Technology and Health Care - Volume 29, issue 4

Authors: Xu, Shuai | Zhang, Gang | Guo, Jun-Feng | Tan, Ying-Hui

Article Type: Research Article

Abstract: BACKGROUND: The protective role of helmet accessories in moderating stress load generated by explosion shock waves of explosive devices is usually neglected. OBJECTIVE: In the presented study, the protective role of the helmet chinstrap against the impulse and overpressure experienced by the maxillofacial region were examined. METHODS: The explosion shock wave and skull interaction were investigated under three different configurations: (1) unprotected skull, (2) skull with helmet (3) skull with helmet and chinstrap. For this purpose, a 3D finite element model (FEM) was constructed to mimic the investigated biomechanics module. Three working conditions were …set according to different explosive charges and distances to represent different load conditions. Case 1: 500 mg explosive trinitrotoluene (TNT), 3 cm, case 2: 1000 mg TNT, 3 cm, and case 3: 1000 mg TNT and 6 cm distance to the studied object. The explosion effect was discussed by examining the shock wave stress flow pattern. Three points were selected on the skull and the stress curve of each point position were illustrated for each case study. RESULTS: The results showed that the helmet chinstrap can reduce the explosive injuries and plays a protective role in the maxillofacial region, especially for the mandible. Show more

Keywords: Maxillofacial injury, blast wave, finite element method

DOI: 10.3233/THC-202406

Citation: Technology and Health Care, vol. 29, no. 4, pp. 735-747, 2021

Authors: Zhang, Chengjie | Guo, Shuai | Xi, Fengfeng (Jeff)

Article Type: Research Article

Abstract: BACKGROUND: The aging population brings the problem of healthcare and dyskinesia. The lack of mobility extremely affects stroke patient’s activities of daily living (ADL) and decreases their quality of life. To assist these mobility-limited people, a robotic walker is designed to facilitate gait rehabilitation training. OBJECTIVE: The aim of this paper is to present the implementation of a novel motion control method to assist disabled people based on their motion intention. METHODS: The kinematic framework of the robotic walker is outlined. We propose an intention recognition algorithm based on the interactive force signal. …A novel motion control method combined with T-S fuzzy controller and PD controller is proposed. The motion controller can recognize the intention of the user through the interactive force, which allows the user to move or turn around as usual, instead of using their hands to control the walker. RESULTS: Preliminary experiments with healthy individuals and simulated patients are carried out to verify the effectiveness of the algorithm. The results show that the proposed motion control approach can recognize the user’s intention, is easy to control and has a higher precision than the traditional proportional–integral–derivative controller. CONCLUSION: The results show that users could achieve the task with acceptable error, which indicates the potential of the proposed control method for gait training. Show more

Keywords: Motion control, intention recognition, robotic walker, lower rehabilitation robot, stroke, gait training, kinematics, disability, mobility, stroke patients, activities of daily living, quality of life

DOI: 10.3233/THC-202503

Citation: Technology and Health Care, vol. 29, no. 4, pp. 749-769, 2021

Authors: Paniagua Collado, Maria Adela | Willauschus, Maximilian | Rüther, Johannes | Lahner, Matthias | Bail, Hermann Josef | Geßlein, Markus

Article Type: Research Article

Abstract: BACKGROUND: Implant specific complications and outcome for the use of proximal humeral nails in different fracture types are not well described. OBJECTIVE: Evaluation of adverse effects and outcome of patients treated with the new Targon PH+ implant for proximal humeral fractures in a geriatric population. METHODS: A consecutive series of patients from a single institution was retrospectively evaluated. Adverse events (AE) were assessed from patients’ files and during follow-up examination. Current pain level was evaluated using the Visual Analogue Scale (VAS). The disability score of arm, shoulder and hand (DASH) …as well as the Constant-Murley score were assessed. Patient satisfaction was evaluated by questionnaire. RESULTS: Forty-nine patients with a mean age of 72.0 ± 10.0 years were included with a follow-up of 2.2 years. Five patients showed twopart fractures (10%), 24 threepart fractures (50%) and 20 fourpart fractures (40%). Additional shaft fracture occurred in twelve cases (24%). Implant-related AE were recorded in six cases (12%). Pain under strain was moderate with a mean of 27.6 ± 27.1 mm. DASH score showed a mean of 25.9 ± 24.9. Constant score of the affected shoulder was 57 ± 23.8 with a mean difference of 16 points compared to reference shoulder. No significant differences in AE, VAS, DASH or Constant score could be found according to fracture groups. Most patients were satisfied with the surgical outcome (84%). CONCLUSIONS: The Targon PH+ nail demonstrated good functional results and low adverse events in geriatric patients. Additional studies including less experienced centres are required to further evaluate the possible benefits of this implant. Show more

Keywords: Humerus, fracture, implant, nailing, outcome

DOI: 10.3233/THC-202388

Citation: Technology and Health Care, vol. 29, no. 4, pp. 771-780, 2021

Authors: Chaturvedi, Saurabh | Addas, Mohamed Khaled | Alqahtani, Nasser M. | Al Ahmari, Nasser M. | Alfarsi, Mohammed A.

Article Type: Research Article

Abstract: BACKGROUND: Fabrication of complete dentures by computer-aided designing and computer-aided manufacturing (CAD-CAM) techniques are now common. Subtractive and Additive are the two principal CAD-CAM techniques used for this purpose. However, studies that evaluated the occlusal forces by CDs manufactured by these techniques are lacking. OBJECTIVES: To compare the occlusal forces in complete dentures fabricated by additive, subtractive and conventional techniques with different occlusal schemes, using computerized occlusal force analysis system [Tech-Scan III (T-Scan III)]. METHODS: Three groups (Gr) were made on the basis of techniques of fabrication of CDs: Conventional CDs (CCD), Subtractive …CDs (SCD), and Additive CDs (ACD). Each group CDs were further divided into three sub groups based on occlusion schemes: bilateral balanced occlusion (BBO), lingualized occlusion (LO) and mono plane occlusion (MO). A total of 45 CDs were made: 15 in each group with 5 CDs of each occlusal scheme. For all samples, occlusal force analysis (percentage of occlusal force applied on the right and left sides of the arch, centralization of forces and percentage of maximum occlusal force) was done using computerized occlusal analysis system: T-Scan III. Univariate regression analysis and logistic regression analysis were used to find the effects of the technique of fabrication and occlusion scheme over the occlusal forces (p < 0.05). RESULTS: The intergroup comparison revealed statistically significant differences (p < 0.01) in right-left side force difference, maximum bite force in CDs fabricated by various techniques and with different occlusion schemes. Though the effect of occlusion scheme was more than the technique of fabrication (according to effect size estimation). The maximum force difference between right-left side was observed in combination of CCD technique and MO scheme (36.88 ± 2.82 N). Furthermore, the maximum bite force was observed for SCD technique (89.14 ± 6.08 N) and LO scheme (92.17 ± 3.22 N). In comparison to ACD, the chances of centre of force out of ellipse was 2.53 time more in CCS and 0.75 times less in SCD techniques and in comparison to MO, the chances of out of ellipse was 0.298 times less in BBO and 0.396 times less in LO schemes, though these chances were not statistically significant (p > 0.05). CONCLUSIONS: The digital CDs fabricated by subtractive technique were proved to be superior to additive technique in terms of occlusal force analysis on tested parameters. However, further research is needed on patients to determine the exact superiority of one technique over the other. Show more

Keywords: Digital dentures, T-Scan, occlusal forces, milling, 3-D printing

DOI: 10.3233/THC-202736

Citation: Technology and Health Care, vol. 29, no. 4, pp. 781-795, 2021

Authors: Chaturvedi, Saurabh | Addas, Mohamed Khaled | Alqahtani, Nasser M. | Al Ahmari, Nasser M. | Alfarsi, Mohammed A.

Article Type: Research Article

Abstract: BACKGROUND: Digital complete dentures (CDs) by computer-aided designing and computer-aided manufacturing (CAD-CAM) techniques (milling and three-dimensional (3-D) printing) have been evaluated clinically and provided satisfactory results. But clinical studies assessing occlusal forces by digital dentures are lacking. OBJECTIVES: To compare the occlusal force parameters in complete dentures (CDs) fabricated by milling, 3-D printing and conventional techniques having 3 commonly used occlusal schemes, using computerized occlusal force analysis system (Tech-Scan III- T-Scan III). METHODS: A total of 45 CDs were fabricated for 5 patients. Nine sets of CDs were made for each patient and were …divided into 3 groups: Conventional CDs (CCD), Milled CDs (MCD), and 3-D printed CDs (3-DP CD). The CDs in each group were further divided into 3 sub-groups based on occlusion schemes – bilateral balanced (BBO), lingualized (LO) and mono plane (MP). Occlusal force analysis [percentage (%) of occlusal force applied on the right and left sides of the arch difference between them, centralization of forces and % of maximum occlusal/bite force] was done using computerized occlusal analysis system (T-Scan III) at the time of denture insertion. Univariate regression analysis and logistic regression analysis were performed (p < 0.05). RESULTS: The intergroup comparison of force distribution on right and left side in CDs fabricated by various techniques showed insignificant differences (p > 0.05) but statistically significant differences (p < 0.01) were found in right-left side force difference, maximum bite force % and centralization of forces. The maximum force difference on right and left side was observed CCD with MO (37.48 ± 1.03 N) and maximum occlusal-bite force % was observed for 3-DPCD with LO (95.40 ± 1.30 N). In comparison to 3-DP CD, the chances of centre of force out of ellipse (centralization of forces) was 3.36 and 2.15 times more in CCD and MCD techniques made CDs respectively. CONCLUSIONS: The occlusal parameters in CDs were affected by the fabrication techniques and occlusal schemes of CDs. The digital CDs retain adjusted occlusal schemes better and 3-DP CDs with BBO and LO occlusal schemes provided centralization of forces, better distribution and high maximum occlusal force % respectively. Show more

Keywords: Digital dentures, T-Scan, occlusal forces, subtractive technique, additive technique milling, CAD-CAM

DOI: 10.3233/THC-202766

Citation: Technology and Health Care, vol. 29, no. 4, pp. 797-811, 2021

Authors: Lan, Fang-Fang | Gan, Lu

Article Type: Other

Abstract: OBJECTIVE: This is a case study on the application of a piggy-back lens in the correction of severe keratoconus. METHODS: From the results of general eye examination, refractive state examination, and corneal morphology examination on the patient, it was determined that corneal protrusion and deformation of the right eye were obvious. The right eye was corrected using a piggy-back lens and the left eye with a rigid gas-permeable contact lens (RGPCL) alone. RESULTS: The right-eye lens fit well and the lens coverage was good. Both the static and dynamic fit results for the …left-eye lens were good. After wearing the glasses for one month, the patient attended a review and stated that the lenses were comfortable to wear. The patient’s vision was good after wearing the lenses. No obvious congestion was found in the conjunctiva under a slit lamp. The effects on both eyes of wearing RGPCLs were favorable. The corneal curvature reduced and the corneal thickness only changed to a small degree. CONCLUSION: For keratoconus patients, application of a piggy-back lens can improve corrected visual acuity, comfort levels, and safety, prolong the wearing time, and enhance the effect of orthokeratology. Show more

Keywords: Keratoconus, piggy-back lens, corrected visual acuity, orthokeratology (Ortho-K)

DOI: 10.3233/THC-212889

Citation: Technology and Health Care, vol. 29, no. 4, pp. 813-822, 2021

Authors: Zhang, Yibin | Cao, Wujing | Yu, Hongliu | Meng, Qiaoling | Lv, Jie

Article Type: Other

Abstract: BACKGROUND: Gait analysis is important for the lower limb prosthesis design. Simulating the natural motion of the human knee in different terrains is useful for the design and performance assessment of the prosthetic knee. OBJECTIVE: This study aimed to propose a four-bar knee joint measurement system which can simulate the natural knee motions to collect the kinetic parameters precisely and analyze the walking characteristics under different terrain conditions. METHODS: A low-cost four-bar knee joint mechanism was proposed and gait characteristics were assessed on level ground, ascending and descending stairs, and ascending and descending …ramp. RESULTS: The initial knee flexion angle during stair ascent at heel strike is obviously larger than in other walking scenes. The stance phase accounts for 53% of a single gait cycle during stair descent, which is slightly lower than other walking scenarios. The period that both the hindfoot and forefoot contact the ground in ramp descent accounts for 18%, which is less than for the others. While the forefoot contacts the ground in ramp ascent, the maximum vertical ground reaction force of the forefoot occurs when the hindfoot and forefoot simultaneously contact the ground, whereas in other scenarios the forefoot contacts the ground solely. CONCLUSIONS: The four-bar knee joint can simulate the natural motion of the human knee accurately. The gait characteristics analysis of different walking scenarios indicated that the low-cost four-bar knee joint exoskeleton was suitable for human knee joint simulation. Show more

Keywords: Gait analysis, knee joint, different terrains, kinetic parameters

DOI: 10.3233/THC-202667

Citation: Technology and Health Care, vol. 29, no. 4, pp. 823-828, 2021

Authors: Chia, Kau Pui | Li, Ooi Ke | Yuong, Teh Shyong | Singh, Om Prakash | Faudzi, Ahmad Athif Bin Mohd | Sornambikai, Sundaram | Madhanagopal, Jagannathan

Article Type: Other

Abstract: BACKGROUND: Force Monitoring Devices (FMDs) reported in the literature to monitor applied force during Joint Mobilization Technique (JMT) possess complex design/bulky which alters the execution of treatment, has poor accuracy and is unable to feel the resistance provided by soft tissues limits its usage in the clinical settings. OBJECTIVES: This study aims to develop a highly accurate, portable FMD and to demonstrate real-time monitoring of force applied by health professionals during JMT without altering its execution. METHODS: The FMD was constructed using the FlexiForce sensor, potential divider, ATmega 328 microcontroller, custom-written software, and …liquid crystal display. The calibration, accuracy, and cyclic repeatability of the FMD were tested from 0 to 90 N applied load with a gold standard universal testing machine. For practical demonstration, the FMD was tested for monitoring applied force by a physiotherapist while performing Maitland’s grade I to IV over the 6 th cervical vertebra among 30 healthy subjects. RESULTS: The obtained Bland-Altman plot limits agreement for accuracy, and cyclic repeatability was - 1.57 N to 1.22 N, and - 1.26 N to 1.26 N, respectively with standard deviation and standard error of the mean values of 3.77% and 0.73% and 2.15% and 0.23%, respectively. The test-retest reliability of the FMD tested by the same researcher at an interval of one week showed an excellent intra-class correlation coefficient of r = 1.00. The obtained force readings for grade I to IV among 30 subjects ranged from 10.33 N to 45.24 N. CONCLUSIONS: Appreciable performance of the developed FMD suggested that it may be useful to monitor force applied by clinicians during JMT among neck pain subjects and is a useful educational tool for academicians to teach mobilization skills. Show more

Keywords: Force monitoring device, joint mobilization, neck pain, accuracy, reliability

DOI: 10.3233/THC-202414

Citation: Technology and Health Care, vol. 29, no. 4, pp. 829-836, 2021

Authors: Fang, Tao | Cao, Wujing | Chen, Chunjie | Zhang, Yu | Wang, Zhuo | Wu, Xinyu

Article Type: Other

Abstract: BACKGROUND: Population aging is now a universal trend. Many elderly persons can only conduct limited and short time walking because of age-related skeletal muscle decline of the lower limbs. The wearable device for walking assistance is beneficial to improve the life quality of the elderly. OBJECTIVE: This study aimed to propose a soft exosuit for walking assistance of the elderly and verify its feasibility. METHODS: The wearable structure and control strategy were presented. The performance of the soft exosuit was tested by force tracking evaluation and metabolic cost test. RESULTS: …The mean error of the measured and target peak force was 1.1%. The metabolic cost with assistance on while wearing the exosuit was reduced by 9.2% compared with that in locomotion assistance off. The reduction of assistance on was 7.1% compared with no exosuit. CONCLUSIONS: The proposed soft exosuit has the potential to improve the walking efficiency of the elderly. Show more

Keywords: Soft exosuit, walking augment, hip assistance, lower limb exoskeleton

DOI: 10.3233/THC-202423

Citation: Technology and Health Care, vol. 29, no. 4, pp. 837-841, 2021

Authors: Lee, Jung Hwan | Lee, Jae Il | Kim, Dong Hwan | Nam, Kyoung Hyup | Jeon, Tae Jin | Han, In Ho

Article Type: Research Article

Abstract: BACKGROUND: Monitoring patients’ position is important, but there have been few studies related to validation. OBJECTIVE: The objective of this study was to assess the validity of position monitoring measured using a wearable device by comparing the device’s measurements to a patient’s actual position. METHODS: We constructed a wearable device with a three-axis gyroscope and applied it to 10 patients who were unable to change their position independently. We compared the actual angle of the position and the angle transmitted from the wearable device using a Bland-Altman plot and a receiver operating characteristic …curve. RESULTS: We compared the actual angle of the position and the angle transmitted from the wearable device using a Bland-Altman plot, but it was difficult to observe statistical similarity. The angles transmitted from the wearable device in the lateral and supine positions showed significant differences. The cutoff value separating the lateral and supine positions was found to be 27.1 ∘ (sensitivity = 100%, specificity = 99.9%). CONCLUSIONS: Through our method, the measured values from the gyroscope-based wearable device did not accurately reflect the patient’s actual position. However, the wearable device was able to distinguish the lateral position from the supine position. Show more

Keywords: Wearable device, validation, monitoring, position change, patients

DOI: 10.3233/THC-202575

Citation: Technology and Health Care, vol. 29, no. 4, pp. 843-848, 2021