A biomechanical evaluation of whiplash using a multi-body dynamic model

This paper presents a biomechanical evaluation of whiplash injury potential during the initial extension motion of the head in a rear-end collision. A four-segment dynamic model is developed in the sagittal plane for the analysis. The model response is validated using the existing experimental data and is shown to simulate the "S-shape" kinematics of the cervical spine and the resulting dynamics observed in human and cadaver experiments. The model is then used to evaluate the effects of parameters such as collision severity, head/headrest separation, and the initial head orientation in the sagittal plane on the "S-shape" kinematics of the cervical spine and the resulting neck loads. It is shown, for example, that the cervical spine forms an "S-shape" for a range of change in speeds and that at lower and higher speeds changes the spine does not form the "S-shape." Furthermore, it is shown that the "S-shape" formation also depends on the head to headrest separation distance.     

Establishing reference values for cervical spine range of motion in pre-pubescent children

Medical professionals, physical therapists, product designers, and computational models all use cervical spine range of motion reference values. To support these functions, researchers have collected a plethora of data to determine the normal range of motion of the cervical spine of adult subjects. However, little to no data exists for subjects under the age of 14. This study utilized the cervical range of motion device, referenced with respect to the Frankfort Plane, to measure the active cervical spine range of motion in all three cardinal planes of the human body, for 106 subjects whose ages ranged from 8 to 10 years. The active range of motion for flexion, extension, lateral extension, and rotation was calculated as 66+/-13 degrees , 85+/-14 degrees , 58+/-8 degrees , and 77+/-7 degrees , respectively, using linear statistics. The observed data significantly differed from the published American Medical Association guidelines for adults but fell within the range of the reference values for 10 year olds. Stratifying and analyzing the range of motion data with respect to gender yielded no significant effect. Appendix A analyzes the data using angular statistics, and produces virtually identical results as those from linear statistics.     

Examining motion in the cervical spine II: characterization of coupled joint motion using an opto-electronic device to track skin markers

Analysis of coupled motion in the cervical spine may be useful in helping to identify injuries. In order to investigate this possibility, the nature of coupled motion in the spine and previous investigations on this subject are reviewed here. An enhanced set of displays are developed for an existing opto-electronic device employed for the non-invasive measurement of movement in the upper spine. This instrument consists of a high resolution motion analysis system which tracks small infrared emitting diodes (IREDs). Kinematic data for the motion of the markers is processed and absolute coordinates for the location of each IRED at any time are tabulated; coupled motion with respect to a fixed calibration frame, as well as for vertebrae relative to each other, is deduced from these. Overall analysis provided by the original device includes assessment of cervical lordosis, thoracic kyphosis, and inter-segmental mobility. Characterization of coupled motion, in particular, involves a series of plots showing principal versus secondary motion. Principal movements include flexion-extension, lateral bending, and axial rotation, corresponding to motion in the sagittal, transverse, and horizontal planes, respectively. Mobility is represented in terms of the direction angles made by virtual vectors orthogonal to the planes made by markers on the head, neck, and shoulders. Development of the enhanced displays and the required refinements are described. Precision of the deduced angles is found to be approximately 1°. This representation of coupled motion is expected to be valuable in improving the accuracy of attempts to identify normal versus pathological motion in the cervical spine.     

Morphological aspects and biomechanical properties of the vertebroaxial joint (C2-C3).

The C2-C3 intervertebral joint must be regarded as a transitional area situated between the upper cervical spine where most rotation of the neck and little flexion and extension occur and the lower cervical spaces where chiefly motion in the sagittal plane and also somewhat rotation take place. Under normal circumstances the range of flexion-extension reaches 11 degrees, slighter than below (19.5 degrees at C5-C6); on the opposite, the range of rotation attains 7 degrees; less than above but much more than below (0 degrees at C5-C6). The motion in the sagittal and coronal planes is relatively poor because of the location of Penning's motor-axis of C2 which runs far from the vertebral body and the lowness of the intervertebral disc. However, the rotation of C2 with respect to C3 is fair by the peculiar inclination of the articular facets which slope sagittally but also coronally and trace a sphere whereupon C2 may move around its motor-centre in any plane. When C2-C3 is surgically fixed by bone graft, the lack of motion is completed by a "compensatory movement" in the upper cervical spaces and especially at the atlantooccipital joint for flexion-extension. In the same way, C2-C3 may improve its mobility especially in the sagittal plane when the inferior partner is blocked by surgical or arthritic fusion.     

Spinal constraint modulates head instantaneous center of rotation and dictates head angular motion

The head is kinematically constrained to the torso through the spine and thus, the spine dictates the amount of output head angular motion expected from an input impact. Here, we investigate the spinal kinematic constraint by analyzing the head instantaneous center of rotation (HICOR) with respect to the torso in head/neck sagittal extension and coronal lateral flexion during mild loads applied to 10 subjects. We found the mean HICOR location was near the C5-C6 intervertebral joint in sagittal extension, and T2-T3 intervertebral joint in coronal lateral flexion. Using the impulse-momentum relationship normalized by subject mass and neck length, we developed a non-dimensional analytical ratio between output angular velocity and input linear impulse as a function of HICOR location. The ratio was 0.65 and 0.50 in sagittal extension and coronal lateral flexion respectively, implying 30% greater angular velocities in sagittal extension given an equivalent impulse. Scaling to subject physiology also predicts larger required impulses given greater subject mass and neck length to achieve equivalent angular velocities, which was observed experimentally. Furthermore, the HICOR has greater motion in sagittal extension than coronal lateral flexion, suggesting the head and spine can be represented with a single inverted pendulum in coronal lateral flexion, but requires a more complex representation in sagittal extension. The upper cervical spine has substantial compliance in sagittal extension, and may be responsible for the complex motion and greater extension angular velocities. In analyzing the HICOR, we can gain intuition regarding the neck’s role in dictating head motion during external loading.     

Analysis of 3D multi-segment lumbar spine motion during gait and prone hip extension

Modeling the lumbar spine as a single rigid segment does not consider the relative contribution of regional or segmental motion that may occur during a task. The current study used a multi-segment model to measure three-dimensional (3D) upper and lower lumbar spine motion during walking and prone hip extension (PHE). The degree of segmental redundancy during these movements was assessed by calculating the cross-correlation of the segmental angle time series (R₀) and the correlation of the segmental ranges of motion (R_ROM). All correlation coefficients (R₀, R_ROM) were interpreted as follows: very strong (0.80–1.00), strong (0.60–0.79), moderate (0.40–0.59), weak (0.20–0.39), and very weak (0.00–0.19). Strong/very strong positive R₀ were demonstrated between the two segments in all three planes during PHE and in the transverse plane during walking. Weak/moderate R₀ were demonstrated in the sagittal and frontal planes during walking. Strong/very strong positive R_ROM were demonstrated in the transverse plane during PHE, and moderate positive R_ROM was demonstrated in the sagittal plane during walking. Non-significant R_ROM were demonstrated for all other planes and movements. These results suggest the motion patterns of the upper and lower lumbar regions during walking and PHE are sufficiently distinct to warrant the use a multi-segment model for these movements. It also appears that the degree of redundancy between the upper and lower lumbar regions may be task-dependent.     

Assessment of the functional method of hip joint center location subject to reduced range of hip motion

Motion analysis of the lower extremities usually requires determination of the location of the hip joint center. The results of several recent studies have suggested that kinematic and kinetic variables calculated from motion analysis data are highly sensitive to errors in hip joint center location. "Functional" methods in which the location of the hip joint center is determined from the relative motion of the thigh and pelvis, rather than from the locations of bony landmarks, are promising but may be ineffective when motion is limited. The aims of the present study were to determine whether the accuracy of the functional method is compromised in young and elderly subjects when limitations on hip motion are imposed and to investigate the possibility of locating the hip joint center using data collected during commonly studied motions (walking, sit-to-stand, stair ascent, stair descent) rather than using data from an ad hoc trial in which varied hip motions are performed. The results of the study suggested that functional methods would result in worst-case hip joint center location errors of 26mm (comparable to the average errors previously reported for joint center location based on bony landmarks) when available hip motion is substantially limited. Much larger errors ( approximately 70mm worst-case), however, resulted when hip joint centers were located from data collected during commonly performed motions, perhaps because these motions are, for the most part, restricted to the sagittal plane. It appears that the functional method can be successfully implemented when range of motion is limited but still requires collection of a special motion trial in which hip motion in both the sagittal and frontal planes is recorded.     

Examining motion in the cervical spine I: imaging systems and measurement techniques

Instruments for measuring mobility in the cervical spine range from plumb-lines and inclinometers to sophisticated optoelectronic systems. In order to investigate the need and possible uses for an enhancement to a new diagnostic instrument, we examine some of the available diagnostic systems suitable for cervical motion analysis. These should be of practical use in a clinical setting for the diagnosis of soft tissue injuries. We begin by evaluating the respective roles of plain radiographs, cineradiography, computer tomography, and magnetic resonance imaging in examining the cervical spine. Then we consider Moiré photography, inclinometers, and some opto-electronic scanners, as well as the mathematical techniques needed to correlate skin and spine motion with these devices. We find that there does not appear to be an effective non-invasive tool for comprehensive clinical cervical motion analysis; in particular, coupled joint motion is inadequately quantified. Improperly diagnosed cervical spine injuries, such as hyperextension and hyperflexion, may result in chronic long-term effects. Therefore, instrumentation that would permit objective, routine clinical evaluation of patients could help to avoid such situations.     

Lumbar spine angles and intervertebral disc characteristics with end-range positions in three planes of motion in healthy people using upright MRI

Understanding changes in lumbar spine (LS) angles and intervertebral disc (IVD) behavior in end-range positions in healthy subjects can provide a basis for developing more specific LS models and comparing people with spine pathology. The purposes of this study are to quantify 3D LS angles and changes in IVD characteristics with end-range positions in 3 planes of motion using upright MRI in healthy people, and to determine which intervertebral segments contribute most in each plane of movement. Thirteen people (average age = 24.4 years, range 18–51 years; 9 females; BMI = 22.4 ± 1.8 kg/m²) with no history of low back pain were scanned in an upright MRI in standing, sitting flexion, sitting axial rotation (left, right), prone on elbows, prone extension, and standing lateral bending (left, right). Global and local intervertebral LS angles were measured. Anterior-posterior length of the IVD and location of the nucleus pulposus was measured. For the sagittal plane, lower LS segments contribute most to change in position, and the location of the nucleus pulposus migrated from a more posterior position in sitting flexion to a more anterior position in end-range extension. For lateral bending, the upper LS contributes most to end-range positions. Small degrees of intervertebral rotation (1–2°) across all levels were observed for axial plane positions. There were no systematic changes in IVD characteristics for axial or coronal plane positions.     

Predicted region of stability for balance recovery: motion at the knee joint can improve termination of forward movement

Earlier experimental studies on balance recovery following perturbation have identified two discrete strategies commonly employed by humans, i.e. hip and ankle strategies. It has hence been implied that the knee joint plays a relatively minor role in balance recovery. The purpose of this study was to determine whether the size of the feasible stability region (FSR) would be affected by allowing knee motion in sagittal plane movement termination. The FSR was defined as the feasible range of anterior velocities of the center of mass (COM) of a human subject that could be reduced to zero with the final COM position within the base of support (BOS) limits. The FSR was computed using a four-segment biomechanical model and optimization routine based on Simulated Annealing algorithm for three scenarios: unrestricted knee motion (UK), restricted knee motion (RK), and unrestricted knee motion with an initial posture that matches RK (UKM). We found that movement termination could benefit little from UK condition when the COM (x_COM) was initially located in the forefoot region [0.00 (toe) >x_COM−0.50 (mid-foot)] with no more than a 17% increase in FSR compared to RK. The effect of knee motion increased in the rear foot region with a 25% increase in FSR at x_COM=−1 (heel). Close to half of this difference (12%) was attributable to the knee-related restriction on initial posture and the rest to movement termination per se. These findings illustrated a theoretical role of knee motion in standing humans’ repertoire of effective posture responses, which include hip and ankle strategies and their variants for balance recovery with stationary BOS.     

Sagittal plane kinematics of the adult hyoid bone

The hyoid bone is a unique bone in the skeleton not articulated to any other bone. The hyoid muscles, which attach to the hyoid bone, may play a role in neck mechanics, but analysis of their function requires quantifying hyoid bone mechanics. The goal of this study was to obtain the detailed kinematics of the hyoid bone over a large range of flexion-extension motion using radiographs at 5 postures. The position of the hyoid bone in the sagittal plane was characterized with respect to head, jaw, and vertebral movements. Sex differences in hyoid kinematics were also investigated. We hypothesized that (1) the position of the hyoid bone in the sagittal plane is linearly correlated with motion of the head, jaw, and vertebrae, and (2) the hyoid position, size, and kinematics are sex-specific. We found that the hyoid bone X, Y, and angular position generally had strong linear correlations with the positions of the head, jaw, and the cervical vertebrae C1-C4. Hyoid X and angular position was also correlated to C5. Sex differences were found in some regressions of the hyoid bone with respect to C1-C5. The angular and linear measurements of the hyoid bone showed sex differences in absolute values, which were not evident after normalization by posture or neck size. Incorporating these results to neck models would enable accurate modeling of the hyoid muscles. This may have implications for analyzing the mechanics of the cervical spine, including loads on neck structures and implants.     

Importance of nonlinear and multivariable flexibility coefficients in the prediction of human cervical spine motion

The flexibility matrix currently forms the basis for multibody dynamics models of cervical spine motion. While studies have aimed to determine cervical motion segment behavior, their accuracy and utility have been limited by both experimental and analytical assumptions. Flexibility terms have been primarily represented as constants despite the spine's nonlinear stiffening response. Also, nondiagonal terms, describing coupled motions, of the matrices are often omitted. Currently, no study validates the flexibility approach for predicting vertebral motions; nor have the effects of matrix approximations and simplifications been quantified. Therefore, the purpose of this study is to quantify flexibility relationships for cervical motion segments, examine the importance of nonlinear components of the flexibility matrix, and determine the extent to which multivariable relationships may alter motion prediction. To that end, using unembalmed human cervical spine motion segments, a full battery of flexibility tests were performed for a neutral orientation and also following an axial pretorque. Primary and coupled matrix components were described using linear and piecewise nonlinear incremental constants. A third matrix approach utilized multivariable incremental relationships. Measured motions were predicted using structural flexibility methods and evaluated using RMS error between predicted and measured responses. A full set of flexibility relationships describe primary and coupled motions for C3-C4 and C5-C6. A flexibility matrix using piecewise incremental responses offers improved predictions over one using linear methods (p<0.01). However, no significant improvement is obtained using nonlinear terms represented by a multivariable functional approach (p<0.2). Based on these findings, it is suggested that a multivariable approach for flexibility is more demanding experimentally and analytically while not offering improved motion prediction.     

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.     

Biomechanical analysis of manual lifting tasks

This paper presents the findings of a study conducted to determine peak forces generated in the human spine while the individual is engaged in lifting maximum acceptable weight. Calculations of forces and moments, acting on each body segment, were based on film data collected on four individuals for twelve variations of the manual lifting task. The variations were defined by: box-size (three different boxes were used), presence or absence of handles, and symmetry and asymmetry of the lifting task (sagittal and nonsagittal lifting). In general, lower loads were accepted for lift when lifting asymmetrically or when lifting boxes without handles or when lifting bigger boxes. However, peak forces (compressive and shear forces in the spine and ground reaction forces) for these situations were not always lower than those generated when handling either compact boxes or boxes with handles or when lifting boxes symmetrically in the sagittal plane. On the basis of these results, it was concluded that lifting loads asymmetrically or in boxes without handles or in bulky boxes is relatively much more stressful than lifting the same load symmetrically or in boxes with handles or in compact boxes.     

Approximation of the functional kinematics of posterior stabilised total knee replacements using a two-dimensional sagittal plane patello-femoral model: comparing model approximation to in vivo measurement

Previous in vivo studies have observed that current designs of posterior stabilised (PS) total knee replacements (TKRs) may be ineffective in restoring normal kinematics in Late flexion. Computer-based models can prove a useful tool in improving PS knee replacement designs. This study investigates the accuracy of a two-dimensional (2D) sagittal plane model capable of predicting the functional sagittal plane kinematics of PS TKR implanted knees against direct in vivo measurement. Implant constraints are often used as determinants of anterior–posterior tibio-femoral positioning. This allowed the use of a patello-femoral modelling approach to determine the effect of implant constraints. The model was executed using motion simulation software which uses the constraint force algorithm to achieve a solution. A group of 10 patients implanted with Scorpio PS implants were recruited and underwent fluoroscopic imaging of their knees. The fluoroscopic images were used to determine relative implant orientation using a three-dimensional reconstruction method. The determined relative tibio-femoral orientations were then input to the model. The model calculated the patella tendon angles (PTAs) which were then compared with those measured from the in vivo fluoroscopic images. There were no significant differences between the measured and calculated PTAs. The average root mean square error between measured and modelled ranged from 1.17° to 2.10° over the flexion range. A sagittal plane patello-femoral model could conceivably be used to predict the functional 2D kinematics of an implanted knee joint. This may prove particularly useful in optimising PS designs.     

MPI CyberMotion Simulator: implementation of a novel motion simulator to investigate multisensory path integration in three dimensions

Path integration is a process in which self-motion is integrated over time to obtain an estimate of one's current position relative to a starting point (1). Humans can do path integration based exclusively on visual (2-3), auditory (4), or inertial cues (5). However, with multiple cues present, inertial cues - particularly kinaesthetic - seem to dominate (6-7). In the absence of vision, humans tend to overestimate short distances (<5 m) and turning angles (<30°), but underestimate longer ones (5). Movement through physical space therefore does not seem to be accurately represented by the brain. Extensive work has been done on evaluating path integration in the horizontal plane, but little is known about vertical movement (see (3) for virtual movement from vision alone). One reason for this is that traditional motion simulators have a small range of motion restricted mainly to the horizontal plane. Here we take advantage of a motion simulator (8-9) with a large range of motion to assess whether path integration is similar between horizontal and vertical planes. The relative contributions of inertial and visual cues for path navigation were also assessed. 16 observers sat upright in a seat mounted to the flange of a modified KUKA anthropomorphic robot arm. Sensory information was manipulated by providing visual (optic flow, limited lifetime star field), vestibular-kinaesthetic (passive self motion with eyes closed), or visual and vestibular-kinaesthetic motion cues. Movement trajectories in the horizontal, sagittal and frontal planes consisted of two segment lengths (1st: 0.4 m, 2nd: 1 m; ±0.24 m/s(2) peak acceleration). The angle of the two segments was either 45° or 90°. Observers pointed back to their origin by moving an arrow that was superimposed on an avatar presented on the screen. Observers were more likely to underestimate angle size for movement in the horizontal plane compared to the vertical planes. In the frontal plane observers were more likely to overestimate angle size while there was no such bias in the sagittal plane. Finally, observers responded slower when answering based on vestibular-kinaesthetic information alone. Human path integration based on vestibular-kinaesthetic information alone thus takes longer than when visual information is present. That pointing is consistent with underestimating and overestimating the angle one has moved through in the horizontal and vertical planes respectively, suggests that the neural representation of self-motion through space is non-symmetrical which may relate to the fact that humans experience movement mostly within the horizontal plane.     

Muscle activation history at different vertical jumps and its influence on vertical velocity

In the present study we investigated displacement, time, velocity and acceleration history of center of mass (COM) and electrical activity of knee extensors to estimate the dominance of the factors influencing the vertical velocity in squat jumps (SJs), countermovement jumps (CMJs) and drop jumps (DJs) performed with small (40°) and large (80°) range of joint motion (SROM and LROM). The maximum vertical velocity (v4) was 23.4% (CMJ) and 7.8% (DJ) greater when the jumps were performed with LROM compared with SROM (p < 0.05). These differences are considerably less than it could be expected from the greater COM and knee angular displacement and duration of active state. This small difference can be attributed to the greater deceleration during eccentric phase (CMJ:32.1%, DJ:91.5%) in SROM than that in LROM. v4 was greater for SJ in LROM than for SJ in SROM indicating the significance of the longer active state and greater activation level (p < 0.001). The difference in v4 was greater between SJ and CMJ in SROM (38.6%) than in LROM (9.0%), suggesting that elastic energy storage and re-use can be a dominant factor in the enhancement of vertical velocity of CMJ and DJ compared with SJ performed with SROM.     

The penguin waddling gait pattern has a more consistent step width than step length

Previous research has indicated that the sagittal plane gait dynamics of humans are more stable and less dependent on active neural control, while the frontal plane dynamics are less stable and require greater neural control. The higher neural demands of the frontal plane dynamics are reflected in a more variable step width than step length. Greater variability in the step width occurs because humans modulate their foot placement for each step to ensure stability and prevent falls. Compared to other terrestrial animals, penguins appear to have excessive amount of frontal plane motion in their gait that is characterized as waddling. If excessive frontal plane motion requires additional neural control and is associated with falls, it would seem that evolutionary pressures would have eliminated such locomotive strategies. Here we measured the step length and width variability to determine if waddling results in a less stable gait. Remarkably, the variability of the step width was less than the variability of the step length. These results are directly opposite of what has been reported for humans. Hence, our data indicate that waddling may be an effective strategy for ensuring stability in the frontal plane dynamics.     

Three-dimensional in vivo motion of adult hind foot bones

Knowledge of hind foot bone motion is important for understanding gait as well as various foot pathologies, but the three-dimensional (3D) motion of these bones remains incompletely understood. The purpose of this study was to quantify the motion of the talus, calcaneus, navicular, and cuboid in normal adult feet during open chain quasi-static uniplanar plantar flexion motion. Magnetic resonance images of the right feet of six normal young adult males were taken from which 3D virtual models were made of each hind foot bone. The 3D motion of these models was analyzed. Each hind foot bone rotated in the same plane about half as much as the foot (mean 0.54 degrees of bone rotation per degree of foot motion, range 0.40-0.73 degrees per degree of foot motion as measured relative to the fixed tibia). Talar motion was primarily uniaxial, but the calcaneus, navicular, and cuboid bones exhibited biplanar (sometimes triplanar) translation in addition to biaxial rotation. Net translational motions of these bones averaged 0.39 mm of bone translation per degree of foot motion (range 0.06-0.62 mm per degree of foot motion). These data reflect the functional anatomy of the foot, extend the findings of prior studies, provide a standard for comparison to patients with congenital or acquired foot deformities, and establish an objective reference for quantitatively assessing the efficacy of various hind foot therapies.