Aim To investigate the effect of qualitatively different types of pedagogical feedback (FB) on the training, transfer and retention of basic manual dexterity dental skills using a virtual reality (VR) haptic dental simulator. Methods Sixty‐three participants (M = 22.7 years; SD = 3.4 years), with no previous dental training, were randomly allocated to one of three groups (n = 21 each). Group 1 received device‐only feedback during the training phase, that is the visual display of the simulator (DFB); Group 2 received verbal feedback from a qualified dental instructor (IFB); and Group 3 received a combination of instructor and device feedback (IDFB). Participants completed four tasks during which feedback was given according to group allocation as well as two skills transfer tests. Skill retention was examined immediately after training, at 1 week and at 1 month post‐test. Results Statistically significant differences were found between the groups in overall performance (P < 0.001) and error (P = 0.006). Post hoc comparisons revealed the IDFB group produced substantially better performance and fewer errors in comparison with DFB and IFB training. This difference translated to improved performance in skill retention and generalisation of knowledge to novel tasks. Conclusion These data indicate that the acquisition and retention of basic dental motor skills in novice trainees is best optimised through a combination of instructor and visual display (VR)‐driven feedback. The results have implications for the utility and implementation of VR haptic technology in dental education.

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This paper describes the development and use of the cooperative control scheme used by the intelligent pneumatic arm movement (iPAM) system to deliver safe, therapeutic treatment of the upper limb during voluntary reaching exercises. A set of clinical and engineering requirements for the control scheme are identified and detailed, which entail controlled, coordinated movement of a dual robot system with respect to the human upper limb. This is achieved by using a 6-DOF model of the upper limb that forms the controller's coordinate system. An admittance control scheme is developed by using this coordinate system such that robotic assistance can be varied as appropriate. Key controller components are derived, including kinematic and force transformations between the upper limb model and the dual robot task space. The controller is tested using a computational simulation and with a stroke subject in the iPAM system. The results demonstrate that the control scheme can reliably coordinate the dual robots to assist upper limb movements. A discussion considers the ramifications of using the system in practice, including the effects of measurement errors and controller limitations. In conclusion, the iPAM system has been shown to be effective at delivering variable levels of assistance to the upper limb joints during therapeutic movements in a clinically appropriate manner.

Handedness, a preference towards using the right or left hand, is established in early childhood. Such specialisation allows a higher level of skill to be maintained in the preferred hand on specific tasks through continuous practice and performance. Hand asymmetries might be expected to increase with age because of the time spent practising with the preferred hand. However, neurophysiological work has suggested reduced hemispheric function lateralisation in the aging brain, and behavioural studies have found reduced motor asymmetries in older adults (Przybla, Haaland, Bagesterio and Sainburg 2011). We therefore tested the predictions of behavioural change from reduced hemispheric function by measuring tracing performance (arguably one of the most lateralised of human behaviours) along paths of different thickness in a group of healthy young and older adults. Participants completed the task once with their preferred (right) hand and once with their non-preferred (left) hand. Movement Time (MT) and Shape Accuracy (SA) were dependant variables. A composite measure of MT and SA, the Speed Accuracy Cost Function (SACF) provided an overall measure of motor performance. Older participants were slower and less accurate when task demands were high. Combined analyses of both hands revealed reduced asymmetries in MT and SACF in the older group. The young were significantly faster when tracing with their preferred hand but older participants were equally slow with either hand. Our results are consistent with the growing literature reporting decreased hemispheric function lateralisation in the aging brain.

Diabetes is highly prevalent throughout the world and imposes a high economic cost on countries at all income levels. Foot ulceration is one devastating consequence of diabetes, which can lead to amputation and mortality. Clinical assessment of diabetic foot ulcer (DFU) is currently subjective and limited, impeding effective diagnosis, treatment and prevention. Studies have shown that pressure and shear stress at the plantar surface of the foot plays an important role in the development of DFUs. Quantification of these could provide an improved means of assessment of the risk of developing DFUs. However, commerciallyavailable sensing technology can only measure plantar pressures, neglecting shear stresses and thus limiting their clinical utility. Research into new sensor systems which can measure both plantar pressure and shear stresses are thus critical. Our aim in this paper is to provide the reader with an overview of recent advances in plantar pressure and stress sensing and offer insights into future needs in this critical area of healthcare. Firstly, we use current clinical understanding as the basis to define requirements for wearable sensor systems capable of assessing DFU. Secondly, we review the fundamental sensing technologies employed in this field and investigate the capabilities of the resultant wearable systems, including both commercial and research-grade equipment. Finally, we discuss research trends, ongoing challenges and future opportunities for improved sensing technologies to monitor plantar loading in the diabetic foot.

27This paper presents a method of characterizing the distribution of colorectal morphometrics. It uses 28 three-dimensional region growing and topological thinning algorithms to determine and visualize the 29 luminal volume and centerline of the colon, respectively. Total and segmental lengths, diameters, 30 volumes, and tortuosity angles were then quantified. The effects of body orientations on these 31 parameters were also examined. Variations in total length were predominately due to differences in 32 the transverse colon and sigmoid segments, and did not significantly differ between body orientations. 33The diameter of the proximal colon was significantly larger than the distal colon, with the largest 34 value at the ascending and caecum segments. The volume of the transverse colon was significantly the 35 largest, while those of the descending colon and rectum were the smallest. The prone position showed 36 a higher frequency of high angles and consequently found to be more torturous than the supine 37 position. This study yielded a method for complete segmental measurements of healthy colorectal 38 anatomy and its tortuosity. The transverse and sigmoid colons were the major determinant in 39 tortuosity and morphometrics between body orientations.

Abstract-An instrumented walking-aid, the iWA system, has been developed to measure kinematic and kinetic properties of walking aid (WA) use and deliver feedback to improve gait. The clinical requirements, technical specification and design of the system are developed through clinical collaboration. The development of the system is described, including hardware components and data analysis used to process the measured data for assessment. The system measurements are validated under controlled laboratory conditions. The iWA system is evaluated in a typical UK clinical environment by a participant in a rehabilitation session. The resultant data successfully capture the quality of the participant's walking aid use and agree with clinical opinion, supporting the efficacy of this approach.

Pelvic organ prolapse (POP) is one of the most common chronic disorders in women, impacting the quality of life of millions of them worldwide. More than 100 surgical procedures have been developed over the decades to treat POP. However, the failure of conservative strategies and the number of patients with recurrence risk have increased the need for further adjuvant treatments. Since their introduction, surgical synthetic meshes have dramatically transformed POP repair showing superior anatomic outcomes in comparison to traditional approaches. Although significant progress has been attained, among the meshes in clinical use, there is no single mesh appropriate for every surgery. Furthermore, due to the risk of complications including acute and chronic infection, mesh shrinkage, and erosion of the tissue, the benefits of the use of meshes have recently been questioned. The aim of this work is to review the evolution of POP surgery, analyzing the current challenges, and detailing the key factors pertinent to the design of new mesh systems. Starting with a description of the pelvic floor anatomy, the article then presents the traditional treatments used in pelvic organ disorders. Next, the development of synthetic meshes is described with an insight into how their function is dependent on both mesh design variables (i.e., material, structure, and functional treatment) and surgical applications. These are then linked to common mesh‐related complications, and an indication of current research aiming to address these issues.