Finite element modeling for predicting the contact pressure between a foam mattress and the human body in a supine position

In this paper, we generated finite element (FE) models to predict the contact pressure between a foam mattress and the human body in a supine position. Twenty-year-old males were used for three-dimensional scanning to produce the FE human models, which was composed of skin and muscle tissue. A linear elastic isotropic material model was used for the skin, and the Mooney–Rivlin model was used for the muscle tissue because it can effectively represent the nonlinear behavior of muscle. The contact pressure between the human model and the mattress was predicted by numerical simulation. The human models were validated by comparing the body pressure distribution obtained from the same human subject when he was lying on two different mattress types. The experimental results showed that the slope of the lower part of the mattress caused a decrease in the contact pressure at the heels, and the effect of bone structure was most pronounced in the scapula. After inserting a simple structure to function as the scapula, the contact pressure predicted by the FE human models was consistent with the experimental body pressure distribution for all body parts. These results suggest that the models proposed in this paper will be useful to researchers and designers of products related to the prevention of pressure ulcers.     

Comparison of contact pressures measured at the sacrum of young and elderly subjects

Contact (interface) pressure measurements were made between the sacrum of groups of young and elderly subjects lying upon two special mattresses used to prevent pressure sores. One mattress was an alternating air pressure mattress, the other a foam mattress. Contact pressures were measured using a hydraulic sensor taped directly to the skin over the sacrum. All mean pressures and ‘pressure impulses’ (total applied pressure per standard time period) appeared higher when measured among the elderly subjects. Compared with the pressures measured from young subjects, the maximum contact pressures were significantly higher (p < 0.05) on both mattresses, with the pressure impulse higher while lying upon the foam mattress (p < 0.05).     

Could martial arts fall training be safe for persons with osteoporosis?: a feasibility study

Background

Osteoporosis is a well-established risk factor for fall-related hip fractures. Training fall arrest strategies, such as martial arts (MA) fall techniques, might be useful to prevent hip fractures in persons with osteoporosis, provided that the training itself is safe. This study was conducted to determine whether MA fall training would be safe for persons with osteoporosis extrapolated from the data of young adults and using stringent safety criteria.

Methods

Young adults performed sideways and forward MA falls from a kneeling position on both a judo mat and a mattress as well as from a standing position on a mattress. Hip impact forces and kinematic data were collected. For each condition, the highest hip impact force was compared with two safety criteria based on the femoral fracture load and the use of a hip protector.

Results

The highest hip impact force during the various fall conditions ranged between 1426 N and 3132 N. Sideways falls from a kneeling and standing position met the safety criteria if performed on the mattress (max 1426 N and 2012 N, respectively) but not if the falls from a kneeling position were performed on the judo mat (max 2219 N). Forward falls only met the safety criteria if performed from a kneeling position on the mattress (max 2006 N). Hence, forward falls from kneeling position on a judo mat (max 2474 N) and forward falls from standing position on the mattress (max 3132 N) did not meet both safety criteria.

Conclusions

Based on the data of young adults and safety criteria, the MA fall training was expected to be safe for persons with osteoporosis if appropriate safety measures are taken: during the training persons with osteoporosis should wear hip protectors that could attenuate the maximum hip impact force by at least 65%, perform the fall exercises on a thick mattress, and avoid forward fall exercises from a standing position. Hence, a modified MA fall training might be useful to reduce hip fracture risk in persons with osteoporosis.

     

A new instrument for the measurement of forces on beds and seats

Knowledge of the interaction of forces between persons and the bed in which they lie or the seat on which they are sitting, provides an insight into the loading of their muscles, bones and soft tissue. To determine the total forces on the body-supporting surfaces (backrest, seat pan, foot rest) resolved in components perpendicular and parallel to these surfaces a new instrument has been developed, with which the forces perpendicular and parallel to three different freely adjustable body-supporting surfaces can be registered. During the first measurements the forces on a bed were measured when a person sits in a bed with the backrest at an angle of 45° to the horizontal and the mattress horizontal. The measurements on a healthy population (mean mass = 77 kg, sd = 11 kg) showed an accuracy of ± 10 N. In this position the mean shear force on the seat pan was 97 N.     

Three-dimensional finite element analysis of the foot during standing--a material sensitivity study

Information on the internal stresses/strains in the human foot and the pressure distribution at the plantar support interface under loading is useful in enhancing knowledge on the biomechanics of the ankle-foot complex. While techniques for plantar pressure measurements are well established, direct measurement of the internal stresses/strains is difficult. A three-dimensional (3D) finite element model of the human foot and ankle was developed using the actual geometry of the foot skeleton and soft tissues, which were obtained from 3D reconstruction of MR images. Except the phalanges that were fused, the interaction among the metatarsals, cuneiforms, cuboid, navicular, talus, calcaneus, tibia and fibula were defined as contact surfaces, which allow relative articulating movement. The plantar fascia and 72 major ligaments were simulated using tension-only truss elements by connecting the corresponding attachment points on the bone surfaces. The bony and ligamentous structures were embedded in a volume of soft tissues. The encapsulated soft tissue was defined as hyperelastic, while the bony and ligamentous structures were assumed to be linearly elastic. The effects of soft tissue stiffening on the stress distribution of the plantar surface and bony structures during balanced standing were investigated. Increases of soft tissue stiffness from 2 and up to 5 times the normal values were used to approximate the pathologically stiffened tissue behaviour with increasing stages of diabetic neuropathy. The results showed that a five-fold increase in soft tissue stiffness led to about 35% and 33% increase in the peak plantar pressure at the forefoot and rearfoot regions, respectively. This corresponded to about 47% decrease in the total contact area between the plantar foot and the horizontal support surface. Peak bone stress was found at the third metatarsal in all calculated cases with a minimal increase of about 7% with soft tissue stiffening.     

The effect of surgical floor mats in prolonged standing: an EMG study of the lumbar paraspinal and anterior tibialis muscles

The purpose of this study was to determine whether or not surgical floor mats affect low back and leg muscle activity during prolonged standing. The EMG activity was measured continuously using surface electrodes on the paraspinal muscles of the low back and on the anterior tibialis muscles; the subjects were normal and stood on two different surfaces. Six male subjects were each instructed to stand for two hours on a specially designed surgical floor mat and then, on a separate day, to stand for two hours on a linoleum-covered concrete surface. Six other subjects carried out the same procedure, but stood on the linoleum first. There was no difference in EMG activity obtained from the anterior tibialis muscles and paraspinal muscles of the low back when the subjects stood on the surgical mat, as compared with the linoleum-covered concrete.     

Predicting changes in knee adduction moment due to load-altering interventions from pressure distribution at the foot in healthy subjects

The purpose of this pilot study of healthy subjects was to determine if changes in foot pressure patterns associated with a lateral wedge can predict the changes in the knee adduction moment. We tested two hypotheses: (1) increases or decreases in the knee adduction moment and ankle eversion moment due to load-altering footwear interventions can be predicted from foot pressure distribution and (2) changes in magnitude of the knee adduction moment and ankle eversion moment due to lateral wedges can be predicted from pressure distribution at the foot during walking. Fifteen healthy adults performed walking trials in three shoes: 0 degrees , 4 degrees , and 8 degrees laterally wedged. Maximum heel pressure ratio, first peak knee adduction moment, and peak ankle eversion moment were assessed using a pressure mat, motion capture system, and force plate. Increases or decreases in the knee adduction moment and ankle eversion moment were predicted well from foot pressure distribution. However, the magnitude of the pressure change did not predict the magnitude of the peak knee adduction moment change or peak ankle eversion moment change. Factors such as limb alignment or trunk motion may affect the knee adduction moment and override a direct relationship between the pressure distribution at the shoe-ground interface and the load distribution at the knee. However, changes (increases or decreases) in the peak knee adduction moment due to load-altering footwear interventions predicted from pressure distribution during walking can be important when evaluating these types of interventions from a clinical perspective.     

A synthesis of interstitial fluid regulation and lymph formation.

The interstitial fluid spaces are filled with a mat of collagen fibers, and the interstices of this mat contain a mucopolysaccharide gel ground substance. Both the collagen fibers and the gel are elastic structures that can be expanded or compacted. In the expanded state the collagen fibers are pushed far apart and pockets of free fluid develop witin the gel. In the compacted state the elastic recoil of the compressed collagen fibers and gel reticular fibrillae seems to cause suction on the fluid within the tissue spaces, thus creating a subatmospheric pressure. Measurements of interstitial fluid pressure using a perforated capsule method indicate that this is normally slightly negative (subatmospheric) in most soft tissues. However, even very slight extra filtration of fluid into the tissue spaces increases the interstitial fluid pressure toward more positive values, which in turn increases lymph flow. The increased lymph flow then decreases the interstitial fluid volume and pressure back toward normal because of two mechanism, 1) direct removal of fluid from the tissue spaces in the lymph, and 2) removal of protein from the interstitial fluid in the lymph, thus decreasing the interstitial fluid colloid osmotic pressure and allowing more effective osmosis of fluid directly from the interstitial spaces back into the capillaries.     

Effect of Different Levels of Pressure Relieving Air-Mattress Firmness on Cough Strength

Cough is an important host-defense mechanism. The elderly and patients who are severely ill cannot cough effectively when lying in the supine position. Furthermore, pressure relieving air-mattresses are recommended for preventing the development of pressure ulcers. In this study, we clarified whether or not the cough peak flow (CPF), an index of cough strength, is affected by different firmness levels of a pressure relieving air-mattress in healthy volunteers in the supine position. Fifty-two healthy young men participated. All the measurements were carried out on each participant in the supine position on a pressure relieving air-mattress. The participants were assessed at two firmness levels, a “hard” and “soft” mode. The CPF, forced vital capacity (FVC), maximal expiratory pressure (PEmax), and maximal inspiratory pressure (PImax) were determined for each mode. The sinking distance of the body into the mattress was measured without any activity and the difference between the sinking distances of the two firmness levels was determined. The CPF, FVC, PEmax, and PImax were determined for each mode. The sinking distance of the body into the mattress was measured and the difference between the sinking distances of the two firmness levels was determined. The CPF, FVC, PEmax and PImax values of the participants coughing on the mattress were significantly lower when the mattress was in “soft” than in “hard” mode. The differences between the sinking distances of the mattress in “soft” and “hard” modes were larger for the anterior superior iliac spine. A harder mattress may lead to increased CPF in healthy young men lying in the supine position, and increased CPF may be important for host defense.     

Effect of peak pressure and pressure gradient on subsurface shear stresses in the neuropathic foot

The pressure distribution on the plantar surface of the foot may provide insights into the stresses within the subsurface tissues of patients with diabetes mellitus and peripheral neuropathy (PN) who are at risk for skin breakdown. The purposes of this study were to (1) estimate the stress distribution in the subsurface soft tissue from a measured surface pressure distribution and determine any differences between values in the forefoot and rearfoot, and (2) determine the relationship between maximum shear stress (MSS) (magnitude and depth) and characteristics of the pressure distribution. The measured in-shoe pressure distributions during walking characterized by the peak plantar pressure and maximum pressure gradient on the plantar surface of the feet for 20 subjects with diabetes, PN and history of a mid foot or forefoot plantar ulcer were analyzed. The effects of peak pressure and maximum pressure gradient at the peak pressure location on the stress components in the subsurface soft tissue were studied using a potential function method to estimate the subsurface tissue stress. The calculated MSSs are larger in magnitude and located closer to the surface in the forefoot, where most skin breakdown occurs, compared to the rearfoot. In addition, the MSS (magnitude and depth) is highly correlated with the pressure gradient (r=-0.77 & 0.61) and the peak pressure (r=-0.61 & 0.91). The peak pressure and the maximum pressure gradient obtained from the surface pressure distribution appear to be important variables to identify where MSSs are located in the subsurface tissues on the plantar foot that may lead to skin break down.     

Automatic sleep/wake scoring from body motion in bed: validation of a newly developed sensor placed under a mattress

The purpose of this study was to formulate a "sleep/wake" scoring algorithm for processing activity measurements obtained using a newly developed nonwear actigraphy (NWA) device, and to test its validity. The NWA device has a highly sensitive pressure sensor and is placed under a mattress. It can continuously record the activity of a person lying on the mattress and identify an "in-bed/out-of-bed" state from the vibrations of the mattress. We formulated the sleep/wake scoring algorithm by using data obtained simultaneously by wrist actigraphy (Act) and the NWA device in 33 healthy participants. Agreement rate, sensitivity, and specificity with Act were 95.7%, 97.6%, and 75.8% (33 healthy people); the corresponding values were 85.9%, 89.1%, and 79.8% for 12 nursing home residents and 93.7%, 97.2%, and 60.8% for 60 nights for 6 healthy persons who slept 10 nights on their futons. Agreement rate, sensitivity, and specificity with polysomnography were in almost perfect agreement with Act (12 nights; 6 healthy persons who slept 2 nights). All our validation results indicate that the NWA device, placed under a mattress or a futon, can produce almost identical sleep/wake scores to Act. It is expected that the NWA device, a nonwear device for scoring sleep/wake and in-bed/out-of-bed, enables convenient long-term sleep-related evaluation in various fields, including hospital settings, home-care settings, and care facility settings such as nursing homes.     

Ecology of yellowstone thermal effluent systems: Intersects of blue-green algae,grazing flies (Paracoenia,Ephydridae) and water mites (Partnuniella,Hydrachnellae)

Summary As subjects for ecosystem studies, thermal spring effluents offer the advantages of trophic diversity with taxonomic simplicity, ease of sampling, replicability, world-wide distribution and manipulability. The dominant primary producers (filamentous blue-green algae) are grazed by ephydrid flies. These in turn harbor larvae of the water mite Partnuniella. The high instrinic rate of increase of the fly enables it to exploit temporary cool spots in the mat. The lower fecundity and longer life cycle of the mite restrict its ability to exploit temporarily suitable habitat. Thus the intersect of mites with flies is a sensitive measure of stability in the algal mat. Springs with a variable-flow pattern and consequent mat instability had both a lower mean incidence of parasitism and a lower mean larval load per fly. The data support our hypothesis that the abundance and relative densities of organisms in higher trophic levels can be predicted from knowledge of the growth and stability patterns of the filamentous blue-green algal mat in thermal spring effluents.     

Analysis of induced electrical currents from magnetic field coupling inside implantable neurostimulator leads

Background

A proper sleep system can affect the spine support in neutral position. Most of the previous studies in scientific literature have focused on the effects of customary mattresses on the spinal alignment. To keep the spine in optimal alignment, one can use sleep surfaces with different zonal elasticity, the so called custom-made arrangements. The required stiffness of a sleep surface for each individual can be obtained by changing this arrangement applying the experimental method and modeling.

Methods

In experimental part, the coordinate positions of the markers mounted on the spinous processes of the vertebrae of 25 male volunteers were registered in frontal plane through the optical tracking method and so the spinal alignment was obtained in lateral sleep position on soft and firm surfaces and on the best custom-made arrangement. Thereupon the π-P₈ angles were extracted from these alignments and then were compared with each other. In modeling part the anthropometric data of four different types of volunteers were used. And then the models built in BRG.LifeMOD (ver. 2007, Biomechanics Research Group, Inc., USA) based on these data and in accordance with the experimental tests, were analyzed.

Results

The one way ANOVA statistical model and the post hoc tests showed a significant difference in the π-P₈ angles between soft & custom-made and soft & firm mattresses at the p = 0.001 level and between firm & soft mattresses at the p = 0.05 level. In modeling part, the required stiffness of the sleep surface for four weight-dimensional groups was acquired quantitatively.

Conclusions

The mattress with a custom-made arrangement is a more appropriate choice for heavier men with pronounced body contour. After data fitting, it was observed that the variations of spinal alignment obtained from both methods have the same trend. Observing the amount of required stiffness obtained for the sleep surface, can have a significant effect on keeping the spine healthy.     

Less frequent turning intervals and yet less pressure ulcers

The aim of the doctoral dissertation summarised here, was to study the effect of different turning intervals and to optimise this method of pressure ulcer prevention. Prior to the main study, the pressure reducing effect of mattresses, cushions, sitting and lying positions was investigated. Based on the results of 3 pre-studies, 4 different turning schemes were compared in a randomised controlled trial in 838 high-risk nursing home residents. Turning every 4 hours in combination with the use of a pressure reducing viscoelastic mattress reduced the number of pressure ulcers significantly compared to the other 3 schemes: turning every 6 hours on a viscoelastic mattress, and turning every 2 or 4 hours on a non-pressure reducing mattress.     

Whole-body vibration increases upper and lower body muscle activity in older adults: potential use of vibration accessories

The current study examined the effects of whole-body vibration (WBV) on upper and lower body muscle activity during static muscle contractions (squat and bicep curls). The use of WBV accessories such as hand straps attached to the platform and a soft surface mat were also evaluated. Surface electromyography (sEMG) was measured for the medial gastrocnemius (MG), vastus lateralis (VL), and biceps brachii (BB) muscles in fourteen healthy older adults (74.8±4.5 years; mean±SD) with a WBV stimulus at an acceleration of 40 m s(-2) (30 Hz High, 2.5 mm or 46 Hz Low, 1.1 mm). WBV increased lower body (VL and MG) sEMG vs baseline (no WBV) though this was decreased with the use of the soft mat. The addition of the bicep curl with hand straps had no effect on lower body sEMG. WBV also increased BB sEMG vs baseline which was further increased when using the hand straps. There was no upper body effect of the soft mat. This study demonstrates WBV increases both lower and upper body muscle activity in healthy older adults. Moreover, WBV accessories such as hand straps attached to the platform or a soft surface mat may be used to alter exercise intensity.     

Finite Element Analysis of the Contact Mechanics of Ceramic-on-Ceramic Hip Resurfacing Prostheses

<正> Ceramics are good alternative to metal as bearing couple materials because of their better wear resistance. A Finite Element(FE) study was performed to investigate the contact mechanics and stress distribution of Ceramic-on-Ceramic (COC) hip resurfacingprostheses. It was focused in particular on a parametric study to examine the effects of radial clearance, loading,alumina coating on the implants, bone quality, and fixation of cup-bone interface. It was found that a reduction in the radialclearance had the most significant effect on the predicted contact pressure distribution among all of the parameters considered inthis study. It was determined that there was a significant influence of non-metallic materials, such as the bone underneath thebearing components, on the predicted contact mechanics. Stress shielding within the bone tissue was found to be a major concernwhen regarding the use of ceramic as an alternative to metallic resurfacing prostheses. Therefore, using alumina implantswith a metal backing was found to be the best design for ceramic resurfacing prostheses in this study. The loading, bone quality,and acetabular cup fixation conditions were found to have only minor effects on the predicted contact pressure distribution alongthe bearing surfaces.     

Can loaded interface characteristics influence strain distributions in muscle adjacent to bony prominences?

Pressure distributions at the interface between skin and supporting tissues are used in design of supporting surfaces like beds, wheel chairs, prostheses and in sales brochures to support commercial products. The reasoning behind this is, that equal pressure distributions in the absence of high pressure gradients is assumed to minimise the risk of developing pressure sores. Notwithstanding the difficulty in performing reproducible and accurate pressure measurements, the question arises if the interface pressure distribution is representative of the internal mechanical state of the soft tissues involved. The paper describes a study of the mechanical condition of a supported buttock contact, depending on cushion properties, relative properties of tissue layers and friction. Numerical, mechanical simulations of a buttock on a supporting cushion are described. The ischial tuberosity is modelled as a rigid body, whereas the overlying muscle, fat and skin layers are modelled as a non-linear Ogden material. Material parameters and thickness of the fat layer are varied. Coulomb friction between buttock and cushion is modelled with different values of the friction coefficient. Moreover, the thickness and properties of the cushion are varied. High shear strains are found in the muscle near the bony prominence and the fat layer near the symmetry line. The performed parameter variations lead to large differences in shear strain in the fat layer but relatively small variations in the skeletal muscle. Even with a soft cushion, leading to a high reduction of the interface pressure the deformation of the skeletal muscle near the bone is high enough to form a risk, which is a clear argument that interface pressures alone are not sufficient to evaluate supporting surfaces.     

Influence of static magnetic fields on pain perception and sympathetic nerve activity in humans.

Static and pulsed magnetic fields have been reported to have a variety of physiological effects. However, the effect of static magnetic fields on pain perception and sympathetic function is equivocal. To address this question, we measured pain perception during reproducible noxious stimuli during acute exposure to static magnets. Pain perception, muscle sympathetic nerve activity, mean arterial pressure, heart rate, and forearm blood velocity were measured during rest, isometric handgrip, postexercise muscle ischemia, and cold pressor test during magnet and placebo exposure in 15 subjects (25 +/- 1 yr; 8 men and 7 women) following 1 h of exposure. During magnet exposure, subjects were placed on a mattress with 95 evenly spaced 0.06-T magnets imbedded in it. During placebo exposure, subjects were placed on an identical mattress without magnets. The order of the two exposure conditions was randomized. At rest, no significant differences were noted in muscle sympathetic nerve activity (8 +/- 1 and 7 +/- 1 bursts/min for magnet and placebo, respectively), mean arterial pressure (91 +/- 3 and 93 +/- 3 mmHg), heart rate (63 +/- 2 and 62 +/- 2 beats/min), and forearm blood velocity (3.0 +/- 0.3 and 2.6 +/- 0.3 cm/s). Magnets did not alter pain perception during the three stimuli. During all interventions, no significant differences between exposure conditions were found in muscle sympathetic nerve activity and hemodynamic measurements. These results indicate that acute exposure to static magnetic fields does not alter pain perception, sympathetic function, and hemodynamics at rest or during noxious stimuli.     

Usage of high‐performance mattresses for transport of Indo‐Pacific bottlenose dolphin

Ground transport can be a stressful operation for dolphins if the long period of restraint causes damage to internal organs, especially to the lung, generated by their own weight. Buoyancy is deprived from dolphins under moist transport, in which dolphins are transported on mattresses. Upgrading mattresses is an effective way to modify the transportation method so as to compensate for the loss of buoyancy. In Indo‐Pacific bottlenose dolphins (Tursiops aduncus), we tried to find mattresses that performed well at distributing the dolphins' weight and preserved their pulmonary function. When using EV‐17 (thickness, 50 mm) put on EE‐20 (thickness, 50 mm), a wider support area, less extreme changes in pressure, and lower maximum pressures were observed compared with other mattress systems tested. On this mattress system, lower breathing rates, lower heart rates, and higher exhaled CO₂ concentrations were shown compared with using standard mattresses. These results suggest that the performance of the combination of EV‐17 and EE‐20 is better than that of the standard mattress in terms of the cardiopulmonary function of dolphins. Zoo Biol 27:331–340, 2008. © 2008 Wiley‐Liss, Inc.