Using distraction forces to drive an autodistractor during limb lengthening.

Distraction osteogenesis can result in high forces developing in the limb. To determine and control the distraction forces (DF), a motorized distractor driven by feedback from DF was developed and used to lengthen the tibiae of 6 sheep undergoing distraction osteogenesis. The forces were measured continually, and, in 4 of the sheep, a force threshold was set, above which an increase in rate was initiated. The rate kept increasing to a set limit if forces remained above the threshold; otherwise, the rate was decreased. Radiographs were acquired biweekly, and muscle samples were analyzed from both the operated and contralateral limbs upon termination of the experiment. Results demonstrated a drop in DF associated with increased lengthening rate, attributed to separation of the callus as indicated by radiography. Histological evidence of muscle damage generally correlated with higher DF levels. There was a significant decrease in muscle fiber diameter in lengthened relative to contralateral limbs. Collectively, the results demonstrated the use of a force-driven distraction system and support the need for considering force data in regulating distraction rates to achieve optimal clinical outcomes.

Force feedback in limb lengthening.

A new variable-rate distraction system using a motorized distractor driven by feedback from the distraction force was designed. The distractor was mounted on a unilateral fixator and attached to the tibiae of 6 sheep that underwent distraction osteogenesis. The sheep were divided equally into 3 groups. In group 1, the forces were recorded but were not used to drive the lengthening rate. In group 2, force feedback was used and the desired distraction force level was set to 300 N and the initial rate was 1 mm/day. Group 3 also underwent force feedback with the desired force limit at 300 N, but the rate change was initiated earlier, at 200 N. The distraction force was recorded at 15 second intervals throughout the distraction phase and stored onboard the distractor.

Design and testing of a functional arm orthosis in patients with neuromuscular diseases.

The objective of this study was to determine the utility of a passive gravity-balanced arm orthosis, the Wilmington robotic exoskeleton (WREX), for patients with neuromuscular diseases. The WREX, a four-degrees-of-freedom functional orthosis, is energized by rubber bands to eliminate gravity and is attached to the wheelchair. The development and clinical testing of WREX is described in this report. Seventeen patients (14 boys and 3 girls) with muscular disabilities participated in the study. Ages ranged from 4 to 20 years. Criteria for inclusion included a weakened arm, use of a wheelchair, the ability to grasp and release objects, and the ability to provide feedback on device use. Testing consisted of administering the Jebsen test of hand function without WREX and then testing again after approximately two weeks of wearing the WREX orthosis. The timed results of each task within the test then were compared. Specific tasks related to vertical movement required less time to perform with the WREX. A large number of subjects were able to perform the Jebsen tasks with the WREX, where they were unable to perform the task without the WREX. Patients can benefit from WREX because it increases their performance in daily living activities and makes many tasks possible. The range-of-motion in the patients' arms increased considerably, while the time required to complete some of the Jebsen test tasks decreased. Most patients were very receptive to WREX, although a few were ambivalent.

Predicting fracture of the femoral neck.

A prediction of the probability of safe loading of the femoral neck, based on queueing theory, is presented. The following methods have been applied: (I) criterion of bone fracture was formulated, taking into consideration the complex state of stress-strain in the porosity zones of the bone; (II) tensile stresses around pores in the stretched zone of the bone were evaluated; (III) the influence of random events of the critical regimes of loading was modeled. The evaluation of the probability of safe loading of bones was obtained based on the levels of the tensile stresses, Young's moduli and ultimate tensile stresses which are affected by the increase in bone porosity and the distribution of the pores. Examples of analysis involving typical mechanical properties of bone in areas of vascular and lacunar-canalicular porosity are demonstrated. The ranges of initial average values of effective Young's moduli and ultimate tensile strengths were taken as 15.8-17.5GPa and 83-95MPa, respectively. The present analysis discovers the existence of three levels of safe loading: (1) a relatively safe level of the nominal tensile stresses (smaller than (2.8-3.2)MPa) where the probability of safe loading is of the order of 0.95 for the bone porosity which is less than 0.15; (2) an intermediate level of safety where the nominal tensile stresses are below (4.2-4.8)MPa and the probability of safe loading is 0.89 or higher, for the same level of bone porosity; (3) a critical level of safe loading where the nominal tensile stresses are about (8.3-9.5)MPa; they lead to sharp drop of probabilities of safe loading to 0.85-0.8 if the porosity is about 0.10 and to probabilities of 0.41-0.4 if the porosity is about 0.15.

Passive exoskeletons for assisting limb movement.

This article presents the state of the art in passive devices for enhancing limb movement in people with neuromuscular disabilities. Both upper- and lower-limb projects and devices are described. Special emphasis is placed on a passive functional upper-limb orthosis called the Wilmington Robotic Exoskeleton (WREX). The development and testing of the WREX with children with limited arm strength are described. The exoskeleton has two links and 4 degrees of freedom. It uses linear elastic elements that balance the effects of gravity in three dimensions. The experiences of five children with arthrogryposis who used the WREX are described.