Handwriting Evaluation Using Deep Learning with SensoGrip.

Handwriting learning disabilities, such as dysgraphia, have a serious negative impact on children's academic results, daily life and overall well-being. Early detection of dysgraphia facilitates an early start of targeted intervention. Several studies have investigated dysgraphia detection using machine learning algorithms with a digital tablet. However, these studies deployed classical machine learning algorithms with manual feature extraction and selection as well as binary classification: either dysgraphia or no dysgraphia. In this work, we investigated the fine grading of handwriting capabilities by predicting the SEMS score (between 0 and 12) with deep learning. Our approach provided a root-mean-square error of less than 1 with automatic instead of manual feature extraction and selection. Furthermore, the SensoGrip smart pen SensoGrip was used, i.e., a pen equipped with sensors to capture handwriting dynamics, instead of a tablet, enabling writing evaluation in more realistic scenarios.

Evaluating the Experiences of Occupational Therapists and Children Using the SensoGrip Pressure-Sensitive Pen in a Handwriting Intervention: Multimethods Study.

BACKGROUND: The acquisition of handwriting skills is essential for a child's academic success, self-confidence, and general school performance. Nevertheless, an estimated 5% to 27% of children face handwriting challenges, where the ability to modulate pressure on the pencil and lead on the paper is a key motor component. OBJECTIVE: We aimed to investigate the experience with and usability of the SensoGrip system, a pressure-measuring pen system with personalized real-time feedback about pressure modulation, in a clinical setting with children and occupational therapists (OTs). METHODS: A multimethods study was conducted, incorporating qualitative interviews and questionnaires with children, user diaries, focus group discussions, and a usability questionnaire with OTs, along with a questionnaire for parents. RESULTS: The study involved OTs (n=8), children with handwriting difficulties (n=16), and their parents (n=16), each of whom used the SensoGrip system in up to 5 therapy sessions. OTs reported that the SensoGrip system helped to focus the child's awareness on handwriting pressure and to measure it objectively. The system received high acceptance and usability ratings from the OTs-usefulness: median score of 4 out of 7; ease of use and ease of learning: median score of 6 out of 7; and satisfaction: median score of 6 out of 7. Participants appreciated that it fosters pressure awareness and motivation to draw and write. CONCLUSIONS: The SensoGrip pressure-sensing system with real-time feedback is a promising tool for pediatric occupational therapy. It supports children with handwriting difficulties to adjust their pressure application during the task. In the future, controlled quantitative trials are warranted to further examine the system's impact.

Evidence-Based and User-Centred Development of an Ecounseling & Learning-System for Parents of Children with ADHD.

Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders in childhood and adolescence. It is characterized by attention deficit, hyperactivity, and impulsivity as the main symptoms. These can lead to increased stress in everyday life for the entire family. The e-counseling and e-learning application is being developed within the ELSA project to support parents of ADHD-diagnosed children in everyday life. The requirements identified included, for example, advice on children's restlessness or measures against sibling rivalry.

Participatory design and needs assessment for a pressure-sensitive pen and mobile application (SensoGrip) for children with handwriting problems.

PURPOSE: Problems with handwriting are a common referral to occupational therapy in children and are often associated with inadequate pen grip and tip pressure. Technologies providing immediate feedback on applied forces are currently not available. Therefore, the aim was to identify user's perspectives on the optimal functionality of a pressure-sensitive pen with an integrated feedback system. METHODS: To ensure that the product meets the requirements of the users, user needs of paediatric occupational therapists, elementary or special education teachers and children were collected in two focus groups and a children's workshops before starting the technical development process. Focus group transcripts were analyzed and rephrased as user stories to identify user-centred requirements. In a second step, user stories were merged and ranked regarding importance and feasibility. RESULTS: 120 user story requirements were generated from the focus groups and children's workshops, indicating requirements regarding design and functionality for the pen and mobile application. Visual feedback, appropriate size and weight, customizability, ease of settings and usability of the pen were pivotal. CONCLUSIONS: This study comprehensively researched the requirements for a device that may facilitate children in adjusting their handwriting pressure and can guide further research and evaluation.

Description of a participatory design process for the development of a pressure-sensitive pen.Understand the needs of different stakeholders for an assistive device for children with handwriting difficulties.Inform the further development of a pressure-sensitive pen with immediate pressure-feedback.

The 1 year outcome of the transobturator retroluminal repositioning sling in the treatment of male stress urinary incontinence.

OBJECTIVE: To evaluate the efficacy and safety of a transobturator retroluminal repositioning sling suspension in the treatment of male stress urinary incontinence (SUI) after prostate surgery. PATIENTS AND METHODS: In 118 men with SUI after prostatic surgery, a transobturator retroluminal repositioning sling suspension was implanted. Patients were evaluated including: complete history and physical examination, 24-h pad test, a questionnaire (International Consultation on Incontinence Questionnaire, Short-Form), urodynamic evaluation and endoscopy. The surgical technique was described previously. The findings before and at 1 year after sling placement were compared. RESULTS: At the 12-month follow-up, 73.7% of the men were cured, 16.9% were improved, and 9.3% were still incontinent. After sling placement the daily pad use decreased significantly (P < 0.001), while the ICIQ-SF improved significantly (P < 0.01). The detrusor voiding pressure, postvoid residual urine volume and maximal flow rates remained unchanged, while the Valsalva leak-point pressure improved significantly (P < 0.01). In 19.5% of the men, there was transient scrotal pain or perineal discomfort. In 5.1% of the men, postoperative urinary retention occurred but resolved spontaneously after a few weeks of catheter placement. In 1.7% of the men adductor pain was reported, which resolved spontaneously. There were no major complications. CONCLUSION: The transobturator retroluminal repositioning sling suspension for the treatment of male SUI is effective and safe with a low complication rate after 1 year of follow-up.

Dorsal urethroplasty with labia minora skin graft for female urethral strictures.

OBJECTIVE: to report a new dorsal labia minora skin-graft urethroplasty as a simple, safe and effective therapeutic alternative for female urethral strictures, as although distal urethral strictures can be treated by meatoplasty, proximal and mid-urethral strictures need appropriate urethroplasty. PATIENTS AND METHODS: eight women with a confirmed proximal or mid-urethral stricture had indications for urethroplasty with the use of a thin free labia minora skin graft using a dorsal (6 o'clock position) urethroplasty technique. Full informed consent was obtained. From the inner aspect of one labium minora a thin free skin flap was prepared. The strictured urethra and the anterior vaginal wall were transected and the graft sutured into the defect. All scar tissue was removed and the anterior vaginal wall closed in two layers over the area of the urethroplasty. Continence was evaluated by a stress test with a full bladder. RESULTS: all patients were operated on with no complications during or after surgery. After 1 and 2 years of follow-up seven and six of the eight patients had no recurrence of stricture disease. All patients remained continent. CONCLUSION: the urethroplasty using an inlay of free thin genital skin graft was safe, uncomplicated and effective.

Chronic pelvic pain in women: still a challenge.

Chronic pelvic pain (CPP), a common condition particularly in reproductive-aged women, causes disability and distress, and significantly compromises quality of life and affects healthcare costs. The pathogenesis of CPP is still poorly understood and consequently poorly managed. Furthermore, the lack of a consensus on the definition of CPP greatly hinders epidemiological studies. Patients present with various associated problems, including bladder or bowel dysfunction, gynaecological pathologies or sexual dysfunction, and other systemic or constitutional symptoms. Other conditions, e.g. depression, anxiety and drug addiction, can also coexist. Effective management presupposes an integrated knowledge of all pelvic organs and other systems, including musculoskeletal, neurological and psychiatric systems. The key to treating CPP is to treat it as the complex disease it is. Treatment options range from conservative medical therapy to surgical intervention, and are primarily directed towards symptom relief. Unsatisfactory results of treatment render this condition a frustrating problem for both patients and physicians.

Anatomical approach for surgery of the male posterior urethra.

OBJECTIVE: To investigate, in a morphological study, the anatomy of the male rhabdosphincter and the relation between the membranous urethra, the rhabdosphincter and the neurovascular bundles (NVBs) to provide the anatomical basis for surgical approach of the posterior urethra as successful outcomes in urethral reconstructive surgery still remain a challenging issue. MATERIALS AND METHODS: In all, 11 complete pelves and four tissue blocks of prostate, rectum, membranous urethra and the rhabdosphincter were studied. Besides anatomical preparations, the posterior urethra and their relationship were studied by means of serial histological sections. RESULTS: In the histological cross-sections, the rhabdosphincter forms an omega-shaped loop around the anterior and lateral aspects of the membranous urethra. Ventrally and laterally, it is separated from the membranous urethra by a delicate sheath of connective tissue. Through a midline approach displacing the nerves and vessels laterally, injuries to the NVBs can be avoided. With meticulous dissection of the delicate ventral connective tissue sheath between the ventral wall of the membranous urethra and the rhabdosphincter, the two structures can be separated without damage to either of them. This anatomical approach can be used for dissection of the anterior urethral wall in urethral surgery. CONCLUSIONS: Based on precise anatomical knowledge, the ventral wall of the posterior urethra can be dissected and exposed without injuring the rhabdosphincter and the NVBs. This approach provides the basis for sparing of the rhabdosphincter and for successful outcomes in urethral surgery for the treatment of bulbo-membranous urethral strictures.

Female sexual dysfunction: a new urogynaecological research field.

OBJECTIVE: To critically review published data on the urogynaecological aspects of female sexual dysfunction (FSD), as FSD is a developing multidisciplinary issue associated with several biological, medical and psychological factors. METHODS: The reported prevalence of FSD is 19-50% and women with lower urinary tract symptoms or urinary incontinence (UI) not only complain of a deteriorating of quality of life but also of sexual life with an incidence as high as 26-47%. Furthermore, urogynaecological surgery represents an important but underestimated cause of FSD. Different databases (Pub Medical, Medline, serial titles, the Cochrane library and the NLM gateway database) were searched for the keywords 'sexuality; sexual function; urinary incontinence; pelvic organ prolapse; questionnaire; symptom severity; epidemiology; quality of life; instruments; sexual health; vagina; vaginal surgery; pelvic surgery'. RESULTS: There is a lack of a standardized instrument for assessing FSD. Recent studies investigate the impact of UI on sexual function, but the pathophysiology has not been elucidated. Vaginal or pelvic surgery does not affect overall sexual satisfaction. CONCLUSIONS: Our investigation highlights the need for studies to assess the anatomical, physiological and sensory mechanisms related to FSD. Specific questionnaire are needed to quantify the problem. In the definition, symptoms assessment and preoperative counselling is important, to make a distinction between overall sexual function and individual parameters, such as psychosocial context. Only in this way, will it be possible to identify new therapeutic targets. A definition of success in urogyneacological terms should include aspects of quality of life and quality of sexual life. Immediate research in this field is needed.

Single-stage dorsal inlay split-skin graft for salvage anterior urethral reconstruction.

OBJECTIVE: To report our initial experience and extended follow-up of single-stage dorsal inlay skin-graft urethroplasty for salvaging recurrent anterior urethral stricture (AUS), as urethral reconstruction remains a challenge, particularly in patients with recurrent AUS after previous surgery, and a paucity of local skin frequently requires free graft reconstruction techniques. PATIENTS AND METHODS: In all, 27 patients (mean age 48.12 years, range 17-79) with recurrent AUS had a dorsal inlay urethroplasty using extragenital split-thickness skin grafts. An electrical dermatome was used for graft harvesting. All patients had contraindications for buccal mucosal grafting (e.g. radiotherapy, leukoplakia). The assessment before repair comprised a clinical investigation, urine analysis, uroflowmetry, retrograde and voiding cystogram, urethral ultrasonography and endoscopy. The follow-up was based on an assessment of flow rate and postvoid residual volume. Success was defined by the absence of symptoms and stable maximum flow rate, while any further instrumentation was considered a failure. RESULTS: The mean (range) stricture length was 8.35 (3-14) cm. The overall complication rate was 7%, with no complications during surgery. During the mean (range) follow-up of 32.43 (5-46) months, 25 (93%) of the patients were successfully cured in one operation. Two patients required further treatment for recurrence and fistula. No long-term complications were noted at the graft donor sites. There was no case of intraurethral hair growth during the extended follow-up. CONCLUSION: If there are contraindications for buccal mucosal grafting, a split-thickness skin can be used for dorsal inlay urethroplasty in recurrent AUS. A well-vascularized recipient bed on the corpora cavernosa is required for reliable graft take. Intra-urethral hair growth is avoided by using split-skin grafts. Although the complication rates are equivalent to those of buccal mucosa, we await the longer follow-up to assess the ultimate value of this alternative single-stage technique.

Penile strangulation in a patient with Parkinson's disease: a case report.

INTRODUCTION: Aberrant sexual behaviour such as hypersexuality or exhibitionism has been reported in patients with Parkinson's disease and its therapy. CASE PRESENTATION: We report a case of a 67-year-old man with a 10-year history of Parkinson's disease, currently under therapy with L-dopa and bromocriptine, who presented with his wedding ring constricting the base of his penis. The ring could be removed with a ring cutter without complications. CONCLUSION: The present literature concerning sexual dysfunction in Parkinson's disease and dopaminergic therapy is discussed. Doctors who treat these patients should be aware of the problem of hypersexuality associated with dopaminergic therapy.