Design Considerations of a Fiber Optic Pressure Sensor Protective Housing for Intramuscular Pressure Measurements

Ankle Sprain Bracing Solutions and Future Design Consideration for Civilian and Military Use

INTRODUCTION

Ankle sprains are common injuries within the civilian and military populations, with lingering symptoms that include pain, swelling, giving-way, and a high likelihood for recurrence. Numerous bracing systems are available to stabilize the ankle joint following sprains, with new design iterations frequently entering the market. Currently available braces generally include sleeve, lace-up, and stirrup designs. Sleeves provide mild compression and warmth but limited stability for the ankle, while lace-ups and stirrups appear to be more effective at preventing and treating lateral ankle sprains.

AREAS COVERED

This review summarizes the use of various brace options in practice. Their major clinical benefits, and limitations are highlighted, followed by an overview of emerging concepts in brace design. Current advancements in biomechanical simulation, multifunctional material fabrication, and wearable, field-deployed devices for human injury surveillance are discussed, providing possibilities for conceiving new design concepts for next-generation smart ankle braces.

EXPERT OPINION

Performance of the commercially available braces are limited by their current design concepts. Suggestions on future brace design include: (1) incorporating high-performance materials suitable for extreme environments, (2) leveraging modeling and simulation techniques to predict mechanical support requirements, and (3) implementing adaptive, customizable componentry material to meet the needs of each unique patient.

Sensor Anchoring Improves the Correlation Between Intramuscular Pressure and Muscle Tension in a Rabbit Model

Intramuscular pressure (IMP) shows promise for estimating individual muscle tension in vivo. However, previous pressure measurements show high variability during isometric contraction and poor correlation with tension during dynamic contraction. We hypothesized that enhanced sensor anchoring/orientation would improve tension estimation and thus developed a novel pressure sensor with a barbed housing. Sensors were inserted into the tibialis anterior (TA) of New Zealand White rabbits (N = 8) both parallel and perpendicular to the fiber orientation. We measured muscle stress and IMP during both isometric and dynamic contractions. Passive stress showed good agreement for both insertion directions across muscle lengths (ICC > 0.8). Active stress and IMP agreement were good (ICC = 0.87 ± 0.04) for perpendicular insertions but poor (ICC = 0.21 ± 0.22) for parallel insertions across both dynamic contractions and isometric contractions within the muscle's range of motion. These findings support use of IMP measurements to estimate muscle tension across a range of contraction conditions.

Modeling Skeletal Muscle Stress and Intramuscular Pressure: A Whole Muscle Active-Passive Approach

Clinical treatments of skeletal muscle weakness are hindered by a lack of an approach to evaluate individual muscle force. Intramuscular pressure (IMP) has shown a correlation to muscle force in vivo, but patient to patient and muscle to muscle variability results in difficulty of utilizing IMP to estimate muscle force. The goal of this work was to develop a finite element model of whole skeletal muscle that can predict IMP under passive and active conditions to further investigate the mechanisms of IMP variability. A previously validated hypervisco-poroelastic constitutive approach was modified to incorporate muscle activation through an inhomogeneous geometry. Model parameters were optimized to fit model stress to experimental data, and the resulting model fluid pressurization data were utilized for validation. Model fitting was excellent (root-mean-square error or RMSE <1.5 kPa for passive and active conditions), and IMP predictive capability was strong for both passive (RMSE 3.5 mmHg) and active (RMSE 10 mmHg at in vivo lengths) conditions. Additionally, model fluid pressure was affected by length under isometric conditions, as increases in stretch yielded decreases in fluid pressurization following a contraction, resulting from counteracting Poisson effects. Model pressure also varied spatially, with the highest gradients located near aponeuroses. These findings may explain variability of in vivo IMP measurements in the clinic, and thus help reduce this variability in future studies. Further development of this model to include isotonic contractions and muscle weakness would greatly benefit this work.

Evaluating skeletal muscle electromechanical delay with intramuscular pressure

INTRODUCTION

Intramuscular pressure (IMP) is the fluid pressure generated within skeletal muscle and directly reflects individual muscle tension. The purpose of this study was to assess the development of force, IMP, and electromyography (EMG) in the tibialis anterior (TA) muscle during ramped isometric contractions and evaluate electromechanical delay (EMD).

METHODS

Force, EMG, and IMP were simultaneously measured during ramped isometric contractions in eight young, healthy human subjects. The EMD between the onset of force and EMG activity (Δt-EMG force) and the onset of IMP and EMG activity (Δt EMG-IMP) were calculated.

RESULTS

A statistically significant difference (p < 0.05) was found between the mean force-EMG EMD (36 ± 31 ms) and the mean IMP-EMG EMD (3 ± 21 ms).

CONCLUSIONS

IMP reflects changes in muscle tension due to the contractile muscle elements.

Evaluate muscle tension using intramuscular pressure device in rabbit tibialis anterior model for improved tendon transfer surgery

Quantitative evaluation of passive tension in a muscle is important in tendon transfer surgeries, however, currently appropriate intraoperative measurement techniques are lacking.

OBJECTIVE

Intramuscular pressure (IMP) is explored as an application to access force.

APPROACH

The tibialis anterior (TA) in New Zealand white rabbits (n  =  9) was used to test the hypothesis of a strong correlation between the IMP, muscle force, and length. This study also helped to develop intraoperative techniques for future human studies evaluating various insertion techniques (parallel versus perpendicular).

MAIN RESULTS

The Pearson correlation between IMP and force for all trials was 0.74  ±  0.30. Separating out the parallel insertion from the perpendicular insertion revealed a significantly higher correlation for parallel, 0.91  ±  0.13 versus 0.56  ±  0.32.

SIGNIFICANCE

These data indicate IMP sensors can be used to assess force in a single muscle and the parallel insertion method should be used. New findings • What is the central question of this study? Successful outcomes of tendon and muscle transfers depend on proper muscle tension. A near linear relationship has been seen between muscle force and intramuscular pressure. This study aims to develop an intraoperative technique for assessing passive muscle tension using intramuscular pressure. • What is the main finding and its importance? The findings from this study reveal a high correlation between pressure and passive tension in a single muscle. The techniques developed in this study will allow the translation to a human model. The work will help to improve surgical outcomes and aim to retain muscle strength in the patient following procedures such as tendon and muscle transfers.

A validated model of passive skeletal muscle to predict force and intramuscular pressure

The passive properties of skeletal muscle are often overlooked in muscle studies, yet they play a key role in tissue function in vivo. Studies analyzing and modeling muscle passive properties, while not uncommon, have never investigated the role of fluid content within the tissue. Additionally, intramuscular pressure (IMP) has been shown to correlate with muscle force in vivo and could be used to predict muscle force in the clinic. In this study, a novel model of skeletal muscle was developed and validated to predict both muscle stress and IMP under passive conditions for the New Zealand White Rabbit tibialis anterior. This model is the first to include fluid content within the tissue and uses whole muscle geometry. A nonlinear optimization scheme was highly effective at fitting model stress output to experimental stress data (normalized mean square error or NMSE fit value of 0.993) and validation showed very good agreement to experimental data (NMSE fit values of 0.955 and 0.860 for IMP and stress, respectively). While future work to include muscle activation would broaden the physiological application of this model, the passive implementation could be used to guide surgeries where passive muscle is stretched.