Understanding the Effect of Epidural Steroid Injection in Lower Back Pain Using Inertial Measurement Unit Wearable Device

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Description
Low back pain (LBP) is the most common symptom leading to hospitalization and medical assistance. In the US, LBP is the fifth most prevalent case for visiting hospitals. Approximately 2.06 million LBP incidents were reported during the timeline between 2004

Low back pain (LBP) is the most common symptom leading to hospitalization and medical assistance. In the US, LBP is the fifth most prevalent case for visiting hospitals. Approximately 2.06 million LBP incidents were reported during the timeline between 2004 and 2008. Globally, LBP occurrence increased by almost 200 million from 1990 to 2017. This problem is further implicated by physical and financial constraints that impact the individual’s quality of life. The medical cost exceeded $87.6 billion, and the lifetime prevalence was 84%. This indicates that the majority of people in the US will experience this symptom. Also, LBP limits Activities of Daily Living (ADL) and possibly affects the gait and postural stability. Prior studies indicated that LBP patients have slower gait speed and postural instability. To alleviate this symptom, the epidural injection is prescribed to treat pain and improve mobility function. To evaluate the effectiveness of LBP epidural injection intervention, gait and posture stability was investigated before and after the injection. While these factors are the fundamental indicator of LBP improvement, ADL is an element that needs to be significantly considered. The physical activity level depicts a person’s dynamic movement during the day, it is essential to gather activity level that supports monitoring chronic conditions, such as LBP, osteoporosis, and falls. The objective of this study was to assess the effects of Epidural Steroid Injection (ESI) on LBP and related gait and postural stability in the pre and post-intervention status. As such, the second objective was to assess the influence of ESI on LBP, and how it influences the participant’s ADL physical activity level. The results indicated that post-ESI intervention has significantly improved LBP patient’s gait and posture stability, however, there was insufficient evidence to determine the significant disparity in the physical activity levels. In conclusion, ESI depicts significant positive effects on LBP patients’ gait and postural parameters, however, more verification is required to indicate a significant effect on ADL physical activity levels.
Date Created
2023
Agent

Sideline Concussion Assessment Methods and the Lockhart Monitor App: Assessing the Impact of Common Athletic Playing Surfaces

Description

Current sideline concussion assessment tools are inaccurate and biased leading to undiagnosed concussions and possibly a second, more severe concussion. This study evaluated the effects of different surface types on postural stability using the Lockhart Monitor iPhone application in order

Current sideline concussion assessment tools are inaccurate and biased leading to undiagnosed concussions and possibly a second, more severe concussion. This study evaluated the effects of different surface types on postural stability using the Lockhart Monitor iPhone application in order to validate its potential use as a data-driven sideline concussion assessment tool. Participants had three components of their postural sway recorded in 30 and 60-second trials on three different surface types, tile, turf, and natural grass, with eyes open and closed. The statistical analysis found that there was a significant difference between surface types for the sway area (p = 0.0268), but there was no difference for the sway path and velocity. These results call for further research to be conducted on the impact of surface types and the use of the Lockhart Monitor as a sideline concussion assessment tool with larger sample sizes and improved methodologies.

Date Created
2023-05
Agent

Sideline Concussion Assessment Methods and the Lockhart Monitor App: Assessing the Impact of Common Athletic Playing Surfaces

Description

Current sideline concussion assessment tools are inaccurate and biased leading to undiagnosed concussions and possibly a second, more severe concussion. This study evaluated the effects of different surface types on postural stability using the Lockhart Monitor iPhone application in order

Current sideline concussion assessment tools are inaccurate and biased leading to undiagnosed concussions and possibly a second, more severe concussion. This study evaluated the effects of different surface types on postural stability using the Lockhart Monitor iPhone application in order to validate its potential use as a data-driven sideline concussion assessment tool. Participants had three components of their postural sway recorded in 30 and 60-second trials on three different surface types, tile, turf, and natural grass, with eyes open and closed. The statistical analysis found that there was a significant difference between surface types for the sway area (p = 0.0268), but there was no difference for the sway path and velocity. These results call for further research to be conducted on the impact of surface types and the use of the Lockhart Monitor as a sideline concussion assessment tool with larger sample sizes and improved methodologies.

Date Created
2023-05
Agent

Reliability of Graphene as a Bio Wearable Sensor For Gait Analysis

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Description
With more people falling every year it is more important to continue to track everyday activity as well as follow the progress that someone is making over time. As well as at risk subjects, athletes are also wanting to track

With more people falling every year it is more important to continue to track everyday activity as well as follow the progress that someone is making over time. As well as at risk subjects, athletes are also wanting to track their activity as well as improve in finer control of their motions and abilities. To improve someone’s balance, strength, flexibility, and more someone can now start to use different biological sensors to help live a healthier and better lifestyle. To build different sensors requires materials that are comfortable to wear and accurate in collecting data. Graphene has been considered a wonder material that is used in many different applications which allow circuits and devices to use the flexible and durable material to conduct electricity. This paper shows multiple different tests and 36 trials of using graphene as a device which measures pressure that can be used to analyze gait patterns. These tests involve walking on a dual force plate treadmill for 90 continuous seconds with the graphene strip in the heel of the shoe wirelessly transmitting data to be recorded. The initial tests show that graphene will pick up noise and that graphene can start to deteriorate without proper protection. When looking at subject 1 there is less than .01 seconds of error between the graphene circuit and the ground truth. The ground truth was collected simultaneously, and the t-tests and ANOVA tests showed that there is no statistical difference between the graphene system and the ground truth. These tests also showed a 96.7% reproducibility score. There are limitations as seen in the later subjects, but these limitations can be overcome by further protecting the graphene and replacing the strip when it starts to show signs of deterioration which will allow graphene to be used in everyday bio wearable devices.
Date Created
2022
Agent

Low-Intensity Blood Flow Restriction Training as a Preoperative Rehabilitative Modality to Improve Postoperative Outcomes for Anterior Cruciate Ligament Reconstruction

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Description
One of the long-standing issues that has arisen in the sports medicine field is identifying the ideal methodology to optimize recovery following anterior cruciate ligament reconstruction (ACLR). The perioperative period for ACLR is notoriously heterogeneous in nature as it consists

One of the long-standing issues that has arisen in the sports medicine field is identifying the ideal methodology to optimize recovery following anterior cruciate ligament reconstruction (ACLR). The perioperative period for ACLR is notoriously heterogeneous in nature as it consists of many variables that can impact surgical outcomes. While there has been extensive literature published regarding the efficacy of various recovery and rehabilitation topics, it has been widely acknowledged that certain modalities within the field of ACLR rehabilitation need further high-quality evidence to support their use in clinical practice, such as blood flow restriction (BFR) training. BFR training involves the application of a tourniquet-like cuff to the proximal aspect of a limb prior to exercise; the cuff is inflated so that it occludes venous flow but allows arterial inflow. BFR is usually combined with low-intensity (LI) resistance training, with resistance as low as 20% of one-repetition maximum (1RM). LI-BFR has been used as an emerging clinical modality to combat postoperative atrophy of the quadriceps muscles for those who have undergone ACLR, as these individuals cannot safely tolerate high muscular tension exercise after surgery. Impairments of the quadriceps are the major cause of poor functional status of patients following an otherwise successful ACLR procedure; however, these impairments can be mitigated with preoperative rehabilitation done before surgery. It was hypothesized that the use of a preoperative LI-BFR training protocol could help improve postoperative outcomes following ACLR; primarily, strength and hypertrophy of the quadriceps. When compared with a SHAM control group, subjects who were randomized to a BFR intervention group made greater preoperative strength gains in the quadriceps and recovered quadriceps mass at an earlier timepoint than that of the SHAM group aftersurgery; however, the gains made in strength were not able to be maintained in the 8-week postoperative period. While these results do not support the use of LI-BFR from the short-term perspective after ACLR, follow-up data will be used to investigate trends in re-injury and return to sport rates to evaluate the efficacy of the use of LI-BFR from a long-term perspective.
Date Created
2022
Agent

Characterization of 2D Human Ankle Stiffness during Postural Balance and Walking for Robot-aided Ankle Rehabilitation

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Description
The human ankle is a vital joint in the lower limb of the human body. As the point of interaction between the human neuromuscular system and the physical world, the ankle plays important role in lower extremity functions including postural

The human ankle is a vital joint in the lower limb of the human body. As the point of interaction between the human neuromuscular system and the physical world, the ankle plays important role in lower extremity functions including postural balance and locomotion . Accurate characterization of ankle mechanics in lower extremity function is essential not just to advance the design and control of robots physically interacting with the human lower extremities but also in rehabilitation of humans suffering from neurodegenerative disorders.

In order to characterize the ankle mechanics and understand the underlying mechanisms that influence the neuromuscular properties of the ankle, a novel multi-axial robotic platform was developed. The robotic platform is capable of simulating various haptic environments and transiently perturbing the ankle to analyze the neuromechanics of the ankle, specifically the ankle impedance. Humans modulate ankle impedance to perform various tasks of the lower limb. The robotic platform is used to analyze the modulation of ankle impedance during postural balance and locomotion on various haptic environments. Further, various factors that influence modulation of ankle impedance were identified. Using the factors identified during environment dependent impedance modulation studies, the quantitative relationship between these factors, namely the muscle activation of major ankle muscles, the weight loading on ankle and the torque generation at the ankle was analyzed during postural balance and locomotion. A universal neuromuscular model of the ankle that quantitatively relates ankle stiffness, the major component of ankle impedance, to these factors was developed.

This neuromuscular model is then used as a basis to study the alterations caused in ankle behavior due to neurodegenerative disorders such as Multiple Sclerosis and Stroke. Pilot studies to validate the analysis of altered ankle behavior and demonstrate the effectiveness of robotic rehabilitation protocols in addressing the altered ankle behavior were performed. The pilot studies demonstrate that the altered ankle mechanics can be quantified in the affected populations and correlate with the observed adverse effects of the disability. Further, robotic rehabilitation protocols improve ankle control in affected populations as seen through functional improvements in postural balance and locomotion, validating the neuromuscular approach for rehabilitation.
Date Created
2020
Agent

Design, Development, and Evaluation of a Soft-Inflatable exosuit for Lower Limb Assistance

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Description
Traditionally, wearable exoskeletons for gait assistance have addressed the issue of high power requirement of providing support during walking. However, exoskeletons often are bulky, and suffer from misalignment of joints between the robot and the user. Soft robots in recent

Traditionally, wearable exoskeletons for gait assistance have addressed the issue of high power requirement of providing support during walking. However, exoskeletons often are bulky, and suffer from misalignment of joints between the robot and the user. Soft robots in recent work have shown the ability to provide a high degree of compliance with a light weight and lower cost. This work presents the design, control, and evaluation of a soft inflatable exosuit to assist knee extension. First, the design of novel soft inflatable actuators of I cross-section and their application in the soft inflatable exosuit is presented. The actuators are applied to a soft and lightweight garment interface to assist in knee extension during the swing phase demonstrating reduced muscle activity for the quadriceps. Second, the control of the soft exosuit is presented with the introduction of a knee angle measurement system and smart shoe insole sensors. A new control method using human joint stiffness models as well as actuator models is developed. The new control method is evaluated with three users and a reduction in the sEMG activity of the quadriceps is observed with an increase in the activity of the hamstrings. Third, an improved version of the exosuit and a controller to assist knee extension in swing phase and initial stance are presented. The exosuit is applied to seven healthy and three impaired participants. Kinematics, muscle activity and gait compensations are studied. Reduced muscle activity for the quadriceps is seen in healthy participants with reduced execution times for functional activities such as timed up-and-go as well as sit-to-stand transitions in impaired participants. Finally, an untethered version of the soft exosuit using inflatable actuator composites and a portable pneumatic source are presented. Finite element models for the composites and inflatable actuators are generated and the actuators are characterized for performance. The design of a portable source for the exosuit is also presented. The inflatable actuator composites and the portable source are implemented in a portable exosuit system which demonstrated a reduction in the Vastus Lateralis activity during incline walking for three participants. Overall, this work investigated the feasibility of several versions of the soft exosuit for gait assistance.
Date Created
2020
Agent

Using Graphene as a Flex Resistor to Detect Biodynamics

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Description
Over the past 30 years the use of graphene has been increasing at a rapid rate. The reason why graphene has become more popular is because it is starting to be understood better, and researchers are starting to recognize graphene’s

Over the past 30 years the use of graphene has been increasing at a rapid rate. The reason why graphene has become more popular is because it is starting to be understood better, and researchers are starting to recognize graphene’s unique properties. Graphene is a single atomic layer of graphite, and graphite is a three-dimensional cube base structure of carbon. Graphite has a high conductivity rate, and graphene has an even higher conductivity, meaning that graphene makes for an excellent resistor in any hardware system. Graphene is flexible, has high durability, and can vary in resistance based on its shape (Sharon 2015). With graphene being able to change its resistivity, it can act as different types of sensors. These sensors include measuring pressure, resistance, force, strain, and angle. One problem across the globe is that patients have arthritis, decaying bone density, and injuries which can easily go mistreated or not treated at all. It can be hard to determine the severity of injuries in joints by observation of the patient. There are tools and equipment that will allow a doctor to track the force and degrees of motion of certain joints, but they are mostly limited to hospitals. With graphene acting as a sensor it can be embedded into casts, braces, and even clothing. With a mobile sensor that relays accurate and continuous data to a doctor they can more precisely determine a therapy or recovery time that will better suit the patients’ needs. In this project the graphene was used to measure the angle of a patient’s wrist while they were wearing a wrist brace. From the data collected, the graphene was able to track the user’s movement of their wrist as they moved it in a single direction. The data showed the angle of the wrist ranging from zero degrees to 90 degrees. This proves that graphene can shape the way biosensing is accomplished. Biodynamics is a growing field, and with more injuries everyday it is important to study graphene and how it can be used to diagnose and prevent injuries related to joints. Graphene can be used as a biosensor which can then be implemented into a brace to allow for accurate biodynamic tracking.
Date Created
2020-05
Agent

Fall Prevention Using Linear and Nonlinear Analyses and Perturbation Training Intervention

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Description
Injuries and death associated with fall incidences pose a significant burden to society, both in terms of human suffering and economic losses. The main aim of this dissertation is to study approaches that can reduce the risk of falls. One

Injuries and death associated with fall incidences pose a significant burden to society, both in terms of human suffering and economic losses. The main aim of this dissertation is to study approaches that can reduce the risk of falls. One major subset of falls is falls due to neurodegenerative disorders such as Parkinson’s disease (PD). Freezing of gait (FOG) is a major cause of falls in this population. Therefore, a new FOG detection method using wavelet transform technique employing optimal sampling window size, update time, and sensor placements for identification of FOG events is created and validated in this dissertation. Another approach to reduce the risk of falls in PD patients is to correctly diagnose PD motor subtypes. PD can be further divided into two subtypes based on clinical features: tremor dominant (TD), and postural instability and gait difficulty (PIGD). PIGD subtype can place PD patients at a higher risk for falls compared to TD patients and, they have worse postural control in comparison to TD patients. Accordingly, correctly diagnosing subtypes can help caregivers to initiate early amenable interventions to reduce the risk of falls in PIGD patients. As such, a method using the standing center-of-pressure time series data has been developed to identify PD motor subtypes in this dissertation. Finally, an intervention method to improve dynamic stability was tested and validated. Unexpected perturbation-based training (PBT) is an intervention method which has shown promising results in regard to improving balance and reducing falls. Although PBT has shown promising results, the efficacy of such interventions is not well understood and evaluated. In other words, there is paucity of data revealing the effects of PBT on improving dynamic stability of walking and flexible gait adaptability. Therefore, the effects

of three types of perturbation methods on improving dynamics stability was assessed. Treadmill delivered translational perturbations training improved dynamic stability, and adaptability of locomotor system in resisting perturbations while walking.
Date Created
2019
Agent

Development of an OpenSim Simulation to Identify Time and Force Magnitude Needed at Toe-Off Stage for an Assistive Force Ankle Device

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Description
Human walking is a complex and rhythmical activity that comprises of the brain, nerves and muscles. Neuromuscular disorder (NMD) is a broad term that refers to conditions that affect the proper use of muscles and nervous system, thus also impairing

Human walking is a complex and rhythmical activity that comprises of the brain, nerves and muscles. Neuromuscular disorder (NMD) is a broad term that refers to conditions that affect the proper use of muscles and nervous system, thus also impairing the walking or gait cycle of an individual. The improper gait cycle might be attributed to the lack of force produced at the toe-off stage. This project addresses if it is possible to create an OpenSim model to find the ideal time and force magnitude needed of an assistive force ankle device to improve gait patterns in individuals with NMD.
Date Created
2019-05
Agent