Surgically Implanted Electrodes Enable Real-Time Finger and Grasp Pattern Recognition for Prosthetic Hands

Currently available prosthetic hands are capable of actuating anywhere from five to 30 degrees of freedom (DOF). However, grasp control of these devices remains unintuitive and cumbersome. To address this issue, we propose directly extracting finger commands from the neuromuscular system via electrodes implanted in residual innervated muscles and regenerative peripheral nerve interfaces (RPNIs). Two persons with transradial amputations had RPNIs created by suturing autologous free muscle grafts to their transected median, ulnar, and dorsal radial sensory nerves. Bipolar electrodes were surgically implanted into their ulnar and median RPNIs and into their residual innervated muscles. The implanted electrodes recorded local electromyography (EMG) with Signal-to-Noise Ratios ranging from 23 to 350 measured across various movements. In a series of single-day experiments, participants used a high speed pattern recognition system to control a virtual prosthetic hand in real-time. Both participants were able to transition between 10 pseudo-randomly cued individual finger and wrist postures in the virtual environment with an average online accuracy of 86.5% and latency of 255 ms. When the set was reduced to five grasp postures, average metrics improved to 97.9% online accuracy and 135 ms latency. Virtual task performance remained stable across untrained static arm positions while supporting the weight of the prosthesis. Participants also used the high speed classifier to switch between robotic prosthetic grips and complete a functional performance assessment. These results demonstrate that pattern recognition systems can use the high-quality EMG afforded by intramuscular electrodes and RPNIs to provide users with fast and accurate grasp control.

SUMMARY

Surgically implanted electrodes recorded finger-specific electromyography enabling reliable finger and grasp control of an upper limb prosthesis.

Spinal cord injury rehabilitation: the experience of women

STUDY DESIGN

Qualitative study.

OBJECTIVES

To develop the knowledge base regarding women's experiences of spinal cord injury (SCI) rehabilitation.

SETTING

United Kingdom.

METHODS

Qualitative interviews with 10 women from four regional SCI rehabilitation centres were transcribed verbatim and analysed according to grounded theory.

RESULTS

The central psychosocial problem identified for women during SCI rehabilitation was vulnerability. Vulnerability was amplified by lack of privacy within the rehabilitation centre, by negative staff interactions (associated with perceived lack of control and lack of respect) and by women's minority status in the rehabilitation setting, which at times left women feeling marginalized and inferior. Vulnerability was contained by: negotiating privacy and space; receiving support and encouragement from staff, other patients and family; and by adopting a positive attitude.

CONCLUSION

The SCI rehabilitation environment and interactions within it have the potential to influence significantly, either positively or negatively, women's feelings and behaviours as they begin to negotiate a revised identity as a disabled person. There is a need for further research to be carried out in this area in order that women's needs and concerns can be better understood and clinical practice developed accordingly.

Investigations of complaints and quality of health care

Malpractice law is frequently justified by the claim that it improves health care services but this belief remains untested. Using a multiple case study in 16 remote rural areas in New Zealand, this study examined the effects of formal quasi-judicial investigations on the quality of health care services. The study found that the fragile local health systems were damaged by the quasi-judicial investigations of the medical disciplinary body and became less efficient and less user-friendly. A few doctors left rural practice and were difficult to replace. The remaining health workers responded to the investigations in a negative manner, losing confidence, enthusiasm and motivation for work; they performed in a less efficient manner, working more slowly, setting up barriers to access, ordering more tests and referring more to secondary care. Complainants also appeared to have been disadvantaged as a consequence of having complained.

What role for the general practitioner in child protection?

BACKGROUND

New government guidance on cooperation in child protection confirms the importance of the general practitioner (GP) contribution. While research highlights the concerns of others about their role in the multi-agency process, relatively little is known about the views and experiences of GPs themselves.

AIM

To examine the understanding that each of the key professional groups had of its own and each other's roles in child protection to identify those factors seen to enhance or inhibit the effective performance of these roles.

METHOD

The research formed part of a larger investigation of the role of health professionals in child protection, which combined case study investigations of child protection networks in three health authority sites with a regional survey of Area Child Protection Committee members.

RESULTS

A lack of correspondence was identified between GPs' perception and performance of their role in child protection and the expectations placed upon them by other child protection professionals and government guidance.

CONCLUSION

The study identifies the need for more explicit discussion of the nature and extent of the GP role in local interagency child protection networks.

Educating health managers: the role of SHAPE

This article highlights the need of health professionals to add management skills to their portfolio, and discusses the role of SHAPE in meeting this need. A list of management-related courses that are available to health professionals is provided.

Management challenges faced by managers of New Zealand long-term care facilities

This article reports on a postal survey of 78 long-term care managers in one region of New Zealand, of whom 45 (58%) responded. Most long-term care managers (73.2%) were middle-aged females holding nursing but not management qualifications. Most long-term care facilities (69%) tended to be stand-alone facilities providing a single type of care (rest home or continuing care hospital). The most prominent issues facing managers were considered to be inadequate funding to match the growing costs of providing long-term care and occupancy levels. Managers believed that political/regulatory, economic and social factors influenced these issues. Despite a turbulent health care environment and the challenges facing managers, long-term care managers reported they were coping well and valued networking.

Implementation of analytical technologies in a pharmaceutical development organization--looking into the next millennium

Managing the implementation of new technology in a pharmaceutical development environment has provided challenges and opportunities to obtain benefits from technologies, e.g. laboratory automation. Successful application of new techniques requires a dedicated resource. Within Pharmaceutical Technologies, this was initially a single person, who has since evolved into a team dedicated to the investigation and development of robotics and non-invasive analytical techniques. Pharmaceutical development is an important interface between research and commercial manufacturing. In research, the success of genomics and combinatorial chemistry will result in a significant increase in the number of development compounds, and this, combined with the desire of commercial manufacturing to move towards parametric release, puts an emphasis on the need for rapid analytical methods. Some ideas on the techniques that will be required to meet these goals will be described together with their impact on automation.

Going with the grain? General practitioners and the new NHS

A number of policy initiatives over the last few years have encouraged general practitioners (GPs) to participate in commissioning, as opposed to simply purchasing, health care. This role was reinforced in the white paper, The New NHS. A qualitative study of GPs in two health authorities uncovered not only concerns about the reforms which have since emerged in the medical and general press, but other issues which have been less frequently articulated. There was also evidence of goodwill towards professional colleagues, including those in social services departments. The preference for professional, as opposed to market relationships may help to secure the collaborative ethos desired by government. However, if the concerns the study uncovered are indicative of a more widespread response to the white paper, they suggest the need for careful support of developing Primary Care Groups (PCGs).

Diatom analysis in victim's tissues as an indicator of the site of drowning

The diagnosis of drowning is one of the most difficult in forensic pathology and previously we proposed criteria for a positive tissue analysis according to the qualitative and quantitative diatom investigations. In the positive cases, we studied the reliability of determining the site of drowning by comparing the diatom taxa found in the lung samples with those of the water samples or in the absence of these samples with the results of the water diatom monitoring programme set up in our region. In this study, we present two series of cases, the first is one of 20 corpses who died from accidental or suicidal drowning with known drowning site, and the second of 20 corpses for which the drowning site was unknown. The results showed that a concordance of the abundance of the diatom taxa in tissues compared to the site of drowning and their distribution relative to one another was 65% in the group where the site of drowning was known and 35% in the other group. The concordance of the individual distribution in the lungs of water diatom taxa may be an interesting method to guide the investigations for determining the site of drowning. The two limiting factors are the concentration of diatoms in the lungs and the development of a river monitoring programme in the district of the study.

Fatigue versus disengagement in unilateral neglect

A letter cancellation task revealed neglect of the lower left quadrant when cancellation began at the top, but of the upper left quadrant when it began in the bottom. When the cancellation was done line by line through a "window" which covered all but the line currently worked on, the quadrant effects disappeared, so that fatigue could not explain these effects. An alternative hypothesis is that as the cancellation progressed, the subject's attention was attracted by progressively more stimuli on the right, and that disengagement difficulty and hence neglect increased proportionately to the number of stimuli.

Clinical management of a man with complex partial seizures and a severe head injury

A case history of a man with complex partial seizures resulting from a severe head injury following a road traffic accident is presented. Details of medical intervention and neuropsychological assessment are also presented and discussed, highlighting the difficulties of balancing therapeutic doses of anticonvulsant medication with cognitive functioning adequate to maintain expected quality of life. An interesting finding revealed that the patient's blood-sodium levels increased rather than decreased with rising doses of anticonvulsant medication.

Active and passive activation of left limbs: influence on visual and sensory neglect

A case of severe left visual neglect who had previously shown reductions in visual neglect with left hand movements in left hemispace showed the same phenomenon when the experiment was repeated, but failed to show it when the left hand was moved passively. However, neglect did reduce when he moved his left leg. Sensory extinction was not affected by left hand movements. Finally, hand movements in left hemispace also reduced neglect for stimuli in far as well as in peripersonal space. These results confirm the close link between visual attention and motor function and provide further support for the idea that contralesional limb movements may reduce visual neglect, possibly by activating a poorly attended body schema which in turn activates corresponding areas of extrapersonal space in at least two spatial systems (reaching and far space, respectively).

Information giving in oncology: a preliminary study of tape-recorder use

This paper describes a pilot study of information giving in an oncology setting. This was achieved by randomly allocating patients to having their consultation tape-recorded or not. The results suggest that this approach increases the retention of information in patients as well as reducing their levels of anxiety. The method is cheap and easy to use, acceptable to patients and their families, and does not inhibit the consultation process.

Spatio-motor cueing in unilateral left neglect: the role of hemispace, hand and motor activation

Reported beneficial effects of left arm activation on neglect are experimentally examined. The present study of a subject with left visual neglect compared left hand finger movement with an instruction to visually anchor perception on the left arm during letter cancellation. Only the finger movements significantly reduced neglect. Another comparison was between "out of sight" finger movements of the left hand in left and right hemispace, respectively. Only left hemispace "blind" finger movements significantly reduced neglect compared to the standard condition. Thirdly, blind left finger movements in left hemispace were compared with passive visual cueing (reading a changing number) and again it was found that only the finger movements reduced neglect. Finally, right finger movements in left hemispace were compared with left finger movements in left hemispace: only the latter reduced neglect. The implications of these findings for theory and therapy of neglect are discussed.

Primary care services. In search of alternative ways of providing services that are affordable, accessible and appropriate. A review of recent literature

Services where the G.P. is the central health professional or "team leader" may satisfactorily provide first-contact medical services. Major problems reported in literature are related to inequity in distribution, and the fee-for-service practice that limits access for those on lower incomes and encourages high throughput. There is a heavy reliance on pharmaceuticals as the main treatment, with health promotion and educative services, and counselling, being generally low. While alternative or complementary therapies may address problems of "failed medicine", these don't answer issues of accessibility, or self-responsibility. Studies on nurse practitioners as the first contact in primary level care demonstrate that technically they can function competently and safely amongst a similar clientele, and that the clients find nurses both satisfactory and acceptable as health care providers. While the quality of care is comparable to that offered by a G.P., the cost is less, both directly to user, or more generally to society. This is related to lower costs of education and remuneration, and that lower costs of pharmaceuticals and diagnostic tests are generated. In addition, the health promotion and educative functions of nurses are overall more prominent, and effective in enhancing peoples self-responsibility in health through improving competence and awareness. User-participation and involvement in health services, and empowerment and self responsibility in health, are therefore more likely to be an outcome of a service in which health promotion and educational activities are central, rather than when medical interventions are the focus. In conclusion, this review of recent literature has raised questions about services currently provided by general practitioners, and as presently funded.(ABSTRACT TRUNCATED AT 250 WORDS)

Diameter, cell type, and survival in stage I primary non-small-cell lung cancer

We analyzed 384 veterans who had "curative" (sometimes conservative) resection from 1966 through 1986 for stage I, non-small-cell primary lung cancer to identify significant variables influencing survival. Operative mortality was 3.1%, mainly from heart attacks. Most patients were asymptomatic, presenting with other diseases of smoking. Five-year survival was 43%; deaths from lung cancer only, 63% (T1, 73%; T2, 49%). Two hundred fourteen (57.5%) of the 372 operative survivors had T1 and 158 (42.5%) had T2 disease. Sixty-five percent had peripheral nodules (84%, T1; 38% T2). Pure squamous cell predominated, in 63% overall (T1, 55%; T2, 74%). Systemic metastases caused most cancer deaths. Within T1, diameter was highly significant. Cell type and time of operation (before or after Dec 31, 1980) were also significant. Under T2, only scarring and differentiation were significant. Veterans in this group live longer if they have small squamous cell tumors.