Design and implementation of robotic devices for physical therapy of distal upper extremity

According to statistics of World Health Organization, hand injuries count for 1/3 of all injuries with more than one million emergency cases annually. Physical rehabilitation accounts for most of the recovery experienced by patients suffering from hand injury. Robotic devices decrease the cost of therapy while providing repetitive exercises with quantitative measurements. In this study, we present the design and implementation of two robotic devices for hand therapy. After kinematic type selection ensuring safety, ergonomics and adjustability; both of the devices are optimally dimensioned to achieve best kinematic and dynamic performance. The primary use for the first device is to assist flexion/extension motions of a finger within its full range, in a natural and coordinated manner, while keeping the tendon tension within acceptable limits to avoid rupture of the suture. The second device is designed for forearm/wrist and grasp therapy of a neurologically injured human arm and hand. Emphasizing the importance of coordinated movements of the wrist and the hand while performing activities of daily living (ADL) tasks, the device possesses 3 degrees of freedom and is designed to assist abduction/adduction and palmar/dorsal flexion of the wrist or pronation/supination of the forearm, concurrently with the grasping and releasing movements of the hand. Thanks to its modular, interchangeable end effectors, the device supports ADL exercises. Both devices are built and experimentally characterized. Human subject experiments and usability tests have been conducted for the devices and the efficacy of devices to deliver desired wrist and hand therapies have been demonstrated

Konik Işın Hüzmeli Bilgisayarlı Tomografi Kullanılan bir Vakada İnternal Rezorbtif Defektlerin Tedavisi

İnternal kök rezorbsiyonunun etiyolojisi tam olarak anlaşılamamıştır. Travma ve kronik pulpitis ana risk faktörleri olarak düşünülmektedir. Proses genellikle asemptomatiktir ve rutin radyografik inceleme sırasında teşhis edilir. 30 yaşında erkek hasta, üst çene lateral dişine kompozit dolgu sonrasında gece ağrısı ve şişlik şikayetleriyle fakülte kliniğine başvurdu. Radyografik inceleme üst çene santral kesicilerde internal rezorbsiyon olduğunu ortaya çıkardı. Konik ışın hüzmeli bilgisayarlı tomografi incelemesi bu durumu doğruladı. Üç dişe kök kanal tedavisi uygulandı, ancak lateral kesicinin kök kanalı apikal üçlüye ulaşmaya müsaade etmedi. Bu nedenle tedavi planlamasına ek olarak cerrahi uygulamada eklendi. Bu vaka raporu üst çene kesici dişlerdeki internal rezobsiyona ortograd ve lateral kesiciye ise retrograd uygulamayı anlatmaktadır

A multi-functional rehabilitation device to assist forearm/wrist and grasp therapies

We present a novel rehabilitation device for forearm/wrist and grasp therapy of a neurologically injured human arm and hand. Emphasizing the importance of coordinated movements of the wrist and hand while performing activities of daily living (ADL) tasks, the device is designed to assist abduction/adduction and palmar/dorsal flexion of the wrist and pronation/supination of the forearm, concurrently with grasping and releasing movements of hand. Thanks to its modular, interchangeable end-effectors, the device supports ADL exercises, such as door opening. It can also be used as a measurement device, to characterize the range of motion and the isometric strength of the injured forearm/wrist and hand. Usability studies have been conducted and accuracy of the measurements provided with the device has been characterized

AssistOn-Finger: An under-actuated finger exoskeleton for robot-assisted tendon therapy

We present AssistOn-Finger, a novel under-actuated active exoskeleton for robot-assisted tendon therapy of human fingers. The primary use for the exoskeleton is to assist flexion/extension motions of a finger within its full range, while decreasing voluntary muscle contractions helping to keep the tendon tension levels to stay within acceptable limits, avoiding gap formation or rupture of the suture. The device can also be employed to administer range of motion (RoM)/strengthening exercises. AssistOn-Finger is designed to be passively back-driveable, can cover the whole RoM of patients, and can do so in a natural and coordinated manner. In particular, the device employs human finger as an integral part of its kinematics and when coupled to a human operator, the parallel kinematic structure of exoskeleton supports three independent degrees of freedom, dictated by the kinematics of the human finger. Automatically aligning its joint axes to match finger joint axes, AssistOn-Finger can guarantee ergonomy and comfort throughout the therapy. The self-aligning feature also significantly shortens the setup time required to attach the patient to the exoskeleton. We present the kinematic type selection for the exoskeleton to satisfy the design requirements for tendon therapy applications, detail optimal dimensional synthesis of the device considering trade-offs between multiple design criteria and discuss implementation details of the exoskeleton. We also present feasibility studies conducted on healthy volunteers and provide statistical evidence on the efficacy of exoskeleton driven exercises in keeping the average muscle recruitment and the maximum tendon tension levels as low as human guided therapies

Finger exoskeleton for treatment of tendon injuries

A finger exoskeleton has been developed to aid treatment of tendon injuries. The exoskeleton is designed to assist flexion/extension motions of a finger within its full range, in a natural and coordinated manner, while keeping the tendon tension within acceptable limits to avoid gap formation or rupture of the suture. In addition to offering robot assisted operation modes for tendon therapies, the exoskeleton can provide quantitative measures of recovery that can help guide the physical therapy program. Usability studies have been conducted and efficacy of exoskeleton driven exercises to reduce muscle requitement levels has been demonstrated

The prevalence of microalbuminuria and relevant cardiovascular risk factors in Turkish hypertensive patients.

Objectives: A growing body of data illustrates the importance of microalbuminuria (MAU) as a strong predictor of cardiovascular risk in the hypertensive population. The present study was designed to define the prevalence of MAU and associated cardiovascular risk factors among Turkish hypertensive outpatients. Study design: Representing the Turkish arm of the multinational i-SEARCH study involving 1,750 sites in 26 countries around the world, a total of 1,926 hypertensive patients from different centers were included in this observational and cross-sectional survey study. Patients with reasons for a false-positive MAU test were excluded. The prevalence of MAU was assessed using a dipstick test, and patients were inquired about comorbidities, comedication, and known cardiovascular risk factors. Results: The overall prevalence of MAU was 64.7% and there was no difference between genders. Most of the patients (82.5%) had uncontrolled hypertension, 35.6% had dyslipidemia, and 35.5% had diabetes, predominantly type 2. Almost one-third of the patients (26.4%) had at least one cardiovascular-related comorbidity, with 20.3% having documented coronary artery disease (CAD). Almost all patients (96.8%) had one or more risk factors for cardiovascular disease in addition to hypertension, including family history of myocardial infarction or CAD, diabetes, dyslipidemia, lack of physical exercise, and smoking. A trend towards higher MAU values in the presence of CAD was determined. Conclusion: Microalbuminuria tests should be routinely used as a screening and monitoring tool for the assessment of subsequent cardiovascular morbidity and mortality among hypertensive patients. © 2011 Turkish Society of Cardiology