Optimising functional rehabilitation

Science topics February 2015 Road safetyHuman behaviourModelling and computer simulation

Raphaël Dumas, Senior researcher - TS2 Department , LMBC Laboratory

In the last few years international research, particularly in Europe, has been facing the challenges raised by the virtual patient and digital medicine1. Biomechanical models2 of the human body can be personalised using medical imaging and result in better patient care.
These models can represent the skeleton, the organs or cells, with varying levels of complexity.
In the case of physical and rehabilitation medicine, in particular with regard to the recovery of optimum motor function after a transport accident, the best tools are models of the musculoskeletal system. These biomechanical models assist the analysis of movement, which is a clinical examination recognised by the health-insurance system3. They therefore help to provide medical care which is increasingly personalised and improve the evaluation of the medical service that is provided.
For example, in the case of an amputee or a person with a spinal cord injury, the best possible selection and fitting of an artificial limb or a wheelchair4 have a considerable influence on the recovery of mobility and autonomy in both day-to-day and occupational life.

 

 

Biomechanical modelling for improved diagnosis of functional capacities …

Such models of the musculoskeletal system provide a very large volume of data which cannot be directly measured. It can be used to guide the rehabilitation team (rehabilitation doctors, limb-fitters, physiotherapists, occupational therapists, etc.) in their diagnosis and care of an individual with a motor disability.
The human body is modelled by a set of rigid segments, mechanical links and cables. Importantly, information provided by these biomechanical models canshow the energy expenditure that is necessary to move and the stresses which are applied to bones, joints, ligaments and tendons 5. This information provides a unique insight into a patient’s functional capacities, particularly those which had been impaired and then restored after an accident.

 

 

Musculoskeletal modelling of the leg during walking.

… and achieving a more complete recovery of mobility..

Motion analysis and models of the musculoskeletal system thus help to optimise recovery of motor dysfunction by providing an objective evaluation of the immediate effect of a re-education programme or the fitting of an artificial limb.
This clinical examination and the biomechanical modelling can reveal compensation and excess stresses in uninjured limbs, which will ultimately lead to secondary musculoskeletal disorders. This evaluation, carried out in the course of the most difficult activities performed during daily life, (such as moving on a cant or a slope or negotiating a step) helps identify when mobility has been recovered.

 

 


1 IFSTTAR belongs to the VPH Institute which fosters integrative biomedical research at a European level. Consult the roadmap

2 «Biomechanics is the study of the structure and function of biological systems […] by means of the methods of mechanics » Wikipedia definition

3 Abbreviated procedure sheet for the Three-dimensional analysis of walking using a force platform.

4 The Laboratory of Impact Mechanics and Biomechanics (LBMC) has taken part in an ANR-funded national research project. This initiative has led to the publication of book on choosing and adjusting a manual wheelchair. More about this book.

5 A musculoskeletal model of the arm has been developed at the Laboratory of Impact Mechanics and Biomechanics (LBMC) by FlorentMoissenet, Laurence Cheze, and Raphaël Dumas and validated by measurements made on patients with an instrumented knee replacement.

Find out more ...

  • Cheze, L. Biomécanique du mouvement et modélisation musculo-squelettique. Techniques de l'Ingénieur, MED8050 , 2014.
  • Cheze, L., Moissenet, F., Dumas, R., 2015. State of the art and current limits of musculo-skeletal models for clinical applications. Science et Motricité, In press 90:7-17.
  • Moissenet F., Cheze, L., Dumas, R., 2014. A 3D lower limb musculoskeletal model for simultaneous estimation of musculo-tendon, joint contact, ligament and bone forces during gait. Journal of Biomechanics 47(1): 50-58.
  • Moissenet, F., Cheze, L., Dumas, R., 2017. Individual muscle contributions to ground reaction and to joint contact, ligament and bone forces during normal gait. Multibody System Dynamics, 40(2), 193-211.