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Orthopedics, Technology

“Intelligent” liner may improve prosthetic limb fit and function

0984-FieldsRuns200.jpgWhen I lived in the triathlete town of San Diego and tagged along for fun with a group who trained, a kind young man always gave me an encouraging word or high-five as he zoomed past me while running or cove swimming. He has a prosthetic leg, and although the device that helps him move around was clearly functional, and even sounded springy on the pavement, I wondered if a small shift in alignment could cause a great deal of discomfort.

This thought came back today as I came across news about an “intelligent” liner for better-fitting prostheses. A prototype of the device, which is being developed by researchers at the University of Southampton, uses sensors to detect pressure and forces at the point of contact between a patient’s stump and the prosthesis. Information on limb loading could lead to a better fitting and perhaps self-adjusting prosthesis, according to a release, which also notes:

There are 50,000 lower-limb amputees in the UK, most of whom use artificial limbs that are attached to the residual limb through a socket. No two stumps are exactly the same shape and size and even an individual’s stump can change shape over the course of a single day.

Pain, discomfort and ulceration are frequently experienced at the socket interface due to poor fit. This stems from the excessive build-up of pressure within the limb socket (causing high ‘loads’ on the stump).

Synthetic liners, worn like a sock over the stump, provide some cushioning against the hard socket, but at present there is no convenient way to accurately measure the critical loads at this interface in the clinic. Without this information, prosthetists face difficulty in fitting replacement limbs and the outcomes for patients are variable.

According to the non-profit Amuptee Coalition, nearly two million people in the United States live with limb loss.

Previously: Stanford graduates partner with clinics in developing countries to test low-cost prostheticBiotech start-up builds artful artificial limbs and Two Stanford students’ $20 device to treat clubfoot in developing countries
Photo by U.S. Army

Medicine and Society, Orthopedics, Stanford News

Art and anatomy: Decades-old collaboration brings augmented reality into the hands of Rodin

Art and anatomy: Decades-old collaboration brings augmented reality into the hands of Rodin

This Wednesday, the Cantor Art Museum is launching a first-of-its-kind exhibit, “Inside Rodin’s Hands: Art, Technology, and Surgery.” This unique exhibit uses 21st Century technology to look inside the works of Rodin’s 19th Century sculptures.  As described by Tracie White in today’s Inside Stanford Medicine, the exhibit:

…is a feat of interdisciplinary collaboration that celebrates a long-time connection between sculptor Auguste Rodin’s fascination with the human form and medicine’s fascination with human anatomy.

“A deep and rich history unites the art of the museum with the medical school,” said Connie Wolf, museum director, which has one of the largest Rodin exhibits, with 200 of his sculptures, including the Thinker and the Gates of Hell. “These statues have inspired faculty at the School of Medicine. Art is informing medicine in this exhibit. It’s unlike anything we’ve ever done before.”

Indeed, the rich history that Wolf refers to goes back to the early 90’s when Albert Elsen, PhD, joined forces with Robert Chase, MD. Elsen, a leading authority on Rodin, was the person most responsible for amassing the museum’s huge collection. Chase, then head of the Division of Anatomy, knew his art, too, having taught a popular course on Renaissance art and anatomy.

Because Rodin was known to use models with diseases and deformities, these two “super docents” delighted in taking med students on strolls through the Rodin Sculpture Garden. They’d wend their way through the garden, from one statue to the next, prompting the students to determine whether there were actual clues belying a medical condition, or were they simply seeing the results of the sculpture’s artistic license?

In 1991, I was lucky enough to tag along on one of these walks. By that time, I’d logged scads of Saturdays and Sundays at the garden, usually with drawing pad in hand. This time, it was a very different kind of tour, more akin to doing rounds in the hospital. These works of art that were models for my drawings, were now being diagnosed like patients. I was fascinated from the get-go. The last stop on our tour was the Gates of Hell. After an introduction to the monumental bronze, the focus shifted to the final “patient,” the life-sized statue of Eve, positioned on the right-side of the Gates. She sparked the liveliest discussion of the tour: Was the model for Eve pregnant? If so, how far along might she have been?

I remember how excited I was, seeing Rodin’s art in an entirely new way. It never entered my mind, that decades down the road, I’d get to experience that newly enlightened excitement, again. Nor, did it occur to me that I’d get to witness the trajectory that spans the last 23 years.

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Imaging, In the News, Orthopedics, Research

Goo inside bones provides structural support, study finds

Goo inside bones provides structural support, study finds

As high-schoolers swarm the med school campus today, hold human brains and satisfy their taste for science, I can’t help but wish the show “You Can’t Do That on Television” still existed and that the producers would set up in the parking lot and slime each participant upon completion of the day. But a welcome alternative is news that scientists have discovered gooey matter inside human bones.

In a 60-Second Health piece, writer Dina Fine Maron explains how “a combination of imaging techniques and modeling has revealed that our bones are filled with a natural chemical goo that’s key to the bones’ function as support structures,” and that the information could be used to inform osteoporosis treatment and prevention. The researchers’ findings were published in the Proceedings of the National Academy of Sciences.

Previously: Exploring the use of yoga to improve the health and strength of bones, 419 million year-old fish fossil may reveal origins of the human jaw and  Teen girls become orthopaedic surgeons for a day

Health and Fitness, In the News, Orthopedics, Stanford News

Watching your phone or tablet while working out may diminish form

Watching your phone or tablet while working out may diminish form

skeletonSnow White’s dwarves whistled while they worked. With the advent of the Walkman, runners could listen to music as they ran. Now, some people watch TV or movies on a mobile device while they hit the gym. Though all make a demanding physical task more entertaining, looking down at your smartphone in text-head position could harm your skeletal alignment, as Michael Fredericson, MD, professor of sports medicine at Stanford and team physician for several of the school’s sports teams, recently told the San Francisco Chronicle.

From the article:

Although [Frederickson's] in favor of anything that gets people to exercise more, he warns that running while you look down at a screen is poor form, and the distraction prevents you from focusing on your body.

“When you lean forward, you create an arch and hyperextension in your neck,” he says. “You may get a good cardio workout, but when you get off, you’ll be stiff in your upper body.”

Listening to music while you exercise might be a better option. Unlike TV or streaming video, many studies show that music can benefit a workout by distracting people from fatigue and elevating mood.

Fredericson said he even encourages people in his community running clinic to align their running cadence with songs that have 90 beats per minute. But he adds that the most serious runners, like those he works with on the Stanford track team, don’t train with media distractions. “They’re very focused on their bodies and the experience,” he said. “They have a goal in mind for every workout.”

Previously: Walking-and-texting impairs posture – and walking, and texting
Photo by Jim, the Photographer

Orthopedics, Sports, Videos

Using motion-capture technology to identify movements that alter tissue in dancers

Using motion-capture technology to identify movements that alter tissue in dancers

In a marvelous duet between humans and technology, the late choreographer Merce Cunningham used motion-capture sensors on dancers’ bodies to record movement and project the electronic dance as visual design for his 1999 work BIPED. Now, computer scientist Nadia Magnenat-Thalmann, PhD, of the University of Geneva in Switzerland has used sensors to capture what happens to dancers’ internal tissues during the movements they perform day after day. She presented her animations at a recent American Association for the Advancement of Science conference.

As New Scientist recently reported:

[Magnenat-Thalmann's] team carried out MRIs – but also asked six ballet dancers to perform typical dance moves while wearing a motion-capture suit. This allowed them to animate the underlying bone image with each dancer’s movements.

The result is a moving three-dimensional model of the ballerina’s skeleton – that mimics her actual movements. Algorithms then calculate how much stress is placed on each part of the body, drawing attention to areas that are likely to cause trouble in the future.

The findings could help doctors address joint problems and cartilage deformation among dancers. (And perhaps, one hopes, save a few from needing altogether-too-common hip replacements?)

Previously: Is repetitive heading in soccer a health hazard?Measuring the physical effects of yoga for seniorsWalking-and-texting impairs posture – and walking, and texting and Researchers look at brain activity to study falling

Orthopedics, Research

Walking-and-texting impairs posture – and walking, and texting

Walking-and-texting impairs posture - and walking, and texting

Figure 1My yoga teacher, Annie Carpenter, frequently includes movement directions in class that counteract a modern epidemic she calls “text head.” (Look down at your phone and notice your posture.) So I was delighted to come across a post today on PopSci.com highlighting a recent study on the very subject, citing many reasons you should bring your head into alignment with your spine right now.

Researchers from the University of Queensland, Australia used motion-capture technology to study how reading or typing with a mobile phone while walking affects the gait. The 26 participants walked in a straight line for approximately 8.5 meters.

PopSci reports that, “No surprise, the people reading or texting were slower, deviated from a straight line more, and on top of everything, didn’t text very accurately.”

From the study:

Gait performance was evaluated using a three-dimensional movement analysis system. In comparison with normal waking, when participants read or wrote text messages they walked with: greater absolute lateral foot position from one stride to the next; slower speed; greater rotation range of motion (ROM) of the head with respect to global space; the head held in a flexed position; more in-phase motion of the thorax and head in all planes, less motion between thorax and head (neck ROM); and more tightly organized coordination in lateral flexion and rotation directions. While writing text, participants walked slower, deviated more from a straight line and used less neck ROM than reading text. Although the arms and head moved with the thorax to reduce relative motion of the phone and facilitate reading and texting, movement of the head in global space increased and this could negatively impact the balance system.

The authors note, “Changes in gait associated with mobile phone use may undermine functional walking and impact on safety in common pedestrian environments.” So, keep your head up!

Previously: Toilets of the future, and the art of squatting, Exploring the use of yoga to improve the health and strength of bonesSpinal bracing for adolescents with scoliosis and “Barefoot” running craze still going strong
Photo by Schabrun et. al

Global Health, Orthopedics, Pediatrics, Rural Health, Stanford News, Technology, Videos

Two Stanford students’ $20 device to treat clubfoot in developing countries

In the video above, Stanford graduate students Jeff Yang and Ian Connolly demo their design for a brace to correct clubfoot in a way that’s comfortable and functional for the children who need it, and reasonable for their families to afford. The $20 device uses injection molded plastic attached to cleats to hold a child’s legs in an upright position so that they can strengthen the muscles they need eventually to maintain the posture without assistance. It also allows them to stand and move around with ease, and the device looks more like a toy than a restraint.

Yang and Connelly visited Brazil to learn more about the birth defect that affects one in 1,000 children whose feet appear to be rotated internally. There, clubfoot is commonly treated using rigid, ineffective metal braces, notes this video and an article on Wired.com. The students began working with the organization Miraclefeet during a Stanford D.School course titled “Design for Extreme Affordability” and put their design into action at a hospital in São Paulo.

Previously: Support for robots that assist people with disabilities, New documentary focuses on Stanford’s Design for Extreme Affordability courseBiotech start-up builds artful artificial limbs and Improving treatment for infant respiratory distress in developing countries
Photo in featured entry box from Design for Extreme Affordability

Aging, Complementary Medicine, Health and Fitness, NIH, Orthopedics, Research

Measuring the physical effects of yoga for seniors

Measuring the physical effects of yoga for seniors

LeslieAs my grandmother marched into her 80s, she would regularly eyeball pieces of furniture before sitting on them. “I’m afraid I won’t be able to get up,” she’d say, in the spirit of fun but with some underlying fear. Even though she and my grandfather stayed active by taking yoga classes at a senior center, and were a neighborhood hit riding their tandem tricycle in matching helmets and T-shirts, declining strength and range of motion with age just made certain everyday movements difficult.

I thought of my grandma while reading about an NIH-funded study from the University of Southern California and University of California, Los Angeles on yoga for seniors. Published in the journal BMC Complementary and Alternative Medicine, the study quantified the physical effects of seven poses in 20 ambulatory older adults whose average age was 70.7 years. Participants attended hour-long Hatha yoga classes twice a week for 32 weeks. The researchers used biomechanical methods joint moments of force (JMOF) and electromyographic analysis at the beginning and end of the study to measure each pose’s demands on select lower-extremity joints and muscles.

In a Research Spotlight, the National Center for Complementary and Alternative Medicine noted:

Findings from the study may be used to help design evidence-based yoga programs in which poses are chosen for the purpose of achieving a clinical goal (e.g., targeting specific joints or muscle groups or improving balance). The physical demands, efficacy, and safety of yoga for older adults have not been well studied, and older adults are at higher risk of developing musculoskeletal problems such as strains and sprains when doing yoga.

Study author Leslie Kazadi, a Los Angeles-based experienced yoga therapist, designed the yoga program with a geriatrician, exercise physiologist/biomechanist, and physical therapist from the research team and taught participants the poses. She told me that standing poses were chosen to target areas of the body that tend to become weak or limited in seniors. Hip stabilizers, for example, help with mobility and balance – and confidence in everyday situations, such as rising from a chair. “What you need to move around in the world is to be strong in your lower body,” Kazadi said. “If you don’t have stability downstairs, then you’re not going to get freedom upstairs no matter what.”

Previously: Exploring the use of yoga to improve the health and strength of bonesAsk Stanford Med: Pain expert responds to questions on integrative medicineExercise programs shown to decrease pain, improve health in group of older adults and Moderate physical activity not a risk factor for knee osteoarthritis, study shows
Photo by NCCAM/RaffertyWeiss Media

Orthopedics, Pain, Parenting, Pediatrics

On being a parent with chronic pain

Mom3The Atlantic posted a moving piece today written by a mother whose severe scoliosis has left her body in a near-constant state of pain. The author, Rachel Rabkin Peachman, points to a recent review of scientific literature documenting how children of parents with chronic pain are affected by their mothers’ and fathers’ condition:

The results, published in the Journal of Child and Adolescent Psychiatric Nursing, are, well, painful to read. It turns out that children whose parents experience chronic pain are at increased risk for adjustment problems and behavioral issues, and are more likely to complain of pain themselves. The whole family suffers.

Peachman details some of the studies’ findings. She also describes her own history with pain and parenting, and discusses the times she was unable to pick up and soothe her crying daughter. She writes:

Science may say the odds are against parents with chronic pain. And I know there are days I’m sidelined and short-tempered. But I’m determined to raise children who feel supported, secure, and loved. I don’t know what my future holds—surgery, therapies, or a lifetime of pain. But I have to believe that despite a deteriorating body, it’s possible to be a successful mother.

The entire piece is worth a read.

Previously: Image of the Week: The agony of painStanford researchers address the complexities of chronic painLetting go of control during chronic illness or pain and Chronic illness in childhood: One patient’s story
Photo by Miki Yoshihito

Complementary Medicine, Orthopedics, Research

Exploring the use of yoga to improve the health and strength of bones

Exploring the use of yoga to improve the health and strength of bones

yogaosteo I’ve written before about research studies on yoga, as well as components of my yoga teacher-training program. Delighted to find connections between the two worlds, I was interested recently to attend a workshop on yoga for osteoporosis and osteoarthritis with Loren Fishman, MD, an assistant clinical professor of rehabilitation and regenerative medicine at Columbia University Medical Center, and Annie Carpenter, founder of SmartFLOW® yoga.

Fishman is a physiatrist, dedicated yogi and proponent of yoga as a non-surgical, non-pharmaceutical approach to healing and preventive medicine. He’s published books on yoga for back pain, arthritis, and sciatica, among others, and he’s conducting a study of yoga in people who have osteoporosis.

Based on a 2009 pilot (.pdf) that showed improvement in bone density over a two-year period for the group of yoga practitioners versus a slight loss of bone in the control group, the current study prescribes a sequence of 12 yoga poses designed to place stress on the bones to generate cells and strengthen the bone’s dynamic support system. Participants track the poses they complete using an online scorecard, and their bone density is measured before and after practice is introduced. So far, he recently reported, in 65,000 hours of practice among 575 participants worldwide, no yoga-related fractures have been documented.

It’s essential for a patient to have a physician’s diagnosis of his condition before beginning yoga or any treatment program, Fishman and Carpenter emphasized in their workshop. And the most important job of a yoga teacher or therapist, Carpenter said, is being able to see the problems people are dealing with in their practice. She provided instruction on how to look at bodies in all three planes, find imbalances, examine the patterning in structure and movement and determine what to offer students as tools to improve their own well-being.

Previously: Ask Stanford Med: Pain expert responds to questions on integrative medicine, Exercise programs shown to decrease pain, improve health in group of older adults, Moderate physical activity not a risk factor for knee osteoarthritis, study shows, Treatments to reduce fractures for children with brittle-bone disease and New genetic regions associated with osteoporosis and bone fracture
Photo by Tiffany Caronia

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