Approach for contact medical device development via integrated testing, skeletal muscle modeling, and finite element analysis.

Development of novel medical devices for the treatment of musculoskeletal pain associated with neuro-muscular trigger points requires a model for relating the mechanical responses of in vivo biological tissues to applied palliative physical pressures and a method to design treatments for optimal effects. It is reasonable to hypothesize that the efficacy of therapeutic treatment is proportional to the maximum tensile strain at trigger point locations. This work presents modeling of the mechanical behavior of biological tissue structures and treatment simulations, supported by indentation experiments and finite element (FE) modeling. The steady-state indentation responses of the tissue structure of the posterior neck were measured with a testing device, and an FE model was constructed using a first-order Ogden hyperelastic material model and calibrated with the experimental data. The error between experimental and FE-generated displacement-load curves was minimized via a two-stage optimization process comprised of an Optimal Latin Hypercube design-of-experiments analysis and a Bayesian optimization loop. The optimized Ogden model had an initial shear modulus (µ) of 5.16 kPa and a deviatoric exponent (α) of 11.90. Another FE model was developed to simulate the deformation of the tissue structures in the posterior neck adjacent to the C3 vertebrae in response to indentation loading, in order to determine the optimal location and angle to apply an indentation force for maximum therapeutic benefit. The optimal location of indentation was determined to be 28° lateral from the sagittal plane along the surface of the skin, measured from the centerline of the spine, at an angle of 8° counterclockwise from the surface normal vector. The optimized spatial orientation of the indentation corresponded to the average of the maximum principal strain across the deep muscle region of the model.

Systems of care for persons who are homeless in the United States.

SUMMARY Occupational therapists work within various systems that provide services to persons who are homeless, including housing, health care, social service, education, and work programs. This article describes the typologies of homelessness, the continuum of care, trends in service delivery, the federal organization and primary sources of funding for homeless services. It is important for therapists to understand these systems and resources in order to deliver and advocate for effective services for persons who are homeless.