Why orthotic devices could be of help in the management of Movement Disorders in the young

BACKGROUND: Movement Disorders (MD) are a class of disease that impair the daily activities of patients, conditioning their sensorimotor, cognitive and behavioural capabilities. Nowadays, the general management of patients with MD is based on rehabilitation, pharmacological treatments, surgery, and traditional splints. Although some attempts have been made to devise specific orthoses for the rehabilitation of patients affected by MD, especially the younger ones, those devices have received limited attention. MAIN BODY: This paper will principally discuss the case of upper limb rehabilitation in Childhood Dyskinesia (CD), a complex motor disease that affects paediatric patients. Through a critical review of the present solutions and a discussion about the neurophysiological characteristics of the disease, the study will lead to the formulation of desirable features of a possible new upper-limb orthosis. CONCLUSIONS: Design principles will be derived to provide specialised orthoses for the dynamic control of posture and the stabilisation of voluntary movements: those include using biomechanical actions and enhanced proprioception to support the sensorimotor rehabilitation of the children affected by CD. A similar approach could be advantageously applied in other MD-related conditions, especially with hyperkinetic and/or hypertonic traits

Primary Sensory and Motor Cortex Activities During Voluntary and Passive Ankle Mobilization by the SHADE Orthosis

n/

Computational fluid dynamics modelling in cardiovascular medicine

This paper reviews the methods, benefits and challenges associated with the adoption and translation of computational fluid dynamics (CFD) modelling within cardiovascular medicine. CFD, a specialist area of mathematics and a branch of fluid mechanics, is used routinely in a diverse range of safety-critical engineering systems, which increasingly is being applied to the cardiovascular system. By facilitating rapid, economical, low-risk prototyping, CFD modelling has already revolutionised research and development of devices such as stents, valve prostheses, and ventricular assist devices. Combined with cardiovascular imaging, CFD simulation enables detailed characterisation of complex physiological pressure and flow fields and the computation of metrics which cannot be directly measured, for example, wall shear stress. CFD models are now being translated into clinical tools for physicians to use across the spectrum of coronary, valvular, congenital, myocardial and peripheral vascular diseases. CFD modelling is apposite for minimally-invasive patient assessment. Patient-specific (incorporating data unique to the individual) and multi-scale (combining models of different length-And time-scales) modelling enables individualised risk prediction and virtual treatment planning. This represents a significant departure from traditional dependence upon registry-based, populationaveraged data. Model integration is progressively moving towards 'digital patient' or 'virtual physiological human' representations. When combined with population-scale numerical models, these models have the potential to reduce the cost, time and risk associated with clinical trials. The adoption of CFD modelling signals a new era in cardiovascular medicine. While potentially highly beneficial, a number of academic and commercial groups are addressing the associated methodological, regulatory, education-And service-related challenges

Strength assessment and strength training in pulmonary rehabilitation

Chronic obstructive pulmonary disease (COPD) is a major disease with high prevalence, mortality, and morbidity. A commonly associated impairment is muscle weakness, which is considered an important systemic marker of the condition and is argued to be an essential variable for assessment and treatment. One successful treatment for COPD is pulmonary rehabilitation (PR), which is a comprehensive programme of exercise and education. Strength training (ST) is recommended in PR to target muscle weakness, along with the assessment of patient muscle strength. However, the use and impact of strength assessment (SA) and ST in PR clinical practice is unclear. First, this thesis conducted a narrative literature review to summarise and synthesise the most relevant literature surrounding SA and ST in COPD and PR. Next, two qualitative studies were carried out, exploring the perspectives and experiences of practitioners (n=11) and patients (n=12) in relation to SA and ST. Lastly, a survey of practitioners (n=219) investigated SA and ST use in PR services across England, as well as practitioner training, attitudes, and perceived barriers. Descriptive data was collected, and further statistical analyses performed that explored predictive factors of use/non-use. The findings show markedly limited guidance for the use of SA and ST in PR. Services report fulfilling basic recommendations, but methods in clinical practice vary. Feasibility is an essential consideration and another explanation for variance, specifically the impact of service-related barriers and differing resources. Staff training is an area of improvement, as many practitioners do not have relevant training despite SA and ST being included in PR programmes. Lastly, findings highlight the importance of patients having the necessary understanding, with education and support identified as a means of facilitation. Overall, successful implementation and use of SA and ST in PR clinical practice is multifactorial - influenced by services, practitioners, and patients

Contribution to the fluid dynamic study of reconstructed aortic arch

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Applications of Shape Memory Alloys for Neurology and Neuromuscular Rehabilitation

Shape memory alloys (SMAs) are a very promising class of metallic materials that display interesting nonlinear properties, such as pseudoelasticity (PE), shape memory effect (SME) and damping capacity, due to high mechanical hysteresis and internal friction. Our group has applied SMA in the field of neuromuscular rehabilitation, designing some new devices based on the mentioned SMA properties: in particular, a new type of orthosis for spastic limb repositioning, which allows residual voluntary movement of the impaired limb and has no predetermined final target position, but follows and supports muscular elongation in a dynamic and compliant way. Considering patients in the sub-acute phase after a neurological lesion, and possibly bedridden, the paper presents a mobiliser for the ankle joint, which is designed exploiting the SME to provide passive exercise to the paretic lower limb. Two different SMA-based applications in the field of neuroscience are then presented, a guide and a limb mobiliser specially designed to be compatible with diagnostic instrumentations that impose rigid constraints in terms of electromagnetic compatibility and noise distortion. Finally, the paper discusses possible uses of these materials in the treatment of movement disorders, such as dystonia or hyperkinesia, where their dynamic characteristics can be advantageous