Correlation between postural stability and fall risk in trans-femoral amputees due to muscle fatigue.

[Purpose] This study aimed to establish a connection between postural stability and falling in individuals with transfemoral amputation (TFA), particularly with muscle fatigue. [Participants and Methods] Fourteen participants were recruited. Muscle fatigue was induced using a sit-to-stand (STS) fatigue protocol. Pre-fatigue and post-fatigue assessments were conducted using the Biodex Balance System (BBS). [Result] The findings of the study revealed significant increases in the postural stability index between the pre-fatigue and post-fatigue conditions for the TFA group, particularly in the overall stability index (OSI) and anterior-posterior stability index (APSI) components. The mean postural stability index scores for the TFA group exhibited a percentage increase of 65.2% for OSI, 52.7% for APSI, and 50% for medial-lateral stability index (MLSI). Furthermore, the TFA fall risk index surged by 61.4%. Regarding the relationships observed, a significant correlation emerged between fall risk and both OSI and APSI. [Conclusion] These findings underscore the impact of muscle fatigue on postural stability and an increase in fall risk among TFA. By mitigating the effects of muscle fatigue, therapists can play an important role in reducing the risk of falls and promoting better postural stability in this population.

Techniques for Interface Stress Measurements within Prosthetic Sockets of Transtibial Amputees: A Review of the Past 50 Years of Research.

The distribution of interface stresses between the residual limb and prosthetic socket of a transtibial amputee has been considered as a direct indicator of the socket quality fit and comfort. Therefore, researchers have been very interested in quantifying these interface stresses in order to evaluate the extent of any potential damage caused by the socket to the residual limb tissues. During the past 50 years a variety of measurement techniques have been employed in an effort to identify sites of excessive stresses which may lead to skin breakdown, compare stress distributions in various socket designs, and evaluate interface cushioning and suspension systems, among others. The outcomes of such measurement techniques have contributed to improving the design and fitting of transtibial sockets. This article aims to review the operating principles, advantages, and disadvantages of conventional and emerging techniques used for interface stress measurements inside transtibial sockets. It also reviews and discusses the evolution of different socket concepts and interface stress investigations conducted in the past five decades, providing valuable insights into the latest trends in socket designs and the crucial considerations for effective stress measurement tools that lead to a functional prosthetic socket.

Design and Development for Capacitive Humidity Sensor Applications of Lead-Free Ca,Mg,Fe,Ti-Oxides-Based Electro-Ceramics with Improved Sensing Properties via Physisorption.

Despite the many attractive potential uses of ceramic materials as humidity sensors, some unavoidable drawbacks, including toxicity, poor biocompatibility, long response and recovery times, low sensitivity and high hysteresis have stymied the use of these materials in advanced applications. Therefore, in present investigation, we developed a capacitive humidity sensor using lead-free Ca,Mg,Fe,Ti-Oxide (CMFTO)-based electro-ceramics with perovskite structures synthesized by solid-state step-sintering. This technique helps maintain the submicron size porous morphology of the developed lead-free CMFTO electro-ceramics while providing enhanced water physisorption behaviour. In comparison with conventional capacitive humidity sensors, the presented CMFTO-based humidity sensor shows a high sensitivity of up to 3000% compared to other materials, even at lower signal frequency. The best also shows a rapid response (14.5 s) and recovery (34.27 s), and very low hysteresis (3.2%) in a 33%-95% relative humidity range which are much lower values than those of existing conventional sensors. Therefore, CMFTO nano-electro-ceramics appear to be very promising materials for fabricating high-performance capacitive humidity sensors.

Uniformly Porous Nanocrystalline CaMgFe1.33Ti3O12 Ceramic Derived Electro-Ceramic Nanocomposite for Impedance Type Humidity Sensor.

Since humidity sensors have been widely used in many sectors, a suitable humidity sensing material with improved sensitivity, faster response and recovery times, better stability and low hysteresis is necessary to be developed. Here, we fabricate a uniformly porous humidity sensor using Ca, Ti substituted Mg ferrites with chemical formula of CaMgFe1.33Ti3O12 as humidity sensing materials by solid-sate step-sintering technique. This synthesis technique is useful to control the grain size with increased porosity to enhance the hydrophilic characteristics of the CaMgFe1.33Ti3O12 nanoceramic based sintered electro-ceramic nanocomposites. The highest porosity, lowest density and excellent surface-hydrophilicity properties were obtained at 1050 °C sintered ceramic. The performance of this impedance type humidity sensor was evaluated by electrical characterizations using alternating current (AC) in the 33%-95% relative humidity (RH) range at 25 °C. Compared with existing conventional resistive humidity sensors, the present sintered electro-ceramic nanocomposite based humidity sensor showed faster response time (20 s) and recovery time (40 s). This newly developed sensor showed extremely high sensitivity (%S) and small hysteresis of <3.4%. Long-term stability of the sensor had been determined by testing for 30 consecutive days. Therefore, the high performance sensing behavior of the present electro-ceramic nanocomposites would be suitable for a potential use in advanced humidity sensors.

Synthesis and Characterizations of Novel Ca-Mg-Ti-Fe-Oxides Based Ceramic Nanocrystals and Flexible Film of Polydimethylsiloxane Composite with Improved Mechanical and Dielectric Properties for Sensors.

Armalcolite, a rare ceramic mineral and normally found in the lunar earth, was synthesized by solid-state step-sintering. The in situ phase-changed novel ceramic nanocrystals of Ca-Mg-Ti-Fe based oxide (CMTFOx), their chemical reactions and bonding with polydimethylsiloxane (PDMS) were determined by X-ray diffraction, infrared spectroscopy, and microscopy. Water absorption of all the CMTFOx was high. The lower dielectric loss tangent value (0.155 at 1 MHz) was obtained for the ceramic sintered at 1050 °C (S1050) and it became lowest for the S1050/PDMS nanocomposite (0.002 at 1 MHz) film, which was made by spin coating at 3000 rpm. The excellent flexibility (static modulus ≈ 0.27 MPa and elongation > 90%), viscoelastic property (tanδ = E″/E': 0.225) and glass transition temperature (Tg: -58.5 °C) were obtained for S1050/PDMS film. Parallel-plate capacitive and flexible resistive humidity sensors have been developed successfully. The best sensing performance of the present S1050 (3000%) and its flexible S1050/PDMS composite film (306%) based humidity sensors was found to be at 100 Hz, better than conventional materials.

Cerebellum-inspired neural network solution of the inverse kinematics problem.

The demand today for more complex robots that have manipulators with higher degrees of freedom is increasing because of technological advances. Obtaining the precise movement for a desired trajectory or a sequence of arm and positions requires the computation of the inverse kinematic (IK) function, which is a major problem in robotics. The solution of the IK problem leads robots to the precise position and orientation of their end-effector. We developed a bioinspired solution comparable with the cerebellar anatomy and function to solve the said problem. The proposed model is stable under all conditions merely by parameter determination, in contrast to recursive model-based solutions, which remain stable only under certain conditions. We modified the proposed model for the simple two-segmented arm to prove the feasibility of the model under a basic condition. A fuzzy neural network through its learning method was used to compute the parameters of the system. Simulation results show the practical feasibility and efficiency of the proposed model in robotics. The main advantage of the proposed model is its generalizability and potential use in any robot.

Effect of geometrical parameters on the performance of longitudinal functionally graded femoral prostheses.

This study aimed to assess the performance of different longitudinal functionally graded femoral prostheses. This study was also designed to develop an appropriate prosthetic geometric design for longitudinal functionally graded materials. Three-dimensional models of the femur and prostheses were developed and analyzed. The elastic modulus of these prostheses in the sagittal plane was adjusted along a gradient direction from the distal end to the proximal end. Furthermore, these prostheses were composed of titanium alloy and hydroxyapatite. Results revealed that strain energy, interface stress, and developed stress in the femoral prosthesis and the bone were influenced by prosthetic geometry and gradient index. In all of the prostheses with different geometries, strain energy increased as gradient index increased. Interface stress and developed stress decreased. The minimum principal stress and the maximum principal stress of the bone slightly increased as gradient index increased. Hence, the combination of the femoral prosthetic geometry and functionally graded materials can be employed to decrease stress shielding. Such a combination can also be utilized to achieve equilibrium in terms of the stress applied on the implanted femur constituents; thus, the lifespan of total hip replacement can be prolonged.

Detection of Prosthetic Knee Movement Phases via In-Socket Sensors: A Feasibility Study.

This paper presents an approach of identifying prosthetic knee movements through pattern recognition of mechanical responses at the internal socket's wall. A quadrilateral double socket was custom made and instrumented with two force sensing resistors (FSR) attached to specific anterior and posterior sites of the socket's wall. A second setup was established by attaching three piezoelectric sensors at the anterior distal, anterior proximal, and posterior sites. Gait cycle and locomotion movements such as stair ascent and sit to stand were adopted to characterize the validity of the technique. FSR and piezoelectric outputs were measured with reference to the knee angle during each phase. Piezoelectric sensors could identify the movement of midswing and terminal swing, pre-full standing, pull-up at gait, sit to stand, and stair ascent. In contrast, FSR could estimate the gait cycle stance and swing phases and identify the pre-full standing at sit to stand. FSR showed less variation during sit to stand and stair ascent to sensitively represent the different movement states. The study highlighted the capacity of using in-socket sensors for knee movement identification. In addition, it validated the efficacy of the system and warrants further investigation with more amputee subjects and different sockets types.

New method for the isolation of endothelial cells from large vessels.

BACKGROUND AIMS: Numerous protocols for the isolation of bovine aortic endothelial cells have been described in the previous literature. However, these protocols prevent researchers from obtaining the pure population of endothelial cells. Thus, this study aimed to develop a new and economical method for the isolation of pure endothelial cells by introducing a new strategy to the enzymatic digestion method proposed by previous researchers. METHODS: With the use of this method, the lumen of a bovine aorta was filled with wash medium and the outer surface of the sample was washed with alcohol for 30 seconds. Under a laminar flow hood, the inner surface of the sample was covered with filter paper. Collagenase type II was dripped onto the filter paper as a digestion enzyme. The digestion fluid was seeded in T25 flasks and fed with complete medium every 3 days. RESULTS: The isolated cells were characterized by markers such as CD31, von Willebrand factor, 1,1'-dioctadecyl-1,3,3,3',3'-tetramethylindocarbocyanine perchlorate acetylated low-density lipoprotein and angiogenesis behavior. The purity of endothelial cells was detected by flow cytometry to be of nearly 90% purity; these results were confirmed by immunostaining. Moreover, endothelial cells formed blood vessel-like tubes in a three-dimensional environment, which is specific dynamic behavior for endothelial cells. CONCLUSIONS: The new strategy presented in the current report enables isolation of a highly pure population of endothelial cells that can survive long-term culture without inducing an overgrowth of fibroblast cells.

Quantitative analysis of human ankle characteristics at different gait phases and speeds for utilizing in ankle-foot prosthetic design.

BACKGROUND: Ankle characteristics vary in terms of gait phase and speed change. This study aimed to quantify the components of ankle characteristics, including quasi-stiffness and work in different gait phases and at various speeds. METHODS: The kinetic and kinematic data of 20 healthy participants were collected during normal gait at four speeds. Stance moment-angle curves were divided into three sub-phases including controlled plantarflexion, controlled dorsiflexion and powered plantarflexion. The slope of the moment-angle curves was quantified as quasi-stiffness. The area under the curves was defined as work. RESULTS: The lowest quasi-stiffness was observed in the controlled plantarflexion. The fitted line to moment-angle curves showed R2 > 0.8 at controlled dorsiflexion and powered plantarflexion. Quasi-stiffness was significantly different at different speeds (P = 0.00). In the controlled dorsiflexion, the ankle absorbed energy; by comparison, energy was generated in the powered plantarflexion. A negative work value was recorded at slower speeds and a positive value was observed at faster speeds. Ankle peak powers were increased with walking speed (P = 0.00). CONCLUSIONS: Our findings suggested that the quasi-stiffness and work of the ankle joint can be regulated at different phases and speeds. These findings may be clinically applicable in the design and development of ankle prosthetic devices that can naturally replicate human walking at various gait speeds.

Biomechanics principle of elbow joint for transhumeral prostheses: comparison of normal hand, body-powered, myoelectric & air splint prostheses.

BACKGROUND: Understanding of kinematics force applied at the elbow is important in many fields, including biomechanics, biomedical engineering and rehabilitation. This paper provides a comparison of a mathematical model of elbow joint using three different types of prosthetics for transhumeral user, and characterizes the forces required to overcome the passive mechanical of the prosthetics at the residual limb. METHODS: The study modeled the elbow as a universal joint with intersecting axes of x-axis and y-axis in a plain of upper arm and lower arm. The equations of force applied, torque, weight and length of different type of prosthetics and the anthropometry of prosthetics hand are discussed in this study. The study also compares the force, torque and pressure while using all three types of prosthetics with the normal hand. RESULTS: The result was measured from the elbow kinematics of seven amputees, using three different types of prosthetics. The F-Scan sensor used in the study is to determine the pressure applied at the residual limb while wearing different type of prostheses. CONCLUSION: These technological advances in assessment the biomechanics of an elbow joint for three different type of prosthetics with the normal hand bring the new information for the amputees and prosthetist to choose the most suitable device to be worn daily.

Development and performance of a new prosthesis system using ultrasonic sensor for wrist movements: a preliminary study.

BACKGROUND: The design and performance of a new development prosthesis system known as biomechatronics wrist prosthesis is presented in this paper. The prosthesis system was implemented by replacing the Bowden tension cable of body powered prosthesis system using two ultrasonic sensors, two servo motors and microcontroller inside the prosthesis hand for transradial user. METHODS: The system components and hand prototypes involve the anthropometry, CAD design and prototyping, biomechatronics engineering together with the prosthetics. The modeler construction of the system develop allows the ultrasonic sensors that are placed on the shoulder to generate the wrist movement of the prosthesis. The kinematics of wrist movement, which are the pronation/supination and flexion/extension were tested using the motion analysis and general motion of human hand were compared. The study also evaluated the require degree of detection for the input of the ultrasonic sensor to generate the wrist movements. RESULTS: The values collected by the vicon motion analysis for biomechatronics prosthesis system were reliable to do the common tasks in daily life. The degree of the head needed to bend to give the full input wave was about 45°-55° of rotation or about 14 cm-16 cm. The biomechatronics wrist prosthesis gave higher degree of rotation to do the daily tasks but did not achieve the maximum degree of rotation. CONCLUSION: The new development of using sensor and actuator in generating the wrist movements will be interesting for used list in medicine, robotics technology, rehabilitations, prosthetics and orthotics.

Evaluation of new suspension system for limb prosthetics.

BACKGROUND: Good prosthetic suspension system secures the residual limb inside the prosthetic socket and enables easy donning and doffing. This study aimed to introduce, evaluate and compare a newly designed prosthetic suspension system (HOLO) with the current suspension systems (suction, pin/lock and magnetic systems). METHODS: All the suspension systems were tested (tensile testing machine) in terms of the degree of the shear strength and the patient's comfort. Nine transtibial amputees participated in this study. The patients were asked to use four different suspension systems. Afterwards, each participant completed a questionnaire for each system to evaluate their comfort. Furthermore, the systems were compared in terms of the cost. RESULTS: The maximum tensile load that the new system could bear was 490 N (SD, 5.5) before the system failed. Pin/lock, magnetic and suction suspension systems could tolerate loads of 580 N (SD, 8.5), 350.9 (SD, 7) and 310 N (SD, 8.4), respectively. Our subjects were satisfied with the new hook and loop system, particularly in terms of easy donning and doffing. Furthermore, the new system is considerably cheaper (35 times) than the current locking systems in the market. CONCLUSIONS: The new suspension system could successfully retain the prosthesis on the residual limb as a good alternative for lower limb amputees. In addition, the new system addresses some problems of the existing systems and is more cost effective than its counterparts.

The effects of prosthetic foot type and visual alteration on postural steadiness in below-knee amputees.

BACKGROUND: Achieving independent upright posture has known to be one of the main goals in rehabilitation following lower limb amputation. The purpose of this study was to compare postural steadiness of below knee amputees with visual alterations while wearing three different prosthetic feet. METHODS: Ten male below-knee amputees were instructed to stand quietly on the Biodex® balance platform while wearing solid ankle cushion heel (SACH), single axis (SA) and energy storage and release (ESAR) prosthetic foot under different visual input conditions (eyes-opened and eyes-closed). The overall stability index (OSI), anterior- posterior stability index (APSI), and medial-lateral stability index (MLSI) were computed. Perceived balance assessment of each foot was evaluated using Activities-specific Balance Confidence (ABC) score. RESULTS: The findings highlights that SACH showed lowest overall stability index (indicating less body sway) during eyes-opened (OSI: SACH = 1.09, SA = 1.58, ESAR = 1.59) and SA showed lowest overall stability index during eyes-closed (OSI: SACH = 2.52, SA = 2.30, ESAR = 2.76) condition. However, overall stability indexes between foot types did not differ significantly during eyes-opened or eyes-closed (p = 0.651). There was a trend of instability which occurred more in medial-lateral compared to anterior-posterior direction for all foot types, with significant result in ESAR foot(eyes-opened: MLSI = 1.59, APSI = 0.65, p = 0.034; eyes-closed: MLSI = 2.76, APSI = 1.80, p = 0.017, respectively). When comparing between visual conditions, stability score was significantly higher during eyes-closed compared to eyes-opened situations for SACH and ESAR foot (eyes-closed vs opened; SACH OSI: 3.43 vs 1.71, p = 0.018 and MLSI: 3.43 vs 1.71, p = 0.018; ESAR OSI: 3.58 vs 1.86, p = 0.043 and APSI: 1.80 vs 0.65, p = 0.027). CONCLUSIONS: The results of this study suggested postural steadiness in below-knee amputees was not affected by the types of prosthetic foot during quiet upright standing, but was significantly affected when visual cues was absent.

Investigation of CPD and HMDS sample preparation techniques for cervical cells in developing computer-aided screening system based on FE-SEM/EDX.

This paper investigated the effects of critical-point drying (CPD) and hexamethyldisilazane (HMDS) sample preparation techniques for cervical cells on field emission scanning electron microscopy and energy dispersive X-ray (FE-SEM/EDX). We investigated the visualization of cervical cell image and elemental distribution on the cervical cell for two techniques of sample preparation. Using FE-SEM/EDX, the cervical cell images are captured and the cell element compositions are extracted for both sample preparation techniques. Cervical cell image quality, elemental composition, and processing time are considered for comparison of performances. Qualitatively, FE-SEM image based on HMDS preparation technique has better image quality than CPD technique in terms of degree of spread cell on the specimen and morphologic signs of cell deteriorations (i.e., existence of plate and pellet drying artifacts and membrane blebs). Quantitatively, with mapping and line scanning EDX analysis, carbon and oxygen element compositions in HMDS technique were higher than the CPD technique in terms of weight percentages. The HMDS technique has shorter processing time than the CPD technique. The results indicate that FE-SEM imaging, elemental composition, and processing time for sample preparation with the HMDS technique were better than CPD technique for cervical cell preparation technique for developing computer-aided screening system.

Intelligent screening systems for cervical cancer.

Advent of medical image digitalization leads to image processing and computer-aided diagnosis systems in numerous clinical applications. These technologies could be used to automatically diagnose patient or serve as second opinion to pathologists. This paper briefly reviews cervical screening techniques, advantages, and disadvantages. The digital data of the screening techniques are used as data for the computer screening system as replaced in the expert analysis. Four stages of the computer system are enhancement, features extraction, feature selection, and classification reviewed in detail. The computer system based on cytology data and electromagnetic spectra data achieved better accuracy than other data.

Technology efficacy in active prosthetic knees for transfemoral amputees: a quantitative evaluation.

Several studies have presented technological ensembles of active knee systems for transfemoral prosthesis. Other studies have examined the amputees' gait performance while wearing a specific active prosthesis. This paper combined both insights, that is, a technical examination of the components used, with an evaluation of how these improved the gait of respective users. This study aims to offer a quantitative understanding of the potential enhancement derived from strategic integration of core elements in developing an effective device. The study systematically discussed the current technology in active transfemoral prosthesis with respect to its functional walking performance amongst above-knee amputee users, to evaluate the system's efficacy in producing close-to-normal user performance. The performances of its actuator, sensory system, and control technique that are incorporated in each reported system were evaluated separately and numerical comparisons were conducted based on the percentage of amputees' gait deviation from normal gait profile points. The results identified particular components that contributed closest to normal gait parameters. However, the conclusion is limitedly extendable due to the small number of studies. Thus, more clinical validation of the active prosthetic knee technology is needed to better understand the extent of contribution of each component to the most functional development.

Effect of intra-articular hyaluronic injection on postural stability and risk of fall in patients with bilateral knee osteoarthritis.

Knee osteoarthritis is a common cause of disability which influences the quality of life. It is associated with impaired knee joint proprioception, which affects postural stability. Postural stability is critical for mobility and physical activities. Different types of treatment including nonsurgical and surgical are used for knee osteoarthritis. Hyaluronic acid injection is a nonsurgical popular treatment used worldwide. The aim of this study was to demonstrate the effect of hyaluronic acid injections on postural stability in individuals with bilateral knee osteoarthritis. Fifty patients aged between 50 and 70 years with mild and moderate bilateral knee osteoarthritis participated in our study. They were categorized into treatment (n = 25) and control (n = 25) groups. The treatment group received five weekly hyaluronic acid injections for both knees, whereas the control group did not receive any treatment. Postural stability and fall risk were assessed using the Biodex Stability System and clinical "Timed Up and Go" test. All the participants completed the study. The treatment group showed significant decrease in postural stability and fall risk scores after five hyaluronic acid injections. In contrast, the control group showed significant increase. This study illustrated that five intra-articular hyaluronic acid injections could significantly improve postural stability and fall risk in bilateral knee osteoarthritis patients. This trial is registered with: NCT02063373.

Postural stability characteristics of transtibial amputees wearing different prosthetic foot types when standing on various support surfaces.

PURPOSE: This study aimed to evaluate the effects of prosthetic foot types on the postural stability among transtibial amputees when standing on different support surfaces. MATERIALS AND METHODS: The postural stability of 10 transtibial amputees wearing solid ankle cushion heel (SACH) foot, single-axis (SA) foot, and energy-saving and return (ESAR) foot was assessed. Results were compared with able-bodied participants. Anterior-posterior stability index (APSI), mediolateral stability index (MLSI), and overall stability index (OSI) were measured by computed posturography in an upright stance on firm, foam, and unstable support surfaces. RESULTS: The mean OSI score of SACH foot was significantly lower than that of an ESAR foot when the participants were standing on a compliant surface. When compared to able-bodied group, MLSI score was significantly higher for each of the prosthetic foot groups while OSI score was significantly higher for ESAR foot only in foam condition. CONCLUSIONS: Differences between prosthetic foot types and groups (amputees versus able-bodied) can only be distinguished when individuals were standing on a compliant surface. Amputees exhibited an increased postural instability in the mediolateral direction than able-bodied individuals. Hence, the restoration of stability in the frontal plane and the enhancement of proprioception at the residual limb should be the basis of rehabilitation programs.

Comparison of various functionally graded femoral prostheses by finite element analysis.

This study is focused on finite element analysis of a model comprising femur into which a femoral component of a total hip replacement was implanted. The considered prosthesis is fabricated from a functionally graded material (FGM) comprising a layer of a titanium alloy bonded to a layer of hydroxyapatite. The elastic modulus of the FGM was adjusted in the radial, longitudinal, and longitudinal-radial directions by altering the volume fraction gradient exponent. Four cases were studied, involving two different methods of anchoring the prosthesis to the spongy bone and two cases of applied loading. The results revealed that the FG prostheses provoked more SED to the bone. The FG prostheses carried less stress, while more stress was induced to the bone and cement. Meanwhile, less shear interface stress was stimulated to the prosthesis-bone interface in the noncemented FG prostheses. The cement-bone interface carried more stress compared to the prosthesis-cement interface. Stair climbing induced more harmful effects to the implanted femur components compared to the normal walking by causing more stress. Therefore, stress shielding, developed stresses, and interface stresses in the THR components could be adjusted through the controlling stiffness of the FG prosthesis by managing volume fraction gradient exponent.