Master of Science, The Ohio State University, 2023, Biomedical Engineering

Objective: The purpose of this thesis was to determine the degree of difference between anthropometric and heel pad tissue characteristics of the lower extremities of PMHS compared to living populations as well as to establish a wholistic procedure for extensive measurements of the foot using methodology previously used in lower limb anthropometry, x-ray imaging, and ultrasound imaging studies. Methods: Thirty-seven PMHS were included in the anthropometry analysis, 21 PMHS were included in the x-ray analysis, and 32 PMHS were included in the ultrasound analysis. For the anthropometry, measurements were taken in seated and standing positions and included bimalleolar breadth, heel breadth, navicular height (medial prominence), navicular height (inferior medial border), talar head height, plantar curvature height, lateral malleolar height, medial malleolar height, acropodion foot length, hallux foot length, horizontal foot breadth, ball of foot length, and dorsum height. Comparisons were then made between left and right feet, seated and standing positions, males and females, and PMHS and living populations. For the x-ray analysis, two of the anthropometry measurements, navicular height (inferior medial border) and talar head height, had values for anthropometry compared against measurements determined through x-ray imaging. For the ultrasound analysis, ultrasound images were taken of the plantar foot at the calcaneus at loadings of 0, 5, 10, 15, 20, and 30 Newtons. Thicknesses, stiffnesses, and compressibility indexes were determined using the images, and these values were then compared against values seen in living populations. Results: Left and right feet were found to have no significant differences in anthropometry. Seated and standing positions were found to be significantly different in 12 of the 13 measurements. Male values were found to be significantly different from female values in both seated and standing positions for all measurements except for plantar (open full item for complete abstract)

Committee: Randee Hunter (Committee Member); John Bolte IV (Advisor) Subjects: Biology; Biomechanics; Biomedical Engineering; Engineering

Master of Science, University of Akron, 2012, Biomedical Engineering

Intermittent pneumatic compression (IPC) devices have proven in the clinic to be a viable alternative to traditional prophylaxis for treatment of deep venous thrombosis (DVT). Yet, the physiological effect of IPC application is not entirely classified. A computational model of the lower leg circulatory system was developed to resolve a more complete understanding, and therefore improved treatment methods. IPC parameters were changed for each simulation, and resulting hemodynamic responses were recorded. The study concludes that wavelike compression, quick rise time, and high pressure application are parameters that are most effective to be used in IPC, because it allows the most efficient blood clearance from blood vessels. The salience of this model is that it can be adapted to individual patients. Modifying model parameters will offer a higher degree of IPC optimization, and ultimately customized treatment. This and other theoretical models give greater insight to the nature of blood flow, providing patients greater protection from DVT.

Committee: Narender Reddy Dr. (Advisor); Dale Mugler Dr. (Committee Member); Daniel Sheffer Dr. (Committee Member) Subjects: Biomedical Engineering; Biomedical Research

Doctor of Nursing Practice, Mount St. Joseph University , 2021, Department of Nursing

Vascular access therapy is a term used to describe accessing the intravascular space of patients, to infuse blood products and other medications as well as remove blood samples for testing. Having reliable vascular access is crucial for the treatment of ill pediatric patients. Providers have many options available when deciding on the type of vascular access device (VAD) and placement location. Among the VAD options are non-tunneled central lines, tunneled central lines, ports, peripherally inserted central catheters (PICC), midline catheters, and peripheral intravenous catheters (PIV). This evidence-based practice quality-improvement (EBP-QI) project will focus specifically on the PICC placement through the use of a Care Algorithm for Vessel Selection to reduce unsuccessful insertions and increase vessel preservation in patients. Keywords: vascular access algorithm, vessel preservation, vascular access device complication, competency for nurses, assessment of nursing skills, nursing interventions, algorithm for central placement, lower extremity PICC placement, and femoral PICC placement.

Committee: Kristin Clephane DNP (Advisor) Subjects: Nursing

Master of Science (MS), Ohio University, 2020, Exercise Physiology-Research (Health Sciences and Professions)

Lower extremity musculoskeletal injuries are a common occurrence that can threaten deployment, completion of duty, and quality of life for a soldier. Repetitive activities, explosive movements, impact forces, and extreme joint angles all increase risk for injury and are often found in military physical training. Addition of external loading is necessary for combat situations and can lead to biomechanical alterations in gait, landing, and reactive forces, even at small bodyweight-relative loads. Although external load might not be able to be manipulated, individual strength levels and appropriate landing technique may reduce the relative risk for injury. The purpose of this study was to determine how a combat-relative body-borne loads can affect lower extremity biomechanics in Reserve Officers' Training Core cadets utilizing 3D motion capture and in-ground force plate analysis. Twenty-five college-aged Ohio University Reserve Officer's Training Core cadets and military personnel conducted two series of three consecutive jump landings from a 30cm high box placed half their height from the landing position on two force plates. The testing series consisted of an unweighted baseline condition and a weighted condition of 35% of their bodyweight added to their person by the way of a tactical weighted vest. Unloaded baseline and weighted conditions were compared using a paired t-test and 95% confidence intervals (p<0.05). The results indicated that the weighted condition demonstrated a significantly greater maximal flexion angle for the hip, knee, and ankle joints, greater initial contact angles for the hip and knee joints, greater overall displacement for the hip, knee, and ankle joints, and lower normalized vertical ground reaction forces compared to the unweighted baseline condition. The resulting data could suggest that military training revolving around specific load accommodation, combat situational movements, and general strength training may allow for synchroniz (open full item for complete abstract)

Committee: Jae Yom PhD (Committee Chair); Sharon Perry PhD (Committee Member); Grooms Dustin PhD (Committee Member) Subjects: Biomechanics

Doctor of Philosophy, The Ohio State University, 2020, Industrial and Systems Engineering

Ergonomic assessments are used to determine the appropriate interventions to minimize the risk of musculoskeletal disorders. However, current ergonomic assessment methods for lower extremity musculoskeletal disorders (LE-MSDs) have several limitations. The main objective of the study was to develop a new instrument for assessing risk factors for LE-MSDs. Specifically, this instrument development effort was focused on LE-MSDs of the hip, knee, and foot/ankle using a three-phase process that included development, validity assessment, and reliability assessment. The development of the new assessment tool involved several steps, including literature searches, evidence assessment, a Delphi survey, and tool development. The first three steps were conducted to construct comprehensive lists of risk factors. The steps confirmed 16 risk factors for LE-MSDs in the hip, 27 risk factors for LE-MSDs in the knee, and 19 risk factors for LE-MSDs in the foot/ankle. The tool, LEAT (Lower extremity Ergonomics Assessment Tool), had 47 input questions that assess occupational and worker-specific factors that were determined based on the confirmed risk factors. Scoring tables for calculating risk assessment scores were also developed based on the confirmed risk factors. The outputs of the tool include both quantitative and qualitative indicators: LEAT scores, degree of risk, and explanation of the risk factor exposures found in the assessed jobs, or workers. The second phase was aimed at assessing the preliminary validity of the tool. Two epidemiological measures, namely the tool's sensitivity and specificity, were utilized to determine the validity. The data were gathered by observing sixty-two full-time employees performing their jobs (to gather the needed input about the job factors in LEAT) and afterward interviewing them (to gather the needed input about worker-specific factors in LEAT). The results of the study revealed that the highest performance was observed when classify (open full item for complete abstract)

Committee: Carolyn Sommerich (Advisor); Steven Lavender (Committee Member); Stephanie Roewer (Committee Member) Subjects: Industrial Engineering; Occupational Health; Occupational Safety

Master of Sciences (Engineering), Case Western Reserve University, 2020, EMC - Mechanical Engineering

This thesis compares two transmissions for use in powered joints of an exoskeleton that successfully integrates with muscle-generated movement. The units use the same motor and brake, but different transmissions. They were designed, built, and tested to evaluate transmission efficiency and passive resistance to optimize future systems that integrate motors with muscle-generated movement. One module incorporated a strain-wave transmission by Harmonic Drive (50:1 gear ratio), while the other implemented a multi-stage planetary gearbox developed by our team (47.29:1). The planetary unit had a mechanical efficiency of approximately 65 percent at 300 degrees per second of output rotational velocity, and only a small fall-off from zero to 300 degrees per second. The harmonic unit had a mechanical efficiency of just under 20 percent at the same output speed, and a sharp fall-off for the same range. Additionally, the planetary transmission provided a 45.1 percent decrease in frictional torque resistance compared to the harmonic device.

Committee: Roger Quinn Dr. (Advisor); Nathan Makowski Dr. (Committee Member); Richard Bachmann Dr. (Committee Member) Subjects: Biomechanics; Mechanical Engineering

Doctor of Philosophy, The Ohio State University, 2018, Health and Rehabilitation Sciences

Approximately 7.8 million high school students participate in athletics annually and although athletic participation comes with many benefits, it also comes with an inherent risk of lower extremity (LE) musculoskeletal (MSK) injury. Effectively identifying individuals at greatest risk of injury first requires an accurate understanding of injury risk. Despite the breadth of research, current injury risk assessment models are inadequate and no gold standard exists for effectively identifying risk of injury in physically active populations. Most research fails to target multiple risk factors and, instead, often focuses on how one specific risk factor alters injury risk. Additionally, research has not examined how injury risk is altered by relationships among risk factors. These gaps in knowledge have formed an understanding of injury risk that does not reflect a multi-factorial model where factors influence risk through a combination of direct, indirect and moderated effects. Therefore, the purpose of this research was to assess the complex multifactorial nature of LE MSK injury risk in adolescent athletes. Aim 1 established similarities and differences in epidemiology of injury in boys' and girls' high school soccer and basketball using a national injury surveillance system. The results of this aim indicated that injury rates are greater in soccer than basketball, and greater in competitions than practices, regardless of sex. The most common injuries were similar between sports, suggesting both sports should emphasize preventing sprains and strains affecting the ankle and knee, specifically those resulting from player contact and noncontact mechanisms. Additional efforts are also needed to prevent hip and thigh/upper leg injuries in soccer. Aim 2 evaluated direct and indirect effects of functional performance asymmetries, as well as drop landing mechanics, on injury in 2,645 high school soccer and basketball players. Results from this aim indicate that ankle do (open full item for complete abstract)

Committee: James Onate PhD, ATC (Advisor); Andrew Persch PhD, OTR/L (Committee Member); Jingzhen Yang PhD, MPH (Committee Member); Ajit Chaudhari PhD (Committee Member); Thomas Best MD, PhD (Committee Member) Subjects: Health Sciences; Sports Medicine

Doctor of Philosophy, The Ohio State University, 2017, Industrial and Systems Engineering

Registered nurses have a higher incidence rate of work-related musculoskeletal disorders (MSDs) compared with the overall rate for MSDs in the U.S. Attention has been on back pain in nurses, but the lower extremities are also a frequent site of discomfort in nurses, though only a few studies have reported on this problem, investigations of risk factors are limited, and reports of successful interventions are primarily anecdotal. The goal of this dissertation study was to investigate factors that might be associated with nurses' lower extremity musculoskeletal disorders, through a comprehensive examination of work-related and individual factors. A comprehensive, theoretical, etiological model of development of lower extremity work-related musculoskeletal disorders in hospital in-patient staff nurses (the “Nurse Lower Extremity MSD Risk Factor Model”) was developed through a review of the literature to provide a framework for the research. A mixed methods research study was conducted to investigate the prevalence of hospital in-patient staff nurses' lower extremity discomfort and examine the associations between musculoskeletal complaints and potential risk factors in the Nurse Lower Extremity MSD Risk Factor Model. Quantitative and qualitative data were collected through a cross-sectional epidemiological survey study, an objective activity monitoring study, as well as semi-structured interviews. A total of 502 staff nurses from 19 in-patient nursing units of several hospitals located in the Midwestern region of the U.S. completed the survey study, providing a response rate of 65%. Seventy-three percent of the respondents reported musculoskeletal discomfort in at least one part of the lower extremity (hip/thigh, knee, and/or foot/ankle) in the last 12 months (12 mo prevalence). Sixty-four percent experienced discomfort in at least one part of the lower extremity in the last 7 days (7-day prevalence). The mean typical intensity of discomfort in the three regio (open full item for complete abstract)

Committee: Carolyn Sommerich (Advisor); Steven Lavender (Committee Member); Esther Chipps (Committee Member); Elizabeth Stasny (Committee Member) Subjects: Epidemiology; Health Care; Industrial Engineering; Occupational Health; Occupational Safety

Doctor of Philosophy, Case Western Reserve University, 2017, Nursing

The purpose of the study is to evaluate the temporal development of symptom onset and severity and to determine relationships between delayed wound healing (wound total surface area), symptoms (depressive symptoms [DS], pain, sleep disturbance [SD]), and health related quality of life (HRQoL) in older adults undergoing Mohs micrographic surgery [MMS] of lower extremity non melanoma skin cancer (NMSC) healing by secondary intention. This is a prospective exploratory study of patients undergoing MMS for NMSC in a single academic dermatological surgery clinic. Subjects were enrolled on the day of surgery and followed weekly for 4 weeks, except 4 subjects were followed weekly until healed. Descriptive statistics and T-tests were used to explore differences between those with and without wound expansion at week 1 among these variables: demographics, co-morbidities, laboratory values, and NIH PROMIS DS, pain, SD, and HRQoL surveys. Logistic regression was performed between the variables and the wound expansion group to determine predictors of wound healing. An analysis revealed that subjects undergoing MMS for NMSC generally have good HRQoL, and symptom measures and HRQoL consistently improve by week 4 postoperatively. There was no significant relationships noted between demographics, co-morbidities, laboratory values, symptom measures, HRQoL, and wound total surface area. A trend was noted with the 14 subjects with 5 experiencing wound expansion greater than -15% expansion and 9 were without expansion at week 1. No significant differences were noted between demographics, co-morbidities, laboratory values, symptom measures, or health related quality of life with those with and without wound expansion, except for age. Age was significantly different with the wound expansion group averaging 12 years older (p = 0.02). Of the 4 subjects followed until healed, 2 subject's wounds expanded and required 10-12 weeks to heal compared to 6-8 weeks in 2 subjects without wound expansi (open full item for complete abstract)

Committee: Elizabeth Madigan PhD, RN (Committee Chair); Kevin Cooper MD (Committee Co-Chair); Andrew Reimer PhD, RN (Committee Member); Diana Morris PhD, RN (Committee Member) Subjects: Medicine; Nursing

Master of Science, The Ohio State University, 2016, Biomedical Engineering

Although Motor vehicle accidents (MVAs) are reported as the leading cause of death and injury for children over the age of 3, life threatening injuries from the head, neck, and thorax are decreasing due to the advancement of car safety research. Such advancement in car safety brings focus to research on non-fatal, but detrimental injuries that cause life-long disability such as lower extremity injuries (Durbin, 2011, NHTSA, 2012). National Highway Traffic Safety Administration (NHTSA) (2010) reported that lower extremity injury in children between ages 4-7 years old is second in prevalence at 17% following head injury at 38%. In order to gain better understanding of both low and high velocity trauma mechanisms, more pediatric biomechanics research of lower extremity is necessary. However, lack of biofidelity in the lower extremities of the child anthropomorphic test device (ATD) pose challenges to studying the interaction between the body and the interior of the vehicle. Previous studies by Boucher, et al. (2013) evaluated the range of motion and stiffness of the ankle on child volunteers, and unpublished work by Boucher, et al. (2014) developed a new prototype Hybrid III 6-year-old ATD lower extremity. The present project continues to finalize and validate this new instrument. This document is divided into two studies. The first study evaluated the stiffness and impact repeatability of the prototype ATD ankle. Using the standard hand-held universal goniometer and an Isokinetic Dynamometer (Biodex System III), range of motion (ROM) and stiffness of the ankle with various stiffness bumpers in dorsiflexion and plantarflexion were determined. The bumper with the most biofidelic response was chosen for further testing. The ATD ankle was then tested for impact repeatability in the tibia and the ankle using a ram impactor. Results of the dynamometer testing indicated that bumper 80A was most comparable with the child volunteers (Boucher, et al., 2013) with the stiffness o (open full item for complete abstract)

Committee: John Bolte IV (Advisor); Amanda Agnew (Committee Member); Laura Boucher (Committee Member) Subjects: Biomechanics; Biomedical Engineering; Biomedical Research

Doctor of Philosophy, The Ohio State University, 2015, Health and Rehabilitation Sciences

Anterior cruciate ligament (ACL) ruptures are common activity-related knee injuries usually requiring surgical reconstruction and extensive rehabilitative therapy to restore knee stability and function. Despite surgical reconstruction and physical rehabilitation, injury of the ACL dramatically increases the risk for a second injury (re-tear or contralateral leg), costly and long-term disabling osteoarthritis as well as decreased lifelong physical activity. The mechanism of this injury is typically non-contact, meaning the individual experiences a loss of neuromuscular control during jump landing, running or a change of direction maneuver without contact from another person or any other external force. Current interventions focus on biomechanical adaptations, mitigating their effectiveness to address the full neuromuscular control system. In spite of the plethora of biomechanical and patient data collected over the last three decades, the re-injury rate has remained high, if returning to activity, and patient dysfunction remains prolonged. Previous investigators have observed central nervous system and somatosensory deficits despite ACL reconstruction and rehabilitation, and we suggest that this is likely due to a neuroplastic adaptation not currently understood. This project connects highly dynamic measures of knee neuromuscular function with whole brain activation patterns to generate a brain-behavior model. The integration of neuroimaging and biomechanics in this investigation identifies the central nervous system components of ACL injury not accounted for in current assessment and intervention techniques. Quantification of the underlying neurological changes that may be driving the biomechanical outcomes after ACL injury will allow neural correlates of function to be targeted in rehabilitation.

Committee: James Onate (Advisor); Stephen Page (Committee Member); Deborah Nichols-Larsen (Committee Member); Ajit Chaudhari (Committee Member); Susan White (Committee Member) Subjects: Health Sciences; Neurosciences; Sports Medicine

Doctor of Philosophy, The Ohio State University, 2014, Anatomy

The rear seat is the safest place for children to sit in a vehicle. It is estimated that approximately 92% of children are seated in the rear seat, which leaves another 8% seated in the front seat where there is increased risk for injury caused from the airbag or dashboard. However, those in the rear seat have an increased risk of injury to the lower extremity, especially in a frontal collision. The 4-7 year old (y.o.) population is vulnerable because only 45% are using the proper restraint type. The other 55% are using the wrong restraint type (i.e. lap and shoulder belt) or are completely unrestrained. Pediatric anthropomorphic test devices (ATDs) lack instrumentation below the knee, making it difficult to experimentally measure forces applied to the leg during impact. The goal of this study was to evaluate the anthropometric characteristics, range of motion (ROM) and stiffness response of the pediatric ankle to gain valuable data for the development of a more biofidelic ATD ankle. Forty-two children between the ages of 4-12y.o. were placed into 2 groups (n=21, 4-7y.o. and 8-12y.o.). Anthropometry measurements were taken bilaterally on the lower extremity. ROM measurements were taken using a universal goniometer. Lastly, stiffness of the ankle was measured using a Biodex Isokinetic Dynamometer. Dorsiflexion (DF) appears to be the most sensitive motion, as there was a significant effect of age, type of movement (passive vs. active), and sex. The 4-7y.o. group was the focus for the remainder of the study. Stiffness results revealed DF was 1.5x stiffer than the other motions tested; Plantar flexion (PF), inversion (INV), eversion (EV). Stiffness data were then used to develop stiffness targets for use with the development of an instrumented 6y.o. ATD lower extremity (ATD-MOD). The ATD was altered to have a tibia load cell and representative ankle motion and stiffness. To validate the ATD-MOD, the leg was measured for anthropometry, ROM, and stiffness. (open full item for complete abstract)

Committee: John Bolte PhD (Advisor); Amanda Agnew PhD (Committee Member); James Onate PhD (Committee Member); Alan Litsky PhD (Committee Member) Subjects: Anatomy and Physiology; Automotive Engineering; Kinesiology

Master of Science, The Ohio State University, 2011, Mechanical Engineering

As improvements in vehicle safety decrease the number of crash fatalities, research in extremity injury is becoming increasingly important (Lund and Ferguson, 1995). Lower extremity injuries, while generally not life threatening, can cause severe impairment and permanent disability. The pediatric population is especially sensitive to these injuries due to potential damage to growth plates and developmental delays during long recovery periods (Winthrop et al, 2005). Currently, little is known about the nature of pediatric lower extremity injuries. This area is lacking due to the deficiencies of pediatric Anthropomorphic Test Devices (ATDs) and the infrequency of pediatric Post Mortem Human Subject (PMHS) testing. The following two studies provide a basis for pediatric lower extremity investigation. In the first study, a pediatric ATD was subjected to knee bolster airbag deployments. The results indicated that long bone injury was possible due to axial tibia loads over 2.5 kN and bending moments over 70 Nm in certain seating positions. In addition, the study revealed important limitations of the ATD itself, such as insufficient instrumentation and the lack of biofidelity of the ankle joint. The results also highlighted the importance of using accurate injury threshold data for pediatric extremities. The second study addresses the need to develop injury criteria directly from pediatric tissue specimens. Pediatric tibiae will soon be available for testing, but the specimens will not be accompanied by surrounding musculature or the fibula. Adult PMHS studies have established that these structures affect the bending strength of the long bones (Kerrigan et al, 2003; Rupp et al, 2008). This study evaluates the difference in mechanical properties between adult tibiae with naturally attached musculature and fibulae vs. artificially attached musculature without fibulae. Three-point bend tests indicate that the artificial attachment of musculature and the absence of the fibula (open full item for complete abstract)

Committee: John Bolte IV (Advisor); Ajit Chaudhari (Committee Member) Subjects: Biomechanics; Mechanical Engineering

Master of Science (MS), Ohio University, 2008, Athletic Training Education (Health and Human Services)

This investigation sought to determine if both sex and foot posture affect vertical ground reaction forces (VGRF) and ankle kinematics during a 30 and 45 cm single leg drop landing. Sex differences have been reported in drop landing research, but the role of foot posture remains unclear. Thirty subjects performed five acceptable trials from each height. Kinetics and kinematics were examined by collecting VGRF data and 2D motion analysis. Data were collected for maximum VGRF, toe contact (F1), and heel contact (F2); and maximum ankle dorsiflexion, and ankle dorsiflexion at F1 and F2. A two-way MANOVA showed no interaction between sex and foot posture. However, a main effect was observed for sex. Females demonstrated greater F1 VGRF at 30 cm and maximum VGRF, F1, and F2 at 45 cm than did males. A main effect was also observed for foot posture. Supinators demonstrated greater F1 VGRF at 45 cm than did pronators.

Committee: Andrew Krause PhD (Committee Chair); Chad Starkey PhD (Committee Member); Sue Bullard PhD (Committee Member); Jeffrey Seegmiller EdD (Committee Member) Subjects: Health Care; Rehabilitation; Sports Medicine