Functional outcome and usage of the prosthesis of lower limb amputees fitted with osseointegrated fixation

This study established that the core principle underlying categorisation of activities have the potential to provide more comprehensive outcomes than the recognition of activities because it takes into consideration activities other than directional locomotion.

Functional outcome of transfemoral amputees fitted with an osseointegrated fixation : temporal gait characteristics

The purpose of this study was to characterise the functional outcome of 12 transfemoral amputees fitted with osseointegrated fixation using temporal gait characteristics. The objectives were (A) to present the cadence, duration of gait cycle, support and swing phases with an emphasis on the stride-to-stride and participant-to-participant variability, and (B) to compare these temporal variables with normative data extracted from the literature focusing on transfemoral amputees fitted with a socket and able-bodied participants. The temporal variables were extracted from the load applied on the residuum during straight level walking, which was collected at 200 Hz by a transducer. A total of 613 strides were assessed. The cadence (46±4 strides/min), the duration of the gait cycle (1.29±0.11 s), support (0.73±0.07 s, 57±3% of CG) and swing (0.56±0.07 s, 43±3% of GC) phases of the participants were 2% quicker, 3%, 6% shorter and 1% longer than transfemoral amputees using a socket as well as 11% slower, 9%, 6% and 13% longer than able-bodied, respectively. All combined, the results indicated that the fitting of an osseointegrated fixation has enabled this group of amputees to restore their locomotion with a highly functional level. Further longitudinal and cross-sectional studies would be required to confirm these outcomes. Nonetheless, the data presented can be used as benchmark for future comparisons. It can also be used as input in generic algorithms using templates of patterns of loading to recognise activities of daily living and to detect falls.

Emotional experience with portable interactive devices

This paper reports on a six month longitudinal study exploring people’s personal and social emotional experience with Portable Interactive Devices (PIDs). The study is concerned with the experience design approach and based on the theoretical framework of Activity Theory. The focus is on emotional experiences and how artefacts mediate and potentially enhance this experience. The outcomes of the study identified interesting aspects of PID interaction. Findings revealed people interact with PIDs emotionally both at a personal and a social level, supporting previous studies. Further, the social level impacts significantly on the emotional experience attained. If negative social experiences exceeded negative personal experiences the emotional experience was constant over six months. If negative personal experiences surpassed negative social experiences the emotional experience was varied over six months. The findings are discussed in regards to their significance to the field of design, their implication for future PID design and future research directions.

Elderly people's use of and attitudes towards assistive devices

People in developed countries are living longer with the help of medical advances. Literature has shown that older people prefer to stay independent and live at home for as long as possible. Therefore, it is important to find out how to best accommodate and assist them in maintaining quality of life and independence as well as easing human resources. Researchers have claimed that assistive devices assist in older people’s independence, however, only a small number of studies regarding the efficiency of assistive devices have been undertaken of which several have stated that devices are not being used. The overall aim of this research was to identify whether the disuse and ineffectiveness of assistive devices are related to change in abilities or related to the design of the devices. The objective was to gather information from the elderly; to identify what assistive devices are being used or not used and to gain an understanding on their attitudes towards assistive devices. Research was conducted in two phases. The initial phase of the research was conducted with the distribution of questionnaires to people over the age of fifty that asked general questions and specific questions on type of devices being used. Phase One was followed on by Phase Two, where participants from Phase One who had come in contact with assistive devices were invited to participate in a semi-structured interview. Questions were put forth to the interviewee on their use of and attitudes towards assistive devices. Findings indicated that the reasons for the disuse in assistive devices were mostly design related; bulkiness, reliability, performance of the device, difficulty of use. The other main reason for disuse was socially related; elderly people preferred to undertake activities on their own and only use a device as a precaution or when absolutely necessary. They would prefer not having to rely on the devices. Living situation and difference in gender did not affect the preference for the use of assistive devices over personal assistance. The majority strongly supported the idea of remaining independent for as long as possible. In conclusion, this study proposes that through these findings, product designers will have a better understanding of the requirements of an elderly user. This will enable the designers to produce assistive devices that are more practical, personalised, reliable, easy to use and tie in with the older people’s environments. Additional research with different variables is recommended to further justify these findings.

Apparatus for monitoring load bearing rehabilitation exercises of a transfemoral amputee fitted with an osseointegrated fixation : a proof-of-concept study

The purpose of this proof-of-concept study was to determine the relevance of direct measurements to monitor the load applied on the osseointegrated fixation of transfemoral amputees during static load bearing exercises. The objectives were (A) to introduce an apparatus using a three-dimensional load transducer, (B) to present a range of derived information relevant to clinicians, (C) to report on the outcomes of a pilot study and (D) to compare the measurements from the transducer with those from the current method using a weighing scale. One transfemoral amputee fitted with an osseointegrated implant was asked to apply 10 kg, 20 kg, 40 kg and 80 kg on the fixation, using self-monitoring with the weighing scale. The loading was directly measured with a portable kinetic system including a six-channel transducer, external interface circuitry and a laptop. As the load prescribed increased from 10 kg to 80 kg, the forces and moments applied on and around the antero-posterior axis increased by 4 fold anteriorly and 14 fold medially, respectively. The forces and moments applied on and around the medio-lateral axis increased by 9 fold laterally and 16 fold from anterior to posterior, respectively. The long axis of the fixation was overloaded and underloaded in 17 % and 83 % of the trials, respectively, by up to ±10 %. This proof-of-concept study presents an apparatus that can be used by clinicians facing the challenge of improving basic knowledge on osseointegration, for the design of equipment for load bearing exercises and for rehabilitation programs.

Load on osseointegrated fixation of a transfemoral amputee during a fall : loading, descent, impact and recovery analysis

Falling represents a health risk for lower limb amputees fitted with an osseointegrated fixation mainly because of the potential damage to the fixation. The purpose of this study was to characterise a real forward fall that occurred inadvertently to a transfemoral amputee fitted with an osseointegrated fixation while attending a gait measurement session to assess the load applied on the residuum. The objective was to analyse the load applied on the fixation with an emphasis on the sequence of events, the pattern and the magnitude of the forces and moments. The load was measured directly at 200 Hz using a six-channel transducer. Complementary video footage was also studied. The fall was divided into four phases: loading (240 ms), descent (620 ms), impact (365 ms) and recovery (2495 ms). The main impact forces and moments occurred 870 ms and 915 ms after the heel contact, and corresponded to 133 %BW and 17 %BWm, or 1.2 and 11.2 times the maximum forces and moments applied during the previous steps of the participant, respectively. This study provided key information to engineers and clinicians facing the challenge to design equipment, and rehabilitation and exercise programs to restore safely the locomotion of lower limb amputees.

The impact of presbyopic spectacles and contact lenses on driving performance

Presbyopia affects individuals from the age of 45 years onwards, resulting in difficulty in accurately focusing on near objects. There are many optical corrections available including spectacles or contact lenses that are designed to enable presbyopes to see clearly at both far and near distances. However, presbyopic vision corrections also disturb aspects of visual function under certain circumstances. The impact of these changes on activities of daily living such as driving are, however, poorly understood. Therefore, the aim of this study was to determine which aspects of driving performance might be affected by wearing different types of presbyopic vision corrections. In order to achieve this aim, three experiments were undertaken. The first experiment involved administration of a questionnaire to compare the subjective driving difficulties experienced when wearing a range of common presbyopic contact lens and spectacle corrections. The questionnaire was developed and piloted, and included a series of items regarding difficulties experienced while driving under day and night-time conditions. Two hundred and fifty five presbyopic patients responded to the questionnaire and were categorised into five groups, including those wearing no vision correction for driving (n = 50), bifocal spectacles (BIF, n = 54), progressive addition lenses spectacles (PAL, n = 50), monovision (MV, n = 53) and multifocal contact lenses (MTF CL, n = 48). Overall, ratings of satisfaction during daytime driving were relatively high for all correction types. However, MV and MTF CL wearers were significantly less satisfied with aspects of their vision during night-time than daytime driving, particularly with regard to disturbances from glare and haloes. Progressive addition lens wearers noticed more distortion of peripheral vision, while BIF wearers reported more difficulties with tasks requiring changes in focus and those who wore no vision correction for driving reported problems with intermediate and near tasks. Overall, the mean level of satisfaction for daytime driving was quite high for all of the groups (over 80%), with the BIF wearers being the least satisfied with their vision for driving. Conversely, at night, MTF CL wearers expressed the least satisfaction. Research into eye and head movements has become increasingly of interest in driving research as it provides a means of understanding how the driver responds to visual stimuli in traffic. Previous studies have found that wearing PAL can affect eye and head movement performance resulting in slower eye movement velocities and longer times to stabilize the gaze for fixation. These changes in eye and head movement patterns may have implications for driving safety, given that the visual tasks for driving include a range of dynamic search tasks. Therefore, the second study was designed to investigate the influence of different presbyopic corrections on driving-related eye and head movements under standardized laboratory-based conditions. Twenty presbyopes (mean age: 56.1 ± 5.7 years) who had no experience of wearing presbyopic vision corrections, apart from single vision reading spectacles, were recruited. Each participant wore five different types of vision correction: single vision distance lenses (SV), PAL, BIF, MV and MTF CL. For each visual condition, participants were required to view videotape recordings of traffic scenes, track a reference vehicle and identify a series of peripherally presented targets while their eye and head movements were recorded using the faceLAB® eye and head tracking system. Digital numerical display panels were also included as near visual stimuli (simulating the visual displays of a vehicle speedometer and radio). The results demonstrated that the path length of eye movements while viewing and responding to driving-related traffic scenes was significantly longer when wearing BIF and PAL than MV and MTF CL. The path length of head movements was greater with SV, BIF and PAL than MV and MTF CL. Target recognition was less accurate when the near stimulus was located at eccentricities inferiorly and to the left, rather than directly below the primary position of gaze, regardless of vision correction type. The third experiment aimed to investigate the real world driving performance of presbyopes while wearing different vision corrections measured on a closed-road circuit at night-time. Eye movements were recorded using the ASL Mobile Eye, eye tracking system (as the faceLAB® system proved to be impractical for use outside of the laboratory). Eleven participants (mean age: 57.25 ± 5.78 years) were fitted with four types of prescribed vision corrections (SV, PAL, MV and MTF CL). The measures of driving performance on the closed-road circuit included distance to sign recognition, near target recognition, peripheral light-emitting-diode (LED) recognition, low contrast road hazards recognition and avoidance, recognition of all the road signs, time to complete the course, and driving behaviours such as braking, accelerating, and cornering. The results demonstrated that driving performance at night was most affected by MTF CL compared to PAL, resulting in shorter distances to read signs, slower driving speeds, and longer times spent fixating road signs. Monovision resulted in worse performance in the task of distance to read a signs compared to SV and PAL. The SV condition resulted in significantly more errors made in interpreting information from in-vehicle devices, despite spending longer time fixating on these devices. Progressive addition lenses were ranked as the most preferred vision correction, while MTF CL were the least preferred vision correction for night-time driving. This thesis addressed the research question of how presbyopic vision corrections affect driving performance and the results of the three experiments demonstrated that the different types of presbyopic vision corrections (e.g. BIF, PAL, MV and MTF CL) can affect driving performance in different ways. Distance-related driving tasks showed reduced performance with MV and MTF CL, while tasks which involved viewing in-vehicle devices were significantly hampered by wearing SV corrections. Wearing spectacles such as SV, BIF and PAL induced greater eye and head movements in the simulated driving condition, however this did not directly translate to impaired performance on the closed- road circuit tasks. These findings are important for understanding the influence of presbyopic vision corrections on vision under real world driving conditions. They will also assist the eye care practitioner to understand and convey to patients the potential driving difficulties associated with wearing certain types of presbyopic vision corrections and accordingly to support them in the process of matching patients to optical corrections which meet their visual needs.

A modified cementing technique using BoneSource to augment fixation of the acetabulum in a sheep model

Background and purpose Our aim was to prove in an animal model that the use of HA paste at the cement-bone interface in the acetabulum would improve fixation. We examined, in sheep, the effect of interposing a layer of hydroxyapatite cement around the periphery of a polyethylene socket prior to fixing it using polymethylemethacrylate (PMMA). Methods We made a randomized study involving 22 sheep to test whether the application of BoneSource hydroxyapatite material to the surface of the ovine acetabulum prior to cementing a polyethylene cup at hip arthroplasty improved the fixation and the nature of the interface. We studied the gross radiographical appearance of the implant-bone interface and the histological appearance at the interface. Results There were more radiolucencies evident in the control group. Histologically, only sheep randomized into the BoneSource group exhibited a fully osseointegrated interface. Use of the hydroxyapatite material did not confer any detrimental effects. In some cases the material appeared to have been fully resorbed. When the material was evident on histological section, it was incorporated into an osseointegrated interface. There was no giant cell reaction present in any case. There was no evidence of migration of BoneSource to the articulation. Interpretation The application of HA material prior to cementation of a socket produced an improved interface. The technique may be useful in man with to extend the longevity of the cemented implant by protecting the socket interface from the effect of hydrodynamic fluid flow and particulate debris.

Wireless sensor devices for animal tracking and control

This paper describes some new wireless sensor hardware developed for pastoral and environmental applications. From our early experiments with Mote hardware we were inspired to develop our devices with improved radio range, solar power capability, mechanical and electrical robustness, and with unique combinations of sensors. Here we describe the design and evolution of a small family of devices: radio/processor board, a soil moisture sensor interface, and a single board multi-sensor unit for animal tracking experiments.

Performance study of two different compensating devices in a custom power park

Simulation study of a custom power park (CPP) is presented. It is assumed that the park contains unbalanced and nonlinear loads in addition to a sensitive load. Two different types of compensators are used separately to protect the sensitive load against unbalance and distortion caused by the other loads. It has been shown that a shunt compensator can regulate the voltage of the CPP bus, whereas the series compensator can only regulate the sensitive load terminal voltage. Additional issues such as the load transfer through a static transfer switch, detection of sag/fault etc. are also discussed. The concepts are validated through PSCAD/EMTDC simulation studies on a sample distribution system.

Is it necessary to re-fuse a non-union of a hallux metatarsophalangeal joint arthrodesis?

BACKGROUND: The standard treatment for a non-union of the hallux metatarsophalangeal joint fusion has been to revise the fusion. Revision fusion is technically more demanding, often involving bone grafting, more substantial fixation and prolonged period of immobilization postoperatively. We present data to suggest that removal of hardware and debridement alone is an alternative treatment option. ---------- MATERIALS AND METHODS: A case note review identified patients with a symptomatic non-union after hallux metatarsophalangeal joint (MTPJ) fusion. It is our practice to offer these patients revision fusion or removal of hardware and debridement. For the seven patients that chose hardware removal and were left with a pseudarthrosis, a matched control group was selected from patients who had had successful fusions. Three outcome scores were used. Hallux valgus and dorsiflexion angles were recorded.---------- RESULTS: One hundred thirty-nine hallux MTPJ arthrodeses were carried out. Fourteen non-unions were identified. The rate of non-union in males and following previous hallux MTPJ surgery was 19% and 24%, respectively. In females undergoing a primary MTPJ fusion, the rate was 2.4%. Twelve non-union patients were reviewed at 27 months (mean). Eleven patients had elected to undergo removal of hardware and debridement. Four patients with pseudarthrosis were unhappy with the results and proceeded to either revision fusion or MTPJ replacement. Seven non-union patients, who had removal of hardware alone, had outcome scores marginally worse compared to those with successful fusions.---------- CONCLUSION: Removal of hardware alone is a reasonable option to offer as a relatively minor procedure following a failed arthrodesis of the first MTPJ. This must be accepted on the proviso that in this study four out of 11 (36%) patients proceeded to a revision first MTPJ fusion or first MTPJ replacement. We also found that the rate of non-union in primary first MTPJ fusion was significantly higher in males and those patients who had undergone previous surgery.