Created more than 30 years ago, 3-dimensional printing (3DP) has recently seen a meteoric rise in interest within medicine, and the field of Physical Medicine and Rehabilitation is no exception. Also called additive manufacturing (AM), the recent increase in the use of 3DP is likely due to lower-cost printers as well as breakthroughs in techniques and processing. This thematic narrative review serves to introduce the rehabilitation professional to 3DP technology and how it is being applied to orthoses, prostheses, and assistive technology (AT). The basics of the technology, as well as the benefits and challenges of using it within the rehabilitation framework, are described. Proponents of the technology suggest that 3DP offers not only a better way to make devices, but a better way to make improved devices. However, the strength of this claim has not been properly tested by the current literature. This narrative review evaluates the evidence and provides a discussion of possible implications for the rehabilitation professional.
The COVID-19 era exposes what was already a crisis in the medical profession: structural racism, ageism, sexism, classism, and ableism resulting in healthcare disparities for Persons with Disabilities (PWD). Early research highlights these disparities, but we do not yet know the full impact of this pandemic on PWD. Over the last 20 years, many medical schools have attempted to develop disability competency trainings, but discrimination and inequities remain, resulting in a pervasive distrust of medicine by the disability community at large. In this commentary, we suggest that disability competency is insufficient because the healthcare disparities experienced by PWD are not simply a matter of individual biases, but structural and systemic factors requiring a culture shift in the healthcare professions. Recognizing that disability is a form of diversity that is experienced alongside other systemic disadvantages like social class, race, age, sex, gender identity, and geographic location, we explore the transformative potential of disability conscious medical education, training, and practice that draws on insights from intersectional disability justice activism. Disability conscious medicine is a novel approach, which improves upon competency programs by utilizing disability studies and the principles of disability justice to guide us in the critique of norms, traditions, and institutions to more fully promote the respect, beneficence, and justice that patients deserve.
Patients who undergo selective dorsal rhizotomy and, to a lesser extent, muscle tendon procedures demonstrate greater improvements in kinematic gait variables compared with nonsurgical interventions in patients with spasticity resulting from CP.
Annual federal stock assessment surveys for Alaskan sablefish also attempt to measure sperm whale depredation by quantifying visual evidence of depredation, including lip remains and damaged fish. A complementary passive acoustic method for quantifying depredation was investigated during the 2011 and 2012 survey hauls. A combination of machine-aided and human analysis counted the number of distinct “creak” sounds detected on autonomous recorders deployed during the survey, emphasizing sounds that are followed by silence (“creak-pauses”), a possible indication of prey capture. These raw counts were then adjusted for variations in background noise levels between deployments. Both a randomized Pearson correlation analysis and a generalized linear model found that noise-adjusted counts of “creak-pauses” were highly correlated with survey counts of lip remains during both years (2012: r(10) = 0.89, p = 1e-3; 2011: r(39) = 0.72, p = 4e-3) and somewhat correlated with observed sablefish damage in 2011 [r(39) = 0.37, p = 0.03], but uncorrelated with other species depredation. The acoustic depredation count was anywhere from 10% to 80% higher than the visual counts, depending on the survey year and assumptions employed. The results suggest that passive acoustics can provide upper bounds on depredation rates; however, the observed correlation breaks down whenever three or more whales are present.
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