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7. Exploration of rehabilitation through the use of virtual reality interventions for patients with upper limb conditions: protocol for scoping review. v1

Author

Stefanie F Andrew, Carol Clark, Sheppard Z.A., Evans M., Hutt J., and Crook T. B.

Subjects
medicine.medical_specialty, medicine.anatomical_structure, Physical medicine and rehabilitation, Rehabilitation, business.industry, medicine.medical_treatment, medicine, Psychological intervention, Upper limb, Virtual reality, business, Protocol (object-oriented programming)
Abstract

Background The use of virtual reality to aid rehabilitation of upper-limb conditions has been an emerging field over the past decade. The majority of research seems to focus on post-stroke therapies with major advances in improving hand function through various robotic and digital techniques (1), however it is still not standard practice. With the recent crisis of COVID 19, home therapy has been thrust into the forefront of rehabilitation. At present a wide variety of technology has been developed to target rehabilitation in the upper limb.This includes hand tracking technology (e.g. Leap Motion) where various prototypes have been tested using haptics (2), robotic-assisted movement devices which predominantly target stroke or neurorehabilitation by means of exoskeleton prototypes (3,4), and exercise programmes through telerehabilitation and virtual reality (5). The majority of hand devices that have been developed are bulky and can impact on the accuracy of functional measurements (6). In terms of virtual reality, studies suggest that patients find it enjoyable and are as, if not more, motivated in these rehabilitation sessions when compared to traditional exercises, even in the older population (7). Hoffman et al in 2020 (8) found that patients undergoing hand rehabilitation with virtual reality felt that their pain was reduced, they had increased levels of motivation and therefore felt more able to perform exercises. This has been matched by studies looking at pain and anxiety levels whilst using virtual reality during wide awake anaesthesia with a significant reduction in both (9). Hand rehabilitation outside of stroke and neurological disorders, for example post-surgery or trauma, involves intensive hand rehabilitation by the hand therapy team but there is a global shortage of this service. Current practice is one-to-one patient-to-therapist and involves intensive rehabilitation, assessment and documentation. Virtual reality could prove a vital technology to develop to enable patients to undertake immersive therapy within their own homes whilst allowing remote assessment of their progress and function from the hand therapy and clinical teams. Aims The overarching aim of this review is to identify the range and variety of virtual reality tools that are available and effective for upper limb conditions. Review objectives 1) What is the “extent (size), range (variety) and nature (characteristics) of the evidence” of virtual tools to enhance hand rehabilitation? 2) Do these tools have the potential to be used in the field of hand surgery and hand rehabilitation? 3) What are the barriers and facilitators to hand rehabilitation using virtual tools? Design The scoping review will be conducted in accordance with PRISMA-ScR guidelines (10) and the frameworks developed by Arksey and O’Malley (11) and Levac et al. (12). Preliminary searches will be conducted and two librarians will be consulted to create a comprehensive search strategy. Screening of titles and abstracts will be undertaken by three independent reviewers, with conflicts resolved by discussions and consensus. Full-text screening will be undertaken following this same approach. A charting form will be developed based on the objectives of the review and refined by the research team. Data will be collated and summarised, with quantitative sources described descriptively and qualitative data analysed thematically (13). Results will be presented using summary tables and/or using pictorial/flow charts, if appropriate. References 1) Saposnik G, Levin M, Outcome Research Canada (SORCan) Working Group. Virtual reality in stroke rehabilitation: a meta-analysis and implications for clinicians. Stroke. 2011 May;42(5):1380-1386. DOI: 10.1161/strokeaha.110.605451. 2) Placidi G, Avola D, Iacoviello D, Cinque L. Overall design and implementation of the virtual glove. Comput Biol Med. 2013 Nov;43(11):1927-40. doi: 10.1016/j.compbiomed.2013.08.026. Epub 2013 Sep 25. PMID: 24209938. 3) Ghassemi M, Ochoa JM, Yuan N, Tsoupikova D, Kamper D. Development of an Integrated Actuated Hand Orthosis and Virtual Reality System for Home-Based Rehabilitation. Annu Int Conf IEEE Eng Med Biol Soc. 2018 Jul;2018:1689-1692. doi: 10.1109/EMBC.2018.8512704. PMID: 30440720. 4) Osuagwu BAC, Timms S, Peachment R, Dowie S, Thrussell H, Cross S, Shirley R, Segura-Fragoso A, Taylor J. Home-based rehabilitation using a soft robotic hand glove device leads to improvement in hand function in people with chronic spinal cord injury:a pilot study. J Neuroeng Rehabil. 2020 Mar 5;17(1):40. doi: 10.1186/s12984-020-00660-y. PMID: 32138780; PMCID: PMC7057671. 5) Levanon Y. The advantages and disadvantages of using high technology in hand rehabilitation. J Hand Ther. 2013 Apr-Jun;26(2):179-83. doi: 10.1016/j.jht.2013.02.002. PMID: 23598084. 6) Rose CG, Pezent E, Kann CK, Deshpande AD, O'Malley MK. Assessing Wrist Movement With Robotic Devices. IEEE Trans Neural Syst Rehabil Eng. 2018 Aug;26(8):1585-1595. doi: 10.1109/TNSRE.2018.2853143. Epub 2018 Jul 5. PMID: 29994401. 7) Van Schaik P, Blake J, Pernet F, Spears I, Fencott C. Virtual augmented exercise gaming for older adults. Cyberpsychol Behav. 2008 Feb;11(1):103-6. doi: 10.1089/cpb.2007.9925. PMID: 18275322. 8) Hoffman HG, Boe DA, Rombokas E, Khadra C, LeMay S, Meyer WJ, Patterson S, Ballesteros A, Pitt SW. Virtual reality hand therapy: A new tool for nonopioid analgesia for acute procedural pain, hand rehabilitation, and VR embodiment therapy for phantom limb pain. J Hand Ther. 2020 Apr-Jun;33(2):254-262. doi: 10.1016/j.jht.2020.04.001. Epub 2020 May 30. PMID: 32482376; PMCID: PMC7719341. 9) Hoxhallari E, Behr IJ, Bradshaw JS, Morkos MS, Haan PS, Schaefer MC, Clarkson JHW. Virtual Reality Improves the Patient Experience during Wide-Awake Local Anesthesia No Tourniquet Hand Surgery: A Single-Blind, Randomized, Prospective Study. Plast Reconstr Surg. 2019 Aug;144(2):408-414. doi: 10.1097/PRS.0000000000005831. PMID: 31348351. 10) Tricco, AC, Lillie, E, Zarin, W, O'Brien, KK, Colquhoun, H, Levac, D, Moher, D, Peters, MD, Horsley, T, Weeks, L, Hempel, S et al. (2018b) PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018,169 (7):467-473. doi:10.7326/M18-0850. 11) Arksey H and O’Malley L (2005) Scoping studies: towards a methodological framework International Journal of Social Research Methodology 8(1): 19-32 12) Levac D, Colquhoun H and O’Brien K (2010) Scoping studies: advancing the methodology Implementation Science 5: 69 13) Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. doi:10.1191/1478088706qp063oa 14) World Health Organisation (2018) Classification of digital health interventions v1.0: A shared language to describe the uses of digital technology for health. WHO/RHR/19.06. Pages 1-20. https://www.who.int/reproductivehealth/publications/mhealth/classification-digital-health-interventions/en/

Published
2021

12. Mixing Characteristics of Coaxial Injectors at High Gas to Liquid Momentum Ratios

Author

Strakey, P. A, Talley, D. G, and Hutt, J. J

Subjects
Fluid Mechanics And Heat Transfer
Abstract

A study of the spray of a swirl coaxial gas-liquid injector operating at high gas to liquid momentum ratios is reported. Mixing and droplet size characteristics of the swirl injector are also compared to a shear coaxial injector, currently being used in the Space Shuttle Main Engine fuel preburner. The injectors were tested at elevated chamber pressures using water as a LOX simulant and nitrogen and helium as gaseous hydrogen simulants. The elevated chamber pressure allowed for matching of several of the preburner injector conditions including; gas to liquid momentum ratio, density ratio and Mach number. Diagnostic techniques used to characterize the spray included; strobe back-light imaging, laser sheet spray imaging, mechanical patternation, and a phase Doppler interferometry. Results thus far indicate that the radial spreading of the swirl coaxial spray is much less than was reported in previous studies of swirl injectors operating at atmospheric back-pressure. The swirl coaxial spray does, however, exhibit a smaller overall droplet size which may be interpreted as an increase in local mixing.

Published
1999

13. Liquid propellant rocket engine combustion simulation with a time-accurate CFD method

Author

Chen, Y. S, Shang, H. M, Liaw, Paul, and Hutt, J

Subjects
Fluid Mechanics And Heat Transfer
Abstract

Time-accurate computational fluid dynamics (CFD) algorithms are among the basic requirements as an engineering or research tool for realistic simulations of transient combustion phenomena, such as combustion instability, transient start-up, etc., inside the rocket engine combustion chamber. A time-accurate pressure based method is employed in the FDNS code for combustion model development. This is in connection with other program development activities such as spray combustion model development and efficient finite-rate chemistry solution method implementation. In the present study, a second-order time-accurate time-marching scheme is employed. For better spatial resolutions near discontinuities (e.g., shocks, contact discontinuities), a 3rd-order accurate TVD scheme for modeling the convection terms is implemented in the FDNS code. Necessary modification to the predictor/multi-corrector solution algorithm in order to maintain time-accurate wave propagation is also investigated. Benchmark 1-D and multidimensional test cases, which include the classical shock tube wave propagation problems, resonant pipe test case, unsteady flow development of a blast tube test case, and H2/O2 rocket engine chamber combustion start-up transient simulation, etc., are investigated to validate and demonstrate the accuracy and robustness of the present numerical scheme and solution algorithm.

Published
1993

14. Rocket injector single element characterization at the Marshall Space Flight Center

Author

Hutt, J, Robertson, T, Mcdaniels, D, Eskridge, R, and Fisher, M

Subjects
Ground Support Systems And Facilities (Space)
Abstract

The paper describes three experimental facilities which are being developed at NASA's Marshall Space Flight Center (MSFC) for rocket injector cold-flow characterization. The first of these is an already operational cold-flow ambient-backpressure facility, which uses water and air to simulate LOX and gaseous hydrogen, respectively; the facility can be used to obtain discharge coefficients, to measure flow uniformity, and to develop diagnostic techniques for use in the high-backpressure cold-flow chamber that is being currently developed at MSFC. The second is a cold-flow acrylic model facility to be used for evaluating the effect of changes in the internal flow geometry on the performance and combustion stability characteristics of a swirl coaxial LOX post. The third is a high-pressure cold-flow facility to be used for the characterization of the injector elements' performance; a specific application is to determine the effect of swirl elements on the temperature striations in the SSME preburners.

Published
1993

15. Stability testing of a modified Space Shuttle Main Engine

Author

Dennis, H, Hutt, J, and Nesman, T

Subjects
Spacecraft Propulsion And Power
Abstract

The testing of the combustion stability characteristics of Space Shuttle Main Engine (SSME) 0208 is described in terms of augmenting the technology base for large O/H thrust-chamber assemblies. The throat area is increased by 12 percent over that of the flight SSMEs, and the thrust chamber assembly does not include stability aids. Acoustic modes in the chamber are excited by means of rapid pressure generators employed in the start-transient through mainstage operations. Stability characteristics are determined by damp times which are facilitated by high-frequency instrumentation measuring oscillations and locating stable operating regions. All vibration modes are damped to within the requirements for a chamber mode set forth by the Chemical Propulsion Information Agency. No sustained chamber acoustic oscillations are exhibited in engine 0208's combustion chamber configuration in spite of the absence of baffles and acoustic cavities.

Published
1991

16. Cerebral perfusion monitoring in adult patients following cardiac surgery: an observational study.

Author

Slater, T, Stanik-Hutt, J, Davidson, P, Slater, T, Stanik-Hutt, J, and Davidson, P

Abstract

BACKGROUND: Following adult cardiac surgery, often difficult to detect fluctuations in regional cerebral perfusion can contribute to strokes. Optimal cerebral perfusion remains elusive and traditional monitoring strategies do not consistently identify acute changes. Non-invasive cerebral oximetry may detect perfusion variations. OBJECTIVE: To assess the feasibility of postoperative non-invasive cerebral oximetry monitoring. METHODS: Non-invasive cerebral oximetry was performed on adult aortic valve surgery patients in a cardiac surgical intensive care unit. Monitoring feasibility was assessed using an investigator-developed, data extraction tool. RESULTS: Non-invasive cerebral oximetry was completed in 94% of patients. Sixty percent had values that fell below pre-set ischemic threshold. Nurses reported monitoring was feasible, and they perceived identifying deleterious cerebral perfusion trends may improve patient care. CONCLUSIONS: Prevalence of low cerebral oximetry values underscores the importance of increasing sensitivity of monitoring tools. Further evaluation is required to assess this modality and the role of nurses in optimizing neurocognitive outcomes. Impact statement: Cerebral oximetry monitoring may help identify adult patients at risk of neurological complications after cardiac surgery, and as a consequence initiate definitive therapeutic strategies.

Published
2017

19. Mixing Characteristics of Coaxial Injectors at High Gas/Liquid Momentum Ratios

Author

AIR FORCE RESEARCH LAB EDWARDS AFB CA PROPULSION DIRECTORATE, Strakey, P. A., Talley, D. G., Hutt, J. J., AIR FORCE RESEARCH LAB EDWARDS AFB CA PROPULSION DIRECTORATE, Strakey, P. A., Talley, D. G., and Hutt, J. J.

Abstract

A study of the spray of a swirl coaxial gas-liquid injector operating at high-liquid momentum ratios is reported. Mixing and droplet size characteristics of the swirl injector are also compared to a shear coaxial injector, currently being used in the space shuttle main engine fuel preburner. The injectors were tested at elevated chamber pressures using water as a liquid oxygen stimulant and nitrogen and helium as gaseous hydrogen simulants. The elevated chamber pressure allowed for matching of several of the preburner injector conditions including gas/liquid momentum ratio, density ratio and Mach number. Diagnostic techniques used to characterize the spray included strobe backlight imaging, laser-sheet spray imaging, mechanical patternation, and phase Doppler interferometry. The results indicate that the radial spreading of the swirl coaxial spray is much less than was reported in previous studies of swirl injectors operating at atmospheric backpressure. The swirl coaxial spray did, however, exhibit a smaller overall droplet size., Pub. in Jnl. of Propulsion and Power, v17 n2 p402-410, March-April 2001.

Published
2003

22. 002 How Painful is Wound Care?

Author

Stotts, N.A., primary, Puntillo, K., additional, Morris, A.B., additional, Stanik-Hutt, J., additional, Thompson, C.L., additional, White, C., additional, and Wild, L.R., additional

Published
2008
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23. Dynamic stability of plates by finite elements

Author

Hutt, J. M and Salam, A. E

Subjects
Structural Mechanics
Abstract

Convergent finite element equations for dynamic stability of plates dependent on vibration and buckling modes

Published
1971

24. Improved fire-resistant coatings

Author

Hutt, J. B and Stuart, J. W

Subjects
Materials
Abstract

Water-base coatings containing potassium silicate show improvement in areas of quick air-drying, crack, craze, and abrasion resistance, adherence, and leach resistance. Coatings are useful as thermal-barrier layers in furnaces, and as general purpose fire resistant surfaces where vapor impermeability is not a requirement.

Published
1971

36. Biological microdosimetry based on radiation cytotoxicity data.

Author

Scott, B. R., Hutt, J., Lin, Y., Padilla, M. T., Gott, K. M., and Potter, C. A.

Subjects
MICRODOSIMETRY, RELATIVE biological effectiveness (Radiobiology), PHOTON emission, PARAMETER estimation, GAMMA rays, X-rays, DATA analysis
Abstract

Researchers in the field of radiation microdosimetry have attempted to explain the relative biological effectiveness (RBE) of different ionising photon radiation sources on the basis of the singly stochastic, microdose metric lineal energy y, which only addresses physical stochasticity related to energy (ɛ) deposition via single events in the critical targets (cell nuclei assumed here). Biological stochasticity related to variable nuclei geometries and cell orientations (relative to the incoming radiation) is usually not addressed. Here a doubly stochastic microdose metric, the single-event hit size q (=ɛ/T), is introduced which allows the track length T to be stochastic. The new metric is used in a plausible model of metabolic-activity-based in vitro cytotoxicity of low-dose ionising photon radiation. The cytotoxicity model has parameters E{q} (average single-event hit size with q assumed to be exponentially distributed) and E{α}, which is the average value of the cellular response parameter α. E{α} is referred to as the biological signature and it is independent of q. Only E{q} is needed for determination of RBE. The model is used to obtain biological-microdosimetry-based q spectra for 320-kV X-rays and 137Cs gamma rays and the related RBE for cytotoxicity. The spectra are similar to published lineal energy y spectra for 200-kV X-rays and 60Co gamma rays for 1-μm biological targets. [ABSTRACT FROM AUTHOR]

Published
2013
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40. Prevention and reversal of nephritis in MRL/lpr mice with a single injection of C-reactive protein.

Author

Rodriguez W, Mold C, Marnell LL, Hutt J, Silverman GJ, Tran D, and Du Clos TW

Abstract

OBJECTIVE: C-reactive protein (CRP) is an acute-phase serum protein with binding reactivity to nuclear autoantigens and immunomodulatory function. The MRL/lpr mouse is an important model of human systemic lupus erythematosus (SLE). These mice develop high-titer anti-DNA antibodies and immune complex-mediated nephritis and exhibit progressive lymphadenopathy. The mortality rate among these mice is 50% by age 18-20 weeks; the most frequent cause of death is glomerulonephritis. The present study was undertaken to determine whether treatment of mice with CRP would affect the course of lupus nephritis. METHODS: MRL/lpr mice were treated with a single 200-mug injection of CRP at either age 6 weeks (before disease onset) or age 13 or 15 weeks (when proteinuria had reached high levels). Proteinuria was measured weekly, and levels of anti-double-stranded DNA autoantibodies and blood urea nitrogen were determined monthly. Glomerular immune complex deposition and renal pathology were assessed in mice ages 15 weeks and 17 weeks. RESULTS: Early CRP treatment markedly delayed the onset of proteinuria and lymphadenopathy, increased survival, and reduced levels of autoantibodies to DNA. Treatment of mice with active disease reversed proteinuria and prolonged survival. Renal disease was decreased in CRP-treated mice, with a marked suppression of glomerular pathology, tubular degeneration, and interstitial inflammation, which correlated with the decrease in proteinuria and azotemia. CONCLUSION: These findings demonstrate that systemic suppression of autoimmunity is initiated by a single injection of CRP. Long-term maintenance of CRP-mediated protection was reversed by injection of an anti-CD25 monoclonal antibody but not by macrophage depletion, suggesting that disease suppression is maintained by CD25-bearing T cells. [ABSTRACT FROM AUTHOR]

Published
2006
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41. Injuries caused by airbags: a review.

Author

Hutt, J. R. B. and Wallis, L. A.

Subjects
*AIR bag restraint systems, *AUTOMOBILE safety appliances, *WOUNDS & injuries, *MEDICAL emergencies, *SURGICAL emergencies, *TRAUMATOLOGY, *SURGERY, *EMERGENCY medicine
Abstract

With the number of vehicles on the road increasing, the safety aspects of motoring are becoming a progressively more important consideration in health care provision and policy. Airbags are a relatively new introduction into our vehicles. Unlike other mechanisms such as seat belts, they offer protection without the need for any action on the part of the occupant. However, the necessarily violent nature of their deployment has led to the emergence of patterns of injury as a direct result. Knowledge of the potential dangers posed by these systems is useful both for emergency department physicians in order to prevent important injuries being missed, and for car manufacturers using increasingly modern technology to design more efficient mechanisms. We undertook a review of the current literature to ascertain the spectrum of injuries that have been attributed to the use of airbags, while putting this into the wider context of their protective contribution. [ABSTRACT FROM AUTHOR]

Published
2004
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43. Signal transducer and activator of transcription 3 activates CCAAT enhancer-binding protein delta gene transcription in G0 growth-arrested mouse mammary epithelial cells and in involuting mouse mammary gland.

Author

Hutt, J A, O'Rourke, J P, and DeWille, J

Abstract

The CCAAT enhancer-binding protein (C/EBP) family of transcription factors is implicated in the regulation of cell proliferation and differentiation in a variety of tissues. C/EBPdelta is involved in regulating G(0) growth arrest and apoptosis of mouse mammary epithelial cells. This study shows that activation of signal transducer and activator of transcription 3 (Stat3), but not activation of Stat1 or Stat5, occurs concurrently with G(0) growth arrest of HC11 mouse mammary epithelial cells, but not NIH 3T3 fibroblasts. Promoter analysis demonstrates that the C/EBPdelta promoter fragment involved in transcriptional activation during G(0) growth arrest contains a Stat3 binding site and that mutation of this site eliminates the G(0) growth arrest inducibility of the C/EBPdelta promoter. Overexpression of Stat3 increases C/EBPdelta promoter activity during G(0) growth arrest of HC11 cells, whereas dominant negative Stat3 decreases C/EBPdelta promoter activity under the same conditions. Neither Stat3 overexpression nor dominant negative Stat3 expression influences C/EBPdelta promoter activity in growing HC11 cells or G(0) growth-arrested NIH3T3 cells, demonstrating that the effect is specific to G(0) growth arrest of mammary epithelial cells. Band shift assays and antibody interference assays demonstrate specific binding of Stat3 to the acute phase response element in the C/EBPdelta promoter in G(0) growth-arrested HC11 cell extracts and 24 h involuting mouse mammary gland extracts. These data indicate that Stat3 activates C/EBPdelta transcription in G(0) growth-arrested mouse mammary epithelial cells and binds to the C/EBPdelta promoter during involution. An autocrine mechanism of Stat3 activation is proposed.

Published
2000
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44. CCAAT/enhancer-binding protein delta regulates mammary epithelial cell G0 growth arrest and apoptosis.

Author

O'Rourke, J P, Newbound, G C, Hutt, J A, and DeWille, J

Abstract

CCAAT/enhancer-binding proteins (C/EBPs) are a highly conserved family of DNA-binding proteins that regulate cell-specific growth, differentiation, and apoptosis. Here, we show that induction of C/EBPdelta gene expression during G0 growth arrest is a general property of mammary-derived cell lines. C/EBPdelta is not induced during G0 growth arrest in 3T3 or IEC18 cells. C/EBPdelta induction is G0-specific in mouse mammary epithelial cells; C/EBPdelta gene expression is not induced by growth arrest in the G1, S, or G2 phase of the cell cycle. C/EBPdelta antisense-expressing cells (AS1 cells) maintain elevated cyclin D1 and phosphorylated retinoblastoma protein levels and exhibit delayed G0 growth arrest and apoptosis in response to serum and growth factor withdrawal. Conversely, C/EBPdelta-overexpressing cells exhibited a rapid decline in cyclin D1 and phosphorylated retinoblastoma protein levels, a rapid increase in the cyclin-dependent kinase inhibitor p27, and accelerated G0 growth arrest and apoptosis in response to serum and growth factor withdrawal. When C/EBPdelta levels were rescued in AS1 cells by transfection with a C/EBPdelta "sense" construct, normal G0 growth arrest and apoptosis were restored. These results demonstrate that C/EBPdelta plays a key role in the regulation of G0 growth arrest and apoptosis in mammary epithelial cells.

Published
1999

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