Why the mask? The effectiveness of face masks in preventing the spread of respiratory infections such as COVID-19 - a home testing protocol.

Since the start of the COVID-19 pandemic there has been much debate in the media on whether masks should be worn to stop the spread of the virus. There are two ways in which they could work. Firstly, to protect the person wearing the mask, and secondly, to reduce the likelihood of the person wearing the mask passing the disease on to anyone else. This is not an easy issue to address and many factors come into play such as droplet size, aerosol transmission and the viral load, as well as the specific properties of any given mask. The method used in this study was to measure the change in relative humidity when wearing a mask, compared to no mask, in various scenarios, based on the assumption that as the virus is air-borne the smaller the increase in humidity the less the spread of the virus. The results above show that the use of a mask, excluding some simple home-made ones, significantly reduces the spread of humidity. However, their effectiveness is device specific and needs to be considered in greater detail for each type of mask, especially the direction of escaping air when forward flow is blocked

Sensors for triggering practical Functional Electrical Stimulation walking systems

Functional Electrical Stimulation (FES) techniques have shown significant improvement in mobility and functionality to many patients with pathological gait resulting from upper motor neurological injuries such as stroke, Multiple Sclerosis (MS), etc. Effective functioning of FES walking systems relies on accurate and reliable detection of gait events (i.e heel rise and heel strike) which depends on the type of sensors and the detection algorithm used

Training and orthotic effects related to functional electrical stimulation of the peroneal nerve in stroke.

OBJECTIVE: To examine the evidence for a training effect on the lower limb of functional electrical stimulation. DESIGN: Cohort study. PATIENTS: A total of 133 patients >6 months post-stroke. METHODS: Training and orthotic effects were determined from walking speed over 10 m, associated minimal and substantial clinically important differences (i.e. >0.05 and >0.10 m/s), and Functional Ambulation Category (FAC), ranging from household walking to independent walking in the community. RESULTS: An overall significant (p < 0.01) training effect was found that was not a clinically important difference (0.02 m/s); however, "community" FAC (≥ 0.8 m/s) and "most limited community walkers" FAC (0.4-0.58 m/s), but not "household walkers" (< 0.4 m/s), benefitted from a clinically important difference. A highly significant (p< 0.001), substantial clinically important orthotic effect (0.10 m/s) was found. In terms of overall improvement of one or more FACs, 23% achieved this due to a training effect, compared with 43% due to an orthotic effect. CONCLUSION: The findings suggest that functional electrical stimulation provides a training effect in those who are less impaired. Further work, which optimizes the use of the device for restoration of function, rather than as an orthotic device, will provide greater clarity on the effectiveness of functional electrical stimulation for eliciting a training effect

The safety of electrical stimulation in patients with pacemakers and implantable cardioverter defibrillators: A systematic review

Introduction: A number of patients are excluded from electrical stimulation treatment because there is concern that electrical stimulation could cause electromagnetic interference with pacemakers and implanted cardioverter defibrillators. The decision to use electrical stimulation in these patients needs to be supported by an assessment of benefit and harm. Methods: We conducted a systematic review of the risk of electromagnetic interference between electrical stimulation and pacemakers or implanted cardioverter defibrillators. We included the electronic databases MEDLINE and EMBASE in the time period between 1966 and 26 August 2016. Results: 18 papers fulfilled the inclusion criteria (eight safety studies and ten case studies). Although we were unable to accurately estimate the risk of electromagnetic interference, the studies revealed that patients having electrical stimulation of the lower limb are less susceptible to electromagnetic interference. Conclusions: The results suggest that electrical stimulation could be used safely to help drop foot in patients with pacemakers or implanted cardioverter defibrillators. However, in order to obtain an accurate estimate of the risk of electromagnetic interference, a large, long-term, and intervention-specific safety study is required. Until such a study is undertaken, electrical stimulation should be used with caution in patients with pacemakers and implanted cardioverter defibrillators

Quality of life and cost effectiveness following the use of Functional Electrical Stimulation (FES) of the peroneal nerve for people with multiple sclerosis

There is a large gap in quality of life for people with MS and the general population. FES is an effective intervention for dropped foot reducing falls by 72% (1), with a mean usage of 4.9 years (2). Improving health related quality of life and cost effectiveness are a priority for the national health system in the UK, who have set a cost effectiveness threshold of £20,000(€24,218) per Quality Adjusted Life Year (QALY) under which interventions will be considered. Method: 45 people with multiple sclerosis (mean age 53, range 40-70) and foot drop completed the EQ-5D-5L (Euroqol) quality of life questionnaire before and after using FES for 20 weeks. Index values were calculated using the latest available value set and checked with the crosswalk value set (3). QALY gain was calculated by multiplying the utility value by the average length of time of FES use, discounted at 3.5% per year. The mean cost minus the expected cost saving due to falls prevention was divided by the QALY gain to give the mean net cost per QALY. Results: The mean index value before treatment (0.542) was highly significant compared to after treatment (0.656) (t=-4.68, p< 0.001), providing a utility value of 0.114 which works out to 0.542 when extrapolated to 4.9 years. The cost of providing FES for 4.9 years is £3095(€3,742)(1), giving a cost per QALY of £5,705(€6,901). However, it is estimated that the reduction of falls may result in a cost saving of £375(€454) per year, bringing the net cost to £1,256(€1,519) and cost per QALY to £2,316(€2,801). Conclusion: These preliminary results must be treated with caution as the data used was taken from three different studies. Nevertheless the analysis indicates that FES is associated with improved health related quality of life and is well within cost effectiveness thresholds

The use and effect of video game design theory in the creation of game-based systems for upper limb stroke rehabilitation

Upper limb exercise is often neglected during post-stroke rehabilitation. Video games have been shown to be useful in providing environments in which patients can practise repetitive, functionally meaningful movements, and in inducing neuroplasticity. The design of video games is often focused upon a number of fundamental principles, such as reward, goals, challenge and the concept of meaningful play, and these same principles are important in the design of games for rehabilitation. Further to this, there have been several attempts for the strengthening of the relationship between commercial game design and rehabilitative game design, the former providing insight into factors that can increase motivation and engagement with the latter. In this article, we present an overview of various game design principles and the theoretical grounding behind their presence, in addition to attempts made to utilise these principles in the creation of upper limb stroke rehabilitation systems and the outcomes of their use. We also present research aiming to move the collaborative efforts of designers and therapists towards a model for the structured design of these games and the various steps taken concerning the theoretical classification and mapping of game design concepts with intended cognitive and motor outcomes