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Mbithi FM, Chipperfield AJ, Steer JW, Dickinson AS. Developing a control framework for self-adjusting prosthetic sockets incorporating tissue injury risk estimation and generalized predictive control. Biomed Eng Lett 2021; 12:59-73. [DOI: 10.1007/s13534-021-00211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/21/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022] Open
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Traa WA, van Turnhout MC, Nelissen JL, Strijkers GJ, Bader DL, Oomens CWJ. There is an individual tolerance to mechanical loading in compression induced deep tissue injury. Clin Biomech (Bristol, Avon) 2019; 63:153-160. [PMID: 30897463 DOI: 10.1016/j.clinbiomech.2019.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/14/2019] [Accepted: 02/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Deep tissue injury is a type of pressure ulcer which originates subcutaneously due to sustained mechanical loading. The relationship between mechanical compression and damage development has been extensively studied in 2D. However, recent studies have suggested that damage develops beyond the site of indentation. The objective of this study was to compare mechanical loading conditions to the associated damage in 3D. METHODS An indentation test was performed on the tibialis anterior muscle of rats (n = 39). Changes in the form of oedema and structural damage were monitored with MRI in an extensive region. The internal deformations were evaluated using MRI based 3D finite element models. FINDINGS Damage propagates away from the loaded region. The 3D analysis indicates that there is a subject specific tolerance to compression induced deep tissue injury. INTERPRETATION Individual tolerance is an important factor when considering the mechanical loading conditions which induce damage.
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Affiliation(s)
- Willeke A Traa
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Mark C van Turnhout
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jules L Nelissen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Dan L Bader
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Cees W J Oomens
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Traa WA, van Turnhout MC, Moerman KM, Nelissen JL, Nederveen AJ, Strijkers GJ, Bader DL, Oomens CWJ. MRI based 3D finite element modelling to investigate deep tissue injury. Comput Methods Biomech Biomed Engin 2018; 21:760-769. [DOI: 10.1080/10255842.2018.1517868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Willeke A. Traa
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Mark C. van Turnhout
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Kevin M. Moerman
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jules L. Nelissen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Gustav J. Strijkers
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Dan L. Bader
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Cees W. J. Oomens
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Nelissen JL, Traa WA, de Boer HH, de Graaf L, Mazzoli V, Savci-Heijink CD, Nicolay K, Froeling M, Bader DL, Nederveen AJ, Oomens CWJ, Strijkers GJ. An advanced magnetic resonance imaging perspective on the etiology of deep tissue injury. J Appl Physiol (1985) 2018; 124:1580-1596. [DOI: 10.1152/japplphysiol.00891.2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Early diagnosis of deep tissue injury remains problematic due to the complicated and multifactorial nature of damage induction and the many processes involved in damage development and recovery. In this paper, we present a comprehensive assessment of deep tissue injury development and remodeling in a rat model by multiparametric magnetic resonance imaging (MRI) and histopathology. The tibialis anterior muscle of rats was subjected to mechanical deformation for 2 h. Multiparametric in vivo MRI, consisting of T2, T2*, mean diffusivity (MD), and angiography measurements, was applied before, during, and directly after indentation as well as at several time points during a 14-day follow-up. MRI readouts were linked to histological analyses of the damaged tissue. The results showed dynamic change in various MRI parameters, reflecting the histopathological status of the tissue during damage induction and repair. Increased T2 corresponded with edema, muscle cell damage, and inflammation. T2* was related to tissue perfusion, hemorrhage, and inflammation. MD increase and decrease was reported on the tissue’s microstructural integrity and reflected muscle degeneration and edema as well as fibrosis. Angiography provided information on blockage of blood flow during deformation. Our results indicate that the effects of a single damage-causing event of only 2 h of deformation were present up to 14 days. The initial tissue response to deformation, as observed by MRI, starts at the edge of the indentation. The quantitative MRI readouts provided distinct and complementary information on the extent, temporal evolution, and microstructural basis of deep tissue injury-related muscle damage. NEW & NOTEWORTHY We have applied a multiparametric MRI approach linked to histopathology to characterize damage development and remodeling in a rat model of deep tissue injury. Our approach provided several relevant insights in deep tissue injury. Response to damage, as observed by MRI, started at some distance from the deformation. Damage after a single indentation period persisted up to 14 days. The MRI parameters provided distinct and complementary information on the microstructural basis of the damage.
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Affiliation(s)
- Jules L. Nelissen
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Willeke A. Traa
- Soft Tissue Engineering and Mechanobiology, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Hans H. de Boer
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Larry de Graaf
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Valentina Mazzoli
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Orthopedic Research Laboratory, Radboud UMC, Nijmegen, The Netherlands
| | | | - Klaas Nicolay
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dan L. Bader
- Soft Tissue Engineering and Mechanobiology, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Cees W. J. Oomens
- Soft Tissue Engineering and Mechanobiology, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
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Dickinson A, Steer J, Worsley P. Finite element analysis of the amputated lower limb: A systematic review and recommendations. Med Eng Phys 2017; 43:1-18. [DOI: 10.1016/j.medengphy.2017.02.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/17/2017] [Accepted: 02/10/2017] [Indexed: 01/18/2023]
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Nelissen JL, de Graaf L, Traa WA, Schreurs TJL, Moerman KM, Nederveen AJ, Sinkus R, Oomens CWJ, Nicolay K, Strijkers GJ. A MRI-Compatible Combined Mechanical Loading and MR Elastography Setup to Study Deformation-Induced Skeletal Muscle Damage in Rats. PLoS One 2017; 12:e0169864. [PMID: 28076414 PMCID: PMC5226723 DOI: 10.1371/journal.pone.0169864] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 12/23/2016] [Indexed: 02/01/2023] Open
Abstract
Deformation of skeletal muscle in the proximity of bony structures may lead to deep tissue injury category of pressure ulcers. Changes in mechanical properties have been proposed as a risk factor in the development of deep tissue injury and may be useful as a diagnostic tool for early detection. MRE allows for the estimation of mechanical properties of soft tissue through analysis of shear wave data. The shear waves originate from vibrations induced by an external actuator placed on the tissue surface. In this study a combined Magnetic Resonance (MR) compatible indentation and MR Elastography (MRE) setup is presented to study mechanical properties associated with deep tissue injury in rats. The proposed setup allows for MRE investigations combined with damage-inducing large strain indentation of the Tibialis Anterior muscle in the rat hind leg inside a small animal MR scanner. An alginate cast allowed proper fixation of the animal leg with anatomical perfect fit, provided boundary condition information for FEA and provided good susceptibility matching. MR Elastography data could be recorded for the Tibialis Anterior muscle prior to, during, and after indentation. A decaying shear wave with an average amplitude of approximately 2 μm propagated in the whole muscle. MRE elastograms representing local tissue shear storage modulus Gd showed significant increased mean values due to damage-inducing indentation (from 4.2 ± 0.1 kPa before to 5.1 ± 0.6 kPa after, p<0.05). The proposed setup enables controlled deformation under MRI-guidance, monitoring of the wound development by MRI, and quantification of tissue mechanical properties by MRE. We expect that improved knowledge of changes in soft tissue mechanical properties due to deep tissue injury, will provide new insights in the etiology of deep tissue injuries, skeletal muscle damage and other related muscle pathologies.
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Affiliation(s)
- Jules L. Nelissen
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Larry de Graaf
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Willeke A. Traa
- Soft Tissue Biomechanics and Engineering, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Tom J. L. Schreurs
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Kevin M. Moerman
- Center for Extreme Bionics, Media lab, MIT, Cambridge, MA, United States of America
| | - Aart J. Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Ralph Sinkus
- Image Sciences & Biomedical Engineering, King’s College London, London, United Kingdom
| | - Cees W. J. Oomens
- Soft Tissue Biomechanics and Engineering, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Klaas Nicolay
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
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Al-Dirini RMA, Reed MP, Hu J, Thewlis D. Development and Validation of a High Anatomical Fidelity FE Model for the Buttock and Thigh of a Seated Individual. Ann Biomed Eng 2016; 44:2805-16. [DOI: 10.1007/s10439-016-1560-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 02/01/2016] [Indexed: 11/29/2022]
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3D anatomy and deformation of the seated buttocks. J Tissue Viability 2015; 24:51-61. [DOI: 10.1016/j.jtv.2015.03.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/12/2015] [Accepted: 03/23/2015] [Indexed: 11/23/2022]
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Oomens CWJ, Bader DL, Loerakker S, Baaijens F. Pressure Induced Deep Tissue Injury Explained. Ann Biomed Eng 2014; 43:297-305. [DOI: 10.1007/s10439-014-1202-6] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
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Sprigle S, Sonenblum S, Conner-Kerr T. mobilityRERC state of the science conference: individualizing pressure ulcer risk and prevention strategies. Disabil Rehabil Assist Technol 2013; 8:454-61. [DOI: 10.3109/17483107.2013.823574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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