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A case of an unusual degloving injury of the descending colon resulting from a crushing injury to the mid-torso is reported. The diagnosis was made at laparotomy for associated injuries. The colon was stripped of its muscle layers and mesentery for 10 cm without perforation.
During a 9-year period, 541 children were admitted with injuries sustained as passengers in motor vehicle accidents. Of these, seven (1.3 per cent) had the cervical seat belt syndrome. Five children had fractures or fracture-subluxations of the proximal cervical spine, while two had injuries of the lower cervical spine. Head injuries occurred in four children, severe cervical spinal cord injuries in three, while a fracture of the larynx and recurrent laryngeal nerve palsies occurred in one child. All children were wearing three- or four-point restraints. In the former group, the neck injuries probably resulted from flexion of the neck over the poorly fitting sash of an adult-type lap-sash belt, while in the latter group, the injuries probably resulted from hyperflexion of the neck while the torso was securely restrained. One child died from a severe head injury and a complete cervical cord injury. Satisfactory spinal alignment and stability were achieved in the surviving children by non-operative treatment. However, only three children recovered completely from their injuries. Two require continuing care for cervical spinal cord damage and one has persistent tracheal stenosis and paralysis of the vocal cords.
Segmental mechanical energy changes were studied in normal adults as a function of walking speed and in a group of subjects with pathologically impaired gait walking at their normal speed to determine the usefulness of this parameter in evaluating locomotor dysfunction. Of particular significance, the degree of exchange between potential and kinetic energy within and between limb segments was quantitatively evaluated. Due to the nature of most pathological gaits, no assumptions were made to impose symmetry between the right and left extremities and the translational as well as rotational kinetic energy of each of the limb segments was computed in three dimensions. Additionally, the torso was modeled as a group of segments with distributed mass in contrast to the commonly employed concentrated point mass model. In toto, a three dimensional twelve segment energetic analysis of the human body was developed and employed. In normal subjects, this analysis suggests a greater exchange between potential and kinetic energy near individually preferred walking speeds. Patterns of energy change noted in those subjects with locomotor dysfunction varied with the type of pathological disorder.
The intersegmental force and couple exchanged between upper and lower body across a transverse section passing through the fourth lumbar vertebra were estimated during level walking on a straight line at speeds ranging from 0.99 to 2.23 ms-1. This was done using 3-D kinematic information relative to the head, upper limbs, and upper torso, obtained through a stereophotogrammetric technique, and the relevant inertial parameters obtained using anthropometric measurements and estimation techniques provided in the literature. Twenty walking cycles of five normal adult male subjects were analysed. The intersegmental force and couple components are presented as referenced to both a laboratory and pelvic set of axes. Using these results some considerations are made concerning the variations which the overall trunk muscles effort undergoes because of mean walking speed changes. The muscular action on the trunk is inferred from the intersegmental couple components. The various factors that contribute to the build-up of the intersegmental force and couple are analysed and their relative importance assessed.
It is shown that stable biped gaits can be achieved by discrete foot placement based on feedback of information available at the time of foot placement. The model, developed by Townsend (1981, J. Biomechanics 14, p. 727) to evaluate the coordinations of torso motions, subsumes most of the salient body members and motions. The modeling yielded a generalized inverted pendulum with a movable support point which physically defines lateral foot placement. The principal result is that stable gaits can be defined by foot placements which are a linear function of the system center of mass position and velocity at the time of foot placement (only). Gaits may be 'smooth' or may have impulsive corrections to adjust the character of the motions and foot placement. Several general algorithms and specific simulations are presented, and calculations for non-impulsive gaits and impulsive corrections are presented. The model predictions are compared with published data. The predictions are sufficiently close to the data such that the general algorithms appear to be validated. Of particular interest are the non-sinusoidal character of the motions and the relatively simple algorithms. Indeed, the simplicity of the algorithms suggests the practical possibility of legged mobile robots. Accordingly, further investigation seems warranted for determining the parametric variation and control of gait. Some attention is also given to continuous-feedback control such as would exist during double-leg support and in specialized tasks such as rope walking or skating. Subsequent investigation will consider superposition of single and double leg support, although clearly the discrete gaits pose the more restrictive stability problem.
A three-dimensional lumped-parameter model of the human head/neck/upper-torso was developed to predict its motion for any specified initial conditions and that could also be used to compare with the results of other investigators. This model consists of ten rigid bodies representing the head, cervical vertebrae C1-C7, T1 and T2 combined with the rest of the torso. These rigid bodies were connected by intervertebral joints described by a stiffness matrix relating the force (moment) and translation (rotation). Fifteen pairs of muscles were incorporated in the model, represented by three-point linear elements with nonlinear constitutive relationships obtained from cadaver test results. The calculated response compared favorably with human volunteer data for both flexion and lateral whiplash. However, tests on an inanimate replica of a human indicated greater flexibility than predicted by the corresponding numerical model. The difference is believed to be due to insufficient mass of the muscles incorporated in the structure.
Effectiveness of the multi-segmented total-human-body models to predict realistically live human response depends heavily on the proper biomechanical description and simulation of the major articulating joints of the body. In these models, the most difficult and the least successful modelling of a joint has been the shoulder complex because of the lack of appropriate biomechanical data as well as the anatomical complexity of the region. This paper in Part I presents various aspects of a research program to collect three-dimensional kinematic data for the shoulder complex. A sonic digitizing technique which utilizes an overdeterminate number of sonic emitters on the moving body segment was used for the kinematics analysis. The numerical results are presented for three male subjects for their voluntary shoulder complex sinuses. The results are given in a locally-defined joint axis system as well as in the torso-fixed coordinate system in the form of globographic representation.
In recent years, multisegmented mathematical models of the total human body have gained increasing attention in view of the high cost of experiments with human cadavers and/or anthropometric dummies. While these models can simulate very complicated load-motion situations, their effectiveness depends heavily on the proper biomechanical description and modeling of the major articulating joints of the human body. In a research effort to obtain the in vivo biomechanical joint property data suitable for incorporation into these models, the senior author and his associates recently developed a new kinematic and force data collection methodology by means of sonic emitters. By applying and extending this data collection methodology, this paper in Part I presents kinematics for determination of the maximal voluntary hip complex sinus. An overdeterminate number of sonic emitters is utilized and the 'most accurate' three-dimensional kinematic data set is selected by first establishing a selection criterion. Quantitative results obtained from three male subjects are presented in a functional expansion form relative to a locally-defined joint axis system as well as in the form of globographic representation relative to the torso-fixed axis system.
A mathematical inertia model which permits the determination of personalized segmental inertia parameter values from anthropometric measurements is described. The human body is modelled using 40 geometric solids which are specified by 95 anthropometric measurements. A 'stadium' solid is introduced for modelling the torso segments using perimeter and width measurements. This procedure is more accurate than the use of elliptical discs of given width and depth and permits a smaller number of such solids to be used. Inertia parameter values may be obtained for body models of up to 20 segments. Errors in total body mass estimates from this and other models are discussed with reference to the unknown lung volumes.
This study describes the effects of varied torso muscle geometries commonly assumed in optimization-based muscle force prediction models. Specifically, the sensitivity of predicted muscle and spinal forces to assumed muscle lines-of-action (LOA) is systematically examined. The practical significance of varied muscle LOAs is addressed by determining the relative precision needed for individual muscle LOAs and assessing which muscles are more critical to accurate prediction of spinal forces. To perform this analysis a nonlinear optimization model was used to generate muscle force predictions during combined frontal and sagittal plane moment loadings with an assumed erect posture. The LOAs of the erector spinae, rectus abdominus, internal and external oblique, and latissimus dorsi were systematically varied in the frontal and sagittal planes over an anatomically feasible range. The results indicated that moderate changes in the assumed LOA could substantially alter the magnitudes of predicted muscle and spinal forces. The estimated activity level of a muscle, as well as the predicted active/silent state could be affected by the LOA of that muscle and others. The patterns of predicted muscle activity, with respect to load orientation, underwent only minor alterations with changing LOA. The relative activation of several muscles, however, was dependent on LOA, and frequently led to variations in predicted spinal compression (> 100 N change) and shear forces (> 50 N change). This dependence of estimated spinal forces on assumed muscle geometry was most pronounced for the obliques and minimal for the more vertically oriented muscles and when loads were sagittally symmetric. This study suggests that muscle LOAs are critical inputs when interpreting absolute muscle and spinal force values predicted by models of physical exertions.
The objective of this study was to determine to what extent the central nervous system activates torso muscles so as to equalize the largest muscle stresses. Two optimization models that treat large muscle stresses differently were formulated. One model minimized spinal compression force subject to the lowest possible muscle stress limit, and the other model minimized the sum of cubed muscle stresses. Experimental conditions were determined for which the two models made different muscle force predictions. Specifically, the models predicted different rectus abdominis activity levels for tasks involving torsion and extension moment loadings. Surface electromyography was used to evaluate the model predictions. Applied loads were chosen to assure that the rectus abdominis EMG exceeded 30% MVC. Analysis of variance indicated that rectus abdominis activity was not affected by torsion loading at the p < 0.05 level of significance in a statistical design having 90% power, which was consistent with the predictions of the model that minimized the sum of cubed muscle stresses. Thus, it was concluded that equalization of the largest muscles stress was not the paramount objective of the central nervous system in the tasks studied.
This study explores the inertial effects of the head and torso on cervical spine dynamics with the specific goal of determining whether the head mass can provide a constraining cervical spine end condition. The hypothesis was tested using a low friction impact surface and a pocketing foam impact surface. Impact orientation was also varied. Tests were conducted on whole unembalmed heads and cervical spines using a drop track system to produce impact velocities on the order of 3.2 m s-1. Data for the head impact forces and the reactions at T1 were recorded and the tests were also imaged at 1000 frames s-1. Injuries occurred 2-19 ms following head impact and prior to significant head motion. Average compressive load a failure was 1727 +/- 387 N. Decoupling was observed between the head and T1. Cervical spine loading due to head rebound constituted up to 54 +/- 16% of the total axial neck load for padded impacts and up to 38 +/- 30% of the total axial neck load for rigid impacts. Dynamic buckling was also observed; including first-order modes and transient higher-order modes which shifted the structure from a primarily compressive mode of deformation to various bending modes. These experiments demonstrate that in the absence of head pocketing, the head mass can provide sufficient constraint to cause cervical spine injury. The results also show that cervical spinal injury dynamics are complex, and that a large sample size of experimentally produced injuries will be necessary to develop comprehensive neck injury models and criteria.
An electrical simulation of a mechanical model of a 60 kg pregnant woman subjected to horizontal and vertical vibrations has been investigated by using a computer software package (MICRO-CAP II). The results have shown that mechanical vibrations affect the body segments differently based on their location, the kind of vibration and pregnancy development. The vibrations' effect on the body varies from segment to segment and a lady driver is affected by vibrations more than a lady passenger. Horizontal vibrations affect body segments (lower arm, upper arm, head, thorax, torso, cervical spine, and lumbar spine) more than vertical vibrations, while the thorax is affected by vertical vibrations, more than horizontal vibrations.
This study tested the possibility of obtaining the activity of deeper muscles in the torso-specifically psoas, quadratus lumborum, external oblique, internal oblique and transverse abdominis, using surface myoelectric electrodes. It was hypothesized that: (1) surface electrodes adequately represent the amplitude of deep muscles (specifically psoas, quadratus lumborum, external oblique, internal oblique, transverse abdominis); (2) a single surface electrode location would best represent the activation profiles of each deep muscle over a broad variety of tasks. We assumed that prediction of activation within 10% of maximum voluntary contraction (RMS difference between the surface and intramuscular channels), over the time history of the signal, was reasonable and acceptable to assist clinical interpretation of muscle activation amplitude, and ultimately for modeled estimates of muscle force. Surface electrodes were applied and intramuscular electrodes were inserted on the left side of the body in five men and three women who then performed a wide variety of flexor tasks (bent knee and straight leg situps and leg raises, curl ups), extensor tasks (including lifting barbells up to 70 kg), lateral bending tasks (standing lateral bend and horizontal lying side support), twisting tasks (standing and sitting), and internal/external hip rotation. Using the criteria of RMS difference and the coefficient of determination (R2) to compare surface with intramuscular myoelectric signals, the results indicated that selected surface electrodes adequately represent the amplitude of deep muscles-always within 15% RMS difference, or less with the exception of psoas where differences up to 20% were observed but only in certain maximum voluntary contraction efforts. It appears reasonable for spine modelers, and particularly clinicians, to assume well selected surface electrode locations provide a representation of these deeper muscles-as long as they recognize the magnitude of error for their particular application.
A computer model of the His-Purkinje system (HPS), based on human geometry, has been developed and used in conjunction with an atrial model and an inhomogeneous torso model to calculate electrocardiograms (ECGs) and isofield potential and magnetic maps. The calculated electric potential maximum for penetrating His bundle (HB) activity is 0.6 microV, somewhat smaller than reported by others. A calculated ECG of combined atrial and HPS activity indicates that atrial repolarization contributes to the ramp pattern observed in the PR segment. Simulated isofield distributions indicate two features that should be present in serial-measured HPS maps: (1) maps preceding HB activity should be included to illustrate the nature of the onset of HB activity and (2) maps should show a change in the location and magnitude of the extrema commensurate with the change in direction and magnitude of the source current circumscribed by the anatomy of the HB and bundle branches.
Present-day computer models of the entire heart, capable of simulating the activation isochrones and subsequently the body surface potentials, focus on considerations of myocardial anisotropy. Myocardial anisotropy enters into play at two levels, first by affecting the spatial pattern of activation owing to faster propagation along cardiac fibers and second by altering the equivalent dipole sources used to calculate the surface potentials. The construction of a new and detailed model of the human heart is described, based on 132 transverse sections obtained following a computed tomography scan of a frozen human heart whose chambers were inflated with pressurized air. The entire heart anatomy was reconstructed as a three-dimensional array of approximately 250,000 points spaced 1 mm apart. Conduction in the thin-walled atria was assumed isotropic from the sinus node region to the atrioventricular node, where it was subject to a 50 ms delay. A two-tier representation of the specialized conduction system was used, with the initial segments of the left and right bundles represented by a system of cables that feeds to the second tier, which is a sheet of conduction tissue representing the distal Purkinje system. Approximately 1,120 "Purkinje-myocardium" junctions present at the terminations of the cables and sprinkled uniformly over the sheet, transmit the excitation to the ventricles. A stylized representation of myocardial fiber rotation was incorporated into the ventricles and the local fiber direction at each model point used to compute the velocity of propagation to its nearest neighbors. Accordingly, the activation times of the entire ventricular myocardium could be determined using the 1,120 or so Purkinje-myocardium junctions as start points. While myocardial anisotropy was considered in the ventricular propagation process, it was ignored in the computation of the equivalent dipole sources. Nevertheless, the computed electrocardiogram, vectorcardiogram, and body surface potential maps obtained with the new heart model properly positioned inside an inhomogeneous torso model were all within normal limits.
Serotonin, administered intrathecally in mice, produced dose-related analgesia in the tail flick test and the subcutaneous hypertonic saline assay. Low doses (2.5-5 ng) of serotonin blocked the biting and scratching response elicited by intrathecal substance P. However, higher doses of serotonin itself elicited a behavioral syndrome characterized by scratching of the torso with the hindlimbs. Both the analgesic response and the scratching response due to serotonin were blocked by specific serotonin antagonists and the analgesia is likely mediated by a postsynaptic action on dorsal horn nociceptive neurons.
Two methods to improve on the accuracy of the Tikhonov regularization technique commonly used for the stable recovery of solutions to ill-posed problems are presented. These methods do not require a priori knowledge of the properties of the solution or of the error. Rather they exploit the observed properties of overregularized and underregularized Tikhonov solutions so as to impose linear constraints on the sought-after solution. The two methods were applied to the inverse problem of electrocardiography using a spherical heart-torso model and simulated inner-sphere (epicardial) and outer-sphere (body) potential distributions. It is shown that if the overregularized and underregularized Tikhonov solutions are chosen properly, the two methods yield epicardial solutions that are not only more accurate than the optimal Tikhonov solution but also provide other qualitative information, such as correct position of the extrema, not obtainable using ordinary Tikhonov regularization. A heuristic method to select the overregularized and underregularized solutions is discussed.