Kaufman, Kenton R.

Patient compliance is important when assessing movement, particularly in a free-living environment when patients are asked to don their own accelerometers. Reducing the number of accelerometers could increase patient compliance. The aims of this study were (1) to determine and compare the validity of different accelerometer combinations and placements for a previously developed posture and dynamic movement identification algorithm. Custom-built activity monitors, each containing one tri-axial accelerometer, were placed on the ankles, right thigh, and waist of 12 healthy adults. Subjects performed a protocol in the laboratory including static orientations of standing, sitting, and lying down, and dynamic movements of walking, jogging, transitions between postures, and fidgeting to simulate free-living activity. When only one accelerometer was used, the thigh was found to be the optimal placement to identify both movement and static postures, with a misclassification error of 10%, and demonstrated the greatest accuracy for walking/fidgeting and jogging classification with sensitivities and positive predictive value (PPVs) greater than 93%. When two accelerometers were used, the waist-thigh accelerometers identified movement and static postures with greater accuracy than the thigh-ankle accelerometers (with a misclassification error of 11% compared to 17%). However, the thigh-ankle accelerometers demonstrated the greatest accuracy for walking/ fidgeting and jogging classification with sensitivities and PPVs greater than 93%. Movement can be accurately classified in healthy adults using tri-axial accelerometers placed on one or two of the following sites: waist, thigh, or ankle. Posture and transitions require an accelerometer placed on the waist and an accelerometer placed on the thigh.

Recording body accelerations has been investigated previously to monitor health, metabolic energy expenditure, postural sway and falls [1]. Activity monitoring and the subsequent analysis of the accelerometry data have also proven useful in detecting physical activity levels among Parkinson’s [2] and osteoarthritis patients [3].

Intramuscular pressure (IMP) has been put forth as a surrogate measure for muscle force. As technological advancements have lead to the creation of smaller IMP microsensors, obtaining IMP readings in the clinic has come closer to becoming a minimally-invasive reality. However, appropriate use of data from these sensors relies upon an understanding of the mechanism of pressure changes within skeletal muscle. To that end, a constitutive model, representing muscle as a transversely isotropic, hyperelastic, and isovolumetric was created [1] for implementation in a finite element simulation. The purpose of this study was to validate this constitutive muscle model with passive elongation tests of skeletal muscle tissue from New Zealand White (NZW) rabbits. Reaction forces and hydrostatic pressures resulting from applied deformations were determined with the finite element modeling (FEM) approach and were compared with previously published experimental data [2].

Knee menisci are semi-lunar, fibrocartilaginous structures that convert applied compressive loads to circumferential hoop stresses which are attenuated at the tibial plateau via the meniscal attachments [1]. These specialized interfaces, located at the lateral anterior (LA), lateral posterior (LP), medial anterior (MA), and medial posterior (MP) horns, are crucial to maintaining mechanical functionality of menisci, thereby preventing osteoarthritis [2]. Soft-tissues subjected to compression and shear loads are known to possess proteoglycans, which aid in resisting these applied stresses by retaining interstitial fluid [1]. Interestingly, proteoglycans are also known to be present at the meniscus to bone interface [3]. Despite the presence of these biphasic attachments and their important role in joint load transfer, there have been no quantitative investigations of the mechanical environment within these attachments under physiological and pathological loads. Recent development of a novel pressure microsensor now allows direct observation of fluid pressure, which will aid in understanding the internal mechanical environment within the attachment sites. Previous work indicates that the attachment sites are geometrically, mechanically, and histologically different [4], thus it is hypothesized that the fluid pressures would likewise differ.

Gait analysis is an important tool in assessing the health and activity levels of patients and regular physical activity has been associated with health improvements in a number of populations. Step counting is one of the most commonly used measures of physical activity [1] and many studies have investigated the use of wearable sensors for step counts [2–4]. Their small size and light weight mean that they may be used in a free living environment and are suitable for home deployment. One of the main issues associated with step counts as a measure of physical activity is that a very high level of accuracy in step detection is needed.

Many single-phase, solid mechanics computational models of skeletal muscle have been created based on the assumptions that skeletal muscle is hyperelastic, transversely isotropic,1,2 and isovolumic. However, muscle has also been observed to have non-linear time-dependent behaviors that can be modeled using viscoelasticity or poroelasticity. The inherent viscoelasticity of muscle may not fully explain the time-dependent nature that may arise from extracellular fluid filtration3 and redistribution4 within the tissue. Further, intramuscular pressure (IMP) has been shown to have a heterogeneous distribution in muscle. This may be attributable to the movement of extracellular fluid, but the mechanisms of fluid redistribution are not completely understood. While a viscoelastic model may predict time-dependent responses of skeletal muscle, viscoelastic theory does not explain underlying causative tissue behaviors.5

Meniscal attachments serve to anchor and transfer loads from menisci to the tibia. These ligamentous tissues are composed of collagen fibers, elastin, ground substance and water. Ligaments have a time- and history-dependent viscoelastic behavior due in part to the interaction of the water and the ground substance [1]. The movement of water within ligamentous tissue is limited because of charged proteoglycan molecules. It has been shown that some exudation of water is present during cyclic loading of ligamentous tissue [2]. The movement and its inhibition could lead to changes of pressure within the meniscal attachments. Therefore, the purpose of this study was to quantify the internal pressure in human meniscal attachments subjected to physiological loading. Since it is thought that the posterior attachment is subjected to both tension and compression, while the anterior attachment is primarily subjected to tension [3–5], we hypothesized that the attachments mechanical environment is dictated by the external loads, and hence, the posterior attachment would elicit higher pressures.

A fully 3D, continuum mechanics based model of skeletal muscle, validated against experimental force data, can be used to computationally solve for individual muscle forces. A constitutive formulation, representing muscle as a transversely isotropic, hyperelastic, and isovolumetric material [1] has been implemented in a finite element model (FEM) of passive skeletal muscle and validated against experimental tension measurements [2]. Of further interest is an expanded formulation that will allow for the addition of muscle activation levels on the overall skeletal muscle force generation. The purpose of this study was to expand the FEA model to include muscle activation and validate it with tests of active skeletal muscle tissue at varied lengths.

The surgical goal in total knee arthroplasty (TKA) is to obtain neutral mechanical alignment within three degrees [4]. This has been considered necessary to achieve optimal function, produce balanced medial and lateral loading distributions, and prolong implant longevity [7]. Under static loading, tibial-femoral alignment angle deviations of 3° have been shown to greatly alter the distribution of pressure and load between the medial and lateral tibial plateaus [13]. However, other studies have challenged the practice that coronal tibiofemoral alignment improves implant longevity [9,10]. These studies did not show a statistical difference in the number of revision surgeries between well aligned knees and mechanical alignment outliers (varus/valgus knees). While it has been suggested that accurate alignment allows for improved joint kinematics and improved outcomes in TKA patients [6], no studies have evaluated the effect of tibial-femoral alignment on tibial plateau loading distribution during gait in the TKA population. Therefore, the purpose of this study was to assess tibial plateau loading following TKA.