Sharif Digital Repository

Background and Purpose: Understanding the role and significance of trunk and upper extremity muscles in paraplegic gait can help in designing more effective assistive devices for these patients and also provides valuable information for improving muscle strengthening programs. Methods: In a patient with a spinal cord injury (SCI) who could walk independently (rating scale of ambulatory capacity, 9) with the aid of bilateral ankle-foot orthosis and a walker, the kinematics, kinetics and electromyographic (EMG) activities of 16 muscles from the trunk and upper and lower extremities were recorded during gait. The onset, cessation, and duration of the EMG signal were associated with the 4 phases... 

In this research, the nonlinear elastic behavior of human extensor apparatus was investigated. To this goal, firstly the best material parameters of hyperelastic strain energy density functions consisting of the Mooney–Rivlin, Ogden, invariants, and general exponential models were derived for the simple tension experimental data. Due to the significance of stress response in other deformation modes of nonlinear models, the calculated parameters were used to study the pure shear and balance biaxial tension behavior of the extensor apparatus. The results indicated that the Mooney–Rivlin model predicts an unstable behavior in the balance biaxial deformation of the extensor apparatus, while the... 

Purpose: This study aimed to investigate the biomechanical impact of laminectomy on cervical intersegmental motion and load sharing using a parametric patient-specific finite element (FE) model towards providing clinicians with a viable quantitative tool for informed decision-making and improved surgical planning. Methods: Ten subject-specific nonlinear osteo-ligamentous cervical spine (C3–C7) FE models were developed using X-ray image-based algorithms. The models were used to evaluate the effect of laminectomy on lower cervical spine biomechanics for two-level (C3–C4) and three-level (C3–C5) laminectomy procedures. Results: The average cervical spine ranges of motion (ROM) for the pre-op... 

Purpose: This study exploits a novel musculoskeletal finite element (MS-FE) spine model to evaluate the post-fusion (L4–L5) alterations in adjacent segment kinetics. Methods: Unlike the existing MS models with idealized representation of spinal joints, this model predicts stress/strain distributions in all passive tissues while organically coupled to a MS model. This generic (in terms of musculature and material properties) model uses population-based in vivo vertebral sagittal rotations, gravity loads, and an optimization algorithm to calculate muscle forces. Simulations represent individuals with an intact L4–L5, a preoperative severely degenerated L4–L5 (by reducing the disc height by ~... 

Background: Controlling pelvic excursions is the focus of stabilization exercises such as legs loading tasks in rehabilitation of non-specific chronic low back pain (NSCLBP) patients. Progression of these exercises is based on the ability to perform tasks with minimal sagittal pelvic excursions. In spite of emphasis on minimizing pelvic motions, no previous studies have investigated kinematic analysis of the pelvic excursions during leg loading exercises in NSCLBP patients. Objective: This study aims to investigate the sagittal pelvis excursion during performing asymmetric leg loading tasks in individuals with and without NSCLBP. Material and Methods: In this cross-sectional study, kinematic... 

Previous studies have measured thoracic Range of Motion (RoM) using either skin-mounted devices or supine CT-imaging and have reported on quite different RoMs. Given the inherent shortcomings of measurements of vertebrae movements from the overlying skin, the present study aims to measure normal RoM of the thoracic spine in the sagittal plane using the upright digital radiography. Lateral radiographs of the thoracic spine were obtained from eight asymptomatic male subjects in upright standing and full forward flexion using a mobile U-arm digital radiographic system. Total (T1-T12), upper (T1-T6), and lower (T6-T12) thoracic RoMs were measured. A throughout comparison of available skin-based... 

Previous studies have measured thoracic Range of Motion (RoM) using either skin-mounted devices or supine CT-imaging and have reported on quite different RoMs. Given the inherent shortcomings of measurements of vertebrae movements from the overlying skin, the present study aims to measure normal RoM of the thoracic spine in the sagittal plane using the upright digital radiography. Lateral radiographs of the thoracic spine were obtained from eight asymptomatic male subjects in upright standing and full forward flexion using a mobile U-arm digital radiographic system. Total (T1-T12), upper (T1-T6), and lower (T6-T12) thoracic RoMs were measured. A throughout comparison of available skin-based... 

Background: The use of knee-ankle-foot orthoses with drop locked knee joints produces some limitations for walking in subjects with quadriceps muscle weakness. The development of stance control orthoses can potentially improve their functionality. Objectives: The aim of this review was to compare the evidence of the effect of stance control orthoses to knee-ankle-foot orthoses with drop locked knee joints in improving kinematic variables and energy efficiency of walking by subjects with quadriceps muscle weakness caused by different pathologies. Study design: Literature review. Methods: Based on selected keywords and their composition, a search was performed in Google Scholar, PubMed,... 

Adjacent segment disorders are prevalent in patients following a spinal fusion surgery. Postoperative alterations in the adjacent segment biomechanics play a role in the etiology of these conditions. While experimental approaches fail to directly quantify spinal loads, previous modeling studies have numerous shortcomings when simulating the complex structures of the spine and the pre/postoperative mechanobiology of the patient. The biomechanical effects of the L4–L5 fusion surgery on muscle forces and adjacent segment kinetics (compression, shear, and moment) were investigated using a validated musculoskeletal model. The model was driven by in vivo kinematics for both preoperative (intact or... 

Objectives: The purpose of this paper is to describe the development and evaluation of a new medial linkage reciprocating gait orthosis (MLRGO) that incorporates a reciprocal mechanism and is sensitive to pelvic motion to potentially assist paraplegic patients to walk and provide functional independence. Case description and methods: The new orthosis was constructed and tested by a 20-year-old female paraplegic subject with transverse myelitis at T10 level, who was 4 years post injury and had also been an isocentric reciprocating gait orthosis (IRGO) user for 2 years. She received gait training for 12 weeks before undertaking gait analysis, and also completed a questionnaire that was... 

In this paper design and fabrication of a wrist exoskeleton robot (ROBOWRIST) has been discussed. The robot has 3 degree of freedom, including flexion/extension, abduction/ adduction and pronation/supination based on the anatomical axis of the body. Four stepper motors are responsible for creating the motion. The exoskeleton can be used for neurorehabilitation and also post-surgery of wrist and forearm. Various therapeutic procedures with a precise tracking can be handled using the control algorithms. Each motor has a separate encoder to measure the angular position and send feedback to the controller. The design goal is to construct a reliable robot that is robust and applicable for... 

The dummies currently used for predicting vehicle occupant response during frontal crashes or whole-body vibration provide insufficient information about spinal loads. Although they aptly approximate upper-body rotations in different loading scenarios, they overlook spinal loads, which are crucial to injury assessment. This paper aims to develop a modified dummy finite element (FE) model with a detailed viscoelastic lumbar spine. This model has been developed and validated against in-vitro and in-silico data under different loading conditions, and its predicted ranges of motion (RoM) and intradiscal pressure (IDP) maintain close correspondence with the in-vitro data. The dominant frequency... 

Evaluation of spinal range of motions (RoMs) and movement coordination between its segments (thorax, lumbar, and pelvis) has clinical and biomechanical implications. Previous studies have not recorded three-dimensional primary/coupled motions of all spinal segments simultaneously. Moreover, magnitude/direction of the coupled motions of the thorax/pelvis in standing posture and lumbopelvic rhythms in the frontal/transverse planes have not been investigated. This study, hence, used an inertial tracking device to measure T1, T5, T12, total (T1-T12) thoracic, lower (T5-T12) and upper (T1-T5) thoracic, lumbar (T12-S1), and pelvis primary and coupled RoMs as well as their movement coordination in... 

Ligaments assist trunk muscles in balancing external moments and providing spinal stability. In absence of the personalized material properties for ligaments, finite element (FE) models use dispersed data from the literature. This study aims to investigate the relative effects of eight different ligament property datasets on FE model responses. Eight L4-L5 models distinct only in ligament properties were constructed and loaded under moment (15 N m) alone or combined with a compressive follower load (FL). Range of motions (RoM) of the disc-alone model matched well in vitro data. Ligament properties significantly affected only sagittal RoMs (∼3.0–7.1° in flexion and ∼3.8–5.8° in extension at... 

Recent advances in medical imaging techniques have allowed pure displacement-control trunk models to estimate spinal loads with no need to calculate muscle forces. Sensitivity of these models to the errors in post-imaging evaluation of displacements (reported to be ∼0.4–0.9° and 0.2–0.3 mm in vertebral displacements) has not yet been investigated. A Monte Carlo analysis was therefore used to assess the sensitivity of results in both musculoskeletal (MS) and passive finite element (FE) spine models to errors in measured displacements. Six static activities in upright standing, flexed, and extended postures were initially simulated using a force-control hybrid MS-FE model. Computed vertebral... 

Measurements of spinal segment ranges of motion (RoMs), movement coordination, and three-dimensional kinematics during occupational activities have implications in occupational/clinical biomechanics. Due to the large amount of adipose tissues, obese individuals may have different RoMs, lumbopelvic coordination, and kinematics than normal-weight ones. We aimed to measure/compare trunk, lumbar, and pelvis primary RoMs in all anatomical planes/directions, lumbopelvic ratios (lumbar to pelvis rotations at different trunk angles) in all anatomical planes/directions and three-dimensional spine kinematics during twelve symmetric/asymmetric statics load-handling activities in healthy normal-weight... 

Spine musculoskeletal (MS) models make simplifying assumptions on the intervertebral joint degrees-of-freedom (rotational and/or translational), representation (spherical or beam-like joints), and properties (linear or nonlinear). They also generally neglect the realistic structure of the joints with disc nuclei/annuli, facets, and ligaments. We aim to develop a novel MS model where trunk muscles are incorporated into a detailed finite element (FE) model of the ligamentous T12-S1 spine thus constructing a gold standard coupled MS-FE model. Model predictions are compared under some tasks with those of our earlier spherical joints, beam joints, and hybrid (uncoupled) MS-FE models. The coupled... 

Spinal fusion surgery is usually followed by accelerated degenerative changes in the unfused segments above and below the treated segment(s), i.e., adjacent segment disease (ASD). While a number of risk factors for ASD have been suggested, its exact pathogenesis remains to be identified. Finite element (FE) models are indispensable tools to investigate mechanical effects of fusion surgeries on post-fusion changes in the adjacent segment kinematics and kinetics. Existing modeling studies validate only their intact FE model against in vitro data and subsequently simulate post-fusion in vivo conditions. The present study provides a novel approach for the comprehensive validation of a lumbar... 

Knee osteoarthritis (KOA) is a common musculoskeletal disorder resulting in altered gait patterns. Uncontrolled manifold (UCM) analysis has been demonstrated as a useful approach for quantitative analysis of motor variability and synergies. The present study aimed to investigate the changes in the kinematic synergy, controlling the center of mass (COM) position while walking on normal and narrow paths in people with KOA compared to asymptomatic participants. In this cross-sectional study, twenty people with mild to moderate KOA and twenty asymptomatic individuals walked at their comfortable preferred speed across normal and narrow paths on a treadmill. The UCM analysis was performed... 

Passive finite element (FE) models of the spine are commonly used to simulate intact and various pre- and postoperative pathological conditions. Being devoid of muscles, these traditional models are driven by simplistic loading scenarios, e.g., a constant moment and compressive follower load (FL) that do not properly mimic the complex in vivo loading condition under muscle exertions. We aim to develop novel passive FE models that are driven by more realistic yet simple loading scenarios, i.e., in vivo vertebral rotations and pathological-condition dependent FLs (estimated based on detailed musculoskeletal finite element (MS-FE) models). In these novel force–displacement control FE models,...