A Rare Phenomenon of Isaacs Syndrome: A Case Report.

We illustrate the case of a 71-year-old male who initially presented with sudden onset muscle weakness and ambulation difficulty. Following medication discontinuation and additional clinical studies, he failed to improve and was admitted to the hospital 11 weeks later. He had an associated 20-pound weight loss, sudorrhea, and muscle stiffness only when weight-bearing. A complete connective tissue cascade and a paraneoplastic panel were obtained. Clinical diagnosis of acquired neuromyotonia, or Isaacs syndrome (IS), was made, and he began experiencing significant improvement after intravenous steroid infusion. IS is a rare disease that has been poorly documented in the literature. There have only been a limited number of cases which are globally documented. One of the difficulties is a lack of definite autoantibody with which to correlate the disease; however, there has been some correlation linking the disease to voltage-gated potassium channels. Ultimately, the diagnosis should be driven by history and clinical presentation. The aim of this case report is to highlight a rare disease process and increase awareness among clinicians. We also describe the associated evaluation and recommended treatment for an optimal patient outcome.

A Flexible Near-Field Biosensor for Multisite Arterial Blood Flow Detection.

Modern wearable devices show promising results in terms of detecting vital bodily signs from the wrist. However, there remains a considerable need for a device that can conform to the human body's variable geometry to accurately detect those vital signs and to understand health better. Flexible radio frequency (RF) resonators are well poised to address this need by providing conformable bio-interfaces suitable for different anatomical locations. In this work, we develop a compact wearable RF biosensor that detects multisite hemodynamic events due to pulsatile blood flow through noninvasive tissue-electromagnetic (EM) field interaction. The sensor consists of a skin patch spiral resonator and a wearable transceiver. During resonance, the resonator establishes a strong capacitive coupling with layered dielectric tissues due to impedance matching. Therefore, any variation in the dielectric properties within the near-field of the coupled system will result in field perturbation. This perturbation also results in RF carrier modulation, transduced via a demodulator in the transceiver unit. The main elements of the transceiver consist of a direct digital synthesizer for RF carrier generation and a demodulator unit comprised of a resistive bridge coupled with an envelope detector, a filter, and an amplifier. In this work, we build and study the sensor at the radial artery, thorax, carotid artery, and supraorbital locations of a healthy human subject, which hold clinical significance in evaluating cardiovascular health. The carrier frequency is tuned at the resonance of the spiral resonator, which is 34.5 ± 1.5 MHz. The resulting transient waveforms from the demodulator indicate the presence of hemodynamic events, i.e., systolic upstroke, systolic peak, dicrotic notch, and diastolic downstroke. The preliminary results also confirm the sensor's ability to detect multisite blood flow events noninvasively on a single wearable platform.

A Preliminary Study to Design and Evaluate Pneumatically Controlled Soft Robotic Actuators for a Repetitive Hand Rehabilitation Task.

A stroke is an infarction in the cortical region of the brain that often leads to isolated hand paresis. This common side effect renders individuals compromised in their ability to actively flex or extend the fingers of the affected hand. While there are currently published soft robotic glove designs, this article proposed a unique design that allows users to self-actuate their therapy due to the ability to re-extend the hand using a layer of resistive flexible steel. The results showed a consistently achieved average peak of 75° or greater for each finger while the subjects' hands were at rest during multiple trials of pneumatic assisted flexion. During passive assisted testing, human subject testing on 10 participants showed that these participants were able to accomplish 80.75% of their normal active finger flexion range with the steel-layer-lined pneumatic glove and 87.07% with the unlined pneumatic glove on average when neglecting outliers. An addition of the steel layer lowered the blocked tip force by an average of 18.13% for all five fingers. These data show strong evidence that this glove would be appropriate to advance to human subject testing on those who do have post stroke hand impairments.

Surgical Management of a Splenic Abscess: Case Report, Management, and Review of Literature.

Splenic abscess is a rare infection that may develop from a multitude of causes. There are several different microorganisms implicated in pathological formation including Staphylococci, Streptococci, Salmonella, and Escherichia coli. Antibiotics are the first line of therapy in treatment with eventual surgical intervention. It is imperative to have surgical intervention performed due to increased rates in mortality with only medical management. However, specific treatment guidelines in the management of splenic abscess have been unclear due to the low number of documented cases. We report the case of a splenic abscess in thirty-year-old female two months following an appendectomy. The goal of this case report is to help provide additional context into management and treatment options for splenic abscess using literature review.

Symptomatic Bradycardia Manifesting as Acute Hypothyroidism Following COVID-19 Infection: A Case Report.

The role of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and associated autoimmune phenomenon behind pathology development has been a scientific mystery since the onset of the pandemic in 2020. Early on, scientific studies showed coronavirus disease 2019 (COVID-19) being linked to many pathological consequences including blood clots, neurocognitive dysfunction, and cardiomyopathy. We present a case of acute hypothyroidism in an 88-year-old female with no previous history of thyroid dysfunction or disease. The eventual workup revealed a thyroid-stimulating hormone (TSH) of greater than 100,000 milli-international units per liter (mlU/L) and a thyroxine (free T4) level of less than 0.10 nanograms per deciliter (ng/dl). At the time of presentation, she was found to have a positive COVID-19 test despite being vaccinated. She was started on a levothyroxine injection, which led to eventual symptom resolution. Our aim of this case report is to highlight the possibility of her acute hypothyroidism being triggered by the onset of COVID-19.

Spontaneous Coronary Artery Dissection and Its Management: A Case Report.

We illustrate a notable case of an elderly male presenting to a community hospital with six out of 10 substernal chest discomfort and electrocardiogram changes consistent with an anterolateral myocardial infarction. Percutaneous Coronary Intervention (PCI) was initiated following aspirin and anticoagulation administration, which further revealed a critical distal left main spontaneous coronary artery dissection (SCAD). Cardiothoracic and Vascular Surgery consults led to the recommendation of emergent two-vessel Coronary Artery Bypass Grafting (CABG). The patient's clinical status resolved to full recovery and was discharged on postoperative day five. The incidence of SCAD in older men has not been well documented in current literature. Prevalence in older males is 0.02%. However, it rises to 10.8% in females less than 50 years of age and with acute coronary syndromes (ACS) and ST-segment elevation. Our aim is to incorporate this case report into the current literature and help improve early diagnosis and treatment based on current recommendations.

Atypical Presentation of Paget-Schroetter Syndrome: Case Report and Management.

Upper extremity deep vein thrombosis (UEDVT) is a rare condition that makes early clinical evaluation and treatment important prior to the formation of deep vein thrombosis (DVT). Typical risk factors include male sex, young age, repetitive arm over abduction and hyperextension, indwelling catheters, cervical first rib, and thoracic outlet syndrome. One common cause of UEDVT is Paget-Schroetter syndrome (PSS). If untreated, pulmonary complications such as venous thromboembolic disease and pulmonary embolism (PE) may develop. We present a case of a 34-year-old Caucasian female who presented to the emergency department with sudden, acute right arm pain after blow-drying her hair, consistent with UEDVT. CT angiography (CTA) demonstrated moderate thromboembolic disease within segmental and subsegmental branches of the left upper, left lower, and right lower lobes. Ultrasonography (US) of the upper extremity showed non-compressibility of the right axillary and basilic vein, a finding consistent with acute DVT. Peripheral angiogram revealed imaging consistent with undiagnosed thoracic outlet syndrome secondary to effort thrombosis. The patient deferred surgical intervention and agreed to begin long-term anticoagulation therapy. PSS requires immediate recognition and treatment to prevent possible long-term neurologic and vascular compromise. Despite the patient lacking the typical population demographics, PSS should be considered given the patient's symptoms and presentation. Recognition of UEDVT despite classic signs and symptoms consistent with known risk factors is imperative upon clinical suspicion. Delay in clinical management may lead to fatal complications. We aim to highlight a case of PSS along with alternative pathways for treatment delivery.

Influence of different passive shoulder exoskeletons on shoulder and torso muscle activation during simulated horizontal and vertical aircraft squeeze riveting tasks.

Aircraft manufacturing involves riveting utilizing squeeze riveting tools at heights from below elbow to overhead levels. This study assessed utilization of passive shoulder exoskeletons on shoulder and torso muscle activation during simulated squeeze riveting. Horizontal and vertical riveting tasks using squeeze riveting tools were performed by 16 aircraft workers wearing three different shoulder exoskeletons and a no-exoskeleton condition capturing electromyographic signals from shoulder and torso muscles. Exoskeletons reduced normalized EMG for the left anterior deltoid at both heights (6.6% and 15.7%), the right anterior deltoid (8.3%) and the right and left medial deltoid (9.3% and 8.9%) at the upper height for horizontal squeeze riveting. Exoskeletons reduced normalized EMG for the right and left anterior deltoids (7.0%-10.6%) and medial deltoids (1.3%-7.1%) within the upper zones during vertical squeeze riveting. Participants felt exoskeletons would be beneficial for squeeze riveting, however no preference was found among the exoskeletons used.

Wheelchair-Mounted Upper Limb Robotic Exoskeleton with Adaptive Controller for Activities of Daily Living.

Neuro-muscular disorders and diseases such as cerebral palsy and Duchenne Muscular Dystrophy can severely limit a person's ability to perform activities of daily living (ADL). Exoskeletons can provide an active or passive support solution to assist these groups of people to perform ADL. This study presents an artificial neural network-trained adaptive controller mechanism that uses surface electromyography (sEMG) signals from the human forearm to detect hand gestures and navigate an in-house-built wheelchair-mounted upper limb robotic exoskeleton based on the user's intent while ensuring safety. To achieve the desired position of the exoskeleton based on human intent, 10 hand gestures were recorded from 8 participants without upper limb movement disabilities. Participants were tasked to perform water bottle pick and place activities while using the exoskeleton, and sEMG signals were collected from the forearm and processed through root mean square, median filter, and mean feature extractors prior to training a scaled conjugate gradient backpropagation artificial neural network. The trained network achieved an average of more than 93% accuracy, while all 8 participants who did not have any prior experience of using an exoskeleton were successfully able to perform the task in less than 20 s using the proposed artificial neural network-trained adaptive controller mechanism. These results are significant and promising thus could be tested on people with muscular dystrophy and neuro-degenerative diseases.

Artificial Neural Network to Detect Human Hand Gestures for a Robotic Arm Control.

Assistive technology is critical to improving daily life of those with muscular issues such as Cerebral Palsy and Duchenne Muscular Dystrophy by augmenting their activities of daily living (ADL). Robotic manipulators are one solution for helping with ADL; however, intuitive, accurate interfaces for higher degrees of freedom (DOF) robotic arms are still lacking. An intuitive control system based on artificial neural network (ANN) classification of real-time surface electromyography (sEMG) signals from the user's forearm to detect nine hand gestures and control the movement of the 6 DOF robotic arm is proposed in this paper. The regular machine learning classifiers with the highest classification accuracies were ensemble-bagged trees at 90.3% and cubic SVM at 89.6%, with linear SVM being 84.8%. However, the classifier chosen was a scaled conjugate gradient backpropagation neural network model, with a classification accuracy of 85%, due to accuracy and usability in a Simulink model. The trained ANN model was incorporated into the control system for the robotic arm and tested in virtual environment. Preliminary testing of the robotic arm shows that the forward kinematic control system works well for most hand poses. Future improvements will include more processing of the sEMG signals and training on sEMG data from multiple subjects for a generalized ANN model.

Simulation of Exoskeleton Alignment and its Effect on the Knee Extensor and Flexor Muscles.

This study presents the analysis of different knee joint impairments and their effects on the knee extensor and flexor muscles. Joint impairments can result from stroke, musculoskeletal diseases, or misalignment of an attached exoskeleton joint. Understanding the correlation between parameters involved in joint movement mechanisms as well as force interactions could provide insight to establish an appropriate design for exoskeletons. Joints can be powered or even be rectified in terms of alignment by exoskeletons to help a patient recover quickly. For the study, OpenSIM 4.0 was used to generate models and simulations of the human musculoskeletal structure with and without introduced knee joint impairments along the sagittal and transverse directions. A scenario to simulate the constraints of an exoskeleton designed with a single hinge joint to mimic the knee joint was also considered. Alterations to the knee joint axis within the range of +5.00 to -6.40 mm would result in a meaningful yet not a significant change in muscle stresses; the simulation outputs indicate that constraining the knee joint motion to the sagittal plane will only increase the force generated by the vastus lateralis muscle up to 4.3%.

Integration of Forearm sEMG Signals with IMU Sensors for Trajectory Planning and Control of Assistive Robotic Arm.

Patients with issues such as cerebral palsy, spinal cord injury, and multiple sclerosis have difficulties with activities of daily living (ADL). Their abilities to perform tasks can be improved through vigorous physical therapy. When that therapy is either not effective or lacking in its progression an assistive robotic device can be used to improve patients' quality of life and help them in accomplishing ADL's. This study presents implementation of an EMG controlled assistive robotic arm to aid patients with upper limb mobility limitations. Using the MYO armband, EMG signals were obtained from three healthy human test subjects and were analyzed in MATLAB® Simulink®. Post signal acquisition, signals were classified to be used as inputs for a Kinova MICO 6 DOF manipulator. Trajectories are planned based on the user EMG signals and robot position data obtained from the Polhemus 6D motion tracker, an IMU-type sensor, which automatically provide position and orientation data. An inverse dynamics controller is developed to drive the robot joints accordingly. Results have shown that the classification accuracy of the EMG signals to control commands for the robot was greater than 90%. The classification accuracy was achieved through the use of a pattern recognition neural network. This preliminary investigation demonstrates the possible future implementation of the system for its intended application.

Assist-as-Needed Controller to a Task-based Knee Rehabilitation Exoskeleton.

This research aims to design and implement an assist-as-needed controller and patient recovery tracking system into a novel task based knee rehabilitation exoskeleton device. The level of support from the exoskeleton is measured through the force sensing resistors (FSR) placed in the interface of lower- leg and the exoskeleton. The signal from the FSR is used as a feedback to control the actuator torque. The intent of the user to start, stop, move left, and right are associated with muscle activities, surface electromyography (sEMG) signals in the upper-leg. The preliminary results have shown that the system has provided the user a visual display of the amount of recovery and history while providing full autonomy to control the exoskeleton device. The successful implementation of these features can eliminate the need of constant supervision, and hence saves time and reduces cost of the rehabilitation process; which can also be used in a home-based or telerehabilitation settings.