In recent years, 3D printing gained considerable attention in the orthopedic sector. This work evaluates the feasibility of producing orthopedic scoliosis braces by 3D printing, comparing performance and costs with classical thermoforming procedures. Critical parameters, such as manufacture time, mechanical properties, weight, and comfort are carefully considered. Polyethylene terephthalate glycol-modified (PETG) was selected among the several filaments materials present on the market. Printed samples were analyzed with electronic microscope, tensile, and impact tests and compared with thermoformed polyethylene (PE) and polypropylene (PP) samples. Moreover, a cost analysis was carried out for the specific application. The thermoformed brace of a volunteer patient affected by scoliosis was reproduced using reverse-engineering techniques. The model was then printed as a single piece and postprocessed by an expert orthotist. Subsequently, the patient wore the brace in a pilot case to compare comfort and mechanical effectiveness. Results show that the 3D printing fabrication method is able to provide a valid alternative to the current fabrication methods, being also very competitive in terms of costs. The morphological analysis does not show critical defects in 3D printed samples, while the mechanical tests highlighted their anisotropy, with an overall brittleness of PETG samples in the direction orthogonal to the fibers. However, in terms of mechanical stresses, a back brace should never reach the polymer yield stress, otherwise the shape would be modified and the therapeutic effect could be compromised. Finally, the patient reported the perception of improved support and no significant comfort differences compared with the thermoformed brace.

Purpose: Human navigation skills are essential for everyday life and rely on several cognitive abilities, among which visual-spatial competences that are impaired in subjects with cerebral palsy (CP). In this work, we proposed navigation tasks in immersive virtual reality (IVR) to 15 children with CP and 13 typically developing (TD) peers in order to assess the individual navigation strategies and their modifiability in a situation resembling real life.Methods: We developed and adapted to IVR an application based on a 5-way maze in a playground that was to be navigated to find a reward. The learning process, navigation strategies, and adaptation to changes were compared between participants with CP and their TD peers and correlated with visual-spatial abilities and cognitive competences.Results: Most participants with CP needed more attempts than TD participants to become proficient in navigation. Furthermore, the learning phase was correlated to visual-spatial memory but not with cognitive competences. Interestingly, navigation skills were comparable between groups after stabilization. While TD participants mainly relied on allocentric strategies based on environmental cues, egocentric (self-centered) strategies based on body motion prevailed in participants with CP. Furthermore, participants with CP had more difficulties in modifying their navigation strategies, caused by difficulties in executive processes beyond the visual-perceptual impairment, with an inefficient shift between implicit and explicit competences.Conclusions: The navigation abilities in participants with CP seem to be different from their TD peers in terms of learning and adaptation to new conditions; this could deeply affect their everyday life and ultimately participation and inclusion. A regular assessing and focused rehabilitative plans could help to better navigate the environment and affect self-perception.

This paper presents a methodology and tools to improve the design of lower limb prosthesis through the measurement of pressure analysis at the interface residual limb-socket. The steps of the methodology and the design tools are presented using a case study focused on a transfemoral (amputation above knee) male amputee. The experimental setup based on F-Socket Tekscan pressure system is described as well the results of some static loading tests. Pressure data are visualized with a colour pressure map over the 3D model of the residual limb acquired using an optical low cost scanner, based on MS Kinect. Previous methodology is useful to evaluate a physical prototype; in order to improve also conceptual design, the Finite Element (FE) Analysis has been carried and results reached so far have been compared with experimental tests. Pressure distributions are comparable, even if some discrepancies have been highlighted due to sensors placements and implemented FE model. Future developments have been identified in order to improve the accuracy of the numerical simulations.

Development of specific medical devices (MDs) is required to meet the healthcare needs of children and young people (CYP). In this context, MD development should address changes in growth and psychosocial maturation, physiology, and pathophysiology, and avoid inappropriate repurposing of adult technologies. Underpinning the development of MD for CYP is the need to ensure MD safety and effectiveness through pediatric MD-specific regulations. Contrary to current perceptions of limited market potential, the global pediatric healthcare market is expected to generate around USD 15,984 million by 2025. There are 1.8 billion young people in the world today; 40% of the global population is under 24, creating significant future healthcare market opportunities. This review highlights a number of technology areas that have led to successful pediatric MD, including 3D printing, advanced materials, drug delivery, and diagnostic imaging. To ensure the targeted development of MD for CYP, collaboration across multiple professional disciplines is required, facilitated by a platform to foster collaboration and drive innovation. The European Pediatric Translational Research Infrastructure (EPTRI) will be established as the European platform to support collaboration, including the life sciences industrial sector, to identify unmet needs in child health and support the development, adoption, and commercialization of pediatric MDs.

Background Patients with cerebellar malformations exhibit not only movement problems, but also important deficits in social cognition. Thus, rehabilitation approaches should not only involve the recovery of motor function but also of higher-order abilities such as processing of social stimuli. In keeping with the general role of the cerebellum in anticipating and predicting events, we used a VR-based rehabilitation system to implement a social cognition intensive training specifically tailored to improve predictive abilities in social scenarios (VR-Spirit). Methods/design The study is an interventional randomised controlled trial that aims to recruit 42 children, adolescents and young adults with congenital cerebellar malformations, randomly allocated to the experimental group or the active control group. The experimental group is administered the VR-Spirit, requiring the participants to compete with different avatars in the reaching of recreational equipment and implicitly prompting them to form expectations about their playing preference. The active control group participates in a VR-training with standard games currently adopted for motor rehabilitation. Both trainings are composed by eight 45-min sessions and are administered in the GRAIL VR laboratory (Motekforce Link, Netherlands), an integrated platform that allows patients to move in natural and attractive VR environments. An evaluation session in VR with the same paradigm used in the VR-Spirit but implemented in a different scenario is administered at the beginning (T0) of the two trainings (T1) and at the end (T2). Moreover, a battery of neurocognitive tests spanning different domains is administered to all participants at T0, T2 and in a follow-up session after 2 months from the end of the two trainings (T3). Discussion This study offers a novel approach for rehabilitation based on specific neural mechanisms of the cerebellum. We aim to investigate the feasibility and efficacy of a new, intensive, social cognition training in a sample of Italian patients aged 7–25 years with congenital cerebellar malformations. We expect that VR-Spirit could enhance social prediction ability and indirectly improve cognitive performance in diverse domains. Moreover, through the comparison with a VR-active control training we aim to verify the specificity of VR-Spirit in improving social perception skills. Trial registration ISRCTN, ID: ISRCTN 22332873. Retrospectively registered on 12 March 2018.

ABSTRACT:Low-cost 3D sensors are nowadays widely diffused and many different solutions are available on the market. Some of these devices were developed for entertaining purposes, but are used also for acquisition and processing of different 3D data with the aim of documentation, research and study. Given the fact that these sensors were not developed for this purpose, it is necessary to evaluate their use in the capturing process. This paper shows a preliminary research comparing the Kinect 1 and 2 by Microsoft, the Structure Sensor by Occipital and the O&P Scan by Rodin4D in a medical scenario (i.e. human body scans). In particular, these sensors were compared to Minolta Vivid 9i, chosen as reference because of its higher accuracy. Different test objects were analysed: a calibrated flat plane, for the evaluation of the systematic distance error for each device, and three different parts of a mannequin, used as samples of human body parts. The results showed that the use of a certified flat plane is a good starting point in characterizing the sensors, but a complete analysis with objects similar to the ones of the real context of application is required. For example, the Kinect 2 presented the best results among the low-cost sensors on the flat plane, while the Structure Sensor was more reliable on the mannequin parts.

The use of 3D digitizing tools is becoming the base for subject-specific products, such as the orthopaedic production process of orthoses and prostheses. This paper aims at comparing the metrological behaviour of low-cost devices (Kinect 1 and 2 by Microsoft, Structure Sensor by Occipital) and high-resolution active sensors (O&P Scan by Rodin4D, NextEngine Ultra HD, Konica Minolta Vivid 9i, GOM ATOS II 400 and Artec Leo) for the survey of human body parts. A calibrated flat plane and a test-field composed of eight calibrated spheres of different radii and placed at different heights were used to evaluate the standard quality parameters (flatness, probing errors in form and size and the standard deviation) for each device as recommended by the VDI/VDE 2634 guidelines. Subsequently, three different parts of a mannequin were surveyed as samples of human body parts. The results demonstrated the higher accuracy of fixed devices with respect to handheld ones, among which Artec Leo and Structure Sensor provided a satisfying level of accuracy for the orthopaedic application. Moreover, the handheld devices enabled performing a fast reconstruction of the mannequin parts in about 20 s, which is acceptable for a person that has to remain as still as possible. For this reason, the Structure Sensor was further tested with five motion approaches which identified that smooth motion provides the lowest deviation and higher reliability. The work demonstrated the appropriateness of handheld devices for the orthopaedic application requirements in terms of speed, accuracy and costs.

In recent years, many research studies have focused on the application of 3D printing in the production of orthopaedic back braces. Several advantages, such as the ability to customise complex shapes, improved therapeutic effect and reduced production costs place this technology at the forefront in the ongoing evolution of the orthopaedic sector. In this work, four different materials, two of them poly(lactic acid) (PLA) and two of them poly(ethylene terephthalate glycol) (PETG), were characterised from a thermal, mechanical, rheological and morphological point of view. Our aim was to understand the effects of the material properties on the quality and functionality of a 3D-printed device. The specimens were cut from 3D-printed hemi-cylinders in two different orientation angles. Our results show that PETG-based samples have the best mechanical properties in terms of elastic modulus and elongation at break. The PLA-based samples demonstrated typical brittle behaviour, with elongation at break one order of magnitude lower. Impact tests demonstrated that the PETG-based samples had better properties in terms of energy absorption. Moreover, 3D-printed PETG samples demonstrated a better surface finishing with a more homogenous fibre–fibre interface. In summary, we demonstrate that the right choice of material and printing conditions are fundamental to satisfy the quality and functionality required for a scoliosis back brace.