Search results for: wearable knee exoskeletons

Authors: D. Sun, L. Saw, A. Onyianta, D. O’Rourke, Z. Lu, C. See, C. Wilson, C. Popescu, M. Dorris

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With the rapid development of wearable technology (e.g., smartwatch, activity trackers and health monitor devices), flexible dielectric materials with environmental-friendly, low-cost and high-energy efficiency characteristics are in increasing demand. In this work, a flexible dielectric nanocomposite was processed by incorporating two components: cellulose nanofibrils and alum sludge in a polymer matrix. The two components were used in the reinforcement phase as well as for enhancing the dielectric properties; they were processed using waste materials that would otherwise be disposed to landfills. Alum sludge is a by-product of the water treatment process in which aluminum sulfate is prevalently used as the primary coagulant. According to the data from a project partner-Scottish Water: there are approximately 10k tons of alum sludge generated as a waste from the water treatment work to be landfilled every year in Scotland. The industry has been facing escalating financial and environmental pressure to develop more sustainable strategies to deal with alum sludge wastes. In the available literature, some work on reusing alum sludge has been reported (e.g., aluminum recovery or agriculture and land reclamation). However, little work can be found in applying it to processing energy materials (e.g., dielectrics) for enhanced energy density and efficiency. The alum sludge was collected directly from a water treatment plant of Scottish Water and heat-treated and refined before being used in preparing composites. Cellulose nanofibrils were derived from water hyacinth, an invasive aquatic weed that causes significant ecological issues in tropical regions. The harvested water hyacinth was dried and processed using a cost-effective method, including a chemical extraction followed by a homogenization process in order to extract cellulose nanofibrils. Biodegradable elastomer polydimethylsiloxane (PDMS) was used as the polymer matrix and the nanocomposites were processed by casting raw materials in Petri dishes. The processed composites were characterized using various methods, including scanning electron microscopy (SEM), rheological analysis, thermogravimetric and X-ray diffraction analysis. The SEM result showed that cellulose nanofibrils of approximately 20nm in diameter and 100nm in length were obtained and the alum sludge particles were of approximately 200um in diameters. The TGA/DSC analysis result showed that a weight loss of up to 48% can be seen in the raw material of alum sludge and its crystallization process has been started at approximately 800°C. This observation coincides with the XRD result. Other experiments also showed that the composites exhibit comprehensive mechanical and dielectric performances. This work depicts that it is a sustainable practice of reusing such waste materials in preparing flexible, lightweight and miniature dielectric materials for wearable technology applications.

Keywords: cellulose, biodegradable, sustainable, alum sludge, nanocomposite, wearable technology, dielectric

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Authors: Tiffanie-Marie Borg, Yasmin Zeinolabediny, Nima Heidari, Ali Noorani, Mark Slevin, Angel Cullen, Stefano Olgiati, Alberto Zerbi, Alessandro Danovi, Adrian Wilson

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Knee Osteoarthritis (OA) is a critical cause of disability globally. In recent years, there has been growing interest in non-invasive treatments, such as intra-articular injection of micro-fragmented fat (MFAT), showing great potential in treating OA. Mesenchymal stem cells (MSCs), originating from pericytes of micro-vessels in MFAT, can differentiate into mesenchymal lineage cells such as cartilage, osteocytes, adipocytes, and osteoblasts. Secretion of growth factor and cytokines from MSCs have the capability to inhibit T cell growth, reduced pain and inflammation, and create a micro-environment that through paracrine signaling, can promote joint repair and cartilage regeneration. Here we have shown, for the first time, data supporting the hypothesis that women respond better in terms of improvements in pain and function to MFAT injection compared to men. Historically, women have been underrepresented in studies, and studies with both sexes regularly fail to analyse the results by sex. To mitigate this bias and quantify it, we describe a technique using reproducible statistical analysis and replicable results with Open Access statistical software R to calculate the magnitude of this difference. Genetic, hormonal, environmental, and age factors play a role in our observed difference between the sexes. This observational, intention-to-treat study included the complete sample of 456 patients who agreed to be scored for pain (visual analogue scale (VAS)) and function (Oxford knee score (OKS)) at baseline regardless of subsequent changes to adherence or status during follow-up. We report that a significantly larger number of women responded to treatment than men: [90% vs. 60% change in VAS scores with 87% vs. 65% change in OKS scores, respectively]. Women overall had a stronger positive response to treatment with reduced pain and improved mobility and function. Pre-injection, our cohort of women were in more pain with worse joint function which is quite common to see in orthopaedics. However, during the 2-year follow-up, they consistently maintained a lower incidence of discomfort with superior joint function. This data clearly identifies a clear need for further studies to identify the cell and molecular biological and other basis for these differences and be able to utilize this information for stratification in order to improve outcome for both women and men.

Keywords: gender differences, micro-fragmented adipose tissue, knee osteoarthritis, stem cells

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Authors: Mukhtar Ibrahim Bello, Ibrahim U. Aikawa, Abubakar Sadiq Muhammad, Muhammad Baballe Ahmad

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These vital signs can be tracked by wearable sensors, which can also be used to assess patients' health. As a result, they can be very beneficial to patients and healthcare professionals in the diagnosis of diseases, particularly when it comes to taking a patient's body temperature in infectious disorders.

Keywords: fire out-break, robots, saving, dangerous environments, impacts

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Authors: Mina Beheshti, Vida Shams, Mojtaba Esfandiari, Farzaneh Abdollahi, Abdolreza Ohadi

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Most of the people who survive a stroke need rehabilitation tools to regain their mobility. The core function of these devices is a brake actuator. The goal of this study is to design and control a magnetorheological brake which can be used as a rehabilitation tool. In fact, the fluid used in this brake is called magnetorheological fluid or MR that properties can change by variation of the magnetic field. The braking properties can be set as control by using this feature of the fluid. In this research, different MR brake designs are first introduced in each design, and the dimensions of the brake have been determined based on the required torque for foot movement. To calculate the brake dimensions, it is assumed that the shear stress distribution in the fluid is uniform and the fluid is in its saturated state. After designing the rehabilitation brake, the mathematical model of the healthy movement of a healthy person is extracted. Due to the nonlinear nature of the system and its variability, various adaptive controllers, neural networks, and robust have been implemented to estimate the parameters and control the system. After calculating torque and control current, the best type of controller in terms of error and control current has been selected. Finally, this controller is implemented on the experimental data of the patient's movements, and the control current is calculated to achieve the desired torque and motion.

Keywords: rehabilitation, magnetorheological fluid, knee, brake, adaptive control, robust control, neural network control, torque control

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Authors: Gubiani Rino, Nicola Zucchiatti, Da Broi Ugo, Bietresato Marco

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The problem of vibrations in agriculture is very important due to the different types of machinery used for the different types of soil in which work is carried out. One of the most commonly used machines is the tractor, where the phenomenon has been studied for a long time by measuring the whole body and placing the sensor on the seat. However, this measurement system does not take into account the characteristics of the drivers, such as their body index (BMI), their gender (male, female) or the muscle fatigue they are subjected to, which is highly dependent on their age for example. The aim of the research was therefore to place sensors not only on the seat but along the spinal column to check the transmission of vibration on drivers with different BMI on different tractors and at different travel speeds and of different genders. The test was also done using wearable sensors such as a dynamometer applied to the muscles, the data of which was correlated with the vibrations produced by the tractor. Initial data show that even on new tractors with pneumatic seats, the vibrations attenuate little and are still correlated with the roughness of the track travelled and the forward speed. Another important piece of data are the root-mean square values referred to 8 hours (A(8)x,y,z) and the maximum transient vibration values (MTVVx,y,z) and, the latter, the MTVVz values were problematic (limiting factor in most cases) and always aggravated by the speed. The MTVVx values can be lowered by having a tyre-pressure adjustment system, able to properly adjust the tire pressure according to the specific situation (ground, speed) in which a tractor is operating.

Keywords: fatigue, effect vibration on health, tractor driver vibrations, vibration, muscle skeleton disorders

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Authors: Mohammad Nasb, Muhammad Rehan, Chen Hong

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Background Meniscus defects critically alter knee function and lead to degenerative changes. Regenerative medicine applications including stem cell transplantation have showed a promising efficacy in finding alternatives to overcome traditional treatment limitations. However, stem cell therapy remains limited due to the substantially reduced viability and inhibitory microenvironment. Since tissue growth and repair are under the control of biochemical and mechanical signals, several approaches have recently been investigated (e.g., low intensity pulsed ultrasound [LIPUS]) to promote the regeneration process. This study employed LIPUS to improve growth and osteogenic differentiation of mesenchymal stem cells derived from human embryonic stem cells to improve the regeneration of meniscus tissue. Methodology: The Mesenchymal stromal cells (MSCs) were transplanted into the epicenter of the injured meniscus in rabbits, which were randomized into two main groups: a treatment group (n=32 New Zealand rabbits) including 4 subgroups of 8 rabbits in each subgroup (LIPUS treatment, MSC treatment, LIPUS with MSC and control), and a second group (n=9) to track implanted cells and their progeny using green fluorescence protein (GFP). GFP consists of the MSC and LIPUS-MSC combination subgroups. Rabbits were then subjected to histological, immunohistochemistry, and MRI assessment. Results: The quantity of the newly regenerated tissue in the combination treatment group that had Ultrasound irradiation after mesenchymal stem cells were better at all end points. Likewise, Tissue quality scores were also greater in knees treated with both approaches compared with controls and single treatment at all end points, achieving significance at twelve and twenty-four weeks [p < 0.05], and [p = 0.008] at twelve weeks. Differentiation into type-I and II collagen-expressing cells were higher in the combination group at up to twenty-four weeks. Conclusions: the combination of mesenchymal stem cells and LIPUS showed greater adhering to the sites of meniscus injury, differentiate into cells resembling meniscal fibrochondrocytes, and improve both quality and quantity of meniscal regeneration.

Keywords: stem cells, regenerative medicine, osteoarthritis, knee

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Authors: Venere Ferraro, Silvia Ferraris

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We live in a world pervaded by new advanced technologies that have been changing the way we live and experience the surrounded. Besides, new technologies enable product innovation at different levels. Nevertheless, innovation does not lie just in the technological development and in its hard aspects but also in the meaningful use of it for the final user. In order to generate innovative products, a new perspective is needed: The shift from an instrument-oriented view of the technology towards a broader view that includes aspects like aesthetics, acceptance, comfort, and sociability. In many businesses, the user experience of the product is considered the key battlefield to achieve product innovation. (Holland 2011) The use of new technologies is indeed useless without paying attention to the user experience. This paper presents a workshop activity conducted at Design School of Politecnico di Milano in collaboration with Chiba University and aimed at generating innovative design concepts of high-tech mask. The students were asked to design the user experience of a new mask by exploiting emerging technologies such as wearable sensors and information communication technology (ICT) for a chosen field of application: safety or sport. When it comes to the user experience, the mask is a very challenging design product, because it covers aspects of product interaction and, most important, psychological and cultural aspects related to the impact on the facial expression. Furthermore, since the mask affects the face expression quite a lot, it could be a barrier to hide with, or it could be a mean to enhance user’s communication to others. The main request for the students was to take on a user-centered approach: To go beyond the instrumental aspects of product use and usability and focus on the user experience by shaping the technology in a desirable and meaningful way for the user reasoning on the metaphorical and cultural level of the product. During the one-week workshop students were asked to face the design process through (i) the research phase: an in-deep analysis of the user and field of application (safety or sport) to set design spaces (brief) and user scenario; (ii) the idea generation, (iii) the idea development. This text will shortly go through the meaning of the product innovation, the use and application of wearable technologies and will then focus on the user experience design in contrast with the technology-driven approach in the field of product innovation. Finally authors will describe the workshop activity and the concepts developed by the students stressing the important role of the user experience design in new product development.

Keywords: product innovation, user experience, technological exploitation, wearable technologies

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Authors: Elham Azimzadeh, Saeedeh Sepehri, Hamidollah Hassanlouei

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Obesity is associated with postural instability, might influence the quality of daily life, and could be considered a potential factor for falling in obese people. The fat body mass especially in the abdominal area may increase body sway. Furthermore, loss of visual feedback may induce a larger postural sway in obese people. Moreover, Muscle fatigue may impair the work capacity of the skeletal muscle and may alter joint proprioception. So, the purpose of this study was to investigate the effect of physical fatigue and visual feedback on body sway and strength of lower extremities in obese people. 12 obese (4 female, 8 male; BMI >30 kg/m2), and 12 normal weight (4 female, 8 male; BMI: 20-25 kg/m2) subjects aged 37- 47 years participated in this study. The postural stability test on the Biodex balance system was used to characterize postural control along the anterior-posterior (AP) and mediolateral (ML) directions in eyes open and eyes closed conditions and maximal voluntary contraction (MVC) of knee extensors and flexors were measured before and after the high-intensity exhausting exercise protocol on the ergometer bike to confirm the presence of fatigue. Results indicated that the obese group demonstrated significantly greater body sway, in all indices (ML, AP, overall) compared with the normal weight group (eyes open). However, when visual feedback was eliminated, fatigue impaired the balance in the overall and AP indicators in both groups; ML sway was higher only in the obese group after exerting the fatigue in the eyes closed condition. Also, maximal voluntary contraction of knee extensors was impaired in the fatigued normal group but, there was no significant impairment in knee flexors MVC in both group. According to the findings, peripheral fatigue was associated with altered postural control in upright standing when eyes were closed, and that mechanoreceptors of the feet may be less able to estimate the position of the body COM over the base of support in the loss of visual feedback. This suggests that the overall capability of the postural control system during upright standing especially in the ML direction could be lower due to fatigue in obese individuals and could be a predictor of future falls.

Keywords: maximal voluntary contraction, obesity, peripheral fatigue, postural control, visual feedback

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Authors: S. Koppikar, P. Kulkarni, D. Ingale , N. Wagh, S. Deshpande, A. Mahajan, A. Harsulkar

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Crucial role of reactive oxygen species (ROS) in the progression Osteoarthritis (OA) pathogenesis has been endorsed several times though its exact mechanism remains unclear. Oxidative stress is known to instigate classical stress factors such as cytokines, chemokines and ROS, which hampers cartilage remodelling process and ultimately results in worsening the disease. Synovial fluid (SF) is a biological communicator between cartilage and synovium that accumulates redox and biochemical signalling mediators. The present work attempts to measure several oxidative stress markers in the synovial fluid obtained from knee OA patients with varying degree of disease severity. Thirty OA and five Meniscal-tear (MT) patients were graded using Kellgren-Lawrence scale and assessed for Nitric oxide (NO), Nitrate-Nitrite (NN), 2,2-diphenyl-1-picrylhydrazyl (DPPH), Ferric Reducing Antioxidant Potential (FRAP), Catalase (CAT), Superoxide dismutase (SOD) and Malondialdehyde (MDA) levels for comparison. Out of various oxidative markers studied, NO and SOD showed significant difference between moderate and severe OA (p= 0.007 and p= 0.08, respectively), whereas CAT demonstrated significant difference between MT and mild group (p= 0.07). Interestingly, NN revealed statistically positive correlation with OA severity (p= 0.001 and p= 0.003). MDA, a lipid peroxidation by-product was estimated maximum in early OA when compared to MT (p= 0.06). However, FRAP did not show any correlation with OA severity or MT control. NO is an essential bio-regulatory molecule essential for several physiological processes, and inflammatory conditions. However, due to its short life, exact estimation of NO becomes difficult. NO and its measurable stable products are still it is considered as one of the important biomarker of oxidative damage. Levels of NO and nitrite-nitrate in SF of patients with OA indicated its involvement in the disease progression. When SF groups were compared, a significant correlation among moderate, mild and MT groups was established. To summarize, present data illustrated higher levels of NO, SOD, CAT, DPPH and MDA in early OA in comparison with MT, as a control group. NN had emerged as a prognostic bio marker in knee OA patients, which may act as futuristic targets in OA treatment.

Keywords: antioxidant, knee osteoarthritis, oxidative stress, synovial fluid

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Authors: Neena Kanojia, R. K. Kanojia

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Background: Osteoarthritis OA of the knee is one of the leading causes of disability characterized by degeneration of hyaline cartilage combined with reparative processes. Its strong association with metabolic syndrome is postulated to be due to both mechanical and biochemical factors. Our study aims to study differential effect of metabolic risk factors on cartilage degeneration and regeneration at biomarker level. Design: After screening 281 patients presenting with knee pain, 41 patients who met the selection criteria were included and were divided into metabolic MetS OA and non-metabolic Non-MetS OA phenotypes using National Cholesterol Education Programme-Adult Treatment Panel-III NCEP ATP III criteria for metabolic syndrome. Serum Cartilage Oligomeric Matrix Protein COMP and Procollagen type IIA N terminal Propeptide PIIANP levels were used as tools to assess cartilage degeneration and regeneration, respectively. Results: 22 among 41 patients 53.66% had metabolic syndrome. Covariates like age, gender, Kellgren Lawrence KL grades were comparable in both groups. MetS OA group showed significant increase in serum COMP levels (p 0.03 with no significant effect on serum PIIANP levels (p 0.46. Hypertriglyceridemia showed independent association with both cartilage anabolism (p 0.03 and catabolism (p 0.03. Conclusion: Metabolic syndrome, though has no effect on cartilage regeneration tends to shift cartilage homeostasis towards degeneration with hypertriglyceridemia showing significant independent effect on cartilage metabolism.

Keywords: metabolic, syndrome, cartilage, degernation

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Authors: Sk Shamim Hasan Abir, Karen Lozano, Mohammed Jasim Uddin

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Over the last few years, nanofiber-based triboelectric nanogenerator (TENG) has caught great attention among researchers all over the world due to its inherent capability of converting mechanical energy to usable electrical energy. In this study, poly(vinylidene fluoride) (PVDF) and thermoplastic polyurethane (TPU) nanofiber prepared by Forcespinning® (FS) technique were used to fabricate TENG for self-charging energy storage device and biomechanical body motion sensor. The surface of the TPU nanofiber was modified by uniform deposition of thin gold film to enhance the frictional properties; yielded 254 V open-circuit voltage (Voc) and 86 µA short circuit current (Isc), which were 2.12 and 1.87 times greater in contrast to bare PVDF-TPU TENG. Moreover, the as-fabricated PVDF-TPU/Au TENG was tested against variable capacitors and resistive load, and the results showed that with a 3.2 x 2.5 cm2 active contact area, it can quick charge up to 7.64 V within 30 seconds using a 1.0 µF capacitor and generate significant 2.54 mW power, enough to light 75 commercial LEDs (1.5 V each) by the hand tapping motion at 4 Hz (240 beats per minutes (bpm)) load frequency. Furthermore, the TENG was attached to different body parts to capture distinctive electrical signals for various body movements, elucidated the prospective usability of our prepared nanofiber-based TENG in wearable body motion sensor application.

Keywords: biomotion sensor, forcespinning, nanofibers, triboelectric nanogenerator

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Authors: Matthew Kostawich, Mohammed Elmorsy, Mohamed Sayed Sifat, Shoukry Shams, Mahmoud Elsaadany

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6G communication systems represent the nominal future extension of current wireless technology, where its impact is extended to touch upon all human activities, including medical, security, and entertainment applications. As a result, human needs are allocated among the highest priority aspects of the system design and requirements. 6G communications is expected to replace all the current video conferencing with interactive virtual reality meetings involving high data-rate transmission merged with massive distributed computing resources. In addition, the current expansion of IoT applications must be mitigated with significant network changes to provide a reasonable Quality of Service (QoS). This directly implies a high demand for Human-Computer Interaction (HCI) through mobile computing modules in future wireless communication systems. This article proposes the utilization of a Printed Ridge Gap Waveguide (PRGW) to host the wearable nodes. To the best of our knowledge, we propose for the first time a physical layer analysis within the context of a complete architecture. A thorough study is provided on the impact of the distortion of the guiding structure on the overall system performance. The proposed structure shows small latency and small losses, highlighting its compatibility with future applications.

Keywords: ridge gap waveguide, edge computing module, 6G, multimedia IoT applications

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Authors: Ru-Yin Yang, Chi Wu, Cheng-Yu Tsai, Yin-Tzu Lin, Wen-Te Liu

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Background: Sleep breathing disorder (SDB) is a condition demonstrated by recurrent episodes of the airway obstruction leading to intermittent hypoxia and quality fragmentation during sleep time. However, the procedures for SDB severity examination remain complicated and costly. Objective: The objective of this study is to establish a simplified examination method for SDB by the respiratory impendence pattern sensor combining the signal processing and machine learning model. Methodologies: We records heart rate variability by the electrocardiogram and respiratory pattern by impendence. After the polysomnography (PSG) been done with the diagnosis of SDB by the apnea and hypopnea index (AHI), we calculate the episodes with the absence of flow and arousal index (AI) from device record. Subjects were divided into training and testing groups. Neuron network was used to establish a prediction model to classify the severity of the SDB by the AI, episodes, and body profiles. The performance was evaluated by classification in the testing group compared with PSG. Results: In this study, we enrolled 66 subjects (Male/Female: 37/29; Age:49.9±13.2) with the diagnosis of SDB in a sleep center in Taipei city, Taiwan, from 2015 to 2016. The accuracy from the confusion matrix on the test group by NN is 71.94 %. Conclusion: Based on the models, we established a prediction model for SDB by means of the wearable sensor. With more cases incoming and training, this system may be used to rapidly and automatically screen the risk of SDB in the future.

Keywords: sleep breathing disorder, apnea and hypopnea index, body parameters, neuron network

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Authors: Nadeem Qaiser, Sherjeel Munsif Khan, Muhammad Mustafa Hussian, Vincent Tung

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One of the emerging fields in the detection of chronic diseases is based on the point-of-care (POC) early monitoring of the symptoms and thus provides a state-of-the-art personalized healthcare system. Nowadays, wearable and flexible sensors are being used for analyzing sweat, glucose, blood pressure, and other skin conditions. However, localized jaw-bone swelling called parotid-swelling caused by some viruses has never been tracked before. To track physical motion or deformations, strain sensors, especially piezoresistive ones, are widely used. This work, for the first time, reports carbon nanotubes (CNTs)-based piezoresistive sensing patch that is highly flexible and stretchable and can record muscle deformations in real-time. The developed patch offers an excellent gauge factor for in-plane stretching and spatial expansion with low hysteresis. To calibrate the volumetric muscle expansion, we fabricated the pneumatic actuator that experienced volumetric expansion and thus redefined the gauge factor. Moreover, we employ a Bluetooth-low-energy system that can send information about muscle activity in real-time to a smartphone app. We utilized COMSOL calculations to reveal the mechanical robustness of the patch. The experiments showed the sensing patch's greater cyclability, making it a patch for personal healthcare and an excellent choice for monitoring the real-time POC monitoring of the human muscle swelling.

Keywords: piezoresistive strain sensor, FEM simulations, CNTs sensor, flexible

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Authors: Johnson C. Y. Pang, Bo Peng, Kara K. L. Reeves, Allan C. L. Fud

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Objective: Dry needling (DN) has long been used as a treatment method for various musculoskeletal pain conditions. However, the evidence level of the studies was low due to the limitations of the methodology. Lack of randomization and inappropriate blinding is potentially the main sources of bias. A method that can differentiate clinical results due to the targeted experimental procedure from its placebo effect is needed to enhance the validity of the trial. Therefore, this study aimed to validate the method as a placebo ultrasound(US)-guided DN for patients with knee osteoarthritis (KOA). Design: This is a randomized controlled trial (RCT). Ninety subjects (25 males and 65 females) aged between 51 and 80 (61.26 ± 5.57) with radiological KOA were recruited and randomly assigned into three groups with a computer program. Group 1 (G1) received real US-guided DN, Group 2 (G2) received placebo US-guided DN, and Group 3 (G3) was the control group. Both G1 and G2 subjects received the same procedure of US-guided DN, except the US monitor was turned off in G2, blinding the G2 subjects to the incorporation of faux US guidance. This arrangement created the placebo effect intended to permit comparison of their results to those who received actual US-guided DN. Outcome measures, including the visual analog scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales of pain, symptoms, and quality of life (QOL), were analyzed by repeated measures analysis of covariance (ANCOVA) for time effects and group effects. The data regarding the perception of receiving real US-guided DN or placebo US-guided DN were analyzed by the chi-squared test. The missing data were analyzed with the intention-to-treat (ITT) approach if more than 5% of the data were missing. Results: The placebo US-guided DN (G2) subjects had the same perceptions as the use of real US guidance in the advancement of DN (p<0.128). G1 had significantly higher pain reduction (VAS and KOOS-pain) than G2 and G3 at 8 weeks (both p<0.05) only. There was no significant difference between G2 and G3 at 8 weeks (both p>0.05). Conclusion: The method with the US monitor turned off during the application of DN is credible for blinding the participants and allowing researchers to incorporate faux US guidance. The validated placebo US-guided DN technique can aid in investigations of the effects of US-guided DN with short-term effects of pain reduction for patients with KOA. Acknowledgment: This work was supported by the Caritas Institute of Higher Education [grant number IDG200101].

Keywords: ultrasound-guided dry needling, dry needling, knee osteoarthritis, physiotheraphy

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Authors: Sebastian Kölbl, Thomas Reitmaier, Mathias Hartmann

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Trial and error approaches to adapt wearable support structures to human physiology are time consuming and elaborate. However, during preliminary design, the focus lies on understanding the interaction between exoskeleton and the human body in terms of forces and moments, namely body mechanics. For the study at hand, a multi-body simulation approach has been enhanced to evaluate actual forces and moments in a human dummy model with and without a digital mock-up of an active exoskeleton. Therefore, different motion data have been gathered and processed to perform a musculosceletal analysis. The motion data are ground reaction forces, electromyography data (EMG) and human motion data recorded with a marker-based motion capture system. Based on the experimental data, the response of the human dummy model has been calibrated. Subsequently, the scalable human dummy model, in conjunction with the motion data, is connected with the exoskeleton structure. The results of the human-machine interaction (HMI) simulation platform are in particular resulting contact forces and human joint forces to compare with admissible values with regard to the human physiology. Furthermore, it provides feedback for the sizing of the exoskeleton structure in terms of resulting interface forces (stress justification) and the effect of its compliance. A stepwise approach for the setup and validation of the modeling strategy is presented and the potential for a more time and cost-effective development of wearable support structures is outlined.

Keywords: assistive devices, ergonomic design, inverse dynamics, inverse kinematics, multibody simulation

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Authors: Maariyah Irfan

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Intro: Current cardiovascular (CV) care faces challenges such as low budgets and high hospital admission rates. This review aims to evaluate Big Data in CV healthcare management through the use of wearable devices in atrial fibrillation (AF) detection. AF may present intermittently, thus it is difficult for a healthcare professional to capture and diagnose a symptomatic rhythm. Methods: The iRhythm ZioPatch, AliveCor portable electrocardiogram (ECG), and Apple Watch were chosen for review due to their involvement in controlled clinical trials, and their integration with smartphones. The cost-effectiveness and AF detection of these devices were compared against the 12-lead ambulatory ECG (Holter monitor) that the NHS currently employs for the detection of AF. Results: The Zio patch was found to detect more arrhythmic events than the Holter monitor over a 2-week period. When patients presented to the emergency department with palpitations, AliveCor portable ECGs detected 6-fold more symptomatic events compared to the standard care group over 3-months. Based off preliminary results from the Apple Heart Study, only 0.5% of participants received irregular pulse notifications from the Apple Watch. Discussion: The Zio Patch and AliveCor devices have promising potential to be implemented into the standard duty of care offered by the NHS as they compare well to current routine measures. Nonetheless, companies must address the discrepancy between their target population and current consumers as those that could benefit the most from the innovation may be left out due to cost and access.

Keywords: atrial fibrillation, big data, cardiovascular healthcare management, wearable devices

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Authors: Ramada R. Khasawneh, Mohammed Z. Allouh, Ejlal Abu-El Rub

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The quadriceps angle (Q angle), formed between the quadriceps muscles and the patella tendon, is considered clinically as a very important parameter which displays the biomechanical effect of the quadriceps muscle on the knee, and it is also regarded as a crucial factor for the proper posture and movement of the knee patella. This study had been conducted to measure the normal Q angle values range in the Arab nationalities and determine the correlation between Q angle values and several body parameters, including gender, height, weight, dominant side, and the condylar distance of the femur. The study includes 500 healthy Arab students from Yarmouk University and Jordan University of Science and Technology. The Q angle of those volunteers was measured using a universal manual Goniometer with the subjects in the upright weight-bearing position. It was found that the Q angle was greater in women than in men. The analysis of the data revealed an insignificant increase in the dominant side of the Q angle. In addition, the Q was significantly higher in the taller people of both sexes. However, the Q angle did not present any considerable correlation with weight in the study population; conversely, it was observed that there was a link with the condylar distance of the femur in both sexes. It was also noticed that the Q angle increased remarkably when there was an increase in the condylar distance. Consequently, it turned out that the gender, height, and the condylar distance were momentous factors that had an impact on the Q angle in our study samples. However, weight and dominance factors did not show to have any influence on the values in our study.

Keywords: Q angle, Jordanian, anatomy, condylar distance

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Authors: Amal A. Mashali, Omar Eltaweel, Elerian Ekladious

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Stature of an individual has an important role in identification, which is often required in medico-legal practice. The estimation of stature is an important step in the identification of dismembered remains or when only a part of a skeleton is only available as in major disasters or with mutilation. There is no published data on anthropological data among Jordanian population. The present study was designed in order to find out relationship of stature to some anthropometric measures among a sample of Jordanian population and to determine the most accurate and reliable one in predicting the stature of an individual. A cross sectional study was conducted on 336 adult healthy volunteers , free of bone diseases, nutritional diseases and abnormalities in the extremities after taking their consent. Students of Faculty of Medicine, Mutah University helped in collecting the data. The anthropometric measurements (anatomically defined) were stature, humerus length, hand length and breadth, foot length and breadth, foot index and knee height on both right and left sides of the body. The measurements were typical on both sides of the bodies of the studied samples. All the anthropologic data showed significant relation with age except the knee height. There was a significant difference between male and female measurements except for the foot index where F= 0.269. There was a significant positive correlation between the different measures and the stature of the individuals. Three equations were developed for estimation of stature. The most sensitive measure for prediction of a stature was found to be the humerus length.

Keywords: foot index, foot length, hand length, humerus length, stature

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Authors: Wei Xu, Abdo S. Haidar, Jianxin Gao

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Prosthetic socket is a component that connects the residual limb of an amputee with an artificial prosthesis. It is widely recognized as the most critical component that determines the comfort of a patient when wearing the prosthesis in his/her daily activities. Through the socket, the body weight and its associated dynamic load are distributed and transmitted to the prosthesis during walking, running or climbing. In order to achieve a good-fit socket for an individual amputee, it is essential to obtain the biomechanical properties of the residual limb. In current clinical practices, this is achieved by a touch-and-feel approach which is highly subjective. Although there have been significant advancements in prosthetic technologies such as microprocessor controlled knee and ankle joints in the last decade, the progress in designing a comfortable socket has been rather limited. This means that the current process of socket design is still very time-consuming, and highly dependent on the expertise of the prosthetist. Supported by the state-of-the-art sensor technologies and numerical simulations, a new socket design system is being developed to help prosthetists achieve rapid design of comfortable sockets for above knee amputees. This paper reports the research work related to establishing biomechanical models for socket design. Through numerical simulation using finite element method, comprehensive relationships between pressure on residual limb and socket geometry were established. This allowed local topological adjustment for the socket so as to optimize the pressure distributions across the residual limb. When the full body weight of a patient is exerted on the residual limb, high pressures and shear forces between the residual limb and the socket occur. During numerical simulations, various hyperplastic models, namely Ogden, Yeoh and Mooney-Rivlin, were used, and their effectiveness in representing the biomechanical properties of soft tissues of the residual limb was evaluated. This also involved reverse engineering, which resulted in an optimal representative model under compression test. To validate the simulation results, a range of silicone models were fabricated. They were tested by an indentation device which yielded the force-displacement relationships. Comparisons of results obtained from FEA simulations and experimental tests showed that the Ogden model did not fit well the soft tissue material indentation data, while the Yeoh model gave the best representation of the soft tissue mechanical behavior under indentation. Compared with hyperplastic model, the result showed that elastic model also had significant errors. In addition, normal and shear stress distributions on the surface of the soft tissue model were obtained. The effect of friction in compression testing and the influence of soft tissue stiffness and testing boundary conditions were also analyzed. All these have contributed to the overall goal of designing a good-fit socket for individual above knee amputees.

Keywords: above knee amputee, finite element simulation, hyperplastic model, prosthetic socket

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Authors: M. F. M. Ali, A. R. Ismail, B. M. Deros

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Soccer is very popular and ranked as the top sports in the world as well as in Malaysia. Although soccer sport in Malaysia is currently professionalized, but it’s plunging achievements within recent years continue and are not to be proud of. After review, the Malaysian soccer players are still weak in terms of kicking techniques. The instep kick is a technique, which is often used in soccer for the purpose of short passes and making a scoring. This study presents the 3D biomechanics analysis on a soccer player during performing instep kick. This study was conducted to determine the optimization value for approach angle, distance of supporting leg from the ball and ball internal pressure respect to the knee angular velocity of the ball on the kicking leg. Six subjects from different categories using dominant right leg and free from any injury were selected to take part in this study. Subjects were asked to perform one step instep kick according to the setting for the variables with different parameter. Data analysis was performed using 3 Dimensional “Qualisys Track Manager” system and will focused on the bottom of the body from the waist to the ankle. For this purpose, the marker will be attached to the bottom of the body before the kicking is perform by the subjects. Statistical analysis was conducted by using Minitab software using Response Surface Method through Box-Behnken design. The results of this study found the optimization values for all three parameters, namely the approach angle, 53.6º, distance of supporting leg from the ball, 8.84sm and ball internal pressure, 0.9bar with knee angular velocity, 779.27 degrees/sec have been produced.

Keywords: biomechanics, instep kick, soccer, optimization

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Authors: Rajan Goyal, S. Lamba, S. Annapoorni

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The indirect exchange coupled system consists of two ferromagnetic layers separated by non-magnetic spacer layer. The type of exchange coupling may be either ferro or anti-ferro depending on the thickness of the spacer layer. In the present work, the strength of exchange coupling in FePt/Al₂O₃/Fe₃Pt has been investigated by varying the thickness of the spacer layer Al₂O₃. The FePt/Al₂O₃/Fe₃Pt trilayer structure is fabricated on Si <100> single crystal substrate using sputtering technique. The thickness of FePt and Fe₃Pt is fixed at 60 nm and 2 nm respectively. The thickness of spacer layer Al₂O₃ was varied from 0 to 16 nm. The normalized hysteresis loops recorded at room temperature both in the in-plane and out of plane configuration reveals that the orientation of easy axis lies along the plane of the film. It is observed that the hysteresis loop for ts=0 nm does not exhibit any knee around H=0 indicating that the hard FePt layer and soft Fe₃Pt layer are strongly exchange coupled. However, the insertion of Al₂O₃ spacer layer of thickness ts = 0.7 nm results in appearance of a minor knee around H=0 suggesting the weakening of exchange coupling between FePt and Fe₃Pt. The disappearance of knee in hysteresis loop with further increase in thickness of the spacer layer up to 8 nm predicts the co-existence of ferromagnetic (FM) and antiferromagnetic (AFM) exchange interaction between FePt and Fe₃Pt. In addition to this, the out of plane hysteresis loop also shows an asymmetry around H=0. The exchange field Hex = (Hc↑-HC↓)/2, where Hc↑ and Hc↓ are the coercivity estimated from lower and upper branch of hysteresis loop, increases from ~ 150 Oe to ~ 700 Oe respectively. This behavior may be attributed to the uncompensated moments in the hard FePt layer and soft Fe₃Pt layer at the interface. A better insight into the variation in indirect exchange coupling has been investigated using recoil curves. It is observed that the almost closed recoil curves are obtained for ts= 0 nm up to a reverse field of ~ 5 kOe. On the other hand, the appearance of appreciable open recoil curves at lower reverse field ~ 4 kOe for ts = 0.7 nm indicates that uncoupled soft phase undergoes irreversible magnetization reversal at lower reverse field suggesting the weakening of exchange coupling. The openness of recoil curves decreases with increase in thickness of the spacer layer up to 8 nm. This behavior may be attributed to the competition between FM and AFM exchange interactions. The FM exchange coupling between FePt and Fe₃Pt due to porous nature of Al₂O₃ decreases much slower than the weak AFM coupling due to interaction between Fe ions of FePt and Fe₃Pt via O ions of Al₂O₃. The hysteresis loop has been simulated using Monte Carlo based on Metropolis algorithm to investigate the variation in strength of exchange coupling in FePt/Al₂O₃/Fe₃Pt trilayer system.

Keywords: indirect exchange coupling, MH loop, Monte Carlo simulation, recoil curve

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Authors: Alaoui Hamza, Moutacalli Mohamed Tarik, Chebak Ahmed

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The number of people suffering from hemiplegia is growing each year. This lower limb disability affects all the aspects of their lives by taking away their autonomy. This implicates their close relatives, as well as the health system to provide the necessary care they need. The integration of exoskeletons in the medical field became a promising solution to resolve this issue. This paper presents an exoskeleton designed to help hemiplegic people get back the sensation and ability of normal walking. For this purpose, three step models have been created. The first step allows a simple forward movement of the leg. The second method is designed to overcome some obstacles in the patient path, and finally the third step model gives the patient total control over the device. Each of the control methods was designed to offer a solution to the challenges that the patients may face during the walking process.

Keywords: ability of normal walking, exoskeleton, hemiplegic patients, lower limb motion- mechatronics

Procedia PDF Downloads 123

Authors: Chiung-Yun Chang, Po-Chou Chen, Jiun-Shiang Tzeng, Ka-Wai Mac, Chia-Chi Hsiao, Jo-Chi Jao

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This study aimed to measure R2* relaxation rates in the liver of New Zealand White (NZW) rabbits. R2* relaxation rate has been widely used in various hepatic diseases for iron overload by quantifying iron contents in liver. R2* relaxation rate is defined as the reciprocal of T2* relaxation time and mainly depends on the composition of tissue. Different tissues would have different R2* relaxation rates. The signal intensity decay in Magnetic resonance imaging (MRI) may be characterized by R2* relaxation rates. In this study, a 1.5T GE Signa HDxt whole body MR scanner equipped with an 8-channel high resolution knee coil was used to observe R2* values in NZW rabbit’s liver and muscle. Eight healthy NZW rabbits weighted 2 ~ 2.5 kg were recruited. After anesthesia using Zoletil 50 and Rompun 2% mixture, the abdomen of rabbit was landmarked at the center of knee coil to perform 3-plane localizer scan using fast spoiled gradient echo (FSPGR) pulse sequence. Afterward, multi-planar fast gradient echo (MFGR) scans were performed with 8 various echo times (TEs) (2/4/6/8/10/12/14/16 ms) to acquire images for R2* calculations. Regions of interest (ROIs) at liver and muscle were measured using Advantage workstation. Finally, the R2* was obtained by a linear regression of ln(SI) on TE. The results showed that the longer the echo time, the smaller the signal intensity. The R2* values of liver and muscle were 44.8  10.9 s-1 and 37.4  9.5 s-1, respectively. It implies that the iron concentration of liver is higher than that of muscle. In conclusion, R2* is correlated with iron contents in tissue. The correlations between R2* and iron content in NZW rabbit might be valuable for further exploration.

Keywords: liver, magnetic resonance imaging, muscle, R2* relaxation rate

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Authors: Derwin K. C. Chan, Alfred S. Y. Lee

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The integrated model of self-determination theory and the theory of planned behaviour has been successfully applied to explain individuals’ adherence to health behaviours, including behavioural adherence toward rehabilitation. This study was a randomised controlled trial that examined the effectiveness of an mHealth intervention (i.e., mobile application) developed based on this integrated model in promoting treatment adherence of patients of anterior cruciate ligament rupture during their post-surgery home-based rehabilitation period. Subjects were 67 outpatients (aged between 18 and 60) who undertook anterior cruciate ligament (ACL) reconstruction surgery for less than 2 months for this study. Participants were randomly assigned either into the treatment group (who received the smartphone application; N = 32) and control group (who receive standard treatment only; N = 35), and completed psychological measures relating to the theories (e.g., motivations, social cognitive factors, and behavioural adherence) and clinical outcome measures (e.g., subjective knee function (IKDC), laxity (KT-1000), muscle strength (Biodex)) relating to ACL recovery at baseline, 2-month, and 4-month. Generalise estimating equation showed the interaction between group and time was significant on intention was only significant for intention (Wald x² = 5.23, p = .02), that of perceived behavioural control (Wald x² = 3.19, p = .07), behavioural adherence (Wald x² = 3.08, p = .08, and subjective knee evaluation (Wald x² = 2.97, p = .09) were marginally significant. Post-hoc between-subject analysis showed that control group had significant drop of perceived behavioural control (p < .01), subjective norm (p < .01) and intention (p < .01), behavioural adherence (p < .01) from baseline to 4-month, but such pattern was not observed in the treatment group. The treatment group had a significant decrease of behavioural adherence (p < .05) in the 2-month, but such a decrease was not observed in 4-month (p > .05). Although the subjective knee evaluation in both group significantly improved at 2-month and 4-month from the baseline (p < .05), and the improvements in the control group (mean improvement at 4-month = 40.18) were slightly stronger than the treatment group (mean improvement at 4-month = 34.52). In conclusion, the findings showed that the theory driven mobile application ameliorated the decline of treatment intention of home-based rehabilitation. Patients in the treatment group also reported better muscle strength than control group at 4-month follow-up. Overall, the mobile application has shown promises on tackling the problem of orthopaedics outpatients’ non-adherence to medical treatment.

Keywords: self-determination theory, theory of planned behaviour, mobile health, orthopaedic patients

Procedia PDF Downloads 173

Authors: Woolfrey K., Woolfrey M., Bolton C. L., Warchuk D.

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Objectives: Osteoarthritis is the most common joint disease of adults worldwide. Despite total knee arthroplasty (TKA) demonstrating high levels of success, 20% of patients report dissatisfaction with their result. VOXX Wellness Stasis Socks are embedded with a proprietary pattern of neuro-receptor activation points that have been proven to activate a precise neuro-response, according to the pattern theory of haptic perception, which stimulates improvements in pain and function. The use of this technology in TKA patients may prove beneficial as an adjunct to recovery as many patients suffer from deficits to their proprioceptive system caused by ligamentous damage and alterations to mechanoreceptors during the procedure. We hypothesized that VOXX Wellness Stasis Socks are a safe, cost-effective, and easily scalable strategy to support TKA patients through their recovery. Design: Double-blinded, placebo-controlled randomized trial. Participants: Patients scheduled to receive TKA were considered eligible for inclusion in the trial. Interventions: Intervention group (I): VOXX Wellness Stasis socks containing receptor point-activation technology. Control group (C): VOXX Wellness Stasis socks without receptor point-activation technology. Sock use during the waking hours x 6 weeks. Main Outcome Measures: Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire completed at baseline, 2 weeks, and 6 weeks to assess pain, stiffness, and physical function. Results: Data analysis using SPSS software. P-values, effect sizes, and confidence intervals are reported to assess clinical relevance of the finding. Physical status classifications were compared using t-test. Within-subject and between-subject differences in the mean WOMAC were analyzed by ANOVA. Effect size was analyzed using Cramer’s V. Consistent improvement in WOMAC scores for pain and stiffness at 2 weeks post op in the I over the C group. The womac scores assessing physical function showed a consistent improvement at both 2 and 6 weeks post op in the I group compared to C group. Conclusions: VOXX proved to be a low cost, safe intervention in TKA to help patients improve with regard to pain, stiffness, and physical function. Disclosures: None

Keywords: osteoarthritis, RCT, pain management, total knee arthroplasty

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Authors: Nayeli Camacho, Fernanda Lara-Perez, Carolina Ortega-Portilla, Diego G. Espinosa-Arbelaez, Juan M. Alvarado-Orozco, Guillermo C. Mondragon-Rodriguez

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Ultra-high molecular weight polyethylene (UHMWPE) has been the gold standard material for total knee replacements for almost five decades. Wear damage to UHMWPE articulating surface is inevitable due to the natural sliding and rolling movements of the knee. This generates a considerable amount of wear debris, which results in mechanical instability of the joint, reduces joint mobility, increases pain with detrimental biologic responses, and causes component loosening. The presence of wear particles has been closely related to adverse reactions in the knee joint surrounding tissue, especially for particles in the range of 0.3 to 2 μm. Carbon-based materials possess excellent mechanical properties and have shown great promise in tribological applications. In this study, diamond-like carbon coatings (DLC) and carbon nanotubes (CNTs) were used to decrease the wear rate of ultra-high molecular weight polyethylene. A titanium doped DLC (Ti-DLC) was deposited by magnetron sputtering on stainless steel precision spheres while CNTs were used as a second phase reinforcement in UHMWPE at a concentration of 1.25 wt.%. A comparative tribological analysis of the wear of UHMWPE and UHMWPE-CNTs with a stainless steel counterpart with and without Ti-DLC coating is presented. The experimental wear testing was performed on a pin-on-disc tribometer under dry conditions, using a reciprocating movement with a load of 1 N at a frequency of 2 Hz for 100,000 and 200,000 cycles. The wear tracks were analyzed with high-resolution scanning electron microscopy to determine wear modes and observe the size and shape of the wear debris. Furthermore, profilometry was used to study the depth of the wear tracks and to map the wear of the articulating surface. The wear tracks at 100,000 and 200,000 cycles on all samples were relatively shallow, and they were in the range of average roughness. It was observed that the Ti-DLC coating decreases the mass loss in the UHMWPE and the depth of the wear track. The combination of both carbon-based materials decreased the material loss compared to the system of stainless steel and UHMWPE. Burnishing of the surface was the predominant wear mode observed with all the systems, more subtle for the systems with Ti-DLC coatings. Meanwhile, in the system composed of stainless steel-UHMWPE, the intrinsic surface roughness of the material was completely replaced by the wear tracks.

Keywords: CNT reinforcement, self-lubricating materials, Ti-DLC, UHMWPE tribological performance

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Authors: Ophir Segal, Daniel Weltsch, Shay Tenenbaum, Ran Thein

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Purpose: Patients with lateral patellar dislocation (LPD) are not always referred to perform an MRI. This might be the case in first time LPD patients without surgical indications or in patients with recurrent LPD who had MRI in previous episodes. Unfortunately, in some cases, there are additional knee pathological findings, which include tearing of the collateral or cruciate ligaments and injury to the tendons or menisci. These findings might be overlooked during the physical examination or masked by nonspecific clinical findings like knee pain, effusion, or hemarthrosis. The prevalence of these findings, which can be revealed by MRI, is misreported in literature and is considered rare. In our practice, all patients with LPD are sent for MRI after LPD. Therefore, we have designed a retrospective comparative study to evaluate the prevalence of additional pathological findings in patients with acute traumatic LPD that had performed MRI, comparing different groups of patients according to age, sex, and Tibial Tuberosity-Trochlear Groove(TT-TG) distance. Methods: MRI of the knee in patients after traumatic LPD were evaluated for the presence of additional pathological findings such as injuries to ligaments: Anterior/Posterior cruciate ligament(ACL, PCL), Medial/Lateral collateral ligament(MCL, LCL), injuries to tendons(QUADICEPS, PATELLAR), menisci(Medial/Lateral meniscus(MM, LM)) and tibial plateau, by a fellowship-trained, senior musculoskeletal radiologist. A comparison between different groups of patients was performed according to age (age group < 25 years, age group > 25 years), sex (Male/Female group), and TT-TG distance (TT-TG<15 groups, TT-TG>15 groups). A descriptive and comparative statistical analysis was performed. Results: 150 patients were included in this study. All suffered from LPD between the years 2012-2017 (mean age 21.3( ± SD 8.9), 86 males). ACL, PCL, MCL, and LCL complete or partial tears were found in 17(11.3%), 3(2%), 22(14.6%), and 4(2.7%) of the patients, respectively. MM and LM tears were found in 10(6.7%) and 3(2%) of the patients, respectively. A higher prevalence of PCL injury, MM tear, and LM tear were found in the older age group compared to the younger group of patients (10.5% vs. 1.8%, 18.4% vs. 2.7%, and 7.9% vs. 0%, respectively, p<0.05). A higher prevalence of non-displaced MM tear and LCL injury was found in the male group compared to the female group (8.1% vs. 0% and 8.1% vs. 0% respectively, p<0.05). A higher prevalence of ACL injury was found in the normal TT-TG group compared to the pathologic TT-TG group (17.5% vs. 2.3%, p= 0.0184). Conclusions: Overall, 43 out of 150 (28.7%) of the patient's MRI’s were positive for additional pathological radiological findings. Interestingly, a higher prevalence of additional pathologies was found in the groups of patients with a lower risk for recurrent LPD, including males, patients older than 25, and patients with TT-TG lower than 15mm, and therefore might not be referred for an MRI scan. Thus, we recommend a strict physical examination, awareness to the high prevalence of additional pathological findings, and to consider performing an MRI in all patients after LPD.

Keywords: additional findings, lateral patellar dislocation (LPD), MRI scan, traumatic patellar dislocation, cruciate ligaments injuries, menisci injuries, collateral ligaments injuries

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Authors: André Rui Coelho Fernandes, Mariana Rufino, Divakar Hamal, Amr Sousa, Emma Fossett, Kamalpreet Cheema

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Aim: A single patella tendon rupture is relatively uncommon, but a simultaneous bilateral event is a rare occurrence and has been scarcely reviewed in the literature. This review was carried out to analyse the existing literature on this event, with the aim of proposing a standardised approach to the diagnosis and management of this injury. Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three independent reviewers conducted searches in PubMed, OvidSP for Medline and Embase, as well as Cochrane Library using the same search strategy. From a total of 183 studies, 45 were included, i.e. 90 patellas. Results: 46 patellas had a Type 1 Rupture equating to 51%, with Type 3 being the least common, with only 7 patellas sustaining this injury. The mean Insall-Salvio ratio for each knee was 1.62 (R) and 1.60 (L) Direct Primary Repair was the most common surgical technique compared to Tendon Reconstruction, with End to End and Transosseous techniques split almost equally. Brace immobilisation was preferred over cast, with a mean start to weight-bearing of 3.23 weeks post-op. Conclusions: Bilateral patellar tendon rupture is a rare injury that should be considered in patients with knee extensor mechanism disruption. The key limitation of this study was the low number of patients encompassed by the eligible literature. There is space for a higher level of evidence study, specifically regarding surgical treatment choice and methods, as well as post-operative management, which could potentially improve the outcomes in the management of this injury.

Keywords: trauma and orthopaedic surgery, bilateral patella, tendon rupture, trauma

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Authors: Javier De La Torre Costa, Belen Rubio Ballester, Martina Maier, Paul F. M. J. Verschure

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After a stroke, a great number of patients experience persistent motor impairments such as hemiparesis or weakness in one entire side of the body. As a result, the lack of use of the paretic limb might be one of the main contributors to functional loss after clinical discharge. We aim to reverse this cycle by promoting the use of the paretic limb during activities of daily living (ADLs). To do so, we describe the key components of a system that is composed of a wearable bracelet (i.e., a smartwatch) and a mobile phone, designed to bring a set of neurorehabilitation principles that promote acquisition, retention and generalization of skills to the home of the patient. A fundamental question is whether the loss in motor function derived from learned–non–use may emerge as a consequence of decision–making processes for motor optimization. Our system is based on well-established rehabilitation strategies that aim to reverse this behaviour by increasing the reward associated with action execution as well as implicitly reducing the expected cost associated with the use of the paretic limb, following the notion of the reinforcement–induced movement therapy (RIMT). Here we validate an accelerometer–based measure of arm use, and its capacity to discriminate different activities that require increasing movement of the arm. We also show how the system can act as a personalized assistant by providing specific goals and adjusting them depending on the performance of the patients. The usability and acceptance of the device as a rehabilitation tool is tested using a battery of self–reported and objective measurements obtained from acute/subacute patients and healthy controls. We believe that an extension of these technologies will allow for the deployment of unsupervised rehabilitation paradigms during and beyond the hospitalization time.

Keywords: stroke, wearables, learned non use, hemiparesis, ADLs

Procedia PDF Downloads 179