An investigation of tendon strains in jersey finger injury load cases using a finite element neuromuscular human body model.

Introduction: A common hand injury in American football, rugby and basketball is the so-called jersey finger injury (JFI), in which an eccentric overextension of the distal interphalangeal joint leads to an avulsion of the connected musculus flexor digitorum profundus (FDP) tendon. In the field of automotive safety assessment, finite element (FE) neuromuscular human body models (NHBMs) have been validated and are employed to evaluate different injury types related to car crash scenarios. The goal of this study is to show, how such a model can be modified to assess JFIs by adapting the hand of an FE-NHBM for the computational analysis of tendon strains during a generalized JFI load case. Methods: A jersey finger injury criterion (JFIC) covering the injury mechanisms of tendon straining and avulsion was defined based on biomechanical experiments found in the literature. The hand of the Total Human Model for Safety (THUMS) version 3.0 was combined with the musculature of THUMS version 5.03 to create a model with appropriate finger mobility. Muscle routing paths of FDP and musculus flexor digitorum superficialis (FDS) as well as tendon material parameters were optimized using literature data. A simplified JFI load case was simulated as the gripping of a cylindrical rod with finger flexor activation levels between 0% and 100%, which was then retracted with the velocity of a sprinting college football player to forcefully open the closed hand. Results: The optimization of the muscle routing node positions and tendon material parameters yielded good results with minimum normalized mean absolute error values of 0.79% and 7.16% respectively. Tendon avulsion injuries were detected in the middle and little finger for muscle activation levels of 80% and above, while no tendon or muscle strain injuries of any kind occurred. Discussion: The presented work outlines the steps necessary to adapt the hand model of a FE-NHBM for the assessment of JFIs using a newly defined injury criterion called the JFIC. The injury assessment results are in good agreement with documented JFI symptoms. At the same time, the need to rethink commonly asserted paradigms concerning the choice of muscle material parameters is highlighted.

Development and verification of a physiologically motivated internal controller for the open-source extended Hill-type muscle model in LS-DYNA.

Nowadays, active human body models are becoming essential tools for the development of integrated occupant safety systems. However, their broad application in industry and research is limited due to the complexity of incorporated muscle controllers, the long simulation runtime, and the non-regular use of physiological motor control approaches. The purpose of this study is to address the challenges in all indicated directions by implementing a muscle controller with several physiologically inspired control strategies into an open-source extended Hill-type muscle model formulated as LS-DYNA user-defined umat41 subroutine written in the Fortran programming language. This results in increased usability, runtime performance and physiological accuracy compared to the standard muscle material existing in LS-DYNA. The proposed controller code is verified with extensive experimental data that include findings for arm muscles, the cervical spine region, and the whole body. Selected verification experiments cover three different muscle activation situations: (1) passive state, (2) open-loop and closed-loop muscle activation, and (3) reflexive behaviour. Two whole body finite element models, the 50th percentile female VIVA OpenHBM and the 50th percentile male THUMS v5, are used for simulations, complemented by the simplified arm model extracted from the 50th percentile male THUMS v3. The obtained results are evaluated additionally with the CORrelation and Analysis methodology and the mean squared error method, showing good to excellent biofidelity and sufficient agreement with the experimental data. It was shown additionally how the integrated controller allows simplified mimicking of the movements for similar musculoskeletal models using the parameters transfer method. Furthermore, the Hill-type muscle model presented in this paper shows better kinematic behaviour even in the passive case compared to the existing one in LS-DYNA due to its improved damping and elastic properties. These findings provide a solid evidence base motivating the application of the enhanced muscle material with the internal controller in future studies with Active Human Body Models under different loading conditions.

Evaluation of muscle strain injury severity in active human body models.

Even though significant efforts in the field of injury detection with finite element active human body models (FE AHBMs) have been made, injuries of the muscle-tendon unit (MTU) have not yet been taken into consideration. Therefore, the goal of this study was to define a muscle strain injury criterion (MSIC) to evaluate the damage sustained by the musculature during muscle driven movement scenarios. The MSIC was derived from biomechanical tests found in the literature and the proposed threshold values were substantiated through a comparison to an estimate of the ultimate tensile strength of human skeletal muscle and the forces acting on the biceps femoris long head muscle during one sprinting gait cycle. The application of the MSIC to state-of-the-art FE AHBMs was demonstrated by evaluating the strain injury severity of selected neck muscles of a full-body AHBM during two seat rotation load cases. The results of the MSIC substantiation suggest that all three injury threshold values proposed in this work fall in a plausible corridor of forces acting on the MTU. The combined results of the AHBM simulations indicate that neither of the two examined seat rotations are likely to cause strain injury to the neck muscles and that the proposed MSIC can easily be applied to current AHBMs without further modification of the model architecture or the muscle parameters. The MSIC was also used to formulate a hypothesis on the aetiology of muscle strain injuries, through which it was demonstrated that material inhomogeneities in the MTU might be the cause for strain injuries sustained during otherwise physiological movements. This work is a first step in the direction of the definition of a wholistic injury criterion for the human skeletal muscle fibre.

'Falling heads': investigating reflexive responses to head-neck perturbations.

BACKGROUND: Reflexive responses to head-neck perturbations affect the injury risk in many different situations ranging from sports-related impact to car accident scenarios. Although several experiments have been conducted to investigate these head-neck responses to various perturbations, it is still unclear why and how individuals react differently and what the implications of these different responses across subjects on the potential injuries might be. Therefore, we see a need for both experimental data and biophysically valid computational Human Body Models with bio-inspired muscle control strategies to understand individual reflex responses better. METHODS: To address this issue, we conducted perturbation experiments of the head-neck complex and used this data to examine control strategies in a simulation model. In the experiments, which we call 'falling heads' experiments, volunteers were placed in a supine and a prone position on a table with an additional trapdoor supporting the head. This trapdoor was suddenly released, leading to a free-fall movement of the head until reflexive responses of muscles stopped the downwards movement. RESULTS: We analysed the kinematic, neuronal and dynamic responses for all individuals and show their differences for separate age and sex groups. We show that these results can be used to validate two simple reflex controllers which are able to predict human biophysical movement and modulate the response necessary to represent a large variability of participants. CONCLUSIONS: We present characteristic parameters such as joint stiffness, peak accelerations and latency times. Based on this data, we show that there is a large difference in the individual reflexive responses between participants. Furthermore, we show that the perturbation direction (supine vs. prone) significantly influences the measured kinematic quantities. Finally, 'falling heads' experiments data are provided open-source to be used as a benchmark test to compare different muscle control strategies and to validate existing active Human Body Models directly.

Implementation and validation of the extended Hill-type muscle model with robust routing capabilities in LS-DYNA for active human body models.

BACKGROUND: In the state of the art finite element AHBMs for car crash analysis in the LS-DYNA software material named *MAT_MUSCLE (*MAT_156) is used for active muscles modeling. It has three elements in parallel configuration, which has several major drawbacks: restraint approximation of the physical reality, complicated parameterization and absence of the integrated activation dynamics. This study presents implementation of the extended four element Hill-type muscle model with serial damping and eccentric force-velocity relation including [Formula: see text] dependent activation dynamics and internal method for physiological muscle routing. RESULTS: Proposed model was implemented into the general-purpose finite element (FE) simulation software LSDYNA as a user material for truss elements. This material model is verified and validated with three different sets of mammalian experimental data, taken from the literature. It is compared to the *MAT_MUSCLE (*MAT_156) Hill-type muscle model already existing in LS-DYNA, which is currently used in finite element human body models (HBMs). An application example with an arm model extracted from the FE ViVA OpenHBM is given, taking into account physiological muscle paths. CONCLUSION: The simulation results show better material model accuracy, calculation robustness and improved muscle routing capability compared to *MAT_156. The FORTRAN source code for the user material subroutine dyn21.f and the muscle parameters for all simulations, conducted in the study, are given at https://zenodo.org/record/826209 under an open source license. This enables a quick application of the proposed material model in LS-DYNA, especially in active human body models (AHBMs) for applications in automotive safety.

EATG training academy STEP-UP: skills training to empower patients.

INTRODUCTION: Most existing conventional capacity building and educational programs are currently executed on ad-hoc basis. Such approach no longer responds to the needs and capabilities of patients, supporters and healthcare providers in their engagement with and contribution to response to HIV/AIDS. In contrast, long-term, course-like trainings have considerably broader thematic scope and are conducive to more effective and sustainable learning, exchange of experience and best practices. METHOD: Over the period of one year, the Academy trains a cohort of 20 activists (10 from East Europe and Central Asia and 10 from Western and Southern Europe). The Academy goes beyond "treatment only" paradigm. Conceptually, five training modules are grouped under three larger domains: treatment literacy, treatment advocacy and treatment activism, thus covering most of the topics pertinent to the current discourse of HIV and related co-infections. To ensure cascade effect and sustainability of the learning, the trainees are offered participation in pan-European HIV conferences (EACS and HIV Glasgow) and resources for follow-up activities. RESULTS: The trainees empirically applied the knowledge to the benefits of their communities. In Uzbekistan, a trainee introduced EACS treatment guidelines to fellow medical students and junior doctors. In Armenia and Albania a series of small-scale trainings were held, outreaching to young homeless people who were traditionally excluded from HIV treatment and prevention discourse in the two countries. A trainee from Spain used the materials of the Academy in his work in Mozambique and the Spanish Ministry of Health. Five trainees engaged in a joint European cross-countries project on treatment literacy for young people who are most at risk of infection. CONCLUSIONS: EATG Training Academy is a unique initiative in the WHO Europe region that both trains future treatment activists and addresses treatment literacy, advocacy and advocacy topics. This type of capacity building can respond to existing HIV-related problems more effectively using less limited resources and reaching out to larger communities.