Augmenting forearm crutches with wireless sensors for lower limb rehabilitation

Forearm crutches are frequently used in the rehabilitation of an injury to the lower limb. The recovery rate is improved if the patient correctly applies a certain fraction of their body weight (specified by a clinician) through the axis of the crutch, referred to as partial weight bearing (PWB). Incorrect weight bearing has been shown to result in an extended recovery period or even cause further damage to the limb. There is currently no minimally invasive tool for long-term monitoring of a patient's PWB in a home environment. This paper describes the research and development of an instrumented forearm crutch that has been developed to wirelessly and autonomously monitor a patient's weight bearing over the full period of their recovery, including its potential use in a home environment. A pair of standard forearm crutches are augmented with low-cost off-the-shelf wireless sensor nodes and electronic components to provide indicative measurements of the applied weight, crutch tilt and hand position on the grip. Data are wirelessly transmitted between crutches and to a remote computer (where they are processed and visualized in LabVIEW), and the patient receives biofeedback by means of an audible signal when they put too much or too little weight through the crutch. The initial results obtained highlight the capability of the instrumented crutch to support physiotherapists and patients in monitoring usage

Study of the ulnar nerve compromise at the wrist of patients with carpal tunnel syndrome

Introduction: That the ulnar nerve compromise occurs concomitant with the carpal tunnel syndrome (CTS) has been cited by previous studies. It seems that the previously mentioned incidence is much higher than what we observe in our electrodiagnosis studies. Material and Method: A prospective study was designed to evaluate the incidence of ulnar nerve compromise in patients with electrodiagnostic evidence of CTS according to age and sex, and also to determine the site of ulnar nerve involvement. Results: One hundred and sixty five limbs with standard elestrodiagnostic criteria of CTS were evaluated. In 9.7 of the tested limbs, the ulnar nerve was involved. The site of the involvement was the wrist area in 43.75. The elbow region was involved in 43.75, and in 12.5, the forearm region was involved. The most prevalent age range of concomitant involvement was 45-54 years old. In patents who had sensory symptoms in the 4th and 5th fingers, the incidence of concomitant ulnar nerve compromise was significantly higher (p < 0.001) than the patients without these symptoms. Discussion: In patients with CTS, concomitant ulnar nerve compromise is much lower than the incidence mentioned in previous researches. Apparently the rate of involvement in wrist and elbow are equal. It is recommended that in evaluation of patients for CTS especially when the patient has sensory symptoms in the hand, special attention is paid to ulnar nerve involvement and two nerve comparison tests are interpreted with caution

Using verbal autopsy to measure causes of death: the comparative performance of existing methods

Background: Monitoring progress with disease and injury reduction in many populations will require widespread use of verbal autopsy (VA). Multiple methods have been developed for assigning cause of death from a VA but their application is restricted by uncertainty about their reliability. Methods: We investigated the validity of five automated VA methods for assigning cause of death: InterVA-4, Random Forest (RF), Simplified Symptom Pattern (SSP), Tariff method (Tariff), and King-Lu (KL), in addition to physician review of VA forms (PCVA), based on 12,535 cases from diverse populations for which the true cause of death had been reliably established. For adults, children, neonates and stillbirths, performance was assessed separately for individuals using sensitivity, specificity, Kappa, and chance-corrected concordance (CCC) and for populations using cause specific mortality fraction (CSMF) accuracy, with and without additional diagnostic information from prior contact with health services. A total of 500 train-test splits were used to ensure that results are robust to variation in the underlying cause of death distribution. Results: Three automated diagnostic methods, Tariff, SSP, and RF, but not InterVA-4, performed better than physician review in all age groups, study sites, and for the majority of causes of death studied. For adults, CSMF accuracy ranged from 0.764 to 0.770, compared with 0.680 for PCVA and 0.625 for InterVA; CCC varied from 49.2% to 54.1%, compared with 42.2% for PCVA, and 23.8% for InterVA. For children, CSMF accuracy was 0.783 for Tariff, 0.678 for PCVA, and 0.520 for InterVA; CCC was 52.5% for Tariff, 44.5% for PCVA, and 30.3% for InterVA. For neonates, CSMF accuracy was 0.817 for Tariff, 0.719 for PCVA, and 0.629 for InterVA; CCC varied from 47.3% to 50.3% for the three automated methods, 29.3% for PCVA, and 19.4% for InterVA. The method with the highest sensitivity for a specific cause varied by cause. Conclusions: Physician review of verbal autopsy questionnaires is less accurate than automated methods in determining both individual and population causes of death. Overall, Tariff performs as well or better than other methods and should be widely applied in routine mortality surveillance systems with poor cause of death certification practices. © 2014 Murray et al.; licensee BioMed Central Ltd

Using Verbal Autopsy to Measure Causes of Death: the Comparative Performance of Existing Methods.

Monitoring progress with disease and injury reduction in many populations will require widespread use of verbal autopsy (VA). Multiple methods have been developed for assigning cause of death from a VA but their application is restricted by uncertainty about their reliability. We investigated the validity of five automated VA methods for assigning cause of death: InterVA-4, Random Forest (RF), Simplified Symptom Pattern (SSP), Tariff method (Tariff), and King-Lu (KL), in addition to physician review of VA forms (PCVA), based on 12,535 cases from diverse populations for which the true cause of death had been reliably established. For adults, children, neonates and stillbirths, performance was assessed separately for individuals using sensitivity, specificity, Kappa, and chance-corrected concordance (CCC) and for populations using cause specific mortality fraction (CSMF) accuracy, with and without additional diagnostic information from prior contact with health services. A total of 500 train-test splits were used to ensure that results are robust to variation in the underlying cause of death distribution. Three automated diagnostic methods, Tariff, SSP, and RF, but not InterVA-4, performed better than physician review in all age groups, study sites, and for the majority of causes of death studied. For adults, CSMF accuracy ranged from 0.764 to 0.770, compared with 0.680 for PCVA and 0.625 for InterVA; CCC varied from 49.2% to 54.1%, compared with 42.2% for PCVA, and 23.8% for InterVA. For children, CSMF accuracy was 0.783 for Tariff, 0.678 for PCVA, and 0.520 for InterVA; CCC was 52.5% for Tariff, 44.5% for PCVA, and 30.3% for InterVA. For neonates, CSMF accuracy was 0.817 for Tariff, 0.719 for PCVA, and 0.629 for InterVA; CCC varied from 47.3% to 50.3% for the three automated methods, 29.3% for PCVA, and 19.4% for InterVA. The method with the highest sensitivity for a specific cause varied by cause. Physician review of verbal autopsy questionnaires is less accurate than automated methods in determining both individual and population causes of death. Overall, Tariff performs as well or better than other methods and should be widely applied in routine mortality surveillance systems with poor cause of death certification practices

Robust metrics for assessing the performance of different verbal autopsy cause assignment methods in validation studies

<p>Abstract</p> <p>Background</p> <p>Verbal autopsy (VA) is an important method for obtaining cause of death information in settings without vital registration and medical certification of causes of death. An array of methods, including physician review and computer-automated methods, have been proposed and used. Choosing the best method for VA requires the appropriate metrics for assessing performance. Currently used metrics such as sensitivity, specificity, and cause-specific mortality fraction (CSMF) errors do not provide a robust basis for comparison.</p> <p>Methods</p> <p>We use simple simulations of populations with three causes of death to demonstrate that most metrics used in VA validation studies are extremely sensitive to the CSMF composition of the test dataset. Simulations also demonstrate that an inferior method can appear to have better performance than an alternative due strictly to the CSMF composition of the test set.</p> <p>Results</p> <p>VA methods need to be evaluated across a set of test datasets with widely varying CSMF compositions. We propose two metrics for assessing the performance of a proposed VA method. For assessing how well a method does at individual cause of death assignment, we recommend the average chance-corrected concordance across causes. This metric is insensitive to the CSMF composition of the test sets and corrects for the degree to which a method will get the cause correct due strictly to chance. For the evaluation of CSMF estimation, we propose CSMF accuracy. CSMF accuracy is defined as one minus the sum of all absolute CSMF errors across causes divided by the maximum total error. It is scaled from zero to one and can generalize a method's CSMF estimation capability regardless of the number of causes. Performance of a VA method for CSMF estimation by cause can be assessed by examining the relationship across test datasets between the estimated CSMF and the true CSMF.</p> <p>Conclusions</p> <p>With an increasing range of VA methods available, it will be critical to objectively assess their performance in assigning cause of death. Chance-corrected concordance and CSMF accuracy assessed across a large number of test datasets with widely varying CSMF composition provide a robust strategy for this assessment.</p

Comparing the ergonomic risk factors threating neurosurgeons during craniotomy surgery in standing and sitting positions

Background: During craniotomy surgery, because of the prolonged action and maintaining a fixed position, neurosurgeons, in both the sitting and standing positions, face various musculoskeletal problems in the absence of proper position. Since, no study using scientific methods was done on the neurosurgeons during craniotomy surgery, this study aimed to compare the ergonomic risk factors threating neurosurgeons during this surgery in both standing and sitting positions. Methods: In a cross sectional study, 20 standing and 20 sitting positions of neurosurgeons during craniotomy surgery were captured and the risks of exposure to musculoskeletal disorders was calculated and determined using quick exposure check (QEC) and rapid entire body assessment (REBA) scores in the three levels of mild, moderate and sever. The collected data were analyzed using SPSS software. Findings: The total percent of the mean risk of musculoskeletal disorders in the standing and sitting positions was 36.39 ± 10.06 and 31.60 ± 6.70 percent, respectively, and there was no statistically difference between the two positions (P = 0.090). In addition, the exposure level in REBA score in the two positions of standing and sitting was 6.00 ± 1.52 and 3.63 ± 0.90, respectively, and the difference between the two groups was statistically significant (P < 0.001). Conclusion: During craniotomy surgery, neurosurgeons either in standing or in sitting position have moderate exposure levels in different areas of the body such as the shoulders/arm, wrist/hand and neck and the risk is higher in standing position. Thus, we recommend more studies be conducted with larger sample sizes. In addition, the required equipment to reduce the risk of the underlying disorders must be provided. Knowledge of the practitioners must be improved via retraining courses, gatherings and meetings, too. © 2015, Isfahan University of Medical Sciences(IUMS). All rights reserved

Association between sedentary behavior and low back pain; A systematic review and meta-analysis

Background: Sedentariness is a substantial risk for many chronic diseases. We aimed to investigate the correlation of sedentary behavior and its indicators with low back pain (LBP) among adults and children. Methods: Original articles published up to April 28, 2020, using PubMed, Embase, Web of Science and Scopus were evaluated. Odds ratio (OR, 95 CI) was considered the overall effect size for desired associations. Results: We reviewed 49 English articles with analytical observational study design, of which, 27 studies with cross sectional/survey design were retained in the meta-analysis. Among adults, sedentary lifestyle was a considerable risk factor for LBP (OR = 1.24, 1.02-1.5); prolonged sitting time (OR = 1.42, 1.09-1.85) and driving time (OR = 2.03, 1.22-3.36) were the significant risk factors. Sedentary behavior was associated with LBP in office workers (OR = 1.23). Moreover, excess weight (OR = 1.35, 1.14-1.59) and smoking (OR = 1.28, 1.03-1.60) were associated with LBP. Among children, sedentary lifestyle was a remarkable risk factor for LBP (OR = 1.41, 1.24-1.60); prolonged TV watching (OR = 1.23, 1.08-1.41) and computer/mobile using and console playing time (OR = 1.63, 1.36-1.95) were significant risk factors for LBP. Consumption of coffee, however, has yield conflicting results to be considered as a risk factor. Moreover, the researches on the correlation between sedentariness and high-intensity LBP are scarce and inconclusive. Conclusion: Sedentary behavior, whether in work or leisure time, associates with a moderate increase in the risk of LBP in adults, children and adolescents

The effect of extracorporeal shockwave therapy on de quervain tenosynovitis; a clinical trial

Background: De Quervain tenosynovitis is mainly managed by conservative treatments, such as anti-inflammatory drugs, splint, and injection; however, surgical treatments are also recommended. Objectives: The present study aimed at assessing the efficacy of extracorporeal shockwave therapy in the treatment of de Quervain tenosynovitis. Methods: The current clinical trial was conducted on 26 patients with de Quervain tenosynovitis eligible for treatment. The intervention group received extracorporeal shock wave therapy (1000 impulses, 2 bar, 15 Hz), and the sham group a treatment without shock wave. Both groups received the same conservative treatments as thumb spica splint and 200 mg celecoxib once daily for three weeks. The assessment instruments included the disabilities of the arm, shoulder, and hand (DASH) questionnaire, the visual analog scale (VAS), and the hand-grip strength test performed before and after treatment. Results: After treatment, the DASH and VAS scores decreased, while the hand-grip strength increased significantly in the groups. DASH and VAS scores were significantly lower in the intervention group than the sham group after treatment (P < 0.05). Conclusions: Extracorporeal shockwave therapy is a safe and easy method to reduce pain and enhance upper extremity functions and hand-grip strength in patients with de Quervain tenosynovitis. © 2021, Author(s)

Integrating physical medicine and rehabilitation into the curriculum of Iranian medical students

Purpose. To evaluate the attitude of interns toward Physical Medicine and Rehabilitation (PM&R) and design a PM&R curriculum for medical students with continued medical education programmes and workshops based on the needs and interest of Iranian medical community. Method. Eighty questionnaires were distributed to the medical interns on the last day after attendance in the PM&R ward after participating in a one-month outpatient and inpatient course including 12 lectures. Results. Out of 80 participants, 34 (42.5) were female and 46 (57.5) were male. All the participants believed participating in a rehabilitation course was necessary; 52 (65) believed that participating in a separate course of PM&R was necessary, and 28 (35) believed that rehabilitation of each field of medicine should be presented in its course. A significant percentage (31.4) of the participants were interested in continuing their education in PM&R specialty. Conclusion. The enthusiasm of the medical students towards PM&R is a promising sign toward progress of PM&R in Iran which must be directed through a strong effort of physiatrists through setting up appropriate educational programmes for medical students and continued medical education programmes in the universities. © 2006 Taylor & Francis

Extracorporeal Shockwave Therapy for Chronic Venous Ulcers: A Randomized Controlled Trial

Background: Chronic venous ulcers (CVUs), demanding specialized care, are still a major socioeconomic problem facing health care systems worldwide. This study's main goal was evaluating the efficacy of ESWT application as an AT in the treatment of wounds for curing CVUs. Materials and Methods: 50 patients presenting with CVUs were divided into two groups of ESWT and control randomly. Then, ESWT was applied one session per week, during four weeks, along with routine CB. The control group also received sham ESWT together with CB. In this respect, pain score, wound size, patient satisfaction and quality of life (QoL) using the Charing Cross Venous Ulcer Questionnaire (CCVUQ) were consequently assessed at baseline, week four, and week eight and then compared between both groups. Results: The findings showed that patients receiving ESWT along with CB had significantly lower pain and were also feeling more satisfied than the cases undergoing CB alone (P<0.05). The significant efficiency of ESWT in improving the healing process of CVUs was further observed (P<0.05). In addition, QoL, assessed by the CCVUQ, was significantly higher in patients receiving ESWT (P<0.05). Conclusion: These findings established that ESWT was a feasible and safe option to treat patients presenting with CVUs in another word, ESWT seems to be a safe and effective adjunct therapy (AT) compared with CB in patients with CVUs