Technology and Health Care - Volume 29, issue 4

Authors: Ma, Yi-Chuan | Zhang, Shun-Hua | Xie, Zong-Yu | Guo, Fei | Chen, Ai-Qi

Article Type: Research Article

Abstract: OBJECTIVE: To compare the spectral computed tomography (CT) imaging parameters between squamous cell carcinoma (SCC) and adenocarcinoma (AC) at the gastroesophageal junction (GEJ). METHODS: A total of 80 patients were enrolled in this retrospective study. Among them, 35 were diagnosed with SCC (SCC group) and 45 were diagnosed with AC (AC group). All patients underwent an enhanced scan with spectral CT. The following CT imaging parameters were evaluated: iodine concentration (IC), water content (WC), effective atomic number (Eff-Z) and slope of the spectral HU curve (λ HU ) of lesions. Receiver operating characteristic …(ROC) curve was used to analyze the predictive value of spectral CT imaging parameters for diagnosis of SCC and AC. RESULTS: Patients with SCC had lower IC, Eff-Z, and λ HU in arterial phase and venous phase compared with AC (p < 0.05). There were no significant differences in WC between the two groups. ROC curve analyses revealed that IC, Eff-Z, and λ HU in arterial phase and venous phase were predictors for diagnosis of SCC and AC (AUC > 0.5). Moreover, the IC, Eff-Z and λ HU in venous phase had better differential diagnostic performances than that in arterial phase. CONCLUSIONS: Spectral CT could be useful in the differential diagnosis of SCC and AC at the GEJ. Therefore, a routine spectral CT scan is recommended for patients with carcinoma of the GEJ. Show more

Keywords: Spectral CT, squamous cell carcinoma, adenocarcinoma, gastroesophageal junction

DOI: 10.3233/THC-202343

Citation: Technology and Health Care, vol. 29, no. 4, pp. 619-627, 2021

Authors: van Campen, C. (Linda) M.C. | Verheugt, Freek W.A. | Rowe, Peter C. | Visser, Frans C.

Article Type: Research Article

Abstract: BACKGROUND: Finger plethysmography derived stroke volumes are frequently measured during tilt table testing. There are two algorithms to determine stroke volumes: Modelflow and Nexfin CO Trek. Most tilt studies used Modelflow, while there are differences between the two algorithms. OBJECTIVE: To compare stroke volume indices by Nexfin CO Trek (SVI NexfinCOTrek ) with suprasternal Doppler derived SVI (SVI Doppler ) in healthy controls (HC) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients during tilt testing. These patients may have a large SVI decrease during the tilt enabling a large range of …SVI to be studied. METHODS: One hundred and fifty-four patients and 39 HC with a normal tilt test were included. Supine and end-tilt SVI Doppler and SVI NexfinCOTrek were compared using the Bland-Altman analysis. Also, the effect of calibrating supine SVI NexfinCOTrek to SVI Doppler was studied. RESULTS: Supine and end-tilt SVI NexfinCOTrek were significantly higher than SVI Doppler : both P < 0.005. Bias, limits of agreement, and percent error (PE) were high with PE’s between 37 and 43%. The calibration procedure resulted in an acceptable variance with a PE of 29%. CONCLUSIONS: SVI NexfinCOTrek overestimates stroke volumes compared to SVI Doppler , leading to high PE’s. Calibration reduced variance to an acceptable level, allowing SVI NexfinCOTrek to be used for assessment of SVI changes during tilt testing. Show more

Keywords: Stroke volume index, aortic VTI Doppler imaging, finger plethysmography, tilt table testing, chronic fatigue syndrome, myalgic encephalomyelitis

DOI: 10.3233/THC-202669

Citation: Technology and Health Care, vol. 29, no. 4, pp. 629-642, 2021

Authors: Khan, Taha | Zeeshan, Ali | Dougherty, Mark

Article Type: Research Article

Abstract: BACKGROUND: Gait impairment is an essential symptom of Parkinson’s disease (PD). OBJECTIVE: This paper introduces a novel computer-vision framework for automatic classification of the severity of gait impairment using front-view motion analysis. METHODS: Four hundred and fifty-six videos were recorded from 19 PD patients using an RGB camera during clinical gait assessment. Gait performance in each video was rated by a neurologist using the unified Parkinson’s disease rating scale for gait examination (UPDRS-gait). The proposed algorithm detects and tracks the silhouette of the test subject in the video to generate a height signal. …Gait features were extracted from the height signal. Feature analysis was performed using the Kruskal-Wallis rank test. A support vector machine was trained using the features to classify the severity levels according to UPDRS-gait in 10-fold cross-validation. RESULTS: Features significantly (p < 0.05) differentiated between median-ranks of UPDRS-gait levels. The SVM classified the levels with a promising area under the ROC of 80.88%. CONCLUSION: Findings support the feasibility of this model for Parkinson’s gait assessment in the home environment. Show more

Keywords: Parkinson’s disease, gait impairment, computervision, motion analysis

DOI: 10.3233/THC-191960

Citation: Technology and Health Care, vol. 29, no. 4, pp. 643-653, 2021

Authors: Wang, Bin | Shi, Han | Cui, Enuo | Zhao, Hai | Yang, Dongxiang | Zhu, Jian | Dou, Shengchang

Article Type: Research Article

Abstract: BACKGROUND: Tubular structure segmentation in chest CT images can reduce false positives (FPs) dramatically and improve the performance of nodules malignancy levels classification. OBJECTIVE: In this study, we present a framework that can segment the pulmonary tubular structure regions robustly and efficiently. METHODS: Firstly, we formulate a global tubular structure identification model based on Frangi filter. The model can recognize irregular vascular structures including bifurcation, small vessel, and junction, robustly and sensitively in 2D images. In addition, to segment the vessels from JVN, we design a local tubular structure identification model with a sliding window. …Finally, we propose a multi-view voxel discriminating scheme on the basis of the previous two models. This scheme reduces the computational complexity of obtaining high entropy spatial tubular structure information. RESULTS: Experimental results have shown that the proposed framework achieves TPR of 85.79%, FPR of 24.83%, and ACC of 84.47% with the average elapsed time of 162.9 seconds. CONCLUSIONS: The framework provides an automated approach for effectively segmenting tubular structure from the chest CT images. Show more

Keywords: Tubular structure segmentation, computer-aided diagnosis, lung nodule, Frangi filter, multi-view discriminating scheme

DOI: 10.3233/THC-202431

Citation: Technology and Health Care, vol. 29, no. 4, pp. 655-665, 2021

Authors: Jeong, Hee Seong | Lee, Sae Yong | Noh, Hyung Jun | O’Sullivan, David Michael | Lee, Young Rim

Article Type: Research Article

Abstract: OBJECTIVE: This study aims to compare and analyze the difference of impact force attenuation according to size and impact location on a Taekwondo body protector. METHODS: Body protectors sized 1 to 5, were impact tested by equipment based on the specifications in the European standard manual (EN 13277-1, 3). The impactor release heights were set to match impact energies of 3 and 15 J. The impactor was made from a 2.5 kg cylindrically cut piece of aluminum. Each body protector was impacted 10 times at the two impact energies and two locations. The differences in performance …for each body protector size were compared using a two-way analysis of variance with a significance level of p < 005. The effect sizes were investigated using a partial eta squared value (η 2 ). RESULTS: The significant mean differences between the body protector size and impact area (p < 005) and the average impact time of impact strengths 3 and 15 J were 0.0017 and 0.0012 s, respectively In addition, when an impact strength of 15 J was applied, the maximum resulting impact force exceeded 2000 N for both locations on all sizes. Furthermore, at an impact strength of 3 J size 3 significantly reduced the impact force more than the other sizes; however, size 1 showed the greatest shock absorption at an impact of 15 J. CONCLUSION: The results of this study show that the shock absorption of body protectors does not increase according to size; i.e., a larger body protector does not reduce the impact load more effectively. To improve safety performance, we recommend a maximum impact force of 2000 N or less for all body protectors. Show more

Keywords: Taekwondo equipment, impact testing, injury prevention, shock absorption

DOI: 10.3233/THC-202598

Citation: Technology and Health Care, vol. 29, no. 4, pp. 667-675, 2021

Authors: Li, Chunguang | Zhu, Yufei | Qu, Wei | Sun, Lining

Article Type: Research Article

Abstract: BACKGROUND: The study of the neural mechanism of human gait control can provide a theoretical basis for the treatment of walking disorders or the improvement of rehabilitation strategies, and further promote the functional rehabilitation of patients with movement disorders. However, the performance and changes of cerebral cortex activity corresponding to gait adjustment intentions are still not clear. OBJECTIVE: The purpose of this study was to detect the blood oxygen activation characterization of the cerebral cortex motor function area when people have the intention to adjust gait during walking. METHODS: Thirty young volunteers (21 …± 1 years old) performed normal walking, speed increase, speed reduction, step increase, and step reduction, during which oxygenated hemoglobin (HbO), deoxygenated hemoglobin (HbR), and total oxyhemoglobin (HbT) information in the prefrontal cortex (PFC), premotor cortex (PMC), supplementary motor area (SMA) was continuous monitored using near-infrared brain functional imaging. RESULTS: (1) With the intention to adjust gait, the HbO concentration in the SMA increased significantly, while the HbT concentration in the medial-PFC decreased significantly. (2) In the HbO concentration, step reduction is more activated than the step increase in the left-PMC (p = 0.0130); step adjustment is more activated than speed adjustment in the right-PMC (p = 0.0067). In the HbR concentration, the speed reduction is more activated than the speed increase in the left-PFC (p = 0.0103). CONCLUSIONS: When the intention of gait adjustment occurs, the increase of HbO concentration in the SMA indicates the initial stage of gait adjustment will increase the cognitive-locomotor demand of the brain. The left brain area meets the additional nerve needs of speed adjustment. The preliminary findings of this study can lay an important theoretical foundation for the realization of gait control based on fNIRS-BCI technology. Show more

Keywords: Functional near-infrared spectroscopy, adjustment intention, gait speed, step length, cortical activation

DOI: 10.3233/THC-202580

Citation: Technology and Health Care, vol. 29, no. 4, pp. 677-686, 2021

Authors: Wang, Yunhong | Hu, Rong | Guo, Yanlei | Qin, Weihan | Zhang, Xiaomei | Hua, Lei | Yang, Yong

Article Type: Research Article

Abstract: OBJECTIVE: In this study we explore the method to prepare tanshinone self-microemulsifying sustained-release microcapsules using tanshinone self-microemulsion as the core material, and chitosan and alginate as capsule materials. METHODS: The optimal preparation technology of chitosan-alginate tanshinone self-microemulsifying sustained-release microcapsules was determined by using the orthogonal design experiment and single-factor analysis. The drug loading and entrapment rate were used as evaluation indexes to assess the quality of the drug, and the in vitro release rate was used to evaluate the drug release performance. RESULTS: The best technology of chitosan-alginate tanshinone self-microemulsifying sustained-release microcapsules …is as follows: the concentration of alginate is 1.5%, the ratio of tanshinone self-microemulsion volume to alginate volume to chitosan mass is 1:1:0.5 (ml: ml: g), and the best concentration of calcium chloride is 2.0%. To prepare the microcapsules using this technology, the drug loading will be 0.046%, the entrapment rate will be 80.23%, and the 24-hour in vitro cumulative release rate will be 97.4%. CONCLUSION: The release of the microcapsules conforms to the Higuchi equation and the first-order drug release model and has a good sustained-release performance. Show more

Keywords: Tanshinone, chitosan-alginate, self-microemulsifying sustained-release microcapsules, preparation, in vitro release

DOI: 10.3233/THC-202529

Citation: Technology and Health Care, vol. 29, no. 4, pp. 687-695, 2021

Authors: Wu, Qianyun | Xie, Naiming | Shao, Yuting

Article Type: Research Article

Abstract: BACKGROUND: Due to its fast service and high utilization, day surgery is becoming more and more important in the medical system. As a result, an effective day surgery scheduling can reasonably release the supply and demand pressure. OBJECTIVE: This paper aims to investigate the day surgery scheduling problem with patient preferences and limited operation room for the sake of increasing operation efficiency and further decreasing surgery costs. METHODS: A multiple objective stochastic programming model is constructed to seek a satisfactory surgical scheduling for both patients and hospitals under different scenarios. Multi-objective genetic algorithm …is designed to solve the model and different scales of scenarios are utilized to test the effectiveness of the algorithm and modeling process. RESULTS: Results show that the proposed model and algorithm can provide a feasible solution for maximizing individual preference of surgeons with surgery date and operation room utilization as well. CONCLUSIONS: Patient preference is proposed to be incorporated into day surgery scheduling, and the variability of surgery duration considered to seek a satisfactory surgery scheduling scheme for both patients and hospitals is more in line with the actual hospital situation. Show more

Keywords: Patient preferences, stochastic operation duration, surgery scheduling, stochastic programming, multi-objective genetic algorithm

DOI: 10.3233/THC-192086

Citation: Technology and Health Care, vol. 29, no. 4, pp. 697-708, 2021

Authors: Xie, Qiaolian | Meng, Qiaoling | Dai, Yue | Zeng, Qingxin | Fan, Yuanjie | Yu, Hongliu

Article Type: Research Article

Abstract: BACKGROUND: Upper limb rehabilitation robots have become an important piece of equipment in stroke rehabilitation. Human-robot coupling (HRC) dynamics play a key role in the control of rehabilitation robots to improve human-robot interaction. OBJECTIVE: This study aims to study the methods of modeling and analysis of HRC dynamics to realize more accurate dynamic control of upper limb rehabilitation robots. METHODS: By the analysis of force interaction between the human arm and the upper limb rehabilitation robot, the HRC torque is achieved by summing up the robot torque and the human arm torque. The …HRC torque and robot torque of a 2-DOF upper limb rehabilitation robot (FLEXO-Arm) are solved by Lagrangian equation and step-by-step dynamic parameters identification method. RESULTS: The root mean square (RMS) is used to evaluate the accuracy of the HRC torque and the robot torque calculated by the parameter identification, and the error of both is about 10%. Moreover, the HRC torque and the robot torque are compared with the actual torque measured by torque sensors. The error of the robot torque is more than twice the HRC. Therefore, the HRC torque is more accurate than the actual torque. CONCLUSIONS: The proposed HRC dynamics effectively achieves more accurate dynamic control of upper limb rehabilitation robots. Show more

Keywords: Human-robot coupling (HRC) dynamics, dynamic model, parameter identification, rehabilitation robotics

DOI: 10.3233/THC-202424

Citation: Technology and Health Care, vol. 29, no. 4, pp. 709-723, 2021

Authors: Alqhtani, Nasser | Alqahtani, Fawaz | Almalki, Abdulrahman | Alanazi, Ahmed | Alkhuriaf, Hamad | Alkhtani, Fahad | AlEnazi, Adel

Article Type: Research Article

Abstract: BACKGROUND: Assessment of buccal alveolar bone thickness (ABT) and crown-to-root dimensions are essential in implant density; therefore, three-dimensional evaluation of these parameters provides a superior visualization than conventional radiographs. OBJECTIVE: The present cross-sectional cohort study aims to investigate the relationship between buccal ABT and crown-to-root dimensions around the mandibular first and second molars using cone-beam-computed tomography (CBCT). METHODS: Initially, CBCT-based scans from 271 individuals were assessed. Based on the inclusion and exclusion criteria, 171 CBCT-based scans were excluded. In total, 100 CBCT-scans were included in the present investigation and processed for data extraction. …On the mandibular first and second molars, the mesial and distal root lengths and mesiodistal diameter of the crowns were measured. The pulpal floor served as a reference point for assessment of root length. The buccal ABT was measured at the coronal, middle and apical one-third of the root. Statistical analysis was performed and the level of significance was set at P < 0.01. One-hundred CBCT-scans from 294 mandibular teeth (137 first molars and 157 second molars) were included. One hundred and eighty-nine and 105 teeth were from males and females, respectively. RESULTS: The normality plot showed a normal data distribution. The mesiodistal crown width showed a weak yet significant correlation with mesial root length (r = 0.137), bone thickness at mesial apical third (r = 0.180), distal apical (r = 0.157) and distal coronal third (r = 0.161). Bone thickness at mesial, middle and apical third correlated significantly with one other (r = 0.786). CONCLUSION: There is a direct correlation between the buccal ABT and tooth dimensions around the mandibular first and second molars. Show more

Keywords: Alveolar bone thickness, tooth dimensions, crown width, root length, and CBCT

DOI: 10.3233/THC-202587

Citation: Technology and Health Care, vol. 29, no. 4, pp. 725-733, 2021

Authors: Xu, Shuai | Zhang, Gang | Guo, Jun-Feng | Tan, Ying-Hui

Article Type: Research Article

Abstract: BACKGROUND: The protective role of helmet accessories in moderating stress load generated by explosion shock waves of explosive devices is usually neglected. OBJECTIVE: In the presented study, the protective role of the helmet chinstrap against the impulse and overpressure experienced by the maxillofacial region were examined. METHODS: The explosion shock wave and skull interaction were investigated under three different configurations: (1) unprotected skull, (2) skull with helmet (3) skull with helmet and chinstrap. For this purpose, a 3D finite element model (FEM) was constructed to mimic the investigated biomechanics module. Three working conditions were …set according to different explosive charges and distances to represent different load conditions. Case 1: 500 mg explosive trinitrotoluene (TNT), 3 cm, case 2: 1000 mg TNT, 3 cm, and case 3: 1000 mg TNT and 6 cm distance to the studied object. The explosion effect was discussed by examining the shock wave stress flow pattern. Three points were selected on the skull and the stress curve of each point position were illustrated for each case study. RESULTS: The results showed that the helmet chinstrap can reduce the explosive injuries and plays a protective role in the maxillofacial region, especially for the mandible. Show more

Keywords: Maxillofacial injury, blast wave, finite element method

DOI: 10.3233/THC-202406

Citation: Technology and Health Care, vol. 29, no. 4, pp. 735-747, 2021

Authors: Zhang, Chengjie | Guo, Shuai | Xi, Fengfeng (Jeff)

Article Type: Research Article

Abstract: BACKGROUND: The aging population brings the problem of healthcare and dyskinesia. The lack of mobility extremely affects stroke patient’s activities of daily living (ADL) and decreases their quality of life. To assist these mobility-limited people, a robotic walker is designed to facilitate gait rehabilitation training. OBJECTIVE: The aim of this paper is to present the implementation of a novel motion control method to assist disabled people based on their motion intention. METHODS: The kinematic framework of the robotic walker is outlined. We propose an intention recognition algorithm based on the interactive force signal. …A novel motion control method combined with T-S fuzzy controller and PD controller is proposed. The motion controller can recognize the intention of the user through the interactive force, which allows the user to move or turn around as usual, instead of using their hands to control the walker. RESULTS: Preliminary experiments with healthy individuals and simulated patients are carried out to verify the effectiveness of the algorithm. The results show that the proposed motion control approach can recognize the user’s intention, is easy to control and has a higher precision than the traditional proportional–integral–derivative controller. CONCLUSION: The results show that users could achieve the task with acceptable error, which indicates the potential of the proposed control method for gait training. Show more

Keywords: Motion control, intention recognition, robotic walker, lower rehabilitation robot, stroke, gait training, kinematics, disability, mobility, stroke patients, activities of daily living, quality of life

DOI: 10.3233/THC-202503

Citation: Technology and Health Care, vol. 29, no. 4, pp. 749-769, 2021

Authors: Paniagua Collado, Maria Adela | Willauschus, Maximilian | Rüther, Johannes | Lahner, Matthias | Bail, Hermann Josef | Geßlein, Markus

Article Type: Research Article

Abstract: BACKGROUND: Implant specific complications and outcome for the use of proximal humeral nails in different fracture types are not well described. OBJECTIVE: Evaluation of adverse effects and outcome of patients treated with the new Targon PH+ implant for proximal humeral fractures in a geriatric population. METHODS: A consecutive series of patients from a single institution was retrospectively evaluated. Adverse events (AE) were assessed from patients’ files and during follow-up examination. Current pain level was evaluated using the Visual Analogue Scale (VAS). The disability score of arm, shoulder and hand (DASH) …as well as the Constant-Murley score were assessed. Patient satisfaction was evaluated by questionnaire. RESULTS: Forty-nine patients with a mean age of 72.0 ± 10.0 years were included with a follow-up of 2.2 years. Five patients showed twopart fractures (10%), 24 threepart fractures (50%) and 20 fourpart fractures (40%). Additional shaft fracture occurred in twelve cases (24%). Implant-related AE were recorded in six cases (12%). Pain under strain was moderate with a mean of 27.6 ± 27.1 mm. DASH score showed a mean of 25.9 ± 24.9. Constant score of the affected shoulder was 57 ± 23.8 with a mean difference of 16 points compared to reference shoulder. No significant differences in AE, VAS, DASH or Constant score could be found according to fracture groups. Most patients were satisfied with the surgical outcome (84%). CONCLUSIONS: The Targon PH+ nail demonstrated good functional results and low adverse events in geriatric patients. Additional studies including less experienced centres are required to further evaluate the possible benefits of this implant. Show more

Keywords: Humerus, fracture, implant, nailing, outcome

DOI: 10.3233/THC-202388

Citation: Technology and Health Care, vol. 29, no. 4, pp. 771-780, 2021

Authors: Chaturvedi, Saurabh | Addas, Mohamed Khaled | Alqahtani, Nasser M. | Al Ahmari, Nasser M. | Alfarsi, Mohammed A.

Article Type: Research Article

Abstract: BACKGROUND: Fabrication of complete dentures by computer-aided designing and computer-aided manufacturing (CAD-CAM) techniques are now common. Subtractive and Additive are the two principal CAD-CAM techniques used for this purpose. However, studies that evaluated the occlusal forces by CDs manufactured by these techniques are lacking. OBJECTIVES: To compare the occlusal forces in complete dentures fabricated by additive, subtractive and conventional techniques with different occlusal schemes, using computerized occlusal force analysis system [Tech-Scan III (T-Scan III)]. METHODS: Three groups (Gr) were made on the basis of techniques of fabrication of CDs: Conventional CDs (CCD), Subtractive …CDs (SCD), and Additive CDs (ACD). Each group CDs were further divided into three sub groups based on occlusion schemes: bilateral balanced occlusion (BBO), lingualized occlusion (LO) and mono plane occlusion (MO). A total of 45 CDs were made: 15 in each group with 5 CDs of each occlusal scheme. For all samples, occlusal force analysis (percentage of occlusal force applied on the right and left sides of the arch, centralization of forces and percentage of maximum occlusal force) was done using computerized occlusal analysis system: T-Scan III. Univariate regression analysis and logistic regression analysis were used to find the effects of the technique of fabrication and occlusion scheme over the occlusal forces (p < 0.05). RESULTS: The intergroup comparison revealed statistically significant differences (p < 0.01) in right-left side force difference, maximum bite force in CDs fabricated by various techniques and with different occlusion schemes. Though the effect of occlusion scheme was more than the technique of fabrication (according to effect size estimation). The maximum force difference between right-left side was observed in combination of CCD technique and MO scheme (36.88 ± 2.82 N). Furthermore, the maximum bite force was observed for SCD technique (89.14 ± 6.08 N) and LO scheme (92.17 ± 3.22 N). In comparison to ACD, the chances of centre of force out of ellipse was 2.53 time more in CCS and 0.75 times less in SCD techniques and in comparison to MO, the chances of out of ellipse was 0.298 times less in BBO and 0.396 times less in LO schemes, though these chances were not statistically significant (p > 0.05). CONCLUSIONS: The digital CDs fabricated by subtractive technique were proved to be superior to additive technique in terms of occlusal force analysis on tested parameters. However, further research is needed on patients to determine the exact superiority of one technique over the other. Show more

Keywords: Digital dentures, T-Scan, occlusal forces, milling, 3-D printing

DOI: 10.3233/THC-202736

Citation: Technology and Health Care, vol. 29, no. 4, pp. 781-795, 2021

Authors: Chaturvedi, Saurabh | Addas, Mohamed Khaled | Alqahtani, Nasser M. | Al Ahmari, Nasser M. | Alfarsi, Mohammed A.

Article Type: Research Article

Abstract: BACKGROUND: Digital complete dentures (CDs) by computer-aided designing and computer-aided manufacturing (CAD-CAM) techniques (milling and three-dimensional (3-D) printing) have been evaluated clinically and provided satisfactory results. But clinical studies assessing occlusal forces by digital dentures are lacking. OBJECTIVES: To compare the occlusal force parameters in complete dentures (CDs) fabricated by milling, 3-D printing and conventional techniques having 3 commonly used occlusal schemes, using computerized occlusal force analysis system (Tech-Scan III- T-Scan III). METHODS: A total of 45 CDs were fabricated for 5 patients. Nine sets of CDs were made for each patient and were …divided into 3 groups: Conventional CDs (CCD), Milled CDs (MCD), and 3-D printed CDs (3-DP CD). The CDs in each group were further divided into 3 sub-groups based on occlusion schemes – bilateral balanced (BBO), lingualized (LO) and mono plane (MP). Occlusal force analysis [percentage (%) of occlusal force applied on the right and left sides of the arch difference between them, centralization of forces and % of maximum occlusal/bite force] was done using computerized occlusal analysis system (T-Scan III) at the time of denture insertion. Univariate regression analysis and logistic regression analysis were performed (p < 0.05). RESULTS: The intergroup comparison of force distribution on right and left side in CDs fabricated by various techniques showed insignificant differences (p > 0.05) but statistically significant differences (p < 0.01) were found in right-left side force difference, maximum bite force % and centralization of forces. The maximum force difference on right and left side was observed CCD with MO (37.48 ± 1.03 N) and maximum occlusal-bite force % was observed for 3-DPCD with LO (95.40 ± 1.30 N). In comparison to 3-DP CD, the chances of centre of force out of ellipse (centralization of forces) was 3.36 and 2.15 times more in CCD and MCD techniques made CDs respectively. CONCLUSIONS: The occlusal parameters in CDs were affected by the fabrication techniques and occlusal schemes of CDs. The digital CDs retain adjusted occlusal schemes better and 3-DP CDs with BBO and LO occlusal schemes provided centralization of forces, better distribution and high maximum occlusal force % respectively. Show more

Keywords: Digital dentures, T-Scan, occlusal forces, subtractive technique, additive technique milling, CAD-CAM

DOI: 10.3233/THC-202766

Citation: Technology and Health Care, vol. 29, no. 4, pp. 797-811, 2021

Authors: Lan, Fang-Fang | Gan, Lu

Article Type: Other

Abstract: OBJECTIVE: This is a case study on the application of a piggy-back lens in the correction of severe keratoconus. METHODS: From the results of general eye examination, refractive state examination, and corneal morphology examination on the patient, it was determined that corneal protrusion and deformation of the right eye were obvious. The right eye was corrected using a piggy-back lens and the left eye with a rigid gas-permeable contact lens (RGPCL) alone. RESULTS: The right-eye lens fit well and the lens coverage was good. Both the static and dynamic fit results for the …left-eye lens were good. After wearing the glasses for one month, the patient attended a review and stated that the lenses were comfortable to wear. The patient’s vision was good after wearing the lenses. No obvious congestion was found in the conjunctiva under a slit lamp. The effects on both eyes of wearing RGPCLs were favorable. The corneal curvature reduced and the corneal thickness only changed to a small degree. CONCLUSION: For keratoconus patients, application of a piggy-back lens can improve corrected visual acuity, comfort levels, and safety, prolong the wearing time, and enhance the effect of orthokeratology. Show more

Keywords: Keratoconus, piggy-back lens, corrected visual acuity, orthokeratology (Ortho-K)

DOI: 10.3233/THC-212889

Citation: Technology and Health Care, vol. 29, no. 4, pp. 813-822, 2021

Authors: Zhang, Yibin | Cao, Wujing | Yu, Hongliu | Meng, Qiaoling | Lv, Jie

Article Type: Other

Abstract: BACKGROUND: Gait analysis is important for the lower limb prosthesis design. Simulating the natural motion of the human knee in different terrains is useful for the design and performance assessment of the prosthetic knee. OBJECTIVE: This study aimed to propose a four-bar knee joint measurement system which can simulate the natural knee motions to collect the kinetic parameters precisely and analyze the walking characteristics under different terrain conditions. METHODS: A low-cost four-bar knee joint mechanism was proposed and gait characteristics were assessed on level ground, ascending and descending stairs, and ascending and descending …ramp. RESULTS: The initial knee flexion angle during stair ascent at heel strike is obviously larger than in other walking scenes. The stance phase accounts for 53% of a single gait cycle during stair descent, which is slightly lower than other walking scenarios. The period that both the hindfoot and forefoot contact the ground in ramp descent accounts for 18%, which is less than for the others. While the forefoot contacts the ground in ramp ascent, the maximum vertical ground reaction force of the forefoot occurs when the hindfoot and forefoot simultaneously contact the ground, whereas in other scenarios the forefoot contacts the ground solely. CONCLUSIONS: The four-bar knee joint can simulate the natural motion of the human knee accurately. The gait characteristics analysis of different walking scenarios indicated that the low-cost four-bar knee joint exoskeleton was suitable for human knee joint simulation. Show more

Keywords: Gait analysis, knee joint, different terrains, kinetic parameters

DOI: 10.3233/THC-202667

Citation: Technology and Health Care, vol. 29, no. 4, pp. 823-828, 2021

Authors: Chia, Kau Pui | Li, Ooi Ke | Yuong, Teh Shyong | Singh, Om Prakash | Faudzi, Ahmad Athif Bin Mohd | Sornambikai, Sundaram | Madhanagopal, Jagannathan

Article Type: Other

Abstract: BACKGROUND: Force Monitoring Devices (FMDs) reported in the literature to monitor applied force during Joint Mobilization Technique (JMT) possess complex design/bulky which alters the execution of treatment, has poor accuracy and is unable to feel the resistance provided by soft tissues limits its usage in the clinical settings. OBJECTIVES: This study aims to develop a highly accurate, portable FMD and to demonstrate real-time monitoring of force applied by health professionals during JMT without altering its execution. METHODS: The FMD was constructed using the FlexiForce sensor, potential divider, ATmega 328 microcontroller, custom-written software, and …liquid crystal display. The calibration, accuracy, and cyclic repeatability of the FMD were tested from 0 to 90 N applied load with a gold standard universal testing machine. For practical demonstration, the FMD was tested for monitoring applied force by a physiotherapist while performing Maitland’s grade I to IV over the 6 th cervical vertebra among 30 healthy subjects. RESULTS: The obtained Bland-Altman plot limits agreement for accuracy, and cyclic repeatability was - 1.57 N to 1.22 N, and - 1.26 N to 1.26 N, respectively with standard deviation and standard error of the mean values of 3.77% and 0.73% and 2.15% and 0.23%, respectively. The test-retest reliability of the FMD tested by the same researcher at an interval of one week showed an excellent intra-class correlation coefficient of r = 1.00. The obtained force readings for grade I to IV among 30 subjects ranged from 10.33 N to 45.24 N. CONCLUSIONS: Appreciable performance of the developed FMD suggested that it may be useful to monitor force applied by clinicians during JMT among neck pain subjects and is a useful educational tool for academicians to teach mobilization skills. Show more

Keywords: Force monitoring device, joint mobilization, neck pain, accuracy, reliability

DOI: 10.3233/THC-202414

Citation: Technology and Health Care, vol. 29, no. 4, pp. 829-836, 2021

Authors: Fang, Tao | Cao, Wujing | Chen, Chunjie | Zhang, Yu | Wang, Zhuo | Wu, Xinyu

Article Type: Other

Abstract: BACKGROUND: Population aging is now a universal trend. Many elderly persons can only conduct limited and short time walking because of age-related skeletal muscle decline of the lower limbs. The wearable device for walking assistance is beneficial to improve the life quality of the elderly. OBJECTIVE: This study aimed to propose a soft exosuit for walking assistance of the elderly and verify its feasibility. METHODS: The wearable structure and control strategy were presented. The performance of the soft exosuit was tested by force tracking evaluation and metabolic cost test. RESULTS: …The mean error of the measured and target peak force was 1.1%. The metabolic cost with assistance on while wearing the exosuit was reduced by 9.2% compared with that in locomotion assistance off. The reduction of assistance on was 7.1% compared with no exosuit. CONCLUSIONS: The proposed soft exosuit has the potential to improve the walking efficiency of the elderly. Show more

Keywords: Soft exosuit, walking augment, hip assistance, lower limb exoskeleton

DOI: 10.3233/THC-202423

Citation: Technology and Health Care, vol. 29, no. 4, pp. 837-841, 2021

Authors: Lee, Jung Hwan | Lee, Jae Il | Kim, Dong Hwan | Nam, Kyoung Hyup | Jeon, Tae Jin | Han, In Ho

Article Type: Research Article

Abstract: BACKGROUND: Monitoring patients’ position is important, but there have been few studies related to validation. OBJECTIVE: The objective of this study was to assess the validity of position monitoring measured using a wearable device by comparing the device’s measurements to a patient’s actual position. METHODS: We constructed a wearable device with a three-axis gyroscope and applied it to 10 patients who were unable to change their position independently. We compared the actual angle of the position and the angle transmitted from the wearable device using a Bland-Altman plot and a receiver operating characteristic …curve. RESULTS: We compared the actual angle of the position and the angle transmitted from the wearable device using a Bland-Altman plot, but it was difficult to observe statistical similarity. The angles transmitted from the wearable device in the lateral and supine positions showed significant differences. The cutoff value separating the lateral and supine positions was found to be 27.1 ∘ (sensitivity = 100%, specificity = 99.9%). CONCLUSIONS: Through our method, the measured values from the gyroscope-based wearable device did not accurately reflect the patient’s actual position. However, the wearable device was able to distinguish the lateral position from the supine position. Show more

Keywords: Wearable device, validation, monitoring, position change, patients

DOI: 10.3233/THC-202575

Citation: Technology and Health Care, vol. 29, no. 4, pp. 843-848, 2021