Reverse shoulder arthroplasty (RSA) is a common treatment for individuals with arthritis of the glenohumeral joint in the presence of a massive rotator cuff tear. Though this procedure has been effective in restoring function to these individuals, it has also been associated with high early to mid-term complications, such as scapular notching and instability. A finite element (FE) modeling approach has previously been used to study the range of motion an individual with RSA could adduct their arm the polyethylene liner impinged on the inferior scapular bone and the contact stress at the impingement site. This model was then validated in a physical experiment using cadaveric tissue. In this document, I introduce modifications to that FE model to further study instability and scapular notching risk. First, modern RSA implant geometries were introduced into the model, and the effect of polyethylene liner rotation and glenoid version on impingement-free range of motion and instability risk was assessed. Then, a physical material property characterization of rotator cuff tissues present after RSA was performed. Finally, those material properties and continuum elements representative of the rotator cuff tendons were introduced into the FE model. Throughout all of these studies, greater complexity and fidelity was added to improve the ability to model both contact at the impingement site and potential dislocation events through more accurate loadings and boundary conditions.

Joint center location is the driving parameter for determining the kinematics, and later kinetics, associated with human motion capture. Therefore the accuracy with which said location is determined is of great import to any and all subsequent calculation and analysis. The most significant barrier to accurate determination of this parameter is soft tissue artifact, which contaminates the measurements of on-body measurement devices by allowing them to move relative to the underlying rigid bone. This leads to inaccuracy in both bone pose estimation and joint center location. The complexity of soft tissue artifact (it is nonlinear, multimodal, subject-specific, and trial specific) makes it difficult to model, and therefore difficult to mitigate. This thesis proposes a novel method, termed Single Frame Optimization, for determining joint center location (though mitigation of soft tissue artifact) via a linearization approach, in which the optimal vector relating a joint center to a corresponding inertial sensor is calculated at each time frame. This results in a time-varying joint center location vector that captures the relative motion due to soft tissue artifact, from which the relative motion could be isolated and removed. The method’s, and therefore the optimization’s, driving assumption is that the derivative terms in the kinematic equation are negligible relative to the rigid terms. More plainly, it is assumed that any relative motion can be assumed negligible in comparison with the rigid body motion in the chosen data frame. The validity of this assumption is investigated in a series of numerical simulations and experimental investigations. Each item in said series is presented as a chapter in this thesis, but retains the format of a standalone article. This is intended to foment critical analysis of the method at each stage in its development, rather than solely in its practical (and more developed) form.

Limited research exists on the comparison of pulsed shortwave diathermy (PSWD) and instrument assisted soft tissue mobilization (IASTM). In addition, minimal research exists on the AcuForce® 7.0 and none of it examines the effects of the AcuForce® 7.0 on range of motion (ROM). This study focused on the comparison of PSWD and IASTM on hamstring flexibility and perceived patient comfort. Twenty male students, faculty, and staff (age 24.5 ± 5.7 years) participated. Active knee extension ROM with the hip flexed at 90º was measured before and after the intervention. Perceived patient comfort was measured after the intervention. The results showed significant increases in ROM in all subjects (p = 0.013). However, there were no significant differences between groups (p = 0.079). Also, there were no significant differences in perceived patient comfort. The results of this study support hamstring flexibility can be increased with the use of either PSWD or the AcuForce® 7.0.

The Graston Technique® is a common treatment that combines a warm-up, Instrument Assisted Soft Tissue Mobilization (IASTM), stretching, and strengthening protocols. The treatment is commonly chosen by clinicians to treat musculoskeletal injuries. The purpose of this study was to determine how the Graston Technique® is used in clinical practice by certified athletic trainers to compare to recommendations made by the Graston Technique®. Factors such as time, expense, lack of training in the Graston Technique®, availability of resources, and an overall lack of evidence-based recommendations may have influenced inconsistencies in clinical practice. Although the technique is not always performed according to recommendations, these findings suggest both clinicians and patients report objective and subjective improvements when treating musculoskeletal pathologies regardless of the techniques used.

Since the late 20th century, breakthroughs in technology have been occurring expeditiously. Indeed, technological innovations have provided the betterment of many aspects of life and ensured humans’ appropriate forms of evolution and civilization. It is safe to claim that medicine has advanced within the past few decades, especially with the upbringing of technological innovations. The world of medicine would not have experienced its recent breakthroughs and profound discoveries without utilizing the available technology. The improvements observed in medicine and technology resulted in better providing of healthcare. Customizing treatments for each patient is now possible. One method of applying customization is through 3D printing of materials such as artificial prosthetics, tissues, and organs. This literature review analyzes 3D printing by stating definitions, assessing its history, discussing its different applications and closing with evaluating future directions. 3D printing first appeared in the late 20th century, and its primary purpose was to design and manufacture products efficiently and accurately. Traditional production of structures involves subtractive manufacturing (carving, cutting, and other methods of reshaping materials) to achieve desired products, whereas 3D printers implement additive manufacturing (a layer-by-layer approach). This provides less time, greater accuracy, and labor-free fabrication of products. Computerized software is one of the essential parts of 3D printing, and functions include designing, scaling, visualizing, controlling production frequency, and many more. In medical applications, the software may require CT scans, cone beam computed tomography, and intraoral scanners (for dental applications). The 3D printing techniques identified in this review are generally applied in oral and maxillofacial procedures—stereolithography, which constructs a product layer-by-layer through curing liquid resin using a UV laser. Digital light projection is a method similar to stereolithography, with a few differences, such as using a UV light instead of a laser and using a liquid crystal display panel. Fused deposition modeling is a technique that melts plastic filaments and extrudes them through a nozzle to form a structure in a layer-by-layer fashion. Selective laser sintering is also similar to stereolithography, where it uses a laser to form an object layer by layer, but the material is a thin layer of plastic powder instead of liquid resin. The power binder printing technique applies droplets onto powdered materials, adhering and forming layers as designed via computerized software. Lastly, computed axial lithography is similar to digital light projection, except the light is projected from many angles at once instead of one layer at a time. The main objectives of this literature review are to investigate each technique, discuss the advantages and disadvantages, and list the commonly applied areas in medicine for each. Also, this review evaluates the current limitations experienced when using 3D printers and suggestions for overcoming them. Some limitations include, but are not limited to, excessive time allocated for producing specific structures, accurate capturing of surgical sites, use of appropriate materials that form printed structures, cost, and deficiencies of reported data. Lastly, this literature review assesses the future projections. The future holds promising breakthroughs in 3D printing technology, including the fabrication of dental stem cells, operating artificial organs, complex vascular tissues, customized artificial alveolar structures for oral and intracranial procedures, and regeneration of periodontal tissues. These projections may occur by overcoming the most reported limitations. Medicine is digitizing rapidly and will continue adapting to the latest technological inventions. The current efforts to advance 3D printing technology will likely positively impact the advancement of many fields, including healthcare, increase chances of positive postoperative outcomes, and potentially combat many health issues society faces today. Professionals across disciplines must come together to further research and educate curriculums to revolve around the innovative technologies to continuing education courses related to 3-D printing technologies.

Indiana University-Purdue University Indianapolis (IUPUI) / Advances in peripheral nerve electrode technology have outpaced the advances in chronic implantation reliability of the electrodes. An observable trend is the increased deposition of fibrotic encapsulation tissue around the electrode to shift its position away from the implantation site and subsequently reducing performance. A finite element model (FEM) is developed in conjunction with tensile testing and digital image correlation of strain to understand the relationship between cuff electrode attachment and the strain environment of the nerve. A laminar and bulk nerve model are both developed with material properties found in literature and geometry found from performing histology. The introduction of a cuff electrode to an axially stretched nerve indicates a significant behavior deviation from the expected response of the axial strain environment. When implemented in ex-vivo tensile testing, results indicate that the reduction of strain is statistically significant but becomes much more apparent when paired with a digital image correlation system to compare predicted and measured effects. A robust FEM is developed and tested to emphasize the effect that the boundary conditions and attachment methodology significantly effects the strain environment. By coupling digital image correlation with FEM, predictive models can be made to the strain environment to better design around the long term chronic health of the implant.

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Introduction: When skeletal transverse discrepancies exist between the maxilla and mandible, they commonly manifest in dental malocclusion. If left uncorrected, the malocclusion can lead to periodontal issues, tooth fractures, tooth loss, or other significant dental problems. Utilization of microimplants in palatal expansion aims to correct transverse discrepancies between the maxilla and mandible by separating the palatal suture in a parallel manner aimed at maximizing skeletal changes and minimizing dental side effects. Overlying soft tissue changes can be affected by the induced skeletal changes. The purpose of this study is to evaluate skeletal expansion and the overlying soft tissue change that occurs using MARPEs (microimplant assisted rapid palatal expanders) at the end of orthodontic treatment in skeletally mature (Cervical Vertebral Maturation (CMV) ≥ 5) patients using cone-beam computed tomography (CBCT) imaging and to evaluate soft tissue changes that occur at the time of orthodontic treatment completion using CBCT imaging. Materials and Methods: CBCT scans from 19 patients who were treated using microimplant assisted rapid palatal expanders were traced and evaluated at three time points: Before orthodontic treatment (T1), post MARPE expansion with MARPE in place (T2), and after orthodontic treatment with MARPE removed. Fourteen hard tissue landmarks and six soft tissue landmarks in the midface and nasal cavity regions were traced by three judges at each time point. The traced landmark points were averaged among all three judges and comparisons were made between the three time points to see the amount of expansion that occurred at various anatomical 2 regions. Intraclass correlation coefficient (ICC) was used to evaluate inter-judge reliability for all measurements. A repeated measures ANOVA test was used for statistical comparison across all three time points and a Tukey post hoc test was used for comparison between time points. Significance was set to .05 and ICC was set to >.70. Results: Expansion with microimplant assisted rapid palatal expanders can affect the hard tissue of the midface region as well as the overlying soft tissue. Increases in skeletal width from the ANS down to the maxillary alveolar bone were statistically significant in both the short term (T1-T2) and long term (T1-T3). The nasal cavity width at inferior turbinate area increased significantly after expansion (T2) and remained increased at treatment completion (T3) and the increased soft tissue width of the alar base that presented after expansion therapy remained increased at treatment completion. Conclusion: Maxillary expansion with microimplant assisted expanders resulted in skeletal changes throughout the maxilla and led to a significant long-term increase in nasal cavity width. The soft tissue changes associated with MARPE treatment show that a widening of the base of the nose may be expected after expansion and can remain at treatment completion.

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