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Design, development and deployment of a hand/wrist exoskeleton for home-based rehabilitation after stroke - SCRIPT project
- F. Amirabdollahian, S. Ates, A. Basteris, A. Cesario, J. Buurke, H. Hermens, D. Hofs, E. Johansson, G. Mountain, N. Nasr, S. Nijenhuis, G. Prange, N. Rahman, P. Sale, F. Schätzlein, B. van Schooten, A. Stienen
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Changes in world-wide population trends have provided new demands for new technologies in areas such as care and rehabilitation. Recent developments in the the field of robotics for neurorehabilitation have shown a range of evidence regarding usefulness of these technologies as a tool to augment traditional physiotherapy. Part of the appeal for these technologies is the possibility to place a rehabilitative tool in one's home, providing a chance for more frequent and accessible technologies for empowering individuals to be in charge of their therapy.
Objective: this manuscript introduces the Supervised Care and Rehabilitation Involving Personal Tele-robotics (SCRIPT) project. The main goal is to demonstrate design and development steps involved in a complex intervention, while examining feasibility of using an instrumented orthotic device for home-based rehabilitation after stroke.
Methods: the project uses a user-centred design methodology to develop a hand/wrist rehabilitation device for home-based therapy after stroke. The patient benefits from a dedicated user interface that allows them to receive feedback on exercise as well as communicating with the health-care professional. The health-care professional is able to use a dedicated interface to send/receive communications and remote-manage patient's exercise routine using provided performance benchmarks. Patients were involved in a feasibility study (n=23) and were instructed to use the device and its interactive games for 180 min per week, around 30 min per day, for a period of 6 weeks, with a 2-months follow up. At the time of this study, only 12 of these patients have finished their 6 weeks trial plus 2 months follow up evaluation.
Results: with the “use feasibility” as objective, our results indicate 2 patients dropping out due to technical difficulty or lack of personal interests to continue. Our frequency of use results indicate that on average, patients used the SCRIPT1 device around 14 min of self-administered therapy a day. The group average for the system usability scale was around 69% supporting system usability.
Conclusions: based on the preliminary results, it is evident that stroke patients were able to use the system in their homes. An average of 14 min a day engagement mediated via three interactive games is promising, given the chronic stage of stroke. During the 2nd year of the project, 6 additional games with more functional relevance in their interaction have been designed to allow for a more variant context for interaction with the system, thus hoping to positively influence the exercise duration. The system usability was tested and provided supporting evidence for this parameter. Additional improvements to the system are planned based on formative feedback throughout the project and during the evaluations. These include a new orthosis that allows a more active control of the amount of assistance and resistance provided, thus aiming to provide a more challenging interaction.
Results of a Stemmed Bone Ingrowth HIP Resurfacing Arthroplasty in the Canine
- W. C. Kim, H. Rechl, H. C. Amstutz, K. Hermens, P. F. O'Carroll, M. Kabo
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- Journal:
- MRS Online Proceedings Library Archive / Volume 55 / 1985
- Published online by Cambridge University Press:
- 22 February 2011, 197
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- 1985
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A stemmed bone ingrowth hip resurfacing arthroplasty designed for use with bone deficient femoral heads raises concerns of stress shielding and is investigated in this study. Ten CoCr bone ingrowth hip resurfacing devices were implanted in five adult canines. Design consisted of a 6mm deep cylindrical cavity with porous beaded surface of 150um pore size and Imm nominal depth. A 3mm diameter smooth CoCr stem was eccentrically fixed to the component for additional fixation with threaded nut at the lateral cortex. Femoral head was reamed for interference fit with hole for the stem placed superiorly. Acrylic fixed polyethylene cups were used for acetabular components. Animals were followed with serial radiographs to sacrifice at 73 to 267 days. After sacrifice microradiographs of ground sections and histologic specimens were evaluated for bone ingrowth, remodeling, and femoral neck attenuation. All specimens showed well ingrown bone at the porous layer. Bone remodeling showed preservation of proximal femoral neck cancellous trabecular pattern and medial cortical support. Resorption of bone at the implant rim and femoral neck thinning were, however, present. Two specimens had neck thinning of 10% or less, four of 10 to 25%, three of 25 to 50%, and one greater than 50%. There was no correlation with time to sacrifice for parameters evaluated. Results indicate preservation of the compressive stresses through the femoral head. Resorption of bone at the rim and femoral neck attenuation, however, indicates load sharing between the implant and bone. Though a lower modulus material such as titanium would decrease load sharing, the geometrical design insures the presence of stress distribution anomalies.
Use of Bone Morphogenetic Protein (BMP) and Cancellous Graft for Porous-Surfaced Interface Voids
- W. C. Kim, H. Rechl, H. C. Amstutz, K. Hermens, P. F. O'carroll, M. Kabo, M. Urist
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- Journal:
- MRS Online Proceedings Library Archive / Volume 55 / 1985
- Published online by Cambridge University Press:
- 22 February 2011, 191
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- 1985
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It is known that bony ingrowth implants without intimate apposition results in diminished ingrowth. In this study the use of bone morphogenetic protein (BMP) and cancellous bone graft to augment ingrowth in interface voids is investigated in the canine. Eight CoCr surface replacement hip implants of chamfered cylinder design with beaded CoCr porous layer were implanted in four adult canines and followed from 23 to 56 days. Prior to implantation, cylindrical defects 4mm diameter by 3mm deep were created in the femoral head and acetabular surfaces and filled with 10mg of BMP in one hip and cancellous bone graft in the contralateral hip. Animals were followed with serial radiographs to sacrifice after which microradiographs of ground sections and histologic specimens were analyzed. All defects were 100% filled with viable new bone without differences in density, organization, or ingrowth in the BMP and cancellous specimens. Femoral specimens uniformly showed unexpected seating gaps which were bridged to varying degrees with viable new organized bone. In five femoral cases seating defects of 2mm or more were completely bridged with ingrowth at the porous layer. In one acetabular case a 6mm gap was 90% bridged. No correlation of results was noted with time to sacrifice. It was concluded that new bone present in the seating gaps was most likely due to spillage of material from the cylindrical defects. Although the amount of ingrowth required for durable fixation is unknown, incongruencies of implant fit are common. As BMP showed no discernible advantage over cancellous graft in results of this study we advocate liberal use of readily available cancellous graft (from reamings or femoral head) to fill interface voids.