Technology and Health Care - Volume 22, issue 2

Authors: Mulvey, Matthew | Fawkner, Helen | Johnson, Mark I.

Article Type: Research Article

Abstract: Background: Perceptual embodiment of an artificial limb aids manual control of prostheses and can be facilitated by somatosensory feedback. We hypothesised that transcutaneous electrical nerve stimulation (TENS) may facilitate perceptual embodiment of artificial limbs. Objective: To determine the effect of TENS on perceptual embodiment of an artificial hand in 32 intact-limbed participants. Methods: Participants were exposed to four experimental conditions in four counterbalanced blocks: (i) Vision (V) watching an artificial hand positioned congruently to the real hand (out of view); (ii) Vision and strong non-painful TENS in the real hand (V+T); Vision and Stroking …(V+S) of the artificial and real hand with a brush; Vision, Stroking and TENS (V+S+T) watching artificial hand being stroked whilst real hand was stroked and receiving TENS. Results: Repeated measure ANOVA detected effects for Condition (P < 0.001), Block (P < 0.001) and Condition x Block interaction (P < 0.001). Pairwise comparisons detected more intense perceptual embodiment for V+S+T compared with V (P < 0.001) and V+T (P < 0.001), and for V+S compared with V (P < 0.001) and V+T (P < 0.001).The intensity of perceptual embodiment increased for later blocks (P < 0.001). Conclusions: A sensation of TENS was generated within the artificial hand in individuals with intact limbs and this facilitated perceptual embodiment. The magnitude of effect was modest. Show more

Keywords: Transcutaneous electrical nerve stimulation (TENS), body image, rehabilitation, perceptual embodiment, artificial limb, amputation

DOI: 10.3233/THC-140780

Citation: Technology and Health Care, vol. 22, no. 2, pp. 157-166, 2014

Authors: Sudha, G. Florence | Karthik, S. | Kumar, N. Selva

Article Type: Research Article

Abstract: Background: According to WHO, Cardiovascular diseases are the major cause of death worldwide. Due to the increase in cardiac diseases, miniaturized and energy efficient remote cardiac monitoring systems are required. Objective: To develop an Activity Aware Energy Efficient priority based Multi Patient Monitoring protocol for Body Sensor Networks to monitor physiological signals continuously. The protocol must also be adaptive to allow for new connections and to renegotiate the nodes services. Method: In this protocol, the ECG signals of multiple patients are monitored one after another in a cyclic order. Slots are allotted to each patient …by means of a dynamic TDMA scheme where the slot duration is dependent upon the criticality of the patient. A Network configuration slot is provided at the end of each frame to reconfigure the network. Using the wearer's activity level, the sensor dynamically manages its activities namely, sampling of the ECG sensor, processing of the data, and wireless transmission to minimize overall power consumption. Additional energy efficiency is achieved by assigning priorities to the devices connected in the network and turning them on and off periodically based on their priorities. Results: The protocol is implemented on Shimmer nodes and ECG signals of N patients are monitored. The reconfiguration of the node's priority and sampling rate based on the health condition of the patient are demonstrated. A comparison of energy consumption, packet delivery ratio and battery life time is made. Conclusions: Energy consumption and nodes lifetime are the parameters to be optimized in the case of BSN. The AAEEPMPM protocol for BSN has been designed and implemented in hardware platform for energy efficiency. The results obtained from the BSN shows that this protocol has higher energy efficiency and provides better lifetime for the network. Show more

Keywords: Priority based ECG monitoring, wireless body sensor network, energy efficiency, dynamic TDMA, network configuration slot

DOI: 10.3233/THC-140782

Citation: Technology and Health Care, vol. 22, no. 2, pp. 167-177, 2014

Authors: Saengsuwan, J. | Laubacher, M. | Nef, T. | Hunt, K.J.

Article Type: Research Article

Abstract: Background: Robotics-assisted tilt table technology was introduced for early rehabilitation of neurological patients. It provides cyclical stepping movement and physiological loading of the legs. The aim of the present study was to assess the feasibility of this type of device for peak cardiopulmonary performance testing using able-bodied subjects. Methods: A robotics-assisted tilt table was augmented with force sensors in the thigh cuffs and a work rate estimation algorithm. A custom visual feedback system was employed to guide the subjects' work rate and to provide real time feedback of actual work rate. Feasibility assessment focused on: (i) implementation (technical …feasibility), and (ii) responsiveness (was there a measurable, high-level cardiopulmonary reaction?). For responsiveness testing, each subject carried out an incremental exercise test to the limit of functional capacity with a work rate increment of 5 W/min in female subjects and 8 W/min in males. Results: 11 able-bodied subjects were included (9 male, 2 female; age 29.6 ± 7.1 years: mean ± SD). Resting oxygen uptake (V̇O2 ) was 4.6 ± 0.7 mL/min/kg and V̇O2 peak was 32.4 ± 5.1 mL/min/kg; this mean V̇O2 peak was 81.1% of the predicted peak value for cycle ergometry. Peak heart rate (HRpeak) was 177.5 ± 9.7 beats/min; all subjects reached at least 85% of their predicted HRpeak value. Respiratory exchange ratio (RER) at V̇O2 peak was 1.02 ± 0.07. Peak work rate) was 61.3 ± 15.1 W. All subjects reported a Borg CR10 value for exertion and leg fatigue of 7 or more. Conclusions: The robotics-assisted tilt table is deemed feasible for peak cardiopulmonary performance testing: the approach was found to be technically implementable and substantial cardiopulmonary responses were observed. Further testing in neurologically-impaired subjects is warranted. Show more

Keywords: Rehabilitation, cardiopulmonary performance testing, rehabilitation robotics, tilt table

DOI: 10.3233/THC-140783

Citation: Technology and Health Care, vol. 22, no. 2, pp. 179-187, 2014

Authors: Xu, Anna | Chomutare, Taridzo | Iyengar, Sriram

Article Type: Research Article

Abstract: Background: Low adherence to prescribed medications leads to serious negative health consequences in older adults. Effective interventions that improve adherence are often labor-intensive and complex. However, most studies do not analyze the separate effects of the components. Objective: Persuasive System Design (PSD) is framework that analyzes the motivations that change behavior. In this paper, we aim to apply the model to changing the pill-taking behaviors of the aging population and determine which persuasive elements in interventions drive improvement in medication adherence. Methods: Systematic review using the databases Medline (1977 to February 2012), Cochrane library (2000 …to June 2013); Cinahl (1975 to June 2013), and Psycinfo (2002 to June 2012). Inclusion criteria were experimental trials with participants' mean age ⩾ 60 years and had medication adherence as a primary or secondary measure. Results: Meta-analysis (40 studies) demonstrated a significant association of tailoring, or one-on-one counseling, with medication adherence. Interventions with simulation (showing the causal relationship between non-adherence and negative effects) and rehearsal (miming medication-taking behavior) also showed evidence for improved adherence. Conclusions: Future medication adherence interventions might be more effective if they were based on persuasive technology. Show more

Keywords: Systematic review, older adults, persuasive technology

DOI: 10.3233/THC-140812

Citation: Technology and Health Care, vol. 22, no. 2, pp. 189-198, 2014

Authors: Tripette, Julien | Ando, Takafumi | Murakami, Haruka | Yamamoto, Kenta | Ohkawara, Kazunori | Tanaka, Shigeho | Miyachi, Motohiko

Article Type: Research Article

Abstract: Background: Several active video game (AVG) intervention studies failed in showing an increase in physical activity by using accelerometry measurements. Objective: To test the validity of accelerometry for monitoring AVG playing intensity. Method: Twenty-two adults performed 80 activities included in the Wii Sports and Wii Fit Plus series. The energy expenditure (EE) and subsequent MET values were measured by indirect calorimetry using metabolic chambers. Subjects wore an accelerometer-based monitor displaying MET values. For each activity, METs values obtained from indirect calorimetry and accelerometry were compared. Each activity was classified as light or moderate to …vigorous physical activity (LPA: < 3METs or MVPA: ⩾ 3METs) for the two methods. Results: AVG intensities have been slightly but significantly underestimated by the acceleromater-based monitor compared to the indirect calorimetry (2.5 ± 1.0 instead of 2.7 ± 0.9 METs). Fourty percent of activities have been significantly misestimated, and 20% have been misclassified. Conclusion: Those results point out the potential bias of accelerometry measurements for evaluating AVG intensities. Because average AVG intensity lays at the boundary between LPA and MVPA classes, misclassifications can frequently occur. Accelerometry data should be interpreted with caution in intervention studies using AVG. Show more

Keywords: Exergame, accelerometry, metabolic chamber, energy expenditure, metabolic equivalent

DOI: 10.3233/THC-140817

Citation: Technology and Health Care, vol. 22, no. 2, pp. 199-208, 2014

Authors: Mori, Futoshi | Hanida, Sho | Ohta, Makoto | Matsuzawa, Teruo

Article Type: Research Article

Abstract: Background: Stent placement for cerebral aneurysms leads to a decrease in blood flow. This occurs not only through the direct obstruction of flow but also by the expansion of the parent artery. The latter has been observed in several clinical studies. Objective: The goal of this study was to clarify the effects of parent artery expansion after stent treatment on the following: 1) decrease in blood flow to an aneurysm, 2) wall shear stress (WSS), and 3) oscillatory shear index (OSI). Methods: The parent artery geometry constructed U-shape. The aneurysm location with respect to …the U-shaped parent artery was determined according to previous clinical data. We performed calculations in unsteady-state situations using constructed models. Results: Parent artery expansion with stent reduces blood inflow to an aneurysm and WSS of the aneurysm wall, in addition to increasing OSI. The aneurysm position affects the decrease of the inflow rate and WSS ratio and increases the OSI ratio. Expansion causes the majority of effects on flow reduction inside an aneurysm model. Thus, the expansion effects of all samples should not be neglected. Conclusion: These data suggest that parent artery expansion and its effect should be measured and included in the total decrease in blood flow. Parent artery expansion may induce intimal hyperplasia, thus increasing the thickness of the aneurysm wall. Show more

Keywords: Parent artery, stent, cerebral aneurysm, flow rate, wall shear stress, oscillatory shear index, intimal hyperplasia

DOI: 10.3233/THC-140829

Citation: Technology and Health Care, vol. 22, no. 2, pp. 209-223, 2014

Authors: Zheng, X. | Tang, Y.J. | Ong, S.K. | Nee, A.Y.C.

Article Type: Research Article

Abstract: Adolescent idiopathic scoliosis is a trunk deformity of the spine with lateral deviation and rotation in the transverse plane. The most traditional measurement index and parameter for scoliosis diagnosis is the Cobb's angle, which evaluates the curves of the scoliotic spine on the radiographic projection of the trunk. Although this method is widely accepted as the benchmark in scoliosis assessment, it has some limitations and restrictions in practical applications because it is measured on a PA (posterior-anterior or back to front) X-ray image, such as potential harmfulness from radiation exposure and high cost. In this paper, a novel evaluation …index for adolescent idiopathic scoliosis measurement and diagnosis is introduced to complement the existing assessment index, such as the Cobb's angle, the differences of shoulder height, etc. The new evaluation index is based on the phenomenon of the tilt and deviation of the vertebras in a scoliotic spine, which forms the tilt angles between each pair of adjacent vertebras. A data sample of 30 X-ray images of scoliotic spines was used in this research to evaluate and examine the usability and validity of the new index. The Cobb's angle and the new index were calculated and compared using the same data sample. The correlation between the Cobb's angle and the index was also determined, and a high correlation is found which demonstrated the usefulness of this proposed index. In this paper, it has been shown that the newly-proposed index has the potential to be used as a tool to support the traditional scoliosis measurement methods. This method can also be generalized on the sagittal plane to define other evaluation indices for assessing the severity of kyphosis and lordosis. The idea of using angular separation to evaluate spinal deformity in multiple planes or in three-dimensional spaces will be discussed in future research. Show more

Keywords: Spinal deformity, scoliosis evaluation index, correlation coefficient with Cobb's angle

DOI: 10.3233/THC-140779

Citation: Technology and Health Care, vol. 22, no. 2, pp. 225-241, 2014

Authors: Alam, K. | Silberschmidt, Vadim V.

Article Type: Research Article

Abstract: Background: Bone drilling is widely used in orthopaedics, dental and neurosurgeries for repair and fixation purposes. One of the major concerns in drilling of bone is thermal necrosis that may seriously affect healing at interfaces with fixtures and implants. Ultrasonically-assisted drilling (UAD) is recently introduced as alternative to conventional drilling (CD) to minimize invasiveness of the procedure. Objective: This paper studies temperature rise in bovine cortical bone drilled with CD and UAD techniques and their comparison using infrared thermography. Methods: A parametric investigation was carried out to evaluate effects of drilling conditions (drilling speed …and feed rate) and parameters of ultrasonic vibration (frequency and amplitude) on the temperature elevation in bone. Results: Higher levels of the drilling speed and feed rate were found responsible for generating temperatures above a thermal threshold level in both types of drilling. UAD with frequency below 20 kHz resulted in lower temperature compared to CD with the same drilling parameters. The temperatures generated in cases with vibration frequency exceeding 20 kHz were significantly higher than those in CD for the range of drilling speeds and feed rates. The amplitude of vibration was found to have no significant effect on bone temperature. Conclusions: UAD may be investigated further to explore its benefits over the existing CD techniques. Show more

Keywords: Bone drilling, orthopaedic, ultrasonically-assisted drilling, infrared thermography, thermal necrosis

DOI: 10.3233/THC-140813

Citation: Technology and Health Care, vol. 22, no. 2, pp. 243-252, 2014

Authors: Alam, K. | Ahmed, Naseer | Silberschmidt, V.V.

Article Type: Research Article

Abstract: Background: Bone drilling is a well-known surgical procedure in orthopaedics and dentistry for fracture treatment and reconstruction. Advanced understanding of the mechanics of the drill-bone interaction is necessary to overcome challenges associated with the process and related postoperative complications. Objective: The aim of this study was to explore the benefits of a novel drilling technique, ultrasonically-assisted drilling (UAD), and its possible utilization in orthopaedic surgeries. Methods: The study was performed by conducting experiments to understand the basic mechanics of the drilling process using high speed filming of the drilling zone followed by measurements to …quantify thrust force, surface roughness and cracking of the bone near the immediate vicinity of the hole with and without ultrasonic assistance. Results: Compared to the spiral chips produced during conventional drilling (CD), UAD was found to break the chips in small pieces which facilitated their fast evacuation from the cutting region. In UAD, lower drilling force and better surface roughness was measured in drilling in the radial and longitudinal axis of the bone. UAD produced crack-free holes which will enhance postoperative performance of fixative devices anchoring the bone. Conclusions: UAD may be used as a possible substitute for CD in orthopaedic clinics. Show more

Keywords: Bone drilling, ultrasonic vibrations, chip formation, drilling force, surface roughness, computed tomography

DOI: 10.3233/THC-140814

Citation: Technology and Health Care, vol. 22, no. 2, pp. 253-262, 2014

Authors: Radtke, Kerstin | Ettinger, Max | Heidgen, Henrik | Floerkemeier, Thilo | Noll, Yvonne | Stukenborg-Colsman, Christina | Windhagen, Henning | von Lewinski, Gabriela

Article Type: Research Article

Abstract: Background: Resurfacing Arthroplasty (RA) of the hip has undergone resurgence with initially mainly good clinical results in young patients. It was mainly performed in younger more active patients with severe symptomatic arthritis of the hip including pelvic deformity. Furthermore the proximal femoral anatomy was preserved for surgical procedures in the future. Objective: The aim of the study was to perform a prospective review of the very first 85 hips that had implantation of one cementless resurfacing system and a mean follow up of 5 years. Methods: 85 cementless Total Hip Resurfacing devices have been performed …in 75 patients in our orthopaedic department. The mean age of the study group was 49.8 years. Harries Hip Score, clinical examination data and radiographic parameters including the neck shaft angle (NSA), stem shaft angle (SSA) and detection of radiolucencies were analyzed. Results: Estimated implant survival at five years of follow-up was 88.2% at 5 years follow-up using revision for all causes as the end point. Mean HHS was 92.5 (range 80–100) five years after Resurfacing Arthroplasty. Conclusions: In conclusion we have to admit, that there was a high proportion of failed hip resurfacings but in the proportion that succeeded we saw good clinical results. Show more

Keywords: Total hip resurfacing, Resurfacing Arthroplasty (RA), clinical results

DOI: 10.3233/THC-140820

Citation: Technology and Health Care, vol. 22, no. 2, pp. 263-272, 2014

Authors: Fang, Juan | Vuckovic, Aleksandra | Galen, Sujay | Cossar, Calum | Conway, Bernard A. | Hunt, Kenneth J.

Article Type: Research Article

Abstract: Background: Rehabilitation of walking should start early after injury to maximise the beneficial effects of gait restoration. Most current gait robotic systems are not suitable for patients who cannot maintain an upright position. Objective: This study aimed to develop a prototype to test a supine-stepping system for early rehabilitation of walking. Methods: Based on the pendulum model of walking, a supine-stepping system was designed through control of the toe and the ankle trajectories. This study implemented the pendulum concept of walking in a functional prototype including a bar-cam mechanism and a foot platform that makes …it possible to perform stepping while lying in a supine position. The kinematics of supine stepping produced by the bar-cam prototype were firstly simulated by a corresponding bar-cam model in Matlab/Simmechanics, then investigated through a preliminary test using an empty leg frame, and lastly by tests on three able-bodied subjects. The experimental results from the bar-cam prototype were compared with the computer simulation results. Furthermore, supine stepping of one subject was compared with his performance during overground walking. Results: The lower extremity kinematics produced while performing stepping using the prototype matched the corresponding simulation results as well as the performance during overground walking. Conclusions: This study demonstrated the technical feasibility of implementing the pendulum concept in a gait orthosis for early rehabilitation of walking. Show more

Keywords: Gait robotics, supine stepping, early rehabilitation of walking

DOI: 10.3233/THC-140821

Citation: Technology and Health Care, vol. 22, no. 2, pp. 273-288, 2014

Authors: Hawi, Nael | Liodakis, Emmanouil | Musolli, Daut | Suero, Eduardo M. | Stuebig, Timo | Claassen, Leif | Kleiner, Carsten | Krettek, Christian | Ahlers, Volker | Citak, Musa

Article Type: Research Article

Abstract: Background: Motion sensing input devices could provide a practical and low-cost alternative method for repeated range of motion measurements. This study aimed to assess the reliability, accuracy and time requirements of a motion sensing input device (Microsoft Kinect) for ROM measurements comparing it with goniometer based measurements and subjective estimation. Material and methods: Full ROM was measured in 14 shoulder and elbow joints using the different methods. The order was randomly selected and each movement was measured twice. The results were recorded in degrees and the time measured in seconds. Results: In general, there …was a poor to moderate agreement between the Kinect system compared to the goniometer. There was a good agreement between the goniometer-based and the subjective technique. The Kinect-based technique showed excellent test-retest reliability. Conclusion: The Kinect system showed good test-retest reliability, but lower accuracy compared to goniometer-based measurements. Improvements in patient positioning and measurement protocol standardization must be made before its implementation in clinical practice. Show more

Keywords: Motion detection, Kinect®, range of motion (ROM), goniometer

DOI: 10.3233/THC-140831

Citation: Technology and Health Care, vol. 22, no. 2, pp. 289-295, 2014

Authors: Ogawa, Yoshikazu | Nakata, Yusuke | Tominaga, Teiji

Article Type: Research Article

Abstract: Background: Modern medical management requires constant quality improvement of the various instruments used for surgical procedures. Higher quality, less complicated handling, and reduced maintenance are all desirable qualities. However, any improvements in instrumentation require that surgeons must clearly understand the application of the device by adherence to the manufacturer's instructions. The weakness of this one-way information flow depends on the low interest among medical personnel for post-purchase reassessment. Objective: Service industries have research departments to investigate the post-purchase behavior of customers, and service recovery is considered essential to retain customers after service failure. All service providers can …suffer service failures, and even the best providers may make errors in delivering service. Such an approach has been increasingly adopted in the risk management at medical institutions. Methods: We report our clinical trials of the post-purchase reassessment and product improvement of surgical instrumentation. Medical personnel reassessed the use of a newly developed endoscope holder based on the manufacturer's manual and made recommendations for possible improvements, which were examined by the manufacturer. Results: Simple but important improvement was achieved for reducing the instability and uncertainty of instrument fixation. Conclusion: This bi-directional post-purchase communication between medical personnel and manufacturers can improve risk management in medical institutions. Show more

Keywords: Improvement, medical device, physician-manufacturer communication, post-purchase, reassessment

DOI: 10.3233/THC-140781

Citation: Technology and Health Care, vol. 22, no. 2, pp. 297-301, 2014