A cerebral palsy assessment tool using anatomically based geometries and free-form deformation

A Narrative Review of Personalized Musculoskeletal Modeling Using the Physiome and Musculoskeletal Atlas Projects

In this narrative review, we explore developments in the field of computational musculoskeletal model personalization using the Physiome and Musculoskeletal Atlas Projects. Model geometry personalization; statistical shape modeling; and its impact on segmentation, classification, and model creation are explored. Examples include the trapeziometacarpal and tibiofemoral joints, Achilles tendon, gastrocnemius muscle, and pediatric lower limb bones. Finally, a more general approach to model personalization is discussed based on the idea of multiscale personalization called scaffolds.

In silico assessment of biomedical products: The conundrum of rare but not so rare events in two case studies

In silico clinical trials, defined as "The use of individualized computer simulation in the development or regulatory evaluation of a medicinal product, medical device, or medical intervention," have been proposed as a possible strategy to reduce the regulatory costs of innovation and the time to market for biomedical products. We review some of the the literature on this topic, focusing in particular on those applications where the current practice is recognized as inadequate, as for example, the detection of unexpected severe adverse events too rare to be detected in a clinical trial, but still likely enough to be of concern. We then describe with more details two case studies, two successful applications of in silico clinical trial approaches, one relative to the University of Virginia/Padova simulator that the Food and Drug Administration has accepted as possible replacement for animal testing in the preclinical assessment of artificial pancreas technologies, and the second, an investigation of the probability of cardiac lead fracture, where a Bayesian network was used to combine in vivo and in silico observations, suggesting a whole new strategy of in silico-augmented clinical trials, to be used to increase the numerosity where recruitment is impossible, or to explore patients' phenotypes that are unlikely to appear in the trial cohort, but are still frequent enough to be of concern.

The Virtual Physiological Human: Ten Years After

Biomedical research and clinical practice are struggling to cope with the growing complexity that the progress of health care involves. The most challenging diseases, those with the largest socioeconomic impact (cardiovascular conditions; musculoskeletal conditions; cancer; metabolic, immunity, and neurodegenerative conditions), are all characterized by a complex genotype-phenotype interaction and by a "systemic" nature that poses a challenge to the traditional reductionist approach. In 2005 a small group of researchers discussed how the vision of computational physiology promoted by the Physiome Project could be translated into clinical practice and formally proposed the term Virtual Physiological Human. Our knowledge about these diseases is fragmentary, as it is associated with molecular and cellular processes on the one hand and with tissue and organ phenotype changes (related to clinical symptoms of disease conditions) on the other. The problem could be solved if we could capture all these fragments of knowledge into predictive models and then compose them into hypermodels that help us tame the complexity that such systemic behavior involves. In 2005 this was simply not possible-the necessary methods and technologies were not available. Now, 10 years later, it seems the right time to reflect on the original vision, the results achieved so far, and what remains to be done.

The convex wrapping algorithm: a method for identifying muscle paths using the underlying bone mesh

Associating musculoskeletal models to motion analysis data enables the determination of the muscular lengths, lengthening rates and moment arms of the muscles during the studied movement. Therefore, those models must be anatomically personalized and able to identify realistic muscular paths. Different kinds of algorithms exist to achieve this last issue, such as the wired models and the finite elements ones. After having studied the advantages and drawbacks of each one, we present the convex wrapping algorithm. Its purpose is to identify the shortest path from the origin to the insertion of a muscle wrapping over the underlying skeleton mesh while respecting possible non-sliding constraints. After the presentation of the algorithm, the results obtained are compared to a classically used wrapping surface algorithm (obstacle set method) by measuring the length and moment arm of the semitendinosus muscle during an asymptomatic gait. The convex wrapping algorithm gives an efficient and realistic way of identifying the muscular paths with respect to the underlying bones mesh without the need to define simplified geometric forms. It also enables the identification of the centroid path of the muscles if their thickness evolution function is known. All this presents a particular interest when studying populations presenting noticeable bone deformations, such as those observed in cerebral palsy or rheumatic pathologies.

Subject-specific modelling of lower limb muscles in children with cerebral palsy

BACKGROUND

Recent studies suggest that the architecture of spastic muscles in children with cerebral palsy is considerably altered; however, only little is known about the structural changes that occur other than in the gastrocnemius muscle. In the present study, Magnetic Resonance Imaging (MRI) and subject-specific modelling techniques were used to compare the lengths and volumes of six lower limb muscles between children with cerebral palsy and typically developing children.

METHODS

MRI scans of the lower limbs of two children with spastic hemiplegia cerebral palsy, four children with spastic diplegia cerebral palsy (mean age 9.6 years) and a group of typically developing children (mean age 10.2 years) were acquired. Subject-specific models of six lower limb muscles were developed from the MRI data using a technique called Face Fitting. Muscle volumes and muscle lengths were derived from the models and normalised to body mass and segmental lengths, respectively.

FINDINGS

Normalised muscle volumes in the children with cerebral palsy were smaller than in the control group with the difference being 22% in the calf muscles, 26% in the hamstrings and 22% in the quadriceps, respectively. Only the differences in the hamstrings and the quadriceps were statistically significant (P=0.036, P=0.038). Normalised muscle lengths in the children with cerebral palsy were significantly shorter (P<0.05), except for soleus and biceps femoris. No significant relationship was found between normalised lengths and volumes of any muscle in either group.

INTERPRETATION

The present results show that lower limb muscles in ambulatory children with cerebral palsy are significantly altered, suggesting an overall mechanical deficit due to predominant muscle atrophy. Further investigations of the underlying causes of the muscle atrophy are required to better define management and treatment strategies for children with cerebral palsy.

Morphing methods to parameterize specimen-specific finite element model geometries

Shape plays an important role in determining the biomechanical response of a structure. Specimen-specific finite element (FE) models have been developed to capture the details of the shape of biological structures and predict their biomechanics. Shape, however, can vary considerably across individuals or change due to aging or disease, and analysis of the sensitivity of specimen-specific models to these variations has proven challenging. An alternative to specimen-specific representation has been to develop generic models with simplified geometries whose shape is relatively easy to parameterize, and can therefore be readily used in sensitivity studies. Despite many successful applications, generic models are limited in that they cannot make predictions for individual specimens. We propose that it is possible to harness the detail available in specimen-specific models while leveraging the power of the parameterization techniques common in generic models. In this work we show that this can be accomplished by using morphing techniques to parameterize the geometry of specimen-specific FE models such that the model shape can be varied in a controlled and systematic way suitable for sensitivity analysis. We demonstrate three morphing techniques by using them on a model of the load-bearing tissues of the posterior pole of the eye. We show that using relatively straightforward procedures these morphing techniques can be combined, which allows the study of factor interactions. Finally, we illustrate that the techniques can be used in other systems by applying them to morph a femur. Morphing techniques provide an exciting new possibility for the analysis of the biomechanical role of shape, independently or in interaction with loading and material properties.

Mesh morphing and response surface analysis: quantifying sensitivity of vertebral mechanical behavior

Vertebrae provide essential biomechanical stability to the skeleton. In this work novel morphing techniques were used to parameterize three aspects of the geometry of a specimen-specific finite element (FE) model of a rat caudal vertebra (process size, neck size, and end-plate offset). Material properties and loading were also parameterized using standard techniques. These parameterizations were then integrated within an RSM framework and used to produce a family of FE models. The mechanical behavior of each model was characterized by predictions of stress and strain. A metamodel was fit to each of the responses to yield the relative influences of the factors and their interactions. The direction of loading, offset, and neck size had the largest influences on the levels of vertebral stress and strain. Material type was influential on the strains, but not the stress. Process size was substantially less influential. A strong interaction was identified between dorsal-ventral offset and dorsal-ventral off-axis loading. The demonstrated approach has several advantages for spinal biomechanical analysis by enabling the examination of the sensitivity of a specimen to multiple variations in shape, and of the interactions between shape, material properties, and loading.

Mesh-morphing algorithms for specimen-specific finite element modeling

Despite recent advances in software for meshing specimen-specific geometries, considerable effort is still often required to produce and analyze specimen-specific models suitable for biomechanical analysis through finite element modeling. We hypothesize that it is possible to obtain accurate models by adapting a pre-existing geometry to represent a target specimen using morphing techniques. Here we present two algorithms for morphing, automated wrapping (AW) and manual landmarks (ML), and demonstrate their use to prepare specimen-specific models of caudal rat vertebrae. We evaluate the algorithms by measuring the distance between target and morphed geometries and by comparing response to axial loading simulated with finite element (FE) methods. First a traditional reconstruction process based on microCT was used to obtain two natural specimen-specific FE models. Next, the two morphing algorithms were used to compute mappings from the surface of one model, the source, to the other, the target, and to use this mapping to morph the source mesh to produce a target mesh. The microCT images were then used to assign element-specific material properties. In AW the mappings were obtained by wrapping the source and target surfaces with an auxiliary triangulated surface. In ML, landmarks were manually placed on corresponding locations on the surfaces of both source and target. Both morphing algorithms were successful in reproducing the shape of the target vertebra with a median distance between natural and morphed models of 18.8 and 32.2 microm, respectively, for AW and ML. Whereas AW-morphing produced a surface more closely resembling that of the target, ML guaranteed correspondence of the landmark locations between source and target. Morphing preserved the quality of the mesh producing models suitable for FE simulation. Moreover, there were only minor differences between natural and morphed models in predictions of deformation, strain and stress. We therefore conclude that it is possible to use mesh-morphing techniques to produce accurate specimen-specific FE models of caudal rat vertebrae. Mesh morphing techniques provide advantages over conventional specimen-specific finite element modeling by reducing the effort required to generate multiple target specimen models, facilitating intermodel comparisons through correspondence of nodes and maintenance of connectivity, and lends itself to parametric evaluation of "artificial" geometries with a focus on optimizing reconstruction.

Integrating modelling and experiments to assess dynamic musculoskeletal function in humans

Magnetic resonance imaging, bi-plane X-ray fluoroscopy and biomechanical modelling are enabling technologies for the non-invasive evaluation of muscle, ligament and joint function during dynamic activity. This paper reviews these various technologies in the context of their application to the study of human movement. We describe how three-dimensional, subject-specific computer models of the muscles, ligaments, cartilage and bones can be developed from high-resolution magnetic resonance images; how X-ray fluoroscopy can be used to measure the relative movements of the bones at a joint in three dimensions with submillimetre accuracy; how complex 3-D dynamic simulations of movement can be performed using new computational methods based on non-linear control theory; and how musculoskeletal forces derived from such simulations can be used as inputs to elaborate finite-element models of a joint to calculate contact stress distributions on a subject-specific basis. A hierarchical modelling approach is highlighted that links rigid-body models of limb segments with detailed finite-element models of the joints. A framework is proposed that integrates subject-specific musculoskeletal computer models with highly accurate in vivo experimental data.

Integration from proteins to organs: the IUPS Physiome Project

The IUPS Physiome Project is an internationally collaborative open source project intended to provide a public domain framework for computational physiology, including the development of modeling standards, computational tools and web-accessible databases of models of structure and function at all spatial scales and across all organ systems. Here, we illustrate the application of this multi-scale modeling approach to three organ systems: the heart, the lungs and the musculo-skeletal system, and in each case we show how the organ level models incorporate tissue and cell-level physiology. Although the computational physiology framework presented here does not yet incorporate models of ageing processes, the model-based approach is certainly capable of describing ageing and disease-related processes both via parameter changes within the models of normal physiological processes and via models of additional processes added to the framework.