Development of Joint Activity Angle Measurement and Cloud Data Storage System.

In this study, we developed a range of motion sensing system (ROMSS) to simulate the function of the elbow joint, with errors less than 0.76 degrees and 0.87 degrees in static and dynamic verification by the swinging and angle recognition modules, respectively. In the simulation process, the É£ correlation coefficient of the Pearson difference between the ROMSS and the universal goniometer was 0.90, the standard deviations of the general goniometer measurements were between ±2 degrees and ±2.6 degrees, and the standard deviations between the ROMSS measurements were between ±0.5 degrees and ±1.6 degrees. With the ROMSS, a cloud database was also established; the data measured by the sensor could be uploaded to the cloud database in real-time to provide timely patient information for healthcare professionals. We also developed a mobile app for smartphones to enable patients and healthcare providers to easily trace the data in real-time. Historical data sets with joint activity angles could be retrieved to observe the progress or effectiveness of disease recovery so the quality of care could be properly assessed and maintained.

Application of Simulated Arms with Real-Time Pressure Monitor in Casting and Splinting by Physiological Sensors.

In the real condition, the small sensor found it difficult to detect the position of the pressure sore because of casting displacement clinically. The large sensor will detect the incorrect pressure value due to wrinkles without close to arm. Hence, we developed a simulated arm with physiological sensors combined with an APP and a cloud storage system to detect skin pressure in real time when applying a short arm cast or splint. The participants can apply a short arm cast or splint on the simulative arm and the pressure in the cast or splint could be immediately displaced on the mobile application. The difference of pressure values from six pressure detection points of the simulated arm between the intern and the attending physician with 20-year working experience were 22.8%, -7.3%, 25.0%, 8.6%, 38.2%, 49.6%, respectively. It showed that the difference of pressure values in two farthest points, such as radius stab and ulnar styloid, was maximal. The pressures on the skin surface of the short arm cast were within acceptable range. Doctors would obtain reliable reference data and instantly understand the tightness of the swathed cast which would enable them to adjust it at any time to avoid complications.

Development of a System for Real-Time Monitoring of Pressure, Temperature, and Humidity in Casts.

Cast fixation is a general clinical skill used for the treatment of fractures. However, it may cause many complications due to careless treatment procedures. Currently, swathing a cast for a patient can only be determined by a doctors' experience; however, this cannot be determined by the value of pressure, temperature, or humidity with objective and reliable equipment. When swathing a cast for a patient, the end result is often too tight or too loose. Hence, in this paper we developed a sensor for detecting pressure, temperature, and humidity, respectively. This could provide reliable reference cast data to help physicians to understand the tightness of cast swathing and to adjust the tightness of cast swathing instantly to alleviate a patient's complications caused by excessive pressure or overheating. In this paper, six pressure sensors and one temperature-humidity sensor are used to detect the pressure, temperature, and humidity in an arm swathed with a cast to confirm whether the tightness of the cast is fixing the fracture efficiently, while avoiding causing any damage by using excessive pressure. Currently, the variation in temperature and humidity can be detected by the inflammation of the wound, displaying secretions, and fever in the cast. Based on the experiments, the voltage and power conversion coefficients of the developed sensors could be compensated for by the nonlinear error of the sensor. The experimental results could be instantly displayed on a human interface, such as a smart mobile device. The average skin pressure in a swathed cast was 12.14 g and ranged from 5.0 g to 17.5 g. A few casts exceeded 37.50 g. The abnormal pressure of wrinkles produced during swathing a cast often ranged from 22.50 g to 38.75 g. This shows that cast wrinkles cause pressure on the skin. The pressure caused by cast wrinkles on bone protrusions ranged from 56.5 g to 84.4 g. Compared to other parts that lacked soft skin cushioning, the pressure of cast wrinkles that occurred in the ulna near the protrusion of the wrist bone increased averagely. The pressure error value was less than 2%, the temperature error was less than 1%, and the humidity error was less than 5%. Therefore, they were all in line with the specifications of commercially available products. The six pressure detection points and one temperature and humidity detection point in our newly designed system can accurately measure the pressure, temperature, and humidity inside the cast, and instantly display the corresponding information by mobile APP. Doctors receive reliable reference data and are instantly able to understand the tightness of the swathed cast and adjust it at any time to avoid complications caused by pressure or overheating due to excessive pressure.

Patellar malalignment treated with modified knee extension training: An electromyography study.

BACKGROUND: Patellar malalignment (PM) in most patients is ascribed to an imbalance of peripatellar soft tissue tension. RESEARCH QUESTION: Conservative treatment of PM initially with enforced training of the vastus medialis obliquus (VMO) has been widely applied. Non-operative techniques for treatment of PM require continuing development. METHODS: Thirty healthy young adults participated in the study. Two surface electromyography (EMG) electrodes were placed on the skin of the dominant lower thigh in each subject: one on the center of the muscle belly of the VMO and the other on the symmetric location of the vastus lateralis (VL). Maximum of knee extension action (from various angles of knee flexion to full extension) was initiated. Tests were conducted with knee flexion decreasing by 10° at each step. Each action was repeated three times, and the average value was calculated. The root mean square value of excited muscles in the EMG was recorded. The ratio of the VMO to the VL (VMO/VL) was used to indicate the effectiveness of the treatment. The knee position varied from 90° flexion initially, decreasing by 10° at each step. RESULTS: Nine sets of values were obtained. All extension actions were effective (VMO/VL >1; range, 1.23-1.35). The maximal value was observed at 60° flexion (VMO/VL = 1.35). Differences were not significant among the nine groups (p = 0.08, ANOVA). SIGNIFICANCE: Using the described knee extension training for conservative treatment of PM may be an effective alternative. The technique is simple, and the results of our experimental tests are encouraging. This method may become another popular and effective technique for treating PM.

Comparative analysis of SmartArc-based dual arc volumetric-modulated arc radiotherapy (VMAT) versus intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma.

The purpose of this study was to evaluate and quantify the planning performance of SmartArc-based volumetric-modulated arc radiotherapy (VMAT) versus fixed-beam intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) using a sequential mode treatment plan. The plan quality and performance of dual arc-VMAT (DA-VMAT) using the Pinnacle3 Smart-Arc system (clinical version 9.0; Philips, Fitchburg, WI, USA) were evaluated and compared with those of seven-field (7F)-IMRT in 18 consecutive NPC patients. Analysis parameters included the conformity index (CI) and homogeneity index (HI) for the planning target volume (PTV), maximum and mean dose, normal tissue complication probability (NTCP) for the specified organs at risk (OARs), and comprehensive quality index (CQI) for an overall evaluation in the 11 OARs. Treatment delivery time, monitor units per fraction (MU/fr), and Gamma(3 mm, 3%) evaluations were also analyzed. DA-VMAT achieved similar target coverage and slightly better homogeneity than conventional 7F-IMRT with a similar CI and HI. NTCP values were only significantly lower in the left parotid gland (for xerostomia) for DA-VMAT plans. The mean value of CQI at 0.98 ± 0.02 indicated a 2% benefit in sparing OARs by DA-VMAT. The MU/fr used and average delivery times appeared to show improved efficiencies in DA-VMAT. Each technique demonstrated high accuracy in dose delivery in terms of a high-quality assurance (QA) passing rate (> 98%) of the Gamma(3 mm, 3%) criterion. The major difference between DA-VMAT and 7F-IMRT using a sequential mode for treating NPC cases appears to be improved efficiency, resulting in a faster delivery time and the use of fewer MU/fr.