Internal Mechanical Conditions Research Articles

Development and evaluation of a new methodology for the fast generation of patient-specific Finite Element models of the buttock for sitting-acquired deep tissue injury prevention

The occurrence and management of Pressure Ulcers remain a major issue for patients with reduced mobility and neurosensory loss despite significant improvement in the prevention methods. These injuries are caused by biological cascades leading from a given mechanical loading state in tissues to irreversible tissue damage. Estimating the internal mechanical conditions within loaded soft tissues has the potential of improving the management and prevention of PU. Several Finite Element models of the buttock have therefore been proposed based on either MRI or CT-Scan data. However, because of the limited availability of MRI or CT-Scan systems and of the long segmentation time, all studies in the literature include the data of only one individual. Yet the inter-individual variability can’t be overlooked when dealing with patient specific estimation of internal tissue loading. As an alternative, this contribution focuses on the combined use of low-dose biplanar X-ray images, B-mode ultrasound images and optical scanner acquisitions in a non-weight-bearing sitting posture for the fast generation of patient-specific FE models of the buttock. Model calibration was performed based on Ischial Tuberosity sagging. Model evaluation was performed by comparing the simulated contact pressure with experimental observations on a population of 6 healthy subjects. Analysis of the models confirmed the high inter-individual variability of soft tissue response (maximum Green Lagrange shear strains of 213 ± 101% in the muscle). This methodology opens the way for investigating inter-individual factors influencing the soft tissue response during sitting and for providing tools to assess PU risk.

The Effects of Matrix Inhomogeneities on the Cellular Mechanical Environment in Tissue-Engineered Cartilage: AnIn SilicoInvestigation

Mechanical stimulation during cartilage tissue-engineering enhances extracellular matrix (ECM) synthesis and thereby improves the mechanical properties of tissue engineered (TE) cartilage. Generally, these mechanical stimuli are of a fixed magnitude. However, as a result of ECM synthesis and spatial variations thereof at both the macroscopic and microscopic scales, the internal mechanical conditions in the constructs change with time. Consequently, the physical signals in the environment of the cells will vary spatially and temporally, even though macroscopically the same loading is applied to the construct. The purpose of the present study was to numerically quantify such effects and thereby reveal the importance of adjusting loading regimes during cartilage tissue-engineering. A validated nonlinear fiber-reinforced poroviscoelastic swelling cartilage model that can accommodate for effects of collagen reinforcement and swelling by proteoglycans was used. At the microscopic scale, ECM was gradually varied from localized in the pericellular area, toward equally distributed throughout the surrounding interterritorial matrix. At the macroscopic tissue scale, ECM was gradually varied from predominantly localized in the periphery of the TE construct toward homogeneously distributed. Both concentration of ECM in the pericellular area and concentration of ECM in the periphery of a construct alter the physical signals up to an order of magnitude compared to those at the onset of the culture. Of particular interest, is the effect of elevated osmotic swelling pressure in the pericellular area, which shields not only the cells from receiving external mechanical compression, but also directly induces tension on the cells. Based on the present computational simulations, it is therefore, proposed that cartilage TE studies should consider ECM distribution as an important factor when developing loading protocols for cartilage culturing process. For instance, the level of mechanical compression should gradually increase to sufficiently deform chondrocytes over time, in case there is matrix accumulation in the pericellular area.

A biochemical/biophysical 3D FE intervertebral disc model

Present research focuses on different strategies to preserve the degenerated disc. To assure long-term success of novel approaches, favorable mechanical conditions in the disc tissue are essential. To evaluate these, a model is required that can determine internal mechanical conditions which cannot be directly measured as a function of assessable biophysical characteristics. Therefore, the objective is to evaluate if constitutive and material laws acquired on isolated samples of nucleus and annulus tissue can be used directly in a whole-organ 3D FE model to describe intervertebral disc behavior. The 3D osmo-poro-visco-hyper-elastic disc (OVED) model describes disc behavior as a function of annulus and nucleus tissue biochemical composition, organization and specific constituent properties. The description of the 3D collagen network was enhanced to account for smaller fibril structures. Tissue mechanical behavior tests on isolated nucleus and annulus samples were simulated with models incorporating tissue composition to calculate the constituent parameter values. The obtained constitutive laws were incorporated into the whole-organ model. The overall behavior and disc properties of the model were corroborated against in vitro creep experiments of human L4/L5 discs. The OVED model simulated isolated tissue experiments on confined compression and uniaxial tensile test and whole-organ disc behavior. This was possible, provided that secondary fiber structures were accounted for. The fair agreement (radial bulge, axial creep deformation and intradiscal pressure) between model and experiment was obtained using constitutive properties that are the same for annulus and nucleus. Both tissue models differed in the 3D OVED model only by composition. The composition-based modeling presents the advantage of reducing the numbers of material parameters to a minimum and to use tissue composition directly as input. Hence, this approach provides the possibility to describe internal mechanical conditions of the disc as a function of assessable biophysical characteristics.

Patient-specific analyses of deep tissue loads post transtibial amputation in residual limbs of multiple prosthetic users

Active transtibial amputation (TTA) patients are at risk for developing pressure ulcers (PU) and deep tissue injury (DTI) while using their prosthesis. It is therefore important to obtain knowledge of the mechanical state in the internal soft tissues of the residuum, as well as knowledge of the mechanical state upon its surface. Our aim was to apply patient-specific MRI-based non-linear finite element (FE) models to quantify internal strains in TTA prosthetic users ( n=5) during load-bearing. By further employing a strain injury threshold for skeletal muscle, we identified patients susceptible to DTI. The geometrical characteristics of the residuum of the TTA participants varied substantially between patients, e.g. the residuum lengths were 7.6, 8.1, 9.2, 11.5 and 13.3 cm. We generally found that internal strains were higher in the bone proximity than in the muscle flap periphery. The highest strains, which in some patients exceeded 50% (engineering strain) for compressive, tensile and shear strains, were found in the shortest residual limbs, i.e. the 7.6 and 8.1 cm-long limbs. Correspondingly, the lowest strains were found in the 13.3 cm-long residuum, which had the bulkiest muscle flap. Yet, even in the case of a long residuum, about a third of the soft tissue volume at the distal tibial proximity area was occupied by large (>5%) internal compressive, tensile and shear strains. For both patients with shorter residual limbs, the internal principal compressive strains above 5% occupied almost the entire distal tibial proximity area. For a patient whose distal tibial end was flat (non-beveled), internal strains were more uniformly distributed, compared to the strain distributions in the other models, where focal elevated strains accumulated in the bone proximity. We found no muscle strains above the immediate injury threshold, indicating that all patients were not at immediate risk for DTI. Two patients whose residuum fat padding was minimal to none, were the only ones identified as theoretically prone to DTI at long (>3 h) continuous weight-bearing periods. We conclude that there is a wide variability in internal mechanical conditions between residual limbs across subjects, which necessitates patient-specific quantitative analyses of internal mechanical states in TTA patients, to assess the mechanical performance of the reconstructed limb and in particular, the individual risk for deep PU or DTI.

Internal mechanical conditions in the soft tissues of a residual limb of a trans-tibial amputee

Most trans-tibial amputation (TTA) patients use a prosthesis to retain upright mobility capabilities. Unfortunately, interaction between the residual limb and the prosthetic socket causes elevated internal strains and stresses in the muscle and fat tissues in the residual limb, which may lead to deep tissue injury (DTI) and other complications. Presently, there is paucity of information on the mechanical conditions in the TTA residual limb during load-bearing. Accordingly, our aim was to characterize the mechanical conditions in the muscle flap of the residual limb of a TTA patient after donning the prosthetic socket and during load-bearing. Knowledge of internal mechanical conditions in the muscle flap can be used to identify the risk for DTI and improve the fitting of the prosthesis. We used a patient-specific modelling approach which involved an MRI scan, interface pressure measurements between the residual limb and the socket of the prosthesis and three-dimensional non-linear large-deformation finite-element (FE) modelling to quantify internal soft tissue strains and stresses in a female TTA patient during static load-bearing. Movement of the truncated tibia and fibula during load-bearing was measured by means of MRI and used as displacement boundary conditions for the FE model. Subsequently, we calculated the internal strains, strain energy density (SED) and stresses in the muscle flap under the truncated bones. Internal strains under the tibia peaked at 85%, 129% and 106% for compression, tension and shear strains, respectively. Internal strains under the fibula peaked at substantially lower values, that is, 19%, 22% and 19% for compression, tension and shear strains, respectively. Strain energy density peaked at the tibial end (104 kJ/m 3). The von Mises stresses peaked at 215 kPa around the distal end of the tibia. Stresses under the fibula were at least one order of magnitude lower than the stresses under the tibia. We surmise that our present patient-specific modelling method is an important tool in understanding the etiology of DTI in the residual limbs of TTA patients.

Compression and hypoxia in an engineered skeletal muscle model

Bouten CV, Oomens CW, Baaijens FP, Bader DL. The etiology of pressure ulcers: skin deep or muscle bound? Arch Phys Med Rehabil 2003;84:616-9. Pressure ulcers are areas of soft tissue breakdown that result from sustained mechanical loading of the skin and underlying tissues; they can affect the quality of life of many individuals. Despite considerable efforts to prevent pressure ulcers, data on prevalence are unacceptably high. This can at least partly be attributed to limited knowledge of the etiology of the clinical condition and the fact that identification and prevention of pressure ulcers mainly focus on skin tissue, even though the underlying muscle tissue may be more susceptible to mechanical loading. The present article proposes a new, hierarchical research approach to obtain improved insights into the basic pathways whereby mechanical loading leads to soft tissue breakdown. This approach investigates the relationships between (1) global mechanical loading at skin level, (2) the resulting local internal mechanical conditions within the soft tissue layers extending from skin to muscle tissue, and (3) the pathophysiologic response to loading. The latter response should be assessed from the various functional tissue units involved in soft-tissue breakdown[mdash]the cells, the interstitial space, and blood and lymph vessels. We predict that the proposed strategy will provide new fundamental knowledge about the etiology of pressure ulcers that can serve as a sound basis for effective clinical identification and prevention.

The etiology of pressure ulcers: Skin deep or muscle bound?

Bouten CV, Oomens CW, Baaijens FP, Bader DL. The etiology of pressure ulcers: skin deep or muscle bound? Arch Phys Med Rehabil 2003;84:616-9. Pressure ulcers are areas of soft tissue breakdown that result from sustained mechanical loading of the skin and underlying tissues; they can affect the quality of life of many individuals. Despite considerable efforts to prevent pressure ulcers, data on prevalence are unacceptably high. This can at least partly be attributed to limited knowledge of the etiology of the clinical condition and the fact that identification and prevention of pressure ulcers mainly focus on skin tissue, even though the underlying muscle tissue may be more susceptible to mechanical loading. The present article proposes a new, hierarchical research approach to obtain improved insights into the basic pathways whereby mechanical loading leads to soft tissue breakdown. This approach investigates the relationships between (1) global mechanical loading at skin level, (2) the resulting local internal mechanical conditions within the soft tissue layers extending from skin to muscle tissue, and (3) the pathophysiologic response to loading. The latter response should be assessed from the various functional tissue units involved in soft-tissue breakdown[mdash]the cells, the interstitial space, and blood and lymph vessels. We predict that the proposed strategy will provide new fundamental knowledge about the etiology of pressure ulcers that can serve as a sound basis for effective clinical identification and prevention.

The mechanical properties of lead-titanate/polymer 0–3 composites

The stiffness and brittleness of pure piezoelectric ceramics limit the application of these materials as embedded sensors within composites. Thin-film compliant sensors have recently been developed by incorporating piezoelectric ceramic particles in a polymer matrix. When embedded in thicker composite structures, these thin-film sensors may be useful in monitoring internal mechanical conditions such as the evolution of damage. The mechanical properties of 0–3 composite films of calcium-modified lead titanate in Epon 828 epoxy and poly(vinylidene fluoride-trifluoroethylene) (P(VDF-TrFE)) matrices have been investigated in this work. The linear viscoelastic properties of these thin-film composites are measured, and the influences of strain, frequency, and ceramic content on these properties are investigated. Analytical and finite-element modeling are used to predict the effective viscoelastic properties of the composites, and these predictions are compared with the experimental results. The storage moduli predicted by these models are comparable to experimental results, while the predicted loss moduli are significantly less than the measured loss moduli. It is shown that the introduction of a third “interphase” layer at the ceramic/polymer boundary within the finite element model results in a better fit to the experimental data.

The mechanical and electromechanical properties of calcium-modified lead titanate/poly(vinylidene fluoride-trifluoroethylene) 0-3 composites

Thin film composite sensors have been fabricated which incorporate piezoelectric ceramic particles in a polymer matrix. Such composites are more compliant than pure piezoelectric ceramics and can be embedded in thick structures to monitor internal mechanical conditions such as the evolution of damage. The mechanical properties and electromechanical interaction of composite films consisting of Ca-modified lead titanate particles in a poly(vinylidene fluoride-trifluoroethylene) matrix are examined in this paper. The viscoelastic properties of these composites (with various volume fractions, up to 60% ceramic) have been measured over a range of frequencies (0.01 to 100 rad ). These composite properties are primarily controlled by the viscoelastic properties of the polymer matrix, and are shown to depend greatly on frequency and ceramic content. The complex piezoelectric coefficients and have been measured for these composites for various volume fractions and over a frequency range from 5 to 100 rad . The magnitudes and phase angles of the piezoelectric coefficients are also shown to be highly frequency dependent.