There are currently 3 established techniques employed routinely to determine the risk of foot ulceration in the patient with diabetes mellitus. These are the assessment of circulation, neuropathy, and foot pressure. These assessments are widely used clinically as well as in the research domain with an aim to prevent the onset of foot ulceration. Routine neuropathic evaluation includes the assessment of sensory loss in the plantar skin of the foot using both the Semmes Weinstein monofilament and the biothesiometer. Thermological measurements of the foot to assess responses to thermal stimuli and cutaneous thermal discrimination threshold are relatively uncommon. Indeed, there remains uncertainty regarding the importance of thermal changes in the development of foot ulcers. Applications of thermography and thermometry in lower extremity wounds, vascular complications, and neuropathic complications have progressed as a result of improved imaging software and transducer technology. However, the uncertainty associated with the specific thermal modality, the costs, and processing times render its adaptation to the clinic. Therefore, wider adoption of thermological measurements has been limited. This article reviews thermal measurement techniques specific to diabetic foot such as electrical contact thermometry, cutaneous thermal discrimination thresholds, infrared thermography, and liquid crystal thermography.
The aim of this paper is to present a comparison of video- and sensor-based studies of swimming performance. The video-based approach is reviewed and contrasted to the newer sensor-based technology, specifically accelerometers based upon Micro-Electro-Mechanical Systems (MEMS) technology. Results from previously published swim performance studies using both the video and sensor technologies are summarised and evaluated against the conventional theory that upper arm movements are of primary interest when quantifying free-style technique. The authors conclude that multiple sensor-based measurements of swimmers' acceleration profiles have the potential to offer significant advances in coaching technique over the traditional video based approach.
There are, currently, 3 established clinical techniques routinely employed to determine the risk of ulceration in the diabetic foot. These are assessment of the circulation, the nervous control of sensation, and foot sensitivity to loading. Macrovascular measurements are used to assess sufficiency of the arterial supply to the foot. Evaluation of somatic neuropathy provides an indication of loss of plantar sensation. Skin pressure measurements indicate abnormalities in plantar loading. This combined approach is effective in allowing preventative measures to be applied prior to the onset of ulceration. In contrast, clinical measurement of microvascular function in the diabetic foot is uncommon. Indeed, there remains uncertainty regarding the importance of micro-vascular complications in the development of foot ulcers. This is in part due to the difficulty of making in vivo measurements of microvascular function. This article evaluates 3 noninvasive measurement techniques for routine microvascular assessment of the diabetic foot: transcutaneous oxygen tension, laser Doppler flowmetry, and near-infrared spectroscopy. These techniques can be used to obtain useful parameters of microvascular function including surface oxygen,blood flow, intracellular oxygenation, and cellular respiration. In principle, such measurements can be related to underlying pathophysiology, for example, microangiopathy or autonomic neuropathy. This article considers how these general techniques can be adapted to support routine clinical measurement of microvascular function, particularly in the neuropathic diabetic foot.
Recent advances in the development of transducers for the measurement of vertical and shear forces acting on the plantar surface of the foot are reviewed. Barefoot and in-shoe discrete and matrix transducers are reviewed in terms of structure, operation, performance and limitations. Examples of capacitive, piezo-electric, optical, conductive and resistive types of transducer are presented. Where available, the current clinical status is specified.
Functional Electrical Stimulation (FES) is a technique that uses electricity to activate the nerves of a muscle that is paralysed due to hemiplegia, multiple sclerosis, Parkinson's disease or spinal cord injury (SCI). FES has been widely used to restore upper limb functions in people with hemiplegia and C5-C7 tetraplegia and has improved their ability to perform their activities of daily living (ADL). At the time of writing, a detailed literature review of the existing upper limb FES devices and their man-machine interfaces (MMI) showed that only the NESS H200 was commercially available. However, the rigid arm splint doesn't fit everyone and prevents the use of a tenodesis grip. Hence, a robust and versatile upper limb FES device that can be used by a wider group of people is required.
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