Springer Japan KK

J. Kajzer, E. Tanaka, H. Yamada (Eds.)

Human Biomechanics and

Injury Prevention
With 2 I7 Figures, Including 3 in Color

, Springer
J ANUSZ K AJZER
Dep artm en t of Mech an ical En gin eer ing
Gr adu ate Sc hoo l of En gineering
Nagoya Unive rsity
Kabimec Co nsulti ng
Eg nahem svagen I, S-444 4 1 Stenungsund, Swe de n

EU CHITANAK A
Dep artment of Mech an o-In format ics and Syste ms
G radu ate School of En gineerin g
Nagoya Universi ty
Furo-cho, Chikusa-ku, Nago ya 464-8603. Jap an

HIROSHI YAMA DA
Dep artment of M icro Sy stem Engineering
G radu ate Sch ool of Engineering
Nagoy a University
Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan

ISBN 978-4-431-66969-2 ISBN 978-4-43 1-66967-8 (eBook)

DOI 10.1007/978-4-431-66967 -8

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Preface

Human biomechanics is an important research field in achieving safety, health, comfort, and
a high quality of life in a world where the older generation soon will outnumber the younger
generation. Recently there have been significant developments in this new field of research,
addressing such issues as injury prevention in various types of accidents, the causes of
human bodily dysfunction, function recovery through medical care and training, and func-
tional reinforcement by sports. These issues are studied on the basis of the biomechanics of
the cells, tissues, organs, and systems of the human body.
To achieve the aim of providing support for better lives from the aspect of mechanical
engineering, the Human Life Support Biomechanics Endowed Chair at the Graduate School of
Engineering at Nagoya University was established more than 3 years ago with a donation
from the Toyota Motor Corporation. Since that time, we have been conducting intensive
research in the field as well as trying to publicize our work in Japan . The results of our
research have been presented at conferences both at home and abroad. We have also en-
deavored to underscore the importance of the field by organizing symposiums with carefully
designed programs.
As a result, the First and Second Symposium on Human Life Support Biomechanics were
held at Nagoya University in 1997 and 1998, and both proved to be a resounding success and
source of satisfaction . Therefore, in 1999 we could extend the program of the Symposium and
invite 18 prominent researchers from around the world for plenary and keynote lectures as
well as another 18 distinguished researchers to present papers .
As the scope of human biomechanics is very wide-ranging, we include reviews in the
selected fields of traffic safety, impact biomechanics, biomechanics of biological tissues and
cells, orthopedic biomechanics, and welfare engineering. The reviews represent important
technical aspects of the status of present research in these fields. The 18 plenary and keynote
lectures were selected by the Scientific Committee of the Symposium to achieve a balanced
agenda of topics at the forefront of these fast-developing new areas of research. The 18
contributed papers were selected in a similar manner.
This book was produced to document the presentations at the 1999 International Human
Life Support Biomechanics Symposium, and to offer the most up-to-date information from the
field.

Janusz Kajzer
Eiichi Tanaka
Hiroshi Yamada

v
Contents

Preface V
Contributors XI

Perspective on Impact Biomechanics from Traffic Accident Analysis

M. Mackay .
Biomechanics and Its Impact on Human Life: From Gene Expression to Organ Physiology
R.M. Nerem 13
Recent Advances in the Biomechanics of the Head and Neck
A.I. King, K.H. Yang 21
The Tibia Index : A Step in the Right Direction
J.R. Crandall, J.R. Funk , R.W. Rudd , L.1. Tourret 29
The Biomechanics of Frontal and Lateral Collision
D. Kallieris 41
Influence of Human Spinal Deformation on Minor Neck Injuries for
Low Speed Rear Impacts
K. Ono, S. Inami, K. Kaneoka, Y. Kisanuki 51
"Hybrid" Approach to Modelling of Biomechanical Systems
C. Rzymkowski . 59
Current Status of Finite Element Human Model Using PAM-CRASH
Y. Matsuoka, K. Ando .. 65
Finite Element Model for Simulation of Muscle Effects on Kinematic
Responses of Cervical Spine in Low-Speed Rear-End Impacts
A. Wittek, K. Ono, J. Kajzer 71
A Biomechanical P.E.E.E.P. Show
R.H. Eppinger 77
The Development of Chest Protection
X. Trosseille, 1.- Y. Foret-Bruno, E. Song, P. Baudrit 85
The Activities and Research Projects of the Ministry of Transport and
Traffic Safety & Nuisance Research Institute
Y.Nanto 93

VII
VIII Contents

Optimized Belt Systems for Front and Rear Seat Passengers

H. Zellmer, S. Luhrs , K. Briiggernann 105
Development of a Finite Element Model of the Human Lower Extremity for Assessing
Automotive Crash Injury Potential
A Tamura, K. Furusu, M. Iwamoto, e. Kato, K. Miki, J. Hasegawa III
Development of a Human AnklelFoot Model
Y. Kitagawa, H. Ichikawa, AI. King, P.e. Begeman 117
The Behavior of Bicyclist in Accidents with Cars
T. Maki, J. Kajzer, T. Asai .. 123
Mechanical Influences on Skeletal Regeneration
D.R. Carter, E.G.L. Polefka, G.S. Beaupre 129
Soft Tissues and Their Functional Repair
D.L. Bader 137
An Application of the Pipette Technique to the Measurement of Local Mechanical
Properties of Aortic Walls
M. Sato, T. Matsumoto, T. Ohashi 147
Locations of Bone Formation Change According to the Waveform of Loads
-Hypothetic Mechanism of Cells to Detect Mechanical Environment of Bone-
K. Takakuda, H. Matsumoto, J. Ohtsuka, K. Nagashima, T. Koizumi, H. Miyairi ....... 155
Active Stress Models of Cardiac Muscle, Smooth Muscle and Skeletal Muscle
H. Yamada, E. Tanaka 161
Development of High-Speed Tensile Test System for Ligaments and Skeletal Muscles
S. Yamamoto, J. Kajzer, E. Tanaka 167
Developments in the Provision of Wheelchairs and Seating in Tayside, Scotland
G. Bardsley....... 173
Bringing Advances in Wheelchairs to the People Who Need Them
R.A Cooper, M .L. Boninger, N. Shapcott, S.G. Fitzgerald 179
One Basic Research Approach for Assistive Technology in Japan
T. Ifukube 191
Some Mechanical Problems to Use Electric Wheelchairs in a Snowy Region
S. Tadano, A. Tsukada 199
Estimation of Lower Limb Muscle Function from Kinematic Gait Analysis and
Muscle Tension Model
M . Tanaka, Y. Akazawa, A Nakagawa 205
A New Force Limitation Mechanism for Risk Redu ct ion in Rehabilitation Robots
N. Tejima 211
Computational Rehabilitation Engineering with a Walking Model
K. Hase 217
Contents IX

Fine-tuning the Reconstruction of the Anterior Cruciate Ligament in the Knee

L. Blankevoort, A. van Kampen, A.B . Wymenga, L. Elrnans, M .P. Arnold,
P. van der Wielen, TJ.A. Mommersteeg 223
Biomechanics of the Soft Tissue in Repetitive Motion Disorders
K.-N . An 231

Biotribological Aspects of Natural Synovial Joints and Artificial Joints

T. Murakami 235
Fundamental Study of Dynamic Analysis of Lumbar Vertebrae
H. Nishigaki, T. Amago, K. Miki, S. Ish iyama, E. Tanaka, S. Yamamoto 243
A Study on Development of the Total Hip Prosthesis Design Fitted for Japanese
Patients with Secondary Osteoarthrosis
1. Sakamoto, 1. ada, A. Kaneuji, T. Matsumoto, T. Sugimori,
M . Nishino, K. Tomita, M. Fujita 249

Mechanical Functions of Human ACL Bundles: Development and Application of

a Robotic Knee Simulator
H. Fujie, T. Mae, T. Sekito, K. Shino 255
Mechanical Properties of Impacted Human Morsellised Cancellous Allografts for
Revision Joint Arthroplasty
Y. Tanabe, H. Maki, T. Meguro. A . Kobayashi, H. Ohashi, Y. Kadoya, Y. Yamano .... 261
Contributors

Akazawa, Y. 205 Inami,S. 51

Amago, T. 243 Ishiyama, S. 243
An, K.-N. 231 Iwamoto, M. 111
Ando, K. 65
Arnold, M.P. 223 Kadoya, Y. 261
Asai, T. 123 Kajzer.J, 71, 123, 167
Kallieris, D. 41
Bader,D.L. 137 van Kampen, A 223
Bardsley, G. 173 Kaneoka , K. 51
Baudrit, P. 85 Kaneuji, A 249
Beaupre, G.S. 129 Kato, e. 111
Begeman, P.e. 117 King, AI. 21,117
Blankevoort, L. 223 Kisanuki, y. 51
Boninger, M.L. 179 Kitagawa, Y. 117
Bruggemann, K. 105 Kobayashi , A. 261
Koizumi, T. 155
Carter, DR 129
Cooper, RA 179 Luhrs, S. 105
Crandall, J.R 29
Mackay,M. 1
Elmans, L. 223 Mae, T. 255
Eppinger, RH. 77 Maki, H. 261
Maki, T. 123
Fitzgerald, S.G. 179 Matsumoto, H. 155
Foret-Bruno, J.-Y. 85 Matsumoto, Tadami 249
Fujie, H. 255 Matsumoto, Takeo 147
Fujita, M. 249 Matsuoka, Y. 65
Funk, 1.R 29 Meguro, T. 261
Furusu, K. 111 Miki, K. 111 ,243
Miyairi, H. 155
Hase, K. 217 Mommersteeg, TJ.A 223
Hasegawa, J. III Murakami, T. 235

Ichikawa, H. 117 Nagashima, K. 155

Ifukube , T. 191 Nakagawa, A 205

XI
XII Contribut or s

Nanto, Y. 93 Tadano, S. 199

Nerem, R.M. 13 Takakuda, K. 155
Nishigaki, H. 243 Tamura, A. III
Nishino, M. 249 Tanabe, Y. 261
Tanaka,E. 161,167,243
Oda,J. 249 Tanaka, M. 205
Ohashi, H. 261 Tejima, N. 211
Ohashi , T. 147 Tomita, K. 249
Ohtsuka, 1. 155 Tourret , LJ. 29
Ono, K. 51,71 Trosseille, X. 85
Tsukada, A. 199
Polefka , E.G.L. 129
van der Wielen, P. 223
Rudd , R.W. 29
Wittek, A. 71
Rzymkowski , C. 59
Wymenga, A.B. 223
Sakamoto, 1. 249
Sato,M. 147 Yamada , H. 161
Sekito, T. 255 Yamamoto, S. 167,243
Shapcott, N. 179 Yamano, Y. 261
Shino, K. 255 Yang, K.H. 21
Song,E. 85
Sugimori, T. 249 Zellmer, H. 105
Perspective on Impact Biomechanics from Traffic Accident
Analysis
Murray Mackay

Birmingham Accident Research Centre, University of Birmingham , Edgbaston, Birmingham BI5

2TI, United Kingdom.

Summary. This paper begins with a brief review of the development of crash investigation
techniques from the 1950s to the present day. Early work at Cornell University in the United States
led to studies in Australia, Sweden and the United Kingdom and a general recognition of the
fundamental importance of a detailed knowledge of the nature and circumstances of actual trauma
to traffic accident victims. Today a number of countries have on-going structured sample date
collection programmes which provide an important means of assessing the effectiveness of
biomechanical advances which are implemented through changing car design and regulations.
Notably, the NASSIFARS programmes in the United States, by being freely available electronically,
have become a valuable source to other countries.

Such research illustrates an important yet still poorly understood aspect of impact biomechanics;
that of variation within the population at risk. Examples are given of this issue in terms of head,
neck, thoracic, leg and abdominal injury studies to show that a factor of three exists between the
weakest and strongest elements of the normal population exposed to impact injury. Age and gender
effects are discussed.

The optimisation of protection recogmsmg the two distributions of crash severity and impact
tolerance variations leads to the conclusion that focusing on very severe collisions does not result in
good overall protection. The links with experimental biomechanics are illustrated and the paper
concludes with proposals for new research directions with increasingly detailed instrumentation of
vehicles and more realistic modelling of the human frame.

Keywords: Injuries, populations, optimisation, variability, biomechanics.

INTRODUCTION
The purpose of this chapter is not to give specific recent research findings from current analyses of
data on actual traffic collisions and consequent injuries; that aspect is covered by other contributors
to this volume. Rather its aim is to review the evolution of the sector of traffic safety research as it
impinges on our knowledge of the biomechanics of impact injuries.

Historically the investigation of transport accidents has varied markedly by the different modes of
travel, but in all modes the early focus was not to study causes of injury, but to examine the causes
of the event. This applied to all the modes, air, road, rail and marine. Hence, many early studies
give very cursory attention as to how injuries actually occurred, and this is still reflected in a
number of the data systems used today. For example, it is still the standard practice in many
hospital systems to describe the "mechanism of the injury" as "pedestrian hit by car" or
"motorcyclist" or, somewhat more advanced, "car occupant in rear seat unrestrained". Clearly such
descriptors provide almost no insight into the actual mechanisms of the specific injuries which have
been sustained.

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000
2 M . Mackay

Indeed there is a useful parallel between such broadbrush descriptions of causes of injuries and
similar sweeping descriptions of the "cause of the accident". A road accident investigation would
cease with the conclusion that the cause of the accident was "inattention" or "driving too fast for the
conditions" . Such conclusions do no more than describe the obvious, without giving any real
insights into why such behaviour occurred. This is still true of many police data bases around the
world in the road accident area. In the early days of rail, air and marine investigations there was
still that same sort of mind-set by the investigating authorities. Rail crash investigations for the last
150 years have often closed the file with the insightful conclusion that the driver failed to obey a red
danger signal. Marine investigations have similarly concluded that the ship ran aground because of
a navigational error. In the world of aircraft, Ken Mason, an eminent aviation pathologist, noted
that "the concept of pilot error has put back crash investigation by a generation" . With the focus of
an investigation being to establish the cause of an accident and often to designate blame, the less
obvious underlying factors of how an injury actually occurred and how it might have been
prevented got scant attention.

In the 1930s, in the aviation and rail sectors, the complexity of the analysis of the causes of an
accident began to be recognised, with a greater appreciation of background factors and an
increasing understanding of the frailties of human behaviour however well trained and supervised.
In parallel with this more sophisticated approach to the investigation of causal factors, was an
increasing insight into the specifics of how people in crashes actually got killed or injured. It was in
that period in aviation that the biomechanics of impacts first began to be investigated objectively. It
took another generation for such an approach to take root in the road crash arena.

EARLY KNOWLEDGE ON THE BIOMECHANICS OF IMPACTS

An implicit recognition of impact biomechanics exists in all of us and is engendered from an early
age. Soft, deformable structures are benign; sharp, rigid objects, like kitchen knives, deserve
caution. From the earliest of times, the underlying principles of impact biomechanics have been
recognised: structures designed to maximise trauma are hard and concentrate loads, such as spears
and clubs, while conversely, shields and armour absorb and distribute loads and protect vulnerable
parts of the anatomy. Hippocrates, writing around 400 BC, noted that for head injuries, padding
was valuable:

"Of those who are wounded in the parts about the bone or in the bone
itself, by a fall, he who falls from a very high place upon a very hard
and blunt object is in most danger of sustaining a fracture and contusion
of the bone, and of having it depressed from its natural position.
Whereas, he that falls upon more level ground, and upon a softer object
is likely to suffer less injury in the bone, or it may not be injured at all."

Like most subjects, impact biomechanics have evolved from early observations of natural
phenomena, through an experimental period to a theoretical framework that outlines general laws
and precepts. Hugh de Haven is normally credited with the first insights into human tolerance of
crash loads. During World War I, he was involved in a mid-air collision . While convalescing, he
realised that his survival was due to the maintenance of the integrity of his cockpit that, together
with a safety harness, protected him from the localised contacts and catastrophic injuries that killed
the other pilot. He also observed that his own serious abdominal injuries related to the buckle of his
harness, causing a severe internal haemorrhage with laceration of the liver. Crash-protective design,
rather than capricious good fortune, had ensured his survival.
Impact Biomechanics from Traffic Accid ent 3

In 1942 De Haven analysed the circumstances of eight people who fell from considerable heights,
seven of whom survived. Speeds at impact ranged from 37 to 59 mph and the objects struck
consisted of fences, a wooden roof, soft ground, and in two cases the bonnets of cars. Decelerations
at impact were estimated and the groundwork for whole body tolerance was laid. Subsequently
Snyder et al (1977) developed this approach into a most useful methodology for obtaining such data.

In 1941, Sir Hugh Cairns published a paper on fatalities occurring among Army dispatch riders. He
showed that for those who wore helmets the head injuries were relatively mild. Later work by
Cairns (1946) showed that following the compulsory wearing of helmets by Army motorcyclists
there was a progressive fall in the death rate. He also noted that most blows on helmets were to the
front and side rather than to the crown. The consequences of that observation have been reflected
30 years later in the evolution of the jet-style and full-face helmets of today and the demise of the
cradle suspension inside the helmet.

John Lane in Australia in 1942 noted that aircraft should be certified in two ways: they should be
both airworthy and crashworthy, and so the term 'crashworthiness' was born, but its application to
automobile design did not begin until some 20 years later.

The experimental period of biomechanics got under way after World War II, with cadaveric studies
by Gurdjian (1945) examining head injury in the main, and volunteer studies conducted by Stapp
(1951). The great contribution by Stapp was to show that the primary forces acting in the majority
of car collisions are entirely survivable if the packaging of the human frame is satisfactory. He
showed that accelerations of 30 G for up to 0.5 s were entirely tolerable with only reversible soft
tissue injuries occurring. At 45 G, signs of concussion and retinal haemorrhage begin to show.
These accelerations were measured on the seat of the dynamic sledge. The accelerations
experienced by the head itself were much greater.

In the 1950s, Severy and Mathewson (1954) were developing the techniques of experimental crash
testing with instrumented dummies and high-speed film analysis. By the mid-1960s, a body of
knowledge had developed that gave insights into the general frequencies of traffic collisions and
injuries, some understanding of the actual mechanisms that generate the injuries, and some means
whereby the forces and accelerations applied to car occupants could be modified. What was largely
missing was accurate information on the tolerance of the actual human frame to specific impact
loadings, ideas of the likely benefits that could be obtained from practical changes in car design,
and what the penalties in design terms would be.

In parallel with the increasing amount of experimental work on both cadavers and animals, studies
of real-world trauma continue . An elegant paper by Sheldon (1960), entitled 'On the natural history
of falls in old age', showed how the routine observations of a practising clinician could lead to new
insights into the aetiology and mechanisms of injury, particularly for long-bone fractures in the
elderly.

In experimental biomechanics Yamada (1963, 1970) presented an immense amount of data which
described the properties of various human tissues, bone, skin, nerve fibres, cartilage and connective
tissues in terms of their basic engineering parameters. He demonstrated the marked anisotropic
characteristics of many tissues, particularly bones, the viscous natures and rate dependency of many
tissues and variations in properties through the population according to gender, age and other
factors. This is an area which still deserves greater recognition.

Pioneering work on seat belts was conducted in Sweden where, by 1960, some 50 per cent of
private cars had belts fitted. The appropriate elongation and geometrical characteristics of belt
systems were evaluated experimentally by Aidman (1962), who demonstrated the importance of
4 M. Mackay

correct anatomical positioning and dynamic properties appropriate to the deformation and
geometrical characteristics of specific car designs.

The subject of biomechanics in relation to car-occupant crash protection grew rapidly in the 1950s
and 1960s and became institutionalised with an extraordinarily important legislative act in the USA.
As a result of government hearings that illustrated the great potential of crash protective design, in
1966 the National Highway Safety Bureau was created by act of Congress and it initiated a set of
standards controlling the performance of cars in terms of their crashworthiness . The effects of
those standards have reverberated through the automotive world ever since. They have been copied,
modified, adopted by almost every country with a significant car population and they have changed
car design from a free market, styling dominated activity to one in which certification, or passing
the standards, with all the attendant engineering problems, is of prime importance in the priorities
of car manufacturers.

The scientific basis of these first crash performance standards was not well founded; many of the
requirements were informed guesswork only. With the benefit of hindsight, quite extraordinarily
few major mistakes were made, but what has also become clear is that the subject is a very complex
one. The real world of collisions contains many surprises. Common sense has that most curious
property of being more correct retrospectively than prospectively, and a major gap was left as the
subject became more under the control of government and industry and away from the individual
efforts of the early workers.

That increasing problem was the absence of sufficiently detailed and representative real world crash
data.

THE DEVELOPMENT OF TRAFFIC ACCIDENT DATABASES

One of the pioneering achievements of Hugh de Haven in the 1950s was establishing the
Automotive Crash Injury Research CACIR) programme at Cornell University in the United States.
Working with local and state police, specific sample studies were conducted in which the police
agreed to collect more data on an accident than was the traditional standard practice. With this
methodology greater knowledge was developed on the frequencies and consequences of various
factors such as ejection, door opening rates, car size, seat belt effectiveness, windshield glass
performance and other crash related factors.

But the limitations of police and insurance company data bases as a source of information on the
specifics of injury mechanisms became apparent. Following this, in the 1960s, individual workers
started to investigate collisions themselves using detailed, multi-disciplinary at the scene and follow
up procedures. Teams of engineers and doctors, at Universities in Michigan, California, Adelaide
and Birmingham began such studies.

From these developments the usefulness of detailed analysis of occupant kinematics , their contacts
with interior structutres and the performance of those structures in mitigating the severity of injuries
was appreciated. That lead to a proliferation world-wide of in-depth crash investigation research
and to the establishment of longitudinal studies in France, Germany, Sweden, Britain and the
United States, which now provide an invaluable source of data covering over 20 years of crash and
injury outcome details. In particular the United States programmes of FARS, NCSS, NASS and its
successors CDS and GES, because the data are freely available under the Freedom of Information
Act of the United States and because of the Internet, are now a valuable research resource used by
Impact Biomechanics from Traffic Accident 5

crash injury researchers all over the world. Such openness with the data paid for by taxpayers could
well be emulated elsewhere.
The current CIREN programme in the United States is a return to the detailed in-depth studies of
the 1960s, where new insights into the biomechanics of injuries are obtained based on very detailed
analysis of a few or even single collisions. Inevitably however, such small samples, biased towards
casualties admitted to trauma centres, mean that the general applicability of the findings must be
examined carefully.

Following the development of these accident data bases specific parameters have evolved which are
used to describe the two fundamental aspects of a crash. These are the severity of the crash itself
and the severity of the outcome in terms of injuries.

In the early days crash severity was defined qualitatively based on photographs of crashed cars, for
example in the TAD and ACIR scales and Moreland's Damage Index. Attempts were then made by
Campbell and Patrick to relate a specific collision to its Equivalent Barrier Speed and by Mackay
somewhat more widely to an equivalent test speed, (Mackay 1968). By the early 1970s the
calculation of the change in velocity (delta V) at the centre of gravity of the vehicle in a given
collision and relating it to the energy and momentum equations and stiffness characteristics from
crash tests was established, particularly by Centre, and delta V is still the preferred parameter for
gauging collision severity today (Centre, 1972).

Alternatives however, have been proposed. For belt restrained occupants, particularly belt load and
hence peak deceleration is a more appropriate parameter and mean deceleration is undoubtedly a
better parameter than delta V for most vehicle to vehicle collisions .

Today however, new technology is on offer, which can give a much more detailed description of a
collision. On-board crash recorders are a realistic proposition for wide scale introduction. They
have the ability to record objectively the shape of the time/deceleration history and many other
events relating to inflatable restraints, vehicle attitudes with time, pre-impact braking, restraint use
and occupant position. Such devices would enhance enormously the accuracy, objectiveness and
detail of ongoing accident data bases and thus provide a major input into our knowledge of injury
biomechanics in actual accidents .

The second fundamental parameter relates to measuring the outcomes of a collision. In the early
days injury scaling was almost totally subjective, with descriptors such as slight, incapacitated,
bleeding, unconscious, serious, being used by both police and researchers. With the rise of in-depth
crash investigation teams in the 1960s, almost every research group had its own injury severity scale.
Agreement and uniformity of terminology arrived with the Abbreviated Injury Scale (AIS), which
has been refined to the current dictionary (AIS 98) and is now accepted and used world-wide. That
acceptance enormously enhanced the value of accident data bases by allowing comparisons and
joint studies to be made. The AIS however is only one dimension of injury severity, that of threat to
life, and clearly for the categories of AIS 1,2 and for many AIS 3 injuries the threat to life is now a
major consideration. Hence, many of those injuries are classified in an agreed category of severity,
but without any obvious outcome comparison.

With an increasing recognition of the importance of disabilities which can arise from injuries
particularly in the AIS 1,2 and 3 categories, there is a clear need for a disability scale, matching the
definitions of injuries described in the AIS and thus applicable to accident data bases throughout the
world Petrucelli, et al (1983).
6 M. Mackay

BIOMECHANICAL INSIGHTS FROM TRAFFIC ACCIDENT ANALYSIS

Impact biomechancs draws on knowledge from several types of research. Laboratory studies used
volunteers, physical dummies, computer modelling of lumped mass or FEM systems, cadavers and
specific human tissue segments, animal studies and analysis of actual traffic crashes. This latter
category has the big advantage of dealing with real people in actual accidents, but with the attendant
disadvantages of all the uncertainties of the reconstruction process. The potential of crash recorder
technology is enormous in this area as has been demonstrated by (Melvin, et al 1998) in the context
of instrumenting crashes at Indianapolis. Data from that work challenges the injury assessment
criterion for lateral loading of the thorax, but the nature of the population exposed, healthy young
males, may well be a reasonable explanation for the differences in outcomes for such loadings
compared to cadaver studies. It is one example of the importance of population variations,
considered below.

Traffic accident analysis, focused on crashes occurring under everyday circumstances has the
unique advantage of providing the epidemiology of impact trauma. Such analyses provide the basic
data on frequency and severity of actual injuries, and with careful reconstruction, the specific of
how those injuries occur.

Frequency issues. The widest use of traffic accident analyses is to describe the basic epidemiology
of impact trauma, the patterns of injury to various road users, the frequencies of various events and
the outcomes in terms of body regions injured, the severity of these injuries and their causes in
terms of contacts made with structures of the vehicle. Such studies establish the priorities for
further research, monitor changing injury patterns with time, and give warnings of new mechanisms
of injury and crash characteristics. Hundred of such studies have been published over the last 30
years. Logically they should be the basis for establishing new vehicle safety regulations and
monitoring existing ones, and providing insights for vehicle designers as to the effectiveness in the
real world of their designs. This approach has only relatively recently been recognised in many
parts of the world, and in Europe for example there is no comparable data base to CDS and FARS,
Such studies as are conducted are small scale and not typical of E.U. collisions generally.

Specific studies from BARC in the United Kingdom have described patterns of injuries over the
years; the relative injury potential of tempered compared with laminated windscreens, still a live
issue in Europe as a tempered windscreen is still allowed and is common in light trucks and in the
after-market; the roll of intrusion and crash severity on lower limb injuries; the increased incidence
of diffuse axonal injury in lateral collisions compared to frontal crashes; the limits of current seat
belts and the injuries which arise in those limiting conditions ; and studies on the effectiveness of
many design changes such as improved door latches, side door beams, energy-absorbing steering
columns, seat back strength and yield characteristics, and patterns and frequencies of injuries to
other road users and the causes of those injuries, particularly for pedestrians and motorcyclists.

These specific projects are listed to illustrate how in-depth studies of traffic crashes, if designed to
be representative of the relevant parameters to be studied by using appropriate sampling techniques,
can produce valid insights into the biomechanics of impact injuries.

Incidence data. A neglected area of accident analysis is the use of simple observational studies of
people in cars. Often however such studies can give useful insights into specific mechanisms of
injury. For example Crandall et al (1996) took video observations of foot positions during driving
and braking demonstrating, amongst other things, that heel separation from the floorpan increased
with decreasing stature, with the result of increased foot and ankle injury risk.
Impact Biomechanics from Traffic Accident 7

Parkin et aI (1993) developed a technique of recording the head position of drivers and passengers
in relation to forward structures for populations in the United Kingdom and the USA, and Mackay
et aI (1997) quantified how small females, in particular, sit significantly closer to the steering wheel
than is suggested by the standard fifth percentile female Hybrid ill dummy position. Similar
observational studies have recorded the incidence with which drivers under straight road conditions
place a forearm across the cover of a hub-mounted airbag. Such studies can be helpful in setting
boundary conditions for risk assessments and experimental investigations.

Individual investigations. The clinical literature is full of papers describing individual, unusual
cases of trauma, and its origins. Similarly, individual collisions when analysed in detail may give
insights into unusual mechanisms of injury, and may give an early indication of an emerging more
general issue. Some detailed analyses of injuries occurring when airbags deploy for example, can
give insights into when during the crash an airbag actually inflates.

Populations at risk. An under-researched area is the relationship of injury risks for the exposed
population . This relates to both the characteristics of collisions and the variations of the
biomechanical and anthropometric properties of the population . It is well known that colIision
severity in all configurations varies in a markedly skewed manner with many low speed events and
very few at very high energy levels. Figures I and 2 illustrate the delta V distributions for frontal
collisions for occupants injured firstly in the range of AIS 2-6, and secondly for fatalities only.
Figure 3 illustrates a similar skewed distribution for rear end collisions (Parkin et aI 1995) for all
levels of injury severity.

Secondly, an extensive literature exists concerning human response to impact forces, mostly
conducted in an experimental context. A general conclusion from that body of knowledge is that for
almost any parameter, there is a variation of at least a factor of 3 for the healthy population exposed to
impact trauma in traffic collisions. That variation applies to variables which are relatively well
researched such as the mechanical properties of bone strength, cartilage, ligamentous tissues and skin.
It is likely to be even greater when applied to gross anatomical regions such as the thigh in
compression, the thoracic cage, the neck or the brain.

How such variability is demonstrated in populations of collisions is less well understood. Data from a
ten year period of the European Co-operative Crash Injury Study (CCIS) for restrained front seat
occupants are given in Figures 4 and 5. The methodology of that work has been described by Mackay,
(1985).

Figure 4 illustrates the effect of age on injury outcome in terms of the frequency of AIS 2 and greater
injuries for three age groups. Data are presented for frontal impacts involving a principal direction of
force (PDF) of II to I o'clock, controlIing for crash severity by equivalent test speed (ETS), generally
close to the delta V of the collision.

The 60+ age group especially shows greater vulnerability than the younger groups. As a broad
generalisation one may conclude that for the same injury severity, the younger age groups must
have a velocity change of some 10 km/hr more than the elderly. The effect is more marked if a
more severe injury level is chosen. Figure 5 illustrates the cumulative frequencies for the three age
groups for injuries of AIS 4 and greater.

Figure 6 shows similar frequency curves for crash severity by sex of occupant. Thus at a velocity
change of 48 kmIhr (30 mph), some 2/3 of male and some 80% of female AIS 2+ injuries have
occurred. As a starting point, therefore, as well as specific body weight and sitting position, a
combination of age, sex and biomechanical variation could be developed as a predictor of the
tolerance of a specific subset within the population range.
8 M. Mackay

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vehicles with occupant injuries of AIS severity 2 through 6. (2) Includ es all sedan , coupe , hatchback.
convertible, and station wagon passenger car with at least one injured occupant. Source : "National Accident
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Fig . 2 Delta V for all fatal passenger vehicles'" (frontal accidents) Notes: II) includes all sedan, coupe ,
hatchback, convert ible and station wagon passenger cars with at least one occupant fatality. Source:
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Imp act Biomechanics from Traffic Accident 9

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injurie s with a MAIS >= 2.
10 M. Mackay

Then there are anthropometric considerations.

Current dummies and modelling cover the 5th percentile female to 95th percentile male range.
Assuming for simplicity that males and females are exposed equally and that there are few males
smaller than the 5th percentile female or females larger than the 95th percentile male, these
conventional limits put 2.5% (l in 40) of the small population and 2.5% of the larger population
beyond those limits; 5% or 1 in 20 overall.

Table 1 gives the I % and 99% ranges for height, sitting height and weight. These data show what
would be required if the design parameters were extended to cover this wider range, so that only 1 in
50 of car occupants would be outside the design parameters (Soc. Actuaries, 1979).

Table 1. Population ranges for height, sitting and weight

Adult Height Sitting Height Weight

ins/em ins/em lbslkg

1%ile female 57/145 28m 82/37

5%ile female 59/150 29/75 90/41
95%ile male 73/185 37/93 225/102
99%ile male 75/190 38/96 236/107

More importantly, it is implicitly assumed in current vehicle designs that height (or sitting height) and
hence sitting position is collinear with the weight of the occupant. In fact, there are data available to
suggest that the relationship between height and weight are rather complex. For example, the body
mass index (BMI) (i.e., the ratio of weight in kilograms to height in meters squared) varies to a greater
degree in women than in men, and particularly at the 75th percentile and above, women have higher
BMIs than men. In addition, the prevalence of overweight increases with age, more with females than
males (Williamson, 1993).

Thus the factors of gender and age, used as a surrogate for biomechanical tolerance, height, weight
and BMI, sitting position and posture can all be quantified in population terms for appropriate
subsets of the occupant population exposed to injury risk in the crash populations illustrated with
examples in Figures 1-3.

The optimisation of protection recognising the twin aspects of human variability and crash severity
exposure remains a major research challenge .

NEW RESEARCH DIRECTIONS

From this brief and superficial review of how traffic accident analysis contributes to biomechanical
knowledge, some directions for new research are proposed.

In-depth, representative databases. With the exception of the United States, there is an absence
of fundamental data about the details of crash frequencies, mechanisms of injury and occupant
characteristics, in terms of comprehensive longitudinal studies. Relatively small scale research
projects exist in Japan, the United Kingdom, Sweden, Germany and France, but there is little
compatibility and integration between them. Given the magnitude of the traffic injury problems
Impact Biomechanics from Tr affic Accident 11

world-wide the absence of detailed investigation and monitoring of crashes is striking. Compared
to other travel modes the quality of the investigation of road traffic deaths and injuries is poor.

Injury reference values. Conceptually these are still considered as single point. pass or fail criteria.
For some parameters, for example the HIC and the TTl, there is some data that allows injury
probabilities to be related to different values of these parameters, but there is little data which
actually examines the consequences of a particular IRV on an actual population. For example, does
an HIC of 1000 have the same injury risk for males as for females? Accident data suggests it does
not.

Optimisation of protection. Given the two populations of human variability and crash severity
exposure, the minimisation of injuries as a result of the interaction of these two populations
becomes a complex matrix. Optimising design for single point requirements in crashes which
represent the upper extremes of the crash severity spectrum will not minimise injuries for everyone
and will leave the vulnerable segments of the population exposed to conditions of less than optimal
design for them.

Human versus dummy response. It is well recognised that current dummies aim to replicate
human response to crash loads at discreet crash severities, mainly at about 50 kmJhr. For lower
speeds the dummy response will not be like that of the human, as is illustrated by the work on rear-
end impacts. Developing transfer functions from dummy to human at a range of crash severities
will be a useful area of biomechanical research; there is no reason to suggest that those functions
will be linear.

Road users other than vehicle occupants. On a global basis, car occupants are a small proportion
of all road casualties. More research on the biomechanics of pedestrian and motorcyclist injuries
must be a top priority.

REFERENCES
[1] R. G. Snyder, D. R. Foust and B. M. Dowman. Studies of Impact Tolerance through Free-
Fall Investigation. Un. Mich. 1977. HSRI Report No.77.
[2] H. Cairns. Crash Helmets. Br. Med. J. 1946. No.4470. p322-328.
[3] E. S. Gurdjian. Experimental Studies on the Mechanism of Head Injury. Res. Bull. Ass.
Nerv. Ment. Dis. 1945. Vo1.24. p48.
[4] J. P. Stapp. Human Exposure to Linear Acceleration. Aero. Med. Lab. Air Force Report.
1951. Report 5912, 2.
[5] D. M. Severy and J. H. Mathewson. Automobile Barrier Impacts. 1954. Nat. Res. Council
Pub. No.334. p39.
[6] J. H. Sheldon. On the Natural History of Falls in Old Age. 1960. Brit. Med. J. Vol.lO.
p1685.
[7] H. Yamada. Human Biomechanics. Kyoto Profectural University of Medicine, Kyoto, Japan.
1963.
[8] H. Yamada. Strength of Biological Materials. Ed. F.G. Evans. Williams and Wilkins Co.
Baltimore. 1970.
[9] B. Aidman. Biodynamic Studies of Impact Protection. Acta. Physiol. Scand. 1962.
Stockholm. No.56. p192.
[10] H. de Haven. Accident Survival- Airplane and Passenger Automobile. Proc. Sym. Packaging
the Passengers. 1952. Soc. Auto. Engrs. New York.
12 M. Mackay

h
[II] G. M. Mackay. Injury and Collision Severity. Proc .lt Stapp Conf. 1968. Soc . Auto. Engrs.
New York . Paper 680779. P207-219.
[12] P. Ventre . Homogeneous Safety Amid Helerogeneous Car Population? Proc . 3'd E.S.V. Conf.
1972. N.H.T.S.A., Washington D.C. p2-39-57.
[13] E. Petrucelli, J. D. States and L. M. Hames. The Abbreviated Injury Scale : Evolution, Usage
and Future Adaptability. Ace . Anal. & Prevo 1981. No.l3. p29-35.
[14] J. W. Melvin, K. J. Baron, W. C. Little and T. W. Gideon. Biomechanical analysis of Indy
car Race Crashes. Proc . Stapp Conf. S.A.E . 1998. p247-266.
[15] J. R. Crandall, P. G. Martin, C. R. Bass , P. C. Dischinger and A. R. Burgess. Foot and Ankle
Injury. Proc. 40 th Conf. Am . Ass . Automotive Med . 1996. PI-18.
[16] S. Parkin, G. M. Mackay and A. Cooper. How Drivers Sit in Cars . Proc. Am. Ass .
Automotive Med . 1993. P375 -388 .
[17] G. M. Mackay, A. M. Hassan and J. R. Hill. Adaptive Restraints - their Characteristics and
Benefits. Autotec. 1997. Published by Inst. Mech . Engrs . Paper C524/l90. P37-52 .
[18] S. Parkin, G. M. Mackay, A. M. Hassan and R. Graham. Rear End Collisions and Seat
Performance. Proc . Ace . Ad. Auto. Med . Conf. Chicago. 1995. P231-244.
[19] G. M. Mackay, S. 1. Ashton, M. Galer and P. Thomas. Methodology of In Depth Studies of
Car Crashes in Britain . Proc. Conf. On Accident Investigation Methodologies. Soc. Auto Engrs.
1985. Paper 850556 .
[20] Society of Actuaries . Build and Blood Pressure Study . London . 1979.
[21] D. F. Williamson. Descriptive Epidemiology of Body Weight and Weight Change in U.S.
Adults . Ann. Intern. Med . 1993. Vo1.119. Pt2. p646-9.
Biomechanics and Its Impact on Human Life:
From Gene Expression to Organ Physiology
Robert M. Nerem

Parker H. Petit Institute for Bioegineering and Bioscience, Georgia Institute of Technology
Atlanta, GA 30332-0363, U.S.A. Ph: 1-404-894-2768, Fax: 1-404-894-2291

Summary: During the latter half of this century biomechanics has made an enormous impact on
medicine and biology. As with virtually all of bioengineering, this started with applying existing
knowledge of mechanics to problems in biology and medicine. In more recent years this has
evolved to where there is a true integration between the engineering mechanics and the biology.
This integration has resulted in not only the application of mechanics to problems which could not
even be envisioned 40 years ago, but also has resulted in the development of the field of
mechanics itself. There are at least three biomedical areas where biomechanics has had a major
impact. These are cardiovascular dynamics, orthopaedics , and injury biomechanics . In all three
of these areas the focus has shifted from the macroscopic to the microscopic, i.e. to molecular and
cellular biomechanics . A relatively recent emerging area is that of tissue engineering , i.e. the
development of biological substitutes for implantation into the body. This field is truly at the
interface of the traditional medical implant industry and the biotechnology industry. It offers the
possibility of implants which will have greater patency. As we move in the 2151 century, the
human genome project will be virtually complete. In this post-genomic era one will move from
the genome to the proteome and ultimately to the physiome. The information that will be
associated with this will be extensive and to the point where proper interpretation will only be
possible if adequate computational models of the dynamics of biological processes can be
developed . These models need to extend all the way from the regulation of gene expression to the
physiological function of tissues and organs. Finally, the development of the educational
programs which truly integrate biology and engineering must be a priority if we are to have the
manpower needed for the future. These are the opportunities and challenges for the 2151 century,
ones to which the biomechanics community can make important contributions .

Key words: Biomechanics, Computational biology, Education, Tissue engineering.

INTR ODUCTION
During the latter half of this century biomechanics has made an enormous impact on medicine and
biology. This started with the recognition that many tissues within the human body reside in a
mechanical environment, i.e. in a stress-strain field. Initially the intent was to apply existing
knowledge of mechanics to problems arising from medicine and biology. As with all of
bioengineering, however, what has evolved is a true integration of the biology with the
mechanics. With this biomechanics has emerged as an important field of endeavor in our attempt
to understand basic biological mechanisms , the physiology of the human body, and disease
processes and to develop new clinical treatment strategies.

As biomechanics has evolved, its application has broadened to include many different tissues and
organs and to extend from the macroscopic down to the microscopic . In regard to the latter, it is
thus common now in days to talk about cellular biomechanics and even molecular biomechanics.

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000
14 R.M. Nerem

Thus, the applications of biomechanics extend all the way from gene expression to organ
physiology.

To illustrate the evolution of biomechanics, three specific areas of application have been chosen
for discussion in the next section. These areas are cardiovasc ular dynamics, orthopaedics, and
inju ry biomechanics. In each of these areas biomechanics has had a major impact. This will be
followed by a look at the new emerging field of tissue engineering and then at the role that
computational modeling has played and more importantly will play in the future. Finally, the
education of engineers for the bio-world of the next century will be considered.

CARDIOVASCULAR DYNAMICS, ORTHOPAEDICS, AND INJURY

BIOMECHANICS

The areas of cardiovascular dynamics, orthopaedics, and inj ury biomechanics represent three
excellent examples of how the application of mechanics to biology and medicine has made a
significant contribution to our understanding. They each also are examples of biomechani cs
extending from the macroscopic to cellular and molecular levels.

Because of my own research activities, the focus of this discussion will be on the cardiov ascular
system, a very dynamic system driven by a biological electro-m echanical pump whose output is
pulsatile in nature. Biomechanicians have contributed to the understanding of the normal heart
and to the effect of disease on myocardial contraction. Equally important has been the role of
biomechanics in the development of the total artificial heart and the evolution of left ventricular
assist devices.

Although considerable effort has been made to understand the dynamics of the heart, equal
attention has been given to the vascular system ranging from the very largest vessels down to the
microcirculation. In regard to the former, i.e. the aorta and larger arteries, these are largely
conduits necessary for the delivery of blood with its nutrients and oxygen to the tissues which
make up the human body. As simple as this function may appear to be, these vessels have a
predilection for the disease atherosclerosis. In its severest form, this disease causes these vessels
to become stenotic and there is a resulting reduction in blood flow.

Even in the earliest stages of diseases, however, research has shown that there is a relationship
between the hemodynamics, i.e. the flow in a vessel, and the development of the disease, i.e. the
genesis of atherosclerosis . It is this possible influence of hemodynamics on atherogenesis that has
motivated much of the research over the past 30 years on the detailed fluid dynamic
characteristics of flowing blood in large vessels and on how the flow environment interacts with,
in fact regulates, the biology of the vessel wall [1].

What we now know is that there is a clear relationship between the hemodynamic environment of
the vessel wall and the biological processes which lead to atherogenesis. The evidence for this
hemodynamic involvement ranges from the pattern of the disease, which shows early lesions to
occur in low shear regions, to the ever accumulating base of know ledge on the effects of physical
forces on vascular cells.

It was in fact back around 1980 that the biomechanics commun ity began to investigate the role of
mechanics in vascular endothelial biology. This certainly was not the start of cellular
biomechanics for in the previous decade the mechanical properties of the red blood cell had been
the subject of study. Investigations of the influence of the hemodynamic environment on the
vascular endothelial cell, however, did thrust cellular biomechanics into the center of vascular cell
biology. This was done by showing how the mechanical environment of a cell could regulate its
Biomechanics and Its Impact on Human Life IS

function. In the case of the endothelial cell what we now know is that it is influenced by a very
complicated mechanical environment, one in which it is exposed both to a time-varying viscous
shear stress and to the direct effect of pulsatile pressure, all the while riding on a basement
membrane, itself undergoing cyclic stretch due to effect of the pulsatile pressure. Depending on
the exact nature of this mechanical environment, there will be alterations in cell morphology,
cytoskeletal localization, proliferative activity, and protein synthesis. These mechanical effects
will extend to the level of gene expression, and there can be interactions between the effects of
this mechanical environment and the biochemical environment in which the cell resides.

In this short presentation, it is not possible to provide the specifics of all of the now known effects
of hemodynamics on endothelial cell biology; however, one example may be illustrative of the
complexity of the influence of mechanics. Let us consider what is called vascular cell adhesion
molecule-l , i.e. VCAM-I , and how flow influences the expression of this molecule [2]. The
surface expression of this molecule is cytokine-inducible, and this has been demonstrated using
vascular endothelial cells in static culture. What then is the influence of flow on the expression of
VCAM-I? If a endothelial cell monolayer is exposed to steady flow for 24 hours, there is no
upregulation of VCAM-l. What is observed, however, is that the ability of a cytokine to
upregulate VCAM-I is very much inhibited. This is in stark contrast to the results obtained when
one exposes an endothelial monolayer to a purely oscillatory flow, i.e. one which sinusoidally
oscillates but with a zero mean flow rate. In this case simply exposing the monolayer to
oscillatory flow results in a significant upregulation ofVCAM-l. On the other hand, exposing the
monolayer to oscillatory flow has only a relatively small inhibitory effect on the cytokine-
inducibility of VCAM-I .

It is through studies, such as represented by the above example and including a myriad of other
related investigations, that biomechanics has impacted our knowledge of atherosclerosis and thus
has had an impact on human life. These studies truly extend from continuum mechanics to the
regulation of gene expression.

Biomechanics has had an influence in other areas of physiology, pathology, and even clinical
treatment. One such area is that of orthopaedic biomechanics, including both soft tissue and hard
tissue. Let us consider first bone as a hard tissue. Biomechanical considerations has led to
improvements in the success of total joint implants through a better understanding of stress
shielding [3,4], Biomechanics has made equally important contributions to the study of fracture
fixation and bone repair [5,6].

Turning to soft tissue, an area of focus has been cartilage mechanics. Articular cartilage is a
complex, triphasic tisssue in which biomechanics research has led to important insights [7].
Another example of soft tissue biomechanics is that of ligaments and tendons. This has been
important to the area of sports mechanics, and in 1998 Professor Savio L-Y Woo received the
Olympic Gold Medal and Prize for Sports Medicine from the International Olympic Committee
for his contributions to this important area of research.

The third area of biomechanics which has had an impact on human life is injury biomechanics.
Much of this activity has been motivated by injuries in automobile accidents and by other causes
of traumatic brain injury. Research in this area has ranged from tissue deformation under high
strain-rate conditions to the associated cellular events, and even DNA damage due to such a
mechanical insult [8-10]. In this it has been critical to understand the cellular mechanics in the
context of the strain field of the deformed tissue. One of the results of research into injury
biomechanics is the development of automobiles which are designed more safely. Clearly this has
had an impact on human life.
16 R.M. Nerem

TISSUE ENGINEERING

Although all of the preceding examples represent areas where biomechanics has had an impact on
human life, there is an emerging area which provides new opportunities for biomechanics. This is
tissue engineering or what I call the engineering of living tissues. The definition of this new,
emerging area is the development of biological substitutes and/or the fostering of remodeling and
regeneration, with the purpose being to replace, repair, maintain, and/or enhance tissue function
[II ].

This new field is giving rise to the next generation of medical implants and is literally at the
interface of the biological revolution and the traditional medical implant industry. Although this
industry is now only in a fledgling state with there only being a few companies with a product
income stream, there is the potential of a multi-billion dollar industry by the year 2020, with some
estimates being as high as in excess of$50 billion annually.

The reason that this represents an opportunity for biomechanics is because many of the tissues
being addressed today in tissue engineering research laboratories are ones which function
normally in a mechanical environment and which have a biomechanical function. The initial
products which have been approved by the Food and Drug Administration in the United States are
skin substitutes; however, a number of other tissues are being addressed both in academic centers
and in industry. This includes cartilage, bone, blood vessels, and heart valves. For each of these
there are important biomechanical considerations; in fact, the function of each of these is
primarily a biomechanical one.

In Atlanta the Georgia Tech/Emory Center (GTEC) for the Engineering of Living Tissues was
established in 1998 by the National Science Foundation with a five-year Engineering Research
Center Award. GTEC has the goal of developing the core, enabling technologies which can
represent a foundation for the emerging tissue engineering industry. The research program of
GTEC has been organized into three programmatic areas, within each of which there are three
core technology thrusts. The three programmatic areas are: cardiovascular substitutes, with the
main focus being on the development of a blood vessel substitute; encapsulated cell technologies,
with the main application here being the bioartificial pancreas; and orthopaedic tissue
engineering, with applications being both bone constructs for the healing of bone defects and
tissue-engineered cartilage.

The three core technology thrusts are: cell technology, including cell sourcing and the
manipulation of cell function; construct technology, including both the engineering of constructs
with an architecture and function which mimics native tissue and the technologies required to
manufacture as well as preserve tissue-engineered products; and the technologies for the
integration of constructs into living systems. This latter includes such issues as living system
models, the quantitative evaluation of both animal experiments and clinical trials, the engineering
of immune acceptance, and the variety of issues related to biocompatibility.

It is through these core, enabling technologies that GTEC believes it can help foster the tissue
engineering industry. The importance of biomechanics must again be emphasized .
Biomechanical factors are important in the regulation of cell phenotype and function, including
gene expression and protein synthesis. An example of this was provided in the previous section.
Biomechanical considerations also are significant in the context of engineering functional, three-
dimensional constructs. Finally, biomechanics is important in the integration of constructs into
the living system.
Biomechanics and Its Impact on Human Life 17

COMPUTATIONAL BIOLOGY

The computational modeling of biologic phenomena has long been an important part of
biomechanics. As a complement to experiment, the use of such modeling has helped us interpret
existing data and design new experiments. Computational modeling has been applied in all three
of the example application areas discussed earlier, i.e. the cardiovascular system, orthopaedics,
and injury biomechanics. Although the work reported in the literature has been primarily at the
tissue and organ levels, more and more we are seeing the application of computational
biomechanics at the cellular and molecular levels.

There is a new opportunity which, however, is facing us. This is due to the enormous explosion
in biological information. This starts with what for biology is the equivalent of the periodic table,
i.e. the human genome. This project is on the verge of completeness, and already people are
talking about the proteome and even the physiome. With all of this we will have provided the
information base for the life sciences.

But how will we interpret this enormous amount of information? How will we be able to use this
to design new experiments that will teach us about the dynamical processes that govern human
life? I believe that a key will be in the development of mathematical models, ones which will be
so complicated as to require the computational power of a super computer. These will extend
from modeling the regulation of gene expression to the prediction of cell function and the
characterization of tissue behavior and organ physiology. Thus, the field of computational
biology must be viewed in the broadest sense possible, i.e, extending from gene to organ, and
including the computational biomechanics of the past several decades.

At the more macroscopic end of this scale already considerable expertise exists, with much of this
coming from the biomechanics community. There are a variety of reports in the literature
describing the use of computational fluid dynamic codes to calculate the characteristics of blood
flow and the application of finite element methods to determine stresses in bones. There are even
examples of computational models of cellular phenomena. An example of this is the prediction of
calcium transients in endothelial cells responding to the onset of flows, in this particular case both
extracellular calcium moving across the cell membrane and intracellular calcium being released
from internal stores are taken into account [12]. What this model shows more than anything else
is the lack of critically needed data to describe cellular processes.

The challenge for all of bioengineering and certainly the biomechanics community is to develop
new models, ones that not only range from gene expression to organ physiology, but in fact
provide the ability to integrate across the biological scales. It is such integrative models that will
allow us to interpret the vast amounts of data coming out of the biological information explosion.
In a very real sense, biology is becoming an information science; however, to maximize our use
of this information will require integrative models. This is needed to interpret the information we
already have, to design new experiments so as to obtain new information, and to provide further
insights into biomedical and biomechanical phenomena.

BIOENGINEERING EDUCAnON

The second half of the zo" century has been a rich one for biomechanics and the community
which identifies with it. It is the hope of this author that this has been demonstrated here, at least
in some small way. The 21st century certainly will offer many new opportunities and
challenges. These will include tissue engineering and the role we will need to have in the
18 R.M. Nerem

integration of the information of the life sciences. There will be many other applications ,
challenges and opportunities, most of which we cannot even foresee today.

This will have an enormous impact on education in our universities, both in our graduate
programs and at the undergraduate level. This impact will not just be in biomechanics, but in all
of bioengineering. In fact bioengineering, which has been a multi-disciplinary field, is emerging
as a discipline in its own right [13].

What will be important is for people in bioengineering to integrate biology with their knowledge
of engineering. The biological revolution has produced new advances in molecular and cellular
biology, and these continue with every week there being new disclosures. These represent
advances in science, but they also represent new tools to be used both in basic research and in the
development of new technologies. The bioengineering community needs to take advantage of
these new tools. Just as the tools of physics and chemistry have been harnessed in the past, the
ever expanding tools of biology need to be integrated into our future.

What is now happening is that new departments and/or schools of biomecial engineering are
being established. This is certainly true in the United States where in many cases the leadership is
being provided by members of the biomechanics community. In my own city of Atlanta, Georgia
Tech and Emory University School of Medicine have joined together to create a new joint
department. This Georgia Tech/Emory Biomedical Engineering Department will offer a joint
Ph.D. degree, one which integrates biology with engineering and which uses problem-based
learning.

This new joint department also will be taking a role in undergraduate education. How can any
undergraduate student be considered as educated for the 21st century without a university-level
course in molecular and cell biology and genetics? What about a biology-based engineering at the
undergraduate level either through a B.S. degree or a combined B.S. - M.S degree? It is
questions such as these that the new Georgia Tech/Emory department faculty will be addressing
and which should be addressed by every major engineering school.

MOVING INTO THE 21 ST CENTURY

With these new tools and with the new, unforeseen opportunities, the future of biomechanics is
bright. Furthermore, there is every reason to believe that biomechanics will continue to have an
impact on human life. To do this, however, will require integrating the tools of biology with our
engineering, literally integrating biology and engineering.

In closing, I wold like to comment on the nature of the biomechanics community . This is truly an
international community, with there being strong centers of activity in the United States, Europe,
and Asia. In fact, one such biomechanics center is here in Nagoya, our host institution. When I
first traveled to Japan 30 years ago in 1969, Nagoya was one of the institutions which I wanted to
visit. Today biomechanics here is one of those centers which is recognized all over the world.
These centers in different countries are all part of an international community, which I believe has
made a significant impact on human life. This we will continue to do if we can harness the
continuing advances coming out of the biological revolution and the new tools of biology,
integrate biology with our engineering, and integrate across the biological scales.
Biomechanics and Its Impact on Human Life 19

ACKNOWLEDGEMENT

The author is appreciative of the support of his research provided by the National Science
Foundation and the National Institutes of Health. He also thanks his colleagues, both at Georgia
Tech and Emory, as well as worldwide, for the many stimulating discussions which he has had
with them.

REFERENCES

[1] R.M. Nerem, Vascular Fluid Mechanics, the Arterial Wall, and Atherosclerosis, ASME
Journal ofBiomechanical Engineering, Vol. 114, pp. 274-282.
[2] S.E. Varner, RW. Alexander, R.M. Medford, R.M. Nerem, Endothelial VCAM-I
Regulation by Steady and Oscillatory Shear Stress, Atherosclerosis XI, Proceeding s ofthe
Xith International Symposium on Atherosclerosis. Elsevier Science, Singapore, 1998, pp.
957-961.
[3] H.E. Rubash, R.K Sinha, A.S. Shanbhag, S.Y. Kim, Pathogenesis of Bone Loss After
Total Hip Arthroplasty, Orthopaedic Clinical North America, Vol. 29, 1998, pp. 173-186.
[4] D.R. Sumner, J.O. Galante, Determinants of Stress Shielding : Design Versus Materials
Versus Interface, Clinical Orthopaedics, Vol. 274,1992, pp. 202-212.
[5] D.R. Carter, P.R. Blenman, G.S. Beaupre, Correlations Between Mechanical Stress
History and Tissue Differentiation in Initial Fracture Healing, Journal of Orthopaedic
Research, Vol. 6,1988, pp.l736-748.
[6] R.E. Guldberg, N.J. Caldwell, X.E. Guo, R.W. Goulet, S.J. Hollister, SA Godlstein,
Mechanical Stimulation of Tissue Repair in the Hydraulic Bone Chamber, Journal ofBone
Mineralization Research, Vol. 12, 1997, pp. 1295-1302.
[7] Mow, V.C., Ateshian, G.A., Spilker, R.L., "Biomechanics of Diarthrodial Joints: A
Review of Twenty Years of Progress. ASME Journal of Biomechanical Engineering ,
1993 Nov. 115 (4B) 460-7.
[8] A.J. King, J.S. Ruan, C. Zhou, W.N. Hardy, T.B. Khalil, Recent Advances in
biomechanics of Brain Injury Research : A Review, Journal of Neuratrauma , Vol. 12,
1995, pp. 651-658.
[9] R. Raghupathi, T.K. McIntosh, D.H. Smith, Cellular Responses to Experimental Brain
Injury, Brain Pathology, Vol. 5, 1995, pp. 437-442.
[10] H.F. Mahmood, S.D. Barbat, M.R. Baccouche, Crashworthiness. Occupant Protection,
and Biomechanics in Transportation Systems, American Society of Mechanical Engineers,
New York, 1999.
[II] R.M. Nerem, A. Sambanis, Tissue Engineering From Biology to Biological Substitutes,
Tissue Engineering, Vol. 1, 1995, pp. 3-13.
[12] T.F. Wiersher, B.C. Berk, R.M. Nerem, A Mathematical Model of the Cytosolic Free
Calcium Response in Endothelial Cells to Fluid Shear Stress. Proceedings ofthe National
Academy ofSciences USA, Vol. 94,1997, pp. 3726-3731.
[13] R.M. Nerem, The Emergence of Bioengineering, The Bridge, Vol. 27,1997, pp. 4-8.
 Recent Advances in the Biomechanics of the Head and Neck

Albert I. King and King H. Yang

Bioengineering Center, Wayne State Univer sity, Detroit , Michigan 48202 , USA

Summary: This paper describe s the development, feature s and validation of a brain injury
model as well as those of a neck injury mode l. The two model s can be linked together to
simulate head and neck motion during a vehicul ar crash. Detail s of each model are provid ed
along with a short history of the developmen t. The model s were validated against available
experimental data conducted on cadavers. For the brain injury model, predicti ons of relative
displacement of the brain with respect to the skull are compared with experimentally derived
data using a bi-axial high-speed x-ray machine. The tests were carried out on cadaveric heads
and were blunt impacts to the occipital region of the head. The neck model was validated against
data from two sets of experiments. It was able to simulate with reasonably accurate kinemat ics
crown impacts to the head and rearend colli sions. The paper discusses the avail ability of the
models to the biomechanical community, their strengths and deficiencies as well as future
direction s for improved model s. It is concluded that sophisticated finite element model s are
useful tools for the study of the biomechanics of injury, if the models have been properl y
validated. There is, however , a continu ing need to obtain more data on the material properties of
the tissues that make up the head and neck and to go to a finer mesh to extract a more detailed
response from the model. More experimental data are being obtained from this laboratory so that
the model s can be validated against a larger volume of experimental data.

Key words: Brain injury , Neck injury, Finite element hum an model, whiplash, intracranial
pressure

INTRODUCTION

Injuries to the central nervou s system (CNS) can be extremely devastating becau se, when they
are severe, they are generally irreversible and have a long-term sequelae of disabilitie s which
incur immense societal costs. Since a cure is not a reachable goal at this time , the only
alternative is prevent ion of these injuries. Experimental studies involving injur y mechanism s and
human tolerance are costly and difficult to conduct becau se they necessarily invol ve the use of
living animals. That is, the devel opment of diffu se axonal injury cannot be tracked in cadaveric
subjects. Howe ver, the cada ver can be used to study the mech anical respon se of the head and
neck to blunt impact. Recent experiments conducted by Hardy et al [I] to map the motion of the
brain during head impact is an example of a cadaveric study on brain respon se. A just completed
study by Deng [2] on the relative motion of cervical vertebrae during a simulated rearend
collision is another example of the use of cadavers to solicit biomechan ical respon se.

There is no question that computer models of impact events can be of major assistance to
researchers in the field . They provide an added capability which is much less expensive and time
consuming than experimental testing if their predictions have been validated rigorously. The y
can also be used to study impact events which are too complex or costly to simulate in the
laboratory or on the proving ground. Howe ver, the accuracy of the predictions appear to depend
on how detailed the model is for a particul ar impact. For example, if the aim is to determine the
strain level in brain tissue at the boundar ies of the white and gray matter, there would be more

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 21
22 A.I. King and K.H. Yang

confidence in the predicted strain levels if the model were made up of very small elements so
that areas of high strain could be identified in the sulci of the brain. On the other hand, a fairly
coarse model will suffice if pressure distribution within the brain is of interest. More
importantly, computer modeling should work in concert with experimental measurements in an
iterative manner so that a better understanding of the inj ury mechanisms involved can be
attained. Better computer models can be developed with the help of useful and accurate
experimental data. On the other hand, a good computer model can be used to guide the
experimentalist who may be led to locate instrumentation in areas of high stress, as predicted by
the model. This paper describes the development of computer models of the head and neck
simulating blunt impact to the head and mechanical response of the neck to a variety of impact
situations. Validation of the models is presented.

THE CURRENT WAYNE STATE UNIVERSITY BRAIN INJURY MODEL

(WSUBIM)

There was a hiatus of about a decade during which no serious effort was dedicated to the
development of finite element models of the brain to simulate blunt impact. The model by Hosey
and Liu [3] was quite complete but it was too large for the computers available at that time. Ruan
et al [4] revived the modeling effort and developed a 3-D model with a three-layered skull that
was validated against experimentally measured intracranial pressures reported by Nahum et al
[5] . The mesh used by Ruan et al [4] was based on the original one published by Shugar [6] . As
for its ability to predict locations of high shear strain where diffuse axonal injury (DAI) might
occur, the model was unable to do so . Experimental results from porcine experiments have
shown that DAI occurs in the white matter at its boundary with gray matter and near ventricles.
A 2-D version of a porcine brain section was developed that produced high strains in the
locations similar to those locations where DAI was found experimentally (Zhou et aI, [7]).
Subsequently, Zhou et al [8] re-meshed the model developed by Ruan et al [4], using much
smaller elements which simulated the gray and white matter separately. The white matter was
assumed to be 60% stronger in shear than the gray matter because of its fibrous structure.
However, the CSF and the brain were modeled as a continuum using a solid material constitutive
law with a low shear modulus. Using this model, the maximum relative displacement between
the brain and the skull was small than 0.5 mm in all
cases simulated.

The current WSUBIM represents a 50th percentile

male human head. Its geometry was based on an atlas
by McGrath and Mills [9] and on brain sections
prepared in the Bioengineering Center of Wayne
State University. It has 32,898 nodes and 41 ,354
elements, with a total mass of 4.3 kg . Anatomical
features of the model included the scalp, the dura,
falx, tentorium, pia, CSF, venous sinuses, ventricles,
gray and white matter, cerebellum, brain stem,
parasagittal bridging veins and anewly introduced
three-layered skull which had an outer table, diploe,
and inner table (Figure 1). Additional details
regarding the make-up of the model can be found in
Zhou [10] . Fig. I. WSUBIM
Recent Advances in the Biomechanics of the Head and Neck 23

To model the CSF layer accurately, fluid elements should be used so that only very low shear
stresses can be transmitted from one component to the other. However, technic al problem s still
exist in coupling the solid and fluid elements in one single model. In the present WSUBIM, the
CSF was modeled as a layer of material with a low shear modulus while allowing the inner
surface of the CSF and the outer surface of the pia matter to slide with a very low coefficient of
friction . In finite element terms , a sliding interface was used to simulate the interface between
the brain and the CSF. To accomplish this, a layer of null material shell elements was created
for the inner surface of the CSF (modeled by solid elements with low shear modulus).
Additionally, the pia matter (modeled by shell elements) was made equivalent to the outer
surface of the brain (modeled by solid elements), and sliding is allowed between the null
material and the pia matter.

Identifying proper brain tissue properties continues to be a major handicap in computational

modeling. In this study, the bulk modulus of the brain (both white and gray matter) was
considered to be 2.19 GPa, the same as that of water. Linear viscoelastic material properties were
chosen for the white and gray matter. The shear modulus used was based on data reported by
Shuck and Advani [II] . Since white matter is more fibrous, its shear modulus was assumed to be
higher than that of gray matter. The linear viscoelastic shear properties of the white matter was
assumed to be 20% stronger than that of gray matter.
For the skull, distinctions were made between cortical
and spongy bone . Additional details for the current
WSUBIM are provided by AI-Bsharat et al [12].

It has been sugge sted that relative motion between the

skull and brain is one of the causes of brain injury. A
unique high-speed x-ray system was used to obtain
brain/skull relative motion data. Neutr al density targets
were inserted into pressurized cadaveric brains . The Fig. 2. Neutraldensity targets inserted
target locations are shown in Figure 2. There was a in a cadaver head used to measure
column of six targets in the occipitoparietal region and relative displacements betweenthe
another column of five in the temporoparietal region . skull and brain.
Additional details of the experiment can be found in
Hardy et al [I]. However, because of limitations of the shutter speed in the camera system , only
low velocity head impacts could be carried out
in order to obtain clear images of the targets . As
a result, experimental data were collected for - F. 'I; f'(: ri ~
.. . \loJ.el
tests in the 3-mls range . It was also unfortunate
that the pressure transducers used in these
cadaveric tests failed to function properly and
the only pressure data available for validation
were those obtained by Nahum et al [5].
,. '

The current WSUBIM was exerci sed for ,.: .-

validation against relative displacement data at
low speed (2.3 to 3.6 ml s) occipital impacts and
for validation against pressure data at higher
speed (6 to 10 mls) front al impacts . Figure 3
shows a compari son of experimental data with
model predictions of the relative motion of the
Fig. 3. Comparison of the relativedisplacement
brain with respect to the skull for the 2.7 mls between the skull and the brain predicted by the
occipital impact. There is good correlation model and that obtainedexperimentally.
between experim ental data and model
24 A.!. King and K.H . Yang

predictions , even though there could have been slight mismatches in time zero between the
model and the experiment. In addition, the relation between contact force and coup/contrecoup
pressure with respect to the impact energy for tests conducted by Nahum et al [5] also correlated
well.

THE WAYNE STATE UNIVERSITY NECK INJURY MODEL (WSUNIM)

Geometric data on the bony tissues of cervical spine of the current WSUNIM were obtained
from an MRI scan of the neck of a healthy male whose anthropometry was close to that of a 50th
percentile male. Standard cervical spine MRI scanning protocol was employed in order to obtain
images with the subject in a supine position. The vertebrae were digitized and the straight neck
was adjusted to assume the lordotic posture by making it
match a previou sly reported average angle of 34 degrees
(Harrison et ai, [13]). Soft tissue geometry, including that of
the ligaments and intervertebral discs, was based on
anatomical texts, using the bony structure as a reference . A
head model , previously developed by Ruan, was
incorporated into the neck model (Ruan, [14]).

The current model is made up of a total of 11,498 solid

elements, 3,071 shell/membrane elements and 108
spring/bar elements (Figure 4). All seven cervic al vertebrae
(CI-C7) and the first thoracic vertebra (Tl) were represented
by solid elements . Contact interfaces were defined to permit
free sliding between the bony surfaces of the atlanto-
occipital joint, the dens and C I, and all articular facet joints.
Material properties used in this study were based on those Fig. 4. WSUNIM
published in the literature . Additional details regarding the
make-up of the model can be found in Yang et al [15].

This model was first validated against free drop head impact
tests conducted at Duke University (Winkelstein et ai, [16]
and Nightingale et ai, [17]). In these tests, head and neck
specimens (without active musculature) were dropped from
a height of 0.53 m onto a plate that was either horizontal or
was tilted 15 degrees anteriorly or posteriorly. A 16-kg
concentrated mass, guided by a vertical rod and attached to
Tl simulated the effective torso mass. During the test, neck
force (measured at TI), contact force (between the head and
the plate), and head accelerations were recorded. To
simulate this series of experiments, all muscles were
removed from the model while a concentrated mass of 16 kg
was attached to T I and a rigid contact surface was added to
the model. The motion ofTI was constrained along a
vertical axis, and the entire system had an initial downward
velocity of 3.2 rn/s just prior to contact.

Figure 5 shows the predicted kinematics of a head and neck Fig. 5. Neck kinematics
drop onto a horizontal surface . Since Tl was allowed to predicted by the model during a
move only in the vertical direction and since the head was vertical drop test.
Recent Advances in the Biomechanicsof the Head and Neck 25

positioned anteriorly with respect to T'l , the lower cervical spine went into flexion immediately
after contact. Additionally , since the head had a minimum amount of rotation after contact, it
appeared that the neck buckled upon loading . Note that the CO-CI joint is rather compliant in
both flexion and extension . Thus , if the head moves in the anterior direction in this test setup, the
upper cervical spine is forced into an extended position and the neck forms an S-shape .
Conversely, if the head is moved posteriorly, the upper neck is loaded in flexion. It is believed
that this neck model would be applicable in the study of neck loads in rollover simulations .
Additionally, head acceleration and neck force time histories predicted by the model agree well
with data obtained experimentally. However, the model head contact force had a l-rns lag.

The model was also used to simulate cadaveric rearend impacts . In this test setup, the rearward
facing instrumented cadaver was seated on a rigid seat at a 20-degree seatback angle, but no
head restraint was used on the Wayne Horizontal Acceleration Mechanism (WHAM III) in these
tests . The sled was accelerated to a constant velocity of 6.7 m/s (15 mph) before being stopped
by a hydraulic snubber at a peak deceleration of 8 g. Both head and TI accelerometer data, as
well as data obtained from three high-speed cameras, were used to record the kinematics . In the
simulation, linear velocities relative to the Tl-fixed coordinate system along the anterior-
posterior (x) and superior-inferior (z) directions, and angular velocity about the medial-lateral
(roy) direction from the third cadaver test were used as input at the center of gravity ofT!. Figure
6 shows the A-P and S-I accelerations of the head for the local coordinate system as predicted by
the model. The predicted neck kinematics and the head A-P and S-I accelerations compare
favorably with that observed experimentally. It is believed that the current WSUBIM is a useful
tool to study neck kinematics not available from other simplified models for rearend impact
simulations.
llead Attdrra llon - X 00 "rod Attrlrra llon • Z (&)

,r--,---,-.,.---.- .,.--,-- r --,---,-"

II ,
'"
-
~.
~looIrl
Tnc ' l
Rnull
,
12 ··· Tnt " o..,..::L---->..........-

..
- Tnt llJ -a

· 12
. ",

·11
-n
~ ~
o 20 .eo 8) !O lOOTl ~/r( ••\4l) UlO 110 200 of-"';"!, ;-~..; ---,!
... -;!; f. (..-;.\~':"~
... -;i;T""I""I;!;;.- , ~",;;--~

Fig. 6. Comparison of the head A-P (left) and S-I (right) accelerations predicted by the
model and that obtained experimentally.

DISCUSSION

Positive Aspects of the WSUBIM and WSUNIM

The WSUBIM is the first finite element model that can predict both intracranial pressure and
brain displacement relatively accurately. It can also compute the strain level within the entire
brain . Thus , it has the potential of being used in a variety of impact situations to study the risk of
injury to the brain . The model has a deformable skull and can be used to simulate both direct
impacts occurring in automotive crashes and contact sports. It can also be used to simulate
indirect impacts if a proper neck boundary condition is added. It is detailed enough to identify
26 A.I. King and K.H. Yang

areas of the brain where a high shear strain is likely to be the cause of DAI or a high tensile
strain in a bridging vein is likely to cause a subdural hematoma .

The WSUBIM can be used to provide boundary conditions needed to study axonal injury in a
specific region. The approximate length of each element of the WSUBIM was 5 rnm, about three
orders of magnitude of that of an individual axon . Because the speed of computing is not
expected to increase exponentially in the near future, no computer simulations using a model that
includes detailed axonal information can be carried out in the next few years. Thus, the
WSUBIM is still needed to provide boundary conditions required for substructure modeling of
axons in a more limited region in order to understand mechanics involved in axonal injuries .

The WSUNIM is again the first finite element model that has been validated against more than
one set of experimental test conditions. The geometry of the model was taken from a person who
had the height and weight of a 50th percentile male. It is also the first computer model that
accounted for the detailed geometry of the facet joints along the entire cervical spine. This
feature is vital to the study of whiplash injury mechanisms because recent research results all
tend to point the facet joint as a source neck pain due to whiplash . The model can handle both
direct crown impacts as well indirect impacts to the head as a result of a rearend collision. The
WSUBIM and WSUNIM can be linked to a previously developed human thorax model (Wang,
[18)) to simulate a single impact event, such as a frontal impact with airbag interaction . This
would be a precursor to the development of a validated finite element model of the entire body.
Such a model will not only yield reliable kinematic results but also computed values of strain
that are predictive of injury not available from crash dummies .

Deficiencies of the WSUBIM and WSUNIM

The range of validity of the WSUBIM is currently limited to relatively low levels of impact
severity. Due to the lack of data and computational problems the model has not been validated
against severe impacts. Validation of brain displacement at the impact speeds in excess of 3.6
m/s cannot be done because no data are available at this time and validation of pressures in
excess of 10 m/s is still not achievable due to problems with the quality of the current mesh. The
choice of material properties for brain tissue is somewhat arbitrary because they are much higher
than measured values recently obtained by Arbogast et al [19]. However, this was done to
account for the heavy concentration of blood vessels in the brain that can significantly increase
the stiffness of intact brain tissue . Material properties were obtained from dissected brain
sections which no longer can fully reflect the tethering effect of the blood vessels. Additionally,
the model did not account for regional difference in material properties although it can be
implemented as soon as such data become available.

The WSUNIM is unable to simulate subluxations, fracture/dislocations and burst fractures,

injuries of major interest because of their potential to cause paralysis . Of course, these
capabilities need to be evolved from an increasingly versatile model. Thus, the current model
needs to be tested and perhaps improved upon to simulate a variety of severe impact condition
that can be potentially hazardous to the eNS. On the other end of the spectrum , a more refined
model of the capsular ligaments as well as of the other ligaments is needed for a better
understanding of the whiplash problem .

Future developments

Acquisition of brain/skull relative displacement data in linear impacts, is still in progress at this
laboratory . In addition , new experiments designed to study the brain/skull relative motion when
the head is subjected to rotational impacts will be conducted in the near future. Further
Recent Advances in the Biomechanicsof the Head and Neck 27

validations will be performed using the current WSUBIM once these data become available . The
current model still does not account for the myriad of blood vessels coursing through the brain.
The material properties were selected to account for it on an aggregate basis but to obtain a
better simulation of the brain during blunt impact it is essential that a finer model be developed
to include the effect of the vasculature . Looking further down the line, it is conceptually possible
to visualize finite element models ofaxons and neurons which are the essential components of
the brain. These models need to account for the membrane structure as well as the subcellular
components of individual cells. The purpose of these models would be to further the
understanding of CNS injury at the cellular level and to seek preventative methods for
minimizing functional injuries . That is, it is anticipated that, in future automotive crashes , severe
injuries will be rare but the victims need to be protected against any substantial loss of CNS
function .

Measurements of motions for each cervical vertebra in low speed rearend impacts, using the
unique high speed x-ray system, are continuing in our laboratory. In this study, radio opaque
markers are embedded in each cervical vertebra while motion data are obtained in whole body
rearend impacts (Deng, [2]). The current model will be validated against these data so that
rearend impact injury mechanism may be depicted. The model can be used to search for areas of
high strain among the soft tissues of the cervical spine. For example, a detailed model of the
capsular ligament and of the facet joint surfaces will be most helpful in establishing the capsule
as a source of neck pain. A parametric study can also be conducted to determine if the capsular
strains are a function of the shape of the facets .

In addition , models that can simulate subluxation of one vertebra over another need to be
developed to look at more severe injuries to the neck. The interaction of cervical vertebrae with
the spinal cord can then be investigated. Other advances include the simulation of fracture of
various components of the cervical spine, including burst fracture which is a major cause of
quadraplegia. These advanced models are likely to require a more refined mesh but even if they
do not, they will need to have the vertebrae modeled separately by cortical and trabecular bone
and the ligaments may need to be modeled individually.

CONCLUSIONS

1. A sophisticated head model and a versatile neck model have been developed. Both have
been subjected to a limited degree of validation .
2. A few more details need to be taken care of before a combined head and neck model can
be made generally available to the biomechanics community.
3. Additional validation is also needed to ensure its applicability to a variety of impact
situations .
4. Additional data are also needed to validate these models .

ACKNOWLEDGMENT

This research was supported in part by CDC Grant No. R491CCR503534-10 and by Wayne State
University . The assistance of A. Al-Bsharat , P.Begeman, B. Deng, W. Hardy, F. Luan, S.
Tashman, L.Zhang and F. Zhu are appreciated.
28 A.1. King and K.H. Yang

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Introduction of a New Technique, Crashworthiness, Occupant protection and Biomechanics
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[2] B. Deng, Kinematics of Human Cadaver Cervical Spine during Low Speed Rear-end
Impacts, Ph.D . Dissertation, Wayne State University, 1999.
[3] R. Hosey, Y. Liu, A Homomorphic Finite Element Model of the Human Head and Neck ,
Finite Element in Biomechanics, pp. 379-401 , John Wiley & Son, New York , 1982.
[4] J. Ruan, T. Khalil , AI. King, Finite Element Modeling of Direct Head Impact , Proc. 37th
Stapp Car Crash Conference , SAE Paper No. 933114 ,1993, pp.69-82 .
[5] A. Nahum, R. Smith, C. Ward, Intracranial Pressure Dynamics during Head Impact , Proc.
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[6] T.A. Shugar , A Finite Element Head Injury Model. DOT HS 803-211 , NTIS, 1977.
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[8] C. Zhou, T. Khalil, AI. King, A New Model Comparing Impact Responses of the
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SAE Paper No . 952714 ,1995, pp.121-138 .
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Switzerland; New York, 1984.
[10] C. Zhou, Finite Element Modeling of Impact Response of an Inhomogeneous Brain, Ph.D .,
Dissertation, Wayne State University, 1995.
[11] L. Shuck, S. Advani, Rheological Response of Human Brain Tissue in Shear, J Basic Eng.
1972, pp. 905-911 .
[12] A.S. AI-Bsharat, W.N. Hardy, K.H. Yang, T.B. Khalil, S. Tashman, AI. King, Brain/Skull
Relative Displacement Magnitude due to Blunt Head Impact: New Experimental Data and
Mode. Proc. 43rd Stapp Car Crash Conference, 1999, pp. 321-332 .
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Cervical Spine Curvatures to a Theoretical Ideal Model of the Static Sagittal Cervical
Spine, Spine , Vo1.21, 1996, pp.667-675 .
[14] J.S. Ruan, Impact Biomechanics of Head Injury by Mathematical Modeling, Ph.D.
Dissertation, Wayne State University, 1994.
[15] K.H. Yang, F. Zhu, F. Luan, L. Zhao, P.c. Begeman, Development ofa Finite Element
Model of the Human Neck, Proc. 42nd Stapp Car Crash Conference, SAE paper No.
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[16] B.A Winkelstein, R.W. Nightingale, B.S . Myers , Impact Neck Injury Dynamics:
Relationships between Impact Surface, Cervical Spine Kinetics, and Injury Risk,
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B.S. Myers , The Dynamic Responses of the Cervical Spine : Buckling, End Conditions, and
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[18] H.-C. K. Wang, Development of a Side Impact Finite Element Human Thoracic Model.
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Frequency Shear Device for Testing Soft Biological Tissues, J. Biomech ., 30(7), 1997, pp.
757-759 .
The Tibia Index: A Step in the Right Direction

Jeff R. Crandall , James R. Funk, Rodney W. Rudd, and Lisa J. Tourret

University of Virginia Automob ile Safety Laboratory, 10 I I Linden Avenue , Charlottesville, VA

22902, U.S.A.

Summary: Leg injuries are frequent occurrences for occup ants involved in automobile crashes.
This paper investigates the efficacy of a proposed inj ury criterion, the tibia index, to predict
fractures of the leg. Using an interaction formula, the tibia index combines the applied
compressive force and moment to predict mid-shaft fractures of the tibia and fibula. Quasistatic
and dynamic test data of the leg are reviewed in an effort to establish critical threshold values of
force and moment. The data indicate that there is minimal dependence of the fracture threshold on
the direction of applied moment and suggest that a resultant moment is appropriate for the index.
Meanwhile, axial loading of the leg results in bending of the tibia due to the curvature of the limb
and eccentricity of the load through the ankle and knee. Since the distal and proximal ends of the
fibula and tibia are weaker than the shaft, a supplemental compres sive criterion is required for
these regions. Validation of proposed indices relative to published experimental testing shows
good correlation for dynamic results and verifies the dependence of the fracture threshold on an
interaction between the applied moment and compressive force. Until additional testing can be
conducted to generate injury risk functions, individual investigators must decide whether the static
or dynamic criteria are most applicable for their test environment. Furthermore , implementation of
the indices into dummy designs requires biofidelic response in order to provide accurate estimates
of the injury risk.

Key words: Leg injuries, Injury criteria

INTRODUCTION

Lower limb injuries resulting from automobile crashes have received increased attention with the
reductions in head and thoracic trauma attributed to the rise in seat belt usage and the widespread
implementation of air bags. Unfortunately, these advanced restraint systems have not provided
corresponding improvements in protection of the lower limb [I] . Using the Abbreviated Injury
Scale [2], leg inj uries remain the second most common site of serious injuries among survivors in
frontal crashes [3]. To predict leg injuries in crash tests and to provide a framework for evaluating
counterme asures, Mertz [4] developed the tibia index that combined the axial load and bending
moment applied to the leg. This paper examines the efficacy of this index in predicting leg injuries
and develops recommendations for its interpretation and application .

Anatomy and injury patterns. The skeletal structure of the leg is comprised of the tibia and
fibula. The tibia is the main weight bearing bone in the lower limb that articulates proximally with
the femur to create the complex hinge of the knee joint and distally with the talus and fibula to
create the mortise hinge of the ankle joint. Because the body of the tibia is unprotected
anteromed ially and is relatively slender in regions, the tibia is the most common long bone to
fracture and to suffer compound injury [5]. The body of the tibia is narrowest at the junction of its
middle and inferior thirds and this is the most frequent site of fracture [6]. Mid-shaft tibia
fractures can be problematic because they are prone to developing compl ications and are relatively
intolerant of inadequate fracture reduction. Improper alignment of the fracture can produce
alteration s in the normal weight distribution and can result in late onset arthritic changes of the
knee and ankle. The tibia is particularly prone to developing non-union because of its relatively

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 29
30 J.R. Crandall et al.

tenuous blood supply: both the main nutrient artery, supplied by the posterior tibial artery, and the
periosteal supply, from the anterior tibial artery are prone to disruption from injury and during
surgical reconstruction . The subcutaneous nature of the tibia also makes it susceptible to open
injuries. These injuries carry with them a set of treatment difficulties ranging from infection to
amputation depending on the degree of soft tissue destruction.

The tibia widens superiorly to form the tibial plateau that comprises the articular surface for the
femoral condyles. Distally, the tibia has a medial extension, the medial malleolus, which serves as
the origin for the deltoid ligaments and provides the medial bony support for the ankle mortise. The
distal weight bearing articular surface of the tibia is called the plafond and this articulates with the
dome of the talus forming the weight-bearing surface of the ankle joint.

The fibula is positioned laterally and posterior to the tibia and can be palpated proximally at its
head and distally at the lateral malleolus of the ankle. It acts as an origin for muscles and the
interosseous membrane. While originally considered to serve only as a lateral strut for ankle
stability, the fibula actually bears some of the load carried by the lower limb. Although the exact
proportion is in dispute, the load borne by the fibula varies with ankle orientation and ranges from
5% [7] to greater than 16% [8] with the greatest percentage of load occurring in the everted and
dorsiflexed condition [9].

The lower limb musculature is divided into four compartments: anterior, peroneal, superficial
posterior, and deep posterior. Each compartment is tightly contained within inelastic fascia tightly
bound to the bone. Because of the anatomical arrangement of the four muscle compartments in the
leg, there exists a tendency for compartment syndrome to develop. When swelling and bleeding
cause the pressure in the compartment to rise above that of the perfusing vessels, there is
compromise of the tissues within the compartment. Irreversible nerve damage and muscle necrosis
are two of the devastating sequelae.

Fildes et al. [10] conducted a retrospective analysis of hospitalized patients who sustained lower
limb injuries in frontal motor vehicle crashes. In addition to developing correlations between crash
severity and the likelihood of injury, the authors postulated the source of injury from the crash
investigation and the injury mechanism based on the observed fracture patterns. For leg trauma,
the breakdown of injury mechanism was 62% compression , 24% perpendicular loading (interpreted
as bending), 5% shear loading, and 5% torsion. It is clear from these data that a predictive criterion
for injury must include both compression and bending.

TIBIA INDEX

The tibia index is derived from the classical theories of failure for a beam subjected to combined
bending and compression . The form of the tibia index falls under the classification of interaction
formulas used for computing beam-column load capacities where

(I)

in which P is the axial compressive force, M is the applied moment at both ends, and Cm is an
empirically derived coefficient. M, is the plastic moment capacity derived from

(2)
The Tibia Index 31

where cry is the yield strength of the material and Zp is the plastic section modulus. Pcr is the
compressive force capacity, calculated as if the beam were a centrally loaded column. If the
slender ratio is large enough, the Euler buckling load can be used for P cr-

Using beam interaction formulas as a guideline, Mertz developed the tibia index to examine
combined loading failures of the tibia using the axial force, F, and the bending moment, M,

F M
-+-::>1 (3)
Fcr Mer

where F cr and M cr are the respective force and bending moment failure thresholds. If the tibia index
exceeded a value of 1.0 at any instant in time, the criteria predicted that leg injury was likely to
occur. Using mass and length scaling techniques, Mertz determined critical values for various
sized occupants (Table I) .

Table 1. Critical force and moment values for occupants.

Parameter Small Female Midsize Male Large Male
Fer 22.9 kN 35.9 kN 44.2 kN
Mer 115 Nm 225 Nm 307 Nm

The F cr and M cr values were based on ultimate strength values published by Yamada [II] for
quasistatic compression and bending tests . Compressive tolerances were based on testing of mid-
shaft tibial segments rather than the whole bone. Bending tests, however, were conducted with
whole tibiae and were loaded in the anterioposterior direction. In addition to the compression
threshold included in the interaction formula, Mertz imposed an additional constraint that F ::> 8000
N. This 8000 N limit on the axial force was derived from doubling the quasistatic compressive
load required to fracture either the medial or lateral aspects of the tibial plaeau or femoral condyles
based on Hirsch [12] . This superimposed threshold is intended to provide protection for the distal
and proximal ends of the tibia.

The European Enhanced Vehicle-safety Committee (EEVC) and other testing agencies have
implemented recent modifications to the tibia index. Specifically, the critical moment has been
adjusted from a moment about only the mediolateral axis to a resultant moment about both the
mediolateral and anterioposterior axes . In addition, the threshold value of the tibia index has been
increased from 1.0 to 1.3. According to Lowne [13], the justification for raising the level to 1.3
was based on a repeatability evaluation of frontal crash tests performed by EEVC with a
Volkswagen Golf. Since variability in the tibia index was noted, a threshold value of 1.3 was
recommended based on an estimate of the two standard deviation limit.

The tibia index inherently includes several assumptions and approximations that require
evaluation: mid-shaft tibia tolerances are appl ied to the entire leg; the contribution of the fibula is
omitted from the ultimate strength criteria; quasistatic values for ultimate strength are used in a
dynamic criteria; and the ultimate stress for bone failure is assumed to be equivalent in
compression and tension. This paper reviews published literature and new test data for the strength
tolerances of the leg, evaluates the validity of the underlying assumptions inherent in the tibia
index, and proposes a modified tibia index in an effort to increase the accuracy of this index in
predicting leg injuries.
32 LR, Crandall ct al.

BENDING STUDIES

Static. As previously noted, Mertz [4] utilized the bending tests of Yamada [11] to determine his
critical bending values for the tibia. Yamada conducted anteroposterior tibia bending tests using
35 specimens obtained from persons of mixed gender and age. Although he provides only the
breaking loads and ultimate deflection, these values along with the calculated support span can be
used to determine the maximum bending moments. It is clear from Yamada's data that there is a
strong dependence on the age of the subject from which the tibia was obtained (Table 2). While
Yamada also states that the bending properties for female bones are lower than those for male
bones, he gives no quantitative results. Although not stated explicitly, it would appear that the
critical bending values chosen by Mertz would be applicable for young male specimens.

In addition to the study presented by Yamada, quasistatic three-point bending tests of the tibia have
been conducted by Messerer and Weber (Table 3). Their values are in relative agreement with
those of Yamada given the inherent variability of biological materials and the observed dependence
on the test population's age and gender. Schreiber et al. [15] conducted quasistatic bending tests of
the leg complex with the tibia and fibula soft tissue intact. Quasistatic bending moments obtained
in the study were higher on average (241 Nm) than values reported previously for three-point
bending studies in the literature. It is likely that this increase resulted from preservation of the
fibula and soft tissue structure during the bending test as well as the testing of specimens obtained
from a modern population.

T a ble 3 Summarv 0 f ouasistauc bendima thresh0 Ids.

o

Maximum Average Bending Moment at Failure

Messerer 207 Nm Male Quasistatic, 3-Point bending of tibia
(in Nvouist 1986) 124 Nm Female
Yamada (970) 184 NmMalelFemale Ouasistatic, 3-Point bending of tibia
Weber 165 Nm Male Quasistatic, 3-Point bending of tibia
(in Nvquist 1986) 125 Nm Female
Schreiber 241 Nm Male/Female Quasistatic, 3-Point bending of tibia/fibula

Dynamic. Dynamic three-point bending tests have been performed by Mather [16] and Nyquist et
al. [17]. Bending moments at failure were not recorded and only energy values were reported
based on the kinetic energy of the impactor prior to impact. Nyquist's dynamic bending tests
loaded legs in the anteroposterior and lateromedial directions, keeping the soft tissue and fibula
intact. However, Nyquist's recorded maximum moment for dynamic failure is questionable
because he reports an estimated attenuation of peak force values by approximately 10%, due to a
1()() Hz filtering process. Despite the shortcomings of the data, Nyquist confirmed earlier findings
by Yamada [11] that bending strength was independent of loading direction (anterioposterior
versus laterornedial).

T a ble 4 Summarvo fdrvnarruc uibiiaI be ndirna thresh0 Ids.

o

Maximum Average Bending Moment at Failure

Nyquist 320Nm Male Dynamic, 3-Point Bending, anteroposterior
(1985) 280Nm Female
Nyquist 330Nm Male Dynamic, 3-Point Bending, lateromedial
(1985) 264Nm Female
The Tibia Index 33

Schre iber et al. [15) conducted posteroanterior three-point bending tests of the leg complex for 12
intact leg specimens (Table 5). For comp arison, six additional tests were conducted in
anterop osterior direction using identical test conditions (Table 5). A Student' s t-test of the
posteroanterior and anterop osterior showed no statistically significant differen ces with a 95 % level
of confidence. Comb ined with the results of Nyquist [17) , the data indicate that the tibia has
approximately the same bend ing moment to failure for all loading directions. This supports the
claim that a resultant bending moment should be utilized in the tibia index formulation. The results
of Schreiber et al. also indicate a significant increase in the maximum dynamic bending moment at
failure relative to the static condition with a relative ratio of 1.60 for the posteroanterior direction.

Scaling factors were used in an effort to account for variability in specimen body mass. The
moment values were scaled to the mass of the so" percent male (78. 15 kg) using the normal ization
procedure s of Eppinger et al. [18). This procedure assume s that the mass density and modulus of
elasticity are constant between subjects for the determination of the scaling factor (eqn. 4).

A = (78.15/ SM )I/3 (50 th percentil e male) (4)

The scaled test parameters, denoted by the subscript s, can then be expre ssed in terms of the scaling
factor A, and the measured parameter, denoted by the SUbscript m.

Bending Momen t: (5)

Using the scaled values of the Table 5 data, the average posteroanterior bending moment at failure
was 492 ± 177 Nm and the average anteropo sterior moment at failure was 420 ± 69 Nm.

Table S. Dynamic Three Point BendingTest Results.

Leg Energyto Mid-shaft Scaled TI Age Body Fracture
Failure Moment Mass Location
(J) (Nm) (yrs) (kg)
Antero-Po sterior Bending
98·FF·14·RL 6.73 265.28 1.67 63 55.8 Mid·shaft
98·FF·7·LL 6.37 341 .03 1.60 72 74.8 Dis!.1/3
98-FF·lo-EXT·LL 12.46 340.88 1.81 86 66.2 Mid·shaft
98-FF·8·EXT·LL 11 .55 425.96 2.16 77 69.4 Mid-shaft
98·FF·14·LL 6.24 260.13 1.64 63 55.8 Mid-shaft
98·FM·94·RL 54.27 736.64 2.44 65 106.1 Mid·shaft
AYerage 16.27 394.99 1.89 71 .00 71.35
Std. Dey. 18.82 178.07 0.34 9.23 18.62
Posteroanterior Bending (Schreiber et aI., 1997)
48·L 32.4 239 1.35 83 61.3 Mid-shaft
l004·R 65.8 535 3.87 59 59.9 Mid-shaft
l003·R 67 577 2.88 77 69.5 Mid-shaft
l000-R 77.6 458 1.52 85 105 Mid-shaft
l005·R 57.9 445 2.1 75 73.6 Mid-shaft
l006-R 68.7 372 2.01 70 80.4 Mid-shaft
iooa-a 55.1 259 1.94 70 57.9 Mid-shaft
101O-R 67.3 440 2.58 55 73.9 Mid-shaft
5o-R 40.2 371 3.45 68 46.7 Dis! 1/3
68·R 120.4 424 2.03 56 72.6 Mid & Dis! 1/3
69·R 116.7 534 2.06 62 90.3 Mid & Dis! 1/3
73-L 54.17 242 1.84 61 57.2 Mid-shaft
AYerage 68.61 408.00 2.30 68.42 70.69
Std.DeY. 26.48 115.48 0.76 10.13 15.97
34 l .R . Crandall et al.

AXIAL LOADING STUDIES

Static. The strength of the tibia under quasistatic axial loading has been investigated by Yamada
[II] and Messerer [in 14]. Yamada conducted compression tests on isolated segments of the tibia
while Messerer used whole tibiae (Table 6). Messerer ' s failure values are approximately one-third
of those determined by Yamada . Messerer' s use of whole bones produced lower failure values due
to lower failure thresholds in segments of the bone away from the mid-shaft as well as bending of
the whole bone due to its curvature . In addition to testing of the mid-shaft segment, Yamada
separated the tibiae into five equal segments ( I - most proximal , 3 - mid shaft, 5 - most distal) and
conducted compres sion tests on each region (Table 7). The data suggest that the distal and
proximal tibial segments fracture at approximately the same force level, and that the failure force at
the end segments is considerably lower than the mid-shaft of the tibia. The compress ive loads for
the mid-shaft tibia were divided by gender with a male average of 3660 kg (35.9 kN), a female
average of 2820 kg ( 27.7 kN), and an overall average of 3240 kg (3 1.8 kN).

T a ble 6 Tb' . II oa d.
113I maximum qua sistatrc axia
Study Thre shold Test Conditions
Messerer 10.36 kN Male Quasistatic Compression of
(in Nvaui st 1986) 7.49 kN Female Whole Tibiae
Yamada 35.95 kN Male Qua sistatic compression of
( 1970) 27.65 kN Female Mid-di aphysis Tibia Sections

th
5
% Load 73 89 100 78 71

Hirsch and Sullivan [19] conducted quasistatic compres sion tests of the tibial plateau using the
femoral condyle s as an indentor. In total, they tested 32 specimens with varying degrees of knee
flexion. The load required to produce a fracture was greater for the extended than the flexed joint
within the range of 0 to 55 degrees of flexion. An overall average load to produce a split fracture
in the male specimens was 7800 N. Presumably , Mertz used this average load to obtain his 8 kN
threshold for axial force.

Dynamic. Few studies have been conducted on the dynamic compressive tolerances of the leg or
whole tibia. Those that exist are largely a subset extracted from testing of the foot and ankle
complex using an intact leg. These studies have produced plafond fractures rather than mid-shaft
fractures of the tibia. However, this paper summarizes the axial tolerances noted for the distal tibia
with the caveat that the tibia index is not intended to predict these injuries.

Roberts [20] dynamically compressed the below knee complex with a constrained knee using an
impactor that struck the plantar surface of the foot. The ankle was initially positioned in 20
degrees of dorsiflexion. No proximal tibia or fibula injuries were observed. However, analysis of
Roberts' study indicated that 5 of the 12 sustained distal tibial fractures with an average maximum
load of 11,378 ± 1439 N. It should be noted that two of these limbs sustained multiple injurie s,
including foot and ankle fractures, so it is impossible to determine whether the tibia fractures
occurred at peak loads. However, there appears to be no significant difference between limbs
sustaining tibial fractures only and those with concomitant foot and ankle fractures.

Kitagawa et al. [21] impacted 16 leg specimens cut at the mid-diaphysis of the tibia and fibula. In
addition to the load applied to the plantar surface of the foot with the ankle in a neutral initial
position, they applied 1.8 kN of constant force through the Achilles tendon. Five of the tests
The Tibia Index 35

produced a pilon (tibial plafond) fracture . The average failure tibial load for the pilon fractures was
7293 N. The fact that these forces are significantly lower than those of Roberts may be partially
attributed to the fact that the specimens in the study by Roberts were initially position in 20° of
dorsiflexion. Calhoun et al. [22] demonstrated a marked increase in the joint contact area of the
tibial plafond with increasing angles of dorsiflexion. The increased area would act to decrease the
maximum stress in the tibial plafond and to increase the fracture tolerance .

COMBINED STUDIES

Schreiber et al. [15] is the only study to examine the validity of the tibia index for combined axial
and bending loading. They conducted dynamic bending tests of the leg complex using a static
compressive preload of 4450 N that was maintained throughout the impact event. The
superposition of axial compression on the dynamic bending moments produced lower compressive
strains in the mid-diaphys is of the anterior tibia compared to the posterior tibia and fibula. This
difference in strain from tibial bending appears to be a result of the eccentric loading that the mid-
tibia receives during compression, which is due to the natural curvature of the bone. The addition
of the compressive load decreased the bending moment to failure by 19% with an average unsealed
failure moment of 311 ± 96 Nm and an average scaled failure moment (50th percentile male) of 372
± 106 Nm. Although no statistically significant differences exist, there is an indication that the
axial load influences the bending tolerance based on comparisons of the compressed and
uncompressed bending tests. This suggests that the concept of interaction between bending and
compression proposed by Mertz for tibial fracture is appropriate. It is important to note, however,
that the values recorded by Schreiber et al. refer to externally applied moments. The curvature of
the bone (anterior bow) would introduce an internal moment based on the application of the
compressive force alone. If the tests had been conducted anteroposterior rather than
posteroanterior, the applied bending force to failure would have presumably increased.

A review of the quasistatic test results for axial loading and bending suggests tolerance values of
approximately 10.3 kN and 240 Nm, respectively for the mid-size male. If a 10% load bearing
capacity of the fibula is assumed , the critical static force becomes 11.3 kN. The dynamic test
results for bending indicate a tolerance value of approximately 450 Nm. If the dynamic scaling
factor of Schreiber et al. is applied to the quastistatic axial load results, a dynamic threshold load of
16.6 kN is obtained without the tibia and 18.3 kN with the fibula. A comparison of the static
values (TI-S) and the dynamic values (TI-D) with only the tibial axial threshold as well as the static
(TI-Sf) and dynamic (TI-Df) values with the fibula's estimated influence was used to analyze the
combined loading data of Schreiber et al. (Table 8). This analysis suggests that for the dynamic
loading environment utilized by Schreiber et al. the dynamic criteria (TI-D and TI-Df) most closely
predict the onset of injury. A plot of the TI thresholds (Figure I) demonstrates the differences in
regions of injury and no injury for the various indices (Note : Since they nearly overlap with the
unmodified tibial thresholds, the modified thresholds incorporating the fibula contribution were not
drawn in Figure I for the sake of clarity).

Table 8. Comparison of TI valuesfor original,static, and dynamicthresholds.

Index TI TI-S TI-D rr.sr TI·Df
Fer (kN) 35.9 10.3 16.6 11.3 18.3
Mer (Nm) 225 240 450 280 450
TI Value 1.79 ± 0.47 2.03 ± 0.46 1.13 ± 0.25 1.99 ± 0.46 1.10 ± 0.24

Using principal shear stress theory and the generalized acceleration model for brain injury [23) as a
guideline , an interaction formula that employed a weighting factor was investigated. The chosen
36 J.R. Crandall et al.

critical values were the dynamic tibial thresholds. A weighting factor of a = 1.3 provided a TI
average value of 1.0. Since this weighting factor is nearly unity, it supports the representation of
the tibial shaft as a column subjected to combined compressive and bending loads.

(-Fer Ja+ (-Mer Ja < I

F M (6)

40
- t r - TI
35
- ' - TI-Df
30 ---lIE-- TI-Sf
Z 25 · - - - A xia l Limit
~
Q)
20
~
0 Note : No injury regions are to the left
u, 15 .
and below the threshold lines indicated
10
5
O·
0 100 200 300 400 500
Moment (Nm)

Fig. 1. Plots of injury regions for the tibia indices.

DUMMY BIOFIDELITY
Although this paper focuses on the underlying biomechanical data, the ultimate use of the tibia
index will be for assessment of tibial forces and mome nts recorded by anthropometric test devices.
The structural geometry of the Hybrid III leg and the alignment of the leg shaft with respect to the
joint centers doe s not exactl y replicate the human tibia and fibula (Figure 2). The distal tibial load
cell of the Hybrid III dummy leg is used to measure moment and force in the tibia index
formulation . Due to leg geometry, the load cell is off-center 8 mm from the line of action between
the knee and ankle and is angled 9 degrees posteriorly. Therefore, an axial compressive load
applied to the Hybrid III leg will result in posterior bowing near the region of the load cell . In
contrast, the human tibia will likely see anterior bowing under an axial compressive load due to the
bone' s natural curvature. The author s recommended that the Hybrid III moments be transferred to
the ankle joint center to account for these errors.

Anterior

~
-------------------- Posterior

Fig. 2. Hybrid ill leg.

The Tibia Index 37

Kuppa et al. [24] demonstrated that the current Hybrid III leg, foot, and ankle design behaves
significantly differently than the human when subjected to axial loads. Specifically, modeling the
human and dummy as second order systems showed a frequency-dependent ratio of dummy to
cadaver tibia force for a given loading input. This suggests that scaling of Hybrid III tests to
predict human injury accurately would have to be handled on a case by case basis where both the
input conditions and the recorded output were known. In most crash test scenarios, this is not
possible. The authors agree, however, that the implementation of a criterion that places limits on
tibial moment and force is an improvement even if the current dummy is incapable of providing
biofidelic responses. Recent advances in dummy design have led to the development of the
THOR-LX, a purportedly more biofidelic dummy lower extremity than the Hybrid III [25-27] that
should facilitate direct implementation of the tibial bending and axial force thresholds.

DISCUSSION AND CONCLUSIONS

The tibia index is intended to represent the injury tolerance of the mid-shaft of the tibia and fibula
complex. The review of testing in this paper verifies Mertz's assertion that an interaction between
bending moment and compressive force in the tibia does exist and should be incorporated into an
injury criterion. Critical values are provided for both static and dynamic test conditions with a
validation in a dynamic test environment.

Bending. The composite results for bending failure of the leg complex suggest the threshold
bending value is relatively independent of the direction of loading and support the use of a resultant
moment. This directional independence is limited to the tibial shaft in which bending failure
occurs in the mid-shaft to distal-third of the tibia. The use of three-point bend tests likely
predisposed the limb to failure at either the mid-shaft or distal third and in some tests the end of the
bones were potted. The clinical literature, however, substantiates these locations as those most
frequent for shaft fracture. Although appropriate for shaft fractures, the bending thresholds should
not be used to predict distal tibia or fibula fractures (i.e., malleolar) as these are considered part of
the ankle complex rather than the leg. A summary of ankle data provided by Tarriere and Viano
[28] demonstrated average quasistatic moments at failure of 33 Nm, 48 Nm, and 47 Nm for
inversion, eversion, and dorsiflexion respectively. Since these moment values are 15% to 20% of
those required to fracture the mid-shaft of the tibia, it is clear that the tibia index should be used
only within the region for which it was developed (i.e., the tibia and fibula mid-shaft).

For tibia and fibula shaft fractures, the critical bending moments recommended by Mertz based on
tibial bending tests are lower than those conducted with intact limbs. Furthermore, the dynamic
thresholds identified by Nyquist [17] and Schreiber et aI. [15] are considerably greater than the
static bending thresholds. It is obvious that the static values provide a more conservative threshold
than the dynamic values. Since the leg in actual crashes experiences a range of loading rates, the
choice of whether to use the static (280 Nm) or dynamic (450 Nm) is dependent on the test
scenario and is ultimately left to the user. Ideally, non-failure testing would be conducted to
complement the existing failure tests and to permit the development of a injury risk function
through logistic regression.

Axial loading. The critical compressive force (35.9 leN) used in the tibia index formulation is
unrealistically high for loading of the whole leg complex. Messerer's whole bone tests (l0.4 leN
threshold) provide a more reasonable estimate for mid-shaft fractures. Scaling of this threshold for
dynamic testing with the fibula contribution provided a good estimate of tibia and fibula fracture
when combined with the dynamic moment threshold (TI-Df = 1.10 ± 0.24).

Although the tibia index is intended to predict shaft fractures of the fibula and tibia, Mertz provides
an additional constraint on the axial force in an effort to detect distal and proximal injuries. The
38 J.R. Crandall et al.

test data of Roberts [20] and Kitigawa [21] suggests this estimate is reasonable for pure
compressive loading of the distal tibia. Fortunately, this threshold coincides with that for the
hindfoot [29,30] so it should also provide protection for more distal structures. However, this paper
focuses exclusively on mid-shaft fractures of the leg and an additional analysis should be done to
verify tolerances of the proximal and distal ends.

Combined loading. The available test data supports Mertz ' s concept of interaction between the
compressive and bending forces of the leg. In terms of assessing critical values to be used in the
injury criteria formulation, the current data allows separate static and dynamic to be estimated . The
recommended static values differ from those of Mertz primarily because the response of the whole
leg rather than isolated segments has been incorporated. The dynamic values have been validated
against an experimental combined loading study and showed reasonable accuracy in predicting
injury. It is important to note, however, that the current interaction formula with an additive effect
between bending and axial loading applies only for PA bending coupled with compressive loading.
Due to the anterior bow of the tibia, the compressive force places the anterior fibers of the bone in
tension which is superimposed on the tensile stress provided by a PA bending moment. If an AP
bending moment is applied. the superposition effects of bending and compression are not additive
under the assumption that the bone fails first in tension. Additional testing is required to determine
the exact nature of the combined AP bending moment and axial compression interactions.

Since the critical axial load was determined for an isolated tibial segment, Mertz' s proposed
interaction formula provided significantly different threshold curves than those based on studies
using the entire leg. However, Mertz' s supplemental constraint of an 8 leN axial threshold to
protect the distal and proximal leg results in much smaller differences between Mertz' s regions of
injury and those determined from interaction formulas based on testing of the leg (Figure I). While
these differences may be small, this results from the fact that the thresholds at the knee and ankle
are significantly lower than the shaft rather than from the underlying biomechanics occurring in the
mid-tibia and mid-fibula regions that the TI is designed to protect. Therefore, the authors
recommend using the bending and axial compressive loads for the entire leg in the TI formulation .
Furthermore, this index should just be used to predict mid-shaft leg fractures and separate injury
criteria should be utilized for the distal and proximal regions.

REFERENCES

[I] A.R. Burgess. P.e. Dischinger. T.D. O'Quinn, e.G. Schmidhauser, Lower Extremity
Injurie s in Drivers of Airbag-Equippped Automobiles: Clinical and Crash Reconstruction
Correlations, Journal of Trauma. Vol. 38, No.2, 1995.
[2] AAAM, The Abbreviated Injury Scale-1990 Revision. Association f or the Advancement of
Automotive Medicine, 1990.
[3] P. Thomas, M. Bradford , A Logistic Regression Analysis of Lower Limb Injury Risk in
Frontal Crashes, , Proc. 39'h AAAM, Oct. 1995, Chicago , IL p. 287-309.
[4] H. J. Mertz, Anthropometric Test Devices. in Accidental Injury: Biomechanics and
Prevention, edited by A. M. Nahum and J. W. Melvin, Springer-Verlage, New York, 1993.
[5] e. K Hersh, P. McGanity, Meeting the Challenge s of Common Tibial Fractures, J.
Musculoskeletal Medicine, July 1995.
[6] K. L. Moore, Clinically Oriented Anatomy, Second Edition, Williams and Wilkins,
Baltimore, MD. 1985.
[7] D. Segal, R. Pick, H. Klein, D.Heskiaoff, The Role of the Lateral Malleolus as a Stabilizing
Factor of the Ankle Joint, Preliminary Report; Foot and Ankle, Vol. 2, No. I, 1981.
[8] K. L. Lambert, The Weight Bearing Function of the Fibula, J. Bone and Joint Surgery, Vol.
53A , No.3, 1971.
The Tibia Index 39

[9] K. Takebe, A Nakagawa, H. Minami, H. Kanazawa, K. Hirohata, The Role of the Fibula in
Weight-bearing, CUn. Orthopedics and Related Research, No. 184; 1984.
[10] B. Fildes, J. Lenard, J. Lane, K. Seyer, Lower Limb Injury in Frontal Crashes, Proc.
International Conference on Pelvic and Lower Extremity Injuries, Washington, D.C. Dec. 4-
6, 1995.
[11] H. Yamada, Strength of Biological Materials , Williams and Wilkins Co., Baltimore, Md.
1970.
[12] G. Hirsch, and L. Sullivan, Experimental Knee Joint Fractures - A Preliminary Report, Acta
Orthopedica Scandinavia, Vol. 36, 1965.
[13] R. Lowne, personal communication, 1999.
[14] G. W.Nyquist, Injury Tolerance Characteristics of the Adult Human Lower Extremities
Under Static and Dynamic Loading, Biomechanics and Medical Aspects of Lower Limb
Injuries, SAE #861925, 1986.
[15] P. Schreiber, J. R. Crandall, T. Micek, S. Hurwitz, Static and Dynamic Bending Strength of
the Leg, Proc. 1997 IRCOBI conference, Hannover, Germany; September 24-26, 1997.
[16] B. S. Mather, Impact Tolerance of the Human Leg, J. Trauma, Vol. 8, No.6, 1968.
[17] G. W. Nyquist, R. Cheng, AEI-Bohy, A King, Tibia Bending: Strength and Response SAE
#851728, 1985.
[ 18] R. H. Eppinger, J. H. Marcus, R. M. Morgan, Development of Dummy and Injury Index for
NHTSA's Thoracic Side Impact Protection Research Program, Pre. 27'h Stapp Car Crash
Conference, Paper 840885, 1984.
[19] G. Hirsch, and L. Sullivan, Experimental Knee Joint Fractures - A Preliminary Report, Acta
Orthopedica Scandinavia, Vol. 36,1965.
[20] D. Roberts, Injury Mechanisms and Tolerance of the Human Ankle Joint, CDC Final Report
R494CCR2036150l, 1992.
[21] Y. Kitagawa, H. Ichikawa, AI. King, R.S. Levine, A Severe Ankle and Foot Injury in
Frontal Crashes and Its Mechanism, 42 nd Stapp Car Crash Conference, Paper No. 983145 ,
1998.
[22] J.H . Calhoun, F. Li, B.R. Ledbetter, S.F. Viegas, A Comprehensive Study of Pressure
Distribution in the Ankle Joint with Inversion and Eversion, Foot & Ankle, Vol. 15, No.3
1994, pp. 125-133 .
[23] J. A Newman, A Generalized Model for Brain Injury Threshold (GAMBIT), Proc .
International Conference of the Biomechanics of Impact (IRCOBI), Zurich, Switzerland,
1986.
[24] S. M Kuppa, G. S. Klopp , J. R. Crandall, N. Khaewpong, R. H. Eppinger, Transformation of
Hybrid III Leg Response to that of a Human Leg in Dynamic Impacts to the Foot; Paper 98-
S7-0-IO, 16th IntI. Technical Conference on the Enhanced Safety of Vehicles, Windsor,
Canada, June 1-4, 1998.
[25] P. Petit , X. Trosseille, Comparison of the THOR, Hybrid III, and Cadaver Lower Leg
Dynamic Responses in Dorsiflexion, Proc . 43'd Stapp Car Crash Conference, San Diego, CA,
1999.
[26] T. Shams, D. Beach, R. White et al., Development and Design of the Thor-LX: The Thor
Lower Extremity, Proc . 43'd Stapp Car Crash Conference, San Diego , CA , 1999.
[27] R. Rudd, 1. Crandall, J. Butcher, Biofidelity Evaluation of Dynamic and Static Response
Characteristics of the THOR LX Dummy Lower Extremity, Proc . International Conference
of the Biomechanics of Impact (IRCOBI), Sitges, Spain, 1999.
[28] C. Tarriere and D. Viano, Biomechanical Synthesis of New Data on Human Lower Leg
Responses and Tolerances in Parallel with Dummies and Injury Criteria, Proc . IntI.
Conference on Pelvic and Lower Extremity Injurie s, Washington, D.C., Dec. 1995.
[29] J. R. Crandall, S.M. Kuppa, G. S. Klopp, G. W. Hall, S. R. Hurwitz, W. D. Pilkey, Injury
Mechanisms and Criteria for the Human Foot and Ankle under Axial Impacts to the Foot, Int.
J. Crashworthiness, Vol. 3 no. 2, p. 147-161, 1998.
40 LR. Crandall et al.

[30] N. Yoganandan, F. Pintar, et al., Dynamic Axial Tolerance of the Human Foot-Ankle
Complex, Proc. 40 th Stapp Car Crash Conference, Albuquerque, NM, 1996.

ACKNOWLEDGMENTS

The authors wish to acknowledge the former American Automobile Manufacturers Association
(Contract UV 9733-754E) for their support of the leg bending experiments . The authors are also
grateful to NHTSA (DTNH22-93-Y-07028) for continued support of lower limb research.
The Biomechanics of Frontal and Lateral Collision
Dimitrios Kallieris

Institute of Legal and Traffic Medicine, University of Heidelberg, Germany

D 69115 Heidelberg, Voss-Str. 2, Germany

Summary: Frontal collisions with instrumented and with restraint systems (belt, force limiter, air
bag) protected cadavers at impact velocities of 47-55 kmlh and average sled decelerations of 10-
20 g will be reported. The main injured part is the lower cervical spine and the transition to the
thoracic vertebral column. Thoracic injuries (mainly rib fractures) are specific for the restraint
system used. The 3-point-standard belt cause high local chest compression from the concentrated
loading of the shoulder belt, sternum and rib fractures along the belt are the results. By using air bag
restraints the chest compression is uniform due to the distributed loading of the air bag; this load
distribution is injury preventive. An acceleration at the 1Sl thoracic vertebra in x-direction of 35 g
produced, with a 50% probability , a thoracic injury severity of AIS~3 .

During a 90 0 car to car or sled test with rigid or padded wall lateral collision with an impact speed
of 24 to 60 km/h the cervical spine of the near side occupant is loaded indirectly, hereby the torso is
impacted directly through the intruding side structures of the car. The injury mechanics of the
cervical spine injuries is shearing and lateral flexion; mainly the cervical spine is injured. The direct
impact of the intruding car side structures causes rib fractures at the impacted torso side as well as
abdominal injuries. The number of rib fractures is age dependent, however not the abdominal
injuries. The torso injury severity is defined mainly by the number of the rib fractures, contusions
and lacerations of the lung are rare. A 50% likelihood of a thoracic injury of AIS~4 for the
investigated collective is associated with

• age = 38 years
• TTl = 155
• acceleration at the level of the 12th thoracic vertebra, y-direction = 90g
th
• VC at the level of the 4 rib = 0.83 m/s

Key words: Experimental Biomechanics, Mechanical Response, Injury Pattern, Injury Severity

INTRODUCTION

The frontal collision is the most frequently occurring accident type and is the accident type towards
which the majority of safety measures have been directed . Due to extensive developments in
passive safety and the effective combination of active and passive safety systems, a high standard of
injury reduction for frontal collisions has been achieved. The aim of this study is to investigate the
behaviour of the standard 3-point belt, an air bag only, and belt with force limiter plus air bag
systems in frontal collisions . The collision characteristics of 47 km/h to 55 km/h with a mean sled
deceleration between 109 and 20g were chosen to represent common accident severities.

The lateral collision is the 2nd frequently occuring accident type; the risk of the injury in side
collisions is higher than in frontal crashes, because there is less vehicle room available for
protection structures. Especially the occupant seating on the struck side of the car is more exposed
to the intruding side structures of the car. To investigate the mechanical response and the injury

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 41
42 D. Kallicris

severity of the near side occ upant lateral impact s with human cadavers at an impact velocit y of 24
to 60 kmlh were performed.

METH OD

Frontal Collision. Test Subjects - The test subject s were 46 unembalmed human cada vers in the
age range 19 to 65 years.

Test Equipment - The tests were performed on the University of Heidelberg's deceleration sled.
Mounted to the sled was the front part of a passenger compartment of a mid-sized car. Test subjects
were positioned in the driver's seat and restrained by either a 3-point stand ard belt, a driver side air
bag-knee bolster, or a 3-point standard belt with or without force limiter and supplemental driver
side air bag comb ination . Fig. I illustrate s the experimental configuration. Frontal collisions were
simulated with impact velocities of 47 to 55 kmlh and a trapezo idal deceleration pulse with an
average value of 10 g to 20 g. A test matrix according to the restraint system is given in table l.

Fig . 1. Test configuration

Tab le 1. Impact conditions accordingto the restraint system used

Restraint system 3-pt-belt Air bag 3-pt-belt & Air bag

n 29 7 10
Impact speed [km/h] range 48-55 47-50 47-53
mean 50 49 49
Average sled dec. [g) range 10-20 10-17 10-18
mean 15 14 13
Age [years) range 19-63 25-55 32-65
mean 36 37 49
The Biomechanics of Frontal and Lateral Collision 43

Lateral Collision. Test Subjects -The surrogates used in the lateral impact tests were unembalmed
human cada vers in the age range 18 to 65 years, with a mean age of 40 years.

Test Equipment. The tests were performed on the Institute's deceleration sled devices by using two
different configurations:

90° Car/Car Lateral Collision. The striking vehicle was the sled, already available , a part of the
CCMC barrier frame and the CCMC deform ation element [1,2] were mounted onto the front of the
sled.The mass of the striking vehicle was 950 kg (Fig. 2). The impact velocity of the striking
vehicle was 40 to 60 km/h. The struck vehicle was a two or a four door car body shell of a lower or
an upper medium class vehicle mounted on a moveable platform (dolly). The mass of the struck
vehicle, including the cadaver, was 950 and 1100 kg. Each vehicle was impacted in a part of the
tests only on the right side, in a second collective the left and right side was impacted. The subject
was located in the near side front passenger seat and restrained by a 3- point belt. The struck vehicle
was initially at rest (Fig. 2).

Fig. 2. 90° car/car lateral collision

Wall Collision. A bench seat with an instrumented side panel was mounted on the sled transverse
to the direction of the travel. The side panel was instrumented with load cells at the thoracic level
and at the pelvic level. The corpses were positioned on the bench seat distal to the side panel and
remained in this position until the sled began to decelerate, the subject then slid across the bench
finally impacting against the side panel at approximately the pre-deceleration sled velocity . All tests
were performed with the arm on the impact side down . A lateral low friction sliding movement was
achieved by dressing the subject and sitting it on two plastic sheet s. The mass of the fully
assembled sled with subject was 710 kg (Fig. 3).

In total 63 tests were performed in both impact configurations in the following test matrix:
44 D. Kallicris

Table 2. Test matrix

Car/car Impact velocity Wall Impact
Side impact (km/h) Impact Velocity
(km/h)
Impact side 40 45 50 60 L Wall 24 32 L
Left 3 8 3 I 15 Padded 0 5 5
Right 2 8 17 0 27 Rigid 7 9 16
1: 5 16 20 I 42 1: 7 14 21

Fig. 3. Rigid wall lateral collision

Instrumentation. The cadavers were instrumented with the twelve accelerometer thoracic array as
developed by Robbins et al [1,2] and were used by Eppinger et al. [1,2]. Furthermore they were
partly instrumented with chest bands in frontal collision tests. The sacrum was instrumented with a
triaxial accelerometer. The head of the cadaver was partly instrumented with a triaxial
accelerometer at the clivus in lateral collisions.

Autopsy - Injury Severity . A detailed autopsy was carried out with special attention on shoulder,
vertebral column, thoracic and abdominal injuries. The injuries were coded according to the AIS
1990.

Calculations. The thoracic Trauma Index (TTl) and the Viscous Criterion (VC) were calculated to
investigate the relationships of the mechanical response and the AIS-Severity. A thorax
deformation-time history was calculated through a double integration of the acceleration-time
differences between the accelerometers mounted at the impact side and the opposite side of the
thorax [2].

Statistical Methods
The statistical analysis aims at investigating the factors which influence the thoracic injury severity
(AIS-level) and explain it on the basis of the cadaver anthropometric data and the most relevant
biomechanical data (anthropometric and mechanical predictors) . A logistic regression analyses was
used [1,3].
The Biomechanicsof Frontal and Lateral Collision 45

RESULTS
Injured body parts observed. The body parts most injured were the cervical spine and the thorax.

Injury mechanism. The injury mechanism is concluded due to the autopsy findings and the high
speed film analysis.

Cervical Spine. The cervical spine mjunes are caused by the frontal collision of the belted
occupants through frontal flexion which result in compression at the front and extension at the rear
side of the cervical spine. The rotation point of the frontal flexion is the cervical-thoracic transition.
The same injury mechanism exists, when using the combination of 3-point standard belt and driver
air bag. By using 3-point belt with force limiter and driver air bag due to the reduced loading of
the cervical spine the injury risk is minimized .

Due to the impact of the trunk through the intruding side structures during the side to side collision
and the inertia of the head maximum shear forces at level of the occipital condyles are observed.
The shearing effect is followed by a lateral flexion of the cervical spine against the impact direction
with a compression nearside and an extension farside of the impact.

Thorax. By using 3-point standard belt the thorax skeleton was exposed to a high local
compression by the frontal collision . Fig. 3 shows the local compression of the thorax contour by
using chest band. By using air bag more uniform load distribution in the front of the thorax was
observed . The fractures are caused at the locations of maximum stress at the front axillar line.
Fig . 4 shows thorax contour of the thorax by using chest band. In case of the lateral impact the
injuries are caused through compression of the exposed trunk by intruding side structures of the
car.

Y[crn] r-r-r-- ----, Y[cm]

30 24 . - - - - - - - - - - - - - - - - - ,

o
-5 '-- --' -1
-25 o
X[cm]
25 -20 o X[cml 20

Fig. 4. Thoracic deformation contoursusing Fig. 5. Thoracicdeformation contours using

3-pointbelt air bag
a: Unloaded situation a: Unloaded situation
b: Maximum local compression b: Maximum compression
throughthe belt through the air bag

Spine: Injuries and Loading. In the case of frontal collision the injuries are located at the whole
cervical spine up to upper thoracic spine while in case of side collision only the cervical spine is
involved . Figure 6 illustrates the location of the vertebral column injuries according to the collision
type.
46 D. Kallicris

~o ntal Co llisio n • Side Co llis ion Frequency

o 5 10 15 20 25

-
I 4 .4 %
.Q....! I I.lJlo
3 .7 %
C 2 :r..t..L.l>
7.a %
C 3 I ~

C 4 7 .S '"

I
:r..t..L.l>
C 5 e.• '"
ll.I.ji
n .1 '"
C 6
,
I ~

C 7 I I I
12 .4 '"
ll........l'

••
TH1 I I I I
11 .1 '"
ll........l'
TH2 I I
15 .3 '"
2.L.llo
TH3
... ""
1 .0
I 2.L.llo
TH4
I I I ll........l'

Fig.6. Location of the vertebral column injuries according to the collision type.

The most frequent injuries were haemorrhages of the intervertebral discs, muscles and joints ,
lacerations of the ligaments and compression fractures of the vertebral bodies. The injury severity
was scaled according to the AIS 90 for the vertebral column and ranged from AIS 0 to AIS 4.
According to the high speed film analysis and by using suitable calculation programs angular
accelerations of the head-neck unit of 950 to 1000 rad/s2 which could lead to AIS I (haemorrhages
caused by strains) were observed; at this response level also AIS 2 injuries (laceration of ligaments
and inter- vertebral discs, fractures of the vertebral bodies, subluxation of joints) were found or the
cervical spine remains uninjured (AIS 0). AIS 3 (complex fractures of the vertebral bodies or facets)
injuries are observed at an angular acceleration of 1300 rad/s 2 and AIS 4 (spinal cord laceration)
injury severity of the cervical spine was found at a rotational acceleration of 4900 rad/s''.

In two 900 car/car lateral collisions fractures of the near side condylus (AIS 3) were found (Fig. 7).
Shear forces of 3035 and 4465 N were calculated at the level of the occipital condyles (the clivus
acceleration in y-direction was multiplied by the head mass).

Fig. 7.
Fractures of the occipital condyles
a) Shear force 3035N
b) Shearforce 4464 N
The Biomechanics of Frontal and Lateral Collision 47

Thorax show characteristic fracture patterns (Figs. 8 - 10) for the three restraint systems used in
frontal collisions. By using 3-point-belt systems the fractures are located mainly at the shoulder belt
path, whereby by using only air bag restraints the front axillar line is involved . By using a standard
belt in combination with a driver air bag the shoulder belt mainly defines the fracture pattern .

Fig. 8. Injury pattern Fig. 9. Injury pattern Fig. 10. Injury pattern
3-pointbelt 3-pointbelt-airbag driver air bag

Fig. 1I shows the location of rib fractures for I 1 right side impacted lateral 50 km/h collisions . The
most fractures are located at the impacted side oft he exposed thorax. Fractures of the far side are
rare .

Fig. 11. Locationof the rib fractures for II right side lateralcollisions(90 50 km/h)
0
,

Rib fractures are the most frequent injuries observed, which also defined the thoracic injury
severity. The most rib fractures are incomplete fractures and they can only be found through
autopsy by palpation . Dislocated ribs were rare at the investigated impact severity .
48 D. Kallicris

Abdomen. In lateral collisions the abdominal injury severity was influenced by the side of the body
impacted and was independent of the age. Liver ruptures occurred most frequently in the right side
impacts.

..
·..
·•
t • .1

··
I • •T

·
e
t
• .5

·• ·.
P
r • .s
0

e
I
I • •J
I
y•
• .e

' .1
·.. " . JS •• s•
[g)

Fig. 12. Logistic plots of probability of thoracic injuryseverity ~3 modelled by

the 3ms acceleration at the 151 thoracic vertebra (TO IXA_3S).

Statistical analysis. Logistic regression analysis were performed with anthropometric data (age)
and biomechanical responses. In frontal collisions the highest correctly predicted observations
(82%) show the 3 ms acceleration at T1 in x-direction for the prediction of the thoracic injury
severity TOAIS ~ 3. The 50% probability of thoracic injury of AIS~ 3 is associated for T1 with an
acceleration of 35 g. Fig. 12 shows a logistic regression plot with the upper and lower confidence
curves of probability of thoracic injury severity TOAIS ~ 3 modeled for the acceleration at T1 in x-
direction 3 ms value.

In lateral collisions the highest reliability to predict thorax injury severity , as uniparametric
magnitude, gives the subject's age (49% correctly predicted observations , 80% correctly ordered
pairs), followed by the mechanical response deflection at the level of the 8th rib, acceleration
maximum at the Th12, y-direction and the VC evaluated at the level of the 4th rib, further the
acceleration maximum at the 4th rib impacted side, the VC8, the acceleration maximum at the 8th
rib impacted side and at last, the compression at the level of the 8th rib (37,1% correctly predicted
observations, 57,6% correctly ordered pairs). The TIl, which is a combination of subject's age and
mechanical responses, shows higher prediction probabilities (52,4% correct predicted observation s,
74,6% correctly ordered pairs), the highest prediction probability was observed with the
combination of the mechanical response, maximum acceleration at the Th12, y-direction with the
age (60,3% correctly predicted observations, 83,9% correctly ordered pairs).
The Biomechanics of Frontal and Lateral Collision 49

------ -- -- - - -- ,- ..-:: ," --------- ------ ,- ,

,, ,
1.0 1.0

0.9 0.9 I

, ,,
I
0.8
0.7
, 0.8
0.7 ,
I , I
0.6 0.6 , I
__________ ., _ .L _
0.5 - --------r" ~I - - - - - - - - - - 0.5
, , ,
I '
,
I '
0.4 0.4

,, ,
I
0.3 0.3
,
0.2
,, 0.2
,,
0.1
... ~ 0.1
... ~

-u-- - -
0.0 0.0 ~;::;::;::::~~~~~~!;.;:;:~
o 10 20 30 40 50 60 70 80 o 100 200 300
AGE TIl
a.) b.)

1.0 ------- --------~-~- -- --

,
0.9 mo.~~ 3 .
0.8 0.9
0.7 0.8

0.6 0.7
0.6

--- --.
0.5
0.5 ························
0.4
0.4
0.3 0.3
0.2 0.2
0.1 0.1
TH12Y [gI l
0 .0 ~~~~'W!:~:;:.;..;::.;:..;:..;.,:..;Jt:.:.=,J 0.01l.====:::Jl;===="'F='="~=J
o 100 200 300
o 1 2 3 4 5
MAX: vc 4th RIB (MIS)

c.) d .)

Fig. 13. Logistic plots of probability of thoracic injury severity vs. (a) age; (b) TTl; (c) VC at
level of the 4lh rib; (d) acceleration at Thl2y at fixed ages 20, 40 and 60 years.

The probability of severe thoracic injury (AIS ~4) versus age and selected biomechanical response
derived from the logistic regression models are shown in figure 13. A 50% likelihood of a thoracic
injury of AIS~ 4 is associated with age =38 years (Fig. 13 a), a TTl = ISS (Fig. 13 b), and a VC at
the level of the 4 th rib =0,83 mls (Fig. 13 c). To demonstrate age related trends the data is separated
into three fixed age groups : 20,40, and 60 years. The 50% probability of injury is significantly
influenced by subject age, i. e., 20-year-old subjects tolerate higher magnitude acceleration at
Th12y (Fig. 13 d).
50 D. Kallieris

Final remarks. Injury patterns are characterized through the collision type and the restraint system
used. Injury patterns are agreed between all biomechanicallabs worldwide; differences exist only in
the injury severity, which is highly influenced by the age of the cadavers used. The main age
dependent factor is the degree of osteoporosis: e.g. a 30- years old belted cadaver remained
uninjured in a 50 kmlh frontal collision, whereby a 60- years old cadaver suffered "flailchest" .
Generally the thoracic injury severity is defined in frontal collisions through the number of rib
fractures. Organ injuries are rare and of minor severity in spite of repressurization of the vascular
system. Lung injuries can be caused by transfixing of the dislocated fractured ribs in the case of
belted older cadavers in frontal collisions, while liver injuries are caused by direct impact of the
intruding car side structures; these injuries are independent from the repressurization .

To define tolerance or occupant protection criteria biomechanical tests with cadavers are needed.
Because the injury severity is influenced by the age the whole age spectrum has to be used;
furthermore a sufficient kind of test series with uniform impact conditions and restraint systems is
needed.

Logistic regression models are suitable to define occupant protection criteria. In spite of the
enormous need for biomechanical data there is a lack of cadavers to carry out experiments. A
worldwide harmonization of the test methods and instrumentation is needed to make results
comparable and also to allow a summarized evaluation for the definition of occupant protection
criteria.

REFERENCES
[I] Kallieris D, Boggasch F, Mattern R (1995) Protection for the Thorax Injury Severity in
the 90-Degree Lateral Collision, Proc. 14th ESV Conf., Paper No. 94-S1-0-02, p. 89-99,
U.S. Dept. of TransportationINHTSA

[2] Kallieris D, Boggasch F, Mattern R (1996), Protection for Thorax Injury Severity in 90
degree Lateral Collision, Shock and Vibration, Vol. 3, p.337-351, Ed. Walter D. Pilkey,
Wiley Interscience, ISSN 1070-9622.

[3] Kallieris D, Cel Conte-Zerial P, Rizzetti A, Mattern R (1999) Prediction of Thoracic

Injuries in Frontal Collisions Proc.16th ESV-Conference Windsor, Canadal998, Paper
No. 98-S7-0-04, U.S. Department of Transportation, NHTSA, Vol. 2, p. 1550-1563.
Influence of Human Spinal Deformation on Minor Neck Injuries
for Low Speed Rear Impacts
Kosh iro Ono', Satoshi Inami-, Koji Kaneoka", and Yoshikatu Kisanuki'
'Japan Automobile Research Inst itute : 2530 Karima, Tsukuba, Ibaraki , Japan 305-0822
2University ofTsukuba: 1-1-1 Tennodai, Tsukuba, Ibaraki , Japan 305-8000
"Tokyo Kosei-Nekin Hospital : 5-1 Tsukudo, Shinjyuku, Tokyo , Japan 162-0821
"Toyota Central R&D Labs ., Inc .: 41-1 Aza Yokomichi, Oaza Nagakute, Nagakute-cho, Aichi-gun,
Aichi-ken, 480-1192, Japan

Summary: The aim ofthe current study is to verify the influence ofthe change ofthe spine configuration
on human cervical vertebral motion and head/neck/torso kinemat ics under low speed rear-end impacts.
During the experiment, the change of the spine configuration, measured by a newly developed flexible
spine deformation sensor on the skin, and the interface load-pressure distribution between seat and subject
were recorded. The localized straightening of the lumbar spine starts at around 20 ms with the rigid seat,
and the localized straightening of the thoracic spine reaches the maximum at around 80 ms. On the other
hand, the pelvis starts to sink into the seat back and cushion at around 50 ms with softer seat. The load-
pressure on the torso region for the softer seat is widely distributed. The results ofthis study can help clarify
the relationship between the localized straightening ofthe spine and cervical vertebrae with respect to the
difference in seat stiffness,

Keywords: Impact Biomechanics, Injury, Volunteer, Cervical Spine, Kinematics

INTRODUCTION

It has been said before that the hyperextension of neck is a major cause of minor neck injuries, but
there are some other factors that should be noted as the causes of minor neck injuries that may occur
even if such a hyperextension does not take place [1], [2]. The authors conducted simulated rear-end
collisions by means of a X-ray cineradiographic system (hereafter called as "cine-sy stem ") with the
participation of volunteers subjected to rear impacts . It was reported the occurrence of a force to push
up the neck in the initial phase of impact, accompanying an axial compression force caused by the
inertia of head acting on the cervical vertebrae and facilitating the flexion and extension of cervical
spine [3]. It was also reported that such motions of cervical spine were beyond the normal physiological
range , whereas they were closely related with the facet injury mechanism acting as a mechanism to
cause minor neck injurie s [4]. It was found that the torso ramping-up motion and spine straightening
tended to become more significant , resulting in more non-physiological motions of cervical spine as
the seat stiffness was increased [5]. However, the relationsh ip between the spine straightening and the
non-physiologi cal motions ofcervical vertebrae could not be clearly determined . In this study, therefore,
spinal deformations and the seatback interface load-pressures have been measured, in order to determine
the influences of seat characteristicss on human head/n eck/torso motions and on the change in spinal
configuration . This also studies the influence ofspinal configuration on the motions ofcervical vertebrae
by means of the cine-system. This is in order to better understand the neck inj ury mechan ism .

METHODOLOGY

The test apparatus and the method are sim ilar to those described in previous report s [4) - [6]. The
outlines of these reports and the flexible spine deformation sensor develop ed and introduced anew by
Kisanuki, et al. [7] are as follows.

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 51
52 K . Ono et aI.

Volunteers and informed consent. Seven healthy adult male volunteers of24 ± 3 years old without
history of neck injury participated in the experiments as subjects. The protocol of the experiments
was reviewed and approved by the Ethics Committee ofTsukuba University. All volunteers submitted
their informed consent to the tests in writing according to the Helsinki Declaration (WHO/ClaMS
Guideline 1988) [8].

Sled apparatus for rear impacts and cine-system. A cineradiographic system (Cine-system: Angiorex
made by Toshiba Medical Inc.; 90 frames per second) was used for the analysis of cervical vertebral
motions in rear impact. A slide apparatus capable of sliding the sled freely over the rails angled at 10
degrees was used to collide the sled against the oil shock absorber for simulation of rear impact. The
outline of the sled apparatus and its coordinate system are shown in Figure 1.

Fig. 1 Outline of sled test apparatus

Measurement method. Measurement items for the sled and the subject's head, chest (Tl and frontal
chest) and pelvis are shown in Table 1. The shear/axial forces and the bending moment acting on the
subject's upper neck (occipital region) were calculated according to the analyzed acceleration at the
center of gravity ofthe head by four channel accelerometers, the estimated head mass and the moment
of inertia. The EMG activities were measured with the electrodes adhered onto the subject's skin at
the stemoclaidomastoid and the paravertebral muscles on both sides of the neck. The data processing
and analysis were done as specified in SAE 1221 [9].

Table 1 Measurement Items

Locations Items Axis Model

Sled Velocity X Photo sensors
Acceleration X.Y.Z Kvowa AS-50HA
Subject Head - Upper Acceleration X.Z Endevco 7264A (2OG Cal.)
-Lower Acceleration X.Z Endevco 7264A (2OG Cal.)
TI Acceleration X,Z Endevco 7264A (2OG Cal.)
Angular velocity Y Murata ENC.()5E
Frontal Chest Acceleration X.Y.Z Kvowa AS-50HA
Pelvis Acceleration X.Z Endevco 63B-) 00
Angular velocity Y Murata ENC.()5E
EMG Control Skin
SCM(L) Stemoclaidomastoid muscle (Left)
PVM(L) Paravertebral muscles (Left)
TZ(L) Trapezius muscles (Left)
SCM(R) Stemoclaidomastoid muscle (Right)
Influence of Human Spinal Deformation on Minor Neck Injuries 53

Copper wire ~ O. t mrn ~..\ A-A sectio n

, OJ) Acce lerometer
train Gauge Gyro-sensor
Ch:l3 -A Ch i

Steel Tape I=O.3mrn

700mm 45mm
Gauge PIlch 20nun

Fig.3 Tape sensor for the spinal deformation

measurement

Fig. 2 Lateral view of head/neck/torso with

mounted accelerometers, EMG
electrodes, targets for high-speed video

Subject's visual motions and spinal extension. The visual motions of the subject's head, neck and
torso were measured as shown in Figure 2. Targets were adhered over two accelerometers on the
upper and lower portions ofthe head, accelerometer on the T1 and front chest, and over the skin below
the auditory meatus close to the center of gravity of the subject's head, shoulder above the 12th rib,
iliac crest, upper sternum and femora of each subject. The motions were measured with a high speed
VTR camera (500 frames per second) . In the analysis, the head/neck joint, neck/torso joint and the
head/neck link were defined, and the rotational angles of the head, neck, and upper torso were analyzed.
The spinal extension was defined and analyzed as the change in the length of linear line connecting the
neck/torso joint and the iliac crest.

Spinal deformation measurement system. The spinal deformation measurement system consisted
of units to measure the deformations of the spine (thoracic spine, lumbar spine and sacra), and the
units to measure the rotational angle and displacement of pelvis (corresponding to the first sacrum) at
the bottom of the spine. The spinal deformations were measured with a tape sensor consisting of a 0.3
mm thick stainless steel sheet with 33 pairs of strain gauges adhered (Figure 3). The motion and the
displacement of the pelvis were measured with the angular gyro-sensor (Murata ENC-05E) and the
three-axial accelerometers (Endevco 63B-199) adhered near the first sacrum. Figure 4 shows the

Fig. 4 Installation of deformation tape

sensor, accelerometer s, and gyro-
sensors for volunteers
54 K. Ono et al.

sensor fitting conditions on a volunteer. The tape sensor was made of a tape for sports taping purpose,
which was adhered along the body surface over the spine and fixed at a point over the first sacrum. A
sheath made of Teflon was placed over the tape, considering the variation of the length over the skin.
The spinal deformation was determined as follows - the deformat ion of the stainless steel sheet was
calculated first according to the strain measured with the tape sensor. At the same time, the values on
the coordinate system at individual measuring locations on the stainless steel sheet were converted
according to the rotational angles and the displacement measured on the pelvis.

Measurement of seatback interface load-pressure distribution. Tekscan system was used for the
measurement ofthe interact load-pressure distribution occurring between the subject and the seatback.
The sheet mat used as the pressure sensors was BIGMAT (Nitto) 2000 type on which 2,112 sensor
units were set over 44 rows and 48 columns. The size of the mat was 440 mm x 480 mm . The
measurement error was within the range of ± 5 %, and the data sampling interval was 10 ms.

RESULTS & DISCUSSION

Outline of results. Table 2 shows the test matrix. Seven subjects participated in the experiments, and
all experiments were conducted without headrest using a rigid wooden seat (hereafter called "R-seat")
and a standard seat (hereafter called "S-seat") of mass production vehicle for differentiation of seat
stiffness at three impact speeds of 4, 6 and 8 kmlh . Since visual motions of subjects could not be
observed with X-ray cineradiography , the experiments were repeated under the same conditions using
a high speed VTR and the cine-system separately . An example of experiment using a R-seat without
headrest at the impact speed of 8 km/h is described here, focusing on the seatback-subject interface
load-pressure distribution and the spine extension.

Table 2 Test Matrix

Impact velocity Sitting position Type of seat Headrest
4 Rigid
7 adult males 6 kmIh Standard Without
8 Standard

Visual motions of subjects. Figure 5a) shows the spinal deformations . Figure 5b) shows the subject's
visual motions taken by a high speed video camera. Figure 5c) shows the variation of the seatback
load-pressure distribution, setting the pressure to zero prior to impact. Figure 6 shows the cervical
vertebral motions observed on the cineradiographic images . Figure 7 shows the time-histories of
accelerations of the sled and at individual regions of subject, and forces acting on the neck.
First, the seatback load-pressure starts to generate on the lumbar spine around 20 ms in the initial
phase of impact, accompanying the localized extension of lumbar. Around 60 ms, the seatback shows
the maximum value of interface load-pressure. The pressure around the lumbar and the upper torso
also become high, with the maximum pressure distribution found around the shoulder blades . At
around 70 ms, the localized extension of thoracic spine was found, and the axial compression of the
neck became maximum. The spinal deformations at that time showed localized flexions and extensions
of the lumbar and upper torso, with a particularly significant deformation ofupper torso corresponding
to the shoulder blades around 80 ms. In terms of cervical vertebral motions around this region, the
torso ramping-up motion increased roughly to maximum, together with the maximum neck axial force.
The visual motions of subject were as follows. Around 50 ms in the initial phase of impact, noticeable
rotational angles of the head and torso were not found. At the time when the neck axial force became
maximum, the backward rotation of torso occurred, and the maximum spine extension was found at
150 ms or so. Around 200 ms in the final phase of impact, the head and torso rotational angles became
maximum with a significant S-shape deformation of cervical vertebrae. All primal impacts to the
cervical vertebrae were already gone around that time.
Influ en ce of Human Spinal D eform ati on on Minor Ne ck Injuri es 55

Oms 30ms 50ms lOOms 150ms 200m s

200 ms
a) Seatback load-pressure distribution by Tekscan system ....
600
500
T 1/ r-- m

I
400
300
J.
D 200 \
N 100 ~

Oms lOOms 200ms 0 "- SI

b) High -speed video (500fls) · 100

-300.200-100 0 100
X· axi s (m m)
Fig . 5 Visual motion together with the spin al deformations
(shown by solid line) c) Tlme-bistories of the spin:
deformations for each 10m

Fig.6 Cervical vertebrae motion by X-

ray cineradiography (9OfIs)

SInl. X

j
/.
/
-'
•.. ,
""""', ....... .. . ....... ..... ''',
tl n d-Gr

TI · R

20
! - S f('k·M om~nl

-
10
I 0
1.10
lI:
· 20

JOO
200
g 100 ....
8 0 .... ...... ....
8 · 100
... .:00 '" ..
,

.JOG

II I'.d A a l ~

TonoA·I~ Fig. 7 Time-h istories of accelerations of

the sled, head, thorax, forces on the
./- . ..... .. .. . . ... ..
~

neck, angles of head and torso on the

subject
50 100 ISO 200 2S0
11mi' fm,l
56 K. Ono ct al.

With the S-seat, on the other hand, the characteristic features were as follows, though the data are not
shown in the figures. The rise of head/T I accelerations was delayed by 20 to 30 ms in comparison to
the R-seat. The subject's pelvis sinked around 70 ms, where the interface pressure rose while the
lower cervical vertebrae started to ramp-up and the vertebral axial compression force became maximum
around 100 ms. The spinal extension became maximum around 140 ms, and the entire torso sank into
the seatback . Then the torso started rebounding around 150 ms, and the entire spine became nearly
straight as the upper torso extended backward and the region around the lumbar extended forward .

Influences of spinal motions on cervical vertebral motions. In this study, the change in spinal
configuration is considered as the change in rotational angle of each vertebral segment when studying
the influence of seat stiffness. Figure 8 shows the rotational angles corresponding to those of individual
cervical vertebral segments analyzed with the cineradiographic images. Figure 9 shows the spine
extension derived from the change of the linear distance between the neck/torso joint and the iliac
crest. Figure 10 shows the rotational angles corresponding to the vertebral segments of sacra, lumbar
and thoracic spines measured with the tape sensor. The rotational angles are plotted in the figure
setting the initial value to zero, with the (+) values representing extension, and (-) values representing
flexion . Figure II shows the angle of sacra, lumbar and thoracic vertebral segments relative to the
lower segments.
It is found from these figures that the lumbar vertebrae (Ll-L4) flex while the thoracic spines (T4-T5)
extend around 30 ms after impact for the rigid seat. The interface load-pressure distribution (Figure 5)
and the time-history show that TIl and Tl2 act as the pivot for the interaction between the subject's
back and the seatback while the lumbar vertebrae beneath the pivot travel backward together with the
pelvis due the femoral inertia caused by the impact, resulting in flexions oflumbar vertebrae (Ll-L3).
On the other hand, the thoracic vertebrae (TI- T5) flex on the pivotal region between T6 and T8,
resulting in the backward travel ofthe upper torso. Around 60 ms after impact, the upper torso vertebrae
- TI in particular - interacts intensely with the seatback, and extend and rotate on the pivotal region
between the thoracic vertebrae (T6-T8) . It can be said that the above mentioned motions result in the
extension and push-up motions against the cervical vertebral lower region (C7-C6), causing non-
physiological motions of the cervical vertebrae . In terms of change in relative rotational angles of the
individual spine vertebrae, the rotational angles become larger for lumbar vertebrae (L4-Ll) and thoracic
spines (T2- T6, TI 0-Tl2). These rotational angles are twice larger than the physiological motion
range reported by White and Panjbi [10]. It can be said from the foregoing results that the rotation of
the first thoracic spine is the direct reflection of the rotation of thoracic spine upper region (T5-T6) .
In comparison with the R-seat, the S-seat (though not shown in the figures) reveals that the lower
lumbar vertebrae (S I-L5) and the upper thoracic vertebrae (TI-T5) extend around 40 rns, while the
upper lumbar vertebrae (Ll-L4) and the lower thoracic vertebrae (T7- Tl2) flex slightly . The lower
lumbar vertebrae (S I, L5) extend backward as the thighs sink into the seatback due to inertia, and
rotate around the pivotal region of the lower lumbar vertebra (L4). The upper thoracic vertebrae (TI-
T5) rotate around the shoulder blades acting as the pivotal region, and the upper torso and the head
extend backward due to inertia. The upper lumbar vertebrae (L I-L4) and the lower thoracic vertebrae
(T8- T 12) flex slightly with the region around T7 acting as the pivot as the torso sinks into the seat
cushion. In terms of changes in relative rotational angles of individual spine vertebrae, significant
motions are found in the regions oflumbar vertebrae (L2-L5) and thoracic vertebrae (T4-T6, T7-T8).
It can be said that the motions ofTl reflect the spinal extension (the localized straightening)of thoracic
vertebrae and lumbar vertebrae, as in the case of the R-seat.

CONCLUSION
In this study, spinal deformations and seatback interface load-pressure distributions have been measured
for the first time, in addition to the low speed rear impact experiments conducted on volunteers by
means of X-ray cineradiography. The interaction between the subject's back, the seatback, and the
spine straightening, and the influence of the spine straightening on the cervical vertebral motions have
been studied and analyzed as follows .
Influen ce of H uman Spina l D e form ation o n M inor Neck In juries 57

:10 ....-
---
egrees C2(O)• --.
-,
/C ~
(0

"'...
~

oil -/ C~
"
:3-
/ 11'/ --. ~
'"
o t50
.'"/ ~ C5(0)

I
1ii>
Oi
~ 0
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100

'30
0
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0
V".d
c 50 .-
P:: 0
~
B
><
"g o V r--

0
's..
CI'l -50
o 50 100 150 200 250 300 o 50 100 150 200 250 300
Time (ms) Time (mm)
Fig. 8 Rotat ional angl es of cer vical verte brae Fig. 9 Spine extension
segments (The initial angle is set to zero)

t lO egrees ./" .........

TI (O)
/ V ...... r--....""" f---
0
0
T2(0) //-t- ..... t--
1'3(0) //

-
0 I"--- TIm : IOd grees
0

--
T4(<)l.; T2fB
0
0
T5~ , /
0
0
T3rr4 r-- -I--.

1'6<<11 T4ffS 17
oil
oil 0 17 (0) "
:3
0
n rrn..-
"

--
:3- 0 0

---- -
~

1'8<0) .!l T6rr7

"'" 0
-
OIl
C 0
1ii> nrrs
~ 0
1'9(0) '" 0
-;;
c

--
Oi T Ul(o) 0 T81T9
c 0
0 0 .~ T9rr1 0
';:l
TlItO) .-.. l--- 0
S 0
0
P:: T I?'o "
.::
;; 0
Tl Offl
0 rurr
LI (o) """t- u
c:: 0
........

--
0
.......-
Tt 2JLJ,
L2(0;" 0
0 I-=- Lt /L2
L3(0) ~ 0
L2JL3' t--- f-
0
0
0
I L4<0 i'-. L3/L4
0 r---
0 L5 0 L4ILS t-
0
5 10 LS/S t
0 0

o 50 100 150 200 250 300 o 50 100 ISO 200 2S0 300
Time (ms) Time (rns)

Fig. 10 Rotational angles corresponding to those

of spinal segments (sacra. lumbar and
thora cic spines) ca lc ulate d fro m the
TSDM S. (The initial angle is set to zero
a nd ve rt e br ae c ur ve s a re s ho w n
separately. Rigid sea t; 8 kmlh)
Fig. 11 Angle of spinal vertebral segments relative
to lower segment. (The initial ang le is set
to zero and vertebrae curves are shown
separately. Rigid seat; 8 krn/h)
58 K. Dna et at.

I) In case of the R-seat, the localized straightening of lumbar vertebrae starts around 30 ms after
impact, and the localized straightening of thoracic spines occurs around 80 ms where the interaction
between the seatback and the subject's shoulders becames maximum.
2) With the S-seat , the pelvis starts to sink around 70 rns, resulting in the localized straightening of the
thoracic spine around 120 ms where the interaction between the seatback and the subject's shoulders
becomes maximum.
3) In case of the R-seat, the rotational angles of the lower lumbar vertebrae are roughly within the
normal physiological range, but the rotational angles of the thoracic spines (T5-T6) become
approximately twice larger than the physiological range . A similar tendency is also found with the
S-seat.
4) It can be said from the foregoing results that such localized straightening of spines are likely to
occur not only in the lumbar spines but also in the thoracic spines .
5) The question whether the lumbar spines flex or extend depends on how the pelvis sink into the seat
cushion - in other words, it depends on the seat stiffness.
6) The localized extension of upper thoracic spines is caused by the backward travel of the shoulders
including arms, and the backward extension of the head causing the upward arch or ramping-up
motion ofthe torso . It is therefore important to properly control the torso motion and the localized
straightening of the spine .

REFERENCES
[1] W. E. McConnel, R.P. Howard, H.M. Guzman, lB. Bomar, Raddian lH., V. Benedict, H.L. Smith,
and CP. Hatsell, Analysis of Human Test Subject Kinematic Responses to Low Velocity Rear-end
Impacts. SAE Paper No. 930889, 1993
[2] T. Matsushita, B. Sato, K. Hirabayashi, S. Fujimura, T. Asazuma, T. Takatori, X-ray Study of the
Human Neck Motiondue to Head InertiaLoading. Proceedingsofthe 38th Stapp Car CrashConference.
Fort Lauderdale: Society ofAutomotive Engineers, Inc., 1994:55-64.
[3] K. Ono and M. Kanno , Influences of the Physical Parameters on the Risk to Neck Injuries in
Low Impact Speed Rear-end Collisions, Proceedings of the International IRCOBI Conference
on the Biomechanics ofImpact. Eindhoven, 1993: pp. 201-212 .
[4] K. Ono and K. Kaneoka, Motion Analysis of Human Cervical Vertebrae during Low Speed
Rear Impacts By the Simulated Sled , Proc . ofIRCOBI Conference, Hannover, Germany , 1997,
pp.223-237
[5] K. Ono, K. Kaneoka, A. Wittek, and 1 Kajzer, Cervical Injury Mechanism Based on the Analysis
of Human Cervical Vertebral Motion and Hed-Neck-Torso Kinematics During Low Speed Rear
Impacts, Proc . of 41st Stapp Car Crash Conference SAE P-315, Paper No . 973340, Florida,
Nov . 13-14, 1997, pp. 339-356
[6] K. Ono, K. Kaneoka, and S. Inami, Influence of Seat Properties on Human Cervical Vertebral
Motion and Head/Neck/Torso Kinematics During Rear-end Impacts, Proc . of IRCOBI
Conference, Gothenberg, Sweden , 1998, pp. 303-318
[7] Y. Kisanuki, S. Sakuma, K. Tsukada, K. Miki, K. Ono , K. Kaneoka, and S. Inami, The
Development of Spinal Deformation Measurement System and Its Application to Rear-End Impact
Test, Japan Society of Automotive Engineers, No.10-99, 1999, pp. 1-4
[8] WHO/ClaMS Proposed Guidelines for Medical Research Involv ing Human Subjects, and the
Guidelines on the Practice of Ethics Committees Published by the Royal College of Physicians,
The Lancet , November 12, 1988, pp. 1128-1131
[9] SAE J211 March 95, SAE Handbook (1995)
[10] III A. White and M. Panjabi, Clinical Biomechanics of the Spine, Second Edition, Publisher : 1
B. Lippincott Company, 1990. pp. 86-120
"Hybrid" Approach to Modelling of Biomechanical Systems
Cezary Rzymkowski

Warsaw University of Technology, Institute of Aeronautics and Applied Mechanics,

Nowowiejska 24, 00-665 Warsaw, Poland

Summary. Two main methods of mathematical modelling of biomechanical systems: finite element
method (FEM) and method of multi-body system analysis are compared in this paper. Main
advantages and limitations of the both methods are pointed out. Then a compromise, task dedicated,
"hybrid" solution is proposed. The model is implemented in the MADYMO software environment.

The final conclusion is, that in the nearest future the development and utilisation of "dedicated"
(designed for specific purposes) models of various accuracy representing individual parts of the
human body, where the method of multi-body systems analysis with certain modifications would be
used as the primary model, and some chosen sub-systems would be modelled by the method of
finite elements, seems to be the most reasonable solution.

Key words. Human body modelling, Hybrid modelling, Biomechanics of impacts, MADYMO

THE SIGNIFICANCE OF COMPUTER MODELLING IN BIOMECHANICS

The phenomenal increase of the calculating power of computers we have seen in recent years
accompanied by a significant drop of prices resulted in mathematical modelling methods and
simulation models designed on the basis of such methods are taking the place of other methods
-mostly experimental-in all fields of science and technology.

As far as biomechanics, and in particular biomechanics of impacts, is concerned, an additional

cause of the growing significance of computer methods is the "destructive" character of most
experiments carried out under real-life conditions. Experiments involving volunteers can only be
used in the case of collision tests conducted at small speeds. Research that uses cadavers and
animals, apart from being problematic with respect to the issue of compatibility with the bodies of
alive humans, raise lots of controversy of ethical nature.

COMPARISON OF TWO MAIN METHODS OF COMPUTER MODELLING

OF SYSTEM DYNAMICS
There are two main methods of mathematical modelling of continuous systems, including
biomechanical systems: finite element method (FEM) and method of multi-body system analysis
(MBA). Although both methods serve similar purposes, there are significant differences between
them. At first sight, the method of finite elements seems to be the best of the two. On a closer
analysis and after weighing its advantages and disadvantages , the situation is not so clear. The
following can be regarded as the most important advantages of the FEM:

• a possibility of constructing a very detailed model that takes into account not only differences
between particular segments of a body but also minor details of its internal structure with
a possibility of getting down to the level of cell structure,

• a possibility of detailed specification of stress patterns, and load and strain distribution at any
particular pint of a body.

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 59
60 C. Rzymkowski

This method, however, also has significant disadvantages :

• using a detailed model like this requires very time-consuming calculations, even when fast
workstations are used,

• in order for the model to represent the reality correctly enough, it is necessary to set the number
of numerical parameters , which is extremely difficult, and often impossible, to do in the case of
biomechanical systems .

The lack of satisfactory parameters, at the present level of scientific knowledge, can lead to results
that have very little in common with the reality. It can happen that the results will be worse than
those obtained much more cheaply with the help of the second method.

An important advantage of the method of multi-body systems analysis lies in much less time-
consuming calculations (frequently, when modelling dynamic phenomena under impact conditions,
the time needed for calculations may be as much as one hundred time shorter). Another advantage
is constituted by the considerably smaller number of experimental parameters (when compared to
FEM) needed to use in the model. In addition, physical interpretation can be ascribed to these
parameters more easily, wherefore the model is more "legible". Unfortunately, the method of multi-
body systems has also very serious limitations :

• models, usually consisting of a dozen or so members with the degree of freedom between about
a dozen and a few dozens (in the FEM model, the degree of freedom coming up to a few
hundred thousand is not uncommon) cannot be employed to represent many phenomena (such
as phenomena taking place inside the bones),

• it is not possible to accurately represent stresses and strains.

POSSIBLE COMPROMISE
In view of the fact that both the method of multi-body analysis and the method of finite elements , in
there pure forms have not only important advantages, but also serious limitations, special emphasis
should be put on a search for compromise solutions.

One of the possible methods of action is abandoning attempts to construct universal , very accurate ,
"all -weather" models of the human muscle and skeletal system (or dumm ies') and constructing
dedicated models to be used in each particular case instead. A similar situation is to be observed in
the case of designing and constructing dummies used in the car and aircraft industries to assess the
danger of injuries and deaths during transport accidents. The types of mechanical dummies used to
study frontal collisions differ from dummies used to study side collisions, "whiplash" effects, or
when simulating a pedestrian being knocked down by a vehicle . This makes it possible to use
simpler structures and to lower prices without major negative impacts on the test accuracy . It seems
reasonable to assume a similar solution when creating mathematical (computer) models.

It also seems that, given the current state of scientific knowledge and calculation capabilities, the
method of multi-body systems, properly modified and supported whenever necessary, by the FEM,
should be taken as the basis for mathematical modelling.

In the general picture of collisions, an important role is played by force s of inertia . Therefore
a mathematical model should crucially allow for an accurate reconstruction of the action of inertial
forces of all the members of the system that is being modelled.
" Hybrid" Approach to Modelling of Biomechanical Systems 61

When modelling a pedestrian being knocked down by a vehicle moving at the speed of 40 krn/h ,
which is the most common situation in urban traffic (with the speed being partially lost during the
braking), special attention should be paid to modelling legs, including the knee joint. Usually, in
cases like this, this part of a body is most susceptible to injuries.

In this situation, an accurate anatomical model of the upper part of the body (trunk, head, arms, and
even the leg which is not hit by the bumper) is not necessary . It will suffice to represent as
accurately as possible the inertial impact of the other body parts on the limb that is being hit. This
makes calculation considerably less labour-consuming, and as a result, makes it possible to
concentrate on the analysis of phenomena occurring in the "sub-system" which is most affected by
the collision.

Solutions like this were assumed in the work [1] devoted to modelling collisions involving
a pedestrian and a vehicle, with taking into account the possibility of fractures of long bones in the
contact area or injuries ofligament apparatus and co-functioning thigh and shank bones in the knee
joint. The whole body of the pedestrian was modelled as a typical multi-body system with typical
kinematic pairs. A knee-joint model that partially corresponded to an anatomical model was built
only for the leg being hit. An appropriate algorithm to predict shank bone fractures in the contact
area was also developed. The algorithm took in consideration both the load history and the changes
of strength properties of bones occurring under dynamic load conditions.

A different, "dedicated" model designed to analyse phenomena in the knee-joint area was examined
in the work [2]. The model proposed in this work employs the "anatomical" description of the knee
joint adapted for a general model of the multi-body type. To establish the contact forces in the knee
joint, the work used the method proposed by L. Blankevoort et al[3].

In the above mentioned cases, computer models were developed in the MADYMO [4] system
environment, while the fracture prediction module in the first instance, and the anatomical knee-
joint model in the second instance, were developed and entered into the system as the so-called
"user subroutines".

THE PROPOSED NEW "HYBRID MODEL"

One of the simplifications commonly used to model human body for the needs of biomechanical
analysis under collision load is to omit the muscle system. If the principle muscle groups of the
whole human body were taken into account, the resulting model would be extremely complicated .
In the solution that is being proposed, the muscle system is taken into account only as far as legs
and the pelvis are concerned . This makes it possible to build a model of the pedestrian (Fig. 1).
A model like this can also be used to analyse loads and to predict injuries occurring during
mountain skiing, especially under extreme conditions (professional skiing and falls).

The MADYMO system has been selected as the calculation environment in this case, too.

The proposed model is a typical "dedicated" model. The upper part of the trunk is modelled in a
standard way-similar to dummies used in vehicle tests (with certain necessary modifications).
Legs and the pelvis are modelled more precisely. The data gathered by S.L. Delp [5] that had been
published on the Internet [6] was selected as the basis for the building of an anatomical model of the
lower part of the human body.

The bone system of the lower part of the body, for the purposes of dynamic analysis, is modelled as
a system consisting of 13 active elements corresponding to the anatomical division of the body in
this area. The base element is the pelvis, which joins the upper part of the body and lower limbs.
62 C. Rzymkowski

Each limb is modelled by 6 elements: the thigh bone (femur), two shank bones (tibia and fibula)
modelled as one element, kneecap (patella), and the foot modelled as 3 elements (talus, calcaneus
and toe).

The surfaces of individual bones treated as members of a multi-body system are modelled with the
help of grids, the so-called "facet surfaces" (triangles and quadrangles with the total number of
nodes around 2500). Unlike the method of finite elements, the grid outlying the form of bones have
no direct influence on the mathematical model of the system, its only purpose is to define fragments
of bone surfaces for the needs of contact analysis (it influences the behaviour of the model via
contact forces). Individual bones (femur, tibialjibula, patella, talus, calcaneus and toe) are treated
as single elements.

Table 1 presents the muscle that have been taken into account in the model.

The parameters used to build a model of the muscles, such as points of their attachment to the
bones, intermediate points (some muscles act along lines which are not straight lines, "wrapping"
phenomena take place when muscles "wrap around" bone elements) have been defined after
S.L. Delp.

The work of J. Kajzer et at [7] has been selected as the source of data used for preliminary
verification of the model.

l
Upper part of the body
- based on standard
HY BRID-III dummy

Lower part of the body

- "anatomical"' model

Fig. 1. "Hybrid" model of the human body .

" Hybrid" App ro ach to Mod ellin g of Biom ech anical Systems 63

Table 1. List of muscles that have been taken into account in the model.

Hip muscles (Pelvis H Femur)

glute us medius (anterior, middle and posterior compartments), gluteus minimus (anterior, middle and
posterior compartments ) , glute us max imus (superior, middle and inferior compartments)'), adductor magnus
(superior, middle and inferior compartments), adduc tor longu s, addu ctor brevis, p ectineus, iliac us'), psoas' ),
quadratus fe mo ris, gemelli. pe riformis' '

Hip and knee muscles (pelvis H Patella, Pelvis H Tibia)

rectus fe mo ris' !, semim embranosus , semitendinos us ' J, biceps fem oris (long head), g racilis'J , sart orius'>,
tensor f asci ae latae' )

Knee muscles (Femur H Patella)

vastus medialis'>, vastus intermedius' J, vastus lateralis ' J, biceps f emoris (short head)

Knee and ankle muscles (Femur H Calcaneus)

medial gastrocnemius'J , lateral gastrocnemius'J

Ankle muscles (Tibia H Calcaneus, Tibia H Toes)

soleus, tibialis posterior '),flexor digitorum longu s'J,flexor hallucis longus ' J, peroneus brevis'J, feroneus
longus", tibialis anterior'), p eron eus tertius' ), extensor digitormum longus ", extensor. hallucis longus J

.) These muscles act along lines which are not straight lines.

FINAL REMARKS
The proposed "hybrid" model of the human body appears to meet the expectations.

One of the problems that still has to be solved is setting the static balance conditions for the model
making it possible to keep the vertical position until external forces make the body loss its balance.

It is also advisable to develop and implement an algorithm for predicting which of the elements of
leg bone surfaces can, at a given moment, come into contact with the environment, which would
make calculations less time-consuming .

It is also necessary to carry out a thorough analysis of the model's response to changes of
parameters (as is well known, biological systems are characterised by a wide variety of properties)
and to conduct a more extensive verification while using the results for a larger and more variable
range of experimental research.

In general , it appears that, in the nearest future, the state of scientific knowledge and processing
capabilities (time intensity of calculations, hardware prices) will not allow for the development and
wide use of very detailed models of the entirety of the human muscle and skeletal system. In this
situation, the development and utilisation of "dedicated" (designed for specific purposes) models of
various accuracy representing individual parts of the human body, where the method ofmuiti-body
systems analysis with certain modifications would be used as the primary model, and some chosen
sub-systems would be modelled by the method of finite elements, seems to be the most reasonable
solution.
64 C. Rzymkowski

REFERENCES
[1] J.K. Yang, C. Rzymkowski, J. Kajzer, Development and Validation of a Mathematical
Breakable Leg Model, Proceedings of Int. IRCOBI Conference on the Biomechanics of
Impacts IRCOBI'93, 1993, pp. 175-186.
[2] C. Rzymkowski, Application of True-Geometry Kinematic Pairs in Multi-Body System
Approach to Simulation in Biomechanics, Vth Int. Symposium on Computer Simulation in
Biomechanics, 1995, pp. 66-67.
[3] L. Blankevoort, J.H. Kuiper, R. Huiskes, H.J. Grootenboer, Articular Contact in a Three-
Dimensional Model of the Knee, Journal of Biomechanics, Vol. 24, No . 11, 1991,
pp.1019-1031.

[4] TNO Road-Vehicles Research Institute. MADYMO User's Manual - version 5.3, TNO, Delft,
The Netherlands, 1997.
[5] . S. L. Delp . Surgery Simulation: a Computer Graphics System to Analyze and Design
Musculoskeletal Reconstructions ofthe Lower Limb, Ph.D. Dissertation, Stanford University,
CA, USA, 1990.
[6] S. L. Delp. Lower limb data sets, http://isb.ri.ccf.org/data/delp/.
[7] J. Kajzer, C. Cavallero, J. Bonnoit, A. Morjane, S. Ghanouchi, Response of the Knee Joint in
Lateral Impact: Effect of Bending Moment". Proceedings ofInt. IRCOBI Conference on the
Biomechanics ofImpacts IRCOBI'93, 1993, pp. 105-116.
Current Status of Finite Element Human Model
Using PAM-CRASH
Yasuhiro MATSUOKA, Kohei ANDO
Nihon ESI K. K., Well Uehara Building SF, Uehara2-47-18, Shibuya-ku, Tokyo 151-0064, JAPAN

Summary: The paper summarizes the current status of biomechanical models at ESI Group
companies, developed for impact and occupant safety simulation. The model has been developed
with Finite Element Method, it consists of outer skin and detailed internal components such as
skeleton and soft tissues.

Key Words: Biomechanical, Human Model, Finite Element

INTRODUCTION
In order to predict the injury and behavior of bones and organs against the impact to human body
such as car accidents, the crashworthiness analysis using finite element human body model is
significant. The paper reports on the current status in biomechanical models for impact and
occupant safety simulation with non-linear explicit finite element code PAM-CRASH/SAFE™ .
The models consist of 2 kind of models, Human Articulated Rigid Body (HARB) models and
detailed deformable human part models (Biomechanical models) .

HARB models consist of rigid body segments connected by joints that have nonlinear rotational
stiffness, damping and friction properties. Each human body parts of HARB models have masses,
centers of gravity, principal axes of inertia and inertia moments, the location of skeletal joints to
predict human body parts behavior. Individual body parts can be replaced with deformable sub-
models for more detailed simulation. For example, the rigid body head segment can be replaced
with deformable head model in order to estimate head injury in the impact to the head of upright
human body.

Biomechanical models are modeled the organization of human body in detail, bones, skins and
fatty tissues are defined as solid elements and tendons and muscles are defined as beam elements,
in addition, bone breaking behavior and internal organs are also available .

Main applications are injury predictions in automobile crash accidents and can be also applicable
for many other fields. Some application examples and the current status of detailed biomechanical
models are summarized with computation and validation results.

HUMAN ARTICULATED RIGID BODY MODELS

Human Articulated Rigid Body (HARB) models are divided into
about 20 body parts. The concept of modularity is to predict the
kinematic behavior of human body in vehicle accidents . HARB
models are fundamentally built with rigid body segments in order
to save CPU time. Figure I shows example of the models . HARB
models are separated into several segments that are linked with
joints. The joints are defined with nonlinear rotational bar,
damping and friction properties . Each segment is treated as rigid
bodies and mass and inertia are specified at the centers of Fig. 1 HARD model

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 65
66 Y. Matsuoka and K. Ando

gravities. The skins of each segment are defined as "null shells" in detail for contact interactions
with other body segments and with the environment.

THE DEFINITION OF BIOMECHANICAL MODELS

Basically Biomechanical models are developed with Finite Element Method in order to
represent the structure of human body tissues faithfully, bones and skins are modeled by shell
elements, ligaments and muscles are done by beam elements which is defined by their entities.
There is a model which has the frangible bones and organs. As one of the examples, an outline of
modeling way for biomecanical models are explained with giving the thorax biomechanical model
[1] [2] in Figure 2. The model contains the ribs, diaphragm, lungs, mediastinum and heart consist
of 24,000 solids and shells. The model characteristics are as follows.

The ribs. The ribs are modeled with elastic-plastic

fracturing material properties, where a damage
parameter, d( E: ), grows from zero (undamaged) to
1.0 (fully damaged) between plastic strains of 2%
and 9%, with d=0.5 (half damage) at 7% in order to
represent bone fracture. And the lower extremity
model which is thought that fracture behavior is
important is modeled with orthotropic materials
considering the tissue of bones, further there is a
model considered the strain rate effect.

The muscles. The muscle tissues like "rib muscle"

which stabilize the bones are modeled simply by
using "nonlinear tension only bar element" or Fig. 2 Thorax biomechanical model
"layered membrane element". In order to calculate
the behavior between ribs, these elements are defined with a specific characteristic that is force
depends on their elongation.

Organs. The organs such as the lungs, heart and diaphragms are modeled as elastic materials by
shell elements. Especially regarding the lungs, in order to calculate the thorax impact behavior
exactly, it needs to consider the effect of the air in lungs, and the flow of the air that escapes out
from the lungs through the trachea. In the reason, the volume of lungs modeled with shell elements
is calculated as a control volume, and renewed the internal pressure in the lungs related with itself
volume by "Gus constant law" at every steps. And by difference of internal pressure of the lungs
and atmosphere, the model is calculated the air volume which are escaped from the lungs through
a vent orifice corresponds to the cross section area of the trachea, and it renews air volume in the
lungs.

Flesh. The flesh including muscle which locates outside of ribs are modeled with "visco-elastic
solid element" because such a flesh plays an important part for energy absorption.

Contact definition. On the Biomechanical models, usually the bones, skin and organs are
modeled with finite element. Therefore it needs considering a contact interactions with other body
parts, and the all outer surface is used for contact computations. The model is modeled without
using merged nodes, and it has capability to calculate the contact phenomenon of each organs and
bone with defined the friction coefficient.
Finite Element Human Model Using PAM-CRASH 67

VALIDATION OF BIOMECHANICAL MODELS

Validation of the thorax biomechanical model is shown by way of example. Figure 3 shows a
section view of deformed shapes of the thorax model in frontal pendulum impact test, Figure 4
shows load-displacement response. Simulation results are in the range of experimental results
reported in the paper of Kroell [3][4] and Viano [5]. In the same way, Figure 5 and 6 show
simulation results in lateral pendulum impact test. Kinematic behavior of thorax model and its
contact interaction between organs are well simulated. Specially, it is significant to visualize
internal deformation of thorax under the impacting and evaluate the impact force transmission. In
comparing load-displacement response shown in Figure 4 and load time history shown in Figure 6
with experimental results, the simulation result is within experimental results range. Thus the
validity of the model is confirmed

Fig. 3 Front impact deformed shapes Fig. 5 Lateral Impact Deformed Shapes

Fig. 4 Force-deformation response on frontal Impact Fig. 6 Force-time response on lateral Impact

EXAMPLE OF BIOMECHANICL MODELS

Skeleton model. Biomechanical model in Figure 7 is modeled accurately up to the scapula and the
clavicle. In the previous models, the number of joints were
usually restricted by a certain level and simplified, but in
order to reproduce the human action, it became to be able
to found devices for modeling the human skeleton structure
as human body. Figure 7 shows the model [6] which is
modeled muscle for moving the scapula and the clavicle
with nonlinear bar elements and the model can reproduce
the shoulder motion. In this way, the case skeleton system
was became to be modeled more fully due to reproduce the
human action accurately

Fig. 7 Shoulder motion model

68 Y. Matsuoka and K. Ando

Head and Neck model. Figure 8 gives the example of simulating the head damage when a steel
bullet hits a helmet for military. It shows the result [6] how a helmet relieves the head impact
including inside of the brain. Figure 9 is the biomechanical model [7] about the head and the neck.
It shows the result how they are damaged in the case of a child who is close to the assistant seat
airbag when it deploys. Therefore the head and neck motion and the impact force for working each
part on impact can be simulated analytically with the time history. The biomechanical model is
expected as it is valid for elucidating a mechanism for the head and neck damage.

Fig.SBullet impact simulation Fig.9 Six year old child airbag simulation

Leg model. Figure 10 shows the example of the simulating the knee joint's damage [6] under the
side impact condition from the leg. And Figure 11 is the example of foot I ankle one [8]. In the leg,
for the reason that the serious damage happens at the joint, the joint is put emphasis on and the
joint model modeled in detail has been used.

Fig.l0 knee lateral impact simulation Fig.ll Foot and ankle to board impact simulation

CONCLUSION
The paper outlines general status of the biomechanical model with finite elements. The history of
the biomechanical model is still young. At this stage, there is a need for modeling devices to
simplify the complex modeling task. Further improvement on material models of PAM-CRASH to
tailor for special materials needed for such a biomechanical muscle modeling are ongoing. The
accumulation of the simulation know-how to model such biomechanical events will also be very
helpful for future simulations.

There are limitations on human body test studying the injury. As long as an object of study is
human, there is a scope to depend on computational engineering to account for some of the
physical testing deficiencies . Future development of biomechanical modeling is expected .
Finite E le me n t Human Model Usi ng PAM-CRASH 69

REFERENCES
[I] Haug, E. : Biomech anical Model s in Vehicle Acci dent Simulatio n, PAM-User's Conference in Asia, PUCA'95,
pp.233-256, Shinyokohama,Ja pan, 1995

[2] A llain, J.e. : Etude et Ca libration d'un Modele N umerique du Thorax, ESI Gro up, 20 rue Saarinen, Silic 270 ,
94578 Rungis-Cedex, 1998

[3] Kroell, C.K . , Schneider, D.e. , Na hum, A.H. : Impact Tolerance and Response of the Human Thorax, SAE
paper 7 1085 1, 15th Stapp Ca r Co nference, 197 1

[4] Kroell, C.K. , Schneider, D.C. , Nahu m, A.H. : Impact Tolerance and Response of the Hum an ThoraxlI, SAE
paper 7411 87, 18th Stapp Ca r Co nference, 1974

[5] Viano, D.C. : Biomechani cal Response and Inj uries in Blunt Lateral Impact, 35 th Stapp Car Conference, 1991

[6] Haug, E., Beaugonin,M., Trame con, A., Hyncik, L.: Current Status of Arti culated and Deformable Human
Models for Impact and Occupant Safety Simulation at ES I Group, PAM-User's Conference in Asia,
PUCA'98, pp. 291-308 , Shiny okohama,Japan, 1998

[7] Haug, E., Nitsche , S. and Kisielewicz T . : Validation of a Finite Element Model of the Human Neck,
PUCA'96, pp.203 -220, Shin yokohama,Japan, 1996

[8] Beaugon in, M., Haug, E., Cesari , D. : Impro vements of Numerical Ankl e/Foot Model Mod eling of
Deformable Bone, 41st Stapp Car Co nference, 1997
Finite Element Model for Simulation of Muscle Effects on
Kinematic Responses of Cervical Spine in Low-Speed
Rear-End Impacts

Adam WITTEK I , Koshiro ONO I , and Janusz KAJZER 2

'Crash Safety Research Division, Japan Automobile Research Institute, 2530 Karima, Tsukuba 305-
0822, lbaraki , Japan
2 Dept. of Mechanical Engineering, Graduate School of Engineering, Nagoya University, Furo-Cho,
Chikusa-ku, Nagoya 464-8603, Japan

Summary. In the current study, the finite element model of the cervical spine with muscles,
previously applied to an investigation of the head-neck complex responses in frontal impacts, was
modified in order to improve its biofidelity in low-speed rear-end impacts. The modified model of
the cervical spine was utillized to investigate effects of muscle tension on the motion of the cervical
vertebrae in low-speed rear-end impacts. The modelling results were compared with the
experimental data obtained in the tests conducted under two distinct conditions of volunteer
preparation for impacts. The volunteers were either asked to keep their muscles relaxed before an
impact started (unexpected impacts) or to tense their muscles (expected impacts) . The current
model of the cervical spine well represented both the global kinematics of the head-neck complex
and angular displacements of the cervical vertebrae recorded using volunteers. Furthermore, our
results suggest that in low-speed rear-end impacts, muscles can significantly reduce rotation angles
between cervical vertebrae. The largest relative reduction was calculated to occur at C2-C3 level.

Keywords : Low-speed rear-end impact, Muscle effect, Cervical vertebrae motion , Global
kinematics of the head-neck complex

INTRODUCTION

The mechanisms of whiplash mjury have been generally considered to involve cervical
hyperextension/hyperflexion and translational displacement of the head in relation to the torso in
the sagittal plane [I]. On the other hand, several authors have recently hypothesized the
mechanisms of whiplash injury that can occur within the physiological range of neck motion [2].
However, most mathematical models for investigation of the dynamic responses of the neck have
been focused on representations of the general kinematics of the head-neck complex . Thus, their
biofidelity has been mainly evaluated in terms of their ability to predict the time histories and peak
values of the head angular and translational displacements and accelerations [3,4]. They have not
been validated against motions of the cervical vertebrae as such. Thus, it is not clear to what extent
they can be applied in understanding the mechanics of injuries within the physiological range of
neck motion.

One of the important problems that needs to be investigated is the effect of muscle activity on the
cervical spine kinematics in collisions at low speeds. It has been experimentally indicated that the
cervical muscles can react fast enough to significantly reduce the head angular displacement during
sudden acceleration [5]. Similarly, mathematical modelling studies suggested that the active
cervical muscles play an important role in reducing the head and neck rotation in frontal impacts at
accelerations of up to 15 g [6]. However , to the best of our knowledge, the possible effects of
muscle activity on motion of cervical vertebrae have not yet been investigated.

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 71
72 A . Wittek ct al.

Thus, the goals of the current study are to develop and validate a mathematical model of the
cervical spine that accurately represents the kinematics of the individual cervical vertebrae during a
low-speed rear-end collision and the effect of muscle activity on this kinematics.

METHODS

Model of cervical spine. We adapted the model previously utilized by us in an investigation of the
effect of muscle tension on the global kinematics of the head-neck complex in a high-speed frontal
collision [7]. As the current study focuses on representing the motions of cervical vertebrae in low-
speed rear-end collisions, important modifications of this model were made. The models of
intervertebral discs were refined by introducing a visco-elastic annulus fibrosus and an almost
incompressible nucleus. Orientation of the vertebral facets was modified according to the literature.
Force-tension properties of the fibers in composite material models of longitudinal and flava
ligaments were redefined as non-linear. We also introduced contact interfaces on the spinal
processes and facet surfaces .

Impact load. The impact load was represented by the vertical and horizontal accelerations of the
first thoracic vertebra Tl obtained in the previously conducted experiments [8]. In these
experiments the volunteers were exposed to acceleration pulses simulating rear-end impacts. The
pulses were generated using a sled apparatus. The peak value of the sled acceleration was around
2.5 g, and the impact speed was 6 km/h. The Tl accelerations utilized here were obtained under two
distinct conditions of volunteer preparation for impacts. The volunteers were either asked to keep
their muscles relaxed before an impact started (unexpected impacts) or to tense their muscles
(expected impacts). To simulate the neck-torso interactions, we applied the Tl accelerations not
only to the head and the neck, but also to the first two thoracic vertebrae. The remaining segments
of the model were fully constrained.

Muscle model. Cervical muscles were modelled using the Hill-type multi-bar muscle element
previously implemented in the BET A2000 version of the PAM-SAFE finite element code [9]. In
this muscle element, a skeletal muscle was represented as a string of series-connected bars . The
behavior of these bars was determined using the Hill-type muscle model. In the current study, the
dynamics of muscle activity was described using the set of first-order ordinary differential
equations according to [10]. Based on the previous literature review [11], we assumed that in the
unexpected impacts muscles were activated by the stretch reflex. Whereas in simulation of the
expected impacts, we assumed that all the cervical muscles reacted immediately after the start of
impact acceleration.

Geometry of cervical muscles. In the present model of the cervical spine, the geometry of the
cervical muscles and their attachment points were estimated based on the literature Almost a1l of
them were subdivided into several portions with different lines of action, which resulted in 90
multi-bar muscle elements (Fig . 1). To simulate the curving of long flexors and extensors around
the vertebrae during cervical spine bending, splenius capitis, splenius cervicis and longus colli were
modeled using three series-connected bars in each multi-bar element.

Validation of cervical spine model. The current cervical spine model was validated against the
results of the previously conducted experiments using volunteers [8]. In these experiments, the
details of the cervical spine motion were recorded by means of cineradiography. Our validation
included angular displacement of the head gravity center, its resultant and angular accelerations,
and relative angles of the cervical vertebrae from C2 to C6 levels. The latter were defined as the
angular displacements between two adjacent vertebrae measured in relation to the inferior vertebra.
Forward rotation (i.e., flexion) was defined to be positive. We were not able to perform a statistical
Muscle Effects in Low-Speed Rear- End Impacts 73

analysis of the experimentally obtained relative vertebrae angles-time histories because of too few
cineradiography recordings.

Fig. 1 Front-oblique view of the current model of

the cervical spine with muscle elements . Only
cervical flexors are shown

RESULTS
Results of validation of global kinematics of the head-neck complex. In the modelling of
unexpected impacts, time histories of angular displacement of the head gravity center were close to
the lower limit of the experimental corridor (Fig. 2a). However, the calculated resultant acceleration
of the head gravity center exhibited several local minima and maxima which were not observed in
the experimental results (Fig. 2b).

(b) ;;

!
(e) -

.
], 100
0.00
ci. -10.00 Ii eo
is ·20.00
-, ""
.q;

.....
~ -30.00
;; ~ ...... 1: 60
l!' -40.00 z::
:>
c .50.00 ---- -Volunt.r Corridor . .............. 40
8 .0000 II:

I
- Mod. 1
(.)
-70.00 8U 20

":I:..
.0000
1 0
TIm. [mil 0

Fig, 2 Comparison of the calculated and experimentally obtained (a) angular displacements of the head
gravity center and (b) resultant accelerations of the head gravity center

In the modelling of expected impacts, the calculated angular displacement of the head gravity center
was in the middle of the experimental corridor. Its maximum value decreased by around 30% in
comparison to that computed on the assumpt ion that the cervical muscles were activated by the
stretch reflex. Furthermore, the peak value of the head gravity center resultant acceleration was
calculated to occur sooner than that obtained while simulating unexpected impacts. Such phase shift
corresponds well to the experimental findings. However , the maximum values of the calculated
angular and resultant acce lerations were lower by around 40% than those obtained in the
experiments.
74 A . Wittek et at.

Results of validation of motion of cervical vertebrae. The modelling of unexpected impacts

yielded time histories of the relative angles of the cervical vertebrae close to those obtained in the
experiments (Fig. 3). Maximum values of their magnitudes were around 4° in C2-C3 functional unit
and around go in C4-C5 and C5-C6 units. Time history of the C2-C3 relative angle exhibited
positive values of low magnitude during the initial 120 ms of an impact. Thus, the current
modelling results indicated that in the initial phase of rear-end impacts at low speed, the lower
cervical vertebrae are in extension whereas the upper ones are in slight flexion. This pattern of
cervical spine deformation is consistent with the experimental findings reported in the literature
[12].

(8) 2 (b) 2
0 0
i:!!. -2 i:!!. -2
•
;;, -4 ...c
.! -4
c
c -6 -Volunt.... r No.1 0( -6
'" -,. · Volunt.... r No.2
l:/
l:l
-6
-10
.....-Model
~0-10-6
-12 -12
0 50 100 150 200 250 300 0 50 100 150 200 250 300
Time [mel Time [mel

Fig. 3 Comparison of the calculated and experimentally obtained relative angles between the cervical
vertebrae in unexpected impacts at the speed of6 km/h . (a) C2-C3 angle and (b) C5-C6 angle

Effect of muscle tension on angular displacement of cervical vertebrae. A decrease in the

angular displacement of the head gravity center in the expected impacts discussed in the previous
section can be explained by an effect exerted by muscles on the relative vertebrae angles . The
modelling of expected impacts yielded relative angles between the cervical vertebrae lower than
those calculated when muscles were assumed to be activated by the stretch reflex (Fig. 4). The
largest relative decrease in the vertebrae angle caused by muscle action was calculated to occur at
C2-C3 level where such angle went down by around 2°, i.e., about 40%. The relative decrease at
C5-C6 level was only around 7%. One possible explanation for such a relative decrease in the C2-
C3 angle might be that the strongest cervical flexor muscles (e.g., sternocleidomastoid} are attached
to the skull and the upper cervical vertebrae.

--- -- --
- - -C2· C3
-C3-C4
· ->c· -C4-C5
-CS-C6

50 100 150 200 250 300 50 100 150 200 250 300
Time [mal Time [msl

Fig. 4 Comparison of the relative angles between vertebrae calculated when modelling of (a) unexpected and
(b) expected impacts
Muscle Effects in Low-Speed Rear-End Imp act s 75

Effect of muscle tension on the global head-neck complex kinematics. Muscle tension
significantly decreased the peak value of the calculated angular displacement of the head gravity
center. The modelling of expected impacts yielded angular displacement of the head gravity center
of around 70% of that obtained while simulating unexpected impacts. Moreover, the peaks of the
angular and resultant accelerations of the head gravity center were calculated to occur 20-50 ms
sooner in expected than in unexpected impacts. One possible explanation for this shift in phase of
the acceleration-time histories is an increase in the stiffness of the head-neck complex caused by
muscle tension in expected impacts.

DISCUSSION

Unlike finite element models of the cervical spine used so far in the field of impact
biomechanics, the current model was validated not only against the global kinematics of the head-
neck complex but also against the motion of the cervical vertebrae recorded using cineradiography.

Validation against the global head-neck complex kinematics indicated that modelling of unexpected
impacts yielded angular displacement, and resultant acceleration of the head gravity center either
inside or very close to the corridors obtained in the experiments using volunteers (Fig. 2).
Furthermore, the current model of the cervical spine correctly predicted that the peaks of the head
gravity center angular and resultant accelerations occur 20 (50) ms sooner in expected than in
unexpected impacts . However, for expected impacts , the calculated maximum values of head
gravity center accelerations were lower than those recorded in the tests using volunteers [8]. These
differences between the experimental and modelling results are likely to result from the following
simplifications of the current model of cervical spine: I) Representing all interactions between the
torso and the neck using the horizontal and vertical accelerations of the first thoracic vertebra Tl ;
and 2) Assuming that in the expected impacts the activation was the same for all the muscles
belonging to a given functional group: flexors or extensors.

The limitations discussed here did not compromise the validity of the current results on motion of
cervical vertebrae . The modelling of unexpected impacts yielded time histories of the relative
angles of the cervical vertebrae close to those obtained in the experiments (Fig. 3). Maximum
values of their magnitudes were around 4° in C2-C3 functional unit and around 8° in C4-C5 and
C5-C6 units. Furthermore, the calculated extension motion in C2-C3 and C3-C4 functional units
was delayed in relation to that in C4-C5 and C5-C6 units. Time histories of the C2-C3 relative
angle exhibited positive values of low magnitude during the initial 120 ms of an impact (Fig. 3).
Thus, the current modelling results indicated that in the initial phase of rear-end impacts at low
speed, the lower cervical vertebrae are in extension whereas the upper ones are in slight flexion.
This pattern of cervical spine deformation is consistent with the experimental findings [12].

A comparison of the current results obtained when modelling unexpected and expected impacts
indicated that the activated muscles can reduce the peak values of relative extension angles between
vertebrae (Fig. 4). These angles are directly related to deformations of ligaments of cervical spine
and capsules of facets joints. Thus, it can presumed that muscles may exert some protective effect
by decreasing these deformations.

Thus, the current model of the cervical spine exhibits good biofidelity in predicting the angular
displacement of the head gravity center and relative angles between the cervical vertebrae in rear-
end impacts at low speeds. As it was mentioned in the Introduction section, several authors have
hypothesized that in such impacts, injuries may occur within physiological range of the neck
motion. Mechanisms of such injuries cannnot be fully understood without knowledge on patterns of
motion of the cervical vertebrae. Therefore, it seems to be reasonable to conclude that investigation
of such mechanisms can be one of the possible applications of the current model of cervical spine.
76 A. Wittek et al.

In order to enable such investigation, it is suggested to improve biofidelity of this model in

predicting the cervical spine responses in situations when car occupants anticipate an impact by
tensing their muscles .

ACKNOWLEDGEMENTS
The authors wish to thank Nihon ESI, Tokyo, Japan, and PAM System International, Rungis,
France for their col1aboration. The authors also acknowledge the help of Dr. S. Inami of the
Orthopaedic Department of Tsukuba University Hospital and Dr. K. Kaneoka of the Department of
Orthopaedic Surgery of Tokyo-Kosei-Nenhin Hospital. The BETA2000 version of the PAM-SAFE
finite element code was utilized in the current study under an agreement between the Japan
Automobile Research Institute and Nihon ESI.

REFERENCES
[1] H. J. Mertz and L. M. Patrick, Investigation of the Kinematics and Kinetics of Whiplash,
Proceedings of11th Stapp Car Crash Conference, 1967, pp. 269-317 .
[2] K. Kaneoka, K. Ono, and S. Inami, Motion Analysis of Cervical Vertebrae During Whiplash
Motion, Spine, Vol. 24,1999, pp. 763-770 .
[3] M. de Jager. Mathematical Head-Neck Models for Acceleration Impacts, Doctoral Thesis.
Eindhoven University of Technology, 1996.
[4] S. Nitsche, G. Krabbel, and E. Haug, Validation of a Finite-Element Model of the Human
Neck , Proceedings ofInt. IRCOBI Conference On the Biomechanics ofImpact, 1996, pp. 107-122.
[5] M. H. Pope, M. Magnusson, A. Aleksiev, L. Hasselquist, K. Spratt, M. Szpalski, V. K. Goel,
and N. Panagiotacopulos, Electromyographic Changes Under Whiplash Loading, in Frontiers in
Head and Neck Trauma, lOS Press, 1998, pp . 338-343.
[6] M. J. van der Horst, J. G. M. Thunnissen, R. Happee, and 1. S. H. M. Wismans, The Influence
of Muscle Activity on Head-Neck Response During Impact, Proceedings of the 41th Stapp Car
Crash Conference, 1997, pp. 487-507 .
[7] A. Wittek, J. Kajzer, and E. Haug, Application of New PAM-SAFE Muscle Model :
Preliminary Modeling of Muscle Effect on Head-Neck Complex Response in 15 g Frontal Impact,
Proceedings ofPAM Users Conference in Asia PUCA98 , 1998, pp. 337-358 .
[8] K. Ono, S. Inami, K. Kaneoka, T. Gotou, Y. Kiasnuki, and K. Miki, Relationship Between
Localized Spine Deformation and Cervical Vertebral Motion For Low Speed Rear Impacts Using
Human Volunteers, Proceedings ofInt. IRCOBI Conference On the Biomechanics ofImpact, 1999,
pp. 149-164.
[9] A. Wittek and J. Kajzer, Modelling of Muscle Influence on the Kinematics of the Head-Neck
Complex in Impacts, Memoirs ofthe School ofEngineering, Nagoya University, Vol. 49,1997, pp .
155-205.
[10] J. M. Winters and L. Stark, Analysis of Fundamental Human Movement Patterns Through the
Use ofIn-Depth Antagonistic Muscle Models, IEEE Transactions on Biomedical Engineering, Vol.
12,1985, pp. 826-839 .
[11] A. Wittek and J. Kajzer, A Review and Analysis of Mathematical Models of Muscle for
Application in the Modelling of Musculoskeletal System Response to Dynamic Load, Proceedings
of9th Biomechanics Seminar Chalmers University ofTechnology and Gothenburg University,1995 ,
pp . 192-216.
[12] K. Ono, K. Kaneoka, A. Wittek, and J. Kajzer, Cervical Injury Mechanism Based on the
Analysis of Human Cervical Vertebral Motion and Head-Neck-Torso Kinematics During Low
Speed Rear Impacts, Proceedings of41st Stapp Car Crash Conference, 1998, pp. 339-356.
A Biomechanical P.E.E.E.P. Show
Rolf H. Eppinger

National Transportation Biomechanics Research Center

National Highway Traffic Safety Administration
U.S. Department of Transportation
400 Seventh Street, S.w. NRD-51
Washington, D.C . 20590

Summary: With the rapidly expanding capabilities and sophistication of experimental and analytical
techniques that can be applied toward biomechanical endeavors, it would appear to be a useful exercise
to review current practice and discuss what might be the form and function offuture research that could
make substantial improvements in the ability to detect and evaluate the potential for automotive impact
trauma. To accomplish this, an exercise, dubbed Prognosticative Extensions and Enhancements to
Existing Practices; a Biomechanical PEEEP Show into the Future will be pursued and presented .
It presents the author's impressions of what are the prevalent injury mechanisms active in each major
body region, his technical evaluation of the efficacy of the currently accepted injury criteria being
applied to detect and evaluate the consequences ofthose injury mechanisms, and presents his vision of
the form and function of future biomechanical capabilities that could, using both enhanced analytical
and experimental research techniques, have the potential for greatly improving both our understanding
of impact injuries and our ability to prevent them.

Key words: Impact injury, Injury mechanisms, Injury criteria, Computer aided trauma prediction

INTRODUCTION

Thirty years ago, the ability of researchers in impact injury biomechanics was severely limited by the
physical equipment available to capture the physics of the highly transient impact events of interest.
Transducers capable of sensing accelerations and forces were often very expensive, large, heavy, and
often of low performance. Their mere presence could often modify the responses that they were
intended to capture. Equipment to document the output ofthese transducers was also likewise limited
with VISICORDERS being the recorder of choice . This device recorded the output oftransducers by
deflecting beams of light onto strips of photosensitive paper with optical galvanometers. This data
format obviously limited any subsequent time-domain analysis of the recorded responses. Optical
observations were accomplished with high speed photography with framing rates up to several thousand
frames per second . However, to realize this information in a useable format required employing long
and tedious but not necessarily accurate, manual digitization processes.

Today's world is vastly different. Transducers, through the miniaturization techniques developed in the
computer industry, are considerably smaller, lighter, and more accurate than their predecessors. Data
acquisition equipment that is capable ofdigitizing and recording hundreds ofchannels ofdata thousands
of times a second is now almost universally available and used . High speed video with automatic
digitization is now also commonplace. The ubiquitous computer can assemble, examine, and generalize
this enormous quantity ofdata with analysis techniques that were previously impossible because oftheir
required computation intensity . Additionally, computers, through the application of sophisticated
simulation techniques, also hold the promise of providing accurate estimations of the time varying
stresses and strains throughout the entire human structure which should enhance our understanding of
the injury process in a more direct way.

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 77
78 R.H. Eppinger

Biomechanical efforts to understand impact injury mechanisms and to develop relationships that use
measurable engineering parameters to predict both the occurrence, extent , and severity of resulting
injuries are, by their very nature, empirical processes. Their success was and still is determined by the
quantity and quality of the experimental observations from which generalizations are formed through
the insightfulness and resourcefulness ofthe researcher. Obviously , early injury criteria, because ofthe
limited quantity and quality ofavailable data, are coarse generalizations ofthe truth and are not capable
of addressing many of the subtleties that can be identified with our increased capacity to observe and
quantify impact events . With the advent of the considerably enhanced experimental and analytical
capabilities, it would be a useful exercise to review current injury predicting practice and discuss what
might be the form and function of future research that could make substantial improvements in our
ability to detect and evaluate the potential for automotive trauma. To accomplish this, an exercise
dubbed Prognosticative Extensions and Enhancements to Existing Practices; a Biomechanical
PEEEP Show into the Future will be pursued and presented. It presents the author's current
impression of what are the prevalent injury mechanisms active in each major body region, his technical
evaluation of the efficacy of the currently accepted injury criteria to detect and evaluate consequence
of those mechanisms, and presents his vision of the form and function of future biomechanical
capabilities that could, using both enhanced analytical and experimental research techn iques, have the
potential ofgreatly improving both our understanding ofimpact injuries and our ability to prevent them .

HEAD

There are four major injury types that are of current biomechanical interest concerning the head . They
are : skull fracture , diffuse axonal injury, bridging vein rupture resulting in acute subdural hematoma,
and focal lesions. Fractures of the cranial vault are a result of the head striking another object and the
pressure/area/time history ofthat interaction generating stresses/strains exceeding the structural capacity
ofthe skull. Diffuse axonal injuries, which can be considered as either functional or physical disruptions
to axons within the brain, are a consequence ofmechanical distortions ofbrain matter usually associated
with rotational motions imposed on the head as a result of either direct or indirect forces . Bridging vein
ruptures also appear to be rotationally induced failures caused by the relative translation of the outer
surface ofthe brain with respect to the skull. Focal lesions, however, appear to be dilatational tensile
failures of the brain matter induced by negative pressures resulting from translational accelerations.

Currently , the most universally used criteria for head injury is the Head Injury Criteria or HIC . It is a
kinematically based function which uses the head 's resultant acceleration as input. With some algebraic
manipulation, it can be shown to be a measure of both the rate of change ofthe head's specific kinetic
energy (dy2 /dt) modulated by the square root of the average acceleration (dY/dt) V, experienced over
the HIC's critical interval. HIC has no ability to detect the area over which impact forces are applied
to the head nor does it explicitly evaluate the magnitude and character of the rotational motions the
head experiences. Statistical studies [I] have shown that it has a reasonable association with skull
fracture , but may be oflesser predictive value for brain injury severity.

Improvements in the predictive capabilities for head injuries can be realized by employing two
methodologies. First, for improved detection of skull fracture conditions, it would appear that an array
load cell attached to the dummy's skull under the surface skin could, with its multiple individual load
sensitive points, provide an accurate approximation of the pressure/area/time history (p/a/t) the skull
experiences while interacting with an impact partner [2]. Then, using a process that will be generically
called Computer Assisted Trauma Evaluation or CATEv, the recorded p/a/t would be applied to
a finite element model of the skull (3) and resultant skull stresses/strains predicted. Based on critical
values determined by calibrating the model to a set experimentally obtained fracture and non fracture
situations, the probability of the skull experiencing a fracturing load could be accurately assessed.
A Biomechanical P.E.E.E.P. Show 79

For the other three injury mechanisms, a similar CATEv approach could also be envisioned [4]. Here
the translational and rotational accelerations ofa specific dummy head impact event would be captured
using a nine-accelerometer array within the dummy's head [5]. These specific kinematic conditions
would then be applied to a robust, three-dimensional finite element model of the brain within a rigid
skull. The extent and severity of diffuse axonal injury would be estimated by a form ofthe Cumulative
Strain Damage Measure (CSDM) algorithm [6,7] which monitors the percent of brain volume that
exceeds prescribed levels of principal strain . Bridging vein rupture would be estimated by the
magnitude ofthe relative displacement between the brain surface and skull in the para-sagittal regions
where bridging veins exist [4]. The risk of focal lesions would be estimated by an algorithm similar to
the CSDM which would evaluate the extent and magnitude ofdilatational stresses observed within the
modeled brain material [4].

It is anticipated that for near term applications, it may not be necessary to have both material and failure
properties of the modeled brain exactly defined for this CATEv process to be viable. Rather, it could
be argued that the best available constitutive properties for the brain could be used and provisional
critical stress, strain, and displacement failure criteria be developed by calibrating the model's output
with existing available experimental observations, [8]. This CATEv would provide a more generalized,
criterion of injury potential to the head .

NECK
Neck injuries manifest themselves in the automotive crash environment as two distinct pathologies:
mild to severe chronic pain situations originating in either the ligamentous cervical spine or surrounding
musculature induced by some as yet unknown mechanism(s) associated with mild whiplash motions or
as relatively catastrophic injuries associated with mechanical failures of structures within the
ligamentous cervical spine resulting from large stresses and/or strains generated during highly transient
loading conditions ofa crash . Ineither case, it can be argued that the occurrence ofinjurious conditions
should be detectable by either monitoring the local generalized kinematic or kinetic conditions. Current
physical injury detection technologies rely on interpreting the output ofload cells monitoring the forces
and moments applied by a dummy 's neck to its head . Occasionally, this is complimented by monitoring
the forces and moments at the junction ofthe neck with the thoracic spine. Current injury criteria either
limit the individual maximums oftension/compression, shear, and moment observed via these load cells
or they limit the maximum of a function that linearly combines the instantaneous sum of both the
moment and tension/compression force at the occipital condyles as in NHTSA's proposed Nij criterion
[9].

Two circumstances can make this form of neck injury evaluation tenuous. The first is when the neck
experiences large translations and rotations. This causes the tensile and shear forces measured at the
ends ofthe neck to no longer be accurate representations ofthe tension and shear forces at intermediate
locations along the neck . The second circumstance concerns itself with the transmission and generation
of the forces and moments developed by the neck and experienced by the head. That is, there is
mounting evidence that suggests that , in the human, only part of the total moment that a human head
experiences is generated by a moment in the ligamentous spine. The other portion is developed by force
couples generated and transmitted by the surrounding musculature. Therefore, the magnitude of the
moments and forces within a human ligamentous spine may be different than generated by existing
dummy necks .

To address the first situation, it is proposed that the further development and application of a device
called COBRA (Cervical Omni-directional Bending Response Apparatus) be pursued . [10]. This
device, which is similar in concept to the chest band [II], will, when inserted within a dummy's neck ,
monitor and provide via a computer algorithm, the neck 's complete geometric shape for each instant
80 R.H. Eppinger

in time. With this information, the forces and moments measured at the end of the neck can be
accuratel y transformed into any local neck coordinate system. With local forces and moments available,
combined with the rich knowledge oflocal failure conditions derived from testing of functional spinal
units, it is foreseen that a CATE v proc ess would examine the local loading conditions along the length
of the cervical spine and compare them with local failure thresholds to predict the overall injury threat
to the neck.

The rectification of the second problem requires a clearer understanding of the relative contributions
to tot al head moment that the ligamentou s spine and cervical musculatu re make so that the dummy neck
gener ates the correct internal forces and moments . This requires development of new research
strategies that can determine these relative contributions. It would be very beneficial if the y could be
applied to both living subjects , to understand effects of active musculature , and cadaveric spec imens,
to characterize and validate injury threshold s. This knowledge would then beused to update the THOR
[12] Advanced Frontal Dummy' s neck so that it would generate the correct internal forces and
moments . The THOR neck already has the capability to simultaneously generate moment as both
functions of the head 's relative rotation with respect to the top of the neck as well as the base of the
neck. The latter moment is developed by steel cables and springs simulating the effects ofthe cervical
musculature.

Combining the two improvement s, I foresee a biofidelic THOR neck outfitted with both a COBRA
along its length and a load cell at its top . A CATEv algorithm would translate the end conditions sensed
by the load cell into local coordinates of the ligamentous spine and these local loading condit ions
monitor ed for injurious loading levels.

CHEST

Because of the considerable diversity of injury mechanisms among the various thor acic structures and
the considerable difficulty of accurately measuring and characterizing highly transient thoraci c impact
responses, early research efforts developed chest injury criteria using single, simple, measur able
responses, such as peak spinal acceleration or midsternal to spine chest deflect ion, to predi ct, not the
occurrence of any particular injury, but the AIS [13] severity level of the most severe observed injury.
To develop, evaluate, and regulate the efficacy of safety systems, instrumentation to detect and measure
these individual injury informati ve responses was incorporated into existing chests of crash test
dummies. Subsequent cadaveric research using advanced instrumentation techniques has demonstrated
that multiple deflection measurements at various positions on the chest's anter ior surface impro ved the
injury predictive capabilities over the range of expected automotive loading conditions. To date, the
deplo yment and use ofmultiple deflection measurements for injury severity prediction has not seen wide
scale application, however, it has been incorporated in the design of several advanced prototype
dummies including NHTSA's advanced frontal dummy, THOR. In either case, whether using a single
or multiple deflection measurement scheme, the current injury criteria are empirically derived
relationships that use gross mechanical respon se measures as input and not more fundamental variables
such as local stress or strain.

Howe ver, current technologies would allow the development of a CATE v proce ss for predicting the
extent and severity of chest injuries from a more fundamental perspective. It would require a series of
cada veric tests to be condu cted where multiple chest bands record deformation of the thorax and
accelerometers record the gross translational motions of the thorax throughout the impact event. A
modeling process would then create a finite element repre sentation of the thor ax, a so called "slice
model", for each chest band location. The initial shape of each model wo uld conform to the initial
shape of its corresponding chest band and would be deformed and translated in time in the same manner
as the chest band and accelerometers determined the actual cross-sec tion deformed and tran slated in
A Biomechanical P.E.E.E.P. Show 81

time : a true boundary value problem . Maximum calculated local stresses and/or strains generated in
each modeling sequence would then be empirically correlated with the occurrence or non-occurrence
of specific types of observed injuries in the actu al cadaveric tests to develop failure criteria based on
these local, structural responses.

Initial investigations have indicated that it would not be necessary to use complete, time varying
contours from multiple dummy chest bands to implement a thoracic CATEv process. Rather , it has
been demonstrated that three deflection time histories , a mid-sagittal and two para-sagittal deflection-
time histories , applied to a generalize slice model are sufficient to reconstruct reasonably accurate
contours that the chest experiences experimentally . Therefore, a thoracic CATEv process would
function as follows . The three dummy measured deflection time histories and spinal accelerations would
be imposed on a generalized thoracic slice model and resulting local material stresses and strains
analytically determined. These local stresses and/or strains would then be evaluated for their local injury
risk by comparing these quantities with previous empirically established local injury thresholds. The
extent and severity of the overall injury risk would be determined by assessing the percent of the
combined thoracic cross-section that exceeds various selected injury severity thresholds.

LOWER EXTREMITY / ANKLE

Interest in lower extremity injuries comes not from any part icularly high risk to life that they pose, but
from the profound personal and financial consequences they cause to the surviving victim.
Under standing the mechanics of prevalent injury processes is very difficult because of the anatomical
complexity ofthe area. The many bones, ligaments, tendons, and articular surfaces together with the
many possible geometric orientations that they can assume even under normal ranges ofmotions , makes
the prospects ofdeveloping a comprehensive, empirically derived injury criterion extremely slim. What
is proposed is a CATEv process that would take the initially empirically derived injury axial load limit
and adjust it by an analytically derived factor that accounts for the effects of in/eversion and
dorsi/plantar flexion.

A detailed , geometrically and materially accurate finite element model ofthe lower leg, ankle, and foot
capable of determining the local stresses and strains as a function of both the applied tibial axial load
and amount of in/eversion and flexion of the foot with respect to the tibia has been developed [14,15]
to accommodate this process. The model is being calibrated with known experimental observations to
establish critical local stress/strain levels calculated by the model that represent the onset of observed
physical damage . It will then be exercised under a variety of inversion/eversion, dorsi/plant ar flexion
conditions to determine the tibial axial load that generates the same previously determined critical
stresses/strains . An inverse function would then be developed that takes the two values describing the
degree of inversion/eversion and dorsi/plantar flexion and returns what level of tibial axial load would
result in critical stresse s/strains within the tibia/ankle/foot complex .

Implementation of this CATEv process would have the dummy leg measure three things: tibial axial
load, angular time history of inversion/eversion, and the angular time history of dorsi/plantar flexion.
The two angular time histories will be introduced into the inverse function , time step by time step, to
determine the critical tibial load level for each time step . This would then be compared time step by
time step with the measured tibial load and, if the measured load exceeds the calculated tolerable load,
the existence of injurious conditions will be presumed .

CONCLUSIONS

Current biomechanical injury criteria are almost exclusively empirical derived relationships that link
features from time varying experimentally measured mechanical variables with the probability of a
82 R.H. Eppinger

certain AIS injury severity level occurring. The predictive capabilities of these relationships has
improved as the quantity and quality of the available experimental data has improved but, because the
features used are almost universally extracted from gross response measures , it appears unlikely that
many new insights into understanding the fundamental mechanics oflocal injury process will be made .

Finite element modeling technologies, on the other hand, offer by far the greatest potential for ultimately
accuratel y predicting both the impact and injury responses . By virtue ofthe modeling technique's ability
to incorporate arbitrary but specified and varied geometrical and material properties throughout the
entire volume ofthe structure it is simulating, it possesses , when it reaches full maturity, the capability
to determine everything the biomechanics practitioner would want. That is, it will determine where an
injury occurs , when it occurs, and what kind of an injury occurs. To accomplish this, to embed this
level of technical capability and knowledge into a mathematical construct, requires researchers to not
abandon their current gross experimental observational efforts, but to assume,'in addition , macroscopic
and microscopic investigations that will characterize the response and failure of the multitude of
individual structures that comprise the human body.

However, before these ultimate finite element models are fully realized, an interim process, called
Computer Aided Trauma Evaluation, or, CATEv, is envisioned . This process would employ
advanced experimental/empirical instrumentation techniques augmented by robust, currently available,
finite element formulations to predict either the overall or organ specific injury risks. Specifically, the
process would directly apply experimentally observed , time dependent, structural responses to a
corresponding model of the same anatomical region . Injury risk would be determined by interpreting
specific local responses of the model that have been shown to have a high correlation with injury. It
is felt that this process, even if the models used do not incorporate every nuance of structural and
material detail, has greater scientific bases than the current empirical proce sses which rely heavily on
the analyst ability to constru ct and apply appropriate injury predicting features.

Initial approaches for develop ing and implementing CATEv processes in several body region s have been
discussed in some detail. They appear , at least in the eye ofthis researcher, to be realizable and should
offer the prospect for substantial extension and enhancement of existing injury predicting practices. It
remains to see if they actually will.

REFERENCES
[I] E. Hertz, A Note on the Head Injury Criterion (HIC) as a Predictor of Skull Fracture,
Proceeding ofthe Association f or the Advancement ofAutomotive Safety - 1993, Des Plaines,
Il1inois, USA.

[2] F. A. Bandak , Biomechanics of Impact Traumatic Brain Injuries, in Crashworthiness of

Transportation Systems: Structural Impact and Occupant Protection, J. A. Ambrosio . (Eds.).
Kluwer Academic Publishers, 53-93, 1996.

[3] F. A. Bandak, M. J. Vander Vorst, L. M. Stuhmiller, P. F. Mlakar, W . E. Chilton , and 1. H.

Stuhmiller, An imaging-based comp utational and experimental study of skull fracture : finite
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Bandak , M. 1. Vander Vorst , L. M. Stuhmiller, P. F. MIakar, W. E. Chilton, and J. H.
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[4] F. A. Bandak, R. E. Tannous, A. X. Zhang, T. G. Toridis, R. H. Eppinger, and F. DiMasi, lise

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A Biomechanical P.E.E.E.P. Show 83

Traumatic Brain Injury. Advisory Group for Aerospace Research and Development,
Mescalero, New Mexico, pp. 10-1--10-13, 1996.

[5] F.P . DiMasi, Transformation of Nine-Accelerometer Package (NAP) Data for Replicating
Headpart Kinematics and Dynamic Loading, US/DOT Volpe Center Report No. DOT-
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[6] F.P. DiMasi, R.H. Eppinger, and FA Bandak, Computational Analysis of Head Impact
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[7] F.A. Bandak and R.H. Eppinger, A Three-Dimensional Finite Element Analysis ofthe Human
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[8] K. Ono, A. Kikuchi, M . Nakamura, H. Kobayashi, and N. Nakamura, Human Head Tolerance
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[9] Supplementary Notice ofProposed Rulemaking, U.S. Federal Register, Vol. 64, No . 214, Page
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[10] M. Haffner, M. Kleinberger, R.H. Eppinger, B. Hennessey, H. Pritz, and M. Beebe, Progress
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Pylon Fracture, in Biomechanics Research : Experimental and Computational, F. A. Bandak
(Ed .), proceedings of the 26 th International Workshop on Human Subjects for Biomechanical
Research, pp . 107-115, Tempe, Arizona, 1998.

[15] R. Tannous, F. Bandak, T. Toridis, and R. Eppinger, A Three Dimensional Finite Element
Model of the Human Ankle: Development and Preliminary Application to Axial Impulsive
Loading, Proceedings of the 40 th STAPP Car Crash Conference, pp. 219-238, 1996.
The Development of Chest Protection
Xavier Trosseille l , Jean-Yves Foret-Bruno I , Eric Song' and Pascal Baudrit 2

I LAB PSA Peugeot Citroen - Renault, 132 rue des Suisses, F92000 Nanterre, France
2CEESAR, 132 rue des Suisses, F92000 Nanterre, France

Summary: Extensive car accident investigations provide a lot of guidelines for car safety
development. In particular, the analysis of belt load limitation devices improve the knowledge of
chest tolerances and allows the increase of occupant protection. Nevertheless, new devices are
sometimes out of the range of crash investigations and are no more in the field of real world
feedback. As a consequence, advanced tools such as enhanced dummies and human body models
are used to evaluate devices efficiency.

This paper describes the methodology used to investigate chest tolerance to belt loading. Results
from the analysis of 256 crash investigations are given and specifications for the development of
restraint systems are proposed.

Then, dummy and human body models are described and the main validation references are
provided. Afterward, technical solutions designed to fulfill specifications are evaluated on the one
hand with the dummy model and on the other hand with the human body model. Results are
analyzed and conclusions about the protection are drawn.

Finally, first crash investigation results with new restraint devices are described and an evaluation
of the design process is proposed.

Key words : Chest protection, Accident investigation, Shoulder belt, Airbag, Numerical model

INTRODUCTION

Crash investigation is a good way to check the efficiency of safety countermeasures applied by car
manufacturers. In the field of shoulder-belt performances, biomechanical studies show that load
limitation is benefic . This was applied in French cars first between 1970 and 1976, and since 1995.
Crash analysis of these cars then allowed to check the efficiency of the 6 kN limitation, and, as a
consequence, to check the resistance of living car occupants in comparison to cadavers.
Consequently, the extensive set of data gave the opportunity to provide injury risk curves as a
function of age range.

The analysis of these results and the evolution of airbag technology has leaded to the decrease of
the belt critical load associated with pressure limited airbags. Unfortunately, the load sharing
between airbag and belt can not be determined from field data. That is the reason why advanced
tool and criteria are necessary to investigate new combinations of restraint systems. Dummy is a
fondamental tool to design systems, but it requires new approaches in order to evaluate new
solutions. The belt and bag combination illustrates the need of a new analysis to take into
consideration the effect of the loading area on the chest. The numerical human body model can
answer this question, but, as of today, cannot replace the dummy. The complementar use of the two
tools can give practical solutions to investigate new restraining systems.

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 85
86 X. Trosseille et al.

CRASH INVESTIGATION - METHODS AND RESULTS

Historically, the relationship between seat-belt tension and the associated thoracic injury risk was
first established in 1978 by Foret-Bruno et al. [1]. It was based on 90 accident cases. The vehicles
examined, were sold in France in the 1970's, and were equipped with front seat 3-point static belts
including load limiters located in the belt webbing between the occupant's shoulder and the upper
anchorage point. The load limitation was based on the tearing of the stitching used to sew loops in
the webbing. During the crash the stitching tore, increasing the webbing from the loop.; As a
consequence, the thorax was allowed to move foreward under a controlled load level.

In 1989, new cases were added to the 1978 sample resulting in a database of 290 vehicles [2]. A
relationship between the lesions sustained and the seat-belt tension exerted on the occupant, and his
(or her) age could be determined from this database.

Since 1995, Renault cars have been one more time equipped with a load limiter based on a different
technological concept. The PRS 1 (Programmed Restraint System, first generation) was
implemented at the retractor level. An accident investigation program was set up throughout France
in order to evaluate this restraint system in real-world accidents as a function of occupant exposure.
It must be noted that the frontal impacts analyzed in this study were much more severe than in the
previous sample with textile limiters. Indeed, the mean of the delta-V was approximately 55 km/h,
compared to 40 km/h.

Further analysis of the thoracic risk was proposed by Foret Bruno [3] from a still enlarged
database. The accident with PRS 1 and with textile load limiters were combined, resulting in a total
of 256 cases. This analysis and results are presented below.

Force measured as a function of the PRS deployment : In most of the cases examined, the PRS
plateau forces ranged between 5 and 6 leN. However, a plateau force of 7.5 leN was reached for
coupes and convertibles. Note that this type of car represents only 5% of the sample. Prior the
plateau force is reached, the force increase measured in laboratory tests was observed to be of
variable slope from one PRS to another. At 30 rom of deployment, it can be considered that the
plateau force is reached and the deployment force remains stable until the thrust stop is reached
(after 260 rom). In real-world accidents, the thrust stop reach was a very rare occurrence.

Numerous dynamic and static tests performed in laboratory have enabled to established a
relationship between the PRS permanent deployment measured statically on a accidented cars and
the shoulder load sustained by the occupant during the crash. In the field data, 80% of the limiters
reached the plateau force. Among them, 13 showed deployments greater than 100 rom. It must be
emphasized that the greater the deployment of the limiter, the greater the force sustained without
this limiter would have been.

Risk analysis with all load limiters: In order to obtain a larger sample, cases with PRS and cases
with textile load limiters for which the exact force at the shoulder level was known were gathered
altogether . For this purpose, all the suspicious cases were eliminated. Suspicious cases were those
in which no strand of the limiter was tom or in which an occupant sustained thoracic injuries of AIS
2+ (likely to occur at a far greater force applied than the force at which the last strand failed)
although all the strands of the limiter were tom.

This new sample was finally composed of 256 occupants for which AIS 2+ and AIS 3+ thoracic
risk probability curves were plotted, first for all ages together (Figure 3) and then as a function of
the age range (figures 4 and 5). In this larger sample, the average age was 37 and the standard
deviation was 15 years. The age distribution was similar to that of front seat occupants from the
Th e Development of Chest Prot ection 87

French accident file. The results of regressions giving the AIS2+ or AIS3+ probabily of AIS2+ or
AIS3+ were as following :

Proba (AIS2+)=1 / ( 1 + exp (18.3, age / 6.2, F shoulder / 0.573»

Proba (AIS3+)= 1 / ( 1 + exp (19.9 · age I 5.9', F shoulder / 0.557»

.
Thorac ic Injury Risk Curves

, 256 Cases
.! .• .
....
B :' "
0.9
0.8
../

.. •
0.7 · ·A IS2.
0.6 - AI"'-'" /
0.5 /
0.4
0.3
0.2
0.1
•
./
~

..... r'"
o
o 3 4 5 6 9 10
F Shoulder (kN)

Fig. 1. Probabilities of AIS2+ and AIS3+ risks as a function of belt

tension at the shoulder for the 256 cases.

Thorac ic Injury Risk Curve (AIS2+)

256 Cases

,
A go
1
0,9
0,6
~: 7'7 - - 20

0,7
/ J' x r / / - - 30
/ / / / ? 40
0,6
/ X /
,.
..
0,5 - - 50
0,4
0,3
/
7
./ -1 /
.I
/ * - -so
? /" / I .I - - 70
0,2
/" ../ .t'
-- -= _G..
0,1 --+- 60
.--.r JW' .AI'

°° 2 4 6 6 10
F Shou lder (kN)

Fig. 2. Probabilities of AIS2+ risk as a function of belt tension at the

shoulder depending on the age groups for the 256 cases.

Thoracic Injury Risk Curve (A1S3+)

256 Cases

,
Age
1 .,- k' A- ~
0.9
f" .r - - 20
0,6
0.7
/ ./ ';( r / 30
40
0,6
I j
"
/
1< ll- 50
r -,I-
0,5 -tl- 60
0,4
! /
I .J - - 70
0,3 --+-60
.I
....... •-' ~~' "
/' / /
0.2
/ .JI. /' ___ J .AI" V
0.1
o ~ ':-:.". ,. .\-J_

o 2 6 10

Fig. 3. Probabilities of AIS3+ risk as a function of belt tension at the

shoulder depending on the age groups for the 256 cases.
88 X. Trosseille et al.

The need for a further belt load reduction: In order to pass offset tests, the car structures have to
be stiffer and stiffer, especially in Europe. Moreover, the car-to-car compatibility criteria requires to
still increase the stiffness of small size cars . As a consequence, the belt load limitation appears to be
necessary in the balance of the occupant injury risks related to intrusion and deceleration.

The results presented above clearly show that a 6 kN belt load limitation threshold is not sufficient
to prevent a risk of serious thoracic injury . It is therefore necessary to go further in the shoulder belt
load reduction. Since the shoulder belt load reduction results in an increase of the head and thorax
excursions, the inclusion of a pretensioner and , of course, an airbag in the restraint system becomes
of major importance. The combination of an airbag and a 3-point belt restraint has been extensively
discussed in the litterature and summarized by Foret Bruno [l] . A threshold of 4 kN for the shoulder
belt load limitation appears to be suitable to reduce the risk of thoracic injury without negative
consequences on other injury measurements.

The population protected by a 4 kN belt load limitation is very broad. Indeed, occupants over-80's
(which are not protected by at this level of force limitation) represent only 1.4% of those involved,
1.8% of severe injuries and 4.2% of fatalities (Table 1). One can also see all the benefits of
reducing the force level from 6 kN to 4 kN, given the number of occupants involved aged over 50,
who account for 21.8% and 30.8% of fatalities .

Table 1. Distribution of front-seat occupants according to the age and

injury severity (France, 1996).
Age INVOLVED SERIOUSLY FATALITIES
INJURED
<30 years 40.3 41.7 35.7
31 to 40 21.1 18.8 17.9
41 to 50 16.8 15.3 15.6
51 to 60 9.9 9.7 10.3
61 to 70 6.7 7.6 8.9
71 to 80 3.8 5.1 7.4
>80 1.4 1.8 4.2
TOTAL 100 100 100

DUMMY AND HUMAN MODEL

Description and validation: The human body model used by the authors was previously presented
at the Stapp Car Crash Conference in 1998 by Lizee et al. [4]. It is a multi-directional 3D finite
elements model, the neck, shoulder, thorax, abdomen and pelvis of which are modeled using
deformable elements. All the others parts are rigid bodies. This model was validated against more
than one hundred biomechanical corridors covering frontal, lateral and oblique impact conditions
for different severities. Figure 1 shows the deformable skeleton parts of this model.

The Hybrid III finite element model (figure 2) used in the study was developed within the
framework of an European project, involving European car manufacturers, academic and industrial
partners [5]. Each segment was validated aga inst certification tests . An overall validation of the
dummy model was performed against a series of sled tests specifically carried out for this purpose.
The Development of Chest Protection 89

Fig. 4. Oblique view of skeleton (human body) Fig. 5. Oblique view of skeleton (HIlI dummy)

Model results. The two models were used to evaluate the influence of the load limitation and the
combination of airbag. The restraint system characteristics and pulse, as well as the main results of
this evaluation were presented the Stapp Car Crash Conference in 1999 by Baudrit [6]. The main
conclusion of Baudrit et al. was that the HIlI model and the Human body model gave comparable
trends as a function of belt load limitation threshold, pretension force and airbag pressure. For
example, Figure 6 shows the effect of shoulder belt load limitation on thoracic deflection, and
Figure 7 shows the effect of the in-bag pressure (measured when the vents start venting) on thoracic
deflection. These 2 graphs also show a lower sensitivity of the HIlI .

80 70
E 70 E 60
E .§.
';;' 60 c 50
.g 50 .!!

~ 1l
~
40
~ 40
OJ HI 'ii 30 - C HI
'tI 30 'tI
U u
"2 20 U 20
e
0 10 0 10
&;
~ 0 I-
0
41<N 61<N 8 1<N 320 rrbar 430 rroar 560 rmar

Fig. 6. Effect of limited shoulder belt load on the Fig. 7. Effect of pressure on the thoracic
thoracic deflection deflection

Although the HIlI model and cadaver model general trends were found to be similar, the response
differences sometimes lead to different conclusions. In particular, the final limiter deployment
lengths were not equal in the two model (Figure 8). As a consequence, the design of load limitation
devices could be different.
t
All these differences (sensitivity, loading of restraining system... ) can explain that HIli will not
demonstrate the efficiency of some technical solutions which are benefic for human being in real-
90 x. Trosseille et al.

world accidents. For instance, the HIlI model did not show any decrease in the thoracic deflection
when comparing a 6 kN shoulder belt load limitation to a combination of 4 kN belt load limitation
with airbag (Figure 9). On the contrary, the Human body model shows that with some chosen
parameters, this combination can be efficient (4 kN with airbag B). It must be noted that in this
case, the thorax displacement was close to the 6 kN situation.

500 E 70 -l
E .§. 60
.§. 400 - c

g
.<: 50
~
g> 300 I
.!!
~ 200 - EI I-ID
~
Qj
40
30 ·
I IOHBI
: ~H III
'C
~ u
U
20
"5 100
..
co 10
li 0
s:
:::l 0 t-
0
4 kN 6kN 8kN
6'. u.~ . . 111'1 HN w.tl'l .. kN . ,. " HN lu i .
' ItlllljJ A l u b.g B littllg C I IIIDIIjI 0

Fig. 8. Load limiter length versus load limiter Fig. 9. Effect of belt and airbag on the thoracic
value in the shoulder belt deflection

NEW ACCIDENT INVESTIGATION

Since 1998, French cars have been equipped with 4 kN belt load limitation device and an airbag
specially designed to absorb the remaining energy due to the decrease of the shoulder belt load from
6kN to 4kN. A spotted accident investigation study was then set up in France to analyze the
efficiency of this new restraint system. As of today, 42 cases were collected and can be compared to
cases with 6kN load limiter or with no limiter.

Table 2 gives the distribution of cases versus AIS for accidents with EES higher than 35 km/h

Table 2. Distribution of cases for EES>35km/h

Load Number of AISO-l AIS2 AIS2+ AIS3+ AIS4+
limitation cases
Without Data 224 135 55 89 34 13
% 60,3 24,6 39,7 15,2 5,8
6kN Data 113 75 24 38 14 4
% 66,4 21,2 33,6 12,4 3,5
4kN with Data 42 30 11 12 1 0
airbag
% 71,4 26,2 28,6 2,3 0

These cases clearly show the efficiency of the purpose designed restraint system, and confirms the
trends given by the Human body model. Table 3 gives the benefits that can be expected with such
combination of belt and bag.

Table 3. Potential benefits of 4kN belt load limitation with purpose designed airbag
Load limitation AIS2+ AIS3+ AIS4+
6kN 15% 18% 39%
4kN + airbag 30% 85% (100%)
The Development of Chest Protection 91

SUMMARY AND CONCLUSIONS

Since the shoulder belt load limiters were introduced in French cars , specific accident investigation
studies were set up to evaluate the efficiency of this new technology. These studies have shown that
6 kN limitation was a sensible improvement in the field of chest protection, but also that this
threshold was still too high to protect people below 50 years . They also resulted in new injury risk
curves for the chest as a function of age and shoulder belt load . These curves show that a 4kN
limitation is a significant improvement for most of the people.

Nevertheless, no information was available concerning the effect of an airbag combination which
was necessary to limit the excursion and dissipate the remaining energy. For this configuration, if
the Hlll didn't demonstrate any improvement in regard to the 6 kN limitation, the Human body
model has shown a decrease of chest deflection with chosen airbag characteristics. It is clear at this
point, that the Human body model is not consistant or validated at a level that allows to take the
conclusions without caution, and is far from being a regulation tool. Nevertheless, it can give some
orientations and explain some behav ior that can help the design of technical solutions.

The last step in the validation process of new devices is to evaluate the efficiency in the real word.
This work is currently in progress with accident investigations dealing with cases involving 4 kN
belt load limiter and a combination of airbag. The first results show a very good tendency in the
chest injury reduction.

REFERENCES

[1] Foret-Bruno J.Y ., Trosseille X., Le Coz J.Y ., Bendjellal E , Steyer C., Phalempin T .,
Villeforceix D., Dandres P., Got c., "Thoracic Injury Risk in Frontal Car Crashes with
Occupant Restrained with Belt Load Limiter", Proceedings of the 42th Stapp Car Crash
Conference, 1998 Paper n° 983166.

[2] Foret Bruno lY., Hartemann E, Thomas C., Fayon A., Tarriere C., Got C., Patel A.,
« Correlation Between Thoracic Lesions and Force Values Measured at Shoulder of 92
Belted Occupants Involved in Real Accidents », Proceedings of Stapp Car Crash Conference,
USA, 1978, SAE Paper No.780892.

[3] J.Y Foret-Bruno, E Brun-Cassan, C. Brigout, C. Tarriere : « Thoracic Deflection of Hybrid

III: Dummy Responses for Simulation of Real Accidents » , Proceedings of the 12th
International Technical Conference on Experimental Safety Veh icles . Goteborg, Sweden,
May 1989.

[4] Lizee E, Robin S. and al, Besnault B. and al., "Development of a 3D Finite Element Model of
the Human Body ", Proceedings of the 42th Stapp Car Crash Conference, 1998 Paper n°
983152 .

[5] European BRITE DUMOCS Project, Final report on Fine HIlI dummy model, version I I) ,
1995

[6] Baudrit P., Hamon J., Song E ., Robin S., Le Coz J.Y., "Comparative studies of Dummy and
Human Body Models Behavior in Frontal and Lateral impact Conditions", Proceedings of
the 43th Stapp Car Crash Conference, 1999 Paper n° 99SC05.
The Activities and Research Projects of the Ministry of
Transport and Traffic Safety & Nuisance Research Institute
Yoshihiro Nanto

Traffic Safety and Nuisance Research Institute, 6-38-1 , Shinkawa, Mitaka , Tokyo 181-0004,
Japan

Summary: The traffic accident situation in Japan is still serious. The recommendations of the
Council for Transport Technology set a numerical target of reducing fatalities by 1,200 by or
before 2010 . To reach this target, research projects, improvement of the safety regulations and
vehicle assessments have to be carried out. The international harmonization of the regulations
and research activities are also covered. The Ministry of Transport has been conducting the New
Car Assessment Program since 1995 and has contributed to the improvement of the
crashworthiness of vehicles. The Traffic Safety and Nuisance Research Institute , the test research
facilities which support transport administration, conducts research and tests related to the safety
and antipollution of air transport, railways, and automobiles, and also carries out Type Approval
Tests for automobiles. For vehicle crash safety, the research projects for vehicle compatibility
and pedestrian protection are conducted.

Key words: Safety regulation, International harmonization, Research projects , Type approval
test

INTRODUCTION
Ensuring safety is the basis of traffic administration, and the promotion of a policy for ensuring
safety is one of the most important subjects for the Ministry of Transport. To ensure the safety of
vehicles, the Ministry of Transport has established a safety regulation for vehicles and has
undertaken international harmonization activities. The Ministry of Transport plans to further
promote measures for reducing the number of victims in collisions. The Traffic Safety and
Nuisance Research Institute (TSNRI) performs research and examinations concerned with traffic
administration as a research institute of the Ministry of Transport. In this report, the activities of
the Ministry of Transport and the TSNRI relating to crash safety will be introduced.

SAFETY STRATEGY OF THE MINISTRY OF TRANSPORT

Situation surrounding vehicle traffic

Increase in vehicle traffic has greatly contributed to the economic prosperity of our country, such
as regional expansion and speed-up of economic activities, but has induced serious problems
with traffic accidents. Because vehicles are indispensable for the activities of society, a matured
vehicle society which is safe and harmonized with the environment is desired .

Under these circumstances with the recognition that ensuring the safety of people is the supreme
proposition of the government, various safety measures have been undertaken by the Ministries
and other governmental organizations related to vehicle traffic. The Ministry of Transport has
promoted a variety of safety measures such as expansion and strengthening of the safety
regulations which affect the structure of vehicles. The change in the number of traffic accidents
is shown in Fig. 1. The number of deaths caused by road traffic accidents has shown a tendency

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 93
94 Y. Nanto

to decrease during these several years due to the effect of various measures which have been
taken so far. On the other hand, the number of traffic accidents has continued to increase since
1978, and exceeded 800,000 cases in 1998. The number of accidents will increase as the number
of vehicles and elderly people increase in the future . Safety measures for prevention of accidents
are being taken, in addition to measures to further decrease the number of deaths .

1.2
N=803878
l.l

1.0 N=990675
Accidents

.
.s
'"
0.9

0.8

0.7 / .
0.6 .... Fatalities N=9211

0.5
70 75 80 85 90 95 98
Year

Fig. 1. Numberof traffic accidents, injuries and fatalities in Japan, using police data.

Vehicle safety measures

Injury prevention in accidents

There are two aspects of vehicle safety measures - one is measures for preventing accidents and
the other is measures for mitigating injuries in accidents. Of these, the measures for reducing
injuries in accidents include safety measures inside the vehicles for the protection of the
occupants and safety measures outside the vehicles for the protection of pedestrians. The
Ministry of Transport has obligated vehicle manufacturers to provide vehicles with seat belts, to
improve the integrity of the passenger compartment, and to provide safety glass windscreen as
safety measures for the protection of vehicle occupants. As safety measures for the protection of
pedestrians, the Ministry has forced vehicle manufacturers to exclude exterior projections from
vehicles and to provide folding type rear view mirrors .

Regulations for vehicle occupant protection in collisions

In view of the remarks in the Traffic Technology Council Report of 1992 on the necessity of
regulations based on car crash tests to evaluate the crashworthiness of vehicles, vehicles have
been obligated to provide for occupant protection during frontal collision since April, 1994. The
increasing tendency of the number of fatalities of vehicle occupants due to traffic accidents while
the Traffic Technology Council was undertaking the study, especially the steep increase in the
number of fatalities after 1988, motivated the enactment of the regulations. After being
introduced for passenger cars in April 1994, the frontal impact regulation also became applicable
to small trucks in July 1997. The side impact regulation was introduced for passenger cars and
small trucks in October 1998. The crashworthiness of vehicles has improved greatly in the past
several years.

The effects of the regulation for vehicle occupant protection in collisions

The effects of the introduction of the vehicle occupant protection regulation in collisions are
manifested by the fact that the annual number of deaths due to vehicle accidents has begun to
Activities of the Japanese Ministry of Transport 95

decrease since 1994. The results of calculations done by the Ministry of Transport and Vehicle
Traffic Bureau indicated that after introduction of the frontal impact regulation for passenger cars
in 1994, the number of fatalities has been reduced by 130 in 1997 and is estimated to be reduced
by as many as 350 per year as vehicles satisfying the regulation increase in the future. Taking
into account the effects which may be brought about by the expansion of the frontal impact
regulation to small trucks and the introduction of a side impact regulation , the number of
fatalities of vehicle occupants is expected to continue to decrease in the future.

Injury prevention strategies in the future U]

Promotion of crash safety

In June 1999, the Council for Transport Technology has worked out the final recommendation
relating to the inquiry by the Minister of Transport about "Future road transport measures
focused on safety and environmental protection." In addition to the decreasing tendency of the
number of traffic accident fatalities, the recommendation sets a target of reducing the annual
fatalities (death within 30 days) by 600 in 2005 and by 1,200 in 2010, taking into account the
increase in crash prevention measures as future technology progresses, the estimated effect of
injury prevention measures, and accident conditions in various foreign countries . The report
refers to promotion of projects such as advanced safety vehicles (ASV) and establishment of
technical guidelines and safety regulations in the chapter of development of safer vehicles and
devices. Given as specific subjects of safety regulations to be studied are measures for securing
compatibility encountered when reducing the aggressiveness of large passenger vehicles such as
utility vehicles and improving self-protection of small vehicles, development of intelligent air
bags, protection of pedestrians by an impact absorbing structure of vehicles, and the like.

Research and study

From the viewpoint of improving safety, the Ministry of Transport is undertaking research on the
subjects of expansion and strengthening of the safety regulations of vehicle occupants in frontal
and side collisions, protection of pedestrians, drive recorders, and aggressiveness of air bags.
Conformity with the safety regulation for safety in frontal collisions is evaluated by the full
frontal impact. Because actual accidents take a variety of crash configurations, the investigations
are carried out for various forms of impact such as the offset frontal crash test. Research on side
collision safety is directed to the evaluation of the safety of occupants in non-stuck side and rear
seats, for which an evaluation method has not yet been established. Research for the injury
mechanism and threshold for the pedestrian is carried out by a component test for reproducing
deformation of vehicles in accidents using impactors simulating a pedestrian's body. Drive
recorders are investigated to clarify the required performance of equipment to be loaded on
vehicles to collect data on the vehicle behavior in an accident. Air bag aggressiveness is
investigated by in-depth accident analysis for airbag deployment, injured body regions and injury
types. From the viewpoint of securing international harmonization, the regulations and test
procedures are compared with those in Europe and America.

The Ministry of Transport has been promoting the development of the advanced safety vehicle
(ASV). The ASV project involves research on the next-generation of intelligent vehicles using
electronic technologies to avoid accidents and mitigate injuries . ASV is a platform of the
Intelligent Transport System. In the first phase of ASV (FY 1991-1995), the basic technologies
were developed and some of them were applied to practical use. At present, the second phase of
ASV continues (5-year plan from FY 1996) and it will encompass the examination of new
element system technology, establishment of human-interface principles, harmonization and
integration of Vehicle/Driver systems and infrastructures for passenger cars, trucks and buses.
96 Y. Nanto

International harmonization

Activities of the Ministry of Transport for ensuring international harmonization

Harmonizing the regulations will not only promote distribution of vehicles which are
international commodities that may contribute to the solution of international frictions, but also
will help secure safety that environmental protection. As a result of an investigation of the
organizations in which countries can discuss international harmonization of the regulations, the
Ministry of Transport found that UN ECE/WP29 (the United Nations/Economic Commission for
Europe/The Working Party on the Construction of Vehicles) was the most appropriate existing
organization and that other countries such as the US and Australia are in a position to utilize the
ECE/WP29 as an organization to discuss the harmonization of the regulations . Based on this
confirmation, the Ministry of Transport attended the ECE/WP29 as an observer and joined to
work for harmonization .

The UN 1958 Agreement on the Mutual Recognition System for Motor Vehicles has been
amended to globalize the ECE/WP29 . Since 1989, the Ministry has taken part in the work for the
amendment to reflect its opinion in cooperation with the US. As the amendment was finalized in
1995, Japan accepted and joined the UN 1958 Agreement in November 1998 as the first
non-European country member. The laws in Japan have also been amended . In 1998, five items
from the ECE regulations were adopted, and about 30 items are contemplated to be additionally
adopted in five years. This will forward mutual acceptance of the certifications among the
agreement member countries .

The US did not join the agreement, but proposed a Global Agreement (the UN 1998 Agreement
on Global Technical Regulat ions for Wheeled Vehicles) for the promotion of international
harmonization of the regulation in the WP29. The proposal was discussed among the US, the EU,
Japan , and agreed among WP 29 member countries in 1998. At present, the US, Canada and
Japan have finished the procedure for joining the agreement, and France and the EU decided to
accept. The agreement will come into effect when three more nations join . The operational rules
have also been amended based on the proposal by Japan to operate the globalized WP29 in a
more suitable manner. The amendment is scheduled to come into force concurrently with the
global agreement, upon which the WP29 will be renamed The World Forum for Harmonization
of Vehicle Regulations . The Ministry of Transport will promote international harmonization of
the regulations and mutual recognition system for vehicles in these international frameworks .

Promotion of international harmon ized research activities

To smoothly advance harmoniz ation of the standards, it is important for the related countries to
cooperate for the establishment of a systematic test method by exchanging information from an
early stage of studying the test methods and the like which affect the regulations and by setting
up an international cooperation system such as share of research necessary for determining the
test methods and the like.

Based on the proposal by the US National Highway Traffic Safety Administrations (NHTSA) in
the 1996 ESV, the International Harmonized Research Activities (IHRA) has established six
working groups, which are the advanced frontal impact group, compatibility group, side impact
group, pedestrian protection group, biomechanics group, and ITS group. Japan is the leading
country for the pedestrian protection group, wherein the test methods relating to pedestrian
protection are investigated. Japan is also actively working for the harmonization of the test
methods and the like by sharing information such as accident analyses, enquiry, experiments of
the other working groups, providing the results, and actively taking part in the research . These
Activities of the Japanese Ministry of Transport 97

results will contribute to the intern ation al harmonization of vehicle safety regulat ions in the
future . The Ministry of Transport is willing to activel y contribute to these new cooperative item s.

New car assessment program (NeAP)

History

Although the vehicles sold in the domestic market conform to the safet y regulations, there are
differences among the vehicles in the degree of equ ipment of various safet y de vice s and safet y
performance. Therefore, the Mini str y of Transport performs tests under conditions more severe
than the regulations, summarizes the results for each type of vehicle based on a fair and neutral
standpoint, and provides the information to vehicle users. It is expected that this ma y not onl y
stimulate wide acceptance of safer vehicles through user selection, but also accelerate
technological development by vehicle manufacturers. Publication of vehicle safety information
was initiated from Fiscal Year (FY) 1995 , and up to FY 1998 front al imp act tests, brake test
results, and safety equipment information for 49 types of vehicles have bee n published.

Frontal impact test

From the viewpoint of reproducibility, distinction, and utility, the full frontal impact test was
adopted to achieve reduction of fatalities and serious injuries in colli sion s. In order to clarify the
difference of the safet y performance of each vehicle model, the test is conducted under more
seve re conditions (impact velocity: 55 km/h) than the safety regulations. The injur y risks to the
occupants are evaluated in six ranks based on the Head Injury Criteria (HIC) and the chest
acceleration (3 ms-G) which are strongly related to death. The trends in the injur y risk ratings of
the driver and front passenger are shown in Fig. 2. Notabl y, in the FY 1997 and 1998 evaluations,
all vehicles received the rating "A" or bette r, i.e, below the injury thresholds even at an impact
speed of 55 km/h . Furthermore, in the FY 1998 eva luation, a significant number of ve hicles
evaluated were given the high est possible rating of "AAA". It is evident from these observations
that the injur y risk ratings in gene ral have been on an improving trend, which is particularly
notable for the front passenger.

100 100 r-r--.-- - - r - , -- == - - .,-.,,---,

~
c
.~

~ 010
is 20

0 o
I99S 1 ~6 1997 1998 1995 1996 1997 1998
Fiscal year Fiscal year

(a) Driver (b) Front passenger

Fig. 2 Trend in driver injury risk ratings.

Future Plan

To provide car users with mor e extensiv e and useful information in the future, safety evalu ation
will be carried out by increasing comparative test items . To this end, side impact test will be
int roduced, and research on offset front al crash and overall eva luatio n will be initiated from
1999 .
98 Y. Nanto

Side impact test - Domestic data on accidents involving fatalities in vehicles indicates that about
24% of accidents were caused by collisions against the side of vehicles. The side impact test has
been performed since FY 1999 to deal with these accidents. The test method is based on the
preservation of order and regulations. In order to increase the coverage of accidents and make a
clear difference by vehicle types, an impact velocity of 55 krn/h, which is 5 km/h higher than the
safety regulation, was adopted.

Offset frontal impact test - Analysis on the real-world accidents in Japan indicates frequent
occurrence of offset frontal collisions. Because of this , offset impact tests will be carried out to
study the test procedure and the evaluation methods. The evaluation by this offset frontal impact
test is scheduled to begin in FY 2000.

Overall evaluation - To make the results of the vehicle safety information available to as many
automobile users as possible, it is necessary to show the users a synthetic evaluation based on
more than one configuration of crash test. For this reason, a method for overall evaluation which
reflects real-world accidents is being studied based on the results of three crash tests : full frontal ,
offset frontal and side impact tests .

RESEARCH AND TYPE APPROVAL TESTS OF THE CRASH SAFETY

AT TSNRI
As a research institute of the Ministry of Transport, the Traffic Safety and Nuisance Research
Institute performs the functions of securing safety of railroads, land transportation by vehicles,
and aviation; research and examination of environmental pollution prevention; and type approval
tests of automobiles. Of these functions, research and automobile type approval tests for crash
safety will be described.

Research on crash safety

Because there are many vehicles of various different sizes in the country, securing compatibility
among these vehicles in colli sions is an important subject. In addition, because the presence of
dead pedestrians is about 28% of the total number of fatalities in traffic accidents in Japan,
protection of pedestrians is also an important subject. For this reason , the TSNRI is undertaking
projects concerning the compatibilit y (a three year project started in FY 1999) and protection of
pedestrians (started in FY 1996). The results of these studies have been reported also to the
IHRA.

Compatibility

Protection of vehicle occupants of all vehicles involved in collisions must be considered in

vehicle-to-vehicle collisions (compatibility). The percentage of passenger cars is the highest
among registered automobiles. Therefore, the compatibility of this type of vehicle is most
important. To further investigate compatibility among passenger cars , they were grouped into
mini cars , sedan s, mini vans, and SUVs (Table 1). Table 1 shows the ratio and number of drivers
who were seriously or fatall y injured in each type of vehicle during a vehicle-to-vehicle frontal
collision. Because of the ratio and number of injuries, the poor self-protection of mini cars (or
aggressiveness of other vehicles with respect to mini cars) is the most important problem of the
compatibility in Japan.
Activities of the Japanese Ministry of Transport 99

Table 1. Ratio and number of drivers who were injured seriously in vehicle-to-vehicle frontal collisions
(Police data: 1993-1996). • The parenthesized numbers indicate the number of injured drivers.

Colli sion artner All drivers Belted drivers

Mini car vs, Sedan
1:0.2 1:0.2
~ (553:104) (328:61)
Sedan vs. Sedan
1:1 1:1
~ (1938:1938) 1084:1084
Mini van vs. Sedan
1:1.6 1:1.3
-.~ (117:189) (73:95)
SUV vs. Sedan
1:4.1 1:4.1
,~ (35:142) (20:81)

A test method must be established to evaluate compatibility performance. The evaluation test
method will be explained here using a moving deformable barrier (MDB) as the colliding vehicle
as an average car. The results of the MDB test using small cars were compared with the results of
the full and offset frontal cra sh tests which are typical test methods employed in many countries.
HYBRID III was seated in the driver's position equipped with an air bag and seat belt. The
impact velocities in the full frontal rigid barrier, offset deformable barri er (ODB), and MDB
crash were 55 km/h, 64 krn/h , and 112 km/h, respectivel y. All these velocities are based on the
presumption in a frontal collision of two vehicles each running at 55 km/h.

The ratios of the injury parameters of the dri ver's of min i car s are shown in Fig . 4. Two
parameters cau sing injury, i.e, the vehicle acceleration and the intrusion into the passenger
compartment, should be ev alu ated for compatibility. Because MDB crash tests result in a high
acceleration and a large intru sion , the injury parameters relating to both of these parameters are
large. Since the compatibility test should est imate injury risks due to accele ration and intrusion
of small cars , compatibility could be evalu ated by the MDB test. There are problems of
overriding and bottoming-out of MDB in this test, so that there are som e problems to be
investigated. On the other hand , for the evaluat ion of compatibilit y there is a test method in
which veh icles are collided aga inst a fixed deformable barrier at two different colli sion speeds to
evaluate the absorbing energy characteristic s and the str ength of the passenger compartment.
This test method will also be studied in the futur e.

1I1km."

't-IBIJ
Full rigid barrie r crash test ODS crash test MDB crash lest

Fig. 3. Crash tests.

100 Y. Nanto

...
b.3 5.5
-.

o Full rigid barrier c ra~h

.g O ODll cra, h
.>1
• MDiI cra,h

0
t;'
~ ~
~

~ u
E
a
..;: .s ]
.... .::
E~
~ ~
"
~ :c
~ ~

.., ~
:0
1= 1=
I.J

Fig. 4. Injury parameters to the driver.

Pedestrian protection

The head is the most important human body region to be protected, because when injured in
traffic accidents this is the part causing death of pedestrians most frequently. The impact test of
EU (Draft) and ISO (TC22/SClO/WG2) are proposed for evaluating protection performance of
the pedestrian's head. This method comprises causing a headform to impact against only the
bonnet top and measuring the HIe. However, recent vehicles have different front configurations
(e.g. a short hood length , wedged shape, etc .) from vehicles which wer e popular when these test
methods were discussed for the first time. For this reason , a pedestrian's head, which used to
contact most frequently with the bonnet-top, now impacts more frequently against the rear part
of the vehicl e such as the windshield and A pillar. Therefore, in this study a headform impact
tests were performed for the wind shield using the same model of small passenger car as shown
in Fig. 5.

The experimental results showed that the HIC was particularly high when the headform impactor
collided against the hood hinge and A pilla r. The contour of the windshield was determined on
the basis of the experimental results and is shown in Fig . 6. The HIC has a low value in the
central part of the windshield, but exhibits a high value at the windshield frame , particularly near
the comers. Therefore, the wind shield frame should be impacted when the wind shield is included
in pedestrian protection tests . Pedestrian protection research will be continued on the subjects of
legform impact test , child protection, and bicycle acciden ts.

Fig. 5. Headform impact test. Impact velocity is 40 krn/h at an angle of 65 degrees.

Activities of the Japanese Ministry of Transport 101

sL
5

-IOOmm

Fig. 6. The HIe districution in the windshield area based on the headform impacttests (40 kmlh).

An automobile type approval test for occupant protection

The institute performs a full frontal impact test (50 km/h), side impact test (50 krn/h), steering
impact test, head restraint test, and seatback impact absorption test as automobile type approval
tests for occupant protection in new vehicle models. In addition, various impact tests such as a
child restraint test are carried out for tests of the motor vehicle equipment type designation .

Frontal and side impact tests

A crash test facility completed in the motor vehicle proving ground of the Traffic Safety and
Nuisance Research Institute in 1996 is used to test the vehicle occupant protection for passenger
cars with a riding capacity of 10 or less persons and trucks with a total vehicle weight of 2.8 ton
or less according to the safety regulations equivalent to the FMVSS 208. Full frontal rigid barrier
crashes are carried out at a velocity of 50 km/h to measure the injury parameters using a dummy
placed in the vehicle and to observe the dummy's behavior, thereby confirming if the tested
vehicle conforms to the safety regulations .

The side impact test is carried out on passenger cars with a riding capacity of 10 or less persons
and trucks with a total vehicle weight of 2.8 ton or less according to the safety regulations
equivalent to the ECE 95. To confirm if the tested vehicle conforms to the safety regulations, a
MDB is collided with the side of a stationary test vehicle from the right angle direction at a
velocity of 50 km/h to measure the injury parameters of the occupant using a EuroSID-l dummy.

Fig. 7. Side impacttest.

Approval test for child restraints

After introduction of the motor vehicle equipment type designation system in November 1998,
several tests have been introduced to confirm conformation of child restraints to the safety
regulation . These tests include a dynamic test comprising fixing a child restraint with an infant
dummy to the trolley and loading a deceleration equivalent to 50 km/h collision to measure the
102 Y. Nanto

dumm y's behavi or (Fig. 8), a tensile strength test to measure the strength of a child belt by
pulling the belt until broken , a buckle opening force test to measure the force required for a
buckle to be released by pressing the push button, and a frame-resistant confirmation test to
measure the burning speed of materials.

Fig. 8. Dynamic test for measuring dummy behavior using a child restraint.

Trends of the test results

Frontal impact - After the introduction of the frontal impact regulations, the injury parameters
showed a tendency to decrease , as indicated by the decrease in the average HIC of 566 in 1993 to
414 in 1998. More recently, no significant improvement in the injury parameters can be seen due
to countermeasure for offset frontal impact tests and for the reduction of the development
pressure of air bags .

Side impact - Vehicle occupant protection measures in side impact which were introduced after
the start of the regulations include strengthening of the floor cross members and their
connections underneath the front seat , addition of a center pillar internal structure, reinforcement
of a sidesill, modification of the door impact beam layout. In addition, the obligation for the
provision of side air bags was expanded. Improvement in the development of air bags to promote
occupant protection performance was seen. For example, some air bags were designed to
develop upward from the chest so that the chest and head are protected, and some had a
curtain-t ype or tube-type development configuration in an allempt to significantly reduce injury
risks to occupant s. The Head Performance Criteria (HPC) and rib deflection in the side impact
tests showed a decrea sing tendency since 1996 (see Fig. 9). Only 30% of passenger cars were
equipped with side air bags in 1996 when the application for compl ying with the side impact
regulation s was initiated . As a result of expansion of the side air bag equipment since then ,
almost 70% of vehicles applied for the compliance are now equipped with side air bags.

I
1.2
o Ord inary-sized car 1.2
ri O Ordinary-sized car
--
c
1.0 Small sized car o
.~
1.0 iii Small sized car - -
U
~ 0.9 - ~ 0.9 - - - - r- - - -
'0 :§
.~ 0.8 '0 0.8 - - - - -

'" 0.7
.2
~ 0.7 - - - -

0.6 0.6
1996 1997 1998 1999 1996 1997 1998 1999
Fisca l year Fiscal year

Fig. 9. Changes in side impact test injury parameters since 1996.

Activities of the Japanese Ministry of Transport 103

Occupant restraint system - Air bags are provided in most driver and front passenger seats.
Some vehicles provide both a pretensioner mechanism and a force limiter mechanism, other
vehicles are equipped with resin ribs or impact absorbers inside the pillars or roof side rails to
mitigate impact, and still other types are equipped with a mechanism which causes the head
restraint to move upward so as to reduce hyperextension of the neck in rear-end collisions . There
were also a variety of improvements in air bags. Some air bags are equipped with a mechanism,
called an air belt, which causes the chest binding part of the three point-type seat belt to develop
by air at collision, thereby mitigating the impact to occupants . Another type is provided with a
sensor which detects a child sleeping in the front passenger seat and prevents the side air bag
from developing upon collision. Still another air bag was designed to develop in two stages
according to the severity of impact. Some vehicles have rear seats equipped with an attachment
of ISO-FIX specification which prevents misuse of a child seat.

Child restraints - Eighteen child restraints have been designated, but 5 were rejected in the test
during the past 19 months. One of the rejected child restraints was found to have a structure
member broken in the dynamic test performed in the reclining most-upright position. In another
rejected child restraint, a dummy was thrown out when reclining in the most relaxed position. In
this manner, some applications were rejected due to failure to meet the dynamic impact test.

CONCLUSION

The Ministry of Transport will continue to promote expansion and strengthening of the safety
regulations and provide safety information with the objective of reducing the number of fatalities
in traffic accidents. The Ministry also will actively work for international harmonization of
safety and environmental regulations and their mutual acceptance. The Traffic Safety and
Nuisance Research Institute will contribute to these activities of the Ministry of Transport by
research and examinations .

REFERENCE
[1] K. Matsumoto, Trends and Priorities in Motor Vehicle Safety for the 21st Century,
Proceedings of 16th International Technical Conference on the Enhanced Safety of Vehicles,
1998, pp. 85-87.
Optimized Belt Systems for Front and Rear Seat Passengers
Harald Zellmer, Stefan Luhrs, and Klaus Briiggemann

Autoliv GmbH, Otto-Hahn-Str. 4, D-25337 Elmshorn, Germany

Summary: a) Restraint systems for front seats have experienced continual improvement in
recent years, in particular through the introduction of airbags. The purpose of the belt system is
the early coupling of the occupant to the car. In the first 50 ms to 60 ms, before the airbag is
fully inflated, the belt system only is responsible for the restraint. A careful analysis of the first
time frame shows, that differences between different pretensioner systems exist. A rating system
was developed in order to get a qualified number of its performance. b) The standard for rear
seats, however, is still the conventional three-point belt on outer seats. As using airbags in rear
seats is very problematic, the feasibility and protective effect will be examined of a belt system
equipped with a belt pretensioner and a load limiter.

Key words: Restraint System, Seat Belt, Frontal Impact Protection, Rear Seats, Pretensioner

INTRODUCTION
The restraint systems on the front seats of automobiles have been continuously improved in
recent years. Thus the best restraint systems today consist of a safety belt with a pretensioner
and load limiter, and an airbag. In rear seats, however, the standard is an automatic three-point
belt for the outer seats and a static lap belt for the middle seat. Only very few models have a
three-point belt on the middle seat and/or a belt system with pretensioner. Due to the
introduction of the 40%-ODB crash test as a prerequisite for type approval of automobiles in
Europe, and an improvement in vehicle structure for this test, the crumple zones of cars -
especially small cars - are becoming stiffer. This can be seen especially in crash tests according
to the US-regulation FMVSS 208 against a rigid barrier with 100% overlap. With vehicle dece-
leration like this, it seems hard to fulfil the 5*-rating of US-NeAP for front seats; and the dum-
my loading on rear seats can even exceed the respective acceptance levels of FMVSS 208. It is
therefore necessary for the restraint system to be adapted to such vehicle deceleration. For front
seats, the "Intelligent Occupant Protection System" (lOPS) [1] provides a solution. The system
offers a dual stage airbag and load limiter performance in order to reduce body loadings for all
crash situations and occupant sizes. Introducing an airbag also for rear-seat passengers, however,
appears problematic. For one thing, there are hardly any suitable mounting locations available,
and for another, the out-of-position problems in rear seats would be much greater than in the
front passenger seat, also and especially because children are usually transported in the rear seat.

This examination is to show what additional protective effect an improved belt system can have
with and without airbag. This improvement can be broken down into two stages:
1) Belt-pretensioning, which starts within the first milliseconds of an impact, thus creating the
optimal preconditions for the restraint system to have its effect (front and rear seats);
2) Load-limiting, which, while the occupant is being shifted forward, limits the belt forces
affecting the occupant and makes the best possible use of the available interior space to
decelerate the occupant (rear seats).

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 105
106 II. Zellmer et al.

BELT PRETENSIONING AND LOAD LIMITING

A large amount of slack in the belt system results in a worsening of the occupant loading values
during a head-on col1ision and can promote submarining. Thus 80% of car drivers' belt slack is
between 40 and 90 mm in summer and between 40 and 120 mm in winter [2]. Similar belt
slackness rates can be expected in rear seats. The pretensioning system is meant to pull the slack
out before the shift forward caused by impact has even begun. High performance systems
pretension the belt system with several 100 Newton in order to enhance the coupling of the
occupant to the car.

The force limitation in a three-point belt is supposed to limit the belt forces and thus in particular
keep the thorax loading values down . Load limiters were used in mass production as early as the
beginning of the 70's - back then of course without airbags . Accident analyses substantiate their
use [3]. Today load limiters are mostly used in combination with an airbag for optimal
performance of the total restraint system .

OPTIMIZED BELT SYSTEM FOR FRONT SEATS

In frontal impacts, one main function of the belt system is the early coupling of the occupant to
the car. A performance criterion for the amount of coupling was developed and is presented in
the following . The feature of load limiting is not looked at in this paper because this has to be
seen always in connection with the airbag [1].

The Performance Criterion is based on the ideas of the "Ride Down Effect" [4], which
calculates the percentage of crumble zone which has already been deformed when the restraint of
the dummy starts. It is based on dummy chest acceleration. Our performance criterion, on the
other hand, looks at the time T4kN when the shoulder belt force attains 4 kN. We assume that at
this time the controlled restraint of the occupant starts . The forward displacement d4kN of the
50th-percentile male dummy at its upper thorax vertebra Tl is determined, and the total remaining
distance dr for the deceleration the occupant is calculated as (cf. Fig. 1):
dr = de + ds - d4kN , with:
de = Remaining length of crumble zone at T4kN •
ds = Available space for dummy forward displacement in compartment at To.
It is obvious that with greater d- more space for controlled deceleration of the occupant is
available . At T4kN no dummy contact to the airbag has jet occurred. For another 10 ms to 20 ms
the belt system alone restraints the occupant. It has to be mentioned that the best ratings would
be gained by a hypothetical belt system which pretension to a shoulder belt force of 4 kN just in
the beginning. But for the reason of limiting the risk of injury in low speed accident, the initial
shoulder belt force should be limited to be below 1.5 kN.

Table 1. Sled tests to evaluate test procedure of pretensioner performance .

Test Pretensioner Belt Slack T4kN ems] d4kN [mm] ds [mm] de [mm] dr[mm]
1 without without 45 134 114 250**) 230
2 System 1 without 41 82 152 250 320
3 System 2 without 44 109 116 250 257
4 System I 120mm 42 94 135 250 291
5 System 2 120mm 47 142 97 250 205
**) Typicalvalue for driver seat in compact cars, includes safety margin.
Optimized Belt Systems for Front and Re ar Seat Passengers 107

Results of Sled Tests with two different

pretensioner systems are shown in table 1. Crumb le Space for forward
zone displace met in
The crash pulse represents that of a
mpartment ds
current compact car at impact with
50 kmIh to a rigid barrier. It clearly
figures out that system I, which is a high
performance system, yields to lower
1
values of dr than system 2, which is a
rather conventional one. However , To
system 2 provides much better results than First contact
to crash blod<
the belt system without pretensioner. In
order to get an estimate on how the
magnitude of dr is related to occupant
loading the following assumptions are
made:
a) Almost no deceleration of the 2
occupant takes place until T4kN,
T4kN
b) The dummy deceleration takes place Be~ load attains
4 kN, controlled
at nearly constant rate after T4kN restraint begins. yel
involving belt and airbag , no contact to airbag

c) The distance dr is completely used for

dummy forward displacement.
With these assumptions, the chest 3
accelerations of the dummy behave like
the inverse of the remaining distances dr.
Maximum forward
Thus , with system 1 the chest dis placeme nt of
accelerations can be reduced by 28 %, occupant
with system 2 by 11 % compared to the
benchmark without pretensioner. It has to
be pointed out at this place, that not only Fig. 1. Car and occupant behaviour in frontal impact.
the performance of the pretensioner has an
influence on dr, but also the locking
mechanism of the retractor, the belt geometry, the fastening of buckle and anchor fitting to the
seat, and of course, the seat, which can yield as well during the crash .

Tests 4 and 5 in table 1 show that the influence of belt slack on dr is less with the high
performance pretensioner than it is with the conventional one. A series of repeatability tests have
so far been performed with different pretensioners and seating positions . With this we are in the
position to state that the test procedure is a suitable tool to determine the performance of the belt
system in the first 50 ms of a crash test.

OPTIMIZED RESTRAINT SYSTEM FOR REAR SEATS

Marginal Conditions in Optimizing the Rear-Seat Belt System can be derived from the special
situation of rear seats [5]:
1) Owing to belt geometry and seat position, a tendency to submarining occurs, which must
not be reinforced through pretensioning and load limiting but rather ideally should even be
reduced.
108 H. Zellmer et al.

2) The load limiting has to be designed such that the free space available to the occupant,
which increases dynamically through the back-rest moving forward, is optimally exploited
without injury-relevant contact to the head coming about.
3) The belt system must qualify for type approval in accordance with ECE-R 16. This
means that in the relevant sled testing in accordance with ECE-R 16, the standardized manikin
must not move forward at chest height any further than 300 mm.
4) The restraint system must be optimized with regard to a chest loading criterion because it
is evident from the accident analyses that thorax injuries are the ones that play the decisive
roll.

Sled Tests and Results. A series of sled tests were carried out to estimate the expected reduction
in dummy loading values by an optimized belt system. To do so, a belt geometry and seat
position were selected that in our experience are typical. A Hybrid-III-50-percentile man was
used as the dummy. A relatively stiff crash pulse was deliberately selected (peak deceleration of
33 g), to allow for the fact that modern vehicles are becoming more stiff. The test modes and the
outcome are listed in table 2.

Table 2. Sledtests 1-3, viscous criterion V*C and chest deflection as a function of the belt system.
Test Belt System V*C [mfs] Deft. [mm]
1 Conventional belt system without pretensioner and load limiter 0.95 61
2 Belt system only with retractor pretensioner, without load limiter 0.55 50
3 Belt system with retractorpretensioner and load limiter 0.28 37

A load limiter level of 5.5 leN was selected first because with such a system the ECE-R 16
requirement for maximum chest forward displacement of 300 mm can be met. A clear reduction
can be seen in chest loading with a pretensioner and especially with a pretensioner and a load
limiter. The viscous criterion Y*C in test 3 is around 70% lower in comparison with reference
test 1, and the chest deflection by 40% . A clear drop in head and neck loading can also be seen,
but as no contact to the head took place, this case can only be considered as a reference value.

Influence of Different Parameters on the Dummy Loading. To determine the influence of

individual parameters on dummy loading, three series of MADYMO simulations were carried out
and evaluated for the effects of the individual parameters . In doing so, special attention is given
to chest deflection and Y*C. The testing was carried out separately for the three possible
pretensioner systems - retractor , buckle and anchor-fitting pretensioners. The variation of the belt
anchoring points is supposed to cover the area possible in the vehicle [5]. The belt slack
approximately represents an average value of real belt slack in summer and winter. The two
stages of the foot position are supposed to represent the positions possible for the lower
extremities with the front seat pushed forward or to the rear respectively. The range of variation
of the angle of the seat ramp is supposed to cover a wide range of possible settings. The load
limiter level was first selected according to the marginal conditions given. The variation of the
vehicle pulse is supposed to make it possible to determine the influence of "stiff" and "soft"
vehicles. Fig. 2 give an overview about the effects of the individual parameters on chest
deflection and viscous criterion for a retractor pretensioner. The following picture results as far
as chest deflection goes: A substantial reduction of 25.5 % is caused by the force limitation,
followed in second place by the vehicle pulse at 16.8 %. The pretensioning contributes with
approx. 13.4% and is in third place with retractors and anchor-fitting pretensioners . For Y*C,
pretensioning for retractor and anchor-fitting pretensioners has the greatest influence; for buckle
pretensioners, the belt slack that follows in second place for the other pretensioners . Vehicle
pulse follows in third place for all types of pretensioners. Load limitation only follows starting
Opt imized Belt Systems for Front and Rear Sea t Passengers 109

from the fifth position. This can be explained in that V*C already assumes its maximum value
before the force limitation comes into effect. The simulations clearly shows that the influence of
the characteristics of a modern belt system, i.e., pretensioning and force limiting, is greater on
the chest loading values than the influence of a 30% stiffer crash pulse.

The Load Limiter Level and the Dummy's Forward Shift . As shown in the previous section,
the force limiter provides the greatest contribution to reducing chest deflection. In another
simulation series, the influence of the force limiter level on chest loading was therefore
systematically investigated, the geometry having been selected corresponding to the sled tests
with stiff crash pulse. The results are given in figure 3 as a function of the maximum shift
forward determined in the head's centre of gravity. One first sees a clear reduction in chest
deflection with a reduction of the force limiter level from 10 leN to 7 leN without forward shift
increasing a great deal. With a further reduction of the force level, a clear increase in the head's
forward shift results, which, however, at 5 leN is still less than 550 mm. With regard to a
reduction of the tendency toward submarining through a low load limiter level, the space
available in a vehicle should definitely be taken advantage of and a force level selected below
6 leN if possible. In the course of the V*C it can be seen that no clear reduction occurs until
between 4 leN and 5 leN [5].

Defl. [mm] V'C [m/s]

Seat ramp Foot position
Foot position
6.8% "'I
f 6.9%
Pillar loop Crash pulse
5.6%
Seat ramp
10,0% 19.8% 4.4%
Crash pulse Pillar loop
16.8%
Anchor, Buckle 9.8%
8.9% Anchor. Buckle
3.9%
Belt slack Belt slack
11.6%
Pretensioner 2 1.0%
13.4%

Load limiter J
25.5%

i l lJ \ nchor, Buckle • Seat ;~mp • Crash pulse • L~;d li~iter

~I~~__ • Foot position • Belt slack~ Prete~sioner

Fig. 2. The influence of the parameters on chest deflection and V*C for retractor pretensioning.

1,1 ,---- ----,

~ --------
E
E 0,9
o
~ 0,8
c
~ 0,7 1---- - - - "c;-~ lIN t~ -- -- - - --- .

~" O,6 1---------~-___.;irTii'""--- --

]j 0,5 r - - - -- - - - - - - ::--......o;:c- -----== =----1
i3 04 r-------------------'~j==----1
0,3 L--- - -l
300 400 500 600 700 BOO 900 1000
Forward displacement of head cog [mml

Fig. 3. Chest deflection as a function of the forward displacement of the head measured in the centre of
grav ity for different load limiter levels.
110 H. Zellmer et al.

CONCLUSION
A test procedure was developed to determine the performance of belt systems with pretensioner .
It clearly shows the potential of high performance pretensioning systems to reduce occupant
loadings in severe frontal impacts. For occupant of the rear seats, a belt system with
pretensioner and load limiter can reduce the chest loadings by great margin and keep it at
moderate values even in modem stiff cars.

REFERENCES
[1] G. Clute, H. Zellmer, S. Jawad, An "Intelligent Occupant Protection System" (lOPS) :
Theoretical Evaluation and Presentation of the Adaptive Load Limiter,
VDI Berichte Nr. 1471, 1999.

G. Clute, H. Zellmer, S. Jawad, "An Intelligent Occupant Protection System (lOPS):

Theoretical Evaluation" 32nd ISArA-Conference, Vienna, Austria , 1999.

[2] A. Bauberger, D. Schaper, Belt Pretensioning and Standarized "Slack" Dummy, 14th
ESV Conference, Melbourne , Australia, 1996.

[3] J.Y. Foret-Brune, F. Brun-Cassan, C. Brigout, C. Tarriere, Thoracic Deflection of

Hybrid III Dummy; Dummy Response for Simulation of Real Accidents, 12th ESV
Conference, Goteborg, Sweden, 1989.

F. Bendjellal, G. Walfisch, C. Steyer, P. Ventre, J.-Y. Foret Bruno, X. Trosseille,

J.-P. Lassau, The Programmed Restraint System- A Lesson from Accidentology,
41st Stapp Car Crash Conference, 1997.

[4] G. Lutter, F. Kramer , H. Appel, Evaluation of Child Restraint Systems on the Basis of
Suitable Assessment Criteria, IRCOBI-Conference, Berlin, Germany, 1991.

[5] H. Zellmer , S. Luhrs, K. Brtiggemann, Optimized Restraint Systems for Rear Seat
Passengers, 16th ESV Conference, Windsor, Canada, 1998.
Development of a Finite Element Model of the Human Lower
Extremity for Assessing Automotive Crash Injury Potential
AtsutakaTamura', KatsuyaFurusu', Masami Iwamoto', Chiharu Kato!, Kazuo Mikil , and Junji Hasegawa?

ITOYOTA Central R&D Labs., Inc., 41-1, Yokomichi, Nagakute, Aichi 480-1192, Japan
~OYOTAMotor Corporation, 1200, Mishuku, Susono, Shizuoka410-1193, Japan

Summary: A finite element (FE) model of the human lower extremity has been developed and
validated against published experimental data quasi-statically and dynam ically. The calculated
results indicate that the current FE model possesses reasonable biomechanical characteristics and
adequate biofidelity in dorsiflexion behav ior. In future work , it is hoped that the applicat ion of
this model for realistic automotive crash analyses can increase not only better understanding of
the injury mechanisms but also basic biomechanical data for further occupant protection.

Key words: Lower extremity, Ankle , Tibia, Dorsiflexion, Achilles tendon

INTRODUCTION

Over the past decades, the installation of safety devices such as safety belts and airbags has led to
be a reduction of severe injuries caused from automotive crash accidents. Although this address
had been lowering head and thoracic injuries so far, a lot of injuries concerning lower extremities
are still frequent, and the detailed injury mechanisms have not been made clear yet. For this
reason , there is an increasing need to focus on the lower limb injuries , particularly foot and ankle
region. In Figure 1, major mechanical motions of the ankle joint are presented. Generally, direct
contacts of lower limb associated with car interiors (knee bolster, dashboard, toeboard) are
considered to cause severe injuries on knees and ankles. As shown in Figure 2, footwell intrusion
often results in an extensive ankle dorsiflexion increasing peak axial loads and bending moments
in the tibia, especially in frontal collisions. On the other hand, inversion and eversion behaviors
are often considered to be the primary sources of malleolar fractures and deltoid ligament
avulsions. These observations suggest that an extensive dorsiflexion is likely to playa large role
on ankle injuries. The authors have been developing a 3-D human finite element (FE) model for
predicting automotive crash injuries . The purpose of this study is to elucidate lower extremity
injury mechanisms in real automotive crash accidents by using the developed FE model validated
against published experimental data.

Dorsiflexion

/'
In version ....

.~ Eversion

Fig. 1. Schematicview of the ankle mechanical motion Fig. 2. Schematicview of the footwell intrusion

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

III
© Springer Japan 2000
112 A. Tamura et al.

FINITEELEMENT MODEL

The outer shape of this FE model is based on the human geometry data (50th percentile male)
digitized by Viewpoint Datalabs. In total, the complete lower extremity model consists of 3628
nodes, 4606 elements . The bone was modeled as deformable body with cortical bone as shell
elements and spongy bone as solid elements . All bones were connected with ligaments as
membrane elements. Achilles tendon was modeled as bar elements . The material properties of
human lower limb parts are provided in Table 1, which were selected from published
biomechanical data (Yamada (1], Abe [2]). An elasto-plastic stress-strain (a - E) law was
implemented to the long bone models in order to represent the elasto-plastic deformations of the
tibia and the fibula. All analyses were performed with using the explicit non-linear finite element
code PAM-CRASH (ESI, France).

Table 1. Materialpropertiesof the lowerextremity model [1,2)

Elastic Poisson Density Thickness Ultimate
Modulus Ratio (kg/m Strength
A3)

(rnm)
Tibia cortical 17.7(GPa) 0.30 2000 1.0-2 .0 140(MPa)
Fibula cortical 17.7(GPa) 0.30 2000 1.0-1.5 146(MPa)
Spongy bone 203(MPa) 0.45 1000 1.18(MPa)
Achilles tendon 588(MPa) 0.22 1100
Deltoid ligament 300(MPa) 0.22 1100 2.0

RESULTS

Static Validation of the Long Bone Bending Property. First of all, to examine the basic
characteristic of long bone models, bending properties of the tibia and the fibula were validated
against the published experimental data obtained from quasi-static three-point bending tests
(Yamada (1]). In the simulation set-up, an impactor was imposed to the mid-diaphysis of long
bones anterioposteriorly while both ends of those were fixed. Figure 3 shows force-displacement
(F -D) curve of the impactor. The comparison between the experimental data and the calculated
results indicates that long bones of the current FE model possess valid bending properties.

3000
•i.. Tibia
2500 .........

2000
g • experiment
CIl 1500 m experiment
(J
- simulation
0
u. - simulation
1000
Fibula
500 m om

0
0 5 10 15 20
Displacement (mm)

Fig. 3. Quasi-static 3-pointbendingtests for the tibia and the fibula

A Finite Element Model of the Human Lower Extremity 11 3

Static Validation of the Ankle Characteristic during Quasi-static Dorsiflexion. The ankle/foot
region of the FE model was validated against human ankle joint property obtained from quasi-
static dorsiflexion test performed by Petit et al. [3]. On the basis of this experimental method , a
part of calcaneus and the motor shaft were made to be a rigid component. As shown in Figure 4,
applied a rotation about medial-lateral axis (this axis for 'dorsiflexion) at a constant rotational
velocity of O.lOrad/s, the ankle joint was made to be dorsal flexed, while the fixed plate with the
proximal tibia was allowed to translate freely except for the medial-lateral direction. The Achilles
tendon characteristic was represented with a non-linear load curve in the form of static tensile
force-strain (F- E) provided by Yamada [1]. If the ankle joint was dorsal flexed, an axial
compressive load was transmitted to the tibia and then rotational ankle moment occurred at the
center of rotation (CR) of the ankle joint. The result of this simulation is represented in Figure 5.
The ankle moment-rotational angle (M- 8 ) relation is within the corridor of cadaveric tests
exhibited by Petit et al. [3].

60 ,-----r----,-- --r-- ---,---,

Fixed Plate
50

40

30
Achilles Tendon
20

~~~~~- Calcaneus

Shaft
10 20 30 40 50
Ang le (deg)

Fig. 4. Simulationset-upfor quasi-static dorsiflexion Fig. 5. M-8 propertyat ankle CR

The model was also validated against dynamic dorsiflexion cadaver tests conducted by Manning
et al. [4], where toe impact test was performed according to the EEVC (European Enhanced
Vehicle-safety Committee) dummy foot certification procedure. An oblique view of the simulation
set-up is shown in Figure 6.

<, Pend ulum Arm

... Soft Ti sue

I

Achille Tendon

Fig. 6. Simulation set-up for toe impact test

114 A . Tamura et al.

The impactor was 235mm in length, with 50mm diameter cylinder of 1250g, and the pendulum
arm was 1250mm in length of 285g. The impactor initial velocities were set at 4 and 6m1s, while
the proximal end of the tibia was constrained rigidly. When the plantar surface of the foot is
impacted dynamically, a response of the impactor deceleration is anticipated to be influenced
significantly by the material property of the plantar soft tissue represented as a padded shoe model
in this study. Due to the lack of available data in material properties of the plantar soft tissue, a
parametric study was conducted to determine a - E curve by comparing with the series of
impactor deceleration responses. In Figure 7, the calculated response of the impactor deceleration
of 6m/s is displayed and in good agreement with the experimental results. On the other hand, there
have been so many discussions about the Achilles tendon tensile effects in previous works that the
load-strain (F - E ) curve of the Achilles tendon should be determined carefully. Therefore, F - E
curve was calibrated by performing another parametric study by comparing with impact test
results, This calibration was made to take into account the boundary condition of the Achilles
tendon insertion. When an ankle joint is made to be dorsal flexed, an axial compressive load
occurs in the tibia, which tends to counterbalance with the tensile force in the Achilles tendon. In
other words, an axial compressive load in the tibia increases with the greater tensile force in the
Achilles tendon at the higher dorsiflexion. As shown in Figure 8, calculated results of tibial axial
force (Fz) and tibial bending moment (My) also agree well with the cadaver responses of 6m/s.
These results indicate that the current FE model is capable of predicting dynamic responses during
dorsiflexion behavior in such an impact loading case.
10 0 10 00 r - ---,---- ,- -r--- ....- - , 20
fI o .... .J. t OI IrrPI~.~..!~. ~ ~~~I . i
.sc
~

t..
5 00

..e
10
~
0 · 10 0
~ o
~
Cll
IL ~
0r-__....~ Q.
eil'
ai ·20 0 iii
o ~
Cll ~ · 500 · 10 ~
0 ·300 al

za
0 :0
tl 1= · 1000 !-- -'-- -'---" n · 20
al ·400
Q. -experiment
.§ - simulation
2.
·5 00 · 1500 I-~~~......""""L .L--=---L_ ---I ·3 0
·0. 0 1 o 0.01 0.02 0 .03 0 .04 · 0.0 1 o 0.0 1 0 .02 0.0 3 0 .0 4
Tim e (msec) Time (sec)

Fig. 7. Comparison of the impactor deceleration Fig. 8. Dynamic responses at tibial midshaft

INJURY ANALYSES DURING DYNAMIC DORSIFLEXION

The investigation of toe impact tests described above was not reflected a real tensile characteristic
of the Achilles tendon properly. Therefore, the static Achilles tensile data provided by Yamada [1]
was used for injury analyses with initial velocities of 4, 6 and l Om/s, Figure 9 compares the
maximum magnitude of tibial axial force IFzl and tibial bending moment IMyl against impactor
initial velocities. As was found here, impact velocity influences both tibial axial force and tibial
bending moment severely. From this result, tibial fracture seems to be concerned well with an
axial compressive load transmitted to the tibia. In the present study, bone failure is supposed to be
identified with the location where maximum equivalent stress exceeded the ultimate stress
strength of cortical bone. According to this assumption , the maximum equivalent stress
distribution indicated that no failure was found at 4 and 6m/s impact simulations. On the one hand,
Figure 10 represents the maximum dorsiflexion state for the simulation at lOm/s impact. This
A Finite Element Model of the Hum an Lower Extremity 11 5

figure shows that bone fracture occurred at the distal tibia, where the maximum equivalent stress
exceeded the ultimate stress strength (140MPa) at that site.

5000 50
-t

=
Z
)(
Cll
4000
toe Impa ct
40
5'
iii'
CD
CIl
:::)
a.
~ 1 . 40 +08 (Fa )
t . 4 0 +0 8 (Fa )
:E 5'
a> 3000 30 co
~ ;;::
0
u.. 0
(ij 20
3
2000 CIl
'x
-c a
Cll ;;::
:0 1000 10 ll>
)(
i= I- Tibia mid My max (Nm>l
Z
0 0 3 Vo =10 (m /s)
3 4 5 6 7 8 9 10 11
Impactor Velocity (m/s)

Fig. 9. Influence of the impactor initial velocity Fig. 10. Maximum equivalent stress distribution

Though the strain limit of a human tendon is presented to be in the range of 0.10-0.15 [5), the
Achilles tensile strain estimated by the model did not reach at the rupturing region under the
conditions tested in this series of impact simulations. In Figure 11, time history plots of the
tensile/compressive stresses observed at tibial midshaft with an impactor initial velocity of 6m/s
are shown. The tibial midshaft has a natural bowing curvature, which is concave posteriorly and
convex anteriorly. As shown in Figure 12, it can be considered that the tibial midshaft is driven to
bend posterioanteriorly along its natural bowing curvature at the beg inning of ankle dorsiflexion.
If plantar soft tissue is impacted in such a direction as the toe impact test , a tensile force generated
in the Achilles tendon will increase a compressive load in the tibia. Compressive loading of the
leg, common in frontal collisions, will induce bending mode in the tibia such that the anterior
aspect of the tibia is placed in tension, while the posterior aspect of the tibia is placed in
compression. Therefore, it seems that tib ial mldshaft fracture correlates well with the bending
mode caused from the axial compressive load. This likely mode of the tib ial fracture patterns is
consistent with the clinical evaluation suggested by Schreiber et al. [6) who performed three-point
bending test posterioanteriorly against cadaveric leg specimens.
7
3 10 r---,----.--~-----,
7
toe Impact (6m /s)

.
2 10 • ;/--...

1 107 . . ...-' . Ten Slon'\\

~ o ~-~~ "\J
-;
~
.1107 I
Q)
7
~ -2 10
-3 107

.4 107

oL::::==:=:!~=~=~~=-----:-l
7
·5 10
0.005 0.0 1 0.015 0 .02
Initi al State I m pact Ti bia I nj ury
Time (s ec)

Fig. 11. Cortical bone stresses at tibial midshaft Fig. 12. Lower leg deformation after toe impact
116 A. Tamura et al.

As can be seen here, if the tibia is compressed with an axial force dominantly, Euler compression
buckling occurs at the tibial midshaft for its natural bowing curvature and its peculiar cross-
sectional profile . On the other hand, bending force is acted extremely at the ankle joint during
initial state, the strong bending force may occur to cause multiple injuries at ankle joint and distal
tibia . In the real world accidental case, initial dorsiflexion angle and footwell intrusion have
considerable influence on ankle injury outcome. As shown in Figure 13, foot-to-toeboard contact
and knee-to-bolster contact greatly increase the severity of the impact force and the risk of injury.
The inertial load of occupant body weight is also considered to influence the injury outcome
significantly. In this regard, future simulations with whole human body model as shown in Figure
14 will greatly help to elucidate the realistic complicated injury mechanisms from now on.
/ Knee bolster
Knee bols ter
Inertial load
'4-11

Fig. 13. Prediction for the tibia injury mechanism Fig. 14. Whole human body model on simple seat

CONCLUSION

1) Human lower extremity model with adequate biomechanical characteristics has .been developed
and conducted injury analyses with this FE model. As the result, an axial compressive load
occurred in the tibia during dorsiflexion was found to playa large role on tibial fracture.
2) Additional investigations should be carried out concerning xversion (inversion/eversion)
behavior influence on ankle injury and material strain-rate influence on bone failures .

REFERENCES

[1] Yamada H., Strength of Biological Materials., The Williams & Wilkins Co., pp. 98-105.,
1970.
[2] Abe H., Hayashi K., Sato M., Data Book on Mechanical Properties of living Cells, Tissues,
and Organs ., Springer-Verlag, pp. 292-349.,1996.
[3] Petit P., Portier L., Foret-Bruno J.-Y., Trosseille X., Parenteau C., Coltat J.-C., Tarriere C.,
Lassau J.-P., Quasistatic characterization of the human foot-ankle joints in a simulated tensed
state and updated accidentological data., IRCOBI Conf. , pp. 363-376.,1996.
[4] Manning P., Wallace A , Owen c.,
Roberts A, Oakley C., Lowne R., Dynamic response and
injury mechanism in the human foot and ankle and an analysis of dummy biofidelity., ESV
Conf., pp. 1960-1998., 1998.
[4] Fung Y. C., Biomechanics Mechanical Properties of Living Tissues., Springer-Verlag., pp.
260-261., 1993.
[6] Schreiber P., Crandall J., Micek T., Hurwitz S., Nusholtz G S., Static and dynamic bending
strength of the leg., IRCOBI Conf., pp. 99-113., 1997.
Development of A Human Ankle/Foot Model
Yuichi Kitagawa I, Hideaki Ichikawa I, Albert I. King 2, and Paul C. Begeman/

1 Vehicle Research Laboratory, NISSAN MOTOR CO., LTD., 1, Natsushirna-cho, Yokosuka 237-
8523,JAPAN
2 Bioengineering Center, Wayne State University, 818 West Hancock, Detroit, MI 48202, U.S.A.

Summary: A finite element model of the human ankle/foot was developed in this study. The bony part
was originally developed by ESI and was well validated against inversion/eversion and dorsiflexion
responses of the cadaveric lower leg . In this study, the ankle/foot model was revised to simulate
mechanical response in compression. Tendons and ligamens were added to the bony model to reproduce
deformation of the mid-foot. Comparison with static test results showed excellent performance of the
revised model. Dynamic response was examined by applying an impact to the sole of the foot with
muscular tension . Model predictions demonstrated a better match with test results than those calculated
by the original bony model.

Key Words: Impact Biomechanics, Ankle/Foot Injury, Finite Elelemt Method

INTRODUCTION

In recent studies in impact biomechanics, numerical simulation has been shown to be useful for
understanding injury mechanisms and estimating injury risk. A great benefit of using the finite element
method is the ability of visualizing stress/strain in the elements. Calculated stress/strain distribution
suggests the location where injury is likely to occur. Injury assessment is possible if the stress/strain
level is validated. Human models can be also used to predict minor injuries such as ankle/foot injuries
while the current dummies are only capable of assessing severe injuries, such as those occurring in the
head or chest.

In this study, the human ankle/foot complex was simulated by a finite element model. The mesh for the
bony part was taken form the original model developed by Beaugonin et al.(1997), which was validated
against dynamic inversion/eversion and dorsiflexion tests done by Begeman et al.(1990, 1993). The
kinematic response of the bony model also showed a good match with the test results. The authors
previously conducted a simulation study on that model by applying a dynamic inpact with muscular
tension (1998). Although the tibial force showed a good match with the test result, high frequency
oscillations were observed in the impactor force history due to metal-to-bone contact. The other concern
was that the model had not been fully validated against a large compressive loading. It was pointed out
by Petit et al.(1996) that mid-foot deformation could result from a tensile force from the Achilles
tendon. Considering the flexibility of the sub-talar joint and Lisfranc joint, the mid-foot could also
deform just under compressive loading to the sole of the foot. The model was revised by adding soft
tissue to the bony ankle/foot. Tendons and ligaments in the sole were introduced to simulate the mid-
foot deformation. The revised model was evaluated by comparing the simulation results with static
and dynamic test results.

MODEL DESCRIPTION

Figure 1 shows a general view of the revised model. The model looks like just the bony model but soft
tissue had been added. Although some ligaments were included in the original model, their purpose
was to restrict joint rotation to specified limits. In the revised model, the plantar aponeurosis, a
membranous tendon connecting the calcaneus and the metatarsal heads, was added to the sole of the
foot. When the foot pushes against the floor, for example, the toe and heel are the contact points with

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 117
us Y. Kitagawa et al.

the floor surface . Since the tibial axis is located between these two points, the arch of the mid-foot is
extended as the compressive force increases. This tendon is supposed to playa major role in the
opening of the arch. The mid-foot deformation results in a nonlinear force-displacement response. The
purpose of modeling the plantar aponeurosis tendon was to simulate this nonlinear response. Its material
property was assumed to be the same as that for the long plantar ligaments. Another modification was
made on the phalanges . In the original model, a rigid body connection was defined for the nodes in the
phalanges, and the metatarsal joints were not modeled. In the revised model, the rigid body connection
was removed and the metatarsal joints were modeled by spring-dashpot elements. Transverse ligaments
were also added between adjacent metatarsal heads to bind the phalanges. Figure 2 shows the anatomy
of the human foot as seen from the bottom, along with the revised model. Lastly, a skin/fat layer was
added to the sole of the foot. It was a flat cushion that was expected to reduce the rate of onset of the
initial reaction force.

Model An atom y

Fig. l.Revised Anklel Foot Model. Fig. 2. Tendons and Ligaments in Sole of Foot.

STATIC LOADING
Begeman et al.(1997) conducted a series of static tests. Human cadaveric lower leg specimens were
axially compressed using an Instron testing machine as shown in Fig. 3. The specimen was cut distal
to the knee and its proximal end was molded in a Ceralow block. This block was mounted to the
moving head of a testing machine so that the tibia was hung vertically with the foot resting on a
horizontal lower table. The specimen was compressed as the head moved downward. The compression
speed was 2 mm/s. Reaction force was measured by a load cell attached to the mounting block as well
as the displacement. Bony fracture occurred when the displacement exceeded approximately 10 mm .
The unloading curve was disregarded when the test result was compared with the simulation result.
This static test was simulated by various version of the models using the explicit finite element code,
PAM-CRASH. An equivalent condition was set up by applying external loading to the sole of the foot
through a flat rigid plate. The plate was induced to move at 2 mm/s in the tibial axial direction while
the proximal end of the specimen was fixed rigidly. The calculation was terminated when the
displacement reached 10 mm. The two other models were the original model with a rigid body connection
at the toe, and a model with the rigid connection removed. Both versions had no tendonslligaments in
the sole.

Figure 4 compares the measured and calculated force-displacement curves. The results obtained with
the other two versions are also plotted for comparison. The revised model showed an excellent match
with the test data . The small force observed at the beginning was probably generated when the foot
contacted the flat plate. The stiffness of the original model was higher than that measured experimentally.
The difference was not only in the stiffness but also in the force level. It would seem that the rigid
body connection at the toe generated a large reaction force without opening up the arch. The other
A Human Ankle/Foot Model 119

version predicted a lower stiffness compared with test data . The force-displacement curves followed
the test data quite well up to 4 mm, but the stiffness of the model decreased after that. Animation of the
results of this version revealed buckling of the foot after 4 ms, as shown in Fig. 5. Since the metatarsals
and the phalanges were separated from one another by removing the rigid body connection without
adding ligaments to bind them together, deformation increased rapidly in the mid-foot after the
compression exceeded a certain level. Thus, it was confirmed that modeling of soft tissues, especially
tendons and ligaments in the sole of the foot, is very important in reproducing a realistic response in
static compression. As seen in Fig. 4, the revised model showed the best match with experimental
results.
T ibial Axia l For ce (N)
10000
WOO

I lIOOO
Revised ModeJ

)
')IJOO
(jJ(I)
Tes t Result
5000
4000
:'<)00
2000

J 1000
o i"'--T"-=-'--r-r-
Ol23J56789W
r--r--r--r--r--',

DispJacc mcn I (mm)

Fig. 3. Test Apparatus for Corrpre ssjon. Fig. 4. StaticResponse of Ankle/ Foot.

Fig. 5. Buckling of Metatarsals in Orginal M:Jdel

DYNAMIC LOADING
The authors conducted a series of dynamic tests at Wayne State University (1998). Since the purpose
of the study was to examine the effects of mucular tension on injury outcome, a tensile force was
applied to the Achilles tendon. The special test apparatus built for this study is shown in Fig. 6. The
tibia was cut 300 mm distal to the knee, then its proximal end was potted in a fiber reinforced Epoxy
block . The Achilles tendon was dissected free so that a tensile force could be applied to it. A steel
cable was attached to the tendon by means of a special tendon catcher which was designed not to cause
any damage to the tendon tissue. A tensile force was applied to the tendon using an electrical winch.
The toe was resisted by another plate on the table, representing the brake pedal in a car. After the
tendon force reached a specified value, it was maintained at a constant level during the test. Dynamic
loading was then applied to the sole of the foot by a rigid impactor covered by an Ensolite pad. The
impactor was activated by a pneumatic piston . The pressure level was adjusted so that the pendulum ,
weighing 18 kg, was accelerated up to 3 m/s. The location of the impact point was 50 mm anterior to
the tibial centerline. This loading condition simulated external loading to the sole of the foot due to
toepan intrusion when the driver is stepping on the brake pedal duing a crash . Impactor force was
120 Y. Kitagawa et al.

measured at the pendulum head and tibial force s and moments were measured at the proximal end.
Dynamic simulation was also performed with PAM-CRASH. The model was carefully reproduced
equivalent loading to the ankle/foot. Figure 7 shows a general view of the model. The proximal end of
the model wa s fixed to the inertial space by restraining the motion of the nodes. A thin plate was
defined under the foot. The foot-plate was not attached to the foot in the simulation model while eastic
bands were used to attach it in the cad aver tests . It wa s not a big problem in the simulation model
becau se foot mot ion was not so large. As the revised model had skin/fat beneath the foot, friction was
exp ected betwe en the bones and the foot-plate. The skin/fat was modeled as flat-shaped layers. The
size of the skin/fat model was just the same with that of the foot-plate. Strictly speaking, the ankle/foot
did not have the soft tissue but the foot-plate had. The anterior part of the foot-plate was resisted by
another plate model fixed to the inertial space . The calculation was started by applying a tensile force
to the node s at the edge of the Achilles tendon. The force was increased gradually using a cosine
function so as not to generate unnec essar y oscillation due to dynamic pulling. After the tendon force
reach ed 1.4 kN , which wa s equivalent to that measured in the test specimen, it was maintained at a
con stant level during the simulation. Then the impactor collided with the foot-plate at 3 mls. Although
only a small portion of the pendulum head and an Ensolite pad were modeled, the total mass and
moment of inertia were simulated. Th e simulation was terminated at 15 ms after impact. Forces and
moments were calculated at the same point s with those in the test.

FIg. 6. Te st Apparatu s for Dynamo Loading at WSo.

Impacto r

Skin/ Fat

FIg. 7. Dynamic Loading Mode l.

A Human Ankle/Foot Model 121

Calculated forces and moments were plotted in Fig. 8 to 11. Because the model was elastic, an uninjured
case was selected from the specimens tested. Impactor forces are compared in Fig. 8. A good agreement
was obtained between the fist peak but the second peak was not consistent. There was no high frequency
oscillation in the impactor force history. Figure 9 compares the tibial axial forces between the simulation
result and the test result. The first two peaks showed an excellent match in their levels as well as in
their timings. Moments were plotted in Fig. 10 and 11. Lateral moments mean inversion/eversion
moments while sagittal moments mean plantarflexion/dorsiflexion moments. Comparison should be
made up to 8 ms after impact because unloading response may become significant in later part. The
sagittal moments showed a better match than the lateral moments. As the moments might be greatly
affected by the initial geometry of the specimen, it is recommended to examine the results of more
than one test. In this study, a detailed comparison was not possible because there was only one uninjured
specimen in the test.

FORCE (k /l.') FORCE (kN)

9 . , - - -- - - - -------, 9

8 8
7 7
6 6

5 5
4
3
2
1
o .p~-_,_-,_-.___,_-_r_-T""'""-'

o 2 4 6 10 12 14 2 4 6 10 12 14
TIME (ms) TIME (ms)

MOMENr( IOMENr l. m)
200 200 .,-- - - - - - - - - - - - -,
150 150 TE~T

100 100
50
0
/:J
-50
- 100 I~ / - 50
- 100
- 150 FEM - 150 FEM
- 200 -2 00 -+-___,r--~-.,...-...,....-,____,-~---J
2 4 6 8 10 12 14 2 4 6 8 10 12 14
TI~I; (rrs) T I I; (ms]

Fig. 10. Lateral Bending MJmenls. Fig. 11. SagittalBending MJments.

CONCLUSION
In this study, the plantar aponeurosis tendon and the transverse ligaments were added to the bony
ankle/foot model. The revised ankle/foot model was evaluated by comparing its static and dynamic
responses with test data. The force-displacement curve calculated by the revised model showed a good
match with the static test result . Comparison was also made between the versions with and without
soft tissue. It was confirmed that the mid-foot deformation was well simulated by adding the tendons
and ligamens . Then, dynamic response of the revised model was evaluated. The simulation result was
122 Y. Kitagawa ct al.

compared with the test data of the uninjured specimen. The revised model showed a better match with
the test result in the impactor force and an excellent match in the tibial axial force .

REFERENCES

(1] Beaugonin, M., Haug, E., Cesari, D. (1996); A Numerical Model of the Human Ankle/Foot Under
Impact Loading in Iversion and Eversion, Proc . 40th Stapp Car Crash Conference, SAE 962428.

[2] Beaugonin, M., Haug, E., Cesari, D. (1997); Improvement of Numerical Ankle/Foot Model :
Modeling of Deformable Bone, Proc. 41st Stapp Car Crash Conference, SAE 973331.

[3] Begeman, P., Balakrishnan, P., Levine, R., King, A. (1993); Dynamic Human Ankle Response to
Inversion and Eversion, Proc . 37th Stapp Car Crash Conference, SAE 933115 .

[4] Begeman, P., Prasad, P. (1990); Human Ankle Impact Response in Dorsiflexion, Proc . 34th Stapp
Car Crash Conference, SAE 902308.

[5] Kitagawa, Y., Ichikawa, H., King, A., Levine, R. (1998); A Severe Ankle and Foot Injury in Frontal
Crashes and Its Mechanism, Proc . 42nd Stapp Car Crash Conference, SAE 983145.

[6] Begeman, P., Paravasthu N. (1997); Static and Dynamic Compression Loading of the Lower Leg,
Proc . 7th Injury Prevention Through Biomechanics Symposium.

[7] Petit, P., Portier, L., Foret-Bruno, J., Trosseille, X., Parenteau, c., Coltat, J., Tarriere, c., Lassau , J.,
Quasistatic Characterization of the Human Foot-Ankle Joints in a Simulated Tensed State and
Updated Accidentological Data, Proc. 1996 IRCOBI.
The Behavior of Bicyclists in Accidents with Cars

Tetsuo Maki', Janusz Kajzer', and Toshiyuki Asai'

'Vehicle Research Laboratory, Nissan Motor Co.,Ud., 1, Natsushima-cho,Yokosuka, 237-8523, Japan

2Department of MechanicalEngineering,Graduate School of Engineering,NagoyaUniversity, Furo-cho,
Chikusa-ku, Nagoya, 464-8603, Japan

Summary: In Japan, bicyclistsaccountfor approximately 10% of all the victimskilled in traffic accidents
annually. Thisindicates thatinaddition toaccidentsinvolving pedestrians attentionshouldalsobepaidtothese
involving bicyclists.The current study compares behavior of bicyclistsand pedestriansstruck laterallyby
cars. Comparisonis madebasedon accidentanalysisandcomputersimulationswith MADYMO.Europeis
moving towardenactinglegislationregardingpedestrianhead protectiontesting. The present study also at-
temptedto determine whetherthesameeffects maybeobtainedwithrespectto headprotectionforbicyclists.

Key Words: Safety, Collision, Bicyclist,MADYMO,Head trajectory

INTRODUCTION

Everyyearin Japan approximately 10,000peopledie in trafficaccidents.It is reportedthat pedestriansand

bicyclistsrespectively accountfor about30 % and 10% of the totalnumberoffatalities. Measuresto protect
these vulnerable road users are seen as important factors in reducingoverall traffic deaths. As one of the
activities in the area of pedestrianprotection, the test proceduresbased on bioengineeringapproaches are
examinedat internationalconferences chaired byJapanunderthe IHRAand ISO. Especially in thepedestrian
headtestprocedure, thetestconditionof the head impactvelocityand thehead impactanglein relationto the
bonnet are discussedwith use of Postmortal Human Subject (PMHS)data.

Bicyclistaccidentanalyseswere also performed. In one conductedin Gothenburgby Kroon'", heshows that

side accidents betweenbicyclists andcarare most common.This configuration wassimulatedbyJanssenand
Wismans' " , However, Part572 dummycharacteristicswere used in the validationprocedureof the cyclist
model.Althoughtheimpactvelocityand the impactangleof thecyclist'sheadare veryimportantparameters
for the head injury, the potentialeffects of proposed pedestrianprotectionmeasures on bicyclistswere ana-
lyzedbyJanssen andWismans-" consideringthe impactvelocityonly. Theyconcludedas follows:
1) Ifimpactortestsareselectedin futureinternationalregulationsfor theevaluationof vehiclefronts, similar
impactormasses and velocitiescan be selected to account for cyclistas well as pedestriansafety.
2) Ifaccidentanalysis studiesor humancadavertestsshowthat typical bicycle-induced injuriesoccurthatare
not observedin pedestrianaccidents, special recommendations could be made.
3) It should be noted here that the results obtained up to now are mainly based on tests with a Part 572
dummy,which is nota realistichumansubstitutefor thistypeof impact.

However, currentdiscussionsconcerntheeffectiveness of variouspedestrian protection measures, including

theirpossiblebenefits forbicyclist protection. Effortstocreatelegislation forpedestrian protection aremoving
forward. In the meantime, pedestrian protection tests are already being conducted as one part of the New
Car Assessment Program(NCAP) in Europe, and the evaluationresultsfor some vehicleshave been made
public. Followingconclusions ofJanssen andWismans'" andcurrentsafety priorities of pedestrian testproce-
dures, it is important to investigate theinfluenceof theseprocedures on thesafetylevelof bicyclists. Therefore
in current research, bicyclist accident analysis has been conducted using macro data from Japan, and a
MADYMOsimulationmodelwith PMHScharacteristics was usedto conduct a fundamentalstudyofbic y-
c1ist behavior when struck by a vehicle. A preliminarystudy was also made on theeffects of the pedestrian
head protection test methodologyon bicyclist head protection.

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 123
124 T. Maki et al.

METHODOLOGY
Accident analysis. Macrodata fromJapan providedby the Institutefor TrafficAccidentResearchand Data
Analysis (ITARDA) wereanalyzed toinvestigate differences in traffic accidents involving bicyclists andpedes-
trians. The analyzeddatawere for the threeyearsfrom 1994 to 1996. To investigate the differencesbetween
bicyclistsand pedestrians,a comparisonwas made in terms of the number of fatal injuries to various body
regions. A comparisonwas also made between bicyclists and pedestrians in termsof the number of deaths,
seriousandminorinjuries sufferedper1,000accidents.Theanalysis of accidents waslimitedtothoseinvolving
personsaged 13 or olderand occurringat a drivingspeed rangeof 40 to 60 km/h, (i.e., the driver's perceived
collision speed).Theseconditionswereselected to eliminate the influence of thedifferences in bicyclistheight
and between lowand highdrivingspeeds.

Simulation of bicyclist model. In the current study,the GEBOD (Generator of Body Data) was used to
generate anAM50(American Male50percentile) pedestrian model,thepostureofwhichwasthenmodifiedto
createa bicyclist model. Themathematical dynamic modeling (MADYMO) wasusedforsimulation ofaccident
event. In theMADYMO model, spherical jointswereadopted. Jointcharacteristics, whichareimportantwhen
creatinga model, were determinedin referenceto PMHSdata compiledby Yanget al(3). The characteristics
reportedby Ishikawaet al'", were referredto in determining the interactions of ellipsoids, which include the
vehicle bodyaswellasthefriction coefficients andotherproperties. Fromthedataavailable fromonone PMHS
experiment involving asideimpacttothebicyclist the
overallkinematics of rider's bodywas obtained(Fig. Investigated points of
1). However, some ingenuityis requiredin order to Shoulder Horizontality

drawanymeaningful correlation betweenthelimited ~

-e
g
testdataavailable andsimulation results. The PMHS
data presented in Fig. 1 indicate that the bicyclist's - ~
'0 Sharp slope increase
thighandpelvisslidoverthehoodaftertheimpactand
thentheupperbodyhitthehoodwhileturning around
the pelvis. It is observedthat thebicyclist'sheadand
t at 10 degrees .

1 - - - - -__,/

tOO ms
shoulders maintained nearly thesameorientation after Elapsed lime after impact

theimpactasat thetimeof thecollision,for80 msand

100rns,respectively. Flg .I. PMHS Test Results for Bicyclist (35 km/h)

One methodthat is generally appliedin analyzinghigh-speed filmsof crashesis to extractthe trajectoryof a

particularpoint, such as the centergravityof head. However, with this methodit is difficultto represent the
rotational motionof eachpart of the bodyafterthe impact. It is alsodifficultto extracthead behaviordirectly
becausetheheadis apt to rotatearounditsverticalaxisin the film.Accordingly, it wasconcludedthatit would
be moreeffective tofocuson thehorizontality of theshoulders in viewof theirproximity to thebicyclist'shead,
the largerotationalinertiaaround the verticalaxis and the great distancebetweenshoulders.The shoulder's
divergence fromthehorizontal increases rapidly afterit exceedsapproximately 10degrees. Therefore, a shoul-
der horizontaland durable time (SHOT)of 100 ms, representingthe intervalin which the divergencefrom
horizontalline of 10 degreesis maintained, was selectedas the targetvalue for the creation of the bicyclist
model.In a similarway, a pedestrian'sSHOT of over50 ms was selectedfrom the PMHS data (4).
Threetypesof simplifiedbicyclemodelswithoutenergy absorption werecreated. Onewas a 26-inch sports-
typebicycle on which theriderleansforward sharply. The othertwo,withoutany horizontal beamin the bike
frame,were26-inchand 24-inchordinarytypesoftenused in Japan for bikingto a nearbytrain stationor for
shopping. On thesebicycles the riderleansforward onlyslightly. Similarto the situations of pedestrians, it is
thoughtthatmanytypesofaccidents occurbecausebicyclists suddenly dartin thepathof a vehicle. Therefore
the simulatedaccidentpattern was an impact type in which the frontof a vehiclecollided with the side of a
stationary bicycle at a speedof 40 km/h. Yoshida'" andAiba(6) havereported thattheheightof thehood leading
edgeand the front-end shape influencethe trajectory of a pedestrian's headwhen struckby a vehicle. There-
Th e Behavior of Bicyclists in Accident s with Ca rs 125

Table 1. Overview of Head and Lumbar Dist ance from Height of Hood Leading Edge
ordinary bicyclist sports bicyclist pedestrian
Height of hood leading 26 inches 24 inches 26 inches
edge from ground (m) head lumbar head lumbar head lumbar head lumbar
car A 0.52 1.08 0.41 1.01 0.43 0.88 0.41 1.11 0.47
car B 0.68 0.92 0.25 0.85 0.18 0.72 0.25 0.95 0.30
car C 0.75 0.85 0.18 0.78 0.11 0.65 0.18 0.88 0.23
car D 0.94 0.66 -0.01 0.59 -0.08 0.46 -o.oi 0.69 0.04
Table 2. Comparison of SHOT smr a 60 . . .
40 loIlfb
*35 kmlh **39 km/h ,,,
PMHS Model with PMHS
characteristics
bicyclist over 100 ms' SHOT 100 ms'
pedestrian over 50 ms" SHOT 60 ms l.
l.
%'IIu,c 400.«

t.. L
ec 8 "" l OO-OC

Fig. 2. Side View of Bicyclist Models Fig.3. Analytical Results for Collision Behavior:
(left: sports type; right: ordinary) Pedestrian and Bicyclist

fore, in the present investigation the level of the hood leading edge of the impacting vehicle and three different
bicycles were simulated in an analysis of bicyclist behavior in order to investigate the influences of these param-
eters . The results of kinematics from these simulations were compared with that for a pedestrian . Table 1 and
Fig. 2 give an outline of the simulation test matrix. As a result ofconstruction procedure of the foregoing model ,
a 60 ms SHOT was obtained for the ped estr ian mod el and a 100 ms SHOT was obtained for the bicyclist
mod el. Therefor e, it was assumed that the response of the bicyclist model corresponded to that of a PMHS
bicycl ist for the most part (Table 2 and Fig. 3).

In order to clarify the effect of the head impact angle and bicyclist position, head impact velocity and head
impact angle were compared between bicycli sts with various riding positions and pedestrians. As the bicyclist
model was not sufficient to estimate the risk of head injury, a preliminary study was made on the effects of
bicyclist head injury, using the pedestrian head protection test procedure. The ratios of the bicyclist head impact
velocity and impact angle to those of the pedestrian for the same impacting vehicle were calculated.

Hood impact test. Since these MADYMO simulation models were created for the specific purpose of exam-
ining the kinematics of a bicyclist in a collision with a vehicle, the results do not permit discussion of the risk of
injury. Therefore, in order to ascertain the effects of the bicyclist's head impact velocity and impact angle , the
head impactors for the evaluation of pedestrian protection were used to conduct hood impact tests. While there
are several methods for estimation of head injury risks, the calculations are performed using the resultant head
acceleration in the current study. Accordingly, comparisons were made of the peak level of resultant head
acceleration in relation to the impact velocity and impact angle . As illustrated in Fig. 4, the child head impactor
and the adult head impactor were struck against a stationary hood that was secured in a bench fixture. The
impact angle s of the child head impactor were set at 40' , 50' and 60' , and those of the adult head impactor at
50' , 65' and 75' , respectivel y.
126 T. Maki et al.

Impact point of
child head impactor Pelvis
......... Impact point of OeS! 4'l>
~:::::j.~~ ~~~ ad ult hcad impactor Neck
8'l> Ab domen
S'l>
6'l>
OeSl
9'l>
Plane View eck 7'l>

Fig.5. Breakdown of Fatal Fig.6. Breakdown of Fatal Pedes-

S ide View Bicyclist Injuries in 1383 Cases trian Injuries in 4416 Cases
, - - - - - - - - - - '784
800 ove r 13 yeus
40 - 60 kmill

Fig. 4. Experimental Set-up to Investigate Influence of Velocity 600 Pedestrian

and Angle of Impact on Acceleration of Head Impactor

RESULTS

Traffic accident analysis. The resultsof traffic ac-

cidentanalysisservedtoclarifythefollowing points. Fili I Accidents Accidents involving
(1) Fewer bicyclistsdie in traffic accidents than pe- accidents ~;~~:~~jury minor injury
destrians, who presentlyaccount for approximately Fig. 7. Comparison Between Bicyclists and Pedestrians in
Terms of Number of Fatal, Serious and Minor Injuries
30% of all trafficfatalities in Japan(Figs.5 and 6). In Suffered per 1,000 Accidents
terms of the major locationsof injuries, the head ac-
counts for over 70% of the fatal injuries suffered by bicyclists.This indicates the great importance of head
protectionfor bicyclists in fatalaccidents, which alsoholdsfor pedestrians.
(2) It is seen that bicyclists are involvedin feweraccidentsleadingto serious injuriesor death than pedestrians,
yet they more often have accidents that result in minor injury (Fig. 7). More detailed analyses of accident
conditionsandothercircumstances willpresumably revealthe exactreasonsforthesedifferenttendencies. Such
differencesare thoughtto affecttheirrespective behaviorwhen struckbya vehicle.Suchdifferences are thought
to be a result of theirrespectivebehaviorwhen struck by a vehicle.

MADYMO analysis. The resultsforthebicyclist andpedestrian headtrajectories obtainedwiththeMADYMO

models describedin the precedingsectionare shown in Figures8 and 9. The bicyclisthead trajectoryshows a
longerintervalof horizontal behaviorfollowingtheimpactthan thatof the pedestrianin most of the simulation
conditionsusedin theanalysis. This isattributed to the factthatthebicyclistslidesover thetopof thehood. Both
thebicyclist andpedestrian headtrajectories show anincreasingly longerintervalof horizontal behaviorfor a low
hood leading edge. The 26-inch ordinary bicycle with a high saddle position and the sports-type bicycle on
which the rider leans forward sharply show a smaller head impact angle than with a 24-inch ordinary bike
dependingon the lowhood leadingedgeheight.Figure 10shows theratiosof the bicyclistheadimpactvelocity
and impactangle to thoseof the pedestrianwhen impactedsame vehicle. In most cases, bicyclisthead impact
velocity and impact angle are lower than those of pedestrians. In only one case, that of a 24-inch ordinary
bicycleanda low hoodleadingedge,werethe headimpactvelocityand impactanglewerelargerthanthevalues
for the pedestrian.This resultis attributedto a changein the bicyclist'sposture becausehis leg and the bicycle
becomeentangled.

Head impact test. The resultsfromtheexperimentswithhead impactorsareshown in Fig.Ll. It is seen that the
peak levelof resultantheadacceleration was reducedbydecreasingthe impactvelocityand impactangle. This
stronglysuggeststhattheheadinjuriessustainedby bicyclists maybe mitigated.
Th e Beh avior of Bicyclists in A ccident s with Ca rs 127

1m 1m

26-i nch o rdinary bicycle q

24· inchordinar y bicycle q
26-inchspous I)'PC bic)'CIe c::) ~~;- ....;;:~~;:;;:S~~

Arrows indica te
head pos ition
i ni li~ 1
y
Results w ith low
Results with 10000'
hood leading edg e
hood leading edge

Fig. 9. Pedest rian Head Trajectory in Relat ion

Fig.8. Bicyclist Head Trajectory in Relation to Hood Edge Height to Hood Edge Height

Ratio of impactangle = (impact angle with Cydist I impact angle withPedestrian) -1

Ratioof impactvelocity = (impactvelocity with Cyclist I impact velocity withPedestrian) -1 Child head impactor

I•oo
~ 20% • • Cardesign
WIth low hood level
500 mlsec2
~ 10%
..:
Car design
with high hood level

·2 0% · 10% T 10% 20% o Normal typo cycle

000 ·10%
WIth inch
24 whee ls

·20% o Normal typo cycle

WIth 26 inch wheels

·30% /),. S ports lype cycle w4h

26 inch wheels ~:;>----'_ _ - - - L_ _----'-- - '

Ratio of head Impact velOCIty

Impact veloc ity
Fig. 10. Relation ship between Head Relative Impact
Fig. 11. Influence of Impact Angle and Velocit y
Angle and Impact Velocity of Bicyclist and Pedestr ian
on Peak Head Acceler ation

DISCUSSION

Since bicyclistsgenerallytravel at a higherspeed than pedestrians,the relativespeed at the time of a collision

betweenbicyclistand car will be greaterthan that of a pedestrianand a car.Accordingly, it could be predicted
that bicyclistswouldshow higherfatalityand seriousinjuryrates than pedestrians, especially in accidents that
occur at low speed. However, the results of current analysis reveal the opposite tendency with respect to
accidentsinvolvingseriousinjuries. This suggests theexistenceof some factorsthatreduceinjurylevelsin car-
bicyclistaccidents. Those factors can not be investigatedby accident analysis,so it was decidedto conduct a
studybasedon mathematical simulation.

Since saddleheightgenerallyvarieswith individualpreferences,even bicyclists havingthesamephysiqueand

ridingthe same sizedbicyclewill leanforwardat differentangles and havedifferentsaddlepositions. Accord-
ingly, it is thoughtthatbicyclistbehaviorincollisionswithvehiclesisevenmore complexthanwhattheresultsof
theanalysis indicate. However,judgingfromtheconditions of theanalysis, it is thought thatwhenbicyclists of the
same physique are struck from the side by a vehicle, the head impact velocity and impact angle tend to be
smaller for bicycliststhan the correspondingvalues for pedestrians. Furthermore it seems that the velocityof
bicyclistshavethepossibility to reducethebicyclistinjuriesdue to contactwithvehicle.

In the pedestriantestprocedure,theimpact velocityand impact angleare 40 km/hand 65- respectively, values

thatare higherthanfora bicyclistimpact.The bicyclist impactbehaviorshows sliding on thehood. Forinstance,
the impact velocityand impact angleof the bicyclists riding on a 26-inch ordinary bicycle decreasewith 20%
128 T. Maki ct a1.

againstpedestrianand the acceleration of thebicyclistheaddecreaseswith50%.The multiplecorrelationcoef-

ficients of the impactangleandimpactvelocity were calculated, andtheresultsshowedanexceptionally strong
correlation of 0.92. Therefore the results obtained by the pedestrian head protection test procedure are not
relevantto anydiscussionof the bicyclist protection. Whenthe effectiveness of the bicyclist'sheadprotection
using a pedestrianhead impactoris evaluated, the test conditionshouldbe changedaccordingto the bicyclist
impactbehavior.

Furthermore, ongoingaccidentanalysis andsimulations of severalaccident conditionswillbe needed,because

thecar shapeaffectsthebicyclistbehaviorandthis shapeis gradually changing.

CONCLUSIONS

Thisstudyofbicyclist behaviorinacollision witha vehicleclarifiesthefollowing.

(1) An analysis of accidents involving bicyclists inJapanrevealed thattheheadwas theprincipal locationof fatal
injuries,whichis the same as forpedestrians. However, a comparisonof the numbersof fataland serious head
injuriesper 1,000accidentsshowedthatbicyclistssustainedfewersuchinjuriesthan pedestrians.
(2) A MADYMO simulation modelof a bicyclistwas created using PMHS pedestriandata. In the analysis,
specialattention was paidto thehorizontality of thebicyclist'sshoulders, andthevalidityof thisparameteras an
indexof bicyclist behaviorwhenstruckbya vehiclewasevaluated. A comparison ofthe simulation resultswith
the cyclist'sPMHS dataconfirmedthatthesatisfactory kinematicsof themodel.
(3)The simulationresultsindicatethatbicyclistbehavioris more complexthan that of pedestriansbecause it
varieswithon the forwardinclination of therider's posture, saddleposition and heightof thehoodleadingedge.
Undertheconditionsof thisanalysis, itwasobservedthatthebicyclist headimpactvelocity and theimpactangle
tendedtobe smallerthanthecorresponding valuesof thepedestrian withthesameheightandweight.Moreover,
thevelocityof bicyclistsprovidethepossibility to reducethebicyclist'sinjuriescausedbycontactwith vehicle.
(4) Pedestrian headimpactorswereusedin impacttestsagainstthe hoodto identifythe influenceof the impact
velocityand impactangle. The resultsindicated that decreasein the impactvelocityand impactangle reduced
theresultant headacceleration level, whichisgenerally usedin calculation headinjurycriteria values.The impact
velocityandimpactangleof bicyclists tendtodecreaseratherthan thoseofpedestrians. Whenthe effectiveness
of the bicyclistshead protectionusing a pedestrianhead impactor is evaluated,the test condition should be
changedaccording to thebicyclists impactbehavior.

REFERENCES

[1] Kroon, P.,BicycleAccidentsin Gothenburg 1983 '84, Doctoralthesisfrom GothenburgUniversity,

1990
[2] Janssen,E.G, Wismans,J.S.H.M.,Experimental and Mathematical Simulationof Pedestrian-Vehicle
and Cyclist, 10th ESV Conference,1985, pp 977-988.
[3] Yang, J.K., Lovsund,P., Development and Validation of a Human-Body Mathematical Modelfor
Simulationof Car-Pedestrian Collision, Proceedings of 1997International IRCOBIConference, 1997,
pp 133-149.
[4] Ishikawa,H., Kajzer,J. and Schroeder, G, ComputerSimulationof ImpactResponseof the Human
Body in Car-PedestrianAccidents,37th STAPPConference, 1993, pp 235-248.
[5] Yoshida, S., Matsuhashi, T., Simulation Systemof Car-Pedestrian Accidentto EvaluateCar Structure,
Proceedingof JSAE, No. 9831946(1998).
[6] Aiba,T., Kajzer, J. and Mizuno, K.,The Influence of Vehicle FrontStructureon PedestrianInjuries,
Proceedingof JSAE, No. 9831928 (1998).
Mechanical Influences on Skeletal Regeneration
DR Carter':", EO Loboa Polefka 'r' and OS Beaupre':"

'Rehabilitation Research and Development Center, VA Palo Alto Health Care System , 3801
Miranda Avenuel153 , Palo Alto , CA 94304-1200, USA
2Biome chanic al Engineering Divi sion , Mech anic al Engineering Department , Stan ford
University , Stanford , CA 94305- 3030, USA

Summary: Skeletal regeneration is accomplished by a series of biolo gical events that include
differentiation of pluripotential tissue and often bone resorption . The se process es, which occur
during fracture healin g and distraction osteogene sis, are strongly influenced by the local
mechanical loading history . Intermittent musculo skeletal force s impo se displ acements and
cyclic stresses and strains in the bone and regenerating tissue near bone surfaces. Using finite
elem ent model s we demon strate that the patterns of tissue differentiation , bone formation , and
bone resorption observed at fracture sites and distraction osteogenesis environments can be
predicted from fundamental mechanobiological co ncepts. These analyses and other
experimental and clinical data indicate that: I) dire ct intramembranou s bone formation is
permitted in areas of low stres s and strain; 2) low to moderate magnitudes of hydrostatic tensile
stress may further stimulate intramembranous ossific ation ; 3) high tensile strain is a stimulu s for
the net produ ction of fibrou s tis sue ; 4) tensile strain with a superimposed hydrostatic
compressive stre ss will stimulate the development of fibroc artilage ; 5) although hydrostatic
compres sive stress is a stimulus for chondrogene sis , excessive hydro static compression near
bone surfaces will cause bone resorption; 6) poor vascularity may lead to cartilage formation in
an otherwise osteogenic environment.

Key words: Tis sue differentiation , Mechanobiology , Fr acture Healing, Distraction

Osteogenesis, Pseudarthro sis

INTRODUCTION

Bone fracture or surgical trauma triggers a compli cated cascade of biological responses that lead
to skeletal tissue regeneration . Regeneration is to be distinguished from tissue repair with scar
formation since it involves de novo skeletal tissue formation that is accomplished by the
proliferation and differentiation of pluripotential mesench ymal cell s. The mechanobiologic al
factors that regulate skeletal regeneration are similar to those involved in development [I] . In
this chapter we examine the mechanobiology of skeletal regeneration in three different contexts :
1) fracture healing; 2) distraction osteogenesis ; and, 3) pseudarthrosis development. Thi s
presentation draws upon the perspective that has been presented in related publications [2-4].

Skeletal regen erati on is initiated by a traumati c episode that involves dam age to the bone that
often include s the periosteum, bone marrow spaces, and surrounding soft tissues . Bone trauma
causes a physical disruption of the mineralized tissue matrix , death of many types of cells, and
interruption of the local blood supply. Local fibrin clotting of blood follow s and additiona l
necrosis around the trauma site res ults from the disruption of the vascul ature . The necrotic cells
release lysosomal enzymes and other products of cell death, thereby initi ating the cell
proliferation and differentiation proces ses associ ated with infl amm ation and ske leta l
regeneration .

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 12lJ
130 D.R. Carter ct al.

The proliferation of cells in the early phase of regeneration leads to a mass of granulation tissue
containing many different cell types. The extent of the proliferative response and thus the size of
the granulation tissue mass are chemically regulated by growth factors . Movement at the trauma
site enhances proliferation . A key stage in skeletal regeneration is the differentiation of
pluripotential mesenchymal cells of the early granulation tissue into cells that form cartilage ,
fibrocartilage, fibrous tissue, or bone. This cell differentiation is influenced by the local
mechanical environment.

Pauwels introduced an important perspective on the mechanobiology of tissue differentiation [5].

His ideas on tissue differentiation were based in large measure upon his observations of
histological patterns in oblique pseudarthroses and angulated fractures . By estimating the
applied loads and inferring local stress and strain levels, he developed general concepts for
explaining the influence of mechanics on differentiation. Pauwels proposed that key information
for tissue differentiation is contained in the hydrostatic (or dilatational) stress and octahedral
shear (or distortional) stress invariants. He further noted that distortional stresses always result
in elongation in one direction and thus summarized his view of differentiation in terms of the
different influences of pressure and elongation. He proposed that pressure leads to the formation
of cartilage and elongation is a specific stimulus for the development of collagen fibers and
fibrous tissue.

Skeletal tissue differentiation is also affected by non-mechanical environmental factors, the most
important of which is the local vascularity. Cartilage, fibrocartilage, and fibrous tissue have
rather low metabolic activity and do not require a rich vascular supply. Bone formation and
maintenance, however, can only be accomplished in the presence of a good vascular bed .
Osteogenesis in skeletal regeneration is therefore closely linked to the revascularization of the
differentiating tissue. Undifferentiated pluripotential cells in regions of poor vascularity are
shunted into a chondrogenic rather than an osteogenic pathway.

LOADING HISTORY AND TISSUE DIFFERENTIATION

We have previously introduced a semi-quantitative theory for tissue differentiation within the
context of fracture healing and the biology of implant-bone interfaces [6, 7] . Our concept for
tissue differentiation can be represented using a "phase diagram" (Figure 1). This diagram
utilizes stress and strain histories to emphasize the fact that the actual loading history is
complicated and we must begin to think of the mechanobiological stimuli in terms of the
frequencies and magnitudes of cyclic loading over time . The importance of a loading history can
be appreciated by noting that a few extreme loading cycles with sufficiently high tensile strains
may lead to fibrous tissue formation at the expense of osteogenesis . The appropriate
mathematical functions to represent the loading histories have yet to be established.
Mechanical Influenceson Skeletal Regeneration 131

Fig. 1. Representation of our

mechanobiologi cal concept for tissue
differentiation using a phase diagram relating
hydrostatic stress and tensile strain histories to
skeletal regeneration. (Adapted with permission
from (2) .)

~ r- " Hydrostatic
Stress
-+-C;;;-:---:-:c;-:-:...l--:"--=---:.---..,~
(-) Compresslon - 0- Tenslcn t- ) History

The principal tensile strain denoted in Figure I is consistent with Pauwels' concept that
"elongation" causes fibrous tissue formation . The horizontal axis is a measure of the cyclic
hydrostatic stress history . Negative hydrostatic stress (compression) increases to the left,
corresponding to increased levels of hydrostatic pressure. Positive hydrostatic stress increases to
the right and corresponds to hydrostatic tension . With a good vascular supply, low levels of
intermittent hydrostatic stress and tensile strain permit the direct formation of bone. However,
even in a low stress environment, bone cannot form without a sufficient blood supply. Instead,
cartilage would form. With excessive tensile hydrostatic stress, sufficient tensile strains might
be created to result in fibrous tissue formation .

The tension and pressure lines that delineate the different tissue regions represent "cut-off"
values . To the left of the pressure line the tissue is subjected to a history of high hydrostatic
pressure, which is a stimulus for the production and maintenance of cartilaginous matrix
constituents. Above the tension line the tissue is subjected to a history of high tensile strains,
which will promote the production and maintenance of fibrous matrix constituents. The collagen
fibers formed will be oriented primarily in the direction of maximum principal tensile strain. A
tissue loading history consisting of a combination of high levels of hydrostatic pressure and high
levels of tensile strain will produce fibrocartilage, as found in menisci and intervertebral discs.
The tension and pressure lines shown suggest the existence of precise cut-off values for
hydrostatic pressure and tensile strain. Realistically , the borders delineating the regions
corresponding to different tissue phenotypes are unlikely to be so distinct.

We explicitly include a region within the phase diagram corresponding to bone . This is
consistent with the observation that for a suitably stable stress and strain environment, bone
formation without an intermediate cartilaginous phase is possible and is the natural course of
events , provided there is an adequate blood supply . Clinical examples of direct bone formation
in a low stress environment include intramembranous bone formed in distraction osteogenesis ,
fracture healing with rigid fixation, bone formation in some areas with non-rigid fixation, and
bone ingrowth into a well-stabilized porous implant surface .

The mechanobiological phase diagram presents a basic framework for understanding the initial
direction s of skeletal tissue differentiation. It provides no information concerning the rates at
which differentiation will proceed. For example , bone is formed directly when the local stresses
and strains are low. Evidence from bone development [8], fracture healing, and distraction
osteogenesis [2] experiments suggest, however, that low levels of hydrostatic tension and/or
tensile strain will actually accelerate this bone formation . Analogously, the rate of cartilage
matrix synthesis may be dependent upon the magnitude and loading frequency of intermittent
pressure [9, 10].
132 D.R. Carter et al.

CYCLIC COMPRESSION OSTEOGENESIS

Healing fractures that are treated without internal fixation almost always experience intermittent
axial compressive forces at the fracture gap. These compressive axial forces produce hydrostatic
pressure in the gap tissues and therefore promote cartilage formation between the bone ends . Yet
it has been demonstrated that intermittently applied axial forces of moderate magnitudes can
actually accelerate fracture healing [11-14]. This apparent paradox can be explained by the fact
that compression forces create regions of mild hydrostatic tensile stresses on the periosteum and
in the external callus that appear to accelerate bone formation in these areas .

Fig. 2. A radiograph of a healing tibial

osteotomy shows the appearance of "tufts" of
new bone two weeks after the application of
daily intermittent compressive axial forces in a
sheep model. (Reprinted with permission from
Hydrostatic Stress [11]) Finite element analysis shows that the
regions where these bone tufts appear
correspond to locations of mild hydrostatic
tensile stress. (Reprinted with permission from
In'ormeOa'. [2].)
O Corrc>r.""""

To understand the effect of cyclic compression on the distribution of stresses and strains in the
differentiating tissue we can consider an axially symmetric finite element model of a transverse
osteotomy with a gap between the bone ends [2]. In this model we idealize the bone as a hollow
circular cylinder and the differentiating tissue around the osteotomy site as a homogeneous soft
tissue mass in the marrow cavity and external to the bone . Since the model geometry is axially
symmetric and only axial force is applied, the stress distributions will be identical in any
longitudinal plane through the central axis of the bone.

When an axial compressive force is imposed on this model, complicated distributions of stresses
and strains are created in the surrounding regenerating tissue. Changes in the magnitude of the
force will alter the magnitudes of the stresses and strains but not their distribution patterns.
Hydrostatic compressive stresses are calculated in the interfragmentary gap, including the
internal marrow spaces of the gap (Figure 2) . The area of greatest pressure is directly between
the cut cortical surfaces. In most areas of the regenerate, very low levels of hydrostatic
compression will be created . At the periosteal surfaces just outside of the gap. however, regions
of mild hydrostatic tension are created (Figure 2). The tensile strains are greatest in the gap
between the bone fragments and just outside the gap on the periosteal surface.

The calculation of hydrostatic pressure in the fracture gap is consistent with observations of
cartilage formation in the gap of a non-rigidly fixed fracture [6]. The tensile strains in the gap
area are related to a local tissue distortion and would be expected to give the gap tissue a
fibrocartilage character. The periosteal surfaces just outside the gap. however, experience cyclic
hydrostatic tension and also tensile strains. If the magnitudes of these stresses and strains were
large, we would expect fibrous tissue to form but if they were not , we would expect bone to
Mechanical Influences on Skeletal Regeneration 133

fonn . Goodship and Kenwright [1 I] studied the effect of intermittent compression on fracture
healing in sheep tibiae using rigid external fixators. In their experiment , we see that not only did
bone form at these locations (Figure 2), but its formation was accelerated and more abundant
than with rigid fixation. This finding suggests that direct bone formation can be enhanced by the
application of mild cyclic tensile hydrostatic stresses.

DISTRACTION OSTEOGENESIS

The suggestion that mild hydrostatic tension can enhance direct bone formation is particularly
significant in the clinical use of distraction osteogenesis techniques to lengthen bones [15-18].
In this treatment, a rigid external fixator is attached to the bone being treated and an osteotomy is
then performed . The gap is progressively distracted by small tensile displacements that ideally
are applied several times per day or continuously using adjustable features of the external fixator
[15-17]. The regenerating tissue in the osteotomy gap forms bone directly in the gap between
the bone ends. When the bone has been sufficiently lengthened, the fixator is held in one
position as the regenerating tissue in the gap matures and fully ossifies . The fixator is removed
and the bone remodels in response to the loading history to which it is exposed. The density and
strength of the newly formed bone increases and the lengthened bone assumes a
histomorphology similar to normal diaphyseal bone.

The rate of bone formation during the lengthening procedure ideally keeps pace with the rate of
distraction . If the rate of daily distraction is too high, however, fibrous tissue forms in the gap.
With rapid distraction, cartilage can also sometimes form in the gap, presumably in response to
vascular damage associated with daily distraction . If the rate of distraction is too slow, the gap
may fully ossify prematurely and the desired lengthening is not achieved.

The distribution of intermittent stresses and strains created in distraction osteogenesis can be
calculated by applying a tensile force to the same finite element model that we used to analyze
the cyclic compression experiment with osteotomies in sheep. The results of the distraction
analysis revealed that the hydrostatic stress distributions are mirror images of the distributions ·
calculated in the compression analysis (Figure 3). Hydrostatic tension is created in the gap
region and hydrostatic pressure is created at the periosteal surface ju st outside of the gap. The
highest tensile strains were again found between the juxtaposed cortices and just outside the gap
on the bone periosteal surface. The enhancement of bone formation in the gap during distraction
is consistent with the enhancement of bone formation in the form of "tufts" of bone that develop
at the periosteal surface during cyclic compression loading (Figure 2). In both of these regions,
hydrostatic tensile stresses are created. The finding of fibrous tissue in the gap when the
distraction rate is too high is consistent with expectations based on our view of the influence of
excessi ve tension on the formation of fibrous tissue (Figure 1).

The production of hydrostatic pressure at the periosteal surface during distraction (Figure 3)
suggests that direct bone formation may be somewhat inhibited and/or cartilage may form at
periosteal sites. Ilizarov has shown that direct bone formation does, in fact, proceed faster in the
interior spaces of the marrow cavity than at the cortices. A study of molecular and cellular
events during distraction osteogenesis by Tay et al. [19] is also of interest in this context. After
an initial latency period of 7 days, an external fixator was used to distract a mouse tibial
osteotomy site at a rate of 0.42 mm twice per day. Animals were sacrificed 6 and 10 days after
distraction began. Histological examinations showed that the gap was characterized by a central
growth interzone that was bordered by new intramembranous bone extending from the bone ends
134 D.R. Carter et al.

(Figure 3). Pluripotential cells and blood populated the interzone. In periosteal areas just
outside the gap islands of cartilage were found . Safranin O/Fast Green staining and in situ
hybridization for collagen type II showed that cartilage was limited to these small, discrete
regions at the periosteal peripheries of the distraction gap .

Fig. 3. Histologic tissue patterns after 6 days of

distraction in a mouse distraction osteogenesis
model. (Reprinted with permission from [3].)
Hydrostatic tension is prevalent throughout the
ff] Diaphyseal Bone NMB • NewtyMinera~zBd Bone
fracture gap region in a finite element analysis
o CartilageFoonat"", LeT « Leese Comec1M! Tossue
of distraction osteogenesis. Isolated regions of
hydrostatic compression on the periosteal bone
surface near the osteotomy plane correspond to
areas of cartilage formation . If the distraction
Hydrostatic Stress rate is too high, fibrous tissue formation occurs
H'9......
in the osteotomy gap, consistent with our

0=
• Tensiof, concept (Figure 1) that excessive hydrostatic
tension and tensile strain lead to fibrous tissue
formation. (Reprinted with permission from
[2].)

o ~P'ession
PSEUDARTHROSIS

A hypertrophic non-union sometimes develops into what is referred to as a pseudarthrosis, or

false joint, since it takes on many histomorphological characteristics of a joint. With exce ssive
motion, fibrinoid forms in the central region of the callus [20]. If motion persists, the fibrinoid
degeneration continues, leading to the formation of an articulating joint surface. A joint capsule
forms around the fracture site and a synovial-like fluid is produced. The articulating bone ends,
meanwhile, develop caps of tissue consisting of fibrocartilage and hyaline cartilage. New bone
that forms in the marrow cavity remodels to form a "subchondral" bony support for the cartilage
caps at the ends of the fracture fragments .

Pseudarthroses can develop when there is an oblique fracture in a long bone (Figure 4) . With
this fracture morphology, axial compression can result in excessive sliding between the fractured
bone ends . Cartilage forms at the bony fracture ends beneath the fibrocartilage layer, bone
formation and resorption occur periosteally, and the entire pseudarthrosis is encapsulated by a
fibrous tissue sheath much like the synovial capsule of a diarthrodial joint.

We used finite element models to determine the stresses and strains in the regenerating tissue of
an oblique fracture in the early stages of fracture healing. The results of these analyses reveal
that the highest tensile strains occur directly within the interfragmentary gap . Based upon a
maximum tensile strain failure criterion, tissue failure would occur within this region .

Roentgenograms of oblique pseudarthroses often reveal a reorientation of bone that presents a

characteristic malunion morphology (Figure 4). This angulated morphology is the result of bone
Mechanical Influences on Skeletal Regener ation 135

,! . Fig . 4. Oblique pseudarthrosis formation.

Hyd ro\la ll(
Sl rMio Roentgenogram of an oblique pseudarthrosis.
(Adapted with permissi on from [5] ) .

.<--
Hydrostatic stress plot from a finite element
.~ analysis of compressive forces acting on an
oblique fracture site. Fibrocartilage and
. ~:::-
..
cartilage formation occur in the interfragmentary
. . -. gap, a region of hydrostatic compre ssion.
Bone formation occurs periosteally in areas
of mild hydrostatic tension (marked "F") and
bone resorption occurs in areas of high
hydrostatic compression (marked "R") [4].

resorption and bone formation at specific periosteal sites adjacent to the gap (marked "R" and
"F" in Figure 4) .

The oblique pseudarthrosis roentgenogram also exhibited periosteal locations of bone resorption
(Figure 4, areas marked UR") . These locations correspond to regions of high hydrostatic pressure
in our finite element models. Applying the tissue differentiation concept (Figures 1, 3), we
would have expected either cartilage or fibrocartilage formation at these locations.

In the finite element analysis of distraction osteogenesis mentioned previously, cartilage

developed at the periosteal comers of the transverse fracture ends in regions of hydrostatic
pressure. The calculated value s of periosteal hydrostatic pressure in our oblique pseudarthrosis
model , however, may be extremely high and could be associated with the development of very
high hydrostatic pressure between the bone surfac e and the fibrous sheath of the pseudarthrosis.
Other investigators have suggested that high pressure at periosteal surfaces could cause bone
necrosis and lysis as a result of vascular compromise. It has also been suggested that vascular
compromise may result from the development of high fluid pressures at bone-implant interfaces
[21,22]. These studies and our finite element results (Figures 3, 4) lead us to conclude that mild
hydrostatic pres sure is conducive to cartilage formation in regenerating tissue but excessive
hydrostatic pressure at bone surfaces may induce bone resorption.

CONCLUSIONS

Skeletal tissue regeneration is similar in many different situations and is very strongly influenced
by vascularity and mechanobiology . We have shown that the initial phase of skeletal
regeneration involves the differentiation of mesenchymal tissue into either bone, cartilage, or
fibrous tissue. Our use of a mechanobiological concept of tissue differentiation relating
hydrostatic stress and tensile strain to skeletal tissue regeneration (Figure 1) has been shown to
be consistent with clinical observations of skeletal tissue format ion associated with normal
secondary fracture healing (Figure 2), distraction osteogenesis (Figure 3), and initial stages of
pseudarthrosis formation (Figure 4).

Acknowledgements-This work was supported by the Department of Veterans Affairs

grant ASOl·4R4 and the Palo Alto Veterans Affairs Rehabilitation R&D Center.
136 D.R. Carter et al.

REFERENCES
[1] D. Carter, Mechanical loading history and skeletal biology, J Biomech, 20, 1987, p. 1095-
1109.
[2] D. Carter, G. Beaupre, N. Giori, 1. Helms, Mechanobiology of skeletal regeneration, Clin.
Orthop. Rei. Res., 355S, 1998, p. S41-S55.
[3] D. Carter and G. Beaupre. Skeletal Function and Form, Cambridge Unive rsity Press,
Cambridge, UK, in press.
[4] D. Carter, E. Polefka, G. Beaupre, Mechanical Influences on Skeletal Regenerat ion and
Bone Resorption. in Bone Engineering, University of Toronto Press, Toronto, in press.
[5] F. Pauwels, Biomechanics of the Locomotor Apparatus. Springer-Verlag, Berlin, 1980.
[6] D. Carter, P. Blenman , G. Beaupre, Correlations between mechanical stress history and
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[7] D. Carter and N. Giori , Effect of mechanical stress on tissue differen tiation in the bony
implant bed , in The Bone-Biomaterial Interface, J. Davies, Editor. 1991, University of
Toronto Press, Toronto. p. 367-379.
[8] G. Zaman , S. Dall as, L. Lan yon , Cultured embryonic bone shafts show osteogenic
responses to mechanical loading, Calcif. Tissue Int., 51, 1992, p. 132-136.
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articular cartilage, J. Orthop. Res., 9, 1991, p. 1-10.
[10] R. Smith, S. Rusk, B. Ellison, P. Wessells, K. Tsuchiya, D. Carter, W. Caler, L. Sandell , D.
Schurman, In vitro stimulation of articular chondrocyte mRNA and extracellul ar matrix
synthesis by hydrostatic pressure, J. Orthop. Res., 14(1), 1996, p. 53-60.
[11] A. Goodship and J. Kenwright, The influence of induced micromovement upon the healing
of experimental tibial fractures, J Bone Joint Surg [Br] , 67(4), 1985, p. 650-5.
[12] J. Kenwright and A. Goodship, Controlled mechanical stimulation in the treatment of tibial
fractures, Clin. Orthop., (24 1), 1989, p. 36-47.
[13] J. Kenwright, J. Richardson, J. Cunningham, S. White, A. Goodship, M. Adam s, P.
Mangnussen, J. Newman , Axial movement and tibial fractures. A controlled randomi sed
trial of treatment , J. Bone Joint Surg. (Br) ,73(4), 1991, p. 654-9.
[14] T. Matsushita and T. Kurokawa , Comparison o f cycl ic co m p ression, cyclic
di straction an d rigid fixat ion. Bone healing in rabbits., Acta. Ortho. Scand., 69(1),
1998, p. 95-98.
[I S] G. Ilizarov, The tension-stress effect on the genes is and growth of tissues : Part II. The
influence of the rate and frequency of distraction, Clin. Orthop., (239), 1989, p. 263-85.
[16] G. Ilizarov, The tension-stress effect on the genesis and growth of tissues. Part I. The
influence of stability of fixation and soft-tissue preser vation, Clin. Orthop., (238), 1989, p.
249-81.
[17] G. Ilizarov , Clinical application of the tension -stre ss effect for limb lengthening, CUn.
Orthop., (250), 1990, p. 8-26.
[18] D. Paley, Current techniques of limb lengthening, J. Pediatr. Orthop., 8(1), 1988, p. 73-92 .
[19] B. Tay, A. Le, S. Gould , J. Helms, Histochemical and molecular analyses of distraction
osteogenesis in a mouse model, J. Orthop. Res., 16(5), 1998, p. 636-642 .
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University of Chicago Press, Chicago, 1968.
[21] G. Ateshian, W. Lai, W. Zhu, V. Mow , An asymptotic solution for the contact of two
biphasic cartilage layers, J. Biomech., 27(1 1), 1994, p. 1347-60.
[22] H. Van der Vis, P. Aspenberg, W. Tigchelaar, C. Van Noorden, Mechanical compressi on
of a fibrous membrane surrounding bone causes bone resorption, Acta. Histochem. , 101(2),
1999, p. 203-12.
Soft Tissues and Their Functional Repair
Dan L. Bader

Department of Engineering and IRC in Biomedical Materials, Queen Mary & Westfield College,
University of London, London, El 4NS, UK.

Summary: This paper discusses the problems associated with the establishment of dynamic
mechanical parameters which can describe the behaviour of human soft tissues and can be used as a
design template in their repair. This is illustrated in the in vitro fatigue behaviour of human tendons.
The model for fatigue damage requires adaptation to include a healing term to explain the presence
of intact tendons throughout the lifetime of most individuals. The introduction of tissue engineering
techniques may prove appropriate for the repair of many soft tissues. The development of a model
system, involving cartilage cells embedded in an agarose construct, has proved appropriate to
examine the effects of in vitro mechanical conditioning. A special apparatus permitted the dynamic
compression at different frequencies of individual constructs in culture conditions for periods of 48
hours. The measurement of cell proliferation and the synthesis of both cartilaginous matrix
components and signalling molecules was performed. Results indicated that the metabolic
parameters were affected by dynamic strain regimens in a separate manner. Indeed the data suggest
these processes occur in different cell sub-populations. This work raises the potential of in vitro
mechanical conditioning as a means to develop implants with long term mechanical functionality for
the repair of soft tissue defects.

Key words: Fatigue, Tendon, Chondrocytes, Mechanotransduction, Tissue Engineering

INTRODUCTION

Soft tissues are biological composite structures. In all cases they contain, in various amounts, the
ubiquitous biological macromolecule, collagen, in fibrous form. The building block of collagen
fibres is the tropocollagen molecule, 300 nm long and 1.5 nm wide, with a molecular weight of
approximately 300 kDa. Its molecular form is ideally designed to support tensile loads, to which
the structural composites are subjected. However, its precise role in the biological composite largely
depends upon the loading associated with the individual soft tissues. Thus tendons contain fibres of
collagen aligned in the direction of the tensile forces encountered during normal physiological
activities. Estimations of the tensile stresses experienced in patellar tendon, for example, range
from 29 MPa during isometric activities to values in excess of 50 MPa corresponding to rigorous
dynamic activities. By contrast, articular cartilage contains collagen fibres closely associated with
proteoglycan gels containing glycosaminoglycan. These solid components are synthesised and
maintained by a low density of cartilage cells. Their interaction provides mechanical integrity for
cartilage to support joint activities of the lower limbs in which the mainly compressive forces
regularly attain 3500 N and can exceed 10,000 N during vigorous sporting activities. If the contact
area of the cartilages are considered, then contact stresses of the order of 5 MPa are common in
normal walking.

BIOMECHANICAL STUDIES

There is a plethora of biomechanical studies on healthy soft tissues, but still little consensus
regarding a set of material constants which can uniquely characterise their dynamic mechanical
J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention
© Springer Japan 2000 137
138 D.L. Bader

properties. However, the mechanical testing of human soft tissues , such as tendons and muscles is
fraught with practical difficulties involving gripping the specimen, the measurement of
cross-sectional area of the load bearing elements, the degree of specimen hydration and the local
strain measurements within these non-homogeneous structures. These practical problems are
particularly critical in long term cyclic testing and this has led to a dearth of studies examining the
fatigue properties of soft tissues. In two related tensile fatigue studies [1,2], it was demonstrated
that human articular cartilage is prone to tensile fatigue failure in vitro. Tests on specimens from
human femoral head cartilage revealed that the fatigue resistance decreased with age at a rate which
was faster than that which could be explained by normal usage . The decrease in fatigue resistance
could not be related to either of the two major solid constituents of the specimens. By combining
the observations the following model was produced :-

S = 23 - O.la - 1.83 10g(N) (1)

where S is the stress in MPa, a is the age in years and N is the number of cycles to failure . In a
recent in vitro study, the effects of partial fatigue on the mechanical properties of articular cartilage
was evaluated [3]. Cartilage specimens were repetitively loaded at a frequency of 0.75 Hz using a
maximum compressive load of 65 N for approximately 80,000 cycles . This procedure revealed no
macroscopic damage to the surface of the cartilage specimen. Subsequent tensile tests produced a
reduction in tensile strength, which was attributed a weakening of the interfibril connections which
link collagen fibrils in the middle and deep zones of the cartilage matrix [4].

A study by the author has addressed the in vitro fatigue behaviour of human tendons [5]. Specimens
prepared from foot tendons were subjected to a cyclic square tension-tension stress waveform at
physiological frequencies. Ten specimens were tested at each of the nine prescribed maximum
stress levels of between 10% and 90% of the UTS. The minimum stress level was set at 1% UTS.
This protocol allowed the use of statistical models for the distribution of fatigue life.

The tendon specimens, which failed in the free-length region between the grips, revealed some
disruption of the fibres and clear evidence of fraying, caused by inter- and intra-fibrillar friction as
the fibres slid past one another during failure . The mean values for the failure strain of the 90
specimens was 14.2 ± 5.6 %. There was no statistical difference between the failure strains at each
of the nine different stress levels .

There was considerable variation in fatigue life at each stress level, the data also revealing a non-
normal distribution. As a consequence, a linear model based on the median value, equivalent to
a 50 % probability of failure , or survival. The relationship between stress and the median fatigue
life, as illustrated in Fig. I, produced a statistically significant linear model of the following form:

S = 101.25 - 14.8310g(N) (2)

where S is the stress normalised to the UTS , as a % age, and N is the number of cycles to failure.

This model predicted a static strength of 101.3 MPa, which was within one standard deviation of
the experimental data obtained in the quasi-static tensile tests. Based on the examined stress range ,
the linear model also suggested the absence of an endurance limit. The probability of failure at each
stress level was found to be adequately described by both the log-normal and the Weibull statistical
distributions. These differ in their hazard functions, i.e. the probability of failure as a function of
time, with the former predicting an endurance limit and the Weibull the absence of such a limit.

The fatigue life of tendons in vivo depends upon the stresses to which they are subjected. At a
stress level of 20 % of the UTS, the fatigue life based on the in vitro linear model for the 50 %
Soft Tissue s and Their Functional Repair 139

probability of failure was of the order of 300,000 cycles. This value is equivalent to a period of
about three months of normal walking activity. However, such an in vitro assessment could not
take into account the in vivo processes of healing and remodelling. Consequently, a modified
approach was required to predict these combined processes in vivo to explain the presence of intact
tendons throughout the majority of the population.

100

80

~
~
60
~
....
...'"'"
I»
100
CI:J
40

20

•
0
0 2 3 4 5 6
Log. Number of Cycles
Fig. 1 Normalised stress versus logarithm of number of cycle s to macroscopic failure . Each value represents
the median of 10 human tendons at each of nine prescribed stress levels (based on [5]).

A cumulative damage model , originally proposed for metallic structures, was extended to self-
healing living structures [6]. The damage was described in terms associated with mechanical
stressing, ageing and disease and a healing term was present for the repair of damage. The terms
associated with ageing and disease can be neglected if the mechanical stressing upon a healthy
structure spans over a short period of time, as was simulated in the study.

-
The self-healing model was simplified to:

D(t) = ~ { ~J H(t) (3)

where D(t) is the cumulative damage index . This parameter ranges from a value of 0, representing
the undamaged state prior to mechanical fatigue , to I, the state of failure due to fatigue. Such a
model was adapted to describe the behaviour of compact bone [7]. The term i
i= 1
{n; I Ni } is the stress

related damage, where n, and N, are the number of cycles at a stress level of S, and the number of
cycles to failure at that same stress level respectively.

A model was proposed involving stress related damage and a healing rate of 1 % per day based on
previous experimental data [8]. A graphical depiction of this model is illustrated in Fig.2 . It
clearly shows that this healing rate was found to be sufficient to eliminate, in less than 24 hours,
any fatigue damage on a tendon subjected to a stress of 20 MPa during daily normal locomotion.
140 D.L. Bader

1.0

stress damage
~
~
0.8
'tl
.5
~ 0.6
e
III

III
-e
.
~

::III
0.4

:;
e
U= 0.2

0.0
0 6 12 18 24
Time I hour

Fig.2 . In vivo model of stress related damage and associated healing for human tendons (based on [5])

Therefore the self-healing, or in vivo, model would predict that accumulated damage might occur if
either the number of load cycles were increased at the same stress level or the stress level was
increased. It is clear that the healing mechanism could be responsible for reducing the damage rate
at high stress levels and establishing an endurance limit at low stress levels.

The practical implications of the data was considered with respect to an athlete who might be
required to double their normal daily mileage prior to an event [5]. After a month the accumulated
damage would amount to 30 % and overuse injuries in the form of fatigue failure of tendons might
occur in approx imately 7 % of these cases

REPAIR STRATEGIES
Degenerative disease and injuries to soft tissues are extremely common in hospital clinics. They
involve all ages of the population. Indeed , soft tissue replacements amount to an estimated 35% of
the world market for all medical devices [9]. However, the vascularity of many soft tissues are poor,
as is the case of many tendons, or non-existent as with articular cartilage, and therefore the natural
healing response is limited . The repair of the latter tissue will be considered.

Many of the conditions causing partial and full thickness defects in cartilage occur commonly in the
younger population. These include trauma, osteochondritis dissecens, chondromalcia and tumours.
Joint replacement arthroplasty, a successful procedure for the elderly, is unsuitable in the young
group due to their physical demands and prolonged life expectancy, which can lead to early loosening
and prosthetic failure . Even a successful prosthesis only lasts about 15 years before a revision is
indicated and for a young patient, a series of revisions would be inevitable.
Soft Tissues and Their Functional Repair 141

A design template for implants to repair these tissues should involve consideration of specific
aspects of the healthy tissues. For example, the structural organisation of articular cartilage, which is
heterogeneous in nature, is dependent on the activity of its cells, or chondrocytes, to produce and
maintain the extracellular matrix. The chondrocytes are present at relatively low density and their
characteristics change with depth of cartilage. The mechanical integrity of cartilage is dependent
on the interaction of its extracellular components. The metabolism of chondrocytes is influenced by
the mechanical environment, a mechanism termed mechanotransduction, with the level of response
dependent on both strain magnitude and frequency. The exact extracellular signalling events in
articular cartilage are complex involving parameters, such as hydrostatic pressure, osmotic pressure,
streaming potential and cell deformation.

Ideally a successful implant will elicit a biological repair at the damaged site and integrate with host
tissue. In addition, the implant must provide mechanical functionality at all time following
implantation. There have been many options proposed for the repair of defects, affecting cartilage
and on occasions the underlying bone. These involve surgical procedures, the implantation of
synthetic materials, allografts, xenografts and the infusion of growth factors. A cellular approach
involving the implantation of isolated viable chondrocytes has largely resulted in the formation of
fibrocartilage, which differs in mechanical function to articular cartilage. To avoid the morbidity
associated with autologous grafts of articular cartilage, another approach involves grafts of
periosteum and perichondrium, both of which contain progenitor cells capable of chondrogenesis.
In an alternative methodology a group in Sweden have injected cultured chondrocytes under a
periosteal flap sutured over a defect in the cartilage surface [lO]. The chondrocytes are obtained
from biopsy tissue from low-load bearing cartilage areas and expanded in monolayer culture. Some
of the early clinical results are quite encouraging, although the mechanical integrity of this repair
system at all times post implantation has not been confirmed. The methodology has been
championed by one of the emerging tissue engineering companies (Genzyme Inc., Mass., USA).

An alternative tissue engineering approach is to contain cells within a 3D resorbable scaffold, with
inherent mechanical integrity. Success will depend on the ability of its cells to synthesise a
functional matrix at a rate sufficient to balance the loss of the resorbing scaffold . On
implantation, such systems will be subjected to normal physiological forces. It is important to
understand the effects of biomechanical conditioning of cells within tissue engineered systems to
predict their success in vivo, as determined by their long term mechanical functionality.

DEVELOPMENT OF CELL MODEL SYSTEM

With regard to the repair of cartilage defects, a well characterised physical model is commonly
used. It involves cells seeded in agarose gel constructs, in which chondrocyte phenotype and
morphology is maintained in culture. The model is ideally suited to examine chondrocyte
deformation under gross compressive strain. A complete mechanical characterisation of the
chondrocyte seeded agarose constructs has been performed. Such constructs are pre-treated with a
fluorescent strain, subjected to compressive loading regimens, and visualised using confocal laser
scanning microscopy (CLSM). Results reveal a change from a rounded morphology in the
unstrained state to an oblate ellipsoid form with applied strains of up to 30% [11,12]. CLSM also
permits the visualisation, usual dual staining techniques, of chondrocytes surrounded by pericellular
matrix elaborated after several days of culture. The presence of the pericellular matrix significantly
reduces the cell deformation in strained constructs [13]. Recently changes in sub-cellular
organisation, involving the nucleus and cytoskeleton components, under compressive strains have
been examined [14].
142 D.L. Bader

BIOMECHANICAL CONDITIONING OF CELL-SEEDED CONSTRUCTS

Conventional in vitro mechanical tests require the soft tissues to be kept in a moist environment and
are either performed on a Universal test facility or on a specially designed test system. However, if
tissue explants or cell containing biomaterial constructs are to be tested, viability must be
maintained in a conventional incubator, whilst the system is subjected to static and dynamic
loading. A common method to apply such loading is via a commercial strain unit (Flexercell,
Flexcell IntI. Corp., Mckeesport, USA), in which cells are attached to a flexible substrate at the
base of culture plates. Negative pressure is applied in a cyclic manner, to provide deflection of the
base of the plate. This produces a non-uniform strain field across the substrate. Studies have used
this system to apply cyclic strain to tendon cells and examine effects, in conjunction with growth
factors, on the stimulation of DNA synthesis [15].

An alternative cell straining apparatus (Dartec Ltd., Stourbridge, U.K.) was developed by the
author and his group in London to apply static and dynamic compression to biomaterial constructs
seeded with chondrocytes [16]. This apparatus, as shown schematically in Fig. 3, consists of a
conventional loading frame with an hydraulic actuator-controlled vertical assembly, which enters a
tissue culture incubator (Heraeus Instruments, Brentwood, U.K.).

t""IIl-- - - - - - - - - - Lo adi ng actuator

'Il ssue culture i ncuba tor

terile box

"F.!" +-+-+-+-+" + - - Loading pin

Fig . 3. Schematic of cell straining apparatus, which was used to apply compressive strain to
chondrocytes seeded agarose constructs.

The assembly is connected to a central rod which is attached to a mounting plate located within a
perspex box which, in turn, is placed on a circular platter fixed to the base of the loading frame. The
mounting plate holds 24 loading pins, half of which are unconstrained to move vertically in
Soft Tissues and Their Functional Repair 143

harmony with the loading assembly. Each loading pin incorporates an Ilmm circular perspex
indenter, which applies compressive strain to samples located within separate wells of a tissue
culture plate. All appropriate components must be sterilised prior to setting up any culture
experiments.

The development of this apparatus has enabled the author to perform a series of studies, which have
examined the performance of chondrocyte-seeded agarose constructs when subjected to prescribed
loading regimens. Constructs contained freshly isolated cells from full depth cartilage removed from
the metacarpalphalangeal joints of 18-month old steers. They were examined under loading
regimens of static compression and dynamic compression, at frequencies of 0.3, 1.0 and 3.0 Hz,
under a maximum strain amplitude of 15% [16]. In all cases during the 48 hour culture period, the
cell viability was maintained at a level in excess of 95% . Cellular performance was examined in
terms of three key metabolic processes, namely the synthesis of glycosaminoglycans (GAG), DNA
and total protein. A summary of the results are provided in Table 1.

Table 1 Summary of the effects of static and dynamic compression on the metabolism and proliferation of
chondrocytes isolated from full depth cartilage and seeded in agarose constructs .

15% Strain Amplitude

Static Dynamic

0.3 Hz 1.0 Hz 3.0 Hz

Cell proliferation ! r r r
GAG synthesis ! ! i nc
GAG released into medium r i r r
Protein synthesis ! ! ! !

Nitrite production nc ! -l. !

i (!) = increased (decreased) ; nc = no change

Values are compared to unstrained controls cultured for 48 hours in DMEM + 20% FCS within
the test apparatus.

It can be seen that static strain reduced cellular proliferation, as indicated by reduced radioactive
thymidene uptake, whereas dynamic strain at all frequencies induced an increase in cellular
proliferation. With respect to extracellular matrix, static and low frequency (0.3 Hz) dynamic strain
inhibited GAG synthesis, while a frequency of I Hz induced a significant stimulation of GAG
synthesis. The observation that at the high frequency of 3 Hz the GAG synthesis returned to
unloaded control levels, suggest the presence of a cut-off frequency which is probably associated
with the nature of fluid flow within these constructs. Although all loading regimens yielded an
inhibition in protein synthesis, as measured using radioactive proline incorporation, the analysis of
data revealed an association between the frequency and the level of inhibition. It is evident that the
three parameters were each influenced by dynamic strain regimens in a distinct manner, implying
that the associated signalling mechanisms are uncoupled.
144 D .L. Bader

160
0 Superficial
.s
l:

• Deep
*
"..=- *
150
0

0
u
140 *
..
.5
l: 130
:a
·s» 120
~
s: *
~ 110
Q
C
. 100
0
u
....0
90
Ill!
80
Control 0.3Hz 1Hz 3Hz

...
160
0 Superficial
150 • Deep

'"
.;] 140
...
GI
.c
c
.... 130
c'" 120
<
t.:l

=
...'"
C
Q
110

....
U
100
*
Q

~ 90

80

70
Control 0.3Hz 1Hz 3Hz

Fig. 4. r
3 H]-thymidene incorporation and GAG synthesis by superfic ial and deep chondrocy tes seed ed in
agaro se constructs and subjected to 15% gro ss compression at variou s freque ncies for 48 hours. All valu es are
normalised to unstrained values . Mean±SEM for at least 12 replic ates.

A further investigation involved the effects of cell origin on compre ssion-induced alterations in
proliferation and GAG synthesis [17). Chondrocytes within the superficial zone of articular cartilage,
Soft Tissues and Their Functional Repair 145

termed "superficial cells" are known to be morphologically and metabolically distinct from cells
deeper within the tissue. Thin slices of cartilage representing the uppermost 20% of the tissue
depth were removed from the bovine metacarpalpahlangeal joint. The residual cartilage tissue was
harvested and the isolated cells, termed "deep cells". The two sub-populations of cells were seeded
into separate agarose constructs and tested using an identical procedure to that previously adopted
[16]. Results, as illustrated in Fig.4, indicated that proliferation of superficial cells was stimulated by
dynamic strain whereas deep cells were not influenced. There was a general inhibition of
glycosaminoglycan synthesis by superficial cells. By contrast, deep cells produced a variable
response to dynamic strain; at I Hz there was a significant stimulation of glycosaminoglycan
synthesis, whereas at 0.3 Hz there was a significant inhibition.

These results strongly suggest that the two metabolic processes in response to dynamic compression
are not merely uncoupled, but occur in different sub-populations of chondrocytes within the full-
depth cell isolate. This conclusion raises the possibility of the involvement of distinct intracellular
mechanotransduction mediators. One possible mediator is nitric oxide which is known to influence
both GAG production and proliferation in chondrocytes. Its production, which can be assessed by the
measurement of its stable breakdown product nitrite, was examined in a separate study using full
depth chondrocytes seeded in agarose constructs and subjected to dynamic mechanical compression
[18]. Analysis of the results, which are summarised in Table I, revealed a frequency dependent
component in the inhibition of nitrite production. Further analysis indicated a significant inverse
correlation between dynamic compressive-strain induced alteration in nitrite production and [3H]_
thymidene incorporation, which was not evident with GAG synthesis. This may indicate that nitric
oxide is a component of mechanotransduction pathways influencing cell production but not
proteoglycan synthesis. This study has been extended to investigate the effects of cytokines, such as
interleukin-Iji, on the synthesis of nitric oxide, using the chondrocyte seeded agarose model.

The work, to date, suggests that the cellular behaviour within the agarose constructs, in terms of
proliferation and matrix synthesis, is highly dependent on both the level of frequency at which
loading is performed and the original source of chondrocytes in terms of cartilage location. It also
affirms the potential effectiveness of in vitro pre-implantation mechanical conditioning to optimise
construct performance post-implantation. The current focus of this mechanical conditioning
approach is involvedwith examining various stages associated with the tissue engineered repair of
cartilage defects [9]. Studies are underway to assess the performance of (i) chondrocytes following
monolayer expansion in vitro, (ii) chondrocytes from different location of the joint surface and (iii)
chondrocytes of human origin

ACKNOWLEDGEMENTS

Much of this work has been performed in collaboration with Dr David Lee and colleagues in the
IRC in Biomedical Materials. Financial support was largely provided by the EPSRC, UK. The
studies on the biomechanics of tendons were performed in association with Dr Helio Schechtman.

REFERENCES

[1] B.Weightman Tensile fatigue of human articular cartilage, Journal of Biomechanics, Vol. 9, 1976,
pp. 193-200.
[2] B.Weightman, DJ. Chappell, E.A. Jenkins, A second study of tensile fatigue properties of human
articular cartilage, Annals Rheumatic Diseases, Vol. 37, 1978, pp. 58-63.
146 D.L. Bader

[3] T. McConnack, J.M. Mansour, Reduction in tensile strength of cartilage precedes surface damage
under repeated compressive loading in vitro, Journal of Biomechanics, Vol. 31, 1998, pp.55-61.
[4] N. Broom, The altered biomechanical state of human femoral osteoarthritic articular cartilage,
Arthritis and Rheumatism., Vol. 27, 1984, pp.1028-1039.
[5] H. Schechtman, D.L. Bader, In vitro fatigue of human tendons. Journal of Biomechanics, Vol. 30,
1997, pp. 829-35.
[6] C.D. Nash C.D. ASME Publication 66-WAlBHF-3, fatigue of self-healing structure: a
generalized theory of fatigue failure, ASME - American Society of Mechanical Engineers, New
York,1966.
[7] D.R. Carter, W.E. Caler, A cumulative damage model for bone fracture, Journal of Orthopaedic
Research, Vol. 3, 1985, pp. 84-90.
[8] K. Hayashi, Biomechanical studies of the remodelling of knee joint tendons and ligaments,
Journal of Biomechanics, Vol. 29,1996, pp. 707-716.
[9] Materials Technology Foresight in Biomaterials, Institute of Materials, London, 1995.
[10] M. Brittberg, A. Lindahl, A Nilsson, C.Ohlsson, O. Isaksson, L.Peterson L, Treatment of deep
cartilage defects in the knee with autologous chondrocyte transplantation, New England
Journal of Medicine, 331, 1994, pp. 889-895.
[11] M.M. Knight, D.A. Lee D.L. Bader, Distribution of chondrocyte deformation in compressed
agarose using confocal microscopy, Cellular Engineering, Vol.1, 1996, pp. 97-102.
[12] M.M. Knight, D.A Lee, D.L. Bader, Measurement of the deformation of isolated chondrocytes
in agarose subjected to cyclic compression, Medical Engineering and Physics, Vol. 20, 1998, pp.
684-88.
[13] M.M. Knight, D.A Lee, D.L. Bader, The influence of elaborated pericellular matrix on the
deformation of isolated articular chondrocytes cultured in agarose. Biochimica et Biophysica Acta,
Vol. 1405, 1998, pp. 67-77.
[14] D.A. Lee, M.M. Knight, J.F. Bolton, B. Idowu, M.V. Kayser, D.L.Bader, Chondrocyte
deformation within compressed constructs at the cellular and sub-cellular levels. Journal of
Biomechanics, Vol. 33,2000, (in press).
[15] AJ. Banes, M.Tsuzaki, P. Hu, B. Brigman, T. Brown, L. Almekinders, W.T. Lawrence, T.
Fischer (1995) PDGF-BB, IGF-l and mechanical load stimulate DNA synthesis in avian
tendon fibroblasts in vitro, Journal of Biomechanics, Vol. 28,1995, pp. 1505-1514.
[16] D.A Lee, D.L. Bader, Compressive strains at physiological frequencies influence the
metabolism of chondrocytes seeded in agarose. Journal of Orthopaedic Research, Vol. 15(2),
1997, pp. 181-188.
[17] D.A. Lee, T. Noguchi, M.M. Knight, L.B. O'Donnell, G. Bentley, D.L.Bader, The response of
chondrocyte sub-populations cultured within unloaded and loaded agarose. Journal of
Orthopaedic Research, Vol. 16, 1998, pp. 726-733.
[18] D.A Lee, S. Frean , P. Lees, D.L. Bader, Dynamic mechanical compression influences nitric
oxide production by articular chondrocytes seeded in agarose. Biochemical and Biophysical
Research Communications, Vol. 251,1998, pp. 580-85.
An Application of the Pipette Technique to the Measurement
of Local Mechanical Properties of Aortic Walls
Masaaki Sato, Takeo Matsumoto, and Toshiro Ohashi

Department ofMechatronics and Precision Engineering, Graduate School of Engineering, Tohoku

University, Aoba-yama 01, Sendai 980-8579, Japan

Summary. Local elastic moduli in the wall of bovine and porcine thoracic aortas were measured
in the axial, circumferential, and radial directions by the pipette aspiration method. Comparing
the relationship between aspiration pressure and aspirated length in experiments with that of the
finite element analysis, we can calculate an elastic modulus of soft tissue. In experiments a glass
pipette was placed perpendicular to the surface of specimen and a negative pressure was applied
to aspirate the surface. The moduli in three directions obtained for bovine aortas were found to
decrease significantly and monotonously from the inner to the outer walls. No directional differences
were statistically found among the moduli at any radial positions in the wall. In contrast with the
bovine aorta, the elastic moduli in the porcine thoracic aortas were almost equal in any radial
positions in the cross section. From the histological point of view, there were quite distinguishable
differences between the bovine and the porcine aortas. Bovine aortas have a heterogeneous
structure, that is, large clusters of smooth muscle cells exist in the adventitial side. In porcine
aortic walls, a regularly layered structure is found. These aortic walls were stained with Azan-
Mallory and Resorcin-Fuchsin, and the histological image analysis was performed to quantitatively
asses the correlation between the elastic moduli and the distribution of the structural components.
The results suggested that the intramural distributions of elastic moduli were closely correlated
with the histological structure.

Key words: Biomechanics, Elastic modulus, Histological heterogeneity, Thoracic aortas

INTRODUCTION

Mechanical property of living soft tissues is one of the very important factors to understand
pathogenesis of disease such as atherosclerosis and to develop the diagnostics, as well as basic
information of the material. In the case of atherogenesis, lipids locally deposit on the lesion area
of arterial lumen, forming fatty streaks and fibrolipid plaques [1]. Atherosclerosis is known to
develop mainly at the favored sites such as arterial branching and sharp curvature. To understand
the mechanisms and predict the fatal plaque rupture, we need to know the local mechanical
property of the degenerated tissue. Microindentation test [2] is one of the possible methods for
the purpose. But, the measuring device seems to be too complicated for the wide use of the
method.

Pipette aspiration technique has been widely used to measure the mechanical properties of a
variety of cells such as erythrocytes [3], leukocytes [4] and endothelial cells [5,6]. This technique
was later refined to apply to the cultured cell treating it as bulk solid [7,8], and further applied to
arterial walls [9,10], atheroma of atherosclerotic lesion [11], ligamentum nuchae [12], and so on.

In this study, we present the intramural distributions of the elastic moduli in bovine and porcine

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 147
148 M. Sato et al.

aortic walls measured by the pipette aspiration method. Histological image analysis is also
performed to assess the correlation between elastic moduli and histology in those aortas. Area
fraction values of structural components in histological sections are calculated by a newly proposed
image processing technique, in which structural components in histological images are classified
based on their color tone [13].

LOCAL ELASTIC MODULI IN AORTIC WALLS

Bovine and porcine descending thoracic aortas were obtained at a local slaughterhouse. The
aortas were immediately immersed in physiological saline solution, transported to our laboratory,
and then stored at 4OC until the mechanical test was performed within 72 hours postmortem.
Three types of specimens having dimensions of 15-20 mm length by 5-10 mm width were
excised from the aortic segment in different directions. They were plates having rectangular
sections perpendicular to the axial, circumferential, and radial directions.

A schematic diagram of the pipette aspiration method is shown in Fig. 1. A detailed description
of experimental procedure has been reported previously [9]. Briefly, after setting a glass pipette
(0.56-0.69 mm inner diameter) perpendicular to a specimen surface, negative pressure was applied
to aspirate the surface. It has been confirmed that diameter variation in this range does not affect
the accuracy ofthe measured results. The aspirated length was optically measured while decreasing
the pressure. The elastic modulus was calculated by comparing the initial slope of the pressure-
deformation curves at the unloaded state obtained from the experiment with that determined by
finite element analysis. Namely, we focused on the initial value of the elastic modulus, i.e.,
Young's modulus. The finite element analysis was given elsewhere in detail [14]. The pipette
was placed in the directions normal to the cross sections, the longitudinal sections, and the
sections perpendicular to radius. We named the elastic moduli obtained in the three directions
EadQ/' E<Ire' and E,w, respectively, as shown in Fig.I. For cross sections and longitudinal sections,
EmJd and E<Ire were obtained by moving the pipette from the inner wall to the outer wall side
stepwise. For sections perpendicular to radius, the sections sliced parallel to the lumen were
aspirated (E,w).

Aspiration pressure
Pipette

Aortic wall

Fig. 1. Schematicdiagram ofthe pipette aspiration method. (10]

Measurement of Local Mechanical Properties of Aortic Walls 149

Intramural distributions of local elastic moduli in bovine and porcine aortas are summarized in
Figs. 2 and 3. Figures 2(a) and 3(a) show intramural distributions obtained from the cross and
longitudinal sections. Radial position in the wall is expressed by the distance from the inner wall,
h, normalized by the total wall thickness, hIt Closed and open circles indicate the elastic moduli
of each aspirated point. The moduli of bovine aortas decreased significantlywith increasing hlh 0
(p<0.01) as shown. For porcine aortas, both EtDIa/ and E_ were almost constant through the wall
as shown. The intramural distributions obtained from the section perpendicular to radius are
shown in Figs. 2(b) and 3(b). E md of bovine aortas decreased significantly with increasing hlho in
the same manner as the other two moduli (p<O.OI). In contrast, for porcine aortas, E,wdid not
also vary much with the measured position in the wall.

HISTOLOGY OF THORACIC AORTAS

After the mechanical tests, histological studies were performed on the cross and longitudinal
sectionsof both bovineand porcineaortas. The aspirated points were marked with water-insoluble
ink. The specimen was then fixed in 4% formaldehyde solution, embedded in paraffin, sliced,
and stained with Azan-Mallory for collagen fibers and smooth muscle cells. The specimen was
also stained with Resorcin-Fuchsin for elastic fibers. Azan-Mallory stains collagen fibers blue

III 400
Q. a • Eaxial
:=.
a
o Ecirc

I:4
Eci'" =162-164(hlho l
UJ 300 r=-o .668 (p<;O.Ol)

/~~~~~~~I
Qj
~ o. ,
~~ I I ~
.3 0.0 0.2 0.4 0.6 0.8 1.0
Relative distance from inner wall hlh o

400 b
lil
Q.
:=.
~ 300
tn

i
.2
~ ~ ~~~~~) Fig. 2 Intramural distributionsof elastic
moduliin bovinethoracicaortas. (a)Cross
100 ~ ~~~1(~011 and longitudinal sections. Solid and
brokenlines are the linearregressionlines
for Eaxial and Ecirc, respectively. blho is
the averaged value between 0.0 and 1.0
§ 0 . at 0.2 intervals. (b) Sectionperpendicular
...J 0.0 0.2 0.4 0.6 0.8 1.0 to radius. Solidlineis thelinearregression
line for the mean values of Erad. All
Relative distance from inner wall hlh o data are given as mean ± SO. [9]
150 M. Sat o et al.

lil Fig. 3 Intramural distributions of elastic

a.. 400 a • Eaxial moduli in porcine thoracic aortas. (a) Cross
~
o Ecirc and longitudinal sections. Solid and broken
~ Ecirc =l56-hAIo lines are the linear regression lines for Eaxial

_-++L~ -tit]--
300 and Ecirc, respectively. h/hois the averaged
1
r=-Q.OOO (N.S.) Eaxial=112-10(hAI
o)
value between 0.0 and 1.0 at 0.2 intervals.
UJ (b) Section perpendicular to radius. Solid
'3 200 line is the linear regression line for the mean
'8 values of Erad. All data are given as mean
E
(J

~
Qj
100
IT- ±SD. [10]

o LL-~----',--~--,-~_,--~......... _----.J

0.0 0.2 0.4 0.6 0.8 1.0

Relative distance from inner wall hlh o

«Xl b

300
Erad=138-29(hlh o)

4I I
r=-Q.253 ( N.S.)

II
200

100
I
I

a '
0.0 0.2 0.4 0.6 0.8 1.0
Relative distance from inner wall hlh o

and smooth muscle cells red. This staining method does not stain elastic fibers, so they remain
transparent Resorcin-Fuchsin stains elastic fibers violet. The microstructure was observed through
a photomicroscope and photographed, and then the 24-bit color image was transferred to a
personal computer system using a digital camera Image processing was performed on three
typical regions of 0.2 x 0.2 rom size: sub-intimal, mid-wall, and sub-adventitial regions .

For collagen fibers and smooth muscle cells, the area fractions of each structural component were
quantitatively determined by image analysis using a package software (IP Lab Spectrum ver . 2.3,
Signal Analytics Corporation). Structural components in the histological image were classified
based on their color tones to obtain area fraction values. Similarity between colors was determined
with Mahalanobis' generalized distance in (R, G, B) color space from predetermined color tones
[13]. The area fraction, A , occupied by each component in the region of interest is calculated by

Number of pixels of each component

Area fraction = - - - - ' - - - - - - . - . ; ; . - - x 100 (%) (I)
Total number of pixels

The area fraction for the elastic fibers was obtained by binarizing the histological image.
Measurem ent of Local Mechan ical Properties of Ao rtic Walls 151

Figures 4 shows typical photomicrographs of cross sections stained with Azan-Mallory in bovine
and porcine aortic walls. In the figure, the whole view and the magnified view of the sub-intimal
and the mid-wall regions of the aortic walls are shown. For bovine aortas, the structure was
extremely unusual. In the sub-intimal region, the histological structure had a fairly uniform
composition bounded by thick elastin lamellae. In the mid-wall and the sub-adventitial regions,
large clusters of smooth muscle cells were abundant and distributed nonuniformly . In addition,
the structural componentsin the sub-adventitial region seemed to be looselyarranged. Thus, this

a b
Luminal side

Advent itial side

Mid-wall Mid-wall

Fig. 4 Photomicrographs of cross section of (a) bovine [9] and (b) porcine [10]
aortas stained with Azan-Mallory.

region obviously had a different histological structure from the sub-intimal region. In contrast,
porcine aortas hada concentric layered structure of fairly uniform compositionwhich is typically
shown in textbooksfor aortas. Collagen fibers and smooth muscle cells were uniformlydispersed
between elastin lamellae. Similar histology was obtained in a longitudinal section and a section
perpendicularto radius for both aortas.

The area fractions of the structural components in the three regions are shown in Fig. 5. For
bovine aortas, the area fractions of collagen and elastic fibers were significantly smaller in the
sub-adventitial region than in the sub-intimal region. A significant increase was found in the
ratio of smooth muscle cell content from the inner to the outer walls. For porcine aortas, the area
fractions of the three structuralcomponents were almost uniformthrough the wall.

DISCUSSION

Intramuraldistributionsoflocal elastic moduli in bovine and porcinethoracicaortas were measured

by the pipetteaspirationmethod. It was shownthat the elastic moduli of bovineaortas significantly
decreased from the inner to the outer side of the wall. In contrast, the elastic moduli of porcine
aortas obtained in the three different directions were independenton the radial position in the
152 M. Sat o ct al.

;e
!!.....
« 100 a - - Collagen fiber (4) 100 b - - Collagen fiber (6)
c:cD - 0 - Smooth muscle cell (10) - 0 - Smooth muscle cell (6)
c: - 4 - Elastic fiber (6) 80 - 4 - Elastic fiber (6)
0 80
Co • P < 0.05 vs Sub-intimal
E
0
0 60 60
s:
0
ltl
cD
'0
c:
40 40
• a"
0
nltl
20 20
~
o OL----'---...l...---..L.--
...cD
ltl
Sub-intimal Mid-wall Sub-adventitial Sub-intimal Mid-wall Sub-adventitial
«
Radial position

Fig. 5 Area fraction of each component in (a) bovine and (b) porcine aortas. All data are
given as mean ± SEM . The number ofthe region ofinterest is shown in parentheses . [10]

wall. In a separate study, we performeda tensile test on a dumbbell-like specimen in bovine and
porcine aortic walls [15,16] . After slicing the walls into four separate layers, the tensile test was
performed on each layer to measure the elastic modulus. The moduli of bovine aortas were
significantly higher in the innennost layer (105.6 ± 24.0 kPa) than in the outermost layer (18.1 ±
1.6 kPa, p<0.05 vs. innennost layer) (15]. The circumferential elastic moduli of porcine aortas
were almost the same among the layers, i.e., their values were 161.0 ± 15.0 kPa and 144.4 ± 14.7
kPa in the innermost and the outermost layers, respectively [16]. These results were in good
agreementwith the results obtained here.

Histological observation revealed that there were marked differences in the histological structure
between bovine and porcine aortic walls. In an image analysis, the fractions of collagen and
elastic fibers were higher in the sub-intimal region than in the sub-adventitial region in bovine
aortas. It is known that the elastic modulus of collagen fibers is much higher than that of the
other two components. Though the smooth muscle cell content was higher in the sub-adventitial
region than in the sub-intimal region, the smooth muscle cells are less responsible for the elastic
modulus of aortic walls than the other two components due to their softness. The nonuniform
distribution of the elastic moduli might be attributable to this histological nonunifonnity. The
area fractions of the three structural components in porcine aortas were found to be almost the
same at any point in the wall. Mechanicaluniformity in the wall correspondedwith this histology.
Both results may indicate that the local elastic moduli of aortic walls are closely related to their
histological structure.

The structure and geometry of aortic walls in mammalian species including bovine and porcine
aortas were measured in detail by Wolinsky and G1agov [17]. They showed that the aortic walls
had concentric layers of fairly uniform composition regardless of species. The porcine aortas
used here had such a uniform layered structure. However, the bovine aortas showed a nonuniform
structure, which was extremely unusual. As described in the previous study [9], we checked the
possibility of the percentage of experimentalartifacts using five bovine thoracic aortas in order to
confirm this unusual histology, e.g. , we had changed the fixation condition of the specimen with
Measurement of Local Mechanical Properties of Aortic Walls 153

formaldehyde solution, resulting in no histological difference. Detailed histological observation

showed that the structure of the sub-intimal region was similar to that of an elastic vessel and that
of the other regions was similar to a muscular vessel. Therefore, such a nonuniform structure
may simply be undergoing transformation from an elastic to a muscular-type vessel. The reason
for this unusual histology remains unclear.

There were significant differences among the three elastic moduli in the three directions at each
section: sub-intimal, mid-wall, and sub-adventitial regions in porcine aortas [10], although no
significant differences were found for bovine aortas [9]. Blood vessel walls are generally anisotropic.
Some researchers have reported that there are significant differences among axial, circumferential,
and radial elastic moduli under normal physiological conditions [18]. However, their results
cannot be directly compared with the present results because strain ranges are different. It should
be kept in mind that the elastic modulus obtained in the pipette aspiration method can be considered
to be an averaged value of elastic moduli in different directions over a local region adjacent to the
pipette tip, where the achieved strain level also differs from point to point [14]. Therefore,
anisotropy with differences in elastic moduli among directions being at most twofold would not
affect the measured results. To clarify anisotropic elastic modulus, the use of a pipette with a
rectangular cross section has been proposed [12]. The rectangular pipette eliminated the effect of
the modulus parallel to the pipette's major axis, if its aspect ratio was greater than four. This
technique will be applied to elucidate the anisotropy of aortic walls in the near future.

CONCLUSIONS

The pipette aspiration method was applied to bovine and porcine aortas to measure intramural
distributions of the elastic moduli. Histological image analysis was also performed to assess the
correlation between elastic moduli and histology. The elastic moduli of bovine aortas decreased
significantly from the inner to the outer side in the wall. This mechanical nonunifonnity
corresponded with the decrease in the area fractions of collagen and elastic fibers from the inner
to the outer side. In contrast, the local elastic moduli of the porcine aortas were independent of
the radial position in the walls, indicating histological unifonnity . The intramural mechanical
properties in aortic walls are closely related to histological structure. Histological analysis is
thus essential to correlate mechanical properties of biological tissues with structural components.

ACKNOWLEDGMENTS

This research was supported financially in part by a Grant-in-aid for Scientific Research from the
Ministry of Education, Science, Sports and Culture, Japan (No. 10480241) and a Sasakawa
Scientific Research Grant from the Japan Science Society (No. 8-304). The authors wish to
express their appreciation to Messrs. Takayasu Sakamoto and Hisato Ando for their superb
technical assistance in the tensile tests, Ms. Yoko Kato for the image analysis and Mr. Yoshiki
Ogawara for carrying out histological observation.

REFERENCES

[I] N. Wolf. Pathology ofAtherosclerosis, Butterworth Scientific, London, 1982.

154 M. Sato et al.

[2] B.S. Gow, RM. Vaishnav, A Microindentation Technique to Measure Rheological Properties
of the Vascular Intima, Journal of Biomechanics, Vol. 28,1975, pp. 344-350.
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[4] G.W. Schrnid-Shonbein, K-L.P. Sung, H. Tozeren , Passive Mechanical Properties of Human
Leukocytes, Biophysical Journal, Vol. 36,1981, pp. 243-256 .
[5] M. Sato , MJ. Levesque, R.M. Nerem, Micropipette Aspiration of Cultured Bovine Aortic
Endothelial Cells Exposed to Shear Stress, Arteriosclerosis, Vol. 7, 1987, pp. 276-286 .
[6] M. Sato, MJ. Levesque, RM. Nerem, An Application of the Micropipette Technique to the
Measurement of the Mechanical Properties of Cultured Bovine Aortic Endothelial Cells,
Journal ofBiomechanical Engineering, Vol. 109, 1987, pp. 27-34.
(7) M. Sato, N. Ohshima, RM. Nerem, Viscoelastic Properties of Cultured Porcine Aortic
Endothelial Cells Exposed to Shear Stress, Jounal of Biomechanics, Vol. 29, 1996, pp.
461-467.
[8] D.P. Theret, MJ. Levesque, M. Sato, RM. Nerem, L.T. Wheeler, The Application of a
Homogeneous Half-space Model in the Analysis of Endothelial Cell Micropipette
Measurements, Journal ofBiomechanical Engineering, Vol. 110,1988, pp. 190-199.
[9] T. Ohashi, T. Matsumoto, H. Abe, T. Aoki, M. Sato, Intramural Distribution of Local Elastic
Moduli in Bovine Thoracic Aorta Measured by Pipette Aspiration Method, Cellular
Engineering, Vol. 2,1997, pp. 12-18.
[10] T. Ohashi, Y. Kato, T. Matsumoto, M. Sato, Intramural Distribution of Elastic Moduli in
Thoracic Aortas and its Relationship to Histology : Comparison between Porcine and Bovine
Thoracic Aortas,JSME International (Series C), Vol. 42,1999, pp. 568-573.
[11] N. Kataoka , T. Ohashi, T. Matsumoto, T. Aoki, M. Sato ,Application of the Pipette Aspiration
Technique to the Measurement of Local Elastic Moduli of Cholesterol-fed Rabbit Aortas,
Theoretical and Applied Mechanics, Vol. 43,1994, pp. 233-238.
[12] T. Ohashi , H. Abe, T. Matsumoto, T. Aoki, M. Sato, Analytical and Experimental Studies on
the Measurement of Soft Biological Tissue Elasticity using a Pipette with Rectangular Cross
Section, Transactions of the Japane Society of Mechanical Engineers (Series C), Vol. 63,
1997, pp. 867-874.
[13] Y. Kato, T. Matsumoto, M. Sato, A Histological Image Analysis Method using Color
Classification Based on Mahalanobis' Generalized Distance, Lift Support, (in press).
[14] T. Aoki, T. Ohashi, T. Matsumoto, M. Sato, The Pipette Aspiration Applied to the Local
Stiffness Measurement of Soft Tissues, Annals of Biomedical Engineering , Vol. 25, 1997,
pp.581 -587.
[15] T. Matsumoto, T. Sakamoto, M. Sato, Stress and Strain Analysis in Bovine Thoracic Aortas
using Tensile Test oftheir Thin Sliced Layers,JSME Proceedings ofthe 11th Bioengineering
Conference, No. 99-3, 1999, pp. 66-67.
(16] H. Ando, Stress and Strain Analysis in Arterial Walls using Tensile Test oftheir Thin Sliced
Layers, Bachelor Thesis, Tohoku University , 1999.
[17] H. Wolinsky, S. Glagov, A Lamellar Unit of Aortic Medial Structure and Function in
Mammals, Circulation Research, Vol. 20, 1967, pp. 99-111.
[18] DJ. Patel, Static Anisotropic Elastic Properties of the Aorta in Living Dogs, Circulation
Research, Vol. 25, 1969, pp. 765-779.
Locations of Bone Formation Change According to the
Waveform of Loads
-Hypothetic mechanism of cells to detect mechanical environment of bone-

Kazuo Takakuda', Hiroko Matsumoto " Jun Ohtsuka' , Katsuya Nagashima' , Takashi Koizurni' ,
and Hiroo Miyairi'

'Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-1 0 Kanda-Surugada i,
Chiyoda-ku, Tokyo 101-0062, Japan
2School of Engineering, Chuo University, 1-13-27 , Kasuga, Bunkyo-ku, Tokyo 112-8551, Japan

Summary: Cellular mechanisms of adaptive bone remodeling are reconsidered for the three
major proposed hypotheses . Candidate cellular mechanotransduction mechanisms introduced are
SA channels for the strain theory, flow mediated mechanotransduction mechanisms for the fluid
flow theory, and voltage gated ion channels for the electric potential theory. The most simple and
appropriate mechanism that explains how the bone cells detect the dynamic compression is given
by the electric potential theory. The strain theory requires undiscovered cellular mechanisms and
the fluid flow theory requires a possible but unobserved fluid flow to be appropriate.

Key words: Bone, Adaptive remodeling, Mechanotransduction, Fluid flow, Electric potential

INTRODUCTION
The chemical signals for bone formation under mechanical stimuli are transported to bone cells
with messenger molecules such as NO, PGI or PGE, according to the latest investigations [1,2,3].
Still the mechanotransduction mechanism, in which the physical signals are converted to the
chemical signals, is not yet been elucidated.

Three major hypothetical theories were proposed, they were the strain theory, the fluid flow
theory and the electric potential theory. We recently found that the locations of bone formation
change according to the waveform of artificially applied loads. It suggests that the bone recognize
not only the magnitude of the mechanical stimuli, but also the dynamic character of the stimuli as
compression or tension . Since the known sensory apparatus in bone cells are quite limited, this
finding introduces a new important issue in the argument on the mechanotransduction; whether
the proposed mechanism enables the cells to distinguish the difference between compress ion and
tension.

In this paper, we reconsider the known specific characters of the adaptive bone remodeling and
the possible sensory apparatus of bone cells, and presume the molecular biology of the
mechanotransduction.

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 155
156 K. Takakuda et al.

ADAPTIVE BONE REMODELING UNDER MECHANICAL STIMULI

Typical adaptive response of bones may be
observed after osteotomy. Immediate periosteal
woven bone formation changes external shape of
the bone, then internal remodeling succeeded make
the bone mature to have the lamellar bone structure.
Since primary and most significant geometrical re-
formation is realized with such periosteal woven
bone formation, we would focus the present
discussion how osteoblasts on periosteum Fig. I. Threepoint bending of rat's tibia

nnnnnnn
recognize the mechanical stimuli for the woven
bone formation. ( ) Oscillation

We have some remarkable characteristics on this

a load J UUUUUUL

JLJLJl
type of bone formation as follows;
i, Static loads have little effect on the bone (b) Pulse
formation, whereas dynamic loads significantly load
enhance the bone formation [4].

JI IUl 1Ui
ii, Dynamic loads must be applied repeatedly to be
(c) Pulse
an effective stimulus, yet it required only small unload
number of dynamic loads and further loading do
not increase the amount of bone formation [5]. Fig. 2. Waveform of applied loads
iii. Bone is formed on the surfaces where dynamic
compressive stresses are generated. Less or no
load-D.
n Oscillation
bone is formed on the surface where dynamic fuJ load
tensile stresses are generated. II Pulseload
The above iii is based on our experiments, in m Pulse
which an artificial three-point bending load was • unload
applied on a rat's tibia. Three waveforms of
loading we have examined were shown in Fig.2.
Bone was formed on different locations of the tibia
for the load of respective waveform. Under the
pulse-load shown in Fig. 2(b), the bone was Fig. 3. Location of boneformation
formed on the loading side as schematically illustrated in Fig.3. Contrarily, under the pulse-unload
shown in (c), the bone was formed on the side opposite to the loading side. Although this finding
looks contradictory, it is consistent with i, which state that the load must be dynamic to be
effective. In fact, the load (c) is the superposition of the static compressive load and the dynamic
tensile load. Since the former component is not the effective stimuli, the applied load is equivalent
to the dynamic tensile load. In this case, the stresses generated in the bone are of the same
magnitude but of the opposite sign as those generated by the compressive load. Thus the above
stated change of the location of the bone formation is quite rigorous, and we would state as iii that
bone was formed on the location where the dynamic compressive stress is generated. On the other
hand, under the oscillation load as shown (a), bone was formed near the neutral axis of the bone
under bending. Although the repetitive compressive or tensile stresses were generated on the
loading side and the opposite side, the effect was not significant. It implies the existing of the
inactive period following a shot ofloading.
Bone Formation Change and W aveform of Load s 157

STRAIN THEORY
SA (Stretch Activated) channels, which are ion channels gated
by stretching of the cell membrane, are reported to be expressed
in the bone cells [6]. With this kind of channels, it is possible
for the cells to directly detect the deformation of the matrix of
the bone. The problem to be examined is whether the cells can
distinguish the compression from the tension or not.

Such task seemed very difficult for the cells, since strain is a
tensor quantity and not a scalar one. If a long tubular bone was bone

• •
loaded with the axial compression, the strain component in the
axial direction is compressive, but that in the perpendicular
direction is determined by the Poisson's ratio of the bone and is tension
tensile. If we assume some populations of the cells have axial
C!:Ws c
IT
polarity and could detect the compressive strain in the axial
direction, the other cells of the perpendicular polarity would
detect the tensile strain as shown in FigA. Thus the cells should C."
be aligning in one direction in order to detect the compressive
strain. Although the bone cells are orderly aligned in normal
Fig . 4. Strains generated in bone
lamellar bones, they are not in tissues regenerated after a
under compression and stretch
fracture on which we observe the typical adaptive remodeling. activated channels of bone cells
Thus it is very difficult for the cells in such bone to distinguish
compressive strain from tensile strain.

Another essential difficulty for the cells is the detection of the compression. Almost of the
reported SA channels are activated with the stretch of the membrane but not with the compression.
Furthermore, it is difficult to imagine the cell membrane in compression. We should rather assume
that the cells were stretched enough in the free state of the matrix, and the degree of stretch would
lessen under the compressive strain. But such SA channels that are activated through the
relaxation of the membrane are not yet confirmed in bone cells.

Hence the strain theory requires undiscovered sensory apparatus of the bone cells than SA
channels to be appropriate . Of course, it remains such possibility that the osteocytes detect both of
the compressive and tensile strains, and the osteoblasts detect the compressive strain.

FLUID FLOW THEORY

Bone tissue fluid was believed to flow with loading on the bone. Furthermore, bone cells were
reported to response to shear stresses generated by the fluid flows [7,8,9]. Our next problem to
examine is whether the bone cells could utilize these flows to recognize the dynamic compression.
We consider here two candidate mechanisms.

One of the first possible mechanisms may be that the cells recognize the fluid shear stress itself.
Since the flow is a spatial phenomenon, a suitably structured network of conduits would enable
the bone cells to detect the compression. For example, if the cell bodies of all osteocytes lie on an
endoostea1 surface of a bone, and they extend their processes radially toward the periosteal
158 K. Takakuda et al.

surface, the flow generated in the bone might be that it

first flows toward the cell bodies and then it flows
back toward the processes. With such structure and the
suitably distributed sensory apparatus for the fluid
shear stresses, the cells might detect the compression,
however, we have never observed such structures in
any bones, and we expect little appropriateness of the
above mechanism.

Another possible mechanism may be that the cells

fi 6fi
l
recognize transportation of some molecules in fluid §
U .~ U• . ~
such as the ATP dependent Ca2+ mobilization. If we
assume that some molecules might be released into the Co
E +-
bone fluid, or some molecules might be receive 8
modifications during the flow through the conduits Fig. 5. Fluid flowin boneunder
among osteocytes, and further assume that lifetimes of compression/tension and flow mediated
such molecules are suitably short, the cells might mechanotransduction on bone cells
detect the compression as shown in Fig.5. For example, if the messenger molecules are exchanged
between the osteocytes and the osteoblasts via the fluid flow, these both cells might perceive the
internal and surface status ofthe bone and detect the compression.

In our experiment of the oscillating load of the waveform shown in Fig.2(a), we have observed the
bone formation near the neutral axis of the bone under bending, but not on the location of
maximum tensile or compressive stresses. Hence if the above fluid flow theory is correct, the
lifetime of the messenger molecules should be less than 1 sec. Under this restriction, we should
note the most probable candidate for the messenger molecule to be NO, whose transportation
might be specified to be through the canaliculi in bone tissue.

Thus the fluid flow theory has a certain chance to be appropriate, although we do know almost
nothing about the dynamic flow in the bones. Of course, it remains again the possibility that the
osteocytes detect both of the compression and the tension, and the osteoblasts detect the
compression.

ELECTRIC POTENTIAL THEORY

Bone cells have ion channels gated by membrane potentials. Our final problem is whether the
bone cells could detect the physical stimuli with these channels.

Electric potentials are generated in a bone with mechanical loading (10]. It is believed that the
load generated fluid flow is the origin of the electric potential, since the surfaces of the cells and
the matrixes are negatively charged and regulate the transportation of cations in the fluid. An in
vitro measurement of electric potentials generated with a mechanical loading of physiological
magnitude shows that the potential is as large as 200 mY/cm in a single osteon [11]. It also was
noted that the negative potential is generated in the compressive side of a bone, and the positive
potential in the tensile side.

Recently, bone cells were reported to have voltage gated Na' channels [12], Ca2+ activated K+
Bone Formation Change and Waveform of Loads 159

channels [13], and T and L type voltage gated Ca2+ channels

[14,15]. Among them the T type Ca2+ channels open with the ~endi ng
membrane depolarization about -60mY. Any change which

....
leads to an unbalanced potential difference between the cell
membrane possibly activate the voltage gated channels on the VG C
membrane. Depolarization of the cell may be triggered by the
decrease of'Na' and Ca2+ in extracellular fluid, the increase of Ca2 +
K+ in extracellular fluid, the decrease of the extracellular
electric potential, and the increase of the intracellular
potential. If the voltage gated Ca2+ channels are activated, the
level of intracellular Ca2+ increases which may result in +
cascade of responses. Similarly the changes in opposite
+
direction may cause a superpolarization of the cell and it also
may be followed by many cellular events. +
Accordingly the potential or ion concentration change
possibly activates the voltage gated ion channels of the bone
cells, and works as the mechanotransduction mechanism. The Fig. 6. Electric potentials
hypothetical stage of the mechanotransduction may be as generated in bone underbending
follows: and voltage gatedchannels of
I . The load on the bone generates fluid flow, which then bone cells
generates streaming potentials. The potential of the extracellular fluid decreases in the
compressive side of the bone and increases in the tensile side.
2. The decrease of the potential depolarizes the bone cells, and activates the T type voltage gated
Ca2+ channels as shown in Fig.6.
3. Repeated influx of Ca" by repeated loading stimulates the cells and activates the L type voltage
gated Ca2+ channels, which causes the increase of [Ca2+] i level.

The advantages of this theory are that we do not need to assume unknown messengers or
undiscovered functions of the cells. Furthermore, some peculiar characteristics of the bone
remodeling correspond to the cellular phenomena. A whole cell patch-cramp test [16] revealed
that a depolarization of 100msec able to activate the T type Ca2+channels of osteoblasts, and
repeated depolarization after 1 to 2 sec interval enhances the stimulation whereas those after 0.5
msec do not. This corresponds to the inactivated period mentioned above. She also remarked a
possibility that the repeated activation of the T type voltage gated Ca2+ channel resulted in the
activation of the L type voltage gated Ca2+ channels, which corresponds to the necessity of
repeated loading stated in above ii.

Another version of the hypothesis may include a coupling of the intracellular and the extracellular
ion concentration and the electric potentials. The volume occupied by the extracellular fluid in the
bone tissue is comparable to those occupied by the cells and the cell processes . Thus We can
imagine extracellular ion waves as well as intracellular calcium waves. The present model does
not specify the bone cells as osteocytes or osteoblasts. The mechanism could be appropriate for
both of the cells. Nevertheless, some evidence supports that different types of channels are
expressed on osteocytes and osteoblasts [17]. It remains again the possibility that the osteocytes
detect both ofthe compression and the tension, and the osteoblasts detect the compression.
160 K. Takakuda et al.

REFERENCES
[1] S.C.Rawlinson, AJ.El-Haj, S.L.Minter, LA.Tavares, ABennett, L.E.Lanyon, Loading-related
increases in prostaglandin production in cores of adult canine cancellous bone in vitro : a role for
prostacyclin in adaptive bone remodeling? Journal of Bone & Mineral Research, Vol.6, 1991,
pp.1345-51.
[2] C.H.Turner, LOwan, D.SJacob, R.McClintock, M.Peacock, Effects of nitric oxide synthase
inhibitors on bone formation in rats, Bone, Vol.21, 1977, ppA87-90.
[3] M.R.Forwood, WL.Kelly, N.F.Worth, Location of Prostaglandin Endoperooxide H Synthase
(PGHS)-l and PGHS-2 in Bone Following Mechanical Loading In Vivo, Anatomical Records,
Vol.252, 1998, pp.580-586.
[4] 1.Hert, M.Liskova, B.Landgrot, Reaction of bone to mechanical stimuli. Part 1. Continuous
and intermittent loading of tibia in rabbit, Folia Morphorogia, Vo1.19, 1971, pp.290-300.
[5] C.T.Rubin, L.E.Lanyon, Regulation of bone mass by mechanical strain magnitude, Calcified
TIssueInternational, Vol.37, 1985, ppAll-417.
[6] R.M.Davidson, D.WTatakis, AL.Auerbach, Multiple forms ofmechanosensitive ion channels
in osteoblast-like cells, Pfluegers Archive, VolA16, 1990, pp.646-651.
[7] K.M.Reich, J.A.Frangos, Protein Kinase C Mediates Flow-Induced Prostagrandin Ez
Production in Osteoblasts, Calcified TIssue International, Vol.52, 1993, pp.62-66.
[8] 1.Klein-Nulend, C.M.Semeins, N.E.Ajubi, P.J.Nijweide, E.H.Burger, Pulsating Fluid Flow
Increases Nitric Oxide (NO) Synthesis by Osteocytes but not Periosteal Fibroblasts - Correlation
with Prostaglandin Upregulation , Biochemical & Biophysical Research Communications, Vol.217,
1995, pp.640-648.
[9] 1.Klein-Nulend, E.H.Burger, C.M.Semeins, L.GRaisz, C.C.Pilbeam, Pulsating fluid flow
stimulates prostaglandin release and inducible prostaglandin GfH synthase mRNA expression in
primary mouse bone cells, Journal ofBone & Mineral Research, Vol.12, 1997, pp.45-51.
[10] D.Gross, WS .Williams, Streaming potential and the electromechanical response of
physiologically-moist bone, Journal ofBiomechanics, Vol.15, 1982, pp.277-295.
[11] WStarkenbaum, S.R.Pollack, E.Korostoff, Microelectrode Studies of Stress-Generated
Potentials in Four-Point Bending of Bone, Journal of Biomedical Materials Research, Vol.13,
1979, pp.729-751.
[12] D.Chesnoy-Marchais, 1.Fritch, Voltage-Gated Sodium and Calcium Currents in Rat
Osteoblasts, Journal ofPhysiology, Vol.398, 1988, pp.291-311.
[13] SJ.Dixon, J.E.Aubin, 1.Dainty, Electrophysiology of a Clonal Osteoblast-Like Cell Line:
Evidence for the Existence of a Caz+-Activated K+ Conductance, Journal of Membrane Biology,
Vol.80, 1984, ppA9-58.
(14] D.T.Yamaguchi, TJ.Hahn, A.lida-Klein, C.R.Kleeman, S.M.Muallem, Parathyroid Hormone-
activated Calcium Channels in an Osteoblast-like Clonal Osteosarcoma Cell Line, Journal of
Biological Chemistry, Vol.262, 1987, pp.7711-7718.
(15] GP.Vadiakis, A1.Banes, Verapamil decreases cyclic load-induced calcium incorporation in
ROS 1712.8 osteoblastoma cell culture, Matrix, Vo1.12, 1992, ppA39-447.
(16] SJ.Publicover, M.R.Preston, AJ.El Haj, Voltage-dependent potentiation of low-voltage-
activated Caz+ channel currents in cultured rat bone marrow cells, Journal ofPhysiology, Vol.489,
1995, pp.649-661.
(17] S.C.Rawlinson, AAPitsillides, L.E.Lanyon, Involvement of different ion channels in
osteoblasts' and osteocytes' early responses to mechanical strain, Bone, Vo1.19, 1996, pp.609-614.
Active Stress Models of Cardiac Muscle, Smooth Muscle and
Skeletal Muscle
Hiroshi Yamada' and Eiichi Tanaka2

'Department of Micro System Engineering, Graduate School of Engineering, Nagoya University,

Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
2Department of Mechanical Engineering, Graduate School of Engineering, Nagoya University

Summary: A common framework is introduced for constitutive equations of the mechanical

behavior of cardiac muscle, smooth muscle and skeletal muscle. Constitutive models were
formulated for each type of muscle based on finite deformation theory and findings on mechanical
and physiological properties presented in the literature. The total stress is expressed as the sum of
passive and active parts. The passive stress-strain relationship is expressed by an incompressible
transversely isotropic strain energy density function. The active stress was formulated so as to
express a stress development in the muscle fiber direction. The models describe the mechanical
behavior of the tissues under various conditions of activation.

Key words: Constitutive equation, Activation, Cardiac muscle, Smooth muscle, Skeletal muscle

INTRODUCTION

The heart, blood vessels and skeletal muscle-tendon complex contain muscular tissues, i.e., cardiac
muscles, skeletal muscles and smooth muscles, respectively. Every type of muscular tissue has the
same basic unit, the myofibril, which causes contraction. These tissues, however, present different
mechanical behaviors. This is because each muscle has a different mechanism of contraction,
different geometry and internal structure, and different mechanical and physiological conditions .
The cardiac muscles contract and relax periodically, as expressed in the cycle on ventricular
pressure-volume diagram. The smooth muscles respond slowly and with a longer contraction
duration to regulate the blood flow. The skeletal muscles develop an active force to shorten the
distance between the ends of the muscle-tendon complex, or to balance an external force under
various loading conditions.

In the current study, we introduce a common framework of constitutive equations to describe the
mechanical behavior of the three types of muscles. We then show our models and numerical
simulation results for the heart and blood vessels [1-3]. We also present one frame of the skeletal
muscle-tendon complex model as an extension ofa one-dimensional (lD) Hill based model [4].

COMMON FRAMEWORK OF MUSCULAR TISSUE MODELS

We make the following assumptions for muscular tissues, i.e., cardiac muscle, smooth muscle and
skeletal muscle, in the heart, blood vessels and skeletal muscle-tendon complex [1,3,4]:

I. The tissue is incompressible.

2. A muscle fiber orients in a single direction at each position in the tissue.
3. The tissue has both passive and active properties in the direction of the muscle fiber, but only
passive properties in the cross-fiber direction.
4. The tissue shows an elastic behavior in the passive state. Viscoelastic properties in the passive
state can be neglected to simplify the model when the loading rate dependence is negligible.
5. The stress on the tissue can be divided into passive and active parts.

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 161
162 H. Yamada and E. Tanaka

6. The active force depends on the number of muscle fibers. Therefore, the active stress is defined
as a nominal stress, i.e., the force in a unit cross sectional area before deformation.
7. The active stress depends on both mechanical and physiological factors in the muscle.

HEART WALL MODEL

A transversely isotropic constitutive model is formulated for cardiac muscle taking account of the
mechanism of excitation-contraction coupling [1]. The model describes the isotonic and isometric
contractions reported in the literature [5]. It also represents inotropic effects because it includes the
evolution equations describing the changes in the concentration of intracellular calcium ions.

The total stress is expressed as the sum of the passive and active parts. Using the second
Piola-Kirchhoff stress tensors, this relationship is expressed as
T=TP+T o • (I)

For the passive part, we postulate an incompressible transversely isotropic strain energy density
function, expressed as
poW =a exp(b)tr2 E + 2b2trE 2 +2b3trEtrME + 4b4trME 1 +bstr2 ME) (2)
where Po is the mass density in the undeformed configuration, E and I are Green's strain tensor and
the identity tensor, respectively, and a, b, ..., b5 are material constants . M is the structural tensor of
transverse isotropy with respect to the direction of anisotropy, obtained using the formula
M=h&Jh (3)
where h is a unit vector in the muscle fiber direction in the undeformed configuration, and the
symbol (&J) denotes a tensor product. The second Piola-Kirchhoff stress tensor 1" is obtained by
F = d(poW) Id E + H(2E + If' (4)
where H is an indeterminate pressure.

For the active part, the first Piola-Kirchhoff stress tensor sa is defined as
So =rORM (5)
where t' is the active stress in the muscle fiber direction. Denoting the rotation tensor R and the left
stretch tensor V, we note that the deformation gradient tensor F can be decomposed as
F =VR. (6)

There are reports describing the calcium ion concentration changes in papillary muscle [6], as well
as some stating that the duration of muscle tension is longer in isotonic contractions than in
isometric contractions [5], and that the reducing rate of the calcium ions in muscle cells depends on
the load on the muscle [6]. We thus express the concentration of free calcium ions in a muscle cell
as
{3 ={3o{(l+X)t}k exp{-(l+ X)lt}, X =[c) +c 2 exp{c3 (Sh -c4)}]y (7)
where k, I, c, ..., C4 are constants . The variable Sh expresses the nominal stress in the muscle fiber
direction as
s, =(Sh)o(Rh) (8)
The variable yexpresses the effect of the muscle shortening velocity with an evolution equation as
dy I dt = dAh I dt-csY (9)
where C5 is a constant. The rate of the stretch ratio in the muscle fiber direction, -ih , is expressed as
dAh ldt=(Eh)ohIJI+2(Eh)oh . (10)
where E is the rate of Green's strain tensor.
Active Stress Models of Cardiac. Smooth and Skeletal Muscle 163

The evolution equation of the concentration of calcium ions a in the vicinity of an actin filament,
which contributes to muscle contraction or muscle force development, is formulated as
da={ C6[1+{gJ+g 2exP(g 3Sh)}YJ(J3-a) , J3~a (II)
dt cl [1+ {g. + g j exp(g6Sh)}YJ(J3 -a), J3 < a
where C6, C7, g" .. ., g6 are constants.

The evolution equation of the ratio of the number of the sites which can react with myosin heads to
the number of all the sites on an actin filament , A,(t) [7J, is
dA,(t) I dt = cga K {I- A,(t)} - c9A,(t) (12)
where C8, C9 and /( are constants. The evolution equation of the ratio of the sites which react with
myosin heads and form cross-bridges to all the sites on an actin filament , n(t), is expressed as
dn(t) I dt =!(y){F(Ah)A,(t) - n(t)} . (13)
The parameter F(Ah) show s the degree of overlap betw een an actin filament and the corresponding
myosin filament s, by
Fh(Ah) = (F; exp[ - {(Ah - AhO) 1LUh}2J- Fo)' F; > Fo > 0 (14)
where Fo and F, are constants , and the symbol « » is the Macauley bracket defined as
< x >= x for x~O, and < x >=O for x<O . (IS)
The variable AhO is the stretch ratio corresponding to the max imum isometric active stress, and LUh
is half of the range of the muscle fiber stretch ratio for the active stress development. The
parameterJ{y) represents the effect of muscle velocity by
!(y)={fo exP {-(Y I J;) 2}, y~O (16)
fo exp {-(y I j;)2} Y > 0
wherefo,/J and.12 are constants.

The evolution equation of the active stress t' is expres sed as

dt" I dt =CIO (I +c" IYl)dn(t )1dt (17)
where C /O and C /I are constants,

To validate the proposed model, the numerical simulation results were compared with the
experimental results of Sonnenbl ick [5]. He measured the change in tension under an isometric
contraction and the change in shortening length under an isoton ic contract ion for papillary muscles
which were excised from the cat right ventr icle and soaked in Krebs-Ringer solut ion. Figure I
shows the change in tension under the isometric contraction. Figure 2 shows the change in the
decrease in stretch ratio under the isotoni c contraction. The value of Ah = 1.20 (corresponding to a
load of 3.9 mN) was chosen as the prestrain for ever y case, The proposed const itutive model well
describes both the isometric and the isotonic behavior of cardiac muscles .

40 0,20
30
0 0
'" Experimenta
Theoret ical
0.15
o '" 0 'V Experimental
Theoret ical
~§ 20
Ah=1.2 t
1.1 8 ~ 0,10
00
.~ 1.12
~ 10 0.05

0 0,00
o 400 800 1200 0 400 800 1200
Timc(ms) Time (ms)
Fig. 1. Isometric contraction of the cat papillary Fig. 2. Isotonic contraction of the cat papillary
muscles [5]. muscles [5].
164 H. Yamada and E. Tanaka

BLOOD VESSEL MODEL

The finite element model of the blood vessel which we have proposed consists of passive and
active elements [2,3]. The passive element corresponds to elastic and collagen fibers. The active
element corresponds to smooth muscles. This model has nine layers of these elements existing
alternately in a hollow cylindrical wall.

Blood vessels show a nonlinear incompressible anisotropic mechanical behavior. However, to the
best of our knowledge, commercially available finite element codes do not offer a material model
to express it. For the passive element, therefore, we postulated an incompressible isotropic strain
energy density function as
3
PoW = CI(lJ -3)+ I,Ck+I(l2 -3l (18)
k='
where II and l: are the first and the second invariants of strain, and CI , .. ., C5 are material constants.
The incompressibility condition is expressed as
/3 =1 (19)
where 13 is the third invariant of the strain. The second Piola-Kirchhoff stress tensor T is obtained
in the same way as Eq. (4). The Cauchy stress tensor ais obtained from the relationship
(T = (det Fr' FTF
T
(20)
where the determinant of deformation gradient tensor is I, which is identical to Eq. (19).

For the active element, we assume the division of the total Cauchy stress tensor as
(T = + (TP (To, (21)
which is identical to the relationship in Eq. (I) for the second Piola-Kirchhoff stress tensors.

The passive part is modeled as a linear hypo-elastic material as

fj . = Ev (trD)I +...!...- D (22)
passive (I +v)(l- 2v) I +v
where (A) is a Jaumann time derivative, D is the rate-of-deformation tensor, and E and v are
Young's modulus and Poisson's ratio, respectively. The active part of the stress is defined as a
nominal stress, i.e., the first Piola-Kirchhoff stress tensor, as
So =Sh(e ,A)RM (23)
where Sh(e, A) is an active stress in the smooth muscle direction, as a function of an activation level
eand a stretch ratio in the muscle direction A. The Cauchy stress tensor can be expressed as
(To = (detFr'Sh(e,A)mV (24)
where m is the structural tensor in the deformed configuration .

The active stress, which develops in the smooth muscle direction, is expressed as
Sh(~,A)=eShmax(A), O~e s: (25)
where S{IQX(A) is the maximum isometric active stress. This is expressed by
max j-4.981()../ A",.. - 1)3-5.522(AI A",.. _1)2 + I, 0.293 ~ AI A",.. s1
S~ ()..) 4.079(AI A",.. _1) 3-5 .068(AI A",.. _1)2 + I, 1< AI A",.. s 1.635 (26)
s, (A",..) 0, AI A",.. < 0.293, AI A",.. > 1.635
based on Murphy's summary for various smooth muscles [8].

Based on the results of an experiment with a canine tibial artery by Price et al. [9], the relationship
between the activation level and the concentration of norepinephrine (NE) is approximated as
log., C NE =[loglQle /(l-~)}]/ a NE + log., CNE k=o.5 (27)
Active Stress Models of Cardiac, Smooth and Skeletal Muscle 165

where CNE is the NE concentration (molll or M), and a NE and log cN£I~=O.5 are material constant s.

A finite element analysis was performed for the model with an inner diameter of 2.8 mm and an
outer diameter of 4.0 mm, using ABAQUS/standard ver. 5.7 (H.K.S., Inc.). The pres sure-diameter
relationship was compared with Cox's expe rimental results [10). The bound ary conditions were a
transmural pressure of 0-27 kPa and a constant axial stretch of 1.7 with various NE concentrations.
The residual stress was not cons idered in the analysis.

Figure 3 shows the simulation results of the pressure-diameter relat ionship of a canine renal artery
at various NE concentrations. When the NE concentration is 1.0* I0'8M, the activation level is zero
(~= 0.00), which corresponds to the passive state. When the NE concentration is 1.0*10'6 M
(~ = 0.20), a large contraction occurs in the low transmural pressure range, Th is tendency in the
pressure-diameter relat ionship is similar to the behav ior of elastic-type arter ies in the active state .
When the NE concentration is 1.6*lO'6M (~=0.33) or 2.5*IO'6M (~=0.48), there is a pressure
level in which a sudden increase in diameter occurs . This phenomenon was reported in
muscular-type arter ies in the literature [II). When the NE concentration is 1.0*10.3 M (~= 1.00),
the unstable phenomenon does not occur in the pressure range of 0-27 kPa . To predict large
changes in diameter in the max imally activated state, inelasti c properties may have to be included .

Figure 4 show s the distr ibutions of the circumferential component of the Cauchy stress in the
arterial wall at the passive state and the max imally activated state under a transmural pressure of 13
kPa . Becau se the residual stress is not considered in this analysis, a stress concentration occurs in
the vicinity of the inner wall. In the pass ive state, the passive elements resist the transmural
pressure. In the active state, on the other hand , the active elements resist this pressure by
developing an active stress in the circumferential direction.

co 600
co
c,
~
25 a Exp (Cox)
NE (M):
!
a
a Active
o,
~ 500 • Pas. Act. state
•... 0 Passive elem .
20 - 1.0'10 -3 V Active elem.
!
~"'
[I! a stales 400
--- 1.0'10.0 f Avera ed
•
::J

.,"'"' 15 _.- 1.6'10.0

D/ .-- · ·· · · · · · · · · , ·~; iii 300
is.. :0... Ii" 1§
~ 10
· ·.., 2.5' 10.0 6/ , ' ~ ' - ' - ' - ' /
:; .
c: 200
,,/
•
Q)
··· ·· 1.0' 10-3 Q; 100 v
••
::J
E
"'
c 5 ~k>--'--'-' E 0 a..o.' v
· · ·· ··.:..:..~ -.-o
.='"
::J
.=
<J •
o ~i/ 0
<> U -108
8 .0 0.5 1.0 1.5 2.0 .0 0.2 0.4 0.6 0.8 1.0
Normalized outer diameter Normal ized location in undeformed wall

Fig, 3, Pressure-diameter relationship of the canine Fig, 4, Circumferential stress distributions of the
renal artery at various levels of activation [10]. artery under a transmuralpressure of 13 kPa.

SKELETAL MUSCLE-TENDON COMPLEX MODEL

A framework of const itut ive equations for a muscle-tendon complex has been formulated [4]. An
advantage of this formulation is that the model predicts the mechanical behavior of the muscle in a
similar way to the 1D model [12] under a uniaxial loading condition, by using parameters similar to
those in the ID model. However, there are drawbacks: (I) the muscle mode l, which consists of a
contract ile element and a parallel elast ic element , and the tendon model, which cons ists of a series
elastic element, can not be correlated clearly with the muscle region and the tendon region in a
muscle-tendon complex, respectively, (2) this model can not describe a history-dependent behavior.
166 H. Yamada and E. Tanaka

For the muscle model, the total stress is assumed to be the sum of the passive and active parts as in
Eq. (I) or Eq . (21) . The passive part can be formulated as an incompressible transversely isotropic
material, as in Eq. (2), which causes a compressive stress for a compressive strain. For the active
part, the active stress is defined in the same way as in Eq. (5) or Eq. (23), i.e., as a nominal stress,
by
sa =Sh(~,£ ,e)RM (28)
where the muscle fiber stress Sh is a function of the active state ~, strain £ and strain rate e .

The tendon model is assumed to be transversely isotropic with a principal axis of anisotropy in the
muscle fiber direction. A strain energy density function can be formulated in the undeformed
configuration as Eq. (2), which is a function of the structural tensor and Green's strain tensor.

ACKNOWLEDGEMENT

This work was partially supported by a Grant-in-Aid for Scientific Research (C) (1I650087) from
the Ministry of Education, Science, Sports and Culture, Japan.

REFERENCES

[I] E. Tanaka, O. Tanaka, Three-dimensional Constitutive Model of Cardiac Muscle Taking into
Account Contraction Mechanism, Simulations in Biomedicine IV, H. Power, C.A. Brebbia, J.
Kenny (Eds .), Computational Mechanics Publications, Southampton, 1997, pp. 113-122 .
[2] H. Yamada, T. Shinoda, E. Tanaka, S. Yamamoto, Finite Element Modeling and Numerical
Simulation of the Artery in Active State, JSME International Journal, Series C, Vol. 42, 1999,
pp.501-507.
[3] H. Yamada, T. Shinoda, E. Tanaka, S. Yamamoto, A Mathematical Model and Numerical
Simulations of Vascular Response to Smooth Muscle Activation, Computer Methods in
Biomechanics and Biomedical Engineering - 3, J. Middleton, M.L. Jones, N. Shrive, G.N.
Pande (Eds .), Gordon and Breach Science Publishers, 2000 (in press).
[4] H. Yamada, 1. Kajzer, A Mathematical Model and Numerical Simulations of Skeletal Muscle
Response under Stretching with a Consideration of Yielding Phenomena, Computer Methods
in Biomechanics and Biomedical Engineering - 3, J. Middleton, M.L. Jones, N. Shrive, G.N .
Pande (Eds.) , Gordon and Breach Science Publishers, 2000 (in press) .
[5] E.H . Sonnenblick, Implications of Muscle Mechanics in the Heart, Federation Proceedings,
Vol. 21,1962, pp. 975-990.
[6] P.R. Housmans, N.K.M. Lee, J.R. Blinks, Active Shortening Retards the Decl ine of the
Intracellular Calc ium Transient in Mammalian Heart Muscle , Science, Vol. 221, 1983, pp.
159-161.
[7] R.B. Panerai, A Model of Cardiac Muscle Mechanics and Energetics, Journal of
Biomechanics , Vol. 13, 1980, pp. 929-940.
[8] R.A. Murphy, Contractile System Function in Mammalian Smooth Muscle, Blood Vessels, Vol.
13,1976,pp.I-23.
[9] J.M. Price , D.L. Davis, E.B. Knauss, Length-Dependent Sensitivity in Vascular Smooth
Muscle, American Journal ofPhysiology, Vol. 241, 1981, pp. H557-H563.
[10] R.H. Cox , Regional Variation of Series Elasticity in Canine Arterial Smooth Muscles,
American Journal ofPhysiology, Vol. 234, 1978, pp. H542-H551 .
[11] R.H. Cox , Mechanics of Canine Iliac Artery Smooth Muscle in Vivo, American Journal of
Physiology, Vol. 230,1976, pp. 462-470.
[12] H. Yamada, J. Kajzer, A Mathematical Model of Skeletal Muscle and Numerical Simulations
of Its Response under Stretching, JSME Int. Journal, Series C, Vol. 42 , 1999, pp. 508-513.
Development of High-Speed Tensile Test System
for Ligaments and Skeletal Muscles
Sota Yamamoto', Janusz Kajzer' and Eiichi Tanaka'

'Dept. of Mechanical Engineering, School of Engineering, Nagoya University,Nagoya 464-8603, Japan

Summary: Although the effects of strain rate on the mechanical properties of ligaments and tendons
has been one of the most popular subjects of investigation , many issues remain to be clarified. More-
over the strain rate conditions in most studies were not fast enough for the examination of injury
prevention in traffic accidents. As for skeletal muscle , only a few dynamic tensile tests have been
done, but the mechanical properties of activated skeletal muscle have not been studied. With this as a
background, the purpose of the current study is to develop a new tensile test system to evaluate the
mechanical properties of ligaments and skeletal muscles at various strain rates and to perform pre-
liminary tests to evaluate the effects of strain rate. We designed a new hybrid type tensile tester which
has an AC servomotor for quasi-static tests and a N 2 gas actuator for high-speed tests . The results of
preliminary experiments with MCL showed the stress-strain curve s to be almost linear for tensile
velocitie s between 0.01 and 10 mm/sec . However, the stress-strain curves changed drastically into a
convex shape under high-speed condition. As for the tibialis anterior muscle , the failure sites were
mainly the muscle-tendon junction (MTJ) in an active state, in contrast to the muscle belly in a pas-
sive state. At 200 mm/sec tensile velocity, failure stress in the active state was greater than that in the
passive state.

Key words: Ligament, Skeletal muscle , Mechanical property, Strain rate dependence

INTRODUCTION

Ligament and tendon injuries often occur in sports and traffic accident s. For example , 1/3 of all traffic
injurie s involved the lower extremities, and knee joints were the locus of 1/9 of all injuries [I]. In
most cases of knee joint injury in sports and traffic accidents, ligaments or tendons are most fre-
quently involved. Injured knee ligaments will take a longer time to heal than bone fractures and often
need grafting operations or artificial ligaments. Accordingly, we can say that the prevention of knee
ligament injuries is very important. Mechanical properties of ligaments and tendons have been stud-
ied from various points of view. In particular, the effects of strain rate has been one of the most
popular subjects [2]-[5] . However it can be said that the strain rate dependency of the mechanical
properties of soft connective tissue is not sufficiently understood, especially in the high strain-rate
range which includes the loading condition in traffic accidents.

The skeletal muscles, which play an important roll in the kinematic s of a body, are prone to frequent
injury . To evaluate the injury criteria of ske letal muscles it is neces sary to clarify the mechanical
properties of these tissues. Information about the mechanical properties of activated muscle is also
useful in discussing the behavior of joints during impact. However, only a few dynamic tensile tests
have been done [6][7] and the mechanical propert ies of activated skeletal muscle have not been stud-
ied except by Myers et al. [8].

With this as a background, the goal of the current study was to develop a new tensile test system for

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 167
168 S. Yamamoto et al.

biological soft tissue in quasi-static and dynamic conditions . Preliminary tests were also performed to
examine the mechanical propertie s of rabbit medial collateral ligaments and tibial anterior muscles
and to validate the functionality of this new testing system.

DEVELOPMENT OF APPARATUS

Specification of tensile test system. This study aims to evaluate the mechanical properties of bio-
logical soft tissues in the wide strain-rate range. To estimate the maximum extension rate, we used a
model case for knee injury in a car-to-pedestrian accident, in which the front bumper of car hits a
pedestrian's knee joint from the lateral side at 36 km/h. This condition is one of the most severe of soft
tissue inj uries. When the lengths of MCL, femur and tibia are about 8, 40 and 40 em, respectively, and
the width of the tibia/femur condyle is 8 em, the strain rate can be estimated as 5000 %/sec. To scale
this condition to rabbit MCL (about 2 em in length) , the corresponding extension rate is 1m/sec.
According to this estimation, we adopted I m/sec as the maximum tensile velocity of the test system.
The minimum tensile velocity was as defined 0.01 mm/sec, making it of comparable value with other
systems .

Development of tensile tester. For quasi-static test, we can find many products which are divided
into two types of actuator: the electric motor type and the hydraulic type . However, both of them are
impossible to apply to dynamic tests. On the other hand, most available dynamic tensile testers of the
hydraulic type are not controllable in a quasi-static test. Therefore, we developed a new hybrid type of
tensile tester which has an AC servomotor and a N z gas actuator. A schematic drawing of the control
and data acquisition system is shown in Fig. I. Thin lines show the control signal and data traffic for
quasi-static tests, and thick lines are for dynamic tests. The velocity ranges of the servomotor and gas
actuator are sequential, that is, the servomotor works as the actuator for quasi-static tests when the
elongation rate is between 0.01 mm/sec and 10 mm/sec, and the N z gas actuator is used for dynamic
tests when the elongation rate is over 100 mm/sec.

The force applied to ligament/muscle is measured by a load cell that consists of a steel rod and
semiconductor type strain gauges (1.7 mm X 0.25 mm X 30 mm). The chuck was made of MC nylon
resin to reduce the active mass under the load cell. The angle of the chuck is adjustable, and the lower
chuck can be moved forward and backward (± 75 mm) or right and left (± 50 mm) . The upper and
lower chucks are set in a tissue bath made of acrylic resin .
- - - High Speed System ( Offline)
Gas Cylinder - - - Low Speed System

Fig. I. Schematic diagram of tensile test

system .
High-Speed Tensile Test System for Ligaments and Skeletal Muscles 169

In the quasi-static test mode, the test system is controlled by a PC with an 10 board (National Instru-
ments, PCI-MIO- 16E-I) which generates pulse signals to the motor driver to control the direction and
velocity of the crosshead movement. The PC is also used as a data acquisition system. The signal of
the load cell inputs the PC through a strain amplifier (NEC San-ei Instruments, AS2103) . The tissue
strain is measured by a video measuring system (Hamamatsu Photonics, C5405, C3l62). This system
(VDA) measures the distance between markers affixed to the surface of the tissue.

The dynamic test is performed manually. First, the gas chamber is pressurized by N 2 gas. Since the
pressure-piston velocity relation is examined in advance, the piston velocity is defined by controlling
the gas pressure . This piston consists of two parts : the main piston and the running part which is
directly connected with the upper chuck . When the piston velocity is under 300 mmlsec , the running
part is fixed to the main piston. On the other hand, the running part is disconnected from the main
piston when the piston velocity exceeds 300 mm/sec, and only the main piston is sufficiently acceler-
ated in advance before the chuck (with specimen) starts to move. When the solenoid-controlled valve
of the chamber is opened manually, data acquisition begins automatically. The signals of the load cell
and rotary encorder mounted on the piston are stored on a digital oscilloscope (Sony Techtronix,
TDS420A). After the test, the data is transmitted to the PC through a GPIB interface. The strain is
measured by a high-speed video camera (Kodak, HS-4540) and VDA (Hamamatsu Photonics, C3162) .
The signal from the solenoid-controlled valve is used as the trigger for the high-speed video camera .
The images are stored in the memory of the camera during the test. The image is analyzed by VDA in
the same way as in a quasi-static test.

All sequences of system control and data acquisition sequences for the PC were programmed by
using a LabVIEW ver. 5.0. I (National Instruments).

Cross sectional area meter. To measure the cross sectional area of soft tissue, a non-contact area
meter was developed . The schematic diagram of the system is shown in Fig. 2. The basic idea of this
system is based on Lee et al. [9], and it consists of specimen holders and a laser micrometer system
(Keyence , LS-5040, LS-55OO) . The holders for the ligament specimen are adjustable to the angle of
the specimen and the distance between the two chucks . The holders for muscle specimens only grips
the tendon or bone in which muscles are inserted. Both chucks are connected with stepping motors
(Oriental Motor, UPK543-NAC) and can rotate 0.72· in one step. The laser micrometer is installed
perpendicular to the longitudinal axes of the specimen. The specimen bisects the laser band (40 mm
width) of the micrometer, so that the specimen widths at each rotational angle can be measured . These
data are acquired over the range of rotational angles from O· to 180· by the PC through the 10 board
described above. This PC also plays the role of a pulse generator for the stepping motors . In addition ,
one chuck is equipped with a load cell (Kyowa, LB-SB-34D) to indicate the tension of the specimens .

Fig. 2. Schematic diagram of cross-sectional

area measuring system .

MATERIALS AND METHODS

In preliminary experiments with the new quasi-static and dynamic tester, we examined the mechani-
cal properties of rabbit MCL and anterior tibial muscle over a wide strain-rate range .
170 S. Yamamoto et al.

Ligament experiments. Twenty female Japanese white rabbits (3.0 ± 0 .1 kg) were used for the
preliminary tests. The rabbits were sacrificed by injecting an overdose of pentobarbital sodium . The
hind limbs were excised and stored in gauze soaked in 0.9 % saline solution . All soft tissues, except
for MCL and their insertions, were removed carefully without damaging MCL, and these femur-
MCL-tibia complexes were used as specimens. The cross sectional area of each specimen was mea-
sured by using the laser cross sectional area meter. After measuring the total cross sectional area, the
outer two-thirds of MCL substance was cut, and the remaining central one third was measured again .
During the measurements of cross sectional areas 5 N force were applied to the specimens. Both ends
of the femur and tibia were embedded in a metal mold with dental resin (GC, Ostron II) and formed
into a tapered shape to make them easy to grip. Black markers were affixed to the surface of MCL by
nigrosin. The femur and tibia were attached to the chucks of the tester. The shapes of the clamps were
also tapered so the specimen could be held rigidly. The tissue bath was filled with 0.9% saline solu-
tion of 37'C. The specimen was preconditioned by 10 cycles of repeated loading with a 0.2 mm
amplitude and a preload of 0.5 N was applied. The specimen was loaded to failure at one of five
extension rate conditions: 0.01, 0.3,10,100 or 300 mm/sec . Conditions of 0.01, 0.3 and 10 mm/sec
were performed in the quasi-static test mode , and those of 100 or 300 mm/sec in the dynamic test
mode.

Muscle experiments. Eleven female Japanese white rabbits (2.9 ± 0.1 kg) were used . The anterior
tibial muscle and deep peroneal nerve were exposed under anesthesia with pentobarbital sodium.
After sacrifice by injecting an overdose of pentobarbital sodium, the anterior tibial muscle was re-
moved with the distal tendon, proximal tibia and deep peroneal nerve . The nerve was cut at the
proximal end of the nervus ischiadicus. The muscle was kept in Krebs-Ringer solution at 4°C. The
primary muscle length was defined by using markers affixed to the surface ofMCL by nigrosin before
removal from the hind limb. In the same way as for ligament, the cross sectional area of each speci -
men was measured at the center of the muscle by using the laser cros s sectional area meter. The
muscle was elongated to its length in situ. After measuring the cross sectional area, the tibial condyle
was embedded in a metal mold with dental resin (GC, Ostron II) to make it easy to grip . Then the
tendon and tibia were attached to the chucks . The tendon was gripped directly by the clip with tooth-
like processes, and the tibial condyle was held by a tapered clamp. To induce electric stimulation, the
electrodes for measurement of EMG signals were attached on the distal end of the muscle substance
and deep peroneal nerve. Then the muscle was elongated to its length in situ again, and the tissue bath
was filled with Krebs-Ringer solution at 37'C with 95% 02 + 5 % CO 2 gas bubbling. Finally, precon-
ditioning was performed by 10 repeated cycles loading with 7 mm amplitude after leaving the muscle
standing for about 20 minutes. The specimen was loaded to failure at one of four extension rate
conditions: 0.1, I, 10 or 200 mm/sec . Conditions of 0.1, I and 10 mm/sec were performed in the
quasi-static test mode and those of 200 mm/sec in the dynamic test mode. Muscles were activated by
a 10 V amplitude, 50 Hz electric wave.

Statistical analysis. All experimental data are represented as mean ± S.D. Statistical analyses were
performed with one-way ANOVA, and the significance of difference was set at P < 0.05.

RESULTS AND DISCUSSIONS

Ligament, The stress-strain curves are shown in Fig. 3. At 0.01, 0.3 and 10 mm/sec, the curves were
almost linear. The typical toe region was observed only at 0.3 mm/sec . In contrast, the stress- strain
curves changed drastically to a convex shape in the range of dynamic conditions from 100 mm/sec to
300 mm/sec. The correlation between the extension rate and maximum stress was statistically signifi-
cant (P« 0.001) . However, there was not a significant correlation between the extension rate and
High-Speed Tensile Test System for Ligaments and Skeletal Muscles 171

150,-----------------, Fig. 3. Stress-strain relationship of rabbit MCL

,+, Breaking Point

in various strain rate.

~100
1Il
c..
~
III
III

~
(J)

50 (Mean ± S.D.)
........O.Olmm/sec (0=7)
-tt-0 .3mm/sec (0=5)
__ 10mm/sec (0=5)
-+-100mm/sec In=5)
-'-300mm/sec n=5)
o
4 6 8 10 12 14
Strain (%)
strain at failure (P = 0.37) when conditions of 0.01, 0.3 and 10 mmlsec were chosen . The rate depen-
dence of failure strain is strong only in the range of high strain rates . The correlation between the
maximum stresses and the strain rates was also exam ined . The correlation coefficient between the
maximum stresses and the logarithm of strain rates was quite high (R = 0.84) but it does not indicate
the strain rate dependence of MCL strength becau se rupture sites also depended on strain rate. All
specimen s were ruptured at mid-substance at 300 mm/sec, while avulsion at the tibial insertion was
observed in all specimens at 0.01 mm/sec. A similar tendency was also observed in another study [5],
and means that MCL is inhomogeneous and that the strain rate dependence of substance strength
depends on the site. Woo et al. [3] pointed out the importance of the maturity of the animals as a factor
which influences the failure mode of MCL. The animals used in this study weighed little so they may
not be mature enough .

Muscle. The site of failure was mainly the muscle -tendon junction (MTJ ) in the active state, in
contrast with the muscle belly in the passive state. At 200 mm/sec tensile velocity, stress in the active
state was greater than that in the passive state. However, in low speed conditions these differences
were small. Stress-strain curves in the active state are shown in Fig. 4. No statistical analyses were
done for those results since the number of tests remains insufficient. The observed muscle tone was
1.2,----------------, 1.2 r - - - - - - - - - - - - - - - ,

-o-O.lmmlsec (n=3) ........O.lmm/sec (0=2)

-c--t .omnvsec (n=l) ........ 1mmlsec (n=2)
-lOmm/sec (n=3) --lOmm/sec (n=2)
-<>-200mm/sec (n=4) __ 200mmlsec (n=3)
0.8 _0.8
til 1Il
c..
c..
:::iE :::iE
-.: 0 .6
III
~0 .6
~ ~
CiJ (J)
0.4 0.4

0.2 0.2

o 0.....tE:.~:::::1=--'---'----'---'---.J
o 5 10 15 20 25 30 35 40 0 5 10 15 20 25 30 35 40
Strain (%) Strain (%)
(a) Passive condition (b) Active condition
Fig. 4. Stress-strain relationship of rabbit tibialis anterior muscle.
172 S. Yamamoto et al.

lower than we could found in the literature [10]. Procedures for the treatment and activation of speci-
mens will be improved in future studies.

CONCLUSIONS

A new quasi-static and dynamic tensile test system for biological soft tissue was developed to study
the responses of ligaments and muscles exposed to transient loads . From preliminary tests performed
by using rabbit MCL and tibial anterior muscle, the following results were obtained:
(I) The developed test system can be used at quite high strain rates and cover a wider strain rate
range in comparison with currently commercially available tensile test systems. This system can be
used for various kinds of soft tissues with only a small modification of the clamp.
(2) Rabbit MCL shows a clear strain rate dependence on failure mode , maximum stress and maxi-
mum strain. Quite a high correlation coefficient was observed, especially between maximum stress
and strain rate .
(3) The stress on muscle in the active state was greater than that in the passive state only under a
high strain rate. The site of failure was mainly the muscle-tendon junction (MTJ) in the active state, in
contrast to the muscle belly in the passive state.

ACKNOWLEDGMENT

The authors are grateful to Messrs. S. Murata, N. Yoshikuni and K. Kimura for their technical assis-
tance and also thank to Messrs. K. Miki and T. Tsukada of Toyota Central R&D Labs ., Inc . for their
advice on designing the test system.

REFERENCES

[I] 1. Kajzer, T. Sato, Epidemiology of injuries analyzed using regional accident data, Proceedings
of 1st Human Life Support Biomechanics Symposium, 1997, pp. 1-6.
[2] J.M. Doriot, M.A.B . Sidi, G.M. Tremblay, G. Drouin, Load Elongation Behavior of the Canine
Anterior Cruciate Ligament, Journal ofBiomechanical Engineering, Vol. 102, 1980, pp. 190-193.
[3] S.L-Y. Woo, R.H . Peterson, J.K. Ohland, T.J. Sites, M.1. Danto, The Effects of Strain Rate on the
Properties of the Medial Collateral Ligament in Skeletally Immature and Mature Rabbits: A Biome-
chanical and Histological Study, Journal of Orthopaedic Research, Vol. 8, 1990, pp. 712-721 .
[4] M.1. Danto, S.L- Y. Woo, The Mechanical Properties of Skeletally Mature Rabbit Anterior Cru-
ciate Ligament and Patellar Tendon over a Range of Strain Rates, Journal of Orthopaedic Re-
search, Vol. 11, 1993, pp. 58-67 .
[5] N. Yamamoto, K. Hayashi, Mechanical Properties of Rabbit Patellar Tendon at High Strain
Rate, Bio-Medical Materials and Engineering, Vol. 8,1998, pp. 83-90.
[6] S.D. Mair, A.V. Seaber, R.R. Glisson, WE. Garrett, The Role of Fatigue in Susceptibility to
Acute Muscle Strain Injury, Am. 1. Sports Med., Vol. 24, 1996, pp . 137-143 .
[7] T.M. Best, J. McElhaney, WE. Garrett , B.S. Myers, Axial Strain Measurement in Skeletal Muscle
at Various Strain Rates, Journal of Biomechanical Engineering, Vol. 117, 1995, pp. 262-265.
[8] B.S. Myers, c.T. Woolley, TL Soltter, WE. Garrett, T.M. Best, The Influence of Strain Rate on
the Passive and Stimulated Engineering Stress - Large Strain Behavior of the Rabbit Tibialis
Anterior Muscle, Journal of Biomechanical Engineering, Vol. 120, 1998, pp. 126-132.
[9] T.Q. Lee, S.L- Y. Woo, A New Method for Determining Cross-Sectional Shape and Area of Soft
Tissues, Journal of Biomechanical Engineering, Vol. 110, 1988, pp . 110-114 .
[10] R.L. Lieber, J. Friden, Selective Damage of Fast Glycolytic Muscle Fibers with Eccentric Con-
traction of the Rabbit Tibialis Anterior, Acta PhysioI.Scand., Vol. 133, 1988, pp. 587-588.
Developments in the Provision of Wheelchairs and Seating in
Tayside, Scotland

Geoff Bardsley

Tayside Orthopaedic and Rehabilitation Technology Centre, Ninewells Hospital, Dundee, DDI 9SY,
Scotland

Summary: This paper summarises developments in Wheelchairs & Seating in Tayside, Scotland,
with emphasis on the conference theme of Welfare and Ageing. It describes in more detail later
work in service delivery. It also attempts to tease out the biomechanical aspects of each of these
developments.

Key words: Biomechanics, Seating, Wheelchairs, Service delivery

BACKGROUND
Historically, our Centre (Dundee Limb Fitting Centre) was established back in 1965 for the
National Health Service (NHS) provision of artificial limbs and the associated rehabilitation
process to patients in Tayside Scotland.

At the same time, the Centre was given the responsibility of providing all NHS wheelchairs.
Further services including Orthotics, Gait Analysis, Special Seating, Disability Equipment and
Electronic Assistive Technology have subsequently been added to the Centre's responsibilities.

In September this year, all these services were brought together under the same roof in a new
purpose-designed building: Tayside Orthopaedic & Rehabilitation Technology Centre. This new
Centre also includes the University of Dundee, Department of Orthopaedics. It is located on the
site of the main acute hospital (Ninewells Hospital) in Tayside.

This process of aggregation of services has facilitated integration of all Rehabilitation Technology
Services in a context closely linked with overall health care of patients within Tayside.

NEEDS SURVEY
The Seating Research Programme commenced in Dundee with a survey of the needs of the disabled
population of Tayside for seating. Although somewhat dated, this study has not been repeated
elsewhere. Nevertheless it has formed a basis for directing research energies to the areas in most
need. The results, indicated that elderly people are the largest group requiring developments in
seating, whereas people with cerebral palsy are the next largest group and present some of the most
difficult problems. Other significant groups included multiple sclerosis, motor neurone disease,
rheumatoid arthritis, and cerebral vascular accidents. Spinal cord injury accounted for only a very
small proportion of this population (less then 2%).

SEATING FOR THE SEVERELY DISABLED

Initial energies were directed towards developing a system of provision of seating for the severely
disabled Cerebral Palsy group of people, who at the that time were regarded almost as unseatable.

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention 173

© Springer Japan 2000
174 G. Bardsley

They present with severe skeletal deformities, typically kyphoscoliosis, and virtually no postural
stability resulting from a combination of paresis and dyskinesia of various forms.

Assessment Techniques: Extensive assessment procedures were developed to document their

seating characteristics and determine their seating requirements.

Because of the highly complex and unpredictable nature of these patients' body shapes, an
empirical approach was considered essential to determine the bio-mechanical support required to
seat these individuals. Consequently a highly adjustable hydraulically powered chair was
developed to assess their support needs and simulate the support provided by a variety of seating
configurations. The adjustable structure of this 'assessment chair' provided the basic support
whilst a system of interfaces simulated the surface characteristics of the prescribed seat.

Moulded Plastic Seating: A system of moulded plastic seating has been adopted for the majority
of the most severely disabled people seen at the Centre. Using the assessment chair, seat shape is
determined using a series of up to 6 bead bags which can be consolidated under vacuum. This
shape is recorded in Plaster of Paris and replicated by vacuum forming in foam and ABS plastic.
The resulting shell is then mounted in a framework to loacte in a wheelchair chassis.

Upholstered Wooden Seating: This empirical approach to determining the biomechanical

requirements of a seat has been extended to the provision of more conventional designs of seating,
including traditional upholstered wooden constructions. Instead of bead bags, foam cushions
provide the interface on the assessment chair to which adjustments are made to optimise seating
comfort and facilitate activities such as rising from sitting.

Biomechanical studies of this important latter activity have been carried out using this equipment
but have proved inconclusive to date. Nevertheless, this approach to determining optimum seating
configurations has proved to be highly successful, albeit time consuming to complete.

MODULAR SEATING FOR CIDLDREN

Initially, the system of individually moulded plastic seating was applied to adults and children with
Cerebral Palsy. Particular emphasis was placed on seating children in symmetrical postures from
an early age in the hope of preventing or reducing the occurrence of fixed skeletal deformities.
Unfortunately the high growth rate of children resulted in the need for frequent replacement of the
seats.

To avoid this problem, a system of modular seating was developed based on a standard car seat for
children to which was added a system of adjustable support pads. The seat is supported on a
framework to give adjustable recline for use on the floor, or in a mobile base, or as a car seat.
This seat permits precise matching of postural support to the child's needs and can be adjusted to
suit growth. This system has been highly successful and is widely available as a commercial
product entitled the 'Snug Seat' .

MODULAR SEATING FOR ELDERLY PEOPLE

In view of the results of the survey at the start of the research programme, considerable effort was
put into developing a seating system for elderly people. This population was identified
predominantly to exhibit moderate postural instability, mild deformities (typically kyphosis),
moderate susceptibility to pressure sores and difficulties in rising from sitting.
Provision of Wheelchairs and Seating in Tayside. Scotland 175

A modular approach was adopted based on 4 sizes of sets of seatlbackrest units mounted into 2
frame designs of static or wheeled versions. Dramatic improvements were made over previous
designs, largely it is considered through the biomechanical stabilising of posture afforded by size
adjustability and seat shaping. A simplified wooden construction with less adjustability has been
developed to improve appearance and has met with significant success for less severely disabled
elderly people. Problems however have been encountered in transferring these designs into a
commercial product.

QUANTIFIED ASSESSMENT METHODS

Experience to date has highlighted the complexity of the biomechanics of sitting. Attempts have
been made in the Centre to quantify a number of variables with little success. Examples include,
joint angles, back shape, muscle activity.

Some success has however been achieved recently with the development of pressure mapping
systems in clinically 'friendly' designs. A variety of systems are now available and one is being
used in the Centre for cushion comparisons for individual patients and for educating patients in
pressure management.

INTERNATIONAL STANDARDS

Interest in introducing a more scientific approach has been stimulated recently though the
establishment of an International Standards Group for Seating. Currently it is concentrating on 3
main areas:-

Terminology - to define consistent terms along with seating and anatomical reference planes
to define dimensions and orientation.

Pressure Management - to develop test methods for determining performance of cushions.

Postural Management - to develop test methods for determining the performance of postural
support devices.

The Centre is playing a leading role in the development of these standards which hopefully should
facilitate commurnnication and help promote a more scientific approach in this field.

MANUAL WHEELCHAIR ADJUSTMENT

The majority of development work at the Centre has been directed towards seating. Nevertheless,
a smaller number of investigations have been pursued in wheelchair areas. The first of these
relates to the need to rationalise the process of adjustment of configuration of high performance
wheelchairs to optimise the performance of people only just able to propel a wheelchair manually.
Modem designs can give large ranges of adjustment but the process of determining optimum
settings for the individual patient is far from clear.

A 'simulator' consisting of a purpose-built readily adjustable wheelchair was developed along with
standardised tests to measure propelling performance. Studies confirmed that AP position of the
occupant relative to the wheels was most important whereas vertical position had less effect.
176 G. Bardsley

TRAINING FOR POWERED WHEELCHAIR USERS

Approximately 7 years ago, additional funds were allocated to the service to provide Indoor /
Outdoor powered wheelchairs. These have proved to fulfil a much needed extension to our
service. There has been considerable concern amongst staff, however, that patients require
extensive training in the safe use of such devices, particularly as there is a high risk of injuries
caused by tipping or collision with other vehicles.

An extensive training programme has been established culminating in a Police road safety test
which all patients must pass. Although time-consuming to carry out, the results of the training
programme are very good with supprisingly high appreciation by patients of its benefits.

SERVICE DELIVERY
The major challenge facing the NHS provision of the Wheelchairs and Seating Service in Scotland
relates to the relentless increase in demand placed on them whilst budgets remain fixed. Increase
in demand is perceived both in terms of increase in numbers of patients referred and increases in
their expectations associated with higher costs of more sophisticated devices.

Computerised management system: Significant efficiencies have been made in the Tayside
Service through the use of a computer-based management system to help run the Service. Its
prime roles are:-

- to store information on patients,

(clinical background, history of all clinical events).
- to store information on devices,
(history of all issues, repairs, maintenance etc).
- to communicate requests for action.
- to automate writing letters to patients, GPs, etc.
- to monitor service.

This system has been in place, through various upgrades for over 5 years and has become an
essential cornerstone of the Service. It is planned to extend its application to collate all similar
Service data for an information service for the whole of Scotland.

Cost I benefit analysis: Given that there are insufficient resources to meet all our patients'
requirements, it is considered important that we attempt to maximise overall benefits by targeting
the patients where most benefits can be achieved. Research is being conducted into measuring the
benefits of the provision of the various types of Wheelchairs & Seating. Hence to date a number
of tools to quantify benefit have been tested resulting in the following which appear to have the best
potential for applications within our Service:-

- quality of life
- functional assessment
- patient satisfaction
- cost analysis

Having been tested on patients before and after intervention with moulded plastic seating, these
measurements have been further refined and are about to be applied to patients with powered
outdoor wheelchairs.
Provision of Wheelchairs and Seating in Tayside. Scotland 177

CONCLUSIONS

A considerable number of developments has taken place in the provision of Seating and
Wheelchairs over the past years. These range from clinical assessment techniques, through the
design of new seating systems, to developments of a purely service delivery nature.

The subject of biomechanic s of seating for the disabled is highly complex and remains in
considerable need of investigation. Preliminary work in International Standards may help to
stimulate further work in this important area.
Bringing Advances in Wheelchairs to The People
Rory A. Cooper!", Michael L. Boninger'", Nigel Shapcott!", and Shirley G. Fitzgerald'v'

'Departments of Rehabilitation Science & Technology, and Physical Medicine & Rehabilitation,
University of Pittsburgh, Pittsburgh, PA, USA, 15260
2 y A Rehabilitation Research .and Development Center, YA Pittsburgh Healthcare System,
Pittsburgh, PA, USA, 15206

Summary: There have been several recent advances in wheelchair technology that could bring
about greater mobility for people with disabilities and people who are elderly. These advances are
dependent upon the proliferation of computing technology (both hardware and software), and
developments in materials and their manufacturing processes. While the new designs of mobility
products and the commercial experimentation with robotics technology for personal mobility are
exciting, the delivery of these products to people in diverse and distributed environments must also
be addressed. Telerehabilitat ion may provide a means for the limited expertise in the advances in
mobility products to become available on a large scale.

Key words: Wheelchair design, Advanced mobility devices, Telerehabilitation, Pain

BACKGROUND
Prevalence of Upper Extremity Injuries and Pain in Manual Wheelchair Users (MWUs)
MWUs have a very high incidence of upper extremity pain. Surveys of MWUs show the
prevalence of shoulder pain to be between 31% and 73%. In addition to reviewing the prevalence
of pain, a few authors have looked for the etiology of this pain. Wylie reviewed medical and
surgical records of 51 individuals who were all greater than 20 years out from an SCl. 1 He found
radiographic shoulder abnormalities in 32% of the subjects. He also reported that patients with
greater activity levels had less complaints of pain. The type of radiographic abnormality was not
reported and shoulder films were not present on all subjects. In a MRI study of veteran's with
paraplegia, 57% of subjects showed rotator cuff tears and severity of tears related to age and
duration of SICID? In our own MRI study of the shoulder, we found a lower prevalence of rotator
cuff tears then has previously been reported. This may be due to the fact that we tested a younger
population than previous studies. We did find subclinical inflammation of the structures
surrounding the rotator cuff.

Elbow, wrist, and hand pain are commonly reported among MWU's. Sie reported elbow, wrist,
and hand pain in 16%, 13%, and 11%, respectively.' This did not include patients with Carpal
Tunnel syndrome (CTS). In addition, Sie further defined significant pain as that which required
analgesia, occurred with two or more activities of daily living or required cessation of activity.
Using this definition, the prevalence of all upper extremity pain complaints was 20% five years
post injury, and 46% from 15 to 19 years post injury.

The prevalence of CTS in MWUs is between 49% and 73%. Gellman, in a study of 77 individuals
with T2 or below paraplegia, found 49% had signs and symptoms of CTS.4 Sie interviewed 103
subjects with paraplegia and found historical or physical examination evidence of CTS in 66%.
Both of these large clinical series found the incidence of CTS increased with increased duration of
paralysis. To add objective criteria to the diagnosis of CTS, a number of investigators have
performed NCS on this population. Aljure studied 47 patients with a SCI below the T2 level and
found electrodiagnostic evidence ofCTS in 63% and clinical evidence ofCTS in 40%.5 This study
also found an increased prevalence of CTS with duration of paralysis. Tun found that 50% of

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 179
180 R.A. Cooper et al.

individuals with paraplegia below the TI level had slowed motor conduction of either the ulnar or
median nerves at the wrist ." Forty-four percent of patients with electrical abnormalities were
asymptomatic. Davidoff studied 31 patients with paraplegia below the Tl level and found
electrodiagnostic evidence of CTS in 55% and symptoms of numbness or tingling in the hand in
74%.7 From these studies , it is apparent that CTS is a common problem among MWUs. Most ofthe
studies found a greater prevalence of abnormalities on NCS than actual clinical symptoms. This
may signify that subclinical nerve damage exists in a number of these individuals. Many of the
studies on both CTS and shoulder injury found an increase in prevalence as individuals were
further out form injury.

Telerehabilitation
Telemedicine, or medicine at a distance, has been in existence for years. First documented in 1959,
an interactive video was used to deliver mental health services in Nebraska." Subsequent projects
were conducted in the late 1960s by Dr. Kenneth Bird to established a link between Massachusetts
General Hospital and a walk-in clinic at Boston's Logan International Airport . In addition, there
have been telemedicine experiments involving teleradiology, telepathology, and teledermatology."
Unfortunately, funding for these and other projects has been limited. Only one program, located at
Memorial University in Newfoundland, has succeeded as a self-sustained telemedicine program
since 1975. 10 In the late 1980s, the need for high quality health care at an affordable cost emerged
and emphasis was placed on using new and developing technologies to increase the telemedicine
capabilities.

To date, many different medical disciplines have tested the feasibility and success of telemedicine
in their practices. Included among these medical disciplines are dermatology, pathology, radiology,
psychiatry, and orthopeadics. Within dermatology, studies have been completed evaluating the
comparability between in-person dermatologic exams and videoconferencing exams . Results have
shown that teleconsultation and in-person interviews are comparable 80% of the time. 11,12 Research
has also been completed examining the feasibility of orthopaedic teleconsultations in rural areas .
Videoconferencing equipment was used to transmit radiographs. Results indicated that no adverse
events occurred to those patients seen via teleconsultations and the patients were satisfied with the
care they received from their physician." Although problems can arise with the technology of
telemedicine, in general, telemedicine research has shown that patients continue to be receptive to
the idea of telemedicine. Problems encountered by Oakley et al in a dermatology telemedicine
project included ISDN lines and failure in equipment; making the process of seeing patients at a
distance frustrating at times." The researcher went on to say that for a successful telemedicine
session, the examination room should be prepared with optimal lighting for videoconferencing
needs and a solid-colored background. High speed of data transmission hardware should be utilized
and different camera types may be needed depending on the medical discipline involved. For
example, cameras that are three-chip (capable of I :1 close-ups) are much better for close-ups in
'dermatologic exams." For any discipline of medicine, an interactive video system is needed to
allow for interaction between patient and clinician .

It is possible to apply the same technology learned in other telemedicine disciplines to the field of
rehabilitation. Telerehabilitation uses videoconferencing and data acquisition technologies and has
been used in different settings including physical therapy, pediatric and geriatric rehab, and rehab
outcomes. 16 Telerehab can been used in educational situations between clinicians and rehabilitation
experts. It can also be used in rural settings where the delivery of rehabilitation and Assistive
Technology (AT) is problematic. It is important to note that the proportion of people with chronic
illness is higher and means to pay for them is reduced in rural settings."

In educational settings, the use oftelerehabilitation has been shown to work in multiple settings, for
example, physical therapy training. IS Strong correlations have been shown between in person
interviews and telephone conversations for several measurement tools including the Activities of
Bringing Advances in Wheelchairs to the People 181

Daily Living" and in-person interviews with patient/proxy telephone calls for the Functional
Independence Measure and others.2o•2 J

METHODS

Three integrated approaches are being used to improve the design and service delivery of wheeled
mobility devices. Manual wheelchairs are primarily improving through a greater understanding of
the interaction between the wheelchair and user; hence increasing mobility and reducing the
likelihood of developing a secondary disability (e.g., repetitive strain injury, spinal deformity).
Electric powered wheeled mobility devices continue to improve through the application of
computing and robotics technology. This has resulted in increased capabilities for the users. Three
approaches are emerging : (1) hybrid systems; (2) multi-configuration systems, and (3) robotics
based systems. The rapid improvements in telecommunications technology also has potential to
improve the delivery of services to people with disabilities and people who are elderly.
Transmission of voice, image, and data could provide a means for experts in wheeled mobility (or
other aspects of rehabilitation) to provide consultation to other healthcare professionals and
consumers .

Fi2. 1. Dynamometer with wheelchair.

Manual Wheelchairs
Kinetic data were obtained through the use of the SMARTWheel and our computer controlled
dynamometer. We have examined the source of uncertainty in our SMART Wheel and the data
reduction equations associated with the calculation of our variables.f The analysis further showed
that we could record accurate data for our key variables . We also examined the effects of selecting
different data reduction equations, and provided means of comparing data from different studies.i
We found no previous studies had analyzed the frequency content of pushrim forces and moment
recordings. Hence, we conducted appropriate analyses to determine the optimal sampling rate and
digital filter design for our force and moment recordings." Moreover, we were unable to find
studies that provided analysis of appropriate sampling frequencies and filter designs for the
collection of motion data during wheelchair propulsion . Therefore, we performed the frequency
analyses in order to ensure that our data collection and conditioning was done properly."
We needed to develop and verify models of the upper extremity during wheelchair propulsion in
order to be able to perform the statistical tests of whether there are links between carpal tunnel
syndrome (CTS) and biomechanics, as well as, links between shoulder joint degeneration (MRI
182 R.A. Cooper et al.

evidence) and biomechanics. We developed a method for determining the point of force application
(PFA) on the pushrim." We later developed a single point center of pressure (CoP) for manual
wheelchair propulsion." These studies were necessary as they provide the starting point for
calculating net joint forces and moments, and the CoP and PFA may provide insight into the
development of CTS . We also developed models of the upper extremity in order to determine net
joint forces and moments at the shoulder." Models were also developed for the wrist during
wheelchair propulsion.i" The model of the wrist was also refined. 3o Later, we developed a method
to compare the pushrim forces/moments from side-to -side." This method showed that there are
side-to-side differences. This indicates that data from both sides should be collected and that
asymmetry may contribute to injury.

I OG r--~--~--~--~--~-----,

9t Re ultanl Force

. :

11

.1
I I I .t" - 51~
I.J.i)' --;;""'c"-~

Time (sec)

Fig. 2. Sample force and momentcurves for wheelchair propulsion.

Electric Powered Mobility Devices

Hybrid systems (combination of manual propulsion and electric powered assist), multi-
configuration systems (elevating, reclining, lowering) , and robotic systems (dynamic stabilization
and transformation) represent significant advances in electric powered mobility.

a Hybrid System (1Wll) b Multi-eonfiguration System c Robotic System (IBOT)

Fig. 3. Examplesof advances in electric powered mobility devices.

Hybrid Systems: The device tested during this study was the JWII produced by Yamaha Motor
Corporation. The device is activated by applying a force to the pushrim of the wheel. The pushrim
force is regulated by sets of linear compression springs and recorded by a simple potentiometer that
Bringing Advances in Wheelchairs to the People 183

senses the relative motion between the pushrim and hub. The potentiometer signals from both
wheels are interfaced to a micro-controlIer. The micro-controller algorithm coordinates control of
each wheel' d.c. motor. The software simulates inertia (i.e., allows for a coast), compensates for
discrepancies between the two wheels (e.g., differences in friction), and provides an automatic
braking system activated when applying a reverse torque to the pushrims. The system is supplied
power by a single custom designed nickel-cadmium (NiCd) or nickel-metal-hydride (NiMH)
battery. The wheels have quick-release axles. The entire unit has a mass of about 10 kg, and a
range of about 12 km on a single charge.

This part of the study consisted of three components: (I) compliance testing to American National
Standards Institute (ANSI) and Rehabilitation Engineering and Assistive Technology Society of
North America (RESNA); (2) metabolic energy consumption testing, and (3) consumer driving test.
Ten manual wheelchair users propelled their personal wheelchairs and a Quickie GP wheelchair
with JWII over an activities of daily living (ADL) course. All subjects were required to transfer to
a car with their personal wheelchair and the wheelchair with the JWlI. Subject ratings were
recorded for the ease of performing alI tasks, perceived ride comfort and ergonomics. Completion
time and heart rates were recorded for each trial of the ADL-course.

Four female and six male fulI-time manual wheelchair users (9 SCI T2-T9, I MS, age 22-50) were
recruited from the laboratory's database. Subjects were asked to propel both their own chair and a
Quickie GP equipped with the JWlI on a computer controlled wheelchair dynamometer. Propulsion
speed was 0.9 and 1.8 mls with the dynamometer set on normal, slight and moderate resistances.
The order of chairs, speeds and resistances was randomized. Oxygen consumption (V0 2) was
measured with Sensormedics Metabolic Measurement Cart and heart rate (HR) was measured with
a heart rate monitor. Three minutes of physiologic data were collected for each trial. Since the data
was not normally distributed, a Wilcoxon signed ranks test was used for statistical analysis.

Robotic Systems : Currently, persons with a functional limitation involving ambulating will often
use a wheeled mobility device to achieve their mobility goals. Persons with either bilateral upper
extremity, or unilateral upper and lower extremity control and strength may use a manual
wheelchair. People who lack the ability to propel a manual wheelchair, who lack the endurance to
propel a manual wheelchair, or have severe upper extremity pain may use a powered wheelchair or
scooter. All current wheeled mobility devices are limited in their functional use. Many
environments are not accessible using a wheeled mobility device (e.g., stairs, high curbs, steep
ramps, high objects, soft surfaces, uneven terrain). Performance trade-offs are numerous and must
be considered for each individual. INDEPENDENCE 3000 IBOT Transporter (!BOT), as an
electronically stabilizing device, provides the opportunity to enhance mobility without some of the
traditional trade-offs.

The !BOT is intended for use as an advanced mobility system, which provides the user with five
separate functions for operation. The functions allow the user the following capabilities:

• indoor mobility (e.g., driving on finished surfaces : carpet, tile)

• outdoor mobility (e.g., traverse uneven terrain, steep inclines, grass , sand, gravel, curbs)
• stair climbing (e.g., independently , assisted)
• elevated height, with a reduced turning radius (e.g., reaching the top shelf in a cabinet, having an eye level
conversat ion with someone standing , maneuvering in a confined space)
• ability to transport the device in some motor vehicles without the use of a motorized lift.

The IBOT is a technologically advanced mobility device designed to overcome many of the
limitations of currently available devices. By incorporating state-of-the-art software and hardware,
the !BOT responds to changes in terrain. This permits the !BOT to be used to traverse non-uniform
surfaces, steep inclines, climb curbs, and negotiate some stairs. The mobility system is based upon
a chair mounted through linkages to a wheeled base. The IBOT has four primary wheels, each
184 R.A. Cooper et al.

controlled through its own electric motor, and two caster wheels. The two sets of drive wheels on
either side of the chair form a cluster. Each cluster may rotate about its central axis while the
wheels may rotate about their hubs. This provides the IBOT with more degrees of freedom than an
electric powered wheelchair. The IBOT is controlled by a set of central custom computers that help
to maintain stability and provide the user with control. The IBOT incorporates a variety of sensors
for attitude control, speed control, self-diagnosis, and for changing operational functions. The
IBOT is operated via a hand controlled "joystick" and a user panel containing several switches.
The controls are attached to an armrest. The IBOT can be operated in five functions: standard
function; four-wheel function; stair function; balance function; and remote function. In standard
function the IBOT operates much like an electric powered wheelchair. When driving in "four-
wheel function" the clusters are allowed to rotate. This provides the freedom to negotiate obstacles
or uneven terrain. The IBOT can also be used to negotiate stairs that have at least a single railing.
In stair function, the IBOT responds to the reaction forces generated by the user against the stair
railing or an assistant can initiate stair negotiation by using the handles on the back of the device.
Cluster rotation is used to negotiate stairs. As the clusters rotate, with the wheels fixed at the
central axis, a wheel from each cluster transitions from one step to another. During stair climbing
there are always two wheels on a step. Because of the cluster design and the specialized controls
incorporated in the IBOT, the device can be balanced above two wheels. Balance function acts to
raise the seat height for reaching high objects or for looking a standing person in the eyes. It also
decreases the turning radius for confined spaces. Surface restrictions for balance function include
wet floors, ice, and snow. Driving on areas of soap, oil or grease spills should be avoided.

TeIerehabilitation
Telerehabilitation concerns itself with a new application of rapidly evolving technologies in
telecommunications and applies it to a specialist area within the field of rehabilitation. Our study
attempts to establish a scientific basis for the reliable use and limits of, telecommunication based
remote prescription of assistive technology (AT), and also to establish methodologies which may
be reproduced for further evaluation activities in this or related fields. This telecommunications
technology has become known as "TeleRehab" and is illustrated below. TeleRehab has the
potential of increasing the availability of specialist services to communities which are not receiving
them because of availability of expertise, geographical and/or transportation issues, and of reducing
the cost of delivering these services at an appropriate level. We have started our research using
Plane Old Telephone System (POTS) and ISDN based video conferencing and data capable
communication systems to evaluate individuals for their seating and mobility needs and to compare
this with a "gold standard" of clinical based prescription.

Expert Hub Rural Site

Visua l and Audio Evaluation
• •
Transfer of Eval Data
PressurelDimensional

'Assistive Technology Practitioner -Non Specialist OTR or PT

'Assistive Technology Supplier 'COTAorPTA
'Registered Nurse 'RTS Technician
·certified Orthotist or Prosthetist 'LPN
'OTR 'Orthotist or Prosthetist
'PT

Fig. 4. Telerehabilitation scenario.

In particular, the system to be developed will support the decision making process concerning
appropriate wheelchair technology selection and environmental modifications for specific people in
Bringing Advances in Wheelchairs to the People 185

particular environments. Our vision for the system is evident in the following scenario. A person
returns home following rehabilitation from a spinal cord injury. The accommodating environment
of an earlier time may now contain significant barriers. We shall pose a cost-effective process in
which the individual and environment would be remotely evaluated and solutions determined. The
site would be photographed with a digital camera or camcorder prior to the on-site clinicians
linking with the central clinic. The images would be transmitted to a central facility where
technicians process them to quickly build a virtualized environment. The virtualized environment
would then be used in an analysis where architectural features are compared to codes and standards.
A clinician specializing in AT could view the virtual environment as well as communicate with the
on-site clinician to make a proper home or worksite assessment. The combination of synchronous
and asynchronous (e.g., virtualized environment) would provide a powerful tool for TeleRehab,
and require less training by the on-site clinician. Proposed changes to the environment could be re-
analyzed and visualized as required by either the rehabilitation professional or the client. As the
technology evolves, real-time model rendering could be accomplished for communicating ideas
and suggested solutions between the client (and perhaps, a community home health care provider)
at the remote site and the professional at the central location.

RESULTS

Manual Wheelchairs
There have been advances in the durability of manual wheelchairs, ride-comfort, and the
ergonomics of wheelchair propulsion. Our research has shown that ultralight wheelchairs have a
lower life-cycle cost and longer fatigue life than both lightweight and depot style wheelchairs. Our
research further indicates that there are differences in rider-perceived comfort and that the
accelerations experienced during manual wheelchair driving exceed those recommended for other
driving activities (e.g., equipment operation). Manual wheelchair users have an incidence of
repetitive strain injury of between 60-80%. Our studies show that moving the moving the axle
forward and lower body mass are correlated with improved median nerve conduction velocities (an
indicator of median nerve health). Individuals that have low body mass and who place the axle
further forward (more weight distributed over the rear wheels) are less likely to develop repetitive
strain injury.

100

90 •
.0

70
•
:;
e
j
60
• •
i., so
to
j 40

30

20

10

0
40 60 IlO 100 120 140 160 '80 200
Pnk Feeee(N)

Fig. S. Scattergram showing relationship betweennerveconduction and pushrim forces.

186 R.A. Cooper et al.

Wheelchair Biomechanics is related to Upper Extremity Pain and Degeneration

First we found that pushrim forces/moments change with speed, and that we had calculated
statistically valid metrics." This was important for validating our testing protocol. We have found
that wheelchair pushrim forces are related to NCS variables .33 Our research has also shown that
wrist forces and moments are correlated with CTS.34 We have also shown that pushrim forces can
be altered by changing the pushrim coating." Vinyl coated pushrims increased contact friction and
reduced non-propulsive pushrim forces. Our results also showed that men and women propel
wheelchairs differently and that gender needs to be accounted for when studying joint and nerve
degeneration ." Pushrim forces normalized for body mass, and normalized for wheelchair mass are
correlated with median nerve function." Moreover, body mass of the wheelchair use is also
significantly correlated with median nerve function. These results suggest that the manner in which
the person pushes and their body mass contribute to median nerve function. People with low body
mass and mechanically efficient strokes are less likely to have median nerve damage. Wheelchair
set-up is also significantly correlated with wheelchair biomechanics." These papers showed that
individuals who sit low and behind the rear wheels had lower propulsive forces and stroke
frequency, both shown to be associated with CTS. In another report, we showed that body-mass
index is associated with MRI findings showing shoulder joint degeneration."

Electric Powered Mobility Devices

Hybrid Systems : The JWII had significantly lower (p<0.05*) mean and peak V0 2 values in all 5
conditions, while mean and peak HR was significantly lower in 3 of 5 trials with the JWII than the
subjects' personal manual wheelchair.

Table I, Metabolic results for propeling a pushrim activated electric powered wheelchair.
VO, HR
MEAN VALUES Mean ± SO with Mean ± SO P Mean ± SO with Mean ± SO P
JWII without JWII JWII without JWII
1.8 mis , normal resistance 7.79 ± 1.57 10.76 ± 2.84 0.022' 112.67 ± 22.75 128.92 ± 27.31 0.059
1.8 mis , slight resistance 7.98 ± 1.39 13.00 ± 2.84 0.005' 111.37 ± 20.19 134.4 ± 24.22 0.005'
0.9 rn/s, normal resistance 5.47 ± 0.83 6.86 ± 1.20 0.005' 95.06 ± 16.06 104.79 ± 20.27 0.022'
0.9 mis, slight resistance 5.93 ± 0.96 7.31 ± '0.5 1 0.005' 98.32 ± 21.14 106.01 ± 19.15 0.066
0.9 mis, moderate resistance 5.93 ± 1.30 7.51 ± 1.83 0.005' 99.84 ± 18.51 106.31 ± 23.54 0.037'

The JWII pushrim activated power assist wheelchair (PAPAW) reduces the physiologic demand of
wheelchair propulsion. This is beneficial for most wheelchair users, particularly the aging or those
in transitional status between manual and powered chairs . In addition, it eases long distance
propulsion by facilitating less strenuous maintenance of higher speed.

The JWII passed all of the ANSIIRESNA Standards. Re-design was required for the curb-drop
fatigue test and the cold-environment tests. The JWII with the power on had higher mean
ergonomic and comfort rankings (p < 0.05) when compared to the subjects' personal wheelchairs.
The results of comparing the rankings of the car transfer between the JWII and the regular
wheelchair showed a significant increase in the effort required to take the wheels off (p=O.O12) and
put the wheels back on (p=0.005) with the JWII PAPAW.

Robotic Systems: The Independence 3000 IBOT Transporter (!BOT) may offer the following
advantages over the majority of electric power wheelchairs:
• Ability to climb curbs
• Ability to climb steps/stairs
• Ability to negotiate loose terrain (sand , gravel, grass)
Ability to negotiate uneven terrain (park trails , ramps, slopes, and non-standard curb-cuts)
• Ability to interact with people and the environment at normal standing height
• Ability to transport the chair by driving it into some vehicles .
Ability to maneuver in a confined space s
Bringing Advances in Wheelchairs to the People 187

With the exception of climbing curbs and transporting the chair in the car, these are advantages
over manual wheelchair use as well.

The cost of an mOT is estimated to be $20,000 .00. This is similar to other high-end power
wheelchairs like the Permobil Chairman. It is important to note that the cost of an IBOT will likely
be offset by a number of other factors . One obvious area of cost savings is the need for home
modifications. With an mOT, it is possible to climb stairs and curbs . This fact may negate the need
for some home modifications such as external ramps or creating a bed and bath on the ground floor.
In addition, the ability of an mOT to elevate and tum in a tight space may decrease the need to
rebuild cabinetry and enlarge tight spaces such as bathrooms. These same modifications would
likely need to be made at the work-site of a wheelchair user as well. This decreased need for
modifications may, in and of itself cover the difference in cost between a manual wheelchair and an
mOT. This cost-savings is especially important for vocational rehabilitation offices which work to
assure accessibility as part of a plan to return a worker with a disability to active employment.

Another area where the mOT can lead to cost saving is in prevention of upper extremity injury .
Use of the mOT protects the arm in two ways . By using powered mobility , manual wheelchair
users will avoid the repetitive trauma of propelling a chair. The use of the mOT also allows a
wheelchair user to perform more activities below shoulder level. Activities which occur above
shoulder height (i.e., reaching above shoulder height) are more likely to cause impingement and
rotator cuff damage.

Prevention of secondary disabilities provides obvious medical cost savings. Although the cost of
treating shoulder and wrist pain in wheelchair users has not been documented the following list of
approximate costs within the USA can help put the relative expense of an IBOT into perspective :

Table 2. Medicalcosts for secondarydisabilities related to wheelchairpropulsion.

Inpatient rehabilitation hospital stays $1250 perday
MRI studies of theshoulder $1200 perstudy
EMG studies for carpal tunnel syndrome $500 perstudy
Physical therapy $90 pervisit
Open surgical rotator cuffrepair $ I5,000
Carpal tunnel release $5000
Skilled Nursing home $300 perday

Non-surgical treatment for shoulder pain easily costs over $5000 dollars and often requires the use
of an electric powered wheelchair. When the loss of independence during the recover phase and
rehabilitation is considered, surgical costs for a shoulder injury care can easily exceed $100,000 . In
addition use of an electric powered wheelchair is often recommended after a surgical repair. By
choosing to use an mOT early, wheelchair users will be less likely to develop upper extremity pain
and require the associated treatment. The mobility offered by the mOT may make it more
attractive to users who will more likely use it reducing their risk of injury and increasing mitigation
of pain .

TeIerehabilitation
Pressure measurement videoconferencing has been completed between Shapcott and Cooper at the
Center for Assistive Technology, USA and clinicians at a seminar on Technology for Disable
People in Adelaide, Australia." Many clinicians now use the Internet in these ways to develop their
expertise, collaborate with peers and get information about assistive devices, and community
supports for their clients .4 1
188 R.A. Cooper et al.

In patient care settings , telerehab has the potential to be effective means of transmitting data.
Preliminary work conducted by Shapcott has compared the use of different telecommunication
technologies (POTS , ISDN) with patients requiring assistive technology. Results of the
telecommunication conference were compared to face-to-face interviews . No differences were
found with regard to evaluations between the two types of technologies, although the POTS line
was slower. Similar recommendations for care were found between the face-to-face evaluation and
telecommunication . Additional studie s have shown that data collected over the telephone can
augment outcomes studies . Telerehabilitation shows promise to bring experts in various technology
areas to remote areas and to address the personnel shortage . Plane old telephone system may be a
useful starting point with limited capability to transmit video and data. However, new systems with
increasing bandwidth are becoming increasingly available.

CONCLUSION

Definitively relating wheelchair biomechanics to wrist and shoulder injury/pain is going to be an

extended process, but the potential impact is profound. If we can determine how the wheelchair
contributes to upper extremity injury, we may be able to select or fit wheelchairs to individuals to
reduce their likelihood of developing secondary disability. There is a relationship between
wheelchair propulsion biomechanics and electro-diagnostic evidence of CTS and MRI evidence of
shoulder joint degeneration. The longitudinal basis for these associations needs to be studied to
establish a cause-and-effect relationship. It is imperative that the population of manual wheelchair
users with paraplegia be studied over the long term. New devices and delivery methods offer a
bright future for people with mobility impairments.

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Vancouver, B.C.pp 175-8.1998
One Basic Research Approach for Assistive
Technology in Japan

Tohru Ifukube'

J Laboratory of Sensory Information Engineering, Research Institute for Electronic Science,

Hokkaido University, KitaI2-Nishi6, Kita-Ku , Sapporo 060-0812, Japan

Summary: One basic research approach for assistive technology in Japan is proposed in this
paper. The author has developed this research approach through about 27 years ' experience in
assistive technology studies . He and his co-researchers have designed several aid devices as
reviewed in this paper and have obtained many basic finding; concerning sensori-motor functions .
Some of the devices have been manufactured in Japan and the technologies as well as the basic
findings have been applied to construct both virtual reality systems and robots . Moreover, newly
developed virtually reality and robotics technologies have been fed back to design better models for
developing assistive devices.

Key words: Assistive technology, Tactile aids, Artificial larynx, Transfer aid, Virtual reality

INTRODUCTION

We have been carrying out the assistive technology studies, espec ially commun ication aid stud ies,
for about 27 years, and have designed several aid devices which are in practical use or will be put
into use. Moreover, we have obtained many findings concerning sensory integration, concept
formation and sensori -motor association in the human brain . We will refer to our research regarding
the aid devices and mention how that research has been related to virtual reality and robotics .
Finally , we will introduce our research approach to developing assistive technology .

ASSISTIVE DEVICES DESIGNED IN OUR LADORATORY

Tactile voice coder. Through fundamental research on auditory and tactile information processing,
we developed a tactile voice coder for the deaf about 23 years ago which has been manufactured in
Japan. The tactile voice coder is a device which produces sound spectral patterns that are analyzed
in 16 frequency components. When an index fingertip touches a piezo-electric vibrator array
consisting of 16 rows by three columns as shown in figure I, the device makes it possible to
discriminate the first and the second formants of vowels as well as some consonants such as
fricatives. Our research was broadcast as a documentary program entitled "my finger can hear
lettersl.lt assists in lip-reading and also helps to obtain feedback for speech training [1]. It has

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 \91
192 T.lfukube

already been put to practical use in Japan, and

studies on its evaluation are being at some
institutes for the deaf. From identification tests
of Japanese monosyllables consisting of Ikul,
Isul, Inul, lfuI, lruI, Itsul and Iy ul , the
identification rate increased from 23% (lip-
reading only) to 68% (lip-reading p Ius tactile
voice coder) after one week of training [5]. In
cooperation with an electronics company, we
are now improving the tactile voice coder using
a digital signal processor (DSP) to make it
smaller and cheaper.

Flg.l. Vibrator array for tactile voce coder

Voice typewriter. About 20 years ago, the tactile voice coder was applied to a voice typewriter for
acquired deaf peop Ie for whom it is difficult to learn lip-reading and finger language. This device can
convert monosy llabic voice sounds such as Ia/lka//sa//t a//na//ha/ into Japanese letters almost in real
time and shows them on a display . There are only 5 vowels and 14 consonants in Japanese. Every
Japanese word is pronounced as a series of monosyllables. For example, Tokyo is pronounced as
Ito//ullki//yol and lui. Every monosyllable corresponds to one Japanese letter. This makes it easy to
design a voice typewriter.

Figure 2 shows the voice typewriter in

which a microprocessor was used. Some
algorithms were performed by the hardware
to decrease the conversion time. Its
recognition rate was 96% and its response
time was about 0.2 [2]. The voice typewriter
is a substitute for fmger language or
conversation writing. We are now designing
the voice typewriter by combining a micro-
processor with a see-through head mounted
display (HMD) which can display the
recognized letters infront of a speaker.

Fig.2. Voice typewriter

Cochlear implant and Tinnitus suppresser. We have been studying auditory prostheses which
stimulate surviving auditory nerves of the deaf who have lost the function of hair cell receptors
inside the cochlea. However, it was almost impossible to continue the study in Japan because of a
lack of co-researchers. Therefore, the author went to Stanford University to continue the study of
auditory prostheses about 15 years ago. In our auditory prosthesis, auditory nerve cells were
electrically stimulated by 8 electrodes placed in the cochlea as shown in figure 3.
Basic Research Approach for Assistive Technology in Japan 193

Spectral patterns were then analyzed in 8

Fig.3. Implanted electrode array
steps . The 8 signals were transmitted
electro-magnetically from a transmitter
outside the body to a receiver inside the
body (3)[6][7] . However, when a tester's
voice stimulated the auditory nerves of a
female patient, she claimed that the
perceived signals sounded very different
from voices which she remembered from
the time she had normal hearing.
Furthermore, her ears were infected twice
during my stay at Stanford.

Although our method was not so effective

for recognition of speech, the fact that electrical stimulation to the cochlea suppresses tinnitus to
some extent was observed in the course of developing the cochlear prosthesis. Therefore, we
applied the technology of the cochlear prosthesis to a tinnitus suppresser. With this treatment,
about 30 % of the patients reported that the tinnitus had disappeared without any side effects [8].

Digital hearing aid In general, elderly people who have suffered from a hearing impairment have
less ability to understand spoken language even though they can hear the speech sounds. This
phenomenon seems to be due to a
decrease in the recognition of auditory
time patterns in the speech area of the
cortex. Therefore, in cooperation with
the Central Research Laboratory of the
Hitachi company, we have designed a
hearing aid which can slow down speech
without any pitch frequency change by
using a digital signal processor as shown
in figure 4 [9].

This hearing aid was evaluated and

improved by our laboratory. In our
hearing aid, first, the pitch frequency of
Fig .4. Digital hearing aid a vowel part is extracted; then the pitch
wave is repeated so that the duration of
the vowel part can be slowed down. We have proved that this device is effective in catching the
meaning of rapidly spoken sentences for the elderly sensorineural hearing-impaired. This hearing
aid has been manufactured by Hitachi company.
194 T.lfukube

FJectric artificial larynx. Various methods for vocal rehabilitation have been applied to patients
who have undergone laryngectomee, thereby losing their speech function. We have studied the
vocalization mechanism of a mynah bird, which can imitate the human voice, in order to apply it to
a synthetic sound generator for such patient. An electric artificial larynx is one of the artificial
larynges for the people who have failed to master other forms of substitute speech. However, this
prosthesis makes it difficult to produce
natural voices. From the analysis of the
mynah's vocalization mechanism, we have
found that the mynah can clearly imitate
phonetic information such as intonation
and accent. This is the reason why
mynahs' voices can be heard as natural
voices by humans. In order to improve a
conventional electric artificial larynx, we
have proposed a new method that can
allow laryngectomee patients to control
intonation by using their respiration.

Fig.S. Electric artificial larynx The device consists of three parts as shown
in figure 5. The first part is a pressure
sensor that can detect exhaled air pressure
produced from a stoma made by a surgical incision into the neck. The second part is a
transformation circuit made of a micro-processor that can convert air pressure into a pitch
frequency for voice. The third part is an electromechanical vibrator that can be attached to the neck.
By using the optimal parameters, the pitch pattern of the electric larynx voice became clearly
similar to the pattern produced from a normal subject after one day of training. This type of electric
artificial larynx has just been manufactured by a company in Japan [IO]. The finding; obtained
from our artificial larynx have been applied to design a high quality speech synthesis [II].

Ultrasonic eyeglasses. A new model of a mobility aid for the blind has been developed using a
microprocessor and ultrasonic devices. In this model, a down swept frequency modulated
ultrasound is emitted from a transmitter with broad directional characteristics in order to detect
obstacles as shown in figure 6.
Ultrasound reflections from the obstacles are picked up by a two-channel receiver.
The frequency of the emitted ultrasound is swept from 70 to 40 kHz within I rns, giving it almost
the same characteristics as the ultrasound
which a FM -bat produces for echo-
location. The frequency of the reflected
ultrasound wave is reduced by about 50 : I
by using a micro-processor with AID and
D/A converters. These audible waves are
then presented binaurally through
earphones. In this way. obstacles may be
perceived as localized sound images
corresponding to the direction and the
distance of the obstacles.

Fig .6. Ultrasonic eyeglasses

Basic Research Approach for Assistive Technology in Japan 195

With this device, a blind person can

recognize a 2-mm-diameter wire at a
distance of about I meter. We also found
that the blind could discriminate
between several obstacles at the same
time without any virtual images. This
mobility aid, modeled after the bats'
echo-location system, is very effective
at detecting small obstacles p laced in
front of the head [12].
Fig. 7. Two steps ofthe obstacle sense
However, most blind people can detect
obstacles without these devices. This
ability is called the "obstacle sense". Figure 7 shows two steps involved in the obstacle sense: ftrst
perception (2) and final appraisal (3). We have been investigating the mechanism of the obstacle
sense based on psychophysical experiments using blind students . We have found the reason why
the blind can detect the obstacle is that they can discriminate the tiny difference of sound fteld
between with obstacle and without obstacle. Furthermore, we were able to make the blind hear
"virtual obstacles" by controlling the sound fteld produced from a speaker array.
This study has also been related to virtual reality research [13].

Virtual reality studies. Based on the above techniques and the findings, we have constructed a
virtual reality (VR) system which consists of a head mounted display, a speaker array, a rotational
chair, and a sound proof room as shown in ftgure 8. The temperature of the room can be changed in
the range from minus 4 degrees to plus 40 degrees. We are now investigating mechanisms of
sensory integration. As one example, we have investigated how the rotational stimulation influences
the visual and auditory sensations . These kinds of findings wiII be useful to design both better
models of VR systems and rehabilitation devices
[13].

A research project of a mixed reality (M R)

sy stem was begun 1997 in order to construct a
kind of augmented reality in cooperation with the
Ministry of International Trade and Industry
(MITI), and Canon company.

MR involves integrating elements from the real

Fig.S. Virtual reality system
world with a virtual world. Information from
reality and virtual reality is put together and
displayed . In order to create a smooth MR
environment, a number of problems have to be
dealt with .
196 T. Ifukubc

We have been asked to evaluate how the problems influence the human body ; In particular, the
visual function, the autonomic nervous system, and the sense of equilibrium. In order to investigate
these influences, the Sapporo research branch was constructed. In the center, we have three rooms :
(1) a control room in which there are some computers such as an Onyx 2 to create 3-D images, (2) a
display room in which an arch-screen (figure 9), a motion base with two force plates , a 3-D motion
analysis system have been installed, and (3) a bio-medical measurement room.

We are planning to investigate how

sensory integration is formed in the human
brain when different stimulations such as
the visual and the balance stimulations are
disp layed simultaneously or successively.
The findings that will be obtained from the
research project of MR will be useful in
creating better aid devices.

Fig.9 . Mixed reality system

Transfer aid We have also designed a transfer aid which can move a bed-ridden patient from a bed
to a wheel chair or from a wheel chair to a bed by using a metal hydride actuator . A metal hydride
(MH) actuator, which uses the reversible reaction between heat energy and mechanical energy of a
hydrogen absorbing alloy, has recently attracted much attention. Hydrogen absorbing alloys are
capable of storing as much hydrogen gas as approximately 1000 times their own volume. By
heating the alloy, hydrogen equilibrium
pressure increases and hydrogen is released
whereas by cooling the alloy, hydrogen
equilibrium pressure decreases and hydrogen
is absorbed .

In this way, it is possible to utilize the

mechanical energy of hydrogen gas pressure
by manipulating heat.

A Peltier element is used as a heat source.

By changing the direction of the electric
current to the element, the alloy is heated or
cooled. The functioning part uses metal
bellows which insulate the hydrogen .
Fig. to.Transfer Aid
The drive function, which uses hydrogen
absorption and desorption, has a buffer effect and prevents extreme power changes or shock. Thus,
this MH actuator is milder for humans and more suitable for use in equipment which is attached to
people [14]. Figure 10 shows a transfer aid in which one MH actuator is used [16]. We have also
Basic Research Approach for Assistive Technology in Japan 197

developed a robot hand with tactile sensory

feedback as shown in figure 11[15] and a
wheelchair with a lifter using an MH actuator with
a40 galloy.

Fig .l1.Tele-existence robot hand

CONCLUSION

It can be said that present-day robots and computers are also "disabled" from the point of view of
their sensori-motor functions . The basic findings concerning human sensori-motor functions and aid
devices for the disabled will be useful for designing virtual reality systems and robots.

In the near future, the newly developed technologies of virtual reality and robots will be applied to
design better models of communication and mobility aid systems for people with sensori-motor
disorders . This is our research approach of assistive technology as schematically shown in figure 12.

Virtual Reality and Robotics

Fig .12. One basic research approach for assistive technology

198 T. Ifukube

REFERNCES

[ I] T.lfukube, A cued tactile vocoder, Comp uters in Ading the Disabled, J. Raviv (ed), North-Holland
Publishing Co., 1982, pp .197-215.
[2] T.lfukube, Design of a Voice Typ ewriter, CQ Publishing Co., (195 pages,in Japanese), 1984.
[3] T.Ifukube, Signal pr ocessing fo r cochlear implants, S. Furui & M. M . Sondhi (ed),Advan ces in
Speech Processing, Marcel Dekker, inc., New York, 1992, pp .269-305.
[4] T.lfukube, Sound-based Assistive Technology f or the Disabled, Corona Publishing Co., (250 pages.
in Japanese) 1997.
[5] T.Ifukube, Discrimination of sy nthetic vowels by using tact ile vocoder and a comparison to that of
an eight-channel cochlear implant, IEEE Trans. , BME, VoI.36.No.ll, 1989,pp.1085-1091.
[6] T.Ifukube, R.L.White, A sp eech processor with lateral inhibition for an eight channel cochlear
implant and its evaluation, IEEE Trans.. BME ,VoI.34, N 0.11, 1987,pp. 876-882.
[7] S.Miyoshi ,T.Ifukube,J .Matsushima, Proposal of a new method for narrowing and moving the
stimulated region of cochlear implants -animal experiment and numerical analysis-, IEEE
Trans..BME,VoI.46,No.4, 1999,pp.451-460.
[8] J.M atsushima, S.Miyoshi,T.Ifukube, Surgical method for implanted tinn itus suppresser, Inter.
Tinnitus Journal. VoI.2.No.l, 1996,pp.21-25.
[9] Y.Nejime,T.Aritsuka, T.Ifukube, J.Mat sushima, A portable digital speech-rate converter for
hearing impairment, IEEE Trans.. Rehabilitation Eng.. VoI.4.No.2, 1996,pp. 73-83.
[IO]T.Ifukube. N, Uemi, A New Electrical Lalynx with Pitch Control Function,Th e second east as ian
conference on ph onosurgery, 1999,pp .7-10.
[II ]N.Aoki,T.Ifukube, Analys is and perception of sp ectral l/f characteristics of amplitude and pres s
fluctuations in normal sust ained vowels, The Journal of the Acoustical Society ofAmerica, VoU 06.
No.1, 1999, pp.423-433.
[12]T.Ifukube, T.Sasaki,C.Peng. A blind mobility aid modeled after echolocation of bats , IEEE Trans..
BME, VoI.38.No.5, 1991,pp. 461-465.
[13]T.Ifukube ,From sensory substitute technology to virtual reality research, Artif Life Robotics
(InvitedArticle),V oI.4.No.2,1998, pp.145- 150. .
[14]T.Tanaka, S.Ino,T.Ifukub e, Objective method to determine the contribution of great toes standing
balance and preliminary observations of age-related effects, IEEE Trans.. Rehabilitation Eng..
VoI.4.No.2, 1996, pp .84-90.
[15]S. Ino,T.Izumi,T.Ifukube, Design of an actuator for tete-existence display of position and force to
human hand and elbow, J. Robotics and Mechatronics, VoI.4.No.l , 1992,pp.43-48.
[16]Y.Wakisaka, M .Muro, S.Ino,T.Ifukube, Applications of hydrogen absorbing valloys to metal and
rehabilitation equipment, IEEE Trans.. Rehabilitation Eng., VoI.5.No.2, 1997,ppI48-157.
Some Mechanical Problems to Use Electric Wheelchairs in a
Snowy Region
Shigeru Tadano' , and Atsushi Tsukada-

I Division of Mechanical Science, Graduate School of Engineering, Hokkaido University, N-13, W-

8, Kita-ku, Sapporo , 060-8628 Japan

2 National Rehabilitation Center for the Disabled, Tokorozawa, 359-8555 Japan

Summary. An appropriate wheelchair is greatly desired to develop for outdoor use during the winter
season in a snowy region. To be clear some mechanical problems to use the electric wheelchair at the
snowy roads, three types of electric wheelchair were tested for their drivability on an icy road, a
snow-covered road and an indoor floor. In addition, computational method was proposed to simulate
the drivability of a wheelchair on the snowy road condition. The batteries equipped in an electric
wheelchair were also examined on the electric property ofcharging and discharging at low temperature.

Key words. Electric Wheelchair, Mechanical Design, Snow Covered Road, Drivability, Battery

INTRODUCTION

A wheelchair is the most popular and effective device to assist outdoor activities of handicapped or
elderly people . Their chances to go out gradually increase with improving their QOL ( Quality of
Life) because of the advances in rehabilitation technologies and welfare policies . In a snowy area,
however, going out involves many difficulties and risks for them during the winter season because of
roads covered with snow and ice. In particular, the Hokkaido area is much snowed for four months
from December to March . An appropriate wheelchair is greatly desired to develop for outdoor use
during the winter season. For the promotion of QOL of handicapped or elderly people living in the
snowy area, we are investigating on the wheelchair to assist their outdoor activities during the winter
[1,5]. In this paper, to be clear some mechanical problems to.use the electric wheelchair at the winter
in a snowy region, the following subjects were reported;

1) Driving test at snowy road : Three types of electric wheelchair with each different driving wheels
and casters were tested on an icy road, a snowy road and an indoor floor. When the wheelchair is
driven on the snowy roads, it is very important that the driving wheel rotates stably without slipping.
Therefore, the experimental method was proposed to evaluate quantitatively the slipping tendency
during driving [1].

2) Computer simulation on the drivability : A wheelchair should be designed taking the individual
ability and size of a user into account. The drivability of wheelchair at the snowy roads will be much
influenced by the structure and the center of gravity of a whole wheelchair including the human body
ofthe user. Therefore, computational methods were proposed to simulate the drivability of each electric
wheelchair [1].

3) Low temperature property of battery: It is a serious problem for an electric wheelchair that the
discharge capacity of battery extremely drops owing to low temperature. The batteries for electric
wheelchair were examined on the charging and discharging properties at a constant low temperature .
The batteries covered with foamed polyurethane were also tested at the same condition. In addition,
practical driving test of an electric wheelchair was carried out to investigate the discharging property
at a fresh-snowy road, a compact snowy road and a summer road [5].

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 199
200 S. Tadano and A. Tsukada

DRIVING TEST

Electric wheelchairs. Three types of electric wheelchair - the RC type ( rear-wheel drive and front
free casters, MCl3S, Suzuki Co.Ltd., Japan), the RD type (rear-wheel drive and front mechanically
controlled casters, MCl3P, Suzuki Co.Ltd ., Japan ), and the FD type ( front-wheel drive and rear
mechanically controlled casters )- were tested for their ability to be driven on icy road, snow-covered
road and indoor floor. Fig. I shows the electric wheelchairs of the RD type and the FD type. For every
wheelchair, the veloc ity at forward driving can be selected manually from three ranges of 3.0 km/h,
4.5 kmlh and 6.0 km/h.

Slip ratio. When a wheelchair is driven on icy and snow-covered roads, it is very important that the
driving wheel rotates stably without slipping . The slipping tendency of driving wheels was evaluated
in this experiment. The slip ratio K(t) was defined as the relationship between the actual velocity
Vert) and the theoretical velocity Vt(t), and was formulated in Eq. (l)[I].

Vc(t) - V,(t)
IVit) I
.....·1Ve(t) HV/(t) I
K (t) = o '" ···1 Ve( /) 1=1 VzCt) I (I)
V/t) - V,(t)
IVe(t) I
...···1 VC<t) 1>1 Vit) I
Where, the actual velocity Vert) of a wheelchair is obtained from the measurement of the acceleration.
An acceleration transducer was mounted under the seat. The theoretical velocity Vt(t) is calculated
from the rotation of the motor, the total reduction ratio and the diameter of the driving wheel. In Eq.
(I) , K(t)= 0 means that the wheel does not slip, 0 <K(t)< I means the degree at which the wheel is
slipping, and K(t) = I means that the wheel slips completely. In addition, - I <K(t)< 0 is the degree to
which the wheel slides by inertia, and K(t)= -I is the wheel slides completely and locks up the rotation.
During driving, the acceleration along three axes and the values of the pulse voltage of the motors
were measured and recorded in the data analyzer (DAA-IIO, Kyowa Electronic Instruments Co .,
Ltd., Japan) . Five pulses of voltage were generated per one rotation of motor. Driving test was carried
out on an icy road, a snow-covered road and an indoor floor. A normal tire and a snow tire with deep
grooves were also examined.

Experimental result. A snow-covered road was produced outdoors in the winter season. The drivability
was tested on a flat road and a slope with a gradient of 1/20. In addition, a driving on fresh snow was

Fig. 1. Electric wheelchairs (Left : the RD type with rear-wheel drive , Right: the FD type with
front-wheel drive)
Use of Electric Wheelchairs in a Snowy Region 201

tested in the temperature of -5 'C . From each test, it was continned that the drivability ofthe FD type
of wheelchair was improved over that of the RD and the RC types .

The variation of slip ratio was measured at the velocity of 3 km/h from start to stop on indoor floor.
The result was obtained as in Fig. 2 (left). Every wheelchair showed stable driving with K(t) = O. The
slip ratio at 3 km/h on a snow-covered road is shown in Fig. 2 (right) . The differences among the
wheelchairs were clear. The RC type much slipped after the start, while the FD type drove stably
without slipping . At 6 km/h on a snow-covered road, every type drives with a constant slip ratio after
the start . Upon braking, the FD type could stop with barely slipping. Thus, the drivability can be
evaluated as the quantitative data provided by the slip ratio. On a snow-covered road and an icy road,
the drivability of the FD type was better than that of the other types. While even the FD type will be
not sufficient to practical use at a snowy road.

COMPUTER SIMULATION

Method. Computational method was developed to simulate the drivability of electric wheelchairs on
a snow-covered road [1]. 3-D computer models of the RD and the FD types were constructed including
a human body as shown in Fig. 3. Each model of the wheelchair is composed of thirteen rigid body
elements ; foot plates , a back seat, a seat and ann rests etc. The human body was modeled from the
values of mass and geometry for each body part based on the published data in Ref. [3]. The total
mass of the human body is 56.2 kg, which is an average value for elderly men. The spring constant
and the damping coefficient between the swing arm and the frame are 44.1 KN/m and 1.6 KNs/m.
The vertical stiffness of a tire is 60 KN/m. These values were determined by measuring the wheelchair.
The slip ratio was calculated for each road condition of dry, wet, snow-covered and icy. These conditions
were expressed in the analysis as friction coefficients between the tire and the road surface are 0.6 on
dry, 0.4 on wet, 0.25 on snow and 0.1 on ice road [4].

In this simulation, a dynamic analysis of multi-body system [2] was done using the software of DADS
(Dynamic Analysis and Design System ; Cybernet Systems, CO. Ltd., Tokyo). Two types of driving
simulation were carried out: One is the driving simulation under a constant acceleration when torques
of 15 Nm or 30 Nm is applied. Another is the driving simulation from start to stop with a driving
mode ; start - acceleration - constant velocity (6krn/h) - deceleration (after 10 s from start) - stop.
These simulations were done at a flat road, uphill and downhill of the slope with a gradient of 8 %.

Simulation result. In the driving simulation under a constant acceleration at a torque of 15 Nm,

0 .5 0 .5 H'''?r.::-=f-='---t----'"'cl:=:---- t -- -H
::<:
.2 It ,~ I _ _" ,~
ro l\'
,,'.
II

a:
.9-
0
-, ""' .. I}'~~ ; ' 'y

en
-0 . 5 - 0 .5 H-- - +-- -t-- - -I-- -+-- ---1H

- 1 - 1 I=!::=;;;:;!;::==!;;;;;==!;;;;;=:±;;;=;±;l
o 2 4 6 8 10 o 2 4 6 8 10
Time (5) Time (5)

Fig. 2. Slip ratio at 3km/h on an indoor floor (left) and a snow-covered road (right)
(_ _ : FD Type, : RC Type, • • ••: RD Type)
202 S. Tadano and A. Tsukada

although every figure is not shown , it was confirmed from the computer simulation that the FD type
improved the drivability on a flat road covered with snow. The variation in the slip ratio for an uphill
drive at a gradient of 8% is also obtained on a dry road and a snow-covered road . In this case, the slip
ratio of the FD type was also lower than that of the RD type. At a torque of30 Nm on a snow -covered
road, a difference in the slip ratio between the FD type and the RD type is not apparent, and both slip
ratio s were close to 1.0. Right figure s in Fig. 4 show the velocity and slip ratio obtained by the
simulation from start to stop under a friction coefficient of 0.25. Every wheelchair moved with much
slipping at start and at stop. Besides the experimental result was shown in the left figures. In comparison

Fig. 3. Computer simulation model

7 7
1-0...
r-,
-"'"
6 6

-
s:
E 5
/
I s:
E 5
1
.T
,
->- 4 4

- -V .f l.
>-
.-u 3 o 3
0 / \ 0 j \
I-
2 2
>'" \ ' >'" I \
0
-, 0
\:.
o 2 3 4 5 6 o 2 4 6 8 10 12

T im e (5) T im e ( 5 )

~
0 .5 1- :.:: 0 .5

\N .I~ ... .. . - ... . . ..

:.::

.~ ~\ ~I,
.
.9 .9

. .
in in
,,
if '
a: 0 , a: 0
.9- I ,

iii .9- I I

-0 .5 ~ I
iii -0. 5 -f •

- 1 - - 1
i
o 2 3 4 5 o 2 4 6 8 10 12
T ime (5) T im e (5)

Fig. 4. Results of computer simulat ion and experiments ( Left: experiment ,

Right: comput er simulati on)
1--- -- :~ ~YP: I
Use of Electric Wheelchairs in a Snowy Region 203

with experimental result, it is clear that this simulation result is almost similar with experiment. It was
also recognized that the slip ratio of a wheel was greatly influenced by the position of the driving
wheel as well as by the center of gravity ofthe wheelchair/human system.

LOW TEMPERATURE PROPERTY OF BATTERY

Method. Power source of an electric wheelchair is usually a storage battery with electrodes made
from lead . It is well known that the discharge capacity of the battery extremely drops owing to low
temperature. The experimental method was developed to investigate the low temperature property of
the battery. The charging and discharging control system (BTS VERI . 60, Tokyo R&D Co. Ltd.) was
used in this test. In this experiment, inner and outer temperature, the values of voltage and electric
current of batteries were measured under charging and discharging at several conditions . The charging
condition is a constant current of 7A during 6 hours at each outer temperatures of 10 "C and 20 ·C .
The discharging condition is under applying the load at a constant electric capacity of 0.2 C and 0.4 C,
where the symbol "C" indicates the discharging rate against the total rated capacity which the battery
has . Then outer temperatures are -20'C, -10'C and 0 ·C . In comparison with low temperature, the
experiment at 30 ' C was also done.

Experimental result. Fig. 5 shows the relationship between the discharging capacity and the outer
temperature. It is clear that the discharging capacity decreases with decreasing outer temperature
under both 0.2 C and 0.4 C. The discharging capacity at -20'C is about 70 % of the rated value of35
Ah. Fig. 6 shows the effect of the cover with foamed polyurethane on the discharging capacity. With
covering the battery case, the discharging capacity increased at both 0.2 C and 0.4 C. Although under
-20·C . Then the discharging capacity maintained over 80 % of the rated value.

Road test for battery. Road test for batteries was carried out to confirm the effect of road condition
on the discharging capacity. The measurement system for voltage, current, inner temperature ofbatteries
was made originally in this work . The result was obtained as Fig. 7. From these figures, the values of
electric power of a battery under driving much fluctuated by the road condition. The driving period on
a sununer road was 250 minutes , while on a compact snowed road and a fresh snowed road were 170
and 80 minutes, respectively. Therefore, the discharging capacity on the winter road extremely dropped
with the influence of low temperature as well as the road condition in the winter.

40 r - -....- - . - - -...- - , -----r- - -r--, 40

'i':

-
'i':
$ 351--+--+---+-~;;fo-""""'__t::;;;;;~. ._j $ 35
?:
'u
~ 3o l---t--Ai::~::::;J;=_.....,,:j:::::=--~--+_l
::-
'u
'c~". 30
~
'\
~
- .-I ]
.-I

~
o

'~" • 0.2 C (charge at 10 DC)

'"
Cl
16 .,..:? T
. 0.2 C
~ 25 I -- --!i'--+---j 0 0.4 C (charge at 10 DC) ~ 25 . 0.4 C
i5 • 0.2 C (charige at 20 DC) i5 Ir'"
0 0.2 C wilh F.P.
o 0.4 C (charge at 10 DC)
20 L - _...L-_.....J.._ _l...-_...L-_.....J.._ _ .l.......J
0 0.4 C wilh F.P.
20
· 30 · 20 · 10 o 10 20 30 · 20 · 15 · 10 ·5 o
Outer te mperature (OC)
Outer tempe ratu re (OCl

Fig. s. Relationship between outer temperature Fig. 6. Discharging capacity of batteries

and discharging capacity covered with or without foamed
polyethylene after charged at 10 'C
204 S. Tadano and A. Tsukada

CONCLUSIONS

The following results were obtained from this work : The slip ratio of an electric wheelchair with
front-wheel drive was significantly less than that ofwheelchairs with rear-wheel drive in snow-covered
road and icy road . The unified three-dimensional model of a wheelchair and a human body was
analyzed as the mult i-body dynamic systems . The similar driving results obtained at the experiment
were also obta ined from the computer simulation. The discharging capacity of battery at outer
temperature of -20 ' C dropped in 66% in comparison with that at 30 'C . When a battery was covered
with formed polyethylene, the discharge capacity improved in 17% down . From the practical road
test, the discharging capacity of battery was strongly affected by not only outer temperature but also
road condition .

REFERENCES

[1] S. Tadano, A. Tsukada, J. Shibano, T. Ukai, Y. Watanuki, Driving Tests and Computer Simulations
of Electric Wheelch airs on Snow-Covered Roads, JSME International Journal, Series C, VolA1,
No.1, 1998, pp. 68-75.
[2] E. J. Huage , Computer Aided Kinematics and Dynamics ofMechan ical System, Basic Methods
vol. 1, Allyn and Bacon, 1989.
[3] Report on Human Body Dimensions Data for Ergonomic Design (in Japanese) : National Institute
ofBioscience and Human-Technology, Vol.2, No.1, 1994, pp. 16-24.
[4] Report on Concept and Implementation of Law on Road Structure (in Japanese): Corporation of
Japan Road Society, 1983, pp. 107.
[5] S. Tadano, A. Tsukada, D. Hayashi, H. Takahashi, M. Iwasaki, T. Ukai, Low Temperature Property
of Battery for Electric Wheelchair, Transactions ofJSME (in Japanese), Series C, Vol. 65, No .
632,1999,pp.1578-1585

800

~ 600
0;
;:
a 400
0

.~
t>Q)
200
W

60 120 160 240 300 0 60 120 18 0 240 300

T im e ( m in) T i m e ( m in)

Fig. 7. Electric power of batteries at driving

on winter road (left) and summer road (right)

Fig. 8. A scene at driving test in the winter

Estimation of Lower Limb Muscle Function from Kinematic
Gait Analysis and Muscle Tension Model
Masao Tanaka', Yasushi Akazawa', and Akio Nakagawa'

I Division of Mechanical Science, Department of Systems and Human Engineering, Graduate

School of Engineering Science, Osaka University, Toyonaka, Osaka 560-8531, Japan
2 Assistive Technology Research and Design Institute, Hyogo Prefectural Rehabilitation Center,
Akebono, Nishi, Kobe 651-2181, Japan

Summary: This article discusses a biomechanical model-based approach toward estimation of

muscle function of lower limb by using planer link model and muscle tension model based on
kinematic gait analysis. The muscle tension model uses the relation between isometric tension
and strain by Kaufman and others, and the relation between the isotonic tension and velocity by
Hatze. A link model of four elements is defined for the sagittal plane motion, and regression
model by Hawkins and Hull is employed to relate the joint angles and lengths of eight
representative muscles. The optimum lengths of muscles are calculated based on a minimization
problem by paying attention to the qualitative EMG pattern during the stance phase. The obtained
muscle tension pattern had the typical characteristics in stance phase in the case of muscle with a
small index of archtecture. As a case study, the function estimation is carried out for a patient
with fibula fracture, and the tension calculated by model-based approach with kinematic data of
gait analysis showed the reasonable recovering process consistent with that found in the joint
moments. This observation encourages the model-based estimation of muscle tension using
kinematic data of gait analysis with model improvement.

Key words: Gait analysis, Muscle tension, Lower limb, Rehabilitation

INTRODUCTION

Locomotion is the fundamental motion realized by the coordination of lower limb muscles, and its
recovery is one of the most primal objectives in rehabilitation for subjects with gait disorder. In
the rehabilitation engineering studies, the gait analysis has very long history and has been
considered as a tool effective to evaluate the state of recovering process of individual subject. In
these decades with the computerization of instruments, the attention has been focused on the kinetic
analysis, i.e. the joint force and moment analysis from the biomechanical viewpoint. However,
the kinematic analysis, i.e. the body segment motion analysis and the foot-floor reaction analysis
have much experience from the clinical point of view. In this article, a biomechanical model-
based approach is considered for the estimation of muscle function of lower limb by using a planer
link model and a muscle tension model with kinematic data of gait analysis.

LOWER LIMB MODEL

Tension modeL The tension of stimulated skeletal muscle is well determined by the isotonic and
isometric characteristics. The isometric tension is a function of the muscle length, and the
isotonic tension depends on the velocity of shortening. The muscle tension is also a function of
physiological cross-section and the muscle architecture. These fundamental features of muscle
tension had been studied and described in biomechanical model [1]. In order to predict the
isometric tension as a function of muscle length, Kaufman et al. [2] proposed a model

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 205
206 M. Tanak a et al.

. [ [(E+I).""'II-I"')-I]'] for t. < 1

S,_ (E",) = exp - 0.35327(1-;J (I)

s,_(E, i,) = expH2.72177 In(E +I)J ] for t. =1

where SisO," stands for the unit tension normalized by the tension at the optimum length L Oo E is the
muscle strain referring to the optimum length, and t, is the index of architecture, the ratio of muscle
fiber length to muscle belly length. For the isotonic tension, Hatze[3] reported the tension-
velocity relationship

(2)

where SISOI is the normalized muscle tension and dn/dt is the contractile velocity normalized by that
under zero load. The resultant muscle tension is characterized as the product of isometric and
isotonic tension models [4]

S=Sj$lOlS i_ (3)

as illustrated in Figure 1. In this consideration, it is assumed that the maximum muscle tension
per unit physiological cross-sectional area does not depend on each muscle, and the muscle tension
is proportional to the physiological cross-sectional area of individual muscle.

Link model and muscle length, A serial link consisting of four rigid elements is employed as the
link model of lower limb, since the primal gait movement is observed in the sagittal plane. In this
link model, the hip, knee and ankle joints are assumed as rotational joints of single degree of
freedom, and the joint angles are defined as shown in Figure 2. With this link model ,

Fig, 1. Muscle tension model Fig. 2. Link model and major muscles
Estimation of Lower Limb Muscle Function 207

eight representative muscles are considered for muscle groups with I) gluteus maximus, 2)
hamstrings, 3) iliopsoas, 4) rectus femoris,S) vastus, 6) gastrocnemius, 7) soleus, and 8) tibialis
anterior. The linear distance between the muscle origin and insertion is the most primitive
prediction for the muscle length, although the real muscle path is complex spatial curve.
Regression curves

L = c. +C,a+C,fJ +C,fJ' +C.r (4)

were submitted as model equations for this simple prediction for the main muscles except gluteus
maximus by Hawkins and Hull[5], where a, f3 and ydenote the angles of hip, knee and ankle joints
and C/, .., C. are regression coefficients. The model coefficients for gluteus maximus are
determined by referring the origin/insertion data in literatures [6,7].

The kinematic data of gait analysis give us the time series of positions and orientations of lower
limb segments, and the muscle length model of Equation (4) provides correspondence between the
joint angles calculated from kinematic data of gait analysis and the muscle length. In order to
predict the muscle tension based on the tension model of Equation (3), the needed parameters are
the index of architecture, the physiological cross-sectional area, and the optimum length. The
index of architecture of each representative muscle is determined based on the muscle fiber length
and belly length in vitro [8, 9] and on the correction factor between in vitro/in vivo data [7]. For
the optimum lengths of main muscles under concern, the literature data are not applicable in this
study, because the relationship between the muscle lengths and the body segment length were not
specified and the muscle-tendon proportion were not specified. In order to resolve this difficulty,
an estimation problem is formulated to determine the optimum length by paying attention to the
fact that the isometric tension exhibits the maximum at that length and by referring to the reports on
the joint moments at different joint angle with the isometric exercise [10-14]. The isometric joint
moment produced by a muscle is written as

M_ =S_(E,;.) A C1 r (5)

by using the physiological cross-sectional area A, the maximum muscle tension (1 per unit
physiological cross-sectional area, and the moment arm r . The error function is defined between
the experimentally observed joint moment M in literatures and the resultant joint moment
calculated by the muscle tension model as a function of optimum lengths of muscles. At the same
time, the qualitative EMG pattern of each muscle during a stance phase is represented as a window
function 8.. for the muscle tension s.., and the difference of 8.. and s.. are attached to the error
function of joint moments for the estimation problem. Thus, the resultant objective function is
minimized with respect to the optimum lengths and the maximum muscle tension per unit
physiological cross-sectional area;

-
subject to L...... <L••• <L_,., 0<C1<C1 (6)

where the index m distinguishes eight representative muscles, index i stands for joints and j does
direction of extension or flexion. The constraint for the range of muscle lengths corresponds to
the joint range of motion, and the limit of maximum tension per unit physiological cross-section
area is determined by referring to the literature [7]. Physiological cross-sectional area and
moment arm data are collected from literatures [8, IS].
208 M. Tanak a ct al.

IJ u

!
1 r -,\
. 0' ! '\.
J .i/
I ....
.
.. ..
~_...--

10 4D 4D 10 4D ID 100
1004 .once pbuo (1I) looll Ilonce pbl.. (1I)

(a) Soleus (b) Vastus

Fig. 3. Muscle tension pattern in stance phase

CASE STUDIES
Young normal subjects. Gait analysis is carried out for five young normal subjects (height
172cm, weight 66.8kg in average) by using a conventional gait analysis system. The kinematic
data of joint angles in sagittal plane during stance phase are used to predict the muscle lengths by
Equation (4), and the problem (6) is solved by means of the simplex method of nonlinear
programming. The velocity of muscle shortening is calculated by numerical differentiation of
muscle lengths. The predicted muscle tension is a function of determined optimum lengths. Its
variation during the stance may exhibits characteristics pattern for muscles which architecture
index is small, since the tension of such a muscle has relatively high sensitivity with respect to the
optimum lengths. In the cases of soleus and vastus, the muscle tension calculated by the model
in the above has the pattern consistent with that known in tile normal gait as shown in Figure 3.
Such characteristic pattern is not obtained for other muscles with relatively larger index of
architecture.

Fibula fractured subject. The recovering process of a young subject (height 158cm, weight
50kg) with a fibula fracture by a fall is evaluated as a case study. The affected lower limb below
knee with ankle was fixed by plaster cast for 40 days, and the resting period of two weeks was
assigned after removal of plaster. The walking in daily activity was then started with full body
weight bearing. The gait analysis was carried out at 0, 2, 4 and 20 week after the start of normal
daily life activity. Figure 4 shows the stick picture and floor reaction of the affected side, and
their major difference was only found in the patterns between 0 and 2 weeks. The calculated
tensions of soleus and vastus are shown in Figure 5. The solid and broken lines distinguish the
average and that with single standard deviation for multiple trials. Both of these muscles exhibit
very small tension throughout the stance phase at 0 week, and the tension of normal side has also
influenced by the abnormal gait motion of affected side. Since the lower limb posture looks like
an almost straight stick as is found in Figure 4, these muscles are kept in the position at which any
useful tension could not be produced. Such a lower limb posture for gait movement would not be
selected, if the function of muscles had been at the normal level. That is, the almost zero muscle
tension calculated from the observed joint postures may be recognized as the result of a strategy to
compensate the muscle function insufficient for the normal gait movement. The tension pattern of
soleus at 2 week is different from that at 20 week, although the tension pattern of vastus at 2 week
is almost same as that at 20 week. At the 4 week, the tension patterns of both of soleus and vastus
 .. rn
.Ii [OW] [OW) ~
!1 (OW) 3'
J ~
r:
I , s
=>
ij r 0
...,
i I.. ).. r-
0
~ ~
I I I I I .~ I , I
......, ~
.: .. .. I. . . I.
r-
l. . . .. MClpMM("l
n.' ..... .... . .1 .....
. . . . Ion. ..... - .... (" 1
. 3'
" " "l11tl'lt u
(2W) sr
!1 (2W) i [2WI
~
\\~illillml'~ i c:
Of>
n
.,-Ie (;"
I
rr t "T'l
c:
i ., r>,\ e
~i I.. !l
/~\ 0'
.; .........
. -- , I
.. I
.
10011 .....,. ,... (')
I
. .• ! -. ;s.. !
I .,.............: : : .:::~:: ::::>
.
f =>

(4W) [4W) "f [4WI

!1
.Ii"
:' j ...... ! I
.,-Ii ................
I >./ .: / .>: '\.~
i \:\
:, I ,/ 4
;i I.. p t /,/
1.. ~
1 ,
~.../
,.00;' :~~
" "
. .
1............. (110)
.. . , 10ft MuEI ...... (1')

u
!i (JOW) ! [20Wj

';;
J ........;.:;:..
J
I;
i
1 1
;i /'::.~~/" "
I.. / ./ ...
~y\ )..
/1/
,/ ~
., tt
.$ ~ " ~" I
t. .
.. .
.-a .... ~)
.
. . . _ _ .... ('5)
.
(a) Soleus (b) Vastus
Fig. 4. Posture and floor reaction Fig. S. Calculated tension N
o
'"'
210 M. Tanaka et al.

are almost identical to those at 20 week, at which normal gait has recovered completely. Some
difference from 20 week is found at 2 week in the joint moments calculated from the floor reaction
by using the link model, and it vanishes at 4 week [16]. This finding is consistent with that
observed in the tension pattern calculated . Same finding is also confirmed in the maximum knee
extension/flexion moments observed by using training equipment [16].

CONCLUSIONS

The model-based approach to the muscle function with the kinematic gait analysis has the potential
to work as a supplemental counterpart of the kinetic gait analysis for joint moments, when the
model is refined by referring to the experimental data.

REFERENCES

[1] K-N An, E.Y.S. Chao and K.R. Kaufinan, Analysis of Muscle and Joint Loads, Basic
Orthopaedic Biomechanics (V.C. Mow and H.C. Hayes eds.), Raven, New York, 1991.
[2] K.R. Kaufinan, K.N. An and E.Y.S. Chao, Incorporation of muscle architecture into the muscle
length-tension relationship, Journal ofBiomechanics, Vol.22, 1989, pp.943-948 .
[3] H. Hatze, A Myochybernetic Control Model of Skeletal Muscle, Biological Cybernetics, Vol.25,
1977, pp.103-119.
[4] D.A. Winter, Biomechanics and Motor Control ofHuman Movement, John Wiley, New York,
1990.
[5] D. Hawkins and M.L. Hull, A method for determining lower extremity muscle-tendon length
during flexion.extension movements, Journal ofBiomechanics, Vol.23, 1990, pp.487-494.
[6] R.A. Brand, A model for lower extremity muscular anatomy, Journal of Biomechanical
Engineering, Vol.104, 1982, pp.304-3l O.
[7] M.G. Hoy, F.E. Zajac, and M.E. Gordon, Journal ofBiomechanics, Vol.23, 1990, pp.157-l69.
[8] J.A. Friedrich and R.A. Brand, Muscle fiber architecture in human lower limb, Journal of
Biomechanics, Vol.23, 1990, pp.9l-95.
[9] T.L. Wickiewicz, R.R. Roland, P.L. Powel and R.E. Edgerton, Muscle architecture of the human
lower limb, Clinical Orthopaedics and Related Research, Vol. 179, 1983, 275-283.
[10] G. Markhede and G. Grimby, Measurement of strength of hip joint muscle, Scandinavian
Journal ofRehabilitation Medicine, VoLl2, 1980, pp.169-l74.
[11] E. Marsh, D. Sale, AJ. McCocmas and J. Quinlan, Influence of joint position on ankle
dorsiflexion in humans, Journal of Applied Physiology: Respiratory Environmental and Exercise
Physiology, Vol.51, 1981, pp.160-l67.
[12] G. Nemethm J. Ekholm, U.P. Arborelius, K. Harms-Ringdahl and K. Schuldt, Influence of
knee flexion on isometric hip extensor strength, Scandinavian Journal ofRehabilitation Medicine,
VoLl5, 1983, pp97-10l.
[13] G.N. Scudder, Torque curves produced at the knee during isometric and isokinetic exercise,
Archives ofPhysical Medicine and Rehabilitation, Vol.6l, 1980, pp.68-72.
[14] D. Sale, J. Quinlan, E. March, J. McComas and A.Y. Belanger, Influence of joint position on
ankle plantarflexion in humans, Journal of Applied Physiology: Respiratory Environmental and
Exercise Physiology, Vol.52, 1982, pp.1636-l642.
[15] N. Yamazaki, Extended model for analysis and simulation of bipedal locomotion,
Biomechanism 3, University of Tokyo Press, pp.26l-269 (in Japanese).
[16] Y. Akazawa, A. Nakagawa and M. Tanaka, Evaluation of gait recovery after removing ankle
cast fixation: a case of fibula-fractured patient, Journal of Japanese Society for Clinical
Biomechanics and Related Research, V01.18, 1997, pp39l-394 (in Japanese).
A New Force Limitation Mechanism for Risk Reduction in
Rehabilitation Robots
Noriyuki Tejima

Dept. of Robotics , Ritsumeikan University , 1-1-1 Noji-Higashi, Kusatsu, Shiga, 525-8577, Japan

Summary: In this paper, a new mechan ism to reduce the risk of rehabilitation robots contacting with
a human is proposed . The device is composed of a force limitation mechanism, a spring and a damper
with anisotropic viscosity . A prototype was developed, and its basic features were experimentally
evaluated. The size of the prototype was too large, but it confirmed that the new mechanism had many
advantages. It could avoid using force stronger than a threshold level above which humans are
affected . As the arrangement of the mechanism was not restricted to the joints of a robot arm, posture
of the robot had no influence upon the threshold force to an end-effector . The anisotropic damper
realizes quick response to excessive forces and slow restoration for safe movement.

Key words: Safety, Rehabilitation robot, Assistive device, Service robot, Torque limiter

INTRODUCTION
They say that more than 200 Handy-1 rehabilitation robot systems for mealing and more than 100
MANUS multipurpose systems have already been sold worldwide. The rehabilitation robot is not a
dream but rather a practical tool for people with disabilities now [1]. However, there are still many
unsolved problems concerning human interfaces, safety and so on. As it is not clear how to reduce
the risk of rehabilitation robots hitting humans, accidents may happen . For example , the MANUS
system seems to be safe because only low-power actuators are used in it. However, it has been
reported that many MANUS users want to get a higher performance robot than the MANUS [2]; the
MANUS moves slowly, it can handle only light goods, and its arm is not enough long. If such a high
performance robot is developed at a user's request, we have no way to prevent accidents. A new risk
reduction strategy for rehabilitation robots must be formulated to realize a useful rehabilitation robot.
The objective of this study is to develop a new risk reduction mechanism for rehabilitation robots.

SAFETY TECHNICS IN ROBOTICS

Several fatalities and many accidents involving industrial robots have been reported [3]. Human safety
has been a major concern in the design, operation and maintenance of industrial robots . The main
strategies for preventing an industrial robot from harming a human are to prevent a human from
entering the robot workspace and to stop the robot when a person enters the workspace. The devices
employed for this purpose include physical fences, partitions, light curtains, contact mats and several
kinds of sensors [4]. However, they are not applicable to the rehabilitation robot, which should serve
a human in its workspace.

I think that making a rehabilitation robot that does not contact a human by any means will be
impossible. The devices to detect and to avoid humans within the robot workspace, before contact
with them, such as ultrasonic sensors or beam sensors [5,6], are unreliable. It is difficult to arrange
sensors without omitting areas from detection, and it is difficult to make them truly fail-safe.
Therefore a policy for safety even if the robot contacts a human should be considered.

According to ISO/lEC Guide 51 [7], safety is defined as freedom from unacceptable risk, and risk is
defined as a combination of the probability of occurrence of harm and the severity of that harm. In

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 2\\
212 N. Tcjima

this point of view, it is necessary to reduce the probability of occurrence of harm and to reduce the
severity of that harm for a robot to be safe. A few studies to reduce the probability of occurrence of
harm have been done [3,4,8]. The central goal of this study is to reduce the severity of the harm. It is
not clear what should be chosen as an index of the severity of the harm at the time of contacting
against a human. The force, the stress, or the kinematic energy that the robot applies to a human can
be considered. In this study, I use the force as an index. If the force the robot can apply to a human,
is below a specific threshold, the robot is presumed safe. In addition, the measured force is not limited
to the force that the robot alone generates. The force between a human and the robot resulting from
the human, and the wheelchair to which the robot is attached, moving should also be considered.

Force sensors and torque sensors for detecting contacts also have problems that lie in low reliability
caused by the intolerability of electronic devices against electromagnetic noises [9]. The control
method using these sensors is not essentially, but supplementarily useful to reduce the risk. Soft
structures, such as soft arms, soft joints or soft covers, work to reduce the peak of impulsive contact
force [10], however, they have many problems; the most suitable compliance values have not
clarified, a soft system is easily resonated, it is deformed even by a weak force, and elastic energy is
freed as kinematic energy when static forces are unloaded.

Force (or torque) limitation mechanisms or low power actuators are effective for a simple system
[11,12]. A force limitation mechanism is rigid against weaker forces than a threshold , but it is
activated by stronger forces to move out of the way. And by dodging them, it can protect a user
against excessive forces from a robot. Nevertheless, deciding the limitation torque value for an
articulated robot is a difficult problem because of the complex relationship between various torques
and an external force. For example, a 2-dimensionaI2-degrees of freedom model as shown in Figure
1 is considered . A torque limitation mechanism that slips when the torque becomes larger than a
threshold torque, T'hl' is attached on joint 1, and a torque limitation mechanism with a threshold
torque, T'h2' is on joint 2. When a force F is applied at an angle lJl to the end-effector, the force
permitted is a function of the joint angle e as follows:

~hl > Filisin /pI and T;h2 > Fill sin cp - 12 sin( e- tp )1 ·

Consequently, when it is going to restrict the force to an end-effector within a range below a threshold
value at every joint angle, the threshold torque, T'hl and T'h2' of the mechanisms must be extremely
small, and as a result, the robot's performance is restricted . The problem will become more
complicated, when a robot with larger degrees of freedom or 3-dimensional models are considered .

Fig.I. A 2-dimensional 2-DOF model with torque Fig.2. A 2-dimensional 2-DOF model with the new
limitation mechanism on joint 1 and 2. force limitation mechanism and a torque limitation
mechanism on joint 1.
Risk Reduction in Rehabilitation Robots 213

DESIGN RATIONALE
In order to solve this problem, a straight-movement type force limitation mechanism was put in the
middle of a link, as shown in Figure 2. When the threshold force of the mechanism is F'h' the force
permitted by the force limitation mechanism and by a torque limitation mechanism on joint 1 is
e
independent of the joint angle as follows:

Consequently, the threshold torque T'hl and the threshold force F'h can be determined appropriately,
so that a force affected to the end-effector will be restricted sufficiently to avoid an accident.

A problem remained, where the original position could not be restored, even after unloading the force,
once the centrally placed force limitation mechanism had been exposed to excessive force . This was
because there was no actuator for the centrally placed force limitation mechanism, although the force
limitation mechanism attached on the joint could be restored by the actuators that drove the joint.
Then a new force limitation mechanism that can be centrally placed in the middle of a link was
proposed. The same problem arose if only a spring was used as an actuator for restoration when
unloaded. This problem was solved by using a damper with anisotropic viscosity. When the viscosity
is set low, rapid respons es for safety will be available when the mechanism works under excessive
forces. On the other hand, at a high viscosity setting the restoration will consume the elastic energy
so that the mechanism is restored slowly.

MATERIALS AND METHODS

A prototype of the mechanism was developed, with a length of 400 mm and a diameter of 200 mm (see
Figure 3). A commercial damper with anisotropic viscosity (Enidine ADA510MTP), two types of
mechanical spring for the restoration and magnets were added to it. Specifications of the damper and
springs are shown in Table 1 and 2. The damper moved at 0.7 m/sec in the direction of the contraction
and at 0.02 m/sec in the direction of the expansion, when a force of 1000 N was loaded to it. Four or
five magnets were used, each of which had an ideal holding force of 98 N with steel. When a weaker
force than the holding force was applied to a magnet stuck to a steel plate, it would not move .

--
I

-
I

I
~

<, <;Magnet
III
III
~ ""-S teel plate

u-. ---
..t- Spring
Fig. 3. A prototype of the force
limitation mechanism. In the original
---0 amper with position (A), the steel plate, which is
anOISO.trOPIC connected to the shaft, is stuck to the
I visCOSily
magnets by magnetic force. When a
I
stronger force than the holding force
i was applied to the shaft, the steel plate
would part from the magnets (B) and
the force would be lessened.
(A) (B)
214 N. Tejima

Table 1. Specifications of the damper Table 2. Specifications of the springs

Damper type ADA5lOMTP Stiffness Pre-load
Stroke 100 mm Type I 2900 N/m 58 N
Maximum load 2000 N Type II 4900 N/m 98N
Speed (compress) 0.70 m/s (1000 N)
Speed (expand) 0.02 m/s (1000 N)

However, when a strong force was applied, it would part from the steel plate and the force would be
lessened. Force limitation was realized by this theory. When four magnets and a spring type I were
used, the threshold of force for the limitation mechanism would be 450 N theoretically. The straight
movement was supported by a ball bearing .

Static forces were loaded to a total of four prototypes of two kinds of spring and two kinds of magnets.
Each was rigid against weaker forces than the threshold, but was activated to move by stronger forces.
The results of the threshold forces are shown in Table 3.

Table 3. Results of the threshold forces

Magnets Spring Result (N) Theoretical Value (N)

4 type I 229.1±7.4 450
4 type II 283.0±8.5 490
5 type I 318 .6±9.6 548
5 type II 371 .1±4.9 588

The travel of the mechanism was also measured with a laser displacement sensor (Keyence LK-2500)
when a static force was loaded or unloaded . The constant force for the experiment is shown in Table
4. A typical example of the results is shown in Figure 4. The results obtained agreed approximately
with those expected . When an excessive force was applied, the steel plate parted from the magnets
immediately and it traveled 55 mm within 0.25 seconds. On the other hand, the mechanism was
restored slowly after the force was unloaded. Time constants of the restoration were 3.4 seconds for
spring type I and 2.4 seconds for spring type II, which were long enough to avoid accidents . On the
last two or three millimeters ofrestoration, the mechanism was quickly moved by the magnetic force .
The distance of the quick movement depended on the force of the spring and the magnets.

,-.,
§ 60 ,...
,-.,
8
'-'
<l)
8 30
'-'

= 40
Co)
<l)
;g
= 20
Co)

;g
:.a'"
U;. 20 :.a'" 10
U;.
r=:'" 0
J
~ 0
0 0.5 1 E-o 0 5 10
Time (sec) Time (sec)
(A) (B)
Fig.4. An example of the results of travel measurement with five magnets and the spring type I. (A) When a
force was applied, the steel plate moved within 0.25 seconds. (B) After the force was unloaded, the steel plate
was restored slowly.
Risk Reduction in Rehabilitation Robots 215

Table 4. Loads for travel measurements

Magnets Spring type I Spring type II
4 230N 330N
5 330N 430N

DISCUSSIONS
As I used a force between a human and a robot for an index of the severity of the harm, it is not clear
just how much force should be used as a threshold. Performing experiments to find the relationship
between force applied and the harm caused is difficult. Yamada, et.a!. [13] pointed out that the
threshold of human pain tolerance was approximately 50 N. Pain is subjective and changes easily
according to psychological conditions, however, I think that a value of 50 N is reasonable as a
threshold. When a robot moves near the face or head, the threshold should be smaller perhaps.
Especially, the users ' eyes must not be hit by a robot even with a weak force . I think that other
protective methods for the users' eyes, such as protective glasses, should be used in addition to the
force limitation mechanism.

A problem of the force limitation mechanism with straight movement is that its traveling distance is
finite. If a force is given continuously even after the activation of the mechanism, the mechanism
would reach the end of its stroke, where finally , an excessive force would be applied to it. To avoid
this, the whole robot system should be stopped by cutting off its power supply when the mechanism
is activated. An excessive force between a robot and a human may be affected by a human movement
even if a robot stops. However, I suggest that in this case the responsibility should lie with the user
and it is not necessary to do anything except stop the robot.

The standard deviations of threshold forces were about 3%, but I think that they were permissible
because human diversities are wider. The results of threshold forces were only 50 to 60% of the
theoretical values . The factors affecting it could be friction, the dead load, the unbalanced load, and
the flatness of the magnets ' surfaces. This will be improved by introduction of a stiffer bearing system
and by precise arrangement of magnets.

The prototype moved linearly, but a torque limitation mechanism for rotation will be also available .
It would also be applicable to an anisotropic force limitation mechanism, which would be useful to
compensate for gravity force effects. To be applied to rehabilitation robots , the force limitation
mechanism should be reduced to a size of 50-100 mm and a threshold force of 50 N. Being
miniaturized by developing a small damper would be possible instead of a commercial one in which
viscosity was adjustable. The viscosity, the stiffness, and the threshold force value should be
considered for a rehabilitation robot used experimentally. .

CONCLUSIONS
A prototype of a new mechanism to reduce the risk of a rehabilitation robot hitting a human was
developed. It was confirmed that the new mechanism had a rapid response to excessive forces and a
slow restoration when unloaded, so that it had a good possibility to reduce the sever ity of any harm.
Miniaturization and a better way to determine parameters will be subjects for future study.

REFERENCES
[1] R. M. Mahoney, Robotic Products for Rehabilitation: Status and Strategy, Proceedings of 5 th Int.
Conf. Rehabilitation Robotics, 1997, pp.12-17
216 N. Tejima

[2] Geer Peters, Daily experience with users and the Manus system, Proceedings ofAM TE '99 SIG 1
Workshop of Rehabilitation Robotics, 1999
[3] B.S. Dhillon, O. C. Anude, Robot safety and Reliability: A Review, Microelectron Reliab., Vol.
33, 1993, ppA13-429
[4] J. Zurada, W. Karwowski, J. H. Graham, Sensory Integration and Management of Uncertainty
in Robot Safety Systems: A Review, Int. Journal of Computer Integrated Manufacturing, Vol.
11, 1998, pp.262-273
[5] M. Kioi, S. Tadokoro, T. Takamori, A Study for Safety of Robot Environment (in Japanese),
Proceedings of 6th Con! Robotic Soc. Japan, 1988, pp.393-394
[6] H. Tsushima, R. Masuda, Distribution Problem of Proximity Sensors for Obstacle Detection (in
Japanese), Proceedings of 10th Con! Robotic Soc. Japan, 1992, pp.1021-1022
[7] ISO/IEC GUIDE 51 : Safety aspects - Guidelines for their inclusion in standards, 1997
[8] B. Davies, R. Hibberd, A Safe Communication System for Wheelchair-Mounted Medical Robots,
Computing and Control Engineering Journal, 1995, pp.216-221
[9] K. Suita, Y. Yamada, N. Tsuchida, K. Imai, H. Ikeda, N. Sugimoto, A Failure-to-Safety
"Kyozon" System with Simple Contact Detection and Stop Capabilities for Safe Human-
Autonomous Robot Coexistence, Proceedings of 1995 IEEE Int. Con! Robotics andAutomation,
1996, pp.3089-3096
[10] T. Morita, N. Honda , S. Sugano, Safety Method to Achieve Human-Robot Cooperation by 7-
D.O.F. MIA ARM - Utilization of Safety Cover and Motion Control- (in Japanese), Proceedings
of 14th Con! Robotic Soc. Japan, 1996, pp.227 -228
[11] H. H. Kwee, Rehabilitation Robotics - Softening the Hardware, IEEE Engineering in Medicine
and Biology, 1995, pp.330-335
[12] T. Saito, N. Sugimoto, Basic Requirements and Construction for Safe Robots (in Japanese),
Proceedings of 1995 JSME Con! Robotics and Mechatronics, 1995, pp.287 -290
[13] Y. Yamada, Y. Hirasawa, S. Y. Huang, Y. Umetani, Fail-Safe HumanJRobot Contact in the
Safety Space, Proceedings of 5th IEEE Int. Workshop on Robot and Human Communication,
1996, pp.59-64
Computational Rehabilitation Engineering
with a Walking Model
Kazunori Hase

Human-Environment System Department, National Institute of Bioscience and Human-

Technology, 1-1, Higashi, Tsukuba, Ibaraki 305-8856, Japan

Summary: This paper describes a computer simulation model of human walking that can
represent characteristics of pathological walking. This model seeks to improve the practicability of
the simulation method for application to rehabilitation. The musculo-skeletal system was
represented by a three-dimensional, 12-rigid-link model and 44 muscle models. Muscular forces
were controlled by a neuronal system model consisting of 34 neural oscillators. This model
successfully generated not only normal walking patterns but also pathological walking, such as
walking by a person with one short leg and walking by a person with a pain in one hip joint. The
simulated walking patterns were three-dimensional , of the entire-body, continuous and
unsymmetrical, and were found to correspond well to those of actual walking. Such simulation
methods will provide us a novel methodology that we call computational rehabilitation
engineering.

Key words: Computer simulation, Pathological walking, Three -dimensional model, Neuro-
musculo-skeletal system, Optimization

INTRODUCTION
Previous studies on human walking motions for rehabilitation have focused on developing a
method to quantitatively evaluate pathological levels of walking. The results obtained by such
research have been limited to only evaluation of the pathological level; they have not provided us a
concrete proposal for rehabilitation. In order to overcome such limitations of this experimental
approach, the authors have developed a computer simulation method for human walking. This
computer simulation method allows us to easily realize some conditions that can hardly be realized
by experiments with actual humans . Therefore, the method has various possibilities for
rehabilitation, such as computationally clarifying factors of walking dysfunction and quantitatively
predicting results of rehabilitation. The purposes of the present study are to construct a precise,
three-dimensional neuro-rnusculo-skeletal model of human walking that can represent
characteristics of pathological walking, and to simulate pathological walking using this model in
order to improve the practicability of the simulation method for rehabilitation.

NEURO·MUSCULO·SKELETAL MODEL
Motion patterns of walking that requires care or training exercises, such as pathological walking,
often consist of three-dimensional and entire-body motion, such as rotation at the hip joint, bilateral
swing in the frontal plane and compensatory motions of the upper body. Therefore, a more precise
three-dimensional entire-body model is required, particularly when simulation methods are applied
to rehabilitation. Moreover, dysfunction of motor control is caused by various factors related to the
neuronal system and the skeletal system, so the simulation models need to represent such
J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention
© Springer Japan 2000 217
21X K. Hase

dysfunction factors. In the present study, the three-dimensional neuro-musculo-skeletal model

described below was constructed.

Musculo-skeletal system model. The inertial properties of the entire human body were
represented by a three-dimensional, 12-rigid-link system, as shown in Fig. l(a) . These links
include the feet, the calves, the thighs, the pelvis, the thorax, the upper arms, and the forearms. The
hip joints and the lumbar joint have three degrees of freedom of rotation; all other joints have one
degree of freedom. A visco-elastic passive moment acts on each joint to represent the influence of
soft tissue. The interaction between foot and ground was modeled as a combination of springs and
dampers. The body dynamic model is driven by 44 muscle models for the entire body, as shown in
Fig. I(a). The geometrical arrangement of each muscle was modeled as a pulley and a line muscle
wound onto it. Thus, the moment arm is assumed to be constant. The mechanical properties of
each muscle were represented by a combination of the force-velocity relationship and the force-
length relationship. Energy consumption including heat production in the muscle was calculated
from generating tension, length and contraction velocity of the muscle.

Neuronal system model. Central pattern generators (CPG) are well-known systems generating
basic neural rhythms for locomotion. In the present study, the neuronal system was modeled as a
recurrent network system consisting of neural oscillators, as shown in Fig. l(b). A pair of neural
oscillators exists for each degree of freedom of the joint. They generate the neuronal stimulus
combined for each degree of freedom by receiving nonspecific stimulus from the higher center and
feedback signals from somatic senses, such as joint angles and foot-ground contact. Each neural
oscillator is mathematically expressed by two differential equations. The neuronal model consists
of 34 neural oscillators. In addition, motoneurons that are elements of the neuronal system
determine the intensity of neural stimuli to each muscle by combining the output from neural
oscillators and other motoneurons.

25 (a) (b)

Top view
ffi?:·:·8·~·:0:.9 00
[D O :
ffi ffi?:.:-8 \9ill
rno : .o-rn
Front view [TI}6\ g /6 {ill m6\.g /6-ill
[ill O ' O o ·{) -@]
@ O ·O O ·{) {ill
@} O - -o rm
® o O @
ill} o ill

19 2022 21

o eu ral osci llator a Motoneuron D Muscle No .

Fig.!. Neuro-museulo-skeletal system model. (a) Three-dimensional musculo-skeletal system model. (b)
Neuronal system model. Numbers in the figure indicate the muscular model numbers.
Computational Reh abilitation Engineering with a Walking Model 219

Mathematical expression. In this non-linear, non-equilibrium system, bipedal walking can be

generated through the mutual entrainment of the non-linear dynamics of the neuronal system and
that of the musculo-skeletal system [1]. The neuro-rnusculo-skeletal system can be mathematically
expressed by a total of 114 non-linear, first order differential equations : 46 equations of motion for
the musculo-skeletal system and 68 equations for the neuronal system. From a computational point
of view, continuous walking patterns are generated by numerically solving all the differential
equations from initial conditions.

ACQUISITION OF VARIOUS WALKING PATTERNS

We will now describe a methodology to acquire various walking patterns, such as normal walking
and pathological waking . In the present study, the neuronal and mechanical properties of the model
were modified by a numerical search method so as to achieve the desired walking pattern. The
search calculation was performed on the following conditions: evaluative criteria for walking
motion ; optimization method called genetic algorithms; search parameters for the neuronal and
body parameters . The calculation flow was as follows: (1) walking pattern was generated using the
simulation model; (2) the evaluative criteria were calculated based on the generated walking
motion ; (3) the neuronal parameters were infinitesimally modified by an optimization method to
improve the results for the evaluative criteria; and (4) these processes were repeated. Various
walking patterns, such as normal walking and pathological walking, can be generated by altering
these evaluative criteria and search parameters. In the present study, we attempted to generate the
following walking patterns.

Normal walking. First, normal walking was generated as a standard pattern of other walking . In
this simulation, the neuronal parameters were adjusted to minimize an index called the specific
power [2]. The specific power S represents the energy efficiency of level locomotion and is
defined as follows:

--t min , (1)

where Ct denotes ~he evaluative criterion for normal walking , Em is the energy consumption rate in
the mth muscle, B is the energy consumption rate in regions other than muscles (e.g. internal
organs), M is the body mass, g is the acceleration of gravity and D is the traveling distance.

Pathological walking with an affected skeletal system. As an example of an affected skeletal

system, a model having one short leg was constructed, and a walking pattern adapted to the
affected skeleton was simulated. A model with a normal skeletal system generating normal
walking was employed as the initial condition in this simulation. The thigh length 4high and the
calf length Leal! of one leg were joined to search parameters in addition to the neuronal parameters .
The evaluative criterion Cz is as follows:

(2)

where a is a weight coefficient. In this simulation, the left leg should be shortened as the search
proceeds.

Pathological walking with an affected joint. As an example of pathological walking with an

affected joint system, a walking model of a person having a pain in the hip joint of one leg was
constructed. In this simulation, walking motions are generated so as to reduce the joint reaction
220 K. Hase

force on one hip joint. Therefore, the reaction force F',.ip on one hip joint was minimized as one
term of the evaluative criterion C3 as follows:

(3)

Pathological walking with an affected neuronal system. Finally, as an example of pathological

walking with an affected neuronal system, we focused on the time-delay properties of the neuronal
system. We hypothesize that walking stability may be related to time-delay properties. In order to
investigate the hypothesis, time-delay elements were added to the neuronal system. In this
simulation, delay-time T,ula y was maximized as one term of the evaluative criterion C4 as follows:

(4)

Calculation conditions. All programs were written in C language on a UNIX machine, and the
Euler method was used for numerical solution of differential equations. The time step size was set
to 0.5 msec. Eight steps of walking were performed in each calculation. In this search, 174
neuronal parameters were modified and 10,000 iterations were performed at each search . The
calculation took about 20 hours using six workstations in parallel.

SIMULATION RESULTS

Nonnal walking. Figure 2(a) shows the walking patterns simulated under the conditions of Eq. 1.
The obtained walking pattern was continuous and stable. The simulation results closely agree with
those of actual walking, not only in terms of kinematics but also in terms of dynamics, such as
muscular tensions and energy consumption. In addition, the walking model has the ability to
stabilize continuous motions against mechanical perturbation and can represent well characteristics
of human motor control [3].

Pathological walking with an affected skeletal system. Figure 2(b) shows the walking pattern
simulated under the conditions of Eq. 2. The left leg (drawn with broken lines) is 5 em shorter than
the right leg (drawn with solid lines). Side views disclose that the step lengths differ between the
right and left legs. The upper body and pelvis incline to the short left leg in order to adapt the
motion to the affected skeletal system.

Pathological walking with an affected joint system. Figure 2(c) shows the walking pattern
simulated under the conditions of Eq. 3. The hip joint of the left leg (drawn with broken lines) is
painful. In order to reduce the load on the affected hip joint, the motions become unsymmetrical
and the ground reaction impact on the opposite leg increases. The model cannot walk straight, as
shown in the top view.

Pathological walking with an affected neuronal system. Figure 2(d) shows the walking pattern
simulated under the conditions of Eq. 4. The walking speed and step length relatively decrease .
The model has difficulty walking straight, as shown in the top view, and falls easily due to changes
of the neuronal parameters. Muscular tension and joint moment pattern s tend to include high-
frequency waveforms as delay time increases. Judging from these results, the time-delay properties
of the neuronal system are closely related to walking stability.

DISCUSSION
Evaluation of the simulation model. The proposed model has a three-dimensional structure for
the entire body and a neuro-rnusculo-skeletal system. The simulated walking patterns were three-
Computationa l Rehabilitati on Engineer ing with a Walkin g Model 221

Top

Fig. 2. Simulation results. (a) Normal walking. (b) Pathological walking with an affected skeletal system .
(c) Pathological walking with an affected joint. (d) Pathological walking with an affected neuronal system.
For the top views. eight-step walking patterns are continuously illustrated. For the side and front views, one
walking cycle, beginning from one heel contact of the right foot and ending at the subsequent heel contact of
the right foot, is illustrated. Each stick picture is traced at 0.1 sec intervals . Upper and lower limbs of the
right side are represented by solid lines, and those of the left side are represented by broken lines.

dimensional and continuous . For pathological waking, the model can even generate unsymmetrical
motions including the compensatory motions of the upper body. A number of simulation models of
human walking have been proposed in biomechanics. However, no model has synthesized three-
dimensional, continuous and unsymmetrical motions for the entire body, such as the proposed
model in this study, to the best of the author 's knowledge, We believe that the simulation results
are remarkable. However, we also understand that it is difficult to evaluate the validity of the
simulation results because of large inter-individual differences.

Significance of simulation study for rehabilitation. We think that there are two possibilities to
apply the simulation method to rehabilitation. One is to computationally investigate motor control
mechanisms. In this way, a hypothesis for motor control is first set up. The hypothesis is then
verified by comparing between the simulation results and the actual phenomena. An example of
this application is pathological walking simulation to investigate the relation between the time-
delay properties of the neuronal system and walking stability in the present study.
222 K. Hase

Another possibility is application as a tool for predicting rehabilitation results. Figure 3 indicates
the concepts. The authors seek to develop a rehabilitation support system for pathological walking
using the following simulation method. (1) Body and neuronal parameters of an actual patient are
measured. (2) A neuro-musculo-skeletal model is constructed to emulate the waking pattern of the
patient. (3) Medical doctors and physical therapists conduct virtual rehabilitation with the
simulation model on a computer. (4) The simulation system predicts the results of the virtual
rehabilitation and indicates the level of improvement in the walking pattern. (5) The doctors can
pre scribe real rehabilitation for the patient based on the simulation results. In this prediction
system, effective treatments can be proposed because all rehabilitation is conducted virtually on a
computer without burdening the patient. Such simulation research differs significantly from
previous research based on analytical approaches and will provide us a novel methodology.

Real Virtual

Fig. 3. Concepts of a rehabilitation support system.

CONCLUSION
In the present study. we developed a more precise simulation model that can generate pathological
walking in order to apply simulation techniques to rehabilitation. The model could synthesize
three-dimensional and unsymmetrical motion and emulate pathological walking well. In future
studies, we will attempt to establish a novel methodology that we call computational rehabilitation
engineering . In order to realize this, we should develop the following: a precise model of motor
control mechanisms; a method of mea suring and estimating body and neuronal parameters; and a
means of integrating the simulation and measurement methods.

REFERENCES
[I] G. Taga, A Model of the Neuro-Musculo-Skeletal System for Human Locomotion. 1.
Emergence of Basic Gait, Biological Cybernetics, Vol. 73, 1995, pp. 97-111.
[2] N. Yamazaki, K. Hase, Biomechanical Criteria for Determination of Cadence and Stride
Length in Free Walking, Biomechanism, Vol. ll, 1992, pp. 179-190 (in Japanese).
[3] K. Hase, A Model of Human Walking with a Three-Dimensional Musculo-Skeletal System
and a Hierarchical Neuronal System, Proceedings of VlIth International Symposium on
Computer Simulation in Biomechanics, 1999, pp. 120-123.
Fine-tuning the Reconstruction of the Anterior Cruciate
Ligament in the Knee

L. Blankevoort', A. van Kampen", A.B. Wymenga' , L. Elmans/ ", M.P. Arnold', P. van der
Wielen 2 and T.J.A. Mommersteeg/

'Orthopaedic Research Center Amsterdam, Academic Medical Center, PO box 22660, NL-II00
DD Amsterdam, The Netherlands
20rthopaedic Research Laboratory , Universit y of Nijmegen, PO box 9101, NL-6500 HB
Nijmegen, The Netherlands
3 St. Maartenskliniek, PO box 9011, NL-6500 GM Nijmegen; The Netherlands.

Summary. Reconstruction of the anterior cruciate ligament (ACL) of the knee joint can be
adjusted by rotating or twisting the insertion of the tendon graft on the tibia . An anatomical helical
shape of the tendon can be achieved through an external twist. As evaluated by experiments on
cadaver joints and simulations in a computer model of the knee, both internal and external rotation
of the tibial graft insertion reduced anterior laxity of the knee. The side effect was the increase of
posterior shift of the tibia relative to the femur. The model study revealed that only external twist
improved the sharing of the load over the fibre bundles of the tendon. At surgery, a special device
was used to measure the force on the tendon graft during flexion-extension motion . The graft force
in the otherwise virtually unloaded joint decreased with external rotation and increased with
internal rotation of the tibial attachment. Bone tunnel location was the primary determinant for the
graft force development as functions of flexion. Rotating the tibia graft insertion could only fine-
tune the level of the graft force.

Key words. Knee joint, Anterior cruciate ligament, Ligament reconstruction, Graft force

INTRODUCTION

The primary function of the anterior cruciate ligament (ACL) of the knee is to constrain anterior
mobility or laxity of the tibia relative to the femur, e.g. [1]). A tom ACL will usually not heal. In
case of serious disability caused by the ACL-insufficiency, the ACL can be reconstructed using an
autologous tendon graft passed through bone-tunnels in the tibia and the femur. In case of a bone -
patellar tendon - bone (BPTB) graft, the bone blocks on either side of the graft can be fixed into
the bone tunnels using interference screws . The primary parameters to be controlled in surgical
ACL reconstruction are the insertion locations and the graft pretension at the time of graft fixation
to the bones and the flexion angle at which the pretension is applied [2].

The natural course of the ACL in the flexed knee is helicoid , i.e. the ACL shows an external twist
from the femur towards the tibia. This twist is usually not considered at the time of ACL-
reconstruction where a more-or-Iess parallel arrangement of the graft fibres is maintained
throughout flexion. Previous studies suggested both an internal and an external twist [I , 3, 4,5,6].
The proposed or reported effects were an enhanced isometry of the graft fibres [6] and a more
anatomical graft position (5].

In this study it was hypothesised that fine-tuning of the ACL reconstruction may be achieved by
twisting the graft. The questions addressed in this study were (I) what are the effects of twisting
the graft on the anterior laxity characteristics, (2) can graft twist affect the forces in the graft

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 223
224 L. Blankevoort et al.

during knee flexion and (3) what is the precise mechanism of graft twist? The study applied three
approaches, i.e. an in-vitro experiment on cadaver joints, a simulation using a mathematical model
of the knee joint and an in-vivo evaluation of graft forces at the time of surgery.

METHODS

In-vitro experiment. In an in-vitro study on 6 cadaver knees, the effects were evaluated of graft
twist on anterior knee laxity at different knee-flexion angles. A motion-and-Ioading rig was used to
prescribe the flexion angle, to restrain axial rotation and to apply an anterior force to the tibia [7].
RoentgenStereophotogrammetric Analysis (RSA) [8] was used to determine the relative anterior-
posterior position of the tibia and femur. The ACL-reconstruction was performed using a bone-
patellar tendon-bone (BPTB) graft [9). A custom-made hook with an offset of 6 mrn determined
the location of the femoral tunnel. A 10 mrn tunnel was drilled lateral from the top of the notch,
preserving the posterior cortex (II or I o'clock position [2]). The proximal bone-block was fixed
in the tunnel using an interference screw. The tibia contained a custom made twisting device at the
location of the tibial bone-tunnel. The distal bone block of the BPTB-graft was cemented in the
twisting cylinder using Polymethylmetacrylate. At each twist orientation, the tibial cylinder was
fixed after the application of a 20 N pretension at 20° flexion. The graft was mechanically
preconditioned using multiple flexion-extension and loading cycles. Thereafter, the graft fixation
procedure was repeated. The effects of cutting the ACL and reconstructing the ACL with neutral,
internal and external twist of 90° and 150° on anterior laxity with 100 N anterior load) were
evaluated at extension and 15°,30°,60°, and 90° flexion.

AP-error was defined as the change in AP-position relative to the intact joint for the unloaded
condition. After cutting the ACL, an anterior shift was observed (positive AP-error). After ACL-
reconstruction, the tibia was dislocated posteriorly relative to the femur (negative AP-error)
because of the anterior pull of the graft on the femur. Anterior laxity was defined as the amount of
anterior tibial translation relative to the femur between the unloaded joint and the joint with a 100
N anterior load. Tibial rotation about its long axis was constrained if the anterior force was
applied.

Model study. The knee joint model used in this study was the implementation of the geometric
and mechanical data from the knee model of Momrnersteeg et al. [10] in to the multi-body-
modelling programme of Kwak et al. [II). In the model, the tibial and femoral cartilage surfaces
were anatomically shaped. Contact between cartilage surfaces was deformable (12). The ligaments
were represented by multiple non-linearly elastic line elements [10]. The model calculated the
relative position of the femur and tibia for given kinematic constraints and external loads.

For the simulation of the ACL-reconstruction, two sets of non-linearly elastic line elements
running from the femur to a bone-block and separated by compression elements represented the
BPTB-graft (Fig. I). The compression elements prevented the two sets of line elements from
collapsing onto each other with graft twist. The structural stiffness of the graft was based on
literature data (13). The bone block was positioned in a tibial bone tunnel. A pretension spring was
used to load the bone block prior to numerically fixing the bone-block to the tunnel in a same
fashion as in the in-vitro experiments.

Anterior laxity and AP-error were determined in a similar way as in the experiments for extension
and 30°, 60°, and 90° flexion and for neutral and 90° and 150° internal and external graft twist.
The resulting forces in the BPTB graft were evaluated for the reconstruction simulations . The
model was not suited to simulate the ACL-deficient condition
Reconstruction of the Anterior Cruciate Ligament in the Knee 225

Fig. 1. A posterior view of the knee model with

the reconstructed ACL.
MCL = medial collateral ligament; LCL = lateral
collateral ligament; PCL = posterior cruciate
lCL ligament; BPTB = bone-patellar tendon-bone
graft.

Pre-tension spring

In-vivo experiment. In a pilot study on 15 consecutive patients who underwent an ACL-

reconstruction,S female and 10 male, age range 16 - 42 years, the total graft force was measured at
the time of surgery using a custom made tensiometer. A chain that was rigidly attached to the bone
block by a screw, was connected to the tensiometer . The load cell and an inclinometer of the
device measured the force of the graft on the bone block and the flexion angle of the knee. A
number of preconditioning cycles preceded the measurements of the graft forces for the neutral
twist and internal and external twist of the tibial bone block of 180°. The graft pretension of 10 N
was set with the tensiometer at 10° flexion. Prior to insertion into the joint, the BPTB-graft was
soaked in contrast medium after an idea of Vaquero et al. [14]. This allowed for observing the
course of the graft and the location of the femoral tunnel exits using fluoroscopy . One fluoroscopic
image was used to measure the location of the femoral tunnel exit according to the method
described by Amis and Jakob [2].

RESULTS

In-vitro experiment. After cutting the ACL, the anterior laxity (Fig. 2) increased for all flexion
angles. After reconstruction of the ACL, anterior laxity decreased, but was still higher than
normal. With increasing twist, both in internal and external rotation, a reduction of anterior laxity

~~ Anterior laxity ~~ AP-error

12 F==~==+=========l r:O=-ci-nta- c-l (-
n=-6)-----, 6 1r===:::;::==============
10 • cut (n=6) 4 - r - -, . - - -I - - - - - - -

I
8 r.t! int 150 (n=4) 2 -
6 - I:il int 90 (n=5) 0
4 neutral (n=6) -2 -
2 ~ ext 90 (n=6·) -4 - - ""j--t-L-H
o l:S exl 150 (n=6"·) -6 - - - - - - - - - - - - - - 1
o 15 30 60 90 ·SOdeg: n=5 0 15 30 60 90
Flexion ~ eg] ·· 0 deg: n=5 Flexion ~eg]
Fig. 2. Anterior laxity and AP-error as functions of flexion and ACL- & graft condition from in-vitro
experiments on 6 cadaverjoints; int = internalgrafttwist; ext = external graft twist.
226 L. Blankevoort et al.

Anterior lax ity

30 60 90 o 30 60 90
Flexio n [deg) Flexion [deg)

Fig. 3.. Anterior laxity and AP-error in the knee model with varyingtwist of the tibial bone block; int =
internal grafttwist; ext = external grafttwist.

was found with increasing twist angles. This resulted in laxity values that were not statistically
different from normal (>0.05, paired Student's T-test). With increasing twist, the posterior AP-
error increased . This was observed for internal and external graft twist and at all flexion angles
(Fig. 2). Analysis of variance showed that the twist effect on anterior laxity was statistically
significant (p<0.05)

Model study. The model simulations gave comparable results as in the cadaver study . Except for
extension, the ACL-reconstruction did not bring anterior laxity back to normal. With increasing
internal and external twist of the tibial bone block the anterior laxity decreased with about Y2 to 1
mm, which was less than in the in-vitro experiments (Fig. 3). Except for extension where the
effects of twist were negligible, both internal and external graft twists increased the AP-error (Fig.
3). With a 100 N anterior force on the tibia, the distribution of the graft force was not balanced
over the two sets of line elements representing two bundles of the BPTB-graft in case of the
neutral twist. With external twist the load was more equally distributed over the medial and lateral
graft bundles, whereas the internal twist did not result in an equal load sharing between the two
bundles (Fig. 4). The total graft force was reduced by maximally 10 percent for the external twist.

In-vivo experiment. Two typical sets of graft force behaviour as functions of flexion were
observed. In 9 out of the 15 patients, the graft force was high in extension and dropped quickly
with increasing flexion. This was called the L-shape curve (Fig. 5). In 5 patients the graft force
was high in extension, dropped with flexion and rose again after about 80 degrees flexion ,

[N) int 150 int 90 neutral ext 90 ext 150

200
I!Ilateral bundle
. medial bundle
160

120

80 -

40

o I. [[
o 30 60 90 0 30 60 90 0 30 60 90 0 30 60 90 a 30 60 90
Flexion [deg)

Fig. 4. Forceson the lateraland medial bundle of the BPTB-graft in the knee modelwith varyingtwist and
an anterior load of 100N; int = internal grafttwist; ext = externalgrafttwist.
Reconstruction of the Anterior Cruciate Ligament in the Knee 227

(N) Graft force I L-shape Fig. 5.Two typical examples of the graft
force as functions of flexion (two different

~~}¢'~ ~.N ,..~ !O"M

:J
patients, neutral twist). The top graph
represents the L-shape curve, the bottom
graph the u-shape curve.
•10 0 10 20 30 40 50 60 70 80 90 100 110
Flex ion (deg) N " "'"

(N)
Graft force I U-sh ape
40
30
20
10
0
- -- - 0
0 'b
0
-10 0 10 20 30 40 50 60 70 80 90 100 110
Flexion (dog) ,, ~ " l

resulting in an V-shaped force curve as functions of flexion (Fig. 5). In one patient the force curve
did not fit into the two categories. The femoral tunnel exits of the L-curve reconstructions were
located more anterior and superior, whereas those of the Ll-curveswere more posterior and inferior
(Fig. 6). The difference in average location along the depth axis of the notch between the V-curve
and L-curve reconstructions was statistically significant (p< 0.05, Student's T-test). Averaged over
all IS patients, external rotation of the tibial bone block resulted in a lower average peak force (64
± 32 N) on the graft for the extended knee relative to the neutral rotation (70 ± 32 N) and internal
rotation (79 ± 38 N) for the extended knee. Despite the large standard deviations, the difference
between external and internal twist was statistically significant (p<0.05, paired Student's T-test).
Four months after surgery, the clinical findings in the L-curve patients showed a slight reduction
of extension and a non-optimal anterior stability with 90° knee-flexion. In the Ll-curve patients,
there was no loss of extension and a better stability in flexion.

DISCUSSION

Study limitations. Each one of the three studies had its limitations that were typical for the
approach used. In the cadaver experiments, the graft forces were not measured, because of the
technically complex nature of force measurements in ligaments. The results of the model were
based on the geometric and mechanical input data from one specific knee joint specimen. The
model was previously validated against the laxity characteristics of the joint from which the data
were obtained [10]. As compared to the average anterior laxity of the cadaver study, the model did
not seem to be valid for extension. During the graft-force measurement at the time ·of ACL-
reconstruction, there was no load control of the flexion-extension motion as conducted by the
surgeon, the measurements were not performed with anterior loading and the laxity and AP-error
were not measured. There were only operational considerations for using different twist angles and
pretension levels between the in-vitro and in-vivo studies

Twist mechanism. Despite the aforementioned limitations, the combination of the specific
findings from the studies led to a simple but clear explanation of the mechanisms involved in the
effects of graft twist on the anterior laxity characteristics and graft forces. The effects of graft twist
in anterior cruciate ligament reconstruction were a reduction of anterior laxity at the cost of a more
posterior position of the unloaded tibia relative to the femur.
228 L. B1ankevoort et al.

Femoral tun nel ex it

40 38 36 34 32 30 28 26 24 22 20
0

"" " 2

" 4
6
.c 8
a.

+'
• •
.c 10
Gl

~
12
14
• 16
18
• 20
% Blumensaat

• U-curve " L-curve I

Fig. 6. The locations of the centre of the femoral tunnels of the 5 If-curve cases and the 9 L-curve cases.
For eachgroupthe average location and standard deviation are given.

Two effects of twist were identified. For these effects it is important to realise that the patellar
tendon of the BPTB graft does not have a central location of its insertion on the bone. The
insertion is off- centre. So the first effect of rotating the tibial bone block is that the tibial insertion
moves anteriorly, thereby pulling the tibia posteriorly relative to the femur. This explains the
increase of posterior AP-error with increasing twist. Secondly, because of the more anterior tibial
insertion of the tendon, the line of action of the tendon gets a lower inclination angle with the AP-
direction, thereby increasing the effectiveness of the graft force in restraining anterior translation.
This explains the reduction of anterior laxity. Both effects are independent of the twist direction
because the starting orientation of the bone block was such that the tendon insertion was located
posteriorly. A reduction of anterior laxity due to an increase of graft stiffness is unlikely because
the effect of graft twist on its structural stiffness is negligibly small [13].

The third effect of twist was clearly demonstrated in the model study. The BPTB-graft has a
parallel arrangement of fibres with more-or-less equal lengths. However, the bone tunnels are
usually not drilled perfectly in-line. There is a certain amount of angulation between the axes of
the two tunnels. This means, that at the time of insertion, the bundles in the graft are not equally
loaded. By twisting the tibial bone-block, the bundles were brought to more an equal length and
thereby to a more equal distribution of the load if the graft is loaded.

Further considerations. In order to understand what the relevant implications are of graft twist, it
is good to consider that after the surgical reconstruction, the tendon graft remodels to a neo-
ligament. Fibroblasts will remove the old collagen fibres and produce new collagen fibres along
the load direction (e.g. [15]). So the findings in this study pertain only to the initial directly
postoperative situation. Van Kampen et al. [16] found in a clinical trial using two different levels
of graft pretension, 20 and 40 N, that initially the posterior AP-error is larger in the patients that
had the 40 N pretension than in the 20 N pretension patients. After a year of rehabilitation and thus
also after remodelling of the graft, the difference in AP-error and anterior laxity was no longer
present between the groups.

The remodelling of the tendon to a neo-ligament will neutralise any pretension differences at the
time of surgery and directly postoperative. What remains is a more uniform loading of the graft at
Reconstruction of the Anterior Cruciate Ligament in the Knee 229

the start of the remodelling phase, possibly leading to a more uniform remodelling process.
Furthermore, it can be expected that with a more uniform loading of the graft the chance for early
graft failure during the rehabilitation phase is reduced.

Conclusions. The total in-situ graft force was predominantly determined by the tunnel locations
and could only marginally be altered by graft twist. However, in view of the model data, a more
uniform loading should be thrived for by applying external graft twist. The in-situ graft force data
may be used as a guide for the early rehabilitation phase, directing the physical therapist in
preventing overloading by restricting early extension in case of high graft forces in extension or by
limiting full flexion in case of high graft loading with flexion.

Some questions remained untouched in the study. The most important one is the effect of graft
twist on graft remodelling and the long-term outcome. Other questions are related to the effects of
variable tunnel orientations on the outcome of graft twist and to the possibility to change the
femoral bone-block position and orientation at the time of surgery based on the graft force
measurements during surgery.

Finally, the results of this study only pertain to the ACL-reconstruction technique using a bone -
patellar tendon - bone graft in which the bone blocks are fixed in pre-drilled tunnels in tibia and
femur.

ACKNOWLEDGEMENTS

The assistance of Willem van de Wijdeven, Rene van der Venne and Huub Peters with the in-vitro
and in-vivo studies and of Arjan Welmers with the model studies are greatly appreciated .

REFERENCES

[1] F.G. Girgis, lL. Marshall, A. Monajem, (1975) The cruciate ligaments of the knee joint.
Anatomical, functional and experimental analysis. Clinical Orthopaedics and Related
Research, Vol. 106,1975, pp. 216-231.
[2] A.A. Amis, R.P. Jakob, Anterior cruciate ligament graft positioning, tensioning and twisting.
Knee Surgery Sports Traumatology and Arthroscopy, Vol. 6,1998, pp. S2-S12.
[3] M. Odensten, 1 Gillquist, Functional anatomy of the anterior cruciate ligament and a
rationale for reconstruction. Journal of Bone and Joint Surgery - American Volume, Vol. 67,
1985, pp. 257-262.
[4] D.D. Buss, R.F. Warren, T.L. Wickiewicz, BJ. Galinat, R. Panariello, Arthroscopically
assisted reconstruction of the anterior cruciate ligament with use of autogenous patellar-
ligament grafts. Results after twenty-four to forty-two months. Journal of Bone and Joint
Surgery - American Volume, Vol. 75,1993 , pp. 1346-1355.
[5] D.E. Cooper, X.H. Deng, A.L. Burstein, R.F. Warren, R.F. The strength of the central third
patellar tendon graft. A biomechanical study. American Journal of Sports Medicine, Vol. 21,
1993, pp. 818-823.
[6] L.F. Draganich, Y.F. Hsieh, B. Reider, Strategies for attachment site locations and twist of
the intraarticular anterior cruciate ligament graft. American Journal of Sports Medicine, Vol.
24,1996,pp.342-349.
[7] L. Blankevoort, R.Huiskes, A. de Lange, The envelope of passive knee joint motion. Journal
of Biomechanics, Vol. 21,1988, pp. 705-720.
[8] G. Selvik, Roentgen stereophotograrnmetry. A method for the study of the kinematics of the
skeletal system. Acta Orthopaedica Scandinavica. Supplementum 232, 1989, pp. 1-51.
230 L. Blankevoort et al.

[9] L.E . Paulos, J. Cherf, T.D. Rosenberg, c.L. Beck , Anterior cruciate ligament reconstruction
with autografts. [Review] Clinics in Sports Medicine, Vol. 10, 1991, pp . 469-485 .
[10] T.J.A. Mommersteeg, R. Huiskes, L. Blankevoort, J.G.M. Kooloos, J.M.G. Kauer, A global
verification study of a quasi-static knee model with multi-bundle ligaments. Journal of
Biomechanics, Vol. 29, 1996, pp. 1659-1664.
[11] S.D. Kwak, G.A. Ateshian, L. Blankevoort, C.S . Ahmad, T.R. Gardner, R.P. Grelsamer,
V.C. Mow, Development of multibody model for diathrodial joints using accurate 3-D
cartilage and bone surfaces. Annals of Bio -medical Engineering, Vol. 23(Sl), 1995, p. 106.
[12] L. Blankevoort, J.H. Kuiper, R. Huiskes, H,J . Grootenboer, Articular contact in a three-
dimensional model of the knee . Journal of Biomechanics, Vol. 24: 1991, pp. 1019-1031.
[13] T. Muellner, R. Reihsner, L. Mrkonjic, W. Kaltenbrunner, O. Kwasny, R. Schabus, M.
Mittlboeck, V. Vecsei, Twisting of patellar tendon grafts does not reduce their mechanical
properties. Journal of Biomechanics, Vol. 31, 1998, pp. 311-315.
[14] 1. Vaquero, C. Vidal, A. Cubillo, Radiographic visualization of patellar tendon grafts for the
reconstruction of the anterior cruciate ligament. Arthroscopy, Vol. 13, 1997, pp. 770-772.
[15] H.W,J . Kok, L. Blankevoort, R. Huiskes, Experimental mechanical and histologic evaluation
of the polydioxanone (PDS) augmentation braid for ACL reconstruction. American Journal
of Sports Medicine, Vol. 17, 1989, p. 705 .
[16] A. van Kampen, A.B. Wymenga H,J .L. van der Heide, H,J . Bakens, The effect of different
graft tensioning in anterior cruciate ligament reconstruction. Arthroscopy, Vol. 14, 1998, pp .
845-850.
Biomechanics of the Soft Tissue in Repetitive Motion
Disorders
Kai-Nan An

Biomechanics Laboratory , Division of Orthopedic Research, Mayo Clinic/Mayo Foundation ,

Rochester, Minnesota 55905, USA

Summary. Repetitive motion or overuse loading resulting from sports activities and certain tasks
in the workplace is thought to be associated with soft tissue disorders . In order to confirm such an
association, numerous ergonomic measurements have been adopted to quantify exposure in
occupational tasks. In addition , clinical evaluations have been utilized to document the symptoms
of such disorders . Nevertheless, the association of soft tissue disorders to repetitive motion and
overuse are still controversial. Recently, however , more insight has been developed relating
external loading exposure to internal stress in the tissue and interaction between the tissues.
Newly generated data on physiological and cellular responses of the tissues to these mechanical
triggers, which would lead to either biological adaptation or chronic pathology , makes the
associations scientifically justifiable. The specific details on the timing of such responses and the
dose response would be essential to establish the proper prevention and treatment modalities .

Key words: Overuse syndrome ; repetitive motion; soft tissue biomechani cs

INTRODUCTION

Repetitive motion and overuse can frequently result in soft tissue pain and the inability to work.
The cost of this work-related disorder to public health is enormous [I]. In the past twenty years,
numerous studies have been performed to measure the injury potential in occupational tasks or
sports activities and to document the clinical symptoms of the associated soft tissue disorders. The
association of such repetitive motion or overuse to chronic soft tissue disorders has been
attempted, but remains debatable . In this presentation, the association ofrepetitive motion to
chronic soft tissue, specifically tendon, will
External Exposure Internal Stressor
be scientifically addressed based on the
-Forcefulness -Tension biomechanical and biological data recently
-Po sture ·Compression reported (Fig. I) . The clinical symptoms of
-Repetition -Shear chronic soft tissue disorders and the exposure
measurements traditionally considered will
-Duration -Friction
be addressed first. Then, the association will

I
Clinical Symptom
1
Biological Response
be bridged based on the relationship between
. the external exposure to the internal stressor,
and the internal stressor to the biological
responses of the tissues .
-Inflammation ·Cellular
-Degeneration -Matrix
-Pain -Vascular
Fig . 1. Relationship betw een the
-Swelling •Neurogenic overuse/overload to the soft tissue disorders .

Clinical Symptoms. Clinically, the related soft tissue disorders could be strictly divided into the
following four categories [2]. (a) Paratenonitis (peritendinitis or tenosynovitis) refers to

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 231
232 K.N.An

inflammation of only the paratenon--either lined by synovium or not. Histologically, the structure
demonstrates edema , thickening, hypervascularity, and inflammatory cell infiltrates in the
paratenon or peritendinou s areolar tissue . Clinically , the cardinal inflammatory signs on
presentation are swelling , pain crepitation, local tendemess, warmth , and dysfunction . (b)
Tendinitis refers to the symptomatic degeneration of the tendon with vascular disruption and
inflammatory repair responses in the tendon. This can be displayed with various stages ranging
from pure inflammation with acute hemorrhage and tear, superimposed upon pre-existing
degeneration , calcification and tear. (c) Tendinosis occurs when there are degenerative alterations
within the tendon, but no evidence of inflammation. Histologic findings are collagen fiber
disorientation, hypocellularity, vascular ingrowth, and local necrosis. Clinically , there is often a
palpable tendon nodule that can be asymptomatic, but may also be point tender. Swelling of the
tendon sheath is absent. (d) Paratenonitis with tendinosis is paratenon inflammation associated
with intratendinosis degeneration . In general, the clinical symptoms of the chronic tendon
disorders are pain, inflammation , and tissue degeneration . Clinically , however , it is essential to
distinguish the identities and the site of soft tissues involved so that the identification of the
mechanism and etiology of the disorder will be possible.

Exposure measurement. The mechanical loading experienced by the tendon is intimately related
to the exposure of the limbs to the surrounding environment. In ergonomic measurement, four of
the most important parameters commonly considered are posture, forcefulness , repetition , and
duration. Posture of the limb can be described based on the joint kinematics and measured by
using goniometers, a video system, and magnetic tracking devices. The forcefulness involved in
activities and tasks has been measured directly using dynamometers, or indirectly based on the
kinematic s and inertia properties . Intersegmental joint moment is a good representation of the load
across the joint as resisted by the muscle . The ratio of the joint moment for a given task to the
strength that could potentially be generated by the muscle has been used to represent the
forcefulness . Repetition refers to the temporal aspect of the task, which is characterized in terms
of the number of exertions per unit time. The number of repetition determines the degree of
muscle fatigue and potential fatigue damage of the soft tissues . In general, the task involving
highest force and highest repetition is the one with highest risk of tissue disorder [3].

The etiology of the repetition-motion-induced soft tissue disorder is complex and multi-factorial,
including the physical aspects and psychosocial factors . In order to establish the scientific cause
and consequence relationship of the repetitive motion disorder , it is necessary to translate the
exposure measurement into the internal stressor of the tissue, as well as the biological responses of
the tissue to the clinical observations.

Internal stressor. Tendon and ligaments are dense connective tissue. The collagen fibrils visible
with the electron microscope are grouped into fibers and fascicles that are visible with a light
microscope. The fibers and fascicles are enclosed in thin films of loose connective tissue called
endotendon or endoligament. The whole tendon or ligament is wrapped in a connective tissue
called the epitendon or epiligament. In some tendons , a further sheath, the paratendon, surrounds
the tendon . The paratendon is comprised of areolar connective tissue, which is loosely connected
to the tendon but firmly connected to the surrounding deep fascia. All of these tissues have the
characteristic mechanical properties of stiffness and failure strength. Furthermore, they all behave
like viscoelastic materials . The internal physical stressor of the soft tissue can be described in
terms of the internal stress within the tissue structures as well as the interface friction forces .

The tendon and ligament usually transmit tensile forces from muscle-to-bone and from bone-to-
bone, respectively . Expression of the tension as a percentage of the failure strength provided a
useful indication of potential failure and damage of the tissue . In general, the tension experienced
in the tendon during activities of daily living, occupational tasks, and even sporting events are
relatively low as compared with the failure strength . Gross rupture would be less common when
Biomechanics of the Soft Tissue in Repetitive Motion Disorders 233

compared with the potential micro trauma or alternation of the collagen fiber arrangements.
Compression would be encountered, when the tendon and soft tissue change direction around a
bony structure or pulley system, or impingement between the bony structures occurs . A
combination of such compressive and tensile force, shear stress is possible within the tissue [4].
Biological adaptation of soft tissue to these types of loading has been observed [5].

The joint movement will determine the amount of the tendon excursion. During tendon sliding,
the amount of friction against the surrounding sheath and tissue depends on the amount of tension
in the tendon , the friction coefficient, and the arc of contact [6]. Therefore, the specific joint
posture is an important determining factor of the risk. Friction force can directly stimulate the
cellular reaction, and can also generate heat and cause thermal effects indirectly. In addition , the
excessive relative motion between tendons and with the surrounding tissue could also cause micro
tear of the peritendon and paratendon tissue and lead to vascular disruption and inflammatory
repair responses.

Biological response. The inflammatory response plays an important role in both the initiation of
the response and the early development of the fibrotic phase of healing . Lack of inflammation-
induced repair could lead to degeneration of the tissue . Chronic stimulation of an inflammatory
reaction can lead to loss of function as well. Tendon and ligament responses to repetitive motion
or loading can involve adaptation, as well as development of pathology. The changes that occur in
the paratendon are edema, increased vascularization, fibrosis, and inflammatory cell infiltrates [7].
The prominent microvascular bed in the synovium is one of the obvious sites that is influenced by
motion and mechanical stress.

The tendon and ligament cells detect and interpret applied load, and respond biologically to those
load signals [8]. Growth factor may enhance or hinder the response to mechanical loading ,
especially those quiescent cells. Excessive load application may stimulate production of
degradative enzymes that initially activate stored growth factor , but then degrade matrix and elicit
production of inflammatory mediators. Transverse compressive loading stimulates the generation
of fibrocartilage within the tendon by metaplasia [5].

Response of the soft tissue to the mechanical loading occurs at both the cellular and matrix levels.
When the response is sufficient to maintain soft tissue integrity, the adaptation of the tissue is
ready for the next loading session . On the contrary, if the response and recovery time is
insufficient, repetitive loading will lead to tissue degeneration or prolonged repairing proces ses
[9]. Intervention, such as rest or pharmaceutical treatment to decrease the matrix degradation or
increase matrix synthesis, would be necessary to stop the vicious cycle (Fig. 2). Neurogenic
inflammation due to neural cell and master cell interaction may also play an important role in
repetitive motion induced soft tissue disorders [10].
Fig. 2. Mechanically induced adaptationand
degeneration of soft tissue.

In summary, there is enough evidence to

support the potential for repetitive
motion or overuse loading to cause soft
tissue disorders . The external loading
exposures are related to the internal stres s
in the tissue and interaction between
tissues . In tum , physiological and
cellular responses are thus triggered,
which lead to either biological
adaptations or chronic pathologies.
234 K.N.An

REFERENCES

[I] Bureau of Labor Statistics . Survey of Occupational/njuries and Illnesses in /994. U.S.
Department of Labor , Washington, D.C., May 1996.

[2] W.G. Clancy, Tendon trauma and obveruse injuries. In: W. Leadbetter, J.A. Buckwater, S.L.
Gordon (eds): Sports-induced Inflammation: Clinical and Basic Science Concepts . Park Ridge,
IL, American Academy of Orthopedic Surgeons , 1990, pp. 609-618 .

[3] A. Moore, R. Wells, D. Ranney , Quantifying exposure in occupational manual tasks with
cumulative trauma disorder potential. Ergonomics, Vol. 34, 1991, pp. 1433-1453.

[4] Z.P. Luo, H.C. Hsu, JJ. Grabowski , B .P. Morrey, KN. An, Mechanical environment
associated with rotator cuff tears, Journal of Shoulder and Elbow Surgery , Vol. 7(6), 1998, pp.
616-620.

[5] KG. Vogel, The effect of compressive loading on proteoglycan turnover in cultured fetal
tendon . Connective Tissue Research, Vol. 34(3),1996, pp. 227-237 .

[6] S. Uchiyama, P.C. Amadio, J.I. Ishikawa, KN. An, Boundary lubrication between the tendon
and the pulley in the finger. Journal of Bone and Joint Surgery, Vol. 79A(2), 1997, pp. 213-218 .

[7] W.B. Leadbetter WB: Cell-matrix response in tendon injury Clinical Sports Medicine , Vol.
11(3), 1992.

[8] AJ. Banes, G. Horesovsky, C. Larson, M. Tsuzaki, S. Judex, J. Archambault, R. Zernicke , W.

Herzog, S. Kelley, L. Miller, Mechanical load stimulates expression of novel genes in vivo and in
vitro in avian flexor tendon cells. Osteoarthritis & Cartilage , Vol. 7(1), 1999, pp. 141-53.

[9] J.M. Archambault, J.P. Wiley, R.C. Bray, Exercise loading of tendons and the development of
overuse injuries . A review of current literature . Sports Medicine , Vol. 20(2), 1995, pp. 77-89.

[10] D.A. Hart, c.B. Frank, R.C. Bray, Inflammatory process in repetitive motion and overuse
syndromes: potential role of neurogenic mechanisms in tendons and ligaments . In S.L. Gordon,
SJ. Blair, LJ. Fine (eds). Repetitive motion disorders of the upper extremity. Rosemont,
American Academy of Orthopedic Surgeons, 1995, pp. 247-262.
Biotribological Aspects of Natural Synovial Joints and
Artificial Joints
Teruo Murakami

Department of Intelligent Machinery and Systems, Graduate School of Engineering, Kyushu

University, Hakozaki, Higashi-ku, Fukuoka 812-8581, Japan

Summary: Human joints play important roles in various daily activities and their durability
depends on the lubrication mechanism. In this paper, the biotribological aspects such as friction,
wear and lubrication in both natural synovial joints and joint prostheses are discussed from the
viewpoint of adaptive multimode lubrication. To examine the lubrication mechanisms in natural
joints and artificial joints with artificial cartilage, pendulum tests, reciprocating tests and simulator
tests have been conducted. Firstly, it was shown in pendulum tests of pig shoulder joints that both
concentration of hyaluronic acid or viscosity and adsorbed film formation of proteins and
phospholipid exerted a significant effect on frictional behavior. The reciprocating tests of articular
cartilage at severe rubbing condition indicated the importance of lubricating proteoglycan gel film
in preserving low friction and protecting cartilage. Next, frictional behavior in artificial knee joints
with compliant artificial cartilage of polyvinylalcohol (PVA) hydrogel specimen during walking
was examined in simulator tests. The difference in friction characteristics between tibial PVA
hydrogel and natural articular cartilage specimens against stainless steel counterface was
investigated Remarkable difference in friction between both materials was confirmed at the initial
stage of rubbing process. In these tests, the influence of addition of protein on frictional behavior
was evaluated. The appropriate addition of y-globulin to sodium hyaluronate (HA) solution
improved frictional property during simulated walking under thin film conditions. These
phenomena are discussed from the viewpoint of adaptive multimode lubrication.

Key words: Biotribology, Natural Synovial Joints, Artificial Joints, Adaptive Multimode
Lubrication

INTRODUCTION

Human diarthroidal joints function as excellent low frictional joints of musculo-skeletal link
system to accomplish various daily activities in human life for 70 to 80 years. The natural healthy
synovial joints appear to operate not only under fluid film lubrication but also under other various
lubrication modes corresponding to the severity of operating conditions, as pointed out by Dowson
[11 Unsworth et al.[2], Sasada [3], Murakami [4] and Ikeuchi [5]. For example, in natural hip,
knee and ankle joints during walking, the elastohydrodynamic lubrication (EHL) mechanism,
which is established by the macro- and microscopic elastic deformation of compliant articular
surfaces and viscous effect of synovial fluid, is likely to play the main role in preserving low
friction and low wear. Under severer thin film conditions with local contacts at start-up after long
standing, however, various supplemental lubrication mechanisms such as weeping, boundary and
gel film lubrication modes seem to operate to protect articular cartilage. This synergistic
lubrication mechanism is called the adaptive multimode lubrication [4, 6, 7]. If some parts of
protective lubrication system, particularly adsorbed film and gel film are worn out, the bulk
articular cartilage is exposed to high shearing force, which may result in a degeneration of
cartilage. Therefore, the biotribological elucidation of lubrication mechanism are required to
maintain healthy condition.

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 235
236 T . Murakami

For patients with osteoarthritis, rheumatoid arthritis or damaged joints, various types of artificial
joints have been applied as replacement joints since successful clinical application of total hip
prostheses by J. Chamley in 1962 [8). Total joint replacement is a highly reliable surgical
procedure, by which the patients have regained daily activities such as walking and even playing
sports, and have been relieved from severe pain. However, for certain cases of clinical
applications of total joint prostheses composed of ultra-high molecular weight polyethylene
(UHMWPE) and metal or bioceramics, serious tribological problems such as wear and loosening
have occurred in longer usage. This is attributable to the insufficiency of fluid film formation in
existing joint prostheses, which results in high wear and high friction. Excessive wear debris,
particularly large amounts of submicron wear debris of UHMWPE attacks the living tissue
inducing the osteolysis and the loosening [9]. To reduce wear fundamentally, the improvement in
lubrication mode is required in joint prostheses. Total hip prosthesis of ceramic-on-ceramic or
metal-on-metal with smooth surface and small radial clearance is a favorable design solution
Numerical analysis by Jin et al [10) suggests that the fluid film lubrication can be established in a
high precision ceramic-on-ceramic hip prosthesis during normal walking. But, as shown in
simulator tests of ceramic-on-ceramic joints of small radial clearance lubricated with serum [11],
high friction due to adverse lubrication may induce the loosening. As another possible design
solution, the application of compliant material as artificial cartilage to bearing surface of joint
prosthesis have been attempted to improve the lubrication mode. Dowson et al [12] described the
design considerations for cushion form bearings on lubrication mechanisms and contact mechanics,
in which soft-EHL as well as micro-EHL [13) become effective. Furthermore, it has been pointed
out that porous hydrogels give lower friction than non-porous polyurethane at start-up or after
breakdown of the fluid film [14]. The authors proposed the design concept of the adaptive
multimode lubrication for joint prostheses [4, IS, 16].
In this paper, the lubrication mechanisms in both natural synovial joints and artificial knee joints
with artificial cartilage are discussed on the basis of experimental results such as pendulum tests of
animal joints, reciprocating tests of articular cartilage and simulator tests of knee prosthesis with a
compliant artificial cartilage or articular cartilage.

PENDULUM TESTS OF NATURAL SYNOVIAL JOINTS

Methods of pendulum tests. The frictional behaviour of pig shoulder joint as fulcrum under
constant load was examined by pendulum testers [6, 7,17). The shoulder joint specimens were
prepared as ellipsoidal joints by articulating parts excised from pigs which are six month olds and
about 100 kg body weight. The specimens were adjusted so that the swinging motion was along
the major radius. After supplying 0.5 ml oflubricant into the concave part (cup) of shoulder joint,
the swinging of the pendulum was observed immediately after loading of 100 N (apparent mean
contact pressure : pa~ 0.25 MPa) at a room temperature of 20·C . Coefficient of friction was
estimated from the linear damping of amplitude ranging between 0.08 and 0.03 rad at an initial
angle of 0.1 rad and a period of 1.0 s.
At first, the pendulum tests were carried out using fresh joints lubricated with saline solutions of
sodium hyaluronate (HA, molecular weight = 8.8 x 10' - 9.6 x 10', Seikagaku Corporation) of
different concentrations (0.1 to 2.0 g/dl). After the first tests, the joints were rinsed with a saline
solution containing poly-oxyethylene p-t-octylphenyl ether (Triton X-IOO, 10 g./dl) to remove the
adsorbed film on the articular cartilage surfaces, for 30 min in an ultrasonic bath and then rinsed
again with saline for 30 min The removal of adsorbed film mostly composed of amphiphilic
molecules such as phospholipids and proteins was confirmed by significant reduction in the contact
angle on dried cartilage surfaces. The second pendulum tests were then carried out under
lubricated conditions with HA solutions of the same concentration to the first corresponding tests.
For low viscosity of 0.2 g./dl HA solution in mixed lubrication regime, the joints used in the second
tests were rinsed with saline and then the third pendulum tests were conducted lubricated with HA
Biotribological Aspects of Natural Synovi al and Artificial Joints 237

solutions with and without human serum proteins (albumin and y-globulin) and liposome of
phospholipid Lll-DPPC (dipalmitoyl phosphatidylcholine).

Results and discussion of pendulum tests. The frictional behaviors in both the first and second
tests are shown as a Stribeck curves for the average sliding at medium damping and viscosity at
shear rate of IO s". It is noticed that the removal of surface films in the second tests caused
remarkable increase in friction in lower viscosity at a mixed lubrication regime. The average value
of friction coefficient at 0.2 gI dl HA in the first test of 0.007 increased to C.OIS in the second test,
which indicates the loss of protection by adsorbed film under mixed lubrication regime. The
effectiveness of the addition of proteins and phospholipid is indicated in the third tests , i.e., Ln-
DPPC of 0.01 g/dl or y-globulin of 1.0 g/dl was effective in reducing friction in natural synovial
joints, although the addition of serum albumin of even 3.0 g/dl was little valid.
These results support the boundary lubricating abilities of phospholipids [18] and y-globulin [6, 17,
19] as amphiphilic molecules. Particularly, phospholipid Lll-DPPC which showed sufficient
effectiveness at physiological concentration is expected to play main role in boundary lubrication.
However, the authors' reciprocating friction tests for pig articular cartilage against glass plates
coated by various Langmuir-Blodgett films [17] exhibited that the mixed bilayer film of Lll-DPPC
and y-globulin showed better frictional property than Lll-DPPC bilayer . In natural synovial joints ,
not only phospholipids but proteins or lubricating glycoproteins [20] appear to function as effective
boundary lubricants. Under severer rubbing condition in which adsorbed films have been
removed, another protective layer in cartilage surface is expected to playa lubricating role.

·
0.2 gldl HA
0.020 ~ "'O'"""F=i-rs-t-te-s-ts--.....

II
(intact surface) 0.025 *
Second tests c: *
§ (after removal of 0 0.020 **

I
0.015 U
:g adsorbed film)

~ ~ 2~ 2
:E
:E '15 0.Q15
'15
c: 0.010
c:
.~ 0.010
Ql
'0 =
Ql
La-DPPC Physiological y-globulin

f""""k4""""JJ ,!
0 0.005
~ ~JnCenlrallon Elf
U
0.005
I I
0
0 ( 0.clo1 0.Q1 0.1 1.0
o L.-_~_-,--_....o..-_--, Coencentration of La-DPPC or y-globulin . gldl
10.7 10-6 10.5 10-4 10.3
Viscosity· [Sliding velocity] / Load , rrr
Fig.l Influence of removal of adsorbed Fig.2 Effectiveness of addition of phospholipid and
film of articular cartilage on friction in y-globulin on friction (N=6, error bars mean
pendulum tests (error bars mean SD) SD, *p <O.OOS, **p <O.OI)

RECIPROCATING TESTS OF ARTICULAR CARTILAGE UNDER

SEVERER CONDITIONS
Method of reciprocating tests. The reciprocating tests [21] of ellipsoidal specimen of articular
cartilage from pig femoral condyle against glass plate were conducted at constant load of 4.9 N
(mean contact pressure : 0.13 MPa), stroke of 35 rnm, sliding speed of 5 rnm s' under both
unlubricated and lubricated (with saline) conditions. The changes in surface morophology were
observed by atomic force microscopy (AFM) at non-contact, fluid tapping mode [21].

Results and discussion of reciprocating tests. Frictional behaviors are shown in Fig. 3. For both
238 T. Murakami

conditions the friction was increased with the sliding distance. However, under not a lubricated
but an unlubricated condition , the lower friction was maintained . Particularly, at the initial stage
very low friction was observed. In friction tests under unlubricated conditions, the lubricant was
not supplied. Therefore, the role of surface layer of the lubricating adsorbed films and/or gel films
was expected to be emphasized, although some contribution of exuded fluid to lubrication was
anticipated To examine the friction mechanism in these transient rubbing process, the articular
surfaces were observed before testing and at definite sliding distances by AFM.
Figure 4(a) shows the AFM image of an intact articular cartilage surface, which has considerably
smooth morphology with maximum height of I to 2 urn, After short sliding of 0.35 m under
unlubricated condition whose coefficient of friction is less than 0.01, the cartilage surface was
slightly rubbed resulting in the smaller roughness. With proceeding of rubbing, the friction
gradually increased. After 9 m sliding, the fibrous tissues appeared , where coefficient of friction is
about 0.1. Therefore, it is considered that the acellular and non-fibrous surface layer has been
rubbed off at this stage. These phenomena suggested that the initial very low friction was
maintained mainly by the adsorbed lubricating molecules, and the following medium friction level
was preserved by the non-fibrous gel layers. The enzyme treatment of articular cartilage with
chondroitinase ABC for 30 h [22] revealed the collagenous surface similar to the observation by
Jurverin et aI.[23]. This fact indicates the surface gel layer is composed of proteoglycan .

5 0 .3 r- = - - - - -- - -- - ---,
'u
~ 0.2 C
O ~~.s=
c:
.!'!
.s
::
CIl
0.1 L.~~~~~~~
Unlubricated Fig.3 Frictional behaviors of natural articular
cartilageagainstglass plate in reciprocating
8 0 2 4 6 8 10 tests
Slidingdistance, m

(a)Intactsurface (b) Surfaceafter 0.35m sliding (c) Surface after 9 m sliding

Fig.4 AFM images of articularcartilage surfaces before and after reciprocating (unlubricated) tests

ADAPTIVE MULTIMODE LUBRICATION IN NATURAL SYNOVIAL

JOINTS

The experimental results mentioned above and related numerical analyses indicate that natural
synovial joints are likely to preserve low friction and low wear by the adaptive multimode
lubrication mechanism as a fail-safe system shown in Fig.5 . Micro-EHL mechanism appears to
prevent the direct contact between articular cartilage during normal walking. Under severe
condition with local direct contact, various lubrication modes such as weeping, adsorbed film (as
boundary lubrication) and gel film lubrication seem to be effective depending on the severity.
Biotribological Aspects of Natural Synovi al and Artificial Joints 239

@
.: : : : ~ ~:t~(ff{\:: :.
Articular cartilage
~
'.:.:.:-:.:.:.:.:.:.:.:.:.:.:.:.:.:.'
Mixed lubrication Weeping lubricat ion Adsorbed film and gel
film lubrication
(a) Soft-EHL, micro-EHL (b) Various lubrication modes for thin film conditon with local
direct contact
Fig.S Adaptive multimode lubrication mechanism in natural synovial joints

SIMULATOR TESTS OF KNEE PROSTHESIS WITH ARTIFICIAL

CARTILAGE
Method of simulator tests. A walking motion was simulated using a knee joint simulator [7,
15.16]. Flexion-extension motion of the femoral component and time-dependent tibial axis loading
were applied by a hydraulic system controlled by a personal computer. In these tests at room
temperature, the walking period was 2 s, and half loading for one condyle was applied. To
examine the frictional behavior, the torque of upper driving axis was measured using strain gauges
attached to the shaft. A spherical stainless steel (SUS316, JIS) specimen of 30 mm radius and
surface roughness of Rrms = 0.06 11m was used as the femoral component as shown in Fig.6. For
tibial surfaces, two kinds of specimens were prepared. One was a soft layer ofPVA hydrogel of2
mm thickness and concave circular radius of 36 mrn supported by PMMA cylindrical sleeve as the
transverse contact conjunction with a smaller radius in the
entraining direction. The PVA hydrogel specimen was
prepared by the repeated freezing-thawing method [7,16].
In this study, a PYA hydrogel of high water content
(equivalent water content; EWe =79%, elastic modulus; E
=1.1 MPa) was used. Another was tibial articular cartilage
supported by subchondral bone and cancellous bone
excised from the tibial medial condyle of pig knee joint.
As lubricants, saline solutions of HA of molecular weight
=9.6X IO'were used. To examine the effect of protein on
friction and lubrication, human serum y-globulin was
added to HA solutions. Fig.6 Knee prosthesis with PVA
hydrogel layer in simulator
Results and discussion of simulator tests. As shown by
previous numerical analysis of soft-EHL and simulator
tests (16], a considerable fluid film was formed in this knee prosthesis with PVA hydrogel
lubricated with medium viscosity lubricants during walking. The lubricated conditions with lower
viscosity lubricants, where significant direct contact between rubbing surfaces may occur, become
important problem. Changes in frictional torque for PVA and articular cartilage are shown in
Fig.7, where torque values at the 5th and SOOth walking cycles lubricated with HA solution of 0.3
g/dl are depicted Artificial cartilage of PVA hydrogel showed higher torque than natural articular
cartilage, although it has a slight decreasing tendency in friction with walking cycles like running-
in. On the contrary, the natural articular cartilage showed very low friction during 5th walking
cycle, which was probably brought about by the protection with the surface film on articular
surface and some fluid film effect even for a low viscosity lubricant. With repetition of walking
cycle, however, fluid film becomes thinner due to gradual squeezing out and the adsorbed film
240 T. Mur akami

Articular cartilage i
~ o.e ..······..···;....·········;·····..·..···j· '--"O";;"7'-'~~1
g
·+·· t ·
0 i ; ;
! ·o.e ····..· i··..· ·j" ·
·1. 61 - - - ' -- - -'-- -'-- - -'-- --'
o 20 40 60 eo 100
Percent 01 cycle

Fig.7 Frictional behaviors of stainless steel femoral Fig.8 Influence of addition of y-globulin to
component and PYA hydrogel or natural articular HA solution on friction for PYA hydrogel and
cartilage specimen during simulated walking lubricated natural cartilage specimens
with 0.3 gldl HA solution

and/or gel film are removed by rubbing in mixed lubrication regime, and then the surface layer of
articular cartilage is worn out.
To improve frictional property of PVA hydrogel, the addition of y-globulin (0.3 gldl) to HA
solution was tried . Figure 8 shows the effectiveness of protein in improvement of friction at the
5th walking cycle. Similar effect was observed for friction of articular cartilage at SOOth cycle,
where y-globulin of 0.3 g/dl is effective for high viscosity HA (1.0 gldl) solution but y-globulin of
1.0 g/dl is required for low viscosity HA (0.3 gldl) solution.

DISCUSSION

On the basis of experimental results mentioned above , it was shown that the lubrication mode
changes depending on the severity of operating conditions. In mixed lubrication regime in the
pendulum tests with HA solution of 0.2 g/dl, higher concentrations ofy-globulin than physiological
level were required to reduce friction, whereas physiological concentration of La-DPPC as
Iiposome was effective. On the other hand, the physiological concentration (0.3 g/dl) ofy-globulin
was effective in simulator tests for both the natural articular cartilage lubricated with HA 1.0 g/dl
solution and PVA hydrogel with HA 0.3 gld!. The lowering of friction for articular cartilage with
HA 0.3 gldl in simulator test was observed for addition of 1.0 g/dl y-globulin. The quantity of
required lubricating constituents appears to depend on the severity and lubrication mode. One
reason for the necessity of high concentration of y-globulin in low viscosity conditions is difficulty
in the self-organization of protective surface films . High concentration may compensate the
availability of y-globulin in the load-carrying conjunction zone under steady load. The invalidity
of high concentration of albumin may be related to the inferior adsorption on articular cartilage due
to the insufficiency of hydrophobic groups in molecules. But, small quantity of albumin was
effective, as reported in the previous paper for the cylindrical knee prosthesis with PYA layer [16].
Biotribological Aspects of Natural Synovial and Artificial Joints 241

Furthermore, the considerable stick-slip observed during stance phase was attenuated by increasing
HA concentration or addition of protein. The addition of phospholipid was not so effective for
PYA hydrogel against stainless steel, although the repetition of rubbing gradually improved .
Thus , the effectiveness of adsorbed molecules depends on the compatibility with mating material
and rubbing severity or lubrication mode . In the artificial joint with PYA hydrogel of high water
content, this low friction mechanism is applicable even under low viscosity condition. The
adsorbed films composed of protein and HA are likely to behave as a protective layer reducing
friction under mild mixed lubrication regime, but have another possibility to increase friction due
to the opposite property of protein under severer mixed lubrication as shown for polyurethane [16].
Under severer reciprocating rubbing condition for articular cartilage, the lubricating surface layer
preserved low level of coefficient of friction less than 0.01 at initial stage and then preserved
medium friction level under 0.1 until the collagenous subsurface structure appeared. In contrast,
the PYA hydrogel has no lubricating surface layer . To attain longevity of PYA hydrogel, some
protective surface layer on PYA is expected to be formed or self-organized .

CONCLUSIONS

In natural synovial joint, the adaptive multimode lubrication mechanism appears to maintain low
friction and low wear in each lubrication mode , where the lubricating constituents such as
hyaluronic acid , proteins, phospholipids and other conjugates synergistically operate depending on
the severity . The concentration of HA or lubricant viscosity mainly controls the fluid film
formation and lubrication mode in not only fluid film but also mixed lubrication regimes. The
effect of addition of proteins and phospholipid to HA solutions on the friction and lubrication was
evaluated in relation to the lubrication mode and effective concentration in the pendulum test of pig
shoulder joint and simulator tests of articular cartilage. The reciprocating tests of articular
cartilage against glass under severer rubbing condition indicated that the proteoglycan gel layer is
likely to protect articular cartilage surface .
The artificial joint with compliant artificial cartilage has advantage on EHL film formation but the
improvement of durability in case of severe direct contact between rubbing surfaces is required for
successful clinical application . The PYA hydrogel without protective surface layer showed
significant high friction level for low viscosity condition even immediately after rubbing in the
simulator. To improve longevity of artificial cartilage, the addition of protective surface layer
such as adsorbed film and gel film should be taken into consideration.

ACKNOWLEDGMENTS

The author wishes to thank Dr. Y. Sawae , Prof. N. Ohtsuki of Kyushu University, Dr. H. Higaki of
Kyushu Sangyo University, Dr . S. Moriyama of Fukuoka University and Dr . Y. Nakanishi of Oita
University for their cooperation. The AFM measurement was conducted using AFM at the Center
of Advanced Instrumental Analysis, Kyushu Un iversity. Sodium hyaluronate was prepared by
Seikagaku Corporation. Financial supports were given by the Grant-in-Aid for Scientific Research
of The Ministry of Education, Science, Sports and Culture, and Kyushu University
Interdisciplinary Program in Education and Projects in Research Development.

REFERENCES

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1966.fJ7, pp.45-54.
[2] A. Unsworth , D. Dowson, Y. Wright, Some new evidence on human joint lubrication, Ann.
Rheum. Dis., Yo1.34, 1975, pp. 277-285.
242 T. Murakami

[3] T. Sasada, Friction and Lubrication in Human Joints, J Jpn.Soc. Lubr. Eng., (in Japanese), Vol.
23, No .2, 1978, pp. 79-84.
[4] T. Murakami, The Lubrication in Natural Synovial Joints and Joint Prostheses, JSME
InternationalJournal, Ser.lII, Vol. 33, No .4, 1990, pp. 465-474.
[5] K. Ikeuchi , The role of synovial fluid in joint lubrication, Lubricants and Lubrication (Eds. D.
Dowson et al.), Elsevier, 1995, pp.65-69.
[6] T. Murakami, N . Ohtsuki , H. Higaki, The adaptive multimode lubrication in biotribological
systems, Proc. Int. Tribol. Con! Yokohama 1995,1996, pp. 1981-1986 .
[7] T. Murakami, H. Higaki, Y. Sawae , N . Ohtsuki, S. Moriyama, Y. Nakanishi, Adaptive
multimode lubrication in natural synovial joints and artificial joints, Proc. Instn. Mech. Engrs. ,Vol.
212, Part H, 1998, pp. 23-35 .
[8] J. Charnley , Low Friction Arthroplasty ofthe Hip, Springer-Verlag, 1979.
[9] P.A. Ravell, N. AL-Saffar, A. Kobayashi, Biological reaction to debris in relation to joint
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1997, pp. 247-256.
[II] S.C. Scholes, A. Unsworth, R.M. Hall, R. Scott, The Effect of Material Combination and
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Vo1.15, 1986, pp. 63-65.
[14] L. Caravia, D. Dowson, J. Fisher, P.H. Corkhill , BJ. Tighe, A comparison of friction in
hydrogel and polyurethane materials for cushion-form joints, J. Mater. Sci., Mater. in Medicin e,
Vol. 4, 1993, pp. 515-520 .
[15] T . Murakami , N. Ohtsuki, H. Higaki, The adaptive multimode lubrication in knee prostheses
with compliant layer during walking, Thin Films in Tribology (Eds. D. Dowson, et al.) , Elsevier,
1993, pp.673-682 .
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Lubrication in Knee Prostheses with Artificial Cartilage during Walking, Elastohydrodynamics-'96
(Eds. D. Dowson, et al.) , Elsevier, 1997, pp.371- 382.
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Meck Engrs.,Vol. 212, Part H, 1998, pp. 337-346 .
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Fundamental Study of Dynamic Analysis of Lumbar Vertebrae
Hidekazu Nishigaki', Tatuyuki Amago', Kazuo Miki l , Shin-ichi Ishiyama',
Eiichi Tanaka' and Sota Yamamoto/

ITOYOTA Central R&D Labs. Inc., Nagakute, Aichi 480-1192, Japan

2Department of Mechanical Engineering, School of Engineering, Nagoya University, Nagoya 464-
8603, Japan

Summary: This paper describes the results of fundamental study of dynamic analysis of the lumbar
vertebrae for the accidental injury. A finite element model with linear brick elements and nonlinear
truss elements is constructed for the study of dynamic responses of the fifth and fourth lumbar
vertebrae . The results of the analyses show the followings : In case of the estimation of the global
behavior of vertebrae, it is efficient method to treat the stiff parts of the bone as rigid elements and
apply the 8-points integration to the other soft brick elements . To determine the stiffness of
ligament for various modeling cases, response surface methodology using design of experiment is
applied and the usefulness is verified. And this design of experiment is also applied to examine the
influence of the disk properties on the lumbar vertebral stiffness. This bending stiffness of the
lumbar vertebrae is rapidly increasing when Poisson's ratio of nucleus pulposus is very close to 0.5.
If Poisson 's ratio is close to 0.5, nucleus pulposus changes its characteristic from compressible to
incompressible. In this case, the disk is expected to function as rotator in the extension or flexion of
the lumbar vertebrae . To verify this function of rotator, the impact response analyses that dropped
block comes into contact with the upper side of the lumbar vertebrae is performed and this function
is verified quantitatively.

Key words: Finite Element Method, Lumbar Vertebra, Dynamic Analysis , Design of Experiment

INTRODUCTION

This study has been carried out as a part of the research , which analyze the occupant injury during
car crashes using a finite element method . The spinal column, which consists of cervical, thoracic
and lumbar vertebrae, has a great influence on the motion of the upper half part of the body. But this
dynamic response analyses with large deformation are the time consuming jobs. So it is important
to study the efficient modeling which can express the motion of spinal column with sufficient
accuracy. Since cervical, thoracic and lumbar vertebrae have similar structure, authors choose
lumbar vertebrae as the object of study.
Authors construct a finite element model with linear brick elements and nonlinear truss elements for
the study of dynamic responses of the fifth and fourth lumbar vertebrae . This model is created on
the basis of the quasi-static analysis model constructed in order to investigate the separation of an
interarticular portion of human vertebra from a mechanical point of view [1].
The contents of the present study are as follows .
I) To reduce the calculation time without decreasing accuracy, the effects of changing the brick
element formulas for rigidity and numerical integration are examined.
2) Because the ligament acts only in the tensional case, the each ligament has the functional
assignment in the extension or flexion of the lumbar vertebrae. In case this model is applied to the
other various cases, the method for finding the appropriate stiffness of ligament must be required to

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 243
244 H. Nishigaki et al.

satisfy the given stiffness of the extension and flexion. Therefore, the response surface methodology
using design of experiment is applied to this problem.
3) The properties of disk also influence the stiffness of the extension and flexion. In this study,
three properties are selected, namely Young's modulus of annulus fibrosus and nucleus pulposus
and Poisson's ratio of nucleus pulposus. The design of experiment is also applied to examine the
influence of the disk properties on the lumbar vertebral stiffness.
4) If Poisson's ratio is close to 0.5, nucleus pulposus changes its characteristic from
compressible to incompressible. For nearly incompressible material with Poisson's ratio greater
than 0.49, applied loads cause the deformation with small volume changes. For this reason, the
disk is expected to function as rotator in the extension or flexion of the lumbar vertebrae. To
verify this function of rotator, the impact response analyses that dropped block comes into contact
with the upper side of the lumbar vertebrae are performed.

FINITE ELEMENT MODEL

The finite element model of the fifth (L5) and the fourth (L4) lumbar vertebrae shown in Fig.! is
constructed on the basis of the tomogram of typical vertebral specimens of a 44-year-old man, and
the reference of anatomy. Material property of the bone of the posterior element is assumed to be
isotropic elastic, and material properties of vertebral body shell and core are assumed to be
orthotropic elastic. Concerning the third lumbar vertebra (L3), since it was made so that the load
may be transmitted to the under elements, the shape is simplified, and it is approximated in the rigid
body. Material properties of disk, which are composed of vertebral end-plate, cartilaginous end-
plate, nucleus and annulus, are assumed to be isotropic elastic. Above mentioned parts are modeled
using the brick elements. Ligaments are modeled using the nonlinear truss elements, which have no
resistance to the compressive load. This finite element model is composed of 1872 elements and
2310 nodes. General-purpose finite element analysis program LS-DYNA (Livermore Software
Technology Corporation) for nonlinear dynamic analysis of structure is used for present analysis.

Exten sion Force :

/Zt . f'~\"""--l' 0-400N (O-IOm )

Fig.I. Finite elementmodel and loading condition.

QUASI-STATIC ANALYSIS OF LUMBAR VERTEBRAE

Since lumbar vertebrae are mostly extended and flexed by deformation of the soft disk and ligament
connected with comparatively hard vertebral body, it is expected that treating the vertebral body as
rigid elements is effective for efficient analysis without decreasing accuracy. Then, the validity of
the approximated model which treat the vertebral body as rigid elements should be examined. And
the decrease in accuracy under the overload of the one point integrated element should be examined,
too.
Dynamic Analysis of Lumbar Vertebrae 245

Loading condition is shown in Fig.I. The nodes at under-surface of the model are fully constrained.
In order to consider the weight of the upper half of the body, force Fz=-200N is loaded on each two
points on the upper surface of the third lumbar vertebra. Furthermore, extension force Fz that
linearly increase from 0 to -4OON by IOms is applied to the tip of the third lumbar vertebra.
Figure 2 shows a summary of the calculated results which were obtained by changing the brick
element formulas for rigidity (rigid body and elastic element) and numerical integration (8-points
and l-point) of the elastic element. In this figure, vertical axis represents the percentage of the
computational time (=7706seconds), displacement (=38.8mm) at loaded point and maximum
equivalent stress (=I9 .5MPa) respectively for the first model whose element formulas is elastic and
8-points integration. The following results are obtained for the first model (vertebral body and other
soft brick element: elastic and 8-points integration) and the third model (vertebral body: rigid, other
soft brick element: elastic and 8-points integration). The displacement at loaded point and
maximum equivalent stress of the first model is about the same as the ones of the third model.
Moreover the percentage of the computational time of the third model is smaller than the one of the
first model by 94%. These results show that the method, which treats the stiff parts of the bone as
rigid body and applies the 8-points integration to the other soft brick elements, is efficient.
By the way, the model using l-point numerical integration reduce the computational time, but
decrease the accuracy. Besides that, the hourglass (zero energy) modes shown in Fig.3 are observed

I
on the deformation shape of this model. These hourglass modes, as a general rule, have bad
influence on the accuracy. This should be the reason of the above-mentioned inaccuracy.

~_-..=
. 8
.. ,::
.=. 200 'Ma ximum'
Eq uivalent
Stress /~
~ 'E 't!- ".
t5 fi: .~::. . _ ~--:;;.~ .~ •.:..~~:.:: •••••~.
I~
I00
I
-
Disp lacemen t

c. ::
I,

I CPU
~~ 0
c:: ~ ~ . ® 1-
-1==-8_-_..,.....=-_---,
Lumbar 4,5 :Elastic
@ 8 - @ 1 -Po in~
Lumba r 4,5 :Rigid
Fig.2. Percentage of calculated results to the first item
(Lumbar 4,5: elastic, g-points integration).

ESTIMATION OFSIGNIFICANT FACTORS OF LIGAMENT

Because the ligament acts only in the tensional case, the each ligament has the functional
assignment in the extension or flexion of the lumbar vertebrae. In case this model is applied to the
other various cases, for example, of the younger or older human spine, the method for finding the
appropriate stiffness of ligament must be required to satisfy the given stiffness of the extension and
flexion. Therefore, the response surface methodology using design of experiment is applied to this
problem by the following procedure.
I) Estimation of significant factor of the ligament by design of experiment to determine
the stiffness of ligament effectively.
2) Decision of design variables by only significant factors.
3) Preparation of response surface, which approximates the objective function.
4) Search for the optimum design variables, which minimize the above-mentioned
approximated objective function.
Figure 4 shows the loading conditions, which adds flexion force as opposed to extension one to the
246 H. Nishigaki et al.

loading condition shown in Fig.1. For simplification, ligaments are divided into three groups, that is
the number of the factors is set to 3. Furthermore, for each factor (group), the cross-sectional areas
ofligament are respectively changed into three levels, which are 1.0,0.75 and 0.5 times as much as
original ones. The displacement of loaded point at l Oms is selected as to be an observation variable.
Although the calculations are originally requested for 3 X 3 X 3=27 times to investigate the all cases,
they are reduced to 9 times by use of Taguchi's design of experiment table L9(3 4) .

Weight: 200N, 200 . (2)FlexionUCDExtension Foree

. Long .u u d'rnaI L'rgamcn]
P ostcnor ' . .- 0-+400 (O-+ IOms)

An terior Lon gitudinal Ligamcnt Ligamcntum Flavum

j}j:l2~~!iz1li Int cr T ra nseverse Ligam cnt
~·~~f:».o" l Supras pinous Ligam cnt
Interspinous Ligam en t
act or C
Fig.4. Loading conditions and grouping of factors
(Lumbar 4,5 : rigid, disk: elastic & 8 points integration).

Figure 5 shows the results of estimation of significant factors of the ligament by design of
experiment. In these figures, vertical axis represents the mean value of displacement at loading
point. Horizontal axis represents the magnification for cross sectional area of ligament. Figure on
the left-hand side is the case of extension. And the other is the case of flexion. In case of extension,
only line of factor A has a large slant. In case of flexion, only line of factor C has a large slant.
These obtained results can be thought as proper because of the fact that the ligament acts only in the
tensional case.
Factor A and C are evaluated as significant ones and consequently magnification a Aand a c for
the cross-sectional area of factor A and C are selected as design variables. The sum of squares of
residuals between calculated displacement at loaded point and desired one for extension and flexion
cases is made to be an objective function. This objective function f is expressed as equation (I).

(1)

Where, dE and d, represent the displacements at loaded point of extension and flexion case
respectively. d' Eand d', also represent the desired ones. In this study, d' Eand d', are assumed to be
38.5mm and 20.0mm respectively. As a result of approximating the objective function by quadratic
function of design variables, approximated function f shown in equation (2) is obtained.

f =69.25a / + l8 .06a c2 +a A(36.19a c-140.09) - 53.38a c +75 .65 (2)

Figure 6 shows the approximated function f of two design variables a Aand a c-

The optimization problem of min f (a Mad is solved in order to obtain the values of design
variables a A and a c which minimize this approximated function f, and the ligament stiffness
which satisfy the given lumbar vertebrae bending stiffness are determined. As the results of the
above procedure, a A and a c are determined as 0.847 and 0.629 respectively.
Finally, in order to verify the validity of the above procedure, whether the determined values of
design variables have realized the desired bending properties or not shall be confirmed. Re-
calculated displacements at loaded point of extension and flexion cases are obtained as 38.4mm and
19.7mm respectively when the values of design variables a A and ac are set at 0.847 and 0.629
respectively. Because these values are very close to the desired ones which are d· E=38.5 and
d· F=20 .0 respectively, the validity of the above procedure is verified.
Dynamic Analysis of Lumbar Vertebrae 247

n r- - - - -

~z:.
- clor:
B
- C

Factor

Annul us Fibrosus
(O uter)
n: E (= 13.31\1 I'a)

Annul us Fibrosus
(Inner) , J I I J :I
Leveb or '-oc\on lntb or F••\on
(a) LlY (b) LI Z
Fig.7. Grouping of factors. Fig.S. Meanvaluesagainstthe levelsof factors.

ESTIMATION OF SIGNIFICANT FACTORS OF DISK

The properties of disk also influence the stiffuess of the extension and flexion; therefore, it is
important to estimate significant factor of the disk.
Loading condition is the same shown in Fig.1. In this study, three properties are selected, namely
Young's modulus E of annulus fibrosus and nucleus pulposus and Poisson's ratio v of nucleus
pulposus (Fig.7). Original values of the first, second and third property are 13.3MPa, O.013MPa and
0.4999 respectively. The number of the factors is set to 3. For the first factor fl, E is changed into
three levels, which are 1.00, 1.01 and 1.02 times as much as original one. For the second one f2, E
is changed into three levels, which are I, 10 and 20 times as much as original one. For the third one
£3, v is changed into three levels which are 0.96, 0.98 and 1.00 times as much as original one. Y
and Z-displacement of loaded point at 10ms are selected as to be the observation variables.
Figure 8 shows the results of estimation of significant factors of the disk by design of experiment.
In these figures, vertical axis represents the mean value of displacement at loading point. Horizontal
axis represents the levels of factors. Figure on the left hand side is the case of LlY. And the other is
the case of LlZ. In both cases, the lines of factor f2 have a small slant and consequently the
sensitivities are small within the current range of the level. Displacements become, in general, small
according to the increase of the level. In case of v of the factor £3, displacements are rapidly
decreasing , when Poisson's ratio of nucleus pulposus is very close to 0.5. However there are few
sensitivities when v is smaller than 0.49(1evel 2).

CONSIDERATION OF JOINT FUNCTION OF LUMBAR VERTEBRAE

If Poisson's ratio v is close to 0.5, nucleus pulposus changes its characteristic from compressible
to incompressible. For nearly incompressible material with Poisson's ratio greater than 0.49,
248 H. Nishigaki et al.

applied loads cause the deformation with small volume changes. For this reason, the disk is
expected to a function as rotator in the extension or flexion of the lumbar vertebrae. To verify this
function of rotator, the impact response analyses that dropped block comes into contact with the
upper side of the lumbar vertebrae is performed.
Figure 9 shows the loading condition. The nodes at under-surface of the model are fully constrained .
Initial velocity of the block is 5.556m/s. The weight of the block is 2.2kg. For comparison, the
model which assumes the characteristic of nucleus pulposus to be compressible and the Poisson's
ratio v is set at 0.3 is also prepared, and two cases are analyzed.
Figure 10 shows the results of impact response analyses at 5ms. Figure on the left hand side is the
case of compressible characteristic (v =0.3). Figure on the right hand side is the case of
incompressible one ( v =0.4999). The result that incompressible model rotates larger than
compressible one is obtained, and the function of rotator is verified quantitatively.

Block
2.2k g
mn
=t1±tj . .15•556 mls

--- '

Nuc leus
Pulp osu s
(a) V =0.3

Fig.9. Loading cond ition . Fig.tO. Result s of impact response analyses

(Displacements at 5ms).

CONCLUSION

The following points summarize the key findings in this work:

I) In case of the estimation of the global behavior of vertebrae, it is efficient method to treat the
stiff parts of bone as rigid bodies and apply the 8-points integration to the other soft brick elements.
2) To determine the stiffness of ligament for various modeling cases, response surface
methodology using design of experiment is useful.
3) This bending stiffness of the lumbar vertebrae is rapidly increasing when Poisson's ratio of
nucleus pulposus is very close to 0.5.
4) The disk is expected to function as rotator in the extension or flexion of the lumbar vertebrae.
This function is verified quantitatively by the impact response analyses in this paper.

REFERENCE

[I] S. Yamamoto, E. Tanaka, K. Mihara, H. Inoue, and K. Ohmori, Finite Element Evaluation of
Spondylolysis Taking Account of Nonlinear Mechanical Properties of Ligaments and Annulus
Fibrosus, JSME lnt. J., Vo1.42, No.3, C, 1999.
A Study on Development ofthe Total Hip Prosthesis Design Fitted
for Japanese Patients with Secondary Osteoarthrosis
Jiro Sakamoto I, Juhachi Oda I, Ayumi Kaneuji 2, Tadami Mastumoto 2, Tanzo Sugimori 2, Mitsuru
Nishino 2, Katsuro Tomita 3, and Masahiko Fujita 4

1 Department of Human and Mechanical Systems Engineering, Faculty of Engineering, Kanazawa

University, Kodatsuno, Kanazawa, 920-8667, Japan
2 Department of Orthopaedics, Kanazawa Medical Universit y
3 Department of Orthopaedics, School of Medicine, Kanazawa University,

4 Bristol-Myers Squibb K. K

Summary: The cementless prostheses used in the total hip replacement (THR) have been predomi-
nantly developed in Western countries . Although many cementless prostheses developed in Western
have been applied to THR of Japanese osteoarthrosis (OA) patients, they have not been always fitted
to shape of Japanese OA femurs . Because they have been designed for the primary OA which is
general in Western but not the secondary OA. There are many cases of the secondary OA which has
large deformation offemoral head caused oflong-term subluxation in Japan . Unfitted prosthesis de-
sign gives a worse influence on its stability and stress distribution in proximal femur, and then it can
cause serious stress-shielding. To develop the prosthes is suitable for Japanes e OA, it is important to
consider their characteristic shape of proximal femur. In this study, three-dimensional models ofproximal
femur with the secondary OA were constructed by using computer aided design (CAD) based on
computed topographic (CT) images, and canal shapes of the femurs were geometrically classified by
comparing these models each other. We found that the secondary OA femurs were divided into three
groups . Three types of prosthetic stem were designed to fit the canal shape of the femur. Furthermore,
finite-element analyses were carried out for the OA femurs with the fitted or unfitted stem. Stress
distribution of each femur type with fitted stem was almost same in spite of shape differences, but
particular stress concentration and reduction were found in the case of femur with unfitted stem. From
the results, effectiveness of the prosthetic stem designs based on propo sed classification is ensured.

Key words: Orthopaedics, Total Hip Prosthesis, Secondary Osteoarthrosis, Computer Aided Design,
Finite Element Analysis

INTRODUCTION
Total hip replacement is indispensable treatment to keep walking ability of severe osteoarthrosis pa-
tients . Development of the surgery technique and design technology of the total hip prosthesis has
provided much contribution for life support of human . The cementless prosthesis is effective to keep
it good connection with bone and to use in long life span, because the prosthetic stem connects with
bone directly. Matching the prosthesis stem shape with canal shape of proximal femur is very impor-
tant factor to establish its long term fixation. So that, a prosthetic stem which is fitted to canal shape of
patient must be used as much as possible. The femoral canal shapes of Japanese OA patients are not
same as Western OA patients because of differences of body size and life style. There are many cases
of the secondary OA in Japan , which has large deformation of femoral head as shown in figure I,
caused oflong-terrn subluxation . Many cementless prostheses produced in Western have been applied
to THR of Japanese OA patients, because operation technique ofTHR has been originally developed
in Western countries. However, they have not been always fitted to shape and size of Japanese OA
femurs. Unfitted prosthesis design gives a worse influence on its stability and stress distribution in
proximal femur, and then it can cause serious stress shielding [I]. To develop the prosthesis suitable

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

249
© Springer Japan 2000
250 J. Sakamoto et al.

for Japanese OA, it is important to consider their characteristic shape

of proximal femur.
Characterization of femoral canal shape of the secondary OA is con-
siderably difficult, because it is not clear what quantities are better
to characterize the three-dimensional canal shape. Furthermore, the
canal shape varies widel y depending on the OA symptoms. CAD
modeling of the femur is very useful to analyze its special feature .
Once the CAD models were created, it was easy to extract quantities
which represented the femur feature from the model. Measurement
of the three-dimensional femur shape is also possible by using CAD
system . Individual femur models of each OA patient can be con-
structed from CT images by image processing technique. A large
number of three-dimensional models of proximal femur with the
secondary OA were constructed by using CAD based on CT images
Fig.! An X-rayimageof hipjoint in this study. Then , canal shapes of the femurs were geometrically
with secondaryosteoarthrosis. classified by comparing these models each other. Shape designs of
the cementless prosthetic stems were determined due to the classifi-
cation. Total hip prosthetic models, in which the stem was inserted to the OA femur model , were
created for several typical cases to estimate geometrical fitness. Furthermore , finite-element analyses
were carried out for the total hip prosthetic models. Stress distributions around proximal femur were
evaluated for the models which had fitted or unfitted prosthetic stem , and effectiveness of the stem
shape designs was discussed .

CLASSIFICATION OF CANAL SHAPE OF THE SECONDARY

OSTEOARTHROSIS FEMUR

Morphological measurement technique of femur has been proposed to determine particular feature of
Japanese secondary OA by some of the authors [2]. In proposed technique , at first, outlines of external
and internal surface of femur were extracted from X-ray CT photograph s by using image processing
software (MedVision, Evergreen Technologies Inc.). Data of the outline s were obtained at intervals of
6mm and saved as universal CAD format. Three-dimensional (3-D) solid model was constructed
based on the outlines by using engineering CAD software (Unigraphics, Unigraphic s Inc.). A bone
axis was defined as a line through around centroids
of femur cross sections in each CT plane by using the
least square method. Coordinate system of femur was
considered based on the bone axis. The base-plane of
the solid model was defined at level of lesser tro-
chanter which was most protrusive point to outside. J~- ~\ -- )1
It was perpendicular to the bone axis . Definition of
the bone axis and the base-plane made it possible to L _J Lavelol
lesser trochanter
_ ~
compare geometric shapes of different femurs each
• Straighten CBllBl/ine
other independent of CT scan direction. 3-D solid
models were created for 113 secondary OA femurs ",-:---;,'<
"":""_ 1 Axis 01 bone _ >,
and 36 normal femurs to contrast.
Because our object was to obtain shape design of the
9.\ ~i· ~oxi=1 _ ~ ~
prosthetic stems suited to OA femurs, proximal canal
shape was focused here. The canal shapes were mea- Distal
sured in frontal plane , which was defined by center
point of femoral head and bone axis, and in side plane
(a) frorital plane (b) side"plane
which was perpendicular to the frontal plane pas s
trough the bone axis . Figure 2 show the frontal and Fig.2 Definition of Om and Op denote the angle of
side plane for measurement. Femur canal lines in this medial and posteriorline. The parameters are used
plane were linearized between the lesser trochanter to classify the canal shapes of femurs
Total Hip Prosthesis for Secondary Osteoarthrosis Patients 251

level and 15mm up of it, and then inclination

angles of the canal lines were measured. The
angles of medial line in frontal plane and poste-
rior line in side plane were used to classify canal
shape, because the parameters seem to represent
wide variety of femoral shape of the secondary
OA . Om and Op denote the angle of medial and
posterior line respectively. When Omwas larger
than or equal to 22 degree, the femur was deter-
mined as type A. Other femur was classified into
type B. Type I or II was defined as Op was lass
than -12 degree or not. These critical values were
determined by considering the frequency distri- Fig.3Classification of canalshapesof proximal femurs
bution versus these parameters [3]. All of mea- and the percentage of each type in the total (OA:
sured femurs were classified into 4 types as AI, Osteoarthrosis, N: Normal)
All, BI and BII. The percentage of each type to all femurs is shown in figure 3. Almost 90% of normal
femurs belonged to the type All , so that it was considered as standard type. Almost all of OA femurs
were classified into three types as AI, All and BII. 42% of the OA femurs have similar canal shape
with normal femur (type All), 26% of them have large angle of canal line in posterior side (type AI),
and 29% of them have small angle of canal line in medial side (type BII). The ratio of the type BI is
negligible in both of normal and OA cases. It was ensured that dispersion of the femoral canal shapes
in the secondary OA was larger than the case of normal femur. Deep angle of the posterior canal line
(type AI) or shallow angle of the medial canal line seems to characterize the femoral shape of the
secondary OA.

FINITE ELEMENT ANALYSIS AND THE RESULTS

Analysis Models. Three types of the prosthetic stem corresponding to three types of the femoral
canal shape were designed by CAD. These stems were designed based on existing stem designs (e.g.
Anatomic Hip System, Bristol-Myers Squibb Co.). Existing stem designs were modified to fit the
surface of the stem for femoral canal shape without direct contact as much as possible . Diameter of
distal end which was one of important reference of stem design was set as same for all types . aI, a2
and b2 denote the types of stem design corresponded to femur types AI, All and BII. Total hip prosthe-
sis models were created as stem models were inserted into canal of OA femur models. A representative
model of femur was selected from each group ofAI, All and BII, to make the total prosthesis models.
The minimum internal Diameters of femoral canal in distal side were same in the three models. Cut-
ting proximal side of the femur and arrangement of the stem were carried out accord ing to practical
operation ofTHR. The model AI-al , AII-a2 and BII-b2 denote the total prosthesis models which have
fit stem. These models are shown in figure 4. To evaluate the influence of unfit stem with canal shape,

(a) ModelAll-a2 (42%) (b) ModelAI-aI (26%) (c) ModelBII-b2 (29%)

Fig.4 Typical three types of solid modelsin CAD for the secondaryOAfemurs with fittedtotal hip stems
252 J. Sakamoto et al.

the model AI-a2 and BII-a2 were also considered. These

models were corresponded to the situation that standard
type stem (a2) was attached to special case of the second-
ary OA (AI or BII) . There were overlap area between the
prosthetic stem and cortical bone of femur in the unfit stem
models. The overlap areas are shown in figure 5. Finite
element models were constructed for three fit stem models
and two unfit stem models, and then stress analyses were
carried out. Finite element meshing was executed by FEM
pre-post software (PATRAN, MSC), and finite element
analyses were carried out by ANSYS (ANSYS Inc.).
Analysis Conditions. A finite element model of Al-a l
(a) Case AI-a2 (b) Case BII-a2 and its boundary condition is shown in figure 6. Number
Fig.SThe a2 type stemsand their overlap of nodes and elements in this model were 2569 and 8548
area with cortical bone while using for respectively. Isotropic and homogeneous materials were as-
unfittedcanal shapes(anteriorview). sumed for cortical and cancellous bone in which Young's
modulus were given as 7GPa and IGPa and Poisson's ratio
were given as 0.25 and 0.3 respectively [4]. Material of the
13'
1500N \ prosthetic stem was determined as titanium alloy (Ti-6Al-
4V) that Young's modulus and Poisson's ratio were given
as 126GPa and 0.27. Proximal region is coated by porous
medium in the cementless prosthetic stem. It is expected
z. 125
z_106
proxtimal that the prosthetic stem is anchored to femoral bone di-
(Les ser UocNntet) rectly caused by bone in-growth into the porous coating
after long-term from the THR operation. Therefore, the in-
terface condition between porous coating area of stem and
cancellous bone was assumed as rigid connection in the
Distal
z. O analyses. The porous coating area was define between bot-
(DistaJtip tom of stem neck and 65mm up from distal end of stem .
01prosthesis)
No contact condition was considered in distal region under
the porous coating area . Static loading condition was con-
Medial side <E- sidered as standing on one leg. 1.5KN load applied to tip
Fig.6 A finite element model of the OA of the stem head in downward direction, and I KN load
femur with prosthetic stem (AI-a!) applied at lateral tip of greater trochanter in upward direc-
tion. Distal end of the femur model was fixed.
Results. Mises stress distributions in the frontal plane are shown in figure 7. Figure 8 shows Mises
stress distributions of cortical and cancellous bone along longitudinal direction in medial side, for the
fit stem models (AI-a I , AII-a2 and BII-b2). The cortical stresses were taken from border with cancel-
lous bone, and the cancellous stresses were taken from border with the stem. z means distance from
distal tip of the prosthesis. Stress distribution patterns of the fit stem models in frontal plane were
similar each other. Stress distributions of these models in medial side were almost same except for
cancellous stress ofAl-al in distal region. It was caused of thick cancellous layer between cortical and
stem surface in this model. Mises stress distributions of medial side in longitudinal direction compar-
ing fit and unfit stem models are shown in figure 9. Medial side stresses of the fit stem models took
higher values than the unfit stem models . It was obvious that stress concentration occurred at direct
connection part between cortical bone and the stem, and then stress was reduced in other part. In fact,
cortical bone stress of unfit stem model at direct connection part was about 1.5 times of the stress of fit
stem model at same point.

CONSIDERATION

Proximal femur shape of the primary OA seems to be not different to normal femur shape, because
femoral head surface is damaged without subluxation and dislocation of femoral joint in the primary
Total Hip Pro sthesis for Second ary Osteoarthrosis Patients 253

Fig.7 Mises stress distribution of the proximal femur with the prosthetic stem in
frontal plane.
50
50
....., ..... • A I -e t cortiul • A I ·a 1 cancelk)us
o A I .&2 Clncellous

.
• A I .• , cortical ,0, A I ·a I cancellous <tI 6 A I -82 cOrlica l
<tI
• A lI ·a2 ecrttcal o A 11 ·.2 canc elloos Q.
40 • B1l·b2 corUcal • B II ·b2 cancellous
Q.
~ c B1l·a2 c(orbcal o B11 ·&2 cancellous
:=: 40 • BlI ·b2 cortica' D B II · b2 cancellous ~
'" • III

'" •
....e
A ••
30
'"
....~
30 • •
• Vl A
Vl A
•I . '" 20
'"
01
20 Q)
Q)

'" •A • • ~'" •
A
~ 0
0

c: 10 0
o -.. c: 10
0
a 0
0 a '1, ~ .... >
> " ""
o ~'R~ IJl ~A ~A. " o
65 75 85 95 105 11 5 12 5 65 75 85 95 105 115 125
z [m m] z[mm ]
Fig.S Mises stress distribution of the proximal femur Fig.9 Comparison of Mises stresses of the proximal
with fit prosthetic stem in medial side. femur with fit and unfit prosthetic stem in medial side.
254 J. Sakamoto et al.

OA. 42% of the secondary OA femur have same feature with normal femur due to our classification.
The prosthetic stems developed for the primary OA cover nearly 40% of the secondary OA (type All),
but they can not be adapted to the others (type AI and BIl) that account for 60% of all. Therefore,
shape design of the stems fitting for the special canal shapes must be necessary .
It was reported that influence of femoral shape to bone stress distribution around the prosthetic stem
was not so large, by Taylor et al [5]. Stress distributions of proximal femur were same in the fit stem
models (AI-a I, AIl-a2 and BIl-b2) analyzed in this study, in spite of both differences offemoral canal
shape and stem shape . Although the canal shapes and the stem shapes of these models are not same
each other, geometric relation between the stem and the canal surface seems to be similar in these
models. Therefore, if femoral canal shape was not normal in the secondary OA, moderate stress con-
dition could be kept by using the stem which was designed to fit the special canal shape. On the other
hand, particular stress concentration and stress reduction were occurred when the standard type stem
(a2) was used to OA femurs with special canal shape (AI and BII) because of the direct connection
with cortical bone. Stress reductions around proximal femur make the risk of stress shielding higher
[I] . In according to the geometrical and mechanical reasons, it is necessary to make the prosthetic
stem design considering special feature of femoral shape in the secondary OA.

CONCLUSION

In this study, three-dimensional CAD models of proximal femur with the secondary OA were con-
structed based on CT images, and canal shapes of the femurs were geometrically classified by com-
paring these models. We found that the secondary OA femurs were classified into three groups. Three
types of prosthetic stem were designed to fit the canal shape of the femur. Finite-element analyses
were carried out for the OA femurs with the fitted or unfitted stem. Following results were obtained ;

(I) Stress distribution of each femur type with fitted stem was almost same in spite of shape differ-
ences . Fitting stem design to the canal shape is effective to keep the stress condition moderate .
(2) Particular stress concentration and reduction were found in the case offemur with unfitted stem.
Stress reductions around proximal cancellous bone make a risk of stress shielding higher.

From these results, effectiveness of the prosthetic stem designs based on proposed classification is
ensured .

ACKNOWLEDGMENT

Ms. Kyoko Onishi and Mr. Kanji Tozaki, Bristol-Myers Squibb K. K, contribute to this research. A
part of the research was supported by SRF of Ministry of Education of Japan, Basic Research (A) (2)
(General) 1998.

REFERENCES

[I] D. Kelsey, S. B. Goodman, Design of the femoral component for cementless hip replacement: the
surgeon's perspective, American Journal ofOrthopaedics, VoI.26-6, 1997, pp.407-412.
[2] T. Miura, T. Matsumoto, M. Nishino, A. Kaneuji, K. Tomita, J. Oda, J. Sakamoto, Morphological
Measurement Technique of Femur and its Application for Japanese Patients with Osteoarthrosis of
Hip, Proc. 3rd World Congress ofBiomechanics, 1998, pp.390.
[3] A. Kaneuji, T. Matsumoto, M. Nishino, T. Miura, T. Sugimori, K. Tomita, J. Oda, J. Sakamoto, M.
Fujita, Three-dimensional Morphological Analysis of Femoral Canal in Japanese Patients with
Osteoarthrosis ofthe Hip Joint, Hip Joint, Vo1.25, 1999, pp.343-348. (in Japanese)
[4] H. Abe, K. Hayashi , M. Sato (Eds.), Data Book on Mechanical Properties ofLiving Cell, Tissues
and Organs , Springer-Verlag, Tokyo, 1996
[5] M. Taylor, E. W. Abel, Finite element analysis of poor distal contact of the femoral component of
a cementless hip endoprosthesis, Proc. Inst. Mech. Eng., Vo1.207, 1993, pp.255-26I
Mechanical Functions of Human ACL Bundles:
Development and Application of a Robotic Knee Simulator
Hiromichi Fujie1 , Tatsuo Mae", Takeshi Sekito", and Konsei Shino/

1 Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka 560-8531, Japan
20saka University Medical School, Suita, Osaka 565-0871, Japan
"Toyota Motor Co ., Toyota, Aichi 471-8572, Japan

Summary: A novel and unique 6-degree of freedom (OOF) robotic simulator, consisting of a 1-
OOF translational axis and serially linked 5-00Faxes, was designed and developed for the study of
knee joint biomechanics. The position accuracy of the simulator was found to be high; error in
displacement was less than 120 urn under the application of 500 N. The simulator was capable of
applying combined loadings to the knee for simulating the quasi-static, physiological condition of
the knee. The simulator was successfully applied to determine forces in the anteromedial (AM) and
posterolateral (PL) bundles of the human anterior cruciate ligament (ACL) in response to externally
applied loads to the knee. A reciprocal function of ACL bundles in response to anterior force was
found; the PL bundle carried larger force than the AM bundle at flexion angles less than 30 degrees,
while the converse was true at flexion angles larger than 30 degrees. We also found that the AM
bundle always carried larger force than the PL bundle in response to varus and valgus moments at 0,
15, and 30 degrees of flexion. These data are important for better understanding the mechanical
function of the ACL and improving the ACL reconstruction technique .

Keywords: Anterior cruciate ligament (ACL), Anteromedial (AM) and posterolateral (PL)
bundles, Robotic simulator, Mechanical function , Universal force moment sensor (UFS)

INTRODUCTION
The anterior cruciate ligament (ACL) is one of the most important structure in the knee joint,
although it is frequently injured (1]. Since conservative treatments do not allow injured ACL to
heal, the restoration of knee function relies on surgical reconstruction treatments. However ,
current reconstruction treatments neither reproduce normal knee kinematics nor fully restore the
functions of the ACL. For more successful clinical results, it is required to know the detailed
function of the normal ACL. In an early study, Girgis et al. [2] indicated that the ACL has a
complex anatomy and can be divided into two different bundles . Amis and Dawkins [3] found that
the anteromedial (AM) and posterolateral (PL) bundles of the ACL contributed almost equally to the
anterior restraints at 20 degrees of flexion, and that the AM bundle contributed the most at 90
degrees of flexion, respectively, although they could not determine the force in the ACL bundles.
Recently, Takai et al. [4] used a kinematic linkage and found that the anterior and posterior bundles
of the ACL carried equal amounts of load at 0 degree of flexion, and the anterior bundle carried the
majority of the ACL force at 30 degree or greater angles of flexion. Livesay et al. [5] applied the
universal force-moment sensor (UFS) methodology [6], and found that the posterior section of the
AM bundle carried larger force than the anterior section of the AM bundle while the PL bundle
carried little force, in response to anterior force to the knee. However , in these studies [4,5], the
knee motion was strictly limited in one direction; therefore, their results might have included errors
caused by constraining joint motion .

Fujie et al. [7] have developed a robotic system to simulate a physiological situation of a biological
joint with 6-DOF. Based on a mathematical description [8], a commercially available 6-DOF
manipulator controlled the mechanical condition of cadaveric knee joints with respect to a clinical
joint coordinate system [9]. Fujie [10] combined the robotic and UFS methodologies to determine
the functions of knee structures . Sakane et al. [11] applied the combined methodology to
determining the functions of ACL bundles. They found that the AM bundle carried larger force

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 255
256 H. Fujie et al.

than the PL bundle in s maller flexion angles and the converse was true at larger flexion angl es, in
response to anterior drawer force to the knee. Although the robo tic methodology provided cru cial
data regarding ACL bundle functio ns, seve ral problems remained. First, the previously-used
manipulators were articu lated typ es w hich w ere o riginally des ign ed for indu strial usage to achieve
high speed of motion w hile perfor ming tasks in a large wo rk space, although precise and steady
control in a relatively small work space is requir ed for biomechanical experiments evaluating knee
ligament function. Second, limitations in the hard ware and so ftware for the control of these
manipulators have also been problematic. Th erefor e, in the present study, we have design ed and
develop ed a novel robo tic simulator, cons isting of a uniqu e manipulator, for the analysis of knee
ligament function. Th e simulator was applied to determining forces in ACL bundles in respon se to
translation al and rotational loadin gs to the kn ee, for better understanding the mechanical function of
the ACL.

INSTRUMENTATION
Robotic simulator. A robo tic simulator,
con sisting of a 6-00F manipulator , servo -motor . / Trans. Z aJlis
'I Trans. X ax IS
controllers, and a control computer, w as designed
~ ROl. axlS l
and developed [12]. The manipulator has two
different movable mechani sms (F ig. 1): a) the first
Upper
mechanism was connected to a fixation clamp for the mechansm
tibia via a un iversal force/mom ent senso r (UFS)
(UFS-45A50-U 7601N, JR 3 , Woodland , USA) and
cons ists of 2 translational and 3 rotatio nal axes in
series ; b) the seco nd mechan ism has one trans lational
axis and was connected to a fixation clamp for the
femur. All axes are driven w ith AC se rvo -motors iOOnvn Trans. Y &xIS

(F HA-25 B-30 15-S248C, BS248C, Harmon ic Drive Fig. 1: Six degrees of freedom knee joint
Sy stems, Tokyo, Japan, and SG MP-OIA312, simulator.
SG MP-04A3 168, Yas ukawa, T o kyo, Ja pa n). Th e
manipulator has a un ique config uration : the 3 translation axes are orthogonal to each other w hile the
3 rotation axes always cross at a sing le point dur ing motion of the manipulator.

After the femoral and tibial coo rdinate s ystems are fixed to the femur and tibia using location s of
tibial inse rtion s ites of the med ial and lateral collateral ligaments [13], the knee joint coordinate
sys tem,' orig inally developed by Grood and Suntay [9], is connected to both coord inate sys tems .
Manipul ator displacements measured fro m the photoencoders in all axes are transform ed to joint
displacement using invers e kinematics. Jo int differential displacement, d 8 calculated from the
difference between joint displ acement, and prescrib ed jo int displacement, is trans formed to
manipul ator differential displacem ents, md.<1, using Equation (1 ),

(1)

wh ere J represents a Jacobian relating the motion at the joint coordinate sys tem to manipulator
motion . Equation (1) allow s the manipul ator to act in position-cont rol of the knee. To control the
forces and moments at the knee, (6x l) the force- moment vector SF measur ed by the UFS is
transform ed to F w ith respect to the joint coordinate sys tem us ing another Jacob ian. A difference
betw een the prescribed forces and momen ts F p , and the curre nt forces and moments F , both
described with resp ect to the knee jo int coordina te system, is calculated and then transformed to a
differential displacement vec tor, d (J using an adequate compliance matrix R , as follo ws,

(2)

Equations ( 1) and (3) enables the sim ulator to con trol the forces and moments applied to the knee.
To perfo rm an A-P trans lation test, for examp le, A-P translation is placed under pos ition contro l at a
Mechanical Functions of Human ACL Bundles 257

constant speed and the flexion-extension angle is held fixed, while the forces and moments in all
other ooFs operated in force control to allow natural motion of the joint. The vector md,1 is
calculated and all actuators are instructed to move by the amount of "d A. This procedure that
includes calculation of the next position of the manipulator as well as the motion of the manipulator
is repeated at a rate of 300-500 ms. Control and data acquisition are performed using a personal
computer in the C-Ianguage programming environm ent with a multi-tasking operating system (CP/Q,
IBM Japan, Kanagawa, Japan).

In order to assess the performance of the knee simulator , an error analysis was performed [13].
The relative displacement between the upper and lower mechanisms along each translational axis
was measured with a laser transducer (LB-Ol , Keyence , Osaka, Japan) when prescribed
displacements of 1, 2, 3, 5, and 10 mm were commanded under the application of 500 N to the
tibial clamp. A good correlation (r=0 .99) was found between the actual displacement and
prescribed displacement; the error was found to be less than 120 urn in the X-axis , 20!-tm in the Y-
axis, and 10 urn in the Z-axis. The clamp-to-clamp stiffne ss of the manipulator was found to be
312, 1035, and 963 N/mm along the X- , Yo, and Z-axes, respectively . Subsequently, a porcine
knee was dissected down to the joint capsule, and fixed to the femoral and tibial clamps. The joint
coordin ate system was then established at the knee using previously described digitizing protocol.
Immediately after the joint contact force of 125 N was applied to the knee, cyclic anterior and
posterior forces up to 100 N were applied at a rate of 0.1 mm/s while allowing natural motion of the
knee. The results confirmed that during application of the cyclic anterior-posterior load, the joint
contact force remained at 125 N while the lateral-medial force as well as varus-valgus and internal-

'+
external moments were maintained at zero (Fig. 2) .
200
~ _ _ ...-_..,... ._.--..~ force
Fig. 2: Temporal change in the anterior-posterior
(A-P), proximal-distal (P-D), and lateral-medial
~loo
E l\ 0 L-M force (L-M) forces during the application of A-P force
to a porcine knee up to :d OG N at a rate of 0.1
f1. rnm/s while controlling the PoD force to 125 N.
. 100 ~force
Anterior, proximal, and lateral forces are shown in
positive.
· 200 o~------------::-:
400 800
Ti me T (sec)

Force determination (UFS methodology). According to the UFS methodology [6], a line
of force applied to a rigid body is described by a vector p, as follows,
_~ 1 (3)
p - Ifl 2 + If I t
wheref and m are force and moment vectors measured by the UFS fixed to the rigid body, while t
is a parameter. When the knee joint experiences an external loading condition, the three
dimensional path of the knee motion as well as the force and moment vectors at the knee are
recorded . After transecting an ACL bundle, the path is reproduced . Finally, a difference in the
force and moment vectors before and after the transection was substituted into Equation (3) to
determine the force in the bundle under the principle of sup erposition.

EXPERIMENTAL METHOD
Eleven intact human knee joints were dissected down to their joint capsules . No ligamentous
injury or degenerative disease was found in the soft tissues and cartilage of the knees. After the
joint coordinate system was established at the knee, anterior force was applied to the knee (n=6) up
to 110 N at a rate of 0.7 rnm/s at 0, 15, 30, 60, and 90 degrees of flexion, allowing natural motion
of the joint. Using a technique by Livesay et al. [5], the AM and PL bundles were separated
longitud inally by a 45 degrees laterally rotated line to the anterior direction. The AM bundle was
258 H. Fujic ct al.

then transccted ncar its tibial insertion site, and the manipulator reproduced the identical path of the
intact knee motion, while measuring the 6-00F forces and moments to the knee from the UFS . In
the same way, after transecting the PL bundle, the manipulator reproduced the identical path of the
intact knee motion, while measuring the 6-00F forces and moments to the knee. The force in the
AM bundle was calculated from the difference between forces and moments in the intact state and
after the transection of the AM bundle. Similarly, the forces in the PL bundle and the entire ACL
were calculated. Sub sequently, varus and valgus moments were applied to the remaining knees
(n=5) up to 15 Nm at 0, 15, and 30 degrees of flexion. The forces in the AM and PL bundles and
in the entire ACL in respon se to varus and valgus moments were also determined using the above-
mentioned method. The paired t test was used to determine significant differences.

RESULTS

r/THpN
In response to 100 N of anterior force, the force in the entire 140 ~~~~~~o1~e~ PL(paired tlest)
ACL was increased with flexion angle between 0 and 30 120 L
degrees, and was decreased with flexion angle between 30 L L.. . . . r~~
and 90 degrees, indicating 90.0±1O.6 (rneaneSfs), ~100 l'
105.0±13.0, 113.O±10.6, 104.3±9.3, and 96.1±7.7 N at 0, IL 80
15, 30, 60 and 90 degrees of flexion, respectively (Fig. 3). ~ ~ M

A reciprocal function of ACL bundles was found; the force in .f :60: J: PL •

the AM bundle was increased with flexion angles from Y
44.0±9.6 N at 0 degree to 68.4±9.9 N at 90 degrees, while
the force in the PL bundle was decreased with flexion angles
from 49.6±7.9 N at 0 degree to 35.6±15.4 N at 90 degree. o 0 10 20 30 40 50 60 70 80 90 100
A significant difference in force between bundles was Flexion angle 8 (degrees)
demonstrated at 90 degree of flexion. In response to 15 Nm Fig. 3: Forces in the ACL and
of varus moment, the force in the entire ACL decreased with ACL bundles in response to 100 N
the flexion angle, indicating 41.6±18.1, 37.2±29.0, and of anterior force to the knee as a
17.9± 10.6 N at 0, 15, and 30 degrees of flexion, respectively function of flexion angle.
(Fig . 4). The forces in both bundles also decreased with the
flexion angle; the force in the AM bundle was 28.8±18.3, 25.9±23.4 and 14.3±9.3 Nat 0, 15, and
30 degrees of flexion, respectively, while the force in the PL bundle was 17.2±13.8, 13.1±12.5
and 7.0±3.4 N at 0, 15, and 30 degrees of flexion, respectively. In response to 15 Nm of valgus
moment, the forces in the ACL and its bundles indicated a different trend as compared to those in
response to varus moment (Fig. 5). The forces in the entire ACL and the AM bundle hit bottom at
15 degrees of flexion, indicating 35.0±29.7, 21.4±9.6, and 26.5±20.6 N in the ACL, and
26.0±19.0, 14.5±6.4 and 19.6±11.0 N in the AM bundle at 0, 15, and 30 degrees of flexion,
respectively. By contrast, the force in the PL bundle slightly increased with the flexion angle,
indicating 6.1±2 .5, 8.0±6.1 and 13.4±15.6 Nat 0, 15, and 30 degrees of flexion, respectively. A
significant difference in force between bundles was demonstrated at 15 degree of flexion.
70
Mean.SO (n=5) 70 Mean.SO (n=5)
• P<0.05 AM vs PL (pairedt test)
60 60
~50
~50
~ Z

~---, ~ 40
IL 40
III

~
III
~ 30 l- ~ 30
u,
20
.f 20
10
t-- PL
10

O'-------'--_......L_ _
o 10 20 30 40 o 10 20 30 40
Flexion angle 8 (degrees) Flexion angle 8 (degrees)
Fig. 4: Forces in the ACL and ACL bundles Fig. 5: Forces in the ACL and ACL bundles
in response to 15 Nm of varus moment to in response to 15 Nm of valgus moment to
the knee as a function of flexion angle. the kneeas a function of flexion angle.
Mechanical Functions of Human ACL Bundles 259

DISCUSSION
We have designed and developed a new robotic knee simulator with a unique configuration that has
two benefits. First, the use of the three translational axes arranged in an orthogonal configuration
provides a reasonable clamp-to-clamp stiffness . The maximum displacement error associated with
our manipulator under the application of 500 N was 120 urn in the X-direction, but only 10-20 urn
in the Y- and Z-directions. Loads applied along the Y- and Z-directions are usually larger
compared with those in the X-direction of the manipulator because the Y- and Z-directions roughly
corresponded to the proximal-distal and anterior-posterior directions of the knee. The
configuration also leads to a simpler treatment of the kinematic description of the manipulator as
compared to articulated manipulators. Another benefit of the simulator is that the C-prograrnming
language is used in the control program on an operating system capable of performing multiple tasks
simultaneously . These benefits, as a result, allows for a smooth and precise control of the motion,
and force and moment of the knee. Through a sequential section of soft tissues with the simulator,
it was possible to determine forces in ACL bundles under extemally applied loads. It should be
noted that the measurement was based on an assumption that an interaction between transected ACL
bundles as well as a deformation within the femur and tibia were negligible. Fortunately, no
mechanical interaction between ACL bundles was found [5], and the bone is stiffer than soft tissues
[3]. It also should be noted that the calculation of forces in bundles was based on an assumption
that the force in each bundle can be represented by a single resultant force.

A reciprocal function of ACL bundles in response to anterior force was confirmed; the PL bundle
carried larger force than the PL bundle at smaller flexion angles while the converse was true at larger
flexion angles, as qualitatively described by Girgis et al. [2], and quantitatively determined by Fujie
[10] and Sakane et al. [11]. This unique function of the ACL may suggest that, at flexion angles
of less than 30 degrees, the PL bundle plays an important role to prepare for avoiding
hyperextension of the knee maintaining the anterior knee stability; however, at flexion angles of
more than 30 degrees, the AM bundle plays an important role in maintaining the anterior knee
stability in the range of knee motion. Thirty degree of flexion is a boundary situation of tightening
and slackening for both the AM and PL bundles in response to anterior force, placing the force in
the ACL nearly uniform . The force distribution in the ACL in response to rotational loadings has
not been fully determined previously owing to a difficulty in the experimental set-up, although it has
been successfully performed by our robotic simulator in the present study . In response to varus
and valgus moments, the mechanical function of the AM bundle was always more important than
that of the PL bundle, which was against a morphological observation that the fiber orientation of
the PL bundle is better for resisting varus and valgus moments as compared to that of the AM
bundle . So far, we could not give an explanation for this discrepancy. Although Sakane et al.
[11] emphasized on the importance of the PL bundle in response to anterior force, it should be noted
that the AM bundle is also important, in particular for resisting varus and valgus moments, which
probably become very large in daily activities. Our data further suggest that the traditional ACL
reconstruction using a single bundle structure is not the most adequate and that the bi-socket ACL
reconstruction using multiple bundle structures, for example reported by Mae et al. [14], is required
for emulating the natural ACL function.

CONCLUSION
In conclusion, a knee joint simulator, designed and developed in the present study, is capable of
performing biomechanical tests of human knee joints . The AM and PL bundles of the human ACL
have a reciprocal function in response to anterior force to the knee, while the function of the AM
bundle is more significant than that of the PL bundle in response to varus valgus moment to the knee.
These data are important for better understanding the mechanical function of the ACL and improving
the surgical technique of ligament reconstruction.
260 H. Fujie et al.

REFERENCES
[1] K.C. Miyasaka, D.M. Daniel, M.L. Stone , P. Hirshman, The Incidence of Knee Ligament
Injuries in the General Population, American Journal of Knee Surgery, Vol. 4, 1991 , pp. 3-8.
[2] F.G . Girgis , J.L. Marshall, AR.S . AI Monajem, The Cruciate Ligaments of the Knee Joint:
Anatomical, Functional and Experimental Analysis . Clinical Orthopaedics, Vol. 106, 1975, pp.
216-231.
[3] AA Arnis, and G.P .c. Dawkins, Functional Anatomy of the Anterior Cruciate Ligament:
Fibre Bundle Actions Related to Ligament Replacements and Injuries . Journal of Bone and
Joint Surgery , Vol. 73(Br), 1991, pp . 260-267.
[4] S . Takai, S.L-Y. Woo, G.A Livesay , D.J . Adams , F.H. Fu , Determination of the In-Situ
Loads on the Human Anterior Cruciate Ligament, Journal of Orthopaedic Research, Vol. 11,
1993, pp . 686 -695 .
[5] G.A Livesay, H. Fujie, S. Kashiwaguchi, M.A Duane, F.H. Fu, S.L-Y. Woo,
Determination of the In-Situ Forces and Force Distribution within the Human Anterior Cruciate
Ligament, Annals of Biomedical Engineering, Vol. 23, 1995 , pp. 467-474.
[6] H. Fujie, G.A Livesay, S.L-Y. Woo , S. Kashiwaguchi, G. Blomstrom, The Use of a
Universal Force-Moment Sensor to Determine In-Situ Forces in Ligaments : A New
Methodology, Journal of Biomechanical Engineering, Vol. 117, 1995 , pp . 1-7 .
[7] H. Fujie, K. Mabuchi, S.L-Y. Woo, G.A Livesay, S. Arai, Y. Tsukamoto, The Use of
Robotics Technology to Study Human Joint Kinematics: A New Methodology, Journal of
Biomechanical Engineering, Vol. 115 , 1993, pp. 211-217.
[8] E.S . Grood, W.J . Suntay, A Joint Coordinate System for the Clinical Description of Three-
Dimensional Motions : Application to the Knee, Journal of Biomechanical Engineering, Vol.
105 ,1983, pp . 136-144.
[9] H. Fujie, G.A Livesay, M. Fujita, S.L-Y. Woo, Forces and Moments in Six-DOF at the
Human Knee Joint: Mathematical Description for Control, Journal of Biomechanics, Vol. 29,
1996, pp. 1577-1585.
[10] H. Fujie, Biomechanical Study on the Force in the Human Anterior Cruciate Ligament, Ph.D.
Thesis, Kyoto University (in Japanese), 1994 .
[11] M. Sakane, R.J. Fox , S. L-Y. Woo, G .A Livesay, G. Li, F.H. Fu , In Situ Forces in the
Anterior Cruciate Ligament and its Bundles in Response to Anterior Tibial Loads. Journal of
Orthopaedic Research, Vol. 15, 1997, pp . 285-293.
(12] T. Sekito , H. Fujie, Y. Ota, K. Hayashi , Development of a Novel Robotic Simulator for the
Analysis of Knee Joint Mechanical Function, Proceedings of the 1997 Bioengineering
Conference (ASME) , 1997 , pp. 393-394.
[13] T. Sekito, Biomechanical Study on Mechanical Functions of the Human Anterior Cruciate
Ligament and Menisci, MS. Thesis, Osaka University (in Japanese), 1999 .
[14] T. Mae, K. Shino, H. Fujie, T. Sekito, M. Hamada, K. Nakata , A Maeda, N. Nakamura, S .
Horibe, T. Ochi, Analysis of the Restored Knee Stability After ACL Reconstruction Using
Autogenous Hamstring Tendon Grafts : Comparison Between Bi-Socket and Single-Socket
Technique, Abstract of the 14th Annual Orthopaedic Research Meeting of the Japanese
OrthopaedicAssociation (in Japanese), 1999, pp . 1910 .

ACKNOWLEDGMENTS
This study was supported by the Ministry of Education, Science, Sports and Culture, Japan , Grant-
In-Aid for Scientific Research (B) No. 09557123, and Grant-In-Aid for Encouragement of Young
Scientists No . 09780804 and 11780619.
Mechanical Properties of Impacted Human Morsellised
Cancellous Allografts for Revision Joint Arthroplasty
Yuji Tanabe', Hiroshi Maki', Takashi Meguro", Akio Kobayashi ', Hirotsugu Ohashi " Yoshinori
Kadoya ' and Yoshiki Yamane'

'Department of Mechanical Engineering, Faculty of Engineering, Niigata University, 8050

Ikarashi Ni-nocho, Niigata 950-2181, Japan
'Graduate School of Science and Technology, Niigata University, 8050 Ikarashi Ni-nocho, Niigata
950-2181, Japan
' Department of Orthopaedic Surgery, Osaka City University Medical School , 1-5-7 Asahi-machi,
Abeno-ku, Osaka 545-8585, Japan

Summary: This paper deals with the characterisation of mechanical properties of impacted
morsellised cancellous allograft ((MCA) produced by dynamic compaction of allograft femoral
heads ground by commercially available bone mills, i.e., rotating rasp, reciprocating blade and
comb blade type bone mills . Various range and profile of particle sizes in the graft aggregates
were obtained using these bone mills, and the effect of number of compaction as well as the
distribution of particle sizes on the mechanical properties of IMCA under quasi-statie compression
and shear loading conditions was discussed. The morsellised cancellous allograft prepared by the
reciprocating blade type bone mill showed a broad distribution of particle sizes, and gave IMCA
superior mechanical properties to the graft with a more uniform size distribution, or prepared by
the rotating rasp and comb blade type bone mills . The increase of number of compa ction also
improved the mechanical properties of IMCA in compression .

Key words: Revision joint arthroplasty, Morsellised cancellous allograft, Impaetion grafting,
Mechanical properties

INTRODUCTION

Revision total hip arthroplasty with massive femoral intramedullary bone loss is a challenge to
surgical reconstruction. A technique using impacted morselli sed cancellous allograft (IMCA) has
been developed for such deficient bone stock cases and some encouraging early results have been
clinically reported [1-3]. However, large early subsidence of the femoral stems probably due to
poor mechanical properties of IMCA was also reported [4]. In some recent studies IMCA was
considered to be particulate aggregates, and its mechanical behaviour was characterised with an
application of engineering soil mechanics [5, 6]. Thus, preparation of the morsellised allograft
could be one of the key factors to the success of revision surgery, but few studies on its optimum
preparation have been done so far. Hence, this paper deals with the determination of the
mechanical properties of severallMCA containing different range and profile of particle sizes, and
the objectives of this study can be explicitly stated as:
I. To determine the range and profile of particle sizes in graft aggregates, or [MCA produced by
dynamically compacting allograft femoral heads ground by currently available bone mills, and
2. To determine the mechanical properties of IMCA under quasi-static compression and shear with
respect to the range and profile of particle sizes, and the number of dynamic compaction.

J. Kajzer et al. (eds.), Human Biomechanics and Injury Prevention

© Springer Japan 2000 261
262 Y. Tanabe et al.

MATERIALS AND METHODS

Preparation of morsellised cancellous allograft. Human femoral heads were obtained from
patients with femoral neck fracture or osteoa rthrit is durin g total hip arthroplasties . Femoral heads
we re stored at -70°C unti l testing. Afte r removing soft tissue and cartilage, femora l heads were
eq ually cut into four pieces and divided into four grou ps at random to minimise heteroge neity
among femoral heads. Three types of bone mills, name ly, a rotating rasp type (Tracer Designs,
Z immer, Santa Paula, CA, USA), a reciproca ting blade type (Le re Bone Mill, Depuy, Warsaw, IN,
USA) and a comb blade type (Kyocera, Kyoto, Japan) were used for graft preparation. Three kinds
of rasps (designated fine, medium and coarse) were used in the rotat ing rasp type. Morse llised
bone was prepared using these five different bone mills (Fig . I).

Fig. I. Appearances of rotating

rasps and blades of bone mills
used in this study: (a) three kinds
of rasps (coarse, medium, fine
from left to right); (b) a
reciprocating blade; (c) a comb
blade.
(a) (b) (c)

Particle size determination. The distri bution of fragment sizes of morsellised bone for eac h bone
mi ll was calculated. To this end, a part of IMCA speci mens after 30 times compaction as
mentioned in the next section was washe d in ethanol, and then dried. Seven specially designed
sieves, i.e., plastic plates with drilled holes of diameter in a range of 2 to 8 mm at every I mm
were made to determi ne the size of the fragments. The sieves were used in order of dec reasing
hole dia mete r with the largest at the first. Approximately 500 milligrams of morseIIised bone take n
from one IMCA speci men were firstly placed on the sieve wit h the largest holes and then the sieve
was manua lly shake n until no furthe r passage of fragments down the gradie nt occ urred. The same
procedure was applied to the other sieves . The mass of particles remaining in each sieve was
measured , and the percentage of the graft in eac h sieve was ca lculated. That is, the mass
distribution of particles in the sieves was used to represent the distribut ion of particl e sizes in this
study .

Production of IM CA specimens by dynamic compaction. Cy lindrica l IMCA speci mens 10 mm

in diameter and 10 mm in length were made by a specially designed dynamic compaction
apparatus (Fig. 2). The apparatus consists of a striker bar, a force transmitter bar, a setting table
and reco rding equipment. Given quantities of the morsellised bone was filled in the hole in the
setti ng tab le and the force trans mitter bar was placed on it. An impinge ment of the striker bar on
the uppe r end of the force transmitte r bar generates compress ive stress pulse trave lling down the
force transmitter bar, and eve ntually, the morsell ised bone was dynamically loaded due to this
stress pulse. Based on the one-dimensional wave propagatio n theory the impact force (Fd appl ied
to the upper end of the bone at any time (1) can be eva luated by the followi ng equatio n [7].

Fe = A {aa(1+f /) + aa(1-1/) - 0b(1)} (I)

Impacted Human Morsellised Cancellous Allografts 263

where
G a , Gb = stress histories detected by strain gauges at the point a and b, respectively

A= cross-sectional area of the force transmitter bar

t I = time required for stress wave propagation from point a to b or from point b to a.
The magnitude of an impact force was chosen to be same as observed in another series of
experiments on simulated femoral impaction grafting [8], and controlled to be approximately 4.2
kN on the average in this study. The impact force was applied to the bone 15 times or 30 times to
investigate the effect of the number of compaction on the mechanical properties of IMCA.

Selli ng Ta ble

Fig. 2. Dynamic compaction

apparatus (left) and cylindrical
IMCA specimens produced
(right).

R ub ber
:'> In rse llised \la nd <j>10 mm X 10 mm
1I0n l'

Mechanical testing. Quasi-static uniaxial compression tests as well as quasi-static shear tests at
various normal compression loads were performed using an Instron type materials testing machine
(Autograph AG-25TD, Shimadzu Co. Ltd., Japan). The IMCA specimens were tested without
lateral constraint in the compression tests. Alternative shear testing apparatus to commercial one
used in the previous study [6] was newly made in this study . The IMCA specimen was sheared
under an application of normal load of 9.8, 19.6 or 29.4 N. Detail of these mechanical tests can be
found in our previous study [9]. All mechanical tests were performed at a constant deformat ion
rate (cross-head speed of 3 mm min-I) and at room temperature (20°C). All specimens were kept
moist during testing. Ten specimens were used for each test, and the results were statistically
compared in five groups of IMCA produced by the five different bone mills.

RESULTS AND DISCUSSION

Particle sizes in morselIised bone. Figure 3 shows physical appearances of bone fragments in
each graft group. The fragments prepared by rotating rasps (fine, medium and coarse groups) were
thin and slightly curled while irregular shapes were observed in the fragments prepared by
reciprocating blade (recipro group) and comb blade (CB group) . Distribution of particle sizes in
each group was obtained as shown in Fig. 4. Morsellised bone prepared by the reciprocating blade
contained larger bone fragments than those prepared by the rotating rasps and comb blade, and
clearly showed a broad size distribution as well.

Stress-strain behaviour of IMeA under compression. Nonlinear or downward convex

characteristics were found in nominal compressive stress-strain curves of all IMCA specimens
independent of the number of compaction . Stiffness in compression defined by the tangent
modulus at strain of 0.2 on the stress-strain curve was evaluated and obtained for each graft group
(Fig . 5). The stiffness appeared to increase with increasing number of compaction in each group.
264 Y. Tanabe et al.

In the case of 30 times co mpaction, IMCA prepared by the reci procating blade showed
significantly higher stiffness than those prepared by the rotati ng rasps and the comb blade.

Me ch an ical stre ng th of (M e A under shea r . Load -displacement curves of all IMCA speci mens
under quasi-static shear obtai ned in this study were upward co nvex . Shear stre ngt h defi ned as the
max imum shear stress on the curve was determined as a func tio n of axial co mpressive or norm al
stress (Fig. 6) . Since no effect of the nu mber of com paction on the relationship between shea r

00 .. . 'I !'I. ) 1) U n I

Fine Medium Coarse Fig, 3. Physical appearances of

morsellised bone fragments, as
prepared with five di fferent
:: .. '0 " t' IOC
bone mills.

CB Recipro

IoU

.~ ...
u

1 ...
c

i Fig. 4. Percentage mass distribution of

..,- ... particles for different bone mills.
~

.;u
211
::;

SitU' pore dia meter, rnm

I EJ ' .( .· · I ~

Fig. 5. Stiffness of IMCA in quasi-

static compression for each graft
group. Stiffness was evaluated at
strain of 0.2 on nominal stress-
strain curve.
Impacted Human Morsellised Cancellous Allografts 265

stre ngt h and norm al stress in eac h graft gro up was found, the result only for the number of
co mpact ion of 30 was show n in this study. Th e result of Fig . 6 can be formulated by the Mohr-
Co ulomb eq uation [10] give n as

TU = C + 0 c tan ep (2)

where
Til = shea r strength

0 c = norm al stress applied

c = co hesive force
ep = angle of shea ring resistanc e or angle of interna l friction.
Th e shea r strength paramet ers, c, ep and T lb of each group are listed in Ta ble I. IMCA prep ared by
the reci proca ting blade show ed significa ntly higher shea r strength than those prepared by the
rotat ing rasps and the comb blade.

- Fine
Medium
...' •A '... Coarse
II ,r.··,oI
~
I.~
................ i.___ .... ... ...... - -. · · CB
I _ _ ReoP<O
,,, . ....... .;. .... ................

]
~

{
.:
..
,
.c
.. .... .. _._._.~ :..
......... ..........
:
.... ~
.... .
:
....... ..... Fig. 6. Shear strength of lMCA
~ _ i ~[
plotted against normal compressive
~
~
~
.c o. ~ ...
. . ..
..... ~ ... ····:·.~··· ·i .: ....
stress.
Z
:.:: :. :. :. :.~ . ~' :':'. .:'; ~:: :- :."' -r ,

0.1 0 .2 003 0" o_~

~. p< O.OI

Table I. Shear strength parameters in Eq. (2) for IMCA specimens compacted 30
times in each graft group,
Cohesion (c) Angle of internal Average shear strength (Tu )
Group
(MPa) friction (t/J) (rad) (0.37 MPa normal stress)
Fine 0.34 0.38 0.49
Medium 0.22 0.46 0.37
Coarse 0.28 0.48 0.46
CB 0.58 0.37 0.8 1
Recipro 1.07 0.25 1.27

Th e result s of Figs . 5 and 6 ind icate that the mechani cal propert ies of IMCA were affected by the
preparation meth od of mor sell ised bone and the number of co mpaction. Th e size distribution and
the shape of bone part icles we re different among the five bon e mills used in this study. It was not
confirmed which factor mainly influence d the mechani cal properties of IMCA, but morsell ised
allog ra ft containing larger bone part icles and/o r broad er part icle size distr ibution seemed to bring
superior mechanical prop erti es to IMCA. Recentl y, some studies measured the imp lant stability in
vitro using human cadaver femora and IMCA with cemented co llarless polished tapered stem was
266 Y. Tanabe et al.

reported to prov ide initial stability of the stem [II, 12]. This study has revealed that IMCA
prepared by the reciprocating blade shows the highest stiffness as well as the largest shear
strength, and therefore could result in better success of the practical impaction femoral grafting.
The mechanical initial stability of the femoral stem in revision arthroplasty using IMCA should be
further discussed.

CONCLUSIONS

The broader range of particle size distribution in morsellised bone could contribute to the stronger
mechanical properties of IMCA. Thus it is important for revision surgery to select the proper bone
mill to obtain good initial stability.

REFERENCES

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Cancellous Allografts and Cement for Revision Total Hip Arthroplasty, The Journal of Bone
and Joint Surgery [Br], Vol. 75-B, 1993, pp . 14-21.
[2] R. G. H. H. Nelissen, T. W. Bauer, L. R. A. Weidenhielm, D. P. Legolvan, W. E. M. Mikhail,
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Bone and Joint Surgery, Vol. 77-A , 1995, pp. 4 I 2-422.
[3] L. R. A. Weidenhielm, W. E. M. Mikhail, R. G. H. H. Nelissen, T . W. Bauer, Cemented
Collarless (Exeter-CPT) versus Cementless Collarless (PCA) Femoral Components, The
Journal ofArthroplasty , Vol. 10, 1995, pp . 592-597.
[4] J. D. J. Eldridge, E. J. Smith, M . 1. Hubble, S. L. Whitehouse, I. D. Learmonth, Massive Early
Subsidence Following Femoral Impaction Grafting, The Journal of Arthroplasty, Vol. 12 ,
1997, pp. 535-540.
[5] M. D. Brodt, C. C. Swan, T. D. Brown, Mechanical Behavior of Human Morselzed Cancellous
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[6] N. T. Brewster, W. J. Gillespie, C. R. Howie, S. P. G. Madabhushi, A. S. Usami, D. R.
Fairbairn, Mechanical Considerations in Impaction Bone Grafting, The Journal of Bone and
Joint Surgery[Br], Vol. 81-B , 1999, pp. 118-124.
[7] N. Yanagihara, Transactions of the Japan Society fo r Mechanical Engineers, Vol. 43, 1977,
pp. 4048-4052 (in Japanese) .
[8] T. Wakui, Y. Tanabe, A. Kobayashi, H. Ohashi, Y. Kadoya, Y. Yamano, Mechanical
Properties of Impacted Cancellous Allograft, Transactions of the Japan Society 4 Clinical
Biomechanics and Related Research, Vol. 19, 1998, pp. 311-316 (in Japanese) .
[9] Y. Tanabe, T. Wakui , A. Kobayashi, H. Ohashi, Y. Kadoya, Y. Yamano, Determination of
Mechanical Properties of Impacted Human Morsellised Cancellous Allografts for Revision
Joint Arthroplasty, Journal of Materials Science: Materials in Medicine (in press) .
[10] R. F. Craig. Soil Mechanics: 5th Edition, Chapman & Hall, London, 1993.
[I I] A. L. Markani, M. 1. Voor, K. A. Fee, C. S. Bates, Femoral Component Revision Using
Impacted Morsellised Cancellous Graft, The Journal of Bone and Joint Surgery[Br] , Vol. 78-
B, 1996, pp. 973-978.
[12] A. Berzins, D. R. Sumner, R. C. Wasielewski, G. O. galante, Impacted Particulate Allograft
for Femoral Revision Total Hip Arthroplasty, The Journal of Arthroplasty, Vol. II , 1996 , pp.
500-506.