A Digital Twin Framework for Precision Neuromusculoskeletal Health Care: Extension Upon Industrial Standards

Abstract

There is a powerful global trend toward deeper integration of digital twins into modern life driven by Industry 4.0 and 5.0. Defense, agriculture, engineering, manufacturing, and urban planning sectors have thoroughly incorporated digital twins to great benefit across their respective product lifecycles. Despite clear benefits, a digital twin framework for health and medical sectors is yet to emerge. This paper proposes a digital twin framework for precision neuromusculoskeletal health care. We build upon the International Standards Organization framework for digital twins for manufacturing by presenting best available computational models within a digital twin framework for clinical application. We map a use case for modeling Achilles tendon mechanobiology, highlighting how current modeling practices align with our proposed digital twin framework. Similarly, we map a use case for advanced neurorehabilitation technology, highlighting the role of a digital twin in control of systems where human and machine are interfaced. Future work must now focus on creating an informatic representation to govern how digital data are passed to, from, and within the digital twin, as well as specific standards to declare which measurement systems and modeling methods are acceptable to move toward widespread use of the digital twin framework for precision neuromusculoskeletal health care.

Towards co-design of rehabilitation technologies: a collaborative approach to prioritize usability issues

“…The system used as an example in the case study presented was a prototype of medical device with Technology Readiness Level 5, wherein the main technological components were integrated in a configuration similar to the final target application and tested in ecologically valid settings. The system followed a proposed framework for the establishment of a digital-twin based approach for interfacing rehabilitation devices to the individual's sensorimotor system ( 26 , 27 ) and associated standards for the integration of this technology to Health Care ( 28 ). A representation of the system is included in Figure 2 .…”

The History and Future of Neuromusculoskeletal Biomechanics

“…Neuromusculoskeletal models that are sufficiently personalized can be thought of as digital twins, a concept that has been used in other industrial sectors over many years with the digitalization of engineering assets. 176 The next stage focuses on the interaction between humans and machines, 177 which is pertinent to neuromusculoskeletal modeling in its application to, for example, in silico design of orthopedic surgeries and implants in the JAB paper Bersani et al, 140 and control of exoskeletons and assistive devices in the JAB papers Mahdian et al 178 and Saxby et al 179 Industry together with regulatory bodies, such as the European Medicines Agency 180 and United States Food and Drug Administration, 181,182 are developing standards for the quality control of the application of digital twins, for example, the American Society of Mechanical Engineers. 183 The medical and health devices industry must learn from other industries, as discussed in the JAB paper Saxby et al 179 In this endeavor, benchmarking data is needed to ensure the quality of neuromusculoskeletal modeling.…”