Compression Garments for Medical Therapy and Sports

Team Approach: Osseointegration Amputation Surgery

» The purpose of this article was to review the multidisciplinary, team-based approach necessary for the optimal management of patients with limb loss undergoing osseointegration surgery.» In this study, we describe the interdisciplinary process of screening, counseling, and surgical and rehabilitation considerations with an emphasis on principles rather than specific implants or techniques.» Integrated perioperative management and long-term surveillance are crucial to ensure the best possible outcomes.» We hope this model will service as an implant-agnostic guide to others seeking to development an osseointegration center of excellence.

Influence of compression garments on proprioception: A systematic review and meta-analysis

Compression garments (CGs) are commonly used in rehabilitation and sports contexts to enhance performance and speed up recovery. Despite the growing use of CGs in recent decades, there is no unanimous consensus on their overall influence on joint proprioception. In this current meta-analysis, we aim to fill this knowledge gap by assessing the impact of CGs on joint proprioception. We conducted a literature search across seven databases and one registry. Ultimately, we included 27 studies with 671 participants. The meta-analysis revealed that wearing CGs resulted in a significant reduction in absolute error during joint position sensing (Hedges' g: -0.64, p = 0.006) as compared to no CGs. However, further analyses of variables such as constant error (p = 0.308), variable error (p = 0.541) during joint position sense tests, threshold to detect passive motion (p = 0.757), and active movement extent discrimination (p = 0.842) did not show a significant impact of CGs. The review also identified gaps in the reporting of certain outcomes, such as parameters of CGs, reporting of performance, individual-reported outcomes, and lack of placebo comparators. Consequently, this review provides guidelines for future studies that may facilitate evidence-based synthesis and ultimately contribute to a better understanding of the overall influence of CGs on joint proprioception.

Stretchable electronic strips for electronic textiles enabled by 3D helical structure

The development of stretchable electronic devices is a critical area of research for wearable electronics, particularly electronic textiles (e-textiles), where electronic devices embedded in clothing need to stretch and bend with the body. While stretchable electronics technologies exist, none have been widely adopted. This work presents a novel and potentially transformative approach to stretchable electronics using a ubiquitous structure: the helix. A strip of flexible circuitry ('e-strip') is twisted to form a helical ribbon, transforming it from flexible to stretchable. A stretchable core-in this case rubber cord-supports the structure, preventing damage from buckling. Existing helical electronics have only extended to stretchable interconnects between circuit modules, and individual components such as printed helical transistors. Fully stretchable circuits have, until now, only been produced in planar form: flat circuits, either using curved geometry to enable them to stretch, or using inherently stretchable elastomer substrates. Helical e-strips can bend along multiple axes, and repeatedly stretch between 30 and 50%, depending on core material and diameter. LED and temperature sensing helical e-strips are demonstrated, along with design rules for helical e-strip fabrication. Widely available materials and standard fabrication processes were prioritized to maximize scalability and accessibility.

Effects of Ankle Compression Garments on Fatigue and Single-Leg Balance in Collegiate Basketball Players

Basketball players are prone to ankle injuries. It is unclear if wearing ankle compression garments (CGs) can enhance balance control and time to fatigue in those athletes. The purpose of this study was to examine the impact of ankle CGs on both time to fatigue and single-leg balance. Sixteen Division II (D2) collegiate basketball players participated in the study. The Cumberland Ankle Instability Tool (CAIT) was used to assess ankle stability. Fatigue was induced through deficit heel raises, and single-leg balance was assessed with the Athletic Single Leg Stability Test (ASLST) of the Biodex Balance System. Ten out of 16 (62.5%) basketball players were classified as having chronic ankle instability (CAI). Wearing CGs did not significantly prolong the time to fatigue (P = .774), and participants with CAI and without CAI had a similar time to fatigue (P = .958). In addition, wearing CGs significantly worsened single-leg balance before fatigue (P = .021), but enhanced balance control after fatigue (P = .027). Results indicate a strong prevalence of CAI in collegiate basketball players, and wearing CGs may not be able to enhance single-leg balance before fatigue. Although participants who wore CGs did not significantly increase their time to fatigue, their single-leg balance significantly improved after fatigue. This finding suggests wearing ankle CGs may have the potential to remediate the impact of fatigue on balance control. Future studies with a larger sample size are needed to further examine the impact of wearing ankle CGs on fatigue and single-leg balance.

The Effects of Lower Leg Compression Garments on Lower Extremity Sports Injuries, Subjective Fatigue and Biomechanical Variables: A Systematic Review with Meta-analysis

The objective of this study was to systematically review the literature on the effect of CGs versus non-CGs (such as regular socks) or versus placebo garments on 1) the incidence of lower extremity sports injuries and 2) subjective ratings of fatigue and biomechanical variables in athletes at participating in any sport that required any level of running performance, given that fatigue-related biomechanical alterations may increase the risk of sports injuries. This study was a systematic review with meta-analyses. PubMed, Embase, CINAHL, Cochrane, PEDro, and Scopus were searched for eligible studies until 7 July 2021. Two reviewers independently assessed the risk of bias using the Cochrane Collaboration's tool for risk of bias. Meta-analyses were performed using a random-effects model. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence for all outcome measures. Twenty-three studies, all with a high risk of bias, were included. Nineteen studies were used in the meta-analyses. No studies focused on the effect of CGs on the incidence of lower extremity sports injuries in athletes. Seventeen studies investigated the effect of CGs on subjective ratings of fatigue, but meta-analysis showed no difference in effectiveness between CGs versus non-CGs (such as regular socks) and versus placebo CGs (low certainty evidence). Because of heterogeneity, pooling of the results was not possible for the biomechanical variables. Nonetheless, low certainty evidence showed no effect of CGs. We identified no evidence for a beneficial or detrimental effect of lower leg CGs on the occurrence of lower extremity sports injuries, subjective ratings of fatigue, or biomechanical variables in athletes at any level of running performance. Based on the variable use of running tests, definitions used for biomechanical variables, and reporting of CG characteristics and more standardized reporting is recommended for future studies evaluating CGs.

Numerical model of pressure generated by elastic compression garments on a compressible human limb analogue

OBJECTIVE

This study aimed to formulate a numerical approach (finite element modelling (FEM)) to calculate pressure values generated by compression garments on a compressible limb analogue, and to validate the numerical approach using experimental measurements. Existing models were also compared.

METHOD

Experimentally measured pressure values and deformation caused by compression bands on a compressible human limb analogue were compared with values predicted using the Young-Laplace equation, a previously formulated analytical model and the FEM.

RESULTS

The FEM provided greater accuracy in predicting the pressure generated by compression bands compared to existing models. The FEM also predicted deformation of the limb analogue with good agreement relative to experimental values.

CONCLUSION

It was concluded that modelling the non-uniform manner in which the way a limb analogue is compressed should be incorporated into future modelling of the pressures generated by compression garments on a compressible limb analogue.

DECLARATION OF INTEREST

The authors have no conflicts of interest to declare.

Biomechanical stress distribution of medical inelastic fabrics with different porosity structures

Clothing fit and pressure comfort play important role in clothing comfort, especially in medical body sculpting clothing (MBSC). In the present study, different body movements (forward bending, side bending, and twisting) were adopted to simulate and investigate the biomechanical stress distribution of the human body with three kinds of porosity inelastic MBSCs through the finite element analysis method. The elastic modulus of the investigated MBSCs was also measured by means of tensile testing. Analytical results showed that in the compression region during body movements, the investigated inelastic MBSCs endured less compression stress, and most of the stress was transmitted to the human body. Moreover, the stresses on the body surface were decreased with the porosity increasing. However, most of the von Mises stresses on the human body were in the desired pressure comfort range. Therefore, these results could provide potential information in the modification of MBSC for medical applications.

The Effectiveness of Compression Garments for Reducing Pain in Non-Vascular Ehlers-Danlos Syndromes: A Prospective Observational Cohort Study

Patients with Ehlers-Danlos Syndrome (EDS) frequently suffer from severe chronic pain. We carried out an observational cohort study to assess the effectiveness of compression garments (CGs) for reducing this pain. Patients with non-vascular EDS were given custom-made Cerecare^® CGs during a visit to a specialist clinic (visit V0). They were followed up over 2 years with visits every 6 months (V1-V4). At each visit, pain was assessed for the joints treated with CGs using a visual analogue scale (VAS; 0-100 mm). Additional measures were obtained to assess neuropathic pain (painDETECT questionnaire), proprioception/balance (Berg Balance Scale), and functional independence, amongst others. Data were analyzed for 67 patients with EDS (hypermobile: 91%; classical: 6%; kyphoscoliotic: 3%). For the most painful joint, the mean VAS rating was 71.5 ± 22.8 mm at V0; this decreased to 53.5 ± 25.5 mm at V1 and 45.7 ± 29 mm at V4 (t-tests: p < 0.0001). From V0 to V4, improvements were also seen for pain at the other joints, neuropathic pain, functional independence, proprioception/balance, and the incidence of sprains and dislocations/subluxations, although not all comparisons were statistically significant (p < 0.05 level). These results indicate that CGs may effectively reduce the pain and joint instability in non-vascular EDS patients.

Development of a comfort suit-type soft-wearable robot with flexible artificial muscles for walking assistance

Anchoring components are added to wearable robots to ensure a stable interaction between the suits and the human body and to minimize the displacement of the suits. However, these components can apply pressure to the body and can cause user dissatisfaction, which can decrease willingness to use the suits. Therefore, this study aims to develop a suit-type soft-wearable robot platform for walking assistance by providing comfortable garment pressure to ensure user satisfaction. The first prototype of a wearable robot suit was developed with anchoring components on the shoulders, waist, and thighs based on previous research results. Wear tests were conducted to measure garment pressure depending on posture using pressure sensors, and satisfaction surveys were conducted. The second prototype design was then developed, and performance tests with flexible artificial muscles and a satisfaction survey were conducted. Regarding the first prototype, the participants felt more than normal pressure in the shoulders and relatively less pressure in the thighs and calves. Thus, compared to the first design, the second design ensured a decreased garment pressure and resulted in an improvement of overall user satisfaction. These results can help provide guidance in the development of wearable robots by taking pressure comfort and user satisfaction into consideration.

Body Compression Corrective Garment and Eating Behavioural Change for Weight Reduction: The Mutsu City Randomised Controlled Trial

Affordable and accessible behaviour-based interventions that do not overwhelm or demoralise overweight/obese individuals are needed. Combining clothing with behaviour change techniques might be an option. This is because clothing is a social norm, and clothing and motivation for weight loss are associated with the common desire to look better. Therefore, we conducted a single-blind randomised controlled trial to examine the effect of an intervention that combined behaviour change techniques, including simplified goal setting and self-monitoring, with a body compression corrective garment (BCCG), which exerts continuous but minimal tactile pressure on the hips and abdomen. We enrolled healthy community-dwelling adults with a body mass index ≥ 25 kg/m2 and assigned 35 and 34 participants to the intervention and control groups, respectively. The reduction in body weight was 1.3 kg more in the intervention group than in the control group after the 12-week intervention period (p < 0.05, repeated-measures mixed model). In addition, eating behaviour and body appreciation showed significant improvement in the intervention group compared with the control group. Our newly developed intervention improved eating behaviour and body appreciation and reduced the body weight of overweight/obese participants. Wearing a BCCG seems to facilitate behavioural changes and lead to weight loss.

Fast NURBS-based parametric modeling of human calves with high-accuracy for personalized design of graduated compression stockings

BACKGROUND AND OBJECTIVES

Accurate human body models are increasingly demanded by high-quality human-centered ergonomic applications, especially the design and manufacturing of compressive functional apparels. However, existing parametric models in related works are not capable to accurately describe detailed local shape features of human.

METHODS

In this work, a high-accuracy parametric modeling approach for human limb was proposed. 3D Scans of human calves were studied. Key data points of the scanned human calves were identified according to human anatomy, forming a quasi-triangular mesh of feature points. Then, non-uniform rational B-splines (NURBS) method was implemented. Control points were calculated from the key data points, with which the human calf shapes can be reconstructed by the smooth NURBS surface, giving rise to a new parametric model of human calves. Error between the scanned and reconstructed calf shapes were analyzed to verify the effectiveness of this model.

RESULTS

Error analysis showed that, this proposed method delivers a high-efficiency and high-accuracy parametric shape modeling approach with averaged error observed as only 0.37% for all the 260 subjects, much less compared to previous relative works (around 5%). For tentative application, customized medical compression stockings were designed based on this model and proved as valid to exert desired gradient compression on the according calf mannequin.

CONCLUSIONS

By introducing the non-uniform rational B-splines method, a parametric model capable of characterizing human limbs with high-accuracy was proposed. Using very small amount of data, this model is expected to highly facilitate remote customized design and provide 3D shape references for design of compressive garments. Moreover, the proposed methods can inspire developments of other mixed modeling methods for high-accuracy applications.

Behavior of medial gastrocnemius muscle beneath kinesio taping during isometric contraction and badminton lunge performance after fatigue induction

Kinesio taping (KT) is widely used in sports for performance improvement and injury prevention. However, little is known of the behavior of the muscle region beneath the KT with movement, particularly when the muscle is fatigued. Accordingly, this study investigated the changes in the medial gastrocnemius muscle architecture and fascia thickness when using KT during maximum isometric plantar flexion (MVIC) and badminton lunges following heel rise exercises performed to exhaustion. Eleven healthy collegiate badminton players (4 males and 7 females) were recruited. All of the participants performed two tasks (MVIC and badminton lunge) with a randomized sequence of no taping, KT and sham taping and repeated following exhaustive repetitive heel rise exercise. In the MVIC task, the fascia thickness with the medial gastrocnemius muscle at rest significantly decreased following fatigue induction both without taping and with KT and sham taping (p = 0.036, p = 0.028 and p = 0.025, respectively). In the lunge task, the fascia thickness reduced after fatigue induction in the no taping and sham taping trials; however, no significant change in the fascia thickness occurred in the KT trials. Overall, the results indicate that KT provides a better effect during dynamic movement than in isometric contraction.

Smart Compression Therapy Devices for Treatment of Venous Leg Ulcers: A Review

Venous leg ulcers can have significant social and economic impacts, and are generally treated by applying compression to the lower limb, which aids in promoting blood return to the heart. Compression therapies commonly involve the use of passive bandages that suffer from issues associated with incorrect application, and although automated solutions have begun to appear; these are often bulky and hinder mobility. Emerging microtechnologies and new materials enable the development of "smart" compression therapy devices, which are defined as systems that use miniaturized and lightweight actuators and electronics to control the applied pressure. This paper reviews the state of the art in smart compression therapy research. A total of seventeen different devices has been identified, categorized as using one of three actuation mechanisms: pneumatic compression, motor-driven mechanisms, and smart materials (including shape memory alloys, shape memory polymers, and electroactive polymers). The field is still in its relative infancy and further refinements are required to create mass manufacturable compression dressing systems that meet medical, ergonomic, and economic standards. The use of miniaturized actuators has immense potential for the development of smart compression dressings, which will ultimately lead to higher compliance, increased patient comfort, enhanced mobility, and better treatment outcomes.

New Mechanical Knee Supporter Device for Shock Absorption

Conventional knee supporters generally reduce knee pain by restricting joint movement. In other words, there were no mechanical knee supporters that functioned powerfully. Considering this problem, we first devised a device in which a spring is inserted into the double structure of the cylinder and piston, and a braking action is applied to the piston. This mechanism retracts when the knee angle exceeds a certain level. Next, the knee and the device were modeled, and the dynamic characteristics of the device were investigated to find effective elements for knee shock absorption. Although various skeletal and muscular structures have been studied for the knee section, we kept the configuration as simple as possible to find effective elements for the device. A shock-absorbing circuit was devised, and air was used as the working fluid to facilitate smooth knee motion except during shock. Increasing the spring constant effectively reduced the knee load.

Effects of Forearm Compression Sleeves on Muscle Hemodynamics and Muscular Strength and Endurance Parameters in Sports Climbing: A Randomized, Controlled Crossover Trial

Purpose: Wearing compression garments is a commonly used intervention in sports to improve performance and facilitate recovery. Some evidence supports the use of forearm compression to improve muscle tissue oxygenation and enhance sports climbing performance. However, evidence is lacking for an effect of compression garments on hand grip strength and specific sports climbing performance. The purpose of this study was to evaluate the immediate effects of forearm compression sleeves on muscular strength and endurance of finger flexor muscles in sports climbers.

Materials and Methods: This randomized crossover study included 24 sports climbers who performed one familiarization trial and three subsequent test trials while wearing compression forearm sleeves (COMP), non-compressive placebo forearm sleeves (PLAC), or no forearm sleeves (CON). Test trials consisted of three performance measurements (intermittent hand grip strength and endurance measurements, finger hang, and lap climbing) at intervals of at least 48 h in a randomized order. Muscle oxygenation during hand grip and finger hang measurements was assessed by near-infrared spectroscopy. The maximum blood lactate level, rate of perceived exertion, and forearm muscle pain were also determined directly after the lap climbing trials.

Results: COMP resulted in higher changes in oxy[heme] and tissue oxygen saturation (StO₂) during the deoxygenation (oxy[heme]: COMP –10.7 ± 5.4, PLAC –6.7 ± 4.3, CON –6.9 ± 5.0 [μmol]; p = 0.014, η_p² = 0.263; StO₂: COMP –4.0 ± 2.2, PLAC –3.0 ± 1.4, CON –2.8 ± 1.8 [%]; p = 0.049, η_p² = 0.194) and reoxygenation (oxy [heme]: COMP 10.2 ± 5.3, PLAC 6.0 ± 4.1, CON 6.3 ± 4.9 [μmol]; p = 0.011, η_p² = 0.274; StO₂: COMP 3.5 ± 1.9, PLAC 2.4 ± 1.2, CON 2.3 ± 1.9 [%]; p = 0.028, η_p² = 0.225) phases of hand grip measurements, whereas total [heme] concentrations were not affected. No differences were detected between the conditions for the parameters of peak force and fatigue index in the hand grip, time to failure and hemodynamics in the finger hang, or performance-related parameters in the lap climbing measurements (p ≤ 0.05).

Conclusions: Forearm compression sleeves did not enhance hand grip strength and endurance, sports climbing performance parameters, physiological responses, or perceptual measures. However, they did result in slightly more pronounced changes of oxy [heme] and StO₂ in the deoxygenation and reoxygenation phases during the hand grip strength and endurance measurements.

Exploration of Effects of Graduated Compression Stocking Structures on Performance Properties Using Principal Component Analysis: A Promising Method for Simultaneous Optimization of Properties

This paper focuses on the comfort properties of graduated and preventive compression stockings for people who work long hours in standing postures and for athletes for proper blood circulation. The present study was conducted in order to investigate the effects of the yarn insertion density and inlaid stitches on the performance of the compression stockings. The effects of these parameters on the thermo-physiological comfort properties were tested with standard and developed methods of testing. All compression stockings were maintained with class 1 pressure as per German standards. The structural parameters of the knitted fabric structures were investigated. The stretching and recovery properties were also investigated to determine the performance properties. The theoretical pressure was predicated using the Laplace’s law by testing the stockings’ tensile properties. The compression interface pressures of all stockings were also investigated using a medical stocking tester (MST) from Salzmann AG, St. Gallen, Switzerland. Correlation between the theoretical pressures and pressures measured using the MST system were also assessed. The current research used a multi-response optimization technique, i.e., principal component analysis (PCA), to identify the best structure based on the optimalization of the above-mentioned properties. The results also revealed that samples with higher insertion density levels exhibit better comfort properties. The results showed that sample R1 was the best sample, followed by R2 and P. In addition, all developed stocking samples exhibited better comfort properties than the control sample from the market.

Study on the Compression Effect of Clothing on the Physiological Response of the Athlete

The study aimed to analyze whether the high compression of unique, tight-fitting sportswear influences the clothing physiology comfort of the athlete. Three specific sportswear with different compression were tested on four subjects while they were running on a treadmill with increasing intensity. The compression effect of the sportswear on the body of the test persons, the temperature distribution of the subjects, and the intensity of their perspiration during running were determined. The results indicate that the compression effect exerted by the garments significantly influences the clothing physiology comfort of the athlete; a higher compression load leads to more intense sweating and higher skin temperature.

Is skin pressure in load carriage over-evaluated?

Skin pressure is a biomechanical measure widely used in the assessment of load carriage systems. However, because of the complicated contour of human body, the stiffness of the pressure sensor array, and the large range of measurable pressures, there is much variability in previously reported results. In this paper, a simple mechanical model for load carriage was proposed, and the skin pressures beneath the shoulder and hip straps were predicted from the strap forces based on Laplace's law. The proposed model was used to analyze data from literature with an aim to check the reliability of existing pressure measurements. The static and dynamic pressures at five locations on eight subjects wearing a backpack with a 10 kg load, while standing and walking on a treadmill, were measured respectively using pressure sensors of the air pack type. The combination of literature data analysis and experimental testing proved that the existing measurement method of interface pressure in load carriage systems often leads to over-estimation and this might misguide the pressure criteria set for load carriage system usage and design. The proposed model will be useful for quick prediction of the interface pressure in load carriage systems.

Predicting Compression Pressure of Knitted Fabric Using a Modified Laplace's Law

The aim of this study is to develop a mathematical model for the prediction of compression pressure based on fabric parameters, such as engineering stress, engineering strain and engineering modulus of elasticity. Four knitted compression fabrics with different fibrous compositions and knit structures were used. Rectangular-cut strips were employed for the force–elongation characterization of the fabrics. The experimental pressure values between the fabric and rigid cylinder were assessed using a Picopress pressure measuring device. The mechanical and physical parameters of the fabric that influence the interface pressure, such as strain, elasticity modulus/stress and thickness, were determined and integrated into Laplace’s law. A good correlation was observed between the experimental and calculated pressure values for all combinations of fabrics, mounted with variable tension on the cylinder. Over the considered range of pressures, the difference between the two datasets was generally less than 0.5 mmHg. The effect of washing after five, ten and fifteen washing cycles on the fabric–cylinder interface pressure was found to be significant.

A method for precise local pressurization in scar-repairing surgery

BACKGROUND

Pressure Garment Treatment (PGT) is currently recognized as an effective method to prevent scar formation or treat scar hyperplasia. Research on PGT remains controversial. These controversies indicate that PGT lacks reliable evidence of evidence-based medicine. Different studies on PGT need to be conducted under the same 'gold standard' so that different studies can be compared. We consider this 'gold standard' to be that the pressure remains stable within a confidence interval during treatment.

METHODS

We calibrated and verified the reference value of the sensor using a cuff of sphygmanometer.A pressure adjustable pressure system was obtained by installing a soft tissue expander on the pressure garment.Local pressure was adjusted by charging and releasing air.Subsequently, the flexible pressure sensor was placed on the upper arm of the healthy volunteers. We validated the compression system on healthy volunteers' forearms and AO standard prostheses (forearms).

RESULTS

Reference value of the sensor was calibrated on No.1 volunteer. Measuring repeated on No.2 and No. 3. The measurement was very reproducible. The test results in the experimental group showed that the local pressure gradually increased with the increase of the inflation of the airbag. However, the pressure at the opposite position of the forearm changed little.

CONCLUSIONS

Real-time pressure monitoring and pressure adjustment enable the pressure to be maintained at a certain value. Our study provides a new idea for the production of elastic clothing with the function of pressure measurement and pressure regulation, which may promote the accuracy and reliability of PGT.

Customised pressure profiles of made-to-measure sports compression garments

The purpose of this study was to make made-to-measure compression garments that elicit pressures within and below clinical standards. The study also examined whether pressures and gradients can be replicated within and between participants’ legs, and between separate compression garment conditions. Ten males volunteered to participate. Based on three-dimensional scans of the participants’ lower body, three different made-to-measure garments were manufactured: control, symmetrical and asymmetrical. Garment pressures were assessed from the malleolus to the gluteal fold using a pressure monitoring device. A root mean squared difference analysis was used to calculate the in vivo linear graduation parameters. Linear regression showed that peak pressure at the ankle in the left and right leg were: control garment, 13.5 ± 2.3 and 12.9 ± 2.6; asymmetrical garment, 12.7 ± 2.5 and 26.3 ± 3.4; symmetrical garment, 27.7 ± 2.2 and 27.5 ± 1.6 (all mmHg, mean ± standard deviation). Pressure reduction from the ankle to the gluteal fold in the left and right leg were: control, 8.9 ± 3.5 and 7.4 ± 3.0; asymmetrical, 7.8 ± 3.9 and 21.9 ± 3.2; symmetrical, 25.0 ± 4.1 and 22.3 ± 3.6 (all mmHg, mean ± standard deviation). Made-to-measure compression garments can be made to elicit pressures within and below clinical standards, and to elicit equivalent pressures and gradients in different participants.

Lower extremity compression garments use by athletes: why, how often, and perceived benefit

Background

Studies on the benefits of lower extremity compression garments (CGs) have focused on their effects on post-exercise recovery and performance improvement. Less is known about why athletes actually use CGs, the frequency with which they use them, and perceived benefits from using CGs. The purpose of this study was to investigate which athletes use CGs, why athletes use CGs, when CGs are worn by athletes, and, in case of an injury or injury prevention, for which injuries CGs are used.

Methods

This cross-sectional study involved 512 athletes who used lower extremity CGs. Athletes completed a questionnaire on the type of CGs they used, and when and why they used them. They also reported their sports participation, past and current sports injuries, and the perceived benefits of using CGs.

Results

88.1% (n=451) of the athletes were endurance athletes and 11.9% (n=61) were non-endurance athletes. Endurance and non-endurance athletes reported running (84.7%, n=382) and obstacle course racing (24.6%, n=15) the most frequently as primary sports, respectively. The most-used CG was the compression sock (59.2%, n=303). In total, 47.5% (n=246) of the athletes used a CG primarily to prevent re-injury and 14.5% (n=74) to reduce symptoms of a current sports injury. Other primary reported aims were primary prevention (13.6%), post-exercise recovery (14.3%), sports performance improvement (8.8%), and to look good (0.2%). The point prevalence of past and current sports injuries among all athletes was 84.2 and 20.2%, respectively. The most common current sports injuries were shin and calf injuries. Many athletes “always” or “often” used their CGs during training (56.8%, n=279) and competitions (72.9%, n=264). Furthermore, almost 90% of the athletes that aimed to prevent re-injury by using CGs reported that CGs contributed to secondary injury prevention.

Conclusion

88% of the CG-users were endurance athletes, of which 85% were runners. All athletes mainly used CGs to prevent injury recurrence, but also to reduce symptoms of a current sports injury. A majority of the athletes reported positive perceived effects from the CGs. CGs were used more during than after sports participation.

Increased risk for sleep disorders in burn patients: A 14-year nationwide, population-based cohort study

BACKGROUND

Burn is a major trauma that causes physical and psychosocial impairments, leading to sleep disorders. However, the data about risks for sleep disorders in patients over 3 years following burn injury are limited.

AIM

To investigate the long-term risks for sleep disorders in patients after burn injury and identify the high-risk population.

METHODS

A 14-year population-based cohort study was performed using data from the 2000-2013 Taiwan National Health Insurance Research Database (NHIRD) which was a valid representative sample of the total population. All diagnoses of medical records in NHIRD were made by physicians and coded according to the ICD-9-CM. Cases diagnosed with burns (ICD-9 CM: N-code 940-949 and E-code 890-899) were included. The control group (non-burn injury group) was comprised quadruple the number of cases matched by index date, sex and age.

RESULTS

In 2000-2013, among the 10,289 burn patients included and followed-up after the index year, burn injury significantly increased the risks for sleep disorders (Hazard Ratio; HR = 1.36, p = 0.044), including insomnia (HR = 1.41, p = 0.036), sleep disturbance (HR = 2.39, p = 0.005) and sleep apnoea (HR = 1.38, p = 0.029). Compared with the control group, those who were women (HR = 1.73, p = 0.021), adolescents (HR = 5.45, p < 0.001), aged 19-24 years (HR = 1.36, p = 0.034), aged 25-44 years (HR = 1.67, p = 0.007), had low income (HR = 2.14, p = 0.001), and without a history of mental disorders (HR = 1.41, p = 0.024) had significantly higher risks for developing sleep disorders when suffered burn injury.

CONCLUSION

Burn had long-term negative effects on sleep during both the first year of burn injury and the subsequent follow-up 14 years. It is important for physicians to long-term assess the sleep quality of burn patients regardless of the number of years after burn injury.

Efficient Upper Limb Position Estimation Based on Angular Displacement Sensors for Wearable Devices

Motion tracking techniques have been extensively studied in recent years. However, capturing movements of the upper limbs is a challenging task. This document presents the estimation of arm orientation and elbow and wrist position using wearable flexible sensors (WFSs). A study was developed to obtain the highest range of motion (ROM) of the shoulder with as few sensors as possible, and a method for estimating arm length and a calibration procedure was proposed. Performance was verified by comparing measurement of the shoulder joint angles obtained from commercial two-axis soft angular displacement sensors (sADS) from Bend Labs and from the ground truth system (GTS) OptiTrack. The global root-mean-square error (RMSE) for the shoulder angle is 2.93 degrees and 37.5 mm for the position estimation of the wrist in cyclical movements; this measure of RMSE was improved to 13.6 mm by implementing a gesture classifier.

Development of Washable Silver Printed Textile Electrodes for Long-Term ECG Monitoring

Long-term electrocardiography (ECG) monitoring is very essential for the early detection and treatment of cardiovascular disorders. However, commercially used silver/silver chloride (Ag/AgCl) electrodes have drawbacks, and these become more obvious during long-term signal monitoring, making them inconvenient for this use. In this study, we developed silver printed textile electrodes from knitted cotton and polyester fabric for ECG monitoring. The surface resistance of printed electrodes was 1.64 Ω/sq for cotton and 1.78 Ω/sq for polyester electrodes. The ECG detection performance of the electrodes was studied by placing three electrodes around the wrist where the electrodes were embedded on an elastic strap with Velcro. The ECG signals collected using textile electrodes had a comparable waveform to those acquired using standard Ag/AgCl electrodes with a signal to noise ratio (SNR) of 33.10, 30.17, and 33.52 dB for signals collected from cotton, polyester, and Ag/AgCl electrodes, respectively. The signal quality increased as the tightness of the elastic strap increased. Signals acquired at 15 mmHg pressure level with the textile electrodes provided a similar quality to those acquired using standard electrodes. Interestingly, the textile electrodes gave acceptable signal quality even after ten washing cycles.

A case study on interface pressure pattern of two garment orthoses on a child with cerebral palsy

Many studies have shown that medical compression products produce different levels of interface pressure during the usage of the products. However, limited studies have explored the pattern of interface pressure exerted by orthotic garments. This case study aimed to investigate the pattern of interface pressure exerted by two types of orthotic garments on a child with cerebral palsy. A 13-year-old child diagnosed with ataxic spastic diplegia cerebral palsy has difficulty to perform sit-to-stand motion even with a walking frame due to his truncal ataxia. A TheraTogsTM orthosis and a Dynamic Lycra® Fabric Orthosis (DLFO) were prepared for the child. The child’s sit-to-stand ability without and with the usage of orthoses was recorded using five sit-to-stand tests. The garments’ interface pressure was measured using F-scan (9811E) and F-scan 6.5.1 version software. The pressure was recorded when the child was in sitting position and performing sit-to-stand-to-sit motion. Overall, the child completed the five sit-to-stand test duration within 2.53 ± 0.04 s and 2.51 ± 0.09 s with the usage of TheraTogsTM orthosis and DLFO, respectively. Higher pressure was exerted by Dynamic Lycra Fabric Orthosis (axillary = 122 mmHg) in contrast to TheraTogsTM orthosis (77 mmHg) when the child was in a sitting position. Lower pressure was exerted by DLFO (7 mmHg), over xiphoid level and for TheraTogsTM orthosis is 1.2 mmHg over axillary level when the child was performing sit-to-stand motion. The largest range of pressure was exerted by TheraTogsTM orthosis with a minimum pressure of 5 mmHg and a maximum pressure of 155 mmHg during sit-to-stand motion. Overall, the DLFO exerted higher mean interface pressure on the child in comparison to TheraTogsTM orthosis when the child’s body was in a sitting position wearing both upper garment and pants. Both TheraTogsTM orthosis and DLFO presented a different range of interface pressure over different body segments and activities.

A tailored, electronic textile conformable suit for large-scale spatiotemporal physiological sensing in vivo

The rapid advancement of electronic devices and fabrication technologies has further promoted the field of wearables and smart textiles. However, most of the current efforts in textile electronics focus on a single modality and cover a small area. Here, we have developed a tailored, electronic textile conformable suit (E-TeCS) to perform large-scale, multimodal physiological (temperature, heart rate, and respiration) sensing in vivo. This platform can be customized for various forms, sizes and functions using standard, accessible and high-throughput textile manufacturing and garment patterning techniques. Similar to a compression shirt, the soft and stretchable nature of the tailored E-TeCS allows intimate contact between electronics and the skin with a pressure value of around ~25 mmHg, allowing for physical comfort and improved precision of sensor readings on skin. The E-TeCS can detect skin temperature with an accuracy of 0.1 °C and a precision of 0.01 °C, as well as heart rate and respiration with a precision of 0.0012 m/s2 through mechano-acoustic inertial sensing. The knit textile electronics can be stretched up to 30% under 1000 cycles of stretching without significant degradation in mechanical and electrical performance. Experimental and theoretical investigations are conducted for each sensor modality along with performing the robustness of sensor-interconnects, washability, and breathability of the suit. Collective results suggest that our E-TeCS can simultaneously and wirelessly monitor 30 skin temperature nodes across the human body over an area of 1500 cm2, during seismocardiac events and respiration, as well as physical activity through inertial dynamics.

Hyperelastic Properties of Platinum Cured Silicones and its Applications in Active Compression

This paper presents the fundamental research of design, development, and evaluation of an active compression system consisting of silicone based inflatable mini-bladders, which could be used in applying radial pressure for the treatment of venous disease. The use of mini-bladders will nullify the effect of radius of curvature and provide a higher resolution to the pressure distribution. They are designed with two elastomeric layers and inflation is limited only to one side. The mini-bladders apply a radial force onto the treated surface when inflated, and the pressure inside mini-bladders could be measured using the concept of back pressure, which provides the flexibility to inflate mini-bladders to a predefined pressure. The 3-D deformation profile of the mini-bladders was analysed using finite element method (FEM) and FEM simulations were validated with experimental data, which showed good agreement within pressure region required for the treatment of venous disease. Finally, the pressure transmission characteristics of mini-bladders were evaluated on a biofidellic lower leg surrogate and the results have shown that the mini-bladders could apply a uniform pressure irrespective of the location on the leg with a 60%–70% of inlet pressure successfully transmitted onto the leg surface, while 40%–50% was available after the fat layers.

Highly Sensitive and Durable Structured Fibre Sensors for Low-Pressure Measurement in Smart Skin

Precise measurements of low pressure are highly necessary for many applications. This study developed novel structured fibre sensors embedded in silicone, forming smart skin with high sensitivity, high durability, and good immunity to crosstalk for precise measurement of pressure below 10 kPa. The transduction principle is that an applied pressure leads to bending and stretching of silicone and optical fibre over a purposely made groove and induces the axial strain in the gratings. The fabricated sensor showed high pressure sensitivity up to 26.8 pm/kPa and experienced over 1,000,000 cycles compression without obvious variation. A theoretical model of the sensor was presented and verified to have excellent agreement with experimental results. The prototype of smart leg mannequin and wrist pulse measurements indicated that such optical sensors can precisely measure low-pressure and can easily be integrated for smart skins for mapping low pressure on three-dimensional surfaces.

Study of Fiber-Based Wearable Energy Systems

Fiber-based electronic and photonic devices have the most desired human-friendly features, such as being soft, ubiquitous, flexible, stretchable, light, and permeable, and thus are ideal to be employed as the interface platform between humans, the environment, and machines. Today, these smart wearable devices are normally powered by rechargeable batteries. It is extremely desirable to have an undisrupted power supply for us to go anywhere at any time. Harvesting energy from the ambient environment or our body can potentially fulfill such a goal. Explorations of high performance, flexible functional materials and energy conversion devices have led many exiting discoveries. In order to realize their applications, equally important are fundamental studies of the physical phenomena and mechanisms that will provide scientific guidance for the direction of exploration and development of devices and systems. Hence, this Account provides a brief review of our recent progress in this topic area. Based upon materials science, mechanics and device physics, we have succeeded in establishment of several new theoretical models for fiber-based piezoelectric, triboelectric, and hybrid generators. These models have been verified experimentally. Excellent results were obtained for fiber-based triboelectric generators without any adjustable parameters. Reasonable agreement was demonstrated for the piezoelectric generators because of some uncertainty in the material properties and deformation modes. From both simulated and experimental results, we did not detect any synergic effect in the hybrid generator consisting of cascaded piezoelectric and triboelectric units. The verified models can be used to predict the output voltage, current, and power of the devices in terms of material properties, parameters of device structure, harvesting circuits, and operating conditions. Furthermore, by considering the electric breakdown due to field-induced-emission and gas-ionization, we have identified the theoretical upper limits of charge density and output power from contact-mode fiber-based triboelectric nanogenerators. The analysis sheds new light on the scope and focus for further exploration and provides guidance on engineering design of such devices. In addition, we have setup an experimental platform for reliable triboelectric charge measurement of highly deformable and porous materials like fabrics. An extended triboelectric series has been reported by us including 21 types of commercial and new fibers. Based upon the findings, we have made significant improvements of the performance of these energy harvesting devices. Finally, we have explored a class of new flexible thermoelectric materials exhibiting high performance for fiber-based thermoelectric generators, which can be fabricated by low-temperature and cost-effective processes, such as in situ reduction coating and three-dimensional printing. The resultant large-area, flexible, and wearable fiber-base thermoelectric generators are key devices for great potential applications such as powering wearable microelectronic systems, active microclimate regulating systems, and waste thermal energy harvesting.