Optimal fibre length and maximum isometric force are the most influential parameters when modelling muscular adaptations to unloading using Hill-type muscle models

Introduction: Spaceflight is associated with severe muscular adaptations with substantial inter-individual variability. A Hill-type muscle model is a common method to replicate muscle physiology in musculoskeletal simulations, but little is known about how the underlying parameters should be adjusted to model adaptations to unloading. The aim of this study was to determine how Hill-type muscle model parameters should be adjusted to model disuse muscular adaptations. Methods: Isokinetic dynamometer data were taken from a bed rest campaign and used to perform tracking simulations at two knee extension angular velocities (30°·s-1 and 180°·s-1). The activation and contraction dynamics were solved using an optimal control approach and direct collocation method. A Monte Carlo sampling technique was used to perturb muscle model parameters within physiological boundaries to create a range of theoretical and feasible parameters to model muscle adaptations. Results: Optimal fibre length could not be shortened by more than 67% and 61% for the knee flexors and non-knee muscles, respectively. Discussion: The Hill-type muscle model successfully replicated muscular adaptations due to unloading, and recreated salient features of muscle behaviour associated with spaceflight, such as altered force-length behaviour. Future researchers should carefully adjust the optimal fibre lengths of their muscle-models when trying to model adaptations to unloading, particularly muscles that primarily operate on the ascending and descending limbs of the force-length relationship.

A novel computational framework for the estimation of internal musculoskeletal loading and muscle adaptation in hypogravity

Introduction: Spaceflight is associated with substantial and variable musculoskeletal (MSK) adaptations. Characterisation of muscle and joint loading profiles can provide key information to better align exercise prescription to astronaut MSK adaptations upon return-to-Earth. A case-study is presented of single-leg hopping in hypogravity to demonstrate the additional benefit computational MSK modelling has when estimating lower-limb MSK loading. Methods: A single male participant performed single-leg vertical hopping whilst attached to a body weight support system to replicate five gravity conditions (0.17, 0.25, 0.37, 0.50, 1 g). Experimental joint kinematics, joint kinetics and ground reaction forces were tracked in a data-tracking direct collocation simulation framework. Ground reaction forces, sagittal plane hip, knee and ankle net joint moments, quadriceps muscle forces (Rectus Femoris and three Vasti muscles), and hip, knee and ankle joint reaction forces were extracted for analysis. Estimated quadriceps muscle forces were input into a muscle adaptation model to predict a meaningful increase in muscle cross-sectional area, defined in (DeFreitas et al., 2011). Results: Two distinct strategies were observed to cope with the increase in ground reaction forces as gravity increased. Hypogravity was associated with an ankle dominant strategy with increased range of motion and net plantarflexor moment that was not seen at the hip or knee, and the Rectus Femoris being the primary contributor to quadriceps muscle force. At 1 g, all three joints had increased range of motion and net extensor moments relative to 0.50 g, with the Vasti muscles becoming the main muscles contributing to quadriceps muscle force. Additionally, hip joint reaction force did not increase substantially as gravity increased, whereas the other two joints increased monotonically with gravity. The predicted volume of exercise needed to counteract muscle adaptations decreased substantially with gravity. Despite the ankle dominant strategy in hypogravity, the loading on the knee muscles and joint also increased, demonstrating this provided more information about MSK loading. Discussion: This approach, supplemented with muscle-adaptation models, can be used to compare MSK loading between exercises to enhance astronaut exercise prescription.

Modifications to the net knee moments lead to the greatest improvements in accelerative sprinting performance: a predictive simulation study

The current body of sprinting biomechanics literature together with the front-side mechanics coaching framework provide various technique recommendations for improving performance. However, few studies have attempted to systematically explore technique modifications from a performance enhancement perspective. The aims of this investigation were therefore to explore how hypothetical technique modifications affect accelerative sprinting performance and assess whether the hypothetical modifications support the front-side mechanics coaching framework. A three-dimensional musculoskeletal model scaled to an international male sprinter was used in combination with direct collocation optimal control to perform (data-tracking and predictive) simulations of the preliminary steps of accelerative sprinting. The predictive simulations differed in the net joint moments that were left 'free' to change. It was found that the 'knee-free' and 'knee-hip-free' simulations resulted in the greatest performance improvements (13.8% and 21.9%, respectively), due to a greater knee flexor moment around touchdown (e.g., 141.2 vs. 70.5 Nm) and a delayed and greater knee extensor moment during stance (e.g., 188.5 vs. 137.5 Nm). Lastly, the predictive simulations which led to the greatest improvements were also found to not exhibit clear and noticeable front-side mechanics technique, thus the underpinning principles of the coaching framework may not be the only key aspect governing accelerative sprinting.

A feasibility study to assess the effectiveness of Muvity: A telerehabilitation system for chronic post-stroke subjects

OBJECTIVES

To assess the feasibility of a telerehabilitation system for chronic post-stroke subjects compared to a conventional treatment.

METHODS

A feasibility cross-over analysis was conducted in ten chronic post-stroke subjects. Two randomized groups followed two eight-weeks treatments, one with the telerehabilitation system Muvity and the other following conventional therapy (in random order). Before and after each treatment, physical evaluations were performed assessing functional independence, the perceived level of pain, balance control and self-reported health status. After the study, the participants answered a short questionnaire to measure the usability of the system.

RESULTS

Four out of six subjects demonstrated better performance in ADLs (equal or higher FIM scores) and five out of six reported lower pain (VAS score) after the treatment with Muvity when compared to the treatment without. There were no clear trends in terms of balance control (Berg scale) or self-reported health status (PCS score within SF-36).

CONCLUSIONS

The results suggest that the proposed telerehabilitation system aids users to overall maintain or improve their ability to perform ADLs without increasing pain, when compared to conventional therapy. Most subjects found the use of Muvity more motivating than the conventional rehabilitation treatment. This provides initial evidence that Muvity might be an appropriate complement for the telerehabilitation of patients with physical disabilities. However, the differences observed between both treatments were not statistically significant. A clinical study with a larger sample size will be necessary to obtain more robust results.

Lateral extraarticular tenodesis improves stability in non-anatomic ACL reconstructed knees: in vivo kinematic analysis

PURPOSE

To carry out an in vivo kinematic analysis to determine whether adding a lateral extraarticular tenodesis (LET) for those patients with subjective instability and objective residual laxity after a transtibial (TT) anterior cruciate ligament reconstruction (ACLR) reduces anteroposterior and rotational laxity and to evaluate the 2-year follow-up clinical outcomes to analyze whether biomechanical changes determine clinical improvement or not.

METHODS

A total of 19 patients with residual knee instability after TT ACLR who underwent a modified Lemaire LET were prospectively evaluated for at least 2-year follow-up. Preoperative, intraoperative, and 6 and 24-month postoperative kinematic analyses were carried out using the KiRA accelerometer and KT1000 arthrometer to look for residual anterolateral rotational instability and residual anteroposterior instability. Functional outcomes were measured with the single-leg vertical jump test and the single-leg hop test. Clinical outcomes were evaluated using the IKDC 2000, Lysholm, and Tegner scores.

RESULTS

A significant reduction in anterolateral rotational instability was detected with the patient under anesthesia (from 3 ± 1.2 to 1.1 ± 1.1 m/s²; p < 0.05) as well as with the patient awake (from 2.1 ± 0.8 to 0.7 ± 1.4 m/s²; p < 0.05). A significant reduction in anteroposterior instability was only present under anesthesia (from 3.4 ± 1.9 to 2.1 ± 1.1 mm; p < 0.05), while no difference was present without anesthesia (from 2.3 ± 1.1 to 1.6 ± 1 mm; n.s.). Postoperative analysis of knee laxity did not show any significant variation from the first to the last follow-up. Both the single-leg vertical jump test and single-leg hop test improved significantly at the last follow-up (both p < 0.05). The mean values of both the IKDC and Tegner scores showed an improvement (p < 0.05 and p < 0.05, respectively), whereas that was not the case with the Lysholm score (n.s.).

CONCLUSIONS

The modified Lemaire LET can improve the kinematics of a non-anatomic ACL reconstructed knee with residual subjective and objective instability. These kinematic changes were able to lead to an improvement in subjective stability as well as the function of the knee in a small cohort of recreationally active patients. At 2-year follow-up, the kinematic changes as well as the level of activity of the patients and the IKDC score show their improvement sustained.

LEVEL OF EVIDENCE

Level IV.

A factorization-based algorithm to predict EMG data using only kinematics information

EMG analyses have several applications, such as identifying muscle excitation patterns during rehabilitation or training plans, or controlling EMG-driven devices. However, experimental measurements can be time consuming or difficult to obtain. This study presents a simple algorithm to predict EMG signals that can be applied in real time during running, given only the instantaneous vector of kinematics. We hypothesize that the factorization of the kinematics of the skeleton together with the EMG data of calibration subjects could be used to predict EMG data of another subject only using the kinematic information. The results showed that EMG signals of lower-limb muscles can be predicted accurately in less than a second using this method. Correlation coefficients between predicted and experimental EMG signals were higher than 0.7 in 10 out of 11 muscles for most prediction trials and subjects, and their overall median value was higher than 0.8. These values confirm that this method could be used to accurately predict EMG signals in real time when only kinematics are measured.

Personalised high tibial osteotomy has mechanical safety equivalent to generic device in a case-control in silico clinical trial

Background

Despite favourable outcomes relatively few surgeons offer high tibial osteotomy (HTO) as a treatment option for early knee osteoarthritis, mainly due to the difficulty of achieving planned correction and reported soft tissue irritation around the plate used to stablise the osteotomy. To compare the mechanical safety of a new personalised 3D printed high tibial osteotomy (HTO) device, created to overcome these issues, with an existing generic device, a case-control in silico virtual clinical trial was conducted.

Methods

Twenty-eight knee osteoarthritis patients underwent computed tomography (CT) scanning to create a virtual cohort; the cohort was duplicated to form two arms, Generic and Personalised, on which virtual HTO was performed. Finite element analysis was performed to calculate the stresses in the plates arising from simulated physiological activities at three healing stages. The odds ratio indicative of the relative risk of fatigue failure of the HTO plates between the personalised and generic arms was obtained from a multi-level logistic model.

Results

Here we show, at 12 weeks post-surgery, the odds ratio indicative of the relative risk of fatigue failure was 0.14 (95%CI 0.01 to 2.73, p = 0.20).

Conclusions

This novel (to the best of our knowledge) in silico trial, comparing the mechanical safety of a new personalised 3D printed high tibial osteotomy device with an existing generic device, shows that there is no increased risk of failure for the new personalised design compared to the existing generic commonly used device. Personalised high tibial osteotomy can overcome the main technical barriers for this type of surgery, our findings support the case for using this technology for treating early knee osteoarthritis.

Three-dimensional data-tracking simulations of sprinting using a direct collocation optimal control approach

Biomechanical simulation and modelling approaches have the possibility to make a meaningful impact within applied sports settings, such as sprinting. However, for this to be realised, such approaches must first undergo a thorough quantitative evaluation against experimental data. We developed a musculoskeletal modelling and simulation framework for sprinting, with the objective to evaluate its ability to reproduce experimental kinematics and kinetics data for different sprinting phases. This was achieved by performing a series of data-tracking calibration (individual and simultaneous) and validation simulations, that also featured the generation of dynamically consistent simulated outputs and the determination of foot-ground contact model parameters. The simulated values from the calibration simulations were found to be in close agreement with the corresponding experimental data, particularly for the kinematics (average root mean squared differences (RMSDs) less than 1.0° and 0.2 cm for the rotational and translational kinematics, respectively) and ground reaction force (highest average percentage RMSD of 8.1%). Minimal differences in tracking performance were observed when concurrently determining the foot-ground contact model parameters from each of the individual or simultaneous calibration simulations. The validation simulation yielded results that were comparable (RMSDs less than 1.0° and 0.3 cm for the rotational and translational kinematics, respectively) to those obtained from the calibration simulations. This study demonstrated the suitability of the proposed framework for performing future predictive simulations of sprinting, and gives confidence in its use to assess the cause-effect relationships of technique modification in relation to performance. Furthermore, this is the first study to provide dynamically consistent three-dimensional muscle-driven simulations of sprinting across different phases.

The Effects of Mechanical Scale on Neural Control and the Regulation of Joint Stability

Recent work has demonstrated how the size of an animal can affect neural control strategies, showing that passive viscoelastic limb properties have a significant role in determining limb movements in small animals but are less important in large animals. We extend that work to consider effects of mechanical scaling on the maintenance of joint integrity; i.e., the prevention of aberrant contact forces within joints that might lead to joint dislocation or cartilage degradation. We first performed a literature review to evaluate how properties of ligaments responsible for joint integrity scale with animal size. Although we found that the cross-sectional area of the anterior cruciate ligament generally scaled with animal size, as expected, the effects of scale on the ligament’s mechanical properties were less clear, suggesting potential adaptations in passive contributions to the maintenance of joint integrity across species. We then analyzed how the neural control of joint stability is altered by body scale. We show how neural control strategies change across mechanical scales, how this scaling is affected by passive muscle properties and the cost function used to specify muscle activations, and the consequences of scaling on internal joint contact forces. This work provides insights into how scale affects the regulation of joint integrity by both passive and active processes and provides directions for studies examining how this regulation might be accomplished by neural systems.

Algorithmic differentiation improves the computational efficiency of OpenSim-based trajectory optimization of human movement

Algorithmic differentiation (AD) is an alternative to finite differences (FD) for evaluating function derivatives. The primary aim of this study was to demonstrate the computational benefits of using AD instead of FD in OpenSim-based trajectory optimization of human movement. The secondary aim was to evaluate computational choices including different AD tools, different linear solvers, and the use of first- or second-order derivatives. First, we enabled the use of AD in OpenSim through a custom source code transformation tool and through the operator overloading tool ADOL-C. Second, we developed an interface between OpenSim and CasADi to solve trajectory optimization problems. Third, we evaluated computational choices through simulations of perturbed balance, two-dimensional predictive simulations of walking, and three-dimensional tracking simulations of walking. We performed all simulations using direct collocation and implicit differential equations. Using AD through our custom tool was between 1.8 ± 0.1 and 17.8 ± 4.9 times faster than using FD, and between 3.6 ± 0.3 and 12.3 ± 1.3 times faster than using AD through ADOL-C. The linear solver efficiency was problem-dependent and no solver was consistently more efficient. Using second-order derivatives was more efficient for balance simulations but less efficient for walking simulations. The walking simulations were physiologically realistic. These results highlight how the use of AD drastically decreases computational time of trajectory optimization problems as compared to more common FD. Overall, combining AD with direct collocation and implicit differential equations decreases the computational burden of trajectory optimization of human movement, which will facilitate their use for biomechanical applications requiring the use of detailed models of the musculoskeletal system.

Rapid predictive simulations with complex musculoskeletal models suggest that diverse healthy and pathological human gaits can emerge from similar control strategies

Physics-based predictive simulations of human movement have the potential to support personalized medicine, but large computational costs and difficulties to model control strategies have limited their use. We have developed a computationally efficient optimal control framework to predict human gaits based on optimization of a performance criterion without relying on experimental data. The framework generates three-dimensional muscle-driven simulations in 36 min on average—more than 20 times faster than existing simulations—by using direct collocation, implicit differential equations and algorithmic differentiation. Using this framework, we identified a multi-objective performance criterion combining energy and effort considerations that produces physiologically realistic walking gaits. The same criterion also predicted the walk-to-run transition and clinical gait deficiencies caused by muscle weakness and prosthesis use, suggesting that diverse healthy and pathological gaits can emerge from the same control strategy. The ability to predict the mechanics and energetics of a broad range of gaits with complex three-dimensional musculoskeletal models will allow testing novel hypotheses about gait control and hasten the development of optimal treatments for neuro-musculoskeletal disorders.

Neuromusculoskeletal Model Calibration Significantly Affects Predicted Knee Contact Forces for Walking

Though walking impairments are prevalent in society, clinical treatments are often ineffective at restoring lost function. For this reason, researchers have begun to explore the use of patient-specific computational walking models to develop more effective treatments. However, the accuracy with which models can predict internal body forces in muscles and across joints depends on how well relevant model parameter values can be calibrated for the patient. This study investigated how knowledge of internal knee contact forces affects calibration of neuromusculoskeletal model parameter values and subsequent prediction of internal knee contact and leg muscle forces during walking. Model calibration was performed using a novel two-level optimization procedure applied to six normal walking trials from the Fourth Grand Challenge Competition to Predict In Vivo Knee Loads. The outer-level optimization adjusted time-invariant model parameter values to minimize passive muscle forces, reserve actuator moments, and model parameter value changes with (Approach A) and without (Approach B) tracking of experimental knee contact forces. Using the current guess for model parameter values but no knee contact force information, the inner-level optimization predicted time-varying muscle activations that were close to experimental muscle synergy patterns and consistent with the experimental inverse dynamic loads (both approaches). For all the six gait trials, Approach A predicted knee contact forces with high accuracy for both compartments (average correlation coefficient r = 0.99 and root mean square error (RMSE) = 52.6 N medial; average r = 0.95 and RMSE = 56.6 N lateral). In contrast, Approach B overpredicted contact force magnitude for both compartments (average RMSE = 323 N medial and 348 N lateral) and poorly matched contact force shape for the lateral compartment (average r = 0.90 medial and -0.10 lateral). Approach B had statistically higher lateral muscle forces and lateral optimal muscle fiber lengths but lower medial, central, and lateral normalized muscle fiber lengths compared to Approach A. These findings suggest that poorly calibrated model parameter values may be a major factor limiting the ability of neuromusculoskeletal models to predict knee contact and leg muscle forces accurately for walking.

Analysis of muscle synergies and activation-deactivation patterns in subjects with anterior cruciate ligament deficiency during walking

BACKGROUND

The knowledge of muscle activation patterns when doing a certain task in subjects with anterior cruciate ligament deficiency could help to improve their rehabilitation treatment. The goal of this study is to identify differences in such patterns between anterior cruciate ligament-deficient and healthy subjects during walking.

METHODS

Electromyographic data for eight muscles were measured in a sample of eighteen subjects with anterior cruciate ligament deficiency, in both injured (ipsilateral group) and non-injured (contralateral group) legs, and a sample of ten healthy subjects (control group). The analysis was carried out at two levels: activation-deactivation patterns and muscle synergies. Muscle synergy components were calculated using a non-negative matrix factorization algorithm.

FINDINGS

The results showed that there was a higher co-contraction in injured than in healthy subjects. Although all muscles were activated similarly since all subjects developed the same task (walking), some differences could be observed among the analyzed groups.

INTERPRETATION

The observed differences in the synergy components of injured subjects suggested that those individuals alter muscle activation patterns to stabilize the knee joint. This analysis could provide valuable information for the physiotherapist to identify alterations in muscle activation patterns during the follow-up of the subject's rehabilitation.