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Incidence of traumatic peripheral nerve injuries and amputations in Sweden between 1998 and 2006
KTH, School of Technology and Health (STH), Neuronic Engineering. (Neuronik)
KTH, School of Technology and Health (STH), Neuronic Engineering. (Neuronik)
(Center of Epidemiology, Swedish National Board for Health and Welfare)
KTH, School of Technology and Health (STH), Neuronic Engineering. (Neuronik)
2008 (English)In: Neuroepidemiology, ISSN 0251-5350, E-ISSN 1423-0208Article in journal (Refereed) Published
Abstract [en]

Background: To define the epidemiological pattern of nerve injuries and traumatic amputations in Sweden, 1998-2006, and investigate possible targets for emerging neural engineering and neuroprosthetic technologies.

Methods: The Swedish Hospital Discharge Register was used as basis of information, including data from all public in-patient care, excluding out-patient data. ICD-10 codes were screened for nerve injuries and traumatic amputations of high incidence or in-patient care time. Selected codes, causing factors, age and gender distribution were discussed in detail, and potential targets for tailored solutions were identified.

Results: Incidence rate was determined to 13.9 for nerve injuries and 5.21 for amputations per 100 000 person-yrs. The majority of injuries occurred at wrist and hand level although it could be concluded that these are often minor injuries requiring less than a week of hospitalization. The single most care consuming nerve injury was brachial plexus injury constituting, in average, 68 injuries and 960 hospital days annually. When minor amputations of fingers and toes were disregarded, most frequent site of amputation was between knee and ankle (24 patients / year).

Conclusions: Based on analysis of incidence and care time, we find that brachial plexus injuries and lower leg amputations should be primary targets of these new technologies.

Place, publisher, year, edition, pages
Basel: Kargel, AG , 2008.
Keyword [en]
Traumatic nerve injury, Traumatic amputations, Epidemiology
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:kth:diva-9844DOI: 10.1159/000197900ISI: 000263534100010Scopus ID: 2-s2.0-58649100228OAI: oai:DiVA.org:kth-9844DiVA: diva2:133563
Note
QC 20100623Available from: 2009-01-12 Created: 2009-01-12 Last updated: 2013-04-03Bibliographically approved
In thesis
1. Conjugated Polymers for Neural Interfaces: Prospects, possibilities and future challenges
Open this publication in new window or tab >>Conjugated Polymers for Neural Interfaces: Prospects, possibilities and future challenges
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Within the field of neuroprosthetics the possibility to use implanted electrodes for communication with the nervous system is explored. Much effort is put into the material aspects of the electrode implant to increase charge injection capacity, suppress foreign body response and build micro sized electrode arrays allowing close contact with neurons. Conducting polymers, in particular poly(3,4-ethylene dioxythiophene) (PEDOT), have been suggested as materials highly interesting for such neural communication electrodes. The possibility to tailor the material both mechanically and biochemically to suit specific applications, is a substantial benefit with polymers when compared to metals. PEDOT also have hybrid charge transfer properties, including both electronic and ionic conduction, which allow for highly efficient charge injection.

 

Part of this thesis describes a method of tailoring PEDOT through exchanging the counter ion used in electropolymerisation process. Commonly used surfactants can thereby be excluded and instead, different biomolecules can be incorporated into the polymer. The electrochemical characteristics of the polymer film depend on the ion. PEDOT electropolymerised with heparin was here determined to have the most advantageous properties. In vitro methods were applied to confirm non-cytotoxicity of the formed PEDOT:biomolecular composites. In addition, biocompatibility was affirmed for PEDOT:heparin by evaluation of inflammatory response and neuron density when implanted in rodent cortex.

 

One advantage with PEDOT often stated, is its high stability compared to other conducting polymers. A battery of tests simulating the biological environment was therefore applied to investigate this stability, and especially the influence of the incorporated heparin. These tests showed that there was a decline in the electroactivity of PEDOT over time. This also applied in phosphate buffered saline at body temperature and in the absence of other stressors. The time course of degradation also differed depending on whether the counter ion was the surfactant polystyrene sulphonate or heparin, with a slightly better stability for the former.

 

One possibility with PEDOT, often overlooked for biological applications, is the use of its semi conducting properties in order to include logic functions in the implant. This thesis presents the concept of using PEDOT electrochemical transistors to construct textile electrode arrays with in-built multiplexing. Using the electrolyte mediated interaction between adjacent PEDOT coated fibres to switch the polymer coat between conducting and non conducting states, then transistor function can be included in the conducting textile. Analogue circuit simulations based on experimentally found transistor characteristics proved the feasibility of these textile arrays. Developments of better polymer coatings, electrolytes and encapsulation techniques for this technology, were also identified to be essential steps in order to make these devices truly useful.

 

In summary, this work shows the potential of PEDOT to improve neural interfaces in several ways. Some weaknesses of the polymer and the polymer electronics are presented and this, together with the epidemiological data, should point in the direction for future studies within this field.

Place, publisher, year, edition, pages
Stockholm: KTH, 2009. vi, 77 p.
Series
Trita-STH : report, ISSN 1653-3836 ; 2009:1
Keyword
neuroprosthetics, conjugated polymers, conducting polymers, PEDOT, functional electrical stimulation, neural electrodes
National Category
Medical Laboratory and Measurements Technologies Neurosciences Other Materials Engineering
Identifiers
urn:nbn:se:kth:diva-9817 (URN)978-91-7415-213-5 (ISBN)
Public defence
2009-01-30, Sal 3-221, Alfred Nobels Allé 10, Huddinge, 13:00 (English)
Opponent
Supervisors
Note
QC 20100623Available from: 2009-01-13 Created: 2009-01-09 Last updated: 2010-06-23Bibliographically approved
2. On the introduction of a grip strengthening glove for rehabilitating and assistive technology
Open this publication in new window or tab >>On the introduction of a grip strengthening glove for rehabilitating and assistive technology
2011 (English)Licentiate thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Stockholm: KTH Royal Institute of Technology, 2011. xiii, 14 p.
Series
Trita-STH : report, ISSN 1653-3836 ; 2011:2
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:kth:diva-38584 (URN)
Presentation
2011-06-07, Sal 3-221, Afred Nobels Allé 10, Felmingsberg, 10:00
Opponent
Supervisors
Note
QC 20110829Available from: 2011-08-29 Created: 2011-08-29Bibliographically approved
3. A Helping Hand: On Innovations for Rehabilitation and Assistive Technology
Open this publication in new window or tab >>A Helping Hand: On Innovations for Rehabilitation and Assistive Technology
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis focuses on assistive and rehabilitation technology for restoring the function of the hand. It presents three different approaches to assistive technology: one in the form of an orthosis, one in the form of a brain-computer interface combined with functional electrical stimulation and finally one totally aiming at rehabilitating the nervous system by restoring brain function using the concept of neuroplasticity. The thesis also includes an epidemiological study based on statistics from the Swedish Hospital Discharge Register and a review on different methods for assessment of hand function.

A novel invention of an orthosis in form of a light weight glove, the SEM (Soft Extra Muscle) glove, is introduced and described in detail. The SEM glove is constructed for improving the grasping capability of a human independently of the particular task being performed. A key feature is that a controlling and strengthening effect is achieved without the need for an external mechanical structure in the form of an exoskeleton. The glove is activated by input from tactile sensors in its fingertips and palm. The sensors react when the applied force is larger than 0.2 N and feed a microcontroller of DC motors. These pull lines, which are attached to the fingers of the glove and thus work as artificial tendons.

A clinical study on the feasibility of the SEM glove to improve hand function on a group of patients with varying degree of disability has been made. Assessments included passive and active range of finger motion, flexor muscle strength according to the Medical Research Council (MRC) 0-5 scale, grip strength using the Grippit hand dynamometer, fine motor skills according to the Nine Hole Peg test and hand function in common activities by use of the Sollerman test. Participants rated the potential benefit on a Visual Analogue Scale.

A prototype for a system for combining BCI (Brain-Computer Interface) and FES (Functional Electrical Stimulation) is described. The system is intended to be used during the first period of recovery from a TBI (Traumatic Brain Injury) or stroke that have led to paresis in the hand, before deciding on a permanent system, thus allowing the patients to get a quick start on the motor relearning. The system contains EEG recording electrodes, a control unit and a power unit. Initially the patients will practice controlling the movement of a robotic hand and then move on to controlling pulses being sent to stimulus electrodes placed on the paretic muscle.

An innovative electrophysiological device for rehabilitation of brain lesions is presented, consisting of a portable headset with electrodes on both sides adapted on the localization of treatment area. The purpose is to receive the outgoing signal from the healthy side of the brain and transfer that signal to the injured and surrounding area of the remote side, thereby having the potential to facilitate the reactivation of the injured brain tissue. The device consists of a control unit as well as a power unit to activate the circuit electronics for amplifying, filtering, AD-converting, multiplexing and switching the outgoing electric signals to the most optimal ingoing signal for treatment of the injured and surrounding area.

Place, publisher, year, edition, pages
Stockholm: KTH Royal Institute of Technology, 2013. viii, 51 p.
Series
TRITA-STH : report, ISSN 1653-3836 ; 2013:2
Keyword
Hand function, Mechatronic system, Orthose, Neurological rehabilitation, Brain-Computer Interface, Functional Electric Stimulation
National Category
Other Medical Engineering
Identifiers
urn:nbn:se:kth:diva-120142 (URN)978-91-7501-703-7 (ISBN)
Public defence
2013-04-18, Sal 4-221, Alfred Nobels Allé 12, Huddinge, 13:00 (English)
Opponent
Supervisors
Note

QC 20130403

Available from: 2013-04-03 Created: 2013-03-28 Last updated: 2017-02-22Bibliographically approved

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