Flexor tendon repair of the hand and rehabilitation are frequently discussed between hand surgeons and therapists. This is mainly due to the poor outcomes commonly achieved after this type of surgery. There are many patients in public hospitals in South Africa who require flexor tendon repair surgery. They are regularly sent to therapists for rehabilitation, where the early passive motion protocol is commonly implemented. Although the early active motion protocol has yielded improved results globally, there is limited evidence on the comparison of the outcomes of these two protocols in the South African context. The aim of the study was to compare the outcomes of an early active motion protocol to the outcomes of an early passive motion protocol in patients with zone II to IV flexor tendon repairs of the hand, attending rehabilitation at Chris Hani Baragwanath Academic Hospital. The study was a quantitative single-blinded comparative controlled trial. Forty-six patients who sustained a zone II-IV flexor tendon injury were recruited for the study and equally distributed between the two groups (early active motion and early passive motion). Out of these participants, 11 did not return for the initial assessment at four weeks post-surgery and were therefore excluded. There were 19 participants in the early active motion group and 16 participants in the early passive motion group. Results were collected and classified at 4, 8 and 12 weeks post-surgery. Data collection took place from December 2014 to January 2016 in the Chris Hani Baragwanath Academic Hospital Hand Unit. At 12 weeks post-surgery, the total active motion, fingertip to table, and distal palmar crease measurements were similar between the two groups. Tendon rupture occurred in 8.57% (n=3, early active motion = 5.71%, early passive motion = 2.86%) of patients. This study found that there was no difference in outcomes between the two groups. Therefore, either protocol could be implemented in South African public hospitals. However, since the early active motion protocol takes less time to implement, this protocol is recommended. A study with a greater magnitude would be necessary to determine a significant comparison between the two groups; however, this is challenging due to poor patient compliance. / Dissertation (MOccupational Therapy)--University of Pretoria, 2017. / Occupational Therapy / MOccupational Therapy / Unrestricted

Background: Decellularization of tendon tissue plays a pivotal role in current tissue engineering approaches for in vitro research as well as for translation of graft-based tendon restoration into clinics. Automation of essential decellularization steps like freeze-thawing is crucial for the development of more standardized decellularization protocols and commercial graft production under good manufacturing practice (GMP) conditions in the future. Methods: In this study, a liquid nitrogen-based controlled rate freezer was utilized for automation of repeated freeze-thawing for decellularization of equine superficial digital flexor tendons. Additional tendon specimens underwent manually performed freeze-thaw cycles based on an established procedure. Tendon decellularization was completed by using non-ionic detergent treatment (Triton X-100). Effectiveness of decellularization was assessed by residual nuclei count and calculation of DNA content. Cytocompatibility was evaluated by culturing allogeneic adipose tissue-derived mesenchymal stromal cells on the tendon scaffolds. Results: There were no significant differences in decellularization effectiveness between samples decellularized by the automated freeze-thaw procedure and samples that underwent manual freeze-thaw cycles. Further, we inferred no significant differences in the effectiveness of decellularization between two different cooling and heating rates applied in the automated freeze-thaw process. Both the automated protocols and the manually performed protocol resulted in roughly 2% residual nuclei and 13% residual DNA content. Successful cell culture was achieved with samples decellularized by automated freeze-thawing as well as with tendon samples decellularized by manually performed freeze-thaw cycles. Conclusions: Automated freeze-thaw cycles performed by using a liquid nitrogen-based controlled rate freezer were as effective as previously described manual freeze-thaw procedures for decellularization of equine superficial digital flexor tendons. The automation of this key procedure in decellularization of large tendon samples is an important step towards the processing of large sample quantities under standardized conditions. Furthermore, with a view to the production of commercially available tendon graft-based materials for application in human and veterinary medicine, the automation of key procedural steps is highly required to develop manufacturing processes under GMP conditions.

This research embodied a three-prong approach for directly determining the residual prestress force of prestressed concrete bridge girders. For bridges that have yet to be constructed, outfitting girders with instrumentation is a highly effective means of determining residual prestress force in prestressed concrete bridge girders. This constitutes the first prong. Still, many bridges are constructed without such instrumentation. For these bridges, a destructive technique can be used to directly determine the residual prestress in a prestressed concrete bridge girder. This implies that the girder(s) being tested have already been taken out of service. This constitutes the second prong. For bridges that are anticipated to remain in service that are lacking embedded instrumentation, the development of a non-destructive technique used to estimate the remaining force in the tendons of prestressed bridge girders is extremely important. This constitutes the third prong used to directly determine residual prestress force. The flexural capacity was also determined from field tests and compared to analytical estimates. By design, the code estimates are meant to be conservative. Alternatively, the residual prestress force for in-service members can be determined directly through the non-destructive technique presented in this research. As such, bridge service capacities can be determined directly and do not need to be conservatively estimated. (231 pages)

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第18200号 / 人健博第17号 / 新制||人健||2(附属図書館) / 31058 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 三谷 章, 教授 杉本 直三 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(工学) / 甲第21355号 / 工博第4514号 / 新制||工||1703(附属図書館) / 京都大学大学院工学研究科社会基盤工学専攻 / (主査)教授 KIM Chul-Woo, 教授 杉浦 邦征, 講師 張 凱淳 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第24541号 / 人健博第112号 / 新制||人健||8(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 青山 朋樹, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Musculoskeletal models and simulations allow for the estimation of forces acting on muscles and joints during human movement and athletic performance. In order to improve the accuracy of these models for a specific application, knowledge about subject-specific in vivo properties of human muscle and tendon is needed. This study presents a method for estimating in vivo mechanical properties of human tendon in the lower leg, using a combination of ultrasound imaging and motion capture. Key mechanical parameters — such as tendon stiffness, moment arm, slack length and force-strain relationship — and the contribution of tendon elongation to ankle mobility of the medial gastrocnemius (MG) and soleus (SOL) aspects of the Achilles tendon were obtained in vivo in 8 typically-developed adults, and the applicability of the method on the tibialis anterior (TA) tendon was investigated. In contrast to previous studies using a comparable method, variable tendon moment arm lengths during passive movement of the ankle joint was taken into consideration. As a novelty, the passive mechanical properties of the Achilles tendon were obtained in vivo in 4 hemiplegic post-stroke subjects and compared to the 8 typically-developed subjects. The estimated mechanical parameters of the MG and SOL aspects of the Achilles tendon were consistent with findings in the literature. In order to estimate stiffness of the TA tendon, it was shown that a larger range of motion (ROM) of the foot during the passive rotation experiments is needed. The comparison between typically-developed and hemiplegic post-stroke subjects revealed significantly lower tendon stiffness and slack angle, and significantly higher contribution of tendon elongation to ankle mobility in the post-stroke group. The developed method enables estimation of in vivo mechanical properties of tendon in the lower leg and contributes to improving the accuracy of subject-specific musculoskeletal models and simulations. / Person-specific biomechanical models

The main goal of the project was to compare how the Achilles tendon is affected while running with traditional shoes, minimalistic shoes and barefoot. Displacement and strain were calculated both for different shoes and for different foot strike patterns. The calculations were done with a speckle tracking algorithm and displacement was calculated for three different depths in the tendon: deep layer, mid layer and superficial layer. The goal was also to conduct this analysis after a review of the algorithm used. The review of the algorithm focused on the size of the region of interest, kernel size and frequency. Literature study showed that it is more common to use a smaller kernel size, but the same shape. The region of interest was chosen depending on the size of the tendon. Displacement and strain in the Achilles tendon was calculated for seven subjects and the result did not show any difference in amount of mean deformation due to different shoe types or foot strike patterns. It was a small sample group but the result indicated a difference in peak displacement between deep and superficial layer depending on different shoe types and foot strike patterns. The difference in peak displacement between deep and superficial layer was lowest when running barefoot, larger when running with minimalistic shoes and greatest when running with traditional shoes. This result was only achieved when running with rear foot strike pattern. When running with fore foot strike pattern the difference in peak displacement between layers did not change with different conditions. In all conditions the difference in peak displacement between the layers was greater when running with rear foot strike pattern than when running with front foot strike pattern. The deep layer displaced more than the superficial layer (p<0.01) for all conditions and foot strike patterns.

Much is known about running economy while running on level ground surfaces. However, with the dynamic of elevation changes during running, more research is needed to understand how various grades that will favor respective mechanics. PURPOSE: In this study, we focused on determining whether certain running mechanics and anatomy would predict a runner's oxygen uptake between downhill versus uphill running. METHODS: Twenty-one experienced runners completed six 5-min running trials (1 shoe x 3 grades x 2 visits) in a Saucony marathon racing shoe model (Type A) on level (3.83 m/s), uphill (+4% grade at 3.35 m/s), and downhill ( ˆ’4% grade at 4.46 m/s) conditions. These treadmill speeds at each grade were predicted as metabolic equivalents through all grades. We measured submaximal oxygen uptake and carbon dioxide production during the entire trial duration with the last 3 min of each trial being averaged. A best-fitting line was generated through oxygen uptake versus grade to classify whether runners were more economical in uphill or downhill conditions relative to other subjects. The slope of this line indicated whether runners were more economical at uphill or downhill running, where a positive slope represented a more economical uphill versus downhill runner. Various running mechanics were measured using Vicon Nexus and a Bertec treadmill. A linear regression determined any correlations between peak vertical force, stride rate, plantar velocity, and ground time against uphill/downhill running ability. RESULTS: Peak vertical force was the only factor associated with the slope of oxygen uptake versus grade (running grade ability; p < 0.01). The slope of oxygen uptake versus grade averaged 0.076 ± 0.278 ((ml/kg/min) / % grade). CONCLUSION: Runners that naturally prefer a higher peak vertical force when running on level ground led to a lower running grade ability (lower oxygen uptake during downhill versus uphill running).

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