Rehabilitation Engineering

Population ageing has major consequences and implications in all areas of our daily life as well as other important aspects, such as economic growth, savings, investment and consumption, labour markets, pensions, property and care from one generation to another. Additionally, health and related care, family composition and life-style, housing and migration are also affected. Given the rapid increase in the aging of the population and the further increase that is expected in the coming years, an important problem that has to be faced is the corresponding increase in chronic illness, disabilities, and loss of functional independence endemic to the elderly (WHO 2008). For this reason, novel methods of rehabilitation and care management are urgently needed. This book covers many rehabilitation support systems and robots developed for upper limbs, lower limbs as well as visually impaired condition. Other than upper limbs, the lower limb research works are also discussed like motorized foot rest for electric powered wheelchair and standing assistance device

A multi-systems approach to human movement after ACL reconstruction: the musculoskeletal system

Several negative adaptations to the musculoskeletal system occur following anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) such as arthrogenic muscle inhibition, decreased lower extremity muscle size, strength, power, as well as alterations to bone and cartilage. These changes have been associated with worse functional outcomes, altered biomechanics, and increased risk for re-injury and post-traumatic osteoarthritis. After ACL injury and subsequent ACLR, examination and evaluation of the musculoskeletal system is paramount to guiding clinical decision making during the rehabilitation and the return to sport process. The lack of access many clinicians have to devices necessary for gold standard assessment of muscle capacities and force profiles is often perceived as a significant barrier to best practices. Fortunately, testing for deficits can be accomplished with methods available to the clinician without access to costly equipment or time-intensive procedures. Interventions to address musculoskeletal system deficits can be implemented with a periodized program. This allows for restoration of physical capacities by adequately developing and emphasizing physical qualities beginning with mobility and movement, and progressing to work capacity and neuromuscular re-education, strength, explosive strength, and elastic or reactive strength. Additional considerations to aid in addressing strength deficits will be discussed such as neuromuscular electrical stimulation, volume and intensity, eccentric training, training to failure, cross-education, and biomechanical considerations. The American Physical Therapy Association adopted a new vision statement in 2013 which supported further development of the profession's identity by promoting the movement system, yet validation of the movement system has remained a challenge. Application of a multi-physiologic systems approach may offer a unique understanding of the musculoskeletal system and its integration with other body systems after ACLR. The purpose of this clinical commentary is to highlight important musculoskeletal system considerations within a multi-physiologic system approach to human movement following ACLR. Level of evidence: 5

The Effects of Whole Body Vibration on Muscle Recovery and Performance

Facilitating muscle recovery in trained individuals is essential, as it allows for a quicker return to activity without reduction in performance. Many proposed modalities have been studied but have not shown consistent effectiveness. A relatively new modality, whole-body vibration (WBV) has been shown to increase strength and power outcomes and recently has been shown to decrease perceived pain associated with muscle soreness. Therefore, the purpose of this study is to examine the effects of WBV following exercise induced muscle damage over a period of 72 hours in recreationally trained females. Participants were randomly selected into either the control group or the WBV group. There were three familiarization visits and four testing visits lasting about 45mins each. During every testing visit, all dependent variables were assessed 3 times (pre, post1, post2) in the following order: vertical jump, maximal voluntary isometric strength, interpolated-twitch, muscle activity, pressure pain threshold (PPT), range of motion (ROM), thigh circumference, and pain on movement. On visit 4, pre assessments were taken folloby 4, 40% front loaded, sets to repetition failure during split squats to induce muscle damage. This was folloimmediately by WBV or control (rest) and the measurement of dependent variables. Following a 10 minute rest, measurements were reassessed. Visits 5-7 were replications of visit 4 with the exclusion of the damage protocol. Each dependent variable was measured by a 2x12 (group x time) mixed factor ANOVA. Significant (p\u3c0.05) main effects for group were found for twitch torque up to 24hr post, with control being greater than WBV. No significant main effects for group were found for all other variables. There were significant main effects for time from 0Pre to 24Pre and 48Pre in all PPT measures, active ROM, and muscle pain on movement. Significant (p\u3c0.05) main effects for time were found for vertical jumping variables, indicating jumping performance declined following muscle damage. A significant (p\u3c0.05) main effect for group was found for normalized peak EMG during jumping, indicating the control group exhibited greater muscle activity than the WBV group. Significant (p\u3c0.05) main effects for time were found for muscle contractile properties, indicating a change in muscle contractile properties following muscle damage. These results indicate that WBV does not aid in alleviating muscle pain or symptoms, vertical jump performance and voluntary muscle contractile properties following exercise induced muscle damage with further research needed in clinical and/or athletic populations

Progressive resistance training during maintenance hemodialysis in patients with end stage renal disease

Background: The global incidence of end-stage renal disease (ESRD) continues to rise annually. Accompanying this rise is an increase in the number of patients on hemodialysis. These trends are being driven by an unprecedented burden of hypokinetic, non-communicable diseases, and particularly the type 2 diabetes-obesity pandemic. The progression of kidney disease is associated with an exponential increase in atherosclerotic cardiovascular disease (CVD) and associated mortality. CVD is the leading cause of hospitalization and death in this cohort. As the ESRD patient population continues to grow, greater efforts must be directed toward improving patient outcomes in this cohort, including morbidity, mortality and health-related quality of life (HRQoL). Aims: This thesis addresses several gaps related to the investigation and application of progressive resistance training (PRT) in the hemodialysis setting. The specific aims were: (i) to systematically review the extant literature on PRT in patients with ESRD, and to outline recommendations for robust clinical trials; (ii) to assess the feasibility and efficacy of including a novel customized resistance training device within a comprehensive intradialytic PRT intervention in a conventional hemodialysis unit; (iii) to investigate the effect of a 12-week intradialytic PRT intervention on measures of CVD risk, specifically, arterial stiffness (i.e. pulse wave velocity; PWV) and associated outcomes (i.e. hemodynamic, anthropometric, and hematologic). Research Program: The research program was undertaken from March 2011 to March 2015 and culminated in a clinical trial enrolling 22 participants conducted across four dialysis centers in Adelaide, South Australia. Conclusions: Chapter 7 presents general conclusions to the thesis, as follows: (i) According to the systematic review of the extance literature (Chapter 4) clinical trials are required to investigate a range of novel research questions related to the benefits and application of PRT in this cohort and its patient subgroups (e.g. diabetes, depression, dyslipidemia, etc.). Future studies must be of high methodological quality to inform clinical practice guidelines. (ii) According to the study presented in Chapter 5, PRT using the novel training device was feasible and improved measures of physical and psychological health and HRQoL. This device can be utilized in most dialysis centers. Future studies are required to evaluate dose-response effects of PRT prescriptions in subpopulations, and the application of PRT in standard dialysis practice. (iii) According to the study presented in Chapter 6, 12 weeks of low-to-moderate intensity intradialytic PRT did not change PWV, hemodynamic, anthropometric or hematologic measures in patients with ESRD. More research is needed to determine whether different intensities or durations of PRT can affect vascular health or other outcomes related to survival in this patient group

Soft pneumatic devices for blood circulation improvement

The research activity I am presenting in this thesis lies within the framework of a cooperation between the University of Cagliari (Applied Mechanics and Robotics lab, headed by professor Andrea Manuello Bertetto, and the research group of physicians referencing to professor Alberto Concu at the Laboratory of Sports Physiology, Department of Medical Sciences), and the Polytechnic of Turin (professor Carlo Ferraresi and his equipe at the Group of Automation and Robotics, Department of Mechanical and Aerospace Engineering) This research was also funded by the Italian Ministry of Research (MIUR – PRIN 2009). My activity has been mainly carried on at the Department of Mechanics, Robotics lab under the supervision of prof. Manuello; I have also spent one year at the Control Lab of the School of Electrical Engineering at Aalto University (Helsinki, Finland). The tests on the patients were taken at the Laboratory of Sports Physiology, Cagliari. I will be describing the design, development and testing of some soft pneumatic flexible devices meant to apply an intermittent massage and to restore blood circulation in lower limbs in order to improve cardiac output and wellness in general. The choice of the actuators, as well as the pneumatic circuits and air distribution system and PLC control patterns will be outlined. The trial run of the devices have been field--‐tested as soon a prototype was ready, so as to tune its features step--‐by--‐ step. I am also giving a characterization of a commercial thin force sensor after briefly reviewing some other type of thin pressure transducer. It has been used to gauge the contact pressure between the actuator and the subject’s skin in order to correlate the level of discomfort to the supply pressure, and to feed this value back to regulate the supply air flow. In order for the massage to be still effective without causing pain or distress or any cutoff to the blood flow, some control objective have been set, consisting in the regulation of the contact force so that it comes to the constant set point smoothly and its value holds constant until unloading occurs. The targets of such mechatronic devices range from paraplegic patients lacking of muscle tone because of their spinal cord damage, to elite endurance athletes needing a circulation booster when resting from practicing after serious injuries leading to bed rest. Encouraging results have been attained for both these two categories, based on the monitored hemodynamic variables

Isolated lumbar extension exercise as an intervention for chronic low back pain

Low back pain (LBP) is highly prevalent, generally categorised as ‘non-specific’ as clear diagnosis for pain is often absent, and further categorised into acute, sub-acute and chronic, with 69-75% of acute cases developing into chronic. This chronic LBP population accounts for the majority of economic costs worldwide associated with LBP. Although LBP is often ‘non-specific’, many physical dysfunctions are associated with it. Thus LBP can be regarded as multifactorial in nature. Dysfunctions include, but are not limited to: deconditioning of the lumbar extensor musculature, limited range of motion (ROM), gait abnormality and disc disorders. The novel approach of this thesis was to consider lumbar extensor deconditioning, LBP and its associated physical dysfunctions within a multifactorial framework, and the potential improvement of associated dysfunctions from intervention using isolated lumbar extension (ILEX) specifically aimed at addressing lumbar extensor deconditioning. Findings from three empirical studies are reported. The first examined limited ROM ILEX exercise compared with full ROM exercise. Results from this study support that limited ROM training is as effective as full ROM training at improving full ROM ILEX strength, pain and disability. The second study examined the effects of ILEX exercise upon lumbar spine kinematic waveform pattern variability during gait. Results from this study demonstrate that ILEX exercise significantly improves sagittal plane variability in chronic LBP participants. The final study examined the effects of ILEX exercise upon disc hydration determined indirectly through measurement of spinal height using seated stadiometry. Results from this study showed improved ILEX strength, pain and disability but did not demonstrate improvement in disc hydration. These results provide evidence for adopting a multifactorial conceptualisation of LBP in the use of ILEX exercise as a treatment. It is concluded that a wide range of improvements including pain, disability and various aspects of function relating to the multifactorial model are possible through use of a single minimal intervention involving ILEX. This conclusion has potential implications for considering direction of treatments from clinicians towards chronic LBP. Such a minimal intervention offering a wide range of benefits may reduce the need for costly and complex multi-disciplinary interventions

Technology applications

A summary of NASA Technology Utilization programs for the period of 1 December 1971 through 31 May 1972 is presented. An abbreviated description of the overall Technology Utilization Applications Program is provided as a background for the specific applications examples. Subjects discussed are in the broad headings of: (1) cancer, (2) cardiovascular disease, (2) medical instrumentation, (4) urinary system disorders, (5) rehabilitation medicine, (6) air and water pollution, (7) housing and urban construction, (8) fire safety, (9) law enforcement and criminalistics, (10) transportation, and (11) mine safety

ACUTE AND CHRONIC RESPONSES TO EXERCISE WITH BLOOD FLOW RESTRICTION

Exercise with blood flow restriction (BFR) allows healthy, clinical, and athletic populations to improve their strength and exercise capacity. The main advantages exercise with BFR has over traditional training are: 1) increases in muscle size, strength, and exercise capacity are elicited at low training loads, 2) these adaptations occur faster with blood flow restriction, 3) increases in muscle size and strength can be stimulated during both resistance and aerobic exercise. Currently, there are no standardized guidelines for exercise with BFR. I used a variety of experimental techniques including ultrasound, near-infrared spectroscopy, expired air analysis, electrical stimulation, and dual-energy X-ray absorptiometry to investigate how cuff pressure and as well as the type of exercise alter acute and chronic responses to exercise with BFR. I was the first to report changes in blood flow during resistance exercise with BFR, and before and after aerobic exercise with BFR. Additionally, I am the first to directly report differences in muscle size, strength, and exercise capacity following aerobic or resistance training with BFR. Overall, I found that the relative reduction in blood flow measured prior to exercise is maintained during exercise. Additionally, I found that moderate cuff pressures of ~60% of limb occlusion pressure increase metabolic stress without completely occluding blood flow, and therefore is an adequate pressure for both aerobic and resistance exercise with BFR. Finally, I found that aerobic exercise with BFR may be more favorable than resistance exercise because it results in similar increases in muscle size and strength, but at a lower ratings of perceived effort and pain. Taken together, these studies will enable researchers, clinicians, and coaches to more effectively prescribe exercise with BFR to improve muscle size, strength and exercise capacity