Browsing by Subject "Orthopedics"
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Item Auditory Impairment and Falls: Investigating the Link Between Hearing Loss and Falls among Elderly Individuals(2013-08-01) Villarreal, Adrian R.; Nicoleta BugnariuRecent studies show that hearing acuity correlates with postural balance, a prerequisite for mobility, and impaired hearing is associated with greater risk for falls. A possible connection between impaired hearing and falls in elderly adults could be that awareness resources may be taxed as cognitive load is increased when people with hearing impairment try to interpret what they hear. This practicum report investigated if an increased cognitive load due to auditory impairments in elderly individuals with hearing loss leads to imbalance while walking. Subjects are placed in a virtual reality world and subjects with and without hearing loss, wearing or not wearing their hearing aids will be monitored as they stand, walk, and listen under various conditions. The outcome measures analyzed were gait speed, medial-lateral and vertical displacement of an estimated center of mass, and average hearing scores. The overall goal was to gain a better understanding of the link between hearing and balance to offer new insight into prevention of falls among the elderly. Although no significant comparisons were observed between hearing impaired subjects on gait speed and center of mass displacement measures, it is important to note that not enough subjects have been observed with their hearing aids to make accurate comparisons. In addition to the experimental study, this practicum report briefly discussed the managerial tasks observed in ensuring the study follows the required guidelines involving human subjects.Item Buchanan, Sam, D.O.(1992-10-21) Buchanan, Sam; Stokes, C. RayDr. Buchanan, a member of TCOM's 2nd graduating class, served as Chairman of the Surgery Department. He shares highlights from his school days and his hopes for the surgery department. Interviewed by C. Ray Stokes, October 21, 1992Item Development of an Osteoinductive Bone Graft(2010-12-01) Sule, Anupam A.; Slobodan Dan DimitrijevichBone is a unique tissue that serves multiple functions. One of its unique features is the ability to heal by formation of new bone, whereas most other tissues undergo the process of scar formation. When a large amount of bone is lost the only treatment available is the use of bone grafts. Multiple bone graft substitutes are being developed to address the shortage of autologous bone graft. 3-D models are being developed to further our understanding of the cellular processes taking place in vivo. In this study I examined the strategy of designing a 3-Dmodel of hard tissue and a potential bone graft substitute using collagen type I and several different porous scaffolds. Factors influencing collagen gel contraction by human mesenchymal stem cells (hMSC) during the process of osteogenic differentiation were studied and it was shown that collagen type I gels prepared in accordance with our patented technology contract far less than any other collagen gels reported in literature. The validity of MTT assay to track proliferation of hMSC in various 3-D matrices was established and allowed me to show that human mesenchymal stem cells (hMSC) proliferated, differentiated along an osteogenic lineage and mineralized the extracellular matrix (ECM). Higher cell seeding density and greater serum concentration in the culture medium, caused increased collagen type I gel contraction. Late passage cells and osteoblasts caused a greater collagen type I gel contraction than undifferentiated early passage hMSC. hMSC that had been transduced to constitutively express human telomerase reverse transcriptase (hTERT), and which had thereby acquired an extended in vitro life span (telomerized hMSC or TMSC), contracted the collagen gel lesser than hMSC. A Collagen type I Gel - Collagen type I foam Scaffold combination (CGCS) was investigated as a 3-D in vitro model to allow extrapolation of soft tissue results to those characteristic of hard tissue. Deep penetration of MSC into the CGCS with uniform distribution was achieved by the use of collagen type I gel, as the cell carrier. Collagen type I gel improved seeding efficiency and facilitated retention of cells that penetrated deep into the scaffold. Longterm survival, proliferation, viability and in situ osteogenic differentiation within the CGCS were demonstrated. A model that demonstrated migration of cells in and out of CGCS was assembled and tested. A need for the presence of fibrillar collagen gel for mineralization process to take place highlighted the benefit of adding collagen gel to the 3-D models. Porous Beta-tricalcium phosphate (-TCP) was used as the scaffold and impregnated with collagen gel to generate Collagen Gel Impregnated Porous Scaffolds (CGIPS). Highly efficient seeding of the cells throughout the porous scaffold was attained with collagen gel. hMSC proliferated in CGIPS without contracting the collagen gel. Cells could migrate into CGIPS and mineralized the ECM when cultured in vitro under osteogenic differentiation conditions. CGIPS allowed the application of pressure and hMSC responded to mechanical force by a change in proliferation. hMSC xenotransplanted into immunocompetent rats survived for a month and expressed markers of osteogenic differentiation. While cells alone improved vascularization of the implants, they did not improve mineralization. Presence of collagen gel alone allowed for faster invasion of cells into the implanted TCP and improved radiodensity but did not affect vascularization. A combination of cell and gel within the TCP (CGIPS) was necessary to improve all the measured varialbes (tissue invasion, vascularization, mineralization and radioopacity). Thus biocompatibility, greater vascularization and enhanced mineralization of CGIPS implants established the foundation to proceed with large animal bone defect model studies utilizing CGIPS in the future. I established that CGIPS could deliver small molecules into the surrounding milieu by a process of simple diffusion. A rapid intital burst followed by a slow sustained release was observed when collagen gel containing EphrinB2-Fc clusters was incorporated ointo CGIPS. The released EphrinB2-Fc was physiologically functional and increased hMSC proliferation and chemotaxis. CGIPS inhibited the growth of Methicillin resistant Staphylococcus aureus when vancomycin was incorporated into the CGIPS. Thus the potential of CGIPS to serve as a drug delivery device was demonstrated. This work has provided the scientific foundation for use of CGIPS as bone graft substitute and 3-D model of osteogenesis. In this research study, a number of challenges were solved and questions answered, and the applications of the proposed strategy formulated. However, as is frequently the case many more avenues of future research have been exposed and a variety of new questions posed to be pursued and answered in future.studies.Item Efficacy of Osteopathic Manipulative Treatment in Improving Clinical Outcomes in Patients with Orthopedic Diagnoses Admitted to a Hospital-Based Rehabilitation Unit(1997-06-01) Brittain, Paul D.; John LicciardoneBrittain, Paul D., Efficacy of Osteopathic Manipulative Treatment in Improving Clinical Outcomes in Patients with Orthopedic Diagnoses Admitted to a Hospital-Based Rehabilitation Unit Master of Public Health (Biomedical Sciences), June, 1997, 75 pp., 12 tables, bibliography, 16 titles. The primary purpose of this study was to determine the efficacy of osteopathic manipulative treatment (OMT) in improving clinical outcomes in patients who had undergone a surgical procedure for either a hip fracture or osteoarthritis affecting the hip or knee. OMT treatment subjects were recruited from an inpatient rehabilitation unit housed with an osteopathic hospital. OMT subjects received a standard course of OMT throughout their stay in the rehabilitation unit. Clinical outcomes were assessed principally through the administration of the Functional Independence Measure (FIM), a standard disability measure, to study subjects on admission to and discharge from the rehabilitation unit. Mean FIM score charges were compared between the OMT and a control group of similar patients. Receipt of OMT was associated with shorter length-of-stay, higher total FIM score change, and greater improvement on FIM locomotion items. These findings suggest that OMT is a beneficial therapy for this population of patients.Item MUSSEL ADHESIVE PROTEIN-INSPIRED BONE GLUE FOR INTEROSSEOUS ADHESION AND HEALING(2013-04-12) Hoffman, JasonPurpose: According to the National Ambulatory Medical Care Survey & American Academy of Orthopaedic Surgeons approximately 1 in 40 people in the USA fracture a bone each year. A rapid return to ambulation is not only desirable from a patient and caregiver perspective, but also immediate weight bearing following bone fracture is believed to promote faster healing and it shortens hospital stays. A variety of bone fillers and cements currently exist, but none of them are capable of gluing broken bones back together. Our goal is to create a technology that is not a filler but rather a biocompatible glue with adhesive properties found in nature. This technology will allow us to glue bones together or bones and surgical implants such as metal plates. Unlike current bone cements, we seek to develop a technology that does not require a high curing temperature or drying of surfaces prior to its application. Inspired by the underwater adhesive properties demonstrated by the glue proteins of aquatic mussels (mollusk bivalves), we are developing an adhesive substance with biomimetic properties capable of accelerated interosseous healing in an aqueous environment similar to that encountered during orthopedic surgical intervention. This would be achieved while still providing the strength and structure of current more invasive techniques. Methods: Similar to mussel glue proteins, we exploited catechol-like chemistries to achieve adhesion to wetted bone. To demonstrate proof-of-concept, a variety of free-flowing liquid prototype adhesives were applied to the ends of moist transversely sectioned long bones from chickens and sheep. These were then allowed to cure at room temperature with the application of minimal compression. Results: We are currently engaged in molecular tailoring of adhesive functionalities to optimize the molecular properties of our glues. Important parameters include adhesive strength and elastic modulus similar to bone. Conclusions: Through the application of our bioinspired bone adhesive, the healing process following various orthopedic injuries can be accelerated by significantly decreasing the time required before weight bearing and ambulation. This coat and stick technology can be delivered via a syringe or other minimally invasive device and thus has the potential to decrease post-surgical infection rates along with other common complications associated with open reduction with internal fixation procedures.Item Osteopathic Management of Mild Leg Length Inequality with Heel Lift Therapy: A Pilot Study Analyzing Altered Gait Kinetics and Kinematics(2014-05-01) Bens, Sebastiaan M.; David MasonThe effects of osteopathic manipulative treatment and heel lift therapy (HLT) to correct mild leg length inequality (LLI) were studied using force plates and 3D motion capture in four adults. Gait and balance data were obtained at a Pre and a Post treatment visit. Participants were tested on balance with feet side-by-side and shoulder-width apart, eyes opened and closed, one minute per trial. Each participant then treadmill walked at a self-paced speed for two minutes. Within the limitations of the study, the following conclusions were drawn: 1) No significant difference in ground reaction forces in quiet standing; 2) A significant increase in anteroposterior center of pressure root mean square post HLT (p = 0.0056); 3) A significant increase in mediolateral displacement post HLT (p = 0.046); and 4) No significant difference in joint angle range of motion was found at the pelvis, hip, knee, or ankle bilaterally.Item Resilience Over Time in a Longitudinal Study Following Patients with Physical Injury(2014-05-01) Rainey, Evan E.; Patricia A. GwirtzPurpose: The goal of the practicum study was to examine psychological resilience among individuals admitted to a Level I trauma center at the time of injury and one year post injury. Hypothesis: Resilience remains stable in individuals over time, regardless of injury type or severity. Methods: This prospective cohort study included patients ≥18 years of age admitted to a Level 1 trauma center for ≥24 hours. Resilience and depression were measured at baseline and 12 months using the Connor Davidson Resilience Scale 10-Item (CD-RISC 10) and the Patient Health Questionnaire (PHQ-8). Injury-related variables included Glasgow Coma Score (GCS), Injury Severity Score (ISS), etiology of injury, and type of injury. Results: The sample size consisted of 110 subjects. Data suggested that there was no significant change in overall resilience. There were negative correlations between resilience and depression. There were also negative correlations between GCS and depression at baseline and 12 months. Analysis of demographic variables revealed a positive correlation among education level and resilience, as well as a significant association between baseline resilience and employment. Conclusion: Resilience did not change over time, suggesting that resilience appears to be more of an inherited trait, rather than a modifiable state. These results show that individuals who have low resilience are more likely to be depressed at 12 months post injury. The results of this study suggest that assessing resilience at the time of injury may be useful in identifying those at risk for depression in the year following injury. Further, this study supports the need for psychological support for individuals who have sustained a traumatic injury to improve outcome.