Novel computational protocol to support transfemoral prosthetic alignment procedure using machine learning techniques.

BACKGROUND: The prosthetic alignment procedure considers biomechanical, anatomical and comfort characteristics of the amputee to achieve an acceptable gait. Prosthetic malalignment induces long-term disease. The assessment of alignment is highly variable and subjective to the experience of the prosthetist, so the use of machine learning could assist the prosthetist during the judgment of optimal alignment. RESEARCH OBJECTIVE: To assist the prosthetist during the assessment of prosthetic alignment using a new computational protocol based on machine learning. METHODS: Sixteen transfemoral amputees were recruited for training and validation of the alignment protocol. Four misalignments and one nominal alignment were performed. Eleven prosthetic limb ground reaction force parameters were recorded. A support vector machine with a Gaussian kernel radial basis function and a Bayesian regularization neural network were trained to predict the alignment condition, as well as the magnitude and angle of required to align the prosthesis correctly. The alignment protocol was validated by one junior and one senior prosthetist during the prosthetic alignment of two transfemoral amputees. RESULTS: The support vector machine-based model detected the nominal alignment 92.6 % of the time. The neural network recovered 94.11 % of the angles needed to correct the prosthetic misalignment with a fitting error of 0.51°. During the validation of the alignment protocol, the computational models and the prosthetists agreed on the alignment assessment. The gait quality evaluated by the prosthetists reached a satisfaction level of 8/10 for the first amputee and 9.6/10 for the second amputee. IMPORTANCE: The new computational prosthetic alignment protocol is a tool that helps the prosthetist during the prosthetic alignment procedure thereby decreasing the likelihood of gait deviations and musculoskeletal diseases associated with misalignments and consequently improving the amputees-prosthesis adherence.

The effect of prosthetic alignment on the stump temperature and ground reaction forces during gait in transfemoral amputees.

BACKGROUND: Lower limb prosthetic alignment is a procedure mostly subjective. A prosthetic misaligned induces gait deviations and long-term joint diseases. The alignment effects for each lower limb and the stump stays uncertain. RESEARCH OBJECTIVE: To identify the effect of the transfemoral alignment prosthesis on ground reaction forces and thermal images of the residual limb. METHODS: The effect of misalignment and nominal alignment was evaluated in sixteen transfemoral amputees. The nominal alignment was considered as the optimal alignment for each subject. Misalignment included random variations in the anterior-posterior and medial-lateral translation of the prosthetic foot and the angle of flexion-extension, abduction-adduction, and internal-external rotation of the socket and prosthetic foot. The control group consisted of fifteen non-amputee individuals. The ground reaction force parameters and stump temperature were analyzed for each alignment condition. The statistical analysis included the one-way ANOVA, Kruskal-Wallis, and multiple comparison tests. RESULTS: The prosthesis did not produce statistically significant changes in the average temperature of residual limbs. However, the temperature distribution on the stump skin was different (P < 0.05). The transfemoral prosthesis misalignment produced an irregular heat diffusion on the anterior, posterior, and lateral sides of the stump contour compared to the nominal alignment (P < 0.05). The sound limb did not show differences between nominal alignments and misalignments for most ground reaction force parameters. For almost all GRF parameters, significant differences were observed for the prosthetic limb between misalignment and nominal alignment (P < 0.001). The symmetry indices of ground reaction force parameters of transfemoral amputees did not show any kind of significant improvements after aligning the prosthesis nominally. SIGNIFICANCE: The stump's temperature distribution and the ground reaction force findings for the prosthetic limb provide a better understanding of the alignment procedure of the transfemoral prosthesis and improve the amputees' compliance to the prosthesis.

Evaluation of different Jaipur foot-ankle assemblies using infrared thermography.

BACKGROUND: Mechanical behavior is difficult to monitor in experimental environments, usually because of geometric or technology implementation limitations. Nevertheless, thermography has been shown to overcome these issues. OBJECTIVES: The aim of this study was to evaluate four types of assemblies between a Jaipur foot and a polyethylene tube using infrared thermography in order to find the best mechanical configuration in terms of thermal behavior. STUDY DESIGN: Mechanical testing. TECHNIQUE: An infrared camera captured short videos every 5 min over 10 h in six different positions (three in the back and three in front of the Jaipur foot) around a prosthesis subjected to repetitive stresses (axial force 980 N) simulating kinematic variables like joint angles. We established a region of interest around the foot-ankle assemblies and calculated maximum temperatures and thermographic indices. RESULTS: In this study, the best foot-ankle assembly used epoxy adhesive because it presented the lowest temperature in the six positions and the lowest thermal index. CONCLUSIONS: Thermographic techniques can be used to study mechanical behaviors in complex experimental situations.

Ensayo clínico aleatorizado para evaluar el efecto de un programa de rehabilitación cardiaca supervisado con ejercicio en el consumo de oxígeno, la función y calidad de vida de pacientes con falla cardiaca crónica / A randomised clinical trial to evaluate the effect of a supervised rehabilitation program with exercise on oxygen consumption, function, and quality of life of patients with chronic heart failure

Resumen Objetivo: evaluar el efecto de un programa supervisado sobre el consumo de oxígeno, la función y la calidad de vida en pacientes con falla cardiaca. Diseño y métodos: ensayo clínico con doble enmascaramiento de grupos paralelos, en pacientes con falla cardiaca estado funcional II-IV por más de 6 meses con fracción de eyección < 40%. El desenlace primario fue el consumo de oxígeno pico a las 8 semanas. Resultados: veintitrés pacientes fueron asignados al grupo de intervención y 26 al grupo de control. Cinco fallecieron, 4 se negaron a completar todas las evaluaciones y 1 no realizó la prueba de ejercicio cardiopulmonar. Diecisiete fueron analizados en el grupo de intervención y 20 en el grupo de control. Respecto al VO2 pico, no se observaron cambios estadísticamente significativos al final del programa de intervención a las 8 semanas (-13,3 ± 3,9 ml/kg/min en el grupo de intervención frente a 14,8 ± 4,6 ml/kg/min en el grupo de control, p = 0,31). Las evaluaciones de funcionalidad y calidad de vida no difirieron entre los grupos a las 8 semanas o 6 meses. Sin embargo, hubo una mejoría en ambos grupos en los resultados de funcionalidad y calidad de vida. Conclusión: el uso de un programa de ejercicio protocolizado y supervisado en pacientes con falla cardiaca con una fracción de eyección < 40%, no produce cambios significativos en el VO2 pico en comparación con un programa comunitario.

Abstract Objective: To evaluate the effect of a supervised exercise program on oxygen consumption, function, and quality of life in patients with heart failure. Design and methods: A double-blind clinical trial, with parallel groups, conducted on patients with functional stage II-IV heart failure for more than 6 months and with an ejection fraction of < 40%. The primary outcome was the peak oxygen consumption at 8 weeks. Results: A total of 23 patients were assigned to the intervention group and 26 to the control group. Of those, 5 died, 4 failed to complete all the evaluations, and 1 did not perform the cardiopulmonary exercise test. Finally, 17 patients were analysed in the intervention group and 20 in the control group. As regards the peak VO2, no statistically significant changes were observed at the end of the intervention program at 8 weeks (-13.3 ± 3.9 ml/kg/min in the intervention group compared to 14.8 ± 4.6 ml/kg/min in the control group, P=.31). There were no differences between the groups in the functional evaluations and the quality of life at 8 weeks or 6 months. However, the results showed an improvement in the functionality and quality of life in both groups. Conclusion: The use of a standard and supervised exercise program by patients with heart failure with an ejection fraction < 40% does not lead to significant changes in the peak VO2, when compared to a community program.

Ensayo clínico aleatorizado con grupos paralelos para comparar los cambios en los niveles del pro-péptido natriurético cerebral (Pro-PNC 1-76 ) en pacientes con falla cardiaca crónica sometidos a un programa de ejercicio supervisado versus basado en la comunidad / Randomized clinical trial with parallel groups to compare changes in N-terminal prohormone of brain natriuretic peptide (ProBNP1-76) levels in patients with chronic heart failure subject to a supervised exercise program versus a community based exercise program

Resumen Objetivo: evaluar los niveles de pro-péptido natriurético cerebral (Pro-PNC - 76) de un grupo de pacientes con falla cardiaca crónica, quienes realizaron un programa de ejercicio protocolizado y compararlos con un grupo control con ejercicio basado en la comunidad. Diseño y métodos: ensayo clínico controlado con: doble enmascaramiento, diseño paralelo en pacientes mayores de 18 años, diagnóstico de falla cardiaca clasificación New York Heart Association (NYHA) II-IV para comparar el cambio en los niveles de pro-péptido natriurético cerebral (Pro-PNQ 1-76 ). Resultados: veintitrés pacientes ingresaron al grupo de intervención y 26 al grupo control. Fallecieron cinco pacientes, seis se rehusaron completar todas las evaluaciones y un paciente no logró realizar la prueba de esfuerzo cardiopulmonar. Los niveles de pro-péptido natriurético cerebral (Pro-PNC1-76) y el consumo de oxígeno (VO2) no se modificaron en el grupo de intervención de forma estadísticamente significativa al compararlo con el grupo control. La calidad de vida relacionada con la salud mejoró significativamente en el grupo de intervención en las dimensiones de cambio en la percepción del estado de salud (p=0.007), desempeño emocional (p=0.011), desempeño físico (p=0.006), función física (p=0.024), salud mental (p=0.009) y salud general (p=0.01). Conclusión: la aplicación de un programa de ejercicio supervisado en pacientes con falla cardiaca no modificó los niveles de péptido natriurético cerebral, ni el consumo de oxígeno a las ocho semanas, pero fue efectivo para mejorar la calidad de vida relacionada con la salud (Clinical trials número NCT02087670). (Acta Med Colomb 2017: 42: 180-188).

Abstract Objective: To evaluate ProBNP 1-76 levels of a group of patients with chronic heart failure, who performed a protocolized exercise program and compare them with a control group with community-based exercise program. Design and Methods: Controlled clinical trial with double masking, parallel design in patients older than 18 years with diagnosis of heart failure, New York Heart Association (NYHA) II-IV Classification, to compare the change in Pro-Brain Natriuretic Peptide (ProBNP 1-76 ) Results: Twenty-three (23) patients were admitted to the intervention group and 26 to the control group. Five patients died, six refused to complete all assessments and one patient failed to perform the cardiopulmonary exercise test. ProBNP1-76 levels and oxygen consumption (VO2) were not altered significantly in the intervention group when compared to the control group. Health-related quality of life improved significantly in the intervention group in the dimensions of change in the perception of health status (p = 0.007), emotional performance (p = 0.011), physical performance (p = 0.006), physical function (p = 0.024), mental health (p = 0.009) and general health (p = 0.01). Conclusion: The application of a supervised exercise program in patients with heart failure did not modify brain natriuretic peptide levels or oxygen consumption at eight weeks, but was effective in improving health-related quality of life (Clinical trials number NCT02087670). (Acta Med Colomb 2017: 42: 180-188).

Progresses and challenges of utilizing traditional birth attendants in maternal and child health in Nigeria.

BACKGROUND AND OBJECTIVES: Despite advances in modern healthcare, Traditional Birth Attendants (TBA) have continued to be heavily utilized in rural communities in Nigeria. Major disparities in maternal health care in Nigeria remain present despite the goal of the United Nations Millennium Development Goal to reduce maternal mortality by 2015. The objective of this study is to review the contribution of TBAs in the birthing process in Nigeria, and to examine barriers and opportunities for utilizing TBAs in improving maternal and child health outcomes in Nigeria. METHODS: A literature review of two major electronic databases was conducted using the PRISMA framework to identify English language studies conducted between 2006 and 2016. Inclusion criteria included articles that examined the role of traditional birth attendants as a factor influencing maternal health in Nigeria. RESULTS: The value of TBAs has not been fully examined as few studies have aimed to examine its potential role in reducing maternal mortality with proper training. Eight manuscripts that were examined highlighted the role of TBAs in maternal health including outcomes of utilizing trained versus non-trained TBAs. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Specific areas of training for TBAs that were identified and recommended in review including: recognizing delivery complications, community support for TBA practices through policy, evaluation of TBA training programs and increasing collaboration between healthcare facilities and TBAs. Policies focused on improving access to health services and importantly, formal health education training to TBAs, are required to improve maternal health outcomes and underserved communities.

Treatment of myofascial pain syndrome with lidocaine injection and physical therapy, alone or in combination: a single blind, randomized, controlled clinical trial.

BACKGROUND: Myofascial pain syndrome (MPS) of the shoulder girdle and cervical region is a common musculoskeletal problem that is often chronic or recurrent. Physical therapy (PT) and lidocaine injections (LI) are two treatments with demonstrated effectiveness compared to a control group, however little is known about their combined value. The objective of this study was to determine whether LI into trigger points combined with a PT program would be more effective than each separate treatment alone in improving pain, function, and quality of life in a group of patients with MPS of the shoulder girdle and cervical region. METHODS: A single-blind, randomized, controlled clinical trial (RCT) was conducted with three parallel groups in the Departments of Physical Medicine and Rehabilitation of two urban hospitals in Medellin, Colombia. One hundred and twenty seven patients with shoulder girdle MPS for more than 6 weeks and pain greater than 40 mm on the visual analog scale (VAS) were assigned to 1 of 3 intervention groups: PT, LI, or the combination of both (PT + LI). The primary outcome was VAS pain rating at 1-month post-treatment. The secondary outcomes included VAS pain rating at 3 months, and, at both 1 and 3 months post-treatment: (a) function, evaluated by hand-back maneuver and the hand-mouth maneuver, (b) quality of life, as measured by sub-scales of the Short Form - 36 (SF-36), and (c) depressive symptoms, as measured by the Patient Health Questionnaire - 9 (PHQ-9). Independent t-tests were used to compare outcomes between groups at 1 month and 3 months post-treatment. RESULTS: In the per protocol analysis, there were no significant intergroup differences in VAS at 1 month PT + LI, 40.8 [25.3] vs. PT, 37.8 [21.9], p = 0.560 and vs. LI, 44.2 [24.9], p = 0.545. There were also no differences between groups on secondary outcomes except that the PT and PT + LI groups had higher right upper limb hand-back maneuver scores compared to the LI alone group at both 1 and 3 months (p = 0.013 and p = 0.016 respectively). CONCLUSIONS: The results of this RCT showed that no differences in pain ratings were observed between the individual treatments (PT or LI) compared to the combined treatment of PT and LI. In general, no difference in primary or secondary outcomes was observed between treatments. TRIAL REGISTRATION: NTC01250184 November 27, 2010.

Prevalencia de patología musculoesquelética asociada al síndrome de falla cardiaca / Prevalence of musculoskeletal pathology associated with heart failure syndrome

Introducción: en pacientes con falla cardiaca se han descrito múltiples patologías asociadas, en especial las de origen musculoesquelético que pueden limitar la capacidad funcional, independiente de la función ventricular y deteriorar la calidad de vida de los pacientes, por lo que su detección permite realizar cambios en la prescripción del ejercicio y en el acondicionamiento aeróbico, aplicar medidas fisioterapéuticas y ergonómicas en los programas de rehabilitación cardiaca acorde con el diagnóstico específico. Material y métodos: estudio descriptivo, de corte transversal y retrospectivo de los pacientes que ingresaron a la Clínica de Falla Cardiaca de la Universidad de Antioquia y el Hospital Universitario San Vicente de Paúl Fundación en un periodo de un año, con el objetivo de establecer la presencia de patología musculoesquelética. Resultados: se ingresaron 151 pacientes durante el periodo de estudio. El 55.6% fueron hombres y la mediana de edad fue de 68 años. La primera causa de falla cardiaca fue la enfermedad coronaria, seguida de la hipertensión arterial. El 33.1% estuvieron en clase funcional de la Asociación de Corazón de Nueva York (NYHA) II y el 32.5% en NYHA III. El 66.9% de los pacientes que asisten a la Clínica de Falla Cardiaca no tenían actividad laboral. Se demostró patología musculoesquelética en 31.8%, siendo la más común la osteoartritis, bien sea de cadera o rodillas, con una frecuencia de 6.6%, seguida de la tendinitis del manguito rotador (4,6%). Otras alteraciones encontradas fueron dolor lumbar, dolor miofascial, neuropatía periférica, disfunción patelofemoral y síndrome de túnel carpiano. El 35.8% de los pacientes se lograron vincular al programa de rehabilitación cardiaca y establecer un programa dirigido, de acuerdo con las comorbilidades encontradas. Conclusiones: la patología osteomuscular en pacientes con falla cardiaca es frecuente, posiblemente por cambios metabólicos e hipoperfusión asociados a la falla cardiaca. El desacondicionamiento físico asociado aumenta el imbalance muscular y facilita síndromes por sobreuso como la tendinitis del manguito rotador. La vinculación a una Clínica de Falla Cardiaca con un programa de rehabilitación establecido, permitirá la detección temprana y la intervención adecuada durante el mismo de las patologías músculoesqueléticas asociadas haciendo que disminuya la discapacidad y mejore la calidad de vida de estos pacientes.

Introduction: in patients with heart failure, multiple associated diseases have been described, especially those of musculoskeletal origin which may limit the functional capacity independent of ventricular function and deteriorate quality of life of patients; therefore, its detection allows changes in exercise prescription and aerobic conditioning, physiotherapy and to apply physiotherapeutic and ergonomic measures in cardiac rehabilitation programs according to the specific diagnosis. Materials and methods: a descriptive, cross-sectional and retrospective cohort study of patients admitted to the Heart Failure Clinic of Antioquia University and the University Hospital San Vicente de Paul Foundation over a period of one year with the aim of establishing the presence of musculo skeletal pathology. Results: 151 patients were admitted during the study period. 55.6% were men and the median age was 68 years. The leading cause of heart failure was coronary heart disease, followed by hypertension. 33.1% were in functional class II of the New York Heart Association (NYHA) and 32.5% in NYHA III. 66.9% of patients attending the heart failure clinic did not have work activity. Musculoskeletal pathology was demonstrated in 31.8%, being osteoarthritis the most common, eitherof hip or knee, with a frequency of 6.6%, followed by rotator cuff tendinitis (4.6%). Other alterations found were low back pain, myofascial pain, peripheral neuropathy, patellofemoral dysfunction and carpal tunnel syndrome. 35.8% of patients were able to link the cardiac rehabilitation program and establish a program targeted according co-morbidities found. Conclusions: musculoskeletal pathology in patients with heart failure is common, possibly due to metabolic changes and hypoperfusion associated with heart failure. Physical deconditioning associated increases muscle imbalance and facilitates overuse syndromes such as rotator cuff tendinitis. Linking of a heart failure clinic with an established rehabilitation program will allow early detection and appropriate intervention during it of the musculoskeletal pathologies associated, reducing in this way disability and improving the quality of life of these patients.