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A 3D printing approach toward targeted intervention in telerehabilitation.

ABSTRACT: Neuromuscular impairment requires adherence to a rehabilitation regimen for maximum recovery of motor function. Consumer-grade game controllers have emerged as a viable means to relay supervised physical therapy to patients' homes, thereby increasing their accessibility to healthcare. These controllers allow patients to perform exercise frequently and improve their rehabilitation outcomes. However, the non-universal design of game controllers targets healthy people and does not always accommodate people with disability. Consequently, many patients experience considerable difficulty assuming certain hand postures and performing the prescribed exercise correctly. Here, we explore the feasibility of improving rehabilitation outcomes through a 3D printing approach that enhances off-the-shelf game controllers in home therapy. Specifically, a custom attachment was 3D printed for a commercial haptic device that mediates fine motor rehabilitation. In an experimental study, 25 healthy subjects performed a navigation task, with the retrofit attachment and without it, while simulating disability of the upper limb. When using the attachment, subjects extended their wrist range of motion, yet maintained their level of compensation. The subjects also showed higher motivation to repeat the exercise with the enhanced device. The results bring forward evidence for the potential of this approach in transforming game controllers toward targeted interventions in home therapy.

SUBMITTER: Barak Ventura R

PROVIDER: S-EPMC7048757 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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A 3D printing approach toward targeted intervention in telerehabilitation.

Barak Ventura Roni R Rizzo Alessandro A Nov Oded O Porfiri Maurizio M

Scientific reports 20200228 1

Neuromuscular impairment requires adherence to a rehabilitation regimen for maximum recovery of motor function. Consumer-grade game controllers have emerged as a viable means to relay supervised physical therapy to patients' homes, thereby increasing their accessibility to healthcare. These controllers allow patients to perform exercise frequently and improve their rehabilitation outcomes. However, the non-universal design of game controllers targets healthy people and does not always accommodat ...[more]

PMID: 32111880

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Project description:3D printing is a rapidly evolving field for biological (bioprinting) and non-biological applications. Due to a high degree of freedom for geometrical parameters in 3D printing, prototype printing of bioreactors is a promising approach in the field of Tissue Engineering. The variety of printers, materials, printing parameters and device settings is difficult to overview both for beginners as well as for most professionals. In order to address this problem, we designed a guidance including test bodies to elucidate the real printing performance for a given printer system. Therefore, performance parameters such as accuracy or mechanical stability of the test bodies are systematically analysed. Moreover, post processing steps such as sterilisation or cleaning are considered in the test procedure. The guidance presented here is also applicable to optimise the printer settings for a given printer device. As proof of concept, we compared fused filament fabrication, stereolithography and selective laser sintering as the three most used printing methods. We determined fused filament fabrication printing as the most economical solution, while stereolithography is most accurate and features the highest surface quality. Finally, we tested the applicability of our guidance by identifying a printer solution to manufacture a complex bioreactor for a perfused tissue construct. Due to its design, the manufacture via subtractive mechanical methods would be 21-fold more expensive than additive manufacturing and therefore, would result in three times the number of parts to be assembled subsequently. Using this bioreactor we showed a successful 14-day-culture of a biofabricated collagen-based tissue construct containing human dermal fibroblasts as the stromal part and a perfusable central channel with human microvascular endothelial cells. Our study indicates how the full potential of biofabrication can be exploited, as most printed tissues exhibit individual shapes and require storage under physiological conditions, after the bioprinting process.

Project description:BackgroundCarotid Artery Stenting (CAS) is increasingly being used in selected patients as a minimal invasive approach to carotid endarterectomy. Despite the long standing tradition of endovascular treatments, visual feedback during stent-deployment is impossible to obtain as deployment is performed under fluoroscopic imaging. Furthermore, the concept of stent-placement is often still unclear to patients. 3D Printing allows to replicate patient-specific anatomies and deploy stents inside them to simulate procedures. As such these models are being used for endovascular training as well as patient education.PurposeTo our knowledge, this study reports the first use of a low-cost patient-specific 3D printed model for teaching CAS deployment under direct visualization, without fluoroscopy.MethodologyA CT-angiogram was segmented and converted to STL format using Mimics inPrint™ software. The carotid arteries were bilaterally truncated to fit the whole model on a Formlabs 2 printer without omitting the internal vessel diameter. Next, this model was offset using a 1 mm margin. A ridge was modelled on the original vessel anatomy which was subsequently subtracted from the offset model in order to obtain a deroofed 3D model. All vessels were truncated to facilitate post-processing, flow and guide wire placement.ResultsCarotid artery stents were successfully deployed inside the vessel. The deroofing allows for clear visualization of the bottlenecks and characteristics of CAS deployment and positioning, including stent foreshortening, tapering and recoil. This low-cost 3D model provides visual insights in stent deployment and positioning, and can allow for patient-specific procedure planning.ConclusionsThe presented approach demonstrates the use of low-cost 3D Printed CAS models in teaching complex stent behavior as observed during deployment. Two main findings are illustrated. On one hand, the feasibility of low-cost in-hospital model production is shown. On the other hand, the teaching of CAS deployment bottlenecks at the carotid level without the need for fluoroscopic guidance, is illustrated. The observed stent characteristics as shown during deployment are difficult to assess in radiologic models. Furthermore, printing patient-specific 3D models preoperatively could possibly assist in accurate patient selection, preoperative planning, case-specific training and patient education.

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A 3D printing approach toward targeted intervention in telerehabilitation.

Publications

A 3D printing approach toward targeted intervention in telerehabilitation.

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