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  1. Article ; Online: Evaluating the impact on hospital acquired pressure injury/ulcer incidence in a United Kingdom NHS Acute Trust from use of sub-epidermal scanning technology.

    Nightingale, Pippa / Musa, Louisa

    Journal of clinical nursing

    2021  Volume 30, Issue 17-18, Page(s) 2708–2717

    Abstract: Background: The incidence of pressure injury/ulcers is persistent despite multiple prevention strategies in hospitals across the globe. Current standard of pressure injury/ulcer care supported by subjective skin tissue assessments, risk assessment tools ...

    Abstract Background: The incidence of pressure injury/ulcers is persistent despite multiple prevention strategies in hospitals across the globe. Current standard of pressure injury/ulcer care supported by subjective skin tissue assessments, risk assessment tools and clinical judgement is ineffective in consistent pressure injury/ulcer prevention.
    Aim: A pragmatic study, aligning with SQUIRE guidelines, was conducted at Chelsea and Westminster hospitals to measure the impact of adding scanning technology to the prevailing standard of care pathway on the incidence of category 2-4 hospital-acquired pressure injury/ulcers.
    Methods: Six hundred and ninety-seven mixed-population patients at risk for pressure injuries/ulcers with a Waterlow score of ≥10 and a mean age ≥65 years were enrolled across four wards over a 6-month period. Scanning technology was added to the prevailing standard of care as a device adjunctive to clinical judgement for the detection of deep and early-stage pressure-induced tissue damage. Ward staff completed comprehensive device training by the device manufacturer. Clinical interventions were initiated by clinical judgement informed by injury/ulcer risk assessments, skin and tissue assessments and scanner readings. Incidence of reportable category 2-4 pressure injuries/ulcers from the prior 12-month period from the same wards were used as a control comparator population. All diagnosed category 2-4 pressure injuries/ulcers, unstageable and deep-tissue injuries were recorded.
    Results: Prior study 12-month pressure injury/ulcer incidence was 0.6% (5/892 patients) in ward A, 4.4% (9/206 patients) in Ward B, 1.1% (12/1,123 patients) in Ward C and 2.6% (16/625 patients) in Ward D. Two pressure injury/ulcers in Ward B were recorded during the study. Zero pressure injuries/ulcers were recorded in the remaining three wards resulting in an 81% incidence reduction across all four wards. Improved clinical decisions from clinical judgement based on Sub-Epidermal Moisture (SEM) Scanner data were reported in 83% patients (n=578/697).
    Conclusion: Implementing scanning technology into routine clinical practice achieves consistent reductions in pressure injury/ulcer incidence.
    MeSH term(s) Aged ; Hospitals ; Humans ; Incidence ; Pressure Ulcer/epidemiology ; Pressure Ulcer/prevention & control ; State Medicine ; Technology ; Trust ; Ulcer ; United Kingdom/epidemiology
    Language English
    Publishing date 2021-07-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 1159483-4
    ISSN 1365-2702 ; 0962-1067 ; 1752-9816
    ISSN (online) 1365-2702
    ISSN 0962-1067 ; 1752-9816
    DOI 10.1111/jocn.15779
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  2. Article ; Online: Center of Mass Estimation for Impaired Gait Assessment Using Inertial Measurement Units.

    Labrozzi, Gabrielle C / Warner, Holly / Makowski, Nathaniel S / Audu, Musa L / Triolo, Ronald J

    IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society

    2024  Volume 32, Page(s) 12–22

    Abstract: Injury or disease often compromise walking dynamics and negatively impact quality of life and independence. Assessing methods to restore or improve pathological gait can be expedited by examining a global parameter that reflects overall musculoskeletal ... ...

    Abstract Injury or disease often compromise walking dynamics and negatively impact quality of life and independence. Assessing methods to restore or improve pathological gait can be expedited by examining a global parameter that reflects overall musculoskeletal control. Center of mass (CoM) kinematics follow well-defined trajectories during unimpaired gait, and change predictably with various gait pathologies. We propose a method to estimate CoM trajectories from inertial measurement units (IMUs) using a bidirectional Long Short-Term Memory neural network to evaluate rehabilitation interventions and outcomes. Five non-disabled volunteers participated in a single session of various dynamic walking trials with IMUs mounted on various body segments. A neural network trained with data from four of the five volunteers through a leave-one-subject out cross validation estimated the CoM with average root mean square errors (RMSEs) of 1.44cm, 1.15cm, and 0.40cm in the mediolateral (ML), anteroposterior (AP), and inferior/superior (IS) directions respectively. The impact of number and location of IMUs on network prediction accuracy was determined via principal component analysis. Comparing across all configurations, three to five IMUs located on the legs and medial trunk were the most promising reduced sensor sets for achieving CoM estimates suitable for outcome assessment. Lastly, the networks were tested on data from an individual with hemiparesis with the greatest error increase in the ML direction, which could stem from asymmetric gait. These results provide a framework for assessing gait deviations after disease or injury and evaluating rehabilitation interventions intended to normalize gait pathologies.
    MeSH term(s) Humans ; Quality of Life ; Gait ; Walking ; Neural Networks, Computer ; Biomechanical Phenomena
    Language English
    Publishing date 2024-01-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1166307-8
    ISSN 1558-0210 ; 1063-6528 ; 1534-4320
    ISSN (online) 1558-0210
    ISSN 1063-6528 ; 1534-4320
    DOI 10.1109/TNSRE.2023.3341436
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  3. Article ; Online: Trunk Posture from Randomly Oriented Accelerometers.

    Friederich, Aidan R W / Audu, Musa L / Triolo, Ronald J

    Sensors (Basel, Switzerland)

    2022  Volume 22, Issue 19

    Abstract: Feedback control of functional neuromuscular stimulation has the potential to improve daily function for individuals with spinal cord injuries (SCIs) by enhancing seated stability. Our fully implanted networked neuroprosthesis (NNP) can provide real-time ...

    Abstract Feedback control of functional neuromuscular stimulation has the potential to improve daily function for individuals with spinal cord injuries (SCIs) by enhancing seated stability. Our fully implanted networked neuroprosthesis (NNP) can provide real-time feedback signals for controlling the trunk through accelerometers embedded in modules distributed throughout the trunk. Typically, inertial sensors are aligned with the relevant body segment. However, NNP implanted modules are placed according to surgical constraints and their precise locations and orientations are generally unknown. We have developed a method for calibrating multiple randomly oriented accelerometers and fusing their signals into a measure of trunk orientation. Six accelerometers were externally attached in random orientations to the trunks of six individuals with SCI. Calibration with an optical motion capture system resulted in RMSE below 5° and correlation coefficients above 0.97. Calibration with a handheld goniometer resulted in RMSE of 7° and correlation coefficients above 0.93. Our method can obtain trunk orientation from a network of sensors without
    MeSH term(s) Accelerometry ; Humans ; Motion ; Muscle, Skeletal/physiology ; Posture/physiology ; Spinal Cord Injuries
    Language English
    Publishing date 2022-10-10
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2052857-7
    ISSN 1424-8220 ; 1424-8220
    ISSN (online) 1424-8220
    ISSN 1424-8220
    DOI 10.3390/s22197690
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  4. Article ; Online: Facilitation of dependent transfers with functional neuromuscular stimulation: a computer simulation study.

    Bean, Nicholas F / Lombardo, Lisa M / Triolo, Ronald J / Audu, Musa L

    Medical & biological engineering & computing

    2022  Volume 60, Issue 12, Page(s) 3435–3445

    Abstract: A two-part simulation process was developed to investigate the facilitation of vertical patient lifts with functional neuromuscular stimulation (FNS) in individuals with spinal cord injury (SCI). First, external lifting forces representing caregiver ... ...

    Abstract A two-part simulation process was developed to investigate the facilitation of vertical patient lifts with functional neuromuscular stimulation (FNS) in individuals with spinal cord injury (SCI). First, external lifting forces representing caregiver assistance were applied to a 3D musculoskeletal model representing the patient and optimized to enforce a specific lifting trajectory during a forward dynamic simulation. The process was repeated with and without the activation of the knee, hip, and trunk extensor muscles of the patient model to represent contractions of the paralyzed muscles generated via FNS. Secondly, the spinal compression experienced by a caregiver at the L5/S1 joint while generating these external lifting forces was estimated using a second musculoskeletal model representing the caregiver. Simulation without muscle activation predicted spinal compression in the caregiver model approximately 1.3 × the National Institute for Occupational Safety and Health (NIOSH) recommended "Action Limit." Comparatively, simulations with two unique patterns of muscle activation both predicted caregiver spinal compressions below NIOSH recommendations. These simulation results support the hypothesis that FNS activation of a patient's otherwise paralyzed muscles would lower the force output required of a caregiver during a dependent transfer, thus lowering the spinal compression and risk of injury experienced by a caregiver.
    MeSH term(s) Humans ; Computer Simulation ; Torso ; Muscle, Skeletal/physiology ; Physical Therapy Modalities ; Spinal Cord Injuries/therapy ; Biomechanical Phenomena
    Language English
    Publishing date 2022-10-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 282327-5
    ISSN 1741-0444 ; 0025-696X ; 0140-0118
    ISSN (online) 1741-0444
    ISSN 0025-696X ; 0140-0118
    DOI 10.1007/s11517-022-02672-3
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  5. Article ; Online: Feedback control of upright seating with functional neuromuscular stimulation during a reaching task after spinal cord injury: a feasibility study.

    Friederich, Aidan R W / Bao, Xuefeng / Triolo, Ronald J / Audu, Musa L

    Journal of neuroengineering and rehabilitation

    2022  Volume 19, Issue 1, Page(s) 139

    Abstract: Background: Restoring or improving seated stability after spinal cord injury (SCI) can improve the ability to perform activities of daily living by providing a dynamic, yet stable, base for upper extremity motion. Seated stability can be obtained with ... ...

    Abstract Background: Restoring or improving seated stability after spinal cord injury (SCI) can improve the ability to perform activities of daily living by providing a dynamic, yet stable, base for upper extremity motion. Seated stability can be obtained with activation of the otherwise paralyzed trunk and hip musculature with neural stimulation, which has been shown to extend upper limb reach and improve seated posture.
    Methods: We implemented a proportional, integral, derivative (PID) controller to maintain upright seated posture by simultaneously modulating both forward flexion and lateral bending with functional neuromuscular stimulation. The controller was tested with a functional reaching task meant to require trunk movements and impart internal perturbations through rapid changes in inertia due to acquiring, moving, and replacing objects with one upper extremity. Five subjects with SCI at various injury levels who had received implanted stimulators targeting their trunk and hip muscles participated in the study. Each subject was asked to move a weighted jar radially from a center home station to one of three target stations. The task was performed with the controller active, inactive, or with a constant low level of neural stimulation. Trunk pitch (flexion) and roll (lateral bending) angles were measured with motion capture and plotted against each other to generate elliptical movement profiles for each task and condition. Postural sway was quantified by calculating the ellipse area. Additionally, the mean effective reach (distance between the shoulder and wrist) and the time required to return to an upright posture was determined during reaching movements.
    Results: Postural sway was reduced by the controller in two of the subjects, and mean effective reach was increased in three subjects and decreased for one. Analysis of the major direction of motion showed return to upright movements were quickened by 0.17 to 0.32 s. A 15 to 25% improvement over low/no stimulation was observed for four subjects.
    Conclusion: These results suggest that feedback control of neural stimulation is a viable way to maintain upright seated posture by facilitating trunk movements necessary to complete reaching tasks in individuals with SCI. Replication of these findings on a larger number of subjects would be necessary for generalization to the various segments of the SCI population.
    MeSH term(s) Humans ; Feasibility Studies ; Activities of Daily Living ; Spinal Cord Injuries ; Posture/physiology ; Physical Therapy Modalities
    Language English
    Publishing date 2022-12-12
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 2164377-5
    ISSN 1743-0003 ; 1743-0003
    ISSN (online) 1743-0003
    ISSN 1743-0003
    DOI 10.1186/s12984-022-01113-4
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  6. Article ; Online: Robust Control of the Human Trunk Posture Using Functional Neuromuscular Stimulation: A Simulation Study.

    Bao, Xuefeng / Audu, Musa L / Friederich, Aidan R / Triolo, Ronald J

    Journal of biomechanical engineering

    2022  Volume 144, Issue 9

    Abstract: The trunk movements of an individual paralyzed by spinal cord injury (SCI) can be restored by functional neuromuscular stimulation (FNS), which applies low-level current to the motor nerves to activate the paralyzed muscles to generate useful torques, to ...

    Abstract The trunk movements of an individual paralyzed by spinal cord injury (SCI) can be restored by functional neuromuscular stimulation (FNS), which applies low-level current to the motor nerves to activate the paralyzed muscles to generate useful torques, to actuate the trunk. FNS can be modulated to vary the biotorques to drive the trunk to follow a user-defined reference motion and maintain it at a desired postural set-point. However, a stabilizing modulation policy (i.e., control law) is difficult to derive as the biomechanics of the spine and pelvis are complex and the neuromuscular dynamics are highly nonlinear, nonautonomous, and input redundant. Therefore, a control method that can stabilize it with FNS without knowing the accurate skeletal and neuromuscular dynamics is desired. To achieve this goal, we propose a control framework consisting of a robust control module that generates stabilizing torques while an artificial neural network-based mapping mechanism with an anatomy-based updating law ensures that the muscle-generated torques converge to the stabilizing values. For the robust control module, two sliding-mode robust controllers (i.e., a high compensation controller and an adaptive controller), were investigated. System stability of the proposed control method was rigorously analyzed based on the assumption that the skeletal dynamics can be approximated by Euler-Lagrange equations with bounded disturbances, which enables the generalization of the control framework. We present experiments in a simulation environment where an anatomically realistic three-dimensional musculoskeletal model of the human trunk moved in the anterior- posterior and medial-lateral directions while perturbations were applied. The satisfactory simulation results suggest the potential of this control technique for trunk tracking tasks in a typical clinical environment.
    MeSH term(s) Biomechanical Phenomena ; Computer Simulation ; Humans ; Muscle, Skeletal/physiology ; Posture/physiology ; Spinal Cord Injuries ; Torso
    Language English
    Publishing date 2022-03-10
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 243094-0
    ISSN 1528-8951 ; 0148-0731
    ISSN (online) 1528-8951
    ISSN 0148-0731
    DOI 10.1115/1.4053913
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  7. Article ; Online: Stabilizing leaning postures with feedback controlled functional neuromuscular stimulation after trunk paralysis.

    Friederich, Aidan R W / Lombardo, Lisa M / Foglyano, Kevin M / Audu, Musa L / Triolo, Ronald J

    Frontiers in rehabilitation sciences

    2023  Volume 4, Page(s) 1222174

    Abstract: Spinal cord injury (SCI) can cause paralysis of trunk and hip musculature that negatively impacts seated balance and ability to lean away from an upright posture and interact fully with the environment. Constant levels of electrical stimulation of ... ...

    Abstract Spinal cord injury (SCI) can cause paralysis of trunk and hip musculature that negatively impacts seated balance and ability to lean away from an upright posture and interact fully with the environment. Constant levels of electrical stimulation of peripheral nerves can activate typically paralyzed muscles and aid in maintaining a single upright seated posture. However, in the absence of a feedback controller, such seated postures and leaning motions are inherently unstable and unable to respond to perturbations. Three individuals with motor complete SCI who had previously received a neuroprosthesis capable of activating the hip and trunk musculature volunteered for this study. Subject-specific muscle synergies were identified through system identification of the lumbar moments produced via neural stimulation. Synergy-based calculations determined the real-time stimulation parameters required to assume leaning postures. When combined with a proportional, integral, derivative (PID) feedback controller and an accelerometer to infer trunk orientation, all individuals were able to assume non-erect postures of 30-40° flexion and 15° lateral bending. Leaning postures increased forward reaching capabilities by 10.2, 46.7, and 16 cm respectively for each subject when compared with no stimulation. Additionally, the leaning controllers were able to resist perturbations of up to 90 N, and all subjects perceived the leaning postures as moderately to very stable. Implementation of leaning controllers for neuroprostheses have the potential of expanding workspaces, increasing independence, and facilitating activities of daily living for individuals with paralysis.
    Language English
    Publishing date 2023-09-28
    Publishing country Switzerland
    Document type Journal Article
    ISSN 2673-6861
    ISSN (online) 2673-6861
    DOI 10.3389/fresc.2023.1222174
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  8. Article: Clinical impact of a sub-epidermal moisture scanner: what is the real-world use?

    Musa, Louisa / Ore, Nicky / Raine, Gillian / Smith, Glenn

    Journal of wound care

    2021  Volume 30, Issue 3, Page(s) 198–208

    Abstract: Objective: The presence of sub-epidermal moisture (SEM) over a bony prominence is indicative of incipient pressure ulcer (pressure injury/decubitus/bedsore) (PU). Early identification of patients at increased risk of PU can prompt interventions that ... ...

    Abstract Objective: The presence of sub-epidermal moisture (SEM) over a bony prominence is indicative of incipient pressure ulcer (pressure injury/decubitus/bedsore) (PU). Early identification of patients at increased risk of PU can prompt interventions that reduce the incidence and severity of hospital (or community)-acquired PUs (HAPUs). This study evaluated the clinical utility of a SEM Scanner device in HAPU management.
    Method: The study used a pragmatic 'real-world' approach. HAPU data before and during SEM Scanner use were obtained through routine audit. Patients had regular visual and daily SEM Scanner skin assessments over the sacrum and heels. Nursing care otherwise followed standard of care according to the established protocols of individual participating sites. HAPU incidence rates were determined and feedback gathered from health professionals on how the device influenced HAPU-related clinical decision-making.
    Results: There were 15 participating sites: 13 acute care, one palliative care and one community care setting. The sample size was 1478 patients. All sites reported a substantial reduction in mean HAPU incidence: 87.2% in acute care settings; 46.7% in the palliative care setting and 26.7% in the community care setting. A 100% incidence reduction was reported in 10 (66.7%) sites. In the palliative care setting, SEM Scanner results changed HAPU-related clinical decision-making for 40% of patients scanned. The community care site demonstrated a 82% change in clinical decision-making.
    Conclusion: In this study, SEM analysis fitted seamlessly into routine skin assessment and enabled early identification of increased risk of tissue damage, with clinically important reductions in the incidence of HAPU across all participating sites.
    MeSH term(s) Decision Trees ; England/epidemiology ; Epidermis ; Hospitals ; Humans ; Incidence ; Pressure Ulcer/epidemiology ; Pressure Ulcer/prevention & control ; Risk Assessment ; Skin Care ; Skin Pigmentation/physiology ; Wound Healing
    Language English
    Publishing date 2021-03-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 1353951-6
    ISSN 0969-0700
    ISSN 0969-0700
    DOI 10.12968/jowc.2021.30.3.198
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  9. Article: Multidrug-Resistant Extended-Spectrum Beta-Lactamase (ESBL)-Producing

    Penati, Martina / Musa, Laura / Filippone Pavesi, Laura / Guaraglia, Alessandro / Ulloa, Fernando / Moroni, Paolo / Piccinini, Renata / Addis, Maria Filippa

    Antibiotics (Basel, Switzerland)

    2024  Volume 13, Issue 3

    Abstract: This study investigated the presence, distribution, and antimicrobial resistance profiles of extended-spectrum beta-lactamase (ESBL)- ... ...

    Abstract This study investigated the presence, distribution, and antimicrobial resistance profiles of extended-spectrum beta-lactamase (ESBL)-producing
    Language English
    Publishing date 2024-03-05
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2681345-2
    ISSN 2079-6382
    ISSN 2079-6382
    DOI 10.3390/antibiotics13030241
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  10. Article ; Online: Characterization of the Force Production Capabilities of Paralyzed Trunk Muscles Activated With Functional Neuromuscular Stimulation in Individuals With Spinal Cord Injury.

    Friederich, Aidan R W / Audu, Musa L / Triolo, Ronald J

    IEEE transactions on bio-medical engineering

    2021  Volume 68, Issue 8, Page(s) 2389–2399

    Abstract: Paralysis of the trunk results in seated instability leading to difficulties performing activities of daily living. Functional neuromuscular stimulation (FNS) combined with control systems have the potential to restore some dynamic functions of the trunk. ...

    Abstract Paralysis of the trunk results in seated instability leading to difficulties performing activities of daily living. Functional neuromuscular stimulation (FNS) combined with control systems have the potential to restore some dynamic functions of the trunk. However, design of multi-joint, multi-muscle control systems requires characterization of the stimulation-driven muscles responsible for movement.
    Objective: This study characterizes the input-output properties of paralyzed trunk muscles activated by FNS, and explores co-activation of muscles.
    Methods: Four participants with various spinal cord injuries (C7 AIS-B, T4 AIS-B, T5 AIS-A, C5 AIS-C) were constrained so lumbar forces were transmitted to a load cell while an implanted neuroprosthesis activated otherwise paralyzed hip and paraspinal muscles. Isometric force recruitment curves in the nominal seated position were generated by inputting the level of stimulation (pulse width modulation) while measuring the resulting muscle force. Two participants returned for a second experiment where muscles were co-activated to determine if their actions combined linearly.
    Results: Recruitment curves of most trunk and hip muscles fit sigmoid shaped curves with a regression coefficient above 0.75, and co-activation of the muscles combined linearly across the hip and lumbar joint. Subject specific perturbation plots showed one subject is capable of resisting up to a 300N perturbation anteriorly and 125N laterally; with some subjects falling considerably below these values.
    Conclusion: Development of a trunk stability control system can use sigmoid recruitment dynamics and assume muscle forces combine linearly.
    Significance: This study informs future designs of multi-muscle, and multi-dimensional FNS systems to maintain seated posture and stability.
    MeSH term(s) Activities of Daily Living ; Humans ; Muscle, Skeletal ; Posture ; Spinal Cord Injuries ; Torso
    Language English
    Publishing date 2021-07-16
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 160429-6
    ISSN 1558-2531 ; 0018-9294
    ISSN (online) 1558-2531
    ISSN 0018-9294
    DOI 10.1109/TBME.2020.3039404
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