Rehabilitation Design Research Articles

Skeletal muscle stiffness as measured by magnetic resonance elastography after chronic spinal cord injury: a cross-sectional pilot study.

Skeletal muscle stiffness is altered after spinal cord injury (SCI). Assessing muscle stiffness is essential for rehabilitation and pharmaceutical interventions design after SCI. The study used magnetic resonance elastography to assess the changes in stiffness after chronic SCI compared to matched able-bodied controls and determine its association with muscle size, spasticity, and peak torque in persons with SCI. Previous studies examined the association between muscle stiffness and spasticity, however, we are unaware of other studies that examined the effects of muscle composition on stiffness after SCI. Ten participants (one female) with chronic SCI and eight (one female) matched able-bodied controls participated in this cross-sectional study. Magnetic resonance elastography was utilized to monitor stiffness derived from shear waves propagation. Modified Ashworth scale was used to evaluate spasticity scores in a blinded fashion. Peak isometric and isokinetic torques were measured using a biodex dynamometer. Stiffness values were non-significantly lower (12.5%; P = 0.3) in the SCI group compared to able-bodied controls. Moreover, stiffness was positively related to vastus lateralis whole muscle cross-sectional area (CSA) (r2 = 0.64, P < 0.005) and vastus lateralis absolute muscle CSA after accounting for intramuscular fat (r2 = 0.78, P < 0.0007). Stiffness was also positively correlated to both isometric (r2 = 0.55–0.57, P < 0.05) and isokinetic peak (r2 = 0.46–0.48, P < 0.05) torques. Our results suggest that larger clinical trial is warranted to confirm the preliminary findings that muscle stiffness is altered after SCI compared to healthy controls. Stiffness appeared to be influenced by infiltration of intramuscular fat and modestly by the spasticity of the paralyzed muscles. The preliminary data indicated that the relationship between muscle stiffness and peak torque is not altered with changing the frequency of pulses or angular velocities. All study procedures were approved by the Institutional Review Board at the Hunter Holmes McGuire VA Medical Center, USA (IRB #: 02314) on May 3, 2017.

PRINCIPLES AND INSTRUCTIONS FOR COMPLEX PROTECTION OF HISTORIC BUILDINGS WITH VAULTED STRUCTURES FROM THE EFFECTS OF DYNAMIC LOADS

Historic buildings located in areas exposed to dynamic effects caused by natural or technical seismicity are one of the most vulnerable types of structures. Masonry buildings often have timber-ceiling structures with insufficient rigidity and not fully functional system of wall and beam ties, therefore being extremely sensitive to the dynamic effects caused by natural or technical seismicity. Main focus of the article is the outline of possible rehabilitation and restoration design approaches for strengthening of historic buildings in terms of dynamic loads. Brief information about the research performed in the field of masonry vaults’ reinforcement due to the dynamic loading is presented.

Does hospital design impact on patient activity levels and time spent alone?

Purpose The aim of this study was to quantify changes in patients’ activity levels, location and people present, within one acute stroke unit (ASU) and one inpatient rehabilitation unit (IRU) with respect to change in hospital design. Methods A prospective observational study using behavioural mapping. We observed participants from 8 am till 5 pm every 10 minutes across two days and compared participant activity (physical, social and cognitive), location and people present pre and post-transition to new units. Built design, staffing levels and models of care were contrasted. Results We recruited 73 participants (63% stroke): old-ASU (n = 19); new-ASU (n = 15); old-IRU (n = 19); new-IRU (n = 20). Compared to old, new units had more single rooms, larger floor spaces and higher staffing levels. We found no significant change in participants’ activity levels between the old and new ASU. Participants in the new IRU showed increased physical activity (43.4% vs. 54.4%, p = 0.02) but social and cognitive activity remained similar. Participants were more alone (ASU 47.4% vs. 66.7%, p = 0.01; IRU 41.7% vs. 58.3%, p < 0.001), and less often with nursing staff (ASU 17.7% vs. 6.7%, p = 0.04; IRU 18.8% vs. 5.7%, p < 0.001) in new units. Conclusion Hospital design appears to impact on patients’ physical activity. Single rooms may increase isolation and reduce interaction with nursing staff. Implications for rehabilitation Design of new rehabilitation units needs to consider patients’ social engagement with family, friends, other patients and staff in addition to privacy and infection control. A change in built design of rehabilitation units should prompt observation of patients’ activity levels and engagement with people and available space to ensure optimal use of new environments. Promotion of communal spaces and activities away from the bedroom to encourage social engagement is recommended for patients recovering in rehabilitation facilities. Less time in contact with nursing staff in rehabilitation environments with predominantly single rooms suggests a review of clinical practice and patient safety is warranted.

Avaliação do potencial de uso do deflectômetro de impacto leve para medidas de deflexão em pavimentos urbanos

O objetivo principal deste estudo foi avaliar o potencial de uso do Deflectômetro de Impacto Leve (LFWD) para medir deflexões em pavimentos urbanos. Para isso, avaliaram-se medidas de deflexões aferidas pelo LFWD, viga Benkelman (VB) e o ensaio de carga com placa (PL) em pavimentos construídos com diferentes materiais, espessuras de revestimento asfáltico e idades de operação. Determinaram-se modelos de regressão linear, que relacionaram as medidas de deflexão entre o LFWD e a VB, e o PL. Os resultados mostraram que não houveram boas relações lineares em estruturas compostas por camadas de revestimento asfáltico mais espessas, como também em estruturas com revestimento asfáltico sobre paralelepípedos. Houve boa relação linear em estruturas compostas por revestimento asfáltico mais delgado. Este estudo estimula o uso de equipamentos dinâmicos de ensaios não destrutivos para medição de deformações elásticas para o projeto de manutenção e reabilitação de vias de baixo volume de tráfego.

EXPERIMENTAL RESEARCH INTO THE RESPONSE OF HISTORICAL STRUCTURE TO THE EFFECTS OF NATURAL SEISMICITY

The article presents the evaluation a building technical survey of a damaged historic rectory building in Luby near Cheb, it analyses the damage and proposes conceptual ideas for the rehabilitation design of a historic building damaged by the effects of natural seismicity applying the results and outputs of the NAKI II research project.

Application of three-dimensional digital simulated design and implementation in esthetic rehabilitation

Objective: To explore and evaluate a three-dimensional (3D) digital simulated design and implementation technique in esthetic rehabilitation. Methods: Thirty patients with esthetic deficiency, who came to the Department of Prosthodontics, Peking University School and Hospital of Stomatology from December 2017 to July 2019, were recruited and randomly assigned into 2 groups. Four males and 11 females which were (36.0±10.5) years old in the experimental group, 6 males and 9 females which were (32.0±6.7) years old in the control group, were enrolled. In the experimental group, 3D digital simulated design was used to predict the post-treatment effect; and the final restorations were designed duplicating from the pre-treatment digital design confirmed by the patient and milled. In the control group, the final restorations were manufactured by the dental technician according to the design of two-dimensional (2D) digital smile design. The simulation degree of digital design and the similarity between preoperative design and postoperative rehabilitation were scored by the patients with visual analogue scales (VAS) in both groups; and the satisfaction rate to the restorations was evaluated by the patients. The quality of the restorations was accessed by a prosthodontist who did not know the grouping of patients according to the modified criteria of United States Public Health Service (USPHS). Results: Three-dimensional digital simulated design and implementation technique was successfully established. The VAS score on the simulation degree of digital design in the experimental group (8.5±0.5) was higher than that in the control group (7.2±0.7) (P<0.01); the VAS score on the similarity between preoperative design and postoperative rehabilitation in the experimental group (9.6±0.3) was higher than that in the control group (7.0±0.9) (P<0.01). The satisfaction rate of the patients to the restorations was significantly higher in the experimental group than in the control group (P<0.05). There was no significant difference of the quality of the restorations between the two groups on the anatomic form, the marginal adaption and the surface quality (P>0.05). Conclusions: Three-dimensional digital simulated design and implementation technique can help achieving 3D digital simulated design before treatment and duplication to the final restorations, and can improve the patients' satisfaction in esthetic rehabilitation.

Adaptation of land use based on the assessment of inundation risk in the Kapos Valley, Southwest Hungary

Complex river rehabilitation/restoration projects devote equal attention to the improvement of hydromorphological conditions and the neighbouring floodplain environment. Since land use exerts a heavy control on the hydrological cycle of floodplains, land use optimization is a central task in floodplain rehabilitation. In floodplains where large surfaces are temporarily inundated, the optimal allocation of land use classes involves the preservation of wetlands, maintenance of grasslands (meadows and pastures) and forests, and the restriction of arable land to higher ground with the lowest inundation hazard. The detailed mapping of land use against the distribution of soil types and fluvial landforms provides a solid basis for land use optimization. Rehabilitation design is presented in the paper on the example of the Kapos Valley, where inundations in the wet year of 2010 caused great damage to agricultural crops and efforts are directed to better water management (excess water reduction and floodwater retention) on the floodplain. Land use conversions, which are less expensive and easier to implement, are preferred to structural (engineering) solutions.

Comparing Performance Indicators for Assessing and Building Resilient Water Distribution Systems

Water distribution systems (WDSs) are critical infrastructures that need to be resilient to cope with and quickly recover from exceptional conditions in an uncertain and challenging future. To build resilience in the design of WDSs, it is essential to explore indicators that can effectively quantify the level of system resilience. On the basis of the optimization of rehabilitation designs of three benchmark WDSs, four resilience related indicators are investigated, i.e., Todini’s index, which is a surrogate and indirect performance indicator, and three direct performance indicators—failure duration, failure magnitude, and a severity-based resilience index. These indicators are widely used in the literature yet have not been comprehensively examined and compared. Results show that strong correlations exist between the four resilience-related indicators, indicating that optimization using any one indicator is likely to improve system resilience measured by other indicators. Nevertheless, they have distinctive advantages and disadvantages. In particular, the severity-based resilience index is effective in identifying nodes susceptible to the occurrence of failures and slow in recovery. Todini’s index can be assessed without the need to set up failure scenarios, which is an advantage compared to the other three resilience indicators; however, its correlations with direct resilience indicators are weaker in WDSs with tanks.

Decreased low-frequency brain effective connectivity in seafarers during voyages: a functional near-infrared spectroscopy study

Objective: During voyages, seafarers experience psychological problems that act to decrease operational safety. Psychological problems in seafarers can lead to changes in functional brain networks. This study investigated the low-frequency brain effective connectivity (EC) in seafarers during voyages by using the coupling strength (CS) of functional near-infrared spectroscopy (fNIRS) imaging. Approach: This study recruited 15 seafarers (seafarer group) working on a container ship and 15 healthy age-matched controls (control group). The EC was assessed using dynamic Bayesian inference (DBI) of the oxygenated hemoglobin concentration (delta HbO2) as measured through a 14-channel fNIRS system. These channels covered the left and right prefrontal cortices (LPFC/RPFC), left and right motor cortices (LMC/RMC), and left and right occipital lobes (LOL/ROL). Main results: The EC levels of LPFC to RMC (F = 4.239, p = 0.049), LPFC to ROL (F = 5.385, p = 0.028), LOL to RPFC (F = 11.128, p = 0.002), ROL to RPFC (F = 10.714, p = 0.003) and LMC to ROL (F= 6.136, p = 0.02) were significantly lower in the seafarer group than in the control group. Correlation analysis revealed that the patient health questionnaire-9 (PHQ-9) scores were positively correlated with the systolic blood pressure (SBP) values, delta HbO2 values and EC levels, respectively. Meanwhile, the correlation analysis revealed that the SBP values significantly positively correlated with the CS values. Significance: Decreased EC levels may be a marker of psychological subhealth in seafarers. The approach combines fNIRS and PHQ-9 scores, providing a quantitative method for the assessment of mental health problems and further help with better rehabilitation designs in seafarers during voyages.

Design Methodology for Rehabilitation Robots: Application in an Exoskeleton for Upper Limb Rehabilitation

This article presents a methodology for the design of rehabilitation devices that considers factors involved in a clinical environment. This methodology integrates different disciplines that work together. The methodology is composed by three phases and 13 stages with specific tasks, the first phase includes the clinical context considering the requirements of the patient and therapist during the rehabilitation, the second phase is focused in engineering based on the philosophy of digital twin, and in the third phase is evaluated the device. This article explains the characteristics of the methodology and how it was applied in the design of an exoskeleton for passive rehabilitation of upper limb.

Serious Game Design of Virtual Reality Balance Rehabilitation with a Record of Psychophysiological Variables and Emotional Assessment

Virtual Reality (VR) offers an alternative to complement physical or neurological rehabilitation based on the efficacy of Gamification as a technique to get compromised, enjoy, and turn treatment periods less annoying through an immersive task. This work presents the design of a VR environment and takes into a count three levels of presence: self-presence, physical, and social. Thirteen healthy participants performed a traditional balance session with a wobble board through a parachute game. The direction of the fall is controlled with the inclination of a wobble board platform instrumented with a Gyroscope, electrocardiography (ECG), electrodermal activity (EDA), and respiratory rate (RESP) signals are simultaneously recorded. These psychophysiological responses of the Autonomous Nervous System (SNA) are contrasted with a standardized emotional self-report questionnaire to gather information about the experience and was filled out by the participant with the eye selection of the Oculus Rift device. The integrated Unity-Matlab system stored and processed some of the extraction data of 15 characteristics associated with the biosignals and three emotional levels, In addition to proposing a severe game as a solution to problems of conventional methodology such as low attention, monotonous and predictable sessions, combining computerized simulation and innovative technologies for more pleasant recovery therapy.

Cardiorespiratory capacity in tetra- and paraplegia shortly after injury

In one hundred patients (86 males, 14 females) with relatively recent spinal cord injuries the oxygen supporting system was evaluated during graded arm ergometry. The patients were assigned according to injury level to 5 subgroups with complete, and to 2 additional groups with incomplete injuries. Mean peak oxygen uptake (VO2) was found to be as low as 0.74 l/min in males with complete tetraplegia and 1.9 l/min in patients with conus and cauda lesions. Peak VO2 was closely correlated (r = 0.74) to the injury level. Peak VO2 was also closely correlated to peak minute ventilation (VE) in all groups. In patients with higher injury levels most of the increase in VE during maximal exercise was due to an increase in respiratory frequency (fR). In patients with tetraplegia and high paraplegia, arm cranking revealed deficient sympathetic regulation of cardiovascular functions resulting in hypotension. In both the complete and incomplete tetraplegic patients there was a relatively low peak heart rate (fH). Peak fH and VO2 varied more in patients with incomplete tetraplegia than in those with complete tetraplegia. Peak VO2 in females with mid-level thoracic paraplegia was on the average lower than in males with corresponding injury levels (16 ml/kg/min against 22 ml/kg/min, respectively). Evaluation of cardiorespiratory functions in spinal cord injured patients during high intensity endurance work performed shortly after the injury adds diagnostic and functionally useful information for the design of rehabilitation and should be recommended as clinical routine.

Barriers to uptake of the hip fracture core outcome set: An international survey of 80 hip fracture trialists.

Core outcome sets are an agreed recommendation to inform the selection of outcome measures in clinical trials. There has been low uptake of the 2014 hip fracture core outcome set. The reasons for this remain unclear. The aim of this study was to understand the reasons for the non-adoption and approaches to increase adoption of the hip fracture core outcome set. Randomised controlled trials from PubMed (2017-2019) and ClinicalTrials.gov (2015-2019) were identified. Corresponding authors for each identified trial (n = 302) were surveyed using five questions on awareness of the hip fracture core outcome set, reasons for non-adoption and approaches to increase adoption. Data were analysed descriptively using frequencies, mean values and standard deviations. Fifty-four percent of the respondents (n = 43) were aware of the concept of core outcome set. Only 15% (n = 12) based the outcome measure selection on the 2014 hip fracture core outcome set. Key reasons for non-adoption included the following: authors being unaware and perceived inappropriateness to their trial design. Eighty-six percent (n = 69) of respondents agreed to the need for increased awareness of core outcome sets through research training, academic and clinical journal requirements, and funding or publication stipulations. Eighty-eight percent (n = 70) of respondents indicated the current core outcome set required revision to focus on trials investigating people with cognitive impairment, caregivers, rehabilitation, surgical interventions and anaesthetic trial designs. Barriers to the adoption of the hip fracture core outcome set centre on education, awareness of the core outcome sets and applicability to the breath of hip fracture trial designs. Further consideration should be made to address these, to improve the harmonisation of outcome measures across hip fracture trials.

Movement asymmetry during low and high demand mobility tasks after dysvascular transtibial amputation

BackgroundMovement asymmetries between lower limbs are commonly exhibited by adults after transtibial amputation. However, the degree of movement asymmetry between low- and high-demand functional tasks remains unknown. MethodsKinematic and kinetic data were collected during overground walking (low-demand) and step ascent (high-demand) tasks for two groups: 1) persons with transtibial amputation and 2) healthy matched peers. Analysis of covariance was used to compare sagittal-plane peak knee moment and joint angle (primary) and hip and ankle moments and joint angles, vertical ground reaction force and impulse (secondary). FindingsWithin transtibial amputation group comparisons showed significantly greater between-limb asymmetry in peak knee moment (p < .01), vertical impulse (p < .01), peak vertical ground reaction force (p = .05), peak ankle angle (p < .01) and peak ankle moment (p < .01) with the step ascent task compared to overground walking. The transtibial amputation group had greater between-limb asymmetry during step ascent in peak knee moment (p < .01), vertical impulse (p < .01), peak vertical ground reaction force (p = .04) and peak ankle angle (p < .01) than healthy matched peers. During overground walking, the transtibial amputation group had greater between-limb asymmetry in peak vertical impulse (p = .05) and peak ankle moment (p < .01) than healthy matched peers. InterpretationMovement asymmetry is increased during step ascent compared to overground walking for adults with transtibial amputation. While the restoration of overground walking is the focus of post-amputation rehabilitation and prosthetic design, higher demand tasks should also be considered to maximize mobility for adults with transtibial amputation.

Cost-effectiveness of performing field investigation for pavement rehabilitation design of non-interstate routes

Many state transportation agencies are faced with making pavement rehabilitation decisions for roadways annually. Their design choices affect the future performance and maintenance cost of those pavements. This study determines if it is cost-effective to perform a field investigation (e.g., FWD, coring) for non-interstate routes to identify pavement structural and functional characteristics at the design stage and whether this information can aid in determining the most appropriate design for rehabilitation. To this end, field investigations are performed on 16 actual roadways (non-interstate routes) in the state of South Carolina prior to their rehabilitation, and an analysis was performed to compare the life-cycle cost between rehabilitation designs with and without field investigations. The results indicate that (1) the rehabilitation design with field investigation tends to produce a pavement that has the necessary depth and made up of higher strength materials that bring the pavement’s SN closer to the required value, (2) the rehabilitation design with field investigation defers the maintenance cycles, and (3) performing field investigation is cost-effective, particularly for those pavements that do not need maintenance treatments until their present serviceability index falls to a 2.

Benchmarking Falling Weight Deflectometer Deflection Bowl Parameters: Case Study for Indian Conditions and the Applications to Rehabilitation Design

AbstractThe paper presents the application of falling weight deflectometer (FWD) for the assessment of the structural capacity of a network of roads at district level by mechanistic-empirical techn...

Effects of Visual Feedback Complexity on the Performance of a Movement Task for Rehabilitation

This study investigated the effects of visual feedback (VF) complexity on movement performance to potentially optimize the design of VF-based rehabilitation. We evaluated the effects of VF complexity on performance of the two-legged squat during training with concurrent (real-time) VF and short-term retention with no VF. Four VF cases were employed to train spatial positioning of the thigh segment in unique combinations of complexity (simple, complex) and representation of body-discernibility (abstract, representative). Eighteen able-bodied subjects attempted to minimize the error between individual body segment positions and a target trajectory during concurrent VF and short-term retention tests. Complex-representative VF demonstrated greater potential for training with increased performance consistency in both motion and muscle activity patterns.

Intervention design for rehabilitation at home after stroke. A pilot feasibility study

This study aimed at identifying the characteristics and feasibility of rehabilitation at home for acute stroke patients in south-west Stockholm. A population-based systematic sample of 16 patients, fulfilling defined criteria, was selected from approximately 1/3 of the stroke patients having been in hospital for one week or more at a neurology department, and offered early discharge in combination with home-based rehabilitation as an alternative to sustained rehabilitation in hospital. Fifteen patients, mean age 68.2 years, male/female ratio 9/6, independent in feeding and continent one week after acute stroke, participated in the study. The most important components of the home-based rehabilitation programme were that: 1) one therapist was selected as case-manager using the other therapists on a consultant basis; 2) the training sessions consisted of different task-specific activities, based on the patients' personal interest; 3) education and individual counselling were offered to all spouses; and 4) adherence to structured training between therapy sessions was promoted. The length of such programmes varied from 4 to 19 weeks after discharge and the mean number of home visits was 11. Reported time for training between therapy sessions for 14 patients was mean 1.2 hours per day. The patients' lifestyle activities, personal and instrumental ADL, and motor capacity at 3, 6 and 12 months after stroke, assessed by validated and reliable methods, followed patterns similar to those reported for other stroke patients. The mean time in hospital for patients in the study was 14 days; for patients with similar ADL capacity but not included in the study it was 27 days.

Rehabilitation Design of a Historic Concrete Arch Bridge in Prague from the Early 20th Century

AbstractThis article presents a proposal of a method for the restoration and rehabilitation of Liben Bridge, a historic concrete vaulted arch bridge structure from the early 20th century. The bridg...

A fuzzy logic expert system for selecting optimal and sustainable life cycle maintenance and rehabilitation strategies for road pavements

ABSTRACT Aged road pavements and insufficient maintenance budgets, along with increasing concerns over the environmental issues related to transportation have introduced additional challenges to highway agencies. Multiobjective optimisation techniques can be used to account for those multiple aspects in the design of maintenance and rehabilitation (M&R) strategies. Contrary to the single-objective optimisation problems where a single solution is optimal, the solution of multiobjective optimisation problems is a set of non-dominated solutions, often referred to as Pareto-optimal set. This set of optimal solutions represents the trade-off between the different and often conflicting objectives, and in many cases is comprised by a vast number of elements. This paper presents the development and application of a fuzzy logic expert system for selecting a single solution from the Pareto set obtained from the multiobjective optimisation of sustainable pavement M&R strategies. It provides decision-makers with an easy and intuitive methodology for the selection of the most preferred solution according to sustainability criteria. The proposed system is applied to a case study from France. Posteriorly, different strategies reflecting the decision-maker’s preferences towards economic and environmental objectives are analysed. Conclusions and recommendations for future improvements are derived from this application.