Design Considerations of a Fiber Optic Pressure Sensor Protective Housing for Intramuscular Pressure Measurements.

Intramuscular pressure (IMP), defined as skeletal muscle interstitial fluid pressure, reflects changes in individual muscle tension and may provide crucial insight into musculoskeletal biomechanics and pathologies. IMP may be measured using fiber-optic fluid pressure sensors, provided the sensor is adequately anchored to and shielded from surrounding muscle tissue. Ineffective anchoring enables sensor motion and inadequate shielding facilitates direct sensor-tissue interaction, which result in measurement artifacts and force-IMP dissociation. The purpose of this study was to compare the effectiveness of polyimide and nitinol protective housing designs to anchor pressure sensors to muscle tissue, prevent IMP measurement artifacts, and optimize the force-IMP correlation. Anchoring capacity was quantified as force required to dislodge sensors from muscle tissue. Force-IMP correlations and non-physiological measurement artifacts were quantified during isometric muscle activations of the rabbit tibialis anterior. Housing structural integrity was assessed after both anchoring and activation testing. Although there was no statistically significant difference in anchoring capacity, nitinol housings demonstrated greater structural integrity and superior force-IMP correlations. Further design improvements are needed to prevent tissue accumulation in the housing recess associated with artificially high IMP measurements. These findings emphasize fundamental protective housing design elements crucial for achieving reliable IMP measurements.

Characterization of three dimensional volumetric strain distribution during passive tension of the human tibialis anterior using Cine Phase Contrast MRI.

Intramuscular pressure correlates strongly with muscle tension and is a promising tool for quantifying individual muscle force. However, clinical application is impeded by measurement variability that is not fully understood. Previous studies point to regional differences in IMP, specifically increasing pressure with muscle depth. Based on conservation of mass, intramuscular pressure and volumetric strain distributions may be inversely related. Therefore, we hypothesized volumetric strain would decrease with muscle depth. To test this we quantified 3D volumetric strain in the tibialis anterior of 12 healthy subjects using Cine Phase Contrast Magnetic Resonance Imaging. Cine Phase Contrast data were collected while a custom apparatus rotated the subjects' ankle continuously between neutral and plantarflexion. A T2-weighted image stack was used to define the resting tibials anterior position. Custom and commercial post-processing software were used to quantify the volumetric strain distribution. To characterize regional strain changes, the muscle was divided into superior-inferior sections and either medial-lateral or anterior-posterior slices. Mean volumetric strain was compared across the sections and slices. As hypothesized, volumetric strain demonstrated regional differences with a decreasing trend from the anterior (superficial) to the posterior (deep) muscle regions. Statistical tests showed significant main effects and interactions of superior-inferior and anterior-posterior position as well as superior-inferior and medial-lateral position on regional strain. These data support our hypothesis and imply a potential relationship between regional volumetric strain and intramuscular pressure. This finding may advance our understanding of intramuscular pressure variability sources and lead to more reliable measurement solutions in the future.

Analysis of fluid movement in skeletal muscle using fluorescent microspheres.

INTRODUCTION: Regional variability in interstitial fluid pressure confounds use of intramuscular pressure measurement to assess muscle force. It is hypothesized that interstitial flow is dependent on intramuscular pressure. The goal of this study was to assess the feasibility of using fluorescent microspheres to evaluate movement of interstitial fluid in skeletal muscle. METHODS: Two diameters of fluorescent microspheres were injected into the rat tibialis anterior during both static (n = 6) and passively lengthened (10% strain) experimental conditions (n = 6). Microsphere dispersion was evaluated using confocal imaging of transverse muscle sections. RESULTS: Fluorescent microspheres tracked interstitial fluid while not penetrating the muscle fiber. When compared with the static condition, significantly greater dispersion (P = 0.003) was seen with passively lengthened conditions (17 ± 9% vs. 31 ± 7%, respectively). Dispersion did not differ for the 2 microsphere sizes (P = 0.811). CONCLUSIONS: Fluorescent microspheres track movement of interstitial fluid, and dispersion is dependent on passive lengthening. Muscle Nerve 54: 444-450, 2016.

Skeletal muscle tensile strain dependence: Hyperviscoelastic nonlinearity.

INTRODUCTION: Computational modeling of skeletal muscle requires characterization at the tissue level. While most skeletal muscle studies focus on hyperelasticity, the goal of this study was to examine and model the nonlinear behavior of both time-independent and time-dependent properties of skeletal muscle as a function of strain. MATERIALS AND METHODS: Nine tibialis anterior muscles from New Zealand White rabbits were subject to five consecutive stress relaxation cycles of roughly 3% strain. Individual relaxation steps were fit with a three-term linear Prony series. Prony series coefficients and relaxation ratio were assessed for strain dependence using a general linear statistical model. A fully nonlinear constitutive model was employed to capture the strain dependence of both the viscoelastic and instantaneous components. RESULTS: Instantaneous modulus (p<0.0005) and mid-range relaxation (p<0.0005) increased significantly with strain level, while relaxation at longer time periods decreased with strain (p<0.0005). Time constants and overall relaxation ratio did not change with strain level (p>0.1). Additionally, the fully nonlinear hyperviscoelastic constitutive model provided an excellent fit to experimental data, while other models which included linear components failed to capture muscle function as accurately. CONCLUSIONS: Material properties of skeletal muscle are strain-dependent at the tissue level. This strain dependence can be included in computational models of skeletal muscle performance with a fully nonlinear hyperviscoelastic model.

Method of quantifying 3D strain distribution in skeletal muscle using cine phase contrast MRI.

Intramuscular pressure (IMP), a correlate of muscle tension, may fill an important clinical testing void. A barrier to implementing this measure clinically is its non-uniform distribution, which is not fully understood. Pressure is generated by changes in fluid mass and volume, therefore 3D volumetric strain distribution may affect IMP distribution. The purpose of this study was to develop a method for quantifying 3D volumetric strain distribution in the human tibialis anterior (TA) during passive tension using cine phase contrast (CPC) MRI and to assess its accuracy and precision.Five healthy subjects each participated in three data collections. A custom MRI-compatible apparatus repeatedly rotated a subject's ankle between 0° and 26° plantarflexion while CPC MRI data were collected. Additionally, T2-weighted images of the lower leg were collected both before and after the CPC data collection with the ankle stationary at both 0° and 26° plantarflexion for TA muscle segmentation. A 3D hexahedral mesh was generated based on the TA surface before CPC data collection with the ankle at 0° plantarflexion and the node trajectories were tracked using the CPC data. The volumetric strain of each element was quantified.Three tests were employed to assess the measure accuracy and precision. First, to quantify leg position drift, the TA segmentations were compared before and after CPC data collection. The Hawsdorff distance measure (error) was 1.5 ± 0.7 mm. Second, to assess the surface node trajectory accuracy, the deformed mesh surface was compared to the TA segmented at 26° of ankle plantarflexion. This error was 0.6 ± 0.2 mm. Third, the standard deviation of volumetric strain across the three data collections was calculated for each element and subject. The median between-day variability across subjects and mesh elements was 0.06 mm3 mm(-3) (95% confidence interval 0.01 to 0.18 mm3 mm(-3)). Overall the results demonstrated excellent accuracy and precision.

Error analysis of cine phase contrast MRI velocity measurements used for strain calculation.

Cine Phase Contrast (CPC) MRI offers unique insight into localized skeletal muscle behavior by providing the ability to quantify muscle strain distribution during cyclic motion. Muscle strain is obtained by temporally integrating and spatially differentiating CPC-encoded velocity. The aim of this study was to quantify CPC measurement accuracy and precision and to describe error propagation into displacement and strain. Using an MRI-compatible jig to move a B-gel phantom within a 1.5 T MRI bore, CPC-encoded velocities were collected. The three orthogonal encoding gradients (through plane, frequency, and phase) were evaluated independently in post-processing. Two systematic error types were corrected: eddy current-induced bias and calibration-type error. Measurement accuracy and precision were quantified before and after removal of systematic error. Through plane- and frequency-encoded data accuracy were within 0.4 mm/s after removal of systematic error - a 70% improvement over the raw data. Corrected phase-encoded data accuracy was within 1.3 mm/s. Measured random error was between 1 to 1.4 mm/s, which followed the theoretical prediction. Propagation of random measurement error into displacement and strain was found to depend on the number of tracked time segments, time segment duration, mesh size, and dimensional order. To verify this, theoretical predictions were compared to experimentally calculated displacement and strain error. For the parameters tested, experimental and theoretical results aligned well. Random strain error approximately halved with a two-fold mesh size increase, as predicted. Displacement and strain accuracy were within 2.6 mm and 3.3%, respectively. These results can be used to predict the accuracy and precision of displacement and strain in user-specific applications.

A method for assessing the fit of a constitutive material model to experimental stress-strain data.

Higher-order polynomial functions can be used as a constitutive model to represent the mechanical behaviour of biological materials. The goal of this study was to present a method for assessing the fit of a given constitutive three-dimensional material model. Goodness of fit was assessed using multiple parameters including the root mean square error and Hotelling's T 2-test. Specifically, a polynomial model was used to characterise the stress-strain data, varying the number of model terms used (45 combinations of between 3 and 11 terms) and the manner of optimisation used to establish model coefficients (i.e. determining coefficients either by parameterisation of all data simultaneously or averaging coefficients obtained by parameterising individual data trials). This framework for model fitting helps to ensure that a given constitutive formulation provides the best characterisation of biological material mechanics.

Transversely isotropic tensile material properties of skeletal muscle tissue.

Of the plethora of work performed analyzing skeletal muscle tissue, relatively little has been done in the examination of its passive material properties. Previous studies of the passive properties of skeletal muscle have been primarily performed along the longitudinal material direction. In order to ensure the accuracy of the predictions of computational models of skeletal muscles, a better understanding of the tensile three-dimensional material properties of muscle tissue is necessary. To that end, the purpose of this study was to collect a comprehensive set of tensile stress-strain data from skeletal muscle tissue. Load-deformation data was collected from eighteen extensor digitorum longus muscles, dissected free of aponeuroses, from nine New Zealand White rabbits tested under longitudinal extension (LE), transverse extension (TE), or longitudinal shear (LS). The linear modulus, ultimate stress, and failure strain were calculated from stress-strain results. Results indicate that the linear modulus under LE is significantly higher than the modulus of either TE or LS. Additionally, the ultimate stress of muscle was seen to be significantly higher under LE than TE. Conversely, the failure strain was significantly higher under TE than under LE.

Performance characteristics of a new generation pressure microsensor for physiologic applications.

A next generation fiber-optic microsensor based on the extrinsic Fabry-Perot interferometric (EFPI) technique has been developed for pressure measurements. The basic physics governing the operation of these sensors makes them relatively tolerant or immune to the effects of high-temperature, high-EMI, and highly-corrosive environments. This pressure microsensor represents a significant improvement in size and performance over previous generation sensors. To achieve the desired overall size and sensitivity, numerical modeling of diaphragm deflection was incorporated in the design, with the desired dimensions and calculated material properties. With an outer diameter of approximately 250 microm, a dynamic operating range of over 250 mmHg, and a sampling frequency of 960 Hz, this sensor is ideal for the minimally invasive measurement of physiologic pressures and incorporation in catheter-based instrumentation. Nine individual sensors were calibrated and characterized by comparing the output to a U.S. National Institute of Standards and Technology (NIST) Traceable reference pressure over the range of 0-250 mmHg. The microsensor performance demonstrated accuracy of better than 2% full-scale output, and repeatability, and hysteresis of better than 1% full-scale output. Additionally, fatigue effects on five additional sensors were 0.25% full-scale output after over 10,000 pressure cycles.

Intraneural ganglia: a clinical problem deserving a mechanistic explanation and model.

Intraneural ganglion cysts have been considered a curiosity for 2 centuries. Based on a unifying articular (synovial) theory, recent evidence has provided a logical explanation for their formation and propagation. The fundamental principle is that of a joint origin and a capsular defect through which synovial fluid escapes following the articular branch, typically into the parent nerve. A stereotypical, reproducible appearance has been characterized that suggests a shared pathogenesis. In the present report the authors will provide a mechanistic explanation that can then be mathematically tested using a preliminary model created by finite element analysis.

The effect of visual biofeedback on the propulsion effectiveness of experienced wheelchair users.

OBJECTIVE: To determine the effect of visual feedback on the propulsion effectiveness of experienced manual wheelchair users. DESIGN: Controlled trial. SETTING: A motion analysis laboratory. PARTICIPANTS: A convenience sample of 16 healthy men and 2 healthy women with T4-L2 traumatic paraplegia, a mean age of 38+/-9 years, and a mean duration of manual wheelchair-based mobility of 14+/-8 years. INTERVENTION: Propulsion was assessed as the subjects propelled an instrumented wheelchair (with and without visual biofeedback) on a custom-built dynamometer at propulsion intensities of .15 and .25W/kg for 10 minutes. MAIN OUTCOME MEASURES: The primary outcome variable was the fraction of effective force (FEF) (ie, the ratio of effective to total force) applied by the subject to the wheelchair's pushrim. Secondary variables included velocity, stroke frequency, and stroke angle. RESULTS: A 2-factor analysis of variance with repeated measurements was used to detect significant differences between the outcome variables. The FEF ratio was 73.9% without feedback and 72.5% with feedback at the lower-intensity level. Propulsion during the higher intensity condition both with and without feedback resulted in a statistically significant improvement in the FEF (73.9%-78.7% with no feedback, 72.5%-80.2% with feedback), compared with the lower-intensity level. Stroke angle increased from 84.3 degrees to 98.7 degrees and frequency decreased from 66 to 57.8 strokes/min with feedback. CONCLUSIONS: Visual biofeedback may have little utility in improving the force effectiveness of manual wheelchair propulsion in experienced wheelchair users. Experienced wheelchair users may have already optimized their stroke in a manner that balances energy expenditure with stroke efficiency. Other variables such as stroke length and frequency may be more amenable to visual biofeedback.

Evaluating the dynamic performance of a fibre optic pressure microsensor.

The dynamic performance of a new fibre optic sensor intended for measuring physiological fluid pressures is assessed in water. The sensor's sensitivity is evaluated at 23 degrees, 35 degrees and 37 degrees C against a Millar pressure catheter for sinusoidal pressure inputs with frequency ranging from 0.5 to 10 Hz. We found that sensitivity versus frequency is flat to 6 Hz and decreases slightly between 6 and 10 Hz. The sensitivity is slightly lower at 23 degrees C than at 37 degrees C. The reproducibility of measurements is excellent (two separate calibration tests in two consecutive days). The output of the fibre optic system used shows a constant time delay (0.13 s) for all frequencies tested. Experiments suggest that, with current sensor design, its immersion in degassed water prior to use ensures a reliable performance.

Electromyographic activity in the immobilized shoulder girdle musculature during contralateral upper limb movements.

The purpose of this study was to quantify electromyographic (EMG) activity in the immobilized shoulder girdle musculature at rest and during a battery of contralateral upper limb activities. Six asymptomatic men, aged 22 to 33 years, volunteered to participate. Fine-wire (supraspinatus, infraspinatus) and surface (deltoids, trapezii, biceps, serratus anterior) electrodes recorded the mean peak normalized (percent maximal voluntary contraction [%MVC]) EMG activity from each immobilized muscle at rest and during slow, fast, and incrementally resisted contralateral upper limb motions (5, 15, and 25 lb). EMG activity in all muscles was low during quiet immobilized standing (<1.5% maximal voluntary contraction [MVC]). During slow contralateral upper limb motions, activity ranged from 0.7% to 51.6% MVC (highest in trapezii) and was less than 15% MVC in the supraspinatus, infraspinatus, and anterior deltoid. Bimanual jar opening increased biceps activity from 7.8% to 16.1% MVC. During fast contralateral upper limb motions, peak infraspinatus activity increased to 56.7% during a fast straightforward reach. Supraspinatus activity was relatively high during all resisted backward-pulling motions (25.2%-32.1% MVC), whereas resisted forward reaching produced relatively little activity in the anterior deltoid, supraspinatus, infraspinatus, or biceps. Several slow and fast motions produced high trapezius activity (>45% MVC) with low supraspinatus, biceps, and anterior deltoid activities (<10% MVC). Our findings suggest that (1) immobilized shoulder girdle muscle EMG activity during quiet standing is negligible in asymptomatic individuals; (2) contralateral upper limb motions at self-selected speeds are not likely to be harmful to healing tissues; (3) during early healing periods, patients with biceps-labral injury should minimize bimanual activities, those with supraspinatus injury should avoid backward-pulling motions, and those with infraspinatus injury should avoid fast straightforward reaches; and (4) cross-body, straightforward, or downward reaches at either a slow or fast speed may be appropriately prescribed as rehabilitative exercises that can be initiated while the shoulder remains immobilized.