An overview of existing head supports for people with reduced or altered head mobility: current solutions and future developments

The first objective of this research was to create an overview of existing assistive devices for supporting the head of people with decreased or altered head mobility. The second objective was to identify future research opportunities, also by investigating what functionalities are still missing in the current head support solutions. A systematic literature review was performed, combined with searches in technology manufacturer databases and websites, to get an overview of existing head support solutions. Expert opinions were gathered, as well as feedback from a number of head support users by means of semi-structured interviews. A database was constructed from the assistive devices that were found. Devices were categorized with respect to type of interface with the user, functionality and amount of adjustability in the system. Existing solutions that stabilize the head are mainly static, meaning that the head can only be stabilized in one position. Some systems offer freedom of movement but do not really support the head. Additionally, some systems can be configured such that there is a certain level of adaptability to the user. However, if head support systems are adjustable, most often it are systems which enable the caregiver and/or end user to manually change the head support to another position. Based on feedback from experts and users it can be concluded that there is a need for assistive devices that provide independent adjustability in such a way that changes in position of the trunk and head are combined with continuous stabilization. Combining this need with current developments in robotic assistive devices, recommendations are given for future research on head supports

An overview of head support solutions for people with reduced or altered head mobility

Objective: To create an overview of existing assistive devices for supporting the head of people with decreased or altered head mobility. Additionally, to investigate if there are any functionalities missing in the current head support solutions. Search strategy: A systematic literature review was performed, combined with searches in technology manufacturer databases and websites, to get an overview of existing head support solutions. Expert opinions were gathered, as well as feedback from a number of head support users by means of semi-structured interviews. Selection of articles: A database was constructed from the assistive devices that were found. Evaluation of articles and results: Devices were categorized with respect to type of interface with the user, functionality and amount of adjustability in the system. Conclusion: Existing solutions that stabilize the head are mainly static, meaning that the head can only be stabilized in one position. Some systems offer freedom of movement but do not really support the head. Additionally, some systems can be configured such that there is a certain level of adaptability to the user. However, if head support systems are adjustable, most often it are systems which enable the caregiver and/or end user to manually change the head support to another position. Based on feedback from experts and users there can be concluded that there is a need for assistive devices that provide independent adjustability in such a way that changes in position of the trunk and head are combined with continuous stabilization

Effects of intranasal insulin application on the hypothalamic BOLD response to glucose ingestion

Abstract The hypothalamus is a crucial structure in the brain that responds to metabolic cues and regulates energy homeostasis. Patients with type 2 diabetes demonstrate a lack of hypothalamic neuronal response after glucose ingestion, which is suggested to be an underlying cause of the disease. In this study, we assessed whether intranasal insulin can be used to enhance neuronal hypothalamic responses to glucose ingestion. In a randomized, double-blinded, placebo-controlled 4-double cross-over experiment, hypothalamic activation was measured in young non- diabetic subjects by determining blood-oxygen-level dependent MRI signals over 30 minutes before and after ingestion of 75 g glucose dissolved in 300 ml water, under intranasal insulin or placebo condition. Glucose ingestion under placebo condition lead to an average 1.4% hypothalamic BOLD decrease, under insulin condition the average response to glucose was a 2.2% decrease. Administration of water did not affect the hypothalamic BOLD responses. Intranasal insulin did not change circulating glucose and insulin levels. Still, circulating glucose levels showed a significant dampening effect on the BOLD response and insulin levels a significant strengthening effect. Our data provide proof of concept for future experiments testing the potential of intranasal application of insulin to ameliorate defective homeostatic control in patients with type 2 diabetes

How could the service delivery process of dynamic arm supports be optimized?

BACKGROUND: The service delivery process of dynamic arm support (DAS) is complex. Obtaining an optimal match between user and DAS depends on a variety of interrelated factors, different professionals are involved, and the market of available solutions is evolving. OBJECTIVE: To determine how the service delivery process of DAS could be optimized. METHODS: Interviews with DAS users that retrospectively focused on the experienced service delivery process, which was compared to the general Dutch prescription guideline. Results were presented in a focus group session to seven DAS consultants, and subsequently verified by a member-check. RESULTS: Sixteen people who considered the Gowing (a DAS new on the market) as a solution and seven DAS consultants participated. Aspects that can be optimized in the current service delivery process included an improved cooperation between clients, professionals and consultants, increased knowledge of DAS in professionals, an embedded user evaluation, and timely delivery. CONCLUSIONS: It is recommended that the service delivery process is optimized by developing a DAS specific prescription framework. The issues identified in this study should be addressed in this framework. For this additional knowledge on how to optimally match persons and DAS is needed

The Effect of Multidisciplinary Lifestyle Intervention on the Pre- and Postprandial Plasma Gut Peptide Concentrations in Children with Obesity

Objective. This study aims to evaluate the effect of a multidisciplinary treatment of obesity on plasma concentrations of several gut hormones in fasting condition and in response to a mixed meal in children. Methods. Complete data were available from 36 obese children (age 13.3 ± 2.0 yr). At baseline and after the 3-month multidisciplinary treatment, fasting and postprandial blood samples were taken for glucose, insulin, ghrelin, peptide YY (PYY), and glucagon-like peptide 1 (GLP-1). Results. BMI-SDS was significantly reduced by multidisciplinary treatment (from 4.2 ± 0.7 to 4.0 ± 0.9, P < .01). The intervention significantly increased the area under the curve (AUC) of ghrelin (from 92.3 ± 18.3 to 97.9 ± 18.2 pg/L, P < .01), but no significant changes were found for PYY or GLP-1 concentrations (in fasting or postprandial condition). The insulin resistance index (HOMA-IR) remained unchanged as well. Conclusion. Intensive multidisciplinary treatment induced moderate weight loss and increased ghrelin secretion, but serum PYY and GLP-1 concentrations and insulin sensitivity remained unchanged

Pharmacological Modulation of Dopamine Receptor D2-Mediated Transmission Alters the Metabolic Phenotype of Diet Induced Obese and Diet Resistant C57Bl6 Mice

High fat feeding induces a variety of obese and lean phenotypes in inbred rodents. Compared to Diet Resistant (DR) rodents, Diet Induced Obese (DIO) rodents are insulin resistant and have a reduced dopamine receptor D2 (DRD2) mediated tone. We hypothesized that this differing dopaminergic tone contributes to the distinct metabolic profiles of these animals. C57Bl6 mice were classified as DIO or DR based on their weight gain during 10 weeks of high fat feeding. Subsequently DIO mice were treated with the DRD2 agonist bromocriptine and DR mice with the DRD2 antagonist haloperidol for 2 weeks. Compared to DR mice, the bodyweight of DIO mice was higher and their insulin sensitivity decreased. Haloperidol treatment reduced the voluntary activity and energy expenditure of DR mice and induced insulin resistance in these mice. Conversely, bromocriptine treatment tended to reduce bodyweight and voluntary activity, and reinforce insulin action in DIO mice. These results show that DRD2 activation partly redirects high fat diet induced metabolic anomalies in obesity-prone mice. Conversely, blocking DRD2 induces an adverse metabolic profile in mice that are inherently resistant to the deleterious effects of high fat food. This suggests that dopaminergic neurotransmission is involved in the control of metabolic phenotype

Coupled wake boundary layer model of wind-farms

We present and test the coupled wake boundary layer (CWBL) model that describes the distribution of the power output in a wind-farm. The model couples the traditional, industry-standard wake model approach with a "top-down" model for the overall wind-farm boundary layer structure. This wake model captures the effect of turbine positioning, while the "top-down" portion of the model adds the interactions between the wind-turbine wakes and the atmospheric boundary layer. Each portion of the model requires specification of a parameter that is not known a-priori. For the wake model, the wake expansion coefficient is required, while the "top-down" model requires an effective spanwise turbine spacing within which the model's momentum balance is relevant. The wake expansion coefficient is obtained by matching the predicted mean velocity at the turbine from both approaches, while the effective spanwise turbine spacing depends on turbine positioning and thus can be determined from the wake model. Coupling of the constitutive components of the CWBL model is achieved by iterating these parameters until convergence is reached. We illustrate the performance of the model by applying it to both developing wind-farms including entrance effects and to fully developed (deep-array) conditions. Comparisons of the CWBL model predictions with results from a suite of large eddy simulations (LES) shows that the model closely represents the results obtained in these high-fidelity numerical simulations. A comparison with measured power degradation at the Horns Rev and Nysted wind-farms shows that the model can also be successfully applied to real wind-farms.Comment: 25 pages, 21 figures, submitted to Journal of Renewable and Sustainable Energy on July 18, 201

Low dystrophin levels are insufficient to normalize the neuromuscular synaptic abnormalities of mdx mice

Neurological Motor Disorder