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BIOMECHANICS: THEORY AND APPLICATIONS SERIES
BIOMECHANICS: PRINCIPLES, TRENDS
AND APPLICATIONS
No part of this digital document may be reproduced, stored in a retrieval system or transmitted in any form or
by any means. The publisher has taken reasonable care in the preparation of this digital document, but makes no
expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No
liability is assumed for incidental or consequential damages in connection with or arising out of information
contained herein. This digital document is sold with the clear understanding that the publisher is not engaged in
rendering legal, medical or any other professional services.
BIOMECHANICS: THEORY AND
APPLICATIONS SERIES
Biomechanics: Principles, Trends and Applications
Jerrod H. Levy (Editor)
2010. ISBN: 978-1-60741-394-3
BIOMECHANICS: THEORY AND APPLICATIONS SERIES
BIOMECHANICS: PRINCIPLES, TRENDS
AND APPLICATIONS
JERROD H. LEVY
EDITOR
Nova Science Publishers, Inc.
New York
Copyright � 2010 by Nova Science Publishers, Inc.
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ISBN: 978-1-61761-865-9 (Ebook)
New York
CONTENTS
Preface vii
Chapter 1 Arts Biomechanics � An Infant Science: Its Challenges and Future 1
Gongbing Shan and Peter Visentin
Chapter 2 Understanding Corneal Biomechanics through Experimental
Assessment and Numerical Simulation 57
Ahmed Elsheikh
Chapter 3 Biomechanics Concepts of Bone-Oral Implant Interface 111
Ahmed Ballo and Niko Moritz
Chapter 4 Biomechanical Remodeling of the Diabetic Gastrointestinal Tract 137
Jingbo Zhao, Donghua Liao, Jian Yang and Hans Gregersen
Chapter 5 Biomechanics of the Gastrointestinal Tract in Health and Disease 163
Jingbo Zhao, Donghua Liao and Hans Gregersen
Chapter 6 Electromyography in the 21st Century: From Voluntary Signals
to Motor Evoked Potentials 207
Petra S. Williams and Brian C. Clark
Chapter 7 Biomechanics in Children with Cerebral Palsy 233
Jessie Chen and Dinah Reilly
Chapter 8 Biomechanical Properties of Cornea 251
Sunil Shah and Mohammad Laiquzzaman
Chapter 9 Some Aspects of the Biomechanics of Skilled Musical Performance 267
Jessie Chen and George Moore
Chapter 10 Contact Hip Stress Measurements in Orthopaedic Clinical Practice 281
Blaz Mavcic, Matej Daniel, Vane Antolic, Ales Iglic
and Veronika Kralj-Iglic
Chapter 11 External Pelvic Fixation during Lumbar Muscle Resistance Exercise 295
Michael C. McGlaughlin, Philip A. Anloague and Brian C. Clark
vi Contents
Chapter 12 Bone Cell Adhesion: An Important Aspect of Cell Biomechanics in
the Development of Surface Modifications for Orthopaedic
Implants 305
Andreas Fritsche, Frank Luethen, Barbara Nebe,
Joachim Rychly, Ulrich Lembke, Carmen Zietz,
Wolfram Mittelmeier and Rainer Bader
Chapter 13 The Differences in Biomechanical Patterns of Fast Motor Learning
of Children and Adults 315
A. Skurvidas, A. Zuoza, B. Gutnik and D. Nash
Chapter 14 Applying Pressure Sensors and Size Differences in Running Shoes
Fit Measurement 317
Y. L. Cheng and Y. L. Hong
Chapter 15 Improvement of the Input Data in Biomechanics: Kinematic and
Body Segment Inertial Parameters 351
Tony Monnet, Mickael Begon, Claude Vallee
and Patrick Lacouture
Index 385
PREFACE
Biomechanics is the application of mechanical principles (statics, strength of materials
and stress analysis to the solution of biological problems of living organisms. This includes
bioengineering, the research and analysis of the mechanics of living organisms and the
application of engineering principles to and from biological systems. This research and
analysis can be carried forth on multiple levels, from the molecular, wherein biomaterials
such as collagen and elastin are considered, all the way up to the tissue and organ level. This
new and important book gathers the latest research from around the globe in the study of this
dynamic field with a focus on issues such as; art biomechanics, understanding corneal
biomechanics, biomechanical remodeling of the diabetic gastrointestinal tract, biomechanics
in children with cerebral palsy, cell biomechanics for orthopaedic implants, and others.
Chapter 1 - While biomechanics has achieved successes in many fields involving
locomotion, motor learning, skill acquisition, technique optimization, injury prevention,
physical therapy and rehabilitation, one area has heretofore been scarcely represented in the
literature � Arts Biomechanics. Biomechanics clearly has significant potential for application
in the performance arts, such as music and dance, since skills needed for these activities are
visibly related to the human musculoskeletal and nervous systems. In such areas, Arts
Biomechanics should begin by focusing on skill analyses and acquisition necessary for the
performance of the artistic act. Subsequently it should engage in a deeper discourse that
explores the relationship between these and the desired aesthetic outcome. Less apparently,
biomechanics may also enhance the analysis and comprehension of other arts, such as
painting, where gesture is often embedded in the artwork by means of symbolism, tradition,
the process of art creation, or as an inherent product of the existential nature of humanity.
Chapter 2 - The Ocular Biomechanics Group was established in 2002 with one clear
target; to develop a virtual reality model of the human eye that can be used effectively and
reliably to predict ocular response to surgery, injury and disease. This ambitious, and
seemingly illusive, target helped plan our activities over the last 6 years and will still be
focusing our efforts as the authors strive to create the necessary knowledge using
experimental methods, build the predictive tools using programming and analysis means, and
validate the findings in both the laboratory and the clinic. This chapter presents an overview
of our biomechanical studies from laboratory material characterisation to finite element
numerical simulation. The chapter describes what has been achieved and points at the
remaining gaps in our knowledge. It explains that while much remains unknown in ocular
behaviour, the authors are now in a good position to use available knowledge to progress
viii Jerrod H. Levy
predictive modelling and use it in actual applications such as improving the accuracy of
tonometry techniques, planning of refractive surgeries and design of contact lenses. The
discussion focuses on the cornea, although scleral biomechanics receive some mention. The
chapter also refers to microstructural, biomechanical and topographic studies conducted by
other research groups. Coverage of these studies has been necessary to provide a more
complete image of current understanding of corneal biomechanics.
Chapter 3 - Osseointegrated implants are actually replacements for natural teeth, and, like
natural teeth, they are exposed to various forces. The success of osseointegration is based on
the clinical outcome; clinicians must ensure that the stresses that the superstructure, implant,
and surrounding bone are subjected to are within the tolerable limits of the various
components. Structural compatibility is the optimum adaptation to the mechanical behavior of
the host tissues. Therefore, structure compatibility refers to the mechanical properties of the
implant material, such as elastic modulus, strength, implant design and optimal load
transmission (minimum interfacial strain mismatch) at the implant/tissue interface, which is
the key to the successful functioning of the implant device.
This chapter reviews some of the reaction, properties and characteristics of the bone and
explains how the bone-implant interface will react under loading condition. The chapter also
includes characteristics, properties and other important information about the implant
biomaterials and implant coating.
Chapter 4 - Gastrointestinal tract sensory-motor abnormalities are common in patients
with diabetes mellitus with symptoms arising from the whole GI tract. Common complaints
include dysphasia, early satiety, reflux, constipation, abdominal pain, nausea, vomiting, and
diarrhea. The pathogenesis of GI symptoms in diabetes mellitus is complex in nature, multi-
factorial (motor dysfunction, autonomic neuropathy, glycemic control, psychological factors,
etc.) and is not well understood. Histologically, many studies have demonstrated prominent
proliferation of different GI wall layers during diabetes. During the past several years, several
studies demonstrated that experimental diabetes induces GI morphological and biomechanical
remodeling. Following the development of diabetes, the GI wall becomes thicker and the
stiffness of the GI wall increases in a time-dependent manner. It is well known that
mechanosensitive nerve endings exist in the GI tract where they serve a critical role for tissue
homeostasis and symptom generation. Mechanoreceptor-like structures such as
intraganglionic laminar nerve endings and intramuscular arrays have been identified. The
changes of stress and strain in the GI wall will alter the biomechanical environment of the
mechanosensitive nerve endings, therefore, the structure as well as the tension, stress and
strain distribution in the GI wall is important for the sensory and motor function.
Biomechanical remodeling of diabetic GI tract including alterations of residual strain and
increase in wall stiffness will alter the tension and stress distribution in the vicinity of the
mechanosensitive afferents with consequences for perception and motility of the GI tract.
Chapter 5 - The gastrointestinal (GI) tract is functionally subjected to dimensional
changes. Hence, biomechanical properties such as the stress-strain relationships are of
particularly importance. These properties vary along the normal GI tract and remodel in
response to growth, aging and disease. The biomechanical properties are crucial for GI motor
function because peristaltic motion that propels the food through the GI tract is a result of
interaction of the passive and active tissue forces and the hydrodynamic forces in the food
bolus and remodeling of the mechanical properties reflects the changes in the tissue structure
that determine a specific motor dysfunction. Therefore, biomechanical data on the GI wall are
Preface ix
important to understand the pathogenesis to the GI motor-sensory function and dysfunction.
Moreover, biomechanical studies of the GI tract pave the way for further mathematical and
computational modelling. Biomechanical studies of the GI tract will advance our
understanding of GI physiological function, diseases such as dyspepsia and visceral pain, and
GI dysfunction due to systemic diseases. Furthermore, integrated GI simulation models will
be beneficial for medical education and for evaluation of the efficacy and safety of new drugs
on GI function.
Chapter 6 - The force produced by skeletal muscle is controlled by the electrical signals
being sent from motor neurons to muscle fibers. These electrical signals, which are known as
action potentials, can be recorded as they travel along the muscle cell membrane and are
referred to as an electromyogram (EMG) signal. It has been more than a century since the
first recording of a voluntary EMG signal was reported, and today it has become a classic
technique for evaluating and recording the activation of skeletal muscles during human
movement. In recent years, the advent and development of transcranial magnetic stimulation
has re-invigorated EMG research, and it is now possible to safely and painlessly evoke EMG
signals directly from the motor cortex of conscious humans. This chapter reviews the
recording and measurement issues associated with EMG and its respective applications.
Particular attention is paid to its role in understanding the neuromechanics of human
movement.
Chapter 7 - Children with cerebral palsy (CP) lack the higher-level motor skills present in
age-matched typically developing (TD) children. The development of postural control is
critical to the acquisition of increasingly complex motor skills as well as to the production of
coordinated motor behavior, such as locomotion. This chapter examines recent developments
in understanding the abnormal postural control in children with CP and assessments of the
effectiveness of rehabilitation techniques using biomechanics measurements. The authors
show that the delayed and impaired development of postural control in children with CP is
not only due to the immaturity of central nervous system but also abnormal postural
alignment and muscle force production.
Children with CP often have difficulty maintaining stability when facing unexpected
threat to balance. The authors present studies comparing reactive balance control in children
with spastic diplegic cerebral palsy (SDCP) and TD children using support surface
perturbation and show that a number of factors contribute to poor balance control in children
with SDCP. 1) There was a temporal disorganization of joint torque activation. 2) There was
a spatial disorganization of the joint torque profiles. 3) Children with SDCP also showed
slower speed to reach peak torque value. In addition, the authors show that when TD children
were asked to mimic crouched stance as that seen in children with SDCP, they exhibited
abnormal postural control as well, indicating that musculoskeletal constraints are also
contributors to the atypical postural muscle response patterns seen in children with SDCP.
These findings suggest that the neuromuscular response patterns of some children with SDCP
may be appropriate strategies for their musculoskeletal constraints secondary to deficits in the
neural system.
In this chapter the authors also discuss the culmination of our findings in relation to
clinical applications in the management of musculoskeletal impairments to improve postural
control in children with SDCP, and the significance of using biomechanical measures to show
a direct relationship between the impairments of the musculoskeletal system and reactive
postural control as well as possible coping strategies used by children with SDCP. The
x Jerrod H. Levy
authors examine the current biomechanical research used to ascertain the effectiveness of two
therapeutic interventions purported to affect the musculoskeletal system for the improvement
of function in children with SDCP, ankle foot orthoses (AFO) and strength training.
Finally, the authors examine the gaps in current clinical research when assessing the
effectiveness of interventions to reduce the musculoskeletal impairments constraining static,
reactive, and dynamic balance control in children with SDCP.
Chapter 8 - The knowledge of corneal biomechanical properties of cornea has gained
importance in recent years. Investigators have been trying to find easy and practical ways to
establish these biomechanical properties but to date have had to rely on corneal thickness
measures to give an idea of corneal biomechanics. This review explores what is known about
the biomechanical properties of the human cornea.
An overview of corneal thickness measurements, its impact on measurement of
intraocular pressure and its importance in various disease states is discussed. The recent
advent of the Ocular Response Analyser, an in-vivo measure of ocular hysteresis and corneal
resistance factor and the pulse waveform associated with this will be discussed. The
importance of this machine with respect to corneal biomechanics will be presented.
Chapter 9 - This chapter addresses a fundamental aspect of musical performance in string
players: how the physical geography of the instrument and bow, and the anthropometric
dimensions of the player interact to produce the stereotypic motor behavior.
Several factors determine movement, but, unlike most biomechanical tasks, the
determining outcome here is acoustic. Both upper extremities are involved in the performance
but in very different ways.
The left arm governs the contact position of the fingers on the string, and hence the pitch
of a note. The spatial relations of the instrument to the body, the contact point of the finger on
the string, the length of the fingerboard, and the dimensions of the arm determine a unique
posture, and thus the muscle activation patterns, for the left arm for each individual player.
The left arm has quite different postures in relation to the body and the instrument for cello
players in comparison to violinists.
The bowing (right) arm draws the bow across the string. Its travel velocity is the principal
determinant of loudness, but its distance from the bridge, the contact position along the bow
length, bow pressure, and its angle of attack on the string leave a noticeable effect on the tone,
or timbre. Bowing movements are essentially determined by the flexion and extension of the
elbow, with subtle motions of the shoulder and wrist to keep the bow moving in a straight line
perpendicular to the string. Given a fixed spatial relation between the body of the performer
and the instrument, the posture of the arm for a given bow/string contact point is uniquely
determined.
In addition, the force of gravity plays a role in the control of movement. The authors
show, however, that it affects cellists and violinists in very different ways. Left arm
movements of cellists are more affected by gravity than those of violinists; whereas gravity
affects the right arm more in violinists.
In this chapter the authors focus on a series of specialized topics: 1) control of the left
arm during shifting movements; 2) fine control of the left arm during corrections of intonation
errors; 3) coordination between the upper arm and forearm; and 4) coordination between the
left and right arms.
Chapter 10 - There exist several invasive and noninvasive methods to measure the
contact hip stress but due to their complexity only few have so far been tested in clinical trials
Preface xi
with large numbers of participating subjects. Consequently, the use of contact hip stress
measurements in orthopaedic clinical practice is still in its experimental phase.
Biomechanical studies of human hips based on the analysis of 2-D pelvic radiographs
have turned out to be a reasonable compromise between the measurement accuracy and the
feasibility in clinical setting. Clinical studies have shown significantly higher values of hip
stress in adult dysplastic hips when compared to normal hips. It has been found that the
cumulative hip stress independently predicts the WOMAC score after 29-years of follow up
in dysplastic hips and does so better than morphological radiographic parameters of hip
dysplasia or the resultant hip force alone. The preoperative value of the contact hip stress and
the magnitude of its operative correction have been found predictors of the long term success
of the Bernese periacetabular osteotomy. Elevated shear stress in femoral neck, but not
elevated hip contact stress, has been found to be a risk factor for slipping of the capital
femoral epiphysis. A statistically significant correlation between the contact hip stress and the
age at the total arthroplasty has been shown in a group of hips with idiopathic hip
osteoarthritis.
Through advances in 3-D imaging with MRI and CAT scan, visualisation of the femoral
head coverage and pelvic muscle attachment points has improved considerably. However, the
need to supplement the morphological hip status with biomechanical analysis remains. The
current trend is to combine the kinetic gait measurements of the resultant hip force with 3-D
imaging of the hip weight-bearing surface in order to better estimate the contact hip stress for
a given activity/body position. The added value of such measurements over 2-D pelvic
radiograph analysis has not been established yet in clinical trials.
Chapter 11 - Resistance exercise has long been used to promote musculoskeletal health
with the application of training regimens for the clinical treatment and prevention of low back
pain growing in popularity over the last couple of decades. A variety of exercise modes have
been utilized in an attempt to stimulate and promote increases in muscle function of the
lumbar extensors. This chapter examines the current state of knowledge regarding the
application of external pelvic fixation during trunk extension exercise and its importance on
the concomitant increase of functional outcomes such as muscle strength, muscle activation
patterns and compensatory muscle growth.
Chapter 12 - Most revisions of total joint replacements are due to implant loosening,
which is mainly caused by wear particles (wear disease) and inadequate primary implant
stability. The optimised integration of cementless total hip and knee endoprostheses into the
bone stock is the most adequate approach to achieve secondary implant stability and to
prevent implant loosening. Secondary stability is characterized by bone ingrowth of the
implant and decreases the amount of relative implant motion between the implant and bone
stock. It has also been suggested that prostheses which are fully occupied by bone cells are
less susceptible to infection. The economic impact of implant loosening is immense, hence
orthopaedic implant manufactures refine their products continuously.
Many technical developments have improved the survival rate of endoprosthetic
implants. Modern materials and surface modifications such as coatings help to reduce wear
rates, promote cell ongrowth or prevent infections. The cell adhesion of bone cells onto
implant surfaces has not been thoroughly investigated so far. However, different methods to
measure cell adhesion have been described. Some workgroups investigate short-term
adhesion or proliferation of bone cells on implant materials in-vitro, but little is known about
the long-term adhesion. Proliferation or short-term adhesion cannot predict how strong the
xii Jerrod H. Levy
bonding between bone and implant will be. In most cases, cost intensive animal studies have
to be performed in order to gain expressive data. Hence, it is important to assess the bone cell
adhesion forces in an adequate experimental setup in- vitro.
The exploration of bone cell adhesion on surfaces of orthopaedic implants encourages the
development of bio-compatible, bio-active and anti-infectious surfaces. The authors have
developed a test device, based on the spinning disc principle, which allows quantitative
measurements of osteoblastic cells on implant surfaces. First results show differences in
adhesion forces depending on the substrate. In future assessments different bio-active and
anti-infectious surface modifications will be analyzed regarding bone cell adhesion prior to
animal studies.
Chapter 13 � The aim of this chapter was to establish and compare the patterns expressed
on the fast model of motor learning of children and adults executing a fast and accurate task.
The acquisition of a new motor skill follows two distinct stages with continued practice:
first, there is an early, fast learning stage in which performance improves rapidly within a
single training session; later, there is a slower learning stage within the time period of several
sessions of practice. Motor learning is characterized by a specific set of changes in
performance parameters. These changes occur gradually in the course of a learning period.
While the decreases or increases in these parameters have been documented in a variety of
tasks, it remains to be determined whether the time of fast learning is different for children
and adults. Therefore the main aim of this study was to establish if there are differences in
reaction time, average and maximal velocity, trajectory, and accuracy as well as the
variability of these parameters during motor learning. The tasks involved 5 series with 20
repetitions in each.
Chapter 14 � Fit is one of the most critical factors affecting footwear comfort. Blistering,
chafing, bunions and pain may be the result of poor fitting shoes. In long run, it may cause the
foot skeleton deformity.
In order to find out the proper fitting of footwear, it involves getting to know the size of
feet, shoes, and the subjective perception for the shoes selection. Traditional method in
measuring the feet size is to measure the length and width of the feet which can be obtained
easily by tape measure and devices like Brannock. However these are considered to be
insufficient for good footwear fitting. Furthermore, researchers were also encountering
problem in quantifying fit as it is rather subjective which was also suggested to be affected by
shoe wearing experience such as tightness and looseness of the shoes. Therefore researchers
are exploring new method in measuring footwear fit, both objectively and subjectively.
Chapter 15 � Usually, biomechanical models used for human motion analysis are
oversimplified, especially for clinical analyses (Helen Hayes model). The calculated net
joint forces and torques are sensitive to the input data: segment kinematics and body segment
inertial parameters. It is therefore necessary to improve these input data using new methods
and models adapted to the population and movement of interest. The general problem is
divided into three parts: (i) minimization of soft tissue artefacts, (ii) joint centre location and
(iii) identification of the personalized body segment parameters.
In: Biomechanics: Principles, Trends and Applications ISBN: 978-1-60741-394-3
Editor: Jerrod H. Levy, pp. 1-55 � 2010 Nova Science Publishers, Inc.
Chapter 1
ARTS BIOMECHANICS � AN INFANT SCIENCE:
ITS CHALLENGES AND FUTURE
Gongbing Shan and Peter Visentin
1Department of Kinesiology,
2Department of Music,
University of Lethbridge,
4401 University Drive, Lethbridge, Alberta. Canada, T1K 3M4
1. OVERVIEW
While biomechanics has achieved successes in many fields involving locomotion, motor
learning, skill acquisition, technique optimization, injury prevention, physical therapy and
rehabilitation, one area has heretofore been scarcely represented in the literature � Arts
Biomechanics. Biomechanics clearly has significant potential for application in the
performance arts, such as music and dance, since skills needed for these activities are visibly
related to the human musculoskeletal and nervous systems. In such areas, Arts Biomechanics
should begin by focusing on skill analyses and acquisition necessary for the performance of
the artistic act. Subsequently it should engage in a deeper discourse that explores the
relationship between these and the desired aesthetic outcome. Less apparently, biomechanics
may also enhance the analysis and comprehension of other arts, such as painting, where
gesture is often embedded in the artwork by means of symbolism, tradition, the process of art
creation, or as an inherent product of the existential nature of humanity.
There are many challenges facing the integration of the Sciences with the Arts. On a
fundamental level, the principles and goals of one often seem at odds with the other. In
reality, neither science nor art is antithetical to the other.
"The most beautiful experience we can have is the mysterious. It is the fundamental
emotion that stands at the cradle of true art and true science. Whoever does not know it and
can no longer wonder, no longer marvel, is as good as dead, and his eyes are dimmed. It was
Ph: (403) 329-2683, e-mail: g.shan@uleth.ca
2 Gongbing Shan and Peter Visentin
the experience of mystery -- even if mixed with fear -- that engendered religion. A knowledge
of the existence of something we cannot penetrate, our perceptions of the profoundest reason
and the most radiant beauty, which only in their most primitive forms are accessible to our
minds...I am satisfied with the mystery of life's eternity and with a knowledge, a sense, of the
marvelous structure of existence -- as well as the humble attempt to understand even a tiny
portion of the Reason that manifests itself in nature."(Einstein, 1931)
However, the self-perceptions of artists and scientists may be problematic. Scientists take
reductionist and reasoned approaches to the world: there is a position/argument; it is
structured in logical steps; a topic sentence names and proves each idea in the discourse; and,
the discourse is aimed at a specific result. For the scientist, these give feelings of comfort,
power, and/or control over the phenomenon. Conversely, the artist is less interested in the
factual and desires to convey the emotional and sensual; reductionist, topical arguments are
considered antithetical to the creation of good art; too precisely formulated a conceptual
structure is perceived as negating mystery and limiting artistic possibilities; and, the result is a
product of the moment � an ever shifting target in time-based performance art. Repeatability
is only a desirable quality in that it can be a measure of skill level. Hence it shows little in
terms of creative ability. The artist wants power and control over others` perceptions of the
phenomenon; each individual audient`s experience of the art responding to and thus
validating the artwork and, by extension, the artist. Perhaps it is the way in which scientists
and artists perceive their own roles that a binary view pervades their respective disciplines �
something is or isn`t. Given this seeming dichotomy, the question arises Why bother with
Arts Biomechanics?
The issue that provides the main inertia to expand this nascent field of biomechanics
comes from artists. It is a medical one. Epidemic rates of debilitating injury (48-76%) occur
in performing arts such as music and dance (Brown, 1997; Fry, 1986, 1987, 1988; Fry, Ross,
and Rutherford, 1988; Hagglund, 1996; Hartsell and Tata, 1991; Lockwood, 1988;
Middlestadt and Fischbein, 1989; Zaza, 1992, 1998). Unfortunately, there is currently little
quantitative research examining the aetiology of performance injuries. Existing strategies to
address injuries are largely qualitative and experience based. And they are normally
employed only after injury has occurred. Even as artists are becoming increasingly aware
regarding their physical needs, career longevity and injury downtime are becoming pervading
arts industrial issues. Only recently have researchers begun to explore scientific approaches,
such as human performance engineering, to trace causal factors related to human bone,
muscle, and nervous systems injuries in the performing arts (Chesky, Kondraske, Henoch,
Hipple, and Rubin, 2002; W. J. Dawson, 2003, 2007; Solomon and Solomon, 2004). Finally,
artists themselves are slowly turning toward science to provide preventative answers and not
merely remedial ones. From a phenomenological point of view, the performing arts share
many characteristics, including health risks, in common with other skill-oriented activities
(Chesky et al., 2002; Lehmann and Davidson, 2002; Wilson, 1986). Commonalities between
athletic and artistic performance seem obvious, particularly in the area of motor skill analysis,
acquisition during skill learning and performance. Like athletes, elite musicians practice, with
many hours of repetition, to perfect complex motor control sequences. However, music
students are seldom introduced to basic principles of movement science and physiology that
underpin that activity. This is largely because the focus of music teaching is artistic and
outcome driven rather than process oriented � this is a difference between practicing and
Arts Biomechanics � An Infant Science 3
training. While some teachers are knowledgeable regarding efficient use of the body for the
benefit of good performance, many are not. In many parts of the world, classical musicians
today are taught in a manner virtually indistinguishable from that used 50 years ago. Nowhere
in the world could the same be said for elite sport.
As such, it seems logical to build on the successes of Sports Biomechanics in the service
of the Arts. Motor learning, skill acquisition and learning while minimizing injuries constitute
the main research focuses of Sports Biomechanics (Ballreich and Baumann, 1996). However,
there is a fundamental ethical difference between these two fields. Whereas Sports
Biomechanics typically directs is energies to achieving specific, goal-driven, quantifiable
results that are valued for their repeatability (e.g. faster, higher, stronger, etc.), Arts
Biomechanics must be satisfied with guiding the process without appearing to identify an
absolute goal � for reasons of artistic and creative freedom. The emphasis of each is on
training, but Arts Biomechanics needs to contribute to a demystification of the learning and
skill acquisition processes, so that artists can realize their full potential and survive their
chosen vocation.
My early love affair with dance gradually had been replaced by a struggle to become
what I could not be. I had selected teachers who felt it was their responsibility to tell me over
and over what was wrong, rather than helping me generate the knowledge that would give me
tools to make things right (Evans, 2003)
Clearly, the need to consider artistic values as well as scientific ones creates particular
challenges for the field of Arts Biomechanics. Facing these challenges is, in our opinion, best
served by a multidisciplinary approach � one where research does not simply adopt a
scientific or artistic practice, but engages in discussion that ultimately transcends the
viewpoint of each discipline. Meaningful and relevant research results will be those where
science informs artistry rather than attempting to modify it. Currently, music and dance are
the two dominant areas of biomechanics research in the arts. For this reason, discourse below
will primarily focus on these disciplines. The main effort of this chapter is to summarize the
state of Arts Biomechanics in the following areas: 1) skill analysis, acquisition and pedagogy,
2) injury risk identification, quantification, prevention and compensation strategies, and 3)
Innovative uses of the tools of movement science in the analysis and creation of art. Further,
this chapter will provide discussion that identifies some of the challenges facing Art
Biomechanics, elaborate on its potential and identify some future directions.
2. PERFORMANCE SKILL ANALYSIS AND ACQUISITION
2.1. Historical Overview
Documentation pertaining to instrumental performance and dance has a long history. In
terms of modern classical performance traditions, documentation that incorporates
information on mechanics and motor skills begins as early as the 16th century for instrumental
performance and the 17th century for dance (Hilton, 1997; Kolneder, 1993). Its very existence
can be considered evidence of a general desire to improve overall quality of music/dance
performance, both stylistically and technically. Most of the documents are pedagogical in
4 Gongbing Shan and Peter Visentin
nature and they are clearly not targeted at the mature or virtuoso performer. For example, in
his seminal treatise on learning to play the keyboard, Carl Phillip Emanuel Bach clearly states
his intent.
...keyboard instruction could be improved in certain respects to the end that the truly
good which is lacking in so much music, but particularly keyboard music, might thereby
become more widespread. The most accomplished performers, those whose playing might
prove instructive, are not to be found in such numbers as might perhaps be imagined. (Bach,
1759)
In terms of classical dance, the beginnings of ballet and classical notation are associated
with the Court of Louis XIV of France (1639-1714) (Hilton, 1997). Iconography, dance
manuals and descriptions of the desired aesthetic provide some of the first rudimentary
(bio)mechanics information for analysis and acquisition of dance skills (Figure 1 and 2).
Figure 1. Choreography of a Minuet providing rudimentary instruction on placing the feet. The original
source is from an English dance manual by Kellam Tomlinson, and documents the influence of French
culture in the 18th century.
Arts Biomechanics � An Infant Science 5
Figure 2. A choreography of steps from Balet de Neuf Danseurs by Feuillet. Paris, 1700.
Collectively, such sources contain fundamental instruction on music/dance and their
contemporary aesthetic goals. They include postural descriptions, instruction pertaining to
skill acquisition such as: fingerings in basic positions, embouchure (for wind instruments) and
bowing techniques (for strings), and they describe the phenomenology of physically
interacting with a musical instrument (how to hold it, the consequences of certain muscular
tensions, tablatures revealing mechanical insights, etc.). Choreographed movement in dance
also create a gestural map for both the performer and dancer, since the music must maintain
aesthetic of bodiliness required in dancing (Bach, 1759; Hilton, 1997; Mozart, 1756; Quantz,
1752; Tromlitz, 1791). Clearly, these point to an awareness of the mechanics of the human-
tool interface, whether that interaction is with an instrument or a physical space.
6 Gongbing Shan and Peter Visentin
Further, almost on a century-by-century basis, one can observe a progression to more and
more systematic approaches toward artistic performance. Documentation pertaining to violin
performance can be considered exemplary in this regard. Earliest documentation, from the
16th century, was descriptive, providing relatively little instruction on technique. The 17th
Century included some of the earliest tutors. They contained fundamental postural
descriptions and instruction on music basics: string tunings, fingerings in basic positions,
elementary bowing techniques. Included are some instructions on bow direction, accents, and
attempts to describe articulations and expression. Tablatures (musical fingering charts)
revealed insights into pedagogy. Information on style and technique may also be gathered
from music that incorporated performance indications by the composer. The 18th Century rise
of a middle class and a corresponding increased interest in education lead to maturation of
instruction methods and pedagogy. More methods and music were published. Contents
became more detailed with broader variety of musical examples and more instructions how to
coordinate techniques in order to play expressively. Some compositions dealt with specific
technical difficulties or material for specific skill acquisition.
The 19th Century showed evidence of a paradigm shift (Baillot, 1835). There was a move
from general education and a collective consciousness to a focus on individual training and
virtuosity. The period marked the beginnings of music pedagogy as a science.
Figure 3. Position of the right arm and wrist held closer to the body when the violinist plays sitting
down. The neck of the violin is then held slightly lower. Position of the hand, wrist and fourth finger in
extensions (top-right). Forced and improper position of the hand, wrist and fourth finger in extensions
(bottom-right).
Arts Biomechanics � An Infant Science 7
Documentation used a new tone emphasizing the development of technique as a means to
achieve the highest degrees of artistry. The focus was on technical training (Figure 3). During
the period, a gradual increase in notion of finding the best way to practice can be observed.
Some writers advocated a mechanical approach to the instrument with attempts to apply
scientific methods to describe these mechanics. Others began to approach the subject of
performance psychology. Regarding anatomy and physiology, methods to this point may be
summarized as rudimentary. They were experience/practitioner-based with superficial
descriptions of postures or (bio)mechanics (Baillot, 1835). Attempts to include an
understanding of anatomy and physiology were a development of late 19th and early 20th
centuries.
Over the course of the 20th century, there was a continued development of systematic
teaching methods. Also, there was an increasing trend toward learning from the standpoint of
different disciplines: physiology, psychology, (bio)mechanics. Some training exercises were
developed (at times by individuals who may have had little to no practical experience
playing music � e.g. medical doctors, physiology professors) that pushed mechanics to
conceptual and physiological limits. As can be seen in Figures 4-6, the body was typically
treated as a machine which could be trained, or programmed, through repeated and structured
movement variations (Hodgson, 1958).
Most 20th-century writings that attempted to document teaching methods of successful
practitioner/pedagogues failed to deal with fundamental psyco-physiological learning,
biomechanics, or neural control except in superficial terms (G. B. Shan, Visentin,
Wooldridge, Wang, and Connolly, 2007). For example, after mentioning postural or internal
motor control factors in general terms, most typically continue with experience-based
description of techniques and their application in selected passages of repertoire. Thus, they
are written in such a way that only those who have experience with the phenomenon and the
aural tradition being described can sympathize with the descriptions.
Figure 4. Illustration considering the curve which results from the identified ordering of notes, while
using a down bow. The two dotted lines give variations in the track followed by the hand.
---
[Cuối tài liệu]
Index 397
oxides, 125 periodontal, 118, 124
oxygen, 61, 81, 122 periodontium, 118, 135
peripheral nerve, 214, 215, 216, 217, 223, 224,
P
225
pain, viii, ix, xi, xii, 12, 20, 26, 35, 137, 139, 141, peristalsis, 161, 165, 170, 194, 197
155, 158, 159, 161, 163, 170, 174, 182, 186, permeability, 160, 203
188, 196, 202, 224, 231, 288, 295, 296, 298, perturbation, ix, 233, 234, 236, 237, 239, 240,
299, 300, 301, 302, 303, 317, 320, 321
241, 247
pain management, 300 perturbations, 243, 244, 245
pancreas transplant, 158 pH, 221, 226
pancreatic, 139, 175, 193 pharmacotherapy, 139
pancreatic insufficiency, 139 pharynx, 188
paradigm shift, 6 phenomenology, 5
parameter, 30, 32, 33, 89, 91, 190, 236, 252, 256, Philadelphia, 248, 259
philosophical, 10
264, 290, 377, 378, 380, 381 phosphate, 125, 126, 128, 132, 133, 306
parameter estimation, 378 photon, 259
parathyroid, 135 physical activity, 49, 226, 291
parathyroid hormone, 135 physical environment, 164
Paris, 5, 50, 350, 382 physical health, 9
Parkinson, 188, 199 physical properties, 115, 123, 276
particles, xi, 126, 131, 132, 255, 305 physical therapy, 1, 222, 248
passenger, 50 physics, 17, 28, 29, 280
passive, viii, 16, 138, 144, 153, 163, 165, 168, physiological, ix, 7, 10, 11, 18, 24, 26, 27, 30, 32,
172, 175, 176, 178, 183, 201, 202 37, 61, 112, 119, 127, 151, 153, 163, 164, 168,
patella, 353 174, 175, 177, 178, 183, 198, 200, 208, 209,
pathogenesis, viii, ix, 137, 138, 142, 152, 154, 211, 219, 221, 223, 227, 284
physiological factors, 221
159, 163, 182, 263, 301 physiologists, 221
pathogenic, 125 physiology, 2, 7, 153, 158, 164, 193, 198, 203,
pathology, 27, 155, 222, 286, 294 209, 217, 223, 226
pathophysiological, 178 physiotherapy, 303
pathophysiology, 152, 156, 164, 193, 196, 234, piezoelectric, 105
pilot study, 134, 135
244, 245 pitch, x, 19, 20, 35, 267, 268, 269, 270, 272, 273,
pathways, 152, 157, 164, 177, 182, 186, 189, 275
placebo, 161
207, 217, 224 planar, 45, 275
patterning, 176 planning, viii, 14, 20, 57, 89, 102, 252, 290
PCT, 63, 66, 100, 102 plantar, 243, 244, 322, 324, 325, 349
pedagogical, 3, 9, 10, 11, 12, 13, 14, 15, 20, 22, plasma, 126, 127, 131, 132, 134, 150, 306
plasticity, 220, 226, 230
23, 34, 53 platforms, 20
pedagogy, 3, 6, 9, 10, 11, 12, 14, 20, 22, 24, 25, plexus, 142, 156, 158
PMMA, 132
26, 34, 35, 279 POAG, 256
pediatric, 289 Poisson, 66, 84, 116
PEEK, 124, 132, 308 polyetheretherketone, 308
pelvic, xi, 224, 227, 281, 282, 283, 287, 288, 289, polyetheretherketone (PEEK), 308
polyethylene, 124
291, 292, 295, 296, 297, 298, 299, 300, 302 polymer, 124, 132, 306
pelvis, 186, 239, 293, 297, 300, 355, 357, 366 polymeric materials, 124
pendulum, 235 polymers, 122, 124
Pennsylvania, 248
peptide, 150, 155
peptides, 155, 161
perceptions, 2, 14, 15, 22, 26, 50
perforation, 139
performers, 4, 12, 13, 14, 15, 20, 22, 24, 26, 34,
35, 36, 38, 269, 270, 274, 279
398 Index
polymyositis, 223 proteoglycans, 59, 104, 105, 307
polynomial, 75 protocol, 19, 20, 35, 119, 221, 258, 296, 298,
poor, ix, xii, 12, 15, 119, 125, 224, 233, 300, 317,
299, 318, 324, 330, 344, 354, 357, 369, 379
320, 347 protocols, 18, 245, 258, 300, 353
population, xii, 138, 261, 286, 287, 289, 291, prototype, 282
proxy, 48, 166
298, 321, 351, 352, 355, 381 pseudo, 139, 367, 368, 380
pores, 107, 130 psychiatric disorder, 229
porosity, 124, 132 psychiatric disorders, 229
porous, 130, 133 psychology, 7, 54
portal vein, 197 pubis, 355
postoperative, 290 public health, 138
postsynaptic, 216, 217 pulse, x, 99, 216, 217, 218, 219, 221, 226, 251,
postural instability, 246
posture, x, 23, 35, 44, 234, 235, 236, 243, 244, 255
PUMA, 368
247, 248, 267, 269, 275, 276, 277, 329 pumping, 61
potassium, 209, 211, 221 pylorus, 141, 176, 194
power, 2, 11, 39, 44, 45, 48, 58, 71, 174, 176, pyramidal, 219
214, 221, 222, 226, 227, 231, 251, 263, 303, Q
346, 347, 349
powers, 36 quadriceps, 227
pragmatic, 303 quality of life, 138, 160
pre-clinical, 124, 283, 292 quantitative research, 2, 10, 11, 21, 22, 27, 36
predictability, 257 quantitative technique, 26
prediction, 90, 323, 342, 346, 347, 378 quasi-linear, 174, 186
predictive model, viii, 57
predictors, xi, 226, 281, 294, 340, 341, 342, 343 R
press, 38, 265, 306, 349
presynaptic, 216, 217 radial distance, 308
prevention, vii, xi, 1, 3, 11, 12, 15, 20, 26, 27, 32, radial keratotomy, 109
34, 35, 36, 53, 295, 301, 303, 349 radiation, 178, 186, 234
primary care, 349 radiation therapy, 186
primary open-angle glaucoma, 262 radiography, 37, 284
primates, 107 radiological, 289, 303
proactive, 236 radiopaque, 141, 157
probe, 140, 166, 176, 186, 201, 253 radiotherapy, 186
production, ix, 20, 35, 139, 210, 233, 234, 237, radius, 61, 62, 66, 69, 90, 92, 176, 255, 283, 284,
239, 243, 244, 245, 246, 247, 272, 296, 300,
302, 319 286, 287, 288, 364, 367
professions, 222, 325 RAGE, 155, 160
prognosis, 228, 231 random, 18, 252, 355, 362, 364
program, 98, 287, 301 ratings, 318, 323, 324, 335, 336, 337, 346
programming, vii, 57, 248 reaction time, xii, 315
prolapse, 189, 196 reactivity, 125, 182
proliferation, viii, xi, 120, 129, 137, 142, 151, real time, 49, 318, 347, 353
305, 307 reality, 1, 29, 34, 42, 57, 91
propagation, 221, 228 receptive relaxation, 176, 188
prostheses, xi, 129, 130, 133, 134, 136, 305 receptors, 151, 152, 154, 159, 161, 177, 189, 218,
prosthesis, 112, 113, 114, 122, 131
protection, 172 219, 229, 312
protein, 151, 154, 155, 179, 184, 195 reconstruction, 16, 45, 47, 190, 366, 367
protein synthesis, 155, 195 recovery, 27, 32, 33, 181, 184, 220, 223, 224,
proteins, 51, 151, 158, 159, 186, 195, 199, 299,
307 226, 231, 236, 237, 240, 241, 242, 243, 244,
245, 246, 248, 262, 298, 303
rectal prolapse, 189, 196
rectification, 18, 214
Index 399
rectum, 161, 174, 175, 177, 186, 188, 190, 195, rigidity, 118, 189, 251, 253, 254, 255, 256, 263,
196, 197, 198, 202 264, 346
rectus abdominis, 19, 20 rings, 90, 167, 170, 176, 177
recurrence, 140 risk, xi, 3, 13, 20, 26, 31, 32, 33, 34, 35, 36, 53,
red light, 332, 333
redundancy, 366, 367 125, 164, 254, 256, 258, 262, 281, 288, 289,
reference frame, 357, 361, 364, 365, 366, 369, 290, 291, 293, 294, 306, 321, 349
risk assessment, 31, 32, 53, 349
370, 372 risk factors, 254, 288, 289
reflexes, 142, 160, 216, 248 risk management, 20, 34, 35, 36
refractive index, 58 risks, 2, 34
refractory, 199 robotics, 201, 378
regeneration, 36, 119 rotations, 275, 353, 380, 382
regional, 103, 168, 204 rotator cuff, 26
regression, 54, 183, 185, 322, 323, 334, 339, 340, Royal Society, 109
Rutherford, 2, 51
341, 342, 343, 346, 347, 348, 349, 353, 355,
381 S
regression analysis, 183, 185
regression equation, 323, 341, 342, 346, 347, sacrum, 239
348, 353, 355 Salen, 130
rehabilitation, vii, ix, 1, 220, 222, 231, 233, 245, sapphire, 131
298, 301, 302, 303 SARA, 355
relaxation, 59, 74, 84, 85, 86, 87, 148, 151, 159, scaffolding, 124
172, 174, 176, 177, 183, 185, 186, 188, 195, scaling, 282
201, 204, 270, 299, 302 scalp, 220, 221
relaxation processes, 151 scapula, 355, 374
relaxation rate, 86 scattering, 105
relaxation time, 299, 302 Schmid, 203
relevance, 38, 49, 107, 264, 301 school, 51, 52, 55
reliability, 67, 91, 110, 318, 330, 334, 335, 344, scientific method, 7, 15
377, 380 sclera, 66, 89, 90, 93, 103, 106, 108, 110, 259
REM, 228 scleroderma, 189, 201
remediation, 12, 14, 27, 34, 36 sclerosis, 159, 178, 179, 185, 202, 224
remodelling, 63, 127, 161, 162, 164, 178, 179, sclerotherapy, 181, 197, 199
180, 184, 186, 187, 188, 189, 195, 204, 205 search, 253, 361
repeatability, 3, 20, 330, 344 searching, 35, 377
repetitions, xii, 300, 315 secondary schools, 51
research design, 225 secretion, 164
resection, 178, 179, 185, 195 segmentation, 190
reservoir, 71, 72, 172 seizure, 18
resilience, 120 self-awareness, 34
resin, 124, 129, 130 self-perceptions, 2, 26
resistance, x, 60, 61, 63, 91, 97, 107, 120, 122, self-report, 288
125, 176, 188, 189, 203, 226, 251, 252, 256, SEM, 135
264, 265, 268, 296, 297, 298, 299, 300, 301, semiconductor, 325
302, 306 sensation, 152, 170, 186, 202, 321, 330, 347
resolution, 71, 175, 201, 215, 258, 303, 353, 369, sensations, 156
376 sensitivity, 18, 94, 141, 182, 202, 258, 344, 345,
retention, 141
retinal detachment, 254, 262 346, 378
rheological properties, 194 sensitization, 182
rhythm, 296, 300 sensors, 20, 53, 117, 270, 318, 323, 326, 330,
riboflavin, 109
331, 332, 333, 341, 342, 343, 347, 348, 349,
351
sensory nerves, 141
400 Index
separation, 86, 223, 235, 246, 247 smoothness, 44
serum, 310 sodium, 209, 211
severity, 55, 140, 156, 186, 222, 287, 301 soleus, 215, 231
sex, 115, 204, 259, 321 sol-gel, 126, 128, 131, 135
shape, 13, 58, 61, 62, 90, 92, 93, 112, 118, 119, solid waste, 165
solidification, 364, 379, 381
176, 211, 226, 251, 252, 255, 284, 286, 289, solid-state, 270
291, 292, 307, 317, 319, 322, 323, 325, 345, spastic, ix, 230, 233, 234, 235, 236, 238, 243,
347, 349, 375, 376
sharing, 127 244, 245, 247, 248, 249
shear, xi, 59, 83, 84, 96, 116, 127, 143, 166, 180, spasticity, 243
281, 290, 307, 308, 311 spatial, ix, x, 21, 43, 48, 170, 175, 176, 208, 213,
shear deformation, 166
shear strength, 127 216, 220, 233, 243, 244, 267, 269, 274, 275,
sheep, 131, 194 276, 277, 351, 379, 382
Shell, 104, 105 spatial location, 208, 220
shoulder, x, 23, 25, 26, 35, 45, 53, 224, 228, 267, species, 60, 115, 168
269, 271, 275, 364, 366 specificity, 221, 302
side effects, 139 spectrum, 122, 214, 221, 222, 226, 227, 230, 288
sigmoid colon, 142, 174, 188, 190, 191, 196, 202 speed, ix, 11, 23, 39, 44, 45, 48, 71, 103, 233,
signal transduction, 117, 164 237, 243, 244, 248, 310, 316, 324
signals, ix, 18, 21, 27, 29, 50, 117, 193, 207, 208, spheres, 366
209, 211, 212, 213, 214, 218, 221, 223, 224, sphincter, 140, 175, 176, 177, 188, 189, 193, 194,
225, 229, 236, 239, 259 195, 196, 197, 198, 199, 201, 202, 203, 204,
signal-to-noise ratio, 208 205
signs, 51, 289 spinal cord, 207, 216, 217, 221, 223, 231
silica, 126, 131 spinal cord injury, 231
silicate, 135 spindle, 216
similarity, 74, 276 spine, 239, 295, 296, 303
simulation, vii, ix, 57, 58, 59, 79, 83, 87, 91, 93, spondylolisthesis, 303
98, 99, 101, 102, 103, 104, 106, 128, 163, 164, spondylolysis, 303
205, 208, 356, 362, 379 spontaneous recovery, 220
simulations, 83, 89, 94, 97, 102, 103, 199, 200, SPSS, 333, 334
349 stability, ix, xi, 44, 49, 125, 130, 132, 233, 234,
singular, 236 241, 244, 245, 246, 251, 295, 299, 305, 306,
sintering, 130, 283 311
sites, 119, 161, 162, 206, 220, 223 stabilization, 297, 298, 301, 302, 303
skeletal muscle, ix, 52, 54, 55, 207, 209, 220, stabilize, 272
226, 227, 230, 298, 299 stages, xii, 10, 11, 13, 14, 25, 27, 36, 86, 99, 101,
skeleton, xii, 317, 320, 354 286, 307, 311, 315
skill acquisition, vii, 1, 3, 5, 6, 9, 11, 12, 13, 15, stainless steel, 123, 126, 308
25, 26, 36 standard deviation, 62, 214
skills, vii, ix, 1, 3, 4, 9, 11, 13, 14, 15, 17, 21, 22, standard error, 240, 356
25, 26, 48, 52, 233, 234, 246, 279 standard model, 352
skin, 16, 18, 31, 52, 209, 225, 239, 270, 351, 353, standardized testing, 127
354, 355, 356, 357, 362, 367, 377, 378, 380, starvation, 183, 195
381 statistical analysis, 83, 85, 86, 334
slipped capital femoral epiphysis, 290, 294 steady state, 236, 256
Slovenia, 281 steatorrhea, 139
SMA, 293 steel, 123, 126, 308
smooth muscle, 144, 159, 174, 176, 177, 185, stem cells, 312
186, 196, 197, 198, 199, 200, 201 stimulus, 215, 217, 218, 219, 220, 221, 226
smooth muscle cells, 177, 198 stomach, 138, 139, 141, 144, 145, 157, 160, 161,
smoothing, 357, 377, 380 165, 168, 170, 175, 176, 177, 182, 188, 190,
192, 194, 199, 200, 201, 203, 205
Index 401
strains, 67, 68, 105, 165, 170, 171, 174, 180, 182, thoracic, 139, 158
205, 258 thorax, 16, 374
threat, ix, 10, 233, 234, 235, 236, 237, 239
strategies, ix, 2, 3, 11, 14, 15, 26, 27, 32, 34, 53, threats, 10, 237, 239, 241, 243, 247
136, 154, 228, 233, 234, 236, 237, 244, 245, three-dimensional, 54, 105, 106, 128, 145, 168,
246, 247
170, 172, 174, 177, 182, 198, 200, 282, 284,
stress level, 94, 98, 177, 185, 186 291
stress-strain curves, 79, 147, 150, 165, 168, 169, threshold, 152, 161, 170, 189, 215, 218, 219, 228,
239, 240, 241, 242, 243, 344
175, 181, 183, 185 threshold level, 215, 219
stromal, 59, 60, 61, 63, 65, 74, 80, 82, 83, 84, 96, thresholds, 44, 140, 182, 204, 216
tibia, 130
97, 102, 103, 107, 252, 254, 259, 266 time consuming, 90, 376
subjective experience, 10 time pressure, 204, 347
subluxation, 288, 292, 293 timing, 17, 18, 21, 119, 208, 212, 215, 224, 270
subjective, xii, 10, 25, 26, 38, 223, 317, 318, 319, TiO2, 125, 135, 307
tissue engineering, 124
322, 323, 324, 325, 328, 330, 333, 334, 339, tissue homeostasis, viii, 137
submucosa, 142, 143, 144, 149, 153, 166, 167, titania, 128
titanium, 122, 124, 125, 126, 128, 129, 130, 132,
168, 172, 174, 180, 182 133, 134, 135, 136, 306, 310
substances, 110, 124 titanium dioxide, 307
subcutaneous tissue, 211 tonic, 153, 174, 177
subcutaneous injection, 161 tonometry, viii, 57, 58, 89, 102, 103, 107, 110,
supramaximal, 214, 215, 216 253, 254, 255, 259, 261, 262, 263, 265
surface tension, 84, 145, 253 topographic, viii, 57, 108
surgical, 89, 105, 133, 155, 164, 193, 252, 257, torque, ix, 233, 236, 237, 239, 241, 242, 243,
244, 245, 248, 296, 299, 302, 352
289, 294, 298, 306 total joint replacements, xi, 305
surgical intervention, 89, 252 trabeculae, 117
stroke, 224, 226, 231, 276 trabecular bone, 116, 135
survival rate, xi, 305, 306, 311 traction, 188
susceptibility, 55, 254 training, x, xi, xii, 3, 6, 7, 11, 12, 13, 15, 18, 20,
swallowing, 131, 175, 188, 199, 204 48, 53, 226, 227, 228, 234, 237, 245, 246, 270,
swelling, 60, 61, 63, 65, 81, 103, 252, 259, 262 295, 297, 298, 299, 301, 302, 303, 315
symptoms, viii, 137, 138, 139, 140, 141, 142, training programs, 301
trajectory, xii, 44, 45, 46, 47, 48, 269, 315
145, 152, 154, 157, 158, 159, 160, 161, 182, transcranial magnetic stimulation, ix, 207, 224,
202, 222, 288, 289 226, 230, 231
synchronization, 211 transducer, 71, 166
synchronous, 214, 216 transduction, 117, 129, 161, 164
syndrome, 26, 51, 155, 188, 196, 202, 263 transfer, 12, 13, 15, 20, 34, 112, 118, 128, 136
synergistic, 235, 298, 299, 300 transformation, 379, 382
synthesis, 52, 150, 155, 195, 248 transition, 63, 277
systemic sclerosis, 159, 178, 185, 202 translation, 16, 234, 356, 357, 358, 361, 364, 365,
366, 372
T translational, 372
transmembrane, 209
tensile, 83, 84, 105, 106, 109, 119, 120, 122, 127, transmission, viii, 111, 112, 122, 131
132, 171, 173, 174, 254, 255 transplantation, 136, 158
transport, 50, 61, 141, 158, 165, 166, 172, 175,
tensile strength, 83, 84, 106, 109, 127, 174, 254, 199, 205
255 transverse colon, 174, 186
tensile stress, 172
tensile, 83, 84, 105, 106, 109, 119, 120, 122, 127,
132, 171, 173, 174, 254, 255
tensile strength, 83, 84, 106, 109, 127, 174, 254,
255
test-retest reliability, 335
therapeutic interventions, x, 234, 237, 244
therapy, 1, 150, 158, 186, 223, 227, 248, 293, 301
thermal expansion, 126
402 Index
trapezius, 224, 228 US Department of Health and Human Services,
trauma, 27, 32, 36, 37, 124, 293 301
trial, 15, 18, 19, 20, 24, 25, 35, 228, 239, 241,
V
263, 273, 278, 303, 321, 330, 332, 366, 367
tribological, 133 valgus, 320
triceps, 270, 271, 272 variability, xii, 26, 190, 214, 216, 224, 229, 230,
triggers, 273
trochanter, 282, 283, 286, 287, 353, 354 264, 270, 280, 282, 286, 315, 316, 367
tumor, 139, 151, 156 variables, 21, 30, 236, 248, 271, 316, 318, 324,
Turku, 111
two-dimensional, 291 339, 340, 341, 342, 343, 350
type 1 diabetes, 159, 202 vascular disease, 138
type 2 diabetes, 157, 160 vastus lateralis, 213
vector, 20, 112, 282, 357, 358, 361, 362, 364,
U
366, 368, 370, 372
UES, 175, 188, 201 vessels, 196, 197
ulcer, 139, 321, 349 veterans, 321, 350
ulceration, 320, 321 virtual reality, vii, 42, 57
ulcerative colitis, 186, 200, 202 viscoelastic properties, 74, 151, 174, 182, 186,
ultrasonography, 164, 170, 190, 197, 198, 200,
203
201 viscosity, 172, 175, 308
ultrasound, 37, 140, 141, 145, 152, 156, 164, 165, Visual Analogue Scale (VAS), 318, 319
170, 194, 199, 204, 205, 253, 258, 260, 261 W
ultrasound biomicroscopy, 260
uncertainty, 358, 366 walking, 215, 234, 235, 236, 246, 247, 249, 283,
underlying mechanisms, 220, 223, 280, 290 291, 292, 321, 324, 326, 330, 332, 335, 336,
uniaxial tension, 73, 87, 88 344, 362, 366, 367, 368, 376, 378, 379, 380
uniform, 65, 67, 71, 73, 74, 90, 91, 92, 93, 94, 95,
weakness, 13, 234, 243, 244, 245, 369
96, 97, 98, 165, 167, 168, 171, 180, 252, 286, wound healing, 103, 266
288, 293, 308
urinary, 224, 227 Z
zirconia, 128, 130, 132
zirconium, 128