Faster or longer steps: Maintaining fast walking in older adults at risk for mobility disability.

Background: The ability to walk at various speeds is essential to independence for older adults. Maintaining fast walking requires changes in spatial-temporal measures, increasing step length and/or decreasing step time. It is unknown how mobility affects the parameters that change between preferred and fast walking.

Establishing Quality and Safety in Hospital-based 3D Printing Programs: Patient-first Approach.

The adoption of three-dimensional (3D) printing is rapidly spreading across hospitals, and the complexity of 3D-printed models and devices is growing. While exciting, the rapid growth and increasing complexity also put patients at increased risk for potential errors and decreased quality of the final product. More than ever, a strong quality management system (QMS) must be in place to identify potential errors, mitigate those errors, and continually enhance the quality of the product that is delivered to patients.

Comparison of texture-based classification and deep learning for plantar soft tissue histology segmentation.

Histomorphological measurements can be used to identify microstructural changes related to disease pathomechanics, in particular, plantar soft tissue changes with diabetes. However, these measurements are time-consuming and susceptible to sampling and human measurement error. We investigated two approaches to automate segmentation of plantar soft tissue stained with modified Hart's stain for elastin with the eventual goal of subsequent morphological analysis.

Mechanical characterization of fibrotic and mineralized tissue in Peyronie's disease.

Peyronie's disease affects penile mechanics, but published research lacks biomechanical characterization of affected tunica albuginea. This work aims to establish mechanical testing methodology and characterize pathological tissue mechanics of Peyronie's disease. Tunica albuginea was obtained from patients (n = 5) undergoing reconstructive surgery for Peyronie's disease, sectioned into test specimens (n = 12), stored frozen at -20 °C, and imaged with micro-computed tomography (µCT).

Evidence-Based Medicine Training in United States-Based Physiatry Residency Programs.

Although the physiatric community increasingly embraces evidence-based medicine (EBM), the current state of EBM training for trainees in physiatry is unclear. The purposes of this article are to report the results of the Association of Academic Physiatrists' surveys of physiatry residency programs in the United States, to discuss the implications of their findings, and to better delineate the "baseline" upon which sound and clear recommendations for systematic EBM training can be made. The two Association of Academic Physiatrists surveys of US physiatry residency programs reveal that most survey respondents report that they include EBM training in their programs that covers the five recommended steps of EBM core competencies.

Self-Management to Improve Function After Amputation: A Randomized Controlled Trial of the VETPALS Intervention.

Objective: To (1) evaluate the effects of a group-based self-management treatment intervention (VETPALS) on physical and psychosocial functioning (primary outcomes) and quality of life (secondary outcome) in individuals with amputation and (2) examine the feasibility and acceptability of the intervention in a large national health care system.

Design: Randomized controlled trial with masked outcome assessment.

Setting: Five Veterans Affairs medical centers geographically dispersed across the United States.

Should I Stay or Should I Go? Identifying Intrinsic and Extrinsic Factors in the Decision to Return to Duty Following Lower Extremity Injury.

Introduction: Rehabilitation research of wounded service members (SMs) commonly focuses on physical ability to return to duty (RTD) as a measure of successful recovery. However, numerous factors or barriers may influence a SM's ability and/or desire to RTD after lower extremity musculoskeletal trauma. SMs themselves as well as the clinical care team that works with them daily, often for years at a time, both offer unique perspectives on the influential factors that weigh into decisions to RTD.

Ankle fusion and replacement gait similar post-surgery, but still exhibit differences versus controls regardless of footwear.

Persons with ankle osteoarthritis (AOA) often seek surgical intervention to alleviate pain and restore function; however, recent research has yielded no superior choice between the two primary options: fusion and replacement. One factor yet to be considered is the effect of footwear on biomechanical outcomes. Comparisons of AOA biomechanics to a normative population are also sparse.

The Physiatry Workforce in 2019 and Beyond, Part 1: Results From a Cross-sectional Survey.

Objective: The aim of the study was to describe the current physiatrist workforce in the United States.

Design: An online, cross-sectional survey of board-certified physiatrists in 2019 (N = 616 completed, 30.1% response) collected information about demographic and practice characteristics, including age, sex, practice area, practice setting, hours worked, patient characteristics, staffing, and work responsibilities.

The Rehabilitation Medicine Scientist Training Program: Updates and Perspectives on Addressing an Ongoing Need in Physiatric Research.

The shortage of physician-scientists in physical medicine and rehabilitation remains a critical problem. The Rehabilitation Medicine Scientist Training Program was developed in 1995 to provide structured career development training for aspiring rehabilitation medicine researchers. Initially funded by a 5-yr K12 grant from the National Institutes of Health National Center for Medical Rehabilitation Research, the structure was revised in 2001, continued in a stable format through three additional funding cycles (2001-2006, 2006-2012, and 2012-2016), and was again revised to a research education program (National Institutes of Health R25) model in 2019.

Higher relative effort of the knee relates to faster adaptation in older adults at risk for mobility disability.

Gait adaptation is crucial for adults at risk for mobility disability, and executive function and physical function may be important for adaptation performance. Gait adaptation can be measured using a treadmill with two belts, known as a split-belt treadmill. Increasing evidence supports that gait adaptability, executive function, and physical function are interrelated in older adults.

A novel walking cane with haptic biofeedback reduces knee adduction moment in the osteoarthritic knee.

Knee osteoarthritis is a leading cause of ambulatory disability in adults. The most prescribed mobility aid, the walking cane, is often underloaded and therefore fails to reduce knee joint loading and provide symptomatic relief. For this study, a novel walking cane with haptic biofeedback was designed to improve cane loading and reduce the knee adduction moment (KAM).

The Physiatry Workforce in 2019 and Beyond, Part 2: Modeling Results.

Objective: The aim of this study was to assess the current and future adequacy of physiatrist supply in the United States.

Design: A 2019 online survey of board-certified physiatrists (n = 616 completed, 30.1% response) collected information about demographics, practice characteristics, hours worked, and retirement intentions.

The effect of custom carbon ankle-foot orthosis alignment on roll-over shape and center of pressure velocity.

Background: Maintaining an optimal rolling of the foot over the ground is thought to increase the stability and efficiency of pathologic gait. Ankle-foot orthoses are often prescribed to improve gait mechanics in individuals with lower extremity injuries; however, their design may compromise how the foot rolls over the ground.

Objectives: The aim of this study was to investigate the effects of the sagittal plane ankle-foot orthosis alignment on roll-over shape and center of pressure velocity in individuals with lower limb reconstructions.

Analysis of the Relative Motion Between the Socket and Residual Limb in Transtibial Amputees While Wearing a Transverse Rotation Adapter.

The coupling between the residual limb and the lower-limb prosthesis is not rigid. As a result, external loading produces movement between the prosthesis and residual limb that can lead to undesirable soft-tissue shear stresses. As these stresses are difficult to measure, limb loading is commonly used as a surrogate.

Modeling the mechanics of elevated vacuum systems in prosthetic sockets.

Elevated vacuum (EV) is suggested to improve suspension and limb volume management for lower limb prosthesis users. However, few guidelines have been established to facilitate configuration of EV sockets to ensure their safe and proper function. A benchtop model of an EV socket was created to study how prosthetic liner tensile elasticity, socket fit, and socket vacuum pressure affect liner displacement and subsequent pressure on the residual limb.

Effects of anterior-posterior shifts in prosthetic alignment on the sit-to-stand movement in people with a unilateral transtibial amputation.

The sit-to-stand movement can be challenging for people with a transtibial amputation (TTA). The alignment of the prosthesis may influence the movement strategies people with TTA use to transfer from sit-to-stand by affecting foot placement. The purpose of this study was to determine how shifting the prosthetic foot anterior and posterior relative to the socket affects movement strategies used to transfer from sit-to-stand.

Inactivation of Severe Acute Respiratory Coronavirus Virus 2 (SARS-CoV-2) and Diverse RNA and DNA Viruses on Three-Dimensionally Printed Surgical Mask Materials.

Background: Personal protective equipment (PPE) is a critical need during the coronavirus disease 2019 (COVID-19) pandemic. Alternative sources of surgical masks, including 3-dimensionally (3D) printed approaches that may be reused, are urgently needed to prevent PPE shortages. Few data exist identifying decontamination strategies to inactivate viral pathogens and retain 3D-printing material integrity.

Neuropathy, claw toes, intrinsic muscle volume, and plantar aponeurosis thickness in diabetic feet.

Background: The objective of this study was to explore the relationships between claw toe deformity, peripheral neuropathy, intrinsic muscle volume, and plantar aponeurosis thickness using computed tomography (CT) images of diabetic feet in a cross-sectional analysis.

Methods: Forty randomly-selected subjects with type 2 diabetes were selected for each of the following four groups (n = 10 per group): 1) peripheral neuropathy with claw toes, 2) peripheral neuropathy without claw toes, 3) non-neuropathic with claw toes, and 4) non-neuropathic without claw toes. The intrinsic muscles of the foot were segmented from processed CT images.

Does Coronal Plane Malalignment of the Tibial Insert in Total Ankle Arthroplasty Alter Distal Foot Bone Mechanics? A Cadaveric Gait Study.

Background: Total ankle arthroplasty (TAA) is becoming a more prevalent treatment for end-stage ankle arthritis. However, the effects of malalignment on TAA remain poorly understood.

Questions/purposes: The purpose of this study was to quantify the mechanical effects of coronal plane malalignment of the tibial insert in TAA using cadaveric gait simulation.

Negshell casting: 3D-printed structured and sacrificial cores for soft robot fabrication.

Soft robot fabrication by casting liquid elastomer often requires multiple steps of casting or skillful manual labor. We present a novel soft robotic fabrication technique: negshell casting (negative-space eggshell casting), that reduces the steps required for fabrication by introducing 3D-printed thin-walled cores for use in casting that are meant to be left in place instead of being removed later in the fabrication process. Negshell casting consists of two types of cores: sacrificial cores (negshell cores) and structural cores.

Calibration of the shear wave speed-stress relationship in in situ Achilles tendons using cadaveric simulations of gait and isometric contraction.

It has been shown that shear wave speed is directly dependent on axial stress in ex vivo tendons. Hence, a wave speed sensor could be used to track tendon loading during movement. However, adjacent soft tissues and varying joint postures may affect the wave speed-load relationship for intact tendons.

Virtual reality hand therapy: A new tool for nonopioid analgesia for acute procedural pain, hand rehabilitation, and VR embodiment therapy for phantom limb pain.

Introduction: Affordable virtual reality (VR) technology is now widely available. Billions of dollars are currently being invested into improving and mass producing VR and augmented reality products.

Purpose Of The Study: The purpose of the present study is to explore the potential of immersive VR to make physical therapy/occupational therapy less painful, more fun, and to help motivate patients to cooperate with their hand therapist.