Biomedical subjects
Publications and source records attributed to R P Wells.
Addition of beta-Ga2O3 to H-ZSM-5, as a physical mixture, enhances the formation of aromatic hydrocarbons in the methanol to hydrocarbons reaction.
OBJECTIVES: This study determined whether the physical and psychosocial demands of work are associated with low back pain. METHODS: A case-control approach was used. Case subjects (n = 137) reported a new episode of low back pain to their employer, a large automobile manufacturing complex. Control subjects were randomly selected from the study base as cases accrued (n = 179) or were matched to cases by exact job (n = 65). Individual, clinical, and psychosocial variables were assessed by interview. Physical demands were assessed with direct workplace measurements of subjects at their usual jobs. The analysis used multiple logistic regression adjusted for individual characteristics. RESULTS: Self-reported risk factors included a physically demanding job, a poor workplace social environment, inconsistency between job and education level, better job satisfaction, and better coworker support. Low job control showed a borderline association. Physical-measure risk factors included peak lumbar shear force, peak load handled, and cumulative lumbar disc compression. Low body mass index and prior low back pain compensation claims were the only significant individual characteristics. CONCLUSIONS: This study identified specific physical and psychosocial demands of work as independent risk factors for low back pain.
OBJECTIVES: (1) To develop a methodology to determine the trajectories of the digital flexor tendons using MRI. (2) To examine changes in tendon trajectories due to wrist posture, with and without pinch force. (3) To calculate the radius of curvature of the flexor tendons and note implications for contact forces on the median nerve. (4) To assess the use of Landsmeer's models at the wrist. DESIGN: Finger flexor tendon centroids were digitized from magnetic resonance images of the carpal tunnel and the tendon paths were determined analytically. Radii of curvature were calculated from the tendon paths. BACKGROUND: Landsmeer's models of joint-tendon interaction (Landsmeer, 1961) have been used to determine moment arms and radius of curvature of the tendon paths about articulations. An explanation for a biomechanical cause of work-related carpal tunnel syndrome originated from these models. METHODS: Three healthy male participants had their right wrist scanned while splinted in four wrist postures (flexed to 20 degrees, 45 degrees, neutral, extended to 20 degrees ) with and without maintaining a 10 N pinch grip. 20-24 cross-sectional images were used for each condition. RESULTS: Volar movement of the tendons was seen with wrist flexion and the opposite was true with extension. Tendon intersection angles were calculated between the tendon as it entered the carpal tunnel and as it exited the tunnel and were 50-65% of the wrist angle (R(2)=0.81-0.96). The radius of curvature was smallest (mean=82-127 mm) with an active pinch grip with the wrist splinted at 45 degrees of flexion (mean actual wrist angle 37 degrees ). CONCLUSIONS: The radius of flexor tendon curvature is not constant as previously assumed and is larger than previous estimates. The addition of tendon force with the wrist flexed acts to reduce the radius of curvature which further increases the contact stress on the median nerve and other wrist structures. The use of MRI to determine the tendon paths has provided new insight into the relationships between the finger flexor tendons and other structures at the wrist. RELEVANCE: These findings provide data for biomechanical models of the carpal tunnel and predict the possible pathophysiology of work-related carpal tunnel syndrome.
Variables, such as peak and accumulated moments and spine compression forces, have been shown to be risk factors for occupational low back pain. Estimates of these forces during prolonged, dynamic, asymmetric tasks using biomechanical models is complex and time-consuming. A simple technique for continuous measurement of these variables over a prolonged period is needed to measure the distribution of spinal loading during both sagittal plane lifts and complex asymmetrical jobs. The aim of this study was to determine whether a linear normalization of erector spinae EMG to spine compression force, called compression normalized EMG (CNEMG), could be used to estimate spinal loading for simulations of asymmetrical occupational tasks. The estimates of spine compression force obtained using the normalized EMG are presented in the form of an amplitude probability distribution function and are compared with estimates of a three-dimensional biomechanical model. The per cent time a worker spends above particular levels of spinal loading of interest, such as the NIOSH action limit for compression, are displayed. Five males performed simulated occupational tasks. The exposure time at a specific level of spine compression force for a combination of three tasks, estimated by CNEMG, was, on average, within 6.5% of the time calculated by the biomechanical model. However, if the task combination was dominated by an axial twisting moment, then the difference was, on average, 13.4%. The difference in magnitude of spine compression at a specific probability was, on average, 14.9% and when axial trunk twist dominated, 30.7%. It is concluded that CNEMG can estimate probability at a specific level of spine compression force when the task combination is characterized by a predominant extensor moment in the sagittal plane. Estimates of spine compression at a specific probability, and estimates obtained during task combinations dominated by an axial twisting moment, are poor.
OBJECTIVES: This paper examines the performance of 4 different methods of estimating peak spinal loading and their relationship with the reporting of low-back pain. METHODS: The data used for this comparison was a subset of subjects from a case-referent study of low-back-pain reporting in the automotive industry, in which 130 random referents and 105 cases (or job-matched proxies) were studied. The peak load on the lumbar spine was determined using a biomechanical model with model inputs coming from a detailed self-report questionnaire, a task-based check list, a video digitization method, and a posture and load sampling technique. RESULTS: The methods were directly comparable through a common metric of newtons or newton meters of spinal loading in compression, shear, or moment modes. All the methods showed significant and substantial associations with low-back pain in all modes (odds ratios 1.6-2.3). The intraclass correlation coefficients (ICC) showed strong similarities between the checklist and video digitized techniques (ICC 0.84-0.91), moderate similarities between these techniques and the work sampling method (ICC 0.49-0.52), and poor correlations (ICC 0.16-0.40) between the self-report questionnaire and the observer recorded measures. CONCLUSIONS: While all the methods detected significant odds ratios, they cannot all be used interchangeably for risk assessment at the individual level. Peak spinal compression, moment, and shear are important risk factors for low-back pain reporting, no matter which measurement method is used. Questionnaires can be used for large-scale studies. At the individual level a task-based checklist provides biomechanical model inputs at lower cost and equal performance compared with the criterion video digitization system.
Two pressure measurement techniques (catheter and bulb) were used to decompose the effects of tendon loads on carpal tunnel pressure (CTP). The catheter technique measures true hydrostatic pressure, whereas the bulb technique is a estimate of contact force or pressure on the median nerve. Eight cadaveric wrists were moved through a range of flexion-extension (0 degrees, 10 degrees, 20 degrees, 30 degrees, and 45 degrees of each) and radioulnar deviation (10 degrees and 20 degrees radial and 0 degrees, 10 degrees, 20 degrees, and 30 degrees ulnar) while CTPs were measured under 4 muscle loading conditions with the thumb, index, and long finger in a pinch-grip posture. The first of these was zero load. Then a 1-kg mass was applied in turn to both flexors of the index and long fingers, the palmaris longus (PL); and the flexor pollicis longus. The hydrostatic pressure was found to be affected by both wrist posture and tendon load. With no load, highest pressures were seen in wrist extension. Muscular loading elevated CPT, particularly the loading of palmaris longus with the wrist in extension and the digital flexors with the wrist flexed. Bulb pressure measurements, related to local contact forces by the digital flexors, indicated the highest loads on the median nerve with the wrist flexed. Palmaris longus loading created the highest pressures in extension and only moderate pressure in flexion, indicating that it may alter the geometry of the transverse carpal ligament. In view of the data from this study, it is necessary to incorporate measures of hydrostatic pressure and local contact forces to describe possible trauma to the median nerve in the carpal tunnel, as neither appears sufficient when used independently.
This is the first of two papers that systematically review available scientific evidence on the causes of disability from occupational low back pain, and the effectiveness of interventions to prevent it-before disability begins (primary prevention-Part I) and after its onset (secondary prevention-Part II). This first paper reviews the risk factors for the onset of pain and associated disability followed by a critical summary of intervention studies attempting to achieve prevention and to evaluate the results.
This is the second of two papers that systematically review available scientific evidence on the causes of disability from occupational low back pain, and the effectiveness of interventions to prevent it after its onset (secondary prevention). This paper reviews the national history of how back pain and the risk factors for its extension into chronic disability, followed by a critical summary of intervention studies attempting to reduce the duration of this disability, and to evaluate the results.
OBJECTIVE: To quantify individual forearm muscle passive forces and evaluate their impact on hand function. DESIGN: The passive force-length properties of the 24 extrinsic hand and wrist muscles were determined in five fresh frozen cadaver arms. BACKGROUND: Muscle force production is a summation of the active and passive force components. The passive properties of the extrinsic finger musculature and wrist musculature appear to strongly affect both hand posture and hand movement. METHODS: The passive force-length properties of extrinsic hand and wrist muscles were determined by applying a slow, continuous extension to each muscle and recording the resulting tension. Each force-length curve was fit using exponential regression and were related to specific joint rotations and seven hand postures by calculating the muscle excursions for those postures. RESULTS: The exponential passive force-length relationship explained over 97% of the experimental variance. The largest passive forces were elicited in the digital extensors in grips involving large flexion angles such as tip pinch, key pinch, and a briefcase grip. CONCLUSIONS: The passive properties of the extrinsic finger musculature and wrist musculature affect both hand posture and movement especially in postures with flexed wrist and fingers.
The purpose of this study was to develop a mathematical model of the linkage dynamics in upright standing, and to use this model to study output principles for postural control. The standing human was modelled in the sagittal plane as a three-segment linkage. Mechanical disturbances were simulated as forces which could be applied at various points in this linkage. An iterative approach was used to find joint torque combinations which would restore balance within 80 ms of these mechanical disturbances. The model predicted that a specific proportional relationship was necessary between the hip, knee and ankle torques in order for balance to be restored. This proportional relationship was shown to be a function of the model structure, but independent of the location, direction and amplitude of the disturbance. These predictions were tested experimentally. A disturbance apparatus was designed to apply an impulsive force to the subjects. The joint torque responses of the subjects were in quantitative agreement with the predictions of the model. The results suggest that a fixed relationship between joint torques may be required to restore balance, and this fixed relationship may make the task of postural control simpler for the nervous system.
The dynamics of postural control in human biped locomotion were studied using (1) a model, and (2) experimentally applied impulsive force disturbances. The model was planar, and contained five rigid segments, articulating at frictionless pin joints. The model was used to identify joint torque combinations which would successfully correct for an impulsive force disturbance applied at different points in the walking cycle. The simulation results suggested that (1) early responses (within 80 ms) can be effective in compensating for impulsive disturbances, (2) the same strategies which successfully counteract similar disturbances during quiet standing are also effective in certain phases of the walking cycle, (3) modifications in the response strategies are needed to accommodate differences in the dynamics over the stride cycle, and (4) the swing leg is ineffective in compensating for disturbances in the short term. These model predictions were tested experimentally. Subject responses to an impulsive force disturbance applied during walking were studied. The electromyographic results generally support the model predictions.
Different methods of calculating the mechanical energy cost of a movement presented in the literature can give results differing by an order of magnitude. The assumptions made concerning the transfer of energy between different parts of the body are part of the problem. This investigation assesses the role of transfer in energy saving and specifically, the possibility of two-joint muscles reducing the mechanical energy cost of a movement compared to a system having one-joint muscles only. An algorithm was developed which recruited one-joint or both one- and two-joint muscles to supply the net joint moments. The work performed under these two conditions was then compared. It was found that activation of both one- and two-joint musculature reduced the mechanical work cost during walking by between 7 and 29% over that required by single-joint musculature alone. This investigation supports suggestions in the literature that one of the functions of two-joint musculature is to reduce the mechanical energy cost and probably the metabolic cost of movement.
Since conflicting statements have been made in the literature regarding the influence of lumbrical contraction on the metacarpophalangeal (MP) joint, a study was undertaken to determine the length-tension curve for the index flexor profundus. Four fresh cadaver hands were used. Measurements for the flexor superficialis and for the common extensor were determined in there. The measurements were correlated with measured displacement of these tendons in six finger positions. Isolated lumbrical contraction was then mechanically simulated, acting against spring homologues of the index extrinsic muscles. The finger moved from the rest position toward the intrinsic position with loads of less than 5 N. This demonstrated that in addition to its effect on interphalangeal joint extension, the lumbrical acting alone can cause flexion of the metacarpophalangeal joint.
A new method of loading the lumbrical muscle in the cadaver hand, based on the bicycle brake cable concept, has been developed. The device can be inserted with the aid of tendon-tunneling forceps and sutured to the profundus tendon at the origin of the lumbrical muscle. Lumbrical function is stimulated by applying a force that approximates the attachment point on the profundus tendon to the lateral wing of the extensor expansion without predetermining which will move the origin, the insertion, or both. This preliminary study reports the use of this device in determining lumbrical length changes in five fresh cadaver hands as the index finger was passively moved through each of six standard finger positions. In the absence of other restraints lumbrical contraction causes the index finger to move from the claw position through the straight to the intrinsic position. The latter position represents maximum shortening.
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The effect of a hockey helmet and face shield on the head and neck during inertial loading was studied. A Hybrid III Anthropometric Test Dummy (ATD) was struck from both the front and rear by a spring-loaded, instrumented striker moving at 2.9 ms-1. Data were collected from a triaxial force transducer mounted at the atlanto-occipital (a-o) junction of the ATD, a load cell in the striker, and by cinematography (250 fps). Angular kinematics of the head and moments of force about the a-o junction were determined along with impact force levels. When compared to a bare-head condition, the addition of a helmet and face shield caused an increase in head angular displacement (20-40%) but did not affect head angular acceleration. Axial and shear forces at the a-o junction did not change appreciably with the addition of a helmet and face shield. A triphasic pattern was evident for the neck moments including a small phase which represented a seating of the headform on the nodding blocks of the uppermost ATD neck segment, and two larger phases of opposite polarity which represented the motion of the head relative to the trunk during the first 350 ms after impact. No substantial differences were apparent between the helmeted and non-helmeted trials. The magnitudes of forces and moments found in the present study were well within tolerance levels reported by others (Melvin, 1979; Cheng et al., 1982). It was concluded that the increase in angular displacement of the head, with the addition of a helmet and face shield, does not place the wearer in a position of increased risk of cervical spine trauma.
A work-energy approach was used to determine the contributions of the muscles crossing the hip, knee and ankle joints to the total positive work done during maximal vertical jumps. It was found that the average relative contributions of the ankle and hip muscles were approximately 23 and 28% respectively, with the remaining 49% of the work being done by the muscles acting at the knee joint. The efficiency of jumping, i.e. the ratio of potential energy gained to the net mechanical work done by the muscles acting at the three lower limb joints was nearly 1.0. These results stress the importance of all three major leg extensor muscle groups to the performance of an explosive activity such as vertical jumping. It is suggested that the work-energy approach supplies useful information concerning joint contributions without the problems associated with other techniques.
The natural course of fibromuscular dysplasia (FMD) of the internal carotid artery (ICA), a stenosing angiopathy associated with cerebrovascular insufficiency, has been described. A search of medical records located 16 female patients with angiographically demonstrated FMD of the ICA. The identical twin of 1 patient was included in the registry on the basis of noninvasive studies consistent with FMD of the ICA. The mean age at diagnosis was 58 years. Follow-up examinations were performed an average of 3.8 years after diagnosis (range, 1 to 9 years); the evaluation included clinical, angiographic, and Doppler studies. Fifteen patients showed no evidence of progression of FMD, whereas 2 patients with coincident atherosclerotic disease had suffered strokes. One patient had undergone surgical dilatation of the ICA, 3 had received oral anticoagulants, and 13 had received either aspirin or no specific therapy. In light of the apparently benign clinical course of uncomplicated FMD of the ICA, it is concluded that dilatation is rarely warranted.