. We show how all of these provide a flexible infrastructure for combining models developed across the VPH/Physiome community.

Computer simulation of vertebral artery occlusion in endovascular procedures.

OBJECTIVE: The aim of this work is to establish a computational pipeline for the simulation of blood flow in vasculatures and apply this pipeline to endovascular interventional scenarios, e.g. angioplasty in vertebral arteries. METHODS: A patient-specific supra-aortal vasculature is digitized from a 3D CT angiography image. By coupling a reduced formulation of the governing Navier-Stokes equations with a wall constitutive equation we are able to solve the transient flow in elastic vessels. By further incorporating a bifurcation model the blood flow across vascular branches can be evaluated, thus flow in a large vasculature can be modeled. Vascular diseases are simulated by modifying the arterial tree configurations, e.g. the effective diameters, schematic connectivity, etc. Occlusion in an artery is simulated by removing that artery from the arterial tree. RESULTS: It takes about 2 min per cardiac cycle to compute blood flow in an arterial tree consisting of 38 vessels and 18 bifurcations on a laptop PC. The simulation results show that blood supply in the posterior region is compensated from the contralateral vertebral artery and the anterior cerebral arteries if one of the vertebral arteries is occluded. CONCLUSION: The computational pipeline is computationally efficient and can capture main flow patterns at any point in the arterial tree. With further improvement it can serve as a powerful tool for the haemodynamic analysis in patient-specific vascular structures.