Functional improvement of patients with Parkinson syndromes using a rehabilitation training software

IntroductionIndividuals with Parkinsonian disorders often face limited access to specialized physiotherapy and movement training due to staff shortages and increasing disease incidence, resulting in a rapid decline in mobility and feelings of despair. Addressing these challenges requires allocating adequate resources and implementing specialized training programs to ensure comprehensive care and support. Regarding these problems, a computer software was invented that might serve as an additional home-based extension to conventional physiotherapy.MethodsThe trial took place in a rehabilitation center where every patient received equivalent treatment apart from the training program that was set up to be investigated over 3 weeks. Seventy four Patients were included and randomized between two intervention and one control group. Intervention group 1 (IG1) trained with the computer-based system two times a week while Intervention group 2 (IG2) received five training sessions a week. Using the markerless Microsoft Kinect® camera, participants controlled a digital avatar with their own body movements. UPDRS-III and Clinical measurements were performed before and after the three-week period.ResultsPatients in all groups improved in UPDRS-III pre and post intervention whereas reduction rates were higher for IG1 (−10.89%) and IG2 (−14.04%) than for CG (−7.74%). Differences between the groups were not significant (value of ps CG/IG1 0.225, CG/IG2 0.347). Growth rates for the arm abduction angle were significantly higher in IG1 (11.6%) and IG2 (9.97%) than in CG (1.87%) (value of ps CG/IG1 0.006 and CG/IG2 0.018), as was the 5-steps-distance (CG 10.86% vs. IG1 24.5% vs. UG2 26.22%, value of ps CG/IG1 0.011 and CG/IG2 0.031).DiscussionThe study shows the beneficial effects of computer-based training and substantiates the assumption of a similar impact in a home-based setting. The utilized software is feasible for such interventions and meets with the patient’s approval. Group dynamics seem to have an additional supporting effect for the aspired objective of improving mobility and should be seen as an essential aspect of video games in therapy

Accuracy of a magnetic resonance imaging‐based 3D printed stereotactic brain biopsy device in dogs

Background: Brain biopsy of intracranial lesions is often necessary to determine specific therapy. The cost of the currently used stereotactic rigid frame and optical tracking systems for brain biopsy in dogs is often prohibitive or accuracy is not sufficient for all types of lesion. Objectives: To evaluate the application accuracy of an inexpensive magnetic resonance imaging‐based personalized, 3D printed brain biopsy device. Animals: Twenty‐two dog heads from cadavers were separated into 2 groups according to body weight (20 kg). Methods: Experimental study. Two target points in each cadaver head were used (target point 1: caudate nucleus, target point 2: piriform lobe). Comparison between groups was performed using the independent Student's t test or the nonparametric Mann‐Whitney U Test. Results: The total median target point deviation was 0.83 mm (range 0.09‐2.76 mm). The separate median target point deviations for target points 1 and 2 in all dogs were 0.57 mm (range: 0.09‐1.25 mm) and 0.85 mm (range: 0.14‐2.76 mm), respectively. Conclusion and Clinical Importance: This magnetic resonance imaging‐based 3D printed stereotactic brain biopsy device achieved an application accuracy that was better than the accuracy of most brain biopsy systems that are currently used in veterinary medicine. The device can be applied to every size and shape of skull and allows precise positioning of brain biopsy needles in dogs

A Comparative Study of Automatic Localization Algorithms for Spherical Markers within 3D MRI Data

Localization of features and structures in images is an important task in medical image-processing. Characteristic structures and features are used in diagnostics and surgery planning for spatial adjustments of the volumetric data, including image registration or localization of bone-anchors and fiducials. Since this task is highly recurrent, a fast, reliable and automated approach without human interaction and parameter adjustment is of high interest. In this paper we propose and compare four image processing pipelines, including algorithms for automatic detection and localization of spherical features within 3D MRI data. We developed a convolution based method as well as algorithms based on connected-components labeling and analysis and the circular Hough-transform. A blob detection related approach, analyzing the Hessian determinant, was examined. Furthermore, we introduce a novel spherical MRI-marker design. In combination with the proposed algorithms and pipelines, this allows the detection and spatial localization, including the direction, of fiducials and bone-anchors

Case Report: Clinical Use of a Patient-Individual Magnetic Resonance Imaging-Based Stereotactic Navigation Device for Brain Biopsies in Three Dogs

Three-dimensional (3D) printing techniques for patient-individual medicine has found its way into veterinary neurosurgery. Because of the high accuracy of 3D printed specific neurosurgical navigation devices, it seems to be a safe and reliable option to use patient- individual constructions for sampling brain tissue. Due to the complexity and vulnerability of the brain a particularly precise and safe procedure is required. In a recent cadaver study a better accuracy for the 3D printed MRI-based patient individual stereotactic brain biopsy device for dogs is determined compared to the accuracies of other biopsy systems which are currently used in veterinary medicine. This case report describes the clinical use of this 3D printed MRI-based patient individual brain biopsy device for brain sampling in three dogs. The system was characterized by a simple handling. Furthermore, it was an effective and reliable tool to gain diagnostic brain biopsy samples in dogs with no significant side effects

Accuracy of a magnetic resonance imaging-based 3D printed stereotactic brain biopsy device in dogs

Background Brain biopsy of intracranial lesions is often necessary to determine specific therapy. The cost of the currently used stereotactic rigid frame and optical tracking systems for brain biopsy in dogs is often prohibitive or accuracy is not sufficient for all types of lesion. Objectives To evaluate the application accuracy of an inexpensive magnetic resonance imaging-based personalized, 3D printed brain biopsy device. Animals Twenty-two dog heads from cadavers were separated into 2 groups according to body weight (20 kg). Methods Experimental study. Two target points in each cadaver head were used (target point 1: caudate nucleus, target point 2: piriform lobe). Comparison between groups was performed using the independent Student's t test or the nonparametric Mann-Whitney U Test. Results The total median target point deviation was 0.83 mm (range 0.09-2.76 mm). The separate median target point deviations for target points 1 and 2 in all dogs were 0.57 mm (range: 0.09-1.25 mm) and 0.85 mm (range: 0.14-2.76 mm), respectively. Conclusion and Clinical Importance This magnetic resonance imaging-based 3D printed stereotactic brain biopsy device achieved an application accuracy that was better than the accuracy of most brain biopsy systems that are currently used in veterinary medicine. The device can be applied to every size and shape of skull and allows precise positioning of brain biopsy needles in dogs

"ZEREPRO" Netzwerk Personalisierte Neurochirurgie: Vortrag gehalten auf dem 9. Medica Tech Forum, 14.11.2018, Düsseldorf

ZEREPRO – Personalisierte Neurochirurgie ist ein Netzwerk, welches seit März 2018 unter der Leitung des Fraunhofer IWU und der Klinik und Poliklinik für Neurochirurgie der Universität als klinischer Partner geführt wird. In dem vom BMWi geförderten Kooperationsnetzwerk arbeiten derzeit 8 Industriepartner und 5 Forschungseinrichtungen an Innovationen im Bereich der Neurochirurgie. Die Vernetzung zwischen Ärzten, Ingenieuren und Medizintechnikunternehmen erlaubt es klinische Frage- und Problemstellungen in eine nutzerfreundliche und vor allem praxistaugliche Lösung zu überführen. Als übergeordnetes Ziel wird die patientenindividuelle Behandlung und Versorgung verfolgt. In einem aus dem Netzwerk entstandenen Projekt werden beispielsweise patientenindividuell gefertigten stereotaktischen Rahmen entwickelt, um hochpräzise neurochirurgische Eingriffe durchzuführen. Die Technologie des 3D-Druckes ermöglicht hierbei die benötigten Geometrien mit entsprechender Genauigkeit zu fertigen und stellt auch die Basis für weitere Projekte, welche sich mit patientenspezifischen Implantaten im Bereich der Neurochirurgie beschäftigen

Akquise biomechanischer Eigenschaften am humanen Knochen mittels Laservibrometrie - Möglichkeiten und Grenzen: Vortrag gehalten beim Deutschen Kongress für Orthopädie und Unfallchirurgie, DKOU 2014, 28.10. - 31.10.2014, Berlin

Für die Beurteilung der Verankerungsstabiltität von Revisionspfannen in der Hüftendoprothetik ist die Nutzung von Finite-Elemente-Modellen unerlässlich. Aus Computertomographiedaten können die entsprechenden Modelle nach der Segmentierung und über Materialabbildungsfunktionen generiert werden. Eine verlässliche Aussage ist dabei nur mit verifizierten Modellen möglich. Über die Untersuchung der modalen Parameter von humanen Hüftbeinen wurden verschiedene Ansätze für die Erstellung patientenindividueller Simulationsmodelle überprüft. Zum Einsatz kam dabei ein 3D-Laservibrometer

Medizinische Vorrichtung zum Durchführen einer Biopsie und Verfahren zum Herstellen der medizinischen Vorrichtung

Die vorliegende Erfindung betrifft eine medizinische Vorrichtung zum Durchführen einer Biopsie an einem Bereich (2) eines zu untersuchenden Körpers (8) und ein Verfahren zum Herstellen der medizinischen Vorrichtung. Die medizinische Vorrichtung weist mindestens drei Anschlusselementen (1) zum Anbringen der Vorrichtung an dem Bereich (2) des Körpers (8) oder zum Anbringen der Vorrichtung an Verankerungselemente, die an dem Bereich (2) des Körpers (8) angeordnet sind, eine Hülse (3) als Führung für ein medizinisches Instrument (6), und ein Verbindungselement (4) auf, durch das die mindestens drei Verankerungselemente (1) mit der Hülse (3) verbunden sind. Zumindest das Verbindungselement (4) ist aus einem Leichtbauwerkstoff ausgebildet

Application of shape memory alloys for active loosening protection of implant structures: Presentation held at Indo-German Workshop "Strategies for improved bone replacement materials and orthopaedic implants: Design - manufacturing - technologies", 19-21 February 2014, Dresden

As an alternative to the fixation with cement or by increasing the screw diameter in injured osseous environment a new screw concept was tested. Firstly the topology of the shape memory alloy (SMA) actuators was optimized using a parameter study. The resulting concept represents a compromise between maximal resistance against translational and rotational movement and the complexity of the actuator. It consists of two along the screw axis running SMA sheets made of NiTi alloy which expand fully by body temperature. The actuators were integrated into a screw demonstrator (Figure 1). First tests according to standard ASTM F543 with bone substitutes and alcohol fixated cervical and thoracic vertebrae by tensile were promising. The pullout strength increased from 432 N to 542 N with bone substitutes and from 240 N up to 293 N by using a human vertebra. The feasibility study shows that SMA actuators are suitable to increase the pullout strength of a pedicle screw. The actuator concept was also used for an adaptive hip stem implant. In non-cemented hip implants, stem loosening can be caused by changes in the applied force and insufficient load transmission between implant and osseous anchor bedding. The target is to achieve a homogeneous force distribution at the implant-bone interface by using SMA. The active components were integrated in hip stems with a new designed surface and inner structures (Figure 2). The results proved that the frictional connection between a stem prosthesis anchored without cement and the femur can be achieved using SMA elements. So there is a potential to stabilize the prosthesis and increase ist lifetime