This study demonstrates the development and application of a novel workflow for designing and fabricating orthoses, using a combination of 3D scanning and 3D printing technologies. The workflow is applied to a clinically relevant translational case study in a patient with a neurological disorder and complex clinical needs. All traditional and commercial approaches to helping the patient's cervical instability and resulting 'head-drop' had previously failed, with associated progressive deterioration in the patient's clinical state and posture. The workflow was developed to design and fabricate a bespoke device for this patient with no viable alternative therapy. The workflow was developed to generate 3D printable geometry from obtained 3D scan data. The workflow includes algorithms to relax geometry, distribute material efficiently and for variational cutting of orthosis padding material. The 3D patient scan was validated against actual measurements to ensure accuracy of measurements. A total of four prototypes were produced with each iteration being improved based on patient and clinical feedback. There was a progressive improvement in subjective feedback through each iteration at sites of discomfort and overall comfort score. There was a marked improvement in the patient's posture with correction at the cervical and lumbar spine with the 3D-printed padded collar being worn for 4 hour periods. This study has implications for the rapid production of personalised orthoses which can help reduce patient waiting time, improve patient compliance, reduce pain and reduce further deterioration. The workflow could form the basis for an integrated process, whereby a single hospital visit results in a bespoke orthosis optimised and personalised for each patient.
Vibration stimulation seems to be an affordable easy-to-use rehabilitation tool. Focal muscle vibration (FV) has potential to reduce spasticity and enhance muscle strength and performance. Combined with robotic assisted movement therapy, the rehabilitation can benefit from improvement of more than one aspect. For example, FV could firstly decrease abnormally increased muscle tone and joint rigidity by tackling volitional control for easier robotic movement exercise. Exactly this approach is evaluated within a clinical trial presented in this paper. FV were applied to relaxed spastic wrist flexor and extensor muscles for 15min. Subsequently, the wrist was engaged in a robotic-assisted game-playing. Results from two cases who completed the trial showed short-term decrease in wrist stiffness as assessed by clinical spasticity measurement Modified Ashworth Scale (MAS). Active range of motion (AROM) and engineering joint stiffness (JS) measurements were estimated using a robotic apparatus and the results complemented previous observations. The AROM increased and JS decreased for both cases when compared at the beginning and at the end of each interventional session. These results are a part of an ongoing clinical trial but show promise for reducing repercussions of spasticity in incomplete spinal cord injury.
The author was asked to share her experience of the Lomax Active wheelchair range, in relation to working within the specific field of spinal cord injury. From clinical experience, it is the author's opinion that, on returning home from initial rehabilitation, the majority of this client group benefits from a relatively high specification wheelchair that allows them to maintain as independent a lifestyle as possible. Such provision allows clients to optimize their potential and promotes reintegration into the community, while allowing the clients to identify their long-term wheelchair specification requirements.
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