Joel B. Myklebust

Measures of postural steadiness: differences between healthy young and elderly adults

Measures of postural steadiness are used to characterize the dynamics of the postural control system associated with maintaining balance during quiet standing. The objective of this study was to evaluate the relative sensitivity of center-of-pressure (COP)-based measures to changes in postural steadiness related to age. A variety of time and frequency domain measures of postural steadiness were compared between a group of twenty healthy young adults (21-35 years) and a group of twenty healthy elderly adults (66-70 years) under both eyes-open and eyes-closed conditions. The measures that identified differences between the eyes-open and eyes-closed conditions in the young adult group were different than those that identified differences between the eye conditions in the elderly adult group. Mean velocity of the COP was the only measure that identified age-related changes in both eye conditions, and differences between eye conditions in both age groups. The results of this study will be useful to researchers and clinicians using COP-based measures to evaluate postural steadiness.

Tensile strength of spinal ligaments

Spinal ligaments from 41 fresh human male cadavers were tested. The ligaments were tested In situ by sectioning all elements except the one under study. The force deflection curves demonstrated a sigmoidal shape, and the point at which an increase in deflection was obtained with decreasing force was taken as failure. The force and deformation at failure are shown for each ligament as a function of spinal level.

Experimental spinal injuries with vertical impact.

Fifteen fresh, intact, human male cadavers suspended head down were dropped vertically from a height of 0.9- 1.5 meters. In eight specimens the heads were restrained to simulate muscle forces. The head-neck complex was oriented for maximal axial loading of the cervical and upper thoracic spine. In several cadavers, load cells were placed in cervical bodies. Head impact forces of 3,000-7,000 N in the unrestrained, and 9,800-14,600 N in the restrained, cadavers were recorded. There were more cervical and upper thoracic fractures in the restrained cadavers than in the nonrestrained subjects. The biomechanic and pathologic findings, including results of cryomicrotomography and computed tomography (CT), are discussed.

Compression Injuries of the Cervical Spine: A Biomechanical Analysis

Three intact cadavers and 10 isolated cervical spinal columns underwent compression, with forces directed vertically, forward, or rearward. Failure modes were often different than force directions. The loads required to produce bony injury or ligamentous disruption ranged from 645 to 7439 N. Flexion and extension injuries were produced at approximately 50% of the loads required for axial compression failures. The direction of force delivery correlated only partially with the resulting pathological condition. Clinical decisions based on retrospective analysis of roentgenograms may not account for the variability of forces and the prominence of ligament injuries seen in spinal trauma. Some of the difficulties encountered in biomechanical analyses of spinal trauma are discussed.

Microtrauma in the lumbar spine: a cause of low back pain.

Excessive mechanical stress on the intervertebral disc may be one of the causes of low back pain. Most studies testing this thesis, however, have been based on quantification of the mechanical response of functional units at failure. Typically, radiography is used to demonstrate trauma to the vertebral body at the failure load. The description of failure and radiographic demonstration of damage are meaningful in specifying the tolerance limits of the structure. It is important, however, to understand the sequence underlying the initiation of injury, which may occur at subfailure physiological loads. In this study, we identified the initiation of injury to the lumbar spine by subjecting functional units to axial compressive loads using the mechanical response as a basis. Because conventional radiography failed to detect trauma at this level, advanced sectioning techniques were used. The initiation of injury (microtrauma) is defined as the point on the load-deflection curve where the structure exhibits a decreasing level of resistance for the first time before reaching its ultimate load-carrying capacity. The load deflection curve on this basis was classified into the ambient or preload phase, physiological loading phase, traumatic phase, and post-traumatic phase. Structures loaded to the end of the physiological loading phase did not exhibit any yielding or microtrauma. Injury in the form of microfractures of the endplate not detected on radiography, however, was observed under cryomicrotomy for structures loaded into the traumatic loading phase.

Biomechanics of cervical spine facetectomy and fixation techniques.

Facetectomy, either unilateral or bilateral, significantly altered the capacity of cervical spine functional units to withstand increasing compression-flexion loads applied in a constant mode to different specimen configurations. Unilateral facetectomy resulted in an average 31.6 ± 9.7 percent decrease in strength whereas bilateral disruption caused an average 53.1 ± 11 percent decrease in strength. Motion analysis in a two-dimensional plane after facetectomy indicated an anterior displacement of the instantaneous axis of rotation (IAR) with a resultant increased load on the vertebral bodies and disc. This anterior shift of the IAR in the horizontal plane was significantly but not completely resolved by wire fixation of the facet joints. These fixation techniques, constisting of either facet to facet or facet to spinous process wiring, demonstrated a similar capability to restore strength to the functional units as well as reducing excessive motion in the vertical and anterior axes induced by the facetectomies.

Stiffness and strain energy criteria to evaluate the threshold of injury to an intervertebral joint

This study is focused to evaluate the threshold of injury to an intervertebral joint based on its mechanical response. The load-deflection behavior of the intervertebral joint indicated non-linear and sigmoidal characteristics with continuously changing stiffness (a measure of the ability to withstand external force). The load corresponding to the point of zero stiffness was identified, according to the classical theories of mechanics, as the maximum load carrying capacity. Further, the initiation of trauma was defined to occur at the point on the load-deflection curve at which the stiffness begins to decrease for the first time. The load, stiffness and energy absorbing capabilities of normal and degenerated intervertebral joints at the initiation of trauma was determined. Axial compressive load experiments were conducted on nine intervertebral joints of fresh human male cadavers and the resulting load-deflection responses were transformed into stiffness-deflection responses using the derivative principle. Energy characteristics were also derived. Load, stiffness and energy at the initiation of trauma were found to be 9.0 kN, 2850 N mm-1, and 10.2 J for normal and 4.4 kN, 1642 N mm-1, and 5.8 J for degenerated segments, respectively. The load and energy values at failure were 11.0 kN, and 18.0 J for normal and 5.3 kN and 5.7 J for degenerated intervertebral joints, respectively.

Major Quantitative Trait Locus for Resting Heart Rate Maps to a Region on Chromosome 4

Abstract—Multiple studies have identified resting heart rate as a risk factor for cardiovascular disease independent of other cardiovascular disease risk factors (such as dyslipidemia and hypertension). Previous studies have examined heart rate in hypertensive individuals, but little is known about the genetic determination of resting heart rate in a normal population. Therefore, our objective was to perform a genome screen on a population containing normotensive and hypertensive individuals. We performed variance decomposition linkage analysis using maximum likelihood methods at ≈10 cM intervals in 2209 individuals of predominantly North European ancestry. We estimated the heritability of resting heart rate to be 26% and obtained significant evidence of linkage (logarithm of the odds [LOD]=3.9) for resting heart rate on chromosome 4q. This signal is in the same region as a quantitative trait locus (QTL) for long QT syndrome 4 and a QTL for heart rate in rats. Within the 1-LOD unit support interval, there are 2 strong candidates: ankyrin-B and myozenin 2.

Measure of tissue resistivity in experimental electrical burns

Studies were conducted in 14 mongrel dogs to compare resistivities in normal muscle with those from muscle subjected to electrical burns. One-ampere, 60-Hz currents were passed between the hind limbs of the dogs producing injury in three measurement regions of the gracilis muscle. Histology, heart rate, body temperature, arterial and pulmonary artery pressure, cardiac output, hematocrit, leukocyte counts, fibrinogen levels, and platelet levels were determined. Muscle resistivity associated with severe tissue necrosis was 70% lower than control values. Resistivity in tissue showing edema and minimal necrosis decreased 20 to 40% from control values. Muscle showing only edema had a 10 to 30% decrease in resistivity.

Experimental electrical injury studies.

Voltages from 10 to 14,000 volts demonstrated currents up to 70 amperes with resistances of approximately 200 ohms in studies in hogs. Below 1,000 volts, a current reduction is observed following arcing and skin necrosis. At the higher voltages, this phenomenon was not observed. The energy required for tissue damage was dependent upon the voltage and time of application. The tissue electrode resistance with stainless steel disc was proportional to the diameter. Skin buring commenced at the periphery of the electrodes and moved inwards. For application of currents between the hindlimbs of the hog, the current per tissue cross-section was greatest in artery and nerve, followed by muscle, fat, bone marrow, and bone cortex.