Identification of injured elements in computational models of spinal cord injury using machine learning.

The purpose of this study was to use machine learning (ML) algorithms to identify tissue damage based on the mechanical outputs of computational models of spinal cord injury (SCI). Three datasets corresponding to gray matter, white matter, and the combination of gray and white matter tissues were used to train the models. These datasets were built from the comparison of histological images taken from SCI experiments in non-human primates and corresponding subject-specific finite element (FE) models. Four ML algorithms were evaluated and compared using cross-validation and the area under the receiver operating characteristic curve (AUC). After hyperparameter tuning, the AUC mean values for the algorithms ranged between 0.79 and 0.82, with a standard deviation no greater than 0.02. The findings of this study also showed that k-nearest neighbors and logistic regression algorithms were better at identifying injured elements than support vector machines and decision trees. Additionally, depending on the evaluated dataset, the mean values of other performance metrics, such as precision and recall, varied between algorithms. These initial results suggest that different algorithms might be more sensitive to the skewed distribution of classes in the studied datasets, and that identifying damage independently or simultaneously in the gray and white matter tissues might require a better definition of relevant features and the use of different ML algorithms. These approaches will contribute to improving the current understanding of the relationship between mechanical loading and tissue damage during SCI and will have implications for the development of prevention strategies for this condition.Clinical Relevance- Linking FE model predictions of mechanical loading to tissue damage is an essential step for FE models to provide clinically relevant information. Combined with imaging technologies, these models can provide useful insights to predict the extent of damage in animal subjects and guide the decision-making process during treatment planning.

Impact forces in backward falls: Subject-specific video-based rigid body simulation of backward falls.

A critical missing component in the study of real-world falls is the ability to accurately determine impact forces resulting from the fall. Subject-specific rigid body dynamic (RBD) models calibrated to video captured falls can quantify impact forces and provide additional insights into injury risk factors. RBD models were developed based on five backward falls captured on surveillance video in long-term care facilities in British Columbia, Canada. Model joint stiffness and initial velocities were calibrated to match the kinematics of the fall and contact forces were calculated. The effect of joint stiffnesses (neck, lumbar spine, hip, and knee joint) on head contact forces were determined by modifying the calibrated stiffness values ±25%. Fall duration, fall trajectories, and maximum velocities showed a close match between fall events and simulations. The maximum value of pelvic velocity difference between Kinovea (an open-source software 2D digitization software) and Madymo multibody modeling was found to be 6% ± 21.58%. Our results demonstrate that neck and hip stiffness values have a non-significant yet large effect on head contact force (t(3) = 1, p = 0.387 and t(3) = 2, p = 0.138), while lower effects were observed for knee stiffness, and the effect of lumbar spine stiffness was negligible. The subject-specific fall simulations constructed from real world video captured falls allow for direct quantification of force outcomes of falls and may have applications in improving the assessment of fall-induced injury risks and injury prevention methods.

The biomechanical implications of neck position in cervical contusion animal models of SCI.

Large animal contusion models of spinal cord injury are an essential precursor to developing and evaluating treatment options for human spinal cord injury. Reducing variability in these experiments has been a recent focus as it increases the sensitivity with which treatment effects can be detected while simultaneously decreasing the number of animals required in a study. Here, we conducted a detailed review to explore if head and neck positioning in a cervical contusion model of spinal cord injury could be a factor impacting the biomechanics of a spinal cord injury, and thus, the resulting outcomes. By reviewing existing literature, we found evidence that animal head/neck positioning affects the exposed level of the spinal cord, morphology of the spinal cord, tissue mechanics and as a result the biomechanics of a cervical spinal cord injury. We posited that neck position could be a hidden factor contributing to variability. Our results indicate that neck positioning is an important factor in studying biomechanics, and that reporting these values can improve inter-study consistency and comparability and that further work needs to be done to standardize positioning for cervical spinal cord contusion injury models.

A Constitutive Model to Characterize In Vivo Human Palmar Tissue.

In vivo characteristics of palmar soft tissue can be used to improve the accuracy of human models to explore and simulate a range of contact scenarios. Tissue characteristics can help to assess injury prevention strategies and designing technologies that depend on quantified physical contacts such as prosthetics, wearables, and assistive devices. In this study, a simplified quasi-linear viscoelastic (QLV) model was developed to quantify large deformation, in vivo soft tissue relaxation characteristics of the palm. We conducted relaxation tests on 11 young adults (6 males, 5 females, 18 < age < 30, mean age: 25 ± 4 yr) and 9 older adults (6 males, 3 females, age > 50, mean age: 61.5 ± 11.5 yr) using a 3 mm indenter to a depth of 50% of each participant's soft tissue thickness. The relaxation parameters of the QLV model were found to differ with age and sex, emphasizing the importance of using targeted material models to represent palmar soft tissue mechanics. Older adults showed on average 2.3-fold longer relaxation time constant compared to younger adults. It took 1.2-fold longer for young males to reach equilibrium than for young females; however, young females had a higher level of relaxation (36%) than young males (33%). Differences in specific QLV model parameters, P1, P2, and α were also found between age and sex groups. QLV characteristics differentiated by age and sex, add biofidelity to computational models which can provide a better representation of the diversity of tissue properties in the population.

Exploring exercise participation and the usability of the adaptive rower and arm crank ergometer through wheelchair users' perspectives.

PURPOSE: Arm crank ergometry and adaptive rowing are existing exercise options for wheelchairs users, but not commonly available. This study was conducted to explore exercise participation of wheelchair users, as well as the usability of the adaptive rowing ergometer (aROW) and arm crank ergometer (ACE). METHODS: This mixed-methods study used a concurrent triangulation design. Following completion of both exercise sessions (5 min each), participants (n = 14) with spinal cord injury/disease (SCI/D) completed the System Usability Scale (SUS), and a semi-structured interview. Participants were asked about the use of both exercise modalities, and general exercise participation. SUS data were analyzed using a paired sample t-test and qualitative data were analyzed through conventional content analysis. RESULTS: Wheelchair users exercised for improved physical and mental health, as well as for functional independence, and community participation; however, lack of accessible equipment was a prominent barrier. Both the aROW and ACE have high usability, but the aROW was perceived as more enjoyable and effective for cardiovascular exercise. CONCLUSIONS: The implementation of the aROW into community gyms has the potential to help close the existing gap in inclusive equipment and may help people with disabilities to be more fully included in their community and lead healthier lives.Implications for rehabilitationWheelchair users perceive exercise as a meaningful activity that enhances physical health and risk of disease, functional independence, community participation, and overall social and emotional health.The adapted rowing machine was perceived as highly usable and was felt to be more enjoyable and effective for cardiovascular exercise compared to traditional arm crank ergometers.The adaptive rower provides an additional accessible equipment option for wheelchair users to obtain effective cardiovascular exercise.More available equipment may increase community participation and promote inclusion for wheelchair users.

In vivo soft tissue compressive properties of the human hand.

BACKGROUND/PURPOSE: Falls onto outstretched hands are the second most common sports injury and one of the leading causes of upper extremity injury. Injury risk and severity depends on forces being transmitted through the palmar surface to the upper extremity. Although the magnitude and distribution of forces depend on the soft tissue response of the palm, the in vivo properties of palmar tissue have not been characterized. The purpose of this study was to characterize the large deformation palmar soft tissue properties. METHODS: In vivo dynamic indentations were conducted on 15 young adults (21-29 years) to quantify the soft tissue characteristics of over the trapezium. The effects of loading rate, joint position, tissue thickness and sex on soft tissue responses were assessed. RESULTS: Energy absorbed by the soft tissue and peak force were affected by loading rate and joint angle. Energy absorbed was 1.7-2.8 times higher and the peak force was 2-2.75 times higher at high rate loading than quasistatic rates. Males had greater energy absorbed than females but not at all wrist positions. Damping characteristics were the highest in the group with the thickest soft tissue while damping characteristics were the lowest in group with the thinnest soft tissues. CONCLUSION: Palmar tissue response changes with joint position, loading rate, sex, and tissue thickness. Accurately capturing these tissue responses is important for developing effective simulations of fall and injury biomechanics and assessing the effectiveness of injury prevention strategies.

Classifying sitting, standing, and walking using plantar force data.

Prolonged static weight-bearing at work may increase the risk of developing plantar fasciitis (PF). However, to establish a causal relationship between weight-bearing and PF, a low-cost objective measure of workplace behaviors is needed. This proof-of-concept study assesses the classification accuracy and sensitivity of low-resolution plantar pressure measurements in distinguishing workplace postures. Plantar pressure was measured using an in-shoe measurement system in eight healthy participants while sitting, standing, and walking. Data was resampled to simulate on/off characteristics of 24 plantar force sensitive resistors. The top 10 sensors were evaluated using leave-one-out cross-validation with machine learning algorithms: support vector machines (SVMs), decision tree (DT), discriminant analysis (DA), and k-nearest neighbors (KNN). SVM and DT best classified sitting, standing, and walking. High classification accuracy was obtained with five sensors (98.6% and 99.1% accuracy, respectively) and even a single sensor (98.4% and 98.4%, respectively). The central forefoot and the medial and lateral midfoot were the most important classification sensor locations. On/off plantar pressure measurements in the midfoot and central forefoot can accurately classify workplace postures. These results provide the foundation for a low-cost objective tool to classify and quantify sedentary workplace postures.

Correlating Tissue Mechanics and Spinal Cord Injury: Patient-Specific Finite Element Models of Unilateral Cervical Contusion Spinal Cord Injury in Non-Human Primates.

Non-human primate (NHP) models are the closest approximation of human spinal cord injury (SCI) available for pre-clinical trials. The NHP models, however, include broader morphological variability that can confound experimental outcomes. We developed subject-specific finite element (FE) models to quantify the relationship between impact mechanics and SCI, including the correlations between FE outcomes and tissue damage. Subject-specific models of cervical unilateral contusion SCI were generated from pre-injury MRIs of six NHPs. Stress and strain outcomes were compared with lesion histology using logit analysis. A parallel generic model was constructed to compare the outcomes of subject-specific and generic models. The FE outcomes were correlated more strongly with gray matter damage (0.29 < R2 < 0.76) than white matter (0.18 < R2 < 0.58). Maximum/minimum principal strain, Von-Mises and Tresca stresses showed the strongest correlations (0.31 < R2 < 0.76) with tissue damage in the gray matter while minimum principal strain, Von-Mises stress, and Tresca stress best predicted white matter damage (0.23 < R2 < 0.58). Tissue damage thresholds varied for each subject. The generic FE model captured the impact biomechanics in two of the four models; however, the correlations between FE outcomes and tissue damage were weaker than the subject-specific models (gray matter [0.25 < R2 < 0.69] and white matter [R2 < 0.06] except for one subject [0.26 < R2 < 0.48]). The FE mechanical outputs correlated with tissue damage in spinal cord white and gray matters, and the subject-specific models accurately mimicked the biomechanics of NHP cervical contusion impacts.

Differentiating Sitting, Standing, and Walking Through Regional Plantar Pressure Characteristics.

Prolonged static weight bearing (WBR) is thought to aggravate plantar heel pain and is common in the workplace, which may put employees at greater risk of developing plantar heel pain. However, objective measures of physical activity and sedentary behaviors in the workplace are lacking, making it difficult to establish or refute the connection between work exposure and plantar heel pain. Characterizing loading patterns during common workplace postures will enhance the understanding of foot function and inform the development of new measurement tools. Plantar pressure data during periods of sitting, standing, and walking were measured in ten healthy participants using the F-Scan in-shoe measurement system (Tekscan Inc, Boston, MA). Peak and average pressure, peak and average contact area, and average pressure differential were analyzed in ten different regions of the foot. A two-way repeated measures analysis of variance (ANOVA) assessed the posture by foot region interaction for each measurement parameter; significant effects of posture by foot region were identified for all five measurement parameters. Ten foot region by measurement parameter combinations were found to significantly differentiate all three postures simultaneously; seven used pressure measures to differentiate while three used area measures. The heel, lateral midfoot (LM), and medial and central forefoot (CFF) encompassed nine of ten areas capable of differentiating all postures simultaneously. This work demonstrates that plantar pressure is a viable means to characterize and differentiate three common workplace postures. The results of this study can inform the development of measurement tools for quantifying posture duration at work.

The Effect of Parity on Age-Related Degenerative Changes in Sagittal Balance.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Evaluate the effects of parity (number of births) on measures of sagittal posture in elderly women. The long-term objective of this study is to identify and mitigate factors contributing to age-related postural deformity in older adults. SUMMARY OF BACKGROUND DATA: Adult spinal deformity is a prevalent condition that often requires costly surgical management. Females are disproportionately represented in spinal deformity surgical cases with up to 90% of patients being women. The potential contributions of pregnancy on postural degeneration have only begun to be acknowledged and require further study. METHODS: Two hundred eight women with standing lateral radiographs were selected from the TwinsUK register. Parity information was extracted from questionnaires. Sagittal balance measurements (thoracic kyphosis, lumbar lordosis [LL], pelvic incidence [PI]) were collected and PI-LL mismatch was calculated. One-way analysis of variance tests were done between three separate age categories for measures of sagittal balance and parity and stepwise multivariate regression was done for PI-LL. RESULTS: Both age and PI-LL mismatch significantly differed between parity categories. PI-LL was on average 7.0°â€Š±â€Š2.5° greater in multiparous (3+ births) subjects than in nulliparous subjects (P < 0.01). Parity did not have an independent relationship with lumbar disc degeneration, lumbar bone mineral density, or any of the individual sagittal balance parameters (P > 0.05 for all), except for PI-LL. From a subanalysis of the effect of parity on sagittal alignment within twin pairs, we found that within pair differences in parity associate with within pair differences in thoracic kyphosis. CONCLUSION: This study established correlations between measures of spinal curvature in older women and parity for the first time. Longitudinal research is required to establish a causative relationship. LEVEL OF EVIDENCE: 4.

Manual wheelchair downhill stability: an analysis of factors affecting tip probability.

BACKGROUND: For people who use manual wheelchairs, tips and falls can result in serious injuries including bone fractures, concussions, and traumatic brain injury. We aimed to characterize how wheelchair configuration changes (including on-the-fly adjustments), user variables, and usage conditions affected dynamic tip probability while rolling down a slope and contacting a small block. METHODS: Rigid body dynamic models of a manual wheelchair and test dummy were created using multi-body software (Madymo, TASS International, Livonia, MI), and validated with 189 experiments. Dynamic stability was assessed for a range of seat angles (0 to 20° below horizontal), backrest angles (0 to 20°), rear axle positions (0 to 20 cm from base of backrest), ground slopes (0 to 15°), bump heights (0 to 4 cm), wheelchair speeds (0 to 20 km/hr), user masses (50 to 115 kg), and user positions (0 to 10 cm from base of backrest). The tip classifications (forward tip, backward tip, rolled over bump, or stopped by bump) were investigated using a nominal logistic regression analysis. RESULTS: Faster wheelchair speeds significantly increased the probability of tipping either forward or backward rather than stopping, but also increased the probability of rolling over the bump (p < 0.001). When the rear axle was positioned forward, this increased the risk of a backward tip compared to all other outcomes (p < 0.001), but also reduced the probability of being stopped by the bump (p < 0.001 compared to forward tip, p < 0.02 compared to rolling over). Reclining the backrest reduced the probability of a forward tip compared to all other outcomes (p < 0.001), and lowering the seat increased the probability of either rolling over the bump or tipping backwards rather than tipping forward (p < 0.001). In general, the wheelchair rolled over bumps < 1.5 cm, and forwards tipping was avoided by reducing the speed to 1 km/hr. CONCLUSIONS: The probability of forward tipping, corresponding to the greatest risk of injury, was significantly reduced for decreased speeds, smaller bumps, a reclined backrest, and a lower rear seat height. For wheelchairs with dynamic seating adjustability, when travelling downhill, on-the-fly adjustments to the seat or backrest can increase the likelihood of safely rolling over a bump.

Compressive mechanical characterization of non-human primate spinal cord white matter.

The goal of developing computational models of spinal cord injury (SCI) is to better understand the human injury condition. However, finite element models of human SCI have used rodent spinal cord tissue properties due to a lack of experimental data. Central nervous system tissues in non human primates (NHP) closely resemble that of humans and therefore, it is expected that material constitutive models obtained from NHPs will increase the fidelity and the accuracy of human SCI models. Human SCI most often results from compressive loading and spinal cord white matter properties affect FE predicted patterns of injury; therefore, the objectives of this study were to characterize the unconfined compressive response of NHP spinal cord white matter and present an experimentally derived, finite element tractable constitutive model for the tissue. Cervical spinal cords were harvested from nine male adult NHPs (Macaca mulatta). White matter biopsy samples (3 mm in diameter) were taken from both lateral columns of the spinal cord and were divided into four strain rate groups for unconfined dynamic compression and stress relaxation (post-mortem <1-hour). The NHP spinal cord white matter compressive response was sensitive to strain rate and showed substantial stress relaxation confirming the viscoelastic behavior of the material. An Ogden 1st order model best captured the non-linear behavior of NHP white matter in a quasi-linear viscoelastic material model with 4-term Prony series. This study is the first to characterize NHP spinal cord white matter at high (>10/sec) strain rates typical of traumatic injury. The finite element derived material constitutive model of this study will increase the fidelity of SCI computational models and provide important insights for transferring pre-clinical findings to clinical treatments. STATEMENT OF SIGNIFICANCE: Spinal cord injury (SCI) finite element (FE) models provide an important tool to bridge the gap between animal studies and human injury, assess injury prevention technologies (e.g. helmets, seatbelts), and provide insight into the mechanisms of injury. Although, FE model outcomes depend on the assumed material constitutive model, there is limited experimental data for fresh spinal cords and all was obtained from rodent, porcine or bovine tissues. Central nervous system tissues in non human primates (NHP) more closely resemble humans. This study characterizes fresh NHP spinal cord material properties at high strains rates and large deformations typical of SCI for the first time. A constitutive model was defined that can be readily implemented in finite strain FE analysis of SCI.

Detecting white matter activity using conventional 3 Tesla fMRI: An evaluation of standard field strength and hemodynamic response function.

Detection of functional magnetic resonance imaging (fMRI) activation in white matter has been increasingly reported despite historically being controversial. Much of the development work to-date has used high-field 4 T MRI and specialized pulse sequences. In the current study, we utilized conventional 3 T MRI and a commonly applied gradient-echo-planar imaging sequence to evaluate white matter (WM) fMRI sensitivity within a common framework. Functional WM activity was replicated in target regions of interest within the corpus callosum, at the group and individual levels. As expected there was a reduction in overall WM activation sensitivity. Individual analyses revealed that 8 of the 13 individuals showed white matter activation, showing a lower percentage of individuals with WM activation detected. Importantly, WM activation results were sensitive to analyses that applied alternate hemodynamic response functions, with an increase in the group level cluster when hemodynamic response function (HRF) onset slope was reduced. The findings supported the growing evidence that WM activation is detectable, with activation levels are closer to thresholds used for routine 3T MRI studies. Optimization factors, such as the HRF model, appear to be important to further enhance the characterization of WM activity in fMRI.

Quantifying the effects of on-the-fly changes of seating configuration on the stability of a manual wheelchair.

In general, manual wheelchairs are designed with a fixed frame, which is not optimal for every situation. Adjustable on the fly seating allow users to rapidly adapt their wheelchair configuration to suit different tasks. These changes move the center of gravity (CoG) of the system, altering the wheelchair stability and maneuverability. To assess these changes, a computer simulation of a manual wheelchair was created with adjustable seat, backrest, rear axle position and user position, and validated with experimental testing. The stability of the wheelchair was most affected by the position of the rear axle, but adjustments to the backrest and seat angles also result in stability improvements that could be used when wheeling in the community. These findings describe the most influential parameters for wheelchair stability and maneuverability, as well as provide quantitative guidelines for the use of manual wheelchairs with on the fly adjustable seats.

Association Between Paraspinal Muscle Morphology, Clinical Symptoms, and Functional Status in Patients With Degenerative Cervical Myelopathy.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: The aim of this study was to assess fatty infiltration and asymmetry of the multifidus (MF), semispinalis cervicis (SCer), semispinalis capitis (SCap), and splenius capitis (SPL) muscles in patients with degenerative cervical myelopathy (DCM), and evaluate their correlations with clinical symptoms and functional scores. SUMMARY OF BACKGROUND DATA: Cervical muscle alterations have been reported in patients with chronic neck pain, but the assessment of cervical muscle morphology has been overlooked in patients with DCM. METHODS: Thirty-eight patients diagnosed with DCM and spinal cord compression at C4-C5 or C5-C6 (first level of compression) were included. Cervical muscle measurements of cross-sectional area (CSA) and ratio of functional CSA (fat-free area, FCSA) to total CSA were obtained from T2-weighted axial images at the level above, same, and level below the most cranial level of spinal cord compression. Muscle fatty infiltration and asymmetry was assessed at every level and their associations with respect to clinical signs and symptoms and functional scores were investigated. RESULTS: There was a significant increase in fatty infiltration (decrease in FCSA/CSA ratio) of the MF (P = 0.001) and SPL (P < 0.001) muscles at the level below the spinal cord compression. A significant increase in MF CSA asymmetry was also observed at the level below the compression. Lower MF FCSA/CSA ratio was associated with longer 30-m walking test time. Lower SCer FCSA/CSA was associated with corticospinal distribution motor deficits and atrophy of the hands. Greater asymmetry in SCap CSA was associated with higher Neck Disability Index (NDI) scores, whereas lower asymmetry in MF CSA was associated with a positive Hoffman sign and weakness. CONCLUSION: A significant increase in muscle fatty infiltration and CSA asymmetry at the level below the compression was observed in patients with DCM. Our results also suggest an association between cervical muscle morphology and DCM clinical symptoms and functional status. LEVEL OF EVIDENCE: 2.

Effects of weld damage on the dynamics of energy-absorbing lanyards.

Manufacturers recommend removing fall protection system components from service for any indication of weld spatter or tool damage; however, little is known about the specific effects of lanyard damage on fall arrest dynamics. Thirty-two energy-absorbing lanyards were drop tested after being damaged with weld spatter, plasma torches and cutting tools and compared with new, undamaged lanyards. Two lanyards damaged with a plasma torch failed completely without deploying the energy absorber while weld spatter damage and tool cuts, up to two-thirds through the width of the webbing, had no effect on fall arrest dynamics. The results highlight the catastrophic implications of high-temperature damage to lanyard webbing resulting from plasma torches - which require immediate removal from service. In addition, the integrated energy absorber design in bungee-style lanyards makes them more susceptible to damage anywhere along the length. We therefore recommended against bungee lanyards for ironworkers and welders.

The Transverse Isotropy of Spinal Cord White Matter Under Dynamic Load.

The rostral-caudally aligned fiber-reinforced structure of spinal cord white matter (WM) gives rise to transverse isotropy in the material. Stress and strain patterns generated in the spinal cord parenchyma following spinal cord injury (SCI) are multidirectional and dependent on the mechanism of the injury. Our objective was to develop a WM constitutive model that captures the material transverse isotropy under dynamic loading. The WM mechanical behavior was extracted from the published tensile and compressive experiments. Combinations of isotropic and fiber-reinforcing models were examined in a conditional quasi-linear viscoelastic (QLV) formulation to capture the WM mechanical behavior. The effect of WM transverse isotropy on SCI model outcomes was evaluated by simulating a nonhuman primate (NHP) contusion injury experiment. A second-order reduced polynomial hyperelastic energy potential conditionally combined with a quadratic reinforcing function in a four-term Prony series QLV model best captured the WM mechanical behavior (0.89 < R2 < 0.99). WM isotropic and transversely isotropic material models combined with discrete modeling of the pia mater resulted in peak impact forces that matched the experimental outcomes. The transversely isotropic WM with discrete pia mater resulted in maximum principal strain (MPS) distributions which effectively captured the combination of ipsilateral peripheral WM sparing, ipsilateral injury and contralateral sparing, and the rostral/caudal spread of damage observed in in vivo injuries. The results suggest that the WM transverse isotropy could have an important role in correlating tissue damage with mechanical measures and explaining the directional sensitivity of the spinal cord to injury.

The dynamics of electric powered wheelchair sideways tips and falls: experimental and computational analysis of impact forces and injury.

BACKGROUND: To reduce the occurrence of wheelchair falls and to develop effective protection systems, we aimed to quantify sideways tip and fall dynamics of electric power wheelchairs (EPWs). We hypothesized that driving speed, curb height and angle of approach would affect impact forces and head injury risk for wheelchair riders. We further expected that fall dynamics and head injury risk would be greater for unrestrained riders compared to restrained riders. METHODS: Sideways wheelchair tip and fall dynamics were reconstructed using a remotely operated rear wheel drive EPW and a Hybrid III test dummy driving at different approach angles (5 to 63°) over an adjustable height curb (0.30 to 0.41 m) at speeds of 0.6-1.5 m/s. Rigid body dynamics models (Madymo, TASS International, Livonia, MI) were developed in parallel with the experiments to systematically study and quantify the impact forces and the sideways tip or fall of an EPW user in different driving conditions. RESULTS: Shallower approach angles (25°) (p < 0.05) and higher curbs (0.4 m) (p < 0.05) were the most significant predictors of tipping for restrained passengers. Unrestrained passengers were most affected by higher curbs (0.4 m) (p < 0.005) and fell forward from the upright wheelchair when the approach angle was 60°. Head impact forces were greater in unrestrained users (6181 ± 2372 N) than restrained users (1336 ± 827 N) (p = 0.00053). Unrestrained users had significantly greater head impact severities than restrained users (HIC = 610 ± 634 vs HIC = 29 ± 38, p = 0.00013) and several tip events resulted in HICs > 1000 (severe head injury) in unrestrained users. CONCLUSIONS: Sideways tips and forward falls from wheelchairs were most sensitive to curb height and approach angle but were not affected by driving speed. Sideways tips and falls resulted in impact forces that could result in concussions or traumatic brain injury and require injury prevention strategies. Seat belts eliminated the risk of falling from an upright chair and reduced head impact forces in sideways wheelchair tips in this study; however, their use must be considered within the ethical and legal definitions of restraints.

Morphological and postural sexual dimorphism of the lumbar spine facilitates greater lordosis in females.

Previous work suggests females are evolutionarily adapted to have greater lumbar lordosis than males to aid in pregnancy load-bearing, but no consensus exists. To explore further sex-differences in the lumbar spine, and to understand contradictions in the literature, we conducted a cross-sectional retrospective study of sex-differences in lumbar spine morphology and sacral orientation. In addition, our sample includes data for separate standing and supine samples of males and females to examine potential sex-differences in postural loading on lumbosacral morphology. We measured sagittal lumbosacral morphology on 200 radiographs. Measurements include: lumbar angle (L1-S1), lumbar vertebral body and disc wedging angles, sacral slope and pelvic incidence. Lumbar angle, representative of lordotic curvature between L1 and S1, was 7.3° greater in females than males, when standing. There were no significant sex-differences in lumbar angle when supine. This difference in standing lumbar angle can be explained by greater lordotic wedging of the lumbar vertebrae (L1-L5) in females. Additionally, sacral slope was greater in females than males, when standing. There were no significant sex-differences in pelvic incidence. Our results support that females have greater lumbar lordosis than males when standing, but not when supine - suggesting a potentially greater range of motion in the female spine. Furthermore, sex-differences in the lumbar spine appear to be supported by postural differences in sacral-orientation and morphological differences in the vertebral body wedging. A better understanding of sex-differences in lumbosacral morphology may explain sex-differences in spinal conditions, as well as promote necessary sex-specific treatments.