Technology and Health Care

Inequality of weight distribution on the lower extremities affects the posture and gait performance of an individual. The effect of wobble board training on weight distribution on the lower extremities is presently unknown. The purpose of this study was to investigate the effects of a six week wobble board exercise training program on the weight distribution in the lower extremities. Subjects (n = 16) in the wobble board group were trained three times a week for the period of six weeks. The subjects in the control group (n = 13) did not receive any training. Weight distribution symmetry scores improved by 9% and 2% in the wobble board and control groups, respectively, no significant difference was found between the two groups' pre-training weight distribution on the lower extremities. The two-ways repeated analysis of variance revealed a significant F ratio between the two groups (P < 0.001). LSD post hoc analysis showed significant improvements in the symmetry of the weight distribution at the 4th and 6th week of training compared to pre-training value within the wobble board group, while no significant improvement was recorded within the control group. Our findings implied that the wobble board exercise program could be used to improve the symmetry of weight distribution on the lower extremities in sedentary subjects.

During natural disasters such as earthquakes or tsunamis, most of the casualties are known to suffer from musculoskeletal injuries. This leads to an enormous need of orthopaedic (surgical) implants such as osteosynthesis plates, which are difficult to provide in developing countries that rely on imported ones. One of the alternatives is utilization of local resources, but only after they have been proven safe to use, and meet the international standards set. Through this paper we would like to urge the international community to include locally produced biomedical products, like osteosynthesis plates in their scientific evaluations and communications. When the quality of local products is proven, the reluctance to use local products also by surgeons from developing countries will disappear and larger scale production can be initiated. This in its turn solves many problems that come after natural disasters and stimulates the national economy in an efficient and effective way.

Mobile patient monitoring devices are becoming an integral part of healthcare industry and these devices will eventually become the method of choice for accessing and implementing health checks for patients located in remote areas. The thrust behind this research work was to investigate how a complete security strategy, comprising of digital signatures, encryption and authorisation on the mobile healthcare devices could be implemented without compromising overall system performance. Java 2, Micro Edition (J2ME) platform has been used to implement the Signature, Encryption and Authentication (SEA) protocol based on Elliptic Curve Cryptography (ECC). The work presented highlights a practical, secure and effective prototype for interactive monitoring of remote patients. The proposed facilities could improve the quality of care and doctor-patient communications; prevent misuse of healthcare data and consequential expenses to the healthcare industry in an efficient user friendly way that does not significantly affect the device performance.

Paralysis of the respiratory muscles in people with tetraplegia affects their ability to breathe and contributes to respiratory complications. Surface functional electrical stimulation (FES) of abdominal wall muscles can be used to increase tidal volume (V_T) and improve cough peak flow (CPF) in tetraplegic subjects who are able to breathe spontaneously.

This study aims to evaluate the feasibility and effectiveness of a novel abdominal FES system which generates stimulation automatically, synchronised with the subjects' voluntary breathing activity. Four subjects with complete tetraplegia (C4-C6), breathing spontaneously, were recruited.

The automatic stimulation system ensured that consistent stimulation was achieved. We compared spirometry during unassisted and FES-assisted quiet breathing and coughing, and measured the effect of stimulation on end-tidal CO₂ (EtCO₂) during quiet breathing.

The system dependably recognised spontaneous respiratory effort, stimulating appropriately, and was well tolerated by patients. Significant increases in V_T during quiet breathing (range 0.05–0.23 L) and in CPF (range 0.04–0.49 L/s) were observed. Respiratory rate during quiet breathing decreased in all subjects when stimulated, whereas minute ventilation increased by 1.05–2.07 L/min. The changes in EtCO₂ were inconclusive.

The automatic stimulation system augmented spontaneous breathing and coughing in tetraplegic patients and may provide a potential means of respiratory support for tetraplegic patients with reduced respiratory capacity.

Although often neglected, finger extension force is of great importance for developing grip strength. This paper describes the design and evaluation of a new finger extension force measurement device (EX-it) based on the biomechanics of the hand. Measurement accuracy and test-retest reliability were analysed. The device allows measurements on single fingers as well as all the fingers (excluding the thumb) of both healthy and deformed hands. The coefficient of variation in the device was 1.8% of the applied load, and the test-retest reliability showed a coefficient of variation no more than 7.1% for healthy subjects. This study also provides reference values for finger extension force in healthy subjects and patients with rheumatoid arthritis (RA). Significant differences were found in extension strength between healthy subject and RA patients (men, p < 0.05 and women, p < 0.001). EX-it provides objective and reliable data on the extension force capacity of normal and dysfunctional hands and can be used to evaluate the outcome of therapeutic interventions after hand trauma or disease.

In femoral revision arthroplasty the orthopaedic surgeon frequently has to decide between performing an extended trochanteric osteotomy or trying to remove the femoral stem without an osteotomy and taking the risk of an intraoperative fracture. As this decision is often hard to make this study compared intraoperative femoral fractures during stem removal with extended trochanteric osteotomies in femoral revision arthroplasties. Twenty-eight femoral revision arthroplasties with an extended trochanteric osteotomy were compared with forty-five intraoperative fractures during revision hip arthroplasty. Preoperatively and after a follow-up of 2.8 years the patients were examined clinically and radiologically. We found no osteosynthesis related complication in the extended trochanteric osteotomy group, but six in the fracture group. Furthermore fewer re-revisions were observed in the osteotomy group. Additionally, a significant better clinical and radiological outcome can be found in the extended trochanteric osteotomy group compared to the fracture group. The results of this study suggest that a well conducted extended femoral osteotomy should be discussed in special cases to prevent femoral fractures during stem and cement removal which would probably lead to a poor postoperative outcome.