Systematic Review of Cerebral Palsy Registries/Surveillance Groups: Relationships between Registry Characteristics and Knowledge Dissemination.

The aims of this study were to provide a comprehensive summary of the body of research disseminated by Cerebral Palsy (CP) registries and surveillance programs from January 2009 through May 2014 in order to describe the influence their results have on our overall understanding of CP. Secondly, registries/surveillance programs and the work they produced were evaluated and grouped using standardized definitions and classification systems. METHOD: A systematic review search in PubMed, CINAH and Embase for original articles published from 1 January 2009 to 20 May 2014 originating from or supported by population based CP registries and surveillance programs or population based national registries including CP were included. Articles were grouped by 2009 World CP Registry Congress aim, registry/surveillance program classification, geographical region, and the International Classification of Function, Disability and Health (ICF) domain. Registry variables were assessed using the ICF-CY classification. RESULTS: Literature searches returned 177 articles meeting inclusion criteria. The majority (69%) of registry/surveillance program productivity was related to contributions as a Resource for CP Research. Prevention (23%) and Surveillance (22%) articles were other areas of achievement, but fewer articles were published in the areas of Planning (17%) and Raising the Profile of CP (2%). There was a range of registry/surveillance program classifications contributing to this productivity, and representation from multiple areas of the globe, although most of the articles originated in Europe, Australia, and Canada. The domains of the ICF that were primarily covered included body structures and function at the early stages of life. Encouragingly, a variety of CP registry/surveillance program initiatives included additional ICF domains of participation and environmental and personal factors. INTERPRETATION: CP registries and surveillance programs, including novel non-traditional ones, have significantly contributed to the understanding of how CP affects individuals, families and society. Moving forward, the global CP registry/surveillance program community should continue to strive for uniformity in CP definitions, variables collected and consistency with international initiatives like the ICF so that databases can be consolidated for research use. Adaptation to new technologies can improve access, reduce cost and facilitate information transfer between registrants, researchers and registries/surveillance programs. Finally, increased efforts in documenting variables of individuals with CP into adulthood should be made in order to expand our understanding of CP across the lifespan.

Vibrational shape tracking of atomic force microscopy cantilevers for improved sensitivity and accuracy of nanomechanical measurements.

Contact resonance atomic force microscopy (CR-AFM) methods currently utilize the eigenvalues, or resonant frequencies, of an AFM cantilever in contact with a surface to quantify local mechanical properties. However, the cantilever eigenmodes, or vibrational shapes, also depend strongly on tip-sample contact stiffness. In this paper, we evaluate the potential of eigenmode measurements for improved accuracy and sensitivity of CR-AFM. We apply a recently developed, in situ laser scanning method to experimentally measure changes in cantilever eigenmodes as a function of tip-sample stiffness. Regions of maximum sensitivity for eigenvalues and eigenmodes are compared and found to occur at different values of contact stiffness. The results allow the development of practical guidelines for CR-AFM experiments, such as optimum laser spot positioning for different experimental conditions. These experiments provide insight into the complex system dynamics that can affect CR-AFM and lay a foundation for enhanced nanomechanical measurements with CR-AFM.

Characterizing the free and surface-coupled vibrations of heated-tip atomic force microscope cantilevers.

Combining heated-tip atomic force microscopy (HT-AFM) with quantitative methods for determining surface mechanical properties, such as contact resonance force microscopy, creates an avenue for nanoscale thermomechanical property characterization. For nanomechanical methods that employ an atomic force microscope cantilever's vibrational modes, it is essential to understand how the vibrations of the U-shaped HT-AFM cantilever differ from those of a more traditional rectangular lever, for which analytical techniques are better developed. Here we show, with a combination of finite element analysis (FEA) and experiments, that the HT-AFM cantilever exhibits many more readily-excited vibrational modes over typical AFM frequencies compared to a rectangular cantilever. The arms of U-shaped HT-AFM cantilevers exhibit two distinct forms of flexural vibrations that differ depending on whether the two arms are vibrating in-phase or out-of-phase with one another. The in-phase vibrations are qualitatively similar to flexural vibrations in rectangular cantilevers and generally show larger sensitivity to surface stiffness changes than the out-of-phase vibrations. Vibration types can be identified from their frequency and by considering vibration amplitudes in the horizontal and vertical channels of the AFM at different laser spot positions on the cantilever. For identifying contact resonance vibrational modes, we also consider the sensitivity of the resonant frequencies to a change in applied force and hence to tip-sample contact stiffness. Finally, we assess how existing analytical models can be used to accurately predict contact stiffness from contact-resonance HT-AFM results. A simple two-parameter Euler-Bernoulli beam model provided good agreement with FEA for in-phase modes up to a contact stiffness 500 times the cantilever spring constant. By providing insight into cantilever vibrations and exploring the potential of current analysis techniques, our results lay the groundwork for future use of HT-AFM cantilevers for accurate nanomechanical property measurements.

Morphing metal-polymer janus particles.

The direct deformation and shape recovery of micron-sized polystyrene particles via nanoimprint lithography is reported. The recovery of the programmed PS particles can be utilized to create a range of smart Janus particles with contrasting properties in conductivity and topography, by use of metal-layer constrained recovery.

Hydrodynamic corrections to contact resonance atomic force microscopy measurements of viscoelastic loss tangent.

We present a method to improve accuracy in measurements of nanoscale viscoelastic material properties with contact resonance atomic force microscope methods. Through the use of the two-dimensional hydrodynamic function, we obtain a more precise estimate of the fluid damping experienced by the cantilever-sample system in contact resonance experiments, leading to more accurate values for the tip-sample damping and related material properties. Specifically, we consider the damping and added mass effects generated by both the proximity of the cantilever to the sample surface and the frequency dependence on the hydrodynamic loading of the system. The theoretical correction method is implemented on experimental contact resonance measurements. The measurements are taken on a thin polystyrene film and are used to determine the viscoelastic loss tangent, tan δ, of the material. The magnitude of the corrections become significant on materials with low tan δ (<0.1) and are especially important for measurements made with the first flexural mode of vibration.

Nanomechanical mapping of the osteochondral interface with contact resonance force microscopy and nanoindentation.

The bone-cartilage, or osteochondral, interface resists remarkably high shear stresses and rarely fails, yet its mechanical characteristics are largely unknown. A complete understanding of this hierarchical system requires mechanical-property information at the length scales of both the interface and the connecting tissues. Here, we combined nanoindentation and atomic force microscopy (AFM) methods to investigate the multiscale mechanical properties across the osteochondral region. The nanoindentation modulus M ranged from that of the subchondral bone (M=22.8±1.8GPa) to that of hyaline articular cartilage embedded in PMMA (M=5.7±1.0GPa) across a narrow transition region <5µm wide. Contact resonance force microscopy (CR-FM), which measures the frequency and quality factor of the AFM cantilever's vibrational resonance in contact mode, was used to determine the relative storage modulus and loss tangent of the osteochondral interface. With better spatial resolution than nanoindentation, CR-FM measurements indicated an even narrower interface width of 2.3±1.2µm. Furthermore, CR-FM revealed a 24% increase in the viscoelastic loss tangent from the articular calcified cartilage into the PMMA-embedded hyaline articular cartilage. Quantitative backscattered electron imaging provided complementary measurement of mineral content. Our results provide insight into the multiscale functionality of the osteochondral interface that will advance understanding of disease states such as osteoarthritis and aid in the development of biomimetic interfaces.

Afferent stimulation provided by glove electrode during task-specific arm exercise following stroke.

BACKGROUND: Sensory amplitude electrical stimulation (SES) and repetitive task practice reduce impairments and arm dysfunction when delivered separately following stroke. OBJECTIVE: To determine if home-based, task-specific arm exercise was more effective when administered concurrent with SES. METHODS: Thirty-eight subjects with chronic stroke and mean Fugl-Meyer Assessment (FMA) score 28/66 (15-45) participated. Subjects were randomly assigned to an SES (n = 20) or sham stimulation (n = 18) group. Subjects engaged in task-based home exercise for 30 minutes, twice daily, for four weeks while wearing a glove electrode on the impaired hand. Experimental subjects received SES while control subjects received sham stimulation during exercise. PRIMARY OUTCOME MEASURES: FMA and Arm Motor Ability Test (AMAT). RESULTS: There were no significant between-group differences for outcome measures. There was a significant difference between the pre- and post-test scores in the SES group AMAT median time (P = 0.003 95% confidence interval (CI): -14.304, -6.365; effect size: 0.84). Practice time was not associated with changes in outcomes. Subjects with more sensorimotor dysfunction had significantly greater improvements on AMAT median time (P = 0.037). There was a significant relationship between baseline FMA score and FMA change score (r = 0.402; P = 0.006). CONCLUSIONS: This study describes a unique SES delivery system via glove electrode that enabled delivery of SES during home-based arm task practice in stroke survivors. Task practice with concurrent SES did not demonstrate significantly better effects than task practice with sham stimulation, however there was a trend for greater improvement in one activity measure.

Low-force AFM nanomechanics with higher-eigenmode contact resonance spectroscopy.

Atomic force microscopy (AFM) methods for quantitative measurements of elastic modulus on stiff (>10 GPa) materials typically require tip-sample contact forces in the range from hundreds of nanonewtons to a few micronewtons. Such large forces can cause sample damage and preclude direct measurement of ultrathin films or nanofeatures. Here, we present a contact resonance spectroscopy AFM technique that utilizes a cantilever's higher flexural eigenmodes to enable modulus measurements with contact forces as low as 10 nN, even on stiff materials. Analysis with a simple analytical beam model of spectra for a compliant cantilever's fourth and fifth flexural eigenmodes in contact yielded good agreement with bulk measurements of modulus on glass samples in the 50-75 GPa range. In contrast, corresponding analysis of the conventionally used first and second eigenmode spectra gave poor agreement under the experimental conditions. We used finite element analysis to understand the dynamic contact response of a cantilever with a physically realistic geometry. Compared to lower eigenmodes, the results from higher modes are less affected by model parameters such as lateral stiffness that are either unknown or not considered in the analytical model. Overall, the technique enables local mechanical characterization of materials previously inaccessible to AFM-based nanomechanics methods.

The cerebral palsy research registry: development and progress toward national collaboration in the United States.

Cerebral palsy is the most common neurodevelopmental motor disability in children. The condition requires medical, educational, social, and rehabilitative resources throughout the life span. Several countries have developed population-based registries that serve the purpose of prospective longitudinal collection of etiologic, demographic, and functional severity. The United States has not created a comprehensive program to develop such a registry. Barriers have been large population size, poor interinstitution collaboration, and decentralized medical and social systems. The Cerebral Palsy Research Registry was created to fill the gap between population and clinical-based cerebral palsy registries and promote research in the field. This is accomplished by connecting persons with cerebral palsy, as well as their families, to a network of regional researchers. This article describes the development of an expandable cerebral palsy research registry, its current status, and the potential it has to affect families and persons with cerebral palsy in the United States and abroad.

Quantitative subsurface contact resonance force microscopy of model polymer nanocomposites.

We present experimental results on the use of quantitative contact resonance force microscopy (CR-FM) for mapping the planar location and depth of 50 nm diameter silica nanoparticles buried beneath polystyrene films 30-165 nm thick. The presence of shallowly buried nanoparticles, with stiffness greater than that of the surrounding matrix, is shown to locally affect the surface contact stiffness of a material for all depths investigated. To achieve the necessary stiffness sensitivity, the CR-FM measurements are obtained utilizing the fifth contact eigenmode. Stiffness contrast is found to increase rapidly with initial increases in force, but plateaus at higher loads. Over the explored depth range, stiffness contrast spans roughly one order of magnitude, suggesting good depth differentiation. Scatter in the stiffness contrast for single images reveals nonuniformities in the model samples that can be explained by particle size dispersity. Finite element analysis is used to simulate the significant effect particle size can have on contact stiffness contrast. Finally, we show how measurements at a range of forces may be used to deconvolve particle size effects from depth effects.

Contact mechanics and tip shape in AFM-based nanomechanical measurements.

Stiffness-load curves obtained in quantitative atomic force acoustic microscopy (AFAM) measurements depend on both the elastic properties of the sample and the geometry of the atomic force microscope (AFM) tip. The geometry of silicon AFM tips changes when used in contact mode, affecting measurement accuracy. To study the influence of tip geometry, we subjected ten AFM tips to the same series of AFAM measurements. Changes in tip shape were observed in the scanning electron microscope (SEM) between individual AFAM tests. Because all of the AFAM measurements were performed on the same sample, variations in AFAM stiffness-load curves were attributed to differences in tip geometry. Contact-mechanics models that assumed simple tip geometries were used to analyze the AFAM data, but the calculated values for tip dimensions did not agree with those provided by SEM images. Therefore, we used a power-law approach that allows for a nonspherical tip geometry. We found that after several AFAM measurements, the geometry of the tips at the very end is intermediate between those of a flat punch and a hemisphere. These results indicate that the nanoscale tip-sample contact cannot easily be described in terms of simple, ideal geometries.