A cutlery set for stroke

<p>Stroke is a common problem that affects approximately 700,000 patients annually in the United States alone and can cause long-term disabilities (Mallory, 2006, p.33). The long-term effects of a stroke can impact on the patient’s ability to use one side of their body. Upper limb, lower limb, postural and communication difficulties are common factors that patients experience after a stroke (Perry, 2004), which can affect the patient’s ability to eat (McLaren, 1997). After a stroke, the impairment of an upper limb can lead to problems that make it difficult for people to use cutlery, and include poor grip, decreased muscle control, tremors and upper limb weakness (Brackenrige, 2016). Currently, there are some assistive technology (AT) cutlery sets aimed to help patients who have difficulty in eating and muscle control. Several reasons why stroke patients abandon AT cutlery are cost, appearance, and function (Vaes, 2014). However, an experiment (Torrens, 2013) in to adaptive cutlery products and previous research suggest that there is a large space to improve this, such as appearance and function. AT cutlery sets have been criticized because of their appearance and inferior functions (Torrens, 2013). This then leads to a disconnection between the user and the AT cutlery products, in which the user experiences visible stigma and links the cutlery to an undesirable characteristic (Vaes, 2012). There are some limitations of the current AT cutlery sets that have been identified in the evaluation (Torren & Smith, 2013), such as poor friction material, stereotypical shapes, and skin-tone handle colour. The limitations create an opportunity for the designers to improve the AT cutlery set to be a selected object and a pleasurable product to use in everyday life. The purpose of this research is to explore how human-centred design can reduce the stigma of using AT cutlery for stroke patients through addressing the appearance and interactions of spoons, forks and knives. The research involves the following steps: observing videos of stroke patients eating, interviewing clinicians, interviewing stroke patients, and iterative design with the supervision of clinicians. Some of the main issues identified surrounding stroke patient eating and using cutlery include grip weakness, muscle contracture, and difficulty of flexion. Based on the product intervention model for stigma (PIMS) (Vaes, 2014), this study utilized existing research surrounding the evaluation of assistive technology. To help understand each stage of the user needs, previous feedback from health-care clinicians and patients will ensure the validity of ergonomic interventions and stigma strategy as a substitute for traditional cutlery design. The output of this research includes a set of cutlery as well as assistive components. The design addresses a patient’s difficulty in using cutlery through an adaptive ring to help the patients’ grip. The utensils allow the user to either carry out eating activities at home or in a restaurant. The feedback from occupational therapists and physiotherapists indicates that the cutlery should accommodate different levels of stroke severity. Based on the findings of literature reviews and feedback, I have focused my design on addressing the stroke patients’ grip weakness, muscle contracture, and difficulty of hand flexion, whilst minimizing stigma, based on the PIMS strategies (Vaes, 2014). The design principle suggests that current cutlery designs with an integrated shape cannot meet all requirements of a stroke patient. Therefore, a combination of additional wearing components needs to be used to help dietary intake.</p>

A cutlery set for stroke

<p>Stroke is a common problem that affects approximately 700,000 patients annually in the United States alone and can cause long-term disabilities (Mallory, 2006, p.33). The long-term effects of a stroke can impact on the patient’s ability to use one side of their body. Upper limb, lower limb, postural and communication difficulties are common factors that patients experience after a stroke (Perry, 2004), which can affect the patient’s ability to eat (McLaren, 1997). After a stroke, the impairment of an upper limb can lead to problems that make it difficult for people to use cutlery, and include poor grip, decreased muscle control, tremors and upper limb weakness (Brackenrige, 2016). Currently, there are some assistive technology (AT) cutlery sets aimed to help patients who have difficulty in eating and muscle control. Several reasons why stroke patients abandon AT cutlery are cost, appearance, and function (Vaes, 2014). However, an experiment (Torrens, 2013) in to adaptive cutlery products and previous research suggest that there is a large space to improve this, such as appearance and function. AT cutlery sets have been criticized because of their appearance and inferior functions (Torrens, 2013). This then leads to a disconnection between the user and the AT cutlery products, in which the user experiences visible stigma and links the cutlery to an undesirable characteristic (Vaes, 2012). There are some limitations of the current AT cutlery sets that have been identified in the evaluation (Torren & Smith, 2013), such as poor friction material, stereotypical shapes, and skin-tone handle colour. The limitations create an opportunity for the designers to improve the AT cutlery set to be a selected object and a pleasurable product to use in everyday life. The purpose of this research is to explore how human-centred design can reduce the stigma of using AT cutlery for stroke patients through addressing the appearance and interactions of spoons, forks and knives. The research involves the following steps: observing videos of stroke patients eating, interviewing clinicians, interviewing stroke patients, and iterative design with the supervision of clinicians. Some of the main issues identified surrounding stroke patient eating and using cutlery include grip weakness, muscle contracture, and difficulty of flexion. Based on the product intervention model for stigma (PIMS) (Vaes, 2014), this study utilized existing research surrounding the evaluation of assistive technology. To help understand each stage of the user needs, previous feedback from health-care clinicians and patients will ensure the validity of ergonomic interventions and stigma strategy as a substitute for traditional cutlery design. The output of this research includes a set of cutlery as well as assistive components. The design addresses a patient’s difficulty in using cutlery through an adaptive ring to help the patients’ grip. The utensils allow the user to either carry out eating activities at home or in a restaurant. The feedback from occupational therapists and physiotherapists indicates that the cutlery should accommodate different levels of stroke severity. Based on the findings of literature reviews and feedback, I have focused my design on addressing the stroke patients’ grip weakness, muscle contracture, and difficulty of hand flexion, whilst minimizing stigma, based on the PIMS strategies (Vaes, 2014). The design principle suggests that current cutlery designs with an integrated shape cannot meet all requirements of a stroke patient. Therefore, a combination of additional wearing components needs to be used to help dietary intake.</p>

Extension-abduction contracture of the hip joint as a consequence of gluteal fibrosis

Introduction The disease that is manifested by primarily induced fibrotic changes in the gluteal muscles resulting in hip contractures and, in particular, in extension-abduction contracture of the hip joints has been known in the English literature as the “gluteal muscle contracture” and “gluteal fibrosis”. The world literature on the subject covers this pathology mostly in pediatric and adolescent patients, whereas this disease has not been sufficiently discussed in the adult patients, even in foreign studies. Therefore, diagnostic methods, methods of examination and treatment of adult patients have not been systematized and this nosology presents certain clinical and diagnostic difficulties for many domestic orthopedists. Materials and methods We searched the PubMed and eLibrary systems for studies on the topic and used combinations of key words “gluteus muscle contracture”, “gluteal fibrosis”, “gluteus maximus contracture”, “abduction contracture of the hip”, ”extension-abduction contracture of the hip”, “aplasia of gluteal muscles” published from October 1974 to February 2020 and found a total of 106 results. The first publication coincides with the date of the initial search period. The criteria for including studies in the analysis were a discussion of the issues of etiology and pathogenesis, epidemiology, diagnostic criteria, clinical presentation, and approaches to the treatment of this pathology. We excluded articles related to the installation of gluteal implants and other pathology of the gluteal region, so the number of articles decreased to 67, what means little investigation of this problem. Results Our analysis showed that out of 67 articles, only 9 articles were related to issues of etiology and pathogenesis, five articles dealt with epidemiology, 15 dealt with diagnostic criteria, treatment options were described in 12 articles, and the majority of publications focused on the results of surgical treatment of clinical samples including 1-2 to 1280 cases. In the context of the 50-year-old depth of the literature search, the analysis indicates the fragmentation of the material devoted to the gluteal muscle fibrosis published over this period of time, which requires the systematization and generalization of the literature data accumulated to date. Conclusion Gluteal fibrosis is a rare independent disease, which is prevalent among certain ethnic groups. The extension-abduction contracture of the hip joint develops due to gluteal fibrosis, the clinical picture of which has been very well documented and has specific radiological signs. Surgical treatment methods vary, from open to endoscopic treatments and minimally invasive techniques. Since the main group of patients described in the literature is children and adolescents and the surgical methods used are discussed for these age groups, treatment methods and their efficacy for adult patients have been little reported. Therefore solution making is difficult for patients older than 18 years. It primarily refers to providing specialized orthopedic care in places where ethnic groups with this pathology reside.

Initial treatment for patients with temporomandibular disorders: pain relief and muscle tone relief by photobiomodulation therapy using carbon dioxide laser

Purpose To investigate the efficacy of photobiomodulation therapy (PBMT) with a CO2 laser (Bel Laser, Takara Belmont, CO. Ltd., Osaka, Japan; wavelength 10.6 μm) (tissue surface absorption effects) in conjunction with mouth opening training in patients with temporomandibular disorders (TMDs). Methods This is a retrospective study on TMD patients with pre- and post-treatment assessments. The study included 36 patients (7 men and 29 women, mean age 58.2 years (SD 18.3)) (after excluding 4 patients due to dropouts, loss to follow up or refusal of treatment) with symptoms of pain and muscle tenderness during mouth opening. Treatment included Amfenac sodium (50 mg per day, thrice daily after meals) for 1–2 weeks for acute symptoms. Based on the diagnostic criteria for TMD, we identified the trigger point (muscle contracture site). We implemented muscle massage and stretching therapy as mouth opening training after PBMT. The laser irradiance conditions were as follows: output 1.5 W, on time 0.01 s, off time 0.05 s, and repeat pulse. Distance between the laser source and the skin was approximately 10 cm; irradiation time was 3 min (approximately 56.9 J/cm2). Mouth opening training involved massaging the areas of muscle contracture that were the trigger points, as well as muscle stretching to improve temporomandibular joint flexibility. One PBMT cycle and mouth opening training was conducted per week for four cycles. We determined the effects before and after intervention. A numeric rating scale (NRS; range 0–10) was used to evaluate pain, and maximum mouth opening (MMO) capacity was also assessed. Data were analyzed using the Wilcoxon signed-rank test. Results The mean (SD) pain levels, as determined via NRS, were 4.9(3.6) and 2.7 (3.0) (p < 0.001), before and after four treatment cycles, respectively. The mean (SD) of MMO was 39.6 (5.9) and 44.6 mm (4.8) (p < 0.001), before and after treatment, respectively. Conclusion The current study suggests that PBMT using a CO2 laser combined with mouth opening training is effective for the treatment of temporomandibular disorders.

miR-29a is a Potential Protective Factor for Fibrogenesis in Gluteal Muscle Contracture

Circulating miRNAs have been proposed as the effective diagnostic biomarkers for muscular fibrosis-associated diseases. However, circulating biomarkers for early diagnosis of contracture muscles are limited in gluteal muscle contracture (GMC) patients. Here we sought to explore the abnormally expressed miRNAs in plasma and contraction bands of GMC patients. The results showed miR-29a-3p expression in plasma and contraction bands tissue was significantly reduced in GMC patients compared with normal control. Cell viability and levels of proliferation-associated protein cyclin D1 and cyclin-dependent-kinase 2 (CDK2) were powerfully inhibited by miR-29a mimics and enhanced by miR-29a inhibitor compared with negative control. Furthermore, miR-29a mimics effectively impeded, while miR-29a inhibitor enhanced the expression of collagen I and collagen III, followed by the secretion of transforming growth factor β1 (TGF-β1), TGF-β3 and connective tissue growth factor (CTGF) in primary human contraction bands (CB) fibroblasts. The miR-29a-3p negatively regulated the expression of TGF-β1 through binding to the 3′ UTR region of SERPINH1 (encoding heat shock protein HSP47), but had no effect on Smad2 activity. The miR-29a-3p was inversely correlated with HSP47 in contraction bands tissue from GMC patients. Collectively, miR-29a was notably depressed and regulated cell viability and fibrosis by directly targeting HSP47 in GMC, which suggest that circulating miR-29a might be a potential biomarker for early diagnosis and provides a novel therapeutic target for GMC.