Soft Manipulation Research Articles

Percutaneous Pedicle Screws in the Obese: Should the Skin Incision Be More Lateral?

Objective: To determine if the skin incision for lumbar percutaneous pedicle screws should be more lateral in the obese patient.Methods: This was a retrospective radiographic analysis of 30 obese and non-obese lumbar spine computed tomography (CT) radiographs comparing the depth of soft tissue along the anatomic axis of the pedicle at L4 and L5.Results: The average distance from the pedicle trajectory on the skin to the lateral border of the pedicle at L4 was 1.4 cm and 3.8 cm in the non-obese and obese groups, respectively. The average distance from the pedicle trajectory on the skin to the lateral border of the pedicle at L5 was 2.1 cm and 4.3 cm in the non-obese and obese groups, respectively; both these differences reached statistical significance, p <0.05.Conclusions: This radiographic study supports a more lateral start point for percutaneous pedicle screws in obese patients to maintain an anatomic trajectory when inserting percutaneous pedicle screws into the lumbar spine at L4 and L5. If a skin incision is made at only 1 cm lateral to the pedicle in the obese patient, the surgeon often has to place significant traction on the skin edge to lateralize their instrumentation to achieve an appropriate angle of insertion. By making a more lateral skin incision, less manipulation of the skin and soft tissues is needed to maintain an anatomic trajectory of the pedicle screw. Decreasing soft tissue manipulation may decrease wound and instrumentation complications in this at-risk population.

ACC Research Agenda Conference 2019: Peer Reviewer Acknowledgments and Abstracts of Proceedings.

ACC Research Agenda Conference 2019: Peer Reviewer Acknowledgments and Abstracts of Proceedings.

The Role of Manual Therapy in Patients with COPD.

Chronic obstructive pulmonary disease (COPD) is a respiratory condition associated with altered chest wall mechanics and musculoskeletal changes. In this narrative review, we describe the underlying musculoskeletal abnormalities in COPD, the reasons for applying manual therapy techniques, their method of application and clinical effects. A variety of manual therapy techniques have been applied in individuals with COPD, including soft tissue therapy, spinal and joint manipulation and mobilisation, and diaphragmatic release techniques. These have been prescribed in isolation and in conjunction with other treatments, including exercise therapy. When applied in isolation, transient benefits in respiratory rate, heart rate and symptoms have been reported. Combined with exercise therapy, including within pulmonary rehabilitation, benefits and their corresponding clinical relevance have been mixed, the extent to which may be dependent on the type of technique applied. The current practical considerations of applying these techniques, including intense therapist–patient contact and the unclear effects in the long term, may limit the broad use of manual therapy in the COPD population. Further high quality research, with adequate sample sizes, that identifies the characteristic features of those with COPD who will most benefit, the optimal choice of treatment approach and the longevity of effects of manual therapy is required.

Evaluation of percutaneous endoscopic lumbar discectomy: a prospective case series

Introduction Lumbar discectomy is one of the most common operations performed worldwide for lumbar-related symptoms. During the latter half of the 19th century, more techniques were developed to remove the herniated disc with minimal invasiveness. The first herniated disc excision using a microscope (microdiscectomy) was performed by Yasargil in 1977. In 1993, Mayer and Brock and then, in 1997, Smith and Foley described endoscopic discectomy techniques. With these minimally invasive techniques, the authors demonstrated decreased soft tissue manipulation, operative time, blood loss, and hospital stay, allowing early recovery. Objective The objective of this study was to evaluate clinical, functional, and surgical outcomes of percutaneous endoscopic lumbar discectomy (PELD) in patients with lumbar disc herniation (LDH). Patients and methods This study is a clinical prospective case series conducted from December 2016 to May 2018; 15 patients who presented with single-level, posterolateral, L4-5 or L5-S1 LDHs underwent PELD within a mean follow-up period of 10.6 months. The procedure was evaluated by the duration of the procedure, blood loss, time of hospital stay, preoperative and postoperative visual analog score (VAS) of low back pain (LBP) and radicular pain (RP) and patient satisfaction according to modified MacNab's criteria. Results There were 10 male patients and five female patients with the mean age of 35.9 years. The mean amount of intraoperative bleeding was 98.67 ml. The mean operative time was 124 min. The mean postoperative hospital stay was 33.6 h. The mean preoperative VAS of LBP was 6.13 and that of RP was 6.73. Postoperatively, the mean VAS of LBP became 1.6 and that of RP was 1.6. Patient satisfaction score according to modified MacNab's criteria was excellent in 80% and good in 20%. Conclusion PELD appears to be an effective intervention for LDH, as it has a small amount of intraoperative blood loss, short postoperative hospital stay, and good clinical and functional outcomes. It needs more training, as it has a long learning curve.

Outcome of small minimal incision technique & posteriorly based periosteal flap with subcutaneous closure in cochlear implant surgery

Background: Although cortical mastoidectomy and posterior tympanotomy has not changed for more than 40 years, the major changes are in the skin flap incision and implant technique in CI surgery. Regarding the incision technique the smaller the incision with less soft tissue manipulation the best. Post-operative healing and scar result also small incision have adequate blood supply and venous drainage, graft has good exposure and coverage of the PP field. There are different types of incisions and flaps which are used by different surgeons around the world for cochlear implant surgery. In this study 3 types of incisions and flaps were used, Small incision for cochlear implant surgery reduce the morbidity and increase parent satisfaction as compared with wider access operation incisions also will prevent the scalp flap complication, this is achieved by good flab design that should have adequate blood supply and venous drainage, enough field exposure and coverage. Methods: This is retrospective study for 145 child age ranges between (1-5)years old, underwent cochlear implant surgery with deferent companies (AB, cochlear, med el) in Al-Yarmouk Teaching Hospital/ENT department from 2014- July.2018. 3 types of incisions and flaps were used, Slight curve line post auricle incision (Small hair line post-auricle incision), Lazy S incision, Small post-auricle with superior extension, was made with posterior flap elevation was used as an axis to the mastoid cavity and the wheel for the implant device, with subcutaneous closure and without skin closure. Result: It’s found that there is early healing, no major flap complication by using Slight curve line post auricle incision (Small hair line post-auricle incision), no skin stitches are required, end with minimum or no scar, minimum time consuming and easy follow-up for the children post-operatively.

DeepDynamicHand: A Deep Neural Architecture for Labeling Hand Manipulation Strategies in Video Sources Exploiting Temporal Information.

Humans are capable of complex manipulation interactions with the environment, relying on the intrinsic adaptability and compliance of their hands. Recently, soft robotic manipulation has attempted to reproduce such an extraordinary behavior, through the design of deformable yet robust end-effectors. To this goal, the investigation of human behavior has become crucial to correctly inform technological developments of robotic hands that can successfully exploit environmental constraint as humans actually do. Among the different tools robotics can leverage on to achieve this objective, deep learning has emerged as a promising approach for the study and then the implementation of neuro-scientific observations on the artificial side. However, current approaches tend to neglect the dynamic nature of hand pose recognition problems, limiting the effectiveness of these techniques in identifying sequences of manipulation primitives underpinning action generation, e.g., during purposeful interaction with the environment. In this work, we propose a vision-based supervised Hand Pose Recognition method which, for the first time, takes into account temporal information to identify meaningful sequences of actions in grasping and manipulation tasks. More specifically, we apply Deep Neural Networks to automatically learn features from hand posture images that consist of frames extracted from grasping and manipulation task videos with objects and external environmental constraints. For training purposes, videos are divided into intervals, each associated to a specific action by a human supervisor. The proposed algorithm combines a Convolutional Neural Network to detect the hand within each video frame and a Recurrent Neural Network to predict the hand action in the current frame, while taking into consideration the history of actions performed in the previous frames. Experimental validation has been performed on two datasets of dynamic hand-centric strategies, where subjects regularly interact with objects and environment. Proposed architecture achieved a very good classification accuracy on both datasets, reaching performance up to 94%, and outperforming state of the art techniques. The outcomes of this study can be successfully applied to robotics, e.g., for planning and control of soft anthropomorphic manipulators.

Knowledge of General Dentists and Senior Dental Students about Indications of Antibiotic Prophylaxis in Yazd, Iran

Introduction: In patients susceptible to infection, after dental procedures which lead to soft tissue manipulation or bleeding, the occurrence of bacteremia is probable. Hence, antibiotic prophylaxis is very important in this group of patients. The purpose of this study was to assess the level of awareness of senior dental students and general dental practitioners in the city of Yazd about the indications of antibiotics prophylaxis and the proper way of prescribing the prophylactic regimens. Materials and methods: This study is a cross-sectional descriptive-analytical study. To collecting data, prepared questionnaires distributed among 60 general dentists and 60 senior students. Results: The mean of knowledge scores of senior dental students and general dentists were 55.43 and 55.06 respectively. Both groups showed acceptable levels of knowledge. Conclusion: The levels of knowledge of senior dental students and general dental practitioners were desirable and this may be due to the participation of practitioners in relevant re-training programs or allocation of related academic resources in this area during their education.

Electro-acupuncture and massage mobilizes mesenchymal stem cell into circulation in canines

Introduction: Acupuncture and massage are types of soft tissue mechanotherapy often used to treat neuromusculoskeletal disorders. Electro-acupuncture (EA) is a form of acupuncture where a small electric current is passed between pairs of acupuncture needles; whereas instrument-assisted soft tissue manipulation (IASTM) is a type of therapeutic massage that uses rigid devices. The aim of this proof-of-concept study was to explore the effects of EA and IASTM on bone-marrow derived mesenchymal stem cells (BMSC) circulation levels in canines.

Assessment of soft materials for anthropomorphic soft robotic fingertips

Abstract In recent decades, research on soft robot manipulations and their materials attracted a huge momentum among various researchers. Selection of appropriate soft material is a vital role in robotic fingertip design, which enables the object to be held in proper orientation without slip and damage. Development of such an anthropomorphic type of soft hand requires knowledge about material selection, types of finger contact and the mechanism behind grasping. This research work presents a comprehensive comparison of six chosen soft materials with human skin for improved robotic manipulation. Extensive research is required to develop such soft hands for better manipulation becausein the final analysis, the human hand is the best soft manipulator as it conforms to objects easily through good contact with an object. In the past decades, many researchers have tried to replace metal hand of robots with appropriate soft materials to enable better manipulation. In this work, the magnitude of contact area, contact pressure and vertical depression of six soft materials was compared with human skin with respect to precision grasping. The simulation results clearly show that neoprene rubber exhibits a close relationship with the characteristics of human skin.

Soft Robotic Manipulation and Locomotion with a 3D Printed Electroactive Hydrogel.

Electroactive hydrogels (EAH) that exhibit large deformation in response to an electric field have received great attention as a potential actuating material for soft robots and artificial muscle. However, their application has been limited due to the use of traditional two-dimensional (2D) fabrication methods. Here we present soft robotic manipulation and locomotion with 3D printed EAH microstructures. Through 3D design and precise dimensional control enabled by a digital light processing (DLP) based micro 3D printing technique, complex 3D actuations of EAH are achieved. We demonstrate soft robotic actuations including gripping and transporting an object and a bidirectional locomotion.

Skin Modeling Analysis of a Force Sensing Instrument-Assisted Soft Tissue Manipulation Device

Instrument-assisted soft tissue manipulation (IASTM) is a form of manual therapy which is performed with rigid cast tools. The applied force during the IASTM process has not been quantified or regulated. Nor have the angle of treatment and strokes frequency been quantified which contribute to the overall recovery process. This paper presents a skin modeling analysis used in the design of a novel mechatronic device that measures force in an IASTM application with localized pressures, similar to traditional, nonmechatronic IASTM devices that are frequently used to treat soft tissue dysfunctions. Thus, quantifiable soft tissue manipulation (QSTM) represents an advancement in IASTM. The innovative mechatronic QSTM device is based on one-dimensional (1D) compression load cells, where only four compression force sensors are needed to quantify all force components in three-dimensional (3D) space. Here, such a novel QSTM mechatronics device is simulated, analyzed, and investigated using finite element analysis (FEA). A simplified human arm was modeled to investigate the relationship between the measured component forces, the applied force, and the stress and strain distribution on the skin surface to validate the capability of the QSTM instrument. The results show that the QSTM instrument as designed is able to correlate the measured force components to the applied tool-tip force in a straight movement on the skin model.

Normal Knee Kinematics After TKA—A Reality?

Design rationale, surgical technique, and soft tissue manipulation weigh heavily on the kinematic performance of total knee arthroplasty. As the orthopedic community continues its quest to provide more functional total knees, one must consider the importance of kinematics. Various investigations involving in vivo, in vitro, and computational methodologies have led to a sound understanding of normal knee kinematics. The results of such investigations are used in the development of new total knee arthroplasty designs and surgical technique. With years of research and development the question remains, “Do TKAs enable normal knee kinematics?” This work reviews results from published fluoroscopic research and presents new data to shed light on this question.

Fourier-Based Shape Servoing: A New Feedback Method to Actively Deform Soft Objects into Desired 2-D Image Contours

This paper addresses the design of a vision-based method to automatically deform soft objects into desired two-dimensional shapes with robot manipulators. The method presents an innovative feedback representation of the object's shape (based on a truncated Fourier series) and effectively exploits it to guide the soft object manipulation task. A new model calibration scheme that iteratively approximates a local deformation model from vision and motion sensory feedback is derived; this estimation method allows us to manipulate objects with unknown deformation properties. Pseudocode algorithms are presented to facilitate the implementation of the controller. Numerical simulations and experiments are reported to validate this new approach.

Prosthetic Stage Of Anterior Maxillary Implant- A Case Study

One of the greatest challenges for implant placement in the maxillary anterior zone is not only the restoration of function but also the esthetics. The reestablishment of a normal alveolar contour after implant placement is a critical step in esthetic success. This important aspect consists of replacing the lost portion of the alveolar process and associated soft tissue. It can be onerous to establish a balance between the tooth and the surrounding apparatus at prosthesis - soft tissue interface. This case presents the implant placement aspect with an in-depth consideration of positional parameters and post implant placement with consideration of soft tissue management and manipulation. Thus, the final restoration fitted precisely and harmoniously with the natural and esthetic contours of the gingiva and provided the esthetic results which both the practitioner and the patient were aiming to achieve. Hence, validating use of this technique for suitable patients.

The effect of manual therapy and exercise in patients with chronic low back pain: Double blind randomized controlled trial.

To determine the effects of spinal stabilization exercises (SSE) and manual therapy methods on pain, function and quality of life (QoL) levels in individuals with chronic low back pain (CLBP). A total of one-hundred thirteen patients diagnosed as CLBP were enrolled to the study. The patients allocated into Spinal Stabilization group (SG) and manual therapy group (MG), randomly. While SSE performed in SG, soft tissue mobilizations, muscle-energy techniques, joint mobilizations and manipulations were performed in MG. While the severity of pain was assessed with Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and Short Form 36 (SF-36) assessments were performed to evaluate the functional status and QoL, respectively. All assessments were repeated before and after the treatment. Intragroup analyses both treatments were effective in terms of sub parameters of pain, function and life quality (p< 0.05). Inter group analyses, there was more reduction in pain and improvement in functional status in favor of MG (p< 0.05). This study showed that SSE and manual therapy methods have the same effects on QoL, while the manual treatment is more effective on the pain and functional parameters in particular.

Utilization of robotic-arm assisted total knee arthroplasty for soft tissue protection

ABSTRACTDespite the well-established success of total knee arthroplasty (TKA), iatrogenic ligamentous and soft tissue injuries are infrequent, but potential complications that can have devastating impact on clinical outcomes. These injuries are often related to technical errors and excessive soft tissue manipulation, particularly during bony resections. Recently, robotic-arm assisted TKA was introduced and demonstrated promising results with potential technical advantages over manual surgery in implant positioning and mechanical accuracy. Furthermore, soft tissue protection is an additional potential advantage offered by these systems that can reduce inadvertent human technical errors encountered during standard manual resections. Therefore, due to the relative paucity of literature, we attempted to answer the following questions: 1) does robotic-arm assisted TKA offer a technical advantage that allows enhanced soft tissue protection? 2) What is the available evidence about soft tissue protection? Recently introduced models of robotic-arm assisted TKA systems with advanced technology showed promising clinical outcomes and soft tissue protection in the short- and mid-term follow-up with results comparable or superior to manual TKA. In this review, we attempted to explore this dimension of robotics in TKA and investigate the soft tissue related complications currently reported in the literature.

Vertical Ridge Augmentation and Soft Tissue Reconstruction of the Anterior Atrophic Maxillae: A Case Series.

Severe vertical ridge deficiency in the anterior maxilla represents one of the most challenging clinical scenarios in the bone regeneration arena. As such, a combination of vertical bone augmentation using various biomaterials and soft tissue manipulation is needed to obtain successful outcomes. The present case series describes a novel approach to overcome vertical deficiencies in the anterior atrophied maxillae by using a mixture of autologous and anorganic bovine bone. Soft tissue manipulation including, but not limited to, free soft tissue graft was used to overcome the drawbacks of vertical bone augmentation (eg, loss of vestibular depth and keratinized mucosa). By combining soft and hard tissue grafts, optimum esthetic and long-term implant prosthesis stability can be achieved and sustained.

Force Sensing for an Instrument-Assisted Soft Tissue Manipulation Device

Instrument-assisted soft tissue manipulation (IASTM) is a form of mechanotherapy, e.g., massage, that uses rigid devices which may be machined or cast. The delivered force, which is a critical parameter during IASTM, is not measured and not standardized in current clinical IASTM practice. In addition to the force, the angle of treatment and stroke frequency play an important role during IASTM. For accurate IASTM treatment, there is a strong need to scientifically characterize the IASTM delivered force, angle of treatment, and stroke frequency. This paper presents a novel, mechatronic design of an IASTM device that can measure the localized pressure on the soft tissue in a clinical treatment. The proposed design uses a three-dimensional (3D) load cell, which can measure all three-dimensional force components simultaneously. The device design was implemented using an IMUduino microcontroller board which provides tool orientation angles. These orientation angles were used for coordinate transformation of the measured forces to the tool–skin interface. Additionally, the measured force value was used to compute the stroke frequency. This mechatronic IASTM tool was validated for force measurements in the direction of tool longitudinal axis using an electronic plate scale that provided the baseline force values to compare with the applied force values measured by the tool. The load cell measurements and the scale readings were found to agree within the expected degree of accuracy.

Fundamentals of soft robot locomotion.

Soft robotics and its related technologies enable robot abilities in several robotics domains including, but not exclusively related to, manipulation, manufacturing, human-robot interaction and locomotion. Although field applications have emerged for soft manipulation and human-robot interaction, mobile soft robots appear to remain in the research stage, involving the somehow conflictual goals of having a deformable body and exerting forces on the environment to achieve locomotion. This paper aims to provide a reference guide for researchers approaching mobile soft robotics, to describe the underlying principles of soft robot locomotion with its pros and cons, and to envisage applications and further developments for mobile soft robotics.

Merits and demerits of endoscopic tympanoplasty

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Aim of the study was to evaluate the merits and demerits of endoscopic tympanoplasty compared to conventional microscopic tympanoplasty. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This prospective comparative study was carried out between October 2015 to September 2016 in our otolaryngology department, for a period of 12 months. Total of 40 patients who fit into inclusion criteria, underwent endoscopic tympanoplasty under local anaesthesia with sedation. All laboratory preoperative testing was done; hearing evaluation was done with audiometry. Postoperative follow up was done at 2&lt;sup&gt;nd&lt;/sup&gt; and 3&lt;sup&gt;rd&lt;/sup&gt; month’s period, graft status and hearing evaluation with PTA for all four frequencies 500, 1000, 2000 and 4000 Hz with air conduction and bone conduction thresholds were recorded. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Out of 40 patients, 16 (40%) were males, and 24 (60%) were females, there were 21 (52.5%) cases had moderate perforation, 15 (37.5%) cases had large perforation and 4 (10%) cases had subtotal perforation. Average time taken was of around 1hour and 30minutes, range was (70-140min.). All patients were evaluated for graft status, hearing gain and cosmetic results. Out of 40 patients, 35 (87.5%) patients had successful graft uptake, 2 (5%) patients had graft infection and 3 (7.5%) patients had residual perforation seen postoperatively. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Use of endoscope not only serves as a great teaching tool, but also helps to visualize the middle ear anatomy and pathology intraoperatively with minimal soft tissue manipulation better cosmesis and reduced postoperative morbidity. In our study, we found that endoscopic tympanoplasty had better graft uptake rate.&lt;/span&gt;&lt;/p&gt;