The effect of an isocentric reciprocating gait orthosis incorporating an active knee mechanism on the gait of a spinal cord injury patient: A single case study

Objective: The aim of this study was to identify the effect of induced knee flexion during gait on the kinematics and temporal-spatial parameters during walking by a patient with spinal cord injury (SCI) through the application of an isocentric reciprocating gait orthosis (IRGO) with a powered knee mechanism.

Methods: Two orthoses were considered and evaluated for an ISCI subject with a T8 level of injury. An IRGO was initially manufactured by incorporating drop lock knee joints and was fabricated with custom molded AFOs to block ankle motion. This orthosis was also adapted with electrically-activated knee joints to provide active knee extension and flexion when disengaged.

Results: Walking speed, stride length and cadence were increased 37.5%, 11% and 26%, respectively with the new orthosis as compared to using the IRGO. The vertical and horizontal compensatory motions reduced compared to mechanical IRGO. At end of stance phase, knee joint flexion was 37.5° for the AKIRGO compared to 7° of movement when walking with the IRGO. The overall pattern of walking produced was comparable to that of normal human walking.

Conclusion: Knee flexion during swing phase resulted in an improved gait performance and also reduction in compensatory motions when compared to a mechanical IRGO.

Implications for Rehabilitation

• Powered orthosis could be used by spinal cord injury subjects.

• A major advantage of this new orthotic mechanism was regeneration of knee movement closer to that of normal human walking.

• The IRGO with a powered knee joint mechanism improved the speed of walking, step length, cadence and vertical displacement in a spinal cord injury patient which also produced near-normal knee joint angle patterns during gait.

     

Exoskeletons' design and usefulness evidence according to a systematic review of lower limb exoskeletons used for functional mobility by people with spinal cord injury

Purpose: Rehabilitation professionals have little information concerning lower limb exoskeletons for people with paraplegia. This study has four objectives: (1) Outline the characteristics of the exoskeletons’ design and their usefulness evidence as assistive mobility devices in the community for the Rewalk?, Mina, Indego®, Ekso? (previously known as the eLEGS?) and Rex®; (2) document functional mobility outcomes of using these exoskeletons; (3) document secondary skills and benefits achieved with these exoskeletons, safety, user satisfaction and applicability in the community; and (4) establish level of scientific evidence of the selected studies. Method: A systematic review of the literature (January 2004 to April 2014) was done using the databases PubMed, CINAHL and Embase and groups of keywords associated with “exoskeleton”, “lower limb” and “paraplegia”. Results: Seven articles were selected. Exoskeleton use is effective for walking in a laboratory but there are no training protocols to modify identified outcomes over the term usage (ReWalk?: 3 months, Mina: 2 months and Indego®: 1 session). Levels of evidence of selected papers are low. Conclusions: The applicability and effectiveness of lower limb exoskeletons as assistive devices in the community have not been demonstrated. More research is needed on walking performance with these exoskeletons compared to other mobility devices and other training contexts in the community.

• Implications for rehabilitation

• Characteristics of the exoskeletons’ design and their usefulness evidence as assistive mobility devices in the community are addressed for the Rewalk?, Mina, Indego®, Ekso? and Rex® ReWalk?, Indego® and Mina lower limb exoskeletons are effective for walking in a laboratory for individuals with complete lower-level SCI.

• The ReWalk? has the best results for walking, with a maximum speed of 0.51 m/s after 45 sessions lasting 60 to 120 min; it is comparable to the average speed per day or per week in a manual wheelchair.

• The level of scientific evidence is low. Other studies are needed to provide more information about performance over the longer term when walking with an exoskeleton, compared to wheelchair mobility, the user’s usual locomotion, the use of different exoskeletons or the training context in which the exoskeleton is used.

     

1996 RESNA/Whitaker Student Scientific Paper Competition

A national survey of providers of pediatric powered wheelchairs was conducted to collect background data on these professionals and to develop a “model” of their current assessment and recommendation practices. Data collected in the survey included provider demographics, frequency of powered wheelchair provision to young children, common reasons for not recommending a powered wheelchair, reasons why a child who is recommended a powered wheelchair does not receive one, current pediatric powered wheelchair assessment and recommendation practices, and subjective data regarding the efficacy of these practices and the impact of powered wheelchairs on children. Respondents rated the frequency with which they performed various wheelchair assessment and recommendation practices, and these ratings were analyzed to determine activities that were performed frequently. These activities were then combined into common “factors” using factor analysis, and the results of the factor analysis were used to create a model of current pediatric powered wheelchair assessment and recommendation practices. A total of 140 surveys were received from providers in 46 states. Of these providers, 54% were clinicians (e.g., physical therapists, occupational therapists), and 46% were suppliers (e.g., Rehabilitation Technology Specialists), representing a variety of geographic locations and facility types. The 3 major reasons for not recommending a powered wheelchair included cognitive, physical, and behavioral factors. The 3 major reasons why a child who is recommended a powered wheelchair does not receive one included funding issues, lack of family support, and transportation issues. The model of current pediatric powered wheelchair provision includes 4 assessment factors: Preliminary Clinical Assessment, Intake, Advanced Clinical Assessment, and Consideration of Other Factors. Typical recommendations include both therapeutic and nonclinical interventions. A modified version of this model, which addresses some issues identified in the survey that limit wheelchair recommendations, is currently being tested at 4 clinical sites.     

支撑喉镜下电动吸割器行小儿喉乳头状瘤切除术

目的 探讨支撑喉镜下电动吸割器在小儿喉乳头状瘤切除术中的应用价值.方法 应用支撑喉镜下电动吸割器对25例小儿喉乳头状瘤患者进行手术治疗.结果 25例患者小儿喉乳头状瘤均手术成功,无严重并发症,症状明显减轻或消失,随访1～3年,20例无复发,5例复发,予以再次手术,现随访暂无复发.结论 支撑喉镜下电动吸割器行小儿喉乳头状瘤切除术具有视野清晰、病变切除彻底、损伤小及复发率低等优点,值得临床推广应用.     

Stakeholder views addressing the development and uptake of powered wheelchair assistive technology

Purpose: The objective of this research is to identify stakeholder views with regard to the development of effective powered wheelchair assistive technologies more suited to the user and carer needs, whilst also meeting the requirements for other stakeholders, such that developers can be better guided towards producing solutions which have a better chance of getting to the market place and hence to the end user.

Method: A questionnaire was designed to collect the views of all stakeholders and circulated to a statistically representative number of them. The question rating data were then checked for correlation between groups, and within groups, to establish validity.

Results: The 74 stakeholders across the eight classes who responded had a good correlation between each other, with a cross class “Pearson’s correlation” ranging between 0.7 and 0.95, and the “Fleiss’s Kappa reliability of agreement” within each class ranging between 0.07 and 0.36.

Conclusions: This research has identified that all stakeholders should be involved in the development of the technology and that some may benefit in 'role-reversal' to help understand user problems and stakeholder concerns more clearly. Cost was a significant barrier to the uptake of appropriate technology, and training of users and carers was a major issue. Furthermore, development should not increase user isolation and the impact on the user must be monitored for 'quality of life'. Technical support and training should be given to the user and their carers, and equipment must be adaptive to meet the changing needs of the user.

• Implications for Rehabilitation

• Improved acceptance and use of technology by the user and their carers.

• Reduced rejection of appropriate provision.

• Improved mobility and interaction with others.

• Improved quality of life for users and carers.

     

腔内射频闭合联合旋切微创治疗下肢静脉曲张的临床疗效观察

目的 介绍并评价血管内射频闭合方法联合旋切术微创治疗下肢静脉曲张的疗效。方法 采用此种方法治疗患者共65例、75条患肢，其中男性39例，女性26例，年龄26-76岁，平均55.6岁；按CEAP分类法，所有患者均为C2-C4级。结果 所有患者治疗后均未发生深静脉血栓、皮肤烧伤或肺栓塞等严重并发症，随访1-10月，元复发。大隐静脉主干经血管腔内射频消融治疗后均闭合，联合旋切术后下肢静脉曲张均临床治愈。结论 腔内射频闭合联合旋切微创治疗是一种的治疗下肢静脉曲张的方法，术式简单，手术时间短，创伤小，治疗彻底且疗效确切。     

The Ventricular-Synchronous, Skeletal-Muscle Ventricle: Preliminary Feasibility Studies

The two requirements for the optimal use of skeletal muscle wrapped around a pouch used to pump blood are.(1) a low poucli diastolic pressure (to assure a iiigh musde capillary blood flow; and (2) a high pouch precontraction pressure (PCP) (to assure a forceful muscle contraction). Both requirements are satisfied with the pumping method described herein. This new type of skeletal-muscle ventricle (SMV) consists of a rectus abdominis muscle wrapped around a pouch connected to the left ventricular apex (with no valve) and to the aorta via a one-way valve. Consequently, the pressure in the SMV pouch is always equal to left ventricular pressure. The high PCP is obtained by stimulating the rectus muscle to contract tt the desired left ventricular pressure. The R (or P) wave of the cardiac electrogram initiates a delayed train of stimuli to cause the rectus muscle to contract tetanically and expel Wood from the pouch. We have designated this pumping configuration the ventricular-synchronous SMV (VS-SMV). In this study, eight ucute anesthetized dogs were used. The muscles were unconditioned and among the items investigated were the importance of the delay (d) between the R (or P) wave and the onset of the stimulus train, the optimal stimulus frequency and train duration, the VS-SMV output with different ratios of VS-SMV to left ventricular contractions, unloading of the left ventricle, Frank-Starling curves for the VS-SMV, pressure-volume loopsforthe VS-SMV with and without contraction of the rectus muscle, and washout characteristics of the VS-SMV. It was found that a stimulus frequency of 40/sec. and a train duration of 250 msec is optimal. It was also found that choice of the proper delay from the R or P wave provided maximal augmentation in stroke volume, typically 20 to 40 mL. Pumping with a ratio of 1:2 provided VS-SMV outputs ranging from 20 to 140 mL/min per kg of body weight. With this same pumping ratio, cardiac output increased by 28% and the post-VS-SMV contraction, left ventricular stroke volume was reduced. The Frank-Starling curves showed that PCPs on the order of aortic pressure are needed for the most forceful muscle contraction. With this new pumping configuration, the left ventricle resembles an atrium which delivers blood to the VS-SMV that is stimulated to contract when the desired PCP is reached. Studies were also conducted in which the VS-SMV outlet (valve end) was closed and filling and emptying occurred through the left ventricle. Saline washout studies were performed to determine the emptying characteristics with and without pumping using the closed-end pouch. A typical emptying was 50% for five VS-SMV contractions with the muscle contracting. However, even without the muscle contracting, there was washout due to the compliant recoil of the pouch which was stretched during ventricular systole. Essentially the same pumping performance was obtained with the closed-end mode of operation.     

An electric tooth pulp vitality tester

A simple battery-powered constant-current pulse generator able to supply up to 200 μA at a maximum of 250 V is described. The tester incorporates a battery status indicator and an overload, incorrect operation and fault condition audible alarm. A simple test routine helps to ensure that the instrument is operating correctly before each application. For enhanced patient co-operation and comfort the tester is activated by the patient.