RESUMO
Chiari Malformation (Chiari) is a congenital condition occurring from an inferior herniation of the cerebellar tonsils into the foramen magnum. Given the role of the cerebellum in postural control, it is reasonable to expect joint motion to be affected in this patient population. In fact, joint stiffness is a common self-reported symptom of Chiari, however it has never been assessed in these individuals. This study aimed to examine if ankle joint quasi-stiffness is correlated with Chiari severity. The human body was considered as an inverted oscillating pendulum without damping. A Fast Fourier Transform was used to extract natural frequency from the center of pressure trajectories during upright standing. Ankle joint quasi-stiffness was then calculated using the relationship between natural frequency and moment of inertia. Twelve Chiari participants (Chiari), six with decompression surgery (Chiari-D) and six without (Chiari-ND), and eight control individuals (Control) participated. Participants completed three, 30-second quiet standing trials on a force plate, focused on a target three meters in front of them. Chiari, regardless of surgery, had significantly lower quasi-stiffness than controls (Chiari-D vs. Control p = 0.0011, Chiari-ND vs. Control, p < 0.001). The proposed method is advantageous as it incorporates the entire center of pressure signal, minimizes error from instantaneous muscular dynamics, and does not require motion capture.
Assuntos
Articulação do Tornozelo , Malformação de Arnold-Chiari , Humanos , Malformação de Arnold-Chiari/fisiopatologia , Feminino , Adulto , Masculino , Articulação do Tornozelo/fisiopatologia , Posição Ortostática , Fenômenos Biomecânicos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Shape memory alloys (SMAs) are well-known for their unique ability to undergo a shape change in response to a thermal stimulus. A frequently-used SMA for biomedical devices is NiTi, although its superelastic features tend to be emphasized more than the ability to change shape. Minimally invasive NiTi implants which can reconfigure or adjust their shape across several temperature points could provide desirable surgical outcomes. For decades, therapeutic ultrasound has been used medically as a non-invasive method for tissue thermal therapy. Ultrasound's ability to quickly raise temperatures, and transcutaneously activate shape changes in NiTi implants is a novel approach for eliciting the martensitic thermoelastic transformation. METHODS: The purpose of this study was to investigate the features of therapeutic ultrasound that correspond with temperature changes in different NiTi specimens. For this purpose, ultrasound was applied to two NiTi specimens for two minutes each at varying low- and high-frequency and power settings using a Sonicator 740 and a Dynatron 150. FINDINGS: The baseline temperature for all 32 trials was room temperature (23.0 ± 1.7°C). This study successfully increased the specimen temperature with the application of Sonicator 740 and Dynatron 150 therapeutic ultrasound machines (2.2 ± 2.4°C and 1.5 ± 1.15°C, respectively). From the statistical analyses of the experimental data, it was clear that there is a significant difference between low- and high-power settings on mean temperature change using the Dynatron 150 (ANCOVA; p = 0.013). Interpretation Of clinical relevance, NiTi implants can quickly and easily increase in temperature when applying therapeutic ultrasound. Ultrasound power causes temperature changes and should be accounted for when designing orthopedic implants for applications where dimensional changes are desirable.
Assuntos
Próteses e Implantes , Titânio , TemperaturaRESUMO
Diabetic foot ulcers are a complex, multifaceted, and widespread complication of diabetes mellitus. Although there are a multitude of risk factors contributing to diabetic foot ulcer development, pressure and (more recently) shear stresses are two biomechanical metrics that are gaining popularity for monitoring risk factors predisposing skin breakdown. Other areas of diabetic foot ulcers under research include plantar temperature measuring, as well as monitoring wear-time compliance and machine learning/AI algorithms. Charcot arthropathy is another diabetes complication that has a relationship with diabetic foot ulcer development, which should be monitored for development alongside ulcer development. The ability to monitor and prevent diabetic foot ulcer development and Charcot neuroarthropathy will lead to increased patient outcomes and patient quality of life.
Assuntos
Artropatia Neurogênica , Diabetes Mellitus , Pé Diabético , Humanos , Pé Diabético/complicações , Qualidade de Vida , Fatores de RiscoRESUMO
BACKGROUND: High impact sports are associated with an increased incidence rate for knee ligament injuries, specifically pertaining to the anterior cruciate ligament and medial collateral ligament. What is less clear is (i) the extent to which high impact activities preferentially load the anterior cruciate ligament versus the medial collateral ligament, and (ii) whether both ligaments experience similar stretch ratios during high loading scenarios. Therefore, the goal of this project was to assess how different loading conditions experienced through more at-risk sporting maneuvers influence the relative displacements of the anterior cruciate ligament and medial collateral ligament. The focus of the study was on adolescent patients - a group that has largely been overlooked when studying knee ligament biomechanics. METHODS: Through kinetic knee data obtained through motion capture experimentation, two different loading conditions (high vs low impact) were applied to 22 specimen-specific adolescent finite element knee models to investigate the biomechanical impact various sporting maneuvers place on the knee ligaments. FINDINGS: The high impact side cutting maneuver resulted in 102% and 47% increases in ligament displacement compared to the low impact baseball swing (p < 0.05) for both the anterior cruciate ligament and medial collateral ligament. INTERPRETATION: Quantifying biomechanical risks that sporting activities place on adolescent subjects provides physicians with insight into knee ligament vulnerability. More specifically, knowing the risks that various sports place on ligaments helps guide the selection of sports for at-risk patients (especially those who have undergone knee ligament surgery).
Assuntos
Lesões do Ligamento Cruzado Anterior , Beisebol , Ligamento Colateral Médio do Joelho , Humanos , Adolescente , Ligamento Colateral Médio do Joelho/lesões , Articulação do Joelho , Ligamento Cruzado Anterior , Fenômenos BiomecânicosRESUMO
Advanced prosthetic knees for transfemoral amputees are currently based on controlled damper mechanisms. Such devices require little energy to operate, but can only produce negative or zero joint power, while normal knee joint function requires alternative phases of positive and negative work. The inability to generate positive work may limit the user's functional capabilities, may cause undesirable adaptive behavior, and may contribute to excessive metabolic energy cost for locomotion. In order to overcome these problems, we present a novel concept for an energy-storing prosthetic knee, consisting of a rotary hydraulic actuator, two valves, and a spring-loaded hydraulic accumulator. In this paper, performance of the proposed device will be assessed by computational modeling and by simulation of functional activities. A computational model of the hydraulic system was developed, with methods to obtain optimal valve control patterns for any given activity. The objective function for optimal control was based on tracking of joint angles, tracking of joint moments, and the energy cost of operating the valves. Optimal control solutions were obtained, based on data collected from three subjects during walking, running, and a sit-stand-sit cycle. Optimal control simulations showed that the proposed device allows near-normal knee function during all three activities, provided that the accumulator stiffness was tuned to each activity. When the energy storage mechanism was turned off in the simulations, the system functioned as a controlled damper device and optimal control results were similar to literature data on human performance with such devices. When the accumulator stiffness was tuned to walking, simulated performance for the other activities was sub-optimal but still better than with a controlled damper. We conclude that the energy-storing knee concept is valid for the three activities studied, that modeling and optimal control can assist the design process, and that further studies using human subjects are justified.
Assuntos
Simulação por Computador , Prótese do Joelho , Desenho de Prótese , Humanos , Fenômenos Mecânicos , Fatores de Tempo , CaminhadaRESUMO
A variety of physiological changes are experienced by astronauts during both short- and long-duration space missions. These include space motion sickness, spatial disorientation, orthostatic hypotension, muscle atrophy, bone demineralization, increased cancer risk, and a compromised immune system. This review focuses on countermeasures used to moderate these changes, particularly exercise devices that have been used by National Aeronautics and Space Administration astronauts over the past six decades as countermeasures to muscle atrophy and bone loss. The use of these devices clearly has shown that a microgravity environment places unusual demands on both the equipment and the human users. While it is of paramount importance to overcome microgravity-induced musculoskeletal deconditioning, it also is imperative that the exercise system (i) is small and lightweight, (ii) does not require an external power source, (iii) produces 1g-like benefits to both bones and muscles, (iv) requires relatively short durations of exercise, and (v) does not affect the surrounding structure or environment negatively through noise and/or induced vibrations.
Assuntos
Desenho de Equipamento , Exercício Físico/fisiologia , Músculo Esquelético/patologia , Equipamentos Esportivos , Ausência de Peso/efeitos adversos , Atrofia/prevenção & controle , Desmineralização Patológica Óssea/prevenção & controle , Humanos , Voo EspacialRESUMO
BACKGROUND: Chiari Malformation (CM) is a congenital disorder occurring when the cerebellar tonsils descend into the foramen magnum, inhibiting cerebrospinal fluid (CSF) flow, causing headaches, dizziness, difficulty swallowing, muscle weakness, and loss of neuromuscular coordination. While there is no cure, surgical decompression of the hindbrain is used to alleviate symptoms. Loss of postural control is a main symptom reported by these patients; however, no study has examined postural stability in this cohort of patients. RESEARCH QUESTION: Do patients with CM exhibit impaired postural stability compared to healthy controls?. METHODS: Twelve female participants diagnosed with CM performed a postural stability test where six participants had undergone decompression (CM-D) surgery while six had not (CM-ND). Participants stood in Romberg fashion on an AMTI force plate according to an IRB-approved protocol. Postural stability measures were quantified by computing Hurst exponents. These values were determined from the Average Wavelet Coefficient method using a level 12 Symlet-2 wavelet to analyze anterior-posterior (AP) center-ofpressure (COP) trajectories in MATLAB. Identical procedures and analyses were performed on healthy control participants with no known neuromuscular disorders. RESULTS: CM participants displayed significantly impaired postural stability compared to healthy controls (p = 0.0002). CM-D participants displayed significantly impaired postural stability compared to CM-ND (p = 0.002). CM-D and CM-ND both displayed significantly impaired postural stability compared to controls (p < 0.0001 and p < 0.003, respectively). SIGNIFICANCE: Loss of postural stability is considered a main symptom of CM, however no study has previously quantified human postural control in this cohort of patients. Quantifying this relationship can provide further insight to neurologists studying the disorder and to therapists planning rehabilitation and pain relief methods.
Assuntos
Malformação de Arnold-Chiari , Siringomielia , Malformação de Arnold-Chiari/cirurgia , Retroalimentação , Feminino , Forame Magno , Humanos , Imageamento por Ressonância Magnética , Equilíbrio PosturalRESUMO
At present, there are no viable systems that can acquire in-shoe measurement of distributed shear forces. Foot-shoe interactions are such that skin shear is a notoriously difficult quantity to measure under the best of conditions. This is further complicated by the presence of forces normal to the skin surface that are large compared to the shear forces, which often results in crosstalk between pressure and shear signals. The present study used multibody dynamic simulations to investigate the combined effects of (i) coefficient of friction (COF) at skin-sock and sock-sensor interfaces, as well as (ii) sock stiffness on the accuracy of measured shear against the skin. These factors were systematically altered within a wide range (COF: 0.04, 0.34, 0.54, and 0.9; sock stiffness: 100, 250, 500, 1000, 1500 and 2000 N/m) to simulate a total of 96 scenarios. The correlation between the shear at the skin and at the sensor was used to compare each set of conditions. The results indicated that a high COF at the sock-sensor interface and a low sock stiffness would individually result in a significantly higher accuracy of shear measurements (p < 0.001). A low COF at the skin-sock interface was observed to reduce the occurred shear against the skin up to a factor of five, with very minimal effect on the accuracy of shear measurements (p = 0.98). These findings allow researchers to understand the potential effects of (i) sock stiffness, and (ii) coefficients of friction, on skin shear, and potentially correct for the effects of interface materials when trying to determine shear at the skin-sock interface.
Assuntos
Pé , Sapatos , Fricção , Pele , Estresse MecânicoRESUMO
OBJECTIVE: Bone staples are internal fixation devices that are frequently used in the foot, ankle, and hand to provide stabilization. Fixation stability is vital after fusion or fracture surgeries to ensure proper bone healing. Patients undergoing surgeries that require fixation to keep bones aligned and stable may present with diminishing bone mechanical properties, and this may compromise the ability of the fixation hardware to maintain a stable construct. The purpose of this study was to investigate the mechanical performance of shape memory and superelastic nitinol bone staples with different bridge geometries in normal, osteopenic, and osteoporotic bone models. Contact forces and maximum principal stress and strain in the bone were recorded. METHODS: Finite element simulations of a bone staple fixation procedure were performed to examine the initial and post-surgery contact force, as well as the maximum principal stress and strain of 15 mm bridge and 20 mm bridge staple-bone constructs. RESULTS: Shape memory nitinol staples exhibited higher contact forces compared to superelastic nitinol staples. Nitinol bone staples with 20 mm bridge lengths displayed higher contact forces and lower stresses in all bone types, as well as lower strains in osteoporotic bone models compared to nitinol staples with a 15 mm bridge length. CONCLUSION: Nitinol bone staple constructs with 20 mm bridge length staples provide higher contact forces and display lower stresses in the bone than 15 mm bridge staple-bone constructs, which may be beneficial in bone with diminishing mechanical properties. Both superelastic and shape memory effect nitinol staples provide adequate compression and stress relief. However, if osteopenia is present, shape memory effect nitinol staples with a 20 mm bridge length may provide more stress relief and compression, if the bone anatomy allows.
Assuntos
Ligas , Osteoporose , Fenômenos Biomecânicos , Análise de Elementos Finitos , Humanos , SuturasRESUMO
Orthopaedic research on in vitro forces applied to bones, tendons, and ligaments during joint loading has been difficult to perform because of limitations with existing robotic simulators in applying full-physiological loading to the joint under investigation in real time. The objectives of the current work are as follows: (1) describe the design of a musculoskeletal simulator developed to support in vitro testing of cadaveric joint systems, (2) provide component and system-level validation results, and (3) demonstrate the simulator's usefulness for specific applications of the foot-ankle complex and knee. The musculoskeletal simulator allows researchers to simulate a variety of loading conditions on cadaver joints via motorized actuators that simulate muscle forces while simultaneously contacting the joint with an external load applied by a specialized robot. Multiple foot and knee studies have been completed at the Cleveland Clinic to demonstrate the simulator's capabilities. Using a variety of general-use components, experiments can be designed to test other musculoskeletal joints as well (e.g., hip, shoulder, facet joints of the spine). The accuracy of the tendon actuators to generate a target force profile during simulated walking was found to be highly variable and dependent on stance position. Repeatability (the ability of the system to generate the same tendon forces when the same experimental conditions are repeated) results showed that repeat forces were within the measurement accuracy of the system. It was determined that synchronization system accuracy was 6.7+/-2.0 ms and was based on timing measurements from the robot and tendon actuators. The positioning error of the robot ranged from 10 microm to 359 microm, depending on measurement condition (e.g., loaded or unloaded, quasistatic or dynamic motion, centralized movements or extremes of travel, maximum value, or root-mean-square, and x-, y- or z-axis motion). Algorithms and methods for controlling specimen interactions with the robot (with and without muscle forces) to duplicate physiological loading of the joints through iterative pseudo-fuzzy logic and real-time hybrid control are described. Results from the tests of the musculoskeletal simulator have demonstrated that the speed and accuracy of the components, the synchronization timing, the force and position control methods, and the system software can adequately replicate the biomechanics of human motion required to conduct meaningful cadaveric joint investigations.
Assuntos
Pé/fisiologia , Articulação do Joelho/fisiologia , Movimento/fisiologia , Postura/fisiologia , Tendões/fisiologia , Algoritmos , Fenômenos Biomecânicos , Cadáver , Humanos , Movimento (Física) , SoftwareRESUMO
Prosthetic liners and sockets insulate a residual limb, causing excessive heat, sweating, skin irritation and maceration. Circulation of a fluid through the socket wall has been shown to have positive cooling effects on the internal surface of the socket, i.e. skin temperature. Moreover, Phase Change Materials (PCMs) have been recognized as a practical method for cooling garments. These materials, such as water or many synthesized polymers, have a high latent heat and their application within a prosthetic liner allows for absorbing heat from the limb for retaining a constant temperature. In this study, a novel prosthetic socket has been designed and prototyped to investigate the interactive effects of fluid circulation and PCM materials on thermal comfort of prosthetic sockets. The results indicate a statistically significant difference (p-value < 0.001) in the duration a PCM liner can retain the appropriate skin temperature, compared to regular silicone liners. Likewise, the presence of air circulation within the socket wall was shown to have statistically significant influences (p-value = 0.018) on providing the efficient cooling effects compared to regular sockets. Hence, incorporating circulation cooling mechanisms along with PCM liners as proposed in this study holds a promising solution to enhance the thermal comfort of prosthetic socket systems.
Assuntos
Membros Artificiais , Desenho de Prótese , Silicones , Temperatura Cutânea , TemperaturaRESUMO
A total of 39 microbes were screened for the ability to selectively N-demethylate (3R,5S,E)-7-(4-(4-fluorophenyl)-6-isopropyl-2-(methyl(1-methyl-1H-1,2,4-triazol-5-yl)aminopyrimidin-5-yl)-3,5-dihydroxy-hept-6-enoic acid (I), a potential drug for lowering blood cholesterol levels. Two Streptomyces species were found to carry out the desired N-demethylation. Bioconversion by Streptomyces griseus A.T.C.C. 13273 and product recovery were scaled up to the multi-gram level.
Assuntos
Bactérias/metabolismo , Fungos/metabolismo , Pirimidinas/metabolismo , Triazóis/metabolismo , Biotransformação , Metilação , Streptomyces/metabolismoRESUMO
Shear forces under the human foot are thought to be responsible for various foot pathologies such as diabetic plantar ulcers and athletic blisters. Frictional shear forces might also play a role in the metatarsalgia observed among hallux valgus (HaV) and rheumatoid arthritis (RA) patients. Due to the absence of commercial devices capable of measuring shear stress distribution, a number of linear models were developed. All of these have met with limited success. This study used nonlinear methods, specifically neural network and fuzzy logic schemes, to predict the distribution of plantar shear forces based on vertical loading parameters. In total, 73 subjects were recruited; 17 had diabetic neuropathy, 14 had HaV, 9 had RA, 11 had frequent foot blisters, and 22 were healthy. A feed-forward neural network (NN) and adaptive neurofuzzy inference system (NFIS) were built. These systems were then applied to a custom-built platform, which collected plantar pressure and shear stress data as subjects walked over the device. The inputs to both models were peak pressure, peak pressure-time integral, and time to peak pressure, and the output was peak resultant shear. Root-mean-square error (RMSE) values were calculated to test the models' accuracy. RMSE/actual shear ratio varied between 0.27 and 0.40 for NN predictions. Similarly, NFIS estimations resulted in a 0.28-0.37 ratio for local peak values in all subject groups. On the other hand, error percentages for global peak shear values were found to be in the range 11.4-44.1. These results indicate that there is no direct relationship between pressure and shear magnitudes. Future research should aim to decrease error levels by introducing shear stress dependent variables into the models.
Assuntos
Inteligência Artificial , Vesícula/fisiopatologia , Pé Diabético/fisiopatologia , Pé/fisiopatologia , Marcha , Modelos Biológicos , Caminhada , Simulação por Computador , Humanos , Resistência ao CisalhamentoRESUMO
BACKGROUND: One of the more serious diabetic complications is Charcot neuroarthropathy (CN), a disease that results in arch collapse and permanent foot deformity. However, very little is known about the etiology of CN. From a mechanical standpoint, it is likely that there is a ;;vicious circle'' in terms of (i) arch collapse causing increased midfoot joint pressures, and (ii) increased joint contact pressures exacerbating the collapse of midfoot bones. This study focused on assessment of peak joint pressure difference between diabetic and non-diabetic cadaver feet during simulated walking. We hypothesized that joint pressures are higher for diabetics than normal population. MATERIALS AND METHODS: Sixteen cadaver foot specimens (eight control and eight diabetic specimens) were used in this study. Human gait at 25% of typical walking speed (averaged stance duration of 3.2s) was simulated by a custom-designed Universal Musculoskeletal Simulator. Four medial midfoot joint pressures (the first metatarsocuneiform, the medial naviculocuneiform, the middle naviculocuneiform, and the first intercuneiform) were measured dynamically during full stance. RESULTS: The pressures in each of the four measured midfoot joints were significantly greater in the diabetic feet (p = 0.015, p = 0.025, p < 0.001, and p = 0.545, respectively). CONCLUSION: Across all four tested joints, the diabetic cadaver specimens had, on average, 46% higher peak pressures than the control cadaver feet during the simulated stance phase. CLINICAL RELEVANCE: This finding suggests that diabetic patients could be predisposed to arch collapse even before there are visible signs of bone or joint abnormalities.
Assuntos
Artropatia Neurogênica/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Robótica , Articulações Tarsianas/fisiopatologia , Caminhada/fisiologia , Suporte de Carga/fisiologia , Idoso , Idoso de 80 Anos ou mais , Articulação do Tornozelo/fisiopatologia , Artropatia Neurogênica/etiologia , Artropatia Neurogênica/patologia , Cadáver , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Neurológicos , Amplitude de Movimento ArticularRESUMO
Diabetic foot ulcers are known to have a biomechanical etiology. Among the mechanical factors that cause foot lesions, shear stresses have been either neglected or underestimated. The purpose of this study was to determine various plantar pressure and shear variables in the diabetic and control groups and compare them. Fifteen diabetic patients with neuropathy and 20 non-diabetic subjects without foot symptoms were recruited. Subjects walked on a custom-built platform capable of measuring local normal and tangential forces simultaneously. Pressure-time integral quantities were increased by 54% (p=0.013) in the diabetic group. Peak AP and resultant shear magnitudes were found to be about 32% larger (p<0.05), even though diabetic subjects walked at a slower velocity. Lower AP and ML stress range (peak-to-peak) values were observed in the control subjects (p<0.05). Shear-time integral values were increased in the diabetic group by 61% and 132% for AP and resultant shear cases, respectively (p<0.05). Plantar shear is known to be a factor in callus formation and has previously been associated with higher ulcer incidence. During gait, shear stresses are induced with twice the frequency of pressure characteristically. Therefore, plantar shear should be investigated further from a broader perspective including the temporal specifications and fatigue failure characteristics of the affected plantar tissue.
Assuntos
Pé Diabético/fisiopatologia , Pé/fisiopatologia , Marcha , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressão , Resistência ao Cisalhamento , Estresse MecânicoRESUMO
Plantar shear stresses are believed to play a major role in diabetic ulceration. Due to the lack of commercial devices that can measure plantar shear distribution, a number of mathematical models have been developed to predict plantar frictional forces. This study assessed the accuracy of these models using a custom-built platform capable of measuring plantar stresses simultaneously. A total of 48 (38 healthy and 10 diabetic) human subjects (75+/-20 kg, 41+/-20 years, 32 males, 16 females) were recruited in the study. Plantar force data were collected for 2s at 50 Hz. Two models (M1 and M2) reported in the literature by different groups were used to predict local shear stresses. Root mean squared errors (RMSE) were calculated to compare model data with the actual data, focusing on three parameters: location, magnitude and timing of peak shear components. RMSE values of estimated peak AP and ML shear locations were 3.1 and 2.2 cm for M1 and 3.1 and 2.1cm for M2, respectively. Magnitude RMS error values for M1 were found to be 86.6 kPa in AP shear and 38.5 kPa in ML shear, whereas these values were determined to be 97.8 and 63.5 kPa, respectively by M2. Time to peak shear RMSE values averaged 17.2% in terms of the gait duration. In conclusion, distribution of plantar shear should be measured rather than predicted, particularly if one is interested in the magnitudes of shear components.
Assuntos
Pé/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fricção , Humanos , Masculino , Pessoa de Meia-Idade , Estresse MecânicoRESUMO
Recurrent foot ulceration is a major cause of morbidity in diabetic patients. Discrepancy between the stiffness of the plantar skin and underlying soft tissues may influence the likelihood of ulceration. Tissue properties change with diabetes primarily due to high blood glucose which promotes intermolecular cross-linking of structural proteins thus leading to altered structure and function of these structural fibers. This study utilizes a non-invasive method for indirectly assessing skin tissue in the context of plantar ulcer formation in diabetic patients' feet. Control (C, n=13), and diabetic subjects with a history of ulceration (n=16) were matched based on gender, age (42-81years old) and BMI. Six subjects re-ulcerated (U) during their 1-year follow-up. At every visit, each subject's plantar skin was excited with a weak laser light (337nm) to induce tissue fluorescence at three locations on each foot. The spectral area under the curve (AUC) was calculated after background subtraction and normalization. The mean AUC was significantly higher for diabetics compared to control subjects, (mean AUC: 145.6+/-7.2, C=112.6+/-8.3, respectively, p=0.006). For those who re-ulcerated (U, n=6), skin site was not a significant factor, but AUC was diminished at the time of re-ulceration (p<0.05). The alteration of intermolecular bonds in diabetic subjects and thinning of skin prior to ulceration could account for these observations. The decrease in AUC prior to an ulcer formation suggests its potential as a marker of tissue changes, which precede ulceration in the diabetic foot.
Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/diagnóstico , Úlcera do Pé/diagnóstico , Pele/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Pé Diabético/etiologia , Pé Diabético/fisiopatologia , Feminino , Fluorescência , Úlcera do Pé/etiologia , Úlcera do Pé/fisiopatologia , Humanos , Lasers , Masculino , Pessoa de Meia-IdadeRESUMO
Foot ulceration is a diabetic complication estimated to result in over $1 billion worth of medical expenses per year in the United States alone. This multifaceted problem involves the response of plantar soft tissue to both external forces applied to the epidermis and internal changes such as vascular supply and neuropathy. Increasing evidence indicates that a combination of elevated external forces (pressure and shear) and altered tissue properties is key to the etiology of foot ulcers. The overall goal of this research is to develop a platform-type hardware system that will allow a clinician to measure three-dimensional stress tensors (i.e. pressure and shear patterns) on the plantar surface and identify areas of concern. Experimental results have demonstrated that an optical approach can provide clear indication of both shear and pressure from 50 to 400 kPa with a frequency response of 100 Hz, a stress measurement accuracy of 100 Pa and a spatial resolution of 8.0mm. Initial evaluation of the system shows strong correlation between (i) applied shear and normal stress loads and (ii) the optical phase retardance computed for each stress axis of the polymer-based stress-sensing elements. These special sensing elements are designed to minimize the need for repeated calibration procedures-an issue that has plagued other attempts to develop multisensor shear and pressure systems.
Assuntos
Úlcera do Pé/etiologia , Pressão , Desenho de Equipamento , Úlcera do Pé/prevenção & controle , Humanos , Projetos de Pesquisa , Estresse MecânicoRESUMO
How high does pressure and shear stress sensor resolution need to be in order to reliably measure the plantar pressure and shear profiles (PPSPs) under normal and diabetic feet? In this study, pressure and shear stress data were collected from 26 total diabetic and control subjects using new instrumentation that measures vertical and horizontal force vectors of the plantar contact surface during multiple instances in the gait cycle. The custom built shear-and-pressure-evaluating-camera-system (SPECS) performs simultaneous recordings of pressure and both components of the horizontal force vector (medio-lateral and antero-posterior) at distinctive regions under one׳s foot, at a spatial resolution for each sensor equal to 1.6mm by 1.6mm. A linear interpolation method was used to simulate the effect of increasing sensor size on PPSPs. Ten square-shaped sensors were included in the analysis, having edge lengths of: (1.6mm, 3.2mm, 4.8mm, 6.4mm, 8mm, 9.6mm, 11.2mm, 12.8mm, 14.4mm, and 16mm). A two-dimensional Discrete Fourier Transform was performed on each data set, for each of the ten sensor sizes. To quantify the difference between sensor sizes, a comparison was made using the maximum pressure and shear stress data over the entire plantar contact surface, equivalent to the peak of the spatial frequency spectrum. A reduction of 5% of any component of the stress vector (i.e., pressure, or medio-lateral shear stress, or anter-posterior shear stress) due to an increase in sensor size was deemed significant. The results showed that a sensor measuring 9.6mm by 9.6mm caused meaningful reductions in all three stress components (p<0.001), whereas sensors measuring 1.6mm by 1.6mm, up to 4.8mm by 4.8mm, can capture the full range of spatial frequencies in both pressure and shear stress data.
Assuntos
Pé Diabético/fisiopatologia , Pé/fisiologia , Adulto , Idoso , Feminino , Pé/fisiopatologia , Análise de Fourier , Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Pressão , Estresse MecânicoRESUMO
BACKGROUND: Exercise is a promising countermeasure to the physiological deconditioning experienced in microgravity, but has not proven effective in eliminating the ongoing loss of bone mineral, most likely due to the lack of high-impact forces and loading rates during in-flight activity. We wanted to determine lower-extremity response to high-impact jumping exercises in true and simulated microgravity and establish if 1-G force magnitudes can be achieved in a weightless environment. METHODS: Jumping experiments were performed in a ground-based zero-gravity simulator (ZGS) in 1 G, and during parabolic flight with a gravity-replacement system. There were 12 subjects who participated in the study, with 4 subjects common to both conditions. Force, loading rates, jump height, and kinematics were analyzed during jumps with three distinct landings: two-footed toe-heel, one-footed toe-heel, and flat-footed. Gravity replacement loads of 45%, 60%, 75%, and 100% bodyweight were used in the ZGS; because of time constraints, these loads were limited to 60% and 75% bodyweight in parabolic flight. RESULTS: Average peak ground-reaction forces during landing ranged between 1902+/-607 and 2631+/-663 N in the ZGS and between 1683+/-807 and 2683+/-1174 N in the KC-135. No significant differences were found between the simulated and true microgravity conditions, but neither condition achieved the magnitudes found in 1 G. CONCLUSION: Data support the hypothesis that jumping exercises can impart high-impact forces during weightlessness and that the custom-designed ZGS will replicate what is experienced in true microgravity.