Purpose : The purpose of the pilot service was to establish the potential of the newly developed system to achieve, in a community setting, more effective orthotic outcomes for patients in whom ...alignment of ground reaction force is an important treatment objective. Methods : Twelve visits were arranged to a paediatric community physiotherapy department. Up to six patients at each visit were selected for assessment of their lower limb orthotic prescription. The patient's gait was assessed using the video vector generator to determine alignment of ground reaction force. Where necessary, adjustments to the orthotic set-up were made to achieve more closely the stated objective. At the conclusion a specification of the orthosis was agreed. Results : In only two of 61 assessments that were conducted was it not possible to achieve a useful outcome. Conclusions : Improvements in biomechanical alignment were achieved in more than 68% of assessments. The pilot service was sufficiently successful for it to be extended to a routine clinical service.
Purpose. The purpose of this study was to demonstrate the feasibility of producing an orthotic knee joint that could lock and unlock during ambulation for eventual use in a reciprocating gait ...orthosis (RGO) for severely disabled patients.
Method. Three prototype orthotic knee joints incorporating braking mechanisms were designed and manufactured to demonstrate their ability to withstand a maximum calculated sagittal plane bending moment of 73 Nm. Each was then subjected to bench trials to test their performance against the required specification.
Results. Although all three joints achieved the requirement to sustain the specified externally applied bending moments, the hydraulic disc brake system proved significantly superior and was selected for more comprehensive testing.
Conclusions. The results confirmed the feasibility of utilising a hydraulic braking mechanism within an orthotic knee joint to withstand the knee flexing moments during walking in a lower limb orthosis. This gave the development group confidence to progress to the prototype design phase with the specific aim of eventually incorporating such a joint in an RGO designed for severely disabled patients such as those with complete paraplegia up to level T4 and those with severe neurological dysfunction.
Cystic fibrosis (CF) is characterized by chronic respiratory infections which progressively decrease lung function over time. Affected individuals experience episodes of intensified respiratory ...symptoms called pulmonary exacerbations (PEx), which in turn accelerate pulmonary function decline and decrease survival rate. An overarching challenge is that there is no standard classification for PEx, which results in treatments that are heterogeneous. Improving PEx classification and management is a significant research priority for people with CF. Previous studies have shown volatile organic compounds (VOCs) in exhaled breath can be used as biomarkers because they are products of metabolic pathways dysregulated by different diseases. To provide insights on PEx classification and other CF clinical factors, exhaled breath samples were collected from 18 subjects with CF, with some experiencing PEx and others serving as a baseline. Exhaled breath was collected in Tedlar bags during tidal breathing and cryotransferred to headspace vials for VOC analysis by solid phase microextraction coupled to gas chromatography-mass spectrometry. Statistical significance testing between quantitative and categorical clinical variables displayed percent-predicted forced expiratory volume in one second (FEV1pp) was decreased in subjects experiencing PEx. VOCs correlating with other clinical variables (body mass index, age, use of highly effective modulator treatment (HEMT), and the need for inhaled tobramycin) were also explored. Two volatile aldehydes (octanal and nonanal) were upregulated in patients not taking the HEMT. VOCs correlating to potential confounding variables were removed and then analyzed by regression for significant correlations with FEV1pp measurements. Interestingly, the VOC with the highest correlation with FEV1pp (3,7-dimethyldecane) also gave the lowest
-value when comparing subjects at baseline and during PEx. Other VOCs that were differentially expressed due to PEx that were identified in this study include durene, 2,4,4-trimethyl-1,3-pentanediol 1-isobutyrate and 5-methyltridecane. Receiver operator characteristic curves were developed and showed 3,7-dimethyldecane had higher ability to classify PEx (area under the curve (AUC) = 0.91) relative to FEV1pp values at collection (AUC = 0.83). However, normalized ΔFEV1pp values had the highest capability to distinguish PEx (AUC = 0.93). These results show that VOCs in exhaled breath may be a rich source of biomarkers for various clinical traits of CF, including PEx, that should be explored in larger sample cohorts and validation studies.
We report on the polarization selection rules of inter-Landau-level transitions using reflection-type optical Hall effect measurements from 600 to 4000 cm(-1) on epitaxial graphene grown by thermal ...decomposition of silicon carbide. We observe symmetric and antisymmetric signatures in our data due to polarization preserving and polarization mixing inter-Landau-level transitions, respectively. From field-dependent measurements, we identify that transitions in coupled graphene monolayers are governed by polarization mixing selection rules, whereas transitions in decoupled graphene monolayers are governed by polarization preserving selection rules. The selection rules may find explanation by different coupling mechanisms of inter-Landau-level transitions with free charge carrier magneto-optic plasma oscillations.
Reciprocal walking orthoses are routinely used by thoracic lesion patients for ambulation using crutches. A primary reason for their prescription is to provide therapeutic benefit and improved ...independence. To achieve this, maximum efficiency of walking and acceptance of the device is necessary to promote long-term compliance. Lateral rigidity in the orthosis influences walking efficiency, but the structural properties of conventional techniques for producing a sufficiently rigid body brace makes them unattractive. Currently patients and clinicians are forced to choose between greater efficiency or cosmesis of the orthosis. Composite materials have the potential to permit the required rigidity in a structure that is less obtrusive. However, their material properties could lead to unsafe forms of failure unless suitable manufacturing methods are devised. It is therefore inappropriate to supply prototypes to patients for field evaluation until laboratory investigation of innovative production methods has ensured that the orthosis is safe. A production technique has been devised that is ostensibly suitable. Prototype body braces have been tested and have been shown to have improved structural properties and safe failure modes. A test programme implemented on a complete concept orthosis has confirmed that improved lateral rigidity can be achieved with a less obtrusive body brace, and that it will behave safely for long enough to permit field evaluation.
A rehabilitation device data logging system Miller, K.; Woollam, P. J.; Powell, G. ...
Disability and rehabilitation: Assistive technology,
2007, Letnik:
2, Številka:
1
Journal Article
Recenzirano
Purpose. The difficulty of recording service history of rehabilitation devices makes it impractical for prescribing centres to monitor treatment effectively, or implement maintenance and replacement ...policies that permit safety and economic viability to be fully complementary. An approach to providing such a facility has been investigated, so that specified treatment can be monitored or device replacement matched to the functional activity of the patient.
Methods. A two-channel data logger has been developed that can record, over periods in excess of 12 months, information in an event-monitoring channel; and in the second channel a varying analogue signal at the time an event occurs. In addition a downloading interface allows data to be transferred and then processed in a personal computer during a routine patient visit.
Results. Laboratory testing demonstrated that the system recorded events accurately. Field trials verified a battery life exceeding 12 months for continuous routine monitoring of twice daily orthosis application in the event logging channel. The analogue channel was tested by applying known signals to the logger at the time events were monitored, and comparing the output to the input signal.
Outcome. The feasibility of routinely monitoring the use of rehabilitation devices was successfully demonstrated and production development is now being undertaken.
Rear support walking frames provide predetermined vertical support for patients with dysfunctional lower limbs that have limited active control; the support is provided through a spring-loaded boom ...hinged on an upright stanchion mounted at the rear of a wheeled frame within which the patient ambulates. The application of these frames for total-body-involved cerebral palsy patients, in combination with a walking orthosis, has highlighted a number of practical problems that need to be addressed for the system to become fully viable. A composite material prototype walking frame has been developed that permits the patient to be transferred by a single carer without the need to use inappropriate manual handling techniques. The frame has improved structural properties, with stiffness in the sagittal and coronal planes increasing by between 50 and 100 per cent. Evaluation with patients showed that the greater structural stiffness permitted the objective of improved continuity of walking to be achieved. The strength of the frame is such that it can accommodate patients of up to 80 kg, more than twice that possible in the earlier system. Since the structural yield point is approximately twice the maximum working load, the device should not be prone to unacceptable fatigue characteristics. Despite the use of carbon composite materials (which have brittle failure characteristics), the mode of failure is of progressive collapse and is therefore inherently safe. The successful outcome of prototype testing has justified production development. Work is now proceeding on a design that incorporates further improvements in structural performance and ease of manufacture.
Ambulation for patients with total body involved cerebral palsy poses greater problems than those encountered in providing reciprocal walking for thoracic lesion paraplegic subjects. Experience with ...a prototype system showed that an orthosis which controls the movement of the lower limbs, in combination with a walking frame giving anterior support, enables such patients to walk. Despite shortcomings which restricted the use of the system to an indoor environment it provided a sound basis on which to examine walking frames to address the problems which had been identified. A review of these devices showed that the most effective means of achieving this aim is the use of a wheeled walking frame which provides vertical support and truncal alignment via a sprung pantograph mounted to the rear of the patient (rear support walking frames). Trials were conducted with two existing rear support walking frames. These indicated their potential for severely disabled patients, but also identified the need for higher stiffness in the structure and more sensitive control of vertical support to be achieved if effective ambulation in a wider range of environments was to be made possible for the target group. Prototypes based on an existing frame, which took account of the specification requirements, were produced for four new total body involved cerebral palsy patients with the same degree of walking dysfunction. Three of the patients were able to walk in a much wider variety of environments than any patient in the original system. A number of other issues related to transfer and steering were identified as requiring further development.
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