Rehabilitation of Patients with Arthrogenic Muscular Inhibition in Pathologies of Knee Using Virtual Reality.

Arthrogenic muscle inhibition (AMI) refers to muscular alterations that are generated, producing biomechanical motor control and movement problems, leading to deficiencies in strength and atrophy. Currently, there exist methods that involve virtual reality (VR) and have been well perceived by physiotherapists. The present research measured the potential benefits in terms of therapeutic adherence and speed of recovery, through a comparative analysis in a healthcare provider institution, in Medellín, Colombia, with and without the aid of VR. For this purpose, dynamometry, and surface electromyography (sEMG) signal acquisition tools were used. The treatment involved neuromodulation, ranges of motion and mobility work, strengthening and reintegration into movement, complemented with TENS, NMENS and therapeutic exercise, where the patient was expected to receive a satisfactory and faster adherence and recovery. A group of 15 people with AMI who include at least 15 min of VR per session in their treatment were compared with another group who received only the base treatment, i.e., the control group. Analyzing the variables individually, it is possible to affirm that VR, as a complement, statistically significantly improved the therapeutic adherence in 33.3% for CG and 37.5% for IG. Additionally, it increased strength with both legs, the symmetry between them, and decreased the level of pain and stiffness that is related to mobility.

Virtual Reality Game for Physical and Emotional Rehabilitation of Landmine Victims.

Landmine victims require an engaging and immersive rehabilitation process to maintain motivation and therapeutic adherence, such as virtual reality games. This paper proposes a virtual reality exercise game called Exogames, which works with Nukawa, a lower limb rehabilitation robot (LLRR). Together, they constitute the general Kina system. The design and development process of Exogames is reported, as well as the evaluation of its potential for physical and emotional rehabilitation. In an initial survey designed ad-hoc, 13 health professionals evaluated compliance with various requirements. They agreed that Exogames would help the user focus on rehabilitation by providing motivation; 92.3% said that the user will feel safe in the virtual world, 66.7% of them agreed or totally agreed that it presents characteristics that may enhance the physical rehabilitation of lower limbs for amputees, 83.3% stated that it would promote the welfare of landmine victims, and 76.9% responded that the graphical interface and data report are useful for real-time assessment, and would be helpful for four interventional areas in all rehabilitation stages. In a second evaluation, using standardized surveys, five physical therapists and one lower limb amputee tried the Kina system as users. They filled out the System Usability Scale (SUS), the Physical Activity Enjoyment Scale (PACES), and the Game Experience Questionnaire (GEQ). The usability of the Kina system overall score was 69 (66, 79) out of 100, suggesting an acceptable though improvable usability. The overall PACES score of 110 (108, 112) out of 126 suggests that users enjoyed the game well. Finally, users indicated a positive effect with a good sense of immersion and smooth of gameplay during the tests, as indicated by the GEQ results. In summary, the evaluations showed that Exogames has the potential to be used as a virtual reality game for the physical and emotional rehabilitation of landmine victims.

Synthesis and characterization of a silver nanoparticle-containing polymer composite with antimicrobial abilities for application in prosthetic and orthotic devices.

BACKGROUND: The presence of skin problems in patients using external lower limb prosthesis is recurrent. This has generated the need to develop interfaces for prosthesis with the ability to control microbial growth. Silver nanoparticles (AgNPs) have been implemented in the development of biomaterials because of their high antimicrobial activity. This article discusses the development of an AgNP-containing polymer composite with antimicrobial activity for developing prosthetic liners. METHODS: AgNPs were synthesized using a photochemical method and certain physicochemical properties were characterized. Furthermore, the antimicrobial activity of AgNPs against Staphylococcus aureus ATCC 25923 and methicillin-resistant Staphylococcus aureus (MRSA), was assessed on the basis of their minimum inhibitory concentrations (MICs). AgNPs were incorporated into a silicon elastomer to assess certain physicomechanical properties, antimicrobial activity and cytotoxic effect of the material. RESULTS: The maximum antimicrobial activity of the material against Staphylococcus aureus ATCC 25923 and MRSA was 41.58% ±2.97% at AgNP concentration of 32.98 µg/mL and 14.85% ±5.94% at AgNP concentration of 16.49 µg/mL, respectively. Additionally, the material exhibited tensile yield strength, rupture tensile strength, and tensile modulus of elasticity of 0.70 - 1.10 MPa, 0.71-1.06 MPa, and 0.20 - 0.30 MPa, respectively. The mechanical characteristics of the material were within the acceptable range for use in external lower limb prosthetic and orthotic interfaces. CONCLUSIONS: It was possible to incorporate the AgNPs in a silicone elastomer, finding that the composite developed presented antimicrobial activity against Staphylococcus aureus ATCC 25923 and MRSA when compared to non-AgNP material samples.

Myoelectric control algorithm for robot-assisted therapy: a hardware-in-the-loop simulation study.

BACKGROUND: A direct blow to the knee is one way to injure the anterior cruciate ligament (ACL), e.g., during a football or traffic accident. Robot-assisted therapy (RAT) rehabilitation, simulating regular walking, improves walking and balance abilities, and extensor strength after ACL reconstruction. However, there is a need to perform RAT during other phases of ACL injury rehabilitation before attempting an advanced exercise such as walking. This paper aims to propose a myoelectric control (MEC) algorithm for a robot-assisted rehabilitation system, "Nukawa", to assist knee movement during these types of exercises, i.e., such as in active-assisted extension exercises. METHODS: Surface electromyography (sEMG) signal processing algorithm was developed to detect the motion intention of the knee joint. The sEMG signal processing algorithm and the movement control algorithm, reported by the authors in a previous publication, were joined together as a hardware-in-the-loop simulation to create and test the MEC algorithm, instead of using the actual robot. EXPERIMENTS AND RESULTS: An experimental protocol was conducted with 17 healthy subjects to acquire sEMG signals and their lower limb kinematics during 12 ACL rehabilitation exercises. The proposed motion intention algorithm detected the orientation of the intention 100% of the times for the extension and flexion exercises. Also, it detected in 94% and 59% of the cases the intensity of the movement intention in a comparable way to the maximum voluntary contraction (MVC) during extension exercises and flexion exercises, respectively. The maximum position mean absolute error was [Formula: see text], [Formula: see text], and [Formula: see text] for the hip, knee, and ankle joints, respectively. CONCLUSIONS: The MEC algorithm detected the intensity of the movement intention, approximately, in a comparable way to the MVC and the orientation. Moreover, it requires no prior training or additional torque sensors. Also, it controls the speed of the knee joint of Nukawa to assist the knee movement, i.e., such as in active-assisted extension exercises.

Optimization of silver nanoparticle synthesis by chemical reduction and evaluation of its antimicrobial and toxic activity.

BACKGROUND: Chemical reduction has become an accessible and useful alternative to obtain silver nanoparticles (AgNPs). However, its toxicity capacity depends on multiple variables that generate differences in the ability to inhibit the growth of microorganisms. Thus, optimazing parameters for the synthesis of AgNPs can increase its antimicrobial capacity by improving its physical-chemical properties. METHODS: In this study a Face Centered Central Composite Design (FCCCD) was carried out with four parameters: A g N O 3 concentration, sodium citrate (TSC) concentration, N a B H 4 concentration and the pH of the reaction with the objective of inhibit the growth of microorganisms. The response variables were the average size of AgNPs, the peak with the greatest intensity in the size distribution, the polydispersity of the nanoparticle size and the yield of the process. AgNPs obtained from the optimization were characterized physically and chemically. The antimicrobial activity of optimized AgNPs was evaluated against Staphylococcus aureus, Escherichia coli, Escherichia coli AmpC resistant, and Candida albicans and compared with AgNPs before optimization. In addition, the cytotoxicity of the optimized AgNPs was evaluated by the colorimetric assay MTT (3- (4,5- Dimethylthiazol- 2- yl)- 2, 5 - Diphenyltetrazolium Bromide). RESULTS: It was found that the four factors studied were significant for the response variables, and a significant model (p < 0.05) was obtained for each variable. The optimal conditions were 8 for pH and 0.01 M, 0.0 6M, 0.01 M for the concentration of TSC, A g N O 3, and N a B H 4, respectively. Optimized AgNPs spherical and hemispherical were obtained, and 67.66% of it had a diameter less than 10.30 nm. A minimum bactericidal concentration (MBC) and minimum fungicidal Concentration (MFC) of optimized AgNPs was found against Staphylococcus aureus, Escherichia coli, Escherichia coli AmpC resistant, and Candida albicans at 19.89, 9.94, 9.94, 2.08 µg/mL, respectively. Furthermore, the lethal concentration 50 (L C 50) of optimized AgNPs was found on 19.11 µg/mL and 19.60 µg/mL to Vero and NiH3T3 cells, respectively. CONCLUSIONS: It was found that the factors studied were significant for the variable responses and the optimization process used was effective to improve the antimicrobial activity of the AgNPs.

Valoración cuantitativa para la reincorporación ocupacional / Quantitative assessment for the occupational reintegration

Resumen El progreso de la bioingeniería ha permitido el desarrollo de herramientas tecnológicas para cuantificar las variables asociadas al examen físico. En este artículo se presenta la descripción, ventajas y limitaciones de tecnologías para la medición de fuerza, arcos de movimiento, equilibrio y estabilidad, coordinación y marcha. Se proponen también alternativas para uso de estas tecnologías como parte del proceso de valoración de pacientes complejos, ya sea porque se sospeche simulación o porque presenten lesiones graves en las que se requiera sugerir opciones en el proceso de rehabilitación o cierre de caso. En tales circunstancias se identifican alternativas para un diagnóstico más completo que disminuyan la subjetividad del terapeuta y con mayores posibilidades de monitoreo.

Abstract The progress of bioengineering has allowed the development of technological tools to quantify the variables associated to the physical assessment process. The description, advantages and limitations of technologies to measure the strength, range of motion, balance and stability, coordination and gait are shown. Some alternatives are proposed for using those technologies as part of the appreciation process in complex patients, either for any suspicion of simulation or because any serious injury can exist where some alternatives for rehabilitation process are required. In such cases, must be identified some options for a more complete diagnosis, decreasing the subjectivity of the therapist and with more monitoring possibilities.