Proposal of a thorax segment coordinate system for the 3D kinematical analysis of the cervical spine

The International Society of Biomechanics detailed the recommendations for 3D kinematics of intervertebral movements (Wu, et al. 2002. J Biomech. 35:543–548), but does not specify how to adapt this proposal to describe the kinematics of the cervical spine, between the head and the thorax. The analysis of the literature shows that no consensus exists at the present time on this subject. The objective of our study was to identify the reference points that formed the most rigid triplet allowing building an optimal thorax segment coordinate system (SCS). We thus measured the variations of distances between markers placed on various anatomical landmarks, and then the deformations of the combinations of three markers on different cervical movements of a sample of 10 asymptomatic subjects. The results show that the triplet formed by the sternum and both acromions undergoes less deformation on the flexion–extension movement. For all the other movements (lateral bending, axial rotation and complex movements), the triplet formed by sternum, T3 and TH (positioned on the thoracic spinal column, in a horizontal plane containing the sternal marker), undergoes less deformation. As a conclusion, the optimal triplet to define the thorax SCS for 3D kinematical analysis of the cervical spine is that formed by the markers: sternum, T3 and TH. This triplet makes it possible to define an orthonormal SCS, the axes of which coincide with anatomical directions, i.e. with the functional axes of the movement.     

Effect of axis alignment on in vivo shoulder kinematics

BACKGROUND. To describe 3D shoulder joint movements, the International Society of Biomechanics (ISB) recommends using segment coordinate systems (SCSs) on the humerus, scapula and thorax, and joint coordinate systems (JCSs) on the shoulder. However, one of the remaining problems is how to define the zero angles when the arm is in an initial reference position. The aim of this paper is to compare various methods of determining the JCSs of the shoulder that make it possible to define the zero angles of the arm in the resting position. METHODS. Able-bodied subjects performed elevation movements in the scapular plane, specifically neutral, internal and external rotations of the humerus. The initial humerus position (at the beginning of the arm movement) and range of motion were analysed for the purpose of clinical interpretation of arm attitude and movement. The following four different JCSs were explored: (1) the standard JCS, defined as recommended by the ISB, (2) a first aligned JCS, where the humerus SCS is initially aligned with the scapula SCS, (3) a second aligned JCS, where the opposite operation is performed and 4) a third aligned JCS, where both the humerus and the scapular SCS are initially aligned with the thorax SCS. FINDINGS. The second aligned JCS was the only method that did not produce any exaggerated range of movement in either anatomical plane. INTERPRETATION. Mathematical JCS alignment allows clearer clinical interpretation of arm attitude and movement.     

Effect of axis alignment on in vivo shoulder kinematics

Background. To describe 3D shoulder joint movements, the International Society of Biomechanics (ISB) recommends using segment coordinate systems (SCSs) on the humerus, scapula and thorax, and joint coordinate systems (JCSs) on the shoulder. However, one of the remaining problems is how to define the zero angles when the arm is in an initial reference position. The aim of this paper is to compare various methods of determining the JCSs of the shoulder that make it possible to define the zero angles of the arm in the resting position.

Methods. Able-bodied subjects performed elevation movements in the scapular plane, specifically neutral, internal and external rotations of the humerus. The initial humerus position (at the beginning of the arm movement) and range of motion were analysed for the purpose of clinical interpretation of arm attitude and movement. The following four different JCSs were explored: (1) the standard JCS, defined as recommended by the ISB, (2) a first aligned JCS, where the humerus SCS is initially aligned with the scapula SCS, (3) a second aligned JCS, where the opposite operation is performed and 4) a third aligned JCS, where both the humerus and the scapular SCS are initially aligned with the thorax SCS.

Findings. The second aligned JCS was the only method that did not produce any exaggerated range of movement in either anatomical plane.

Interpretation. Mathematical JCS alignment allows clearer clinical interpretation of arm attitude and movement.     

Abdominal muscle activation changes if the purpose is to control pelvis motion or thorax motion

The aim of this study was to compare trunk muscular recruitment and lumbar spine kinematics when motion was constrained to either the thorax or the pelvis. Nine healthy women performed four upright standing planar movements (rotations, anterior–posterior translations, medial–lateral translations, and horizontal circles) while constraining pelvis motion and moving the thorax or moving the pelvis while minimizing thorax motion, and four isometric trunk exercises (conventional curl-up, reverse curl-up, cross curl-up, and reverse cross curl-up). Surface EMG (upper and lower rectus abdominis, lateral and medial aspects of external oblique, internal oblique, and latissimus dorsi) and 3D lumbar displacements were recorded. Pelvis movements produced higher EMG amplitudes of the oblique abdominals than thorax motions in most trials, and larger lumbar displacements in the medial–lateral translations and horizontal circles. Conversely, thorax movements produced larger rotational lumbar displacement than pelvis motions during rotations and higher EMG amplitudes for latissimus dorsi during rotations and anterior–posterior translations and for lower rectus abdominis during the crossed curl-ups. Thus, different neuromuscular compartments appear when the objective changes from pelvis to thorax motion. This would suggest that both movement patterns should be considered when planning spine stabilization programs, to optimize exercises for the movement and muscle activations desired.     

A Biomechanical Model of the Scapulothoracic Joint to Accurately Capture Scapular Kinematics during Shoulder Movements

The complexity of shoulder mechanics combined with the movement of skin relative to the scapula makes it difficult to measure shoulder kinematics with sufficient accuracy to distinguish between symptomatic and asymptomatic individuals. Multibody skeletal models can improve motion capture accuracy by reducing the space of possible joint movements, and models are used widely to improve measurement of lower limb kinematics. In this study, we developed a rigid-body model of a scapulothoracic joint to describe the kinematics of the scapula relative to the thorax. This model describes scapular kinematics with four degrees of freedom: 1) elevation and 2) abduction of the scapula on an ellipsoidal thoracic surface, 3) upward rotation of the scapula normal to the thoracic surface, and 4) internal rotation of the scapula to lift the medial border of the scapula off the surface of the thorax. The surface dimensions and joint axes can be customized to match an individual’s anthropometry. We compared the model to “gold standard” bone-pin kinematics collected during three shoulder tasks and found modeled scapular kinematics to be accurate to within 2mm root-mean-squared error for individual bone-pin markers across all markers and movement tasks. As an additional test, we added random and systematic noise to the bone-pin marker data and found that the model reduced kinematic variability due to noise by 65% compared to Euler angles computed without the model. Our scapulothoracic joint model can be used for inverse and forward dynamics analyses and to compute joint reaction loads. The computational performance of the scapulothoracic joint model is well suited for real-time applications; it is freely available for use with OpenSim 3.2, and is customizable and usable with other OpenSim models.     

A scapular coordinate frame for clinical and kinematic analyses

The aim of this study was to define a body-fixed coordinate frame for the scapula that minimises axes variability and is closely related to the clinical frame of reference. Medical images of 21 scapulae were used to quantify 14 different axes from identifiable landmarks. The plane of the blade of the scapula was defined. The orientations of the quantified axes were calculated. The angular relationships between axes were quantified and applied to grade the sensitivity of each axis to inter-scapular variations in the others. The volume of data required to define an axis was noted for its dependency on pathology and the three criteria were weighted according to relative importance. The two axes with the highest weighting were applied to define a body-fixed Cartesian coordinate frame for the scapula. A least square medio-lateral line through the centre of the spine root was the most optimal axis. The plane formed by the spine root line and a least square line through the centre of the lateral border ridge was the most optimal scapular plane. This body-fixed Cartesian coordinate frame is closely aligned to the cardinal planes in the anatomical position and thus is a clinically applicable, specimen invariant coordinate frame that can be used in patient-specific kinematics modelling.     

Difference between palpation and optoelectronics recording of scapular motion

The aim of this study is to determine the errors of scapular localisation due to skin relative to bone motion with an optoelectronic tracking system. We compared three-dimensional (3D) scapular positions obtained with skin markers to those obtained through palpation of three scapular anatomical landmarks. The scapular kinematics of nine subjects were collected. Static positions of the scapula were recorded with the right arm elevated at 0°, 40°, 80°, 120° and 160° in the sagittal plane. Palpation and subsequent digitisation of anatomical landmarks on scapula and thorax were done at the same positions. Scapular 3D orientation was also computed during 10 repeated movements of arm elevation between 0° and 180°. Significant differences in scapular kinematics were seen between static positions and palpation when considering anterior/posterior tilt and upward/downward rotation at angles over 120° of humeral elevation and only at 120° for internal/external rotation. There was no significant difference between positions computed during static positions and during the movement for the three scapular orientations. A rotation correction model is presented in order to reduce the errors between static position and palpation measurement.     

Effect of shoulder model complexity in upper-body kinematics analysis of the golf swing

The golf swing is a complex full body movement during which the spine and shoulders are highly involved. In order to determine shoulder kinematics during this movement, multibody kinematics optimization (MKO) can be recommended to limit the effect of the soft tissue artifact and to avoid joint dislocations or bone penetration in reconstructed kinematics. Classically, in golf biomechanics research, the shoulder is represented by a 3 degrees-of-freedom model representing the glenohumeral joint. More complex and physiological models are already provided in the scientific literature. Particularly, the model used in this study was a full body model and also described motions of clavicles and scapulae. This study aimed at quantifying the effect of utilizing a more complex and physiological shoulder model when studying the golf swing. Results obtained on 20 golfers showed that a more complex and physiologically-accurate model can more efficiently track experimental markers, which resulted in differences in joint kinematics. Hence, the model with 3 degrees-of-freedom between the humerus and the thorax may be inadequate when combined with MKO and a more physiological model would be beneficial. Finally, results would also be improved through a subject-specific approach for the determination of the segment lengths.     

Sagittal kinematics of the cervical spine--how constant are the motor axes?

The aim of this study was to establish whether or not the axes of cervical spine movement in the sagittal plane are constant (an impression conveyed by the literature). Based on 60 functional radiographs (of which 24 showed degenerative discopathy or atlas subluxations), the axes of seven motor segments (C1-D1) were determined geometrically. The axes of the segments C5/C6 proved to scatter least; the further the distance of a segment is to the latter, the larger the tendency of scattering appears. Hence, the axes are neither constant in time nor in location and thus only convey the momentary kinematic situation of the cervical spine. Clearly pathologic axis positions could not be found, except in the case of an extreme atlas subluxation.     

In-vivo analysis of sternal angle,sternal and sternocostal kinematics in supine humans during breathing

This paper aims at contributing to the understanding of the combination of in vivo sternum displacement, sternal angle variations and sternocostal joints (SCJ) kinematics of the seven first rib pairs over the inspiratory capacity (IC). Retrospective codified spiral-CT data obtained at total lung capacity (TLC), middle of inspiratory capacity (MIC) and at functional residual capacity (FRC) were used to compute kinematic parameters of the bones and joints of interest in a sample of 12 asymptomatic subjects. 3D models of rib, thoracic vertebra, manubrium and sternum were processed to determine anatomical landmarks (ALs) on each bone. These ALs were used to create local coordinate system and compute spatial transformation of ribs and manubrium relative to sternum, and sternum relative to thoracic vertebra. The rib angular displacements and associated orientation of rotation axes and joint pivot points (JPP), the sternal angle variations and the associated displacement of the sternum relative to vertebra were computed between each breathing pose at the three lung volumes. Results can be summarized as following: (1) sternum cephalic displacement ranged between 17.8 and 19.2 mm over the IC; (2) the sternal angle showed a mean variation of 4.4° ± 2.7° over the IC; (3) ranges of rib rotation relative to sternum decreased gradually with increasing rib level; (4) axes of rotation were similarly oriented at each SCJ; (5) JPP spatial displacements showed less variations at first SCJ compared to levels underneath; (6) linear relation was demonstrated between SCJ ROMs and sternum cephalic displacement over the IC.     

Kinetics of the cervical spine in pediatric and adult volunteers during low speed frontal impacts

Previous research has quantified differences in head and spinal kinematics between children and adults restrained in an automotive-like configuration subjected to low speed dynamic loading. The forces and moments that the cervical spine imposes on the head contribute directly to these age-based kinematic variations. To provide further explanation of the kinematic results, this study compared the upper neck kinetics - including the relative contribution of shear and tension as well as flexion moment - between children (n=20, 6-14 yr) and adults (n=10, 18-30 yr) during low-speed (<4 g, 2.5 m/s) frontal sled tests. The subjects were restrained by a lap and shoulder belt and photo-reflective targets were attached to skeletal landmarks on the head, spine, shoulders, sternum, and legs. A 3D infrared tracking system quantified the position of the targets. Shear force (F(x)), axial force (F(z)), bending moment (M(y)), and head angular acceleration (θ(head)) were computed using inverse dynamics. The method was validated against ATD measured loads. Peak F(z) and θ(head) significantly decreased with increasing age while M(y) significantly increased with increasing age. F(x) significantly increased with age when age was considered as a univariate variable; however when variations in head-to-neck girth ratio and change in velocity were accounted for, this difference as a function of age was not significant. These results provide insight into the relationship between age-based differences in head kinematics and the kinetics of the cervical spine. Such information is valuable for pediatric cervical spine models and when scaling adult-based upper cervical spine tolerance and injury metrics to children.     

Quantitative assessment of trunk deformation during running

The trunk has a multi-segmental structure and is composed of the cervical, thoracic, and lumber spines and surrounding soft tissue elements; this allows flexible deformation during dynamic movements. The purpose of this study was to quantitatively assess trunk deformation during dynamic movement. Ten male subjects performed running at four different speeds: 8 km/h, 10 km/h, 12 km/h, and 14 km/h. Forty reflective markers were placed on the backs of these individuals to define 56 small triangular areas, and three-dimensional kinematic data was recorded with a motion capture system. The coefficients of variation (CV) of the horizontal and vertical lengths between two adjacent markers and the standard deviation (SD) of the normal vectors of triangular areas were calculated as measures for translational and angular trunk deformation, respectively. Up to about 14% of CV and 78° of SD appeared as the measure of translational and angular deformation, respectively. These results imply that the trunk underwent a significant amount of position-specific deformation. These findings would be useful in the construction of an optimal trunk segment model to represent the complex and flexible trunk movement during dynamic movements.     

The skeletal kinematics of lung ventilation in three basal bird taxa (emu, tinamou, and guinea fowl)

In vivo visceral and skeletal kinematics of lung ventilation was examined using cineradiography in two palaeognaths, the emu (Dromaius novaehollandiae) and the Chilean tinamou (Nothoprocta perdicaria), and a basal neognath, the helmeted guinea fowl (Numida meleagris). Upon inspiration, the thorax expands in all dimensions. The vertebral ribs swing forward and upward, thereby increasing the transverse diameter of the trunk. The consistent location of the parapophysis throughout the dorsal vertebral series, ventral and cranial to the diapophysis, ensures a relatively uniform lateral expansion. An increase in the angle between the vertebral and the sternal ribs causes the sternal ribs to push the sternum ventrally. Owing to the greater length of the caudal sternal ribs, the caudal sternal margin is displaced further ventrally than the cranial sternal margin. When observed in lateral view, sternal movement is not linear, but elliptical. The avian thorax is highly constrained in its movement when compared with crocodylians, the other extant archosaur clade. Birds lack a lumbar region and intermediate ribs. Sternal ribs are completely ossified, and have a bicondylar articulation with the sternum. Considering the importance of pressure differences between cranial and caudal air sac complexes for the generation of unidirectional air flow in the avian lung, it is hypothesized that a decrease in the degrees of freedom of movement of the avian trunk skeleton, greater expansion of the ventrocaudal trunk region, and elliptical sternal movement may represent specific adaptations for fine-tuned control over air flow within the complex avian pulmonary system.     

In vivo determination of the anatomical axes of the ankle joint complex: An optimization approach

This study investigates the feasibility of a subject-specific three-dimensional model of the ankle joint complex for kinematic and dynamic analysis of movement. The ankle joint complex was modelled as a three-segment system, connected by two ideal highe joints: the talocrural and the subtalar joint. A mathematical formulation was developed to express the three-dimensional translation and rotation between the foot and shank segments as a function of the two joint angles, and 12 model parameters describing the locations of the joint axes. An optimization method was used to fit the model parameters to three-dimensional kinematic data of foot and shank markers, obtained during test movements throughout the entire physiological range of motion of the ankle joint. The movement of the talus segment, which cannot be measured non-invasively, is not necessary for the analysis.

This optimization method was used to determine the position and orientation of the joint axes in 14 normal subjects. After optimization, the discrepancy between the best fitting model and actual marker kinematics was between 1 and 3 mm for all subjects. The predicted inclination of the subtalar joint axis from the horizontal plane was 37.4±2.7°, and the medial deviation was 18.0±16.2°. The lateral side of the talucrural axis was directed slightly posteriorly (6.8±8.1°), and inclined downward by 7.0±5.4°. These results are similar to previously reported typical results from anatomical, in vitro, studies. Reproducibility was evaluated by repeated testing of one subject, which resulted in variations of about one-fifth of the standard deviation within the group, the inclination of the subtalar joint axis was significantly correlated to the arch height and a radiographic ‘tarsal index’. It is concluded that this optimization method provides the opportunity to incorporate inter-individual anatomical differences into kinematic and dynamic analysis of the ankle joint complex. This allows a more functional interpretation of kinematic data, and more realistic estimates of internal forces.     

An analysis of possible movements of human upper rib cage

A geometrically realistic mathematical model of the first six ribs and vertebrae of the human rib cage is described. Under the assumption that the individual elements of the rib cage do not deform significantly, the possible range of movements of the model are determined subject to the constraint that the joint surfaces remain in contact. It is shown that normal movements of the ribs cannot be described as a rotation about a single fixed axis. The possible movements of the ribs are analyzed in terms of the misfit incurred at the costovertebral joint surfaces. This analysis shows that there is a movement, corresponding to lateral expansion of the rib for an increase in anteroposterior diameter, in which the misfit at the joint is minimized and also that small deviations from this movement involve only very small degrees of misfit at the joint surfaces. It is concluded that many observed "deformations" of the chest wall can be explained by rigid ribs and normal movements at the costovertebral joints. The interaction between the ribs and the spine is analyzed. It is shown that there can be considerable independent movement of the sternum and the spine, thus allowing mobility of the spine without forcing concomitant movements of rib cage.     

Quantification of the segmental kinematics of spontaneous infant movements

This article introduces a method to capture the movements of the upper and the lower limb of infants using an electromagnetic tracking system and to reliably calculate the segmental kinematics. Analysis of the spontaneous movements of infants is important e.g. in the context of the "General Movement Analysis", which aims at the early diagnosis of motor dysfunctions. Due to special constraints regarding infant anatomy, previous approaches based on optical tracking could only gather position data of the infant' segments, whereas with this method in addition relative segment angles can be calculated. The spontaneous movements of the infant and simple calibration movements of the hand and the foot are used to calculate the joint centers and the joint axes of a multi-segmental chain model. The quality of the calibration movements is assessed at calibration time by calculating the root mean square deviation from the total least squares regression plane. The general accuracy of the recording is evaluated by the difference between recorded and estimated sensor positions and the difference between recorded and estimated sensor orientations. Movements of 20 infants between term and 3 months post term age were recorded and processed. A first application illustrates how abnormal movement patterns are manifested in the segmental kinematics. The results show that the presented method is a practicable and reliable way to record spontaneous infant movements and to calculate the segmental kinematics.     

Effects of abnormal posture on capsular ligament elongations in a computational model subjected to whiplash loading

Although considerable biomechanical investigations have been conducted to understand the response of the cervical spine under whiplash (rear impact-induced postero-anterior loading to the thorax), studies delineating the effects of initial spinal curvature are limited. This study advanced the hypothesis that abnormal curvatures (straight or kyphotic) of the cervical column affect spinal kinematics during whiplash loading. Specifically, compared to the normal lordotic curvature, abnormal curvatures altered facet joint ligament elongations. The quantifications of these elongations were accomplished using a validated mathematical model of the human head-neck complex that simulated three curvatures. The model was validated using companion experiments conducted in our laboratory that provided facet joint kinematics as a function of cervical spinal level. Regional facet joint ligament elongations were investigated as a function of whiplash loading in the four local anatomic regions of each joint. Under the normal posture, greatest elongations occurred in the dorsal anatomic region at the C2-C3 level and in the lateral anatomic region from C3-C4 to C6-C7 levels. Abnormal postures increased elongation magnitudes in these regions by up to 70%. Excessive ligament elongations induce laxity to the facet joint, particularly at the local regions of the anatomy in the abnormal kyphotic posture. Increased laxity may predispose the cervical spine to accelerated degenerative changes over time and lead to instability. Results from the present study, while providing quantified level- and region-specific kinematic data, concur with clinical findings that abnormal spinal curvatures enhance the likelihood of whiplash injury and may have long-term clinical and biomechanical implications.     

Combination of a model-deformation method and a positional MRI to quantify the effects of posture on the anatomical structures of the trunk

Understanding the postural effects on organs and skeleton could be crucial for several applications. This paper reports on a methodology to quantify the three-dimensional effects of postures on deformable anatomical structures. A positional MRI scanner was used to image the full trunk in four postures: supine, standing, seated and forward-flexed. The MRI stacks were processed with a custom toolbox, implemented using open source software. The semi-automated segmentation was based on the deformation of generic models of the pelvis, sternum, femoral heads, spine, liver, kidneys, spleen, skin, thoracic and abdominal cavities. The toolbox was designed to be easily extended by additional image filters, deformation schemes, or new generic models. Results obtained on one subject demonstrate that the method can be used to quantify the effects of postures on skeleton and organs. The spinal curvature, the pelvic parameters and the volume of the thoracic cavity were affected by the four postures. The volumes of the kidneys, spleen, liver and abdominal object were mostly unaffected. The movement of organs was coherent with the effect of gravity. The deformation of organs between postures was expressed using geometrical transformations. Investigations should be pursued on a larger population to confirm the patterns observed on the first subject.     

Rotation sequence is an important factor in shoulder kinematics. Application to the elite players’ flat serves

The aim of this study was to test three different rotation sequences (YXY, ZXY, and XZY) on the shoulder kinematics (rotations of the humerus relative to the thorax) during an original movement such as the tennis flat serve (FS). Nine elite male and female players performed a minimum of five flat serves. An optoelectronic motion analysis system was used to record the movements. Segment kinematics during each FS was reconstructed from the spatial trajectories of the markers according to ISB recommendations. For each rotation sequence, three angles were reported for the shoulder joint, each corresponding to a rotation component around a defined axis. The occurrence of gimbal lock (GL) and angle amplitude coherences were examined. From these three rotation sequences tested, it appears that the XZY sequence was the only decomposition not to suffer from GL. Moreover, the rotation sequence XZY was found to be coherent for all rotation components. Thus, these results show that the best rotation sequence, from both GL and amplitude coherence points of view, is XZY to describe the shoulder kinematics during the tennis serve.