Abstract
This chapter describes a novel approach to determining muscle anthropometry using medical imaging and processing techniques to evaluate and quantify: (1) progression of atrophy in permanent muscle lower motor neuron (LMN) denervation in humans and (2) muscle recovery as induced by functional electrical stimulation (FES). Briefly, we used three-dimensional reconstruction of muscle belly and bone images to study the structural changes occurring in these tissues in paralyzed subjects after complete lumbar-ischiatic spinal cord injury (SCI). These subjects were recruited through the European project RISE, an endeavour designed to establish a novel clinical rehabilitation method for patients who have permanent and non-recoverable muscle LMN denervation in the lower extremities. This chapter describes the use of anthropometric techniques to study muscles in several states: healthy, LMN denervated-degenerated not stimulated, and LMN denervated-stimulated. Here, we have used medical images to develop three-dimensional models, including computational models of activation patterns induced by FES. Shape, volume and density changes were measured on each part of the muscles studied. Changes in tissue composition within both normal and atrophic muscle were visualized by associating the Hounsfield unit values of fat and connective tissue with different colours. The minimal volumetric element (voxel) is approximately ten times smaller than the volume analyzed by needle muscle biopsy. The results of this microstructural analysis are presented as the percentage of different tissues (muscle, loose and fibrous connective tissue, fat) in the total volume of the rectus femoris muscle; the results display the first cortical layer of voxels that describe the muscle epimisium directly on the three-dimensional reconstruction of the muscle. These analyses show restoration of the muscular structure after FES. The three-dimensional approach used in this work also allows measurement of geometric changes in LMN denervated muscle. The computational methods developed allow us to calculate curvature indices along the muscle’s central line in order to quantify changes in muscle shape during the treatment. The results show a correlation between degeneration status and changes in shape; the differences in curvature between control and LMN denervated muscle diminish with the growth of the latter. Bone mineral density of the femur is also measured in order to study the structural changes induced by muscle contraction and current flow. Importantly, we show how segmented data can be used to build numerical models of the stimulated LMN denervated muscle. These models are used to study the distribution of the electrical field during stimulation and the activation patterns.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
Modern CT scanners might use broader beams and sensor arrays to scan larger regions of the body at once.
- 2.
In the case of thresholding, segments (i.e. pixel classes) are defined by ranges of grey values. Spatial information is not used to determine class membership of pixels.
- 3.
Region growing uses spatial information when determining pixel class membership: pixels that belong to the same region are connected.
- 4.
Assuming that shapes change little from one slice to the next the adaptation necessary is small. It is done with active contours that “snap” to boundaries.
Abbreviations
- 3D:
-
Three dimensional
- BMD:
-
Bone mineral density
- CT:
-
X-ray Computer Tomography
- DTI:
-
Diffusion Tensor Imaging
- FD:
-
Finite difference
- FE:
-
Finite element
- FES:
-
Functional electrical stimulation
- h-b FES:
-
Home based functional electrical stimulation
- HU:
-
Hounsfield units
- LMN:
-
Lower motor neuron
- MBMD:
-
Mean bone mineral density
- MRI:
-
Magnetic resonance imaging
- RF:
-
Rectus femoris
- SCI:
-
Spinal Cord Injury
- UMN:
-
Upper motor neuron
References
Andersen JL, Mohr T, Biering-Sørensen F. Myosin heavy chain isoform transformation in single fibres from m. vastus lateralis in spinal cord injured individuals: Effects of long-term functional electrical stimulation (FES). Pflugers Archiv Eur J Physiol. 1996;431:513–8.
Barrett R, Berry M, Chan TF, Demmel J, Donato J, Dongarra J, Eijkhout V, Pozo R, Romine C, van der Vorst H. Templates for the solution of linear systems: building blocks for iterative methods. Philadelphia: SIAM; 1994. xiv +112 pp.
Biral D, Kern H, Adami N. Atrophy-resistant fibers in permanent peripheral denervation of human skeletal muscle Excitation-contraction coupling and charge movement in denervated rat extensor digitorum longus and soleus muscles. Neurol Res. 2008;30:137–44.
Dulhunty AF, Gage PW. Of worms and women: sarcopenia and its role in disability and mortality. J Physiol. 1985;358:375–89.
Fisher AL. Computational methods to analyze tissue composition and structural changes in denervated muscle undergoing therapeutic electrical stimulation. J Am Geriatr Soc. 2004;52(7):1185–90.
Gargiulo P, Helgason T, Ingvarsson P, Knútsdóttir S, Gudmundsdóttir V, Yngvason S. Restoration of Muscle Volume and Shape Induced by Electrical Stimulation of Denervated Degenerated Muscles: Qualitative and Quantitative Measurement of Changes in Rectus Femoris Using Computer Tomography and Image Segmentation. Basic Appl Myol. 2007; 17:133–6.
Gargiulo P, Vatnsdal B, Ingvarsson P, Knútsdóttir S, Gudmundsdóttir V, Yngvason S, Helgason T. Quantitative color three-dimensional computer tomography imaging of human long-term denervated muscle. Artif Organs. 2008;32:609–13.
Gargiulo P, Vatnsdal B, Ingvarsson P, Knútsdóttir S, Gudmundsdóttir V, Yngvason S, Kern H, Carraro U, Helgason T. Computational methods to analyze tissue composition and structural changes in denervated muscle undergoing therapeutic electrical stimulation. Basic Appl Myol. 2009;19:157–61.
Giangregorio LM, Webber CE, Phillips SM, Hicks AL, Craven. BC, Bugaresti JM, McCartney N. Can body weight supported treadmill training increase bone mass and reverse muscle atrophy in individuals with chronic incomplete spinal cord injury? Appl Physiol Nutr Metab. 2006;31:283–91.
Gorgey SA, Dudley GA. Skeletal muscle atrophy and increased intramuscular fat after incomplete spinal cord injury. Spinal Cord. 2007;45:304–9.
Helgason T, Gargiulo P, Jóhannesdóttir F, Ingvarsson P, Knútsdóttir S, Gudmundsdóttir V, Yngvason S. Monitoring muscle growth and tissue changes induced by electrical stimulation of denervated degenerated muscles with CT and stereolithographic 3D modeling. Artif Organs. 2005;29:440–3.
Janssen I, Heymsfield S B, Ross R. J. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. Am Geriatrics Soc. 2002;50:889–96.
Kern H, Hofer C, Strohhofer M, Mayr W, Richter W, Stohr H. Standing up with denervated muscles in humans using functional electrical stimulation. Artif Organs. 1999;23:447–52.
Kern H, Boncompagni S, Rossini K, Mayr W, Fanò G, Zanin ME, Podhorska-Okolow M, Protasi F, Carraro U. Long-Term Denervation in Humans Causes Degeneration of Both Contractile and Excitation-Contraction Coupling Apparatus, Which Is Reversible by Functional Electrical Stimulation (FES): A Role for Myofiber Regeneration? J Neuropath Exp Neurol. 2004;63:919–31.
Kern H, Salmons S, Mayr W, Rossini K, Carraro U. Recovery of long-term denervated human muscles induced by electrical stimulation. Muscle Nerve. 2005;31:98–101.
Kern H, Hofer C, Mödlin M, Mayr W, Vindigni V, Zampieri S, Boncompagni S, Protasi F, Carraro U. Stable muscle atrophy in long-term paraplegics with complete upper motor neuron lesion from 3-to 20-year SCI. Spinal Cord. 2007;46:293–304.
Kern H, Hofer C, Mayr W, Carraro U. European Project RISE: Partners, protocols, demography. Basic Appl Myol. 2009;19:211–6.
Lind M, Bunger C. Factors stimulating bone formation. Eur Spine J. 2001;10 (Suppl 2):102–9.
Lotta S, Scelsi R, Alfonsi E, Saitta A, Nicolotti D, Epifani P, Carraro U. Morphometric and neurophysiological analysis of skeletal muscle in paraplegic patients with traumatic cord lesion. Paraplegia. 1991;29:247–52.
Mandl T, Meyerspeer M, Reichel M, Helmut K, Hofer C, Mayr W. Functional electrical stimulation of long-term denervated, degenerated human skeletal muscle: Estimating activation using T2-parameter magnetic resonance imaging methods. Artif Organs. 2008;32(8):604–8.
Mayr W, Bijak M, Rafolt D, Sauermann S, Unger E, Lanmuller H. Basic design and construction of the Vienna FES implants: existing solutions and prospects for new generations of implants. Med Eng Phys. 2001;23:53–60.
Mohr T, Andersen JL, Biering-Sorensen F, Galbo H, Bangsbo J, Wagner A, Kjaer M. Long-term adaptation to electrically induced cycle training in severe spinal cord injured individuals. Spinal Cord. 1997;35:1–16.
Mödlin M, Forstner C, Hofer C, Mayr W, Richter W, Carraro U, Protasi F, Kern H. Electrical stimulation of denervated muscles: First results of a clinical study. Artif Organs. 2005;29:203–6.
Paige C, Saunders MA. Solution of Sparse Indefinite Systems of Linear Equations. SIAM J Numer Anal. 1975;12:617–29.
Rattay F. Electric nerve stimulation (theory, experiments and applications). Wien, Austria/New York: Springer; 1990.
Reichel M, Mayr W, Rattay F. Computer simulation of field distribution and excitation of denervated muscle fibers caused by surface electrodes. Artif Organs. 1999;23:453–6.
Reichel M, Mayr W, Rattay F. Simulation of the three-dimensional electrical field in the course of functional electrical stimulation. IFESS Proc. 2002:152–4.
Taylor PN, Ewins DJ, Fox B, Grundy D, Swain ID. Limb blood flow, cardiac output and quadriceps muscle bulk following spinal cord injury and the effects of training for the Odstock Functional Electrical Standing System. Paraplegia. 1993;3:303–10.
Acknowledgements
The authors wish to express their sincerest gratitude to the following institutions and funds:
RANNĂŤS the Icelandic Centre for Research, Science Fund of LandspĂtali University Hospital of Iceland, the Icelandic Students Innovation Fund (NSN), the European Union Commission Shared Cost Project RISE (Contract n.QLG5-CT-2001-02191), the Austrian Ministry of Transport Innovation and Technology “Impulsprogramm”, Research Funds from the Ludwig Boltzmann Institute for Electrostimulation and Physical Rehabilitation (Wilhelminenspital, Vienna, Austria), the Italian C.N.R. funds, the Italian MIUR funds and the PRIN 2004–2006 Program.
The authors also wish to express their sincerest gratitude to Dr. Amber Pond of Purdue University, West Lafayette, Indiana for in-depth discussions and critical reading of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Gargiulo, P. et al. (2012). Anthropometry of Human Muscle Using Segmentation Techniques and 3D Modelling: Applications to Lower Motor Neuron Denervated Muscle in Spinal Cord Injury. In: Preedy, V. (eds) Handbook of Anthropometry. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1788-1_18
Download citation
DOI: https://doi.org/10.1007/978-1-4419-1788-1_18
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4419-1787-4
Online ISBN: 978-1-4419-1788-1
eBook Packages: MedicineMedicine (R0)