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Technology and Health Care is intended to serve as a forum for the presentation of original articles and technical notes, observing rigorous scientific standards. Furthermore, upon invitation, reviews, tutorials, discussion papers and minisymposia are featured.
The following types of contributions and areas are considered:
1. Original articles:
Technology development in medicine: New concepts, procedures and devices associated with the use of technology in medical research and clinical practice are presented to a readership with a widespread background in engineering and/or medicine.
Significance of medical technology and informatics for healthcare: The appropriateness, efficacy and usefulness deriving from the application of engineering methods, devices and informatics in medicine and with respect to public health are discussed.
2. Technical notes:
Short communications on novel technical developments with relevance for clinical medicine.
3. Reviews and tutorials (upon invitation only):
Tutorial and educational articles for persons with a primarily medical background on principles of engineering with particular significance for biomedical applications and vice versa are presented.
4. Minisymposia (upon invitation only):
Under the leadership of a Special Editor, controversial issues relating to healthcare are highlighted and discussed by various authors.
Abstract: BACKGROUND: Blood vessels are constantly exposed to flow-induced stresses, and endothelial cells (ECs) respond to these stresses in various ways. OBJECTIVE: In order to facilitate endothelialization after endovascular implantation, cell behaviors around a metallic wire using a flow circulation system are observed. METHODS: A parallel flow chamber was designed to reproduce constant shear stresses (SSs) on cell surfaces and to examine the effects of a straight bare metal wire on cell monolayers. Cells were then exposed to flow for 24 h under SS conditions of 1, 2, and 3 Pa. Subsequently, cell distributions…were observed on the plate of the flow chamber and on the surface of the bare metal wire. Flow fields inside the flow chamber were analyzed using computational fluid dynamics under each SS condition. RESULTS: After 24 h, ECs on the bottom plate were concentrated toward the area of flow reattachment. The matching of higher cell density and CFD result suggests that flow-induced stimuli have an influence on EC distributions. CONCLUSION: Typical cell concentration occurs on dish plate along the vortexes, which produces large changes in SSs on cell layer.
Abstract: BACKGROUND: In neurorehabilitation, clinicians and managers are searching for new client-centred task-oriented applications which can be administered without extra costs and effort of therapists, and increase the client’s motivation. OBJECTIVE: To develop and evaluate a prototype of an intelligent activity-based client-centred training (i-ACT) system based on Microsoft Kinect ® . METHODS: Within an iterative user centred process, the i-ACT prototype was developed and necessary features were established for use in neurological settings. After the test trial with a high fidelity prototype, the value, usefulness, and credibility were evaluated.…RESULTS: Seven therapists participated in focus groups and 54 persons with neurological problems participated in test trials. A prototype was established based on the user’s experience. Results show that clients and therapists acknowledge the value and usefulness (clients 5.71/7; therapists 4.86/7), and credibility (clients 21.00/27; therapists 14.50/27) of i-ACT. CONCLUSIONS: Therapists want to be able to record an endless range of movements and activities which enables individualised exercise programs for persons with disabilities. For therapists it is important that the system provides feedback about the quality of movement and not only results. In future work, clinical trials will be performed towards feasibility and effectiveness of i-ACT in neurorehabilitation and other rehabilitation domains.
Abstract: BACKGROUND: Acrylic resin is employed for drilling bone biomodels. Since drilling causes temperature rise, the mechanical properties of thermoplastic acrylic resin can be altered, consequently affecting drilling properties. However, it is currently unclear how this temperature increase impacts drilling. OBJECTIVE: This study reports the effects of temperature rise on both mechanical and drilling properties through experiments in which acrylic resin is drilled under machining conditions employed in surgical operations. METHODS: Drilling tests were performed using a surgical drill on medical acrylic resin under dry conditions to observe generated cutting chips and measure drilling…properties such as torque, drilling time, and temperature rise. Dynamic mechanical analysis measurements were performed to consider temperature effects. RESULTS: According to the morphological classification of the cutting chips, the drilling process is divided into three phases corresponding with the generation of cylindrical helix, waved, and rounded nubby chips respectively. During drilling, the temperature of the chips can exceed the glass transition temperature (100 ∘ C) resulting in decreased viscoelasticity, which is associated with decreased torque. CONCLUSIONS: While drilling acrylic resin under surgical machining conditions, increasing temperature can decrease torque and morphologically change cutting chips due to the decrease in mechanical properties above the glass transition temperature.
Abstract: BACKGROUND: The human brain controls all actions of the body. Walking is one of the most important actions that deals with the movement of the body. In fact, the brain controls and regulates human walking based on different conditions. One of the conditions that affects human walking is the complexity of path of movement. Therefore, the brain activity should change when a person walks on a path with different complexities. OBJECTIVE: In this research we benefit from fractal analysis to study the effect of complexity of path of movement on the complexity of human brain reaction.…METHODS: For this purpose we calculate the fractal dimension of the electroencephalography (EEG) signal when subjects walk on different paths with different fractal dimensions (complexity). RESULTS: The results of the analysis show that the complexity of brain activity increases with the increment of complexity of path of movement. CONCLUSION: The method of analysis employed in this research can also be employed to analyse the reaction of the human heart and respiration when subjects move on paths with different complexities.
Keywords: Human brain, walking path, fractal dimension, complexity, electroencephalography (EEG) signal
Abstract: BACKGROUND: Reduced coordination of precise small movements of the hand, wrist and fingers in Parkinson’s disease (PD) has been mostly solved by medications and deep brain stimulation. The effects have been evaluated by clinical tests only. OBJECTIVE: Virtual reality-based exergaming may enhance fine movements, decrease the medications dosage and provide an additional non-subjective evaluation. METHODS: 3D pick-and-place task (10Cubes) has been developed in a virtual world. The person placed the virtual cubes by the virtual hand, an avatar of the real hand tracked by a Leap Motion Controller (LMC). The system computed the…time of manipulating the cube, the total time, the average time, the speed, and the distance. It counted and managed the number of cubes touched, and calculated the hand shake level, i.e. the average tremor index. A pilot test was carried out in a healthy neurologically intact person and a patient with PD using a 3D head-mounted device (HMD) or LCD screen. RESULTS: The results indicate that substantial and also statistically significant (p < 0.05) differences exist between both participants in all objective parameters; the most noteworthy is the average tremor index. However, we found the parameters only marginally different with 2D equipment. CONCLUSIONS: The evaluation system of 10Cubes has proved applicable at an unchanged medication plan, but its clinical effectiveness could be confirmed with a randomized study.
Keywords: Virtual rehabilitation, Parkinson’s disease, kinematics, sensors, camera
Abstract: BACKGROUND: Virtual reality is becoming popular in the rehabilitation field thanks to the several advantages it can offer to patients and physicians. Indeed, serious games can: motivate and engage the patient; offer different levels of challenge and difficulty based on the patient baseline, and integrate objective measures of the patient’s performance during each rehabilitation session. OBJECTIVE: We designed and implemented a serious game for shoulder rehabilitation based on real-time hand tracking. The aim was to maintain the medical benefits of traditional rehabilitation, while reducing human resources and costs and facilitating active patient participation. METHODS:…Our software application provides the user with a shoulder horizontal adduction exercise. This exercise takes place in a 2D interactive game environment, controlled by hand movements on a desk pad. The hardware includes a standard desktop computer and screen, and the Leap Motion Controller: a hand tracking system. Changing the desk pad material allows the physiotherapist to vary the friction between the user hand and the supporting surface. RESULTS: Fourteen healthy volunteers and six rehabilitation experts tested our serious game. The results showed that the application is attractive, ergonomic and clinically useful. CONCLUSION: Despite promising results, clinical validation is necessary to demonstrate the efficacy of the serious game.
Abstract: BACKGROUND: There is a clear tendency towards cementless acetabular components in primary total hip arthroplasty. OBJECTIVE: The aim of this study was to assess the long-term clinical and radiological outcome of titanium cementless acetabular cups when combined with a highly crosslinked polyethylene liner. METHODS: This study is a retrospective follow-up of 67 cups in 64 patients. Clinical outcomes were assessed using the Harris Hip Score. Radiolucent lines, osteolysis and loosening were assessed radiologically. Implant survival was determined using the Kaplan-Meier analysis. RESULTS: The average Harris Hip Score at follow-up was…80.3 ± 14.5. Signs of osteolysis were observed in 7.1% of the radiographs. No aseptic loosening of the cup was reported. Survival of the cup with aseptic loosening as an endpoint was 100%. A comparison with 19 other studies using the same material combination demonstrated very similar results. All manufacturers with available studies have at least one report of 100% survivorship at 10-year follow-up for their titanium cup and highly crosslinked polyethylene acetabular component combination with aseptic loosening as an endpoint. CONCLUSIONS: The data suggests that the rate of aseptic loosening of a titanium cup combined with a highly-crosslinked polyethylene liner at 10-year follow-up could be as low as 0%.
Keywords: Hip arthroplasty, cementless, acetabulum, polyethylene, titanium
Abstract: BACKGROUND: Over time, scholars have invented various types of feeding robots to help patients with hand disabilities. However, most commercially available feeding robots are functionally simple or expensive. OBJECTIVE: The purpose of this study is to develop a cheap, multi-functional feeding robot with excellent performance to help disabled elderly eat independently. METHODS: Our feeding robot (called ‘I-feed’) uses human-computer interaction based on voice recognition. The feeding system we developed with a four-degree-of-freedom robotic arm is capable of completing the two tasks of food selection and feeding through speech recognition, but also simultaneously meets…users’ diverse needs with three bowls. We also designed a U-shaped table to adjust the height of the feeding robot. RESULTS: This newly developed feeding robot can not only select bowls with different foods by efficient voice commands, but also adapts to users of different heights through a U-shaped table with an adjustable height. CONCLUSIONS: The experimental results show that the accuracy of speech recognition is excellent, and the robot arm can perform the corresponding tasks successfully.
Abstract: BACKGROUND: After an operation, the shoulder and wrist might not be able to lift and swing freely, and must be assisted with rehabilitation training. OBJECTIVE: In this paper, Kinect combined with multiple sensors of a Bluetooth ball is proposed to improve the measurement function of the arm’s micro-motion trajectory, rotation amount, and acceleration, which cannot be detected by Kinect alone. METHODS: We designed two virtual scene rehabilitation games for clinical trials. We performed validity analysis with a paired sample t -test. RESULTS: A significance value of P…* < 1 was obtained, and the arm lift angle shows an improvement from 30 ∘ to 60 ∘ , indicating that the range of motion of the hand and shoulder is gradually improving. CONCLUSION: Experiments show that virtual games combined with multiple sensors can better understand the patient’s rehabilitation situation.
Keywords: Humerus tuberosity, shoulder rehabilitation, Bluetooth ball, Kinect, virtual game
Abstract: BACKGROUND: Sleep monitoring is essential to maintain a healthy life, especially for the elderly who want to age well. Among various forms of sleep devices, the non-wearable and home-adapted device might be preferred because it can be easily used. OBJECTIVE: In this study, we evaluated the performance of a non-contact home-adapted device compared to polysomnography (PSG), a gold standard method. METHODS: As a preliminary study, eight subjects were recorded over fourteen nights through PSG. The non-contact home-adapted device comprised a microwave sensor, passive infrared sensor, and smartphone application. Through the device, heart rate,…respiratory rate, and body movement were collected and used to estimate sleep stages. Sleep structure was labeled in four classes: wake, REM, light, and deep sleep, and were classified using a weighted k-nearest neighbor algorithm. RESULTS: The device correctly estimated sleep structures with an overall epoch-by-epoch accuracy of 98.65% ± 0.05% based on leave-one-out cross-validation. The device showed significantly positive correlations with PSG in sleep indices including total sleep time, sleep efficiency, and wake after sleep onset. CONCLUSIONS: Our findings demonstrate a good performance of this non-contact and home-adapted device and suggest its suitability for sleep monitoring.
Keywords: Healthy aging, home sleep monitoring, polysomnography, sleep architecture, smart home
Abstract: BACKGROUND: Prolonged wheelchair sitting is known to lead to venous stasis and results in leg edema. OBJECTIVE: To clarify how a dynamic cushion affects leg edema in people with spinal cord injuries (SCI) evoked by wheelchair sitting, we measured the changes in leg volume induced during wheelchair sitting with a dynamic air cushion or a static cushion. METHODS: Seven wheelchair users with SCI participated in this study. Leg edema during wheelchair sitting was evaluated with strain gauge plethysmography (the gauge was placed 10 cm proximally from the medial malleolus). Following a period of…rest, the subjects sat on a reclining wheelchair containing a dynamic cushion for 15 min. Then, the protocol was repeated with a static cushion. The above two procedures were performed in a random order. These data were statistically compared between the two procedures. RESULTS: The change in leg volume observed during sitting on the dynamic cushion (- 0.02 ± 0.21 ml/100 ml) was smaller than that observed during sitting on the static cushion (0.18 ± 0.28 ml/100 ml) (P < 0.05). CONCLUSIONS: These results suggested that the dynamic air cushion relieved leg edema induced by wheelchair sitting in individuals with SCI.
Keywords: Wheelchair cushion, leg volume, spinal cord injury, plethysmography
Abstract: BACKGROUND: The use of transcutaneous electrical stimulation for neuromodulation is an important treatment strategy for functional nerve diseases. It can not only reduce patient pain and prevent the development of drug-resistant disease, but is also more effective than alternative treatment methods. OBJECTIVE: Ag/AgCl electrodes are commonly used for transcutaneous stimulation. However, the silver ions can dissolve in tissue during electrical stimulation, which can lead to heavy metal poisoning and other issues. This study analyzed the amount of residual silver ions found in tissue after electrical stimulation. METHODS: Saline solution and animal skin were…chosen as experimental analogs for human tissue and the amount of residual silver ions were analyzed via ultraviolet spectrophotometer. RESULTS: After a volume-to-quantity conversion, we found that after using a pair of electrodes for three hours, the concentrations of silver ions dissolved in the saline solution and the skin were less than 0.1 ppb and 0.5 ppb, respectively, due to its low solubility. CONCLUSIONS: By analyzing the ion dissolution concentration, we found that the residual silver ion concentration in vivo was less than 0.1 ppb, which is within the safe range for humans. Therefore, we believe it is safe to use Ag/AgCl electrodes for transcutaneous electrical stimulation.
Keywords: Transcutaneous electrical stimulation, neuromodulation, saline experiment, pigskin experiment, Ag ion dissolution concentration