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The Pennsylvania State University

The Graduate School


College of Engineering




BIOMECHANICAL ANALYSIS OF HAND GRIP MOTION
FOR OPTIMAL HANDLE DESIGN
USING A CADAVER MODEL


A Dissertation in
Industrial Engineering
by
Shihyun Park
2009 Shihyun Park


Submitted in Partial Fulfillment
of the Requirements
for the Degree of

Doctor of Philosophy
August 2009

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The Dissertation of Shihyun Park was reviewed and approved* by the following:

Andris Freivalds
Professor of Industrial and Manufacturing Engineering
Dissertation Advisor
Chair of Committee

David J. Cannon
Associate Professor of Industrial and Manufacturing Engineering

Ling Rothrock
Associate Professor of Industrial and Manufacturing Engineering

Neil A. Sharkey
Professor of Kinesiology, Orthopaedics and Rehabilitation
Associate Dean of Research and Graduate Education

M. Jeya Chandra
Professor of Industrial and Manufacturing Engineering
Graduate Program Coordinator

*Signatures are on file in the Graduate School





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ABSTRACT

Forceful exertion of tendons while gripping hand tools may be one of the factors
that lead to the development of work-related musculoskeletal disorders (WRMSDs). Also,
the ratio between internal tendon force and externally applied grip force is necessary to
design an optimal handle size to maximize efficiency of the force and reduce an
excessive tendon force. Previous research has indicated that flexor digitorum profundus
(FDP) and flexor digitorum superficialis (FDS) forces can be up to 3.7 times the external
forces predicted by a biomechanical model. However, these values were indirect
estimates derived from the biomechanical model to predict internal tendon forces.
Although anatomically precise, the model was challenging to implement in practice,
since it requires input parameters that are often difficult or impossible to measure.
Therefore, it is imperative that the model is validated with direct measurement of tendon
forces using human cadaver forearms. The cadaver model with hand motion simulator
allowed the application of controlled forces to the flexor tendons by the force delivery
unit while the resulting grip forces were measured with force sensitive resistors.
Consequently, the actual tendon forces generated by the actuators were compared with
externally applied force (grip force and finger force distribution) in power grip motion
with various diameter handles. Moreover, the effect of different tendon force ratios of
FDP to FDS was investigated to explore kinematic role of the ratio in power grip motion.
Also, the resulting data were compared to similar measures reported in the literature and
input to mathematical model to validate.
Results of validation of the hand motion simulator with showed that actual tendon
forces activated by the system had an average of 0.97N error compared to target forces
input. It was acceptable to use the hand motion simulator for the experiments. In terms of
tendon force ratios of FDP to FDS, 40% of FDS to total tendon force (3:2 FDP to FDS)
showed highest grip force and contact force distribution. The ratio of internal tendon
force and externally applied force showed that the tendon force was on average 5.3 times
higher than grip force and the efficiency of the forces was best at the 3:2 FDP to FDS
force ratio and the smallest diameter handle. Grip force generated by pulling tendons was


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highest with small diameter handle (30mm) and lowest with large handle (60mm). The
index and middle fingers contributed an average of 57.6% of total contact force of each
phalange and the contribution of ring finger was smaller, followed by the little finger
with the smallest contribution. Most phalange forces in power grip motion were
concentrated on the distal phalange (72.4%) and others were notably low. In the
assessment of finger joint angle, the joint angles were changed according to the tendon
force ratios of FDP to FDS. Higher FDP force ratio made DIP joint flex and PIP joint
straight. On the other side, high proportion of FDS force in flexor tendon showed
stretched DIP joint and flexed PIP joint angle.
Finally, the result of this study was input to the mathematical model to validate
the model. The predicted FDP force calculated by the model was 61% higher than the
actual FDP force directly measured by the cadaver model and the predicted FDS force
was 38% less than the actual FDS force. Despite some differences, in general the hand
motion simulator with a cadaver model produced finger kinematics closely resembling
those that occur in normal human grasping and showed similar hand biomechanics result
with previous studies that investigated grip force and finger force distribution with
handles.



v
TABLE OF CONTENTS
LIST OF FIGURES ..................................................................................................... viii
LIST OF TABLES ....................................................................................................... xi
ABBREVIATIONS ..................................................................................................... xii
ACKNOWLEDGEMENTS ......................................................................................... xiii
Chapter 1 INTRODUCTION ...................................................................................... 1
1.1. Problem Statement ......................................................................................... 1
1.2. Study Objectives ............................................................................................ 4
Chapter 2 BACKGROUND ........................................................................................ 7
2.1. Review of Work-Related Musculoskeletal Disorders (WMSDs) .................. 7
2.1.1. Occupational injuries in the U.S. ......................................................... 7
2.1.2. Work-Related Musculoskeletal Disorders (WMSDs) ......................... 9
2.1.3. Risk factors associated with WMSDs ................................................. 10
2.2. Anatomy of the Hand and Wrist .................................................................... 12
2.2.1. Skeleton of the hand ............................................................................ 12
2.2.2. Joint of the hand .................................................................................. 13
2.2.3. Muscles of the hand ............................................................................. 15
2.2.4. Pulley system of the flexor tendon sheath ........................................... 24
2.3. Biomechanical analysis of the hand .............................................................. 26
2.3.1. Analytic models ................................................................................... 26
2.3.2. Experimental analysis .......................................................................... 29
2.3.3. Tendon force ratio of the FDP and FDS .............................................. 33
2.3.4. A Two dimensional hand model .......................................................... 39
Chapter 3 THE HAND MOTION SIMULATOR ...................................................... 45
3.1. Support Frame ............................................................................................... 45
3.1.1. Forearm fixators .................................................................................. 47
3.1.2. Cylindrical handle and handle fixture ................................................ 49
3.2. Motion System ............................................................................................... 51
3.2.1. Force delivery unit ............................................................................... 51
3.2.2. Muscle force control ............................................................................ 53
3.2.3. Muscle forces in the experiment .......................................................... 56
3.3. Data Acquisition System ............................................................................... 58
3.3.1. Tendon and grip force measurement ................................................... 58
3.3.2. Finger force distribution measurement ................................................ 61
3.4. Machine Vision System ................................................................................. 63
3.4.1. Vision system ...................................................................................... 63


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3.4.2. Image process ...................................................................................... 65
3.5. Software ......................................................................................................... 66
3.6. Calibration ..................................................................................................... 68
3.6.1. Motion calibration ............................................................................... 68
3.6.2. Force transducer calibration ................................................................ 72
Chapter 4 EXPERIMENTS ........................................................................................ 74
4.1. Overview ........................................................................................................ 74
4.2. Specimen ........................................................................................................ 74
4.2.1. Anthropometric data ............................................................................ 76
4.3. Experimental Procedure ................................................................................. 77
4.3.1. Tendon forces ...................................................................................... 77
4.3.2. Procedures ........................................................................................... 77
Chapter 5 RESULT ..................................................................................................... 79
5.1. Overview ........................................................................................................ 79
5.2. Validation of the Hand Motion Simulator ..................................................... 79
5.2.1. System summary ................................................................................. 80
5.3. Grip Force Analysis ...................................................................................... 84
5.3.1. Handle size analysis ........................................................................... 88
5.3.2. Tendon force ratio analysis ................................................................. 90
5.4. Finger Force Distribution Analysis ............................................................... 95
5.4.1. Finger and phalange forces .................................................................. 95
5.4.2. Tendon force ratio ............................................................................... 99
5.5. Finger joint angle analysis ............................................................................. 104
5.6. Validation of mathematical model ................................................................. 109
Chapter 6 SUMMARY AND DISCUSSION ............................................................. 112
6.1. Hypothesis 1: The hand motion simulator ..................................................... 112
6.2. Hypothesis 2: The tendon force ratio ............................................................. 114
6.3. Hypothesis 3: The efficiency of internal force to external force ratio ........... 115
6.4. Hypothesis 4: The handle size effect ............................................................. 116
6.5. Hypothesis 5: Finger Force Distribution ....................................................... 120
6.6. Hypothesis 6: Finger Joint Angles ................................................................. 122
6.7. Mathematical Model Validation .................................................................... 123
Chapter 7 SUGGESTION FOR FUTURE RESEARCH............................................ 125
7.1. Handle Design ............................................................................................... 125
7.2. Finger Force Distribution .............................................................................. 126
7.3. Intrinsic Muscles ............................................................................................ 126
7.4. Passive Force-Length Relationship ............................................................... 127
REFERENCES ............................................................................................................ 128


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APPENDIX A: Hand Motion Simulator control block diagram ................................. 137
APPENDIX B: Calibration of Force Transducer (FSRs) ............................................ 141
APPENDIX C: Result of Statistical Analysis .............................................................. 144



viii
LIST OF FIGURES
Figure 2.1. Incidence rates of injury and illness in manufacturing industry, 1982-
2001 (Adapted from Bureau of Labor Statistics, 2001) ................................... 8
Figure 2.2. Bones of wrist and hand (source: Netter, 1989) ........................................ 14
Figure 2.3. Muscles of the hand (source Higgins and Mandiberg, 2000) .................. 16
Figure 2.4. Individual muscles of forearm: Flexors of Digits (source: Netter,1989) .. 17
Figure 2.5. FDP and FDS tendons of a typical digit (source: Netter, 1989) ................ 23
Figure 2.6. Pulley Structure of the Finger (A = annular, C = cruciate). ...................... 25
(source: Nordin and Frankel, 2001) ............................................................................. 25
Figure 2.7. Free-body diagram for a two-dimensional hand model. (source: Kong,
2001) ................................................................................................................ 40
Figure 3.1. Schematic drawing of the hand motion simulator ..................................... 46
Figure 3.2. Schematic drawing of the hand motion simulator ..................................... 47
Figure 3.3. Fixators for fastening the pins cross-drilled into radius and ulna ............. 48
Figure 3.4. Adjustable wrist fixator (Wristjack, Source: Surgeons Manual) .......... 48
Figure 3.5. Split cylindrical handles with five different diameters .............................. 50
Figure 3.6. Handle fixture with a height adjustable knob and handle fixing clamps .. 50
Figure 3.7. The Components of Force Delivery Unit (DFU) ...................................... 52
Figure 3.8. Motor and motion controller in FDU ........................................................ 52
Figure 3.9. Workflow of the force feedback control system ....................................... 55
Figure 3.10. Data acquisition system of the Hand Motion Simulator ......................... 59
Figure 3.11. Data acquisition system with force transducers ...................................... 60
Figure 3.12. Split cylindrical handle with force transducer inserted ........................... 60
Figure 3.13. FlexComp system with FSRs .................................................................. 62
Figure 3.14. FSRs attached on each phalanges ............................................................ 62


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Figure 3.15. Image Process to compute finger joint angles ......................................... 65
Figure 3.16. Hand motion simulator monitoring panels .............................................. 67
Figure 3.17. Hand motion simulator controlling panels .............................................. 67
Figure 3.18. Calibration setting for force delivery unit and force transducers ............ 70
Figure 3.19. Regression of the displacement and axial rotation of the stepper
motors .............................................................................................................. 71
Figure 3.20. The regression of the voltage (mV) and actual force (Kg) ...................... 73
Figure 3.21. The regression of the raw signals and actual force (N) ........................... 73
Figure 4.1. Specimen mounted on a custom fixation device in hand motion
simulator .......................................................................................................... 75
Figure 4.2. Diagram for phalange length measurement for each finger ...................... 76
Figure 5.1. Sample data plots showing performance of the force feedback control
in the Hand Motion Simulator. FDP, FDS, Grip force plotted in the graph
according to time sequential. Target Force was 100N and 50N for FDP
and FDS, respectively. ..................................................................................... 80
Figure 5.2. Boxplot of Actual FDP Force .................................................................... 83
Figure 5.3. Boxplot of FDS Force ............................................................................... 83
Figure 5.4. The grip force variation on each handle .................................................... 88
Figure 5.5. The interaction of the Internal force and the handle .................................. 89
Figure 5.6. The effect of the tendon force ratio between the FDP and FDS ............... 91
Figure 5.7. The interaction between the relative FDS percentage and the handle
size ................................................................................................................... 93
Figure 5.8. The interaction between the relative FDS percentage and the handle
size ................................................................................................................... 94
Figure 5.9. The main effects (Finger) for grip force. The number of finger is the
order of finger from the index to the little finger, respectively. ...................... 97
Figure 5.10. The main effects (Phalange) for grip force. The number of phalange
is the order of phalange from the distal to the metacarpal phalange,
respectively. ..................................................................................................... 97
Figure 5.11. The interaction effects for grip force (Finger * Phalange) ...................... 98


x
Figure 5.12. Main Effects Plot (data means) for Total ................................................ 99
Figure 5.13. The interaction effects for grip force (Finger * %FDS) .......................... 103
Figure 5.14. The interaction effects for grip force (%FDS * Finger) .......................... 103
Figure 5.15. Finger joint angles on tendon force ratio and handle .............................. 107
Figure 5.16. Inter phalangeal joint angles on handle size and %FDS ......................... 108
Figure 6.1. The main effect of handle with mean grip force ....................................... 118
Figure 6.2. Mean contact force of each finger and phalange ....................................... 121


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LIST OF TABLES
Table 2.1. Extrinsic muscles of the hand and wrist (Source: Spence, 1990) ............... 18
Table 2.2. Intrinsic muscles of the hand and wrist (Source: Spence, 1990) ............... 19
Table 2.3. In vivo tendon forces (kg) of FDP and FDS ............................................... 34
Table 2.4. Ratios of tendon and joint forces in power grip function ........................... 35
Table 3.1. Fundamental parameter of an imaging system ........................................... 64
Table 4.1. Dimension of phalanges on each finger ...................................................... 76
Table 5.1. Comparison of target forces to actual forces .............................................. 82
Table 5.2. One sample t-test actual FDP to target force 100N .................................... 82
Table 5.3. ANOVA for Grip Force, using Adjusted SS for Tests ............................... 84
Table 5.4. Tukey tests on the difference in the grip force ........................................... 86
Table 5.5. The total/individual finger forces and contributions on each %FDS .......... 87
Table 5.6. ANCOVA for Grip Force, using Adjusted SS for Tests ............................. 92
Table 5.7. The individual phalange forces contributions on each finger ..................... 96
Table 5.8. Tukey procedure comparing the fingers ..................................................... 96
Table 5.9 Tukey procedure comparing the phalanges ................................................. 96
Table 5.10. The total/individual finger forces and contributions on each %FDS ........ 102
Table 5.11.The total/individual phalange forces and contributions on each %FDS .... 102
Table 5.12. Finger Joint Andlge flexion on %FDS and handle ................................... 106
Table 5.13. Each phalange force on 40% FDS level ................................................... 109
Table 5.14. Comparison of predicted flexor tendon forces and actual finger forces ... 111



xii
ABBREVIATIONS


WMSD Work related Musculo-Skeletal Disorder
FDP Flexor Digitorum Profundus
FDS Flexor Digitorum Superficialis
FPL Flexor Pollicis Longus
DIP Distal Inter-Phalangeal
PIP Proximal Inter-Phalangeal
MCP MetaCarpo-Phalangeal
HMS Hand Motion Simulator
FDU Force Delivery Unit
DAQ Data Acquisition
FSR Force Sensitive Resistor
GF Grip Force
F
A
Actual Force
F
T
Target Force
%FDS Percent FDS force



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ACKNOWLEDGEMENTS

The work presented here would not have been possible without the support of my family,
friends and mentors over the years. First and foremost, I would like to thank my advisor,
Professor Andris Freivalds for his constant guidance throughout the whole period of my doctoral
studies. I sincerely believe that studying and working under his supervision have been the largest
achievements in my career, and I am glad that I had that opportunity. I am also grateful to
Professor Neil Sharkey, who gave me the opportunity to expand my expertise on the
biomechanics study of Kinesiology, committee members, Professor David J. Cannon and Ling
Rothrock for providing valuable comments and suggestions and Professor Chang Min Lee, who
was the first mentor in academic studies.
Andrew Hoskins, Yatin Kirane and Jesun Hwang, for sharing their scientific knowledge
and for enthusiastic discussion. I would also like to thank the faculty, staff and students of the
department of Industrial and Manufacturing Engineering, both past and present, who have had a
profound effect on my life through their generosity, intellect, friendships and dedication to
research.
To my grandmother and parents, Jin Soon Cho, Maeng Ro Park and Jung Ok Kim, for
patiently supporting me through all of the ups and downs we have encountered along the way.
Lastly and most importantly, I am deeply grateful to my wife, Jung Soo, for her love, support, and
encouragement during these years. The best experiences of this period were the births of our son
and daughter, Jude and Sarah, who had thence dramatically changed and enriched our life.




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Chapter 1

INTRODUCTION
1.1. Problem Statement
Failure to properly consider tendon and applied forces in designing a hand tool
can have harmful effects on users. These effects may range from minor discomfort and
fatigue to work related disorders or cumulative trauma disorders (CTDs) of the finger,
hand and forearm (NIOSH, 1997). In this vein, forceful exertion of the upper extremities
is widely recognized as one of the physical risk factors associated with the development
of upper extremity Work Related Musculoskeletal Disorders (WMSDs), which are of
increasing concern to employers as a source of Worker Compensation claims, lost work
time and reduced productivity (National Research Council & Institute of Medicine, 2001).
Especially, work related musculoskeletal symptoms and injuries; such as carpal tunnel
syndrome and tendonitis are common among operators of hand-held tools (Nathan et al.,
1992).
For quantifying peak exertion intensity with hand tools, biomechanical modeling
of the hand is important for understanding how exerted forces act on the internal tissues
for various hand functions. The National Institute for Occupational Safety and Health
(NIOSH) has been supporting the development and validation of models for the
quantitative assessment of exposure to ergonomic risk factors including forceful exertion
(NIOSH, 2001). However, the mechanisms leading to risk of WMSDs have not been
identified.


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Quantitative mechanical hand modeling has been considered since the early 1960s
(Landsmeer, 1961) and has increased in complexity (An et al., 1979; Spoor, 1983;
Valero-Cuevas et al., 1998; Kong, 2001). Some extensive studies included all known
intrinsic and extrinsic muscles involved in grasp (Chao et al., 1976; An et al., 1979;
Spoor, 1983; Valeo-Cuevas et al., 1998; Li et al., 2001). Although anatomically precise,
these models are challenging to implement in practice, since they require input
parameters that are often difficult or impossible to measure. Assumptions regarding
muscle recruitment and optimization methods sometimes produce results that have been
found inaccurate (Dennerlein et al, 1998).
Electromyography can investigate muscle activation patterns (Bendz, 1980;
Darling and Cole, 1990; Darling et al., 1994; Dennerlein et al., 1998; Vallbo and
Wessberg, 1993), but this method yields only an estimate of muscle activation, as many
motor units may be active (Basmajian and Luca, 1985).
The most reliable assessment of the effects of external loading conditions on
tendon forces is obtained by directly measuring tendon forces in human body. Direct
measurement of tension in the tendon provides a measure of forces within the human
musculoskeletal system that have been earlier predicted by isometric force models.
Validating the mathematical models by experimental measurement in vivo was
undertaken in previous researchers (Schuind et al. 1992; Dennerlein et al., 1998; Kursa et
al, 2005). However, Schuind et al. did not record finger joint positions, while Dennerlein
et al. measured force in only one tendon. In addition, Kursa et al.(2005) measured force
in only one finger. Also, in vivo test, true tendon forces are probably lower than the
predicted results because these experiments were performed during carpal tunnel surgery.


3
In such case, the muscles are partially inactive and weaken pinch and power grip forces
(Chao, 1989).
Therefore, cadaveric experiments make no limitation of finger motion and
measuring extrinsic muscles. Cadaveric studies have focused on the flexor tendon forces
in both tip pinch and power grip actions (Bright and Urbaniak, 1976) or the relationship
between tendon pulley integrity and flexor tendon excursion (Armstrong et al., 1978;
Idler et al., 1986; Lin et al, 1990). Also, Brand et al. reported the relative tension
capacities of forearm and hand muscles with cross-sectional area of the muscles in
cadaver hand (1981). However, no method has solved the force ratio between the tendon
force and the externally applied force in power grip motion with various handles. In
addition, no simultaneous comparison of kinematic data with tendon forces exists in the
literature of power grip.
In this study, a hand motion simulator: a cadaver model was developed to
investigate hand biomechanics of power grip motion and examine grip force and finger
force distribution of the hand generated by extrinsic flexor muscles (FDP and FDS).
Moreover, the interaction effect of tendon force ratio (FDP to FDS) with finger joint
motion was also investigated with the cadaver model using various sizes of cylindrical
handles to find optimal handle size. Finally, contact forces and kinematic data were used
to validate the biomechanical hand model.




4
1.2. Study Objectives
In terms of hand biomechanics research, many studies have focused on hand tool
design based on simple experiments with an EMG or a force sensor. Most studies have
focused on the externally applied force and the magnitude of muscle exertion in power
grip on cylindrical handles. Also, anatomical and biomechanical studies of the human
hand have been investigated to understand the tendon and muscle forces that correspond
to externally applied forces. However, no such models have been employed to define the
kinematic role of flexor muscles in grasping various sizes handles.
In the previous study performed in our laboratory, a mathematical hand model
was developed to estimate tendon forces of the flexor muscles (FDP and FDS) in each
finger (Kong and Freivalds, 2003). The biomechanical model showed that the internal
tendon force were about 3.7 times higher than the externally applied force in the gripping
task. However, the model only used the externally applied forces to estimate the FDP and
FDS tendon forces and the prediction model was not validated. Consequently, to validate
the biomechanical hand model, the cadaver model with hand motion simulator was
developed to measure internal tendon forces directly with a cadaver hand. This hand
motion simulator allowed the application of controlled forces to the FDP and FDS
tendons, resulting in the closing of the fingers around the handle with concurrent
application of forces to the handle.
Therefore, this study focused on the work that has gone into developing the
cadaver model as well as the work necessary to refine it as a comprehensive research tool.
Furthermore, quantified data from the cadaver model was used to investigate the


5
relationship between internal flexor tendon forces and externally applied forces in power
grip with various handles and validated the mathematical model as well.

This thesis addressed the following research objectives:

1. The cadaver model: The Development of a hand motion simulator with a cadaver
hand to generate the tendon forces (FDP and FDS) associated with power grip motion on
various cylindrical handle sizes.
2. Force ratio: Analyses of the relationship between two flexor tendons (FDP and FDS)
and between internal tendon forces (FDP and FDS) and externally applied forces (grip
force and finger force distribution).
3. Handle size effect: Investigation of the optimal handle diameter for maximizing
applied grip force generated by constant tendon forces.
4. Validation of the mathematical model: Validation of the biomechanics hand model
through quantification of internal tendon forces and results of grip forces and finger
motions in power grip motion.




6
To accomplish these objectives, the following hypotheses were proposed

Hypothesis 1.
Actual tendon forces generated by this cadaver model equal to the target forces input.
Hypothesis 2.
Tendon force ratios of FDP to FDS force affect grip force and finger force distribution.
Hypothesis 3.
Flexor tendon-to-grip force ratios are different depending on handle diameters.
Hypothesis 4.
Small diameter handle has higher grip force than larger diameter handles.
Hypothesis 5.
Middle finger and distal phalange have highest contact force among all fingers and
phalanges.
Hypothesis 6.
The tendon force ratios of FDP to FDS affects finger joint angles in power grip.




7
Chapter 2

BACKGROUND
2.1. Review of Work-Related Musculoskeletal Disorders (WMSDs)
2.1.1. Occupational injuries in the U.S.
The term musculoskeletal disorders (MSDs) refers to conditions that involve the
nerves, tendons, muscles, and supporting structures of the body. These include such
ailments as low back pain, shoulder disorders, and distal upper extremity disorders,
including tendonitis and carpal tunnel syndrome (Waters, 2004). Work-related
musculoskeletal disorders (WMSDs) are included as a class of musculoskeletal disorders.
They represent a wide range of disorders, which can differ in severity from mild periodic
symptoms to severe chronic and debilitating conditions. Usually WMSDs are associated
with occupational factors (i.e., repeated and highly forceful stresses, awkward or static
postures and vibrations) (Silverstein et al., 1986; Putz-Anderson, 1988; Armstrong, 1994).
The report from the Bureau of Labor Statistics (BLS, 2001) that in 2001 there
were 522,528 MSD cases, 75% of those were due to overexertion and another 11.5%
were due to repetitive motion disorders (OSHA, 2001). Also, 60,099 injuries or illnesses
occurred as a result of repetitive motion, including typing or key entry, repetitive use of
tools, and repetitive placing, grasping, or moving of objects other than tools. Based on
these investigations, it is clear that work-related injuries and illnesses represent a
significant health problem for the industrial labor force in the United States. Trends in the
numbers of cases of reported injuries and illnesses have steadily declined in the last 10


8
years. According to the BLS, the number of injury and illness cases that resulted in lost
work days in manufacturing industries steadily decreased since about 1990, as can be
seen in Figure 2.1. During that same period of time, however, the number of cases
resulting in restricted work activities steadily increased. The reasons for these declines in
lost day injuries and illnesses are unclear, but may include: a smaller number of disorders
could be occurring because of more intensive efforts to prevent them; more effective
prevention and treatment programs could be reducing days away from work; employers
or employees may be more reluctant to report or record disorders; or the criteria used by
health care providers to diagnose these conditions could be changing (NIOSH, 1997).

Figure 2.1. Incidence rates of injury and illness in manufacturing industry, 1982-2001
(Adapted from Bureau of Labor Statistics, 2001)
Incidence rates per 100 full-time workers
0
1
2
3
4
5
6
7
1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Lost workday cases
Cases with days away from work
Cases with days of restricted
work activity onl y
Lost workday cases incidence rates, injuries and illnesses
Manufacturing, 1982-2001


9
2.1.2. Work-Related Musculoskeletal Disorders (WMSDs)
Work related musculoskeletal disorders (WMSDs), also known as Cumulative
Trauma Disorders (CTD), Repetitive Strain Injuries, or Overuse Syndrome, are a group
of health problems caused by over-use or misuse of muscles, tendons and
nerves. Usually, WMSDs can be classified into three basic types by anatomical
characteristics: Tendon disorders, Muscle injuries and Nerve disorders. Tendon disorders
occur at or near the joints where the tendons irritate nearby ligament and bones. Tendons
without sheaths are vulnerable to repetitive motions and awkward postures. In fact, when
a tendon is repeatedly tensed, some of its fibers can tear apart. The tendon becomes
inflamed, thickened and bumpy. Tendonitis is the general term indicating inflammation
of the tendon. The most frequently noted symptoms are a dull aching sensation over the
tendon, discomfort with specific movements and tenderness to touch. Recovery is usually
slow and condition may easily become chronic if the cause is not eliminated (Lipscomb,
1995).
Muscle injuries arise from excessive force exertions. The mechanism of injury for
muscle disorders is quite different from tendon disorders. Typically, muscle injury occurs
as the result of excessive external forces on the passive structures, mainly connective
tissue, rather than from overuse. Excessive contractions also cause structural damage and
loss of force generating capacity (McComas, 1968). Nerve disorders occur when repeated
or sustained work activities expose the nerves to pressure from hard, sharp edges of the
work surface, tools or nearby bones, ligaments, and tendons (Feldman et al., 1983). The
symptoms include pain, tingling, and numbness in the hand. Carpal tunnel syndrome
(CTS) is the most common nerve disorder. The carpal tunnel is formed by the bony


10
carpal arch and the overlying transverse carpal ligament and flexor retinaculum. Typical
symptoms of CTS include pain, numbness, tingling and clumsiness in the affected area of
the hand and fingers resulting in difficulties performing normal activities (Phalen, 1972).
Careful job and hand tool designs and work place re-designs are recommended to reduce
the incidence of CTS.
2.1.3. Risk factors associated with WMSDs
The WMSDs of the distal upper extremities may result from the interaction
between physical and personal factors. Specific risk factors of WMSDs are difficult to
identify because many risk factors may interact simultaneously to induce the condition
(Moore, 1992; NIOSH, 1997).
2.1.3.1. Physical risk factors
Repetitive motions
There is strong evidence for a positive association between highly repetitive
works with WMSDs. Highly repetitive work may directly damage tendons with repeated
stretching and elongation as well as increase muscle fatigue and decrease the time for
fatigue recovery Numerous studies identified repetitive motions as a risk factor
associated with development of CTS (Keyserling et al., 1993; Silverstein et al., 1987).
Many workers perform the same tasks and stereotyped motions over and over, sometimes
thousands or tens of thousands time each day. Highly repetitive motions require fast
muscle contractions, which become less efficient and demand greater recovery time


11
because muscle capacity to produce force diminishes with increasing contraction speed.
Silverstein et al. (1987) reported that odds ratios for risk of CTS and CTDs were 1.9 and
3.6, respectively, in high repetition jobs compared to jobs that requires a low number of
repetitions. Based on these results, they indicated that jobs which have a basic cycle time
of 30 seconds or less, and jobs in which over 50 percent of the work cycle are spent
performing the same basic motions pattern have been associated with elevated rates of
CTS.
Forceful exertion
The forceful exertion required to do the task plays an important role in the onset
of WMSDs. More force equals more muscular effort, and consequently, a longer time is
needed to recover between tasks. Since in repetitive work, as a rule, there is not sufficient
time for recovery, the more forceful movements develop fatigue much faster (Chaffin,
1973). Exerting force in certain hand positions is particularly hazardous. The amount of
force needed depends on the weight of the tools and objects that the worker is required to
operate or move, and their placement in relation to the worker's body in manual material
handling tasks (Keyseling et al., 1993). Forceful exertions of the upper extremities (i.e.,
using knives, wrenches and other hand tools; using fingers and hands to shape or surface
finish materials and parts, etc.) may cause upper extremity musculoskeletal disorders
such as joint inflammation, muscle spasms, sprains, tendinitis, or diseases of the
peripheral nerves (Armstrong et al., 1979; Silverstein et al., 1987).




12
Awkward posture
Awkward posture is one of the most frequently cited risk factors for CTS
(Armstrong, 1978, 1994; Moore, 1992). Common examples of awkward wrist postures
include excessive flexion, extension, radial and ulnar deviation, and pinch grips (Keir,
1999). Awkward postures overload muscles and tendons, loads joints in an asymmetric
manner, thereby inhibiting blood flow (VanWely, 1970). The median nerve may be under
considerable risk during awkward hand postures that place extreme pressure on the flexor
tendon. In fact, sizable compressive forces have been demonstrated in the median nerve
when hand movements involve simultaneous pinching and extreme wrist flexion (Rempel
and Horie, 1994).
2.2. Anatomy of the Hand and Wrist
2.2.1. Skeleton of the hand
The skeleton of the hand consists of a series of bones. The proximal rows are in
articulation with the carpal bones and are called metacarpals; these in turn are in
articulation with the phalanges. Each phalange and each metacarpal consists of a base, a
shaft and a head; each finger has three phalanges; the thumb has only two. Figure 2.2
shows the skeletal structure of the hand.
There are eight carpal bones at the wrist, arranged in two transverse rows of four
bones each. The bones of the proximal row, from lateral to medial, are the scaphoid,
lunate, triquetrum, and pisiform. Those of the distal row, from lateral to medial, are the


13
trapezium, trapezoid, capitate, and hamate. The scaphoid and lunate articulate with the
distal end of the radius to form the wrist joint.
Five metacarpal bones form the skeleton of the palm of the hand. They are
numbered from lateral to medial. Proximally, the metacarpals articulate with the distal
row of the carpal bones and with each other. Distally, each articulates with the proximal
end of a phalange.
The skeleton of the fingers is formed by 14 phalanges. Each finger contains three
phalanges: proximal, middle, and distal. An exception is the first digit (thumb), which has
only proximal and distal phalanges (Spence, 1990).
2.2.2. Joint of the hand
There are four joints in each finger, in sequence from the proximal to distal:
carpometacarpal joints (CMC), metacarpophalangeal (MCP), proximal interphalangeal
(PIP), and distal interphalangeal (DIP) joints (see Figure 2.2.). The CMC joints are
composed of the articulations between the distal carpal row and the bases of four medial
metacarpals, and are united by articular capsule and three types of ligaments (volar,
dorsal, interosseus). The movement of this joint is more regulated by the ligaments, and
consists of flexion-extension, abduction-adduction and some axial rotation, which take
places concurrently with the other motions (Norkin, 1989). The MCP joints consist of the
convex metacarpal head and the concave base of the proximal phalange and stabilized by
a joint capsule and ligaments. The movements permitted at this joint are flexion-
extension, abduction-adduction and circumduction (Norkin, 1989). Steindler (1955)
reported that the range of the dorsovolar movement in this joint is approximately 110-120


14
degrees (90 degrees for flexion and 20 degrees for extension) and the range of the lateral
movement is approximately 40-60 degrees. However, this type of movement has different
ranges with the individual fingers (index: 60 deg., little: 50 deg., middle and ring: 45
deg.). The IP joints are true hinge joints, having one degree of freedom. Each finger has
two IP joints (proximal and distal); the thumb has only one IP joint which is structurally
and functionally identical to the distal IP joints of the finger (Norkin, 1989). The
excursion ranges of dorsovolar direction in the proximal IP and in the distal IP joints are
approximately 110-130 and 45-90 degrees. Generally, this range of movement at each
joint (IP joint) increases ulnarly and proximally (Steindler, 1955).




Figure 2.2. Bones of wrist and hand (source: Netter, 1989)


15

2.2.3. Muscles of the hand
Based on the origin of the muscles, the muscle groups associated with movement
of the forearm and the hand can be divided into extrinsic and intrinsic muscle groups. The
extrinsic muscles originate in the forearm while the intrinsic muscles are entirely
contained in the hand. In this regard, extrinsic muscles are long and large so as to provide
greater excursion and strength while intrinsic muscles are short and small so as to provide
precise coordination of the fingers.
Extrinsic muscles of the forearm and hand can be divided into two groups, which
are named as anterior muscles and posterior muscles based on the locations. Again, each
muscle group can be separated further into superficial and deep muscle groups based on
its location. The anterior muscle groups serve as flexors. Most anterior muscles originate
from the medial epicondyle of the humerus and insert on the carpal bones, metacarpals or
phalanges. Among the anterior superficial muscles, the flexor digitorum superficialis
serves for flexion of the fingers. The flexor carpi ulnaris both flexes and adducts the wrist
while the flexor carpi radialis flexes and abducts the wrist. The palmaris longus flexes the
wrist and tenses the palm. Among the anterior deep muscles, the flexor pollicis longus
flexes the thumb. The extrinsic muscles of anterior and flexors are illustrated in
Figure 2.4, and summarized in Table 2.1. The pronator teres performs pronation of the
forearm so that the palm turns downward when the elbow flexed and forearm horizontal.
The brachioradialis performs flexion of the forearm and it also serves as a synergist of the
biceps brachii of the upper, which is a strong supinator muscle. The posterior forearm
muscles serve as extensors. Most of these muscles originate from the lateral epicondyle


16
of the humerus and insert on the carpus, metacarpals or phalanges. Each muscle group
can be divided further into superficial and deep muscle groups. Intrinsic muscles whose
origin and insertion are both in the hand make possible the fine and precise movements
that are typical of the fingers. They are divided into three groups: the thenar, the
hypothenar and midpalmar muscle groups acting on the thumb, on the little finger, and on
the all phalanges except the thumb, respectively. The intrinsic muscles are illustrated in
Figure 2.3, and the locations and actions of extrinsic and intrinsic muscles are listed in
Table 2.2.





Figure 2.3. Muscles of the hand (source Higgins and Mandiberg, 2000)


17



Figure 2.4. Individual muscles of forearm: Flexors of Digits (source: Netter,1989)


18




Table 2.1. Extrinsic muscles of the hand and wrist (Source: Spence, 1990)
Group Layer Name Function
Anterior
Superficial
Flexor carpi radialis
Flex and abduct the hand
Support flexion of forearm
Palmaris longus Flex hand
Flexor carpi ulnaris Flex and adduct hand
Middle
Flexor digitorum
superficialis
Flex phalanges and the hand
Deep
Flexor digitorum profundus Flex phalanges and the hand
Flexor pollicis longus
Flex the thumb
Support flexion of the hand
Posterior
Superficial
Extensor carpi radialis
longus
Extend and abduct hand
Extensor carpi radialis brevis Extend hand
Extensor digitorum
communis
Extend fingers and hand
Extensor digiti minimi Extend little finger
Extensor carpi ulnaris Extend and adduct hand
Deep
Abductor pollicis longus
Extend thumb and abduct
hand
Extensor pollicis brevis
Extend thumb and abduct
hand
Extensor pollicis longus
Extend thumb and abduct
hand
Extensor indicis Extend index finger



19


Table 2.2. Intrinsic muscles of the hand and wrist (Source: Spence, 1990)
Group Name Abbrev. Function
Thenar
muscles
Abductor pollicis AbPB Abducts thumb
Opponents pollicis OP
Pulls thumb in front of the palm to meet
little finer
Flexor pollicis FPB Flexes and adducts thumb
Adductor pollicis AdPB Adducts thumb
Hypothenar
muscles
Palmaris brevis PB
Pulls the skin toward the middle of the
palm
Abductor digiti ADM Abducts little finger
Flexor digiti
Minimi brevis
FDM Flexes little finger
Opponens digiti
minimi
ODM Brings little finger out to meet thumb
Midpalmar
muscles
Lumbricales L
Flex proximal phalange
Extend the middle and distal phalanges
of the second through fifth fingers
Dorsal interossei DI
Abduct fingers from the middle finger,
flex the proximal phalange
Palmar interossei PI
Adduct fingers toward the middle
finger, flex the proximal phalange




20
2.2.3.1. General characteristics of the flexors
As the main flexor muscles, the flexor digitorum profundus (FDP) and flexor
digitorum superficialis (FDS) are the principal muscles involved in most repetitive work-
related functions. Long et al. (1970) have studied these flexors using electromyography
(EMG). They showed that the FDP is the muscle that performs most of the unloaded
flexion movement of the fingers and that the FDS comes in when more strength is needed.
The resting fiber length of the FDP tendon is slightly shorter than that of the FDS tendon.
In general, the lengths of resting muscle fibers vary by finger. The FDP comprises about
12% of the total muscle capability below the elbow. Although, in the middle finger, the
tension capabilities of the FDP and FDS are equal, the average tension capability of the
FDP is about 1.5 times as strong as the FDS. The FDP of the little finger may be three
times stronger than the FDS. There is significant variation (range: 0.9~3.4%) in the
tension capabilities of the FDS tendons for each finger, while there is fairly constant
tension capabilities for the FDP tendons of each finger (2.7~3.4%). It is generally agreed
that the middle finger is the strongest and the little finger is the weakest finger for both
the FDP and FDS.
2.2.3.1. Flexor Digitorum Profundus (FDP)
Flexor Digitorum Profundus (FDP) is a strong broad muscle that originates from
the upper three-fourths of the volar surface of the ulna and gives rise to tendons that are
inserted into the base of the distal phalange of each finger. The fiber bundles of FDP
descend nearly vertically and give rise to a common belly nearly at the wrist that soon
divides into four portions. After the division, tendons pass side by side under the


21
transcarpal ligament to the base of each finger (see Figure 2.5). Specially, FDP tendons
pass through the slit in the superficial tendon on the volar surface of the proximal
phalange (see Figure 2.6). In the palm, each profundus tendon gives rise to the lumbrical
muscle which diverts some profundus power away from PIP flexion and DIP flexion to
the extensor side of these joints, thus allowing the MCP joints to precede and dominate
the beginning of the sequence of finger closure. The FDP muscles of the middle, ring and
little fingers are somewhat dependent upon each other since there is a close connective
tissue binding them together. However, the index finger is capable of greater functional
independence since it has a fairly individual muscle belly (Brand et al., 1993). At the
level of the carpal tunnel, profundus muscles are interconnected by tendinous cross-
connection.
The lengths of muscle fibers for each finger varies between 6.2~6.8cm (Brand et
al., 1981) and are on average 0.5cm shorter than that of FDS. The main function of the
FDP is the flexion of distal interphalangeal (DIP) joint, proximal interphalangeal (PIP)
joint and metacarpo-phalangeal (MCP) joints.
2.2.3.1. Flexor Digitorum Superficialis (FDS)
FDS arise from the medial epicondyle of the humerus and from the radius and the
ulnar, and sends tendons into the sides of the volar surface of the shafts of the middle
phalange of each finger. In the forearm, a large flat common tendon connects the single
proximal muscle belly to the three separate distal muscles, thus forming a complex
muscle unit (see Figure 2.5). The four tendons pass together through the carpal tunnel
under the transverse carpal ligament to the index and little finger such that the middle and


22
ring finger tendons lie at first superficial. All of these tendons within the carpal tunnel
have a degree of freedom. After passing through the carpal tunnel, the FDS tendon
diverges together with a FDP tendon, and passes over the MCP joint into an osteofibrous
tunnel on the palmer surface of the middle phalange such that FDP tendon can pass
through, and fold about the FDP tendon so that their lateral edges come to meet in the
midline beneath this tendon. Then they again separate, extend distally, and attach to a
ridge on each side of the middle phalange. The FDS tendon of the middle finger is always
independent while ring finger is sometimes independent. However, FDS tendons of the
index and little fingers are closely linked to each other. The nerve of the FDS is supplied
by the median nerve (Steinberg, 1992).
The length of the muscle fibers of the FDS is between 7.0~7.3cm, which is a little
longer than that of FDP (Brand et al., 1981). The main action of the FDS muscle is to flex
the middle phalange on the proximal interphalangeal joint, to flex the fingers on the hand
and the hand on the forearm. There is wide variation in the tension capabilities of the
FDS muscles.


23







Figure 2.5. FDP and FDS tendons of a typical digit (source: Netter, 1989)


24
2.2.4. Pulley system of the flexor tendon sheath
The tendon sheath is an important physiologic and biomechanical element of the
flexor tendon mechanism. The sheath, a double walled tube, surrounds the tendons and
contains synovial fluid. The synovial sheath provides a low-friction gliding environment
for the flexor tendon and nutrients for maintenance of the tendon and tenocytes, along
with the intrinsic blood supply. The flexor tendon sheath begins at the neck of the
metacarpal phalange and ends at the distal interphalangeal joint. In each finger, two main
flexors (FDP & FDS) are surrounded by their synovial sheath and held against the
phalanges by the fibrous tendon sheath. Overlaying the synovial sheath is the pulley.
The pulley can be divided into three types according to the locations: a palmar
aponeurosis pulley, five annular pulleys (A1, A2, A3, A4 and A5) and three cruciate
pulleys (C1, C2 and C3). The A2 and A4 pulleys are located on the proximal and middle
phalanges, respectively. The A1, A3 and A5 pulleys are located at the palmar surface of
the MCP, PIP and DIP joints (Figure 2.6).
These pulleys maintain a relatively constant moment arm and prevent tendon
bowstringing across the joints during flexion. In detail, the broader and denser annular
pulleys prevent tendon bowstring to provide optimal joint flexion for a given amount of
tendon excursion. The more variable and thinner cruciate pulleys provide flexibility of
the flexor sheath.
Many researchers (Doyle, 1989; Idler, 1985; Lin et al., 1990) have clinically and
anatomically studied the finger pulley system. Mostly they underscored the importance of
the A2 and A4 pulleys for normal function and a stable joint. The other pulleys such as
palmar aponeurotic and A3 pulleys become important only when the A2 and A4 pulleys


25
have been damaged. Marco et al., (1998) performed a study for rupture of the flexor
tendon pulleys in the crimp (or cling) grip with 21 cadaver fingers. In most of cases, the
initial failure occurred either in the A2 or A4 pulleys followed by the rupture of A3
pulley despite its relative weakness and its location at the center of the proximal
interphalangeal (PIP) joint. Based on a review of the videotapes, they explained that the
A3 pulley stretched to the volar side as the force increased in the flexor tendons. The
forces were transferred from the A3 pulley to the stiffer A2 and A4 pulleys, then these
two pulleys were damaged before the more flexible A3 pulley.



Figure 2.6. Pulley Structure of the Finger (A = annular, C = cruciate).
(source: Nordin and Frankel, 2001)
A1 A2
A3
C1 C2
A4
C3
A5


26
2.3. Biomechanical analysis of the hand
The relationship between the finger tendon forces and the externally applied
forces to the fingers is essential to understand the mechanisms of hand disorders.
Studying tendon forces can help us understand how external forces are transmitted to the
internal tendons and identify which tendons are highly exposed to these external forces.
In addition, these studies can help the clinician in planning and optimizing interventions
for the best recovery of mechanical function. (Weightman and Amis, 1982; Schuind et al.,
1992). .
There are two common methods for quantification of tendon forces: analytic
models experimental and analysis. Several analytic biomechanical finger models that are
based on the equations of static equilibrium at each joint of the finger have been
developed to evaluate tendon forces based on externally applied forces. Experimental
direct tendon force measurement models also have been applied for more comprehensive
understanding of the mechanism of these tendons inside of the fingers.
2.3.1. Analytic models
In the field of biomechanics, there has been continued interest in quantitative
evaluation of the forces imposed on the human body. Many analytic models that predict
muscle forces by applying mechanical laws have been formulated. In these models, the
human body was considered as a system of rigid, articulating segments on which known
external forces and unknown muscle and joint force acted. The objective of the analytic


27
model is to determine the muscle forces that are required for static and dynamic
equilibrium.
However, one of most restrictive problems in analytic modeling is the redundant
nature of the system being analyzed, in which more muscles than are strictly necessary to
obtain equilibrium normally cross a joint. Accordingly, the number of muscles crossing
the joint exceeds the number of equilibrium conditions at the joint and no unique solution
can be obtained. To solve this indeterminate problem, two methods have been employed;
the reduction method and the optimization method. The reduction method is performed
either by grouping functionally similar muscles, or by eliminating them based on EMG
observation while the optimization method is performed by applying an optimization
algorithm with respect to selected optimization criterion.
2.3.1.1. Reduction methods
The reduction method that reduces excessive unknown variables has been one of
the most commonly used methods in this area. The main objective of this method is to
reduce the number of excessive variables until the number of unknown forces is equal to
the number of required equilibrium equations, thus eliminating static indeterminacy.
Borelli was the first researcher who applied Newtons law to the human body to
calculate muscle forces and used the reduction method (Dul, 1983). Since then, several
researchers (Hirsch et al., 1974: thumb, Smith et al., 1964: finger; Chao et al, 1976:
finger) used the reduction method to estimate muscle forces.
Smith et al. (1964) analyzed index finger metacarpophalangeal (MCP) joint forces
during tip pinch with a two dimensional model. The authors assumed (i) that the extensor


28
muscles were relaxed, (ii) that the radial and ulnar interossei could be treated as a single
force and (iii) that the lumbrical muscle exerted a force of one sixth of the total
interosseous force. Solution of three moment equilibrium equations, for an external load
of P, produced values of 3.8P, 2.5P, and 2.1P for the flexor digitorum profundus (FDP),
flexor digitorum superficialis (FDS) and intrinsic tensions, respectively.
Chao et al. (1976) used a three dimensional model to analyze the forces at all
three finger joints during tip, lateral, and ulnar pinch, and grasp. Particularly, in this paper,
the joint and tendon orientations were well defined. In order to determine tendon and
joint forces, unknown tendon forces were systematically eliminated on the basis of EMG
and physiological assessment. They found that flexor muscles have greater strength
during pinch, whereas intrinsic muscles have greater strength during grasp. However,
they did not verify their results. As seen in the above two studies, the reduction method
has beeen appreciated by many researchers for its simplicity. However, the anatomical
simplification inevitable for the reduction method might have induced considerable errors.
2.3.1.2. Optimization method
The optimization method is an alternative solution method for the analytical
model. Instead of eliminating unknown muscle forces in the redundant equation system,
an unique solution can be obtained from a mathematical formulation and optimization
algorithm. The most influencing factor in this approach is an optimization criterion
(usually physiological criterion in muscle force calculation) which corresponds to the
objective function. Hence the optimization criterion is decided first. Second, objective
functions and constraints which represent the system considered are formulated. Then, an


29
optimization algorithm is applied to decide the best solution among candidate solution
provided by the objective function.
Chao and An (1978) studied the middle finger during tip pinch and power grip
actions, with an aid of three-dimensional analysis. They analyzed the same problem using
the optimization and linear programming (LP) technique of Chao et al. (1976) instead of
the previously described EMG and permutation-combination method. The predicted
middle finger muscle and joint forces were very similar to those of the previous study
(Chao et al., 1976), except for the intrinsic muscle forces whose predicted values were
considerably lower. They found that the highest joint contact forces for all three joints
occurred for pinch grip rather than power grip. They also found that the main flexors
(FDP and FDS) were most active in both pinch and power grip functions, whereas the
intrinsic muscles were less active in power grip than in pinch.
However, in terms of optimization methods, these models were unable to predict
synergistic muscle action. Thus, cautions must be imposed on drawing conclusions about
the validity of an optimization criterion when the results are correlated with EMG
observations.
2.3.2. Experimental analysis
2.3.2.1. EMG studies
The EMG method is a readily available technique which can be applied to the
force analysis and the muscle function analysis. Also, it is used to validate the analytical
model. Generally, muscle activity is recorded either via a surface electrode on the skin or


30
via a needle or wire electrode in the muscles. The biggest problem in using
electromyographic technique was in locating the electrodes. While it has been relatively
easy to identify large, superficial muscles, considerable difficulty has been experienced
with small and deep muscles.
Chao et al. (1989) first used EMG technique to quantify the amount of force
exerted in hand muscles under isometric contraction. Their initial motivation for this
study was in the verification of predicted results from their mathematical model. They
conducted two experiments: an isolated isometric test and a pinch/grasp function test. In
the former study, they derived maximum EMG signals of tested muscles in the naturally
extended position and established the muscle tension and EMG relationship. In the latter
part of the study, the forces were measured simultaneously with EMG signals during
pinch/grasp functions. They developed an algorithm for force analysis, based on the
polynomial relationship between tension and integrated EMG. Absolute muscle forces
during several pinch/grasp functions were calculated by using this algorithm, and were
normalized against the applied force. Particularly, ranges of the forces in FPL (Flexor
Pollicis Longus) and EPL (Extensor Pollicis Longus) muscles showed a good accordance
with the results from the analytical math model.
2.3.2.2. in vivo Studies
Directly measured tendon forces under isometric finger function were first
reported by Bright and Urbaniak (1976). They developed a force transducer to measure
the tendon forces in both tip pinch and power grip actions during operative procedures.
Flexor tendon forces were found to be in the range of 4.0 to 20.0 kg and 1.25 to 15.0 kg


31
for the Flexor Digitorum Profundus (FDP) and Flexor Digitorum Superficialis (FDS),
respectively in power grip action, while 2.5 to 12.5 kg for the FDP and 1.0 to 7.5 kg for
the FDS in pinch action. Since they directly measured the tendon forces only, they did
not report the actual applied pinch and power grip force and the ratio of tendon force to
the externally applied force.
Schuind et al. (1992) directly measured forces in the flexor tendons (FPL, FDP
and FDS) during various finger functions. They developed an s-shaped tendon force
transducer and measured flexor tendon forces in pinch and power grip functions. Also, a
pinch dynamometer was used to record the applied loads in pinch action. The tendon
forces showed proportionality to the externally applied forces. To compare their results
with the previously published mathematical finger models, they normalized their tendon
forces, as a ratio of the tendon force to the applied forces. In tip pinch, the ratios were
3.6P, 7.92P and 1.73P, for the externally applied force P, for the FPL, FDP and FDS,
respectively. In lateral pinches, the ratios were 3.05P, 2.9P and 0.71P for the FPL, FDP
and FDS, respectively. Although the FDP and FPL showed high forces during tip and
lateral pinch, the maximal values recorded are probably on the lower side of the potential
forces and it could be explained by the significantly weaker pinch and power grip forces
during carpal tunnel surgery due to the denervation or partial anesthesia of the sensory
area of the median nerve. However, generally the magnitude of tendon forces in this
study was similar to values reported by Bright and Urbaniak (1976), although direct
comparison is not possible since the applied force was not recorded in their study.
In another in vivo tendon force measurement study, Dennerlein et al. (1998)
measured only FDS tendon forces of the middle finger at three finger postures, which


32
ranged from extended to flexed pinch postures using a gas-sterilized tendon force
transducer (Dennerlein et al., 1997) and a single axis force transducer (GreenLeaf
Medical Pinch Meter, Palo Alto, CA). The investigation was centered upon the average
ratio of the FDS tendon tension to the externally applied force. The average ratio ranged
from 1.7P to 5.8P, with a mean of 3.3P, in the study. Tip pinches with the DIP joint
flexed were also studied with the tendon-to-tip force ratio being 2.4P. These ratios were
compared with the results of their own three finger models as well as other
contemporarily published isometric tendon force models. These ratios were larger than
those of other studies. The average values were also slightly higher than that (1.73P) of
Schuind et al.'s (1992) in vivo tendon force measurement study. It was found that the
tendon force ratios and muscle strength varied substantially from individual to individual,
although the ratio of force from tendon to tendon was relatively constant within the same
limb for all studies (Brand et al., 1981; Dennerlein et al., 1998).
2.3.2.3. Cadaveric Studies
Brand et al. (1981) measured the mass or volume of a muscle that is proportional
to its work capacity, and the fiber length of a muscle that is proportional to its potential
excursion. The mass fraction of FDP was 29.4% higher than the FDS and tension fraction
of FDS was 30.3% less than the FDP. Consequently, the tendon force ratio of FDP to
FDS was 3:2 FDP to FDS. An et al. (1985) also measured the volume and fiber length of
muscles. By dividing the volume of the muscle by the fiber length of the muscle, the
Physiological Cross-Sectional Area (PCSA) of the muscle was determined. The PCSA of


33
all fibers was proportional to maximum tension. Thus, he reported the FDP had 12.3%
larger than the FDS in analysis of PCSA.
Valero-Cuevas et al. (2000) measured tip pinch motion of cadaver hands to
estimate fingertip force reduction following peripheral nerve injuries. For the tension of
tendons, they used springs pulling extrinsic and intrinsic tendons and anchoring Nylon
cords tied to the proximal end of a spring. Thus, known tensions could then be applied to
individual tendons, and simultaneously to several tendons, and the fingertip force output
measured. The comparison of the ratio of tendon tension to fingertip force was 2.8 and
1.33 for FDP and FDS, respectively. Therefore, flexor tendon force was 4.13 times higher
than the external fingertip force.
2.3.3. Tendon force ratio of the FDP and FDS
Although the intrinsic muscles are more active in pinch action than in power grip
action, the relative magnitudes of the main flexor tendon forces (such as FDP and FDS)
are usually high in both actions. The in vivo tendon forces of the flexors measured in
previous studies, are presented in Table 2.3. In general, the averages and ranges of tendon
forces are similar with a few exceptions. Schuind et al. (1992) showed lower FDS tendon
forces in power grip action than those of other types of grips. They also indicated
significant differences between FDP and FDS tendon forces in both pinch and power grip,
whereas the others showed that the force of FDP tendon was only slightly larger than that
of the FDS tendon. These discrepancies can be explained by the different finger postures
utilized in each study, since each finger could have various functional muscle


34
capacities depending upon its joint configuration (Chao and An, 1978). In all
these in vivo tendon force studies, the muscle and tendon forces were proportional to the
externally applied forces. However, the predicted maximum tendon forces are probably
lower than the true potential forces because these experiments were performed during
carpal tunnel surgery under local anesthesia in the median nerve innervation area. In such
cases, the muscles are partially inactive and produce lower pinch and power grip forces.
To normalize these tendon forces, the ratios of the tendon force to the applied force, FDP
to FDS, and joint forces are studied for both pinch and power grip functions (see Table
2.4). Average ratios of tendon forces to the applied forces in the tendon force prediction
models were, for an external force of P, 3.5P (SD: 0.74), 1.8P (SD: 1.03) and 3.67P (SD:
2.29) for the FDP, FDS and I (intrinsic) tendons in pinch, while 3.14P (SD: 0.29), 3.48P
(SD: 0.72) and 11.4P (SD: 6.6) were for FDP, FDS and I tendons in power grip,
respectively. Generally all data agreed with high contributions of flexor tendons (FDP
and FDS) for both pinch and power grip actions, although intrinsic tendons showed high
Table 2.3. Cadaver (Kg) and in vivo tendon forces (N) of FDP and FDS
Finger Configuration FDP FDS
Brand et al., 1981 - 14.9* (13.5-17.0) 10.4* (4.5-17)
Ketchum et al., 1978 MCP joint flexion 5.7* (5.27-6.18) 6.12* (3.73-7.63)
Bright et al., 1979
Tip Pinch 2.5-12.5 1.0-7.5
Power grip 4.0-20.0 1.25-15.0
Schuind et al., 1992
Tip Pinch 8.3 (2.0-12.0) 1.9 (0.3-3.5)
Power grip 4.0 (1.9-6.4) 0.6 (0.0-0.9)

(Note: *- average tendon forces for all fingers in cadaver studies)


35
variations among those data. The average ratios of FDP to FDS were also obtained,
2.92:1 and 0.93:1 for pinch and power grip, respectively. These data showed the
significant strength of the FDP tendon for the pinch actions, whereas the fairly equal
contributions of these two flexors to the overall power grips.
Validating these mathematical solutions by experimental measurement was
undertaken by Schuind et al. (1992), although they did not measure the externally applied
force at the same time with tendon forces in power grip. They only used the pinch
dynamometer for measuring the amount of the applied force for pinch functions. Thus,
the mean tendon forces were applied for validating power grip functions in this study.
In pinch actions, Schuind et al. (1992) reported the higher ratio of FDP to the
applied force (7.92P) than the result (3.5P) of mathematical tendon force prediction
models. The FDS ratio to the applied force (1.73P), however, was fairly similar to the
Table 2.4. Tendon and joint forces ratios to external forces in power grip function
Finger
Muscle Force Joint Force
FDP FDS FDP/FDS I DIP PIP MCP
Bright et al., 1976 -
4.0-20.0* 1.25-15.0* - - - - -
Schuind et al.,
1992
-
4.0** 0.6** 6.67 - - - -
Chao et al., 1976
Index
2.77 2.53 1.09 5.76 .09 4.35 12.7
Middle
3.05 4.23 0.72 .10 .17 7.11 3.9
Little
3.37 3.40 0.99 5.21 3.31 6.02 4.5
Chao and An,
1978
Middle
3.37 3.75 0.9 1.64 3.89 6.8 5.18
An et al., 1985 Index
3.17-3.47 1.51-2.14 0-1.19 2.8-3.4 4.5-5.3 3.2-3.7

(Note1: *: tendon force, unit: kg; **: mean tendon forces, unit: kg)
(Note2: I: intrinsic (interossei plus lumbrical) muscle)


36
average ratio (1.8P) in the finger model studies. Because of the large force measurement
for the FDP tendon, higher ratio of FDP/FDS (4.6P) was presented in their study than that
of finger model studies. As another direct measurement data, Dennerlein et al. (1998)
found the higher tension ratio of the FDS tendon to the applied force (3.3P) than those of
mathematical finger model studies.
In power grip actions, there were no in vivo tendon force data for the ratio of
tendon force to the externally applied force. Thus, only the FDP: FDS ratio of direct
measurement study can be used for the comparison with the finger model studies. They
presented a 6.67:1 ratio based on their mean tendon forces of FDP and FDS. The force of
FDP was significantly larger than that of FDS in direct measurement study, whereas both
FDP and FDS had similar contributions to power grip (3.14P for FDP and 3.48P for FDS)
and a FDP: FDS ratio of 0.93:1 was also calculated in finger force prediction models. The
variability of these results may be expected since all researchers did not use the same
finger characteristics: moment arms, finger configurations and angles of the applied
forces to the finger tip or pulp area.
There are controversial issues for the functions of tendons (intrinsic muscles vs.
flexors) during pinch and power grip actions in biomechanical finger models. Based on
the solutions from the three moment equations, Smith et al. (1964) found that flexor
tendons usually carry larger forces than the intrinsic muscles during tip pinch. Chao and
An (1978) also supported this result in their study. They showed that the flexors were
most active and produced high tendon forces in both pinch and power grip actions.
However, Chao et al. (1976) and An et al. (1985) suggested contradictory results for the
contributions of intrinsic muscles in finger actions. They presented higher contributions


37
of intrinsic muscles than those of the flexors in pinch and power grip functions. In
general, although the magnitude of the intrinsic muscle force was less than that of the
flexors, the intrinsic muscles were more active in pinches than in power grip. An et al.
(1985) also agreed with high intrinsic muscle forces in pinches and explained it by the
need for these intrinsic muscles to balance and stabilize the large MCP joint forces.
Most of these studies showed similar trends for joint forces. Small constraint
forces and moments were seen at both the DIP and PIP joints, while the constraint forces
and moments were considerably higher at the MCP joint in both actions. DIP and PIP
joint forces of the power grip actions were relatively lower than those of the pinch actions.
This may explained why hands are more adaptable in performing powerful grip actions
rather than pinches since it is more difficult to maintain the proper stability requirements
at the distal joints (Chao et al., 1976).
Through these two- or three-dimensional models, many researchers have tried to
understand how the externally applied forces are transmitted across finger joint to the
internal tendons of the human hand and how these tendon forces relate to the applied
forces. Generally most studies agreed with high contributions of flexor tendons (FDP and
FDS) in power grips and good proportionality tendon forces to the external forces.
However, generally, the in vivo direct flexor tendon forces and the FDP to FDS ratios
were larger than those predicted from the finger models.
In spite of the relatively low tendon forces predicted in biomechanical finger
models, FDP and FDS tendon forces were 3.14~3.5 times and 1.8~3.48 times larger than
the applied forces in pinches and power grips, respectively. Thus, large and repeated
tendon forces can be a contributory factor in tendon disorder, especially in hand intensive


38
tasks. In addition, these tendon forces varied due to the finger joint configurations or
finger postures utilized in each task. Therefore, properly designed hand tools, which
optimize the hand posture to minimize tendon forces, can reduce and prevent work-
related musculoskeletal disorders.
The essential part of the finger model is the basic assumptions to simplify the
finger mechanism. From a mathematical point of view, the simpler the anatomy, the
simpler the finger model. However, these simplifications of the finger mechanics can lead
to misleading information on the joint and tendon forces calculated from the finger model.
In addition, most of these finger models have been developed for clinical and
rehabilitation purpose to simulate the muscle and tendon forces involved in grasping an
object (Chao et al., 1976; Cooney and Chao, 1977). There are only a few studies that
have applied to the analysis and evaluations of the hand tool tasks and hand tool designs.
Therefore, the development of a more carefully and accurately designed
biomechanical finger model is critical to understanding the mechanism of tendon
disorders. The finger model should then be applied to more practical working conditions
(such as intensive hand tasks, hand tool designs).
Because of the limitations of the external force measurement system, it was not
possible to truly analyze the ratio of each tendon force to the applied force in power grip
function. Therefore, the development and application of better experimental systems are
needed to do more reliable validation for the results from the theoretical finger models.


39
2.3.4. A Two dimensional hand model
From a biomechanical perspective, the extrinsic finger flexors, FDP and FDS,
comprise the main sources of power for finger flexion in grasping type motions,
especially power grip. Kong and Freivalds (2003) established static equilibrium equations
for each phalange and for each finger (see Figure 2.7). Because most of the tendon-pulley
attachments are in line with the long axis of the phalanges and there are small lateral
force components, only two axis, the x and y, need to be defined. Therefore, a simple
two-dimensional model utilizing those two tendons should be sufficient for most
applications. To further define the model, several other assumptions need to be made. All
assumptions and equations were quoted from Kongs study (2001).

Assumptions of the hand model
In order to define and simplify the system of biomechanical analysis, these
assumptions, which were adapted from Chen (1991), are necessary in this study.

1. No effects of intrinsic muscles and extensors: The effects of these muscles on the
finger flexion can be neglected since these muscles will relax their viscoelastic
property when the joint angles are within their normal range of motion during power
grip or grasp (Armstrong, 1978).
2. Hinge Joints: All of the interphalangeal and metacarpal joints (DIP, PIP and MCP
joints) are hinge joints; consequently, they only permit flexion and extension.
3. Flexor digitorum superficialis (FDS) insertion: Anatomic analysis shows that the FDS
is inserted by two slips to the sides of the proximal end of the middle phalange

(Steinbe
palmar
insertio
In a tw
along th
side of

4. Tendon
Therefo
force (C
5. Externa
exerted

Figure 2.7

erg, 1992).
side of the
on is assume
wo-dimensio
he sides of
the proxima
ns and tend
ore, a single
Chao et al.,
al load: The
d at the mid
7. Free-body
However,
proximal e
ed to be par
onal biomec
the bone is
al end of the
don sheaths
e tendon pa
1976).
e externally
d-point pulp
y diagram fo
it is assum
nd of the m
rallel to the
chanical mo
s the same a
e middle ph
are model
assing throu
y applied fo
p of a dista
for a two-dim
med that eac
middle phala
e proximal p
odel, the eff
as having o
halange.
led as frict
ugh several
forces are a
al phalange
mensional h
ch FDS ten
ange. Furthe
phalanges l
ffect of hav
one tendon
ionless cab
joints main
assumed to
for pinch o
hand model.
ndon is inse
ermore the
long axis in
ing two spl
inserted on
ble and pul
ntains the s
be a single
or by three
. (source: K
40
erted to the
direction of
n this study
lits inserted
n the palmar
ley system
same tensile
e unit-force
-unit forces
Kong, 2001)
0
e
f
.
d
r
.
e
e
s


41
applied normally at the mid-point of each phalange and metacarpal bone for grasp as
seen in Figure 2.7. The direction of the force is assumed to be perpendicular to the
long axis of the bone. Also, any geometrical parameters of the axis of hand
musculature remain unaffected by the magnitude of the load.
6. No effect of finger deformations: Deformation of the bones and the tendons are
neglected since only healthy subjects were used with no injuries occurring during the
experimental grasp exertions.
7. No mass effect: The weight of the bones together with other soft tissues on the hand
was assumed to be negligible. In case of involving the external load, the mass effect
was a very small percentage of the external load.
8. The tendon force ratio of FDP to FDS at the each phalange: It is assumed 3:1 (that is,
= 0.333 (Marco et al., 1998). Marco et al. used a 3:1 profundus-to-superficialis
tendon force ratio that resulted in rupturing the pulleys before avulsion of the flexor
digitorum superficalis tendon.
9. Tendon moment arms: Tendon moment arms of the two flexors (FDP & FDS) can be
estimated for distal and proximal interphalangeal and metacarpal phalangeal joints of
different thickness (Armstrong, 1978). The tendon moment equations for these
flexors are predicted by following equations:





FDP: PR
ik
(mm) = 6.19-1.66X
1
-4.03X
2
+0.225X
3
Eq. 0.1
FDS: SR
ik
(mm) = 6.42+0.10X
1
-4.03X
2
+0.225X
3
Eq. 0.2


42
where,
PR
ik
= FDP moment arm for the i
th
finger and k
th
joints.
SR
ik
= FDS moment arm for the i
th
finger and k
th
joints.
X
1
= 1 for the proximal interphalangeal joint (PIP) and 0 for all others.
X
2
= 1 for the distal interphalangeal joint (DIP) and 0 for all others.
X
3
= Joint thickness (mm) measured according to Garrett (1970).

Consequently, these equations can be summarized as follows:

Four Cartesian coordinate systems are established to define the locations and
orientations of the tendons and to describe the joint configuration. There are two
coordinate systems for both the middle and proximal phalanges and only one system for
the distal and metacarpal phalanges. The y-axis is defined along the long axis of the each
phalange, from the proximal end to the distal end. The x-axis is defined as perpendicular
to the long axis of each phalange and in the palmar-dorsal plane, from the palmar side to
the dorsal side of the finger bone. Both x- and y-axes have their origins at the center of
the proximal end of phalange. In terms of notation, subscribe i refers to fingers, with 1 to
4 for the index, middle, ring, and little fingers, respectively, subscript j refers to joints,
DIP joint: PR
i
(mm)= 2.16+0.225 X
3
Eq. 0.3
PIP joint: PR
i
(mm)= 4.53+0.225 X
3
Eq. 0.4
SR
i
(mm)= 6.52+0.225 X
3
Eq. 0.5
MCP joint: PR
i
(mm)= 6.19+0.225 X
3
Eq. 0.6
SR
i
(mm)= 6.42+0.225 X
3
Eq. 0.7


43
with 1 to 4 for the DIP, PIP, MCP, and wrist joints, respectively, while subscript k refers
to phalanges, with 1 to 4 for the distal, middle, proximal phalanges, and the metacarpal
bone, respectively.
In terms of model input values, the external force on each phalange of each finger
is indicated by F(i,j). The finger joint flexion angles, measured with reference to straight
fingers as the hand is lying flat, are indicated by (i, j). The length of each phalange for
each finger is indicated by L(i,k).
For the model output variables, the FDP tendon force for each phalange of each
finger is indicated by TP(i,k). The FDS tendon force for each phalange and each finger is
indicated by TS(i,k). Finally, joint constraint forces along the X
k
- and Y
k
-axes are
indicated by R
xk
(i,j) and R
yk
(i,j), respectively.
To solve for the above unknown model output variables, a static equilibrium
analyses of each phalange in the x- and y-axes must be zero. Similarly, the summation of
all moments acting on each phalange must also be equal to zero.
Therefore, joint forces and tendon forces for each phalange can be obtained:


44

DISTAL PHALANGE:
MIDDLE PHALANGE:
PROXIMAL PHALANGE:

Therefore, final tendon forces of the FDP and FDS are calculated by following equation.
TP (i,1)= 0.5 [L(i,1) / PR (i,1)] F(i,1) Eq. 0.8
Ry
1
(i,1)= TP(i,1)cos(i,
1
) Eq. 0.9
Rx
1
(i,1)= TP(i,1)sin(i,
1
)-F(i,1) Eq. 0.10
TP (i,2)=
[0.5F(i,2)-R
x1
(i,1)cos(i,
1
)+R
y1
(i,1)sin(i,
1
)]L(i,2)/[ SR(I,2)+PR(i,2)]
Eq. 0.11
TS (i,2)= TP(i,2) Eq. 0.12
Ry
2
(i,2)= Rx
1
(i,1)sin(i,
1
)+ Ry
1
(i,1)cos(i,
1
)+ (+1) TP(i,2)cos(i,
2
) Eq. 0.13
Rx
2
(i,2)= Rx
1
(i,1)cos(i,
1
)- Ry
1
(i,1)sin(i,
1
)+(1+ ) TP(i,2)sin(i,
2
)-F(i,2) Eq. 0.14
TP (i,)=
{0.5F(i,3)-R
x2
(i,2) cos(i,
2
)+R
y2
(i,2)sin(i,
2
)}L(i,3)/ [ SR(i,3) +PR(i,3)]
Eq. 0.15
TS (i,3)= TP (i,3) Eq. 0.16
Ry
3
(i,3)= Rx
2
(i,2)sin(i,
2
)+ Ry
2
(i,2)cos(i,
2
)+ (+1) TP(i,3)cos(i,
3
) Eq. 0.17
Rx
3
(i,3)= Rx
2
(i,2)cos(i,
2
)-Ry
2
(i,2)sin(i,
2
)+ (1+)* TP(i,3)sin(i,
3
)-F(i,3) Eq. 0.18
FDP = TP(1)+TP(2)+TP(3) Eq. 0.19
FDS = TS(2)+TS(3)
Eq. 0.20


45
Chapter 3

THE HAND MOTION SIMULATOR

The Hand Motion Simulator (HMS) was built to simulate hand motions and
postures in a cadaver hand. Muscle forces generated by linear actuators with force
feedback control were applied to the tendons of the extrinsic muscles of the hand. The
HMS was composed of five essential parts: frame supporting a specimen, motion
delivery unit through stepper motor driven linear actuators applying forces to the muscle
tendons, data acquisition unit for force transducers measuring internal and external forces,
kinematic vision measuring finger joint angles, and operating program to control the
HMS.
3.1. Support Frame
Aluminum T-slotted profile bars support the main structure of the frame (see
Figure 3.1, 3.2). The external fixation frame was incorporated into the inner-frame with
two bars placed parallel to each other through the radius and the ulna. 6 fixators for
securing the forearm were suspended from the bars with vertical shafts to adjust the
height. An adjustable handle fixture was rigidly located on top of the frame. The handle
fixture secured the handle to the frame to prevent shifting during power grip motion. All
fixtures are adjustable to allow for vertical & parallel positioning. Fixtures are used to
secure a forearm, fasten a handle, and attach a camera on the external cage. In terms of
the motion capture, a CCD camera was placed on the side of external frame


46
perpendicular with lateral view to record finger joint angles. In the motion unit, two
stepper motors were vertically installed on the side of frame, and faced each other on the
inner & outer fame to arrange force delivery cables in a row. Force delivery metal wires
connected the stepper motor to a clamp for each tendon. However, since the line from a
motor was perpendicular to the line from a clamp, a pulley system was placed on the top
of frame side. The pulley wheel had a non-friction ball bearing to minimize friction with
a cable.



Figure 3.1. Schematic drawing of the hand motion simulator



47

Figure 3.2. Schematic drawing of the hand motion simulator
3.1.1. Forearm fixators
Fixators for a forearm were placed on the both sides of the frame. To adjust the
forearm position, the fixture was designed with horizontal & vertical adjustability (Figure
3.3). To fasten the forearm in position, six Schanz screws (self-drilling
4.0mm/175mm(length)/40mm(thread), Synthes Inc.) were laterally cross-drilled into the
radius and ulna, and the screws pins were thrust into fixators suspended from the sidebars.
An adjustable fixation system (Wristjack, Hand Biomechanics Lab, Inc) was also
secured to the forearm frame. It held the wrist in specific angles of flexion or extension,
postures observed in power grip motion (Figure 3.4). Two small pins were screwed into
the metacarpals through the metacarpal bar to fasten the hand to the fixator. The inner-
frame with the wrist fixator allows incremental adjustment of palmar tilt, radial
inclination, length and rotation.

Load Cells
Freeze clamps
Force Deliver Unit
(FDU)
FSRs
Wristjack

Camera


48


Figure 3.3. Fixators for fastening the pins cross-drilled into radius and ulna



Figure 3.4. Adjustable wrist fixator (Wristjack, Source: Surgeons Manual)



49
3.1.2. Cylindrical handle and handle fixture
A cylindrical force transducer dynamometer was designed and constructed to
measure force in a single axis of sensitivity and to measure all forces applied along the
handle length, independent of point of contact. It was split and a force transducer was
inserted in between halves handles. This type of split cylindrical handle has been used to
measure grip force by many researchers (Ayoub and Lo Presti, 1971; Dong et al., 2004;
Edgren et al., 2004; Irwin and Radwin, 2008). The force transducer signals were
amplified and digitized using a 12-bit analog-digital converter. The data acquisition
sample rate was 10 Hz. The handles included cylinders of 30, 37, 45, 50, and 60 mm
diameter (see Figure 3.5). The handles were made of aluminum and were inter-
changeable with a force transducer.
These handles were required to be fixed in position while pulling tendons for
power grip motion. Since a cadaver hand did not have stable reaction force to a thumb
and palm, the handle might be tilted by finger flexion for power grip motion. To prevent
the undesired movement of the handle, the handle fixture was installed to keep the handle
in place. The fixture consisted of vertical poles attached to the frame, a knob to adjust
vertical position, and also a cross bar to fix the vertical poles on the main frame (see
Figure 3.6). A camera fixture was attached on the side of the cage in lateral view. The
fixture could be slid on the side of cage to stand in line with the cross-sectional side of
the handle. Thus, the camera vision kept a lateral view to the handle and grip posture and
also captured the finger joint angle of power grip motion.

Figure
Figure 3.5
3.6. Handle
5. Split cylin
e fixture wit
ndrical hand
th a height a

dles with fiv

adjustable k
ve different
knob and ha
t diameters
andle fixing
50
clamps
0


51
3.2. Motion System
3.2.1. Force delivery unit
The excursion of the Flexor Digitorum Superficialis (FDS) and the Flexor
Digitorum Profoundus (FDP) was controlled by a two Force Delivery Units (FDU) (see
Figure 3.7). Each FDU consisted of a stepper motor driven linear actuator (model EC2H:
Industrial Devices. Novato, California) in series with a force transducer (model LCCA-
500; Omega Engineering). Each force transducer was attached to a cable (metal wire)
connected to a freeze clamp in the line of force of each muscle. The freeze clamp was
employed to maintain a secure couple between a force delivery cable and fresh musculo-
tendinous tissues and without slippage. These devices have been successfully employed
in other muscles (Sharkey et al. 1995). The freeze clamp was attached firmly to the
tendons and liquid nitrogen was circulated through one half of the clamp in order to
freeze the tendon solid at the interface to provide an extremely rigid connection between
cable and tendon. The FDU frame was adjusted to maintain cable length irrespective of
specimen size. The linear actuator of each FDU was powered and controlled by using a
stepper motor controller that receives command input from a motion controller (UMI-
7764, NI) (see Figure 3.8). This motion controller residing in a controlling PC was
coupled with a universal motion interface (UMI) card. Since the UMI had compatibility
of different manufactured parts, the protocol was not a problem between the motor and
motion controller. The UMI incorporated a host PC power monitor that inhibits the
motion driver if the host PC loses power during motion control. In addition, The UMI
monitored the +5 VDC from the PC and activated the inhibit signals if the voltage fell out


52
of tolerance. The controlling computer received a force feedback from force transducers
measuring actual tendon forces and implemented a force-feedback control loop in order
to reduce the steady state error between the actual force and the target force for the
muscles to less than deadband offset. The controlling computer used a velocity control to
converge the motion to the target force.

Figure 3.8. Motor and motion controller in FDU


Figure 3.7. The Components of Force Delivery Unit (DFU)
Freeze clamps
Stepper Motor Driven
Linear Actuators
Load Cells
Cables
Controlling
Computer
ForcePIC
Micro-Controller
Stepper Motor
Controller
Tendons


53
3.2.2. Muscle force control
To control muscle force, the custom developed HMS Software (LabView,
National Instruments, Inc.) had two modes: the force feedback control loop and direct
control. Muscle forces were controlled by a feedback control loop based on the actual
force, F
A
, measured by each force transducer and the desired force, F
D
.
The HMS software read in three forces: actual force, F
A
, target force, F
T
, and
adjustable deadband offset force, F
db
, used to control the sensitivity of the control loop.
The data acquisition system with analog to digital converters read these voltages and the
motion controller kept pulling until reaching the target force, F
T
. Stepper motors in the
feedback control loop could possibly overshoot and oscillate. For smoother convergence
of the motion on the target force, a velocity control algorithm was incorporated in the
force feedback control. When the actual force was greater than the target force in
accordance with overshoot, the velocity of the actuator was reduced by a half of the
original velocity the moment the actuator let the cable out. Likewise, when the actual
force, F
A
went down below the target force, F
T
, the velocity of the actuator was decreased
by a half of the already reduced velocity the moment the actuator pulled in. Through
these successive repetitions of reducing velocity, the motion finally stopped at the
convergent point balancing with the target force, F
T
. However, a ripple of force signals
from force transducers made the stepper motors have infinite oscillated motions. To
remove these small fluctuations of the motion of motors, the force feedback control loop
were controlled by adjustable deadband offset, F
db
. The offsets force of the FDP and the
FDS was determined by the ripple variation of signals from force transducers, and could
be regulated during the operation. Consequently, the motion of the Force Delivery Unit


54
was finally suspended on target forces with this force feedback control loop. The entire
process is presented in Figure 3.9 and the following shows the simple flow of the force
feedback control loop.

Input Target Force

= F
T1

Input Initial Pulling Speed = V
default


While 1
F
1
=Read Actual Force
V = V
default

If F
1
< F
T1

Pull in
Else if F
1
> F
T1

Let out
V = V / 2
Else
Do nothing
End


In terms of visco-elastic properties of tendon and muscle, the tensions of cables
connected with suspended motors sometimes decreased with tendon creep, and the actual
forces slowly went down below the target force with lapse of time. To compensate for
loss of cable tensions, the actuator needed to re-activate the pulling motion by the force
feedback control. According to the re-activation of the force feedback control loop, initial
velocity was input to the feedback control after reset of the final zero velocity. The
sensitivity of motion was also adjusted by F
db
on the front panel.







Figure 3.9. Workf

flow of the fforce feedbaack control system
55

5


56
The Force Delivery Unit (FDU) could be operated in direct modes as well. In this
mode, the user has direct control of the each FDU and can move the actuators in and out
directly. Hence, the operator could manually control the HMS in direct mode. This mode
was used for tendon length adjustment when the specimen was being placed in the HMS
and the freeze-clamps were being attached. In terms of safety, the operator is able to
intervene and stop a test at any point.
3.2.3. Muscle forces in the experiment
Basically, tendon forces and ratios between the FDP and FDS might be diverse,
depending on finger postures in power grip motion. As seen in section 2.3.3, the tendon
forces and the ratio of FDP and FDS had a large variability that may be expected because
all researchers did not use the same finger characteristics. Therefore, in this study, the
hand motion simulator activated the flexor tendons with various tendon force ratios to
define power grip mechanism, and the ratios were investigated with response variables
(grip force, finger force distribution and finger joint angle).
There were two types of experiments conducted with different ratios. In the first
experiment, the FDP force was held constant at 100N, and the FDS force was increased
in 20N increments from 20N to 100N. Hence, the total tendon force of the flexor tendons
was also increased from 120N to 200N along with the FDS force increase as five
different FDS forces applied. The tendon force ratio was simultaneously changed from
100:20 (5:1) FDP to FDS force to 100:100 (1:1) as well. The second experiment was
conducted in a different way. The total flexor tendon force was a constant (200N) and
both FDP and FDS forces were set at five different ratios whereby FDS increased from


57
20N to 100N by 20N increments. Simultaneously, the FDP force decreased from 180N to
100N. Consequently, the tendon force ratio was shifted at 180:20 (9:1) FDP to FDS force
to 100:100 (1:1). That meant the relative FDS force ratios (%FDS) to the total tendon
force were 10% at 9:1 FDP to FDS and 50% at 1:1 ratio. These different levels of FDP to
FDS ratios induced different mechanical behavior during power grip.



58
3.3. Data Acquisition System
A data collecting system was utilized to measure external forces and internal
forces while grasping. External forces were defined as grip force measured from a force
transducer inserted in a split cylindrical handle, and internal forces were determined as
tendon forces taken by force transducers in line with the force delivery unit. The data
acquisition system was designed for measuring internal and external forces coupled with
force feedback control system.
3.3.1. Tendon and grip force measurement
To measure tendon tension and grip pressure during the grasping motion, the
HMS was composed of a SCXI Chassis system (National Instruments) with three force
transducers (See figure 3.10). The SCXI chassis included an amplifier and an A/D
converter. The stainless steel force transducers (LC202-500, Omega Inc.) had dual
mounting studs for easy installation in the FDU or handle (see Figure 3.11) and with a
range of 500 lb and accuracy of 0.25%. Two force transducers were connected in line of
cable with a FDU to measure tendon tension as an internal force, and force transducer
was inserted into a split cylindrical handle presented in section 3.1.2 to measure grip
force as an external force (see Figure 3.12). The amplifier and A/D converter (SCXI-
1600, NI Inc.) required a terminal block (SCXI-1314, NI) and a strain gauge input
module (8-ch. SCXI-1520, NI). SCXI-1600 amplifies and digitizes the signal with 16bit
A/D converter. The SCXI system was monitored and controlled by a custom programmed
software (Labview, NI).


59




Figure 3.10. Data acquisition system of the Hand Motion Simulator



60


Figure 3.11. Data acquisition system with force transducer


Figure 3.12. Split cylindrical handle with force transducer inserted



61
3.3.2. Finger force distribution measurement
To explore the finger force distribution, contact forces on each phalange were
measured by conductive polymer sensors with a data encoder. Force sensitive resistors
(FSRs) have been used previously to measure force and pressure distributions at the
hand-handle interface (Fellows and Freivalds, 1989; Kong and Freivalds, 2003). Previous
researchers have demonstrated the utility of FSRs have made it possible to measure the
force distribution pattern in the hand during various activities. Furthermore, FSRs are
well suited for the evaluation of the force or pressure distributions associated with
different handle shapes and textures (Chang et al., 1999; McGorry, 2001). We employed
the same type of FSR, FlexiForce resistance sensor (A201, Tekscan: Capacity: 25lb.)
in this study since its flexibility and reliability of force measurement has been
successfully demonstrated. Hence, FSRs were attached on each phalange (distal to
metacarpal phalange) of all four fingers (index to little finger). Figure 3.13 and 3.14
illustrate the FlexComp Infiniti data collection system and a specimen with 16 channel
FSRs on each phalange. The contact forces were gathered via FlexComp Infiniti data
collection system (Thought Technology). FlexComp Infiniti system could collect the
data up to ten sensors. FlexComp Infiniti system consists of the FlexComp Infiniti
encoder unit, the TT-USB interface unit, fiber optic cable, and operating software
(BioGraph Infiniti Ver. 2.1.). The FlexComp Infiniti encoder is a multi-modality
device for real time data acquisition with ten channels. The FlexComp Infiniti encoder
can render a wide and comprehensive range of objective physiological signs used in
ergonomics, clinical observation, and biofeedback.


F
Figure 3.1
Figure 3.14
13. FlexCom
. FSRs attac
mp system w

ched on eac
with FSRs
ch phalanges
622




63
3.4. Machine Vision System
The HMS used a machine vision instead of other traditional manual measurement
tools because it offered unique abilities not found in many traditional tools. We can
implement many other applications using traditional tools, but machine vision made these
tasks much easier. In terms of measuring finger joint angles, a goniometer is the most
traditional approach. However, it is not effective to measure every joint manually with
repetition. It can be troublesome and inaccurate to read finger joint angle with a manual
goniometer. Also, since electro goniometers can be unstable with small joint flexion, we
needed to capture each finger joint angles of the index finger on different conditions
while simulating power grip motions.
3.4.1. Vision system
The vision system consisted of a hardware part and a software part. To acquire,
analyze, and process images, the imaging system was set up with the supporting frame.
Five factors comprise an imaging system: resolution, field of view, working distance,
depth of field, and sensor size (See Table 3.1).
In the HMS, the images were captured using a small camera (Model Quickcam
Pro 9000, Logitech Corporation) with a 2,000,000 pixels CCD image sensor to get image,
so it was ample resolution to process captured images with vision analysis algorithm. To
read finger joint angles, the field of view was 160mm x 120mm showing finger flexions
motions with each phalange angle. The captured image had a resolution of 960 pixels by
720 pixels. Thus, the resolution that the imaging system could distinguish was 1mm per 6


64
pixels. A total of 691,200 pixels are involved to process the image captured by the
camera. It was enough to process the image data with vision analysis algorithm compared
with 2,000,000 pixels capacity. The focal length of the camera is 3.7 mm and it offered
wide angle with proper working distance.
The real-time video on the HMS control panel had a resolution of 600 pixels by
480 pixels and 15 frames per seconds. This video was used to monitor the movement of
fingers controlled by motion delivery units. Upon clicking the capture button on the panel,
captured images representing static grip postures of each condition are saved in an 8-bit
stacked JPG format. As the post process, saved images were analyzed by the custom
Labview software to read finger joint angles on each condition.

Table 3.1. Fundamental parameter of an imaging system
Resolution
The smallest feature size on your object that the imaging system can distinguish
Pixel resolution
The minimum number of pixels needed to represent the object under inspection
Field of view
The area of the object under inspection that the camera can acquire
Working distance
The distance from the front of the camera lens to the object under inspection
Sensor size
The size of a sensors active area, defined by the sensors horizontal dimension
Depth of field
The maximum object depth that remains in focus


3.4.2. Imag
Sav
used in ma
for many m
about the
detectors lo
change in
location of
Moreover,
intersection
the angle o
finger joint
algorithm (




ge process
ved images
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location o
ocate the e
the graysca
f the edge
we can u
n points. Th
of the line
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(See Figure
Figure
were analy
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to make m
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e 3.15. Imag

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65
commonly
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66
3.5. Software
The Custom program by Labview software (National Instruments, Austin, Texas)
controlled the motion delivery units and the data acquisition system. This program was
designed to provide the user with complete control of the simulation from adjustment of
calibration settings for force transducers and external triggering set-up (see Figure 3.16.
and 3.17). The HMS software required manual input by manual to support the force
feedback control. The input data comprised the target forces (FDP & FDS) and deadband
force offset, and the output data were composed of actual tendon forces, tendon
displacements and a grip force. Hence, operator can individually control the desired
forces for FDP and FDS and change the force ratio between FDP vs. FDS. Moreover,
operator could control the motion delivery unit by manual control buttons on the front
panel. The output data were saved to an Excel format.
The entire process of the system was fully illustrated in the following chapter. In
addition, the block diagrams of source codes showing the logic of force feedback control,
velocity control and data saving are attached on the Appendix A.




67

Figure 3.16. Hand motion simulator monitoring panels


Figure 3.17. Hand motion simulator controlling panels


68
3.6. Calibration
Before conducting the experiment, all equipments were calibrated to validate the
system. Motion calibration was conducted with an accurate linear measurement tool in
terms of the stepper motor movement. Also, two types of force transducers (orce
transducer and FSRs) were calibrated with an accurate digital force gauge. These
calibration data were used to operate the hand motion simulator with the force feedback
control.
3.6.1. Motion calibration
To validate the motion of the FDU, the calibration of the stepper motor is required
to measure the displacement of a force delivery cable. According to pulling/pushing
motion of the stepper motor, the cable tension would be changed by the motion. This
tension force is used to provide a feedback control in the HMS system. Hence, the
displacement of the motion is related with the force variation of the tension.
The stepper motor used in the experiment has 16mm/rev ballscrew with a
drive/pulley system. However, since it is hard to say the real displacement of rod equals
to the theoretical movement of the motor specification due to friction and gear slips. Thus,
an accurate linear measurement tool (Mitutoyo ID-F150HE) was used to calibrate the
linear motion of the motor (see Figure 3.18). The Digimatic Indicator (Mitutoyo ID-
F150HE) has an absolute linear encoder technology for measuring accurate tolerance in
linear dimension. The accuracy is 0.0003mm and resolution is 0.001 mm. The linear
measurement tool was fastened with a universal clamp in a straight line of the rod of


69
stepper motor. Also, the stem of the tool contacted with the end tip of the motor rod.
After rigidly fixing the position, the stepper motor was activated to test rectilinear motion.
To minimize the tolerance, a straight line between the tool and the motor was very
important in the test. A calibration was conducted to test two stepper motors. Each
stepper motor was calibrated individually with the linear measurement tool. The
revolution of the screw in the motor was manually input on the control panel and the real
displacement output was screened on the linear measurement tool. The linear
measurement tool measured 10mm displacement as 246100 steps of the screw in the
stepper motor. Thus, the calibration scale was 0 mm to 130 mm and the 246100 steps
was repeated thirteen times to record the linear displacement of the motion. After the first
sampling, the next known revolution was input on the panel. Based on the result, the
motor moves 1 mm / 24610 steps. The result of calibration of actuators was shown in
Figure 3.19. Consequently, though the motor is controlled by the revolution of a
ballscrew, we can monitor and record the real displacement of the motion. It will be very
useful to verify the tendon characteristics.









Figu

ure 3.18. Caalibration se

etting for forrce delivery y unit and foorce transdu
70
ucers
0



71



Figure 3.19. Regression of the displacement and axial rotation of the stepper motors


0
20
40
60
80
100
120
140
0 1000000 2000000 3000000 4000000
D
i
s
p
l
a
c
e
m
e
n
t
Axial rotation
displacement
Linear(displacement)
S 0.119671
R-Sq 100%
R-Sq(adj) 100%
y = 0.00004x + 0.3828
0
20
40
60
80
100
120
140
0 1000000 2000000 3000000 4000000
D
i
s
p
l
a
c
e
m
e
n
t
Axial rotation
displacement
Linear(displacement)
S 0.0987486
R-Sq 100%
R-Sq(adj) 100%
y = 0.000041x + 0.01662


72
3.6.2. Force transducer calibration
A calibration for force transducers and FSRs was conducted with the force
delivery unit. Each force transducers and FSRs were individually calibrated by an
accurate digital force gauge (Chatilon Co.; Accuracy: 0.5N) with a stepper motor. All
force transducer were contacted with the digital force transducer to measure the force
produced by a stepper motor pushing. The stepper motor was controlled by manual and
the digital force transducer indicated the force in real time sequence. Based on the digital
force transducer, the force range for the calibration was 0 to 225N with 42 steps separated
sampling data points. According to increment of the pushing force by 5N, successively,
from 0 to 225N, force transducer signal was recorded on the computer, respectively. All
sampling were tested in three trials. The mean values at 42 calibration points were plotted
as the linear graphs (see Figure 3.20).
The calibration for FSRs was conducted the same way, but the force range for
calibration was 0 to 50N by 5N increments. Accordingly, 11 data points were measured
by the digital force transducer in line with a stepper motor that generate pressure to the
FSR. This calibration was conducted for all 16 FSRs, and all regression plots and
equations are shown in Appendix B. Figure 3.21 shows sample regression plots and
equations for FSRs calibration.




73


Figure 3.20. The regression of the voltage (mV) and actual force (Kg) for Force
Transducers


Figure 3.21. The regression of the raw signals and actual force (N) for FSRs

y=24045x+0.041
R=1
0
5
10
15
20
25
0.0001 5E05 0
FDS
Linear(FDS)
y=240405x+0.0372
R=1
0
5
10
15
20
25
0.00010.000080.000060.000040.00002 0
FDP
Linear(FDP)
y=455.0ln(x) 853.8
R=0.987
1000
800
600
400
200
0
200
400
600
800
1000
1200
0 20 40 60
CH1
Log.(CH1)
y=451.5ln(x) 796
R=0.994
1000.00
800.00
600.00
400.00
200.00
0.00
200.00
400.00
600.00
800.00
1000.00
1200.00
0 20 40 60
CH3
Log.(CH3)


74
Chapter 4

EXPERIMENTS
4.1. Overview
The hand motion simulator was used to investigate the power grip motion with
cylindrical handles on a cadaver model, and experiments were designed to determine the
relationships between grip forces and handle size, flexor tendon forces, tendon force
ratios and finger force distributions in power grip motion.
4.2. Specimen
One female fresh-frozen human cadaveric left hand specimen was used in this
study. The specimen was amputated at the middle humerus and was free from apparent
musculoskeletal disorders and anatomical abnormalities. After thawing overnight at room
temperature, the specimen was minimally dissected to expose the musculotendinous
junctions of the extrinsic muscles. The specimen was prepared with the entire forearm
below the elbow joint and mounted into the Hand Grip Simulator after the preparation. In
this experiment, since we only focused on flexor muscles among the extrinsic muscles,
flexors of the extrinsic were grouped into each tendon. The flexor digitorum profundus
(FDP) and the flexor digitorum superficialis (FDS) were the main finger flexor muscles
and were selected to simulate the power grip motion. To maintain the structure of interior
tissues including muscles, tendons and vascular system, only the FDP and FDS were
extracted and isolated from the other muscles in the forearm and other tissues left


75
undisturbed. After dissection of the forearm, three Schanz screws (4.0mm diameter) were
drilled vertically into the proximal part of the radius and three additional Schanz screws
were drilled into the ulnar aspect of the forearm for fastening the entire forearm into the
simulator. Two small size Schanz screws (2.5mm diameter) were drilled into the
metacarpal bone of index finger for the wrist fixator. The wrist fixator (Wristjack) was
attached on the radius side of the wrist through the Schanz screw on radius aspect of the
hand. The wrist fixator maintained a functionally neutral wrist angle of 20 extension
allowing free motion for all fingers (Li, 2006). Each flexor tendon separated from flexor
muscles was securely coupled with a freeze clamp (Sharkey, 1994) and coolant tubes for
liquid nitrogen were connected to the freeze clamps (see Figure 4.1).


Figure 4.1. Specimen mounted on a custom fixation device in hand motion simulator

4.2.1. Anth
Mu
lengths of t
as the dista
extended. A
length and
For compu
shown in F
(Kong, 200
Table 4.1. D
Phalange
Distal
Middle
Proximal
Total
Percentile

F
hropometri
sculoskeleta
the segmen
ance from th
All phalang
segment len
utational ph
Figure 4.2 a
01).
Dimension
Index
2.04
2.19
2.51
6.74
45
th
%ile
Figure 4.2. D
ic data
al modelin
nts. Hand le
he wrist crea
ge lengths w
ngths range
halange len
and it was
of phalange
Middle
2.13
2.38
2.62
7.13
12
th
%il
Diagram for
g of hand
ength was m
ase baseline
were measu
ed from a 12
gths, the le
used for in
es on each f
e Rin
1.8
2.0
2.5
6.4
le 32
th
%
r phalange l
requires a
measured us
e to the tip o
ured by a
2
th
to a 73
th
ength of ea
nput data fo
finger

ng L
81 1
04 1
57 1
42 4
%ile 19
t
length meas
anthropome
sing the me
of the midd
sliding cali
percentile
ach phalang
or the biom
Little Pa
1.29
1.43
1.88
4.60
th
%ile 7
surement fo
etric data s
ethod of Ga
dle finger wi
iper and sh
female (see
ge was det
mechanical h

alm length
-
-
-
10.21
73
th
%ile
r each finge
76
such as the
arrett (1971)
ith the hand
howed hand
e Table 4.1)
termined as
hand model
(Unit: cm)
Hand length
-
-
-
17.3
42
th
%ile

er
6
e
)
d
d
.
s
l
)


77
4.3. Experimental Procedure
4.3.1. Tendon forces
As already mentioned in section 3.3.2, the flexor muscle force was the
independent factor for an analysis of variance (ANOVA) procedure and it was controlled
by two experimental modes. In the first experiment, FDP force was fixed at 100N and
FDS force increased from 20N to 100N by 20N at once. Hence, the total tendon force
was also increased as the FDS force increased. Secondly, total tendon force (sum of FDP
and FDS force) was fixed at 200N and both FDP and FDS forces were adjusted with
regular ratios: FDP force decreased from 180N to 100N and FDS simultaneously
increased from 100N to 180N. Consequently, the total force was always 200N, but the
tendon force ratio of FDP and FDS was different at the different combination of two
tendon forces. Through these two conditions for the experiment, the grip force and finger
force distribution were analyzed in this study, respectively.
4.3.2. Procedures
Before the experiment, coolant (liquid nitrogen) was delivered directly to the
body of the freeze clamps that have separate linkages with cables to actuators. Coolant
flow was hand-regulated at a liquid nitrogen tank and an initial freezing period of 3-5 min
was required. Flow was maintained until the tissue was frozen 1cm distal to the clamp
nose. This tissue was periodically checked and maintenance pulses of liquid nitrogen
were given when required (10-15 min intervals)


78
One end of the pulling cable was connected to a freeze clamp at the
musculotendinous junction and the other end of the cable was connected to the force
transducer coupled with an actuator rod. Prior to actual pulling, the two cables were fully
released from the actuator with no tension and all fingers were preconditioned to
standardize the positions of the joints. During the preconditioning, fingers were manually
moved for 10 seconds through their neutral postures and then placed in a position with
minimal resistance to motion.
After setting the target forces input by the operator, loading was initiated from 0N
to target in 30 seconds, and real time force signals (FDP, FDS and grip forces) were
displayed on the screen by a custom Labview program. Also, contact forces on each
phalange were also recorded and monitored on the second screen by a custom FlexComp
program (Thought Technology). Real time videos of finger motion were monitored and
recorded using a lateral view camera that recorded 15 frames per second during the
experiment.
Three trials were run for each five different handles and five different tendon
force ratios, with three minutes intervals between each trial. All of the 15 trials (5 tendon
force ratios x 3 trials) were completely randomized for each handle. The reason that the
handle could not be randomized was for the consistency of the initial handle position with
a hand. A sequence of five handles was also randomized as 45, 60, 47, 30 and 37mm.
After each trial, tendon forces (FDP and FDS), Grip force and phalange forces were
saved as an Excel file.
79

Chapter 5

RESULTS
5.1. Overview
This chapter presents the system validation to show the reliability of the hand
motion simulator with the force feedback control. It also describes the relationship of the
effect of tendon force ratio and handle size on response variables (grip force, finger force
distribution and finger joint angle). The effect of tendon force ratio and the handle size
are presented to evaluate the model performance as well. Also, these results were
compared with the mathematical model to predict tendon forces for validation.
5.2. Validation of the Hand Motion Simulator
The hand motion simulator was operated under force feedback control to attain
target forces and compensate for deviation of the tendon tension compared with the target
forces during the operation. To validate the accuracy of the hand motion simulator, the
target forces and actual forces over the duration of three repeated simulations for two
flexor tendons (FDP and FDS) were compared. Also, the finger force distribution on each
phalange was analyzed to validate the system.


80

5.2.1. System summary
Figure 5.1 shows how the HMS performed the motion with coordination of two
stepper motors connected with two flexor tendons. In the sample motion, the target force
of FDP and FDS were 100N and 50N, respectively. The real time tensions from the force
transducers in line of tendon pulling cables went through the force feedback control to
match the actual forces to the target forces. Since the input FDS force was less than the
input FDP, the FDS force reached first to the target force during continuous pulling the
FDP tendon. Consequently, as shown in the Figure 5.1, the FDS motion usually rippled to
compensate the deviation of real time actual force during pulling the FDP. However, it
finally reached a stable condition as soon as the FDP reached the target force. The actual
forces in stable condition were compared to the target forces, and the average error
between the actual and target force was 1.0N.
Figure 5.1. Sample data plots showing performance of the force feedback
control in the Hand Motion Simulator. FDP, FDS, Grip force (GF) plotted in
the graph according to time sequential. Target Force was 100N and 50N for
FDP and FDS, respectively.
0
20
40
60
80
100
120
0 20 40 60 80
F
o
r
c
e


(
N
)
Motion Time (sec.)
Sample Data
FDP_F
FDS_F
GF
81

5.2.2. System reliability
To validate the accuracy and reliability of the force feedback control in the system,
the actual force achieved was compared with the target force input by the operator. Table
5.1 shows the result of the validation experiment of the hand motion simulator. Box plots
of variations of actual FDP and FDS forces are shown in the Figure 5.2 and 5.3,
respectively.
FDP target forces were all 100N in the experiment, the target force (100) was
compared with the actual force generated by the HMS. Table 5.2 suggests that is
statistically significant difference between actual FDP force and target force, given p
<0.05. The average of the actual force was 99.07, which was statistically different from
the target force of 100N. Nevertheless, this 0.93N of difference may not imply practical
significance. In other words, the system had average 0.93N (SD: 0.42) error probability
compared with the target force, and it seems to be negligible to operate the simulator that
has diverse tendon tensions.
The experiment was also conducted for FDS actuator. The FDS force was
separated by 20N increase (20, 40, 60, 80 and 100N). The differences of actual force and
target force were similar with the result of FDP that showed about 1N error with the
desired force. However, the error was increased at 100N level. It can be explained by the
tension of both FDP and FDS. Since total force at 100N FDS force was 200N, balancing
of both high-tension tendons made the accuracy a little bit lower. Of course, we could
decrease the error range to increase the accuracy of the system through slowing the
tendon pulling speed down. However, it would take too much time to get to the target
force.
82



Table 5.1. Comparison of target forces to actual forces (unit: N)
Grip Force Experiment Finger Force Distribution Experiment
Target
Force
Actual FDP
Force
Target
Force
Actual FDS
Force
Target
Force
Actual FDP
Force
Target
Force
Actual FDS
Force
20 - 20 19.04 0.66 180 178.85 0.83 20 19.19 0.42
40 - 40 39.12 0.41 160 159.01 0.62 40 39.20 0.19
60 - 60 59.03 0.52 140 139.21 0.68 60 59.17 0.33
80 - 80 79.05 0.43 120 119.01 0.48 80 78.92 0.58
100 99.07 0.43 100 98.79 0.78 100 99.21 0.12 100 98.84 0.68


Table 5.2. One sample t-test actual force to target force as 100N
One-Sample T: Actual Force
Test of mu = 100 vs not = 100
Var i abl e N Mean St Dev SE Mean 95%CI T P
Act ual FDP 150 99. 07180 0. 4271 0. 0349 ( 99. 0029, 99. 1407) - 26. 62 0. 000


83


FDP Force
100.0 99.5 99.0 98.5 98.0
X
_
Ho

Figure 5.2. Boxplot of Actual FDP Force

Desired FDS Force
A
c
t
u
a
l

F
D
S

F
o
r
c
e
100 80 60 40 20
100
90
80
70
60
50
40
30
20
10

Figure 5.3. Boxplot of FDS Force

84

5.3. Grip Force Analysis
The effect of the nominal internal force and handle size were studied based on the
grip force measured by five different diameter cylindrical handles that was split with a
force transducer in the handle. Analyses of variance were performed to test the
significance of the main and interaction factors with the grip force. Data were analyzed
by the Minitab. Table 5.4 shows the grip force on each handle and different tendon force
ratio of the FDP and FDS. Before looking at the analysis result, the normality and
homogeneity of variance assumption of data were checked for ANOVA analysis.
Because the shape of the histogram is bell-shaped and the normal probability plot is
almost a straight line, the normality assumption can be accepted. In other words, any
large variation was not detected in the diagnostic plot to check the normality and
homogeneity of variance assumption for ANOVA analysis (See Appendix C.1).
Therefore, the results from the ANOVA model are reliable. Data analysis on grip
force showed significant effects for handle size (p <0.001) and nominal internal tendon
force (p <0.001), but not the interaction effect of handle and nominal internal force (See
Table 5.3).

Table 5.3. ANOVA for Grip Force, using Adjusted SS for Tests
Source DF SS MS F P
Handle 4 1788.35 447.09 56.80 < 0.001
Nominal Int. Force 4 1518.45 379.61 48.23 < 0.001
Handle*Nominal Int. Force 4 142.70 8.92 1.13 0.353
Error 50 393.53 7.87
Total 74 3843.03
S = 2.0545 R-Sq = 89.76% R-Sq(adj) = 84.84%
85

All pair-wise comparisons among levels of finger (Tukeys multiple comparisons
procedure) showed that the grip force increased linearly according to the increment of the
internal tendon force. Table 5.4 presents the results of Tukey mean test and the
corresponding mean values. Those were grouped by vertical lines do not differ
significantly at < 0.05. In terms of the effect of the tendon force ratio, even when
changing the tendon force ratio of the FDP and FDS, it seemed that the grip force was not
affected by the ratio. Thus, we need to investigate this further in detail.
In the analysis of the relation between grip force and handle size, the smallest
diameter handle (30mm) indicated significantly high grip force compared with other
handles in power grip (p < 0.001). Also, the largest size handle (60mm) had significantly
less force than the other handles (p < 0.001). However, the average grip force on 37mm,
45mm and 50mm handles were not different from each other. The previous studies of
handle size with power grip also reported that grip force drops when increasing the
handle diameter (Edgrenm 2004; Kong and Lowe, 2005; Seo and Amstrong, 2008). Table
5.5 shows the grip forces on five different diameter handles as response to different
tendon force ratios. The handle size effect will be described in following section 5.3.1. in
detail.

86




Table 5.4. Tukey tests on the difference in the grip force
Main Factor Grip Force (Mean: N) Grouping (Tukeys)
Nominal
Internal Force
120 22.92
140 26.25
160 30.28
180 32.66
200 36.92
Handle
1 38.32
2 29.27
3 29.70
4 28.97
5 22.76

87


Table 5.5. The total/individual finger forces and contributions on each %FDS

(F: applied grip force unit)

* The value in ( ) indicates the efficiency of the internal force to external force
Tendon force (N) Grip Force (N) on handle
FDP FDS Total 1 [30mm] 2 [37mm] 3 [45mm] 4 [50mm] 5 [60mm] Mean
100 100 200 45.7 (4.4 F) 34.2 (5.9 F) 36.9 (5.4 F) 39.1 (5.1 F) 28.7 (7.0 F) 36.9 (5.5 F)
100 80 180 41.5 (4.3 F) 32.1 (5.6 F) 34.0 (5.3 F) 31.9 (5.6 F) 23.9 (7.5 F) 32.7 (5.7 F)
100 60 160 40.9 (3.9 F) 27.8 (5.7 F) 30.5 (5.4 F) 28.8 5.6 F) 23.4 (6.8 F) 30.3 (5.5 F)
100 40 140 32.5 (4.3 F) 26.3 (5.3 F) 25.7 (5.5 F) 26.2 (5.3 F) 20.6 (6.8 F) 26.3 (5.4 F)
100 20 120 31.1 (3.9 F) 26.3 (4.6 F) 23.4 (5.1 F) 22.6 (5.3 F) 18.2 (6.6 F) 24.3 (5.1 F)
Mean 160 38.3 (4.2 F) 29.3 (5.5 F) 30.1 (5.3 F) 29.7 (5.4 F) 23.0 (7.0 F) 30.1 (5.3 F)
88

5.3.1. Handle size analysis
The relationship between the internal tendon force and the external grip force was
analyzed to assess the effect of different diameter handle sizes. The number of handle
from 1 to 5 represents 30mm, 37mm, 45mm, 50mm and 60mm cross-sectional diameter,
respectively.
Data summary
Figure 5.4 presents the grip force variations with the box plots on each handle. As
already discussed, the grip force for the smallest handle size was 20% (significant at p
<0.05) larger than the mean grip force and 23% lower force than the mean grip force for
the largest handle size. The reason that there were high variations of the grip force in
Figure 5.4 was that the average grip force derived from different tendon force ratios.
handle
G
r
i
p

F
o
r
c
e
5 4 3 2 1
50
40
30
20
10

Figure 5.4. The grip force variation on each handle
89

Thus, we need to analyze the interaction effect of handle and nominal internal force with
separated tendon force ratios.
Optimal handle size
The graph in Figure 5.5 shows clearly which handle had the highest grip force
within each internal force level. Since the ANOVA output did not suggest an interaction
effect between nominal internal force and handle size, we only need to check which
handle has the highest grip force overall and also handle size effect was analyzed with all
levels of internal force. The handle effect was already shown by the Tukey pairwise
comparisons in Table 5.4 with handle 1 having significantly higher grip forces than the
other handles (p-value compared with other handles are <0.001); handle 5 also had
Int. Force
M
e
a
n
200 180 160 140 120
45
40
35
30
25
20
handle
3
4
5
1
2
Figure 5.5. The interaction of the Internal force and the handle

90

significantly lower grip force than the other handles. Handle 2,3, and 4 are not
significantly different from each other. Consequently, the smallest (30mm) handle
diameter had maximum grip force, and it was the optimal handle size among five
different diameter handles at least for this size hand. As shown in Table 5.5, the grip
force was highest in the smallest handle (30mm) with highest grip force and the
efficiency of internal tendon force (4.2F), for an external grip force F, was highest with
the smallest handle as well. The largest diameter handle (60mm) had lowest grip force
and worst tendon force efficiency (7.0F).
5.3.2. Tendon force ratio in Grip force
The relationship of two flexor tendon forces on different sizes of handles was
analyzed to find the effect of different FDP and FDS ratios.
Data summary
Figure 5.6 shows the relationship between the grip force and the internal force as
internal forces increase. FDP forces were always constant (100N) and FDS forces were
increased from 20N to 100N. Thus, the internal force increase was due exclusively to
increasing FDS tendon force. As shown in Figure 5.6, the mean grip forces increased
linearly as the internal force increased, and it seems that the slope of grip force was
constant,. That means that the ratio between the FDP and FDS does not affect grip force.
Hence, we need to analyze the tendon force ratio effect on each handle in detail.
91

Int. Force
G
r
i
p

F
o
r
c
e
200 180 160 140 120
50
40
30
20
10

Figure 5.6. The effect of the tendon force ratio between the FDP and FDS

To find the relationship between the tendon force ratio and grip force on different
sizes of handle, Analysis of Covariance (ANCOVA) was used to solve the hypothesis.
ANCOVA is a technique that combines ANOVA and regression analysis to examine both
the influence of categorical and continuous variables on the response. ANCOVA
evaluates the influence of the continuous variable (covariate) on the response variable
and at the same time enables the comparison of treatments on a common basis relative to
the value of the covariates (Kuehl, 2000). In this experiment, the relative FDS force is a
continuous variable on the grip force as the response.
Before statistical analysis, the diagnostic plots were presented to check whether
the dataset achieves the normality and homogeneity of variance assumptions for
ANCOVA analysis (See Appendix C). From the residuals vs. fitted value plot, the
variance is not different across each handle. The normal probability plot of studentized
92

residual appears to be a straight line that indicated that the residuals are approximately
normally distributed. Therefore, the assumptions for ANCOVA analysis hold.
Table 5.6 shows the result of ANCOVA. Both handle type and relative FDS%
have significant influence on grip force (p < 0.001). Moreover, the interaction of handle
and relative FDS% is also significant with p-value <0.012. This term tests the hypothesis
that the slopes of each regression line between relative FDS% and grip force are equal
across five handle types. Its significance suggests that the regression lines of five handle
types do not have identical slops (See Figure 5.7). The relationship between relative FDS%
and grip force are different across five handles. Hence, we need to investigate this further
for subtle differences.

Table 5.6. ANCOVA for Grip Force, using Adjusted SS for Tests
Source DF SS MS F P
Handle 4 193.03 48.26 5.23 0.001
Relative FDS% 1 1740.12 1740.12 188.74 < 0.001
Handle*Relative FDS% 4 128.94 32.23 3.50 0.012
Error 65 599.26 9.22
Total 74 4304.81
S = 3.3636 R-Sq = 86.08% R-Sq(adj) = 84.15%



93

Relative FDS%
G
r
i
p

F
o
r
c
e
50 45 40 35 30 25 20 15
50
45
40
35
30
25
20
handle
3
4
5
1
2
fg
Figure 5.7. The interaction between the relative FDS percentage and the handle size

Since regression lines for five handles did not have equal slopes, to get the
regression slope of each handle type, we can split the dataset based on handle types and
conduct regression analysis of each handle size. The summarized output of the regression
of each handle type is shown in the appendix C.2.3. The output suggests that the
relationship between relative %FDS and grip force were all significant (p-value of the
relative FDS% coefficient is <0.001) but the slopes (relative FDS% coefficient) are not
identically the same. Handle 2 and 5 apparently have a slope that is much flatter
(regression coefficient 0.269 and 0.343, respectively) than other handles whose
regression coefficients are at least 0.5.
However, when the model order of regression was plotted with the quadratic, the
slope of each handle increased as relative FDS% increase. Especially, this was noticeable
94

at 40-50% of relative FDS%, most slopes of handles were drastically increased (see
Figure 5.8). This means that relatively higher FDS tendon force (40% to 50%) yielded a
better grip force during the power grip motion. This result agrees with the study of
mechanical characteristics of a muscle (Brand and Hollister, 1981). They analyzed the
FDP and FDS characteristics with the mass, average fiber length and cross-sectional area
of all fibers. Based on the mass fraction (%) of the FDP and FDS, the ratio of two
tendons was 3:2. In addition, the tension fraction (%) ratio of two tendons showed 3:2.3
profundus to superficialis tendon force ratio. The findings indicate that the physical FDS
had 20% - 30% less force than the FDP. Thus, their study showed that the slope of grip
force increased with 35% -50% FDS of the total internal force.

Figure 5.8. The interaction between the relative FDS percentage and the handle size
Relative FDS%
G
r
i
p

F
o
r
c
e
50 45 40 35 30 25 20 15
50
45
40
35
30
25
20
handle
3
4
5
1
2
95

5.4. Finger Force Distribution Analysis
To explore the reliability of the hand motion simulator, the finger force
distribution was also measured by 16 FSRs attached on each phalange from distal
phalanx to metacarpal of each finger. The individual finger force was defined as the sum
of the four phalangeal segment forces for that finger, and the total finger force was
defined by the sum of all four-finger forces, from index to little fingers (see Table 5.7).
Analyses of variance (ANOVA) were performed to test the significance of the man and
interaction factors with gripping force.
5.4.1. Finger and phalange forces
Data analysis on contact force showed significant differences for each finger (p<
0.001) (Figure 5.9). As shown in Table 5.8, all pairwise comparisons among levels of
finger (Tukeys multiple comparisons procedure) showed that middle finger applied
significantly more force (55.5%) than the other fingers. The index finger generated
significantly more force (25.5%) than the other fingers. The ring finger (12.2%) and the
little finger (6.7%) were not notably different from each other (see Table 5.8). These
results are similar to those of previous studies (Kong, 2001).
Each phalange also indicated significantly different force distributions in power
grip motion (Figure 5.10). In the Tukey test, the distal phalange (73%) had significantly
more force than the other phalanges (p < 0.001). However, the average forces loaded on
the middle (5%), proximal (5.6%), and metacarpal (16.3%) were not different from each
other (see Table 5.9). The result of interphalangeal force distribution studies indicated as
96

well that the distal phalange always exerted more force and maintained a fixed lead over
the other two phalanges (Amis, 1987; Kong et al., 2004, 2005).

Table 5.7. The individual phalange forces contributions on each finger
Finger
Total
Phalange
Force (N)
Mean forces of individual phalanges and percentage contribution (N)
Distal Middle Proximal Metacarpal
Index 9 6.6 (73.33%) 0.4 (4.44%) 0.1 (1.11%) 1.9 (21.21%)
Middle 18.9 13.9 (73.54%) 1.4 (7.41%) 1.5 (7.94%) 2.1 (11.11%)
Ring 4.2 2.6 (61.90%) 0 (0%) 0.1 (2.38%) 1.5 (35.71%)
Little 2.3 1.8 (78.26%) 0 (0%) 0.4 (17.39%) 0.1 (4.35%)
Total (N) 34.4 24.9 (72.38%) 1.8 (5.23%) 2.1 (6.11%) 5.6 (16.28%)

Table 5.8. Tukey procedure comparing the fingers
Finger Index Middle Ring Little
Mean (N) 9 18.9 4.2 2.3







(Underlined means are not significantly different at 5% level)
Table 5.9 Tukey procedure comparing the phalanges
Phalange Distal Middle Proximal Metacarpal
Mean (N) 24.9 1.8 2.1 5.6





(Underlined means are not significantly different at 5% level)
97


FINGER
C
o
n
t
a
c
t

F
o
r
c
e

(
N
)
4 3 2 1
30
25
20
15
10
5
0
Figure 5.9. The main effects (Finger) for grip force. The number of finger is the order
of finger from the index to the little finger, respectively.
Phalange
C
o
n
t
a
c
t

F
o
r
c
e

(
N
)
4 3 2 1
25
20
15
10
5
0
Figure 5.10. The main effects (Phalange) for grip force. The number of phalange is
the order of phalange from the distal to the metacarpal phalange, respectively.
98

Figure 5.11 shows the interaction between finger and phalange. As described in
pair-wise comparison analyses, the distal phalange (phalange 1) force on the middle
finger (finger 2) had the highest force among other phalanges and the ring and little
finger showed the lowest force, followed by the index finger. Otherwise, the force
distributions of the middle, proximal and metacarpal phalange showed similar patterns
along all fingers. This means that most contact force was generated by the distal phalange
among all segments. In addition, the middle and index finger tip had significantly high
contact force while the ring and little finger had a feeble contact force distribution.
The distal phalange force distribution had pattern similar to the previous study,
but the middle and proximal phalange force patterns were quite low compared to other
studies. It will be discussed in Section 6.5 in detail.
FINGER
M
e
a
n
4 3 2 1
14
12
10
8
6
4
2
0
Phalange
3
4
1
2
zx
Figure 5.11. The interaction effects for grip force (Finger * Phalange)
99

5.4.2. Tendon force ratio in Finger force distribution
To explore the tendon force ratio of the FDP and FDS, the difference of finger
forces were analyzed with the different tendon force ratios. The variation of each finger
force summing phalange forces was significant with fingers and relative percentage of
FDS force (%FDS). However, there was no interaction effect of finger and %FDS. Also,
all phalange forces were significantly different on each finger and distal and metacarpal
had significant difference with %FDS. But there were no interaction effects for all
phalanges as well (See Appendix C).
As shown in the Figure 5.12, the mean finger force was significantly higher at the
40% FDS force ratio. In the pair-wise comparison, the mean finger force at 40% FDS
Figure 5.12. Main Effects Plot (data means) for Total
%FDS
M
e
a
n

o
f

F
i
n
g
e
r

F
o
r
c
e

(
N
)
50 40 30 20 10
12
11
10
9
8
7
6
100

increased significantly (48%) from the 10% and 20% FDS force level. In terms of the
efficiency of tendon force (internal force) vs. finger force (external force), Table 5.10
shows the highest ratio of flexor tendon force to the applied finger grip force was 7.9F
generated with the 10% FDS force and the lowest ratio was 4.1F with the 40% FDS force
(3:2 PDF to FDS tendon force ratio). Thus, 4.1F was most efficient ratio between internal
force and external force, and the ratio of FDP and FDS to the applied finger grip force
was 2.5F and 1.6F, respectively.
Table 5.11 shows the individual phalange forces and total phalange forces on
different tendon force ratios. Total phalange force was also highest (12.2N) at 40% FDS
force and it was decreased with %FDS decreased (6.4N at 10% FDS). Most contact force
(66.24% - 75.41%) was concentrated on distal phalange with whatever tendon force
ratios changed. All other phalanges had merely 25% - 34% contact force on fingers in
power grip. In pair-wise comparison, the distal phalange force was significantly different
with others ( < 0.001)
The finger forces increased significantly on the index and middle finger as
the %FDS force increased, but those dropped slightly at the 50% of FDS. Also, finger
forces at the 40% of FDS force showed more contact forces than other tendon force ratios.
Specifically, index and middle finger contact force increased significantly up to 40%
FDS, but the dropped at 50% FDS. In Figure 5.13, similar trends took place in each
finger at the different tendon force ratios, but the 40% FDS force had better contact force
distribution followed by the 50% FDS, and the contact force was the lowest at 10% FDS
force. In Figure 5.14, the effect of the tendon force ratio is more clearly presented by
mean finger contact forces for each tendon force ratio. Middle and index finger forces
101

peaked at 40% while the other fingers were similar. Therefore, 40% FDS generally
showed best contact force distributions on all four fingers. The 40% FDS means that the
optimal tendon force of the FDP vs. the FDS is 3:2 for the power grip. In other words, the
FDS force should be 33% less than the FDP force in power grip motion.
This conclusion derived from sum of finger force and finger force distribution is
consistent with the result of the grip force of split handles that showed the force slope
was increased for 40% of FDS force. Brand et al. (1981), who analyzed relative tension
and potential excursion of muscles in the forearm and hand by dividing the fiber length
into the volume of each muscle (the cross-sectional area of the muscle) and relative
tension capacities of forearm and hand muscle, found a 3:2 profundus-to-superficialis
tendon-force ratio, which agreed with my results.
102


Table 5.10. The total/individual finger forces and contributions on each %FDS
(F: applied grip force unit)
%FDS
Total
Finger
Force (N)
Tendon
Force
FDP force FDS force
Mean forces of individual fingers and percentage contribution (N)
Index Middle Ring Little
50% 36.6 5.5F 2.7F 2.7F 11.1 (30.33%) 19.2 (52.46%) 4.3(11.75%) 2.0 (5.46%)
40% 48.8 4.1F 2.5F 1.6F 15.2 (31.15%) 24.4 (50.00%) 5.4 11.07%) 3.8 (7.79%)
30% 31.0 6.5F 4.5F 1.9F 8.6 (27.74%) 17.4 (56.13%) 3.1 (10.00%) 1.9 (6.13%)
20% 28.9 6.9F 5.3F 1.4F 6.3 (21.80%) 18.2 (62.98%) 2.6 (9.00%) 1.8 (6.23%)
10% 25.1 7.9F 7.2F 0.8F 3.7 (14.74%) 14.4 (57.37%) 5.2 (20.72%) 1.8 (7.17%)


Table 5.11.The total/individual phalange forces and contributions on each %FDS
%FDS
Total
Phalange Force (N)
Mean forces of individual phalanges and percentage contribution (N)
Distal Middle Proximal Metacarpal
50% 9.1 6.8 (74.73%) 0.4 (4.40%) 0.4 (4.40%) 1.5 (16.48%)
40% 12.2 9.2 (75.41%) 0.5 (4.10%) 0.7 (5.74%) 1.8 (14.75%)
30% 8.0 5.3 (66.25%) 0.4 (5.00%) 0.4 (5.00%) 1.9 (23.75%)
20% 7.2 5.3 (73.61%) 0.4 (5.56%) 0.5 (6.94%) 1 (13.89%)
10% 6.4 4.5 (70.31%) 0.5 (7.81%) 0.4 (6.25%) 1 (15.63%)

103




Figure 5.13. The interaction effects for grip force (Finger * %FDS)

%FDS
M
e
a
n
50 40 30 20 10
25
20
15
10
5
0
FI NGER
3
4
1
2

Figure 5.14. The interaction effects for grip force (%FDS * Finger)

FINGER
M
e
a
n
4 3 2 1
25
20
15
10
5
0
%FDS
30
40
50
10
20
104

5.5. Finger joint angle analysis
The finger joint angles were generated by a custom developed program by
Labview for measuring the interphalangeal joint angles (Table 5.12). The effect of handle,
the relative percentage of FDS force (%FDS) and the interaction of handle and %FDS
were all significant (p <0.001). Figure 5.15 shows the captured grip postures representing
finger joint angles in lateral view depending on different tendon force ratios and handle
sizes. The main effects on DIP, PIP and MCP joint angles due to different handle sizes
and the relative FDS forces (%FDS) are plotted in Figure 5.16.
In terms of handle size, the joint angles at the MCP and PIP joint showed a
descending pattern as the handle diameter increased, but DIP joint angle showed convex
pattern according to handle size increasing. Essentially, flexions of MCP and PIP joint
decreased as the handle size increased, but the DIP joint angle was most flexed for the
middle handle size.
The loading of the tendon forces with different ratio (FDP vs. FDS) produced
different finger joint motions. According to increasing the percent FDS force from 10%
to 50% of total tendon force, on average, the MCP joint angle gradually increased from
19.7 to 23.8; in contrast, the PIP joint angle showed a rapid rise from 70.1 to 83.4 in
the high proportion of FDS while the DIP joint angle displayed a rapid decline from
32.8 to 2.7. These results clearly show that the tendon force ratio of FDP to FDS affects
the finger joint motion while grasping a handle. Higher percent FDP force with less FDS
force produced flat PIP joint angles and flexed DIP joint angles; In contrast, the same
proportion of FDP to FDS force (i.e. PDF : PDS = 1 : 1) produced flexed PIP joints and
flattened DIP joints. Thus, the DIP would be too flexed with low portion of FDS force
105

compared with FDP force, and would be too flat with same level of FDS to FDP force.
Therefore, 3:2 FDP to FDS tendon ratio that already concluded before can be supported
by this mechanism of finger joint angles by different tendon force ratios.
106




Table 5.12. Finger Joint Andlge flexion on %FDS and handle

Handle 1 2 3 4 5
%FDS MCP PIP DIP MCP PIP DIP MCP PIP DIP MCP PIP DIP MCP PIP DIP
50% 33.5 98.9 0.1 37.2 89.4 4.4 23.2 79.2 5.7 11.1 83.1 -3.7 14.0 66.2 9.4
40% 34.9 93.9 8.8 35.0 90.6 10.4 19.7 64.3 13.6 11.7 81.1 0.2 14.7 71.0 10.1
30% 35.7 80.3 23.6 30.8 89.8 24.0 12.1 66.9 30.7 11.4 73.1 9.2 10.5 78.2 9.9
20% 33.1 76.8 34.1 31.7 84.0 34.9 8.4 61.0 47.7 13.9 67.0 16.4 14.5 67.2 12.0
10% 32.6 75.2 38.4 31.8 80.2 42.1 6.6 69.0 52.3 15.5 55.5 16.7 15.1 62.1 14.1
107


Figure 5.15. Finger joint angles on tendon force ratio and handle


108

M
e
a
n

o
f

M
P

A
n
g
l
e
5 4 3 2 1
35
30
25
20
15
10
50 40 30 20 10
handle %FDS
Main Effects Plot (data means) for MP

M
e
a
n

o
f

P
I
P

A
n
g
l
e
5 4 3 2 1
87.5
85.0
82.5
80.0
77.5
75.0
72.5
70.0
50 40 30 20 10
handle %FDS
Main Effects Plot ( data means) for PI P

M
e
a
n

o
f

D
I
P

A
n
g
l
e

(

)
5 4 3 2 1
35
30
25
20
15
10
5
0
50 40 30 20 10
handle %FDS
Main Effects Plot ( data means) for DI P

Figure 5.16. Inter phalangeal joint angles on handle size and %FDS


109
5.6. Validation of mathematical model
To validate the mathematical model described in the previous chapter, the actual
anthropometric data, actual finger joint angles and finger force distributions of each
finger were computed in the model with the manipulated forearm flexor tendon forces.
Since the optimal tendon force ratio for power grip that I found in this study was 3:2 FDP
to FDS ratio, the input data set were selected from the data at 40% FDS force level. The
specific phalange forces at the 40% FDS force level are shown in Table 5.13.
Table 5.14 shows the comparison of the ratio of tendon forces to the applied
finger forces. Average ratios of predicted tendon forces to the applied finger forces in the
tendon force prediction models were, for an external force of F, 9.29F, 9.38F, 8.51F and
4.51F for the index, middle, ring, and little finger in power grip, respectively, while 4.92F
were for the ratio of actual tendon force measured by the simulator. Also, the FDP and
FDS tendon force were 7.6F and 1.2F to the external finger force F in the prediction
model, while 3.0F and 2.0F were for the actual FDP and FDS forces in power grip,
respectively.

Table 5.13. Each phalange force on 40% FDS level
Finger
Mean phalange force (N)
Distal Middle Proximal
Index 12.41 0.40 0.00
Middle 18.98 1.52 0.50
Ring 3.22 0.00 0.07
Little 2.36 0.00 1.19



110
The predicted flexor tendon forces were, on average 44% higher than the actual
tendon forces. Also, the predicted FDP force was 61% higher than the actual FDS force,
but the FDS force was 38% less in the predicted FDS force, probably due to the
parameter used in the prediction model. The parameter is the tendon force ratio of the
FDP to FDS assumed by 3:1. However, the mathematical model has contradiction in
terms of the tendon force ratio. Kong already assumed that the FDP to FDS ratio is 3:1,
but final FDP force ratio must be higher than 3 times to the FDS force, because the FDP
force is the summation of three phalange forces (distal, middle, proximal) but the FDS
force is the sum of two phalange forces (middle, proximal) divided by three ( = 0.3).
Moreover, the tendon force ratio was varied on the finger joint angle in power grip. As
shown in the main effect plots of finger joint angles and the relative FDS force in Figure
5.15, the PIP joint angle increase as the %FDS increase, while the DIP joint angle
decrease as the %FDS increase. Consequently, the parameter (tendon force ratio)
should be predetermined by the PIP and DIP joint angles in power grip motion.
These findings can be compared with the results from the other biomechanical
finger models. Although researchers generally agreed on the proportion of muscle and
tendon forces required for the externally applied forces, they presented various ranges of
these ratios for the external force to internal tendon force. Average ratios were, for an
external force of F, 2.27F-3.47F for the FDP and 1.51-4.23F for the FDS in power grip
motion (An et al., 1985; Chao et al., 1976; Chao and An, 1978). The FDP and FDS ratio
were smaller than the result of predicted tendon force ratio but similar with the result of
this study.




111







Table 5.14. Comparison of predicted flexor tendon forces and actual finger forces
(F: applied finger force unit)
Finger
Predicted Tendon Force (N)
Actual
Finger
Force (N)
Ratio
FDP FDS TOTAL
Index 102 (8.0F) 17 (1.3F) 119 12.81 9.29F
Middle 170 (8.1F) 27 (1.3F) 197 21 9.38F
Ring 24 (7.3F) 4 (1.2F) 28 3.29 8.51F
Little 14 (3.9F) 2 (0.6F) 16 3.55 4.51F
Total Predicted
Tendon Force (N)
310 (7.6F) 50 (1.2F) 360
40.65
8.86F
Actual Tendon
Force (N)
120 (3.0F) 80 (2.0F) 200 4.92F





112
Chapter 6

SUMMARY AND DISCUSSION

In this chapter, the results will be summarized and compared with previous
studies. The main topics to be covered include the hand motion simulator, tendon force
ratio, internal force and external force ratio, handle size effects, finger force distributions,
finger joint angles, and validation of the prior mathematical model. Conclusions and
suggestions for future research will follow.
6.1. Hypothesis 1: The hand motion simulator
To study forearm flexor tendons and hand motion in cadavers, the hand motion
simulator (HMS) was built. The model was composed of a main frame, and force
delivery, data acquisition and kinematic vision units. The main frame supporting a
specimen and all equipment was constructed with an aluminum T-slotted profile
providing very rigid structure. Six forearm fixators (Schanz screws, Synthes Inc.) were
used to secure a forearm in position and stabilize it against pulling force of stepper
motors. This mounting system did not interrupt the excursion of forearm muscles and
there was no interference between the fixator and hand motion. To operate the system, a
custom control program was developed in Labview for motion control, data monitoring,
and data storage functions. Muscle forces generated by linear actuators under force
feedback control were applied to the major flexor tendons in the forearm to produce a
power grip motion. Also, two force transducers connected in line with the cables from


113
each stepper motor measured muscle tensions (internal tendon forces) and one was
inserted in a split cylindrical handle to measure the hand grip force. The tendon forces
measured by the force transducers provided force feedback to the motion delivery unit for
comparison to target forces. To validate system reliability, the actual tendon tensions
were compared with the target forces input into the system. Though significantly
different in the desired target, the average error (0.93N) at different level of pulling forces
was acceptable. It was concluded that the hand motion system provided very accurate
motion control with the force feedback control.
The hand motion simulator provides great flexibility for hand and forearm
researches. All parts in the system are adjustable vertically and horizontally depending on
specimen size or the objective of studies. The handle fixture with a handle could be
modified with other tools or equipment to cooperate with a hand such as a handle with
vibration or a trigger for a power tool. Grip strength was measured using the split
cylinder, in which the two halves of the cylinder were connected by a force transducer.
The split cylindrical handle was useful to measure grip force and provided grip forces on
different handle diameters (Ayoub and Lo Presti, 1971; Dong et al., 2004; Edgren et al.,
2004; Irwin and Radwin, 2008). Also, the force trend on each handle was consistent with
previous studies. However, the split handle employed only one directional sensor, which
limits sensitivity. A modified handle with the ability to measure shear forces and
moments in the three cardinal planes would be a great improvement. Nonetheless, most
previous researches have used a split cylindrical handle with one directional force
transducer (An, 1985; Edgren et al., 2004; Seo, 2008; Aldien, 2005, Welcome, 2004).
Furthermore, the split cylindrical dynamometer is much better than a Jamar dynamometer


114
which may not be reliably applicable to the assessment of tools with cylindrical handles,
but more closely approximates a two-handled tool (pliers, etc). The dynamometer used in
this study approximates a cylindrical handle for a power grip motion (Edgren, 2004).
Therefore, a three directional force transducer inserted in a split handle may increase the
sensitivity for measuring different directional phalange forces on a cylindrical handle.
Alternatively, a cylindrical handle with three directional measuring arms can be used to
measure overall grip strength, as well as show the grip force distribution around the
circumference of the handle (Wimer, 2009).
6.2. Hypothesis 2: The tendon force ratio
The tendon force ratio was explored to validate the biomechanical model and also
to better understand the power grip mechanics. Accordingly, the tendon force ratios of
the FDP to the FDS were classified by adjusting each tendon. In the analysis of the grip
force, the regression plot with the quadratic showed the slope of most grip forces
dramatically increased at the segment from 35-50% of relative FDS%. That means
relatively higher FDS tendon force (35% to 50%) shows better grip force during the
power grip motion. Regarding the analysis of finger force distribution, the mean finger
force was highest with a 40% FDS force ratio. In the pair-wise comparison, the mean
finger force at 40% FDS (3:2 FDP to FDS ratio) increased significantly (48%) from the
10% and 20% FDS force (See Table 5.10). The index and middle fingers increased
significantly as %FDS force increased, and finger forces were highest at the 40% FDS
level (3:2 FDP to FDS force ratio). Consequently, the 40% FDS ratio generally showed
best contact force distributions on four fingers. The 40% FDS ratio means that the


115
optimal tendon force of the FDP vs. the FDS is 3:2 for the power grip motion. These
results supported Hypothesis 2 by showing the optimal tendon force ratio based on grip
force and finger force distribution. Brand (1981) analyzed the FDP and FDS
characteristics by measuring the mass, average fiber length and cross-sectional area of all
fibers, and the ratio of two muscles was 3:2 (40% FDS force to FDP). Their finding was
consistent with the result in this study (3:2 FDP to FDS force ratio).
6.3. Hypothesis 3: The efficiency of internal force to external force ratio
Ratios between tendon forces generated by the force delivery unit and the grip
force applied by power grip motion were investigated during a task involving increasing
tendon force linearly with five different diameter handles. The efficiency of internal
forces to external forces was compared to understand the mechanisms of hand disorders
and the relationship between the flexor tendon forces and the externally applied forces to
the handles and the fingers. In terms of handle sizes, the average internal tendon force of
the smallest handle size (30mm) was, for external grip force F, 4.2F and the largest
handle showed 7.0F. Also, the mean efficiency of the internal forces to the external
forces was 5.3F (See Table 5.5). In other words, the force efficiency decreased
significantly as the cylinder diameter increased. These finding supported Hypothesis 3 by
showing the efficiency of flexor tendon-to-grip force ratios on different handle sizes.
More description about handle size effects will be discussed in the following section 6.4.
In terms of the tendon force ratio between FDP and FDS, the efficiency of
external forces to internal forces was improved as the %FDS increased (10% to 40%), but
it dropped at 50% FDS (i.e. FDP:FDS = 1:1). The efficiency at the 40% FDS force (i.e.


116
FDP:FDS = 3:2) was significantly better (4.1F) and it was worst for the 10% FDS force
(7.9F) in power grip. Consequently, the efficiency of the external to internal forces was
optimal at 40% FDS force (3:2 FDP to FDS force ratio) with the smallest diameter handle.
These findings can be compared with the results from previous studies. Although
researchers generally agreed on the proportion of muscle and tendon forces required for
the externally applied forces, they presented various ranges of these ratios for the external
force to internal tendon force. In the result of biomechanical model, Kong (2001) showed
the average ratios were, for an external force of F, 9.05F for FDP and 2.83F for FDS in
power grip motion. Chao et al. (1989) also reported 3.17 and 1.51 for FDP and FDS in
grasp motion, respectively. In terms of validation experiment, Schuind et al. (1992)
reported that 7.92 for FDP and 1.73 for FDS in tip pinch motion. The variability of these
results may be expected because all researchers did not use the same finger
characteristics: moment arm, finger configurations, and angles of the applied forces to the
finger tip regarding the function of intrinsic vs. extrinsic muscles during power grip
motion.
6.4. Hypothesis 4: The handle size effect
Grip force was measured using five different diameter split cylindrical handles
with a force transducer inserted. These grip force data presented the effect of handle
diameter on grip strength. There was a negative relationship between handle diameter and
grip force, which showed that the grip force increased from 38.3 to 23.0 N, as the
cylindrical handle diameter increased from 30 to 60 mm. Thus, the highest grip force was
generated on the smallest handle size (30mm), and the lowest grip force was on the


117
largest diameter handle (60mm). This finding supporting Hypothesis 4 is straightforward
and consistant with other studies (Edgren et al., 2004; Seo and Amstrong, 2008)(see
Figure 6.1). Edgren et al. (2004) also found the inverse relationship of handle size and
grip force measured by a cylindrical gauge dynamometer like a split handle with a force
transducer used in this study. Seo and Amstrong (2008) measured split cylinder grip
strength decreased with increasing ratio of handle diameter to hand length and hand size.
Kong and Lowe (2005) presented that the total finger force, which was defined as the
sum of all phalangeal segments showed a significant inverse relationship with handle
diameter as the fingers were more extended to grasp larger handles, but they measured
the finger force distribution with FSR film sensors on each phalange instead of using a
split handle dynamometer.
Previous investigators have suggested that the grip force decrease with large
handle diameters may be due to muscle length-strength relationship and the locations of
the fingertip on the handle. Also, the smaller handles created a biomechanical
configuration that was described by Replogle (1983) in which the fingers more
completely encircle the handle and the phalanges can generate forces that effectively
counter act one another. In other hands, when a handle diameter increases, the finger
becomes less flexed. Accordingly, the index finger, the ring finger and the little finger
(which are all shorter than the middle finger) may lose some of their mechanical
advantage and may thus lose the ability to exert more force (Chen, 1991).

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119
way data were collected: Grip strength was measured by split cylindrical handles,
whereas typical use of usually considers the one directional force only. There might be
grip force losses due to shear forces and uncoordinated force direction, some previously
discussed.
The current data, like previous studies, demonstrate that there is an optimal
handle diameter to produce the highest magnitude grip force. Its hard to define the
optimal handle size due to the diversity of human hand length and span. Thus, the
optimal handle can be defined by qualitative measuring. Pheasant and ONeill (1975)
indicated that grip force was highest when the thumb tip was aligned with the four
fingertips. Seo et al. (2007) speculated that maximum grip force can be achieved when
the fingertips and thumb tip work together against the palm, thus resulting in great
reaction force on the palm. In the captured pictures in Figure 5.15, the power grip motion
with the smallest handle (30mm) shows that the thumb tip aligned with the four fingertips
and fingertips worked against the palm. As shown in Figure 5.15, when handle diameter
increased from the optimal diameter (smallest handle), fingers opened more and moment
arms for finger flexors decreased. Consequently, the grip force may decrease as the
moment arms decrease (An, 1983). Based on the specimen hand size, the 30mm handle
was optimal in producing maximum grip force in this experiment. To find out the optimal
handle size in detail, we need to normalize the handle size compared with hand sizes. To
get normalized data, more specimen and iterations are required with diverse
anthropometric hand data.


120
6.5. Hypothesis 5: Finger Force Distribution
A method for measuring the hand-handle contact force was proposed and
evaluated to assess the finger force distribution in power grip motion. The contact force
applied at the hand-handle interface was measured using a thin-film FSR under different
combinations of the tendon force ratio (FDP vs. FDS). On average, the forces produced
by the middle finger and distal phalange were always significantly larger than those
produced by the other fingers and phalanges. These patterns for the magnitudes and
percentage contributions of individual finger and phalange forces to the total force in the
finger force distribution are similar with the findings in previous studies of the grip force
tasks (Amis 1987; Kong and Lowe 2005) and also supported Hypothesis 5 by showing
finger and phalange forces.
Figure 6.2 shows the main effect of finger force distribution and each phalange
forces. Also, Kong (2001)s result measured by a human subject was plotted in the same
graph to compare the trend of force distributions. In both plots, middle finger had
significantly highest contact force followed by index finger force and little finger was
lowest. However, finger forces were notably less than the previous study, but overall
force patern of each finger was quite similar. In terms of phalange forces, middle and

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122
6.6. Hypothesis 6: Finger Joint Angles
The simulated contraction of extrinsic muscles generated concurrent flexion at the
interphalangeal (IP) joints, i.e. the joints were rotated in one direction only. High
proportion of FDP force with less FDS force made PIP joint angle decrease and DIP joint
angle increase. In contrast, the same proportion of FDP and FDS force, i.e. 1:1 FDP to
FDS, produced flexed PIP joint and flatten DIP joint. Therefore, 3:2 FDP to FDS tendon
force ratio that already described in previous sections showed most identical curvature
motion and this finding supported Hypothesis 6. Furthermore, the finger motions
produced with a 3:2 tendon force ratio was applied to validate the biomechanical hand
model in section 5.6. Through the index finger motion captured by lateral view camera,
the handle size effect could be explained.
In terms of the metacarpophalangeal (MCP) joints, it was hard to control the MCP
joint by pulling the extrinsic flexor muscles (FDP and FDS). The MCP joints of specimen
were extended in rest condition due to high flexibility of the MCP joints. Thus, we had to
hold up MCP joints until PIP and DIP joints were fully flexed during activating the grip
motion. The role of the extrinsic finger flexor muscles (FDP and FDS) in initiating
rotation of the MCP joint and in coordinating flexion at the MCP, PIP and DIP joints
remains a matter of some debate (Kamper 2002). A previous study reported that the
intrinsic muscles (Lumbrical and Ulnar/Radious interosseous) were seen as the primary
MCP flexors, especially in regard to initiation of MCP flexion (Moore and Dalley, 1999).
Also, a cadaver study utilizing static loading of the FDS tendon found that significant PIP
flexion occurred before the loads become sufficient to initiate MCP flexion (Delattre et


123
al., 1983). Furthermore, Kampler et al. speculated that intrinsic muscles may assist MCP
flexion indirectly by increasing the resistance to the interphalangeal flexion.
Therefore, these previous studies support that the variation of MCP joint angle in
Figure 5.16 was quite small and did not have any effect from the different tendon force
ratio. It was a limitation of the cadaver experiment that MCP joint could not be well
controlled by pulling extrinsic flexor tendon forces.
6.7. Mathematical Model Validation
In the comparison of the biomechanical prediction model and this study, actual
data (phalange length, finger force distribution and finger joint angle) were input to the
prediction model. The predicted flexor tendon forces were, on average 44% higher than
the actual tendon forces. Also, the predicted FDP force was 61% higher than the actual
FDP force, but the FDS force was 38% less in the predicted FDS force. The reason that
the predicted FDP was higher than the actual FDP and the smaller predicted FDS than the
actual can be expected under the assumption of the prediction model. The model assumed
the tendon force ratio of the FDP to FDS as 3:1. However, the result of the model always
shows more FDP force and less FDS force than 3:1 due to the constant value (0.3) in
the model. Consequently, to get more identical results, the parameter (tendon force
ratio) should be predetermined depending on the PIP and DIP joint angles in power grip
motion. The actual tendon forces were compared with the results from other
biomechanical finger models. Average ratios were, for an external force of F, 2.27F-
3.47F for the FDP and 1.51-4.23F for the FDS in power grip motion (An et al., 1985;
Chao et al., 1976; Chao and An, 1978). These ratios were smaller than the result of


124
predicted tendon force ratio but quite similar with the ratio of actual tendon force
(internal force) and grip force (external force) measured in this study.





125
Chapter 7

SUGGESTION FOR FUTURE RESEARCH

The contribution of this study was to validate the mathematical model and analyze
the mechanism of hand flexor tendons in power grip function. Thus, tendon force ratio
and efficiency of grip force were analyzed by measuring grip force with split cylindrical
handles. Also, those results were compared with finger joint angle and the prediction
model. Though it provides novel insights into the functional manifestation of the power
grip motion with cylindrical handles and assess excessive internal tendon loads to prevent
musculo-skeletal disorders (MSDs), there are several improvements required.
7.1. Handle Design
The grip force measured with a split cylinder depends on the handle at which the
force transducer is placed in the hand (Edgren et al., 2004). Therefore, grip force
measured with a split cylinder in this study may have some limitation to reflect the true
grip forces on these cylindrical handles. Consequently, instead of a one directional force
transducer, a three directional force transducer inserted in a split handle may increase the
sensitivity for measuring different directional phalange forces to a cylindrical handle and
three dimensional force directions can be calculated to get the vector grip force.
Moreover, the handle design could be modified to other shapes like a trigger. Repetitive
and forceful triggering is a risk factor in general work environments as well as grasping.


126
To investigate the triggering mechanism, this cadaver model can be modified with the
triggering handle.
7.2. Finger Force Distribution
Finger force distribution measurement has the several advantages. First, finger
force distribution measurement is not affected by device or hand orientation. Second, it is
proportional to friction that is applied during object manipulation, such as lifting, twisting,
and pushing. However, it has a disadvantage as well. The finger force measurement does
not include direct measurement of shear force. Accordingly, a finger force measurement
need to be accompanied with a grip force measurement on a cylindrical handle. In
cadaver model, it was hard to measure each phalange force with film FSRs. A FSR force
sensor usually provided an accurate contact force in a human subject, but attaching FSRs
on a cadaver hand was difficult to contact the small spot of sensor on a handle surface. If
a large flexible pressure pad is covered around a cylindrical handle, contact forces on
each phalange could be measured more accurately.
7.3. Intrinsic Muscles
Future studies delineating the motion contribution of the intrinsic muscles would
be useful in drawing concrete conclusions about their role in phalangeal joint motion. It
was assumed that the effect of intrinsic muscles on the finger flexion can be neglected.
However, metacarpal joint was not controlled without the tension of intrinsic muscles in
cadaver model. Kamper et. al. (2006) also stated that the intrinsic muscle is necessary to


127
produce MCP flexion, especially to initiate the flexion. Hence, although the muscle may
not be controlled by the motion unit, it should be pulled by cables or weights to keep
proper tensions for more realistic power grip motion.
7.4. Passive Force-Length Relationship
Although acknowledged by most researchers, passive muscle force in the
antagonist muscles have been neglected and assumed to be dependent on the external
force applied to the fingers (An et al., 1985; Chao et al., 1976, Schuind et al., 1992). By
definition, passive force cannot be dependent on the external force applied on activation
level, as implied by relating it to external force, but must be dependent on muscle length
alone. Since the cadaver model developed in this study could conduct the test for passive
force-length relationship, the quantification of the relationship would provide important
factors in post-surgical rehabilitation, splinting, and tool design as well.



128
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137
APPENDIX A: Hand Motion Simulator control block diagram
A.1. Force Feedback Motion Control




138
A.2. Manual Motion Control


139
A.3. Velocity Control







140
A.4. Data Saving





141
APPENDIX B: Calibration of Force Transducer (FSRs)
B.1. Regression plots of actual forces and force units for 16 channels



y=455.0ln(x) 853.8
R=0.987
1000
800
600
400
200
0
200
400
600
800
1000
1200
0 20 40 60
CH1
Log.(CH1)
y=452.0ln(x) 893.3
R=0.978
1000
800
600
400
200
0
200
400
600
800
1000
0 20 40 60
CH2
Log.(CH2)
y=451.5ln(x) 796
R=0.994
1000.00
800.00
600.00
400.00
200.00
0.00
200.00
400.00
600.00
800.00
1000.00
1200.00
0 20 40 60
CH3
Log.(CH3)
y=459.9ln(x) 897.2
R=0.975
1000.00
800.00
600.00
400.00
200.00
0.00
200.00
400.00
600.00
800.00
1000.00
0 20 40 60
CH4
Log.(CH4)
y=453.7ln(x) 834.7
R=0.988
1000.00
800.00
600.00
400.00
200.00
0.00
200.00
400.00
600.00
800.00
1000.00
1200.00
0 20 40 60
CH5
Log.(CH5)
y=455.2ln(x) 869.5
R=0.983
1000.00
800.00
600.00
400.00
200.00
0.00
200.00
400.00
600.00
800.00
1000.00
1200.00
0 20 40 60
CH6
Log.(CH6)


142






y=482.6ln(x) 865.8
R=0.982
1000.00
800.00
600.00
400.00
200.00
0.00
200.00
400.00
600.00
800.00
1000.00
1200.00
0 20 40 60
CH7
Log.(CH7)
y=452.0ln(x) 860.9
R=0.985
1000.00
800.00
600.00
400.00
200.00
0.00
200.00
400.00
600.00
800.00
1000.00
1200.00
0 20 40 60
CH8
Log.(CH8)
y=436.4ln(x) 824.4
R=0.991
1000.00
800.00
600.00
400.00
200.00
0.00
200.00
400.00
600.00
800.00
1000.00
0 20 40 60
CH9
Log.(CH9)
y=436.7ln(x) 816.2
R=0.994
1000.00
800.00
600.00
400.00
200.00
0.00
200.00
400.00
600.00
800.00
1000.00
0 20 40 60
CH10
Log.(CH10)
y=415.5ln(x) 805.3
R=0.988
1000.00
800.00
600.00
400.00
200.00
0.00
200.00
400.00
600.00
800.00
1000.00
0 20 40 60
CH11
Log.(CH11)
y=439.3ln(x) 791.3
R=0.990
1000.00
800.00
600.00
400.00
200.00
0.00
200.00
400.00
600.00
800.00
1000.00
1200.00
0 20 40 60
CH12
Log.(CH12)


143


y=441.9ln(x) 680.5
R=0.997
800.00
600.00
400.00
200.00
0.00
200.00
400.00
600.00
800.00
1000.00
1200.00
0 20 40 60
CH13
Log.(CH13)
y=413.3ln(x) 881.6
R=0.959
1000.00
800.00
600.00
400.00
200.00
0.00
200.00
400.00
600.00
800.00
1000.00
0 20 40 60
CH14
Log.(CH14)


144
APPENDIX C: Result of Statistical Analysis
C.1. Residual Plots for the normality
(Top: for ANCOVA Bottom: for ANOVA)



Residual
P
e
r
c
e
n
t
10 5 0 -5 -10
99.9
99
90
50
10
1
0.1
Fitted Value
R
e
s
i
d
u
a
l
40 30 20
5
0
-5
-10
Residual
F
r
e
q
u
e
n
c
y
4 2 0 -2 -4 -6 -8
16
12
8
4
0
Observation Order
R
e
s
i
d
u
a
l
75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 1
5
0
-5
-10
Normal Probability Plot of the Residuals Residuals Versus the Fitted Values
Histogram of the Residuals Residuals Versus the Order of the Data
Residual Plots for Grip Force
Residual
P
e
r
c
e
n
t
10 5 0 -5 -10
99.9
99
90
50
10
1
0.1
Fitted Value
R
e
s
i
d
u
a
l
40 30 20
5
0
-5
-10
Residual
F
r
e
q
u
e
n
c
y
4 2 0 -2 -4 -6 -8
16
12
8
4
0
Observation Order
R
e
s
i
d
u
a
l
75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 1
5
0
-5
-10
Normal Probability Plot of the Residuals Residuals Versus the Fitted Values
Histogram of the Residuals Residuals Versus the Order of the Data
Residual Plots for Grip Force


145
C.2. Grip Force Experiment
C.2.1. Analysis of Variance (ANOVA): General Linear Model

Anal ysi s of Var i ance f or Gr i p For ce, usi ng Adj ust ed SS f or Test s

Sour ce DF Seq SS Adj SS Adj MS F P
I nt . For ce 4 1784. 05 1784. 05 446. 01 46. 28 0.000**
handl e 4 1846. 00 1846. 00 461. 50 47. 89 0.000**
I nt . For ce*handl e 16 192. 88 192. 88 12. 05 1. 25 0. 265
Er r or 50 481. 88 481. 88 9. 64
Tot al 74 4304. 81


S = 3. 10445 R- Sq = 88. 81% R- Sq( adj ) = 83. 43%



C.2.2. Pair-wise comparison of tendon force ratios

Tukey Si mul t aneous Test s
Response Var i abl e Gr i p For ce
Al l Pai r wi se Compar i sons among Level s of I nt . For ce
I nt . For ce = 120 subt r act ed f r om:

I nt . Di f f er ence SE of Adj ust ed
For ce of Means Di f f er ence T- Val ue P- Val ue
140 3. 329 2. 191 1. 519 0. 5537
160 7. 361 2. 191 3. 359 0. 0108
180 9. 736 2. 191 4. 443 0. 0003
200 13. 994 2. 191 6. 386 0. 0000


I nt . For ce = 140 subt r act ed f r om:

I nt . Di f f er ence SE of Adj ust ed
For ce of Means Di f f er ence T- Val ue P- Val ue
160 4. 032 2. 191 1. 840 0. 3594
180 6. 407 2. 191 2. 924 0. 0364
200 10. 665 2. 191 4. 867 0. 0001


I nt . For ce = 160 subt r act ed f r om:

I nt . Di f f er ence SE of Adj ust ed
For ce of Means Di f f er ence T- Val ue P- Val ue
180 2. 375 2. 191 1. 084 0. 8141
200 6. 633 2. 191 3. 027 0.0276


I nt . For ce = 180 subt r act ed f r om:

I nt . Di f f er ence SE of Adj ust ed
For ce of Means Di f f er ence T- Val ue P- Val ue
200 4. 258 2. 191 1. 943 0. 3048



146
C.2.2. Pair-wise comparison of handle

Tukey 95. 0%Si mul t aneous Conf i dence I nt er val s
Response Var i abl e Gr i p For ce
Al l Pai r wi se Compar i sons among Level s of handl e

Tukey Si mul t aneous Test s
Response Var i abl e Gr i p For ce
Al l Pai r wi se Compar i sons among Level s of handl e
handl e = 1 subt r act ed f r om:

Di f f er ence SE of Adj ust ed
handl e of Means Di f f er ence T- Val ue P- Val ue
2 - 9. 05 1. 134 - 7. 98 0.0000
3 - 8. 62 1. 134 - 7. 60 0.0000
4 - 9. 35 1. 134 - 8. 25 0.0000
5 - 15. 56 1. 134 - 13. 72 0.0000


handl e = 2 subt r act ed f r om:

Di f f er ence SE of Adj ust ed
handl e of Means Di f f er ence T- Val ue P- Val ue
3 0. 429 1. 134 0. 378 0. 9955
4 - 0. 298 1. 134 - 0. 263 0. 9989
5 - 6. 506 1. 134 - 5. 740 0.0000


handl e = 3 subt r act ed f r om:

Di f f er ence SE of Adj ust ed
handl e of Means Di f f er ence T- Val ue P- Val ue
4 - 0. 727 1. 134 - 0. 641 0. 9675
5 - 6. 935 1. 134 - 6. 118 0.0000


handl e = 4 subt r act ed f r om:

Di f f er ence SE of Adj ust ed
handl e of Means Di f f er ence T- Val ue P- Val ue
5 - 6. 209 1. 134 - 5. 477 0.0000


147
C.2.3. Regression of Grip Force on Relative FDS% for 5 handles


Regression Analysis: Grip Force versus Relative FDS% (Handle = 1)
The r egr essi on equat i on i s Gr i p For ce = 22. 5 + 0. 450 Rel at i ve FDS%

Pr edi ct or Coef SE Coef T P
Const ant 22. 468 2. 553 8. 80 0. 000
Rel at i ve FDS% 0.45012 0. 06865 6. 56 0. 000

S = 3. 17975 R- Sq = 76. 8% R- Sq( adj ) = 75. 0%

Regression Analysis: Grip Force versus Relative FDS% (Handle = 2)
The r egr essi on equat i on i s Gr i p For ce = 20. 6 + 0. 246 Rel at i ve FDS%

Pr edi ct or Coef SE Coef T P
Const ant 20. 630 2. 367 8. 71 0. 000
Rel at i ve FDS% 0.24588 0. 06366 3. 86 0. 002

S = 2. 99563 R- Sq = 53. 4% R- Sq( adj ) = 49. 9%

Regression Analysis: Grip Force versus Relative FDS% (Handle = 3)
The r egr essi on equat i on i s Gr i p For ce = 13. 3 + 0. 465 Rel at i ve FDS%

Pr edi ct or Coef SE Coef T P
Const ant 13. 327 1. 571 8. 49 0. 000
Rel at i ve FDS% 0.46505 0. 04222 11. 01 0. 000

S = 1. 96472 R- Sq = 90. 3% R- Sq( adj ) = 89. 6%

Regression Analysis: Grip Force versus Relative FDS% (Handle = 4)
The r egr essi on equat i on i s Gr i p For ce = 9. 83 + 0. 542 Rel at i ve FDS%

Pr edi ct or Coef SE Coef T P
Const ant 9. 825 3. 109 3. 16 0. 008
Rel at i ve FDS% 0.54245 0. 08348 6. 50 0. 000

S = 3. 84066 R- Sq = 76. 5% R- Sq( adj ) = 74. 6%

Regression Analysis: Grip Force versus Relative FDS% (Handle = 5)
The r egr essi on equat i on i s Gr i p For ce = 11. 9 + 0. 306 Rel at i ve FDS%

Pr edi ct or Coef SE Coef T P
Const ant 11. 947 2. 341 5. 10 0. 000
Rel at i ve FDS% 0.30603 0. 06275 4. 88 0. 000

S = 2. 89860 R- Sq = 64. 7% R- Sq( adj ) = 61. 9%


148
C.3. Finger Force Distribution Experiment

C.3.1. ANOVA for phalange forces on different finger and %FDS

Analysis of Variance for Total, usi ng Adj ust ed SS f or Test s

Sour ce DF Seq SS Adj SS Adj MS F P
FI NGER 3 2438. 67 2438. 67 812. 89 53. 58 0.000**
%FDS 4 251. 32 251. 32 62. 83 4. 14 0.007**
FI NGER*%FDS 12 168. 13 168. 13 14. 01 0. 92 0. 533
Er r or 40 606. 88 606. 88 15. 17
Tot al 59 3465. 00

S = 3. 89513 R- Sq = 82. 49% R- Sq( adj ) = 74. 17%
Analysis of Variance for Distal, usi ng Adj ust ed SS f or Test s

Sour ce DF Seq SS Adj SS Adj MS F P
FI NGER 3 1387. 76 1387. 76 462. 59 36. 79 0.000**
%FDS 4 171. 86 171. 86 42. 96 3. 42 0.017*
FI NGER*%FDS 12 175. 13 175. 13 14. 59 1. 16 0. 343
Er r or 40 502. 88 502. 88 12. 57
Tot al 59 2237. 63

S = 3. 54571 R- Sq = 77. 53% R- Sq( adj ) = 66. 85%
Analysis of Variance for Middle, usi ng Adj ust ed SS f or Test s

Sour ce DF Seq SS Adj SS Adj MS F P
FI NGER 3 19. 0049 19. 0049 6. 3350 395. 70 0.000**
%FDS 4 0. 0895 0. 0895 0. 0224 1. 40 0. 252
FI NGER*%FDS 12 0. 1576 0. 1576 0. 0131 0. 82 0. 629
Er r or 40 0. 6404 0. 6404 0. 0160
Tot al 59 19. 8924

S = 0. 126529 R- Sq = 96. 78% R- Sq( adj ) = 95. 25%
Analysis of Variance for Proximal, usi ng Adj ust ed SS f or Test s

Sour ce DF Seq SS Adj SS Adj MS F P
FI NGER 3 20. 0554 20. 0554 6. 6851 58. 29 0.000**
%FDS 4 0. 9367 0. 9367 0. 2342 2. 04 0. 107
FI NGER*%FDS 12 2. 3771 2. 3771 0. 1981 1. 73 0. 097
Er r or 40 4. 5878 4. 5878 0. 1147
Tot al 59 27. 9570

S = 0. 338665 R- Sq = 83. 59% R- Sq( adj ) = 75. 80%
Analysis of Variance for Metacarp, usi ng Adj ust ed SS f or Test s

Sour ce DF Seq SS Adj SS Adj MS F P
FI NGER 3 35. 7824 35. 7824 11. 9275 22. 48 0.000**
%FDS 4 9. 0516 9. 0516 2. 2629 4. 27 0.006**
FI NGER*%FDS 12 7. 2044 7. 2044 0. 6004 1. 13 0. 363
Er r or 40 21. 2199 21. 2199 0. 5305
Tot al 59 73. 2582

S = 0. 728352 R- Sq = 71. 03% R- Sq( adj ) = 57. 28%



149
C.3.2. Pair-wise comparison of fingers

Tukey Si mul t aneous Test s
Response Var i abl e Tot al
Al l Pai r wi se Compar i sons among Level s of FI NGER
FI NGER = 1 subt r act ed f r om:

Di f f er ence SE of Adj ust ed
FI NGER of Means Di f f er ence T- Val ue P- Val ue
2 9. 761 1. 563 6. 244 0. 0000
3 - 4. 833 1. 563 - 3. 092 0. 0159
4 - 6. 687 1. 563 - 4. 278 0. 0004


FI NGER = 2 subt r act ed f r om:

Di f f er ence SE of Adj ust ed
FI NGER of Means Di f f er ence T- Val ue P- Val ue
3 - 14. 59 1. 563 - 9. 34 0. 0000
4 - 16. 45 1. 563 - 10. 52 0. 0000


FI NGER = 3 subt r act ed f r om:

Di f f er ence SE of Adj ust ed
FI NGER of Means Di f f er ence T- Val ue P- Val ue
4 - 1. 854 1. 563 - 1. 186 0. 6381


C.3.3. Pair-wise comparison of phalange

Tukey Si mul t aneous Test s
Response Var i abl e For ce
Al l Pai r wi se Compar i sons among Level s of Phal ange
Phal ange = 1 subt r act ed f r om:

Di f f er ence SE of Adj ust ed
Phal ange of Means Di f f er ence T- Val ue P- Val ue
2 - 5. 950 0. 5770 - 10. 31 0. 0000
3 - 5. 898 0. 5770 - 10. 22 0. 0000
4 - 4. 957 0. 5770 - 8. 59 0. 0000


Phal ange = 2 subt r act ed f r om:

Di f f er ence SE of Adj ust ed
Phal ange of Means Di f f er ence T- Val ue P- Val ue
3 0. 05200 0. 5770 0. 09011 0. 9997
4 0. 99317 0. 5770 1. 72114 0. 3150


Phal ange = 3 subt r act ed f r om:

Di f f er ence SE of Adj ust ed
Phal ange of Means Di f f er ence T- Val ue P- Val ue
4 0. 9412 0. 5770 1. 631 0. 3632



VITA
SHIHYUN PARK

Shihyun Park was born in November 30, 1974 in Busan, the Republic of Korea.
He received a B.S. in Industrial Engineering from the Dong-Eui University in 1997. After
finishing his undergraduate degree, Shihyun took three years hiatus from formal
education and served as a military officer in ROK Army. In August 2000, he entered the
Graduate School of the Dong-Eui University in the department of Industrial Engineering.
He was a research assistant and focused on the ergonomics studies during MS degree.
Shihyun Park completed his Masters degree in February of 2002 and moved to
State College, PA, where he began working on his doctorate in Industrial and
Manufacturing Engineering at Pennsylvania State University. As a research assistant,
Shihyun worked at the Center for Cumulative Trauma Disorder Research where he
concentrated primarily on the ergonomic program for manufacturing companies and the
biomechanics of the hand and a cadaver model of the power grip motion. He is a member
of the Human Factors and Ergonomics Society (HFES) and the American Society of
Biomechanics (ASB).

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