Technology transfer of neuroprosthetic devices.

Despite long development periods for neuroprosthetic devices, the numbers in clinical use or clinical trials are rising, with an estimated 3,000 systems in use today. As they gain experience with the regulatory approval process, developers are learning to conduct research to best prepare for transfer of technology to industry. The track record of the first motor prosthesis to be approved by the United States Food and Drug Administration contains important lessons for a company planning to undergo the regulatory process. Throughout the development of a neuroprosthesis, the capabilities and preferences of the customers who will use it (physicians, surgeons, therapists, and end-users) should be sought out and used in device design. When a device has reached clinical application, particular attention is needed to maximize both the population who will use it and each individual's degree of use (optimal, partial, reluctant). Identification of person-technology mismatches can help to select training strategies and other interventions that can be applied to ensure a good rehabilitation outcome.

Physiologic costs of reciprocal gait in FES assisted walking.

This study reports the velocity and physiologic cost index (PCI) of ambulation using a functional electrical stimulation (FES) system for ambulation in paraplegic spinal cord injured subjects. Using established techniques, average velocity and heart rate (HR) were measured on five subjects trained with the Parastep system. PCI was reported for the four subjects who achieved a steady state during ambulation with the Parastep system. It was found that walking performance varied greatly between subjects, and was correlated to frequency of use of the system. Velocity of walking with the Parastep system ranged from 4.6 to 24.3 m/min. In the four subjects where steady state was achieved, PCI ranged from 2.30 to 6.26 beats/m. The average walking speed and PCI were similar to the values reported using alternative mechanical or hybrid systems available to the spinal cord injured for restoration of upright locomotion.

Biomechanical comparison of rising from two types of chairs.

This study compared the joint moments and ranges of motion of healthy subjects and patients during rising from a standard chair with a seat height of 0.43 m and a specially designed chair (E-Z Up Artherapedic Chair) with a seat height of 0.64 m. Ten healthy male subjects and four male patients with lower extremity disabilities rose from each chair with and without the use of their upper extremities. Hip, knee, and ankle joint moments and angles were calculated with film analysis and force plate data. An analysis of variance with repeated measures showed the following results for the healthy subjects: 1) no effect of upper extremity use on joint angles, 2) no effect of chair type on ankle joint angles or moments, 3) significantly smaller hip and knee flexion angles with use of the E-Z chair than of the standard chair (p less than .05), and 4) significantly smaller hip and knee extension moments with use of the E-Z chair than of the standard chair (p less than .05) or with use of the upper extremities. Similar results were found with the four disabled subjects. Use of the E-Z chair can significantly decrease the joint moments and ranges of motion needed at the hip and knee and thus make rising from a chair less stressful to these joints.

Cardiac rehabilitation. An overview.

The paper is intended to acquaint physical therapists with the theory and practice of cardiac rehabilitation, which is often prescribed for patients who have coronary heart disease, and the therapists' responsibilities in this effort. The related exercise physiology literature is reviewed, and physiological, psychological, physical, and prognostic advantages of cardiac rehabilitation are described. Cardiac rehabilitation is presented in three phases: acute care, outpatient, and further conditioning programs. The protocols for exercise testing and programs of progressive activity are discussed, with emphasis upon the role of physical therapists. Data collected at Tufts New England Medical Center demonstrating the measurable effects of cardiovascular training for patients with coronary heart disease ar presented.