Conceptualization of an exoskeleton Continuous Passive Motion(CPM) device using a link structure.

This study is about developing an exoskeleton Continuous Passive Motion (CPM) with the same Range of Motion (ROM) and instant center of rotation as the human knee. The key feature in constructing a CPM is an accurate alignment with the human knee joint enabling it to deliver the same movements as the actual body on the CPM. In this research, we proposed an exoskeleton knee joint through kinematic interpretation, measured the knee joint torque generated while using a CPM and applied it to the device. Thus, this new exoskeleton type CPM will allow precise alignment with the human knee joint, and follow the same ROM as the human knee in any position.

Segmental dynamics of forward fall arrests: a system identification approach.

BACKGROUND: Fall-related injuries are multifaceted problems. One approach to identify the critical biomechanical factors is biodynamic simulation. METHODS: A 2-degree-of-freedom discrete impact model was constructed through system identification and validated using experimental data in order to understand the dynamic interactions of various biomechanical parameters in bimanual forward fall arrests. FINDINGS: The bimodal reaction force responses from the identified models had very small identification errors (<3.5%) and high coherence (R(2)=0.95) between the measured and identified model responses. Model validation with separate experimental data also demonstrated excellent validation accuracy and coherence, less than 7% errors and R(2)=0.87, respectively. The first force peak was usually greater than the second force peak and strongly correlated with the impact velocity of the upper extremity, while the second force peak was associated with the impact velocity of the body. The impact velocity of the upper extremity relative to the body could be a major risk factor to fall-related injuries as observed from model simulations that a 75% faster arm movement relative to the falling speed of the body alone could double the first force peak from that of a soft landing, thereby readily exceeding the fracture strength of the distal radius. INTERPRETATION: Despite the time-critical nature of falling often calling for a rapid arm movements, the safe use of the upper extremity in forward fall arrests requires adequate reaction times and coordinated protective motions of the upper extremity.

Biomechanical efficiency of wrist guards as a shock isolator.

Despite the use of wrist guards during skate- and snowboard activities, fractures still occur at the wrist or at further proximal locations of the forearm. The main objectives of this study were to conduct a human subject testing under simulated falling conditions for measurement of the impact force on the hand, to model wrist guards as a shock isolator, to construct a linear mass-spring-damper model for quantification of the impact force attenuation (Q-ratio) and energy absorption (S-ratio), and to determine whether wrist guards play a role of an efficient shock isolator. While the falling direction (forward and backward) significantly influenced the impact responses, use of wrist guards provided minimal improvements in the Q- and S-ratios. It was suggested based on the results under the submaximal loading conditions that protective functions of the common wrist guard design could be enhanced with substantial increase in the damping ratio so as to maximize the energy absorption. This would bring forth minor deterioration in the impact force attenuation but significant increase in the energy absorption by 19%, which would help better protection against fall-related injuries of the upper extremity.

Shock attenuation of various protective devices for prevention of fall-related injuries of the forearm/hand complex.

BACKGROUND: Attenuation of the peak impact force is essential in any protective devices for prevention of fall-related injuries. HYPOTHESIS: Common wrist guards have limited effectiveness because of the multifaceted nature of wrist injury mechanisms, and other modalities may provide enhanced shock-absorbing functions. STUDY DESIGN: Controlled laboratory study. METHODS: A free-fall device was constructed using a mechanical surrogate to simulate falling impact. At 4 different falling heights, 5 different hand conditions were tested: bare hand, a generic-brand wrist guard, a Sorbothane glove, an air cell, and an air bladder condition. The impact force from the ground and the transmitted impact force to the forearm/hand complex were simultaneously measured. RESULTS: The falling height and hand condition significantly modulated the impact responses. The padded conditions always had significantly smaller peak impact forces compared with the bare-hand condition. The wrist guard became ineffective in impact force attenuation beyond the falling height of 51 cm. On the other hand, the air bladder condition maintained less than 45% of the peak impact force of the bare-hand condition and remained below the critical value, whereas other conditions were all ineffective. CONCLUSION: It was reconfirmed that common wrist guard design could provide limited impact force attenuation, whereas damped pneumatic springs would provide substantially enhanced shock-absorbing functions. CLINICAL RELEVANCE: A wrist guard incorporating volar padding with the pneumatic spring design principle might be more effective at preventing injuries than are currently available designs.

Shock-absorbing effects of various padding conditions in improving efficacy of wrist guards.

The use of wrist guards has limited efficacy in preventing wrist injuries during falling in many sports activities. The objectives of this study were to measure the ground reaction force of the hand under simulated impact of the forearm and hand complex with different padding conditions of wrist guards and to analyze their impact force attenuation and maximum energy absorption for improved functional efficiency. A total of 15 subjects, wearing a commercial wrist guard, participated in a cable-released hand impact experiment to test four different conditions on the volar aspect of the hand, which include a wrist guard without a volar splint (bare hand), with a volar splint (normal use), with a volar splint and additional viscoelastic polymeric padding, and a volar splint and additional air cell padding. The ground reaction force and acceleration of the hand were measured using a force platform mounted on an anti-vibration table and a miniature accelerometer, respectively. Additional padding on the bare hand could substantially improve the maximum energy absorption by more than 39%, with no differences with each other. However, only the air cell padding could simultaneously improve the impact force attenuation by 32% compared with the bare hand impact without compromising the maximum energy absorption. It is recommended that common wrist guard design should provide more compliant padding in the volar aspect to improve the impact force attenuation through optimal material selection and design. Key PointsTHE CONTROVERSIAL EFFICACY OF WRIST GUARDS IN PREVENTING WRIST INJURIES DURING FALLING WAS TESTED THROUGH INVESTIGATION OF THEIR IMPACT FORCE ATTENUATION AND MAXIMUM ENERGY ABSORPTION FROM THE MEASURED GROUND REACTION FORCE OF THE HAND UNDER SIMULATED IMPACT OF THE FOREARM AND HAND COMPLEX WITH FOUR DIFFERENT PADDING CONDITIONS OF WRIST GUARDS: a wrist guard without a volar splint (bare hand), with a volar splint (normal use), with a volar splint and additional viscoelastic polymeric padding, and a volar splint and additional air cell padding.In general, padding on the bare hand could improve the maximum energy absorption by more than 39%, while only the air cell padding could simultaneously attenuate the peak impact force by 32% without compromising the maximum energy absorption.Common wrist guard design requires more compliant padding in the volar aspect to improve the impact force attenuation, which should be done through optimal material selection and design.

Biomechanics of fall arrest using the upper extremity: age differences.

OBJECTIVE: This study tried to isolate critical biomechanical factors in fall arrests using the upper extremity during simulated forward falls. This study also attempted to find the differences in those factors between young and old age groups. BACKGROUND: The role of the upper extremity is not well defined despite its primary usage as a local shock absorber during fall impact. DESIGN: Comparative study in which two age groups underwent motion analysis.Methods. Ten healthy older males (mean age, 66.4 years) and 10 young males (mean age, 24.1 years) volunteered to perform self-initiated and cable-released falls at selected falling distances, while the joint motion and impact forces at the hand were recorded. RESULTS: Significant age differences were demonstrated in joint kinematics and impact force parameters at close distances. Excessive reflexive responses of the upper extremity in cable-released falls for the older adults resulted in 10-15 times higher peak impact forces and 2-3 times shorter body braking time than in self-initiated falls. CONCLUSIONS: Pre-impact activities of the upper extremity predispose the post-impact response during fall arrests. Suppressing excessive pre-impact reflexive activation of the arms could efficiently decrease the risk of fall-related injuries, which calls for securing sufficient arm movement time. Any fall prevention strategy that can increase arm movement time would be effective against injuries of the upper extremity during falling in the older adults. RELEVANCE: The findings will help to understand underlying mechanisms of fall arrest using the upper extremity for prevention of fall-related fractures.

An in vitro study of individual ankle muscle actions on the center of pressure.

The objective of this study was to correlate the effects of muscle force on the movement of the center of pressure (COP) for increased clinical utility of the COP measurement. Five fresh frozen cadaveric specimens were used to apply a 49 N sinusoidal muscle force to isolated or grouped extrinsic ankle muscles, and a constant ankle joint reaction force at different tibial positions. The muscle force and the vertical ground reaction force (GRF) play the role of a mechanical lever system so that the differential COP movement can be interpreted as a moment arm for the vertical GRF.

Development of a quantitative reflex hammer for measurement of tendon stretch reflex.

Quantification of tendon stretch reflex requires precise measurement of the tapping force of a reflex hammer. A quantitative reflex (QR) hammer consisting of two cut rubber pieces from a generic rubber reflex hammer and a uniaxial force transducer was constructed. Finite element stress analyses were conducted to estimate the natural frequency characteristics of the hammer and to find the stress distributions during the impact. Pendulum impact testing was conducted at four different heights to assess the calibration linearity and repeatability of the measurement. The QR hammer had a fundamental natural frequency of 515 Hz and showed minimal displacement and stress at the tip from the finite element simulation of the impact. The QR hammer also provided reliable and repeatable measurements as demonstrated with high coefficients of determination, exceeding 0.994 and small coefficients of variations, less than 4%. The calibration linearity was 0.64% compared with the reference force platform measurement. The QR hammer demonstrated sufficient accuracy and reliability for precise clinical assessment of tendon stretch reflexes.