Scientific Report 2003-2004 - Cleveland Clinic Lerner Research ...

Examples of devices that are being designedare (i) a device to simultaneously measurepressure and shear forces at specific sitesunder the feet of patients with distal peripheryneuropathy; (ii) rehabilitation devices to enhancethe ambulatory capabilities of patients withmusculoskeletal problems, and (iii) novel exercisedevices for astronauts to use on the InternationalSpace Station.Foot injuriesCalcaneal fractures, Achilles tendonruptures, posterior tibialis insufficiency and manyother musculoskeletal injuries of the foot greatlyaffect patients’ mobilityand, consequently, theirquality of life. Throughfunding from theDepartment of Defense,the focus of our studies ison understanding themechanisms of variousfoot injuries, includingmetatarsal stress fracturesand hindfoot impactinjuries. Throughcollaborations withcolleagues in the OrthopaedicResearch Center,new models are beingdeveloped to optimizesurgical approaches usedto correct foot pathologies.Shear and pressure measurement deviceFoot ulceration, a diabetic complicationthat is difficult to treat, results in significantmorbidity and, in many cases, precedes limbamputation. It has been reported that 20% of alldiabetic patients in hospitals have been admittedfor foot problems. Previous research hasestablished the significance of nerve damage anda compromised vascular system in the etiology ofdiabetic foot ulcers.In recent years, the importance ofmechanical factors such as pressure and frictionalforces has also been established, but to date, thesetwo loading conditions have never been measuredsimultaneously. As a consequence, the true threedimensionalloads that are applied to the sole ofthe foot have never been quantified. Therationale behind the current research is that by (i)quantifying localized skin loads and (ii) obtainingnoninvasive measurements of tissue properties,the factors leading to diabetic skin ulceration willThe Department of Biomedical EngineeringLower Extremity Biomechanical AnalysisAims to Stem Bone Loss in Space,Aging and Diseasebe more fully understood.RehabilitationAn NIH-funded research and developmenteffort focuses on the design of an instrumenteddual-track treadmill. The device will permit realtimemonitoring, analysis and rehabilitation of apatient’s gait. The walking surface will beconnected to force sensors that permit bothvertical and longitudinal shear loads to bemeasured. These data will be combined in asoftware system to produce detailed informationon the kinetics of the lower limb joints ofamputee, arthritis and stroke patients.Countering bone loss inastronautsBone demineralizationis a well-documentedphysiologic effect of spaceflight. Animal experimentsdone in 1G have indicatedthat (i) certain bone strainand strain rates stimulatebone deposition, and (ii)repetitive loading of thelower extremity canincrease osteonal boneformation even as proximallyas the vertebralcolumn. In a previous CCFstudy, “Exercise Countermeasuresfor Astronauts,”Brian L. Davis, Ph.D.the merits of performingjumping exercises in microgravity were investigated.We are now designing a countermeasuredevice to optimize bone deposition while keepingvibration effects on the International SpaceStation below thresholds set by NASA.BIOMECHANICSTHE B. DAVISLABORATORYINVESTIGATORSSusan E. D’Andrea, Ph.D.Azita Tajaddini, D.Eng.Julie Perry, M.S.Gail Perusek, M.S.Jennifer Kuznicki, B.S.GRADUATE STUDENTSYan Chen, Ph.D.Nelson Morales, M.S.Solomon Praveen, Ph.D.UNDERGRADUATE STUDENTSRandy BlyLuke JanikLindsay KellerAri LevineMary OrtolanoAbby WaltersCOLLABORATORSPeter R. Cavanagh, Ph.D. 1Brian Donley, MD. 2Helen E. Kambic, Ph.D. 1Mark Luciano, M.D. 3Cahir A. McDevitt, Ph.D. 1James Redhed, C.P.O. 4James Sferra, M.D. 2Ton van den Bogert, Ph.D. 11Dept. of BiomedicalEngineering, CCF2Dept. of Orthopaedic Surgery,CCF3Dept. of NeurologicalSurgery, CCF4Dept. of Orthotics andProsthetics, CCFKao, P., Davis, B.L., and P.A. Hardy (1999) Characterization of the calcaneal fatpad in diabetic and non-diabetic patients using magnetic resonance imaging. Magn.Reson. Imaging 17:851-857.Perusek, G.P., Davis, B.L., Sferra, J.J., Courtney, A.C., and S.E. D’Andrea (2001)An extensometer for global measurement of bone strain suitable for use in vivo inhumans. J. Biomech. 34:385-391.Perry, J.E., Davis, B.L., and M.G. Luciano (2001) Quantifying muscle activity innon-ambulatory children with spastic cerebral palsy before and after selective dorsalrhizotomy. J. Electromyogr. Kinesiol. 11:31-37.Perry, J.D., Hall, J.O., and B.L. Davis (2002) Simultaneous measurement of plantarpressure and shear forces in diabetic individuals. Gait Posture 15:101-107.Praveen, S.S., Hanumantha, R., Belovich, J.M., and B.L. Davis (2003) Novel hyaluronicacid coating for potential use in glucose sensor design. Diabetes Technolo.Ther. 5:393-399.19