[An active approach to music therapy through percussion instruments]. / Une approche active de la musicothérapie par les percussions.

Percussion instruments, creativity and the helping relationship are at the heart of the evolution of a rhythmic expression workshop towards a structure designed for the practice of active music therapy. Thanks to instruments within everyone's reach, the therapy based on sound production, improvisation and creativity enables patients to express themselves, communicate and create links, while constructing an identity.

Tabla: A Proof-of-Concept Auscultatory Percussion Device for Low-Cost Pneumonia Detection.

Pneumonia causes the deaths of over a million people worldwide each year, with most occurring in countries with limited access to expensive but effective diagnostic methods, e.g., chest X-rays. Physical examination, the other major established method of diagnosis, suffers from several drawbacks, most notably low accuracy and high interobserver error. We sought to address this diagnostic gap by developing a proof-of-concept non-invasive device to identify the accumulation of fluid in the lungs (consolidation) characteristic of pneumonia. This device, named Tabla after the percussive instrument of the same name, utilizes the technique of auscultatory percussion; a percussive input sound is sent through the chest and recorded with a digital stethoscope for analysis. Tabla analyzes differences in sound transmission through the chest at audible frequencies as a marker for lung consolidation. This paper presents preliminary data from five pneumonia patients and eight healthy subjects. We demonstrate 92.3% accuracy in distinguishing between healthy subjects and patients with pneumonia after data analysis with a K-nearest neighbors algorithm. This prototype device is low cost and simple to implement and may offer a rapid and inexpensive method for pneumonia diagnosis appropriate for general use and in areas with limited medical infrastructure.

Modified device for fluid percussion injury in rodents.

Fluid percussion (FP) injury model is a popular animal model of traumatic brain injury (TBI), but still there are some issues need to be addressed. To increase the validity and reliability of this technique, we adapted the FP device using electromagnetic protractor, stainless-steel cylinder, changing pressure transducer position, and foam pads to adjust the parameters of FP pulse. Besides, the adjusted FP device is more automatic. The FP pulse is promptly measured and displayed in a graphic user interface software. The modified device resulted in reliable FP pulse. The accuracy of the pendulum leveling was improved with using the electromagnetic protractor with slots. We then collected behavioral, cognition, electrophysiological, and immunohistochemical data to verify the percussion effects in TBI mice. Lateral fluid percussion injury (FPI) or sham treatment was administered at the right frontal motorsensory region of male C57BL/6J mice. TBI mice showed evident motor, cognitive, and functional impairments, characterized by evaluation of neurological, righting, geotaxis and cliff aversion reflexes, limb asymmetrical use, rotarod running, and Morris water maze testing. The neurobehavioral damages were scaled with histopathological findings. Further, the overall firing rates and theta powers in hippocampal CA1 were significantly reduced in TBI mice compared to sham mice at Days 2 and 3 after electrode implanting. The adapted device induced effects on behavior and biology in mice that agree with existing models. These findings confirmed the validity of adjustments, and the modified device may boost the interest in TBI studies.

Midline (central) fluid percussion model of traumatic brain injury in pediatric and adolescent rats.

OBJECTIVE Experimental traumatic brain injury (TBI) models hold significant validity to the human condition, with each model replicating a subset of clinical features and symptoms. TBI is the leading cause of mortality and morbidity in children and teenagers; thus, it is critical to develop preclinical models of these ages to test emerging treatments. Midline fluid percussion injury (FPI) might best represent mild and diffuse clinical brain injury because of the acute behavioral deficits, the late onset of behavioral morbidities, and the absence of gross histopathology. In this study, the authors sought to adapt a midline FPI to postnatal day (PND) 17 and 35 rats. The authors hypothesized that scaling the craniectomy size based on skull dimensions would result in a reproducible injury comparable to the standard midline FPI in adult rats. METHODS PND17 and PND35 rat skulls were measured, and trephines were scaled based on skull size. Custom trephines were made. Rats arrived on PND10 and were randomly assigned to one of 3 cohorts: PND17, PND35, and 2 months old. Rats were subjected to midline FPI, and the acute injury was characterized. The right reflex was recorded, injury-induced apnea was measured, injury-induced seizure was noted, and the brains were immediately examined for hematoma. RESULTS The authors' hypothesis was supported; scaling the trephines based on skull size led to a reproducible injury in the PND17 and PND35 rats that was comparable to the injury in a standard 2-month-old adult rat. The midline FPI suppressed the righting reflex in both the PND17 and PND35 rats. The injury induced apnea in PND17 rats that lasted significantly longer than that in PND35 and 2-month-old rats. The injury also induced seizures in 73% of PND17 rats compared with 9% of PND35 rats and 0% of 2-month-old rats. There was also a significant relationship between the righting reflex time and presence of seizure. Both PND17 and PND35 rats had visible hematomas with an intact dura, indicative of diffuse injury comparable to the injury observed in 2-month-old rats. CONCLUSIONS With these procedures, it becomes possible to generate brain-injured juvenile rats (pediatric [PND17] and adolescent [PND35]) for studies of injury-induced pathophysiology and behavioral deficits, for which rational therapeutic interventions can be implemented.

Intrapulmonary percussive ventilation improves lung function in cystic fibrosis patients chronically colonized with Pseudomonas aeruginosa: a pilot cross-over study.

High levels of shear stress can prevent and disrupt Pseudomonas aeruginosa biofilm formation in vitro. Intrapulmonary percussive ventilation (IPV) could be used to introduce shear stress into the lungs of cystic fibrosis (CF) patients to disrupt biofilms in vivo. We performed a first-of-its-kind pilot clinical study to evaluate short-term IPV therapy at medium (200 bursts per minute, bpm) and high frequency (400 bpm) as compared to autogenic drainage (AD) on lung function and the behavior of P. aeruginosa in the CF lung in four patients who are chronically colonized by P. aeruginosa. A significant difference between the three treatment groups was observed for both the forced expiratory volume in 1 s (FEV1) and the forced vital capacity (FVC) (p < 0.05). More specifically, IPV at high frequency significantly increased FEV1 and FVC compared to AD (p < 0.05) and IPV at medium frequency (p < 0.001). IPV at high frequency enhanced the expression levels of P. aeruginosa planktonic marker genes, which was less pronounced with IPV at medium frequency or AD. In conclusion, IPV at high frequency could potentially alter the behavior of P. aeruginosa in the CF lung and improve lung function. TRIAL REGISTRATION: The trail was retrospectively registered at the ISRCTN registry on 6 June 2013, under trial registration number ISRCTN75391385.

Automated Rotational Percussion Bed and Bronchoscopy Improves Respiratory Mechanics and Oxygenation in ARDS Patients Supported with Extracorporeal Membrane Oxygenation.

Extracorporeal membrane oxygenation (ECMO) has been used to provide "lung rest" through the use of low tidal volume (6 ml/kg) and ultralow tidal volume (<6 ml/kg) ventilation in acute respiratory distress syndrome (ARDS). Low and ultralow tidal volume ventilation can result in low dynamic respiratory compliance and potentially increased retention of airway secretions. We present our experience using automated rotational percussion beds (ARPBs) and bronchoscopy in four ARDS patients to manage increased pulmonary secretions. These beds performed automated side-to-side tilt maneuver and intermittent chest wall percussion. Their use resulted in substantial reduction in peak and plateau pressures in two patients on volume control ventilation, while the driving pressures (inspiratory pressure) to attain the desired tidal volumes in patients on pressure control ventilation also decreased. In addition, mean partial pressure of oxygen in arterial blood (PaO2)/fraction of inspired oxygen (FiO2) ratio (109 pre-ARPB vs. 157 post-ARPB), positive end-expiratory pressure (10 cm H2O vs. 8 cm H2O), and FiO2 (0.88 vs. 0.52) improved after initiation of ARPB. The improvements in the respiratory mechanics and oxygenation helped us to initiate early ECMO weaning. Based on our experience, the use of chest physiotherapy, frequent body repositioning, and bronchoscopy may be helpful in the management of pulmonary secretions in patients supported with ECMO.

Comparison of the Primary Stability of Two Implant Designs in Two Different Bone Types: An In Vitro Study.

PURPOSE: Achievement of primary stability upon surgical placement of dental implants is a key factor for successful osseointegration and depends mainly on implant-related factors. The aim of this study was to compare and assess the primary stability of implants with active and regular threads in type 2 as well as type 4 bone. MATERIALS AND METHODS: Fresh cow vertebrae and a pelvis were used as models of type 4 bone and type 2 bone, respectively. Implants with two different designs-regular-threaded and active-threaded-both 4.3 mm wide and 13 mm long, were placed in both types of bone (n = 80). Stability measurements were completed by four prosthodontists using two different Periotest devices and resonance frequency analysis. Statistical analyses were performed with the Mann-Whitney U test. RESULTS: No statistically significant differences were found between the implant types in either type of bone in the stability measured with different methods. For both implant types, the mean resonance frequency values in type 2 bone were statistically significantly higher than in type 4 bone, whereas the mean Periotest values in type 2 bone were statistically significantly lower than in type 4 bone. CONCLUSION: Within the limitations of this in vitro study in bone types 2 and 4, the active-threaded implant, which was invented to increase primary stability, did not show higher primary stability compared to a regular-threaded implant.

Comparative ex vivo evaluation of two electronic percussive testing devices measuring the stability of dental implants.

BACKGROUND: A comparative ex vivo study was performed to determine electronic percussive test values (PTVs) measured by cabled and wireless electronic percussive testing (EPT) devices and to evaluate the intra- and interobserver reliability of the wireless EPT device. METHODS: Forty implants were inserted into the vertebrae and forty into the pelvis of a steer, a safe distance apart. The implants were all 4.3 mm wide and 13 mm long, from the same manufacturer. PTV of each implant was measured by four different examiners, using both EPT devices, and compared. Additionally, the intra- and interobserver reliability of the wireless EPT device was evaluated. RESULTS: Statistically significant differences (P <0.05) were observed between PTVs made by the two EPT devices. PTVs measured by the wireless EPT device were significantly higher than the cabled EPT device (P <0.05), indicating lower implant stability. The intraobserver reliability of the wireless EPT device was evaluated as excellent for the measurements in type II bone and good-to-excellent in type IV bone; interobserver reliability was evaluated as fair-to-good in both bone types. CONCLUSION: The wireless EPT device gives PTVs higher than the cabled EPT device, indicating lower implant stability, and its inter- and intraobserver reliability is good and acceptable.

An in vitro comparison of quantitative percussion diagnostics with a standard technique for determining the presence of cracks in natural teeth.

STATEMENT OF PROBLEM: The detection of cracks and fractures in natural teeth is a diagnostic challenge. Cracks are often not visible clinically nor detectable in radiographs. PURPOSE: The purpose of this study was to evaluate the diagnostic parity of quantitative percussion diagnostics, transillumination, clinical microscopy, and dye penetration. MATERIAL AND METHODS: Three independent examiners provided blind testing for the study. Examiner 1 transilluminated 30 extracted teeth and 23 three-dimensional copy replica control teeth and documented any visible cracks. Each tooth was then mounted in acrylic resin with a periodontal ligament substitute. Examiner 2 examined each specimen aided by the clinical microscope and transillumination and documented visible tooth cracks and fractures. Examiners 1 and 3 then independently tested all specimens with a device developed for quantitative percussion diagnostics. All visible cracks/fractures were removed with a water-cooled fine diamond rotary instrument. Crack visibility was enhanced by the use of a clinical microscope, dye penetrant, and accessory transillumination. This disassembly process was video documented/photographed for each specimen. One more quantitative percussion diagnostics testing was administered when the disassembly was complete. RESULTS: Quantitative percussion diagnostics crack detection agreed with the gold standard microscope and transillumination method in 52 of 53 comparisons (98% agreement). Moreover, the method achieved 96% specificity and 100% sensitivity for detecting cracks and fractures in natural teeth. When all tooth cracks were removed, quantitative percussion diagnostics indicated no further structural instability. CONCLUSIONS: Quantitative percussion diagnostics can nondestructively detect cracks and fractures in natural teeth with accuracy similar to that of the clinical microscope, transillumination, and dye penetrant. In addition, the method was able to reveal the presence of many cracks that were not detected by conventional transillumination.

A rapid lateral fluid percussion injury rodent model of traumatic brain injury and post-traumatic epilepsy.

Traumatic brain injury is a leading cause of acquired epilepsy. Initially described in 1989, lateral fluid percussion injury (LFPI) has since become the most extensively used and well-characterized rodent traumatic brain injury and post-traumatic epilepsy model. Universal findings, particularly seizures that reliably develop after an initial latent period, are evident across studies from multiple laboratories. However, the LFPI procedure is a two-stage process, requiring initial surgical attachment of a skull fluid cannula and then reanesthesia for delivery of the epidural fluid pressure wave. We now describe a modification of the original technique, termed 'rapid lateral fluid percussion injury' (rLFPI), which allows for a one-stage procedure and thus shorter operating time and reduced anesthesia exposure. Anesthetized male Long-Evans rats were subjected to rLFPI through a length of plastic tubing fitted with a pipette tip cannula with a 4-mm aperture. The cannula opening was positioned over a craniectomy of slightly smaller diameter and exposed dura such that the edges of the cannula fit tightly when pressed to the skull with a micromanipulator. Fluid percussion was then delivered immediately thereafter, in the same surgery session. rLFPI resulted in nonlethal focal cortical injury in all animals. We previously demonstrated that the rLFPI procedure resulted in post-traumatic seizures and regional gliosis, but had not examined other histopathologic elements. Now, we show apoptotic cell death confined to the perilesional cortex and chronic pathologic changes such as ipsilesional ventriculomegaly that are seen in the classic model. We conclude that the rLFPI method is a viable alternative to classic LFPI, and--being a one-stage procedure--has the advantage of shorter experiment turnaround and reduced exposure to anesthetics.

Assessment of the primary stability of dental implants in artificial bone using resonance frequency and percussion analyses.

PURPOSE: There is no quantitative gold standard instrumentation to assess the quality of implant osseointegration. The purpose of this exploratory study was to evaluate the response of two devices (one based on resonance frequency analysis, the Osstell device, and another that analyzes the percussion energy response, the Periometer) to assess the primary stability of implants embedded in artificial bone models. MATERIALS AND METHODS: Standard implants were placed into polyurethane blocks of varying densities, and the two mechanical devices were challenged to test the specimen block series. Both analysis of variance and regression analysis were used to examine the output from each device over each series of specimen blocks as well as to directly compare outputs between the two devices. RESULTS: The stability of the implants increased with the foam density for solid block specimens. Linear regression analysis showed significant correlation between the two instruments for testing with monolithic blocks ( r2 = 0.984). Both devices also indicated that a hybrid block with the greatest density at the top provided the best implant stability versus a hybrid block with relatively low density at the top of the block. However, resonance frequency analysis readings seemed to be more dependent on the density of the top layer of the hybrid blocks. CONCLUSION: Osstell and Periometer readings were in good agreement for monolithic blocks, and they were reasonably consistent when blocks of hybrid density were tested.

Primary stability/mobility of 1-stage and 2-stage dental implants: a comparative in vitro study.

PURPOSE: To evaluate the primary stability of 1-stage (nonsubmerged) and 2-stage (submerged) implants via newest wireless resonance frequency (RF) analyzer and newer wireless mobility measuring (MM) device. MATERIALS AND METHODS: Six 1-stage dental implants with internal hex connection and six 2-stage dental implants, 4.1 mm in diameter and 11.5 mm in length, were inserted bilaterally into the first premolar, second premolar, and first molar regions of 6 standard mandibular transparent self-curing acrylic resin models. After that, the periimplant circular bone defects were created in millimeter increments ranging between 0 and 5 mm to the same extent on all implants. RESULTS: Implant stability quotient values significantly decreased at 1-stage and 2-stage implants when periimplant defects increased. Similar implant stability quotient values were found for both implant types; however, significantly lower MM values were noted for 2-stage implants. Irrespective of implant systems, the results indicated a significant association between wireless RF analyzer and wireless MM device. CONCLUSION: Both wireless RF analyzer and wireless MM device were adequate in assessing implant stability. There was no difference between 2-stage and 1-stage implant systems, except lower MM values were noted for nonsubmerged implants.

[Periodontal tissue spectral assessment].

The periodontal condition was investigated by means of tooth natural frequency assessment. The correlation between tooth natural frequency and mobility was found out. The comparative estimation of percussion and spectral methods for natural frequency assessment revealed the percussion method to be more complicates because the initial acoustic signal is disturbed by external noises and hammer sound. The spectral method allows receiving reliable and reproducible results when using modified two-parametrical periodontometer.

Lateral fluid percussion: model of traumatic brain injury in mice.

Traumatic brain injury (TBI) research has attained renewed momentum due to the increasing awareness of head injuries, which result in morbidity and mortality. Based on the nature of primary injury following TBI, complex and heterogeneous secondary consequences result, which are followed by regenerative processes (1,2). Primary injury can be induced by a direct contusion to the brain from skull fracture or from shearing and stretching of tissue causing displacement of brain due to movement (3,4). The resulting hematomas and lacerations cause a vascular response (3,5), and the morphological and functional damage of the white matter leads to diffuse axonal injury (6-8). Additional secondary changes commonly seen in the brain are edema and increased intracranial pressure (9). Following TBI there are microscopic alterations in biochemical and physiological pathways involving the release of excitotoxic neurotransmitters, immune mediators and oxygen radicals (10-12), which ultimately result in long-term neurological disabilities (13,14). Thus choosing appropriate animal models of TBI that present similar cellular and molecular events in human and rodent TBI is critical for studying the mechanisms underlying injury and repair. Various experimental models of TBI have been developed to reproduce aspects of TBI observed in humans, among them three specific models are widely adapted for rodents: fluid percussion, cortical impact and weight drop/impact acceleration (1). The fluid percussion device produces an injury through a craniectomy by applying a brief fluid pressure pulse on to the intact dura. The pulse is created by a pendulum striking the piston of a reservoir of fluid. The percussion produces brief displacement and deformation of neural tissue (1,15). Conversely, cortical impact injury delivers mechanical energy to the intact dura via a rigid impactor under pneumatic pressure (16,17). The weight drop/impact model is characterized by the fall of a rod with a specific mass on the closed skull (18). Among the TBI models, LFP is the most established and commonly used model to evaluate mixed focal and diffuse brain injury (19). It is reproducible and is standardized to allow for the manipulation of injury parameters. LFP recapitulates injuries observed in humans, thus rendering it clinically relevant, and allows for exploration of novel therapeutics for clinical translation (20). We describe the detailed protocol to perform LFP procedure in mice. The injury inflicted is mild to moderate, with brain regions such as cortex, hippocampus and corpus callosum being most vulnerable. Hippocampal and motor learning tasks are explored following LFP.

Influence of bony defects on implant stability.

INTRODUCTION: The purpose of this study was to analyze the evolution of implant mechanical stability in different types/sizes of bony defects using both Periotest and Osstell devices as "objective tools." MATERIALS AND METHODS: Thirty-two implants were randomly allocated to one of the four types of bone defects: marginal bone loss, peri-apical bone defect, constant width dehiscence and constant length dehiscences. Periotest/Osstell measurements were completed before and during staged bone removal (to enlarge defect size). RESULTS: Significant differences (P<0.05) with initial values were found after a 2 mm marginal bone removal (Osstell/Periotest); for a peri-apical bone lesion, after removal of 5 mm (Osstell) or 8 mm (Periotest); for a 6-mm-long dehiscence, after removal up to 180 degrees of the implant perimeter (Osstell/Periotest); for a 3-mm-wide dehiscence, after removal of 10 mm (Osstell) or 6 mm (Periotest). CONCLUSION: Periotest and Osstell are in general not very sensitive in the identification of peri-implant bone destruction, except for marginal bone loss.

[Lab study of splinted teeth mobility with the help of periotestmetry].

Mobility of splinted teeth was determined with the help of the device Periotest, its meterage depended upon abutment fixation nature and their number. Critical for the device sensitivity was the weight of splinting construction equal to 12.71+/-0.81 g.

A novel apparatus for lateral fluid percussion injury in the rat.

Lateral fluid percussion injury (LFPI) is the most commonly used experimental model of human traumatic brain injury (TBI). To date, investigators using this model have produced injury using a pendulum-and-piston-based device (PPBD) to drive fluid against an intact dural surface. Two disadvantages of this method, however, are (1) the necessary reliance on operator skill to position and release the pendulum, and (2) reductions in reproducibility due to variable friction between the piston's o-rings and the cylinder. To counteract these disadvantages, we designed a low-priced, novel, fluid percussion apparatus that delivers a pressure pulse of air to a standing column of fluid, forcing it against the intact dural surface. The pressure waveforms generated by this apparatus are similar to those reported in the LFPI/PPBD literature and had little variation in appearance between trials. In addition, our apparatus produced an acute and chronic TBI syndrome similar to that in the LFPI/PPBD literature, as quantified by histological changes, MRI structural changes and chronic behavioral sequelae.

An improved impact technique for monitoring percutaneous implant integrity.

PURPOSE: The purpose of this study was to investigate the validity of the current Periotest system when measuring implant systems and to present a new system to monitor implant interface integrity. MATERIALS AND METHODS: The new system records an impact accelerometer signal and utilizes software for data analysis to determine the resonance frequency of an implant-abutment system. The new system uses the handpiece from the Periotest to acquire an impact signal but makes no use of the rest of the device. Tests were completed to determine the repeatability of the new system along with the effects clinical variables such as abutment torque, angulation of the handpiece, striking height, and distance handpiece is held from the abutment have on the measurement results. Accuracy of the current Periotest method as well as the new system was independently evaluated through the use of an abutment with a strain gauge attached. RESULTS: The new system for impact testing is shown to have greater accuracy than that of the Periotest device. Additionally, the effects of handpiece distance from abutment and torque (when above 15 Ncm) were found to be negligible while angulation of the handpiece and striking height affected the resonance frequency of the new system. CONCLUSION: The results of the in vitro testing indicate that greater resolution and accuracy can be achieved from an impact test that utilizes a clinical measurement protocol and independent analysis of the impact accelerometer signal.

Weir Mitchell's 1859 demonstration of "a peculiar contraction" produced by a percussion hammer.

BACKGROUND: The 1875 publications of Erb and Westphal brought widespread attention to the percussion of muscle stretch reflexes. Although the maneuver may have been observed before 1875, there is little concrete evidence of this. OBJECTIVES: To bring to light an early report of percussion eliciting the muscle stretch response. METHODS: While studying the Weir Mitchell papers (Philadelphia College of Physicians), the author came across an early report of the maneuver. RESULTS: The 531-word 1859 report, published in the Proceedings of the Academy of Natural Sciences of Philadelphia, was written by a pro tem reporter who observed Mitchell's demonstration of the phenomenon. The other attendees, including Dr. William Hammond, were so well aware of the phenomena that Dr. Mitchell "did not consider it necessary to describe them more fully." Mitchell viewed the response as muscular in nature and the relationship between this response and disease was not explored in the report. CONCLUSIONS: This 1859 report preceded the Erb and Westphal publications by nearly two decades. It is perhaps the first concrete proof that neurologists were observing this phenomenon as early as the mid-1800s. Mitchell viewed the phenomenon as a local muscle response. While the concepts that later allowed Erb to correctly interpret the phenomenon as a reflex arc were already in place, Mitchell did not synthesize these concepts.