Objective:To explore the effect of evidence-based care on lower-limb thrombosis and negative emotions following hip arthroplasty.Methods:A total of 108 patients undergoing hip arthroplasty at our hospital were randoml...Objective:To explore the effect of evidence-based care on lower-limb thrombosis and negative emotions following hip arthroplasty.Methods:A total of 108 patients undergoing hip arthroplasty at our hospital were randomly assigned to the observation group(n=54,evidence-based care)and the control group(n=54,conventional care).Postoperative complications,negative emotions,quality of life,activities of daily living,and patient satisfaction were compared between the two groups.Results:The observation group had a lower incidence of lower-limb thrombosis and overall complications,as well as higher patient satisfaction than the control group(all P<0.05).One month after discharge,patients in the observation group showed significantly lower scores on the Hamilton Anxiety Scale,the Hamilton Depression Scale,and activities of daily living scale,but with increased Generic Quality of Life Inventory-74 scores,compared with before intervention(all P<0.05).Conclusion:Evidence-based care significantly relieves anxiety and depression,reduces the incidence of lower-limb thrombosis,and improves quality of life in patients after hip arthroplasty.展开更多
This paper proposes virtual impedance adaptation of the lower-limb exoskeleton for human performance augmentation(LEHPA) based on deep reinforcement learning(VIADRL) to mitigate reliance on model accuracy and address ...This paper proposes virtual impedance adaptation of the lower-limb exoskeleton for human performance augmentation(LEHPA) based on deep reinforcement learning(VIADRL) to mitigate reliance on model accuracy and address the ever-changing human-exoskeleton interaction(HEI) dynamics. The classical sensitivity amplification control strategy is expanded to the virtual impedance control strategy with more learnable virtual impedance parameters. The adjustment of these virtual impedance parameters is formalized as finding the optimal policy for a Markov Decision Process and can then be effectively resolved using deep reinforcement learning algorithms. To ensure safe and efficient policy training, a multibody simulation environment is established to facilitate the training process, supplemented by the innovative hybrid inverse-forward dynamics simulation approach for executing the simulation. For comparison purposes, the SADRL strategy is introduced as a benchmark. A novel control performance evaluation method based on the HEI forces at the back, thighs, and shanks is proposed to quantitatively evaluate the performance of our proposed VIADRL strategy. The VIADRL controller is systematically compared with the SADRL controller at five selected walking speeds. The lumped ratio of HEI forces under the SADRL strategy relative to those under the SADRL strategy is as low as 0.81 in simulation and approximately 0.89 on the LEHPA prototype. The overall reduction of HEI forces demonstrates the superiority of the VIADRL strategy in comparison to the SADRL strategy.展开更多
Objective: To assess the effects of Tai Chi (Chinese shadow boxing exercise) for improving the lower-limb muscle strength in elderly people. Methods: The PUBMED database (from 1950), EMBASE-ASP database (from 1974), C...Objective: To assess the effects of Tai Chi (Chinese shadow boxing exercise) for improving the lower-limb muscle strength in elderly people. Methods: The PUBMED database (from 1950), EMBASE-ASP database (from 1974), Cochrane Library (from 1991), Elsevier sciences database (from 1990), OVID full text database (from 1997), Springer-link database (from 1997), The National Research Register database, ISI Web of knowledge (from 1963), Chinese Medical Citation Index/Chinese Medical Current Contents (CMCI/CMCC, from 1989), China Knowledge Resource Integrated Database (CNKI, from 1915),VIP database (from 1989), and Wanfang database (from 1977) have been searched only for the English and Chinese literatures updated to 10-30-2010. Two researchers independently assessed the methodological quality of studies, extracted and checked the data one another according to the include/exclude standards. Disagreement was resolved by discussions or with the third person. The Review Manage Software 5.0 was used for Meta-analysis. Results: Eventually, 2 randomized controled studies and 2 non-randomized controled studies met the inclusion criteria, with 163 subjects involved in the present meta-analysis. The meta-analysis demonstrated that Tai Chi exercise could improve the ankle flexor/extensor muscle strength and the knee extensor/flexor muscle strength, tested with an isokinetic dynamometer. The limb muscle strength increased significantly after Tai Chi exercise (P<0.01). Conclusion: The meta-analysis favours Tai Chi exercise for improving the lower-limb muscle strength in the older people.展开更多
Unilateral motor impairment can disrupt the coordination between the joints,impeding the patient’s normal gait.To assist such patients to walk normally and naturally,an adaptive control algorithm based on inter-joint...Unilateral motor impairment can disrupt the coordination between the joints,impeding the patient’s normal gait.To assist such patients to walk normally and naturally,an adaptive control algorithm based on inter-joint coordination was proposed in this work for lower-limb exoskeletons.The control strategy can generate the reference trajectory of the affected leg in real time based on a motion coordination model between the joints,and adopt an adaptive controller with virtual windows to track the reference trajectory.Long Short-Term Memory(LSTM)network was also adopted to establish the coordination model between the joints of both lower limbs,which was optimized by preprocessing angle information and adding gait phase information.In the adaptive controller,the virtual windows were symmetrically distributed around the reference trajectory,and its width was adjusted according to the gait phase of the auxiliary leg.In addition,the impedance parameters of the controller were updated online to match the motion capacity of the affected leg based on the spatiotemporal symmetry factors between the bilateral gaits.The LSTM coordination model demonstrated good accuracy and generality in the gait database of seven individuals,with an average root mean square error of 3.5 and 4.1 for the hip and knee joint angle estimation,respectively.To further evaluate the control algorithm,four healthy subjects walked wearing the exoskeleton while additional weights were added around the ankle joint to simulate an asymmetric gait.From the experimental results,it was shown that the algorithm improved the gait symmetry of the subjects to a normal level while exhibiting great adaptability to different subjects.展开更多
Aim: We devised a self-care supporting program targeting patients with early stages of secondary lower-limb lymphedema. The program incorporates “Simple exercises to replace lymphatic drainage” based on lymphatic fl...Aim: We devised a self-care supporting program targeting patients with early stages of secondary lower-limb lymphedema. The program incorporates “Simple exercises to replace lymphatic drainage” based on lymphatic flow. The purpose of this study was to consider the feasibility of continuing this program. Methods: The participants were patients in the early stages of secondary lower-limb lymphedema after gynecological cancer surgery and lymphedema therapists with more than five years of experience. Patients continued self-care at home after being briefed on the program, and they were analyzed on their self-care continuity status one month later based on a self-administered questionnaire survey and self-care notes. We interviewed the lymphedema therapists about this program to discuss the feasibility of continuing it and obtain feedback. Results: The patients who participated in the study were six women who underwent surgery with lymph node dissection for gynecological cancer. The therapists were five nurses and one occupational therapist. The patient understood the importance of all items in the self-care. “Observation,” “Touching,” and “Skin care” were relatively easy to continue. “Lymph drainage” and “Exercise” were continued with “Simple exercises to replace lymphatic drainage”. “Other exercises” were able to continue by adding distance and time to daily activities. Furthermore, “Measurement” and “Recording” became a burden and were difficult to continue. Nonetheless, this program was generally approved by the lymphedema therapists. They also pointed out the content and format of the self-care notes as improvements. Conclusions: We found that the self-care supporting program that incorporated “Simple exercises to replace lymphatic drainage” might be feasible to continue self-care for patients with early stages of secondary lower-limb lymphedema. Furthermore, we found that we needed to improve the “Measurement” and “Recording” sections of this program.展开更多
AIM To evaluate the lower-limb muscle oxygenation in hemodialysis(HD) patients and identify the factors associating with muscle oxygenation.METHODS Sixty-seven HD patients(53 men and 14 women; mean age, 67.1 ± 1....AIM To evaluate the lower-limb muscle oxygenation in hemodialysis(HD) patients and identify the factors associating with muscle oxygenation.METHODS Sixty-seven HD patients(53 men and 14 women; mean age, 67.1 ± 1.2 years; mean HD duration, 5.6 ± 0.9 years) were recruited. In addition, 15 healthy individuals(nine men and six women; mean age, 38.2 ± 4.6 years) were recruited as the control group. Lower-limb muscle regional saturation of oxygen(rS O_2) was monitored on the lateral side of the gastrocnemius muscle before HD using an INVOS 5100C(Covidien Japan, Tokyo, Japan), which utilizes near-infrared spectroscopy. Here, we evaluated the association between lower-limb muscle rS O_2 and clinical parameters.RESULTS The r SO_2 values were significantly lower in patients undergoing HD than in healthy individuals(50.0%± 1.7% vs 76.8% ± 2.5%, P < 0.001). Lower-limb muscle r SO_2 showed significant positive correlations with diastolic blood pressure, blood urea nitrogen concentration, serum creatinine concentration, serum potassium concentration, serum inorganic phosphate concentration, and serum albumin concentration as well as negative correlation with HD duration. We conducted a multiple linear regression analysis using parameters that were significantly correlated with the lower-limb muscle r SO_2 in a simple linear regression analysis. Multiple regression analysis demonstrated that lowerlimb muscle r SO_2 was independently associated with serum inorganic phosphate(standardized coefficient: 0.27) and serum albumin concentrations(standardized coefficient: 0.24). In addition, there were no differences in lower-limb muscle r SO_2 between diabetic and nondiabetic HD patients. This study has several limitations. Firstly, its sample size was relatively small. Secondly, we could not evaluate the association between lowerlimb muscle r SO_2 and calculated nutritional markers, including normalized protein catabolic rate and body mass index, anthropometric measurements representing nutritional status, and the severity of protein-energy wasting. Finally, we did not routinely examine the arterial vascular status of HD patients without symptoms of peripheral artery disease. As such, it is possible that some HD patients with subclinical peripheral artery disease may have been included in this study.CONCLUSION In HD patients, the oxygenation of lower-limb muscle tissue was associated with serum inorganic phosphate and albumin concentrations, both of which represent nutritional status.展开更多
Modern human has different body proportion from early hominids and great apes.Comparing with others,in general,modern human adults have relatively long lower limb and heavier body weight.Since the lower limbs provide ...Modern human has different body proportion from early hominids and great apes.Comparing with others,in general,modern human adults have relatively long lower limb and heavier body weight.Since the lower limbs provide support to the whole body and play an important role in walking,it is proposed that the ratio of the lower limb to the whole body for modern human could be beneficial to bipedal walking.This study tried to estimate the muscle parameters of the lower limb in walking for the subjects with various body proportions.Using a simplified musculoskeletal model,some muscle parameters of the lower limb,e.g.muscle force,stress,work and power,were estimated for modern human adult,child,AL 288-1(the fossil specimens of Australopithecus afarensis,3.18 million years old)and apes.The results show that with the body proportion modern human adult spends less muscle work and power in walking than other subjects.The results imply that using the cost of transport(i.e.the muscle work of the lower limb per unit of displacement)as the criteria,the early hominids,if their body proportions were structurally similar to AL 288-1,could evolve towards what modern human adult looks like,in order to save energy during bipedal walking.展开更多
Patients undergoing lower-limb orthopedic surgery may experience multiple postoperative complications.Although peripheral nerve stimulation(PNS)is a promising nonpharmacological approach that has been used in lower-li...Patients undergoing lower-limb orthopedic surgery may experience multiple postoperative complications.Although peripheral nerve stimulation(PNS)is a promising nonpharmacological approach that has been used in lower-limb postoperative recovery,the clinical efficacy of PNS remains inconclusive.This study systematically searched three databases(PubMed,Embase,and Cochrane Library)for randomized controlled trials(RCTs)that examined the treatment effects of PNSs in patients who underwent lowerlimb orthopedic surgery up to September 29,2023.Two investigators independently identified studies,extracted data,and conducted meta-analyses with Review Manager 5.4.The outcomes were pain relief(measured by reductions in pain intensity and analgesic consumption)and functional improvements(range of motion[ROM]and length of hospitalization[LOH]).A total of 633 patients including 321 in the experimental groups and 312 in the control groups from eight RCTs were included.PNS showed no significant effect on pain intensity,while analgesic consumption was marginally significantly reduced in the experimental group.Furthermore,no significant differences were observed regarding functional improvements in ROM or LOH after the intervention.Although PNS had no significant effect on pain relief or functional improvements,the intervention exhibited a marginally significant reduction in analgesic consumption.Future trials should be conducted with larger sample sizes,longer follow-up periods,and more varied stimulation parameters.展开更多
文摘Objective:To explore the effect of evidence-based care on lower-limb thrombosis and negative emotions following hip arthroplasty.Methods:A total of 108 patients undergoing hip arthroplasty at our hospital were randomly assigned to the observation group(n=54,evidence-based care)and the control group(n=54,conventional care).Postoperative complications,negative emotions,quality of life,activities of daily living,and patient satisfaction were compared between the two groups.Results:The observation group had a lower incidence of lower-limb thrombosis and overall complications,as well as higher patient satisfaction than the control group(all P<0.05).One month after discharge,patients in the observation group showed significantly lower scores on the Hamilton Anxiety Scale,the Hamilton Depression Scale,and activities of daily living scale,but with increased Generic Quality of Life Inventory-74 scores,compared with before intervention(all P<0.05).Conclusion:Evidence-based care significantly relieves anxiety and depression,reduces the incidence of lower-limb thrombosis,and improves quality of life in patients after hip arthroplasty.
文摘This paper proposes virtual impedance adaptation of the lower-limb exoskeleton for human performance augmentation(LEHPA) based on deep reinforcement learning(VIADRL) to mitigate reliance on model accuracy and address the ever-changing human-exoskeleton interaction(HEI) dynamics. The classical sensitivity amplification control strategy is expanded to the virtual impedance control strategy with more learnable virtual impedance parameters. The adjustment of these virtual impedance parameters is formalized as finding the optimal policy for a Markov Decision Process and can then be effectively resolved using deep reinforcement learning algorithms. To ensure safe and efficient policy training, a multibody simulation environment is established to facilitate the training process, supplemented by the innovative hybrid inverse-forward dynamics simulation approach for executing the simulation. For comparison purposes, the SADRL strategy is introduced as a benchmark. A novel control performance evaluation method based on the HEI forces at the back, thighs, and shanks is proposed to quantitatively evaluate the performance of our proposed VIADRL strategy. The VIADRL controller is systematically compared with the SADRL controller at five selected walking speeds. The lumped ratio of HEI forces under the SADRL strategy relative to those under the SADRL strategy is as low as 0.81 in simulation and approximately 0.89 on the LEHPA prototype. The overall reduction of HEI forces demonstrates the superiority of the VIADRL strategy in comparison to the SADRL strategy.
文摘Objective: To assess the effects of Tai Chi (Chinese shadow boxing exercise) for improving the lower-limb muscle strength in elderly people. Methods: The PUBMED database (from 1950), EMBASE-ASP database (from 1974), Cochrane Library (from 1991), Elsevier sciences database (from 1990), OVID full text database (from 1997), Springer-link database (from 1997), The National Research Register database, ISI Web of knowledge (from 1963), Chinese Medical Citation Index/Chinese Medical Current Contents (CMCI/CMCC, from 1989), China Knowledge Resource Integrated Database (CNKI, from 1915),VIP database (from 1989), and Wanfang database (from 1977) have been searched only for the English and Chinese literatures updated to 10-30-2010. Two researchers independently assessed the methodological quality of studies, extracted and checked the data one another according to the include/exclude standards. Disagreement was resolved by discussions or with the third person. The Review Manage Software 5.0 was used for Meta-analysis. Results: Eventually, 2 randomized controled studies and 2 non-randomized controled studies met the inclusion criteria, with 163 subjects involved in the present meta-analysis. The meta-analysis demonstrated that Tai Chi exercise could improve the ankle flexor/extensor muscle strength and the knee extensor/flexor muscle strength, tested with an isokinetic dynamometer. The limb muscle strength increased significantly after Tai Chi exercise (P<0.01). Conclusion: The meta-analysis favours Tai Chi exercise for improving the lower-limb muscle strength in the older people.
基金supported by the Graduate Scientific Research and Innovation Foundation of Chongqing,China(CYB19062)the China Scholarship Council(CSC202206050121).
文摘Unilateral motor impairment can disrupt the coordination between the joints,impeding the patient’s normal gait.To assist such patients to walk normally and naturally,an adaptive control algorithm based on inter-joint coordination was proposed in this work for lower-limb exoskeletons.The control strategy can generate the reference trajectory of the affected leg in real time based on a motion coordination model between the joints,and adopt an adaptive controller with virtual windows to track the reference trajectory.Long Short-Term Memory(LSTM)network was also adopted to establish the coordination model between the joints of both lower limbs,which was optimized by preprocessing angle information and adding gait phase information.In the adaptive controller,the virtual windows were symmetrically distributed around the reference trajectory,and its width was adjusted according to the gait phase of the auxiliary leg.In addition,the impedance parameters of the controller were updated online to match the motion capacity of the affected leg based on the spatiotemporal symmetry factors between the bilateral gaits.The LSTM coordination model demonstrated good accuracy and generality in the gait database of seven individuals,with an average root mean square error of 3.5 and 4.1 for the hip and knee joint angle estimation,respectively.To further evaluate the control algorithm,four healthy subjects walked wearing the exoskeleton while additional weights were added around the ankle joint to simulate an asymmetric gait.From the experimental results,it was shown that the algorithm improved the gait symmetry of the subjects to a normal level while exhibiting great adaptability to different subjects.
文摘Aim: We devised a self-care supporting program targeting patients with early stages of secondary lower-limb lymphedema. The program incorporates “Simple exercises to replace lymphatic drainage” based on lymphatic flow. The purpose of this study was to consider the feasibility of continuing this program. Methods: The participants were patients in the early stages of secondary lower-limb lymphedema after gynecological cancer surgery and lymphedema therapists with more than five years of experience. Patients continued self-care at home after being briefed on the program, and they were analyzed on their self-care continuity status one month later based on a self-administered questionnaire survey and self-care notes. We interviewed the lymphedema therapists about this program to discuss the feasibility of continuing it and obtain feedback. Results: The patients who participated in the study were six women who underwent surgery with lymph node dissection for gynecological cancer. The therapists were five nurses and one occupational therapist. The patient understood the importance of all items in the self-care. “Observation,” “Touching,” and “Skin care” were relatively easy to continue. “Lymph drainage” and “Exercise” were continued with “Simple exercises to replace lymphatic drainage”. “Other exercises” were able to continue by adding distance and time to daily activities. Furthermore, “Measurement” and “Recording” became a burden and were difficult to continue. Nonetheless, this program was generally approved by the lymphedema therapists. They also pointed out the content and format of the self-care notes as improvements. Conclusions: We found that the self-care supporting program that incorporated “Simple exercises to replace lymphatic drainage” might be feasible to continue self-care for patients with early stages of secondary lower-limb lymphedema. Furthermore, we found that we needed to improve the “Measurement” and “Recording” sections of this program.
文摘AIM To evaluate the lower-limb muscle oxygenation in hemodialysis(HD) patients and identify the factors associating with muscle oxygenation.METHODS Sixty-seven HD patients(53 men and 14 women; mean age, 67.1 ± 1.2 years; mean HD duration, 5.6 ± 0.9 years) were recruited. In addition, 15 healthy individuals(nine men and six women; mean age, 38.2 ± 4.6 years) were recruited as the control group. Lower-limb muscle regional saturation of oxygen(rS O_2) was monitored on the lateral side of the gastrocnemius muscle before HD using an INVOS 5100C(Covidien Japan, Tokyo, Japan), which utilizes near-infrared spectroscopy. Here, we evaluated the association between lower-limb muscle rS O_2 and clinical parameters.RESULTS The r SO_2 values were significantly lower in patients undergoing HD than in healthy individuals(50.0%± 1.7% vs 76.8% ± 2.5%, P < 0.001). Lower-limb muscle r SO_2 showed significant positive correlations with diastolic blood pressure, blood urea nitrogen concentration, serum creatinine concentration, serum potassium concentration, serum inorganic phosphate concentration, and serum albumin concentration as well as negative correlation with HD duration. We conducted a multiple linear regression analysis using parameters that were significantly correlated with the lower-limb muscle r SO_2 in a simple linear regression analysis. Multiple regression analysis demonstrated that lowerlimb muscle r SO_2 was independently associated with serum inorganic phosphate(standardized coefficient: 0.27) and serum albumin concentrations(standardized coefficient: 0.24). In addition, there were no differences in lower-limb muscle r SO_2 between diabetic and nondiabetic HD patients. This study has several limitations. Firstly, its sample size was relatively small. Secondly, we could not evaluate the association between lowerlimb muscle r SO_2 and calculated nutritional markers, including normalized protein catabolic rate and body mass index, anthropometric measurements representing nutritional status, and the severity of protein-energy wasting. Finally, we did not routinely examine the arterial vascular status of HD patients without symptoms of peripheral artery disease. As such, it is possible that some HD patients with subclinical peripheral artery disease may have been included in this study.CONCLUSION In HD patients, the oxygenation of lower-limb muscle tissue was associated with serum inorganic phosphate and albumin concentrations, both of which represent nutritional status.
基金Supported in part by the grants fromthe BiotechnologyBiological Sciences Research Council,the Leverhulme Trustthe Natural Environment Research Council,U.K.
文摘Modern human has different body proportion from early hominids and great apes.Comparing with others,in general,modern human adults have relatively long lower limb and heavier body weight.Since the lower limbs provide support to the whole body and play an important role in walking,it is proposed that the ratio of the lower limb to the whole body for modern human could be beneficial to bipedal walking.This study tried to estimate the muscle parameters of the lower limb in walking for the subjects with various body proportions.Using a simplified musculoskeletal model,some muscle parameters of the lower limb,e.g.muscle force,stress,work and power,were estimated for modern human adult,child,AL 288-1(the fossil specimens of Australopithecus afarensis,3.18 million years old)and apes.The results show that with the body proportion modern human adult spends less muscle work and power in walking than other subjects.The results imply that using the cost of transport(i.e.the muscle work of the lower limb per unit of displacement)as the criteria,the early hominids,if their body proportions were structurally similar to AL 288-1,could evolve towards what modern human adult looks like,in order to save energy during bipedal walking.
基金supported by the National Natural Science Foundation of China(No.32200901,32171078)the project funded by China Postdoctoral Science Foundation(No.2022M723363)the Scientific Foundation of Institute of Psychology,Chinese Academy of Sciences(No.E2CX6815CX).
文摘Patients undergoing lower-limb orthopedic surgery may experience multiple postoperative complications.Although peripheral nerve stimulation(PNS)is a promising nonpharmacological approach that has been used in lower-limb postoperative recovery,the clinical efficacy of PNS remains inconclusive.This study systematically searched three databases(PubMed,Embase,and Cochrane Library)for randomized controlled trials(RCTs)that examined the treatment effects of PNSs in patients who underwent lowerlimb orthopedic surgery up to September 29,2023.Two investigators independently identified studies,extracted data,and conducted meta-analyses with Review Manager 5.4.The outcomes were pain relief(measured by reductions in pain intensity and analgesic consumption)and functional improvements(range of motion[ROM]and length of hospitalization[LOH]).A total of 633 patients including 321 in the experimental groups and 312 in the control groups from eight RCTs were included.PNS showed no significant effect on pain intensity,while analgesic consumption was marginally significantly reduced in the experimental group.Furthermore,no significant differences were observed regarding functional improvements in ROM or LOH after the intervention.Although PNS had no significant effect on pain relief or functional improvements,the intervention exhibited a marginally significant reduction in analgesic consumption.Future trials should be conducted with larger sample sizes,longer follow-up periods,and more varied stimulation parameters.
