Strap Tension Research Articles

Biomechanical modeling of brace treatment of scoliosis: effects of gravitational loads

The biomechanics of bracing in adolescent idiopathic scoliosis is still not fully understood. Finite element models (FEM) have been used but the gravity forces were not included and the production of spinal stresses not evaluated. An improved FEM to simulate brace treatment was thus developed. The 3D geometry of the spine, rib cage, pelvis, and of the trunk external surface of five scoliotic patients was acquired using a multi-view X-ray technique and surface topography. A FEM of the patient's trunk including gravity forces was created. Custom-fit braces were modeled and their installation simulated. Immediate geometrical corrections and pressures were computed and validated. The resulting compressive loads on the vertebral endplates were quantified. The influence of the strap tension, spine stiffness, and of the gravity forces was evaluated. Results showed that the brace biomechanical action was importantly to prevent the scoliotic spine from bending under the gravity forces. The immediate correction depended on the strap tension and spine stiffness. The distribution and amplitude of computed pressures were similar to those measured with the real braces. After the brace installation, the coronal asymmetrical compressive loading on the vertebral endplates was significantly reduced. In conclusion, the model developed presents improvements over previous models and could be used to better understand and optimize brace treatment.

Comparison of the biomechanical 3D efficiency of different brace designs for the treatment of scoliosis using a finite element model

The biomechanical influence of thoraco-lumbo-sacral bracing, a commonly employed treatment in scoliosis, is still not fully understood. The aim of this study was to compare the immediate corrections generated by different virtual braces using a patient-specific finite element model (FEM) and to analyze the most influential design factors. The 3D geometry of three patients presenting different types of curves was acquired with a multi-view X-ray technique and surface topography. A personalized FEM of the patients' trunk and a parametric model of a virtual custom-fit brace were then created. The installation of the braces on the patients was simulated. The influence of 15 design factors on the 3D correction generated by the brace was evaluated following a design of experiments simulation protocol allowing computing the main and two-way interaction effects of the design factors. A total of 12,288 different braces were tested. Results showed a great variability of the braces effectiveness. Of the 15 design factors investigated, according to the 2 modalities chosen for each one, the 5 most influential design factors were the position of the brace opening (posterior vs. anterior), the strap tension, the trochanter extension side, the lordosis design and the rigid shell shape. The position of the brace opening modified the correction mechanism. The trochanter extension position influenced the efficiency of the thoracic and lumbar pads by modifying their lever arm. Increasing the strap tension improved corrections of coronal curves. The lordosis design had an influence in the sagittal plane but not in the coronal plane. This study could help to better understand the brace biomechanics and to rationalize and optimize their design.

The Patient-Specific Brace Design and Biomechanical Analysis of Adolescent Idiopathic Scoliosis

Brace application has been reported to be an effective approach in treating mild to moderate idiopathic adolescent scoliosis. However, little attention is focused on the biomechanical study of patient-specific brace treatment. The purpose of this study was to propose a design method of personalized brace and to analyze its biomechanical behavior and to compare the brace forces with the I-Scan measurement system. Based on a three-dimensional patient-specific finite element model of the spine, rib cage, pelvis, and abdomen, a parametric patient-specific model of a thoracolumbosacral orthosis was built. The interaction between the torso and the brace was modeled by surface-to-surface contact interface. Three standard strap tensions (20 N, 40 N, and 60 N) were loaded on the back of the brace to simulate the strap tension. The I-Scan distribution pressure measurement system was used to measure the different region pressures, and the equivalent forces in these regions were calculated. The spinal curve changes and the forces acted on the brace generated by the strap tension were evaluated and compared with the measurement. The reduction in the coronal curvature was about 60% for a strap tension of 60 N. The sacral slope and the lordosis were partially reduced in this case, but the kyphosis had no obvious change. The brace slightly modified the axial rotation at the apex of the scoliotic curve. The forces generated in finite element analysis were approximately in good agreement with the measurement. The design and biomechanical analysis methods of patient-specific brace should be useful in the design of more effective braces.

Infinite models in scoliosis: a review of the literature and analysis of personal experience

The purpose of this study was to introduce infinite models in scoliosis and to analyze personal experience. Based on a three-dimensional patient-specific finite element model of the spine, rib cage, pelvis and abdomen, a parametric individual model of a thoracolumbosacral orthosis was built. Three standard strap tensions (20, 40, 60 N) were loaded on the back of the brace to simulate the strap tension. The I-Scan distribution pressure measurement system was used to measure the pressure of the different regions and the equivalent forces in these regions were calculated. The spinal curve changes and the forces acted on the brace generated by the strap tension were evaluated and compared with the measurement results. The reduction of the coronal curvature was approximately 60% for a strap tension of 60 N. The sacral slope and the lordosis were partially reduced in this case. The brace modified the axial rotation at the deformed vertebrae. The forces generated in finite element analysis were in good agreement with the measurement. The findings supported the feasibility of such an approach to analyze individual bracing biomechanics, which may be useful in the design of more effective individual braces.

Study of the pressures applied by a Chêneau brace for correction of adolescent idiopathic scoliosis

We performed a study on 32 idiopathic scoliotic patients (30 females, 2 males) treated with a Chêneau brace. Eighteen patients had a single right thoracic curve and 14 had a single right thoracolumbar curve. We used the TekScan system (ClinSeat Type 5315 Sensor, TekScan, Boston MA, USA) to measure pressures at the skin-brace interface, assess the effect of strap tension and analyze the variation of these pressures with position and activity. The TekScan device enabled identification of the pressure areas corresponding to the brace's three loading points. The pressure under the main pad had a greater mean value than the pressure under the two counter-pads. Tightening the straps led to a significant increase in the pressures, whatever the position studied or the curve pattern. Compared with the standing (reference) position, we observed significantly higher pressures during maximal inspiration (p < 0.001) and lower pressures during maximal expiration, in the prone position and after having risen from a lying position, for both thoracic curves (p < 0.001) and thoracolumbar curves (p < 0.01). The pressures for thoracolumbar curves were lower than those for thoracic curves, whatever the position studied and both before and after strap adjustment. For lying positions, lying on the right side produced the greatest increase pressure. Even though the TekScan system does not provide direct information on the correction of spinal curvature, it appears to be a useful tool in the treatment of scoliotic patients. Strap adjustment clearly influences the applied pressures - particularly those on the rib cage. During activity, there is a natural tendency to decrease the pressure; this justifies efforts to maintain strap tensions in general and during day wear in particular.

Virtual prototyping of a brace design for the correction of scoliotic deformities

Based on a three-dimensional patient-specific finite element model of the spine, rib cage, pelvis and abdomen, a parametric model of a thoraco-lumbo-sacral orthosis (TLSO) was built. Its geometry is custom-fit to the patient. The rigid shell, pads and openings are all represented. The interaction between the trunk and the brace is modeled by a point-to-surface contact interface. During the nonlinear simulation process, the brace is opened, positioned on the patient and strap tension is applied. A TLSO similar to Boston brace system was built for a right-thoracic scoliotic patient. The influences of the trochanter pad and strap tension on the 3-D geometrical corrections and on the forces generated by the brace were evaluated. The role of the trochanter pad as a lever arm is confirmed by the model. The brace induces a reduction of the lordosis and pelvic tilt. The reduction of the frontal curvature is about 20% for a strap tension of 60 N. Axial rotation does not significantly change and rib hump is worsened. By using an explicit brace model and a contact interface, a more realistic simulation of orthotic treatment of scoliosis can be achieved. The stabilization of the brace on the patient can be represented and less restrictive boundary conditions can be applied. This model could be used to study the effect of design parameters on the brace efficiency.

Poster 18: Clinical Significance of Strap Tension Adjustment on Spinal Orthoses for Neuromuscular Scoliosis

Objectives: To quantify the strap tension of spinal orthoses and to find an optimal value to achieve the best correction of spinal deformity but least compromise of pulmonary function. Design: Single case. Setting: Orthotic services at a rehabilitation engineering research center in Taiwan. Participant: A 7-year-old girl with spinal muscular atrophy, presenting with a scoliotic curve. The curve was a left lumbar C curve, and the apex was at L1. Intervention: A custom copolymer anterior-opening thoracic-lumbar-sacral orthosis (TLSO) with 3 adjustable straps.

Effects of tension of the girth strap on respiratory system mechanics in horses at rest and during hyperpnea induced by administration of lobeline hydrochloride

To determine whether tension of the girth strap of a saddle would sufficiently affect rib motion and reduce lung volume to alter pulmonary resistance in horses. 10 healthy adult horses. We used classical techniques to measure the effects of tightening a girth strap (15 kg of tension) on pulmonary dynamics during eupnea and hyperpnea in horses. Respiratory impedance was evaluated by use of oscillometry, and resistance and reactance data were partitioned into lung and chest wall components. Rib cage and abdominal contributions to tidal volume and minute ventilation were measured by use of respiratory inductance plethysmography. Effects of strap tension on functional residual capacity (FRC) were measured during eupnea by use of a helium-dilution technique. In a subgroup of 6 horses, we also measured transdiaphragmatic pressures during eupnea and hyperpnea induced by administration of lobeline hydrochloride (0.2 mg/kg, i.v.). Pulmonary resistance measured by use of oscillometry but not by use of classical methods was significantly increased by the tension of the girth strap. However, the increase in pulmonary resistance could not be explained by a decrease in FRC. Motion of the rib cage was significantly reduced during eupnea and hyperpnea. However, ventilatory variables (tidal volume, minute ventilation, and peak flows), FRC, and transdiaphragmatic pressures were unaltered by strap tension. Although tension of the girth strap caused measurable changes in respiratory mechanics (loss of rib motion and increased pulmonary resistance), there was no evidence that ventilation was limited.

The effect of simulated school load carriage configurations on shoulder strap tension forces and shoulder interface pressure

Recently, several studies have addressed the physical demands of school student's load carriage, in particular the load weight carried, using physical demands indicators such as oxygen consumption, gait, and posture. The objective of this study was to determine the effects of different load carriage configurations on shoulder strap tension forces and shoulder interface pressure during simulated school student's load carriage. A load carriage simulator was used to compare shoulder strap forces and shoulder pressure for 32 combinations of gait speed, backpack weight, load distribution, shoulder strap length and use of a hip-belt. The results showed that the manipulation of backpack weight, hip-belt use and shoulder strap length had a strong effect on shoulder strap tension and shoulder pressure. Backpack weight had the greatest influence on shoulder strap tension and shoulder pressure, whereas hip-belt use and then shoulder strap adjustment had the next greatest effects, respectively. While it is clear that researchers and practitioners are justified in focusing on load magnitude in backpack studies as it has the greatest effect on shoulder forces, hip-belt use and shoulder strap adjustment should also be examined further as they too may have significant effects on the demands placed on backpack users. Based on the present findings, school students should wear their backpacks with the least weight possible, use the hip-belt if present, allow a reasonable amount of looseness in the shoulder straps and should position the heaviest items closest to their back. However, more detailed work using human participants needs to be undertaken before these recommendations can be confirmed.

Biomechanical assessment of lateral stiffness elements in the suspension system of a backpack

The purpose of this study was to examine the change in load distribution characteristics associated with adding lateral stiffness elements (rods) to a rucksack (backpack). A load distribution mannequin was instrumented with two 3D load cells to allow determination of the load applied to the shoulders and upper torso independent of the load applied to the hips and lower trunk. Position and mass of the payload (25 kg) were fixed at the centre of the volume of the rucksack and held constant during all testing. It was hypothesized that lateral rods would provide a force bridge that transfers part of the vertical load of the pack from the upper back and shoulders to the hip belt thereby reducing the vertical load on the torso, and possibly reducing the horizontal reaction force that produces a shear load on the spine. Results showed that these active stiffness elements shifted 14% of the vertical load from the upper torso to the pelvic region with lumbar shear load remaining relatively unchanged for all combinations of shoulder strap and waist belt tension. The lateral rods also provided a mean increase of 12% in the extensor moment at the L3 – L4 level, thus reducing some demand on the erector spinae muscles.

Finite element modeling of guyed back spars in cable logging

In this study a finite element model of a back spar system was developed with three guylines opposing the skyline strap tension. In this paper the allowable skyline strap tension is the tension in the skyline strap that results in the maximum normal stress on a transverse cross section of the tree being equal to an assumed allowable stress. An iterative routine was developed to find the allowable skyline strap tension, and this routine was found to converge rapidly from initial values that were below and above the allowable skyline strap tension. Two algorithms were developed for finding the maximum normal stress on a transverse cross section of a tree, method 1 and method 2. If the plane that the tree displaced in was known a priori, then method 2 could be used, and it was found to be less sensitive to mesh coarseness. If the plane that the tree displaced in was not known a priori, then method 1 had to be used with a less coarse mesh. It was found that the stress concentrations due to simplified cable connections were not significant for rigging configurations that allowed a larger rigging point displacement. The rigging configurations that allowed larger rigging point displacements have stress fields that are dominated by bending, while for rigging configurations that allow only small rigging point displacements, the stress fields are dominated by axial compression.

Noninvasive reduction of open-book pelvic fractures by circumferential compression.

To determine the efficacy and optimal application parameters of circumferential compression to reduce external rotation-type pelvic fractures. Biomechanical investigation on human cadaveric specimens. Biomechanics laboratory. Partially stable and unstable external rotation injuries of the pelvic ring (OTA classification 61-B1 and 61-C1) were created in seven human cadaveric specimens. A prototype pelvic strap was applied subsequently at three distinct transverse levels around the pelvis. Circumferential pelvic compression was induced by gradual tensioning of the strap to attempt complete reduction of the symphysis diastasis. Pelvic reduction was evaluated with respect to strap tension and the strap application site. The effect of circumferential compression on intraperitoneal pressure and skin-strap interface pressure was measured. A successive increase in circumferential compression consistently induced a gradual decrease in symphysis diastasis. An optimal strap application site was determined, at which circumferential compression most effectively yielded pelvic reduction. The minimum strap tension required to achieve complete reduction of symphysis diastasis was determined to be 177 +/- 44 Newtons and 180 +/- 50 Newtons in the partially stable and unstable pelvis, respectively. Application of circumferential compression to the pelvic soft tissue envelope with a pelvic strap was an efficient means to achieve controlled reduction of external rotation-type pelvic fractures. This study derived application parameters with direct clinical implication for noninvasive emergent management of traumatic pelvic ring disruptions.

Influence of girth strap tensions on athletic performance of racehorses.

Eight horses were exercised at speeds to produce 80% of maximal heart rates, on 4 occasions using a randomised block design, and girthed at tensions of approximately 5, 10, 15 or 20 kg using a standard canvas girth attached to a racing saddle. Tension was recorded continuously using an in-line load cell connected to a physiograph. Horses ran until fatigued on a treadmill inclined at 10% slope. Tensions were measured at peak inhalation (T/inh) and exhalation (T/exh), recorded at rest (rest) and during exercise (ex). Data were analysed by ANOVA and, in addition, least squares linear regression was performed to determine the relationship between distance travelled, time to fatigue and the recorded maximum tensions at inhalation and minimum tensions at exhalation. For T/inhrest, every increase in girth tension by 1 kg was associated with a reduction in distance to fatigue by 98.3 +/- 28.6 m and a corresponding reduction in run times of 0.24 +/- 0.07 min (P = 0.01). Results for T/exhrest were similar, with a reduction of mean +/- s.e. 81.3 +/- 26.9 m and 0.20 +/- 0.07 min per 1 kg increase in tension (P = 0.02). The mean distances to fatigue for the T/exhrest of 5, 10, 15 and 20 kg were 6624, 5812, 5268 and 5405 m respectively. These data indicate that distances to fatigue are similar once T/exhrest equals or exceeds 10 kg. Based on this study, resting girth tensions less than 10 kg are optimal for performance, but from our survey data, tensions exceeding this tension are typical for Thoroughbred racing in Victoria.

Point Of View: Variability of Strap Tension in Brace Treatment for Adolescent Idiopathic Scoliosis

Point Of View: Variability of Strap Tension in Brace Treatment for Adolescent Idiopathic Scoliosis

Effect of strap tension on the pressure generated by the boston brace on idiopathic scoliosispatients: A preliminary study

Effect of strap tension on the pressure generated by the boston brace on idiopathic scoliosispatients: A preliminary study

The effect of functional knee bracing on the anterior cruciate ligament in the weightbearing and nonweightbearing knee.

We investigated the effect of functional bracing on anterior cruciate ligament strain in humans by arthroscopic implantation of a differential variable reluctance transducer on the ligament and measurement of its strain behavior. Strains were measured while "injury mechanism" loads were applied to the weightbearing and nonweightbearing knees for both braced and unbraced conditions. For the unbraced knee, there was a significant increase in ligament strain values when subjects went from a seated position (minimal shear and compressive loads across the knee) to a standing posture (substantial shear and compressive loads across the knee). Similar strain values were found between these same seated and standing postures when a 140-N anterior-directed load was applied to the tibia. This indicates that the ligament is strained during weightbearing and demonstrates that the compressive load across the knee produced during weightbearing does not significantly reduce ligament strain values in comparison with the unweighted joint with relaxed muscles for the 140-N load limit of our anterior shear test. Bracing produced a protective effect on the ligament by significantly reducing the strain values for anterior-directed loading of the tibia up to 140 N with the knee in both weightbearing and nonweightbearing conditions. Likewise, bracing produced a protective effect on the ligament by significantly reducing strain values in response to internal-external torque of the tibia up to 6 N-m with the knee nonweightbearing. The brace strap that contacts the tibia just distal to the insertion of the patellar tendon was instrumented with a load sensor, allowing us to measure the posterior-directed loads applied by the brace to the tibia. Adjustment of strap tension between low and high settings did not modulate the protective effect of the brace on the ligament.

Physiological responses to 90 min of simulated dinghy sailing.

A dinghy sailing race protocol was developed from video analysis of elite Laser class sailors competing in fairly windy (> 12 knots) national level races. A dinghy sailing ergometer was constructed for use with a 90 min protocol. Subjects watched a video of a Laser dinghy skipper sailing (on-water) according to the protocol while themselves hiking (leaning out) from the ergometer and simulating their normal on-water movements in tandem with the video. This simulation was used to examine physiological responses to dinghy sailing and factors correlated with hiking performance in 10 of Australia's top 30 Laser dinghy sailors. Simulated dinghy sailing elicited a large blood pressure response but a low rate of aerobic and anaerobic metabolism. During the 20 min upwind legs, the mean (+/- S.E.M.) systolic and diastolic blood pressures were 172 +/- 18 and 100 +/- 14 mmHg respectively, and mean arterial blood pressure (MABP) was 123 +/- 14 mmHg. Oxygen uptake during the simulated upwind legs was 1.12 +/- 0.22 1 min-1. Both blood pressure and VO2 were significantly lower during the 12 min reaching legs. The mean of the blood lactate concentrations measured 1 min following each of the upwind legs was 2.32 +/- 0.81 mM. Isometric knee extension strength (at 130 degrees) and the length to which subjects set the hiking strap on the ergometer were moderately related to upwind hiking performance (knee extension strength and upwind hiking strap tension, r = 0.62; hiking strap length and upwind righting moment, r = 0.66; both P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of spinal immobilization devices on pulmonary function in the healthy, nonsmoking man.

In the prehospital management of trauma, a variety of devices are used for immobilization of the spinal column during extrication and transport. Two of these commonly used immobilizers, the Zee Extrication Device and the long spinal board, use crisscrossing straps over the thorax to affix the patient to the device. Our study was designed to determine if these two devices alter pulmonary function in the healthy, nonsmoking man. We took 15 healthy, nonsmoking male volunteers and tested four pulmonary function parameters: forced vital capacity (FVC), forced expiratory volume in one second (FEV1), the ratio FEV1:FVC, and forced mid-expiratory flow (FEF 25%-75%). A Breon spirometer was used to test these functions both before and after the volunteers were strapped into the two devices. Three separate trials were given for each parameter and the best scores were used for data computation. Strap tension was controlled by placing a sphygmomanometer beneath each strap and adding tension to produce 10 mm Hg pressure. We found a significant difference (P less than .05) between prestrapping and poststrapping values for three of the four functions tested using the long spinal board: FVC (P = .0079), FEV1 (P = .0001), and FEF 25%-75% (P = .0252). Similarly significant differences were found for three of the four parameters using the Zee Extrication Device: FVC (P = .004), FEV1 (P = .0022), and FEF 25%-75% (P = .008). These differences reflect a marked pulmonary restrictive effect. The ratio FEV1:FVC can be normal or even slightly elevated with restrictive airway disease due to proportional reductions of each parameter. Correspondingly, we found no significant difference between prestrapping and poststrapping FEV1:FVC values (P greater than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Bobath axillary support for adults with hemiplegia. A biomechanical analysis.

The purpose of this article is to report on a simple biomechanical analysis of the effects of an axillary support on shoulder subluxation. The underlying postulate was that an axillary support always is accompanied by an increase in shoulder abduction. The immediate effect of axillary support, as confirmed by roentgenograms, was a partial reduction of inferior subluxation and a decrease in the magnitude of the vertical component of the internal resultant force on the shoulder. After the axillary support was applied, the total force acting on the shoulder tissues increased with the abduction angle. The results of this study indicate that the axillary roll size and position and the stabilizing strap tension should be adjusted to the patient's specific problem or problems. This article provides a simple method to estimate, in a given patient, the magnitude and the direction of the forces involved in axillary support.