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.

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.

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.

scholarly journals Association of kidney function with effectiveness of procalcitonin-guided antibiotic treatment: a patient-level meta-analysis from randomized controlled trials

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Eva Heilmann ◽  
Claudia Gregoriano ◽  
Yannick Wirz ◽  
Charles-Edouard Luyt ◽  
Michel Wolff ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Kidney Function ◽  
Antibiotic Treatment ◽  
Treatment Duration ◽  
Infection Type ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
To Receive

AbstractObjectivesPatients with impaired kidney function have a significantly slower decrease of procalcitonin (PCT) levels during infection. Our aim was to study PCT-guided antibiotic stewardship and clinical outcomes in patients with impairments of kidney function as assessed by creatinine levels measured upon hospital admission.MethodsWe pooled and analyzed individual data from 15 randomized controlled trials who were randomly assigned to receive antibiotic therapy based on a PCT-algorithms or based on standard of care. We stratified patients on the initial glomerular filtration rate (GFR, ml/min/1.73 m2) in three groups (GFR >90 [chronic kidney disease; CKD 1], GFR 15–89 [CKD 2–4] and GFR<15 [CKD 5]). The main efficacy and safety endpoints were duration of antibiotic treatment and 30-day mortality.ResultsMean duration of antibiotic treatment was significantly shorter in PCT-guided (n=2,492) compared to control patients (n=2,510) (9.5–7.6 days; adjusted difference in days −2.01 [95% CI, −2.45 to −1.58]). CKD 5 patients had overall longer treatment durations, but a 2.5-day reduction in treatment duration was still found in patients receiving in PCT-guided care (11.3 vs. 8.6 days [95% CI −3.59 to −1.40]). There were 397 deaths in 2,492 PCT-group patients (15.9%) compared to 460 deaths in 2,510 control patients (18.3%) (adjusted odds ratio, 0.88 [95% CI 0.78 to 0.98)]. Effects of PCT-guidance on antibiotic treatment duration and mortality were similar in subgroups stratified by infection type and clinical setting (p interaction >0.05).ConclusionsThis individual patient data meta-analysis confirms that the use of PCT in patients with impaired kidney function, as assessed by admission creatinine levels, is associated with shorter antibiotic courses and lower mortality rates.

Efficacy of daikenchuto for the intestinal hypomotility after open abdominal surgery: A pooled analysis of three randomized controlled trials.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 801-801
Author(s):  
Toru Kono ◽  
Mitsuo Shimada ◽  
Masaaki Nishi ◽  
Yuji Morine ◽  
Kozo Yoshikawa ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Bowel Movement ◽  
Multidisciplinary Treatment ◽  
Pooled Analysis ◽  
Controlled Trials ◽  
Efficacy Analysis ◽  
Randomized Controlled ◽  
Intent To Treat ◽  
Prevention Methods ◽  
To Receive

801 Background: Postoperative intestinal hypomotility (IH) is very common after open abdominal (OAS) surgery. Although several advances have been made in medical therapy, very few recognized treatment or prevention methods are currently available. Daikenchuto (DKT), a traditional Japanese prescribed medicine, peripherally stimulates the neurogenic pathway, attempted to reduce postoperative IH in three exploratory randomized controlled trials (RCT). For further analysis of whether DKT accelerates IH recovery after scheduled OAS we conducted a pooled analysis of three RCTs. Methods: A pooled retrospective subset analysis of OAS patients with colon, liver, or gastric cancer in DKT RCTs was performed; RCTs were supported by the Japanese Foundation for Multidisciplinary Treatment of Cancer (JFMC). Among all patients enrolled and randomized in the three RCTs (JFMC project numbers 39-0902, 40-1001, and 42-1002), 740 patients who were eligible were included for the efficacy analysis. The modified intent-to-treat population was 410 patients, who did not have their bowel movement before the first meal; these patients were randomized to receive either 5 g DKT (n = 214) or placebo (n = 196) orally, three times a day for up to 12 days. The primary end point of each trial was the time from the end of the surgery (extubation) to the first bowel movement; this was assessed using survival analysis. Results: Compared with the placebo group, the time from the end of the surgery to the first bowel movement was accelerated in the DKT group (p = 0.004, hazard ratio;1.337 (95% CI 1.096-1.631)), with a difference of median 14.8 h. The tolerability profiles were similar in both the groups. Conclusions: Compared with the placebo, DKT was well tolerated, and it significantly accelerated IH recovery in patients who underwent OAS. Clinical trial information: UMIN000026292.

Efficacy of Vitamin D on Chronic Heart Failure Among Adults

2020 ◽  
Vol 90 (1-2) ◽  
pp. 49-58 ◽  
Author(s):  
Wang Chunbin ◽  
Wang Han ◽  
Cai Lin
Keyword(s):  
Heart Failure ◽  
Vitamin D ◽  
Chronic Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Confidence Interval ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Controlled Trials ◽  
Ventricular Ejection Fraction ◽  
Randomized Controlled

Abstract. Vitamin D deficiency commonly occurs in chronic heart failure. Whether additional vitamin D supplementation can be beneficial to adults with chronic heart failure remains unclear. We conducted a meta-analysis to derive a more precise estimation. PubMed, Embase, and Cochrane databases were searched on September 8, 2016. Seven randomized controlled trials that investigated the effects of vitamin D on cardiovascular outcomes in adults with chronic heart failure, and comprised 592 patients, were included in the analysis. Compared to placebo, vitamin D, at doses ranging from 2,000 IU/day to 50,000 IU/week, could not improve left ventricular ejection fraction (Weighted mean difference, WMD = 3.31, 95% confidence interval, CL = −0.93 to 7.55, P < 0.001, I2 = 92.1%); it also exerts no beneficial effects on the 6 minute walk distance (WMD = 18.84, 95% CL = −24.85 to 62.52, P = 0.276, I2 = 22.4%) and natriuretic peptide (Standardized mean difference, SMD = −0.39, 95% confidence interval CL = −0.48 to 0.69, P < 0.001, I2 = 92.4%). However, a dose-response analysis from two studies demonstrated an improved left ventricular ejection fraction with vitamin D at a dose of 4,000 IU/day (WMD = 6.58, 95% confidence interval CL = −4.04 to 9.13, P = 0.134, I2 = 55.4%). The results showed that high dose vitamin D treatment could potentially benefit adults with chronic heart failure, but more randomized controlled trials are required to confirm this result.

Haemostaseological complication management in caval and iliac venous stenting

VASA ◽  
2018 ◽  
Vol 47 (3) ◽  
pp. 243-246 ◽  
Author(s):  
Corinne Kohler ◽  
Torsten Fuss ◽  
Ronny Schweizer ◽  
Iris Baumgartner ◽  
Nils Kucher ◽  
...  
Keyword(s):  
Anticoagulation Therapy ◽  
Postthrombotic Syndrome ◽  
Controlled Trials ◽  
Complication Management ◽  
Endovascular Stent ◽  
Caval Vein ◽  
Clopidogrel Resistance ◽  
Venous Stenting ◽  
Randomized Controlled ◽  
Vein Occlusion

Abstract. Antiplatelet and anticoagulation therapy after venous stenting is still not standardized, data from randomized-controlled trials are missing. Rare prothrombotic disorders and nonresponsiveness to drugs must be taken into account. This case report demonstrates successful haemostaselogical complication management in recurrent rethromboses due to underlying clopidogrel resistance and low responsiveness to anticoagulation with dabigatran after endovascular stent reconstruction of chronic pelvic and caval vein occlusion in a patient with severe postthrombotic syndrome.

Intravascular ultrasound in the diagnosis and treatment of central venous diseases

VASA ◽  
2021 ◽  
Vol 50 (1) ◽  
pp. 2-10 ◽  
Author(s):  
Xin Li ◽  
Giuseppe D’Amico ◽  
Cristiano Quintini ◽  
Teresa Diago Uso ◽  
Sameer Gadani ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Patient Outcomes ◽  
Controlled Trials ◽  
Ivc Filter ◽  
Venous Anatomy ◽  
Central Venous ◽  
Detailed Measurement ◽  
Filter Placement ◽  
Randomized Controlled ◽  
Venous Diseases

Summary: Intravascular ultrasound (IVUS) has been used extensively in coronary applications. Its use in venous applications has increased as endovascular therapy has increasingly become the mainstay therapy for central venous diseases. IVUS has been used for both diagnostic and therapeutic purposes in managing venous stenotic disease, venous occlusive disease, and IVC filter placement and removal. IVUS has been proven to be effective in providing detailed measurement of the venous anatomy, which aid in determining the appropriate size and the approach for venous stent placement. In IVC filter placement, IVUS can provide detailed measurement and guide IVC filter placement in emergent and critical care settings. It also has certain utility in filter removal. At any rate, to date there are only a few studies examining its impact on patient outcomes. Prospective randomized controlled trials are warranted in the future.

The Effect of Partly Missing Covariates on Statistical Power in Randomized Controlled Trials With Discrete-Time Survival Endpoints

Methodology ◽  
2017 ◽  
Vol 13 (2) ◽  
pp. 41-60
Author(s):  
Shahab Jolani ◽  
Maryam Safarkhani
Keyword(s):  
Randomized Controlled Trials ◽  
Discrete Time ◽  
Treatment Effect ◽  
Survival Data ◽  
Controlled Trials ◽  
Missing Covariates ◽  
Indicator Method ◽  
Imputation Methods ◽  
Randomized Controlled ◽  
Baseline Covariates

Abstract. In randomized controlled trials (RCTs), a common strategy to increase power to detect a treatment effect is adjustment for baseline covariates. However, adjustment with partly missing covariates, where complete cases are only used, is inefficient. We consider different alternatives in trials with discrete-time survival data, where subjects are measured in discrete-time intervals while they may experience an event at any point in time. The results of a Monte Carlo simulation study, as well as a case study of randomized trials in smokers with attention deficit hyperactivity disorder (ADHD), indicated that single and multiple imputation methods outperform the other methods and increase precision in estimating the treatment effect. Missing indicator method, which uses a dummy variable in the statistical model to indicate whether the value for that variable is missing and sets the same value to all missing values, is comparable to imputation methods. Nevertheless, the power level to detect the treatment effect based on missing indicator method is marginally lower than the imputation methods, particularly when the missingness depends on the outcome. In conclusion, it appears that imputation of partly missing (baseline) covariates should be preferred in the analysis of discrete-time survival data.

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