A Novel Method to Sanitize Breast Pump Equipment in the Neonatal Intensive Care Unit.

BACKGROUND: Enhancing the current breast pump sanitization method may improve maternal satisfaction and increase a mother's likelihood of providing human milk for their hospitalized infants in the Neonatal Intensive Care Unit (NICU). Other than Centers for Disease Control (CDC) data, there is lack of studies on sanitization practices. Currently, the only option in the hospital setting for breast pump equipment cleaning is a steam sanitization plastic bag. PURPOSE: Using the Q. Basin will increase participant satisfaction compared to the steam sanitization bag. METHODS: A multi-phased pilot study was conducted in our quaternary care NICU to test the Q. Basin, a novel design developed to wash, dry, and safely steam sanitize breast pump equipment compared to the standard steam bag. A bacterial study was conducted on breast pump equipment from 10 mothers by swabbing the equipment immediately at hour zero and 24 hours. Twenty NICU mothers concurrently evaluated their satisfaction via a 3-question survey comparing the Q. Basin and the steam sanitization plastic bag method. RESULTS: The results showed a 20% increase in satisfaction with Q. Basin compared to the steam bag method. IMPLICATIONS FOR PRACTICE AND RESEARCH: Data analysis from the satisfaction survey concludes that mothers pumping preferred the Q. Basin as a quicker, faster, and more environmentally friendly method for breast pump part sanitization. Additional safety and materials studies are required before using the Q. Basin in the clinical environment.

Machine learning for automatic identification of thoracoabdominal asynchrony in children.

BACKGROUND: The current methods for assessment of thoracoabdominal asynchrony (TAA) require offline analysis on the part of physicians (respiratory inductance plethysmography (RIP)) or require experts for interpretation of the data (sleep apnea detection). METHODS: To assess synchrony between the thorax and abdomen, the movements of the two compartments during quiet breathing were measured using pneuRIP. Fifty-one recordings were obtained: 20 were used to train a machine-learning (ML) model with elastic-net regularization, and 31 were used to test the model's performance. Two feature sets were explored: (1) phase difference (ɸ) between the thoracic and abdominal signals and (2) inverse cumulative percentage (ICP), which is an alternate measure of data distribution. To compute accuracy of training, the model outcomes were compared with five experts' assessments. RESULTS: Accuracies of 61.3% and 90.3% were obtained using ɸ and ICP features, respectively. The inter-rater reliability (i.r.r.) of the assessments of experts was 0.402 and 0.684 when they used ɸ and ICP to identify TAA, respectively. CONCLUSIONS: With this pilot study, we show the efficacy of the ICP feature and ML in developing an accurate automated approach to identifying TAA that reduces time and effort for diagnosis. ICP also helped improve consensus among experts. IMPACT: Our article presents an automated approach to identifying thoracic abdominal asynchrony using machine learning and the pneuRIP device. It also shows how a modified statistical measure of cumulative frequency can be used to visualize the progression of the pulmonary functionality along time. The pulmonary testing method we developed gives patients and doctors a noninvasive and easy to administer and diagnose approach. It can be administered remotely, and alerts can be transmitted to the physician. Further, the test can also be used to monitor and assess pulmonary function continuously for prolonged periods, if needed.

Comparative evaluation of one-handed versus two-handed mask holding techniques in children during inhalational induction of anesthesia: A randomized crossover study.

BACKGROUND: We aimed to evaluate if two-handed mask airway is superior to one-handed mask airway during inhalational induction of anesthesia in children. METHODS: A randomized, two period, crossover study was performed on 60 children aged 1-8 years, with obstructive sleep apnea due to adenotonsillar hypertrophy, scheduled for adenotonsillectomy. Children were assigned to two study sequences and one control sequence of 20 subjects each. A control sequence was added to evaluate the effect of anesthetic depth. Sequence 1: One-handed followed by two-handed airway, 30 seconds each; Sequence 2: two-handed followed by one-handed airway, 30 seconds each and Sequence 3: two-handed airway, for 60 seconds. The work of breathing indices, phase angle, and labored breathing index were recorded using respiratory inductance plethysmography. Additional outcome measures were tidal volume, minute ventilation, and respiratory rate. A straight comparison and a crossover analysis was performed. RESULTS: The initial comparison revealed that one-handed airway had greater phase angle (mean diff. 17.4; 95% confidence interval [CI] 1.07-33.68; P = .034), greater labored breathing index (mean diff. 0.56; 95% CI 0.16-1.04; P = .004),lower minute ventilation (mean diff. -1567; 95% CI -2695 to -5.4; P = .004),and lower tidal volume (mean diff. -39; 95% CI -2.7 to -5.4; P = .02) than two-handed airway. On crossover analysis, within-subject difference in the phase angle was greater during one-handed than two-handed airway (34.3; 95% CI 8.46-60.14; P = .01) as was labored breathing index (mean diff. 1.2; 95% CI 0.39-2.00; P < .0046).Minute ventilation was lower during one-handed than two-handed airway (mean diff. -3359; 95% CI -4363 to -2355, P < 0.0001) as was tidal volume(mean diff. -78; 95% CI -110.4 to -45.8; P < .0001). CONCLUSION: In children with obstructive sleep apnea due to adenotonsillar hypertrophy, two-handed airway provides superior airway patency that was not influenced by the anesthetic depth.

Age-related ranges of respiratory inductance plethysmography (RIP) reference values for infants and children.

The current noninvasive method for respiratory monitoring is respiratory inductance plethysmography (RIP); two bands are connected, one each to the chest and the abdomen, to measure the breathing pattern. RIP requires post hoc analysis to calculate indices such as respiratory rate, phase angle, labored breathing index, and percent of rib cage contribution to breathing. Clinical studies have provided patient RIP values and age-matched normal values, but they lack global evaluation of normative data for a wide age range of pediatric subjects. Herein, we compiled normative RIP indices from numerous studies for a large range of pediatric ages. From these data, we derived regression equations useful for computing normal RIP parameters as a function of age. The presented review will provide caregivers the ability to compare RIP data of pediatric patients against the regression analysis. This comparison will help identify patients with pulmonary complications and aid in guiding respiratory therapy.

Activity of daily living for Morquio A syndrome.

The aim of this study was to evaluate the activity of daily living (ADL) and surgical interventions in patients with mucopolysaccharidosis IVA (MPS IVA). The factor(s) that affect ADL are age, clinical phenotypes, surgical interventions, therapeutic effect, and body mass index. The ADL questionnaire comprises three domains: "Movement," "Movement with cognition," and "Cognition." Each domain has four subcategories rated on a 5-point scale based on the level of assistance. The questionnaire was collected from 145 healthy controls and 82 patients with MPS IVA. The patient cohort consisted of 63 severe and 17 attenuated phenotypes (2 were undefined); 4 patients treated with hematopoietic stem cell transplantation (HSCT), 33 patients treated with enzyme replacement therapy (ERT) for more than a year, and 45 untreated patients. MPS IVA patients show a decline in ADL scores after 10years of age. Patients with a severe phenotype have a lower ADL score than healthy control subjects, and lower scores than patients with an attenuated phenotype in domains of "Movement" and "Movement with cognition." Patients, who underwent HSCT and were followed up for over 10years, had higher ADL scores and fewer surgical interventions than untreated patients. ADL scores for ERT patients (2.5years follow-up on average) were similar with the-age-matched controls below 10years of age, but declined in older patients. Surgical frequency was higher for severe phenotypic patients than attenuated ones. Surgical frequency for patients treated with ERT was not decreased compared to untreated patients. In conclusion, we have shown the utility of the proposed ADL questionnaire and frequency of surgical interventions in patients with MPS IVA to evaluate the clinical severity and therapeutic efficacy compared with age-matched controls.

Bariatric Left Gastric Artery Embolization for the Treatment of Obesity: A Review of Gut Hormone Involvement in Energy Homeostasis.

OBJECTIVE: The global population is becoming more overweight and obese, leading to increases in associated morbidity and mortality rates. Advances in catheter-directed embolotherapy offer the potential for the interventional radiologist to make a contribution to weight loss. Left gastric artery embolization reduces the supply of blood to the gastric fundus and decreases serum levels of ghrelin. Early evidence suggests that this alteration in gut hormone balance leads to changes in energy homeostasis and weight reduction. The pathophysiologic findings and current evidence associated with the use of left gastric artery embolization are reviewed. CONCLUSION: The prevalence of obesity continues to increase at an alarming rate, and, thus far, advances in medical management have been relatively ineffective in slowing this trend. Lifestyle modifications such as diet and exercise are effective initially, but most patients regain the weight in the long term. Bariatric surgery is the most effective strategy for achieving long-term weight loss; however, as with all surgical procedures, it has potential complications.

Feasibility and Effectiveness of a Novel Exoskeleton for an Infant With Arm Movement Impairments.

PURPOSE: To determine whether a novel exoskeletal device (Pediatric-Wilmington Robotic Exoskeleton [P-WREX]) is feasible and effective for intervention to improve reaching and object interaction for an infant with arm movement impairments. METHODS: An 8-month old infant with arthrogryposis was followed up every 2 weeks during a 1-month baseline, 3-month intervention, and 1-month postintervention. At each visit, reaching and looking behaviors were assessed. RESULTS: Within sessions, the infant spent more time contacting objects across a larger space, contacting objects with both hands, and looking at objects when wearing the P-WREX. Throughout intervention, the infant increased time contacting objects both with and without the device and increased bilateral active shoulder flexion. CONCLUSIONS: (1) It may be feasible for families to use exoskeletons for daily intervention, (2) exoskeletons facilitate immediate improvements in function for infants with impaired upper extremity mobility, and (3) interventions using exoskeletons can improve independent upper extremity function across time.

The Effect of Trypsin-Chymotrypsin on Postoperative Pain after Single Visit Endodontic Treatment: A Randomized Controlled Trial.

INTRODUCTION: The efficacy of trypsin-chymotrypsin in postoperative pain management following single-visit root canal treatment of teeth with symptomatic irreversible pulpitis was evaluated. Additionally, synergistic effects with nonsteroidal anti-inflammatory drugs and reported side effects were also investigated. METHODS: This prospective, parallel, triple-blinded phase IV randomized controlled trial included 60 patients with mandibular first molars exhibiting symptomatic irreversible pulpitis. The patients were randomly allocated using computer software to one of four treatment groups (n = 15 each), and either ibuprofen (600 mg), ambezim-G (trypsin 5mg-chymotrypsin 5 mg), a combination of both, or a placebo drug were administered postoperatively. The participants scored pain intensity at different time-intervals using a numerical scale, and passive surveillance of harm was used to detect clinical safety. Age was compared between groups using a one-way analysis of variance test. Pain scores were analyzed using the Kruskal-Wallis and Friedman's tests and, if significant, Dunn's test was used for pairwise comparisons. The chi-square test was used to compare qualitative data, and the significance level was set at P value ≤ .05. RESULTS: All interventions were found to be effective in reducing postoperative pain, and no statistically significant differences were observed between the ibuprofen, trypsin-chymotrypsin, and combination groups. However, all 3 groups differed significantly from the placebo group. The safety profile of the interventions did not differ significantly. CONCLUSIONS: Trypsin-chymotrypsin exhibits comparable efficacy to nonsteroidal anti-inflammatory drugs. No synergistic effects occur when the 2 are used in combination. This is the first randomized controlled trial to assess the effects of proteolytic enzymes on postendodontic pain. TRIAL REGISTRATION: clinicaltrials.gov, Identifier: NCT05479747.

Improved distribution of leg forces after fibular resection and synostosis.

PURPOSE: Genu varum- a common symptom in achondroplasia- may lead to ankle valgus in children. Ankle valgus may be mitigated by tibiofibular synostosis, but this is not always the case. The mechanical environment around the growth plates plays an important role in ankle valgus. The purpose of this project is 1) to determine the strain through the distal fibular growth plate before and after tibiofibular synostosis, and 2) postulate whether the change in strain affects ankle valgus. This project measured the distal fibular strain in a porcine hind leg model. METHODS: The lower legs of seven pigs were removed, instrumented with strain gauges, and loaded compressively in a material testing machine. Loads were applied at three phases: 1) the intact leg, 2) leg with fibula resected, and 3) leg with fibula resected and tibiofibular synostosis. Mean strains were compared between phases using a mixed affect model. The significance level was adjusted for multiple comparisons using the Bonferroni method. RESULTS: Phase 1, intact leg, had the highest strain value at 1247.9µÉ›. In phase 2, the mean strain was 106.2µÉ›. In phase 3, the compressive mean strain dropped to 477.4µÉ›, which is 38% of the strain in phase 1. Standard error was 86.8µÉ›; p < 0.001. CONCLUSION: Results indicate that more of the force through the leg is transmitted through the tibia after fibular resection and tibiofibular synostosis, which improves the balance of forces through the leg.

Spatial aerosol deposition correlated to anatomic feature development in 6-year-old upper airway computational models.

The upper airways of children undergo developmental changes around age 6, yielding differences between adult and pediatric anatomies. These differences include the cricoid ring area shape, the location of narrowest constriction, and the angle of the epiglottis, all of which are expected to alter local fluid dynamic profiles and subsequent upper airway deposition and downstream aerosol delivery of inhaled therapeutics. In this work, we quantify "pediatric"-like and "adult"-like geometric and fluid dynamic features of two computed tomography (CT)-scan derived models of 6-year-old upper airways in healthy subjects and compare to an idealized model. The two CT-scan models had a mixture of "adult"- and "pediatric"-like anatomic features, with Subject B exhibiting more "pediatric"-like features than Subject A, while the idealized model exhibited entirely "adult"-like features. By computational fluid-particle dynamics, these differences in anatomical features yielded distinct local fluid profiles with altered aerosol deposition between models. Notably, the idealized model better predicted deposition characteristics of Subject A, the more "adult"-like model, including the relationship between the impaction parameter, dp2Q and the fraction of deposition across a range of flow rates and particle diameters, as well as deposition of an approximate pharmaceutical particle size distribution model. Our results with even this limited dataset suggest that there are key personalized metrics that are influenced by anatomical development, which should be considered when developing pediatric inhalable therapeutics. Quantifying anatomical development and correlating to aerosol deposition has the potential for high-throughput developmental characterization and informing desired aerosol characteristics for pediatric applications.

Wilmington robotic exoskeleton: a novel device to maintain arm improvement in muscular disease.

BACKGROUND: Upper-extremity movement is limited in individuals with muscular weakness. This paper describes a novel, articulated upper-extremity orthosis, the Wilmington Robotic Exoskeleton (WREX), which helps people overcome this movement deficit. METHODS: This prospective, case-controlled study involved an ambulatory patient with arthrogryposis multiplex congenita and 2 nonambulatory patients with spinal muscular atrophy type II. The WREX uses elastic bands to negate the effects of gravity; it allows a person with neuromuscular weakness to move their arm in 3 dimensions. The WREX can be fixed on a brace for ambulatory patients and on the wheelchair for nonambulatory patients. Assessment was performed through motion analysis (with and without the WREX), clinical examination, and qualitative questionnaire. RESULTS: Motion analysis showed a marked improvement in upper-extremity function with the WREX. The questionnaire illustrated enhanced functionality with the WREX including self-feeding, fine motor control, and use of a television remote control. Enhanced functionality resulted in improved quality of life by increasing participation in school, raising self-esteem, and increasing social interaction. Two unexpected outcomes were increased security with trunk inclination and amelioration of the effects of contractures. CONCLUSIONS: The WREX provided an increase in functionality and improved the quality of life of the patients. The device has become an integral part of the lives of the 3 patients. LEVEL OF EVIDENCE: Level III in Therapeutic Studies-Investigating the Results of Treatment.

Tracking manikin tracheal intubation using motion analysis.

OBJECTIVES: This study investigates whether laryngoscope motion-tracking technology can be used to differentiate expert versus novice providers' techniques during endotracheal intubation in infant manikins; this may help improve intubation techniques. METHODS: Each of 11 experts and 11 novices intubated an infant manikin head (Laerdal Corp, Wappinger Falls, NY) 10 times. Laryngoscope motion was tracked using electromagnetic technology during: (1) time from acquisition of laryngoscope to oral insertion, (2) insertion to stabilization of laryngoscope, and (3) stabilization of laryngoscope to insertion of endotracheal tube and withdrawal of laryngoscope. There were 213/220 analyzable data files. Expert versus novice rate of success, laryngoscope blade-tip motion path length, handle angle at intubation, time in each phase, and motion of handle relative to manikin were compared. RESULTS: Intubation success rate was greater for experts (105/105 = 100% vs novices 101/108 = 93.5%, P < 0.001). Expert path of motion in phase 2 was longer (mean, 39 vs 29 cm, P < 0.001). The mean difference in the laryngoscope handle angle relative to the manikin occiput was statistically significant (mean angle, -54.42 vs -56.63 degrees; P = 0.001) but within the equipment testing margin of error (2 degrees). Time from insertion to withdrawal of laryngoscope (phases 2 and 3 combined) was greater for experts (16.45 vs 13.15 seconds; P = 0.02). Both experts and novices "rocked" the laryngoscope to achieve laryngeal visualization. CONCLUSIONS: It is feasible to track laryngoscope motion during manikin intubation comparing expert versus novice technique. Experts had a greater success rate, but longer path length, and took longer to achieve manikin intubation. Motion-tracking technology may provide an analytic tool to improve techniques of intubation.

Automated Assessment of Thoracic-Abdominal Asynchrony in Patients with Morquio Syndrome.

Morquio syndrome is a rare disease caused by a disorder in the storage of mucopolysaccharides that affects multiple organs, including musculoskeletal, respiratory, cardiovascular, and digestive systems. Respiratory failure is one of the leading causes of mortality in Morquio patients; thus, respiratory function testing is vital to the management of the disease. An automated respiratory assessment methodology using the pneuRIP device and a machine-learning algorithm was developed. pneuRIP is a noninvasive approach that uses differences between thoracic and abdominal movements (thoracic-abdominal asynchrony) during respiration to assess respiratory status. The technique was evaluated on 17 patients with Morquio (9 females and 8 males) between the ages of 2 and 57 years. The results of the automated technique agreed with the clinical assessment in 16 out of the 17 patients. It was found that the inverse cumulative percentage representation of the time delay between the thorax and abdomen was the most critical variable for accurate evaluation. It was demonstrated that the technique could be successfully used on patients with Morquio who have difficulty breathing with 100% compliance. This technique is highly accurate, portable, noninvasive, and easy to administer, making it suitable for a variety of settings, such as outpatient clinics, at home, and emergency rooms.

Spirituality and Quality of Life among Parents of Adolescents with Spina Bifida.

In this investigational cross-sectional study, we explored the relationships among caregiver burden, depressive symptoms, spirituality, and quality of life (QOL) in 58 parental caregivers of adolescents with spina bifida (SB). A hierarchical linear regression analysis provided evidence that depressive symptoms and caregiver burden were negatively related to QOL scores, but spirituality was positively related. We found a significant interaction between caregiver burden and spirituality, suggesting that spirituality moderates the relationship between caregiver burden and quality of life. The negative effect of caregiver burden on QOL decreased as spirituality increased. These results warrant further research into how caregiver burden and spirituality intersect and impact QOL in parental caregivers of adolescents with SB.

Diagnostic differences in respiratory breathing patterns and work of breathing indices in children with Duchenne muscular dystrophy.

RATIONALE: Pulmonary function testing (PFT) provides diagnostic information regarding respiratory physiology. However, many forms of PFT are time-intensive and require patient cooperation. Respiratory inductance plethysmography (RIP) provides thoracoabdominal asynchrony (TAA) and work of breathing (WOB) data. pneuRIPTM is a noninvasive, wireless analyzer that provides real-time assessment of RIP via an iPad. In this study, we show that pneuRIPTM can be used in a hospital clinic setting to differentiate WOB indices and breathing patterns in children with DMD as compared to age-matched healthy subjects. METHODS: RIP using the pneuRIPTM was conducted on 9 healthy volunteers and 7 DMD participants (ages 5-18) recruited from the neuromuscular clinic, under normal resting conditions over 3-5 min during routine outpatient visits. The tests were completed in less than 10 minutes and did not add excessive time to the clinic visit. Variables recorded included labored-breathing index (LBI), phase angle (Φ) between abdomen and rib cage, respiratory rate (RR), percentage of rib cage input (RC%), and heart rate (HR). The data were displayed in histogram plots to identify distribution patterns within the normal ranges. The percentages of data within the ranges (0≤ Φ ≤30 deg.; median RC %±10%; median RR±5%; 1≤LBI≤1.1) were compared. Unpaired t-tests determined significance of the data between groups. RESULTS: 100% patient compliance demonstrates the feasibility of such testing in clinical settings. DMD patients showed a significant elevation in Φ, LBI, and HR averages (P<0.006, P<0.002, P<0.046, respectively). Healthy subjects and DMD patients had similar BPM and RC% averages. All DMD data distributions were statistically different from healthy subjects based on analysis of histograms. The DMD patients showed significantly less data within the normal ranges, with only 49.7% Φ, 48.0% RC%, 69.2% RR, and 50.7% LBI. CONCLUSION: In this study, noninvasive pneuRIPTM testing provided instantaneous PFT diagnostic results. As compared to healthy subjects, patients with DMD showed abnormal results with increased markers of TAA, WOB indices, and different breathing patterns. These results are similar to previous studies evaluating RIP in preterm infants. Further studies are needed to compare these results to other pulmonary testing methods. The pneuRIPTM testing approach provides immediate diagnostic information in outpatient settings.

A novel noninvasive approach for evaluating work of breathing indices in a developmental rat model using respiratory inductance plethysmography.

Pulmonary function testing (PFT) is an important component for evaluating the outcome of experimental rodent models of respiratory diseases. Respiratory inductance plethysmography (RIP) provides a noninvasive method of PFT requiring minimal cooperation. RIP measures work of breathing (WOB) indices including phase angle (Ф), percent rib cage (RC %), breaths per minute (BPM), and labored breathing index (LBI) on an iPad. The aim of this study was to evaluate the utility of a recently developed research instrument, pneuRIP, for evaluation of WOB indices in a developmental rat model. Sprague Dawley rats (2 months old) were commercially acquired and anaesthetised with isoflurane. The pneuRIP system uses two elastic bands: one band (RC) placed around the rib cage under the upper armpit and another band (AB) around the abdomen. The typical thoracoabdominal motion (TAM) plot showed the abdomen and rib cage motion in synchrony. The plots of phase angle and LBI as a function of data point number showed that values were within the range. The distribution for phase angle and LBI was within a narrow range. pneuRIP testing provided instantaneous PFT results. This study demonstrated the utility of RIP as a rapid, noninvasive approach for evaluating treatment interventions in the rodent model.

Elbow Flexion Assist Orthosis for Arthrogryposis.

INTRODUCTION: People with arthrogryposis multiplex congenita (AMC) often have muscle weakness in the biceps that makes elbow flexion difficult. An elbow-flexion assist orthosis was designed using the force of springs, combined with a sliding joint, to apply appropriate elbow torque to aid a user in lifting her hand to her mouth. The sliding joint allows an increasing elbow torque despite a decreasing spring force. METHODS: The device was prototyped for a user with AMC. An occupational therapist measured the user's flexion with and without the device. Benchtop torque measurements were also determined and compared with user trials. RESULTS: The assist orthosis applied an increasing torque as the elbow flexed, thereby allowing the subject to reach her mouth for feeding and then extend her elbow to a position of no applied torque. Without the device, the subject had active elbow flexion of 87 degrees. With the device, this flexion increased to 120 degrees. CONCLUSION: The novel prototype is a lightweight, spring-powered flexion orthosis which can be made relatively easily and is potentially concealed under clothing. It provides the appropriate torque to move the hand against gravity and increases elbow-flexion of the user.

Measures of respiratory inductance plethysmography (RIP) in children with neuromuscular disease.

BACKGROUND: Pulmonary function testing (PFT) is essential for the clinical assessment of respiratory problems. Respiratory inductance plethysmography (RIP) is a non-invasive method of PFT requiring minimal patient cooperation. RIP measures the volumetric change in the ribcage and abdomen, from which work of breathing (WOB) indices are derived. WOB indices include: phase angle (Ф), percent ribcage (RC%), respiratory rate (RR), and labored breathing index (LBI). Heart rate (HR) is collected separately. AIM: The goal of this study was to assess the utility of a newly developed RIP system, the pneuRIP, in an outpatient clinic setting in children with neuromuscular (NM) disease. METHOD: The pneuRIP system measures and displays the WOB indices in real-time on an iPad display. Forty-three subjects, 22 NM patients and 21 healthy children (ages: 5-18 years) were enrolled. RESULTS: Patients' means showed an increase of 119.8% for Ф, 15.7% for LBI, and 19.9% for HR compared with healthy subjects, when adjusted for age and gender. The study found significant differences between the mean values of the healthy subjects and patients in Ф (P = 0.000), LBI (P = 0.001), and HR (P = 0.001). No differences were noted for RC% and RR between groups. Data for Ф in NM patients were diffusely distributed as compared with healthy subjects based on analysis of histograms. CONCLUSION: Non-invasive pneuRIP testing provided instantaneous PFT results. As compared to healthy subjects, NM patients showed abnormal results with increased markers of thoracoabdominal asynchrony, WOB indices, and biphasic breathing patterns likely resulting from NM weakness.

Development and simulation of a passive upper extremity orthosis for amyoplasia.

INTRODUCTION: People who are born with arthrogryposis multiplex congenita are typically not able to perform activities of daily living (ADL) due to decreased muscle mass, joint contractures and unnatural upper extremity positioning. They are, therefore, potential users of an assistive device capable of aiding in ADL and increasing their independence. A passive orthosis can support the weight of their arm against gravity, allowing them to perform movements with less effort. METHODS: This study presents a prototype design with four degrees-of-freedom that uses musculoskeletal modelling to optimize the stiffness of the springs in the device to partially gravity balance the upper extremity while compensating for the usual internally rotated glenohumeral joint. A single subject-specific musculoskeletal model was developed to simulate the effects of the passive orthosis during 10 static postures during ADL. RESULTS: For a given configuration using a mono- and a bi-articular spring, the simulations showed that spring stiffnesses of 400 Nm-1 and of 1029 Nm-1, respectively, were able to lower the maximal muscle activity estimated by the musculoskeletal model to a level in which the 10 postures can be realized. CONCLUSION: By augmenting residual muscle strength with a partially gravity-balanced passive orthosis, ADLs may be achievable for people with arthrogryposis multiplex congenita.

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.