ABSTRACT
Virtual Reality has been used to great effect in the field of retraining and strengthening neural pathways in victims of serious brain injury and stroke.Meanwhile, VR visualisation of missing limbs in amputees has been used to great effect not only in the treatment of "phantom limb syndrome" but in helping amputees restore muscle tone in remaining limb sections and torso prior to fitting these areas for prosthetics.The natural next step, combining elements of both approaches, is the potential application of virtual reality to actively train the patient for using these prostheses prior to them being fitted, and furthermore adjusting and customising the prosthetic itself to the emergent needs of the patient whilst using the VR training.This raises fascinating new applications not only for virtual reality itself, but for the numerous peripheral technologies which have risen around VR. These technologies include force feedback, "haptic" sensory simulation and monitoring of muscle strength, position and movement ranges.This chapter aims to assess the capabilities of these technologies, both now and in the future.By reviewing the work of two key studies in this area this chapter aims to bring together the necessary skills and establish the collaborative crossovers (and existing precedents) which would be required to develop this application of VR in the future.
Subject(s)
Amputees/rehabilitation , Prostheses and Implants , Virtual Reality , HumansABSTRACT
BACKGROUND: Spinal injury causes a significant burden on patients, families and health services. Cervical facet fractures are uncommon, and there is a paucity of functional and health-related quality-of-life data in patients who are managed non-operatively for this injury. METHODS: Victorian State Trauma Registry patients managed in a halothoracic brace for cervical facet injuries from August 2006 to June 2013 were included. Health status (12-item Short-Form health survey), function (Glasgow Outcome Scale-Extended), pain and return to work outcomes were assessed at 6, 12 and 24 months post-injury. Subgroup analysis was performed for age, sex, comorbidity, compensable status, Injury Severity Score (ISS) and education. RESULTS: Outcome data were available for 54 patients, with road trauma being the most common mechanism (69%), followed by a fall from height (18%). Overall, good 24-month function was achieved in 35% of patients, and 51% and 77% of patients reported good physical and mental health status, respectively. Ongoing moderate-severe neck pain was present in 19% of patients. Poorer function was associated with compensable status (P = 0.05), an ISS > 12 (P = 0.001) and a lower level of education (P = 0.04). Poorer physical health status was associated with age ≥50 (P = 0.05), pre-existing comorbidities, an ISS > 12 (P = 0.04) and a lower level of education (P = 0.03). CONCLUSION: Although many patients achieved good function and health status by 24 months, neck pain remains prevalent. A number of demographic factors were associated with a poorer outcome. This understanding helps to inform prognosis when managing this injury.
Subject(s)
Cervical Vertebrae/injuries , Fracture Fixation/methods , Orthotic Devices , Spinal Fractures/therapy , Adult , Disease Management , Female , Fracture Fixation/instrumentation , Health Status , Humans , Injury Severity Score , Male , Middle Aged , Pain Measurement , Return to Work , Treatment OutcomeSubject(s)
Anatomy, Regional/education , Education, Medical/standards , Health Knowledge, Attitudes, Practice , Medical Staff/education , Muscle, Skeletal/innervation , Orthopedics/education , Peripheral Nerves/anatomy & histology , Humans , Motor Activity , Muscle, Skeletal/physiology , Peripheral Nerves/surgery , Problem-Based Learning/methods , Sensation/physiology , Surveys and QuestionnairesABSTRACT
BACKGROUND: Non-surgical immobilization strategies for type 2 odontoid fractures vary considerably, with some surgeons preferring rigid collars, halothoracic bracing or the Minerva brace. Choice of device should be informed by the effectiveness in achieving union, whilst minimizing mortality and complications. OBJECTIVES: Perform a systematic review evaluating the efficacy of non-surgical interventions for type 2 odontoid fractures. DATA SOURCES: MEDLINE (OvidSP), EMBASE (OvidSP) and The Cochrane Library, ClinicalTrials.gov, Current Controlled Trials. METHODS: We conducted a systematic review of studies directly comparing the halothoracic brace and cervical collars or the Minerva brace for union, mortality and complications. Studies were appraised for quality and bias, and results were pooled for analysis. RESULTS: Our search identified 1794 citations, 13 of which met inclusion criteria. There were no randomized or prospective studies. All studies were small, retrospective and observational. Our results demonstrate a greater likelihood of developing stable union (osseous and fibrous); relative risk (RR) 1.27 (95% confidence intervals (CI) 1.03 to 1.57; P = 0.03); and airway complications; RR 7.52 (95% CI 1.39 to 40.83; P = 0.02) with halothoracic bracing compared with cervical collar. In patients >65, there was a greater risk of airway complications; RR 7.50 (0.96-58.36; P = 0.05). No other significant differences were identified. CONCLUSION: Evidence to support selection of non-surgical immobilization in type 2 odontoid fractures is poor. Osseous union has traditionally been the benchmark for 'successful' treatment; however, evidence of association between union and improved outcomes is lacking. We highlight the need for a randomized study to promote evidence-based decision-making in the non-surgical management of this injury.
