Correlation of electromyography and clinical results after bicondylar knee joint prosthesis implantation]

AIM OF THE STUDY: To investigate clinical findings in patients receiving bicondylar sledge prostheses, and their correlation with electromyographic measurements in comparison with healthy volunteers. MATERIAL AND METHODS: An average of 31.9 months after implantation of a bicondylar sledge prosthesis, 15 patients were clinically examined and compared with 11 control subjects. Electromyographic measurements of the rectus femoris, vastus medialis and lateralis, semitendinosus, biceps femoris, tibialis anterior, and gastrocnemius muscles were obtained. RESULTS: All clinical scores were significantly poorer in the patient group. The activity of the vastus lateralis was significantly reduced. The activity in the lower leg of the operated side was significantly higher than in the control group. Significant differences were found in the tibialis anterior and gastrocnemius muscles between controls and patients. Analysis of the correlation between the clinical scores and the electromyographic measurements showed no significance. CONCLUSION: The clinical results correlated only slightly with the electromyographic activity of the muscles investigated. The commonly presumed quadriceps insufficiency was not confirmed.     

Development of EMG-based mode and intent recognition algorithms for a computer-controlled above-knee prosthesis

Conventional above-knee prostheses are unable to replace normal leg function due to the lack of adaptive control. Computer-controlled prostheses offer the possibility to implement such adaptive control. For a particular locomotion mode, control algorithms can generate appropriate damping profiles as a function of selected sensory inputs and stored information on normal walking. However, it is essential in such systems that the locomotor modes can be determined accurately from the inputs of the control system. Recognition of the intent to change from one mode to another is also a necessity because the control system has to account for such transitions. The possibility of using EMG signals from hip muscles and muscle residuals of the stump for this purpose is investigated. The modes tested are level walking, ramp ascent and ramp descent with slopes of 6° and 9°. EMG activity curves for three muscles: gluteus maximus, gluteus medius and tensor fasciae latae, are presented for the different modes. The results are obtained from two reference groups of 12 normal individuals and from a prosthetic patient. The results show the possibility of discriminating between modes. A discussion is made of the implementation of the results obtained by a finite state approach and the difficulties relating to the use of EMG signals for control purposes.     

Analysis of a new polycentric above-knee prosthesis with a pneumatic swing phase control

The four-bar linkage mechanism used by many designers for the knee joint of an above-knee prosthesis can provide knee rotation suitable for walking only. In Afro-Asian countries people are habituated to the squatting posture in their daily activities. A six-bar linkage knee-ankle mechanism above-knee prosthesis with a pneumatic swing phase control is developed and its analysis shows its suitability for producing a motion closely resembling that of a normal subject during walking and squatting.     

Meniscal wear at a three-component total ankle prosthesis by a knee joint simulator

Despite the fundamental value of wear simulation studies to assess wear resistance of total joint replacements, neither specialised simulators nor established external conditions are available for the human ankle joint. The aim of the present study was to verify the suitability of a knee wear simulator to assess wear rates in ankle prostheses, and to report preliminary this rate for a novel three-component total ankle replacement design. Four intact 'small' size specimens of the Box ankle were analysed in a four-station knee wear simulator. Special component-to-actuator holders were manufactured and starting spatial alignment of the three-components was sought. Consistent load and motion cycles representing conditions at the ankle joint replaced exactly with the prosthesis design under analysis were taken from a corresponding mechanical model of the stance phase of walking. The weight loss for the three specimens, after two million cycles, was 32.68, 14.78, and 62.28mg which correspond to a linear penetration of 0.018, 0.008, and 0.034mm per million-cycle, respectively for the specimens #1, #2, and #3. The knee wear simulator was able to reproduce load-motion patterns typical of a replaced ankle. Motion of the meniscal bearing in between the tibial and talar components was smooth, this component remaining in place and in complete congruence with the metal components throughout the test.     

Identification of the critical level of implantation of an osseointegrated prosthesis for above-knee amputees

The aim of our study was to identify potential critical levels of implantation of an osseointegrated prosthesis for above-knee amputees. The implant used was the OPRA system. It was inserted in the femur at four different amputation heights, characterized by their residual limb ratios (0.299, 0.44, 0.58 and 0.73). The stress and strain distribution was evaluated in the bone-implant system during walking, considering a body mass of 100 kg. Considerably high stimulus (11,489 με) in the tissue near the tip was found at the highest implantation level. All models presented small non-physiologic stress values in the tissue around the implant. The results revealed that the implantation level has a decisive effect on bone-implant performance. Mainly, the analysis indicates adverse biomechanical conditions for implantations in very short residual limbs.     

Further evidence of joint time-place control of rats' behavior: results from an 'open hopper' test

Rats were trained on an interval time-place task. Food was intermittently available on each of four levers for 4 min in a 16-min session. After baseline training the rats received 'open hopper' sessions in which food was available on all levers for all of the 16-min sessions. Despite the absence of any contingencies for doing so, the rats continued to press the levers in the 'correct' sequence, for roughly the 'correct' amount of time. This confirms that the rat behavior was controlled, in part, by a representation of an elapsed interval of time. The rats responding was more variable in 'open hopper' sessions and error increased (in an exponential fashion) as the session proceeded. This finding suggests that the rats may have used shifts in the location of food availability to minimize the accumulation of error throughout baseline sessions.     

Stance phase control of above-knee prostheses: knee control versus SACH foot design

The mobility of above-knee amputees (A/K) is limited, in part, due to the performance of A/K prostheses during the stance phase. Currently stance phase control of most conventional A/K prostheses can only be achieved through leg alignment and choice of the SACH (Solid Ankle Cushioned Heel) foot. This paper examines the role of the knee controller in relation to a SACH foot during the stance phase of level walking. The three-dimensional gait mechanics were measured under two stance phase conditions. In the first set of trials, the amputee used a prosthesis with a conventional knee controller that allowed the amputee to maintain the knee joint in full extension during the stance phase. In the second set of trials, the prosthetic knee, during stance, echoed the modified kinematics of the amputee's sound (intact) knee that had been recorded during the previous sound stance phase. Analysis and interpretation of the data indicate the following: (1) SACH foot design can strongly influence the walking mechanics independent of the knee controller; (2) knee controller design and SACH foot design are mutually interdependent; and (3) normal kinematics imposed on the prosthetic knee does not necessarily produce normal hip kinematics (e.g. reduce the abnormal rise in the prosthetic side hip trajectory). Future research is necessary to explore and exploit the interdependency of prosthetic knee control and foot design.     

Torsion and bending imposed on a new anterior cruciate ligament prosthesis during knee flexion: an evaluation method

A new composite prosthesis was recently proposed for the anterior cruciate ligament. It is implanted in the femur and the tibia through two anchoring channels. Its intra-articular portion, composed of a fiber mesh sheath wrapped around a silicone rubber cylindrical core, reproduces satisfactorily the ligament response in tension. However, the prosthesis does not only undergo elongation. In addition, it is submitted to torsion in its intra-articular portion and bending at its ends. This paper presents a new method to evaluate these two types of deformations throughout a knee flexion by means of a geometric model of the implanted prosthesis. Input data originate from two sources: (i) a three-dimensional anatomic topology of the knee joint in full extension, providing the localization of the prosthesis anchoring channels, and ii) a kinematic model of the knee describing the motion of these anchoring channels during a physiological flexion of the knee joint. The evaluation method is independent of the way input data are obtained. This method, applied to a right cadaveric knee, shows that the orientation of the anchoring channels has a large effect on the extent of torsion and bending applied to the implanted prosthesis throughout a knee flexion, especially on the femoral side. The study suggests also the best choice for the anchoring channel axes orientation.     

Transferrin-modified liposomes equipped with a pH-sensitive fusogenic peptide: an artificial viral-like delivery system

Liposomes are one of the most promising systems for selective cellular targeting via introduction of specific ligands for cell-surface receptors. After being taken up by the cells, these liposomes usually follow intracellular pathways of receptor-mediated endocytosis. Control of intracellular trafficking is required for optimized drug delivery. In this study, we elucidated the intracellular fate of transferrin-modified liposomes and succeeded in altering it by introducing the pH-sensitive fusogenic peptide, GALA (WEAALAEALAEALAEHLAEALAEALEALAA). Transferrins that are chemically attached to a liposomal surface (Tf-L) were internalized via receptor-mediated endocytosis more slowly than unmodified transferrins. In contrast to the recyclable nature of transferrin, liposome-attached transferrins together with encapsulated rhodamines were retained in vesicular compartments. When GALA was introduced into liposomal membranes using a cholesteryl moiety for anchoring (Chol-GALA), rhodamines were efficiently released and diffused into the cytosol. The addition of GALA to the Tf-L-containing medium or the encapsulation of GALA in Tf-L did not induce similar effects. These results clearly indicate that GALA must be present on the surface of liposomes to exert its function. In vitro energy transfer and dynamic light scattering experiments suggested that the endosomal escape of the encapsulates in Tf-L equipped with Chol-GALA can be attributed to pH-dependent membrane fusion. With GALA present on the surface, intracellular trafficking of liposomes after receptor-mediated endocytosis could be successfully controlled.     

Uncertainty of knee joint muscle activity during knee joint torque exertion: the significance of controlling adjacent joint torque.

In the single-joint torque exertion task, which has been widely used to control muscle activity, only the relevant joint torque is specified. However, the neglect of the neighboring joint could make the procedure unreliable, considering our previous result that even monoarticular muscle activity level is indefinite without specifying the adjacent joint torque. Here we examined the amount of hip joint torque generated with knee joint torque and its influence on the activity of the knee joint muscles. Twelve healthy subjects were requested to exert various levels of isometric knee joint torque. The knee and hip joint torques were obtained by using a custom-made device. Because no information about hip joint torque was provided to the subjects, the hip joint torque measured here was a secondary one associated with the task. The amount of hip joint torque varied among subjects, indicating that they adopted various strategies to achieve the task. In some subjects, there was a considerable internal variability in the hip joint torque. Such variability was not negligible, because the knee joint muscle activity level with respect to the knee joint torque, as quantified by surface electromyography (EMG), changed significantly when the subjects were requested to change the strategy. This change occurred in a very systematic manner: in the case of the knee extension, as the hip flexion torque was larger, the activity of mono- and biarticular knee extensors decreased and increased, respectively. These results indicate that the conventional single knee joint torque exertion has the drawback that the intersubject and/or intertrial variability is inevitable in the relative contribution among mono- and biarticular muscles because of the uncertainty of the hip joint torque. We discuss that the viewpoint that both joint torques need to be considered will bring insights into various controversial problems such as the shape of the EMG-force relationship, neural factors that help determine the effect of muscle strength training, and so on.     

Kinematic and dynamic analysis of an anatomically based knee joint

This paper presents a knee-joint model to provide a better understanding on the interaction between natural joints and artificial mechanisms for design and control of rehabilitation exoskeletons. The anatomically based knee model relaxes several commonly made assumptions that approximate a human knee as engineering pin-joint in exoskeleton design. Based on published MRI data, we formulate the kinematics of a knee-joint and compare three mathematical approximations; one model bases on two sequential circles rolling a flat plane; and the other two are mathematically differentiable ellipses-based models with and without sliding at the contact. The ellipses-based model taking sliding contact into accounts shows that the rolling-sliding ratio of a knee-joint is not a constant but has an average value consistent with published measurements. This knee-joint kinematics leads to a physically more accurate contact-point trajectory than methods based on multiple circles or lines, and provides a basis to derive a knee-joint kinetic model upon which the effects of a planar exoskeleton mechanism on the internal joint forces and torque during flexion can be numerically investigated. Two different knee-joint kinetic models (pin-joint approximation and anatomically based model) are compared against a condition with no exoskeleton. The leg and exoskeleton form a closed kinematic chain that has a significant effect on the joint forces in the knee. Human knee is more tolerant than pin-joint in negotiating around a singularity but its internal forces increase with the exoskeleton mass-to-length ratio. An oversimplifying pin-joint approximation cannot capture the finite change in the knee forces due to the singularity effect.     

Ocular prosthesis: a brief review and fabrication of an ocular prosthesis for a geriatric patient

Objective: A review of literature for ocular prosthesis is presented along with a case report of a geriatric patient. Review of literature: The evolution of ocular prosthesis, materials and methods, fabrication techniques for custom and stock eye prosthesis, delivery and after care for the ocular prosthesis are reviewed. Case report: A 74‐year‐old female patient who had undergone enucleation of her right eye was restored with a stock ocular prosthesis. Conclusion: The use of stock ocular prosthesis of appropriate contour, size and colour can provide an acceptable aesthetic result.     

Is there a correlation between clinical results or quality of life and radiological findings after implantation of a total knee prosthesis?]

AIM OF THE STUDY: To establish whether there is a clinical correlation between clinical outcome or quality of life and radiographic findings. MATERIAL AND METHODS: 17 patients (mean age 68.2 years) with total knee arthroplasty were examined after an average follow-up of 24.6 months. The examination included the HSS score for clinical parameters, and the SF-36 questionnaire quality of life. Radiographs were evaluated in accordance with Ewald and Lotke, and a schema of our own. RESULTS: The HSS score returned a mean of 81 points, and the SF-36 questionnaire showed significantly poorer results in comparison with age-matched healthy subjects. The Lotke evaluation of the X-rays showed a mean value of 76.3. Correlations between the radiographic findings and the HSS score were not seen. Correlations between X-ray parameters (Ewald and Lotke) and the SF-36 were found only for pain and vitality. CONCLUSIONS: This is the first study to investigate the correlation between clinical parameters (including quality of life) and X-ray findings. Neither the clinical score nor the quality of life score was found to correlate with the radiographic findings. Nor was more than minimal correlation found between quality of life and HSS score. These results show that the presence of radiolucent lines or deviations from the perfect prosthesis position must not necessarily be considered to be of importance for clinical outcome and quality of life.     

Evaluation of an intact,an ACL-deficient,and a reconstructed human knee joint finite element model

The human knee joint has a three-dimensional geometry with multiple body articulations that produce complex mechanical responses under loads that occur in everyday life and sports activities. Understanding the complex mechanical interactions of these load-bearing structures is of use when the treatment of relevant diseases is evaluated and assisting devices are designed. The anterior cruciate ligament (ACL) in the knee is one of four main ligaments that connects the femur to the tibia and is often torn during sudden twisting motions, resulting in knee instability. The objective of this work is to study the mechanical behavior of the human knee joint and evaluate the differences in its response for three different states, i.e., intact, ACL-deficient, and surgically treated (reconstructed) knee. The finite element models corresponding to these states were developed. For the reconstructed model, a novel repair device was developed and patented by the author in previous work. Static load cases were applied, as have already been presented in a previous work, in order to compare the calculated results produced by the two models the ACL-deficient and the surgically reconstructed knee joint, under the exact same loading conditions. Displacements were calculated in different directions for the load cases studied and were found to be very close to those from previous modeling work and were in good agreement with experimental data presented in literature. The developed finite element model for both the intact and the ACL-deficient human knee joint is a reliable tool to study the kinematics of the human knee, as results of this study show. In addition, the reconstructed human knee joint model had kinematic behavior similar to the intact knee joint, showing that such reconstruction devices can restore human knee stability to an adequate extent.     

Melatonin in epilepsy: first results of replacement therapy and first clinical results

At a single evening dose of 5-10 mg, melatonin (MLT), the pineal gland hormone, can exert a positive effect on the frequency of epileptic attacks in children with sleep disturbances of various etiologies. We have shown that the sleep behavior can be normalized and an existing epilepsy can be favorably influenced. Pretherapeutic MLT secretion profiles can provide new information concerning the origin and treatment of these disturbances. In vitro experiments suggest that this effect might be the result of the interaction between MLT and MLT-specific receptors in the neocortex. Due to its favorable safety profile, MLT can be liberally administered in the specified doses and be considered as a useful antiepileptic drug.