Existing methods that use a fringe projection technique for orthotic and prosthetic designs produce good results for the trunk and lower limbs; however, the devices used for this purpose are expensive. This thesis investigates the use of an inexpensive passive method involving 3D surface reconstruction from video images taken at multiple views. The design and evaluation methodology, consisting of a number of techniques suitable for orthotic and prosthetic design, is developed. The method that focuses on fitting the reference model (3D model) of an object to the target data (3D data) is presented. The 3D model is obtained by a computer program while the 3D data uses the shape-from silhouette technique in an approximately circular motion.

Misalignment in the lower limb prosthesis can cause great discomfort in the stump- socket interface and disturbance to gait function. In the long run, it could deteriorate the musculoskeletal system. In practice, the assessment still depends heavily on the verbal feedback of an amputee and experiences of a prosthetist. Moreover it is inconsistent amongst the prosthetists. Prosthetic alignment involves the adjustment of the prosthetic components relative to the gait quality. Some methods were proposed, including symmetry index, variation in a step-to-step transition, stability within the zone of integrated balance, matching roll-over shape eROS) to an ideal ROS and etc. It is not clear if the optimum alignment could be achieved. These methods exhibit a few limitations, i.e. limited use of gait variables in a single comparison and non-uniform results when different gait variables are applied. There is a need to provide an objective assessment method that processes high dimensional gait variables and presents them in a simple form. In addition, it could be impractical and expensive clinically to spend excessive time on a patient. An ambulatory gait measurement system could achieve this objective to a certain extent. This research investigates a potential engineering solution that is able to provide an assistive and objective assessment of the lower limb prosthetic alignment that provides optimal gait quality. The effort includes a development of a low-cost ambulatory gait measurement system which could be reliably used during indoor and outdoor trials. Human walking trials using the designed ambulatory system are designed and performed to justify the proposed solution. A novel gait analysis method using Principle Component Analysis and Self-Organizing Feature Map is proposed to process high dimensional gait data into a simple plot and a decision guide. The proposed methodology could help to collect sufficient gait data during indoor and outdoor gaits and could provide an objective gait assessment during the application of lower limb prosthetic alignments.

Every year, thousands of above-knee amputations are carried out around the world due to circulatory problems, complications of diabetes, or trauma. The loss in mobility results in a degradation of the quality of life of the amputees. Therefore, there is a real need to develop an efficient lower limb prosthesis to restore mobility functions. The current trends in knee prostheses research are limited to either purely passive (mechanical), actively controlled using adaptive damping, or actively driven (powered) knee prostheses. Attempts to develop actively powered knee prostheses have sought to completely replace the muscle activity with an actuator. However, they do not take into consideration the fact that the human muscle works either passively or actively according to the phase or task. Hence, there is a lack of research in developing a prosthetic knee based on a hybrid approach (semi-active), which behaves closely to the natural functioning of a limb. This research involves the design and development of a novel electromechanical semi-active prosthetic knee that is back-driveable when operating passively under the influence of gravity. It also takes advantage of the dynamic coupling interaction between the amputee's stump and the prosthetic knee. The mechanism is driven in active mode via a de permanent magnet motor and a ball screw. In addition, this mechanism is back-driven by either the gravity forces or the dynamic coupling energy in the passive mode. This research, based on extensive investigations, provides the key design factors and parameters that affect the prosthetic knee performance. The assembly modes, the governing kinematic and dynamic relationships of the proposed knee mechanism are presented. The research also covers the study of the energy reflected from the hip to the prosthetic knee due to the dynamic coupling effect. This dynamic coupling is generated due to the change in the kinetic, and the potential energies of the segments and it is controlled by the kinematic parameters of the hip. A finite element model (FEA) was developed for the CAD model, and normative data for the ground reaction forces and the knee trajectory for level ground walking were applied and imported to the model. The FEA was used to VI check the von Mises stress in addition to the factor of safety for the main parts and components under the required loads and trajectories. A prototype of the proposed system was then manufactured. Experiments were carried out on the prosthetic knee for three prosthesis weights to characterise its performance in both open and closed loops for the active mode. Furthermore, the passive mode performance was tested for three prosthesis weights and braking (damping) scenarios due to braking torques. Furthermore, the dynamic coupling effect was tested, and the results showed that the energy generated by dynamic coupling helps to reduce the power consumption by the motor in the active mode if it works in the same direction. This leads to more efficient lower limb prostheses, and paves the way to significant improvements in prosthetic knees.

No description available.

Post-operative wound pain is a disincentive to potential live kidney donors. The transverse abdominis plane (TAP) block is a technique where the local anaesthetic agent is given to block the afferent nerves of the abdominal wall. The safety and efficacy of this technique is well established for other surgical procedures. The TAP block technique is shown to be beneficial and reduced the postoperative morphine requirement in lower abdominal surgeries such as hysterectomy, appendicectomy, and caesarean section. A similar incision is being used for retrieval of kidney after laparoscopic donor nephrectomy. This technique has never been tested before in laparoscopic donor nephrectomy patients; hence the aim of thesis was to establish the efficacy of TAP block in reducing the pain and assessing its impact on reducing total morphine requirement. An initial retrospective study showed a potential of TAP block to reduce postoperative pain and cumulative postoperative morphine requirements. Thereafter based on these results, a double blinded randomised placebo controlled trial was setup. The randomised trial has demonstrated that a TAP block with bupivacaine reduced early morphine requirement at 6 hours. But, there was no difference seen in the total postoperative morphine usage. The visual analogue pain score in TAP block group with bupivacaine was significantly lower on day 1 and 2 after surgery. Further cytokine assay in this randomised study showed no difference in the plasma cytokine levels at 6, 24 and 48 hours after donor nephrectomy. Hence the TAP block technique appears to be a safe and effective method of postoperative pain in laparoscopic donor nephrectomy patients. The study thus established the contributory role of TAP block in multimodal analgesia. This can be an alternative to post-operative wound infiltration with local anaesthetic agents.

No description available.

No description available.

Hands-on robotic surgery is where the surgeon controls the tool's motion by applying forces and torques to the robot holding the tool, allowing the robot-environment interaction to be felt though the tool itself. To further improve results, shared control strategies are used to combine the strengths of the surgeon with those of the robot. One such strategy is active constraints, which prevent motion into regions deemed unsafe or unnecessary. While research in active constraints on rigid anatomy has been well-established, limited work on dynamic active constraints (DACs) for deformable soft tissue has been performed, particularly on strategies which handle multiple sensing modalities. In addition, attaching the tool to the robot imposes the end effector dynamics onto the surgeon, reducing dexterity and increasing fatigue. Current control policies on these systems only compensate for gravity, ignoring other dynamic effects. This thesis presents several research contributions to shared control in hands-on robotic surgery, which create a more natural motion for the surgeon and expand the usage of DACs to point clouds. A novel null-space based optimization technique has been developed which minimizes the end effector friction, mass, and inertia of redundant robots, creating a more natural motion, one which is closer to the feeling of the tool unattached to the robot. By operating in the null-space, the surgeon is left in full control of the procedure. A novel DACs approach has also been developed, which operates on point clouds. This allows its application to various sensing technologies, such as 3D cameras or CT scans and, therefore, various surgeries. Experimental validation in point-to-point motion trials and a virtual reality ultrasound scenario demonstrate a reduction in work when maneuvering the tool and improvements in accuracy and speed when performing virtual ultrasound scans. Overall, the results suggest that these techniques could increase the ease of use for the surgeon and improve patient safety.

Background: Surgical quality improvement (QI) research has been conducted with promising results, but translating learning into practice is complicated by incomplete reporting. This research aimed to identify which reporting items are most frequently incomplete, and why incomplete reporting occurs. Methods: A systematic review aimed to identify the current standard of reporting in the surgical QI literature. MEDLINE, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched. Articles were scored against a modified Template for Intervention Description and Replication (TIDieR) checklist. A qualitative interview study was conducted. QI authors, consumers (those who apply QI research in practice), editors and reporting guideline authors were interviewed to identify why reporting is hard. An author checking exercise involved asking the interview participants to describe how they would replicate an intervention described in a QI article. The article’s authors checked whether their intervention matched the participants’ interpretation. Data was analysed using the constant comparative method. Results: The systematic review identified 100 relevant articles. Reporting of fidelity was absent in 74% of articles; and modifications were absent in 73%. Participants (42) in the qualitative study included: 15 authors, 12 consumers, 11 journal editors and four reporting guideline authors. Of these, 28 were clinicians. Reporting QI is hard because: QI is an emerging field; features of hospitals and journals create tensions for reporting; context is hard to describe; publications are not always intended to be used for exact replication. Discussion and conclusion: QI is a youthful field but stakeholders have well developed aspirations for QI reporting. As the field matures, those involved in QI reporting place value on describing context, identifying active ingredients, and recognising how QI publications are to be used in practice. This research is relevant to an international audience and could help galvanise a renewed sense of importance for reporting.

In the UK, more than 235,000 children admitted to hospital each year receive an operation or investigation under general anaesthesia. It is not known whether nociceptive stimulation evokes a change in cortical brain activity in the anaesthetised child. The aim of this thesis is to determine whether noxious stimulation administered to anaesthetised children results in a measurable change in brain activity and whether this evoked activity is altered in children who have been born prematurely and experienced a high level of pain in early life. Changing patterns of neuronal activity evoked by noxious and non-noxious stimuli were 'time locked' to electrophysiological recordings by means of a novel high-speed camera and an event detection interface developed during this thesis. Changes in band power were examined pre- and post-stimuli and across the different stimulus modalities. In all children, background EEG activity was dominated by delta ( < 3 Hz) and alpha (8-12 Hz) band frequencies, consistent with previously reported anaesthetic literature. Clinical and experimental noxious stimulation, and tactile stimulation evoked a significant increase in delta activity (p<0.05) with no changes in average heart rate or ipsilateral EMG activity observed between pre- and post-stimulus. The application of local anaesthetic to the stimulation site diminished the evoked increase in delta activity. The response to noxious stimulation in the children born prematurely was not significantly different from the age-matched control group (p > 0.05) but they had striking differences in their background EEG activity. Prematurely born children had significantly lower alpha and beta band activity. The electrophysiological recordings we have obtained show that it is possible to measure evoked brain activity following a variety of noxious and non-noxious stimuli to investigate how the paediatric human brain processes sensory information under anaesthesia. The EEG measures were more sensitive to nociception than changes in autonomic activity and reflex withdrawal activity. Noxious stimulation caused a significant increase in delta activity, representing an increase in cortical synchronisation. While the children who were born prematurely did not respond differently to the noxious stimulation they had dramatically different background activity, which could have clinical relevance when using brain-derived patterns of EEG activity to help establish anaesthetic depth.