Stiffening of the gluteal muscle increased the intramuscular stress: An in-silico implication of deep tissue injury

Heliyon, 2023 · DOI: https://doi.org/10.1016/j.heliyon.2023.e13459 · Published: February 3, 2023

Spinal Cord Injury Dermatology Biomechanics

Simple Explanation

Deep tissue injury (DTI) is a severe type of pressure ulcer that occurs in muscle tissues, particularly in individuals with restricted mobility, such as those with spinal cord injury (SCI). Muscle spasms, which are frequent in SCI patients and cause muscle stiffening, may contribute to DTI. This study investigates the relationship between gluteal muscle stiffness and intramuscular stress. A computer model was used to simulate the human buttock and analyze how changes in muscle stiffness affect stress and strain within the muscle tissue, providing insights into DTI development.

Study Duration

Not specified

Participants

One male subject (height of 1.72 m, weight of 70 kg)

Evidence Level

Not specified

Key Findings

1
Increased gluteal muscle stiffness, represented by a higher shear modulus, leads to increased compressive stress, strain energy density, and average von Mises stress within the muscle.
2
The percentage of damaged area in the muscle initially decreases in the short term (within 60 minutes) with stiffer muscles but increases significantly in the long term (after 120 minutes).
3
Compressive stress and strain energy density are identified as key parameters indicating deep tissue damage risk.

Research Summary

This study investigates the relationship between gluteal muscle shear modulus and intramuscular stress/strain using a semi-3D finite element model of the human buttock to understand deep tissue injury (DTI) in spinal cord injury (SCI) patients. The results indicate that increased muscle stiffness leads to higher compressive stress and strain energy density, potentially increasing the risk of DTI in the long term. The study suggests adjusting posture every 90 minutes to mitigate DTI risk. The research identifies compressive stress and strain energy density as key parameters for assessing DTI risk and highlights the importance of managing muscle spasms and external contact pressure to prevent DTI.

Practical Implications

Clinical Practice

Clinicians should consider the impact of muscle stiffness on DTI risk in SCI patients. Regular repositioning (every 90 minutes) can help alleviate pressure and prevent long-term damage.

Therapeutic Interventions

Strategies to reduce muscle spasms, such as muscular relaxants or electrical stimulation, may be beneficial in preventing DTI. Massage may also help to relieve spasms and decrease stiffness.

Cushion Design

Cushion design should focus on reducing intramuscular stress/strain by optimizing external contact pressure. Incorporating musculoskeletal imaging to assess muscle mechanical properties could aid in personalized cushion design.

Study Limitations

1
The semi-3D FE model may not accurately represent the actual anatomical structure and pressure distribution compared to a full 3D model.
2
Muscle shear modulus estimation using inverse FEA could be improved by direct measurement via musculoskeletal elastography.
3
Changes in muscle geometry and shape during spasms were not considered; incorporating in vivo tests to obtain muscle geometry variance information could enhance the model.

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