Connected healthcare: Improving patient care using digital health technologies

Now more than ever, traditional healthcare models are being overhauled with digital technologies of Healthcare 4.0 being increasingly adopted. Worldwide, digital devices are improving every stage of the patient care pathway. For one, sensors are being used to monitor patient metrics 24/7, permitting swift diagnosis and interventions. At the treatment stage, 3D printers are currently being investigated for the concept of personalised medicine by allowing patients access to on-demand, customisable therapeutics. Robots are also being explored for treatment, by empowering precision surgery or targeted drug delivery. Within medical logistics, drones are being leveraged to deliver critical treatments to remote areas, collect samples, and even provide emergency aid. To enable seamless integration within healthcare, the Internet of Things technology is being exploited to form closed-loop systems that remotely communicate with one another. This review outlines the most promising healthcare technologies and devices, their strengths, drawbacks, and scopes for clinical adoption

AN INVESTIGATION OF ELECTROMYOGRAPHIC (EMG) CONTROL OF DEXTROUS HAND PROSTHESES FOR TRANSRADIAL AMPUTEES

In reference to IEEE copyrighted material which is used with permission in this thesis, the IEEE does not endorse any of Plymouth University's products or services.There are many amputees around the world who have lost a limb through conflict, disease or an accident. Upper-limb prostheses controlled using surface Electromyography (sEMG) offer a solution to help the amputees; however, their functionality is limited by the small number of movements they can perform and their slow reaction times. Pattern recognition (PR)-based EMG control has been proposed to improve the functional performance of prostheses. It is a very promising approach, offering intuitive control, fast reaction times and the ability to control a large number of degrees of freedom (DOF). However, prostheses controlled with PR systems are not available for everyday use by amputees, because there are many major challenges and practical problems that need to be addressed before clinical implementation is possible. These include lack of individual finger control, an impractically large number of EMG electrodes, and the lack of deployment protocols for EMG electrodes site selection and movement optimisation. Moreover, the inability of PR systems to handle multiple forces is a further practical problem that needs to be addressed. The main aim of this project is to investigate the research challenges mentioned above via non-invasive EMG signal acquisition, and to propose practical solutions to help amputees. In a series of experiments, the PR systems presented here were tested with EMG signals acquired from seven transradial amputees, which is unique to this project. Previous studies have been conducted using non-amputees. In this work, the challenges described are addressed and a new protocol is proposed that delivers a fast clinical deployment of multi-functional upper limb prostheses controlled by PR systems. Controlling finger movement is a step towards the restoration of lost human capabilities, and is psychologically important, as well as physically. A central thread running through this work is the assertion that no two amputees are the same, each suffering different injuries and retaining differing nerve and muscle structures. This work is very much about individualised healthcare, and aims to provide the best possible solution for each affected individual on a case-by-case basis. Therefore, the approach has been to optimise the solution (in terms of function and reliability) for each individual, as opposed to developing a generic solution, where performance is optimised against a test population. This work is unique, in that it contributes to improving the quality of life for each individual amputee by optimising function and reliability. The main four contributions of the thesis are as follows: 1- Individual finger control was achieved with high accuracy for a large number of finger movements, using six optimally placed sEMG channels. This was validated on EMG signals for ten non-amputee and six amputee subjects. Thumb movements were classified successfully with high accuracy for the first time. The outcome of this investigation will help to add more movements to the prosthesis, and reduce hardware and computational complexity. 2- A new subject-specific protocol for sEMG site selection and reliable movement subset optimisation, based on the amputee’s needs, has been proposed and validated on seven amputees. This protocol will help clinicians to perform an efficient and fast deployment of prostheses, by finding the optimal number and locations of EMG channels. It will also find a reliable subset of movements that can be achieved with high performance. 3- The relationship between the force of contraction and the statistics of EMG signals has been investigated, utilising an experimental design where visual feedback from a Myoelectric Control Interface (MCI) helped the participants to produce the correct level of force. Kurtosis values were found to decrease monotonically when the contraction level increased, thus indicating that kurtosis can be used to distinguish different forces of contractions. 4- The real practical problem of the degradation of classification performance as a result of the variation of force levels during daily use of the prosthesis has been investigated, and solved by proposing a training approach and the use of a robust feature extraction method, based on the spectrum. The recommendations of this investigation improve the practical robustness of prostheses controlled with PR systems and progress a step further towards clinical implementation and improving the quality of life of amputees. The project showed that PR systems achieved a reliable performance for a large number of amputees, taking into account real life issues such as individual finger control for high dexterity, the effect of force level variation, and optimisation of the movements and EMG channels for each individual amputee. The findings of this thesis showed that the PR systems need to be appropriately tuned before usage, such as training with multiple forces to help to reduce the effect of force variation, aiming to improve practical robustness, and also finding the optimal EMG channel for each amputee, to improve the PR system’s performance. The outcome of this research enables the implementation of PR systems in real prostheses that can be used by amputees.Ministry of Higher Education and Scientific Research and Baghdad University- Baghdad/Ira

The application of impantable sensors in the musculoskeletal system: a review

As the population ages and the incidence of traumatic events rises, there is a growing trend toward the implantation of devices to replace damaged or degenerated tissues in the body. In orthopedic applications, some implants are equipped with sensors to measure internal data and monitor the status of the implant. In recent years, several multi-functional implants have been developed that the clinician can externally control using a smart device. Experts anticipate that these versatile implants could pave the way for the next-generation of technological advancements. This paper provides an introduction to implantable sensors and is structured into three parts. The first section categorizes existing implantable sensors based on their working principles and provides detailed illustrations with examples. The second section introduces the most common materials used in implantable sensors, divided into rigid and flexible materials according to their properties. The third section is the focal point of this article, with implantable orthopedic sensors being classified as joint, spine, or fracture, based on different practical scenarios. The aim of this review is to introduce various implantable orthopedic sensors, compare their different characteristics, and outline the future direction of their development and application

The development of an adaptive and reactive interface system for lower limb prosthetic application

Deep tissue injury (DTI) is a known problem correlating to the use of a prosthetic by a transtibial amputee (TTA), causing ulcer-like wounds on the residual limb caused by stress-induced cell necrosis. The magnitude of these stresses at the bone tissue interface has been identified computationally, far exceeding those measured at the skin's surface. Limited technology is available to directly target and reduce such cellular loading and actively reduce the risk of DTI from below-knee use. The primary aim of this project was to identify whether a bespoke prosthetic socket system could actively stiffen the tissues of the lower limb. Stabilising the residual tibia during ambulation and reducing stress concentrations on the cells. To achieve this, a proof-of-concept device was designed and manufactured, a system that allowed the change in displacement of a magnet to be responded to by counterbalancing load. The device was evaluated through experimentation on an able-bodied subject wearing an orthotic device designed to replicate the environment of a prosthetic socket. The chosen sensor effector system was validated against vector data generated by the Motek Medical Computer Assisted Rehabilitation Environment (CAREN.) The project explored a new concept of reactive loading of a below-knee prosthesis to reduce tibial/socket oscillation. The evaluation of the device indicated that external loading of the residual limb in such a manner could reduce the magnitude of rotation about the tibia and therefore minimise the conditions by which DTIs are known to occur. Efforts were made to move the design to the next iteration, focusing on implementing the target demographic.Deep tissue injury (DTI) is a known problem correlating to the use of a prosthetic by a transtibial amputee (TTA), causing ulcer-like wounds on the residual limb caused by stress-induced cell necrosis. The magnitude of these stresses at the bone tissue interface has been identified computationally, far exceeding those measured at the skin's surface. Limited technology is available to directly target and reduce such cellular loading and actively reduce the risk of DTI from below-knee use. The primary aim of this project was to identify whether a bespoke prosthetic socket system could actively stiffen the tissues of the lower limb. Stabilising the residual tibia during ambulation and reducing stress concentrations on the cells. To achieve this, a proof-of-concept device was designed and manufactured, a system that allowed the change in displacement of a magnet to be responded to by counterbalancing load. The device was evaluated through experimentation on an able-bodied subject wearing an orthotic device designed to replicate the environment of a prosthetic socket. The chosen sensor effector system was validated against vector data generated by the Motek Medical Computer Assisted Rehabilitation Environment (CAREN.) The project explored a new concept of reactive loading of a below-knee prosthesis to reduce tibial/socket oscillation. The evaluation of the device indicated that external loading of the residual limb in such a manner could reduce the magnitude of rotation about the tibia and therefore minimise the conditions by which DTIs are known to occur. Efforts were made to move the design to the next iteration, focusing on implementing the target demographic

Biomedical Engineering

Biomedical engineering is currently relatively wide scientific area which has been constantly bringing innovations with an objective to support and improve all areas of medicine such as therapy, diagnostics and rehabilitation. It holds a strong position also in natural and biological sciences. In the terms of application, biomedical engineering is present at almost all technical universities where some of them are targeted for the research and development in this area. The presented book brings chosen outputs and results of research and development tasks, often supported by important world or European framework programs or grant agencies. The knowledge and findings from the area of biomaterials, bioelectronics, bioinformatics, biomedical devices and tools or computer support in the processes of diagnostics and therapy are defined in a way that they bring both basic information to a reader and also specific outputs with a possible further use in research and development

Biomanufacturing Technologies for Tissue Engineering

Il seguente lavoro di tesi ha come obiettivo lo studio e la realizzazione di device biomedicali realizzati tramite la manifattura additiva. La manifattura additiva sta avendo una forte crescita negli ultimi anni grazie soprattutto alla possibilità di realizzare facilmente geometrie complesse. Questa caratteristica permette di personalizzare i prodotti ad un costo competitivo. Inoltre, lo spreco di materiale viene ridotto moltissimo dal principio di fabbricazione. Tutte queste proprietà hanno fatto in modo che negli ultimi anni la manifattura additiva prendesse sempre più piede in campi come l’automotive, l’aerospace e il biomedicale. Questo lavoro di tesi è focalizzato sull’utilizzo di alcune tra le più diffuse tecnologie additive per la produzione di device biomedicali. In particolare, il lavoro si è concentrato principalmente sulla realizzazione di due modelli, il primo per lo studio dello sviluppo dei black floaters all’interno del corpo vitreo dell’occhio, il secondo per l’emulazione del comportamento dell’osso mandibolare durante la foratura per l’installazione di impianti dentali. Il modello dell’occhio è composto da due elementi principali, un supporto e un hydrogel. Il supporto serve a contenere e supportare l’hydrogel. Deve essere trasparente, biocompatibile facilmente manovrabile in laboratorio. La sua realizzazione è avvenuta tramite stereolitografia. L’hydrogel, invece, ha lo scopo di fornire un’ambiente 3D per la crescita e sviluppo delle cellule. Deve perciò anche lui essere biocompatibile e con adeguate caratteristiche meccaniche e di stampabilità. La struttura 3D è stata realizzata tramite material extrusion. Il modello di osso mandibolare è stato realizzato tramite fused filament fabrication. Il modello si compone di due parti, una parte esterna piena per emulare l’osso corticale, e una parte interna porosa per emulare l’osso trabecolare. Le prove di foratura sono state realizzate con un trapano dentistico agganciato a robot collaborativi. La ricerca ha infine toccato ulteriori due ambiti, lo studio delle proprietà di strutture lattice realizzate tramite laser based- powder bed fusion e la valutazione di diversi trattamenti di finitura superficiale. La tesi, dunque, ha la seguente organizzazione. Il capitolo 1 presenta un’introduzione sull’additive manufacturing e il bioprinting. Le tecnologie ed i materiali utilizzati sono brevemente descritti e sono riportati alcuni esempi di applicazione della manifattura additiva nel campo biomedicale. I capitoli seguenti, invece, riportano gli articoli pubblicati o in corso di pubblicazione riguardo alle diverse tematiche affrontate. Nello specifico, il capitolo 2 riporta la ricerca sulle strutture lattice e la loro realizzazione. I capitoli 3 e 4 comprendono gli studi relativi al modello dell’occhio. Il capitolo 3 si concentra sulla realizzazione del supporto, il 4 sulla formulazione e la valutazione dell’hydrogel. Il capitolo 5 approfondisce lo studio del modello per l’emulazione del comportamento dell’osso mandibolare a foratura mentre il capitolo 6, l’ultimo di questo elaborato, si concentra sui processi di finitura superficiale. Per concludere, la manifattura additiva include processi molto diversi tra loro, ma che presentano molti punti in comune come la flessibilità, libertà di progettazione e personalizzazione. Sfruttando queste proprietà è possibile realizzare oggetti su misura, soprattutto in campi come quello biomedicale dove la personalizzazione e la specificità sono fondamentali.The following thesis aims to study and to develop biomedical devices made through additive manufacturing. Additive manufacturing has been experiencing a strong growth in recent years, mainly due to its ability to easily realize complex geometries. This feature allows customization of products at a competitive cost. In addition, material waste is greatly reduced by the manufacturing principle. All these properties helped the recent years diffusion of additive manufacturing in fields such as automotive, aerospace and biomedical. This thesis focuses on the use of some of the most popular additive technologies for the production of biomedical devices. In particular, the work focused mainly on the fabrication of two models, the first to study the development of black floaters within the vitreous body of the eye, and the second to emulate the mandibular bone behavior during drilling for the installation of dental implants. The eye model consists of two main elements, a scaffold and a hydrogel. The scaffold contains and provides support to the hydrogel. It must be transparent, biocompatible easily handled in the laboratory. It is printed by stereolithography. The hydrogel, on the other hand, is intended to provide a 3D environment for cell growth and development. Therefore, it must be biocompatible and have adequate mechanical properties together with good printability. The 3D scaffold structure was made by material extrusion. The mandibular bone model was made by fused filament fabrication. The model consists of two parts, a solid outer part to emulate cortical bone, and a porous inner part to emulate trabecular bone. Drilling tests were performed with a dental drill attached to collaborative robots. Finally, the research covered two additional areas, the study of the properties of lattice structures made by laser-based- powder bed fusion and the evaluation of different surface finish treatments. The following thesis, therefore, has the following organization. Chapter 1 presents an introduction on additive manufacturing and bioprinting. The technologies and materials used are briefly described, and examples of additive manufacturing applications in the biomedical field are given. The following chapters, on the other hand, report published or forthcoming articles regarding the various topics mentioned above. Specifically, Chapter 2 reports the research on lattice structures and their fabrication. Chapters 3 and 4 include studies related to the eye model. Chapter 3 focuses on the fabrication of the support, and Chapter 4 on the formulation and evaluation of the hydrogel. Chapter 5 presents the study of the model for emulating the behavior of mandibular bone upon drilling, while Chapter 6, the last of this work, focuses on surface finishing processes. In conclusion, additive manufacturing includes various processes that are very different from each other but have many common points such as flexibility, freedom of design, and customization. By exploiting these properties, it is possible to make tailored objects, especially important in fields such as the biomedical one, where customization and specificity are a great added value