scholarly journals Exploiting telerobotics for sensorimotor rehabilitation: a locomotor embodiment

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Min Hyong Koh ◽  
Sheng-Che Yen ◽  
Lester Y. Leung ◽  
Sarah Gans ◽  
Keri Sullivan ◽  
...  
Keyword(s):  
Robotic Arm ◽  
Heel Strike ◽  
Locomotor Training ◽  
Robot Interaction ◽  
Interaction Forces ◽  
Motor Responses ◽  
Randomized Controlled ◽  
Treadmill Speed ◽  
Gait Feature ◽  
To Receive

Abstract Background Manual treadmill training is used for rehabilitating locomotor impairments but can be physically demanding for trainers. This has been addressed by enlisting robots, but in doing so, the ability of trainers to use their experience and judgment to modulate locomotor assistance on the fly has been lost. This paper explores the feasibility of a telerobotics approach for locomotor training that allows patients to receive remote physical assistance from trainers. Methods In the approach, a trainer holds a small robotic manipulandum that shadows the motion of a large robotic arm magnetically attached to a locomoting patient's leg. When the trainer deflects the manipulandum, the robotic arm applies a proportional force to the patient. An initial evaluation of the telerobotic system’s transparency (ability to follow the leg during unassisted locomotion) was performed with two unimpaired participants. Transparency was quantified by the magnitude of unwanted robot interaction forces. In a small six-session feasibility study, six individuals who had prior strokes telerobotically interacted with two trainers (separately), who assisted in altering a targeted gait feature: an increase in the affected leg’s swing length. Results During unassisted walking, unwanted robot interaction forces averaged 3−4 N (swing–stance) for unimpaired individuals and 2−3 N for the patients who survived strokes. Transients averaging about 10 N were sometimes present at heel-strike/toe-off. For five of six patients, these forces increased with treadmill speed during stance (R2 = .99; p < 0.001) and increased with patient height during swing (R2 = .71; p = 0.073). During assisted walking, the trainers applied 3.0 ± 2.8 N (mean ± standard deviation across patients) and 14.1 ± 3.4 N of force anteriorly and upwards, respectively. The patients exhibited a 20 ± 21% increase in unassisted swing length between Days 1−6 (p = 0.058). Conclusions The results support the feasibility of locomotor assistance with a telerobotics approach. Simultaneous measurement of trainer manipulative actions, patient motor responses, and the forces associated with these interactions may prove useful for testing sensorimotor rehabilitation hypotheses. Further research with clinicians as operators and randomized controlled trials are needed before conclusions regarding efficacy can be made.

scholarly journals Exploiting Telerobotics for Sensorimotor Rehabilitation: A Locomotor Embodiment

2021 ◽  
Author(s):  
Min Hyong Koh ◽  
Sheng-Che Yen ◽  
Lester Y. Leung ◽  
Sarah Gans ◽  
Keri Sullivan ◽  
...  
Keyword(s):  
Robotic Arm ◽  
Heel Strike ◽  
Controlled Trials ◽  
Robot Interaction ◽  
Interaction Forces ◽  
Motor Responses ◽  
Randomized Controlled ◽  
Treadmill Speed ◽  
Gait Feature ◽  
To Receive

Abstract Background: Manual treadmill training is used for rehabilitating locomotor impairments but can be physically demanding for trainers. This has been addressed by enlisting robots, but in doing so, the ability of trainers to use their experience and judgment to modulate locomotor assistance on the fly has been lost. This paper explores the feasibility of a telerobotics approach that allows patients to receive physical assistance from robotically augmented trainers.Methods: In the approach, a trainer holds onto a small robotic manipulandum that shadows the motion of a large robotic arm, which is magnetically attached to the leg of a locomoting patient. When the trainer deflects the manipulandum, the robotic arm applies a proportional force to the patient. After an initial evaluation of the telerobotic system’s ability to follow the leg during unassisted locomotion with unimpaired participants, a small feasibility study was performed with six patients with prior strokes. Over six days, the patients interacted with two robotically augmented trainers (separately), who assisted in altering a targeted gait feature: an increase in the affected leg’s swing length. Results: During unassisted walking, unwanted robot interaction forces averaged 3−4 N (swing−stance) for unimpaired individuals and 2−3 N for the patients who survived strokes. Transients averaging about 10 N were sometimes present at heel-strike/toe-off. For five of six patients, these forces increased with treadmill speed during stance (R2 = .99; p < .001) and increased with patient height (R2 = .71; p = .073) during swing. During assisted walking, the trainers applied 3.0 ± 2.8 N (mean ± standard deviation across patients) and 14.1 ± 3.4 N of force anteriorly and upwards, respectively. The patients exhibited a 20 ± 21% increase in unassisted swing length between Days 1−6 (p = .058). Conclusions: The results support the feasibility of locomotor assistance with a telerobotics approach. Simultaneous measurement of trainer manipulative actions, patient motor responses, and the forces associated with these interactions may prove useful for testing sensorimotor rehabilitation hypotheses. Further research with clinicians as operators and randomized controlled trials with more comprehensive outcome measures are needed before conclusions regarding efficacy can be reached.

Radiofrequency ablation for markedly incompetent perforators versus compression therapy in the management of post-phelebtic venous ulcers: A randomized controlled trial

Vascular ◽  
2021 ◽  
pp. 170853812110100
Author(s):  
Mohamed Shukri Abdelgawad ◽  
Amr M El-Shafei ◽  
Hesham A Sharaf El-Din ◽  
Ehab M Saad ◽  
Tamer A Khafagy ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Radiofrequency Ablation ◽  
Controlled Trial ◽  
Compression Therapy ◽  
Randomized Controlled ◽  
Venous Ulcers ◽  
Group A ◽  
Group B ◽  
To Receive

Background Venus ulcers developed mainly due to reflux of incompetent venous valves in perforating veins. Patients and methods In this randomized controlled trial, 119 patients recruited over two years, with post-phelebtic venous leg ulcers, were randomly assigned into one of two groups: either to receive radiofrequency ablation of markedly incompetent perforators (Group A, n = 62 patients) or to receive conventional compression therapy (Group B, n = 57 patients). Follow-up duration required for ulcer healing continued for 24 months post randomization. Results Statistically significant shorter time to healing (ulcer complete healing or satisfactory clinical improvement) between both groups (56 patients, 90.3% of cases in Group A versus 44 patients 77.2% of cases in Group B) over the follow-up period of 24 months was attained ( p  = 0.001). Also, significantly different ulcer recurrence was recorded between both groups, 8 patients (12.9%) in Group A versus 19 patients (33.3%) in Group B ( p = 0.004). Conclusion In absence of deep venous obstruction, the monopolar radiofrequency ablation for incompetent perforators is a feasible and effective method that surpasses the traditional compression protocol for incompetent perforator-induced venous ulcers in terms of time required for healing even in the presence of unresolved deep venous valvular reflux.

scholarly journals Efficacy of Mobile phone use on adherence to Nevirapine prophylaxis and retention in care among the HIV-exposed infants in prevention of mother to child transmission of HIV: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lilian M. N. Kebaya ◽  
Dalton Wamalwa ◽  
Nyambura Kariuki ◽  
Bashir Admani ◽  
Philip Ayieko ◽  
...  
Keyword(s):  
Mobile Phone ◽  
Infant Feeding ◽  
Retention In Care ◽  
Control Group ◽  
Hiv Exposed Infants ◽  
Randomized Controlled ◽  
Phone Calls ◽  
Hiv Exposed ◽  
To Receive

Abstract Background HIV is a major contributor to infant mortality. A significant gap remains between the uptake of infant and maternal antiretroviral regimens and only a minority of HIV-exposed infants receives prophylaxis and safe infant feeding. Losses to follow-up of HIV-exposed infants are associated with shortcomings of facility-based PMTCT models with weak community support of linkages. Use of mobile phones offers an opportunity for improving care and promoting retention assessed by timely attendance of scheduled appointments for the mother-baby pairs and achievement of an HIV-free generation. The objective of this study was to compare self-reported adherence to infant Nevirapine (NVP) prophylaxis and retention in care assessed by timely attendance of scheduled appointments over 10 weeks in HIV exposed infants randomized to 2-weekly mobile phone calls (intervention) versus no phone calls (control). Methods In this open label randomized controlled study, one hundred and fifty HIV infected women drawn from 3 health facilities in Western Kenya and their infants were randomly assigned to receive either phone-based reminders on PMTCT messages or standard health care messages (no calls) within 24 h of delivery. Women in the intervention arm continued to receive fortnightly phone calls. At 6- and 10-weeks following randomization we collected data on infant adherence to Nevirapine, mode of infant feeding, early HIV testing and retention in care in both study arms. All analyses were intention to treat. Results At 6 weeks follow-up, 90.7% (n = 68) of participants receiving phone calls reported adherence to infant NVP prophylaxis, compared with 72% (n = 54) of participants in the control group (p = 0.005). Participants in the intervention arm were also significantly more likely to remain in care than participants in the control group [78.7% (n = 59) vs. 58.7% (n = 44), p = 0.009 at 6 weeks and 69.3% (n = 52) vs. 37.3% (n = 28), p < 0.001 at 10 weeks]. Conclusions These results suggest that phone calls are potentially an important tool to improve adherence to infant NVP prophylaxis and retention in care for HIV-exposed infants. Trial registration PACTR202007654729602. Registered 6 June 2018 - Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3449

Incidence of hypersensitivity reactions in patients on H1-receptor antagonists receiving oxaliplatin-based chemotherapy

2021 ◽  
pp. 107815522110039
Author(s):  
Christine Barrett ◽  
Seon Jo Park ◽  
Lindsay Edmondson ◽  
Dulabh Monga
Keyword(s):  
Observational Study ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Controlled Trials ◽  
Severe Reaction ◽  
Hypersensitivity Reactions ◽  
H1 Receptor ◽  
Receptor Antagonists ◽  
Randomized Controlled ◽  
To Receive

Objective This study determined the incidence of hypersensitivity reactions in patients receiving oxaliplatin-based chemotherapy while on H1-receptor antagonists (H1RAs). Prophylaxis for patients receiving oxaliplatin is not currently recommended. H1RAs are used for the treatment of reactions; however, prophylactic H1RAs have not been well-studied. Methods This retrospective chart review included patients with solid tumor malignancies who received H1RAs while on oxaliplatin-based chemotherapy between August 1, 2016 and October 31, 2019. Results Of fifty-one patients, there were four hypersensitivity reactions (8%), most of which were mild, occurred within 60 minutes of the start of the infusion, and did not result in an interruption in treatment. One severe reaction occurred, which required discontinuation of therapy. Forty-two patients (82%) were able to receive at least 9 cycles of oxaliplatin without a reported reaction. Conclusion In this observational study, the incidence rate of hypersensitivity reactions in patients receiving oxaliplatin while on H1RAs was lower than reported in previous literature. Most reactions were mild, and patients were able to continue oxaliplatin-based therapy. With future, randomized controlled trials, H1RAs may prove to be effective in preventing or delaying the onset of hypersensitivity reactions related to oxaliplatin.

Effect of Subarachnoid Bupivacaine Block on Anesthetic Requirements for Thiopental in Rats 

1998 ◽  
Vol 88 (4) ◽  
pp. 1036-1042 ◽  
Author(s):  
Sunil Eappen ◽  
Igor Kissin
Keyword(s):  
Local Anesthetic ◽  
Direct Action ◽  
Afferent Input ◽  
Crossover Design ◽  
Hemodynamic Parameters ◽  
Motor Responses ◽  
Withdrawal Reflex ◽  
Corneal Reflex ◽  
To Receive ◽  
The Brain

Background Subarachnoid bupivacaine blockade has been reported to reduce thiopental and midazolam hypnotic requirements in patients. The purpose of this study was to examine if local anesthetically induced lumbar intrathecal blockade would reduce thiopental requirements for blockade of motor responses to noxious and nonnoxious stimuli in rats. Methods After intrathecal and external jugular catheter placement, rats were assigned randomly to two groups in a crossover design study, with each rat to receive either 10 microl of 0.75% bupivacaine or 10 microl of normal saline intrathecally. The doses of intravenously administered thiopental required to ablate the eyelid reflex, to block the withdrawal reflex of a front limb digit, and to block the corneal reflex were compared. In two separate groups of animals, hemodynamic parameters and concentrations of thiopental in the brain were compared between intrathecally administered bupivacaine and saline. Results The thiopental dose required to block the described responses was decreased with intrathecally administered bupivacaine versus intrathecally administered saline from (mean +/- SD) 40 +/- 5 to 24 +/- 4 mg/kg (P &lt; 0.001) for the eyelid reflex, from 51 +/- 6 to 29 +/- 6 mg/kg (P &lt; 0.005) for front limb withdrawal, and from 67 +/- 8 to 46 +/- 8 mg/kg (P &lt; 0.01) for the corneal reflex. The concentration of thiopental in the brain at the time of corneal reflex blockade for the group given bupivacaine was significantly lower than in the group given saline (24.1 vs. 35.8 microg/g, P = 0.02). Conclusion This study demonstrates that lumbar intrathecally administered local anesthetic blockade decreases anesthetic requirements for thiopental for a spectrum of end points tested. This effect is due neither to altered pharmacokinetics nor to a direct action of the local anesthetic on the brain; rather, it is most likely due to decreased afferent input.

Efficacy of Chinese Herbal Medicine Jiangniaosuan Formula for Treatment of Hyperuricemia: Study Protocol For A Double-Blinded Non-Inferiority Randomized Controlled Clinical Trial

2021 ◽  
Author(s):  
Yafang Guo ◽  
Hong Lu ◽  
Jing Gan ◽  
Dongdong Li ◽  
Jiandong Gao ◽  
...  
Keyword(s):  
Herbal Medicine ◽  
Chinese Herbal Medicine ◽  
Serum Uric Acid Level ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Controlled Clinical Trial ◽  
Randomized Controlled ◽  
Chinese Herbal ◽  
To Receive ◽  
Be The Change

Abstract Background: Jiangniaosuan formula (JNSF) is commonly used in China for treating hyperuricemia, but there is little research-based evidence to support its use. This randomized controlled trial aims to assess the efficacy and safety of JNSF.Methods: A total of 72 patients with hyperuricemia will be selected and randomly assigned in a ratio of 1:2 to receive either Western medicine i.e., febuxostat 40 mg (WG group; n = 24) or Chinese herbal medicine group, i.e., Jiangniaosuan formula + febuxostat 20 mg (WJNSG; n = 48). After 12 weeks, the WJNSG will be randomly divided into two groups of 24 patients each; one group (WJNSG; n = 24)still will receive febuxostat 20 mg + Jiangniaosuan formula and the other group(JNSG; n = 24) will continue to receive Jiangniaosuan formula+Placebo. Participants will be followed up at 4-week intervals. The primary outcome will be the change in serum uric acid level, and the secondary outcome will be the change in Traditional Chinese Medicine (TCM) syndrome scores. Serum creatinine, blood glucose, and insulin levels will also be measured.Discussion: We hypothesize that patients with hyperuricemia will benefit from JNSF. This study will provide evidence-based recommendations for clinicians.Dissemination: The results will be published in a peer-reviewed journal and disseminated by academic conferences.Trial registration : This trial is registered with ClinicalTrials.gov, number ChiCTR2000041083. 22 Registered on 3 May 2021.

A Quasi-Static Model for Studying Physical Interaction Between a Soft Robotic Digit and a Human Finger

2018 ◽  
Author(s):  
Mahdi Haghshenas-Jaryani ◽  
Muthu B. J. Wijesundara
Keyword(s):  
Human Performance ◽  
Theoretical Models ◽  
Element Model ◽  
Human Robot Interaction ◽  
Physical Interaction ◽  
Robotic Hand ◽  
Robot Interaction ◽  
Interaction Forces ◽  
Comparison Of The Results ◽  
Human Finger

This paper presents the development of a framework based on a quasi-statics concept for modeling and analyzing the physical human-robot interaction in soft robotic hand exoskeletons used for rehabilitation and human performance augmentation. This framework provides both forward and inverse quasi-static formulations for the interaction between a soft robotic digit and a human finger which can be used for the calculation of angular motions, interaction forces, actuation torques, and stiffness at human joints. This is achieved by decoupling the dynamics of the soft robotic digit and the human finger with similar interaction forces acting on both sides. The presented theoretical models were validated by a series of numerical simulations based on a finite element model which replicates similar human-robot interaction. The comparison of the results obtained for the angular motion, interaction forces, and the estimated stiffness at the joints indicates the accuracy and effectiveness of the quasi-static models for predicting the human-robot interaction.

scholarly journals Effectiveness of non-medical health worker-led counselling on psychological distress: a randomized controlled trial in rural Nepal

2019 ◽  
Vol 6 ◽  
Author(s):  
N. Markkula ◽  
V. Lehti ◽  
P. Adhikari ◽  
S. Peña ◽  
J. Heliste ◽  
...  
Keyword(s):  
Health Care ◽  
Randomized Controlled Trial ◽  
Psychological Distress ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Primary Health ◽  
Percentage Difference ◽  
Psychosocial Counselling ◽  
Rural Nepal ◽  
To Receive

Background. An essential strategy to increase coverage of psychosocial treatments globally is task shifting to non-medical counsellors, but evidence on its effectiveness is still scarce. This study evaluates the effectiveness of lay psychosocial counselling among persons with psychological distress in a primary health care setting in rural Nepal. Methods. A parallel randomized controlled trial in Dang, rural Nepal (NCT03544450). Persons aged 16 and older attending primary care and with a General Health Questionnaire (GHQ-12) score of 6 or more were randomized (1:1) to receive either non-medical psychosocial counselling (PSY) or enhanced usual care (EUC). PSY was provided by lay persons with a 6-month training and consisted of 5-weekly counselling sessions of 35–60 min with a culturally adapted solution-focused approach. EUC was provided by trained primary health workers. Participants were followed up at 1 (T1) and 6 months (T2). The primary outcome, response to treatment, was the reduction of minimum 50% in the Beck Depression Inventory (BDI) score. Results. A total of 141 participants, predominantly socially disadvantaged women, were randomized to receive PSY and 146 to EUC. In the PSY, 123 participants and 134 in the EUC were analysed. In PSY, 101 participants (81.4%) had a response compared with 57 participants (42.5%) in EUC [percentage difference 39.4% (95% CI 28.4–50.4)]. The difference in BDI scores at T2 between PSY and EUC was −7.43 (95% CI −9.71 to −5.14). Conclusions. Non-medical (lay) psychosocial counselling appears effective in reducing depressive symptoms, and its inclusion in mental health care should be considered in low-resource settings.

Awareness Is Not Enough: A Double-Blind Randomized Controlled Trial of the Effects of Providing Discipline Disproportionality Data Reports to School Administrators

2020 ◽  
Vol 49 (7) ◽  
pp. 533-537
Author(s):  
Kent McIntosh ◽  
Keith Smolkowski ◽  
Cody M. Gion ◽  
Lauren Witherspoon ◽  
Eoin Bastable ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
School Improvement ◽  
School Administrators ◽  
Controlled Trial ◽  
School Improvement Plan ◽  
Double Blind ◽  
Racial Disproportionality ◽  
Randomized Controlled ◽  
Discipline Disproportionality ◽  
To Receive

One commonly used strategy used in attempts to decrease racial disproportionality in school discipline across the country is sharing data with school administrators that discipline disparities are a problem in their schools with the assumption that it will increase attention to equity and improve outcomes. The purpose of this study was to assess the effects of providing monthly disciplinary equity reports to school administrators in 35 schools on levels of (a) disciplinary equity report viewing, (b) disciplinary equity, and (c) inclusion of disciplinary equity into school improvement plan goals. We used a small, double-blind randomized controlled trial in which half of the schools were randomly assigned to receive either monthly disciplinary equity reports or monthly general discipline reports. Results showed that schools receiving the equity reports had significantly increased rates of viewing equity reports but no meaningful change in disciplinary equity or equity goal setting.

scholarly journals Robotic arm-assisted bi-unicompartmental knee arthroplasty maintains natural knee joint anatomy compared with total knee arthroplasty: a prospective randomized controlled trial

2020 ◽  
Vol 102-B (11) ◽  
pp. 1511-1518
Author(s):  
Matthew S. Banger ◽  
William D. Johnston ◽  
Nima Razii ◽  
James Doonan ◽  
Philip J. Rowe ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Randomized Controlled Trial ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Controlled Trial ◽  
Robotic Arm ◽  
Randomized Controlled ◽  
Unicompartmental Knee ◽  
Postoperative Changes ◽  
Total Knee

Aims The aim of this study was to compare robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) in order to determine the changes in the anatomy of the knee and alignment of the lower limb following surgery. Methods An analysis of 38 patients who underwent TKA and 32 who underwent bi-UKA was performed as a secondary study from a prospective, single-centre, randomized controlled trial. CT imaging was used to measure coronal, sagittal, and axial alignment of the knee preoperatively and at three months postoperatively to determine changes in anatomy that had occurred as a result of the surgery. The hip-knee-ankle angle (HKAA) was also measured to identify any differences between the two groups. Results The pre- to postoperative changes in joint anatomy were significantly less in patients undergoing bi-UKA in all three planes in both the femur and tibia, except for femoral sagittal component orientation in which there was no difference. Overall, for the six parameters of alignment (three femoral and three tibial), 47% of bi-UKAs and 24% TKAs had a change of < 2° (p = 0.045). The change in HKAA towards neutral in varus and valgus knees was significantly less in patients undergoing bi-UKA compared with those undergoing TKA (p < 0.001). Alignment was neutral in those undergoing TKA (mean 179.5° (SD 3.2°)) while those undergoing bi-UKA had mild residual varus or valgus alignment (mean 177.8° (SD 3.4°)) (p < 0.001). Conclusion Robotic-assisted, cruciate-sparing bi-UKA maintains the natural anatomy of the knee in the coronal, sagittal, and axial planes better, and may therefore preserve normal joint kinematics, compared with a mechanically aligned TKA. This includes preservation of coronal joint line obliquity. HKAA alignment was corrected towards neutral significantly less in patients undergoing bi-UKA, which may represent restoration of the pre-disease constitutional alignment (p < 0.001). Cite this article: Bone Joint J 2020;102-B(11):1511–1518.

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