Technology and Health Care - Volume Pre-press, issue Pre-press

Authors: Jung, Jihye | Choi, Wonjae | Lee, Seungwon

Article Type: Research Article

Abstract: BACKGROUND: Symmetry of gait is an important component of rehabilitation in stroke patients. Insufficient weight-bearing causes gait asymmetry. OBJECTIVE: This study aimed to identify the immediate effects of sufficient weight-bearing on the forefoot during the stance phase using visual feedback. METHODS: Twenty-seven individuals with stroke enrolled in this study. All patients were evaluated for gait parameters with and without visual feedback. Visual feedback was provided through a smart application and a beam projector screen that showed a weight shift as a change in color. Spatiotemporal gait parameters were evaluated, resulting in values for …a calculated symmetry index, in addition to heel % and toe % temporal values. RESULTS: Velocity and cadence were significantly decreased when visual feedback was provided (p < 0.05). Spatiotemporal parameters, except for bilateral step length, swing time of affected side, and single-limb support of less affected side, showed significant improvement (p < 0.05). The gait pattern of subjects was more symmetrical with visual feedback compared to non-visual feedback (p < 0.05). The toe-on time significantly improved on the affected side with visual feedback (p < 0.05). CONCLUSION: This study suggests that visual feedback aids in the improvement of gait symmetry, forefoot weight-bearing on the affected side, and spatiotemporal parameters. Show more

Keywords: Biofeedback, gait, weight-bearing, stroke

DOI: 10.3233/THC-192016

Citation: Technology and Health Care, vol. Pre-press, no. Pre-press, pp. 1-9, 2020

Authors: Viglialoro, Rosanna M. | Condino, Sara | Turini, Giuseppe | Mamone, Virginia | Carbone, Marina | Ferrari, Vincenzo | Ghelarducci, Giulia | Ferrari, Mauro | Gesi, Marco

Article Type: Research Article

Abstract: BACKGROUND: Virtual reality is becoming popular in the rehabilitation field thanks to the several advantages it can offer to patients and physicians. Indeed, serious games can: motivate and engage the patient; offer different levels of challenge and difficulty based on the patient baseline, and integrate objective measures of the patient’s performance during each rehabilitation session. OBJECTIVE: We designed and implemented a serious game for shoulder rehabilitation based on real-time hand tracking. The aim was to maintain the medical benefits of traditional rehabilitation, while reducing human resources and costs and facilitating active patient participation. METHODS: …Our software application provides the user with a shoulder horizontal adduction exercise. This exercise takes place in a 2D interactive game environment, controlled by hand movements on a desk pad. The hardware includes a standard desktop computer and screen, and the Leap Motion Controller: a hand tracking system. Changing the desk pad material allows the physiotherapist to vary the friction between the user hand and the supporting surface. RESULTS: Fourteen healthy volunteers and six rehabilitation experts tested our serious game. The results showed that the application is attractive, ergonomic and clinically useful. CONCLUSION: Despite promising results, clinical validation is necessary to demonstrate the efficacy of the serious game. Show more

Keywords: Serious game, virtual rehabilitation, shoulder disorders, Leap Motion Controller

DOI: 10.3233/THC-192081

Citation: Technology and Health Care, vol. Pre-press, no. Pre-press, pp. 1-12, 2020

Authors: Fröschen, Frank Sebastian | Walter, Sebastian Gottfried | Randau, Thomas Martin | Gravius, Nadine | Gravius, Sascha | Hischebeth, Gunnar Thorben Rembert

Article Type: Research Article

Abstract: BACKGROUND: To date only scanty data exist regarding the effect of failed debridement, antibiotics, irrigation and retention of the prostheses (DAIR) and negative pressure wound therapy (NPWT) on the outcome of a subsequent exchange arthroplasty. OBJECTIVE: The objective of this study was to determine the success rate of a two- or multi-stage procedure after initial failed DAIR/NPWT in patients with an acute periprosthetic joint infection (PJI) and to evaluate the influence of possible risk factors for treatment failure. METHODS: Nineteen consecutive patients with a persisting PJI and ongoing NPWT …after treatment of an acute PJI with DAIR of the hip or knee joint from October 2010 to June 2017 were included. All patients were treated according to a structured treatment algorithm after referral to our hospital. The endpoint was a successful reimplantation with absence of signs of infection two years after replantation (“replantation group”) or treatment failure (“treatment failure group”) in terms of a permanent girdlestone arthroplasty, fistula, amputation or death. A risk factor analysis was performed between the two groups. RESULTS: Explantation was performed in 15 cases, amputation in one case, and DAIR/establishment of a fistula in three cases. The treatment success rate after reimplantation in terms of “definitively free of infection” two years after surgery according to Laffer was 36.85% (seven out of 19 patients). Statistical analysis revealed the number of surgeries until wound consolidation (p = 0.007), number of detected bacterial strains (p = 0.041), a polymicrobial PJI (p = 0.041) and detection of a difficult-to-treat organism (p = 0.005) as factors associated with treatment failure. After failed DAIR/NPWT we could detect a significant higher number of different bacterial strains (p = 0.001). CONCLUSIONS: The treatment success rate after failed DAIR and NPWT with 36% is low and associated with a high treatment failure rate (permanent girdlestone arthroplasty, fistula or amputation, death). Thus, the definition of risk factors is crucial. We found that the number of revisions until wound consolidation, a polymicrobial PJI and detection of a difficult-to-treat organisms were risk factors for treatment failure. Furthermore, after failed DAIR/NPWT we could detect a significant higher number of different bacterial strains, with a possible adverse effect on a consecutive exchange. Show more

Keywords: Revision total joint arthroplasty, PJI, NPWT, reimplantation, multi-stage revision, risk factor

DOI: 10.3233/THC-192095

Citation: Technology and Health Care, vol. Pre-press, no. Pre-press, pp. 1-11, 2020

Authors: Kang, Young Sic | Cho, Ki Hun

Article Type: Research Article

Abstract: BACKGROUND: Few quantitative analyses have been performed on muscle activation and gait function according to cane dependence. OBJECTIVE: The purpose of this study was to measure changes in the lower limb muscle activation and gait function according to reduced cane dependence using a weight-bearing feedback cane (WBFC) that had been designed to quantitatively measure cane dependence in stroke patients during walking. METHODS: Twenty-four subjects were recruited from a local rehabilitation hospital. The WBFC measured the average weight support (AWS, kg) loaded on the cane during walking through a Bluetooth connection to laptop software. …All subjects walked 20 m using a WBFC set in the three levels of weight support (WSR, 100%, 60%, and 20%) based on the measured AWS. Paretic lower limb muscle activation and gait function (velocity, cadence, paretic side stride length, and symmetry index) were measured using wireless surface EMG and a 3-axis accelerometer during walking. RESULTS: The paretic side lower limb muscle activation of the 20% WSR on the cane was significantly higher than that of the 100% WSR on the cane (p < 0.05). Gait functions of the 20% WSR on the cane were significantly lower than those of the 100% WSR on the cane (p < 0.05). CONCLUSION: These findings suggest that indiscreet weight support on the cane during walking can interfere with lower limb muscle activation and gait function. Therefore, in a clinical setting, reducing cane dependence during stroke gait training should be carefully considered. Show more

Keywords: Cane dependence, gait, muscle activation, stroke

DOI: 10.3233/THC-192075

Citation: Technology and Health Care, vol. Pre-press, no. Pre-press, pp. 1-9, 2020

Authors: Yoon, Yeong Sook | Hahm, Jarang | Kim, Kwang Ki | Park, Su Kyung | Oh, Sang Woo

Article Type: Other

Abstract: BACKGROUND: Sleep monitoring is essential to maintain a healthy life, especially for the elderly who want to age well. Among various forms of sleep devices, the non-wearable and home-adapted device might be preferred because it can be easily used. OBJECTIVE: In this study, we evaluated the performance of a non-contact home-adapted device compared to polysomnography (PSG), a gold standard method. METHODS: As a preliminary study, eight subjects were recorded over fourteen nights through PSG. The non-contact home-adapted device comprised a microwave sensor, passive infrared sensor, and smartphone application. Through the device, heart rate, …respiratory rate, and body movement were collected and used to estimate sleep stages. Sleep structure was labeled in four classes: wake, REM, light, and deep sleep, and were classified using a weighted k-nearest neighbor algorithm. RESULTS: The device correctly estimated sleep structures with an overall epoch-by-epoch accuracy of 98.65% ± 0.05% based on leave-one-out cross-validation. The device showed significantly positive correlations with PSG in sleep indices including total sleep time, sleep efficiency, and wake after sleep onset. CONCLUSIONS: Our findings demonstrate a good performance of this non-contact and home-adapted device and suggest its suitability for sleep monitoring. Show more

Keywords: Healthy aging, home sleep monitoring, polysomnography, sleep architecture, smart home

DOI: 10.3233/THC-192036

Citation: Technology and Health Care, vol. Pre-press, no. Pre-press, pp. 1-8, 2020

Authors: Wang, Kai | Lu, Chunhua | Ye, Rongju | He, Wen | Wei, Xiating | Li, Yuan | Pan, Xiaolin | Zhao, Cuilian | Yu, Xiang

Article Type: Research Article

Abstract: BACKGROUND: Leg length discrepancy (LLD) can cause abnormal posture, muscle and/or joint pains, which leads to walking difficulties. The common treatment is to use a shoe lift on the shorter leg side, but this has unsatisfying results. OBJECTIVE: Through research and development, we created 3D printing orthotic insoles for LLD patients and aimed to improve their symptoms. METHODS: 1. Research and development of 3D printing orthotic insole: (1) foot scan and data acquisition; (2) insole software modeling; (3) 3D printing insole using TPU materials, and (4) post-processing. 2. Clinical observation: we customized insoles …for LLD patients and required them to wear them while walking. We conducted general inquiries and a functional evaluation before and after 12 weeks of wearing insoles. RESULTS: There are seven complete cases. The joint and lower back pains were alleviated. The stride frequency, stride and pace were improved in all seven cases. Patients’ overall health condition improved significantly. CONCLUSIONS: The 3D printing orthotic insoles are made with clear procedures and practical operability. By wearing insoles, patients’ muscle and/or joint pains were relieved and their gaits were improved. Show more

Keywords: Leg length discrepancy (LLD), pain, gait deviations, 3D printing, orthotic insole

DOI: 10.3233/THC-202170

Citation: Technology and Health Care, vol. Pre-press, no. Pre-press, pp. 1-10, 2020

Authors: Choudhury, Avishek | Perumalla, Sunanda

Article Type: Research Article

Abstract: BACKGROUND: One of the most broadly founded approaches to envisage cancer treatment relies upon a pathologist’s efficiency to visually inspect the appearances of bio-markers on the invasive tumor tissue section. Lately, deep learning techniques have radically enriched the ability of computers to identify objects in images fostering the prospect for fully automated computer-aided diagnosis. Given the noticeable role of nuclear structure in cancer detection, AI’s pattern recognizing ability can expedite the diagnostic process. OBJECTIVE: In this study, we propose and implement an image classification technique to identify breast cancer. METHODS: We implement the …convolutional neural network (CNN) on breast cancer image data set to identify invasive ductal carcinoma (IDC). RESULT: The proposed CNN model after data augmentation yielded 78.4% classification accuracy. 16% of IDC (- ) were predicted incorrectly (false negative) whereas 25% of IDC (+ ) were predicted incorrectly (false positive). CONCLUSION: The results achieved by the proposed approach have shown that it is feasible to employ a convolutional neural network particularly for breast cancer classification tasks. However, a common problem in any artificial intelligence algorithm is its dependence on the data set. Therefore, the performance of the proposed model might not be generalized. Show more

Keywords: Convolutional neural network, deep learning, artificial intelligence, machine learning, breast cancer, ductal carcinoma

DOI: 10.3233/THC-202226

Citation: Technology and Health Care, vol. Pre-press, no. Pre-press, pp. 1-11, 2020

Authors: Wang, Heng Li

Article Type: Short Communication

Abstract: BACKGROUND: The use of transcutaneous electrical stimulation for neuromodulation is an important treatment strategy for functional nerve diseases. It can not only reduce patient pain and prevent the development of drug-resistant disease, but is also more effective than alternative treatment methods. OBJECTIVE: Ag/AgCl electrodes are commonly used for transcutaneous stimulation. However, the silver ions can dissolve in tissue during electrical stimulation, which can lead to heavy metal poisoning and other issues. This study analyzed the amount of residual silver ions found in tissue after electrical stimulation. METHODS: Saline solution and animal skin were …chosen as experimental analogs for human tissue and the amount of residual silver ions were analyzed via ultraviolet spectrophotometer. RESULTS: After a volume-to-quantity conversion, we found that after using a pair of electrodes for three hours, the concentrations of silver ions dissolved in the saline solution and the skin were less than 0.1 ppb and 0.5 ppb, respectively, due to its low solubility. CONCLUSIONS: By analyzing the ion dissolution concentration, we found that the residual silver ion concentration in vivo was less than 0.1 ppb, which is within the safe range for humans. Therefore, we believe it is safe to use Ag/AgCl electrodes for transcutaneous electrical stimulation. Show more

Keywords: Transcutaneous electrical stimulation, neuromodulation, saline experiment, pigskin experiment, Ag ion dissolution concentration

DOI: 10.3233/THC-202192

Citation: Technology and Health Care, vol. Pre-press, no. Pre-press, pp. 1-7, 2020

Authors: Bai, Xue-Shan | Wang, Ming | Cui, Ling-Ling | He, Yu-Wei | Wang, Can | Li, Xin-De | Qu, Xiao-Jie | Sun, Ming-Shu | Li, Chang-Gui

Article Type: Research Article

Abstract: BACKGROUND: Gout is the most common inflammatory arthritis affecting 1.1% of the population in mainland China with a higher prevalence in coastal areas. OBJECTIVE: The purpose of the study was to investigate the clinical outcomes following urate-lowering therapy (ULT) in a real-world group study of primary gout patients in China. METHODS: Electronic medical records of all the gout patients (n = 1588) that visited the Clinical Medical Center of Gout of the Affiliated Hospital of Qingdao University from September 2016 to February 2018 were analyzed in this study. …The patients were treated with a standard treat-to-target (T2T) ULT strategy according to the 2016 EULAR Guidelines. Clinical data were collected in the first visit and one-month (defined as the baseline of ULT), 7-month, and 13-month follow-ups were completed. RESULTS: Amongst the patients in the study, 92.70% accepted ULT and 82.93% completed ULT for 3 months, 63.54% for 6 months, and 40.49% (n = 643) for 12 months. Further analysis of the 643 patients included the following data: the sUA level reduced at month 7 and reduced further at month 13. The gout flares, patient global pain visual analogue score, and health assessment questionnaire score improved at month 7 but did not improve further at month 13, and the index tophus size did not change at month 7 but reduced at month 13. The eGFR deteriorated to below the baseline in month 13 for group A (established) but not for group B (newly-onset). Both the SBP and DBP improved above the baseline at month 13 in group B but not in group A. CONCLUSIONS: The long-term standard treat-to-target ULT strategy benefits patients for both gout-related issues and their extra-articular organs. The current study suggests that there is a better chance to achieve the rates of adherence to ULT and the target of sUA levels in the setting of a dedicated gout clinic. Show more

Keywords: Urate-lowering therapy, gout, real-world, retrospective study, treat-to-target

DOI: 10.3233/THC-191951

Citation: Technology and Health Care, vol. Pre-press, no. Pre-press, pp. 1-11, 2020

Authors: Zhang, Zhihong | Luo, Yingchun | Deng, Xudong | Luo, Weinan

Article Type: Research Article

Abstract: BACKGROUND: Digital image technology has made great progress in the field of foreign body detection and classification, which is of great help to drug purity extraction and impurity analysis and classification. OBJECTIVE: The detection and classification of foreign bodies in lyophilized powder are important. The method which can obtain a higher accuracy of recognition needs to be proposed. METHODS: We used digital image technology to detect and classify foreign bodies in lyophilized powder, and studied the process of image preprocessing, median filtering, Wiener filtering and average filtering balance to better detect and classify …foreign bodies in lyophilized powder. RESULTS: Through industrial small sample data simulation, test results show that in the process of image preprocessing, 3 × 3 median filtering is best. In the aspect of foreign body recognition, the recognition based on principal component analysis (PCA) and support vector machine (SVM) algorithm and the recognition based on PCA and Third-Nearest Neighbor classification algorithm are compared and results show that the PCA+ SVM algorithm is better. CONCLUSION: We demonstrated that integrating PCA and SVM to classify foreign bodies in lyophilized powder. Our proposed method is effective for the prediction of essential proteins. Show more

Keywords: Foreign bodies, median filtering, PCA, SVM

DOI: 10.3233/THC-209020

Citation: Technology and Health Care, vol. Pre-press, no. Pre-press, pp. 1-9, 2020