abstract: Lower-limb prosthesis users have commonly-recognized deficits in gait and posture control. However, existing methods in balance and mobility analysis fail to provide sufficient sensitivity to detect changes in prosthesis users' postural control and mobility in response to clinical intervention or experimental manipulations and often fail to detect differences between prosthesis users and non-amputee control subjects. This lack of sensitivity limits the ability of clinicians to make informed clinical decisions and presents challenges with insurance reimbursement for comprehensive clinical care and advanced prosthetic devices. These issues have directly impacted clinical care by restricting device options, increasing financial burden on clinics, and limiting support for research and development. This work aims to establish experimental methods and outcome measures that are more sensitive than traditional methods to balance and mobility changes in prosthesis users. Methods and analysis techniques were developed to probe aspects of balance and mobility control that may be specifically impacted by use of a prosthesis and present challenges similar to those experienced in daily life that could improve the detection of balance and mobility changes. Using the framework of cognitive resource allocation and dual-tasking, this work identified unique characteristics of prosthesis users’ postural control and developed sensitive measures of gait variability. The results also provide broader insight into dual-task analysis and the motor-cognitive response to demanding conditions. Specifically, this work identified altered motor behavior in prosthesis users and high cognitive demand of using a prosthesis. The residual standard deviation method was developed and demonstrated to be more effective than traditional gait variability measures at detecting the impact of dual-tasking. Additionally, spectral analysis of the center of pressure while standing identified altered somatosensory control in prosthesis users. These findings provide a new understanding of prosthetic use and new, highly sensitive techniques to assess balance and mobility in prosthesis users. / Dissertation/Thesis / Doctoral Dissertation Biomedical Engineering 2017

ABSTRACT There are various factors that affect the success and outcome of root canal treatment.  The aim of the study is to thoroughly investigate the prognosis of endodontic treated by general dental practitioners in the region of Västerbotten, Sweden, and try to identify factors that are related to an unsuccessful root canal treatment. Our hypothesis is about prognosis for teeth, which are treated by a general dentist, is worse than the teeth, which are treated by specialists, and dental students.  Total 210 patients were included in our study. Of those 100 were excluded due to lack of documentation. We analysed these factors, aseptic treatment e.g. rubber dam, quality of root filling length, coronal restoration, and radiograph after 4 years.  In our study, rubber dam was used only in 64 teeth (58 %) throughout whole treatment and only in 27 teeth (22 %) have seen that root filling follow the standard criteria. Twenty-two teeth (20 %) have received coronal restoration and only 21 teeth (19 %) had radiograph after 4 years, six teeth (5 %) had retreatment and 5 teeth (4 %) have been extracted. Lack of documentation was another striking finding which made it difficult for our study to extract complete information.  In conclusion, we identified some factors, which can be improved.   Inadequate documentation.   Deficiencies in pre-treatment diagnostics.   Aseptic treatment e.g. rubber dam   Failure in follow-up documentation of treated teeth   Quality of root filing. / Enodontics

There is a compelling need for the development of new sensory and neural prosthetic devices which are capable of more precise point stimulation. Current prosthetic devices suffer from the limitation of low spatial resolution due to the non-specific stimulation characteristics of electrical stimulation, i.e., the spread of electric fields generated. We present a visible light stimulation method for modulating the firing patterns of electrically-excitable cells using surface plasmon resonance phenomena. In in-vitro studies using gold (Au) nanoparticle-coated nanoelectrodes, we show that this method (substrate coated with nanoparticles) has potential for incorporating the technology into neural stimulation prosthetics, such as cochlear implants, with arbitrarily high spatial resolution. Au nanoparticles (NPs) were coated on micropipettes using aminosilane linkers; and these micropipettes were used for stimulating and inhibiting the action potential firing patterns of SH-SY5Y human neuroblastoma cells and neonatal cardiomyocytes. Our findings pave the way for development of biomedical implants and neural testing devices using nanoelectrodes capable of temporally and spatially precise excitation and inhibition of electrically-excitable cellular activity.

Thesis title: Evaluation of effectiveness of using myoelectric prosthesis by people with congenital or acquired amputation of the upper limb Aims: The aim of my thesis is to evaluate the effectiveness of myoelectric prosthesis using by people with upper limb amputation. Find out how effectively users are able to manage individual tasks with myoprosthesis and basic ADL activities. Methodology: The research group consisted of 6 people with upper limb amputation. In this thesis, there were used three methods of data collection. The first method that was applied was a survey, which was used to obtain anamnestic data by the research group. The second method of data collection was the observation of probands during the performance of individual tasks. The third chosen method was measurement by using a special test aimed at evaluation of the effectiveness while using and the involvement of myorpothesis in the locomotor chain against a healthy upper limb. Results: Based on observations and measurements, it was performed that all probands are able to functionally and effectively involve the myoprosthesis in the locomotor chain in the performance of individual tasks. Another positive result of this thesis was the finding that all probands obtained in the test over 50% rate of effective use when comparing the...

OBJECTIVES: To assess the viability of using high-strength polymers as framework materials for full arch implant-supported fixed prostheses, veneered with full-coverage restorations of different materials. The machinability, mechanical performance, and damping capacity of the polymer-based materials was of interest. METHODS: The two framework polymers – a polyetheretherketone (JUVORA™ Dental Disk, Juvora) (PEEK) and a fiber-reinforced composite (TRINIA™ CAD/CAM Disk, Trinia) (TR) – were characterized with Fourier-Transform Infrared (FTIR) Spectroscopy and energy-dispersive X-ray spectroscopy (EDS). Phase 1 consisted of a machinability study involving the merlon fracture test, which tested the milling success of PEEK and TR at 0.1 mm, 0.2 mm, 0.3 mm, 0.4 mm, and 0.5 mm. 10 four-walled merlons of each thickness and material were milled out of CAD/CAM Disks (n = 100 merlons, n = 400 walls) using a 5-axis milling machine, inLab MC X5 (Dentsply Sirona, Germany). Milling success rate, fracture height, fracture length, fracture position, fracture direction, and chipping factor were assessed. In phase 2, 20 bars of dimensions 3.3 mm x 10 mm x 40 mm were milled from each of the two framework materials, PEEK and TR, and two veneer materials – a composite resin material (Shofu Disk HC, Shofu, Inc., Kyoto, Japan) (COM), and a high-translucency 3 mol% yttria-stabilized tetragonal zirconia polycrystal material (Cercon® ht, Dentsply Sirona, Bensheim, Germany) (ZR). Framework and veneer bars were bonded to each other in 4 framework/veneer combinations of 10 bilayers each: PEEK/COM (PCB), PEEK/ZR (PZB), TR/COM (TCB), and TR/ZR (TZB). Bilayer bars were loaded to failure in a 3-point bending test. Failure load, biaxial flexural strength, failure pattern and failure mode were documented. In Phase 3, 10 full arch fixed implant-supported frameworks were designed and fabricated in TR material over an epoxy resin model containing 4 implants in the second premolar and lateral incisor positions. 5 frameworks were veneered by COM in the canine to first molar region, while the other 5 were veneered by ZR. Four loading sites were designated per prosthesis in the occlusal surface of the first molars and the first premolars. Prostheses were loaded at the four occlusal sites in 5 cycles of loading and unloading. The damping capacity of the prostheses was calculated based on energy absorbed during loading and unloading. Displacement and permanent deformation values of the prosthesis structures were obtained from the load-displacement data. Prostheses were loaded to failure at the same sites, and failure load and failure mode were observed. RESULTS: The minimum machined thickness of PEEK and TR was 0.5 mm. There was no significant difference between milling success of PEEK and TR, but cumulative success rate was slightly superior in PEEK. PEEK exhibited a ductile response to machining damage, while TR showed a more brittle response. Chipping factor of PEEK was higher than TR eightfold, meaning TR showed an improved marginal integrity at 0.5 mm. Both materials showed concerning signs of machining damage with the milling parameters and tools used in this study. Bilayer bars with a TR framework withstood significantly higher loads at failure compared to bilayers with a PEEK framework. Bilayer bars with a ZR veneer withstood significantly higher loads at failure compared to bilayers with a COM veneer. The biaxial flexural strength of the four framework/veneer combinations could not be compared due to the occurrence of delamination in 3 of the 4 groups. The PZB group was the only group with fracture of both the veneer and framework without any delamination and exhibited a mean biaxial flexural strength of 46.15 ± 5.76 MPa. None of the bilayer bars with a TR framework exhibited framework fracture. In delaminated specimens, bilayer bars with a TR framework exhibited mixed adhesive-cohesive failure on both layers, while bilayer bars with a PEEK framework exhibited purely adhesive failure on the PEEK-cement interface. Full arch implant prostheses with a TR framework demonstrated elastic hysteresis in continuous cycles of cyclic loading, which is evidence of viscoelastic damping. Significantly higher energy absorption was observed in prostheses veneered with COM compared to ZR. Energy absorption decreased with increasing cycles of loading-unloading. Significantly higher maximum displacement was observed in prostheses veneered with COM compared to ZR, and in cantilever support compared to bounded support. Maximum displacement was inversely related to the thickness of the veneer and framework materials. Permanent deformation of the prosthesis was negligible after 10 cycles. The failure pattern of all prostheses presented as fracture in the veneer only and partial delamination of the veneer with mixed adhesive-cohesive failure mode. The mean failure load at ZR-veneered bounded sites was significantly higher than that of COM-veneered bounded sites. The mean failure load at bounded loading sites was significantly higher than that of cantilever loading sites. ZR-veneered prostheses demonstrated failure load values above 1000 N at all sites. CONCLUSION: The merlon fracture test is well-complemented by several quantitative and qualitative measures to assess the machinability of materials. Optimized tools and parameters for milling PEEK and TR should be investigated. Full arch implant prostheses with TR framework and ZR veneer are a viable option for fixed implant rehabilitation demonstrating damping capacity, adequate failure load values, and easy repairability.

Traditional prosthetic socket fabrication is a laborious and time consuming process that involves physical measurements, plaster wrapping of the stump, plaster casting for positive mold preparation, and a thermoforming process. During the mold preparation stage, significant modifications are performed subjectively based on the prosthetist's experience to transmit an optimum load to the residual limb through the socket. Rapid Prototyping techniques have advanced rapidly during the recent decades emerging as a computer aided socket design alternative which promises a potential reduction in the fabrication time, and a more systematic design approach. In addition, 3-D scanning provides accurate and fast virtual replica of the stump which can be imported in CAD environments. Within 3-D CAD software, prosthetists are able to perform modifications precisely and store files indefinitely. This work examines the potential use of ZCorp 3-D printers to directly manufacture the thermoforming mold required for prosthetic socket manufacture. This work analyses the performance of Rapid Tooling molds for thermoformed socket based on three main parameters: pneumatic permeability, flexural strength and wear rate. The traditional material for mold casting, Plaster of Paris, is compared to materials used for three dimensional printing by Zcorp printers: zp130 and zp140 untreated as well as using them with custom and novel post treatments. To obtain the flexural strength of the different materials, three point bend tests were performed in a universal test machine using ASTM Standard D790-03 requirements. In addition, pneumatic permeability tests were performed to cylindrical specimens of the different materials following ASTM Standard D6539-00. Thermoforming tests confirm that Zcorp 3-D printed parts can serve as effective molds for thermoforming of prosthetic socket.

Population-level neurocontrol has been advanced predominately through the miniaturization of hardware, such as MEMS-based electrodes. However, miniaturization alone may not be viable as a method for single-neuron resolution control within large ensembles, as it is typically infeasible to create electrode densities approaching 1:1 ratios with the neurons whose control is desired. That is, even advanced neural interfaces will likely remain underactuated, in that there will be fewer inputs (electrodes) within a given area than there are outputs (neurons). A complementary “software” approach could allow individual electrodes to independently control multiple neurons simultaneously, to improve performance beyond naïve hardware limits. An underactuated control schema, demonstrated in theoretical analysis and simulation (Ching & Ritt, 2013), uses stimulus strength-duration tradeoffs to activate a target neuron while leaving non-targets inactive. Here I experimentally test this schema in vivo, by independently controlling pairs of cortical neurons receiving common optogenetic input, in anesthetized mice. With this approach, neurons could be specifically and independently controlled following a short (~3 min) identification procedure. However, drift in neural responsiveness limited the performance over time. I developed an adaptive control procedure that fits stochastic Integrate and Fire (IAF) models to blocks of neural recordings, based on the deviation of expected from observed spiking, and selects optimal stimulation parameters from the updated models for subsequent blocks. I find the adaptive approach can maintain control over long time periods (>20 minutes) in about 30% of tested candidate neuron pairs. Because stimulation distorts the observation of neural activity, I further analyzed the influence of various forms of spike sorting corruption, and proposed methods to compensate for their effects on neural control systems. Overall, these results demonstrate the feasibility of underactuated neurocontrol for in vivo applications as a method for increasing the controllable population of high density neural interfaces.

No description available.

The aim of this study was to explore the knowledge, practices, and the sources of knowledge that certified prosthetists/orthotists (CPOs) have experienced regarding early pressure injury assessment for different skin tones. This was examined across different contexts of skin tone demographics using qualitative semi-structured interviews with CPOs from different contexts. Seven participants from six different clinics were recruited using purposive sampling. Of the interviewed participants, five were from Scandinavia, one from South Africa, and one from Nigeria. The interviews were conducted to explore the participants’ own experience of this phenomenon using a phenomenological approach and an interpretivist paradigm. Qualitative content analysis was used to analyse the transcribed interviews inductively. The results consisted of five main categories: Assessment, Standardized Methods, Perceptions of Assessment regarding Skin Tones, Sources of Knowledge regarding Skin Tones, and Relevance of Knowledge Improvement, each with a number of subcategories. There were two main findings. Firstly, CPOs lack systematized knowledge of early pressure injuries irrespective of skin tones. Secondly, many CPOs lack assessment knowledge for darker skin tones as it is only learned from experience and is not taught in education or literature. In conclusion, the field of prosthetics and orthotics must develop to improve systematic early pressure injury knowledge and assessment differences between skin tones.

Intra-Body Communication (IBC) is a prospective technology where human tissue may be used as a signal medium in order to transmit useful data within the human body. Proposed applica- tions of this technology are prosthetics control or implanted device communication, potentially by establishing an Intra-Body Area Network (IBAN), which could further be enhanced by other IoT applications and 5G radio systems. Previous research at Uppsala University has shown the fat tissue to be a promising medium due to its low permittivity and loss tangent. This form of implementation is named Fat-IBC. This thesis aimed to produce a Fat-IBC enabled device, as a proof of concept. This project successfully produced and characterized phantom tissue, produced a basic demonstrator device in the form of a 3D-printed arm prosthetic, and integrated a wireless communication system into the arm prosthetic. The communication system was implemented using Arduino microcontrollers and XBee RF modules, based on the 802.15.4-based ZigBee protocol at 2.45 GHz. Muscle, fat, and skin phantom tissues were produced, with the muscle tissue being similar to other comparable tissue samples, while the fat and skin tissues deviated from such samples. A signal loss transmission test measured a -67 dB loss over 20 cm of fat tissue. Several potential issues with production and measurement were discussed. The arm demonstrator device was also tested by transmitting the control signal across phantom fat tissue, being fully functional through 10cm of tissue, and of limited function across 20cm of tissue.