Dinesh Bhatia

Current interventions in the management of knee osteoarthritis

Osteoarthritis (OA) is progressive joint disease characterized by joint inflammation and a reparative bone response and is one of the top five most disabling conditions that affects more than one-third of persons > 65 years of age, with an average estimation of about 30 million Americans currently affected by this disease. Global estimates reveal more than 100 million people are affected by OA. The financial expenditures for the care of persons with OA are estimated at a total annual national cost estimate of

Pacemakers charging using body energy

15.5-

Effect of r-TMS over standard therapy in decreasing muscle tone of spastic cerebral palsy patients

28.6 billion per year. As the number of people >65 years increases, so does the prevalence of OA and the need for cost-effective treatment and care. Developing a treatment strategy which encompasses the underlying physiology of degenerative joint disease is crucial, but it should be considerate to the different age ranges and different population needs. This paper focuses on different exercise and treatment protocols (pharmacological and non-pharmacological), the outcomes of a rehabilitation center, clinician-directed program versus an at home directed individual program to view what parameters are best at reducing pain, increasing functional independence, and reducing cost for persons diagnosed with knee OA.

State of art: Functional Electrical Stimulation (FES)

Life-saving medical implants like pacemakers and defibrillators face a big drawback that their batteries eventually run out and patients require frequent surgery to have these batteries replaced. With the advent of technology, alternatives can be provided for such surgeries. To power these devices, body energy harvesting techniques may be employed. Some of the power sources are patients heartbeat, blood flow inside the vessels, movement of the body parts, and the body temperature (heat). Different types of sensors are employed, such as for sensing the energy from the heartbeat the piezoelectric and semiconducting coupled nanowires are used that convert the mechanical energy into electricity. Similarly, for sensing the blood flow energy, nanogenerators driven by ultrasonic waves are used that have the ability to directly convert the hydraulic energy in human body to electrical energy. Another consideration is to use body heat employing biothermal battery to generate electricity using multiple arrays of thermoelectric generators built into an implantable chip. These generators exploit the well-known thermocouple effect. For the biothermal device to work, it needs a 2°C temperature difference across it. But there are many parts of the body where a temperature difference of 5°C exists – typically in the few millimeters just below the skin, where it is planned to place this device. This study focuses on using body heat as an alternative energy source to recharge pacemaker batteries and other medical devices and prevent the possibility of life-risk during repeated surgery.

Upper limb prosthetic control using toe gesture sensors

Abstract Spastic cerebral palsy (CP) is the one of most common neurological disorders occurring due to damage to the immature brain or any other brain lesion at the time of birth. To aid in making the life of the CP patient meaningful, several interventions such as medical, surgical and rehabilitation have been employed to date. Besides these, recently repetitive Transcranial magnetic stimulation (r-TMS) is a new found approach which is being employed for treating various neurological and psychological conditions. The aim of this study was to observe the effects of r-TMS on muscle spasticity in CP patients by stimulating the motor cortex area of the brain, which is responsible for muscle movements. In this study, 20 subjects diagnosed with CP were recruited and 10 each were placed in two groups, namely the research group (RG) (mean age, height and weight were 7.99 (SD = 4.66) years, 116.7 (SD = 23.57) cm and 21.40 (SD = 10.95) kg, respectively) and the control group (CG) (mean age, height and weight were 8.41 (SD = 4.32) years, 107.9 (SD = 26.33) cm, 21.40 (SD = 12.63) kg, respectively). r-TMS frequencies of 5 Hz and 10 Hz were administered for 15 min daily to patients in RG followed by standard therapy (ST) of 1 h duration daily for 20 days. Moreover, the patients in the control group (CG) were given only standard therapy (ST) of 1 h duration for 20 days. Modified Ashworth Scale (MAS) was used as an outcome measure to determine the level of muscle spasticity. A pre- assessment of MAS score was performed on both RG and CG to determine the level of spasticity prior to starting therapy; and similarly post-assessment after 20 days was done to observe the changes post-therapy. Statistical analysis of pre vs post MAS scores showed that few muscles showed reduction in muscle tightness after administering only ST in the CG. On the contrary, the RG that underwent r-TMS therapy combined with ST showed a significant decrease (p < 0.05) in muscle tightness for all the muscles selected for the therapy.

Transcranial Magnetic Stimulation Therapy in Spastic Cerebral Palsy Children Improves Motor Activity

Persons, who are paralysed due to accidents, use mechanical devices for their rehabilitation, as drugs really do not cure them. These devices could be passive or active having their own disadvantages of size, weight and overall complexity and providing limited degrees of freedom. As such, none of the available orthotic devices aid the patients with long term rehabilitation. This has led to a new area of studies, wherein a combination of the available body energy with sophisticated electronic devices, called Functional Electrical Stimulation (FES) is used for rehabilitation. FES is a rehabilitation technique that applies electrical currents to activate nerves innervating extremities affected by paralysis resulting from Spinal Cord Injury (SCI), head injury, stroke or other neurological disorders, restoring function in people with disabilities. The paper highlights the role played by FES in the rehabilitation of patients affected by paralysis of muscles like hemiplegia, paraplegia or quadriplegia. It focuses on its growth, applications, limitations and current status. The paper provides useful insight to those who want to work in the field of rehabilitation.

Recent advancements in prosthetic hand technology.

A novel scheme to control upper-limb prosthesis with toe gesture sensing system is presented in this paper. In the proposed system, copper/polymer stack capacitive touch sensors fabricated on a flexible substrate, interfaced with electronics and wireless transmitters forms a smart sensing insole. The scheme takes advantage of the user making various gestures with their left and right hallux digits in the form of a Morse code. The touch results in change in capacitance of the sensors from 56 ±2 pF to 75±3 pF, which is readout by an interface circuitry. This is transmitted wirelessly to a computing system attached to the prosthetic hand, which controls it resulting in various upper-limb prosthetic gestures or grasp patterns depending on the corresponding mapped Morse code. The differential current at the output of the capacitor is converted into voltage through an integrator based capacitance-voltage converter(CVC), fabricated with 0.18μm CMOS technology. The CVC is interfaced with off-the-shelf components. Details of the sensor, sensor interface and systems design, fabrication, validation, and overall functional assessment are presented in this work to show the potential of using toe gestures for upper-limb prosthetic control.

Coordination between lower limb muscles in different locomotion activities

Transcranial magnetic stimulation (TMS) is a new interventional tool used in the study of neuronal activity and treatment of psychiatric disorders. Repetitive TMS (rTMS) is a non-invasive technique of stimulating the brain employing magnetic pulses. Recent research has demonstrated the efficacy of rTMS in facilitating motor functions. Using these evidences, we studied the effectiveness of rTMS in improving motor activity in spastic cerebral palsy (CP) children. CP is a neuro-developmental disorder of movement and posture that is caused by injury to the developing brain that restrict activities of daily living. In the quest to treat CP, several interventions are used among which physical therapy is the mainstay therapy. In this study, we selected 45 spastic CP children and divided them randomly into three groups-the reference group (RG) that was provided only physical therapy (PT) for 30 minutes daily for 20 days; the interventional group (IG) that was administered rTMS frequency of 5Hz (IG-A) and 10Hz (IG-B) for 15 minutes (1500 pulses) daily followed by PT as in RG. Gross motor function measure (GMFM) was used as assessment tool to evaluate the motor performance. Prior to start of therapy, pre-assessment of GMFM was performed on all participants and post assessment after completion of 20 sessions. The result was statistically significant in all three groups (p<0.001) and the mean change demonstrated 0.64%, 1.75% and 2.59% improvement in motor activity among participants in RG, IG-A and IG-B respectively. The study demonstrated positive effect of rTMS in improving motor activity when combined with PT.

Study of signal processing techniques for EMG analysis

Abstract Recently, significant advances over the past decade have been made in robotics, artificial intelligence and other cognitive related fields, allowing development of highly sophisticated bio-mimetic robotics systems. In addition, enormous number of robots have been designed and assembled by explicitly realising their biological oriented behaviours. To enhance skill behaviours and adequate grasping abilities in these devices, a new phase of dexterous hands has been developed recently with bio-mimetically oriented and bio-inspired functionalities. The aim in writing this review paper is to present a detailed insight towards the development of the bio-mimetic based dexterous robotic multi-fingered artificial hand. An “ideal” upper limb prosthesis should be perceived as a part of their natural body by the amputee and should replicate sensory-motor capabilities of the amputated limb. Upper-limb amputations are most often the result of sudden trauma to the body, although they also can be caused by malignancy, congenital deficiencies and vascular diseases. This paper discusses the different bio-mimetic approaches using a framework that permits for a common description of biological and technical based hand manipulation behaviour. In particular, the review focuses on a number of developments in the inspired robotic systems. In conclusion, the study found that a huge amount of research efforts in terms of kinematics, dynamics, modelling and control methodologies are being put in to improve the present hand technology, thereby providing more functionality to the prosthetic limb of the amputee. This would improve their quality-of-life and help in performing activities of daily living (ADL) tasks with comparative ease in the near future.

Comparative study and feature extraction of the muscle activity patterns in healthy subjects

Locomotion activity is performed by the coordination of lower limb muscles. Cross-correlation is a mathematical tool to quantify the coordination. This study quantifies the coordination between hip-thigh muscles, using EMG (Electromyogram), in performing specific locomotion activities. Hip-Thigh muscles are the initial active muscles for general routine locomotion activity and hence their coordination gives a well insight to visualise the performance. The results show that the IL-GM (Iliopsoas and Gluteus Maximus) has highest level of coordination in almost all types of examined locomotion activities. The results can be employed in aiding the disabled and developing adaptive prosthesis.