Repeatability of static load bearing exercises during rehabilitation of individuals with transfemoral amputation fitted with osseointegrated implant

Bone-anchored prostheses, relying on implants to attach the prosthesis directly to the residual skeleton, are the ultimate resort for patients with transfemoral amputations (TFA) experiencing severe socket discomfort. The first patient receiving a bone-anchored prosthesis underwent the surgery in 1990 in the Sahlgrenska University Hospital (Sweden). To date, there are two commercially available implants: OPRA (Integrum, Sweden) and ILP (Orthodynamics, Germany). The key to success to this technique is a firm bone-implant bonding, depending on increasing mechanical stress applied daily during load bearing exercises (LBE). The loading data could be analysed through different biomechanical variables. The intra-tester reliability of these exercises will be presented here. Moreover the effect of increase of loading, axes of application of the load and body weight as well as the difference between force and moment variables will be discussed.

Static load bearing exercises during rehabilitation of individuals with transfemoral amputation fitted with osseointegrated implant: Load compliance

Osseointegration has been introduced in the orthopaedic surgery in the 1990’s in Gothenburg (Sweden). To date, there are two frequently used commercially available human implants: the OPRA (Integrum, Sweden) and ILP (Orthodynamics, Germany) systems. The rehabilitation program with both systems include some form of static load bearing exercises. These latter involved following a load progression that is monitored by the bathroom scale, providing only the load applied on the vertical axis. The loading data could be analysed through different biomechanical variables. For instance, the load compliance, corresponding to the difference between the load recommended (LR) and the load actually applied on the implant, will be presented here.

Description of body posture during Static load bearing exercises for individuals with transfemoral amputation fitted with bone-anchored prosthesis

The rehabilitation programs of bone-anchorage prostheses relying either on the OPRA (Integrum, Sweden) or the ILP (Orthodynamics, Germany) fixation involve some forms of static load bearing exercises (LBE). So far, most of biomechanical studies of these static LBEs focused on the direct measurements of the actual forces and moments applied on the OPRA fixation of individuals with transfemoral amputation (TFA). To date, the proof-of-concept of an apparatus to conduct these kinetic measurements has been presented, along with some preliminary data. The understanding of the kinetic data is essential to improve rehabilitation programs as well as the design of upcoming loading frames. However, kinetic information alone is difficult to interpret without concomitant kinematic data. The purpose of this preliminary study was to introduce a qualitative analysis describing the different body postures during LBE for a group of TFAs.

Static load bearing exercises during rehabilitation of individuals with transfemoral amputation fitted with osseointegrated implant: Kinetic analysis

The desire to solve problems caused by socket prostheses in transfemoral amputees and the acquired success of osseointegration in the dental application has led to the introduction of osseointegration in the orthopedic surgery. Since its first introduction in 1990 in Gothenburg Sweden the osseointegrated (OI) orthopedic fixation has proven several benefits[1]. The surgery consists of two surgical procedures followed by a lengthy rehabilitation program. The rehabilitation program after an OI implant includes a specific training period with a short training prosthesis. Since mechanical loading is considered to be one of the key factors that influence bone mass and the osseointegration of bone-anchored implants, the rehabilitation program will also need to include some form of load bearing exercises (LBE). To date there are two frequently used commercially available human implants. We can find proof in the literature that load bearing exercises are performed by patients with both types of OI implants. We refer to two articles, a first one written by Dr. Aschoff and all and published in 2010 in the Journal of Bone and Joint Surgery.[2] The second one presented by Hagberg et al in 2009 gives a very thorough description of the rehabilitation program of TFA fitted with an OPRA implant. The progression of the load however is determined individually according to the residual skeleton’s quality, pain level and body weight of the participant.[1] Patients are using a classical bathroom weighing scale to control the load on the implant during the course of their rehabilitation. The bathroom scale is an affordable and easy-to-use device but it has some important shortcomings. The scale provides instantaneous feedback to the patient only on the magnitude of the vertical component of the applied force. The forces and moments applied along and around the three axes of the implant are unknown. Although there are different ways to assess the load on the implant for instance through inverse dynamics in a motion analysis laboratory [3-6] this assessment is challenging. A recent proof- of-concept study by Frossard et al (2009) showed that the shortcomings of the weighing scale can be overcome by a portable kinetic system based on a commercial transducer[7].

Static load bearing exercises of individuals with transfemoral amputation fitted with an osseointegrated implant: Reliability of kinetic data

This study aimed at presenting the intra-tester reliability of the static load bearing exercises (LBEs) performed by individuals with transfemoral amputation (TFA) fitted with an osseointegrated implant to stimulate the bone remodelling process. There is a need for a better understanding of the implementation of these exercises particularly the reliability. The intra-tester reliability is discussed with a particular emphasis on inter-load prescribed, inter-axis and inter-component reliabilities as well as the effect of body weight normalisation. Eleven unilateral TFAs fitted with an OPRA implant performed five trials in four loading conditions. The forces and moments on the three axes of the implant were measured directly with an instrumented pylon including a six-channel transducer. Reliability of loading variables was assessed using intraclass correlation coefficients (ICCs) and percentage standard error of measurement values (%SEMs). The ICCs of all variables were above 0.9 and the %SEM values ranged between 0 and 87%. This study showed a high between-participants’ variance highlighting the lack of loading consistency typical of symptomatic population as well as a high reliability between the loading sessions indicating a plausible correct repetition of the LBE by the participants. However, these outcomes must be understood within the framework of the proposed experimental protocol.

Walking and talking with living texts: Breathing life against static standardisation

Current educational reform, policy and public discourse emphasise standardisation of testing, curricula and professional practice, yet the landscape of literacy practices today is fluid, interactive, multimodal, ever-changing, adaptive and collaborative. How then can English and literacy educators negotiate these conflicting terrains? The nature of today’s literacy practices is reflected in a concept of living texts which refers to experienced events and encounters that offer meaning-making that is fluid, interactive and changing. Literacy learning possibilities with living texts are described and discussed by the authors who independently investigated the place of living texts across two distinctly different learning contexts: a young people’s community arts project and a co-taught multiliteracies project in a high school. In the community arts project, young people created living texts as guided walks of urban spaces that adapt and change to varying audiences. In the multiliteracies project, two parents and a teacher created interactive spaces through co-teaching and cogenerative dialoguing. These spaces generate living texts that yield a purposefully connected curriculum rich in community-relevant and culturally significant texts. These two studies are shared with a view of bringing living texts into literacy education to loosen rigidity in standardisation.

Comparative durability study of CFRP strengthened tubular steel members under cold weather

In strengthening systems, the CFRP (Carbon Fibre Reinforced Polymer) materials typically have excellent resistance against environmental conditions; however, the performance of adhesives between CFRP and steel is generally affected by various environmental conditions such as marine environment, cold and hot weather. This paper presents the comparative durability study of CFRP strengthened tubular steel structures by using two different adhesives such as MBrace saturant and Araldite K630 under four-point bending. The program consisted of testing twelve CFRP strengthened specimens having treated with epoxy based adhesion promoter, untreated surface and one unstrengthened specimen and conditioned under cold weather for 3 and 6 months to determine the environmental durability. The beams were then loaded to failure in quasi-static manner under four-point bending. The structural responses of CFRP strengthened tubular steel beams were compared in terms of failure load, stiffness and modes of failure. The research findings show that the cold weather immersion had adversely affected the durability of CFRP strengthened steel members. Design factor is also proposed to address the short-terms durability performance under cold weather.

Treatment of proximal interphalangeal joint flexion contracture: Combined static and dynamic orthotic intervention compared with other therapy intervention: randomized controlled trial

Purpose To test the effectiveness of static and dynamic orthoses using them as an exclusive treatment for proximal interphalangeal (PIP) joint flexion contracture compared with other hand therapy conservative treatments described in the literature. Methods 60 patients who used orthoses were compared with a control group that received other hand therapy treatments. Clinical assessments were measured before the experiment and 3 months after and included active PIP joint extension and function. Results A significant improvement in the extension active range of motion at the PIP joint in the second measurement was found in both groups, but it was significantly greater in the experimental group. Improvement in function (Disabilities of the Arm, Shoulder, and Hand score) between the first and second assessment was similar in the control and experimental groups. Conclusions Using night progressive static and daily dynamic orthoses as an exclusive treatment during the proliferative phase led to significant improvements in the PIP joint active extension, but the improvement did not correlate with increased function as perceived by the patient.

Development of a new ultrasound-based system for tracking motion of the human lumbar spine: Reliability, stability and repeatability during forward bending movement trials

The aim of this study was to develop a new method for quantifying intersegmental motion of the spine in an instrumented motion segment L4–L5 model using ultrasound image post-processing combined with an electromagnetic device. A prospective test–retest design was employed, combined with an evaluation of stability and within- and between-day intra-tester reliability during forward bending by 15 healthy male patients. The accuracy of the measurement system using the model was calculated to be ± 0.9° (standard deviation = 0.43) over a 40° range and ± 0.4 cm (standard deviation = 0.28) over 1.5 cm. The mean composite range of forward bending was 15.5 ± 2.04° during a single trial (standard error of the mean = 0.54, coefficient of variation = 4.18). Reliability (intra-class correlation coefficient = 2.1) was found to be excellent for both within-day measures (0.995–0.999) and between-day measures (0.996–0.999). Further work is necessary to explore the use of this approach in the evaluation of biomechanics, clinical assessments and interventions.

Behaviour and strength of hollow flange channel sections under torsion and bending

Hollow flange channel section is a cold-formed high-strength and thin-walled steel section with a unique shape including two rectangular hollow flanges and a slender web. Due to its mono-symmetric characteristics, it will also be subjected to torsion when subjected to transverse loads in practical applications. Past research on steel beams subject to torsion has concentrated on open sections while very few steel design standards give suitable design rules for torsion design. Since the hollow flange channel section is different from conventional open sections, its torsional behaviour remains unknown to researchers. Therefore the elastic behaviour of hollow flange channel sections subject to uniform and non-uniform torsion, and combined torsion and bending was investigated using the solutions of appropriate differential equilibrium equations. The section torsion shear flow, warping normal stress distribution, and section constants including torsion constant and warping constant were obtained. The results were compared with those from finite element analyses that verified the accuracy of analytical solutions. Parametric studies were undertaken for simply supported beams subject to a uniformly distributed torque and a uniformly distributed transverse load applied away from the shear centre. This paper presents the details of this research into the elastic behaviour and strength of hollow flange channel sections subject to torsion and bending and the results.

Bending and torsion of hollow flange channel beams

The LiteSteel beam (LSB) is a cold-formed high strength steel channel section made of two torsionally rigid closed flanges and a slender web. Due to its mono-symmetric characteristics, its centroid and shear centre do not coincide. The LSBs can be used in floor systems as joists or bearers and in these applications they are often subjected to transverse loads that are applied away from the shear centre. Hence they are often subjected to combined bending and torsion actions. Previous researches on LSBs have concentrated on their bending or shear behaviour and strengths, and only limited research has been undertaken on their combined bending and torsion behaviour. Therefore in this research a series of nine experiments was first conducted on LSBs subject to combined bending and torsion. Three LSB sections were tested to failure under eccentric loading at mid-span, and appropriate results were obtained from seven tests. A special test rig was used to simulate two different eccentricities and to provide accurate simple boundary conditions at the supports. Finite element models of tested LSBs were developed using ANSYS, and the ultimate strengths, failure modes, and load–displacement curves were obtained and compared with corresponding test results. Finite element analyses agreed well with test results and hence the developed models were used in a parametric study to investigate the effects of load locations, eccentricities, and spans on the combined bending and torsion behaviour of LSBs. The interaction between the ultimate bending and torsional moment capacities was studied and a simple design rule was proposed. This paper presents the details of the tests, finite element analyses, and parametric study of LSBs subject to combined bending and torsion, and the results.

Loading compliance of static load bearing exercises performed by transfemoral amputees fitted with an osseointegrated implant

Background To date bone-anchored prostheses are used to alleviate the concerns caused by socket suspended prostheses and to improve the quality of life of transfemoral amputees (TFA). Currently, two implants are commercially available (i.e., OPRA (Integrum AB, Sweden), ILP (Orthodynamics GmbH, Germany)). [1-17]The success of the OPRA technique is codetermined by the rehabilitation program. TFA fitted with an osseointegrated implant perform progressive mechanical loading (i.e. static load bearing exercises (LBE)) to facilitate bone remodelling around the implant.[18, 19] Aim This study investigated the trustworthiness of monitoring the load prescribed (LP) during experimental static LBEs using the vertical force provided by a mechanical bathroom scale that is considered a surrogate of the actual load applied. Method Eleven unilateral TFAs fitted with an OPRA implant performed five trials in four loading conditions. The forces and moments on the three axes of the implant were measured directly with an instrumented pylon including a six-channel transducer. The “axial” and “vectorial” comparisons corresponding to the difference between the force applied on the long axis of the fixation and LP as well as the resultant of the three components of the load applied and LP, respectively were analysed Results For each loading condition, Wilcoxon One-Sample Signed Rank Tests were used to investigate if significant differences (p<0.05) could be demonstrated between the force applied on the long axis and LP, and between the resultant of the force and LP. The results demonstrated that the raw axial and vectorial differences were significantly different from zero in all conditions (p<0.05), except for the vectorial difference for the 40 kg loading condition (p=0.182). The raw axial difference was negative for all the participants in every loading condition, except for TFA03 in the 10 kg condition (11.17 N). Discussion & Conclusion This study showed a significant lack of axial compliance. The load applied on the long axis was significantly smaller than LP in every loading condition. This led to a systematic underloading of the long axis of the implant during the proposed experimental LBE. Monitoring the vertical force might be only partially reflective of the actual load applied, particularly on the long axis of the implant.

Molecular Origin of the Intrinsic Bending Force for Helical Morphology Observed in Chiral Amphiphilic Assemblies: Concentration and Size Dependence

The formation of the helical morphology in monolayers and bilayers of chiral amphiphilic assemblies is believed to be driven at least partly by the interactions at the chiral centers of the amphiphiles. However, a detailed microscopic understanding of these interactions and their relation with the helix formation is still not clear. In this article a study of the molecular origin of the chirality-driven helix formation is presented by calculating, for the first time, the effective pair potential between a pair of chiral molecules. This effective potential depends on the relative sizes of the groups attached to the two chiral centers, on the orientation of the amphiphile molecules, and also on the distance between them. We find that for the mirror-image isomers (in the racemic modification) the minimum energy conformation is a nearly parallel alignment of the molecules. On the other hand, the same for a pair of molecules of one kind of enantiomer favors a tilt angle between them, thus leading to the formation of a helical morphology of the aggregate. The tilt angle is determined by the size of the groups attached to the chiral centers of the pair of molecules considered and in many cases predicted it to be close to 45 degrees. The present study, therefore, provides a molecular origin of the intrinsic bending force, suggested by Helfrich (J. Chem. Phys. 1986, 85, 1085-1087), to be responsible for the formation of helical structure. This effective potential may explain many of the existing experimental results, such as the size and the concentration dependence of the formation of helical morphology. It is further found that the elastic forces can significantly modify the pitch predicted by the chiral interactions alone and that the modified real pitch is close to the experimentally observed value. The present study is expected to provide a starting point for future microscopic studies.

Static analysis of infinite laminated cylindrical shell panel

This paper presents an approximate three-dimensional elasticity solution for an infinitely long, cross-ply laminated circular cylindrical shell panel with simply supported boundary conditions, subjected to an arbitrary discontinuous transverse loading. The solution is based on the principal assumption that the ratio of the thickness of the lamina to its middle surface radius is negligible compared to unity. The validity of this assumption and the range of application of this approximate solution have been established through a comparison with an exact solution. Results of classical and first-order shear deformation shell theories have been compared with the results of the present solution to bring out the accuracy of these theories. It is also shown that for very shallow shell panels the definition of a thin shell should be based on the ratio of thickness to chord width rather than the ratio of thickness to mean radius.

A Network Model of Static Foam Drainage

On the basis of a more realistic tetrakaidecahedral structure of foam bubbles, a network model of static foam drainage has been developed. The model considers the foam to be made up of films and Plateau borders. The films drain into the adjacent Plateau borders, which in turn form a network through which the liquid moves from the foam to the liquid pool. From the structure, a unit flow cell was found, which constitutes the foam when stacked together both horizontally and vertically. Symmetry in the unit flow cell indicates that the flow analysis of a part of it can be employed to obtain the drainage for the whole foam. Material balance equations have been written for each segment of this subsection, ensuring connectivity, and solved with the appropriate boundary and initial conditions. The calculated rates of drainage, when compared with the available experimental results, indicate that the model predicts the experimental results well.